tbuckley/cabot-search huggingface dataset:
Cost-effectiveness of Atezolizumab Plus Bevacizumab vs Sorafenib for Patients With Unresectable or Metastatic Hepatocellular Carcinoma
Authors: Xin Zhang, Jingjing Wang, Juanjuan Shi, Xiaoli Jia, Shuangsuo Dang, Wenjun Wang
Journal: JAMA Network Open (2021)

Atezolizumab plus bevacizumab as a first-line therapy for patients with unresectable or metastatic hepatocellular carcinoma has been shown to improve overall and progression-free survival compared with standard sorafenib treatment. However, because of the high cost of atezolizumab plus bevacizumab, assessment of its value by considering both efficacy and cost is needed.To evaluate the cost-effectiveness of atezolizumab plus bevacizumab vs sorafenib for patients with unresectable or metastatic hepatocellular carcinoma from a US payer perspective.This economic evaluation was performed from June through September 2020, with a 6-year investment time period. Hypothetical patients were male and female adults 18 years or older who had a diagnosis of locally advanced metastatic or unresectable hepatocellular carcinoma confirmed by histologic or clinical features.Health care costs (adjusted to 2020 US dollars), life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) of atezolizumab plus bevacizumab vs sorafenib were examined using a partitioned survival model. One-way deterministic and probabilistic sensitivity analyses were used to examine model uncertainty. The model was also used to estimate price reductions of atezolizumab plus bevacizumab that would achieve more favorable cost-effectiveness.In the base case analysis of a hypothetical sample of 424 patients, atezolizumab plus bevacizumab was associated with an increase of 0.623 life-years (1.840 vs 1.218 life-years) and 0.484 QALYs (1.412 vs 0.928 QALYs) and with an incremental cost of $156 210 per patient compared with sorafenib. The ICER was $322 500 per QALY (5th to 95th percentile, $149 364-$683 744 per QALY), with 0.6% and 5.1% chance of being cost-effective at willingness-to-pay thresholds of $100 000 and $150 000 per QALY, respectively. The ICER never decreased below $150 000 per QALY in the 1-way sensitivity analyses. To achieve more favorable cost-effectiveness under the thresholds of $150 000 to $100 000 per QALY, the prices of atezolizumab and bevacizumab would need to be reduced by 37% to 47%.In this economic evaluation, atezolizumab plus bevacizumab was associated with clinical benefit but was not cost-effective compared with sorafenib for first-line treatment of unresectable or metastatic hepatocellular carcinoma from a US payer perspective. A substantial reduction in price for atezolizumab plus bevacizumab would be needed to achieve favorable cost-effectiveness for this new therapy.
Hemodynamic findings at rest and during mild supine exercise in adults with isolated, uncomplicated ventricular septal defects.
Authors: J EOtterstad, SSimonsen, JErikssen
Journal: Circulation (1985)

Fifty-two patients with isolated congenital ventricular septal defects (VSDs), studied for the first time at age 10 or older, were restudied an average of 16 years later (range 4 to 21). The study protocol included a symptom-limited bicycle ergometer test, M mode echocardiographic examination, and hemodynamic studies at rest and during mild supine exercise. Of the 52, 17 had been operated on an average of 19 years earlier (range 11 to 21) (group 1) and 35 with smaller defects were not operated on (group 2). Although more pronounced findings were made in group 1, a similar pattern was observed in group 2: In most subjects in both groups a subnormal working capacity was observed. A subnormal left ventricular fractional shortening and circumferential shortening velocity was noted in a high proportion at echocardiography. A number of hemodynamic aberrations were observed in a high proportion of patients during exercise but not at rest. Thus a subnormal increase in left and right ventricular cardiac output was...
Endoscopy During The Covid-19 Pandemic: How To Minimize The Risks? A Single Outpatient Centre Experience
Authors: A Panarese, R Licinio, S Palermo, C Marucci, R Lovero, F Abbruzzi, N Labarile
Journal: Endoscopy (2021)

Aims All gastrointestinal endoscopic procedures have a high risk of aerosol contamination of the novel coronavirus to all healthcare workers. For this reason, during the lockdown the health systems reduced all non-urgent endoscopic activities. On this second wave of the coronavirus disease 2019 (COVID 19) pandemic we cannot afford to suspend activities, as the health system is already overloaded. Our centre has continued regular endoscopic activity following a strict protocol to ensure maximum safety for patients and for endoscopy staff.
From the Authors
Authors: A. Torres
Journal: European Respiratory Journal (2001)

The recent task force report is a welcome review of the situation regarding ventilator associated pneumonia (VAP) [1].In the prevention of VAP section a number of nonpharmacological measures, including posture were discussed.However there was no mention of rotational therapy [2-9].Admittedly, these publications are variously limited by: selected patient diagnoses, extensive exclusion criteria, various definitions of outcomes (including VAP), lack of controls and small numbers.There is no trial that has produced statistically and clinically significant results that can be generalized to the majority of patients.How successful this treatment is in a wide variety of patients and how it compares with other treatment strategies, alone or in combination, needs to be studied.This subject deserves further research and should be included in the "What should be investigated" section.
Hip Fracture Surgery vs Elective Total Hip Replacement—Reply
Authors: Yannick Le Manach, Gary S. Collins, P. J. Devereaux
Journal: JAMA (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Selective stimulation of parasympathetic nerve fibers to the human sinoatrial node.
Authors: M DCarlson, A SGeha, JHsu, P JMartin, M NLevy, GJacobs, A LWaldo
Journal: Circulation (1992)

BACKGROUNDIn animals, parasympathetic nerve fibers that innervate the sinoatrial node can be selectively stimulated to increase atrial cycle length. These nerve fibers course through an epicardial fat pad at the margin of the right superior pulmonary vein, the superior vena cava, and the right atrium. We hypothesized that similar nerves exist and can be selectively stimulated in humans.METHODS AND RESULTSMicroscopic examination of fat pads excised from the margin of the right superior pulmonary vein, the superior vena cava, and the right atrium during two human autopsies revealed the presence of nerve fibers and ganglia. We electrically stimulated this epicardial fat pad in 16 patients during cardiac surgery. The fat pads were stimulated with continuous-pulse trains for 15 seconds via a hand-held bipolar electrode using constant current (10-15 mA), constant pulse width (0.02-0.05 msec), and at 6.6, 10, 20, 25, and 30 Hz. The mean atrial cycle length +/- 1 SEM increased from 734 +/- 34 msec at baseline to ...
Staged reperfusion attenuates myocardial stunning in dogs. Role of transient acidosis during early reperfusion.
Authors: MHori, MKitakaze, HSato, STakashima, KIwakura, MInoue, AKitabatake, TKamada
Journal: Circulation (1991)

BACKGROUNDAcidosis during early reperfusion is reported to be beneficial for myocardial stunning. We tested in 31 dogs the hypothesis that staged reperfusion is beneficial to myocardial stunning.METHODS AND RESULTSContractile dysfunction was observed 3 hours after the onset of reperfusion after 15 minutes of occlusion of the coronary artery. In the staged reperfusion, pH of the coronary venous blood was lower for 20 minutes and fractional shortening was significantly improved compared with the control reperfusion group. When we increased pH of the reperfused myocardium by an intracoronary infusion of sodium bicarbonate, beneficial effects of the staged reperfusion were abolished. Furthermore, an intracoronary infusion of hydrogen chloride, which mimicked the changes in pH in coronary venous blood of the staged reperfusion, attenuated myocardial stunning.CONCLUSIONSThese results indicate that acidosis during staged reperfusion primarily attenuates myocardial stunning. This procedure is clinically applicabl...
Use of Selected Recommended Clinical Preventive Services — Behavioral Risk Factor Surveillance System, United States, 2018
Authors: Suhang Song, Allison White, James E. Kucik
Journal: MMWR Morbidity and Mortality Weekly Report (2021)

Clinical preventive services play an important role in preventing deaths, and Healthy People 2020 has set national goals for using clinical preventive services to improve population health (1). The Patient Protection and Affordable Care Act (ACA) requires many health plans to cover certain recommended clinical preventive services without cost-sharing when provided in-network (covered clinical preventive services).* To ascertain prevalence of the use of selected recommended clinical preventive services among persons aged ≥18 years, CDC analyzed data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), a state-based annual nationwide survey conducted via landline and mobile phones in the United States, for 10 clinical preventive services covered in-network with no cost-sharing pursuant to the ACA. The weighted prevalence of colon, cervical, and breast cancer screening, pneumococcal and tetanus vaccination, and diabetes screening ranged from 66.0% to 79.2%; the prevalence of the other four clinical preventive services were <50%: 16.5% for human papillomavirus (HPV) vaccination, 26.6% for zoster (shingles) vaccination, 33.2% for influenza vaccination, and 45.8% for HIV testing. Prevalence of HIV testing had the widest variation (3.1-fold differences) across states among the 10 services included in this report. The prevalence of use of clinical preventive services varied by insurance status, income level, and rurality, findings that are consistent with previous studies (2-6). The use of nine of the 10 services examined was lower among the uninsured, those with lower income, and those living in rural communities. Among those factors examined, insurance status was the dominant factor strongly associated with use of clinical preventive services, followed by income-level and rurality. Understanding factors influencing use of recommended clinical preventive services can potentially help decision makers better identify policies to increase their use including strategies to increase insurance coverage.
Evaluation of potassium-43 scintillation images during early myocardial ischemia in an animal model.
Authors: BHaider, H AOldewurtel, C BMoschos, T JRegan
Journal: Circulation (1976)

To assess the validity of myocardial imaging with potassium-43 (43K) early after the onset of ischemia, the left anterior descending artery was occluded with a baloon tip catheter in 32 intact anesthetized dogs. 99mTechnetium ventriculograms localized the left ventricle. 43K was administered intravenously and serial images were obtained in four views using an Anger camera with a pinhole collimator. The heart was arrested after 60 minutes and removed for imaging and tissue counts to ascertain extracardiac and geometric factors. In normals (group 1) left ventricular images were relatively homogeneous, except for the thin walled apex, both in vivo and in the isolated heart. Equilibration with 43K prior to ischemia (group 2) gave similar images to group 1, associated with a small reduction in tissue count after one hour of ischemia. Group 3 was infused with 43K after initiation of ischemia. Despite a reduction of 43K counts in the ischemic area to less than one-fourth of the nonischemic site (P less than 0.00...
Two to three years of failure-free testing of a rechargeable pacemaker in experimental complete heart block.
Authors: H CHughes, R RBrownlee, G FTyers
Journal: Circulation (1976)

Six hermetically sealed single cell rechargeable mercury-zinc pacemakers (B.T.) that will run continuously for over 4 years between rechargings have paced dogs with complete heart block for from 2 to 3 years. To maintain full cell capacity (over 1,000 mA hours) requires recharging for from 2-3 min/day to 60 to 80 hr once every 4 years, with any variation between these extremes being acceptable. Six realtime bench tests continue after over 7 years and accelerated tests have simulated a minimum of 50 years continuous pacing. Battery voltage is assessed by direct telemetry, eliminating the risk of patient intrinsic rhythm-pacemaker competition which is present with all current indirect (stimulation rate change) battery assessment techniques. The B.T. is an excellent 4-5 year primary pacemaker, fully rechargeable after several 4 year periods of battery rundown. A clinical test series has been initiated.
Response of type B atrial vagal receptors to changes in wall tension during atrial filling.
Authors: GRecordati, FLombardi, V SBishop, AMalliani
Journal: Circulation Research (1975)

In anesthetized curarized cats with their chests open, we recorded the activity of type B right atrial vagal stretch receptors, right atrial pressure, and instantaneous dimensional changes of the right atrium. The nervous activity was analyzed during alterations in atrial dynamics produced by acute volume loading of the right atrium under control conditions and during sympathetic and vagal stimulations. Our results demonstrated that the mean frequency of discharge in the burst was dependent on the absolute tension and the rate of change in tension developed in atrial muscles during filling. The responses of different receptors to changes in atrial dynamics were qualitatively similar but characteristic for each receptor studied. In some experiments nervous activity was recorded after the cats had been killed: static and dynamic changes in atrial tension were then produced by injecting blood into the right atrium. Under these conditions dynamic stimuli always activated the receptors at tensions below the th...
Synergistic combinations of recombinant human tissue-type plasminogen activator and human single-chain urokinase-type plasminogen activator. Effect on thrombolysis and reocclusion in a canine coronary artery thrombosis model with high-grade stenosis.
Authors: A AZiskind, H KGold, TYasuda, MKanke, J LGuerrero, J TFallon, TSaito, DCollen
Journal: Circulation (1989)

The synergistic effects of recombinant human tissue-type plasminogen activator (rt-PA) and single-chain urokinase-type plasminogen activator (scu-PA) on coronary arterial thrombolysis were investigated in open-chest dogs with thrombosis of the left anterior descending coronary artery and a superimposed high-grade stenosis. A 90% stenosis was generated by external constriction, reducing blood flow to 40 +/- 10% of baseline. Localized thrombosis was produced by endothelial cell injury and instillation of thrombin and fresh blood. Intravenous infusion for 60 minutes of either 30 micrograms/kg/min rt-PA alone or 10 micrograms/kg/min scu-PA alone consistently produced coronary artery recanalization (six of eight dogs and five of five dogs, respectively) but was almost always associated with reocclusion during or shortly after the end of the infusion (four of six dogs and five of five dogs, respectively). Infusion of either 15 micrograms/kg/min rt-PA or 5 micrograms/kg/min scu-PA for 60 minutes did not cause co...
Patient Acceptability of Optical Diagnosis for Diminutive Polyps With a Resect And Discard Strategy In Bowel Cancer Screening Colonoscopy
Authors: A Ahmad, A Wilson, S Thomas-Gibson, N Suzuki, A Humphries, A Haycock, K Monahan, M Vance, A Dhillon, B Saunders
Journal: Endoscopy (2021)

Aims Colonoscopy with polypectomy reduces the rate of subsequent colorectal cancer and associated mortality. Most polyps resected are diminutive and with a low cancer risk. Currently, these diminutive polyps are resected and examined histologically. Using advanced imaging technologies some studies show we can distinguish adenomas from non-adenomas optically. This could potentially avoid unnecessary polypectomies and associated histology costs in cases where there is high confidence in the diagnosis of the polyps allowing polyps to be resected and discarded. The aim of this study is to assess the acceptability of such a strategy for patients in real life clinical practice.
Abstract 11560: Long Term Outcome of Transfemoral Device Implantation: Success Rate, Pitfalls and Complications
Authors: Pooneh Nabavizadeh, Mehran Attari, Faisal F Syed, Jitender Munjal, Reza Mehzad, Srinivas Rajsheker
Journal: Circulation (2019)

Background: Pectoral implant of cardiac devices may not be an option in a small subset of patients due to prior infection, lack of access or existence of other intravascular devices. Transfemoral o...
Effect of an eccentric severe stenosis on fibrin(ogen) deposition on severely damaged vessel wall in arterial thrombosis. Relative contribution of fibrin(ogen) and platelets.
Authors: AMailhac, J JBadimon, J TFallon, AFernández-Ortiz, BMeyer, J HChesebro, VFuster, LBadimon
Journal: Circulation (1994)

BACKGROUNDCoronary thrombosis is a dynamic process dependent on the pathological substrate, the local shear forces, and blood factors.METHODS AND RESULTSWe investigated the effect of a severe (80%) eccentric stenosis on fibrin(ogen) interaction with a deeply damaged vessel wall, its relation to platelet deposition in thrombus formation, and the influence of time on thrombus growth. Porcine 125I-fibrinogen and autologous 111In-platelets were injected into pigs instrumented for extracorporeal circulation and treated with low-dose heparin (aPTT ratio < 1.5) that has been previously shown and herein confirmed not to affect platelet and/or fibrin(ogen) attachment. Tunica media, as a model of severely injured vessel wall, was mounted in a tubular perfusion chamber containing an eccentric axisymmetric sinusoidal stenosis obstructing the lumen and exposed for 1, 5, and 10 minutes to perfusing blood. A shear rate of 424 s-1 at the laminar, parallel parabolic local flow perfused segments one to two orders of magnit...
Abnormal blood pathways in left ventricular cavity in acute myocardial infarction. Experimental observations with special reference to regional wall motion abnormality and hemostasis.
Authors: SBeppu, SIzumi, KMiyatake, SNagata, Y DPark, HSakakibara, YNimura
Journal: Circulation (1988)

To elucidate the mechanism of regional hemostasis in the left ventricular (LV) cavity during myocardial infarction, the blood pathway in LV cavity was examined with contrast echocardiography injected from the left atrium before and after coronary ligation in nine canines. Before coronary ligation, contrast echoes spread over LV cavity with one rush. After ligation, smokelike echoes indicating hemostasis were observed at the apical middle of the LV cavity in five dogs with apical akinesis and at the apical area in four dogs with apical dyskinesis. The contrast echoes did not reach the apex within one diastolic period but turned upward to the outflow tract in the middle of the cavity in all dogs. In the cardiac beats that followed, some contrast echoes spread slowly toward the apex, forming a thin layer along the posterior wall in cases with akinesis but not in cases with dyskinesis. The area separated from the blood pathway developed where the smokelike echoes had been developed. Tachycardia exaggerated th...
Resonance. The missing phenomenon in hemodynamics.
Authors: Y YWang, S LChang, Y EWu, T LHsu, W KWang
Journal: Circulation Research (1991)

To simulate a short segment of the aorta, we studied wave propagation in an elastic tube with a side branch balloon. The small balloon simulated the organ (group of arterioles). Ligation of this side branch would reduce the moduli of the higher harmonics when the length of the side branch was appropriate. Electrical analogy of vessels was used to analyze this phenomenon. This simulation can explain the ligation results we found in rats. It may also clarify the discrepancies between the prediction of the Womersley equation and the experimental results. We suggest that the aorta and the closely attached organ can produce coupled oscillation; theoretically, this structure is equivalent to a resonance circuit.
Influence of hypertonic mannitol on ventricular performance and coronary blood flow in patients.
Authors: J TWillerson, G CCurry, J MAtkins, RParkey, L DHorwitz
Journal: Circulation (1975)

The influence of a relatively small increase in serum osmolality produced by hypertonic mannitol on ventricular and systemic arterial hemodynamics and coronary blood flow was studied in 20 patients undergoing cardiac catheterization. Mannitol given to increase serum osmolality 10 mOsm resulted in a small but significant increase in mean systemic arterial pressure, maximum LV dp/dt, left ventricular end-diastolic pressure and cardiac output but no significant change in heart rate or hematocrit. The most prominent change in the patients studied, however, was in coronary blood flow which increased 39% after mannitol. Patients with severe two and three vessel coronary artery disease had increased in coronary blood flow similar to those in patients without coronary artery disease. The data suggest the need to further evaluate the physiological importance of the increase in coronary blood flow produced by mannitol in patients with coronary artery disease and indicate the possibility that mannitol might be of va...
Gel immersion technique for the examination and treatment of an ampullary tumor
Authors: Haruka Toyonaga, Kuniyuki Takahashi, Toshifumi Kin, Tsuyoshi Hayashi, Akio Katanuma
Journal: Endoscopy (2021)

Endoscopic papillectomy using the underwater technique [1] for ampullary tumors allows for involutions of the mucosal folds and permits resection without capturing the muscularis propria and without the need for submucosal fluid injection [2] [3]. However, there are some disadvantages to underwater endoscopic papillectomy. For example, it can be difficult to maintain a sufficient amount of water, there is a risk of flushing away the resected specimens, and mixing of any blood with the water can cause loss of visibility. To overcome these disadvantages, we successfully applied the gel immersion technique, a novel method for securing the endoscopic visual field using gel with an appropriate viscosity (Viscoclear; Otsuka Pharmaceutical Factory, Inc., Tokushima, Japan) during gastrointestinal tract bleeding [4] [5].