tbuckley/cabot-search huggingface dataset:
Physician Compliance With Warfarin Prophylaxis for Central Venous Catheters in Patients With Solid Tumors
Authors: Karen M. Carr, Ian Rabinowitz
Journal: Journal of Clinical Oncology (2000)

There is an established benefit of prophylactic warfarin in cancer patients with central venous catheters. This study assessed the compliance rate of prophylactic low-dose warfarin prescription in cancer patients with central venous catheters at a single institution.Oncology patients with central venous catheters were identified by a retrospective chart review. Information retrieved included whether prophylactic warfarin had been prescribed and whether the patient had suffered a thrombotic or bleeding event. After the initial chart review, physicians were notified of the benefits of warfarin prophylaxis, and subsequently, a physician-independent mechanism of prescribing prophylactic warfarin was instituted. After each of these interventions, we retrospectively reviewed a further two cohorts of patients to assess compliance with warfarin prophylaxis.During the baseline study, only 10% of patients were prescribed prophylactic warfarin. After physician notification, the compliance rate increased to only 20% (P =.3). After instituting the physician-independent mechanism of prescribing prophylactic warfarin, the compliance rate increased to 95% (P <.001). The rate of catheter-related thrombosis was 11% for patients who were prescribed warfarin compared with 21% in those who were not anticoagulated (P =.2).At our institution, the rate of prescribing prophylactic warfarin was low in this patient population, and there was a reluctance of treating physicians to change their prescribing practice. Mechanisms exist to improve the rate of anticoagulant prophylaxis in this clinical setting. We recommend that institutions review their rate of compliance with prophylactic anticoagulation for patients with central venous catheters and solid tumors.
Routine serum protein electrophoresis and detection of alpha1-antitrypsin deficiency
Authors: Stefania Ottaviani, Maria Trevisan, Ilaria Ferrarotti, Marina Gorrini, Raffaele Baldo, Luisa Quargentan, Maurizio Luisetti
Journal: European Respiratory Journal (2013)

Background:  Alpha 1 -antitrypsin (AAT) deficiency (AATD) is a largely underdiagnosed genetic disorder. Reduced serum levels of AAT lead to a higher risk of developing emphysema and chronic liver disease at an early age. Several strategies are currently being proposed to improve detection rates.   Aims:  Little attention has previously been paid to subjects with a reduced alpha-1 globulin (A1G) electrophoresis band. We therefore investigated the potential of routine serum protein electrophoresis (RSPEP) to improve AATD detection rates based on this marker.   Methods:  The RSPEP pilot study included 214,894 electrophoresis samples. Nephelometric measurement of AAT was performed and a number of subjects were referred for verification of AATD diagnosis. Data were compared with results from the Italian AATD targeted detection program.   Results:  In the 16-year period (1996-2012) the program obtained 3595 samples. Patients with severe AATD, who were tested because of a reduced A1G band, comprised 0.75% of the total sample. In the RSPEP pilot study, 601 samples showed A1G to be    Conclusions:  The RSPEP strategy combines detection of reduced A1G levels and nephelometric AAT measurement. By applying an appropriate AAT level cutoff, this technique allows the identification of asymptomatic AATD subjects and increases AATD detection rates at a low cost.
Bronchial epithelial cell mediator release in children with wheeze or eczema
Authors: David Miller, Daniella Spiteri, Emily Pringle, Helen Richardson, Graham Devereux, Garry Walsh, Steve Turner
Journal: European Respiratory Journal (2012)

Introduction. Airway epithelial cell (AEC) function is thought to be important in the regulation of airway remodelling and inflammation in health and disease. Due to the challenges in accessing paediatric airways relatively little is known about bronchial AEC function in children. Our hypothesis was that bronchial AEC mediator release will be different between children with and without a history of recent wheeze.  Methods. Children scheduled for elective operation were recruited. Bronchial AEC were removed by brushings and grown in submerged culture. Second culture passage monolayers were stimulated for 24 hours with TNF-alpha and IL-1B. Supernatants were removed and the following mediators analysed: IL-6, IL-8, MMP-9, TIMP-1, VEGF, GCSF, RANTES and MCP-1.  Results. 32 children were recruited, mean age 6.5 years (range 1.1-16.0). 7 reported wheeze in the last year, 13 had a history of eczema including three with recent wheeze. Concentrations of MMP-9 were reduced in children with recent wheeze (geometric mean 3.4 [SEM ±1.7] pg/ml secreted from 10 4  AEC) compared to those without symptoms (11.0 ± 14.5) p=0.021. There was a similar reduction in MMP-9 concentrations among those with eczema (3.7 ±SEM 2.1) compared to those without (11.3 ±5.2), p=0.037. Children with eczema also had reduced bronchial AEC release of MCP-1 (0.15 ±0.15) compared to those without (0.73 ±0.35), p=0.002. There were no differences for other mediators studied  Conclusion. Bronchial AEC release of MMP-9 is reduced in children with recent wheeze. The similar relationship seen among those with eczema but no wheeze suggests that the underlying mechanism may be related to atopy but may not be important to symptoms in this age group.
Innovation in the management of soft tissue sarcomas in infants and young children: high-dose-rate brachytherapy.
Authors: S Nag, R Martínez-Monge, F Ruymann, A Jamil, C Bauer
Journal: Journal of Clinical Oncology (1997)

PURPOSE Conventional low-dose-rate (LDR) brachytherapy is effective in treating childhood sarcomas, but often not practical (due to the associated radiation hazards) in the young children who require continuous observation and sedation. Fractionated high-dose-rate brachytherapy (HDR) was used to deliver adequate tumoricidal radiation while preserving bone and organ growth in children. MATERIALS AND METHODS Twelve children with diverse sarcomas were treated with fractionated HDR. The median age at diagnosis was 18 months (range, 1 to 42). Nine patients had rhabdomyosarcoma and three had other soft tissue sarcoma (STS) variants. Ten patients had microscopic residual disease at the time of brachytherapy. All patients were treated with appropriate chemotherapy and surgery. HDR was delivered in 3-Gy fractions twice a day to a total dose of 36 Gy in 8 days. External-beam radiation therapy (EBRT) was avoided. Patients were monitored for a median of 61 months (range, 30 to 78). RESULTS One patient developed local recurrence and distant metastases to the lungs. The 6-year actuarial local control and overall survival rates were 91% and 81%, respectively. Brachytherapy-related morbidity occurred in 50% of patients. The morbidity was mild to moderate in 42% of patients and consisted primarily of acute skin and mucosal reaction. One patient experienced severe (grade III to IV) toxicity. Another child, treated to the tongue, had delayed dentition only in the teeth adjacent to the brachytherapy site. The other children have exhibited only minimal or none of the bone growth retardation expected with EBRT. CONCLUSION The combination of conservative surgery, chemotherapy, and exclusive HDR to postchemotherapy tumor volume with a modest margin, avoiding EBRT, provided disease control in carefully selected young children, while preserving bone growth and organ function. The short duration of therapy and small volume irradiated allowed chemotherapy to be resumed shortly after brachytherapy. The use of HDR challenges the present philosophy of radiotherapy treatment volume, which holds that the prechemotherapy tumor volume should be treated with an acceptable margin. Brachytherapy should be included in multicentric clinical trials in young children.
Cancer Incidence Among Cosmetologists&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: M J Teta, J Walrath, J W Meigs, J T Flannery
Journal: JNCI Journal of the National Cancer Institute (1984)

This cohort study examined cancer incidence in 13,650 Connecticut cosmetologists who had held licenses for 5 years or more and had begun hairdressing school prior to January 1, 1966. Cancer incidence rates for the general Connecticut population, 1935-78, were compared with those for 11,845 female and 1,805 male cosmetologists. The females had a standardized cancer incidence ratio (SIR) of 112 (P less than .01). A significant excess of lung cancer (SIR = 141) and excesses of brain (SIR = 168) and ovarian cancer (SIR = 134) of borderline significance were observed. No significant cancer risk was evident for female cosmetologists licensed since 1935, even for those with 35 years or more of follow-up, although the SIRs for brain cancer, lymphoma, and leukemia were elevated. Female cosmetologists who entered the profession between 1925 and 1934, however, experienced a significant overall cancer incidence (SIR = 129) and significant excesses of respiratory, breast, corpus uterine, and ovarian cancers. Those with 35 years or more from time of first license appeared to be at the highest risk. Among males the overall cancer incidence rate was close to that expected (SIR = 105). Smoking habits and reproductive factors that could not be taken into account may explain some of the excesses among females. Although no specific occupational agent could be identified, the excess numbers of leukemias in females and brain cancers among males and females merit continued surveillance.
Clinical presentations and serotypes causing invasive pneumococcal disease in adults vaccinated with the 23-valent polysaccharide pneumococcal vaccine (PPV23) in Spain. The ODIN study (2010-2013)
Authors: Antoni Torres, Emilio Bouza, Román Pallarés, Luis Molinos, Miguel Salavert, Pedro Llinares, José Luis De la Cruz, Inmaculada Alfageme, Olga Rajas, Asunción Fenoll, Josefina Liñares, Cristina Méndez
Journal: European Respiratory Journal (2014)

Objectives: To analyse by serotype (St) clinical presentations of Invasive Pneumococcal Disease (IPD) in adults previously vaccinated with PPV23 in Spain.

Methods: A prospective, hospital-based surveillance of culture-confirmed IPD episodes in hospitalized adults (≥18 years) was performed in 9 Spanish hospitals (August 2010-June 2013). IPD was considered as isolation of S. pneumoniae from sterile fluids. Clinical presentations were: complicated pneumonia-CP-(pneumonia with pleural effusion and/or empyema and/or multilobar infiltration), non-complicated pneumonia(N-CP) and others(O;including meningitis, primary bacteremia and peritonitis).

Results: 637 patients were included and, 120 (18.8%) reported PPV23 vaccination history. Among the vaccinated 95% had ≥1 underlying condition considered as risk factor for IPD, being the most frequent chronic obstructive pulmonary disease (43%). Pneumonia accounted for 74.1% of the cases (44.1% N-CP and 30% CP).

68 (56.7%) vaccinated subjects presented an IPD episode caused by a PPV23 St (vaccine failures). Fatality rate was 14.2% and 47% of the deaths were caused by a PPV23 St.

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Conclusions: The high number of vaccination failures among PPV23 vaccinated patients raises concerns regarding the effectiveness of PPV23 in preventing IPD. New preventive approaches should be taken into account.

 [1]: pending:yes
Offshore Medical Schools
Authors: I. Porzecanski
Journal: New England Journal of Medicine (1986)

expose program weaknesses because this might disrupt what they consider an acceptable status quo, endanger career advancement or draw attention to problems that will reduce the attractiveness of training programs.This means that any analysis will require input from external sources.It is in the University of Manitoba's best interest to appoint external experts to assess these tragedies and possible precipitating factors.In this way, similar tragedies might be averted, and the lessons learned could be applied in other centres.
Arsenic and Respiratory Cancer in Man: An Occupational Study
Authors: Anna M. Lee, Joseph F. Fraumeni
Journal: JNCI Journal of the National Cancer Institute (1969)

To clarify the role of arsenic in human carcinogenesis, the mortality experience of 8,047 white male smelter workers exposed to arsenic trioxide during 1938–63 was studied and compared with that of the white male population of the same States. Smelter workers had an excess total mortality, due mainly to malignant neoplasms of the respiratory system and diseases of the heart. The threefold increase in respiratory cancer was analyzed in relation to the length of employment and degree of exposure to arsenic, sulfur dioxide, and other elements in the smelter. The excess of respiratory cancer was as high as eightfold among employees who worked more than 15 years and who were heavily exposed to arsenic; it showed a gradient in proportion to the degree of exposure to arsenic and sulfur dioxide. The findings support the hypothesis that inhaled arsenic is a respiratory carcinogen in man, but an influence of sulfur dioxide or unidentified chemicals, varying concomitantly with arsenic exposure, cannot be discounted.
Malignant mesothelioma: prognostic variables in a registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women's Hospital experience over two decades, 1965-1985.
Authors: K Antman, R Shemin, L Ryan, K Klegar, R Osteen, T Herman, G Lederman, J Corson
Journal: Journal of Clinical Oncology (1988)

All mesothelioma patients identified by a computer search of pathologic diagnoses at the Dana-Farber Cancer Institute (DFCI) between 1965 and 1985 were the subjects of this analysis. A total of 180 patients were identified, 136 with pleural and 37 with peritoneal mesothelioma. There were five pericardial and two testicular primaries. Of the two decades included in the study, later patients were significantly older, with a more advanced disease stage, and a lower performance status than those accrued early in the study. Factors at diagnosis associated with a significantly prolonged survival for all patients with mesothelioma included a 0 to 1 performance status, absence of chest pain, age less than 50 years, and epithelial histology. Factors at diagnosis associated with prolonged survival for the subset of patients with pleural mesothelioma included epithelial histology, 0 to 1 performance status, the absence of chest pain, an interval of greater than 6 months from onset of symptoms, and treatment with chemotherapy and pleuropneumonectomy. This last result must be interpreted with caution, since this was not a randomized study.
Deregulation of idiotype expression. Induction of tolerance in an anti-idiotypic response.
Authors: L Ortiz-Ortiz, W O Weigle, D E Parks
Journal: The Journal of Experimental Medicine (1982)

The induction of tolerance in an anti-idiotypic response was attempted by in vivo exposure to excess idiotype. Monoclonal immunoglobulin from the anti-p-azobenzenearsonate (ABA) hybridoma R16.7 was used as a representative of cross-reactive idiotype-positive (CRI+) antibodies because this hybridoma protein (HP) shares one or more closely related public idiotypic determinants with the serum CRI in A/J mice. Immunologic unresponsiveness was established by a single injection of the R16.7 idiotype and persisted for at least 6 wk. The level of circulating anti-idiotypic antibodies in tolerized A/J mice was significantly depressed after immunogenic challenge with eigher antigen, ABA-keyhole limpet hemocyanin (KLH), or the idiotype R16.7 HP. Experimental depletion of anti-idiotypic antibodies by tolerization allowed assessment of immunoregulation within this altered idiotype-anti-idiotype network. Deregulation of idiotype expression in tolerized mice challenged with ABA-KLH was manifest with up to 96% of the anti-ABA antibodies cross-reacting with the R16.7 idiotype. This selective enhancement of a major idiotype was accomplished without substantial alteration of the level of the overall anti-hapten response. Both the unresponsiveness established in anti-idiotypic antibody-producing cells and the enhanced synthesis in idiotype-producing cells were stable upon adoptive transfer into lethally irradiated, syngeneic recipients. Finally, previous immunization with the antigen ABA-KLH interfered with the induction of unresponsiveness to the idiotype. This interference is presumed to be mediated by prior activation of anti-idiotypic cells and/or antibody because injection of antigen with tolerogenic idiotype did not abrogate tolerance induction.
Guidelines for the Treatment of Community-acquired Pneumonia
Authors: Rosario Menéndez, Antoni Torres, Rafael Zalacaín, Javier Aspa, Juan J. Martín-Villasclaras, Luis Borderías, José M. Benítez-Moya, Juan Ruiz-Manzano, Felipe Rodríguez de Castro, José Blanquer, Diego Pérez, Carmen Puzo, Fernando Sánchez-Gascón, José Gallardo, Carlos Álvarez, Luis Molinos
Journal: American Journal of Respiratory and Critical Care Medicine (2005)

Some studies highlight the association of better clinical responses with adherence to guidelines for empiric treatment of community-acquired pneumonia (CAP), but little is known about factors that influence this adherence.Our objectives were to identify factors influencing adherence to the guidelines for empiric treatment of CAP, and to evaluate the impact of adherence on outcome.We studied 1,288 patients with CAP admitted to 13 Spanish hospitals. Collected variables included the patients' clinical and demographic data, initial severity of the disease, antibiotic treatment, and specialty and training status of the prescribing physician.Adherence to guidelines was high (79.7%), with significant differences between hospitals (range, 47-97%) and physicians (pneumologists, 81%; pneumology residents, 84%; nonpneumology residents, 82%; other specialists, 67%). The independent factors related to higher adherence were hospital, physician characteristics, and initial high-risk class of Fine, whereas admission to intensive care unit decreased adherence. Seventy-four patients died (6.1%), and treatment failure was found in 175 patients (14.2%). After adjusting for Fine risk class, adherence to the guidelines was found protective for mortality (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.3-0.9) and for treatment failure (OR, 0.65; 95% CI, 0.5-0.9). Treatment prescribed by pneumologists and residents was associated with lower treatment failure (OR, 0.6; 95% CI, 0.4-0.9).Adherence to guidelines mainly depends on the hospital and the specialty and training status of prescribing physicians. Nonadherence was higher in nonpneumology specialists, and is an independent risk factor for treatment failure and mortality.
Inheritance of antibody specificity. II. Anti-(4-hydroxy-5-bromo-3-nitrophenyl) acetyl in the mouse.
Authors: T Imanishi, O Makela
Journal: The Journal of Experimental Medicine (1975)

Mice of 17 inbred strains produced anti-(4-hydroxy-5-bromo-3-nitrophenyl)-acetyl (NBrP) of three different fine specificity types. Anti-NBrP antibodies of all allotype b mice (five strains tested) had a high relative affinity for (4-hydroxy-3.5-dinitrophenyl) acetyl (NNP) but low for (4-hydroxy-5-cloro-3-nitrophenyl) acetyl (NCP). Another category was characterized by high relative affinity for NCP but low for NNP. This category included most of the tested strains. The third category (CBA and C3H strains) had an intermediate fine specificity. Associated with fine specificity characteristics were anti-NBrP titers, mice of allotype b had lower titers than the other mice. Studies of congenic, recombinant inbred, F1 and backcross mice showed that both fine specificity and the magnitude of the anti-NBrP response of tbalb/C MICE WERE CONTROLLED BY AN ALLOTYPE-LINKED GENE. This gene was dominant over the C57BL/6 ALLELE. Lack of recombinant mice in the backcross generatioterns on the other suggest close linkage between the two genes.
Activity of Oral Fludarabine Phosphate in Previously Treated Chronic Lymphocytic Leukemia
Authors: M. A. Boogaerts, A. Van Hoof, D. Catovsky, M. Kovacs, M. Montillo, P. L. Zinzani, J. L. Binet, W. Feremans, R. Marcus, F. Bosch, G. Verhoef, M. Klein
Journal: Journal of Clinical Oncology (2001)

PURPOSE: A prospective, multicenter, open-label phase II clinical trial was conducted to assess the efficacy and safety of oral fludarabine phosphate. Reference to an historical group of patients treated with the intravenous (IV) formulation allowed the investigators to compare the two formulations. PATIENTS AND METHODS: Efficacy was assessed using the International Workshop on Chronic Lymphocytic Leukemia (IWCLL) and National Cancer Institute (NCI) criteria for complete remission (CR), partial remission (PR), stable disease, or disease progression. Safety monitoring included World Health Organization (WHO) toxicity grading for all adverse events. RESULTS: Seventy-eight (96.3%) of 81 recruited patients with previously treated B-cell chronic lymphocytic leukemia (CLL) received 10-mg tablets of fludarabine phosphate to a dose of 40 mg/m 2 /d for 5 days, repeated every 4 weeks, for a total of six to eight cycles. According to IWCLL criteria, the overall remission rate was 46.2% (CR, 20.5%; PR, 25.6%). The comparative figures using NCI criteria were 51.3% (CR, 17.9%; PR, 33.3%). Overall, 30 incidents of severe adverse events were reported for 22 patients. WHO grade 3 or grade 4 hematologic toxicities included granulocytopenia (53.8%), leukocytopenia (28.2%), thrombocytopenia (25.6%), and anemia (24.4%). Gastrointestinal adverse events were more common with the oral formulation than previously reported with IV fludarabine phosphate. However, these events were generally mild to moderate. CONCLUSION: This study demonstrates that oral fludarabine phosphate has similar clinical efficacy to the IV formulation and a safety profile that is both predictable and essentially similar to that of the IV formulation.
Bacterial endocarditis due to Lactococcus lactis subsp. cremoris: case report
Authors: Giampietro Pellizzer, Paolo Benedetti, Francesca Biavasco, Vinicio Manfrin, Marzia Franzetti, Mariuccia Scagnelli, Claudio Scarparo, Fausto de Lalla
Journal: Clinical Microbiology and Infection (1996)
Lung function and respiratory symptoms as predictors of mortality: The HUNT study
Authors: Linda Leivseth, Tom Ivar Lund Nilsen, Xiao-Mei Mai, Roar Johnsen, Arnulf Langhammer
Journal: European Respiratory Journal (2012)

Background: Impaired lung function is associated with increased mortality. However, whether respiratory symptoms, independent of lung function, are associated with all-cause or cardiovascular (CV) mortality is not clear.

Objective: To prospectively study associations of lung function and respiratory symptoms with all-cause and CV mortality in a general population.

Methods: The study included 5519 women and 4972 men who participated in the Lung study of the Norwegian HUNT study in 1995-97. Cox regression was used to calculate adjusted hazard ratios (HRs) for all-cause and CV death associated with pre-bronchodilator percent of predicted FEV1 (ppFEV1), grades of COPD, and respiratory symptoms (chronic bronchitis, wheeze, and dyspnoea).

Results: Lung function was inversely associated with all-cause mortality. A 10% reduction in ppFEV1 gave a HR of 1.17 (95% confidence interval [CI] 1.09-1.25) in women and 1.23 (95% CI 1.16-1.30) in men. Compared to ppFEV1≥100, ppFEV1<50 was associated with a HR of 6.85 (95% CI 4.46-10.52) in women and 3.88 (95% CI 2.60-5.79) in men. Results for COPD grades corresponded to those found for ppFEV1 levels. Of the respiratory symptoms, only dyspnoea remained associated with all-cause mortality after adjusting for lung function (HR 1.68 [95% CI 1.11-2.53] in women and 1.53 [95% CI 1.11-2.11] in men), and within levels of lung function. Overall, associations between lung function and CV mortality were weaker, and no clear relation was found for respiratory symptoms.

Conclusion: Our results suggest that pre-bronchodilator lung function is a strong predictor of all-cause mortality, and that dyspnoea is associated with all-cause mortality independent of lung function.