tbuckley/cabot-search huggingface dataset:
Variation in Outpatient Antibiotic Prescribing for Acute Respiratory Infections in the Veteran Population
Authors: Barbara Ellen Jones, Brian Sauer, Makoto M. Jones, Jose Campo, Kavitha Damal, Tao He, Jian Ying, Tom Greene, Matthew Bidwell Goetz, Melinda M. Neuhauser, Lauri A. Hicks, Matthew H. Samore
Journal: Annals of Internal Medicine (2015)

Despite efforts to reduce antibiotic prescribing for acute respiratory infections (ARIs), information on factors that drive prescribing is limited.To examine trends in antibiotic prescribing in the Veterans Affairs population over an 8-year period and to identify patient, provider, and setting sources of variation.Retrospective, cross-sectional study.All emergency departments and primary and urgent care clinics in the Veterans Affairs health system.All patient visits between 2005 and 2012 with primary diagnoses of ARIs that typically had low proportions of bacterial infection. Patients with infections or comorbid conditions that indicated antibiotic use were excluded.Overall antibiotic prescription; macrolide prescription; and patient, provider, and setting characteristics extracted from the electronic health record.The proportion of 1 million visits with ARI diagnoses that resulted in antibiotic prescriptions increased from 67.5% in 2005 to 69.2% in 2012 (P < 0.001). The proportion of macrolide antibiotics prescribed increased from 36.8% to 47.0% (P < 0.001). Antibiotic prescribing was highest for sinusitis (adjusted proportion, 86%) and bronchitis (85%) and varied little according to fever, age, setting, or comorbid conditions. Substantial variation was identified in prescribing at the provider level: The 10% of providers who prescribed the most antibiotics did so during at least 95% of their ARI visits, and the 10% who prescribed the least did so during 40% or fewer of their ARI visits.Some clinical data that may have influenced the prescribing decision were missing.Veterans with ARIs commonly receive antibiotics, regardless of patient, provider, or setting characteristics. Macrolide use has increased, and substantial variation was identified in antibiotic prescribing at the provider level.U.S. Department of Veterans Affairs, Centers for Disease Control and Prevention.
Management of Extramedullary Leukemia as a Presentation of Acute Myeloid Leukemia
Authors: Samuel J. Slomowitz, Paul J. Shami
Journal: Journal of the National Comprehensive Cancer Network (2012)

Extramedullary involvement is considered to be an uncommon presentation of acute myeloid leukemia (AML), although some data suggest it may be present in up to 30% of patients. Extra-medullary involvement by AML can present in a variety of clinical manifestations, most notably in the form of myeloid sarcoma, leukemia cutis, and central nervous system involvement. Each presents a unique clinical scenario in terms of symptoms and management. Extramedullary disease in any form presenting without evidence of bone marrow disease is still considered evidence of systemic disease and is usually treated as such. Most commonly, extramedullary disease presents concurrently with bone marrow disease, and although it may require additional local therapy in the form of intrathecal chemotherapy or radiation, the principles of systemic treatment remain unchanged. The prognostic impact of extramedullary disease is unclear. Specifically, whether hematopoietic stem cell transplantation should be considered in first remission irrespective of other prognostic factors has not been established. Patients who undergo transplantation have similar outcomes as patients without extramedullary disease, although they do have a higher rate of extramedullary relapse. More research is needed to define the molecular basis for extramedullary disease, its prognostic impact, and optimal management.
Clindamycin phosphate 1·2%-benzoyl peroxide 3·0% fixed-dose combination gel has an effective and acceptable safety and tolerability profile for the treatment of acne vulgaris in Japanese patients: a phase III, multicentre, randomised, single-blinded, acti
Authors: M. Kawashima, H. Hashimoto, A.B. Alió Sáenz, M. Ono, M. Yamada
Journal: British Journal of Dermatology (2014)

Background A topical fixed-dose clindamycin phosphate 1·2% and benzoyl peroxide 3·0% combination gel (CLNP/BPO 3%) is known to be effective and safe in white people with acne. Objectives To evaluate the efficacy and safety of CLNP/BPO 3·0% topically applied once or twice daily vs. CLNP twice daily in Japanese patients with acne. Methods Eight hundred patients were randomized to receive CLNP/BPO 3·0% once daily, CLNP/BPO 3·0% twice daily or CLNP twice daily for 12 weeks. Primary endpoints were absolute change in number of total lesions (TLs) from baseline to week 12 to demonstrate the superiority of CLNP/BPO 3·0% twice daily and noninferiority of CLNP/BPO 3·0% once daily vs. CLNP twice daily. Secondary endpoints were absolute and percentage changes in TLs, inflammatory lesions (ILs), noninflammatory lesions (non-ILs) and Investigator's Static Global Assessment (ISGA) score. Safety assessments included adverse events (AEs), laboratory tests, vital signs and local skin tolerability. Results Change in TL counts from baseline to week 12 for CLNP/BPO 3·0% twice daily was superior to CLNP twice daily (difference −11·0; P < 0·01); CLNP/BPO 3·0% once daily was not inferior to CLNP twice daily (difference −10·3; P < 0·01). Absolute and percentage reductions in TL, IL and non-IL counts and ISGA score were greater for CLNP/BPO 3·0% once or twice daily than for CLNP twice daily with significant differences seen from early on. Most AEs were mild or moderate. The incidence of adverse drug reactions was higher for CLNP/BPO 3·0% once (24·0%) or twice (35·1%) daily than for CLNP twice daily (9·0%). Conclusions Compared with CLNP twice daily, CLNP/BPO 3·0% once daily was more effective and CLNP/BPO 3·0% twice daily at least as effective, with an early onset of action and an acceptable safety and tolerability profile in Japanese patients.
Incidence of Histologic Types of Cancer of the Small Intestine&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: Noel S. Weiss, Chin-Po Yang
Journal: JNCI Journal of the National Cancer Institute (1987)

Data from nine population-based cancer registries participating in the Surveillance, Epidemiology, and End Results Program from 1973 through 1982 were analyzed to determine the demographic correlates of the incidence of the four major histologic types of cancer of the small intestine: carcinomas, malignant carcinoid tumors, lymphomas, and sarcomas. These tumors were uncommon: The average annual incidence per million persons was 3.9, 2.9, 1.6, and 1.2, respectively. The age-specific incidence rate for each type was quite low through middle age, after which it rose sharply. Males experienced higher rates than females for each of the four histologic types. Blacks were at a 40-70% greater risk than whites for the occurrence of carcinomas and carcinoid tumors but at a 50% lower risk for lymphomas. The reported incidence of malignant carcinoid tumors increased during the decade under study, the rate at the end of the interval being 50% greater than that at the beginning. The extent to which this increase represents improved detection of these tumors or a change in the criteria separating malignant from benign tumors could not be evaluated. There was no change in the incidence of carcinomas, lymphomas, or sarcomas of the small intestine. The four histologic types varied considerably with regard to their proportional distribution among the subsites of the small intestine. Carcinoid tumors, lymphomas, and sarcomas rarely occurred in the duodenum, whereas nearly half of the carcinomas were found there. Eighty-seven percent of the carcinoid tumors and 60% of the lymphomas occurred in the ileum. Clues to the etiologies of tumors of the small intestine are sparse. The incidence data presented here suggest that at least some of the etiologies will differ among the histologic types.
Chronic mucus hypersecretion in asthma: Relation to smoking status and disease severity
Authors: Rekha Chaudhuri, Charles McSharry, Mark Spears, Neil C. Thomson
Journal: European Respiratory Journal (2012)

Background 

Chronic mucus hypersecretion occurs in chronic asthma, but the effects of smoking status and disease severity on this symptom are not clearly established. We assessed the prevalence of chronic mucus hypersecretion in patients with asthma recruited to the Glasgow COPD and Asthma Biomarker study.

Methods 

One hundred and twenty subjects with asthma, smokers and never smokers of different GINA severity and fifty-four COPD subjects of different GOLD severity were recruited. Assessments included demographics, history of chronic cough and sputum production and spirometry.

Results 

Baseline demographic and lung function data in the smokers with asthma and never smokers with asthma were similar. The COPD group were older and had a higher pack year history than the asthmatic group. Chronic mucus hypersecretion was strongly associated with smoking in the whole asthma group (Chi-sq=22.8, p<0.001). The proportion of patients with asthma and COPD of different disease severity and smoking status giving a history of chronic mucus hypersecretion is shown in Table 1.

View this table:

Table 1





Chronic mucus hypersecretion increased with asthma severity overall (p=0.003) and in the smokers and never smokers with asthma, but not in COPD.

Conclusions 

Chronic mucus hypersecretion is a common symptom in adults with chronic asthma particularly in smokers and patients with severe disease. This finding suggests that novel treatments targeting this symptom may be of value in the management of asthma.
Effect of inhaled liposomal retinoids on the hyperoxia induced lung injury in newborn guinea pigs
Authors: Iryna Katovich, Zhanna Rutkovskaya, Svetlana Anischenko, Anatoly Tahanovich
Journal: European Respiratory Journal (2014)

Pharmacological approaches to prevent bronchopulmonary dysplasia (BPD) have been not developed yet. We used  model of BPD to study the influence of inhaled liposomal retinoids on the lung morphology and lung tissue growth factors (TGFβ1, VEGF), neutrophil elastase and its inhibitor, α1-antitrypsin (A1-AT) in newborn guinea pigs. The studied groups: “hyperoxia” (n=10, 70% O2, 14 days), “hyperoxia+liposomes” (n=6, liposomes containing dipalmitoylphosphatidylcholine (45 mg/kg), retinol (6 mg/kg), retinoic acid (0,6 mg/kg) were introduced by nebulizer on alternate days on  exposure), “control” (n=9, exposed to room air). Increased level of elastase and A1-AT (2,9-fold and 1,8-fold, respectively, p<0,05 versus controls), reduced VEGF (82% from controls, p<0,05) and unchanged TGFβ1 have been found in hyperoxia group. Lung sections demonstrated small-focal atelectases, parenchymal inflammatory cell infiltrates, decreased alveolar number and septa, increased area of alveolar spaces (11,7 (11,3 – 12,4) μm2 versus 10,5 (10,3 – 10,7) μm2 in controls, p<0,05). In “hyperoxia+liposomes” group growth factors in the lung tissue were not changed as compared to “hyperoxia”, elastase level decreased and did not differ significantly from the control group, the activity of A1-AT was 2,5-fold higher than in controls (p<0,05). Intraalveolar accumulation of macrophages was revealed (probably, in response to liposome introduction), however, lung morphometry data showed correspondence with the control group. Thus, inhaled liposomal retinoids improve elastase/A1-AT ratio and prevent the development of morphological changes in lungs of newborn guinea pigs exposed to prolonged hyperoxia.
A randomized study of the bronchoscopic valve blockade of the affected part of the lung in the complex treatment of patients with cavitary drug-resistant pulmonary tuberculosis
Authors: Sergey Sklyuev, Denis Krasnov
Journal: European Respiratory Journal (2012)

In according to the existing hypothesis application of the endobronchial valve will result in a selective curative atelectasis of the affected part of the lung, which contributes to early closure of cavities.  Aims: To assess and to analyze the influence of the endobronchial-valve therapy on the current of the disease.  Methods: We have compared the efficacy of endobronchial-valve therapy in the complex treatment of patients with cavitary drug-resistant pulmonary tuberculosis against the standard therapy. The closure of cavities was selected as a criterion of effectiveness. In total, 68 patients with drug-resistant destructive pulmonary tuberculosis were taken into the study, they were randomly divided on two groups - one for 33 patients for endobronchial-valve installation (EBV) and another – for 35 to receive standard treatment (control group). Standard chemotherapy for all groups was administered continued throughout the study period.  Results: 22 cases (66.7%) in the EBV-group have demonstrated closure of cavities versus 7 (20.0%) patients in the control group (p = 0.001). Cavities remained in 11 cases (33.3%) in the EBV-group and in 28 cases (80.0%) of the control group (p = 0.001).  Conclusions: The application of endobronchial-valve treatment can significantly improve the effectiveness of standard chemotherapy regimens for DR cavitary pulmonary tuberculosis.
Clinical efficacy and patients' satisfaction for 100 consequent COPD patients using tiotropium respimat
Authors: Motokazu Kato, Takashi Teranishi, Takehiko Kobayashi, Yumi Izuhara, Yuichi Higami, Yoshihiko Koshimo, Satoshi Marumo, Kohki Miura, Masahiro Kawashima
Journal: European Respiratory Journal (2011)

Tiotropium Respimat® is a newly developed device which delivered the drug with ease. In this paper we9ve described the efficacy and patients9 satisfaction for two groups of patients, 1; the first users of anti-muscarinic inhelor (33 patients) 2; changed users from Tiotropium Handyhelor® to Respimat® (67 patiens).   Methods:  One hundred consequent COPD patients administered Tiotropium Respimat® were enrolled. Eight weeks later, impressions about the devices and pulmonary function tests were recorded. Patients satisfaction was measured by the following, 1) Easily understand how to use the device, 2) time consumption to inhale, 3) irritability of the inhaled drug, 4) easy to mobile the device, 5) adherence. Visual analogue scale from 1 (most negative) to 5 (most positive) were used.   Results:  1) - 1 Patients mean impression score of first users showed rather positive impression, Q1: 3.78, Q2: 3.89, Q3: 4.27, Q4: 4.03, Q5: 3.55. 1) - 2 Patients impression score of the changed users (from Handyhelor® to Respimat®) were significantly improved. Q1: 2.75±0.09 to 3.80±0.08. Q2: 1.32±0.07 to 3.40±0.07, Q3: 2.54±0.07 to 3.68±0.07, Q4: 1.91±0.08 to 3.80±0.08, and Q5: 1.55±0.09 to 3.77±0.08 (p=0.001∼0.0001). 2) Pulmonary function tests of the changed users showed no significant improvement about VC and IC and showed not significant but a little improvement of FEV1 and FEV1% (G) (FEV1; 1.65±0.09 to 1.69±0.09, FEV1% (G); 59.04±2.21 to 60.99±2.40 (%), (p=0.08). Peak expiratory flow was significantly improved after changed the device (4.53±0.35 to 4.77±0.28,p=0.004).   Conclusion:  Tiotropium Respimat® was a simple and comfortable device and it may improve the pulmonary function for the patients with COPD.
Longitudinal changes in time domain spirogram indices and their variability
Authors: T Nakadate, T Sato, J Kagawa
Journal: European Respiratory Journal (1994)

The purpose of this study was to describe longitudinal changes in time domain spirogram indices and their variability. We therefore measured forced expiratory spirograms of 326 middle-aged male employees in two asbestos-using factories four times over 5 yrs. From the original sample of 326, 225 healthy subjects, who provided reliable results for three or more surveys, were selected for analysis. The mean and standard deviation of transit time and their log-transformed values (MTT, STT, ln(MTT), and ln(STT), respectively), as well as two indices of the estimated time constant distribution (Mu and Sigma, respectively) were analysed using a longitudinal model. The longitudinally estimated annual increase of MTT, STT, ln(MTT), and ln(STT) was about three times larger than the cross-sectional estimate, whilst they were comparable in Mu and Sigma. A highly significant contribution of between-subject variability was found in all indices. This was particularly remarkable in the mean components. The between-subject variability was about eight times larger than the error variance in Mu, and three times in MTT and ln(MTT). We conclude that the longitudinal data of transit time indices should not be compared with cross-sectional reference values, and that the magnitude of error variance of these indices in longitudinal repeated measurements will be rather less than the cross-sectional counterpart reported previously.
Abstract 4075: LAG3 and PD1 co-inhibitory molecules directly interact to limit CD8+ T cell signaling
Authors: Ruea-Yea Huang, Cheryl Eppolito, Ahmed Fadiel, Adel Hamza, Shashikant Lele, Junko Mastuzaki, Kunle Odunsi
Journal: Cancer Research (2014)

Abstract Increasing evidence indicate that dual blockade of Lymphocyte Activation Gene-3 (LAG3) and programmed cell death 1 (PD1) synergistically enhances autoimmunity and anti-tumor immunity. Despite the fact that these co-inhibitory receptors individually attenuate T cell receptor signaling, it is not clear whether they interact at the physical, biochemical and/or molecular levels, to regulate the functional fate of T cells. To answer these questions, we first simulated possible direct interaction of LAG3 and PD1 using in-silico molecular docking techniques. Using confocal microscopy and ImageStream analyses, we demonstrated that LAG3 and PD1 molecules co-localized in a subset of activated murine CD8+ T cells. The co-localization occurred at the trans-Golgi vesicles, early/recycling endosomal compartments, lysosomes, and microtubule organizing center (MTOC). Importantly, LAG3 and PD1 cluster with pLck at the immunological synapse of CD8+ T cell and dendritic cell conjugates. Reciprocal immunoprecipitation of the T cell extracts with specific antibodies for LAG3 and PD1 revealed a physical association between LAG3 and PD1 and this interaction was absent in T cells isolated from LAG3 and PD1 knockout mice. Finally, LAG3 protein was also associated with Src family tyrosine phosphatase-2 (SHP2) that is recruited by PD1 during T cell signaling. The recruitment of phosphatases is additively reduced in CD8+ T cells deficient in both LAG3 and PD1. Taken together, our data suggest that LAG3 interacts and collaborates with PD1, following T cell activation, for rapid translocation from early/recycling endosomal compartments to the immunological synapse, leading to a synergistic inhibitory effect on T cell signaling. Citation Format: Ruea-Yea Huang, Cheryl Eppolito, Ahmed Fadiel, Adel Hamza, Shashikant Lele, Junko Mastuzaki, Kunle Odunsi. LAG3 and PD1 co-inhibitory molecules directly interact to limit CD8+ T cell signaling. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4075. doi:10.1158/1538-7445.AM2014-4075
Multiplex real-time PCR and blood culture for identification of bloodstream pathogens in patients with suspected sepsis
Authors: H. Westh, G. Lisby, F. Breysse, B. Böddinghaus, M. Chomarat, V. Gant, A. Goglio, A. Raglio, H. Schuster, F. Stuber, H. Wissing, A. Hoeft
Journal: Clinical Microbiology and Infection (2009)
An ongoing measles outbreak in Bulgaria, 2009
Authors: L Marinova, M Kojouharova, Z Mihneva
Journal: Eurosurveillance (2009)

After seven years without indigenous transmission of measles in Bulgaria, an increasing number of cases have been reported since 15 April 2009. By 19 June, the total number of notifications reached 84. To date, 64 were confirmed as measles cases and 15 cases, for whom laboratory results are pending, have been classified as probable. The present measles outbreak affects mostly the Roma population living in the north-eastern part of the country. The most affected age groups are young children below 1 year of age and children 1 to 9 years of age. An immunisation campaign was started in the affected administrative regions, targeting all persons from 13 months to 30 years of age who had not received the complete two-dose MMR vaccination.
Effects of air pollution from biomass burning in nasal mucociliary clearance of Brazilian sugarcane cutters
Authors: Aline D. Ferreira, Ercy M.C. Ramos, Giovana N.B. Ferrari, Rafaella F. Xavier, Luiz C.S. Carvalho Junior, Alessandra C. Toledo, Dionei Ramos
Journal: European Respiratory Journal (2011)

Nasal mucociliary (NM) system is the first line of defense of the upper airways and it is responsible for the clearance of inhaled particles, including particulate matter (PM) from biomass burning. Several epidemiological studies have demonstrated a consistent association between levels of air pollution from biomass burning and increase in hospitalization for respiratory diseases and mortality. About 44,3% of the sugarcane is burned to facilitate the manual harvesting every year and the most exposed people are the sugarcane cutters. Nevertheless no previous reports studied respiratory effects of PM from biomass burning in these individuals. This study evaluated the effects of exposure to PM from biomass burning on NM transport after harvest. Twenty-five non-smokers (mean age = 25,7±4,5 years; BMI 23,9±2,6 kg/m2) workers in a Sugar and Ethanol Company located in Martinopolis, state of Sao Paulo, Brazil, in April/2010, were evaluated in two periods: pre-harvest season and three months after harvest. Mucociliary clearance by saccharin transit time test (STT) and nasal symptoms were assessed. STT was 7,9±3,4 min at pre-harvest and decreased significantly after harvest 3,9±2,2 min, p<0.001).

![Figure][1] 



Nasal symptoms did not change following exposure. Our results suggest that acute exposure to particulate matter from sugarcane burned affects mucociliary clearance in non-smokers workers in the absence of symptoms.

 [1]: pending:yes
Inspiratory muscle weakness in mildly- to moderately-hyperinflated patients with COPD
Authors: Daniel Langer, Casey Ciavaglia, Kathy Webb, J. Alberto Neder, Denis O'Donnell
Journal: European Respiratory Journal (2014)

It is unknown whether inspiratory muscle weakness might be present and related to exertional dyspnea in patients with COPD who are not severely hyperinflated. Clinically stable patients (n=300) underwent complete pulmonary function tests and a maximal incremental cycle exercise test. After excluding patients with severe hyperinflation (IC/TLC<0.25; n=72) we compared patients with reduced (Pi,max<60%pred; n=88) and preserved (Pi,max:≥60%pred; n=140) inspiratory muscle strength (Table).

View this table:

Characteristics of patients with reduced (Pi,max<60%pred), and preserved (Pi,max≥60%pred) inspiratory muscle strength. 





Thirty-nine percent of patients in this population had a Pi,max of less than 60% of the predicted normal value. After correcting for resting hyperinflation and other baseline differences (ANCOVA) patients with reduced Pi,max achieved lower peak work rates (W,max: 88±38 vs 76±31 Watt; p=0.004) and oxygen consumption (VO2,max: 1.5±0.6 vs 1.3±0,5 L/min; p=0.001), but higher ventilation-corrected dyspnea scores (0.105±0.052 vs 0.122±0.061; p=0.023). A higher proportion of patients with reduced Pi,max reported 'shallow breathing' at peak exercise (38% vs 20%; p=0.019). Inspiratory muscle weakness in COPD patients is prevalent even in those who are not severely hyperinflated. Inspiratory muscle weakness might contribute to dyspnea and exercise limitation in selected patients.