tbuckley/cabot-search huggingface dataset:
Abstract 12412: Imaging the PM/AICD Patient; Does the Diagnostic Value Justify the Risk?
Authors: Huma Y Samar, June Yamrozik, Ronald Williams, Mark Doyle, Robert Biederman
Journal: Circulation (2014)

Background: MR imaging is infrequently performed on patients with implanted pacemakers/AICDs. When the risk justifies the end, however, consideration to perform 'high-risk’ scanning can be made on a case-by-case basis but typically with trepidation. This raises a critically important question: "Is the MRI scan adding valuable and irrefutable information to warrant such risk? Methods: 84 patients with implanted devices (13AICD,10 AICD/PM,5 retained leads, 6 REVO and 50 dual chamber PM.) were imaged via MRI/CMR (1.5T GE, Milwaukee, WI) over 3 years in a single institution. Specific criteria were followed for all patients to objectively define whether final diagnosis by MRI imaging enhanced patient care. A checklist of 3 questions was answered following scan interpretation by both the technologist and performing MRI physician(s): 1) Did the diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Did patient management change? If ‘Yes’ was answered to any of the above questions, it was considered that the MRI scan was of value to patient diagnosis and/or therapy. Results: All patients completed the procedure with no death, VT/VF, power-on-reset or adverse events. Average MRI study time: 20±55min. The device was interrogated pre and post MRI by EP/cardiologist to determine changes in impedance, amplitude or threshold. No clinically meaningful changes occurred, no post-procedure revisions to generator/lead or parameters were required. Conclusion: The use of PM/AICD imaging in MRI remains controversial. Our study shows that MR imaging in carefully selected patients under the supervision of experienced physicians is not only safe but extremely beneficial, substantially adding value and often irrefutable information to patient diagnosis and management. PM/AICDs when imaged properly are safe and no longer 'forbidden’ in the MRI environment. Moreover there is frequently marked life-altering and life-saving information obtained.
Occurrence of malignancy after an initial diagnosis of post-thoracoscopy fibrinous pleuritis
Authors: Ben Sutton, Rakesh Panchal, Sanjay Agrawal, Jonathan Bennett
Journal: European Respiratory Journal (2012)

Introduction  Fibrinous pleuritis(FP) is a common thoracoscopic diagnosis and implies a benign aetiology, however, the number of cases that subsequently result in malignancy is not fully known.  Objectives  To evaluate what proportion of patients with FP following thoracoscopy develop malignancy.  Methods  Retrospective analysis was conducted of all thoracoscopies performed for unexplained exudative pleural effusions between 2005-2009. In cases with an initial histological diagnosis of FP, review of radiology and histology for at least 24 months post thoracoscopy was undertaken.  Results  Of 177 thoracoscopies, 90(49%) were malignant and 87(51%) were non-malignant. FP was the diagnosis in 68(38%) of cases, with 55(81%) male and a mean age of 72.5 (+/-10.4) yrs.  In 10 (15%) FP cases the subsequent diagnosis confirmed malignancy, with 5 (7.5%) of mesothelioma. Four had further immediate positive investigation (false negatives), six developed overt malignancy at a later stage. Of the 68 patients 35 (51%) had died, 27(39%) with no evidence of malignancy, with a mean survival of 502 days.  Mean survival of those with malignancy was 534 days p 0.75. Patients who died with a benign process were significantly older; 74.7yrs vs. 70.5yrs p0.043 (+/-11.4)  Conclusion  The majority of FP cases follow a benign course but need 2 years follow-up, as a proportion develop malignancy after a significant interval. Benign exudative pleural effusion is a poor prognostic marker in the elderly despite the absence of subsequent malignancy.
Outlet Syndrome: Is There a Surgical Option?
Authors: M R B Keighley, P Shouler
Journal: Journal of the Royal Society of Medicine (1984)

Of 46 patients investigated for constipation, 21 were found to have some other primary abnormality, leaving 25 patients for study: 6 had evidence of the outlet syndrome alone, 5 had slow transit constipation, 8 had both abnormalities and 6 had no apparent physiological disorder in the colon or rectum. Although colectomy and ileorectal anastomosis gave good results for slow transit constipation, partial pelvic floor division provided satisfactory long-term improvement in only one of the 7 patients with the outlet syndrome.
Air pollution in UK: the public health problem that won't go away
Authors: N. Hawkes
Journal: BMJ (2015)

Sixty years after the Clean Air Act, air pollution is back in the headlines. The government has been accused of a failure to act while drivers of diesel cars, who were encouraged to believe they were doing the environment a favour, are now categorised as polluters in chief. Air pollution now kills 29  000 people a year in the UK, according to the headlines. In 2011, the Environmental Audit Committee of the House of Commons said: “The costs to society from poor air quality are on a par with those from smoking and obesity.”1

Air pollution of all sorts has declined sharply in the past 25 years according to official figures.2 Nitrogen oxide levels have fallen by almost two thirds from their 1990 peak, and particulates have more than halved over the same period. But the decline has slowed, and recent studies of the health effects of these two pollutants have raised the bar. While pollution is actually lower than it used to be, the damage it does is better quantified.

The figure comes from a 2014 report by the Committee on Medical Effects of Air Pollutants 3 and relates to particulates—small particles less …
Balancing Benefit, Risk, and Time to New Cancer Therapies
Authors: Howard (Jack) West
Journal: JAMA Oncology (2015)

Dickran Kazandjian, MD; Sean Khozin, MD, MPH; Gideon Blumenthal, MD; Lijun Zhang, PhD; Shenghui Tang, PhD; Meredith Libeg, BS; Paul Kluetz, MD; Rajeshwari Sridhara, PhD; Patricia Keegan, MD; Richard Pazdur, MD
TPI 287, a third-generation taxane, is active and well tolerated as 2<sup>nd</sup> line therapy after failure of docetaxel in hormone refractory prostate cancer (HRPC)
Authors: M. Gross, K. Pendergrass, S. Leitner, G. Leichman, L. Pugliese, S. Silberman
Journal: Journal of Clinical Oncology (2008)

16130 Background: TPI 287 is a semi-synthetic compound manufactured from yew with modifications rendering it more lipophilic, enhancing ß-tubulin binding, and circumventing multi-drug resistance. Two Phase 1 studies have demonstrated TPI 287 to be safe, well tolerated with evidence of antitumor activity. Methods: Inthis Phase 2 study in HRPC, TPI 287 is administered at 160 mg/m2 q 3 weeks. Patients (pts) must have had one prior taxane regimen, and are stratified (40 pts per arm) by time on prior treatment (Arm 1: >3 months vs. Arm 2: ≤3 months). At least 2 responses per arm are required (Simon two-stage design) to continue enrollment past 22 patients in each arm independently. Responses are either reduction in PSA (modified Bubley criteria), or reduction in measurable disease (RECIST criteria) in the absence of an increase in the other criteria. Secondary endpoints include time to progression, overall survival, safety, changes in pain and analgesic use, and a comparison of outcomes between each arm. In addition, proteomic and gene expression profiles will be correlated with response to both prior and current therapy. Results: A total of 9 patients have been enrolled, with 5 currently evaluable for efficacy. Four patients were enrolled in Arm 1 (prior taxane therapy a median of 9.5 months, range 4 - 15), and five patients were enrolled in Arm 2 (prior taxane therapy a median of 3 months, range 2–3), with a median age of 70 (range 59 - 79). All patients had documented bone metastases, two with measurable disease. The median PSA at baseline was 106 (range 5–1700). The most frequent adverse event (AE) was fatigue in 2 patients (Grade 1) and the only other AEs reported in one patient each were neuropathy, neutropenia, and constipation (all Grade 2). In Arm 1, a confirmed PR (9+ cycles) and SD (6 cycles) by PSA criteria were reported. In Arm 2, a confirmed PR by PSA lasting 10 cycles was reported. Conclusion: TPI 287 appears to be very well tolerated in 2nd line HRPC after prior taxane therapy, and has shown efficacy in both arms of the study, with two confirmed PSA responses lasting more than 9 cycles and 1 SD lasting 6 cycles. The trial continues enrollment to further explore safety and efficacy in this patient population. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Tapestry Pharmaceuticals, Inc.
Non-attendance at outpatients departments
Authors: S. Castan-Cameo, J. Johnston, S. McGhee, D. Lawlor, B. Hanratty, W. Hamilton, A. Round, D. Sharp
Journal: BMJ (1999)

Editor—The trial by Hamilton et al1 examining the effect of giving patients a copy of their referral letter on non-attendance at outpatient departments raises several interesting and controversial issues, but it is difficult to assess for an international audience who may not be familiar with the British healthcare system. This issue of being international has been raised by others,2 and surely if the BMJ aspires to be an international journal, the research setting needs to be clarified for international readers.

For example, what is the usual referral procedure in the United Kingdom? In Hong Kong a referral letter is always given to the patient and is required for access to secondary care. Patients make their own appointments. Hamilton et al also fail to establish the justification for the research under discussion.

What was the rationale for this randomised controlled trial? They hypothesise that a lack of communication between the patient and the referring doctor is the cause of non-attendance. If so, how will a copy of the referral letter be expected to improve this communication or guarantee attendance? An explanation of the topic antecedents and justification of the research question are required together with a discussion of the cost implications of this intervention.

Although Hamilton et al quote a national (England or United Kingdom) non-attendance rate of 12%, their own study had a much lower non-attendance rate. The situation in Hong Kong is very different, despite patients receiving a referral letter, and such low rates would be welcomed in Hong Kong. The authors offer no explanation to account for the difference between the study and the national non-attendance rates. This may be due to the study selection criteria. Excluding patients because of severity of disease, previous suboptimal care, or patients' attitude or lifestyle may have biased the sample and led to an incorrect estimate of the non- attendance rates. The intervention was intended to reduce non-attendance and it did not target the appropriate population, the non-attenders. As the authors have not specified the reasons for patients' non-attendance, the reader does not know whether the intervention is appropriate.

The BMJ is a widely read journal, and to reach an international audience enough information should be provided to facilitate the assessment of the research and its potential for application elsewhere.
Bronchoprotector Properties of Calcitonin Gene–related Peptide in Guinea Pig and Human Airways
Authors: ALAIN CADIEUX, NATHALIE P. MONAST, FRANÇOIS POMERLEAU, ALAIN FOURNIER, CHANTAL LANOUE
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

Calcitonin gene–related peptide (CGRP), a neuropeptide released from sensory nerves during axonal reflexes, has strong bronchoprotector properties in rat isolated airways. In this study, we examined this ability of CGRP to prevent agonist-induced contraction in guinea pig and human airways and determined whether inflammatory reaction affects its function. CGRP administered intravenously (0.38 to 114 μ g/kg) in anesthesized guinea pig had no effect per se on airway resistance but caused a dose-related inhibition of substance P (SP; 13.5 μ g/kg)-induced bronchoconstriction (60% at 114 μ g/kg). Similarly, CGRP (10− 9 to 10− 6 M) prevented in a concentration-dependent manner the contraction elicited by SP (5 × 10− 8 M) in guinea pig isolated main bronchi and parenchymal strips, the inhibition caused by CGRP being more pronounced in distal than in proximal airways (47 and 20%, respectively, at 10− 6 M). The breaking effect of CGRP on SP-induced constriction was however significantly reduced (p < 0.05) in guinea pig actively sensitized to ovalbumin (OA) and the loss in its potency was of similar magnitude ( > 40%) whether it was administered in vivo or in vitro. A same phenomenon was observed in human isolated peripheral bronchi. CGRP (10− 6 M) reduced by more than 75% the extent of the contraction evoked by 10− 6 M of carbamylcholine and its protector effect was totally abolished in bronchi showing clear morphological manifestation of inflammatory reaction. It is concluded that CGRP acts as a potent bronchoprotector agent on both guinea pig and human airways but its ability to limit the extent of airway responsiveness is strongly impaired in inflammatory conditions.
Primary care workers are given guidance on managing mental health in humanitarian crises
Authors: J. Clark
Journal: BMJ (2015)

Non-specialist health workers have been given new guidance to help identify and manage the mental health needs of populations during disasters and conflict.

The Mental Health Gap Action Programme (mhGap) Humanitarian Intervention Guide, released in Geneva on 5 May, has been developed by the World Health Organization in collaboration with the United Nations High Commission for Refugees.1

In humanitarian emergencies, which often occur in resource poor settings as is the case with the recent earthquake in Nepal and the ongoing conflict in Yemen, existing healthcare systems are weak, with little or no resources for tackling mental health. General medical staff, including primary care doctors and nurses, are …
Lung Volume Reduction Surgery
Authors: HENRY E. FESSLER, ROBERT A. WISE
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

Lung volume reduction surgery (LVRS) has been widely studied and has been available for the treatment of advanced emphysema for 10 years. This paper reviews some of the historical attempts at surgical treatment of emphysema, the physiology of LVRS, and the modern data on patient selection, risks, and benefits. Data from the National Emphysema Treatment Trial are presented in the context of the large body of case series and smaller randomized trials that have preceded that study. Future technologies of bronchoscopic lung volume reduction are also discussed.
Cetuximab plus gemcitabine/oxaliplatin (GEMOX) for patients with unresectable/recurrent intrahepatic cholangiocarcinoma refractory to GEMOX
Authors: B. Paule, M. Bralet, M. Herelle, E. Rage, M. Ducreux, C. Guettier, R. Adam
Journal: Journal of Clinical Oncology (2006)

14084 Background: Gemcitabine-oxaliplatin (GEMOX) is active and well tolerated in advanced biliary tract adenocarcinomas. We report a single institution retrospective study on using cetuximab plus GEMOX in patients with intrahepatic cholangiocarcinoma that expresses Epidermal Growth Factor Receptor (EGFR) and who have progressed on first line chemotherapy (GEMOX). Methods: 9 patients (5 females, 4 males, mean age: 54 years, range: 27–74, performance status: 0–1) with a recurrent or unresectable intrahepatic cholangiocarcinoma (peripheral n=6, hilar n=3, histologically proven) resistant to GEMOX received cetuximab 400 mg/m 2 on day 1 then 250mg/m 2 weekly, in combination with gemcitabine 1,000 mg/m 2 as a 10 mg/m 2 /min infusion on day 1 and oxaliplatin 85mg/m2 as a 4-h infusion on day 2, every 3 weeks. EGFR expression was determined by immunohistochemistry (n=9) and EGFR gene copy number on tumour cells was detected by fluorescent in situ hybridization (FISH) (n=8). Tumor response was measured using standard RECIST criteria. Results: EGFR was detected by immunohistochemistry (9/9) in more than 10% tumour cells without gene amplification (8/8). A total of 57 cycles were given (range: 3–11 per patient). Median duration follow-up was 7 months (range: 6–12). At 3 months, 3/9 had partial response, 3/9 stable disease and 3/9 a progression disease. At 6 months, CT scan showed 1 complete response, 1 partial response, 1 stable disease and 6 progression diseases. The median time to tumour progression was 6 months, with a median duration of response of 3 months (range: 2–8). Five patients died. Of the 4 patients who are still alive, the mean duration follow-up is 11 months (range: 10–14). There was no treatment related death, no anemia, no neurotoxicity. One grade 3 neutropenia was noted and acne-like rash was observed in 7/9 patients. The median survival from time of initiation of treatment was 10 months. Conclusions: Even if there is no amplification of EGFR gene, Cetuximab plus GEMOX is well tolerated and provides good palliative effects in advanced cholangiocarcinoma. A prospective phase II trial with GEMOX with and without cetuximab is being planned to assess the real impact of cetuximab in unresectable cholangiocarcinoma expressing EGFR. No significant financial relationships to disclose.
Intermediate lymphocytic lymphoma: clinical and pathologic features of a recently characterized subtype of non-Hodgkin's lymphoma.
Authors: R A Shivdasani, J L Hess, A T Skarin, G S Pinkus
Journal: Journal of Clinical Oncology (1993)

PURPOSE We present a comprehensive review of clinical, pathologic, molecular, and prognostic features and therapy of intermediate lymphocytic (mantle cell) lymphoma (ILL/MCL), a recently characterized subtype that represents 2% to 8% of non-Hodgkin's lymphomas (NHLs), but which has not been included in most classification schemes, including the International Working Formulation. DESIGN The English-language literature encompassing the above aspects, published between 1977 and 1992, is critically reviewed. RESULTS AND CONCLUSION ILL/MCL is a disease of proliferating B lymphocytes that is characterized by generalized lymphadenopathy and frequent, often extensive, involvement of the spleen, bone marrow, and gastrointestinal tract. The malignant cells usually express the markers CD5 and IgM with or without IgD, but not CD10, on the cell surface, and grow in one of two dominant histologic patterns: mantle zone and diffuse. The characteristic cytogenetic abnormality is a t(11;14)(q13;q32) translocation, which juxtaposes the bcl-1 locus on chromosome 11 with the immunoglobulin (Ig) heavy-chain locus on chromosome 14, and appears to result in dysregulated expression of the gene encoding cyclin D1. Median survival is in the range of 2 to 5 years. While responses to chemotherapy may be seen in up to half the patients, relapses are the rule, and longterm survival is uncommon. The optimal treatment remains undefined, although therapy may be deferred until there are symptoms or complications, at which time judicious administration of alkylating agents and glucocorticoids may result in effective palliation.
Differences in airway inflammation between children with primary ciliary dyskinesia (PCD) and cystic fibrosis (CF)
Authors: Hartmut Grasemann, Valerie Waters, Nancy McDonald, Yvonne Yau, Sharon Dell, Felix Ratjen
Journal: European Respiratory Journal (2014)

PCD and CF lung disease are similar in many aspects, but may differ in inflammatory responses. We compared markers of airway inflammation in patients with mild PCD or CF pulmonary exacerbation.  Methods: Patients with an established diagnosis of CF or PCD were recruited from clinic if able to do pulmonary function testing and produce sputum.  P. aeruginosa  or  B. cepacia  complex infections were among the exclusion criteria. Sputum was obtained before (V1) and after (V2) 21 days of oral antibiotic treatment and analyzed for qualitative and quantitative micobiology, cell counts, interleukin-8 (IL-8) concentrations and neutrophil elastase activity.  Results: Eleven PCD and 16 CF patients were included. Mean age was 10 (range 7-16) yrs in both groups. Mean (±SD) FEV1 at V1 was 63 (±13.8) % in PCD and 74 (±18.3) % predicted in CF (p=0.1). FEV1 improved to 71 (±21.2) % in PCD (p S. aureus  and  H. influenza  density in sputum at V1 was significantly lower in PCD than CF. Sputum cell counts were not different. Mean (±SEM) IL-8 levels in sputum were similar in PCD and CF on V1 (237.3±77.8 vs 118.4 ±27.7 ng/ml, p=0.09) and V2 (211.5±105.2 vs 138.4±35.0 ng/ml, p=0.9). In contrast, while sputum elastase activity was similar in PCD and CF at V1 (83.0 ±15.0 vs 61.5±14.8 nanomol/min, p=0.16) it decreased at V2 in PCD (20.9±8.0, p  Conclusions: Children with PCD differ from CF patients in their responses to treatment of a mild pulmonary exacerbation. While lung function improved in both groups, neutrophil elastase persisted at higher levels in CF at the end of treatment.
Cardiovascular risk markers in patients with OSA. Effects of CPAP treatment
Authors: Felipe Villar-Álvarez, Fernanda Troncoso-Acevedo, Ivonne Cabrejos-.Salinas, Teresa Gómez-García, Germán Peces-Barba, Belén Gallegos-Carrera, Ramón Martínez-Carranza, Nicolás González-Mangado
Journal: European Respiratory Journal (2012)

INTRODUCTION:  Our main objective was to establish the etiological association between systemic inflammation and endothelial vascular dysfunction in OSA patients, as well as the effects of CPAP treatment.  METHODS:  Observational case control study in OSA patients and healthy individuals. All of them were tested for serum and urinary markers. Peripheral arterial tonometry by oscillometric sphygmomanometer (ENDO-PAT 2000) was used to measure endothelial dysfunction (Reactive Hyperemia Index-RHI). These measurements were repeated one year after with CPAP treatment. This study has been supported by Neumomadrid.  RESULTS:  This study involved 81 participants (53 with OSA and 28 healthy controls). Mean age: OSA 56,01, controls 53,03. Mean BMI: OSA 31,2, controls 26,8. The OSA severity was severe in 54,8%, moderate in 20,7% and mild in 24,5% of them. In the results for the serum and urinary markers there were statistically significant in D-dimer (p 0,01) and microalbuminuria (p 0,01). There was statistically significant in the vascular endothelial dysfunction meseaured with RHI value (p 0,00). These markers, in 10 patients, and after CPAP treatment (mean pressure of 7,7 cm H2O and 5.8 mean hours of use), showed an increase in the RHI value from 1.42 to 1.80 (p 0,04).  CONCLUSIONS:  An association between OSA and cardiovascular risk can be established by measuring D-dimer, microalbuminuria and RHI. Treatment with CPAP significantly improves endothelial dysfunction data.