tbuckley/cabot-search huggingface dataset:
Noninvasive ventilation in the weaning of patients with acute-on-chronic respiratory failure due to COPD
Authors: Gamal Agmy, Yasser Gad, Yossef Ahmed
Journal: European Respiratory Journal (2011)

Background:  Endotracheal intubation (ETI) and mechanical ventilation are often needed in patients with acute-on-chronic respiratory failure (ACRF) due to acute exacerbations of COPD (AECOPD).   Purpose:  It was to assess the usefulness of non invasive ventilation as an early extubation and weaning technique in ACRF secondary to AECOPD.   Patients and methods:  Among 384 consecutively intubated patients admitted for ACRF due to AECOPD, a prospective, randomized controlled trial of weaning was conducted in 264 patients who failed a 2-h spontaneous breathing trial, although they met simple cri-teria for weaning. Conventional invasive pressure support ventilation (IPSV) was used as the control weaning technique in 130 patients (IPSV group), and NIV was applied immediately after extubation in 134 patients (NIV group).   Results:  No statistical difference was found in the characteristics of the two groups at randomization. In the IPSV group, 100 of 130 patients were successfully weaned and extubated, versus 124 of 134 in the NIV group (p    Conclusions:  1. NIV like IPSV significantly and similarly improves gas exchange during weaning, of patients with ACRF secondary to AECOPD, from invasive MV. 2. NIV reduces significantly the duration of ETI, weaning failure, nosocomial pneumonia, ICU stay and hospital stay.
Investigating tamoxifen resistance in the luminal B estrogen receptor positive breast cancer subtype: Tailoring treatment in hormone responsive breast cancer
Authors: S. Loi, C. Sotiriou, B. Haibe-Kains, F. Lallemand, N. Conus, M. J. Piccart, T. Speed, G. A. McArthur
Journal: Journal of Clinical Oncology (2007)

10603 Background: We recently reported that the two estrogen receptor (ER) positive breast cancer (BC) molecular subtypes can be defined by their expression of proliferation genes using a gene expression index (GGI): the luminal A and B subtypes have low and high levels respectively (J Clin Onc, in press). When treated with adjuvant tamoxifen, luminal A tumors have a good prognosis, however the clinical outcome of the luminal B subtype was poor. This study aimed to explain the biological basis for these observations using global gene expression profiling and an in vitro model of ER+ BC. Methods: 246 ER+ BC samples from women treated with adjuvant tamoxifen monotherapy were analyzed with affymetrix gene expression arrays and evaluated using gene set enrichment analysis (GSEA). ER+ MCF-7 BC cells (control) treated with tamoxifen (TAM) and heregulin (HRG) were used to investigate molecular pathways identified using GSEA. Results: We found that a gene set suggesting ERBB2 pathway activation was significantly enriched in the luminal B subtype (p=0.02). Only 10% of samples overexpressed HER2 by immunohistochemistry, suggesting that activation of HER2 signaling pathways is independent of HER2 overexpression and may contribute to TAM resistance in this subtype. To validate this hypothesis, MCF-7 cell-lines were treated with HRG (HRG-MCF7) to create a model of ERBB2 pathway activation. HRG-MCF7 cells displayed phosphorylation of HER2/3 without HER2 overexpression. Treatment with HRG overcame TAM induced cell cycle arrest with higher S-phase fraction (p&lt;0.01) and increased anchorage- independent colony formation (p&lt;0.01). Gene expression profiling confirmed significant enrichment of the ERBB2 gene set (p&lt;0.01) and higher GGI levels (p=0.02) in HRG-MCF7 cells compared with control. Conclusions: HRG-MCF7 cells may be useful as an in vitro model of the TAM resistant luminal B subtype. In this group, targeting activated HER2 signaling may be a helpful treatment strategy despite the lack of HER2 overexpression. Our data suggests that agents like lapatinib may be effective only in the luminal B and not the luminal A tumors, demonstrating the importance of stratifying by subtype in future clinical trials of ER+ disease. No significant financial relationships to disclose.
Effects of Extended-Release Niacin with Laropiprant in High-Risk Patients
Journal: New England Journal of Medicine (2014)

Patients with evidence of vascular disease are at increased risk for subsequent vascular events despite effective use of statins to lower the low-density lipoprotein (LDL) cholesterol level. Niacin lowers the LDL cholesterol level and raises the high-density lipoprotein (HDL) cholesterol level, but its clinical efficacy and safety are uncertain.After a prerandomization run-in phase to standardize the background statin-based LDL cholesterol-lowering therapy and to establish participants' ability to take extended-release niacin without clinically significant adverse effects, we randomly assigned 25,673 adults with vascular disease to receive 2 g of extended-release niacin and 40 mg of laropiprant or a matching placebo daily. The primary outcome was the first major vascular event (nonfatal myocardial infarction, death from coronary causes, stroke, or arterial revascularization).During a median follow-up period of 3.9 years, participants who were assigned to extended-release niacin-laropiprant had an LDL cholesterol level that was an average of 10 mg per deciliter (0.25 mmol per liter as measured in the central laboratory) lower and an HDL cholesterol level that was an average of 6 mg per deciliter (0.16 mmol per liter) higher than the levels in those assigned to placebo. Assignment to niacin-laropiprant, as compared with assignment to placebo, had no significant effect on the incidence of major vascular events (13.2% and 13.7% of participants with an event, respectively; rate ratio, 0.96; 95% confidence interval [CI], 0.90 to 1.03; P=0.29). Niacin-laropiprant was associated with an increased incidence of disturbances in diabetes control that were considered to be serious (absolute excess as compared with placebo, 3.7 percentage points; P<0.001) and with an increased incidence of diabetes diagnoses (absolute excess, 1.3 percentage points; P<0.001), as well as increases in serious adverse events associated with the gastrointestinal system (absolute excess, 1.0 percentage point; P<0.001), musculoskeletal system (absolute excess, 0.7 percentage points; P<0.001), skin (absolute excess, 0.3 percentage points; P=0.003), and unexpectedly, infection (absolute excess, 1.4 percentage points; P<0.001) and bleeding (absolute excess, 0.7 percentage points; P<0.001).Among participants with atherosclerotic vascular disease, the addition of extended-release niacin-laropiprant to statin-based LDL cholesterol-lowering therapy did not significantly reduce the risk of major vascular events but did increase the risk of serious adverse events. (Funded by Merck and others; HPS2-THRIVE ClinicalTrials.gov number, NCT00461630.).
The findings of high resolution computed tomography in smear negative pulmonary tuberculosis patients according to their culture status
Authors: Tayfun Çaliskan, Tuncer Özkisa, Serkan Aribal, Hatice Kaya, Mehmet Incedayi, Asim Ülçay, Faruk Çiftçi
Journal: European Respiratory Journal (2014)

Objective: The aim of this study was to assess the clinical features and high-resolution computed tomography (HRCT) findings of smear negative pulmonary tuberculosis (PTB) and to evaluate the correlation between these parameters and the culture results.  Methods: We retrospectively studied 78 patients with active smear negative PTB with a mean age of 22.48 ± 3.18 years. They were divided into two groups according to the culture results. HRCT findings and clinical features at the start of antituberculosis treatment were reviewed.  Results: Micronodules (87 %), large nodules (63 %) and centrilobular nodules (62 %) were the most common HRCT findings.  Statistically significant differences for HRCT findings and clinical features were not observed between groups 1 (culture positive) and 2 (culture negative) (p > 0.05). Cough (37 %) and chest pain (32 %) were the most frequent symptoms. HRCT findings were observed in the right upper (72 %), left upper (56 %), right lower (32 %), and left lower lobes (29 %), in descending order.  Conclusions: Significant differences were not observed between group 1 and group 2 for HRCT findings and clinical features. Thus, the patient with compatible clinical and radiological features for PTB in case of smear and culture negativity should be considered for tuberculosis treatment.
Intracellularly Degradable, Self‐Assembled Amphiphilic Block Copolycurcumin Nanoparticles for Efficient In Vivo Cancer Chemotherapy
Authors: Li Lv, Yuan Guo, Yuanyuan Shen, Jieying Liu, Wenjun Zhang, Dejian Zhou, Shengrong Guo
Journal: Advanced Healthcare Materials (2015)

Intracellularly degradable, self-assembled amphiphilic biotin-poly(ethylene glycol)-b-poly(curcumin-dithiodipropionic acid) nanoparticles are developed. They display excellent in vivo anticancer efficacy, benefitted from their high tumor-targeted accumulation and stimuli-triggered intracellular drug release. They can be loaded with other anticancer drugs (e.g., doxorubicin) to exploit the synergy of combinational dual-drug therapy to further enhance in vivo anticancer efficacy. As a service to our authors and readers, this journal provides supporting information supplied by the authors. Such materials are peer reviewed and may be re-organized for online delivery, but are not copy-edited or typeset. Technical support issues arising from supporting information (other than missing files) should be addressed to the authors. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Dose-finding study for tiotropium and olodaterol when administered in combination via the Respimat® inhaler in patients with COPD
Authors: René Aalbers, M. Reza Maleki-Yazdi, Alan Hamilton, Stella Waitere-Wijker, Anna Pivovarova, Olaf Schmidt, Leif Bjermer
Journal: European Respiratory Journal (2012)

Background : The novel long-acting β 2 -agonist olodaterol (O) and long-acting muscarinic antagonist tiotropium (T) have a duration of action of at least 24 h in clinical studies. Dual administration may provide improved bronchodilation with convenient once-daily dosing.   Objective:  To determine the optimum once-daily combination of T+O delivered via the Respimat® inhaler in patients with COPD.   Methods:  In a randomised, double-blind, 4-period, incomplete crossover study, patients with post-bronchodilator forced expiratory volume in 1 second (FEV 1 ) of ≥30% and  1  response (L) at the end of week 4.   Results:  In total, 232 COPD patients (133 male; 99 female) received treatment. FEV 1  responses (trough and up to 6 h post-dose) for O 5 and 10 μg monotherapy were similar. For all doses of T, FEV 1  responses were significantly increased when added to O 5 and 10 μg. Dose ordering for T when added to O was evident. No safety or tolerability concerns were identified.   Conclusions:  Addition of T to O resulted in significant improvements in FEV 1  versus O alone. These data support further investigation of T 2.5 and 5 μg combined with O 5 μg in the Phase III T+O clinical trial programme.
After source control in intraabdominal infections, 4-day and longer-duration antibiotics did not differ at 30-days
Authors: Sameer Kadri, Naomi P. O’Grady
Journal: Annals of Internal Medicine (2015)

ACP Journal Club20 October 2015After source control in intraabdominal infections, 4-day and longer-duration antibiotics did not differ at 30-daysSameer Kadri, MD, Naomi P. O’Grady, MDSameer Kadri, MDNational Institutes of Health Clinical Center, Bethesda, Maryland, USA (S.K., N.P.O.)Search for more papers by this author, Naomi P. O’Grady, MDNational Institutes of Health Clinical Center, Bethesda, Maryland, USA (S.K., N.P.O.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2015-163-8-006 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationSawyer RG, Claridge JA, Nathens AB, et al.Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996-2005. https://pubmed.ncbi.nlm.nih.gov/25992746Clinical Impact RatingsHospitalists: Gastroenterology: Infectious Disease: Reference1. Blot S, De Waele JJ. Critical issues in the clinical management of complicated intra-abdominal infections. Drugs. 2005;65:1611-20. [PMID: 16060697] Google Scholar Author, Article, and Disclosure InformationAffiliations: National Institutes of Health Clinical Center, Bethesda, Maryland, USA (S.K., N.P.O.)This article was published at Annals.org on 6 October 2015. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 20 October 2015Volume 163, Issue 8Page: JC6KeywordsAdverse eventsAntibioticsAntimicrobialsConfidence intervalsLeukocytosisRectumTemperatureToxicity ePublished: 20 October 2015 Issue Published: 20 October 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
A preoperative consultation for a patient with chronic cough and wheeze
Authors: AF Mobeireek
Journal: European Respiratory Journal (1998)

A preoperative pulmonary consultation was requested for a 58 yr old female patient, who was admitted electively for cholecystectomy and thought to have asthma. She had experienced intermittent dry cough for over 40 yrs, which was described as irritating and barking. It was associated with dyspnoea and wheeze, and was usually triggered by upper respiratory tract infections (URTI) and exercise, but not by smells, dust or other irritants. There was no history to suggest nasal disease, gastrooesophageal reflux or dysphagia. The patient had been seen many times in general and chest clinics and emergency departments and given different diagnostic labels, including asthma, bronchitis, chronic cough and URTI. Treatment had usually included short courses of bronchodilators, antibiotics, cough mixtures and sometimes steroids, but the symptoms took their course, lasting 3–8 weeks before improvement. There was no history to suggest other atopic disorders and no family history of atopy. The past medical history was significant for diabetes mellitus and hypertension controlled with diet and nifedipine tablets. The patient was a lifetime nonsmoker. On preoperative examination, blood pressure (BP) was 160/90 mmHg and the patient looked comfortable. Examination of the chest and other systems was unremarkable. Investigations showed that complete blood count, differential and serum electrolytes were within the normal range. Chest radiographs are presented in figure 1. Spirometric values were: forced expiratory volume in one second (FEV1) 1.72 L (90% of predicted); forced vital capacity (FVC) 2.19 L (95% pred), FEV1/FVC 79%; peak expiratory flow rate (PEFR) 2.91 L·s-1 (53% pred) and maximal midexpiratory flow rate at 25–75% of FVC (MMEF25–75) 1.68 L·s-1 (59% pred). The flow-volume loop (FVL) at a maximum inspiratory and expiratory manoeuvre is presented in figure 2.
Tivantinib-Gemcitabine: Pharmacological Rational for a New Combination in Pancreatic Cancer
Authors: C.D. Rolfo, A. Avan, L.G. Leon, M. Castiglia, R. Honeywell, P. Pauwels, M. Peeters, G. Peters, E. Giovannetti
Journal: Annals of Oncology (2014)
Progress and controversies: Radiation therapy for prostate cancer
Authors: Neil E. Martin, Anthony V. D'Amico
Journal: CA A Cancer Journal for Clinicians (2014)

Radiation therapy remains a standard treatment option for men with localized prostate cancer. Alone or in combination with androgen-deprivation therapy, it represents a curative treatment and has been shown to prolong survival in selected populations. In this article, the authors review recent advances in prostate radiation-treatment techniques, photon versus proton radiation, modification of treatment fractionation, and brachytherapy-all focusing on disease control and the impact on morbidity. Also discussed are refinements in the risk stratification of men with prostate cancer and how these are better for matching patients to appropriate treatment, particularly around combined androgen-deprivation therapy. Many of these advances have cost and treatment burden implications, which have significant repercussions given the prevalence of prostate cancer. The discussion includes approaches to improve value and future directions for research.
Variations in population health status
Authors: A. Bowling
Journal: BMJ (1998)

Breast cancer screening: false positive rate is lower in older womenEditor-Werneke and McPherson 1 question the detection rates of cancer observed in the breast screening programme in East Sussex, Brighton, and Hove that we reported in our recent paper. 2 They suggest that these are the result of a high proportion of false positive screens.It is unfortunate that they did not consult us beforehand.The paper gives results of an ongoing study, but the cancers reported are those confirmed by histological examination after surgery, not preliminary suspected cancers at "positive" screens.The statistical programme was not run until some months after the end of the screening period, when all the screening episodes had been completed and the women concerned had been assessed, diagnosed, and operated on as appropriate.The East Sussex area has always tended to have a high detection rate for cancer, possibly because of the local sociodemographic composition of the population, and the rate over this period was higher than in the following year, without being exceptional.The 1995-6 result for the whole South West Thames region was 7.6 women with cancer for every 1000 women screened overall. 3he small study of older women in north London found 14.2 women with cancer per 1000 women screened aged 65-9. 4uring the period reported in our study the recall for assessment rate in women aged 65-7 was 4.6% (95% confidence interval 3.9% to 5.2%) and 6.2% (5.2% to 7.2%) in those aged 68-9, compared with 6.1% (5.8% to 6.4%) in those aged 50-64.Given the higher number of cancers detected this indicates a lower false positive rate in older women.This is to be expected because of the relative ease of interpreting mammograms and decreasing incidence of benign breast lesions in older women. 5 We now have the first year's results from the other two pilot sites, which will be published in due course.They confirm higher detection rates of cancer in older women but similar recall rates.Attendance is also encouragingly high.
The evaluation of diaphragmatic motion by M-mod ultrasonography in chronic obstructive lung diseases
Authors: Ülkü Aka Aktürk, Benan Niku Çaglayan, Ali Fidan, Banu Salepçi, Demet Turan, Sevda Sener Cömert, Sühendan Cosanketenci
Journal: European Respiratory Journal (2013)

To determine the role of M-mod ultrasonography(US) in evaluation of diaphragmatic function in control and COPD patients and the correlation between pulmonary function tests(PFT) and diaphragmatic function in COPD patients.

Hemidiaphragmatic excursion during tidal ventilation(TV) and deep breathing(DB) and diaphragmatic thickness(DT) were measured by M-mode US in study population in 2009.Diaphragmatic motion in both groups and the correlation between PFT and diaphragmatic motion was evaluated statistically.

We included 76 COPD patients and 30 control subjects.Mean diaghragmatic motion during TV was 2.21±0.56 cm in control group and it was 1.65±0.66 cm in COPD patients.The difference was statistically significant.During DB the mean diaphragmatic excursion was 6.23±0.74 cm in control group and 4.64±1.34 cm in COPD patients.Also the difference was statistically significant(p<0.001).COPD patients were classified into two groups according to severity of obstruction.Group A consisted of mild and moderate,group B enclosed severe and very severe obstruction.In group A,a moderate corelation between FEV1,FVC and diaphragmatic motion during TV was obtained.Also there was a good corelation between diaphragmatic motion during DB and FEV1,FEV1%,FVC,FVC% in this group.In group B,a moderate corelation between diaphragmatic motion during DB and MEP,MEP% was determined.

M-mode ultrasonography is a non invasive and inexpensive method in evaluation of diaphragmatic motion.Diaphragmatic excursion was significantly lower in COPD patients than in control group.In mild and moderate obstructive COPD patients, a good corelation was confirmed between diaphragmatic motion during DB and FEV1,FEV1%,FVC, FVC%.
Liver Biopsy: Modified Menghini and Trucut Needles for Fibrin Sealing of the Biopsy Channel: Clinical Experience
Authors: G. Judmaier, W. Vogel, H. P. Dinges, K. Zatloukal
Journal: Endoscopy (1995)

Histologic investigation of liver tissue obtained by percutaneous needle biopsy remains the mainstay in the diagnosis of liver disease. Impaired blood clotting or thrombocytopenia precludes percutaneous liver biopsy for the danger of sometimes life-threatening hemorrhage as the most serious complication. The feasibility of plugging the intrahepatic needle track with fibrin sealant to minimize the risk of bleeding has been shown. The advantage of the method presented here is that biopsy and sealing can be performed as a one-step procedure, thus shortening the time necessary and minimizing the risk of complications. We considered laparoscopic control most reliable to optimize handling of the double-channel needles and to assess the reliability of fibrin plugging for the "blind" percutaneous approach. In 27 patients a modified Menghini needle and in 10 patients a modified Trucut needle were tested. In our experience the handling of the modified Trucut needle proved easier. There was, however, no significant difference in the length of the biopsy core obtained with the two needles (16 ± 8.6 mm Menghini needle and 15.75 ± 7.1 mm Trucut needle), resulting from the larger diameter of the Menghini needle (1.8). The thin trickle of bleeding observed around the plug in a few patients was without clinical significance, reflecting the prolonged coagulation time in these patients. In summary, in the hands of an experienced investigator the combined biopsy-plugging device is a safe and reliable tool for obtaining liver tissue in patients with impaired blood coagulation. As a one-step procedure it can be performed quickly, thus increasing safety by diminishing the need for patient cooperation.