tbuckley/cabot-search huggingface dataset:
Predicting complications following sentinel lymph node biopsy for melanoma
Authors: B. Roaten, N. Pearlman, R. Gonzalez, W. Robinson, R. Gonzalez, M. McCarter
Journal: Journal of Clinical Oncology (2004)

7536 Background: Complications from regional lymph node dissection for melanoma are well known, however, complications from sentinel lymph node biopsy (SLNBX) from melanoma are less well studied. A recent report has suggested there is an overall complication rate of around 5%. The goal of this investigation was to identify risk factors associated with SLNBX for melanoma. Methods: A retrospective review of all patients (n=352) undergoing SLNBX for melanoma was conducted by chart review, patient and physician follow-up. Tumor characteristics, patient characteristics (including comorbidities), and technical factors of the procedure were assessed. Results: The SLN was successfully identified in 338 (96%) patients of whom, 69 (20%) had lymph node metastasis. No complications occurred in the 14 unsuccessful SLNBX procedures. Median follow-up was 16 months. The overall complication rate for successful SLNBX was 5.8% (n=20) with seroma (1.2%), wound infection (0.9%), nerve injury (0.9%), and lymphedema (0.9%) being the most common events. For comparison, the complication rate for regional lymph node dissection was 19% (14/75). The number of sentinel lymph nodes removed was strongly correlated with the risk of complications (r=0.999, Chi Sq. = <0.001 for 1 (2.5%) or 2 (6.7%) vs =3 (11.4%)). The use of a drain was associated with increased complications (12.5% with drain vs. 2.2% without, p<0.001 Chi Sq.). The primary site of head and neck trended toward more complications (10.8%) than trunk (3.8%) and extremity sites (5.2% UE, 5.7% LE). The presence of pre-operative comorbid conditions (any one of obesity, smoking, COPD, PVD) also trended towards more complications, but this did not reach significance (9.3% vs. 4.5% for no comorbidities, p=0.223). Conclusion: The number of sentinel lymph nodes removed and the use of closed suction drainage significantly increase the risk of complications following SLNBX for melanoma. Patients and physicians should be made aware of the increased risk for complications when the above factors are present or encountered perioperatively. No significant financial relationships to disclose.
Cardiac chambers and hyperinflation in COPD patients
Authors: Orlando López Jové, Guillermina Culaciatti, Héctor Paves Palacios, Silvia Rey, Eduardo Giugno, Valeria Barrionuevo, Ana Galdames, Yu Feng Wu, Gabriela Tabaj, Eva López González
Journal: European Respiratory Journal (2013)

Background:Hyperinflation in COPD has extrapulmonary effects as cardiac dysfunction and heart size.

Aims: Evaluate the relationship of static hyperinflation with heart chambers size and Systolic pulmonary artery pressure (SPAP) in COPD patients.

Methods: we performed a prospective study in patients with COPD.Tests: pulmonary function, Doppler echocardiography. Static hyperinflation (inspiratory-to-total lung capacity ratio [IC/TLC] ≤0.25). Performed at Hospital Cetrangolo, Argentina.

Results: We evaluated 84 patients, mean age 63.1+/-8.3 years. Females 28.9%. GOLD Stage: I: 2.6%, II: 47.8%, III: 37.2%, and IV:12.4%. IC/TLC: Mean 0,31+/- 0,088. Cardiac Chamber Sizes:Left Atrium Area:16.6+/-4.7cm2, Right Atrium Area:14.1+/-4.2cm2, Left Ventricular End-Diastolic Diameter:4.9+/-0.7cm2, Left Ventricular End-Sistolic Diameter:3.1+/-0.6cm2, Right Ventricular End-Diastolic Diameter:2.1+/-1.3cm2.

View this table:

Correlations Between Lung Function and Cardiac Chamber Sizes





SPAP:27.8+/-10.8mmHg, without association with IC/TLC ratio (p=0.19)

Conclusion: Static lung hyperinflation showed stronger inverse relationship with cardiac chamber size than did measurements of airways obstruction or TLCO. Pulmonary artery pressure did not correlate with IC/TLC ratio.
The measurement of the impact of breathlessness in advanced COPD
Authors: Patrick White, Cathy Shipman, Sara Booth, Claudia Bausewein, Morag Farquhar, Irene Higginson, Helen Booth
Journal: European Respiratory Journal (2011)

Introduction:  Breathlessness is the main symptom of COPD and should be a key outcome measure in studies of advanced disease. Measures of breathlessness have been poorly researched. There is no gold standard for the assessment of breathlessness in advanced disease. In this study we aimed to identify using existing tools a valid and reliable self-report measure of breathlessness for clinical research in advanced COPD.   Methods:  260 eligible patients with advanced COPD were identified from the disease registers of 72 general practices. Spirometry, MRC dyspnoea scale, mBorg, NRS, CRQ-SAS, Dyspnoea 12, and Hospital Anxiety and Depression Scale, were administered at interview. Distribution of responses, associations and correlations were examined.   Results:  146 (56%) patients were interviewed. Association between the different measures of breathlessness was variable with least correlation between the numerical measures mBorg and NRS and the other measures, and greatest correlation between CRQ-SAS and Dyspnoea 12. Usefulness of tools was limited by ceiling effects (limited room for more severe breathlessness) in MRC Dyspnoea scale and by floor effects (limited room for less severe breathlessness) in mBorg and NRS. Factor analysis of the five measures confirmed that the CRQ-SAS dyspnoea questionnaire (loading -0.74) and Dyspnoea 12 questionnaire (loading 0.73) were closest to the hypothesized latent true value of breathlessness (eigenvalue 2.33, difference 2.21).   Conclusions:  Combination of CRQ-SAS dyspnoea and Dyspnoea 12 is the most suitable approach to valid, repeatable, measurement of breathlessness in clinical research in advanced COPD that is sensitive to change. MBorg retains a particular role in standardised exercise testing.
Improvement in obstructive sleep apnoea features under targeted hypoglossal neurostimulation is independent from body mass index and collar size
Authors: Daniel Rodenstein, Benny Mwenge, Myriam Dury, Benoit Lengele, Philippe Rombaux
Journal: European Respiratory Journal (2011)

Background: The treatment of moderate to severe obstructive sleep apnoea (OSA) is continuous positive pressure (CPAP) applied during sleep. Although its health effects are beyond doubt, many patients refuse or stop CPAP because of intolerance or local side effects. Alternative therapies are needed.

Aim: We used targeted hypoglossal neurostimulation (THN) to treat 11 patients (1 female) non compliant with CPAP therapy with the aim of improving both breathing and sleep.

Methods: One hypoglossal nerve was stimulated through a multicontact cuffed electrode positioned around the main trunk of the nerve and connected to a stimulator implanted in a subcutaneous pocket on the anterior chest wall. Stimulation was applied continuously during sleep.

Results: The BMI of the group was 30.7+3.5 kg/m2; on diagnostic polysomnography the average apnoea-hypopnoea index (AHI) was 47.5+16.6, the 4% oxygen desaturation index (ODI) 28.6+21.5 and the microarousal index (MAI) 35.5+13.8, all per hour of sleep. After 3 months therapy the BMI was unchanged whereas the AHI was 21.5+12.2, the ODI 13.9+14.7 and the MAI 24.8+15.1, all p<0.05. There was a significant correlation between initial AHI and ODI and BMI (p<0.05) and there was a tendency for initial AHI to correlate to collar size (p<0.1). The final ODI correlated to BMI (p<0.05). By contrast, there was no significant correlation between changes in AHI, or changes in ODI with THN and BMI or collar size.

Conclusions: THN may improve breathing and sleep irrespective of body size and of collar size, two well known determinants of OSA severity.
Age-period-cohort analysis of asthma incidence in Italy, from 1940 to 2010. Preliminary results
Authors: Giancarlo Pesce, Francesca Locatelli, Simone Accordini, Giuseppe Verlato, Ane Johannessen, Roberto de Marco
Journal: European Respiratory Journal (2014)

Background:  The prevalence of asthma has been rising all over the world. The causes of this epidemic are still not completely known. In this study we aim to estimate the separate effects of age, period and birth cohort on the trends of asthma incidence in Italy.   Methods:  Individual information on the history of asthma was collected on 35,375 adults aged 20-64 and born from 1940 to 1989, who were randomly sampled from the general Italian population in 1990/93, 1998/2000 and 2007/10. Overall 3,295 subjects reported asthma from 1,293,801 person-years at risk. Age-specific incidence rates were estimated for both sexes using 5-year age classes in different cohorts and period. Poisson regression models were used to estimate the incidence rates by age, birth cohort and period in males and females.   Results:  Age, period and cohort showed significant independent effects (pl0.001) on incidence rates of asthma, which was greater in younger subjects and dramatically increased in recent generations. Males and females had significantly different age-trends of asthma incidence, with males having nearly 50% greater risk to develop asthma in the first decade of life and nearly 40% lower risk after the age of 30 compared with women.   Conclusions:  Our results suggest that the trend of asthma is still increasing in Italy, and that more recently born cohorts are at greater risk of developing the disease.
Abstract 2319: Mapping and Radiofrequency Catheter Ablation of the Marshall Bundle in the Treatment of Persistent Atrial Fibrillation
Authors: Seongwook Han, Boyoung Joung, Mauricio Scanavacca, Eduardo Sosa, Peng-Sheng Chen, Chun Hwang
Journal: Circulation (2009)

Background: Previous studies showed that complex fractionated atrial electrogram (CFAE) is often present in the Marshall bundle (MB) during persistent atrial fibrillation (AF), suggesting that MB i...
Cost-Utility Analysis of Chemotherapy Using Paclitaxel, Docetaxel, or Vinorelbine for Patients With Anthracycline-Resistant Breast Cancer
Authors: P. P. Leung, I. F. Tannock, A. M. Oza, A. Puodziunas, G. Dranitsaris
Journal: Journal of Clinical Oncology (1999)

PURPOSE: Paclitaxel, docetaxel, and vinorelbine have been approved for chemotherapy in patients with advanced breast cancer that is resistant to anthracyclines. Selecting which agent to use is difficult because each possesses advantages and disadvantages related to clinical response, toxicity, method of administration, and cost. A cost-utility analysis was therefore performed to create a rank order on the basis of effectiveness, quality of life, and economic considerations. PATIENTS AND METHODS: Eighty-eight anthracycline-resistant breast cancer patients who had received paclitaxel (n = 34), docetaxel (n = 29), or vinorelbine (n = 25) during the past 2 years were identified. Total resource consumption was collected, which included expenditures for chemotherapy, supportive care, laboratory tests, management of adverse effects, and all related physician fees. Utilities from 25 oncology care providers and 25 breast cancer patients were estimated using the time trade-off technique. The economic estimates from the chart review and clinical data from the literature were then modeled using the principles of decision analysis. RESULTS: Each of the three drugs led to a similar duration of quality-adjusted progression-free survival (paclitaxel, 37.2 days; docetaxel, 33.6 days; vinorelbine, 38.0 days). Vinorelbine was the least costly strategy, with an overall treatment expenditure of Can $3,259 per patient, compared with Can $6,039 and Can $10,090 for paclitaxel and docetaxel, respectively. CONCLUSION: Palliative chemotherapy with vinorelbine in anthracycline-resistant metastatic breast cancer patients has economic advantages over the taxanes and provides at least equivalent quality-adjusted progression-free survival. These benefits are largely related to its lower drug acquisition cost and better toxicity profile.
Exhaled particles from small airways in COPD patients – A pilot study
Authors: Mona Lärstad, Sven Larsson, Björn Bake, Anna-Carin Olin
Journal: European Respiratory Journal (2014)

Exhaled breath contains endogenous particles (particles in exhaled air, PEx) originating from the respiratory tract lining fluid in small airways and formed during airway closure and re-opening. In COPD the vital capacity is usually decreased, probably due to closed-off airways that may result in less airway opening and less PEx.  The objectives of the present study were to evaluate if COPD patients in fact have decreased levels of particles in exhaled air and if the levels were related to lung function.  Consecutive COPD patients with moderate or severe, stable, disease (n = 17) attending an outpatient lung clinic were included. Healthy, nonsmoking control subjects (n= 9) served as controls. PEx were sampled using a novel technique, where PEx is collected in a device containing a 3-stage impactor and an optical particle counter. A breathing maneuver allowing for airway closure and re-opening was performed. All subjects completed questionnaires and performed spirometry.  The median number and mass of exhaled particles per litre exhaled air were significantly lower (p  3  vs. 34.8 x 10 3  particles/L, and 1.3 vs. 9.4 ng/L, respectively), and were positively correlated to FVC and FEV 1 . The content of surfactant protein A will be quantified.  Exhaled particles may be future noninvasive biomarkers to identify and monitor patients with COPD, and may also be used in mechanistic studies.
Free triple combination of glycopyrronium, indacaterol and ICS improves lung function and dyspnoea versus free double combination of indacaterol and ICS in patients with COPD: A post-hoc analysis from the GLOW6 study
Authors: Walter Vincken, Joseph Aumann, Pankaj Goyal, Pablo Altman
Journal: European Respiratory Journal (2014)

Introduction 

The GLOW6 study reported rapid onset and sustained bronchodilation with co-administration of indacaterol (IND) and glycopyrronium (GLY) compared to IND alone in patients (pts) with COPD.1 In this post-hoc analysis, we compared the effect of free combination use of GLY+IND+ICS vs IND+ICS on lung function and dyspnoea in a sub-group of pts using ICS during the study.

Methods 

The 12-week, multicentre, double-blind, parallel group GLOW6 study randomised 449 symptomatic pts with moderate-to-severe COPD to GLY+IND or IND alone. 132 (29.4%) pts had ≥1exacerbations in the year prior to randomisation. 280 (62.6%) pts were on stable dose of ICS at baseline and were allowed to continue ICS during the study. We analysed this subgroup comparing free combination GLY+IND+ICS vs IND+ICS for improvements in trough FEV1, FEV1 area under the curve from 0 to 4h (AUC0-4h), and transition dyspnoea index (TDI).

Results 

Of the 280 pts, 138 were on GLY+IND+ICS and 142 on IND+ICS. Compared to free combination of IND+ICS, free combination of GLY+IND+ICS significantly improved trough FEV1 (mean treatment difference [MTD] 64ml; p=0.021) at Wk12, FEV1 AUC0-4h on Day1 (MTD 111ml; p<0.001) and at Wk12 (MTD 118ml; p<0.001) and dyspnoea in terms of TDI score (MTD 0.7; p=0.041).

Conclusion 

Over 12 wks, the free triple combination (GLY+IND+ICS) showed significantly better improvements in lung function and dyspnoea compared to the free double combination (IND+ICS) in symptomatic pts with moderate-to-severe COPD.

Reference 

1. Vincken W, et al. Int J Chron Obstruct Pulmon Dis 2013 [In press].
Optimization of Aerosol Deposition by Pressure Support in Children with Cystic Fibrosis
Authors: BRIGITTE FAUROUX, EMMANUEL ITTI, JÉRÔME PIGEOT, DANIEL ISABEY, MICHEL MEIGNAN, GILLES FERRY, FRÉDÉRIC LOFASO, JEAN-MARIE WILLEMOT, ANNICK CLÉMENT, ALAIN HARF
Journal: American Journal of Respiratory and Critical Care Medicine (2000)

Nebulized aerosols are commonly used to deliver drugs into the lungs of patients with cystic fibrosis (CF). The aim of this study was to assess the effectiveness of pressure-support (PS) ventilation in increasing aerosol deposition within the lungs of children with CF. An in vitro study demonstrated the feasibility of coupling a breath-actuated nebulizer to a PS device. An in vivo study was done with 18 children (ages 6 to 21 yr) with clinically stable CF, each of whom underwent both a standard and a PS-driven ventilation scan (control session and PS session, respectively). In addition, a perfusion scan was used to determine lung outlines and to construct a geometric model for quantifying aerosol deposition by radioactivity counting in MBq. Homogeneity of nebulization was evaluated from the four first-order moments of aerosol distribution in the peripheral and central lung regions. The time–activity nebulization curve was linear in all patients, with higher slopes during the PS than during the control session (0.43 ± 0.07 [mean ± SD] MBq/min and 0.32 ± 0.23 MBq/min, respectively; p < 0.018). Quantitatively, aerosol deposition was about 30% greater after the PS session (4.4 ± 2.7 MBq) than after the control session (3.4 ± 2.1 MBq; p < 0.05). Similarly, deposition efficacy (as a percentage of nebulizer output) was significantly better during the PS session than during the control session (15.3 ± 8.3% versus 11.5 ± 5.7%, p < 0.05). No differences in the regional deposition pattern or in homogeneity of uptake were observed. In conclusion, our data show that driving the delivery of a nebulized aerosol by noninvasive PS ventilation enhances total lung aerosol deposition without increasing particle impaction in the proximal airways.
Breast cancer statistics, 2015: Convergence of incidence rates between black and white women
Authors: Carol E. DeSantis, Stacey A. Fedewa, Ann Goding Sauer, Joan L. Kramer, Robert A. Smith, Ahmedin Jemal
Journal: CA A Cancer Journal for Clinicians (2015)

In this article, the American Cancer Society provides an overview of female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Approximately 231,840 new cases of invasive breast cancer and 40,290 breast cancer deaths are expected to occur among US women in 2015. Breast cancer incidence rates increased among non-Hispanic black (black) and Asian/Pacific Islander women and were stable among non-Hispanic white (white), Hispanic, and American Indian/Alaska Native women from 2008 to 2012. Although white women have historically had higher incidence rates than black women, in 2012, the rates converged. Notably, during 2008 through 2012, incidence rates were significantly higher in black women compared with white women in 7 states, primarily located in the South. From 1989 to 2012, breast cancer death rates decreased by 36%, which translates to 249,000 breast cancer deaths averted in the United States over this period. This decrease in death rates was evident in all racial/ethnic groups except American Indians/Alaska Natives. However, the mortality disparity between black and white women nationwide has continued to widen; and, by 2012, death rates were 42% higher in black women than in white women. During 2003 through 2012, breast cancer death rates declined for white women in all 50 states; but, for black women, declines occurred in 27 of 30 states that had sufficient data to analyze trends. In 3 states (Mississippi, Oklahoma, and Wisconsin), breast cancer death rates in black women were stable during 2003 through 2012. Widening racial disparities in breast cancer mortality are likely to continue, at least in the short term, in view of the increasing trends in breast cancer incidence rates in black women.
Interleukin‐21 Promotes Germinal Center Reaction by Skewing the Follicular Regulatory T Cell to Follicular Helper T Cell Balance in Autoimmune BXD2 Mice
Authors: Yanna Ding, Jun Li, PingAr Yang, Bao Luo, Qi Wu, Allan J. Zajac, Oliver Wildner, Hui‐Chen Hsu, John D. Mountz
Journal: Arthritis & Rheumatology (2014)

Follicular regulatory T (Tfr) cells act as the regulatory counterpart of follicular helper T (Tfh) cells to suppress germinal center (GC) B cell differentiation. We recently showed that interleukin-21 (IL-21) promoted Tfh cell differentiation in autoimmune BXD2 mice that develop spontaneous GCs. This study was undertaken to determine the modulatory effects of IL-21 on Tfr cells and the Tfr cell to Tfh cell balance in BXD2 mice.The percentage and phenotype of Tfr cells were determined in BXD2 and BXD2-IL21(-/-) mice. The effects of IL-21 on Tfr cells and the Tfr cell:Tfh cell ratio were evaluated. Sorted Tfr cells from BXD2-IL21(-/-) mice were cocultured with Tfh cells and B cells, or transferred into BXD2 mice to determine their function.The percentages and numbers of GC B cells and Tfh cells were significantly reduced, but the percentage of Tfr cells was 2-fold higher in BXD2-IL21(-/-) mice than in wild-type BXD2 mice. Administration of AdIL-21 to BXD2-IL21(-/-) mice decreased the percentages and numbers of Tfr cells and the Tfr cell:Tfh cell ratio but increased the number of GC B cells in the spleen. Recombinant murine IL-21 suppressed FoxP3 and significantly reduced Tgfb1, Il2, and Gitr but enhanced Il21, Il6, Pd1, Cxcr5, and Icos expression in Tfr cells. IL-21 also counteracted Tfr cell-mediated inhibition of antibody secretion in the Tfh cell-B cell coculture system. Transfer of Tfr cells into young BXD2 mice reduced GC size and decreased the numbers of autoantibody-producing B cells.Our findings indicate that high levels of IL-21 selectively enhance Tfh cell differentiation but inhibit Tfr cell commitment and the suppressive function of Tfr cells on Tfh cells and B cells, suggesting that IL-21 skews the balance from Tfr cells to Tfh cells to promote autoreactive GC reactions in BXD2 mice.
Treatment of chronic myelogenous leukemia in accelerated and blastic phases with daunorubicin, high-dose cytarabine, and granulocyte-macrophage colony-stimulating factor.
Authors: H M Kantarjian, M Talpaz, D Kontoyiannis, J Gutterman, M J Keating, E H Estey, S O'Brien, M B Rios, M Beran, A Deisseroth
Journal: Journal of Clinical Oncology (1992)

PURPOSE The study was undertaken to improve the results of intensive chemotherapy in chronic myelogenous leukemia (CML) in accelerated (CML-AP) and blastic phases (CML-BP) by the addition of granulocyte-macrophage colony-stimulating factor (GM-CSF) as supportive therapy. PATIENTS AND METHODS Forty-eight patients were treated with daunorubicin 120 mg/m2 intravenously on day 1, cytarabine (ara-C) 1.5 g/m2/d by continuous infusion over 24 hours for 4 days, and Solu-Medrol (methylprednisolone; The Upjohn Co, Kalamazoo, MI) 100 mg/d for 5 days, followed on day 5 by GM-CSF 125 micrograms/m2/d over 6 hours until recovery of granulocyte count above 2.0 x 10(3)/microliters. Twenty-four patients had CML-BP, and 24 had CML-AP. RESULTS During remission induction, 45 patients (94%) developed febrile episodes (fever of unknown origin, 23 patients [48%]; documented infections, 22 patients [46%]). The median time to recovery of granulocyte count above 0.5 x 10(3)/microliters was 29 days and to platelet count above 30 x 10(3)/microliters, 28 days. Overall, 14 of 48 patients (29%) achieved a complete hematologic remission (CHR), and seven (15%) reverted to a second chronic phase. CHR was noted in eight of 24 patients with CML-BP (33%), and in six of 24 patients with CML-AP (25%). Cytogenetic responses were observed in 11 patients (23%), but were transient. Sixteen patients developed either fluid retention, hypotension, pleuropericardial effusions, or pericarditis, or a combination of these side effects. These side effects were severe in four patients and are likely to be disease-associated, as a similar regimen of intensive chemotherapy and GM-CSF at the same dose and schedule in acute lymphocytic leukemia was not associated with these side effects. CONCLUSIONS The results pertinent to remission rates, induction mortality, myelosuppression profile and related complications, and overall survival were not significantly improved compared with previous experience. In summary, the results of intensive chemotherapy in CML-transformed phases remain poor, despite the addition of GM-CSF as a supportive measure.