tbuckley/cabot-search huggingface dataset:
Integrated care model between pneumology and primary care: Impact in respiratory diseases control
Authors: Joel Francesqui, Jacobo Sellarés, Nestor Soler, Carmen Lucena, Cristina Embid, Mireia Dalmases, Gemma Argemi, Joan Ramón Badía, Ramón Marrades, Miquel Ferrer, Ignacio Menacho, Mónica Gomez, Carmen Hernández, Joan Escarrabill, David Font, Alvar Agustí
Journal: European Respiratory Journal (2014)

Introduction 

A new model of integrated care was established in our hospital since 2008, in which hospital specialists attend patients in different primary care centers. We assessed the impact of this model in the respiratory diseases management.

Methods 

Retrospective, observational study comparing 2 care models in the same cohort of patients: conventional (prior model of care by pulmonologists not integrated into primary care teams) and integrated. Different clinical outcomes were analyzed in relation to the management of respiratory diseases.

Results 

We evaluated 545 patients consecutively attended during a period of 6 months, in five primary care centers. The diagnoses that were established after the start of the new model were: COPD (30 %), bronchial asthma (32%), OSAS (7%), bronchiectasis (15 %), chronic cough (1%) and others (25%). The number of registered spirometries increased after the beginning of the new care model (19 % to 68 %, p < 0.001). A change in diagnoses and treatments occurred in 21% and 49% of cases respectively after initiating the new model. After assessing consultations for exacerbations in a period of 2 years before and after the application of the new model , a significant overall reduction in the number of consultations for exacerbation per patient was observed: 1.07 ± 1.40 to 0.88 ± 1.25 (p=0.001).

Conclusions 

The implementation of a respiratory care model integrated into primary care improved the follow up of these patients by reducing the overall number of visits for exacerbations, possibly due to the optimization of the diagnosis and treatment.

Funded by: Atencio Integral de Salut de Barcelona Esquerra.
Peripheral natural killer cells exhibit qualitative and quantitative changes in patients with psoriasis and atopic dermatitis
Authors: C. Luci, C. Gaudy-Marqueste, P. Rouzaire, S. Audonnet, C. Cognet, A. Hennino, J.-F. Nicolas, J.-J. Grob, E. Tomasello
Journal: British Journal of Dermatology (2012)

Psoriasis and atopic dermatitis are the most recurrent skin inflammatory disorders. Despite their distinct aetiology and clinical aspects, these diseases share several immunological features. Besides the largely documented role of T cells, emerging literature supports a potential involvement of innate immune effectors, the natural killer (NK) cells, in both pathologies. In the peripheral blood, NK cells consist of CD3-CD56dim and CD3-CD56bright cell subsets, harbouring a distinct cell surface phenotype, but both endowed with the main NK-cell effector functions: cytotoxicity and cytokine production.To determine whether the frequency, the cell surface phenotype and the functional properties of peripheral NK cells were affected in patients with psoriasis or atopic dermatitis.Peripheral blood mononuclear cells were isolated from 11 patients with psoriasis, nine patients with atopic dermatitis and 16 healthy individuals. By using flow cytometry, we analysed the following parameters of peripheral NK cells: the frequency, the cell surface expression of several NK-cell receptors (NKR) and the activation of the effector functions upon various in vitro stimuli.Peripheral NK cells were significantly reduced in both skin diseases. The cell surface expression of various NKR was differently modified in peripheral NK cells of the two cohorts of patients. Finally, NK-cell natural cytotoxicity was affected only in atopic dermatitis, while interferon-γ production was defective in both groups of patients.Psoriasis and atopic dermatitis are associated with quantitative and qualitative changes of peripheral NK cells, mostly shared by both diseases, supporting a common process implicating these innate effectors in skin inflammation.
Thoracoscopic palliative treatment of malignant pleural effusions
Authors: Costica Mitrofan, Cristina-Elena Mitrofan, Dragos Barzu, Mugurel Bosanceanu, Lucian Farmatu, Denis Trufa, Cristina Grigorescu
Journal: European Respiratory Journal (2011)

The aim of this study was to analyze the results of pleurodesis for malignant pleural effusion.   Methods:  We performed retrospectively study on 743 thoracoscopies for malignant effusions done in our clinic in the period January 2001 and December 2010. There were 336 males (45.2%) and 407 females (54.8%), ranging in age from 18 to 81 years (mean age: 59.4 years). The effusion was on the right side in 379 patients (51%), on the left side in 308 (41.5%), and bilateral in 56 (7.5%). Straw colored effusions were present in 423 cases (57%) and hemorrhagic in 320 cases (43%). The surgical procedure consist in diagnostic of thoracoscopy with drainage of pleural effusion, multiply pleural biopsy, pleurodesis and continuous pleural drainage. In our study, the talc powder (5g) was successfully as sclerosing agent.   Results:  There was no intraoperative mortality. The primary tumor was: lung- 248 (33.4%), breast-218 (29.4%), mesothelioma-126 (17%), stomach-18, ovarian-24, prostate-9, colon-15, lymphoma-12, leukemia-9, plasmocytoma-4 and unknown primary tumor in 60 cases (8%). Adverse effects included-chest pain-252 cases (34%), fever-135 cases (18%), empyema-27cases, prolonged air leak -24 cases, pulmonary infection-6 cases, acute respiratory failure-5 case, malignant invasion of scar-3 patient. Duration of postoperative pleural drainage ranged between 2 and 10 days (mean: 3.23 days). The postoperative hospital stay ranged from 2 to 21 days (mean: 3.4 days). The results were very good in 654 patients (88%), acceptable in 71 patients (9.6%), and there was a failure in 18 patients (2.4%) after 1 month-follow-up.   Conclusions:  Thoracoscopic talc pleurodesis is a safe, economical and effective treatment for malignant pleural effusion.
Computed tomography in the diagnosis of bronchiectasis
Authors: Ricardo Holderbaum Do Amaral, Carlos Schuler Nin, Vinicius Valerio de Souza, Edson Marchiori, Bruno Hochhegger
Journal: European Respiratory Journal (2015)

We read with great interest the article by Hurst et al . [1], who discussed the overlap between chronic obstructive pulmonary disease (COPD) and bronchiectasis, and provided the position statement from the BRONCH-UK Consortium. Bronchiectasis diagnosis and significance can be influenced by technical parameters and physiological variations <http://ow.ly/OatKb>
Evaluating Continuous Tumor Measurement-Based Metrics as Phase II Endpoints for Predicting Overall Survival
Authors: Ming-Wen An, Xinxin Dong, Jeffrey Meyers, Yu Han, Axel Grothey, Jan Bogaerts, Daniel J. Sargent, Sumithra J. Mandrekar
Journal: JNCI Journal of the National Cancer Institute (2015)

Background:We sought to develop and validate clinically relevant, early assessment continuous tumor measurement–based metrics for predicting overall survival (OS) using the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 data warehouse.
Effect of early and advanced atherosclerosis on vascular responses to serotonin, thromboxane A2, and ADP.
Authors: J A Lopez, M L Armstrong, D J Piegors, D D Heistad
Journal: Circulation (1989)

In monkeys with early and advanced atherosclerosis, we examined responses to the three major vasoactive agonists that are released when platelets aggregate. Measurements were obtained in normal cynomolgus monkeys and in monkeys fed an atherogenic diet for 4 +/- 1, 9 +/- 1, and 19 +/- 1 months (mean +/- SEM). Morphometry of femoral and iliac arteries indicated that 4 months of atherogenic diet produced only slight intimal thickening, 9 months produced early lesions, and 19 months produced approximately 5-10 fold greater intimal proliferation than did 9 months of atherogenic diet. Serotonin and adenosine 5'-diphosphate (ADP), which are endothelium-dependent agonists, and adenosine and phenylephrine, which are endothelium-independent agonists, were injected intra-arterially into the perfused hind limb. Thromboxane A2 analogue U46619 also was studied. Vasoconstrictor responses to serotonin were potentiated, and vasodilator responses to ADP were impaired by early and advanced atherosclerosis. In contrast, vasoconstrictor responses to phenylephrine and vasodilator responses to adenosine were similar in all groups. Vasoconstrictor responses to U46619 were potentiated by advanced atherosclerosis. Thus, vascular responses to serotonin, ADP, and thromboxane A2 are altered by atherosclerosis in a direction that would favor vasoconstriction when platelets aggregate. Furthermore, because responses to endothelium-dependent agonists are altered, these data suggest that endothelium is dysfunctional in early atherosclerosis. These findings may explain, in part, the propensity for exaggerated vasoconstriction even in arteries with minimal atherosclerotic lesions.
Risk factors for periodontal disease
Authors: Robert J. Genco, Wenche S. Borgnakke
Journal: Periodontology 2000 (2013)

Abstract Risk factors play an important role in an individual’s response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors for periodontal disease, such as smoking, diabetes and obesity, and osteoporosis in postmenopausal women, are relatively common and can be expected to affect most patients with periodontal disease seen in clinics and dental practices. Hence, risk factor identification and management has become a key component of care for periodontal patients.
FGFR3 mutations have different effects on disease course in tumors from the bladder, ureter, and renal pelvis
Authors: Johanna M. M. Van Oers, Ellen C. Zwarthoff, Ishtiaq Rehman, Abdel-Rahmene Azzouzi, Oliver Cussenot, Mark Meuth, Freddie C. Hamdy, James W. F. Catto
Journal: Cancer Research (2006)

4513   The urothelial lining of the upper and lower urinary tract is histologically identical and tumors of the upper and lower urinary tract show morphological similarities. Despite these similarities, genetic and epigenetic differences occur: microsatellite instability and promoter hypermethylation are more frequent and more extensively present in upper tract tumors (UTT), when compared to bladder tumors. Methylation is associated with advanced tumor stage and increased tumor progression and mortality rates. On the other hand, fibroblast growth factor receptor 3 (FGFR3) mutations have been found at a high frequency in bladder tumors of low stage and grade with a low risk of progression. We hypothesised that FGFR3 mutations occur at a lower frequency in UTT. We analysed 253 tumor samples, of which 106 were bladder tumors and 154 were UTT (both ureter and renal pelvis). FGFR3 mutations were detected by SNaPshot analysis. Analysis for hypermethylation at 11 CpG islands was performed using methylation sensitive PCR and bisulphite sequencing. FGFR3 mutations occur with the same frequency in bladder (46%, 49/106) and upper tract (49%, 75/154) tumors, and are associated with a milder disease course (less often progression, better survival) in both bladder and ureter tumors (p
Abstract 16038: Health Literacy Predicts Cardiovascular Risk in the Male Prison Population
Authors: Jennifer L Miller, Misook Chung, Alison Connell, Alison L Bailey, Terry A Lennie, Debra K Moser
Journal: Circulation (2012)

Background: Cardiovascular disease (CVD) is the leading cause of death in inmates in the United States. CVD risk reduction is essential in this population. Limited health literacy may reduce one’s ...
Abstract 355: Snf1-related kinase is Upregulated in the Ischemic Heart and Regulates Cellular Metabolism and Death
Authors: Michael A Burke, George Ochenjele, Richard P Fernandez, Hossein Ardehali
Journal: Circulation (2008)

Sucrose non-fermenting (Snf1)-related kinase (SNRK) is a novel kinase homologous to the Snf1 kinase of yeast and the AMP-activated protein kinases (AMPK) of mammals. SNRK is expressed in a variety of tissues; however, its role in the cardiovascular system is unclear. While AMPK and Snf1 regulate metabolism, the primary function of SNRK is not known. We hypothesized that like AMPK, SNRK regulates cellular metabolism and influences cell survival. Western blots of protein extracts from several cell types showed that SNRK is widely expressed and exists in different forms in the nucleus and cytoplasm. We next assessed the effects of ischemia, hypoglycemia and increased AMP on SNRK levels. Dog hearts subjected to ischemia displayed a 41% increase in SNRK levels ( P &lt;0.01), while explanted hearts from patients with ischemic cardiomyopathy showed a 220% increase compared to controls ( P &lt;0.05). SNRK mRNA levels and subcellular location were altered by hypoglycemia and increased AMP levels. The role of SNRK on cell death and metabolism was then assessed by transfecting HEK293 cells with GFP, a SNRKGFP fusion construct, or SNRKGFP containing a mutation in the nuclear localization sequence (SNRKnls). SNRKGFP overexpression increased cell death by 10% ( P =0.007) compared to controls both in the absence and presence of oxidant stress. Nuclear respiratory factors (NRF)2α and -2β (transcription factors that induce mitochondrial biogenesis) were upregulated with SNRK overexpression by 30% and 90%, respectively ( P &lt;0.05). SNRKnls did not induce a significant change. SNRK overexpression, but not SNRKnls, resulted in a 15% reduction in cellular ATP content compared to controls ( P =0.0001). A gene array performed on cells overexpressing either SNRKGFP or GFP showed that SNRK overexpression strongly correlates with numerous nuclear and metabolic functions. These data show that SNRK is upregulated in ischemic heart disease and suggest that it induces cell death. SNRK also appears to be a component of the cellular metabolic machinery, likely exerting its actions via entry into the nucleus. Thus, by altering cellular metabolism, SNRK may play an important role in the response of the heart to ischemia, and may provide a novel target for cardiovascular therapeutic interventions.
Regular review: Prevention of ischaemic stroke
Authors: G. Gubitz, P. Sandercock
Journal: BMJ (2000)

Recent advances in the treatment of acute ischaemic stroke have focused largely on drug treatments, and yet the number of effective and widely practicable treatments remains limited. After a spate of trials with negative results, no neuroprotective agents have yet been licensed for acute stroke. Although thrombolysis with tissue plasminogen activator is now available in the United States and Canada, most eligible patients are not treated, and thrombolysis remains the subject of considerable debate in the international research community. 1 2 Other important interventions for people with acute stroke include organised care in multidisciplinary stroke units and routine use of aspirin in acute ischaemic stroke. 3 4 Stroke is the second most common cause of death worldwide, and with no major panacea for acute stroke imminent, we must not ignore stroke prevention.5

Medical and surgical treatments to prevent stroke carry some risk (and some cost). These preventive strategies should be targeted at those who are at the highest absolute risk of stroke, because these individuals are likely to derive the greatest absolute benefit.6 These patients generally have a history of occlusive vascular diseases with symptoms— that is, prior ischaemic stroke or transient ischaemic attack, coronary heart disease, or peripheral vascular disease. Among the 80% of patients who survive an acute stroke, the risk of recurrent stroke is highest within the first few weeks and months; about 10% in the first year and about 5% per year thereafter. These patients are also at a major risk of other vascular disease, including myocardial infarction, emphasising the need for early preventive treatments.7 Individual risk factors such as a history of hypertension, smoking, hyperlipidaemia, increased blood glucose concentration, and obesity are important considerations for all patients, especially those at high risk.

#### Summary points

Reduction of blood pressure is effective at preventing a first …
A tolerability study of a cremophor free, nanoparticle albumin bound paclitaxel intravenously administered in Chinese patients with advanced solid tumor
Authors: X. Teng, Z. Guan, Z. Yao, D. Liu, N. Zhou, H. Luo, M. J. Hawkins, P. Soon-Shiong
Journal: Journal of Clinical Oncology (2005)

5571 Background: Capxol (ABI-007, Abraxane) is an albumin-bound, nanoparticle form of paclitaxel with an improved therapeutic index that may be related to biological interactions with endogenous albumin receptors (eg, gp60) and binding proteins (eg, SPARC). This phase I study evaluated the maximum tolerated dose (MTD) and dose limiting toxicities of Capxol administered intravenously in Chinese patients with advanced solid tumors to provide the recommended dose for further trials. Methods: Capxol at dose levels from 135 up to 350 mg/m2 every 3-weeks was administered intravenously over 30 minutes, without premedication. Results: 22 patients (6 breast, 5 NSCLC, 5 nasopharyngeal carcinoma (NPC), 3 rectum/colon, 1 each esophageal, stomach and synovial sarcoma) were treated with a total of 94 cycles of Capxol. No acute hypersensitivity reactions were observed during the infusion or on the 1st day post dosing. The treatment was tolerated well. Most of AEs (95%) were grade 1/2. The most common toxicities were mild leucopenia and peripheral sensory neuropathy. The dose-limiting toxicities, which occurred at dose level of 350 mg/m2, were grade 4 neutropenia (1 out of 3 patients) and grade 3 diplopia (1 out of 3 patients). The MTD was determined to be 300 mg/m2. Among 21 patients who were evaluable for efficacy, 1 CR and 7 PR were observed (38%; 95% CI: 17.3% - 58.9%). 3 of 5 pts with NPC had responses lasting 25, 18 and 13+ weeks. Conclusions: As in the U.S. Phase I trial, in Chinese patients the MTD of Capxol was 300 mg/m2 given without premedication over 30 minutes. Additional trials of Capxol are planned in Chinese patients with breast cancer and NSCLC. Antitumor activity in NPC seen in this study and known SPARC over-expression in head and neck tumors (Chin et al: Int J Cancer. 2004) warrant further evaluation in these tumors. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration American BioScience
Abstract 4045: Pediatric osteosarcoma lung metastasis: variations in clinical management
Authors: Andrea T. Vo, Onita Bhattasali, Michael Roth, Jonathan Gill, David Geller, Lor Randall, Richard Gorlick
Journal: Cancer Research (2014)

Abstract Background: Nearly 20% of patients with newly diagnosed osteosarcoma have detectable metastatic disease at presentation, most of which is located in the lungs. These patients have a poor prognosis with survival of generally less than 30%. NCCN guidelines as well as many osteosarcoma clinical trials endorse resection of metastases as part of standard treatment. There are limited recommendations as to the timing or method of resection. Methods: An anonymous online questionnaire was distributed to establish practice patterns among members of the Connective Tissue Oncology Society, a multi-disciplinary sarcoma focused organization. Participants were asked about management of lung metastases in 3 clinical scenarios (2 cm unilateral, 0.5 cm unilateral, and multiple bilateral lung nodules). Questions evaluated timing of management, decision to resect, technique of resection, and decision to explore the contralateral lung. Results: 183 individuals completed the survey. Most report initiating nodule management after neoadjuvant therapy. If the nodule disappeared after neoadjuvant therapy or definitive surgery, most report not performing surgical resection. Among nodules resected after neodjuvant therapy or definitive surgery that were unchanged in size, thoracotomy is the most commonly reported surgical technique. When only unilateral nodules were present on imaging, few choose to explore the contralateral lung (11% in 2.0cm and 10% in 0.5cm, compared to 70% in multiple bilateral nodules). Pediatric Oncologists were more likely to initiate management earlier than Medical Oncologists for 2.0cm nodule (90% vs 63%, p&amp;lt;0.001), 0.5 cm nodule (77% vs. 47%, p &amp;lt;0.005), and multiple bilateral nodules (79% vs. 51%, p =0.008). Conclusion: There is marked heterogeneity among treating clinicians in their management of pulmonary metastases in osteosarcoma. Variation was also noted between medical specialties. Prospective trials are needed to evaluate if these differences have significant implications on outcomes for patients with newly diagnosed metastatic osteosarcoma. Citation Format: Andrea T. Vo, Onita Bhattasali, Michael Roth, Jonathan Gill, David Geller, Lor Randall, Richard Gorlick. Pediatric osteosarcoma lung metastasis: variations in clinical management. [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 4045. doi:10.1158/1538-7445.AM2014-4045
Allogeneic Transplantation in Elderly Patients with AML and MDS Comparing Reduced-Intensity Conditioning with Flamsa-Busulfan Versus Fludarabine/BCNU/Melphalan
Authors: Nicole Engel, Wolfgang Hill, Susanne Fritsch, Dusan Prevalsek, Anna-Katharina Zoellner, Max Hubmann, Veit Buecklein, Andreas Hausmann, Georg Ledderose, Hans-Jochem Kolb, Wolfgang Hiddemann, Johanna Tischer
Journal: Blood (2014)