tbuckley/cabot-search huggingface dataset:
Implementing criteria-based early switch/early discharge programmes: a European perspective
Authors: D. Nathwani, W. Lawson, M. Dryden, J. Stephens, S. Corman, C. Solem, J. Li, C. Charbonneau, N. Baillon-Plot, S. Haider, C. Eckmann
Journal: Clinical Microbiology and Infection (2015)

Early switch (ES) from intravenous (IV) to oral antibiotic therapy programmes is increasingly included as a component of hospital antimicrobial stewardship initiatives that aim to optimize antimicrobial therapy while limiting toxicity and resistance. In terms of prioritizing the most cost-effective stewardship interventions, ES has been seen as a 'low-hanging fruit', which refers to selecting the most obtainable targets rather than confronting more complicated issues. Administration of highly bioavailable oral antibiotics should be considered for nearly all non-critically ill patients and has been recommended as an effective and safe strategy for over two decades. However, to accrue the most benefit from ES, it should be combined with an early discharge (ED) plan, protocol, or care pathway. Benefits of this combined approach include improved patient comfort and mobility, reduced incidence of IV-line-related adverse effects, reduced IV antimicrobial preparation time, decreased hospital stays, reduced antimicrobial purchasing and administration costs, decreased patient deconditioning, and shortened recovery times. Results from published studies document decreases in healthcare resource use and costs following implementation of ES programmes, which in most studies facilitate the opportunity for ED and ED programmes. Barriers to the implementation of these programmes include clinician misconceptions, practical considerations, organizational factors, and a striking lack of awareness of IV to oral switch guidance. These and other barriers will need to be addressed to maximize the effectiveness of ES and ED programmes. As national antimicrobial stewardship programmes dictate the inclusion of ES and ED programmes within healthcare facilities, programmes must be developed and success must be documented.
Perceptions of cancer patients and their physicians involved in phase I trials.
Authors: C Daugherty, M J Ratain, E Grochowski, C Stocking, E Kodish, R Mick, M Siegler
Journal: Journal of Clinical Oncology (1995)

PURPOSE In an attempt to understand some of the complex issues related to the participation of cancer patients in phase I trials, and the perceptions of patients toward these trials, we conducted a pilot survey study of 30 cancer patients who had given informed consent to participate in a phase I trial at our institution. Concurrently, the oncologists identified by the surveyed patients as responsible for their care were surveyed as well. PATIENTS AND METHODS Twenty-seven of 30 consecutive patients agreed to and completed the survey. Patients were surveyed before they received any investigational agents. Eighteen oncologists participated in this survey study. RESULTS Eighty-five percent of patients decided to participate in a phase I trial for reasons of possible therapeutic benefit, 11% because of advice/trust of physicians, and 4% because of family pressures. Ninety-three percent said that they understood all (33%) or most (60%) of the information provided about the trials in which they had decided to participate. Only 33% were able to state the purpose of the trial in which they were participating, with patients able to state the purpose of phase I trials being more educated (P = .01). Surveyed oncologists had wide-ranging beliefs regarding expectations of possible benefits and toxicities for their patients participating in phase I trials. CONCLUSION Cancer patients who participate in phase I trials are strongly motivated by the hope of therapeutic benefit. Altruistic feelings appear to have a limited and inconsequential role in motivating patients to participate in these trials. Cancer patients who participate in phase I trials appear to have an adequate self-perceived knowledge of the risks of investigational agents. However, only a minority of patients appear to have an adequate understanding of the purpose of phase I trials as dose-escalation/dose-determination studies.
Clinical Spectrum of Encephalitis Associated With Antibodies Against the α-Amino-3-Hydroxy-5-Methyl-4-Isoxazolepropionic Acid Receptor
Authors: Bastien Joubert, Philippe Kerschen, Anastasia Zekeridou, Virginie Desestret, Véronique Rogemond, Marie-Océane Chaffois, François Ducray, Vincent Larrue, Benoit Daubail, Ahmed Idbaih, Dimitri Psimaras, Jean-Christophe Antoine, Jean-Yves Delattre, Jérôme Honnorat
Journal: JAMA Neurology (2015)

<h3>Importance</h3> The clinical features of autoimmune encephalitis associated with antibodies against the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR-Abs) remain poorly defined. <h3>Objectives</h3> To describe 7 patients with encephalitis and AMPAR-Abs and to provide a review of the literature on this disease entity. <h3>Design, Setting, and Participants</h3> The setting was the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (Lyon, France), and participants were 7 consecutive patients diagnosed as having encephalitis and AMPAR-Abs between January 1, 2010, and December 1, 2014. Patients' clinical data were analyzed, with a median follow-up period of 12 months (range, 2-31 months). Relevant articles were identified in the MEDLINE database using the keywords<i>autoimmune encephalitis</i>and<i>AMPA receptor antibodies</i>until February 15, 2015. <h3>Main Outcomes and Measures</h3> Modes of onset, full clinical presentations, and cancer prevalence. <h3>Results</h3> The patients included 4 women and 3 men (median age, 56 years). Four main modes of encephalitis onset were observed, including confusion (3 patients), epileptic (1 patient), amnestic (1 patient), and a severe form of fulminant encephalitis (2 patients). In contrast with previous reports, we observed only 1 patient with seizures. Two patients had cancer (1 lung carcinoma and the other thymic carcinoma). Analysis of the literature identified 35 published cases of encephalitis and AMPAR-Abs, including 18 with clinical data. The same modes of encephalitis onset were observed, including confusion (12 patients), epileptic (1 patient), amnestic (3 patients), and fulminant encephalitis (2 patients). Eleven patients were initially seen with a neoplasm (lung, breast, thymoma, or ovary). <h3>Conclusions and Relevance</h3> The clinical spectrum of AMPAR encephalitis is variable. Cancer was found in 13 of 27 patients (48%) with known cancer status. Most patients are seen with symptoms suggestive of autoimmune limbic encephalitis, although they can be paucisymptomatic or may manifest severe panencephalitis that evolves to a minimally conscious state and diffuse cortical atrophy. Patients suspected of having autoimmune encephalitis should undergo screening for serum and cerebrospinal fluid AMPAR-Abs.
Assessment of Self-Poisoning Patients by Psychiatrists and Junior Medical Staff
Authors: D Black, F Creed
Journal: Journal of the Royal Society of Medicine (1988)

Case notes of patients admitted to hospital or seen in the casualty department following an overdose were assessed in a standardized way. The medical records were deficient in several important areas, especially for those patients seen in casualty and not referred to a psychiatrist. If only selected patients were to be assessed by psychiatrists, closer monitoring of the psychiatric assessments and management initiated by junior medical staff would be required. Although the poor records may reflect lack of motivation as much as lack of education, there was no significant relationship between the doctors' attitudes towards self-poisoning patients in general and the standard of their assessments.
Abstract 5793: Novel Semi-Automatic Quantitative Assessment of The Aortic Valve and Aortic Root from Volumetric 3D Echocardiography: Comparison to Volumetric Cardiac Computed Tomography (CT)
Authors: Jung Hyun Choi, Bogdan Georgescu, Razvan Ionasec, Subha Raman, Geu-Ru Hong, Shizhen Liu, Helene Houle, Mani A Vannan
Journal: Circulation (2008)

Accurate anatomical and functional assessment of AV and aortic root is crucial to understand the pathophysiology of abnormalities and management decision-making in patient with aortic valve diease and aortic aneurysm. The aim of this study was to evaluate the feasibility of novel semi-automatic assessment of AV and aortic root from volumetric 3-D Echo compared to CT. Volume-rendered 3-D TEE data were obtained using V5M transducer(Sequoia, Siemens). 6 points(commisures and valve tips) at ED and ES were identified on the 3-D TEE data. Volumetric CT images were acquired using 64-Slice CT(Avanto, Siemens). A dynamic 3-D model of the AV and root were obtained by standard mathematical modeling approach (non-uniform rational B-splines). This enabled automatic visualization and quantification of AV and root. We measured phasic change of the AVA(cm2), diameter of sinotubular junction(d-STJ, mm), sinus of Valsalva(d-SV, mm) and basal ring(d-BR, mm). 364 CT volumes from 41 patients and 23, 3-D TEE volumes from 15 patients with normal to mild AR were acquired. 3-D TEE data about AV and root showed strong correlation with CT data(table ). Figure showed representative examples of 3-D Echo and CT modeling. This novel automated 3-D Echo approach provides accurate dimensions of the AV and the aortic root and may aid in valve and root repair procedures. Comparison of AVA and aortic diameter between 3-D TEE and CT Figure 1. Top; Aortic root model, Bottom; Aortic valve model Figure 2. Automatic calculation from 3D TEE data (left; AVA, right; Aortic root diameter) Figure 3. Aortic root model segmentation (left two; 3D TEE, right two; CT)
What Would You Do? Specialists’ Perspectives on Cancer Genetic Testing, Prophylactic Surgery, and Insurance Discrimination
Authors: Ellen T. Matloff, Heather Shappell, Karina Brierley, Barbara A. Bernhardt, Wendy McKinnon, Beth N. Peshkin
Journal: Journal of Clinical Oncology (2000)

To examine what cancer genetics specialists predict they would do personally if they were at 50% risk of carrying a mutation that predisposes to hereditary breast/ovarian cancer (BRCA1/BRCA2) and hereditary nonpolyposis colon cancer (HNPCC).Questionnaire survey of the membership of the National Society of Genetic Counselors (NSGC) Special Interest Group (SIG) in Cancer.Of the 296 active members of the NSGC Cancer-SIG surveyed, 163 (55%) responded. Eighty-five percent predicted that if they had a 50% risk of carrying a BRCA1/BRCA2 mutation, they would pursue genetic testing. If they tested positive for a mutation at age 35, 25% predicted they would pursue prophylactic bilateral mastectomies and 68%, prophylactic oophorectomy. Ninety-one percent of respondents believe they would pursue genetic testing for HNPCC, and 17% would elect prophylactic colectomy; 54%, prophylactic hysterectomy; and 52%, prophylactic oophorectomy if they tested positive for a mutation. The majority (68%) would not bill their insurance companies for genetic testing because of fear of discrimination, and 26% would use an alias when undergoing testing. Fifty-seven percent of counselors would seek professional psychologic support to help them cope with the results of testing.A large percentage of cancer genetic counseling providers predicted they would opt for prophylactic surgery at a young age if they carried a BRCA or HNPCC mutation, and most would seek professional psychologic assistance when undergoing testing. More than half of respondents would not bill their insurance companies for genetic testing, largely because of fear of genetic discrimination. The vast majority of those providers most familiar with cancer genetic testing and its associated medical, psychologic, and legal implications would still pursue genetic testing.
Original article: SCF and IL‐31 rather than IL‐17 and BAFF are potential indicators in patients with allergic asthma
Authors: Z. Lei, G. Liu, Q. Huang, M. Lv, R. Zu, G.‐M. Zhang, Z.‐H. Feng, B. Huang
Journal: Allergy (2008)

Background: Although the prevalence of allergic asthma increased quickly in the past decade, the diagnostic criteria have not been well established. The aim of the present study was to explore whether stem cell factor (SCF), B cell‐activating factor (BAFF), and cytokines interleukin (IL)‐17 and IL‐31 are usable parameters for the diagnosis of allergic asthmatics. Methods: Blood samples were collected from patients with allergic asthma, control patients, and healthy control subjects. The serum concentrations of SCF, BAFF, IL‐17, and IL‐31 were measured by enzyme‐linked immunosorbent assay. The corresponding mRNA levels in peripheral blood mononuclear cells (PBMCs) were determined by real‐time reverse‐transcription polymerase chain reaction. Results: A good correlation existed between protein levels of SCF and IL‐31 and their mRNA levels (SCF: r = 0.6162; IL‐31: r = 0.5463). The serum concentrations of SCF and IL‐31 in allergic asthmatic patients, but not control patients, were significantly higher than those in normal control subjects (SCF: median 1.83 vs 0.85 ng/ml, P &lt; 0.01; IL‐31: 50.15 vs 10.01 pg/ml, P &lt; 0.001). Consistently, the levels of SCF and IL‐31 mRNAs in allergic asthmatic patients’ PBMCs were also significantly higher than those in normal control subjects ( P = 0.002 and P &lt; 0.001, respectively). Conclusions: These findings suggest that allergic asthma is characterized by an elevation of cytokines SCF and IL‐31 and the measurement of their expression at either protein level in serum or mRNA level in PBMCs will be a valuable parameter for the diagnosis of allergic asthma.
Adipokines and bone loss at the terminal stage of chronic respiratory failure
Authors: Evgenia Kochetrova, Ludmila Ugay, Ksenia Burya, Romain Kessler
Journal: European Respiratory Journal (2011)

Aim of this study to evaluate associations between the adipokines (tumor necrosis factor-alpha (TNF-α) and its receptors, leptin, adiponectin), body composition and bone mineral density (BMD) in the patients with terminal stage of chronic respiratory failure.

Material and methods: 47 patients with end-stage of chronic respiratory failure (COPD, emphysema and cystic fibrosis) and 35 healthy subjects were estimated. Bone mineral density, wool body composition was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine (LS) and left femur neck (FN). We estimated respiratory function testing, serum levels TNF-α, TNFR-1, TNFR-2, leptin, adiponectin.

Results: We indentified a decreased BMD characterized by T-score <-1,0 in 43/47 patients, as measured on the FN or the lumbar spine (LS). There was negative association between TNF-α and BMD (r=-0,43, p=0,04). Parameters of body compositions and serum concentrations of leptin and adiponectin were significantly associated with FN hip and LS. Serum leptin levels was significant lower (p=0,047) and adiponectin concentrations was higher (p=0,039) in the osteoporosis group. Serum leptin significantly positively correlated with parameters of body composition, serum adiponectin concentrations was negative association with TNFR-1, TNFR-2 (p=0,007). There was a significant inverse relationship between leptin and adiponectin.

Conclusion: These results shows possibly role of adipokines in the increasing of bone loss at the terminal stage of chronic respiratory failure.
Renal effects of calcitonin and parathyroid extract in man
Authors: Heinrich G. Haas, Maximilian A. Dambacher, Jan Gun
aga, Thierry Lauffenburger
Journal: Journal of Clinical Investigation (1971)

To clarify the controversial renal action of calcitonin (CT) and a possible interrelationship between CT and parathyroid hormone, eight patients with untreated surgical hypoparathyroidism were studied. Various calcitonins, i.e. extracted porcine, synthetic porcine, synthetic human, and synthetic salmon CT in doses of 150 Medical Research Council U or 1.5 mg were infused over a 3 hr period. Subsequently, six of the same subjects received 500 USP U parathyroid extract (PTE) (Eli Lilly & Co., Indianapolis, Ind.) in 3 hr and later a combination of CT and PTE. In addition, two patients were given an infusion of ammonium phosphate with the aim of producting a phosphaturia of comparable degree as seen after CT and PTE, thus differentiating hormonal from nonhormonal influences on cation excretion. A protocol of serial clearance (C) studies using the patients as their own controls was followed. Serum and urinary inorganic phosphate (P), calcium (Ca), magnesium (Mg), sodium (Na), potassium (K), and creatinine (Cr) were determined and the clearance values calculated. All CT peptides caused a uniform, immediate and significant increase of C(P), C(Na), C(K), C(Ca), and C(Mg), PTE evoked a rise of C(P), C(Na), and C(K), but C(Ca) and C(Mg) were reduced, the Ca and Na figures being not statistically significant. The administration of both CT and PTE resulted in a summation of individual hormone effects on Ca and Mg excretion. Phosphate infusion on the other hand induced an isolated phosphaturia but no concomitant changes of the urinary cations.The hypoparathyroid data demonstrate that calcitonin enhances urinary elimination of P, Na, K, Ca, and Mg independently of parathyroid action, CT and PTE act qualitatively similarly on P, Na, and K excretion, while an antagonism seems to exist for the renal handling of Ca and Mg.
Tristetraprolin Limits Inflammatory Cytokine Production in Tumor-Associated Macrophages in an mRNA Decay–Independent Manner
Authors: Franz Kratochvill, Nina Gratz, Joseph E. Qualls, Lee-Ann Van De Velde, Hongbo Chi, Pavel Kovarik, Peter J. Murray
Journal: Cancer Research (2015)

Tristetraprolin (TTP) is an inducible zinc finger AU-rich RNA-binding protein essential for enforcing degradation of mRNAs encoding inflammatory chemokines and cytokines. Most studies on TTP center on the connection between mRNA half-life and inflammatory output, because loss of TTP amplifies inflammation by increasing the stability of AU-rich mRNAs. Here, we focused on how TTP controls cytokine and chemokine production in the nonresolving inflammation of cancer using tissue-specific approaches. In contrast with model in vitro macrophage systems, we found constitutive TTP expression in late-stage tumor-associated macrophages (TAM). However, TTP's effects on AU-rich mRNA stability were negligible and limited by constitutive p38α MAPK activity, which was the main driver of proinflammatory cytokine production in TAMs at the posttranscriptional level. Instead, elimination of TTP caused excessive protein production of inflammatory mediators, suggesting TTP-dependent translational suppression of AU-rich mRNAs. Manipulation of the p38α-TTP axis in macrophages has significant effects on the growth of tumors and therefore represents a means to manipulate inflammation in the tumor microenvironment.
Relationship between Retinopathy and Glycaemic Control in Insulin-Dependent and Non-Insulin-Dependent Diabetes
Authors: J P Monson, G Koios, G C Toms, P G Kopelman, B J Boucher, S J W Evans, W L Alexander
Journal: Journal of the Royal Society of Medicine (1986)

The possible relationship between antecedent diabetic control, as determined by serial glycosylated haemoglobin (HbA1) measurements, and diabetic retinopathy was examined in 40 insulin-dependent and 41 non-insulin-dependent diabetics selected consecutively from our clinic population. Multiple logistic regression analysis demonstrated a significant association between mean HbA1 and prevalence of retinopathy in both groups of patients. This association was independent of duration of diabetes which was also significantly associated with retinopathy prevalence. Hypertension and smoking were not obvious risk factors in this group of patients; an apparent association of hypertension and diabetes was entirely accounted for by a positive relationship between the presence of hypertension and duration of diabetes.
Fatty acids in breast milk and development of atopic eczema and allergic sensitisation in infancy
Authors: C. Thijs, A. Müller, L. Rist, I. Kummeling, B. E. P. Snijders, M. Huber, R. Van Ree, A. P. Simões-Wüst, P. C. Dagnelie, P. A. Van Den Brandt
Journal: Allergy (2010)

One of the explanations for the increasing prevalence of atopic diseases is a relative low perinatal supply of n-3 fatty acids. However, this does not explain the protective effects of whole-fat dairy products or high levels of transfatty acids in breast milk, observed in some studies. We evaluated the role of perinatal supply of fatty acids in the early development of atopic eczema and allergic sensitisation.Fatty acids, including n-3 long-chain polyunsaturated fatty acids (LCPs) as well as ruminant fatty acids (rumenic acid, cis-9,trans-11-C18:2 conjugated linoleic acid; and vaccenic acid, trans-11-C18:1), were determined in breast milk sampled at 1 month postpartum from 310 mother-infant pairs in the KOALA Birth Cohort Study, the Netherlands. Children were followed for atopic outcomes until 2 years of age.Higher concentrations of n-3 LCPs as well as ruminant fatty acids were associated with lower risk of (1) parent-reported eczema, (2) atopic dermatitis (UK Working Party criteria), and (3) sensitisation at age 1 year (as revealed by specific serum IgE levels to cow's milk, hen's egg and/or peanut). In multivariable logistic regression analysis, the inverse associations between ruminant fatty acid concentrations in breast milk and atopic outcomes were found to be independent from n-3 LCPs.The results confirm a protective role of preformed n-3 LCPs in the development of atopic disease. Moreover, this is the first study in humans confirming results from animal studies of protective effects of ruminant fatty acids against the development of atopic manifestations.
Toxicity and efficacy of escalating dosages of recombinant human interleukin-6 after chemotherapy in patients with breast cancer or non-small-cell lung cancer.
Authors: G J Veldhuis, P H Willemse, D T Sleijfer, W T van der Graaf, H J Groen, P C Limburg, N H Mulder, E G de Vries
Journal: Journal of Clinical Oncology (1995)

PURPOSE To evaluate the safety, tolerability, and efficacy of varying doses of recombinant human interleukin-6 (rhIL-6) after chemotherapy. PATIENTS AND METHODS In this phase I/II study, 19 breast (stage III to IV) or non-small-cell lung cancer (NSCLC) patients received mitoxantrone (10 mg/m2) and thiotepa (40 mg/m2) every 3 weeks, followed by rhIL-6 subcutaneously (days 5 to 15) at six dose levels: 0.5, 1.0, 2.5, 5.0, 10.0, and 20.0 micrograms/kg/d body weight/d (micrograms/kg/d). rhIL-6 was increased to the next level in the individual patient in case of incomplete bone marrow recovery (leukocyte count &lt; 3 x 10(9)/L and/or platelet count &lt; 100 x 10(9)/L at day 22) and/or platelet nadir less than 25 x 10(9)/L in two consecutive cycles. RESULTS Flu-like symptoms were observed in most of the patients. Nausea and vomiting were reported in seven of 48 and 19 of 48 cycles, respectively. Dose-limiting toxicity at 20.0 micrograms/kg/d of rhIL-6 consisted of World Health Organization (WHO) grade 3 to 4 flu-like symptoms, nausea, and vomiting. Platelet recovery was faster in cycle 1 at 10.0 and 20.0 micrograms/kg/d of rhIL-6 than at lower dose levels (P &lt; .05); thrombocytopenia grade 4 was observed at most levels. However, only two patients needed platelet transfusions (1.0 and 2.5 micrograms/kg/d rhIL-6). rhIL-6 effects on leukocytes were not dose-related, with a trend for the neutrophil nadir to increase with rhIL-6 up to 10 micrograms/kg/d. rhIL-6 dose escalation did not affect hematologic parameters and chemotherapy cycle duration. Hemoglobin (P &lt; .001) and cholesterol (P &lt; .05) levels decreased, while acute-phase proteins increased. CONCLUSION rhIL-6 following chemotherapy is tolerable up to 10 micrograms/kg/d; flu-like symptoms and nausea were dose-limiting at 20 micrograms/kg/d. Platelet nadir did not differ for the various rhIL-6 doses. However, a faster platelet recovery was observed at 10.0 and 20.0 micrograms/kg/d of rhIL-6.