tbuckley/cabot-search huggingface dataset:
Impact on Overall Survival of Glandular Metastasis in Patients with Metastatic Clear Cell Renal Cell Carcinoma. on Behalf of the Renal Cross Channel Group
Authors: G. Gravis, B. Chanez, L. Derosa, B. Beuselinck, B. Laguerre, P. Barthelemy, P.E. Brachet, F. Joly Lobbedez, B. Escudier, G.D. Stewart, D. Harrison, A. Laird, N. Vasudev, C. Ralph, J. Larkin, H. Lote, J. Walz, J. Thomassin, N. Salem, J.M. Boher
Journal: Annals of Oncology (2014)
Bill Seeks to Exempt Tribes From Large-Employer Mandate
Authors: Laura Buchholz
Journal: JAMA (2015)

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ORAL HERPETIC INFECTION IN ADULTS.
Authors: J. C. SOUTHAM, I. T. COLLEY, N. G. CLARKE
Journal: British Journal of Dermatology (1968)

SUMMARY.— The clinical features of the various types of oral infection in adults which may be caused by the herpes group of viruses are described. These are primary herpetic stomatitis, herpes labialis, recurrent intra‐oral herpes simplex infection, chicken pox and zoster. The cytological changes in the epithelial cells are described and discussed. Different changes are induced by giant‐cell and proliferative strains of Herpesvirus hominis: both strains can be isolated from all clinical infections. The diagnostic value of cytological smears in oral infections is emphasized and 6 illustrative cases are reported. Several smears should be made from each case as relatively few cells may be affected and as the cytological changes may be difficult to detect when the cells are degenerate and when only changes due to the proliferative strain are present. Evidence is presented for the increasing susceptibility of adults, including medical personnel, to primary infection with Herpesvirus hominis.
One year's experience of mobile bedside chest ultrasound service for pleural diseases in a district general hospital
Authors: Ali Al-Ameri, Jan Droste, Franco Guarasci, Clare Smart, Jawad Azim
Journal: European Respiratory Journal (2012)

Introduction/Objectives   The role of chest ultrasound for the management of pleural diseases has evolved rapidly over the last few years. The National Patient Safety Agency9s rapid response report and the latest British Thoracic Society guidelines have recommended the use of chest ultrasound prior to intervention in pleural effusion. We describe our experience with using mobile bedside chest ultrasound including complication rates, impact on waiting time and length of hospital stay.   Method   Prospective data from all patients receiving mobile chest ultrasound over a 12 month period in 2011 was collected. Scans were performed by an acute medicine physician and respiratory registrars with level 1 competency in chest ultrasound as classified by the Royal College of Radiology. Case notes, coding and radiology data were assessed, and comparisons made to waiting time and length of hospital stay for those receiving chest ultrasound in the radiology department   Results   Overall 126 scans were evaluated with 123 performed the same day as requested and 3 the next day. Of those, 24 were followed by chest drain insertion, 56 by pleural aspiration and 46 with no intervention. Two patients had small pneumothoraces post aspiration (3.8%) whilst 1 chest drain insertion and 2 pleural aspirations failed. Average hospital stay was 13.3 days compared to 18.6 days for those having scans in the radiology department  An average time of 21 minutes which included scanning duration, collecting and returning the device was documented in 71 patients.   Conclusion   Mobile bedside chest ultrasound when performed by level 1 competent physicians appears to be safe and considerably reduces length of hospital stay.
Screening of diabetes mellitus among new cases of tuberculosis
Authors: Parvaneh Baghaei, Majid Marjani, Afshin Moniri, Payam Tabarsi
Journal: European Respiratory Journal (2013)

Objectives  The risk relationship between diabetes and tuberculosis is largely suggested by epidemiological evidences but the preferred method for screening of DM among TB cases has not been determined. This study performed to compare efficacy of fasting blood sugar (FBS) and glycosylated hemoglobin (Hb A1c) for screening of DM among TB cases.  Methods  In a prospective study, 221 new cases of tuberculosis were recruited in National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran. On the first day of TB diagnosis and before initiation of anti tuberculosis drugs, fasting blood sugar and glycosylated hemoglobin were measured. DM was defined as FBS more than 126 mg/dl or Hb A1c more than 6.5%. After exclusion of known cases, rate of new cases of DM diagnosed by every test was measured.  Results  Among 221 new cases of tuberculosis, Sixty seven patients had FBS>126 mg/dl and Hb A1c was more than 6.5% in 134 persons. History of DM was positive for 31and 112 cases were found after TB diagnosis. Hb A1c was more sensitive than FBS for diagnosis of DM (92% in comparison to 32%). Nine cases of recently diagnosed DM had normal level of HbA1c but FBS>126 mg/dl.  Conclusion  DM was very common among new cases of tuberculosis in our setting. Majority of DM cases were unaware of their disease. Measurement of Hb A1c is more effective than FBS for screening of DM among tuberculosis patients.
Clinical staging versus laparotomy and combined modality with MOPP versus ABVD in early-stage Hodgkin's disease: the H6 twin randomized trials from the European Organization for Research and Treatment of Cancer Lymphoma Cooperative Group.
Authors: P Carde, A Hagenbeek, M Hayat, M Monconduit, J Thomas, M J Burgers, E M Noordijk, A Tanguy, J H Meerwaldt, R Le Fur
Journal: Journal of Clinical Oncology (1993)

PURPOSE To compare (1) clinical staging and irradiation alone versus staging laparotomy and treatment adaptation in patients with a favorable prognosis (H6F); (2) two combined modalities in patients with an unfavorable prognosis (H6U). PATIENTS AND METHODS The H6F trial (n = 262) consisted of randomization to clinical staging plus subtotal nodal irradiation (STNI) or to staging laparotomy plus treatment adaptation (adjuvant chemotherapy [CT] only in the 33% with negative laparotomy). The H6U trial (n = 316) consisted of no laparotomy, randomization to mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) or doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), and mantle irradiation. RESULTS In the H6F trial, 6-year freedom from progression (FFP) rates (78% v 83%; P = .27) were similar in clinical and laparotomy stagings, respectively. Survival rates were 93% and 89%, due to laparotomy-related deaths. In the H6U trial, the ABVD arm had superior results (6-year FFP rate, 88% v 76%; P = .01), but they were not significant for survival (91% v 85%; P = .22). CT discontinuation due to hematologic intolerance occurred more often with MOPP (14.5% v 7.3%). Decrease of the pulmonary vital capacity ([VC] &lt; 70% of the theoretic value) was observed more frequently after ABVD than after MOPP (12% v 2%; P = .08), with two lethal pulmonary insufficiencies occurring in the ABVD arm. No modification of the isotopic left ventricular ejection fraction (LVEF) occurred. Gonadal toxicity was less in the ABVD arm. CONCLUSION Early-stage patients benefit from treatment adaptation to initial characteristics in terms of tumor control and late toxicities. Staging laparotomy before STNI may be deleted even in favorable patients at no cost to survival or FFP. In unfavorable patients, ABVD achieved better results than MOPP, at lower hematologic and gonadal cost. Therefore, despite its pulmonary toxicity, ABVD is the best choice to design improved CT regimens associated with mantle irradiation.
Study of CD44 expression in fibroblastoid cells isolated from BAL of LTR
Authors: Emanuela Cova, Simona Inghilleri, Simona Miserere, Monica Morosini, Daniela Capuano, Rita Di Domenica, Tiberio Oggionni, Federica Meloni
Journal: European Respiratory Journal (2012)

Progressive and irreversible fibroproliferative process leads to BOS. The presence of mesenchymal cells, the primary source of fibrotic cells, has been described in BAL fluid of LTR as predictive of BOS onset (Badri et al, 2011). CD44 cell surface glycoprotein has been found increasingly expressed by graft infiltrating lymphocytes, macrophages and AR fibroblasts with active OB. CD44 has been also associated to an invasive fibroblast phenotype. Inhibition of mTOR, responsible of cell over-proliferation has been found effective in treating fibrotic process.  Aim of this work is to assay CD44 expression in fibroblastoid cells derived from colony-forming units (CFU) of mesenchymal cells isolated from BAL of LTR patients with BOS 0p, 1 and 2 to evaluate its implication in fibrotic process. In addition, in the same cells expression of the active form of mTOR has been assayed to specifically target pharmacological treatment.  Methods: Mesenchymal CFUs from BAL were isolated from two patients with BOS 0p, two with BOS 1 and one with BOS 2, respectively. Proliferation rate was evaluated at 24, 48 and 72 h. CD44 and mTOR expression was assayed by immunocystochemistry.  Results: BOS 1 and 2 patients showed moderate to strong expression of both CD44 and mTOR in 80% cells and weak in 20% cells. BOS 0P subjects displayed moderate to high expression in 5% cells, weak signal in 60% and no detection in 35% cells. We also found that cells isolated from BOS 0p had a significantly (P  Conclusion: These results open new perspectives in the identification of a specific fibroblastoid phenotype linked to BOS grades and to target a therapeutic treatment.
Phase II study with the combination etoposide, doxorubicin, and cisplatin in advanced measurable gastric cancer.
Authors: P Preusser, H Wilke, W Achterrath, U Fink, L Lenaz, A Heinicke, J Meyer, H J Meyer, H Buente
Journal: Journal of Clinical Oncology (1989)

In this phase II multicenter trial, 67 evaluable patients with advanced measurable gastric carcinoma were treated with a combination of etoposide, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and cisplatin (EAP). The overall response rate was 64%, including 21% complete responses (CRs). In 55 patients with metastatic disease, 31 responses (51%) including eight CRs (15%) were achieved. Responses were seen in all metastatic sites, but the response rate was lower in patients with peritoneal carcinomatosis. In 12 patients with locoregional disease, six CRs and six partial responses (PRs) were observed. Eight CRs (three and five in patients with metastatic and locoregional disease, respectively) were pathologically confirmed. The overall median response duration was 7 months; it was 16 months for patients achieving CR (22 months for pathologically confirmed CR [pCR]), and 6 months for PR. The median survival time for all patients was 9 months, for the patients who achieved CR 17 months, for pCR 23 months, and for PR 9.5 months. Median survival time for all patients with metastatic disease was 8 months, and for locoregional disease 12.5 months. Six patients (9%) (four local, two metastatic disease) were alive at 2 years, and four patients are alive and disease free at 35+ to 56+ months. Main toxicities were leukopenia and thrombocytopenia, with 64% of patients developing grade 3 to 4 myelosuppression and 12% severe infections. Nonhematologic toxicities of World Health Organization (WHO) grade 4 were not observed.
Artificial neural network (ANN) for prediction of pulmonary tuberculosis in hospitalized patients
Authors: Fabio Aguiar, João Pinto, Rodrigo Torres, Jose Seixas, Fernanda Mello
Journal: European Respiratory Journal (2013)

Tuberculosis (TB) endangers all individuals, irrespective of country of origin. Hospitals have an established relationship with transmission of TB, and a delay in detection of TB can lead to the spread of disease. Rio de Janeiro has a high burden of TB and up to 1/3 of its cases are diagnosed in hospitals. Rapid diagnosis and respiratory isolation (RI) are essential to reduce nosocomial transmission. Unfortunately, the costs of isolation rooms (IR) are high, so optimization of its use is necessary. Clinical models have been described to reduce RI, without an increase in the risk of transmission. We developed an ANN to predict pulmonary TB in a high complexity hospital in Rio de Janeiro. The network is a multilayer perceptron (MLP) network, with clinical and radiological data collected from a cohort of 290 patients admitted to IR due to suspicion of TB. The ANN has one hidden layer, and was trained with the resilient back propagation algorithm and has the hyperbolic tangent as the activation function. The training group consisted of 80% of the patients. The remaining were used for validation. The stop criterion was the SP product. The neural model included 21 variables and has a sensitivity of 100%, specificity of 99.3%, positive and negative predictive values of 98.3% and 100%, respectively. The variable with the greatest discriminative value is chest X-ray. HIV status was a cofounder, so the final model did not include it. In conclusion, the ANN developed had a high accuracy for pulmonary TB diagnosis and could be used as a tool to optimize use of IR in hospitals. However, this model should be prospectively evaluated before routine use in distinct epidemiological scenarios.
Graves' Ophthalmopathy
Authors: Luigi Bartalena, Maria Laura Tanda
Journal: New England Journal of Medicine (2009)

A 40-year-old woman in whom Graves' disease was recently diagnosed comes for a follow-up visit. She has been taking methimazole, at a dose of 10 mg per day, and is now euthyroid, but for the past 3 months, she has had bothersome eye symptoms, including redness, tearing, grittiness, photophobia, diplopia at the extremes of gaze, and ocular pain associated with eye movements. She smokes 10 cigarettes per day. How should Graves' ophthalmopathy be managed?
Unexplained Illness: The Mind versus the Environment
Authors: Michael J Radcliffe, Pamela Ashurst, Jonathan Brostoff
Journal: Journal of the Royal Society of Medicine (1995)

Every doctor in clinical practice is familiar with the patient who presents with multiple 'soft' symptoms. Where organic pathology cannot be demonstrated, there is a tendency to apply psychiatric labels. Indeed, it has been suggested that the risk of psychiatric disorder increases linearly with the number of presented symptoms. In psychiatric practice, the mere absence of an organic cause of disease is often regarded as adequate reason to invoke a psychological mechanism. However, this action precludes the possibility of any other diagnosis, and thus constricts therapeutic management to the psychiatric realm. Such psychologization of illness is commonplace, overworked and infrequently challenged. This highlights the longstanding controversy over multiple allergy and the role of psychiatric disorder.
Survival of multiple myeloma patients who are potential candidates for early high-dose therapy intensification/ autotransplantation and who were conventionally treated.
Authors: J Bladé, J F San Miguel, M Fontanillas, A Alcalá, J Maldonado, J García-Conde, E Conde, G Conzález-Brito, M J Moro, M L Escudero, J Trujillo, A Pascual, C Rozman, J Estapé, E Montserrat
Journal: Journal of Clinical Oncology (1996)

PURPOSE To analyze the outcome of patients with multiple myeloma (MM) who were potential candidates for early high-dose therapy (HDT) intensification followed by autotransplantation from a series treated with conventional chemotherapy. PATIENTS AND METHODS From January 1985 through December 1989, 487 patients with symptomatic MM were entered onto a randomized study to compare melphalan and prednisone (MP) versus vincristine, cyclophosphamide, melphalan, and prednisone (VCMP) /vincristine, carmustine (BCNU), doxorubicin, and prednisone (VBAP). The sub-group of 77 patients who could have been candidates for early intensification with HDT followed by stem-cell support (ie, &lt; 65 years of age, stage II or III disease, performance status &lt; 3, and objective or partial response to initial chemotherapy) are the subjects of this report. RESULTS Seventy-seven of 487 patients could have been candidates for early intensification. The median age was 56 years (range, 27 to 64). At diagnosis, 12% had abnormal renal function, 16% hypercalcemia, and 42% serum beta 2-microglobulin level &gt; or = 6 mg/L; 62% had stage III disease at diagnosis. Thirty-six patients were initially treated with MP and 41 with VCMP/VBAP. The median response duration to initial chemotherapy was 22 months, and the actuarial probability of being in continued first response at 5 years was 14%. After a median follow-up time of 58 months, 59 patients have died, one was lost to follow-up evaluation, and 17 are still alive 69 to 119 months after initial chemotherapy. The median survival time from initiation of treatment was 60 months and from the time when autotransplantation would be considered, 52 months. The only independent prognostic parameter for survival was renal function at diagnosis. CONCLUSION The median survival time of patients with MM who are less than 65 years of age and who respond to initial chemotherapy is 5 years. This survival duration is similar to that reported in selected series of patients given early HDT and stresses the importance of ongoing randomized trials to determine the role of HDT in the treatment of younger myeloma patients.
Severe Cavitary, Fistulating <i>Mycobacterium avium–intracellulare</i> Complex Disease in an Immunocompetent Host
Authors: Sarah L. O’Beirne, Joanna G. Escalon, Shabnam Momtahen, Erika Hissong, Jeffrey L. Port, Edward J. Schenck, Alan C. Legasto, Robert J. Kaner
Journal: American Journal of Respiratory and Critical Care Medicine (2015)
Low muscle mass is a strong predictor for osteoporosis in smokers with or without COPD
Authors: Miek Hornikx, Hans Van Remoortel, Heleen Demeyer, Kristien De Bent, Marc Decramer, Thierry Troosters, Wim Janssens
Journal: European Respiratory Journal (2013)

Rationale  Reduced bone mineral density (BMD) is used to define osteopenia and osteoporosis. It is unclear if loss of bone mass exists in early COPD and if sarcopenia predisposes osteopenia and osteoporosis in early COPD.  Methods  132 (ex)-smokers were stratified by spirometry in COPD and smoking controls (SC). DXA scan measured femoral neck (FN), total femur (TF) and lumbar spine BMD. Low BMD (LBMD) was defined as T-score  Results  Significant correlations were found between BMD and RASM (Figure1) and between sarcopenia and BMD (FNBMD: R=-0.25; p=0.004; TFBMD: R=-0.26; p=0.004; SBMD: R=-0.20; p=0.02). MW can act as an alternative for sarcopenia since they are correlated. (R=0.23; p=0.008). Multivariate linear regression confirmed MW to be associated with TFBMD (p=0.09), independently of COPD.  Conclusion  In (ex)-smokers, BMD is associated with MW, independently of COPD. In patients with sarcopenia, training may induce additional health benefits for bone and muscle mass.
COPD case-finding application: SYNERGY project
Authors: Claudia Vargas, Filip Velickovski, Felip Burgos, Albert Alonso, Luigi Ceccaroni, Josep Roca
Journal: European Respiratory Journal (2013)

Background-The Synergy-COPD project aims at exploring underlying mechanisms of heterogeneities seen in COPD patients. The project develops subject-specific predictive modelling to enhance patient stratification and case management. The results are feeding Clinical Decision Support Systems (CDSS) integrated into an open Information and Communication Technological (ICT) platform supporting coordinated care for chronic patients. Underdiagnosis of COPD is a well identified problem with a high impact on preventive strategies targeting early disease stages.  Aims-To develop and assess a CDSS designed to support a community-based COPD case-finding program linking pharmacy offices and primary care physicians. The study addressed usability and diagnostic efficacy of the CDSS.  Method- Modified Nielsen9s heuristics and Multiple Heuristic Evaluation Table were used with 7 pharmacists and 3 primary care physicians. Three reported studies (n=2.925), including a cohort of reference subjects, a COPD case finding study (FarmaEPOC) and the PAC_COPD cohort were used to compare between a fixed FEV1/FVC ratio of 0,70 (GOLD) against LLN-FEV1/FVC ratio of selected reference equations.  Results – CDSS assessment showed achievement of most of the selected heuristics (95%) and t minimal correctable errors. The fixed-ratio overestimated COPD diagnosis by an average of 23% compared with selected reference equations.  Conclusion- The CDSS showed usability, applicability and acceptability by health professionals. The use of LLN-FEV1/FVC is highly advised. The results allow for extensive deployment of the ICT-supported COPD case-finding program.  Supported by Synergy-COPD (FP7-ICT-270086) and PITES (FIS-PI09/90634).
Dynamic preferences for site of death among patients with advanced chronic organ failure
Authors: Daisy Janssen, Martijn Spruit, Jos Schols, Emiel Wouters
Journal: European Respiratory Journal (2012)

Background: Being able to die at the preferred site is seen as a key principle of a good death. Aims of this study were to assess 1-year stability and determinants of preferences for site of death among patients with advanced COPD, Chronic Heart Failure (CHF), or Chronic Renal Failure (CRF) and to assess agreement between the actual site of death and the site patients indicated in advance as their preferred site.

Methods: 265 outpatients (105 COPD; 80 CHF; 80 CRF) were recruited. 206 patients (77.7%; 67.2 (13.1) years; 64.1% male) completed 1-year follow-up. Patients were visited at baseline, 4, 8, and 12 months to assess the preferred site of death. Patient characteristics were recorded. A bereavement interview was done with the closest relative of patients who died within 2 years after baseline (n=66, 24.9%) to assess actual site of death.

Results: At baseline, 106 patients (51.5%) preferred to die at home, 61 (29.6%) at the hospital, 21 (10.2%) at a care home or hospice and 18 (8.7%) did not know. Patients living with a partner were more likely to prefer to die at home (OR 3.21 (1.73-5.92)). During 1 year, 61.2% of the patients changed their preference for site of death. During the interview before their death, 34 patients (51.5%) preferred to die at home; 22 (33.3%) at the hospital; 8 (12.2%) at a care home or hospice and 2 (3.0%) did not know. 57.6% died at the hospital, 27.3% at home and 39.4% died at the preferred site (Kappa 0.07, p=0.42).

Conclusions: Although most patients preferred to die at home, the majority died in the hospital. Only 39% of the patients died in the preferred site. However, 61% of the patients changed their preference for site of death at least once during 1 year.