tbuckley/cabot-search huggingface dataset:
Changes in Weight, Body Composition, and Factors Influencing Energy Balance Among Premenopausal Breast Cancer Patients Receiving Adjuvant Chemotherapy
Authors: Wendy Demark-Wahnefried, Bercedis L. Peterson, Eric P. Winer, Lawrence Marks, Noreen Aziz, P. Kelly Marcom, Kimberly Blackwell, Barbara K. Rimer
Journal: Journal of Clinical Oncology (2001)

PURPOSE: Weight gain is a common problem among breast cancer patients who receive adjuvant chemotherapy (CT). We undertook a study to determine the causes of this energy imbalance. PATIENTS AND METHODS: Factors related to energy balance were assessed at baseline (within 3 weeks of diagnosis) and throughout 1 year postdiagnosis among 53 premenopausal women with operable breast carcinoma. Thirty-six patients received CT and 17 received only localized treatment (LT). Measures included body composition (dual energy x-ray absorptiometry), resting energy expenditure (REE; indirect calorimetry), dietary intake (2-day dietary recalls and food frequency questionnaires) and physical activity (physical activity records). RESULTS: Mean weight gain in the LT patients was 1.0 kg versus 2.1 kg in the CT group (P = .02). No significant differences between groups in trend over time were observed for REE and energy intake; however, a significant difference was noted for physical activity (P = .01). Several differences between groups in 1-year change scores were detected. The mean change (± SE) in LT versus CT groups and P values for uncontrolled/controlled (age, race, radiation therapy, baseline body mass index, and end point under consideration) analysis are as follows: percentage of body fat (−0.1 ± 0.4 v +2.2 ± 0.6%; P = .001/0.04); fat mass (+0.1 ± 0.3 v +2.3 ± 0.7 kg; P = .002/0.04); lean body mass (+0.8 ± 0.2 v −0.4 ± 0.3 kg; P = .02/0.30); and leg lean mass (+0.5 ± 0.1 v −0.2 ± 0.1 kg; P = .01/0.11). CONCLUSION: These data do not support overeating as a cause of weight gain among breast cancer patients who receive CT. The data suggest, however, that CT-induced weight gain is distinctive and indicative of sarcopenic obesity (weight gain in the presence of lean tissue loss or absence of lean tissue gain). The development of sarcopenic obesity with evidence of reduced physical activity supports the need for interventions focused on exercise, especially resistance training in the lower body, to prevent weight gain.
Risks of general anaesthesia in people with obstructive sleep apnoea
Authors: Cindy den Herder, Joachim Schmeck, Dick J K Appelboom, Nico de Vries
Journal: BMJ (2004)

Sleep is an integral part of human existence and is now, more than ever, the subject of clinical and research interest. Why do we spend approximately one third of our lives asleep? Sleep probably has a recovery function, especially for the brain. Throughout rapid eye movement sleep, neuronal connections in the catecholamine system are created, and this activity is essential to maintain cognitive function.w1 During rapid eye movement sleep in particular, the body is at its most relaxed state, and a three dimensional collapse of muscle (musculus genioglossus and musculus geniohyoideus) and fatty tissue around the upper airway may cause obstruction.1 When a pre-existent narrowing and slackening of the upper airway is also present,2 apnoeas (complete cessation of breathing for 10 seconds or more) or hypopnoeas (> 50% diminishing of airflow or oxygen desaturations > 3% for 10 seconds or more) may result. The prevalence of obstructive sleep apnoea in middle age is 2% for women and 4% for men.3 In practice, obstructive sleep apnoea seems to be under-reported; obstructive sleep apnoea is undiagnosed in an estimated 80% of patients.4

Patients with obstructive sleep apnoea are particularly vulnerable during anaesthesia and sedation.5 w2 This is not only the case for operations or other invasive interventions aiming at alleviation of obstructive sleep apnoea through reduction of the obstructive upper airway; even after surgery not related to obstructive sleep apnoea, such as hip and knee operations, patients with obstructive sleep apnoea are at risk of developing respiratory and cardiopulmonary complications postoperatively. Serious complications include reintubations and cardiac events.6 Anaesthetic management must focus on and deal with the increased likelihood of morphological alterations of the upper airway leading to an increased rate of difficulties in securing and maintaining a patent airway.7

In this review we …
Comorbitities, responses and survival in pts with NSCLC
Authors: Maria Papaioannou, Efimia Boutsikou, Paul Zarogoulidis, Sofia Lampaki, Kostas Porpodis, Dionisios Spyratos, Ellada Eleftheriadou, Kostas Zarogoulidis
Journal: European Respiratory Journal (2014)

INTRODUCTION:  Treatment of NSCLC depends upon the cell subtype, tumor stage, molecular characteristics and assessment of patient9s medical condition. The purpose of this study was to evaluate comorbitities, tumor response and survival of pts treated with 1 st  and 2 nd  line chemotherapy(CHT).   METHODS:  1519 pts first diagnosed with NSCLC, with non-operable stage IIIa, IIIb and IV, received 1 st  line platinum based CHT for up to six cycles. 1110 pts continued with follow up or best supportive care(BSC) if needed and 409 pts who progressed after the completion of1 st  line CHT were treated with 2 nd  line CHT at the time of progression: 225/409 pts received taxanand carboplatin(CP), 85/409 pts received CP and other than taxan agent,59/409 received taxan and other than CP agent and 40/409 received agents other than taxan and CP (biological agents).   RESULTS:  Pts administered 2 nd  line CHT lived significantly longer with median survival 27 months(mo) compared to10 mo in pts with BSC only (p nd  line CHT lived 31 mo(95% CI 35-26) vs 48 mo in CP-non taxan group (95% CI 25-68), statistically not significant (p=0.08) vs 18 mo in taxan-non CP group(95% CI 14-22), statistically significant (p st  line CHT and 5 % for 2 nd  line. The most common concomitant diseases were cardiovascular diseases (44%) and diabetes mellitus(23.5%).   CONCLUSIONS:  Initial management of NSCLC is largely determined by the stage of disease and the comorbitities. However, generally requires the sequential use of systemic therapies in an effort to prolong overall survival.
Abstract 16823: Care Standardization in the Cardiac Surgical Intensive Care Unit: Clinical Outcome and Value
Authors: Juan N Pulido, David J Cook, Jeffrey E Thompson, Thor Sundt, Thomas R Rohleder, Veronique L Roger
Journal: Circulation (2011)

Objective : Practice analysis of cardiac surgical service lines suggested that, for patients having routine cardiac surgery, standardization of care processes in the ICU could reduce cost and improve outcomes. We tested this hypothesis in a large surgical practice. Methods : Patients eligible for a standardized care pathway were prospectively identified preoperatively. ICU protocol development and practice redesign occurred in 2009 with implementation in 2010. In the ICU, all major process steps to recovery were managed by tiered and integrated protocols whereby care advancement is the default if clinical criteria are met. We compared outcomes of patients managed by protocol to those managed by standard care. ICU metrics (time intubated, drip weaning, length of stay) were benchmarked against a sample of 65 CABG patients from 2008. Return to ICU and to OR for standardized care patients were compared to concurrent patients under routine care. We report on all patients having cardiac surgery for 12 months beginning March 2010. Findings : Over 12 months, the ICU care of 1289 patients followed standardized tiered protocols, while 1309 patients were managed by standard care. After implementation of standardized protocols, ICU metrics improved in protocol patients relative to 2008 (2010 versus 2008): mean intubation time in hours (7.4 vs 11.6), mean time on hemodynamic drips in hours (16.2 vs 25.3), average ICU length of stay in hours (25.1 vs 35.9). The safety of protocol based care is demonstrated by lower rates of return to ICU and to OR among patients under protocol vs non-protocol: return to OR (1.8% vs 8.9%), return to ICU (1.6% vs 6.2%). Conclusions: With proper patient selection and rigorous protocols that make care advancement the default, cardiac surgical care in the ICU can be standardized and clinical metrics improved. The safety of this strategy is demonstrated by very low rates of return to OR or ICU. This practice model is translatable to other ICU practices.
Effect of oral high frequency oscillation
Authors: M van Henstrum, J Festen, C Beurskens, M Hankel, W van den Broek, F Corstens
Journal: European Respiratory Journal (1991)

Laros et al. state -probably on the basis of experience in one patient that oral high frequency oscillation (OHFO) combined with forced expiration manoeuvres on tracheobronchial clearance is disappointing in patients with flaccid lungs.Their letter to the editor suggests that our conclusions, meaning that OHFO combined with forced expiration manoeuvres is inefficient, could not be made because the pulmonary compliance of our patients is unknown.Although we did not measure the compliance, it is hard to believe that patients with this minor degree of airway obstruction have flaccid lungs.Other lung function data, like TLC, FRC, RV or the different between FEV 1 and FIV 1 , as indications for flaccid lungs, did support this.After OHFO there was no increase in TLC or RV, measured by body plethysmography and helium-equilibration method.The method used by Laros et al. is different from the method used in our study.The influence of the oral cavity can be important because of its flaccidity, as stated by Laros.Since
Positron emission tomography with 5-hydroxytryprophan in neuroendocrine tumors.
Authors: H Orlefors, A Sundin, H Ahlström, P Bjurling, M Bergström, A Lilja, B Långström, K Oberg, B Eriksson
Journal: Journal of Clinical Oncology (1998)

PURPOSE Carcinoid tumors, especially those of midgut origin, produce serotonin via the precursors tryptophan and 5-hydroxytryptophan (5-HTP). We have evaluated the usefulness of positron emission tomography (PET) with carbon-11-labeled 5-HTP in the diagnosis and treatment follow-up evaluation of patients with neuroendocrine tumors. PATIENTS AND METHODS PET using 11C-labeled 5-HTP was compared with computed tomography (CT) in 18 patients (14 midgut, one foregut, one hindgut carcinoid, and two endocrine pancreatic tumors [EPT]). In addition, 10 of 18 patients were monitored with PET examinations during treatment. RESULTS All 18 patients, including two with normal urinary 5-hydroxyindole acetic acid (U-5-HIAA), had increased uptake of 11C-labeled 5-HTP in tumorous tissue as compared with normal tissue. Liver metastases, as well as lymph node, pleural, and skeletal metastases, showed enhanced 5-HTP uptake and PET could detect more lesions than CT in 10 patients and equal numbers in the others. Tumor visibility was better for PET than for CT due to the high and selective uptake of 5-HTP with a high tumor-to-background ratio. Binding studies indicated an irreversible trapping of 5-HTP in the tumors. Linear regression analyses showed a clear correlation (r = .907) between changes in U-5-HIAA and changes in the transport rate constant for 5-HTP during treatment. CONCLUSION PET with 11C-labeled 5-HTP demonstrated high uptake in neuroendocrine gastrointestinal tumors and thereby allowed improved visualization compared with CT. The in vivo data on regional tumor metabolism, as expressed in 11C-5-HTP uptake and transport rate, provided additional information over conventional radiologic techniques. The close correlation between the changes in 11C-5-HTP transport rate and U-HIAA during medical treatment indicates the potential of 11C-5-HTP-PET as a means to monitor therapy.
Racial Differences in the Surgical Care of Medicare Beneficiaries With Localized Prostate Cancer
Authors: Marianne Schmid, Christian P. Meyer, Gally Reznor, Toni K. Choueiri, Julian Hanske, Jesse D. Sammon, Firas Abdollah, Felix K. H. Chun, Adam S. Kibel, Reginald D. Tucker-Seeley, Philip W. Kantoff, Stuart R. Lipsitz, Mani Menon, Paul L. Nguyen, Quoc-Dien Trinh
Journal: JAMA Oncology (2015)

There is extensive evidence suggesting that black men with localized prostate cancer (PCa) have worse cancer-specific mortality compared with their non-Hispanic white counterparts.To evaluate racial disparities in the use, quality of care, and outcomes of radical prostatectomy (RP) in elderly men (≥ 65 years) with nonmetastatic PCa.This retrospective analysis of outcomes stratified according to race (black vs non-Hispanic white) included 2020 elderly black patients (7.6%) and 24,462 elderly non-Hispanic white patients (92.4%) with localized PCa who underwent RP within the first year of PCa diagnosis in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1992 and 2009. The study was performed in 2014.Process of care (ie, time to treatment, lymph node dissection), as well as outcome measures (ie, complications, emergency department visits, readmissions, PCa-specific and all-cause mortality, costs) were evaluated using Cox proportional hazards regression. Multivariable conditional logistic regression and quantile regression were used to study the association of racial disparities with process of care and outcome measures.The proportion of black patients with localized prostate cancer who underwent RP within 90 days was 59.4% vs 69.5% of non-Hispanic white patients (P < 001). In quantile regression of the top 50% of patients, blacks had a 7-day treatment delay compared with non-Hispanic whites. (P < 001). Black patients were less likely to undergo lymph node dissection (odds ratio [OR], 0.76 [95% CI, 0.66-0.80]; P < .001) but had higher odds of postoperative visits to the emergency department (within 30 days: OR, 1.48 [95% CI, 1.18-1.86]); after 30 days or more (OR, 1.45 [95% CI, 1.19-1.76]) and readmissions (within 30 days: OR, 1.28 [95% CI, 1.02-1.61]); ≥ 30 days (OR, 1.27 [95% CI, 1.07-1.51]) compared with non-Hispanic whites. The surgical treatment of black patients was associated with a higher incremental annual cost (the top 50% of blacks spent $1185.50 (95% CI , $804.85-1 $1566.10; P < .001) more than the top 50% of non-Hispanic whites). There was no difference in PCa-specific mortality (P = .16) or all-cause mortality (P = .64) between black and non-Hispanic white men.Blacks treated with RP for localized PCa are more likely to experience adverse events and incur higher costs compared with non-Hispanic white men; however, this does not translate into a difference in PCa-specific or all-cause mortality.
A phase II trial of PI-88, a novel antiangiogenic and antimetastatic heparanase inhibitor, in patients with advanced melanoma
Authors: D. B. Thomson, R. Gonzalez, M. Millward, T. Price, A. Haydon, W. Robinson, A. Powell, K. Roberts, B. Creese
Journal: Journal of Clinical Oncology (2005)

7559 Background: PI-88 is a novel anti-angiogenic drug, which acts by inhibiting heparanase and binding to pro-angiogenic growth factors. This pilot study is designed to evaluate the safety and efficacy of PI-88 in patients (pts) with advanced melanoma where other effective therapy is not available or has failed. Methods: PI-88 250 mg/day was administered by subcutaneous injection on four consecutive days every week in a 28-day cycle. Tumour lesions were measured after every second cycle. Results: Forty-four pts have been enrolled with the following demographics: M:F ratio = 30:14; median age = 59 (range 29–79); ECOG 0:1:2 ratio = 29:13:2. The number of prior chemotherapy/biochemotherapy treatments 0:1:2+ was 19:21:4. 11 pts had prior immunotherapy (vaccine or interferon). 41 pts were evaluable for efficacy. Only 5 pts experienced Gr 3/4 toxicities; these were were brain hemorrhage in one pt in cycle 1 (associated with cerebral metastasis), thrombocytopenia (TCP) in 2 pts in cycle 1, arterial thrombosis (AT) in one pt in cycle 2, and ALT elevation in one pt in cycle 2. AT and one case of TCP were associated with development of antibodies that cross-reacted with heparin-platelet factor 4. Preliminary evaluation of efficacy based on investigator assessments was as follows: two PRs were observed after 4 cycles (one confirmed), and another 3 pts had SD after 6 cycles. Disease sites in pts with PR were periurethral and inguinal node, and right neck and paraortic node, respectively. Another patient had stable or reduced lesions, except for one rapidly increasing cutaneous lesion; although this patient met the formal criteria for PD, he continued to receive PI-88 after resection of the expanding cutaneous lesion. Disease control rate, based on best overall response of PR or SD was 36%. Kaplan-Meier analysis of progression-free survival showed non-progression rate of 46%, 24% and 11% after 2, 4 and 6 cycles respectively. Three pts are still on study with SD (cycles 7, 7 and 11). Conclusions: PI-88 was well tolerated in patients with advanced melanoma. Preliminary efficacy data indicate that the drug is worthy of further investigation. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Progen Industries Ltd Progen Industries Ltd Progen Industries Ltd
Connective tissue disorders as the factor that changes clinical course of community-acquired pneumonia in children
Authors: Zoia Nesterenko, Olena Ivanina
Journal: European Respiratory Journal (2011)

Aim: To study peculiarities of clinical course of community-acquired pneumonia (CAP) in children with connective tissue disorders (CTD).

Methods: 64 children with CAP aged 1-18 were studied during one year. Patients were divided for analysis into two age groups: children aged 1-3 (group A, n = 16), and aged 4-18 (group B, n= 48). All patients had manifestations of CTD. CAP was clinically and radiographically diagnosed with detection of serum antibodies (IgG and IgM) against intracellular pathogens measured by enzyme-linked immunosorbent assay (ELISA).

Results: All patients had CAP caused by atypical pathogens with indistinct clinical manifestations and symptoms. Recurrent course of CAP was in 54 (84,4%) patients. CAP caused by Chlamydophilla pneumonia (Cp) was more frequent in group A – in 15 (93,7% of the group) patients. CAP caused by Mycoplasma pneumonia (Mp) was more frequent in group B - in 44 patients (91,6% of the group), in 6,8% - together with Cp, in 27,3% - with Cytomegalovirus. Asthma was diagnosed in 29 (45,3%) patients mainly of group B, with recurrent CAP in 10 (34,5% of patients with asthma); 62,1% of these children had pulmonary hypertension (PH). 44,4% of patients with PH had evidence of pulmonary fibrosis (PF), which led to pneumatocele (PC) in 27,7%, polyserositis (PS) in 11,1% and spontaneous pneumothorax (SP) in 3,4% of patients.

Conclusions: 1. Close relationship between CTD and CAP is revealed. 2. In children up to 3 years old Cp CAP was more frequent, in children aged 4-18 - Mp CAP. 3. More than one-third of patients with asthma had recurrent CAP. 4. Asthma in children with CAP and CTD was more severe with development of PH, PF, PS, SP.
La Belle Dame Sans Merci
Authors: Tamzin Cuming
Journal: BMJ (2007)

Keats, it is well known, had some medical training. He completed his house jobs at Guy's Hospital after becoming one of the first people to pass the licence of the Society of Apothecaries—a GP of the era. His experience of the family tuberculosis that would eventually kill him at the age of 25 and his early years of surgical assistance gave him knowledge and experience of death, the only clue to his medical background that can be seen in his work.

In La Belle Dame Sans Merci, an imitation of a medieval ballad, an alluring, otherworldly damsel has fatally tempted the “knight-at-arms” who is found, at the poem's beginning, “alone and palely loitering.” The narrator who addresses the opening line to the knight could be a medic taking a history—“Oh what can ail thee”—and goes on to a physical inspection of the lovelorn and possibly hallucinating knight (changed to “wretched wight,” or creature, for the first publication of the poem, perhaps to augment pity over the picturesque): “I see a lily on thy brow/With anguish moist and fever-dew.” The flower, a symbol of death, connects in the next line to another flower, a rose, seen fading on his cheeks, which “fast withereth too.” When consumption was at its height, the pallor of the skin was felt to be in beautiful contrast with the rosy cheeks. These changes, however attractive, Keats knew were a death warrant. Tuberculosis had no cure. Indeed it was steeped in mythology involving spirits and even vampires. 

The knight's reply to these inquiries—the rest of the poem—is his story of the faery lady, followed by his recounting a sinister dream populated by “pale warriors, death-pale were they all,” who inform him ghoulishly that “La Belle Dame Sans Merci/Hath thee in thrall.” He finishes by reflecting on his captive, hopeless state, repeating the famous first verse with a subtle change in rhythm, “And this is why I sojourn here/Alone and palely loitering/Though the sedge is withered from the lake/And no birds sing.” 

A mysterious poem of seemingly endless interpretations, it uses images of death to straddle the supernatural and make it eerily present. Keats, by his own account, was not the most attentive of students: “The other day, during the lecture, there came a sunbeam into the room, and with it a whole troop of creatures floating in the ray; and I was off with them to Oberon and fairy-land.” Eventually he deemed himself unfit for surgery, saying of his last operation, “The opening of a man's temporal artery . . . I did it with the utmost nicety, but reflecting on what passed through my mind at the time, my dexterity seemed a miracle, and I never took up the lancet again.” 

Not every desultory junior doctor has such insight. Keats was a doctor for whom medicine could not compete with poetry. Our literature is the greater for it. Few doctor writers found a balance as Chekhov did: “Medicine is my lawful wife, and literature my mistress; when I get tired of one, I spend the night with the other.”
Incidence and timing of hepatotoxicity due to anti-tuberculous treatment
Authors: Alice Shrestha, Paul Whitaker, Rose Mozdiak, Rizwan Ahmed, Muhammad Arif, Toby Capstick, John Watson
Journal: European Respiratory Journal (2011)

Hepatotoxicity is a life threatening complication of anti-tuberculous treatment. It is unclear how closely to monitor liver enzymes during treatment. In the absence of liver risk factors, the American Thoracic Society advises checking them if symptoms develop. The aim of this study was to assess the timing and causative factors associated with hepatotoxicity.

We reviewed patients treated for TB in Leeds between 2006 and 2010. Elevations of aminotransferase (ALT) greater than two times the upper limit of normal (ULN) were considered abnormal. Our local policy recommends that patients should have ALT checked at weeks 0, 2, 4 and 8.

634 patents underwent treatment for TB during this period. 46 (7.3%) patients had ALT rises two times ULN and 14 (2.2%) five times ULN. Interestingly, hepatotoxicity was more common in Caucasians (p=0.02) and increasing age (p=0.07). Gender, HIV status, pregnancy, and organs affected by TB did not predict hepatotoxicity. The average time for the hepatotoxicity to develop was 28 days (range 3-306); however, this time was increased to 42 days (4-306) in patients with ALT rises greater than five times ULN. Only one patient presented with clinical symptoms of hepatitis, this patient subsequently died from liver failure. In the 14 patients with rises five times ULN, the cause was felt to be pyrazinamide in 8, isoniazid in 3, rifampicin in 1, and not established in 2.

It is unknown whether identifying an elevated ALT and stopping treatment prior to symptoms reduces the severity of liver injury. We feel that careful biochemical monitoring and prompt cessation of treatment is appropriate. Only 2 patients developed hepatitis with ALT five times ULN at a time point beyond our 8 week protocol.