tbuckley/cabot-search huggingface dataset:
Can controlled oxygen be safely given in the home environment
Authors: Philip Mitchelmore, Rahul Shrimanker, Graham McClue, Justin Pepperell
Journal: European Respiratory Journal (2012)

Introduction  Long term oxygen therapy is a widely used treatment in end stage COPD. Uncontrolled oxygen therapy can be dangerous due to CO2 retention. In hospital these patients would often receive controlled oxygen via Venturi mask systems (VMS). Historically VMS have not been used in the community as they may cause concentrators to alarm and may not deliver an accurate FiO2. With newer concentrators and VMS available, we wanted to know if accurate FiO2 could now be practically delivered.  Aims  To compare the actual delivered oxygen concentration versus the manufacturers expected oxygen concentration through various combinations of VMS and oxygen concentrators.  Methods  We measured percentage oxygen output at manufacturers recommended flow rates via a concentrator. We tested three makes of VMS (Respironics, Salter Labs and Intersurgical) and 2 types of concentrator, the AirSep New Life Elite 0-5l/min and the AirSep VisionAire3 0-3 l/min. We also tested the VMS with the hospital oxygen supply.  Results  The average differences from the stated percentage for the 3 makes of VMS via the concentrators were 2.2% (Respironics), 1.4% (Salter labs) and 1.1% (Intersurgical). For walled oxygen it was 4.2%, 0.3% and 1.6%. Some combinations of oxygen source and VMS delivered oxygen that was higher than expected. This occurred in 45% of cases via the concentrator and 81.8% of cases via the walled oxygen. For all VMS the oxygen percentage delivered was lower or equal when using concentrators than from the wall oxygen source. The use of VMS with oxygen concentrators did not trigger the devices used to alarm.  Conclusion  Oxygen delivered by a VMS and a home concentrator appears safe compared to controlled oxygen in hospital.
Decreased Caudate Volume in Neuroleptic-Naive Psychotic Patients
Authors: Matcheri S. Keshavan, David Rosenberg, John A. Sweeney, Jay W. Pettegrew
Journal: American Journal of Psychiatry (1998)

Previous studies, mostly involving neuroleptic-treated patients, have suggested enlarged basal ganglia size in schizophrenia. The authors sought to examine basal ganglia volume in neuroleptic-naive psychotic patients.Magnetic resonance imaging volumetric studies were conducted in newly diagnosed neuroleptic-naive schizophrenic and non-schizophrenic psychotic patients and in matched healthy comparison subjects.Both patient groups had bilaterally reduced caudate, but not putamen, volumes, compared to the healthy subjects, after adjustment for intracranial volume.Decreases in caudate volume in newly diagnosed psychotic patients may be related to the primary pathophysiology of these disorders; prior observations of increased caudate volume may reflect effects of neuroleptic treatment.
Total Direct Medical Expenses and Characteristics of Privately Insured Adolescents Who Incur High Costs
Authors: Susan H. Gray, Emily K. Trudell, S. Jean Emans, Elizabeth R. Woods, Jay G. Berry, Louis Vernacchio
Journal: JAMA Pediatrics (2015)

IMPORTANCEAccountable care payment models aim to reduce total direct medical expenses for high-cost patients through improved quality of care and preventive health services.Little is known about health care expenditures of privately insured adolescents, especially those who incur high costs.OBJECTIVES To assess health care expenditures for high-cost adolescents and to describe the patient characteristics associated with high medical costs.DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort analysis was conducted of data from January 1 to December 31, 2012, of 13 103 privately insured adolescents aged 13 to 21 years (mean [SD] age, 16.3 [2.4] years; 6764 [51.6%] males) at 82 independent pediatric primary care practices in Massachusetts.Analysis was conducted from April 1, 2014, to April 1, 2015. MAIN OUTCOMES AND MEASURESWe compared demographic (age, sex, median income by zip code) and clinical (obesity, behavioral health problem, complex chronic condition) characteristics between high-cost (top 1%) and non-high-cost adolescents.We assigned high-cost adolescents to clinical categories using software from the Agency for Healthcare Research and Quality to describe clinically relevant patterns of spending. RESULTSTotal direct medical expenses were $41.2 million for the entire cohort and a median $1167 per patient.A total of 132 (1.0%) patients with the highest costs accounted for 23.6% of expenses of the cohort, with a median $52 577 per patient.Mental health disorders were the most common diagnosis in high-cost patients; 78 (59.1%) of these patients had at least 1 behavioral health diagnosis.Pharmacy costs accounted for 28.4% of total direct medical expenses of high-cost patients; primary care accounted for 1.0%.Characteristics associated with being a high-cost patient included having 1 complex chronic condition (relative risk [RR], 6.5; 95% CI, 4.7-9.0),having 2 or more complex chronic conditions (RR, 23.5; 95% CI, 14.2-39.1),having any behavioral health diagnosis (RR, 3.6; 95% CI, 2.6-5.1), and obesity (RR, 2.0; 95% CI, 1.3-3.0). CONCLUSIONS AND RELEVANCETotal direct medical expenses for privately insured high-cost adolescents are associated with medical complexity, mental health conditions, and obesity.Cost reduction strategies in similar populations should be tailored to these cost drivers.
Intrapericardial tetracycline sclerosis in the treatment of malignant pericardial effusion: an analysis of thirty-three cases.
Authors: S Davis, P Rambotti, F Grignani
Journal: Journal of Clinical Oncology (1984)

Thirty-three unselected patients with cardiac tamponade secondary to malignant pericardial effusion were treated by intrapericardial instillation of tetracycline hydrochloride. Complete control of the initial signs and symptoms of tamponade was obtained in 30 patients without concomitant chemotherapy or radiotherapy. The procedure did not result in clinically significant complications. Failure of the technique was related to premature removal of the catheter by the patient (one patient) or the inability to totally remove hemorrhagic, clot-filled pericardial fluid (two patients). Survival ranged between 28-704 days and extended survival was related to the performance status and/or chemoradiosensitivity of the primary cancer. No patient successfully treated subsequently developed recurrent cardiac tamponade or alternatively, constrictive pericarditis. Tetracycline pericardial instillation remains a safe, simple, and efficacious treatment of tamponade secondary to malignant disease.
Expression of tachykinins and their receptors in plaque psoriasis with pruritus
Authors: B. Amatya, H. El-Nour, M. Holst, E. Theodorsson, K. Nordlind
Journal: British Journal of Dermatology (2011)

BACKGROUND Various mediators of pruritus have been suggested that might be responsible for the mechanism of pruritus in psoriasis.To study the expression levels of members of the tachykinin family, substance P and neurokinin (NK) A and their receptors, NK-1 and NK-2, in psoriasis and to correlate their expression with the intensity of pruritus. A possible correlation with chronic stress and depression was also evaluated.Biopsies were obtained from 28 patients with chronic plaque psoriasis; the majority had pruritus. The samples were taken from lesional and nonlesional areas on the back and also from 10 healthy controls, for immunohistochemistry staining, and from lesional skin for radioimmunoassay. Prior to biopsy, the clinical severity of the psoriasis of each patient was assessed by the Psoriasis Area and Severity Index (PASI) and the intensity of pruritus was measured by using a visual analogue scale (VAS). Levels of depression and stress were measured using Beck's Depression Inventory (BDI) and the salivary cortisol test, respectively.Substance P-, NKA- and NK-2 receptor-immunoreactive nerves, and non-neuronal inflammatory cells positive for substance P and NKA and their respective receptors, NK-1 and NK-2, were numerous in psoriasis compared with healthy controls. The numbers of substance P-positive nerves and NK-2 receptor-positive cells in lesional skin were significantly correlated to pruritus intensity. The cortisol ratio was inversely correlated with the number of NK-1 receptor-immunoreactive inflammatory cells in lesional and nonlesional psoriasis skin. There was also a positive correlation between the BDI score and the number of substance P-positive cells in nonlesional skin and with NK-1 receptor-positive cells in lesional and nonlesional skin.Tachykinins may play a role in psoriasis per se, in addition to pruritus in this disease. Targeting the combined NK-1 and NK-2 receptors might be a possible treatment.
Antibodies against Nuclear Components in Schistosomiasis
Authors: G. Bendixen, T. Hadidi, R. Manthorpe, H. Permin, J. Struckmann, A. Wiik, M. Zaghloui
Journal: Allergy (1984)

Occurrence of autoantibodies against nuclear material was compared in groups of patients with rheumatoid arthritis (RA n = 22), systemic lupus erythematosus (SLE n = 24), osteoarthrosis (OA n = 25), and chronic schistosomiasis mansoni (CSM n = 28). Anti-ds DNA antibody was detected by an ammonium sulphate precipitation radioimmunoassay antibodies against extractable nuclear antigen (ENA) were detected and differentiated in RNAse-resistant and RNAse-sensitive components (Sm and RNP antigens) with an ELISA technique. IgG organ-non-specific and granulocyte-specific antinuclear antibodies (ANA) were detected by immunofluorescence technique with quantitative titration of positive reactions and determination of complement-fixing properties. The results in groups of patients with SLE, RA and OA were of confirmative nature and supported that the different methods detect different systems of autoantibodies and nuclear autoantigens. In CSM it was demonstrated that 23 of 28 cases had positive reactions to the RNAse-resistant part of ENA (the Sm-antigen), a significant difference from the three other groups of patients (P less than 0.001). The antibody was in all cases of IgM class, in seven cases also of IgA class. Antibodies against nuclear material in CSM are probably a consequence of heavy disturbance of the immune system in this chronic infection with great permanent antigen load. It is a matter of discussion, whether production of these antibodies is induced by nuclear material from the host or from the parasite.
Access to bone marrow transplantation for leukemia and lymphoma: the role of sociodemographic factors.
Authors: J M Mitchell, K R Meehan, J Kong, K A Schulman
Journal: Journal of Clinical Oncology (1997)

Use of bone marrow transplantation (BMT), a complex, costly treatment for many forms of cancers, has increased significantly in recent years. The increasingly competitive health care marketplace raises concerns about patient access to costly medical procedures such as BMT. We attempted to evaluate patient access to BMT for the treatment of leukemias and lymphomas.We analyzed inpatient hospital discharge data from four states (California, Maryland, Massachusetts, and New York) for 2 years (1988 and 1991) to examine whether the use of BMT for patients with either leukemia or lymphoma varies by sociodemographic characteristics and insurance coverage. We developed a sorting algorithm to collapse the discharge data into patient level records. We used logistic regression to analyze the odds of receiving a BMT stratified by disease type (leukemia or lymphoma).After controlling for other factors, black patients with leukemia are 51% to 53% as likely as whites, while black patients with lymphoma are 34% to 45% as likely as white patients to undergo a BMT (P < .05). Medicaid, self-pay patients, and Health Maintenance Organization (HMO) enrollees with either leukemia or lymphoma are significantly less likely to undergo a BMT compared with patients with private insurance. Younger patients are significantly more predisposed to undergo a BMT than older patients. The odds of receiving a BMT have increased over time, but the rates of increase vary by state. Consistent with clinical expectations, the relative odds of BMT vary significantly by type of leukemia or lymphoma.Substantial variation exists in access to BMT for patients with either leukemia or lymphoma. Black patients, those enrolled in HMOs, those covered by Medicaid, and self-pay patients were less likely to receive a BMT when admitted for either leukemia or lymphoma. These findings raise concerns about access to cancer treatments for patients in the current health care system.
A Significant Metabolic and Radiological Response after a Novel Targeted MicroRNA-based Treatment Approach in Malignant Pleural Mesothelioma
Authors: Steven C. Kao, Michael Fulham, Kirby Wong, Wendy Cooper, Himanshu Brahmbhatt, Jennifer MacDiarmid, Scott Pattison, Jin Og Sagong, Yennie Huynh, Felicity Leslie, Nick Pavlakis, Stephen Clarke, Michael Boyer, Glen Reid, Nico van Zandwijk
Journal: American Journal of Respiratory and Critical Care Medicine (2015)
Coronary Artery Reperfusion
Authors: W. R. Ginks, H. D. Sybers, P. R. Maroko, J. W. Covell, B. E. Sobel, J. Ross
Journal: Journal of Clinical Investigation (1972)

The question of whether or not the size of an area of myocardial infarction, measured at 1 wk after coronary occlusion, can be influenced by coronary artery reperfusion was examined in dogs. In seven control experiments the anterior descending coronary artery was ligated, while in seven other studies the occlusion was released after 3 hr. In all animals calibrated photographs were used to assess the zone of hypoperfusion and the acutely injured area of epicardial ST segment elevation, as well as the extent of damage at postmortem 1 wk later. In control dogs, the gross infarct size at postmortem averaged 63.8+/-7.3% of that predicted from the acutely injured zone. However, in reperfused hearts the average gross infarct size at 1 wk was only 10.2+/-4.4% of that predicted. Transmural specimens were obtained at autopsy for histology and measurement of myocardial creatine phosphokinase (CPK) activity from sites initially used for epicardial electrocardiography. In control animals, there was a direct relationship between the degree of ST segment elevation and the degree of cell necrosis in transmural histologic sections. ST segment elevation also predicted myocardial CPK (international units per milligram protein): log CPK = - 0.0613 ST + 1.17 (r = 0.66, n = 56 sites). In the reperfused animals, log CPK = - 0.166 ST + 1.36 (r = 0.69, n = 46 sites) showing almost complete preservation of CPK activity at 1 wk, sparing being most prominent in the epicardial zone. Similarly, there was a good correlation between myocardial CPK activity and the histological assessment of cell destruction, the degree of cell damage = - 0.152 CPK + 3.86 (r = 0.86; n = 102 sites). Thus, control dogs showed severe myocardial CPK depletion and histologic evidence of extensive cell destruction, whereas animals subjected to coronary artery reperfusion had little CPK depletion and much less evidence of myocardial cell necrosis 1 wk later.
MicroRNA regulation of lymphocyte tolerance and autoimmunity
Authors: Laura J. Simpson, K. Mark Ansel
Journal: Journal of Clinical Investigation (2015)

Understanding the cell-intrinsic cues that permit self-reactivity in lymphocytes, and therefore autoimmunity, requires an understanding of the transcriptional and posttranscriptional regulation of gene expression in these cells. In this Review, we address seminal and recent research on microRNA (miRNA) regulation of central and peripheral tolerance. Human and mouse studies demonstrate that the PI3K pathway is a critical point of miRNA regulation of immune cell development and function that affects the development of autoimmunity. We also discuss how miRNA expression profiling in human autoimmune diseases has inspired mechanistic studies of miRNA function in the pathogenesis of multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, type 1 diabetes, and asthma.
Use of Preoperative Magnetic Resonance Imaging for Breast Cancer
Authors: Angel Arnaout, Christina Catley, Christopher M. Booth, Matthew McInnes, Ian Graham, Vikaash Kumar, Demetrios Simos, Carl Van Walraven, Mark Clemons
Journal: JAMA Oncology (2015)

<h3>Importance</h3> Contrary to practice guidelines, breast magnetic resonance imaging (MRI) is commonly used in the preoperative evaluation of women with breast cancer. While existing literature has found little benefit to MRI in most patients, potential downstream consequences associated with breast MRI are not well described. <h3>Objective</h3> To describe patterns of preoperative breast MRI utilization in a health care system with universal insurance and its association with downstream investigations and clinical outcomes. <h3>Design, Setting, and Participants</h3> This was a population-based retrospective cohort study using administrative heath care databases in Ontario, Canada (2012 population, 13.5 million) over 14 geographic regions were evaluated within the data set. Participants comprised 53 015 patients with primary operable breast cancer treated from 2003 to 2012. <h3>Main Outcomes and Measures</h3> Use of preoperative breast MRI by year, geographic region, and breast cancer stage. Postdiagnosis imaging, biopsy, and short-term surgical outcomes were also evaluated between those who did and did not receive MRI. <h3>Results</h3> Overall, 14.8% of patients (7824 of 53 015) had a preoperative MRI. During the 10-year study period, MRI use increased across all stages by 8-fold (from 3% to 24%;<i>P</i> &lt; .001 for trend). Factors associated with MRI use were younger age, higher socioeconomic status, higher Charlson comorbidity score, surgery performed in a teaching hospital, and fewer years of surgeon experience. Multivariate analyses showed that preoperative breast MRI was associated with higher likelihood of the following: postdiagnosis breast imaging (odds ratio [OR], 2.09; 95% CI, 1.92-2.28), postdiagnosis breast biopsies (OR, 1.74; 95% CI, 1.57-1.93), postdiagnosis imaging to assess for distant metastatic disease (OR, 1.51; 95% CI, 1.42-1.61), mastectomy (OR, 1.73; 95% CI, 1.62-1.85), contralateral prophylactic mastectomy (OR, 1.48; 95% CI, 1.23-1.77), and a greater than 30-day wait to surgery (OR, 2.52; 95% CI, 2.36-2.70) (all ORs are adjusted). <h3>Conclusions and Relevance</h3> Preoperative breast MRI use has increased substantially in routine clinical practice and is associated with a significant increase in ancillary investigations, wait time to surgery, mastectomies, and contralateral prophylactic mastectomies.
Underascertainment of Acute Hepatitis C Virus Infections in the U.S. Surveillance System
Authors: Shauna Onofrey, Jasneet Aneja, Gillian A. Haney, Ellen H. Nagami, Alfred DeMaria, Georg M. Lauer, Kelsey Hills-Evans, Kerri Barton, Stephanie Kulaga, Melinda J. Bowen, Noelle Cocoros, Barbara H. McGovern, Daniel R. Church, Arthur Y. Kim
Journal: Annals of Internal Medicine (2015)

Background: In 2010, the incidence of hepatitis C virus (HCV) infection in the United States was estimated to be 17 000 cases annually, based on 850 acute HCV cases reported to the Centers for Disease Control and Prevention by local public health authorities. Absence of symptomatic disease and lack of a specific laboratory test for acute infection complicates diagnosis and surveillance. Objective: To validate estimates of the incidence of acute HCV infection by determining the reporting rate of clinical diagnoses of acute infection to the Massachusetts Department of Public Health (MDPH) and Centers for Disease Control and Prevention. Design: Case series and chart review. Setting: Two hospitals and the state correctional health care system in Massachusetts. Patients: 183 patients clinically diagnosed with acute HCV infection from 2001 to 2011 and participating in a research study. Measurements: Rate of electronic case reporting of acute HCV infection to the MDPH and rate of subsequent confirmation according to national case definitions. Results: 149 of 183 (81.4%) clinical cases of acute HCV infection were reported to the MDPH for surveillance classification. The MDPH investigated 43 of these reports as potential acute cases of HCV infection based on their surveillance requirements; ultimately, only 1 met the national case definition and was counted in nationwide statistics published by the Centers for Disease Control and Prevention. Discordance in clinical and surveillance classification was often related to missing clinical or laboratory data at the MDPH as well as restrictive definitions, including requirements for negative hepatitis A and B laboratory results. Limitation: Findings may not apply to other jurisdictions because of differences in resources for surveillance. Conclusion: Clinical diagnoses of acute HCV infection were grossly underascertained by formal surveillance reporting. Incomplete clinician reporting, problematic case definitions, limitations of diagnostic testing, and imperfect data capture remain major limitations to accurate case ascertainment despite automated electronic laboratory reporting. These findings may have implications for national estimates of the incidence of HCV infection. Primary Funding Source: National Institutes of Health.
Evolution of cellular inflammatory pattern in induced sputum in patients with mild-moderate asthma for five years
Authors: Elena Forcen, Elisabet Vera, Angela Fernandez, Jose Angel Carretero, Juan Antonio Domingo, Enrique Chacon, Salvador Bello
Journal: European Respiratory Journal (2011)

Background: Prospective study of cellular inflammatory pattern in samples of induced sputum can identify inflammatory changes in the natural history of asthma. The aim of our study is to know whether there are modifications of cellular inflammatory pattern in mild-moderate asthma along 5 years.

Materials and methods: The patients with mild- moderate asthma were studies along 5 years.

The outcomes were: lung function FEV1 (% pred), no. exacerbations/year (EY), use of relief therapy (RT), dose of inhaled corticosteroid/day (ICs), bacterial and viral cultures and total and differential cell count in induced sputum.

Cellular inflammatory pattern was classified as eosinophilic (>2% of eosinophils), neutrophilic (>61% of neutrophils), paucigranulocytic ( 2% eosinophils and > 61% neutrophils).

Results: The study began with 24 patients and in 18 we repeated the induced sputum 5 years after. The profitability were of 100%. 55% showed the same cellular inflammatory pattern in the sputum (11% eosinophilic, 11% neutrophilic y 33% paucigranulocytic). In 45% were found out differents patterns; 11% benign forms (paucigranulocytic), 22%agressive forms (neutrophilic, eosinophilic o mixted) and a 11% changed the inflammatory pattern but with agressive forms too.

Conclusions: In stable patients with mild- moderate asthma, the most recurrent inflammatory pattern is thepaucigranulocytic.The positivity of bacterial cultures in sputum may be the cause of the changes in the induced sputum to agressive forms.Nonsignificant changes towards neutrophilic patterns have been observed that warrant further study in larger groups.