tbuckley/cabot-search huggingface dataset:
Primary Mediastinal Germ Cell Tumors in Children and Adolescents: Results of the German Cooperative Protocols MAKEI 83/86, 89, and 96
Authors: Dominik T. Schneider, Gabriele Calaminus, Harald Reinhard, Peter Gutjahr, Bernhard Kremens, Dieter Harms, Ulrich Göbel
Journal: Journal of Clinical Oncology (2000)

To evaluate children and adolescents with primary mediastinal teratoma and malignant germ cell tumors (GCTs).Forty-seven patients from the German nontesticular GCT studies were analyzed (median age, 2.5 years; range, neonate to 17 years). Teratoma (n = 21) were resected, and no adjuvant treatment was given. Malignant GCTs (n = 26) were treated with cisplatin-based chemotherapy and resection. Three of 26 patients underwent radiotherapy.In all patients with teratoma, tumor markers were normal. Surgery of teratoma was complete in 17 of 21 patients and microscopically incomplete in four of 21 patients, and we observed no relapse after a median follow-up of 29 months. In 23 of 26 patients with malignant GCTs, alpha-fetoprotein and/or beta-human chorionic gonadotropin were elevated. Twelve of 26 patients received adjuvant chemotherapy after initial resection, which was complete in six of 12 patients, whereas delayed resection after preoperative chemotherapy was complete in 10 of 11 patients (P =.03). Four of six patients underwent second-look thoracotomy after incomplete primary surgery. Three of 26 patients did not undergo tumor resection. The final completeness of resection was the strongest prognostic indicator (event-free survival ¿EFS, 0.94 +/- 0.06 v 0.42 +/- 0.33; P <.002). Local stage and distant metastases were not prognostically significant at the.05 level. For all malignant GCTs, the 5-year survival rate was 0.87 +/- 0.05 (median follow-up, 51 months), with an EFS of 0.83 +/- 0.05.The prognosis of mediastinal teratoma is excellent after complete or microscopically incomplete resection. In children with malignant GCT, the prognosis is favorable with a therapeutic strategy of delayed resection after preoperative chemotherapy. In most children, the diagnosis can be based on elevated tumor markers and imaging. Biopsy is indicated in nonsecreting GCT.
The risk of fall and fracture with the initiation of a prostate-selective α antagonist: a population based cohort study
Authors: Blayne Welk, Eric McArthur, Lisa-Ann Fraser, Jade Hayward, Stephanie Dixon, Y Joseph Hwang, Michael Ordon
Journal: BMJ (2015)

<b>Study question</b> Do men starting treatment with prostate-specific α antagonists have increased risk of fall and fracture? <b>Methods</b> Administrative datasets from the province of Ontario, Canada, that contain patient level data were used to generate a cohort of 147 084 men aged ≥66 years who filled their first outpatient prescription for prostate-specific α antagonists tamsulosin, alfuzosin, or silodosin between June 2003 and December 2013 (exposed men) plus an equal sized cohort matched 1:1 (using a propensity score model) who did not initiate α antagonist therapy. The primary outcome was a hospital emergency room visit or inpatient admission for a fall or fracture in the 90 days after exposure. <b>Study answer and limitations</b> The men exposed to prostate-specific α antagonist had significantly increased risks of falling (odds ratio 1.14 (95% CI 1.07 to 1.21), absolute risk increase 0.17% (0.08 to 0.25%)) and of sustaining a fracture (odds ratio 1.16 (1.04 to 1.29), absolute risk increase 0.06% (0.02 to 0.11%)) compared with the unexposed cohort. This increased risk was not observed in the period before α antagonist use. Secondary outcomes of hypotension and head trauma were also significantly increased in the exposed cohort (odds ratios 1.80 (1.59 to 2.03) and 1.15 (1.04 to 1.27) respectively). The two cohorts were similar across 98 different covariates including demographics, comorbid conditions, medication use, healthcare use, and prior medical investigation. Potential unmeasured confounders, such as physical deconditioning, mobility impairment, and situational risk factors, may exist. The data used to identify the primary outcomes had limited sensitivity, so the absolute risks of the outcomes are probably underestimates. The study only included men ≥66 years old, and 84% of exposed men were prescribed tamsulosin, so results may not be generalizable to younger men, and there may not be statistical power to show small differences in outcomes between the drugs. <b>What this study adds</b> Prostate-specific α antagonists are associated with a small but significant increased risk of fall, fracture, and head trauma, probably as a result of induced hypotension. <b>Funding, competing interests, data sharing</b> This project was conducted at the Institute for Clinical Evaluative Sciences (ICES) Western Site through the Kidney, Dialysis, and Transplantation (KDT) research program. BW has received a research grant from Astellas, and L-AF does consultancy for Amgen.
Lung function time change in infants born pretem with and without bronchopulmonary dysplasia
Authors: Rosa M. Pacheco-Gonzalez, Manuel Sánchez-Solís, Luis García-Marcos, Virginia Pérez, Juan J. Quesada, Vicente Bosch
Journal: European Respiratory Journal (2013)

Introduction: Lung function is lower in preterm infants with bronchopulmonary dysplasia (BPD) as compared with those without BPD. This study compares how lung function changes with time in both groups.  Material and methods: FVC, FEV0.5, FEF75 and FEF25-75 were measured in 51 infants born preterm (18 with BPD and 33 without BPD) by the rapid thoracic compression with raised volume technique at three time points: initial visit, and 6 and 12 months later. To check for differences troughout the year of study, ANOVA for repeated measurements was performed. In order to analyze the influence of BPD on the change over time of z-scores of those lung function parameters (corrected to the Jaeger equipment) a model was built using the generalized estimated equations method, which was adjusted for gestational age, sex, corrected age, z-score of body mass index.  Results: At the moment of the first visit non-BPD patients were 4.8 (sd: 0.5) months of age and BPD 5.2 (sd: 0.6) months (p>0.05).  Conclusion: Except for FVC, lung flows increased during the study year in both BPD and non-BPD groups. However, those flows increased significantly more in non-BPD infants.
Intravenous Artesunate for the Treatment of Severe and Complicated Malaria in the United States: Clinical Use Under an Investigational New Drug Protocol
Authors: Patrick S. Twomey, Bryan L. Smith, Cathy McDermott, Anne Novitt-Moreno, William McCarthy, S. Patrick Kachur, Paul M. Arguin
Journal: Annals of Internal Medicine (2015)

Quinidine gluconate, the only U.S. Food and Drug Administration-approved treatment for life-threatening malaria in the United States, has a problematic safety profile and is often unavailable in hospitals.To assess the safety and clinical benefit of intravenous artesunate as an alternative to quinidine.Retrospective case series.U.S. hospitals.102 patients aged 1 to 72 years (90% adults; 61% men) with severe and complicated malaria. Patients received 4 weight-based doses of intravenous artesunate (2.4 mg/kg) under a treatment protocol implemented by the Centers for Disease Control and Prevention between January 2007 and December 2010. At baseline, 35% had evidence of cerebral malaria, and 17% had severe hepatic impairment. Eligibility required the presence of microscopically confirmed malaria, need for intravenous treatment, and an impediment to quinidine.Clinical and laboratory data from each patient's hospital records were abstracted retrospectively, including information from baseline through a maximum 7-day follow-up, and presented before a physician committee to evaluate safety and clinical benefit outcomes.7 patients died (mortality rate, 6.9%). The most frequent adverse events were anemia (65%) and elevated hepatic enzyme levels (49%). All deaths and most adverse events were attributed to the severity of malaria. Patients' symptoms generally improved or resolved within 3 days, and the median time to discharge from the intensive care unit was 4 days, even for patients with severe liver disease or cerebral malaria. More than 100 concomitant medications were used, with no documented drug-drug interactions.Potential late-presenting safety issues might occur outside the 7-day follow-up.Artesunate was a safe and clinically beneficial alternative to quinidine.
Interaction between allopurinol and pyrazinamide
Authors: C Lacroix, C Guyonnaud, M Chaou, H Duwoos, O Lafont
Journal: European Respiratory Journal (1988)

Pyrazinamide (PZA) is increasingly used with isoniazid and rifampicin, in short-course antituberculous chemotherapy in service programme conditions. Complicating arthralgias occur due to hyperuricaemia induced by the inhibition of renal tubular secretion of uric acid by pyrazinoic acid, the main PZA metabolite. Allopurinol (Al), a hypouricaemic agent, provides no substantial clinical improvement. Pharmacokinetics of PZA and its metabolites were studied in six healthy volunteers, in a cross-over design, after a single oral dose of PZA alone and, in a second trial, after the same dose together with Al. Plasma and urinary concentrations were measured by high pressure liquid chromatography with a column of cation exchange resin. Analysis of the pharmacokinetic parameters showed that Al induced marked changes in levels of PZA metabolites and accumulation of pyrazinoic acid. Despite decreasing uric acid synthesis, allopurinol increased plasma concentrations of pyrazinoic acid, which is directly responsible for the inhibition of renal urate secretion. Other drugs, which do not involve xanthine oxidase inhibition, should be used in the treatment of this side effect of chemotherapy.
Outcome of sleep assessment (SA) in children with cranio-facial anomalies (CFA): Experience of supra-regional centre
Authors: Rajesh Srikantaiah, Hiroshi Nishikawa, Guirish Solanki, Steve Dover, Priti Kenia, Satish Rao
Journal: European Respiratory Journal (2013)

Introduction  It is recognised that CFA patients can develop sleep disordered breathing (SDB). SA includes clinical history, examination and investigations e.g. polysomnography. In this study, we sought to determine the use of SA and its impact on clinical management in symptomatic CFA patients at a Supra-regional Centre.  Method  Retrospective analysis of patients with syndromic and non–syndromic CFA who reported symptoms of SDB was undertaken at Birmingham Children’s Hospital (BCH), UK. Demographic features, clinical signs, symptoms, results of multichannel sleep study and clinical outcome following SA were collected over 2 year period (January 2011-December 2012).  Results  14 patients with CFA and SDB symptoms were referred for SA [age (range): 2-16 years]. 11 (80%) had a diagnosis of specific syndromic (e.g. Apert’s) and 3 (20%) had non-syndromic craniosynostosis. SA showed features of SDB in 13 (90%) [mild obstructive sleep disordered breathing (OSDB) in 5 (38%), moderate OSDB 4 (30%) and severe OSDB 3 (23%)]. 1 patient had no evidence of OSDB and 1 patient had central SDB. Based on the SA results, 5 (35%) children were managed conservatively, 3 (21%) started on non-invasive ventilation (NIV), 6 (44%) had surgery (2-facial advancement and 4-adeno-tonsillectomy).  Conclusion  SA assessment allowed non-surgical management in significant proportion of symptomatic CFA patients including NIV. In those who required surgery, it informed optimum timing, further investigations and the type of surgery. These findings suggest that SA should be performed in all symptomatic CFA patients. Further research is required to ascertain role of SA in asymptomatic patients.
Tele-education in asthma management. What are the benefits?
Authors: Olga Vakhno, Vitaly Kupaev, Dmitry Nagatkin
Journal: European Respiratory Journal (2012)

The aim was to research two approaches of asthma9 education and to find the most effective one.  98 mild asthmatic patients have been involved randomly so far (age 41.0±15.2 yrs). We study 3 groups according to the type of chosen education: 1 st  -group have passed the ordinary asthma education (were educated by physician)(n=22), 2 nd - have passed tele-education asthma program (n=36), 3 d -didn9t have any advantage (n=40). Criteria to objectify the effectiveness were: asthma control assessed by ACT and ACQ, life quality level, lung function, Cooperation Index (CI), the cost of intervention, self-management, knowledge control test results.  The majority of patients initially had partly controlled asthma (43.9%) and current working social status (60.6%). Finally we have detected that patients of the 1 st  and 2 nd  groups have obtained significantly higher control level, higher life quality values, decrease in taking reliever medications in comparison with the 3 d  group (p st  group (Mean=67.0%, p st  group) was 20.1 € and tele-education (the 2 nd  group) -10.7 €. There were significant correlations in the 2 nd  group between results of asthma control (ACT™ and ACQ scores) and knowledge control test results (r ACT =0.77, p ACQ =0.68, p d  group (Mean  ACT =16.3 pts, Mean  ACQ = 1.8, p  Conclusion: So, each of the approaches to asthma education leads to higher asthma control. Besides this, tele-education has shown more cost effectiveness. This instrument is required to be available to each patient.
Treatment of Major Depression With Nortriptyline and Paroxetine in Patients With Ischemic Heart Disease
Authors: J. Craig Nelson, John S. Kennedy, Bruce G. Pollock, Fouzia Laghrissi-Thode, Meena Narayan, Mitchell S. Nobler, Deborah W. Robin, Ivan Gergel, James McCafferty, Steven Roose
Journal: American Journal of Psychiatry (1999)

This study compared the efficacy, tolerability, and safety of paroxetine and nortriptyline in depressed patients with ischemic heart disease.After a 2-week, single-blind placebo lead-in phase, 81 outpatients with DSM-III-R-defined nonpsychotic unipolar major depression and ischemic heart disease were randomly assigned to double-blind treatment with paroxetine or nortriptyline for 6 weeks. Paroxetine was administered at a fixed-flexible dose of 20-30 mg/day. Nortriptyline dose was adjusted with the use of blood-level monitoring to reach a plasma concentration of 50-150 ng/ml.Twenty-seven of the 41 patients who started treatment with paroxetine and 29 of the 40 patients who started treatment with nortriptyline had an improvement of at least 50% in their Hamilton Depression Rating Scale scores. Significantly more patients taking nortriptyline discontinued treatment prematurely (35% versus 10%), and more patients taking nortriptyline had adverse events resulting in termination (25% versus 5%).Both treatments were efficacious. Sixty-three percent of all patients improved at least 50%, and of these, 90% met the criteria for remission. Paroxetine was better tolerated than nortriptyline and less likely to produce cardiovascular side effects.
Abstract 9296: Prediction of Six Minute Walk Test Distance Using ECG Gated 320 Slice CT, Echocardiogram and Right Heart Catheter Examinations in Subjects with Pulmonary Hypertension in Multiple Regression Models
Authors: Akihisa Kataoka, Nobusada Funabashi, Masae Uehara, Toshihiko Sugiura, Nobuhiro Tanabe, Hiroyuki Takaoka, Koichiro Tatsumi, Yoshio Kobayashi
Journal: Circulation (2011)

Purpose: The six minute walk test (6MWT) as defined by the American Thoracic Society integrates responses of pulmonary and cardiovascular systems. We tried to predict 6MWT distance in subjects with pulmonary hypertension (PH) using 320 slice CT, transthoracic echocardiogram (TTE), and right heart catheter (RHC) examinations. Materials and Methods: 16 consecutive PH subjects (11 female, mean 54 years, 7 primary PH, 9 chronic pulmonary arterial thromboembolism) underwent retrospective ECG gated 320 slice CT, RHC and 6MWT. CT images were reconstructed every 5% from 0-95% of R-R interval. We quantified right ventricular (RV) end systole volumes (RVESV) and end diastole volumes (RVEDV), and RV ejection fraction (RVEF) by CT, maximum RV area (maxRVA) and RV fractional area change (RVFAC) by TTE, and mean pulmonary artery pressure (MPAP) by RHC. Results: RVEDV and RVEF were 143.8±53.2ml and 46.7±10.6%. maxRVA, RVFAC on TTE, MPAP on RHC and 6MWT distance were 26.7±5.8, 29.1±8.9%, 35.8±14.2mmHg, and 404.8±85.7m. A significant positive correlation was seen between 6MWT distance and RVFAC (0.626, P=0.01), and a negative correlation was seen between 6MWT distance and, RVEDV and MPAP (r=-0.635, and -0.648, p&lt;0.01). All predictor variables using CT and RHC were analyzed and 6MWT distance was predicted by multiple regression formula: Y=-3.0X1 -0.6X2 -2.2X3 -45.3X4 -0.7X5 +814.1 (Y=6MWT distance, X1=age (yrs), X2= RVEDV, X3=MPAP, X4=female gender, X5= RVEF) (R2=0.725, p&lt;0.05). All predictor variables using TTE and RHC were analyzed and 6MWT distance was predicted by multiple regression formula Y=4.2X1 -2.7X2 -57.8X3 -1.5X4 +2.4X5 +461.6 (Y= 6MWT distance, X1=RVFAC, X2=age, X3=female gender, X4 MPAP, X5=maxRVA) (R2=0.719, p&lt;0.05). Conclusion: 6MWT distance can be predicted by 320 slice CT as well as or slightly better than by TTE and RHC. RVEDV on CT and MPAP on RHC may be negative predictors and RVFAC on TTE may be a positive predictor for estimating 6MWT distance in subjects with PH.
Pulmonary rehabilitation in idiopathic pulmonary fibrosis: Predictors of adherence and exercise improvement
Authors: Maureen M. Peasey, Claire M. Nolan, Samantha S.C. Kon, Jane L. Canavan, Sarah E. Jones, Amy L. Clark, William D.-C. Man
Journal: European Respiratory Journal (2013)

Background   Although there is evidence to support short term benefits of pulmonary rehabilitation (PR) in idiopathic pulmonary fibrosis (IPF), there are concerns about adherence and heterogeneity in response, particularly in patients with more severe disease.   Aim   To determine whether baseline parameters (age, sex, BMI, MRC dyspnoea score (MRC), oxygen saturations on room air (SpO 2 ), FVC %pred, incremental shuttle walk (ISW) and Hospital Anxiety and Depression scale (HAD)) predict PR completion and exercise response to PR in IPF.   Method   We analysed data from 82 consecutive IPF patients referred for outpatient PR. Completion was defined as attendance to ≥50% sessions. Exercise response was determined by change in incremental shuttle walk (ISW) pre and post PR. Correlations between baseline variables and completion or exercise improvement were determined by Spearman’s rank. Multiple logistic regression and multiple linear regression were used to identify baseline variables independently associated with completion and exercise improvement.   Results   40 IPF patients completed PR (49%). Completion was more likely with lower MRC, higher SpO 2  and ISW (r=-0.28,0.27,0.35; all p 2  (r=-0.40,0.34; p=0.02,0.03). Baseline FVC% did not correlate with completion or exercise response. A multiple logistic regression model had a completion predictor success of 63% with a Nagelkerke’s R 2  of 0.218. A multiple linear regression model comprising age and SpO 2  explained only 11% of variance in ISW change.   Conclusion   In IPF patients, simple baseline parameters of disease severity cannot predict completion of or exercise response to PR.
Low-dose cytarabine versus intensive chemotherapy in the treatment of acute nonlymphocytic leukemia in the elderly.
Authors: H Tilly, S Castaigne, D Bordessoule, P Casassus, P Y Le Prisé, G Tertian, B Desablens, M Henry-Amar, L Degos
Journal: Journal of Clinical Oncology (1990)

We conducted a randomized multicenter trial comparing low-dose cytarabine (LD ARA-C) (20 mg/m2 for 21 days) with an intensive chemotherapy (rubidazone [a daunorubicin-derived agent], 100 mg/m2 for 4 days, ARA-C 200 mg/m2 for 7 days) in 87 patients over 65 years of age with de novo acute nonlymphocytic leukemia (ANLL). Forty-one patients received LD ARA-C and 46 received intensive chemotherapy. The number of complete remissions (CRs) but also of early deaths was higher in the intensive chemotherapy group, while partial remissions (PRs) and failures were more frequent in the LD ARA-C group (P less than .001). Infectious complications during induction treatment were more numerous and more severe in the intensive chemotherapy group (P less than .01). Patients treated with LD ARA-C required fewer RBC transfusions (P less than .02), fewer platelet transfusions (P less than .01), and had a shorter hospital stay for induction treatment (P less than .01). Overall survival and CR duration were not significantly different in either group. In the LD ARA-C group, the survival of patients with PR and those of patients in CRs was identical. We conclude that in a selected group of elderly patients with de novo ANLL a higher number of CRs may be obtained with intensive chemotherapy, but that with LD ARA-C, the number of early deaths is lower, and long-lasting PRs are obtained, resulting in a similar overall survival.
Development and validation of a patient-reported tool to evaluate legal and financial needs in patients with advanced cancer.
Authors: Arif Kamal, Richard Morgan Bain, Yousuf Zafar, Hope Elizabeth Uronis, John H. Strickler, Jonathan Nicolla, Abigail H. Goodman, Chrissy Liu
Journal: Journal of Clinical Oncology (2014)

174 Background: Cancer patients frequently report problems with finances, housing, advance care planning, and work-related issues. Because of these complex legal needs, cancer centers are developing Medical-Legal Programs (MLP) to connect referred patients with legal professionals. These programs lack validated screening methods to target services to those with the greatest legal distress. To date, no validated, patient-reported measure to assess the portfolio of legal needs has been developed for patients with cancer. Methods: We developed the Cancer Legal Screener to address five common domains within MLP practice: Housing; Income and Insurance; Employment; Family Stability; and Legal Status and General concerns. The 15 questions were then reviewed in two rounds for face validity by two of each: social workers, oncologists, palliative care physicians, attorneys, and lay persons. After two iterative updates, we piloted the screener in our palliative care and gastrointestinal malignancies clinics for six months. After participants completed the screener, they responded to a 10-item survey rating three areas: Consent/Presentation, Ease of Use, and Value to Care. Each question was measured on a 5-point Likert scale. Scores were weighted one through five and averages calculated. Results: We received scores from 79 patients. Their median age was 61 years; 39% were female, 29% were African-American. Regarding socioeconomic status, 75% had completed at least some college and 53% reported having an income level ≤ $50,000. During patient-reported validation testing, all 10 items across the three domains satisfied the feasibility criteria with average weighted satisfaction scores ranging from 3.22-3.89. Of patients surveyed, most indicated “Agree” or “Strongly Agree” regarding understandability of included questions (84%), prompts being “easy to follow” (81%), and “this form may help my doctors deliver better care” (63%). Conclusions: We have developed and validated one of the first patient-reported tools to assess medical-legal needs in patients with cancer. Future research will test triage models to target the appropriate legal resources to patients with the greatest legal needs.