tbuckley/cabot-search huggingface dataset:
Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck: long-term results.
Authors: J R Clark, P M Busse, C M Norris, J W Andersen, A I Dreyfuss, R M Rossi, M D Poulin, A D Colevas, R B Tishler, R Costello, J W Lucarini, D Lucarini, L Thornhill, M Lackey, E Peters, M R Posner
Journal: Journal of Clinical Oncology (1997)

PURPOSE A phase II trial of cisplatin, fluorouracil, and leucovorin (PFL) induction chemotherapy in patients with locally advanced squamous cell carcinomas of the head and neck region (HNCA). PATIENTS AND METHODS One hundred two patients (stage III/IV, previously untreated) were treated with induction PFL. Patients with resectable primary tumor site lesions and clinical complete response (CR) were offered radiotherapy (RT) without surgery to the primary tumor site. Response, toxicity, local-regional therapy, survival, and preservation of the primary tumor site were assessed. RESULTS Among 279 courses, the overall response rate was 81%. Nineteen (19%) failed to respond, including three who died during therapy. Sixty-seven (69%) of 97 with assessable primary lesions had a clinical CR at the primary tumor site. Pathologic CR was recorded in 46 of 55 (84%) clinical CR patients who had biopsies performed on the primary tumor site. Toxicities resulted in unexpected hospitalizations in 19% of cases. After definitive local-regional therapy, 84 (82%) were disease-free including 71 (69%) with preserved primary tumor site anatomy. With a median follow-up time of 63 months, the cause-specific, overall (OS), and failure-free survival (FFS) rates at 5 years are 58%, 52%, and 51%. Local failure occurred in 29 of 102 (29%) and the local control rate at 5 years was 68%. CONCLUSION PFL has significant activity with acceptable toxicity in patients with advanced disease who have a good performance status. Preservation of the primary tumor site could be achieved without apparent loss of local control or survival. Management of neck disease by surgery or RT must be individualized and separate from management of primary tumor. Survival compares favorably with similar trials of induction chemotherapy or chemoradiotherapy.
Neisseria sicca pneumonia and bronchiectasis
Authors: P Gris, G Vincke, JP Delmez, JP Dierckx
Journal: European Respiratory Journal (1989)

Neisseria sicca, although considered a harmless saprophyte, has been recognised as an etiologic agent in three cases of pneumonitis, and rare cases of endocarditis, meningitis, and osteomyelitis, particularly in immunocompromised hosts. We report the case of a 76-year-old man with a community-acquired pneumonia, in whom both sputum samples and bronchial secretions obtained with bronchoscopic protected catheter brush grew pure culture of N. sicca with abundant polymorphonuclear neutrophils. Dramatic clinical improvement only occurred after initiation of an appropriate antibiotherapy according to susceptibility spectrum of the isolated N. sicca. Bronchiectasis underlying lesions were disclosed by computed tomography. N. sicca should be added to the list of commensal organisms able to cause pulmonary infection. Moreover, the association of N. sicca and bronchiectasis has never been published.
Tumor Cell-Triggered Macrophage-Mediated Suppression of the T-Cell Cytotoxic Response to Tumor-Associated Antigens. I. Characterization of the Cell Components for Induction of Suppression&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: C C Ting, D Rodrigues
Journal: JNCI Journal of the National Cancer Institute (1982)

A tumor cell-triggered macrophage-mediated suppressor mechanism was demonstrated. It suppressed the induction of specific tumor immunity in the syngeneic, primary mixed lymphocyte tumor cell culture reactions. Preexposure of splenic adherent cells (SAC) to syngeneic FBL-3 tumor cells induced complete suppression of the generation of cytotoxic T-cells. The SAC responsible for inducing suppression were consistent with being macrophages. They were resistant to the treatment of anti-Thy-1.2 antibody plus complement and were relatively radioresistant (at least less than or equal to 750 R X-radiation). Adherent cells obtained from lymph nodes or thymuses acted in the same way as SAC. However, preexposure of peritoneal adherent cells to tumor cells failed to induce suppression. In contrast, the simultaneous presence of peritoneal adherent cells with SAC upon exposure to tumor cells prevented the induction of suppression. These peritoneal cells were also consistent with being macrophages. These results confirmed our previous observations obtained with experiments performed in the allogeneic system. An immunoregulatory circuit existed between two subsets of macrophages that were derived from the population of cells in the peritoneal cavity and from spleen, lymph nodes, or thymus. In the presence of tumor cells, these macrophages produced both positive regulation and negative regulation of the T-cell-mediated cytotoxic response against syngeneic tumor cells. The tumor cells may have utilized the host's own immune network to activate the suppressor mechanisms, thus successfully evading the host's immune surveillance.
Private health care in developing countries
Authors: I. Mather, S. Ramaiah, P. Crowley
Journal: BMJ (2002)

Editor—Zwi et al in their editorial suggest means by which governments in developing countries should try to harness private providers to improve the health of their citizens.1 A recent article by Whitehead et al, however, points to a medical poverty trap, created by the introduction of user fees for public services and the growth of out of pocket expenses for private services.2 The authors conclude that the main challenge in developing countries is to improve public health services and enable the poorest sections of society to obtain the health care they need.

India has experienced a massive growth in private health provision despite high public investment in health services. Several studies have shown that there is a marked reluctance to use free facilities even among the poorest sections in Indian society. For example, a study of health and health care among scheduled castes showed that 38% sought private medical help when their children became ill, compared with 28% for government health facilities.3 Another study, which focused on the urban poor in Calcutta, concluded that public health facilities were used for emergency purposes but there was a preference for private practitioners for all other types of care.3 The implication of these studies is that access cannot be equated simply with supply but is dependent on locational, economic, and social access, as well as the quality of the services themselves.

At the same time as trying to make public services more responsive it is vital that resources are used efficiently in areas that maximise health improvement. At present, in India, over half of the health budget is spent on secondary and tertiary curative services, whereas better health outcomes could be achieved by investing in preventive measures. The emphasis on private healthcare provision may serve to distort these priorities even further.
Anxiety and depression in patients with asthma
Authors: J. De Miguel, V. Hernandez Barrera, T. Gomez Garcia, M.P. Carrasco Garrido, M.C. Juarez Morales, L. Puente Maestu, J. Hernandez Fernandez, R. Jimenez Garcia
Journal: European Respiratory Journal (2011)

Aim: To study the existence of anxiety and depression in patients with asthma and chronic bronchitis.

Material and methods: Descriptive epidemiological population-based study (2009 European Health Survey for Spain). Study subjects were selected by means of probabilistic multistage sampling, with the first-stage units being census section, and the second-stage units, main family dwellings. Subjects aged 18 years and over were selected. We identified asthmatic and chronic bronchitis (CB) individuals through a specific questionnaire. We analyzed socio-demographic characteristics and health related variables, including health care services use and concomitant chronic diseases diagnosed such as anxiety and depression.

Results: From 19.598 subjects included in the study, 1.632 were classified as asthmatic (8.32%, CI 95% 7.93-8.71) and 1467 (7.48, CI 95% 7.11-7.85%) as CB. The overall prevalence of anxiety was 7.69% (95% CI: 7.38-8.04) among people with asthma and 6.96% (95% CI: 6.62-7.31) among people with CB, no significant differences between them, although there were differences between each of them with healthy individuals, where the prevalence was 4.38% (95% CI: 4.09-4.67). The overalls prevalence of depression was 7.43% (95% CI: 6.18-8.67) among asthmatics and 9.93% (95% CI: 8.30-11.56) in those with CB, no significant differences between them, although there were differences between each of them with healthy individuals, where the prevalence was 4.57% (95% CI 4.28-4.86).

Conclusions: Patients with asthma and CB have higher rates of anxiety and depression than healthy individuals. Doctors involved in the management of these processes should take account of these results to improve control of their patients.
Marjolin’s ulcer
Authors: Robert Choa, Sukbhir Rayatt, Kamal Mahtani
Journal: BMJ (2015)

#### The bottom line

The tissue viability nurse refers a 72 year old woman with lower limb venous stasis and a six year history of a non-healing ulcer on her shin (figure⇓) to her general practitioner. The GP refers her to the plastic surgery team, where incisional biopsy of the ulcer confirms squamous cell carcinoma (SCC), consistent with a Marjolin’s ulcer. Further examination shows palpable lymph nodes in the right inguinal region.



Marjolin’s ulcer of the right anterolateral leg. The ulcer has an irregular border and base. It had bled intermittently and had increased in size despite compression bandaging



Marjolin’s ulcers are tumours that most commonly arise from areas of chronic inflammation or injury and develop over many years.1 They are most common in old burn scars, but they are also seen in traumatic wounds, venous stasis ulcers, pressure sores, …
Evolution of Cell-Mediated Immunity in Mice Bearing an Antigenic Tumor. Influence of Tumor Growth and Surgical Removal
Authors: Georges Barski, Jung Koo Youn
Journal: JNCI Journal of the National Cancer Institute (1969)

Specific, cell-mediated immunity was studied in BALB/c mice with tumors produced by inoculation of a syngeneic, in vitro-cultivated T5 cell line. The T5 cells, which had an antigen induced by an attenuated Rauscher virus, were malignant but nonleukemogenic, and mice could be easily immunized against a challenge with high doses of viable T5 cells. Cells obtained by peritoneal washings from immunized mice inhibited efficiently, in a colony growth inhibition (CGI) test, the growth of T5 cells. The use of peritoneal cells (PC) made it possible to check systematically in a “vertical” study the specific immunological status of BALB/c mice with T5 tumors growing unhindered or after their surgical removal, followed or not by reinoculation of X-irradiated T5 tumor cells. From the obtained data we found that PC taken from mice at the beginning of tumor growth showed some cell-mediated immunological activity which disappeared completely in mice bearing tumors 4 weeks old or more. The state of immunological “inertia” extended for at least 7 days and, in some experiments, up to 3 weeks after surgical removal of the tumors. However, later, the specific immunological potential of the mice that had surgery recovered entirely and, in CGI test, their PC became as active as those sampled from mice immunized with X-irradiated cells. Several experiments produced evidence that reinoculation of X-irradiated and frozen T5 tumor cells into mice, 7 and 14 days after tumor removal, not only did not disturb the recovery of the anti-T5 cell immunological activity of the PC but accelerated significantly this recovery. The results are discussed in the light of the available data concerning variation of cell immunity status in tumor-bearing hosts.
Neurotoxicity of purine analogs: a review.
Authors: B D Cheson, D A Vena, F M Foss, J M Sorensen
Journal: Journal of Clinical Oncology (1994)

PURPOSE The purine analogs, fludarabine, cladribine, and pentostatin, are active against a broad spectrum of indolent lymphoid malignancies. They also have similar toxicities, including myelosuppression, immunosuppression, and sporadic neurotoxicity. This review compares the spectrum of neurotoxicity of each of these agents. Now that these drugs are commercially available and are being widely used, physicians should be aware of potentially serious side effects that may be encountered. METHODS The literature was searched using MedLine and Cancerline, as well as the bibliographies of published reports through the fall of 1993. In addition, case records from National Cancer Institute (NCI) Group C protocols were reviewed for fludarabine in chronic lymphocytic leukemia (CLL), and cladribine and pentostatin in hairy cell leukemia (HCL), as well as adverse drug reactions reported to the NCI from January 1980 through September 1993. RESULTS At higher than recommended doses, life-threatening and fatal neurotoxicity were encountered with all three drugs. At the recommended doses, each agent induced neurotoxicity in approximately 15% of patients, mostly mild and reversible. However, severe neurologic complications were reported; these were occasionally delayed, sometimes fatal, but often at least partially reversible. CONCLUSION The doses of these three agents should not be increased above the recommended levels. Development of moderate or worse neurotoxicity should result in discontinuation of that drug.
Rheumatoid Arthritis, Anti–Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative
Authors: Rachel H. Mackey, Lewis H. Kuller, Kevin D. Deane, Brian T. Walitt, Yue‐Fang Chang, V. Michael Holers, William H. Robinson, Russell P. Tracy, Mark A. Hlatky, Charles B. Eaton, Simin Liu, Matthew S. Freiberg, Mehret Birru Talabi, Erik B. Schelbert, Larry W. Moreland
Journal: Arthritis & Rheumatology (2015)

To evaluate the incidence of cardiovascular disease (CVD) morbidity and mortality over the course of 10 years among the more than 160,000 postmenopausal women in the Women's Health Initiative (WHI) in relation to self-reported rheumatoid arthritis (RA), taking disease-modifying antirheumatic drugs (DMARDs), anti-cyclic citrullinated peptide (anti-CCP) positivity, rheumatoid factor (RF) positivity, CVD risk factors, joint pain, and inflammation (white blood cell count and interleukin-6 levels). Anti-CCP and RF were measured in a sample of WHI participants with self-reported RA (n = 9,988). RA was classified as self-reported RA plus anti-CCP positivity and/or taking DMARDs. Anti-CCP-negative women with self-reported RA and not taking DMARDs were classified as having "unverified RA." Age-adjusted rates of coronary heart disease (CHD), stroke, CVD, fatal CVD, and total mortality were higher in women with RA than in women with no reported RA, with multivariable-adjusted hazard ratios of 1.46 (95% confidence interval [95% CI] 1.17-1.83) for CHD and 2.55 (95% CI 1.86-3.51) for fatal CVD. Among women with RA, anti-CCP positivity and RF positivity were not significantly associated with higher risk of any outcomes, despite slightly higher risk of death for those who were anti-CCP positive than for those who were anti-CCP negative. Joint pain severity and CVD risk factors were strongly associated with CVD risk, even in women with no reported RA. CVD incidence was increased in women with RA versus women with no reported RA at almost all risk factor levels, except for low levels of joint pain or inflammation. Among women with RA, inflammation was more strongly associated with fatal CVD and total mortality than with CHD or CVD. Among postmenopausal women, RA was associated with 1.5-2.5-fold higher CVD risk. CVD risk was strongly associated with CVD risk factors, joint pain severity, and inflammation, but not with anti-CCP positivity or RF positivity.
The impact of an electronic self-management system for patients with COPD
Authors: Mal North, Tom Wilkinson, Simon Bourne
Journal: European Respiratory Journal (2014)

Aim: 

NICE quality standards for COPD recommends that patients receive a current individualised comprehensive self-management plan. Our group developed a web-based self-management system to help patients in managing their COPD. This comprised of online education, bespoke widgets (symptom alerts) as well as inhaler technique and exercise videos. The project evaluated if access to the solution over a 3-month period improved patient symptoms and inhaler technique.

Method: 

36 patients with a confirmed diagnosis of COPD were recruited. Each had two visits from a qualified healthcare professional at the beginning and end of the project. At Visit 1 patients were given access to the web system and visit 2 was scheduled at 3 months. The COPD Assessment Test (CAT) score and a video recording of their inhaler technique were recorded at both visits.

Results: 

Of the 36 participants, 27 completed the project. 95% of the 22 participants who used the system showed a mean decrease in CAT score of 4 (SD+/-2.8)(P<0.001) and a significant improvement in inhaler technique. 5 subjects (control group) did not use the system and had a mean increase in their CAT score of 2.4 points (SD+/-1.0).

![Figure][1] 



Conclusion: 

This project revealed that patients receiving access to advanced electronic self-management and education for 3 months significantly improves symptom scores and inhaler technique in patients with COPD.

 [1]: pending:yes
Cognitive Function in Patients With Colorectal Cancer Who Do and Do Not Receive Chemotherapy: A Prospective, Longitudinal, Controlled Study
Authors: Janette L. Vardy, Haryana M. Dhillon, Gregory R. Pond, Sean B. Rourke, Tsegaye Bekele, Corrinne Renton, Anna Dodd, Haibo Zhang, Philip Beale, Stephen Clarke, Ian F. Tannock
Journal: Journal of Clinical Oncology (2015)

Cognitive dysfunction is reported in people with cancer. Therefore, we evaluated longitudinal changes in cognitive function and underlying mechanisms in people with colorectal cancer (CRC) and healthy controls (HCs).Participants completed cognitive assessments and questionnaires reporting cognitive symptoms, fatigue, quality of life, and anxiety/depression at baseline (before chemotherapy, if given) and 6, 12, and 24 months. Blood tests included cytokines, clotting factors, apolipoprotein E genotype, and sex hormones. Primary end point was overall cognitive function measured by the Global Deficit Score at 12 months.We recruited 289 patients with localized CRC (173 received chemotherapy; median age, 59 years; 63% male), 73 patients with limited metastatic/recurrent CRC, and 72 HCs. Cognitive impairment was more frequent in patients with localized CRC than HCs at baseline (43% v 15%, respectively; P < .001) and 12 months (46% v 13%, respectively; P < .001), with no significant effect of chemotherapy. Attention/working memory, verbal learning/memory, and complex processing speed were most affected. Cognitive impairment was similar in patients with localized and metastatic CRC. Cytokine levels were elevated in patients with CRC compared with HCs. There was no association between overall cognitive function and fatigue, quality of life, anxiety/depression, or any blood test. Cognitive symptoms at 12 months were reported in 25% of patients with localized CRC versus 17% of HCs (P = .19). More participants who received chemotherapy had cognitive symptoms at 6 months (32%) versus those who did not (16%; P = .007), with no significant difference at 12 months (29% v 21%, respectively; P = .19). Objective cognitive function was only weakly associated with cognitive symptoms.Patients with CRC had substantially more cognitive impairment at every assessment than HCs, with no significant added effect of chemotherapy. Mechanisms of cognitive impairment remain unknown.
Impact of diagnostic pitfalls on the management of pulmonary sarcoidosis
Authors: Ilya Sivokozov, Olga Lovacheva, Eugene Shmelev, Natalya Makaryants
Journal: European Respiratory Journal (2012)

Background. Work-up in patients with sarcoidosis includes differentiation mainly with pulmonary TB, hypersensitivity pneumonitis and community-acquired pneumonia. Usually bronchoscopy is performed with lung biopsy and BAL, but often this option is not availiable, and thus diagnostic mistakes arise.  Aim. To evaluate frequency and possible impact of diagnostic pitfalls on management of sarcoidosis patients.  Materials. 127 patients with newly diagnosed sarcoidosis based on results of lung biopsy and BAL during bronchoscopy were enrolled into study. We analyzed primary diagnosis and treatment, duration of treatment, age, sex, usage of systemic steroids after the final diagnosis and mean dose of them in patients with correct (controls) and incorrect primary diagnose (study group).  Results. 23 patients (18,11%) had diagnostic pitfalls, from them 12 were treated from pulmonary TB in HRZE regimen around a year (46,57+3,32 wks), 7 treated from pneumonia for 3,11+1,13 wks with further obsrevation for 20,33+5,52 wks, and 4 pts were diagnosed as having an hypersensitivity pneumonitis with mean treatment with steroids for 12,75+2,49 wks. Groups were comparable for sex and age. In study group, 10/23 (43,5%) pts had relapse of disease versus 30/104 (28,8%) in controls (p  Conclusions. Diagnostic pitfalls in work-up process among sarcoidosis patients are quite frequent, and lead to a more severe disease flow with higher frequency of systemic steroids usage and higher dose of them.
Interim results of a phase I trial of intraventricular rituximab plus methotrexate in recurrent CNS lymphoma: Macrophage polarization and acquired resistance to therapy.
Authors: J. L. Rubenstein, C. Kadoch, V. S. Wong, W. Hyun, C. Lowell
Journal: Journal of Clinical Oncology (2010)

2532 Background: We recently studied the safety and activity of intraventricular rituximab monotherapy in the treatment of recurrent intraocular and CNS lymphomas (JCO 2007 25: 1350-1356). While most patients exhibited initial responses to rituximab, acquired resistance usually developed, most often within 2 to 12 weeks. While rituximab efficacy appears to be mediated predominantly by ADCC, with tumor-associated macrophages being the dominant effector cell, there is an extreme paucity of data regarding the role and phenotype of macrophages in NHL. We hypothesize that the phenotype of intratumoral macrophages (M1 vs. M2) may be a determinant of rituximab efficacy and resistance. Methods: Thus far, six patients with recurrent CD20+ CNS NHL have been treated at UCSF on a phase I clinical trial involving twice weekly intraventricular rituximab at 10 mg and 25 mg dose levels, administered over a planned eleven week schedule. Rituximab is combined with MTX (12 mg) during the second intrathecal injection each week. We implemented a novel flow-cytometry-based method, developed in our laboratory, to serially isolate and characterize distinct subpopulations of tumor macrophages from CSF, based upon the relative expression of nitric oxide synthase (iNOS) and CD206. Results: No serious treatment-related toxicity has been detected with intraventricular rituximab/MTX at the 10 mg and 25 mg dose levels. While there is preliminary evidence for efficacy using this combination, with the most durable response being eight months, resistance developed in each of the patients thus far treated. Notably, we detected increases in the proportion of CSF M2 macrophages compared to baseline (usually greater than 3-fold; p<0.001) which anticipated the onset of rituximab resistance and tumor progression in each of these cases. Conclusions: Intraventricular rituximab/MTX is potentially safe and active in recurrent CNS NHL. The elucidation of distinct subpopulations of lymphoma macrophages may provide insight into tumor pathogenesis, prognosis, and rituximab resistance. NCT00221325. Supported by Leukemia and Lymphoma Society and NIH Grant CA13908301. No significant financial relationships to disclose.