tbuckley/cabot-search huggingface dataset:
Patients With Cancer Referred to Hospice Versus a Bridge Program: Patient Characteristics, Needs for Care, and Survival
Authors: David Casarett, Janet L. Abrahm
Journal: Journal of Clinical Oncology (2001)

PURPOSE: The purpose of this study was to compare the characteristics and needs of patients with advanced cancer who were referred to hospice with those referred to a prehospice “bridge” program that is staffed by hospice nurses. PATIENTS AND METHODS: Data were gathered through retrospective review of computerized clinical records using precoded data fields of 284 patients with cancer enrolled in a bridge program and 1,000 who enrolled in a hospice program. Patient characteristics, needs for supportive care at the time of enrollment, and survival were assessed. RESULTS: Bridge patients were less likely to have Medicare or Medicaid (43% v 72%; odds ratio, 0.30; P &lt; .001) and were younger (69 v 73 years, rank sum test; P &lt; .001), more likely to be married (59% v 43%; odds ratio, 1.90; P &lt; .001), and more likely to be in the highest income category (14% v 10%; odds ratio, 1.77; P = .009). Bridge patients had at least as many needs for care as did patients in hospice. Bridge patients lived significantly longer (median, 46 v 19 days; log-rank test of survivor functions, P &lt; .001). CONCLUSION: Patients referred to this bridge program had prognoses that are significantly better than those of patients who enter hospice, but they have needs for supportive care that are at least as great. These findings underscore the importance of initiatives to extend some of the benefits of hospice care to a wider population of patients and should encourage the analysis of similar programs’ ability to meet these needs.
Understanding the relationship between percentage emphysema as assessed by volumetric CT and lung function in patients with chronic obstructive pulmonary disease
Authors: Lalita Fernandes, Anthony Mesquita, Mahesh Sardesai
Journal: European Respiratory Journal (2014)

Background : COPD is a heterogeneous disease characterized by airway inflammation and emphysema. It is an underestimated disease with delayed diagnosis until airway obstruction is detected on spirometry. Spirometry is the most relied upon method to assess severity and progression of disease. Newer methods like volumetric Computed Tomography measure the percentage emphysema. The aim of the study was to determine the relationship between CT measures of emphysema and lung function in Chronic Obstructive Pulmonary Disease.   Methods :65 stable COPD patients were enrolled. COPD was diagnosed by GOLD guidelines 2009 with post bronchodilator FEV1/FVC    Results : 78% patients were in moderate to severe COPD category.Mean age 63.9(8.2),mean FEV1 post 58.1(18.9), mean % emphysema was 23.4%. Correlation coefficient of FEV1 post to % emphysema was -0.31, p=0.01 and linear regression explained 9% variability in FEV1 and Mean Lung Density r=0.172,p=0.17.   Conclusions : % emphysema showed moderate correlation with lung function in COPD. Analysing expiratory CT findings of air trapping and airway wall thickening may explain the variability in lung function.
A phase I study of intraarterial iododeoxyuridine in patients with colorectal liver metastases.
Authors: A E Chang, J M Collins, P A Speth, R Smith, J B Rowland, L Walton, M G Begley, E Glatstein, T J Kinsella
Journal: Journal of Clinical Oncology (1989)

Regional delivery of iododeoxyuridine (IdUrd) to patients with colorectal liver metastases was examined in a phase I study. The maximum-tolerated intraarterial (IA) dose (MTD) was 1,333 mg/m2/d administered continuously for 14 days. The dose-limiting toxicity was thrombocytopenia. Thrombocytopenia and leukopenia were correlated with the amount of IdUrd incorporated into DNA of peripheral granulocytes. In contrast to our experience with 5-fluorodeoxyuridine, there was no evidence of hepatobiliary toxicity. In 11 patients who received IA IdUrd alone, seven had a greater than or equal to 50% decrease in carcinoembryonic antigen (CEA) levels, with five having tumor volume reductions of 65%, 48%, 46%, 44%, and 27%. Thus, IA IdUrd alone has antitumor efficacy. Patients subsequently received IdUrd in combination with external beam radiation to a total dose of 2,400 cGy without acute local toxicity. In addition to these favorable clinical findings, we have previously shown that IdUrd is selectively incorporated into tumor DNA compared with normal liver in these patients. Further phase II evaluations of this approach are warranted.
The Relation Between HbA1c and Cardiovascular Events in Patients With Type 2 Diabetes With and Without Vascular Disease
Authors: Guido Kranenburg, Yolanda van der Graaf, Joep van der Leeuw, Hendrik M.W. Nathoe, Gert Jan de Borst, L. Jaap Kappelle, Frank L.J. Visseren, Jan Westerink
Journal: Diabetes Care (2015)

OBJECTIVE Poor glycemic control is related to vascular events in patients with type 2 diabetes, but the presence of vascular disease might influence this relation. We evaluated the relation between glycemic control (HbA1c level) and new cardiovascular events and mortality in patients with type 2 diabetes, with and without vascular disease. RESEARCH DESIGN AND METHODS In a cohort of 1,687 patients with type 2 diabetes enrolled in the Second Manifestations of Arterial Disease (SMART) study, the continuous relation between HbA1c and cardiovascular events (composite of myocardial infarction, stroke, and vascular mortality) and all-cause mortality was evaluated with Cox proportional hazard analyses stratified for the presence of vascular disease. RESULTS During a median follow-up time of 6.1 years (interquartile range 3.1–9.5 years), a new cardiovascular event developed in 293 patients and 340 patients died. In all patients, the hazard ratio (HR) of the relation between HbA1c level and cardiovascular events was 1.06 (95% CI 0.97–1.17). A 1 percentage point higher HbA1c level was related to a 27% higher risk of a cardiovascular event in patients with type 2 diabetes without vascular disease (HR 1.27 [95% CI 1.06–1.51]), but not in patients with vascular disease (HR 1.03 [95% CI 0.93–1.15], P for interaction = 0.195). A 1 percentage point higher HbA1c level was related to a 16% higher risk of death (HR 1.16 [95% CI 1.06–1.28]) in patients with vascular disease and a nonsignificant 13% higher risk of all-cause mortality (HR 1.13 [95% CI 0.97–1.31]) in patients without vascular disease. CONCLUSIONS In patients with type 2 diabetes, there is a modest, but not statistically significant, relation between HbA1c level and cardiovascular events, and, as there was no statistically significant interaction, this relation was not different for patients with or without clinical manifestation of vascular disease.
Treatment of advanced colorectal and gastric adenocarcinomas with 5-fluorouracil and high-dose folinic acid.
Authors: D Machover, E Goldschmidt, P Chollet, G Metzger, J Zittoun, J Marquet, J M Vandenbulcke, J L Misset, L Schwarzenberg, J B Fourtillan
Journal: Journal of Clinical Oncology (1986)

We report the results of an expanded trial of 5-fluorouracil (5-FU) combined with high-dose folinic acid for treatment of patients with advanced colorectal or advanced gastric adenocarcinoma. In each treatment course, the patients received both 5-FU (340 to 400 mg/m2/d by intravenous (IV) infusion for a period of 15 minutes) and folinic acid (200 mg/m2/d by IV bolus) for 5 consecutive days, with a 21-day interval between courses. Eighty-six patients with colorectal carcinoma were evaluated. The combined complete and partial response rates were 39% for 54 patients who did not receive prior chemotherapy and 22% for 32 patients who had previously received chemotherapy. Four patients who were previously resistant to 5-FU attained objective responses. The median time to disease progression for the 28 responders was 10 months. The median survival time of responders was 19.5 months, and the probability of their being alive at 2 years was 40%. Of 27 patients with gastric adenocarcinoma, 13 (48%) responded to therapy. Their median time to disease progression was 5.5 months. The median survival time of responders was 11 months, and their probability of being alive at 15 months was 30%. Toxicity was within acceptable limits. Toxic effects included stomatitis, diarrhea, conjunctivitis, skin rash, and mild myeloid hypoplasia. In a separate study, plasma concentrations of L-folates greater than 10(-5) mol/L were achieved after a rapid single IV injection of 200 mg/m2 of folinic acid. Comparisons of our results with those reported in previous studies on 5-FU administered as a single agent suggest that, in advanced colorectal and gastric adenocarcinoma, folinic acid administered in high doses enhances the effectiveness of 5-FU administered concomitantly. Furthermore, some colorectal tumors that were previously resistant to 5-FU become sensitive to this drug. The survival of the patients who responded to therapy was markedly improved over that observed in reported series of untreated patients with advanced colorectal and gastric adenocarcinomas.
Demographics, clinical characteristics, health resource utilization and cost of patients with CTEPH: Retrospective results from six European countries
Authors: Bernd Schweikert, David Pittrow, Dario Vizza, Joanna Pepke-Zaba, Marius Hoeper, Anja Gabriel, Jenny Berg, Mirko Sikirica
Journal: European Respiratory Journal (2012)

OBJECTIVE: To describe demographics, treatment patterns, health resource utilization and related costs of patients with chronic thromboembolic pulmonary hypertension (CTEPH) in 6 European countries.

METHODS: We reviewed medical charts from patients diagnosed with CTEPH and treated with medications for pulmonary arterial hypertension (PAH): Endothelin receptor antagonists (ERA), PDE-5-inhibitors (PDE5i) or prostacyclin analogues (PA). Demographic and clinical characteristics, medications, and health resource utilization were retrospectively abstracted from patients' medical records at specialized PH treatment centers from 6 European countries. Resource utilization was valued using country-specific unit costs; descriptive statistical analyses were performed.

RESULTS: Twenty-one hospitals documented 119 CTEPH patients over 25.4 months time. Patients were inoperable (83.2%) or persistent after surgery (16.0%) with mean age 67.5±12.1 years, 61% female, 6-minute walking distance 297±119 meters, and NYHA class II/III/IV in 27/59/14%. At baseline, 59.7% patients received ERA, 34.4% PDE5i, and 5.8% PA. CTEPH patients experienced 1.8±2.2 hospitalizations per year accounting for 14.8±26.1 days in hospital. Annual cost of PAH-specific medication was the predominant economic factor averaging €36,768±€22,630 per year. Hospitalization costs (€4,496±€7,923) and concomitant medications (€2,510±€2,503) were lower. Other health care resource items accounted for marginal additional costs.

CONCLUSION: These data show clinical characteristics and cost estimates for CTEPH patients receiving off-label therapy with medications that have been approved for PAH.
Plasma exudation in the airways: mechanisms and function
Authors: CG Persson
Journal: European Respiratory Journal (1991)

Inflammatory challenges of tracheobronchial and nasal mucosa produce prompt extravasation or exudation of plasma from the well developed microcirculation just beneath the epithelial base. Plasma exudation is not an exaggeration of the normal capilliary exchange of fluid and solutes but a specific inflammatory response of post-capilliary venules. The exuded plasma may not produce oedema. By a rapid, undirectional, unfiltered and yet non-injurious process, plasma exudates cross the mucosal lining to appear on the airway surface at the site of challenge. In vitro data suggests the possibility that a slightly increased hydrostatic pressure moves the acellular exudate through valve-like openings between epithelial cells. By the venular-mucosal exudation mechanism all the potent protein systems of circulating plasma will operate in respiratory defence on the surface of an intact mucosa. A further inference is that exudative indices obtained from the airway surface quantitatively reflect the intensity and time course of mucosal/submucosal inflammatory processes. Irrespective of which particular cellular mechanism happens to fuel the inflammation. Mucosal exudation of plasma characteristically occurs in health and disease also when there is no airway oedema, no epithelial disruption, and no increased absorbtion ability. However, exuded plasma and its derived peptide mediators potentially contribute to several pathophysical and pathophysiological characteristics of inflammatory airway diseases.
Burden of high-risk HPV infection in women in the United States and implications for anal cancer screening: NHANES (1999-2012).
Authors: Erin Dunn, Kevin J. Moore, Tulay Koru-Sengul
Journal: Journal of Clinical Oncology (2015)

532 Background: High-risk Human Papilloma Virus (HPV) infections put women at risk for cervical, anal, vaginal, and vulvar cancers. HPV can spread from the genital region to the anus even in absence of sexual intercourse. As anal cancer is more prevalent in women, it is important to consider HPV transmission from the vagina to the anus. National surveys provide estimates of population-specific prevalence to identify the burden of high-risk HPV infection in women. Appreciating high-risk HPV infection in women and the potential for HPV spread from the genitals to the anus is crucial for cancer screening efforts. Methods: We calculated prevalence of HPV infections in women in the United States from 1999-2012 National Health and Nutrition Examination Survey (NHANES) to obtain a representative sample of the U.S. non-institutionalized civilian population. NHANES performs in-person interviews and physical examinations and collects biological samples at homes and mobile examination centers. We provided epidemiology of HPV infection and its types for women. Analysis was performed by SAS v9.3. Results: DNA-measured HPV from vaginal swabs showed 42.9% of women were HPV positive. We calculated odds ratios across demographic groups for high-risk HPV types (16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73, 82). Non-Hispanic White (NHW) women had the highest prevalence of high-risk HPV (62.5%). Other Hispanic women had lower odds of having high-risk HPV compared to NHW (OR=0.65; 95% CI=0.49, 0.88). Never married women had greater odds of high-risk infection than married women (1.61; 1.26, 2.06). Current smokers had greater odds than never smokers of high-risk infection (1.26; 1.00, 1.59). Conclusions: Our results show the burden and demographic disparities of high-risk HPV infection in women. Understanding the burden of potentially oncogenic HPV infections in the female genital region is important for cervical cancer screening and highlights a potential importance for anal cancer screenings in HPV positive women. Recognizing demographic disparities could lead research into risk factors and risk conditions that guide the preponderance of HPV infection and anal cancer in specific female populations.
Non-invasive pressure difference estimation from PC-MRI using the work-energy equation
Authors: Fabrizio Donati, C. Alberto Figueroa, Nicolas P. Smith, Pablo Lamata, David A. Nordsletten
Journal: Medical Image Analysis (2015)

Pressure difference is an accepted clinical biomarker for cardiovascular disease conditions such as aortic coarctation. Currently, measurements of pressure differences in the clinic rely on invasive techniques (catheterization), prompting development of non-invasive estimates based on blood flow. In this work, we propose a non-invasive estimation procedure deriving pressure difference from the work-energy equation for a Newtonian fluid. Spatial and temporal convergence is demonstrated on in silico Phase Contrast Magnetic Resonance Image (PC-MRI) phantoms with steady and transient flow fields. The method is also tested on an image dataset generated in silico from a 3D patient-specific Computational Fluid Dynamics (CFD) simulation and finally evaluated on a cohort of 9 subjects. The performance is compared to existing approaches based on steady and unsteady Bernoulli formulations as well as the pressure Poisson equation. The new technique shows good accuracy, robustness to noise, and robustness to the image segmentation process, illustrating the potential of this approach for non-invasive pressure difference estimation.
Cause-Specific Deaths in Non–Dialysis-Dependent CKD
Authors: Sankar D. Navaneethan, Jesse D. Schold, Susana Arrigain, Stacey E. Jolly, Joseph V. Nally
Journal: Journal of the American Society of Nephrology (2015)

CKD is associated with higher risk of death, but details regarding differences in cause-specific death in CKD are unclear. We examined the leading causes of death among a non-dialysis-dependent CKD population using an electronic medical record-based CKD registry in a large healthcare system and the Ohio Department of Health mortality files. We included 33,478 white and 5042 black patients with CKD who resided in Ohio between January 2005 and September 2009 and had two measurements of eGFR<60 ml/min per 1.73 m(2) obtained 90 days apart. Causes of death (before ESRD) were classified into cardiovascular, malignancy, and non-cardiovascular/non-malignancy diseases and non-disease-related causes. During a median follow-up of 2.3 years, 6661 of 38,520 patients (17%) with CKD died. Cardiovascular diseases (34.7%) and malignant neoplasms (31.8%) were the leading causes of death, with malignancy-related deaths more common among those with earlier stages of kidney disease. After adjusting for covariates, each 5 ml/min per 1.73 m(2) decline in eGFR was associated with higher risk of death due to cardiovascular disease (hazard ratio [HR], 1.10; 95% confidence interval [95% CI], 1.08 to 1.12) and non-cardiovascular/non-malignancy diseases (HR, 1.12; 95% CI, 1.09 to 1.14) but not to malignancy. In the adjusted models, blacks had overall-mortality hazard ratios similar to those of whites but higher hazard ratios for cardiovascular deaths. Further studies to confirm these findings and explain the mechanisms for differences are warranted. In addition to lowering cardiovascular burden in CKD, efforts to target known risk factors for cancer at the population level are needed.
The effects of an 8 week pilot community pulmonary rehabilitation programme on exercise tolerance and quality of life
Authors: Clare Baily, Michelle Spencer, Niamh Murphy, Paula Barron
Journal: European Respiratory Journal (2011)

Introduction: Hospital gyms have been common sites for pulmonary rehabilitation programmes, however they are high in demand and weekly availability can be limited [1]. Pulmonary rehabilitaiton in a community environment may enable more patients to access this essential component of care. The aim of this pilot community pulmonary rehabilitation programme was to examine its effects on quality of life and exercise tolerance.

Methods: Seven patients (3 female, 4 male) from the SJH pulmonary rehabilitation waiting list were included in the programme. All underwent an 8-week programme (8 supervised sessions, 16 unsupervised home sessions) of exercise training and education. Subjects were assessed at baseline and on programme completion on measures of exercise capacity (6MWT) and quality of life (Chronic Respiratory Questionnaire).

Results: Six patients (3 female, 3 male) completed the programme-mean age 66.6 years, mean% predicted FEV1 43.8%. The mean number of classes attended was 7 and mean number of home sessions completed was 9. On completion of the programme there was a significant increase in the 6MWT of 75.5metres, a significant decline in the fatigue domain of the CRQ (4.6 to 4.1) and no other significant changes in the CRQ.

Conclusion: Results of this pilot study support the potential role of community pulmonary rehabilitation programmes in improving exercise tolerance in patients with chronic respiratory disease.

References: 

*   1. Ward JA, Akers G, Ward DG, Pinnuck M, Williams S, Trott J et al. Feasibility and effectiveness of a pulmonary rehabilitation programme in a community hospital setting. British Journal of General Practice 2002; 52(480):539-542.
Comprehensive Genetic and Histopathologic Study Reveals Three Types of Neuroblastoma Tumors
Authors: Maria Łastowska, Catherine Cullinane, Sadick Variend, Simon Cotterill, Nick Bown, Seamus O’Neill, Katia Mazzocco, Paul Roberts, James Nicholson, Caroline Ellershaw, Andrew D.J. Pearson, Michael S. Jackson
Journal: Journal of Clinical Oncology (2001)

To determine the relationship between multiple genetic features, tumor morphology, and prognosis in neuroblastoma.The genetic alterations and morphologic features that underpin three histopathologic risk classifications were analyzed in 108 neuroblastoma patients. Tumors were subdivided into four groups based on the three most frequent and prognostically significant genetic alterations (17q gain, 1p deletion, and MYCN amplification), and all other genetic, morphologic, and clinical data were analyzed with respect to these groups.Our analyses identify three nonoverlapping tumor types with distinct genetic and morphologic features, defined here as types 1, 2, and 3. Type 1 tumors show none of the three significant genetic alterations and have good prognosis. Both type 2 (17q gain only or 17q gain and 1p del) and type 3 (17q gain, 1p del, and MYCN amplification) tumors progress. However, these tumor types are distinguished clinically by having significantly different median age at diagnosis and median progression-free survival (PFS). Multivariate analysis indicates that 17q gain is the only independent prognostic factor among all genetic, histopathologic, and clinical factors analyzed. Among histopathologic risk systems, the International Neuroblastoma Pathology Classification was the best predictor of PFS.Our results indicate that specific combinations of genetic changes in neuroblastoma tumors contribute to distinct morphologic and clinical features. Furthermore, the identification of two genetically and morphologically distinct types of progressing tumors suggests that possibilities for different therapeutic regimens should be investigated.
Aromatase inhibitors and bisphosphonates reduce deaths from breast cancer, studies show:
Authors: Zosia Kmietowicz
Journal: BMJ (2015)

As the number of indexes and index-based investment products expands, it is critical for investors to understand relative index volatility. This article discusses the issues to consider when evaluating index risk and shares insights and data from the author’s recent historical index volatility analysis. The research evaluates the risk of index exposure from multiple perspectives—over time and on a relative basis—and encompasses U.S. equity, global equity, U.S. sector, U.S. Treasury, and select commodity market indexes. Specifically, the author explores how time dimension affects perception and assessment of risk, the cyclicality of volatility measures, patterns that may signal a future shift in risk, how index volatility measures trend compared to index return measures, and how index volatility behaves above and below the median, as well as under increasing levels of risk. Based on this research, the author shares several important insights, including the observation that risk can suddenly shift well above median levels for a given index, and those shifts often occur simultaneously across multiple indexes. As a result, significant short-term value changes may occur if portfolios are not modified to reduce risk when the inherent volatility of indexes rises. Alternatively, heightened risk may also present tactical investment opportunities for investors who have an ability to anticipate directional index moves. <b>TOPICS:</b>VAR and use of alternative risk measures of trading risk, volatility measures, portfolio construction