tbuckley/cabot-search huggingface dataset:
Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients.
Authors: K Lote, T Egeland, B Hager, B Stenwig, K Skullerud, J Berg-Johnsen, I Storm-Mathisen, H Hirschberg
Journal: Journal of Clinical Oncology (1997)

PURPOSE We report survival, prognostic factors, and treatment efficacy in low-grade glioma. PATIENTS AND METHODS A total of 379 patients with histologic intracranial low-grade glioma received post-operative radiotherapy (n = 361) and intraarterial carmustine (BCNU) chemotherapy (n = 153). Overall survival and prognostic factors were evaluated with the SPSS statistical program (SPSS Inc, Chicago, IL). RESULTS Median survival (all patients) was 100 months (95% confidence interval [CI], B7 to 113); in age group 0 to 19 years (n = 41), 226 months; in age group 20 to 49 years (n = 263), 106 months; in age group 50 to 59 years (n = 49), 76 months; and for older patients (n = 26), 39 months. Projected survival at 10 and 15 years was 42% and 29%, respectively. Patient age, World Health Organization (WHO) performance status, tumor computed tomography (CT) contrast enhancement, mental changes, or initial corticosteroid dependency were significant independent prognostic factors (p &lt; .05), while histologic subgroup, focal deficits, presence of seizures, prediagnostic symptom duration, tumor category, and tumor stage were not. Patients aged 20 to 49 years with no independent negative prognostic factors (n = 132) had a median survival time of 139 months versus 41 months in patients with two or more factors (n = 33). Patients who presented with symptoms of expansion (n = 97) survived longer when resected (P &lt; .03); otherwise no survival benefit was associated with initial tumor resection compared with biopsy. Intraarterial chemotherapy and radiation doses more than 55 Gy were not associated with prolonged survival. Among 66 reoperated patients, 45% progressed to high-grade histology within 25 months. CONCLUSION Prognosis in low-grade glioma following postoperative radiotherapy seems largely determined by the inherent biology of the glioma and patient age at diagnosis.
Determination of the existence of a correlation between lung function decline and changes in the COPD assessment test
Authors: Takashi Motegi, Takeo Ishii, Kumiko Hattori, Yuji Kusunoki, Ryuko Furutate, Akihiko Gemma, Kozui Kida
Journal: European Respiratory Journal (2014)

Background:  COPD assessment test (CAT) is used to ascertain the health status of patients with COPD. Although the clinical factors related to CAT score changes have been researched, there are few reports on the relationship between changes in the forced expired volume in 1 s (FEV 1 ) and the CAT. Aims: To determine whether annual FEV 1  changes are associated with CAT changes.  Methods:  An observational study was performed using data obtained from 180 patients (mean 70.5 years) followed up for a year or more. A pulmonary function test was performed and CAT were determined every 6 months. Baseline 6 min walking distance (6MWD), dyspnea scale, BODE index, and emphysema severity detected on CT (LAA%) were examined. The annual exacerbation rate was determined during the study period. ΔCAT/year and ΔFEV 1 /year were expressed as the regression line slope. Linear regression analysis was performed to ascertain the effect of the clinical factors on ΔCAT.  Results:  The median follow-up duration was 2.1 years. The mean baseline CAT score and baseline %FEV 1  were 13.9 (±SD 7.2) and 57.2 (21.2)%, respectively. The overall ΔCAT was -0.18(2.8). The mean ΔFEV 1  was -43.4 (108.7) mL/yr. The ΔCAT was significantly correlated with the baseline CAT score, baseline FEV 1 , 6MWD, BODE, LAA%, and the exacerbation rate (p  1 . Multiple regression analysis showed a significant correlation between ΔCAT and baseline CAT score, BODE, LAA%, and exacerbation rate.  Conclusion:  Although a correlation was observed between baseline FEV 1  and overall CAT score changes, the decline in annual FEV 1  was not correlated.
High-dose consolidation therapy with autologous stem cell rescue in stage IV breast cancer.
Authors: S F Williams, R Mick, R Desser, J Golick, J Beschorner, J D Bitran
Journal: Journal of Clinical Oncology (1989)

We designed a phase II study to determine whether induction chemotherapy (CT) consisting of leucovorin, vincristine, methotrexate, doxorubicin, and cyclophosphamide (LOMAC) followed by high-dose intensification chemotherapy (ICT) with cyclophosphamide, thiotepa, and autologous stem cell rescue (ASCR) could increase the complete response (CR) rate and survival in women with stage IV breast cancer. Twenty-nine women were enrolled on study; 16 patients had received prior adjuvant chemotherapy and no patient had received chemotherapy for stage IV disease. Two patients were found to be ineligible and excluded from further analysis. Of the 27 patients treated, four (15%) obtained a CR and 15 (56%) a partial response (PR) after LOMAC induction, for an overall response rate of 70%. Of the 22 patients treated with ICT, 12 patients had a CR, and nine were in PR after induction and converted to CR after ICT. The toxicities included nausea/vomiting, mucositis, diarrhea, dermatitis, alopecia, and infections secondary to neutropenia. The 1-year survival is 60%; the median has not yet been reached. The time to treatment failure for patients on study is 10 months. The treatment approach of ICT and ASCR following induction chemotherapy can lead to an improved CR rate in stage IV breast cancer. How this increased CR rate leads to a prolonged disease-free survival requires further follow-up.
Bone marrow transplantation for myelodysplastic and myeloproliferative syndromes.
Authors: M R O'Donnell, A P Nademanee, D S Snyder, G M Schmidt, P M Parker, P J Bierman, J L Fahey, A S Stein, R A Krance, A D Stock
Journal: Journal of Clinical Oncology (1987)

Twenty patients (age range, 4 to 48 years; median age, 36 years) with de novo or drug-induced myelodysplastic syndromes or myeloproliferative disorders were treated with myeloablative immunosuppressive therapy followed by bone marrow transplantation (BMT). Four preparative regimens were used; three regimens consisted of combined total body irradiation (TBI) and chemotherapy and one of combination chemotherapy only. One patient received marrow from his identical twin brother, whereas the other 19 patients were grafted with marrow from histocompatible siblings. In 19 patients the abnormal clone was at least temporarily ablated, while in one patient the congenital myelodysplasia persisted. Eight patients are alive and well for +108 to +3,359 days post-transplantation. Nine patients died of transplant-related complications (six of interstitial pneumonia, two of gastrointestinal bleeding, and one of fungal sepsis) and three patients died with persisting or recurring disease. One patient with a late recurrence has undergone a second successful bone marrow transplant procedure. Outcome of BMT was not related to French-American-British (FAB) type, marrow fibrosis, cytogenetic abnormalities, or preparation regimen. Marrow transplantation as a means of providing long-term disease-free survival and possible cure should be considered in patients if a suitable donor is available.
Multidrug-resistant tuberculosis and HIV infection in Eastern Europe: Two overlapping epidemics
Authors: Matteo Zignol, Dennis Falzon, Dara Masoud
Journal: European Respiratory Journal (2012)

Background : The number of people living with HIV has increased nearly three times in the former Soviet Union since 2000. Meanwhile, this is one of the world9s region most severely affected by multidrug-resistant tuberculosis (MDR-TB), with nearly half of patients with TB having MDR-TB in some settings.   Methods : Available drug resistance surveillance data between 2006 and 2011 were analysed from Belarus, Estonia, Latvia, Republic of Moldova, and Ukraine to explore the association between HIV and MDR-TB.   Results : In all 5 countries a significant positive association between MDR-TB and HIV was documented (range OR: 1.5-2.6, p value 2 =19.2%) and the difference was statistically significant.   Conclusions : The association between HIV and MDR-TB epidemics found in these countries is alarming. Patients with dual HIV/MDR-TB infection require complex treatment with anti-retrovirals and toxic, expensive anti-TB drugs. The likelihood of successful outcome is low and transmission of MDR-TB to others is high. Urgent measures should be implemented to strengthen HIV prevention and treatment, contain the spreading of MDR-TB, and improve collaboration between HIV and TB control activities, particularly for individuals at high risk of dual infection such as people who inject drugs and those in congregate settings. Further operational research to identify the determinants and conditions leading to MDR-TB in people living with HIV is needed.
Assessment of the left adrenal gland using an EBUS scope
Authors: Laurence Crombag, Peter Bonta, Jouke Annema
Journal: European Respiratory Journal (2013)

Introduction: In lung cancer patients, the left adrenal adrenal gland (LAG) is a predilection site for distant metastases. Esophageal endoscopic ultrasound (EUS), using a conventional GI endoscope, is an accurate method to assess the LAG. Complete endosonographic mediastinal investigation [endobronchial ultrasound (EBUS) combined with EUS] is the standard for mediastinal nodal staging. Reports show that complete endosonongraphic mediastinal staging can be performed using a single EBUS scope by introducing it in the esophagus after the EBUS procedure. Whether the EBUS scope is also suitable for transgastric LAG analysis is unknown.  Aim: To investigate the feasibility to detect the LAG with an EBUS scope.  Method: Retrospective analysis of patients who underwent complete endosonographic mediastinal and LAG assessment with a single EBUS scope.  Results: 16 patients [(suspected) lung cancer (n=10), sarcoidosis (n=3), or mediastinal masses (n=3)] with normal sized (CT) and FDG-PET negative LAG were investigated with an EBUS scope in patients lying in supine position. In 12/16 patients (75%) the LAG was clearly visualized. In one patient, with a slightly enlarged body, aspirates revealed normal adrenal gland tissue. In 4 patients the LAG was not found possibly due to shortness of the scope or poor contact between ultrasound transducer and stomach wall.  Conclusion: The EBUS scope allows identification of the LAG in the majority of patients.  Implication: Complete mediastinal staging including LAG analysis using a single EBUS scope seems feasible. In case large studies, including fine needle aspiration, confirm these initial findings, endosonographic N2 and M1 staging can be performed in a cost-effective single scope procedural setting.
Risk factors for uncontrolled asthma in a Swedish asthma population – Results from the PRAXIS-study
Authors: Karin Lisspers, Christer Janson, Anna Källander, Scott Montgomery, Björn Ställberg, Josefin Sundh, Mary Kämpe
Journal: European Respiratory Journal (2014)

Background: Asthma control is achieved in low proportion of patients. The aims were to evaluate asthma control, risk factors for uncontrolled asthma and the association of asthma control with quality of life.  Methods: A cross-sectional study in 2005 with 1675 randomly selected patients with asthma, 18-75 years; 846 from primary and 341 from secondary care, response rate 71%. Data from questionnaires and medical records. The survey included questions about asthma control according to GINA and a QoL-questionnaire, mini-AQLQ, with four domains. A follow-up in 2012 included 750 patients who participated in 2005.  Results: Asthma control in 2005 was achieved in 36% of the sample; 38% in primary and 29 % in secondary care. In primary and secondary care 35% and 45% had uncontrolled asthma, respectively. Risk factors for not having controlled asthma were female sex [OR 1.31 (95%CI 1.00 - 1.70)], older age [2.18 (1.28 - 3.73)], lower educational level [1.63 (1.14 - 2.33)] and current smoking [OR 1.68 (1.16 - 2.43)]. Older age and lower educational level remained significantly associated with not having controlled asthma in the stratum of never smokers. Depression was an independent risk factor for not having controlled asthma among men [3.44 (1.12 - 10.54)]. The mini-AQLQ total mean and domain scores were significantly lower in uncontrolled asthma. Data from the follow-up showed that asthma control in 2012 was achieved by 41% compared with 34% in 2005 (p  Conclusion: Risk factors for uncontrolled asthma were female sex, older age, low educational level and smoking. Uncontrolled asthma was significantly associated with lower quality of life. Asthma control improved from 2005 to 2012.
The decrease of surfactant protein D in bronchoalveolar lavage fluid in patients with idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia
Authors: Hirotaka Nishikiori, Hirofumi Chiba, Mitsuo Otsuka, Koji Kuronuma, Hiroki Takahashi
Journal: European Respiratory Journal (2012)

Background:  Surfactant protein (SP)-A and SP-D are useful biomarkers for the diagnosis and evaluation of activity of interstitial lung diseases. SP-A and SP-D, which are lung specific proteins, belong to a subgroup of the C-type lectin superfamily. It has been reported that those proteins play important roles in fibrotic lung. Although they are mainly produced by type II pneumocytes and clara cells, it is not clarified these production and clearance in fibrotic lung.   Methods:  To elucidate those issues, we measured levels of SP-A, SP-D and KL-6 by enzyme-linked immunosorbent assay in BAL fluid (BALF) and serum of 24 IPF patients, 36 NSIP patients (8 patients diagnosed by surgical biopsy, 28 patients clinically diagnosed) and 17 sarcoidosis patients. The levels of SP-A and SP-D in BALF were compared with those from 20 healthy controls. We investigated also the relationship of protein levels between serum and BALF.   Results:  In IPF and NSIP patients, SP-D levels in BALF were significantly lower than those from healthy controls (p=0.006 and p=0.003) and sarcoidosis patients (p=0.02 and p=0.01). SP-A levels in BALF were no significant difference among these patients and controls. The significant positive correlation of SP-D levels between serum and BALF was found in IPF patients (r=0.529, p=0.008). In NSIP patients, the correlation of SP-D levels between them was not significant. No correlation of SP-A levels between serum and BALF was observed in any patients groups.   Conclusion:  In IPF patients, SP-D levels in BALF were lower than those in healthy controls and had significant positive correlation with those in serum.
A family outbreak due to an emm-type 11 multiresistant strain of Streptococcus pyogenes
Authors: C. Martinaud, A. Doloy, B. Graffin, T. Gaillard, R. Poyet, S. Mallet, F. Carsuzaa, P. Brisou, A. Bouvet
Journal: Clinical Microbiology and Infection (2009)
Evaluating the efficiency of complex treatment of influenza A (H1N1) in hospital conditions
Authors: Olga Titova, Dmitri Larin, Vladimir Volchkov
Journal: European Respiratory Journal (2011)

Aim:  To study the efficiency of oseltamivir depending on the time of its administration to patients with typed A (H 1 N 1 ) and non-typed influenza.   Methods:  The prospective evaluation of disease severity, frequency of complications and mortality in hospital patients with influenza has been executed. 720 patients with suspicion on a virus infection were surveyed. From them at 373 patients the influenza A (H 1 N 1 ) was typed by RT-PCR test. Shortness of breath was assessed by MRC scale, severity of patient state was estimated by scale APACHE II. Patients underwent x-rays, laboratory tests, spirometry and diffusion capacity of the lungs.   Results:  At oseltamivir administration after 48 hours from the disease beginning efficiency of therapy decreased and frequency of complications increased. The severe course of influenza on APACHE II scale was accompanied by an increase in mortality (p   Conclusion:  The administration of oseltamivir later than 48 hours from onset of illness, severe state of patients on a scale of APACHE II, the increase of dyspnea after decrease of temperature, obesity and diabetes mellitus are risk factors for complications and adverse outcome of influenza A (H 1 N 1 ).
Suicidality among patients with mixed and manic bipolar disorder
Authors: S M Strakowski, S L McElroy, P E Keck, S A West
Journal: American Journal of Psychiatry (1996)

Patients with mixed or manic bipolar disorder were studied to determine whether suicidality in mania is associated with increasing depression in general (i.e., a dimensional construct based on symptom severity) or with the presence of a mixed state per se (i.e., a categorical construct requiring the presence of a full depressive syndrome).Diagnostic (categorical) assessments of 91 consecutively hospitalized patients with DSM-III-R mixed or manic bipolar disorder were made by using the Structural Clinical Interview for DSM-III-R. Symptom (dimensional) assessments were made by using the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Scale of the Assessment of Positive Symptoms. Logistic regression models were employed to test the relative associations between suicidality and dimensional and categorical depression measures. Receiver operating characteristics analysis was performed to identify a potential threshold depression rating that predicted suicidality.Suicidality was more common in mixed than manic bipolar disorder. However, when adjusted for total depression scores, this association with affective state did not persist, but the statistical model significantly improved. In the improved model, depressive symptom ratings were significantly associated with suicidality. Hamilton depression scale ratings greater than 18 identified over 90% of the patients with suicidality, although there was also a high rate of false positives (32%).It is the severity of concurrent depressive symptoms in mania, rather than the presence of a depressive syndrome per se (i.e., mixed state), that is associated with suicidality in bipolar patients.
Is vitamin D deficiency a risk factor for COPD exacerbations
Authors: Louise Jeanette Pauline Persson, Marianne Aanerud, Pieter Sicco Hiemstra, Jon Andrew Hardie, Per Sigvald Bakke, Tomas Mikal Eagan
Journal: European Respiratory Journal (2013)

Background: Vitamin D deficiency is associated with Chronic Obstructive Pulmonary Disease (COPD) and might be a risk factor for COPD exacerbations.  Methods: Number of exacerbations the previous year and every six months over a 3-year period were registered in 426 COPD patients, GOLD stage II-IV, aged 40-76 in the Bergen COPD Cohort Study from 2006 through 2009. Serum levels of 25(OH)D were measured at baseline using high- performance liquid chromatography coupled with mass spectrometry. Levels below 20ng/mL defined vitamin D deficiency (VDD; yes/no).  A Cox proportional hazard model was fitted to examine the effect of VDD on time to first exacerbation. A random effects Poisson model was fitted to examine the effect of VDD on annual exacerbation rate during follow-up. In both models we adjusted for age, gender, season of blood sampling, smoking status and forced expiratory volume in one second (FEV 1 ) measured at baseline.  Results: One third of the patients had VDD (n=142) and mean (SD) value of baseline FEV 1  in percent predicted was 49(14).  240 individuals had no exacerbations the first year and 106 had remained free from exacerbations after three years.  Mean 25(OH)D levels in patients with frequent exacerbations(≥2) one year prior study or after one year of follow-up (23.7 and 23.7ng/mL), were not statistically different from patients not frequently exacerbating (25.4 and 25.8ng/mL), p=0.18 and p=0.08 respectively.  Vitamin D deficiency at baseline did not predict time to first exacerbation (hazard ratio: 1.03, 95% CI: 0.70-1.50, p=0.89), or exacerbation rate (IRR: 0.91, 95% CI: 0.70-1.18, p=0.47).  Conclusion: Vitamin D deficiency was not associated with exacerbations in a cohort of COPD patients followed three years.
UK academic general practice and primary care
Authors: John Campbell, F D Richard Hobbs, Bill Irish, Sandra Nicholson, Mike Pringle, Joanne Reeve, Joe Rosenthal
Journal: BMJ (2015)

Visible? Viable? Invaluable

The report of Higher Education England’s commission on the primary care workforce is timely and welcome.1 The UK has led the way in delivering high quality, effective, accessible, and equitable healthcare at modest cost.2 Getting the right workforce to deliver the strongest possible NHS primary care focus3 is critically important in times of financial constraint, healthcare innovation, and the changing population demographic characterised by complex care needs and multimorbidity. But in parallel, attention must be given to the importance of recruiting, retaining, and developing the primary care academic workforce—an agenda that was beyond the remit of the commission.

The UK’s 205 senior academic GPs comprise just 6.5% of all clinical academics, and a tiny fraction of the 64 923 GPs currently registered with the General Medical Council (32 628 established GP full time equivalents). The overall increase in GP academic capacity from 153 full time equivalents in 2000 to 205 in 2014 has been almost exclusively the result of an increase in the numbers of GP professors from 33 to 78; the static number of GP lecturer posts (40) …
The pathogenesis of Shigella Diarrhea
Authors: Gerald T. Keusch, George F. Grady, Leonardo J. Mata, James McIver
Journal: Journal of Clinical Investigation (1972)

A strain of Shigella dysenteriae 1, freshly isolated from a patient with dysentery in Guatemala in August 1969, was found to elaborate an enterotoxin into the liquid of broth cultures. Partial purification of the enterotoxin by ultrafiltration on graded polymeric membranes and Sephadex gel filtration (Pharmacia Fine Chemicals, Inc., Piscataway, N. J.) suggested an approximate molecular weight of 55,000-60,000. The partially purified toxin was heat-labile, pronase sensitive, and activated by alkaline pH, and it elicited fluid production in ligated rabbit ileal segments; it failed, however, to cause increased vascular permeability in skin. When the activities of equal weights of identically prepared Vibrio cholerae and S. dysenteriae enterotoxins were compared in the rabbit ileum the latter caused a significantly smaller volume response with increased concentrations of potassium, chloride, and protein. The previously described neurotoxic (mouse lethal) factor was also present and eluted from Sephadex G-150 with the enterotoxin. If these biological activities prove to be possessed by a single molecular species, it is suggested that it be renamed Shigella enterotoxin in recognition of the physiologically more relevant biological action.
Factors associated with virological success with raltegravir-containing regimens and prevalence of raltegravir-resistance-associated mutations at failure in the ARCA database
Authors: S. Rusconi, P. Vitiello, F. Adorni, B. Bruzzone, A. De Luca, V. Micheli, P. Meraviglia, R. Maserati, M. Di Pietro, G. Colao, G. Penco, A. Di Biagio, G. Punzi, L. Monno, M. Zazzi
Journal: Clinical Microbiology and Infection (2013)