tbuckley/cabot-search huggingface dataset:
Join us at The Lancet Clinic
Authors: Sabine Kleinert, Richard Horton, Elena Becker-Barroso, Niall Boyce, David Collingridge, Justine Davies, Emma Grainger, Peter Hayward, John McConnell, Zoë Mullan, Lan-Lan Smith
Journal: The Lancet Neurology (2015)

On Oct 5, 2015, we launch the first 45 disease-specific pages of a major new online initiative involving all Lancet journals that will bring together an overview Seminar and relevant Reviews, Clinical Series, Commissions, research, Case Reports, and Clinical Pictures. Over the next 18 months or so when The Lancet Clinic is complete, there will be online pages for 135 diseases, which we have identified by a combination of global burden of disease data and clinical practice needs. We hope that The Lancet Clinic will help practising doctors make better informed decisions that ultimately lead to better lives of people worldwide, and help others who want to educate or update themselves keep abreast of the evolving evidence base. Importantly, these pages will be updated at regular intervals. The authors of newly commissioned Seminars have agreed to provide regular summaries of important new evidence for 4 years. Individual clinical editors will pull together newly published material from across the Lancet journals and post links to these on the page regularly. In addition, we are continuing our regular editorial policies of commissioning more specialised Clinical Reviews and Series across The Lancet Group to provide a more focused and in-depth assessment for key diseases. And beyond providing knowledge and information, we want to encourage academic and practising clinicians to use this knowledge for advocacy and change. In 2014, The Lancet published the first Clinical Commission on liver disease in the UK and in February, 2015, we launched our first Clinical Campaign based on this Commission. A Cancer Campaign as a joint effort between The Lancet and The Lancet Oncology followed in April. Clinical Campaigns aim to effect change based on data, knowledge, and expert interpretation in partnership with others. Further Clinical Commissions on asthma, hypertension, dementia, tuberculosis, traumatic brain injury, psychotherapy, chronic obstructive pulmonary disease, and others are underway across all Lancet journals. With these Clinical Commissions and Campaigns, we hope to extend our goal to publish the best science for better lives to being an active partner in using this science for actual change. Commissions and Campaigns will be part of the disease pages to encourage engagement and actions. The Lancet Clinic invites you to be part of this endeavour.
Impact of anemia on dyspnea on exertion and exercise tolerance in patients with acute exacerbation of chronic obstructive pulmonary disease
Authors: Adam Nowinski, Daruisz Kaminski, Damian Korzybski, Michal Bednarek, Anna Stoklosa, Dorota Gorecka
Journal: European Respiratory Journal (2011)

Introduction:  Dyspnea and decreased exercise tolerance are symptoms of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Anemia is a risk factor for reduced functional capacity and dyspnea in stable COPD. There is limited information about the impact of anemia on functional capacity and dyspnea of patients during AECOPD. The aim of this study was to evaluate the impact of decreased blood hemoglobin level to results of six minute walking test in patients during after AECOPD.   Materials and methods:  A retrospective analysis of data collected from long term study on AECOPD was performed. Haemoglobin level from the first obtainable hospital measurement was included in the assessment. 6MWD was performed after clinical improvement of the patient. Dyspnoea at baseline and after exercise was measured. Oxygen saturation (SpO2) during exercise was measured.   Results:  404 patients with AE COPD were analyzed. GOLD stages, hemoglobin level and results of 6MWD are shown in Table 1. Results are means ±SD. *p  The hemoglobin level did not correlate with 6MWD, dyspnea after 6MWT, exercise oxygenation and blood desaturation after exercise.   Conclusion:  Decreased blood hemoglobin level didn9t influence the results of 6MWT in patients after AECOPD.
Effect of physical inactivity on COPD exacerbations
Authors: David Donaire-Gonzalez, Elena Gimeno-Santos, Judith Garcia-Aymerich
Journal: European Respiratory Journal (2013)

Background: Physical inactivity is one of the few modifiable risk factors of exacerbation in chronic obstructive pulmonary disease (COPD). 2,500 steps per day has been proposed as a threshold between inactivity and limited activity in elderly or special populations (Tudor-Locke 2011, Int J Behav Nutr Phys Act).  Aim: To evaluate the effect of physical inactivity, measured objectively, on the risk of admission for a COPD exacerbation.  Methods: At baseline, 177 COPD patients from the PAC-COPD cohort provided the number of days per week performing less than 2,500 steps/day from an activity monitor (SenseWear® Pro 2  Armband). Information about COPD hospital admissions during the follow up [mean (SD): 2.5 (0.8) years] was obtained from validated centralised datasets. The relationship between baseline physical activity and risk of COPD admission was tested using a multivariate Cox proportional hazards regression.  Results: At baseline, patients were mean (SD) age of 71(8) years, and had postBD FEV 1  of 52(16)%. Two thirds of the patients (64%) walked more than 2,500 steps/day all days of the week, while 13% of them fulfilled this condition none or only one day. During follow-up, 65(38%) patients had suffered at least a COPD admission. After adjusting for having suffered a previous COPD admission, FEV 1 , PaO 2  and season, patients who walked 2,500 steps/day less than 2 days per week showed an increased risk of COPD admission (HR (95% CI) 1.88 (1.00 to 3.51), p=0.048) as compared to those who walked 2,500 steps/day two to seven days/week.  Conclusion: COPD patients should be encouraged to avoid inactivity in order to reduce COPD admissions.
Cancer clinical trials available in the community setting: A 5-year analysis from 1999–2004
Authors: J. K. Keller, J. Bowman, J. A. Lee, M. A. Mathiason, K. A. Frisby, C. M. Meyer, L. A. Meyer, L. J. Wright, R. S. Go
Journal: Journal of Clinical Oncology (2006)

6056 Background: Less than 5% of newly diagnosed cancer patients are accrued into clinical trials. In the community setting, the lack of appropriate clinical trials is a major barrier. Our prospective study in 2004 determined that 58% of newly diagnosed adult cancer patients at our community-based cancer center didn’t have a clinical trial available appropriate for their disease stage. Among those with clinical trials, 23% were subsequently found to be ineligible (Go RS, et al. Cancer 2006, in press). However, the availability of clinical trials may vary from year to year. Methods: A retrospective study was conducted to determine what clinical trials were available for newly diagnosed adult cancer patients at our institution from June 1999-July 2004. The study also investigated the proportions of newly diagnosed patients who had a clinical trial available appropriate for type and stage of disease and patients accrued. Results: Over the 5-year period, 207 (82, 87, 99, 102, 117, years 1–5, respectively) trials were available. Most (50.7%) trials were for the following cancers: breast (15.5%), lung (13.5%), head and neck (7.7%), colorectal (7.2%) and lymphoma (6.8%). ECOG (53%), RTOG (26%), and CTSU (9%) provided the majority of the trials. A total of 5,776 new adult cancer patients were seen during this period. Overall, 60% of the patients had a trial available appropriate for type and stage of their cancer, but only 103 (3%) were enrolled. There was a significant upward trend in the proportions of patients with available trials over the years (60.2%, 55.9%, 59.2%, 60.7%, 63.9%, years 1–5, respectively; Mantel-Haenszel P=.008). The proportion of patients with a trial available was highest for prostate (97.3%), lung (90.9%), and breast (73.9%), and lowest for melanoma (17.1%), renal (11.6%), and bladder (7.2%). The majority of patients accrued to trials had the following cancers: breast (32%), lung (17%), lymphoma (9%), colon (7%), and prostate (5%). Conclusions: Nearly half of the newly diagnosed adult patients at our center had no trials available appropriate for type and stage of their cancers. It is likely that if strict clinical trial eligibility criteria were applied, approximately 2/3 of our patients would not be eligible for a clinical trial. No significant financial relationships to disclose.
Chemokine release by neutrophils in COPD
Authors: Kristin Blidberg, Lena Palmberg, Barbro Dahlén, Ann-Sophie Lantz, Kjell Larsson
Journal: European Respiratory Journal (2011)

Background: Neutrophils are among the first cells to arrive at the site of injury and chemokines secreted by neutrophils affect the migration not only of other neutrophils but also of other inflammatory cells such as monocytes. It has also been reported that LPS-induced release of interleukin-8 (IL-8, CXCL-8) by neutrophils is amplified by neutrophil derived tumour necrosis factor (TNF)-α. We hypothesize that chemokine release by neutrophils is altered in COPD as compared to healthy controls and that TNF-α might be involved in this change.  Methods: Peripheral blood neutrophils isolated from smokers with COPD (n=12), smokers without COPD (n=12) and healthy non-smokers (n=12) were stimulated with LPS, TNF-α or organic dust. Anti TNF-α antibody (infliximab) was used to study the effect of neutrophil derived TNF-α. Release of CXCL-8, macrophage inflammatory protein-1 α (MIP-1α, CCL-3), monocyte chemotactic protein-1 (MCP-1, CCL-2) and TNF-α was measured.  Results: Neutrophils spontaneously release CXCL-8, CCL-2 and CCL-3. Inhibition of TNF-α reduced the spontaneous release of CXCL-8 and CCL-3. Stimulation with LPS and organic dust increased the release of CXCL-8 and CCL-3, an effect that was inhibited by infliximab. In the COPD group inhibition of TNF-α failed to significantly inhibit the release of LPS induced CXCL-8.  Conclusion: Neutrophil derived TNF-α contributed to the release of chemokines after stimulation with LPS and organic dust as the response was inhibited by infliximab. In the COPD group infliximab did not significantly inhibit the release of CXCL-8 suggesting that the role of TNF-α is somehow altered in COPD.
Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment
Authors: Anlys Olivera, Natasha Lejbman, Andreas Jeromin, Louis M. French, Hyung-Suk Kim, Ann Cashion, Vincent Mysliwiec, Ramon Diaz-Arrastia, Jessica Gill
Journal: JAMA Neurology (2015)

Approximately one-third of military personnel who deploy for combat operations sustain 1 or more traumatic brain injuries (TBIs), which increases the risk for chronic symptoms of postconcussive disorder, posttraumatic stress disorder, and depression and for the development of chronic traumatic encephalopathy. Elevated concentrations of tau are observed in blood shortly following a TBI, but, to our knowledge, the role of tau elevations in blood in the onset and maintenance of chronic symptoms after TBI has not been investigated.To assess peripheral tau levels in military personnel exposed to TBI and to examine the relationship between chronic neurological symptoms and tau elevations.Observational assessment from September 2012 to August 2014 of US military personnel at the Madigan Army Medical Center who had been deployed within the previous 18 months. Plasma total tau concentrations were measured using a novel ultrasensitive single-molecule enzyme-linked immunosorbent assay. Classification of participants with and without self-reported TBI was made using the Warrior Administered Retrospective Casualty Assessment Tool. Self-reported symptoms of postconcussive disorder, posttraumatic stress disorder, and depression were determined by the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist Military Version, and the Quick Inventory of Depressive Symptomatology, respectively. Group differences in tau concentrations were determined through analysis of variance models, and area under the receiver operating characteristic curve determined the sensitivity and specificity of tau concentrations in predicting TBI and chronic symptoms. Seventy participants with self-reported TBI on the Warrior Administered Retrospective Casualty Assessment Tool and 28 control participants with no TBI exposure were included.Concentration of total tau in peripheral blood.Concentrations of plasma tau were significantly elevated in the 70 participants with self-reported TBI compared with the 28 controls (mean [SD], 1.13 [0.78] vs 0.63 [0.48] pg/mL, respectively; F1,97 = 4.97; P = .03). Within the self-reported TBI cases, plasma total tau concentrations were significantly associated with having a medical record of TBI compared with self-reported TBI only (mean [SD], 1.57 [0.92] vs 0.85 [0.52] pg/mL, respectively; F1,69 = 6.15; P = .02) as well as reporting the occurrence of 3 of more TBIs during deployment compared with fewer than 3 TBIs (mean [SD], 1.52 [0.82] vs 0.82 [0.60] pg/mL, respectively; F1,69 = 8.57; P = .008). The severity of total postconcussive symptoms correlated with total tau concentrations in the self-reported TBI group (r = 0.37; P = .003).Military personnel who report multiple TBIs have long-term elevations in total tau concentration. The total tau concentration relates to symptoms of postconcussive disorder.
Effect of patient centredness and positive approach
Authors: D. Shepherd
Journal: BMJ (2002)

Editor—Little et al say that doctors should be aware that airing their uncertainties might reduce satisfaction and empowerment.1 This conclusion is not really supported by their research because the positive approach statements dealt with the patient's problem and not the specific diagnosis. It is possible for the doctor to acknowledge uncertainty about a diagnosis or prognosis while giving the patient a clear positive message about what they can expect to happen, or what the doctor thinks they could do about the problem and what to do if things do not go according to expectation.

This safety net is likely to be perceived as positive by the patient, who may feel even more empowered as the doctor has clearly planned for the uncertainty that all patients know exists. Pretending to know the future or exact diagnosis fools no one and is likely to lessen satisfaction and empowerment. Helping patients to handle uncertainty effectively is an important part of enablement. This clarification of what is meant by a positive approach should be addressed in future research.
Pulmonary hemodynamics and lung function in patients with COPD and DPLD
Authors: Sabine Grachtrup, Hans Pankau, Hans-Juergen Seyfarth, Hubert Wirtz
Journal: European Respiratory Journal (2014)

Introduction: In patients with chronic lung diseases pulmonary hypertension is associated with a worse prognosis. Aim of this study was to compare pulmonary hemodynamics in patients with chronic obstructive pulmonary disease (COPD) and diffuse parenchymal lung disease (DPLD) and to correlate them to lung function.  Methods:We performed body plethysmography, six minute walking distance test (6MWD) and right heart catheter in 56 COPD and 44 DPLD patients. Hemodynamic data were analysed for significant difference between COPD and DPLD patients. Correlation to lung function parameters was tested.  Results:We found significant higher median values for right atrial pressure (8 vs.4 mmHg) and pulmonary capillary wedge pressure (PCWP;11 vs.8 mmHg) in COPD vs. DPLD patients. 6MWD in COPD patients was significantly higher than in DPLD patients (205 vs.160m). In COPD patients mean pulmonary artery pressure and pulmonary vascular resistance showed a strong correlation to FEV1,total lung capacity(TLC),residual volume(RV),and residual volume in % of total lung capacity (all p  Conclusion:Our data support a relationship between hemodynamic and lung function data in COPD patients. This assumption is not applicable in our examined DPLD patients. Differences in hemodynamics between COPD and DPLD patients demonstrate the different intrathoracic pressure caused by the diseases.
Implications of the medical model and its alternatives
Authors: P H Blaney
Journal: American Journal of Psychiatry (1975)

The term "medical model" is often used as if it referred to a single, well-understood set of assumptions about psychiatric disorders. Actually, there are at least four different meanings that a person saying "emotional disorders are diseases" might intend to communicate. The models usually suggested as alternatives are addressed to one or another of these medical model implications. A distinction should be maintained between the virtues of these models as conceptual aids and their virtues and weakness as shapers of public opinion and professional practice.
Transdermal testosterone in female cancer survivors with decreased libido
Authors: D. L. Barton, C. Loprinzi, D. Wender, R. Dalton, E. Balcueva, P. Atherton, A. Bernath, W. Dekrey, T. Larson, J. Bearden, J. Sloan
Journal: Journal of Clinical Oncology (2006)

8507 Background: Problems with sexual functioning are an issue negatively affecting the quality of life of female cancer survivors. Testosterone has been implicated as an important hormone in sexual functioning such as libido. Studies of transdermal testosterone have shown benefit in enhancing libido in women who have been diagnosed with hypoactive sexual desire disorder after bilateral oophorectomy. This phase III placebo-controlled clinical trial evaluated whether transdermal testosterone would increase libido in female cancer survivors. Methods: Women with a history of cancer, currently without evidence of disease, were eligible if they reported a decrease in sexual desire and had a sexual partner. Women must have been postmenopausal. Eligible women were randomized to receive 2% testosterone in Vanicream (10 mg daily) versus placebo Vanicream for four weeks, then crossed over to the opposite treatment. The primary endpoint, libido, was measured via the desire subscales of the Changes in Sexual Functioning Questionnaire (CSFQ), which were completed at baseline and at the end of 4 and 8 weeks of treatment. The primary endpoint was the average intra-patient change from baseline to four weeks in the CSFQ subscales between the two arms. A total of 64 patients per group were needed to provide 80% power to detect a difference of 8 units between the treatment means. Two-sided alternative hypothesis testing and a 5% Type I error rate were used. Results: One hundred fifty women were enrolled onto this study. Complete data were available for 132 women. For those on active testosterone cream, serum bioavailable testosterone levels increased significantly over placebo, with a mean change from baseline of 12 and 10 ng/dl for the first and second period, respectively (p&lt;.0001). The average intra-patient change from baseline to week 4 in libido was 5.5 on testosterone and 4.4 on placebo (p=0.58). No carryover effect was detected. The difference in average intra-patient changes from baseline for the entire crossover design between the two arms was only 1.1 points (95% confidence interval of -1.2 to 3.4, p=0.35). Conclusion: Testosterone is not a panacea for libido troubles in women with a history of cancer. Further studies are needed to determine whether there is a role for transdermal testosterone in this population. No significant financial relationships to disclose.
Adverse Events After Routine Immunization of Extremely Low-Birth-Weight Infants
Authors: Stephen D. DeMeo, Sudha R. Raman, Christoph P. Hornik, Catherine C. Wilson, Reese Clark, P. Brian Smith
Journal: JAMA Pediatrics (2015)

Immunization of extremely low-birth-weight (ELBW) infants in the neonatal intensive care unit (NICU) is associated with adverse events, including fever and apnea or bradycardia, in the immediate postimmunization period. These adverse events present a diagnostic dilemma for physicians, leading to the potential for immunization delay and sepsis evaluations.
Pluripotent, cytokine-dependent, hematopoietic stem cells are immortalized by constitutive Notch1 signaling
Authors: Barbara Varnum-Finney, Lanwei Xu, Carolyn Brashem-Stein, Cynthia Nourigat, David Flowers, Sonia Bakkour, Warren S. Pear, Irwin D. Bernstein
Journal: Nature Medicine (2000)
Outbreak of Salmonella serotype Javiana infections - Orlando, Florida, June 2002.
Authors: B. Toth, D. Bodager, R. M. Hammond, S. Stenzel, J. K. Adams, T. Kass-Hout, R. M. Hoekstra, P. S. Mead, P. Srikantiah
Journal: MMWR Morbidity and Mortality Weekly Report (2002)
Phase II trial of 96-hour paclitaxel plus oral estramustine phosphate in metastatic hormone-refractory prostate cancer.
Authors: G R Hudes, F Nathan, C Khater, N Haas, M Cornfield, B Giantonio, R Greenberg, L Gomella, S Litwin, E Ross, S Roethke, C McAleer
Journal: Journal of Clinical Oncology (1997)

PURPOSE To evaluate the antitumor activity of 96-hour paclitaxel and daily oral estramustine phosphate (EMP) in patients with metastatic hormone-refractory prostate cancer (HRPC). PATIENTS AND METHODS Thirty-four patients with adenocarcinoma of the prostate that progressed after one or more hormonal therapies and a trial of antiandrogen withdrawal were enrolled onto this phase II trial. Patients received paclitaxel 120 mg/m2 by 96-hour intravenous (i.v.) infusion on days 1 through 4 of each 21-day cycle, together with daily oral EMP 600 mg/m2/d, continuously. RESULTS Four of nine patients with measurable disease had objective responses (one complete response [CR] and three partial responses [PRs]) in liver (two patients) or nodes (two patients) of 2, 6, 8, and 20 months' duration. Of 25 assessable patients with metastases limited to bone, 14 had a &gt; or = 50% decline in pretreatment prostate-specific antigen (PSA) level sustained for at least 6 weeks and seven had a &gt; or = 80% decline. Overall, 17 of 32 patients (53.1%) with elevated pretreatment PSA levels had a &gt; or = 50% decline of PSA and nine (28.1%) had a &gt; or = 80% decrease. The main toxicities (&gt; or = grade 2) were nausea, fluid retention, and fatigue, which occurred in 33%, 33%, and 24.2% of patients. Median time to progression, based on increasing PSA level and other clinical criteria, was 22.5 weeks. The estimated median overall survival time is 69 weeks. CONCLUSION The combination of EMP and 96-hour paclitaxel is an active regimen for patients with HRPC. These results further support the therapeutic strategy of combining agents that impair microtubule function by complementary mechanisms.