tbuckley/cabot-search huggingface dataset:
Diabetes mellitus type 2 in patients with COPD admitted for exacerbation: Preliminary data
Authors: Evgeni Mekov, Yanina Slavova, Marianka Genova, Svetlana Hadjieva, Adelina Tsakova
Journal: European Respiratory Journal (2014)

Introduction: Diabetes mellitus (DM) affects 2-37% of patients with COPD, depending on the subgroup examined and is highly variable in different studies. Co-existence worsens each condition and the prognosis for the patient.  Aim: To find out the prevalence of DM and its correlation with comorbidities and disease characteristics in patients with COPD admitted for exacerbation.  Methods: 92 patients were investigated for the presence of DM. All of them were also investigated for metabolic syndrome. Data were gathered for smoking status and exacerbations in the last year. The patients completed CAT and mMRC questionnaires and underwent spirometry.  Results: 12% (n=11) of patients are taking medications for diabetes. Additional 21,7% (n=20) have evidence of newly discovered DM and 31,5% (n=29) have prediabetes. Only 34,8% of the studied patients do not have DM or prediabetes. 74% (23 from 31) of patients with diabetes had HbA1c>6,5% suggesting prolonged hyperglycemia. The presence of DM is associated with more severe exacerbations (hospitalizations) during the previous year (p=0.037), higher total cholesterol (p=0.025) and older age (p=0.04). There is a tendency for a correlation between the presence of DM and metabolic syndrome (p=0.075). DM is not associated with worsening pulmonary function and does not differ between sexes. The prevalence of DM in this study is significantly higher when compared to national representative data (12,8% in subjects over 40 years).  Conclusions: Patients with COPD admitted for exacerbation are at great risk for impaired glucose metabolism. 33,7% of them have DM and 31,5% have prediabetes. The majority of the patients in this study are unaware of having diabetes.
Combination chemotherapy with gemcitabine and docetaxel for recurrent germ cell tumors in the central nervous system
Authors: J. Ikeda, H. Kobayashi, N. Ishii, Y. Sawamura, H. Aoyama, H. Shirato
Journal: Journal of Clinical Oncology (2004)

1540 Background: Through the use of cisplatin-based combination chemotherapy and radiotherapy, outcomes have improved for patients with intracranial germ cell tumor. An appropriate therapy for recurrent germ cell tumors, however, remains to be established. The present feasibility study investigates the toxicity and activity of a gemcitabine/docetaxel combination in patients with multiply relapsed germ cell tumor. Methods: Gemcitabine was administered at a dose of 1000 mg/m2 over 30 minutes on days 1, 8 followed by docetaxel (1 h-infusion) at a dose of 60 mg/m2 on day 8, with courses repeated every 21 days. Results: From 9/00 to 9/01 5 patients with a median age of 15 [13–32] years were enrolled. Patients had been pretreated with a median of 9 [3–16] platin-containing cycles and 1 patient had previously failed high-dose chemotherapy with PBSCT. All patients were considered cisplatin-refractory. Median number of applied cycles was 2 [2–4]. All patients achieved a radiological partial response with a tumor marker normalization resulting in an objective response rate of 100%. However, the remissions after chemotherapy alone were not durable. Three of the 5 patients received an additional low-dose of irradiation following the chemotherapy. Median progression-free interval was 26 [7–39+] months with 2 patients remaining without disease progression for more than 30 months. Toxicity was generally acceptable: CTC grade III/IV neutropenia of short duration occurred in all patients. No case of grade III/IV non-hematological adverse effect was observed. Conclusions: The combination of gemcitabine/docetaxel is feasible and associated with an acceptable toxicity in patients with multiply relapsed and cisplatin-refractory germ cell tumor. It exhibits a significant activity with responses observed in all patients. No significant financial relationships to disclose.
Nigro regimen treatment of squamous cell cancer of the anus
Authors: S. R. Kalmadi, R. J. Pelley, E. Kay, J. P. Saxton, R. M. Bukowski, R. D. Kim, I. C. Lavery, V. W. Fazio
Journal: Journal of Clinical Oncology (2007)

14545 Background: To identify prognostic factors for patients with squamous cell cancer (SCC) of the anus treated with Nigro Regimen chemo/radiation therapy. Methods: Survival data of 61 patients with SCC of the anal canal were reviewed who were treated with definitive radiochemotherapy (RCT) between 9/83 and 3/06. All patients received RCT at the Cleveland Clinic Foundation. Results: Patient characteristics were typical of other studies. Median age was 57 years (34–82), women: men (42:19), PS 0–1 (95%), smokers 52%, and clinically lymph node positive tumors 27%. T3–4 tumors were 50%, high for most series. The median follow-up time was 52 mos (7–246 mos). The median disease free survival (DFS) and overall survival (OS) have not been reached. 5-year DFS was 76% (95% C.I. 62–88%) and 5-year OS was 76% (95% C.I. 60–86%). Colostomy free survival at 5-years was 41/61 (67%). Log rank analyses showed that female sex (5-yr DFS 82 vs 55%, p=0.03), and clinical stage (5-yr DFS, stage 1 100%, stage 2 80%, stage 3a 65%, stage 3b 0%) correlated with better disease free survival. Patient age (less than 60 or greater), time of diagnosis (before 1996 or later), and smoking status did not correlate with better disease free survival. There were 14 recurrences, 7 systemic, 7 local with APR salvaging 4 patients with local relapse. There were 2 cases of treatment related hemolytic uremic syndrome, with one death. Conclusions: The Nigro regimen is successful in curing anal cancer in a significant majority of patients. We appear to have reached a therapeutic plateau and have not had any significant improvement in cure rates over the last two decades. Identification of subsets more prone to relapse is crucial, to target with more intense treatment in future trials. In the current series, male sex and advanced clinical stage correlated with poor disease free survival, when anal cancer patients were treated with the Nigro regimen RCT. Future studies should investigate whether more intensive treatment is needed in males, and patients with more advanced disease. No significant financial relationships to disclose.
Effects of Acupuncture in Bronchial Asthma: Preliminary Communication
Authors: P L R Dias, S Subramaniam, N D W Lionel
Journal: Journal of the Royal Society of Medicine (1982)

Twenty patients randomly assigned to an experimental and a control group participated in a double blind study to assess the effectiveness of acupuncture in bronchial asthma, using the peak expiratory flow rate (PEFR) as an index of bronchial patency. All patients in the control group showed a significant improvement in their PEFR while only 3 patients in the treated group showed an improvement. A subjective improvement and a reduction in drug dosages were observed in both groups. It is concluded that acupuncture has a placebo effect in bronchial asthma.
Practical advice is available
Authors: Kelwyn D Williams
Journal: BMJ (2008)

<h3>BACKGROUND AND PURPOSE:</h3> An accurate evaluation of the World Health Organization grade is critical in pediatric intracranial tumors. Our aim was to explore the correlations between parameters derived from conventional DWI, intravoxel incoherent motion, and diffusional kurtosis imaging with histopathologic features to evaluate the accuracy of diffusion parameters for grading of pediatric intracranial tumors. <h3>MATERIALS AND METHODS:</h3> Fifty-four pediatric patients with histologically proved intracranial tumors who underwent conventional DWI, intravoxel incoherent motion, and diffusional kurtosis imaging were recruited. The conventional DWI (ADC), intravoxel incoherent motion (pure diffusion coefficient [D], pseudodiffusion coefficient [D*], perfusion fraction [f], diffusional kurtosis imaging [K], and diffusion coefficient [Dk]) parameters in the solid component of tumors were measured. The cellularity, Ki-67, and microvessel density were measured. These parameters were compared between the low- and high-grade pediatric intracranial tumors using the Mann-Whitney <i>U</i> test. Spearman correlations and receiver operating characteristic analysis were performed. <h3>RESULTS:</h3> The ADC, D, and Dk values were lower, whereas the K value was higher in high-grade pediatric intracranial tumors than in low-grade tumors (all, <i>P</i> &lt; .001). The K value showed positive correlations (<i>r</i> = 0.674–0.802; all, <i>P</i> &lt; .05), while ADC, D, and Dk showed negative correlations with cellularity and Ki-67 (<i>r =</i> −0.548 to −0.740; all, <i>P</i> &lt; .05). The areas under the curve of ADC<sub>VOI</sub>, D<sub>VOI</sub>, Dk<sub>VOI</sub>, and K<sub>VOI</sub> were 0.901, 0.894, 0.863, and 0.885, respectively, for differentiating high- from low-grade pediatric intracranial tumors. The area under the curve difference in grading pediatric intracranial tumors was not significant (all, <i>P</i> &gt; .05). <h3>CONCLUSIONS:</h3> Intravoxel incoherent motion– and diffusional kurtosis imaging–derived parameters have similar performance compared with conventional DWI in predicting pediatric intracranial tumor grade. The diffusion metrics may potentially reflect tumor cellularity and Ki-67 in pediatric intracranial tumors.
The role of a pleural service in optimising pleural disease management
Authors: Matthew Knight, Leda Yazbeck, Sofia Hanger, Oliver Butters, Dean Creer
Journal: European Respiratory Journal (2014)

Introduction  The complication rate of Pleural procedures is reduced from 8% to 1% when managed by a pleural specialist. We reviewed pleural disease managed by the department of medicine at our hospital in London to assess the potential effect a dedicated pleural service on patient safety, doctor training and on reducing length of stay.  Methods  Patients admitted over 12 months were identified, length of stay analysed and management audited against criteria for Ambulatory care and British Thoracic Society guidelines. Doctors were surveyed to assess training and confidence in pleural procedures. An economic analysis was performed.  Results  349 patients were admitted for pleural effusion management. Average length of stay under a Respiratory team was substantially shorter than under a general medicine team.  30% of admitted patients could have been managed in an ambulatory setting. Early involvement of a Respiratory team could have saved over 700 bed days over 1 year.  Only 50% of patients managed by a non-respiratory team had pleural procedures performed compliant with national guidelines. Junior doctors covering 9out of hours9 did not feel confident in performing pleural procedures, and few had sufficient experience and training in ultrasound use.  An economic analysis demonstrated that a pleural service would be cost effective.  Conclusion  This audit clearly establishes the need for a dedicated pleural service at our hospital. The main drivers from an organisational perspective are improved patient safety and reduced length of stay. We have identified a serious deficiency in training for junior doctors who cover the hospital out of hours, which will be addressed by a new training programme run by the pleural team.
Pleuroscopy with an autoclavable semi rigid thoracoscope
Authors: Julia Tarrega, Yolanda Galea, Pere Poch, Montserrat Nieto, Enric Barbeta
Journal: European Respiratory Journal (2011)

Aim:  Describe our experience with a endoscope similar in design to commonly used bronchoscope. This pleuroscope interfaces with processors and light sources employed for flexible bronchoscopy and, therefore, are available in most endoscopy units.   Method:  Pleuroscopies were performed under local anaesthesia with conscious sedation. by a Respiratory Physician in a endoscopic suit. A single puncture technique and pleuroscope Olympus LTF-160.was used   Results:  31 pleuroscopies undertaken over a 14-month period. From the 31 patients, 22 were men, and 9 women, mean age of 68,6. Four patients have bilateral pleural effusion. 17 procedures were performed on the right pleural space, and 14 on the left. The indication in 22 procedures was for diagnostic of a pleural effusion, in the other 9 procedures, the indication was pleurodesis in patients with previous diagnostic of malignancy. Pleural biopsy were obtained in the 22 patients and a histologic diagnosis of malignancy was made in 10 (3 mesothelioma and 7 metastasis of carcinoma) six patients has non specific pleuritis and 2 patient has necrotizing granulomes. In 3 patients with previous diagnostic of malignancy (esophagus and 2 bronchial carcinoma), metastatic pleurisy were ruled out. In 18 patients, pleurodesis with talc poudrage was performed. There were minor complications in 3 patients (1 subcutaneous emphysema, 1 infection of point of suture and 1 thoracic pain in the 6 hours after the procedure)   Conclusion:  The Pleuroscopy with autoclavable semi rigid thoracoscope is a safe and useful technique in the diagnosis and management of pleural diseases.  The semirigid pleuroscope must increase the performance of pulmonologists in the diagnosis and management of pleural disease.
Phase I dose escalation of paclitaxel in patients with advanced ovarian cancer receiving cisplatin: rapid development of neurotoxicity is dose-limiting.
Authors: A N Gordon, C A Stringer, C M Matthews, D L Willis, J Nemunaitis
Journal: Journal of Clinical Oncology (1997)

To determine the maximum-tolerable dose (MTD) of paclitaxel in a phase I dose-escalation study when combined with cisplatin in patients with advanced ovarian cancer receiving filgrastim for prophylaxis of myelosuppression.A total of 23 patients with stage II (bulky residual), III, or IV epithelial ovarian cancer were treated (following debulking surgery) with paclitaxel as a 3-hour infusion followed by cisplatin (75 mg/m2) administered over 4 hours on day 1, repeated every 21 days for six cycles. Filgrastim (5 micrograms/kg/d) was administered subcutaneously (SC) beginning on day 2 of each cycle through neutrophil recovery (absolute neutrophil count [ANC] > 10,000/microL). Patients were assigned to one of six escalating dose levels of paclitaxel: 150 (n = 3), 175 (n = 3), 200 (n = 3), 225 (n = 4), 250 (n = 4), and 275 mg/m2 (n = 6).At each paclitaxel dose level (150, 175, 200, 225, 250, and 275 mg/m2), the numbers of patients who completed six cycles without dose reduction were three (100%), three (100%), two (66%), two (50%), three (75%), and zero (0%), respectively. The numbers of patients who experienced a grade III/IV adverse event (hematologic or nonhematologic) were zero (0%), two (66%), two (66%), one (25%), four (100%), and five (80%), respectively. Reasons for dose reduction included neurotoxicity (225 mg/m2, n = 1; 275 mg/m2, n = 2), neutropenia (225 mg/m2, n = 2), diarrhea (275 mg/m2, n = 2), and nephrotoxicity (225 mg/m2, n = 1). Reasons for not completing six cycles at full or reduced dose included neuropathy (200, 225, and 275 mg/m2, n = 1 each) physician request (275 mg/m2, n = 1), and death (275 mg/m2, n = 1). Hematopoietic toxicity was minimal. Six patients developed grade III/IV neutropenia. No patient developed thrombocytopenia below a level of 50,000/microL.The MTD of paclitaxel was determined to be 225 mg/m2 when administered as a 3-hour infusion and combined with cisplatin (75 mg/m2). Nonhematologic dose-limiting toxicities were neuropathy and diarrhea. The neuropathy often had a rapid onset, especially at the higher dose levels.
Effect of smoking on prognosis and mortality in patients hospitalized due to community acquired pneumonia
Authors: Feride Durmaz, Aysin Sakar Coskun, Yavuz Havlucu, Aykut Cilli, Burcu Karaboga, Oguz Kilinc, Seda Salman, Sezai Tasbakan, Abdullah Sayiner
Journal: European Respiratory Journal (2014)

This study investigated the effect of smoking on prgnosis and mortality in patients with CAP by using the Pneumonia Data Base (PDB).  702 hospitalized CAP patients and registered to PDB in Pulmonary Departments of Celal Bayar,Akdeniz,Dokuz Eylul University,and Ege Universities between November 2009 and May 2013 were included to the study.PDB that prepared by Turkish Thoracic Society Respiratory Infections Scientific Assembly included the datas about findings of patients at first day hospitalization,controls at hospitalization and discharged date,and treatment results at first month.  There were 66,2% male and mean age was 65 years.The percentage of never smoker,current smoker,and ex-smoker were 37,2%,11%,and 51,7% respectively.In current smokers,ALT andAST levels were found significantly higher and oxygen saturation were found lower.There were no relation between smoking status and CRP and PCT.PSI was found significantly higher in ex-smokers whereas there was no relation between CURB-65 and smoking status.No relation was found between smoking status and hospitalization duration and treatment cost.According to treatment results,in 3-5 days,percentage of totally cured patients were high in active smokers and the percentage of partially cured patients were high in never smokers and ex-smokers.Mortality rate was found as 8,5%.Older age,presence of comorbidity,presence of smoking history were found related with mortality.  As a result,we found that smoking affect many factors realted with CAP development and prognosis negatively and it increases the mortality in CAP with other factors like presence of comorbidity and older age.
Cyst hydatid patients in a pediatric pulmonology department in Turkey
Authors: Ayse Tana Aslan, Tugba Eyuboglu
Journal: European Respiratory Journal (2012)

Human hydatid disease due to  Echinococcus granulosus  is of worldwide importance in many countries.  The aim of this study is to review our experience in pediatric pulmonary hydatid cysts focusing on clinical symptoms, location of the cyst, type of the intervention, postoperative complications and long-term results.  Between January 2007- December 2011 there were 26 patients with Cyst Hydatid Disease (CH) at Gazi University Pediatric Pulmonology Department. There were 26 patients with a mean age of 12,8 (8-18) years. Hydatid cysts were localized in the lungs in 18 patients, in the liver in 14 patients. Nine patients have lung and liver CH together. Two patients have vertebral, one patient has splenic and one patient has surrenal involvement.  The most common symptoms were cough and chest pain. Cysts were found in right lung in 6 patients, in left lung in 7 patients and bilateral in 4 patients. The cysts were perforated into the bronchia in 3 patients.  Surgical treatment was performed in 15 patients. Cystotomy plus capitonage was the most frequent administered surgical technique. The mean hospitalization time was 14 days. There were no complication related to surgery such as pneumothorax and infection. Nine patients had PAIR.  All of the patients recevied albendazole therapy and 6 patients recevied praziquantel therapy. Mean follow-up time was 17.6 (1-52) months. Six patients left the follow-up.  There were two recurrence, one patient was with pulmonary CH and the other was with vertebral CH. 18 patients continue to follow-up of without recurrence.  Cyst hydatic is an important public health problem especially in countries where it is common in agriculture and animal husbandry.
THE EFFECT OF BACTERIAL ENDOTOXINS ON THE WATER INTAKE AND BODY WEIGHT OF MICE
Authors: Rene J. Dubos, Russell W. Schaedler
Journal: The Journal of Experimental Medicine (1961)

Injection of endotoxin of Gram-negative bacilli into NCS mice caused an immediate reduction or interruption of water intake by these animals, with a resultant loss of body weight. Endotoxins prepared by three different techniques from four different cultures of Gram-negative bacilli yielded products having approximately the same activity in inhibiting water intake. The minimum effective dose was 0.1 microg. or less. With all toxin preparations tested, the duration of the effect was directly related to the dose injected. The heat-killed cells of Esch. coli proved approximately as effective as the endotoxins prepared from Gram-negative bacilli. In contrast, heat-killed cells of Mycobacterium tuberculosis (BCG) were much less active, and heat-killed cells of Staphylococcus aureus were essentially inactive. Mice previously treated with endotoxin exhibited a marked degree of tolerance to the inhibition of water intake caused in normal animals by a subsequent treatment with the same material. Tolerance could also be induced by vaccination with heat-killed Gram-negative bacilli. Tolerance overlapped from one bacterial species to another but was more pronounced toward the endotoxin prepared from the bacterial culture with which the animal was vaccinated. The duration of the inhibitory effect of endotoxin on water intake was much shorter with mice fed a complete diet than with mice fed a deficient diet (corn). It took approximately the same dose of endotoxin (0.1 microg.) to inhibit water intake, reduce the influx of polymorphonuclear leucocytes, and enhance staphylococcal infection.
Galectin-3 and CD44v6 Isoforms in the Preoperative Evaluation of Thyroid Nodules
Authors: Alessandra Gasbarri, Marco Paolo Martegani, Fabrizio Del Prete, Teresa Lucante, Pier Giorgio Natali, Armando Bartolazzi
Journal: Journal of Clinical Oncology (1999)

Thyroid cancer is the most frequently occurring endocrine malignancy; however, preoperative diagnosis of some lesions, in particular those with follicular histology, is difficult, and a consistent number of not otherwise-specified "follicular nodules" are surgically resected more for diagnosis than therapeutic purposes. In this study, we investigated whether the lectin-related molecules CD44v6 and galectin-3, the expression of which is altered during deregulated cell growth and malignant transformation, could be potential markers for improving the diagnostic accuracy of conventional cytology.A comparative immuno-chemical and molecular analysis was performed on 157 thyroid specimens representative of normal, benign, and malignant tissues, and on 36 cytologic samples obtained preoperatively by fine-needle aspiration biopsy from nonselected patients with palpable thyroid nodules.Normal thyrocytes did not express galectin-3 nor CD44v6. Although the expression of CD44v6 isnegligible in thyroiditis, these molecules are variably detected in benign and malignant proliferative lesions. Interestingly, galectin-3 is never expressed in benign lesions, but it is invariably detected in cancers. A comparative evaluation of CD44v6 and galectin-3 expression in thyroid malignancies demonstrated that these molecules are coexpressed at the messenger RNA and protein level in almost all lesions.Our findings suggest that CD44v6 and galectin-3 could be potential markers to preoperatively identify malignant transformed thyrocytes. Immunodetection of these molecules on cytologic specimens obtained by fine-needle aspiration biopsy is an accurate and improved method for selecting, on a molecular basis, those nodular lesions of the thyroid gland that need to be surgically resected.