tbuckley/cabot-search huggingface dataset:
Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group.
Authors: R Arriagada, M G Lê, F Rochard, G Contesso
Journal: Journal of Clinical Oncology (1996)

A randomized trial was conducted to compare tumorectomy and breast irradiation with modified radical mastectomy. We have analyzed the patterns of failure in each arm of the trial and the prognostic factors that have an independent effect on treatment failures and overall survival.The trial included 179 patients with breast cancer of up to 20 mm in diameter at macroscopic examination. Eighty-eight patients had conservative management and 91 a mastectomy. All patients had axillary dissection with frozen-section examination. For patients with positive axillary nodes (N+), a second randomization was performed: lymph node irradiation versus no further regional treatment. Patterns of failure were determined by a competing-risk approach and multivariate analysis. A prognostic-score was determined by multivariate analysis.Overall survival, distant metastasis, contralateral breast cancer, new primary malignancy, and locoregional recurrence rates were not significantly different between the two surgical groups, or between lymph node irradiation groups. Most recurrences appeared during the first 10 years. Three distinct prognostic groups were determined taking into account age, tumor size, histologic grading, and number of positive axillary nodes.Long-term results support conservative treatment with limited surgery and systematic breast irradiation as a safe procedure for the management of small breast cancers. Four easily obtainable clinical and histologic factors may be combined in a prognostic score that is highly predictive of overall and event-free survival.
A study of the words used by patients and physicians to express asthma symptoms and daily activities limitations in primary care – The “Asthma Languague” study
Authors: Mina Gaga, Eleftherios Zervas, Konstantinos Kostikas, Stelios Loukides, Petros Bakakos, Elena Panitti, Nikos Nikas
Journal: European Respiratory Journal (2011)

Intoduction:  Expression of symptoms and daily activities limitations is a core element in physician-patient dialogue in asthma management.   Aim:  To identify the words most frequently used by physicians and patients to express asthma symptoms and limitations of daily activities, and to assess the patient-physician concordance regarding these words.   Methods:  The “Asthma Language” study (NCT00986219) (descriptive, cross-sectional survey) enrolled patients with asthma receiving ICS-based treatment for ≥ 6 months. Investigators and patients chose up to 4 words from 2 lists (a symptoms and a daily activities limitations list) identical for patients/physicians. Furthermore, patients completed the ACQ-5.   Results:  695 patients (F: 57%, age 46.8±14.8 years) were enrolled. Time since diagnosis was 12.9±9.4 years. Treatment with ICS/LABA±LTRA was reported by 82% of patients. ACQ-5 score was 1.5±1.1. The words most frequently used to express asthma symptoms were “cough”, “dyspnoea” and “wheezing” (35%-56%), while those used to express activities limitations were “stairs climbing” “fast walking” and “uphill walking” (40.5%-53%). In terms of word concordance regarding expression of asthma symptoms and activities limitations, full concordance was observed in 4.3% and 19.1% and partial concordance in 75.4% and 74.9%, respectively. By grouping the words expressing the same symptom, full concordance was observed in 21.7% and partial concordance in 72%.   Conclusions:  This study showed that there is a discordance regarding physician-patient communication in terms of the words used to express symptoms and daily activities limitations caused by asthma.
Corrections
Authors: Audry Birute Morrison, Volker Rainer Schöffl
Journal: British Journal of Sports Medicine (2007)

Background:  Key questions regarding the training and physiological qualities required to produce an elite rock climber remain inadequately defined. A paucity of research exists on young climbers.    Purpose:   To critically review climbing literature alongside relevant literature characterising physiological adaptations in young athletes. Evidence-based recommendations were sought to inform the training of young climbers.    Method:  Fifty from 200 climbing studies, and large-scale physiological studies highlighting specific common development growth variables in youngsters were selected for appropriateness to this review. Where reported, measured mean and standard deviation values are indicated. The term youngster in this review refers to those aged 7 to 17 years.     Finding:   Based on injury data, climbers aged <16 cannot participate in international bouldering competitions, and intensive finger strength training is not recommended. The majority of climbing foot injuries result from wearing climbing shoes unnaturally shaped or too small in size. Isometric and explosive strength improvements are strongly associated with the latter stages of sexual maturation and specific ontogenetic development. Improvement in motor abilities declines at ages closely associated with the second and third stages of sexual maturation. The final growth spurt in pubescence is associated with a greater incidence of physeal fractures. Climbing literature uses chronological age, rather than measures such as Tanner stages, to mark biological or pubertal maturation. It is not known whether selection, intensive training and/or disordered dietary habits can account for limited data on competitive young climbers who were shorter, lighter and with less body fat than athletic controls and normative data. Somatotyping that might identify common physical attributes in elite climbers of any age was incomplete.    Conclusion:  Accomplished adolescent climbers can now climb identical grades and compete against elite adult climbers aged up to and >40 years. As the implications of a youngster’s high-intensity sports training requiring leanness can result in more significantly altered and delayed pubertal and skeletal development, metabolic and neuroendocrine aberrations, and trigger eating disorders, this should be sensitively and regularly monitored. Training should reflect efficacious exercises for a given gender and biological age.
Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology
Authors: Jan Groen, Jürgen Pannek, David Castro Diaz, Giulio Del Popolo, Tobias Gross, Rizwan Hamid, Gilles Karsenty, Thomas M. Kessler, Marc Schneider, Lisette ’t Hoen, Bertil Blok
Journal: European Urology (2015)
NOGA-Guided Analysis of Regional Myocardial Perfusion Abnormalities Treated With Intramyocardial Injections of Plasmid Encoding Vascular Endothelial Growth Factor A-165 in Patients With Chronic Myocardial Ischemia
Authors: Mariann Gyöngyösi, Aliasghar Khorsand, Sholeh Zamini, Wolfgang Sperker, Christoph Strehblow, Jens Kastrup, Eric Jorgensen, Birger Hesse, Kristina Tägil, Hans Erik Bøtker, Witold Ruzyllo, Anna Teresiñska, Dariusz Dudek, Alicja Hubalewska, Andreas Rück, Søren Steen Nielsen, Senta Graf, Gerald Mundigler, Jacek Novak, Heinz Sochor, Gerald Maurer, Dietmar Glogar, Christer Sylven
Journal: Circulation (2005)

Background— The aim of this substudy of the EUROINJECT-ONE double-blind randomized trial was to analyze changes in myocardial perfusion in NOGA-defined regions with intramyocardial injections of plasmid encoding plasmid human (ph)VEGF-A 165 using an elaborated transformation algorithm. Methods and Results— After randomization, 80 no-option patients received either active, phVEGF-A 165 (n=40), or placebo plasmid (n=40) percutaneously via NOGA-Myostar injections. The injected area (region of interest, ROI) was delineated as a best polygon by connecting of the injection points marked on NOGA polar maps. The ROI was projected onto the baseline and follow-up rest and stress polar maps of the 99m-Tc-sestamibi/tetrofosmin single-photon emission computed tomography scintigraphy calculating the extent and severity (expressed as the mean normalized tracer uptake) of the ROI automatically. The extents of the ROI were similar in the VEGF and placebo groups (19.4±4.2% versus 21.5±5.4% of entire myocardium). No differences were found between VEGF and placebo groups at baseline with regard to the perfusion defect severity (rest: 69±11.7% versus 68.7±13.3%; stress: 63±13.3% versus 62.6±13.6%; and reversibility: 6.0±7.7% versus 6.7±9.0%). At follow-up, a trend toward improvement in perfusion defect severity at stress was observed in VEGF group as compared with placebo (68.5±11.9% versus 62.5±13.5%, P =0.072) without reaching normal values. The reversibility of the ROI decreased significantly at follow-up in VEGF group as compared with the placebo group (1.2±9.0% versus 7.1±9.0%, P =0.016). Twenty-one patients in VEGF and 8 patients in placebo group ( P &lt;0.01) exhibited an improvement in tracer uptake during stress, defined as a ≥5% increase in the normalized tracer uptake of the ROI. Conclusions— Projection of the NOGA-guided injection area onto the single-photon emission computed tomography polar maps permits quantitative evaluation of myocardial perfusion in regions treated with angiogenic substances. Injections of phVEGF A 165 plasmid improve, but do not normalize, the stress-induced perfusion abnormalities.
Is systemic oxygen extraction on exercise impaired in pulmonary arterial hypertension
Authors: Stephen Thomson, Martin Johnson
Journal: European Respiratory Journal (2013)

Background  Exercise capacity is reduced in pulmonary arterial hypertension (PAH) and it has been suggested that this may be due in part to skeletal muscle dysfunction causing impaired systemic oxygen extraction (Tolle et al. Med Sci Sports Exerc 2008;40(1):3-8) but this remains a subject of debate.  Aims  This study aimed to measure the effect of exercise on mixed venous oxygen saturation (SvO2) in patients with PAH to investigate the hypothesis that systemic oxygen extraction is not reduced in PAH.  Methods  Patients with pulmonary arterial hypertension undergoing right heart catheterisation (RHC) in our unit were recruited if they were able to perform a standard upright cardiopulmonary exercise test (CPET). During RHC patients exercised using a supine cycle ergometer at approximately 50% of the peak work rate achieved during the erect CPET. At rest and after 5 minutes of exercise blood was sampled from the pulmonary artery via the distal port of the Swan Ganz catheter and oxygen saturation measured.  Results  7 patients with PAH were studied. Resting pulmonary arterial pressure was 29-70mmHg, median 51mmHg; pulmonary artery wedge pressure 2-7mmHg, median 5mmHg; and pulmonary vascular resistance 5-15 Wood units, median 12 Wood units. SvO2 at rest was 41-70%, median 57%, and after 5 minutes of exercise fell to 16-28%, median 18%.  Conclusions  SvO2 on maximal exercise in healthy individuals is approximately 24% (Wassserman K, Principles of exercise testing and interpretation, 4E). In our series of patients with PAH the results show that mixed venous oxygen saturations reach lower than normal levels on exercise, suggesting that the ability of skeletal muscle to extract oxygen is not impaired in PAH.
Abstract 14509: Aortic Root Areas: A Three-Dimensional Echocardiographic Study
Authors: Wendy Tsang, Vivian Cui, Razvan Ionasec, Masaaki Takeuchi, Helene Houle, Lynn Weinert, David A Roberson, Roberto M Lang
Journal: Circulation (2012)

Background: Recent studies have shown that the aortic root is elliptical rather than spherical. Thus, 2DE diameter measurements poorly estimate true aortic root size. However, three-dimensional ech...
Proposal for revised clasification of disease severity of idiopathic pulmonary fibrosis in Japan
Authors: Hiroyuki Taniguchi, Kensuke Kataoka, Yasuhiro Kondoh, Sakae Homma, Michiaki Mishima, Yoshikazu Inoue, Takashi Ogura, Masashi Bando, Koichi Hagiwara, Hiroki Takahashi, Kingo Chida, Kazuma Kishi, Yukihiko Sugiyama
Journal: European Respiratory Journal (2011)

Background:  PaO 2  at rest and presence of desaturation during a 6-minute walk test (6MWT) were shown to be prognostic factor in idiopathic pulmonary fibrosis (IPF). In Japan, classification of disease severity of IPF (stage I-IV) has been used for the decision of medical care subsidies. Stages of severity of IPF are as follows. stage I (PaO 2  ≥ 80 torr at rest), stage II (70-80 torr), stage III (60-70 torr), stage IV ( 2  during a 6MWT is less than 90%, then the severity should be increased by one stage. We hypothesized that patients whose PaO 2  is ≥ 80 torr with desaturation (classified as stage I in present) might have poor prognosis.   Methods:  Two hunred fifteen patients with IPF in 10 centers performing 6MWT routinely were studied by using a questionnaire survey.   Results:  The proportion of present stage I was 47.9%, and among them, 51.5% patients showed desaturation during 6MWT. The median survival time (MST) of stage I with and without desaturation were 50.5±1.9 mo. and 99.3±35.0 mo. respectively.( p =0.0033). In revised severity stages of patients with IPF, MST of stage I (n=44), stage II (n=77), stage III (n=50), and stage IV (n=44) were 99.3±35.0 mo., 52.0±2.7 mo., 38.6±8.7 mo., and 22.9±4.3 mo. respectively. New survival curves between the each stage have been adequately separated.   Conclusion:  The patients whose PaO 2  is ≥ 80 torr at rest with desaturation during 6MWT should be classified as stage II in revised classification of disease severity in patients with IPF.  This work was supporteted in part by a grant-in-aid for interstitial lung diseases from the Japanese Ministry of Health, Labor and Welfare.
High-resolution ultrasonography assists the differential diagnosis of blue naevi and cutaneous metastases of melanoma
Authors: M. Samimi, A. Perrinaud, M. Naouri, A. Maruani, E. Perrodeau, L. Vaillant, L. Machet
Journal: British Journal of Dermatology (2010)

Metastases of cutaneous melanoma may simulate benign blue naevi clinically.To investigate the value of ultrasonography in the differential diagnosis of lesions that look similar clinically, i.e. blue naevi and cutaneous metastases of melanoma.Participants were invited for inclusion in the study if they had a cutaneous blue lesion clinically suggestive of a blue naevus or cutaneous metastasis of melanoma. After obtaining signed consent, the lesion was photographed and studied using dermoscopy and high-resolution ultrasonography before being removed for histological examination. Clinical, dermoscopic and ultrasonographic images were reviewed anonymously by four dermatologists to assign the diagnosis of blue naevus or metastasis of melanoma. The diagnostic performance of clinical examination, dermoscopy and sonography was assessed for the ability of each to differentiate between metastases of melanoma and blue naevi with reference to the histological diagnosis. Moreover, experts undertook a semeiological description of each ultrasonographic image according to seven items: location of the lesion, echogenicity, homogeneity, shape of the lesion, definition of margins, posterior acoustic shadow and increased posterior echogenicity. Twenty-eight patients were included with a total of 39 blue skin lesions, and 17 of the 28 patients had a previous history of melanoma. Interobserver agreement in the semeiological description of the sonographic images was good (κ≥0·6) for five of seven items. Sonography was more specific (94%) than clinical examination (77%) and dermoscopy (74%). The sonographic features contributing to the differential diagnosis were: location of the lesion (P=0·027), shape of the lesion (P<0·001), homogeneity (P=0·001) and increased posterior echogenicity (P=0·007).Ultrasonography is a reproducible and specific tool that can assist the differential diagnosis between blue naevi and metastases of melanoma. A blue naevus is a homogeneous, hypoechoic, 'dish-shaped' lesion, located in the superficial dermis, whereas metastases of melanoma are 'potato-shaped', hypoechoic, heterogeneous lesions, located in the hypodermis.
Comparison of asthma and COPD patients' perception of appropriate metered-dose inhaler technique with a questionnaire and supervision based reference standard
Authors: Josef Micallef, Lara Angelle Micallef, Caroline Gouder
Journal: European Respiratory Journal (2014)

Aim:  To compare patient perception of correct metered-dose inhaler (MDI) technique with what is considered to be the right technique using a questionnaire and under direct supervision.  Method:  Asthmatic and COPD patients randomly recruited over a seven-month period from the medical wards and respiratory outpatients clinics, answered a standard questionnaire, which included patient self-assessment out of a maximum score of 10. This was followed by formal scoring out of a maximum score of 8, based on eight steps for proper MDI technique. The inhaler technique was scrutinised under direct supervision by the interviewer. The data collected was then analysed using Spearman9s correlation.  Results:  A total of 174 patients on MDI treatment were included: 118 (67.8%) were asthmatics and 56 (32.2%) COPD patients. Eighty-six asthmatics rated themselves at 9 or 10 on self-assessment but only 21 (17.8%) managed a maximum score of 8 on questionnaire and direct supervision (p=0.007). As regards COPD patients, 31 (55.4%) had a self-assessment score of 9 or 10 with only 3 patients (5.4%) managing a full score on objective assessment (p=0.04).  Conclusion:  There is a significant difference in both asthmatic and COPD patients comparing self- assessment and proper MDI technique. Most assume their technique is correct but medical supervision shows otherwise. Self-assessment shows COPD patients to be more uncertain with MDI technique and only few master it fully when compared to asthmatics. Revision and reinforcement of technique by professionals is necessary during admissions and follow up visits to decrease exacerbations and hospital visits.
Phenotypic characteristics of patients with arterial hypertension and chronic obstructive pulmonary disease
Authors: O. Agapova, Y. Dolgusheva, L. Ratova, I. Chazova, K. Zykov
Journal: European Respiratory Journal (2012)

Patients with combination of COPD with arterial hypertension (AH) have a worse clinical course, higher risk of cardiovascular events (CE) than AH without COPD. However, the specific phenotypic characteristics of such comorbidity is still unclear.  Objective: To reveal clinical features, risk of CE in patients AH with and without COPD included in clinical trials.  Methods: A retrospective analysis of five clinical trials conducted in Russia from 2005 to 2010. The analysis included 3409 patients from 40 to 80 years with essential or isolated systolic AH. Age, sex, risk factors (RF), target organ damage (TOD), the presence of associated clinical conditions (ACC) were evaluated.  Results: 2936 from 3409 patients had AH, 385 patients had AH with COPD. In COPD with AH patients had lower age than without COPD (55,4±8,9 and 57,9±9,1, p  Conclusion: patients COPD with AH phenotypically have lower age, more severe condition and have higher risk of CE. Differences in age are possibly due to the fact that patients with COPD have a worse clinical course and older patients are not included in clinical trials in according to the criteria of inclusion/exclusion, which may affect the representativeness of the results with respect to AH with COPD subgroup of patients.
The Effect of Helium and Oxygen on Exercise Performance in Chronic Obstructive Pulmonary Disease
Authors: Elizabeth A. Laude, Nicholas C. Duffy, Chloe Baveystock, Beatriz Dougill, Michael J. Campbell, Rod Lawson, Paul W. Jones, Peter M. Calverley
Journal: American Journal of Respiratory and Critical Care Medicine (2006)

Rationale: Breathing supplemental oxygen reduces breathlessness during exercise in patients with chronic obstructive pulmonary disease (COPD). Replacing nitrogen with helium reduces expiratory flow resistance and may improve lung emptying. Combining these treatments should be independently effective.Objectives: Study the effect of changing oxygen or helium concentration in inspired gas during exercise in patients with stable COPD.Methods: In 82 patients (mean age, 69.7 yr; mean FEV1, 42.6% predicted), we measured endurance shuttle walking distance, resting and exercise oxygen saturation, and end-exercise dyspnea (Borg scale) while patients breathed Heliox28 (72% He/28% O2), Heliox21 (79% He/21% O2), Oxygen28 (72% N2/28% O2), or medical air (79% N2/21% O2). Gases were administered using a randomized, blinded, crossover design via a face mask and an inspiratory demand valve.Results: Breathing Heliox28 increased walking distance (mean ± SD, 147 ± 150 m) and reduced Borg score (−1.28 ± 1.30) more than any other gas mixture. Heliox21 significantly increased walking distance (99 ± 101 m) and reduced dyspnea (Borg score, −0.76 ± 0.77) compared with medical air. These changes were similar to those breathing Oxygen28. The effects of helium and oxygen in Heliox28 were independent. The increase in walking distance while breathing Heliox28 was inversely related to baseline FEV1 breathing air.Conclusion: Reducing inspired gas density can improve exercise performance in COPD as much as increasing inspired oxygen. These effects can be combined as Heliox28 and are most evident in patients with more severe airflow obstruction.
Modified Th2 Responses at High-Dose Exposures to Allergen
Authors: Hayley Jeal, Adrian Draper, Jessica Harris, Anthony Newman Taylor, Paul Cullinan, Meinir Jones
Journal: American Journal of Respiratory and Critical Care Medicine (2006)

Rationale: The relationships between allergen exposures and allergy and asthma are complex. High exposure levels to cat allergen are associated with IgG- and IgG4-specific antibody responses without sensitization or risk of asthma, a process described as a "modified Th2 response." Attenuation of risk of allergy and asthma at high exposure levels has been reported in longitudinal studies of both childhood and occupational asthma.Objectives: To investigate, using an occupational model, the relationships among estimated exposure to aeroallergens, the production of specific IgE, IgG and IgG4 antibodies, and the prevalence of associated symptoms.Methods: Cross-sectional survey of employees exposed to rats at work on six pharmaceutical sites across the United Kingdom. A total of 689 (89%) provided a blood sample and completed a questionnaire.Measurements and Main Results: At highest exposure to rats, there was an attenuation of the exposure response for sensitization and symptoms. In contrast, the frequency of individuals producing high quantities of specific IgG and IgG4 increased with exposure intensity. Ratios of IgG4/IgE were highest in those handling the greatest number of rats. Risk of developing work-related chest symptoms was lower for those who produced both specific IgE and IgG4 compared to those with specific IgE only..Conclusions: High exposure to rats is associated with lower rates of specific IgE and symptoms but an increased frequency of high specific IgG and IgG4 production. Specific IgG4 produced together with specific IgE may reduce the risk of developing work-related chest symptoms compared with when specific IgE is produced alone.