tbuckley/cabot-search huggingface dataset:
Severe asthma: Clinical features and management in Tunisia
Authors: Manel Loukil, Sana Cheikh Rouhou, Nawel Ben Salem, Hajer Racil, Nawel Chaouch, Mourad Zarrouk, Abdellatif Chabbou
Journal: European Respiratory Journal (2011)

Chronic severe asthma (CSA) is a complex and heterogeneous condition with distinct subphenotypes leading to impaired quality of life and excessive healthcare need. Aim of the study was to describe the different subphenotypes of CSA and to assess its management in Tunisia.

Methods: The clinical data of 54 patients (1998-2011) with CSA were analysed. Three groups were identified according to the CSA WHO definition. G1: untreated CSA due to unavailability of therapy, G2: difficult-to-treat CSA due to compliance issues and inappropriate use of medicines, and G3: treatment-resistant CSA. The latter includes 2 subgroups: uncontroled asthma despite the highest level of recommended treatment (G3a) and asthma which is controled only with the highest level of recommended treatment (G3b).

Results: Patients are distributed as follows: G1: 27 patients (50%), G2: 8 patients (15%), G3: 19 patients (25%) including 9 cases of G3a (17%) and 10 cases of G3b (18%). Treatment included high doses of inhaled corticosteroids in all groups, long acting β2-agonists were available for G2 and G3 but not for G1 due to absence of social coverage. Oral corticosteroids were prescribed in 18 patients (33%), among whom 50% belong to G1. Admissions in intensive care unit for severe exacerbation were recorded in 18 cases (29%) and near-fatal-asthma was diagnosed in 13 cases (21%). CSA aetiologies were allergy: 37 cases, allergic bronchopulmonary aspergillosis: 3 cases, gastro oesophageal reflux: 4 cases and sensitivity to aspirin: 1 case.

Conclusions: Management of CSA in Tunisia hospitals still suffers from unavailability of appropriate therapy for an important proportion of patients, which makes recourse to oral corticosteroids more frequent than in the reported literature.
Differences between active and inactive patients with COPD
Authors: Fabiane Monteiro, Nidia Hernandes, Thais Sant'Anna, Carlos Camillo, Renato Vitorasso, Vanessa Probst, Fabio Pitta
Journal: European Respiratory Journal (2011)

Objectives:  To investigate differences between patients with COPD who achieve or not the minimum physical activity recommended by the American College of Sports Medicine (ACSM) according to age.   Methods:  Physical activity in daily life (DynaPort monitor and SenseWear armband), lung function, exercise capacity, body composition, quality of life, respiratory and peripheral muscle force and disease severity indexes (BODE and GOLD) were evaluated in 70 patients (41 male, 66±9 years, FEV 1  38±14%pred, BMI 27±6kg m -2 ). Groups were divided according to ACSM guideline in: active (>30 minutes/day of moderate physical activity [threshold: 4 MET for 40-64 years; 3.2 MET for 65-79 years and 2 MET for >80 years); and inactive (those who did not achieve these recommendations).   Results:  There was significant difference between the groups in body composition (weight, BMI, fat mass and%fat-free mass; p 1 %pred (p=0.007), number of steps/day (p=0.0009), time spent walking/day (p=0.001), total energy expenditure (p=0.04) and GOLD stage (p=0.05). No differences were observed concerning exercise capacity, muscle force and BODE index. Modest but significant correlations were found between time spent daily in moderate physical activity and age (r=-0.32), BMI (r=-0.28), fat mass (r=-0.32), steps/day (r=0.56), time spent walking/day (r=0.48), total energy expenditure (r=0.43), FEV 1  (r=0.36) and GOLD (r=-0.33).   Conclusion:  Physically inactive patients with COPD have worse pulmonary function, quality of life and body composition than those who are active. Differences between active and inactive patients in terms of daily physical activity involve both time spent walking and energy expenditure.
Medicare could save up to $16bn if allowed to negotiate drug prices, paper finds
Authors: Michael McCarthy
Journal: BMJ (2015)

Medicare could save up to $16bn (£10.3bn; €14.6bn) a year if it were allowed to negotiate drug prices directly with drug makers, just as Medicaid and the Veterans Benefits Administration currently can, a new policy briefing paper has concluded.

Medicare, the federal insurance plan for people 65 years of age or older and for permanently disabled people, subsidizes the cost of drugs and premiums for prescription drug insurance plans, which are administered through private insurance plans.

Although the private insurance plans administering the drug plans can negotiate drug prices, Medicare by law cannot. This limitation was included to win support from the drug industry. In 2013 Medicare spent $69.3bn on the program called Medicare Part D, which provides prescription drug coverage for 39.1 million people.

In …
Is diurnal PEF variation sensitive and specific for the diagnosis of occupational asthma
Authors: Vicky Moore, Maritta Jaakkola, Cedd Burge, Alastair Robertson, Charles Pantin, Sherwood Burge
Journal: European Respiratory Journal (2011)

Serial peak expiratory flow (PEF) measurements on days at and away from work are recommended as the first step in the objective confirmation of occupational asthma. This study aims to identify the best cut off for the difference between diurnal variation (DV) at work and DV at rest (days off work) that is both sensitive and specific for diagnosing occupational asthma.

Methods: Mean 2-hourly PEFs were plotted separately for work days and rest days for 109 workers with occupational asthma and 117 control asthmatics. DV at work and rest was calculated by the Oasys program from records containing ≥ 4 day shifts, ≥ 4 rest days and ≥ 6 readings per day. DV at work minus DV at rest was calculated by% predicted and% mean. Patients were randomly divided into 2 datasets (analysis and test sets). Receiver operator characteristic curve analysis determined a cut off point from Set 1 that best identified those with occupational asthma, which was then tested in Set 2.

Results: ROC curve analysis gave an area under the curve of 0.68 (set 1) and 0.69 (set 2) analysed as% mean and 0.70 (set 1 and set 2) analysed as% predicted. Table 1 shows the sensitivity and specificity of DV at different cut offs in set 2.

View this table:

Table 1





Conclusion: A 1.4% higher DV at work compared to rest has the best combined sensitivity and specificity for the diagnosis of occupational asthma. Although the sensitivity and specificity are acceptable, they are somewhat lower than other scores calculated by the Oasys program.
Eastern Cooperative Oncology Group phase II trial of ifosfamide in the treatment of previously treated advanced urothelial carcinoma.
Authors: R S Witte, P Elson, B Bono, R Knop, R R Richardson, R Dreicer, P J Loehrer
Journal: Journal of Clinical Oncology (1997)

Alkylating agents have modest activity in advanced urothelial carcinoma. Ifosfamide (IFX) is an agent as yet unstudied in advanced urothelial carcinoma. Despite recent advances in the treatment of this disease, there continues to be a need to identify new active agents and their toxicity spectra. Here we report results from the use of IFX in this population.Ambulatory patients with advanced urothelial carcinoma were treated with IFX 3,750 mg/m2 and mesna 2250 mg/m2 both intravenously (IV) daily for 2 days every 3 weeks. Significant renal and CNS toxicity required a dose change of IFX to 1,500 mg/m2 IV with mesna 750 mg/m2 IV for 5 days every 3 weeks. Doses were modified for hematologic, renal, and CNS toxicity.Of 56 eligible patients entered onto the study, 26 received the 2-day schedule and 30 were treated on the 5-day regimen. All patients had progressive disease following prior systemic chemotherapy. There were five complete responses (CRs) and six partial responses (PRs) for an overall response rate of 20% (exact 95% confidence interval [CI], 10% to 32%). Renal and CNS toxicity was severe before the change in schedule, but manageable after the change. Major identified toxicities were gastrointestinal, myelosuppressive, renal, and CNS. There were four early deaths to which treatment probably contributed, but were multifactorial in etiology.IFX has significant activity, but also major toxicity in a heavily cisplatin-pretreated cohort with advanced urothelial carcinoma. A modification of dose and/or schedule from that described should be considered in future trials. Combination regimens using this agent should be explored.
Ought Low Alcohol Intake to be Promoted for Health Reasons?
Authors: C D J Holman, D R English
Journal: Journal of the Royal Society of Medicine (1996)

There is increasingly widespread acceptance that alcohol taken in moderation by the population aged 35 years or older reduces the risks of ischaemic heart disease and all-cause mortality. Ten causal criteria are used to evaluate the scientific evidence for a protective effect of low alcohol intake on ischaemic heart disease. Inferences for public policy are then assessed using the principles of beneficence, non-maleficence, justice and autonomy to support a framework of nine ethical considerations: intervention versus causation; effect modification by gender, smoking, biogenetic and other factors; inappropriate adoption of recommendations; competing hazards between atherosclerotic disease and cancer; opportunity cost; equity of access; the value system used to judge outcomes; the degree of social influence warranted; and consent and responsibility. We conclude that in the absence of more adequate scientific knowledge and informed community debate it is unethical to promote low alcohol intake as a preventive health measure.
Age and d<scp>PCR</scp> can predict relapse in <scp>CML</scp> patients who discontinued imatinib: The <scp>ISAV</scp> study
Authors: Silvia Mori, Elisabetta Vagge, Philipp le Coutre, Elisabetta Abruzzese, Bruno Martino, Ester Pungolino, Chiara Elena, Ivana Pierri, Sarit Assouline, Anna D'Emilio, Antonella Gozzini, Pilar Giraldo, Fabio Stagno, Alessandra Iurlo, Michela Luciani, Giulia De Riso, Sara Redaelli, Dong‐Wook Kim, Alessandra Pirola, Caterina Mezzatesta, Anna Petroccione, Agnese Lodolo D'Oria, Patrizia Crivori, Rocco Piazza, Carlo Gambacorti‐Passerini
Journal: American Journal of Hematology (2015)

Imatinib is effective for the treatment of chronic myeloid leukemia (CML). However even undetectable BCR‐ABL1 by Q‐RT‐PCR does not equate to eradication of the disease. Digital‐PCR (dPCR), able to detect 1 BCR‐ABL1 positive cell out of 10 7 , has been recently developed. The ISAV study is a multicentre trial aimed at validating dPCR to predict relapses after imatinib discontinuation in CML patients with undetectable Q‐RT‐PCR. CML patients under imatinib therapy since more than 2 years and with undetectable PCR for at least 18 months were eligible. Patients were monitored by standard Q‐RT‐PCR for 36 months. Patients losing molecular remission (two consecutive positive Q‐RT‐PCR with at least 1 BCR‐ABL1/ABL1 value above 0.1%) resumed imatinib. The study enrolled 112 patients, with a median follow‐up of 21.6 months. Fifty‐two of the 108 evaluable patients (48.1%), relapsed; 73.1% relapsed in the first 9 months but 14 late relapses were observed between 10 and 22 months. Among the 56 not‐relapsed patients, 40 (37.0% of total) regained Q‐RT‐PCR positivity but never lost MMR. dPCR results showed a significant negative predictive value ratio of 1.115 [95% CI: 1.013–1.227]. An inverse relationship between patients age and risk of relapse was evident: 95% of patients &lt;45 years relapsed versus 42% in the class ≥45 to &lt;65 years and 33% of patients ≥65 years [ P (χ 2 ) &lt; 0.0001]. Relapse rates ranged between 100% (&lt;45 years, dPCR+) and 36% (&gt;45 years, dPCR‐). Imatinib can be safely discontinued in the setting of continued PCR negativity; age and dPCR results can predict relapse. Am. J. Hematol. 90:910–914, 2015. © 2015 Wiley Periodicals, Inc.
Salivary gland protection by amifostine in high-dose radioiodine treatment: results of a double-blind placebo-controlled study.
Authors: K H Bohuslavizki, S Klutmann, W Brenner, J Mester, E Henze, M Clausen
Journal: Journal of Clinical Oncology (1998)

PURPOSE Salivary gland impairment is a well-recognized side effect following high-dose radioiodine treatment (HD-RIT). Since differentiated thyroid cancer has a good prognosis, reduction of long-term side effects is important. Therefore, the effect of amifostine was studied in HD-RIT. PATIENTS AND METHODS Parenchymal function was assessed by quantitative salivary gland scintigraphy performed prospectively in 50 patients with differentiated thyroid cancer before and 3 months after HD-RIT with either 3 GBq iodine ((131)I) (n=21) or 6 GBq (131)I (n=29) in a double-blind, placebo-controlled study. Twenty-five patients were treated with 500 mg/m2 amifostine intravenously before HD-RIT and 25 patients served as controls, who received physiologic saline solution. Xerostomia was graded according to World Health Organization (WHO) criteria. RESULTS Before HD-RIT in 25 control patients, uptake of technetium-99m (99mTc)-pertechnetate was 0.45%+/-0.16% and 0.42%+/-0.16% in parotid and submandibular glands, respectively. Three months after HD-RIT, parenchymal function was significantly (P &lt; .001) reduced by 40.2%+/-14.1% and 39.9%+/-15.3% in parotid and submandibular glands, respectively. Nine control patients developed grade I and two grade II xerostomia. In 25 amifostine-treated patients, uptake of 99mTc-pertechnetate was 0.46%+/-0.16% and 0.43%+/-0.17% in parotid and submandibular glands, respectively. Three months after HD-RIT, parenchymal function of salivary glands was not significantly altered (P=.691) and xerostomia did not occur in any of these patients. CONCLUSION Parenchymal damage in salivary glands caused by HD-RIT can significantly be reduced by amifostine, which may improve the quality of life of patients with differentiated thyroid cancer.
The evaluation of systemic inflammation in COPD patients comorbided with cardiovascular diseases or diabetes mellitus
Authors: Yoko Yumino, Satoko Fujii, Naoki Takasaka, Jun Kojima, Hiromichi Hara, Takanori Numata, Takeo Ishikawa, Makoto Kawaishi, Keisuke Saito, Jun Araya, Katsutoshi Nakayama, Kazuyoshi Kuwano
Journal: European Respiratory Journal (2011)

Background:  COPD is one of so-called life-style related diseases and reported to show systemic inflammation, due to strong relationship to long-time tobacco smoking. Therefore, COPD patients often have a variety of comorbid diseases, including cardiovascular diseases (CVD), diabetes mellitus (DM), and other systemic diseases.   Purpose:  To investigate smoking status and frequency of comorbid COPD among the patients with CVD, DM, or both, who had smoking history (>10 pack×years), and also to investigate how CVD, DM or COPD is associated with systemic inflammation, oxidative stress and clinical disorders.   Method:  Totally 83 patients, over 40 years with history of cigarette smoking, were recruited for this study. All the participants were examined for pulmonary function test with bronchodilator, urine 8-OHDG/Creatinine, plasma levels for TNF-α, hs-CRP and pentosidine as predictors of airway obstruction, oxidative stress and systemic inflammation.   Results:  11 in the 21 patients with CVD (52.4%) were diagnosed as COPD, 14 in 37 with DM (37.8%), and 9 in 25 with both (36.0%). Further analyses on the associations between each disease and systemic inflammation or oxidative stress were performed by logistic multivariate analyses adjusted with age, sex, smoking history, statin use, and each disease. As the results, Systemic inflammation evaluated by hsCRP increased significantly with statin use. The risk of oxidative stress evaluated by 8-OHdG increased approximately 3 fold with COPD.   Conclusions:  Because the smokers with DM or CVD seem to have much higher risk of COPD than smokers without them, they should be examined with pulmonary function test.
Cisplatin, Ifosfamide, Oral Etoposide, and Concurrent Accelerated Hyperfractionated Thoracic Radiation for Patients With Limited Small-Cell Lung Carcinoma: Results of Radiation Therapy Oncology Group Trial 93-12
Authors: Bonnie Glisson, Charles Scott, Ritsuko Komaki, Benjamin Movsas, Henry Wagner
Journal: Journal of Clinical Oncology (2000)

PURPOSE: The combination of cisplatin, ifosfamide, and oral etoposide (PIEo) given concurrently with accelerated hyperfractionated thoracic radiation was studied in patients with limited small-cell lung cancer in a phase II trial to assess response, survival, and toxicity. PATIENTS AND METHODS: Sixty-seven patients were accrued between March 1994 and April 1996. Chemotherapy doses were cisplatin 20 mg/m 2 and ifosfamide 1,200 mg/m 2 on days 1 to 3 and etoposide 40 mg/m 2 administered orally days 1 through 14. Radiation consisted of accelerated hyperfractionated thoracic radiation (AHTRT) 1.5 Gy bid × 30 fractions (total 45 Gy) days 1 through 19, concurrent with cycle 1 of chemotherapy. Three additional cycles of chemotherapy were given every 4 weeks after completion of chemoradiation. Prophylactic cranial radiation (25 Gy in 10 fractions) was offered to patients for whom complete response (CR) after completion of chemotherapy was achieved. RESULTS: An overall objective response rate of 78% (41 CRs [67%] and seven partial responses [11%]) was seen in 61 patients whose disease response could be evaluated. Median progression-free and overall survival estimates were 12.7 and 23.7 months, respectively. Two- and 3-year survival rates were estimated at 50% and 39%, respectively. Major toxic effects included grade 4 granulocytopenia in 34 (55%), grade 4 thrombocytopenia in 16 (26%), grade 3 to 5 fever/infection in six (10%; with one death resulting from sepsis), and grade 3/4 esophagitis in 27 patients (43%). Other nonhematologic toxic greater than grade 2 occurred in 11 patients (18%). CONCLUSION: Relative to conventional etoposide/cisplatin and concurrent AHTRT, chemoradiation with PIEo produced similar median and 2-year survival rates and a higher rate of acute esophageal toxicity. However, the locoregional control rate with a minimum follow-up of 2 years is excellent at 80%. It is conceivable that longer follow-up will prove this regimen more promising. Research efforts should focus on other methods to improve disease control in all potential sites of recurrence.
Airflow obstruction in the general population: Bronchodilation makes the difference
Authors: Robab Breyer-Kohansal, Marie-Kathrin Breyer, Andrea Schrott, Alexander Hartmann, Otto Burghuber, Sylvia Hartl
Journal: European Respiratory Journal (2013)

Introduction  Although recommended, most lung function studies in the general population abandon bronchodilation when defining airflow obstruction and evaluating the prevalence of chronic obstructive lung diseases. The aim of the present study was to evaluate the prevalence of airflow obstruction pre and post bronchodilation in a general population.  Methods  The ongoing Austrian LEAD study intends to investigate the natural decline in lung function in a general population. Participant9s lung function was assessed pre and post bronchodilation. Airflow obstruction was defined as FEV1/FVC  Results  In total 1268 participants (male: 46%, age: 53±17 years) were included. Airflow obstruction was diagnosed pre and post bronchodilation in 15.3% and 10.4%, respectively (p  Conclusion  When defining airflow obstruction in the general population, lung function including bronchodilation should be performed in order to accurately evaluate the prevalence of chronic obstructive lung diseases.
Additional diagnostic yield with the ultrasound bronchoscope for the transesophageal assess of mediastinal or paramediastinal lesions
Authors: Carmen Centeno, Felipe Andreo, Zoran Stojanovic, Jose Sanz-Santos, Gloria Bonet, Eva Castella, Pere Serra, Mariona Llatjos, Juan Ruiz Manzano
Journal: European Respiratory Journal (2013)

Objective: To evaluate the role of transesophageal endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) in patients with mediastinal or paramediastinal lesions.  Material and methods: Prospective study which included 279 consecutive patients (221 men; mean age 63, SD 13.08), referred to realize EBUS-TBNA, during a 20 months period. Cases that needed substituting or complementing the EBUS-TBNA for EUS-B-FNA were registered. In all the cases with previously realized EBUS-TBNA, cytological samples “in situ” were evaluated before realizing additional transesophageal exploration.  Results: In 50 patients (17.9%) EUS-B-FNA was performed. In 4 cases indication for the procedure was completing the staging, in 9 cases was EBUS intolerance, 20 had inaccessible lesions or technical difficulties for EBUS-TBNA and 17 for being contraindicated or with high risk. A total of 77 lesions were punctured (range 4,2-48,9mm): 3 pulmonary left sided apical masses, 1 subaortic, 1 in the upper right lobe, 3 mediastinal masses, 1 pleural and 68 lymph nodes. In 26 cases (52%) additional diagnostic results were obtained (23 cytological and/or microbiological, 1 for immunohistochemistry and 2 molecular), which supposed 9.3% improvement compared to all of the realized procedures, and 17.3% (26/150) of diagnostic examinations. No complications were observed.  Conclusions: The EUS-B-FNA is a feasible technique, which can be an alternative or complementary procedure and can improve the diagnostic yield. In our experience it was necessary in at less than one fifth of the cases.  Project financed by SEPAR 2010 grant.
In an era where VATS and medical thoracoscopy is readily accessible - Does diagnostic thoracocentesis still have a role in diagnosing malignant pleural effusions?
Authors: Kerry Woolnough
Journal: European Respiratory Journal (2012)

Introduction   The diagnostic sensitivity of medical thoracoscopy is reported as 92.6% and is approximately 95% for video-assisted thoracoscopic surgery (VATS). Complication rates are acceptably low (2.3 % for medical thoracoscopy and    Method   We retrospectively looked at all pleural fluid samples taken from a diagnostic thoracocentesis and specimens sent from a VATS procedure over a 12 month period in patients who had a confirmed diagnosis of malignancy. The presence of malignant cells, pathological diagnosis and the primary site of malignancy was recorded.   Results   Over a 12 month period 34 patients underwent VATs and an additional 88 patients had a diagnostic thoracocentesis performed for a malignant pleural effusion. 88.2% (N=30) had a pathological diagnosis made in samples taken during VATs and 73.6% (n=64) had a diagnosis of pleural malignancy confirmed on cytology taken from a diagnostic aspirate.   Conclusion   With the increased availability of medical thoracoscopy and VATS it is tempting to incorporate these into the first step of a diagnostic algorithm for suspected malignant effusions. However the high diagnostic yield revealed by our retrospective analysis of pleural fluid cytology illustrates that diagnostic thoracocentesis and pleural fluid cytology remains a valid initial step in the diagnostic pathway. It is more cost effective, less time consuming and less invasive for the patient.
Where Are We With Adjuvant Therapy of Stage III and IV Melanoma in 2009?
Authors: Leslie A. Fecher, Keith T. Flaherty
Journal: Journal of the National Comprehensive Cancer Network (2009)

Adjuvant therapy options for advanced melanoma in 2009 remain active observation, high-dose interferon, or clinical trial participation. Close observation is currently the only required adjuvant management, with the purpose of detecting the emergence of regional or metastatic disease early, when surgical management may still be possible. The National Comprehensive Cancer Network guidelines for the workup and follow-up of all stages of melanoma must be tailored to specific patients by the treating physician. This article explores the factors to consider when individualizing care within the scope of these guidelines.