tbuckley/cabot-search huggingface dataset:
P232 Does one model of pulmonary rehabilitation fit all? a modified approach to pulmonary rehabilitation
Authors: FM Lang, H Matthews, P Brice
Journal: Thorax (2016)

<h3>Introduction and objectives</h3> Pulmonary Rehabilitation (PR) is defined as a multidisciplinary programme for patients with chronic respiratory impairment that is individually tailored and designed to optimise each patient’s physical and social performance and autonomy (NICE, 2010). Our service was involved in RCP PR Pilot Accreditation Scheme. Individuals MRC 2–5, functionally limited by breathlessness are referred to PR (BTS, 2013). There is a wide spread of functional disability and breathlessness for these individuals. Does one approach to PR address the needs of all patients within these broad groupings? <h3>Aims</h3> Modifying PR may improve attendance and completion of full PR for patients MRC5. <h3>Methods</h3> Following service review, Modified Programme was offered; 2 × Gym Sessions and education. Session one; patients difficulties were discussed. Breathing control techniques, improved posture and lung inflation were demonstrated. Daily home exercises were promoted. Following 2 weeks of homework, the patients were invited to a review. Any improvement in breathlessness and confidence was discussed with the patients offered Full PR where appropriate. The patient who did not complete full programme continued to attend education. 1 patient attended the first session with no further engagement. 1 patient deferred until June 2016. Qualitative data reports significant benefit. This modified approach was observed during the RCP site visit. Feedback included the need for feedback to the BTS with regards to greater flexibility with the standards and their future developments as a consequence of observing our modified approach to PR. <b>What Next?</b> Modification to standard PR offers significant improvement in attendance and completion of PR for patient with significant dyspnoea (MRC5). Could these results be replicated within other PR service? We continue to offer modified PR and now include MRC4 patients with significant co-morbidities which would otherwise restrict attendance. <h3>References</h3> National Institute for Health and Clinical Excellence. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care (CG<i>101).</i> London: NICE, 2010. British Thoracic Society. <i>BTS guideline on pulmonary rehabilitation in adults</i>. London: BTS, 2013.
Effect of Allogeneic Hematopoietic Cell Transplant in First Complete Remission on Post-Relapse CR Rate and Survival in Acute Myeloid Leukemia
Authors: Daisuke Araki, Megan Othus, Roland B. Walter, Brenda M. Sandmaier, Pamela S. Becker, Vicky Sandhu, Frederick R. Appelbaum, Elihu H. Estey
Journal: Blood (2014)
Western diets, gut dysbiosis, and metabolic diseases: Are they linked?
Authors: Kristina B. Martinez, Vanessa Leone, Eugene B. Chang
Journal: Gut Microbes (2017)

Obesity afflicts 36.5% of the US population and 600 million individuals world-wide. Thus, it is imperative to understand the risk factors underlying metabolic disease including diet, activity level, sleep, and genetics. Another key contributory factor is the gut microbiota given its widely reported role in the development of metabolic disease. The gut microbiota, particularly its structure and function, is heavily influenced by Western style diets rich in a complex mixture of fats and high in simple sugars. In this review, the profound impact of obesity and Western diets on the gut microbiota will be illustrated, and the following research questions will be addressed: 1) to what extent do high fat diets (HFDs) alter community membership and function and does this depend upon the amount or type of fat consumed?, 2) how rapidly do dietary shifts alter gut microbial communities?, 3) are these alterations sustained or can the microbiome recover from dietary stress?, 4) how does diet drive host-microbe interactions leading to obesity?, and 5) what can be done to restore the detrimental impact of HFD on the gut microbiota? The goal of this review is to address these questions by parsing out the effects and underlying mechanisms of how Western diets impact the gut microbiota and host. By doing so, potential avenues for further exploration and strategies for microbiome-based interventions to prevent or treat diet-induced obesity may become more apparent.
P120 Challenges in using hierarchical clustering to identify asthma subtypes: choosing the variables and variable transformation
Authors: M Deliu, S Yavuz, M Sperrin, D Belgrave, C Sackesen, U Sahiner, A Custovic, O Kalayci
Journal: Thorax (2016)

<h3>Introduction</h3> The use of unsupervised clustering has identified different subtypes of asthma. Choosing the variables to input into the clustering algorithm is one of the important considerations. The majority of previous studies selected variables based on expert advice, whilst others used dimension reduction techniques such as principal component analysis (PCA). We aimed to compare the results of unsupervised clustering when using raw variables, or variables transformed using dimensionality reduction techniques. <h3>Methods</h3> We performed our analysis on 613 asthmatics aged 6–23 years from Ankara, Turkey. We conducted extensive phenotyping and recorded 49 variables including demographic data, sensitisation, lung function, medication, peripheral eosinophilia, and markers of asthma severity. We performed hierarchical clustering (HC) using: (1) all variables; and (2) variables transformed using dimensionality reduction techniques. <h3>Results</h3> PCA revealed 5 components describing atopy and variations in asthma severity, which were then used to infer cluster assignment. The optimal HC solution in both PCA-transformed and raw untransformed data identified five clusters. However, these clusters were not identical. Both identified mild asthma with good lung function, severe atopic asthma and late-onset mild atopic asthma. However, the overlap between children assigned to these three clusters in two HC analyses was modest. Clustering without PCA identified early-onset severe atopic asthma and late-onset atopic asthma with high BMI, whilst early onset non-atopic mild asthma in females was identified in HC with PCA. Using both methods, we identified four features that characterised the clusters. These were age of onset, atopy, asthma attacks, and asthma severity. Using only these four features, we identified early onset atopic mild asthma, early onset non-atopic mild asthma, severe asthma, late onset asthma, and exacerbation prone asthma. Cluster stability increased drastically. <h3>Conclusion</h3> Different methodologies applied to the same dataset identified differing clusters of asthma. We identified four features that characterised the clusters. We propose that these four features could be more useful in identifying asthma endotypes.
OA19.02 Sex Differences Are Detected in the Profile of Tumor Associated Inflammatory Cells (TAICs) Are Lung Adenocarcinoma
Authors: Carmen Behrens, Edwin Parra, Jaime Rodriguez-Canales, Pamela Villalobos, Boris Sepesi, Annikka Weissferdt, Neda Kalhor, John Heymach, Cesar Moran, Don Gibbons, Ignacio Wistuba
Journal: Journal of Thoracic Oncology (2017)
A reply to Ovanesov et al.
Authors: Eric M. Ammann, Elizabeth A. Chrischilles
Journal: American Journal of Hematology (2017)

We thank Ovanesov et al. for their letter1 and discussion of research concerning IVIg-associated thromboembolic adverse events (TEEs).2-6 We agree that our study7 does not rule out a causal relationship between IVIg and increased TEE risk. As they note, TEEs are rare events, limiting our power to rule out a clinically meaningful increased risk of TEEs in the trial populations included in our meta-analysis. Moreover, with regard to external generalizability, it is possible that the risk of TEEs varies by IVIg product and dose, as well as patient factors such as age and preexisting risk factors for TEEs. We agree with Ovanesov et al.—as well as the clinicians who have written to us with plausible case reports of IVIg-associated TEEs—that this remains a valid topic of concern for clinicians and regulatory authorities. IVIg is often used in serious health situations when there are no or few therapeutic alternatives. In considering whether IVIg treatment is appropriate, clinicians and patients must weigh the likely benefits and risks of treatment. We view the main contribution of our meta-analysis7 of 31 IVIg randomized controlled trials as helping to establish a rough upper bound (≤1%) for the absolute risk of IVIg-caused acute myocardial infarction, stroke, or venous thromboembolism among young and middle-aged adults with a low baseline risk of TEEs. However, data from observational studies of IVIg-associated TEEs should also be considered, particularly for assessing risk in patients of advanced age or with other major TEE risk factors.4-6, 8, 9
P1.02-078 Expression Profiling of LKB1 Pathway in Young and Old Lung Adenocarcinoma Patients
Authors: Laura Boldrini, Mirella Giordano, Adele Servadio, Cristina Niccoli, Marco Lucchi, Franca Melfi, Alfredo Mussi, Gabriella Fontanini
Journal: Journal of Thoracic Oncology (2017)
P2.03b-047 The Clinical Impact of Multiplex ctDNA Gene Analysis in Lung Cancer
Authors: Smadar Geva, Anna Belilovski Rozenblum, Maya Ilouze, Laila Roisman, Tal Twito, Addie Dvir, Lior Soussan-Gutman, Elizabeth Dudnik, Alona Zer, Richard Lanman, Nir Peled
Journal: Journal of Thoracic Oncology (2017)
Chronic Lymphocytic Leukemia Cells Recognize Conserved Epitopes Associated with Apoptosis and Catabolic Chemical Modifications
Authors: Rosa Catera, Gregg J. Silverman, Katerina Hatzi, Till Seiler, Sebastien Didier, Lu Zhang, Maxime Hervé, Eric Meffre, David Graham Oscier, Helen Vlassara, Yifang Chen, Steven L. Allen, Kanti R. Rai, Charles C. Chu, Nicholas Chiorazzi
Journal: Blood (2008)
P3.06-001 Phase I/II Study to Evaluate Safety and Efficacy DCVAC/LuCa with 1st Line Chemotherapy +/- Immune Enhancers vs Chemotherapy, Stage IV NSCLC
Authors: Libor Havel, Vitezslav Kolek, Milos Pesek, Milada Zemanová, Jirina Bartunkova, Jan Fagerberg, Radek Spisek, Inna Krasnopolskaya
Journal: Journal of Thoracic Oncology (2017)
P2.03b-026 Next-Generation Sequencing for Molecular Diagnosis of Tumor Specimens from Patients with Advanced Lung Adenocarcinoma
Authors: Maria Gabriela Fernandes, José Costa, Joana Reis, Conceição Moura, Vanessa Santos, Henrique Queiroga, Adriana Magalhães, António Morais, José Machado, Venceslau Hespanhol
Journal: Journal of Thoracic Oncology (2017)
IKZF2, a Novel Target of MSI2 RNA-Binding Protein Plays an Oncogenic Role in Myeloid Leukemia
Authors: Sun Mi Park, Angela Thornton, Ly P. Vu, Sagar Chhangawala, Gerard Minuesa, Trevor Barlowe, James Taggart, Patrick Tivnan, Theodore Kim, Ethan Shevach, Christina S Leslie, Michael G. Kharas
Journal: Blood (2015)
A novel technique for biliary biopsy using the sheath of a plastic stent and a non-return valve
Authors: Shinichi Morita, Tsutomu Kanefuji, Takahiro Hoshi, Masaaki Kobayashi, Takeshi Suda, Takeshi Mizusawa, Shuji Terai
Journal: Endoscopy (2017)

Endoscopic transpapillary biopsy has been widely performed for the diagnosis of biliary disease. Direct-vision biliary biopsy using peroral cholangioscopy has been reported to be very useful [1] [2] [3] [4]. At centers where peroral cholangioscopy is unavailable, biliary biopsy can be performed under fluoroscopic guidance. It is however sometimes difficult to obtain adequate biopsy specimens owing to issues with guidance of the biopsy forceps. Hijioka et al. reported a useful technique for biliary biopsy using mini-forceps with a biliary dilator [5]. Herein, we report a useful modification of their procedure.
P247 Specificity of dyspnoea relief with inhaled furosemide
Authors: JC Grogono, C Butler, H Izadi, SH Moosavi
Journal: Thorax (2016)

<h3>Introduction</h3> Dyspnoea is prevalent and reduces quality of life in patients with chronic disease. Inhaled furosemide offers a potential complementary novel treatment for these patients. The mechanism of action is unclear but current theory suggests sensitisation of slowly adapting pulmonary stretch receptors (saPSR) altering neural feedback that informs the brain of the level of breathing. Clinical dyspnoea comprises several components including air hunger (AH; an uncomfortable urge to breathe) and a sense of breathing work/effort (WE) which are thought to arise from different neural pathways. We therefore hypothesised that inhaled furosemide would relieve AH but not WE. <h3>Methods</h3> A double-blind, placebo-controlled trial was conducted on healthy volunteers (n = 16; 9 males). Test sessions involved 3 inhalations of furosemide (40 mg) or saline (4 ml) separated by 30–60 mins. Order of inhalations was furosemide-saline-furosemide in half the subjects and saline-furosemide-saline in the other half. Before and after each inhalation, AH was induced with hypercapnia (mean ± SD PCO2 = 49.8 ± 3.7 mmHg) and constrained ventilation (mean ± SD 9.2 ± 1.5 l/min) on one test-day while WE was induced with targeted ventilation (mean ± SD 16.6 ± 3.1 l/min) and external resistive load (20cmH2O/L/s) on the other test-day. During saline inhalations 1.5 mg furosemide in 15ml saline was infused to match the expected systemic absorption of furosemide from the lungs over 15 mins of inhalation. Corresponding infusions of saline during furosemide inhalations maintained blinding from noticeable diuresis. Subjects rated AH or WE every 20s on a visual analogue scale (VAS). Hypercapnia (AH) or targeted ventilation (WE) were imposed for 4 mins and the ratings in the last minute were analysed using Linear Mixed Model procedure (SAS 9.4). <h3>Results</h3> The final model produced a main effect of mist (furosemide or saline; p = 0.016), time (pre or post inhalation; p = 0.047) and a significant condition (AH or WE)*mist interaction (p = 0.004). Mean ± SE AH was significantly lowered by inhaled furosemide relative to inhaled saline (-9.7 ± 2.1 mm VAS; p = 0.0015) but mean ± SE WE was not (+ 1.6 mm ± 2.4; p = 0.903). <h3>Conclusion</h3> Inhaled Furosemide is effective at relieving AH, but not WE. This is consistent with a mechanism involving modulation of parenchymal lung mechanoreceptor activity leading to dyspnoea relief that specifically applies to the AH component. The treatment may therefore benefit patients with the most unpleasant form of dyspnoea.
P81 Straight to CT delivers earlier first definitive treatment in lung cancer– effect of a simple intervention
Authors: P Malhotra, P Murphy, C Dawson, N Hunt, J Hendry
Journal: Thorax (2016)

<h3>Background</h3> The National Optimal Lung Cancer Pathway (NOLCP) recommends performing a CT scan before a patients first appointment in a rapid access suspected lung cancer clinic. A local audit in 2014 at our hospital which receives over 350 two week rule suspected lung cancer referrals per year found that less than 50% of patients had a CT scan before their first appointment. <h3>Objective</h3> To determine the effect of a simple cue for physicians stamped on 2 week rule referral forms on the proportion of patients who have a CT scan before their first appointment in a rapid access suspected lung cancer clinic, and its effect on the time to definitive treatment. <h3>Methods</h3> This was a retrospective analysis of the lung cancer clinic database at a large district general hospital. Two periods were audited: September – November 2014 (pre-intervention), and July – September 2015 (post-intervention). Data on demographic characteristics, date of first clinic, date of performance of CT scan, and time to definitive treatment was collected. From January 2016 onwards, a simple new intervention was put in place: all 2 week rule referrals were stamped with a cue (“Pre-clinic CT: Yes or No?”) for Consultants triaging the referral to prompt them to arrange a pre-clinic CT scan if appropriate. Re-audit was carried out during the period July–September 2015. <h3>Results</h3> Seventy-six out of 81 two week rule referrals between September–November 2014 had a CT scan during their management pathway. Thirty-six (47%) of these scans were performed before the patients first appointment in clinic. Re-audit between July-September 2015 after introduction of the stamp revealed that 88 CT scans were performed on 101 two week referrals. Of these, 70 (80%) patients had a CT scan before their first appointment. Time to first definitive treatment improved by 1 week from 38.7 days in the pre-intervention cohort, to 31.5 days in the post-intervention cohort. <h3>Conclusion</h3> A simple cue stamped on 2 week rule referral forms increased the proportion of patients who had a CT scan before their first appointment in a rapid access suspected lung cancer clinic from 47% to 80%, and reduced the time to definitive treatment by 1 week.
OA02.01 The microRNA-15/16 Family Regulates Tumor Cell Growth via Fibroblast Growth Factor Signals in Malignant Pleural Mesothelioma
Authors: Karin Schelch, Michaela Kirschner, Marissa Williams, Ruby Lin, Yuen Yee Cheng, Michael Grusch, Walter Berger, Nico Van Zandwijk, Glen Reid
Journal: Journal of Thoracic Oncology (2017)
M17 Limited value of baseline chest radiography in adults with non-tuberculous mycobacteria
Authors: ME Murphy, NM Shah, T Bharucha, C Cash, JR Cleverley, IM Cropley, S Hopkins, MCI Lipman
Journal: Thorax (2016)

Chest radiographic changes are associated with mycobacterial burden, treatment response and outcome in patients with tuberculosis. There is a paucity of similar data for non-tuberculous mycobacteria (NTM). We describe the chest radiology (CXR) findings in a cohort of adults without cystic fibrosis. <h3>Methods</h3> Patients with NTM isolated from respiratory specimens between 2010–2013 at our centre were reviewed. Chest X-rays (CXR) nearest the date of positive NTM culture were read independently by two consultant Radiologists for 5 categories of abnormality (nodules, cavities, bronchiectasis, bronchial wall thickness [BWT] and consolidation) in each of 6 zones. A consensus result was agreed where discrepant. CXR results were recorded as “normal” or “abnormal” overall and for each category per zone. The total number of zones affected in all categories was summed to provide a measure of radiological extent of disease (with a maximum score of 30), e.g. a patient with cavitation in 2 zones and bronchiectasis in 3 would score 5/30. Results were compared to clinical and microbiological data (including time-to-positivity in liquid culture, TTP). <h3>Results</h3> Of 79 patients, 44/79 (56%) were male, median age 63 years [IQR_53;75]. CXR was performed median 5-days [IQR_2;28] from sample collection. Inter-rater CXR agreement was 92%, kappa 0.57 [95% CI: 0.52–0.63]. 58/79 (75%) of subjects had an abnormal CXR [Table 1]: half had nodules and BWT, with 41%, 23% and 20% bronchiectasis, consolidation and cavities respectively. Using symptoms present in &gt;1/3 patients, only sputum and difficulty breathing were significantly associated with CXR score (p = 0.04; p = 0.01). <i>M.avium</i> and <i>M.intracellulare</i> were the most common NTM isolated [Table 1]. The highest abnormal median score for CXR was for <i>M.xenopi</i> (6/30) followed by <i>M.perigrinum</i> (5/30), and <i>M.abscessus</i> (4.5/30). For <i>M.kansasii </i>there was significant correlation between CXR score and TTP (r = −0.82 ; p = 0.01) with cavitation being associated with a significantly lower TTP (4.5 vs 17.5 days; p = 0.03). CXR score did not predict whether or not a patient started treatment (OR 1.07; p = 0.40). <h3>Conclusion</h3> CXR abnormalities were present in 75% of patients in whom NTM was isolated. Unlike <i>M.tuberculosis</i>, the extent of radiographic changes correlated poorly with clinical symptoms or mycobacterial burden. Better simple, repeatable measures of NTM disease severity are required.
Safety, Maximum Tolerated Dose and Immunogenicity of CMV-MVA-Triplex in Healthy Volunteers with or without Prior Immunity to CMV and Vaccinia
Authors: Don J. Diamond, Corinna La Rosa, Jeffrey Longmate, Joy Martinez, Qiao Zhou, Theodora Kaltcheva, Jennifer Drake, Mary Carroll, Sanjeet Dadwal, Ibrahim Aldoss, Ryotaro Nakamura, John A. Zaia
Journal: Blood (2015)
Academic Community Standards for Chronic Transfusion Therapy in Children with Sickle Cell Anemia and Stroke.
Authors: Russell E. Ware, Marsha A. McMurray, William H. Schultz, Ofelia A. Alvarez, Banu Aygun, Mary Ellen Cavalier, Bea Files, Charles W. Daeschner, Catherine Driscoll, Matthew M. Heeney, Lee Hilliard, Rathi V. Iyer, Karen Kalinyak, Janet Kwiatkowski, Peter A. Lane, Margaret Lee, Scott T. Miller, Caterina Minniti, Brigitta Mueller, Zora R. Rogers, Sharada A. Sarnaik, J.P. Scott, Alexis Thompson, Winfred C. Wang, Gerald M. Woods, Yih-Ming Yang, Ronald S. Helms
Journal: Blood (2006)
P2.05-009 The Outcome and Adverse Event of Chemoradiation ± Surgery for Stage III Non-Small Cell Lung Cancer
Authors: Shigehiro Kudo, Yoshihiro Saito, Hiroki Ushijima, Yu Okubo, Tomoko Kazumoto, Jun-Ichi Saito, Hideaki Mizutani, Yuki Yamane, Junko Sudo, Futoshi Kurimoto, Hiroshi Sakai, Yuki Nakajima, Hiroyasu Kinoshita, Hirohiko Akiyama
Journal: Journal of Thoracic Oncology (2017)
M20 Pleural service in a large university teaching hospital – 1 year retrospective review
Authors: A Fawzi, N Maddekar, S Khan, S Bikmalla, M Iqbal, AKA Abi Musa Asa’ari, T Cusay, A Austin, C Moore, M Haris
Journal: Thorax (2016)

<h3>Introduction</h3> Over the last decade, there has been a paradigm shift in the management of both pleural effusions and pneumothoraces. Specialty pleural day-case services have been established offering one-stop clinical assessment, imaging and intervention, with a view to early diagnosis, improved patient care and admission avoidance. We wished to evaluate the pleural service at a large university teaching Hospital. <h3>Methods</h3> 650 consecutive outpatient episodes presenting to the pleural day-case clinic between January 2015 and January 2016 were reviewed. Patient characteristics, source of referral, diagnosis, interventions and outcomes were evaluated. <h3>Results</h3> Total number of patient episodes: 650. 264 new outpatients, 322 outpatient follow-ups, 64 pleural in-reach. Male 403 (62%), Female 247 (38%). Referral Source: GP 151 (58%), acute medicine unit/A&amp;E/other specialties 103 (38%) and external referrals 10 (4%). Pleural Interventions: 27 diagnostic aspirations, 113 therapeutic aspirations, 27 chest drain insertions, 37 indwelling pleural catheters. Indications for referrals: Pneumothorax: 24, 27 parapneumonic/Complicated effusions, 57 known malignancy, 150 unknown effusions, 8 others. Average length of stay (based on the BTS Pleural audit 2014)<sup>1</sup> was 8 days. Admission avoidance: 264 patients × 8 days = 2,112 bed days saved in 48 weeks. Early discharge assuming 4 days (66 patients × 4 days) = 264 bed days saved. Total bed days saved = 2376 in 48 weeks – Equivalent of 7 bed days per patient. <h3>Conclusions</h3> A dedicated pleural service has resulted in improvement in both patient outcomes and experience. The number of unnecessary pleural procedures has reduced. Complicated cases are discussed in Pleural MDT meetings. A recent patient feedback survey conducted over 2 months has shown a highly favourable patient experience of the service itself. The pleural service has allowed the department to recruit to several appropriate NIHR trials. The number of bed days saved is significant, raising the question as to whether a nationwide adoption of pleural services in the majority of trusts, would take some of the strain off of an overburdened NHS. <h3>Reference</h3> Hooper CE, Welham SA, Maskell NA. Pleural procedures and patient safety: a national BTS audit of practice.<i> Thorax</i> 2013;<b>70</b>(2):189–191.
P3.02b-125 Failure to Tyrosine Kinase Inhibitors and Patterns of Progression in Patients with Advanced Non-Small Cell Lung Cancer
Authors: Feliciano Barron, Laura-Alejandra Ramirez-Tirado, Enrique Caballe-Perez, Gisela Sanchez, Andrés Cardona, Oscar Arrieta
Journal: Journal of Thoracic Oncology (2017)