tbuckley/cabot-search huggingface dataset:
FRI0242 Disease Burden of Ankylosing Spondylitis in Taiwan: A Population-Based Analysis: Table 1.
Authors: B.C. Wang, C.-H. Tang, W. Furnback, J.P. Ney, Y.-W. Yang, C.-H. Fang, W.-S. Chen
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Ankylosing spondylitis (AS) is a form of arthritis that affects the spine. The spinal joints are inflamed causing severe pain and discomfort. Severe effects of AS can include new bone formation on the spine causing immobility. It is associated with decreased quality-of-life in its patients, and pharmacological and non-pharmacological treatments are available. <h3>Objectives</h3> This research aims to estimate the economic burden of AS in Taiwan. <h3>Methods</h3> The National Health Insurance Research Database (NHIRD), a claims-based dataset encompassing 99% of Taiwan9s population, was utilized. The costs and quantities of the direct economic burden were calculated based on 2011 data of NHIRD. We identified AS patients and a control cohort matched 1:4 on demographic and clinical covariates to calculate the incremental cost related to AS. We used a micro-costing approach for direct health care costs by estimating the quantities and prices of cost categories. Direct costs included surgeries, hospitalizations, medical devices and materials, lab tests, and drugs. Costs were presented in 2014 USD (1 USD =30.09 TWD). <h3>Results</h3> A total of 12,783 AS patients were included in the database with incremental total direct cost of $18,002,445 due to AS. This resulted in an average incremental direct cost of $1,408 per AS patient. Within direct costs, the largest burdens were associated with medication ($15,884,949; 88.24%), lab tests ($1,432,333; 7.96%), surgery ($329,471; 1.83%), medical devices and materials ($305,609; 1.7%) and ward usage ($50,084; 0.28%). Medications are broken down by class in table 1. <h3>Conclusions</h3> The economic burden of AS in Taiwan is driven by medication costs and lab tests. Efficient management of AS may reduce the utilization and treatment costs associated with the disease. <h3>Disclosure of Interest</h3> B. C. Wang Grant/research support from: Pfizer, C.-H. Tang Grant/research support from: Pfizer, W. Furnback Grant/research support from: Pfizer, J. P. Ney: None declared, Y.-W. Yang Employee of: Pfizer Taiwan, C.-H. Fang Employee of: Pfizer Taiwan, W.-S. Chen: None declared
Improved Albumin Synthesis in Postoperative Patients by Amino Acid Infusion
Authors: John J. Skillman, Victor M. Rosenoer, Paul C. Smith, Mina S. Fang
Journal: New England Journal of Medicine (1976)

To determine whether intravenous 3.5 per cent amino acid solution enhanced the rate of albumin synthesis in postoperative patients, we measured the albumin synthesis rate by the (14C) carbonate technic in 10 patients on the fourth day after elective gastrointestinal-tract operations. Five patients were randomized to receive a 3.5 per cent solution of essential and non-essential amino acids, and five to receive 5 per cent glucose. A mean (+/-S.E.M.) of 75.0+/-2.0 per day of amino acids or 111.0+/-12.4 glucose was given. In the amino acid group the mean (+/-S.E.M.) albumin synthesis rate was 237+/-24 mg per kilogram per day, in comparison to 157+/-23 in the glucose group (P less than 0.05). The infused amino acids were apparently more effective than plain glucose in promoting albumin synthesis.
Phase II study of sagopilone (ZK-Epo) in patients with recurrent metastatic breast cancer (MBC)
Authors: P. H. Morrow, S. G. Divers, L. Provencher, S. Luoh, T. M. Petrella, M. Giurescu, L. Fielding, Y. Wang, G. N. Hortobagyi, L. T. Vahdat
Journal: Journal of Clinical Oncology (2009)

1083 Background: Sagopilone is a novel, fully synthetic epothilone, which represents a new class of microtubule stabilizing agents. It has shown significant pre-clinical activity in taxane resistant breast cancer cell lines and in tumor models, as well as clinical activity in both taxane naïve and pretreated MBC. Methods: MBC patients who received ≤ 3 prior anthracycline and taxane containing chemotherapies were eligible. Sagopilone was given either at 16 mg/m 2 (arm A) or at 22 mg/m 2 (arm B, amended additional cohort) IV over 3 hours every 21 days for up to 6 cycles. The primary end point was tumor response by RECIST. The Simon 2-Stage design required 3 responders in the first 24 evaluable patients in stage 1 and 10 responders in 65 evaluable patients to declare success. Results: Between June 2006 and June 2008, 65 patients were enrolled and treated (39 in arm A, 26 in arm B). Majority of metastases were in lymph nodes (62%), liver (55%), bone (49%), lung (37%), and cutaneous sites (19%). Median number of cycles delivered was 2 (1–17). Neither arm met Stage 1 criteria for responders. Nevertheless, 2 patients in arm A and 1 in arm B had confirmed partial response, and lasted 4, 7, and 2 months, respectively. 26% patients in arm A, and 42% in arm B had stable disease. 42 patients discontinued study prior to cycle 6 due to progressive disease/death, 14 due to adverse events, and 1 due to other reasons. All 65 patients are evaluable for safety. Adverse events documented or reported in ≥ 20% patients are: sensory neuropathy 80% (23% grade 3), nausea 57% (no grade 3), fatigue 45% (12% grade 3), vomiting 29% (no grade 3), myalgia 28% (5% grade 3), diarrhea 25% (2% grade 3), insomnia 25% (no grade 3), pain in extremity 25% (2% grade 3), headache 23% (5% grade 3), arthralgia 22% (5% grade 3), constipation 22% (2% grade 3). Conclusions: Sagopilone had limited activity in these heavily pretreated MBC patients. It appeared tolerable at both dose levels. [Table: see text]
A Broken Heart
Authors: D Zahger, E Milgalter
Journal: New England Journal of Medicine (1996)

A 70-year-old man was brought to the emergency department because of syncope. He had a long history of type II diabetes treated with oral hypoglycemic agents but no history of heart disease, chest pain, shortness of breath, palpitations, retinopathy, neuropathy, nephropathy, hypertension, hyperlipidemia, or smoking and no history of heart disease in the family. During the night before his admission, he awoke with mild chest pain that lasted 30 minutes and subsided spontaneously. He then went back to sleep. Shortly after waking in the morning, the patient collapsed suddenly and was brought to the hospital.His chest pain . . .
Multicenter phase II study of pemetrexed and oxaliplatin as first-line therapy in advanced gastric cancer
Authors: L. Celio, S. Sachetta, S. Mosconi, I. La Torre, C. Barone, R. Berardi, V. Amoroso, G. Pinotti, F. Di Costanzo, E. Bajetta
Journal: Journal of Clinical Oncology (2006)

14045 Background: We have previously reported that single-agent pemetrexed is active in metastatic gastric cancer. On the basis of the potential synergism of pemetrexed and oxaliplatin, we explored the combination in patients with locally advanced/metastatic gastric carcinoma. Methods: The primary objective was activity of the combination. Eligible patients had to ≥1 measurable lesion according to RECIST. Pemetrexed 500 mg/m 2 was given intravenously over 10 minutes, and oxaliplatin 120 mg/m 2 was given over 2 hours; both drugs were given on day 1 of a 21-day cycle. Patients were to receive ≥6 (maximum of 8) cycles unless disease progression occurred. Vitamin supplementation was given as well as dexamethasone. A total of 43 patients were planned in a two-stage design with 13 patients in the first stage. An interim analysis was planned at the end of the first stage, so the trial could be stopped if ≤3 responses were observed. Results: Between May 2004 and January 2005, 13 patients (6 females) entered the study. Median age was 52 years (range, 27–75). One patient (7.8%) had locally advanced disease, and 5 patients (38.5%) retained primary gastric cancer. Main disease sites included lymph nodes (100%) and liver (23.1%). A total of 60 cycles were administered (median 6; range, 2–6). All 13 patients were evaluable for efficacy with 3 complete and 2 partial responses (ORR 38.5%; 95% CI, 13.9%-68.4%). Stable disease occurred in 3 patients (23.1%). G3 toxicities were neutropenia (30.8%), vomiting, hepatic toxicities and leucopenia (7.7%) each; no G4 toxicity were found. Conclusions: This interim analysis suggests that the activity and tolerability of the combination in advanced gastric cancer is very promising. Study accrual was ended in October 2005, and final results will be presented at the meeting. No significant financial relationships to disclose.
Case 30-1991
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, David J. Kuter, Leonard Ellman, Robert T. McCluskey
Journal: New England Journal of Medicine (1991)

Presentation of CaseAn 85-year-old woman was admitted to the hospital because of progressive impairment of renal function, neurologic deterioration, and seizures.The patient was in excellent health and appeared well when visited by her family in the evening three days before admission. On the next day the patient failed to respond to telephone calls. Her son arrived and found that she was confused and unable to understand his speech. She was admitted to another hospital, where physical examination showed that she was confused but answered some questions. Neurologic examination revealed an expressive aphasia. The hematocrit was 33.3 percent, and . . .
Concurrent weekly cisplatin and radiation therapy for nasopharyngeal carcinoma
Authors: Y. Beldjillali, K. A. Benhadji, D. Yekrou, F. Dali Youcef, L. Djellali, M. Yamouni
Journal: Journal of Clinical Oncology (2006)

15507 Background: Platimum based chemotherapy and radiotherapy combinations are the corner stone of management of nasopharyngeal carcinoma. Concomitant chemoradiotherapy may increase activity of the treatment but also increase toxicity. The purpose of the present study was to evaluate both aspects in patients (pts) with nasopharyngeal carcinoma (NPC). Methods: Previously untreated patients with NPC and ECOG performance status 0–2, were enrolled in this study. Cisplatin was administered weekly, starting on day 1 as an intravenous infusion at 40 mg/m 2 together with radiation therapy: 1.8–2.0 Gy per fraction, 5 fractions a week. The total dose delivered to the nasopharynx was 65 to 70 Gy and 45 Gy to lymph nodes with a boost of 15 Gy the node-bearing areas. Treatments were administered during 6 weeks. Results: 86 pts were enrolled in this study, 56 male and 30 female, with a median age of 41 years (range 16–69). 26 pts had stage IVb, 24 pts stage IVa, 17 pts stage III, 18 pts stage II and one pt stage I disease. 62 pts had undifferentiated, 22 poorly differentiated and 2 differentiated NPC. The complete response rate was 86% for all patients and the overall response rate was 93%, 7% of cases remained stable. After 494 cycles, grade 3 &amp; 4 toxicity (NCI) were: neutropenia (1%), anemia (1%), nausea and vomiting (14%), dysphagia (12%). 4 pts had cutaneous induration/fibrosis. All pts presented hyposialosis. The disease free survival and overall survival at one year were 78% and 83% respectively. Conclusion: Concomitant chemotherapy and radiotherapy in pts with NPC result in a high complete response rate with an acceptable safety profile. Further follow-up is necessary to assess the curative potential of this combined modality. [Table: see text]
Rejection of the Transplanted Human Heart
Authors: James J. Nora, Denton A. Cooley, Donald J. Fernbach, Donald G. Rochelle, John D. Milam, John R. Montgomery, Robert D. Leachman, William T. Butler, Roger D. Rossen, Robert D. Bloodwell, Grady L. Hallman, John J. Trentin
Journal: New England Journal of Medicine (1969)

The human heart is highly vulnerable to rejection. In 16 patients with 17 allografts rejection progressed relentlessly in histocompatibility matches of C and D grades. Only three patients were still living, 63 to 181 days after transplantation, at the time of this report. The longest survival was 203 days. Signs of rejection were an increase in congestive heart failure, pericardial friction rub, electrocardiographic changes, malaise and a rise in the serum lactate dehydrogenase-1 level. Immunosuppression with azathioprine, adrenal steroids and antilymphocytic globulin has not been as successful in combating rejection over the long term as earlier experience indicated.
ERCC1 expression is a predictor of clinical outcome in germ cell tumors treated with standard cisplatin based chemotherapy
Authors: A. A. Azambuja, L. S. Viola, J. Piccoli, A. Gaiger, C. H. Barrios
Journal: Journal of Clinical Oncology (2008)

16013 Background: The excision repair cross-complementation group 1 (ERCC1) enzyme is a key element of the nucleotide excision repair pathway removing cisplatin-induced DNA adducts and has been associated with resistance to platinum-based chemotherapy. Germ cell tumors (GCT) are associated with a high cure rate, and are very sensitive to platinum. We assessed the correlation of ERCC1 immunohistochemical expression with clinical outcome in a group of patients with GCT treated with standard platinum combinations. Methods: We identified 36 patients (pts) with GCT treated with platinum-based chemotherapy from 2000 to 2007 in our service. We were able to collect tumor blocks and perform immunohistochemistry (IHC) analysis (ERCC1 clone 3H11, Lab. Vision Co., Fremont, CA) in 26 cases. ERCC1 expression was considered as positive or negative by a pathologist blinded to the clinical outcome of each patient. Results: Median age of the group was 29 (18–50), 68% were non-seminomas. All the patients were treated with standard BEP or EP chemotherapy (CT). ERCC1 expression was positive in 10/26 (38%) patients and was significantly associated with a higher risk of recurrence (RR 3.4, 95%CI:1,3–8,7;p=0,02), persistent tumor marker elevation after first line CT (RR 3.2, 95%CI:1,7–6,0; p=0,04) and death (RR 3.3, 95%CI: 1,7–6,0; p=0,04). Conclusions: ERCC1 expression appears to confer a significantly worse prognosis in patients with GCT treated with standard platinum based chemotherapy. ERCC1 may represent a marker predicting clinical outcome and response to treatment. Further analysis in a larger cohort of patients is underway to confirm these initial results. No significant financial relationships to disclose.
Early Performance of Accountable Care Organizations in Medicare
Authors: J. Michael McWilliams, Laura A. Hatfield, Michael E. Chernew, Bruce E. Landon, Aaron L. Schwartz
Journal: New England Journal of Medicine (2016)

In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. We used quasi-experimental methods to assess the early performance of MSSP ACOs.Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group), with adjustment for geographic area and beneficiary characteristics. We analyzed the 2012 and 2013 ACO cohorts separately because entry time could reflect the capacity of an ACO to achieve savings. We compared ACO savings according to organizational structure, baseline spending, and concurrent ACO contracting with commercial insurers.Adjusted Medicare spending and spending trends were similar in the ACO cohorts and the control group during the precontract period. In 2013, the differential change (i.e., the between-group difference in the change from the precontract period) in total adjusted annual spending was -$144 per beneficiary in the 2012 ACO cohort as compared with the control group (P=0.02), consistent with a 1.4% savings, but only -$3 per beneficiary in the 2013 ACO cohort as compared with the control group (P=0.96). Estimated savings were consistently greater in independent primary care groups than in hospital-integrated groups among 2012 and 2013 MSSP entrants (P=0.005 for interaction). MSSP contracts were associated with improved performance on some quality measures and unchanged performance on others.The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups.
Risk of developing pulmonary carcinoid tumors following breast cancer.
Authors: J. A. Hocking, J. Mitchell, M. Harp, J. Ejiofor, J. M. DiMaio
Journal: Journal of Clinical Oncology (2010)

e12025 Background: There have been isolated reports of bronchial carcinoid tumorlets mimicking breast cancer metastases as well as one analysis showing an increased risk of subsequent breast cancer following diagnosis of bronchial carcinoid. We noticed an increased incidence of previous breast cancer in our patients with carcinoid tumors. We sought to determine if this relationship could be confirmed. Methods: We conducted a retrospective review of all patients with pulmonary carcinoid tumors undergoing surgical resection at our institution between 1998 and 2009. Results: There were 42 patients in our cohort. Of the 24 women who underwent resection, seven (29%) had a history of breast cancer. Women with a history of breast cancer were significantly older (p = 0.015) as compared to those without. Other characteristics including tumor size and type, stage, family history of cancer, race and smoking status were not significantly different between the two groups. Characteristics in the women with breast cancer varied, including cell type, hormone positivity and breast cancer treatment modality, age and interval between breast cancer and carcinoid diagnosis. Conclusions: In this cohort, the incidence of females with breast cancer is more than double the expected rate (29% vs. 12.5% adjusted for race). In the variables we examined we could find nothing to account for this difference. There is evidence supporting that this is more than result of selection bias. Morphologically, breast cancer and carcinoid cells can appear similar; with immunoperoxidase studies used to help differentiate the two. However, 2%-5% of breast cancers have neuroendocrine differentiation by chromogranin A and synaptophysin staining and there are some reports of estrogen and progesterone receptor positivity in carcinoid tumor. Additionally, data from the SEER database associated a diagnosis of carcinoid with an increased risk of subsequent breast cancer within 5 years. Our series suggests that there may be an increased risk of developing a pulmonary carcinoid tumor following a diagnosis of breast cancer. Further studies evaluating histochemical and molecular characteristics of these tumors are warranted to define the possible association No significant financial relationships to disclose.
S6 The profiles of JMJD3, UTX and H3K27me3 expression in pulmonary vasculature in rat MCT model of PAH and human iPAH: implications for pulmonary arterial hypertension
Authors: D Shao, BE Garfied, A Crosby, P Young, F Perros, M Humbert, IM Adcock, N Morrell, SJ Wort
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> There is increasing interest in the role of epigenetic gene regulation in the pathogenesis of pulmonary arterial hypertension (PAH), a condition associated with pulmonary vascular cell proliferation. Methylation on histone H3K27 (H3K27me3) has been found to be a key regulator of development and cell homeostasis. Methylation at H3K27 can be reversed by the Jumonji C (JmjC) domain-containing proteins, JMJD3 and UTX. <h3>Methods</h3> Immunohistochemistry for JMJD3, UTX and H3K27me3 was performed on lungs from a monocrotoline (MCT) rat model of PAH, in control animals and in patients with idiopathic PAH and healthy control subjects. <h3>Results</h3> In the rat MCT model of PAH, we found that the expression of JMJD3 protein is increased in all three cell layers (endothelial cells, smooth muscle cells and fibroblasts) in remodelled pulmonary arterioles (PA). The greatest increase is within endothelial cells, particularly in partially occluded or completely occluded PA (Appendix Figure 1). In contrast, the expression of UTX is unchanged. There was a corresponding decrease in H3K27me3 staining in remodelled PA and some cells completely lost H3K27me3 expression. JMJD3 protein expression was also found in remodelled PA in the lung of patients with iPAH especially in endothelial cells and the plexiform lesion. <h3>Conclusion</h3> Our data suggest that JMJD3 expression and H3K27 histone methylation could play an important role in the pathogenesis of iPAH. The rat MCT model of PAH is a suitable model for further mechanistic and intervention studies.
In Sight and Out of Mind
Authors: Nasia Safdar, Andrew Odden, Cybele L. Abad, Rameet Thapa, Sanjay Saint
Journal: New England Journal of Medicine (2015)

A 21-year-old man presented to the emergency department with fever and rash. His fever had started about 1 week before presentation and was associated with chills, myalgia, nausea, and vomiting. He also had a headache without photophobia.
P257 Modern Day Scrofulous Swellings: Breast Tuberculosis in East London
Authors: BJ Butler, A Khanam, VLC White, N Jayasekera, JL Potter, H Kunst
Journal: Thorax (2015)

<h3>Introduction</h3> Breast tuberculosis (TB) is rare and diagnosis may be delayed. It was first described in 1829. Incidence is highest in TB endemic areas. Here we describe a series of cases diagnosed in East London (UK). <h3>Methods</h3> We conducted a retrospective study of all patients treated at our institution for breast TB between 2005 – 2015. Data including demographics, symptoms, microbiological, histological diagnoses and treatment outcomes were recorded. <h3>Results</h3> 35 cases of breast TB were identified (1 male). Mean age at diagnosis was 33 years (range 16 – 63). 24 patients were from the Indian subcontinent, 3 Asian other, 7 Black-African and 1 Middle Eastern; no patients were Caucasian. Three patients were lactating, two were pregnant. Four patients had a previous history of TB and one was HIV positive. All patients presented with a breast lump, 58% in the upper outer quadrant. 25 patients initially presented to their general practitioner (GP), of which 24 were referred to breast clinic and 1 directly to TB clinic. Eight cases presented to hospital. In two cases there was insufficient data. The breast lump was associated with skin changes in six cases, inverted nipple in three, discharge in one, and 49% had ipsilateral axillary lymphadenopathy. Erythrocyte sedimentation rate and C-reactive protein was raised in 84% and 53% cases respectively. Thirty percent of patients had abnormal mammography, 68% abnormal ultrasound breast findings. 25 out of 35 cases had biopsies/fine needle aspirations (FNA), all of these were sent for culture; 17 were culture positive with 3 drug resistant cases. Nine cases had necrotising granulomatous changes on histology, of which 1 was positive for Ziehl-Neelson (ZN) stain, 9 cases had non-necrotising granulomas, of which 2 were ZN positive, and 7 cases had inflammatory changes only (none were ZN positive). All patients received at least three anti-tuberculous drugs. Median treatment duration was six months, leading to complete resolution of breast TB. <h3>Conclusion</h3> This case series highlights the difficultly in diagnosing breast TB. Raising awareness of the classical presentation of breast TB amongst GPs and breast services may improve diagnosis and treatment of this rare disease.