tbuckley/cabot-search huggingface dataset:
Trends in demographics and survival for patients (pts) with advanced non-small cell lung cancer (NSCLC)
Authors: K. Kubota, H. Masuhara, K. Hosoya, K. Yoh, S. Niho, K. Goto, H. Ohmatsu, Y. Nishiwaki, N. Saijo
Journal: Journal of Clinical Oncology (2006)

7114 Background: In clinical trials, concurrent chemoradiotherapy improves survival of pts with inoperable stage III NSCLC compared with sequential chemoradiotherapy or radiotherapy alone, and platinum doublets with third-generation chemotherapy prolong survival of pts with stage IV NSCLC. Epidermal growth factor receptor antagonist is active as second-line chemotherapy. Few outcomes research regarding demographics and survival trends in advanced NSCLC has been conducted. Methods: The National Cancer Center Hospital East Database was searched for all pts with inoperable stage III and IV NSCLC. Data was recorded for histology, age, sex, smoking history, tumor location, stage, performance status (PS), and treatment modality. Pts were divided into two groups; group A: newly registered pts from July 1992 to December 1997, group B: from January 1998 to June 2004. Survival curves were evaluated using the Kaplan-Meier methods, and statistical significance was estimated by the log-rank test. Results: 2,135 pts (771 pts group A vs. 1364 pts group B) were identified. Pts demographics of each group (% group A/B) were as follows; male; 74/77, non-smoker; 19/19, PS 0–1; 79/85, squamous cell histology; 26/24, stage III; 45/44. Median age was 63 years old in group A and 64 in group B. Median survival (MS), 1-year survival rate (1ys), 2ys and 3ys were 8 months (M), 33%, 12% and 7% in group A, 10M, 42%, 23% and 14% in group B, respectively (P &lt; .0001). In pts with stage III, MS, 1ys, 2ys, 3ys were 12M, 46%, 20%, 12% in group A and 15M, 56%, 34%, 20% in group B (P &lt; .0001). In non-smoker, MS, 1 ys, 2 ys were 11 M, 46%, 19% in group A and 15 M, 56%, 30% in group B (P &lt; .0001). In females, MS, 1 ys, 2 ys were 10 M, 39%, 16% in group A and 15 M, 55%, 31% in group B (P &lt; .0001). Conclusion: Although there were no apparent differences in demographics between the two groups, survival was significantly improved chronologically. The improvement was prominent in stage III, non-smokers and females suggesting the benefit of chemoradiotherapy and tyrosine kinase inhibitors. [Table: see text]
The Abuse of Bed Rest in the Treatment of Myocardial Infarction
Authors: C. Warren Irvin, Alexander M. Burgess
Journal: New England Journal of Medicine (1950)

IN MEDICINE the ritualistic following of unproved traditional procedures is a common fault. Although it is never sound to desert the established practice because it is unproved, it is always important to review periodically the evidence bearing upon it. This is especially true when the treatment involves conflicts with the natural, perhaps instinctive, tendencies of the patient. For many years the physician rigidly restricted the fluid intake of edematous persons, with no voice but the patient's raised in protest. Surgical and obstetric patients were likewise kept at prolonged postoperative or postpartum bed rest until critical thought, and perhaps the shortage . . .
Impact of Nurse-Led, Multidisciplinary Home-Based Intervention on Event-Free Survival Across the Spectrum of Chronic Heart Disease
Authors: Simon Stewart, Joshua F. Wiley, Jocasta Ball, Yih-Kai Chan, Yasmin Ahamed, David R. Thompson, Melinda J. Carrington
Journal: Circulation (2016)

Background— We sought to determine the overall impact of a nurse-led, multidisciplinary home-based intervention (HBI) adapted to hospitalized patients with chronic forms of heart disease of varying types. Methods and Results— Prospectively planned, combined, secondary analysis of 3 randomized trials (1226 patients) of HBI were compared with standard management. Hospitalized patients presenting with heart disease but not heart failure, atrial fibrillation but not heart failure, and heart failure, as well, were recruited. Overall, 612 and 614 patients, respectively, were allocated to a home visit 7 to 14 days postdischarge by a cardiac nurse with follow-up and multidisciplinary support according to clinical need or standard management. The primary outcome of days-alive and out-of-hospital was examined on an intention-to-treat basis. During 1371 days (interquartile range, 1112–1605) of follow-up, 218 patients died and 17 917 days of hospital stay were recorded. In comparison with standard management, HBI patients achieved significantly prolonged event-free survival (90.1% [95% confidence interval, 88.2–92.0] versus 87.2% [95% confidence interval, 85.1–89.3] days-alive and out-of-hospital; P =0.020). This reflected less all-cause mortality (adjusted hazard ratio, 0.67; 95% confidence interval, 0.50–0.88; P =0.005) and unplanned hospital stay (median, 0.22 [interquartile range, 0–1.3] versus 0.36 [0–2.1] days/100 days follow-up; P =0.011). Analyses of the differential impact of HBI on all-cause mortality showed significant interactions (characterized by U-shaped relationships) with age ( P =0.005) and comorbidity ( P =0.041); HBI was most effective for those aged 60 to 82 years (59%–65% of individual trial cohorts) and with a Charlson Comorbidity Index Score of 5 to 8 (36%–61%). Conclusions— These data provide further support for the application of postdischarge HBI across the full spectrum of patients being hospitalized for chronic forms of heart disease. Clinical Trial Registration— URL: http://www.anzctr.org.au . Unique identifiers: 12610000221055, 12608000022369, 12607000069459.
Feedback Inhibition of Insulin Secretion by Insulin: Relation to the Hyperinsulinemia of Obesity
Authors: Dariush Elahi, Murugasu Nagulesparan, Richard J. Hershcopf, Denis C. Muller, Jordan D. Tobin, Petra M. Blix, Arthur H. Rubenstein, Roger H. Unger, Reubin Andres
Journal: New England Journal of Medicine (1982)

We investigated the possible existence of a negative short-loop feedback of circulating insulin on the parent beta cell in 10 lean Caucasians, 10 obese Caucasians, and 10 obese Pima Indians. Plasma insulin levels were raised acutely by 100 microunits per milliliter for 90 minutes, and plasma glucose was maintained by the "clamp" technique. C-peptide levels were suppressed in all groups to approximately 50 per cent of basal values. However, the obese groups had absolute C-peptide levels much higher than those of the lean group. During the hour after infusion, the rate and magnitude of C-peptide recovery in the obese groups were higher than in the lean group. Thus, negative short-loop insulin-beta-cell feedback was operative in both the lean and obese states. Despite this suppression, the insulin-secretion rate in obese subjects was still greater than that in non-obese subjects. Inadequate feedback suppression may account in part for the prevailing hyperinsulinemia of the obese.
Case 20-1971
Authors: Richard C. Cabot, Benjamin Castleman, Betty U. McNeely, Daniel S. Ellis, Walter G. J. Putschar
Journal: New England Journal of Medicine (1971)

Presentation of CaseA 31-year-old woman was admitted to the hospital because of multiple complaints.At birth a Klippel-Feil syndrome and Sprengel's deformity were observed. At the age of seven years she was admitted to another hospital because of persistent vomiting, and radiographic evidence of gastric obstruction was found. A laparotomy was performed, and a gastrojejunostomy was constructed. Exploration of the abdomen disclosed malrotation of the bowel, with the small intestine lying on the left side of the abdomen and the colon on the right. A Meckel diverticulum was resected, and an appendectomy was performed. Peptic esophagitis developed, requiring antacid . . .
M23 The use of Wearables for COPD patients: A Qualitative study
Authors: S Nabhani, R Siva, R Kayyali, C Yagambrun, P Robinson, M Spruit, A Vaes, J Wacker, L Caldani, R Paradiso, J Chang
Journal: Thorax (2015)

<h3></h3> There have been significant advances in Technology enabled care (TEC) including wearable technology. However, to our knowledge, there is a paucity of literature related to patient perceptions of smart wearable sensors. The WELCOME platform (FP-7 funded project) is an innovative integrated system using wearable sensors and smart computing for COPD patients with co-morbidities.<sup>1</sup> The aim of this platform is the early diagnosis of exacerbations and disease deterioration allowing for early intervention. The wearable sensors in this project have been integrated into a vest (Figure 1) and several prototypes with mock sensors were developed. A structured interview was designed to explore COPD patient perceptions pertaining to vest comfort, ease of wear and handling, willingness to use and concerns. Interviews were designed to take place at the clinic (England and Netherlands) where patients are provided with a suitably sized vest to try on followed by the structured interviews. To date, 15 interviews have been completed at Croydon Healthcare services Trust, and the Dutch interviews are underway. <h3>Results</h3> The interview transcripts were thematically analysed using mostly framework analysis. Analysis was conducted using NVIVO 10. The following themes emerged from the data.1) Acceptance of vest 2) willingness to wear the vest during daytime 3) Discomfort with sensor size and shape prohibiting night wear 4) Demonstrated capability of donning the vest and handling of the sensors 5) Safety concerns emphasising importance of patient education before use 6) Gender related concerns regarding vest design. <h3>Conclusion</h3> The vests were well received by patients however the above results illustrate the importance of involving the end users in the design and development of any smart intervention. These results will be used for the final design and development of the vest. <h3>Reference</h3> 1 Chouvarda I, Philip NY, Natsiavas P, <i>et al</i>. WELCOME-innovative integrated care platform using wearable sensing and smart cloud computing for COPD patients for comorbidities. <i>Conf Proc IEEE Eng Med Biol Soc</i>. 2014;<b>2014</b>:3180–3. doi: 10.1109/EMBC.2014.6944298
PTH-018 Predicting survival in palliative oesophageal stent insertion
Authors: R Driver, C Handforth, S Kite, G Radhakrishna, M Hull, S Everett
Journal: Gut (2015)

<h3>Introduction</h3> Self-expanding metal stents (SEMS) are an important treatment modality in palliation of malignant dysphagia, either alone or in addition to chemotherapy or radiotherapy. However, the optimal timing of stent insertion remains uncertain when considering prognosis in advanced malignancy. We present a large single centre experience of patients undergoing SEMS insertion for malignant dysphagia. The aim was to identify risk factors associated with overall and 30 day mortality post-oesophageal stenting. <h3>Method</h3> All patients receiving an oesophageal stent for palliation of dysphagia in primary oesophageal malignancy between January 2009 and December 2013 in Leeds Teaching Hospitals NHS Trust were included. All devices used were Niti S double covered stents inserted by four experienced practitioners using a combined endoscopic and fluoroscopic procedure. Demographics, tumour site and stage, performance status, Charlson co-morbidity index, dysphagia score, previous oncological therapies and serum albumin and CRP in the week prior to stent insertion were retrieved from electronic patient records. Kaplan-Meier survival estimates and Cox proportional hazards regression were performed to identify risk factors predictive of mortality. <h3>Results</h3> Among 259 patients (mean age 70.3 (range 32 to 99)), the median post-stent survival was 100 days (95% CI, 87 to 116). 51 patients (20%) died within 30 days of the stenting procedure and 10 patients (4%) died within 7 days. 35 patients (14%) required repeat stenting for tumour overgrowth, stricture or stent migration; the median time to re-stent was 137 days (95% CI, 99 to 175). Serum CRP &gt; 50 was an independent predictor of 30 day mortality (hazard ratio [HR], 3.7; 95% CI, 1.7 to 8.0). Overall post-stent mortality was associated with CRP &gt; 50 (HR, 2.3; 95% CI, 1.6 to 3.2) and albumin &lt; 30 (HR, 1.9; 95% CI, 1.1 to 3.1). <h3>Conclusion</h3> Our 30 day mortality of 20% is consistent with data published elsewhere (13<sup>1</sup>–25%<sup>2</sup>), but this study identifies the association of elevated CRP with short-term mortality. This may reflect advanced disease or concurrent infection (such as aspiration pneumonia) and may be a useful guide to optimising timing of stent insertion. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Homs MY, Steyerberg EW, Eijkenboom WM, <i>et al</i>. Single-dose brachytherapy versus metal stent placement for the palliation of dysphagia from oesophageal cancer: multicentre randomised trial. Lancet 2004;364(9444):1497–504 van Heel NC, Haringsma J, Boot H, <i>et al</i>. Comparison of 2 expandable stents for malignant esophageal disease: a randomized controlled trial. Gastrointestinal Endoscopy;76(1):52–8
Incremental value of pulmonary artery diameter indexed for BSA in pulmonary hypertension
Authors: Marloes P Huitema, Herre J Reesink, Martijn C Post
Journal: Thorax (2015)

With great interest, we read the article by Rajaram et al 1 regarding the prevalence and prognostic value of CT measures in patients with pulmonary arterial hypertension. They found the inferior vena cava area and presence of pleural effusion or septal lines to be the only significant predictors of mortality. A vascular parameter, the ratio of the pulmonary artery (PA) to ascending aorta (Ao), was no predictor for mortality during a mean follow-up of 3 years.1 A better vascular …
Esophageal Hiatal Hernia
Authors: F. Henry Ellis
Journal: New England Journal of Medicine (1972)

HERNIATION of abdominal contents into the thorax through the esophageal hiatus has been known to the medical profession for centuries; yet it remains a poorly understood phenomenon and controversy over its proper management persists. This controversy reflects changing concepts regarding the cause of symptoms resulting from esophageal hiatal hernia and different approaches toward their alleviation. It is becoming increasingly evident that correction of abnormal physiology as well as abnormal anatomy should be the prime goal of those responsible for the care of patients with symptomatic hiatal hernia.Definition and PrevalenceHiatal hernia, broadly defined, implies the protrusion of a portion . . .
Abstract 18463: A Novel Grading System for Post-implant Right Heart Failure Correlates With One-year Survival After Continuous-flow Left Ventricular Assist Device
Authors: E. Wilson Grandin, Jeremy A Mazurek, Payman Zamani, Gregory S Troutman, Edo Y Birati, Pavan Atluri, Kenneth B Margulies, J. Eduardo Rame
Journal: Circulation (2015)

Introduction: Right ventricular failure (RVF) is a common complication after continuous-flow left ventricular assist device (cf-LVAD) and carries an increased risk of mortality. There is a spectrum of early RVF and the optimal definition is controversial, hindering efforts to identify relevant risk factors. Correlating the severity of RVF with outcome after LVAD could inform clinical criteria for this important syndrome. Hypothesis: Increasing severity of RVF will be associated with worse one-year survival. Methods: We identified 196 patients undergoing isolated durable cf-LVAD since 2005 at our center. Post-implant RVF was graded as absent, mild (requiring inotropes for 14-20 days), moderate (requiring inotropes for ≥ 21 days), or severe (requiring unplanned RVAD at any time during the index hospitalization). One-year survival, censored at the time of heart transplant or VAD explant for recovery, was examined using Kaplan-Meier plots, the log-rank test, and Cox proportional-hazard modeling. Results: Seventy-three patients (37.2%) developed RVF: 35 (17.9%) mild, 24 (12.2%) moderate, and 14 (7.1%) severe. The median follow-up time was 266 days (IQR: 81-761), and 51 patients (26%) died within one year. Compared to patients without RVF, those with mild RVF had similar one-year survival (HR 0.69, 95%CI:0.26-1.80, p=0.45) while the risk of death was substantially increased in patients with moderate (HR 2.65, 95%CI:1.27-5.54, p=0.009) and severe RVF (HR 8.16, 95%CI:3.97-16.76, p&lt;0.0001). The severity of RVF was strongly associated with one-year mortality, which persisted in multivariate modeling (Figure). Conclusions: A simple grading system for the severity of early RVF is strongly associated with one-year survival after cf-LVAD, supporting the notion that there is a spectrum of post-implant RVF. If confirmed in other cohorts, targeting risk-prediction and risk-mitigation strategies for moderate and severe RVF could improve post-LVAD survival.
EPID-18THE ASSOCIATION BETWEEN ALLERGIC CONDITIONS AND PEDIATRIC BRAIN TUMORS IN NEUROFIBROMATOSIS TYPE 1
Authors: Kimberly Johnson, Bree Porcelli, Nancy Zoellner, Salmafatima Abadin, David Gutmann
Journal: Neuro-Oncology (2015)

Evidence from studies of brain tumors, particularly adult gliomas, suggests that allergic conditions may protect against these tumors.It is widely recognized that individuals with the common genetic syndrome, Neurofibromatosis type 1 (NF1), are predisposed to developing pediatric brain tumors (PBTs), particularly optic gliomas; however, risk factors are not well defined.In this study, we sought to evaluate associations between allergic conditions and PBTs in NF1.NF1 subjects were ascertained from two data sources: (1) the NF1 Patient Registry Initiative (NPRI, n ¼ 1672) and (2) medical records (MRs) from a large medical center (n ¼ 629).Using logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), we determined associations between NPRI participant-or MR-reported PBTs and allergic condition diagnoses (allergies, asthma, and eczema).We observed significant positive associations between medication allergies and PBTs for both data sources, but not for other allergy types or eczema.Weak nonsignificant inverse associations between PBTs and asthma were observed (NPRI: OR ¼ 0.80, 95% CI 0.55-1.17;MR: OR ¼ 0.71, 95% CI 0.40-1.28),with a significant inverse association (OR ¼ 0.60; 95% CI 0.36-0.89)detected in an NPRI subgroup analysis that excluded PBT cases (and a matched non-case) whose asthma diagnosis was reported to occur after their PBT diagnosis.No significant associations were observed in similar analyses for eczema or allergies.In conclusion, our study supports a possible role for asthma in PBT risk in NF1.However, these results should be considered exploratory in light of limitations of both data sources with additional replication required to make firm conclusions.
Modeling and simulation of neutropenia to support dosing regimens for liposome-encapsulated paclitaxel easy-to-use (LEP- ETU)
Authors: T. H. Grasela, G. J. Fetterly, J. L. Dul, D. LeComte, A. Y. Grahn, J. B. Fiedler-Kelly, J. W. Sherman, N. Damjanov, M. N. Fishman, A. R. Tan
Journal: Journal of Clinical Oncology (2007)

13011 Background: LEP-ETU is a liposomal formulation of paclitaxel designed to reduce toxicities while maintaining or enhancing the efficacy of the drug. A PKPD model was used to characterize the time course of neutrophils in relation to blood exposure of LEP-ETU in patients with solid tumors. Simulations were performed to provide justification for dosing schedule in Phase 3 trials. Methods: Data from 63 patients in two phase I studies with advanced malignancies were utilized. LEP-ETU was infused intravenously over 90 min. at 135, 175, 225, 275, 325, and 375 mg/m 2 every 21 days (Q3W). A separate cohort received 175 mg/m 2 of LEP-ETU infused over 3 hours following a Q3W regimen. Population PKPD modeling and simulations were performed to assess the influence of dose and schedule (275 - 325 mg/m 2 Q3W vs. 90 - 110 mg/m 2 QW) on neutropenia. Results: The temporal relationship between circulating neutrophils and paclitaxel concentrations was adequately characterized using a model representative of progenitor cells undergoing differentiation and maturation into neutrophils. Mean predicted (%SEM) baseline ANC was 4.3 (6) x 10 9 /L, representative of a normal neutrophil count. Mean transit time (%SEM) was 80 (8) hr, representing a post-mitotic time delay to neutrophil maturation. The neutrophil T 1/2 was 14 hr, comparable to published values. The drug effect (Slope·C p ) on the proliferation rate constant is decreased by 9- and 91-fold when 10 or 100 units of drug is present, indicative of paclitaxel’s inhibition of progenitor cell production in bone marrow. Simulations suggest a higher risk of neutropenia with the Q3W regimen and dose-dependent severity for both the Q3W and QW regimens. The predicted incidence of grade 4 toxicity increased from 33% - 42% across the dose range of 275 - 325 mg/m 2 Q3W. For a dose of 110 mg/m 2 given QW, the incidence of grade 4 neutropenia was 16% compared to 42% for the same total dose of 325 mg/m 2 given Q3W. Conclusions: Modeling and simulation predict that a Q3W regimen of 325 mg/m 2 LEP- ETU (MTD) provides acceptable neutropenia outcomes comparable to 175 mg/m 2 paclitaxel Q3W, while minimizing the Cremophor- associated adverse events. Future consideration of QW regimens may be explored. No significant financial relationships to disclose.
Relationship Between Nasal Symptom Scores, IgE Class and Skin Prick Test (SPT) Size in the Environmental Exposure Unit (EEU) – Relevance of IgE Class and Spt Diameter
Authors: Dan Adams, Mena Soliman, Lisa M. Steacy, Terry J. Walker, Barnaby Hobsbawn, Jenny Thiele, Anne K. Ellis
Journal: Journal of Allergy and Clinical Immunology (2016)
Increasing visits for anaphylaxis and the benefits of early epinephrine administration: A 4-year study at a pediatric emergency department in Montreal, Canada
Authors: Elana Hochstadter, Ann Clarke, Sarah De Schryver, Sebastien La Vieille, Reza Alizadehfar, Lawrence Joseph, Harley Eisman, Moshe Ben-Shoshan
Journal: Journal of Allergy and Clinical Immunology (2016)
Steroid Excretion in Obese Patients with Colored Abdominal Striae
Authors: Benjamin Simkin, Rodrigo Arce
Journal: New England Journal of Medicine (1962)

PURPLE or red abdominal striae are one of the striking physical signs of Cushing's syndrome. However, they are not pathognomonic of this disease, since they are also seen occasionally in pregnant women, obese normal persons and in adolescent children. In these conditions white or colorless striae are quite common, but those of the tinted variety are not. In the dermatologic literature synonyms for striae are striae albicantes,1 striae atrophicae2 and striae distensae.3 In the vernacular striae are referred to as "stretch marks." Various dermatologic textbooks1 2 3 4 5 ascribe this curious condition to distention or stretching of the skin, with an associated loss . . .