tbuckley/cabot-search huggingface dataset:
M20 A five-year analysis of an integrated COPD service in Hackney, London – is this the right direction?
Authors: A Garner, M Hodson, G Ketsetzis, A Bhowmik
Journal: Thorax (2015)

<h3></h3> In response to high mortality rates, high numbers of COPD admissions, poor quality of care and a lack of integration of services for people with COPD, City and Hackney Primary Care Trust tendered the provision of an acute- and community-based COPD service from Homerton University Hospital in 2009 (the Acute COPD Early Response Service: ACERS). We studied the impact of ACERS on outcomes for COPD patients in City and Hackney including patient CAT scores, healthcare usage (admissions, length of stay and bed days) and place of death, from 2010 to 2015. We found a decrease in COPD admissions (from 1.38 admissions per 1000 population to 1.24 per 1000 population) following the establishment of the ACERS service (compared to an increase seen nationally over this time) and a significant reduction in the number of bed days for COPD patients – from 1,817 per year to 1,200 per year (Mann Whitney U test Z-Score 3.6607, p &lt; 0.05). This was alongside a significant increase in patients staying less than 2 days in hospital – from 27% to 34% (significant at p &lt; 0.0001) reflecting the effect of the service on early discharge. We also found a significant increase in the number of patients dying outside of hospital (a proxy for quality of end of life care as most patients express wishes to be cared for and die in their own home or a hospice). The percentage of City and Hackney COPD patients dying outside of hospital increased from 24% to 42% following introduction of ACERS (p = 0.00015). Patient satisfaction with the service was high and patients saw a clinically significant improvement in CAT scores (from 24 to 20, n = 69) following intervention by the ACERS team. This data was used in a locally developed economic model to determine the economic benefits of the ACERS team and whether therefore, when comparing to the cost of the service, this service was cost-saving overall. The model found that the impact on place of death and healthcare usage meant that ACERS had net monetary benefits to commissioners. We conclude that an exemplar integrated COPD service can provide financial and other benefits to commissioners which equate to a cost saving service with high return on initial investment. ACERS has been expanded from its original remit to now include management of patients with asthma and bronchiectasis.
Cirrhosis and Primary Carcinoma of the Liver
Authors: Richard A. MacDonald
Journal: New England Journal of Medicine (1956)

OCCASIONAL reports of a high incidence of * primary carcinoma of the liver have appeared in the American medical literature in recent years. These observations have not in general received a great deal of attention, owing at least in part to the fact that the number of cases of carcinoma in such reports has been small. During the course of a review of biliary-system neoplasms at this hospital it was noted that the number of primary carcinomas of the liver, both hepatomas and cholangiomas, had significantly increased during the past eight years. Whereas the incidence in 15,491 autopsies during the . . .
Transdermal nicotine and smoking behavior in psychiatric patients
Authors: N Hartman, G B Leong, S M Glynn, J N Wilkins, M E Jarvik
Journal: American Journal of Psychiatry (1991)

The authors used a double-blind crossover design to observe the effect of transdermally administered nicotine on the smoking behavior of 13 psychiatric patients who were not trying to stop smoking. The patients smoked significantly fewer cigarettes while receiving nicotine than while receiving placebo. These data suggest that transdermally administered nicotine can be a useful adjunct in treating nicotine-addicted psychiatric patients in a non-smoking environment.
Safety and activity of MDX-1106 (ONO-4538), an anti-PD-1 monoclonal antibody, in patients with selected refractory or relapsed malignancies
Authors: J. R. Brahmer, S. Topalian, I. Wollner, J. D. Powderly, J. Picus, C. Drake, J. Covino, A. Korman, D. Pardoll, I. Lowy
Journal: Journal of Clinical Oncology (2008)

3006 Background: Programmed death-1 (PD-1), an inhibitory receptor expressed on activated T cells, may suppress antitumor immunity. Objectives of this first in human phase I trial of MDX-1106 (ONO-4538), a fully human IgG4 anti-PD-1 blocking antibody, are to evaluate safety and maximum tolerated dose (MTD). Other objectives include evaluation of pharmacokinetics (PK) and immunological effects. Methods: Patients (pts) had treatment refractory metastatic non-small cell lung cancer (NSCLC), renal cell carcinoma (RCC), colon cancer (CC), melanoma (MEL), or prostate cancer (HRPC), and no history of autoimmune disease. Sequential cohorts of 6 pts received a single IV dose of MDX-1106 at 0.3, 1, 3, or 10 mg/kg. Disease status was evaluated at wk 8 by RECIST criteria. Pts with SD or lesional responses could receive additional MDX-1106 at wks 12 and 16, at the original dose. Results: 24 pts, 6 at each dose level (9 CC, 5 NSCLC, 6 MEL, 4 HRPC), were enrolled through 11/07. 23 pts have been assessed for tumor response at 8 wks. All doses were well tolerated and no MDX-1106 related SAEs occurred. Two pts (treated at 3 and 10 mg/kg) developed arthritic symptoms requiring treatment, and 2 pts had an asymptomatic TSH elevation. Objective tumor responses (CR or PR) were not observed within 8 wks. Three pts had significant lesional regressions (1 NSCLC pt at 1 mg/kg, 2 MEL pts at 10 mg/kg). Five pts with SD or lesional regressions received retreatment. Biopsy of a regressing MEL lymph node metastasis showed a moderately increased CD8+ T cell infiltrate post treatment. PK and immunological evaluations are underway. Conclusions: The targeted maximum dose of 10 mg/kg of MDX-1106 was achieved without observing dose-limiting toxicities, and lesional tumor regressions were observed in 3 of 23 pts evaluated. An expansion cohort at 10 mg/kg is enrolling 15 additional pts. Therapy with MDX-1106 to enhance endogenous antitumor immunity, either alone or in combination with other therapeutic modalities, warrants further study. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amplimmune, Inc., Medarex Amplimmune, Inc., Bristol-Myers Squibb, Medarex, Inc. Amplimmune, Inc., Medarex Cell Genesys, Inc., Medarex
P95 Growth and Nutrition in Ataxia Telangiectasia
Authors: EL Stewart, A Tooke, S Pasalodos, M Suri, A Bush, J Bhatt
Journal: Thorax (2015)

<h3>Background</h3> Ataxia telangiectasia (A-T) is a rare multisystem disease with high early mortality from lung disease and cancer. Nutritional failure adversely impacts outcomes in many respiratory diseases. Several factors influence nutrition in children with A-T including catabolism during recurrent infections and inadequate oral intake (fatigue, difficulties with chewing or swallowing, poor appetite, and nausea due to medications). We hypothesised that children with A-T have progressive growth failure. <h3>Methods</h3> Data was collected prospectively on weight, height and body mass index (BMI) at the national paediatric A-T specialist clinic in Nottingham. Adequacy and safety of oral intake was assessed. Nutritional advice was given at each multidisciplinary review. <h3>Results</h3> 92 children (46 girls) (33 once, 37 twice, 20 thrice, 1 child four times and 1 child 5 times) had 176 measurements since 2009. Median (range) age was 9.2 (1.5 to 18.4) years. Weight, height and BMI Z-scores were respectively -0.84 (-8.34 to 3.58), -0.98 (-5.85 to 3.66) and -0.24 (-4.45 to 2.75). Weight, height and BMI Z-scores inexorably declined over time. 10 children had a gastrostomy, with longitudinal data available for 8. 87.5% of these children improved their BMI Z-score with time. 18.5% (17) children were considered wasted (BMI Z-score ≤-2). All of these children were above 8 years old. Longitudinal data was available for 14 wasted children. 6 of these children had a gastrostomy inserted and 5 then improved their Z-score. Of the remaining 8 children without gastrostomy, 7 (87.5%) continued to decrease their BMI over time despite dietary advice to fortify food or add in supplements. <h3>Conclusions</h3> There is a remorseless decline in growth over time. There is an urgent need for new strategies, including an understanding of why growth falters. Undernutrition adversely affects acute and chronic lung health. Outcomes for late gastrostomy insertion in AT are poor (<i>Lefton Greif</i><i>OJRD;2011;210</i>). We suggest early proactive consideration of gastrostomy from age 8 years upwards in order to prevent respiratory deterioration.
P227 Lung cancer diagnosis at emergency admission – How does Dorset compare?
Authors: C Bradley, E Harvey, N Ranaweera
Journal: Thorax (2015)

<h3>Introduction</h3> Survival for lung cancer patients in the UK is worse than in comparable countries, at least partly because they present with more advanced disease.<sup>1</sup> Recent data suggest that rural residence is associated with an increased risk of early death in lung cancer.<sup>2</sup> As our region encompasses rural areas, we investigated rates of emergency admission at the three major hospitals in our region and factors which may lead to this. <h3>Methods</h3> We retrospectively identified new presentations of lung cancer as emergencies from August to October 2014. We gathered patient demographics, mortality and GP presentation data and compared them with local lung cancer database data for the same time period. <h3>Results</h3> We identified 41 new lung cancer diagnoses in this period, from a total of 119 new diagnoses. This gives an emergency diagnosis rate of 34.5%, comparable to national figures of 39%.<sup>1</sup> However, there was significant variation (21–43%) between the three sites. When analysed by gender, only 30% of male diagnoses were made at emergency presentation, compared with 41% of females. Unfortunately our sample size was not large enough to demonstrate statistical significance (p = 0.22). GP data were available for 28 patients, of whom 17 had reported symptoms to their GP. The median duration between first reporting symptoms to the GP and being admitted as an emergency was only 4 days. As expected, staging in emergency patients was significantly higher than in those diagnosed as outpatients (Figure 1, ✻ indicates p &lt; 0.001). Mortality at 3 months was comparable: 56% compared with 13% (p &lt; 0.001). <h3>Conclusions</h3> Emergency presentation data for our region are comparable with national figures, with comparable mortality. Further examination of variability in admission rates between our hospitals, and possible gender inequality, could suggest future avenues to improve early lung cancer diagnosis. <h3>References</h3> 1 Walters S, Maringe C, Coleman MP, <i>et al</i>. Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study 2004-2007. <i>Thorax</i> 2013;<b>68</b>:551–564 2 O’Dowd EL, McKeever TM, Baldwin DR, <i>et al</i>. What characteristics of primary care and patients are associated with early death in patients with lung cancer in the UK? <i>Thorax</i> 2015;<b>70</b>:161–168
Selective Inhibition of Histone Deacetylase 6 (HDAC6) and HDAC3 As a Novel Therapeutic Strategy in Mantle Cell Lymphoma (MCL)
Authors: Fengdong Cheng, Bing Xia, Eva Sahakian, Tint Lwin, Hongwei Wang, Limin Xing, Bijal D. Shah, Patricio PerezVillarroel, Maritza LienlafMoreno, Yizhuo Zhang, Steven N Quayle, Simon S Jones, Javier Pinilla-Ibarz, Alejandro Villagra, Eduardo M. Sotomayor, Jianguo Tao
Journal: Blood (2014)
Cloning of PRV-1, a novel member of the uPAR receptor superfamily, which is overexpressed in polycythemia rubra vera
Authors: Snežana Temerinac, Steffen Klippel, Elisabeth Strunck, Sabine Röder, Michael Lübbert, Winand Lange, Marc Azemar, Gerold Meinhardt, Hans-Eckart Schaefer, Heike L. Pahl
Journal: Blood (2000)
IL-33 promotes food anaphylaxis in epicutaneously sensitized mice by targeting mast cells
Authors: Claire Galand, Juan Manuel Leyva-Castillo, Juhan Yoon, Alex Han, Margaret S. Lee, Andrew N.J. McKenzie, Michael Stassen, Michiko K. Oyoshi, Fred D. Finkelman, Raif S. Geha
Journal: Journal of Allergy and Clinical Immunology (2016)
Case 32-2008
Authors: James G.H. Dinulos, Artur Zembowicz
Journal: New England Journal of Medicine (2008)

A 10.8-year-old girl was seen in the pediatric dermatology clinic because of recurrent oral ulcers and cutaneous bullae since 2 years of age. White lesions in the mouth and vesicles and bullae on the dorsal and plantar surfaces of the feet, the knees, and the hands that ulcerated and became painful occurred at intervals of 3 to 4 months, lasted 4 days to 2 weeks, and resolved without scarring. Biopsy of a lesion 2 years earlier was reported to show features of epidermolysis bullosa. A diagnostic procedure was performed.
Food Sensitivity in 100 Asthmatic Children
Authors: Lewis Webb Hill
Journal: New England Journal of Medicine (1948)

THAT food can cause asthma in children is a fact beyond dispute. The frequency of this sensitivity, as well as its relative importance to recurrent respiratory infection, sensitization to pollens and other environmental allergens, is an entirely different question, concerning which there is considerable difference of opinion.An example of the way allergy is not infrequently treated is provided by the history of an asthmatic child of five years who was recently seen. She had previously been treated in another city and brought with her a typed list, bound in the form of a small book, of the foods that . . .
Case 20-1976
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, Jerome P. Kassirer, Robert T. McCluskey
Journal: New England Journal of Medicine (1976)

Presentation of CaseA 19-year-old man was admitted to the hospital for a second renal transplant.He was well until the age of 14 years, when the nephrotic syndrome developed. Prednisone, 60 mg daily, was given. The edema improved, but the proteinuria increased over the ensuing six months to a level of excretion of 12 to 14 g daily. At that time the urine gave a + + + + test for protein, and the sediment contained 10 red cells per high-power field, with fatty and waxy casts. The urea nitrogen was 20 mg, the creatinine 0.9 mg, the complement . . .
The clinical impact and prognostic value of 18F-fluorodeoxyglucose PET/CT in the initial staging non-small cell lung cancer at MD Anderson Cancer Center.
Authors: Satoshi Takeuchi, Benjapa Khiewvan, Stephen Swisher, Eric Rohren, Homer A. Macapinlac
Journal: Journal of Clinical Oncology (2013)

11079 Background: 18 F-fluorodeoxyglucosePositron Emission Tomography/Computed Tomography (FDG-PET/CT) has an important role for Non-Small Cell lung cancer (NSCLC) management, especially in staging. Our objective was to assess stage migration, the clinical impact, and prognostic value of PET/CT in patients with NSCLC at MD Anderson Cancer Center (MDACC). Methods: We retrospectively reviewed the database from MDACC, and identified 729 NSCLC patients referred for staging between 2006 and 2011. Stage was classified using TNM classification. FDG-PET/CT and conventional imaging staging were compared with all-cause mortality and the survival rates of the respective clinical stage. The management impact of FDG-PET/CT was determined based on conventional imaging and PET/CT management plans. A change in stage was confirmed by histopathology and/or further imaging. Results: We identified 598 NSCLC patients with FDG-PET/CT and conventional imaging performed. FDG-PET/CT changed stage in 28.1 % (16.4 % upstaged, 11.7 % downstaged). Based on FDG-PET/CT, treatment plans were modified in 38 % of patients. Median progression free survival (PFS) and overall survival (OS) was significantly worse in patients with management impact of FDG-PET/CT than patients without impact (PFS, 24.9 v 60.6 months, P &lt; 0.001; OS, 66.7 v 115.9 months, P &lt; 0.001). Multivariate analysis showed that the impact of FDG-PET/CT impact on management was an independent prognostic factor for DFS (hazard ratio [HR] = 2.08; 95 % CI, 1.63 to 2.65; P &lt; 0.001) and OS (HR = 2.16; 95 % CI, 1.56 to 2.99; P &lt; 0.001). Stage migration from stage I (40/249 patients) showed worse outcome than those without change (PFS, 21.0 v 60.0 months, P &lt; 0.001; OS, 64.7 v 115.9 months, P = 0.003). Conclusions: FDG-PET/CT has major role in NSCLC management. The added staging information provided by FDG-PET/CT as compared to conventional imaging resulted in a change in management in more than one third NSCLC patients. FDG-PET/CT is also a powerful tool for outcome prediction. Even in patients diagnosed as stage I by conventional method, FDG-PET/CT at initial diagnosis may have an impact on survival.
“We Don't Carry That” — Failure of Pharmacies in Predominantly Nonwhite Neighborhoods to Stock Opioid Analgesics
Authors: R. Sean Morrison, Sylvan Wallenstein, Dana K. Natale, Richard S. Senzel, Lo-Li Huang
Journal: New England Journal of Medicine (2000)

We have observed that many black and Hispanic patients receiving palliative care at a major urban teaching hospital are unable to obtain prescribed opioids from their neighborhood pharmacies. In this study, we investigated the availability of commonly prescribed opioids in New York City pharmacies.
The Effect of Cessation and Resumption of Moderate Alcohol Intake on Serum High-Density-Lipoprotein Subfractions
Authors: William L. Haskell, Carlos Camargo, Paul T. Williams, Karen M. Vranizan, Ronald M. Krauss, Frank T. Lindgren, Peter D. Wood
Journal: New England Journal of Medicine (1984)

High-density lipoproteins (HDL) in plasma may be divided into two subfractions: less dense HDL2, the concentration of which appears to be negatively associated with coronary heart disease, and more dense HDL3, which is reportedly unrelated to coronary disease. Alcohol consumption correlates with both reduced coronary heart disease and increased plasma HDL cholesterol concentrations; however, the relation of moderate alcohol intake to HDL2 and HDL3 is obscure. To study the effect of alcohol on these HDL subfractions, we randomly assigned 24 men who were moderate drinkers to an abstention group (n = 12) or a control drinking group (n = 12). After six weeks, concentrations of HDL cholesterol and HDL3 mass were decreased in abstainers but not in drinkers (P≤0.05), whereas HDL2 mass was unchanged. Resumption of drinking increased the levels of HDL cholesterol and HDL3 mass (P≤0.05) without affecting HDL2 mass. These data suggest that the association of alcohol with coronary disease is not mediated by increases in plasma HDL2 levels. Furthermore, the HDL3 fraction may not be "inert" with respect to coronary heart disease, or the association of alcohol with coronary disease may operate through mechanisms unrelated to HDL. (N Engl J Med 1984;310:805–10.)
Treatment patterns in high risk and metastatic melanoma: Evidence from linked electronic medical records and administrative claims data
Authors: S. Kotapati, K. L. Davis, D. Mitra, U. Iloeje
Journal: Journal of Clinical Oncology (2008)

17540 Background: Treatment patterns in melanoma have not been widely examined using retrospective data from real-world practice settings. Our objective was to analyze electronic medical records (EMR) linked with administrative claims data to document treatment patterns in a population with high-risk (stage IIB/C or III) or metastatic (stage IV) malignant melanoma. Methods: Data were acquired from Convergence CT, a company that links longitudinal electronic medical records and claims data from large physician practices, clinics, ambulatory centers, and hospitals in the US. Subjects with ≥1 diagnosis of malignant melanoma (ICD-9 172.xx, 173.xx, V10.82) between 7/1/03 and 11/30/06 and a pathology-confirmed disease stage of IIB/C, III, or IV were selected. Additional stage IV patients were identified based on evidence of a subsequent ICD-9 code (197.xx, 198.xx) for secondary metastases. Prevalence of four major therapeutic options (surgery, radiation, chemotherapy, immunotherapy) was documented from the index stage IIB or higher diagnosis until end of follow-up as defined by patients’ last observed record in the database. Results: 268 subjects were identified for inclusion. Stage distribution was: IIB/C (18%); III (21%); IV (61%). 58% were ≥65 years of age, 62% were male, and median follow-up was 10 months. Surgery was the predominant treatment in stage IIB/C and III (received by >80% of subjects), but was seen in only 38% of stage IV patients. Radiation therapy was most prevalent (29%) in stage IV patients, and was seen in only 12% and 16% of stage IIB/C and III cases, respectively. Chemotherapy was most prevalent in subjects with stage III or IV disease (27% and 31%, respectively), but was uncommon in stage IIB/C (12% of cases). Across all subjects receiving chemotherapy, dacarbazine and cisplatin were the most prevalent agents observed. Immunotherapy was most prevalent in subjects with stage III melanoma (20%), but was uncommon in stages IIB/C (8%) and IV (7%). Among subjects receiving immunotherapy, interferon was the predominant agent observed. Conclusions: A small proportion of patients with high risk or metastatic melanoma receive systemic treatment. These findings demonstrate an unmet treatment need in this population. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Bristol-Myers Squibb Bristol-Myers Squibb Bristol-Myers Squibb
Optic Neuritis Due to<i>Bartonella henselae</i>Infection
Authors: Arnd M Herz, J Michael Lahey
Journal: New England Journal of Medicine (2004)

14-year-old girl presented with worsening headaches, uni lateral decreased visual acuity (20/20 in the right eye and 5/200 in the left eye), and ocular pain in the left eye. The results of a neurologic examination were unremarkable. Contrast-enhanced computed tomography of the head and a lumbar puncture showed no abnormalities. A retinal examination showed bilateral optic-disk elevation with edema, lipid exudates that formed a macular star, and an area of choroiditis surrounded by serous fluid. The results of serologic evaluation for syphilis and Lyme disease and of a skin test for tuberculosis were negative. Indirect immunofluorescence assays showed that the titers of antibodies against Bartonella henselae were 1:160 or more for IgM and 1:512 or more for IgG. This constellation of findings has been called Leber’s idiopathic stellate neuroretinitis, according to a description by Theodor Leber in 1916. Modern serodiagnostic testing has shown that in many cases the findings are due to B. henselae, the gram-negative bacterium that causes cat scratch disease. The patient owned a cat but did not recall a specific scratch. Pharmacologic treatment of optic neuritis due to B. henselae infection in immunocompetent hosts is of uncertain value; the symptoms can resolve spontaneously, and controlled studies are lacking. Nonetheless, our patient was treated with prednisone and azithromycin. Six months later, the lipid exudates in the macula had been reabsorbed, and normal vision (20/20 in the right eye and 20/25 in the left eye) had returned.
The Prognosis of Chronic Ulcerative Colitis in Children
Authors: William M. Michener, Robert P. Gage, William G. Sauer, Gunnar B. Stickler
Journal: New England Journal of Medicine (1961)

THE controversy concerning the treatment for chronic ulcerative colitis has never ended. The question whether surgical or medical management prolongs these patients' lives with greater certainty has never been answered. The problem is particularly difficult in children. Complete colectomy is a formidable procedure, and problems associated with permanent ileostomy are often difficult. There is also the very real hazard that complicating carcinoma may develop, and in addition the survival period from the disease is variable.In 1959 Rosenqvist and his associates1 reported their experience with 150 cases of chronic ulcerative colitis in their pediatric department. They stated that cancer of . . .