tbuckley/cabot-search huggingface dataset:
Chemotherapy toxicity in gynecologic cancer patients with a BSA &gt; 2 m<sup>2</sup>: The experience from the program in Women's Oncology/Brown Medical School
Authors: J. R. Schwartz, B. Toste, D. S. Dizon
Journal: Journal of Clinical Oncology (2008)

5570 Background: Despite the increasing prevalence of obesity and its association with the risk of cancers, there is no consensus on how to appropriately dose chemotherapy in these patients. While some have a practice of capping doses at a maximum BSA of 2 m2 in obese patients to prevent toxicity, it is unknown whether dosing patients at their actual body weight (ABW) really results in an excess of toxicity. At our institution, patients are dosed by ABW unless on a protocol mandating otherwise. The aim of this evaluation is to compare the differences in toxicity between patients with a BSA > 2 m2 dosed based on their ABW, versus those dosed with a capped BSA at 2 m2. Methods: In this retrospective study, patients with a BSA >2 treated with paclitaxel (T) and carboplatin (C) for a gynecologic malignancy between 1/98 to 7/07 were identified through the chemotherapy database. Records were reviewed for patient age, diagnosis and stage, BSA, chemotherapy doses, toxicities on treatment graded by NCI-CTC 3.0, dose delays (DD), reductions (DR), or discontinuations (DC.) Characteristics were compared using Fisher's exact test. Results: We identified 59 women (mean age 58, range 40–82) with ovarian (n=49) or endometrial cancer (n= 10) who received adjuvant T/C and had a BSA > 2 m2. Patients were considered capped based on dose of T, and 9/59 patients had doses capped at BSA = 2 m2 while 50/59 were dosed by ABW (non-capped.) We found no difference in toxicity rates based on dosing (see table). Conclusions: Obese patients with a BSA > 2 m2 dosed at ABW in our population do not experience an excess of chemotherapy related toxicity, and do not seem to have increased toxicity as compared to published data sets of the T/C regimen with doses capped at BSA = 2 m2. A priori dose reduction or dose capping in obese patients may lead to suboptimal treatment, and it not recommended. Capped (n=9) Non-capped (n=50) p T- DD 3/9 (33%) 12/50 (24%) >0.5 T-DR 3/9 (33%) 7/50 (14%) >0.1 T-DC 0/9 8/50 (16%) >0.1 Neuropathy Gr 3/4 1/9 (11%) 3/50 (6%) 0.49 Neutropenia Gr 3/4 1/9 (11%) 1/50 (2%) >0.1 Nausea Gr 3/4 1/9 (11%) 2/50 (4%) >0.1 Hepatic Gr 3/4 1/9 (11%) 0/50 >0.1 Febrile Neutropenia 1/9 (11%) 2/50 (4%) >0.1 Leukopenia, thrombocytopenia, anemia Gr 3/4 0/9 0/50 NA No significant financial relationships to disclose.
Three Complementary Pathways Characterize the Suppressive Properties of Epit-Induced Tregs
Authors: Benjamin Pelletier, Lucie Mondoulet, Emilie Puteaux, Mélanie Ligouis, Véronique Dhelft, Camille Plaquet, Christophe Dupont, Pierre-Henri Benhamou
Journal: Journal of Allergy and Clinical Immunology (2016)
S4 Pulmonary Artery Pressure and Exercise Tolerance in Patients with Pulmonary Arteriovenous Malformations
Authors: T Hall, H Tighe, K Hornby, M Park, V Santhirapala, K Murphy, JE Jackson, L Howard, CL Shovlin
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> Pulmonary arteriovenous malformations (PAVMs) provide direct communications between pulmonary arteries and pulmonary veins, bypassing the pulmonary capillary bed. Greater improvements in exercise capacity following embolization therapy have been reported by PAVM patients with raised pulmonary artery pressures (PAPs). The objective of this study was to test the hypothesis that lower PAPs are associated with greater exercise capacity in hypoxaemic PAVM patients. <h3>Methods</h3> Patients attending our tertiary care institution were recruited at the time of PAVM assessment or embolization. Pulmonary artery pressure measurements were obtained by right-heart catheterisation immediately prior to contrast injection and embolization. For both patients and healthy controls, incremental cardiopulmonary exercise tests were performed seated on an adjustable cycle ergometer (MasterScreen CPX; Via Sprint). <h3>Results</h3> A total of 19 patients and 26 controls were recruited for the study. Significantly lower arterial oxygen saturations (median 91% vs. 98%, p &lt; 0.0001) and end-tidal PCO<sub>2</sub> levels were demonstrated in patients alongside significantly raised V[dot]e/V[dot]CO<sub>2</sub> slopes (32.2 vs. 24.1 L/min/L/min, p = 0.0003). The regression models that best described peak oxygen uptake (V[dot]O<sub>2</sub>) as a percent of predicted values, were similar between PAVM patients and controls. Surprisingly, despite the differences in SaO<sub>2</sub> between PAVM and control subjects, the addition of SaO<sub>2</sub> to the final models did not improve the significance of the final model nor did it raise the adjusted-r<sup>2 </sup>value. For the PAVM subgroup, the median mean PAP was 14.5 mmHg, (IQR 12.5–16.0; range 6–22). Univariate and multiple regression analyses demonstrated no significant relationships between systolic, diastolic or mean PAPs, and peak exercise parameters. <h3>Conclusions</h3> This study has demonstrated in a population of PAVM patients with hypoxaemia and PAPs essentially within the normal range, that PAP does not have a major influence on peak exercise capacity.
“Frog Sign” in Atrioventricular Nodal Reentrant Tachycardia
Authors: Fernando M Contreras-Valdes, Mark E Josephson
Journal: New England Journal of Medicine (2016)

An 83-year-old man was evaluated for frequent palpitations. During an episode, examination of the neck revealed rapid and regular pulsations with bulging of the internal jugular veins, shown in a video. A 12-lead electrocardiogram showed a regular, narrow-complex tachycardia.
Epidemic Giardiasis at a Ski Resort
Authors: Gordon T. Moore, W. Michael Cross, David McGuire, Cecil S. Mollohan, Neva N. Gleason, George R. Healy, Ladene H. Newton
Journal: New England Journal of Medicine (1969)

Abstract An outbreak of protracted, intermittent diarrhea, often associated with symptoms suggesting malabsorption, occurred in persons who vacationed in Aspen, Colorado, during the 1965–66 ski season. A survey of 1094 skiers showed that the characteristic illness had developed in at least 11.3 per cent. The association of Giardia lamblia with the illness, the absence of other pathogens, and the response to treatment suggest that G. lamblia was the agent responsible for the illness. Environmental studies carried out after the epidemic demonstrated contamination of well water by sewage leaking from defective pipes passing near wells. G. lamblia cysts were found in the sewage from the defective pipes and in stools from 6.9 per cent of the permanent residents of the city living in the area served by the defective sewage lines. The findings are consistent with a hypothesis of water-borne spread of giardiasis.
Decreased Erythropoietin Response in Patients with the Anemia of Cancer
Authors: Carole B. Miller, Richard J. Jones, Steven Piantadosi, Martin D. Abeloff, Jerry L. Spivak
Journal: New England Journal of Medicine (1990)

Patients with solid tumors are often anemic even before they undergo cytotoxic therapy. Since the cause of the anemia of cancer is unknown, we examined the possible role of erythropoietin. Using a sensitive radioimmunoassay, we determined serum immunoreactive erythropoietin levels in 81 anemic patients with solid tumors. For any given degree of anemia, the serum concentration of immunoreactive erythropoietin was lower in this group of patients than in a group of control patients with iron-deficiency anemia (P = 0.0001). Furthermore, the expected inverse linear relation between serum levels of immunoreactive erythropoietin and of hemoglobin was absent in the group with cancer. The erythropoietin response was further decreased in patients receiving chemotherapy; it was not influenced by the presence or absence of cisplatin in the treatment regimen. The inability of the patients with cancer to produce erythropoietin was not absolute; if they had hypoxemia, adequate erythropoietin production was restored. We conclude that erythropoietin levels are inappropriately low in anemia associated with cancer, and that erythropoietin deficiency may contribute to the development of this form of anemia. Treatment of the anemia of cancer with erythropoietin may be of value.
Pregnenolone in Rheumatoid Arthritis
Authors: Jack R. Dordick, Mortimer E. Ehrlich, Stuart Alexander, Milton Kissin
Journal: New England Journal of Medicine (1951)

PREGNENOLONE (Δ 5-pregnen-3βol-20-one) has recently been recommended as effective in the treatment of rheumatoid arthritis.1 2 3 4 5 Since Cortisone (17 hydroxy-11 dehydrocorticosterone) and ACTH (adrenocorticotrophic hormone) are scarce, expensive and not free from side effects, interest in pregnenolone is growing. Pregnenolone is freely available, may be given by mouth and is relatively inexpensive. Some of the claims that have appeared suggest that this drug may be used in place of Cortisone or ACTH. Pregnenolone is a steroid hormone that resembles Cortisone in its structural formula. It is apparently a precursor of many related steroids,5 and has been derived synthetically from the degradation . . .
Effect of IGF-1R inhibitor BMS-754807 on tumor glucose metabolism and proliferation in Sal-IGF xenografts by FDG and FLT- PET imaging
Authors: P. L. Chow, C. P. Ho, D. Kan, R. M. Attar, F. Graf Finckenstein, J. M. Carboni, S. M. Galbraith, F. Y. Lee, M. M. Gottardis, B. S. Krishnan
Journal: Journal of Clinical Oncology (2009)

e14501 Background: The type 1 insulin-like growth factor receptor (IGF-1R) plays a critical role in mitogenesis and survival in a variety of human tumor cells. IGF-1R is also closely related to the insulin receptor (IR). It is becoming increasingly evident that stimulation of IR or IR/IGF-1R hybrid receptors by insulin or IGF-1/2 may contribute to cancer growth, suggesting that both IGF-1R and IR may be targets for cancer therapy. BMS-754807 (‘807) is an oral IGF-1R tyrosine kinase antagonist under development that also blocks IR activity. This study explores the feasibility of fluorodeoxyglucose (FDG) and fluorothymidine (FLT) positron emission tomography (PET) as pharmacodynamic imaging biomarkers in a xenograft model. Methods: Mice were implanted with fragments of Sal-IGF, a transgenic salivary gland tumor expressing constitutively active IGF-1R. Once tumors reached desired size, the mice were divided into 3 treatment groups (vehicle, 6.25 mg/kg ‘807, &amp; 50 mg/kg ‘807 on days 1–4). FDG-PET scans were performed on day -2 (prior to treatment), days 1 &amp; 2 (max/min concentrations post day 1 dose), and days 4 &amp; 5 (max/min day 4 dose). FLT-PET scans were performed on days -2, 2 (min day 1 dose), &amp; 5 (min day 4 dose). Results: With FDG-PET imaging, a 66% reduction (P&lt;0.05, paired t-test) in tumor SUV mean was observed at the end of the 50 mg/kg therapy (day 4) and sustained for 24h (day 5) with a concomitant reduction of 37% in tumor burden by day 5 (P&lt;0.05). FLT-PET studies demonstrated a 45% reduction (P&lt;0.05) in tumor SUV mean observed 24h after the end of 50 mg/kg therapy (day 5) with a concomitant reduction of 50% in tumor burden (day 5, P&lt;0.05). Conclusions: Correlation with tumor growth inhibition suggests feasibility of FDG- PET despite IR blockade. These results support the use of both FDG and FLT PET imaging in clinical trials with ‘807. [Table: see text]
The Efficacy of a<i>Salmonella typhi</i>Vi Conjugate Vaccine in Two-to-Five-Year-Old Children
Authors: Feng Ying C. Lin, Vo Anh Ho, Ha Ba Khiem, Dang Duc Trach, Phan Van Bay, Tran Cong Thanh, Zuzana Kossaczka, Dolores A. Bryla, Joseph Shiloach, John B. Robbins, Rachel Schneerson, Shousun C. Szu, Mai Ngoc Lanh, Steven Hunt, Loc Trinh, Jeanne B. Kaufman
Journal: New England Journal of Medicine (2001)

Typhoid fever is common in developing countries. The licensed typhoid vaccines confer only about 70 percent immunity, do not protect young children, and are not used for routine vaccination. A newly devised conjugate of the capsular polysaccharide of Salmonella typhi, Vi, bound to nontoxic recombinant Pseudomonas aeruginosa exotoxin A (rEPA), has enhanced immunogenicity in adults and in children 5 to 14 years old and has elicited a booster response in children 2 to 4 years old.In a double-blind, randomized trial, we evaluated the safety, immunogenicity, and efficacy of the Vi-rEPA vaccine in children two to five years old in 16 communes in Dong Thap Province, Vietnam. Each of the 11,091 children received two injections six weeks apart of either Vi-rEPA or a saline placebo. Cases of typhoid, diagnosed by the isolation of S. typhi from blood cultures after 3 or more days of fever (a temperature of 37.5 degrees C or higher), were identified by active surveillance over a period of 27 months. We estimated efficacy by comparing the attack rate of typhoid in the vaccine group with that in the placebo group.S. typhi was isolated from 4 of the 5525 children who were fully vaccinated with Vi-rEPA and from 47 of the 5566 children who received both injections of placebo (efficacy, 91.5 percent; 95 percent confidence interval, 77.1 to 96.6; P<0.001). Among the 771 children who received only one injection, there was 1 case of typhoid in the vaccine group and 8 cases in the placebo group. Cases were distributed evenly among all age groups and throughout the study period. No serious adverse reactions were observed. In all 36 children studied four weeks after the second injection of the vaccine, levels of serum IgG Vi antibodies had increased by a factor of 10 or more.The Vi-rEPA conjugate typhoid vaccine is safe and immunogenic and has more than 90 percent efficacy in children two to five years old. The antibody responses and the efficacy suggest that this vaccine should be at least as protective in persons who are more than five years old.
Management of Patients With Lung Cancer and Poor Performance Status
Authors: Ajeet Gajra, Alissa S. Marr, Apar Kishor Ganti
Journal: Journal of the National Comprehensive Cancer Network (2014)

Patients who are able to care for themselves but are unable to perform most work-related activities are considered to have a poor performance status (PS). Individuals who fulfill these criteria constitute a significant proportion of all patients with lung cancer. Patients with lung cancer and a poor PS, irrespective of age, have an increased incidence of adverse effects with therapy and poorer outcomes. Thus, although these individuals must be treated differently, data on optimal approaches for these patients are lacking, because this cohort is underrepresented in conventional clinical trials due to enrollment restrictions. This article presents the available evidence on the treatment of this group of patients with lung cancer. Although patients with PS 2 have worse overall outcomes than those with good PS, a selected proportion may still benefit from standard therapy. Further trials are needed to identify optimal strategies to treat this group of patients with lung cancer.
Nature and Nurture
Authors: Harry Harris
Journal: New England Journal of Medicine (1977)

...our genes cannot make bricks without straw. The individual differences which men and women display are partly due to the fact that they receive different genes from their parents and partly due to the fact that the same genes live in different houses.*We are all well aware of human individuality. We differ one from another in our physical characteristics, our physiognomies, our temperaments and our aptitudes. In fact, we have no difficulty in telling one another apart. We also differ from one another in whether we suffer from particular diseases or other abnormalities. But we know that these individualities, . . .
Early Detection and Biomarkers in Pancreatic Cancer
Authors: David E. Misek, Tasneem H. Patwa, David M. Lubman, Diane M. Simeone
Journal: Journal of the National Comprehensive Cancer Network (2007)

Major advances in cancer control will be greatly aided by early detection for diagnosing and treating cancer in its preinvasive state before metastasis. Unfortunately, for pancreatic ductal adenocarcinoma (PDAC), which is the fourth leading cause of cancer-related death in the United States, effective early detection and screening are currently not available and tumors are typically diagnosed at a late stage, frequently after metastasis. Partly because of low sensitivity/specificity, existing biomarkers such as CA19-9 are not adequate as early detection markers of pancreatic cancer. Thus, a great need exists for new biomarkers for pancreatic cancer. This article focuses on recent developments in the identification of new serum protein biomarkers that are useful in the early detection of PDAC.
Randomized Phase Ii Study of Cpt-11 Vs Ptx Vs Each Combination Chemotherapy with S-1 in Patients with Advanced Gastric Cancer Refractory to S-1 or S-1 Plus Cddp (Ogsg0701)
Authors: J. Matsuyama, H. Imamura, M. Gotoh, Y. Kimura, S. Ueda, K. Nishikawa, N. Sugimoto, J. Fujita, T. Tamura, N. Fukushima, D. Sakai, T. Shimokawa, Y. Kurokawa, T. Satoh, T. Tsujinaka, H. Furukawa
Journal: Annals of Oncology (2014)
Case 1-1994
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Michael P. O'Leary, Anthony R. Mattia
Journal: New England Journal of Medicine (1994)

Presentation of CaseA 27-year-old woman was admitted to the hospital because of secondary infertility and a bladder mass.The patient was a native of Zimbabwe. She resided in an urban area and frequently visited relatives in the countryside, where she swam in streams as a child. The patient was in good general health and had delivered one full-term infant by emergency cesarean section for fetal distress six years earlier; her son was well. During that pregnancy an ultrasonographic examination of the abdomen and pelvis was reported to show a “problem” with her bladder, which was considered not serious and . . .
Extraosseous Osteosarcoma of the Liver Demonstrated on 18F-FDG PET/CT Imaging
Authors: Lei Jiang, Lijuan Luan, Hong Yun, Yingyong Hou, Hongcheng Shi
Journal: Clinical Nuclear Medicine (2016)

A 66-year-old woman presented with abdominal pain for 1 month. Ultrasonography displayed multiple hepatic masses that were thought as metastases. FDG PET/CT was performed to assess the nature of these masses and to search primary malignancy. The images showed elevated FDG activity in the partially calcified hypodense lesions in the liver without abnormality elsewhere. The lesions were subsequently confirmed as primary extraosseous osteosarcoma in the liver. The patient received liver transplantation. Six months later, her CA-125 was significantly increased. The follow-up PET/CT scan demonstrated the widespread metastases.
Inapparent Congenital Cytomegalovirus Infection
Authors: Mary L. Kumar, George A. Nankervis, Eli Gold
Journal: New England Journal of Medicine (1973)

A follow-up study on 15 children with congenital cytomegalovirus infection was undertaken to assess physical and mental development in their first four years of life. Infection was inapparent at birth in all children except one. Assessment included a complete physical examination, psychologic testing and virologic studies. None of the children who appeared normal at birth and at one year manifested any late sequelae at four years of age. The mean IQ of the infected children was 85.2, whereas that of the eight controls was 86.5. Eleven of the 15 children (73 per cent) were excreting virus; nine of these had detectable cytomegalovirus complement-fixing antibody. All seven males tested had viruria, as compared to four out of eight females (p<0.05). Complement-fixation titers in virus-negative children were not significantly different from titers in virus-positive children. (N Engl J Med 288:1370–1372, 1973)
Common over-the-counter medicines are linked to cognitive impairment in elderly people, shows study
Authors: Susan Mayor
Journal: BMJ (2016)

Anticholinergic drugs found in many commonly used over-the-counter medicines, such as night time cold remedies, are associated with brain scan changes linked to cognitive impairment in older people, a study in JAMA Neurology has shown.1

Previous research had found that anticholinergic drugs were associated with an increased risk of cognitive impairment and dementia. Researchers investigated the potential mechanism of this link by analysing brain scans in 451 …
Getting the Diagnosis Right in NHL: Role of Immunohistochemistry and Molecular Diagnostic Testing
Authors: Julie Teruya-Feldstein
Journal: Journal of the National Comprehensive Cancer Network (2008)

Challenges in diagnosing lymphoid neoplasms include their complex heterogeneity and the fact that approximately 40 or more diseases exist. Immunophenotyping and molecular diagnostics have made important contributions to precise and accurate diagnoses. Strong interactions with clinical colleagues and meticulous attention at the microscope by expert hematopathologists are important in making a correct diagnosis. Awareness of the literature and interactions with research colleagues, including clinical, basic, and translational scientists, have expanded understanding of these complex diseases, providing prognostic information that can ultimately assist in appropriate clinical management of patients or development of new targeted therapies. This article reviews recent published immunophenotypic diagnostic and biomarker studies, discusses molecular diagnostic expression profiling studies of the more common entities encountered in daily clinical practice, and references published summaries from the combined Society of Hematopathology and European Association for Haematopathology Workshops. A precise lymphoma diagnosis therefore involves integration of clinical information, morphologic architectural and cytologic patterns, immunohistochemistry, cytogenetics, and molecular biology, to ultimately allow identification of specific diseases, thereby implying prognostic significance and potential therapeutic targets.
The Cost of Initial Care for Medicare Patients With Advanced Ovarian Cancer
Authors: Renata R. Urban, Hao He, Rafael Alfonso-Cristancho, Melissa M. Hardesty, Barbara A. Goff
Journal: Journal of the National Comprehensive Cancer Network (2016)

In preparation for payment reform, we evaluated Medicare payments for the initial treatment of patients with advanced ovarian cancer and assessed factors responsible for variation.Using the linked SEER-Medicare database, we identified a cohort of 9,491 women aged 65 years or older with stage III/IV epithelial ovarian cancer diagnosed between 1995 and 2007. Diagnostic and procedural codes specific to the care of ovarian cancer were used to estimate total medical costs for the treatment of ovarian cancer. Costs were adjusted for geography and for inflation to the 2009 US dollar. NCCN Guideline-consistent care was defined as surgery and 6 cycles of chemotherapy. A generalized linear regression was performed to assess factors associated with variability in cost.The mean total payment per patient in the initial treatment period was $65,908 (range of means, $30,745-$96,360). Increasing medical comorbidity, use of PET/CT, surgical complications, and readmissions were associated with increased costs. Treatment with NCCN Guideline-consistent surgery and chemotherapy had a mean annual cost of $85,987 compared with $89,149 for non-NCCN Guideline-consistent treatment with surgery and chemotherapy. The cost of surgery and chemotherapy that was not consistent with NCCN Guidelines was approximately $7,000 more than the cost of therapy that was consistent (P<.001) CONCLUSIONS: The financial burden of caring for patients with ovarian cancer is substantial. Treatment that is consistent with NCCN recommendations for treating advanced ovarian cancer, which is shown to have improved outcomes, is not associated with higher cost.