bluuebunny/crossref_metadata_2025_split huggingface dataset:
Noninvasive ventilation for chest wall and neuromuscular disorders
Authors: Shneerson J.M. , Simonds A.K. 
Published: October 2002

Neuromuscular and chest wall disorders are individually uncommon but together form an important group of conditions that can lead to chronic ventilatory failure. This is best recognised in scoliosis, kyphosis, following a thoracoplasty, in muscular dystrophies, such as Duchenne muscular dystrophy (DMD), and myotonic dystrophy, after poliomyelitis and with motor neurone disease (amyotrophic lateral sclerosis).If bulbar function is impaired, tracheostomy ventilation may be required, but in other situations, noninvasive ventilation is preferable. Positive pressure techniques using nasal and face masks are usually the first choice, but negative pressure ventilation is an alternative.There are no randomised-controlled trials regarding the indications for initiating noninvasive ventilation, but this is usually provided if there are symptoms due to nocturnal hypoventilation or right heart failure in the presence of a raised carbon dioxide tension in arterial blood (Pa,CO2) either at night or, more usually, in the daytime as well. There is no evidence that “prophylactic” ventilatory support is of benefit if this is provided before ventilatory failure has appeared. Careful selection of patients is required, especially in the presence of progressive neuromuscular disorders such as DMD and motor neurone disease.There are no randomised-controlled trials concerning the outcome of noninvasive ventilation in these conditions, but studies have shown an improved quality of life, physical activity and haemodynamics, normalisation of blood gases and slight improvement in other physiological measures, such as the vital capacity and maximal mouth pressures. Survival in chest wall disorders is ∼90% at 1 yr and 80% at 5 yrs, and similar figures have been obtained in nonprogressive neuromuscular conditions. If, however, the underlying disorder is deteriorating, particularly if it involves the bulbar muscles, it may limit survival despite the provision of adequate noninvasive ventilatory support.
The role of supplemental oxygen during submaximal exercise in patients with cystic fibrosis
Authors: McKone E.F. , Barry S.C. , FitzGerald M.X. , Gallagher C.G. 
Published: October 2002

Repeated bouts of submaximal exercise are an important part of most pulmonary rehabilitation programmes. Patients with moderate-to-severe cystic fibrosis (CF) often demonstrate oxygen desaturation during submaximal exercise, which may limit their ability to participate in these programmes. This study examines whether arterial desaturation contributes to submaximal exercise limitation by testing whether supplemental O2improves submaximal exercise capacity.Eight patients with CF (mean forced expiratory volume in one second 41% predicted) each underwent two submaximal exercise tests on a bicycle ergometer at 80% of maximal workload. The two tests were identical except for the addition of supplemental O2(inspiratory O2fraction 39%) during one of the tests.Exercise duration was significantly longer in the supplemental O2studyversuscontrol (673±63 sversus835±99 s). Arterial O2saturation was also higher in the supplemental O2study than the control exercise test (96±0.3%versus86±1.5%). There was no statistical difference at end exercise between O2consumption, minute ventilation and heart rate. There was a significant relationship between improvement in exercise capacity and the amount of desaturation during the control exercise test.Results indicate that supplemental oxygen improves submaximal exercise capacity in patients with moderate-to-severe cystic fibrosis. Oxygen therapy may be an important intervention to improve participation and maximise the benefits of pulmonary exercise rehabilitation programmes.
The effect of postrehabilitation programmes among individuals with chronic obstructive pulmonary disease
Authors: Brooks D. , Krip B. , Mangovski-Alzamora S. , Goldstein R.S. 
Published: October 2002

The purpose of this study was to examine the effects of two postrehabilitation programmes on functional exercise tolerance and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD).Subjects with COPD (n=109) were randomised to receive either enhanced follow-up (EF) or conventional follow-up (CF). Subjects in the EF group attended a monthly support group and received a telephone call from a staff member at the midpoint (2 weeks) between their visits. Both groups had scheduled appointments with a physical therapist and physician at 3‐monthly intervals after discharge.Longitudinal data were recorded in 85 subjects (37 EF and 48 CF). Over the course of the study, there was no difference in distance walked in 6 min between the two groups but a significant difference for time and a group-time interaction. There was no difference in total chronic respiratory disease questionnaire score between groups at baseline or at any time interval despite a significant difference with time.There was a clear deterioration in functional exercise capacity and health-related quality of life after completion of respiratory rehabilitation but no difference between the groups.
Intravenous iloprost for treatment failure of aerosolised iloprost in pulmonary arterial hypertension: Table 1—
Authors: Hoeper M.M. , Spiekerkoetter E. , Westerkamp V. , Gatzke R. , Fabel H. 
Published: October 2002

Treatment with aerosolised iloprost, a prostacyclin analogue, has beneficial effects in patients with pulmonary arterial hypertension (PAH). It is unclear if patients, whose clinical condition deteriorates under treatment with aerosolised iloprost, benefit from switching to continuous intravenous iloprost.The current authors report on 16 patients with severe PAH who received continuous intravenous iloprost after primary or secondary failure of treatment with aerosolised iloprost. Determinants of efficacy were survival, New York Heart Association (NYHA) class, and walking distance in the 6‐min walk test.Of 93 patients with PAH treated with aerosolised iloprost, 16 required switching to intravenous iloprost for clinical deterioration. These patients had severe right heart failure with a cardiac index of 1.6±0.2 L·min−1·m−2and a mixed-venous oxygen saturation of 52±6%. Five of these patients showed no improvement and eventually died. Three patients had further deterioration in NYHA class and exercise capacity; two of them underwent lung transplantation; the third patient is still alive. Eight patients showed marked clinical improvement; one underwent lung transplantation and the others are currently alive and stable. In the latter group of patients, the walking distance in the 6‐min walk test increased from 205±94 to 329±59 m. It was not possible to identify clinical or haemodynamic factors that would predict whether switching from inhaled to intravenous iloprost would have a beneficial effect.In patients with pulmonary arterial hypertension who deteriorated while being treated with aerosolised iloprost, switching to continuous intravenous iloprost caused substantial improvement in exercise capacity in eight of 16 patients but could not prevent progression of pulmonary hypertension in the remaining eight patients. Since it was impossible to predict the individual effects of this approach, intravenous prostaglandin treatment should be considered in pulmonary arterial hypertension patients who deteriorate while receiving iloprost aerosol.
Persistent asthma: disease control, resource utilisation and direct costs
Authors: Van Ganse E. , Laforest L. , Pietri G. , Boissel J.P. , Gormand F. , Ben-Joseph R. , Ernst P. 
Published: October 2002

Despite evidence that adverse outcomes are less frequent when asthma management is optimised, the link between the level of control, disease severity and medical resource utilisation (MRU) is poorly documented. This relationship was investigated in a group of patients suffering from persistent asthma (Global Initiative for Asthma (GINA) ≥2) in France.In 1998 a computerised family practice database was used to identify asthma patients aged 17–50 yrs. Information from the database was complemented by a patient survey to retrospectively assess the level of asthma control and hospital contacts. Costs of MRU over a 12­month study period were related to demographics, medical history, asthma control, and doses of inhaled corticosteroids prescribed during the prestudy period.A review of the computerised medical database identified 1,038 adult patients with persistent asthma, who completed the survey questionnaire. Over a 12­month period, the mean cost of MRU was 549.8 E for well­controlled patients, 746.3 E per patient with moderate control, and 1,451.3 E per patient with poor control. Costs also increased significantly with age, access to free asthma care, comorbid conditions, asthma symptoms in the past year and whether inhaled corticosteroids had been prescribed before the study period.In patients with persistent asthma, large differences were observed in the use of medical resources according to control and severity. Therefore, if patients appropriately use prescribed control therapy, their use of medical resources may be reduced.
Assessment of Stroke Index Using Impedance Cardiography: Comparison with Traditional Vital Signs for Detection of Moderate Acute Blood Loss in Healthy Volunteers
Authors: Kosowsky Joshua M. , Han Jin H. , Collins Sean P. , McAfee Andrew T. , Storrow Alan B. 
Published: October 2002

AbstractObjectives:Impedance cardiography has been used to detect early hemorrhagic shock, but, to the best of the authors' knowledge, no previous study has looked at the test characteristics of bioimpedance‐derived hemodynamic parameters for the detection of a measured loss of blood volume. The authors set out to investigate the effect of controlled hemorrhage on stroke index (SI) using impedance cardiography, and to evaluate the performance of this test for moderate blood loss in comparison with the performance of traditional vital signs.Methods:Supine and standing measurements of SI were made using a thoracic electrical bioimpedance monitor in 197 healthy, adult volunteers before and after donation of a standard unit (500 mL) of whole blood. Pre‐ and post‐donation means for supine SI, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP), and for the postural changes in each of these measurements (▵SI, ▵HR, ▵SBP, ▵DBP), were compared using a paired‐sample, two‐tailed t‐test. For each term, receiver operating characteristic (ROC) curves were generated, treating pre‐ and post‐donation populations as independent. Areas under the ROC curves were compared using a method for correlated test result data.Results:Mean ± SD pre‐ and post‐donation values for SI were 47.0 ± 6.9 mL/m2and 43.9 ± 7.3 mL/m2, respectively (p < 0.0001). Mean pre‐ and post‐donation values for ▵SI were ‐7.7 ± 5.8 mL/m2and ‐9.0 ± 8.2 mL/m2, respectively (p = 0.02). For discriminating between pre‐ and post‐donation status, the areas under the ROC curves for SI and ▵SI were 0.62 and 0.58, respectively. In comparison, the areas under the ROC curves for HR, SBP, DBP, ▵HR, ▵SBP, and ▵DBP were 0.49, 0.61, 0.56, 0.82, 0.53, and 0.50, respectively. The area under the ROC curve for ▵HR was significantly greater than the area under any of the other curves (p < 0.0001).Conclusions:Moderate blood loss was associated with a decline in mean SI that was clearly detectable with impedance cardiography. However, as a test for moderate blood loss in this controlled setting, neither SI nor ▵SI performed better than traditional vital signs.
Perspectives on Practicing Procedures on the Newly Dead
Authors: Oman Kathleen S. , Armstrong John David , Stoner Martha 
Published: October 2002

AbstractInvasive procedures are commonly practiced and taught on newly deceased patients (the newly dead) in emergency and critical care settings. Justified by the claim of necessity for professional competence to provide lifesaving care, these procedures, commonly hidden from public and professional scrutiny, are frequently performed on the newly dead without consent from family or interested parties. Objective: To describe older adults' beliefs about practicing and teaching lifesaving procedures on the newly dead and their belief about the requirement for consent for these procedures. Methods: An exploratory, descriptive design used a seven‐item Likert‐type instrument with open‐ended questions to gather data from a convenience sample of 100 adults in two metropolitan cities. Results: The typical respondent was 74.5 years old (mean; range of 55‐95 years), female (71%), and married (44.8%) or widowed (36.5%). Most respondents were high school graduates (94%), and 63% had some level of college education. The majority of the sample was white (75%), they were predominately Protestant (40%), and 72% reported their health as good to excellent. Most study participants believed that practicing or teaching lifesaving skills on a newly dead body is acceptable (54%), and that provision for consent is necessary (80%). Planning to donate organs and preferring an autopsy were associated with agreeing that using the newly dead body for skill practice was acceptable; preferring cremation was related to believing that consent for skill practice on the newly dead was not necessary. Conclusions: The participants in this study value the use of the newly dead to practice and teach lifesaving skills, and believe that consent for this practice is necessary.
Are Intubation Conditions Using Rocuronium Equivalent to Those Using Succinylcholine?
Authors: Perry Jeffrey Joseph , Lee Jacques , Wells George 
Published: October 2002

Abstract Objective: To determine whether the intubation conditions created by rocuronium are equivalent to those of succinylcholine during rapid‐sequence induction (RSI). Methods: Medline, EMBASE, and the Cochrane Controlled Trials Register were searched for randomized clinical trials (RCTs). The search strategy included all generic and trade names for succinylcholine and rocuronium, anesthesia, neuromuscular blockade, and a validated RCT filter. Intubation conditions were a required outcome. Two reviewers assessed studies for eligibility, data extraction, and quality. Intubation conditions were scored with Goldberg's scale (excellent conditions defined as clear vocal cords, easy tube insertion, and no cough). A‐priori subgroup analysis was conducted for the sedative, use of opioids, true versus modified RSI, age group, and the dose of rocuronium. Data were analyzed with Metaview 4.1 for relative risk (RR) of achieving excellent intubation conditions. A sample size calculation determined that n = 468 is required for equivalence. Results: Forty articles were identified; ten articles were excluded by the inclusion criteria, two were duplicate publications, and two had insufficient data. Therefore, 26 studies were analyzed. Overall, rocuronium was inferior to succinylcholine, with a RR = 0.87 (95% CI = 0.81 to 0.94) (N = 1,606). However, intubation conditions were similar in the propofol subgroup, with a RR = 0.96 (95% CI = 0.87 to 1.06) (N = 640). Failed intubations (N = 28) were equivalent in the two groups. Conclusions: Overall, succinylcholine creates excellent intubation conditions more reliably than rocuronium. If a second‐line agent is required, rocuronium used with propofol creates intubation conditions equivalent to those with succinylcholine.
Residency Training in Emergency Ultrasound: Fulfilling the Mandate
Authors: Heller Michael B. , Mandavia Diku , Tayal Vivek S. , Cardenas Evelyn E. , Lambert Michael J. , Mateer James , Melanson Scott W. , Peimann Nathan P. , Plummer David W. , Stahmer Sarah A. 
Published: October 2002

AbstractAlthough bedside ultrasound is listed in the Model of the Clinical Practice of Emergency Medicine as an integral diagnostic procedure, the manner in which the didactic, hands‐on, and experiential components of emergency ultrasound are taught is not specifically prescribed by the Residency Review Committee for Emergency Medicine (RRC‐EM) or any single sponsoring group. Seven professional organizations [the American Board of Emergency Medicine (ABEM), the American College of Emergency Medicine (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents Association (EMRA), the National Association of EMS Physicians (NAEMSP), the RRC‐EM, and the Society for Academic Emergency Medicine (SAEM)] developed the Scope of Training Task Force, with the goal of identifying emerging areas of clinical importance to the specialty of emergency medicine, including emergency department (ED) ultrasound. The Task Force then identified a group of recognized authorities to thoughtfully address the issue of ED ultrasound training. This report represents a consensus of these identified experts on how emergency ultrasound training should be incorporated into emergency medicine residency programs.
Clinical Pharmacokinetics of Irinotecan and Its Metabolites: A Population Analysis
Authors: Xie Rujia , Mathijssen Ron H.J. , Sparreboom Alex , Verweij Jaap , Karlsson Mats O. 
Published: October 2002

PURPOSE: To build population pharmacokinetic (PK) models for irinotecan (CPT-11) and its currently identified metabolites. PATIENTS AND METHODS: Seventy cancer patients (24 women and 46 men) received 90-minute intravenous infusions of CPT-11 in the dose range of 175 to 300 mg/m2. The PK models were developed to describe plasma concentration profiles of the lactone and carboxylate forms of CPT-11 and 7-ethyl-10-hydroxycamptothecin (SN-38) and the total forms of SN-38 glucuronide (SN-38G), 7-ethyl-10-[4-N-(5-aminopentanoic acid)-1-piperidino]-carbonyloxycamptothecin (APC), and 7-ethyl-10-[4-amino-1-piperidino]-carbonyloxycamptothecin (NPC) by using NONMEM. RESULTS: The interconversion between the lactone and carboxylate forms of CPT-11 was relatively rapid, with an equilibration half-life of 14 minutes in the central compartment and hydrolysis occurring at a rate five times faster than lactonization. The same interconversion also occurred in peripheral compartments. CPT-11 lactone had extensive tissue distribution (steady-state volume of distribution [Vss], 445 L) compared with the carboxylate form (Vss, 78 L, excluding peripherally formed CPT-11 carboxylate). Clearance (CL) was higher for the lactone form (74.3 L/h) compared with the carboxylate form (12.3 L/h). During metabolite data modeling, goodness of fit indicated a preference of SN-38 and NPC to be formed out of the lactone form of CPT-11, whereas APC could be modeled best by presuming formation from CPT-11 carboxylate. The interconversion between SN-38 lactone and carboxylate was slower than that of CPT-11, with the lactone form dominating at equilibrium. The CLs for SN-38 lactone and carboxylate were similar, but the lactone form had more extensive tissue distribution. CONCLUSION: Plasma data of CPT-11 and metabolites could be adequately described by this compartmental model, which may be useful in predicting the time courses, including interindividual variability, of all characterized substances after intravenous administrations of CPT-11.
Complication Rates Among Cancer Patients With Peripherally Inserted Central Catheters
Authors: Walshe Louise J. , Malak Sharp F. , Eagan Janet , Sepkowitz Kent A. 
Published: October 2002

PURPOSE: Peripherally inserted central catheters (PICCs) are frequently used to deliver outpatient courses of intravenous therapy. However, the rates and risks of complication for this device have not been well-studied. Our objective was to determine the incidence and risk factors of PICC-related complications with a 1-year prospective observational study. PATIENTS AND METHODS: All PICCs inserted in adult and pediatric patients at Memorial Sloan-Kettering Cancer Center (MSKCC) were followed prospectively. The device insertion team, inpatient nurses, and various home-care companies and outside institutions collected longitudinal data. RESULTS: Three hundred fifty-one PICCs were inserted during the study period and followed for a total of 10,562 catheter-days (median placement, 15 days; range, 1 to 487 days). Two hundred five PICCs (58%) were managed by home-care companies and outside institutions, and 146 PICCs (42%) were managed exclusively at MSKCC. For these 205 PICCs, 131 nurses from 74 home-care companies and institutions were contacted for follow-up clinical information. In all, 115 (32.8%) of 351 PICCs were removed as a result of a complication, for a rate of 10.9 per 1,000 catheter-days. Patients with hematologic malignancy or bone marrow transplant were more likely to develop a complication, whereas those with metastatic disease were less likely. CONCLUSION: Complications occur frequently among cancer patients with PICCs, and long-term follow-up is onerous. Despite a high complication rate, the ease of insertion and removal argues for continued PICC use in the cancer population.
Vinyl- and Dienylpalladium Complexes Formed via Insertion of Alkyne into Sterically Hindered Pd–Aryl Bonds
Authors: Yagyu Takeyoshi , Osakada Kohtaro 
Published: October 2002

Abstract
[PdI(C6H3Me2-2,6)(bpy)] reacts with excess amounts of dimethyl acetylenedicarboxylate to produce [PdI{CZ=CZ-(C6H3Me2-2,6)}(bpy)] (2, Z = COOMe) and [PdI{CZ=CZ–CZ=CZ(C6H3Me2-2,6)}(bpy)] (3). Crystallographic study revealed the molecular structures of 2 and 3 the latter of which has an s-trans dienyl ligand.
Conformational Study of a Tetraacyl Biosynthetic Precursor of Lipid A by NMR
Authors: Oikawa Masato , Shintaku Tetsuya , Yoshizaki Hiroaki , Fukase Koichi , Adachi Seiji , Lee Keonil , Kusumoto Shoichi 
Published: October 2002

Abstract
During the course of a conformational study of lipid A, which is a bioactive entity of lipopolysaccharide of the Gram-negative bacterial cell surface, the molecular conformation of its tetraacyl biosynthetic precursor in dimethyl sulfoxide was unambiguously determined by means of NMR using both 6-13C-labeled and nonlabeled synthetic specimens. The conformation of the hydrophilic moiety was determined by an NMR analysis based on the spin-coupling constants and nuclear Overhauser enhancement data around the glycosidic linkage. The whole molecular shape of the glycolipid was then elaborated with the aid of molecular mechanics calculations.
Static and Dynamic Stereochemistry of N-Alkyl- and N,O-Dialkyl- N-9-triptycylhydroxylamine Derivatives
Authors: Yamamoto Gaku , Nakajo Fusako , Endo Naoka , Mazaki Yasuhiro 
Published: October 2002

Abstract
Stereochemistry of N-9-triptycylhydroxylamine and its N-alkyl and N,O-dialkyl derivatives was studied. X-ray crystallographic analysis of N,O-diethyl-N-9-triptycylhydroxylamine revealed (a) the chiral nature of the molecule, (b) an almost tetrahedral geometry of the nitrogen atom, and (c) a nearly eclipsing arrangement of the O–Et bond with the nitrogen lone-pair orbital. In solution, enantiomerization takes place rapidly at room temperature on the NMR time scale but slows down at low temperatures. The stereomutation proceeds by way of two processes, “R-passing,” and “O-passing,” in which the alkyl (R) and oxy (OH or OR) groups attached to the nitrogen atom, respectively, pass over a benzene ring, accompanied by nitrogen inversion and partial rotation of the N–O bond. The energy barriers to these processes were obtained by dynamic NMR spectroscopy.
InCl3-Catalyzed Reductive Coupling of Aromatic Carbonyl Compounds in the Presence of Magnesium and Chlorotrimethylsilane
Authors: Mori Kenji , Ohtaka Seiji , Uemura Sakae 
Published: October 2002

Abstract
Reductive homocoupling of aromatic aldehydes and ketones has been achieved in tetrahydrofuran at room temperature using a catalytic amount of InCl3 (0.005–0.1 molar amount) under nitrogen atmosphere in the presence of both chlorotrimethylsilane and magnesium metal (Mg turnings) to provide the corresponding 1,2-diols in good to moderate yields with a high diastereoselectivity.