bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical prognostic indicators of high-grade pre-invasive bronchial lesions
Authors: Moro‐Sibilot D. , Fievet F. , Jeanmart M. , Lantuejoul S. , Arbib F. , Laverrière M.H. , Brambilla E. , Brambilla C. 
Published: July 2004

Lung cancer arises from multistep genetic damage of bronchial epithelium, driving multifocal progressive dysplastic lesions. However, the risk of progression of high-grade pre-invasive bronchial lesions to cancer is poorly assessed. The purpose of this study was to better define the parameters that predict the outcome of these lesions.The current authors prospectively studied 27 patients with 31 histologically proven severe dysplasia (SD) and carcinomain situ(CIS), with repeated bronchoscopy and endobronchial treatment. The influence of respiratory-cancer history, histopathological classification, tobacco consumption, and number of biopsies on the progression rate into cancer was studied.The actuarial progression rate to cancer was 17% at 1 yr and 63% at 3 yrs. A total of 11 cases of CIS progressed to invasive cancer, 17 were stable or regressed during the study, two with SD regressed and one progressed to invasive cancer. Progression of CIS appeared more frequent in lesions diagnosed as “questionable CIS”. Persistence of smoking did not influence high-grade lesion outcome. The existence of synchronous lung cancer did not seem to impact on progression. The number of biopsies did not influence the outcome.In conclusion, the current study suggests that the outcome of high-grade pre-invasive lesions is not modified by the number of biopsies performed on these lesions. Careful pathological examination of these lesions and pathological revision seem necessary, since questionable cases have the worse progression rate.
Laser-assisted uvulopalatoplasty for snoring: does it meet the expectations?
Authors: Larrosa F. , Hernandez L. , Morello A. , Ballester E. , Quinto L. , Montserrat J.M. 
Published: July 2004

The high prevalence of habitual snoring (35% of the general population) and the increasing demand for an effective treatment have led, in the last decade, to the generalisation of laser-assisted uvulopalatoplasty (LAUP). However, acceptable studies on its effectiveness are lacking.The present randomised, placebo-controlled study included 25 nonapnoeic and mild obstructive sleep apnoea snorers to evaluate LAUP effectiveness for snoring. Group I received a one-stage LAUP treatment and group II a placebo (simulated snore surgery followed by an oral placebo). Before each treatment and 3 months after, the variables and procedures assessed were: body weight; sleepiness (Epworth sleepiness scale); quality of life (SF‐36); subjective snoring intensity (0–10 analogue scale); objective snoring intensity (average decibel intensity); snoring index (number of snores per hour); and apnoea/hypopnea index.No differences were observed in body weight, sleepiness, quality of life, subjective and objective intensity, and frequency of snoring, and apnoea/hypopnea index between the groups before and 3 months after treatment.In conclusion, this study provides evidence of the lack of effectiveness of one-stage laser-assisted uvulopalatoplasty for snoring in nonapnoeic and mild obstructive sleep apnoea patients, with the result that it does not meet the expectations generated by the procedure.
Normal nasal mucociliary clearance in CF children: evidence against a CFTR‐related defect
Authors: McShane D. , Davies J.C. , Wodehouse T. , Bush A. , Geddes D. , Alton E.W.F.W. 
Published: July 2004

Studies on mucociliary clearance (MCC) in cystic fibrosis (CF) have produced conflicting results. This study aimed to differentiate primary (ion transport-related) from secondary (inflammatory) causes of delayed MCC in CF.Nasal MCC was measured in 50 children (CF, primary ciliary dyskinesia (PCD) and no respiratory disease). Nasal lavage fluid was analysed for interleukin (IL)‐8 and tumour necrosis factor‐α. Similar measurements were obtained in adult CF patients with and without chronic sinusitis (CS).Children with CF had neither delayed MCC nor increased levels of cytokines. Conversely, children with PCD had prolonged MCC times (all >30 min) and significantly raised levels of IL‐8. CS‐positive CF adults had significantly slower MCC than CS‐negative subjects, but IL‐8 levels were low and similar in both groups.Decreased airway surface liquid and delayed mucociliary clearance are the postulated primary mechanisms in cystic fibrosis. However, the current study reports that cystic fibrosis children have normal nasal mucociliary clearance. Abnormalities appeared in cystic fibrosis adults with symptoms of chronic sinus disease, suggesting a secondary rather than primary phenomenon. Studies to explore this mechanism in the distal, more sparsely-ciliated airways could aid an understanding of pathogenesis and the development of new treatments.
PPAR‐γ agonists as therapy for diseases involving airway neutrophilia
Authors: Birrell M.A. , Patel H.J. , McCluskie K. , Wong S. , Leonard T. , Yacoub M.H. , Belvisi M.G. 
Published: July 2004

Peroxisome proliferator-activated receptors (PPARs) are a family of ligand-activated nuclear hormone receptors belonging to the steroid receptor superfamily. Previously, the present authors have shown that PPAR‐γ agonists inhibit the release of inflammatory cell survival factors and induce apoptosisin vitro. The aim of this study was to determine the effect of two structurally different PPAR agonists in anin vivomodel of lipopolysaccharide (LPS)-induced airway inflammation.Mice were treated with PPAR agonists, rosiglitazone or SB 219994, prior to exposure to aerosolised LPS, and the extent of airway inflammation was assessed 3 h later.In these experiments, the PPAR ligands inhibited LPS-induced airway neutrophilia and associated chemoattractants/survival factors (keratinocyte-derived chemokine and granulocyte-colony stimulating factor) in the mouse lung.The present authors postulate that if a peroxisome proliferator-activated receptor agonist has the same effect in man, and neutrophils are important in the progression of respiratory diseases, such as chronic obstructive pulmonary disease, then this class of compounds could be a potential therapy. Furthermore, several peroxisome proliferator-activated receptor‐γ agonists have been shown to be clinically effective for the treatment of type II diabetes, suggesting that any benefit of peroxisome proliferator-activated receptor‐γ ligands in the progression of respiratory diseases, which may involve airway neutrophilia, could be explored relatively quickly.
Comparison of99mTc‐DTPA and urea for measuring cefepime concentrations in epithelial lining fluid
Authors: Bayat S. , Louchahi K. , Verdière B. , Anglade D. , Rahoui A. , Sorin P‐M. , Tod M. , Petitjean O. , Fraisse F. , Grimbert F.A. 
Published: July 2004

The efficacy of antimicrobial agents against pulmonary infections depends on their local concentrations in the lung. The aims of the present study were to: 1) compare technetium‐99m diethylenetriaminepenta-acetic acid (99mTc‐DTPA) and urea as markers of epithelial lining fluid (ELF) dilution for measuring ELF concentrations of pharmaceuticals; 2) quantify ELF cefepime concentrations in normal and injured lung; and 3) measure the increase in permeability to cefepime following oleic acid-induced acute lung injury.A modified bronchoalveolar lavage technique, based on equilibration of infused99mTc-DTPA, was used to measure ELF volume. Cefepime was administered intravenously at steady plasma levels. Six serial bronchoalveolar lavages were performed 5 h after the beginning of infusion.ELF to plasma cefepime concentration ratios were 95±17 and 100±14.5% in normal and injured lung respectively. When urea was used as marker, cefepime concentration ratios were underestimated at 16.4±2.7 and 73.9±8.4% respectively. Cefepime blood/airspace clearance increased from 3.8±0.7 µL·min−1in controls to 39.8±4.9 µL·min−1in acute lung injury.It was concluded that: 1) cefepime concentrations in epithelial lining fluid were in equilibrium with those in plasma in both normal and injured lung after 5 h at steady plasma concentrations; 2) epithelial lining fluid cefepime concentration by the urea method was much less underestimated in injuredversusnormal lung; and 3) acute lung injury induces a 10‐fold elevation of cefepime blood/airspace clearance.
Cavitary lung masses in SLE patients: an unusual manifestation of CMV infection
Authors: Najjar M. , Siddiqui A.K. , Rossoff L. , Cohen R.I. 
Published: July 2004

The typical radiographical findings of cytomegalovirus pneumonitis are bilateral interstitial infiltrates.In this study, the current authors describe two patients on corticosteroid treatment for systemic lupus erythematosus, complicated by histologically confirmed cytomegalovirus pneumonitis, presenting as cavitary masses.This rare presentation of cytomegalovirus pneumonitis broadens the differential diagnosis of cavitary lesions to include cytomegalovirus infection in immunocompromised individuals.
Idiopathic pulmonary haemosiderosis revisited
Authors: Ioachimescu O.C. , Sieber S. , Kotch A. 
Published: July 2004

Idiopathic pulmonary haemosiderosis is a rare cause of diffuse alveolar haemorrhage of unknown aetiology. It occurs most frequently in children, has a variable natural history with repetitive episodes of diffuse alveolar haemorrhage, and has been reported to have a high mortality. Many patients develop iron deficiency anaemia secondary to deposition of haemosiderin iron in the alveoli.Examination of sputum and bronchoalveolar lavage fluid can disclose haemosiderin-laden alveolar macrophages (siderophages), and the lung biopsy shows numerous siderophages in the alveoli, without any evidence of pulmonary vasculitis, nonspecific/granulomatous inflammation, or deposition of immunoglobulins. Contrary to earlier reports, corticosteroids alone or in combination with other immunosuppressive agents may be effective for either exacerbations or maintenance therapy of idiopathic pulmonary haemosiderosis.
Clonal strains ofPseudomonas aeruginosain paediatric and adult cystic fibrosis units
Authors: O'Carroll M.R. , Syrmis M.W. , Wainwright C.E. , Greer R.M. , Mitchell P. , Coulter C. , Sloots T.P. , Nissen M.D. , Bell S.C. 
Published: July 2004

Despite recent reports of clonal strains ofPseudomonas aeruginosain cystic fibrosis (CF) units, the need for routine microbiological surveillance remains contentious.Sputum was collected prospectively from productive patients attending the regional paediatric and adult CF units in Brisbane, Australia. AllP. aeruginosaisolates were typed using pulsed-field gel electrophoresis. Spirometry, anthropometrics, hospitalisations and antibiotic sensitivity data were recorded.The first 100 sputum samples (first 50 patients at each clinic) harboured 163 isolates ofP. aeruginosa. A total of 39 patients shared a common strain (pulsotype 2), 20 patients shared a strain with at least one other patient and 41 patients harboured unique strains. Eight patients shared a strain identical to a previously reported Australian transmissible strain (pulsotype 1). Compared with the unique strain group, patients harbouring pulsotype 2 were younger and had poorer lung function. Treatment requirements were similar in these two groups, as were the rates of multiresistance.In conclusion, 59% of patients harboured a clonal strain, supporting the need for routine microbiological surveillance. In contrast to previously described clonal strains, the dominant pulsotype was indistinguishable from nonclonal strains with respect to both colonial morphology and multiresistance. The clinical significance of clonal strains remains uncertain and requires longitudinal study.
Immunokinetics in severe pneumonia due to influenza virus and bacteria coinfection in mice
Authors: Seki M. , Yanagihara K. , Higashiyama Y. , Fukuda Y. , Kaneko Y. , Ohno H. , Miyazaki Y. , Hirakata Y. , Tomono K. , Kadota J. , Tashiro T. , Kohno S. 
Published: July 2004

Coinfections of bacteria and influenza are a major cause of excessive mortality during influenza epidemics. However, the mechanism of the synergy between influenza virus and bacteria are poorly understood.In this study, mice were inoculated with influenza virus, followed 2 days later by inoculation withStreptococcus pneumoniae. The kinetics of viral titres, bacterial numbers and the immune response (cytokine and chemokine production) were also analysed.Short-term survival correlated with pathological changes in the lungs of infected mice. Influenza virus orS. pneumoniaeinfection alone induced moderate pneumonia; however, severe bronchopneumonia with massive haemorrhage in coinfected mice, which caused death of these mice ∼2 days after inoculation withS. pneumoniae, was noted. Intrapulmonary levels of inflammatory cytokines/chemokines, type‐1 T‐helper cell cytokines and Toll-like receptors, and the related mitogen-activated protein kinase signalling molecules (phosphorylated extracellular signal-regulated kinase ‐1 and ‐2, p38 and c‐Jun N‐terminal kinase), were increased in coinfected mice.These results suggest that immune mediators, including cytokines and chemokines, through Toll-like receptors/mitogen-activated protein kinase pathways, play important roles in the pathology of coinfection caused by influenza virus andStreptococcus pneumoniae.
Prescribing of clozapine and olanzapine: dosage, polypharmacy and patient ethnicity
Authors: Taylor David M. 
Published: July 2004

Aims and MethodThe aim of this study was to determine the existence and extent of differences in prescribing practice for patients according to ethnic group, with two widely used atypical antipsychotics, olanzapine and clozapine. All in-patient prescription charts were screened and patients receiving olanzapine and clozapine identified. Dosage, antipsychotic co-prescription and race were recorded, along with demographic details, and evaluated using comparative statistical analysis.ResultsOverall, 1441 prescriptions were screened; 328 patients received olanzapine and 200 clozapine. Details of ethnic origin were available for 287 of those prescribed olanzapine and 188 of those prescribed clozapine. There was no significant difference between ethnic groups in age or gender, for either drug. For clozapine, dosage and extent of antipsychotic co-prescription did not differ significantly between ethnic groups; for olanzapine, there was no significant difference in daily dose between the groups, but co-prescription was significantly more common in Black (33%) than in White patients (20%; P=0.023).Clinical ImplicationsImportant differences in the prescription of olanzapine and clozapine between ethnic groups are uncommon, but demand further investigation. Larger studies incorporating additional baseline details such as diagnosis and body weight are called for.
Are dedicated research posts of value to psychiatry trainees?
Authors: Strydom Andre , Higgins Nicola 
Published: July 2004

AimsTo explore psychiatric trainees' (senior house officers') experience of a dedicated 6-month research post.MethodA questionnaire survey was conducted by post or e-mail of all previous post-holders of two research posts in a large London training rotation.Results and Clinical ImplicationsTwenty of the 28 post-holders completed the questionnaire. Overall, their experiences were positive in terms of research experience, exposure to academic environment and in facilitating future career opportunities. A minority of respondents found supervision to be unsatisfactory. Dedicated research posts are a valuable training opportunity that can complement clinical experience for trainees and foster an interest in research.
Profiles in Patient Safety: When an Error Occurs
Authors: Hobgood Cherri , Hevia Armando , Hinchey Paul 
Published: July 2004

AbstractMedical error is now clearly established as one of the most significant problems facing the American health care system. Anecdotal evidence, studies of human cognition, and analysis of high‐reliability organizations all predict that despite excellent training, human error is unavoidable. When an error occurs and is recognized, providers have a duty to disclose the error. Yet disclosure of error to patients, families, and hospital colleagues is a difficult and/or threatening process for most physicians. A more thorough understanding of the ethical and social contract between physicians and their patients as well as the professional milieu surrounding an error may improve the likelihood of its disclosure. Key among these is the identification of institutional factors that support disclosure and recognize error as an unavoidable part of the practice of medicine. Using a case‐based format, this article focuses on the communication of error with patients, families, and colleagues and grounds error disclosure in the cultural milieu of medial ethics.
Ultrasound Image Quality Comparison between an Inexpensive Handheld Emergency Department (ED) Ultrasound Machine and a Large Mobile ED Ultrasound System
Authors: Blaivas Michael , Brannam Larry , Theodoro Daniel 
Published: July 2004

AbstractQuestions have been raised regarding image quality (IQ) provided by portable ultrasound (US) machines. Objectives: To determine if a difference exists between images obtained with a common portable US machine and those obtained with a more expensive, larger US machine when comparing typical views used by emergency physicians. Methods:The authors performed a cross‐sectional, blinded comparison of images from similar sonographic windows obtained on healthy models using a SonoSite 180 Plus and a General Electric (GE) 400 US machine. Both machines were optimized by company representatives. Images obtained included typical abdominal and vascular applications using the abdominal and linear transducers on each machine. All images were printed on identical high‐resolution printers and then digitized using a bitmap format at 300 dots‐per‐inch resolution (RES). Images were then cropped, masked, and placed into random order comparing each view per model by a commercial Web design company (loracs.com). Three credentialed emergency physician sonologists, blinded to machine type, rated each image pair for RES, detail (DET), and total IQ as previously defined in the literature using a ten‐point Likert scale; 10 was the best rating for each category. Paired t‐test, 95% confidence intervals (95% CIs), and interobserver correlation were calculated. Results: A total of 49 image pairs were evaluated. Mean GE 400 RES, DET, and IQ scores were 6.8, 6.8, and 6.6, respectively. Corresponding SonoSite means were 6.3, 6.3, and 6.0, respectively. The difference of 0.5 (95% CI = 0.13 to 1.1) for DET was not statistically significant (p = 0.06). The differences of 0.5 (95% CI = 0.1 to 1.1) and 0.6 (95% CI = 0.2 to 1.2) for RES and IQ were statistically significant, with p = 0.01 and 0.01. There was good interobserver agreement (κ= 0.71; 95% CI = 0.67 to 0.78). Conclusions: A statistically significant difference was seen between GE 400 and SonoSite in IQ and RES, but not DET.
Emergency Medicine Narratives: A Systematic Discussion of Definition and Utility
Authors: Hawkins Seth Collings 
Published: July 2004

AbstractA substantial number of emergency medicine providers are publishing stories and other creative expressions related to their medical experiences. This is a systematic review of such publications, introduces the term “emergency medicine narratives” to describe such pieces, and proposes a framework to classify the various forms of expression. Specifically, six genres of emergency medicine narratives are discussed: medical autobiography, clinical narratives, creative narratives, out‐of‐hospital narratives, lay exposition, and photojournalism. This review explores the utility of these narratives and the role they play within the field of emergency medicine, provides a bibliography of emergency narratives, and suggests future questions that might be addressed regarding this growing phenomenon in the field of emergency medicine.
Emergency Medicine Resident Rotation in Pediatric Emergency Medicine: What Kind of Experience Are We Providing?
Authors: Chen Esther H. , Shofer Frances S. , Baren Jill M. 
Published: July 2004

Abstract Objectives: To characterize emergency medicine (EM) residents' clinical experience during a pediatric emergency medicine (PEM) rotation. Methods:Prospective observational study of EM resident–patient encounters in a children's hospital emergency department (ED). Results: Fifty‐six residents participated in the study. The mean (±SD) patient age was 6.3 (±5.6) years. Ambulatory infectious disease, respiratory illness, and wound management represented almost 50% of final diagnoses. Six and a half procedures/resident were performed per rotation, mainly nonemergent procedures, whereas resuscitations and child abuse evaluations were rare. A minority of patients required data interpretation: 34.4% had laboratory testing, 24.6% had radiographic studies, and 2.3% had electrocardiograms. Conclusions: Analysis of patient encounters during a PEM rotation showed deficiencies in critical care procedures, resuscitations, child abuse evaluations, and neonatal evaluations. Quantitative data of skills utilized during rotations can be used by residency programs to identify and correct deficiencies in their residents' PEM education.
Evaluating the Impact of an Educational Intervention on Documentation of Decision‐making Capacity in an Emergency Medical Services System
Authors: Riley Jennifer , Burgess Rob , Schwartz Brian 
Published: July 2004

Abstract Objectives: To compare the documentation of decision‐making capacity by advanced life support (ALS) providers and signature acquisition before, one month after, and one year after an educational intervention. Methods:The intervention comprised a one‐and‐a‐half‐hour module on assessment and documentation of decision‐making capacity. Ambulance call reports were reviewed for all ALS calls occurring during three two‐month periods, and refusals of transport were recorded. Provider compliance with documentation of decision‐making capacity and signature acquisition were determined from a convenience sample of 75 reports from each period. Reviewers were blinded to study period. Twenty‐percent double data entry was undertaken to evaluate accuracy. Ninety‐five percent confidence intervals were calculated to compare frequencies of cancelled calls and documentation. Results: From the emergency medical services database, 7,744 calls before the intervention, 7,444 immediately after, and 7,604 one year later were identified. Documentation rates in the second and third periods did not differ from that prior to the intervention (1.3% vs. 0.0% and 0.0% in subsequent periods), nor did the rates of signature acquisition differ (85.3% vs. 85.3% and 78.6%). The accuracy of data entry was 92.6%. However, the frequency of call refusals decreased significantly after the intervention (from 9.0% to 2.0% and 6.6% in the respective periods). Conclusions: An educational intervention resulted in no change in the rate of decision‐making capacity documentation or signature acquisition by ALS providers for refusal of transport. There was a temporary increase in the number of transported patients.