tbuckley/cabot-search huggingface dataset:
Agreement between the lung clearance index and bronchiectasis detected via chest computed tomography in infants and children with cystic fibrosis (CF)
Authors: Kathryn Ramsey, Timothy Rosenow, Billy Skoric, Anne-Marie Adams, Caroline Gallagher, Georgia Banton, Conor Murray, Sarath Ranganathan, Stephen Stick, Graham Hall
Journal: European Respiratory Journal (2014)

Introduction: The lung clearance index (LCI) is a measure of ventilation inhomogeneity from the multiple breath washout test (MBW). In older children with CF, LCI is reported to have good agreement with the presence of structural lung disease on chest computed tomography (CT). We assessed the agreement between LCI and bronchiectasis across the entire paediatric age range.

Methods: LCI was assessed in 44 infants with CF (0-2y) using MBW with sulphur hexafluoride under sedation and 76 children with CF (3-16y) using multiple breath nitrogen washout prior to a volumetric inspiratory chest CT scan. Bronchiectasis presence and extent was assessed using a simplified CF-CT scoring system. ROC analysis was used to assess agreement.

Results: There was significant agreement between LCI and the presence of bronchiectasis in preschool (3-6y; n = 29; ROC area under curve (AUC) = 0.78; p = 0.03), school-age (7-9y; n = 25; ROC AUC = 0.80; p = 0.01) and adolescence (10-16y; n = 22; ROC AUC = 0.84; p = 0.03) but not infancy (ROC AUC = 0.618; p = 0.24). In children with CF an LCI greater than 7.26 lung turnovers had an 88% sensitivity, 70% specificity, 86% positive predicted value (PV) and 73% negative PV to detect the presence of bronchiectasis on CT. LCI values correlated with the extent of bronchiectasis in children (p < 0.001) but not infants (p = 0.48).

Conclusions: These data suggest LCI may be useful as a surveillance tool in children with CF but there is not enough evidence to suggest LCI should be used as a substitute for CT to detect structural lung disease. Longitudinal studies are required to assess how LCI tracks in early CF lung disease.
Genetic Differences in the Induction of Colorectal Tumors by 1,2-Dimethylhydrazine in Inbred Mice 2
Authors: Bhalchandra A. Diwan, Hans Meier, Kenneth E. Blackman
Journal: JNCI Journal of the National Cancer Institute (1977)

Journal Article Genetic Differences in the Induction of Colorectal Tumors by 1,2-Dimethylhydrazine in Inbred Mice Get access Bhalchandra A. Diwan, Bhalchandra A. Diwan Search for other works by this author on: Oxford Academic PubMed Google Scholar Hans Meier, Hans Meier Search for other works by this author on: Oxford Academic PubMed Google Scholar Kenneth E. Blackman Kenneth E. Blackman Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 59, Issue 2, August 1977, Pages 455–458, https://doi.org/10.1093/jnci/59.2.455 Published: 01 August 1977 Article history Received: 18 January 1977 Accepted: 28 March 1977 Published: 01 August 1977
Hepatitis C treatment as prevention of viral transmission and liver‐related morbidity in persons who inject drugs
Authors: Anthony Cousien, Viet Chi Tran, Sylvie Deuffic‐Burban, Marie Jauffret‐Roustide, Jean‐Stéphane Dhersin, Yazdan Yazdanpanah
Journal: Hepatology (2015)

Hepatitis C virus (HCV) seroprevalence remains high in people who inject drug (PWID) populations, often above 60%. Highly effective direct‐acting antiviral (DAA) regimens (90% efficacy) are becoming available for HCV treatment. This therapeutic revolution raises the possibility of eliminating HCV from this population. However, for this, an effective cascade of care is required. In the context of the available DAA therapies, we used a dynamic individual‐based model including a model of the PWID social network to simulate the impact of improved testing, linkage to care, and adherence to treatment, and of modified treatment recommendation on the transmission and on the morbidity of HCV in PWID in France. Under the current incidence and cascade of care, with treatment initiated at fibrosis stage ≥F2, HCV prevalence decreased from 42.8% to 24.9% (95% confidence interval: 24.8‐24.9) after 10 years. Changing treatment initiation criteria to treat from F0 was the only intervention leading to a substantial additional decrease in prevalence, which fell to 11.6% (95% CI: 11.6‐11.7) at 10 years. Combining this change with improved testing, linkage to care, and adherence to treatment decreased HCV prevalence to 7.0% (95% CI: 7.0‐7.1) at 10 years and avoided 15% (95% CI: 14‐17) and 29% (95% CI: 28‐30) of cirrhosis complications over 10 and 40 years, respectively. Conclusions: Major decreases in prevalent HCV infections occur only when treatment is initiated at early stages of fibrosis, suggesting that systematic treatment in PWID, where incidence remains high, would be beneficial. However, elimination within the 10 next years will be difficult to achieve using treatment alone, even with a highly improved cascade of care. (H epatology 2016;63:1090–1101)
Fibrotic component in patients with emphysema reduces both exercise capacity and quality of life and increases exacerbations
Authors: Nariaki Kokuho, Takeo Ishii, Hiroki Hayashi, Misuzu Kurahara, Takashi Motegi, Kumiko Hattori, Kouichi Yamada, Koichiro Kamio, Akihiko Gemma, Kozui Kida
Journal: European Respiratory Journal (2011)

Background: Characteristics of the combined pulmonary fibrosis and emphysema (CPFE) remain to be elucidated. Little is known regarding the effect of the fibrotic component on exercise capacity, quality of life (QOL), and exacerbations.

Methods: A total of 220 smokers (current or ex-smokers) with and without COPD were recruited. The fibrotic component, defined as reticular opacities and honeycombing, was graded according to the Kazerooni score and the existence and severity of the the extent of emphysema were determined also by HRCT. Data on age, gender, smoking history, pulmonary function, body mass index (BMI), exercise tolerance (6-min walking test; 6MWT), modified Medical Research Council (MMRC) Dyspnea Scale and Oxygen Cost Diagram (OCD), QOL (St. George's Respiratory Questionnaire; SGRQ), and outcome data were collected. The association between the fibrotic component and exercise tolerance, QOL, and exacerbations were studied with adjustment by emphysema.

Results: The subjects (age, 68.9±9.6 years; M/F: 196/23) included 176 patients with emphysema and 64 patients with CPFE. The fibrotic component worsened hypoxemia during the 6MWT (p < 0.05). In CPFE, the severe fibrotic component resulted in worsened dyspnea (MMRC Dyspnea Scale, p <0.03; OCD, p <0.02), reduction in the distance in 6MWT with borderline significance (p = 0.08), and reduction in the minimum blood-oxygen saturation level (p < 0.01); further, the severity of the fibrotic component was positively associated with exacerbations (p < 0.04) and hospitalization (p < 0.01).

Conclusions: In CPFE, fibrotic change worsened both dyspnea and exercise capacity and also increased exacerbations.
Rethinking the appraisal and approval of drugs for type 2 diabetes:
Authors: Huseyin Naci, Richard Lehman, Olivier J Wouters, Ben Goldacre, John S Yudkin
Journal: BMJ (2015)

<b>Huseyin Naci and colleagues</b> call for improvements in the regulatory standards for licensing, reimbursing, and adopting new preventive drugs to ensure that treatments for type 2 diabetes really benefit patients
Outcomes of antioxidant administration in experimentally induced pneumonia
Authors: Usman Farkhutdinov
Journal: European Respiratory Journal (2013)

Active oxygen forms (AOF) play an important role in lung inflammation. Excessive production of AOF initiated processes of free radical oxidation (FRO), requires administration of antioxidants in the treatment of lung diseases.  The aim was to study the effect of α-tocoferol (α-TF) on the production of AOF by alveolar macrophages (AM) in experimentally induced pneumonia (PN).   Methods:  PN was induced in 160 white rats by transthoracic injection of pneumococcus culture. A group of 80 rats received 100 mg/kg dose of α-TF during 7 days. The animals were sacrificed at the 1st, 3d, 7th day of PN course. The content of malonic dialdehyde (MDA) was determined in the animal lungs. The production of AOF by AM was determined by nitroblue tetrazolium (NBT) test. In addition phagocytic activity (PhA) of AM has been assessed and morphological investigations were performed.   Results  The injection of pneumococcus culture into animals was accompanied by the increase of MDA content in the lungs, increase of NBT-test values and PhA of AM. The NBT values of AM correlated directly to MDA content in the lungs. The levels achieved maximum values by the 3d day of PN. The injection of α-TF into rats resulted in the decrease of MDA content in the pulmonary tissue by 1.5 times, in the reduction NBT values and PhA of AM. Destructive changes have been observed in the animal pulmonary tissue on the 7th day of PN.   Conclusion:  AOF produced by AM initiated FRO in experimentally induced PN. α-TF suppresses FRO and microbicidal potential of AM that may result in the development of inflammatory complications.
UK law on consent finally embraces the prudent patient standard
Authors: L. C. Edozien
Journal: BMJ (2015)

But it will take much more to change clinical practice

The UK Supreme Court’s decision in the Montgomery case is a landmark judgment, establishing beyond doubt the court’s commitment to protecting patients’ right to self determination. 1 The judgment concerns Nadine Montgomery, a woman with diabetes whose son was born with serious and permanent disabilities after a shoulder dystocia during delivery. Montgomery’s obstetrician had not warned her of the risk of shoulder dystocia during vaginal delivery or discussed alternatives such as caesarean section. The court held that the doctor should have done both: doctors have a duty to ensure that each patient is aware of any material risks of any recommended treatment and of any reasonable alternative treatments. The test of materiality is whether a reasonable person in that particular patient’s position would be likely to attach importance to the risk, or whether the doctor is—or should reasonably be—aware that that particular patient would be likely to attach importance to it. The message for clinicians is: know your patient and provide tailored information.

The patient must be given sufficient information, but what constitutes sufficient? Two standards of disclosure have been employed: the professional standard (the court relies on medical …
Peripheral T-cell lymphomas. Clinico-pathologic study of 168 cases diagnosed according to the R.E.A.L. Classification
Authors: S. Ascani, P.L. Zinzani, F. Gherlinzoni, E. Sabattini, A. Briskomatis, A. de Vivo, M. Piccioli, G. Fraternali Orcioni, F. Pieri, A. Goldoni, P.P. Piccaluga, D. Zallocco, R. Burnelli, L. Leoncini, B. Falini, S. Tura, S.A. Pileri
Journal: Annals of Oncology (1997)
Optimisation of tidal volume (Vt) for minimising tidal lung overdistension during mechanical ventilation in ALI/ARDS: A modelling approach
Authors: Emanuela Zannin, Peter Frykholm, Raffaele Dellacà
Journal: European Respiratory Journal (2013)

BACKGROUND: Respiratory system reactance (Xrs) measured by the forced oscillation technique (FOT) allows the identification of the open lung PEEP (PEEPol) during mechanical ventilation (Dellaca Intensive Care Med, 37(6):1021-30, 2011) and could potentially provide useful information for optimising also Vt.

In this study we developed a mathematical model that uses Xrs measured within-breath during a decremental PEEP trial. The model identifies the highest Vt that prevents tidal overdistension on an individual basis.

METHODS: We adapted the mathematical model proposed by Hickling (Hickling, Am J Respir Crit Care Med, 163: 69–78, 2001) to make use of Xrs data measured at end-inspiration and at end-expiration during a PEEP trial and we applied the model to data recorded in a porcine surfactant depleted model of ALI/ARDS. For each subject the highest Vt preventing tidal overdistension was identified as the point of maximal curvature (VtPMC) of the tidal p-v loop.

RESULTS: PEEPol as defined by the simulated data was on average±SD 10±2 cmH2O irrespective of Vt. The same Vt could result in intra-tidal recruitment below PEEPol or overdistension depending on the PEEP level. The VtPMC was an average ±SD of 13±3 ml/kg at PEEPol and decreased with increasing PEEP (VtPMC=11±2 ml/kg at PEEPol+2 cmH2O).

CONCLUSION: Our simulations showed that to provide a lung protective ventilation there is a maximum Vt which changes significantly with the level of PEEP applied. Once the PEEPol has been identified by FOT, our mathematical model fitted on Xrs data could help in identifying the maximal Vt that prevents tidal overdistension for each individual patient.
Abstract 14913: Declining Incidence and Improved Outcome of Cardiogenic Shock at the Acute Stage of MI. A Report from the USIK 1995, USIC 2000 and FAST-MI French Nationwide Registries
Authors: Nadia Aissaoui, Etienne Puymirat, Michel Hanssen, Bernard Charbonnier, Francois Schiele, Thierry Lefevre, Eric Durand, Didier Blanchard, Tabassome Simon, Jean-Pierre Cambou, Nicolas Danchin
Journal: Circulation (2010)

Background: There is conflicting evidence on the evolution of incidence and outcome of cardiogenic shock (CS) in AMI patients over the past decade. Aim: to compare 30-day death in AMI patients from...
Spontaneous Occurrence of Atypical Hyperplasia and Adenocarcinoma of the Uterus in Androgen-Sterilized SD Rats&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: Shinichi Morikawa, Souei Sekiya, Masabumi Naitoh, Hiroshi Iwasawa, Bin Takeda, Hiroyoshi Takamizawa
Journal: JNCI Journal of the National Cancer Institute (1982)

In SD female rats sterilized by a single injection of testosterone Propionate at 2 days after birth, the spontaneous occurrence of atypical hyperplasia and adenocarcinoma of the uterus was observed for a fairly long period (>2 yr). Two atypical hyperplasias and 2 adenocarcinomas were detected in 25 androgen-sterilized rats (ASR) after 500 days of age; in contrast, in 111 normal control rats no abnormal uterine proliferation was detected during a 750-day observation period. These results indicate that a persistence of both hormone imbalances and dysfunctional uteri in ASR induces abnormal uterine proliferation at a late age.
Patient Perspectives on the Learning Health System: The Importance of Trust and Shared Decision Making
Authors: Maureen Kelley, Cyan James, Stephanie Alessi Kraft, Diane Korngiebel, Isabelle Wijangco, Emily Rosenthal, Steven Joffe, Mildred K. Cho, Benjamin Wilfond, Sandra Soo-Jin Lee
Journal: The American Journal of Bioethics (2015)

We conducted focus groups to assess patient attitudes toward research on medical practices in the context of usual care. We found that patients focus on the implications of this research for their relationship with and trust in their physicians. Patients view research on medical practices as separate from usual care, demanding dissemination of information and in most cases, individual consent. Patients expect information about this research to come through their physician, whom they rely on to identify and filter associated risks. In general, patients support this research, but worry that participation in research involving randomization may undermine individualized care that acknowledges their unique medical histories. These findings suggest the need for public education on variation in practice among physicians and the need for a collaborative approach to the governance of research on medical practices that addresses core values of trust, transparency, and partnership.
Rehabilitation of traumatised refugees and survivors of torture
Authors: Metin Basoglu
Journal: BMJ (2006)

After almost two decades we are still not using evidence based treatments 

In a 1988 BMJ editorial,1 Marks and I reviewed the available knowledge on the mental health effects of torture and their treatment and presented a critical look at rehabilitation programmes for survivors. Eighteen years later, it is time to cast another look at the advances in our understanding of torture and its treatment and how this progress has translated into rehabilitation work with survivors. Such an update is timely: given the political developments of the last two decades, torture has become an ever more serious problem. 

An important advance in the 1990s was the demonstration of an association between torture and post-traumatic stress disorder through controlled studies using standardised assessment instruments.2 Further work provided insight into the psychological mechanisms that played a part in torture-induced post-traumatic stress. In a controlled study survivors who felt that those they held responsible for the torture did not receive the punishment they deserved were more likely to have a sense of injustice, …
Nutritional outcome in children with severe generalized recessive dystrophic epidermolysis bullosa: a short- and long-term evaluation of gastrostomy and enteral feeding
Authors: V. Colomb, E. Bourdon-Lannoy, C. Lambe, F. Sauvat, S. Hadj Rabia, D. Teillac, Y. De Prost, C. Bodemer
Journal: British Journal of Dermatology (2011)

Journal Article Nutritional outcome in children with severe generalized recessive dystrophic epidermolysis bullosa: a short‐ and long‐term evaluation of gastrostomy and enteral feeding Get access V. Colomb, V. Colomb Department of Paediatric Gastroenterology and Nutrition, French Reference Centre for Rare Digestive Diseases, Nutrition Support Team Search for other works by this author on: Oxford Academic Google Scholar E. Bourdon‐Lannoy, E. Bourdon‐Lannoy Department of Dermatology, French Reference Centre of Genetic Skin disorders (MAGEC) and Search for other works by this author on: Oxford Academic Google Scholar C. Lambe, C. Lambe Department of Paediatric Gastroenterology and Nutrition, French Reference Centre for Rare Digestive Diseases, Nutrition Support Team Search for other works by this author on: Oxford Academic Google Scholar F. Sauvat, F. Sauvat Department of Paediatric Surgery, Necker‐Enfants Malades Hospital, AP‐HP, University René Descartes Paris V, 149 rue de Sèvres, 75015 Paris, France Search for other works by this author on: Oxford Academic Google Scholar S. Hadj Rabia, S. Hadj Rabia Department of Dermatology, French Reference Centre of Genetic Skin disorders (MAGEC) and Search for other works by this author on: Oxford Academic Google Scholar D. Teillac, D. Teillac Department of Dermatology, French Reference Centre of Genetic Skin disorders (MAGEC) and Search for other works by this author on: Oxford Academic Google Scholar Y. De Prost, Y. De Prost Department of Dermatology, French Reference Centre of Genetic Skin disorders (MAGEC) and Search for other works by this author on: Oxford Academic Google Scholar C. Bodemer C. Bodemer Department of Dermatology, French Reference Centre of Genetic Skin disorders (MAGEC) and Christine Bodemer. E‐mail: christine.bodemer@nck.aphp.fr Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 166, Issue 2, 1 February 2012, Pages 354–361, https://doi.org/10.1111/j.1365-2133.2011.10592.x Published: 01 February 2012 Article history Accepted: 21 August 2011 Published: 01 February 2012
The Anxious Brain: The Neurobiological Basis of Anxiety Disorders and How to Effectively Treat Themby Margaret Wehrenberg, Psy.D., and Steven M. Prinz, M.D. New York, WW Norton &amp; Co., 2007, 288 pp., $32.00.
Authors: JAMES L. ABELSON, MARK LYUBKIN
Journal: American Journal of Psychiatry (2007)
Role of muscarinic receptor activation in regulating immune cell activity in nasal mucosa
Authors: T. Liu, C. Xie, X. Chen, F. Zhao, A.‐M. Liu, D.‐B. Cho, J. Chong, P.‐C. Yang
Journal: Allergy (2009)

The prevalence of airway inflammatory disorders keeps rising; its pathogenic mechanism is still not fully understood.The present study aimed to investigate the role of muscarinic receptor (M receptor) in regulating the immune cell activity in nasal mucosa by using surgical removed nasal mucosa from patients with nasal polyposis (NP) as a study platform.Human nasal mucosal sample was collected from inferior turbinectomy of 86 patients with NP or/and allergic rhinitis. Expression of tumor necrosis factor alpha (TNF-alpha), M receptor, OX40 ligand was measured in nasal mucosa by enzyme-linked immunosorbent assay, flow cytometry, and Western blotting assay.When compared with non-NP (nNP) nasal mucosa, contents of TNF-alpha and TNF-alpha+ cells markedly increased in NP nasal mucosa; immune staining colocalized M3 receptor+ and TNF-alpha+ cells in NP nasal mucosa; exposure of isolated CD4+ T cells to methacholine induced the release of TNF-alpha. We also found CD11c+/M3 receptor+ cells in NP nasal mucosa. Methacholine increased the expression of OX40L in dendritic cells. Staphylococcal (S) aureus and S. enterotoxin B (SEB) were detected in NP nasal mucosa. Exposure of dendritic cells or naïve CD4+ T cells to SEB initiated the expression of M3 receptor at mRNA and protein levels.The present data demonstrate that parasympathetic activity has the capacity to activate dendritic cells to release OX40 ligand, the latter induces CD4+ T cells to produce IL-4 and TNF-alpha that may further contribute to the pathogenesis of NP.
Changing a hospital inhaler policy to improve in-hospital inhaler use
Authors: Imran Sulaiman, Deirdre Long, Jansen Sehelut, Shona D'Arcy, Elaine MacHale, Richard Reilly, Richard Costello
Journal: European Respiratory Journal (2014)

Most respiratory patients are prescribed inhaled medication. During a hospital admission, in Ireland, these inhalers are often left with the patient at their bedside for self-administration. We have no idea of how many doses the patient has taken, or even if the medication was taken properly.

A novel acoustic inhaler tracking device was used to assess when and how an individual took their inhaler, INhaler Compliance Assessment (INCA). An initial audit of inhaler use in hospital was done.

A quality improvement program (inhaler policy) occurred in our hospital, which involved inhalers being stored in individually labelled 'inhaler bags' in the drug trolley and administered only as prescribed and supervised for technique errors by nursing staff. A follow-up audit of inhaler use was done with the INCA device.

Fifty-one in-patients on a salmeterol/fluticosone Diskus inhaler were randomly selected. Errors were divided in to timing and technique. Errors in timing were noted in 37% of patients, with 16% having significant overdosing. Technique errors were high, with 40% of patients having problems with inhaler technique.

Fifty-nine patients were randomly selected post policy. Errors in timing reduced to 11%, and technique errors also reduced to 19%.

A change of inhaler policy, recorded by a novel inhaler tracker device showed a satisfactory improvement in patient timing and technique errors. We have proposed this new 'inhaler policy' to become a national hospital policy.

View this table:

Table 1: Comparing Pre and Post Policy Change