tbuckley/cabot-search huggingface dataset:
Doctors facing manslaughter charges should not automatically be suspended, High Court rules
Authors: C. Dyer
Journal: BMJ (2015)

Doctors facing manslaughter charges should not automatically be suspended from the medical register pending trial or a full hearing by the Medical Practitioners Tribunal Service, a High Court judge has declared.

Mr Justice Knowles lifted an interim order of 18 months’ suspension on Hadiza Bawa-Garba, a paediatric specialist registrar charged with gross negligence manslaughter over the death of 6 year old Jack Adcock at Leicester Royal Infirmary in February 2011.1

The judge said that the case first came to the notice of the General Medical Council in April 2012, but it was not until after the GMC learnt in December 2014 that Bawa-Garba and two nurses had been charged with manslaughter that it began …
Treatment of children with clear-cell sarcoma of the kidney: a report from the National Wilms' Tumor Study Group.
Authors: D M Green, N E Breslow, J B Beckwith, J Moksness, J Z Finklestein, G J D'Angio
Journal: Journal of Clinical Oncology (1994)

PURPOSE To evaluate the effect of the sequential addition of doxorubicin (DOX) and cyclophosphamide (CTX) to the combination of vincristine (VCR) and dactinomycin (AMD) on the relapse-free survival of children with clear-cell sarcoma of the kidney (CCSK). PATIENTS AND METHODS We determined the 6-year relapse-free survival rate for patients with CCSK treated on National Wilms' Tumor Study (NWTS)-1, NWTS-2, or NWTS-3 with the combination of VCR and AMD, with or without DOX, and for patients treated on NWTS-3 with the combination of VCR, AMD, and DOX with (regimen J) or without (regimen DD-RT) CTX. RESULTS The 6-year relapse-free survival rate for the eight children with CCSK treated with VCR, AMD, and radiation therapy was 25.0%, compared with 63.5% for the 58 children treated with VCR, AMD, DOX, and radiation therapy (P = .09). The 6-year relapse-free survival rate for children with CCSK treated on regimen DD-RT was 64.6%, compared with 58.2% for those treated on regimen J (P = .79). CONCLUSION We conclude that the addition of DOX to the combination of VCR plus AMD appeared to improve the 6-year relapse-free survival rate of children with CCSK. The addition of CTX in the dose and schedule used in NWTS-3 did not improve the 6-year relapse-free survival rate of children with CCSK. Because 30% of relapses occurred more than 2 years after diagnosis, prolonged follow-up evaluation of patients with CCSK is necessary.
Asthma phenotypes in Turkey: A multicenter study
Authors: Fusun Yildiz, Dilsad Mungan, Bilun Gemicioglu, Berna Dursun, Dilek Saka, Arzu Yorgancioglu, Ferda Oner Erkekol, Candan Ogus, Haluk Turktas, Gulhan Bogatekin, Fusun Topcu, Figen Deveci, Hasan Bayram, Meltem Tor, Fuat Kalyoncu
Journal: European Respiratory Journal (2012)

Introduction: The aim of this study was to determine the distrubition of phenotypes in patients with asthma in Turkey.  Materials and methods: A total of 1400 adult asthmatic patients from 13 centers of different geographic locations were involved. A standard questionnaire was applied between February -December 2011.  Results: The percentage of females was 75%. Severity of the disease was found as mild persistant in 10%, mild intermittant in 40%, moderate in 38% and severe in 12%. 12% of the patients had irreversible airway obstruction. Smoking/quitted patients were 34% of the study group, 42% of the patients had obesity (BMI> 30), 11% had analgesic intolerance and 29% had psychological triggers. Smoking rate was found to be lower in females (p  Conclusion: To our knowledge this is the first study on asthma phenotypes in our country and we believe that it will have significant contribution in obtaining control in our asthma patients.
Systemic hypoxia contributes to pulmonary hypertension in heart failure
Authors: Bryan Taylor, Cesar Mojica, Thomas Olson, Paul Woods, Bruce Johnson
Journal: European Respiratory Journal (2011)

Background: The classical mechanism for pulmonary hypertension (PH) in heart failure (HF) is related to a passive rise in pulmonary venous pressure secondary to an increase in LV filling pressure. However, much of the PH in HF is reversed by vasodilators. This suggests a reactive component to the elevated pulmonary vascular resistance (PVR) that is likely related to dysregulation of vascular smooth muscle tone. Although the cause of this dysregulation is unclear, hypoxia may play a role. We examined whether variations in resting systemic O2 levels influence PVR in HF.

Methods: Thirty-nine patients (54±9 yr, LVEF 20±6%, NYHA class I-III) undergoing right heart catheterization for pre transplant assessment were studied. PVR was derived from pulmonary arterial and wedge pressures measured via Swan Ganz catheter and cardiac output measured via direct Fick. Mixed venous and arterial blood was drawn from the pulmonary and radial arteries for measurement of PaO2, PvO2, SaO2, SvO2 and endothelin-I (ET-I).

Results: Group mean PVR, PaO2, PvO2, SaO2 and SvO2 were 303±215 dynes/s/cm5, 72±12 mmHg, 32±4 mmHg, 94±4% and 57±11%, respectively. PVR was negatively correlated with PaO2, PvO2, SaO2 and SvO2 ( r = -0.53, -0.62, -0.48, -0.67, respectively, all P <0.01). Multiple linear regression suggested that SvO2 was the strongest predictor of PVR. In combination, PaO2, PvO2, SaO2 and SvO2 accounted for ∼60% of the variance in PVR. In addition, ET-I was related to both SvO2 ( r = -0.75) and PVR ( r =0.50) ( P <0.01).

Conclusion: Systemic hypoxia, particularly a low SvO2, appears to play a role in PH and elevated PVR in HF. We suggest a hypoxia-mediated increase in the release of the vasoconstrictor ET-I as a likely mechanism. NIH HL71478
Parent Presence during Invasive Procedures and Resuscitation
Authors: Martha A. Q. Curley, Elaine C. Meyer, Lisa A. Scoppettuolo, Elizabeth A. McGann, Bethany P. Trainor, Christine M. Rachwal, Patricia A. Hickey
Journal: American Journal of Respiratory and Critical Care Medicine (2012)

Parent presence during invasive procedures and/or resuscitation is a relatively underdeveloped and controversial practice. Much of the concern stems from the apprehension of the medical community.To evaluate whether implementation of formal practice guidelines and corresponding interprofessional education would improve clinicians' sense of preparation and comfort in providing parents with options during their children's procedures.Multiphase pre-post survey of (1) clinician perceptions and (2) practice from the perspective of clinicians and parents experiencing the same procedure. Data were collected over 4 years from a cardiovascular and critical care program in one U.S. children's hospital.More than 70% of clinicians participated in the perception surveys (n = 782) and 538 clinicians and 274 parents participated in the practice surveys. After the intervention, clinicians reported that parents were present during more invasive procedures and reported higher levels of comfort with the practice of providing options to parents during resuscitative events. Levels of comfort were higher in clinicians who had practiced skills in a simulated learning environment. During both phases, few clinicians reported that parent presence affected their technical performance (4%), therapeutic decision-making (5%), or ability to teach (9%). During the post phase, clinicians reported more active parent behaviors during procedures. Parents who reported receiving information to help them prepare for their children's procedures reported higher levels of procedural understanding and emotional support.Implementation of practice guidelines and interprofessional education had a positive impact on clinicians' perceptions and practice when providing parents with options and support during their children's invasive procedures and/or resuscitation.
Utility and cost of routine bronchoalveolar lavage in diagnosing pulmonary fungal infections
Authors: Fasih Ur Rahman, Muhammad Irfan, Ahmed Suleman Haque, Kauser Jabeen
Journal: European Respiratory Journal (2013)

INTRODUCTION:  Bronchial washings(BW) for microbiological examination is a useful investigation for detecting microorganism causing respiratory tract infections. Considering low prevalence of fungal pneumonia in the community, routine practice of sending BW for fungal smear and C/S increases the cost considerably. The cost of fungal C/S is approximately Rs 1600 (17 US$) in Pakistan.  OBJECTIVE:  To evaluate the yield and cost of routine fungal smear and culture/sensitivity on BW.  METHODS:  Clinical records of all cases undergoing bronchoscopy with BW were reviewed for fungal smear and culture during the period of 2011-2012.  RESULTS:  273 cases underwent bronchoscopy during the study period .Of these 205 samples were sent for fungal C/S. The 3 most common indications of bronchoscopy were hemoptysis, non-resolving pneumonia or suspicion of malignancy.  Out of 205 samples 31 patients were positive on smear and/or culture (15.1%). 16 cases (7.8%) were both smear and C/S positive. Only 5 (2.4%) were clinically significant and required treatment.  Aspergillus fumigatus was most common fungus on culture (2 out of 5), followed by Aspergilus niger, A.terreus and A. flavus. Most of the C/S were positive in patients who had received chemotherapy.  Only 5 (2.4%) cases was clinically significant (at a cost of Rs 8000 as against a total cost of Rs. 3,20,000)  CONCLUSION:  We report that huge amount of money is unnecessarily spent on requesting routine fungal smear and C/S on BW. These test should only be sent in high risk patients so that burden on the patient/health care systems can be minimized.
Inhibition of Glycolysis and Interference With Protein Synthesis in Hepatoma Cells
Authors: M. Elena Ferrero, Elisabetta Ferrero, A. Bernelli Zazzera
Journal: JNCI Journal of the National Cancer Institute (1977)

Ascites hepatoma cells grown in Wistar rats were incubated anaerobically in the absence of glucose or in the presence of both glucose and D(+)glucosamine, or monoiodoacetate, or NADH, which interfered with glycolysis at different steps and with different mechanisms: Under all these conditions the incorporation of amino acids into the proteins of hepatoma cells was severely reduced without any clear relationship to the degree of inhibition of glycolysis. The postmitochondrial supernatants showed defective incorporation only when obtained from cells incubated in the absence of glucose or in the presence of monolodoacetate; inhibition of glycolysis by glucosamine and NADH did not seem to affect the subcellular basis for protein synthesis. When present, the defect of the cell sap (monoiodoacetate and absence of glucose) and to disaggregation and reduced functional capacity of the polysomes (absence of glucose). The results suggested that the effects of the inhibition of glycolysis on protein synthesis and on the integrity of the protein-synthesizing machinery--which were primarily due to the depletion of the energy stores--might have been modified by the particular mechanism of action of the inhibitor and by the way low levels of ATP were reached in the cell.
Effects of pH Management During Deep Hypothermic Bypass on Cerebral Microcirculation: Alpha-Stat Versus pH-Stat
Authors: Lennart F. Duebener, Ikuo Hagino, Takahiko Sakamoto, Lotfi Ben Mime, Christof Stamm, David Zurakowski, Hans-Joachim Schäfers, Richard A. Jonas
Journal: Circulation (2002)

There is controversy regarding the optimal pH strategy during deep hypothermic bypass in children. We directly visualized the effects of the pH-stat and alpha-stat strategy on cerebral microcirculation (including leukocyte/endothelial cell interactions) in a piglet model using intravital fluorescence microscopy.Two groups of 5 piglets (mean weight 9.6+/-1.3 kg) with a cranial window over parietal cerebral cortex underwent 10-minute normothermic bypass, 40-minute cooling on cardiopulmonary bypass ([CPB] Hct 30%, 100 mL/kg/min), 60-minute circulatory arrest at 15 degrees C, and 40-minute rewarming with alpha-stat (group alpha) or pH-stat (group pH). Plasma was labeled with fluorescein-ITC-dextran for assessment of microvascular diameter. Circulating leukocytes were labeled and observed in postcapillary venules for adhesion before and up to 120 minutes after CPB. Cerebral tissue oxygenation was evaluated by quantification of NADH autofluorescence, which increases during ischemia.At the end of normothermic bypass diameter of cerebrocortical microvessels increased to 116+/-9% (alpha) versus 119+/-10% (pH) of pre-CPB baseline values. During cooling microvascular diameter decreased in group alpha and significantly increased in group pH (89+/-11% (alpha) versus 132+/-13% (pH) at the end of cooling; P<0.001). During the first 10 minutes of rewarming, the cerebral microvascular diameter was significantly larger when the pH stat strategy was used. Tissue oxygenation at the end of cooling was significantly greater in the pH-stat group (P=0.008). On reperfusion, the pH-stat strategy resulted in significantly more rapid return of tissue oxygenation toward baseline although at the end of rewarming the metabolic recovery was complete in both groups. The whole body lactate during early rewarming was significantly less with the pH stat strategy. There was no significant difference between the groups regarding the number of adherent leukocytes throughout the time course of the experiment.pH-stat management increases tissue oxygenation during deep hypothermic bypass and after circulatory arrest. Leukocyte/endothelial cell interactions during hypothermic bypass are mild with both alpha-stat and pH-stat.
Why is Plasma Angiotensin-Converting Enzyme Activity Elevated in Hyperthyroidism?
Authors: J E Roulston, A Gold, M Wright, S W Walker
Journal: Journal of the Royal Society of Medicine (1987)

The elevation in plasma angiotensin-converting enzyme (ACE) levels observed in patients with hyperthyroidism is unexplained. In this study three hypotheses were investigated. Results from a study using rats treated with thyroid hormones indicated that the increased ACE was not due to increased cleavages of enzyme from lung endothelia. Data from patients with specific tissue damage argue against a nonspecific release of ACE from damaged cells. Data from cultured cell experiments, however, strongly support a direct effect of thyroid hormones upon ACE synthesis and secretion.
N-Terminal Pro–B-Type Natriuretic Peptide-Guided Treatment for Chronic Heart Failure
Authors: John G. Lainchbury, Richard W. Troughton, Kim M. Strangman, Christopher M. Frampton, Anna Pilbrow, Timothy G. Yandle, Amjad K. Hamid, M. Gary Nicholls, A. Mark Richards
Journal: Journal of the American College of Cardiology (2009)
Portable peak flow meters: physical characteristics, influence of temperature, altitude, and humidity
Authors: OF Pedersen, MR Miller, T Sigsgaard, M Tidley, RM Harding
Journal: European Respiratory Journal (1994)

Little is known about the linearity of portable peak flow meters, or about physical gas factors affecting peak expiratory flow (PEF) readings. We therefore tested five portable peak flow meters of three types in an altitude chamber (sea level to 5,500 m) and in a climate chamber at sea level (7-37 degrees C) to determine the influence of the physical conditions of the gas on the reading of the meters. The nonlinear response of the variable orifice meters was confirmed and, when this was corrected for, the readings of these meters were found to be significantly reduced by higher altitude and lower temperature. The readings from a turbine type of peak flow meter were not affected by altitude but were reduced at low temperature. A mathematical model for the variable orifice meters could correct for both their nonlinear behaviour and the effect of gas density (altitude, temperature and humidity). The model showed that correction is not necessary for the differences in gas conditions between calibration and taking of measurements under normal laboratory conditions. All the meters tested had impedances higher than recommended (0.05 kPa.l-1.s) and this may influence PEF at high flows. The mean uncorrected PEF of six healthy subjects when measured with a Mini Wright peak flow meter at sea level and at 3,000 m fell by 5%, but the mean corrected PEF increased by 12%. This increase in PEF was about 60% of that predicted for fully density-dependent flow and agreed with the findings of other similar studies.(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract 2585: Continuous Flow Left Ventricular Assist Devices (LVADs) Effectively Improve Pulmonary Hemodynamics in Bridge-to-Transplant Patients with End-Stage Heart Failure
Authors: Forum Kamdar, Andrew Boyle, Monica Colvin-Adams, Kenneth Liao, Lyle Joyce, Ranjit John
Journal: Circulation (2007)

Introduction : Pulmonary hypertension is a frequent sequelae of end-stage heart failure and remains a contraindication for cardiac transplantation. Pulsatile LVADs have been shown to effectively reduce pulmonary hypertension in these patients. However, it remains to be seen if newer continuous flow LVADs have a similar effect on pulmonary hypertension. The objective of this study was to determine if the Heartmate (HM) II, a continuous flow LVAD is effective in improving pulmonary hemodynamics in bridge-to-transplant patients. Methods : 30 patients with end-stage heart failure underwent placement of HM II LVAD as a bridge-to-transplant (BTT) at a single center. Pulmonary hemodynamics were evaluated with right heart catheterization at baseline, after placement of an intra-aortic balloon pump (IABP), and post-LVAD (prior to heart transplant). Results : Demographic data of these patients were as follows: mean age 51.6 ± 13.3 years, 70% male, LVEF 14.7 ± 5.11%, 56.6% ischemic etiology and 83.3% received IABP prior to LVAD. Following LVAD support (mean duration of 146. 41 ± 73.83 days), systolic and diastolic pulmonary artery pressures (SPAP and DPAP) decreased significantly (SPAP 56.8 ± 13.55 mmHg, DPAP 28.27 ± 6.23 mmHg to SPAP 35.38 ± 10.23 mmHg, DPAP 15.71 ± 5.36 mmHg; p &lt; 0.001). Similarly, pulmonary vascular resistance (PVR) decreased significantly from 3.69 ± 2.02 to 2.00 ± 0.85 Woods units (p = 0.004). Transpulmonary gradient (TPG) also declined significantly post-LVAD from 13.3 ± 5.6 to 9.35 ± 2.98 mmHg (p = 0.02). Conclusion : Continuous flow LVADs effectively improve pulmonary hemodynamics associated with end-stage heart failure. Therefore, adequate left ventricular decompression achieved with continuous flow LVAD support can reverse significant pulmonary hypertension in end-stage heart failure patients making them eligible for cardiac transplantation.
Clinical Features of Hypersensitivity Reactions to Carboplatin
Authors: Maurie Markman, Alexander Kennedy, Kenneth Webster, Paul Elson, Gertrude Peterson, Barbara Kulp, Jerome Belinson
Journal: Journal of Clinical Oncology (1999)

To characterize the clinical features of carboplatin-associated hypersensitivity reactions.Patients with gynecologic malignancies treated at the Cleveland Clinic Foundation from June 1995 through July 1998 who experienced a carboplatin-associated hypersensitivity reaction were the subjects of this evaluation.Of the 205 patients treated with carboplatin during this time period, 24 (12%) developed a carboplatin hypersensitivity reaction. The median number of platinum (carboplatin plus cisplatin) courses for the first episode was eight (range, six to 21). Only three patients (13%) developed this toxicity during their initial chemotherapy regimen, with the remainder experiencing a reaction during their second (n = 15) or third (n = 6) carboplatin treatment program for recurrent disease. Thirteen patients (54%) developed at least moderately severe symptoms (diffuse erythroderma, tachycardia, chest tightness, wheezing, facial swelling, dyspnea, hypertension, or hypotension). In approximately one half of patients, the reaction developed after more than 50% of the carboplatin had been infused. Only one of three patients was successfully treated with the agent upon rechallenge.Carboplatin hypersensitivity reactions develop in patients who have been extensively pretreated with the agent. The clinical features are highly variable, but they are sufficiently different from those noted after the administration of paclitaxel that it should not be difficult to distinguish between reactions to the two agents. As carboplatin is increasingly used as initial and second-line chemotherapy of ovarian cancer and other malignancies, it can be anticipated that hypersensitivity reactions to the drug will become a more common and difficult clinical management issue.
Expression of matrix metalloproteinases and TIMP inhibitors in circulation/lung in patients with chronic obstructive pulmonary disease
Authors: Martin Petrek, Zdenka Navratilova, Zatloukal Jaromir, Eva Kriegova, Kolek Vitezslav
Journal: European Respiratory Journal (2012)

In chronic obstructive pulmonary disease (COPD), increased expression of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) has been repeatedly reported. Some of MMPs/TIMPs, e.g. MMP9, have been investigated both in serum and lung; others were measured only in one of these localisations.

To extend the profile of MMPs/TIMPs systemic / local expression in COPD, we created two pilot cohorts of COPD patients and control healthy subjects, both comprising 20 subjects. Protein expression of MMP2,8,9 and TIMP1,2,3,4 was determined in parallel in serum and in BronchoAlveolar Lavage Fluid (BALF) by a microsphere multiplex assay. To complement protein measurements, mRNA expression was evaluated in BAL cells which were available from 13 COPD patients and 18 controls.

Compared with controls, in patients MMP9 levels were increased systemically (serum protein: p =0.03) as well as locally (BALF protein: p <0.001, mRNA in BAL cells: p =0.002). MMP2 and 8 mRNA were upregulated in BAL cells ( p =0.001 and p =0.03, respectively); MMP8 protein was elevated in BALF ( p <<0.001). Serum concentrations of TIMP4 paralleled increase of MMP2 and 9 mRNA in BAL cells ( p =0.005 and p =0.007, respectively). The number of TIMP1 transcripts correlated with the number of months free of exacerbation(s) during 2-years follow-up after the BAL sampling ( p =0.03)

In conclusion, distinct expression profiles of MMPs/TIMPs were observed at systemic and local level in our COPD patients. These pilot data will be subject to further extension and verification, including subanalyses according to the GOLD stage.

Grant support: IGAPU_ LF\_2012\_07, CZ.1.05/2.1.00/01.0030.