tbuckley/cabot-search huggingface dataset:
Drug-induced sleependoscopy in children with persistent obstructive sleep apnoea following adenotonsillectomy
Authors: An Boudewyns, Stijn Verhulst, Mieke Maris, Vera Saldien, Paul Van de Heyning
Journal: European Respiratory Journal (2013)

Introduction: Children with persistent symptoms of snoring or obstructive sleep apnoea (OSA) following (adeno) tonsillectomy (A)TE should undergo a comprehensive upper airway (UA) evaluation to guide future treatment.  Aim: To investigate the value of drug-induced sleep endoscopy (DISE) in children with residual symptomatic disease following (A)TE.  Methods: Children with persistent symptoms of upper airway obstruction (snoring, noisy breathing, apnea) or daytime symptoms following (A)TE and abnormal polysomnographic findings were included. Each child underwent an endoscopic examination of the upper airway during spontaneous breathing following administration of sevoflurane and/or propofol. During DISE, site (s) of UA obstruction or hypotonia were documented.  Results: Data are available for 10 children with a previous history of ATE (n=5) or adenotomy (n=5). Age 7.3 ± 2.3 years, BMI 16.5 ± 4.7 kg/m2, obstructive apnea/hypopnea index: 11. 5 ± 18.8/hr. None of them had significant adenoid obstruction requiring adenotomy. Two children had significant obstruction at the level of the tonsils and underwent a tonsillectomy. Five had global airway hypotonia and 3 had laryngomalacia. Collapse at the level of the tonguebase or epiglottis occured in combination with obstruction at other levels. These findings directed further treatment (either medical, orthodontic or CPAP).  Conclusions: DISE allows for detection of sites with persistent UA collapse or hypotonia in children with residual symptoms of upper airway obstruction following adeno (tonsillectomy). This information should be taken into account before additional treatment decisions are made.
Maintaining older people's dignity and autonomy in healthcare settings
Authors: A J D Macdonald, P. Malouf, F. Paulus
Journal: BMJ (2001)

Editor—Unfortunately, I cannot agree with Lothian and Philp in their article on the dignity and autonomy of older people in the healthcare setting.1 On several occasions I have put forward the view that British health care is failing older patients as a consequence of system-wide abuse of staff, managers, purchasers, and politicians.2,3 As long as this corrosive, self sustaining culture remains untouched it is impossible to improve the dignity and autonomy of any group, let alone the more disadvantaged ones. What Lothian and Philp call the anecdotal evidence of a continuing, serious problem is already overwhelming and is still growing.

Recently, a 91 year old family member was finally given a hospital bed after being taken to an accident and emergency department after falling down the stairs. She had fractured three ribs and sustained a severe, immobilising calf injury. She spent eight hours, until 3 am, in hospital A's accident and emergency department on a trolley. She was admitted to a ward for six hours and then transferred to hospital B, where she spent 10 hours in the accident and emergency department on a trolley, without food or drink until her daughter arrived, before being admitted to a ward.

After 18 hours she was transferred back to hospital A, where she waited again on a trolley in the accident and emergency department. Her daughter became distressed at this and made a formal complaint, whereupon a bed was found, although the atmosphere was unpleasant. At no point did she receive any considered investigation or treatment.

Several dedicated, hard working, and kind NHS staff watched this happen with apparent indifference. If you can tell anything at all about theory from the current raft of documents from the Department of Health3,4 the government seems to explain this outrage (both what happened and what did not happen) in terms of either the absence of clear and agreed standards or, as Lothian and Philp do, inadequacies in training. The evidence for the former is overwhelmingly negative and for the latter at best scanty.

We must stop wasting time and energy on standards and frameworks5: they simply add to the abusive cycle and make things worse. We must also stop the scapegoating of frontline staff by suggesting that retraining will help. Until we look at the whole system, away from the patients and staff immediately involved, we will never prevent such degrading treatment.
Is flying safe for individuals with pulmonary arteriovenous malformations and hereditary haemorrhagic telangiectasia? A questionnaire-based study
Authors: Christopher Mason, Claire Shovlin
Journal: European Respiratory Journal (2011)

Background:  Flight-related complications reported in individuals with pulmonary arteriovenous malformations (PAVMs) and hereditary haemorrhagic telangiectasia (HHT) have included deep venous thrombosis (DVT), ischaemic stroke, and haemorrhage from PAVMs. In addition there are concerns that the reduced barometric pressure associated with flying might exacerbate PAVM-induced hypoxaemia.   Methods:  With ethical approval (NRES 10/H0806/8), individuals with PAVMs and/or HHT were sent a questionnaire to document flights they had taken, and symptoms experienced during or shortly afterwards. Responses were correlated with sea level erect oxygen saturations (SaO 2 ), and haemoglobin (Hb).   Results:  159 replies were received (response rate 52%). 147 individuals had flown, 97 (66%) with PAVMs. The median number of flights per individual was 25, totalling 18,943 flight hours in 3,950 flights. 111 (77%) respondents reported no complications. Six (4%) reported dyspnoea, two (1%) had a deep vein thrombosis, and one had an ischaemic stroke whilst flying. However the most common in-flight complications were HHT-related nosebleeds, reported by 26 (18%). There was no difference in SaO 2  at sea level between those who reported dyspnoea, and those who did not (medians 93 [range 85–96]%; 94 [84–99]%). There was also no difference in Hb measured in clinic between the groups that developed complications, and those who did not.   Conclusion:  Flight appears safe for the majority of individuals with PAVMs and HHT. It is difficult to predict who will experience complications. Recognition of potential thrombotic and haemorrhagic sequelae should influence pre-flight advice.
Pivotal preclinical trial of the spheroid reservoir bioartificial liver
Authors: Jaime M. Glorioso, Shennen A. Mao, Brian Rodysill, Taufic Mounajjed, Walter K. Kremers, Faysal Elgilani, Raymond D. Hickey, Hakon Haugaa, Christopher F. Rose, Bruce Amiot, Scott L. Nyberg
Journal: Journal of Hepatology (2015)
Angiotensin II receptor 1 blocker (losartan) restores the ability of the lung to clear edema in rats
Authors: Reem Ismael-Badarneh, Julia Guetta, Niroz Abu-Saleh, Geula Klorin, Gidon Berger, Zaid Abassi, Zaher Azzam
Journal: European Respiratory Journal (2013)

Alveolar fluid clearance (AFC) is important in keeping the airspaces free of edema, mainly due to alveolar epithelial Na,K-ATPase pump and Na channels (ENaC). Angiotensin II (AngII) stimulates a variety of physiologic responses that supports arterial blood pressure and renal function. We previously showed that AngII impairs AFC (AFC in control rats was 0.44±0.04 ml/h (Mean ± SEM) and decreased by 40% in AngII treated rats (P = 0.003)). AngII effects are mediated by two specific receptors; AT1 and AT2. The localization of these two receptors in the lung was recently discovered, specifically in alveolar epithelial cells type II (ATII), but no studies investigated whether they play a role in AFC. In order to understand AngII mechanism, we investigated the effect of AT1 specific blocker (Losartan) using the isolated perfused lung model. Losartan administration, followed by AngII restored the inhibitory effect of AngII, indicating an AT1 mediated effect of AngII on AFC.

Furthermore, Oubain (Na,K-ATPase ihhibitor) and Amiloride (ENaC ihibitor) reduced AFC to 5.9±0.4 ml/hr and 5.8±0.11 ml/hr respectively. The administration of either Oubain or Amiloride with AngII tended to have more inhibitory effect on AFC (4.41±0.2 ml/hr or 5.29±0.08ml/hr respectively), suggesting that AngII signaling may target more than one protein. In ATII cells treated with AngII the expression of AT1 levels was upregulated. Notably, there was no significant change in αNa,K-ATPase and αENaC abundance after AngII treatment.

We herein provide a new mechanism of clinical relevance by which angiotensin adversely impairs the ability of the lungs to clear edema.
Abstract 5918: Length of Stay for Acute Heart Failure: Effects of Cohorting Patients on Variability
Authors: Mitchell Saltzberg, Maria Albert, Donna Mahoney, Lynne Bouffard, William Weintraub
Journal: Circulation (2008)

Background: Quality metrics for heart failure (HF) are increasingly utilized as an indicator of quality care. Mean length of stay (LOS) is a commonly utilized metric that is made available to the public but variability in LOS is not reported. Efforts to cohort HF pts in the hospital improve quality of care but the effect on LOS is less well defined. Methods: As part of an ongoing performance improvement project at ChristianaCare, LOS was evaluated using standard descriptive statistics. A LOS distribution was also generated monthly to visualize LOS variability. Comparisons were made for HF pts cohorted on a dedicated HF unit (HFU) vs. all other units (Other) and by inclusion/exclusion of HF pts with prolonged LOS &gt; 10 days to reduce the effects of outliers. Results: 71 % of all HF patients were discharged in &lt; 5 days, 82 % in &lt; 10 days. Mean LOS (March 07–March 08) for HF was 6.63 days overall (6.1 HFU vs. 7.2 other; p = 0.05). After exclusion of long LOS HF pts, mean LOS fell to 4.4 days (4.3 HFU vs. 4.5 Other; p = 0.06). Median LOS for all HF patients was 5.0 days regardless of location. The standard deviation of LOS was significantly lower for HFU patients (4.5 vs. 11.5 days, p &lt; 0.02) The LOS graph (Graph 1) highlights the wide variability in LOS and how mean statistics may be misleading. Conclusions: Mean LOS can be misleading as a metric for quality of HF care provided as outliers significantly impact this value. Other statistics and graphical displays can more accurately reflect quality of care. In addition, cohorting of HF patients significantly reduces overall variability in LOS and suggests a more consistent approach to acute HF care.
Continuos positive airway pressure by helmet in exacerbation of idiopathic pulmonary fibrosis
Authors: Stefano Baglioni, Amir Eslami, Patrizia Liuzzi, Marta Abbritti, Elvio Scoscia, Maurizio Dottorini
Journal: European Respiratory Journal (2013)

The prognosis of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF)is very poor, and the role of conventional mechanical ventilation (CMV)in these patients is questionable. Noninvasive mechanical ventilation (NIV)has been used to avoid intubation and CMV in acute respiratory failure (ARF), including ARDS. NIV could have a role also reducing dyspnoea in this kind of patients.  We describe the outcome of a group of 16 pts. suffering from AE-IPF, admitted to our four -bed Respiratory Intensive Care Unit (RICU) for ARF, treated with CPAP application by helmet.  METHODS:Inclusion criteria: recent worsening of dyspnoea (within one month), severe hypoxemic ARF, diagnosis of IPF, CHEST X-ray or CT confirming IPF exacerbation, exclusion of other known causes of exacerbation. An informed consent was obtained from each patient.Microbiological tests included blood cultures and BAL. All pts. were treated with high-dose corticosteroids.  CPAP was delivered through a high flow generator by helmet (Harol srl, MI, Italy); CPAP was applied with an initial PEEP of 10 cmH2O and a FiO2 set to mantain a SaO2≥ 92%.  RESULTS: PaO2 improved significantly after CPAP application by helmet in the majority of subjects. 5 pts. required tracheal intubation and CMV, 9 died (56%) during RICU stay, one pt. passed away after discharge to general ward. 4 refused intubation. Only one among the intubated patients survived. Mean duration of CPAP application was.7.7± 2.9 days, global tolerability was good (only 1 made the decision to stop helmet after few hours).  CONCLUSION: CPAP application by helmet in AE-IPF could be an accettable modality of treatment, improving PaO2, reducing dyspnoea and avoiding CMV.
LSC 2014 abstract - Increased myelopoiesis induced by cigarette smoke transiently increases kinetics of lung bacterial clearance in mice
Authors: Paola Basilico, Tiziana Patrizia Cremona, Charaf Benarafa
Journal: European Respiratory Journal (2014)

Effective clearance of pulmonary bacterial infections requires a rapid mobilization of neutrophils from the bone marrow to the blood and to the infection site. Mice deficient in the neutrophil protease inhibitor serpinB1 ( sB1 -/-  ) have a defect in bacterial clearance associated with decreased neutrophil survival, bone marrow neutropenia and increased protease activity. Here we evaluated bacterial clearance from the lungs of mice exposed to cigarette smoke for 6 weeks (5h/day, 5days/week) in combination with dysregulated neutrophil protease activity ( sB1 -/-   mice). Interestingly,  sB1 -/-   mice exposed to cigarette smoke had an efficient clearance of lung  P. aeruginosa  (PAO1) when infected 24h after the last smoke exposure. Increased clearance kinetics were also observed in wild-type mice exposed to cigarette smoke and infected with  P. aeruginosa  as well as with  S. pneumoniae  (6B and 19F). Importantly, when mice were inoculated 2 and 6 weeks after smoking cessation, clearance kinetics returned to levels similar to mice never exposed to cigarette smoke. We found that neutrophil proliferation and counts in the bone marrow was increased following smoke exposure. Similarly, treatment of  sB1 -/-   mice with G-CSF for 5 days also increased neutrophil numbers and was associated with an ameliorated bacterial clearance. Our findings indicate that cigarette smoke exposure dramatically but transiently accelerates the kinetics of  P. aeruginosa  and  S. pneumoniae  clearance in the lungs in part through systemic inflammation resulting in increased neutrophil production.
Effect of COPD severity on hemodynamic responses to exercise in patients with GOLD stages I-IV
Authors: Maroula Vasilopoulou, Ioannis Vogiatzis, Ioannis Nasis, Stavroula Spetsioti, Evgenia Cherouveim, George Kaltsakas, Eleni Kortianou, Maria Koskolou, Antonia Koutsoukou, Manos Alchanatis, Nikolaos G. Koulouris
Journal: European Respiratory Journal (2011)

Introduction:  Exercise-induced dynamic hyperinflation and large intrathoracic pressure swings can compromise the normal increase in cardiac output (Q) during exercise in COPD. Therefore, it is anticipated that the greater the disease severity, the greater would be the impairment in Q during exercise.   Aim:  Thus, the aim of the study was to investigate whether the Q response is more severely impaired in the more advanced stages of COPD.   Method:  We studied sixty COPD patients (15 patients at each stage, I to IV). Patients undertook a constant load test (75% WR peak ) and a six minute walking test (6MWT). Q at rest and during exercise protocols measured by bioimpedance (PhysioFlow, Enduro) to determine the kinetic response at the onset of exercise (On-transient) and during recovery (Off-transient).   Results:  While Q kinetics (On & Off) was not different between the two exercise protocols, on-transient and off-transient time constants were slower the more severe the disease severity was (Table 1).   Conclusion:  The more advanced the disease severity the more impaired was the hemodynamic response to the 6MWT and the constant load test, possibly reflecting greater cardiovascular impairment in COPD or greater physical deconditioning. The 6MWT reflects, equally well as the constant load test, the degree of impairment in the hemodynamic response to exercise.
Prospective randomized trial comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic totally extra peritoneal (TEP) approach for bilateral inguinal hernias
Authors: Deborshi Sharma, Kamal Yadav, Priya Hazrah, Saurabh Borgharia, Romesh Lal, Shaji Thomas
Journal: International Journal of Surgery (2015)
Impact of weight on anaerobic threshold (AT) values in preoperative assessment
Authors: Bethany Howard, Jonathan Fuld, Richard Parker, Jennifer Colbourne, Karl Sylvester
Journal: European Respiratory Journal (2011)

Introduction:  AT is an outcome often used in preoperative assessment. Although usually calculated using total body mass (TBM), as fat uses minimal oxygen, using lean body mass (LBM) may be more appropriate.   Method:  Retrospective data was collected from 95 patients (47M/48F) performing ramp cycle ergometry. Age range 11 to 82 years, standing height 1.39 to 1.96 metres, weight 30 to 140 kg and BMI 15.9 to 52 kg/m 2 . AT was quoted as ml/kg/min for TBM and adjusted for LBM using Boer formulae.   Results:  Considering AT adjustment by TBM to LBM: i) Bland Altman plots demonstrated a positive bias (fig. 1), with overweight/obese BMI (>25 kg/m 2 ) patients9 AT adjusted to a greater proportion than underweight/normal BMI ( 2 ) patients; ii) The mean (±2SD) 95% limits of agreement for change in AT was 4.4 (±3.6) ml/kg/min in underweight/normal BMI versus 7.4 (±5.6) ml/kg/min in overweight/obese BMI; iii) Using transformed Kendall9s tau 28% of patients changed relative ranking with weak correlation (Kendall tau coefficient 0.437). Using a cutoff of 11 ml/kg/min, 29% of patients were considered unfit for surgery using TBM adjustment versus 1% adjusting for LBM; here the mean change in anaerobic threshold was 5.6 ml/kg/min.   Conclusions:  AT reporting by TBM or LBM has potentially important impacts. These relate to relative ranking of individuals fitness and their ability to reach preset thresholds of operative suitability, both more marked with increasing BMI.
Relationship between obstructive sleep apnea syndrome severity and age
Authors: Nesrin Kiral, Banu Salepçi, Ali Fidan, Elif Torun, Sevda Cömert, Gülsen Saraç, Ayse Havan, Benan Çaglayan
Journal: European Respiratory Journal (2011)

Aim:  To investigate the effect of age on severity of obstructive sleep apnea syndrome (OSAS) severity was the aim of this study.   Material and Method:  The files of 874 OSAS patients diagnosed in our sleep laboratory between January 2005 – January 2010 were retrospectively analysed. Polysomnography was performed with Sleep Screen - Viasys device and scorring was done according to the criteria of Rech-Schaffen Kales. Chi-square and student9s t-test was used in statistical analysis.   Results:  There were of 874 OSAS cases in the study. The mean age was 49.1±10.7 and of the cases, 602 (68.9%) were male, 272 (31.1%) were female. The severity of OSAS was mild in 235 (26.9%), moderate in 224 (25.6%) and severe in 415 (47.5%). A great majority of OSAS cases were belonging (65.2%) 40-59 years age group. Younger cases were 18.2% and older cases were%16.7 of OSAS patients. Mean AHI was 33.9 in younger (age   Conclusion:  OSAS is getting worser as the age is getting advanced.
Intracellular pH and Glycolysis in Ehrlich Ascites Tumor Cells: Effect of Membrane-Active Drugs in Potassium Depletion2
Authors: Doris T. Poole, Thomas C. Butler, Mary E. Williams
Journal: JNCI Journal of the National Cancer Institute (1972)

Journal Article Intracellular pH and Glycolysis in Ehrlich Ascites Tumor Cells: Effect of Membrane-Active Drugs in Potassium Depletion Get access Doris T. Poole, Doris T. Poole Search for other works by this author on: Oxford Academic PubMed Google Scholar Thomas C. Butler, Thomas C. Butler Search for other works by this author on: Oxford Academic PubMed Google Scholar Mary E. Williams Mary E. Williams Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 49, Issue 6, December 1972, Pages 1659–1665, https://doi.org/10.1093/jnci/49.6.1659 Published: 01 December 1972 Article history Received: 12 June 1972 Accepted: 22 August 1972 Published: 01 December 1972
Growth and Persistence of Friend Leukemia Virus In Tissue Culture&lt;xref ref-type="fn" rid="FN1"&gt;2&lt;/xref&gt;
Authors: Alice E. Moore
Journal: JNCI Journal of the National Cancer Institute (1963)

Mouse-embryo tissue cultures that had been exposed to leukemic cells obtained from mice inoculated with Friend virus continued to produce small amounts of infective virus for periods up to 633 days. No cytopathic effect or growth of leukemic cells was noted. Mouse embryo cells exposed to leukemic filtrates and passed 30 times at weekly intervals produced leukemia when inoculated into mice, but only erratically and unpredictably. Many different culture methods used to increase the virus yield were unsuccessful.
Risk of Leukemia Associated With the First Course of Cancer Treatment: An Analysis of the Surveillance, Epidemiology, and End Results Program Experience&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: R E Curtis, B F Hankey, M H Myers, J L Young
Journal: JNCI Journal of the National Cancer Institute (1984)

The risk of leukemia associated with the first course of cancer treatment was evaluated in over 440,000 patients diagnosed during 1973-80 (average follow-up = 1.91 yr) from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Although the reporting of the first course of therapy probably was incomplete, 34 acute nonlymphocytic leukemias (ANLL) developed compared with 7.6 expected among 70,674 patients known to receive initial chemotherapy [relative risk (RR) = 4.5, 95% confidence interval (Cl) = 3.1-6.3]. Significant ANLL excesses were observed following chemotherapy for breast cancer (RR = 8.1), ovarian cancer (RR = 22.2), and multiple myeloma (RR = 9.5). Patients initially treated with radiation (with no record of chemotherapy) also had a significantly increased ANLL risk; 45 leukemias occurred versus 17.9 expected (RR = 2.5, 95% Cl = 1.8-3.4). In this group, excess ANLL were found following irradiation for uterine corpus cancer (RR = 4.0). Kidney and renal pelvis cancer patients had a twofold leukemia risk (all types) that was unrelated to treatment (RR = 2.2).
Tuberculosis and other opportunistic infections in tofacitinib-treated patients with rheumatoid arthritis
Authors: K L Winthrop, S-H Park, A Gul, M H Cardiel, J J Gomez-Reino, Y Tanaka, K Kwok, T Lukic, E Mortensen, D Ponce de Leon, R Riese, H Valdez
Journal: Annals of the Rheumatic Diseases (2015)

Objectives To evaluate the risk of opportunistic infections (OIs) in patients with rheumatoid arthritis (RA) treated with tofacitinib. Methods Phase II, III and long-term extension clinical trial data (April 2013 data-cut) from the tofacitinib RA programme were reviewed. OIs defined a priori included mycobacterial and fungal infections, multidermatomal herpes zoster and other viral infections associated with immunosuppression. For OIs, we calculated crude incidence rates (IRs; per 100 patient-years (95% CI)); for tuberculosis (TB) specifically, we calculated rates stratified by patient enrolment region according to background TB IR (per 100 patient-years): low (≤0.01), medium (&gt;0.01 to ≤0.05) and high (&gt;0.05). Results We identified 60 OIs among 5671 subjects; all occurred among tofacitinib-treated patients. TB (crude IR 0.21, 95% CI of (0.14 to 0.30)) was the most common OI (n=26); median time between drug start and diagnosis was 64 weeks (range 15–161 weeks). Twenty-one cases (81%) occurred in countries with high background TB IR, and the rate varied with regional background TB IR: low 0.02 (0.003 to 0.15), medium 0.08 (0.03 to 0.21) and high 0.75 (0.49 to 1.15). In Phase III studies, 263 patients diagnosed with latent TB infection were treated with isoniazid and tofacitinib concurrently; none developed TB. For OIs other than TB, 34 events were reported (crude IR 0.25 (95% CI 0.18 to 0.36)). Conclusions Within the global tofacitinib RA development programme, TB was the most common OI reported but was rare in regions of low and medium TB incidence. Patients who screen positive for latent TB can be treated with isoniazid during tofacitinib therapy.