tbuckley/cabot-search huggingface dataset:
An Abnormal Intraoperative Cholangiogram
Authors: Antonio Navarro-Sánchez, Hutan Ashrafian, Alberto Martínez-Isla
Journal: JAMA Surgery (2015)

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Better balance, fewer falls
Authors: Sarah E Lamb, Jill E Lamb
Journal: BMJ (2015)

Encourage older women to attend balance training

Falls are a major problem for older people because they are so common and can result in injury and loss of quality of life. Age associated decline in muscle strength and the nervous system can lead to a sense of unsteady walking. In turn, this can lead to a loss of confidence in moving and, for some people, serious falls.

We have known for some time that strength and balance training is effective in preventing falls and improving mobility and confidence.1 Most studies have lasted a maximum of a year period, and programmes require investment of time and effort from older people.1 This is not always a popular option.2

The linked article by El-Khoury and colleagues (doi:10.1136/bmj.h3830) provides important advances and reassurance and should help older people decide whether investment in exercise is worth it and what type of exercise to invest in.3 The logic of improving balance and unsteadiness to reduce falls is borne out once again in this well conducted trial including women from a broad geographical area of France. As not …
Concept of caring – Family caregiver's perspective on end-of-life care in advanced COPD
Authors: Bettina Korn
Journal: European Respiratory Journal (2011)

Background: Informal family caregivers provide the majority of care to patients with advanced COPD wishing to be cared for and die at home. Little is known about family caregiver's perspective on end-of-life care.

Aims: This study aimed to conceptualise caregiver's insight into caring for their family member with advanced COPD.

Methods: This sub analysis of data was part of a larger study and utilised an explorative descriptive qualitative design. Eight family caregivers that had cared for a loved one dying at home from COPD committed to semi-structured interviews about their experience. Transcripts of the interviews, field notes and reflective journal entries underwent a qualitative template analysis.

Results: The “concept of caring” was one of five themes identified. Seven subthemes within this theme describe the level of involvement caregivers had in the care of their family member. Carers understand complex care issues, describe the effect caring has on their own life and demonstrate organisational skills. They describe how family and kinship enables them to care and how they witness, recognise and respond to physical decline and suffering of their dying family member. Caring for their loved one was an all-encompassing, all-consuming affair and left them exhausted but gratified. A novel finding was the caregiver's detailed experiential knowledge of end-of-life care.

Conclusions: The key finding was family caregiver's experiential knowledge. This knowledge is largely unrecognised by health care professionals. It remains a challenge to health care professionals to tap into this wealth of caregiver's experiential knowledge in order to provide better end-of-life care in advanced COPD.
LSC 2011 Abstract: Bronchoalveolar lavage in radiation pneumonitis after radiotherapy for breast cancer
Authors: Claudia Lucia Toma, Aneta Serbescu, Mihai Alexe, Luminita Cervis, Diana Ionita, Miron Alexandru Bogdan
Journal: European Respiratory Journal (2011)

Radiation pneumonitis is a complication of radiotherapy which limits its application in cancer therapy.   Aim:  To compare the bronchoalveolar lavage (BAL) findings in patients with symptomatic radiation pneumonitis (RP) versus asymptomatic RP.   Material and method:  We evaluated 65 female patients with RP after radiotherapy for breast cancer.   Results:  Forty-nine patients were symptomatic (fever, cough and/or dyspnea) and 16 were asymptomatic. All patients had a newly discovered infiltrate or consolidation on chest radiography, corresponding to the radiation field. BAL in symptomatic patients had an increased number of cells.  Lymphocytosis was present in all patients with RP, but it was higher in symptomatic (34.9±18.81% vs. 26.14±14.3%). Macrophages were decreased in all patients. Neutrophils were slightly increased (8.88% in symptomatic and 3.34% in asymptomatic) and eosinophils were normal in both groups (2.56% and 1.22, respectively). Almost all lymphocytes were T type (CD3+). CD4+ lymphocytes were increased in both groups with normal CD4/CD8 ratio (2.72 in symptomatic and 1.5 in asymptomatic group).   Conclusion:  Lymphocytic alveolitis with T lymphocytes was present in all patients with RP with a higher proportion in symptomatic patients.
Acute undifferentiated human diarrhea in the tropics
Authors: J. G. Banwell, S. L. Gorbach, N. F. Pierce, R. Mitra, A. Mondal
Journal: Journal of Clinical Investigation (1971)

The nature and magnitude of fluid and electrolyte loss into the small intestine were defined by the marker perfusion technique in patients with acute undifferentiated diarrhea (AUD) in the tropics. The patients were divided into two groups according to their small bowel bacteriologic findings, namely those with a predominant Escherichia coli flora and those with a mixed flora. 11 normal subjects served as controls. Net jejunal fluid secretion occurred into the lumen in four of seven patients with E. coli flora and three of seven with a mixed flora. The magnitude of secretion in the jejunum was greater in the E. coli flora patients than in those with a mixed flora. Four E. coli patients and one mixed flora patient had net fluid secretion in the ileum, although the magnitude of secretion in this area was less than in the jejunum. Intestinal fluid had higher bicarbonate concentration in the ileum than in the jejunum but was isotonic in both regions. It resembled in composition fluid from the same region of intestine in normal individuals. Recovery of normal fluid and electrolyte absorptive function was usually complete in both jejunum and ileum by 6-8 days after onset of the disease. Increase in unidirectional flux rates for H3O and 24Na occurred in acute E. coli flora diarrhea and returned to normal levels in recovery: increase in Jβ (plasma to lumen flux) primarily accounted for the increase in fluid loss. Intestinal biopsy revealed no alterations in villous architecture.
Comparison of airway damage after swimming and indoor cycling in swimmers
Authors: Valerie Bougault, Julie Turmel, Louis-Philippe Boulet
Journal: European Respiratory Journal (2013)

Background : The respective roles of exercise ventilation and chlorine byproducts inhalation on the development of airway disorders observed in competitive swimmers remain to be determined.  Aim : To compare the effect of an exercise performed in a chlorinated swimming pool and on an bicycle at a same heart rate on pulmonary epithelium in swimmers.  Methods : Changes of pneumoproteins (surfactant-associated protein D (SP-D) and Clara cell protein (CC16)) were measured in the serum of 17 swimmers (19±3 years) before and 10 min after two identical training sessions: swimming (S) and cycling (C) sessions. Both sessions were performed at the same heart rate (166±7 b.min-1), at the same hour of the afternoon, and separated by at least one day. The total duration of each training was 41±1min, constituted of 6 to 8 repetitions of exercise periods (mean duration: 316±19sec) separated by one minute rest. A spirometry was performed before and 5 min after each session. During S, trichloramines varied from 0.2 to 0.5 ppm in the water and from 0.4 to 1.2 mg.m-3 in the air.  Results : No swimmers had a bronchoconstriction after S or C. No significant difference in serum CC16, SP-D, CC16/SP-D was observed at rest before S and C. The SP-D and CC16 were significantly increased in blood after S (p  Conclusion : Our study suggests that exercise induces airway damage, probably increased by chlorine by-products inhalation.
Abstract 1712: Sunitinib-resistant ccRCC cell lines subjected to TKI/mTOR inhibitors as a model for sequence therapy
Authors: Gerhard Unteregger, Darja Schendel, Joana Heinzelmann, Anne Weiland, Simone Ernst, Michael Stoeckle, Kerstin Junker
Journal: Cancer Research (2014)

Abstract Introduction: Treatment of advanced renal cell carcinoma (RCC) by tyrosine kinase inhibitors like Sunitinib (SUN) is hampered by the appearance of drug resistance. Sequence therapy using different TKIs as well as inhibitors attacking the mTOR pathway offers a promising tool to overcome this lack in ccRCC therapy. Material and Methods: CAKI-1/2, A-498 and 786-O cell lines were treated with different SUN-concentrations to obtain the corresponding IC50-values. Using sub-lethal SUNI-concentrations they were cultivated for up to 20 passages. At defined intervals total RNA was isolated. Microarray analysis was performed for a global miRNA expression profiling, SUN-resistant cell lines were subjected to an ongoing sequence therapy using TKI 258 (Novartis) and RAD001 as a mTOR inhibitor. Resistance-development as well as drug efficacy during sequence therapy was monitored by sequential quantification of the growth behavior and changes in drug-sensitivity by proliferation-assays. Results: Growth behavior of all ccRCC cell lines during SUN-application is reduced down to 10-60% depending on cell number and cell type. Long term application (10-20 passages) of SUN at concentrations near the IC50 value results in a constantly increasing drug resistance and the cells acquire a growth rate of 60-90% compared to the untreated long term control. Accordingly to these phenomenon we observed characteristic changes in miRNA expression. Starting sequence therapy SUN-resistant cell lines (CAKI-1 and 786-0) offer initially an increase in drug resistance to TKI 258 in pretreated CAKI-1 cells. In contrast long term SUN-application had no influence in the sensitivity to RAD001 as compared to untreated controls in both cell lines. Conclusion: Understanding the molecular changes during drug resistance in ccRCC provides an indispensable prerequisite to create new therapeutic strategies in the treatment of metastatic renal cell carcinoma. The results indicate a complex mechanism in drug resistance depending on therapeutic protocol and cell type. However, drug-resistant cell lines offer a promising tool to elucidate the molecular mechanism responsible for drug-resistance as well as to simulate the benefit of a sequence therapy. Since miRNAs represent an important tool in gene regulation the observed patterns may help to elucidate new genes involved in drug resistance in ccRCC. Citation Format: Gerhard Unteregger, Darja Schendel, Joana Heinzelmann, Anne Weiland, Simone Ernst, Michael Stoeckle, Kerstin Junker. Sunitinib-resistant ccRCC cell lines subjected to TKI/mTOR inhibitors as a model for sequence therapy. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1712. doi:10.1158/1538-7445.AM2014-1712
Association of breast milk fatty acids at 6 weeks and 6 months with wheezing phenotypes and asthma - the Ulm birth cohort study
Authors: Chad Logan, Stephanie Brandt, Martin Wabitsch, Ines Florath, Hermann Brenner, Tamás Marosvölgyi, Tamás Decsi, Dietrich Rothenbacher, Jon Genuneit
Journal: European Respiratory Journal (2014)

Rationale: A role of breast milk fatty acids in allergic disease has been implicated by various studies documenting their effects on atopic eczema or atopic sensitization. However, data on the effects on wheezing and asthma are scarce.

Objectives: Our aim was to explore the association of a range of breast milk fatty acids with childhood asthma and wheezing phenotypes up to age 11 years.

Methods: Breast milk was collected at 6 weeks and 6 months of age in the Ulm Birth Cohort Study (n=704 and n=449, respectively). Fatty acids were measured by high-resolution capillary gas-liquid chromatography, expressed as %weight of total fat weight, and analyzed individually or in chemically grouped sums. Adjusted risk ratios with parent-reported wheezing phenotypes and doctor-diagnosed asthma were computed using a modified Poisson regression.

Results: Patterns of associations differed across sampling periods and outcome. The associations for doctor-diagnosed asthma resembled associations for late-onset wheeze. We observed more associations in the 6-week than the 6-month study population, in particular (i) positive associations of ω3 polyunsaturated fatty acids (PUFA) with all but early transient wheeze, (ii) positive associations of ω6-PUFA with late-onset wheeze and doctor-diagnosed asthma, and (iii) negative associations of the ω6/ω3-ratio with persistent and late-onset wheeze.

Conclusion: Exposure to several ω3-and ω6-PUFA in the breast milk may play a role in the development of childhood asthma.
Is education about small volume nebulizer aerosol, by an expert respiratory nurse to colleagues, a guarantee for better adherence to aerosol guidelines?
Authors: Daniel Schuermans, Fatima Snoussii, Annemie Schoonis, Pascale Oumaziz
Journal: European Respiratory Journal (2014)

Aim:  To investigate whether education of the correct guidelines, about nebulization during hospitalisation, has an impact for better use of nebulisation.   Materials and methods:   In two hospitals an individual questionnaire was distributed about correct use, education and correct patient instructions in 2010. After an intensive educational programme during 2013 in both hospitals, the same questionnaire was performed in 2014.  Questions were: Did you have special nebulization education recently? Which is the preferred system for correct use: a mask or mouthpiece? At which flow and for how long do you use the nebulizer? Which instructions do you give to the patients about their breathing pattern?   Results:  There were 312 responders in 2010 (group A) and 318 in 2014 (group B). A sub analysis in group B is done between recently educated n= 98 (group B1) or not n=202 (group B2).   Conclusion:  Overall, the existing procedure for nebulization protocols was poorly adhered to in 2010 but improved significant in 2014. In 2014 a significant difference is found in the educated group which caused the difference 2010 versus 2014. Education implies better adherence to nebulisation guidelines, although there is still room for improvement.
Involvement of cytoskeletal protein paxillin in the pathogenesis of pulmonary hypertension
Authors: Christine Veith, Werner Seeger, Norbert Weissmann, Grazyna Kwapiszewska
Journal: European Respiratory Journal (2011)

Pulmonary arterial hypertension (PAH) is a fatal disease characterised by a pronounced remodelling of the pulmonary vasculature. The remodelling process entails deposition of the extracellular matrix (ECM) proteins, proliferation of pulmonary arterial smooth muscle cells (PASMC), and changes in the composition of cytoskeletal proteins. Paxillin is one of the most important cytoskeletal proteins, mediating protein-protein interactions and consequently modulating cell signalling. In this study we have investigated the contribution of Paxillin in vascular remodelling.  In lungs of IPAH patients we detected enhanced Paxillin expression compared to controls on both mRNA and protein levels. Immunohistochemical analysis demonstrated expression of Paxillin in pulmonary vasculature and PASMC. Similarly, in the hypoxia mouse model of pulmonary hypertension, expression of Paxillin was localised to the vessels. Laser microdissection of intrapulmonary arteries revealed elevated Paxillin expression in hypoxic lung vessels. Functional measurements were performed by silencing Paxillin expression. Paxillin knockdown caused changes in the phosphorylation status of Akt, and Erk1/2 leading to decreased cell viability, proliferation as well as increased apoptosis of human primary PASMC. Furthermore, immunofluorescence of PASMC revealed that Paxillin knockdown led to cytoskeletal alterations and impaired cell adhesion.  Paxillin has previously been documented to be involved in cell spreading and migration, features characteristic of vascular remodelling. This is however the first report that indicates the involvement of Paxillin in vascular remodelling in the lung, and its association with human PAH disease.
Behavior, knowledge and attitude of Iranian professional athletes towards smoking
Authors: Zahra Hessami, Hooman Sharifi, Gholamreza Heydari, Mohammadreza Masjedi, Mahshid Aryanpur
Journal: European Respiratory Journal (2012)

Purpose   This study aimed to assess the rate of tobacco consumption among professional athletes in Iran and assessing their knowledge and attitude in this regard.   Materials and Methods:  A total of 738 athletes from 10 different types of sports were evaluated. Athletes were all members of the priority leagues. After obtaining consent from the Physical Education Organization and coordination with the related federations, athletes were asked to fill out the standard questionnaire.   Findings:  All understudy subjects were males. The mean age was 28.4±2.7 yrs. A total of 46.7% had high school diploma. In general, 293 subjects (39.7%) were playing individual and 445 (60.3%) were playing team sports. The mean age of initiation of sport in these subjects was reported to be 12.3±4.01 yrs... Sixty four subjects (9%) were current smokers. Twenty one cases (44.7%) were smoking less than 10 cigarettes a day. A total of 26 (66.7%) current smokers stated that smoking helps them in sport competitions. A total of 40 sportsmen from individual sports were current smokers, this rate was 24 (5.5%) among team players (P=0.00). The mean score of knowledge about hazards of smoking was 7.8±0.62 and the mean score of attitude was 26.4±4.1   Conclusion:  Rate of smoking among professional athletes is lower than general population average. So participation in organized sports may be a protective factor against tobacco use in people. Percentage of smoker athletes was significantly higher in individual sports compared to team sports. Athletes had good knowledge about hazards of smoking and had a positive attitude in this respect. Further studies are needed to evaluate reasons of cigarette and hookah smoking among athletes.
Impact of chromosomal translocations on prognosis in childhood acute lymphoblastic leukemia.
Authors: C M Rubin, M M Le Beau, R Mick, M A Bitter, J Nachman, R Rudinsky, H J Appel, E Morgan, C R Suarez, H R Schumacher
Journal: Journal of Clinical Oncology (1991)

The presence of a chromosomal translocation in the leukemic cells at diagnosis of acute lymphoblastic leukemia (ALL) in children is associated with a high risk for treatment failure. We have reexamined the relationship between translocations and prognosis in 146 children with ALL who received risk-based therapy such that high-risk patients were treated with intensive drug schedules. In univariate analysis, multiple factors were associated with a relatively poor event-free survival (EFS) including age less than 2 years or greater than 10 years (combined group), WBC count greater than 10 x 10(9)/L, French-American-British (FAB) morphologic classification L2, absence of common ALL antigen (CALLA, CD10) expression, absence of hyperdiploidy with a chromosome number of 50 to 60, and presence of the specific translocations t(4; 11)(q21;q23) or t(9;22)(q34;q11) (combined group). However, there was no disadvantage with respect to EFS in patients with translocations compared with those who lacked translocations (73% at 4 years in both groups). Furthermore, when patients with specific cytogenetic abnormalities for which the prognostic significance has been well established (hyperdiploid 50 to 60, t(4;11), and t(9;22] were removed from the analysis, the remaining group with other translocations had a better EFS than the remaining group lacking translocations, although this was not statistically significant (81% v 65% at 4 years, P = .24). In a multivariate analysis, a model including WBC count and FAB classification was the strongest predictor of EFS. The presence or absence of translocations was not an independent predictor of EFS and did not contribute to the ability of any model to predict EFS. In conclusion, when effective intensive therapy is used to treat childhood ALL with high-risk clinical features, categorization of patients on the basis of chromosomal translocations without attention to the specific abnormality is not useful as a prognostic factor.
Providers' concordance with survivorship clinical algorithms.
Authors: Frances Ann Zandstra, Guadalupe R. Palos, Ludivine Russell, Katherine R. Gilmore, Jacklyn J. Flores, Delrose Ozeri, Maria Alma Rodriguez
Journal: Journal of Clinical Oncology (2013)

e20645 Background: The utility of algorithms to guide clinical practice related to long-term survivorship care is unclear. In 2012, lymphoma survivorship algorithms for Hodgkin’s and Large B-Cell were developed as part of an institutional clinical practice initiative to enhance survivors’ outcomes. Here we describe providers’ concordance with minimum standards recommended in survivorship lymphoma algorithms. Methods: Concordance, the primary outcome, was defined as whether minimum recommendations, summarized in lymphoma algorithms, were provided during a survivorship visit. Concordance was measured using a “yes/no” response format assessing whether a provider’s recommendations were consistent with algorithms’ minimum standards including: 1) physical examination, 2) laboratory and imaging testing, 3) cancer screening procedures, and 4) health promotion education. Data were abstracted from electronic medical records and Passports (summary care plans). Secondary outcomes were number of survivors seen and Passports issued. All data included in these analyses were de-identified. Results: From 05/01 to 09/30/2012, all 63 survivors seen in the Lymphoma Survivorship Clinic received a Passport. Providers individualized Passports based on a survivor’s needs relevant to disease surveillance, life-style changes, screening recommendations, and specific procedures to assess for a recurrence or late treatment effects. Results indicated 100% of survivors received a physical exam, adult vaccinations, and cardiovascular screening. Similar rates were achieved for CBC testing, chest X-rays, assessing survivors’ psychosocial distress, and counseling survivors on screening recommendations specific to breast, cervical, colorectal and prostate cancers. Additionally, rates for skin exam recommendations were 97%. Conclusions: Based on concordance results, providers met the minimum recommendations listed in the lymphoma algorithms. Future research is needed to assess the impact of providers’ use of algorithms on survivors’ outcomes and feasibility of replicating concordance analyses in other clinical care settings.