tbuckley/cabot-search huggingface dataset:
Behavioral treatment in two cases of obsessive-compulsive disorder with concomitant bipolar affective disorder
Authors: L Baer, W E Minichiello, M A Jenike
Journal: American Journal of Psychiatry (1985)

The authors describe two cases of obsessive-compulsive disorder with concomitant bipolar affective disorder. Behavior therapy consisting of in vivo exposure plus response prevention controlled the obsessive-compulsive symptoms only after the affective illness was well controlled pharmacologically.
Telespirometry in the Netherlands
Authors: Christian F. Melissant, Joep Hoevenaars
Journal: European Respiratory Journal (2011)

Diagnosing obstructive pulmonary disease has proven difficult in primary practice, leading to incorrect referrals. In telespirometry general practitioners (GPs) digitally consult pulmonologists for advice on spirometry. We hypothesized, that telespirometry, applied after patient selection by the GP, would reduce referrals and improve triage of referrals.  GPs log on to a secured web-based teleconsultation system (KSYOS) and send a lung function (PDF) and - voluntarily - some clinical information to the pulmonologist. Its purpose was to ask advice or to prevent referral. 293 closed teleconsultations were analyzed.  The GP answers two quality indicators, before (Q1) and after (Q2) each teleconsultation:   (Q1:) Without telespirometry, would you have referred this patient to the hospital?    (Q2:) Will you refer this patient to the hospital?   Of the total 101 teleconsultations intended for referral, 75 referrals (74%) were prevented. Of 192 teleconsultations intended for advice (2/3 of all teleconsultations), 42 patients (22%) were referred after teleconsultation.  Although still small numbers, this analysis shows a reduction in referrals to the pulmonologist, which in times of necessary cost-reduction is very interesting and helpful for insurance companies. Furthermore, teleconsultations showed initially unforeseen referrals, consisting of patients having a pulmonary disease, who needed to be investigated more properly in hospital.
Asthma remission and longitudinal changes in control in the Italian Study on Asthma in the Young Adults (ISAYA)
Authors: Amelia Grosso, Lucia Cazzoletti, Angelo Corsico, Federica Albicini, Erica Gini, Vanessa Ronzoni, Eti Maria Giulia Di Vincenzo, Roberto de Marco, Isa Cerveri
Journal: European Respiratory Journal (2012)

There is a little information on asthma remission and longitudinal changes in control in the last decade. In the frame of the ISAYA, a random sample of 354 asthmatics identified between 1998 and 2000 in 6 Italian centres (Pavia, Torino, Verona, Pisa, Sassari, Sassuolo) was followed-up 10 years apart (response rate 60%). At follow-up, asthma was considered in remission if a subject did not report any asthma-like symptom or drug use in the last year. A modified version of the GINA classification of asthma control, based on the frequency of diurnal and nocturnal symptoms, daily life activity limitations, and rescue medication use, was used. Out of the 210 subjects who participated in the follow-up, asthma had remitted in 61 (29%) subjects and was still present in 149 (71%). The likelihood of remission for subjects reporting asthma-like symptoms, attacks and asthma drug use at baseline was less than half the same risk in subjects who did not report them, as evaluated by means of a logistic model. Among non remittent subjects, 41 (28%) had controlled, 60 (41%) partially controlled and 46 (31%) uncontrolled asthma at baseline. Among 138 subjects with information at follow-up, 38 (28%) had controlled, 69 (50%) partially controlled and 31 (22%) uncontrolled asthma. At a multinomial logistic model, women were more likely to have partially or uncontrolled asthma than men; increasing age, chronic cough and phlegm and total or partial lack of control at baseline increased the risk of uncontrolled asthma at follow-up. More than 1 out of 4 subjects with asthma recover from their illness; however, less than 30% of the remaining subjects had controlled asthma a decade after.
Guiding outbreak management by the use of influenza A(H7Nx) virus sequence analysis
Authors: M Jonges, A Meijer, R A Fouchier, G Koch, J Li, J  C Pan, H Chen, Y L Shu, M P Koopmans
Journal: Eurosurveillance (2013)

The recently identified human infections with avian influenza A(H7N9) viruses in China raise important questions regarding possible source and risk to humans. Sequence comparison with an influenza A(H7N7) outbreak in the Netherlands in 2003 and an A(H7N1) epidemic in Italy in 1999–2000 suggests that widespread circulation of A(H7N9) viruses must have occurred in China. The emergence of human adaptation marker PB2 E627K in human A(H7N9) cases parallels that of the fatal A(H7N7) human case in the Netherlands.
GPs should consider delaying prescription of antibiotics, says NICE
Authors: Ingrid Torjesen
Journal: BMJ (2015)

Doctors should resist pressure from patients to prescribe antibiotics by sending samples for testing to confirm the cause of an infection first or by offering a delayed prescription, the final guideline on antibiotic stewardship published by the National Institute for Health and Care Excellence (NICE) has said.1

Data indicate that nine in 10 GPs feel pressurised by patients to prescribe antibiotics when they are unnecessary2 and that 97% of patients who ask for antibiotics are ultimately prescribed them,3 by consulting another doctor or even attending emergency departments if they are denied them the first time.

Mark Baker, director of the Centre for Clinical Practice at NICE, …
Gradual loss of vision in adults
Authors: S. Borooah, A. Dhillon, B. Dhillon
Journal: BMJ (2015)

#### The bottom line 

#### How patients were involved in the creation of this article

In the process of writing this article we sought the opinions of patients who had recently undergone cataract surgery. They were asked what they would have liked to have known before the surgery. Their responses were taken into account when writing box 2. They were also asked what symptoms have improved since their surgery. Their input was used to modify the history section.

A 70 year old man presents with gradual blurry vision in both eyes. He has recently noticed increasing glare when looking at lights.

Gradual loss of vision has many causes, and cataract is one of the most common causes in this age group. A logical history and examination can help to exclude sinister causes that require urgent treatment.

### History

How quickly has your vision become blurry? — Sudden visual loss within weeks is unlikely to be caused by age related cataract. Symptoms of age related cataract usually develop over months to years.

Does the blurring affect only part of your vision? — Patients who describe a central dark spot probably have wet age related macular degeneration and require urgent ophthalmic referral. Consider intracerebral or glaucomatous causes of visual loss in patients with bilateral field defects.

Do you have any other changes to your vision?— New floaters or flashing lights (suggesting posterior vitreous detachment, retinal detachment, or a vitreous haemorrhage) or visual changes that cause the patient to note the bending …
Serum biomarkers analysis in workers with occupational salt dust exposure in underground conditions in dependence of length of service
Authors: Nicolaj Denisevich, Ekaterina Kolesneva, Lyudmila Dubovskaya, Igor Volotovski
Journal: European Respiratory Journal (2011)

Objective:  We assessed serum biomarkers distribution in underground workers with occupational salt dust exposure in dependence of length of service.   Methods:  Serum samples of male donors who are not working at Belaruskaly, and workers employed in underground working conditions of Belaruskaly with a mean age 40±7 years were enrolled. All donors were divided into 4 groups.Group I included healthy donors who do not work in the enterprise; II - workers with underground work experience of 5 years; III- consisted of workers with underground work experience of 5 to 15 years; IV - workers with underground experience of more than 15 years.To analyze the qualitative composition of serum proteins were obtained by two-dimensional maps of proteins in blood serum from healthy donors and the study group by two-dimensional gel electrophoresis.Proteomic maps were statistically analyzed in dependence of length of service.   Results:  We found that total protein value in group II-IV differed from the samples of the 1st group. No statistically significant changes nave been revealed in the serum protein composition of underground workers.Proteomic maps revealed abnormalities indicating the presence of inflammation in the bronchopulmonary system of workers. This could be the diagnostic indicator of early stages of lung diseases in the absence of clinical evidence.   Conclusions:  Analysis of serum proteome changes under the influence of sylvinite aerosols could help to search for specific biomarkers of the body functioning of workers under the influence of occupational factors and predict risk of lung morbidity in occupational exposure to sylvinite aerosols.
Dynamic of morphologic and molecular remission in patients (pts) with APL treated with frontline ATRA and arsenic trioxide (ATO).
Authors: M. Ayoubi, H. Kantarjian, J. E. Cortes, S. Faderl, G. Garcia-Manero, S. Wen, J. Fiorentino, X. Huang, R. Luthra, F. Ravandi Kashani
Journal: Journal of Clinical Oncology (2010)

6548 Background: APL is associated almost in all pts with t (15; 17) (q21; q22) leading to the fusion gene PML-RARα which can be identified by reverse transcriptase polymerase chain reaction (RT-PCR). Minimal residual disease (MRD) monitoring based on the detection of PML-RARα transcripts by PCR technology has a well-demonstrated role in APL. Purpose: To describe the dynamics of response in pts with APL on our frontline study of ATRA and ATO. Methods: From February 2002 to January 2010, 111 pts with newly diagnosed APL have been treated with ATRA plus ATO. The first cohort of 65 pts received ATRA and ATO (beginning on day 10 of ATRA). High risk pts (WBC > 10 x 109/L) received GO (gemtuzumab) on the first day. The second cohort of 46 pts (38 evaluable pts) received ATRA and ATO concomitantly on day one. They also received GO on day one, if high risk, and if their WBC increased to more than 30 x 109/L during induction. Quantitative PCR (Q-PCR) for PML-RARα fusion gene was conducted after induction and throughout consolidation and follow up for the latter cohort. Results: The median time (range) to CR was 29 days (19-70) in the first cohort, 29 days (25-73) in the second cohort; the median time to complete molecular response (CMR) was 117.5 days (26-323) in the first cohort, was 101.5 days (25-240) in the second cohort. There was no difference of time to CMR between two cohorts (p = 0.15). Three pts in the first and 2 pts in the second cohort have relapsed, all having previously achieved CMR. Two pts with CNS relapse remained PCR-negative at the time of relapse. All other relapsed pts had positive peripheral blood (PB) or bone marrow (BM) PCR tests prior to relapse. There was strong correlation (Spearman correlation: 0. 86, p < 0.0001) between PB and BM Q-PCR on 75 concomitant samples (within 1 day of each other) from 25 pts; no significant difference between BM and PB (p = 0.76, paired Wilcoxon test). Conclusions: There was no significant difference between ATO at day 1 of ATRA or day 10 regarding time to CR and time to CMR. Relapse occurred in 5% and was preceded by a positive PCR except for CNS relapse. Among the available paired samples there is a strong correlation between BM and PB PCR suggesting that PB may be used to monitor pts for impending relapse. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Cepahlon Cepahlon
Breast Cancer Diagnosed During Pregnancy
Authors: Sibylle Loibl, André Schmidt, Oreste Gentilini, Bella Kaufman, Christine Kuhl, Carsten Denkert, Gunter von Minckwitz, Anastasia Parokonnaya, Hanne Stensheim, Christoph Thomssen, Kristel van Calsteren, Philip Poortmans, Paul Berveiller, Udo R. Markert, Frederic Amant
Journal: JAMA Oncology (2015)

Breast cancer during pregnancy (BCP), although rare, is becoming more common and treatment should be as similar as possible to that for nonpregnant young patients with breast cancer. A group of specialists convened to review current guidelines and provide guidance on how recent advances in breast cancer diagnosis and treatment can be adapted for pregnant patients. The majority of patients with BCP will be considered for treatment during the pregnancy. Premature delivery should be avoided whenever possible. Most treatments, including sentinel lymph node biopsy, systemic therapy with taxanes, platinum agents, or dose-dense treatment can be safely given during pregnancy, after careful risk/benefit assessment for mother and child. Chemotherapy is contraindicated during the first trimester because of a higher risk of fetal malformations but is feasible in the second and third trimesters. Other treatments such as radiation therapy or anti-human epidermal growth receptor 2 treatment are in general not indicated during pregnancy but might be considered in some instances. Patient data should be collected in a systematic way whenever possible.
Histopathologic features of lung tissue in cryobiopsy specimens
Authors: Mihan Pourabdollah, Shahram Sabeti, Arda Kiani, Mahdi Karimi, Hamidreza Jabbari, Shirin Karimi
Journal: European Respiratory Journal (2013)

Background:Conventional TransBronchial Lung Biopsies(TBLB)used for diagnosis of diffuse lung diseases usually lack adequacy due to small sample size and crush artifact.Flexible cryoprobe is useful in obtaining lung biopsy bronchoscopically(FCLB).Methods:41patients who were candidates forTBLBwas included in this study in Masih Daneshvari Hospital.BothTBLBand FCLBwere performed on each patient sequentially.Histopathologic assessment was done by 2 pathologists,blindly .2dimensions were measured by microscope and area calculated mathematically.Results:The mean specimen area was5(0.2–16)mm2in TBLBs compared to20(2–100)mm2,p =0.00inFCLBs.19of41(46.34%)TBLBand1of41(2.43%)FCLB specimens were inadequate. 10 FCLBs&1TBLBS of22 adequate ones were the only diagnostic specimens.11of 22(50%)TBLBs &28of40(70%)FCLBs showed diagnostic findings including granuloma,Pneumocystis Jiroveci, Alveolar Proteinosis,Langerhans Cell Histiocytosis,Pulmonary Hemorrhage,carcinoma,IV abuse disease,aspiration ,and hypersensitivity pneumonitis.Bronchioles and acinar structures were included in 6/62 (9.67%) total adequate biopsies, all of them were FCLBs.TBLBs andFCLBs showed crush artifact(15/22=68.18%) and microscopic hemorrhage(8/40=20%)as the most common artifactual changes respectively.Intraalveolar ciliated columnar epithelial cells(7/40=17.5%)was the other artifact in FCLB group, not reported previously.  Conclusions:In comparison with TBLBs, FCLBs give larger size lung tissue and as a special morphologic finding,contain acinus and bronchiolar structures.They also have special artifacts and pathologists should be familiar with the special histomorphologic features of these specimens.
Acute effect of inhaled corticosteroid on exhaled breath temperature in asthmatic patients
Authors: Tanya Kralimarkova, Vasil Dimitrov, Todor Popov
Journal: European Respiratory Journal (2012)

Background: Measurement of exhaled breath temperature (EBT) with a portable hand held device is applicable as a non-invasive method to monitor the control of asthma. While inhaled corticosteroids (ICS) have proven suppressive effect on airway inflammation decreasing EBT in the long run, there is no data on the immediate effect of inhaling them. The aim of this study was to explore the acute effect of ICS on EBT.

Methods: We recruited 21 subjects (mean age 47 years, 12 women) from among the patients of the Clinic of Allergy and Asthma in Sofia, Bulgaria: 12 were with controlled; 9 with partly controlled asthma. Patients were randomized to inhale 2 puffs of either ciclesonide or placebo from identical looking inhalers in the morning of consecutive days. Spirometry and assessment of EBT by means of PHD (X-halo, Delmedica, Singapore) were performed before and at 4 time points (5, 30 60 and 120 min.) after inhalation.

Results: Compared to baseline EBT (mean 33.78 ± s.e.m.0.10°C, ±), there was a significant increase in EBT 5 min. (34.17±0.10, P=0.001), 30 min. (34.07±0.10, P=0.002), and 60 minutes (33.90±0.10, P=0.046) post ICS inhalation. The pre- / post- inhalation differences between ICS and placebo differed significantly (P=0.001). Inhalation of ICS and placebo did not bring about any significant changes in the spirometry of the patients. There was no difference between the controlled and the partly controlled asthmatics in EBT changes.

Conclusions: EBT increases 1 hour after inhalation of ICS in a dose, prescribed for maintenance treatment of asthma. This needs to be taken into consideration if EBT is applied for monitoring of the disease.
Role of hypoxia in epithelial-to-mesenchymal transition (EMT) in non-small cell lung cancer (NSCLC)
Authors: Stéphane Renaud, Dominique Guenot, Pierre-Emmanuel Falcoz, Gilbert Massard, Michèle Beau-Faller
Journal: European Respiratory Journal (2014)

Introduction : Non small cell lung cancer (NSCLC) remains the first cause of cancer-related death worldwide, mainly because of treatment resistance and late diagnosis. Epithelial-to-mesenchymal transition (EMT) is linked with tumor progression and drug resistance in many cancers. Our aim was to evaluate in vitro if hypoxia, could induce EMT on NSCLC. Material and methods : Our work is performed on 2 EGFR mutated NSCLC cell lines (H1650 cell line : exon 19 deletion, H1975 cell line : L858R and T790M mutations). We studied in normoxia (21% O2) and hypoxia (1% O2) conditions of culture : cells morphology, proliferative and migrative capacities, HIF-1αexpression, protein and mRNA expression of epithelial (E-cadherin) and mesenchymal (vimentine) markers, as well as EMT transcription factors (ZEB-1, Snail-1, Snail-2, Twist-1 and Twist-2). Results : Hypoxia leads to a fibroblastoid morphology in both cell lines. Proportion of migrated cells is significantly higher in hypoxia in both cell lines H1650 and H1975 (p<0.001). Expression of HIF-1αincreases in hypoxia, associated with a decrease of the expression of E-cadherin with a cytoplasmic translocation, and an increase in vimentin expression in both cells. Expression of the EMT-transcription factors increases in hypoxia in both cells. Experiments with HIF-1a SiRNa show that over-expression of EMT-transcription factors is lost when HIF-1αis inhibited. Conclusion : Hypoxia seems to induce a partial EMT phenotype in NSCLC cell lines harboring EGFR mutation, in part related to HIF-1α expression.
Clinical Analysis of Laryngeal Trauma Secondary to Intubation
Authors: M J Gleeson, A J Fourcin
Journal: Journal of the Royal Society of Medicine (1983)

A study was undertaken to analyse the effect of short-term intubation on the voice. Children were examined laryngographically both pre- and postoperatively. Changes in larynx frequency distribution following intubation were documented using the technique of electrolaryngography; the resolution of these changes was similarly recorded. The results, in comparison with the frequency distributions associated with other disease states, give insight into the nature of the damage and its effect on vocal fold vibratory patterns. The technique therefore enables objective evidence of minor degrees of laryngeal trauma to be demonstrated and differentiated.
Non-invasive ventilation in acute respiratory failure: Non-formal indications
Authors: Mariana Mendes, Catarina Dias, Catarina Ferreira, Cidália Rodrigues, Joaquim Moita
Journal: European Respiratory Journal (2013)

Background 

Non Invasive Ventilation (NIV) is recognized as a first-line treatment in several clinical conditions.

Aim 

To determine the effectiveness of NIV in the treatment of ARF secondary to clinical conditions which do not meet established criteria for that therapeutic approach.

Methods 

The authors reviewed the medical records of patients undergoing NIV between October2011 and April2012, in Hospital Geral do Centro Hospitalar e Universitario de Coimbra . Patients with diagnosis currently considered formal indications for treatment with NIV were excluded. For each selected case, the clinical details and the final result (death, need for invasive mechanical ventilation, transfer to another hospital and hospital discharge) where identified.

Results 

During that period of time, 24 patients treated with NIV had ARF secondary to conditions which do not meet the criteria for that ventilatory mode. 17 cases of pneumonia in immunocompetent individuals with no previous pulmonary disease [9 died,one was transferred to another hospital,and seven were discharged home], two cases of interstitial lung disease (one was transferred to another hospital, and the other was discharged home), two cases of multiple organ dysfunction (one died, and the other was transferred to another hospital), one case of metastatic pleural effusion (transferred to another hospital), one case of poisoning by methadone (that required invasive mechanical ventilation) and, finally, one case of massive stroke (died).We verified failure of NIV in 53,8% of cases.

Conclusion Our experience showed weak evidence with the use of NIV in the management of ARF in the context of pneumonia in immunocompetent individuals with no previous pulmonary disease.
Determinants of exercise capacity in patients with COPD without other comorbidities
Authors: Gloria Samperiz, Laura Madre, Pablo Cubero, Marta Forner, Elena Forcen, Santiago Carrizo, Jose M. Marin
Journal: European Respiratory Journal (2012)

Introduction. The 6 min walking test (6MWT) is frequently used to assess exercise limitation and exertional dyspnoea in COPD. Age, sex, metabolic, cardiovascular, neuromuscular and respiratory variables can contribute to determine the final individual value of the 6MWT.  Aims. To evaluate exercise performance with the 6MWT in COPD patients free of other co-morbidities.  Methods. From the Bode International Cohort Study we selected 148 men with COPD and no other cardiovascular, cerebrovascular, metabolic o neuromuscular disorder. In addition, patients who were taking beta-blockers or anti-hypertensives were also excluded. A pre-specified protocol including two standardized 6MWT was applied to all patients.  Results. The mean ± SD of the post bronchodilator FEV1 % predicted and 6MWT was 62 ± 21 and 398 ± 99 meters respectively. Walked distance correlated significantly with age, height, weight, baseline dyspnoea (as assessed by the MRC scale), CAT questionnaire, spirometric parameters, lower heart rate (HR) and higher basal O2 Saturation (O 2 Sat). After forward stepwise multiple linear regression to evaluate the predictive value of the different factors to explain the 6MWD, four variables stay in the model: age, MRC score, change in O 2 Sat and change in HR from baseline to the end of the test (adjusted r 2  = 0.33, p  Conclusions. In COPD without comorbidities, age, exertional dyspnoea, and higher changes in O 2 Sat and HR were the most important determinants of exercise capacity.  Funded by Instituto Carlos III, Madrid, Spain (FIS 09/02449).