tbuckley/cabot-search huggingface dataset:
COPD - Prevalence and risk study from rural north India
Authors: Mukhmohit Singh, Anup K. Mukherjee, Surendra K. Ahluwalia, Anu Bhardwaj, Shveta Saini
Journal: European Respiratory Journal (2012)

BACKGROUND: The increasing impact of Chronic Obstructive Pulmonary Disease (COPD) on health care resources is now being recognized as a major public health problem and is projected to be the third leading cause of death worldwide by 2020.AIMS and OBJECTIVES: To estimate the prevalence and assess the risk factors for COPD in adults using spirometry (GOLD criteria).METHODS:A community-based, cross sectional, multiphasic survey was conducted on 2112 adults, age >35 years. COPD was diagnosed using fixed ratio post bronchodilator FEV1/FVC 65 years [OR 1.079 95% CI 1.064-1.095], exposure to high risk occupation [OR 2.395 95% CI 1.485-3.861] and smoking [OR 2.263 95% CI 1.467–3.492]. Other factors as exposure to passive tobacco smoke, education, socio economic status did play a role independently, however no significant higher risk was observed using multivariate statistical model. CONCLUSION:Ageing, smoking, occupation and biomass smoke exposure certainly explain the web of causation on the background of other risk factors as passive smoking, education and socioeconomic status.
Effect of Dietary Fat on Growth Kinetics of Transplantable Mammary Adenocarcinoma in BALB/c Mice&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;&lt;xref ref-type="fn" rid="FN3"&gt;3&lt;/xref&gt;
Authors: H Gabor, L A Hillyard, S Abraham
Journal: JNCI Journal of the National Cancer Institute (1985)

The growth of mammary adenocarcinomas in BALB/c mice fed a diet containing 10% corn oil (CO), which has about 60% of its fatty acids as linoleate, was significantly greater than that for tumors in mice fed diets containing either 10% hydrogenated cottonseed oil (HCTO), which has no linoleate, or 10% CO plus 0.003% indomethacin (IM). The proportion of the tumor occupied by the various cell types was quantitated from histologic sections for 2 different mammary adenocarcinomas. At 2 weeks post implantation the degree of inflammatory cell (IC) infiltration of the first adenocarcinoma (tumor IX) did not account for the difference in tumor mass induced by dietary fat. This conclusion was confirmed by a study of a group of tumors arising from hyperplastic alveolar nodule transplants, which showed a similar dietary response but in which IC infiltration was minimal even in the largest tumors. Cell cycle parameters of tumor IX were determined by the fraction-of-labeled-mitoses (FLM) procedure. No differences were found in the duration of the G1, S, G2, or M phases of the cell cycle or the total cell cycle time in neoplasms from the CO and HCTO diet groups. The fraction of tumor cells dividing in neoplasms from the 2 diet groups was also identical. The only parameter that was significantly different was the rate of tumor cell loss when determined by both indirect (FLM) and direct [( 125I]iododeoxyuridine) methods. Tumor cell loss for adenocarcinomas from mice fed HCTO or CO plus IM was approximately twice that obtained for tumors from the CO-fed mice. These observations on tumor cell loss were discussed in terms of: the influence of dietary linoleate on the size of mammary tumors and the involvement of prostaglandins in this process.
Changes in pulmonary function in patients with lung tuberculoma
Authors: Larisa Kiryukhina, Pavel Gavrilov, Igor Savin, Olesya Tamm, Alena Demidenko, Olga Litvishko, Armen Avetisyan, Igor Vasilyev, Piotr Yablonsky
Journal: European Respiratory Journal (2013)

The lung tuberculoma (LT) is capsulated caseous focus. If LT is progressing and prolong therapy does not give any results, the surgical treatment will be shown. In these cases lung resection may be from the minimal removal of lung tissue to lobectomy. So evaluation an adequate respiratory reserve is very important, but often these patients were examined only by spirometry.

Aim: To evaluate changes of pulmonary function in patients with LT.

Methods: We have observed 28 patients with LT (16M/12F; 32±2 yrs). All patients underwent Spirometry, Bodyplethysmography, measurement of CO Diffusion capacity (DLCO), High resolution computed tomography and 10 patients from them underwent Perfusion scintigraphy (PS). Spearman correlation coefficient of DLCO with the age of smoking and maximal diameter of tuberculoma were analyzed.

Results: There were mild obstructive disorders in 10 patients and decrease of DLCO from mild to significant in all patients. There were correlations DLCO and the age of smoking (-0,48; p<0,01) and maximal diameter of tuberculoma (-0,37; p<0,05). To assess the influence of the fairly localised specific lesion on DLCO we examined 18 patients without signs of ventilation disorders, non-smokers or of the age of smoking less 5 pack-years. There was significant correlation DLCO with maximal diameter of tuberculoma (-0.43; p<0,05) but not significant with the age of smoking (-0,28; p<0,26). PS had shown decrease of lung capillary blood flow in zones exceeding tuberculoma focus.

Conclusion: Patients with LT even without airways disorders had decrease of DLCO. It may be connected with defeat of lung capillary blood flow. This fact should be taken into account before the lung resection in patients with LT.
Making a bronchiolitis pathway work: If at first you don't succeed ...
Authors: Leo Thanikkel, Georgia Spentzou, Roona Aniapravan, Rob Ross Russell
Journal: European Respiratory Journal (2011)

Introduction: Last year we presented a poster asking why we were so poor at following bronchiolitis guidelines. A number of measures were undertaken following last year's poor performance. This year we re-audited the pathway.

Methods: In 2008 we developed a care pathway for bronchiolitis trying to reduce unnecessary investigations and treatments, and optimise supportive care. Over the first winter we failed to produce any impact [1]. Analysis showed that the problem lay in the first hours of admission, and with doctors unfamiliar with the pathway. Formal and informal feedback, and focused teaching was instituted. Monthly data on key targets were collated and disseminated to staff.

Results: Over the first 4 months of the 2010/11 season the use of unnecessary investigations and treatments fell considerably (see table). Median length of stay also fell, from 3.0 days to 2.0 days.

This translates to significant savings. The reduced length of stay saved 77.4 beddays (∼£40,000 (€48,000), 0.63 beds) and approximately £1500 (€1800) in investigation costs over the 4 month period. There have also been considerable savings in treatment costs.

View this table:



Conclusion: Our work shows that the introduction of a guideline has to be continuously followed up with clear aims, focused teaching, and careful analysis. We believe that engaging doctors at all levels and regular feedback about progress are essential. Perseverance is important in order for the pathway to pay off, especially in a system where at regular intervals doctors rotate into the department.

Reference: 

*   1. Gupta et al. P2706. ERS meeting, Barcelona.
Value of molecular monitoring during the treatment of chronic myeloid leukemia: a Cancer and Leukemia Group B study.
Authors: W Stock, C A Westbrook, B Peterson, D C Arthur, T P Szatrowski, R T Silver, D A Sher, D Wu, M M Le Beau, C A Schiffer, C D Bloomfield
Journal: Journal of Clinical Oncology (1997)

PURPOSE Disappearance of the Philadelphia chromosome during treatment for chronic myeloid leukemia (CML) has become an important therapeutic end point. To determine the additional value of molecular monitoring during treatment for CML, we performed a prospective, sequential analysis using quantitative Southern blot monitoring of BCR gene rearrangements of blood and marrow samples from Cancer and Leukemia Group B (CALGB) study 8761. PATIENTS AND METHODS Sixty-four previously untreated adults with chronic-phase CML who were enrolled onto CALGB 8761, a molecular-monitoring companion study to a treatment study for adults with chronic-phase CML (CALGB 9013). Treatment consisted of repetitive cycles of interferon alfa and low-dose subcutaneous cytarabine. Blood and marrow Southern blot quantitation of BCR gene rearrangements was compared with marrow cytogenetic analysis before the initiation of treatment and of specified points during therapy. Reverse-transcriptase polymerase chain reaction (RT-PCR) analysis was performed to detect residual disease in patients who achieved a complete response by Southern blot or cytogenetic analysis. RESULTS Quantitative molecular monitoring by Southern blot analysis of blood samples was found to be equivalent to marrow monitoring at all time points. Twelve of 62 (19%) follow-up samples studied by Southern blot analysis had a complete loss of BCR gene rearrangement in matched marrow and blood specimens. Southern blot monitoring of blood samples was also found to be highly correlated to marrow cytogenetic evaluation at all points, although there were four discordant cases in which Southern blot analysis of blood showed no BCR gene rearrangement, yet demonstrated from 12% to 20% Philadelphia chromosome-positive metaphase cells in the marrow. RT-PCR analysis detected residual disease in five of six patients in whom no malignant cells were detected using Southern blot or cytogenetic analyses. CONCLUSION Quantitative Southern blot analysis of blood samples may be substituted for bone marrow to monitor the response to therapy in CML and results in the need for fewer bone marrow examinations. To avoid overestimating the degree of response, marrow cytogenetic analysis should be performed when patients achieve a complete response by Southern blot monitoring. This approach provides a rational, cost-effective strategy to monitor the effect of treatment of individual patients, as well as to analyze large clinical trials in CML.
Exercise and the Cardiovascular System
Authors: Carl J. Lavie, Ross Arena, Damon L. Swift, Neil M. Johannsen, Xuemei Sui, Duck-chul Lee, Conrad P. Earnest, Timothy S. Church, James H. O’Keefe, Richard V. Milani, Steven N. Blair
Journal: Circulation Research (2015)

Substantial evidence has established the value of high levels of physical activity, exercise training (ET), and overall cardiorespiratory fitness in the prevention and treatment of cardiovascular diseases. This article reviews some basics of exercise physiology and the acute and chronic responses of ET, as well as the effect of physical activity and cardiorespiratory fitness on cardiovascular diseases. This review also surveys data from epidemiological and ET studies in the primary and secondary prevention of cardiovascular diseases, particularly coronary heart disease and heart failure. These data strongly support the routine prescription of ET to all patients and referrals for patients with cardiovascular diseases, especially coronary heart disease and heart failure, to specific cardiac rehabilitation and ET programs.
Impact of exhalation system and additional leak on oxygenation during noninvasive ventilation
Authors: Jan Storre, Sophie Huttmann, Emelie Ekkernkamp, Stephan Walterspacher, Michael Dreher, Claudia Schmoor, Wolfram Windisch
Journal: European Respiratory Journal (2011)

Objective: Supplemental oxygen (O2) when added to longterm noninvasive ventilation (NIV) is usually inserted into the ventilatory circuit next to the ventilator, but the impact of different exhalation systems and leaks on actual FiO2 needs to be elucidated.

Methods: Four daytime measurements (each 60 minutes, randomized) were performed in 20 patients receiving NIV and ≥2L O2/min: active valve circuit (AVC) or leak circuit (LC) with and without additional artificial leak (4mm I.D.) next to the fullface mask. FiO2 was measured at the site of oxygen (FiO2-ventilator) as well as mask (FiO2-mask) following exhalation system (AVC or LC) and opened or closed artificial leak. Capillary blood gas analyses were performed at start and end of each measurement.

Results: Overall, FiO2-mask (29±5%) was lower compared to FiO2-ventilator (34±4%) with a mean (95%CI) difference of 5.1 (4.2 to 5.9, p<0.0001)%. With LC FiO2-mask decreased by 3.2 (2.6 to 3.9, p<0.0001)% compared to AVC (Figure). PaO2 tended to be 6.3 (-1.0 to 13.7)mmHg lower after 60 minutes of NIV comparing LC and ACV, p=0.08. Implementing an artificial leak FiO2-mask decreased by 5.7 (5.1 to 6.4, p<0.0001)% (Figure) with lowered PaO2 of 10.4 (3.1 to 17.7, p<0.0001)mmHg.

![Figure][1] 



Conclusion: Leak circuits regularly used for exhalation during NIV and unintended air leak significantly reduce FiO2 in patients receiving NIV and O2, which substantially deteriorates patients' oxygenation.

 [1]: pending:yes
Paradoxical motion time as an early indicator of nocturnal desaturation in adolescents with Duchenne muscular distrophy (DMD)
Authors: Rita Priori, Marianna Laviola, Marianna Romei, Antonella Lo Mauro, Maria Grazia D'Angelo, Andrea Aliverti
Journal: European Respiratory Journal (2013)

In DMD there is a progressive loss of muscular strength that leads to the need of nocturnal noninvasive ventilation (NIV).We aimed to determine if analysis of chest wall (CW)movement could provide new predictors of nocturnal desaturation in DMD.  We studied 37 DMD patients >14 years old(age 18.2±4.8)not yet on NIV, and 16(age 22.3±11.3)male controls(CTR).Spirometry and nocturnal oxygen saturation(SpO2)were measured in all DMD.Compartmental and total CW volumes were measured during quiet breathing(QB)in supine posture by opto-electronic plethysmography.Inspiratory and expiratory paradox time(%IPt, %EPt)were calculated as the % of total inspiratory(expiratory)time during which one compartment was moving paradoxically to total CW volume.  No %IPt nor %EPt were found in CTR.While %IPt in DMD was similar to CTR,we found high values of abdominal %EPt(%EPtAB)and a strong difference with CTR(p  Analysis of compartmental CW motion during QB in supine is a valid indicator of respiratory muscle dysfunction in DMD.Our results indicate that abdominal %EPt should be considered as an early indicator of nocturnal hypoxemia.
High caesarean section rates among women over 30
Authors: J. C Marwick, R. Lynn, J. Weaver, H. Statham, M. Richards
Journal: BMJ (2001)

Editor—Bell et al's finding that rates of caesarean section increase with age1 are similar to findings from our analysis of all 103 883 births in New Zealand hospitals between 1 July 1996 and 30 June 1998.2 Interestingly, our analysis shows that rates of caesarean section increase in a continuum from teenage years upwards: there was no age from which the increased likelihood of the operation first began to be noticed. Similar findings have been noted previously from, among other places, Britain,3 Jordan,4 and Italy.5

Our analysis shows that women who are having a repeat caesarean section explain some of the increase, but a steady increase is still present in women who have not had a previous caesarean section. Rosenthal and Paterson-Brown suggest that this may be related to physiological changes with increasing maternal age.3

The remarkably consistent finding from diverse countries about the effect of age led us to conclude that it is unlikely to be a result of clinical practice or societal pressures.
Health care workers participation in helping smoking cessation
Authors: Nikolay Antonov, Victoria Donitova, Galina Sakharova
Journal: European Respiratory Journal (2013)

Success in smoking cessation depends on knowledge of heath care workers as well as on their attitude towards smoking and readiness to help smokers to quit. To assess those parameters we have developed a questionnaire of 32 questions and conducted a survey of 715 health care workers in 4 medical institutions in Moscow, Russia, using continuous sampling.

Results. Prevalence of smoking: 25% of respondents were smokers, 32% have shown signs of high nicotine dependence. 28% of respondents were exposed to secondhand smoking. Knowlegde: 10% of respondents believed that smoking does not affect health, 17% believed that secondhand smoking does not affect health, 45% believed that consuming smokeless tobacco does not affect health. Known motivational techniques: 40% of respondents have named informational materials, 31% hypnosis and 31% behavioral therapy. Known stopping smoking treatments: 42% have named nicotine replacement therapy, 35% auto-training, 29% hypnosis and 26% acupuncture.

Working with patients: 59% of respondents did not ask their patients about smoking. Attitude towards smoking of health care workers: 87% of respondents believed that health care workers should not smoke at all or at least not at work. Readiness to help quitting smoking: 51% of respondents believed that smoking cessation should be included in treatment regimen.

Conclusion. In order to provide better help in smoking cessation following aspects should be improved: lessen high prevalence of smoking among health workers, improve knowledge on tobacco consumption effects on health, motivational techniques and stopping smoking treatments. Establishing smoke-free hospitals would also benefit.
Decision making in acute hypercapnic respiratory failure due to COPD: Criteria in patient selction & determining ceiling of care
Authors: Laura Tanner, Stephen Murphy
Journal: European Respiratory Journal (2011)

Background:  Non-invasive ventilation (NIV) is effective in acute hypercapnic respiratory failure (AHRF) due to COPD but the UK National COPD Audit (2008) raised concerns about patient selection; only 70% of eligible patients received NIV and invasive mechanical ventilation (IMV) was used in only 3% if NIV failed.   Aims:  The aim of this study was to ascertain criteria clinicians use to make decisions regarding NIV.   Methods:  A 12 point questionnaire was sent to doctors involved in acute care of patients admitted with acute exacerbation of COPD. Key areas included arterial blood gas (ABG) criteria for NIV, prognostic factors and decisions on ceiling of care. Comparisons were made between grades and specialities.   Results:  31 questionaires were completed. 61.3% consultants, 16.1% specialist registrar (SPR), 24.5% other training grades (OT). Specialties: ITU 16.1%, Respiratory (RESP) 22.6%, Other general medical 61.3%. Most (74.1%) made decisions on NIV at least weekly. There was poor agreement on ABG criteria for NIV ( Kappa  0.36). Adherence to guideline criteria for NIV varied by specialty: RESP 85.7% v non-RESP 41.6% OR 8.4 (1.08-59.8). Agreement on prognostic criteria was poor ( K  0.17). 80% of SPR and 28.5% OT grades frequently make decisions on ceiling of care.   Conclusions:  AHRF due to COPD is often managed by non-respiratory physicians. There is marked deviation from guideline criteria for initiation of NIV. There is poor agreement between physicians regarding prognostic criteria used to determine ceiling of care. These decisions are frequently made by junior medical staff.
Artemisinin resistance in Myanmar – Authors' reply
Authors: Mallika Imwong, Kyaw Myo Tun, Tin Maung Hlaing, Eric P Grist, Philippe Guerin, Frank Smithuis, Arjen M Dondorp, Nicholas P Day, Francois Nosten, Nicholas White, Charles J Woodrow
Journal: The Lancet Infectious Diseases (2015)
Medicare Fee Cuts and Cardiologist-Hospital Integration
Authors: Zirui Song, Jacob Wallace, Hannah T. Neprash, Michael R. McKellar, Michael E. Chernew, J. Michael McWilliams
Journal: JAMA Internal Medicine (2015)

Physician practices are increasingly integrating with hospitals.1 For physicians, the expansion of accountable care organization contracts centered on providers taking responsibility for population spending and quality makes independent practice more challenging. For hospitals and health systems, acquiring practices helps them control referral patterns, coordinate care, and improve their bargaining power with payers.

In 2010, based on recommendations from the American Medical Association and a national practice expense survey of physicians, the Centers for Medicare and Medicaid Services reduced fees for cardiology services, focusing on those delivered in the office setting.2 For example, payment for a myocardial perfusion image in the office was cut 26%, compared to 5% in the hospital outpatient department (HOPD). That for an echocardiogram was cut 16% in the office, compared to a 3% increase in the HOPD setting. This widened the already existing payment gap favoring HOPDs—by 2013, an echocardiogram cost Medicare 141% more in HOPDs than in the office.3

The American College of Cardiology (ACC) projected a surge of integration in response to physician office fee reductions, with cardiologists exchanging practice ownership for more predictable salaries as hospital employees.4 We analyzed trends in cardiologist-hospital integration.
Neuromuscular Activity and Upper Airway Collapsibility
Authors: JAMES A. ROWLEY, BERNESTA C. WILLIAMS, PHILIP L. SMITH, ALAN R. SCHWARTZ
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

We have shown that tracheal and tongue displacement represent two basic mechanisms by which upper airway collapsibility can be altered. In this study, we investigated whether hypercapnia, which activates upper airway muscles, alters upper airway collapsibility by a mechanism similar to tracheal or tongue displacement. To answer this question, we utilized a feline isolated upper airway preparation in which maximal inspiratory airflow (Vimax), the pharyngeal critical pressure (Pcrit) and the nasal resistance (Rn) upstream to the flow-limiting site (FLS) were measured. In protocol #1, upper airway airflow dynamics were studied at two levels of trachea displacement under either hypo- or hypercapnic conditions. We found that the increase in Vimax with 1 cm of caudal tracheal displacement was attenuated by hypercapnia (44 +/- 12 ml/s versus 81 +/- 7 ml/s during hypocapnia, p = 0.048), as was the decrease in Pcrit (-2.4 +/- 1.1 cm H2O versus -5.2 +/- 1.1 cm H2O, p = 0.001). In protocol #2, we investigated the effect of transecting the cervical strap muscles and hypoglossal nerves on airflow dynamics during hypercapnia. Vimax, Pcrit, and Rn did not change after transecting either the strap muscles or the hypoglossal nerves. We conclude that the primary mechanism for changes in Pcrit during hypercapnia is similar to trachea displacement and is mediated by muscles other than the straps or tongue.
Changes in Testicular DNA Produced in BALB/c Mice by Diethylstilbestrol&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: Toru Uchikawa, Robert A. Huseby, M. Zain-ul-Abedin, Leo T. Samuels
Journal: JNCI Journal of the National Cancer Institute (1970)

Within the first 2 weeks of administration, relatively large closes of diethylstilbestrol (DES) increased the DNA content of the cryptorchid testes of BALB/c mice. This increase was associated with testicular weight gain, but DNA per unit mass also increased significantly. An increase in DNA secondary to similar treatment with DES was not seen in (C3H/Bi × A/Bi)F1 (ZAF1) mice that have a significantly lower incidence of DES-induced Leydig-cell tumors or in Holtzman rats in which estrogeninduced interstitial cell tumors have not been reported. Measurements of 3H-thymidine incorporation in the testes of BALB/c mice indicated an early (1–7 days) “spurt”in DNA synthesis that was not detectable in ZAF1 mice. Autoradiographic studies of BALB/c testes demonstrated that this augmented incorporation was primarily, if not entirely, in cells of the interstitiurn. Both quantitative and autoradiographic studies showed that 3H-thymidine incorporation then dropped to levels approaching those of untreated animals until about the time of tumor development. Incorporation then increased significantly, and this upsurge was associated with the development of pretumorous nodules of interstitial cells, many of which were actively synthesizing DNA.