tbuckley/cabot-search huggingface dataset:
Improving the safety of right heart catheterisation in sickle cell disease
Authors: Jenny Louise Bacon, Praveen Kumar Molanguri, Adam Loveridge, Francois J. Raphael, Brendan Madden
Journal: European Respiratory Journal (2014)

Background:   Pulmonary hypertension(PH) is a recognised complication in patients with sickle cell disease(SCD) with a prevalence of 6-10%. 1  The gold standard to diagnose PH is right heart catheterisation(RHC), but SCD patients are at increased risk of developing complications including vasoocclusive crises. Our centre performs >160 RHC annually and developed a protocol in conjunction with our haematologists to attempt to reduce the risk of SCD complication during RHC. This involves pre hydration, supplemental oxygenation and passive warming.   Methods:   Electronic records were retrospectively reviewed to identify all patients with SCD who underwent RHC over 4years. Procedure indication, method and complications were recorded, haemodynamic variables and echocardiography results reviewed.   Results:   11 procedures were performed with pre hydration, passive warming and perioperative supplemental oxygen given in all cases. Mean mPAP was 21mmHg(range 15-39mmHg). 3 patients had PH but normal pulmonary vascular resistance. There was 1 episode of abdominal pain post procedure but no episodes of vasoocclusive crisis or other complication.Echocardiography diagnosis was 66% sensitive, 60% specific.   Discussion:   No specific protocol regarding optimisation for RHC in SCD has previously been reported. This study demonstrates that RHC can be performed in SCD without complication. By taking simple measures physicians can attempt to minimise the risk of vasoocclusive crisis. Measurement of pulmonary haemodynamics by RHC should be encouraged when clinically indicated in SCD to obtain accurate pulmonary haemodynamic values and formulate appropriate management strategies.  (1)Parent F et al. NEJM 2011.
Impact of Diagnosis on Utilities Assigned to States of Illness
Authors: Rosalind Rabin, Rachel M Rosser, Carole Butler
Journal: Journal of the Royal Society of Medicine (1993)

This paper addresses some of the fundamental issues surrounding the measurement of quality of life in relation to health care and highlights the need for continuous and careful review. Healthy volunteers were used to study the effect of diagnosis on the utilities placed on three dimensions of health-related quality of life encompassing 17 states of disability, distress, and discomfort including pain. The standard gamble (SG) was used to elicit values for appropriate levels of each dimension for selected diagnostic conditions. It was shown that clinical diagnosis affects the utilities that people assign to different states of ill-health. Mental conditions were consistently assigned lower utilities with subjects attributing their decisions to the social unacceptability and intractability associated with these conditions. These findings suggest that the comprehensiveness of the descriptive system for health indicators and profiles is important and should be kept under review. Furthermore, these data have implications for the role of the Quality Adjusted Life Years (QALY) estimates which assume that utility is uniform across various conditions. Finally, the study may have implications for mental health services if other population samples were to accord such high priority to the relief of mental conditions.
Prognostic power of biomarkers to predict in-hospital and postdischarge mortality in community acquired pneumonia
Authors: Ane Uranga, Pedro Pablo Espana, Alberto Capelastegui, Rosa Díez, Amaia Bilbao, Carmen Mar, Edurne Bereciartua
Journal: European Respiratory Journal (2013)

Background:   Recently, an extensive research has gone into identifying the predictive value of biomarkers for long term mortality in community-acquired pneumonia (CAP).   Objective:   The aim of this study was to evaluate the utility of inflammatory biomarkers measured on admission to predict mortality in patients with CAP.   Methods:   We prospectively included patients over 18 years old for a period of one year. Procalcitonin (PCT), C reactive protein (CRP) and Pro adrenomedullin (ProADM) levels were were compared according to in-hospital mortality, 30, 90 and 180-day mortality, and 1 year mortality, by means of the nonparametric Wilcoxon test. In addition, the predictive accuracy of each biomarker for mortality was analysed by means of logistic regression models, and the AUC was used to measure the predictive ability of each biomarker.   Results:   A total of 610 patients with diagnosis of CAP were included in our study and samples for biomarkers could be extracted in 491 of them. PCT and ProADM levels were significantly higher for short, medium and long term mortality. ProADM was the best biomarker in predicting complications. Figure 1 shows the results of the predictive ability of each biomarker for mortality.   Conclusions:   ProADM is a powerful tool not only for the prediction of short and medium mortality, but also for long term mortality.
Clinical features of nursing and healthcare-associated pneumonia in patients who underwent tube feeding
Authors: Shinichiro Nakao, Hiromi Tomioka, Nobuaki Mamesaya, Reina Sekiya, Shuji Yamashita, Toshihiko Kaneda, Yoko Kida, Chihiro Nishio, Masahiro Kaneko
Journal: European Respiratory Journal (2014)

[Background] Enteral feeding may cause the elevated risk of multidrug-resistant(MDR)pathogens in healthcare-associated pneumonia(HCAP). A better understanding of their clinical features is needed.The Japan Respiratory Society documented a new category,nursing and healthcare-associated pneumonia(NHCAP).The criteria were;(1)residence in a nursing home or an extended-care ward,(2)a discharge from a hospital in the preceding 90 days,(3)an elderly or handicapped patient who needs long-term care,(4)a patient who regularly requires vascular access in an outpatient setting.[Objectives] To evaluate clinical characteristics of NHCAP patients who underwent tube feeding,and to compare the features of the patients with or without enteral nutrition.[Methods] Retrospective study of 412 hospitalized NHCAP patients at a single center.[Results] Fifty-one patients(12.3%)underwent enteral feeding(49 percutaneous endoscopic gastrostomy tube,2 nasogastric tube).Mean age; 78±15. Forty sputum samples(78.4%)were evaluated,which included 9(22.5%)acceptable specimens judged by the criteria of Geckler. MDR pathogens were isolated in 4(10.0%)(Pseudomonas aeruginosa, MRSA, ESBL producing bacteria, and Acinetobacter in each patient).The 30-day mortality rate was 16.0%. Compared with patients without tube feeding,those with enteral nutrition were younger and more likely to have cerebral infarction and Parkinson disease.[Conclusion] The population presented a higher rate of neurological complications,which may cause inadequate sputum specimens.Careful interpretation of bacteriological examination should be done to select appropriate antibiotics.
Changing Incidence of Breast Cancer in Japanese-American Women2
Authors: Philip Buell
Journal: JNCI Journal of the National Cancer Institute (1973)

Mortality studies for the period around 1950 and 1960 showed breast cancer mortality rates of Japanese-American women only slightly above levels prevailing in Japan, though other site-specific cancer risks had shifted more markedly toward levels of white Americans. The Third National Cancer Survey of 1969–71 reveals that breast cancer risks for Japanese-American women in the San Francisco-Oakland metropolitan area closely approached those for whites. This upward shift occurred among both the Nisei (second generation) and the Issei (immigrant generation). The contribution of the Issei to the increased rates was substantial but somewhat less than that of the Nisei. Although Japanese and Polish migrants arrived in the United States about the same time, and both were mainly of rural origin, only the Polish women demonstrated a substantially increased risk of breast cancer by 1950. Japanese migrants may have retained their traditional culture longer, and when the strong upward shift in breast cancer risk occurred, it did so among Japanese-American women potentially exposed to a new culture and environment at preadult and early adult ages.
Pulmonary function improvement following septoplasty: How lower airways are effected?
Authors: Arzu Tuzuner, Gulden Bilgin, Sule Demirci, Gulbahar Darilmaz Yuce, Cemile Acikgoz, Erdal Samim
Journal: European Respiratory Journal (2014)

OBJECTIVE: Nazal obstruction due to septal deviation is a common reason for increased nasal airway resistance. Narrowed nasal airway would result in decreased airlow through lung. The aim of the present study to evaluate the effect of pulmonary function variations by spirometric findings and 6 minutes walking test (6MWT) parameters following septoplasty surgery.  METHODS: 30 (22 men and 8 women) patients aged between 17-59 years with markedly deviated nasal septal deviation were enrolled the study. Otolaryngologic exam, spirometry and 6MWT were performed on all patients. One month after results were compared.  RESULTS: Systolic and diastolic blood pressure,heart rate, dyspnea ,fatigue before, SpO 2  results did not changed statistically following surgery (Table 1).  CONCLUSION: Septoplasty surgery increase the nasal breath pattern and increase the extrathoracic parameters of spirometry. FIF50 and PEF value were significantly higher after septoplasty (p
Contemporary Radiation Therapy in Combined Modality Therapy for Hodgkin Lymphoma
Authors: Amol K. Narang, Stephanie A. Terezakis
Journal: Journal of the National Comprehensive Cancer Network (2015)

The advent of effective combination chemotherapy markedly changed the management of Hodgkin lymphoma, establishing combined modality therapy as the standard of care for most patients with this disease. In response, significant interest has been shown in refining the delivery of radiation in the combined modality setting such that toxicity is minimized while still preserving disease control. An understanding of the way in which radiation treatment fields, prescription dose, and advanced technology have evolved to accomplish these goals is critical. Moreover, fluency in the clinical literature exploring contemporary questions, such as the omission of radiation and response-based treatment, is equally important. Knowledge of these topics will yield both an appreciation of the value of radiation in the combined modality setting and the ability to better customize treatment regimens to individual patients.
Excessive daytime sleepiness and fatigue in nonapnoeic snorers: improvement after UPPP
Authors: C Janson, G Hillerdal, L Larsson, E Hultcrantz, CE Lindholm, H Bengtsson, J Hetta
Journal: European Respiratory Journal (1994)

Even in the absence of sleep apnoea, heavy snoring may be a cause of excessive daytime sleepiness (EDS) and fatigue. The aim of this investigation was to study whether uvulopalatopharyngoplasty (UPPP) is effective in relieving snoring and excessive daytime sleepiness in nonapnoeic snoring patients. UPPP was assessed in 155 nonapnoeic, snoring patients (136 men and 19 women, mean age 45 yrs). Postoperative evaluation was made after 3 months in 105 patients, and after 12 months in 50 patients. Fifty four patients were evaluated after both 3 and 12 months. In 49 patients, a further evaluation was made after 2 yrs. The results were compared with those of 76 conservatively-treated, nonapnoeic, snoring patients, who were reinvestigated 12 months after their initial examination. The proportion of patients with frequent loud snoring had decreased postoperatively from 96 to 18%. A highly significant improvement was reported in EDS and daytime fatigue. The proportion of patients who reported problems staying awake when driving had decreased from 29 to 7%, and the number who felt rested when awakening in the morning had increased from 23 to 78 after the operation. The patients in the UPPP group had somewhat more severe symptoms before treatment than those treated conservatively. One year after treatment the situation had been reversed, with significantly more snoring and excessive daytime sleepiness in the conservatively-treated group. In conclusion, these results indicate that UPPP is effective in relieving snoring and EDS in nonapnoeic snorers.
Dection of early lung cancer in patient with ground-glass opacity (GGO) lung lesion by HRCT in Taiwan
Authors: Yao-Ling Lee, Wer-Erh Cheng, Shuo-Chueh Chen, Wei-Chih Liao, Chuen-Ming Shih, Chih-Yi Chen
Journal: European Respiratory Journal (2013)

Background: The introduction of HRCT scan for screening has enabled the earlier detection of lung cancer. The Ground-Glass Opacity (GGO) was defined as a hazy increase in lung attenuation without obscuring the underlying bronchial or vascular structures.Most peripherally located lung cancers detected with CT scan have been stage Ia disease, and their surgical outcome has been excellent.

Methods: Between July 2006 and December 2011, 256 patients with 308 GGO lung lesions underwent lung resection for lung carcinoma at the China Medical University Hospital in Taiwan.

Results: There were 206 lung cancer (114 Adenocarcinoma,80 BAC and 12 others). Most patients' TNM satging were tage I (94%) - including stage IA(88%) and stage IB(6%). The patients were divided into three groups: TypeA: pure GGO, TypeB: mixed GGO with GGO predominance andType C: mixed GGO with solid predominance. Increasing incidence from type A to C (14%, 36%, 63%) were noted in adenocarcinoma patients. Decreasing incidence from type A to C (44%, 39%, 0%) were noted in BAC patients.The incidence of malignance was 67% in all resected nodules.

Conclusions: The incidence of adenocarcinoma increased with correlation to the increasing ratio of solid component (GGO type A to type C). The incidence of BAC decreased with correlation to the increasing ratio of solid component. GGO component was related to the presence of BAC and the solid component increased the ratio of adenocarcinoma. Among all malignant pure GGO nodules less than 1 cm, they were almost stage IA (96%) and BACs account for the majority (47%). Limited resection was done in (46%) BAC and no recurrence developed during the follow-up period.
Introduction of John T. Potts Jr.
Authors: J. Larry Jameson
Journal: Journal of Clinical Investigation (2013)

It is a great honor to present the 2013 Kober Medal to my mentor and friend, John T. Potts Jr., for his outstanding contributions to medical science. John transformed the field of calcium metabolism by characterizing parathyroid hormone (PTH), documenting its exquisite regulation of serum calcium and developing a series of translational advances to improve the management of primary hyperparathyroidism and osteoporosis. In his role as Chief of Medicine at the Massachusetts General Hospital (MGH), John mentored a generation of physician-scientists and pioneered their training in molecular biology as a means to support their careers and catalyze breakthrough discoveries that have transformed medicine across multiple disciplines.
Bispectral index in children and young adults: Is it able to identify natural sleep stages?
Authors: Mohamed-Rida Benissa, Sonia Khirani, Sarah Hartley, Annie Adala, Adriana Ramirez, Marta Fernandez-Bolanos, Maria-Antonia Quera-Salva, Brigitte Fauroux
Journal: European Respiratory Journal (2014)

Introduction   Polysomnography (PSG) is the gold standard for the analysis of sleep architecture. However, PSG is not always available in routine clinical practice, as it is time consuming and expensive. Bispectral index (BIS), developed to quantify the deepness of general anesthesia, may be used as a simplified tool to evaluate natural sleep depth.   Objectives   To objectively record sleep patterns in young patients using the latest BIS-Vista monitor and correlate BIS values with PSG sleep stages.   Methods   Patients, referred for the screening of obstructive sleep apnea syndrome, idiopathic hypersomnia, or narcolepsy, were recruited. Overnight PSG and BIS were performed simultaneously. BIS values were averaged for each sleep stage. Pre-sleep wakefulness (W) and overnight wakefulness (WASO) were also differentiated. BIS values were discarded for a signal quality index    Results   Twelve patients (7 Males, 5.7-29.3 years old) were included. Mean BIS values were 83±8, 76±12, 77±11, 70±10, 43±10, and 75±10 for W, WASO, N1, N2, N3 and R stages, respectively. BIS failed to distinguish W, WASO, N1 and R stages. BIS threshold that identified stage N2 was    Conclusion   The BIS identifies stage N3 with satisfactory sensitivity and specificity but is limited by its inability to distinguish REM sleep and wake. Further studies integrating chin electromyogram and/or electrooculogram could be of interest.
Cancer immunotherapy: harnessing the immune system to battle cancer
Authors: Yiping Yang
Journal: Journal of Clinical Investigation (2015)

The recent clinical successes of immune checkpoint blockade and chimeric antigen receptor T cell therapies represent a turning point in cancer immunotherapy. These successes also underscore the importance of understanding basic tumor immunology for successful clinical translation in treating patients with cancer. The Reviews in this Review Series focus on current developments in cancer immunotherapy, highlight recent advances in our understanding of basic aspects of tumor immunology, and suggest how these insights can lead to the development of new immunotherapeutic strategies.
Role of NMDA receptors in vascular remodelling associated to pulmonary hypertension
Authors: Sébastien J. Dumas, Frédéric Perros, Gilles Bru-Mercier, Benoit Ranchoux, Catherine Rücker-Martin, Elodie Gouadon, Matthieu Vocelle, Peter Dorfmüller, Elie Fadel, Marc Humbert, Sylvia Cohen-Kaminsky
Journal: European Respiratory Journal (2014)

Background   Vascular cells express the NMDA receptor (NMDAR) but whether this glutamate receptor participates to the development of pulmonary arterial hypertension (PAH) is unknown.   Aims   1) Highlight components of glutamatergic communication in pulmonary vascular cells. 2) Search for deregulation of this signalling pathway in PAH. 3) Study the contribution of pulmonary arterial smooth muscle cell (PASMC) NMDAR to PH. 4) Assess the effects of an NMDAR antagonist on established PH.   Methods   Immunohistochemistry and mass spectrometry imaging were used to detect components of glutamatergic communication in human lungs and vascular cells. A real-time enzymatic assay was used to detect glutamate release. PASMC proliferation was measured using BrdU incorporation. NMDAR knock out mice in PASMC were exposed to hypoxia for 3 weeks. The NMDAR antagonist MK-801 (3mg/kg/day) was administrated to monocrotaline (MCT) rats.   Results   1) Pulmonary vascular cells express NMDAR subunits, vesicular glutamate transporters, and release glutamate in a calcium-dependent way. 2) Remodeled arteries from iPAH patients contain higher level of glutamate compared to control arteries. Beside, Phospho896-GluN1 subunit of NMDAR, involved in its trafficking to the cell membrane, is present in vascular lesions from iPAH patients but not in controls. 3) NMDAR activation participates to PASMC proliferation induced by FBS or PDGF-BB and knocking out NMDAR in PASMC decreases PH in hypoxic mice. 4) Administration of MK-801 reverses PH in MCT rats.   Conclusion   Glutamatergic signaling through pulmonary vascular NMDAR occurs in PAH pathophysiology and may represent a new therapeutic target.   Support:  INSERM, Univ. Paris-Sud, CCML, LabEx LERMIT, FRSR.
Treatment of the carcinoid tumor and the malignant carcinoid syndrome.
Authors: C G Moertel
Journal: Journal of Clinical Oncology (1983)

Certainly in treatment of the carcinoid tumor surgery has a well-established curative and palliative potential. The primary challenge is a knowledgable marriage between stage of disease and aggressiveness of operative procedure. Nonsurgical treatment of the malignant disease per se has thus far not produced optimum results and, in the opinion of this author, should still be confined to a clinical research setting. It would seem very doubtful, however, that the more mundane types of trials, empirically testing drug after drug and arbitrarily concocted drug combinations, is the most productive road to follow. There is an evident need for more sophisticated approaches to this tumor, which has unique metabolic characteristics that should be pharmacologically exploitable. Past experience has indicated that such a setting may permit dramatic therapeutic accomplishment. There is a strong need for animal models or established cell lines which would facilitate preclinical therapeutic exploration. The carcinoid syndrome presents an unparalleled opportunity for fundamental physiologic observations and for experimental therapeutic study that can have applicability not only in palliating the syndrome itself but also in the management of other pathophysiologic states that may involve more subtle abnormalities of the same hormonal mechanisms. The patient with the carcinoid tumor should not just be a fascinating curio for grand rounds exhibition. He should be a focal point for research involving an experienced, multidisciplinary clinical team supported by devoted basic scientists. If our patient resources and efforts can be concentrated in this manner, the carcinoid should be a strong candidate for the next medically curable human cancer.
Effect of regular inhaled beclomethasone on exercise and methacholine airway responses in school children with recurrent wheeze
Authors: NJ Freezer, H Croasdell, IJ Doull, ST Holgate
Journal: European Respiratory Journal (1995)

The role of airway inflammation in the pathogenesis of asthma in childhood is uncertain. In the present study, 27 atopic and nonatopic children aged 7-9 yrs who had &gt; or = 5 episodes of wheeze and symptoms of exercise-induced asthma (EIA) in the previous 12 months, performed a methacholine challenge and exercise test on separate days at monthly intervals. The subjects had not received oral or inhaled corticosteroids for 12 months prior to the study. The dose-response relationship to inhaled methacholine was expressed as the cumulative dose provoking a 20% decrease in forced expiratory volume in one second (PD20). Forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) were measured prior to the exercise test and at 0, 3, 5, 10, 15 and 20 min following maximal exercise. Following the first methacholine challenge and exercise test, the children were randomized in a double-blind manner to receive inhaled beclomethasone dipropionate (BDP) 200 micrograms b.i.d. or a placebo b.i.d. from a Diskhaler for 3 months. All children were asymptomatic at the time of testing, and there was no significant change in the baseline FEV1 of any subject prior to either challenge throughout the study period. When compared to placebo, the bronchial responsiveness to exercise and methacholine was significantly attenuated in the children who had received inhaled BDP for at least 1 month. There was no relationship between the bronchial responsiveness to methacholine and exercise. There was no significant difference in the bronchial responsiveness to either stimulus in the atopic and nonatopic children. The results of this study suggest that immunoglobulin E (IgE)- and non-IgE-mediated airway inflammation are important in exercise- and methacholine-induced bronchoconstriction in children with recurrent wheeze, although it is probable that different mechanisms are responsible.