tbuckley/cabot-search huggingface dataset:
Outpatient management of primary spontaneous pneumothorax- A safety and economic review
Authors: Deepak S. Rao, Caroline Morley, Liju Ahmed
Journal: European Respiratory Journal (2013)

Background: At Guys and St. Thomas NHS Foundation Trust uncomplicated primary spontaneous pneumothorax (PSP) are managed as outpatient using a normal seldinger drain attached with pneumostat valve as opposed to standard British Thoracic Society guidelines. We conducted a retrospective service evaluation of the new outpatient model looking at the safety and health economic impact.

Methods: 

A retrospective data of all patients presented with PSP between was 1 January 2011 to 30 December 2012 was compiled. Data was collected for length of stay (LOS); complications such as pain, infection, bleeding, drain falling out and the ability for patients to self manage.

Inclusion criteria – uncomplicated PSP requiring chest tube insertion.

Exclusion Criteria – any secondary pneumothorax or complicated primary PSP and significant co-morbidities.

The cost of acute medical bed was calculated from our hospital finance department.

Results: 

Data for 84 patients with pneumothorax was collected.

39 patients met the above inclusion criteria- 23 Inpatients: 16 Outpatient.

Of the 23 inpatient (15 Male: 8 Female), age range was 17 - 36 years. Mean LOS was 7 days (range of 1 to 12 days).

16 outpatients (11 Male: 4 female) age range 16.5 to 33 years. LOS for this group was less than 1 day.

No significant difference was noted in terms of complications between the 2 groups. None of the patients had problems managing the drain out of hospital.

The average total bed day cost was £225. Mean cost saving was £1575 (£225 - £2700).

Conclusions: 

This study clearly demonstrates outpatient management of uncomplicated PSP is safe with significant reduction in LOS to less than 1 day with significant health economic impact.
A psychometric analysis of outcome measures in peripheral spondyloarthritis
Authors: Maureen C Turina, Sofia Ramiro, Dominique L Baeten, Philip Mease, Jacqueline E Paramarta, In-Ho Song, Aileen L Pangan, Robert Landewé
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Objectives</h3> To assess the discriminatory capacity of various outcome measures and response criteria in patients with peripheral spondyloarthritis (pSpA). <h3>Methods</h3> Data originated from two randomised controlled trials, ABILITY-2 and Tnf Inhibition in PEripheral SpondyloArthritis (TIPES). Continuous outcome measures included patient9s global assessment (PGA)/physician9s global assessment of disease (PhGA), C-reactive protein (CRP), tender joint counts (TJC)/swollen joint counts (SJC), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Ankylosing Spondylitis Disease Activity Score (ASDAS). Dichotomous response criteria included Peripheral SpondyloArthritis Response Criteria (PSpARC), American College of Rheumatology (ACR), ASDAS and BASDAI response criteria. The capacity to discriminate between adalimumab and placebo groups was assessed by standardised mean differences (SMD) for continuous variables, and Pearson9s χ<sup>2</sup> for dichotomous response criteria. <h3>Results</h3> Within each trial, the composite indices for axial SpA assessment, ASDAS-CRP (SMD: −0.63 and −0.89 in ABILITY-2 and the TIPES trial, respectively) and BASDAI (SMD: −0.50 and −0.73), and the single-item measures PGA (SMD: −0.47 and −1.12) and PhGA (SMD: −0.64 and −0.87) performed better than other single-item measures, such as CRP (SMD: −0.18 and −0.53), SJC or TJC. In general, the PSpARC and ACR response criteria discriminated better than ASDAS and BASDAI response criteria. <h3>Conclusions</h3> The axial SpA-specific ASDAS-CRP and BASDAI, but also PGA and PhGA, demonstrated good discriminatory ability in patients with pSpA. The pSpA-specific pSpARC response criteria and the rheumatoid arthritis-specific ACR response criteria also discriminated well. To fully capture typical pSpA manifestations, it may be worth developing new pSpA-specific indices with better performance and face validity. <h3>Trial registration numbers</h3> ABILITY-2: NCT01064856; TIPES: EUDRACT 2008-006885-27.
Discrimination between moderate and severe disease may be used in patients with either treated or untreated allergic rhinitis
Authors: A. Valero, M. Ferrer, E. Baró, J. Sastre, A. M. Navarro, E. Martí‐Guadaño, I. Dávila, A. Del Cuvillo, C. Colás, I. Antépara, J. Alonso, O. Mola, I. Izquierdo, J. Mullol
Journal: Allergy (2010)

Allergic rhinitis (AR) is a common disease with major socioeconomic burden and a significant impact on quality of life. The aim of this study was to discriminate between moderate and severe AR patients whether receiving treatment or not, using a modified criterion of allergic rhinitis and its impact on asthma (ARIA) classification.The modified ARIA severity classification (J Allergy Clin Immunol, 120, 2007, 359) categorizes AR as mild (no items affected), moderate (1-3 items affected), and severe (all four items affected). We applied these criteria to 1666 treated and 1058 untreated AR patients and compared their symptoms total four-symptom score (T4SS) and quality of life (ESPRINT-15), according to their clinical severity.Allergic rhinitis clinical status was significantly worse (P < 0.001) in treated than in untreated patients. For both treated and untreated patients, T4SS and ESPRINT-15 Quality of life scores were significantly worse (P < 0.001) in severe than in moderate patients.The modified ARIA severity classification is a useful clinical tool to discriminate moderate from severe AR among both treated and untreated patients.
Nigeria May Be Next Country to Eliminate Polio
Authors: M. J. Friedrich
Journal: JAMA (2015)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Quantitative studies on the precursors of cytotoxic lymphocytes. III. The lineage of memory cells.
Authors: Teh H-S, R A Phillips, R G Miller
Journal: The Journal of Experimental Medicine (1977)

In the course of a mixed lymphocyte culture, memory cells are produced which can give rise to a large secondary cytotoxic lymphocyte response on reexposure to the sensitizing alloantigen. We have studied the lineage of these memory cells using a clonal assay for precursors of cytotoxic T lymphocytes (CLP). Our data provide conclusive evidence that individual CLP, upon stimulation with alloantigens, gives rise to clones which contain memory cells of the same specificity as the CLP. Only half of the clones that responded in the primary stimulation could be reactivated upon exposure to the original priming alloantigen.
Physiotherapy intervention improves symptoms in patients with exercise induced laryngeal obstruction
Authors: Amy Olley, Rachel Johnston, Andrew Menzies-Gow, James Hull
Journal: European Respiratory Journal (2013)

Introduction

Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise. This produces transient upper airway obstruction & mimics asthma. It has been proposed that a physiotherapy delivered breathing & laryngeal retraining program can improve symptoms of EILO, however evidence in this context is lacking.The aim of this study is to report our experience with breathing retraining in EILO.

Methodology

Patients referred to the out-patient physiotherapy department with EILO Aug 2012-Feb 2013 were evaluated. Diagnosis was made using the gold standard technique; continuous laryngoscopy during exercise. Treatment is standardised over 4 sessions & includes breathing re-training,education & preventative strategies; both at rest & during exercise. Dyspnoea12 (D12);six minute walking test (6MWT);anxiety score (HAD);asthma quality of life (AQLQ) were evaluated before & after intervention.

Results

Eight patients were assessed following referral; mean(SD) age 38.3(21.1)yrs, BMI 26.5(8.3), FEV1%pred 94.3(18.6),symptoms 4.4(5.9)yrs.4 patients had a co-existent diagnosis of asthma.Results were available for 4 patients.

Clinically significant improvements were found in quality of life measures (D12 & AQLQ) & exercise capacity (6MWT).

View this table:

Table1





Conclusion

Our preliminary data indicate that physiotherapy delivered breathing control intervention for EILO leads to a clinically significant improvement in dyspnoea control, exercise capacity & quality of life.Further data to be presented at the ERS.
Inhibition of Oral Carcinogenesis by a Protease Inhibitor&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: D V Messadi, P Billings, G Shklar, A R Kennedy
Journal: JNCI Journal of the National Cancer Institute (1986)

The effect of the Bowman-Birk inhibitor (BBI) and soybean trypsin inhibitor (SBTI) on experimental 7,12-dimethylbenz[a]anthracene [(DMBA) CAS: 57-97-6]-induced oral carcinogenesis in Syrian male hamsters was examined. All treatments were applied topically on both cheek pouches for 20 weeks, and the animals were then sacrificed. Gross and microscopic evaluations revealed a statistically significant reduction in the number of invasive carcinomas, the total number of tumors, and the tumor mass for the DMBA + BBI treatment group compared to animals treated with DMBA alone, DMBA and autoclaved BBI (a preparation in which protease inhibitor activity is destroyed), or DMBA + SBTI. A protease activity (with the use of Boc-Val-Pro-Arg-MCA as substrate) was measured and found to be elevated about tenfold in tumorous and nontumorous tissue from DMBA-treated cheek pouches. This protease activity was found to be decreased in the DMBA and BBI treatment group but not in the DMBA + SBTI or DMBA and autoclaved BBI treatment groups, as compared to the protease activity in the DMBA treatment group. Partial characterization of the Boc-Val-Pro-Arg-MCA hydrolyzing activity with diisopropyl fluorophosphate suggests that the proteolytic activity is a serine protease. Iodoacetamide and diethyl pyrocarbonate also inhibit enzyme activity, suggesting that other residues may be necessary for catalysis, possibly including cysteine and histidine. Our results suggest that this protease activity may play a role in DMBA-induced cheek pouch carcinogenesis.
Airways response of asthmatics after a 30 min exposure, at resting ventilation, to 0.25 ppm NO2 or 0.5 ppm SO2
Authors: R Jorres, H Magnussen
Journal: European Respiratory Journal (1990)

We compared the effect of inhaled NO2 and SO2 on airway tone and airway responsiveness in 14 nonsmoking mild asthmatics (mean +/- SD age 34 +/- 14 yrs; mean +/- SD baseline forced expiratory volume in one second (FEV1), 86 +/- 17% pred). On 3 separate days, 30 min tidal breathing (average minute ventilation 10.6 l.min-1) of either filtered air, 0.25 ppm NO2, or 0.5 ppm SO2 was followed by an isocapnic hyperventilation test with 0.75 ppm SO2. To determine the provocative ventilation necessary to increase specific airway resistance (sRaw) by 100% (PV100sRaw) ventilation was increased in steps of 15 l.min-1, each step lasting 3 min. Resting ventilation of filtered air, NO2, or SO2 was followed by a slight but significant overall decrease of sRaw from 8.8 to 7.7 cmH20.s-1, with no differences between the study days. Mean +/- SEM PV100sRaw(SO2) was 46.5 +/- 5.1, 37.7 +/- 3.5 and 45.4 +/- 4.2 l.min-1 after tidal breathing of filtered air, NO2, and SO2, respectively. PV100sRaw(SO2) was significantly lower after NO2 as compared to filtered air or SO2 (p less than 0.01). There was a significant correlation (rs = 0.86) between the individual shift of PV100sRaw(SO2) after NO2 and the shift after SO2 as compared to filtered air. From these individual comparisons we suggest that in asthmatics short-term exposure to NO2 at rest enhances airway responsiveness to hyperventilation of SO2 without altering airway tone, whereas short-term exposure with low concentrations of SO2 does not.
Health related quality of life (HRQoL) and dyspnea of COPD patients 3 and 6 months after a 3-week inpatient pulmonary rehabilitation (PR)
Authors: Konrad Schultz, Danijel Jelusic, Michael Wittmann, Michael Schuler
Journal: European Respiratory Journal (2014)

Background:  The current GOLD Document postulates 6 weeks as a minimum duration of PR in COPD. In Germany, PR usually is carried out as 3-week inpatient PR.   Method:  This prospective study investigates whether HRQoL improves in COPD patients 3 and 6 months after 3-week inpatient PR. Primary outcome: SGRQ (St George9s Respiratory Questionnaire). Secondary Outcome: TDI (transition dyspnea index). Patient population: 104 COPD-patients (GOLD stages 2-4, age 56.7 ±7.2 years, 59.9% male, FEV1 53.0±15.6% pred.).   Results:    Discussion:  The SGRQ total score improved at t1 by 10.2 points with SRM by 1.0 (strong effect). After 3 and 6 months the scores were still 7.6 respectively 6.2 points better than at t0 (SRM = 0.5 resp. 0.4). All domains of the SGRQ improved at the end of rehabilitation but also 3 and 6 months after discharge clinically relevant. In addition the TDI improved at t1 by 4.88 points (MID=1) and remained clinically relevant improved after 3 and 6 months.   Conclusion:  These results contradict the apodictic 6-week postulate of the current GOLD document.
A new index to determine regional lung heterogeneity in healthy and emphysema
Authors: Caterina Salito, Jason C. Woods, Andrea Aliverti
Journal: European Respiratory Journal (2013)

Specific gas volume (SVg, ml/g) converts CT lung density into the physiological meaningful index of volume of gas per gram of tissue (Salito, C. et al. Radiology 2009).

The aim of this study was to study regional differences of SVg in the different bronchopulmonary segments in healthy and patients with severe emphysema.

CT scans of 10 healthy subjects and 10 patients with emphysema were obtained at end inspiration (TLC) and end-expiration (RV). For each subject, ΔSVg (ΔSVg =SVg,TLC –SVg,RV) vs ΔVL (ΔVL =VL,TLC –VL,RV) was plotted for each bronchopulmonary segment and for entire lung (gray and black lines, respectively, in figure) and an Heterogeneity Index (HI) was defined as √( (d12+ d22+···+ dn2) / n) ⁄ ΔVL (d=distance of ΔVL-ΔSVg in the plot of each bronchopulmonary segment point and the entire lung at RV; n= number of bronchopulmonary segments; see figure).

In healthy lungs all bronchopulmonary segments showed similar slopes, ΔSVg /ΔVL, while in emphysema an high variance of slopes was found. As a consequence HI was significantly higher in emphysema than in healthy subjects (0.80 ±0.34 and 0.15±0.10,respectively, p<0.001).

In conclusion, SVg variations within the lung are highly homogeneous in healthy subjects. Conversely, the larger heterogeneity in emphysema reflects an inhomogeneous lung emptying and therefore HI can be considered as a biomarker for surgical planning and post-treatment evaluation.

![Figure][1]  [1]: pending:yes
Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer patients: Final analysis of the EORTC AMAROS trial (10981/22023).
Authors: Emiel J. Rutgers, Mila Donker, Marieke Evelien Straver, Philip Meijnen, Cornelis J. H. Van De Velde, Robert E. Mansel, Helen Westenberg, Lorenzo Orzalesi, Willem H. Bouma, Huub van der Mijle, Grard A. P. Nieuwenhuijzen, Sanne C. Veltkamp, Leen Slaets, Carlo G. M. Messina, Nicole J. Duez, Coen Hurkmans, Jan Bogaerts, Geertjan van Tienhoven
Journal: Journal of Clinical Oncology (2013)

LBA1001 The full, final text of this abstract will be available at abstract.asco.org at 7:30 AM (EDT) on Monday, June, 3, 2013, and in the Annual Meeting Proceedings online supplement to the June 20, 2013, issue of Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Monday edition of ASCO Daily News.
Results of a phase I trial administering Zyflamend to subjects with high-grade prostatic intraepithelial neoplasia
Authors: A. E. Katz, P. M. Pierorazio, P. Masson, E. T. Goluboff, B. A. Stone, J. M. McKiernan, M. C. Benson, C. A. Olsson
Journal: Journal of Clinical Oncology (2006)

14575 Background: Subjects diagnosed with prostatic intraepithelial neoplasia (PIN) at prostate biopsy are at increased risk of developing prostate cancer on later biopsies. We initiated a phase I clinical trial to asses the safety and efficacy of the novel herbal anti-inflammatory, Zyflamend, to prevent prostate cancer in high-risk subjects with PIN. Methods: Men ages 40–75 diagnosed with high-grade PIN (without prostate cancer) on biopsy within the last six months were enrolled. Patients were assigned to one of eight treatment groups, with successive dose-escalation occurring in each group. Patients were evaluated every three months for 18 months; at which time they had a physical exam and blood samples drawn to monitor for toxicity, to check for fluctuations in PSA and testosterone, and monitor a battery of inflammatory serum. At 6, 12 and 18 months, 12-core transrectal ultrasound guided biopsy of the prostate was performed. Biopsy tissue was evaluated for the presence of PIN and/or prostate cancer then stained for inflammatory biomarkers. A NCI common terminology criteria for adverse events (v3.0) based questionnaire was used to monitor side effects. Endpoints are completion of the 18 month protocol without adenocarcinoma or diagnosis of adenocarcinoma prior to 18 months. Results: To date 25 patients have been enrolled; the expected closure date is March, 2006. The median patient age is 65.1 years with a median PSA level of 6.8. There have been no adverse events reported or toxicities apparent. Five patients (20%) have complained of grade I dyspepsia resolving spontaneously without intervention. Preliminary results include a total of 22 biopsies performed in 19 patients. 18 of the 22 biopsies were performed per protocol at scheduled visits, the remaining four were performed between scheduled visits. Of 22 biopsies completed seven returned positive for PIN (31.8%) and three have returned with adenocarcinoma (13.6%). Conclusions: The novel herbal anti-inflammatory, Zyflamend, appears to be associated with minimal toxicity and no serious adverse events when administered orally. Short term biopsy results indicate a low progression rate, although long-term efficacy awaits further studies. No significant financial relationships to disclose.
Short-Course Radiation Versus Long-Course Chemoradiation for Rectal Cancer
Authors: Bruce D. Minsky, Claus Rödel, Vincenzo Valentini
Journal: Journal of the National Comprehensive Cancer Network (2012)

The 2 broad approaches to preoperative therapy for rectal cancer are chemoradiation and short-course radiation. The outcomes of these 2 approaches reported in nonrandomized trials are not comparable because patients selected for treatment with short-course radiotherapy included those with cT1–3 disease, whereas patients selected for chemoradiation included those with T3 and/or N+ disease. However, more recent trials of short-course radiation have included patients with cT3 and/or N+ disease who also underwent sequential or postoperative chemotherapy, allowing a more relevant comparison with chemoradiation. This article compares the 2 preoperative approaches and addresses their emerging roles.
Activating PPARα Prevents Post–Ischemic Contractile Dysfunction in Hypertrophied Neonatal Hearts
Authors: Victoria H. Lam, Liyan Zhang, Alda Huqi, Arata Fukushima, Brandon A. Tanner, Arzu Onay-Besikci, Wendy Keung, Paul F. Kantor, Jagdip S. Jaswal, Ivan M. Rebeyka, Gary D. Lopaschuk
Journal: Circulation Research (2015)

Post-ischemic contractile dysfunction is a contributor to morbidity and mortality after the surgical correction of congenital heart defects in neonatal patients. Pre-existing hypertrophy in the newborn heart can exacerbate these ischemic injuries, which may partly be due to a decreased energy supply to the heart resulting from low fatty acid β-oxidation rates.We determined whether stimulating fatty acid β-oxidation with GW7647, a peroxisome proliferator-activated receptor-α (PPARα) activator, would improve cardiac energy production and post-ischemic functional recovery in neonatal rabbit hearts subjected to volume overload-induced cardiac hypertrophy.Volume-overload cardiac hypertrophy was produced in 7-day-old rabbits via an aorto-caval shunt, after which, the rabbits were treated with or without GW7647 (3 mg/kg per day) for 14 days. Biventricular working hearts were subjected to 35 minutes of aerobic perfusion, 25 minutes of global no-flow ischemia, and 30 minutes of aerobic reperfusion. GW7647 treatment did not prevent the development of cardiac hypertrophy, but did prevent the decline in left ventricular ejection fraction in vivo. GW7647 treatment increased cardiac fatty acid β-oxidation rates before and after ischemia, which resulted in a significant increase in overall ATP production and an improved in vitro post-ischemic functional recovery. A decrease in post-ischemic proton production and endoplasmic reticulum stress, as well as an activation of sarcoplasmic reticulum calcium ATPase isoform 2 and citrate synthase, was evident in GW7647-treated hearts.Stimulating fatty acid β-oxidation in neonatal hearts may present a novel cardioprotective intervention to limit post-ischemic contractile dysfunction.