tbuckley/cabot-search huggingface dataset:
Regular review: The pleural cavity
Authors: Giles J Peek, Sameh Morcos, Graham Cooper
Journal: BMJ (2000)

Diseases of the pleural space are common. In this review we discuss the pathophysiology, diagnosis, and treatment of pneumothorax, pleural effusion, and empyema.

#### Summary points

After a second spontaneous pneumothorax there is a 40% chance of recurrence; video assisted thoracoscopic bullectomy and pleurodesis is the treatment of choice.

Needle decompression (second interspace, mid-clavicular line) is the best treatment for suspected tension pneumothorax.

Ultrasonography is helpful in cases of pleural effusion.

A chest drain should be inserted in cases of exudative (protein content greater than 3 g/l) pleural effusion that recur after aspiration, or in parapneumonic effusions when the pH is less than 7.2 or the glucose concentration is less than 3.33 mmol/l.

A chest drain should be inserted for early empyema.

Late presenting empyema should be treated by decortication if the patient is fit, but patients who are unfit for major surgery should receive thrombolytic instillation or thoracostomy.

We searched Medline (1966 to 1999), standard textbooks of thoracic surgery, and life support manuals for articles that answered questions that in our experience non-specialists commonly ask of specialists in the diagnosis and management of pneumothorax, pleural effusion, and empyema.

The pleura is a thin serous layer, which covers the lungs (visceral pleura) and is reflected, by way of the lung hila, on to the chest wall and pericardium (parietal pleura). The pleural space thus created extends from the root of the neck, 3 cm above the mid-point of the clavicle, down behind the abdominal cavity, in the costodiaphragmatic recess, to the 12th rib overlying the kidney.1 Only a thin layer of pleural fluid separates the parietal and visceral pleura. The parietal layer secretes 2400 ml of fluid daily, which is resorbed by the visceral layer.2 Maintenance of negative intrapleural pressure is necessary for respiration.

Pneumothorax describes air within the pleural cavity. …
Effects of an Angiotensin-Converting–Enzyme Inhibitor, Ramipril, on Cardiovascular Events in High-Risk Patients
Authors: S Yusuf, P Sleight, J Pogue, J Bosch, R Davies, G Dagenais
Journal: New England Journal of Medicine (2000)

Angiotensin-converting–enzyme inhibitors improve the outcome among patients with left ventricular dysfunction, whether or not they have heart failure. We assessed the role of an angiotensin-converting–enzyme inhibitor, ramipril, in patients who were at high risk for cardiovascular events but who did not have left ventricular dysfunction or heart failure.
Alcohol Abuse and Stage of HIV Disease in Intravenous Drug Abusers
Authors: Gerond Lake-Bakaar, Roger Grimson
Journal: Journal of the Royal Society of Medicine (1996)

Our objective was to identify factors that might correlate with human immunodeficiency virus (HIV) disease stage in intravenous drug abusers (IVDA). Particular attention was given to alcohol abuse. We accordingly explored in a cross-sectional study the relation between stage of HIV disease and age, sex, needle sharing, ethnicity, self-reported history of alcohol consumption and CAGE scores. IVDA from a single municipal hospital were subdivided into three groups according to HIV disease status. Group 1 comprised 42 individuals with AIDS; group 2 comprised 114 who were HIV positive but without AIDS; and group 3 comprised 52 who were HIV negative. Information on alcohol consumption and CAGE responses were obtained by questionnaire and interview. Discriminant analysis indicated that alcohol abuse, assessed either by self-reported consumption or by CAGE scores, was significantly more common in the AIDS group than in either the HIV positive or the HIV negative groups, when controlled for age, sex, and needle sharing status. The relative risk of AIDS was 3.8 times higher in the heavy drinkers than in moderate drinkers. Needle sharing was also more common in the AIDS group than in the HIV positive or HIV negative groups when the other factors were controlled for. AIDS was more common in black than white IVDA, and this increased frequency did not appear related to alcohol consumption since the distribution of heavy drinkers within each category of HIV disease did not differ within the ethnic groups. These data indicate that a history of heavy alcohol consumption is more common in IVDA with AIDS than in IVDA at earlier stages of HIV disease.
Membrane-bound Klotho is not expressed endogenously in healthy or uraemic human vascular tissue
Authors: Rik Mencke, Geert Harms, Katarina Mirković, Joyce Struik, Joris Van Ark, Ellen Van Loon, Melissa Verkaik, Martin H De Borst, Clark J Zeebregts, Joost G Hoenderop, Marc G Vervloet, Jan-Luuk Hillebrands
Journal: Cardiovascular Research (2015)

Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD), a disease state that is strongly associated with loss of renal and systemic (alpha-)Klotho. Reversely, murine Klotho deficiency causes marked medial calcification. It is therefore thought that Klotho conveys a vasculoprotective effect. Klotho expression in the vessel wall, however, is disputed. We assessed Klotho expression in healthy human renal donor arteries (n = 9), CKD (renal graft recipient) arteries (n = 10), carotid endarterectomy specimens (n = 8), other elastic arteries (three groups of n = 3), and cultured human aortic smooth muscle cells (HASMCs) (three primary cell lines), using immunohistochemistry (IHC), immunofluorescence, quantitative reverse transcriptase–polymerase chain reaction, and western blotting (WB). We have extensively validated anti-Klotho antibody KM2076 by comparing staining patterns with other anti-Klotho antibodies (SC-22220, SC-22218, and AF1819), competition assays with recombinant Klotho, IHC on Klotho-deficient kl/kl mouse kidney, and WB with recombinant Klotho. Using KM2076, we could not detect full-length Klotho in vascular tissues or HASMCs. On the mRNA level, using primers against all four exon junctions, klotho expression could not be detected either. Fibroblast growth factor 23 (FGF23) injections in mice induced FGF23 signalling in kidneys but not in the aorta, indicating the absence of Klotho-dependent FGF23 signalling in the aorta. Using several independent and validated methods, we conclude that full-length, membrane-bound Klotho is not expressed in healthy or uraemic human vascular tissue.
Priority setting in health care
Authors: R. Cookson
Journal: BMJ (2000)

Editor—Torgerson and Gosden argue that eliciting public views on healthcare priority setting is a waste of money.1 It is implicit in their argument that the many health economists who dabble in this allegedly inefficient activity should know better. As health economists and practitioners of the dark art of including the public in priority setting, we believe that we ought to respond to this charge.

The problem with Torgerson and Gosden's argument is that it does not distinguish between facts and values. It seems reasonable to assume that patients normally know less than clinicians about the facts concerning the effects of different treatments. As Torgerson and Gosden argue, this form of asymmetric information is one reason why many British health economists believe that public funding of health care is more efficient than private funding, which provides clinicians with a profit motive for supplying unnecessary treatments to ill-informed patients.

Torgerson and Gosden assert that patients generally know less than specialists about the “facts” concerning the effects of alternative priority setting decisions, and they conclude that setting priorities on the basis of ill-informed opinions is inefficient. What Torgerson and Gosden do not recognise, however, is the possibility that patients generally know more than specialists about their own values concerning their health and the health of others.

This kind of asymmetrical information can lead well meaning clinicians, managers, and policymakers to provide inefficient healthcare services, poorly in tune with patients' values. That is why health economists have devoted considerable energy to developing methods of valuing the effects of treatments from the patient's point of view. That is also why health economists are now devoting energy to developing methods of consulting patients about their values concerning priority setting.

Asymmetrical information about facts can cause inefficiency in a private system, which is why we need a public system. Asymmetrical information about values can cause inefficiency in a public system, which is why we need to include the public in healthcare priority setting. Efficient decision making requires the use of best available information about facts and values. Our experience in conducting preference elicitation studies suggests that asking the taxpayer can be a fruitful source of information about the latter—and that public opinions are more sophisticated, and less predictable, than Torgerson and Gosden like to think.
The Effect of Cryo-Maze Procedure on Early and Intermediate Term Outcome in Mitral Valve Disease: Case Matched Study
Authors: Hiroyuki Nakajima, Junjiro Kobayashi, Ko Bando, Kazuo Niwaya, Osamu Tagusari, Yoshikado Sasako, Takeshi Nakatani, Soichiro Kitamura
Journal: Circulation (2002)

The maze procedure is an effective way to treat atrial fibrillation (AF) associated with mitral valve disease. In a last several years, cryoablation was substituted for atrial incision in many reports to simplify the maze procedure. However, there has been no comparative study to delineate the feasibility of the use of cryoablation.We compared the early and intermediate-term results of the maze procedure including pulmonary venous isolation from the left atrium using cryoablation (CM) with our conventional (Kosakai) maze procedure (KM) including encircling incision around the orifices of pulmonary veins. One hundred and 10 pairs of patients were matched in the age, left atrial dimension >70 mm, duration of AF >0 years, previous cardiac surgery, mechanical valve implantation and concomitant aortic valve procedures. CM required significantly shorter cardiopulmonary bypass time (186+/-56 minute versus 214+/-47 minute, P=0.001) and aortic cross-clamp time (134+/-43 minute versus 144+/-37 minute, P=0.03) than KM with less chest tube drainage (590+/-353 mL versus 745+/-618 mL, P=0.02) for 12 hours after operation. The sinus rhythm restoration rate in CM group (85.4%) was comparable with KM group (86.4%) at discharge. In the late results, the actuarial freedom from recurrence of sustained AF at 3 years in CM group (97.7%) was not significantly (P=0.11) different from that in KM group (90.4%). The actuarial freedom from stroke at 3 years in CM group was 99.0%.The modification of the maze procedure including cryoablation for pulmonary venous isolation provided less aortic cross-clamp time and less amount of chest tube drainage with the comparable recovery and maintenance of sinus rhythm with KM. CM is a reliable and less invasive surgical option for the AF associated with mitral valve disease.
Abstract 14309: Beta Blocker Cessation Does Not Restore Chronotropic Response in Patients With Advanced Heart Failure
Authors: Benjamin J Hirsh, Andrea Mignatti, Daniel Sims, Nir Uriel, Paolo Colombo, Ulrich Jorde
Journal: Circulation (2011)

Background: Chronotropic incompetence (CI) is defined as inability to reach 80% of maximally predicted heart rate (MPHR) or 80% of HR reserve (% HRR = [Peak - Resting HR / Achieved Peak HR - Restin...
Abstract 4940: Inflammatory Thrombotic Interactions in Young Type 1 Diabetes Subjects: Effects of Glycaemic Control
Authors: Katharina Hess, Mathew Mathai, Thet Koko, Kristina F Standeven, Philip Holland, Angela M Carter, Fladia Phoenix, Peter J Grant, Ramzi A Ajjan
Journal: Circulation (2009)

The inflammatory and thrombotic pathways have a crucial role in the development of coronary artery disease, and inflammatory thrombotic markers predict cardiovascular events. Although the atherosclerotic process in type 1 diabetes (T1DM) starts at an early age, little is known about inflammatory markers and clot structure in this population. The aims of this study were to investigate C-reactive protein (CRP), complement C3 (C3) and fibrin clot structure/fibrinolysis in children and young adults with T1DM, the effects of improving glycaemic control on these parameters and complement/fibrin interactions affecting clot structure/function. In 47 children (14±3yrs) C3 levels were higher in T1DM than controls (1.13±0.24 versus 0.83±0.24mg/ml respectively; p&lt;0.001), whereas CRP levels were no different. Clot final turbidity (FT), an indicator of clot density, was higher in diabetes children compared with controls, and lysis time longer (599±18 and 516±17 secs, respectively, p=0.02). In 18 young adults with T1DM (23±5yrs) a 1.3% reduction in HbA1c was associated with a decrease in C3 levels from 1.09±0.05 to 0.96±0.05mg/ml (p&lt;0.05), with no effect on CRP levels. Improving glycaemic control reduced FT and shortened lysis time from 601±21 to 550±19 secs (p=0.02). Clot FT and lysis correlated positively with C3 plasma levels (r=0.39 and r= 0.585, respectively; p&lt;0.01). C3 incorporation into the plasma clot was 26% and 19% in T1DM and controls respectively, a difference that failed to reach statistical significance. However, clots made from plasma-purified fibrinogen diabetes patients exhibited a 71% increase in lysis time in the presence of purified C3, whereas this increase was only 41% using fibrinogen purified from controls (p=0.03). These results demonstrate that young children with T1DM already have evidence of inflammatory thrombotic processes as indicated by elevated C3 levels, a denser clot structure and prolonged clot lysis times. Interactions between C3 and fibrin occur in non-diabetic subjects, but are significantly enhanced in the presence of diabetes. Improving glycaemic control is associated with reduction in C3 levels and favourable changes in clot structure/function, which is potentially due to a direct effect of C3 on clot lysis.
Physical, social, and psychological function in asthma patients with and without analgesic tolerance
Authors: Deniz Inal-Ince, Sema Savci, Naciye Vardar-Yagli, Ebru Calik, Melda Saglam, Hulya Arikan, Meral Bosnak-Guclu, Gul Karakaya, Fuat Kalyoncu
Journal: European Respiratory Journal (2011)

Purpose:  Ingestion of aspirin and similar drugs triggers severe bronchospasm in some asthmatic patients. The purpose of this study was to compare physical, social and psychological function between analgesic intolerant and tolerant asthmatic (AIA and ATA, respectively) patients.   Methods:  Twenty-seven AIA and 29 ATA patients participated in this study. Respiratory and quadriceps muscle strength (QMS) were measured. Asthma Control Questionnaire and Asthma Knowledge Test were applied. Six-minute walk test was performed, and physical activity level was determined using International Physical Activity Questionnaire (IPAQ). Dyspnea and fatigue perception was evaluated using modified Medical Research Council dyspnea scale and Fatigue Severity Scale, respectively. Psychological function was evaluated using Beck Depression Inventory and State Trait Anxiety Inventory. General and disease specific quality of life were determined using Nottingham Health Profile and Asthma Quality of Life Questionnaire, respectively.   Results:  The FEV 1 , QMS, IPAQ walking score, and Asthma Knowledge Test score were significantly higher in AIA patients as compared to those of ATA patients (p 0.05).   Conclusion:  The AIA patients share similar characteristics with ATA patients except better airway function, peripheral muscle strength and physical activity level, and worse asthma knowledge. Presence of analgesic intolerance effects components of physical function in asthma.
Abstract 16019: African American Race is Significantly Associated With Risk of Sudden Cardiac Death Among Diabetics
Authors: Carmen Teodorescu, Audrey Uy-Evanado, Kyndaron Reinier, Harpriya Chugh, Jo Ayala, Ronald Mariani, Karen Gunson, Jonathan Jui, Sumeet S Chugh
Journal: Circulation (2011)

Introduction: Diabetes has been linked with increased risk of sudden cardiac death (SCD) in multiple studies but most were performed among Caucasians; and our current ability to risk-stratify diabe...
Abstract 313: KLF5 Plays an Important Role in Endoplasmic Reticulum Stress Response in both Cardiovascular and Metabolic System
Authors: Kosei Eguchi, Ichiro Manabe, Hua Shen, Yumiko Ohishi, Katsuhito Fujiu, Norifumi Takeda, Ryozo Nagai
Journal: Circulation (2007)

We have previously shown that the transcription factor KLF5 plays an important role in cardiovascular diseases. KLF5 heterozygous knockout ( KLF5 +/− ) mice exhibited much less neointima formation in vascular injury models and less severe cardiac hypertrophy and fibrosis in the angiotensin II-loading model. We have also found that KLF5 is expressed in metabolic tissues, such as adipose tissue, pancreatic β-cell, and skeletal muscle. When KLF5 +/− mice were fed with high-fat diet, they were protected from metabolic syndrome. These findings demonstrate that KLF5 plays important roles in stress response in both cardiovascular and metabolic systems. To better understand how KLF5 responds to metabolic and inflammatory stress, we analyzed signaling pathways that activate KLF5. One such pathway was the unfolded protein response (UPR). Indeed, in KLF5 +/− mice fed with high-fat diet exhibited much less severe pancreatic islets remodeling, in which endoplasmic reticulum (ER) stress and UPR have been shown to play an essential role. To further analyze KLF5’s role in ER stress responses, we treated mouse MIN6 pancreatic β cells with palmitate as a model of lipotoxicity. Palmitate induced ER stress markers, CHOP, Bip and phosphor-eIF2α. The increases in ER stress markers were accompanied by induction of KLF5, while insulin expression was decreased. When ER stress was attenuated by 4-phenylbutyrate and tauroursodeoxycholate, the induction of KLF5 and the down regulation of insulin expression were significantly inhibited. When the KLF5 was knocked down with siRNA, the down regulation of insulin mRNA expression in response to palmitate was suppressed. These results demonstrate that KLF5 is a downstream effecter protein of ER stress in β-cells and is involved in insulin expression. We then analyzed it in the cardiovascular system. We found that KLF5 was also induced by ER stress in smooth muscle cells (SMCs). Moreover, interleukin-1, which is known to induce inflammatory genes in SMCs, activated KLF5 via ER stress. Results of the present study suggest that KLF5 responds to ER stress in both cardiovascular and metabolic systems and that this signaling pathway plays important roles in pathogenesis and progression of metabolic syndrome as well as cardiovascular diseases.
10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors
Authors: Robyn L. McClelland, Neal W. Jorgensen, Matthew Budoff, Michael J. Blaha, Wendy S. Post, Richard A. Kronmal, Diane E. Bild, Steven Shea, Kiang Liu, Karol E. Watson, Aaron R. Folsom, Amit Khera, Colby Ayers, Amir-Abbas Mahabadi, Nils Lehmann, Karl-Heinz Jöckel, Susanne Moebus, J. Jeffrey Carr, Raimund Erbel, Gregory L. Burke
Journal: Journal of the American College of Cardiology (2015)
Pembrolizumab versus investigator-choice chemotherapy for ipilimumab-refractory melanoma (KEYNOTE-002): a randomised, controlled, phase 2 trial
Authors: Antoni Ribas, Igor Puzanov, Reinhard Dummer, Dirk Schadendorf, Omid Hamid, Caroline Robert, F Stephen Hodi, Jacob Schachter, Anna C Pavlick, Karl D Lewis, Lee D Cranmer, Christian U Blank, Steven J O'Day, Paolo A Ascierto, April K S Salama, Kim A Margolin, Carmen Loquai, Thomas K Eigentler, Tara C Gangadhar, Matteo S Carlino, Sanjiv S Agarwala, Stergios J Moschos, Jeffrey A Sosman, Simone M Goldinger, Ronnie Shapira-Frommer, Rene Gonzalez, John M Kirkwood, Jedd D Wolchok, Alexander Eggermont, Xiaoyun Nicole Li, Wei Zhou, Adriane M Zernhelt, Joy Lis, Scot Ebbinghaus, S Peter Kang, Adil Daud
Journal: The Lancet Oncology (2015)
Sleep and breathing disorders in newly diagnosed lung cancer patients
Authors: Eleni Perantoni, Vassilis Michailidis, Dimitra Siopi, Pavlos Zarogoulidis, Nikos Moysiadis, Pashalis Steiropoulos, Venetia Tsara
Journal: European Respiratory Journal (2013)

Sleep disturbances in lung cancer patients are often unaddressed and there is little information about breathing pattern during sleep in these patients. The aim of the study was to assess breathing and sleep quality in newly diagnosed lung cancer patients.  Patients/Methods: A sleep study was performed in 28 patients with lung cancer (13 SCLC and 15 NSCLC). Demographic characteristics, Athens Insomnia Scale (AIS), Epworth Sleepiness Scale (ESS) and Fatigue Severity Scale (FSS) were also completed and collected.  Results: Patients were primarily smokers, aged 59.8±9.8 years with BMI 27.1±5.4 kg/m². Sleep Efficiency was 76.2±17.0%, the ESS was low whereas AIS and the FSS were high. There was a positive correlation between AIS and the duration of stage 3 and the number of arousals (p  Conclusions: In these newly diagnosed lung cancer patients, sleep quality was low with high perception of insomnia and fatigue. Sleep related disordered breathing occurred in almost the half of the patients.
活動性関節リウマチ成人における皮下投与アバタセプトの評価: 休薬および再導入が免疫原性,有効性および安全性に及ぼす影響(第IIIb相 ALLOW試験)
Authors: Kaine Jeffrey, Gladstein Geoffrey, Strusberg Ingrid, Robles Manuel, Louw Ingrid, Gujrathi Sheila, Pappu Ramesh, Delaet Ingrid, Pans Miranda, Ludivico Charles
Journal: Annals of the Rheumatic Diseases (2012)
Pharmacogenetic stimulation of cholinergic pedunculopontine neurons reverses motor deficits in a rat model of Parkinson’s disease
Authors: Ilse S. Pienaar, Sarah E. Gartside, Puneet Sharma, Vincenzo De Paola, Sabine Gretenkord, Dominic Withers, Joanna L. Elson, David T. Dexter
Journal: Molecular Neurodegeneration (2015)

Patients with advanced Parkinson's disease (PD) often present with axial symptoms, including postural- and gait difficulties that respond poorly to dopaminergic agents. Although deep brain stimulation (DBS) of a highly heterogeneous brain structure, the pedunculopontine nucleus (PPN), improves such symptoms, the underlying neuronal substrate responsible for the clinical benefits remains largely unknown, thus hampering optimization of DBS interventions. Choline acetyltransferase (ChAT)::Cre+ transgenic rats were sham-lesioned or rendered parkinsonian through intranigral, unihemispheric stereotaxic administration of the ubiquitin-proteasomal system inhibitor, lactacystin, combined with designer receptors exclusively activated by designer drugs (DREADD), to activate the cholinergic neurons of the nucleus tegmenti pedunculopontine (PPTg), the rat equivalent of the human PPN. We have previously shown that the lactacystin rat model accurately reflects aspects of PD, including a partial loss of PPTg cholinergic neurons, similar to what is seen in the post-mortem brains of advanced PD patients. In this manuscript, we show that transient activation of the remaining PPTg cholinergic neurons in the lactacystin rat model of PD, via peripheral administration of the cognate DREADD ligand, clozapine-N-oxide (CNO), dramatically improved motor symptoms, as was assessed by behavioral tests that measured postural instability, gait, sensorimotor integration, forelimb akinesia and general motor activity. In vivo electrophysiological recordings revealed increased spiking activity of PPTg putative cholinergic neurons during CNO-induced activation. c-Fos expression in DREADD overexpressed ChAT-immunopositive (ChAT+) neurons of the PPTg was also increased by CNO administration, consistent with upregulated neuronal activation in this defined neuronal population. Overall, these findings provide evidence that functional modulation of PPN cholinergic neurons alleviates parkinsonian motor symptoms.