tbuckley/cabot-search huggingface dataset:
Factors associated with outcome among COPD patients undergoing pulmonary rehabilitation
Authors: Stefanni Nonna Paraguas, Bernice Ong-Dela Cruz, Percival Punzal
Journal: European Respiratory Journal (2013)

Pulmonary Rehabilitation provides a comprehensive intervention for patients with chronic respiratory diseases.Since identification of additional benefits are not detected by usual measures, determination of other factors are considered to ensure success.Evaluation included Spirometry,Six-Minute Walk Test,cardiopulmonary exercise testing and a self administered respiratory questionnaire using St. George Questionaire and Medical Research Council Dyspnea Scale.Successful primary outcome was defined as greater than the minimum clinically important difference in one or more areas of attendance,MMRC,SGRQ and 6MWT.In total,320 patients completed the study.Educational attainment and distance between the facility and patients’ residence were signficant factors that determine success at p-value 0.009 and 0.013 respectively.Age,gender,civil status,weight,height and body mass index showed no significant correlation.Impact of a single or aggregated co-morbidities on the effect of the program was also significant at p-value 0.004.Advanced stage of COPD is associated with poor outcome.Significant correlations were found with outcome, presence of hypoxemia and episodes of exacerbations.Patients with partial pressure of oxygen at >80 mm Hg(72.8%) and experiencing less than twice a year exacerbations(97.8%) were noted to have more successful outcome.Educational attainment, distance between the facility and patient’s residence, number of co-morbidities, severity of COPD, degree of hypoxemia and episodes of exacerbations determined the outcome of pulmonary rehabilitation program.These were statistically significant and clinically important in the improvement of the quality of life of COPD patients.
Review of interventions to prevent heart disease
Authors: D. Batty, S. Ebrahim, G. D. Smith
Journal: BMJ (1997)

Progress in reducing inpatient mortality from acute myocardial infarction is slowEditor-Brown et al report a substantial increase in the use of beneficial interventions for patients admitted to hospital with acute myocardial infarction in Nottingham from 1982 to 1992. 1 However, they found no change in inpatient mortality adjusted for age and sex.This contrasts with findings in Ontario, Canada, where hospital discharge abstracts show that inpatient mortality fell from 1981 to 1991 2 and has since fallen further (data on request).Brown et al suggest that the disparate results may reflect coding errors in the Ontario administrative data.Our group has assessed the classification of deaths from acute myocardial infarction in inpatients in the Ontario discharge abstracts.Matching Ontario administrative data to data from the GUSTO-I and LATE trials, we found the specificity of the administrative data to be 100% (1403/1403 alive), with overall sensitivity of 94% (104/111 deaths detected). 3he classification of acute myocardial infarction itself is more problematic.The sensitivity of the primary diagnosis of acute myocardial infarction is high, but specificity varies. 4 5There are two common reasons for false positive coding.Firstly, patients may be admitted to a coronary care unit with possible acute myocardial infarction but this diagnosis is ruled out and they are sent home quickly.Alternatively, patients recently admitted to hospital with acute myocardial infarction are readmitted for coronary angiography or with complications other than overt reinfarction, and the code for acute myocardial infarction is wrongly used again.Thus the analysis of outcomes in Ontario excluded both patients with a primary diagnosis of acute myocardial infarction who were discharged in under four days and patients who had been admitted to hospital for acute myocardial infarction in the preceding three months. 2t is therefore doubtful that imprecise coding explains the improving outcomes of acute myocardial infarction in Ontario.Indeed, only systematic coding errors could explain the observed trends in inpatient mortality, and we have found neither evidence nor a rationale for this.Ontario's administrative data do mirror the findings of Brown et al in two respects 2 : admissions for acute myocardial infarction, particularly among elderly patients, increased over the period studied, and inpatient mortality ranged from 16% to 21%, which is much higher than in the large randomised trials of thrombolytic treatment.Thus while the trends in Ontario are more positive than those in Nottingham, we agree with Brown et al that the cardiovascular megatrials have been enrolling skewed patient populations 3 and that progress in the battle to reduce inpatient mortality from acute myocardial infarction remains slow.
Abduction results in family, emotional, and legal problems
Authors: L. Bernardino
Journal: BMJ (1996)

The turnover of the artificial surfactant Exosurf after its administration to infants with respiratory distress syndrome was studied. High performance liquid chromatography was used to compare the phosphatidylcholine (PC) composition of serial endotracheal tube secretions from three groups of infants. There were 22 infants who received two doses of Exosurf in 24 hours (group 1), 10 infants who received four doses in 36 hours (group 2), and 41 control infants who did not receive Exosurf. Two parameters were studied: (i) dipalmitoylphosphatidylcholine (DPPC), which is present in both Exosurf and endogenous surfactant, expressed as a percentage of total PC (% DPPC) and (ii) the ratio of DPPC to the entirely endogenous palmitoyloleoylphosphatidylcholine (DPPC:POPC ratio). The administration of Exosurf produced changes in endotracheal tube aspirate PC composition that were detectable for over one week. Four doses of Exosurf in 36 hours prolonged the persistence of these changes compared with two doses in 24 hours, but the numbers of infants were small, and should not be over-interpreted. We conclude that after giving two doses of Exosurf, further doses might best be delayed until after two days, and that further clinical evaluation of dosage regimens is required.
Shot and long-term effects of pulmonary rehabilitation program in sarcoidosis
Authors: Halina Baradzina
Journal: European Respiratory Journal (2013)

Pulmonary rehabilitation is not an established treatment modality for sarcoidosis patients now. Total strategy and an appropriate protocol need to be determined. The aim: to evaluate the shot and long-term effects of multidisciplinary individualized rehabilitation program in sarcoidosis.  Sarcoidosis patients were randomized into rehabilitation (R) (70 patients, 31m/49f, mean age 36 yrs) and a control (C) groups (70 patients, 30m/40f, mean age 35 yrs) in accordance with attendance of multidisciplinary rehabilitation program, included exercise training (40 min/5 times weekly), physiotherapeutic procedures, education, nutritional advice, stress management. All patients were examined before, just after and in 5 yrs after course of rehabilitation with lung functional tests, chest x-ray, electrocardiography, walking test, laboratory tests and quality of life (QL) by WHO questionnaire.  Just after rehabilitation course there was no significant difference in the radiological picture, laboratory tests and ECG compared to the baseline and between the groups. But only in R group there was significant improvement (p  Conclusion: Pulmonary rehabilitation has positive shot and long–term effects on health status and quality of life in sarcoidosis.
Clopidogrel With Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) Trial
Authors: Yilong Wang, Yuesong Pan, Xingquan Zhao, Hao Li, David Wang, S. Claiborne Johnston, Liping Liu, Xia Meng, Anxin Wang, Chunxue Wang, Yongjun Wang
Journal: Circulation (2015)

Background— The Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial showed that the combined treatment of clopidogrel and aspirin decreases the 90-day risk of stroke without increasing hemorrhage in comparison with aspirin alone, but provided insufficient data to establish whether the benefit persisted over a longer period of time beyond the trial termination. We report the 1-year follow-up outcomes of this trial. Methods and Results— The trial was a randomized, double-blind, placebo-controlled trial conducted at 114 centers in China. We randomly assigned 5170 patients within 24 hours after onset of minor stroke or high-risk transient ischemic attack to clopidogrel-aspirin therapy (loading dose of 300 mg of clopidogrel on day 1, followed by 75 mg of clopidogrel per day for 90 days, plus 75 mg of aspirin per day for the first 21 days) or to the aspirin-alone group (75 mg/d for 90 days). The primary outcome was stroke event (ischemic or hemorrhagic) during 1-year follow-up. Differences in outcomes between groups were assessed by using the Cox proportional hazards model. Stroke occurred in 275 (10.6%) patients in the clopidogrel-aspirin group, in comparison with 362 (14.0%) patients in the aspirin group (hazard ratio, 0.78; 95% confidence interval, 0.65–0.93; P =0.006). Moderate or severe hemorrhage occurred in 7 (0.3%) patients in the clopidogrel-aspirin group and in 9 (0.4%) patients in the aspirin group ( P =0.44). Conclusions— The early benefit of clopidogrel-aspirin treatment in reducing the risk of subsequent stroke persisted for the duration of 1-year of follow-up. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00979589.
Abstract 2551: Regional Distribution and Characteristics of Complex Fractionated Atrial Electrogram in Electroanatomically Remodeled Left Atrium in Patients With Atrial Fibrillation
Authors: Jae Hyung Park, Hui-Nam Pak, Jong Il Choi, Sook Kyoung Kim, Euy Seok Hwang, Moon Hyung Lee, Sung Soon Kim, Chun Hwang, Young-Hoon Kim
Journal: Circulation (2009)
Gender differences in substance use disorders
Authors: K T Brady, D E Grice, L Dustan, C Randall
Journal: American Journal of Psychiatry (1993)

The goals of this study were to explore gender differences in demographic variables, psychiatric comorbidity, and personality disorders in individuals with substance use disorders.A total of 100 treatment-seeking substance users (50 men and 50 women) admitted to a university-based and a university-affiliated private chemical dependency hospital were compared with regard to demographic variables and comorbid psychiatric and personality diagnosis according to the Structured Clinical Interview for DSM-III-R after 14-21 days in treatment.Men were significantly more likely to have a higher household income and to be alcohol dependent. Women were significantly more likely to have another axis I disorder in addition to substance use disorder, particularly anxiety disorders, but these gender differences were not substantially different from the gender prevalence of these disorders in the general population. Men had more affective disorders relative to women than would be expected from the general population data. Female alcoholics had substantially more psychopathology than male alcoholics, and generally these differences were consistent with the ratios of these disorders in the general population. For cocaine users, female/male ratios of anxiety and affective disorders were inconsistent with general population ratios and indicated more psychopathology than would be expected in male cocaine users. There were no gender differences in axis II diagnoses.Some of the gender differences in psychopathology in substance users are at odds with gender differences for psychopathology in the general population. Further exploration of these differences could have important theoretical and treatment implications.
The role of amino-terminal pro-brain natriuretic peptide (NT-proBNP in clinical evaluation of patient with acute exacerbation chronic obstructive pulmonary disease
Authors: Lamia Shaaban, Amany Mohamed, Hanan Mohamed
Journal: European Respiratory Journal (2014)

COPD is a progressive disease, often associated with chronic co morbidities, leading to a significant burden for the patient.   Aim of the work  :toassess plasma NT-proBNP level in patients with acute exacerbation of COPD (AECOPD )  and to evaluate the prognostic value of elevated NT-proBNP levels to predict in-hospital outcome of those patients.  Material and Methods:   From 1 November 2010 to 30 April 2011, 45 adult patients ≥ 40 years of age with acute exacerbation of COPD (AECOPD) admitted to department of pulmonary medicine oAssiut University Hospital; Egypt were enrolled in this study. Plasma NT-proBNP levels were measured and systolic pulmonary arterial pressure (SPAP) was estimated by echocardiography.  Results:   NT-proBNP levels were significantly elevated during the acute exacerbation compared to recovery (254 pg/mL vs 89 pg/mL ; p = 0.000). Also in those patients requiring ICU admission [416 pg/mL ] vs [200.5 pg/mL ]p=0.000.To predict ICU admission in AECOPD, ROC analysis was performed with NT-proBNP level > 300 has the best sensitivity and specificity (Sensitivity = 89.5%, Specificity = 92.3%) with area under the ROC curve (AUC) = 0.933.NT-proBNP levels at exacerbation were significantly elevated in patients with cor pulmonale compared to those without cor pulmonale [329 pg/mL ] vs [197pg/mL ]p=0.000. With cut-off level of NT-proBNP > 214 pg/ml, which gives the best sensitivity and specificity (Sensitivity = 95.7%, Specificity = 72.7%) with AUC = 0.895.  Conclusions:   plasma NT-proBNP levels are elevated in AECOPD patients and can predict the need for ICU admission.
PSYCHOTHERAPEUTIC USE OF ACTH IN PSYCHOSOMATIC DISEASE
Authors: GORDON SAVER, ROBERT R. MORRIS, JOSEPH E. GIANSIRACUSA
Journal: American Journal of Psychiatry (1955)

1. A case of chronic ulcerative colitis treated by inducing active patient collaboration in therapy with an internist and psychiatrist is reported. 2. Advantages and disadvantages of the psychotherapeutic use of ACTH and cortisone are considered. 3. ACTH and cortisone are discussed as valuable adjuncts to the psychotherapy of ulcerative colitis. 4. The philosophy of creating a collaborative therapist out of a chronically ill, masochistically-dependent individual by presenting the patient with personal control of ACTH as a "crutch" or tool, rather than an unrealistic panacea—we feel bears with it an explicit invitation to independent action and health. Such an approach may be applicable to other chronic psychosomatic diseases.
Abstract 17969: Coronary Plaque Composition in Symptomatic African American and White Patients: Insights From with Coronary CT Angiography
Authors: Mouaz Al-Mallah, Waqas Qureshi, Khaled Abdul Nour, Tanmay Swadia, Khurram Nasir
Journal: Circulation (2011)

Background: Despite worse cardiovascular outcomes, previous studies have demonstrated that African American (AA) patients have lower coronary calcium score (CCS) compared to Caucasians (CA). The aim of this analysis is to assess the racial differences in coronary plaque burden and composition in symptomatic patients undergoing coronary CT Angiography (CCTA). Methods: A total of 838 symptomatic patients (47% male, mean age: 57±12years) underwent CCS and CCTA for evaluation of chest pain syndrome. Each coronary artery segment was evaluated for the presence of and type (calcified, non-calcified, mixed) of atherosclerotic plaque. Presence and extent of atherosclerotic plaque was compared between AA and CA patients using multivariate regression. Results: African American patients (n=325) were more often males with higher prevalence of diabetes (23% vs. 18%, p=0.044) and hypertension. They less often had any detectable coronary calcifications (46% vs. 55%, p=0.01) as well as lower median CCS score (0 vs. 10, p&lt;0.0001). In univariate analysis, AA patients had a lower prevalence of calcified plaque (34% vs. 42%, p=0.033) with no differences in non-calcified and mixed plaques (Figure). This continued to be significant after adjusting for potential confounders. (OR of AA having more than 2 calcified plaques compared to CA: 0.52, 95%-CI: 0.34 - 0.83, p=0.007). Conclusion: Our analysis suggests that in comparison to Caucasians, symptomatic African-American patients have lower burden of calcified plaque without increase in the presence of non-calcified plaque or mixed plaques as detected by CCTA.
Subnetwork-Specific Homeostatic Plasticity in Mouse Visual Cortex In Vivo
Authors: Samuel J. Barnes, Rosanna P. Sammons, R. Irene Jacobsen, Jennifer Mackie, Georg B. Keller, Tara Keck
Journal: Neuron (2015)

Homeostatic regulation has been shown to restore cortical activity in vivo following sensory deprivation, but it is unclear whether this recovery is uniform across all cells or specific to a subset of the network. To address this issue, we used chronic calcium imaging in behaving adult mice to examine the activity of individual excitatory and inhibitory neurons in the same region of the layer 2/3 monocular visual cortex following enucleation. We found that only a fraction of excitatory neurons homeostatically recover activity after deprivation and inhibitory neurons show no recovery. Prior to deprivation, excitatory cells that did recover were more likely to have significantly correlated activity with other recovering excitatory neurons, thus forming a subnetwork of recovering neurons. These network level changes are accompanied by a reduction in synaptic inhibition onto all excitatory neurons, suggesting that both synaptic mechanisms and subnetwork activity are important for homeostatic recovery of activity after deprivation.
Soundings: The cow war
Authors: George Dunea
Journal: BMJ (2001)

Seventy years before the current livestock epidemic, enraged farmers in southern Iowa used clubs, gas pipes, rubber hoses, and tree limbs to attack officials and vets sent to test their herds. They threw stones, dirt, even pumpkins, manhandled officials, and damaged their cars. It was one of a series of incidents in what became known as the cow war.

This war of September 1931 was described in detail by George Mills in his book One Armed Bandits (Mid-Prairie Books, 1997). It was precipitated not by prions or foot and mouth viruses but by bovine tuberculosis, which had been greatly hemmed in after many states made testing of livestock compulsory. Farmers were compensated for cattle that had to be slaughtered and generally supported the programme.

Against testing, during the hard times of the early 1930s, was a small minority of farmers, many of German and Irish descent who were opposed to “outside influences.” They argued that tuberculin testing was unreliable, caused cows to abort, produced deformed calves, or infected them with tuberculosis. They tried to fight compulsory testing in the courts, but lost. They were further inflamed by the incendiary radio broadcasts of a cancer quack who railed against authorities, corporations, vivisectionists, vaccinationists, and organised medicine.

Protests began in early 1931. Petitions were signed, rallies held, and officials prevented from entering farms. Farmers blocked roads, threatening and striking vets, splattering them with eggs, water, and “contents of chamber pots.” When one farmer was arrested in a small town, the crowds attacked the jail and freed him. At last the governor called out the troops; and soldiers advancing with drawn bayonets came to support the teams testing the herds.

By October most cattle had been tested; and the war petered out in November. It had claimed only one serious casualty, a soldier who shot himself in the stomach while cleaning his gun but who recovered. Two ringleaders were sentenced to three years in jail, but were released after 40 days.

Widespread testing of herds has continued; and most states are now bovine-tuberculosis free. Only around El Paso, in Texas, does the disease survive, suspected to originate from dairies in Mexico; and also in northern Michigan, where some 1500 cows have had to be destroyed in recent years.
Smad1 deficiency and female gender contribute to the development of pulmonary hypertension
Authors: Kirsty Mair, Xu Yang, Lu Long, Kevin White, Margaret Nilsen, Nick Morrell, Margaret R. MacLean
Journal: European Respiratory Journal (2014)

Introduction. Pulmonary arterial hypertension (PAH) occurs more frequently in females; the primary genetic defect of heritable (hPAH) is a mutation in the gene encoding bone morphogenetic protein receptor type 2 (BMPR2). We have previously demonstrated that deficiency in Smad1, a key signalling moiety in the BMPR2 pathway, plays a role in the development of pulmonary hypertension (PH) in female mice but not male.   Aim.  Here we further investigate the role of Smad1 and female gender in the development of PH.   Methods.  Female Smad1 deficient (Smad1+/-) mice and their wildtype (WT) littermates were ovariectomised at 8 weeks of age to remove the major site of female hormone production. These mice were then aged to 6 months old before pulmonary haemodynamics were measured. The role of Smad1 in the proliferation of human pulmonary artery smooth muscle cells (PASMCs) was also assessed by knocking-down Smad1 using siRNA.   Results.  At 6 months old female Smad1+/- mice spontaneously develop PH as displayed by elevated right ventricular pressure (SRVP) (WT SRVP = 20.1±0.9mmHg; +/- SRVP = 29.9±0.5mmHg; p   Conclusions.  These findings suggest that the presence of female hormones, coupled with Smad1 deficiency plays a role in the female susceptibility to develop PH.
Current weekly limits too mean
Authors: J C Duffy
Journal: BMJ (1994)

EDITOR, - John Kemm uses careful selection from the evidence to defend the current recommendations on weekly limits of alcohol consumption.1 Several studies have shown an inverse association rather than a flat curve between the risks of various cardiovascular diseases (morbidity and mortality) and alcohol consumption.2 Whether men who drink about seven units a week have rates of heart disease close to the lowest depends on the studies chosen and the grouping of consumption.

In the British regional heart study the mortality from cardiovascular disease among moderate consumers (16-42 units a week) was three …
Aspirin for everyone older than 50?
Authors: Peter Elwood, Gareth Morgan, Ginevra Brown, Janet Pickering
Journal: BMJ (2005)

Current population screening for vascular disease is neither efficient nor effective. Peter Elwood and colleagues believe we should have a public information strategy highlighting the benefits (and risks) of aspirin for older people, but Colin Baigent argues that the evidence of benefit is not yet strong enough

It is 30 years since the first randomised trial was published showing a link between aspirin and myocardial infarction.1 We believe that the evidence now supports more widespread use of aspirin prophylaxis, and there needs to be a strategy to inform the public and enable older people to make their own decision. The evidence focuses on a crucial question—namely, at what age does the balance between benefit and risk justify low dose aspirin prophylaxis? Of further relevance is a possible reduction of cancer and dementia by aspirin.

Although several groups have recommended aspirin prophylaxis based on age alone, including a recommendation of daily aspirin for everyone over 50,2 3 cardioprotection is usually given only to people at vascular risk. Many formulas are available to assess risk, and one of these4 is the basis of the recommendation that prophylactic aspirin be considered if the five year risk of a vascular event is 3% or more.5

Application of the Framingham risk formula4 to the …
Abstract P97: Femoral Artery Temperature for Monitoring Core Temperature During Mild Hypothermia in Patients Resuscitated From Cardiac Arrest
Authors: Danica Krizanac, Peter Stratil, Andreas Janata, Fritz Sterz, Anton Laggner, Moritz Haugk, Christoph Testori, Michael Holzer, Wilhelm Berhinger
Journal: Circulation (2009)