tbuckley/cabot-search huggingface dataset:
Low-t3 state a crucial biomarker in determining NIV failure and outcome in pulmonary patient?
Authors: Elvio Scoscia, Stefano Baglioni, Elisabetta Fiandra, Maurizio Dottorini, Oronzo Penza
Journal: European Respiratory Journal (2011)

Background: Various low T3 states have been described in severe nonthyroidal diseases; they have been associated with a poor prognosis in cardiovascular and pulmonary disease patients.

Aim: We assessed thyroid function in patients suffering from respiratory failure (RF), needing invasive or non-invasive mechanical ventilation (NIV), in order to evaluate the prognostic value of nonthyroidal illness syndrome in NIV failure.

Methods: We studied retrospectively 32 consecutive patients with acute or acute on chronic RF needing mechanical ventilation. Measured variables upon admission included: APACHE II score, the ratio of the partial pressure of oxygen in arterial blood to the fraction of oxygen in inspired gas (PaO2/FiO2), plasma levels of freeT3 (fT3), freeT4 (fT4), and Thyroid Stimulating Hormone (TSH) levels.

Results: Plasma levels of fT3 were below normal range in 17 patients (53%). Plasma fT3 correlated with PaO2/FiO2 (p<0.001), and with APACHE II score (p=0.003).

Ten patients with low levels of fT3 needed invasive mechanical ventilation due to NIV failure. These patients, with comparable APACHE II score and gas exchange, showed fT3 value significantly lower than patients improving with NIV.

FT3 levels were significantly lower (p=0.002) in four patients (12.5%) who died, in comparison to the patients who survived. FT3 value was the only factor significantly associated with an increased risk of death, according univariate logistic regression analysis (Odds Ratio 64.23, 95% Confidence Interval 1.78 to 2316.86, p=0.023).

Conclusion: Our data suggest that low T3 state can predict NIV failure and outcome in pulmonary patients with acute RF.
Abstract 9324: Optimal Acute Plasma Glucose Level for Cardiac Arrest Patients in the Therapeutic Hypothermia Era
Authors: Eisuke Kagawa, Keigo Dote, Masaya Kato, Shota Sasaki, Yoshinori Nakano, Kiho Itakura, Yusuke Ochiumi, Yu Takiguchi
Journal: Circulation (2011)

Introduction: Hyperglycemia has adverse outcomes in resuscitated patients who have experienced cardiac arrest. Therapeutic hypothermia has a neuroprotective effect in these patients and improves outcome. However, the optimal acute plasma glucose level for cardiac arrest patients in the therapeutic hypothermia era is still unclear. Hypothesis: We assessed the hypothesis that mild to moderately acute hyperglycemia is associated with improved neurological outcome in cardiac arrest patients treated with hypothermia. Methods: Between September 2003 and May 2011, comatose survivors of cardiac arrest, who were treated with mild hypothermia, were retrospectively enrolled in this study. Plasma glucose was measured after the indexed cardiac arrest. The study patients were divided into four groups according to plasma glucose levels: Q1 (&lt;11.1 mmol/l), Q2 (11.2-14.5 mmol/l), Q3 (14.6-18.4 mmol/l), and Q4 (&gt;18.5 mmol/l). Neurological outcomes were assessed by cerebral performance categories at discharge. Cox proportional regression analysis was used to estimate independent predictors of favorable neurological outcome and optimal acute plasma glucose levels. Results: Median age, rate of ventricular fibrillation, and median time interval from collapse to return of spontaneous circulation in Q1 (N = 36), Q2 (N = 38), Q3 (N = 37), and Q4 (N = 37) patients were 58, 55, 63, and 57 y (P = 0.42); 42%, 76%, 62%, and 54% (P = 0.02); and 40, 23, 33, and 41 min (P = 0.01), respectively. The rates of favorable neurological outcome in Q1 (N = 36), Q2 (N = 38), Q3 (N = 37), and Q4 (N = 37) patients were 25%, 66%, 43%, and 16%, respectively. Q1 [odds ratio (OR) 0.21; 95% confidence interval (CI), 0.05-0.78] and Q4 (OR, 0.14; 95%CI, 0.03-0.56) were significantly associated with an unfavorable neurological outcome after adjusting for baseline characteristics. Conclusions: Optimal acute plasma glucose levels for cardiac arrest patients treated with hypothermia ranged from 11.2-18.4 mmol/l, which was usually thought to be hyperglycemia.
Anaphylaxis to Patent Blue V. II. A unique IgE‐mediated reaction
Authors: S. G. O. Johansson, A. Nopp, H. Öman, P. Stahl‐Skov, A. S. Hunting, A. B. Guttormsen
Journal: Allergy (2009)

Patent Blue V (PBV) is injected in order to map sentinel nodes during cancer staging procedures. Anaphylactic reactions, allegedly IgE antibody mediated, have been reported. The aim of the study was to explore the immunological mechanism of anaphylaxis to PBV.PBV allergen threshold basophil sensitivity, CD-sens, was performed on cells from nine patients diagnosed as having had adverse reactions to PBV. The mechanisms of the CD-sens were studied by immunological and immuno-chemical methods.Five of the nine patients had a positive CD-sens to PBV which was completely eliminated by washing the cells in phosphate buffered saline before allergen challenge. However, the positive CD-sens was completely reconstituted by incubating the cells in plasma or serum of that patient or the other PBV-anaphylactic patients for 15 min at room temperature. In some patients the factor mediating CD-sens was completely or partially destroyed by heating at +56 degrees C for 30 min or being exposed to the low pH used for elution from anti-Ig columns. A 1000-fold excess of monoclonal IgE blocked the reconstitution by approximately 50%.Anaphylactic reactions to PBV are mediated by IgE antibodies giving a classical CD-sens reaction. However, the allergenic configuration seems to constitute a structure completely dependent on PBV, as a hapten, linked to a, so far, unknown carrier that seems to be unique for patients having experienced a PBV-induced reaction. Further studies are needed to characterize the postulated carrier.
β-blockers in pulmonary arterial hypertension: evolving concepts of right heart failure
Authors: Frances S. de Man, M. Louis Handoko
Journal: European Respiratory Journal (2015)

Current guidelines advise against the use of β-blockers in pulmonary arterial hypertension (PAH) to avoid systemic hypotension [1]. In addition, PAH patients have a fixed stroke volume, and are therefore highly dependent on heart rate to increase their cardiac output [2–4]. Indeed, Provencher et al . [5] showed that withdrawal of β-blockers significantly improved exercise capacity in portopulmonary hypertension. Peacock and Ross [6] described another case of portopulmonary hypertension, in which the use of a β-blocker to treat a supraventricular tachycardia in an already haemodynamically unstable patient was nearly fatal. Beta-blockers can be used safely by some PAH patients with comorbidities such as arrhythmias or hypertension <http://ow.ly/P2JHg>
Biotin-response Organicaciduria
Authors: M. Saunders, L. Sweetman, B. Robinson, K. Roth, R. Cohn, R. A. Gravel
Journal: Journal of Clinical Investigation (1979)

Fibroblast cultures from two individuals with biotin-responsive organicacidemia were found to have a pleiotropic deficiency of propionyl-CoA carboxylase, β-methylcrotonyl-CoA carboxylase, and pyruvate carboxylase activities after growth in biotin limited culture medium, conditions which do not affect the carboxylase activities of normal cells. All three enzyme activities were restored to normal levels after transferring the mutant strains to biotin-rich medium. Both patients excreted abnormal levels of an array of metabolic intermediates, including β-methylcrotonate, β-hydroxyisovalerate, β-hydroxypropionate, and lactate, which reflect metabolic blocks at all three carboxylase sites.
Ankle Motion after External Fixation of Tibial Fractures
Authors: G J Taylor, R L Allum
Journal: Journal of the Royal Society of Medicine (1988)

Loss of ankle movement is a complication of severe tibial fractures. This can be exacerbated if the foot is allowed to drop into equinus, particularly when an external fixator is employed. The range of ankle motion following external fixation of tibial fractures as compared to the opposite normal ankle was studied in 40 of 55 patients treated over a ten-year period. Nine were excluded due to other causes of ankle stiffness, leaving 31 cases for analysis. The mean follow up was 2 years 7 months (range 1 year to 8 years 3 months), and union had occurred by a mean of 35 weeks (range 9–100 weeks). The mean loss of ankle movement was 8° of plantar-flexion and 12° of dorsiflexion (overall loss 20°), the difference between the two being highly significant (P&gt; 0.001, t test). Loss of ankle motion closely paralleled the degree of soft tissue trauma, being 6° for closed fractures and 22° for open fractures (0.05 &gt; P&gt; 0.02). Ankle function is therefore at risk when a severe tibial fracture is treated by external fixation, and appropriate measures should be taken to preserve movement and prevent an equinus contracture.
Endoscopic lung volume reduction in patients with very low FEV1
Authors: Philipp M. Lepper, Sebastian Fähndrich, Franziska Trudzinski, Dominik Ballek, Katharina Rentz, Heinrike Wilkens, Ralf Kaiser, Frank Langer, Martin Hetzel, Robert Bals
Journal: European Respiratory Journal (2014)

Background: Even though endoscopic lung volume reduction (eLVR) with endobronchial valves (EBV) is an established therapy option for patients with severe emphysema, patients with a FEV1≤ 20% pred. are usually excluded from treatment.  Methods: We retrospectively evaluated all patients treated in our department with EBV at an FEV1 ≤ 20% pred. regarding lung function and six-minute walking test (6-MWT). All patients underwent V/Q-Scan and were evaluated for collateral Ventilation to determine the target lobe.  Results: We treated 18 patients; 15 were evaluated to date (aged 59.3 ± 6.8 years), eight were female. Mean (± SD) FEV1 before EBV implantation was 0.48 ± 0.13 L equal. 16.3 ± 2.7 % pred.; mean residual volume (RV) was 6.9 ± 1.5 L (326.0 ± 84.3 % pred.). Initial 6-MWT was 241 ± 70 m. Right upper lobe was treated 4-times, left upper lobe was treated 4-times, right lower lobe once, left lower lobe was treated 6-times. Four patients were treated bilaterally. After EBV treatment, mean FEV1 was 0.59 ± 0.11 L equal. 20.2 ± 2.6 % pred. (+23%); mean RV was 6.0 ± 1.8 L (275.6 ± 49.6 % pred; -13%). 6-MWT increased to 312 ± 98.5 m an (+29%). The pneumothorax rate was 20% (3/15 pat.); all pneumothoraces were treatable by chest tube only. 6/15 Patienten developed an atelectasis of the target lobe. Bilaterally treated patients benefitted from the treatment oft he 2nd side in the lung function tests.  Discussion: At a low rate of complications, patients benefitted from EBV treatment despite initially low FEV1. Some patients improved remarkably, especially when they developed an atelectasis of the target lobe. The results of this retrospective analysis show that EBV treatment in patients with an FEV1 ≤ 20% pred. is feasible and safe.
The efficacy of brief dynamic psychotherapy: a meta-analysis
Authors: P Crits-Christoph
Journal: American Journal of Psychiatry (1992)

Insurance companies, legislators, and funding agencies have become increasingly concerned with efficacy and accountability in regard to psychotherapy, and psychodynamic therapy is a primary target of concern because it is widely practiced in outpatient settings. This paper is a meta-analytic review of recent well-controlled studies of the efficacy of brief dynamic therapy.The meta-analysis included both published studies, located through an extensive computerized search of psychiatry and psychology journals, and studies reported at conferences. Eleven studies met the inclusion criteria: use of a specific form of short-term dynamic psychotherapy as represented in a treatment manual or manual-like guide; comparison of brief dynamic therapy and a waiting list control condition, nonpsychiatric treatment, alternative psychotherapy, pharmacotherapy, or other form of dynamic therapy; provision of the information necessary for calculation of effect sizes; at least 12 therapy sessions; and therapists who were trained and experienced in brief dynamic therapy. The outcome measures compared were target symptoms, psychiatric symptoms generally, and social functioning.Brief dynamic therapy demonstrated large effects relative to waiting list conditions but only slight superiority to nonpsychiatric treatments. Its effects were about equal to those of other psychotherapies and medication.These data confirm previous indications that various psychotherapies do not differ in effectiveness, although this finding should not be generalized to all patient populations, outcome measures, and treatment types. Also, the highly controlled conditions of these studies limit conclusions about actual practice. Future studies should address various treatment lengths, follow-up assessments, and specific treatments, patient groups, and outcome measures.
Determination of cutoff points for smoking biological markers and the influence of involuntary tobacco smoke exposure
Authors: Raquel Barros, Paula Pinto, Cristina Bárbara
Journal: European Respiratory Journal (2011)

Background:  The reference values used for smoking biological markers should be determined in each country or region because there are many factors that can influence them.   Objective:  To estimate the cutoff points of exhaled carbon monoxide (ECO), carboxyhemoglobin (COHb), plasma cotinine and urinary cotinine in order to differentiate active smokers from never-smokers.   Methods:  In a cross-sectional study with 53 active smokers (30 males) and 49 non-smokers (14 males), ECO, COHb, plasma cotinine and urinary cotinine were measured.   Results:  Anthropometric variables in both groups showed no statistically significant differences (p-value≥0,05).  Active smokers had significantly higher levels of ECO, COHb, plasma cotinine and urinary cotinine than non-smokers (p-value  It was determined the following cutoff points for biological markers: ECO - 4 ppm (sensitivity 100% and specificity 96,2%); COHb - 1,6% (sensitivity 100% and specificity 96,2%); plasma cotinine - 10 ng/mL (sensitivity 100% and specificity 96,2%) and urinary cotinine - 779 ng/mL (sensitivity 100% and specificity 94,3%).  In the absence of smoking exposure, the cutoff point for urinary cotinine changed to 22 ng/mL.   Conclusion:  All the biomarkers presented an excellent ability to discriminate between smokers and non-smokers.
The changes in smoking related behaviours, second hand smoke and smoking cessation after the smoking ban in Izmir, Turkey
Authors: Pakize Ayse Turan, Gul Ergor, Muzaffer Onur Turan, Sinem Doganay, Oguz Kilinc
Journal: European Respiratory Journal (2013)

The aim of the study is to determine people’s smoking related behaviours after the publishment of law which prohibits use of tobacco products in closed public areas.  MATERIAL-METHODS:Questionnaire including 47 questions was performed to 600 people,which presents the overall Izmir city population.  RESULTS:232 people were smoking(39%), 257 never smoked(42%) and 111 quited smoking(19%).Men were smoking more than women(p=0.0001).The smoke cessation percentage of women was statistically significantly higher than men(p=0.006).Non-smokers were exposed to second hand smoke(SHS) at homes(34.1%),vehicles(14,9%) and work places(14,4%).98% of all participants were aware of the law with 91.5% support.The law support of women(95,3%) was statistically significantly higher than men(88.5%;p=0.002). 42% of participants who succeeded in quitting had managed it after the ban.Restriction of areas, rise of prices and effects of SHS were the most popular reasons of reducing or quitting smoking after the law.The number of cigarettes smoking in one day was reduced by 3.19 cigarettes/day.The rate of violation of the ban was 32,3%.96,4% of supporters of the law was finding law successful and sufficient.  CONCLUSION:The frequency of smoking was higher than Turkey’s average in Izmir.The mean age of starting smoking was below 18.A big amount of participants thinks about quitting, and the law is thought to have important effect on this decision.The ban seems to have more effects in women.SHS has reduced mostly in public areas with ban, but law must be enlarged to prevent SHS at private areas.As a result; the ban encouraged smokers to quit and reduced SHS at public areas.
Latex tissue glue (LTG) application in lungs surgery and thoracic traumas for sealing lungs tissue: Suture, bronchial stump
Authors: Stanislav Skryabin
Journal: European Respiratory Journal (2011)

Stable sealing of lungs tissue is the core principle and the key condition for positive results of postoperative recovery period after thoracic surgery. Hardest complication in thoracic surgery is the inconsistency of bronchial stump, the bronchial fistulas (15,5%). Due to this possibility of glue usage for lung surface processing with sealing effect is the most actual for thoracic surgery; as the possibility of adequate elasticity while lungs tissue elongation with min. collateral effects.  The advantages of LTG: inexpensiveness, highly adhesiveness and hydrophilia, ability to change elasticity, viscosity, adhesiveness, high rupture strength, microbiological stability, low toxicity. In our thoracic department actively applied till September 2010 latex glue, resulted drainage period average 2-3 days after operations (in purulent-destructive processes max 5 days).  Traditionally the average drainage period more than 5-7 days, and more complications. The larger scale of application is possible but not happen due to lack of financing from our hospital administration.
Two Indian states promise to enforce act that punishes violent attacks against doctors
Authors: P. Pulla
Journal: BMJ (2015)

Doctors’ associations across India have scored a victory in their campaign for better implementation of the Medical Protection Act, with the state governments of Uttar Pradesh and Tamil Nadu agreeing to educate their police forces about the provisions of the act. The government of Haryana has promised similar action in the coming weeks, leading the state branch of the Indian Medical Association (IMA) to cancel a strike scheduled for 20 May.

The Medical Protection Act makes attacks on doctors and clinical property a non-bailable offence, punishable by imprisonment of up to three years and a penalty of Rs50 000 (£500; €690; $785). It is currently in force in 17 states. But, although it is widely implemented in some states such as Andhra Pradesh, the first state to pass the act, others such as Uttar Pradesh and Bihar haven’t seen state-wide adoption. As a result, there is no legal deterrent to the escalating incidents of violence against doctors …
Long-term follow-up of pulmonary function in chronic eosinophilic pneumonia. Groupe d'Etude en Pathologie Interstitielle de la Societe de Pathologie Thoracique du Nord
Authors: J Durieu, B Wallaert, AB Tonnel
Journal: European Respiratory Journal (1997)

The prognosis of chronic eosinophilic pneumonia (CEP) is usually good under corticosteroid therapy (CST). The main complications are relapses when treatment is tapered or discontinued. The aim of this retrospective, multicentre study was to evaluate the long-term consequences of CEP on pulmonary function tests. Nineteen patients (mean +/- SEM age 51 +/- 16 yrs) with CEP were studied. Lung function tests were performed at the time of diagnosis and at follow-up, and included flow-volume curve. The results of the first pulmonary function test were normal in six patients, restrictive in nine, and obstructive in four. Relapses (recurrence of initial signs) occurred in nine patients. The last evaluation (mean +/- SEM follow-up of 49 +/- 44 months, range 12-142 months) showed a complete recovery in 8 of the 19 patients. One patient developed bilateral apical fibrosis. The remaining 10 patients, exhibited obstructive pulmonary function without relapse of CEP at this time. Bronchoalveolar lavage (BAL) eosinophilia at the time of the initial evaluation tended to be higher (p = 0.05) in these 10 patients than in those with normal pulmonary function findings at follow-up. This study demonstrates: firstly, that the development of an obstructive ventilatory defect is a common finding during the course of chronic eosinophilic pneumonia (CEP); secondly, that bronchial obstruction might appear despite the absence of clinical and radiological signs of relapse; and, thirdly, that a markedly increased bronchoalveolar lavage eosinophilia at the initial evaluation is associated with a higher risk of development of bronchial obstruction. These results suggest that pulmonary function tests should be included in the management of chronic eosinophilic pneumonia.
Role of the parasympathetic nervous system in the allergen-induced airway sensitization and lung responsiveness
Authors: Iliona Malaspinas, Camille Doras, Aurélie Baudat, Xavier Belin, Ferenc Petak, Walid Habre
Journal: European Respiratory Journal (2014)

Rational:  While atropine pretreatment enhances allergen-induced bronchial hyperreactivity, the role of parasympathetic nervous system (PNS) on sensitization and lung responsiveness remains unclear. We characterized effects of chronic inhibition of the PNS on the ovalbumin (OVA)-induced lung inflammation and responsiveness to OVA challenge.  Methods:  Brown Norway rats (31) were randomly assigned to 5 groups summarized in figure. A subcutaneous pump for continuous infusion of atropine during 21 days was placed in two groups. Airway responsiveness to iv administration of 2 mg OVA was established at day 21 by forced oscillations following bilateral vagotomy. Lung cellularity was determined from bronchoalveolar lavage fluid (BALF).  Results:  Percentage increase in airway resistance (Raw) following iv OVA was significantly higher in groups receiving atropine (fig.). Magnitude of airway responsiveness was lower in sensitized animals. While percentage of eosinophils in BALF increased in all sensitized animals with OVA aerosol, pretreated animals with atropine exhibited an increase in neutrophils (48% and 35% in groups 3 and 5, respectively, p=0.001).  Conclusion:  Inhibition of the PNS-related pathway potentiated inflammatory cell infiltration and allergen-induced bronchoconstriction. However, repeated sensitization may have diminished the immune response to allergen challenge.   Supported by SNSF grant 332003B-143331/1 .
Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer.
Authors: J A Broeckel, P B Jacobsen, J Horton, L Balducci, G H Lyman
Journal: Journal of Clinical Oncology (1998)

Clinical reports suggest that many breast cancer patients experience persistent fatigue as a long-term side effect of adjuvant chemotherapy treatment. To investigate this issue further, we examined the characteristics and correlates of fatigue in women who had completed adjuvant chemotherapy for breast cancer and in a comparison group of women with no history of cancer.Participants were 61 women with breast cancer who had completed chemotherapy an average of 471 days previously and 59 women with no history of cancer. All participants completed standardized self-report measures of fatigue, sleep quality, menopausal symptoms, and coping and were administered a structured clinical interview to identify current and past psychiatric disorder.Compared with women with no history of cancer, former adjuvant chemotherapy patients reported more severe fatigue (P < .01) and worse quality of life because of fatigue (P < .05). More severe fatigue among patients was significantly (P < .05) related to poorer sleep quality, more menopausal symptoms, greater use of catastrophizing as a coping strategy, and current presence of a psychiatric disorder.These findings support the view that many breast cancer patients experienced heightened fatigue after completion of adjuvant chemotherapy treatment. Results yield a profile of women who are at increased risk for heightened fatigue after chemotherapy and suggest ways to intervene clinically to prevent or reduce fatigue in this patient population.