tbuckley/cabot-search huggingface dataset:
Genotype MTBDR plus Line Probe Assay as a rapid tool for the diagnosis of smear-negative tuberculosis in bronchoalveolar lavage fluid in Pakistan
Authors: Farah Idrees, Muhammad Irfan, Kauser Jabeen, Rumina Hasan
Journal: European Respiratory Journal (2014)

Background:   The Genotype Line probe assay (MTBDR  Plus ) has been validated in sputum for rapid diagnosis of tuberculosis (TB) and isoniazid and rifampicin resistance. Its utility in bronchoalveolar lavage (BAL) especially in smear negative cases is unclear.   Objective:   To evaluate the accuracy of the MTBDR  Plus  in BAL in sputum scarce/smear negative patients.   Methods:   Cross sectional study (Jan-Dec 2013) at Aga Khan University, Karachi Pakistan. Suspected pulmonary TB patients who underwent bronchoscopy were selected. Specimens on which both culture and MTBDR  Plus  was performed were analyzed. Sensitivity and specificity of MTBDR  Plus  with culture as reference method was determined.   Results:   Of the 154 patients, 34 had culture-confirmed TB. MTBDR  Plus  was positive in 20/34 patients [Sensitivity 59% (95% CI: 41% to 75%) & Specificity 95% (95%CI: 89% to 98%)].  A significantly lower proportion was detected by smear compared with MTBDR  Plus  (29.4% versus 59%; p Plus  positive. The sensitivity and specificity of MTBDR  Plus  in Sm+/CS+ cases was 100 % and 100% and in Sm-/CS+ cases was 42% and 95% respectively. 114 of 120 culture negative patients were also MTBDR  Plus  negative. Two cases of MDR TB were identified by MTBDR  Plus .   Conclusion:   MTBDR  Plus  detected TB cases more accurately and rapidly in BAL than smear with early detection of MDR TB. The use of MTBDR  Plus  in BAL for TB diagnosis will lead to early and appropriate treatment of such cases in our setting.
Relation of plasma osteopontin levels with the clinical course in patients with COPD
Authors: Satoshi Konno, Masaru Suzuki, Hironi Makita, Kaoruko Shimizu, Rose Maciewicz, Masaharu Nishimura
Journal: European Respiratory Journal (2014)

Introduction : Osteopontin (OPN) is an extracellular matrix protein with a wide range of functions. Previous studies showed that OPN is involved in the development of emphysema in a murine model.In addition, high OPN expression in alveolar macrophages is associated with decreased FEV1/FVC in subjects with COPD. However, there is limited information regarding the association between the circulating OPN levels and the clinical course of COPD.

Objective : To evaluate the association of circulating OPN levels and the clinical course of COPD in a 5-year prospective observational cohort study.

Methods : A total of 261 subjects who participated in the Hokkaido COPD cohort study were included for this analysis. Plasma OPN levels were measured at enrollment using Human CardiovascularMAP® (Myriad RBM, Austin, TX). All subjects were divided into two groups according to their plasma OPN levels (high OPN group, OPN ≥ 10 ng/mL; low OPN group, OPN < 10 ng/mL). We compared the baseline characteristics and clinical course of COPD, including the annual change in FEV1, exacerbation rate, and mortality during follow-up.

Results : Univariate analysis showed that the mean body mass index (BMI) was lower andCT emphysema score was higher in the high OPN group than that in the low OPN group (P < 0.05).Multivariate Cox proportional hazards models revealed that higher plasma OPN levels was significantly increased the risk of exacerbation and mortality during follow-up after controlling for age, sex, height, and BMI (P < 0.05), whereas the mean annual change in FEV1 was not statistically different between the two groups.

Conclusion : Plasma OPN levels were associated with the exacerbation rate and mortality in patients with COPD.
Risk of occult pleural infection in patients with malignant effusions
Authors: Anna Bibby, Susan Dawson, Andrew Stanton
Journal: European Respiratory Journal (2013)

Patients with malignant pleural effusions may undergo repeated aspirations prior to definitive intervention and are at risk of iatrogenic infection. We reviewed pleural fluid samples received for microbiological analysis between 1/6/12 and 1/1/13 alongside demographic data, clinical suspicion of infection prior to procedure and final diagnosis.  124 samples were taken from 99 patients (53% male), aged 16 to 92 years (mean 69.5, ±15.85). 32 samples (25.8%) from 25 patients had positive microbiology or a final diagnosis of pleural infection. Of 57 samples (46%) taken from patients with malignancy, 17 (29.8%) were infected.  20 patients had repeated aspirations, of whom 50% had cancer. Four of these patients (20%) developed infection. All four had underlying malignancy.  81 procedures were done in patients where suspicion of pleural infection was low, 11 (13.6%) yielded infection. Eight of these patients (72.7%) had a pre-existing diagnosis of malignancy. Compared to the prevalence of cancer in the study population (46%) and in the low suspicion group (60%) this suggests that patients with known malignancy are less frequently suspected of having concomitant infection.  Patients with malignant effusions often undergo repeated aspiration for diagnostic or therapeutic purposes. The risk of iatrogenic infection is high and effort should be made to minimise intervention by undertaking definitive procedures early. Patients with malignant effusions may develop pleural infection in the absence of classical symptoms, or symptoms may be wrongly attributed to cancer rather than infection. Infection should be suspected in all persistent effusions and fluid be sent for microbiological analysis every time it is sampled.
Abstract 950: Direct Evidence for an Important Role of Agonist-independent Constitutive I <sub>K,ACh</sub> Channel Activity in Atrial Tachycardia Remodeling
Authors: Niels Voigt, Ange Maguy, Yung-Hsin Yeh, Xiao-Yan Qi, Ursula Ravens, Dobromir Dobrev, Stanley Nattel
Journal: Circulation (2007)

Background: Although atrial tachycardia (AT) appears to promote agonist-independent constitutively active I K,ACh that increases susceptibility to AF, direct demonstration of dysregulated I K,ACh channel function is lacking. We studied AT effects on single I K,ACh channel activity in dog atria. Methods: I K,ACh channel activity was recorded with cell-attached patch clamp in isolated atrial myocytes of control (CTL) and AT (7 days, 400 min −1 ) dogs. Results : AT prolonged inducible AF duration from 44±22 to 413±167 s; N=9 dogs/gp, P&lt;0.001. In the absence of cholinergic stimulation, single-channel openings with typical I K,ACh conductance and rectification were observed in CTL and AT (Figure ). AT produced prominent agonist-independent I K,ACh activity due to 7-fold increased opening frequency (f o ) and 10-fold increased open probability (P o ) vs CTL (P&lt;0.01 for each), but unaltered open time and single channel conductance. With maximum I K,ACh activation (10 μm carbachol, CCh), f o was 38% lower, open time constant 25% higher, and P o and unitary conductance unchanged for AT vs CTL. The selective Kir3 blocker tertiapin (100 nM) reduced f o and P o by 48% and 51% (P&lt;0.05 each) without altering other channel properties, confirming the identity of I K,ACh. Conclusions : AT produces prominent agonist-independent constitutive single-channel I K,ACh activity, providing a molecular basis for previously-observed AT-enhanced macroscopic I K,ACh , as well as associated AP-shortening and tertiapin-suppressible AF promotion. These results suggest an important role for constitutively active I K,ACh channels in AT-remodeling and support their interest as a potential novel AF-therapy target.
Chemotherapy and Bone Marrow Transplantation for Cancer Patients Who Are Also Chronic Hepatitis B Carriers: A Review of the Problem
Authors: Raymond Liang, George K.K. Lau, Y. L. Kwong
Journal: Journal of Clinical Oncology (1999)

In places where hepatitis B virus (HBV) infection is endemic, itis often necessary to give chemotherapy to or perform bone marrowtransplantation for cancer patients who are also chronic HBV carriers.When standard chemotherapy was given to lymphoma patients, elevation ofliver transaminases was observed in nearly half of those who werechronic HBV carriers. Ten percent of them became jaundiced, and theoverall liver-related mortality was about 5%. There is currently noreliable way to predict the severity of HBV reactivation afterchemotherapy. The risk is probably higher when the chemotherapy used issignificantly immunosuppressive and the viral load in the liver ishigh. Different strategies have been used in an attempt to reduce therisk of HBV reactivation after chemotherapy, but they have not beenvery successful. Further studies will be required to determine theimpact of newly available antiviral agents that are active against HBV. Recipients who are carriers of HBV or who receive hepatitis B surfaceantigen (HBsAg)-positive marrow are at increased risk of hepatitisB-related morbidity and mortality after bone marrow transplantation(BMT). There is evidence to suggest that prophylactic use of an activeantiviral agent, such as famciclovir, may result in a significantdecrease in the incidence and severity of HBV reactivation after BMT.Sustained serologic clearance of chronic HBV infection has also beenreported in many HBsAg-positive marrow recipients receiving hepatitis Bsurface antibody-positive marrow from their allogeneic donors. Thereseems to be a transfer of both humoral and cellular immunity againstHBV from donors to recipients. Further prospective studies are required to define the best approach tomanage HBsAg-positive cancer patients receiving chemotherapy or BMT. Itis recommended that all cancer patients be checked for their hepatitisB status before receiving chemotherapy or a bone marrow transplant,especially if they reside in or come from endemic areas of HBVinfection.
Weekly docetaxel versus weekly docetaxel/gemcitabine as first-line therapy for patients who are elderly or with poor performance status (PS) or with serious comorbidities with advanced non-small cell lung cancer (NSCLC): Interim safety analysis of a Minnie Pearl Cancer Research Network phase III trial
Authors: M. G. Mainwaring, J. D. Hainsworth, D. R. Spigel, J. R. Gray, D. L. Shipley, L. H. Morrissey, S. Greenwell, G. Joseph, J. E. Bradof, F. M. Schnell, F. A. Greco
Journal: Journal of Clinical Oncology (2005)

7151 Background: We have previously shown that weekly docetaxel (D) and weekly docetaxel/gemcitabine (D/G) are active well tolerated regimens for advanced NSCLC patients who are elderly or with poor PS or with serious comorbidities. This ongoing phase III trial was designed to compare the survival of patients randomized to single agent weekly D vs. weekly D/G and will require a total of 346 pts to detect an improvement of 1-year survival from 25% to 40%. The objective of this analysis is to compare the safety/toxicity of the two regimens. Methods: Eligibility included: stage IIIB/IV NSCLC, previously untreated, age ≥ 65 years or with serious coexistant medical illness or PS=2; adequate organ function, informed consent. Patients received either weekly D 36mg/m2 IV Days 1, 8, 15 every 28 days for 6 courses or D 30mg/m2 IV/G 800mg/m2 IV Days 1, 8, 15 every 28 days for 6 courses. Results: 214 patients have been enrolled in this ongoing trial. The clinical characteristics of patients, including serious comorbidities, in both treatment arms are similar (PS=2 in 33 pts and 29 pts, respectively). The incidence of several grade 3/4 toxicites was lower with D vs. D/G: neutropenia 5% vs. 16%; thrombocytopenia 0% vs. 8%; fatigue 13% vs. 17%; diarrhea 6% vs 10%. Hospitalizations (4% vs 17%) and treatment-related deaths (1% vs. 3%) were also less common with D vs. DG. The relative dose intensity was 90% (D) and 80% (D/V). There is no difference in toxicities in comparing PS 2 with PS 0, 1. Conclusions: The interim safety results of this trial show both therapies to be relatively well tolerated in this elderly patient population many with serious cormobidities and PS 2. This study continues with anticipated completion in 6–12 months. No significant financial relationships to disclose.
Ocular Air-Gun Injury: 19 Cases
Authors: G N Shuttleworth, P H Galloway
Journal: Journal of the Royal Society of Medicine (2001)

There have been many calls for preventive action against injuries caused by air-guns. Eye injuries are particularly serious, and we conducted a retrospective study to review their characteristics. Ophthalmic consultants in the south-west region of England and South Wales were asked to recollect any injuries that had resulted from air weapons. Information was recorded on the nature and circumstances of the injury, subsequent management, and long-term effects. 19 cases of ocular injury were identified, sustained at mean age 19.7 years, all in the past decade. 15 of the victims were male. At least 12 shootings were accidental but 2 were deliberate. The injury was self-inflicted in 5 cases, and in 6 the assailant was known to the victim. 9 sustained ruptured globes and 8 had severe contusions. Ultimately 4 individuals required enucleation and 2 evisceration. At last review, visual acuity was no perception of light in 10 (53%) and "counting fingers" or worse in 16. Victims spent an average of nearly 10 days as an inpatient. The characteristics of the incidents that lead to ocular air-weapon injuries are unchanged. Reform of the firearms laws is probably the best way to prevention.
Abstract 4865: The Amplitude Ratio of the First to Second Heart Sound Mirrors Left Ventricular Systolic Function
Authors: Bill P Hsieh, Kamil Unver, Edward McNulty, Nelson B Schiller
Journal: Circulation (2008)

Background: In animal studies, the amplitude of the mitral component of the first heart sound (S1) is proportional to the rate of left ventricular pressure rise (dP/dt). To develop a clinical application for this property, we tested the hypothesis that the relative amplitudes of S1 and S2 (aortic component of second heart sound) represent left ventricular dP/dt and ejection fraction (EF) in humans. Methods: Phono-electrocardiographic recordings using a digital hand-held device (HD Medical Group Ltd) followed by an echocardiogram were performed within two hours of a clinically indicated cardiac catheterization. Left ventricular dP/dt was estimated by intracardiac manometer or Doppler echocardiogram, left ventricular EF was measured by biplane 2D. The largest positive to negative deflections of the first and second heart sound components were defined as S1 and S2. The ratios of S1 to S2 (S1/S2) were obtained from the right upper sternal border (RUSB), left upper sternal border (LUSB) and apical area. Normal EF and dP/dt were defined as ≥ 55% and ≥ 1000 mmHg/s respectively. Results: We studied 61 patients with dP/dt ranging from 400 to 2850 mmHg/sec, EF ranging from 11 to 78 %. Body mass index, P-R interval, pulmonary or systemic blood pressure were not different between the normal and reduced EF or dP/dt groups. Compared with the group with reduced dP/dt or EF, the median S1/S2 at LUSB and RUSB were significantly higher in those with normal dP/dt (1.52 vs 0.78 for LUSB; 1.31 vs 0.75 for RUSB, p&lt;0.05) or EF (1.44 vs 0.95 for LUSB; 1.65 vs 0.83 for RUBS, p&lt;0.05). On receiver operating curve analysis, S1/S2 at LUSB and RUSB, had significant discriminative values for detecting normal dP/dt (AUC = 0.82 for LUSB, 0.74 for RUSB) and EF (AUC = 0.72 for LUSB, 0.68 for RUSB). The sensitivity and specificity of S1/S2 ≥1 for detecting normal left ventricular systolic function (normal dP/dt or EF) were 72– 80% and 57–71% respectively. Conclusion: This study demonstrated that S1, corrected for S2, mirrors left ventricular systolic function. A ratio of S1 to S2 of ≥1 is a useful indicator of normal left ventricular systolic function defined by dP/dt ≥1000 mmHg/s or EF ≥55%. Digital phonocardiography appears promising as an adjunctive bed-side tool for assessing left ventricular systolic function.
Disease burden in COPD patients in the first 24 months following diagnosis in a UK primary care setting
Authors: Keele Wurst, Amit Shukla, Hana Muellerova, Kourtney Davis
Journal: European Respiratory Journal (2013)

Objectives: To examine chronic obstructive pulmonary disease (COPD) progression over 24 months following the first recorded COPD diagnosis and disease burden variation using routinely collected data in the UK General Practice Research Database (GPRD).  Methods: A retrospective cohort of newly diagnosed COPD patients was identified in the GPRD between 1/1/2008- 31/12/2009 and followed for up to 24 months; patients were censored at death or end of study period. Age, gender, body mass index (BMI), and smoking status were defined at diagnosis. Values for Medical Research Council (MRC) dyspnea score and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage of airflow limitation closest to 24 months of follow-up were utilized. Comorbidities were included if they occurred any time in a patient’s record. Moderate/severe exacerbations and general practitioner (GP) visits were observed over 24 months.  Results: Among the 7,881 COPD patients, the mean age was 67.2 yrs and 45% were female. During follow-up, 8% (n=618) of patients died and the exacerbation rate was 0.64 per person-year. As airflow limitation increased from GOLD stage 1 to 4, the exacerbation rate increased from 0.55 to 1.05. As dyspnea increased from MRC score of 1 to 5, the exacerbation rate increased from 0.44 to 1.15. The GP visit rate also increased as dyspnea increased. The rates of exacerbations and GP visits varied by comorbidities and BMI.  Conclusion: In addition to lung function, outcomes in COPD patients also varied by levels of dyspnea, BMI and comorbidities; these results support a holistic patient assessment to improve COPD management.  Funded by GSK (Protocol WEUSKOP5904).
Phase angle versus conventional bioelectric impedance analysis in patients hospitalised with an acute exacerbation of COPD
Authors: Sarah Jones, Samantha Kon, Jane Canavan, Claire Nolan, Mandy Dickson, Brigette Haselden, Paul Cullinan, Michael Polkey, William Man
Journal: European Respiratory Journal (2014)

Introduction  Bioelectric impedance analysis (BIA) is a non-invasive bedside method used to estimate body composition. However, validity of estimates are dependent on multiple assumptions that are frequently violated in sick and hospitalised patients. Raw impedance parameters, such as phase angle (PA) are less affected by hydration status and fluid shifts.   Hypothesis  PA may be a better indicator of body composition than conventional BIA-derived fat free mass (FFM) in patients hospitalised with AECOPD.   Method  PA, FFM (Bodystat 4000), 4-metre gait speed(4MGS), five-repetition sit-to-stand(5STS), quadriceps maximum voluntary contraction(QMVC) and handgrip strength(HG) were measured at discharge in 209 patients hospitalised for AECOPD. Pearson9s correlations were used to assess the relationship between PA and FFM with muscle strength and physical performance.   Results  Cohort characteristics were:53%male; mean(SD) age 72(11);BMI 26.5(6.9);FEV1%pred 40(20); MRC dyspnoea score 4(1); median(IQR) length of stay 3(1,5). Correlations between PA and FFM with muscle strength and physical performance are shown in Table 1. FFM did not correlate significantly with 4MGS,5STS,QMVC or HG.   Conclusion  Conventional BIA-derived FFM does not correlate with parameters of muscle strength and physical performance in hospitalised patients with COPD. Raw impedance parameters such as phase angle are better indicators of muscle health in hospitalised patients with COPD.
Impact of Conventional and Three-Dimensional Thallium-Technetium Scans on Surgery for Primary Hyperparathyroidism
Authors: B J Jenkins, M S Newell, A W Goode, B J Boucher, J P Monson, C L Brown
Journal: Journal of the Royal Society of Medicine (1990)

Twenty-nine patients with primary hyperparathyroidism underwent double-tracer subtraction scanning after injection of 201Tl as thallous chloride for thyroid and parathyroid images followed by 99mtechnetium as sodium pertechnetate for thyroid images prior to surgical exploration of the neck. The operative findings were correlated with the scans. All 23 adenomas (100%) and 13 of 18 (72%) hyperplastic glands were correctly localized. The ability of the scan to identify abnormal parathyroids was determined by the gland mass rather than whether the tissue was adenomatous or hyperplastic as all 32 (100%) abnormal glands weighing more than 180 mg were successfully localized in contrast to four of nine (44%) glands weighing less than 180 mg. An additional technique, in which emission tomography was carried out after subtraction scintigraphy, was used on 11 patients in the series. In all 11, the site of a single abnormal gland was predicted by the conventional subtraction scan: in nine of these patients, emission tomography provided additional localization of the gland in the anteroposterior plane.
Breast Reconstruction at a District General Hospital
Authors: Abigail A Evans, Virginia F Straker, Richard M Rainsbury
Journal: Journal of the Royal Society of Medicine (1993)

Breast reconstruction is normally carried out by plastic surgeons, but the advent of permanent tissue expanders places post-mastectomy reconstruction within easy reach of the general surgeon. Nineteen patients underwent breast reconstruction between 1989 and 1991 using a subpectoral silicone-based, double lumen tissue expander. Assessment of results was by: (a) patient completed questionnaire; and (b) third party evaluation of standardized photographs. The mean operating time was 58 min (40-80 min) and mean hospital stay 3 days (2-7 days). Complications included one flap necrosis and one leaking injection port. Outpatient tissue expansion required an average of seven visits (4-11) and was completed in an average of 12 months (7-19). The injection port was subsequently removed under local anaesthetic as a day case. The fully dressed appearance following reconstruction was graded good or excellent by 100% of patients and in over 80% of third-party assessments. Equivalent figures for the appearance when wearing a bra were 93% and 60% and undressed 57% and 47%, respectively. All patients recommended the procedure but 25% found inflation uncomfortable. Subpectoral tissue expansion is a safe, cosmetically acceptable method of breast reconstruction which is associated with a high level of patient satisfaction.