tbuckley/cabot-search huggingface dataset:
Clinical features and prognosis of 108 patients with lymphangioleiomyomatosis
Authors: Yoshikazu Inoue, Masaki Hirose, Koh Nakata, Toru Arai, Chikatoshi Sugimoto, Yoshinobu Matsuda, Naoko Takeuchi, Aya Hirooka, Kazunobu Tachibana, Akiko Matsumuro, Tomomi Honnma, Masanori Kitaichi, Masanori Akira, Masaji Okada, Seiji Hayashi
Journal: European Respiratory Journal (2014)

[Introduction]  Lymphangioleiomyomatosis (LAM) is a rare multisystem disease predominantly affecting premenopausal women. Previous reports showed that age, lung function, hormone therapy, pneumothorax, or pulmonary cystic changes was associated with prognosis. To clarify prognostic factors, we analyzed the clinical features and prognostic from our cohort.  [Subjects and Methods]  108 patients {Japanese female, sporadic LAM (n=93) and TSC-LAM (n=15), female} were consecutively registered in NHO Kinki-Chuo Chest Medical Center Cohort until 2013. The age (onset) was 36(30-45) {median(IQR)} years old. We retrospectively analyzed the clinical features and prognosis.  [Results and conclusion]  Angiomyolipomas and lymphangioleiomyomas were detected in 31 and 28 patients. 48 patients had pneumothoraces and 5 patients had chylous effusion. 27 patients were treated with Gn-RH analogues and 39 patients with sirolimus. Initial %FEV 1.0  was 78(57-104) %, %DLco was 60(39-77) %. Serum VEGF-D level was 1786(781-3610) pg/ml. Eight patients died from respiratory failure (n=6), abdominal bleeding (n=1), and seizure (n=1), and 5 patients had lung transplantation. Estimated 10-year survival free from death and transplant from the registration (survival) was 73%. There was no significant difference of survival between sporadic LAM and TSC-LAM. Serum VEGF-D  1.0  ≥ 70%, and %DLco ≥ 60%, were associated with better prognosis (p  The prognosis was relatively better than previous reports. Development of new drugs such as mTOR inhibitors are expected to make more improvement.
Bronchiectasis in Auckland, New Zealand: Ethnic differences in severity
Authors: Sally de Boer, Wendy Fergusson, Christopher Lewis, Margaret Wilsher
Journal: European Respiratory Journal (2012)

Introduction: Bronchiectasis is more prevalent in Maori and Pacific Islanders (PI) than Europeans. The aim of this study was to evaluate differences in severity and microbiology between ethnicities.

Methods: Records of 250 patients (66% female, mean age 62yrs, FEV1% predicted 64.6%) attending the bronchiectasis clinic at Auckland District Health Board were retrospectively reviewed. Demographic and clinical variables were recorded. Ethnicity was compared to NZ Department Statistics 2006 census data for central Auckland.

Results: PI (23%) and Maori (12%) are over-represented in this cohort; European (44%) and Asian (16%) under-represented. Mean FEV1 %predicted was higher in Europeans (70.7%) than Maori (63%) and PI (54%), p <0.0001 and remained so when corrected for smoking status p<0.0001. Similar statistically significant differences were seen in FVC %predicted. Maori patients were younger (mean age 56yrs) than PI (60yrs) and Europeans (66yrs), p=0.02. There was a trend to later diagnosis in Maori and PI compared to Europeans. 124 patients had at least one sputum sampled that year with Haemophilus 29%, Pseudomonas 13.7%, Aspergillus 4.8%, Pneumococcus 2.4% and non tuberculous mycobacteria 2.4%. There was no significant difference in sputum microbiology by ethnicity.

Conclusions: Maori and PI are over-represented in the bronchiectasis clinic and tend to be younger with more severe disease than other ethnicities. Disease severity is independent of smoking status, microbiology and gender suggesting other factors such as genetic susceptibility or socioeconomic status influence outcome.
Mechanically assisted cough in amyotrophic lateral sclerosis: Effect on vital capacity decline and timing of non invasive ventilation onset
Authors: Emiliana Meleo, Amelia Conte, Flaminio Mormile, Marco Scapigliati, Francesco Macagno, Anna Zito, Mario Sabatelli, Salvatore Valente
Journal: European Respiratory Journal (2011)

Background:  Mechanically assisted cough with an insufflator-exsufflator (MAC) increases peak cough flow and improves management of secretions in patients with Amyotrophic Lateral Sclerosis (ALS).   Study objective:  To evaluate the effect of MAC on VC decline in a group of patients before the onset of NIV.   Patients:  Criteria for starting MAC were VC=70% of predicted value and cough insufficiency. We enrolled 43 patients not being treated with NIV during the studying time. NIV was started when VC decreased below 55% of predicted value.   Results:  Our patients were divided in MAC compliant (n=21) and not compliant (n=22).The groups were similar for age at onset, sex, and body site at onset, bulbar or limb. Differences were found in time from onset to MAC starting time (20,5 months in MAC not compliant vs 26,5 in compliant) and in VC at the first respiratory evaluation (85,59 vs 93,42), although the VC decrease was similar before the offering of MAC. VC at MAC starting time was similar in compliant and non compliant groups (70,8% of predicted value vs 71,7%). In the compliant group the VC decreased to 69,4% and 60,4% of predicted value at 4,7 and at 12,2 months after the start of MAC therapy. In the not compliant group VC decreased to 54,3% and 43,5% of predicted value after 4,0 and 8,1 months from offering MAC. The differences were significant: 69,38 vs 54,27; p=0,03 and 60,35 vs 43,5; p=0,008.   Conclusion:  MAC compliant patients, in similar condition, meet the prescription criteria for MAC treatment later than the not compliant patients. Their VC decline is reduced and they need to start treatment with NIV later than the not tolerating patients.
Abstract 16105: Significance of Asymptomatic Ventricular Tachycardia Observed During Pacemaker Clinic Interrogations
Authors: Jigar Patel, Heidi Fagerlund, Mark Lee, Allen D Johnson, Guy Curtis
Journal: Circulation (2011)

Modern pacemakers chronicle a variety of arrhythmias over time. Asymptomatic ventricular tachycardia (VT) is observed in this setting, but its frequency, significance, and treatment are unclear. Th...
QRS Duration in Patients Hospitalized for Worsening Heart Failure
Authors: Peter Höglund, L. A. Fredrik Nilsson
Journal: JAMA (2008)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Prediction of Intestinal Recovery after Ischaemic Injury Due to Arterial, Venous and Mixed Arterial and Venous Occlusions
Authors: Thomas F Gorey
Journal: Journal of the Royal Society of Medicine (1980)

Methods to predict intestinal viability after release of vascular occlusion were evaluated in a rat model of reversible segmental strangulation. Visual criteria of colour, pulsation and peristalsis in the ischaemic intestine were applied both in the immmediate period after restoration of the circulation and at `second-look' 24 hours later. In addition two simple tests using a Doppler probe and surface fluorescence were evaluated. As a test in identifying nonviable intestine the fluorescent method had an overall sensitivity of 96% with a specificity of 95% for all types of vascular occlusion, which compared favourably with the other methods tested.
Stronger grip on overheads and increased productivity could save NHS hospitals 5bn a year
Authors: C. White
Journal: BMJ (2015)

<h3>Background</h3> Up to 80% of people with spinal cord injury (SCI) suffer from chronic constipation. MOWOOT is a medical device that administers an intermittent colonic exoperistalsis (ICE) to treat chronic constipation. It is a non-invasive, non-pharmacological solution developed to facilitate natural bowel movements. Here, its in-use evaluation was performed to generate information on the efficacy and quality of life of patients. <h3>Methods</h3> Constipated SCI patients used MOWOOT for 10–20 min/d in their daily routine at home. MOWOOT pneumatic elements automatically inflate and deflate clockwise over the colon administering the ICE treatment. (IDDF2022-ABS-0096 Figure 1. The ice medical device) Patients filled up a structured questionnaire giving anonymous feedback about their bowel function and satisfaction, at baseline (F1) and after some time under ICE treatment (F2). <h3>Results</h3> The data results from N= 28 SCI patients (10 females, 18 males) of 35 to 78 years old [60.71(2.79)yr] who were using MOWOOT from 2 weeks to 24 months at the moment of feedback collection (F2). The results were further analyzed according to time under treatment: short-term [3.69(2.35) months, n= 17], and long-term treatment [13,27(4,03) months, n=11]. (IDDF2022-ABS-0096 Table 1) No one reported any serious adverse event. Six patients described occasional low to moderate abdominal pain, which did not affect the treatment compliance. All the assessed variables ameliorated with time since those under long-term treatment showed better results, especially in time saved per evacuation (24.5 min). <h3>Conclusions</h3> Feedback from SCI patients in the out-patient sector demonstrates the medical benefit of ICE treatment with MOWOOT in long-term use. Due to the ease of use and positive long-term effects demonstrated in homecare settings, MOWOOT is a solution that the patients can easily keep using after their hospital stay, improving the patient’s health and quality of life, and reducing the workload for healthcare professionals in hospital settings.
Unusual multisystemic relapse of sarcoidosis after corticosteroids withdrawal
Authors: Mariana Sponholz Araujo, Daniel Antunes Silva Pereira, Bruno Guedes Baldi, Carolina Salim Gonçalves Freitas, Celso Madeira Padovesi, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro Carvalho
Journal: European Respiratory Journal (2013)

Sarcoidosis is a multisystemic disease with variable presentations. We report a case of unusual clinical course after corticosteroids withdrawal. A 40-year-old man presented with visual impairment and eye pain. Ophthalmoscopic examination diagnosed left anterior uveitis. HRCT revealed mediastinal lymphadenopathy, perilymphatic micronodules and hepatomegaly. The diagnosis of sarcoidosis was proposed. Broncoscopy showed enanthematous and grainy surface of the laryngeal and bronchial mucosa. Biopsy of those sites revealed non-caseous chronic granulomatous inflammation. Sarcoidosis was confirmed and oral corticosteroid started. Six months after initiation of therapy, lymphadenopathy and pulmonary lesions improved, signs of uveitis were absent and prednisone was tapered. Five months after corticosteroid suspension (2.5 years after the first dose) the patient reported erectile dysfunction, polydipsia, polyuria and asthenia. A biopsy of a right epididymal nodule was performed and showed chronic granulomatous inflammation. Laboratory showed impaired renal function and low thyreothopin, IGF-1 and free testosterone. Parathormone was supressed. Diabetes insipidus was suspected by a urinary volume of 4000ml/24h and an upper limit serum sodium. Cranial MRI revealed absence of the usual bright signal at pituitary gland and a thickened stalk. Prednisone 0.5 mg/kg daily, methotrexate and desmopressin were initiated. Three months later, erectile dysfunction, polydipsia and polyuria improved, hormonal dosages and renal function became normal. This atypical multisystemic relapse after prednisone withdrawal once again raise the discussion whether glucocorticoid treatment predisposes to worse evolution in sarcoidosis.
11C-Choline and 18F-FDG PET/CT in the Detection of Occult Prostate Cancer in the Context of a Paraneoplastic Syndrome
Authors: Julio Jiménez-Bonilla, Remedios Quirce, Ignacio Banzo, Isabel Martínez-Rodríguez, José Manuel Carril
Journal: Clinical Nuclear Medicine (2015)

In a 73-year-old man, an occult neoplasm was suspected after 2 consecutive deep venous thrombosis, the latter under anticoagulant therapy and previous axonopathy. After normal CT and MRI findings, a requested 18F-FDG PET/CT showed a focal uptake in the prostate. Because FDG uptake in the prostate is infrequent, a 11C-choline PET/CT was indicated revealing a focal uptake in the same location. No other abnormalities were detected in the rest of the body. A guided biopsy by ultrasonography was performed revealing a prostate carcinoma and inflammation in both prostatic lobes.
Changes in cancer patients’ perceptions of do-not-resuscitate orders as end of life (EOL) approaches
Authors: I. N. Olver, J. A. Eliott
Journal: Journal of Clinical Oncology (2005)

8072 Background: In formulating policy on do not resuscitate (DNR) orders we sought patients’ views, postulating that perceptions may change with approaching death. Methods: In consecutive studies patients with cancer had semi-structured interviews recorded, transcribed and subjected to discourse analysis, to find their perceptions of DNR orders. The 1st group was 23 patients with cancer not considered near the end of life; the 2nd was 28 patients within 3 months of dying. Accrual ended when no new issues were arising. Results: Major demographic differences were that in study 1, 61% had stage IV disease, none dying within 6 months whereas in study 2, all had stage VI disease and 82% died within 3 months. Half chose to have others present at interview in study 2 compared to1 in study 1. The 1st group used hypothetical and third-person constructions when discussing EOL decisions where the 2nd used the first-person. DNR orders were on file for 2 of the 1st group but 15 of the 2nd; for 39% of this group, views expressed at interview and what was recorded were not compatible, 9 patients wanting DNR with none recorded, and 2 not wanting DNR but with one on file; 4 expressed views for and against. Both groups assigned the decision to the patient unless cognitively impaired when it was usually delegated to the family who also were seen as having an impact on the decision itself. Generally patients’ emotional states were thought primary in deciding when to discuss EOL issues and in both studies some patients believed this could best be determined by the doctor. Implicit within this are assumptions that DNR discussions imply impending death, and are difficult discussions that should be avoided unless justifiable. In both studies some patients put themselves outside the group to whom DNR orders applied, justified by showing a resistance to death, having something to live for (7 patients in study 2), or claims that they were not sick enough (4 patients expressing this in study 2). Conclusions: Patients closer to death give their own views on EOL decisions rather than treating the issue as hypothetical. Formulating DNR policy will require the ability to accommodate a full range of views including patients who do not wish to discuss DNR orders even when close to death. No significant financial relationships to disclose.
Tricyclic antidepressants and cardiac patients with pacemakers
Authors: G S Alexopoulos, C A Shamoian
Journal: American Journal of Psychiatry (1982)

Mr. A, Ms. B, and Mr. C, aged 78, 83, and 70 years, respectively, all had depressive symptoms. Mr. A had a bipolar disorder and Ms. B and Mr. C had recurrent unipolar affective disorders. Psychiatric diagnosis was made according to DSM-I!1. The three patients had implanted demand pacemakers with ventricular leads because of sick sinus syndrome and episodes of syncope. Before treatment with tricyclic antidepressants the patients were examined by their cardiologists to establish that the pacemakers were functioning well. Furthermore, the treating psychiatrists discussed with the cardiologists the indications and adverse effects of tricyclic antidepressants, the properties of the patients’ pacemakers, and the pathophysiology and possible complications of their heart disease. Arrangements were made for regular telephone monitoring of the pacemakers’ function. The patients were taught to monitor their pulse regularly and report any unusual symptoms. ECGs and rhythm strips were obtained at least weekly during the first month of treatment. Mr. A received imipramine at gradually increasing doses up to 250 mg/day. Despite the high dose, his steady-state plasma tricyclic level remained low, never exceeding 80 ng/ ml. While taking imipramine he had a consistent increase in the number of pacemaker-initiated heart contractions, from 0-8/mm to 20-28/mm. However, Mr. A had no symptoms of reduced output or other complications, and administration of imipramine continued uninterrupted for 6 weeks. Imipramine treatment was then discontinued because Mr. A’s symptoms of depression did not respond, and he received ECT with excellent antidepressant results. Ms. B received nortriptyline in doses gradually increasing
Detection of exosomal miRNA in pulmonary sarcoidosis
Authors: Amit Kishore, Zdenka Navratilova, Vitezslav Kolek, Martin Petrek
Journal: European Respiratory Journal (2014)

Background:  MicroRNAs (miRNAs) are implicated in pathogenesis of pulmonary sarcoidosis, namely in posttranscriptional regulation of (pro)inflammatory cytokines. Circulatory miRNAs are stable miRNAs packaged in exosomes during cellular communication that protect miRNA molecules from degradation. There has been no information on the presence of exosomal miRNA in sarcoid lung. We have, therefore, investigated 11candidate miRNAs in exosomes from sarcoid bronchoalveolar (BAL) space.  Method:  Exosomes were isolated from BAL fluid (BALF) from sarcoidosis patients (n=39) by differential centrifugation (3000g followed by 10000g) for 30 min each at 4°C. The supernatant was 0.2 µm filtered and centrifuged at 140000g (2 hrs at 4°C). From the obtained exosomal pellet, miRNAs was isolated and quantified using RT-qPCR. The expression data was normalized to spike-in control and BALF input volume. Result:  In BALF exosomes, miR-21, -26a and -146a expression was detected with concentration (ng/µl)/ sample volume (ml) ratio ranging from 0.004-0.116 (Ct=16.4-27.3) for miR-21; 0.002-0.225 (18.9-26.9) miR-26a and 0.002-0.185 (17.9-25.0) miR-146a. Sub-analysis comparing non-smokers in radiological stage I (n=6) with stage II (n=17) showed no difference in their expression (pg0.05). MiR-15a, -129, -133a, -133b, -134, -195, -452 and -589 were not detectable in BALF exosomes.  Conclusions:  The implemented methodology for detection of miRNA in exosomes from BALF enabled to detect exosomal miR-21, -26a and -146a in sarcoidosis. Future analyses will focus on detailed characterization of exosomal expression profile in sarcoidosis, also in comparison with healthy subjects / diffuse lung disease. Grant support: CZ.1.07/2.3.00/30.0041, CZ.1.05./2.1.00/01.0030.
Segmental Aortic Stiffness in Children and Young Adults With Connective Tissue Disorders
Authors: Ashwin Prakash, Himanshu Adlakha, Nicole Rabideau, Cara J. Hass, Shaine A. Morris, Tal Geva, Kimberlee Gauvreau, Michael N. Singh, Ronald V. Lacro
Journal: Circulation (2015)

Aortic diameter is an imperfect predictor of aortic complications in connective tissue disorders (CTDs). Novel indicators of vascular phenotype severity such as aortic stiffness and vertebral tortuosity index have been proposed. We assessed the relation between aortic stiffness by cardiac MRI, surgical root replacement, and rates of aortic root dilation in children and young adults with CTDs.Retrospective analysis of cardiac MRI data on children and young adults with a CTD was performed to derive aortic stiffness measures (strain, distensibility, and β-stiffness index) at the aortic root, ascending aorta, and descending aorta. Vertebral tortuosity index was calculated as previously described. Rate of aortic root dilation before cardiac MRI was calculated as change in echocardiographic aortic root diameter z score per year. In 83 CTD patients (median age, 24 years; range, 1-55; 17% <18 years of age; 60% male), ascending aorta distensibility was reduced in comparison with published normative values: median z score, -1.93 (range, -8.7 to 1.3; P<0.0001 versus normals). Over a median follow-up period of 2.7 years, there were no aortic dissections or deaths, but 16 of 83 (19%) patients underwent surgical aortic root replacement. In multivariable analysis, lower aortic root strain (P=0.05) and higher vertebral tortuosity index (P=0.01) were independently associated with aortic root replacement. Lower ascending aorta strain (P=0.02) was associated with a higher rate of aortic root dilation.Higher aortic stiffness is associated with higher rates of surgical aortic replacement and aortic root dilation in children and young adults with CTDs.
Abstract 2003: The Characteristics of Non-Culprit Coronary Plaques in Patients with Acute Coronary Syndrome: Noninvasive Assessment by 64-Slice Computed Tomography
Authors: Hirohiko Ando, Tetsuya Amano, Tadayuki Uetani, Michio Nanki, Nobuyuki Marui, Masataka Kato, Bunichi Kato, Tomohiro Yoshida, Kiminobu Yokoi, Soichiro Kumagai, Ayako Kunimura, Hideki Ishii, Tatsuaki Matsubara, Nigishi Hotta, Toyoaki Murohara
Journal: Circulation (2008)

Some invasive imaging modalities such as intravascular ultrasound and angioscopy have shown the vulnerability of non-culprit plaques in patients with acute coronary syndrome (ACS). Recently multi-slice CT (MSCT) has been used to assess the characteristics of coronary plaque and the major advantage of MSCT is that it can evaluate all coronary plaques noninvasively. The purposes of this study are to assess coronary plaques noninvasively by MSCT and compare the differences of plaque composition between culprit and non-culprit lesions in patients with ACS and stable lesions in the patients with stable angina pectoris (SAP). 64-slice CT was performed in 27 patients with ACS and 33 patients with SAP before percutaneous coronary intervention. According to CT value, we defined plaque components as soft plaque (SP &lt;50 HU), fibrous plaque (50 HU &lt;FP &lt;150 HU) and calcified plaque (CP &gt;500 HU). In all obstructive lesions, we evaluated plaque characteristics by calculating the volume of SP, FP and CP. On the basis of clinical presentation, electrocardiogram and angiographic appearance, coronary lesions in the patients with ACS are divided into culprit or non-culprit lesions. Coronary lesions in the patients with SAP are defined as stable lesions. We analyzed 89 lesions with excellent image quality. Culprit lesions (n=19) and non-culprit lesions (n=25) had significantly larger volumetric percentage of SP and higher remodeling index compared to stable lesions (n=40) (34.4% vs. 29.3% vs. 21.0%, p&lt;0.0001 and 1.061 vs. 1.061 vs. 0.971, p=0.01, respectively). But there was no significant difference in plaque composition between culprit lesions and non-culprit lesions. We assessed coronary plaques noninvasively by MSCT and found that non-culprit lesions in the patients with ACS, as well as culprit lesions, had significantly larger volumetric percentage of SP and higher remodeling index compared to stable lesions in the patients with SAP, supporting the concept of multiple vulnerable plaques in patients with ACS.