tbuckley/cabot-search huggingface dataset:
Abstract 17972: Low Levels of High-Density Lipoprotein Cholesterol (HDL-C) at Presentation in Acute Coronary Syndromes (ACS) and its Relation to Angiographically-Observed Atherosclerotic Burden: Results from the NCDR®
Authors: Subroto Acharjee, Matthew T Roe, Ezra A Amsterdam, DaJuanicia Holmes, William E Boden
Journal: Circulation (2011)

Background: Although low levels of HDL-C are a known independent risk predictor in stable cardiovascular disease, limited data exist regarding its association with atherosclerotic burden as observed by coronary angiography in patients admitted with ACS. Methods: We evaluated HDL-C levels among 83,110 non-ST-elevation MI patients from the NCDR ACTION-GWTG registry who underwent diagnostic angiography at 461 U.S. hospitals from January 2007 through December 2010. Clinical and angiographic characteristics were analyzed by quartiles of HDL-C measured during hospitalization. Multivariable models were created to determine the risk of severe CAD (left main or 3 vessel disease) vs 1-2 vessel CAD in each quartile, using the highest quartile as referent. Results: Over half of the patients in the examined cohort had presentation HDL-C levels lower than or equal to median (36.9 mg/dL). Patients in lower HDL-C quartiles were younger, more often male, white, smokers, obese, diabetic, hypertensive and had greater rates of prior MI, PCI, CABG and revascularization (P = 0.04 for hypertension, &lt;0.0001 for others) compared to those in higher HDL-C quartiles. Use of medical therapy (aspirin, clopidogrel, beta-blocker, ACE inhibitor or ARB, statin and other lipid-lowering agents) at home was greater among patients with lower HDL-C (P = 0.02 for statin, &lt;0.0001 for others). Individuals in lower HDL-C quartiles had a greater extent of angiographic stenoses and higher risk of severe CAD. This association persisted despite multivariable adjustment, with patients in the lowest HDL-C quartile demonstrating a 28% greater risk of severe CAD compared with their counterparts in the highest HDL-C quartile (Table 1). Conclusion: Among patients undergoing diagnostic angiography for non-ST-elevation ACS, low level of HDL-C at presentation was common and was independently associated with greater angiographically-observed atherosclerotic burden, including more left main or 3 vessel CAD.
Occupational lung cancer in Middle Norway
Authors: Siri Slåstad, Håkon Lasse Leira, Oddfrid Aas, Tore Amundsen, Sveinung Sørhaug, Stein Sundstrøm, Bjørn Henning Grønberg, Bjørn Hilt
Journal: European Respiratory Journal (2014)

Background  Lung cancer may be related to exposures at work, but this relation is often not established or reported. In this study we wanted to look at work relation, reporting and compensation for newly diagnosed cases of lung cancer.  Method  The aim of the study was to interview newly diagnosed lung cancer patients about occupation and exposures at work. The relation between lung cancer and occupation was established for each patient as probably, possibly or not probably occupational. The patients were counselled about possibilities for compensation. The number of reported cases in the project period from all health regions in Norway to The Norwegian Labour Inspection Authority was assessed, and information about granted compensation among the study participants was collected from The Norwegian Labour and Welfare Administration (NAV).  Results  We interviewed 105 lung cancer patients, 73 men and 32 women. Among men 16% were diagnosed as probably and 22% as possibly occupational. No cases among women were judged as occupational. From the different health regions in Norway 1,7-5,1% of lung cancers were reported as occupational. Among the patients who applied for compensation 9 out of 11 with probable and 5 out of 12 with possible ocupational disease were granted compensation from NAV.  Discussion  Attributable fraction for male lung cancer is about 20%. The proportion of patients with work related disease in our study is of the same magnitude. The underreporting of occupational lung cancer is considerable. In the diagnostic approach to lung cancer an assessment of the patient9s occupational exposures is often forgotten. More patients could have had their disease compensated if this interview was a compulsary part of the diagnostic procedure.
Abstract 978: The Clinical Significance of Borderline Elevated Troponin-I Levels Across Different Assays
Authors: Maliha Zahid, Chester B Good, Ali F Sonel
Journal: Circulation (2008)

Background : Markedly elevated troponin I (TnI) is a strong predictor of adverse cardiac events. It is not clear if borderline elevations with different commercially available TnI assays provide similar prognostic information. Methods : From 1/01 to 2/04, three different TnI assays (Beckman Access TnI, Beckman Access AccuTnI and Vitros ECI Troponin) were used to evaluate the peak TnI value in1094 consecutive patients admitted with suspected ACS/NSTEMI. Recommended cut-offs were used to differentiate borderline from marked elevations reported as consistent with myocardial infarction (MI). Clinical data and 30-day death/new MI were determined by chart abstraction. Results : Demographics and cardiac risk factors were similar for the three groups. Frequency of borderline TnI ranged widely between the assays (18.7– 42.1%) but was significantly less with the Vitros ECI TnI assay (p&lt;0.0001). Prognostic significance of borderline elevated TnI varied greatly by assay as well, with borderline Beckman Access AccuTnI elevations being predictive of adverse 30-day outcomes (OR=4.0, 95% CI=1.46 – 10.97, p-value=0.007), but not the other two assays. Borderline elevations were significantly associated with chronic renal insufficiency (CRI, serum Cr&gt;1.5); the relationship to adverse 30-day outcomes and borderline elevations persisted after correcting for CRI in a multivariate logistic regression model. Conclusions : Although borderline elevated troponin-I levels are common and significantly associated with chronic renal insufficiency, they do not all portend the same clinical prognosis. This study highlights the need for standardization of TnI levels across different assays. Combined Outcomes by Troponin-I Assay and Range.
Late-breaking abstract: Efficacy of inhaled N-acetylcystein in patients with interstitial pneumonia
Authors: Ryo Okuda, Tomohiro Ohba, Tomotaka Nishizawa, Rie Kawabe, Koujiro Honda, Masako Amano, Hidekazu Matsushima
Journal: European Respiratory Journal (2014)

Background: An oxidant-antioxidant imbalance may be associated with the disease process in Idiopathic pulmonary fibrosis (IPF). N-acetylcystein might contribute to a reversal of the oxidant-antioxidant imbalance. The inhalation of N-acetylcystein might be the best way of reaching N-acetylcystein to respiratory epithelial lining fluid. Furthermore, the efficacy of inhaled N-acetylcystein in patients with secondary interstitial pneumonia remains unclear.  Aim: To assesse the clinical efficacy of inhaled N-acetylcystein therapy in patients with interstitial pneumonia.  Methods: The study design was a prospective, single-arm study of the clinical effects of inhaled N-acetylcystein in patients with interstitial pneumonia who visited one institute in Saitama, Japan, between January 1 and December 31, 2013.  Results: A total of 40 patients were included. The patients with interstitial pneumonia were diagnosed as follows: IPF, 29 cases; idiopathic nonspecific interstitial pneumonia, 5 cases; connective tissue disease, 5 cases; and chronic hypersensitive pneumonitis, 1 case. The mean change in FVC during the 6 months after N-acetylcystein therapy was -10 mL. The effect of N-acetylcystein was only examined in patients (n = 28) who had conducted a respiratory function test at 6 months before the initiation of therapy. The mean change in FVC during 6 months prior to the N-acetylcystein therapy was -127 mL, while the mean change in FVC during 6 months after the initiation of therapy was -19 mL. The absolute serum level of KL-6 decreased significantly from 1372 U/mL to 1065 U/mL after the therapy. Conclusions: These results showed that inhaled N-acetylcystein had a beneficial effect in patients with interstitial pneumonia.
The relationship between uric acid levels and mean platelet volume and metabolic syndrome in males with with obstructive sleep apnoea syndrome
Authors: Ahmet Akkaya, Önder Öztürk, Ulugh Bik Khayri, Mustafa Saygin, Mehmet Has
Journal: European Respiratory Journal (2012)

Aim:  The aim of our study was to investigate the post-treatment changes in the level of UA and the relationship between serum uric acid (UA) levels and mean platelet volume (MPV) and metabolic syndrome in males with obstructive sleep apnoea syndrome (OSAS).   Material and Methods:  Seventy nine men who had been performed a single night polysomnography (PSG) (mean AHI=42.59±2.79 events/hour), were included to the study. Demographics characteristics, serum uric acid levels, MPV and PSG results were recorded. We divided patients in two groups according to 75 percentiles of UA levels: 1st with hyperuricaemia - UA≥ 6.86 mg/dL and 2nd with normouricaemia - UA    Results:  There was a statistically positive correlation between UA (6.03±0.13 mg/dL) and AHI (p=0.037), BMI (p=0.013), waist circumference (p=0.027), O 2  desaturation % (p=0.047). Subjects with hyperuricaemia had higher AHI, BMI, (p 2  desaturation % and triglyceride. The duration of REM decreased and Stage 1 and 3 increased. The UA and MPV were found higher in patients with MS and OSAS and UA levels decreased after CPAP treatments. However, ODI and MPV were included to the model to estimate AHI at stepwise regression analysis (R square %89, p   Conclusion:  This study showed that obesity was the determinant of hyperuricemia and high levels of UA was found with MS and OSAS. The levels were decreased after CPAP therapy. An also, it is thought that high levels UA and MPV are associated with cardiovascular complications in OSAS.
Wounds and wound healing: new insights, fresh challenges
Authors: K. Harding
Journal: British Journal of Dermatology (2015)

The scholarly review in this issue of the BJD provides a summary of the current state of knowledge and understanding of wounds and wound healing. In the recent past, chronic wounds may have been an irritation and inconvenience for some dermatologists. Even now, it is hard to reconcile the scale of the clinical challenge faced by society concerning wounds and wound healing with the limited and patchy academic and clinical interest in this field. The purpose of this scholarly review is to explore wound healing through four state‐of‐the‐art reviews. To set the scene, Martin and Nunan1 provide a concise and readable account of the biology of wound healing. As with other biological systems in the skin, this is complex and involves a number of interacting and overlapping cellular and molecular processes. In view of the complexity it is not surprising that it can be perturbed. Martin and Nunan explain that better understanding of the cellular and molecular processes involved in healing through the development of new and improved laboratory models of human chronic wounds has created a platform for the development of more effective therapies.
Initial National Cancer Institute Studies on Mutagenesis as a Prescreen for Chemical Carcinogens: An Appraisal
Authors: L A Poirier, F J de Serres
Journal: JNCI Journal of the National Cancer Institute (1979)

The efficacy of several in vitro and in vivo assays to detect carcinogens from a list of compounds was evaluated. Salmonella and polymerase A-deficient Escherichia coli in vitro were the most effective systems studied. Together they detected 82% of the organic carcinogens tested. Potential prescreening systems, which were thought to be currently insufficiently sensitive for the routine screening of potential carcinogens, included a) the development of resistance to thymidine overloading, methotrexate, and cytosine arabinoside by L5178y cells, b) Saccharomyces cerevisiae D3, c) the intraperitoneal host-mediated assay, and d) thymidine uptake as a reflection of DNA repair.
Compression artifact free flow-volume loops used to establish objective measurements in patient effort with spirometry
Authors: Kristoffer Neu, Gusssan Koussa, Loni Hart, Nadia Stachowicz, Damian Compa
Journal: European Respiratory Journal (2011)

Background: Flow-volume loops (FVL) measured by using pressure-compression volume plethysmography has been described in the literature and is commonly called compression artifact free flow-volume loops (FVLc). The utility of this technique has been to help demonstrate good patient effort and to help identify upper airway obstruction. There are no studies demonstrating measurable objective data to help confirm patient effort with FVLc.

Goal: Our study looks to identify the utility of FVLc by trying to establish a percentage cut off point for FVLc peak expiratory flow and what normal flow should be at 25, 50, and 75% intervals of the FVLc that can demonstrate good patient effort.

Methods: 76 patient's charts that had FVLc in our lab were randomly reviewed. We looked to see if the peak flow on the FVLc was 25% higher than the traditional FVL. We recorded the flow percentages at the 25, 50, and 75% intervals of each patient's FVLc. Patients were divided by having a peak flow greater than 25% (group A) or less than 25% (group B).

Results: 57 subjects peak flows on FVLc were greater than 25% and 19 patients were less than 25%. Comparing groups, the flow at the 25% interval in group A were statistically higher (mean 0.58 vs 0.35, P=0.0001). All patients with peak flow greater than 25% had higher flow rates at the 25% and 50% flow intervals (P=0.0001).

Conclusion: Evaluating patient effort with FVLc may be helpful if the peak flow is 25% greater than seen on traditional FVL and if the 25% interval flow is greater. Further study is needed to establish the validity of this technique.
Sleep-disordered Breathing and Coronary Artery Disease
Authors: THOMAS MOOE, KARL A. FRANKLIN, KARIN HOLMSTRÖM, TERJE RABBEN, URBAN WIKLUND
Journal: American Journal of Respiratory and Critical Care Medicine (2001)

The evidence linking sleep-disordered breathing to increased mortality and cardiovascular morbidity has been conflicting and inconclusive. We hypothesized that a potential adverse effect of disordered breathing would be more obvious in patients with established vascular disease. In a prospective cohort study 408 patients aged 70 yr or younger with verified coronary disease were followed for a median period of 5.1 yr. An apnea–hypopnea index (AHI) of ⩾ 10 and an oxygen desaturation index (ODI) of ⩾ 5 were used as the diagnostic criteria for sleep-disordered breathing. The primary end point was a composite of death, cerebrovascular events, and myocardial infarction. There was a 70% relative increase and a 10.7% absolute increase in the primary composite end point in patients with disordered breathing defined as an ODI of ⩾ 5 (risk ratio 1.70, 95% confidence interval [CI] 1.15–2.52, p = 0.008). Similarly, patients with an AHI of ⩾ 10 had a 62% relative increase and a 10.1% absolute increase in the composite endpoint (risk ratio 1.62, 95% CI 1.09–2.41, p = 0.017). An ODI of ⩾ 5 and an AHI of ⩾ 10 were both independently associated with cerebrovascular events (hazard ratio 2.62, 95% CI 1.26–5.46, p = 0.01, and hazard ratio 2.98, 95% CI 1.43–6.20, p = 0.004, respectively). We conclude that sleep-disordered breathing in patients with coronary artery disease is associated with a worse long-term prognosis and has an independent association with cerebrovascular events.
Late-breaking abstract: Is the effect of inhaled adrenaline for in acute bronchiolitis modified by allergic disease?
Authors: Håvard Ove Skjerven, Leif Bjarte Rolfsjord, Teresa Løvold Berents, Kai-Håkon Carlsen, Edin Dizdarevic, Hanne Engen, Jon Olav Hunderi, Bente Kvenshagen, Cathrine Midgaard, Marianne Hanneborg Aas, Petter Mowinckel, Karin Cecilie Lødrup Carlsen
Journal: European Respiratory Journal (2014)

Background  Treating infant acute bronchiolitis is supportive, with no significant benefit by inhaled racemic adrenaline (iRA) over saline inhalations. It is unclear if treatment effect may differ in patients who develop atopic eczema (AE) or allergic sensitization (AS). We aimed to investigate if treatment effect of iRA in moderate to severe bronchiolitis in infancy was modified by atopic disease development of recurrent bronchial obstruction or atopic disease up to two years of age.  Methods  294 of 404 children participating in a randomized controlled trial comparing the effect (length of hospital stay (LOS)) of iRA with inhaled saline were reinvestigated 18 months later including a structured, physician-led parenteral interview, clinical examination and a skin prick test (SPT) for 17 allergens. Analyses were performed with robust regression and stratified by atopic disease in case of significant interaction.  Results  Later AS and/or AE (n=77) interacted significantly (p=0.02) with LOS for iRA. Compared to saline, iRA treatment was associated with significantly shorter mean estimated LOS in patients with negative AS and AE at two years, (-13.9 hours (95% CI 1.4-26.5), p=0.003), but no significant differences were found in children with positive AE or AS(+16.2 hours (95% CI -43.3 to 11.0), p=0.24).  The presence of recurrent bronchial obstruction (n=207) at two years of age did not influence the effect of adrenaline inhalations.  Conclusions  Children who by two years did not have allergic sensitization or atopic eczema had a significant benefit of adrenaline inhalations when hospitalized for acute bronchiolitis in infancy, suggesting that iRA may be efficient in some infants with bronchiolitis.
Atypical presentation of Legionella pneumonia among patients with underlying cancer: A fifteen-year review
Authors: Maria del Castillo, Anabella Lucca, Andrew Plodkowski, Yao-Ting Huang, Janice Kaplan, Kathleen Gilhuley, N. Esther Babady, Susan K. Seo, Mini Kamboj
Journal: Journal of Infection (2015)
Human apyrase (APT102) treatment attenuates the development of severe pulmonary arterial hypertension (PAH)
Authors: Maike Leberl, Ridong Chen, Zakaria Moumen, Martin Zamora, Laima Taraseviciene-Stewart
Journal: European Respiratory Journal (2013)

Introduction: The apyrase CD39 is expressed on the surface of immune and endothelial cells, where it hydrolyzes adenosine triphosphate (ATP) to adenosine bi- (ADP) and monophosphate (AMP). This function is especially important during hypoxia and lung injury, when ATP is released from vascular and blood cells.  Objective: We hypothesize that excessive extracellular ATP contributes to pathological vascular remodeling and right ventricular hypertrophy in the pathogenesis PAH.  Methods: Sprague Dawley rats (n=3/per group) were treated with a single injection of vascular endothelial growth factor receptor (VEGFR) blocker SU5416 and exposed to hypoxia (Hx) for 2 weeks, and then treated with APT102, an optimized human apyrase for another 3 weeks. The enzymatic activity of CD39 in lung CD4+ T and other cells; right ventricular systolic pressure (RVSP) and right ventricle over left ventricle plus septum (RV/LV+S) weight ratios were assessed. Results from APT102-treated rats were compared to those from Hx control and Hx/SU5416 treated rats.  Results: Animals treated with endogenous APT102 had reduced RV/LV+S ratio (0.44±0.06) compared to Hx/SU5416 rats (0.57±0.09, p  Conclusions: The treatment with APT102 attenuated the development of experimental PAH, suggesting that APT102 might be beneficial to treat human condition.  Funded by AHA 0735388N, 11GRNT7520020, FAMRI CIA 072053 and Emphysema Research Fund.
Minoxidil lotion over the counter
Authors: A. B Shrank
Journal: BMJ (1995)

Hair today and hair tomorrow--but at the price of continuous treatment

On the advice of the Committee on the Safety of Medicines, the Medicines Control Agency removed the prescription only label from 2% minoxidil lotion and made it available over the counter from pharmacies in January 1995. But it is still not available on prescription from the NHS.

Once Upjohn has prepared its product for marketing direct to the public, patients will no longer need to badger their general practitioner for private prescriptions. How many hours our general practitioners will save and how much income they will lose are unknown, but those plagued by patients for this drug for male and female baldness will no doubt be relieved.

The discovery that oral minoxidil induces widespread hirsutism was entirely serendipitous. The mechanism is still obscure, but the logic of seeking a local effect soon followed. Publications in the …
The impact of education to healthcare professionals (HCPs) on smoking cessation in changing patient referral patterns
Authors: Ben Vlies, Ahsen Nazir, Chris Walsh, Sanjeev Agarwal, Dilip Nazareth, Paul Stockton
Journal: European Respiratory Journal (2011)

Background: NICE (UK) recommends that every smoker should be advised to quit and referred to a smoking cessation service (SCS) for support. In a previous survey [1], 74% of patients had a missed opportunity for referral to SCS. The current survey evaluates the impact of a HCP education programme on referral patterns.  Method: HCPs including doctors, nurses and pharmacists completed an anonymous, voluntary questionnaire in January 2011.  Results: 58/65 HCPs completed the survey. 45% were aware of local smoking cessation guidelines. 50% had received information on smoking cessation in the last 12 months. 24% did not wish to receive training. 95% evaluated smoking cessation to be important, but only 79% considered that a hospitalization was a useful opportunity to stop smoking. Education by SCS did not alter the reasons given for not referring patients for smoking cessation [Fig 1] of HCPs, although awareness of, and referral to, SCS was higher in the group of HCPs who received education (64% vs 54%). 12% of respondents indicated that referring to SCS was not part of their role.  Conclusion: Education of HCPs did not alter overall attitudes towards smoking cessation in this group, but did result in increased awareness and positively influenced referral rate to the SCS.  References:  1ERJ 2010 Vol 35 Supp 54 p.1498.
A System of Neglect: Indian Boarding Schools
Authors: ERIC DLUGOKINSKI, LYN KRAMER
Journal: American Journal of Psychiatry (1974)

This paper examines the frustrations and dilemmas present in maintaining separate schools for Indian children. The diversity of approaches in these schools, the problems of acculturation, and a history of poor individual academic and emotional adjustment suggest that a reformulation of tasks and priorities be undertaken that emphasizes creative solutions to special needs. Counseling services that are more peer-oriented, as well as multifaceted supportive services, are recommended. The authors also discuss such issues as intertribal rivalry and student apathy.
The Cost Effectiveness of Combined Rapid Tests (Multistix) in Screening for Urinary Tract Infections
Authors: George A Fowlis, Janet Waters, Gordon Williams
Journal: Journal of the Royal Society of Medicine (1994)

Urinary tract infections (UTI) are relatively common in the urology outpatient's department and the renal transplant unit. Clinical diagnosis is imprecise and laboratory methods take time and are costly. Combined rapid tests (Multistix) were used to screen 400 consecutive mid stream specimens of urine: 200 from urology outpatients and 200 from renal transplant patients. All specimens were also tested in the laboratory. The negative predictive value for excluding UTI was excellent (> 98%) but positive predictive value for confirming presence of UTI was only 50%. However, with this simple screening method, up to 75% of urines can be excluded from laboratory analysis. Since there is a 20-fold difference in cost between dipstix and laboratory testing, the potential savings from this simple screening test is considerable.