tbuckley/cabot-search huggingface dataset:
Long-Term Parenteral Nutrition: Problems with Venous Access
Authors: A S McIntyre, D J Gertner, S Wood, R K S Phillips, J E Lennard-Jones
Journal: Journal of the Royal Society of Medicine (1990)

Long-term parenteral nutrition requires central venous access, often difficult in patients who have had several central venous catheterizations. Therapy may be complicated by thrombosis and sepsis which may further compromise central access. We report five cases illustrating such difficulties and suggest that these patients be referred early to specialist centres where experienced catheter insertion and management results in a greatly reduced incidence of complications.
The "Tree in bud" pattern on chest CT: Radiologic and microbiologic correlation
Authors: Shimon Goldberg, Nissim Arish, Yonit Wiener-Well, Naama Bogot, Ariel Rokach, Gabriel Izbicki
Journal: European Respiratory Journal (2013)

Background: The tree-in-bud pattern is a well described radiologic image seen on high resolution chest CT reflecting bronchiolar mucoid impaction. However its microbiologic significance is yet to be formally elucidated.

Methods : We performed a two arm study of all patients with the tree-in-bud pattern detected on chest CT in our institution over a period of five years. A computer search was performed on all chest CT reports during the study period to identify studies with the tree in bud pattern as evaluated by a senior radiologist. Microbiology samples were ascertained where available in order to assess the frequency of the various organisms isolated in the tree in bud population. The number of lobes with the tree in bud pattern was documented in each case as was the presence of relevant clinical co-morbidities such as underlying lung disease and immune-compromise.

Results: During the above period, the tree-in-bud pattern was described in 326 patients undergoing chest CT. Of these, 220 (67.5%) patients had an infectious etiology, 34 (10.4%) had aspiration pneumonia, 13 (4%) had lung malignancy, 31 (9.5%) had other malignancies, 20 cases (6%) were inconclusive or incidental findings and 8 (2.5%) had other non-infectious inflammatory disorders. The relative incidence of the various organisms isolated on sputum culture reflected the overall incidence of these bacteria in the populations independent of the tree-in-bud pattern. Conclusion: The tree-in-bud pattern reflects endo-bronchial inflammation due mainly but not exclusively to an infectious cause. The microbiologic etiology in patients with this finding is similar to that of community acquired pneumonia.
Rapid on-site evaluation of medical thoracoscopic biopsy specimens for the diagnosis of pleural disease
Authors: Ilias Porfyridis, Frangiskos Frangopoulos, Georgios Georgiadis, Alexis Papadopoulos, Michalis Michael, Paris Vogazianos, Andreas Georgiou
Journal: European Respiratory Journal (2014)

Introduction: Medical thoracoscopy (MT) is a useful method for the management of pleural disease. Rapid on-site evaluation (ROSE) of transbronchial needle aspirates improves the diagnostic yield of bronchoscopy.  Aim: To evaluate the diagnostic value of ROSE of MT biopsy specimens.  Methods: Patients with exudative pleural effusions, without specific diagnosis after routine investigation, further investigated with MT, were enrolled in the study. MT was performed under local anaesthesia and intravenous sedation, using the rigid pleuroscope (KARL STORZ, Germany). ROSE with the Hemacolor rapid staining method and cytological examination with Papanicolaou staining method from MT biopsy specimens was performed. The final diagnosis was established following histopathological examination.  Results: Thirty patients were enrolled in the study. Thoracoscopic pleural biopsies were diagnostic in 29 patients (96.6%). The final diagnoses were: malignant mesothelioma (n=8), metastatic lung cancer (n=5), tuberculosis (n=1), benign asbestos exposure (n=1), parapneumonic effusions (n=10) and non specific pleuritis (n=5). The accuracy of ROSE in predicting the final diagnosis of malignancy was 82%. ROSE had a sensitivity of 66%, specificity of 94%, positive predictive value of 88% and negative predictive value of 80%. The cytological examination with Papanicolaou method showed similar diagnostic accuracy.  Conclusion: ROSE during MT was helpful for predicting malignancy. ROSE can result in shorter procedures reducing the number of biopsies required and can be a useful tool in thoracoscopist9s decision making for pleurodesis, especially in cases with inconclusive macroscopic appearance.
Diagnosis of Nonalcoholic Fatty Liver Disease
Authors: Jin Woo Lee
Journal: JAMA (2003)

It is important to have a safe and effective diagnostic tool for liver fibrosis. Currently, liver biopsy is the technique of choice for determining hepatic fat deposition and the stage of fibrosis. However, it is an invasive procedure and its use is limited. It may also be subject to sampling error. Because of need for less invasive techniques, new diagnostic modalities are emerging to replace biopsy. In the present review, available new techniques are introduced and the advantages and disadvantages of each one are discussed. Although none of these non-invasive techniques is able to differentiate between steatosis and steatohepatitis and to reveal all features visible using histology, the proposed diagnostic modalities offer a wide range of additional information instead of liver biopsy. (Korean J Med 79:475-480, 2010)
Attenuated <i>Bordetella pertussis</i> Vaccine Protects against Respiratory Syncytial Virus Disease via an IL-17–Dependent Mechanism
Authors: Corinna Schnoeller, Xavier Roux, Devika Sawant, Dominique Raze, Wieslawa Olszewska, Camille Locht, Peter J. Openshaw
Journal: American Journal of Respiratory and Critical Care Medicine (2013)

We attenuated virulent Bordetella pertussis by genetically eliminating or detoxifying three major toxins. This strain, named BPZE1, is being developed as a possible live nasal vaccine for the prevention of whooping cough. It is immunogenic and safe when given intranasally in adult volunteers.Before testing in human infants, we wished to examine the potential effect of BPZE1 on a common pediatric infection (respiratory syncytial virus [RSV]) in a preclinical model.BPZE1 was administered before or after RSV administration in adult or neonatal mice. Pathogen replication, inflammation, immune cell recruitment, and cytokine responses were measured.BPZE1 alone did not cause overt disease, but induced efflux of neutrophils into the airway lumen and production of IL-10 and IL-17 by mucosal CD4(+) T cells. Given intranasally before RSV infection, BPZE1 markedly attenuated RSV, preventing weight loss, reducing viral load, and attenuating lung cell recruitment. Given neonatally, BPZE1 also protected against RSV-induced weight loss even through to adulthood. Furthermore, it markedly increased IL-17 production by CD4(+) T cells and natural killer cells and recruited regulatory cells and neutrophils after virus challenge. Administration of anti-IL-17 antibodies ablated the protective effect of BPZE1 on RSV disease.Rather than enhancing RSV disease, BPZE1 protected against viral infection, modified viral responses, and enhanced natural mucosal resistance. Prevention of RSV infection by BPZE1 seems in part to be caused by induction of IL-17. Clinical trial registered with www.clinicaltrials.gov (NCT 01188512).
Abstract 1855: SCT methylation is a potential cancer biomarker for lung cancer
Authors: Yu-An Zhang, Xiaotu Ma, Junya Fujimoto, Ignacio Wistuba, Stephen Lam, Victor Stastny, Boning Gao, Jill Larsen, Xiaoyun Liu, John D. Minna, Michael Q. Zhang, Adi F. Gazdar
Journal: Cancer Research (2014)

Abstract Purpose: To validate SCT (secretin) methylation as a potential cancer biomarker for lung cancer. Background: There is an urgent need for specific and sensitive biomarkers for lung cancer. The human secretin (SCT) gene is located on chromosome 11p15.5 and encodes the precursor gene of secretin, an endocrine hormone. From analysis of The Cancer Genome Atlas methylation array data, we (XM and MQZ) observed that the exon 1 promoter region of SCT gene is differentially hypermethylated in lung cancer (unpublished). These observations led us to further validate whether SCT methylation can be a useful cancer biomarker for lung cancer. Methods/Results: (1). We designed a novel nested PCR assay for SCT bisulfite sequencing of the promoter and exon 1 region of SCT. Bisulfite sequencing showed that SCT was fully methylated in nearly all CpG sites examined in 10 lung cancer cell lines, whereas SCT was non-methylated in 11 normal WBC blood cells. Accordingly we designed a semi-quantitative SCT qMSP assay. (2). We applied SCT qMSP on genomic DNA from frozen tissues of 131 lung tumors and 65 non-malignant adjacent lung tissues (53 paired). The level of SCT methylation was significantly higher (&amp;gt;24 fold) in all 111 malignant lung tumors (64 adenocarcinomas, 19 squamous cell carcinomas, 12 large cell neuroendocrine carcinomas, 16 NSCLC-other type), as compared to 65 non-malignant adjacent lung tissues. The high SCT methylation was further confirmed in malignant lung tumor formalin-fixed paraffin-embedded (FFPE) tissues samples (8 pairs tested). SCT methylation distinguishes malignant lung from non-malignant adjacent lung with area under curve (AUC) score of 0.92 (p&amp;lt;0.0001). (3). Interestingly, SCT hypermethylation does not significantly distinguishes low grade lung carcinoids tumors (n=20) from non-malignant adjacent lung with AUC score of 0.54 (p=0.5759). (4). Nearly full SCT methylation was detected in lung cancer cell lines (n=27) as compared to absent or lower levels of SCT methylation in immortalized human respiratory cell lines (n=38). Conclusions: SCT methylation is a highly specific and sensitive tissue biomarker for malignant lung cancer and can be detected in FFPE samples. SCT methylation is infrequent in low grade lung carcinoids tumors. Its clinical uses need to be explored. Citation Format: Yu-An Zhang, Xiaotu Ma, Junya Fujimoto, Ignacio Wistuba, Stephen Lam, Victor Stastny, Boning Gao, Jill Larsen, Xiaoyun Liu, John D. Minna, Michael Q. Zhang, Adi F. Gazdar. SCT methylation is a potential cancer biomarker for lung cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1855. doi:10.1158/1538-7445.AM2014-1855
Neural respiratory drive during recovery from exacerbations of COPD
Authors: Eui-Sik Suh, Swapna Mandal, Michelle Ramsay, Meera Kamalanathan, Rachel Harding, Katherine Henderson, John Moxham, Nicholas Hart
Journal: European Respiratory Journal (2013)

Background:  Neural respiratory drive (NRD), obtained from 2 nd  intercostal parasternal muscle electromyography (EMG para ), is a useful physiological biomarker of treatment failure in acute exacerbations of COPD (AECOPD) (Murphy  et al,  Thorax 2012). However, the trajectory of NRD change following hospital discharge is unknown. We hypothesised that there would be improvements in NRD, spirometry and symptoms 1 month after discharge.   Methods:  AECOPD patients were enrolled within 12 hours of hospital admission. EMG para , spirometry, inspiratory capacity (IC), modified Borg scale and COPD Assessment Test (CAT) score were recorded when medically fit for discharge and at 1 month. NRD (expressed as EMG para%max ) was derived by normalising the per-breath peak inspiratory parasternal muscle EMG activity to a value obtained during a maximal manoeuvre. Data were analysed using paired t- or Mann Witney U tests.   Results:  30 hospitalised AECOPD patients were recruited and attended 1 month follow-up. Mean age was 66±9years, 47% male, BMI 27.0±7.2kg/m 2  and %predicted FEV 1  29.0±9.3. Median length of hospital stay was 2 (IQR 2-7) days. Admission EMG para%max  was 20.3±9.7%. There were improvements in EMG para%max  (15.8±6.3% to 13.1±6.0%; p 1  (0.76±0.29L to 0.92±0.45L; p=0.002) and IC (1.65±0.54L to 1.90±0.60L, p=0.005) between discharge and 1 month. Surprisingly, there were no improvements in Borg or CAT scores.   Conclusions:  There was no change in the recorded symptom scores at 1 month following AECOPD. NRD, airways obstruction and hyperinflation were however improved at this point, suggesting that patient-reported symptoms, as measured, may not be a reliable indicator of the changes in respiratory load during recovery from AECOPD.
Telephone-Delivered Cognitive Behavioral Therapy and Telephone-Delivered Nondirective Supportive Therapy for Rural Older Adults With Generalized Anxiety Disorder
Authors: Gretchen A. Brenes, Suzanne C. Danhauer, Mary F. Lyles, Patricia E. Hogan, Michael E. Miller
Journal: JAMA Psychiatry (2015)

<h3>Importance</h3> Generalized anxiety disorder (GAD) is common in older adults; however, access to treatment may be limited, particularly in rural areas. <h3>Objective</h3> To examine the effects of telephone-delivered cognitive behavioral therapy (CBT) compared with telephone-delivered nondirective supportive therapy (NST) in rural older adults with GAD. <h3>Design, Setting, and Participants</h3> Randomized clinical trial in the participants' homes of 141 adults aged 60 years and older with a principal or coprincipal diagnosis of GAD who were recruited between January 27, 2011, and October 22, 2013. <h3>Interventions</h3> Telephone-delivered CBT consisted of as many as 11 sessions (9 were required) focused on recognition of anxiety symptoms, relaxation, cognitive restructuring, the use of coping statements, problem solving, worry control, behavioral activation, exposure therapy, and relapse prevention, with optional chapters on sleep and pain. Telephone-delivered NST consisted of 10 sessions focused on providing a supportive atmosphere in which participants could share and discuss their feelings and did not provide any direct suggestions for coping. <h3>Main Outcomes and Measures</h3> Primary outcomes included interviewer-rated anxiety severity (Hamilton Anxiety Rating Scale) and self-reported worry severity (Penn State Worry Questionnaire–Abbreviated) measured at baseline, 2 months' follow-up, and 4 months' follow-up. Mood-specific secondary outcomes included self-reported GAD symptoms (GAD Scale 7 Item) measured at baseline and 4 months' follow-up and depressive symptoms (Beck Depression Inventory) measured at baseline, 2 months' follow-up, and 4 months' follow-up. Among the 141 participants, 70 were randomized to receive CBT and 71 to receive NST. <h3>Results</h3> At 4 months' follow-up, there was a significantly greater decline in worry severity among participants in the telephone-delivered CBT group (difference in improvement, −4.07; 95% CI, −6.26 to −1.87;<i>P</i> = .004) but no significant differences in general anxiety symptoms (difference in improvement, −1.52; 95% CI, −4.07 to 1.03;<i>P</i> = .24). At 4 months' follow-up, there was a significantly greater decline in GAD symptoms (difference in improvement, −2.36; 95% CI, −4.00 to −0.72;<i>P</i> = .005) and depressive symptoms (difference in improvement, −3.23; 95% CI, −5.97 to −0.50;<i>P</i> = .02) among participants in the telephone-delivered CBT group. <h3>Conclusions and Relevance</h3> In this trial, telephone-delivered CBT was superior to telephone-delivered NST in reducing worry, GAD symptoms, and depressive symptoms in older adults with GAD. <h3>Trial Registration</h3> clinicaltrials.gov Identifier:NCT01259596.
Motives to quit smoking: Insight from the Melen study
Authors: Leyla Yilmaz Aydin, Hakan Ozhan, Talha Dumlu, Suber Dikici, Melih Engin Erkan, Sule Bulur, Adem Gungor, Gokhan Celbek
Journal: European Respiratory Journal (2011)

Background:  Ethnic, cultural and social factors influence the motives to quit smoking.   Aim:  To investigate the current prevalence of smoking and motives to quit on smoking cessation in Turkey in a large population-based epidemiologic study.   Methods:  A total of 2298 subjects with a mean age of 50 (age range 18 to 92) were interviewed. The subjects reported information regarding socio- economic status, medical history and current use of medications. Tobacco use behaviors (current status of smoking, number of cigarettes smoked daily, duration of smoking, age of addiction, attempts and desire to quit) and motives of quitting were asked.   Results:  Sixty five percent of the study population (1495 subjects) had never smoked. Three hundred eighty nine subjects were current smokers where as 414 subjects had quitted smoking. Crude smoking rate of the population was 17%. The most frequent motive was the smokers9 health status (having a chronic disease that urged the patient to use drugs daily and continuously). The most common motive in primary prevention was the assistance of a physician. Self motivation and religious beliefs showed better success rates. Age and existence of chronic diseases were found to be the independent predictors of quitting (Odds ratio (OR): 1.03 [95% confidence interval (CI): 1.02-1.05], p:    Conclusions:  Prevalence of smoking is decreasing in Turkey. Smoking ban, cost, physician assistance, comorbidities, notices on packages, religion, care for family members and self motivation are the most important motives to quit.
Endocarditis caused by Enterococcus faecalis with highlevel resistance to aminoglycosides: failure of ampicillin and ceftriaxone combined therapy
Authors: Mario Venditti, Camillo Brandimarte, Alessandro Capone, Marco Cassone, Maurizia Galié, Agapito Tarasi, David Tarasi
Journal: Clinical Microbiology and Infection (1997)
Abstract 2065: Uncorrected Moderate Tricuspid Regurgitation Impacts Late Survival In Patients Undergoing Mitral Valve Replacement
Authors: Vincent Chan, Joel Price, Ian Burwash, B-Khanh Lam, Thierry G Mesana, Marc Ruel
Journal: Circulation (2007)

Introduction: Little is known regarding the evolution and clinical impact of moderate tricuspid regurgitation (TR) in patients undergoing mitral valve replacement (MVR). This natural history study was conducted to determine: the predictors of TR progression and the impact of TR progression on late survival. Methods: Between 1989 and 2005, 352 patients (mean age 63.5 ± 12.4y) who underwent mitral valve replacement with contemporary prostheses (mechanical/bioprostheses = 70%/30%) were followed for the evaluation of their concomitant tricuspid regurgitation (mean grade 2.0+ at mitral surgery). These patients did not undergo concomitant tricuspid valve repair or replacement. Concomitant coronary artery bypass grafting (CABG) was performed in 34% of patients, with a mean of 2.1 grafts. Clinical and echocardiographic follow-up was 100% complete and averaged 5.7 ± 3.9 years. Parametric and semi-parametric techniques were used to determine predictors of outcomes. Results: Thirty-day mortality was 2.2%. Postoperative progression of TR was noted in 36% of patients. Multivariate predictors of TR progression included female gender (odds ratio (OR) 10.3; p=0.03) and right ventricular systolic pressures ≥ 50 mmHg preoperatively (OR 8.1; p=0.05). Atrial fibrillation, concomitant CABG, the degree of preoperative mitral regurgitation, and mitral prosthesis size were not predictive of TR progression. TR progression in patients whose TR was 2+ or more at the time of initial surgery was associated with significantly decreased late survival (hazard ratio 3.7; p=0.05). Conclusions: Based on these data, it appears that if TR is not surgically corrected at time of MVR, it may progressively worsen over time in a sizable proportion of patients. In patients with TR 2+ or more at the time of MVR, TR progression is associated with decreased late survival. It therefore appears indicated to repair TR of grade 2+ or more at the time of mitral surgery, particularly in female patients and in patients with right ventricular systolic pressures of 50 mmHg or more, which are both predictive of postoperative TR progression.
Epilepsy and Driving: Attitudes and Practices among Patients Attending a Seizure Clinic
Authors: William Dickey, James I Morrow
Journal: Journal of the Royal Society of Medicine (1993)

Although the loss of freedom to drive is a serious consequence of the diagnosis of epilepsy, it is unclear how well current regulations are understood and adhered to by patients. Using questionnaires completed anonymously, we assessed attitudes and practices among 104 patients with epilepsy. Seventeen (16%) patients were driving, three illegally. In total, eight (8%) patients had at some stage driven illegally, even though seven admitted to having been warned not to do so. Even among the 14 patients currently driving and eligible to do so, only eight (57%) had informed the licensing authority and six (43%) their insurers. Only 34 (33%) patients showed satisfactory knowledge of current regulations, including seven (50%) of those currently driving and 21 (50%) of 42 patients who expressed a wish to drive in the future. Of these 34, only 14 (41%) expressed complete agreement with the regulations. Thus, a significant proportion of patients with epilepsy has driven illegally or has failed to inform the licensing authority or insurers. Understanding of regulations is poor. Less stringent restrictions have been shown to be safe in other countries and might improve compliance.
Assessing the Needs of the Elderly Using Unsolicited Visits by Health Visitors
Authors: Susan Harrison, Sian Rous, Edwin Martin, Sheila Wilson
Journal: Journal of the Royal Society of Medicine (1985)

Thirty-five percent of patients over 70 years old who received an unsolicited visit by a health visitor were found to have previously unidentified needs. In all, 71% of the 110 patients surveyed were found to have problems involving mobility, communication or caring for themselves. Most of their needs were social ones. It was concluded that unsolicited visiting by health visitors was efficient use of time by members of the primary health care team. Changes in practice administration are suggested to improve access to medical care for elderly patients.
Emergency response to nuclear, biological and chemical incidents: challenges and countermeasures
Authors: Hai-Long Li, Wen-Jun Tang, Ya-Kun Ma, Ji-Min Jia, Rong-Li Dang, Er-Chen Qiu
Journal: Military Medical Research (2015)

Given the multiple terrorist attacks that have occurred in recent years in China, medical rescue teams and specialized incident assessment teams have been established by the government; however, medical rescue after nuclear, biological, and chemical incidents remains challenging and is often inefficient. In the present article, problems were analyzed regarding the assessment of responder countermeasures, training of professionals and the management of emergency medical incidents related to nuclear, biological and chemical attacks. Countermeasures, the establishment of response coordination, public education, practical training and exercise, and a professional consultant team or system should be the focus of emergency medical response facilities. Moreover, the government was offered professionals who are involved in managing nuclear, biological and chemical incidents.