tbuckley/cabot-search huggingface dataset:
Impact of close-proximity and background air pollution on lung function of elementary schoolchildren in Guadeloupe (French West Indies)
Authors: Brice Amadeo, Céline Robert, Virginie Rondeau, Marie-Alice Mounouchy, Lucie Cordeau, Eddy Citadelle, Jacques Gotin, Monique Gouranton, Gérard Marcin, David Laurac, Chantal Rahérison
Journal: European Respiratory Journal (2012)

Background: Air pollution is often associated with respiratory diseases. High levels of asthma prevalence and severity of respiratory symptoms were found in West Indies, but little is known about the impact of air pollution in these regions. This study aimed at describing air pollution impact on lung function of schoolchildren in Guadeloupe.  Methods: Data from 27 randomly chosen elementary Guadeloupian schools including 1,463 children (8-13 years old) were obtained using a standardized protocol adapted from the second phase of the International Study of Asthma and Allergy Childhood (ISAAC). Two dependent variables (peak expiratory flow before run (PEF) and variation of peak expiratory flow after run (ΔPEF)) were investigated using several linear mixed models to measure effects of i) medium-term close-proximity pollution (indoor and outdoor) of O3 and NO2 and ii) short and medium term background pollution of O3, NO2, SO2 and PM10. The heterogeneity between schools was assessed by random intercept.  Results: Of 1,463 children, 223 (16 %) were found with asthma. The values of PF and ΔPF were in average 272 L/min (range: 130-460) and -1% (range: -56%-97%) respectively. A 1-µg/m3 increase in outdoor medium-term close-proximity O3 pollution level was significantly associated with a PF decrease (β=-0.32; 95% CI: -0.61;-0.03). Effect of medium term background O3 pollution on PF was higher in asthmatic children than non-asthmatic children. No association was identified with the other air pollutants.  Conclusion: Our results suggest that O3 has an acute effect on child lung function in Guadeloupe even with value levels inferior to WHO guidelines.
In vitro comparison of emitted dose with 2 types of nebulizers during non invasive ventilation
Authors: Jean-Bernard Michotte, Emilie Jossen, Jean Roeseler, Giuseppe Liistro, Grégory Reychler
Journal: European Respiratory Journal (2012)

Introduction: 

Non invasive ventilation (NIV) and inhaled therapy are important components of the medical management of COPD patients. Sometimes, both therapies need to be administered simultaneously. It has been shown that it is feasible and effective to deliver nebulized bronchodilatators during NIV.

Objectives:

Primary objective was to compare emitted dose (ED) of different types of nebulizers coupled with a single limb circuit bilevel ventilator. Secondary objective was to evaluate the impact of the position of nebulizers on the circuit.

Material and methods:

Amikacin (500mg in 4 mL) was nebulized by two vibrating mesh nebulizers (Aeroneb®Pro and Aeroneb® Solo, Aerogen, Ireland) and by a classical jet nebulizer (SideStream; Medic-Aid; UK). The nebulizers were connected to a single limb circuit ventilator (Trilogy® 100, Philips-Respironics, USA), either before (Position 1) or after (Position 2) the passive exhalation port (Whisper Swivel II® Philips-Respironics, USA). The bilevel ventilator was set in spontaneous mode and connected to a lung model to mimic a COPD patient breathing (RR of 16 breaths/minute, I/E ratio of 1:3 and VT of 400 mL). A filter was interposed between the lung model and the circuit. ED was measured by the residual gravimetric method.

Results:

View this table:

Emitted dose by nebulizer at each position





Conclusion:

Associated with a single limb circuit bilevel ventilator, emitted dose of vibrating mesh nebulizers are greater than jet nebulizer. Moreover to place the nebulizer after the passive exhalation port is optimal for all the devices.
Costs of some drugs will be displayed on packs to try to reduce waste and improve adherence
Authors: Ingrid Torjesen
Journal: BMJ (2015)

Packs of drugs costing over £20 (€28; $31) will be marked with their indicative cost from next year to remind patients how much their tax funded treatment is costing, the health secretary for England has announced.

Jeremy Hunt announced the measure, the latest in a package of Department of Health initiatives aimed at reducing waste in the NHS in England, in a speech to the Local Government Association’s annual conference in Harrogate on 1 July. Previous measures were outlined in a report from the life peer Patrick Carter last …
A successful treatment with ustekinumab in a case of antilaminin-γ1 pemphigoid associated with psoriasis
Authors: Y. Majima, H. Yagi, C. Tateishi, S. Groth, E. Schmidt, D. Zillikens, H. Koga, T. Hashimoto, Y. Tokura
Journal: British Journal of Dermatology (2012)
A phase II trial of brachytherapy alone following lumpectomy for stage I or II breast cancer: initial outcomes of RTOG 9517
Authors: R. R. Kuske, K. Winter, D. W. Arthur, J. Bolton, R. A. Rabinovitch, J. R. White, W. F. Hanson, R. M. Wilenzick
Journal: Journal of Clinical Oncology (2004)

565 Background: In order to shorten the conventional 6–7 week radiation treatment time, and to treat only the tissue at greatest risk for recurrence, this phase II trial evaluates partial breast irradiation with 4–5 days of interstitial brachytherapy as an alternative to external beam. Methods: Eligibility criteria included patients (pts) with invasive ≤ 3cm non-lobular carcinoma, 0–3 positive axillary nodes with no extracapsular extension and at least 6 nodes removed, negative surgical margins, no residual suspicious microcalcifications, no extensive intraductal component, and no collagen vascular disease. After lumpectomy and axillary dissection, pts were treated with either high (34 Gy in 10 fractions over 5 days) or low (45 Gy in 3.5–5 days) dose rate (HDR or LDR) brachytherapy. Treatment volume was the lumpectomy cavity plus 2cm, except where limited by chest wall or skin. Systemic therapy was given after brachytherapy at physician discretion. Endpoints included local and regional control, disease-free (DFS) and overall survival (OS). Results: One hundred pts were enrolled and one was ineligible because only a sentinel node was removed. Median follow-up is 3.7 years, range 0.6–5.7. Eighty-seven pts had T1 and 12 had T2 tumors. Seventy-nine were pathologically N0 and 20 were N1. The actuarial 4-year breast and nodal recurrence rate is 3% (3 pts, all HDR, T1N0 x2 and T1N1) and 3% (2 pts, both HDR, T1N0 x2), respectively. Distant metastasis occurred in 6 pts, 3 T1N0 and 3 T2N1, for an actuarial 4-year rate of 6%, HDR 8% and LDR 4%. DFS and OS were 85% and 93% at 4 years (82% and 95% HDR, 90% and 90% LDR). Contralateral breast cancer developed in 3 pts, 1 HDR and 2 LDR. Six pts had non-breast second primaries, 4 HDR and 2 LDR. Conclusions: We conclude that partial breast brachytherapy on this RTOG trial yields excellent tumor control at this early analysis (<1% local failure per year), warranting support for a future phase III trial. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Nucletron Proxima Therapeutics
Abstract 3929: Daily Therapy With the Phospholipase A2 Inhibitor, PX-18, Improves the Chronic Inflammatory State in Obese Mice and Reduces Infarct Size Following Ischemia/Reperfusion
Authors: Amit Varma, Fadi N Salloum, Nicholas N Hoke, Rakesh C Kukreja
Journal: Circulation (2009)

Background: The low-molecular weight, calcium-dependent type IIA secretory phospholipase A2 (sPLA2-IIA) has been implicated in irreversible cell damage following ischemia-reperfusion (I/R) injury p...
Association of percentage of tumor burden removed with debulking nephrectomy and progression-free survival (PFS) in metastatic renal cell carcinoma (mRCC) patients (Pts) treated with VEGF-targeted therapy
Authors: J. Barbastefano, J. A. Garcia, P. Elson, L. S. Wood, B. S. Lane, R. Dreicer, S. Campbell, B. I. Rini
Journal: Journal of Clinical Oncology (2009)

5095 Background: Debulking nephrectomy is a standard of care in mRCC, although data in patients subsequently treated with targeted therapy is lacking. The objective of this study was to determine if fractional percentage of tumor volume (FPTV) removed with debulking nephrectomy is associated with PFS on subsequent VEGF-targeted therapy. Methods: The Cleveland Clinic Urologic Oncology database from 2005–2008 was retrospectively reviewed to identify mRCC patients who had undergone debulking nephrectomy followed by VEGF-targeted therapy, defined as treatment with sunitinib, sorafenib, bevacizumab or sunitinib + bevacizumab. FPTV was determined by the diameter of the primary tumor divided by the total tumor burden (per RECIST criteria) by investigator re-review of imaging studies. PFS was defined from the start date of systemic therapy to disease progression per RECIST criteria. Results: Seventy-five Pts were identified; 76% male, median age 60 years (range, 34–84), 95% clear cell histology and 69% ECOG PS 0. Pts received treatment with bevacizumab (28 pts), sunitinib (23), sorafenib (20), or sunitinib + bevacizumab (4). Lung (76%) and lymph node (48%) were the predominant sites of metastasis. The median diameter of the primary tumor was 9.3 cm (range, 3.3–21 cm). The median FPTV removed was 95% (range, 80–99%). The median PFS was 12 months. In univariable analysis, the FPTV removed was associated with prolonged PFS (p &lt; 0.001), as were low nuclear grade (p = 0.009), longer interval from diagnosis to treatment (p = 0.05), normal hemoglobin (p = 0.02), number of metastatic sites (p = 0.05), and lack of lung (p = 0.05) and brain (p = 0.05) metastasis. In multivariable analysis, the FPTV removed, as well as the interval from diagnosis to treatment (p = 0.03), were found to be independent predictors of PFS (&lt; 0.001). Conclusions: Improved PFS on targeted systemic therapy is significantly associated with a greater percentage of tumor burden removed at debulking nephrectomy. No significant financial relationships to disclose.
Relationship of tumor-cell ploidy to histologic subtype and treatment outcome in children and adolescents with unresectable rhabdomyosarcoma.
Authors: D N Shapiro, D M Parham, E C Douglass, R Ashmun, B L Webber, W A Newton, M L Hancock, H M Maurer, A T Look
Journal: Journal of Clinical Oncology (1991)

Clinical and histopathologic features are often inadequate for accurate prediction of relapse or survival of individual patients with rhabdomyosarcoma (RMS). We therefore studied the cellular DNA content (ploidy) of RMS cells in relation to histology and response to therapy in 37 patients with unresectable tumors. Using flow cytometric techniques, we found that about one third of patients had diploid tumor stem lines, regardless of the histologic subtype. In the group with abnormal ploidy, a hyperdiploid classification (1.10 to 1.80 times the DNA content of normal diploid cells) was exclusively associated with embryonal histology (P = .001). By contrast, near-tetraploidy (1.80 to 2.60 times the DNA content of normal cells) was strongly associated with alveolar histology (P = .001). Thus, in these histologic subtypes of RMS, abnormal ploidy appears to arise through different mechanisms. Tumor-cell ploidy had a significant impact on survival that was especially apparent in patients with unresectable, nonmetastatic (group III) tumors. In this subgroup, hyperdiploidy conferred the best prognosis and diploidy the worst (P less than .0001). None of the eight patients with diploid tumors survived for more than 18 months. Tumor-cell ploidy was the best predictor of treatment outcome for patients with either embryonal (P less than .001; relative risk, 25.5) or alveolar (P = .073; relative risk 7.1) RMS and contributed significantly after adjustment for disease stage and anatomic site. Patients with unresectable diploid RMS have an unacceptably high risk of treatment failure, justifying new therapeutic approaches for this distinct subgroup.
Re: Massimiliano Spaliviero, Bing Ying Poon, Christoph A. Karlo, et al. An Arterial Based Complexity (ABC) Scoring System to Assess the Morbidity Profile of Partial Nephrectomy. Eur Urol 2016;69:72–9
Authors: Gianluca Giannarini, Alessandro Crestani, Andrea Porzionato, Veronica Macchi, Vincenzo Ficarra
Journal: European Urology (2015)
Regulation of vascular endothelial growth factor expression in a mouse model of acute respiratory distress syndrome (ARDS)
Authors: Anja Buchbinder, Juliane Ott, Andrea Mohr, Werner Seeger, Konstantin Mayer
Journal: European Respiratory Journal (2013)

ARDS is a common condition in critically ill. It9s characterized by barrier dysfunction, edema, and leukocyte influx. Vascular endothelial growth factor (VEGF) A is responsible for alveolar integrity but also important for permeability regulation. The role of VEGF in ARDS is a matter of on-going discussion  We examined the regulation of VEGFA expression after induction of lung injury in a murine model of intratracheal endotoxin instillation. Mice were sacrificed at 0, 24, 48 and 72h. Lungs were lavaged (BAL) and embedded. By laser microdissection we isolated precapillary small arterioles and alveolar septa. Total mRNA was isolated and realtime RT-PCR performed. Expression of VEGFA was evaluated in whole lung homogenates and the different cell types by mRNA levels and VEGF protein. Expression of VEGF receptors flt-1 and flk-1 was also investigated. Leukocytes were counted and VEGF protein was measured by ELISA in BAL.  After lung injury we found a massive leukocyte influx in the alveolar space within 24h, which was not cleared within 72h. Concentrations of VEGFA protein were highly elevated in BAL after 24h and returned to baseline within 72h.  At all times we could not detect any regulation on mRNA level of either VEGFA or its receptors in whole lung homogenates or in endothelial cells. In the alveolar epithelium mRNA of VEGFA and flk-1 was decreased within 4h and remained low.  In this model of lung injury the regulation of VEGFA and its receptor flk-1 occur predominantly in the alveolar epithelium, whereas we detected no regulation in the endothelium. This knowledge might be crucial for therapeutic approaches targeting VEGF-pathways in ARDS.
Tracheobronchomalacia in children- a ten year experience from Vestfold County Norway
Authors: Anette Faye-Lund, Thomas Møller, Jorg Geisler
Journal: European Respiratory Journal (2013)

Background 

Tracheobronchomalacia (TBM) is generally considered underdiagnosed in children,but the actual incidence remains unknown. Symptoms often mimic other respiratory disease like bronchial asthma.Flexible bronchoscopy has been the gold standard for diagnosing TBM, but the test requires general anaesthesia and it has methodological limitations. Cine fluoroscopy has a high positive predictive value. It is a quick, non- invasive test and it does not require general anaesthesia or a cooperation.

Methods: We retrospectively reviewed the medical records of all children from Vestfold county in Norway, who were diagnosed with tracheobronchomalacia (ICD diagnosise Q32) from January 2001 through May 2012.

Results: We identified 75 patients.(63% male. 21 born prematurely). Coughing and rattling were the main symptoms. Median age of symptom debut was 1 month. 69/75 were diagnosed after positive cine fluoroscopy and only a minor part (6/75) after bronchoscopy. Seventy-three percent of the children were diagnosed during the last 5.5 years of the observation period time. Sixty-one children (81%) had respiratory distress requiring hospital admissions at least once. Median age for first admission was 4 month range(0-43).Preterm infants used significantly more inhaled steroids compared to matures at the age of one year (p = 0.035). 52 % had asthma diagnosis at any time, but this was only confirmed for 13 %.

Conclusion: Cine fluoroscopy should be performed with a low threshold in infants with onset of coughing and rattling during the first month of life or within children having respiratory symptoms not responding at conventional asthma therapy.
Plasma and Lipoprotein Lipids and Apolipoproteins AI, AII and B in Patients with Chronic Airflow Limitation
Authors: C H Bolton, E Mulloy, J Harvey, L G Downs, M Hartog
Journal: Journal of the Royal Society of Medicine (1989)

Plasma and lipoprotein cholesterol and triglycerides, and plasma apolipoproteins AI, AII and B were compared in patients with chronic airflow limitation, and normal controls matched for body mass index. The controls were non-smokers, and free from respiratory disease. High-density lipoprotein (HDL) cholesterol concentration was significantly elevated in the patients, due mainly to a raised HDL2 cholesterol level. HDL triglyceride was significantly lower in the patients. All other lipids were not different from normal. Apolipoprotein AI levels were significantly raised in the patients but other apolipoproteins were unchanged. The changes found may account in part for the fact that patients with chronic airflow limitation have a lower incidence of atherosclerotic heart disease.
Nitrous Oxide-Oxygen Analgesia: The Performance of the MC Mask Delivery System
Authors: R Ooi, P Joshi, N Soni
Journal: Journal of the Royal Society of Medicine (1992)

Nitrous oxide administration via an oxygen facemask such as the Mary Catterall (MC) is an accepted technique for supplementing regional anaesthesia. This study assessed the range of nitrous oxide and oxygen concentrations delivered to the trachea using a mechanical lung model. The inspired concentrations of these two gases were determined by the total fresh gas inflow rates, their concentrations in the fresh gas mixture and the peak inspiratory flow rate of the analogue lung. A 1:1 nitrous oxide-oxygen mixture in the fresh gas with an inflow rate of 4-6 l/min is recommended to ensure adequate oxygen delivery into the trachea as well as achieving the therapeutic concentrations of nitrous oxide (20-30%).
Albumin controversy continues
Authors: R. Patey, G. Wilson, T. Hulse, S. Workman
Journal: BMJ (1999)

Editor—With the recent Cochrane Injuries Group meta-analysis regarding albumin1 and subsequent correspondence in mind, we undertook a postal survey of paediatric departments in the South East Thames region. We asked clinicians which fluid (crystalloid, albumin, or other colloid) would be used in a variety of scenarios, before and after 25 July 1998, in light of the meta-analysis. Altogether 12 of 13 departments replied, which equals a 92% response rate (table). 

We found that all 12 would use crystalloid for 5% dehydration after gastroenteritis, both before and after 25 July. Crystalloids are favoured over “other colloids” for all indications. Recent publications have influenced routine clinical practice, reducing clinicians’ willingness to use albumin, but most departments have not made changes. Only in trauma resuscitation has there been a substantial shift away from albumin to crystalloid, and in meningococcal disease clinicians are still regularly using albumin. This suggests that published reservations2 regarding the meta-analysis are borne out in clinical practice.
Pomalidomide Plus Low-Dose Dexamethasone (POM + LoDEX) for Relapsed and Refractory Multiple Myeloma (RRMM): Results from a Pharmacoeconomic Evaluation
Authors: Steve Schey, Sujith Dhanasiri, Dawn Lee, Lars Sternas, Xin Yu, Mohamed H. Zaki, Jamie Elvidge, Michael O'Dwyer
Journal: Blood (2014)
Indian institute should screen patients by disease severity to reduce delays, report says
Authors: Sanjeet Bagcchi
Journal: BMJ (2015)

The All India Institute of Medical Sciences, a leading medical education and research university in Delhi, should introduce a screening system to ensure that people with more severe disease are investigated and treated as priorities, a report from a parliamentary panel has recommended.

The Parliamentary Standing Committee on Health and Family Welfare said in its report that the average waiting times for investigations or surgery at the institute are too long.1 Tests and surgery are currently provided …
Predictive value of Berlin questionnaire and STOP Bang for obstructive sleep apnea
Authors: Margarida Aguiar, Ines Alves, Ana Campos, Silvia Rodrigues, Antonio Bugalho, Sofia Furtado
Journal: European Respiratory Journal (2014)

The Berlin Questionnaire (BQ) and STOP Bang are two of the most widely used screening instruments for subjects with suspected sleep disorders.  To determine the accuracy of the BQ and STOP Bang in predicting obstructive sleep apnea (OSA) in patients admitted to our sleep clinic, using overnight polysomnography (PSG) as the “gold standard”. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of BQ and STOP-BANG scores for identifying a respiratory disturbance index (RDI) >5/hour. Patients were screened with BQ and Stop Bang and then submitted to a PSG.  During 2013, 162 patients with suspected sleep disorders were referred to our sleep clinic. Fifty two percent were male, age 53.5±14.3, BMI 29.8±16,6 Kgm2. 62% had a positive PSG (IDR>5); 28% mild, 18% moderate and 16% severe OSA. A total of 75.3% scored positive in the BQ (positive in at least two categories) and 40.7% scored >4 in the STOP-Bang questionnaire. For BQ sensitivity was 83.2%, specificity was 37.7%, PPV was 68.9% and NPV was 57.5% (positive likelihood ratio: 1.34 95% 1.08-1.65). For STOP-Bang sensitivity was 56%, specificity was 83.6%, PPV was 84.8% and NPV was 53.7% (positive likelihood ratio: 3.42 95% 1.8-6.18)  We concluded that these questionnaires alone cannot reliably predict the presence of OSA. Objective physiological measurement is critical for the diagnosis or exclusion of OSA.