tbuckley/cabot-search huggingface dataset:
Lower limb muscle mass using ultrasound predicts re-hospitalisation following admission for acute exacerbations of chronic respiratory disease
Authors: Neil Greening, Theresa Harvey-Dunstan, Johanna Williams, Mike Morgan, Sally Singh, Michael Steiner
Journal: European Respiratory Journal (2014)

Introduction

Skeletal muscle dysfuction is an important marker for chronic respiratory disease (CRD), predicting mortality and healthcare utilisation. We hypothesised that measurements of lower limb muscle function measured during hospitalisation for acute exacerbation would predict re-admission in the subsequent 12 months.

Methods

Rectus femoris cross sectional area (Qcsa) using ultrasound, quadriceps strength and measures of exercise capacity were performed in subjects enrolled in a clinical trial of early rehabilitation during acute exacerbation of chronic respiratory disease. Subjects were followed up for 12 months.

Results

191 subjects were recruited. 121 (63.4%) of the subjects were readmitted in the year following their index admission. Mean time to readmission was 121 days (SD 106). Multivariate analysis identified 3 independent risk factors for re-admission

View this table:

Multivariate analysis of risks factors for hospital readmission





. Figure 1 shows a significant difference in risk of re-admission in subjects with smaller or larger Qcsa (p=0.013)

![Figure][1] 



.

Conclusion

Ultrasound assessment of Qcsa is a non-invasive measure of muscle mass that can be performed at the bedside and independently predicts the risk of re-hospitalisation.

 [1]: pending:yes
Recommendations From an International Expert Panel on the Use of Neoadjuvant (Primary) Systemic Treatment of Operable Breast Cancer: An Update
Authors: Manfred Kaufmann, Gabriel N. Hortobagyi, Aron Goldhirsch, Suzy Scholl, Andreas Makris, Pinuccia Valagussa, Jens-Uwe Blohmer, Wolfgang Eiermann, Raimund Jackesz, Walter Jonat, Annette Lebeau, Sibylle Loibl, William Miller, Sigfried Seeber, Vladimir Semiglazov, Roy Smith, Rainer Souchon, Vered Stearns, Michael Untch, Gunter von Minckwitz
Journal: Journal of Clinical Oncology (2006)

Neoadjuvant (primary systemic) treatment is the standard treatment for locally advanced breast cancer and a standard option for primary operable disease. Because of new treatments and new understandings of breast cancer, however, recommendations published in 2003 regarding neoadjuvant treatment for operable disease required updating. Therefore, a second international panel of representatives of a number of breast cancer clinical research groups was convened in September 2004 to update these recommendations. As part of this effort, data published to date were reviewed critically and indications for neoadjuvant treatment were newly defined.
Preservation of canine lung for re-implantation using hypothermia and hyperbaric oxygen: Survival following contralateral pneumonectomy
Authors: C. A. Ross, R. F. Alves
Journal: Thorax (1969)

<b>Aim:</b> to investigate the relationship of systolic pulmonary arterial pressure (SPAP) with pulmonary functional test (PFT) indices and the fractional exhaled nitric oxide level (FeNO) in ethnic Kyrgyz. <b>Methods and Materials:</b> 551 ethnic Kyrgyz were investigated (mean age - 47.6 ± 14.15 years, mean body mass index (BMI) - 28.1 ± 5.5 kg/m2): 460 women (83.49%) and 91 men (16.51%). The study included a clinical examination, an anthropometry (height and weight), 2D and Doppler echocardiography, PFT, and measurement of FeNO. SPAP was measured non-invasively by echocardiography. Statistic analysis was performed to measure the correlation SPAP with PFT indices and the FeNO levels. <b>Results:</b> the results are presented in the table Mean Analysis of the results revealed a significant, though weak negative correlation between SPAP and FVC (r = -0.211; p = 0.000), FEV1 (r = -0.231; p = 0.000). However, there were no correlation between the FeNO levels and SPAP. <b>Conclusion:</b> negative correlation was found between SPAP and FVC and FEV1 in ethnic Kyrgyz.
Costs and Effects of Long-term Oral Anticoagulant Treatment After Myocardial Infarction
Authors: Paul F. M. M. van Bergen
Journal: JAMA (1995)

<h3>Objective.</h3> —To investigate the costs and effects of long-term oral anticoagulant treatment after myocardial infarction. <h3>Design.</h3> —Cost-effectiveness analysis, based on a randomized, double-blind, placebo-controlled trial. <h3>Setting.</h3> —Sixty Dutch hospitals. <h3>Patients.</h3> —A total of 3404 hospital survivors of acute myocardial infarction randomized within a median period of 4 days after discharge to either oral anticoagulant treatment or placebo. The mean follow-up was 37 months. <h3>Intervention.</h3> —Oral anticoagulant treatment aimed at a target international normalized ratio of 2.8 to 4.8. <h3>Main Outcome Measurements.</h3> —Costs of hospital stay during readmissions, costs related to major cardiologic interventions, and costs of oral anticoagulant treatment. <h3>Results.</h3> —The costs of oral anticoagulant treatment were estimated at 394 Dutch guilders (Dfl) per patient-year (Dfl1=US $0.58). Placebo patients stayed 18 830 days in the hospital compared with 15 083 days for anticoagulation patients. Average costs per patient of medical care during follow-up were estimated at Dfl 10784 for placebo patients and Dfl 9878 for anticoagulation patients. <h3>Conclusions.</h3> —Costs of long-term anticoagulant treatment are outweighed by the costs of prevented clinical events. (<i>JAMA</i>. 1995;273:925-928)
Pacemaker Periodicity in Atrial Fibrillation
Authors: EDWARD J. BATTERSBY
Journal: Circulation Research (1965)

The presence of a periodic component in the atrial waveform of patients with chronic atrial fibrillation can be demonstrated by the use of autocorrelation techniques, and is interpreted as evidence for the presence of a periodic or almost periodic pacemaking mechanism. In twelve patients the average rate of this periodic element was 421 per minute with a range of 346 to 528. No correlation is present between increasing rate and disorder of the waveform. The presence of persistent random wavelets modifying the beat-to-beat spread of excitation generated by a periodic focal pacemaker is proposed as a unifying hypothesis explaining the variability of the atrial waveform in atrial fibrillation in man.
Erratum. Is There a Link Between Liraglutide and Pancreatitis? A Post Hoc Review of Pooled and Patient-Level Data From Completed Liraglutide Type 2 Diabetes Clinical Trials. Diabetes Care 2015;38:1058–1066
Authors: Troels M. Jensen, Kishore Saha, William M. Steinberg
Journal: Diabetes Care (2015)
Physician judgement is a crucial adjunct to pneumonia severity scores in low-risk patients
Authors: G. Choudhury, J.D. Chalmers, P. Mandal, A.R. Akram, M.P. Murray, P. Short, A. Singanayagam, A.T. Hill
Journal: European Respiratory Journal (2011)

This study investigates the reasons for hospitalisation in patients with low-risk (CURB-65 score 0-1) community-acquired pneumonia (CAP), with a view to identifying the potential for improving outpatient management. As part of a prospective observational study of CAP, we evaluated reasons for hospitalisation in these low-risk patients. 565 patients had low-risk CAP and 420 of these were admitted (for >12 h). 39.3% had additional markers of severity justifying admission, 29.5% of the admissions were required for further management that could not be provided rapidly in the community, 11.9% had unsafe social circumstances and 19.3% had no clinical reason justifying hospitalisation. 30-day mortality was increased in patients with additional severity markers (6.7%), which was significantly higher compared with 0% for patients awaiting investigations (p=0.009) and 0% without a clear indication for hospitalisation (p=0.04). In a logistic regression analysis, parameters associated with 30-day mortality were chronic cardiac comorbidity (adjusted odds ratio (aOR) 5.73, 95% CI 1.52-21.6; p=0.01), acidosis (aOR 5.14, 95% CI 1.44-18.3; p=0.01), hypoxia (aOR 9.86, 95% CI 2.39-40.7; p=0.002) and multilobar chest radiograph shadowing (aOR 4.54, 95% CI 1.21-17.1; p=0.03). This study supports recommendations from international guidelines that pneumonia severity scores should be used as an adjunct to clinical judgement, when deciding on hospitalisation.
Aldose Reductase Inhibition by AS-3201 in Sural Nerve From Patients With Diabetic Sensorimotor Polyneuropathy
Authors: Vera Bril, Robert A. Buchanan
Journal: Diabetes Care (2004)

OBJECTIVE—The primary purpose of this investigation was to determine whether AS-3201, a new aldose reductase inhibitor, penetrates the sural nerve and inhibits sorbitol and fructose accumulation in patients with diabetic sensorimotor polyneuropathy (DSP). An additional aim was to determine whether any changes in nerve function would manifest with AS-3201 therapy. RESEARCH DESIGN AND METHODS—Patients with mild to moderate DSP based on nerve conduction studies were randomized into one of three treatment groups in a double-blind fashion: placebo or AS-3201 at 5 or 20 mg/day. After 12 weeks of administration, the sural nerve was biopsied for measurement of sorbitol, fructose, and AS-3201. RESULTS—At baseline, no important clinical, electrophysiological, or laboratory differences were found between the three groups. The nerve sorbitol concentration of 3.14 × 10−2 nmol/mg wet nerve in patients in the placebo group was inhibited by 65 and 84% in patients on AS-3201 at 5 and 20 mg/day, respectively (P &amp;lt; 0.001). Fructose levels were similarly inhibited. Sensory nerve conduction velocities improved by ≥1 m/s (P &amp;lt; 0.05). CONCLUSIONS—AS-3201 penetrates the sural nerve and inhibits sorbitol accumulation in patients with DSP. Additional studies are needed to confirm the electrophysiological suggestion that AS-3201 delays progression or leads to regression of DSP.
Global epidemiology of HIV among female sex workers: influence of structural determinants
Authors: Kate Shannon, Steffanie A Strathdee, Shira M Goldenberg, Putu Duff, Peninah Mwangi, Maia Rusakova, Sushena Reza-Paul, Joseph Lau, Kathleen Deering, Michael R Pickles, Marie-Claude Boily
Journal: The Lancet (2014)

Female sex workers (FSWs) bear a disproportionately large burden of HIV infection worldwide. Despite decades of research and programme activity, the epidemiology of HIV and the role that structural determinants have in mitigating or potentiating HIV epidemics and access to care for FSWs is poorly understood. We reviewed available published data for HIV prevalence and incidence, condom use, and structural determinants among this group. Only 87 (43%) of 204 unique studies reviewed explicitly examined structural determinants of HIV. Most studies were from Asia, with few from areas with a heavy burden of HIV such as sub-Saharan Africa, Russia, and eastern Europe. To further explore the potential effect of structural determinants on the course of epidemics, we used a deterministic transmission model to simulate potential HIV infections averted through structural changes in regions with concentrated and generalised epidemics, and high HIV prevalence among FSWs. This modelling suggested that elimination of sexual violence alone could avert 17% of HIV infections in Kenya (95% uncertainty interval [UI] 1–31) and 20% in Canada (95% UI 3–39) through its immediate and sustained effect on non-condom use) among FSWs and their clients in the next decade. In Kenya, scaling up of access to antiretroviral therapy among FSWs and their clients to meet WHO eligibility of a CD4 cell count of less than 500 cells per μL could avert 34% (95% UI 25–42) of infections and even modest coverage of sex worker-led outreach could avert 20% (95% UI 8–36) of infections in the next decade. Decriminalisation of sex work would have the greatest effect on the course of HIV epidemics across all settings, averting 33–46% of HIV infections in the next decade. Multipronged structural and community-led interventions are crucial to increase access to prevention and treatment and to promote human rights for FSWs worldwide.
Progress and Opportunities in Tobacco Control
Authors: V. Cokkinides, P. Bandi, E. Ward, A. Jemal, M. Thun
Journal: CA A Cancer Journal for Clinicians (2006)

Much progress has been made in reducing tobacco use in the United States. Despite the continuing challenges of tobacco control and the massive burden of illness, death, and economic costs caused by tobacco products, there are now unprecedented opportunities to prevent and treat tobacco dependence through a combination of interventions that have proven effective at both the population and individual levels. This report briefly reviews population trends in tobacco use by youth and adults, describes some of the policy measures that have proven effective in comprehensive tobacco control, and discusses the role of clinicians in the diagnosis and treatment of tobacco dependence in patients.
Effects of tennis training on lipid metabolism and lipoproteins in recreational players.
Authors: A Ferrauti, K Weber, H K Strüder
Journal: British Journal of Sports Medicine (1997)

OBJECTIVE: To investigate the short term effects of tennis training on lipid metabolism and to find out if a typical tennis training programme has positive longitudinal effects on cardiovascular risk factors in recreational players. METHODS: The experimental design consisted of an exercise study and a subsequent longitudinal study. In the exercise study the short term metabolic effects of a two hour technically orientated tennis training (TT) session and a running intensive tennis training (RIT) session were investigated in 16 recreational tennis players (eight men: 46 (SD 7) years, 177 (6) cm, 81 (10) kg; and eight women: 44 (5) years, 165 (5) cm, 64 (6) kg). In the longitudinal study the long term effects of a six week RIT programme in 22 players (11 men and 11 women) of similar characteristics were compared with those in 16 control subjects (eight men and eight women). The results of the exercise study (higher lipolytic activity and cardiopulmonary demand, as well as acceptance by the players) led to the RIT method being chosen for all training sessions in the longitudinal study. RESULTS: In RIT, significantly higher values for heart rate (148 (SD 10) v 124 (11) beats/minute) and lactate (2.8 (1.1) v 1.5 (0.6) mmol/l), significantly higher post exercise concentrations of serum glycerol (0.37 (0.15) v 0.29 (0.14) mmol/l) and high density lipoprotein cholesterol (1.31 (0.55) v 1.20 (0.50) mmol/l) and a higher acceptance than in TT (15 of the 16 players preferred RIT) were found. During the six week tennis training programme the changes in body weight (-1.41 (1.56) v 0.00 (1.50) kg) and anaerobic threshold (1.04 (0.84) v -0.08 (0.92) km/h) were significantly different between the training and control group. In the training group several parameters of the lipoprotein profile tended to change in an antiatherosclerotic direction. CONCLUSIONS: The results indicate that typical regular tennis training influences cardiovascular risk factors in a positive manner and can be suggested as an attractive alternative to other current health orientated sports programmes. A more frequent use of running intensive exercises during tennis training is recommended.
Effects of human mesenchymal stem cells on ER-positive human breast carcinoma cells mediated through ER-SDF-1/CXCR4 crosstalk
Authors: Lyndsay V Rhodes, James W Antoon, Shannon E Muir, Steven Elliott, Barbara S Beckman, Matthew E Burow
Journal: Molecular Cancer (2010)

Adult human mesenchymal stem cells (hMSC) have been shown to home to sites of carcinoma and affect biological processes, including tumour growth and metastasis. Previous findings have been conflicting and a clear understanding of the effects of hMSCs on cancer remains to be established. Therefore, we set out to investigate the impact of hMSCs on the oestrogen receptor positive, hormone-dependent breast carcinoma cell line MCF-7. In this study, we show the effects of hMSCs on cancer cells are mediated through a secreted factor(s) which are enhanced by cancer cell-hMSC contact/communication. In addition to enhanced proliferation when in co-culture with hMSCs, MCF-7 cells were found to have increased migration potential in vitro. Inhibition of ER signalling by the pure anti-oestrogen ICI 182,780 decreased the effect of hMSCs on MCF-7 cell proliferation and migration supporting a role for ER signalling in the hMSC/MCF-7 cell interaction. Additionally, hMSCs have been shown to secrete a wide variety of growth factors and chemokines including stromal cell-derived factor-1 (SDF-1). This coupled with the knowledge that SDF-1 is an ER-mediated gene linked with hormone-independence and metastasis led to the investigation of the SDF-1/CXCR4 signalling axis in hMSC-MCF-7 cell interaction. Experiments revealed an increase in SDF-1 gene expression both in vivo and in vitro when MCF-7 cells were cultured with hMSCs. SDF-1 treatment of MCF-7 cells alone increased proliferation to just below that seen with hMSC co-culture. Additionally, blocking SDF-1 signalling using a CXCR4-specific inhibitor decreased hMSC induced proliferation and migration of MCF-7. However, the combined treatment of ICI and AMD3100 reduced MCF-7 cell proliferation and migration below control levels, indicating targeting both the ER and CXCR4 pathways is effective in decreasing the hMSCs induction of MCF-7 cell proliferation and migration. The sum of these data reveals the relationship between tumour microenvironment and tumour growth and progression. Better understanding of the mechanisms involved in this tumour stroma cell interaction may provide novel targets for the development of treatment strategies for oestrogen receptor positive, hormone-independent, and endocrine-resistant breast carcinoma.
Proximal pulmonary emboli modify right ventricular ejection pattern
Authors: A Torbicki, M Kurzyna, M Ciurzynski, P Pruszczyk, R Pacho, A Kuch-Wocial, M Szulc
Journal: European Respiratory Journal (1999)

Analysis of the systolic flow velocity curve (SFVC) in the right ventricular outflow tract is considered as an alternative to the tricuspid valve pressure gradient (TVPG) method for echo-Doppler assessment of pulmonary arterial pressure (P(pa)). The present study checked whether or not SFVC is affected by the cause of pulmonary hypertension. Doppler recordings of 86 patients (39 female, aged 55.5+/-15.2 yrs) with acute (AP-PE) or chronic (CP-PE) proximal pulmonary embolism, chronic obstructive pulmonary disase (COPD) or primary pulmonary hypertension (PPH) were retrospectively analysed by two observers unaware of the purpose of the study. Despite having the lowest TVPG (48+/-13 mmHg), patients with AP-PE had the shortest acceleration time (t(acc); 56+/-15 ms) and time to midsystolic deceleration (t(msd); 105+/-16 ms). t(acc) &lt;60 ms in patients with TVPG &lt;60 mmHg had 98% specificity and 48% sensitivity for AP-PE. In PPH, SFVC was less abnormal (t(acc) 64+/-14 ms, t(msd) 125+/-25 ms, both p&lt;0.03) despite having a TVPG twice as high (92+/-12 mmHg, p&lt; 0.001). In contrast to t(acc), TVPG showed strong correlation with direct P(pa) measurements whenever performed (r=-0.43, p=0.02, versus r=0.80, p&lt;0.001; n=30). There was no correlation between t(acc) and TVPG in a pooled study group and SFVC seemed strongly affected by the presence of both AP-PE and CP-PE. While potentially useful for evaluation of the true right ventricular afterload during pulsatile flow conditions, the systolic flow velocity curve does not provide a reliable estimate of pulmonary arterial pressure.
A molecular trigger for intercontinental epidemics of group A Streptococcus
Authors: Luchang Zhu, Randall J. Olsen, Waleed Nasser, Stephen B. Beres, Jaana Vuopio, Karl G. Kristinsson, Magnus Gottfredsson, Adeline R. Porter, Frank R. DeLeo, James M. Musser
Journal: Journal of Clinical Investigation (2015)

The identification of the molecular events responsible for strain emergence, enhanced virulence, and epidemicity has been a long-pursued goal in infectious diseases research. A recent analysis of 3,615 genomes of serotype M1 group A Streptococcus strains (the so-called "flesh-eating" bacterium) identified a recombination event that coincides with the global M1 pandemic beginning in the early 1980s. Here, we have shown that the allelic variation that results from this recombination event, which replaces the chromosomal region encoding secreted NADase and streptolysin O, is the key driver of increased toxin production and enhanced infection severity of the M1 pandemic strains. Using isoallelic mutant strains, we found that 3 polymorphisms in this toxin gene region increase resistance to killing by human polymorphonuclear leukocytes, increase bacterial proliferation, and increase virulence in animal models of pharyngitis and necrotizing fasciitis. Genome sequencing of an additional 1,125 streptococcal strains and virulence studies revealed that a highly similar recombinational replacement event underlies an ongoing intercontinental epidemic of serotype M89 group A Streptococcus infections. By identifying the molecular changes that enhance upper respiratory tract fitness, increased resistance to innate immunity, and increased tissue destruction, we describe a mechanism that underpins epidemic streptococcal infections, which have affected many millions of people.
Phase I Study of Individualized Stereotactic Body Radiotherapy of Liver Metastases
Authors: Mark T. Lee, John J. Kim, Robert Dinniwell, James Brierley, Gina Lockwood, Rebecca Wong, Bernard Cummings, Jolie Ringash, Regina V. Tse, Jennifer J. Knox, Laura A. Dawson
Journal: Journal of Clinical Oncology (2009)

To report on the outcomes of a phase I study of stereotactic body radiotherapy (SBRT) for treatment of liver metastases.Patients with liver metastases that were inoperable or medically unsuitable for resection, and who were not candidates for standard therapies, were eligible for this phase I study of individualized SBRT. Individualized radiation doses were chosen to maintain the same nominal risk of radiation-induced liver disease (RILD) for three estimated risk levels (5%, 10%, and 20%). Additional patients were treated at the maximal study dose (MSD) in an expanded cohort. Median SBRT dose was 41.8 Gy (range, 27.7 to 60 Gy) in six fractions over 2 weeks.Sixty-eight patients with inoperable colorectal (n = 40), breast (n = 12), or other (n = 16) liver metastases were treated. Median tumor volume was 75.2 mL (range, 1.19 to 3,090 mL). The highest RILD risk level investigated was safe, with no dose-limiting toxicity. Two grade 3 liver enzyme changes occurred, but no RILD or other grade 3 to 5 liver toxicity was seen, for a low estimated risk of serious liver toxicity (95% CI, 0 to 5.3%). Six (9%) acute grade 3 toxicities (two gastritis, two nausea, lethargy, and thrombocytopenia) and one (1%) grade 4 toxicity (thrombocytopenia) were seen. The 1-year local control rate was 71% (95 CI, 58% to 85%). The median overall survival was 17.6 months (95% CI, 10.4 to 38.1 months).Individualized six-fraction liver metastases SBRT is safe, with sustained local control observed in the majority of patients.
Antiviral defense: interferons and beyond
Authors: Daniel B. Stetson, Ruslan Medzhitov
Journal: The Journal of Experimental Medicine (2006)

Mice lacking the adaptor protein that initiates an antiviral response downstream of the RNA helicases retinoic acid–inducible gene I (RIG-I) and melanoma differentiation-associated gene 5 (MDA5) have recently been described. These studies highlight the essential and nonredundant role of nucleic acid recognition in the induction of type I interferon production and raise important questions regarding the nature of cell-autonomous virus detection in coordinating the antiviral response.