tbuckley/cabot-search huggingface dataset:
Discrepancies between Perceptions by Physicians and Nursing Staff of Intensive Care Unit End-of-Life Decisions
Authors: Edouard Ferrand, François Lemaire, Bernard Regnier, Khaldoun Kuteifan, Michel Badet, Pierre Asfar, Samir Jaber, Jean-Luc Chagnon, Anne Renault, René Robert, Frédéric Pochard, Christian Herve, Christian Brun-Buisson, Philippe Duvaldestin
Journal: American Journal of Respiratory and Critical Care Medicine (2003)

Several studies have pointed out ethical shortcomings in the decision-making process for withholding or withdrawing life-supporting treatments. We conducted a study to evaluate the perceptions of all caregivers involved in this process in the intensive care unit. A closed-ended questionnaire was completed by 3,156 nursing staff members and 521 physicians from 133 French intensive care units (participation rate, 42%). Decision-making processes were perceived as satisfactory by 73% of physicians and by only 33% of the nursing staff. More than 90% of caregivers believed that decision-making should be collaborative, but 50% of physicians and only 27% of nursing staff members believed that the nursing staff was actually involved (p < 0.001). Fear of litigation was a reason given by physicians for modifying information given to competent patients, families, and nursing staff. Perceptions by nursing staff may be a reliable indicator of the quality of medical decision-making processes and may serve as a simple and effective tool for evaluating everyday practice. Recommendations and legislation may help to build consensus and avoid conflicts among caregivers at each step of the decision-making process.
Oral antibiotics prior to hospitalisation for community-acquired pneumonia
Authors: P. G. P. Charles
Journal: European Respiratory Journal (2008)

We would like to thank S. Teramoto and co-workers for the important issues they raised.While appraising their comments, it is important to make a distinction between the use of severity rules inside and outside hospital settings.Looking at the available literature, we think that the pneumonia severity index (PSI) and CURB-65 (Confusion, Urea .7 mmol?L -1 , Respiratory rate o30 breaths?min -1 , Blood pressure (systolic value ,90 mmHg or diastolic value f60 mmHg)) are both valid and useful in hospital settings.However, it is an interesting suggestion to improve CURB-65 by introducing more detailed age groups in the score.In primary care, PSI and CURB-65 are less useful for various reasons.Regarding the predictive value of age, the results of our study [1] showed that age .80yrs was a better predictor of outcome than age categories between 65-80 yrs.Probably as there are a lot of healthy individuals aged 65-80 yrs in primary care who have a low risk for poor outcome.
Platelets and P-Selectin Control Tumor Cell Metastasis in an Organ-Specific Manner and Independently of NK Cells
Authors: Lucy A. Coupland, Beng H. Chong, Christopher R. Parish
Journal: Cancer Research (2012)

The prometastatic role of platelets has long been recognized with proposed mechanisms of action including shielding tumor cells from natural killer (NK) cell destruction and aiding endothelial attachment and extravasation of tumor cells with platelet P-selectin being implicated in these processes. However, many aspects of the prometastatic function of platelets remain unclear. In this study, we used mouse models of metastatic breast cancer and melanoma to investigate the platelet effect, focusing on organ specificity, the relationship with NK cells and the relative importance of platelet-derived versus endothelial-derived P-selectin. We found that platelets promote lung metastasis in the absence of NK cells in both acute and spontaneous metastasis models. In addition, the prometastatic action of platelets was found to be organ specific, clearly enhancing lung metastasis but not affecting B16F1 liver metastasis, in fact, liver metastasis was enhanced in the absence of platelets. Furthermore, the profound antimetastatic activity of NK cells was equally effective in the presence or absence of platelets and chronologically distinct from the prometastatic role of platelets. Finally, it was shown that endothelial-derived P-selectin is just as important as platelet-derived P-selectin in promoting lung metastasis and also plays an important role in liver metastasis. Taken together, our findings help clarify the roles of platelets, NK cells and P-selectin in metastasis, and they identify P-selectin as an attractive therapeutic target for preventing metastasis in multiple organs.
Is a Failure to Recognize an Increase in Food Intake a Key to Understanding Insulin-Induced Weight Gain?
Authors: Miriam Ryan, M. Barbara E. Livingstone, Pierre-Henri Ducluzeau, Agnès Sallé, Manon Genaitay, Patrick Ritz
Journal: Diabetes Care (2008)

The present study aimed to assess the contribution of energy intake to positive energy balance and weight gain with insulin therapy. Changes in energy intake (self-report and weighed food intake), dietary behavior (auto-questionnaires), resting energy expenditure (REE) (indirect calorimetry), physical activity (accelerometry), and glucosuria were monitored over the first 6 months of insulin therapy in 46 diabetic adults. No change in REE, activity, or glucosuria could explain weight gain in the type 1 (4.1 +/- 0.6 kg, P < 0.0001) or type 2 (1.8 +/- 0.8 kg, P = 0.02) diabetic groups. An increase in energy intake provides the most likely explanation for weight gain with insulin. However, it is not being recognized because of significant underestimation of self-reported food intake, which appears to be associated with increased dietary restraint.
National standards for diabetes self-management education and support.
Authors: Linda Haas, Melinda Maryniuk, Joni Beck, Carla E. Cox, Paulina Duker, Laura Edwards, Edwin B. Fisher, Lenita Hanson, Daniel Kent, Leslie Kolb, Sue McLaughlin, Eric Orzeck, John D. Piette, Andrew S. Rhinehart, Russell Rothman, Sara Sklaroff, Donna Tomky, Gretchen Youssef
Journal: Diabetes Care (2012)

By the most recent estimates, 18.8 million people in the U.S. have been diagnosed with diabetes and an additional 7 million are believed to be living with undiagnosed diabetes. At the same time, 79 million people are estimated to have blood glucose levels in the range of prediabetes or categories of increased risk for diabetes. Thus, more than 100 million Americans are at risk for developing the devastating complications of diabetes (1).

Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and those at risk for developing the disease. It is necessary in order to prevent or delay the complications of diabetes (2–6) and has elements related to lifestyle changes that are also essential for individuals with prediabetes as part of efforts to prevent the disease (7,8). The National Standards for Diabetes Self-Management Education are designed to define quality DSME and support and to assist diabetes educators in providing evidence-based education and self-management support. The Standards are applicable to educators in solo practice as well as those in large multicenter programs—and everyone in between. There are many good models for the provision of diabetes education and support. The Standards do not endorse any one approach, but rather seek to delineate the commonalities among effective and excellent self-management education strategies. These are the standards used in the field for recognition and accreditation. They also serve as a guide for nonaccredited and nonrecognized providers and programs.

Because of the dynamic nature of health care and diabetes-related research, the Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes education community. In the fall of 2011, a Task Force was jointly convened by the American Association of Diabetes Educators (AADE) and the American Diabetes Association …
Impact of Stressful Life Events, Depression, Social Support, Coping, and Cortisol on Progression to AIDS
Authors: Jane Leserman, John M. Petitto, Robert N. Golden, Bradley N. Gaynes, Hongbin Gu, Diana O. Perkins, Susan G. Silva, James D. Folds, Dwight L. Evans
Journal: American Journal of Psychiatry (2000)

OBJECTIVE: This study examined prospectively the effects of stressful events, depressive symptoms, social support, coping methods, and cortisol levels on progression of HIV-1 infection. METHOD: Eighty-two homosexual men with HIV type-1 infection without AIDS or symptoms at baseline were studied every 6 months for up to 7.5 years. Men were recruited from rural and urban areas in North Carolina, and none was using antiretroviral medications at entry. Disease progression was defined as CD4+ lymphocyte count <200/μl or the presence of an AIDS indicator condition. RESULTS: Cox regression models with time-dependent covariates were used adjusting for race, baseline CD4+ count and viral load, and cumulative average antiretroviral medications. Faster progression to AIDS was associated with higher cumulative average stressful life events, coping by means of denial, and higher serum cortisol as well as with lower cumulative average satisfaction with social support. Other background (e.g., age, education) and health habit variables (e.g., tobacco use, risky sexual behavior) did not significantly predict disease progression. The risk of AIDS was approximately doubled for every 1.5-unit decrease in cumulative average support satisfaction and for every cumulative average increase of one severe stressor, one unit of denial, and 5 mg/dl of cortisol. CONCLUSIONS: Further research is needed to determine if treatments based on these findings might alter the clinical course of HIV-1 infection.
Intensive, Very Short-Term Chemotherapy for Advanced Burkitt’s Lymphoma in Children
Authors: Filippo Spreafico, Maura Massimino, Roberto Luksch, Michela Casanova, Graziella S. Cefalo, Paola Collini, Andrea Ferrari, Daniela Polastri, Monica Terenziani, Marco Gasparini, Franca Fossati-Bellani
Journal: Journal of Clinical Oncology (2002)

PURPOSE: To improve the 63% event-free survival (EFS) achieved before 1986 in Murphy’s stage III to IV Burkitt’s lymphoma (BL), both chemotherapy and supportive care were intensified. PATIENTS AND METHODS: From May 1987 to February 2001, 60 children, median age 9 years (range, 2.1 to 17 years), with advanced BL were enrolled onto two sequential institutional studies. From 1987 to 1992, 30 patients were stratified according to the absence (regimen IA, n = 19) or presence (regimen IB, n = 11) of bone marrow (BM) or CNS involvement. After 5-week cytoreductive chemotherapy consisting of vincristine, cyclophosphamide, doxorubicin, high-dose (HD) methotrexate (MTX), and intrathecal MTX or cytarabine, HD cytarabine and cisplatin were provided as a 4-day continuous infusion. Regimen IB was intensified by adding etoposide and HD ifosfamide and escalating MTX doses. Since 1992, regardless of BM or CNS status, 30 patients have been placed on regimen II, which is identical to IB but without ifosfamide. The scheduled duration of regimen II was 45 days. RESULTS: EFS and disease-free survival at 5 years are 81% ± 5% and 87% ± 5%, respectively, for 59 assessable patients (73% ± 8% and 85% ± 7% for regimen IA + IB, 89% ± 6%, EFS and disease-free survival, for regimen II; median follow-up, 6.7 years; range, 0.6 to 13.5 years). Six patients, two of whom were receiving regimen II, died as a result of initial treatment failure or relapse, and five patients, none receiving regimen II, died as a result of treatment-related complications. CONCLUSION: This 45-day intensive chemotherapy program is the shortest schedule for disseminated BL and overcomes previously recognized risk factors such as BM and CNS infiltration.
Mice that Lack Endothelial Nitric Oxide Synthase Are Protected against Functional and Structural Modifications Induced by Acute Peritonitis
Authors: Jie Ni, Pierre Moulin, Pierre Gianello, Olivier Feron, Jean-Luc Balligand, Olivier Devuyst
Journal: Journal of the American Society of Nephrology (2003)

ABSTRACT. Pharmacologic studies suggest that the release of nitric oxide (NO) by endothelial NO synthase (eNOS) contributes to functional alterations of the peritoneal membrane (PM) induced by acute peritonitis. In this study, peritoneal permeability parameters in a mouse model of peritoneal dialysis were characterized, and the effects of eNOS deletion on the PM structure and permeability at baseline and after catheter-induced bacterial peritonitis were examined. Exposure of C57BL/6 mice to standard dialysate yielded a transport of urea and glucose, a sodium sieving, and a net ultrafiltration that were remarkably similar to the values obtained in rats. In comparison with controls, mice with catheter-induced peritonitis were characterized by structural changes in the PM (mononuclear cells infiltrate, vascular proliferation), upregulation of endothelial and inducible NOS, increased permeability for urea and glucose, decreased ultrafiltration, and increased protein loss in the dialysate. Comparison of eNOS wild-type and knockout mice revealed that the permeability modifications and structural changes induced by acute peritonitis were significantly reversed in eNOS knockout mice, resulting in a net increase in ultrafiltration. In contrast, the deletion of eNOS in mouse peritoneum was not reflected by permeability modifications or structural changes at baseline. These results are the first to take advantage of a knockout mouse model to demonstrate directly the crucial importance of eNOS in the permeability and structural modifications caused by acute peritonitis. The characterization of this mouse model suggests that genetically modified mice represent useful tools to investigate the molecular bases of the peritoneal changes during peritoneal dialysis.
An L-arginine-dependent mechanism mediates kupffer cell inhibition of hepatocyte protein synthesis in vitro
Authors: TR Billiar, RD Curran, DJ Stuehr, MA West, BG Bentz, RL Simmons
Journal: The Journal of Experimental Medicine (1989)

The hepatic failure associated with severe sepsis is characterized by specific, progressive, and often irreversible defects in hepatocellular metabolism (1). Although the etiologic microbe can often be identified, the direct causes and mechanisms of the hepatocellular dysfunction are poorly understood. We have hypothesized that Kupffer cells (KC), which interact with ambient septic stimuli, respond by providing signals to adjacent hepatocytes (HC) in sepsis . Furthermore, we have provided evidence (2, 3) that KC activated by LPS from Gram-negative bacteria can induce profound changes in the function of neighboring HC in coculture. In our model, coculture of either KC (2) or peritoneal macrophages (Mφ)(3) with HC normally promotes HC protein synthesis ([(3)H]leucine incorporation). The addition of LPS or killed Escherichia colt' to such cocultures induces a profound decrease in HC protein synthesis, as well as qualitative changes ([(35)S]methionine, SDS-gel electrophoresis) in protein synthesis without inducing HC death (2, 3) . In this report we show that the inhibition in protein synthesis is mediated via an L-arginine-dependent mechanism. The metabolism of L-arginine by activated Mφ to substances with cytostatic and even lethal effects on target cells is a relatively recent discovery. After the description by Stuehr and Marletta (4, 5) that LPS- triggered Mφ produced nitrite/nitrate (NO(2)(-)/NO(3)(-)), Hibbs et al. (6, 7) and Iyengar et al. (8) demonstrated that L-arginine was the substrate for the formation of both these nitrogen end products and citrulline. A role for the arginine-dependent mechanism in Mφ tumor cytotoxicity (6, 7) and microbiostatic activity (9) has been suggested. However, the in vivo functions of this novel Mφ mechanism have not yet been defined, but it is possible that there are both physiologic as well as pathologic roles. Our in vitro results raise the possibility that some metabolic responses to microbial invasion maybe partially mediated by the L-arginine-dependent mechanism. What other metabolic responses are affected and the possible pathologic consequences remain to be studied.
Predicting responses to sunitinib using single nucleotide polymorphisms: Progress and recommendations for future trials
Authors: Ram N Ganapathi, Ronald M Bukowski
Journal: Genome Medicine (2011)

Targeted therapy with tyrosine kinase inhibitors has led to a substantial improvement in the standard of care for patients with advanced or metastatic clear cell renal cell carcinoma. Because the mechanism of action, metabolism and transport of tyrosine kinase inhibitors can affect outcome and toxicity, several investigators have pursued the identification of single nucleotide polymorphisms (SNPs) in genes associated with these actions. We discuss SNPs associated with outcome and toxicity following sunitinib therapy and provide recommendations for future trials to facilitate the use of SNPs in personalized therapy for this disease.
Ultrastructure of the liver in non-cirrhotic portal fibrosis with portal hypertension
Authors: B. N. Tandon, R. Lakshminarayanan, S. Bhargava, N. C. Nayak, S. K. Sama
Journal: Gut (1970)

The aetiology of the ultrastructural abnormalities of non-cirrhotic portal fibrosis is not known. In an attempt to elucidate the pathophysiology of this condition, the hepatic ultrastructure in nine cases of non-cirrhotic portal fibrosis with portal hypertension has been studied.
Chemokine receptors in advanced breast cancer: differential expression in metastatic disease sites with diagnostic and therapeutic implications
Authors: N. Cabioglu, A.A. Sahin, P. Morandi, F. Meric-Bernstam, R. Islam, H.Y. Lin, C.D. Bucana, A.M. Gonzalez-Angulo, G.N. Hortobagyi, M. Cristofanilli
Journal: Annals of Oncology (2009)
Altered DNA Mismatch Repair Expression in Synchronous and Metachronous Colorectal Cancers
Authors: Harry R. Aslanian, Lawrence J. Burgart, Jonathan J. Harrington, Douglas W. Mahoney, Alan R. Zinsmeister, Stephen N. Thibodeau, David A. Ahlquist
Journal: Clinical Gastroenterology and Hepatology (2008)
Diagnostic Accuracy of Noninvasive Tests to Evaluate Bladder Outlet Obstruction in Men: Detrusor Wall Thickness, Uroflowmetry, Postvoid Residual Urine, and Prostate Volume
Authors: Matthias Oelke, Klaus Höfner, Udo Jonas, Jean J. de la Rosette, Dirk T. Ubbink, Hessel Wijkstra
Journal: European Urology (2006)
Inherent weaknesses of the current ICD coding system regarding idiopathic pulmonary fibrosis
Authors: Vasilios Tzilas, Demosthenes Bouros
Journal: European Respiratory Journal (2015)

Idiopathic pulmonary fibrosis (IPF) is the most prevalent of the idiopathic interstitial pneumonias (IIPs). It carries an ominous prognosis with a median survival of 3 years. Its epidemiology is poorly described because of its rarity and lack of unanimity in diagnostic and coding practices [1]. However, during the last few years, significant improvement has been achieved in our understanding of the pathogenesis, diagnosis and management of IPF and IIP in general. This is reflected in the 2011 American Thoracic Society (ATS)/European Respiratory Society (ERS)/Japanese Respiratory Society/ALAT consensus statement on IPF [2] and the 2013 ATS/ERS update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias [3]. To obtain a robust understanding of the epidemiology of IPF is important, especially as novel therapies are emerging. The International Classification of Disease (ICD) coding system represents a great opportunity to create such registries that will expand our knowledge on IPF epidemiology. However, under its current formation, the 10th edition (ICD-10) coding system has severe deficiencies regarding the accurate classification of IPF. ICD-10 does not adequately classify IPF <http://ow.ly/HHNqD>
Modernizing medical careers
Authors: K. Walsh
Journal: Journal of the Royal Society of Medicine (2006)

One of the few things that Osborne and Craft agree about is that the number of hours of training that doctors undergo has fallen dramatically over the past 10 years.1,2 We will have to make better use of training time as Craft suggests; but with more and more targets for clinicians to reach, surely something will have to give. Will it be training? In the General Medical Council's Good Medical Practice, good clinical care comes in at number one but teaching and training comes in a poor fifth. The good news is that we can learn from other professions and make use of new training methods and technologies to make up for reduced training times. Pilots in training spend hours practising in simulators and a number of realistic medical simulators have grown up around the UK. They do a great job but there are only about three in the UK for the thousands of foundation year doctors to use. But practicing like this should be like taking your brain to the gym—something that juniors should be able to do whenever and wherever they want. How far are we away from this becoming a reality at the moment?

Certainly a number of online learning sites have emerged in the past few years.3 They are scaleable and you can do them in the workplace. Most of them offer interactive case histories which are crude, mainly text-based, first generation simulators. To date there is a small evidence base of their effectiveness.4,5 They do not offer the immediacy that you can get when you attend a course, nor can they offer you as good personal feedback as a one-on-one encounter. But trainees cannot get such training everyday. With the widening availability of broadband and the technology to produce multimedia learning becoming cheaper, there is now a case for increasing the quantity and quality of online learning. Our foundation year doctors have a new curriculum and need traditional and new learning methods to help them.
Dyspnoea and cyanosis in a cirrhotic patient
Authors: G. Stratakos, K. Malagari, E. Broutzos, E. Zakynthinos, C. Roussos, S. Papiris
Journal: European Respiratory Journal (2002)

<b>Introduction</b>: The EU label for omalizumab (Xolair) was extended to children &lt; 12 years in July 2009. The X-HALE study is a non-interventional study to observe the clinical effects of Xolair in children and adolescents (6-18 years) with severe allergic asthma. This study aimed to investigate changes in quality of life (QoL), physical activity, to collect data concerning the therapy utilization of Xolair and evaluate efficacy. <b>Methods</b>: The following parameters were evaluated at baseline and end of the 4–6 month study period: QoL (PAQLQ); evaluation of adolescents’ school productivity impairment; physical activity (measured over 7 days by the Sense-Wear-Pro-Armband®); practicability of administration in routine clinical practice; rate of exacerbations; emergency visits/hospitalizations; concomitant medication; physician9s assessment (GETE) and adverse events. <b>Results</b>: A total of 18 patients (12.6 years) with SAA were included. Increases in PAQLQ scores (2.3) indicated QoL improvement. In addition, differences in teaching hours/week (+3.8) and missed school hours (-8.3) were shown. Data of 12 patients were valid for analysis of physical activity and suggested no significant treatment differences. Xolair doses and frequency of administration remained stable. Changes in co-medication were recorded in 44.4% of patients, with a reduction of ICS in 42.9%. The number of exacerbations was reduced, as were emergency visits and hospitalizations. Physicians assessed the control of asthma as excellent in 66.7% of the patients. 3 adverse events occurred, 1 (eczema) was related to Xolair. <b>Conclusion</b>: Xolair was associated with an improvement in QoL, reduced the number of exacerbations and was well-tolerated in children and adolescents with SAA.
[749] SERUM APOPTOTIC CASPASE ACTIVITY AS MARKER OF DISEASE SEVERITY IN CHRONIC HEPATITIS C (CH-C) OR NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD)
Authors: G.V. Papatheodoridis, E. Hadziyannis, E. Tsochatzis, N. Chrysanthos, A. Georgiou, G. Kafiri, S. Manolakopoulos, E.K. Manesis
Journal: Journal of Hepatology (2007)