tbuckley/cabot-search huggingface dataset:
Efficacy of speech pathology management for chronic cough: a randomised placebo controlled trial of treatment efficacy
Authors: A E Vertigan, D G Theodoros, P G Gibson, A L Winkworth
Journal: Thorax (2006)

Chronic cough that persists despite medical treatment may respond to speech pathology intervention, but the efficacy of such treatment has not been investigated in prospective randomised trials. The aim of this study was to determine the efficacy of a speech pathology intervention programme for chronic cough.A single blind, randomised, placebo controlled trial was conducted in 87 patients with chronic cough that persisted despite medical treatment. Patients were randomly allocated to receive either a specifically designed speech pathology intervention or a placebo intervention. Participants in both groups attended four intervention sessions with a qualified speech pathologist.Participants in the treatment group had a significant reduction in cough (8.9 to 4.6, p<0.001), breathing (7.9 to 4.7, p<0.001), voice (7.3 to 4.6, p<0.001) upper airway (8.9 to 5.9, p<0.001) symptom scores and limitation (2.3 to 1.6, p<0.001) ratings following intervention. There was also a significant reduction in breathing (6.8 to 5.6, p = 0.047), cough (7.6 to 6.3, p = 0.014), and limitation (2.3 to 2.0, p = 0.038) scores in the placebo group, but the degree of improvement was significantly less than in the treatment group (p<0.01). Clinical judgement of outcome indicated successful ratings in 88% of participants in the treatment group compared with 14% in the placebo group (p<0.001).Speech pathology is an effective management intervention for chronic cough which may be a viable alternative for patients who do not respond to medical treatment.
Complete testicular feminization caused by an amino-terminal truncation of the androgen receptor with downstream initiation.
Authors: S Zoppi, C M Wilson, M D Harbison, J E Griffin, J D Wilson, M J McPhaul, M Marcelli
Journal: Journal of Clinical Investigation (1993)

We have characterized the molecular defect causing androgen resistance in two 46,XY siblings with complete testicular feminization. Although binding studies in genital skin fibroblasts showed a reduced Bmax, an increased dissociation rate of ligand, and an 8S peak of dihydrotestosterone binding on sucrose density gradient centrifugation, no immunoreactive androgen receptor (AR) was detected in immunoblots using anti-NH2-terminal antibodies, suggesting an abnormal amino terminus. Sequence analysis of the AR gene revealed a point mutation CAG-->TAG (Gln-->Stop) at nucleotide 340. In vitro mutagenesis studies suggest the synthesis of the mutant AR is initiated downstream of the termination codon at reduced levels and that each molecule is functionally impaired. These results define a novel mechanism causing androgen resistance: the combination of decreased amount and functional impairment of AR caused by an abnormality within the amino terminus of the receptor. These findings suggest that domains important to the in vivo function of the receptor reside within the amino terminus and that disruption of these domains can occur with only subtle effects on receptor binding. Identification of this mutation made it possible to identify the mutant allele within the family and to ascertain antenatally that it was not present in a 46,XY fetal sibling of the proband at 9 wk gestation.
The significance of the left atrial appendage in rheumatic heart disease.
Authors: M J Kelley, L P Elliott, S T Shulman, E M Ayoub, B E Victorica, I H Gessner
Journal: Circulation (1976)

The possible diagnostic value of an enlarged left atrial appendage (LAA) on the posterior-anterior or right anterior oblique chest film as a means of implicating a rheumatic etiology for mitral valve disease in children was investigated. Chest films were examined without prior knowledge of clinical or laboratory data, and the results were later correlated with this information in 113 children and adolescents. The clinical and laboratory data included application of the modified Jones criteria for the diagnosis of acute rheumatic fever, streptococcal antibody titers and clinical and cardiac catheterization findings. In children with mitral valve disease, our data suggest that as enlarged LAA, especially in the presence of pulmonary venous obstruction, is characteristic of rheumatic heart disease. This finding appears to be particularly useful, in conjunction with streptococcal antibody studies, in distinguishing rheumatic from nonrheumatic patients with mitral insufficiency.
Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: a TBNET consensus statement
Authors: Christoph Lange, Ibrahim Abubakar, Jan-Willem C. Alffenaar, Graham Bothamley, Jose A. Caminero, Anna Cristina C. Carvalho, Kwok-Chiu Chang, Luigi Codecasa, Ana Correia, Valeriu Crudu, Peter Davies, Martin Dedicoat, Francis Drobniewski, Raquel Duarte, Cordula Ehlers, Connie Erkens, Delia Goletti, Gunar Günther, Elmira Ibraim, Beate Kampmann, Liga Kuksa, Wiel de Lange, Frank van Leth, Jan van Lunzen, Alberto Matteelli, Dick Menzies, Ignacio Monedero, Elvira Richter, Sabine Rüsch-Gerdes, Andreas Sandgren, Anna Scardigli, Alena Skrahina, Enrico Tortoli, Grigory Volchenkov, Dirk Wagner, Marieke J. van der Werf, Bhanu Williams, Wing-Wai Yew, Jean-Pierre Zellweger, Daniela Maria Cirillo
Journal: European Respiratory Journal (2014)

The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) substantially challenges TB control, especially in the European Region of the World Health Organization, where the highest prevalence of MDR/XDR cases is reported. The current management of patients with MDR/XDR-TB is extremely complex for medical, social and public health systems. The treatment with currently available anti-TB therapies to achieve relapse-free cure is long and undermined by a high frequency of adverse drug events, suboptimal treatment adherence, high costs and low treatment success rates. Availability of optimal management for patients with MDR/XDR-TB is limited even in the European Region. In the absence of a preventive vaccine, more effective diagnostic tools and novel therapeutic interventions the control of MDR/XDR-TB will be extremely difficult. Despite recent scientific advances in MDR/XDR-TB care, decisions for the management of patients with MDR/XDR-TB and their contacts often rely on expert opinions, rather than on clinical evidence. This document summarises the current knowledge on the prevention, diagnosis and treatment of adults and children with MDR/XDR-TB and their contacts, and provides expert consensus recommendations on questions where scientific evidence is still lacking.
Optimised, low cost, low field dedicated extremity MRI is highly specific and sensitive for synovitis and bone erosions in rheumatoid arthritis wrist and finger joints: comparison with conventional high field MRI and radiography
Authors: B J Ejbjerg
Journal: Annals of the Rheumatic Diseases (2005)

To evaluate a low field dedicated extremity MRI unit for detection of bone erosions, synovitis, and bone marrow oedema in wrist and metacarpophalangeal (MCP) joints, with a high field MRI unit as the standard reference.In 37 patients with RA and 28 healthy controls MRI of the wrist and 2nd-5th MCP joints was performed on a low field MRI unit (0.2 T Esaote Artoscan) and a high field MRI unit (1.0 T Siemens Impact) on 2 subsequent days. MRI was performed and evaluated according to OMERACT recommendations. Additionally, conventional x ray, clinical, and biochemical examinations were performed. In an initial low field MRI "sequence selection phase", based on a subset of 10 patients and 10 controls, sequences for comparison with high field MRI were selected.With high field, spin echo MRI considered as the reference method, the sensitivity, specificity, and accuracy of low field 3D gradient echo MRI for erosions were 94%, 93%, 94%, while the corresponding values for x ray examination were 33%, 98%, and 83%. Sensitivity, specificity, and accuracy of low field MRI for synovitis were 90%, 96%, and 94%, and for bone marrow oedema 39%, 99%, and 95%. Intraclass correlation coefficients between low field and high field scores were 0.936 (p<0.005) for bone erosions and 0.923 (p<0.05) for synovitis.Low field MRI provides high accuracy for detection and grading of erosions and synovitis, with high field MRI as the standard reference. For bone marrow oedema, specificity is high, but sensitivity only moderate. Low cost, patient compliant, low field dedicated extremity MRI provides similar information on bone erosions and synovitis as expensive high field MRI units.
Androgen Receptor (AR) Coregulators: A Diversity of Functions Converging on and Regulating the AR Transcriptional Complex
Authors: Hannelore V. Heemers, Donald J. Tindall
Journal: Endocrine Reviews (2007)

Androgens, acting through the androgen receptor (AR), are responsible for the development of the male phenotype during embryogenesis, the achievement of sexual maturation at puberty, and the maintenance of male reproductive function and behavior in adulthood. In addition, androgens affect a wide variety of nonreproductive tissues. Moreover, aberrant androgen action plays a critical role in multiple pathologies, including prostate cancer and androgen insensitivity syndromes. The formation of a productive AR transcriptional complex requires the functional and structural interaction of the AR with its coregulators. In the last decade, an overwhelming and ever increasing number of proteins have been proposed to possess AR coactivating or corepressing characteristics. Intriguingly, a vast diversity of functions has been ascribed to these proteins, indicating that a multitude of cellular functions and signals converge on the AR to regulate its function. The current review aims to provide an overview of the AR coregulator proteins identified to date and to propose a classification of these AR coregulator proteins according to the function(s) ascribed to them. Taken together, this approach will increase our understanding of the cellular pathways that converge on the AR to ensure an appropriate transcriptional response to androgens.
Thymolipoma simulating cardiomegaly: a clinicopathological rarity.
Authors: C Almog, D Weissberg, E Herczeg, M Pajewski
Journal: Thorax (1977)

This report describes a 19-year-old girl with a chest radiograph strongly suggestive of cardiomegaly. Although she did not consent to haemodynamic studies, cardiomegaly wasru led out on the basis of the clinical course. Careful radiological study proved the existence of a large mass in the anterior mediastinum, simulating cardiomegaly. At thoracotomy a thymolipoma weighing 450 g was resected. The pathogenesis of thymolipoma is discussed.
A new approach to evaluate anterior knee joint laxity
Authors: C Mouton, R Krecke, D Theisen
Journal: British Journal of Sports Medicine (2011)

Background Knee instability after Anterior Cruciate Ligament (ACL) reconstructive surgery may lead to osteoarthritis. Objective To complete current evaluation of anterior knee laxity. Design Cross-sectional pilot study. Setting Physical therapy unit of the Clinique d'Eich, Centre Hospitalier de Luxembourg. Patients 14 patients were examined 197±25 days following arthroscopic ACL reconstructive surgery (11 men and 3 women, age: 28±9 years) using the GNRB, a new knee arthrometer measuring anterior tibial displacement (ATD) when applying a standardised, progressive anterior tibial force. Inclusion criteria were: isolated ACL rupture; no prior injury in the controlateral knee. Interventions Both knees were tested using three trials with a progressive force up to 200 N, starting with the controlateral leg. The average ATD-force curve of trials 2 and 3 were used for further calculations. Main outcomes ATD at 134 and 200 N, and new variables: primary energy dissipation (PED: area under the ATD-force curve from 0 to 100 N), secondary energy dissipation (SED: area under the ATD-force curve from 100 to 200 N), primary compliance (PC: slope of the ATD-force curve between 30 and 50 N) and secondary compliance (SC: slope of the ATD-force curve between 100 and 200 N) were used as indicators of knee laxity. Results The results found for the operated and the controlateral knee, respectively, were: ATD at 134 N=5.6±1.6 and 4.0±0.9 mm (difference: 42%); ATD at 200 N=7.2±1.8 and 5.3±1.0 mm (difference: 34%); PED=230±80 and 146±46 N/mm; SED=622±167 and 445±96 N/mm (difference of area between both curves at 134 N: 52%, at 200 N: 44%); PC=63±22 and 40±13 μm/N; SC=25±6 and 22±4 μm/N. Results were significantly different (p&lt;0.05) for all indicators except SC (Student t-test). Conclusion Anterior knee joint laxity 5 to 10 months after ACL reconstructive surgery remains greater than the non-injured contralateral knee. A complete evaluation of anterior knee laxity could help the prognostic of osteoarthritis after ACL reconstructive surgery.
Time-location analysis for exposure assessment studies of children using a novel global positioning system instrument.
Authors: Kai Elgethun, Richard A Fenske, Michael G Yost, Gary J Palcisko
Journal: Environmental Health Perspectives (2002)

Global positioning system (GPS) technology is used widely for business and leisure activities and offers promise for human time-location studies to evaluate potential exposure to environmental contaminants. In this article we describe the development of a novel GPS instrument suitable for tracking the movements of young children. Eleven children in the Seattle area (2-8 years old) wore custom-designed data-logging GPS units integrated into clothing. Location data were transferred into geographic information systems software for map overlay, visualization, and tabular analysis. Data were grouped into five location categories (in vehicle, inside house, inside school, inside business, and outside) to determine time spent and percentage reception in each location. Additional experiments focused on spatial resolution, reception efficiency in typical environments, and sources of signal interference. Significant signal interference occurred only inside concrete/steel-frame buildings and inside a power substation. The GPS instruments provided adequate spatial resolution (typically about 2-3 m outdoors and 4-5 m indoors) to locate subjects within distinct microenvironments and distinguish a variety of human activities. Reception experiments showed that location could be tracked outside, proximal to buildings, and inside some buildings. Specific location information could identify movement in a single room inside a home, on a playground, or along a fence line. The instrument, worn in a vest or in bib overalls, was accepted by children and parents. Durability of the wiring was improved early in the study to correct breakage problems. The use of GPS technology offers a new level of accuracy for direct quantification of time-location activity patterns in exposure assessment studies.
Residual Thrombosis on Ultrasonography to Guide the Duration of Anticoagulation in Patients With Deep Venous Thrombosis
Authors: Paolo Prandoni, Martin H Prins, Anthonie W A Lensing, Angelo Ghirarduzzi, Walter Ageno, Davide Imberti, Gianluigi Scannapieco, Giovanni B Ambrosio, Raffaele Pesavento, Stefano Cuppini, Roberto Quintavalla, Giancarlo Agnelli
Journal: Annals of Internal Medicine (2009)

Background: The optimal duration of oral anticoagulant therapy in patients with deep venous thrombosis (DVT) of the lower extremities remains uncertain. Objective: To assess whether tailoring the duration of anticoagulation on the basis of the persistence of residual thrombi on ultrasonography reduces the rate of recurrent venous thromboembolism (VTE) compared with the administration of conventional fixed-duration treatment in adults with proximal DVT. Design: Parallel, randomized trial from 1999 to 2006. Trained physicians who assessed outcomes were blinded to patient assignment status, but patients and providers were not. Setting: 9 university or hospital centers in Italy. Patients: 538 consecutive outpatients with a first episode of acute proximal DVT at completion of an uneventful 3-month period of anticoagulation. Intervention: Patients were randomly assigned (stratified by center and secondary vs. unprovoked DVT by using a computer-generated list that was accessible only to a trial nurse) to fixed-duration anticoagulation (no further anticoagulation for secondary thrombosis and an extra 3 months for unprovoked thrombosis) or flexible-duration, ultrasonography-guided anticoagulation (no further anticoagulation in patients with recanalized veins and continued anticoagulation in all other patients for up to 9 months for secondary DVT and up to 21 months for unprovoked thrombosis). For the primary outcome assessment, 530 patients completed the trial. Measurements: The rate of confirmed recurrent VTE during 33 months of follow-up. Results: Overall, 46 (17.2%) of 268 patients allocated to fixed-duration anticoagulation and 32 (11.9%) of 270 patients allocated to flexible-duration anticoagulation developed recurrent VTE (adjusted hazard ratio [HR], 0.64 [95% CI, 0.39 to 0.99]). For patients with unprovoked DVT, the adjusted HR was 0.61 (CI, 0.36 to 1.02) and 0.81 (CI, 0.32 to 2.06) for those with secondary DVT. Major bleeding occurred in 2 (0.7%) patients in the fixed-duration group and 4 (1.5%) patients in the flexible-duration group (P = 0.67). Limitations: The trial lacked a double-blind design. The sample size was not powered to detect differences in bleeding between groups and to detect effectiveness of the intervention in the subgroups of patients with unprovoked and secondary DVT. Patients with previous thromboembolism, permanent risk factors for thrombosis, and thrombophilic abnormalities other than factor V Leiden and prothrombin mutation were excluded. Conclusion: Tailoring the duration of anticoagulation on the basis of ultrasonography findings reduces the rate of recurrent VTE in adults with proximal DVT. Primary Funding Source: None.
The red tide toxin, brevetoxin, induces embryo toxicity and developmental abnormalities.
Authors: K L Kimm-Brinson, J S Ramsdell
Journal: Environmental Health Perspectives (2001)

Brevetoxins are lipophilic polyether toxins produced by the red tide dinoflagellate Gymnodinium breve, and their neurotoxic effects on adult animals have been documented. In this study, we characterized adverse developmental effects of brevetoxin-1 (PbTx-1) using an exposure paradigm that parallels the maternal oocyte transfer of toxin. Medaka fish (Oryzias latipes) embryos were exposed to PbTx-1 via microinjection of toxin reconstituted in a triolein oil droplet. Embryos microinjected with doses of 0.1-8.0 ng/egg (ppm) of brevetoxin-1 exhibited pronounced muscular activity (hyperkinesis) after embryonic day 4. Upon hatching, morphologic abnormalities were commonly found in embryos at the following lowest adverse effect levels: 1.0-3.0 ppm, lateral curvature of the spinal column; 3.1-3.4 ppm, herniation of brain meninges through defects in the skull; and 3.4-4.0 ppm, malpositioned eye. Hatching abnormalities were also commonly observed at brevetoxin doses of 2.0 ppm and higher with head-first, as opposed to the normal tail-first, hatching, and doses > 4.1 ng/egg produced embryos that developed but failed to hatch. Given the similarity of developmental processes found between higher and lower vertebrates, teratogenic effects of brevetoxins have the potential to occur among different phylogenetic classes. The observation of developmental abnormalities after PbTx-1 exposure identifies a new spectrum of adverse effects that may be expected to occur following exposure to G. breve red tide events.
The Feasibility of Conducting Clinical Trials in Infants and Children with Acute Respiratory Failure
Authors: Adrienne G. Randolph, Kathleen L. Meert, Mary E. O'Neil, James H. Hanson, Peter M. Luckett, John H. Arnold, Rainer G. Gedeit, Peter N. Cox, Joan S. Roberts, Shekhar T. Venkataraman, Peter W. Forbes, Ira M. Cheifetz
Journal: American Journal of Respiratory and Critical Care Medicine (2003)

Designing robust clinical trials in critically ill, mechanically ventilated children requires an understanding of the epidemiology and course of pediatric respiratory failure. As part of a clinical trial, we screened all mechanically ventilated children in nine large pediatric intensive care units (ICUs) across North America for 6 consecutive months. Of 6,403 total ICU admissions, 1,096 (17.1%) required mechanical ventilator support for a minimum of 24 hours. Of these, 701 (64%) met one or more exclusion criteria for trial enrollment. Common reasons for exclusion were upper airway obstruction (13.5%) and cyanotic congenital heart disease (11.5%). Life support interventions were restricted for 9.7% of patients, and 5.5% were chronically ventilator dependent. In the patients who were eligible for respiratory failure studies, 62.4% had an acute primary diagnosis of pulmonary disease, 14.2% neurologic disease, and 8.9% cardiac disease. Chronic underlying conditions were present in 43.2% of the patients. The most common acute diagnosis was bronchiolitis in infants (43.6%) and pneumonia in children 1 year old and older (24.5%). Mortality was rare (1.6%), and the median duration of ventilation was 7 days. The design of clinical trials in critically ill children is feasible but must account for the diverse population, infrequent mortality, and short duration of mechanical ventilation.
Near-fatal asthma related to menstruation☆
Authors: Eva Martinez-Moragón, Vicente Plaza, José Serrano, Cesar Picado, Juan Bautista Galdiz, Antolín López-Viña, Joaquín Sanchis
Journal: Journal of Allergy and Clinical Immunology (2004)

BackgroundMenstruation has been suggested as a possible trigger of near-fatal asthma (NFA), but the evidence supporting this association remains weak.ObjectiveWe sought to assess the role of menstruation as a contributing factor in the development of NFA episodes in women of reproductive age.MethodsForty-four female patients of reproductive age with near-fatal attacks were enrolled in a multicenter study. Data on patient and clinical characteristics were collected. We also performed spirometric and allergy studies when the patients were in stable condition.ResultsSignificantly more NFA episodes were observed on the first day of menstruation (11 [25%] patients) than on the remaining days (33 [75%] patients, P = .022), and patients who presented for care on the first day of menstruation used more inhaled salbutamol as rescue medication (9 [9.5] vs 1.8 [3.7] μg/d during the 7 days before the asthma exacerbation, P = .003).ConclusionMenstruation might act as a contributing factor in the development of NFA episodes in patients with unstable asthma. Specific recommendations should be included in educational programs, and the self-management plans of asthmatic women of reproductive age should include the systematic recording of their asthma symptoms and pulmonary function in the perimenstrual phase.