News - Part 7

The primary end point was an improvement in oxygenation as assessed by a > 10 mm Hg decrease in the room air alveolar-arterial oxygen gradient (P[A-a]O2). For the patients who received GM-CSF therapy after hospital admission for bilateral lavage (history of two or more WLLs in the prior 4 months), the primary outcome variable was the need for subsequent therapeutic lavage or further hospital admission days (rather than oxygenation). Secondary end points were as follows: (1) improvement in symptoms as assessed by a dyspnea questionnaire, pulmonary function tests, 6-min walk distance with oxygen saturation, and CXR abnormalities; (2) overall tolerability of therapy; (3) requirement for WLL and sustainability of a response as assessed by follow-up telephone interview; and (4) quality of life as measured by the SF-36 survey.
Single frontal CXRs were graded as to the presence and extent of lung opacification using a visual scoring system similar to one described by Remy-Jardin et al. Scores were determined for degree of opacification, extent of opacification, and severity of opacification.

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An Open-Label Trial of Granulocyte Macrophage Colony Stimulating Factor Therapy for Moderate Symptomatic Pulmonary Alveolar Proteinosis: Dosage and Dose EscalationPatients were treated with recombinant human yeast-derived GM-CSF (Leukine; formerly Immunex Corporation and now Berlex; Seattle, WA) administered subcutaneously once daily for 3 months. Patients were trained to self-administer daily subcutaneous therapy. The starting dose was 250 Mg/d, which was progressively increased to 5 |xg/kg/d for the second month of study, and to 9 |xg/kg/d for the third month. After the patient received therapy for 3 months, if the clinical response was still suboptimal and the patient was tolerating therapy, the patient underwent further dose escalation from 9 to 18 |xg/kg/d (12 Mg/kg/d at 3 months, 15 Mg/kg/d at 4 months, and 18 Mg/kg/d at 5 months). If the patient had an adequate response based on above-mentioned criteria, that dose was continued from 3 to 12 months. more

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The study was a prospective, open-label clinical trial of daily GM-CSF therapy in a group of patients with idiopathic PAP. The study was approved by the Institutional Review Board at the Cleveland Clinic Foundation, and informed consent was obtained from all patients prior to enrollment. A diagnosis of idiopathic PAP was confirmed by transbronchial lung biopsy (n = 8) or open-lung biopsy (n = 17) in all patients. All patients had pretreatment serum assayed for GM-CSF-neutralizing antibody as previously published. Approximately 10 subjects were initially planned for inclusion in the study for a treatment duration of 10 weeks starting from March 1998. Preliminary efficacy and safety data indicated that extending the duration of therapy to 12 months was potentially beneficial. Hence, the total enrollment was increased to 20 subjects in October 1999 as well as the duration of therapy to 12 months. Based on additional data on the first 20 patients, the Institutional Review Board approved an increase to 25 patients in April 2001. in detail

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An Open-Label Trial of Granulocyte Macrophage Colony Stimulating Factor Therapy for Moderate Symptomatic Pulmonary Alveolar ProteinosisPulmonary alveolar proteinosis (PAP) is an uncommon idiopathic disease characterized by the deposition of extracellular granular lipoproteina-ceous material within the lung alveoli. To date, < 500 cases have been reported in the literature. There is no specific therapy for PAP. Sequential whole-lung lavage (WLL) is the standard of care.2 WLL is a cumbersome and invasive procedure that requires general anesthesia and double-lumen endotracheal intubation. WLL does not correct the underlying defect in PAP. this

Although there is persisting uncertainty about the pathogenesis of PAP, current thinking indicates that idiopathic adult PAP is an autoimmune disorder characterized by circulating anti-granulocyte macrophage colony stimulating factor (GM-CSF) antibodies and dysfunction in GM-CSF signaling, which result in an abnormality in surfactant clearance from the alveoli. Murine gene-targeting studies have shown that mice that are homozygous for a disrupted GM-CSF gene acquire a lung lesion that is histologically similar to PAP, which can be resolved by exogenous GM-CSF or by local expression of GM-CSF by a surfactant protein-C promoter in a transgenic mouse model. The adult human disease is likely not due to GM-CSF gene deletion or receptor abnormality.

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How Authors Can Cope With the Burden of English as an International Language: Take-Home MessagesIn order for the revision process to move beyond the simple goal of “fixing” a text to a process in which EIL authors are developing their writing skills on the way toward becoming independent writers, input from both a language professional and an experienced peer is important. The language professional should ideally be a schooled and experienced applied linguist, and the peer a specialist in the subject matter of the manuscript. This ideal is difficult to achieve, in part because EIL authors may only have access to native English-speaking “amateurs.” Also, peers who are specialists in the discrete subject matter may be difficult to find. However, making the ideal available to a significant number of EIL authors is a realistic goal for the future. In the meantime, the following is our “take-home message.” other

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Background: We reviewed the patients who underwent tricuspid valve replacement (TVR) to compare the long-term clinical results of bioprosthetic valve with mechanical valve in tricuspid position.
Language Professional Draft
Background: The choice of a bioprosthetic vs a mechanical valve in tricuspid valve replacement (TVR) continues to be debated. We reviewed the long-term clinical results of TVR involving these two valves.
Peer Revision Draft
Background: Tricuspid valve replacement (TVR) has been accomplished with mechanical and biopros-thetic valves. The relative long-term merits of the two types of valves are incompletely known.
In the above, the EIL authors simply stated the nature of their research, while the language professional and peer thought that the background could be strengthened by highlighting a need for the research. In the peer’s draft, this was accomplished by stating that the relative merits of the two valves were unknown, while the language professional went so far as to suggest that the choice of valve, rather than the merits of each, was a source of debate. canadian healthcare mall

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How Authors Can Cope With the Burden of English as an International Language: Peer Revision DraftDespite improvements in the suturing method for closure of perimembranous ventricular septal defects (VSD), the postoperative incidence of complete right bundle branch block (CRBBB) has remained from 20 to 62%. Conventionally, stitches have been placed away from the posterior-inferior rim of the defect, hoping thereby to avoid the bundle of His in its left ventricular course.
The reformulation written by the language professional clearly differs from the drafts of the surgeons, who began by focusing on the unacceptably high incidence of the complication when the conventional suturing method was used. The language professional instead proposed beginning with the information given in the second sentence about the conventional suturing method because she assumed this was common knowledge. Her proposed strategy was to delay the statement of the problem until later in the introduction. She employed the often-used strategy of starting with information already known to readers. In the next sentence, she suggested that the author explain why the conventional method had been used, but she had to resort to queries to the author (in italics) rather than to a more concrete suggestion because she lacked subject knowledge. www.canadian-familypharmacy.com

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