tbuckley/cabot-search huggingface dataset:
Clinical Outcomes and Stent Thrombosis Following Off-Label Use of Drug-Eluting Stents
Authors: Htut K. Win, Angel E. Caldera, Kelly Maresh, John Lopez, Charanjit S. Rihal, Manish A. Parikh, Juan F. Granada, Sachin Marulkar, Deborah Nassif, David J. Cohen, Neal S. Kleiman, for the EVENT Registry Investigators
Journal: JAMA (2007)

Clinical trials that have excluded patients at high risk for cardiac events have led to commercial labeling approval of drug-eluting stents; nevertheless, such high-risk patients commonly undergo stent placement in clinical practice. The degree to which they experience cardiac events at a higher rate than non-high-risk patients is unclear.To assess the rates of major adverse cardiac events during the index admission and 1 year after the implantation of drug-eluting stents in patients with high-risk angiographic and clinical features.From July 2004 to September 2005, consecutive patients who underwent attempted stent placement at 42 different hospitals throughout the United States were enrolled in a prospective multicenter registry. We analyzed outcomes of 3323 patients who received at least 1 drug-eluting stent for a reason other than acute ST-segment elevation myocardial infarction. The study population was divided into 2 groups based on presence of at least 1 of 9 off-label characteristics based on the current US Food and Drug Administration-approved indications for sirolimus- and paclitaxel-eluting stents.The composite clinical outcomes of death, myocardial infarction, or target vessel revascularization during the index admission and death, myocardial infarction, or target lesion revascularization at 1 year were evaluated.Of the 3323 patients, 1817 (54.7%) had at least 1 off-label characteristic. During the index hospitalization, the composite clinical outcome occurred in 198 (10.9%) of patients in the off-label group and 76 (5.0%) of patients in the on-label group (adjusted odds ratio, 2.32; 95% confidence interval [CI], 1.75-3.07; P<.001). At 1 year, the composite clinical outcome occurred more often in the off-label group compared with the on-label group; 309 (17.5%) vs 131 (8.9%) (adjusted hazard ratio [HR], 2.16; 95% CI, 1.74-2.67; P<.001). Stent thrombosis also occurred more frequently among patients in the off-label group during the initial hospitalization (8 [0.4%] vs 0) and at 1 year: 29 (1.6%) vs 13 (0.9%), adjusted HR, 2.29 (95% CI, 1.02-5.16; P = .05).Compared with on-label use, off-label use of drug-eluting stents is associated with a higher rate of adverse outcomes during the index admission and at 1 year. Stent thrombosis occurred predominantly in patients who underwent off-label drug-eluting stent implantation. Clinicians should be cautious about extrapolating the benefits of drug-eluting stents over bare-metal stents observed in randomized clinical trials to higher-risk clinical settings that have not been assessed.
Normal range for transdiaphragmatic pressures during sniffs with catheter mounted transducers.
Authors: S A Evans, L Watson, A J Cowley, I D Johnston, W J Kinnear
Journal: Thorax (1993)

Transdiaphragmatic pressure (sniff PDI) during maximal sniffs is a useful clinical test of inspiratory muscle function. Although a normal range has been established for sniff PDI using air filled balloons, no comparable data are available for catheter mounted pressure transducers.Using a single catheter with two pressure transducers 15 cm apart, oesophageal and gastric pressures were recorded in 50 normal volunteers (25 women), five of each sex from each decade between the third and seventh decades of life. Each subject performed 10 maximal sniffs at functional residual capacity.Mean (SD) sniff PDI was 149 (32) cm H2O in men and 127 (22) cm H2O in women. The lower limits of normal for sniff PDI (mean -1.96 x SD) after logarithmic transformation of the data were 95 and 78 cm H2O in men and women respectively.With this technique transdiaphragmatic pressure can be measured using a single catheter which can easily be cleaned and reused. The values for sniff PDI are similar to those recorded previously with air filled balloons, suggesting that the method of recording pressure does not significantly affect the values obtained.
What Is Inappropriate Care?
Authors: Albert G. Mulley
Journal: JAMA (1988)

Though wide variations in the application of medical technologies have been recognized for decades, they have only recently become the object of intense scrutiny and debate. Such variations have important implications for the cost and quality of medical care. But these variations also raise specific questions about the process of clinical decision making for patients, physicians, and those charged with the responsibility to gather and disseminate information on which clinical decisions are based. The focus on the decision-making process has been sharpened by the professional uncertainty hypothesis that holds that variations can largely be explained by differences in physicians' beliefs about the value of procedures and practices for meeting patient needs.<sup>1</sup> The professional uncertainty hypothesis has sparked its own controversy. Patients have been told by informed commentators that medicine is an imprecise science "at its base, more gamble and guesswork than certainty" (<i>The Boston Globe</i>, Feb 3, 1986). Physicians
Cerebellitis in Infectious Mononucleosis
Authors: James W. Gilbert
Journal: JAMA (1972)

<h3>To the Editor.—</h3> Infectious mononucleosis may be related to infection with the EB virus, and involves many organ systems. Although not common, involvement of the central nervous system (CNS) has included alterations of consciousness, seizure, transient hemiparesis, cranial nerve involvement, and meningoencephalitis. One large review of CNS involvement listed 12 examples among a total of 1,285 cases.<sup>1</sup>We report one of the more rare CNS manifestations, acute cerebellitis. <h3>Report of a Case.—</h3> A 15-year-old boy was well until he was knocked unconscious in a fight one month prior to his admission to the hospital. He remained unconscious from four to five minutes and upon recovery had a posttraumatic amnesia of ten minutes' duration. He was then well until a severe sore throat and myalgia developed one week prior to admission. This was treated with penicillin administered orally. He felt better, but four days later upon awakening his gait was
Differentiation Capacity of Cultured B Lymphocytes from Immunodeficient Patients
Authors: L. Y. F. Wu, A. R. Lawton, M. D. Cooper
Journal: Journal of Clinical Investigation (1973)

Peripheral blood lymphocytes from 27 healthy individuals and from 18 patients with a diverse spectrum of defects in humoral immunity were examined for their capacity to undergo terminal differentiation in vitro. Pokeweed mitogen induced cells from normal persons to synthesize and secrete IgM. IgG, and IgA as detected by Immunofluorescence and incorporation of [(14)C]amino acids, Lymphocytes from three boys with X-linked agammaglobulinemia were stimulated to proliferate, but did not synthesize immunoglobulin. Lymphocyte cultures from three of four patients having agammaglobulinemia with B lymphocytes produced different immunoglobulin classes in ratios similar to the in vivo distribution of classes of B lymphocytes, Lymphocytes from a dysgammaglobulinemic boy deficient in serum IgG and IgA, but who had normal numbers of IgM-, IgG-, and IgA-bearing B lymphocytes, could not be stimulated by pokeweed mitogen to make IgG and IgA. Synthesis and secretion of IgA, as well as IgM and IgG, was detected in cell cultures from each of 10 patients with isolated IgA deficiency. The results suggest that deficiencies in immunoglobulin synthesis may reflect either (a) failure to develop B lymphocytes, (b) arrested development of B lymphocytes due to intrinsic metabolic abnormalities, or (c) disturbance of factors extrinsic to the B lymphocyte which are essential for normal induction of plasma cell maturation.
Genotypes and haplotypes of the VEGF gene are associated with higher mortality and lower VEGF plasma levels in patients with ARDS
Authors: R Zhai, M N Gong, W Zhou, T B Thompson, P Kraft, L Su, D C Christiani
Journal: Thorax (2007)

<b>Background:</b> Endothelial injury is an important prognostic factor in acute respiratory distress syndrome (ARDS). Vascular endothelial growth factor (VEGF) plays a critical role in endothelial destruction and angiogenesis. Genetic variations of the <i>VEGF</i> gene have been associated with VEGF production. A study was undertaken to investigate the impact of <i>VEGF</i> gene polymorphisms on the clinical outcomes of ARDS. <b>Methods:</b> Three <i>VEGF</i> polymorphisms <i>(−460C/T</i>, <i>+405C/G</i> and <i>+936C/T)</i> were determined in 1253 patients in an intensive care unit with risk factors for ARDS, 394 of whom developed ARDS. Patients were followed for assessment of 60 day survival. Plasma VEGF levels were measured in 71 patients with ARDS. <b>Results:</b> The <i>+936TT</i> (OR 4.29, 95% CI 1.12 to 16.40, p = 0.03) and <i>+936CT+TT</i> (OR 1.98, 95% CI 1.14 to 3.42, p = 0.01) genotypes were significantly associated with increased mortality from ARDS. Plasma VEGF levels in patients with ARDS with the <i>+936CT+TT</i> genotype were significantly lower than in subjects with the <i>+936CC</i> genotype (median 49 (IQR 16–98) pg/ml vs 112 (IQR 47–162) pg/ml, p = 0.02). At the haplotype level, haplotype <i>TCT (−460T+405C+936T</i>) was significantly associated with a higher rate of mortality (OR 2.89, 95% CI 1.30 to 6.43, p = 0.009) and haplotype <i>CGT (−460C+405G+936T</i>) was associated less strongly with increased mortality (OR 1.90, 95% CI 0.94 to 3.83, p = 0.07) in patients with ARDS. Lower plasma VEGF levels were correlated with the probability of haplotype <i>CGT</i> (coefficient = −0.26, p&lt;0.05), but the same trend of correlation was not significant to haplotype <i>TCT</i>. <b>Conclusions:</b><i>VEGF</i> polymorphisms may contribute to the prognosis and inter-individual variations in circulating VEGF levels in patients with ARDS.
Functional disability and antibody response to influenza vaccine in elderly patients in a Dutch nursing home
Authors: E J Remarque, H J M Cools, T J Boere, R J van der Klis, N Masurel, G J Ligthart
Journal: BMJ (1996)

Serological studies have yielded conflicting results about the antibody response to influenza vaccines in elderly people1—hence the association of advanced age with declined protection is in question. Differences in subjects' state of health may be one reason for the divergent findings.1 2 We therefore investigated the influence of chronic disease, drug treatment, and functional disability on the immune response to influenza vaccine in elderly people.

Influenza vaccine was offered to all of the patients in one nursing home in Delft, the Netherlands, who were not terminally ill. A total of 175 patients gave their informed consent and were included in the study. Their mean age was 82 (SD 7), and 133 patients were women. The study was approved by the …
A Question of Medical Ethics.
Authors: Frank W. Porterfield
Journal: JAMA (1897)

Atlantic, Iowa, Nov. 9, 1897. <h3>To the Editor:</h3> —The great medical charities of this country are a credit to the profession and others whose gratuitous services make their existence possible; and no medical man will deny that the good done by these institutions is well-nigh incalculable. That abuses of the system have been and are constantly being practiced no one will deny, and the periodic complaints from those physicians who live near the large dispensaries are familiar to all who read the current medical journals. That abuses of medical charities had begun to extend into the country was not suspected by me until lately, when there fell under my observation something that I think needs attention from that portion of the profession who believe that quackish methods are not admissible even in the practice of those who are wont to assume that they are exempt from the operation of the
Duty to Warn Third Parties
Authors: Jerome S. Beigler
Journal: JAMA (1983)

To the Editor.—  I am pleased to note the initiation by Bernard D. Hirsh, JD (1982;248:473), of a LAW AND MEDICINE feature and to comment on the first article of the series entitled Duty to Warn Third Parties by Almeta E. Cooper, JD (1982;248:431), which helped to translate the intricacies of the legal world into clinically applicable precepts regarding a widely misunderstood perceived duty imposed on physicians (especially psychiatrists) to warn the presumed potential victims of their patients' aggressions.  The unreliability of predicting a patient's dangerousness is compounded by the unpredictability of the consequences of such warnings. Experience has demonstrated that most intended victims already were aware of the danger and were helpless to protect themselves. 1 Falsepositive warnings could expose the therapist to legal action, should the  change his life unnecessarily or become ill because of the warning. Furthermore, if the warned victim also proved to be dangerous,
Management of CAP using a validated risk score
Authors: Luca Richeldi, M. De Guglielmo, Leonardo Fabbri, D. Giovanardi, F. Marchetti, M. Larosa, V. Solfrini, M. Altini
Journal: Thorax (2005)

The management of patients with community acquired pneumonia (CAP) is characterised by considerable variation in admission rates, length of hospital stay,1 and use of institutional resources2 in different settings. The Pneumonia Severity Index (PSI) is a prediction rule for the short term risk of death in patients with CAP,3 improving the efficiency of patient care.4 In the year 2000, 86% of patients with CAP presenting at the emergency department of our hospital were admitted. A retrospective analysis of the PSI scores of these patients showed that 37% of them were in low risk classes (1 and 2) based on their PSI results, so their admissions were potentially avoidable.4,5 We therefore designed a prospective study to assess the safety, feasibility, and efficacy of the PSI score for management decisions in patients with CAP. The study was approved by the local ethics committee and …
Left Atrial Radiofrequency Ablation During Mitral Valve Surgery for Continuous Atrial Fibrillation
Authors: George Doukas, Nilesh J. Samani, Christos Alexiou, Mehmet Oc, Derek T. Chin, Peter G. Stafford, Leong L. Ng, Tomasz J. Spyt
Journal: JAMA (2005)

Although left atrial radiofrequency ablation (RFA) is increasingly used for the treatment of chronic atrial fibrillation during mitral valve surgery, its efficacy to restore sinus rhythm and any resulting benefits have not been examined in the context of an adequately powered randomized trial.To determine whether intraoperative RFA of the left atrium increases the long-term restoration of sinus rhythm and improves exercise capacity.Randomized, double-blind trial performed in a single UK tertiary referral center with enrollment between December 2001 and November 2003. A total of 101 patients referred for mitral valve surgery with at least 6 months' history of uninterrupted atrial fibrillation were assessed for eligibility; 97 were enrolled. Patients were followed up for 12 months.Patients were randomly assigned to undergo mitral valve surgery and RFA of the left atrium (n = 49) or mitral valve surgery alone (controls; n = 48).The primary outcome measure was presence of sinus rhythm at 12 months; secondary measures were patient functional status and exercise capacity (assessed by shuttle-walk test), left atrial contractility, and left atrial and left ventricular dimension and function and plasma levels of B-type natriuretic peptide.At 12 months, sinus rhythm was present in 20 (44.4%) of 45 RFA patients and in 2 (4.5%) of 44 controls (rate ratio, 9.8; 95% CI, 2.4-86.3; P<.001). Restoration of sinus rhythm in the RFA group was accompanied by a greater improvement in mean (SD) shuttle-walk distance compared with controls (+94 [102] m vs +48 [82] m; P = .003) and a greater reduction in the plasma level of B-type natriuretic peptide (-104 [87] fmol/mL vs -51 [82] fmol/mL; P = .03). Patients randomized to receive RFA had similar rates of postoperative complications and deaths as control patients.Radiofrequency ablation of the left atrium during mitral valve surgery for continuous atrial fibrillation significantly increases the rate of sinus rhythm restoration 1 year postoperatively, improving patient exercise capacity. On the basis of its efficacy and safety, routine use of RFA of the left atrium during mitral valve surgery may be justified.ClinicalTrials.gov Identifier: NCT00238706.
Enhanced Metastasis Suppression by Targeting TRAIL Receptor 2 in a Murine Model of Triple-Negative Breast Cancer
Authors: Dmitry Malin, Feng Chen, Carol Schiller, Jennifer Koblinski, Vincent L. Cryns
Journal: Clinical Cancer Research (2011)

Metastatic breast cancer is a deadly disease which requires new therapeutic strategies. Endogenous TNF-related apoptosis-inducing ligand (TRAIL) functions as a metastasis suppressor by activating proapoptotic TRAIL receptors (TRAIL-R1/DR4 and/or TRAIL-R2/DR5) in transformed cells, making it an attractive pathway for antimetastatic therapies. However, it is unclear whether TRAIL-R1 or TRAIL-R2 is a better therapeutic target in metastatic breast cancer.Several metastatic, triple (estrogen receptor, progesterone receptor, and HER2)-negative cancer cell lines were treated with human agonistic monoclonal antibodies targeting TRAIL-R1 (mapatumumab) or TRAIL-R2 (lexatumumab). The effects on cell viability, apoptosis, and caspase-8 activation were determined. An orthotopic model of triple-negative breast cancer in which fluorescently labeled breast cancer cells metastasize from the mammary gland to lymph nodes and lung was utilized to evaluate the effects of mapatumumab, lexatumumab, or doxorubicin on primary and metastatic tumor burden in vivo.Lexatumumab was more effective than mapatumumab in activating caspase-8, inducing apoptosis and inhibiting long-term survival of metastatic cancer cells, which expressed both TRAIL-R1 and TRAIL-R2. Human mammary epithelial cells transformed by oncogenic Ras were more sensitive to lexatumumab than nontransformed cells. Lexatumumab inhibited lymph node and lung metastases more robustly than mapatumumab in an orthotopic model of triple-negative breast cancer; both agents inhibited mammary tumor growth. In addition, lexatumumab was more effective than doxorubicin at suppressing metastases at doses of doxorubicin that were associated with toxicity, even though doxorubicin reduced primary tumor burden more robustly than lexatumumab.Targeting TRAIL-R2 receptor may be an effective therapeutic strategy for metastatic breast cancer.
Semiquantitative Gallium Scintigraphy in Patients with Osteogenic Sarcoma
Authors: SAMUEL D J YEH, GERALD ROSEN, BRENDA CAPARROS, RICHARD S. BENUA
Journal: Clinical Nuclear Medicine (1984)

Sequential gallium scans were performed in 37 patients with newly diagnosed osteogenic sarcoma. High gallium uptake was found more often in males in the 10 to 19 age group and in femoral lesions. High uptake was also seen in patients who had predominantly osteoblastic or mixed changes on radiographs and in those who had a soft tissue mass. Following chemotherapy, significant decrease of tumor to nontumor ratio occurred in the patients who responded to treatment as shown by a Grade III or IV response on histologic examinations at the time of en bloc resection. It is concluded that semiquantitative gallium scintigraphy is useful in monitoring therapeutic response in patients with osteogenic sarcoma.
Physicians' Duties in an Era of Cost Containment: Advocacy or Betrayal?
Authors: Peter A. Ubel
Journal: JAMA (1999)

A PATIENT'S DIAGNOSIS falsely ina medical record to gain benefits for the patient?The small amount of empirical research available suggests that many physicians do indeed choose to deceive third-party payers.In a decade-old survey, 70% of a sample of clinicians stated that hypothetically, they would write "rule out cancer" to secure funding for screening mammography if the patient's insurance would not otherwise fund it. 1 Nearly half the physicians in a more recent survey admitted to exaggerating the severity of patients' conditions to get the care they felt the patient needed. 2 In another study, in 1998, 39% of the physician sample admitted to exaggerating the severity of patients' conditions, changing official billing diagnoses, and documenting nonexistent symptoms-all to gain additional benefits for patients. 3 Several approaches to such a dilemma have been articulated.One consider the ethics of lying.Sissela Bok champions the "principle of veracity," which emphasizes the intrinsic moral undesirability of a lie because no one likes to be deceived. 4 Others worry about the effect lying would have on trust on the patient-physician relationship. 5 Still others worry that exaggerated and inaccurate diagnoses may frighten patients and compromise their future clinical care. 6 Alternatively, the question may be interpreted as one of distributive justice.The reimbursement boundaries set by third-party payers are a de facto resource allocation mechanism.Much has been written about whether physicians should ever withhold available interventions because of a high cost-to-benefit ratio. 7,8 The same reasoning applies to the question of whether physicians should ever transgress reimbursement boundaries to secure benefits not covered by insurance plans.Entrants in the 1999 John Conley Ethics Essay Contest for Medical Students were asked: "Suppose a potentially useful procedure is available that is not covered by a patient's medical insurance.Under what circumstances, if any, would you consider it appropriate to miscode (and thereby make available) the needed procedure?"Peter Ubel, MD, frames the issue as a question of distributive justice.Then, from opposed perspectives, the winners of this year's contest argue that miscoding is unethical because of its effect on the "medical commons" (Dena Rifkin) and that miscoding is sometimes justifiable based on the role society accords physicians (Greg Webster).On reading these essays, we hope readers will be better equipped to answer this question for themselves.
Myocardial enzyme activities in patients with mitral regurgitation or mitral stenosis
Authors: E JANSSON, C SYLVEN, A HENZE, L KAIJSER
Journal: Cardiovascular Research (1987)

Journal Article Myocardial enzyme activities in patients with mitral regurgitation or mitral stenosis Get access E JANSSON, E JANSSON ** From the Department of Clinical Physiology, St Erik's Hospital, Stockholm, Sweden Address for correspondence and reprints: Dr Eva Jansson, Department of Clinical Physiology, Karolinska Sjukhuset, S-104 01 Stockholm, Sweden. Search for other works by this author on: Oxford Academic PubMed Google Scholar C SYLVÉN, C SYLVÉN ‡ From the Department of Internal Medicine, St Erik's Hospital, Stockholm, Sweden Search for other works by this author on: Oxford Academic PubMed Google Scholar A HENZE, A HENZE † From the Department of Thoracic Surgery, Karolinska Hospital, St Erik's Hospital, Stockholm, Sweden Search for other works by this author on: Oxford Academic PubMed Google Scholar L KAIJSER L KAIJSER ** From the Department of Clinical Physiology, St Erik's Hospital, Stockholm, Sweden Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, Volume 21, Issue 3, March 1987, Pages 202–207, https://doi.org/10.1093/cvr/21.3.202 Published: 01 March 1987 Article history Received: 02 March 1986 Accepted: 27 August 1986 Published: 01 March 1987