tbuckley/cabot-search huggingface dataset:
OC-024 Predicting 30-day Mortality Following Peg Insertion: External Validation Of A Previous Scoring System And Analysis For Additional Predictive Factors
Authors: CS MacLeod, R McKay, D Barber, AW Mckinlay, JS Leeds
Journal: Gut (2014)

<h3>Introduction</h3> Percutaneous endoscopic gastrostomy (PEG) insertion is a well-established technique for providing long-term enteral nutrition. However concerns have been raised regarding the high 30-day mortality associated with PEG, and the related ethical implications of patient selection. Accordingly, a previous predictive tool was developed using age and serum albumin level but was created on a relatively small cohort. External validation of the score was performed in the same region but has not been outside of this area. This study aimed to externally validate this previous scoring system and also try to identify any further predictors of 30-day mortality in a larger cohort. <h3>Methods</h3> Retrospective review of all gastroscopy reports documenting PEG insertions between January 2001 and January 2012 in our centre was undertaken. Hospital electronic systems were used to determine patient demographics, laboratory results and outcome at 30 days. In patients with newly inserted PEG tubes, the scoring system was applied and assessed using receiver operating curve analysis to determine the discriminative capacity. Furthermore, univariate and multivariate binary logistic regression analyses were performed using the current database to identify additional predictors of 30-day mortality. <h3>Results</h3> The PEG database included 1373 patients, of which 808 were new PEG insertions and suitable for analysis. For each increasing gradation of the scoring system, mortality rose with 4% of those scoring zero dying compared to 50% scoring three. An area under the ROC curve of 0.686 (95% confidence interval 0.635–0.737) indicated reasonable discriminative capacity. Multivariate analysis demonstrated that age ≥60 years (OR = 2.097 [p = 0.016]), serum albumin levels of 25–34 g/l (OR = 2.447 [p = 0.001]) or &lt; 25 g/l (OR = 6.769 [p &lt; 0.001]), C-Reactive Protein ≥10 mg/l (OR = 2.713 [p = 0.009]) and lymphocyte count of &lt;1.5 × 10<sup>9</sup>/l (OR = 2.016 [p = 0.004]) increased the odds of 30-day mortality, whilst inpatient PEG placement decreased the risk of death (OR = 0.529 [p = 0.005]). <h3>Conclusion</h3> The previous scoring system demonstrated reasonable predictive proficiency but the area under the ROC curves were not &gt;0.8. The recognition of further predictors of 30-day mortality allows for remodelling of the score which may improve the accuracy. However, future prospective, multicentre studies with defined outcomes are necessary to improve data collection. Additionaly, more information is needed about cause of 30-day mortality and importantly quality of life following PEG insertion. <h3>Disclosure of Interest</h3> None Declared.
Birth Defects in the Seveso Area After TCDD Contamination
Authors: Pierpaolo Mastroiacovo
Journal: JAMA (1988)

A study on the frequency of birth defects was conducted in the area around Seveso, Italy, which was contaminated by 2,3,7,8-tetrachlorodibenzo-<i>p</i>-dioxin in July 1976; this has been the largest population ever exposed to dioxin. From Jan 1, 1977, to Dec 31, 1982, a total of 15291 births (still and live) were examined, and malformations were reported to an ad hoc birth defects registry. In the most highly contaminated area, 26 births were observed. None of these infants had any major structural defect. Two infants had mild defects. The frequencies of major defects detected in the areas of low or very low contamination were 29.9/1000 and 22.1/1000, respectively. A frequency of 27.7/ 1000 was registered in the control area. Relative risks were calculated for specific categories of birth defects and for grouped malformations. Although the data collected failed to demonstrate any increased risk of birth defects associated with 2,3,7,8-tetrachlorodibenzo-<i>p</i>-dioxin, the number of exposed pregnancies was not big enough to show a low and specific teratogenic risk increase. (<i>JAMA</i>1988;259:1668-1672)
Respiratory effects of ethyl alcohol intoxication
Authors: R. E. Johnstone
Journal: JAMA (1972)

To the Editor.—  Death from acute alcohol intoxication is thought by many to be due to respiratory failure. Yet in recent laboratory studies, moderately intoxicating doses of ethyl alcohol (120 mg/100 ml) had no consistent effect on respiratory rate or minute volume and sometimes increased ventilation. We therefore studied ten severely intoxicated adults brought to the Cincinnati General Hospital emergency unit. Very high blood concentrations of ethyl alcohol (BEC) in these patients caused only moderate respiratory depression.  The patients were chronic alcoholics without clinical evidence of cardiopulmonary disease. Screening of blood samples by means of gas chromatography excluded the presence of other drugs in addition to ethyl alcohol. Of the ten patients, two were unconscious and eight were conscious but lethargic, with slurred speech and incoordination. Arterial blood for pH and gas analysis was drawn while the patients breathed room air. Venous BEC were determined by gas chromatography.  Arterial blood
Recent developments in Bell's palsy: Summary of responses
Authors: Alison Tonks
Journal: BMJ (2004)

EDITOR—Holland and Weiner's clinical review on recent developments in Bell's palsy prompted 24 responses, 10 of them critical of the views on treatment.1 The authors were wrong to recommend early treatment with steroids or antiviral agents, or both, because the supporting evidence they offered was inconclusive and flawed; they ignored the best evidence (two systematic reviews) and selected other trials to support their own opinion; neither treatment is harmless, and antiviral agents are expensive; and they glossed other potentially useful treatments.

A physiotherapist thought the review a bit light on facial retraining for people with residual paralysis, and a surgeon from Seattle wanted more on the potential benefits of decompression surgery. A patient said that speech therapy …
LONGEVITY OF THE ERYTHROCYTE
Authors: Alexander S. Wiener
Journal: JAMA (1934)

<h3>To the Editor:—</h3> In a recent editorial on the longevity of the erythrocyte (The Journal, April 21, p. 1304) are quoted the results of studies made by Escobar and Baldwin, who found the life of the red blood cell to be from eighteen to thirty days. The method used by Escobar and Baldwin and also the other methods mentioned in the editorial are indirect and therefore may yield inconclusive results. There is a simple method for determining the life of an erythrocyte by means of which accurate results can be obtained but which is not mentioned in the editorial; namely, by tracing the fate of transfused blood cells. In the editorial, the following statement was made: "Unfortunately, one cannot earmark an erythrocyte and follow its fate in the circulation or in some secluded organ." This is not entirely true, for there are certain natural "earmarks" by which the transfused red
The Peroxisome Proliferator-Activated Receptor- 2 P12A Polymorphism and Type 2 Diabetes in an Arab Population
Authors: S. M Wakil
Journal: Diabetes Care (2006)

The association of type 2 diabetes with the P12A polymorphism of the peroxisome proliferator–activated receptor gene ( PPAR-γ2 ) has been established in several populations (1). However, no studies have thus far been reported for Arab populations. While many variants have been identified in this gene, the most prevalent and best studied is the P12A polymorphism. There is considerable interpopulation variance in the incidence of the risk allele (P12). This ranges in frequency from a high of 0.96–0.98 in populations including the Japanese, Chinese, and African Americans to 0.91 in …
Choledocholithiasis - a practical approach from the endosonographer
Authors: D. O’Toole, L. Palazzo
Journal: Endoscopy (2006)

The widespread availability of endoscopic ultrasound (EUS) has facilitated evaluation of the pancreas and extra-hepatic biliary system. EUS to date has been shown to be highly sensitive in the detection of both choledocholithiasis (especially in patients with small stones and non-dilated bile ducts) and gallbladder microlithiasis, however the use of this technique in relation to endoscopic retrograde cholangiography (ERCP) and laparoscopic surgery in gallstone disease remains somewhat confusing. EUS has the added advantage of accurately discriminating CBD obstruction due to choledocholithiasis and other causes such as small ampullary tumours, cholangiocarcinoma, benign extra-heaptic cholangitis, congenital bile duct or peri-ampullary abnormalities (which together account for 10 - 20 % of cases of CBD obstruction in patients with suspicion of CBD stones). This review highlights technical aspects of examining the extra-hepatic biliary duct system and the clinical performance and results of EUS in this context and proposes strategies in relation to its use in association with ERCP and surgery in common clinical practice. The use of EUS in patients with a asymptomatic dilated common bile duct (CBD) is also discussed.
Diet and atopic dermatitis
Authors: Raymond V. Caputo, Ilona Frieden, Bernice R. Krafchik, Alfred T. Lane, Anne Lucky, Amy Paller, Sharon S. Raimer, James E. Rasmussen, Lawrence A. Schachner, Mary K. Spraker, David H. Stein, Mary L.K. Williams
Journal: Journal of the American Academy of Dermatology (1986)
THE RELATION OF PROTEOLYTIC ENZYMES IN THE PNEUMONIC LUNG TO HYDROGEN ION CONCENTRATION. AN EXPLANATION OF RESOLUTION
Authors: Frederick T. Lord
Journal: The Journal of Experimental Medicine (1919)

Evidence is given of the presence in the cellular material obtained from the pneumonic lung of a proteolytic enzyme digesting coagulated blood serum at hydrogen ion concentrations of 7.3 to 6.7 and inactive at higher; i.e., more acid concentrations. In addition, evidence is brought forward of the presence in the cellular material from the pneumonic lung of a proteolytic enzyme splitting peptone to amino-acid nitrogen. This enzyme is operative at hydrogen ion concentrations from 8.0 to 4.8, but most active at 6.3 or 5.2. These findings may be regarded as having a bearing on resolution in pneumonia. During the course of the disease a gradual increase in the hydrogen ion concentration of the exudate probably takes place. With the breaking down of cellular material an enzyme digesting protein (fibrin) in weakly alkaline and weakly acid media may be liberated. With a gradual increase in the hydrogen ion concentration of the pneumonic lung the action of this enzyme probably ceases. An enzyme capable of splitting peptone to amino-acid nitrogen is probably active during the proteolysis of the fibrin and further activated when the hydrogen ion concentration of the pneumonic lung is increased to within its range of optimum activity at a pH of 6.3 and 5.2. By this means it may be conceived that the exudate is dissolved and resolution takes place.
Association between Prenatal Lead Exposure and Blood Pressure in Children
Authors: Aimin Zhang, Howard Hu, Brisa N. Sánchez, Adrienne S. Ettinger, Sung Kyun Park, David Cantonwine, Lourdes Schnaas, Robert O. Wright, Hector Lamadrid-Figueroa, Martha Maria Tellez-Rojo
Journal: Environmental Health Perspectives (2011)

Lead exposure in adults is associated with hypertension. Altered prenatal nutrition is associated with subsequent risks of adult hypertension, but little is known about whether prenatal exposure to toxicants, such as lead, may also confer such risks.We investigated the relationship of prenatal lead exposure and blood pressure (BP) in 7- to 15-year-old boys and girls.We evaluated 457 mother-child pairs, originally recruited for an environmental birth cohort study between 1994 and 2003 in Mexico City, at a follow-up visit in 2008-2010. Prenatal lead exposure was assessed by measurement of maternal tibia and patella lead using in vivo K-shell X-ray fluorescence and cord blood lead using atomic absorption spectrometry. BP was measured by mercury sphygmomanometer with appropriate-size cuffs.Adjusting for relevant covariates, maternal tibia lead was significantly associated with increases in systolic BP (SBP) and diastolic BP (DBP) in girls but not in boys (p-interaction with sex = 0.025 and 0.007 for SBP and DBP, respectively). Among girls, an interquartile range increase in tibia lead (13 μg/g) was associated with 2.11-mmHg [95% confidence interval (CI): 0.69, 3.52] and 1.60-mmHg (95% CI: 0.28, 2.91) increases in SBP and DBP, respectively. Neither patella nor cord lead was associated with child BP.Maternal tibia lead, which reflects cumulative environmental lead exposure and a source of exposure to the fetus, is a predisposing factor to higher BP in girls but not boys. Sex-specific adaptive responses to lead toxicity during early-life development may explain these differences.
Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long‐Term Registry
Authors: Aldo P. Maggioni, Stefan D. Anker, Ulf Dahlström, Gerasimos Filippatos, Piotr Ponikowski, Faiez Zannad, Offer Amir, Ovidiu Chioncel, Marisa Crespo Leiro, Jaroslaw Drozdz, Andrejs Erglis, Emir Fazlibegovic, Candida Fonseca, Friedrich Fruhwald, Plamen Gatzov, Eva Goncalvesova, Mahmoud Hassanein, Jaromir Hradec, Ausra Kavoliuniene, Mitja Lainscak, Damien Logeart, Bela Merkely, Marco Metra, Hans Persson, Petar Seferovic, Ahmet Temizhan, Dimitris Tousoulis, Luigi Tavazzi
Journal: European Journal of Heart Failure (2013)
Abstract P4-13-08: Diabetes, Related Factors and Breast Cancer Risk
Authors: P Boyle, M Boniol, A Koechlin, M Bota, C Robertson, D Leroith, J Rosenstock, GB Bolli, P Autier
Journal: Cancer Research (2012)

Abstract Diabetes and breast cancer are both extremely common conditions in women and may share common risk factors. It is natural to investigate any potential common risk factors and to seek biological clarification and improve prospects for prevention. Therefore, in order to help clarify the potential association between diabetes, related factors and breast cancer risk, a comprehensive literature review and formal meta-analysis was carried out, planned, conducted and reported following PRISMA guidelines regarding meta-analysis of observational studies. Variables studies in relation to breast cancer risk were adiposity, physical activity, glycaemic load, glycaemic index, diabetes, IGF-1, fasting glucose, fasting insulin and C-peptide, adiponectin and metformin and glargine use among patients with diabetes. For all variables except diabetes and breast cancer, only prospective studies were included in meta-analyses. Summary Relative Risks (SRR) and corresponding 95% Confidence Intervals (CI) were calculated from random effect models. For breast cancer at all ages, the calculated risks were as follows: diabetes (SRR = 1.27 95% CI (1.16, 1.39); physical activity (SRR = 0.88, 95% CI (0.85, 0.92)); glycaemic load (SRR = 1.06, 95% CI (1.00, 1.12)); glycaemic index (SRR = 1.04, 95% CI (0.99, 1.10)); fasting glucose (SRR = 1.12, 95% CI (1.01, 1.24)); serum insulin (SRR = 1.18, 95% CI (0.75, 1.85)); c-peptide (SRR = 1.29, 95% CI (0.91, 1.82)); adiponectin (SRR = 1.16, 95% CI (0.93, 1.46)); metformin (SRR = 1.00, 95% CI (0.69, 1.46)); and glargine (SRR = 1.11, 95% CI (1.00, 1.24)). An increase of 5 units in Body Mass Index (a weight increase if 14.5 kg in a person 1.70 metres tall) was associated in post-menopausal breast cancer (SRR = 1.12, 95% CI (1.08, 1.16)) but not at pre-menopausal ages (SRR = 0.83, 95% CI (0.72, 0.95)). Serum insulin was associated with breast cancer at post-menopausal ages but not at pre-menopausal ages whereas with c-peptide there was a significant association at pre-menopausal ages but not post-menopausal. For IGF-1, Hodge's Standardised Mean Difference (HSMD) was calculated in cohort studies and there was no significant association with breast cancer at all ages (HSMD = 0.003, 95% CI (−0.059, 0.065)), at post-menopausal ages (HSMD = −0.014, 95% CI (−0.106, 0.077)) or at pre-menopausal ages (HSMD = 0.039, 95% CI (−0.038, 0.117)). The risk of breast cancer is increased among post-menopausal women who have diabetes. Among those factors related to diabetes, key risk factors for breast cancer appear to be adiposity and lack of physical activity which are both related to the risk of developing diabetes. Action on these lifestyle factors should form the basis of a common prevention strategy. There is a need to re-evaluate potential biological mechanisms to explain the increased risk in post-menopausal women with diabetes. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-13-08.
The Influence of Rate Heterogeneity among Sites on the Time Dependence of Molecular Rates
Authors: Julien Soubrier, Mike Steel, Michael S.Y. Lee, Clio Der Sarkissian, Stéphane Guindon, Simon Y.W. Ho, Alan Cooper
Journal: Molecular Biology and Evolution (2012)

Molecular evolutionary rate estimates have been shown to depend on the time period over which they are estimated. Factors such as demographic processes, calibration errors, purifying selection, and the heterogeneity of substitution rates among sites (RHAS) are known to affect the accuracy with which rates of evolution are estimated. We use mathematical modeling and Bayesian analyses of simulated sequence alignments to explore how mutational hotspots can lead to time-dependent rate estimates. Mathematical modeling shows that underestimation of molecular rates over increasing time scales is inevitable when RHAS is ignored. Although a gamma distribution is commonly used to model RHAS, we show that when the actual RHAS deviates from a gamma-like distribution, rates can either be under- or overestimated in a time-dependent manner. Simulations performed under different scenarios of RHAS confirm the mathematical modeling and demonstrate the impacts of time-dependent rates on estimates of divergence times. Most notably, erroneous rate estimates can have narrow credibility intervals, leading to false confidence in biased estimates of rates, and node ages. Surprisingly, large errors in estimates of overall molecular rate do not necessarily generate large errors in divergence time estimates. Finally, we illustrate the correlation between time-dependent rate patterns and differential saturation between quickly and slowly evolving sites. Our results suggest that data partitioning or simple nonparametric mixture models of RHAS significantly improve the accuracy with which node ages and substitution rates can be estimated.
"Getting the lead out" in Hartford, Connecticut: a multifaceted lead-poisoning awareness campaign.
Authors: Tara J McLaughlin, Owen Humphries, Tung Nguyen, Rose Maljanian, Katherine McCormack
Journal: Environmental Health Perspectives (2003)

As part of a citywide effort to increase lead poisoning awareness within the city of Hartford, Connecticut, the Hartford Health Department implemented a multifaceted public health campaign involving several novel elements and partnerships, including the use of municipal sanitation trucks to disseminate lead-poisoning prevention messages throughout the city. To evaluate campaign reach and effectiveness, Health Department personnel collected measures of lead-poisoning knowledge, recall of campaign components, and reports of steps taken to prevent lead poisoning from 180 largely ethnic minority parents of preschool-age children. Key results were as follows: a) Recall of campaign components ranged from 21.5 to 62.6%, with newspaper advertisements and signs on buses and billboards recalled most often and a video broadcast on public-access television recalled least often. b) More than 45% of respondents reported that they took steps to prevent lead poisoning because of at least one of the campaign components, with the newspaper advertisements being the most effective component in terms of prompting lead-poisoning prevention behavior. c) Respondents' awareness was particularly low in terms of how medical personnel and procedures can and cannot detect and prevent lead poisoning in children. This campaign prompted caregivers to take steps to prevent lead poisoning and may help public health professionals in other communities to develop novel ideas through which to embark on similar initiatives.
UK medical device regulation is criticised as both cumbersome and inadequate
Authors: G. Watts
Journal: BMJ (2012)

Medical device regulations were criticised last week by manufacturers who make devices and doctors who use them.

At a press briefing on 16 February, manufacturers said the regulations were unnecessarily cumbersome, while doctors criticised them for being inadequate and subject to conflicts of interest. The recent breast implant affair may have brought the issue to public attention, but medical professionals and manufacturers alike say they have been questioning the system for years.

At the briefing organised by the independently funded Science Media Centre, Stephen O’Connor, who works for a medical equipment manufacturer, pointed out that it can take 18 months to get approval for a study. Clinical trials must be agreed by national …
Bronchoalveolar lavage cytology and immunocytology in pulmonary tuberculosis.
Authors: G B Hoheisel, L Tabak, H Teschler, F Erkan, C Kroegel, U Costabel
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

Limited data on the cellular and immunocytologic characteristics of bronchoalveolar lavage (BAL) fluid in pulmonary tuberculosis have been reported. We therefore studied 40 patients with active disease. BAL fluid differential cell counts and lymphocyte subsets were determined. The findings were compared with data from 47 patients with active sarcoidosis and 30 healthy control subjects. The proportion of lymphocytes was increased in both diseases (p < 0.001 versus control subjects) but with no difference compared to one another. The CD4/CD8 ratio was normal in 33 of 40 patients with pulmonary tuberculosis in contrast to sarcoidosis, with an increased ratio in 33 of 47 patients. HLA-DR+ T lymphocytes were significantly increased in both pulmonary tuberculosis and sarcoidosis (p < 0.05 versus control group). The proportion of CD57+ lymphocytes was normal in all study groups. We conclude that pulmonary tuberculosis and sarcoidosis are characterized by an increased percentage of lymphocytes in BAL fluid with a similar proportion of activated T cells. In contrast to active sarcoidosis, in which an elevated CD4/CD8 ratio is characteristic, in the majority of pulmonary tuberculosis patients the CD4/CD8 ratio is within the normal range.
Modern treatments for internal haemorrhoids
Authors: J. L Pfenninger
Journal: BMJ (1997)

Almost everyone suffers from haemorrhoids at some time in their lives. The symptoms include bleeding, prolapsing tissue, fullness after defecation, and pain. Bleeding can mimic or mask the diagnosis of cancer and must be thoroughly evaluated. In most cases, however, swift, simple, and effective treatment can be given in an outpatient clinic or a health centre.1 2 3 4 The key to understanding the feasibility of outpatient treatment is that there are no sensory nerve fibres above the dentate (pectinate) line in the anus, which is at the squamomucosal junction. Internal haemorrhoids arise above this line, so they can be treated without an anaesthetic. External haemorrhoids develop below the dentate line and are exquisitely sensitive. Little preparation is needed for the treatment of internal haemorrhoids, but an enema will make them easier to see as well as making the procedure more aesthetically acceptable.

Haemorrhoids are graded by the degree of prolapse, and this grading determines the most appropriate methods of treatment. First degree haemorrhoids are merely visible vessels, second degree lesions prolapse with defecation but return spontaneously, third degree lesions prolapse and require manual replacement, and fourth degree lesions remain prolapsed out of the anal canal despite attempts …