tbuckley/cabot-search huggingface dataset:
The Cesarean Section Rate
Authors: Paul R. Overhulse
Journal: JAMA (1990)

<h3>To the Editor.—</h3> In response to the Special Communication by Dr Stafford<sup>1</sup>regarding cesarean sections, I would like to make a few comments. Why is the trend toward more and more cesarean sections? I submit that, in this day of advanced anesthesiological and surgical techniques, cesarean section is both easier and safer than vaginal delivery. Why should the modern woman undergo the sweaty, gut-wrenching ordeal of labor that may last 12 to 24 hours or more? Why must she face the frantic rush to the operating room for a stat section when the fetal heart rate drops? Why should she and her physician worry about the cord wrapped around the neck, fetal distress, breech presentation, pelvic dystocia, injured fetal parts (arms or necks), retained placenta, or transmitting herpesvirus to the infant during vaginal delivery? The mortality and morbidity rates of planned cesarean section, I am sure, are as low
Plasma from stored packed red blood cells and MHC class I antibodies causes acute lung injury in a 2-event in vivo rat model
Authors: Marguerite R. Kelher, Tomhiko Masuno, Ernest E. Moore, Sagar Damle, Xianzhong Meng, Yong Song, Xiayuan Liang, Jerry Niedzinski, Steven S. Geier, Samina Y. Khan, Fabia Gamboni-Robertson, Christopher C. Silliman
Journal: Blood (2009)
Prevalence and clinical relevance of local allergic rhinitis
Authors: C. Rondón, P. Campo, L. Galindo, N. Blanca‐López, M. S. Cassinello, J. L. Rodriguez‐Bada, M. J. Torres, M. Blanca
Journal: Allergy (2012)

Abstract Background Evidence demonstrates the existence of local allergic rhinitis ( LAR ) in nonatopic patients, although its prevalence in the rhinitis population remains unknown. The aim, therefore, of this study was to evaluate the prevalence, clinical characteristics, and severity of LAR in a S panish rhinitis population, compared with patients having classical allergic rhinitis ( AR ) with systemic atopy or nonallergic rhinitis ( NAR ). Methods A group of 452 adult rhinitis patients were randomly selected from a total of 3860 who attended our allergy service over 1 year. A clinical questionnaire, skin prick test ( SPT ), spirometry, and serum total and specific IgE ( sIgE ) were evaluated. A nasal allergen provocation test with multiple aeroallergens (NAPT‐M), including D ermatophagoides pteronyssinus , pollens, alternaria , and dog epithelia, was performed in patients with negative SPT and serum sIgE . Results A total of 428 patients completed the study; 24 were excluded because of nasal hyper‐reactivity. LAR was diagnosed in 25.7%, AR in 63.1%, and NAR in 11.2%. The LAR and AR patients had a similar clinical profile: a nonsmoking woman with severe, persistent perennial rhinitis frequently associated with conjunctivitis and asthma. More than 36% of LAR patients reported rhinitis onset in childhood. NAPT ‐M detected aeroallergen polysensitization in 37.3% of the LAR patients. D ermatophagoides pteronyssinus was the main sensitizing aeroallergen in LAR and AR (60% vs 54%, P &gt; 0.05). Conclusions Local allergic rhinitis is a prevalent entity in patients evaluated with rhinitis. Persistent and severe symptoms associated with conjunctivitis and/or asthma and polysensitization were likely to be detected in LAR and AR .
Function of vitamin B<sub>12</sub> in the central nervous system as revealed by congenital defects
Authors: Charles A. Hall
Journal: American Journal of Hematology (1990)

Abstract The 13 cases of methylcobalamin (MeCbl) deficiency presenting in early infancy have all been developmentally delayed, and the majority have had seizures, hypotonia, lethargy, and microcephaly. The CNS injury appears to occur during the first 6 months of postnatal life. The same symptoms are seen in acquired cobalamin (Cbl) deficiency in the same age group. MRI performed at age 18–19 months and after 13–14 months of large amounts of Cbl, in two cases showed delayed myelination, most pronounced in the cerebrum. Isolated MeCbl deficiency is the consequence of cblE and G mutations where the lesion is of a single Cbl‐dependent enzyme, the methyltransferase. One effect of a deficiency of MeCbl, and of the associated failure of the methionine synthase reaction, is, therefore, an impairment of myelination of the brain of the newborn. The slow, but usually incomplete, improvement in psychomotor status after years of treatment with Cbl may be related to the eventual myelination. However, the hypotonia, lethargy, and impaired responsiveness react to treatment with Cbl within 24–48 hours, which suggests an expression of MeCbl deficiency on the CNS distinct from the delayed myelination. Although there is much to be learned, it is now clear that a normally functioning Cbl‐dependent methyl transferase is required for development and function of the human brain.
Violence and Leveraged Community Treatment for Persons With Mental Disorders
Authors: Jeffrey W. Swanson, Richard A. Van Dorn, John Monahan, Marvin S. Swartz
Journal: American Journal of Psychiatry (2006)

Objective: This article explores the link between violence and the practice of legally mandating treatment in the community or leveraging benefits from the social welfare system, such as subsidized housing and disability income support, to ensure adherence to treatment. Method: Data are presented from a survey of 1,011 persons with psychiatric disorders receiving treatment in public mental health service systems in five U.S. cities. Multinomial logit analysis was used to examine the association between physically assaultive behavior and experience of social welfare leverage, legal leverage, or both types of leverage, with the analyses controlling for demographic and clinical characteristics. Results: Across study sites, 18% to 21% of participants reported having committed violent acts in the past 6 months; 3% to 9% reported having used or made threats with a lethal weapon, committed sexual assault, or caused injury. About three-quarters of subjects who reported such serious violence also reported having experienced some form of leveraged treatment, compared with about one-half of subjects who did not report serious violence. Demographic and clinical factors that were independently associated with the likelihood of experiencing both types of leverage included younger age, male gender, poorer clinical functioning, more years in treatment, more frequent hospitalizations, higher frequency of outpatient visits, and negative attitudes toward medication adherence. Among participants who did not voluntarily take psychotropic medication, even minor assaultiveness was associated with having experienced legal leverage. Conclusions: A combination of concerns about safety and treatment nonadherence may influence decisions by clinicians and judges to apply legal leverage.
Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families
Authors: Sandra B. Dunbar, Cynthia M. Dougherty, Samuel F. Sears, Diane L. Carroll, Nathan E. Goldstein, Daniel B. Mark, George McDaniel, Susan J. Pressler, Eleanor Schron, Paul Wang, Vicki L. Zeigler
Journal: Circulation (2012)

Significant mortality benefits have been documented in recipients of implantable cardioverter defibrillators (ICDs); however, the psychosocial distress created by the underlying arrhythmia and its potential treatments in patients and family members may be underappreciated by clinical care teams. The disentanglement of cardiac disease and device-related concerns is difficult. The majority of ICD patients and families successfully adjust to the ICD, but optimal care pathways may require additional psychosocial attention to all ICD patients and particularly those experiencing psychosocial distress. This state-of-the-science report was developed on the basis of an analysis and critique of existing science to (1) describe the psychological and quality-of-life outcomes after receipt of an ICD and describe related factors, such as patient characteristics; (2) describe the concerns and educational/informational needs of ICD patients and their family members; (3) outline the evidence that supports interventions for improving educational and psychological outcomes for ICD patients; (4) provide recommendations for clinical approaches for improving patient outcomes; and (5) identify priorities for future research in this area. The ultimate goal of this statement is to improve the precision of identification and care of psychosocial distress in ICD patients to maximize the derived benefit of the ICD.
Agbiotech: Success Depends on Trust
Authors: INDER M. VERMA
Journal: Molecular Therapy (2004)

Nearly one in eight people on this planet is chronically hungry. This problem is most acute in developing nations, whose populations continue to increase rapidly. There is little doubt that genetically engineered crops could be part of the solution to the challenge of feeding the world's poor. Sadly, a report by the Food and Agriculture Organization (FAO) of the United Nations has concluded that this is unlikely to happen, because too little research has been carried out on the basic food crops grown by these very developing countries.
Update in Critical Care Medicine
Authors: M J Tobin, J M Luce
Journal: Annals of Internal Medicine (1997)

Letters15 June 1997Update in Critical Care MedicineJames R. Johnson, MDJames R. Johnson, MDUniversity of Minnesota, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-12-199706150-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The reviewers of a recent study of sepsis-related clinical states [1] concluded that the systemic inflammatory response syndrome, sepsis, severe sepsis, and septic shock “… often seem to occur in the absence of confirmed infection” [2]. This conclusion contradicts the definitions of sepsis, severe sepsis, and septic shock, which require the presence of a confirmed infectious process. The authors' intended meaning was probably that the physiologic derangements observed in these syndromes often follow noninfectious insults in the absence of infection, which is true. However, it must be recognized that in the absence of a confirmed infection, a ...References1. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA. 1995; 273:117-23. Google Scholar2. Tobin MJ, Luce JM. Update in critical care medicine. Ann Intern Med. 1996; 125:909-16. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Minnesota, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 June 1997Volume 126, Issue 12Page: 1004KeywordsCritical careEpidemiologySepsisShockSystemic inflammatory response syndrome Issue Published: 15 June 1997 CopyrightCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Spectrum Bias or Spectrum Effect? Subgroup Variation in Diagnostic Test Evaluation
Authors: Stephanie A. Mulherin, William C. Miller
Journal: Annals of Internal Medicine (2002)

Diagnostic tests must be evaluated in a clinically relevant population. However, test performance often varies across population subgroups. Spectrum bias, a term commonly used to describe this heterogeneity, is typically thought to occur when diagnostic test performance varies across patient subgroups and a study of that test's performance does not adequately represent all subgroups. Yet subgroup variation is not a bias if appropriate analyses are conducted. Failure to recognize and address heterogeneity will lead to estimates of test performance that are not generalizable to the relevant clinical populations. Heterogeneity can be addressed with relatively simple stratification procedures, limited primarily by the sample size and the precision of the estimates. This paper proposes the use of the term spectrum effect, rather than spectrum bias, and outlines strategies for using stratified sensitivity and specificity estimates, likelihood ratios, and receiver-operating characteristic curves. Investigators of diagnostic tests should consider the potential for spectrum effect seriously and should address heterogeneity in their analyses. Furthermore, clinicians should consider study samples carefully to determine whether results are generalizable to their specific patient population.
Endoscopic ultrasound-guided fine needle aspiration or fine needle biopsy: the beauty is in the eye of the beholder
Authors: Bronte Holt, Shyam Varadarajulu
Journal: Endoscopy (2014)

The impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) on pancreatic tissue acquisition has been so profound that the technique is regarded as a disruptive innovation [1]. However, EUS-FNA has two major limitations: the diagnostic performance is dependent on the availability of a cytopathologist to render rapid onsite evaluation and it doesn’t provide histology, which may be required to establish a conclusive diagnosis when FNA cytology alone is insufficient. The ProCore biopsy needle was developed to overcome these limitations. In this issue of the journal, two randomized trials compare the diagnostic performance of the ProCore and standard FNA needles for tissue acquisition in solid pancreatic mass lesions [2] [3].
Intractable Hiccups and Gastroesophageal Reflux Disease
Authors: M. Ammar Hatahet
Journal: Annals of Internal Medicine (1997)

Letters15 December 1997Intractable Hiccups and Gastroesophageal Reflux DiseaseM. Ammar Hatahet, MDM. Ammar Hatahet, MDWayne State University; Detroit, MI 48201Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-127-12-199712150-00036 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read with interest the brief communication by Brzana and Koch [1] describing 10 patients with intractable nausea who were found to have gastroesophageal reflux. One of my patients presented with intractable hiccups that did respond to traditional medical therapy. Results of physical examinations, laboratory evaluation, and abdominal radiography were all normal. Upper gastroendoscopy revealed severe reflux and esophagitis. The hiccups responded well to omeprazole. Schreiber and colleagues [2] described a similar case, in which gastroesophageal reflux caused intractable hiccups. An interesting fact is that hiccups in infants are strongly associated with reflux [3].I agree with ...References1. Brazana RJ, Koch KL. Gastroesophageal reflux disease presenting with intractable nausea. Ann Intern Med. 1997; 126:704-7. Google Scholar2. Schreiber LR, Bowen MR, Mino FA, Craig TJ. Hiccups due to gastroesophageal reflux. South Med J. 1995; 88:217-9. Google Scholar3. Feranchak AP, Orenstein SR, Cohn JF. Behaviors associated with onset of gastroesophageal reflux episodes in infants. Clin Pediatr. 1994; 33:654-62. Google Scholar Author, Article, and Disclosure InformationAuthors: M. Ammar Hatahet, MDAffiliations: Wayne State University; Detroit, MI 48201 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byHiccup and neurosurgeons: a report of 4 rare dorsal medullary compressive pathologies and review of the literatureWat is de oorzaak van een jaren bestaande, recidiverende hik? 15 December 1997Volume 127, Issue 12Page: 1135KeywordsDiagnostic radiologyGastroesophageal reflux diseaseInfantsNauseaResearch laboratories ePublished: 15 August 2000 Issue Published: 15 December 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
A sense of belonging
Authors: K. Kumar
Journal: BMJ (1997)

I come from the state of Bihar in India. This is very poor compared with other states and not surprisingly the medical facilities are not as developed as they are in the main cities. When I took up a career in paediatrics I did so because I loved working with children. But the real breakthrough came when I got a place on the postgraduate MD course at Delhi University. The two years I spent as a resident at Safdarjung Hospital were the most rewarding years of my professional career.

By the end of my term there I had developed a strong dislike for the institution where I did my earlier training. I felt that it was still 25 years behind so far as the knowledge and practice of medicine was concerned. It was no wonder that I wanted to stay on in …
Molecular Outcome Prediction in Diffuse Large-B-Cell Lymphoma
Authors: Ash A. Alizadeh, Andrew J. Gentles, Izidore S. Lossos, Ronald Levy
Journal: New England Journal of Medicine (2009)

To the Editor: Lenz et al. (Nov. 27 issue)1 report the results of an important study of gene expression and survival in patients with diffuse large-B-cell lymphoma. We reassessed the performance of a survival predictor that we had previously reported2 by applying it to the expression profiles of tumors from patients described by Lenz et al. Our model performed well in predicting overall survival in these patients, whether they were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or with CHOP in combination with rituximab (R-CHOP) (P<0.001) (Figure 1). Furthermore, when risk was in the model as a continuous variable, . . .
Left ventricular myocardial blood flow in multivessel coronary artery disease.
Authors: P H Chen, A B Nichols, M B Weiss, R R Sciacca, P D Walter, P J Cannon
Journal: Circulation (1982)

The relationship between resting left ventricular (LV) myocardial blood flow (MBF) and hemodynamic determinants of myocardial oxygen consumption was investigated in 15 patients with multivessel coronary artery disease (CAD) and in 10 patients with normal coronary arteriograms. Mean LV MBF per unit mass of tissue was measured with a multicrystal scintillation camera from the regional clearance rates of xenon-133 injected into the left main coronary artery. Peak LV wall stress, mean velocity of circumferential fiber shortening (Vcf), rate of ejection during the first third of systole (1/3 SV), LV ejection fraction (EF), and the ratio of peak LV systolic pressure to LV end-systolic volume were measured by contrast left ventriculography. Mean LV MBF per unit mass was significantly reduced (48 +/- 11 vs 67 +/- 12 ml/100 g.min; p less than 0.01) in patients with multivessel CAD. However, none of the patients with CAD experienced chest pain or had electrocardiographic evidence of myocardial ischemia during the resting MBF measurements. Ejection phase indexes were lower in the patients with CAD: LVEF (56 +/- 10% vs 64 +/- 7%, p less than 0.05); 1/3 SV (35 +/- 3 vs 44 +/- 4%, p less than 0.05); and mean Vcf (1.05 +/- 0.30 vs 1.19 +/- 0.27 circ/sec, NS). LV wall thickness (9.8 +/- 1.9 vs 7.5 +/- 1.4 mm, p less than 0.01) and LV mass index (94 +/- 32 vs 64 +/- 17 g/m2, p less than 0.05) were significantly increased in the patients with CAD, accounting for the reduction in peak LV wall stress (276 +/- 73 vs 373 +/- 91 dyn-cm-2 x 10(-3), p less than 0.05) observed in these patients. Multiple regression analysis indicated that indexes of three of the major determinants of myocardial oxygen consumption explained 65% of the variation in MBF in patients with CAD: peak LV stress, mean Vcf and heart rate. After adjustment for these three indexes, the average LV MBF rates were not significantly different in the two patient groups (54.8 +/- 1.8 vs 57.6 +/- 2.3 ml/100 g.min). In both groups, resting LV MBF/beat correlated most highly with peak LV wall stress (r = 0.79). Thus, the reduction in LV MBF per unit mass observed in patients with multivessel CAD at rest is related to lower levels of hemodynamic variables that determine myocardial oxygen consumption. Peak LV wall stress is the most important hemodynamic variable determining the level of resting MBF in patients with and without CAD.
Effects of atrial natriuretic peptide in the canine coronary circulation.
Authors: R J Bache, X Z Dai, J S Schwartz, D G Chen
Journal: Circulation Research (1988)

Atriopeptin II has been reported to cause profound coronary vasoconstriction in the isolated perfused guinea pig heart and in the blood perfused canine heart. Consequently, this study was carried out to examine possible mechanisms by which vasomotor effects of human atrial natriuretic peptide (ANP) occur in the canine coronary circulation. Bolus dosages of ANP were administered into the left circumflex coronary artery of in situ dog hearts perfused at constant flow rate. ANP produced dose-related coronary vasodilation with a threshold dosage of 2 ng/kg; a dosage of 2 micrograms/kg caused a 27 +/- 4% decrease in coronary vascular resistance. Coronary vasodilation produced by ANP was not altered by beta-adrenergic blockade with propranolol (1 mg/kg i.v.). In addition, neither adenosine receptor blockade with 8-phenyltheophylline (5 mg/kg i.v.) nor cyclooxygenase inhibition with indomethacin (5 mg/kg i.v.) significantly altered the response to intra-arterial ANP. These data demonstrate that in the in vitro blood perfused canine heart, ANP administered intra-arterially results in coronary vasodilation that does not utilize adenosine-dependent or prostaglandin-dependent mechanisms.
Association of Serum Digoxin Concentration and Outcomes in Patients With Heart Failure
Authors: Saif S. Rathore, Jeptha P. Curtis, Yongfei Wang, Michael R. Bristow, Harlan M. Krumholz
Journal: JAMA (2003)

Context The Digitalis Investigation Group (DIG) trial reported that digoxin provided no overall mortality benefit and only a modest reduction in hospitalizations among patients with heart failure and depressed left ventricular systolic function. The clinical outcomes associated with digoxin therapy at different serum concentrations in the DIG trial have not been assessed. Objective To assess variations in serum digoxin concentration (SDC) and their association with mortality and hospitalization in patients with heart failure. Design, Setting, and Patients Post hoc analysis of the randomized, double-blinded, placebo-controlled DIG trial, conducted from August 1991 to December 1995, with the main analysis restricted to men with a left ventricular ejection fraction of 45% or less (n = 3782). Patients randomly assigned to receive digoxin were divided into 3 groups based on SDC at 1 month (0.5-0.8 ng/mL, n = 572; 0.9-1.1 ng/mL, n = 322; and ≥1.2 ng/mL, n = 277) and compared with patients randomly assigned to receive placebo (n = 2611). Main Outcome Measure All-cause mortality at a mean follow-up of 37 months. Results Higher SDCs were associated with increased crude all-cause mortality rates (0.5-0.8 ng/mL, 29.9%; 0.9-1.1 ng/mL, 38.8%; and ≥1.2 ng/mL, 48.0%; P = .006 for trend). Patients with SDCs of 0.5 to 0.8 ng/mL had a 6.3% (95% confidence interval [CI], 2.1%-10.5%) lower mortality rate compared with patients receiving placebo. Digoxin was not associated with a reduction in mortality among patients with SDCs of 0.9 to 1.1 ng/mL (2.6% increase; 95% CI, − 3.0% to 8.3%), whereas patients with SDCs of 1.2 ng/mL and higher had an 11.8% (95% CI, 5.7%-18.0%) higher absolute mortality rate than patients receiving placebo. The association between SDC and mortality persisted after multivariable adjustment (SDC 0.5-0.8 ng/mL hazard ratio [HR] 0.80, 95% CI, 0.68-0.94; SDC 0.9-1.1 ng/mL HR 0.89, 95% CI, 0.74-1.08; SDC ≥1.2 ng/mL HR 1.16, 95% CI, 0.96-1.39; and HR of 1.00 [referent] for placebo). Conclusions Our findings demonstrate that higher SDCs were associated with increased mortality and suggest that the effectiveness of digoxin therapy in men with heart failure and a left ventricular ejection fraction of 45% or less may be optimized in the SDC range of 0.5 to 0.8 ng/mL.