tbuckley/cabot-search huggingface dataset:
Diagnostic Errors in Pediatric Echocardiography
Authors: Oscar J. Benavidez, Kimberlee Gauvreau, Kathy J. Jenkins, Tal Geva
Journal: Circulation (2008)

Background— Despite increased interest in complications within pediatric cardiology, the domain of imaging-related diagnostic errors has received little attention. We developed a new taxonomy for diagnostic errors within pediatric echocardiography that categorizes errors by severity, preventability, and primary contributor. Our objectives were to examine its findings when applied to diagnostic error cases and to identify risk factors for preventable or possibly preventable diagnostic errors. Methods and Results— Diagnostic errors were identified at a high-volume academic pediatric cardiac center from December 2004 to August 2007. Demographic, clinical, and situational variables were collected from these cases and controls. During the study period, ≈50 660 echocardiograms were performed. Among the 87 diagnostic error cases identified, 70% affected clinical management or the patient was at risk of or experienced an adverse event. One third of the errors were preventable and 46% were possibly preventable; 69% of preventable errors were of moderate severity or greater. Univariate analysis demonstrated that preventable or possibly preventable errors were more likely to involve younger patients, lower body weight, study location, sedated/anesthetized patients, studies performed and interpreted at night, uncommon diagnoses, and greater anatomic complexity than controls. Multivariate analysis identified the following risk factors: rare or very rare diagnoses (adjusted odds ratio [AOR], 9.2; P &lt;0.001), study location in the recovery room (AOR, 7.9; P &lt;0.001), moderate anatomic complexity (AOR, 3.5; P =0.004), and patient weight &lt;5 kg (AOR, 3.5; P =0.031). Conclusions— A diagnostic error taxonomy and knowledge of risk factors can assist in identification of targets for quality improvement initiatives that aim to decrease diagnostic error in pediatric echocardiography.
The proposed review will not be independent without NICE
Authors: K. J. Jorgensen, P. C. Gotzsche
Journal: BMJ (2011)

Mike Richards and Harpal Kumar, chief executive at Cancer Research UK, were put in charge of the review but neither is independent. 

For Richards, this is reflected in the references he chose for his letter.1 The first is used to support his claim of a 35% effect of breast screening in attenders, although they are healthier than non-attenders. The estimate is therefore misleading.

The second …
Sellar Enlargement With Hyperprolactinemia and a Rathke's Pouch Cyst
Authors: Krinos M. Trokoudes
Journal: JAMA (1978)

A woman with secondary amenorrhea was found to have hyperprolactinemia without clinical galactorrhea. Radiological findings of an enlarged sella turcica with displacement of the pituitary stalk were considered consistent with a prolactin macroadenoma. Treatment with bromocriptine corrected the amenorrhea and hyperprolactinemia, and the patient inadvertently became pregnant. However, no complications to the mother or fetus occurred during pregnancy or postpartum. On transsphenoidal surgery three months postpartum, the unexpected presence of a large Rathke's pouch cyst with a microadenomatous or nodular hyperplasia type of prolactin-secreting tumor was observed to account for the preoperative clinical and radiological findings. (<i>JAMA</i>240:471-473, 1978)
PGE1 reduced caspase-3 and -6 activation induced by D-galactosamine in primary culture of rat hepatocytes, role of oxidative stress
Authors: E. Siendones, J. Muntané, A. Quintero, J.L. Montero, J.C. Fernández-Checa, M. De la Mata, G. Miño
Journal: Journal of Hepatology (2000)
A Hard Diagnosis
Authors: Mary E. Margaretten, Lawrence M. Tierney, Gurpreet Dhaliwal
Journal: New England Journal of Medicine (2009)

A 56-year-old woman presented to the emergency room with a 4-week history of malaise. The patient reported no dyspnea, chest pain, weight loss, nausea, abdominal pain, hematuria, myalgias, or arthralgias. For many years, she periodically had an urticarial rash on her arms; the most recent episode was 4 weeks previously. Her medical history was notable only for autoimmune thyroiditis and vitiligo.
DIET AND TISSUE GROWTH
Authors: Theodore S. Moise, Arthur H. Smith
Journal: The Journal of Experimental Medicine (1927)

The effects of the ingestion of diets containing different concentrations of protein on the remaining kidney in adult white rats after a unilateral nephrectomy has been studied. In the animals on the high protein diet (85 per cent casein), actual glomerular and tubular lesions were observed in the kidneys of animals maintained for 90, 120 and 150 days after nephrectomy. In the animals on the standard ration, 18 per cent casein, no significant renal lesions were observed within the experimental period. Spontaneous focal lesions in the kidneys of rats maintained on Sherman's diets "A" and "B" were inconspicuous at the age of 350 days but became progressively more frequent and were commonly observed after 500 days. The animals on the high protein and standard rations were all under 350 days old at the completion of the experiment. It is suggested that the age factor is of importance in that young animals may have greater powers of adaptation in withstanding the injurious effect of high protein rations. The animals on the high protein ration excreted definitely larger quantities of protein in the urine, and showed a higher incidence of casts in periods roughly corresponding to those in which anatomic lesions were observed than did the rats on the standard diet.
Folic Acid and Prevention of Birth Defects-Reply
Authors: Peadar N. Kirke
Journal: JAMA (1996)

<h3>In Reply.</h3> —The letter by Dr Czeizel about the protective effect of a multivitamin preparation containing folic acid on NTDs and other congenital malformations raises an important public health issue. It is now accepted that periconceptional folic acid prevents both the recurrence and occurrence of NTDs. However, we wish to emphasize that the evidence to date regarding the effects of folic acid in preventing other birth defects, cardiovascular disease, or some cancers is much more tenuous. Most of the studies examining these questions were observational rather than randomized, and the protective effects, in the main, were related to multivitamins that happened to include folic acid. In particular, the protective effects on birth defects noted in the letter by Czeizel, though based on a randomized trial, were for a preparation that contained folic acid as just 1 of many ingredients. The efficacy of folic acid per se in conditions other than
Atrial receptors with nonmedullated vagal afferents in the cat. Discharge frequency and pattern in relation to atrial pressure.
Authors: P N Thorén
Journal: Circulation Research (1976)

The response of 14 atrial receptors with nonmedullated vagal afferents to changes in atrial pressure was determined in anesthetized thoracotomized cats. Recordings were made from 11 single fibers and three two-fiber filaments. Mean conduction velocity was 0.9 m/sec (range, 0.35 to 2.2 m/sec). During the control period, either no activity was detected or there was a sparse discharge (mean, 1.4 impulses/sec), which occasionally was related to the a or v waves. As atrial pressure was increased by transfusion or by occlusion of the aortic, pulmonary arterial, mitral, and tricuspid orifices, an increased rate of firing occurred, often related to the atrial v wave. The threshold for individual receptors was between 2 and 3 mm Hg (mean pressure) in the right atrium, and 5 and 12 mm Hg in the left atrium. The maximal firing rate was 5-11 impulses/sec for right atrial and 10-20 impulses/sec for left atrial receptors. The receptors were localized by probing the opened heart, and were identified in both atria, in the interatrial septum, and in the atrial-venous junctions. Thus receptors connected to vagal C fibers are present throughout both atria and are activated by moderate changes in pressure.
Abstract 3468: Endoscopic diagnosis and treatment of esophageal tumor using a novel DDS-type photoactivatable agent
Authors: Kozo Miyazaki, Yuji Morimoto, Hitomi Hiruma, Aki Inoue, Takahiro Nomoto, Shigeto Fukushima, Keiichi Iwaya, Nariyoshi Shinomiya, Nobuhiro Nishiyama, Kazunori Kataoka
Journal: Cancer Research (2012)

Abstract Introduction: Photodynamic diagnosis (PDD) and therapy (PDT) have been clinically used for the early phase cancer of hollow organs. We are advancing the photomedicine to the next stage, in which treatment is carried out immediately after the detection of lesions. For achieving the simultaneous diagnosis and treatment, we established a novel DDS-type photoactivatable agent, micelle-based photosensitizer loading dendrimer porphyrin (DP/M). A micelle-based shell structure is expected to be selectively accumulated in tumors. An intensely emitted fluorescence from porphyrin can be used for lesion detection and a highly quantum yield of porphyrin promises an effective PDT. Apart from the agent, we recently developed a fluorometric system equipped with an ultrathin endoscope that has a spatial resolution of 15,000 pixels even with a diameter of 0.8 mm. The aim of this study was to verify practical effectiveness of the novel photosensitizer combined with the endoscopic fluorometric system for simultaneous diagnosis and treatment. In this study, we targeted esophageal cancer because satisfactory results are not always obtained with conventional therapies and an endoscopic approach is applicable. Materials and Methods: A rat orthotopic esophageal tumor model was established in female Fischer F344 rats by orally administered with NMBuA (N-Nitroso Methylbutylamine) solved in drinking water. After intravenous administration of DP/M, PDD was carried out using the endoscopic fluorometric system (ex. 405 nm, em. &amp;gt; 630 nm). After the detection of lesions, tumors were irradiated using a diffuser tip fiber connected to a 635nm LD laser. Results: About 6 weeks after the administration of NMBuA, polypoid tumors were observed in the esophagus. Pathological analysis revealed that proliferated polymorphonuclear cells were seen: a part of which reached the muscular layer of mucosa. A selective accumulation of DP/M in the tumors was confirmed with the endoscopic fluorometric system. This modality enabled repeated observations of tumors without sacrifice. The following PDT provided a promising result. Conclusions: DP/M combined with the endoscopic fluorometric system brought the simultaneous diagnosis and treatment for the orthotopic rat esophagus tumor models. Acknowledgment: This research is granted by the Japan Society for the Promotion of Science (JSPS) through the “Funding Program for World-Leading Innovative R&amp;D on Science and Technology (FIRST Program),” initiated by the Council for Science and Technology Policy (CSTP). Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3468. doi:1538-7445.AM2012-3468
A third of Massachusetts healthcare spending is "wasteful," says report
Authors: M. McCarthy
Journal: BMJ (2014)

Around one third of spending on healthcare in Massachusetts could be considered wasteful, a state commission report has concluded.1

Examples of waste included $700m (£430m; €515m) in preventable hospital readmissions, $550m in unnecessary visits to emergency departments, $10m to $18m in healthcare associated infections, $3m to $8m in early elective inductive deliveries, and $1m to $2m in inappropriate imaging for lower back pain, the report said.

Overall, wasteful spending ranged from an estimated 21% to 39% ($14.7m to $26.9m) of the state’s total annual healthcare expenditures.

In 2006 Massachusetts was the first state to adopt a law that sought to achieve universal healthcare coverage, and now 96.9% of the state’s residents have …
Lung Transplantation in Perspective
Authors: Frank J. Veith
Journal: New England Journal of Medicine (1986)

Success in transplantation of the lung has lagged behind success with other organs for a variety of reasons. Paramount among these is the extreme scarcity of healthy donor lungs that can be used as transplants. The common occurrence of pulmonary edema, aspiration, and pneumonia in brain-dead patients precludes the use of lungs from most otherwise acceptable organ donors, particularly in communities such as ours in New York, where there is usually a delay of several days between identification of a donor and declaration of brain death. This scarcity of donor lungs has resulted in the death of 49 of our . . .
Changes in the population aged over 75 of an urban general practice: implications for screening.
Authors: H Graham, B Livesley
Journal: BMJ (1986)

In an urban group practice of six principals 545 (4.2%) of 13 100 patients were over 75 years of age. Although 54 of these patients died during one year, there were 72 "urban migrants" (42 removed from the district and were replaced by 30 new registrations) and 58 age transfers within the age-sex register. Although urban migrants who were aged over 75 and over 85 represented only a small percentage (0.6% and 0.1% respectively) of the total practice population, they accounted for 12.8% and 14.9% of their respective age groups. There may be delays of up to three months before such patients are routinely registered with new practices. Thus a potentially hidden and appreciably vulnerable section of the aged population who are likely to require crisis intervention has been identified. This may explain previous conflicting views about the value of health screening programmes in the elderly.
Antizymes, Adaptation and Homeostasis
Authors: W. Eugene Knox
Journal: New England Journal of Medicine (1976)

For many, biologic regulation still means homeostasis. This fertile conceptual scheme of Walter Bradford Cannon continued to be useful beyond his own masterly exploitation of it.1 Some say it still is. "Any paper published today, at least in physiology, which is worth the paper it is printed on, should further clarify a homeostatic mechanism," recently said the editor of landmark papers on the subject.2 And yet, still another paper has just been printed reporting not the least of a continuing series of discoveries, not mere clarifications, of new homeostatic mechanisms.3 Now and for 25 years such discoveries have been born . . .
GLANDULAR HYPERTROPHY AT BASE OF TONGUE. LINGUAL TONSIL. CASE REPORT.Read in the Section of Laryngology and Otology at the Forty-first Annual Meeting of the American Medical Association, Nashville, Tenn., May, 1890.
Authors: A. B. THRASHER
Journal: JAMA (1890)

It is not an unusual thing to find hypertrophy of the glandular tissue at the base of the tongue. When in a normal condition this region is crowded with glands which are large in comparison with the other lingual glands. But in the case which I report to you to-day the tissue, in size and appearance, was a real lingual tonsil, as can easily be seen from the photograph which I herewith present to you. Mrs. H., æt. 44, was sent to me in May, 1884, by her family physician. Dr. DeWitt, of Mt. Auburn, for the removal of a tumor at the base of the tongue. When young she had been quite delicate and menstruation had been delayed until her nineteenth year. About this time she had a severe attack of "sore throat," the nature of which I was unable to more than conjecture, which left her with a
Chlorhexidine Gluconate–Impregnated Central Access Catheter Dressings as a Cause of Erosive Contact Dermatitis
Authors: Nicole A. Weitz, Christine T. Lauren, Jessica A. Weiser, Nicole R. LeBoeuf, Marc E. Grossman, Katherine Biagas, Maria C. Garzon, Kimberly D. Morel
Journal: JAMA Dermatology (2012)

Chlorhexidine gluconate-impregnated dressings have become widely adopted as a means to reduce the risk for catheter-associated bloodstream infections. These dressings release antiseptic under occlusion onto the skin surrounding catheter insertion sites. Although chlorhexidine gluconate is a known cause of contact dermatitis, the phenotypic range of this adverse effect of chlorhexidine gluconate–impregnated dressings in critically ill patients has not been described.We report 7 cases of erosive irritant contact dermatitis due to chlorhexidine gluconate-impregnated transparent dressings. Six of these patients were children (age range, 4 months to 2 years); the adult was a critically ill 62-year-old man. Four patients were immunosuppressed after solid organ transplant and all were receiving blood pressure support at the time of this reaction. The insertion sites of femoral catheters were involved in all but 1 case; 3 catheter sites were involved in the adult patient. Results of extensive infectious workups were negative. All lesions resolved with discontinuation of the chlorhexidine gluconate-containing dressings, local wound care, and alternative antimicrobial dressings.Erosive contact dermatitis is an under-recognized complication of chlorhexidine gluconate-impregnated dressings. Health care providers should be aware of this risk, particularly in young children and immunosuppressed and/or critically ill patients, who may be more susceptible to the irritant effects of these dressings. When the dressings are used, patients should be monitored closely for skin breakdown.
Enhanced transduction of fibroblasts in transplanted kidney with an adenovirus having an RGD motif in the HI loop
Authors: M. Sandovici, L.E. Deelman, A. Smit-van Oosten, H. van Goor, M.G. Rots, D. de Zeeuw, R.H. Henning
Journal: Kidney International (2005)

Application of gene therapy to the renal graft has a powerful potential to improve the outcome of kidney transplantation and eliminate detrimental side effects associated with systemic therapy, through local expression of immunoregulatory or other protective molecules. However, the search for the optimal vector is still ongoing. In this study, we used a modified adenovirus that has an Arg-Gly-Asp (RGD) motif inserted in the HI loop of the fiber knob, as a successful strategy to transduce the renal graft. Donor Lewis rat kidneys were infused via the renal artery with a solution containing either a fiber-modified adenovirus (AdTL-RGD) or an unmodified adenovirus (AdTL), or with saline. Syngeneic recipients were killed after 3, 7 or 14 days. Efficiency, selectivity, localization, time course of gene expression and side effects were studied using biochemical and immunohistological techniques. Enhanced gene expression was achieved selectively in the transplanted kidney by AdTL-RGD, when compared to AdTL. Transgene expression lasted for at least 2 weeks. With the AdTL-RGD vector, the transgene was abundantly expressed in the renal interstitial fibroblasts. An increase in the number of cytotoxic T lymphocytes accompanied the use of either vector, when compared to saline. These data convincingly show enhanced and selective gene transfer to the fibroblasts of transplanted kidneys using an RGD-modified adenovirus, providing a highly efficient vector system for future therapeutic interventions.
Pivotal Role for Endothelial Tetrahydrobiopterin in Pulmonary Hypertension
Authors: Jeffrey P. Khoo, Lan Zhao, Nicholas J. Alp, Jennifer K. Bendall, Taija Nicoli, Kirk Rockett, Martin R. Wilkins, Keith M. Channon
Journal: Circulation (2005)

Pulmonary hypertension is a fatal disease characterized by vasoconstriction and vascular remodeling. Loss of endothelial nitric oxide bioavailability is implicated in pulmonary hypertension pathogenesis. Recent evidence suggests that the cofactor tetrahydrobiopterin (BH4) is an important regulator of nitric oxide synthase enzymatic function.In the hph-1 mouse with deficient BH4 biosynthesis, BH4 deficiency caused pulmonary hypertension, even in normoxic conditions, and greatly increased susceptibility to hypoxia-induced pulmonary hypertension. In contrast, augmented BH4 synthesis in the endothelium, by targeted transgenic overexpression of GTP-cyclohydrolase I (GCH), prevented hypoxia-induced pulmonary hypertension. Furthermore, specific augmentation of endothelial BH4 in hph-1 mice by crossing with GCH transgenic mice rescued pulmonary hypertension induced by systemic BH4 deficiency. Lung BH4 availability controlled pulmonary vascular tone, right ventricular hypertrophy, and vascular structural remodeling in a dose-dependent manner in both normoxia and hypoxia. Furthermore, BH4 availability had striking effects on the immediate vasoconstriction response to acute hypoxia. These effects of BH4 were mediated through the regulation of nitric oxide compared with superoxide synthesis by endothelial nitric oxide synthase.Endothelial BH4 availability is essential for maintaining pulmonary vascular homeostasis, is a critical mediator in the pathogenesis of pulmonary hypertension, and is a novel therapeutic target.
Increasing Prevalence of Gestational Diabetes Mellitus (GDM) Over Time and by Birth Cohort
Authors: Dana Dabelea, Janet K. Snell-Bergeon, Cynthia L. Hartsfield, Kimberly J. Bischoff, Richard F. Hamman, Robert S. McDuffie
Journal: Diabetes Care (2005)

OBJECTIVE—The prevalence of gestational diabetes mellitus (GDM) varies in direct proportion with the prevalence of type 2 diabetes in a given population or ethnic group. Given that the number of people with diabetes worldwide is expected to increase at record levels through 2030, we examined temporal trends in GDM among diverse ethnic groups. RESEARCH DESIGN AND METHODS—Kaiser Permanente of Colorado (KPCO) has used a standard protocol to universally screen for GDM since 1994. This report is based on 36,403 KPCO singleton pregnancies occurring between 1994 and 2002 and examines trends in GDM prevalence among women with diverse ethnic backgrounds. RESULTS—The prevalence of GDM among KPCO members doubled from 1994 to 2002 (2.1–4.1%, P &amp;lt; 0.001), with significant increases in all racial/ethnic groups. In logistic regression, year of diagnosis (odds ratio [OR] and 95% CI per 1 year = 1.12 [1.09–1.14]), mother’s age (OR per 5 years = 1.7 [1.6–1.8]) and ethnicity other than non-Hispanic white (OR = 2.1 [1.9–2.4]) were all significantly associated with GDM. Birth year remained significant (OR = 1.06, P = 0.006), even after adjusting for prior GDM history. CONCLUSIONS—This study shows that the prevalence of GDM is increasing in a universally screened multiethnic population. The increasing GDM prevalence suggests that the vicious cycle of diabetes in pregnancy initially described among Pima Indians may also be occurring among other U.S. ethnic groups.
Clinical Evaluation of Hostility in Depression
Authors: MYRNA M. WEISSMAN, GERALD L. KLERMAN, EUGENE S. PAYKEL
Journal: American Journal of Psychiatry (1971)

Multiple assessments of hostility in 40 depressed women showed discrepancies in the expression of hostility in different situations. The depressed women were cooperative and not hostile at the initial interview, but they reported a moderate amount of hostile behavior to others. Comparison with a normal sample confirmed that the depressed women showed increased hostile behavior toward others. Moreover, hostility was greater toward those with whom the patient had a close relationship, particularly the spouse and children. The authors discuss these findings in the context of psychoanalytic theory and explore their implications for the adequate evaluation and formulation of a treatment plan.