tbuckley/cabot-search huggingface dataset:
Abstract 2098: Clinical Predictors of Hepatic Fibrosis in Chronic Heart Failure
Authors: Jill Gelow, Akshay Desai, Jonathan Glickman, James Fang
Journal: Circulation (2007)

Background : Chronic heart failure (HF) may lead to irreversible liver injury and cirrhosis. However, the clinical features associated with advanced liver disease in HF patients are poorly defined. We sought to determine the clinical predictors of hepatic fibrosis in HF patients undergoing evaluation for heart transplant or ventricular assist device (VAD).   Methods : Of 873 patients evaluated by the Advanced Heart Disease Service at our hospital from 1995–2006, we identified 61 patients who had liver tissue available for analysis. Pathologic specimens were obtained from the transjugular approach (n=35), at the time of VAD implantation (n=8), or at autopsy (n=18). Electronic medical records were reviewed for medical history and clinical data. Biopsy specimens were reviewed by a dedicated pathologist and scored for hepatic fibrosis. Tissue was insufficient for scoring in 2 patients. Student’s t-test and Chi-Square tests were used to compare clinical characteristics between patients with and without fibrosis.   Results : Of the 59 patients with sufficient tissue for analysis, 47 had hepatic fibrosis on liver biopsy. As shown (Table), patients with hepatic fibrosis had worse renal function and were more likely to have moderate or severe tricuspid regurgitation (TR) (OR 5.0; 95% CI 1.2–21.7) and obstructive or mixed liver function (LFT) abnormalities (OR 5.0; 95% CI 1.4–22.4) than patients without hepatic fibrosis. There was no association between hepatic fibrosis and gender, age, type of cardiomyopathy, duration of symptoms, left or right ventricular function, filling pressures, hepatitis C status or abnormal abdominal imaging.   Conclusions : Hepatic fibrosis is common in patients with advanced HF. Renal insufficiency, significant TR and abnormal LFTs were associated with hepatic fibrosis, but the predictive value of other clinical features is limited. Liver biopsy may be the best assessment of hepatic fibrosis in HF patients prior to transplantation or VAD.
Is Primary Care Practice Sustainable? From the Secretary's Desk
Authors: Marisa A. Montecalvo
Journal: Annals of Internal Medicine (2015)

On Being a Doctor1 September 2015Is Primary Care Practice Sustainable? From the Secretary's DeskMarisa A. Montecalvo, MDMarisa A. Montecalvo, MDFrom New York Medical College, Valhalla, New York.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-0339 Audio Reading - "Is Primary Care Practice Sustainable? From the Secretary's Desk" Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Is Primary Care Practice Sustainable? From the Secretary's Desk," by M.A. Montecalvo. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail As a medical student in 1984, I thought being a primary care provider was the "right thing to do." The soaring costs of health care coupled with a rebound away from specialization led many to pursue primary care internal medicine. I did not. I chose infectious diseases, and for the past 25 years I have worked in a hospital-based academic practice. In an odd turn of events, I recently had some free time, and my husband, an internist, suddenly lost his secretary. Thus, I became the secretary for his solo internal medicine practice, one within a larger organization but an ... Author, Article, and Disclosure InformationAffiliations: From New York Medical College, Valhalla, New York.Corresponding Author: Marisa A. Montecalvo, MD, Division of Infectious Diseases, Department of Medicine, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY 10595; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - "Is Primary Care Practice Sustainable? From the Secretary's Desk" Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Is Primary Care Practice Sustainable? From the Secretary's Desk," by M.A. Montecalvo. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetailsSee AlsoIs Primary Care Practice Sustainable? Marisa A. Montecalvo Is Primary Care Practice Sustainable? Edward Volpintesta Metrics Cited byIs Primary Care Practice Sustainable?Edward Volpintesta, MD 1 September 2015Volume 163, Issue 5Page: 394-395KeywordsElectrocardiographyElectronic medical recordsHealth careInfectious diseasesMedicareResearch laboratoriesSafetySurgeonsSurgeryVaccines ePublished: 1 September 2015 Issue Published: 1 September 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Correctional Psychiatry and Phase Psychotherapy
Authors: ANTONIO J. DY
Journal: American Journal of Psychiatry (1974)

Although prison populations have been shown to be susceptible to all psychiatric disorders, psychiatry in correctional institutions is a very young branch of the discipline; its treatment approach and philosophy are still evolving. The author presents one approach to treating prison inmates that focuses on the different phases inmates go through from the time they are first apprehended to the time they are released from prison.
A memorable anaesthetic: "Shouldn't we do something about the fire?"
Authors: P. Young
Journal: BMJ (2000)

Can this have happened only about 40 years ago? It would be unthinkable now, for many reasons. What makes it memorable is the aspect of saving life; we all, in our disillusioned moments, make cynical jokes about saving life, but on this occasion I may actually have saved several lives all in one go. I was a second year clinical student, doing part of my obstetric attachment in January in one of the colder parts of Britain.

Late one evening, the obstetric registrar asked me if …
Abstract 1340: Disruption of a Hepatocyte Growth Factor/c-Met Receptor Autocrine Loop Severely Impairs the Potency of Pluripotent Adipose Stromal Cells
Authors: Liying Cai, Brian H Johnstone, Zhong Liang, Dmitry Traktuev, Todd G Cook, Jingling Li, Dongni Feng, Kenneth Cornetta, Elliot D Rosen, Keith L March
Journal: Circulation (2007)

Background Paracrine stimulation of endogenous repair, rather than direct tissue regeneration, is increasingly accepted as a major mode of therapeutic stem and progenitor cell action; yet, this principle has not been fully established in vivo . Adipose-derived stem cells (ASCs) secrete many factors and promote reperfusion and tissue repair in ischemia models. RNA interference was used to silence the expression of the abundant protein, hepatocyte growth factor (HGF), to determine its contribution to ASC potency in vivo . Methods and Results Dual-cassette lentiviral vectors, expressing GFP and either a small hairpin RNA (shRNA) specific for HGF mRNA (shHGF) or a control sequence (shCtrl), were used to stably transduce ASCs (ASC-shHGF or ASC-shCtrl). ASC-shHGF secreted 5-fold less HGF, which resulted in a reduced ability of these cells to promote survival, proliferation and migration of mature and progenitor endothelial cells in vitro ( p &lt;0.01). HGF knockdown also severely impaired the ability of ASCs to promote reperfusion in a mouse hindlimb ischemia model. Perfusion of the ischemic leg at 15 d in mice treated with ASC-Ctrl was 84±4%, compared to only 69±5% for ASC-shHGF ( p &lt;0.05). Even so, ASC-shHGF retained residual activity as indicated by greater reperfusion ( p &lt;0.05) than with saline treatment (58±6%). Capillary densities in ischemic tissues from each group followed a similar rank order (ASC-Ctrl&gt;ASC-shHGF&gt;saline) ( p &lt;0.05 between each group). While there was no difference in total GFP + cells in ischemic limbs at 5 d after infusion, indicating similar homing potentials, 3-fold fewer ASC-shHGF were present in ischemic tissues at 15 d compared to ASC-shCtrl ( p &lt;0.01). This was accompanied by an increase in TUNEL-positive ASC-shHGF cells (61 ± 0.1%) compared to ASC-Ctrl (41% ± 3.2%) in ischemic tissues at 5 d ( p &lt;0.01); suggesting that attenuated potency of ASC-shHGF was related to reduced survival in ischemic tissues. Conclusions These results indicate that secretion of HGF is critically important for ASC potency. In addition to promoting endogenous repair, the data suggest that an important effect of HGF is autocrine promotion of ASC survival in ischemic tissue. Enhanced donor cell survival is an important goal for increasing the efficacy of cell therapy.
Smart cards are expensive and easily damaged
Authors: R. Fawdry
Journal: BMJ (1995)

approach.Case finding, notification of cases, enhanced surveillance, and modification of the environment in which the disease exists are strategies that can usefully be applied to bullying.Doctors are perhaps better placed than parents to push this approach.We need also to recruit the vast majority of children who are neither bullies nor victims.In my survey of a secondary school in Nottingham the response of three quarters of children to the bully- ing of another child was that of a bystander who does not want to get involved; a fifth said they could be persuaded to join in (unpublished data).Whitney and Smith found that most children did nothing to help victims either because they did not know how to help or because they thought it was not their business.2Perhaps this statistic would make a good indicator of the success of an anti- bullying programme.Children should be taught not only not to bully others but also not to tolerate bullying of others.Health care staff working with children in the primary care setting have a vested interest in working in concert with school authorities towards this ideal: they will have less morbidity related to bullying to deal with.One approach would be to regard the detection of a case of bullying as an indication of serious problems in the interrelation- ships of children in the school.As in established child protection procedures, a case conference should be called of all professionals concerned and a strategy agreed for the prevention of future cases.
Surgical Aspects of Esophageal Disease
Authors: Joseph B. Zwischenberger, Clare Savage, Akhil Bidani
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

Esophageal perforation presents as an emergency because treatment delay reduces survival. Iatrogenic perforation, spontaneous perforation, and trauma account for a large majority of esophageal perforations (1–4). Endoscopic procedures are the most common cause of iatrogenic esophageal perforation, with the cricopharyngeal area most commonly injured (1). Midand distal esophageal perforations usually result from biopsies to document malignancy or from dilatations. Infrequent causes of iatrogenic esophageal perforation include difficult endotracheal intubation, blind insertion of a minitracheostomy, resection of lung cancer, blind dissection of the abdominal esophagus, operations on the cervical spine, thyroidectomy, and palliative intubation, stenting, or laser treatment of esophageal tumors. Boerhaave’s syndrome, esophageal rupture induced by straining, is the most common type of spontaneous perforation. Ruptures usually occur in the left posterior aspect of the lower esophagus and are five times more frequent in males (1). Severe reflux and candidal, herpetic, and immunodeficiency infections also cause pathologic perforations. Destruction of the esophageal wall by carcinoma may cause mediastinal or pleural perforations. Esophageal perforations from penetrating or blunt trauma are frequently overshadowed by associated injuries and have a poor prognosis if unrecognized (1, 5, 6).
Experience of using diaskintest in adult patients with tuberculosis and non-tuberculosis respiratory diseases in a regional TB hospital
Authors: Liudmila Pankratova, Natalia Kazimirova, Inna Volchkova, Artem Zlatorev
Journal: European Respiratory Journal (2013)

The study of a new Diaskintest (DST) diagnostic test for tuberculosis was conducted to assess the sensitivity and specificity of the test. A total of 370 patients aged 17 to 82 years, treated in the TB hospital in Saratov (Russia) in 2010-2012, included:

• 257 patients with tuberculosis (TB) (including 42 patients with HIV infection –

16.3%)

• 113 patients with non-tuberculous respiratory diseases (NTRD) (including 3 patients with HIV infection - 2.7%).

In the TB group, a positive DST result was detected in 73.9% (taking into account any papule size, mean size 10.6 ± 9.18 mm). In the non-HIV TB group, the number of responders was 78.1%, M 11.2 ± 8.97 mm. In the group of HIV-positive TB patients only 52.4% reacted, M 7.4 ± 9.70 (p< 0.01).

In the NTRD group, a positive reaction to DST was observed in 40.1% of cases (including patients with pneumonia - in 36.5% of cases; with COPD - in 55.6%; with benign tumors - in 55.6%; with malignant tumors - in 41.7%; with sarcoidosis – in 33.4%; with residual changes after an inflammatory disease – in 37.5%).

CONCLUSION

According to our data, the sensitivity of Diaskintest diagnostic test in patients with pulmonary tuberculosis was 78.1%. A positive response to the DST was also noted in 40.1% (p< 0.001) of patients with non-tuberculous lung diseases.
Randomized Controlled Phase 2 Study (RCT) with Tivantinib in pre-treated hepatocellular carcinoma(HCC): Efficacy, Safety, and MET-analysis
Authors: Ivan Borbath
Journal: Hepatology (2012)

Background: Tivantinib (T), a selective, oral inhibitor of MET, the hepatocyte growth factor (HGF) receptor, was successfully tested in HCC patients (pts) in Phase 1 studies as monotherapy and with sorafenib. Methods: Multi center RCT; key selection criteria: unresectable HCC, 1 prior systemic therapy, PS  2+ in >50% of tumor cells by immunohistochemistry) patients, safety. Results: 107 enrolled patients, 71 on T (TA: 38, TB: 33), 36 on P. Pt characteristics were generally well balanced, also when grouped by MET status. In ITT, median TTP was: 1.6 vs 1.4 mos (HR 0.64, 90%CI 0.43-0.94; P=0.04). Most promising results were obtained in the MET High group, TTP: 2.7 vs 1.4 mos (HR 0.43, 95%CI 0.19-0.97; P=0.03), DCR (95%CI): 50% (28–72%) vs 20% (4–48%), OS 7.2 vs 3.8 mos (HR 0.38, 95%CI 0.18-0.81, P=0.01). Prognostic role of several factors was evaluated in the P group: MET High patients had a 60% higher risk of progression and a 195% higher risk of death; high HGF (cutoff: median value of 2307 pg/mL) patients showed a similar trend in terms of TTP and OS. In MET High patients on T, the most common AEs were fatigue (7, 31.7%) and asthenia (6, 27.3%). Blood levels (PK) of T were higher than in non HCC studies. No relation between MET and HBV/HCV, HGF or PK was observed. Strict dose reduction guidelines and the TB starting dose dramatically reduced the G≥3 neutropenia rate without changing efficacy. Conclusions: This study showed MET positivity is an independent, strong, negative prognostic factor in pretreated HCC patients. MET High patients on tivantinib achieved a 163% survival improvement compared to placebo. Biopsy is key to establish the MET status. Larger studies with tivantinib are being planned in MET High HCC patients.
2009 Pandemic influenza A (H1N1) virus infections - Chicago, Illinois, April-July 2009.
Authors: K. A. Ritger, R. C. Jones, K. N. Weaver, E. Ramirez, S. Smith, J. Y. Morita, C. J. Lohff, S. B. Black, J. D. Jones, W. Wong, U. Samala, S. I. Gerber, G. Dizikes, J. Nawrocki, J. Price, L. A. Hicks, J. E. Staples, M. Fischer, D. Swerdlow, S. Lyss, F. Serdarevic, K. Janusz, J. Cortes
Journal: MMWR Morbidity and Mortality Weekly Report (2009)
Influence of Mannan Binding Lectin (MBL) serum levels on the risk of infection during chemotherapy induced neutropenia (N) in adult haematological cancer patients (pts)
Authors: M. Vekemans, A. Georgala, C. Heymans, M. Paesmans, J. Klastersky, J. Robinson, O. Marchetti, A. Ferrant, K. Petersen, M. Aoun
Journal: Journal of Clinical Oncology (2005)

8147 Background MBL deficiency (MBL-D)with an incidence of approximately 30% is probably the most common defect of the innate immune system. With an intact immune system the defect is of limited importance, while during chemotherapy induced-N the MBL-D may result in an increased risk of nfections. Methods The study was a prospective observational one and all pts with haematological malignancies admitted for at least one chemotherapy cycle from Dec. 2001 through Dec. 2003 were eligible. MBL level and genotype, fever, neutrophil counts and signs of infectious episodes were assessed following each chemotherapy cycle. MBL-D was defined as <500 ng/mL. MBL assessments were unknown to investigators during the study. Our objective is to investigate if MBL-B was associated with more frequent and/or severe infections. Poisson regression models were used for analysing counts of infections. Kaplan-Meier estimates and log-rank tests were used for analysing time to event variables. Results Overall 255 pts were eligible for the study. 62 (24%) of the pts had MBL-D, 241 developed N and are the basis of this report. The rate of severe infections during N was higher for the MBL-D group, 4.46/100 days vs. 3.44/100 days (P=0.10) and significantly higher when acute leukemic pts were excluded (4.99/100 days versus 2.96, p=0.01). Time to severe infection based on days of N was significantly shorter in the MBL-D population (median of 10 days compared to 21 days, p=0.05) and the impact of MBL-D was strengthened when acute leukemic pts were excluded (medians of 8 versus 35 days, p=0.01). No difference in the occurrences of febrile N was found between the two groups (P=0.35). Conclusions MBL-D in N haematological pts was associated with more frequent severe infection, especially when acute leukemic pts were excluded. This finding supports the importance of MBL mesurement with intensive monitoring for signs of infection in this group of pts at increased risk and strengthens the hypothesis of MBL replacement therapy. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Natimmune Natimmune Natimmune
Anaemia in patients with aortic stenosis: influence on long-term prognosis
Authors: Arnold C.T. Ng, William K. F. Kong, Vasileios Kamperidis, Matteo Bertini, M. Louisa Antoni, Dominic Y. Leung, Nina Ajmone Marsan, Victoria Delgado, Jeroen J. Bax
Journal: European Journal of Heart Failure (2015)
A Definition of Proximal and Distal Tubular Compliance
Authors: Stanley Cortell, F. John Gennari, Michael Davidman, William H. Bossert, William B. Schwartz, Melvin L. Ponte
Journal: Journal of Clinical Investigation (1973)

Micropuncture studies were carried out in the rat to evaluate the in situ distensibility characteristics of the proximal and distal tubules under a variety of experimental conditions. In the first phase, we determined the response of tubular diameter (D) to changes in tubular pressure (P) induced by partially obstructing single tubules. The response observed under these conditions (i.e., when interstitial pressure is presumed to be constant) has been defined as the compliance of the tubule. Over the range of tubular pressures studied (10-35 mm Hg for the proximal tubule, 5-25 mm Hg for the distal tubule) the compliance characteristics of the proximal and distal tubule were found to be markedly different; the proximal tubular pressure-diameter relationship was linear, DeltaD/DeltaP = 0.45 mum/mm Hg, whereas the distal pressure-diameter relationship was curvilinear, DeltaD/DeltaP = c(-0.1xP+2.2). In the second phase we used the compliance data to construct a series of theoretical pressure-diameter curves that define the response of the tubule to increments in interstitial as well as intratubular pressure. These curves indicate that changes in distal diameter should provide a sensitive index of a rise in interstitial pressure under conditions in which the transtubular pressure gradient is increased by a small amount, but that proximal diameter should provide a more sensitive index of changes in interstitial pressure when the transtubular pressure gradient is increased by a large amount. In subsequent experiments in which furosemide was administered, we observed that the pressure-diameter relationships for both the proximal and distal tubule were indistinguishable from the compliance curves, a finding consistent with the interpretation that interstitial pressure was not appreciably changed from control. By contrast, when mannitol was administered, both proximal and distal tubular pressure-diameter relationships were significantly altered in a fashion consistent with a large increase in interstitial pressure. Neither with furosemide nor mannitol administration did it appear likely that significant changes in tubular compliance could account for the observed behavior of the tubule.Finally, we propose that a knowledge of tubular compliance will be useful in exploring the interrelationships between tubular and peritubular pressures, tubular anatomy, and transtubular ionic permeability. Recent studies linking changes in the geometry of lateral intercellular spaces of the tubule to changes in passive ion movement suggest that an investigation of such anatomical-functional correlates should be productive.
Bendamustine and rituximab combination in the management of chronic lymphocytic leukemia-associated autoimmune hemolytic anemia: A multicentric retrospective study of the French CLL intergroup (GCFLLC/MW and GOELAMS)
Authors: Anne Quinquenel, Christophe Willekens, Jehan Dupuis, Bruno Royer, Loic Ysebaert, S. De Guibert, Anne‐Sophie Michallet, Pierre Feugier, Romain Guieze, Vincent Levy, Alain Delmer
Journal: American Journal of Hematology (2014)

We report our experience on bendamustine and rituximab (BR) combination in 26 patients with chronic lymphocytic leukemia (CLL) complicated by autoimmune hemolytic anemia (AIHA). At the time of BR initiation, 88% of the patients had already been treated for AIHA and CLL was progressive regardless of AIHA in all patients but one. Overall response rates were 81% for AIHA and 77% for CLL. Median time to next treatment was 28.3 months and 26.2 months for AIHA and CLL, respectively. BR therapy may represent a good and safe therapeutic option in this setting where adequate control of CLL seems important for long-term AIHA response.
Multifactorial Determinants of Functional Capacity in Peripheral Arterial Disease
Authors: Justin D. Anderson, Frederick H. Epstein, Craig H. Meyer, Klaus D. Hagspiel, Hongkun Wang, Stuart S. Berr, Nancy L. Harthun, Arthur Weltman, Joseph M. DiMaria, Amy M. West, Christopher M. Kramer
Journal: Journal of the American College of Cardiology (2009)
Biopsychobehavioral correlates of insomnia, V: Clinical characteristics and behavioral correlates
Authors: Joyce D Kales, Anthony Kales, Edward O. Bixler, Constantin R. Soldatos, roger J. Cadieux, Glenn J. Kashurba, Antonio Vela-Bueno
Journal: American Journal of Psychiatry (1984)

The authors compared two large samples of insomniac patients with a group of control subjects. Sleep difficulty usually began before the age of 40 and generally persisted for many years (average duration, 14 years). Several characteristic behaviors were correlated with the symptom of insomnia. During the day and at bedtime, patients reported difficulty relaxing and frequently described themselves as tense, anxious, overly preoccupied, worried, and depressed. Reports of poor mental and physical health were far more prevalent in the insomniac patients than in control subjects. These results indicate that psychiatric factors need to be a primary focus in the multidimensional treatment of chronic insomnia.