tbuckley/cabot-search huggingface dataset:
Critical Care Use during the Course of Serious Illness
Authors: Theodore J. Iwashyna
Journal: American Journal of Respiratory and Critical Care Medicine (2004)

Despite its expense and importance, it is unknown how common critical care use is. We describe longitudinal patterns of critical care use among a nationally representative cohort of elderly patients monitored from the onset of common serious illnesses. A retrospective population-based cohort study of elderly patients in fee-for-service Medicare is used, with 1,108,060 Medicare beneficiaries at least 68 years of age and newly diagnosed with serious illnesses: 1 of 9 malignancies, stroke, congestive heart failure, hip fracture, or myocardial infarction. Medicare inpatient hospital claims from diagnosis until death (65.1%) or fixed-right censoring (more than 4 years) were reviewed. Distinct hospitalizations involving critical care use (intensive care unit or critical care unit) were counted and associated reimbursements were assessed; repeated use was defined as five or more such hospitalizations. Of the cohort, 54.9% used critical care at some time after diagnosis. Older patients were much less likely to ever use critical care (odds ratio, 0.31; comparing patients more than 90 years old with those 68-70 years old), even after adjustment. A total of 31,348 patients (2.8%) were repeated users of critical care; they accounted for 3.6 billion dollars in hospital charges and 1.4 billion dollars in Medicare reimbursement. We conclude that critical care use is common in serious chronic illness and is not associated solely with preterminal hospitalizations. Use is uneven, and a minority of patients who repeatedly use critical care account for disproportionate costs.
Quantitation of venous clot lysis with the D-dimer immunoassay during fibrinolytic therapy requires correction for soluble fibrin degradation.
Authors: B Brenner, C W Francis, S Totterman, C M Kessler, A K Rao, R Rubin, H C Kwaan, K R Gabriel, V J Marder
Journal: Circulation (1990)

Plasma cross-linked fibrin-degradation products were analyzed using a D-dimer (DD) immunoassay in patients with deep vein thrombosis (DVT) or acute myocardial infarction (MI) treated with fibrinolytic therapy, and the results were correlated with clot lysis documented angiographically. In 13 patients with DVT, the mean DD concentration increased 10-fold (1,074 +/- 252 to 10,333 +/- 1,004 ng/ml) during therapy, but neither the peak level nor the DD concentration integrated over the course of therapy correlated with clot lysis. Since plasma DD can derive from degradation of soluble plasma fibrin as well as from thrombi, the contribution of the former was estimated by in vitro incubation of the pretreatment plasma with plasminogen activator. Subtraction of this value from the measured posttreatment DD concentration provided a "corrected" level that represented DD originating from lysis of thrombi. This modification resulted in improved correlation of DD levels with clot lysis. The mean corrected peak DD was higher in patients with successful thrombolysis (8,780 +/- 1,352 ng/ml) compared with patients without lysis (3,075 +/- 589 ng/ml, p less than 0.001). There was a moderate correlation between the volume of clot lysed and the corrected peak DD (r = 0.62) and a higher correlation with the corrected DD integrated over the course of treatment (r = 0.97). By contrast, the corrected DD concentrations were near zero in patients treated for MI with or without thrombolytic reperfusion, suggesting that fibrin in small coronary thrombi did not contribute significantly to total plasma DD during therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Ideal Cardiovascular Health Predicts Lower Risks of Myocardial Infarction, Stroke, and Vascular Death Across Whites, Blacks, and Hispanics
Authors: Chuanhui Dong, Tatjana Rundek, Clinton B. Wright, Zane Anwar, Mitchell S.V. Elkind, Ralph L. Sacco
Journal: Circulation (2012)

Background— Evidence of the relationship of cardiovascular health (CVH), defined by the American Heart Association, and specific cardiovascular outcomes is lacking, particularly among Hispanics. This study sought to evaluate the relationship between the number of ideal CVH metrics and cardiovascular risk, overall and by event subtype, in a multiethnic community-based prospective cohort. Methods and Results— A total of 2981 subjects (mean age, 69±10 years; 54% Caribbean Hispanic, 25% black, 21% white) free of myocardial infarction and stroke at baseline in the Northern Manhattan Study were prospectively followed up (median follow-up, 11 years). The relationship between the number of ideal CVH metrics and the risk of cardiovascular disease, including myocardial infarction, stroke, and vascular death, was investigated. Overall, a strong gradient relationship was observed between the adjusted hazard ratios for cardiovascular disease and the number of ideal CVH metrics: 0.73 (95% confidence interval, 0.60–0.89), 0.61 (95% confidence interval, 0.50–0.76), 0.49 (95% confidence interval, 0.38–0.63), and 0.41 (95% confidence interval, 0.26–0.63) for those having 2, 3, 4, and 5 to 6 ideal CVH metrics, respectively, compared with those having 0 to 1 ideal CVH metrics ( P for trend &lt;0.0001). Similar graded relationships were found between the number of ideal CVH metrics and the adjusted incidence rate for each specific outcome and among whites, blacks, and Caribbean Hispanics. Conclusions— Our findings demonstrated a steep gradient relationship between ideal CVH and individual cardiovascular disease end points, including stroke, that was similar for whites, blacks, and Caribbean Hispanics. This evidence supports the application of the AHA ideal cardiovascular health metrics for cardiovascular disease risk assessment and health promotion for all Americans regardless of race-ethnic background.
Abstract 2688: Establishment of high avidity CTL clones induced by HLA-A2 restricted glypican-3 (GPC3) peptide vaccine
Authors: Toshiaki Yoshikawa, Shiro Suzuki, Munehide Nakatsugawa, Hirofumi Shirakawa, Daisuke Nobuoka, Noriko Sakemura, Yutaka Motomura, Tetsuya Nakatsura
Journal: Cancer Research (2011)

Abstract Glypican-3 (GPC3) is an onco-fetal antigen which is overexpressed in human hepatocellular carcinoma (HCC) and that among normal tissues it is slightly expressed in placenta and embryonic liver. Previously, we have identified a HLA-A2-restricted GPC3144-152 (FVGEFFTDV) peptide which can induce GPC3-reactive cytotoxic T lymphocytes (CTLs) without inducing autoimmunity. In the present study, we performed phase I clinical trial of HLA-A2 restricted GPC3-derived peptide vaccine to the 14 patients with advanced HCC. Immunological responses were analyzed by ex vivo IFN-γ Enzyme-linked immunospot (ELISPOT) assay. The frequency of GPC3 peptide specific CTLs after vaccinations (mean, 96; range, 5-441) was statistically significantly larger than that before vaccination (mean, 6.5; range, 0-43) (P &amp;lt; 0.01). An increase of the GPC3 peptide specific CTL frequency was detected in 12 (86%) of 14 patients after vaccination. Additionally, there was a significant correlation between the maximum value of GPC3 peptide specific CTLs after vaccination and dose of peptide injected (P = 0.0166, r = 0.665). Moreover, we established some GPC3 peptide specific CTL clones from PBMCs of patients vaccinated with GPC3 peptide by single cell sort using Dextramer and CD107a antibody. These CTL clones were high avidity CTLs (10−10M and 10−11M) and could recognize HCC cell lines expressing GPC3 in a HLA-class I-restricted manner. These results suggest that tumor-cytolytic T cells are indeed elicited in patients after vaccination. Now we investigate whether the GPC3 based immunotherapy have possibility of the application for other GPC3 expressing cancers including melanoma, clear cell carcinoma of the ovary, pediatric cancer or not, using established GPC3 peptide specific CTL clone. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 2688. doi:10.1158/1538-7445.AM2011-2688
Epidemiologic Studies of Obesity
Authors: REUEL A. STALLONES
Journal: Annals of Internal Medicine (1985)

Epidemiologic methods quantitatively assess the relations between body weight and general or cause-specific morbidity and mortality. This research is especially difficult because of the complex interrelations between weight and diet, physical activity, cigarette smoking, blood pressure, diabetes, ischemic heart disease, and other conditions. The interactions are not easily summarized with available mathematical models. Weight may be either a dependent or an independent variable, according to the analysis. Epidemiologic studies of body weight are subject not only to biases of sampling and selection, but also marked difficulties in definition and measurement. There are variations of interpretation, sometimes even of the same set of data. However, epidemiology continues to uncover important information that is consistent across studies, and that may be used to formulate programs for disease prevention.
Restoring creativity to the dying patient.
Authors: D R Frampton
Journal: BMJ (1986)

The hospices have largely directed their attention towards maintain? ing excellence in nursing care and control of symptoms, providing counselling and spiritual support, setting up and running home care services, providing bereavement support, and caring for the carers. Much less attention has been paid (by the medical profession) to the question of what should be done with the patient when he is symptom free, or nearly so, and expertly nursed in the appropriate environment. How do we put flesh on the phrase living to the end for those who for reasons of temperament, lethargy induced by disease, or emotional preoccupation cannot rise above their circumstances?
Short-Term Psychotherapy with College Students
Authors: Graham B. Blaine
Journal: New England Journal of Medicine (1957)

SHORT-term psychotherapy is particularly effective with patients in the college age group. Although it can be a useful method with adults and children, treatment at these ages usually must be long term.Child psychiatrists utilize a type of therapy that involves the therapist to a greater degree than the patient. Because of the language barrier, communication must be through the symbolism of play and the direct expression of emotion instead of the more easily understood symbolism of speech. It takes a long time to understand fully what the child is trying to get across and even longer to establish a . . .
Observations on interpretation of blood alcohol levels derived from analysis of urine.
Authors: J. P. Payne, D. V. Foster, D. W. Hill, D. G. Wood
Journal: BMJ (1967)

Facial in the treatment of this condition is lacking, but it is possible that in really adequate dosage it would prove as effective as the less convenient pituitary hormone: a careful trial of early treatment with the oral preparation would be a very suitable project for the Research Committee of the College of General Practitioners.
Effect of a Short Course of Prednisone in the Prevention of Early Relapse after the Emergency Room Treatment of Acute Asthma
Authors: Kenneth R. Chapman, P. Richard Verbeek, John G. White, Anthony S. Rebuck
Journal: New England Journal of Medicine (1991)

Relapse after the treatment of acute asthma in the emergency room is common (occurring in 25 to 30 percent of cases) and is not accurately predicted by any available measurements. We studied the usefulness of prednisone in reducing this high rate of relapse.One hundred twenty-two patients treated in the emergency room for acute exacerbations of asthma were assigned in a randomized, double-blind fashion to receive at discharge either prednisone for eight days (the dose being tapered from 40 to 0 mg per day) or matching placebo. Ninety-three were subsequently discharged from the emergency room and participated in the trial. On days 1, 7, and 14 after discharge, the patients were assessed during home visits with spirometry and diary-card review; they were contacted by telephone on day 21. Relapse was defined as an unscheduled medical visit occasioned by the patient's perceived need for further asthma treatment.The overall risk of relapse was significantly lower in the prednisone group (P less than 0.05), with a significantly reduced rate of relapse during the first 10 days of follow-up (3 of 48, as compared with 11 of 45 in the placebo group; P less than 0.05). Thereafter (days 11 through 21), there was no further significant difference in relapse rates between treatment groups (five in the prednisone group and six in the placebo group). During the first week after discharge, patients receiving prednisone reported significantly lower mean (+/- SD) daily symptom scores for shortness of breath (1.4 +/- 0.4 vs. 2.5 +/- 0.4, P less than 0.01) and less frequent use of an inhaled bronchodilator (5.2 +/- 0.5 vs. 6.9 +/- 0.2 puffs per day, P less than 0.05) than patients receiving placebo. Subsequently, symptom scores and bronchodilator use were similar in the two groups.A short course of prednisone reduced early relapse rates after the treatment of acute asthma in the emergency room, an effect limited to the period of steroid administration.
Genetic correction of the fetal brain increases the lifespan of mice with the severe multisystemic disease mucopolysaccharidosis type VII
Authors: Brian A. Karolewski, John H. Wolfe
Journal: Molecular Therapy (2006)

Neurogenetic diseases typically have globally distributed lesions, and pathology usually develops early in life, requiring early diagnosis and treatment. We investigated the effects of transferring a corrective gene into the fetal brain before the onset of pathology in the mucopolysaccharidosis (MPS) type VII mouse, a model of a lysosomal storage disease. A single adeno-associated virus serotype 1 vector injection into the ventricle at 15.5 days of gestation resulted in widespread distribution and lifelong expression of the normal gene in the brain and spinal cord. The normal enzyme was distributed to neighboring cells (as expected) and completely prevented the development of storage lesions throughout the central nervous system (CNS). No vector transfer was found outside the CNS, including the gonads, but a small amount of enzyme was present in visceral tissues, consistent with transfer from cerebrospinal fluid to venous circulation. The enzyme was present peripherally in such low amounts that it did not result in the severe skeletal dysmorphology that occurs readily when systemic treatment is used in neonates. However, the survival probability of the treated animals was significantly increased. The results suggest that the nervous system disease may contribute to the overall physiologic health of the animal in this type of disease.
Stimulation of Toll-like receptor 3 and 4 induces interleukin-1β maturation by caspase-8
Authors: Jonathan Maelfait, Elisabeth Vercammen, Sophie Janssens, Peter Schotte, Mira Haegman, Stefan Magez, Rudi Beyaert
Journal: The Journal of Experimental Medicine (2008)

The cytokine interleukin (IL)-1β is a key mediator of the inflammatory response and has been implicated in the pathophysiology of acute and chronic inflammation. IL-1β is synthesized in response to many stimuli as an inactive pro–IL-1β precursor protein that is further processed by caspase-1 into mature IL-1β, which is the secreted biologically active form of the cytokine. Although stimulation of membrane-bound Toll-like receptors (TLRs) up-regulates pro–IL-1β expression, activation of caspase-1 is believed to be mainly initiated by cytosolic Nod-like receptors. In this study, we show that polyinosinic:polycytidylic acid (poly[I:C]) and lipopolysaccharide stimulation of macrophages induces pro–IL-1β processing via a Toll/IL-1R domain–containing adaptor-inducing interferon-β–dependent signaling pathway that is initiated by TLR3 and TLR4, respectively. Ribonucleic acid interference (RNAi)–mediated knockdown of the intracellular receptors NALP3 or MDA5 did not affect poly(I:C)-induced pro–IL-1β processing. Surprisingly, poly(I:C)- and LPS-induced pro–IL-1β processing still occurred in caspase-1–deficient cells. In contrast, pro–IL-1β processing was inhibited by caspase-8 peptide inhibitors, CrmA or vFLIP expression, and caspase-8 knockdown via RNAi, indicating an essential role for caspase-8. Moreover, recombinant caspase-8 was able to cleave pro–IL-1β in vitro at exactly the same site as caspase-1. These results implicate a novel role for caspase-8 in the production of biologically active IL-1β in response to TLR3 and TLR4 stimulation.
Blastomycosis-like pyoderma in a man with AIDS
Authors: Jeffrey J. Crowley, Youn H. Kim
Journal: Journal of the American Academy of Dermatology (1997)

Blastomycosis-like pyoderma is rare and usually occurs only in patients who are locally or systemically immunocompromised. It most likely represents an unusual exaggerated tissue reaction to prolonged primary or secondary bacterial infection. 1 The lesions consist of erythematous indurated plaques that may be verrucous. Histologic examination shows pseudoepithelial hyperplasia with abscesses. Culture reveals one or more pathogenic bacteria, including streptococci, staphylococci, and gram-negative species.
A randomised controlled trial of the reciprocating syringe in arthrocentesis
Authors: H T Draeger
Journal: Annals of the Rheumatic Diseases (2005)

Long-term synaptic plasticity is a putative mechanism for learning in adults. However, there is little understanding of how synaptic plasticity mechanisms develop or whether their maturation depends on experience. Since inhibitory synapses are particularly malleable to sensory stimulation, long-lasting potentiation of inhibitory synapses was characterized in auditory thalamocortical slices. Intracortical high-frequency electrical stimulation led to a 67% increase in inhibitory synaptic currents. In the absence of stimulation, inhibitory potentiation was induced by a brief exposure to exogenous brain-derived neurotrophic factor (BDNF). BDNF exposure occluded any additional potentiation by high-frequency afferent stimulation, suggesting that BDNF signaling is sufficient to account for inhibitory potentiation. Moreover, inhibitory potentiation was reduced significantly by extracellular application of a BDNF scavenger or by intracellular blockade of BDNF receptor [tropomyosin-related kinase B (TrkB)] signaling. In contrast, glutamatergic or GABAergic antagonists did not prevent the induction of inhibitory potentiation. Since BDNF and TrkB expression are influenced strongly by activity, we predicted that inhibitory potentiation would be diminished by manipulations that decrease central auditory activity, such as hearing loss. Two forms of hearing loss were examined: conductive hearing loss in which the cochleae are not damaged or sensorineural hearing loss in which both cochleae are removed. Both forms of hearing loss were found to reduce significantly the magnitude of inhibitory potentiation. These data indicate that early experience is necessary for the normal development of BDNF-mediated long-lasting inhibitory potentiation, which may be associated with perceptual deficits at later ages.
INR reporting in Canadian medical laboratories
Authors: M. Andrew, M. Brigden, J. Bormanis, M. Cruickshank, W. Geerts, A. Giles, J. Hirsh, R. Hull, J. Johnson, M. Johnston, J. Leclerc, M. Mant, G. Pineo, S. Robinson, D. Robitaille, S. Rudledge Harding, M. F. Scully, A. G. Turpie, L. Vickars, L. Whitman
Journal: American Journal of Hematology (1995)

A written survey of all licensed medical laboratories in Canada performing coagulation testing was performed to investigate the level of knowledge and overall usage of the INR system for reporting prothrombin time results in medical laboratories. There was an overall response rate of 857 of 1,228 laboratories surveyed. Fifty-seven percent of responding laboratories utilized some format of INR reporting. The ISI of the individual thromboplastin utilized was known by 89% of laboratories. The ISI of the thromboplastin utilized was known to be specific for the particular reagent/instrument combination in 44% of cases. Fifty-five percent of client physicians preferred PT results to be reported in seconds while 42% desired an INR format. The situation in Canada is similar to the United States in that further education regarding the INR system for PT reporting is required by both medical laboratories and physicians.
Antibodies to Native and Denatured Deoxyribonucleic Acid in Systemic Lupus Erythematosus*
Authors: Roberto Arana, Maxime Seligmann
Journal: Journal of Clinical Investigation (1967)

The relative reactivities with native and denatured DNA of 35 lupus sera were investigated by quantitative complement fixation and precipitin studies and showed great variations. The use of purified native DNA demonstrated that, in at least 22 of these 35 sera, the anti-DNA antibodies reacted with the native form, independently of denatured contaminants. Systemic lupus sera were shown to contain three main types of DNA antibodies: those reacting only with denatured DNA, those reacting to the same extent with both forms of DNA, and those reacting preferentially with native DNA. In some instances, the latter antibodies fix complement and precipitate only with native DNA but are inhibited by the denatured form. This finding points to the importance of conformation in the antigenic structure of DNA. The simultaneous occurrence of different varieties of DNA antibodies was demonstrated in several sera. Evidence was obtained that some of these human antibodies to DNA can belong to the IgM class. Thus, DNA antibodies from systemic lupus patients differ in many respects from most of the experimentally produced antibodies capable of reacting with DNA.
Bone Imaging in the Diagnosis of Fractures of the Femur and Pelvis in the Sixth to Tenth Decades
Authors: JAMES D. SLAVIN, JOHN MATHEWS, RICHARD P. SPENCER
Journal: Clinical Nuclear Medicine (1986)

A review was made of the records of 24 consecutive trauma patients (aged 55-94 years) who had under gone radiographic examinations and a positive bone image of the femur or pelvis. There was considerable discordance between the radiographs and the bone images. Initially, 25% of the radiographs were interpreted as positive. Even after additional radiographs and retrospective review, only 38% of the x-ray studies were positive. Bone imaging was a useful adjunct in these patients, both to confirm or exclude suspected fractures and to detect occult fractures. The necessity of delaying bone imaging for several days after the trauma was discussed.
Statistical Studies on Anorexia nervosa in Japan: Detailed Clinical Data on 1,011 Patients
Authors: Hiroyuki Suematsu, Hitoshi Ishikawa, Tomifusa Kuboki, Takako Ito
Journal: Psychotherapy and Psychosomatics (1985)

Statistical studies on anorexia nervosa in Japan were carried out by our research group. Questionnaires were sent to physicians at 1,030 representative institutions throughout Japan and data were collected from 315 institutions. The total number of patients with anorexia nervosa in 1981 was 940 outpatients and 372 inpatients. The number of patients in 1981 was twice as high as in 1976. Detailed data on 1,011 patients were investigated. As most of the patients had certain endocrinological abnormalities which improved after weight gain, indications are that at least a part of the endocrinological abnormalities might be secondary changes due to weight loss.