tbuckley/cabot-search huggingface dataset:
A hemodynamically responsive antitachycardia system. Development and basis for design in humans.
Authors: T J Cohen, L B Liem
Journal: Circulation (1990)

Current automatic implantable cardioverter-defibrillators detect tachyarrhythmias primarily by rate-only algorithms and cannot adequately distinguish hemodynamically stable from unstable tachyarrhythmias. The responses of right atrial (mean) and right ventricular pressures (mean, systolic, diastolic, and pulse) to 64 induced and paced supraventricular and ventricular tachyarrhythmias were studied in 10 patients (left ventricular ejection fraction of 32 +/- 6%) to develop an algorithm capable of differentiating stable from unstable rhythms. Tachyarrhythmias were defined as hemodynamically unstable when mean arterial pressure decreased by 25 mm Hg or more during 15 seconds. Mean right atrial, right ventricular systolic, and right ventricular pulse pressures were found to be useful in distinguishing the hemodynamic significance of a tachyarrhythmia. A combined detection algorithm was developed that identified a hemodynamically unstable rhythm when the heart rate was 150 beats/min or more and mean right atrial pressure increased by 4 mm Hg or more and right ventricular systolic pressure decreased by 5 mm Hg or more during 15 seconds. This algorithm was then applied to the next 20 consecutive patients (left ventricular ejection fraction of 34 +/- 4%) and compared with the current rate-only algorithm (heart rate of 150 beats/min or more) in 143 tachyarrhythmias, and the sensitivity and specificity for detection of hemodynamically unstable tachyarrhythmias were determined. The rate-only detection algorithm had 100% sensitivity but only 68% specificity for detection of unstable tachyarrhythmias, whereas the combined rate-mean right atrial pressure-right ventricular systolic pressure detection algorithm had sensitivity and specificity of 100%. Therefore, the performance of an antitachycardia system may be significantly improved by detection algorithms that integrate hemodynamic and rate criteria.
Drug Evaluation by Council on Drugs
Authors: John R. Lewis
Journal: JAMA (1963)

WHEN A PHYSICIAN writes a prescription for a completely new drug, it is a moment of great decision. He has had to assess a welter of claims before deciding to use a new drug in preference to one of the older drugs that he knows well. Many hopes rest on that moment. The physician hopes that his patient will be benefited, perhaps uniquely so, and his patient shares that hope. The manufacturer hopes that he will be repaid for his extensive efforts and investment in research and development. The personnel of the Food and Drug Administration (FDA) hope that their action in approving the new drug application will prove to be correct. But the physician's hope should be based on more than a guess, a hunch, a long shot, or uncritical reliance upon the manufacturer's claims. It should be based on a rational choice, which, in turn, is possible only after proper and
Clinical Studies of Recombinant Human C1 Inhibitor (rhC1INH) in Patients with Acute Attacks of Hereditary Angioedema
Authors: J. Nuijens, R. Verdonk, B. Giannetti, S. Visscher, M. van Doorn, T. Resink, M. Levi, C. Hack, H. Farkas, K. Obtulowicz, T. Caballero, M. Cicardi
Journal: Journal of Allergy and Clinical Immunology (2008)
The Immune Reconstitution Inflammatory Syndrome in Whipple Disease
Authors: Gerhard E. Feurle, Verena Moos, Katina Schinnerling, Anika Geelhaar, Kristina Allers, Federico Biagi, Hendrik Bläker, Annette Moter, Christoph Loddenkemper, Andreas Jansen, Thomas Schneider
Journal: Annals of Internal Medicine (2010)

Background: Whipple disease, which is caused by infection with Tropheryma whipplei, can be treated effectively with antimicrobials. Occasionally, inflammation reappears after initial improvement; this is often interpreted as refractory or recurrent disease. However, polymerase chain reaction for T. whipplei in tissue is sometimes negative during reinflammation, indicating absence of vital bacteria, and this reinflammation does not respond to antimicrobials but does respond to steroids. Objective: To demonstrate that the immune reconstitution inflammatory syndrome (IRIS) occurs in patients treated for Whipple disease. Design: Cohort study. (International Standard Randomised Controlled Trial Number Register registration number: ISRCTN45658456) Setting: 2 academic medical centers in Germany. Methods: 142 patients treated for Whipple disease out of a cohort of 187 were observed for reappearance of inflammatory signs after effective antibiotic therapy. Definitions of IRIS in HIV infection, tuberculosis, and leprosy were adapted for application to Whipple disease. Results: On the basis of study definitions, IRIS was diagnosed in 15 of 142 patients. Symptoms included fever, arthritis, pleurisy, erythema nodosum, inflammatory orbitopathy, small-bowel perforation, and a hypothalamic syndrome. Two patients died. There was a positive correlation with previous immunosuppressive treatment and a negative correlation with previous diarrhea and weight loss. Limitations: The study was observational and thus has inherent weaknesses, such as incomplete and potentially selective data recording. Conclusion: The immune reconstitution inflammatory syndrome was diagnosed in about 10% of patients with Whipple disease in the study cohort; the outcome varied from mild to fatal. Patients who had had previous immunosuppressive therapy were at particular risk. An immune reconstitution syndrome should be considered in patients with Whipple disease in whom inflammatory symptoms recur after effective treatment. Early diagnosis and treatment with steroids may be beneficial; prospective studies are needed. Primary Funding Source: European Commission and Deutsche Forschungsgemeinschaft.
Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis.
Authors: M Luostarinen, J Isolauri, J Laitinen, M Koskinen, O Keyrilainen, H Markkula, E Lehtinen, A Uusitalo
Journal: Gut (1993)

Of 46 patients who had Nissen fundoplication for proved gastro-oesophageal reflux, 25 were available for follow up after a median of 20 years, 15 had died of unrelated causes, and six could not be traced. All 25 patients in the follow up study were personally interviewed: 21 consented to an endoscopy, 14 to 24 hour recording of oesophageal pH and manometry, and 15 to radionuclide transit test. Repeat fundoplication for recurrent reflux was performed in two cases during the study. Heartburn and regurgitation were significantly lessened (p &lt; 0.005), but the incidence of dysphagia was slightly increased. Endoscopy showed six of 21 fundic wraps to be defective. Erosive oesophagitis was seen in two patients, and Barrett9s oesophagus (histologically confirmed) in one of them and six other patients. Total reflux time was abnormal in four of 14 patients. No patient with an intact fundic wrap seen on endoscopy, only two of seven with Barrett9s oesophagus, and one of four with abnormal reflux had oesophagitis. Fundoplication in itself did not affect oesophageal motility or transit, provided that the wrap was intact. It is concluded that Nissen fundoplication gave a reasonably good longterm effect in chronic reflux disease, with the stage of the fundic wrap as the main determinant of outcome.
AIDS and Priorities in the Global Village
Authors: Dale F. Nordenberg
Journal: JAMA (1993)

<h3>To the Editor.</h3> —Dr Berkley's Editorial<sup>1</sup>on why US physicians should care about the human immunodeficiency virus (HIV) epidemic beyond the borders of the United States articulates several compelling reasons for the mutual interest that all nations share in combatting the HIV pandemic. It is important to note that while the acquired immunodeficiency syndrome (AIDS) leads in accelerating global health interdependence,<sup>2</sup>it is far from alone in so doing. Other major diseases affecting developing nations that do not impact on the industrialized world—such as malaria and many respiratory and intestinal pathogens—have similarly inhibited the economic development of most of humanity and acted to marginalize large populations. AIDS has tended to obscure the enormous human losses to preventable morbidity and mortality throughout most of the developing world that are attributable to other causes. Despite considerable progress and advances in reducing preventable disease and death through international assistance efforts, the
Benefits, Harms, and Costs for Breast Cancer Screening After US Implementation of Digital Mammography
Authors: Natasha K. Stout, Sandra J. Lee, Clyde B. Schechter, Karla Kerlikowske, Oguzhan Alagoz, Donald Berry, Diana S. M. Buist, Mucahit Cevik, Gary Chisholm, Harry J. de Koning, Hui Huang, Rebecca A. Hubbard, Diana L. Miglioretti, Mark F. Munsell, Amy Trentham-Dietz, Nicolien T. van Ravesteyn, Anna N. A. Tosteson, Jeanne S. Mandelblatt
Journal: JNCI Journal of the National Cancer Institute (2014)

Compared with film, digital mammography has superior sensitivity but lower specificity for women aged 40 to 49 years and women with dense breasts. Digital has replaced film in virtually all US facilities, but overall population health and cost from use of this technology are unclear. Using five independent models, we compared digital screening strategies starting at age 40 or 50 years applied annually, biennially, or based on density with biennial film screening from ages 50 to 74 years and with no screening. Common data elements included cancer incidence and test performance, both modified by breast density. Lifetime outcomes included mortality, quality-adjusted life-years, and screening and treatment costs. For every 1000 women screened biennially from age 50 to 74 years, switching to digital from film yielded a median within-model improvement of 2 life-years, 0.27 additional deaths averted, 220 additional false-positive results, and $0.35 million more in costs. For an individual woman, this translates to a health gain of 0.73 days. Extending biennial digital screening to women ages 40 to 49 years was cost-effective, although results were sensitive to quality-of-life decrements related to screening and false positives. Targeting annual screening by density yielded similar outcomes to targeting by age. Annual screening approaches could increase costs to $5.26 million per 1000 women, in part because of higher numbers of screens and false positives, and were not efficient or cost-effective. The transition to digital breast cancer screening in the United States increased total costs for small added health benefits. The value of digital mammography screening among women aged 40 to 49 years depends on women's preferences regarding false positives.
US scientists clone first human embryo
Authors: A. Vass
Journal: BMJ (2001)

American scientists announced the cloning of the first human embryo earlier this week, emphasising that they had done it for therapeutic purposes only. It comes in the week that the British government pushed through emergency legislation to ban reproductive cloning after the recent high court judgment that no law existed to prevent cloning of human embryos (24 November, p 1203).

Results reported on 25 November by Jose Cibelli and colleagues in the on-line journal e-biomed: the Journal of Regenerative Medicine (www.liebertpub.com/ebi) describe how human embryos were created by somatic cell nuclear transfer (the method used for …
Homozygosity for the patatin-like phospholipase-3/adiponutrin I148M polymorphism influences liver fibrosis in patients with nonalcoholic fatty liver disease
Authors: Luca Valenti, Ahmad Al‐Serri, Ann K. Daly, Enrico Galmozzi, Raffaela Rametta, Paola Dongiovanni, Valerio Nobili, Enrico Mozzi, Giancarlo Roviaro, Ester Vanni, Elisabetta Bugianesi, Marco Maggioni, Anna Ludovica Fracanzani, Silvia Fargion, Christopher P. Day
Journal: Hepatology (2010)

Inherited factors play a major role in the predisposition to nonalcoholic fatty liver disease (NAFLD), and the rs738409 C→G polymorphism of PNPLA3/adiponutrin, encoding for the isoleucine-to-methionine substitution at residue 148 (I148M) protein variant, has recently been recognized as a major determinant of liver fat content. However, the effect of the rs738409 polymorphism on the severity of liver fibrosis in patients with NAFLD is still unknown. In this study, we considered 253 Italian patients, 179 healthy controls, and 71 family trios with an affected child with NAFLD. Analyses were replicated in 321 patients from the United Kingdom. The rs738409 polymorphism was determined by TaqMan assays. Liver histology was scored according to Kleiner et al. Hepatic expression of genes regulating liver damage was assessed by real-time polymerase chain reaction in 52 patients. The rs738409 GG genotype was more prevalent in patients than in controls (14% versus 3%, adjusted odds ratio [OR] = 3.29, 95% confidence interval [CI] = 1.8-6.9), and in the family study, the G allele was overtransmitted to affected children (P = 0.001). In Italian and United Kingdom patients, adiponutrin genotype influenced alanine aminotransferase levels and the severity of steatosis. Adiponutrin genotype was associated with the expression of genes involved in the steatosis-related liver damage, including the proapoptotic molecule Fas ligand. In the whole series combined, adiponutrin genotype was associated with steatosis grade >1 (OR = 1.35, 95% CI = 1.04-1.76), nonalcoholic steatohepatitis (OR = 1.5, 95% CI = 1.12-2.04), and fibrosis stage >1 (OR = 1.5, 95% CI = 1.09-2.12), independent of age, body mass index, and diabetes. Adiponutrin genotype demonstrated a dose effect with heterozygote risk intermediate between CC and GG homozygotes. Conclusion: In patients with NAFLD, adiponutrin rs738409 C→G genotype, encoding for I148M, is associated with the severity of steatosis and fibrosis and the presence of nonalcoholic steatohepatitis. (Hepatology 2010;51:1209–1217)
454. Mouse Models for the Analysis of Genetic Risk Factors for Hematopoietic Transformation in XSCID Gene Therapy
Authors: Yan Shou, Lilia Stepanova, Brian P. Sorrentino
Journal: Molecular Therapy (2005)

Two patients in a XSCID gene therapy trial have developed T-cell malignancies associated with integration of a gc-expressing oncoretroviral vector and activation of the LMO2 gene. These findings suggest that transformation could be due to cooperation between LMO2 oncogene and enforced gc expression. To test this hypothesis, an experimental model was generated using mice which express LMO2 protein under control of a metallotheinin promoter. Bone marrow cells from MT-LMO2 mice were transduced with a MSCV-gc-IRES-GFP vector. As controls, MSCV-Jak3-IRES-GFP and MSCV-IRES-GFP vectors were also used. Transduced cells were transplanted into lethally irradiated mice (20 recipients for each vector) at doses of about 8.5106 cells/mouse. After four weeks the recipient mice were given zinc in their water to induce expression of the LMO2 transgene. Very few T-cell lymphomas were detected in transplanted mice (2 lymphomas in the gc group at 13 and 17 weeks after transplant, and 1 lymphoma in the GFP group at 26 weeks after transplant). In no cases were tumor cells found to express GFP. In the time interval from 40 to 54 weeks, an increased death rate was noted in the gc and JAK3 groups relative to the GFP group. No tumors were seen during this interval by autopsy and the mice appeared to die from severe anemia. Altogether, these results fail to show evidence of increased T cell neoplasms due to cooperation between LMO2 and gc expression.
L'imagerie du grêle par résonance magnétique est peu sensible mais plus performante que la vidéo-capsule endoscopique dans le dépistage des hamartomes du grêle dans le syndrome de Peutz-Jeghers
Authors: D Lamarque, M Gaudric, A Oudjit, R Coriat, C Cassaz, S Grandjouan, P Legmann, S Chaussade
Journal: Endoscopy (2010)

Introduction: Chez les patients atteints du syndrome de Peutz-Jeghers, les hamartomes de l'intestin grêle doivent être réséqués pour prévenir les complicationsmécaniques et l'évolution maligne. L'examen du grêle par vidéocapsule et par résonance magnétique (entéro-IRM) sont des méthodes diagnostiques non irradiantes qui n'ont pas étéévaluées par rapport à l'entéroscopie double ballon (DB) ou per opératoire. Le but de cette étude prospective a été de comparer la sensibilité diagnostique de la vidéocapsule et de l'entéro-IRM par rapport à l'entéroscopie DB ou per opératoire.
The ward round.
Authors: R. Armstrong
Journal: BMJ (1992)

The pirate white coat sped on, followed furiously by duckling medical students. Breast cancer, the signs! The sardine cluster separated. Speak up, boy!  Bang! Pistol finger shot the first casualty with humiliation. Silence, then peeps of protestation and chirps of fluffy facts escaped the startled gaggle. The piper followed, cried, Chronic obstructive airways disease, name the types! Consultant eyes flashed laser beams. Come on, I'm waiting! A marooned student suffocated in his burning face, patting at the fire with his damp palms. D-d-don't know, sir!  Tut! Triggerhappy criticism melted the boy, dripping to the sheltered aft. You! I was unearthed from my white linen camouflage. What are the features of thyrotoxicosis? Sensing a field ofneurotic mines, I navigated the reply. Weight loss; increased appetite; tremor; lid lag; exophthalmos; heat intolerance; irritability; oligomenhorrhoea; my reply was concise. The posse, stunned by brilliance, was rapidly outmanoeuvred by an imminent new case.
The Relationship between Human Endocardial Fibroelastosis and Obstruction of the Cardiac Lymphatics
Authors: IRWIN K. KLINE, ALBERT J. MILLER, RUTH PICK, LOUIS N. KATZ
Journal: Circulation (1964)

Two patients with marked ventricular endocardial fibroelastosis and evidence of obstruction of cardiac lymphatic vessels lend support to the hypothesis derived from dog experiments that chronic impairment of the cardiac lymph flow leads to endocardial fibroelastosis. One patient, aged 52 years, developed chronic myocarditis 7 years prior to her death. The other patient, a 6-month-old infant, had congenital lymphangiectasis with diffuse involvement of the gastrointestinal tract, lymph nodes, and heart. Microscopic examination of the hearts revealed markedly dilated and tortuous lymphatic channels throughout the myocardium and epicardium, a finding present with long-standing obstruction to lymph flow. It is concluded that chronic obstruction of cardiac lymph flow, from whatever cause, results in ventricular endocardial fibroelastosis.
Report on THE TREATMENT OF MALIGNANT DISEASE BY COLLOIDAL LEAD
Authors: S. Wyard
Journal: BMJ (1928)

I TN BRTlJXA remedy caninot always be relied uponi to accompi)lissh tlhe desired result, for a recturrence may follow wlihen the niail grows again.A mole simple method is to pare and(i scrape the nails to the utmost limit of tlle p)atient's end(luirance, and then apply a 2 per cent.solutioii of silver nlitrate or Fehling's solutioii.It is esseltial to keep the fingers dry, for the disease is most commion in thiose whiose oceil)atioll entails the immersion of the iainIds in water.It is also advisable to conitiinue the treatmenit withl a weaker soliutio1n after the disease is ap)l)arentlv curied.In conclusion, 1 would emllhasize the poinit that these diseases are imiore commzlsoni than is genierally supposel; they are of sufficient medical anld social importance to deserve recognitioni anid st(lVd by mnedical practitioners.REFERENCES.
Straight Talk at the President's Biomedical Panel
Authors: Daniel S. Greenberg
Journal: New England Journal of Medicine (1975)

Would you like to listen in on some unusually candid talk of several persons who are senior and influential in national biomedical affairs?This is easily done by attending the meetings of the President's Biomedical Research Panel, a group that, in the mysterious processes of routine news coverage, exists below the threshold of reportorial notice. It is even more easily done by picking up verbatim transcripts of the Panel's proceedings, which are available for the asking, though not often asked for.When last reported on here (N Engl J Med 292:489–490,1975), the Panel had just come into existence to carry . . .
Diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis
Authors: M. Skov, C. Koch, C. M. Reimert, L. K. Poulsen
Journal: Allergy (2000)

Background: The diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients may be difficult to establish because ABPA shares many characteristics with coexisting atopy or other lung infections in these patients. This study aimed to evaluate the sensitivity and specificity of various paraclinical parameters in the diagnosis of ABPA in patients with CF. Methods: Accumulated data from a 5‐year period in 238 CF patients were used to divide patients into two groups designated the ABPA group ( n =26) and the non‐ABPA group ( n =35). Patients in both groups were colonized with Aspergillus fumigatus , but only the ABPA group consistently demonstrated specific IgE antibodies and specific precipitins. Patients without A. fumigatus colonization were not assigned to either of these groups ( n =177). By this selection as the true diagnosis , 10 patients were selected from the ABPA group and 10 patients from the non‐ABPA group. Results: The groups were comparable as to age, sex, lung function ( P =0.6), and presence of chronic Pseudomonas ae ruginosa infection ( P &gt;0.1). No significant difference between the groups in unspecific atopic parameters such as eosinophil count ( P =0.9) or eosinophil cationic protein (ECP) in sputum, plasma, or serum ( P =0.9, P =0.59, and P =0.9, respectively) was demonstrated. Total IgE was significantly higher in the ABPA group ( P &lt;0.01). The groups were comparable in skin prick test (SPT) positivity to a standard panel of aeroallergens (pollen, dander, molds, and mites) ( P &gt;0.2). Statistically significantly higher levels in the ABPA group were demonstrated in specific IgE to Af. ( P &lt;0.05), SPT positivity to Af. ( P &lt;0.02), and Af. precipitins ( P &lt;0.05). Histamine release (HR) to Af . tended to be higher ( P =0.075) in the ABPA group. Specific IgE to Af. was determined by Magic Lite (ML), CAP, and Maxisorp (in‐house RAST). The CAP level was one to two classes higher than the ML level; however, the results were comparable ( r =0.66, P &lt;0.005). IgE to Af. measured by CAP was the test which offered the highest positive predictive value (PPV) and negative predictive value (NPV). Optimal diagnostic cutoff levels for the diagnosis of ABPA were determined: class 2 for HR to Af ., 200 kU/l for total IgE, and 3.5 (titer) for precipitating antibodies to Af. , and class 2 for IgE to Af. (by CAP System). Conclusions: Unspecific atopy markers were of limited value for the diagnosis of ABPA. Patients with ABPA do not seem to be more atopic to other aeroallergens than non‐ABPA patients. The most valid parameters for the diagnosis of ABPA in CF are SPT to Af ., IgE to Af. in combination with precipitating antibodies to Af ., and/or total IgE.