tbuckley/cabot-search huggingface dataset:
Role of the routine neonatal examination
Authors: D. Walker, S P Leung
Journal: BMJ (1999)

Caring for and about acute general medicine Expansion in consultant numbers is neededEditor-Forgacs's review provides an excellent picture of the unpleasant reality of acute medicine, as practised at present. 1 The Royal College of Physicians is well aware of the need to cost future improvements in increasing the number of hospital doctors and to provide evidence of the likely benefits.The latter will be a difficult task but must be tackled.Indeed, a working group of the three Royal Colleges of Physicians is currently reviewing all aspects of the problems regarding acute medicine.As chairman of the group which produced the document "Consultant physicians working for patients" and main author, 2 I (JDW) can assure readers that I have had experience, on many occasions, of handling more than 20 acutely ill patients during a 24 hour period of acute medicine as a general physician in Sheffield.Our working group realises that hundreds more consultants tomorrow and much smaller numbers of "take patients" is unrealistic.We do know from several sources that doctors are working 14-16 sessions per week and close to a 60 hour week.We know that consultation times in outpatient departments have been pared to the bone.We know that clinical governance in all its guises will place further demands on consultants.If we do not state our requirements now for an expansion in the number of consultants we will never achieve improvements.
A research priority in the UK
Authors: Jose M Valderas, Barbara Starfield, Martin Roland
Journal: BMJ (2007)

Further to the three research areas Fortin et al identify for investigation,1 four additional aspects of multimorbidity are also relevant. Firstly, acute conditions also contribute to comorbidity, and there is no reason for their exclusion. Secondly, comorbidity is of particular relevance to primary care, which is person focused and not disease focused.2 Thirdly, research on the …
Transcatheter Aortic Valve Implantation for the Treatment of Severe Symptomatic Aortic Stenosis in Patients at Very High or Prohibitive Surgical Risk
Authors: Josep Rodés-Cabau, John G. Webb, Anson Cheung, Jian Ye, Eric Dumont, Christopher M. Feindel, Mark Osten, Madhu K. Natarajan, James L. Velianou, Giuseppe Martucci, Benoît DeVarennes, Robert Chisholm, Mark D. Peterson, Samuel V. Lichtenstein, Fabian Nietlispach, Daniel Doyle, Robert DeLarochellière, Kevin Teoh, Victor Chu, Adrian Dancea, Kevin Lachapelle, Asim Cheema, David Latter, Eric Horlick
Journal: Journal of the American College of Cardiology (2010)
Midregion Prohormone Adrenomedullin and Prognosis in Patients Presenting With Acute Dyspnea
Authors: Alan Maisel, Christian Mueller, Richard M. Nowak, W. Frank Peacock, Piotr Ponikowski, Martin Mockel, Christopher Hogan, Alan H.B. Wu, Mark Richards, Paul Clopton, Gerasimos S. Filippatos, Salvatore Di Somma, Inder Anand, Leong L. Ng, Lori B. Daniels, Sean-Xavier Neath, Robert Christenson, Mihael Potocki, James McCord, Oliver Hartmann, Nils G. Morgenthaler, Stefan D. Anker
Journal: Journal of the American College of Cardiology (2011)
Association Between Coronary Artery Calcification Progression and Microalbuminuria
Authors: Andrew P. DeFilippis, Holly J. Kramer, Ronit Katz, Nathan D. Wong, Alain G. Bertoni, Jeffrey Carr, Matthew J. Budoff, Roger S. Blumenthal, Khurram Nasir
Journal: JACC. Cardiovascular imaging (2010)

This study sought to evaluate the relationship between microalbuminuria (MA) and the development and progression of atherosclerosis, as assessed by incident and progression of coronary artery calcification (CAC). MA is associated with an increased risk of cardiovascular disease, but the mechanism by which MA imparts this increased risk is not known. The MESA (Multi-Ethnic Study of Atherosclerosis) study is a prospective cohort study of 6,814 self-identified White, African-American, Hispanic, or Chinese participants free of clinical cardiovascular disease at entry. Of the 6,775 individuals with available urine albumin data, we excluded 97 subjects with macroalbuminuria and 1,023 with missing follow-up CAC data. The final study population consists of 5,666 subjects. At baseline, individuals with MA were more likely to have CAC >0 compared with those without MA (62% vs. 48%, p < 0.0001). During a mean follow-up of 2.4 ± 0.8 years, those with MA and no CAC at baseline were more likely to develop CAC (relative risk [RR]: 2.05, 95% confidence interval [CI]: 1.41 to 3.02, p < 0.0001) as compared with those without MA in demographic-adjusted analyses. After multivariant adjustment, the relationship was attenuated but remained statistically significant (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005). Among those with CAC at baseline, those with versus those without MA had a 15 (95% CI: 8 to 22, p < 0.0001) volume units higher median increase in CAC in demographic-adjusted analyses. After multivariant adjustment, MA remained associated with incident CAC (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005) and with progression of CAC (median increase in CAC volume score of 9 [95% CI: 2 to 16, p = 0.009]), relative to those without MA. This large multiethnic, population-based study of asymptomatic individuals demonstrates an increased risk of incident CAC as well as greater CAC progression among those with MA. Further study is needed to determine the degree to which MA precedes and predicts progression of atherosclerosis and how this information can be used to reduce cardiovascular events.
Bimodal breast cancer incidence patterns provide support for a dualistic model of mammary carcinogenesis
Authors: W. F. Anderson, R. M. Pfeiffer, G. M. Dores, M. E. Sherman
Journal: Journal of Clinical Oncology (2006)

595 Background: Although breast cancers are extremely heterogeneous with respect to clinical presentation, histopathological appearance, and molecular alterations; breast cancer is often viewed as a single biologic entity with common etiology and unified pathogenesis. Accumulating data has challenged this view, demonstrating that the stratification of tumors by gene expression profiles, immunohistochemical (IHC) staining patterns, and other techniques may permit the categorization of breast cancers into two main pathways of mammary carcinogenesis. Based upon cellular origin and/or estrogen receptor (ER) expression there are 1) tumors from stem cells committed to luminal differentiation and ER expression and 2) neoplasms from stem cells programmed to display basal differentiation and lacking ER expression. If confirmed, these observations may form the basis for revised conceptual frameworks. Methods:: We applied age-at-diagnosis density plots and a two component statistical mixture model to breast cancer cases overall (n=270,124) in the SEER program. These age distributions were reevaluated after stratification by histopathologic type, race, and ER. Results: A bimodal distribution provided a better fit for the age distribution patterns than a single distribution for breast cancers overall and for all histologic types, except medullary carcinoma. However, the proportion of early-onset and late-onset tumors varied: ductal and tubular carcinomas demonstrated relatively equal proportions; lobular, papillary and mucinous tumors were associated with late-onset populations; and inflammatory and medullary tumors were more related to early-onset disease. Medullary carcinomas were exceptional in showing a single distribution irrespective of race and/or ER status. Of note, medullary breast carcinomas are rare tumors that are associated with germline mutations in BRCA1. Conclusion: Most histopathologic types of breast carcinomas demonstrated a bimodal mixture of early- and late-onset cancer populations, possibly representing two major age-related causal pathways. These population-based results seem consistent with emerging molecular data, showing two main classes of breast cancer based upon cellular origin and ER expression. No significant financial relationships to disclose.
Abstract 305: ECPR Indication Criteria -From the Cost Effective Analysis in SAVE-J Study-
Authors: Atsumi Takahiro, Tetsuya Sakamoto, Naoto Morimura, Ken Nagao, Yasufumi Asai, Hiroyuki Yokota, Yoshio Tahara, Mamoru Hase, Satoshi Nara, Koichi Ariyoshi, Yoko Asaka, Noriaki Aoki
Journal: Circulation (2013)

Background: Last year, we have reported extracorporeal cardiopulmonary resuscitation (ECPR) improves the outcome of out-of hospital cardiac arrest. (SAVE-J study) Objectives: The aim is to determine the most effective indication criteria of ECPR. Method: The registered cases of SAVE-J from December 2008 to September 2011 were evaluated for cost effective analysis. The age, time to arrival, 6months outcome and the hospitalization costs were evaluated. The Quality Adjusted Life Years (QALY) and costs were evaluated for accumulation of Incremental Cost-Effectiveness Ratios (ICER). Different age groups and time to hospital arrival were sorted to extract data, and cost effectiveness of each group was compared. Result: The ICER of overall SAVE-J inclusion criteria was $85,800. By restricting to below the age of 50, the ICER was $54,800 and below the age of 40 was $38,300. With the sortation by arrival time, ICER was $64,100 within 25 minutes, and was $43,800 within 20 minutes. Conclusion: In Japan, implementation of new treatment is said to be about $50,000~60,000 per QALY. From cost-effectiveness point of view, the inclusion criteria for ECPR are below the age of 50, or arrival time to hospital within 20 minutes seems reasonable.
Abstract 18212: Relationship Between Aortic Distensibility and Coronary Blood Flow in Patients with Ascending Thoracic Aortic Aneurysm
Authors: Chirag Bavishi, Faisal Siddiqi, Haider Alkhateeb, Scott LeMaire, Joseph Coselli, Jose G Diez
Journal: Circulation (2011)

Introduction: We have observed coronary slow flow in patients with aortic aneurysms in the absence of coronary artery disease (CAD). Other observations have identified that aortic wall distensibility influences coronary blood flow. In order to further evaluate this phenomenon, we sought to study the relationship between aortic distensibility and coronary blood flow among the patients with ascending thoracic aortic aneurysms (ATAA). Methods: Evaluation of consecutive patients referred for surgical repair of ATAA who had non- obstructive CAD (&lt;40% stenosis) as evaluated by coronary angiography. Aortic distensibility was calculated from aortograms using the formula D = 2 x (change in aortic diameter) / (diastolic aortic diameter) x (change in aortic pressure). Coronary blood flow was measured in all major coronary arteries by calculating TIMI frame count. Spearman rank correlation test was performed to evaluate the correlation between aortic distensibility and TIMI frame counts for the three major coronary arteries. Results: Out of 96 patients with angiographic slow flow, 89 (92.7%) patients had involvement of the ascending aorta with or without arch and/or descending aorta and non-obstructive CAD. Analysis of the 89 ATAA patients showed a significant correlation between decreased ascending aortic distensibility and prolonged TIMI frame count in all the three coronary arteries. Correlation coefficient between ascending aortic distensibility and LAD flow is r = -0.23, p = 0.03, LCX is r = -0.28, p = 0.007, RCA is r = -0.30, p = 0.005. A significant inverse correlation, r = -0.23, p = 0.04 is also observed between aortic arch distensibility and LAD flow. Conclusion: As the distensibility of the aorta decreases in patients with thoracic aortic aneurysm, the coronary blood flow also decreases. Our study for the first time shows that among the patients with thoracic aortic aneurysms, aortic distensibility does impact coronary blood flow in the absence of significant CAD, possibly through alteration in coronary blood flow mechanics and microvascular dysfunction. The clinical impact of this finding warrants further studies.
The HERBY study: A phase II open label, randomized, multicenter, comparative study of bevacizumab (Bv)-based therapy in pediatric patients with newly diagnosed supratentorial high-grade glioma (HGG).
Authors: Jacques Grill, Darren R Hargrave, Pascale Varlet, Tim Jaspan, Chris Jones, Maura Massimino, Adela Cañete, Amedeo A. Azizi, Marie-Cécile Le Deley, Frank Saran, Paul Morgan, Gudrun Zahlmann, Louis Viviers, Jeanette Bachir, Aijing Shang, Raphael F. Rousseau, Gilles Vassal
Journal: Journal of Clinical Oncology (2012)

TPS9596 Background: Despite therapeutic advances, outcomes in pediatric HGG remain poor. The phase I study (Glade-Bender et al., J Clin Oncol. 2008) indicated that Bv is well tolerated in children with refractory solid tumors and yielded pharmacokinetic (PK) data that support further studies of Bv in childhood cancer. Reports of Bv used in children with solid tumors showed safety profiles consistent with data from adults. Methods: 120 evaluable patients aged 3-18 years with newly diagnosed histologically confirmed WHO grade 3or 4 HGG are randomized to receive standard combined modality therapy as currently adopted worldwide by the pediatric neuro-oncology community with or without Bv. Treatment consists of 6 weeks of concomitant TMZ and local radiotherapy, followed by a 4-week TMZ treatment break and 48 weeks of adjuvant TMZ with or without Bv every other week. Primary endpoint is event-free survival (EFS). Progression is based on RANO criteria. Secondary endpoints are overall survival (OS), safety, feasibility, and tolerability. PK sampling is performed during cycles 1-4 of the adjuvant TMZ phase on all patients randomized to receive Bv. Health-related quality of life, neurocognitive functions, MGMT methylation status, functional changes in tumor based on magnetic resonance diffusion &amp; perfusion imaging and spectroscopy are explored as well as the correlation of biomarkers with clinical activity and adverse events. All randomized patients will be followed for at least 3 years. Analysis of EFS and secondary endpoints will be performed after the 120 patients evaluable for EFS have been followed for 1 year. Multimodal imaging will provide a platform to develop new imaging criteria for pediatric neuro-oncological treatment response. An updated OS and safety analysis will be performed 3 years after the last patient has been randomized. The first patient was randomized in October 2011; completion of the study is expected in 2016.
The Philadelphia Pulmonary Neoplasm Research Project
Authors: Katharine R. Boucot, David A. Cooper, William Weiss
Journal: JAMA (1971)

During a ten-year prospective study of 6,136 men, aged 45 and older, screened every six months by 70-mm photofluorograms and questionnaires, 121 men who did not have lung cancer visible on the entry film developed lung cancer; 94 cases were proved histologically. The overall survival rate was 8% at five years. From a study of various factors in the 94 proved cases, the profile of the men most likely to survive five years includes age less than the median of 64 years, smoking one pack of cigarettes per day or less, absence of chronic cough prior to detection, a histologic type of squamous cell carcinoma or adenocarcinoma, a roentgenogram of the chest negative for cancer within 12 months before detection of the cancer, and resectability of the cancer with survival longer than 30 days after surgery.
Abstract 1660: Digital Signal Processing in Implanted Dual Chamber Pacemakers for Improved Atrial Signal Classification and Far-Field-R-Wave Discrimination
Authors: Thorsten Lewalter, Susann Remerie, Ype Tuininga, Deventer Ziekenhuis, Peter Wohlgemuth
Journal: Circulation (2007)

Background. Far-Field R-Wave (FFRW) oversensing and P wave blanking are the major causes of inaccurate atrial signal classification in current pacemaker (PM) devices leading to inaccurate stored diagnostic information and to inadequate PM reactions like mode-switching or preventive pacing. The prospective and multi-center MARS (Morphology of Atrial Signals) study therefore investigated during daily life the capabilities of Digital Signal Processing (DSP) in an implanted dual chamber PM to improve P-wave classification accuracy. Methods . 55 patients with an implanted dual chamber PM (Vitatron T- or C-series) were included: During 24 hours with daily life activity and a stress test, a Holter ECG collected surface ECG, PM markers and all atrial EGM’s. The DSP algorithm analysed atrial events sensed nearby a ventricular event using the minimum and the maximum amplitude of the digitalized and filtered signal and the maximum and minimum amplitude of the slope signal. After comparing to the characteristics of a normal P wave, each of these atrial signals were then classified as a true atrial signal or FFRW. DSP classification results were then compared to the conventional PM signal classification by three independent reviewers. Results . Classification accuracy for the traditional PM functionality after optimizing blanking and sensitivity settings was 97.1% (19.5–100%) as compared to 99.4% (76.9–100%) using the DSP algorithm (p&lt;0.001). Conclusion . The DSP algorithm significantly improved the classification accuracy of sensed atrial events as an important prerequisite for a correct diagnostic and therapeutic PM function. The herewith presented approach of analysing atrial signals by form and timing may allow to reduce or even eliminate atrial blanking periods thus leading to larger PM sensing windows to prevent from atrial tachyarrhythmia undersensing without an increase in FFRW sensing.
Abstract 2226: Association between Framingham Cardiovascular Risk Score and Carotid Plaque Burden, Structure, and Composition: A Magnetic Resonance Imaging Study
Authors: Wei Yu, Li Dong, Hunter Underhill, Hideki Ota, Tianli Gao, Zhaoqi Zhang, Zhuo Zhang, Zixu Yan, Miao Guo, Minako Oikawa, Xihai Zhao, Chun Yuan, Hatsukami Tom
Journal: Circulation (2008)

Purpose We sought to identify the association between Framingham cardiovascular risk score (FCRS) and severity of carotid atherosclerotic disease. Methods Seventy-five mainland Chinese subjects (72...
Leukokinetic studies
Authors: C. R. Bishop, J. W. Athens, D. R. Boggs, H. R. Warner, G. E. Cartwright, M. M. Wintrobe
Journal: Journal of Clinical Investigation (1968)

The mechanism by which adrenocortical steroids induce granulocytosis in man has been investigated using granulocytes labeled with radioactive diisopropylfluorophosphate. After an intravenous injection of 200 mg of cortisol was given to five normal subjects, the mean value for the total blood granulocyte pool increased from 79 to 138 x 10(7) cells per kg of body weight and reflected an increase in the size of both the circulating granulocyte pool and the marginal granulocyte pool. When granulocytes in the circulation were labeled with diisopropylfluorophosphate and granulocytosis was induced later by the intravenous administration of cortisol, the rate of decline of granulocyte specific activity was increased, indicating that the blood pool was being diluted at an accelerated rate by unlabeled cells entering from the bone marrow. The rate of egress of granulocytes from the blood pool to an inflammatory exudate was studied by the "skin window" technique. After the administration of cortisol, there was a mean reduction in the cellularity of induced inflammatory exudates of 75%. However, this reduction in cellularity varied considerably from subject to subject (45-98%). From these studies we can infer that steroids induce an absolute granulocytosis by decreasing the rate of egress of cells from the total blood granulocyte pool as well as by increasing the influx of cells from the bone marrow. By model simulation studies of the non-steady state induced by cortisol injection, it has been possible to quantitate these rate changes. In the present studies cortisol injection resulted in a mean decrease in blood granulocyte egress of 74% (1-99%) and a mean increase in cell inflow of 450% (300-750%).
Emergency Contraception
Authors: Carolyn Westhoff
Journal: New England Journal of Medicine (2003)

A healthy 19-year-old woman comes in for a routine appointment. She is sexually active in a monogamous relationship; her partner uses condoms most of the time. Pregnancy is not currently desired. She has had sexual intercourse several times since her last menses, including an episode of unprotected intercourse four days earlier. A urine pregnancy test is negative. Should emergency contraception be prescribed?
Abstract 16034: Affect of Warfarin on Long Term Pulmonary Arterial Hypertension (PAH) Mortality: Change of facts?
Authors: Wajeeha Saeed, Nidhish Tiawari, Muhammad R Sardar, Jason N Salamon, Zia Rab, Muhammad M Iqbal, Ronald Zolty
Journal: Circulation (2011)

Introduction: PAH is a progressive disease with high mortality. Vascular changes in PAH like vasoconstriction, smooth muscle cell and endothelial proliferation, prothrombotic agents and cytokines a...
Abstract 18214: Interpreting Troponin Elevation in Relation to Symptom Onset in Intermediate-Risk Pulmonary Embolism
Authors: Nicolas F Meneveau, Sebastien Janin, Romain Chopard, Marie-France Seronde, Francois Schiele, Yvette Bernard
Journal: Circulation (2011)

Background: Troponin dosage plays an increasingly important role in risk stratification in pulmonary embolism (PE), especially in patients (pts) without hemodynamic compromise. Troponin elevation in the setting of acute PE is of small magnitude and short duration and thus, can go unnoticed in pts referred late after symptom onset. Methods: Prospective, single-center registry of patients with confirmed intermediate-risk PE, defined as at least 1 echocardiographic finding indicating right ventricular (RV) dysfunction (RV/left ventricular end-diastolic diameter ratio * 1 in the 4-chamber view, paradoxical septal systolic motion or pulmonary hypertension defined as a RV/atrial gradient &gt;30 mmHg), or a positive troponin test. We used a combined in-hospital endpoint defined as death, non-fatal recurrent PE, or residual pulmonary vascular obstruction (RPVO) &gt;30% as measured by V/Q scan before discharge. Results: In total, 199 patients were included, average age 69±15, 56% women, 116 (58%) pts referred within ≤5 days after symptom onset, and 83 (42%) after &gt;5 days, of whom 25 were referred after &gt;15 days since symptom onset. All patients had at least 1 sign of RV dysfunction. Troponin elevation was observed in 78/116 pts (67.2%) treated within ≤5 days, and in 40/83 pts (48.2%) treated after &gt;5 days (p=0.03). Sensitivity and specificity of troponin elevation to predict adverse outcome as defined above are shown in the table. Conclusion: Our results show that there is a significant relation between troponin elevation and symptom onset in patients with intermediate-risk PE. Time since symptom onset should be taken into consideration when interpreting troponin elevation in this population. Negative predictive value of troponin elevation is adequate in pts treated early (≤5 days) but is suboptimal in pts treated &gt;5 days after symptom onset.
Australia and New Zealand have taken the lead
Authors: B. Donovan, G. Neilsen, A. Mindel
Journal: BMJ (1995)

EDITOR,—Yvonne Stedman and Max Elstein's editorial touches on an issue in which Australia and New Zealand have perhaps taken the lead—the development of broad based sexual health services.1 Indeed, as well as providing services for sexually transmitted diseases and basic family planning under one roof2—a common practice for state funded sexually transmitted disease clinics for over 20 years—the clinical staff increasingly receive training in such diverse topics as sexual and relationship counselling, sexual assault, sexual dysfunction, and promotion of sexual health.3 As a minimum this promotes the identification of problems and efficient referral. Specialist counsellors on site can manage most of these broader problems, particularly …