tbuckley/cabot-search huggingface dataset:
Periprocedural Stroke and Bleeding Complications in Patients Undergoing Catheter Ablation of Atrial Fibrillation With Different Anticoagulation Management
Authors: Luigi Di Biase, J. David Burkhardt, Pasquale Santangeli, Prasant Mohanty, Javier E. Sanchez, Rodney Horton, G. Joseph Gallinghouse, Sakis Themistoclakis, Antonio Rossillo, Dhanunjaya Lakkireddy, Madhu Reddy, Steven Hao, Richard Hongo, Salwa Beheiry, Jason Zagrodzky, Bai Rong, Sanghamitra Mohanty, Claude S. Elayi, Giovanni Forleo, Gemma Pelargonio, Maria Lucia Narducci, Antonio Dello Russo, Michela Casella, Gaetano Fassini, Claudio Tondo, Robert A. Schweikert, Andrea Natale
Journal: Circulation (2014)

Periprocedural thromboembolic and hemorrhagic events are worrisome complications of catheter ablation for atrial fibrillation (AF). The periprocedural anticoagulation management could play a role in the incidence of these complications. Although ablation procedures performed without warfarin discontinuation seem to be associated with lower thromboembolic risk, no randomized study exists.This was a prospective, open-label, randomized, parallel-group, multicenter study assessing the role of continuous warfarin therapy in preventing periprocedural thromboembolic and hemorrhagic events after radiofrequency catheter ablation. Patients with CHADS2 score ≥1 were included. Patients were randomly assigned in a 1:1 ratio to the off-warfarin or on-warfarin arm. The incidence of thromboembolic events in the 48 hours after ablation was the primary end point of the study. The study enrolled 1584 patients: 790 assigned to discontinue warfarin (group 1) and 794 assigned to continuous warfarin (group 2). No statistical difference in baseline characteristics was observed. There were 39 thromboembolic events (3.7% strokes [n=29] and 1.3% transient ischemic attacks [n=10]) in group 1: two events (0.87%) in patients with paroxysmal AF, 4 (2.3%) in patients with persistent AF, and 33 (8.5%) in patients with long-standing persistent AF. Only 2 strokes (0.25%) in patients with long-standing persistent AF were observed in group 2 (P<0.001). Warfarin discontinuation emerged as a strong predictor of periprocedural thromboembolism (odds ratio, 13; 95% confidence interval, 3.1-55.6; P<0.001).This is the first randomized study showing that performing catheter ablation of AF without warfarin discontinuation reduces the occurrence of periprocedural stroke and minor bleeding complications compared with bridging with low-molecular-weight heparin.http://www.clinicaltrials.gov. Unique identifier: NCT01006876.
Postal survey of bronchoscopic practice by physicians in the United Kingdom.
Authors: F G Simpson, A G Arnold, A Purvis, P W Belfield, M F Muers, N J Cooke
Journal: Thorax (1986)

In 1983 a postal survey of the bronchoscopic practice of chest physicians in the United Kingdom produced a 90% response rate. Two hundred and thirty one physicians were carrying out bronchoscopy; they had performed about 40 000 bronchoscopies in the preceding year, 87% of these being fibreoptic procedures with topical anaesthesia. The mortality rate of fibreoptic bronchoscopy was 0.04%, with a 0.12% incidence of major complications. Transbronchial biopsy carried both an appreciably higher mortality rate of 0.12% and a major complication rate of 2.7%. There is wide variation in the use and choice of sedative drugs for fibreoptic bronchoscopy. Many of the drug combinations could be criticised on pharmacological grounds. The mean dose of lignocaine was 342 mg, most operators exceeding the usual maximum recommended dose; but adverse reactions were rare. Routine supplemental oxygen was given by only 18% of bronchoscopists. Basic resuscitation equipment was often inadequate. Radiological screening was used for transbronchial lung biopsy by 53% of respondents and significantly reduced the incidence of pneumothorax from 2.9% to 1.8%. Both the number of bronchoscopies performed and the complication rate were higher than previous estimates. Bronchoscopists should re-examine their policy on drugs and safety precautions to minimise the risks of the procedure.
Allergic rhinitis and inflammation: the effect of nasal corticosteroid therapy
Authors: W. J. Fokkens, T. Godthelp, A. F. Holm, H. Blom, A. Klein‐Jan
Journal: Allergy (1997)

Topical corticosteroids have proved to be effective in the treatment of allergic rhinitis. The symptomatology of allergic rhinitis is considered to be the result of the accumulation and activation of inflammatory cells and cytokine release and hence the efficacy of corticosteroids is associated with their anti‐inflammatory action. New advances in allergic inflammation now suggest that not only mast cells and eosinophils but also T‐lymphocytes and antigen‐presenting dendritic cells, play an important role in the inflammatory reaction. The effect of topical fluticasone propionate on cellular infiltration in the nasal mucosa is examined, with an emphasis on two studies performed in Rotterdam, The Netherlands. The cells influenced most by corticosteroid therapy were Langerhans' cells (antigen‐presenting cells), which were almost completely eradicated, possibly resulting in diminished antigen presentation, and eosinophils. There was a reduction in the number of epithelial mast cells, but the number of T‐lymphocytes only decreased following high doses of corticosteroid therapy or long‐term treatment. However, T‐lymphocyte function was influenced, as shown by the reduction in the T‐helper, (Th J ‐related cytokines, interleukin (1L)‐4 and IL‐5. Topical corticosteroid therapy had no effect on the accumulation of macrophages. The reduction in antigen presentation, and the decrease in T‐lymphocyte stimulation and cytokine production, may cause a reduced influx of eosinophils and other inflammatory cells, resulting in diminished symptomatology.
Virus Detection, Cytokine Response Profiles, and Eosinophil Activation in Acute Exacerbation of Childhood Asthma
Authors: M. Kato, M. Saitoh, H. Tsukagoshi, K. Maruyama, Y. Hayashi, K. Kozawa, H. Kimura
Journal: Journal of Allergy and Clinical Immunology (2006)
Kant, Sartre, and the Categorical Imperative
Authors: George E. Ehrlich
Journal: JAMA (1982)

<h3>To the Editor.—</h3> Sartre certainly "was onto [<i>sic</i>] something when he said that each of us should make decisions about conduct as if our every act were irretrievably binding on mankind": the shoulders of Kant. The categorical imperative admonishes one to act so that one's every act shall be a universal law. Kant was on to something, too. In his fundamental principles of the metaphysics of ethics, he was only restating an age-old ethical principle.
ALLHAT, or the Soft Science of the Secondary End Point
Authors: Franz H. Messerli
Journal: Annals of Internal Medicine (2003)

The recent Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) showed that the primary end point, coronary heart disease, was identical in the chlorthalidone, lisinopril, and amlodipine groups. Yet the major conclusion of this trial was that thiazide diuretics are superior in preventing 1 or more major forms of cardiovascular disease and should be preferred for first-line antihypertensive therapy. This conclusion was based solely on an analysis of secondary end points and cost. As evidenced by the dictum to "use thiazides for most patients with uncomplicated hypertension" in the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, this interpretation of ALLHAT broadly adumbrated these guidelines. Although diuretics will rightfully remain a cornerstone in antihypertensive therapy, we should remember (as we were told by the ALLHAT investigators) that secondary end points are "soft data" that should not form a basis for main conclusions or lead to a labeling of a drug class as preferred.
Prevalence of overweight and obese children between 1989 and 1998: population based series of cross sectional studies
Authors: P. Bundred
Journal: BMJ (2001)

<h3>Abstract</h3> <b>Objective:</b> To determine trends in weight, height, and body mass index in children between 1989 and 1998. <b>Design:</b> Retrospective series of cross sectional studies of routinely collected data. <b>Setting:</b> Primary care in the Wirral Health Authority. <b>Participants:</b> 35 662 infants aged 1-3 months (representing 88% of live births) and 28 768 children aged 2.9-4.0 years. 21 582 infants and children (25.1%) were excluded because of missing or inaccurate data. <b>Main outcome measures:</b> Weight, height, sex, and age routinely recorded by health visitors. Height, weight, and body mass index standardised for age and sex. SD score &gt;1.04 for body mass index (&gt;85th centile) was defined as overweight and &gt;1.64 (&gt;95th centile) as obese. Body mass index was not calculated in infants as it is difficult to interpret. <b>Results:</b> From 1989 to 1998 there was a highly significant increasing trend in the proportion of overweight children (14.7% to 23.6%; P&lt;0.001) and obese children (5.4% to 9.2%; P&lt;0.001). There was also a highly significant increasing trend in the mean SD score for weight (0.05 to 0.29; P&lt;0.001) and body mass index (−0.15 to 0.31; P&lt;0.001) but not height. Infants showed a small but significantly increasing trend in mean SD score for weight (−0.17 to −0.05; P=0.005). <b>Conclusions:</b> From 1989 to 1998 there was a highly significant increase in weight and body mass index in children under 4 years of age. Routinely collected data are valuable in identifying anthropometric trends in populations.
Effects of burglary on elderly people.
Authors: D. O'Neill, B. O'Shea, R. Lawlor, C. McGee, J. B. Walsh, D. Coakley
Journal: BMJ (1989)

Relation between breast feeding, formula feeding, and diarrhoeal disease during early infancy with subsequent development ofCrohn's disease in childhood.Results ofrelative risk estimate for each factor were adjusted for presence ofotherfactor(s) in model with matched multivariate analysis Adjusted 95%°Confideincc p Value p Value relative risk interval for variable for model
GIFT FORM FOR HOSPITALS
Authors: W. D. Sansum
Journal: JAMA (1935)

To the Editor:—  Readers ofThe Journalmay be interested in a simple plan that has been in use at the Sansum Clinic for the past two years not only to interest an increasing number of patients in medical research problems but also to increase the much needed income for this purpose. We call it Our Birthday Better Health Plan.  During the depression the income from regular sources for the maintenance of research work has been materially reduced but every effort is being made to permit it to be continued. To help maintain this research work we have initiated a simple plan, which is receiving favorable response. We invite our patients who have been aided by the results of medical research with which they are familiar to contribute one dollar on each birthday anniversary. Although modest in amount, such contributions have provided us with considerable money.  We have thousands of
Cheyne-Stokes Respiration in Patients with Cardiac Enlargement and Prolonged Circulation Time
Authors: WILLIAM W. PRYOR
Journal: Circulation (1951)

A study has been made of arterial blood changes during the respiratory cycle in patients with cardiac enlargement, prolonged circulation time, and Cheyne-Stokes breathing. In these patients, Cheyne-Stokes breathing appeared to depend upon the delay in passage of blood from the lungs to the arterial chemoreceptors and respiratory center. This delayallowed cyclic over- and underventilation. There was little or no central nervous system depression. In contrast, one case of Biot's breathing is presented as an example of another mechanism responsible for periodic breathing. Here irregular breathing seems to depend on fluctuations in activity of a severely damaged central nervous system.
Fabrication of uniformly shaped hydrogel microparticles based on crosslinked hyperbranched polyglycerol by micromolding and photolithographic methods
Authors: M.H.M. Oudshoorn, R. Penterman, R. Rissmann, J.A. Bouwstra, D.J. Broer, W.E. Hennink
Journal: Journal of Controlled Release (2008)
Reactive lymphocytes in lacrimal gland and vasculitic renal lesions of autoimmune MRL/lpr mice express L3T4.
Authors: D A Jabs, R A Prendergast
Journal: The Journal of Experimental Medicine (1987)

The lacrimal gland inflammatory lesions and renal vasculitic lesions of autoimmune MRL/lpr mice were analyzed for the lymphocyte subsets present. The majority of cells were Thy-1.2+ T cells (mean, 85%) of the L3T4+ helper T phenotype (mean, 64 and 58%, respectively). Lesser numbers of Lyt-2+ suppressor/cytotoxic T cells, B cells, and macrophages were present. The finding that the majority of lymphocytes in both the lacrimal gland inflammatory lesions and renal vasculitis of MRL/lpr mice expressed L3T4 suggests that these cells may be capable of responding to antigen presentation and that an active immunologic response occurs at these sites.
Signal transduction in spontaneous myogenic tone in isolated arterioles from rat skeletal muscle
Authors: E Bakker
Journal: Cardiovascular Research (1999)

The mechanism of spontaneous myogenic tone was investigated in isolated arteriolar segments.Arterioles were isolated from rat cremaster muscle. Segments were endothelium-denuded and mounted in a pressure myograph at 75 mmHg. Under this condition, segments spontaneously constricted from a passive diameter of 167 +/- 3 to 82 +/- 4 microns (n = 41). The effects of several inhibitors were tested on the maintenance of myogenic tone.Gadolinium (10(-6)-10(-4) M), a putative inhibitor of stretch-activated cation channels, was ineffective. The phospholipase C (PLC) inhibitor 2-nitro-4-carboxyphenyl-N,N-diphenylcarbamate (NCDC) induced a dose-dependent inhibition of tone. NCDC inhibited phenylephrine- (10(-6) M), but not potassium buffer-induced (100 mM) constriction. The protein kinase C (PKC) inhibitors staurosporine, chelerythrine and calphostin C inhibited myogenic tone in a concentration-dependent manner. At an intermediate concentration, calphostin C selectively inhibited phenylephrine-induced constriction. However, all PKC inhibitors abolished responses to phenylephrine and potassium buffer at higher concentrations. The cytochrome P450 inhibitor 17-ODYA (0.3-3 x 10(-6) M) did not inhibit myogenic tone.No evidence was found for a role of gadolinium-sensitive, stretch-activated cation channels or cytochrome P450 metabolites. On the other hand, both PLC and PKC contribute to the maintenance of myogenic tone.
Thiabendazole Probable Cure for Trichinosis
Authors: Orville J. Stone, Charles T. Stone, J. Fred Mullins
Journal: JAMA (1964)

THIABENDAZOLE ( 2-( 4′thiazolyl) -benzimidazole) represents a new class of broad spectrum anthelmintics with a wide range of activity. 1 In addition to its marked potency against helminths, it has negligible mammalian toxicity. This drug has been the subject of intense veterinary research. 2-7 It is limited to investigational use in humans, but is currently being evaluated in this country and several foreign areas. Studies from Brazil 8 and Liberia 9 indicate that it is highly effective in cases of human strongyloidiasis. There were no serious side effects in the total 140 cases reported. In a small number of patients treated, transient dizziness, drowsiness, nausea, or vomiting occurred. One child receiving over 2 1/2 times the normal dosage developed a papular eruption. Some of these minor side effects might be the result of the release of toxic material derived from dead parasites. The authors 10 recently reported the first systemic use
Ethical Problems in the Medical Office
Authors: Julia E. Connelly
Journal: JAMA (1988)

The majority of health care in this country is provided to patients in the office setting. This study, conducted in an internal medicine office practice, describes the ethical problems encountered in medical offices. Two hundred eighty consecutive patients, a total of 562 office visits, were prospectively evaluated. Ethical problems were defined as being present when specific ethical issues came into conflict with the physician's moral obligation to benefit the patient. The majority of the patients studied were white (214) and were women (212). The mean age of the patients was 49 years, with a range from 17 to 98 years. Ethical problems were present in 84 (30%) of the patients and in 119 (21%) of the office visits. The most common ethical problems for the patients were costs of care (11.1%), psychological factors that influence preferences (9.6%), competence and capacity to choose (7.1%), refusal of treatment (6.4%), informed consent (5.7%), and confidentiality (3.2%). Ethical problems were more common in patients over 60 years of age. This study establishes an educational as well as a research base for a broad study of biomedical ethics that looks beyond the problems encountered in the hospital.In an effort to broaden the traditional focus of biomedical research and education on problems that occur in the hospital, the authors describe the prevalence and range of ethical problems encountered by 280 outpatients during 562 office visits to a community-based general internal medicine practice. Their study, which compiles statistics about the frequency of ethical problems during office visits according to sex, race, age, and classification of ethical issues, indicates that almost one third of the patients seen in office visits present ethical problems that influence their health care. Failure to teach students skills in this area may leave young physicians unable to cope with ethical problems, which may compromise good quality health care and diminish both the physicians' and the patients' satisfaction with medicine in general.
Carcinogenesis of isoniazid in mice.
Authors: S. H. Ferebee
Journal: BMJ (1965)

Carcinogenesis of Isoniazid in Mice SIR,-Reports in the last few years that isoniazid in very large doses can produce pulmonary tumours in several strains of mice led to speculation that it might be carcino- genic for man.The need for investigation of the question has most recently been pointed out in these columns (12 June, p. 1508).
The 2030 sustainable development goal for health
Authors: G. Yamey, R. Shretta, F. N. Binka
Journal: BMJ (2014)

Must balance bold aspiration with technical feasibility

In the year 2000, 193 countries adopted the millennium development goals (MDGs), a milestone in global development. The eight goals were simple to grasp, measurable, and time bound, ending in 2015. Goals 4, 5, and 6 focused on reducing child, maternal, and infectious disease mortality, respectively, raising health to the top of the global agenda and mobilising new health financing.1 Although the three health related goals are unlikely to be met, there has been substantial progress towards their achievement, particularly for infectious diseases.2

As the MDGs come to an end, a new set of sustainable development goals (SDGs) will be debated during the UN General Assembly that starts on 24 September 2014. These goals will have a 2030 end date. They could catalyse further transformations in global health.

An intergovernmental open working group is writing the new goals and has just published its first draft.3 Whereas the MDGs were “‘top-down goals’ formulated by policy elites,”4 the working group deserves credit for drafting the new goals using a bottom-up approach, based on wide ranging consultations. There is much to like in the draft: …
Stress Tests-Reply
Authors: John T. Philbrick
Journal: JAMA (1983)

In Reply.—  I agree that the use of stress tests (and all other diagnostic tests) should be reserved for those circumstances in which the usefulness of the test has been established. However, as has been pointed out, 1 it is seldom clear which clinical groups have been adequately evaluated. Consequently, any use of the stress test constitutes an educated guess based on the clinician's knowledge of the literature, what he has been told by other physicians, his personal experience, and the patient's clinical characteristics. For example, in studying a patient taking a β-blocker, a clinician may reasonably conclude that a positive stress test result provides useful information while a negative test result is unhelpful, particularly if the target heart rate was not achieved. He then must use his knowledge and experience to decide what the test results mean for his patient.  The calculations of Epstein 2 and Diamond and Forrester
Outcome of Active Surveillance and Endocrine Therapy Alone for DCIS.
Authors: A. Meyerson, B. Joe, D. Wolverton, J. Lessing, E. Hwang
Journal: Cancer Research (2009)

Abstract Objective: There are currently no nonsurgical options offered to patients with DCIS. The purpose of this study was to assess clinical outcome in a cohort of women declining surgery for pathologically proven ductal carcinoma in situ (DCIS) who have opted for endocrine therapy and clinical/radiographic follow-up.Methods: Between 2003 and 2008, 52 women with ER-positive DCIS enrolled in an IRB-approved single-arm study of 3 months of neoadjuvant enodocrine therapy. The study design included definitive surgical excision. However, 9 women withdrew from the parent study at completion of 3 months and declined surgery, opting instead for a plan of active surveillance, with the intent to proceed with conventional therapy in the event of disease progression or radiographic suspicion for invasive disease. All women were amenable for follow up every 6 months with diagnostic mammography and breast MRI, and wished to continue endocrine therapy, despite unproven benefit in this setting. Endocrine treatment consisted of tamoxifen for premenopausal women or an aromatase inhibitor for postmenopausal women. Each patient was informed of the current treatment guidelines for DCIS, as well as the increased future probability for invasive cancer in the absence of standard treatment for DCIS.Results: The median age of the cohort was 48 years (41-60 years) at enrollment. Of these, 5 women were premenopausal on Tamoxifen, and 4 were post menopausal (3 on letrozole and 1 on arimidex). At the time of analysis, median follow up was 23 months (range 9-66 months). During follow up, 4 patients proceeded with surgery either electively (1 patient) or due to changes at imaging (3 patients). Two of these patients had node-negative invasive breast carcinoma identified at surgery, measuring 6 mm and 4 mm. Five patients have elected to continue surveillance (median follow up 34 months; range 10-66 months), and have had either stable disease or continued regression based on both mammographic and MRI criteria. Four patients remain on endocrine therapy. The patient with longest follow up has had almost complete resolution of radiographic abnormalities at 6 years of surveillance.Conclusion: In this pilot cohort, two-thirds of women who continued endocrine therapy and surveillance for ER-positive DCIS had radiographically stable disease or regression with short-term follow up. Women who initially declined surgery elected to undergo excision in the face of radiographic progression. Active surveillance with endocrine therapy for ER-positive DCIS is feasible, and a well-informed patient cohort is essential to minimize risk. The impact of such an approach on long-term morbidity is unknown, but requires further investigation. Ongoing efforts to improve the detection of invasive cancer in women with DCIS are expected to facilitate such an approach. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 954.
Two cases of peroneus brevis tendon tear
Authors: O Minoyama, E Uchiyama, H Iwaso, K Hiranuma, Y Takeda
Journal: British Journal of Sports Medicine (2002)

A longitudinal tear of the peroneal tendon is thought to be the result of repetitive peroneal subluxation. However, this report documents two cases of longitudinal split of the peroneus brevis tendon that had no peroneal tendon subluxation. Primary suture was performed. Subluxation of the peroneal tendons was not identified surgically in either case.