tbuckley/cabot-search huggingface dataset:
Abstract 16774: Prenatal Diagnosis of Congenital Heart Disease and Association with Morbidity Among Survivors of Initial Palliation for Single Ventricle Heart Disease: Analysis of the National Pediatric Cardiology Quality Improvement Collaborative Database
Authors: David W Brown, Patricia O'Brien, Katie E Cohen, Kimberlee Gauvreau, Thomas S Klitzner, Robert H Beekman, John D Kugler, Gerard R Martin, Steven R Neish, Geoffrey L Rosenthal, Carole Lannon, Kathy J Jenkins
Journal: Circulation (2011)

Background: Among infants with single ventricle congenital heart disease (SVD) requiring Stage I Norwood operation (S1P), the impact of prenatal diagnosis on outcomes has been variably characterized. We sought to further characterize this impact in a large multi-center cohort of survivors of S1P in the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). Methods: Retrospective analysis of demographic and outcomes data to time of Glenn operation (BDG) in infants enrolled in the NPC-QIC database; eligibility includes SVD requiring S1P and survival to hospital discharge. Results: From 31 contributing surgical centers, 195 infants were enrolled in the NPC-QIC database and had data available to time of BDG (177) or interstage death (18). Median gestational age was 39 weeks (32-41), 65% were male, 64% had variants of hypoplastic left heart syndrome, 8% had major syndromes, and 12% had major non-cardiac organ system anomalies. A prenatal diagnosis (PD) of SVD was made in 147 (75%) and did not vary by race or ethnicity. While infants with PD had slightly lower gestational age at birth (p&lt;0.001) and lower age at S1P, there were no significant differences in birth weight, presence of major syndromes or other organ system anomalies, APGAR scores, lowest pH prior to post-natal intervention, age at intubation, or presence of pre-operative risk factors. Those without PD were more likely to have significant atrioventricular valve regurgitation (p=.03) and acidosis (p=0.02), although rates of ventricular dysfunction, pre-operative mechanical ventilation and shock were similar between groups. In multivariate analysis, length of intubation was not associated with PD, and hospital length of stay was the same between groups (26 days). Interstage readmissions and deaths were not associated with PD. At time of BDG, those with PD were slightly younger (5.0 vs 5.4 months, p=0.03) and smaller (6.1 vs 6.5 kg, p=0.003) but had similar rates of post-operative complications and similar hospital length of stay. Conclusions: In a large cohort of infants with SVD surviving to hospital discharge after S1P, PD had minor associations with pre-operative risk factors and no significant association with subsequent outcomes through time of BDG.
Employment after Myocardial Infarction Amongst Previously Healthy Men
Authors: P A Watson, J F Mayberry, B Calcraft, G Colbourne
Journal: Journal of the Royal Society of Medicine (1986)

A postal questionnaire was sent to 55 men 18 months after their first myocardial infarction; information obtained was supplemented by interview with two of the authors (PW and GC). Fifty-three men had been in full-time employment prior to their illness, 38 of them in manual work. Their return to work and changes in employment were examined and, in addition, enquiries were made about subsequent health, assistance from trade unions and the local Disabled Resettlement Officer (DRO). Details of attitude to subsequent physical exercise and sexual activity were also recorded. Eighteen months after myocardial infarction, only 35% of these men were employed and 27% asymptomatic. Patients in heavy manual work were largely unable to return to their previous job and little assistance was obtained from trade unions. Even when patients were made aware of the existence of the DRO, few approached him for advice. A counselling service is needed for patients recovering from an infarct to encourage them to return to an active and profitable life.
Borderline personality disorder symptoms and severity of sexual abuse
Authors: K R Silk, S Lee, E M Hill, N E Lohr
Journal: American Journal of Psychiatry (1995)

This study explored the relationship of specific symptoms of borderline personality disorder to dimensions of severity of sexual abuse experiences in childhood.A group of 41 patients with borderline personality disorder who retrospectively reported a childhood history of sexual abuse on the Familial Experiences Interview were studied. Six items from the Diagnostic Interview for Borderline Patients (DIB) were chosen on the basis of their univariate (chi-square) association with a sexual abuse severity scale that was developed by the authors and their research team. These six DIB items were each modeled in a logistic regression. Predictor variables were the most severe experience within each of three dimensions of sexual abuse: 1) perpetrator (sexual abuse by a parent), 2) duration (sexual abuse that was ongoing), and 3) type (sexual abuse that involved penetration).The severity dimension that was most frequently found to be a significant predictor of the sum of the six DIB items as well as the total scaled DIB score was the duration dimension. Ongoing sexual abuse predicted parasuicidal behavior as well.Ongoing sexual abuse may be a strong determinant of specific aspects of the disordered interpersonal behavior and functioning found in patients with borderline personality disorder. The expectation that the world is an empty, malevolent place may have some of its roots in the repetition of sexual abuse experiences in childhood. This expectation of malevolence among patients with borderline personality disorder may manifest itself in psychotherapy through regressive and distancing behavior.
Heterogeneous causes and degree of exercise limitation in COPD GOLD1 and 2: Predictive value of CCQ and MRC
Authors: Frans Krouwels, Willemien Thijs
Journal: European Respiratory Journal (2011)

In COPD severity of disease is assessed with spirometry and dypnoea score such as CCQ (Clinical COPD Questionaire) or MRC (Medical Research Councel). Dyspnoea scores and spirometry are poorly correlated, dyspnoea may also be the result of other, not pulmonary aspects, especially in COPD GOLD 1 and 2.

Questions: 1. What is the predictive value of CCQ and MRC with respect to the degree and cause of exercise limitation in patients with COPD

2. Which factors predict a pulmonary limitation?

Methods: 60 symptomatic COPD patients in a stable phase without relevant comorbidity. At baseline they scored CCQ and MRC. A score of > 2 was considered abnormal dyspnoea (D +), others were D -. Exercise limitation in a cardiopulonary exercise test was labelled pulmonary (pulm), cardiac (card) or nonspecific (nonspec).

Results: 

View this table:

Main exercise limitating factor





D + patients had a higher BMI (p<0.05), lower FEV1% (p <0.01), a lower Wattmax, VO2max and Inspiratory Capacity (p<0.005).

In patients with a strict pulmonary limitation dyspnoea was not different from patients without pulmonary limitation. FEV1 and DLCO were significantly different, p<0.0001. Positive predictive value of dyspnoea score for pulmonary or cardiac limitation was 84% in all and 75% in patients with GOLD 1 and 2. Negative predictive value was 35% and 44% respectively.

Conclusions: In COPD patients GOLD 1 and 2 exercise limitation was not due to pulmonary factors in 86% and 43% of patients, respectively.

Pulmonary or cardiac limitation can be expected at high CCQ or MRC score, and can not be excluded in patients with a low score.
May the Nuss operation be minimally invasive procedure in adults
Authors: Rauf Gorur, Fatih Candas, Akin Yildizhan, Nurettin Yiyit, Turgut Isitmangil
Journal: European Respiratory Journal (2012)

The repair of pectus excavatum with Nuss procedure (group N) is well established among pediatric surgeons. It named minimally invasive surgery. Studies on adult patients are rare. We compared Nuss procedures and Ravitch procedures (group R) on adult patients, which of them minimally invasive in respect tos cin incisions.  We retrospectively analysed 35 adult patients (16 Nuss procedures, 19 Ravitch procedures) from 2007 to 2011. In two groups all patients aged older than 20. Ravitch procedures performed midsternal vertical incision and substernal metal bar. For Nuss procedures three scin incisions was performed, a 10-mm blunt-tip trocar was introduced into the chest. A subcutaneous tunnel was created by blunt dissection to the highest point of the funnel. A long steel introducer was inserted into the chest and pushed behind the sternum anterior to the pericardium. Finally, the bar was rotated 180°, and the sternum was tilted upward. A stabilizer was placed on the left side of the bar.  In group R 12.5 cm (10-17 cm) scin incision was performed. Non-steroidal anti-inflamatuar analgesic used for post-operative pain. We did not observe any relaps and major complication. In group N 8.5 cm (7-12.5cm) scin incision was performed. Opioid derived was used for post-operative pain. We observed early bar dislocation at four patients, two haemothoraces, three pneumothoraces and one severe post-operative pain.  In Nuss procedures should not require chest wall resection and it may do small scin incisions. But Nuss procedure have lots of complications. In Ravitch procedure, much more effective and less invasive and have little complication. We have lots of question marks.
Practical experience of ustekinumab in the treatment of psoriasis: experience from a multicentre, retrospective case cohort study across the U.K. and Ireland
Authors: P.M. Laws, A.M. Downs, R. Parslew, B. Dever, C.H. Smith, J.N. Barker, B. Moriarty, R. Murphy, B. Kirby, A.D. Burden, S. McBride, A.V. Anstey, S. O’Shea, N. Ralph, C. Buckley, C.E.M. Griffiths, R.B. Warren
Journal: British Journal of Dermatology (2011)

Background There are limited data on the use of ustekinumab outside of clinical trials. Objectives To assess the efficacy and safety of ustekinumab in patients with severe psoriasis attending 10 dermatology centres in the U.K. and Ireland. Methods A retrospective case‐note review of 129 patients with psoriasis treated with ustekinumab. Results Baseline Psoriasis Area and Severity Index (PASI) was 22·9 ± 10·1 (mean ± SD). After 16 weeks of treatment with ustekinumab PASI 75 (75% reduction in PASI) was observed in 63·0% (n = 80/127) of patients, although four patients required concomitant therapy at the 16‐week time point. Previous biologic use did show a small, non‐significant trend towards treatment failure. A PASI 75 response was seen in 29·4% (n = 5/17) of individuals weighing 90–100 kg and treated with the standard 45 mg ustekinumab dose compared with PASI 75 of 70·3%, 71·4%, 75·0% and 55·6% for weight groups < 80, 80–90, 100–110 and > 110 kg, respectively (P = 0·024). Ustekinumab therapy was well tolerated; serious adverse events were observed in 2·3% (n = 3/129) of patients. Conclusions Ustekinumab is a novel biologic agent for psoriasis. When used in everyday clinical practice it demonstrates high levels of short‐term therapeutic efficacy with an acceptable short‐term safety profile.
Clinically and Mammographically Occult Breast Lesions Demonstrated by Ultrasound
Authors: H M Y Fung, F I Jackson
Journal: Journal of the Royal Society of Medicine (1990)

Histologic proof from 62 sites in 58 patients in whom an ultrasonic abnormality was detected in the absence of palpable or mammographic evidence revealed no malignancy. It is suggested that decision to biopsy be made on clinical grounds.
MDR-1 expression and response to vincristine, doxorubicin, and dexamethasone chemotherapy in multiple myeloma refractory to alkylating agents.
Authors: J J Cornelissen, P Sonneveld, M Schoester, H G Raaijmakers, H K Nieuwenhuis, A W Dekker, H M Lokhorst
Journal: Journal of Clinical Oncology (1994)

PURPOSE To assess whether the presence of enhanced multiple drug resistance (MDR)-1 gene expression in multiple myeloma (MM) patients predicts survival, as well as response to vincristine, doxorubicin, and dexamethasone (VAD) chemotherapy. PATIENTS AND METHODS Sixty-three MM patients refractory to alkylating therapy were studied. The presence of the MDR-1 gene product, a 170-kd glycoprotein (P-170), was analyzed in bone marrow plasma cells by means of the alkaline phosphatase (APAAP) technique using the P-170-specific monoclonal antibody (MoAb) C219. The prognostic value of MDR-1 gene expression, examined before VAD treatment, was compared with other established prognostic factors including beta 2-microglobulin, albumin, lactate dehydrogenase (LDH), and the plasma cell labeling index. RESULTS Fifty-nine percent of all samples were P-170-positive. No association could be demonstrated between response to VAD and MDR-1 gene expression (chi 2 P = .359), in contrast to high serum beta 2-microglobulin levels, which were positively correlated with response (P = .006). P-170-positive and -negative patients showed a median survival duration of 23 and 22 months, respectively, a difference that was not statistically significant (P = .9). beta 2-microglobulin, LDH, albumin, and the plasma cell labeling index were all significantly correlated with survival. CONCLUSION These results indicate that other mechanisms of resistance must be involved in MM apart from MDR. The role of MDR status at this stage of disease may be biased by the major contribution of dexamethasone to induction of response by VAD in MM patients.
Long-Term Prognosis After Resection of Hepatocellular Carcinoma Associated With Hepatitis B–Related Cirrhosis
Authors: Ronnie Tung-Ping Poon, Sheung-Tat Fan, Chung-Mau Lo, Chi-Leung Liu, Irene Oi-Lin Ng, John Wong
Journal: Journal of Clinical Oncology (2000)

PURPOSE: The optimum management of hepatocellular carcinoma (HCC) associated with cirrhosis has not yet been clarified. Very few data are available in the literature regarding the prognosis after resection of HCC associated with hepatitis B virus (HBV)–related cirrhosis. This study evaluated the long-term results and prognostic factors after resection of HCC complicating HBV-related cirrhosis. PATIENTS AND METHODS: One hundred forty-six patients with HBV-related Child’s A or B cirrhosis who had undergone resection of HCC over a 10-year period were prospectively studied for long-term results. They were compared with 155 noncirrhotic patients with HBV-related HCC resected in the same period. RESULTS: The overall survival results of cirrhotic patients after resection of HCC were comparable to those of noncirrhotic patients (5-year survival, 44.3% v 45.6%, respectively; P = .216), but the former group had significantly smaller tumors. Stratified according to tumor size, the survival results were similar between cirrhotic and noncirrhotic patients with tumors ≤ 5 cm (5-year survival, 60.7% v 61.7%, respectively; P = .327) but were worse in cirrhotic compared with noncirrhotic patients with tumors greater than 5 cm (5-year survival, 27.8% v 39.5%, respectively; P = .034). Stage by stage, there were no significant differences in survival results between cirrhotic and noncirrhotic patients. Preoperative serum AST level greater than 100 IU/L (P = .004), perioperative transfusion (P = .015), and venous invasion (P &lt; .001) were independent adverse prognostic factors. CONCLUSION: The prognosis after resection of HCCs less than 5 cm in patients with compensated HBV-related cirrhosis was comparable to that of noncirrhotic patients, which suggests that surgical resection may be considered a first-line treatment for these patients. Patients with underlying active hepatitis as indicated by a high preoperative transaminase level are less favorable candidates for resection. Further studies are needed to define the relative roles of resection and transplantation for HCC associated with hepatitis B cirrhosis.
Review: Treat to Target in Rheumatoid Arthritis: Fact, Fiction, or Hypothesis?
Authors: Daniel H. Solomon, Asaf Bitton, Jeffrey N. Katz, Helga Radner, Erika M. Brown, Liana Fraenkel
Journal: Arthritis & Rheumatology (2013)

The treatment armamentarium for rheumatoid arthritis (RA) has grown substantially over the last 15 years since the development of targeted biologic and non-biologic disease modifying anti-rheumatic drugs (DMARDs). These drugs have broadened the treatment possibilities and changed how rheumatic disease experts approach the clinical management of RA. The goal of reducing disease activity to very low levels (or remission) is now realistic, and emerging evidence suggests that treating to achieve these targets enhances long term structural and quality of life outcomes.(1–7) Consequently, “treat to target” (TTT) has become an attractive concept in the clinical management of rheumatoid arthritis (RA). TTT is generally defined as a treatment strategy in which the clinician treats the patient aggressively enough to reach and maintain explicitly specified and sequentially measured goals, such as remission or low disease activity. TTT is proactive, has a clear endpoint (the “target”), and can be operationalized as a specific treatment algorithm, simplifying the multitude of complex medication sequences that can be used to treat active RA. The emerging TTT paradigm is supported by findings from many randomized controlled clinical trials in the last decade, not designed as TTT strategy trials, that suggest the benefits of early aggressive treatment approaches.(5, 8, 9)
Abstract 1668: SIRT1 Regulates Human Vascular Smooth Muscle Cell Lifespan
Authors: Cynthia S Ho, Eric P van der Veer, J. G Pickering
Journal: Circulation (2006)

Vascular smooth muscle cells (SMCs) in diseased arteries are prone to accelerated aging because of local atherosclerotic stresses and ongoing cell replication. This premature aging could limit the ...
Palliative Care Across the Continuum of Cancer Care
Authors: Tara B. Sanft, Jamie H. Von Roenn
Journal: Journal of the National Comprehensive Cancer Network (2009)

Optimal oncology care requires the integration of palliative medicine into oncology care across the disease trajectory. All patients require screening for palliative care services at the initial oncologic visit and reassessment throughout the continuum of care. As a result of the increasing attention focused on palliative care nationally and internationally, the domains of palliative cancer care have been elucidated and have fostered the development of guidelines for quality palliative care. The recent recognition of palliative medicine as a subspecialty in the United States, the growing number of hospital-based palliative care programs, and the accreditation of palliative medicine fellowship programs by the Accreditation Council for Graduate Medical Education highlight the increased visibility of palliative medicine. This provides hope for the future of oncologic care. The palliative approach is subsumed in cancer care—it provides assistance with decision-making, symptom management, and access to financial, emotional, and spiritual services. A fully integrated program of oncology and palliative care provides the greatest opportunity for care and cure.
Feedback on Abortion Consultation
Authors: DOUGLAS M. HARPER
Journal: American Journal of Psychiatry (1974)

The author agree's with C.M. Friedman's article ("Making Abortion Consultation Therapeutic," November 1973) that psychiatrists should stop prostituting themselves by claiming an abortion is necessary to safeguar d the woman's mental health. However, he feels the real human issue is whether a lift whould be destroyed simply because it is inconvenient for the mother and not, as Dr. Friedman suggests, because of "her mature longings for a child, her present capacity to love and give, her present reality, and a weighing of her morality."
Inhalation of nano-scaled titianium dioxide particles aggravates airway inflammation in allergen-challenged mice
Authors: Sofia Jonasson, Åsa Gustafsson, Bo Koch, Emelie Näslund-Salomonsson, Anders Bucht
Journal: European Respiratory Journal (2011)

Titanium dioxide (TiO2) nanoparticles are manufactured worldwide and although TiO2 is chemically inert, it may have adverse health effects especially in sensitive populations. The use of nanomaterials has increased over the past years and the detrimental effects on various airway diseases are poorly characterized. Thus we investigated if a single exposure of TiO2 before or during ovalbumin (OVA)-challenge could promote airway inflammation in mice with allergic airway disease.

BALB/c mice were sensitized to OVA (10 μg i.p.) on day 0 and 14, then challenged with nebulized 1% OVA for 30 min on day 29,32 and 34. Lung exposure of aerosolized TiO2 was performed before (day 28) and during OVA challenge (day 33). The approximated deposited dose of TiO2 in the mouse lung was estimated to be 0.53 ml/m3 (2h, nose-only exposure). The experiment ended on day 35 with assessment of bronchial reactivity to methacholine and inflammatory cell counts in bronchoalveolar lavage (BAL).Total inflammatory cell counts in BAL was increased both when TiO2 was exposed on day 28 and day 33 (both p < 0.05) compared to exposure to only OVA. When mice were exposed for TiO2 before OVA challenge there was a larger decline in respiratory compliance (p = 0.03) and a greater impact on peripheral airways (tissue resistance and tissue elastance (both p<0.05)) compared to TiO2 administrated during the OVA-challenge and to animals exposed to only OVA. In conclusion, we aimed to study effects of combined exposure of nanoparticles and pro-allergic proteins in a mouse model of asthma, indicating that TiO2 administration before and during allergen-challenge have proinflammatory effects in peripheral airways.
Lung CT density correlates with measurements of airflow limitation and the diffusing capacity
Authors: GA Gould, AT Redpath, M Ryan, PM Warren, JJ Best, DC Flenley, W MacNee
Journal: European Respiratory Journal (1991)

We studied 80 subjects (63 M, 17 F; 23-82 yrs) and related lung computerized tomography (CT) density with age, height, spirometry, lung volumes, diffusing capacity and arterial blood gas tensions. These subjects demonstrated a wide range of physiological impairment (forced expiratory volume in one second (FEV1) 8-116% predicted; diffusing capacity (Kco) 15-139% predicted; arterial oxygen tension (Pao2) 38-91 mmHg). They ranged from normal subjects to patients with chronic respiratory failure. Lung density was derived from CT density histograms measured as both mean Emergency Medical Information (EMI) number (EMI scale: 0 = water, -500 = air, EMI number of normal lung tissue range approximately -200 to -450) and the lowest 5th percentile EMI number, the latter value being more likely to represent the density of lung parenchyma. Lung CT density correlated most strongly with airflow obstruction (EMI 5th percentile versus FEV1/forced vital capacity (FVC) % predicted, r = 0.73, p less than 0.001) and diffusing capacity (EMI 5th percentile versus Kco, r = 0.77, p less than 0.001). This suggests that reduction in lung density, which reflects loss of the surface area of the distal airspaces, is a major index of respiratory function in patients with smoking related chronic obstructive pulmonary disease (COPD). These data provide no indication of other factors such as small and large airways disease, and loss of elastic recoil, which may contribute to airflow limitation, or disruption of the pulmonary vascular bed which may also affect CT lung density.