tbuckley/cabot-search huggingface dataset:
HEPARIN AND SYMPATHETIC NERVE BLOCK IN FROSTBITE
Authors: Yrjo Kulhia
Journal: JAMA (1953)

<h3>To the Editor:</h3> —InThe Journal(<b>149:</b>1199 [July 26] 1952), Edwards and Leeper published a paper "Frostbite: An Analysis of Seventy-One Cases." The summary of that article contains the statement, "The use of sympathicolytic drugs in the acute stage seemed to have no effect on the outcome. Anticoagulants would appear to deserve a more thorough trial, and more data may help in the question of rapid versus slow thawing." I have successfully treated two severe cases of frostbite by the methods described by these authors. On Jan. 4, 1950, when the temperature was 28 C, a guard, aged 46, from Kokkola came to me for treatment. His left foot had been frozen that evening; he came to the outpatient department two and one-half hours after the foot was frozen. Before he came to the hospital, his foot had been thawed and massaged at the Kokkola railway station. On admission,
Autonomic mechanisms and sudden death. New insights from analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction.
Authors: P J Schwartz, E Vanoli, M Stramba-Badiale, G M De Ferrari, G E Billman, R D Foreman
Journal: Circulation (1988)

We have suggested that among conscious dogs with a healed anterior wall myocardial infarction (MI) a depressed baroreflex sensitivity (BRS) carries a higher risk of developing ventricular fibrillation during a brief ischemic episode associated with an exercise stress test. The clinical and pathophysiological implications of our previous findings prompted the present study, which addressed three major questions: 1) Is, indeed, analysis of BRS after MI a specific and sensitive marker for sudden death-risk stratification? 2) Does MI modify BRS? 3) Does analysis of BRS before MI provide information about outcome during ischemic episodes occurring after MI? An anterior MI was produced in 301 dogs, and 4 weeks later, a 2-minute circumflex coronary artery occlusion beginning during the last minute of an exercise stress test could be performed in 192 animals. Ventricular fibrillation occurred in 106 (55%) dogs (susceptible to sudden death), whereas 86 (45%) dogs (resistant to sudden death) survived. BRS was assessed by the phenylephrine method and was expressed by the regression line relating RR intervals to blood-pressure changes. BRS was significantly lower among susceptible than among resistant dogs (9.1 +/- 6.0 vs. 17.7 +/- 6.5 msec/mm Hg, p less than 0.0001). The risk for sudden death increased from 20% (15 of 73 dogs) for a BRS greater than 15 msec/mm Hg to 91% (62 of 68 dogs) for a BRS less than 9 msec/mm Hg (p less than 0.001). An internal control study in 55 animals showed that BRS was reduced 4 weeks after MI compared with control conditions (13.5 +/- 6.7 vs. 17.8 +/- 6.6 msec/mm Hg, p less than 0.001) and that a reduction occurred in 73% of animals. Susceptible dogs and those that spontaneously died after MI had a lower BRS even before the MI (16.2 +/- 5.9 vs. 22.2 +/- 6.2 msec/mm Hg, p less than 0.001). The risk for sudden death after MI increased from 35% (nine of 26 dogs) for a BRS before MI greater than 20 msec/mm Hg to 85% (17 of 20 dogs) for a BRS before MI less than 14 msec/mm Hg (p less than 0.001). This study demonstrates that the presence of a reduced BRS is associated with a greater susceptibility to ventricular fibrillation during subsequent ischemic episodes. In the majority of dogs, BRS is reduced after an MI. The results in 192 conscious dogs with a healed MI indicate that analysis of BRS is a powerful tool for risk stratification not only after, but even before, the occurrence of an MI.
TCT-896 Prognostic Value and Predictors Value of Reverse Ventricular Remodeling in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement
Authors: Asim Rafique, Tarun Chakravarty, Niraj Doctor, Hasan Jilaihawi, Raj Makkar
Journal: Journal of the American College of Cardiology (2012)
Comparison of Inhaled Long-Acting β-Agonist and Anticholinergic Effectiveness in Older Patients With Chronic Obstructive Pulmonary Disease
Authors: Andrea Gershon, Ruth Croxford, Teresa To, Matthew B. Stanbrook, Ross Upshur, Paula Sanchez-Romeu, Thérèse Stukel
Journal: Annals of Internal Medicine (2011)

Background: Chronic obstructive pulmonary disease (COPD), a largely preventable and manageable respiratory condition, affects an estimated 12% to 20% of adults. Long-acting inhaled β-agonists and anticholinergics have both been shown to improve COPD outcomes and are recommended for moderate to severe disease; however, little is known about their comparative effectiveness. Objective: To compare survival in older patients with COPD who initially receive inhaled long-acting β-agonists with that of patients who receive anticholinergics. Design: Population-based, retrospective cohort study. Setting: Ontario, Canada. Patients: Patients aged 66 years or older (who carry the largest burden of COPD and for whom data were available) who met a validated case definition of COPD on the basis of health administrative data and were newly prescribed an inhaled long-acting β-agonist or a long-acting anticholinergic (but not both) between 2003 and 2007. Patients were followed for up to 5.5 years. Measurements: The primary outcome was all-cause mortality. Results: A total of 46 403 patients with COPD (mean age, 77 years; 49% women) were included. Overall mortality was 38.2%. Mortality was higher in patients initially prescribed a long-acting anticholinergic than in those initially prescribed a long-acting inhaled β-agonist (adjusted hazard ratio, 1.14 [95% CI, 1.09 to 1.19]). Rates of hospitalizations and emergency department visits were also higher in those initially prescribed a long-acting anticholinergic. Limitation: Patients were classified as having COPD on the basis of health administrative records, which did not contain information about lung function. Conclusion: Older adults initially prescribed long-acting inhaled β-agonists for the management of moderate COPD seem to have lower mortality than those initially prescribed long-acting anticholinergics. Further research is needed to confirm these findings in younger patients and in a randomized, controlled trial. Primary Funding Source: Government of Ontario, Canada.
The antibody atliximab attenuates collagen-induced arthritis by neutralizing AIMP1, an inflammatory cytokine that enhances osteoclastogenesis
Authors: Shin Hee Hong, Jin Gu Cho, Kang Jun Yoon, Dae-Seog Lim, Chul Hoon Kim, Sang-Won Lee, Sang Gyu Park
Journal: Biomaterials (2015)
Treatment of Lupus Nephritis — A Work in Progress
Authors: Ronald J. Falk
Journal: New England Journal of Medicine (2000)

Until the pathogenesis of nephritis due to systemic lupus erythematosus has been unraveled, optimal treatment for patients with this disease will remain an elusive goal. When the causes of lupus nephritis become known, we should be able to design specific immunosuppressive and immunomodulating therapy. Genetic and environmental risk factors may be useful for identifying patients at risk and possibly preventing the development of nephritis. Optimal treatment would include reprogramming B- and T-cell immune responses to ignore nephritogenic antigens, thereby eliminating the elaboration of injurious inflammatory mediators and growth factors and promoting healing.Patients with systemic lupus erythematosus often have inflammatory . . .
Thrombolysis in acute ischaemic stroke: time for a rethink?
Authors: B. S. Alper, M. Malone-Moses, J. S. McLellan, K. Prasad, E. Manheimer
Journal: BMJ (2015)

As the UK regulator reviews alteplase in ischaemic stroke, <b>Brian Alper and colleagues</b> interpret the evidence to suggest increased mortality with uncertain benefit for its use beyond three hours
NICE recommends abiraterone for prostate cancer after manufacturer reduces price
Authors: Z. Kmietowicz
Journal: BMJ (2012)

The National Institute for Health and Clinical Excellence (NICE) has amended draft guidance on the drug abiraterone (marketed in the United Kingdom as Zytiga) for men with advanced prostate cancer after the manufacturer agreed a reduced price deal for the NHS.

Abiraterone, which is made by Janssen, was initially rejected by NICE for use in England and Wales in draft guidance launched in February because it was too expensive.1 But after negotiations with Janssen the guidance has been reissued, although the discount offered to the NHS on the drug—which costs £2930 (€3650; $4640) for a month’s supply—has been kept confidential for commercial reasons. …
Guidelines to control heparin treatment.
Authors: A G Fennerty, S Renowden, N Scolding, D P Bentley, I A Campbell, P A Routledge
Journal: BMJ (1986)

With new guidelines for the control of heparin infusion rates the proportion of kaolin cephalin clotting time ratios was significantly improved compared with ratios achieved without their use. Further improvement might result from careful preparation and delivery of the infusion.
The efficacy and safety of duodenal stenting: a prospective multicenter study
Authors: I. Graber, R. Dumas, B. Filoche, J. Boyer, D. Coumaros, H. Lamouliatte, J. Legoux, B. Napoléon, T. Ponchon
Journal: Endoscopy (2007)

Duodenal stenting has become a popular treatment in cases of malignant stenosis. However, a prospective evaluation of the efficacy and morbidity of this procedure has not been performed. A prospective multicenter study of duodenal stenting was conducted by the Société Française d'Endoscopie Digestive (SFED).A total of 51 patients were selected (mean age 72), the majority (69%) having pancreatic adenocarcinoma. Palliative treatment was chosen because of irresectability (61.2%), inoperability (18.4%), or both (20.4 %). Enteral Wallstent prostheses were used, and the patients were followed up on day 3, after 1 month, and then every month, with weight measurement, and symptomatic and laboratory evaluation.One prosthesis was sufficient in 46 patients. Stent positioning and deployment were correct in 50/51 patients (98%). Twenty patients also underwent biliary stenting in addition to the duodenal stenting. On day 3, 43 patients (84%) were able to tolerate soft solids or a full diet. Six complications were attributed to stenting: three intestinal hemorrhages, two cases of peritonitis due to bowel perforation, and one case of septicemia, and these led to five deaths (mortality 9.8%). Stent dysfunction was observed in 12 cases (23.5%) after a mean delay of 75 days, comprising 11-malignant obstructions and one migration: a new stent was inserted inside the first one and was effective in eight cases; and no treatment was given in the other four patients because of their clinical state. The median survival was 71.5 days.Palliative endoscopic treatment of malignant duodenal stenosis using metallic prostheses is highly feasible, even with associated biliary stenting. Symptomatic improvement is fast. However, the mortality and the obstruction rate are high, suggesting that a prospective trial comparing this treatment with surgery is still required.
Crisis in the Emergency Department
Authors: Arthur L. Kellermann
Journal: New England Journal of Medicine (2006)

Interview with Arthur Kellermann on the crisis in emergency care in the United States. (08:41)Download At 2 a.m. on July 27, 1996, I stood in the ambulance bay of Grady Memorial Hospital, awaiting the first of 35 severely injured bombing victims who would be brought to Grady from Atlanta's Olympic Park over the next 2 hours. Although it was a harrowing experience for all involved, the response of Grady's ambulance service, emergency physicians, and trauma surgeons was so efficient that the hospital had returned to normal operations by 7 a.m.Much has changed in the decade since the Atlanta bombing. The power and sophistication of terrorist bombings have increased dramatically, but America's emergency and trauma . . .
Abstract 773: Identification and characterization of natural product-based inhibitors of hypoxia inducible factor-2 alpha
Authors: Daniel C. Rabe, Tawnya McKee, Girma M. Woldemichael, James R. Vasselli, James McMahon, W Marston Linehan, Donald P. Bottaro
Journal: Cancer Research (2010)

Abstract Clear cell renal cell carcinoma (RCC) is the most prevalent form of kidney cancer and is frequently associated with loss of von Hippel Lindau (VHL) gene function, resulting in the aberrant transcriptional activation of hypoxia response genes that contribute to tumor growth, angiogenesis and metastasis. Prior studies have shown that normoxic stabilization of hypoxia inducible factor (HIF)-1-alpha alone, while capable of mimicking some aspects of VHL loss, are not sufficient to reproduce tumorigenesis, indicating that it is not the most critical oncogenic substrate of VHL protein. To isolate compounds that selectively modulate HIF2-alpha for use as research tools and drug development leads, a cell-based high throughput screen of the NCI Natural Products Repository was performed. Stably transformed clones of the human renal clear cell carcinoma cell line 786-0 expressing a luciferase reporter construct under the control of the human vascular endothelial growth factor (VEGF) promoter-enhancer were used to identify natural product samples with inhibitory activity and minimal cellular toxicity. Leads from initial high throughput screen were chromatographically separated into component structures yielding several pure compounds with micromolar or submicromolar IC50 values, &amp;gt;80% inhibition and &amp;lt;5% cell toxicity. These compounds were then characterized biologically for their ability to inhibit VEGF protein secretion by intact 786-0 cells; several compounds showed &amp;gt;90% inhibition of VEGF secretion at micromolar doses under normoxic conditions. Studies to establish HIF selectivity and effects on RCC cell proliferation, survival, motility and anchorage independent growth are underway. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 773.
Point 1: Sometimes a Greal Notion
Authors: J. S. Macdonald
Journal: JNCI Journal of the National Cancer Institute (1990)

The National Cancer Institute decided in May 1988 that results of certain breast cancer clinical trials were so compelling that physicians - and their patients-needed to be informed immediately. In advance of publication of these results in a peer-reviewed journal, NCI mailed a summary notice of the findings, called a Clinical Alert, to 13, 000 physicians, and shortly thereafter released the alert to the news media. Ferment ensued over the breach of tradition. In October 1989, NCI issued a similar statement, called an Update, on adjuvant therapy for colon cancer. NCI's clinical-alert policy is the subject of the first Point/Counterpoint - the Journal's new department that will, on occasion, present opposing views on timely and sometimes controversial issues. In this instance, John S. Macdonald, professor of medicine and director of Temple University Comprehensive Cancer Center, agreed to write Point; I. Craig Henderson, associate professor of medicine, Harvard University, and medical coordinator of DanaFarber Cancer Institute's Breast Evaluation Center, agreed to write Counterpoint. Macdonald, it should be noted, is a former director of the NCI Cancer Therapy Evaluation Program (CTEP). Accompanying the personal views of these writers is the NCI institutional view, a Point provided by Michael A. Friedman, current director of CTEP.
Balance in long term follow up between secondary and primary care is necessary
Authors: P J Watkins
Journal: BMJ (1997)

The central problem is often poor design and conduct of trialsEditor-We are concerned about some aspects of the recent articles on consent. 1 2 Len Doyal claims that informed consent may not be necessary for three most vulnerable groups: young children, patients with learning difficulties, and unconscious or semiconscious patients.Yet young children (unlike all adult groups) have the protection of their parents' consent, and this should always be respected. 3 The other two groups show the limitations of applying Kantian respect for autonomy, designed for property owning 18th century gentlemen, to vulnerable dependent patients.There is an urgent need to agree new ways of making research decisions with and for these minority groups.As is usual in arguments against seeking informed consent, there is a tendency to concentrate on dramatic extremes: patients with severe mental impairment and patients receiving heroic cancer treatment.The development of principles from extremes is dangerous and should be discouraged.Difficulties with relatively small groups should not be used to excuse researchers from requesting the consent of the vast majority of the millions of people every year who help with research into mundane pharmaceutical trials of treatments of arthritis or everyday misery.A deeper problem with the articles is the assumption that consent is the central problem in research.We suggest that, more often, the central problem is the poor design and conduct of trials which alienate or distress people on whose practical support researchers depend.The solution here is not to tinker with consent but to clean up research.Health service users could help at every stage of clinical research: the selection of questions worth investigating; the design and conduct of trials, including the information materials; the interpretation and reporting of the evidence; dissemination; and working with practitioners to put findings into practice.Consumers for Ethics in Research has been working with health service users, researchers, and practitioners on these issues for the past eight years, partly through regular open meetings, during which many practical ideas have been advanced.
The Hypoglycemia Index
Authors: A. Hadji-Georgopoulos
Journal: JAMA (1980)

<h3>To the Editor.—</h3> The authors of "Reactive Hypoglycemia" (243:1151, 1980) state that "hypoglycemic symptoms occurring during the [oral glucose tolerance] test were not related to level of plasma glucose nadir or to rate of descent of glucose level." Our recently published results<sup>1</sup>support the conclusion that the blood glucose nadir should not be used as the sole criterion for diagnosis. However, the hypoglycemic index<sup>2</sup>(defined as the fall in blood glucose level during a 90-minute period before reaching the nadir divided by the value of the glucose nadir) can separate with no overlap symptomatic from asymptomatic patients. The hypoglycemic index correlated with the insulin levels 90 minutes before the lower blood glucose levels. Therefore, an elevated hypoglycemic index is associated with symptoms and reflects later hyperinsulinism.
P49 Treating hepatitis C in the patient's home: a hospital and homecare partnership
Authors: K. Jack, J. Barnett, B. Thomson
Journal: Gut (2011)

<h3>Introduction</h3> It is long established that the UK has poorer outcomes regarding numbers of patients treated with antivirals for chronic hepatitis C (HCV) than it9s European counterparts. Exploring alternative models of care that will facilitate the engagement of those whom regular hospital attendance would be a barrier to treatment is important if one is to reduce the incidence of end stage liver disease among this group of patients. Against this backdrop we initiated a project in Nottingham to deliver care in tandem with a community nursing service. <h3>Aim</h3> To treat HCV infected patients with pegylated interferon and ribavirin in the patient9s home via a partnership between secondary care and an established homecare company. <h3>Method</h3> Patients with stable HCV infection and no evidence of decompensated liver disease are offered this model of care in the hepatitis clinic and referred to the homecare company by the Consultant or Specialist Nurse. The antiviral drugs are delivered directly to the patient9s home, and a skilled homecare nurse trained in the management of HCV visits the patient to undertake: teaching how to self inject pegylated interferon and take ribavirin correctly; draw blood samples for monitoring treatment progress and safety, to assess side effects and provide nursing care in managing these; and regularly report back to the referring clinician. Nursing support is available to patients 24 h a day. Once treatment is complete the patient returns to the hepatitis clinic to be reviewed. <h3>Results</h3> Since this model9s inception in February 2004, approximately 110 patients were offered the option of homecare. 87 patients elected to be treated at home and were referred by the secondary care HCV clinic using an agreed proforma. Investigations during treatment were conducted using the same schedule as the specialist clinic and hospital staff reviewed the results. The specialist team took all decisions on changes to drug treatment. Treatment outcomes and drop out rates are comparable to hospital-managed clinics, but the non-attendance rates are exceptionally low; only two home visits have been missed by patients. No adverse events as a result of receiving treatment and monitoring at home have occurred. Furthermore this model of care is cost effective; drugs are supplied VAT-free by not being routed into the hospital pharmacy, and this offsets the home nursing cost. <h3>Conclusion</h3> Our results demonstrate that homecare treatment for HCV infection is feasible, safe and the preferred option of most patients. It is well tolerated by patients with very high compliance rates which we anticipate will lead to improvements in treatment outcomes. We suggest that this innovative homecare model can be an important facet of hospital HCV services, and thus be a major means of facilitating the engagement of more patients into therapy without an additional burden of nursing staff costs.
Pacing Techniques in the Treatment of Tachycardias
Authors: ISAAC WIENER
Journal: Annals of Internal Medicine (1980)

Pacemakers are playing an increasing role in the management of patients with tachycardia. Pacing to prevent tachycardia must be differentiated from pacing to terminate tachycardia. Pacing is of proven value in preventing ventricular tachycardia that occurs in the setting of complete heart block or the setting of drug-induced QT interval prolongation and may be valuable in some other patients with nonsustained ventricular tachycardia. Pacing termination has found its greatest use as an alternative to cardioversion in patients with atrial flutter, especially those with suspected digitalis toxicity or sick sinus syndrome or patients after cardiac surgery. Implanted pacemakers that can be activated by the patient are a promising area or investigation for the termination of tachycardias that are recurrent and debilitating despite medical therapy.
A double-blind trial of bromocriptine in steroid dependent asthma.
Authors: K M Christensen, H Letman, A G Mikkelsen
Journal: Thorax (1979)

The pilot study of Newman Taylor et al (1976) in which, by adding bromocriptine to the full medical treatment, they improved the symptoms of three out of four asthmatic patients, prompted us to carry out this study. Bromocriptine is a dopaminergic agonist that is used in acromegalic patients, as well as an inhibitor of prolactin in doses of 5 to 20 mg a day. We decided to use 15 mg a day, which is usually without major side effects.