tbuckley/cabot-search huggingface dataset:
Secondary Prevention of Stroke and Transient Ischemic Attack
Authors: James K. Liao
Journal: Circulation (2007)

Background— Recurrent cerebrovascular events constitute an estimated 200 000 of the 700 000 strokes reported annually in the United States, which makes secondary stroke prevention an important goal in the management of disease among patients who have experienced stroke or transient ischemic attack. Methods and Results— Various pharmacological approaches have been advocated, but the relative efficacy and safety of these regimens has remained the subject of much debate. The results of recent clinical trials on the use of antiplatelet therapy suggest that patients with a history of stroke or transient ischemic attack may constitute a population distinct from patients with coronary or peripheral vascular disease. This may be caused, in part, by the differing etiologies of stroke and the increased vulnerability of cerebral vessels to bleeding. Indeed, dual antiplatelet therapy, which has been found to be beneficial for the treatment of acute coronary syndromes and percutaneous coronary interventions, does not confer secondary stroke protection. The emerging paradigm is that some level of platelet inhibition is required for secondary stroke protection; a level beyond which increased risk of bleeding arises. Conclusion— Because the vast majority of patients with ischemic stroke have recurrent stroke or transient ischemic attack, rather than myocardial infarction, as their next event, antiplatelet therapies for these patients should be administered according to what has been shown to be efficacious for secondary stroke protection rather than for myocardial protection. Combination therapies, which provide optimal platelet inhibition as well as vascular protection, may offer the best strategy for secondary stroke protection.
Fecal DNA versus Fecal Occult Blood for Colorectal-Cancer Screening in an Average-Risk Population
Authors: Thomas F. Imperiale, David F. Ransohoff, Steven H. Itzkowitz, Barry A. Turnbull, Michael E. Ross
Journal: New England Journal of Medicine (2004)

Although fecal occult-blood testing is the only available noninvasive screening method that reduces the risk of death from colorectal cancer, it has limited sensitivity. We compared an approach that identifies abnormal DNA in stool samples with the Hemoccult II fecal occult-blood test in average-risk, asymptomatic persons 50 years of age or older.Eligible subjects submitted one stool specimen for DNA analysis, underwent standard Hemoccult II testing, and then underwent colonoscopy. Of 5486 subjects enrolled, 4404 completed all aspects of the study. A subgroup of 2507 subjects was analyzed, including all those with a diagnosis of invasive adenocarcinoma or advanced adenoma plus randomly chosen subjects with no polyps or minor polyps. The fecal DNA panel consisted of 21 mutations.The fecal DNA panel detected 16 of 31 invasive cancers, whereas Hemoccult II identified 4 of 31 (51.6 percent vs. 12.9 percent, P=0.003). The DNA panel detected 29 of 71 invasive cancers plus adenomas with high-grade dysplasia, whereas Hemoccult II identified 10 of 71 (40.8 percent vs. 14.1 percent, P<0.001). Among 418 subjects with advanced neoplasia (defined as a tubular adenoma at least 1 cm in diameter, a polyp with a villous histologic appearance, a polyp with high-grade dysplasia, or cancer), the DNA panel was positive in 76 (18.2 percent), whereas Hemoccult II was positive in 45 (10.8 percent). Specificity in subjects with negative findings on colonoscopy was 94.4 percent for the fecal DNA panel and 95.2 percent for Hemoccult II.Although the majority of neoplastic lesions identified by colonoscopy were not detected by either noninvasive test, the multitarget analysis of fecal DNA detected a greater proportion of important colorectal neoplasia than did Hemoccult II without compromising specificity.
Abstract A32: Aberrant gene repression with H3K27me3 modification in human small cell lung cancer
Authors: Atsushi Kaneda, Teruyuki Sato, Shingo Tsuji, Takayuki Isagawa, Toshihiro Nukiwa, Yuichi Ishikawa, Hiroyuki Aburatani
Journal: Cancer Research (2013)

Abstract Small cell lung cancer (SCLC), approximately 15% of all the lung cancer cases, is a subtype of lung cancer with poor prognosis. Expression profiling analysis of 23 SCLC cases and 42 normal tissues revealed that EZH2 and other PRC2 members were highly expressed in SCLC. ChIP-seq analysis for H3K27me3 in 3 SCLC cell lines, Lu130, H209 and DMS53, showed that genes enriched with H3K27me3 mark in SCLC were not only PRC2-target genes in ES cells, but also other genes, such as cellular adhesion-related genes. These H3K27me3(+) genes in SCLC were significantly repressed in expression, and introduction of them into SCLC cell lines lead to growth inhibition. Shorter overall survival of clinical SCLC cases correlated to repression of those H3K27me3(+) genes, including PRC target genes. Treatment with a PRC2 inhibitor resulted in growth inhibition of SCLC cell lines, indicating that high expression of PRC2 would contribute to gene repression in SCLC, and may play a role in genesis of SCLC. Citation Format: Atsushi Kaneda, Teruyuki Sato, Shingo Tsuji, Takayuki Isagawa, Toshihiro Nukiwa, Yuichi Ishikawa, Hiroyuki Aburatani. Aberrant gene repression with H3K27me3 modification in human small cell lung cancer. [abstract]. In: Proceedings of the AACR Special Conference on Chromatin and Epigenetics in Cancer; Jun 19-22, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2013;73(13 Suppl):Abstract nr A32.
Anatomy for the Anesthesiologist: A Stereoscopic Atlas. With viewer
Authors: John B. Stetson
Journal: JAMA (1964)

<b>Anatomy for Anesthetists</b>. By Harold Ellis. Illustrated by Margaret McLarty. 340 pp, 174 illus. $9. F. A. Davis Co., 1914 Cherry St, Philadelphia 19103, 1963 The bindings of the two books, one American, the other British, display similar titles. The sections on the autonomic or sympathetic nervous system begin on page 222 in each book, but beyond these similarities the books are truly an ocean apart. The British book is written by a surgeon and illustrated by a medical artist. The American book is written by an anesthesiologist, and art work and lettering often appear to be amateur productions. The stereoscopic atlas idea is novel and Professor Dornette is to be complimented on his bravery for attempting its use. Unfortunately, some of the photographic reproductions in the book seem to be of poor quality and the viewing glasses too small, or perhaps the reviewer just doesn't "have the hang of
Sequencing of Tamoxifen and Radiotherapy After Breast-Conserving Surgery in Early-Stage Breast Cancer
Authors: Lori J. Pierce, Laura F. Hutchins, Stephanie R. Green, Danika L. Lew, Julie R. Gralow, Robert B. Livingston, C. Kent Osborne, Kathy S. Albain
Journal: Journal of Clinical Oncology (2004)

Tamoxifen (TAM) is thought to exert a cytostatic effect on hormone-sensitive breast cancer cells. Some preclinical studies show reduced radiosensitivity in irradiated malignant mammary epithelial cells when pretreated with TAM; other studies refute these results. Recent randomized clinical trials suggest an antagonistic effect of TAM on cytotoxic therapy, with improved disease-free survival (DFS) with sequential versus concurrent TAM. An exploratory analysis was undertaken to evaluate the optimal sequencing of TAM and radiotherapy (RT) after breast-conserving surgery.Southwest Oncology Group trial 8897 (Intergroup 0102) randomly assigned node-negative women with T1-3 breast cancers to cyclophosphamide, doxorubicin, fluorouracil (CAF); CAF --> TAM; cyclophosphamide, methotrexate, fluorouracil (CMF); and CMF --> TAM. For this analysis, data are reported only in the TAM groups. RT was allowed either before adjuvant therapy (sequential [SEQ] RT; 107 patients) or after chemotherapy but concurrent with TAM (concurrent [CONC] RT; 202 patients). Survival data were adjusted for receptor status, age, and tumor size.With a median follow-up of 10.3 years, 10-year DFS values were 83% and 83% for CONC versus SEQ RT groups (log-rank P = .73; P = .76 adjusted for patient characteristics), and 10-year overall survivals were 88% and 90%, respectively (log-rank P = .59; adjusted P = .65). Patterns of failure showed no increase in in-breast recurrence rates between CONC RT and SEQ RT groups, with 10-year local recurrence rates of 7% for CONC RT and 5% for SEQ RT (hazard ratio, 0.73; 95% CI, 0.26 to 2.04; P = .54).The current analysis does not suggest an adverse effect on local or systemic control with CONC versus SEQ TAM and RT in node-negative breast cancer. A randomized trial is encouraged to validate these results.
US spent $2.7 trillion on healthcare in 2011, but growth remains steady
Authors: B. Roehr
Journal: BMJ (2013)

Total US healthcare spending reached $2.7 trillion in 2011, or $8680 (£5410; €6625) per person, show figures released by the Center for Medicare and Medicaid Services.1 The relatively low 3.9% rise from 2010 was roughly in line with growth in the economy, and for the third straight year spending remained at 17.9% of gross domestic product. Previous years had seen higher rises in healthcare spending, such as 7.6% in 2007.

The intriguing but unanswered question is whether this deceleration in healthcare spending is the effect of the economic recession or whether it represents a fundamental restructuring of healthcare delivery and costs.

Among the fastest growing components of healthcare spending in 2011 were increases in personal spending, prescription drugs, and physician and clinical services. These were …
Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation.
Authors: M Enriquez-Sarano, A J Tajik, H V Schaff, T A Orszulak, K R Bailey, R L Frye
Journal: Circulation (1994)

Left ventricular dysfunction is a frequent cause of death after successful surgical repair of mitral regurgitation. The role of preoperative echocardiographic left ventricular variables in the prediction of postoperative survival and thus their clinical implications remain uncertain.The survival of 409 patients operated on between 1980 and 1989 for pure, isolated, organic mitral regurgitation and with a preoperative echocardiogram (within 6 months of operation) was analyzed. The overall survival was 75% at 5 years (90% of expected), 58% at 10 years (88% of expected), and 44% at 12 years (73% of expected). Operative mortality was 6.6% and markedly improved from 1980 to 1984 (10.7%) to 1985 to 1989 (3.7%). Multivariate analysis showed that age (P = .0003), date of operation (P = .003), and functional class (P = .016) but not left ventricular function were predictors of operative mortality. In the most recent period (1985 to 1989), operative mortality was 12.3% in patients age 75 years or older and 1.1% in patients younger than 75 years. Late survival was analyzed in the operative survivors. Multivariate analysis showed that the most powerful predictor was echocardiographic ejection fraction (EF) (P = .0004), followed by age (P = .0031), creatinine level (P = .0062), systolic blood pressure (P = .0164), and presence of coronary artery disease (P = .0237). The late survival at 10 years was 32 +/- 12% for patients with EF < 50%, 53 +/- 9% for EF 50% to 60%, and 72 +/- 4% for EF > or = 60%. The hazard ratio compared with EF > or = 60% was 2.79 (95% confidence interval, 1.65 to 4.72) for EF < 50% and 1.81 (95% confidence interval, 1.11 to 2.95) for EF 50% to 60%. Echocardiographic EF remained the best predictor of late survival, even when combined with left ventricular angiographic variables. The survival of patients with EF > or = 60% was 100% of expected at 10 years but was better in patients in class I or II than in those in class III or IV (82 +/- 6% versus 59 +/- 6%, respectively, at 10 years; P = .0021). The preoperative predictors of operative and late mortality remained significant independent of the type of surgical correction performed in combined multivariate analyses.In organic mitral regurgitation, (1) operative mortality has markedly decreased recently, being at a low 1.1% in patients younger than 75 years, and is predicted by age and symptoms and not by left ventricular function, and (2) left ventricular EF measured by echocardiography is the most powerful predictor of late survival. These results suggest that surgical treatment should be considered early, even in the absence of severe symptoms, in patients with severe mitral regurgitation, before left ventricular dysfunction occurs.
Variables, sample estimates, and population parameters
Authors: P. Sedgwick
Journal: BMJ (2013)

Researchers evaluated the effect of initial trophic feeding compared with full enteral feeding on physical function in patients with acute lung injury. A cluster randomised controlled trial study design was used. In total, 525 patients with acute lung injury admitted to hospital were recruited. Participants were randomised to low energy permissive underfeeding (“trophic feeding”) or full energy enteral feeding (“full feeding”) for up to six days; thereafter, all patients still receiving mechanical ventilation received full feeding.1

The primary outcome was blind assessment of the physical function domain of the SF-36 instrument, adjusted for age and sex, 12 months after …
THE PRESENCE OF PROTECTIVE SUBSTANCES IN HUMAN SERUM DURING LOBAR PNEUMONIA
Authors: A. R. Dochez
Journal: The Journal of Experimental Medicine (1912)

These experiments demonstrate that protective substances are usually present in the blood of patients recovering from lobar pneumonia. As a rule, the appearance of protective bodies in the blood, when demonstrable, coincides rather sharply with the period of critical fall in temperature and the disappearance of symptoms. These substances are not present in the blood in any measurable degree before the crisis, but afterward they may reach a considerable concentration. In certain instances, protective substances either become evident some time after the occurrence of the crisis, or cannot be demonstrated at any period of the disease. Experiments in which it is possible to test serum against an homologous strain of pneumococcus yield in the majority of cases evidence of the presence of protective bodies; whereas in those in which stock cultures are used, the serum, as a rule, shows no protection. The development of specific protective substances in the serum of patients with lobar pneumonia suggests that these bodies may play a part in the mechanism of recovery.
Experimental pulmonary inflammatory injury in the monkey.
Authors: S D Revak, C L Rice, I U Schraufstätter, W A Halsey, B P Bohl, R M Clancy, C G Cochrane
Journal: Journal of Clinical Investigation (1985)

Inflammatory pulmonary injury was induced in Macaca mulatta rhesus monkeys by the intrabronchial instillation of the formylated peptide norleu-leu-phe (FNLP) or phorbol myristate acetate (PMA). Indicators of pulmonary injury included an increase in mean protein content of bronchoalveolar lavage (BAL) fluid from 0.51 mg/ml in untreated animals to 3.74 mg/ml and 6.64 mg/ml in FNLP- and PMA-treated animals, respectively, the appearance of a diffuse pulmonary infiltrate in chest roentgenograms, and histologic evidence of a predominantly neutrophilic leukocytic infiltration. Concomitant with the appearance of pulmonary injury was the generation of proteases and oxidants in the BAL fluids. Neutrophil elastase, bound to alpha 1-protease inhibitor (alpha 1-PI), was found to increase from 0.47 micrograms/ml in untreated monkeys to 0.99 micrograms/ml in FNLP-treated animals and 1.23 micrograms/ml in monkeys receiving PMA. Radioiodinated human prekallikrein, instilled for 2 min into the inflammatory site and retrieved by lavaging, was found to have undergone proteolytic cleavage; this cleavage was not consistently inhibitable with the inclusion of antibody to elastase. BAL fluids were shown to contain an amidolytic activity when tested on the synthetic substrate H-D-pro-phe-arg-pNA. This activity was partially inhibitable with known inhibitors of active Hageman factor and kallikrein. beta-Glucuronidase levels in the BAL fluids increased from 0.85 U/ml to 4.36 U/ml and 8.25 U/ml in FNLP- and PMA-treated animals, respectively. Myeloperoxidase (MPO) levels also increased from 1.37 OD U/ml X min to 16.59 and 30.47 OD U/ml X min in the same groups of animals. Oxidant generation was also assessed in several different ways. The specific activity of the oxidant-sensitive inhibitor alpha 1-PI recovered in the BAL fluid decreased from 0.80 in control samples to 0.57 and 0.65 in FNLP- and PMA-treated animals. That this inactivation was due to oxidant injury of the molecule was confirmed by the return to full activity of four out of five BAL samples after their incubation with the reducing agent dithiothreitol in the presence of methionine sulfoxide peptide reductase. The specific activity of catalase in the BAL fluids of animals given 3-amino, 1,2,4 triazole (AT) 1 h before lavaging showed drops from 0.97 in untreated monkeys to 0.04 in FNLP-treated and 0.49 in PMA-treated monkeys. MPO levels also fell in the AT-treated injured animals from 16.59 to 0.85 delta OD/min X ml in FNLP animals in the absence and presence of AT, and 30.47 to 0.60 delta OD/min X ml in PMA-treated animals. Inhibition of MPO by AT was shown in vitro to be H2O2 dependent. Total glutathione levels in the BAL fluids did not change appreciably after FNLP or PMA treatment. These studies present substantial evidence of the generation of both proteases and oxidants during the establishment of acute pulmonary inflammatory injury in an experimental primate model.
P258 Is Chronic Thromboembolic Pulmonary Hypertension (CTEPH) under diagnosed in the UK?
Authors: S. Sturney, G. Robinson, G. Coghlan, J. Pepke-Zaba, J. Easaw, J. Suntharalingam
Journal: Thorax (2010)

<h3>Introduction</h3> Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare but treatable condition. In selected cases Pulmonary Endarterectomy (PEA) surgery is potentially curative, with 80–85 procedures performed annually at a single national centre, Papworth Hospital. Previous studies suggest the disease may be under diagnosed. <h3>Aim</h3> To identify whether developing a local Pulmonary Hypertension (PH) service improves the number of CTEPH cases diagnosed in a DGH setting. <h3>Methods</h3> In 2005, a regional PH satellite service was set up at the Royal United Hospital (RUH), Bath, in conjunction with the Royal Free, London. The service aims to provide local access to PH-specific therapies at national standards of care. New cases of CTEPH are investigated with a number of investigations including right heart catheterisation and pulmonary angiography and then referred to Papworth Hospital9s MDT to determine eligibility for surgery. This abstract examines the number of cases diagnosed in RUH9s own catchment area following a rolling education programme targeting local physicians and radiologists. <h3>Results</h3> Prior to 2007 no RUH patients had undergone PEA surgery. Since 2007, 12 patients have been diagnosed with CTEPH (7 male) with mean age 62.3 years (SD 12.1, range 37–72). Only 5 (41.7%) had a documented history of previous thromboembolic disease. Referrals were received from a variety of sources including respiratory, vascular, rheumatology, gastroenterology, primary care, ENT, stroke physician and cardiology. Four (33.3%) were referred as inpatients. At referral 33.3% were NYHA class II, 41.7% class III and 25.0% class IV. Mean pulmonary haemodynamics were: RA 10.9 mm Hg (6.4), mPAP 46.3 mm Hg (13.1), PCWP 13.2 mm Hg (4.4), CO 4.8 l/min (0.9), PVR 7.8WU (4.1). 8 have undergone or are awaiting surgery, 1 died of unrelated causes and 3 are being treated medically. (Abstract P258 Figure 1). <h3>Conclusions</h3> Underdiagnosis of CTEPH may be exacerbated by patients presenting to a variety of specialties. The number of CTEPH cases diagnosed at the RUH has increased significantly since 2007, probably as a result of raised local awareness of the condition. It is therefore likely that this potentially curable condition is under diagnosed in areas with more limited access to PH specialist facilities.
The Rural-to-Urban Malnutrition Gradient
Authors: Carlos L. Krumdiek
Journal: JAMA (1971)

When the idea of studying the role of malnutrition in the pathogenesis of slums was conceived, the notion that malnutrition plays not one, but a number of roles in the establishment, evolution, prognosis, and therapy of this disease of human groups was not clearly perceived. No other single factor affects the slum inhabitant as adversely as malnutrition. In the adult, it lowers his working capacity and makes him more susceptible to disease and less capable of tolerating the physical environmental insults or the physiologic demands of pregnancy and lactation. The children who survive face the tragic fate (where the word tragic is used as Whitehead defined it, not to mean unhappiness, but the "... remorseless working of things—the inevitableness of destiny..."<sup>1</sup>) of being less endowed because they either suffered irreparable brain damage early in life<sup>2,3</sup>or lost their opportunity for receiving an education due to frequent illness or because of having
Cumulative Effect of Oxidative Stress-Related Gene Polymorphisms on Myocardial Infarction in Type 2 Diabetes
Authors: Naoto Katakami, Ken'ya Sakamoto, Hideaki Kaneto, Munehide Matsuhisa, Keizo Ohno, Ikki Shimizu, Fukashi Ishibashi, Takeshi Osonoi, Atsunori Kashiwagi, Ryuzo Kawamori, Yoshimitsu Yamasaki
Journal: Diabetes Care (2009)

It is well-known that oxidative stress plays critical roles in the pathogenesis of atherosclerotic diseases. In this study, we examined the association between four common genetic variants related to oxidative stress (glutamate-cysteine ligase modifier subunit (GCLM) C-588T, myeloperoxidase G-463A, human paraoxonase-1 Gln192Arg, and NADPH oxidase p22phox C242T) and the prevalence of myocardial infarction in type 2 diabetic patients.

All type 2 diabetic patients who periodically attended the outpatient diabetes clinics of five participating hospitals were asked to participate in this study. Subjects who were eligible had type 2 diabetes, diagnosed by diabetologists based on World Health Organization criteria, and were aged ≥50 years. A total of 2,561 type 2 diabetic subjects were included: men, 62%; age, mean ± SD 60.9 …
Prognostic Significance of Microvascular Invasion in Localized Renal Cell Carcinoma
Authors: Murat Sevin&ccedil;, Ziya K&inodot;rkal&inodot;, Kutsal Y&ouml;r&uuml;ko&gbreve;lu, U&gbreve;ur Mungan, Murat Sade
Journal: European Urology (2000)
Diseases of the Nervous System in Infancy, Childhood and Adolescence
Authors: Kenneth R. Magee
Journal: JAMA (1966)

This is the fifth edition of a text that has been the standard reference in pediatric neurology since its first appearance in 1937. The new edition will continue to be a favorite of many physicians because of its clinical orientation, broad coverage, and personal style. So many books are now composed by batteries of authors that it is a pleasant change to read a text which moves with the smoothness of a single viewpoint and unified writing. As before, Dr. Ford has included both old and new clinical entities, illustrated by well-chosen case studies and photographs. The book's scope is indicated by the unusual topics that augment the conventional subject-matter, for example, snake and spider bites, bee and wasp stings, venom of the stingray, lionfish, and stonefish, trypanosomiasis, and Sabin's encephalopathy. The text is well-balanced, giving more weight to common disorders than to rare conditions. More than two thousand references
766-5 Depressed Intracellular Calcium Homeostasis and Mechanical Properties of Cardiomyocytes in Annexin VI Transgenic Mouse
Authors: Guojie Song, Ann-Marie E. Gunteski-Hamblin, Gerald W. Dorn II, Darryl L. Kirkpatrick, John R. Dedman, Richard A. Walsh
Journal: Journal of the American College of Cardiology (1995)