tbuckley/cabot-search huggingface dataset:
Hematocrit Level and Postsurgical Outcome
Authors: Farhood Farjah, David R. Flum
Journal: JAMA (2007)

Context Elderly patients are at high risk of both abnormal hematocrit values and cardiovascular complications of noncardiac surgery. Despite nearly universal screening of patients for abnormal preoperative hematocrit levels, limited evidence demonstrates the adverse effects of preoperative anemia or polycythemia. Objective To evaluate the prevalence of preoperative anemia and polycythemia and their effects on 30-day postoperative outcomes in elderly veterans undergoing major noncardiac surgery. Design Retrospective cohort study using the VA National Surgical Quality Improvement Program database. Based on preoperative hematocrit levels, we stratified patients into standard categories of anemia (hematocrit  54%). We then estimated increases in 30-day postoperative cardiac event and mortality risks in relation to each hematocrit point deviation from the normal category. Setting and Patients A total of 310 311 veterans aged 65 years or older who underwent major noncardiac surgery between 1997 and 2004 in 132 Veterans' Affairs medical centers across the United States. Main Outcome Measures The primary outcome measure was 30-day postoperative mortality; a secondary outcome measure was composite 30-day postoperative mortality or cardiac events (cardiac arrest or Q-wave myocardial infarction). Results Thirty-day mortality and cardiac event rates increased monotonically, with either positive or negative deviations from normal hematocrit levels. We found a 1.6% (95% confidence interval, 1.1 %-2.2%) increase in 30-day postoperative mortality associated with every percentage-point increase or decrease in the hematocrit value from the normal range. Additional analyses suggest that the adjusted risk of 30-day postoperative mortality and cardiac morbidity begins to rise when hematocrit levels decrease to less than 39% or exceed 51 %. Conclusions Even mild degrees of preoperative anemia or polycythemia were associated with an increased risk of 30-day postoperative mortality and cardiac events in older, mostly male veterans undergoing major noncardiac surgery. Future studies should determine whether these findings are reproducible in other populations and if preoperative management of anemia or polycythemia decreases the risk of postoperative mortality.
Severity assessment in community-acquired pneumonia: moving on
Authors: W. S. Lim
Journal: Thorax (2007)

The CURB65 score displays moderate to good discriminatory value in validation studies involving over 11000 patients

Severity assessment is recognised as a pivotal step in the management of community-acquired pneumonia (CAP). Consequently, much effort over the last three decades has gone into developing tools to aid this process. The Pneumonia Severity Index (PSI) was introduced in 1997 following a study in over 50 000 patients and is well established as a robust severity assessment tool in patients with CAP.1 The CURB65 and CRB65 scores—which take account of the presence of Confusion, raised Urea (in the case of CURB65), raised Respiratory rate, low Blood pressure and age >65 years—were introduced more recently in 2003.2 One of the main benefits of the CURB65 and CRB65 scores is their simplicity in comparison with the PSI which comprises 20 variables. A number of studies over the last 2 years have therefore sought to confirm the value of these scores in different healthcare settings.

In this issue of Thorax , Man et al 3 report a large and well conducted validation study of these three severity assessment tools—the PSI, CURB65 and CRB65 scores ( see page 348 ). They recruited 1016 adults with CAP seen in the emergency department of a teaching hospital in Hong Kong and found that all three severity assessment tools performed equally well at discriminating patients into mortality risk groups. The area under the receiver operating characteristic curve (AUC) …
SUCCINYL-CHOLINE-IODIDE AS A MUSCULAR RELAXANT IN ELECTROSHOCK THERAPY
Authors: G. HOLMBERG, S. THESLEFF
Journal: American Journal of Psychiatry (1952)

Succinyl-choline-iodide has been used to produce muscular relaxation in 136 patients in connection with 512 electroshock treatments. A method is described in which the preparation is administered intravenously in a mixture with a rapidly acting barbiturate. The powerful and brief effect of succinyl-choline-iodide makes it possible to reduce the convulsions until they are practically negligible, without the risk of prolonged respiratory difficulties. Except for an insignificant vertebral fracture no serious complications were observed either during or after the treatments. In the opinion of the writers, succinyl-choline-iodide is particularly suitable for routine use in connection with electroshock therapy.
SUPPRESSION OF MURINE LEUKEMIAS BY <scp>L</scp>-ASPARAGINASE
Authors: Edward A. Boyse, Lloyd J. Old, H. A. Campbell, Louise T. Mashburn
Journal: The Journal of Experimental Medicine (1967)

A survey of 109 recently derived leukemias of the mouse revealed that sensitivity to suppression by guinea pig serum is a common property of transplanted leukemias of certain classes. The sensitive leukemias included five that arose spontaneously in mice of strains with a low incidence of leukemia and 21 that were induced by X-radiation. Two GPS-sensitive leukemias were not more sensitive than a GPS-resistant leukemia to a range of standard chemotherapeutic agents. The effectiveness of L-asparaginase EC-2 from Escherichia coli in suppression of the GPS-sensitive leukemia EARAD1 depends upon the conditions of assay. Whereas it is not inhibitory when administered as a single dose at the time of inoculation of the leukemia it is considerably more effective than GPS when used in the treatment of established leukemia. Permanent cures of 7-day generalized transplants of EARAD1 can be effected by the administration of 2000 or more units of EC-2. Immunological factors apparently do not contribute to cure as treated survivors are fully susceptible to rechallenge with minimal numbers of cells from the same leukemia. Reinoculated survivors with progressively growing transplants have been successfully retreated with EC-2. The blood clearance of EC-2 L-asparaginase injected into mice is much more rapid than that of GPS L-asparaginase. After intraperitoneal inoculation of the EC-1 L-asparaginase, which does not have leukemia-inhibitory activity, only very low levels of enzyme activity could be detected in the serum. The effectiveness of EC-2 from E. coli and its availability from a virtually limitless source will make it possible to extend the study of inhibition of leukemias and other tumors by L-asparaginase to species other than small rodents.
TCT-462 The difference in Temporal Change of Peri-stent Contrast Staining Between Drug-eluting Stent and Bare-metal Stent
Authors: Takeshi Tada, Kazushige Kadota, Seiji Habara, Hiroyuki Tanaka, Yasushi Fuku, Tsuyoshi Goto, Kazuaki Mitsudo
Journal: Journal of the American College of Cardiology (2013)
Inhibition of Lipocalin 2 Impairs Breast Tumorigenesis and Metastasis
Authors: Xiaohong Leng, Tian Ding, Hui Lin, Yan Wang, Limei Hu, Jianhua Hu, Barry Feig, Wei Zhang, Lajos Pusztai, W. Fraser Symmans, Yun Wu, Ralph B. Arlinghaus
Journal: Cancer Research (2009)

Abstract Lipocalin 2 (LCN2; also known as NGAL) is a secreted glycoprotein and its elevated expression has been observed in breast cancers. However, the importance of LCN2 in breast tumorigenesis is unclear. Here, we employed a spontaneous mammary tumor mouse model showing that MMTV-ErbB2(V664E) mice lacking mouse LCN2 had significantly delayed mammary tumor formation and metastasis with reduced matrix metalloproteinase-9 activity in the blood. LCN2 expression is upregulated by HER2/phosphoinositide 3-kinase/AKT/NF-κB pathway. Decreasing LCN2 expression significantly reduced the invasion and migration ability of HER2+ breast cancer cells. Furthermore, injecting an anti-mouse LCN2 antibody into mice bearing established murine breast tumors resulted in significant blockage of lung metastasis. Our findings indicate that LCN2 is a critical factor in enhancing breast tumor formation and progression possibly in part by stabilizing matrix metalloproteinase-9. Our results suggest that inhibition of LCN2 function by an inhibitory monoclonal antibody has potential for breast cancer therapy, particularly by interfering with metastasis in aggressive types of breast cancer. [Cancer Res 2009;69(22):8579–84]
Doctors must do more to identify child abuse, Dutch association says
Authors: T. Sheldon
Journal: BMJ (2008)

The Dutch Medical Association is urging its members to speak out if they suspect child abuse. Between 100 000 and 170 000 cases, resulting in at least 50 deaths, are believed to occur in the Netherlands each year. But only about 2% of reports in 2007 originated from doctors.

Peter Holland, the association’s chairman, said, “There are far too few reports of child abuse by doctors, and there must now be a real change.” The association argues that doctors, through their special contact with families and children, bear a great responsibility and can make an important contribution in identifying children who are at risk.

Apologies, due to a technical fault the video is not available. …
Pay award a step in the right direction
Authors: A. Vass
Journal: BMJ (2002)

Doctors' unions in the United Kingdom gave a cautious welcome to the government's pay rises, announced just before Christmas, calling them a step in the right direction in the problems of recruitment and retention.

All hospital doctors and nurses were awarded 3.6% from April, double the underlying rate of inflation, while GPs are to receive a 4.6% increase in fee income.

GP registrars are set to get the largest increase, 19.5% due largely to a hike in their entitlement …
Acquired von Willebrand disease?hemostatic management of major orthopedic surgery with high-dose immunoglobulin, desmopressin, and continuous factor concentrate infusion
Authors: Rolf Dario Frank, Dagmar Kunz, Dieter Christian Wirtz
Journal: American Journal of Hematology (2002)

Abstract Acquired von Willebrand disease (aVWD) is a rare bleeding disorder that mimics congenital VWD in previously healthy individuals; it is most frequently associated with monoclonal gammopathy. Hemostatic therapy of aVWD is challenging due to the extremely shortened half‐life of endogenous and exogenous VWF. High‐dose intravenous immunoglobulin (ivIG) is recommended as the treatment of choice, usually rapidly normalizing coagulation; but in case of failure, alternative treatment options are not well explored. We report successful major orthopedic surgery in a 61‐year‐old woman with multiple myeloma IgG lambda and aVWD. IvIG alone failed to correct hemostasis. However, ivIG pretreatment improved the VWF ristocetin cofactor (VWF:RCo) half‐life from only 1.5 hr to more than 4 hr, allowing desmopressin infusions twice daily to maintain sufficient VWF:RCo levels. Because of diminishing desmopressin effect, we attempted for the first time in aVWD a continuous VWF/FVIII infusion (Haemate HS ® , 2.1–2.7 FVIII U/kg/hr or 51–64 U/kg/day, respectively 4.6–6.0 VWF:RCo U/kg/hr or 110–145 U/kg/day) to reach constant factor levels. The steady‐state clearance was 2.4 mL/kg/hr for FVIII:C and 13.5 mL/kg/hr for VWF:RCo. During surgery, VWF:RCo, FVIII:C, and PFA‐100 closure time were normalized. Until day 5, VWF:RCo was kept above 50%, from day 6 to 10 at least 30% activity were attained. FVIII:C levels were always &gt;70%. The clinical course was uneventful without bleeding. Two weeks after hip surgery the patient was discharged from the hospital without complaints. The therapy described can be recommended as safe and feasible for further evaluation in aVWD patients who are hyporesponsive to ivIG treatment alone. Continuous VWF/FVIII infusion can improve substitution therapy in aVWD. Am. J. Hematol. 70:64–71, 2002. © 2002 Wiley‐Liss, Inc.
Acid sphingomyelinase–ceramide system mediates effects of antidepressant drugs
Authors: Erich Gulbins, Monica Palmada, Martin Reichel, Anja Lüth, Christoph Böhmer, Davide Amato, Christian P Müller, Carsten H Tischbirek, Teja W Groemer, Ghazaleh Tabatabai, Katrin A Becker, Philipp Tripal, Sven Staedtler, Teresa F Ackermann, Johannes van Brederode, Christian Alzheimer, Michael Weller, Undine E Lang, Burkhard Kleuser, Heike Grassmé, Johannes Kornhuber
Journal: Nature Medicine (2013)
Inhibiting HDAC for human hematopoietic stem cell expansion
Authors: Hal E. Broxmeyer
Journal: Journal of Clinical Investigation (2014)

In this issue of the JCI, Chaurasia and colleagues report an impressive ex vivo expansion of HSCs from human cord blood (CB) using cytokines and altering epigenetic modifications. The application of this protocol provides information that has potential for clinical consideration. The enhanced expansion of CB HSCs is a substantial advance over recent work from the Chaurasia and Hoffman group, in which ex vivo production of human erythroid progenitor cells from CB was promoted by chromatin modification. Moreover, this study takes advantage of information from the rapidly emerging, but not yet fully elucidated, field of epigenetics.
A previously healthy adolescent with evolving infiltrates and progressive respiratory distress
Authors: W A Gower, J M Collaco, C L Ellis, A C Halbower, P J Mogayzel
Journal: Thorax (2009)

A 14-year-old boy was transferred to our paediatric referral centre with a 1-day history of worsening respiratory distress. He had initially presented to a community hospital complaining of dyspnoea, cough and emesis, and was treated with antibiotics and methylprednisolone prior to transfer. He was taking no other medications and his history was notable only for mild wheezing as …
BIOGRAPHY OF DR. BIGGS
Authors: C.-E. A. Winslow
Journal: JAMA (1925)

<h3>To the Editor:</h3> —I have just undertaken, at the request of Mrs. Biggs, to write a biography of the late Dr. Hermann M. Biggs. I shall be particularly grateful for copies of correspondence or other material relating to Dr. Bigg's life and work which readers ofThe Journalmay have in their possession and may be willing to make available for use in this task.
Symbiosis Therapy: The Potential of Using Human Protozoa for Molecular Therapy
Authors: Dennis E. Vaccaro
Journal: Molecular Therapy (2000)

The concept of symbiosis is proposed as a disease therapy model. It is hypothesized that protozoa that live naturally in human tissues can be genetically modified for the production and delivery of therapeutic proteins. Approximately 30 identified species of protozoa live in a variety of human tissues, both intracellularly and extracellularly. <i>Leishmania,</i> one species of human protozoa, has been genetically altered for conditional auxotrophy and has shown no pathology in both mouse and nonhuman primate safety tests. Several species of protozoa have been transfected with a variety of genes and have successfully manufactured active foreign proteins. Protozoa have biochemical mechanisms to glycosylate proteins. Human protozoa have evolved sophisticated mechanisms for evading immune rejection and can sometimes persist for the lifetime of the host. Symbiosis therapy does not involve genetic alteration of the host and is potentially fully reversible. Research on treating genetic diseases is currently ongoing. For example, there is a group of more than 40 genetic diseases, lysosomal storage diseases, which result from defects in lysosomal enzymes primarily in macrophages. <i>Leishmania</i> specifically targets the lysosomal compartment of the macrophage and therefore may be the optimal vector for treatment of many of these diseases.
The Medicine Society
Authors: Barry Liskow
Journal: JAMA (1993)

Many words by many individuals have been expended on defining and understanding the drug crisis in America. The historical roots of these efforts date to at least the turn of the century and have often centered on explaining the etiology of the crisis in terms of the pharmacologic effects of specific drugs. Although attention remains focused on specific drugs, scrutiny in the 1990s is turning to society's role in causing and sustaining the crisis.<i>The Medicine Society</i>is a reflection of such scrutiny. The volume, which appears to be the author's graduate treatise, argues that the drug crisis is rooted in American culture. Scriven attempts to demonstrate that the crisis is a consequence of a liberal attitude toward drug use (licit and illicit) colliding with a Victorian repressive stance toward those drugs when used by certain subgroups of the populace, namely the underclass and, to a lesser extent, youth. This
Lower oesophageal sphincter response to gastrin--pharmacological or physiological?
Authors: J M Henderson, G Lidgard, D H Osborne, D C Carter, R C Heading
Journal: Gut (1978)

The response of the lower oesophageal sphincter (LOS) to intragastric instillation of protein was assessed in 10 healthy volunteers. Sphincter pressures were measured by a rapid pull-through technique and serum gastrin concentrations during each test were determined by radioimmunoassay. Despite stimulation of gastrin release by protein instillation, no significant change in LOS pressure was observed. However, intravenous pentagastrin (0.25 and 0.5 microgram/kg) produced an immediate increase in sphincter pressure, which then returned to the basal level within four minutes. Thus, although pentagastrin is an effective pharmacological stimulant of the sphincter, endogenous gastrin appears not to be a physiological determinant of LOS pressure in man.
Radiographic Identification of Commonly Used Pulse Generators—1970
Authors: William H. Walter
Journal: JAMA (1971)

In November 1969, we published an article entitled "The Radiographic Identification of Commonly Used Implanted Pacemakers."<sup>1</sup>Since that article was prepared, several new pulse generators have been released for clinical use by various manufacturers. (The Implantable Pacemaker Subcommittee of the Association for the Advancement of Medical Instrumentation [AAMI] has recommended that the term "pulse generator" be used to describe that portion of the pacemaker assembly which includes the power source and pulse-forming elements.) It is the purpose of this communication to update the previous article and identification chart. In this communication, the terminology as recommended by AAMI will be used. A new chart has been prepared that includes the newer pulse generators. In November 1969, Cordis introduced a ventricular inhibited (demand/standby) pulse generator— the Stanicor. This unit is round and is distinguished by its five eccentric batteries, a single active connector, and eight superior transistors. Cordis has also changed
Thallium-201 myocardial perfusion imaging in infants and children. Value in distinguishing anomalous left coronary artery from congestive cardiomyopathy.
Authors: H P Gutgesell, W W Pinsky, E G DePuey
Journal: Circulation (1980)

In infants and children, anomalous origin of the left coronary artery (ALCA) from the pulmonary artery may be difficult to distinguish from congestive cardiomyopathy (CCM) of other causes. We performed thallium-201 myocardial perfusion imaging in seven children with ALCA and in nine with CCM to study the usefulness of this technique in distinguishing between these lesions. Localized abnormalities of thallium uptake were present in each of the seven patients with ALCA, including two asymptomatic 4-year-old children. Thallium distribution was normal in five patients with CCM, diffusely irregular in three, and was absent in the lateral and posterobasal portions of the left ventricle in one patient. We conclude that thallium-201 imaging is a sensitive noninvasive method of detecting ALCA. However, perfusion abnormalities are not limited to patients with coronary artery abnormalities, and may be present in patients with myocardial ischemia or infarction of other causes.
Management of Women With BRCA Mutations
Authors: Nadine Tung
Journal: JAMA (2011)

Ms E, a 41-year-old BRCA1 mutation carrier, was diagnosed 4 years ago as having breast cancer and opted for breast-conserving therapy. Prior to receiving chemotherapy, she harvested her eggs through in vitro fertilization and subsequently used preimplantation genetic diagnosis; 3 months ago she delivered a healthy boy. This review examines the prevalence of BRCA mutations in women with breast cancer, as well as current recommendations for surgery and systemic therapy in these women. In particular, the risk of a contralateral breast cancer is reviewed to help guide the choice of prophylactic mastectomies vs breast-conserving therapy. The technology of preimplantation genetic diagnosis and genetic testing in relatives of mutation carriers is discussed.
High Prevalence of Premalignant Lesions in Prophylactically Removed Breasts From Women at Hereditary Risk for Breast Cancer
Authors: N. Hoogerbrugge, P. Bult, L.M. de Widt-Levert, L.V. Beex, L.A. Kiemeney, M.J.L. Ligtenberg, L.F. Massuger, C. Boetes, P. Manders, H.G. Brunner
Journal: Journal of Clinical Oncology (2002)

Women with a hereditary predisposition for breast cancer have an extremely high risk of developing invasive breast carcinoma, and many women consider prophylactic mastectomy to avoid this risk. The use of prophylactic mastectomy is still debated. Identification of frequent premalignant lesions in mastectomy specimens would support the preventive concept of prophylactic mastectomy.We performed a prospective study of breast specimens from 67 women at extremely high genetic risk of breast cancer, with or without previous breast cancer, who were undergoing prophylactic mastectomy (66% were carriers of a BRCA1 or BRCA2 mutation). Breast specimens were studied by radiographic and macroscopic examination of 5-mm tissue slices, with subsequent histology of suspicious lesions and random samples from each quadrant of the breast and the nipple area.In 57% of the women, one or more different types of high-risk histopathologic lesions were present: 37% atypical lobular hyperplasia, 39% atypical ductal hyperplasia, 25% lobular carcinoma-in-situ, and 15% ductal carcinoma-in-situ. A 4-mm invasive ductal carcinoma was found in one woman with ductal carcinoma-in-situ. None of these lesions was detected at palpation or mammography, which were performed before the mastectomy. The presence of high-risk lesions was independently related to age older than 40 years (odds ratio, 6.6; P =.01) and to bilateral oophorectomy before prophylactic mastectomy (odds ratio, 0.2; P = 0.02).Many women at high risk of hereditary breast cancer develop high-risk histopathologic lesions, especially after the age of 40 years. Surveillance does not detect such high-risk histopathologic lesions.
Comparison of 18F-FDG PET/CT and 68Ga-DOTATATE PET/CT Imaging in Metastasized Merkel Cell Carcinoma
Authors: Maximilian Epstude, Katharina Tornquist, Christian Riklin, Francesca di Lenardo, Ralph Winterhalder, Urs Hug, Klaus Strobel
Journal: Clinical Nuclear Medicine (2013)

Merkel cell carcinoma (MCC) is a rare but very aggressive neuroendocrine tumor of the skin in elderly patients with higher mortality compared with melanoma. No evidence-based standardized chemotherapy exists for metastasized patients.We report the case of an 87-year-old patient with the history of resection of a large MCC of the parietal scalp planned for radiotherapy and staged with FDG PET/CT showing disseminated distant metastases. Ga-DOTATATE PET/CT revealed more extensive tumor load compared with FDG, and due to the intensive expression of somatostatin receptors the patient qualified for Y DOTATOC therapy.