tbuckley/cabot-search huggingface dataset:
Risk Assessment of Tuberculosis in Immunocompromised Patients. A TBNET Study
Authors: Martina Sester, Frank van Leth, Judith Bruchfeld, Dragos Bumbacea, Daniela M. Cirillo, Asli Gorek Dilektasli, José Domínguez, Raquel Duarte, Martin Ernst, Fusun Oner Eyuboglu, Irini Gerogianni, Enrico Girardi, Delia Goletti, Jean-Paul Janssens, Inger Julander, Berit Lange, Irene Latorre, Monica Losi, Roumiana Markova, Alberto Matteelli, Heather Milburn, Pernille Ravn, Theresia Scholman, Paola M. Soccal, Marina Straub, Dirk Wagner, Timo Wolf, Aslihan Yalcin, Christoph Lange
Journal: American Journal of Respiratory and Critical Care Medicine (2014)

In the absence of active tuberculosis, a positive tuberculin skin test (TST) or interferon-γ release assay (IGRA) result defines latent infection with Mycobacterium tuberculosis, although test results may vary depending on immunodeficiency.This study compared the performance of TST and IGRAs in five different groups of immunocompromised patients, and evaluated their ability to identify those at risk for development of tuberculosis.Immunocompromised patients with HIV infection, chronic renal failure, rheumatoid arthritis, solid-organ or stem-cell transplantation, and healthy control subjects were evaluated head-to-head by the TST, QuantiFERON-TB-Gold in-tube test (ELISA), and T-SPOT.TB test (enzyme-linked immunospot) at 17 centers in 11 European countries. Development of tuberculosis was assessed during follow-up.Frequencies of positive test results varied from 8.7 to 15.9% in HIV infection (n = 768), 25.3 to 30.6% in chronic renal failure (n = 270), 25.0% to 37.2% in rheumatoid arthritis (n = 199), 9.0 to 20.0% in solid-organ transplant recipients (n = 197), 0% to 5.8% in stem-cell transplant recipients (n = 103), and 11.2 to 15.2% in immunocompetent control subjects (n = 211). Eleven patients (10 with HIV infection and one solid-organ transplant recipient) developed tuberculosis during a median follow-up of 1.8 (interquartile range, 0.2-3.0) years. Six of the 11 patients had a negative or indeterminate test result in all three tests at the time of screening. Tuberculosis incidence was generally low, but higher in HIV-infected individuals with a positive TST (3.25 cases per 100 person-years) than with a positive ELISA (1.31 cases per 100 person-years) or enzyme-linked immunospot result (1.78 cases per 100 person-years). No cases of tuberculosis occurred in patients who received preventive chemotherapy.Among immunocompromised patients evaluated in this study, progression toward tuberculosis was highest in HIV-infected individuals and was poorly predicted by TST or IGRAs. Clinical trial registered with www.clinicaltrials.gov (NCT 00707317).
ACCURATE PREDICTION OF FALSE POSITIVE STEMI: READY FOR PRIME TIME
Authors: Nephertiti Efeovbokhan, Mary Crouse, Mark Heckle, Mason Chumpia, Inyong Hwang, Robert T. Ellis, Poojitha Valasareddy, Benjamin Ross Zambetti, Blake Smith, Allen C. Brown, Darshan Naik, Uzoma Ibebuogu, Guy Reed, Rami Khouzam
Journal: Journal of the American College of Cardiology (2015)
Physician Payment Incentives to Improve Care Quality
Authors: David U. Himmelstein, Steffie Woolhandler
Journal: JAMA (2014)

The analysis by Dr Bardach and colleagues1 of pay-for-performance incentives rests on data recorded by clinicians. But only the incentivized group had reason to put a positive spin on their numbers. Subtle manipulation could easily bias their results.

For instance, colleagues of ours speak of clinic managers who have coached them to change their digit preference when recording blood pressure levels from 140 mm Hg to 139 mm Hg. In other cases, administrators have discouraged further monitoring (until the next pay-for-performance incentive year) once a goal blood pressure level or hemoglobin A1C has been recorded. Either strategy would distort Bardach et al’s blood pressure results. Their process of care measures are even easier to undermine. Notably, their outcome measure (cholesterol level), which is harder to game, showed no improvement.
Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure.
Authors: M T Naughton, P P Liu, D C Bernard, R S Goldstein, T D Bradley
Journal: American Journal of Respiratory and Critical Care Medicine (1995)

A previous uncontrolled study suggested that nasal continuous positive airway positive airway pressure (NCPAP) may improve left ventricular ejection fraction (LVEF) in patients with congestive heart failure (CHF) and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). In order to more critically evaluate the effects of NCPAP on cardiac function, we undertook a randomized, controlled trial of NCPAP in 29 patients with heart failure and CSR-CSA over a 3-mo period, with LVEF as the primary outcome measure. Patients with CHF and associated CSR-CSA who were receiving optimal medical therapy were randomly assigned to a control group (n = 15) or a group receiving nightly NCPAP (n = 14). Twelve patients in each group completed the study. There was a greater improvement of LVEF in the NCPAP group than in the control group during the study (mean +/- SEM = 7.7 +/- 2.5 versus - 0.5 +/- 1.5%, p = 0.019). In addition, there was a significantly greater reduction in the number of apneas and hypopneas (-28.5 +/- 3.9 versus -6.1 +/- 7.0 per hour of sleep, p = 0.012) in the NCPAP group than in the control group. Significantly greater improvements in symptoms of fatigue (5.6 +/- 1.2 versus 0.8 +/- 0.7, p = 0.005) and disease mastery (3.6 +/- 1.1 versus -0.7 +/- 0.7, p = 0.031) were also observed in the NCPAP group. We conclude that in patients with chronic heart failure and CSR-CSA, nightly administration of NCPAP can attenuate CSR-CSA, improve cardiac function, and alleviate symptoms of heart failure.
A CASE OF AMAUROSIS DEPENDENT UPON DENTAL IRRITATION.
Authors: W. W. ALLPORT
Journal: JAMA (1883)

[Read to Section on Oral Surgery, June, 1883.] Mrs. L., aged 34 years, of nervo-bilious temperament, and fairly good health, called, in May, 1879, for an examination of her mouth. Found the left first superior biscupid tooth decayed upon the distal surface, but not so extensively as to expose the pulp, or sufficiently near to it to require, in my judgment, special protection. The cavity was filled with gold and the case discharged. In April, 1881, one Sabbath, I was called in great haste to see the patient at her home. The tooth which I had filled had become suddenly very sore, with great pain in the left eye. The patient then explained to me as the reason she had not visited me for a regular examination, as had been her custom every three or four months, a serious difficulty with the left eye, involving partial loss of sight, profuse
Clopidogrel, Genetics, and Drug Responsiveness
Authors: Jane E. Freedman, Elaine M. Hylek
Journal: New England Journal of Medicine (2009)

Despite great progress in the diagnosis and treatment of unstable coronary syndromes, it is estimated that 785,000 Americans will have new acute cardiac events and 470,000 will have recurrent events this year.1 Central to the pathogenesis of acute coronary syndromes is the adhesion and activation of platelets leading to aggregation, thrombus formation, and vessel occlusion. Unfortunately, the absolute risk of recurrent vascular events among patients taking platelet inhibitors remains relatively high.1 The observation that platelet-dependent thrombosis occurs despite treatment with platelet inhibitors has led to a large number of studies assessing the cause of these treatment failures. Often termed "resistance," . . .
Specific HLA-DR4-associated histocompatibility molecules characterize patients with seropositive juvenile rheumatoid arthritis.
Authors: B S Nepom, G T Nepom, E Mickelson, J G Schaller, P Antonelli, J A Hansen
Journal: Journal of Clinical Investigation (1984)

The structural and functional heterogeneity of HLA-DR4-associated specificities was investigated in patients with seropositive juvenile rheumatoid arthritis, a DR4-associated disease. Using a combination of HLA-D analysis by mixed lymphocyte culture and electrophoretic analysis of immunoprecipitated Ia molecules by two-dimensional polyacrylamide gels, we observed a surprisingly homogeneous pattern of HLA-D antigen expression. All patients expressed common structural products of the DR and DS loci, and 7/12 homozygous DR4 patients expressed a rare and subtle HLA-D heterozygous phenotype.
Children Who Witness Violence
Authors: Louise A. Kosta
Journal: JAMA (1993)

<h3>To the Editor.</h3> —Groves et al<sup>1</sup>have done a good service in bringing the needs of children who witness violence to the attention of clinicians. Their suggestions for intervention in such cases, unfortunately, depend for their efficacy on matters of fact that may simply not obtain. The most important observation that must be made in this context is that parents of children who witness violence may not be reliable sources of either information about what has happened to the child, or of help in protecting the child from further trauma. Indeed, such parents may be actively perpetrating violence in and around the home—in response to economic pressures, substance abuse, environmental crime, or other factors. It is a serious mistake to assume that parents attempting to function in such circumstances will easily meet the expectations of physicians who assume that parents are uniformly benign, or even capable of considering the
Committee on Prophylaxis of Venereal Diseases.
Authors: Ludwig Weiss
Journal: JAMA (1903)

New York, March 4, 1903. <h3>To the Editor:</h3> —At the last (fifty-third) meeting of the American Medical Association, held at Saratoga Springs, June 10-13, 1902, a joint resolution from the Sections of Cutaneous Medicine and Surgery and Hygiene and Sanitary Science was introduced in the House of Delegates, as follows: Whereas, There is a burning necessity to check the spread of venereal diseases, and, assuming that the States can not with impunity ignore the condition, it lies in the province of the medical profession to discuss and recommend to the respective state legislatures and municipalities means not regulamentative, but social, economic, educative and sanitary in their character, to diminish the danger from venereal diseases. <i>Resolved</i>, That the Section on Cutaneous Medicine and Surgery of the American Medical Association invite the Section on Hygiene and Sanitary Science to co-operate with the Section on Cutaneous Medicine and Surgery in bringing about a
CNS Delivery of Vectored Prion-specific Single-chain Antibodies Delays Disease Onset
Authors: Charles A Wuertzer, Mark A Sullivan, Xing Qiu, Howard J Federoff
Journal: Molecular Therapy (2008)

A unifying characteristic of prion diseases is the conversion of a normal cellular protein (PrPc) to an abnormal pathogenic conformation, designated PrPsc. Antibodies directed against PrPc, when added to scrapie-infected cell cultures or passively administered in vivo, can result in elimination of PrPsc or prevent its replication, respectively. In our efforts to develop an approach with potential prophylactic utility we employed a recombinant adeno-associated vector type 2 (rAAV2) viral vector platform to express PrPc-specific single-chain fragment variable (scFv) antibodies within the central nervous system (CNS) of susceptible mice that were subsequently inoculated peripherally with infectious prions. Vector expressed scFvs delayed onset of prion pathogenesis as evidenced by improvements in clinical signs and rotarod performance, in extended incubation periods, and in decreased PrPsc burden in the CNS. This novel antibody delivery platform enables the in vivo translation of prion prophylactics to other species afflicted by transmissible spongiform encephalopathies (TSEs) and which also has relevance to the development of therapeutics for other protein-misfolding diseases such as Alzheimer's or Parkinson's disease. A unifying characteristic of prion diseases is the conversion of a normal cellular protein (PrPc) to an abnormal pathogenic conformation, designated PrPsc. Antibodies directed against PrPc, when added to scrapie-infected cell cultures or passively administered in vivo, can result in elimination of PrPsc or prevent its replication, respectively. In our efforts to develop an approach with potential prophylactic utility we employed a recombinant adeno-associated vector type 2 (rAAV2) viral vector platform to express PrPc-specific single-chain fragment variable (scFv) antibodies within the central nervous system (CNS) of susceptible mice that were subsequently inoculated peripherally with infectious prions. Vector expressed scFvs delayed onset of prion pathogenesis as evidenced by improvements in clinical signs and rotarod performance, in extended incubation periods, and in decreased PrPsc burden in the CNS. This novel antibody delivery platform enables the in vivo translation of prion prophylactics to other species afflicted by transmissible spongiform encephalopathies (TSEs) and which also has relevance to the development of therapeutics for other protein-misfolding diseases such as Alzheimer's or Parkinson's disease.
Pulmonary embolectomy by flying squad.
Authors: J A Booker
Journal: BMJ (1972)

until a week later, when on provocation she muttered two expletives.Thereafter she was mobilized and made satisfactory progress.The tracheostomy was closed and it subsequently healed.Four weeks after stopping the diazepam it was clear that her mental faculties were unimpaired and that she retained a remarkably good sense of humour.She was discharged home three months after her admission walking well, thinking clearly, and with her original wounds almost healed.When seen as an outpatient two months after discharge she was completely cured and had no appreciable physical, haematological, or biochemical defect.She was living alone and managing her home without difficulty. CommentReviewing 271 cases of death from massive pulmonary embolism, Donaldson et al. ( 1963) concluded that about one in five patients suffering from massive fatal embolism may on 11 July
PTU-222 A comparison of patient tolerance of bowel preparation regimens used for conventional colonoscopy, small bowel and colon capsule endoscopy
Authors: K Drew, S Hardcastle, A J Lobo, D S Sanders, R Sidhu, M McAlindon
Journal: Gut (2012)

<h3>Introduction</h3> That patients tolerate swallowing a capsule better than undergoing conventional colonoscopy (CC) is self evident, but without the ability to cleanse the bowel during the procedure capsule endoscopy is critically reliant on a clean bowel and preparation regimens tend to be more rigorous, which may affect the patients9 acceptance of the procedure. In this study, patient tolerance of a standard regimen used for colon capsule endoscopy (CCE) was compared with that used for CC and a smaller volume regimen used for small bowel capsule endoscopy (SBCE) as a control. <h3>Methods</h3> All patients undergoing CC, SBCE and CCE on the Clinical Investigation Unit were asked to score symptoms of nausea, vomiting, bloating, abdominal pain and headache as none, mild, moderate, severe or extreme and provide an overall tolerance score on a visual analogue scale (0: intolerable; 10: no symptoms). Laxatives administered were 4L (CC) and 2L (SBCE) Klean prep (Norgine Ltd., UK). 2L Klean prep was given the day before aswell as the day of CCE when two further “booster” doses of Fleet phospho-soda (Fleet Labs., Lynchburg, USA; 30 and 25 ml) were also administered. χ<sup>2</sup> test was used to compare patients suffering none-mild and moderate-extreme symptoms with different regimens and one-tailed t test to compare overall tolerance. <h3>Results</h3> 104 patients had bowel preparation for CC (n=28), SBCE (n=54) and CCE (n=22) and suffered moderate-extreme nausea (4, 21 and 18% respectively), vomiting (4, 8, 0%), bloating (21,17, 36%), abdominal pain (14, 25, 23%) and headache (11, 21, 32%). Moderate to extreme nausea was more common in those taking bowel preparation for SBCE than CC (p=0.04), but there were no differences in the distribution of any of the other symptoms between the different regimens. Overall tolerance score was (median (range)) 7.2 (1–9) with no difference between regimens. CCE and SBCE groups were similar in terms of sex (64 and 58% female respectively) and age (mean 39 and 49 years, p=0.1). <h3>Conclusion</h3> Bowel preparation for endoscopic procedures is commonly associated with a wide range of symptoms. However patient tolerance of regimens used for CCE and CC were equivalent and indeed not demonstrably worse than the low volume preparation used for SBCE. This study suggests that the bowel preparation regimen is unlikely to influence patients9 choice of CCE or CC as an investigative modality. <h3>Competing interests</h3> None declared.
The Relationship Between Quantitative Perfusion and Functional Results and Acquisition Time With Reduced Administered Activity for 99mTc Tetrofosmin Myocardial Gated-SPECT
Authors: Lucia Leva, Marco Brambilla, Roberta Matheoud, Luca Vigna, Paolo Marino, Eugenio Inglese
Journal: Clinical Nuclear Medicine (2012)

The aim of this study was to assess the relationship between administered 99mTc tetrofosmin activity in myocardial gated-SPECT and findings of myocardial perfusion and left ventricular ejection fraction (LVEF) as markers of diagnostic outcome.Fifty-two patients with heterogeneous cardiac diseases and a clinical referral for myocardial perfusion imaging were prospectively studied. A separate-day acquisition protocol was adopted with a low fixed activity of 370 MBq, which corresponds to an average reduction of 31% with respect to the median value of 533 MBq usually administered in our laboratory. A standard acquisition with a time/frame of 25 seconds was performed (ST). Immediately after the conclusion of the first acquisition, a second acquisition was performed with a high time/frame of 33 seconds (HT), which corresponds to an increase of 31% with respect to standard time/frame adopted in our laboratory. The order of ST and HT acquisitions was randomized in individual patients. The summed stress scores (SSS), the summed rest scores (SRS), the LVEF, and the end-diastolic volume (EDV) were automatically calculated.The image quality score was significantly higher in HT than in ST. No significant differences were found in SSS, SRS, LVEF, and EDV between HT and ST SPECT. The agreement between HT and ST was 84% (kw=0.88) in the correct classification of stress images. The agreement between HT and ST was 84% (k=0.70) in the detection of ischemia and scar. The limits of agreement between the HT and the ST methods were roughly within ±3 points for SSS and SRS, ±13% for poststress LVEF, and ±18 mL for poststress EDV.Using about half of the activity recommended by the current diagnostic reference levels for separate-day myocardial perfusion imaging, the present study demonstrates that images may be obtained using ST protocol with quantitative results comparable with those from studies performed using the HT protocol, which is equivalent to an administered activity of 530 MBq. The former protocol would allow for a significant reduction of the dose to the patients as well as to the operators. Further studies are needed to confirm that this dose-sparing approach does not hamper sensitivity and specificity for coronary stenoses.
Reduced beta 1 receptor messenger RNA abundance in the failing human heart.
Authors: M R Bristow, W A Minobe, M V Raynolds, J D Port, R Rasmussen, P E Ray, A M Feldman
Journal: Journal of Clinical Investigation (1993)

Heart failure in humans is characterized by alterations in myocardial adrenergic signal transduction, the most prominent of which is down-regulation of beta 1-adrenergic receptors. We tested the hypothesis that down-regulation of beta 1-adrenergic receptors in the failing human heart is related to decreased steady-state levels of beta 1 receptor mRNA. Due to the extremely low abundance of beta 1 receptor mRNA, measurements were possible only by quantitative polymerase chain reaction (QPCR) or by RNase protection methods. Because the beta 1 receptor gene is intronless and beta 1 receptor mRNA abundance is low, QPCR yielded genomic amplification in total RNA, and mRNA measurements had to be performed in poly (A)(+)-enriched RNA. By QPCR the concentration of beta 1 receptor mRNA varied from 0.34 to 7.8 x 10(7) molecules/microgram poly(A)(+)-enriched RNA, and the assay was sensitive to 16.7 zeptomol. Using 100-mg aliquots of left ventricular myocardium obtained from organ donors (nonfailing ventricles, n = 12) or heart transplant recipients (failing ventricles, n = 13), the respective beta 1 mRNA levels measured by QPCR were 4.2 +/- 0.7 x 10(7)/micrograms vs. 2.10 +/- 0.3 x 10(7)/micrograms (P = 0.006). In these same nonfailing and failing left ventricles the respective beta 1-adrenergic receptor densities were 67.9 +/- 6.9 fmol/mg vs. 29.6 +/- 3.5 fmol/mg (P = 0.0001). Decreased mRNA abundance in the failing ventricles was confirmed by RNase protection assays in total RNA, which also demonstrated a 50% reduction in beta 1 message abundance. We conclude that down-regulation of beta 1 receptor mRNA contributes to down-regulation of beta 1 adrenergic receptors in the failing human heart.
Exposure to a Mixture of Polychlorinated Biphenyls and Polychlorinated Dibenzofurans Resulted in a Prolonged Time to Pregnancy in Women
Authors: Chiu-Yueh Yang, Ying-Jan Wang, Pau-Chung Chen, Shaw-Jenq Tsai, Yueliang Leon Guo
Journal: Environmental Health Perspectives (2008)

Polychlorinated biphenyls (PCBs), dibenzofurans (PCDFs), and dibenzodioxins (PCDDs) may affect the female reproductive system in animals and humans. In 1978-1979, a mass poisoning occurred in central Taiwan due to PCB/PCDF-contaminated cooking oil; this incident was called Yucheng ("oil disease" in Chinese).The purpose of our study was to determine whether PCB/PCDF exposure affected fertility in exposed women.After the event, we followed the exposed individuals and a reference group who were sex-, age-, and community-matched. In 2003, we obtained fertility histories from Yucheng and reference women by telephone interview. We used Kaplan-Meier survival curves and multivariable Cox regression to compare time to pregnancy (TTP) between Yucheng and reference women, and we performed multiple logistic regression to determine whether PCB/PCDF exposure caused infertility.In total, 412 women responded, with a median TTP of 4 months in Yucheng women and 3 months in reference women (p = 0.019). After adjusting for confounders by Cox regression, we found a fecundability ratio of 0.90 [95% confidence interval (CI), 0.80-1.00] for Yucheng women. Among the 408 women who had non-contraceptive sexual activity for > 12 months, 19.7% of Yucheng women and 9.7% of reference women did not become pregnant (i.e., they were infertile). After we adjusted for confounders by logistic regression, the infertility odds ratio was 2.34 (95% CI, 1.23-4.59) for Yucheng women compared with the reference group.We found prolonged TTP and reduced fertility among women previously exposed to PCBs/PCDFs. Because of the limited sample size and the relatively small decrease in the fertility rate, these effects require cautious interpretation and further investigation for confirmation.
Body Iron Stores and the Risk of Coronary Heart Disease
Authors: Christopher T. Sempos, Anne C. Looker, Richard F. Gillum, Diane M. Makuc
Journal: New England Journal of Medicine (1994)

Recent studies have suggested an association between higher body iron stores and the risk of coronary heart disease. To assess these findings, we examined the association between transferrin saturation and the risk of coronary heart disease, myocardial infarction, overall mortality, and mortality from cardiovascular causes in a large population.