tbuckley/cabot-search huggingface dataset:
Warfarin-Related Bleeding in the Elderly
Authors: Stephan D. Fihn
Journal: Annals of Internal Medicine (1997)

Letters15 April 1997Warfarin-Related Bleeding in the ElderlyStephan D. Fihn, MD, MPH, Mary B. McDonell, MS, and Jorja Henikoff, MSStephan D. Fihn, MD, MPHVeterans Affairs Puget Sound Health Care System, Seattle, WA 98108Search for more papers by this author, Mary B. McDonell, MSVeterans Affairs Puget Sound Health Care System, Seattle, WA 98108Search for more papers by this author, and Jorja Henikoff, MSVeterans Affairs Puget Sound Health Care System, Seattle, WA 98108Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-8-199704150-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate Dr. Fiore's comments but believe that he has misinterpreted our data and conclusions. Although he focuses on “an astonishingly high absolute annual risk” for life-threatening and fatal hemorrhage in patients 80 years of age and older, he seems to have overlooked our strong rejoinder that this result must be “interpreted with great caution” because the numbers of patients and events were relatively small. Even though our study sample was larger than those in almost all other published studies, the confidence limits around the risk estimate were wide, ranging from 1.3 to 15.6. Excessive concern for this ...References1. Fihn SD, McDonell M, Martin D, Henikoff J, Vermes D, Kent D, et al. Risk factors for complications of chronic anticoagulation. A multicenter study. The Warfarin Optimized Outpatient Follow-up Study Group. Ann Intern Med. 1993; 118:511-20. Google Scholar2. Kent DL, Vermes D, McDonell M, Henikoff J, Fihn SD. A model for planning optimal follow-up for outpatients on warfarin anticoagulation. Med Decis Making. 1992; 12:132-41. Google Scholar3. Fihn SD, McDonell MB, Vermes D, Henikoff JG, Martin D, Kent DL. Optimal scheduling of patients on warfarin using a stochastic model: a multicenter randomized trial. J Gen Intern Med. 1994; 9:131-9. Google Scholar4. White RH, McKittrick T, Takakuwa J, Callahan CM, McDonnell MA, Fihn SD. Management and prognosis of life-threatening bleeding during warfarin therapy. Arch Intern Med. 1996; 156:1197-201. Google Scholar5. Lancaster TR, Singer DE, Sheehan MA, Oertel LB, Maraventano SW, Hughes RA, et al. The impact of long-term warfarin therapy on quality of life. Evidence from a randomized trial. Arch Intern Med. 1991; 151:1944-9. Google Scholar Author, Article, and Disclosure InformationAffiliations: Veterans Affairs Puget Sound Health Care System, Seattle, WA 98108 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByAnticoagulation orale en pratique gériatrique 15 April 1997Volume 126, Issue 8Page: 660-661KeywordsConfidence limitElderlyHemorrhageProspective studies Issue Published: 15 April 1997 CopyrightCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Phenotypic Correction of a Mouse Model for Primary Hyperoxaluria With Adeno-associated Virus Gene Transfer
Authors: Eduardo Salido, Marisol Rodriguez-Pena, Alfredo Santana, Stuart G. Beattie, Harald Petry, Armando Torres
Journal: Molecular Therapy (2010)

Primary hyperoxaluria type I (PH1) is an inborn error of metabolism caused by deficiency of the hepatic enzyme alanine-glyoxylate aminotransferase (AGXT or AGT) which leads to overproduction of oxalate by the liver and subsequent urolithiasis and renal failure. The current therapy largely depends on liver transplantation, which is associated with significant morbidity and mortality. To explore an alternative treatment, we used somatic gene transfer in a mouse genetic model for PH1 (Agxt1KO). Recombinant adeno-associated virus (AAV) vectors containing the human AGXT complementary DNA (cDNA) were pseudotyped with capsids from either serotype 8 or 5, and delivered to the livers of Agxt1KO mice via the tail vein. Both AAV8-AGXT and AAV5-AGXT vectors were able to reduce oxaluria to normal levels. In addition, treated mice showed blunted increase of oxaluria after challenge with ethylene glycol (EG), a glyoxylate precursor. In mice, AGT enzyme activity in whole liver extracts were restored to normal without hepatic toxicity nor immunogenicity for the 50 day follow-up. In summary, this study demonstrates the correction of primary hyperoxaluria in mice treated with either AAV5 or AAV8 vectors.
Role of Phasic Dynamism of p38 Mitogen-Activated Protein Kinase Activation in Ischemic Preconditioning of the Canine Heart
Authors: Shoji Sanada, Masafumi Kitakaze, Philip J. Papst, Kazuhito Hatanaka, Hiroshi Asanuma, Toshihiko Aki, Yoshiro Shinozaki, Hisakazu Ogita, Koichi Node, Seiji Takashima, Masanori Asakura, Junko Yamada, Tomi Fukushima, Akiko Ogai, Tsunehiko Kuzuya, Hidezo Mori, Naohiro Terada, Ken-ichi Yoshida, Masatsugu Hori
Journal: Circulation Research (2001)

Abstract —Although ischemic stress, including ischemic preconditioning (IP), activates p38 mitogen-activated protein kinase (MAPK), the relationship between p38 MAPK activation and the underlying cellular mechanisms of cardioprotection by IP is not verified in vivo. We examined the effects of the selective p38 MAPK inhibition on the cardioprotective effect of IP in the open-chest dogs. The coronary artery was occluded 4 times for 5 minutes, separated by 5 minutes of reperfusion (IP) followed by 90 minutes of occlusion and 6 hours of reperfusion. We infused SB203580 into the coronary artery during IP and 1 hour of reperfusion, during IP alone, and during sustained ischemia in the IP group. p38 MAPK activity markedly increased during IP but did not additionally increase at the onset of ischemia and was even attenuated at 15 minutes of sustained ischemia, and heat-shock protein (HSP) 27 was phosphorylated and translocated from cytosol to myofibril or nucleus without affecting total protein level at the onset of ischemia compared with the control group. SB203580 treatment (1 μmol/L) only during IP blunted the infarct size limitation by IP (37.3±6.3% versus 7.4±2.1% in the IP group, P &lt;0.01) and attenuated either phosphorylation or translocation of HSP27 during IP. Although the SB203580 treatment throughout the preischemic and postischemic periods had no significant effect on infarct size (33.3±9.4%) in this model, treatment with SB203580 only during ischemia partially mimicked the infarct size limitation by IP (26.8±3.5%). Thus, transient p38 MAPK activation during ischemic preconditioning mainly mediates the cardioprotection followed by HSP27 phosphorylation and translocation in vivo in the canine heart.
Acid-Suppressive Medication and Hospital-Acquired Pneumonia
Authors: Matt P. Wise
Journal: JAMA (2009)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
29 EARLY TRANSPLANTATION IMPROVES SURVIVAL OF NON-RESPONDERS TO CORTICOSTEROIDS IN SEVERE ALCOHOLIC HEPATITIS: A CHALLENGE TO THE 6 MONTH RULE OF ABSTINENCE
Authors: H. Castel, C. Moreno, T. Antonini, J.-C. Duclos-Vallée, J. Dumortier, V. Leroy, S. Dharancy, E. Boleslawski, V. Lucidi, C. Letoublon, D. Samuel, C. Francoz, F. Durand, F.-R. Pruvot, P. Mathurin
Journal: Journal of Hepatology (2010)
Drug companies lobby against generic versions of biologics
Authors: M. E. Tucker
Journal: BMJ (2013)

Biotechnology companies have launched a lobbying initiative to try to stop or slow down the introduction of generic versions of expensive biological drugs. State legislatures across the United States are introducing bills that could make it more difficult for doctors to prescribe—and for patients to obtain—cheaper versions of the drugs.

Generic versions of biological drugs are known as biosimilars. The original versions of the biologics include drugs such as rituximab (marketed as Rituxan or MabThera), trastuzumab (Herceptin), and bevacizumab (Avastin). These are among the best selling anticancer drugs in the world. The drugs, which are produced in cell systems, are said to account for about 25% of the US annual drug bill of $320bn (£205bn; €235bn).

Like other generic drugs, biosimilars are designed to be cheaper versions of brand name drugs. But they are created by …
Classification of the Primary Immune Deficiencies: Who Recommendation
Authors: H. H. Fudenberg, R. A. Good, W. Hitzig, H. G. Kunkel, I. M. Roitt, F. S. Rosen, D. S. Rowe, M. Seligmann, J. R. Soothill
Journal: New England Journal of Medicine (1970)

Since the initial description of agammaglobulinemia in 1952, a large number of patients with a wide variety of primary immune deficiencies have been described. In an attempt to clarify the categorization of these immune disorders, the World Health Organization recently convened a group of investigators who proposed a classification of the primary immunodeficiencies. The complete report of this committee will be published shortly in the Bulletin of the World Health Organization. A portion of the report is quoted below:Immunological responses are classically divided into those mediated by humoral antibody and by cells. Both depend upon the activity of small . . .
Results over a Ten-Year Period of Palliation followed by Corrective Surgery for Complete Transposition of the Great Arteries
Authors: PATRICIA M. CLARKSON, BRIAN G. BARRATT-BOYES, JOHN M. NEUTZE, JAMES B. LOWE
Journal: Circulation (1972)

One hundred and twenty patients with transposition of the great arteries (TGA) were encountered over a decade. Survivors have been followed until after definitive repair, and 39% were alive when reviewed. The majority (69%) had no significant communication between the pulmonary and systemic circulations. Of 48 patients in this poor-mixing group who had an atrial septectomy, 23 (48%) survived to have an atrial baffle repair at an average age of 37 months, and 37% were alive at the time of review. In contrast, 18 of 22 (82%) patients with poor mixing who had a balloon septostomy had a definitive operation at an average age of 13 months, and 17 (77%) survived. Twenty patients (17%) had good mixing between the two circulations due to the presence of a large ventricular septal defect (VSD) or patent ductus arteriosus, and presented with mild cyanosis and heart failure. Of this group, 35% were alive when reviewed. Four of the five patients who had a successful atrial baffle repair and correction of associated lesions were less than 4 months of age when this was performed. Where TGA was associated with VSD and pulmonary stenosis, 36% survived. Definitive operation at an early age has been made possible by the introduction of a surgical technic using profound surface-induced hypothermia and limited cardiopulmonary bypass.
The Rational Diet for The Obese
Authors: J. Walden Retan
Journal: JAMA (1974)

<h3>To the Editor.—</h3> It is appropriate that changing of the editorial guard is announced in the same issue ofThe Journalthat presents the article on rational diet construction for mild and grand obesity (226:70, 1973). I read this article with enthusiasm, hoping to find therein some indication for dietary support that would be as effective for my patients as the admonition to attend the Weight Watcher's Organization. Sadly, while the advice in the article seems good, I see no reason to believe that it would be therapeutically as effective in accomplishing weight loss, while preserving nutritional health, as the Weight Watcher's directions for the mildly obese. In the malignant obesity problem, the primary advice is careful psychiatric evaluation and appropriate psychiatric treatment. Somewhere in my reading, I have missed evidence that psychiatric care and treatment are more effective than any other means of helping the malignantly obese to reduce.
The aftermath of Angie's overdose: is soap (opera) damaging to your health?
Authors: S Platt
Journal: BMJ (1987)

In a study designed to evaluate the behavioural impact of a fictional parasuicide--namely, Angie's overdose on the popular television soap opera EastEnders--information about cases of deliberate overdose treated in accident and emergency departments in 63 hospitals throughout Britain was obtained for the week after the televised overdose (experimental period) and the week before the overdose (control period). After adjusting for trends in the equivalent weeks in a control year (1985) the increase in the cases of parasuicide treated by hospitals during the experimental week was not found to be significant. A significant increase (31%) was found among people aged greater than or less than 45, but this is not thought to be reliable. The increase among women alone (21%) was significant with a one tailed test. Contrary to expectations there was a positive association between trends in overdose and distance from London--that is, the further the distance of the region from London the greater the increase in cases of overdose during the experimental period--and a negative association between trends in overdose and viewing figures--that is, the higher the viewing figure the less the impact on the incidence of overdoses. These findings do not lend support to the claim that there was a strong imitation effect after this televised parasuicide.
Quality and Equity of Care in U.S. Hospitals
Authors: Amal N. Trivedi, Wato Nsa, Leslie R.M. Hausmann, Jonathan S. Lee, Allen Ma, Dale W. Bratzler, Maria K. Mor, Kristie Baus, Fiona Larbi, Michael J. Fine
Journal: New England Journal of Medicine (2014)

Nearly every U.S. hospital publicly reports its performance on quality measures for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia. Because performance rates are not reported according to race or ethnic group, it is unclear whether improvements in equity of care have accompanied aggregate improvements in health care quality over time. We assessed performance rates for quality measures covering three conditions (six measures for acute myocardial infarction, four for heart failure, and seven for pneumonia). These rates, adjusted for patient- and hospital-level covariates, were compared among non-Hispanic white, non-Hispanic black, and Hispanic patients who received care between 2005 and 2010 in acute care hospitals throughout the United States. Adjusted performance rates for the 17 quality measures improved by 3.4 to 57.6 percentage points between 2005 and 2010 for white, black, and Hispanic adults (P<0.001 for all comparisons). In 2005, as compared with adjusted performance rates for white patients, adjusted performance rates were more than 5 percentage points lower for black patients on 3 measures (range of differences, 12.3 to 14.2) and for Hispanic patients on 6 measures (5.6 to 14.5). Gaps decreased significantly on all 9 of these measures between 2005 and 2010, with adjusted changes for differences between white patients and black patients ranging from -8.5 to -11.8 percentage points and from -6.2 to -15.1 percentage points for differences between white patients and Hispanic patients. Decreasing differences according to race or ethnic group were attributable to more equitable care for white patients and minority patients treated in the same hospital, as well as to greater performance improvements among hospitals that disproportionately serve minority patients. Improved performance on quality measures for white, black, and Hispanic adults hospitalized for acute myocardial infarction, heart failure, or pneumonia was accompanied by increased racial and ethnic equity in performance rates both within and among U.S. hospitals. (Funded by the Centers for Medicare and Medicaid Services and the Veterans Affairs Health Services Research and Development Career Development Program.).
One More Hypothesis
Authors: George E. Thibault
Journal: New England Journal of Medicine (1993)

A 72-year-old man was sent to the emergency room by a visiting nurse, who had found him at home in respiratory distress. He had a two-week history of malaise, anorexia, dyspnea, and chest pain.My primary concern is to determine the cause of the respiratory distress. The illness is subacute with a two-week prodrome. The antecedent malaise and the anorexia are consistent with a viral illness, but the dyspnea and chest pain also make me think about a cardiac process. At this time I don't have enough information. I want to know more about the nature of the . . .
S137 The At-Risk Registers in Severe Asthma (ARRISA) Study: a cluster-randomised controlled trial in primary care
Authors: J. R. Smith, M. J. Noble, S. D. Musgrave, J. Murdoch, G. Price, A. Martin, J. Windley, R. Holland, B. D. W. Harrison, D. Price, A. Howe, I. Harvey, A. M. Wilson
Journal: Thorax (2010)

<h3>Objectives</h3> To evaluate the effectiveness of using electronic registers to identify and improve management of high-risk asthma patients in primary care. <h3>Design</h3> Cluster-randomised controlled trial with stratification by high/low deprivation scores and 1-year follow-up. <h3>Participants</h3> 29 GP practices in Norfolk, UK with suitable software systems used electronic searches and clinical knowledge to identify 911 patients aged 5+ years at high risk from their asthma as defined by British asthma guidelines (severe asthma plus adverse psychosocial characteristics, including poor adherence). <h3>Intervention</h3> Intervention practices established registers of high-risk asthma patients and used an electronic alert to identify these patients at all practice encounters. This allowed reception staff to prioritise appointments and facilitate patient access to clinicians and clinical staff to review patients9 asthma at all opportunities. Practice staff received a 1-h tailored training session on the use of alerts and actions to be taken from a GP (MN) and nurse (JW). Control practices continued with routine care. <h3>Outcomes</h3> A composite measure of moderate–severe exacerbations (primary outcome, see Abstract S137 Table 1 for definition), disaggregated exacerbation-related events, consultations and medications (secondary outcomes) were derived from anonymous clinical data extracted from practice-based patient records for the year before and after implementation of registers. <h3>Results</h3> See Abstract S137 Table 1 for results of unadjusted analyses. After adjustment for relevant covariates at baseline similar effects were observed but only the effect on nebulised β-agonists prescriptions remained significant. <h3>Conclusions</h3> Use of at-risk registers had no significant effect on the overall rate of moderate–severe exacerbations. However, they were associated with increases in prescriptions of oral steroids, inhaled steroids and long-acting β-agonists, coupled with reductions in asthma hospitalisations, prescriptions of nebulised short-acting β-agonists and in failures to attend primary care appointments. Together these are suggestive of improved asthma management in the intervention group.
Vagotomy or Gastrectomy for Gastric Ulcer
Authors: H. L. Duthie, N. K. Kwong
Journal: BMJ (1973)

Patients treated in a randomized controlled comparison of management of benign gastric ulcer of the body of the stomach, comprising 50 patients treated by Billroth I partial gastrectomy and 50 patients treated by vagotomy and pyloroplasty and biopsy of the ulcer, were followed up for about five years (range one and a half to eight and a half years). No statistically significant difference has been found between the functional results (Visick grading) of the two groups. There was no operative mortality. Postoperative morbidity (17 against 5) and length of stay in hospital (14 against 10 days) were significantly greater after gastrectomy. Seven patients after vagotomy have been submitted to gastrectomy (three for recurrent gastric ulceration, three for gastric cancer, and one for bleeding), which is a statistically significant excess compared with no reoperation after gastrectomy. While vagotomy and pyloroplasty can be useful to avoid a technically difficult gastrectomy, it cannot be said to replace partial gastrectomy in the treatment of gastric ulcer.
Insulin resistance and the disruption of Glut4 trafficking in skeletal muscle
Authors: Mike Mueckler
Journal: Journal of Clinical Investigation (2001)

The facilitative transport of glucose across animal cell membranes is mediated by members of the Glut protein family (1). These 50- to 60-kDa glycoproteins are ubiquitously expressed in mammalian tissues and are responsible for the uptake of sugar from the blood into cells, supplying cellular glucose for ATP production and for a wide variety of anabolic reactions. Additionally, glucose transport in certain tissues plays a critical role in whole-body glucose homeostasis. During fasting or starvation, the liver and kidney maintain euglycemia by becoming net producers of blood glucose, initially via the breakdown of glycogen stores and later through the catabolism of amino acids. Conversely, when the insulin level rises during the postprandial period in response to ingested carbohydrates, fat and muscle tissue become the major sites of glucose metabolism and storage.

The appropriate output or uptake of glucose from these tissues via the Glut proteins is critical to health and survival. For example, a disruption in the normal process by which insulin stimulates glucose transport into skeletal muscle is the cause of the peripheral insulin resistance associated with non–insulin-dependent diabetes mellitus (NIDDM) (2). Insulin resistance is the earliest detectable abnormality observed during the natural history of NIDDM and is believed to be a major triggering event in the development of the disease (3). Thus, a detailed understanding of how insulin regulates glucose transport in muscle is essential to unraveling the molecular basis of NIDDM. In this issue, Yang et al. (4) identify syntaxin 4 as one of the key molecular components in insulin-stimulated glucose transport in skeletal muscle. They also provide evidence supporting a novel mechanism for the pathogenesis of insulin resistance — the downregulation of a factor involved in glucose transporter subcellular trafficking.
An Evaluation of the Ability of Priscoline, Regitine, and Roniacol to Overcome Vasospasm in Normal Man
Authors: HAROLD D. GREEN, W. KENNETH GOBEL, MICHAEL J. MOORE, THOMAS C. PRINCE
Journal: Circulation (1952)

This paper is a study of the comparative efficacy of Priscoline, Regitine, and Roniacol in relaxing vasospasm in the extremities of normal human subjects. A total of 60 studies were performed on 14 subjects. Severe cutaneous vasospasm was induced by exposure of the lightly clad subject to an environmental temperature of 20 C. for one hour or more. In half the tests the severe vasospasm was reduced to moderate vasospasm by application of heat to the torso of the chilled subjects. The effectiveness of the drugs was tested by giving them by intravenous infusion after the appropriate state of vasospasm had been obtained. The degree of relaxation of vasospasm was estimated from the resulting changes in cutaneous temperature recorded with thermocouples.