tbuckley/cabot-search huggingface dataset:
Clinical and statistical analyses of new and evolving therapies for primary biliary cirrhosis
Authors: Russell H. Wiesner, Patricia M. Grambsch, Keith D. Lindor, Jurgen Ludwig, E. Rolland Dickson
Journal: Hepatology (1988)

Primary biliary cirrhosis is a chronic, progressive, cholestatic liver disease thought to be related to abnormalities in immune regulation. The disease is associated with granulomatous bile duct destruction, cholestasis, hepatic copper overloading and the development of hepatic fibrosis or cirrhosis or both. There have been numerous therapeutic trials evaluating immunosuppres-sive, antifibrotic and cupruretic agents. Prednisolone, D-penicillamine, azathioprine, colchicine and chloram-bucil have been evaluated in controlled clinical trials, and biochemical improvement of liver function has been noted with all of the agents, except D-penicillamine. Improved survival has also been reported in patients treated long-term with azathioprine and colchicine. However, none of the therapeutic agents has been demonstrated to halt histologic progression of the disease or to induce a complete clinical, biochemical and histologic remission as has been reported in patients with autoimmune chronic active hepatitis treated with corticoste-roids. Many of the trials did not use a double-blind design, failed to use the "intent to treat" rule or failed to define an objective time to analyze results. Many of the studies involved small numbers of patients with short-term follow-up and thus potentially were inadequate to appreciate drug effects that might be of clinical benefit. Currently, there is no totally effective therapy for primary biliary cirrhosis. We believe that well-designed clinical trials can provide important information to better understand this disease until a totally effective therapy is available. New clinical trials should use well-established methodologic guidelines in study design and well-accepted statistical standards in the analysis and interpretation of results.
Immunoregulation of murine myeloma in vitro. II. Suppression of MOPC-315 immunoglobulin secretion and synthesis by idiotype-specific suppressor T cells.
Authors: G L Milburn, R G Lynch
Journal: The Journal of Experimental Medicine (1982)

In previous studies, BALB/c mice immunized with trinitrophenyl-specific IgA protein (M315) produced by MOPC-315 developed idiotype (Id315)-specific T cells that suppressed M315 secretion in vivo. In the present in vitro studies, we show that inhibition of M315 secretion is mediated by a theta,Lyt-1-2+ cell that expresses a surface membrane receptor for Id315. The suppressor signal is a diffusable product that acts directly on M315-secreting myeloma cells. Inhibition of M315 secretion is T cell dose-dependent, Id315-specific, reversible, and occurs without any effect on MOPC-315 growth, viability, or surface membrane expression of M315. Inhibition of M315 secretion results from a selective inhibition of M315 synthesis in the myeloma cell. These studies provide new insight into the mechanisms of direct B cell regulation by idiotype-specific T cells.
VEGF-C induced angiogenesis preferentially occurs at a distance from lymphangiogenesis
Authors: A. V. Benest, S. J. Harper, S. Y. Herttuala, K. Alitalo, D. O. Bates
Journal: Cardiovascular Research (2007)

Vascular endothelial growth factor-C (VEGF-C) has been shown to stimulate both angiogenesis and lymphangiogenesis in some but not all models where VEGF-C is over-expressed. Our aim was to investigate the interaction between lymphangiogenesis and angiogenesis in adult tissues regulated by VEGF-C and identify evidence of polarized growth of lymphatics driven by specialized cells at the tip of the growing sprout.We used an adult model of lymphangiogenesis in the rat mesentery. The angiogenic effect of VEGF-C was markedly attenuated in the presence of a growing lymphatic network. Furthermore, we show that this growth of lymphatic vessels can occur both by recruitment of isolated lymphatic islands to a connected network and by filopodial sprouting. The latter is independent of polarized tip cell differentiation that can be generated all along lymphatic capillaries, independently of the proliferation status of the lymphatic endothelial cells.These results both demonstrate a dependence of VEGF-C-mediated angiogenesis on lymphatic vascular networks and indicate that the mechanism of VEGF-C-mediated lymphangiogenesis is different from that of classical angiogenic mechanisms.
Patrick Joseph Murphy
Authors: J. HEATHCOTE
Journal: BMJ (2003)

Former general practitioner Bromley, Kent, (b 1914; q University College, Cork, 1940), d 29 June 2003.

On qualifying, he joined the Royal Navy and served on board HMS Grenville in the Atlantic convoys before joining a general practice in Falmouth. In 1958 he came to Bromley. He was still working at full strength at the age of 76 when then health secretary Kenneth Clarke's new contract forced him into premature retirement. After 10 years of unaccustomed leisure, his last years were diminished by Alzheimer's disease and prostate cancer. He leaves a wife, Greta, and a son.
A Randomized Trial of Deferred Stenting Versus Immediate Stenting to Prevent No- or Slow-Reflow in Acute ST-Segment Elevation Myocardial Infarction (DEFER-STEMI)
Authors: David Carrick, Keith G. Oldroyd, Margaret McEntegart, Caroline Haig, Mark C. Petrie, Hany Eteiba, Stuart Hood, Colum Owens, Stuart Watkins, Jamie Layland, Mitchell Lindsay, Eileen Peat, Alan Rae, Miles Behan, Arvind Sood, W. Stewart Hillis, Ify Mordi, Ahmed Mahrous, Nadeem Ahmed, Rebekah Wilson, Laura Lasalle, Philippe Généreux, Ian Ford, Colin Berry
Journal: Journal of the American College of Cardiology (2014)

The aim of this study was to assess whether deferred stenting might reduce no-reflow and salvage myocardium in primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). No-reflow is associated with adverse outcomes in STEMI. This was a prospective, single-center, randomized, controlled, proof-of-concept trial in reperfused STEMI patients with ≥1 risk factors for no-reflow. Randomization was to deferred stenting with an intention-to-stent 4 to 16 h later or conventional treatment with immediate stenting. The primary outcome was the incidence of no-/slow-reflow (Thrombolysis In Myocardial Infarction ≤2). Cardiac magnetic resonance imaging was performed 2 days and 6 months after myocardial infarction. Myocardial salvage was the final infarct size indexed to the initial area at risk. Of 411 STEMI patients (March 11, 2012 to November 21, 2012), 101 patients (mean age, 60 years; 69% male) were randomized (52 to the deferred stenting group, 49 to the immediate stenting). The median (interquartile range [IQR]) time to the second procedure in the deferred stenting group was 9 h (IQR: 6 to 12 h). Fewer patients in the deferred stenting group had no-/slow-reflow (14 [29%] vs. 3 [6%]; p = 0.006), no reflow (7 [14%] vs. 1 [2%]; p = 0.052) and intraprocedural thrombotic events (16 [33%] vs. 5 [10%]; p = 0.010). Thrombolysis In Myocardial Infarction coronary flow grades at the end of PCI were higher in the deferred stenting group (p = 0.018). Recurrent STEMI occurred in 2 patients in the deferred stenting group before the second procedure. Myocardial salvage index at 6 months was greater in the deferred stenting group (68 [IQR: 54% to 82%] vs. 56 [IQR: 31% to 72%]; p = 0.031]. In high-risk STEMI patients, deferred stenting in primary PCI reduced no-reflow and increased myocardial salvage. (Deferred Stent Trial in STEMI; NCT01717573)
TCT-815 Prognostic Role Of Serum Cardiac Biomarker Elevation After Transcatheter Aortic Valve Replacement
Authors: Israel Barbash, Danny Dvir, Itsik Ben Dor, Salem Badr, Petros Okubagzi, Rebecca Torguson, Paul Corso, Lowell Satler, Augusto Pichard, Ron Waksman
Journal: Journal of the American College of Cardiology (2012)
Cost-Effectiveness of Cholesterol-Lowering Therapies according to Selected Patient Characteristics
Authors: Lisa A. Prosser, Aaron A. Stinnett, Paula A. Goldman, Lawrence W. Williams, Maria G.M. Hunink, Lee Goldman, Milton C. Weinstein
Journal: Annals of Internal Medicine (2000)

Background: The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) recommends treatment guidelines based on cholesterol level and number of risk factors. Objective: To evaluate how the cost-effectiveness ratios of cholesterol-lowering therapies vary according to different risk factors. Design: Cost-effectiveness analysis. Data Sources: Published data. Target Population: Women and men 35 to 84 years of age with low-density lipoprotein cholesterol levels of 4.1 mmol/L or greater (≥ 160 mg/dL), divided into 240 risk subgroups according to age, sex, and the presence or absence of four coronary heart disease risk factors (smoking status, blood pressure, low-density lipoprotein cholesterol level, and high-density lipoprotein cholesterol level). Time Horizon: 30 years. Perspective: Societal. Interventions: Step I diet, statin therapy, and no preventive treatment for primary and secondary prevention. Outcome Measures: Incremental cost-effectiveness ratios. Results of Base-Case Analysis: Incremental cost-effectiveness ratios for primary prevention with step I diet ranged from $1900 per quality-adjusted life-year (QALY) gained to $500 000 per QALY depending on risk subgroup characteristics. Primary prevention with a statin compared with diet therapy was $54 000 per QALY to $1 400 000 per QALY. Secondary prevention with a statin cost less than $50 000 per QALY for all risk subgroups. Results of Sensitivity Analysis: The inclusion of niacin as a primary prevention option resulted in much less favorable incremental cost-effectiveness ratios for primary prevention with a statin (>$500 000 per QALY). Conclusions: Cost-effectiveness of treatment strategies varies significantly when adjusted for age, sex, and the presence or absence of additional risk factors. Primary prevention with a step I diet seems to be cost-effective for most risk subgroups but may not be cost-effective for otherwise healthy young women. Primary prevention with a statin may not be cost-effective for younger men and women with few risk factors, given the option of secondary prevention and of primary prevention in older age ranges. Secondary prevention with a statin seems to be cost-effective for all risk subgroups and is cost-saving in some high-risk subgroups.
Clinical Skills and Cost of Good Care
Authors: James R. Webster, Richard L. Hughes, William B. Buckingham
Journal: Annals of Internal Medicine (1977)

Comments and Corrections1 March 1977Clinical Skills and Cost of Good CareJAMES R. WEBSTER JR., M.S., M.D., F.A.C.P., RICHARD L. HUGHES, M.D., F.A.C.P., WILLIAM B. BUCKINGHAM, M.D., F.A.C.P.JAMES R. WEBSTER JR., M.S., M.D., F.A.C.P.Search for more papers by this author, RICHARD L. HUGHES, M.D., F.A.C.P.Search for more papers by this author, WILLIAM B. BUCKINGHAM, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-86-3-361 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Brook, Williams, and Avery (Ann Iniern Med 85:809-817, 1976) have incisively assessed the problems surrounding quality assurance, particularly in terms of its methods, problems, costs, and goals. Their recommendations are well grounded and answer critics such as Illich (1) who point to the lack of data showing that processes affect outcome in health.Brook and associates cite the difficulties in attempting to change physician behavior as a means of improving quality care and comment that "attempts to raise the level of quality of care by efforts directed solely at improving cognitive skills must be resisted." We agree...References1. ILLICH : Medical Nemesis: The Expropriation of Health. Great Britain, Trinity Press, 1975 Google Scholar2. SHAPIROWYMAN SS: CAT fever. N Engl J Med 294:954-956, 1976 CrossrefMedlineGoogle Scholar3. WIENERNATHANSON SM: Physical examination. Frequently observed errors. JAMA 236:852-855, 1976 CrossrefMedlineGoogle Scholar4. MALONEY J: Discussion of faculty practice income. Clin Res 21:918-920, 1973 Google Scholar5. PEABODY F: Care of the patient. Cambridge, Massachusetts, Harvard University Press, 1927 CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Department of Medicine Northwestern University Medical School Northwestern Memorial Hospital Chicago, IL 60611 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 March 1977Volume 86, Issue 3Page: 361-362KeywordsBehaviorHealth care qualityHealth care quality assessment Issue Published: 1 March 1977 PDF downloadLoading ...
Renal Failure in Laennec's Cirrhosis ("Hepatorenal Syndrome").
Authors: S. Papper
Journal: Annals of Internal Medicine (1963)

s1 April 1963Renal Failure in Laennec's Cirrhosis ("Hepatorenal Syndrome").S. Papper, M.D., F.A.C.P.S. Papper, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-58-4-742_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThere has been considerable debate concerning the existence of renal failure occurring in the course of Laennec's cirrhosis in the absence of causes of renal insufficiency.Our group has studied 46 patients with cirrhosis who developed renal failure without apparent cause.The group was not a homogeneous one clinically. Jaundice and ascites ranged from minimal to severe. Histologically, the liver revealed various stages of cirrhosis.The following evidence suggests that renal failure was due to a disturbance of renal circulation, rather than to any parenchymal lesion: (1) renal failure developed abruptly; (2) blood pressure was generally reduced; (3) renal blood... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Albuquerque, N. M. (CS) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1963Volume 58, Issue 4Page: 742-742KeywordsAscitesBlood pressureCirrhosisHepatorenal syndromeLesionsLiverRenal circulationRenal failure Issue Published: 1 April 1963 PDF downloadLoading ...
Elder Self-Neglect — How Can a Physician Help?
Authors: Alexander K. Smith, Bernard Lo, Louise Aronson
Journal: New England Journal of Medicine (2013)

Interview with Dr. Alexander Smith on ways of improving the safety and health of self-neglecting elderly patients. (13:34)Download Clinicians often expend considerable effort caring for elderly patients who neglect their own needs. But there are some practical approaches to the clinical care of self-neglecting patients.
Cryptococcemia and the BACTEC 460 Blood Culture System
Authors: GORDON L. LOVE
Journal: Annals of Internal Medicine (1987)

Letters and Corrections1 April 1987Cryptococcemia and the BACTEC 460 Blood Culture SystemGORDON L. LOVE, M.D., GILDA D. BOYD, M.T. (ASCP), ELROY J. LEBLANC JR., M.T. (ASCP)GORDON L. LOVE, M.D.Search for more papers by this author, GILDA D. BOYD, M.T. (ASCP)Search for more papers by this author, ELROY J. LEBLANC JR., M.T. (ASCP)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-106-4-633_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Microbiology laboratories are increasingly using BACTEC instruments (Johnson Laboratories, Towson, Maryland) to monitor metabolic gas production as an indicator of microbial growth, eliminating tedious examination of negative subcultures (1, 2). Although the BACTEC system has been shown to be as reliable for detection of a wide range of microorganisms, isolation ofCryptococcus neoformanshas been reported infrequently (1-5). Since installation of the BACTEC system in June 1984, 11 blood isolates ofC. neoformansfrom five patients have been detected at the Veterans Administration Medical Center in New Orleans. Two cultures were screened as negative on the BACTEC...References1. MCLAUGHLINEVERSOFFICER JJJ. Lack of requirement for blind subcultures of BACTEC blood culture media. J Clin Microbiol. 1981;14:567-70. CrossrefMedlineGoogle Scholar2. ARAJHOPFERWENGLARFAINSTEIN GRMV. Value of terminal subcultures from negative BACTEC blood culture bottles. J Clin Microbiol. 1981;14:589-90. CrossrefMedlineGoogle Scholar3. BRANNONKIEHN PT. Large-scale clinical comparison of the lysis-centrifugation and radiometric systems for blood culture. J Clin Microbiol. 1985;22:951-4. CrossrefMedlineGoogle Scholar4. PREVOSTBANNISTER EE. Detection of yeast septicemia by biphasic and radiometric methods. J Clin Microbiol. 1981;13:655-60. CrossrefMedlineGoogle Scholar5. HOPFERORENGOCHESNUTWENGLAR RASM. Radiometric detection of yeasts in blood cultures of cancer patients. J Clin Microbiol. 1980;12:329-31. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Veterans Administration Medical Center Louisiana State University School of Medicine New Orleans, LA 70146 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byFungal Infections in AIDS 1 April 1987Volume 106, Issue 4Page: 633-634KeywordsBloodCryptococcus neoformansMicrobiology Issue Published: 1 April 1987 PDF downloadLoading ...
An Apple a Day -- A Futuristic Parable
Authors: Charles E. Phelps
Journal: New England Journal of Medicine (1994)

It all began about 20 years ago, in early 1994, when somebody joked with Hillary Rodham Clinton that “an apple a day keeps the doctor away,” noting that this would provide the best cost control imaginable. The idea took root as if both Johnny and Joanie Appleseed had been spreading their wares across the land. “I wonder,” Mrs. Clinton is reported to have replied, “whether there really is anything to that old houseperson's tale.” Thus began the search for evidence.Mrs. Clinton is said to have asked Michael McGinnis, M.D., director of the Office of Disease Prevention in the Public . . .
Succinylcholine-Induced Hyperkalemia in Neuromuscular Disease
Authors: Lee H. Cooperman
Journal: JAMA (1970)

The dangerously high levels of plasma potassium known to follow succinylcholine chloride administration in patients with burns or trauma have also been noted in patients with paraplegia or hemiplegia, muscular dystrophy, and multiple sclerosis. Of 40 patients with these neuromuscular diseases, 15 had increases in potassium levels between 1 and 6 mEq/liter after receiving succinylcholine chloride, 1 mg/kg of body weight. Most increases over 1 mEq/liter occurred in those patients who had been ill for less than six months or, if longer, who had disease of a progressive nature. The degree and extent of muscle paralysis seemed directly correlated with relaxant-induced hyperkalemia.
Etude de l'effet d'un ballon intra-gastrique à eau sur le poids, la composition corporelle et la consommation énergétique chez des sujets obèses
Authors: M Potier, G Airinei, A Pernot, JM Catheline, D Sfedj, JJ Raynaud, B Bejou, C Bon, JL Fournier, R Cohen, A Baglieri, R Benamouzig
Journal: Endoscopy (2008)

Introduction: L'obésité est un problème médical dont l'importance est croissante. La pose d'un ballon intragastrique est une des modalités thérapeutiques proposées pour la prise en charge des patients résistant à une prise en charge diététique adaptée. Le ballon entraîne une distension gastrique permanente qui pourrait modifier le comportement alimentaire. Cependant, peu d'études prospectives se sont intéressées à l'effet du ballon intra-gastrique à eau de type Allergan sur la composition corporelle et l'effet de ce ballon sur la prise alimentaire n'a jamais été étudié sur le long terme.
Surrogate Consent for Genetic Testing, the Reconsent Process, and Consent for Long-Term Outcomes in Acute Respiratory Distress Syndrome Trials
Authors: Alexandra Smart, B. Taylor Thompson, Dale M. Needham, Ramona O. Hopkins, Andre Williams, Ellen L. Burnham, Marc Moss
Journal: American Journal of Respiratory and Critical Care Medicine (2013)

An ATS Clinical Practice Guideline reviewed treatments for exercise-induced bronchoconstriction (EIB) and commented briefly on vitamin C (1).The authors identified two controlled trials (2, 3) in which vitamin C halved the fall in FEV 1 after exercise, but the authors did not calculate confidence intervals (CIs) for the effect.A third randomized, double-blind, placebo-controlled trial on vitamin C and EIB has also been published (4) and was included in a metaanalysis (5).The pooled relative effect estimate of three trials (2-4) indicated a 48% reduction (95% CI, 33 to 64%; P , 0.001) in the postexercise FEV 1 decline when vitamin C was administered before exercise (5).The third study (4) needed imputations to include it in the metaanalysis, but it also reported that vitamin C decreased the proportion of participants who suffered from EIB by 50 percentage points (95% CI, 23 to 68; P , 0.001); this calculation did not need data imputations (5).The ATS Guideline comments that the evidence for vitamin C was limited by imprecision (1).The CIs calculated in the metaanalysis are, however, particularly narrow (5).The total number of participants in the three vitamin C trials is only 40.Nevertheless, the trials were performed in three different decades and on two different continents.The criteria for EIB differed, and the mean age of the participants was 25 and 26 years in two studies (2, 3) but 14 years in the third study (4).Still, all of the studies are consistent with a 50% reduction in the fall in FEV 1 after exercise.It is not evident how far this 50% estimate can be generalized, but the close estimate in such different studies suggests that vitamin C is probably beneficial for several people who suffer from EIB.The ATS Guideline considers that the burden of dietary modification might limit the usefulness of vitamin C (1).However, two of the vitamin C studies administered the vitamin as a single dose 1 to 1.5 hours before exercise (2, 4), which is no more burdensome than administering a b 2 -agonist before exercise (1).Further research on the effect of vitamin C on EIB should be performed.Nevertheless, given the safety and low cost of vitamin C, and the positive findings in the three EIB studies, it seems reasonable for physically active people to test vitamin C if they suffer from EIB (5).