tbuckley/cabot-search huggingface dataset:
The Role of Carotid Arterial Intima-Media Thickness in Predicting Clinical Coronary Events
Authors: Howard N. Hodis
Journal: Annals of Internal Medicine (1998)

Background: Carotid arterial intima-media thickness is used as a noninvasive surrogate end point to measure progression of atherosclerosis, but its relation to coronary events has not been fully explored. Objective: To determine whether carotid arterial intima-media thickness predicts coronary events. Design: Long-term follow-up (average, 8.8 years) of a previously assembled cohort of persons who completed the 2-year Cholesterol Lowering Atherosclerosis Study, a randomized arterial imaging trial designed to study the effects of lipid lowering on progression of atherosclerosis. Setting: University-based ultrasonography laboratory. Patients: 146 men 40 to 59 years of age who had previously had coronary artery bypass graft surgery. Measurements: Preintrusive atherosclerosis in the common carotid artery was evaluated every 6 months with B-mode ultrasonography, and intrusive atherosclerosis in the coronary arteries was evaluated at baseline and at 2 years with quantitative coronary angiography. After the trial, the incidences of coronary events (nonfatal acute myocardial infarction, coronary death, and coronary artery revascularization) were documented. Results: For each 0.03-mm increase per year in carotid arterial intima-media thickness, the relative risk for non-fatal myocardial infarction or coronary death was 2.2 (95% CI, 1.4 to 3.6) and the relative risk for any coronary event was 3.1 (CI, 2.1 to 4.5) (P < 0.001). Absolute intima-media thickness was also related to risk for clinical coronary events (P < 0.02). Absolute thickness and progression in thickness predicted risk for coronary events beyond that predicted by coronary arterial measures of atherosclerosis and lipid measurements (P < 0.001). Conclusion: Noninvasive B-mode ultrasonographic measurement of progression of intima-media thickness in the distal common carotid artery is a useful surrogate end point for clinical coronary events.
Long term disease control outcomes for partial breast irradiation using MammoSite brachytherapy.
Authors: JL Harper, JM Watkins, MK Baker, DJ Cole, AE Dragun, E Garrett-Mayer, AE Wahlquist, JM Jenrette
Journal: Cancer Research (2009)

Abstract Abstract #5145 Purpose: To describe 4-year local and ipsilateral breast recurrence-free intervals, overall freedom from disease failure, and disease-specific and overall survivals in a cohort of MammoSite Brachytherapy (MBT) patients with mature follow-up, treated at a single institution over a 6-year period.&amp;#x2028; Methods and Materials: An analysis of MBT cases was performed using prospectively collected quality assurance database, departmental chart review, and electronic medical records. Patient-, tumor-, treatment-, and outcome-specific data were extracted and recorded into a research database. Eligible patients were required to have &amp;gt;6 months post-MBT follow-up. Local tumor failure was defined as pathologically-proven recurrence within 2 cm of the resected tumor bed, with all other ipsilateral breast recurrences (excluding axilla or internal mammary nodal failures) defined as ipsilateral breast failures. Any local, ipsilateral breast, nodal, or distant failure was censored for overall freedom from failure.&amp;#x2028; Results: From 2004 through 2008, 115 MBT patients have been treated, of which 104 were eligible for the present analysis. Median patient age was 62 years (range 25–86). Primary tumors included ductal carcinoma in situ (DCIS) for 20 patients, T1a (12), T1b (31), T1c (34), and T2 (7). Lymph nodes were assessed in 94 patients (including all patients with invasive carcinomas), and revealed pN0 disease in 85 patients, pN1(mic) (3), and pN1a (6). Histologies of invasive carcinomas were ductal in 68 patients, lobular (3), mixed ductal/lobular (3), mucinous/colloid (7), medullary (2), and tubular (1). At a median follow up of 45.7 months (range 7.3-71.4), 6 patients have experienced disease recurrence, including 4 within the ipsilateral breast. Three patients with ipsilateral breast recurrence underwent salvage mastectomy, two of whom remain without evidence of disease recurrence at 56 and 14 months, respectively. Seven patients have died, 3 of or with recurrent breast cancer. Estimated 4-year outcomes for the entire cohort were: local tumor control 100%, ipsilateral breast control 97.0% (95% CI, 93.6%-100%), overall freedom from failure 93.8% (88.5%-99.5%), disease specific survival 97.8% (94.8%-100%) and overall survival 92.7% (87.2%-98.6%).&amp;#x2028; Conclusions: The present study demonstrates low rates of local and ipsilateral breast disease failure in a well-defined cohort of MBT patients with mature follow-up. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5145.
PD4-3-8: Survival of patients with advanced non-small cell lung cancer before and after the general introduction of palliative chemotherapy in Norway - a population based study
Authors: Christian von Plessen, Trond-Erik Strand, Tore Wentzel-Larsen, Ernst Omenaas, Nils Wilking, Roy Bremnes, Stein Sundstrøm, Ulf Aasebø, Sverre Sörenson
Journal: Journal of Thoracic Oncology (2007)
Protocol Management of Dysuria, Urinary Frequency, and Vaginal Discharge
Authors: SHELDON GREENFIELD
Journal: Annals of Internal Medicine (1974)

A protocol to be administered by nurses for the management of dysuria, frequent urination, and vaginal discharge was validated. In a randomized, controlled trial, 146 women were seen by both nurse and physician and then assigned to either the nurse-protocol treatment plan or the physician treatment plan. The clinical data collected by the nurse showed no important differences from the physicians' data. The protocol recommended that 89% of the patients be sent home without seeing the physician. The physicians agreed with the protocol-recommended disposition in all but two cases. All patients with complications were appropriately referred to the physician. In follow-up, more than 95% of both groups reported symptomatic improvement, and repeat urine cultures were negative. We conclude that the protocol can be accurately administered, makes sound recommendations, is safe, and efficiently saves physician time.
Infertile couples to be given three shots at IVF
Authors: Caroline White
Journal: BMJ (2004)

Guidance aimed at raising infertility service provision in England and Wales to the standards enjoyed elsewhere in Europe has been published this week.

But concerns have been expressed that the funding and infrastructure needed to implement the guidelines across England and Wales will not be in place for several years.

The guidance was developed by the National Collaborating Centre for Women and Children's Health on behalf of the National Institute for Clinical Excellence (NICE), in a bid to rationalise NHS services and …
The Human Resources for Health Program in Rwanda — A New Partnership
Authors: Agnes Binagwaho, Patrick Kyamanywa, Paul E. Farmer, Tej Nuthulaganti, Benoite Umubyeyi, Jean Pierre Nyemazi, Soline Dusabeyesu Mugeni, Anita Asiimwe, Uzziel Ndagijimana, Helen Lamphere McPherson, Jean de Dieu Ngirabega, Anne Sliney, Agnes Uwayezu, Vincent Rusanganwa, Claire M. Wagner, Cameron T. Nutt, Mark Eldon-Edington, Corrado Cancedda, Ira C. Magaziner, Eric Goosby
Journal: New England Journal of Medicine (2013)

A global shortage of 4.3 million health professionals poses a major bottleneck to poor people worldwide with regard to benefiting from the fruits of modern medicine. 1Among existing health professionals, there are also staggering inequities in skill levels and geographic distribution. 2-4Unsurprisingly, the deepest national gaps in human resources for health run parallel to poor population-level health outcomes. 1ub-Saharan Africa bears 24% of the global burden of disease 5 but is served by only 4% of the global health workforce. 1The health graduate schools in the region face overwhelming financial, infrastructural, and personnel constraints, limiting their ability to address the shortage. 2,5,
Learning from low income countries: what are the lessons?: Sources of information should focus on developing countries
Authors: James N Newell, Andrew S Furber
Journal: BMJ (2004)

EDITOR—Both the BMJ and the Lancet claim to be globally relevant.1 2 We tested this assertion and assessed the opportunities for readers of these journals in developed countries to learn from research from the developing world.

We abstracted research articles from the BMJ (“papers” and “primary care” sections) …
Variation in CDKN2A at 9p21.3 influences childhood acute lymphoblastic leukemia risk
Authors: Amy L Sherborne, Fay J Hosking, Rashmi B Prasad, Rajiv Kumar, Rolf Koehler, Jayaram Vijayakrishnan, Elli Papaemmanuil, Claus R Bartram, Martin Stanulla, Martin Schrappe, Andreas Gast, Sara E Dobbins, Yussanne Ma, Eamonn Sheridan, Malcolm Taylor, Sally E Kinsey, Tracey Lightfoot, Eve Roman, Julie A E Irving, James M Allan, Anthony V Moorman, Christine J Harrison, Ian P Tomlinson, Sue Richards, Martin Zimmermann, Csaba Szalai, Ágnes F Semsei, Daniel J Erdelyi, Maja Krajinovic, Daniel Sinnett, Jasmine Healy, Anna Gonzalez Neira, Norihiko Kawamata, Seishi Ogawa, H Phillip Koeffler, Kari Hemminki, Mel Greaves, Richard S Houlston
Journal: Nature Genetics (2010)
Individual differences, affective and social factors
Authors: Adrian Furnham
Journal: Behavioral and Brain Sciences (2006)

The target article overestimates the power of money as a motive/incentive in order to justify trying to provide a biological theory. A great deal of the article is spent trying to force-fit other explanations into this course categorization. Lea &amp; Webley's (L&amp;W's) account seems to ignore systematic, individual differences, as well as the literature on many negative affective associations of money and behavioural economics, which is a cognitive account of money motivation.
Tumours of the bladder.
Authors: M J Garrett
Journal: BMJ (1971)

which is usually in the right iliac fossa).The point is not entirely academic or his- torical in its importance but has a truly practical application even today.The authority of your editorials is such that young surgeons and others reading your statement of "Murphy's triad" may be per- suaded that the diagnosis of acute appendicitis can never be established or accepted when the patient has a normal temperature.They will then refrain from operating when operation without delay may indeed be very necessary.-Iam, etc.,
PEG-interspersed nitrilotriacetic acid-functionalized quantum dots for site-specific labeling of prion proteins expressed on cell surfaces
Authors: Min Xie, Kan Luo, Bi-Hai Huang, Shu-Lin Liu, Jun Hu, Di Cui, Zhi-Ling Zhang, Geng-Fu Xiao, Dai-Wen Pang
Journal: Biomaterials (2010)
Gradually worsening shortness of breath
Authors: A. Baldwin, D. Howlett, D. Maxwell
Journal: BMJ (2010)

A 38 year old woman who smoked presented to her general practitioner with intermittent shortness of breath and wheeze. She admitted smoking 15 cigarettes a day for the past 20 years. A diagnosis of asthma was made and appropriate inhalers prescribed. Over the next few months she re-presented to her doctor several times with persistent productive cough and increasing shortness of breath. Symptoms were treated as an infective exacerbation with repeated courses of antibiotics. Despite continued treatment with bronchodilators and inhaled steroids little clinical improvement was seen. She returned intermittently to her general practitioner with worsening shortness of breath. Initially this was evident only on exertion, but over the course of two years it began to limit even mild activity. Auscultation showed decreased breath sounds in the lower zones with increased resonance to percussion. Simple spirometry performed at the general practitioner’s surgery showed prolonged expiration and airflow obstruction.

She was referred to a chest physician, and chest radiography was performed as part of her initial investigations (fig 1⇓).



Fig 1 Chest radiograph





### 1 What are the radiological findings?

#### Short answer

The chest radiograph shows hyperinflation with bullous emphysematous changes in the lower zones bilaterally (fig 2⇓).



Fig 2 Chest radiograph of a patient with α1 antitrypsin deficiency showing marked emphysema in the lower zones



#### Long answer

Chest radiography in patients with α1 antitrypsin deficiency typically shows hyperinflation and reduced lung markings; it can also show bulla formation associated with emphysematous changes.1 Areas are also described as oligaemic—lacking the usual pattern of branching blood vessels.2 The lung bases are often affected in these patients, whereas in patients with typical COPD emphysema is usually apically distributed.3 This …
Prevalence of morbidity associated with abortion before and after legalisation in South Africa
Authors: R. Jewkes
Journal: BMJ (2002)

Abortion on request has been legal in South Africa since 1997.The Choice in Termination of Pregnancy Act of South Africa 1996 allows abortion on request up to 20 weeks' gestation.Since it was introduced, 40 000 legal abortions have been performed annually. 1 A national study in 1994 on morbidity associated with incomplete abortion (illegally induced and spontaneous miscarriage) assisted the act's passage through parliament. 2 We studied the impact of legislative change on morbidity and medical management by repeating the 1994 study of morbidity due to incomplete abortion among patients presenting to public hospitals in 2000.
Routine Biliary Sphincterotomy May Not be Indispensable for Endoscopic Pancreatic Sphincterotomy
Authors: M. H. Kim, S. J. Myung, Y. S. Kim, H. J. Kim, D. W. Seo, S. W. Nam, J. H. Ahn, S. K. Lee, Y. I. Min
Journal: Endoscopy (1998)

It is generally accepted that biliary sphincterotomy is mandatory to avoid possible cholestasis and infection due to edema after pancreatic sphincterotomy. However, biliary sphincterotomy is an invasive procedure and the above claim on dual sphincterotomy has not been proven by a prospective randomized study. The aim of our study was to determine whether cholangitis develops more frequently when the patients have not undergone concomitant biliary sphincterotomy during the endoscopic pancreatic sphincterotomy.From January 1990 to November 1997, 60 patients (38 men, 22 women, age range 19-45 years) with non-alcoholic chronic calcifying pancreatitis were prospectively enrolled. The patients with jaundice (bilirubin > or = 3 mg/dl), cholangitis, or parenchymal liver disease were excluded. The patients were randomly subjected either to dual sphincterotomy (group I, n = 30) or to pancreatic sphincterotomy alone (group II, n = 30). Groups I and II were further classified as IA (or IIA) and IB (or IIB), according to the level of serum alkaline phosphatase (sALP) and the diameter of the common bile duct (CBD). Group IA (or IIA) was defined when abnormal in both sALP (> or = 2 times the upper limit of normal) and CBD diameter (> or = 12 mm), whereas group IB (or IIB) was defined when normal, or solely abnormal in sALP or CBD diameter.As a complication after sphincterotomy, pancreatitis developed in one of eight patients (12.5%) in group IA, whereas cholangitis occurred in one of 22 (4.5%) and hemorrhage in one of 22 (4.5%) cases in group IB. By contrast, in group IIA, the cholangitis developed in 56% (five of nine patients), which was significantly more frequent than in any other groups (P < 0.05). Hemorrhage (one of 21, 4.8%) and pancreatitis (one of 21, 4.8%) occurred in group IIB.Our results suggest that dual sphincterotomy may be indicated only in patients who have both dilated choledochus and elevated alkaline phosphatase in chronic pancreatitis. Routine biliary sphincterotomy may not be indispensable for pancreatic sphincterotomy.
Response to Chlorambucil in Macroglobulinemia
Authors: Dallas V. Clatanoff, Ovid O. Meyer
Journal: JAMA (1963)

MACROGLOBULINEMIA has been the subject of many reports and of several recent reviews.<sup>1-3</sup>Waldenström<sup>4</sup>first noted the occurrence of high molecular weight serum globulins as a prominent feature of certain blood dyscrasias. Despite the possibility of multiple etiologic factors, the well-defined biochemical abnormality and a generally recognized clinical picture lead one to the acceptance of macroglobulinemia as a disease entity. The disease is now considered to be a neoplasm of the reticuloendothelial system characterized by the proliferation of an abnormal cell type from which the macroglobulins probably originate. The abnormal cell has been variously described as "lymphocytoid," "lymphoid," and "plasmacytoid." It is our prime intention to report the results obtained with long-term administration of chlorambucil to our 2 patients with this condition, supporting the favorable observations reported by Bayrd.<sup>5</sup> <h3>Material and Methods</h3> We have had the opportunity to follow the clinical courses and serum protein patterns
Efficacy and Cost-effectiveness of Autologous Bone Marrow Transplantation in Metastatic Breast Cancer
Authors: Bruce E. Hillner
Journal: JAMA (1992)

<h3>Objective.</h3> —To assess the efficacy and cost-effectiveness of standard chemotherapy and high-dose chemotherapy with autologous bone marrow transplantation (ABMT) in metastatic breast cancer. <h3>Design.</h3> —Decision analysis model using a Markov process. <h3>Setting.</h3> —Response and recurrence rates from the published literature for standard therapy and from case series of ABMT. Costs were based on local charges and on adjusted Medicare data. <h3>Patients.</h3> —Hypothetical cohorts of women with metastatic breast cancer who had no bone marrow involvement and no comorbid illness. <h3>Intervention.</h3> —The standard chemotherapy cohort received cyclophosphamide, doxorubicin, and fluorouracil. The ABMT cohort was treated with intense induction chemotherapy, then additional high-dose chemotherapy following a remission, with ABMT support. <h3>Main Outcome Measures.</h3> —Anticipated survival, incremental cost per year of life, and incremental cost per quality-adjusted year of life gained using a 5-year time horizon. Rigorous sensitivity analyses were done, including assessing a benefit "tail" of normal life expectancy for those free of disease after 5 years. <h3>Results.</h3> —ABMT was the preferred approach under almost all assumptions, but the size of the benefit varied greatly. ABMT had a survival benefit of 6.0 months at 5 years at an incremental cost of $115 800 per year of life saved. If patients who were free of disease after 5 years had normal survival, the benefit was 18.1 months at an incremental cost of $28 600 per year. The benefit of ABMT was primarily dependent on whether the recurrence risk was constant or decreases after a finite period of time. <h3>Conclusion.</h3> —Using reasonable assumptions, ABMT provided a substantial benefit but at a cost that may be untenable. Decision analysis highlights the limitations in the currently available data and the assumptions made for the emotional question of using ABMT in metastatic breast cancer. The model supports the need for randomized clinical trials. (<i>JAMA</i>. 1992;267:2055-2061)
The stimulation of CD8+ T cells by dendritic cells pulsed with polyketal microparticles containing ion-paired protein antigen and poly(inosinic acid)–poly(cytidylic acid)
Authors: Michael J. Heffernan, Sudhir P. Kasturi, Stephen C. Yang, Bali Pulendran, Niren Murthy
Journal: Biomaterials (2008)
Reversal of portal hypertension and hyperdynamic splanchnic circulation by combined vascular endothelial growth factor and platelet-derived growth factor blockade in rats
Authors: Mercedes Fernandez, Marc Mejias, Ester Garcia-Pras, Raul Mendez, Juan Carlos Garcia-Pagan, Jaime Bosch
Journal: Hepatology (2007)

Vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) pathways are crucial to angiogenesis, a process that contributes significantly to the pathogenesis of portal hypertension. This study determined the effects of inhibition of VEGF and/or PDGF signaling on hyperdynamic splanchnic circulation and portosystemic collateralization in rats with completely established portal hypertension, thus mimicking the situation in patients. Portal vein-ligated rats were treated with rapamycin (VEGF signaling inhibitor), Gleevec (PDGF signaling inhibitor), or both simultaneously when portal hypertension was already fully developed. Hemodynamic studies were performed by transit-time flowmetry. The extent of portosystemic collaterals was measured by radioactive microspheres. The expression of angiogenesis mediators was determined by Western blotting and immunohistochemistry. Combined inhibition of VEGF and PDGF signaling significantly reduced splanchnic neovascularization (i.e., CD31 and VEGFR-2 expression) and pericyte coverage of neovessels (that is, alpha-smooth muscle actin and PDGFR-beta expression) and translated into hemodynamic effects as marked as a 40% decrease in portal pressure, a 30% decrease in superior mesenteric artery blood flow, and a 63% increase in superior mesenteric artery resistance, yielding a significant reversal of the hemodynamic changes provoked by portal hypertension in rats. Portosystemic collateralization was reduced as well.Our results provide new insights into how angiogenesis regulates portal hypertension by demonstrating that the maintenance of increased portal pressure, hyperkinetic circulation, splanchnic neovascularization, and portosystemic collateralization is regulated by VEGF and PDGF in portal hypertensive rats. Importantly, these findings also suggest that an extended antiangiogenic strategy (that is, targeting VEGF/endothelium and PDGF/pericytes) may be a novel approach to the treatment of portal hypertension.
Late, persistent expressions of ICAM-1 and VCAM-1 on myocardial tissue in children with lymphocytic myocarditis
Authors: T Ino
Journal: Cardiovascular Research (1997)

Background: Both intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) have been implicated in cardiac allograft rejection. However, there is little information about the relationship between the expression of these adhesion molecules and myocarditis in children. Methods and Results: Immunoreactivities of ICAM-1 and VCAM-1 were examined by enzyme immunoassay in 31 biopsy specimens obtained from 11 pediatric patients with biopsy-proven myocarditis or cardiomyopathy. Five of the 11 patients had clear evidence of acute myocarditis. The other 6 had ECG abnormalities identified by mass screening for heart disease, and subsequently had been histologically diagnosed as having non-specific cardiomyopathy. The period between onset of myocarditis or identification of ECG abnormality and immunohistochemical studies was 23 to 60 days and 8 months to 3 years, respectively. Expression of ICAM-1 and VCAM-1 was assessed by counting ICAM-1- and VCAM-1-positive vessels and dividing by the total number of vessels. ICAM-1 was significantly present on 81% (P<0.01) of myocardial tissue samples in the 5 patients with healing-stage acute myocarditis, and on 45% (P<0.05) in the remaining 6 patients with non-specific cardiomyopathy, compared with 24% in control specimens obtained from right ventricular muscle resected at surgery for tetralogy of Fallot. VCAM-1 was also present on 50% (P<0.05) of the samples from the 5 patients with acute myocarditis, but was not present in those with non-specific cardiomyopathy. Conclusion: This persistent expression of ICAM-1 suggests that myocardial cell damage may persist immunologically for a long period in myocarditis. In addition, immunostaining for these adhesion molecules may be of diagnostic value in clinically silent lymphocytic myocarditis and chronic cardiomyopathy.