tbuckley/cabot-search huggingface dataset:
Pneumococcal antigen detection in bronchoalveolar lavage fluid from patients with pneumonia.
Authors: P Jimenez, M Meneses, F Saldias, M Velasquez
Journal: Thorax (1994)

BACKGROUND--Pneumococcal pneumonia can be diagnosed by the detection of capsular antigen in sputum, serum, pleural fluid, or urine using countercurrent immunoelectrophoresis and latex agglutination. In addition, quantitative cultures of bronchoalveolar lavage (BAL) fluid are also reliable for establishing the aetiology of pneumonia. This study investigated the value of rapid detection of pneumococcal antigen in BAL fluid from patients with pneumonia. METHODS--Pneumococcal antigen was detected by countercurrent immunoelectrophoresis and latex agglutination. Patients were grouped according to BAL quantitative culture results into pneumococcal pneumonia (n = 24), other known aetiology (n = 18), and unknown aetiology (n = 17). Thirteen patients with interstitial lung disease and without pneumonia served as a control group. RESULTS--In patients with pneumococcal pneumonia, antigen was detected by countercurrent immunoelectrophoresis in 50% and by latex agglutination in 54% of cases. In patients with pneumonia of unknown aetiology pneumococcal antigen was detected by latex agglutination in 53% of cases. Antigen was not detected in patients with pneumonia of other known aetiology or in control patients, yielding a specificity of 100%. CONCLUSIONS--In patients with pneumococcal pneumonia requiring fibreoptic bronchoscopy detection of pneumococcal antigen in BAL fluid may rapidly and accurately confirm the aetiology. Furthermore, in nearly half the cases of pneumonia of unknown aetiology antigen can be detected, suggesting that Streptococcus pneumoniae is a major causative agent in such patients.
Herellea (Bacterium Anitratum) Endocarditis
Authors: Samuel R. Hirsch, Marie L. Koch
Journal: JAMA (1964)

ALTHOUGH a variety of microorganisms have been incriminated 1 as the cause of endocarditis, so far as the authors are able to ascertain, only two other cases of bacterial endocarditis due to Herellea have been reported. 2,3 Another case is herein reported.  Report of a Case  The patient was a 52-year-old white man who was admitted to the hospital at the Veterans Administration Center, Wood, Wis, on July 4, 1962, with the chief complaint of swelling of the legs. About one month prior to admission he noted rapid onset of ankle swelling, aching pain in the legs, marked dyspnea on exertion and occasionally at rest, weakness, anorexia, weight loss, mild nocturia, and malaise. A history of rheumatic fever was absent.  Physical examination on admission showed a well-developed, alert, fairly well-nourished, middle-aged male who appeared to be acutely and chronically ill. Blood pressure was 140/36 mm Hg, pulse was 100 beats/minute
Diagnosis and Treatment of Seborrheic Keratosis-Reply
Authors: Robert S. Stern
Journal: JAMA (1991)

<h3>In Reply.—</h3> We thank Dr Hunt et al and Dr Epstein for their comments. Our pilot study assessed the possibility that the wealth of information now available on pathology laboratory computers could be used as a cost-effective means of monitoring the quality of care of ambulatory surgery, now largely unmonitored. We believe that it demonstrated the potential of that approach as well as the wide variation among groups of physicians in diagnostic accuracy and appropriateness ofcare. In Massachusetts, pathological analysis of tissues that are surgically removed is required. Hence, selection bias is likely to be a far smaller problem than Hunt et al suggest. We do hope to apply the principles tested in our pilot study to study all cutaneous lesions submitted for pathological examination. This would further reduce selection bias and permit determination of additional parameters of physician performance, including predictive values and the proportion of biopsy specimens that
Forecasting physician workforce requirements
Authors: J. L. Kaufman
Journal: JAMA (1995)

To the Editor.  —The forecast of the US physician workforce by Dr Weiner 1 is flawed as it applies to surgeons. First, it fails to account for workforce attrition through early retirement in the next decade. There are several active trends, especially a sense of burnout, such that the average age of retirement for general surgeons has decreased to younger than 60 years. This is also reflected in the unprecedented numbers of physicians now using disability as a rationale for retirement, whereas in the past they would shift job functions or specialty to continue working (Mark Shea, CLU, written communication, December 3,1994). There is a clearly expressed lockerroom and cafeteria sentiment among my associates that if they were financially able, they would reduce exposure to stresses in work by reduction in their hours or their emergency on-call availability or by change of specialty by 55 years of age. For physicians
How to prevent caesarean deliveries deserves more study
Authors: James M Nicholson, Lisa C Kellar, Peter F Cronholm
Journal: BMJ (2005)

EDITOR—Declercq et al bring to light “no indicated risk” as a new classification of caesarean delivery.1 Like other classes of caesarean delivery, annual rates of caesarean sections with no indicated risk have been increasing in the United States and around the world. In the context of these increases, we are …
Survival of patients with severe congestive heart failure treated with oral milrinone
Authors: Donald S. Baim, Wilson S. Colucci, E. Scott Monrad, Harton S. Smith, Richard F. Wright, Alyce Lanoue, Diane F. Gauthier, Bernard J. Ransil, William Grossman, Eugene Braunwald
Journal: Journal of the American College of Cardiology (1986)
Abstract LB-184: Differential effects of sulforaphane and related isothiocyanates on HDAC turnover and the DNA damage response in colon cancer cells
Authors: Praveen Rajendran, Ariam I. kidane, Tian-Wei Yu, Wan-Mohaiza Dashwood, Emily Ho, David E. Williams, Roderick H. Dashwood
Journal: Cancer Research (2012)

Abstract Protein acetylation is mediated by histone deacetylases (HDACs) and acetyltransferases, which influence chromatin dynamics, protein turnover, and the DNA damage response. HDACs overexpressed in cancer cells have been implicated in protecting against genotoxic insults, whereas HDAC inhibitors circumvent this protection (Rajendran et al. Clin Epigenetics 2011,3:4). Here, we show in human colon cancer cells that sulforaphane and related isothiocyanates (ITCs) inhibited HDAC activity and increased HDAC protein turnover, with the potency directly proportional to alkyl chain length. Under these conditions, DNA damage signaling was triggered by ATR kinases, leading to increased double-strand breaks and histone (H2AX) phosphorylation. Activation of checkpoint kinase-2 was followed by growth arrest and cell death. HDAC inhibition by ITCs enhanced the acetylation of repair proteins, like CtIP, leading to their degradation. Notably, cancer cells were more susceptible than normal cells, the latter exhibiting efficient double-strand-break processing and repair. Thus, dietary ITCs preferentially exploit the HDAC turnover pathways, faulty DNA repair mechanisms, and genomic instability in cancer cells. Supported by NIH grants CA090890, CA65525, CA122906, CA122959, CA80176, and ES007060. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-184. doi:1538-7445.AM2012-LB-184
Examination of the Intrarenal Hematocrit Ratio with the Technique of Circulatory Stop-Flow in Dogs
Authors: Ewald E. Selkurt, Richard J. Laurence
Journal: Circulation Research (1969)

Estimates of the intrarenal hematocrit ratio vary widely, depending on the techniques used for its determination. Computation of blood volume from the product of mean transit time of labeled erythrocytes and albumin, and minute volume blood flow, yields values averaging approximately 90% of the systemic vessel hematocrit. To the other extreme are values that are slightly less than half of the systemic hematocrit ratio based on the determination of total renal blood volume by labeled red cells and albumin. Intermediate values are obtained by methods involving draining the blood from the kidney and measuring its hematocrit ratio. The current investigation, by a technique of circulatory stop-flow, has shown that a substantial fluid shift occurs in the kidney within 2 minutes of circulatory arrest, so that interstitial fluid, supplemented by fluid reabsorbed by the nephrons, dilutes the erythrocytes within the peritubular capillaries to reduce the hematocrit ratio to almost half of the systemic figure. The drainage methods are subject to error as a result of this mechanism, but if such fluid shifts are taken into account, values for the intrarenal hematocrit closer to the ratio of systemic blood can be anticipated.
Expression of Tissue Factor Pathway Inhibitor in Vascular Smooth Muscle Cells and Its Regulation by Growth Factors
Authors: Noel M. Caplice, Cheryl S. Mueske, Laurel S. Kleppe, Timothy E. Peterson, George J. Broze, Robert D. Simari
Journal: Circulation Research (1998)

Abstract —Tissue factor pathway inhibitor (TFPI) in vivo is thought to be synthesized mainly by endothelial cells. To date, no significant regulator of TFPI synthesis has been described. Vascular smooth muscle cells (VSMC) express tissue factor in vitro and in vivo, which may contribute to vascular thrombosis. We hypothesized that VSMC might also express TFPI. To determine this, we examined growth-arrested coronary VSMC in culture and found that VSMC secreted an amount of TFPI similar to that seen in endothelial cells. Immunohistochemistry of normal human coronary arteries showed TFPI staining throughout the media and intima of the vessel with localization to VSMC and endothelial cells. To determine regulation of TFPI expression in VSMC, we examined the effects of serum stimulation on TFPI secretion and found that FBS induced a 5-fold increase in TFPI antigen and activity levels in conditioned medium at 48 hours ( P &lt;0.001) when compared with serum-free conditions. A similar stimulatory effect was seen with 10% pooled human serum. Moreover, epidermal growth factor and platelet-derived growth factor-B increased TFPI secretion by 4- to 5-fold and 2- to 3-fold, respectively ( P &lt;0.05), and these growth factors accounted for ≈50% of the TFPI secretion effects of human serum. The serum effect was associated with a 3-fold increase in TFPI mRNA 24 hours after release from growth arrest and a 50% decrease in TFPI secretion after treatment with actinomycin D. Taken together, this study suggests that there is significant TFPI expression in VSMC in culture and in VSMC within the intima and media of the normal coronary artery wall. We present the first evidence for TFPI regulation by serum in VSMC and more specifically by its constituent growth factors, epidermal growth factor and platelet-derived growth factor-B.
Circulating heparan sulfate proteoglycan anticoagulant from a patient with a plasma cell disorder.
Authors: M S Khoory, M E Nesheim, E J Bowie, K G Mann
Journal: Journal of Clinical Investigation (1980)

A woman, aged 68, with multiple myeloma (immunoglobulin[Ig]A kappa type) developed an anticoagulant with properties suggestive of heparin. The anticoagulant prolonged the thrombin time but not the reptilase time and was resistant to boiling, proteolytic enzyme digestion, and trichloracetic acid precipitation. The thrombin time was corrected by the addition (in vitro) of protamine sulfate or the addition of purified platelet Factor 4 (PF4) to the plasma. The anticoagulant was isolated by PF4-Sepharose affinity chromatography and analyzed in terms of its molecular weight, uronic acid, and amino acid composition. The proteoglycan isolated had a mol wt of 116,000 and appears to consist of two 38,000 dalton polysaccharide units interconnected by peptide material totaling 39,000 daltons. Electrophoretic analysis of the pronase digested peptidoglycan using the lithium acetate-agarose technique suggested the material was of the heparan sulfate type. The peptidoglycan had about one-tenth the specific activity of commercially available heparin on a weight basis. The isolated proteoglycan was indistinguishable from commercial heparin when analyzed in terms of its ability to act as a cofactor in the antithrombin III inhibition of thrombin.
Diaphragmatic fatigue investigated by phonomyography.
Authors: M Petitjean, J Ripart, J Couture, F Bellemare
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

Diaphragmatic phonomyogram (PMG) evoked by maximal bilateral phrenic nerve stimulation has previously been described as a good index of contractility of fresh and fatigued diaphragm. In the present study we hypothesized that diaphragmatic contractility changes could be even more simply evaluated by recording the relationship between the PMG and the compound motor action potential (CMAP) amplitudes during graded submaximal unilateral phrenic nerve stimulation at various intensities. Relationships between CMAPs and PMGs from left and right hemidiaphragms were recorded by means of surface electrodes and miniature microphones placed over the lower rib cage (eighth intercostal space) in five healthy subjects before and after a diaphragmatic fatigue task. These relationships in each subject were linear. The slope of these relationships decreased by 61.1 +/- 20.7% and by 70.4 +/- 14.6% on the right and left side respectively, but the intercepts did not change significantly. By comparison, transdiaphragmatic twitch pressure during maximal bilateral stimulation (PdiT) declined by 49.4 +/- 15%. We conclude that PMG during submaximal unilateral phrenic nerve stimulation is a reliable index of diaphragm contractility changes caused by fatigue. Using this method we have shown that all diaphragmatic motor units can be affected by fatigue.
Effect of exercise intensity and duration on regional function during and after exercise-induced ischemia.
Authors: D C Homans, D D Laxson, E Sublett, T Pavek, M Crampton
Journal: Circulation (1991)

BACKGROUND Transient reversible myocardial dysfunction has been documented after episodes of exercise-induced ischemia. This study was undertaken to determine whether the duration or intensity of exercise affects the severity of postischemic dysfunction in this setting. METHODS AND RESULTS Ten dogs were instrumented with ultrasonic microcrystals for measurement of wall thickening, with circumflex coronary artery flow probes, and with hydraulic occluders. Dogs performed low-intensity exercise, which was sufficient to increase coronary perfusion 50% above control, and high-intensity exercise, which was sufficient to double coronary blood flow. To investigate the effects of exercise intensity on postischemic dysfunction, we had dogs perform high-intensity exercise for 5 minutes in the presence of a stenosis. On the alternate day, dogs performed low-intensity exercise for 10 minutes in the presence of a stenosis. These two protocols provide equivalent coronary flow debts. Mean transmural blood flow during high-intensity exercise without stenosis (2.61 +/- 0.54 ml/min/g) was significantly higher than that during low-intensity exercise (1.74 +/- 0.61 ml/min/g, p less than 0.002). During high-intensity exercise with coronary artery stenosis, subendocardial blood flow was significantly lower than that during low-intensity exercise with stenosis (0.64 +/- 0.40 versus 1.08 +/- 0.28 ml/min/g, p less than 0.02). This difference in subendocardial perfusion was associated with greater degrees of regional dysfunction during exercise (circumflex wall thickening was 44 +/- 23% of control for high-intensity exercise versus 60 +/- 18% of control for low-intensity exercise, p less than 0.01). In addition, from 10 to 30 minutes after exercise, wall thickening in myocardium perfused by the circumflex coronary artery remained significantly lower after high-intensity exercise than that after low-intensity exercise. To assess the effects of exercise duration on the severity of postischemic dysfunction, we had dogs perform low-intensity exercise in the presence of a coronary stenosis for 10 minutes and low-intensity exercise for only 5 minutes on alternate days. Systolic wall thickening was significantly lower after low-intensity exercise for 10 minutes than after low-intensity exercise for 5 minutes. CONCLUSIONS High-intensity exercise results in greater degrees of subendocardial hypoperfusion and greater degrees of regional dysfunction both during and after exercise-induced ischemia than does low-intensity exercise. Second, exercise duration also exerts an effect on the severity of postischemic dysfunction, although the magnitude of this effect is less important than the effect of exercise intensity.
Acute Quadriplegia in Diabetic Hyperosmotic Coma With Hypokalemia
Authors: Francisco Manzano
Journal: JAMA (1969)

A 42-year-old man had quadriplegia with associated hyperosmotic diabetic coma, marked hypokalemia, and mild ketoacidosis. The exact etiology of the paralysis could not be determined but three possibilities were considered: (1) hypokalemia, (2) diabetic neuropathy, and (3) Guillain-Barré syndrome. This is the second reported case of hyperosmotic diabetic coma in an insulin-dependent diabetic patient.
Proposed new International Health Regulations
Authors: Angus Nicoll, Jane Jones, Preben Aavitsland, Johan Giesecke
Journal: BMJ (2005)

Agreement must be reached to protect the global village from pandemic influenza 

I nfectious diseases have never respected national boundaries, and ever increasing movement of people and goods means that no country or region, no matter how wealthy, can make itself invulnerable to infections emerging elsewhere.1 2 Equally neither can any country be confident that it will not be the source of a threat to the global community.2 The International Health Regulations are legal instruments designed to provide the maximum security against the international spread of infectious disease with minimal interference with world traffic.3 4 Although the World Health Organization is responsible for the regulations, they are agreed collectively by its member states. Individual states may state a reservation, but great trouble is taken to come up with regulations that almost every country will sign up to. The current regulations (in place since 1969) have been recognised to be inadequate for today's global village and the acid tests that countries may face (box).5 6 WHO has been revising the regulations since 1995. Progress was initially slow, but the relative irrelevance of the regulations during the outbreaks of severe …
Strain Echocardiography Improves Risk Prediction of Ventricular Arrhythmias After Myocardial Infarction
Authors: Kristina H. Haugaa, Bjørnar L. Grenne, Christian H. Eek, Mads Ersbøll, Nana Valeur, Jesper H. Svendsen, Anca Florian, Benthe Sjøli, Harald Brunvand, Lars Køber, Jens-Uwe Voigt, Walter Desmet, Otto A. Smiseth, Thor Edvardsen
Journal: JACC. Cardiovascular imaging (2013)
Health-Related Quality-of-Life Assessments and Patient-Physician Communication
Authors: Symone B. Detmar, Martin J. Muller, Jan H. Schornagel, Lidwina D. V. Wever, Neil K. Aaronson
Journal: JAMA (2002)

There has been increasing interest in the use of health-related quality-of-life (HRQL) assessments in daily clinical practice, yet few empirical studies have been conducted to evaluate the usefulness of such assessments.To evaluate the efficacy of standardized HRQL assessments in facilitating patient-physician communication and increasing physicians' awareness of their patients' HRQL-related problems.Prospective, randomized crossover trial.Outpatient clinic of a cancer hospital in the Netherlands.Ten physicians and 214 patients (76% women; mean age, 57 years) undergoing palliative chemotherapy who were invited to participate between June 1996 and June 1998.At 3 successive outpatient visits, patients completed an HRQL questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30). The responses were computer scored and transformed into a graphic summary. Physicians and patients received a copy of the summary before the consultation.Audiotapes of the consultations were content analyzed to evaluate patient-physician communication. Physicians' awareness of their patients' health problems was assessed by comparing physicians' and patients' ratings on the Dartmouth Primary Care Cooperative Information Functional Health Assessment (COOP) and the World Organisation Project of National Colleges and Academics (WONCA) charts.The HRQL-related issues were discussed significantly more frequently in the intervention than in the control group (mean [SD] communication composite scores: 4.5 [2.3] vs 3.7 [1.9], respectively (P =.01). Physicians in the intervention group identified a greater percentage of patients with moderate-to-severe health problems in several HRQL domains than did those in the control group. All physicians and 87% of the patients believed that the intervention facilitated communication and expressed interest in its continued use.Incorporating standardized HRQL assessments in daily clinical oncology practice facilitates the discussion of HRQL issues and can heighten physicians' awareness of their patients' HRQL.
Incidence of thromboembolic complications in patients with atrial fibrillation or mechanical heart valves with a subtherapeutic international normalized ratio: A prospective multicenter cohort study
Authors: Francesco Dentali, Pasquale Pignatelli, Alessandra Malato, Daniela Poli, Matteo Nicola Dario Di Minno, Leonardo Di Gennaro, Elena Rancan, Daniele Pastori, Elena Grifoni, Alessandro Squizzato, Sergio Siragusa, Giovanni di Minno, Walter Ageno
Journal: American Journal of Hematology (2012)

Subtherapeutic international normalized ratio (INR) is frequently encountered in clinical practice, and patients with high-risk atrial fibrillation (AF) and with mechanical heart valve (MHV) with inadequate anticoagulation may be exposed to an increased risk of thromboembolic events (TE). However, there are no prospective data evaluating this risk. Consecutive patients with a history of stable anticoagulation, but with a subtherapeutic INR, were prospectively included. Data on use and dose of low-molecular weight heparin (LMWH) bridging therapy were collected. The incidence of objectively confirmed TE and of major bleeding events within 90 days after the index INR was assessed. Five hundred and one patients with INR value 0.5-1 INR units below the lower limit of the patient-specific target INR were included in the study (280 with MHV and 221 with AF and CHADS2 score ≥3). LMWH was prescribed for 64 patients (12.8%). During follow-up, seven patients had a TE (1.40%; 95% confidence interval 0.68, 2.86%; 5.58 events for 100 patients year). All the events occurred within 14 days after the index INR. When we consider only patients who did not receive bridging therapy, the incidence of TE was 1.14% (5 of 437 patients; 95% confidence interval 0.49, 2.64%; 4.58 events for 100 patients year). There were no major bleeding events. The risk of TE in this population was not negligible. Given the frequent observation of subtherapeutic INR levels when monitoring vitamin K antagonists, this finding warrants additional investigation to improve the management of these patients.