tbuckley/cabot-search huggingface dataset:
The Risk of Midline Catheterization in Hospitalized Patients: A Prospective Study
Authors: Leonard A. Mermel
Journal: Annals of Internal Medicine (1995)

To assess the risk associated with midline catheter use in hospitalized patients.Prospective, consecutive enrollment.A 719-bed university-affiliated hospital.Patients were enrolled if they were likely to require at least 7 days of intravascular catheterization while hospitalized.Patients were monitored for adverse reactions. Catheter segment, insertion site, hub, infusate, and blood cultures were assessed.From February 1993 through June 1994, 251 Landmark midline catheters were inserted in 238 patients. One hundred forty catheter cultures were obtained from 130 patients who remained hospitalized for the duration of catheterization. For these 130 patients, the mean duration of catheterization was 9 days, the incidence of catheter colonization was 5.0 per 1000 catheter days, and the incidence of catheter-related bloodstream infection was 0.8 per 1000 catheter days. During the study period, two severe, unexpected adverse reactions occurred that may have been associated with the use of Landmark midline catheters; no such reactions were associated with the insertion of 58,580 Teflon peripheral catheters (P < 0.00001; exact 95% lower bound of the odds ratio, 68.9). Fifty-three similar reactions associated with Landmark midline catheters, including two deaths, have been reported to the Food and Drug Administration through June 1994.The risk for midline catheter-related infection is low. However, Landmark midline catheters are associated with life-threatening adverse reactions that are probably attributable to the catheter material itself.
Selective Intra-arterial Streptokinase Therapy in the Immediate Postoperative Period
Authors: Laurence S. Chaise
Journal: JAMA (1982)

We report successful lysis of acute arterial calf thrombosis by intra-arterial streptokinase infusion seven hours after retroperitoneal dissection and repair of an ipsilateral common femoral artery laceration. No systemic effects or complications developed. Local intra-arterial thrombolytic therapy is more effective and safer than intravenous systemic therapy and may now be considered in the immediate postoperative period, providing the drug is delivered downstream from the operative site. (<i>JAMA</i>1982;247:2397-2400)
Lesson of the Week: Retention of drugs in venous access port chamber: a note of caution
Authors: M. Ben-Arush, M. Berant
Journal: BMJ (1996)

Indwelling tunnelled central venous catheters are widely used for venous access in patients who require intravenous nutrition, fluids, antibiotics, chemotherapy, and other drugs for protracted periods.1 2 Maintaining these central venous catheters warrants meticulous adherence to protocol, which includes adequately flushing after drug administration and leaving a heparin lock for preventing blockages, rigorous care of the catheter exit site on the skin, and, most important, strict observation of aseptic techniques when handling the external tubing so as to minimise the risk of infection, which is the main complication of long use intravenous catheters.3 4

Failure immediately to flush a port venous access device after delivery of drugs can have grave consequences

The advent of completely implanted subcutaneous port systems5 has simplified long term venous access and also appears to have reduced significantly the risk of infection.1 6 Central venous placement of port linked catheters is similar to that of external catheters, but the venous catheter of a port system, instead of exiting through the skin, is attached to a reservoir within a port …
Evidence supporting somatic assembly of the DNA segments (minigenes), coding for the framework, and complementarity-determining segments of immunoglobulin variable regions.
Authors: E A Kabat, T T Wu, H Bilofsky
Journal: The Journal of Experimental Medicine (1979)

Two sets of apparently conflicting data on the genes coding for the variable region are being accumulated. One suggests that the sets of nucleotides coding for the framework segments of immunoglobulin light and heavy (VL and VH) chains assort independently and are therefore germ-line minigenes which, together with sets of nucleotides coding for the complementarity-determining regions (CDR) or segments assemble to form complete variable (V)-region genes (15, 16, 33). The other, based on the findings with clones from 12-d-old embryo and adult mouse coding for V-regions, infer that the first three frameworks and the three complementarity-determining segments are already assembled as germ-line V-genes (17-21). It is now generally accepted that the J segment, which in the one instance sequenced (21) is made up of nucleotides coding for framework (FR)4 plus two residues of CDR3, is a minigene. An examination of sequences of human, mouse, and rabbit V-regions, assuming the latter hypothesis, indicates that individual framework sets would have to be present in many copies. The FR2 segment found in one human, 20 mice, and 13 rabbits would have to be present in at least 10/14 copies in the NZB, and 5/6 in the BALB/c mouse, and 12/13 in the rabbit. The X-ray crystallographic data show this region to be a loop, projecting out from the V-domain, capable of accommodating many substiutions and 12 and 8 alternative sequences for this FR2 segment have been found in mouse and rabbit VK chains with substitutions possible at 13 of the 15 positions. These alternative sequences occur much less frequently than the preserved FR2 segment. Thus, there is no basis in the protein structure to account for evolutionary stability of this FR2 segment if it occurs in so many copies in germ-line genes coding for residues 1-96, but its stability is easily explained if it were coded for by a separate germ-line minigene present as a single copy; the alternative forms could then have arisen by duplication and mutation of this minigene. Somatic assembly of the minigene segments for the three framework and three complementarity-determining segments during differentiation would account completely for our assortment data from which FR4 was inferred to be a minigene.
Impact of the “July Effect” on Patient Outcomes
Authors: Shimon (Seymour) M. Glick
Journal: Annals of Internal Medicine (2012)

Letters17 January 2012Impact of the “July Effect” on Patient OutcomesShimon (Seymour) M. Glick, MDShimon (Seymour) M. Glick, MDFrom Ben Gurion University of the Negev, Beer Sheva, Israel, 84105.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-2-201201170-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The article by Young and colleagues (1) and its accompanying editorial (2) highlight an unfortunate situation for quality of patient care.In 1966, I suggested a simple, albeit partial, solution (3) to dealing with the problem: There is no good reason why interns and residents must change on the same day—July 1. It should be standard practice throughout the United States to have interns report for duty at least 1 week before July 1. Such a practice is currently possible for most interns and should be made universal. During this first week or two, the new interns ...References1. Young JQ, Ranji SR, Wachter RM, Lee CM, Niehaus B, Auerbach AD. “July effect”: impact of the academic year-end changeover on patient outcomes: a systematic review. Ann Intern Med. 2011;155:309-15. [PMID: 21747093] LinkGoogle Scholar2. Barach P, Philibert I. The July effect: fertile ground for systems improvement [Editorial]. Ann Intern Med. 2011;155:331-2. [PMID: 21747094] LinkGoogle Scholar3. Glick S. Changing the guard. N Engl J Med. 1966;275:733. CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Ben Gurion University of the Negev, Beer Sheva, Israel, 84105.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee Also“July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes John Q. Young , Sumant R. Ranji , Robert M. Wachter , Connie M. Lee , Brian Niehaus , and Andrew D. Auerbach The July Effect: Fertile Ground for Systems Improvement Paul Barach and Ingrid Philibert Impact of the “July Effect” on Patient Outcomes Louella Vaughan , Derek Bell , and Graeme McAlister Impact of the “July Effect” on Patient Outcomes Mark P. Jarrett Impact of the “July Effect” on Patient Outcomes John Q. Young , Andrew D. Auerbach , and Sumant R. Ranji Metrics Cited ByImpact of Resident Rotations on Critically Ill Patient Outcomes: Results of a French Multicenter Observational Study 17 January 2012Volume 156, Issue 2Page: 167KeywordsConflicts of interestHealth care qualityMorbidityPatients ePublished: 17 January 2012 Issue Published: 17 January 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
The trouble with dabigatran
Authors: B. Charlton, R. Redberg
Journal: BMJ (2014)

Doctors and patients must tread carefully through emerging risks

Options for stroke prevention in high risk non-valvular atrial fibrillation have recently broadened with the addition of new oral anticoagulants as an alternative to warfarin, the traditional and effective treatment. The new class of drug promised safety and effectiveness without the monitoring and dose adjustment needed for warfarin. However, recent insights into the development and approval of dabigatran—the first new oral anticoagulant brought to market—have raised serious questions about its risks.1 New analysis published in The BMJ today illuminates a lack of transparency about the safety of unmonitored dabigatran, compounded by the drug’s fickle pharmacokinetics, which can cause a fivefold variation of plasma concentration.2 3 

Equally unsettling are data integrity issues, which prompted the US Food and Drug Administration initially to refuse to review dabigatran. The investigators reviewed the data and identified 81 new events, including one stroke, one systemic embolism, and 69 major haemorrhages.4 An accelerated FDA review process also contributed to a less robust evaluation of risks and benefits. In effect, the current situation leaves clinicians and patients the choice between the devil they know and the one they don’t.

The …
Cardiac Arrest during Sleep
Authors: Leonard A. Cobb
Journal: New England Journal of Medicine (1984)

Unexpected cardiac arrest happens hundreds of times each day in the United States. In view of its frequency, it is remarkable that so little is known about the events immediately preceding sudden death. When ambulatory electrocardiograms are recorded by chance during unexpected cardiac arrest, ventricular fibrillation, often preceded by a short burst of ventricular tachycardia, is usually found.1 However, it is also clear that a sudden arrest is initiated by asystole in at least a small number of selected cases.1 Nocturnal death, apparently during sleep, is not uncommon — in keeping with the observation that there is little diurnal variation . . .
Efficient Transduction and Engraftment of G-CSF-Mobilized Peripheral Blood CD34+ Cells in Nonhuman Primates Using GALV-Pseudotyped Gammaretroviral Vectors
Authors: Brian C. Beard, Pau Mezquita, Julia C. Morris, Hans-Peter Kiem
Journal: Molecular Therapy (2006)

The optimal stem cell source for stem cell gene therapy has yet to be determined. Most large-animal studies have utilized peripheral blood or marrow-derived cells collected after administration of granulocyte colony-stimulating factor (G-SCF) and stem cell factor (SCF); however, SCF is unavailable for clinical use in the United States and the European Union. A recent study in a competitive repopulation assay in the rhesus macaque showed very inefficient marking of G-CSF-mobilized (G/only) peripheral blood (G-PBSC) CD34(+) cells relative to G-CSF and SCF-mobilized cells using vectors with an amphotropic pseudotype. Because G-PBSC would be the preferred target cell population for most clinical stem cell gene therapy applications, we asked whether we could achieve efficient transduction and engraftment of G-PBSC using Phoenix-GALV-pseudotyped vectors. We transplanted three baboons with G/only mobilized CD34(+) cells transduced with GALV-pseudotyped retroviral vectors. We observed high-level, persistent engraftment of gene-modified G-PBSC in all animals with gene marking levels in granulocytes up to 60%. We analyzed amphotropic (PIT2) and GALV (PIT1) receptor expression in G/only cells and found preferential expression of PIT1 after G/only, which may explain the inferior results with amphotropic pseudotypes. These findings demonstrate that high stem cell gene transfer levels can be achieved using G-CSF-mobilized PBSC with Phoenix-GALV-pseudotyped vectors.
Effects of Anti-inflammatory Lipid Mediator, Protectin D1, on Human Eosinophil Functions
Authors: J. Miyata, K. Asano, K. Fukunaga, T. Takihara, N. Ohmari, M. Kodama, K. Tomomatsu, H. Ogura, K. Tanaka, N. Kamiishi, K. Niimi, T. Oguma, K. Sayama, R. Takamiya, A. Ishizaka
Journal: Journal of Allergy and Clinical Immunology (2010)
Fulminant Epstein–Barr virus esophagitis in an immunocompetent patient
Authors: A. Annaházi, G. Terhes, J. Deák, L. Tiszlavicz, A. Rosztóczy, T. Wittmann, R. Róka
Journal: Endoscopy (2011)

A 48-year-old man presented to our hospital with a 3-week history of fever, nausea, and dysphagia. He had undergone bilateral femoral amputation 5 years ago following an accident. Besides hypertension he had no other pathology. He lived with his family and was a smoker but did not take any drugs or alcohol. On examination, his skin was pale and there was slight epigastric tenderness. Initial laboratory tests revealed normocytic anemia. Abdominal ultrasound showed hepatosplenomegaly. The patient was admitted and upper endoscopy carried out, which revealed severe esophagitis with denuded ulcers ([Fig. 1]).
Predictors of Long-Term Outcomes in Symptomatic Hypertrophic Obstructive Cardiomyopathy Patients Undergoing Surgical Relief of Left Ventricular Outflow Tract Obstruction
Authors: Milind Y. Desai, Aditya Bhonsale, Nicholas G. Smedira, Peyman Naji, Maran Thamilarasan, Bruce W. Lytle, Harry M. Lever
Journal: Circulation (2013)

We report the predictors of long-term outcomes of symptomatic hypertrophic cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction.We studied 699 consecutive patients who have hypertrophic cardiomyopathy with severe symptomatic left ventricular outflow tract obstruction (47±11 years, 63% male) intractable to maximal medical therapy, who were referred to a tertiary hospital between January 1997 and December 2007 for the surgical relief of left ventricular outflow tract obstruction. We excluded patients <18 years of age, those with an ejection fraction <50%, those with hypertensive heart disease of the elderly, and those with more than mild aortic or mitral stenosis. Clinical, echocardiographic, and Holter data were recorded. A composite end point of death, appropriate internal cardioverter defibrillator discharges, resuscitated from sudden death, documented stroke, and admission for congestive heart failure was recorded. During a mean follow-up of 6.2±3 years, 86 patients (12%) met the composite end point with 30-day, 1-year, and 2-year event rates of 0.7%, 2.8%, and 4.7%, respectively. The hard event rate (death, defibrillator discharge, and resuscitated from sudden death) at 30 days, 1 year, and 2 years was 0%, 1.5%, and 3%, respectively. Stepwise multivariable analysis identified residual postoperative atrial fibrillation (hazard ratio, 2.12; confidence interval, 1.37-3.34; P=0.001) and increasing age (hazard ratio, 1.49; confidence interval, 1.22-1.82; P=0.001) as independent predictors of long-term composite outcomes.Symptomatic adult hypertrophic cardiomyopathy patients undergoing surgery for the relief of left ventricular outflow tract obstruction have low event rates during long-term follow-up; worse outcomes are predicted by increasing age and the presence of residual atrial fibrillation during follow-up.
Use of Random Excitation and Spectral Analysis in the Study of Frequency-Dependent Parameters of the Cardiovascular System
Authors: Michael G. Taylor
Journal: Circulation Research (1966)

If a randomly varying signal or noise is used as input, it is possible to study the input-output relations of a system, over a wide band of frequencies, by the use of power spectrum analysis. This technique has been applied to the cardiovascular system, by deliberately introducing irregularity in the pressure and flow pattern, by random electrical pacing of the heart. Examples are given of the determination, by spectral analysis in the range of 0.25 to 25 cycles/sec, of aortic and femoral arterial impedance in the dog, and also of the transmission ratio for pressure oscillations along the aorta. The results agreed satisfactorily with those obtained by the Fourier analysis of single pulses. When the time scale of the irregularities was made sufficiently great, it was possible to examine aortic impedance in the very low frequency range 0.00125 to 0.125 cycle/sec. In this range the operation of the baroreceptor reflexes became apparent.
Incidence of Treatment for End-Stage Renal Disease Among Individuals With Diabetes in the U.S. Continues to Decline
Authors: Nilka Ríos Burrows, Yanfeng Li, Linda S. Geiss
Journal: Diabetes Care (2010)

The comment by Villar et al. (1) about our article (2) on diabetes-related end-stage renal disease (ESRD) highlights the data limitations of renal registries. Our article acknowledged these as well. We reported that the age-adjusted diabetes-related ESRD incidence decreased from 1996 to 2006; among those aged <45 years, diabetes-related ESRD incidence concurrently decreased. We used the U.S. Renal Data System (USRDS) to determine the number of individuals with diabetes as the primary diagnosis who initiated ESRD …
A NEW TONSILLECTOME
Authors: W. Edwards-Schenck
Journal: JAMA (1913)

The pathologic tonsil has impressed the profession with the value of measures for its removal and this necessity has resulted in many efforts by capable operators to perform the operation as rapidly and safely as human ingenuity permits. Hence the literature shows a number of instruments devised for this special operation. An article by Dr. Joseph C. Beck,<sup>1</sup>with illustration of the tonsillectome he devised and uses, covers this operation fully and explicitly, and I can do no better than to endorse his method and refer the reader to the article. His instrument, however, lacks certain salient features that I have endeavored to incorporate in the new instrument herewith illustrated. Early in 1911, I experimented by lashing the fenestrated part of a McKenzie guillotine to a tonsil-snare, thus stiffening the wire so that, with the finger, the tonsil could be pushed into the fenestra
Christopher Plunkett Elliott-Binns
Authors: Bernard Baillon
Journal: BMJ (2004)

General practitioner and author Northampton (b 1924; q Cambridge/Middlesex Hospital Medical School 1948; DCh, MD, FRCGP), died from bronchopneumonia and heart disease on 16 December 2003.​2003.




Figure 1




After house jobs in Cornwall and national service in the Royal Air Force Christopher trained in Northampton before entering general practice. An early member of the Royal College of General Practitioners, he became provost of the Thames Valley faculty in 1982. He founded the Northampton vocational training scheme and made valuable contributions to GP education throughout the Oxford region. Christopher wrote many articles for the medical press and the books A Human Approach to General Practice (1963), How to Treat your Doctor (1965), and Medicine, the Forgotten Art (1978), comparing modern ethics with those of Hippocrates. He leaves three children.
Gene-expression profiling identifies distinct subclasses of core binding factor acute myeloid leukemia
Authors: Lars Bullinger, Frank G. Rücker, Stephan Kurz, Juan Du, Claudia Scholl, Sandrine Sander, Andrea Corbacioglu, Claudio Lottaz, Jürgen Krauter, Stefan Fröhling, Arnold Ganser, Richard F. Schlenk, Konstanze Döhner, Jonathan R. Pollack, Hartmut Döhner
Journal: Blood (2007)
Neisseria meningitidis and Neisseria gonorrhoeae Bacteremia Associated with C6, C7, or C8 Deficiency
Authors: BRUCE H. PETERSEN
Journal: Annals of Internal Medicine (1979)

We summarize data from 24 previously described or newly diagnosed cases of homozygous deficiency of the sixth, seventh, or eighth components of complement. Thirteen of 24 patients had at least one episode, and usually two or more episodes of Neisseria meningitidis or Neisseria gonorrhoeae bacteremia, or both. Deficiency of C6, C7, or C8 is a meaningful risk factor for repeated neisserial bacteremia; conversely, hemolytic complement studies are indicated in patients who develop recurrent neisserial infections. When a person with C6, C7, or C8 deficiency is identified, family members should also be studied.
Plasma endothelin in congestive heart failure: effect of the ACE inhibitor, fosinopril
Authors: S GALATIUSJENSEN, H WROBLEWSKI, C EMMELUTH, P BIE, S HAUNSO, J KASTRUP
Journal: Cardiovascular Research (1996)

Objectives:The study evaluates the influence of treatment with the angiotensin-converting enzyme inhibitor, fosinopril, on the plasma endothelin level in patients with congestive heart failure, and the relationship between plasma endothelin and clinical study parameters (bicycle exercise test, echocardiography, heart failure score and blood pressure). Methods: Plasma endothelin was measured in 34 patients with moderately severe congestive heart failure at randomisation in the fosinopril/placebo-controlled study 'Fosinopril Efficacy and Safety Trial' and at the end of the 12-week study period. Results: The patients had elevated pre-treatment plasma endothelin concentrations (3.5 ± 1.2 pg/ml, mean ± s.d., n = 34) compared with healthy volunteers (2.0 ± 0.4 pg/ml, n = 21, P < 0.0001). Treatment with fosinopril for 12 weeks lowered plasma endothelin from 3.5 ± 1.2 to 2.5 ± 0.7 pg/ml (n = 18, P < 0.005), in contrast to the non-significant increase in the placebo-treated group (3.5 ± 1.3 to 4.3 ± 2.5 pg/ml, n = 16). A multiple regression analysis for baseline study parameters, demonstrated a significant relationship between plasma endothelin and exercise test duration and a composite heart failure score classification (r = 0.53, P < 0.001). Conclusions: Treatment of patients with congestive heart failure with the angiotensin-converting enzyme inhibitor, fosinopril, reduce the elevated plasma endothelin level to normal values. The relation between plasma endothelin and clinical parameters indicates that endothelin may play a pathophysiological role in the progression of congestive heart failure.