tbuckley/cabot-search huggingface dataset:
Long-Term Outcome of Proton Therapy and Carbon-Ion Therapy for Large (T2a–T2bN0M0) Non–Small-Cell Lung Cancer
Authors: Hiromitsu Iwata, Yusuke Demizu, Osamu Fujii, Kazuki Terashima, Masayuki Mima, Yasue Niwa, Naoki Hashimoto, Takashi Akagi, Ryohei Sasaki, Yoshio Hishikawa, Mitsuyuki Abe, Yuta Shibamoto, Masao Murakami, Nobukazu Fuwa
Journal: Journal of Thoracic Oncology (2013)
The Relation of Diabetes, Impaired Fasting Blood Glucose, and Insulin Resistance to Left Ventricular Structure and Function in African Americans
Authors: Ervin R. Fox, Daniel F. Sarpong, Joe C. Cook, Tandaw E. Samdarshi, Harsha S. Nagarajarao, Philip R. Liebson, Mario Sims, George Howard, Robert Garrison, Herman A. Taylor
Journal: Diabetes Care (2011)

OBJECTIVE We assessed the relation of diabetes and insulin resistance (IR) on left ventricular (LV) structure and function in African Americans. RESEARCH DESIGN AND METHODS Among those receiving echocardiograms in cycle 1 of the Jackson Heart Study, we assessed the sex-specific relation of fasting blood glucose (FBG), diabetes, and IR to LV structure and function, adjusting for age, systolic blood pressure, antihypertensive medications, and BMI. RESULTS Among 2,399 participants, LV mass index (Pwomen = 0.0002 and Pmen = 0.02), posterior wall thickness (Pwomen = 0.01 and Pmen = 0.05), and interventricular septal wall thickness (Pwomen = 0.01) were related to FBG categories. Among those with normal FBG and no diabetes, concentric remodeling and low ejection fraction in women and LV mass index and posterior wall thickness in men were related to IR. CONCLUSIONS In the largest study of its kind in a community-based cohort of African Americans, we found a relation of FBG category and IR to LV structure and function.
Multiple-Organ Necrosis in Shock-Reply
Authors: Meryl H. Haber
Journal: JAMA (1963)

<h3>To the Editor:—</h3> We thank Dr. Nigogosyan for his interest in our cases. At the time we submitted our paper toThe Journal, the correlation between halothane (Fluothane) anesthesia and liver necrosis had just come to our attention, and we therefore considered the possibility of a relationship in our cases. In case 1, the anesthetic was cyclopropane. In case 2, halothane was used in both surgical procedures, but at no time during either was hypotension or any other abnormality noted. Not until 9 days after the second operation (for perforated peptic ulcer) did hypotension, hematemasis, and bloody diarrhea develop in the patient. If the anesthetic agent was responsible for the liver necrosis found at autopsy, one would have expected a more rapid onset of symptoms after the administration of the gas, rather than a prolonged course of 9 days as our patient experienced. In addition, the well-known hepatotoxic agents such
Importance of Free Fatty Acids as a Determinant of Myocardial Oxygen Consumption and Myocardial Ischemic Injury during Norepinephrine Infusion in Dogs
Authors: Ole D. Mjøs, John K. Kjekshus, Jon Lekven
Journal: Journal of Clinical Investigation (1974)

Increased delivery of free fatty acids raises myocardial oxygen consumption (ṀVO2) without influencing mechanical performance. The effects of norepinephrine on ṀVO2 and on the size of ischemic injury after acute coronary occlusion were therefore studied before and during inhibition of lipolysis with β-pyridylcarbinol. In spite of similar mechanical responses to norepinephrine, ṀVO2 increased by 57±11% before and significantly less, 31±6%, (P < 0.01) during inhibition of lipolysis. After coronary occlusion the ischemic injury associated with norepinephrine infusion, as evidenced by epicardial mapping of S-T segment elevation, was larger before (7.9±1.1 mV) than during inhibited lipolysis (2.8±0.4 mV; P < 0.005). Average S-T segment elevation associated with norepinephrine infusion during inhibited lipolysis (2.8±0.4 mV) was even lower (P < 0.05) than during control occlusion alone, before drug administration (4.4±0.7 mV). In conjunction with an antilipolytic agent, norepinephrine was shown to reduce the extent and magnitude of the myocardial ischemic injury produced by acute coronary occlusion; this could be due to an improved balance between myocardial oxygen supply and requirement.
Association Between Marijuana Exposure and Pulmonary Function Over 20 Years
Authors: Mark J. Pletcher, Eric Vittinghoff, Ravi Kalhan, Joshua Richman, Monika Safford, Stephen Sidney, Feng Lin, Stefan Kertesz
Journal: JAMA (2012)

Marijuana smoke contains many of the same constituents as tobacco smoke, but whether it has similar adverse effects on pulmonary function is unclear.
Drug companies face pressure on profits
Authors: D. Josefson
Journal: BMJ (2002)

Major pharmaceutical corporations in the United States are bracing themselves for reduced profits as states, healthcare plans, and consumers lobby for lower prices for prescription drugs.

Some manufacturers are also facing the expiry of patents on some of their biggest selling drugs, which threatens to further erode their profits. Among the expected casualties are such pharmaceutical giants as Merck, Bristol-Myers Squibb, Eli Lilly, Schering-Plough, and Pharmacia.

Popular prescription brand name drugs such as …
Polymerase chain reaction based C4AQ0 and C4BQ0 genotyping: association with systemic lupus erythematosus in southwest Han Chinese
Authors: X-Y Man
Journal: Annals of the Rheumatic Diseases (2002)

To investigate the association of complement C4 null genes (C4Q0, including C4AQ0 and C4BQ0) and C2 gene with systemic lupus erythematosus (SLE) in southwest Han Chinese; 136 patients with SLE and 174 matched controls were genotyped.C4 null genes were determined by a polymerase chain reaction (PCR) procedure with sequence specific primers (PCR-SSP). The 2 bp insertion in exon 29, which was previously identified in non-Chinese populations and caused defective C4A genes, was directly typed by sequencing the whole exon 29 using exon specific primers. The exon 6 of complement C2 was also sequenced in both the patients and controls.The frequency of homozygous C4AQ0 allele was 12.5% (17/136) in patients with SLE compared with 1.1% (2/174) in controls (p<0.001, odds ratio (OR)=12.286, 95% confidence interval (95% CI) 2.786 to 54.170). There was no significant difference for homozygous C4BQ0 allele between patients with SLE and controls (p=0.699). Patients with the C4AQ0 gene had an increased risk of acquiring renal disorder, serositis, and anti-dsDNA antibodies compared with those without C4AQ0 (for renal disorder, p=0.018, OR=8.951, 95% CI 1.132 to 70.804; for serositis, p=0.011, OR 4.891, 95% CI 1.574 to 15.198; for anti-dsDNA, p=0.004, OR 7.630, 95%CI 1.636 to 35.584). None of the patients or controls had the 2 bp insertion in exon 29 of the C4 gene. The type I C2 deficiency was not detected in the 310 samples.It is suggested that deficiency of C4A (not due to a 2 bp insertion in exon 29), but not C4B or C2, may be a risk factor for acquiring SLE in south west Han Chinese; this results in increased risk of renal disorder, serositis, and anti-dsDNA antibodies in patients with SLE. Racial differences seem to be relevant in susceptibility to SLE
Adolescent Health Care: Use, Costs and Problems of Access
Authors: Richard R. Brookman
Journal: JAMA (1992)

Access to health care has become a hot topic of the 1990s for many national health professional organizations. Despite incredible advances in the technology of medical care, we remain challenged, if not overwhelmed, by socioeconomic obstacles to care for many of those in need. Adolescent medicine is based on the art of establishing and maintaining a provider-patient/family relationship that enables the science of health care to occur. Access to the provider is the critical first step. For many adolescents, this step seems insurmountable. "Access to the provider is the critical first step. For many adolescents, this step seems insurmountable." The authors of this monograph have compiled data from several national surveys as well as more limited samples to document utilization of health care by American adolescents and to examine many factors, especially economic, that may limit adolescents' access to care. They provide a wealth of information and analysis for policy
Cardiac contractile dysfunction during mild coronary flow reductions is due to an altered calcium-pressure relationship in rat hearts.
Authors: V M Figueredo, R Brandes, M W Weiner, B M Massie, S A Camacho
Journal: Journal of Clinical Investigation (1992)

Coronary artery stenosis or occlusion results in reduced coronary flow and myocardial contractile depression. At severe flow reductions, increased inorganic phosphate (Pi) and intracellular acidosis clearly play a role in contractile depression. However, during milder flow reductions the mechanism(s) underlying contractile depression are less clear. Previous perfused heart studies demonstrated no change of Pi or pH during mild flow reductions, suggesting that changes of intravascular pressure (garden hose effect) may be the mediator of this contractile depression. Others have reported conflicting results regarding another possible mediator of contractility, the cytosolic free calcium (Cai). To examine the respective roles of Cai, Pi, pH, and vascular pressure in regulating contractility during mild flow reductions, Indo-1 calcium fluorescence and 31P magnetic resonance spectroscopy measurements were performed on Langendorff-perfused rat hearts. Cai and diastolic calcium levels did not change during flow reductions to 50% of control. Pi demonstrated a close relationship with developed pressure and significantly increased from 2.5 +/- 0.3 to 4.2 +/- 0.4 mumol/g dry weight during a 25% flow reduction. pH was unchanged until a 50% flow reduction. Increasing vascular pressure to superphysiological levels resulted in further increases of developed pressure, with no change in Cai. These findings are consistent with the hypothesis that during mild coronary flow reductions, contractile depression is mediated by an altered relationship between Cai and pressure, rather than by decreased Cai. Furthermore, increased Pi and decreased intravascular pressure may be responsible for this altered calcium-pressure relationship during mild coronary flow reductions.
Ionising radiation in infancy and adult cognitive function
Authors: Jill Meara, Gerry Kendall, Colin Muirhead, Barry Wall
Journal: BMJ (2004)

Editor—Hall et al report adverse effects on adult cognitive function among male patients treated with radiation for skin haemangioma during infancy.1 The evidence for effects was strongest among those receiving the highest doses.

It is unclear whether there was a dose threshold below which no effects occurred. This study of a sizeable cohort seems to be well conducted with minimal risk of bias. A group of patients with haemangioma was compared by brain dose rather than with an external group. Consequently confounding would seem plausible only if the severity of the clinical condition affected cognitive function and was correlated with brain dose.

Other studies have shown adverse effects of radiation on intellectual development, although interpretation is complicated because some studies used higher doses from exposures in utero or may have been subject to confounding.

Good radiation protection practice (reducing unnecessary exposures and minimising radiation doses) controls well established risks, largely of radiation induced cancers. Computed tomography entails higher doses than plain radiography. Computed tomography of the head is a first line examination only for children whose symptoms imply notable brain injury.2​2




Figure 1



Credit: PHILLIPPE PLAILLY/SPL




Nevertheless, unless the protocol for computed tomography scanning is adjusted for infants, the brain dose (as opposed to the “effective dose,” which is integrated across the whole body) could exceed 100 mGy, within the upper range of doses in the study by Hall et al. This reinforces the need for optimising protocols for computed tomography, minimising the dose to the patient and restricting examinations to infants with clear clinical indications.
Relationship of Activated Partial Thromboplastin Time to Coronary Events and Bleeding in Patients With Acute Coronary Syndromes Who Receive Heparin
Authors: Sonia S. Anand, Salim Yusuf, Janice Pogue, Jeffrey S. Ginsberg, Jack Hirsh
Journal: Circulation (2003)

Antithrombotic therapy with intravenous heparin in conjunction with aspirin reduces negative cardiovascular (CV) outcomes in patients with acute coronary syndromes. The need for a therapeutic range with the activated partial thromboplastin time (APTT) has not been validated in patients with arterial thrombosis who receive heparin. Therefore, it is unclear whether there is an association between recurrent CV events and low APTT values and between bleeding and high APTT values.We examined the relationship between the APTT and recurrent cardiovascular events and bleeding among 5058 patients with an acute coronary syndrome without ST elevation who received intravenous heparin in the OASIS-2 trial. The increase in relative risk of recurrent CV events was 1.54 (95% CI 1.10 to 2.15; P=0.01) among patients with APTT values <60 seconds compared with patients with APTT values > or =60 seconds. When patients had persistently subtherapeutic APTT values for more than 48 hours, the increase in relative risk of a recurrent CV event was 1.84 (95% CI 1.25 to 2.70). Higher APTT values were associated with bleeding; for every 10-second increase in the APTT, the probability of major bleeding was increased by 7% (95% CI 3% to 11%; P=0.0004).In patients with acute coronary syndromes without ST elevation who are treated with intravenous heparin, our findings justify regular APTT monitoring to minimize recurrent ischemic events and bleeding.
Targeted case finding for cardiovascular prevention
Authors: T. Marshall
Journal: BMJ (2010)

The obvious and sensible choice compared with universal screening

In the linked study (doi:10.1136/bmj.c1693), Chamnan and colleagues estimate the effect of different screening strategies for identifying and treating people at high risk of cardiovascular disease.1 The study is a clear exposition of some simple ideas—that to get the most from the money spent on preventing heart disease, we should use all the information available to identify and target those most likely to benefit. Compared with universal screening of untreated individuals aged 40-74, the study shows that using a targeted strategy to identify the 20% of the population at highest risk can prevent 50% more cardiovascular disease; targeting the 40% at highest risk can prevent 75% more; and targeting the 60% at highest risk can prevent almost all cardiovascular disease. They may have overestimated the number of people treated under a universal strategy, however, because it is …
Effects of Alpha Adrenergic Blockade upon Coronary Hemodynamics
Authors: Arthur E. Orlick, Donald R. Ricci, Edwin L. Alderman, Edward B. Stinson, Donald C. Harrison
Journal: Journal of Clinical Investigation (1978)

The effect of alpha adrenergic block-ade on coronary blood flow regulation at rest was studied in 11 normally innervated patients and 8 cardiac allograft recipients by measuring arterial pressure and coronary sinus blood flow by thermodilution before and after alpha adrenergic blockade with phentolamine. Coronary vascular resistance was calculated by using coronary sinus blood flow and mean arterial pressure, and metabolic demand was estimated by the product of systolic arterial pressure and heart rate. In addition, the coronary sinus blood flow response to tachycardia was examined in 9 innervated patients and 12 denervated patients, with measurements repeated after phentolamine in 8 of the 9 innvervated patients and 6 of the 12 denervated patients. There was a 7.3±4.4% increase in coronary sinus blood flow in the innervated patients in response to alpha blockade, whereas the transplanted patients had an 8.2±1.8% fall in coronary sinus blood flow, despite equivalent changes in rate pressure product. The innervated patients also demonstrated a significantly greater increase in coronary sinus blood flow than did the transplanted patients during the first 5 s of an abrupt increase in heart rate (26±4 vs. 8±2.5 ml/min, P <0.001). This early response was blunted after alpha adrenergic blockade. We conclude that there is basal alpha adrenergic tone present on the coronary vasculature in man that is withdrawn by a sudden increase in heart rate.
Tragic choices and the role of administrative law
Authors: C. Stewart
Journal: BMJ (2000)

Chris Ham's article on tragic choices in health care highlights the increasing need for transparency and fairness in medical decision making.1 Although Ham argued on ethical grounds for greater accountability in resource allocation, there is a growing body of law that is beginning to regulate this area. Administrative law is a branch of public law that deals with judicial review of decisions made by government bodies. Traditionally, this area of law has had little impact on medical decision making. However, as the healthcare system becomes increasingly bureaucratised, greater levels of dissatisfaction may force some patients to seek redress for their complaints through the avenue of administrative law. The case of Child B was an example of such a complaint.1 Even though the Child B case was a failure, these types of claims are beginning to increase in frequency. The United Kingdom leads the way in this area, and it is the only country in the Commonwealth where administrative law is having a major impact on medical decision making. The basic principles of administrative law are, however, shared by all common law jurisdictions, and other countries (particularly Australia and New Zealand) are now seeing similar claims arise. 2 3 There is a pressing need for medical decision makers to familiarise themselves with the basic principles of administrative law.

#### Summary points

Administrative law has a practical relevance to medical decision making

It allows judges to review decisions on the grounds that they are unlawful, procedurally unfair, or unreasonable

The types of medical decisions that the courts will review are growing—they include decisions that unfairly discriminate between patients, blanket policies not to treat particular conditions, and decisions to not provide promised services

Medical decision makers need to become familiar with the principles of administrative law to avoid litigation

This article is the result …
Abstract 2389: A microfluidic system for the selection of circulating tumor cells that utilizes both affinity and size capture technologies
Authors: Denis Smirnov, Keith Merdek, Kam Sprott, Alison Skelley, Richard Huang, Don Tenney, Chunsheng Jiang, Aladin Milutinovic, David Tims, Yi Dong, Jason Cain, Michele Wolfe, Bill Pierceall, Walter Carney
Journal: Cancer Research (2012)

Abstract Cancer is a disease of uncontrolled cell growth and dissemination. As tumors increase in size and vascularity, populations of cells break off from the primary tumor, enter into the circulation, and are transported to distant parts of the host. These circulating tumor cells (CTCs) may constitute a seed population that is responsible for subsequent growth of additional tumors (metastasis) in different tissues. Therefore capture, and subsequent characterization of CTCs from patient's blood, offers an opportunity to both study and monitor progression of the disease. One of the most common methodologies used for CTC capture is affinity based, where specific antibodies bind to cell surface antigens and allow cell capture. A second technique employs size filtration. CTCs are generally larger than normal leukocytes and this size differential can be exploited to enrich CTCs. Here we describe a CTC dual capture platform developed at On-Q-ity Inc. that combines both of these isolation techniques to offer more efficient CTC capture than either technology alone. Performance of On-Q-ity platform will be compared to Veridex's CellSearch. Utility of On-Q-ity platform for sophisticated molecular and cellular characterization of captured cells will also be described. 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 2389. doi:1538-7445.AM2012-2389
OC-022 Endoscopy Pitfalls in Celiac Disease Diagnosis; a Multicentre Study
Authors: K Rostami, M Rostami Nejad Vincenzo Villanacci, Sabine Hogg- Kollars, Umberto Volta, Stefania Manenti, Mohammad Reza Zali, Giacomo Caio, Paolo Giovenali, Ausrine Barakauskiene, Edita Kazenaite, Gabriel Becheanu, Mircea Diculescu, Salvatore Pellegrino, Giuseppe Magazzù, Giovanni Cas
Journal: Gut (2013)

<h3>Introduction</h3> The traditional diagnosis of celiac disease (CD) requires a small bowel biopsy to identify at histology the characteristic mucosal changes. The current biopsy practise among endoscopists for celiac disease is in most part unknown. The aims of this study were to compare the different diagnostic criteria in various centres in Italy, Iran, Lithuania, Romania and the UK, the methodological approach to the biopsy and to investigate the pitfalls of CD diagnosis. To measure the number of specimens submitted during duodenal biopsy among patients in Italy, Iran, Lithuania, Romania and the UK, and to determine the incremental diagnostic yield of adherence to the recommended number of specimens. <h3>Methods</h3> A total of 931 patients who underwent duodenal biopsy for CD were recruited prospectively at nine centres in European and Middle East countries. Small-bowel biopsies were obtained from the duodenal bulb and the second part of the duodenum (and from the duodenal bulb when it had a micronodular appearance). The histopathological appearances were described according to the modified Marsh classification. <h3>Results</h3> The most frequent degree of villous atrophy amongst Iranian subjects was 3A and that of the rest of the study population was 3C. The most common number of biopsy specimens for Romanian subjects was 1 (52%) followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). The main presenting symptom was anaemia (18.7%) followed by malabsorption (10.5%), diarrhoea (9.3%) and dyspepsia (8.2%). <h3>Conclusion</h3> Taking less biopsy samples than recommended will have a negative impact in detecting massive number of undiagnosed cases. As CD is more common with atypical presentation, taking 4 duodenal biopsies is mandatory for an accurate diagnosis or its exclusion. <h3>Disclosure of Interest</h3> None Declared