tbuckley/cabot-search huggingface dataset:
Increased prescription of thrombolytic treatment to elderly patients with suspected acute myocardial infarction associated with audit.
Authors: T. J. Hendra, A. J. Marshall
Journal: BMJ (1992)

To assess prescription of thrombolytic treatment to elderly patients with suspected acute myocardial infarction and the incidence of side effects.Retrospective analysis of prescriptions during five months (first audit) followed by prospective analysis of uptake of treatment during five months after interventions in clinical management; prospective assessment of adverse events during thrombolytic treatment.Coronary care unit of large district general hospital.110 patients aged greater than or equal to 65 with subsequently proved acute myocardial infarction admitted in first audit and 119 admitted in the second.Site of infarct, prescription of thrombolysis treatment, reasons for nonprescription, complications.Before intervention thrombolytic treatment was prescribed to 13/110 (12%) patients with subsequently confirmed myocardial infarction and after intervention to 55/119 (46%) patients (p less than 0.01). In the first audit no patients with angina received thrombolytic treatment whereas 13/79 (16%) were treated in the second audit. Increased prescription of thrombolytic treatment in the second audit was associated with significantly fewer exclusions owing to dyspepsia (p less than 0.05) and unstated or unsatisfactory reasons (p less than 0.01) Streptokinase infusions were completed uneventfully in 75% (48/64) and 77% (10/13) of patients with infarction and angina respectively. Side effects of treatment were more common in patients with inferior than with anterior infarcts (16/42 (30%) v 3/24 (13%), p less than 0.05).Low rates of prescription of thrombolytic treatment to elderly patients with suspected acute myocardial infarction were identified and corrected. Streptokinase treatment was associated with transient arrhythmias or hypotension in about a third of these patients with infarcts, particularly those with electrocardiographic changes in inferior leads.
Incidence of pertussis in persons ≤15 years of age in Valencia, Spain: seroprevalence of antibodies to pertussis toxin (PT) in children, adolescents and adults
Authors: Javier Diez-Domingo, Alfredo Ballester, José-Marı́a Baldó, Marı́a-Victoria Planelles, José V. Villarroya, Trinidad Alvarez, M. Carmen Peidró, Pura Calero, Marı́a D. Garcés, Ignacio Sorribes, Marta Graullera, Angels Jubert, Marı́a San-Martı́n, Antonio González
Journal: Journal of Infection (2004)
Patient Outcomes with Teaching Versus Nonteaching Healthcare: A Systematic Review
Authors: Panagiotis N Papanikolaou, Georgia D Christidi, John P. A Ioannidis
Journal: PLoS Medicine (2006)

Extensive debate exists in the healthcare community over whether outcomes of medical care at teaching hospitals and other healthcare units are better or worse than those at the respective nonteaching ones. Thus, our goal was to systematically evaluate the evidence pertaining to this question.We reviewed all studies that compared teaching versus nonteaching healthcare structures for mortality or any other patient outcome, regardless of health condition. Studies were retrieved from PubMed, contact with experts, and literature cross-referencing. Data were extracted on setting, patients, data sources, author affiliations, definition of compared groups, types of diagnoses considered, adjusting covariates, and estimates of effect for mortality and for each other outcome. Overall, 132 eligible studies were identified, including 93 on mortality and 61 on other eligible outcomes (22 addressed both). Synthesis of the available adjusted estimates on mortality yielded a summary relative risk of 0.96 (95% confidence interval [CI], 0.93-1.00) for teaching versus nonteaching healthcare structures and 1.04 (95% CI, 0.99-1.10) for minor teaching versus nonteaching ones. There was considerable heterogeneity between studies (I(2) = 72% for the main analysis). Results were similar in studies using clinical and those using administrative databases. No differences were seen in the 14 studies fully adjusting for volume/experience, severity, and comorbidity (relative risk 1.01). Smaller studies did not differ in their results from larger studies. Differences were seen for some diagnoses (e.g., significantly better survival for breast cancer and cerebrovascular accidents in teaching hospitals and significantly better survival from cholecystectomy in nonteaching hospitals), but these were small in magnitude. Other outcomes were diverse, but typically teaching healthcare structures did not do better than nonteaching ones.The available data are limited by their nonrandomized design, but overall they do not suggest that a healthcare facility's teaching status on its own markedly improves or worsens patient outcomes. Differences for specific diseases cannot be excluded, but are likely to be small.
Chronic Health Conditions in Adult Survivors of Childhood Cancer
Authors: Kevin C. Oeffinger, Ann C. Mertens, Charles A. Sklar, Toana Kawashima, Melissa M. Hudson, Anna T. Meadows, Debra L. Friedman, Neyssa Marina, Wendy Hobbie, Nina S. Kadan-Lottick, Cindy L. Schwartz, Wendy Leisenring, Leslie L. Robison
Journal: New England Journal of Medicine (2006)

Only a few small studies have assessed the long-term morbidity that follows the treatment of childhood cancer. We determined the incidence and severity of chronic health conditions in adult survivors. The Childhood Cancer Survivor Study is a retrospective cohort study that tracks the health status of adults who received a diagnosis of childhood cancer between 1970 and 1986 and compares the results with those of siblings. We calculated the frequencies of chronic conditions in 10,397 survivors and 3034 siblings. A severity score (grades 1 through 4, ranging from mild to life-threatening or disabling) was assigned to each condition. Cox proportional-hazards models were used to estimate hazard ratios, reported as relative risks and 95% confidence intervals (CIs), for a chronic condition. Survivors and siblings had mean ages of 26.6 years (range, 18.0 to 48.0) and 29.2 years (range, 18.0 to 56.0), respectively, at the time of the study. Among 10,397 survivors, 62.3% had at least one chronic condition; 27.5% had a severe or life-threatening condition (grade 3 or 4). The adjusted relative risk of a chronic condition in a survivor, as compared with siblings, was 3.3 (95% CI, 3.0 to 3.5); for a severe or life-threatening condition, the risk was 8.2 (95% CI, 6.9 to 9.7). Among survivors, the cumulative incidence of a chronic health condition reached 73.4% (95% CI, 69.0 to 77.9) 30 years after the cancer diagnosis, with a cumulative incidence of 42.4% (95% CI, 33.7 to 51.2) for severe, disabling, or life-threatening conditions or death due to a chronic condition. Survivors of childhood cancer have a high rate of illness owing to chronic health conditions.
Dementia From Alzheimer Disease and Mixed Pathologies in the Oldest Old
Authors: Bryan D. James
Journal: JAMA (2012)

To the Editor: The oldest old (≥90 years of age) are the fastest growing segment of the US population and account for half of all persons with dementia. Alzheimer disease (AD) is the most common pathology underlying dementia in the old (ages 65-89 years). Recent community-based autopsy studies1,2 suggest the relationship between AD pathology and expression of dementia is attenuated in the oldest old.3 Studies may be complicated by the common coexistence of AD plus infarct and/or Lewy body (LB) pathology (mixed pathologies).4 Few data exist on mixed pathologies and dementia in the oldest old.5 We examined the relationship of AD and mixed pathologies to dementia in the oldest old compared with the old. We tested the hypothesis that the clinical expression of AD and mixed pathologies differs across age groups.
969 THE REQUIREMENT FOR IMMUNOSUPPRESSIVE TREATMENT DURING THE COURSE OF PRIMARY BILIARY CIRRHOSIS MAY BE DETECTED AT FIRST PRESENTATION ALREADY
Authors: N. Pannicke, I. Patanwala, C. Weiler-Norman, C. Wiegard, J.L. Newton, D.E. Jones, A.W. Lohse, C. Schramm
Journal: Journal of Hepatology (2012)
Atrioventricular and semilunar valve innervation in sheep, pigs, and cattle
Authors: R. B. Smith
Journal: Cardiovascular Research (1971)

The intrinsic innervation of the cardiac valves of cattle, sheep, and pigs was investigated and described. The atrioventricular valves appear to be innervated from three sources: (1) a plexus extending from the basal muscle ring, (2) branches from contained perivascular plexuses, and (3) extensions from the atrial subendocardial plexus. Nerves associated with the chordae tendineae were also noted. The tricuspid contains more complex nerve networks than the mitral valves and the existence of nerve cells in the non-muscular parts of ovine tricuspid valves is described. Both atrioventricular valves are more profusely innervated than the semilunar valves in all animals examined, and the pulmonary valve contains more nervous elements than the aortic. The existence of complex unencapsulated and simple endings was confirmed in the tricuspid, mitral, and pulmonary valves. Their possible functional significance is discussed.
Malabsorption of Crystalline Vitamin B<sub>12</sub>in Cystic Fibrosis
Authors: Julius J. Deren, Bimla Arora, Phillip P. Toskes, John Hansell, Maarten S. Sibinga
Journal: New England Journal of Medicine (1973)

THE malabsorption of crystalline vitamin B12 has been documented both in pancreatic injury associated with alcohol abuse in the adult1 2 3 and after partial pancreatic extirpation in the rat.4 It was of interest, therefore, to study vitamin B12 absorption in cystic fibrosis since severe insufficiency of the exocrine pancreas is generally observed in this disease.5 Methods and MaterialsThe methods were similar to those previously reported3 except for the dose of radioactive 57Co-labeled vitamin B12, which was reduced to 0.25 μCi in 0.5 μg of unlabeled vitamin B12. The diagnosis of cystic fibrosis was established . . .
IgE antibodies of fish allergic patients cross‐react with frog parvalbumin
Authors: C. Hilger, L. Thill, F. Grigioni, C. Lehners, P. Falagiani, A. Ferrara, C. Romano, W. Stevens, F. Hentges
Journal: Allergy (2004)

Background: The major allergens in fish are parvalbumins. Important immunoglobulin (Ig)E cross‐recognition of parvalbumins from different fish species has been shown. Recently frog parvalbumin α has been found to be responsible for a case of IgE‐mediated anaphylaxis triggered by the ingestion of frog meat. The aim of this study was to investigate whether IgE antibodies of fish allergic persons cross‐react with frog parvalbumin and to appreciate its clinical relevance. Methods: The sera of 15 fish allergic patients and one fish and frog allergic patient were tested by IgE‐immunoblotting against frog muscle extract. Sera were tested against recombinant parvalbumin α and β from Rana esculenta . Skin prick tests were performed in selected patients with recombinant frog parvalbumin. Ca 2+ depletion experiments and inhibition studies with purified cod and frog recombinant parvalbumin were done to characterize the cross‐reactive pattern. Results: Fourteen of the sera tested had IgE antibodies recognizing low molecular weight components in frog muscle extract. Calcium depletion experiments or inhibition of patient sera with purified cod parvalbumin led to a significant or complete decrease in IgE binding. When tested against recombinant parvalbumins, three of 13 sera reacted with α parvalbumin and 11 of 12 reacted with β parvalbumin from R. esculenta . Skin prick tests performed with recombinant frog parvalbumin were positive in fish allergic patients. Inhibition studies showed that a fish and frog allergic patient was primarily sensitized to fish parvalbumin. Conclusion: Cod parvalbumin, a major cross‐reactive allergen among different fish species, shares IgE binding epitopes with frog parvalbumin. This in vitro cross‐reactivity seems to be also clinically relevant. Parvalbumins probably represent a new family of cross‐reactive allergens.
Prospective study of effect of fenclofenac on thyroid function tests.
Authors: R Taylor, F Clark, I D Griffiths, J Weeke
Journal: BMJ (1980)

CommentIncreases in osteoid volume with sodium fluoride, calcium, and vitamin D treatment are well documented.Small decreases in mineralisation rate have also been reported.2But osteomalacia in the presence of high plasma 25-OHD concentrations has not been described in patients treated with this regimen.The plasma 1,25-(OH)2D3 concentration in our patient was just below the lower limit of normal, but the total plasma 1,25-(OH)2D (1,25-(OH)2D2-+1,25-(OH)2D3) concentration was probably normal since she was taking vitamin D2 and the radioimmunoassay did not measure plasma 1,25-(OH)2D2.The mechanisms by which fluoride may produce osteomalacia despite high plasma 25-OHD concentrations require further investigation.Possibilities include fluoride-induced end-organ resistance in bone to active vitamin D metabolites or an effect of fluoride on processes of bone mineralisation that are unaffected by vitamin D metabolites.Alternatively, fluoride might affect the metabolism of 25-OHD to other metabolites.Although lack of calcium supplements was probably unimportant in our patient, since the plasma calcium concentration remained above 2 40 mmol,l throughout treatment and dietary calcium intake was adequate, we cannot exclude it as a factor in the development of osteomalacia.Our results indicate that vitamin D in doses that produce high plasma 25-OHD concentrations does not protect against fluoride-induced mineralisation defects and that patients treated with this regimen require careful supervision.Transiliac biopsy provides a sensitive method for diagnosing generalised bone disease such as osteomalacia and may be necessary to detect its development when, as in our patient, plasma biochemical changes are not diagnostic.
Surgical Procedure Justification
Authors: Robert Raskind
Journal: JAMA (1971)

To the Editor.—  In light of our own past experience with Tissue Committee Questions Justification of Surgical Procedure—I (217:347,1971), we are presently reviewing our own most recent series of surgically removed solitary metastatic tumors of the brain. Craniotomy for solitary metastatic lesions of the brain is recorded in standard texts as a reasonable means of palliating very distressing symptoms as well as prolonging life.  Careful preoperative evaluation is most important, both as to the general condition of the patient and the surgical accessibility of the tumor mass. Most favorable are those lesions in a polar position, that is, occupying the frontal, temporal, or occipital pole. Less favorable are the centrally located lesions, and completely unfavorable for excision are those adjacent to and involving the thalamus. Lesions in the posterior fossa are generally unfavorable.  Accurate localization of the tumor by contrast studies, preoperative preparation with steroids and osmolar diuretics, accurate
RBC Destruction Caused by a Micropore Blood Filter
Authors: William F. Schmidt
Journal: JAMA (1982)

Two infants who received whole blood filtered through commercially available woven stainless steel micropore filters experienced a sudden onset of hemoglobinuria. The plasma hemoglobin level in one child was 200 mg/dL. To investigate whether filters might lead to RBC destruction, we experimentally quantitated filter-induced hemolysis using standard conditions. Our studies in vitro show that hemolysis decreases with increased speed to transfusion. Hemolysis is particularly extensive with blood stored more than 14 days, but measurable hemolysis occurs with blood stored for as little as one day.
Study of patients' psychological attitudes to a coronary care unit
Authors: J. Dominian, M. Dobson
Journal: BMJ (1969)

Seventy-four consecutive male patients aged 38 to 63 years were admitted to a coronary care unit with their first myocardial infarction. Their attitude to the unit was studied by interview and personality tests. Only six patients found the unit anxiety-provoking. Dependency feelings were found to occur frequently, both after transfer from the unit to the general wards and after discharge from hospital. It is suggested that the weaning process from the unit should be gradual and that at least one follow-up outpatient appointment should be arranged, as well as good liaison between the family doctor and the hospital.
EPINEPHRIN IN THE TREATMENT OF THE PAIN OF HERPES ZOSTER
Authors: W. W. Duke
Journal: JAMA (1924)

Herpes zoster belongs in the category of diseases that cause severe pain, especially when it occurs in individuals of mature or advanced age. The pain may start before, during or after the appearance of the vesicles, and may persist almost without remission for weeks or months. Pain of this type is difficult to alleviate with anything milder than morphin. For this reason, any remedy that offers relief in a fair number of cases should be gratefully accepted by the patient. In epinephrin we have a remedy that will temporarily relieve the pain in a majority of cases. My use of epinephrin in the treatment of herpes zoster was based on an observation of a case of hives and angioneurotic edema in a patient who had recently weaned a baby. About one hour before I saw her, there had appeared about fifteen or twenty vesicles on the lower lip, associated with
Immunoglobulin metabolism in ataxia telangiectasia
Authors: Warren Strober, R. Dean Wochner, Mahlon H. Barlow, Dale E. McFarlin, Thomas A. Waldmann
Journal: Journal of Clinical Investigation (1968)

Immunoglobulin metabolism has been studied in five patients with ataxia telangiectasia and in control subjects. Serum IgG levels were normal, increased, or decreased, reflecting normal, increased, or decreased synthetic rates, respectively. Serum IgM concentration was normal in three cases and slightly elevated in two cases. IgM turnover studies in the three cases with normal serum IgM levels showed normal IgM synthetic and catabolic rates. None of the five patients with ataxia telangiectasia had detectable serum IgA, and the maximum IgA synthetic rates possible for these patients were 0.3-10% of the normal mean synthetic rate (24 +/- 15 mg/kg per day) of 12 control individuals. Three of the patients had normal IgA fractional catabolic rates: 22% of the intravascular pool per day vs. 25 +/- 4% in controls. In two patients, fractional catabolic rates 4 and 20 times normal were found. In these cases, metabolic turnover, in vitro precipitation, radioimmunoelectrophoresis, and (or) the C'la fixation and transfer test provided evidence for the presence of a circulating antibody directed against IgA causing immune elimination of the molecule. These studies suggest that therapy with exogenous IgA may not be possible in some patients with ataxia telangiectasia or in other subjects with dysgammaglobulinemia.
A Pack Is Not a 'Pack' Is Not a Pack
Authors: Robert Lee Brawley
Journal: JAMA (1985)

<h3>To the Editor.—</h3> Magazines and newspapers are now advertising a new type of cigarette pack, a 25s pack, instead of the traditional pack of 20 cigarettes. This new marketing concept is "for smokers who prefer the convenience of five more cigarettes per pack." If the 25s pack is accepted by the consumer and widely marketed by the industry, smoking risk will have to be calculated in terms of both old pack-years and new pack-years. Particularly disturbing is that individuals who buy their cigarettes in the 25s pack and continue to smoke a pack a day will be increasing their cigarette consumption by 25%. The marketing ploy of convenience for the customer appears to be a more obvious attempt to increase per capita consumption and thus sales of cigarettes. In fact, one tobacco company, in introducing nationwide distribution of their 25s pack cigarette, predicts annual sales of more than $185 million
IFN-α inhibits HBV transcription and replication in cell culture and in humanized mice by targeting the epigenetic regulation of the nuclear cccDNA minichromosome
Authors: Laura Belloni, Lena Allweiss, Francesca Guerrieri, Natalia Pediconi, Tassilo Volz, Teresa Pollicino, Joerg Petersen, Giovanni Raimondo, Maura Dandri, Massimo Levrero
Journal: Journal of Clinical Investigation (2012)

HBV infection remains a leading cause of death worldwide. IFN-α inhibits viral replication in vitro and in vivo, and pegylated IFN-α is a commonly administered treatment for individuals infected with HBV. The HBV genome contains a typical IFN-stimulated response element (ISRE), but the molecular mechanisms by which IFN-α suppresses HBV replication have not been established in relevant experimental systems. Here, we show that IFN-α inhibits HBV replication by decreasing the transcription of pregenomic RNA (pgRNA) and subgenomic RNA from the HBV covalently closed circular DNA (cccDNA) minichromosome, both in cultured cells in which HBV is replicating and in mice whose livers have been repopulated with human hepatocytes and infected with HBV. Administration of IFN-α resulted in cccDNA-bound histone hypoacetylation as well as active recruitment to the cccDNA of transcriptional corepressors. IFN-α treatment also reduced binding of the STAT1 and STAT2 transcription factors to active cccDNA. The inhibitory activity of IFN-α was linked to the IRSE, as IRSE-mutant HBV transcribed less pgRNA and could not be repressed by IFN-α treatment. Our results identify a molecular mechanism whereby IFN-α mediates epigenetic repression of HBV cccDNA transcriptional activity, which may assist in the development of novel effective therapeutics.
Effects of Corticosteroids on Immunity in Man I. DECREASED SERUM IgG CONCENTRATION CAUSED BY 3 OR 5 DAYS OF HIGH DOSES OF METHYLPREDNISOLONE
Authors: William T. Butler, Roger D. Rossen
Journal: Journal of Clinical Investigation (1973)

To study the effects of methylprednisolone on immune mechanisms in the absence of other immunosuppressive agents or immunologically mediated diseases, we gave 17 normal adult male volunteers 96 mg of methylprednisolone daily for 3-5 days and compared results with 12 untreated controls who were studied simultaneously, 86% of treated volunteers had significant decreases in the concentrations of serum IgG. 2-4 wk after methylprednisolone, the treated volunteers had a mean decrease in IgG of 22% compared with a decrease of only 1% in untreated controls. Likewise, significant decreases in IgA concentration occurred in 43% of treated volunteers, whereas significant decreases in IgM occurred in only 14%. The lowest immunoglobulin levels occurred during the 2nd wk after a 3 day course of methylprednisolone and during the 3rd wk after a 5 day course of drug. Slightly decreased plasma concentration of [(125)I]IgG was seen in six of seven volunteers who received a 5 day course but in only one of four who received a 3 day course of drug. However, an increase in the rate of plasma clearance of IgG occurred only during the treatment period itself. During the period when the serum concentration of IgG was falling, the specific activity of IgG in the serum was relatively higher in treated men than in controls indicating decreased entry of newly synthesized IgG into the circulation. These findings suggest that a short course of methylprednisolone treatment causes a pronounced and sustained decrease in serum IgG due to increased catabolism during drug administration and to decreased synthesis during and for a variable time after drug administration.