tbuckley/cabot-search huggingface dataset:
Chronic respiratory failure
Authors: G P Bootsma
Journal: Thorax (2003)

Revision of BTS guidelines for treatment of asthmaThe paper by Ward et al 1 confirms the findings of Laitinen et al 2 showing that airways inflammation is present even in patients with mild asthma.This emphasises the importance of using anti-inflammatory drugs (steroids) as soon as the diagnosis of asthma has been confirmed, even in patients thought to have only "mild asthma".Without antiinflammatory treatment, symptoms resulting from bronchial hyperresponsiveness are never controlled and optimal lung function is never attained.Over time, structural changes (remodelling) occur leading to a progressive decline in lung function 3 and the risk of fixed obstruction (chronic obstructive pulmonary disease).The present widespread dependence on bronchodilators in the UK may contribute to the fact that we have one of the highest respiratory death rates in Europe. 4The use of bronchodilators alone as in step 1 of the BTS guidelines should be discouraged, and treatment started at step 2 with regular inhaled corticosteroids to control symptoms and maximise peak flow rate.Bronchodilators should be used only as necessary for breakthrough wheezing.These principles have been used in Finland since 1994 with remarkable success in treating asthma. 5 The new BTS guidelines would do well to follow their example.
Anxiety and Pain
Authors: Augustus S. Rose
Journal: JAMA (1969)

<h3>To the Editor:—</h3> The signed editorial, "Anxiety and Pain" (<b>209</b>:1080, 1969), by H. K. Beecher, MD, invites comment. The statement is succinct, clear, and strongly supportive of the well-established relationship between anxiety and fear and the behavioral reaction to pain. However, I am distressed by the rather offhand use of the term "hysteria" in connection with patients who react excessively to a painful injury. Furthermore, the vivid illustration of a soldier injured in battle who was quieted by a moderate dose of barbiturate, although not presented as a recommendation for management, could be misinterpreted. A clinical case of that nature and the word hysteria used in discussion might imply to some that such patients may not actually be experiencing severe pain. It seems to me that this is inexact and possibly an unjust implication. The assessment of pain severity in a patient is always difficult. In common practice the
Topical aminolaevulinic acid-based photodynamic therapy as a treatment option for psoriasis? Results of a randomized, observer-blinded study
Authors: S. Radakovic-Fijan, U. Blecha-Thalhammer, V. Schleyer, R.M. Szeimies, T. Zwingers, H. Honigsmann, A. Tanew
Journal: British Journal of Dermatology (2005)

Topical aminolaevulinic acid-based photodynamic therapy (ALA-PDT) has recently been tried in small open studies for several inflammatory dermatoses including psoriasis.The purpose of this randomized, within patient comparison study was to investigate whether topical ALA-based PDT using a range of light doses can induce a satisfactory response in localized psoriasis.Twenty-nine patients with chronic plaque type psoriasis were enrolled in the study. After keratolytic pretreatment three psoriatic plaques in each patient were randomly allocated to PDT with 1% ALA and a light dose of 5 J cm(-2), 10 J cm(-2) or 20 J cm(-2), respectively. Treatment was performed twice weekly until complete clearance or for a maximum of 12 irradiations. As a measure of clinical response the psoriasis severity index (PSI) of the three target plaques was assessed separately by an observer blinded to the treatment at baseline, before each PDT treatment and 3-4 days after the last irradiation.Eight patients withdrew prematurely from the study. Keratolytic pretreatment alone reduced the baseline PSI in all three dose groups by about 25%. Subsequent PDT with 20 J cm(-2) resulted in a final reduction of PSI by 59%, PDT with the lower doses of 10 J cm(-2) and 5 J cm(-2) decreased the baseline PSI by 46% and 49%, respectively. The difference in clinical efficacy between 20 J cm(-2) and 10 J cm(-2) or 5 J cm(-2) was statistically significant (P = 0.003; P = 0.02), whereas no difference was found between 10 J cm(-2) and 5 J cm(-2) (P = 0.4). All patients reported some degree of PDT-induced stinging or burning during irradiation.The unsatisfactory clinical response and frequent occurrence of pain during and after irradiation renders topical ALA-based PDT an inadequate treatment option for psoriasis.
Cyclosporin A as prophylaxis against graft-versus-host disease in 36 patients.
Authors: A J Barrett, J R Kendra, C F Lucas, D V Joss, R Joshi, P Pendharkar, K Hugh-Jones
Journal: BMJ (1982)

Oral cyclosporin A was used as prophylaxis against graft-versus-host disease in (a) 31 patients with acute leukaemia or aplastic anaemia given transplants of HLA-matched bone marrow and (b) five patients with inborn errors of metabolism given transplants of haplotype-identical (parental) bone marrow. Twenty-six patients survived longer than two months after the operation. Despite the cyclosporin A, 31 patients (86%) suffered an acute form of graft-versus-host disease and 22 (61%) a chronic form. Nevertheless, the disease was usually treatable with immunosuppressive agents and caused the death of only one patient. Cyclosporin A caused renal toxicity in all cases; occasionally this was associated with a "capillary leak" syndrome, fatal in two patients. In children hypertension, fits, and fluid retention were common side effects. Blood concentrations of cyclosporin A correlated with blood urea values and blood pressure but did not predict the occurrence of graft-versus-host disease. Four different dose schedules were used to find the optimum way to administer this drug. Oral cyclosporin A is extremely effective at reducing the severity of graft-versus-host disease, but prevention of the disease is limited by toxicity of the drug and variable absorption. Better results might be achieved with parenteral administration or by using the drug in combination with other methods.
Abstract 4704: Prognostic significance of T gene SNP s2305089 in individuals with spinal column chordoma
Authors: Peter Varga, Charles Fisher, Lawrence Rhines, Ziya Gokaslan, Stefano Boriani, Áron Lazary, Wei-Lien ‎ Wang, Niccole Germscheid, Stephen Yip, Chetan Bettegowda
Journal: Cancer Research (2014)

Abstract Chordoma is the most common primary spinal column tumor with a median survival of only 6-7 years, with extremely high recurrence rates. Radical surgical resection remains the mainstay of treatment for these tumors, with radiation often utilized to enhance local disease control. There are no approved chemotherapeutic agents for chordomas. Recently, Pillay and colleagues found that the single nucleotide polymorphism (SNP) rs2305089 in the T gene was strongly associated with chordoma development1. The variant A allele at rs2305089 results in a p.GLy177Asp alteration in brachyury, the protein encoded by the T gene. Brachyury has been implicated in the pathogenesis of chordomas and is highly expressed in most of these tumors. Given the rarity of this disease, with an incidence of 0.08 per 100,000 individuals, determining the clinical significance of this SNP has been challenging. In order to address whether the rs2305089 SNP was associated with altered prognosis in individuals with spinal column chordomas, we performed a retrospective analysis on 82 chordomas from 5 different high volume centers in Europe and North America. Each sample was linked to well curated clinical outcomes data that were collected after receiving institutional review board approval. The A variant at rs2305089 was present in 74 of 82 cases analyzed. In our cohort, there were no differences in gender, age, location, ethnicity, histologic subtype or time to local recurrence based on the presence of the A variant. However, overall survival was significantly worse (log-rank = 0.003) in individuals who lacked the A variant. To our knowledge, this is the first time the rs2305089 SNP has been implicated in the prognosis and survival of individuals with chordoma. This finding warrants further investigation and may have important implications on clinical decision-making. 1Nature Genetics. 2012 Nov;44(11):1185-7 Note: This abstract was not presented at the meeting. Citation Format: Peter Varga, Charles Fisher, Lawrence Rhines, Ziya Gokaslan, Stefano Boriani, Áron Lazary, Wei-Lien ‎ Wang, Niccole Germscheid, Stephen Yip, Chetan Bettegowda. Prognostic significance of T gene SNP s2305089 in individuals with spinal column chordoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4704. doi:10.1158/1538-7445.AM2014-4704
Diarrhoea, dysentery, and food poisoning: Author's reply
Authors: A J Hay
Journal: BMJ (1992)

general managers.Aspirin and streptokinase remain the treatment of choice in myocardial infarction; there seems little justification for adding heparin."'This is not good news for those patients who, after mvocardial infarction, have to proceed to urgent or semiurgent cardiac surgery for unstable angina or other aspects of the infarc- tion.
COMBINED SUCTION TIP AND GROOVE DIRECTOR
Authors: I. S. Ravdin
Journal: JAMA (1927)

Dr. George P. Muller and I have found this suction tip exceedingly useful on many occasions. It has been used chiefly in gastro-enterostomies, in which, after a small incision has been made into the stomach or jejunum, the aspirator is introduced to remove any fluid present. The suction tip is then held tightly against the stomach or bowel, and the incision is made directly down on the groove. In this way, the bowel and stomach are opened with a minimum of injury.
Childhood Exposure to Phthalates: Associations with Thyroid Function, Insulin-like Growth Factor I, and Growth
Authors: Malene Boas, Hanne Frederiksen, Ulla Feldt-Rasmussen, Niels E. Skakkebæk, Laszlo Hegedüs, Linda Hilsted, Anders Juul, Katharina M. Main
Journal: Environmental Health Perspectives (2010)

Phthalates are widely used chemicals, and human exposure is extensive. Recent studies have indicated that phthalates may have thyroid-disrupting properties.We aimed to assess concentrations of phthalate metabolites in urine samples from Danish children and to investigate the associations with thyroid function, insulin-like growth factor I (IGF-I), and growth.In 845 children 4-9 years of age, we determined urinary concentrations of 12 phthalate metabolites and serum levels of thyroid-stimulating hormone, thyroid hormones, and IGF-I.Phthalate metabolites were detected in all urine samples, of which monobutyl phthalate was present in highest concentration. Phthalate metabolites were negatively associated with serum levels of free and total triiodothyronine, although statistically significant primarily in girls. Metabolites of di(2-ethylhexyl) phthalate and diisononyl phthalate were negatively associated with IGF-I in boys. Most phthalate metabolites were negatively associated with height, weight, body surface, and height gain in both sexes.Our study showed negative associations between urinary phthalate concentrations and thyroid hormones, IGF-I, and growth in children. Although our study was not designed to reveal the mechanism of action, the overall coherent negative associations between urine phthalate and thyroid and growth parameters may suggest causative negative roles of phthalate exposures for child health.
Deep-Vein Thrombosis Mimicking Acute Appendicitis
Authors: Deepak Vij
Journal: JAMA (1982)

IN THE very young and the elderly, acute appendicitis commonly has an atypical presentation and a high perforation rate.<sup>1</sup>It represents a difficult clinical challenge. The surgical and nonsurgical conditions that mimic acute appendicitis are well known.<sup>2</sup>The overall rate of a normal appendix at appendectomy is 20%, and the rate is much higher in women.<sup>1</sup>In highrisk patients, particularly those with a history of recent myocardial infarction or other serious illnesses, a correct preoperative diagnosis is of the utmost importance because unnecessary surgery carries with it a substantial morbidity and mortality for these patients. Recent literature has incriminated the Swan-Ganz catheter and other invasive intravascular devices in the development of venous or arterial thrombosis. Ileofemoral venous thrombosis can mimic the symptoms of acute appendicitis, and it should be included in the differential diagnosis of right lower quadrant abdominal pain. A complete history and careful physical examination
Cardiac Toxicity of Aerosol Propellants
Authors: Alex Azar
Journal: JAMA (1971)

To the Editor.—  Taylor and Harris 1 recently reported experiments which they interpreted as demonstrating that the fluorocarbon propellants used in asthma inhalers produced a toxic effect on the heart of anesthetized mice, which could explain sudden deaths in asthmatics and which casts doubt on the safety of other aerosol products. We believe that their findings may be explained on a physiologic basis which is related to the asphyxia rather than a specific chemical cardiotoxicity, and we believe that deductions made in the paper about the safety of other aerosol products therefore are open to question.  The cardiac toxicity of the propellants was demonstrated by Taylor and Harris in the following manner. Mice anesthetized with pentobarbital sodium were exposed to the inhalation of an unknown but presumably very high concentration of the propellants for a few seconds. Following this, their heads were enclosed in a tightly fitting plastic bag. These
Selecting Models of Nucleotide Substitution: An Application to Human Immunodeficiency Virus 1 (HIV-1)
Authors: David Posada, Keith A. Crandall
Journal: Molecular Biology and Evolution (2001)

The blind use of models of nucleotide substitution in evolutionary analyses is a common practice in the viral community. Typically, a simple model of evolution like the Kimura two-parameter model is used for estimating genetic distances and phylogenies, either because other authors have used it or because it is the default in various phylogenetic packages. Using two statistical approaches to model fitting, hierarchical likelihood ratio tests and the Akaike information criterion, we show that different viral data sets are better explained by different models of evolution. We demonstrate our results with the analysis of HIV-1 sequences from a hierarchy of samples; sequences within individuals, individuals within subtypes, and subtypes within groups. We also examine results for three different gene regions: gag, pol, and env. The Kimura two-parameter model was not selected as the best-fit model for any of these data sets, despite its widespread use in phylogenetic analyses of HIV-1 sequences. Furthermore, the model complexity increased with increasing sequence divergence. Finally, the molecular-clock hypothesis was rejected in most of the data sets analyzed, throwing into question clock-based estimates of divergence times for HIV-1. The importance of models in evolutionary analyses and their repercussions on the derived conclusions are discussed.
Promoting Weight Loss in Type II Diabetes
Authors: Sharon A Brown, Sandra Upchurch, Roberta Anding, Mary Winter, Gilbert Ramìrez
Journal: Diabetes Care (1996)

OBJECTIVE To examine strategies—behavioral therapies, exercise, diet, anorectic drugs, surgery, or a combination of strategies—used for promoting weight loss in people with type II diabetes. RESEARCH DESIGN AND METHODS Meta-analysis was used to synthesize research of promoting weight loss in the population. Literature search strategies involved reviewing bibliographies, conducting computer searches and surveys of relevant master's degree programs, and contacting representatives of the Centers for Disease Control. The final sample consisted of 89 studies involving 1,800 subjects. Data were extracted on 80 variables characterizing the sample of studies/subjects and on 23 outcome variables, including weight, metabolic control, lipids, and other physiological parameters. RESULTS Diet alone had the largest statistically significant impact on weight loss (−20 lb) and metabolic control (−2.7% in glycosylated hemoglobin). All diets significantly improved fasting blood sugar. Behavioral programs alone had a statistically significant impact on weight loss (−6.4 lb) and metabolic control (−1.5%) but effects were &amp;lt; for diet alone. Data from the few exercise studies indicated that weighted average effects for exercise on weight loss (−3.4 lb) and metabolic control (−0.8%) were &amp;lt; diet alone. Behavioral therapy plus diet plus exercise was associated with statistically significant effect size estimates for weight loss (−8.5 lb) and metabolic control (−1.6%). Diet alone achieved better results. Effects of weight promotion strategies, in general, were smaller in experimental studies and for individuals over age 55. CONCLUSIONS Dietary strategies are most effective for promoting short-term weight loss in type II diabetes. A number of gaps exist in the extant literature—descriptions of subjects, interventions, or longitudinal outcomes beyond 12 months after intervention.
Altruistic Discourse in the Informed Consent Process for Childhood Cancer Clinical Trials
Authors: Christian Simon, Michelle Eder, Eric Kodish, Laura Siminoff
Journal: The American Journal of Bioethics (2006)

Scholars have debated the role that altruistic considerations play--and should play--in recruitment and decision-making processes for clinical trials. Little empirical data are available to support their various perspectives. We analyzed 140 audiotaped pediatric informed consent sessions, of which 95 (68%) included at least one discussion of how participation in a cancer clinical trial might benefit: 1) the pursuit of scientific knowledge generally; 2) other children with cancer specifically; and 3) "the future" and other vaguely defined recipients. Clinicians initiated most (80%) of these discussions of altruism. The enrollment rate of children in the clinical trial was high (83%) overall, but not higher among children whose parents were involved in an altruism-oriented discussion. These findings suggest that: (1) clinicians invoke a spectrum of altruistic considerations rather than a single monothematic notion of altruism, and (2) the effect of altruistic considerations on subsequent enrollment decisions is marginal. While further research on this topic is warranted, bioethical debate should strive to reflect the diversity of altruistic discourse in clinical research encounters and to place this discourse in the context of other, including nonaltruistic, considerations.
Dissociation of Intrinsic Factor from its Antibody: Application to Study of Pernicious Anaemia Gastric Juice Specimens
Authors: M. S. Rose, I. Chanarin
Journal: BMJ (1969)

Intrinsic factor antibody may sometimes be concealed in the gastric secretions of pernicious anaemia subjects, being complexed with residual amounts of intrinsic factor.A method is described for dissociating intrinsic factor from its antibody. Antibody to the vitamin-B(12)-binding site of intrinsic factor was identified in 16 (57%) out of 28 samples of pernicious anaemia gastric juice after dissociation but in only 10 before dissociation. There was no clear relationship between the incidence of antibody in the serum and in the gastric juice of these patients.
Adequacy of Lymph Node Transbronchial Needle Aspirates Using Convex Probe Endobronchial Ultrasound for Multiple Tumor Genotyping Techniques in Non–Small-Cell Lung Cancer
Authors: Erik Folch, Norihiro Yamaguchi, Paul A. VanderLaan, Olivier N. Kocher, David H. Boucher, Michael A. Goldstein, Mark S. Huberman, Michael S. Kent, Sidharta P. Gangadharan, Daniel B. Costa, Adnan Majid
Journal: Journal of Thoracic Oncology (2013)

Adequate tumor acquisition is essential to identify somatic molecular alterations in non-small-cell lung cancer (NSCLC), such as epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) translocations. The success and failure rates for tumor genotyping of tissue obtained from fine-needle aspirates of nodal tissue using a convex probe endobronchial ultrasound (CP-EBUS) and other diagnostic modalities in routine NSCLC care have not been described.Clinicopathologic data, tumor genotype success and failure rates were retrospectively compiled and analyzed from 207 patient-tumor samples sent for routine tumor genotype in clinical practice, including 42 patient-tumor samples obtained from hilar or mediastinal lymph nodes using CP-EBUS.The median age of the patients was 65 years, 62.3% were women, 77.8% were white, 26.6% were never smokers, 73.9% had advanced NSCLC, and 84.1% had adenocarcinoma histology. Tumor tissue was obtained from CP-EBUS-derived hilar or mediastinal nodes in 42 cases (20.2% of total). In this latter cohort, the overall success rate for EGFR mutation analysis was 95.2%, for Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation 90.5%, and for ALK fluorescence in situ hybridization 90.5%. In the complete 207 tumors, the success rate for EGFR was 92.3%, for KRAS 91.8%, and for ALK 89.9%. The failure rates were not significantly different when comparing CP-EBUS-derived nodal tissue versus all other samples or versus surgical biopsies of mediastinal nodes, but were significantly lower than image-guided percutaneous transthoracic core-needle biopsies.The success rate of multiple tumor genomic analyses techniques for EGFR, KRAS, and ALK gene abnormalities using routine lung cancer tissue samples obtained from hilar or mediastinal lymph nodes by means of CP-EBUS exceeds 90%, and this method of tissue acquisition is not inferior to other specimen types. Tumor genotype techniques are feasible in most CP-EBUS-derived samples and therefore further expansion of routine tumor genotype for the care of patients with NSCLC may be possible using targeted sample acquisition through CP-EBUS.
Plasma Homocysteine and Parental Myocardial Infarction in Young Adults in Jerusalem
Authors: J.D. Kark, R. Sinnreich, I.H. Rosenberg, P.F. Jacques, J. Selhub
Journal: Circulation (2002)

Background — A causal role for mildly elevated plasma homocysteine (tHcy) in cardiovascular disease remains undetermined. To address the unresolved issue of the antecedent-consequent directionality of the relationship, we assessed the familial association of tHcy with parental myocardial infarction (MI) in young Israeli men and women. We also compared tHcy concentrations in Jerusalem, where rates of coronary heart disease (CHD) are high, with the United States Third National Health and Examination Survey (NHANES III). Methods and Results — A total of 8646 17-year-olds and 6952 parents were examined from 1976 to 1979 in Jerusalem. At ages 28 to 32 years, offspring of parents who experienced a documented MI during a 10-year follow-up (n=133 men, 62 women; 72% response) and offspring of CHD-free parents (n=389 men, 208 women; 71% response) were reexamined. tHcy levels were determined by the same laboratory for the NHANES non-Hispanic white population aged 25 to 34 years (n=379) and the Jerusalem population sample (n=858). Men from Jerusalem, but not women, had clearly higher tHcy levels than the sample from the United States (90th percentile, 23 versus 14 μmol/L). This difference was largely attributable to lower plasma vitamin B 12 levels in the Israeli population. Male case offspring had higher adjusted tHcy than did controls (1.9 μmol/L, P =0.002). Logistic modeling revealed a graded increase in risk of parental MI across quintiles of offspring tHcy, with an adjusted odds ratio of 2.7 in the 5th quintile ( P =0.0026 for trend). Conclusions — The higher tHcy in young male offspring of parents with CHD suggests that elevated tHcy precedes manifestation of CHD. The elevated population tHcy in men may contribute to the high incidence of CHD in Israel.