tbuckley/cabot-search huggingface dataset:
Is 'silent' myocardial ischemia really as severe as symptomatic ischemia? The analytical effect of patient selection biases.
Authors: J Klein, S Y Chao, D S Berman, A Rozanski
Journal: Circulation (1994)

BACKGROUND The clinical significance of exercise-induced chest pain remains controversial, as reflected by sharply discordant clinical results within the medical literature. Thus, we developed a prospective study to compare the functional significance of silent versus symptomatic ischemia and to evaluate whether patient selection biases influence this analysis. METHODS AND RESULTS We evaluated 117 patients (mean age, 63 +/- 9 years) with ischemic ST-segment depression during treadmill testing. Each patient underwent Tl-201 myocardial perfusion single-photon emission computed tomography (SPECT) after exercise followed by 24-ambulatory ECG monitoring. Patients were divided into silent versus symptomatic cohorts and were compared for the degree of hemodynamic, exercise and ambulatory ECG, and thallium abnormalities during stress testing. Analyses were repeated as the patient population became increasingly restricted. Compared with the silent patients, patients with chest pain during exercise had a shorter exercise duration (P &lt; .009), lower peak heart rate (P = .009) and double product (P = .005), lower heart rate threshold for ST depression (P &lt; .05), more episodes of ambulatory ST-segment depression (P &lt; .05), a higher frequency of ischemia abnormalities during Tl-201 SPECT (P = .02), and higher summed Tl reversibility scores (P = .002). As the population became increasingly restricted, the relative magnitude of differences in silent versus symptomatic cohorts diminished, whereas the absolute magnitude of ischemic abnormalities progressively increased in both cohorts. For example, within the restricted group having ischemia on both exercise and ambulatory ECG, 50% of the silent cohort had severe ischemia on Tl SPECT (five or more reversible defects) and more than one third demonstrated the ominous finding of transient left ventricular dilation after exercise. CONCLUSIONS The induction of chest pain is associated with substantially more functional abnormalities when it is analyzed in a relatively "broad-spectrum" coronary artery disease population; by contrast, chest pain tends to lose its apparent value as a clinical test parameter when its analysis is restricted to coronary artery disease populations with a greater a priori likelihood of manifesting inducible ischemia. These findings may help resolve some of the previous discordant literature reports.
Serendipitous Diagnosis of Superior Vena Caval Obstruction on a Posterior Abdominal Flow Study
Authors: JOE C. LEONARD, SUSAN M. NANNEY, PAULETTE PITTMAN
Journal: Clinical Nuclear Medicine (1985)

The use of radionuclide flow studies to diagnose and follow superior vena caval (SVC) obstruction and to evaluate renal perfusion and function as part of bone scintigraphy has been reported. This case presents a patient referred for bone imaging who was not suspected of having SVC obstruction until the renal perfusion study, with subsequent proof by an upper extremity flow study.
The effect of scaffold composition on the early structural characteristics of chondrocytes and expression of adhesion molecules
Authors: Jan C. Schagemann, Haymo Kurz, Michelle E. Casper, James S. Stone, Mahrokh Dadsetan, Sun Yu-Long, Eike H. Mrosek, James S. Fitzsimmons, Shawn W. O'Driscoll, Gregory G. Reinholz
Journal: Biomaterials (2010)
Antilymphocyte Antisera in Immunologically Mediated Renal Disease
Authors: Bernard Pirofsky
Journal: JAMA (1969)

Antilymphocyte and antithymocyte antisera were produced in goats and used to treat three patients with severe renal disease. Two subjects had progressive lupus erythematosus nephropathy and one patient had Goodpasture's syndrome. Corticosteroid and azathioprine therapy had failed in all. Prompt remissions were initiated in two of the three patients. No untoward local or systemic reactions were encountered. Goat rather than equine antisera appear to offer distinct advantages for such therapy.
BAD-LAMP is a novel biomarker of nonactivated human plasmacytoid dendritic cells
Authors: Axel Defays, Alexandre David, Aude de Gassart, Francesca De Angelis Rigotti, Till Wenger, Voahirana Camossetto, Pierre Brousset, Tony Petrella, Marc Dalod, Evelina Gatti, Philippe Pierre
Journal: Blood (2011)
Philadelphia General Hospital
Authors: David Kirsh
Journal: JAMA (1987)

<h3>To the Editor.—</h3> Your recent article entitled "Demise of Philadelphia General an Instructive Case; Other Cities Treat Public Hospital Ills Differently"<sup>1</sup>evoked many fond memories of a hospital that ill deserved to pass into oblivion. It began in the first half of the 18th century as an almshouse that evolved into a hospital. Its identification as the oldest hospital in the country was challenged by its neighbor a few miles away, the Pennsylvania Hospital, which was deemed a hospital at its inception. The legendary Dr William Osier served on the Philadelphia General staff early in his career. His role there was memorialized by a painting commissioned by one of the pharmaceutical houses that depicted Osier in the Autopsy Building, which later became a museum honoring him. Interns were attracted from all over the country and were selected on a competitive basis by a written and oral examination. During my
Intracytoplasmic Sperm Injection and Potential Transmission of Genetic Disease
Authors: Benjamin M. Tripp
Journal: JAMA (1997)

To the Editor.  —Dr Palermo and colleagues 1 recently reported that when intracytoplasmic sperm injection (ICSI) was used to produce pregnancy, the pregnancies, frequency of chromosomal abnormalities, and incidence of congenital abnormalities in the babies conceived in such a manner were comparable to those conceived with standard in vitro fertilization (IVF).  Although this study is reassuring, its conclusions may lead to the injudicious, and sometimes inappropriate, use of ICSI and similar technology, ie, round spermatid nuclear injection. With the advent of ICSI combined with testicular sperm extraction as a therapeutic option, men with clinical azoospermia, who were once thought to be sterile and untreatable, now have the ability to procreate.  A major concern with ICSI is the potential transmission of genetic disease to offspring. 2 A host of known genetic diseases and syndromes can cause male infertility, and more are yet to be delineated. With the use of ICSI, these
INFLUENCE OF FAMILY HISTORY ON ACUTE AORTIC DISSECTION: AN ANALYSIS FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION (IRAD)
Authors: Artur Evangelista Masip, Reed Pyeritz, Matthias Voehringer, Truls Myrmel, Marek P. Ehrlich, Mark Peterson, Linda Pape, Toru Suzuki, Guillaume Jondeau, Andrea Ballotta, Daniel Montgomery, Eric Isselbacher, Christoph Nienaber, Kim Eagle, Patrick O'Gara
Journal: Journal of the American College of Cardiology (2013)
Randomized Trials of Warfarin for Atrial Fibrillation
Authors: Daniel E. Singer
Journal: New England Journal of Medicine (1992)

The article by Ezekowitz et al. in this issue of the Journal 1 marks the completion of a remarkable set of five contemporaneous randomized trials testing the efficacy of warfarin in the prevention of stroke in patients with nonrheumatic atrial fibrillation.1 2 3 4 5 The trials are noteworthy for the consistency of their results, a feature often lacking in prevention trials. Each trial was stopped early because of the marked efficacy of warfarin in preventing stroke (the Canadian study5 was stopped because of the results of other trials). Although there was no plan at the outset to have five independent trials, experience has demonstrated . . .
Association Between Telomere Length and Experimentally Induced Upper Respiratory Viral Infection in Healthy Adults
Authors: Sheldon Cohen, Denise Janicki-Deverts, Ronald B. Turner, Margaretha L. Casselbrant, Ha-Sheng Li-Korotky, Elissa S. Epel, William J. Doyle
Journal: JAMA (2013)

Although leukocyte telomere length is associated with mortality and many chronic diseases thought to be manifestations of age-related functional decline, it is not known whether it relates to acute disease in younger healthy populations.To determine whether shorter telomeres in leukocytes, especially CD8CD28- T cells, are associated with decreased resistance to upper respiratory infection and clinical illness in young to midlife adults.Between 2008 and 2011, telomere length was assessed in peripheral blood mononuclear cells (PBMCs) and T-cell subsets (CD4, CD8CD28+, CD8CD28-) from 152 healthy 18- to 55-year-old residents of Pittsburgh, Pennsylvania. Participants were subsequently quarantined (single rooms), administered nasal drops containing a common cold virus (rhinovirus 39), and monitored for 5 days for development of infection and clinical illness.Infection (virus shedding or 4-fold increase in virus-specific antibody titer) and clinical illness (verified infection plus objective signs of illness).Rates of infections and clinical illness were 69% (n = 105) and 22% (n = 33), respectively. Shorter telomeres were associated with greater odds of infection, independent of prechallenge virus-specific antibody, demographics, contraceptive use, season, and body mass index (PBMC: odds ratio [OR] per 1-SD decrease in telomere length, 1.71 [95% CI, 1.08-2.72]; n = 128 [shortest tertile 77% infected; middle, 66%; longest, 57%]; CD4: OR, 1.76 [95% CI, 1.15-2.70]; n = 146 [shortest tertile 80% infected; middle, 71%; longest, 54%]; CD8CD28+: OR, 1.93 [95% CI, 1.21-3.09], n = 132 [shortest tertile 84% infected; middle, 64%; longest, 58%]; CD8CD28-: OR, 2.02 [95% CI, 1.29-3.16]; n = 144 [shortest tertile 77% infected; middle, 75%; longest, 50%]). CD8CD28- was the only cell population in which shorter telomeres were associated with greater risk of clinical illness (OR, 1.69 [95% CI, 1.01-2.84]; n = 144 [shortest tertile, 26%; middle, 22%; longest, 13%]). The association between CD8CD28- telomere length and infection increased with age (CD8CD28- telomere length × age interaction, b = 0.09 [95% CI, 0.02-0.16], P = .01, n = 144).In this preliminary study among a cohort of healthy 18- to 55-year-olds, shorter CD8CD28- T-cell telomere length was associated with increased risk for experimentally induced acute upper respiratory infection and clinical illness.
Sex, pregnancy, hormones, and melanoma.
Authors: I Jatoi, M E Gore
Journal: BMJ (1993)

disease has a characteristic picture of impairment, with a small number of shared features.'4At present there are no simple bedside tests to assess speed of cognition in patients with subcortical dementia, though more subtle tests of language, memory, problem solving, and naming objects represented by pictures may help differentiate it from the cortical variety.'5Distinguishing cortical from subcortical dementia may have some therapeutic value as states of subcortical dementia (in addition to parkinsonism) may be amenable to treatment with dopamine agonists and levodopa.Clinically, most treatable dementias exhibit a subcortical pattern, whereas Alzheimer's disease remains incurable.'6Better awareness of the cognitive deficits associated with particular dementias will hopefully lead to better management.
Complications From Surgery and Hospital Finances
Authors: Jeff Stensland
Journal: JAMA (2013)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Engineering the Brain Tumor Microenvironment Enhances the Efficacy of Dendritic Cell Vaccination: Implications for Clinical Trial Design
Authors: Yohei Mineharu, Gwendalyn D. King, AKM G. Muhammad, Serguei Bannykh, Kurt M. Kroeger, Chunyan Liu, Pedro R. Lowenstein, Maria G. Castro
Journal: Clinical Cancer Research (2011)

Glioblastoma multiforme (GBM) is a deadly primary brain tumor. Clinical trials for GBM using dendritic cell (DC) vaccination resulted in antitumor immune responses. Herein, we tested the hypothesis that combining in situ (intratumoral) Ad-Flt3L/Ad-TK-mediated gene therapy with DC vaccination would increase therapeutic efficacy and antitumor immunity.We first assessed the immunogenicity of tumor lysates generated by Ad-TK (+GCV), temozolomide (TMZ), or freeze/thawing cycles (FTC) in a syngeneic brain tumor model. We also assessed phenotypic markers, cytokine release, and phagocytosis of bone marrow-derived DCs generated by fms-like tyrosine kinase 3 ligand (Flt3L) + IL-6 or by granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin (IL) 4. Inhibition of tumor progression and production of anti-GBM antibodies was assessed following vaccination with (i) tumor cell lysates, (ii) DCs generated with either Flt3L/IL-6 or GM-CSF/IL-4 loaded with either Ad-TK/GCV-, TMZ-, or FTC-generated tumor lysates, or (iii) DCs in combination with in situ Ad-Flt3L/Ad-TK gene therapy.DCs loaded with tumor cell lysates generated with either Ad-TK/GCV or TMZ led to increased levels of phagocytosis, therapeutic efficacy, and humoral immune response. In situ immunogene therapy in combination with DC vaccination led to brain tumor regression and long-term survival in about 90% of animals, a significant increase when compared with either therapy alone.Our results indicate that modifying the tumor microenvironment using intratumoral Ad-Flt3L/Ad-TK-mediated gene therapy potentiates therapeutic efficacy and antitumor immunity induced by DC vaccination. These data support novel phase I clinical trials to assess the safety and efficacy of this combined approach.
PROTEIN TRANSPORT IN MOUSE KIDNEY UTILIZING TYROSINASE AS AN ULTRASTRUCTURAL TRACER
Authors: Constance Oliver, Edward Essner
Journal: The Journal of Experimental Medicine (1972)

The morphological basis of glomerular filtration and protein reabsorption in mouse kidney was examined by using mushroom tyrosinase subunits (mol wt 34,500), as an ultrastructural tracer. Almost immediately after injection tyrosinase reaction product was visualized in the glomerulus, and within the capillary lumen extending into the endothelial fenestrae. The entire basement membrane showed accumulations of tyrosinase in the subendothelial and subepithelial layers. The urinary space contained considerable amounts of reaction product, some of which was adsorbed to the cell coat of the podocytes. Reaction product could also be seen in the brush border region of the proximal tubule cells. By 30 min after injection, no tyrosinase reaction product was demonstrable in the glomerulus except for dense vesicles in mesangial cells. Most of the reaction product was localized in absorption droplets in the apical cytoplasm of proximal tubule cells. Occasionally, some tyrosinase reaction product was present within the basal infoldings of these cells. The behavior of tyrosinase in the mouse kidney is in accordance with that of other low molecular weight tracers. The pattern of localization within the basement membrane provides additional support for the presence of two filtration barriers in the glomerulus. The adherence of tyrosinase to the cell coat of the glomerular epithelial cells suggests that this may be an additional mechanism whereby protein is removed from the glomerular filtrate. Tyrosinase subunits may prove to be a useful new tracer for the study of protein transport.
THE DIAGNOSIS OF CHRONIC INDURATIVE OR INTERSTITIAL NEPHRITIS.
Authors: ALOYSIUS O. J. KELLY
Journal: JAMA (1902)

Discussing so trite a subject as the diagnosis of chronic indurative or interstitial nephritis, one can scarcely do more than emphasize the importance of certain pathologic and clinical features of the disease—features that have significant diagnostic, prognostic and therapeutic bearings. It is impossible to add anything new to our knowledge of the subject. Indeed, as a matter of fact, we at this day are scarcely better informed on the subject than was Bright himself. It is true that Aetius (died 367 A. D.), Avicenna (980-1036), and Van Helmont (1577-1644) attributed certain cases of dropsy to disease of the kidneys, and that Cotunnius (1736-1822), in 1770, discovered that the urine of dropsical patients is coagulable by heating, but our first insight into the true nature of the nonsuppurative diseases of the kidneys was furnished by Richard Bright (1789-1858) in his memorable publications in 1827 and subsequently. It is also true that
Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors
Authors: E. Kim, K. Cho, K. Park, K. Lee, B. Jang, W. Chung, J. Hwang
Journal: Endoscopy (2011)

Although perforation of the colon is known as one of the main complications of endoscopic submucosal dissection (ESD) for colorectal tumor management, factors predictive of perforation have not been fully evaluated. This study aimed to determine the factors associated with perforation during colorectal ESD.Patients with colorectal tumors undergoing ESD were enrolled and their records were reviewed retrospectively. Age, sex, co-morbidity, medication history, procedure time, resection method, tumor size, location, gross morphology, the presence of fibrosis, and histologic findings were included as possible risk factors. In the cases where perforation had occurred, factors associated with the duration of hospitalization were analyzed.One hundred eight lesions in 108 patients were eligible for inclusion in the study (68 patients were male; mean patient age was 63.01 ± 10.71 years). Mean tumor size was 27.59 ± 10.10 mm (range: 8 - 53 mm). Laterally spreading tumor was the most common type (75 %), followed by the protruding type (25 %). Procedure time was 61.95 ± 41.90 minutes (range: 5 - 198 minutes). Complete en bloc resection was achieved for 85 lesions (78.7 %). Perforation occurred in 22 patients (20.4 %). Multivariate analysis confirmed that tumor size [odds ratio (OR): 1.084; 95 % confidence interval (CI): 1.015 - 1.158; P = 0.017] and the presence of fibrosis (OR: 4.551; 95 %CI: 1.092 - 18.960; P = 0.037) were independent risk factors for perforation. All cases of perforation were managed with nonsurgical treatment. Younger age and abdominal pain appeared to be related to prolonged hospitalization.Tumor size and fibrosis are important factors related to complications during colorectal ESD. Younger age and development of abdominal pain can predict the hospital course in patients with perforation after ESD.
Anesthetic Management for Carotid Artery Surgery
Authors: Chester W. White
Journal: JAMA (1967)

During carotid reconstruction in 200 patients with symptomatic extracranial stenosis, four patients died, four were stabilized, and 192 were improved. The anesthetic technique used consisted of enhancement of cerebral blood flow by hypercapnia, diminution of cerebral oxygen requirements by halothane anesthesia, spontaneous respiration, and maintenance of each patient's normal blood pressure during the reconstruction. Narrowing of the carotid artery ranged from a 30% compromise on one side to a 100% compromise on one side with 75% on the other. The figures on the patients' recovery are comparable to recent reports of similar work and are superior to earlier experience with local anesthesia. Cerebral venous oxygen saturation proved to be the best guide to management; arterial carbon dioxide tension (Pco<sub>2</sub>) is an inadequate index of cerebral blood flow and oxygenation in cerebrovascular atherosclerosis. Few arrhythmias were observed during hypercapnia. It is probably desirable to maintain an optional Pco<sub>2</sub>for good cerebral circulation in all patients.
Can Power Doppler Enhanced Transrectal Ultrasound Guided Biopsy Improve Prostate Cancer Detection on First and Repeat Prostate Biopsy?
Authors: Mesut Remzi, Michael Dobrovits, Andreas Reissigl, Vincent Ravery, Mattias Waldert, Christian Wiunig, Yan Kit Fong, Bob Djavan
Journal: European Urology (2004)
Dial Access Library-Patient Information Service
Authors: Marjorie H. Bartlett, Ann Johnston, Thomas C. Meyer
Journal: New England Journal of Medicine (1973)

Abstract To decrease patient anxiety and physician frustration, an information system, available at four Madison, Wisconsin Hospitals, enables patients to receive authoritative messages of four to five minutes relating to the hospital and its personnel, diagnostic procedures, general medical subjects, x-ray studies, financial matters and other pertinent topics. After making their selection from a listing of audio-taped messages, patients, by using the bedside or other hospital telephone, dial a main service number and then request and hear the selection of their choice. Between January 18, 1971, and March 31, 1973, requests totaled 12,101, of which 7,485 were from patients and 4,616 from nonpatients. Evaluation showed patient response to be generally enthusiastic. Health professionals find value in recommending use of the service for basic and supplementary patient education in area of specific concern. (N Engl J Med 288:994–998, 1973)
Three-Dimensional Architecture of Cardiomyocytes and Connective Tissues in Hypertrophic Cardiomyopathy
Authors: Yumiko Kanzaki, Yohei Yamauchi, Makoto Okabe, Fumio Terasaki, Nobukazu Ishizaka
Journal: Circulation (2012)

S canning electron microscopy is a useful modality to visualize the 3-dimensional structures of tissues at high resolution.In addition, processing the tissue samples can provide further architectural information: The removal of connective tissue around the cardiomyocytes and, conversely, the removal of nonfibrous tissue enable us to clearly observe the cardiomyocytes and connective tissue, respectively.Furthermore, backscattered electron emission after heavy-metal staining can provide higher-quality images of the intracellular architecture. 1We have previously reported the 3-dimensional structure of the human left ventricular myocardium. 2 Here, we performed an electron microscopic examination of a myectomy specimen from a patient with hypertrophic cardiomyopathy using a Hitachi S-800 scanning electron microscope (Hitachi, Ltd, Tokyo, Japan).In this patient, asymmetrical hypertrophy of the left ventricular wall (interventricular septum, 19 mm; anterolateral wall, 14 mm) and a pressure gradient