tbuckley/cabot-search huggingface dataset:
Mortality and volume of cases in paediatric cardiac surgery: retrospective study based on routinely collected data
Authors: D. J Spiegelhalter
Journal: BMJ (2002)

<h3>Abstract</h3> <b>Objectives:</b> To determine whether mortality between 1991 and 1995 in hospitals in England carrying out surgery for congenital heart disease in children was associated with the annual volume of cases and to estimate the extent to which an association could explain the apparent divergent mortality at Bristol Royal Infirmary. <b>Design:</b> Retrospective analysis of data from two sources, a register of returns by surgeons to their professional society and an administrative database. <b>Setting:</b> 12 hospitals in England carrying out surgery for congenital heart disease over the period April 1991 to March 1995. <b>Main outcome measure:</b> 30 day mortality. <b>Results:</b> For open heart operations in children under 1 year old, and in particular for arterial switches and repair of atrioventricular septal defect, there is strong and consistent evidence of an inverse association between mortality and volume of cases (not taking into account any data from Bristol). A hospital carrying out 120 open operations per year in 1991-5 on children aged under 1 year would be expected to have a mortality 25% lower than that in a hospital carrying out 40 operations. If the children in the hospitals had the same mix of operations, this reduction is 34%. Stratifying for types of operation or including the results from Bristol strengthens this association. It was also estimated that less than a fifth of the excess mortality at Bristol Royal Infirmary in open operations in children less than 1 year old was due to the hospital9s lower volume of surgery. <b>Conclusions:</b> Using appropriate methods, this study showed that mortality in paediatric cardiac surgery was inversely related to the volume of surgery. Considerable caution is needed in interpreting these results, and it does not necessarily follow that concentrating resources in fewer centres would reduce mortality. <h3>What is already known on this topic</h3> Mortality in children undergoing heart operations has been shown to be lower in hospitals with a high volume of such operations Studies showing a relation between volume of cases and mortality have a range of methodological inadequacies, in particular the choice of a threshold defining high and low volume after the analysis to increase the significance of the results <h3>What this study adds</h3> Disregarding data from Bristol, there is strong and consistent evidence that in England in 1991-5 hospitals performing a higher number of open heart operations in children aged under 1 year tended to have lower mortality This association explains only a small proportion (less than a fifth) of the excess mortality seen at the Bristol Royal Infirmary over this period
Television Language: Foster of Illiteracy
Authors: Hugh H. Hussey
Journal: JAMA (1974)

Although pen once splashed ink against the grammatical perfidies of television commercials as they influence the youth of the United States (<i>JAMA</i>217:69, 1971), the shows themselves were not brought to shame or blame. Consider "All in the Family," viewing of which is said to have high ratings. There, grammatical argot is rife, as it probably should be, if to be realistic, in the language of typical New York blue-collar parents, Archie Bunker and his persevering wife, who forgot or never learned language at its best in high school. Yet, protection of our youthful ones, those who will speak and write now and in the future, merits attention. Let their parents play a game with the youngsters, taxing them to identify the grammatical aberrations and malapropisms of Archie Bunker and, so doing, learn language, spoken or written, as it should be spoken or written, lest they be victims of wrongly
Outpatient Treatment of Paget's Disease of Bone with Mithramycin
Authors: DENNIS LEBBIN
Journal: Annals of Internal Medicine (1974)

Mithramycin is a cytotoxic antibiotic that causes hypocalcemia and diminishes the elevated osteoclastic activity characteristic of Paget's disease. Previous inpatient studies have shown that this drug causes striking clinical and biochemical improvement in patients with severe widespread disease. To simplify therapy and lessen toxicity, 13 patients with this form of Paget's disease were treated for 1 to 14 months with either of two different outpatient regimens. During therapy the elevation in the serum alkaline phosphatase decreased by 40% to 99%, and all patients reported symptomatic improvement. Manifestations of toxicity were mild and transient.
THE SUBCELLULAR DISTRIBUTION OF ANTIGEN IN MACROPHAGES
Authors: E. Kölsch, N. A. Mitchison
Journal: The Journal of Experimental Medicine (1968)

The intracellular fate of phagocytosed antigens in cells from peritoneal exudate in CBA mice has been studied by using (126)I and (131)I labeled antigens. After uptake of labeled antigen, cells were homogenized and the subcellular fractions were analyzed by isopycnic centrifugation in a sucrose gradient. The uptake of heat-denatured BSA (c BSA) by these cells in vivo is 3.5 microg/mg c BSA injected/10(8) cells. The uptake by cells in animals which were exposed 2 days earlier to 900 r whole body irradiation is slightly lower but does not differ significantly. 90% of the phagocytosed material is degraded within 2-3 hr, the residual 10% is retained at least over an 8 hr periods. Using a pulse and chase technique, with (125)I and (131)I c BSA in vitro and in vivo it was shown that newly phagocytosed antigen is found mainly in a lysosomal turnover compartment of a density 1.19 g cm(-3). Antigen which has been in the cells for longer was found in a denser fraction (1.26 g cm(-3)). In a comparison of nhrmal and X-irradiated cells it can be shown that after irradiation with 900 r less c BSA is found in this storage compartment. Binding of the antigen to the subcellular fractions, and its behavior towards several detergents has been studied. Subcellular fractions do not have the increased immunogenic capacity of antigen enclosed in living macrophages. Two synthetic polypeptide antigens, poly(D-Tyr, D-Glu, D-Ala) and poly-(L-Tyr, L-Glu) have a different subcellular distribution from c BSA, BSA, or bovine gamma globulin. Apart from also being found in the 1.26 storage compartment the polypeptide antigens are mainly located in a 1.15 compartment and only to a small extent in the 1.19 compartment. The half-life of these antigens in the cells is much longer than the half-life of the protein antigens studied. The finding of several subcellular compartments is discussed in connection with the functions possibly performed by macrophages.
Temporal Trends in BMI Among Adults With Diabetes
Authors: Cynthia L. Leibson, David F. Williamson, L. Joseph Melton, Pasquale J. Palumbo, Steven A. Smith, Jeanine E. Ransom, Peter L. Schilling, K. M. Venkat Narayan
Journal: Diabetes Care (2001)

Increasing obesity within the general population has been accompanied by rising rates of diabetes. The extent to which obesity has increased among people with diabetes is unknown, as are the potential consequences for diabetes outcomes.Community medical records (hospital and ambulatory) of all Rochester, Minnesota, residents aged > or =30 years who first met standardized research criteria for diabetes from 1970 to 1989 (n = 1,306) were reviewed to obtain data on BMI and related characteristics as of the diabetes identification date (+/-3 months). Vital status as of 31 December 1999 and date of death for those who died were obtained from medical records, State of Minnesota death tapes, and active follow-up.As of the identification date, data on BMI were available for 1,290 cases. Of the 272 who first met diabetes criteria in 1970-1974, 33% were obese (BMI > or =30), including 5% who were extremely obese (BMI > or =40). These proportions increased to 49% (P < 0.001) and 9% (P = 0.012), respectively, for the 426 residents who first met diabetes criteria in 1985-1989. BMI increased significantly with increasing calendar year of diabetes identification in multivariable regression analysis. Analysis of survival revealed an increased hazard of mortality for BMI > or =41, relative to BMI of 23-25 (hazard ratio 1.60, 95% CI 1.09-2.34, P = 0.016).The prevalence of obesity and extreme obesity among individuals at the time they first met criteria for diabetes has increased over time. This is disturbing in light of the finding that diabetic individuals who are extremely obese are at increased risk of mortality compared with their nonobese diabetic counterparts.
Cutaneous infection with Tunga pemtrans
Authors: A. G. DOUGLAS-JONES, M. B. LLEWELYN, C. M. MILLS
Journal: British Journal of Dermatology (2006)

A 23‐year‐old man presented with a small black lesion at the distal margin of the right great toenail. He had returned from the Ivory Coast 1 month previously, having spent 6 weeks there. Histopathological examination of material extruded from the lesion showed a variety of arthropod internal organs, allowing a definitive diagnosis of infection with the ectoparasitic flea Tunga penetrans. Curettage of the lesion revealed a gravid adult female flea.
Clinical Observations ON A KIDNEY WHICH CONTAINED MORE THAN FORTY THOUSAND IRIDESCENT CALCULI
Authors: J. Bland-Sutton
Journal: BMJ (1905)

i.All the stitches are placed and the posterior row tied before the bowel is opened, and it remains open just long enough to control the haemorrhage.2. The size of the newly-formed pyloric opening is limited on]y by the mobility of the stomach and duodenum and by the judgement of the operator.3. Unless the stomach is very much dilated or has descended to an unusual extent, the lower limit of the new outlet is at or near the level of its most dependent portion.Should the stomach be very much dilated, a gastropexy or gastroplication can be performed at the same time.
MULTIPLE HEMANGIOMAS OF BONE, PROBABLY CONGENITAL
Authors: John W. Pierson
Journal: JAMA (1941)

Diffuse osteolytic lesions of the skeletal system are often among the clinician's most difficult diagnostic problems. Even microscopic examination of biopsy material may be inconclusive for exact diagnosis. We have recently seen a patient whose widespread lesions confused several physicians in other localities as well as ourselves. The correct diagnosis was established only by skeletal biopsy. Because we have found in the literature no clinical description of a similar case, we feel justified in calling the entity to the attention of the profession in order that it may be considered in the differential diagnosis of patients who suffer with multiple skeletal lesions, osteolytic in character. <h3>REPORT OF CASE</h3><h3>History.—</h3> R. P., a white man aged 21, was referred to us by Dr. Warfield M. Firor for diagnostic study. The patient's medical history was free of all but minor illnesses until his skeletal difficulty was accidentally brought to light. Birth
THE PRINCIPLES OF THE TREATMENT OF ECZEMA. Prof. O. Lassar
Authors: Frank H. Barendt
Journal: British Journal of Dermatology (1896)

Journal Article THE PRINCIPLES OF THE TREATMENT OF ECZEMA. Prof. O. Lassar Get access Frank H. Barendt Frank H. Barendt Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 8, Issue 4, 1 April 1896, Pages 155–156, https://doi.org/10.1111/j.1365-2133.1896.tb16920.x Published: 01 April 1896
Cigarette Smoking Potentiates Endothelial Dysfunction of Forearm Resistance Vessels in Patients With Hypercholesterolemia
Authors: Thomas Heitzer, Seppo Ylä-Herttuala, Jukka Luoma, Sabine Kurz, Thomas Münzel, Hanjörg Just, Manfred Olschewski, Helmut Drexler
Journal: Circulation (1996)

Background Risk factors for atherosclerosis such as hypercholesterolemia and hypertension are associated with endothelial dysfunction of conduit and resistance vessels; however, the interaction of these risk factors and underlying mechanisms affecting endothelial function remain to be determined. The present study investigated the role of long-term smoking and hypercholesterolemia and their impact on endothelial function of peripheral resistance vessels in relation to plasma levels of autoantibodies against oxidized LDL, which has been implicated in the development of endothelial dysfunction and atherosclerosis. Methods and Results The vascular responses to the endothelium-dependent agent acetylcholine (7.5, 15, 30, and 60 μg/min) and the endothelium-independent agent sodium nitroprusside (1, 3, and 10 μg/min) were studied in normal control subjects (n=10), patients with hypercholesterolemia (n=15), long-term smokers (n=15), and hypercholesterolemic patients who smoked (n=15). Drugs were infused into the brachial artery, and forearm blood flow (FBF) was measured by venous occlusion plethysmography. The FBF responses to acetylcholine were significantly blunted in all three patient groups compared with normal control subjects ( P &lt;.05). The acetylcholine-induced increase in FBF was significantly attenuated in patients with hypercholesterolemia who smoked compared with hypercholesterolemic nonsmokers and normocholesterolemic smokers ( P &lt;.05 for both). The response to sodium nitroprusside was not statistically different in all four groups. Plasma levels of autoantibody titer against oxidized LDL were inversely related to acetylcholine-induced changes in FBF ( r =−.53, P &lt;.002) and were substantially increased in the group with both risk factors. Conclusions These results demonstrate that cigarette smoking and hypercholesterolemia synergistically impair endothelial function and that their combined presence is associated with increased plasma levels of autoantibodies against oxidized LDL. These observations raise the possibility that long-term smoking potentiates endothelial dysfunction in hypercholesterolemic patients by enhancing the oxidation of LDL.
Clinical aspects of allergic disease: A double-blind study of the discontinuation of ragweed immunotherapy
Authors: Robert M. Naclerio, David Proud, Birgitta Moylan, Susan Balcer, Linda Freidhoff, Anne Kagey-Sobotka, Lawrence M. Lichtenstein, Peter S. Creticos, Robert G. Hamilton, Philip S. Norman
Journal: Journal of Allergy and Clinical Immunology (1997)

Background: Immunotherapy effectively treats the symptoms of allergic rhinitis and improves its pathophysiology. We studied whether the effects of immunotherapy on the early response to nasal challenge with antigen and seasonal symptoms persist after discontinuation. Methods: Twenty subjects with ragweed allergy who were receiving immunotherapy and who had nasal challenges performed before initiation of treatment were selected. The patients had been receiving maintenance therapy with aqueous ragweed extract at a dose of 12 μg of Amb a 1 equivalent for a minimum of 3 years, at which point they were randomized to receive either placebo injections or to continue with the maintenance dose. Nasal challenges were performed before and 1 year after randomization. Nasal challenges were monitored by counting the number of sneezes and measuring histamine, N-α-tosyl-L-arginine methyl ester–esterase activity, and kinins in recovered nasal lavages. In the same year symptom diaries were collected during the ragweed season. Results: The initial immunotherapy significantly reduced responses to nasal challenge in both groups. The group continuing to receive active treatment showed no significant changes from the response before randomization. In contrast, the group randomized to placebo treatment showed a partial return of histamine, kinins, and N-α-tosyl-L-arginine methyl ester–esterase in nasal secretions and the numbers of sneezes. IgG antibodies to ragweed declined only in the group switched to placebo treatment. Seasonal rises of IgE antibodies to ragweed did not return during the first season after treatment was stopped. Symptoms reported during the ragweed season were not different between the groups. Conclusions: One year after discontinuation of ragweed immunotherapy, nasal challenges showed partial recrudescence of mediator responses even though reports during the season appeared to indicate continued suppression of symptoms. (J Allergy Clin Immunol 1997;100:293-300.)
608 GENE-EXPRESSION PROFILING REVEALS AN UNEXPECTED DEFECT IN INDUCTION OF INTERFERON TARGET GENES IN LPS-STIMULATED IMMUNE CELLS FROM CIRRHOTIC PATIENTS
Authors: E. Weiss, M. Fasseu, P.-E. Rautou, L. Elkrief, C. Paugam-Burtz, D. Valla, D. Lebrec, R. Moreau
Journal: Journal of Hepatology (2013)
Autonomic disturbances in narcolepsy
Authors: Giuseppe Plazzi, Keivan Kaveh Moghadam, Leonardo Serra Maggi, Vincenzo Donadio, Roberto Vetrugno, Rocco Liguori, Giovanna Zoccoli, Francesca Poli, Fabio Pizza, Uberto Pagotto, Raffaele Ferri
Journal: Sleep Medicine Reviews (2010)
Unusual Lower Limb Skeletal Metastases From Carcinoma of the Cervix
Authors: Venkatesh Rangarajan, Sumeet Dua, Nilendu C. Purandare, Sneha Shah, Anshu R. Sharma
Journal: Clinical Nuclear Medicine (2010)

Osseous metastases from carcinoma of the cervix are often associated with locoregional and nodal recurrence, and bear an adverse correlation with survival. The lumbar spine is the commonest site and metastases to the distal appendicular and sacral bones are an infrequent finding. Positron emission tomography/computed tomography (PET/CT) using fluorodeoxyglucose as tracer (FDG) is being increasingly used in staging and follow-up of patients treated for carcinoma of the cervix. We report rare osseous sites of metastatic recurrence in the tibia, patella, and the intermediate cuneiform detected on FDG PET/CT in a patient treated for cervical cancer, findings hitherto undescribed.
Staphylococcal Infections in Hospitals
Authors: André J. Nahmias, Theodore C. Eickhoff
Journal: New England Journal of Medicine (1961)

THE past decade and a half has seen the problem of staphylococcal infections in hospitals grow into one of the major challenges confronting contemporary medicine. Many approaches have been and are being sought to curb the progress of the parasite among medical and surgical patients, newborn infants and hospital personnel, and to forestall its dissemination into the community at large. This review proposes to present these approaches in relation to the various factors believed to play a part in the epidemiology of staphylococcal infections. Recent developments in epidemiologic and laboratory investigation will be emphasized. No attempt will be made to . . .
Cost-Effectiveness of Using High-Sensitivity C-Reactive Protein to Identify Intermediate- and Low-Cardiovascular-Risk Individuals for Statin Therapy
Authors: Keane K. Lee, Lauren E. Cipriano, Douglas K. Owens, Alan S. Go, Mark A. Hlatky
Journal: Circulation (2010)

Many myocardial infarctions and strokes occur in individuals with low-density lipoprotein cholesterol levels below recommended treatment thresholds. High sensitivity C-reactive protein (hs-CRP) testing has been advocated to identify low- and intermediate-risk individuals who may benefit from statin therapy.A decision analytic Markov model was used to follow hypothetical cohorts of individuals with normal lipid levels but without coronary artery disease, peripheral arterial disease, or diabetes mellitus. The model compared current Adult Treatment Panel III practice guidelines, a strategy of hs-CRP screening in those without an indication for statin treatment by current practice guidelines followed by treatment only in those with elevated hs-CRP levels, and a strategy of statin therapy at specified predicted risk thresholds without hs-CRP testing. Risk-based treatment without hs-CRP testing was the most cost-effective strategy, assuming that statins were equally effective regardless of hs-CRP status. However, if normal hs-CRP levels identified a subgroup with little or no benefit from statin therapy (<20% relative risk reduction), then hs-CRP screening would be the optimal strategy. If harms from statin use were greater than generally recognized, then use of current clinical guidelines would be the optimal strategy.Risk-based statin treatment without hs-CRP testing is more cost-effective than hs-CRP screening, assuming that statins have good long-term safety and provide benefits among low-risk people with normal hs-CRP.
Abstract 2858: Mirk/dyrk1B kinase inhibition increases ROS and apoptosis in ovarian cancer cells, but has little effect on normal diploid cells
Authors: Jing Hu, Eileen A. Friedman
Journal: Cancer Research (2012)

Abstract Quiescent cancer cells in vivo, including stem cell populations, are relatively insensitive to most chemotherapeutic drugs and radiation. Tumor cells in culture can be placed in G0 by serum or nutrient deprivation, and then can be targeted by a small molecule Mirk kinase inhibitor. Mirk/dyrk1B levels are elevated up to 10-fold in quiescent tumor cells where Mirk blocks cell cycling and increases viability by decreasing reactive oxygen species (ROS). In prior studies Mirk was detected in 75% of ovarian cancers, and was amplified in a subset. In contrast, Mirk expression was quite low in most normal cell types and Mirk knockout or depletion had no detectable effects on normal cells. Response to a Mirk kinase inhibitor was compared between two strains of normal diploid fibroblasts, early passage cultures of normal human ovarian epithelial cells, and a series of ovarian cancer cell lines where Mirk had been shown to be an active kinase. Serum-starved normal diploid cells entered a G0 quiescent state and had minimal response to the Mirk inhibitor, but serum-starved cancer cells were kept in cycle by the Mirk inhibitor, which reduced E2F4 sequestration by p130/Rb2 by 2-3fold. Mirk inhibitor treated cancer cultures had several-fold more sub-G0/G1 apoptotic cells and about 30-fold higher levels of the apoptotic proteins cleaved PARP and cleaved caspase 3 compared with normal diploid cells. The Mirk inhibitor increased total ROS levels and superoxide levels only in the cancer cells, in a rapid time-course of 2-3 days. Cancer cell loss after Mirk kinase inhibitor treatment was due at least in part to ROS, since the ROS scavenger N-acetyl cysteine reduced the amount of cleaved PARP and the extent of cancer cell loss. The Mirk inhibitor decreased the EC50 of cisplatin up to 9-fold in ovarian cancer cells. Thus ovarian cancer cells, which exhibit elevated Mirk expression/amplification and active Mirk kinase, were shown to be more susceptible to the Mirk kinase inhibitor than normal diploid cells. 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 2858. doi:1538-7445.AM2012-2858
Ethical Dilemmas in the Care of the III
Authors: Leon R. Kass
Journal: JAMA (1980)

IN REFLECTING on the nature of the medical vocation, we have come via a somewhat labyrinthine path to a not very startling assertion: the doctor, by teaching and technique, through patient understanding and astute judgment, promotes the patient's good. Our third perplexity follows directly: What is the patient's good? More precisely, of the many things that are good for the patient, which is it the physician's business to promote? We are no longer asking about medicine's foreign or domestic relations, but about its very constitution: What is the purpose of medicine? This is, in a way, a strange question to be asking, since most of the time physicians can go about unreflectively doing their proper business, tacitly if silently clear about the nature and limits of the purposes of medicine. But because new technological powers permit physicians to serve multiple ends, and because much of medical practice is so fragmented