tbuckley/cabot-search huggingface dataset:
Destabilizing Effects of Mental Stress on Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators
Authors: Rachel Lampert, Diwaker Jain, Matthew M. Burg, William P. Batsford, Craig A. McPherson
Journal: Circulation (2000)

The incidence of sudden cardiac death increases in populations who experience disasters such as earthquakes. The physiological link between psychological stress and sudden death is unknown; one mechanism may be the direct effects of sympathetic arousal on arrhythmias. To determine whether mental stress alters the induction, rate, or termination of ventricular arrhythmias, we performed noninvasive programmed stimulation (NIPS) in patients with defibrillators and ventricular tachycardia (VT), which is known to be inducible and terminated by antitachycardia pacing, at rest and during varying states of mental arousal.Eighteen patients underwent NIPS in the resting-awake state (nonsedated). Ten underwent repeat testing during mental stress (mental arithmetic and anger recall). Induced VT was faster in 5 patients (P=0.03). VT became more difficult to terminate in 5 patients during mental stress; 4 required a shock (P=0.03). There was no change in ease of induction with mental stress. There was no evidence of ischemia on ECG or continuous ejection fraction monitoring. Eight patients received a shock in the resting-awake state and did not perform mental stress. Four underwent repeat NIPS after sedation; 3 then had induced VT terminated with antitachycardia pacing. All patients with an increase in norepinephrine of >50% had alterations in VT that required shock for termination (P<0.01).Mental stress alters VT cycle length and termination without evidence of ischemia. This suggests that mental stress may lead to sudden death through the facilitation of lethal ventricular arrhythmias.
The Effects of Selection Against Spurious Transcription Factor Binding Sites
Authors: M. W. Hahn
Journal: Molecular Biology and Evolution (2003)

Most genomes contain nucleotide sequences with no known function; such sequences are assumed to be free of constraints, evolving only according to the vagaries of mutation. Here we show that selection acts to remove spurious transcription factor binding site motifs throughout 52 fully sequenced genomes of Eubacteria and Archaea. Examining the sequences necessary for polymerase binding, we find that spurious binding sites are underrepresented in both coding and noncoding regions. The average proportion of spurious binding sites found relative to the expected is 80% in eubacterial genomes and 89% in archaeal genomes. We also estimate the strength of selection against spurious binding sites in the face of the constant creation of new binding sites via mutation. Under conservative assumptions, we estimate that selection is weak, with the average efficacy of selection against spurious binding sites, Nes, of -0.12 for eubacterial genomes and -0.06 for archaeal genomes, similar to that of codon bias. Our results suggest that both coding and noncoding sequences are constrained by selection to avoid specific regions of sequence space.
Influence of gender and endotracheal tube size on preextubation breathing pattern.
Authors: S K Epstein, R L Ciubotaru
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

An imbalance between work of breathing and respiratory muscle capacity often results in rapid, shallow breathing (increased respiratory rate/tidal volume [f/VT]). Because this imbalance commonly causes unsuccessful weaning from mechanical ventilation, it is not surprising that an elevated f/VT accurately predicts weaning failure. However, while studying extubation outcome, we observed that women and patients with narrow endotracheal tubes are often successfully extubated with an elevated f/VT. We studied 218 medical patients in the intensive care unit who had a f/VT measured through an oral endotracheal tube (off of ventilatory support) during 1 min of spontaneous respiration at the onset of a weaning trial that culminated in extubation. Men and women were comparable at the onset of mechanical ventilation and weaning trials in severity of illness, etiology of respiratory failure, ventilator settings, and gas exchange data. Women were found to have a higher f/VT (79 +/- 5 versus 56 +/- 3 breaths/L, p < 0.001), lower tidal volumes (381 +/- 14 versus 494 +/- 13 ml, p < 0.001), and higher respiratory rate 26 +/- 1 versus 24 +/- 1, p < 0.05). The differences persisted after controlling for extubation outcome. Smaller endotracheal tubes were associated with a higher f/VT, especially for women (< or = 7 mm, 86 +/- 6 versus > 7 mm, 68 +/- 6, p < 0.05). Women were more likely to have a f/VT > or = 100 (19/82 [women] versus 10/136 [men], p < 0.001). Although the overall incidence of extubation failure was similar (11/82 [women] versus 23/136 [men], p = NS), among patients with f/VT > or = 100, men were more likely to require reintubation (3/19 [women] versus 5/10 [men], p = 0.08). We conclude that women, especially when breathing through small endotracheal tubes, have a higher f/VT (including likelihood of f/VT > or = 100) than men, independent of extubation outcome. Consideration of factors that elevate the f/VT, unrelated to physiologic work of breathing and respiratory muscle capacity, should improve application of this index to extubation decision making.
Clinical outcome of hepatitis C as a function of mode of transmission
Authors: Stuart C. Gordon, Nasser Bayati, Ann L. Silverman
Journal: Hepatology (1998)

Several reports suggest that posttransfusion hepatitis C causes more aggressive histological activity than disease that is acquired via other routes. We sought to determine whether mode of transmission affects disease outcome. We studied the demographics, presenting laboratory data, and clinical course of 627 consecutively evaluated nonalcoholic patients with chronic hepatitis C. Two hundred eighty-two patients (45%) were transfusion recipients, 262 (42%) acquired the disease via other routes of percutaneous exposure, and 83 (13%) were without risks. Liver histology was available in 463 patients (215 transfusion recipients, 195 non-transfusion recipients, and 53 who were were without risks) and showed noncirrhosis in 274 (59%), cirrhosis in 173 (37%), and hepatocellular carcinoma in 16 patients (4%) who also had underlying cirrhosis. Duration of follow-up was 1 to 25 years (mean, 48 months; median, 21 years). One hundred eighteen of 173 (68%) cirrhotic patients were transfusion recipients; 40 of 173 (23%) cirrhotic patients acquired infection via other percutaneous exposure, and the remainder were without known risk factors (P < .001). Among the 215 patients with blood transfusions for whom histology was available, 118 of 215 (55%) had cirrhosis and 89 of 215 (41%) were noncirrhotic (P < .001); 8 transfused patients (4%) had hepatocellular carcinoma. In the percutaneous group, 40 of 195 (21%) of the patients were cirrhotic versus 153 of 195 (78%) who were noncirrhotic (P < .001); 2 patients (1%) had hepatocellular carcinoma. During the follow-up period, 59 of 189 (31%) of the cirrhotic patients (including those 16 individuals with hepatocellular carcinoma) developed hepatic decompensation. By univariate analysis, the risk of liver failure was related to age at viral acquisition, but by logistic regression analysis, only mode of transmission, and not age or estimated disease duration, predicted risk of liver failure. Patients with posttransfusion hepatitis C were more likely to develop decompensation than individuals who were not transfusion recipients (relative risk, 3.921; CI = 2.205 to 7.015). Serum albumin, prothrombin time, and platelet count at presentation were independent laboratory predictors of subsequent hepatic decompensation. The rate of hepatocellular carcinoma development among all cirrhotic patients during the follow-up period was 1.2% per year. Patients with posttransfusion hepatitis C are at greater risk of cirrhotic decompensation than those individuals with non-transfusion-acquired disease. The risk of liver failure is more closely related to the mode of transmission than to age at viral acquisition or to the duration of infection.
Adjuvant radiotherapy for breast cancer
Authors: C. Hiley, A. Tutt, M. Torres, C. Palmieri
Journal: BMJ (2008)

Changes in delivery must be driven by evidence from ongoing clinical trials

The incidence of breast cancer is rising worldwide, particularly in women over 50—it increased by 30-40% between 1973 and 1997.1 In the United States it has decreased by around 10% in line with the reduced use of hormone replacement therapy, but globally the problem is growing.

Since the publication of the landmark National Surgical Adjuvant Breast and Bowel Project B-06, breast preserving treatment consisting of lumpectomy and postoperative radiation has become a widely accepted alternative to mastectomy.2 The UK Department of Health’s 2007 cancer reform strategy underscores the lack of resources allocated to radiotherapy and estimates that an 80% increase in service capacity will be needed by 2016.3 Lack of equipment and personnel can lead to protracted periods between lumpectomy and breast radiotherapy.4 5 To implement the strategy, we need to optimise current treatment regimens, adequately invest in radiotherapy infrastructure, develop more efficient radiotherapy techniques, and define when radiotherapy is not needed.

One way of tackling the scarcity of radiotherapy services …
329 INFLUENCE OF G308A POLYMORPHISM OF TUMOR NECROSIS FACTOR ALPHA GENE ON HISTOLOGICAL CHANGES OF NON ALCOHOLIC FATTY LIVER DISEASE AND INSULIN RESISTANCE
Authors: R. Aller, D. De Luis, O. Izaola, M. González, R. Conde, T. Alvarez, L.I. Fernández, F. Lozano, E. Castro, J.M. González
Journal: Journal of Hepatology (2010)
A Medical Tour Through the Whole Island of Great Britain
Authors: T Snow
Journal: BMJ (1994)

Louis Appleby Faber, £14.99, pp 192 ISBN 0-571-16178-2

There was an unsurprisingly British reaction to the murder of James Bulger by two 10 year old boys, as to any other piece of depressing news: a yearning for times past - in this case, when families were more cohesive and the young were taught “the difference between right and wrong.” But we have a powerful ability to remember selectively things that were good about the past and to forget, more or less, what was corrupt, violent, degrading, or dull.

This is the engine that drives Louis …
Poverty and Child Health
Authors: I. Roberts
Journal: BMJ (1996)

Nick Spencer Radcliffe, £18.50, pp 240 ISBN 1 85775 068 3

If childhood poverty had no adverse health effects would paediatricians still write books about it? I like to think that they would. The systematic exclusion of children from full participation in society is unjust and detestable, and paediatricians as advocates for children should take action to stop it. But Nick Spencer's book Poverty and Child Health provides another compelling reason to put poverty high on the paediatric agenda—childhood poverty is a leading cause of …
Immunotherapy With Allergens
Authors: Richard W. Weber
Journal: JAMA (1997)

Allergen immunotherapy has been shown to be efficacious in numerous studies for the clinical indications of allergic asthma and rhinitis, as well as hymenoptera venom hypersensitivity. How allergen immunotherapy improves clinical symptoms is still not entirely clear. Decreases in specific IgE follow a complex cascade of effects: a shifting of the cytokine milieu from T<sub>H</sub>2 to T<sub>H</sub>1 predominance, with resultant decrease in interleukin 4, decreased recruitment and activation of eosinophils, and decreased proliferation of mast cells. Allergen exposure has a lessened ability to stimulate an inflammatory cell response, with decreased target organ hyperreactivity. Since allergen immunotherapy is not without risk, the decision needs to be made whether injection therapy is safe and provides benefit not achievable by medical management. The continued clarification of optimal allergen concentrations through careful studies of standardized extracts will allow better control of adverse events by limiting unnecessarily potent mixtures.
Peptic-Ulcer Factors in American Indians
Authors: MAURICE L. SIEVERS
Journal: Annals of Internal Medicine (1976)

Comments and Corrections1 June 1976Peptic-Ulcer Factors in American IndiansMAURICE L. SIEVERS, M.D., F.A.C.P.MAURICE L. SIEVERS, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-84-6-755_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In the recently published UCLA Conference, "A New Look at Peptic Ulcer" (Ann Intern Med 84:57-67, 1976), Sturdevant summarized epidemiologic studies that contribute to understanding genetic, psychological, and environmental factors predisposing to ulcer. Omitted from the presentation, however, were some significant observations among American Indians (1-3).Although the southwestern Indians develop gastric carcinoma and pernicious anemia as often as the general population, they have much lower rates for gastric ulcer and duodenal ulcer, especially for the latter (1, 2). In a 17-year period, the comparative frequency of these diagnoses amongfull heritagesouthwestern Indians at the Phoenix...References1. SIEVERS M: Unusual comparative frequency of gastric carcinoma, pernicious anemia, and peptic ulcer in southwestern American Indians. Gastroenterology 65:867-876, 1973 CrossrefMedlineGoogle Scholar2. SIEVERS M: Disease patterns among southwestern Indians. Public Health Rep 81:1075-1083, 1966 CrossrefMedlineGoogle Scholar3. SIEVERSMETZGERGOLDBERG MAL: Pernicious anemia in southwestern American Indians. Blood 41:309-317, 1973 CrossrefMedlineGoogle Scholar4. SIEVERS M: Cigarette and alcohol usage by southwestern American Indians. Am J Public Health 58:71-82, 1968 CrossrefGoogle Scholar5. SIEVERS M: Myocardial infarction among southwestern American Indians. Ann Intern Med 67:800-807, 1967 LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Phoenix Indian Medical Center Phoenix, AZ 85016 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 June 1976Volume 84, Issue 6Page: 755-756KeywordsDuodenal ulcersGastric ulcersMolecular epidemiologyNative American peoplePeptic ulcersPernicious anemia Issue Published: 1 June 1976 PDF downloadLoading ...
<i>BRCA1</i> and <i>BRCA2</i> Cancer Risks
Authors: Antonis C. Antoniou, Paul D.P. Pharoah, Douglas F. Easton, D. Gareth Evans
Journal: Journal of Clinical Oncology (2006)

Jewish families and consequently our complete analysis was repeated in 209 families (including 51 with BRCA mutations), with the 37 families of Jewish ancestry (15% of the probands) excluded as they suggest.Additional data for this comparison are given in Table 1.As reported in our article, the Manchester score (along with the Family History Assessment Tool) showed improved performance in this analysis, although the changes in accuracy (as measured by the area under the receiver operator curve) are not large and the overall rank order of the methods remains the same.Evans et al, are correct in noting that in the smaller group of non-Jewish families the differences between the methods no longer reach statistical significance, however, neither these data nor the findings of the recent study by Barcenas et al, 3 are consistent with the conclusion that the Manchester score outperforms other existing methods as has been suggested. 2Overall, the difference between the accuracy of the least accurate methods in our comparison and the highest levels of selection accuracy achieved, which were observed with the probabilistic methods when an adjustment was made to incorporate the pathology findings of the proband's tumor, could not be described as marginal.We have emphasized that the accuracy of a method is only one component that needs to be considered when selecting a family for BRCA gene testing.The experience and clinical expertise of local clinicians and counselors, the ethnic composition of the population, and the available resources all need to be taken into account when designing a testing strategy.However, in services where clinical, financial, or laboratory resources are limited, accurate selection of those families at genuinely increased risk is critical to achieving effective patient care.
Circulating Cancer Cells
Authors: Elizabeth A. McGrew
Journal: JAMA (1966)

This small book, volume 608 in the American Lecture Series, is a review of current knowledge regarding malignant cells in circulating blood. It is indeed a conscientious and fairly complete survey of the writings of those since 1829 who have wondered about the mechanisms of spread of tumor cells, and of those since 1955 who have struggled to develop techniques of isolation and recognition of tumor cells from blood samples. It is, on the whole, a faithful representation of the confusion which presently reigns in this field.  There is little conscious attempt to separate speculation from findings, and some nonchalance regarding the validity of reports of various authors. It is helpful in evaluating this work to learn that part of it was submitted as a thesis for the degree of MD at Cambridge. This explains a certain quality of innocence with regard to pathology, the precise morphologic criteria of malignancy
Neonatal mortality in Germany since the Chernobyl explosion.
Authors: J. Scheer
Journal: BMJ (1992)

difficult, is one based on the balance of proba- bilities.More research is required and should focus on the general concept of work related disorders rather than be confined to the upper limb.If health promotion is to mean anything it should mean that going to work tends to engender fitness.This is why unemployment is considered to be bad for society in general and individual workers in particular.A more positive attitude should be taken towards work, and this should be embodied in the concept that to work is to keep fit.No one would suggest that all pain at work was caused by the work itself: it may be caused by sports injuries acquired over a weekend or be part of intercurrent disease.Hence the importance of the therapeutic test of altering circumstances at work to see if the symptoms remit.With the implementation of the European Com- munity's regulations for workers the medical professions and ergonomists will have to cooperate if pains are to be prevented.Staff working in district rheumatological, orthopaedic, and remedial ser- vices should work more closely with occupational physicians and ergonomists.Perhaps it is time for a combined medicoergonomics society.
The cowardice continues.
Authors: J E Caughey
Journal: BMJ (1977)

group as a whole (P <0 025).The antipyrine half life of the 20 non-deficient people was 11 3±2-1 h, which was significantly shorter than in either the group as a whole (P < 0-05) or the 16 people with low vitamin levels (P< 0001).We conclude that poor nutrition in the elderly is at least in part responsible for the decline in microsomal enzyme function with age.
The Use and Efficacy of Child Restraint Devices
Authors: Michael D. Decker
Journal: JAMA (1984)

The Tennessee Child Passenger Protection Act, mandating the use of child restraint devices for children younger than 4 years, took effect in 1978. In the years 1978 through 1983, eighty-one children younger than 4 years died in Tennessee traffic accidents; only two were in child restraint devices. During this period, as child restraint device use rose from 8% to more than 30%, the number of deaths among children younger than 4 years declined more than 50%. Analysis of supplemental accident reports filed in investigations of motor vehicle accidents involving children younger than 4 years during 1982 and 1983 showed that child restraint devices are highly effective in preventing death and in preventing or reducing injury. Children not in child restraint devices were 11 times more likely to die in an accident than children in child restraint devices. Children traveling in the arms of an adult were exposed to a risk of injury or death comparable to that of children left entirely unrestrained.
'Brain Death' and Organ Retrieval
Authors: Tom Tomlinson
Journal: JAMA (1989)

To the Editor. —  Although I heartily agree with their conclusion that health professionals are confused over the meaning of death on a respirator, Youngner et al 1 lose sight of the most clinically important concern in a hunt for bigger philosophical game, which encourages a willingness to draw welcome conclusions from insufficient evidence.  One of the reported findings is that many health professionals have difficulty understanding and applying the whole-brain criterion of death. This conclusion is based largely on responses to the question, What  functions must be lost for a patient to be declared  dead? The only response scored as correct was irreversible loss of all  function. As a matter of fact, brain dead in the vernacular of both the health professions and the lay public refers to a whole spectrum of severe  damage. If understood in this vaguer sense, it is equally correct to
Abstract ES3-2: Clinical Trial Designs for New Therapies: What Agents Should We Study?
Authors: A DeMichele
Journal: Cancer Research (2012)

Abstract Biologically-targeted, novel agents hold great promise in breast cancer, but require adjustments to traditional study design, conduct and patient selection to be tested safely, effectively and economically. Key questions to be address in this talk include: Is the drug safe? Is it hitting the target? Can we identify the “right” patients to test? In what setting do we test it? Toxicities of these agents move well-beyond traditional myelosuppression and fatigue, encompassing almost every organ system and requiring changes in monitoring and management to assure safety. Dosing and assessment strategies must be aimed at optimally modulating target and assessing whether hitting the target has the desired effect on the natural history of the disease. The concurrent development of predictive biomarkers is necessary to select appropriate study subjects, which may be limited to a relatively small subset of patients with the disease. Finally, selecting the best therapeutic setting (treatment naïve, refractory, acquired resistance) can greatly impact the performance of the agent and requires knowledge of cancer biological evolution through the metastatic process. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr ES3-2.
Agencies scale up African relief
Authors: Chibuzo Odigwe
Journal: BMJ (2005)

The United Nations, aid agencies, and governments of rich countries are scaling up relief efforts to try to bring the food crisis in Niger and neighbouring areas under control.

Khaled Adly, acting regional director of the UN's World Food Programme in west Africa, said: “The generosity of donor countries and individuals has been tremendous over the past three weeks, but we still need more contributions to ensure that the people of Niger have enough food to get them through to the harvest in about 10 weeks' time.” The programme's $58m (£32m; €47m) appeal has so far raised only $33m.

The World Food Programme and other aid agencies, such as Medecins …
Tetraspanin family member CD9 inhibits Aggrus/podoplanin-induced platelet aggregation and suppresses pulmonary metastasis
Authors: Youya Nakazawa, Shigeo Sato, Mikihiko Naito, Yukinari Kato, Kazuhiko Mishima, Hiroyuki Arai, Takashi Tsuruo, Naoya Fujita
Journal: Blood (2008)