tbuckley/cabot-search huggingface dataset:
Hemodynamic effects of dynamic exercise in children and adolescents with moderate-to-small ventricular septal defects.
Authors: C Bendien, K K Bossina, A E Buurma, A M Gerding, J R Kuipers, M L Landsman, G A Mook, W G Zijlstra
Journal: Circulation (1984)

We studied the hemodynamic effects of dynamic exercise during cardiac catheterization in 35 children and adolescents with small-to-moderate ventricular septal defects. Eighteen of them exercised at 25% and 50% of their maximum workload and 17 exercised at 60%. There was no significant difference between the two groups with respect to age and body mass, height, and surface area. The changes evoked by exercise showed the same pattern at the different workloads, although they were more marked at the higher than at the lower percentage of maximum workload. During exercise the pulmonary vascular resistance did not change, in contrast to the systemic vascular resistance, which decreased. The pulmonary and systemic blood flows both increased, while the left-to-right shunt flow did not change, which led to a decrease of the left-to-right shunt fraction. As the heart rate increased and the shunt flow did not change, the shunt volume per beat decreased during exercise. We conclude that in patients with small-to-moderate ventricular septal defects the hemodynamic effects of dynamic exercise are favorable because the normal rise in systemic blood flow occurs without a corresponding increase in left-to-right shunt flow. Consequently, children and adolescents with such defects should not be restricted in their dynamic exercise activities.
The Predictive Value of Childhood Cholesterol Screening
Authors: William R. Clarke, Ronald M. Lauer
Journal: JAMA (1992)

A RECENT commentary inTHE JOURNAL, The Case Against 'the Case Against Childhood Cholesterol Screening,' by Resnicow et al, 1 questioned the methods and reasoning of our work evaluating the use of screening cholesterol levels in childhood to predict adult hypercholesterolemia. 2   Resnicow et al question our method of calculating the sensitivity and predictive value of childhood cholesterol levels in relation to adult hypercholesterolemia. We accepted the cutpoint suggested by the National Cholesterol Education Program Adult Treatment Panel for the identification of adults who require individual treatment by a health care professional. Resnicow et al are correct in indicating that this resulted in asking what percentage of adults (age 20 to 30 years) with cholesterol levels above about the 80th percentile had values greater than the 90th percentile as children. They indicate that this results in a test the sensitivity of which could not exceed 50%. While  this is the
United States starts to consider paying organ donors
Authors: D. Josefson
Journal: BMJ (2002)

The United States is moving closer to allowing payment for organ donation. Such payment has been outlawed since 1984, when Congress passed the National Organ Transplant Act, banning the sale of kidneys from living donors to organ brokers.

The 1984 act recognised only altruism as a motivation for organ donation. But altruism alone has not increased the pool of organ donors, leading to a shift in thinking. The ethical sea change now holds that it may be more unethical to fail to explore new ways of procuring organs and to make use of available organs than to proscribe their sale.

At its interim meeting in December 2001, the American Medical Association's Council for Ethical and …
Informed Consent for Genetic Research on Stored Tissue Samples
Authors: Ellen Wright Clayton
Journal: JAMA (1995)

To develop recommendations for obtaining adequate informed consent in the future when gathering tissue samples that may be used for genetic studies and defining the circumstances under which it is necessary to obtain further consent if tissue samples already in hand are to be used for such research.Scientists, ethicists, lawyers, and consumers selected by the National Center for Human Genome Research and the Centers for Disease Control and Prevention to represent a wide array of opinions.Statutes, regulations, and cases and articles on law and ethics.Initial workshop, followed by circulation of several drafts of this document with opportunities for comment by workshop participants and others as well as smaller meetings involving participants with widely differing views.Genetic research using stored tissue samples poses an array of benefits and risks to individuals, researchers, and society. As a result, the workshop participants conclude that (1) informed consent is required for all genetic research using linkable samples unless conditions for limitation or waiver are met; (2) informed consent is not required for genetic research using anonymous samples but may be considered if identifiers are to be removed from currently linkable samples; (3) institutional review boards could usefully review all protocols that propose to use samples for genetic research; and (4) further work regarding these issues is warranted.
Efficacy of entecavir in chronic hepatitis B patients with mildly elevated alanine aminotransferase and biopsy-proven histological damage
Authors: I‐Chin Wu, Ching‐Lung Lai, Steven‐Huy Bui Han, Kwang‐Hyup Han, Stuart C. Gordon, You‐Chen Chao, Chee‐Kiat Tan, William Sievert, Tawesak Tanwandee, Dong Xu, Boon‐Leong Neo, Ting‐Tsung Chang
Journal: Hepatology (2009)

Current guidelines for management of chronic hepatitis B recommend treatment for patients presenting with elevated hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) >2 × upper limit of normal (ULN) or histological evidence of liver disease. Retrospective analyses have demonstrated that significant hepatic necroinflammation and fibrosis were present in a substantial proportion of patients with ALT 1 to 2 × ULN. To assess therapeutic efficacy in this clinical setting, we retrospectively examined treatment endpoints among the subset of nucleoside-naïve chronic hepatitis B (CHB) patients treated in phase 3 clinical trials of entecavir who had both screening and baseline serum ALT 1.3 to 2 × ULN. A total of 1347 patients were randomized to treatment with entecavir or lamivudine. Three hundred thirty-six patients, constituting 25% of the total study population, had screening and baseline ALT 1.3 to 2 × ULN. Clinically significant necroinflammation (Knodell necroinflammation score ≥7) was observed in 60% and 72% of hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients, respectively, whereas marked fibrosis (Ishak fibrosis score ≥4) was observed in 8% and 15% of HBeAg-positive and HBeAg-negative patients, respectively. Among entecavir-treated HBeAg-negative patients, the proportions of patients achieving histological improvement, HBV DNA <300 copies/mL, and ALT normalization were similar between patients with mildly elevated ALT and those with ALT >2 × ULN. However, entecavir-treated HBeAg-positive patients with mildly elevated ALT had lower response rates for histological improvement, HBV DNA less than 300 copies/mL, ALT normalization, and HBeAg seroconversion than those with ALT greater than 2 × ULN. Conclusion: This retrospective analysis demonstrated that HBeAg-negative CHB patients treated with entecavir responded similarly irrespective of baseline ALT level. However, HBeAg-positive patients with mildly elevated ALT responded less well to treatment with entecavir than did those with ALT greater than 2 × ULN. (HEPATOLOGY 2010.)
Microfluorimetric analysis of a purinergic receptor (P2X7) in GH4C1 rat pituitary cells: effects of a bioactive substance produced by Pfiesteria piscicida.
Authors: A C Melo, P D Moeller, H Glasgow, J M Burkholder, J S Ramsdell
Journal: Environmental Health Perspectives (2001)

Pfiesteria piscicida Steidinger &amp; Burkholder is a toxic dinoflagellate that leads to fish and human toxicity. It produces a bioactive substance that leads to cytotoxicity of GH4C1 rat pituitary cells. Extracellular adenosine 5'-triphosphate (ATP) acting on P2X7 purinergic receptors induces the formation of a nonselective cation channel, causing elevation of the cytosolic free calcium followed by a characteristic permeabilization of the cell to progressively larger ions and subsequent cell lysis. We investigated whether GH4C1 rat pituitary cells express functional P2X7 receptors, and if so, are they activated by a bioactive substance isolated from toxic P. piscicida cultures. We tested the selective agonist 2'-3'-O-(benzoyl-4-benzoyl)-ATP (BzATP) and antagonists piridoxalphosphate-6-azophenyl-2'-4'-disulfonic acid (PPADS) and oxidized-ATP (oxATP) using elevated cytosolic free calcium in Fura-2 loaded cells, and induced permeability of these cells to the fluorescent dye YO-PRO-1 as end points. We demonstrated that in GH4C1 cells, BzATP induces both the elevation of cytosolic free calcium and the permeabilization of the cell membrane. ATP-induced membrane permeabilization was inhibited by PPADS reversibly and by oxATP irreversibly. The putative Pfiesteria toxin (pPfTx) also elevated cytosolic free calcium in Fura-2 in GH4C1 cells and increased the permeability to YO-PRO-1 in a manner inhibited fully by oxATP. This study indicates that GH4C1 cells express a purinoceptor with characteristics consistent with the P2X7 subtype, and that pPfTx mimics the kinetics of cell permeabilization by ATP.
Analysis of Observer Variability in Measurement of Pulmonary Artery Occlusion Pressures
Authors: TAMIM AL-KHARRAT, STUART ZARICH, YAW AMOATENG-ADJEPONG, CONSTANTINE A. MANTHOUS
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

The goal of this study was to determine inter- and intraobserver variability in measurement of pulmonary artery occlusion pressure (Ppao), comparing values recorded by critical care nurses and those measured by physician specialists. Critical care nurses (CCNs) obtained contiguous pulmonary artery and occlusion pressure paper tracings, up to twice a day, between June 1997 and March 1998. All tracings were interpreted on two separate occasions, in blinded fashion, by our Chiefs of Critical Care (CCMD) and Cardiology (CARD). Their values of Ppao were compared with those that had been recorded by CCNs. One hundred and forty-seven measurements of Ppao were performed on 40 patients with a mean age of 62.5 +/- 2.2 yr and a mean APACHE II score of 21.5 +/- 0.8. Either or both physician readers found 34 tracings as not satisfactory for Ppao interpretation. Intraobserver agreement of Ppao measurements, determined by correlation coefficients, was 0.91 for the CCMD and 0. 87 for the CARD. Correlation coefficients for interobserver comparisons were 0.83 for CCMD-CARD, 0.66 for CARD-CCN, and 0.67 for CCMD-CCN. Clinically significant differences were observed between CCMD-CARD (range of differences, -11 to 12 mm Hg), CARD-CCN (-13 to 15 mm Hg), and CCMD- CCN (-11 to 15 mm Hg). When Ppao readings were categorized as low (< 5 mm Hg), normal (5-15 mm Hg), and high (> 15 mm Hg), kappa values were 0.57 for CARD-CCMD, 0.51 for CARD-CCN, and 0.41 for CCMD-CCN comparisons. Interobserver variability was not explained by positive pressure ventilation or by the presence of (> 4 mm Hg) ventricular waves. The absolute values of interobserver differences in tracings with respiratory phasic variations (RPV) >/= 8 mm Hg were significantly greater than for tracings with variations < 8 mm Hg (p < 0.05, except CCMD-CCN, p = 0.10). Intraobserver differences also tended to be higher for tracings with RPV >/= 8 mm Hg (p = 0.06 and 0.05). When selected tracings were presented to 23 CCNs and 18 physicians, variability of Ppao interpretation was twice as great for tracings with large RPVs as compared with those with minimal RPVs. These data suggest that observer variability of Ppao interpretation is of potential clinical importance and that the degree of variability is associated with the magnitude of respiratory phasic variation of intrathoracic pressures. Although this could represent a local aberration, this study highlights a factor (respiratory phasic variation of Ppao) responsible for significantly increased intra- and interobserver variabilities.
Improving on improvement
Authors: Fiona Godlee
Journal: BMJ (2006)

Last week, members of a small but increasingly confident tribe of healthcare enthusiasts gathered in Prague for their annual meeting, the Forum on Quality Improvement in Health Care. Run jointly by the BMJ Publishing Group and the Institute for Healthcare Improvement (www.ihi.org/ihi), the forum is in its 11th year and, according to the feedback we've received, its best year yet.

Discussions in the sessions and over lunch—and through the evening in Prague's many bars—were wide ranging: what has happened to clinical leadership, what can happen when you learn to think like a designer, the importance …
Duodenal Decompression in Gastrectomy
Authors: Grant V. Rodkey, Claude E. Welch
Journal: New England Journal of Medicine (1960)

THE problems related to dissection and closure of the duodenum in gastrectomy for duodenal ulcer constantly stimulate surgeons to develop improved technics in their management. In general, the methods employed constitute an indirect or a direct approach to treatment of the duodenal ulcer. Representative of the former are the Bancroft operation,1 McKittrick's two-stage gastrectomy,2 vagotomy and gastroenterostomy,3 vagotomy and pyloroplasty4 and vagotomy with antral exclusion.5 All these methods avoid direct dissection of the ulcer and duodenal closure. They seek to accomplish permanent healing of the retained ulcer or, in McKittrick's procedure, amelioration of local inflammation to permit safer dissection after . . .
Immunologic Reactivity in Patients with Leprosy
Authors: JOHN N. SHEAGREN
Journal: Annals of Internal Medicine (1969)

Alterations in some aspects of immunologic reactivity in a group of patients with leprosy were found primarily in patients with the lepromatous form of the disease. Such patients had impaired lymphocyte transformation to streptolysin 0 antigen. The ability to form circulating antibodies was preserved. Levels of IgG and IgA immunoglobulins were increased in lepromatous disease while IgM levels were normal in all groups. The concentration of serum complement was normal in all patients with uncomplicated disease but was elevated in those lepromaotus patients suffering erythema nodosum leprosum (ENL) reactions or amyloidosis. Reticuloendothelial system phagocytic function was increased in patients with lepromatous leprosy and especially in those with ENL reactions. Thus, the lepromatous form of leprosy is associated with a variety of abnormal immunologic responses.
1072 LOWER CUT-OFF LIMIT FOR ALANINE TRANSAMINASE IS NOT EFFECTIVE IN EXCLUDING SIGNIFICANT HISTOLOGICAL DISEASE IN CHRONIC HEPATITIS C (HCV)
Authors: F.M. Sanai, A.A. Abdo, C.S. Dale, A.S. Helmy, K.I. Bzeizi, K. Katada, H. Al-Ashgar, H. Al-Husseini, M. Al-Quaiz, A. Hashim, H. AlMana, M.H. Rajab, P.J. Marotta
Journal: Journal of Hepatology (2010)
A CASE OF RENAL TUBERCULOSIS.
Authors: J. DUTTON STEELE
Journal: JAMA (1897)

The following case occurred in the wards of Dr. Joseph Hearn in the Philadelphia Hospital. I am indebted to him for the clinical history. L. H., 23 years of age, a native of Ireland, white and married. There is no tubercular family history. She was admitted in October 1896. The patient had measles in childhood. Influenza five years ago which left her with a "weak right side." In January 1896 she was delivered of a six months fetus and since that time has been confined to bed continually. She has become much emaciated and has a profuse diarrhea. Examination of abdomen shows a large mass the size of a baby's head, in the right lumbar region. This is movable, and the skin is not adherent. The tumor is not painful except on deep pressure. A slightly tympanic note is heard in percussion over this mass. There is marked edema posteriorly
ABC of Medical Computing: HOSPITAL BASED COMPUTER SYSTEMS
Authors: N. Lee, A. Millman
Journal: BMJ (1995)

A computer's usefulness is greatly enhanced if it is connected to others in a network, as this allows information and resources to be shared by all. A network can be anything from a simple link between two computers in an office to a complex installation joining thousands of computers at many sites around the world.

In a hospital two types of networks are commonly found. The first is the local area network (LAN), which is typically used to connect the secretaries and medical staff in one department. This allows everyone to use and build up a departmental database and to use standard letter templates for correspondence (such as clinic letters and discharge summaries), which saves time and greatly facilitates audit and research.

The second type is the wide area network (WAN), such as a hospital-wide system that connects all departments to a central computer running a patient administration system (PAS) with microwave or leased line links to outlying hospitals and clinics. Such networks are primarily designed to manage hospital activity (such as outpatient appointments, theatre lists, etc). Information about hospital activity extracted from these systems is required by purchasers and the Department of Health.

#### Advantages of networking



This is the simplest type of network and is ideal for linking a small number of computers together. The key feature of a peer to peer network is that all computers connected to it can be considered equal. Any hardware attached to one computer--such as a printer, CD ROM drive, or fax modem--can be made available to all computers on the network. Furthermore, users can, if they wish, easily share data stored on their hard discs with …
Hepatitis C virus: From epidemiology and molecular virology to immunobiology Koziel MJ, Dudley D, Afdhal N, Choo Q-L, Houghton M, Ralston R, Walker B. Hepatitis C virus (HCV): specific cytotoxic t lymphocytes recognized epitopes in the core and envelope proteins of HCV. J Virol 1993;67: 7522–7532
Authors: J Lau
Journal: Hepatology (1994)
High frequency oscillation in patients with acute lung injury and acute respiratory distress syndrome (ARDS): systematic review and meta-analysis
Authors: S. Sud, M. Sud, J. O. Friedrich, M. O. Meade, N. D. Ferguson, H. Wunsch, N. K. J. Adhikari
Journal: BMJ (2010)

Objective To determine clinical and physiological effects of high frequency oscillation compared with conventional ventilation in patients with acute lung injury/acute respiratory distress syndrome (ARDS). Design Systematic review and meta-analysis. Data sources Electronic databases to March 2010, conference proceedings, bibliographies, and primary investigators. Study selection Randomised controlled trials of high frequency oscillation compared with conventional ventilation in adults or children with acute lung injury/ARDS. Data selection Three authors independently extracted data on clinical, physiological, and safety outcomes according to a predefined protocol. We contacted investigators of all included studies to clarify methods and obtain additional data. Analyses used random effects models. Results Eight randomised controlled trials (n=419 patients) were included; almost all patients had ARDS. Methodological quality was good. The ratio of partial pressure of oxygen to inspired fraction of oxygen at 24, 48, and 72 hours was 16-24% higher in patients receiving high frequency oscillation. There were no significant differences in oxygenation index because mean airway pressure rose by 22-33% in patients receiving high frequency oscillation (P≤0.01). In patients randomised to high frequency oscillation, mortality was significantly reduced (risk ratio 0.77, 95% confidence interval 0.61 to 0.98, P=0.03; six trials, 365 patients, 160 deaths), and treatment failure (refractory hypoxaemia, hypercapnoea, hypotension, or barotrauma) resulting in discontinuation of assigned therapy was less likely (0.67, 0.46 to 0.99, P=0.04; five trials, 337 patients, 73 events). Other risks were similar. There was substantial heterogeneity between trials for physiological (I2=21-95%) but not clinical (I2=0%) outcomes. Pooled results were based on few events for most clinical outcomes. Conclusion High frequency oscillation might improve survival and is unlikely to cause harm. As ongoing large multicentre trials will not be completed for several years, these data help clinicians who currently use or are considering this technique for patients with ARDS.
Loss of FBP1 by Snail-Mediated Repression Provides Metabolic Advantages in Basal-like Breast Cancer
Authors: Chenfang Dong, Tingting Yuan, Yadi Wu, Yifan Wang, Teresa W.M. Fan, Sumitra Miriyala, Yiwei Lin, Jun Yao, Jian Shi, Tiebang Kang, Pawel Lorkiewicz, Daret St Clair, Mien-Chie Hung, B. Mark Evers, Binhua P. Zhou
Journal: Cancer Cell (2013)
Abstract SY31-01: Combinatorial development of biomaterials for tissue engineering and drug delivery
Authors: Daniel G. Anderson
Journal: Cancer Research (2011)

Abstract High throughput, combinatorial approaches have revolutionized small molecule drug discovery. Here we describe our work on high throughput methods for developing and characterizing biomaterials for drug delivery and tissue engineering. We have developed automated methods allowing for rapid nanoliter scale synthesis of 1000's of biomaterials, as well as the testing of their chemical, material, and biological properties. These methods have also been applied towards the development of new methods to control stem cell behavior, as well as vehicles for drug delivery. In particular, these combinatorial libraries of different biomaterials have enabled new methods for microparticulate drug delivery, non-viral gene therapy, siRNA delivery, and vaccines. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr SY31-01. doi:10.1158/1538-7445.AM2011-SY31-01
Racial and Socioeconomic Disparities in Childhood Mortality in Boston
Authors: Paul H. Wise, Milton Kotelchuck, Mark L. Wilson, Mark Mills
Journal: New England Journal of Medicine (1985)

We examined racial and income-related patterns of mortality from birth through adolescence in Boston, where residents have high access to tertiary medical care. Childhood mortality was significantly higher among black children (odds ratio, 1.24; P less than 0.05) and low-income children (odds ratio, 1.47; P less than 0.001). Socioeconomic effects varied for different age groups and causes of death. The largest relative disparity occurred in the neonatal and postneonatal periods, and the smallest in adolescence. Of the total racial differential in neonatal mortality (6.88 deaths per 1000 live births), 51.2 per cent occurred in premature infants, 13.4 per cent in term infants who were small for their gestational age, and 25.9 per cent in neonates who were both premature and small for their age. Black neonatal mortality was elevated at all income levels. Beyond the neonatal period, mortality from respiratory disease, fire, and homicide had strong inverse relationships with income, and mortality from injuries to the occupants of motor vehicles was directly related to income. These data suggest that despite access to tertiary medical services, substantial social differentiation in mortality may exist throughout childhood. Equity in childhood survival will probably require policies that emphasize preventive goals.