tbuckley/cabot-search huggingface dataset:
Case-crossover design in air pollution epidemiology
Authors: J.J.K. Jaakkola
Journal: European Respiratory Journal (2003)

The case-crossover design was developed to study the effects of transient, short-term exposures on the risk of acute events, such as myocardial infarction, in the early 1990s. This paper illustrates how the principles of case-crossover design are related to the principles of crossover and case-control designs and stipulates the possibilities of case-crossover design in air pollution epidemiology. In the case-crossover design, the study population consists of subjects who have experienced an episode of the health outcome of interest. Similar to a crossover study, each subject serves as his or her own control. As in a matched case-control study, the inference is based on a comparison of exposure distribution rather than the risk of disease. The case-crossover study is most suitable for studying relations with the following characteristics: 1) the individual exposure varies within short time intervals; 2) the disease has abrupt onset and short latency for detection; and 3) the induction period is short. Case-crossover design allows use of routinely monitored air pollution information and at the same time makes it possible to study individuals rather than days as the unit of observation. Case-crossover design is amenable for studying the effects of varying short-term air pollution exposure on health outcomes with an abrupt onset, such as myocardial infarction or asthma attack.
The J-Curve Phenomenon and the Treatment of Hypertension
Authors: Lisa Farnett
Journal: JAMA (1991)

We critically appraised the medical literature to evaluate whether there is a point beyond which blood pressure reduction in hypertensive subjects is no longer beneficial and possibly even deleterious. Thirteen studies that stratified cardiovascular outcomes by level of achieved blood pressure in treated hypertensive subjects who had been followed up for at least 1 year were critiqued by four independent reviewers. Data addressing population, protocol, and methodological characteristics were evaluated. Studies did not show a consistent J-shaped relationship between treated blood pressure and stroke, but they did demonstrate a consistent J-shaped relationship for cardiac events and diastolic blood pressure. The beneficial therapeutic threshold point was 85 mm Hg. We conclude that low treated diastolic blood pressure levels, ie, below 85 mm Hg, are associated with increased risk of cardiac events.
Enhanced Effectiveness of Photodynamic Therapy with Laser Light Fractionation in Patients with Esophageal Cancer
Authors: H. Messmann, R. M. Szeimies, W. Bäumler, R. Knüchel, H. Zirngibl, J. Schölmerich, A. Holstege
Journal: Endoscopy (1997)

Background and Study Aims: The fractionated application of laser light has been shown to enhance the effect of photodynamic therapy (PDT) on normal rat colon after photosensitization with 5-aminolevulinic acid. In a pilot study, we examined whether this modified laser treatment can also enhance the effect of PDT in patients with esophageal cancer after sensitization with hematoporphyrins.
Trends in Prostate Cancer Survival in Sweden, 1960 Through 1988: Evidence of Increasing Diagnosis of Nonlethal Tumors
Authors: F. Helgesen, L. Holmberg, J.-E. Johansson, R. Bergstrom, H.-O. Adami
Journal: JNCI Journal of the National Cancer Institute (1996)

Background:The incidence of prostate cancer has increased during the past 30 years but has been paralleled by increases in survival rates from this disease, despite the absence of documented major improvement in curative treatment. Since a high prevalence of microscopic prostate cancer has been observed in autopsied men and because many prostate cancers may never surface clinically, increased diagnostic activities might have led to increased detection of less aggressive tumors.
Metal Stents for Tumors of the Distal Esophagus and Gastric Cardia
Authors: P. D. Siersema, N. Marcon, N. Vakil
Journal: Endoscopy (2003)

More than 50 % of patients with cancer of the esophagus and gastric cardia have incurable disease at presentation and require palliative treatment for dysphagia. Placement of a self-expanding metal stent has become the treatment of choice for the majority of these patients. As the incidence of adenocarcinoma of the distal esophagus is rising rapidly [1], it is likely that deployment of metal stents across the gastroesophageal junction (GEJ) will increase. However, stenting of tumors of the distal esophagus and gastric cardia constitutes a particular problem. In comparison with stents placed for more proximally located esophageal tumors, these procedures provide inferior palliation and may have a higher complication rate [2].
ELECTROCONVULSIVE THERAPY FOLLOWING AN OPERATION FOR COARCTATION OF THE AORTA
Authors: SHIRLEY RUBERT
Journal: American Journal of Psychiatry (1961)

Improvement in and more widespread use of corrective surgical procedures for congenital anomalies will result in a new life experience for many patients. It will also increase the life span for some of them. These patients may present new problems for the psychiatrist. In the case reported here, unmodified electroconvulsive therapy was used without untoward effects in a man who had undergone a major intrathoracic vascular surgical procedure involving the use of a synthetic graft. The first treatment was given 47 days following the operation. Certain dramatic aspects of the preoperative and postoperative reactions have also been described.
Endosonographic Doppler-Guided Manometry of Esophageal Varices: Experimental Validation and Clinical Feasibility
Authors: J. M. Pontes, M. C. Leitão, F. Portela, A. Nunes, D. Freitas
Journal: Endoscopy (2002)

Background and Study Aims: The risk of variceal bleeding cannot be accurately predicted using endoscopy alone. Although variceal pressure has been demonstrated to be a major determinant for the rupture of esophageal varices, direct determination by needle puncture is unsuitable for routine clinical use. Due to their operator-dependency, current noninvasive endoscopic methods for determination of variceal pressure have not gained wide acceptance. We have developed a new method of measuring variceal pressure, using endoscopic power Doppler imaging to monitor the manometry of esophageal varices. The aims of this study were to test in vitro the accuracy of Doppler-guided manometry and to assess the clinical feasibility of this method. Materials and Methods: Experimental validation of this technique was performed using an in vitro model of artificial varices of different sizes. A linear-array endosonography (EUS) probe with power Doppler capability was used to assess flow in the varices and a balloon for manometry of esophageal varices was attached to the tip of the probe. Pressure readings were made at the time of disappearance of the Doppler signal during variceal compression by the balloon. Linear regression analysis was used to compare the results of Doppler-guided and direct intraluminal pressure measurement in the artificial varices. Variceal pressure was then measured with this technique in 28 patients with portal hypertension and esophageal varices without previous bleeding, and the results were compared with portal pressure assessed according to the hepatic vein pressure gradient (HVPG). Results: In vitro studies demonstrated a good correlation between the pressure measured with Doppler monitoring and the actual intravariceal pressure (r ≥ 0.922; P < 0.001). The determination of variceal pressure with this method was technically successful in 26/28 patients (93 %). The intraoperator variance was 9.3 ± 8.6 %. Overall, the mean variceal pressure was significantly lower than the mean HVPG (21.2 ± 5.3 mmHg vs. 24.3 ± 7.8 mmHg; P < 0.01). Variceal pressure and portal pressure (as assessed by the HVPG) correlated significantly (r = 0.64; P < 0.001). Conclusions: Our preliminary results indicate that EUS Doppler-guided manometry of esophageal varices is feasible and accurate. This technique may become a more reliable method for noninvasive measurement of variceal pressure and warrants further investigation.
The SUPPORT Project and Improving Care for Seriously III Patients
Authors: Bruce Jennings
Journal: JAMA (1996)

<h3>To the Editor.</h3> —The SUPPORT project<sup>1</sup>found that an intervention designed to enhance health care decision making near the end of life failed to achieve improvements in end-of-life care. We are concerned that these results may lead many clinicians and the public to draw overly broad or negative conclusions about the possibility of improving terminal and palliative care in the United States. In various capacities, each of us has been involved in Decisions Near the End of Life, a national initiative to improve health care decision making for critically ill and terminally ill patients. To date, 160 hospitals and nursing homes in 31 states and approximately 35 000 health care professionals are participating in this initiative. These facilities constitute a virtual laboratory for looking more closely at whether and how end-of-life care can be improved. We have seen that change is possible, but only if program planners adopt a
Large genomic deletions of SMAD4, BMPR1A and PTEN in juvenile polyposis
Authors: W. A. van Hattem, L. A. A. Brosens, W. W. J. de Leng, F. H. Morsink, S. Lens, R. Carvalho, F. M. Giardiello, G. J. A. Offerhaus
Journal: Gut (2008)

Juvenile polyposis syndrome (JPS) is a rare autosomal dominant disorder characterised by multiple gastrointestinal juvenile polyps and an increased risk of colorectal cancer. This syndrome is caused by germline mutation of either SMAD4 or BMPR1A, and possibly ENG. PTEN, originally linked to Cowden syndrome and Bannayan-Riley-Ruvalcaba syndrome, has also been associated with JPS. By direct sequencing, germline mutations are found in only 30-40% of patients with a JPS phenotype. Therefore, alternative ways of inactivation of the known JPS genes, or additional genes predisposing to JPS may be involved. In this study, a comprehensive genetic analysis of SMAD4, BMPR1A, PTEN and ENG is performed through direct sequencing and multiplex ligation-dependent probe amplification (MLPA) in JPS patients.Archival material of 29 patients with JPS from 27 families was collected. Direct sequencing and MLPA analysis were performed to search for germline defects in SMAD4, BMPR1A, PTEN and ENG.A germline defect in SMAD4, BMPR1A or PTEN was found in 13 of 27 (48.1%) unrelated JPS patients. Nine mutations (33.3%) were detected by direct sequencing, including six (22.2%) SMAD4 mutations and three (11.1%) BMPR1A mutations. MLPA identified four additional patients (14.8%) with germline hemizygous large genomic deletions, including one deletion of SMAD4, one deletion of exons 10 and 11 of BMPR1A, and two unrelated patients with deletion of both BMPR1A and PTEN. No ENG gene mutations were found.Large genomic deletions of SMAD4, BMPR1A and PTEN are a common cause of JPS. Using direct sequencing and MLPA, a germline defect was detected in 48.1% of JPS patients. MLPA identified 14.8% (4/27) of these mutations. Since a substantial percentage of JPS patients carry a germline deletion and MLPA is a reliable and user-friendly technique, it is concluded that MLPA is a valuable adjunct in JPS diagnosis.
Brain Volume and Metabolism in Fetuses With Congenital Heart Disease
Authors: Catherine Limperopoulos, Wayne Tworetzky, Doff B. McElhinney, Jane W. Newburger, David W. Brown, Richard L. Robertson, Nicolas Guizard, Ellen McGrath, Judith Geva, David Annese, Carolyn Dunbar-Masterson, Bethany Trainor, Peter C. Laussen, Adré J. du Plessis
Journal: Circulation (2009)

Adverse neurodevelopmental outcome is an important source of morbidity in children with congenital heart disease (CHD). A significant proportion of newborns with complex CHD have abnormalities of brain size, structure, or function, which suggests that antenatal factors may contribute to childhood neurodevelopmental morbidity.Brain volume and metabolism were compared prospectively between 55 fetuses with CHD and 50 normal fetuses with the use of 3-dimensinal volumetric magnetic resonance imaging and proton magnetic resonance spectroscopy. Fetal intracranial cavity volume, cerebrospinal fluid volume, and total brain volume were measured by manual segmentation. Proton magnetic resonance spectroscopy was used to measure the cerebral N-acetyl aspartate: choline ratio (NAA:choline) and identify cerebral lactate. Complete fetal echocardiograms were performed. Gestational age at magnetic resonance imaging ranged from 25 1/7 to 37 1/7 weeks (median, 30 weeks). During the third trimester, there were progressive and significant declines in gestational age-adjusted total brain volume and intracranial cavity volume in CHD fetuses relative to controls. NAA:choline increased progressively over the third trimester in normal fetuses, but the rate of rise was significantly slower (P<0.001) in CHD fetuses. On multivariable analysis adjusted for gestational age and weight percentile, cardiac diagnosis and percentage of combined ventricular output through the aortic valve were independently associated with total brain volume. Independent predictors of lower NAA:choline included diagnosis, absence of antegrade aortic arch flow, and evidence of cerebral lactate (P<0.001).Third-trimester fetuses with some forms of CHD have smaller gestational age- and weight-adjusted total brain volumes than normal fetuses and evidence of impaired neuroaxonal development and metabolism. Hemodynamic factors may play an important role in this abnormal development.
Medical Motion Pictures in Private Practice
Authors: Donald W. Leonard
Journal: New England Journal of Medicine (1947)

PRIVATE practice, especially in rural communities, often makes an active physician believe that he is no longer practicing scientific medicine. He must fight the impression that the distance between him and the nearest medical center is directly responsible for the distance he seems to be from ever producing anything of value to medical science. When faced with the reality of a patient at home, he is sure to remember the skillful correlation of x-ray, laboratory and clinical facts that gave him such pride as an intern and to feel dismayed at the seeming hypocrisy of entering a private home to . . .
Hercule Poirot and the unquiet brain
Authors: Steven Rose
Journal: The Lancet Neurology (2007)

"Have you ever noticed how wonderful a baby's head smells?" asks Louis Cozolino. Indeed! And it is hard not to cheer the author of a neuroscience text who is able to permit himself such responses. But then Cozolino is a clinical psychologist rather than a neuroscientist, and his book is an attempt to relate knowledge of brain function to the study and treatment of clinical states such as depression, anxiety, self-harm, and psychopathy. His perspective is clear from the title and opening pages. Traditional neuroscience is reductive and individualising, treating brains practically in isolation from bodies, let alone the outside world.
SPECIFIC READING DISABILITY— STREPHOSYMBOLIA
Authors: SAMUEL T. ORTON
Journal: JAMA (1928)

It has long been recognized that there are certain children who have a more or less selective difficulty in learning to read. The earlier observers of this condition, among them Berkhan,<sup>1</sup>in 1885, apparently assumed that it was related to a general mental defect and described such cases as partial imbeciles (halbidiote). A more or less complete inability to learn to read, particularly when it is associated as it often is with atrocious handwriting and poor spelling, naturally enough would incline the uncritical observer to assume that the child was, if not truly defective, at least not as bright as he should be to accomplish his school tasks. Very often the logic of this explanation forms a typical vicious circle. The child is said to be feebleminded because he cannot learn to read, and his inability to learn to read is said to be because he is feebleminded. Gradually,
Changes in L-type calcium channel abundance and function during the transition to pacing-induced congestive heart failure
Authors: Rupak Mukherjee, Kenneth W Hewett, Jennifer D Walker, Charles G Basler, Francis G Spinale
Journal: Cardiovascular Research (1998)

Objective: The development of congestive heart failure (CHF) is accompanied by left ventricular (LV) and myocyte contractile dysfunction. However, time-dependent cellular and ionic events which contribute to the initiation and progression of CHF remain unclear. This study tested the central hypothesis that changes in L-type Ca2+ channel current (ICa) and abundance (Bmax) are early events in the transition to CHF. Methods: LV fractional shortening by echocardiography, isolated LV myocyte shortening velocity by videomicroscopy, ICa by voltage-clamp, and Bmax by [3H]nitrendipine binding were determined at each week during the progression of pacing-induced CHF in pigs (240 bpm; n=6/week for 3 weeks). Myocyte and L-type Ca2+ channel function were determined under basal conditions and after β-adrenergic receptor stimulation with 25 nM isoproterenol. Results: After 1 week of pacing, myocyte and L-type Ca2+ current responses to β-adrenergic receptor stimulation were reduced by 20% from control values and was accompanied by over a 210% increase in plasma catecholamine levels. After 2 weeks of pacing, reductions in LV fractional shortening and myocyte shortening velocity from control values (20±1 vs. 34±2% and 36.7±2.9 vs. 50.6±2.4 μm/s, respectively, P<0.05) were paralleled by decreased ICa (2.47±0.10 vs. 3.63±0.25 pA/pF, P<0.02) and Bmax (149±16 vs. 180±12 fmol/mg, P<0.03). After 3 weeks of pacing, LV fractional shortening was reduced by over 50%, myocyte shortening velocity by 37%, and ICa and Bmax were reduced by over 25% from control values. Furthermore, after 3 weeks of pacing, the ICa/Bmax ratio was reduced from control values (16.2±0.9 vs. 20.6±1.2 [fA/pF]/[fmol/mg], P<0.03), which suggests functional defects in the remaining L-type Ca2+ channels. Conclusions: An early event during the transition to pacing-induced CHF was diminished β-adrenergic receptor augmented L-type Ca2+ current, which was followed by an absolute loss of steady-state L-type Ca2+ current and channel abundance. The development of severe CHF was accompanied by a loss of Ca2+ carrying capacity through residual channels. These unique findings suggest that a contributory molecular mechanism for the initiation and progression of CHF is changes in the structure and function of the L-type Ca2+ channels.
Ethical and Human-Rights Issues in Research on Mental Disorders That May Affect Decision-Making Capacity
Authors: Alexander Morgan Capron
Journal: New England Journal of Medicine (1999)

For research with human subjects, the more things change, the more they remain the same. In the 50-odd years since the 10 principles of the Nuremberg Code were set forth by the U.S. judges who convicted the Nazi concentration-camp physicians of crimes against humanity, the tensions inherent in using human beings as a means to advance biomedical knowledge have surfaced repeatedly. Ever more detailed codes and regulations from governments as well as professional bodies, such as the World Medical Association in its oft-revised Declaration of Helsinki,1 have not put the subject to rest. Indeed, the lesson of the past half-century . . .
P103Impact of diabetes mellitus on myofilaments phosphorylation and calcium sensitivity is aortic stenosis patients
Authors: I Falcao-Pires, P Wijnke, C Gavina, WJ Paulus, AF Leite-Moreira, J Van Der Velden
Journal: Cardiovascular Research (2014)

Background: Diabetes mellitus (DM) is an independent risk factor for progression of aortic valve stenosis (AS) and significantly impacts longterm outcome after valve replacement. Our aim was to clarify myofilamentary changes induced by DM on AS patients.
The Fetus as Patient: Ethical Issues
Authors: John C. Fletcher
Journal: JAMA (1981)

Harrison and others, elsewhere in this issue ofThe Journal(p 774), point to a growing number of treatable congenital defects in the fetus. By my count there are 33 opportunities for treatment, mainly after induced or cesarean delivery. The authors cite seven opportunities for in utero treatment. Techniques of sonography, fetoscopy, amniocentesis, amniography, and fluid collection in the fetus are used in prenatal diagnosis of the defect. Treatments vary from an indirect mode through the mother to direct manipulation of the fetus, including surgery. The authors write that it "seems that the fetus with a treatable birth defect is on the threshold of becoming a patient." What are the "complex ethical issues" raised by fetal therapy to which the authors refer? At first glance these issues will not be apparent because the facts reported here will be "good news" to most physicians and the public. I, too, rejoice in
Quantifying Options for Reducing Coronary Heart Disease Mortality By 2020
Authors: Mark D. Huffman, Donald M. Lloyd-Jones, Hongyan Ning, Darwin R. Labarthe, Maria Guzman Castillo, Martin O’Flaherty, Earl S. Ford, Simon Capewell
Journal: Circulation (2013)

The American Heart Association (AHA) 2020 Strategic Impact Goal proposes a 20% improvement in cardiovascular health of all Americans. We aimed to estimate the potential reduction in coronary heart disease (CHD) deaths.We used data on 40 373 adults free of cardiovascular disease from the National Health and Nutrition Examination Survey (NHANES; 1988-2010). We quantified recent trends for 6 metrics (total cholesterol, systolic blood pressure, physical inactivity, smoking, diabetes mellitus, and obesity) and generated linear projections to 2020. We projected the expected number of CHD deaths in 2020 if 2006 age- and sex-specific CHD death rates remained constant, which would result in ≈480 000 CHD deaths in 2020 (12% increase). We used the previously validated IMPACT CHD model to project numbers of CHD deaths in 2020 under 2 different scenarios: (1) Assuming a 20% improvement in each cardiovascular health metric, we project 365 000 CHD deaths in 2020 (range 327 000-403 000) a 24% decrease reflecting modest reductions in total cholesterol (-41 000), systolic blood pressure (-36 000), physical inactivity (-12 000), smoking (-10 000), diabetes mellitus (-10 000), and obesity (-5000); (2) Assuming that recent risk factor trends continue to 2020, we project 335 000 CHD deaths (range 274 000-386 000), a 30% decrease reflecting improvements in total cholesterol, systolic blood pressure, smoking, and physical activity (≈167 000 fewer deaths), offset by increases in diabetes mellitus and body mass index (≈24 000 more deaths).Two contrasting scenarios of change in cardiovascular health metrics could prevent 24% to 30% of the CHD deaths expected in 2020, though with differing effects by age. Unfavorable continuing trends in obesity and diabetes mellitus would have substantial adverse effects. This analysis demonstrates the utility of modelling to inform health policy.
Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis
Authors: Colin N A Palmer, Alan D Irvine, Ana Terron-Kwiatkowski, Yiwei Zhao, Haihui Liao, Simon P Lee, David R Goudie, Aileen Sandilands, Linda E Campbell, Frances J D Smith, Gráinne M O'Regan, Rosemarie M Watson, Jo E Cecil, Sherri J Bale, John G Compton, John J DiGiovanna, Philip Fleckman, Sue Lewis-Jones, Gehan Arseculeratne, Ann Sergeant, Colin S Munro, Brahim El Houate, Ken McElreavey, Liselotte B Halkjaer, Hans Bisgaard, Somnath Mukhopadhyay, W H Irwin McLean
Journal: Nature Genetics (2006)
IMPACT OF POINT-OF-CARE PLATELET FUNCTION TESTING AMONG DIABETIC AND NON-DIABETIC PATIENTS UNDERGOING PCI WITH DRUG-ELUTING STENTS: AN ADAPT-DES SUBSTUDY
Authors: Ajay J. Kirtane, Thomas Stuckey, Helen Parise, Bernhard Witzenbichler, Giora Weisz, Michael Rinaldi, Franz-Josef Neumann, David Metzger, Timothy Henry, David Cox, Peter Duffy, Bruce Brodie, Ernest Mazzaferri, Ecaterina Cristea, Roxana Mehran, Gregg Stone
Journal: Journal of the American College of Cardiology (2012)