tbuckley/cabot-search huggingface dataset:
Diagnosis and treatment of early breast cancer, including locally advanced disease--summary of NICE guidance
Authors: A. Harnett, J. Smallwood, V. Titshall, A. Champion
Journal: BMJ (2009)

Breast cancer is the commonest cancer in women, with over 40 500 new cases diagnosed each year in England and Wales.1 2 Despite a steady decline in age standardised mortality rates owing to screening and better management, the disease still causes 10 900 deaths each year in England and Wales,1 2 with a huge social and emotional impact. This article outlines the most important recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the diagnosis and treatment of early and locally advanced breast cancer.3 NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group's opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. This new guideline covers women presenting with breast cancer in whom the primary tumour may have been non-palpable and detected by screening mammography through to women with cancers over 5 cm but in whom there is no evidence of spread beyond the breast and axillary lymph nodes. The guideline includes a large spectrum of disease, ranging from ductal carcinoma in situ (DCIS) to inflammatory breast cancer, and also includes breast cancer in men, which is rare. Advanced breast cancer is the subject of another guideline.4 ### Diagnosis and preoperative assessment
Coronary Artery Bypass With Only In Situ Bilateral Internal Thoracic Arteries and Right Gastroepiploic Artery
Authors: Hiroshi Nishida, Yasuko Tomizawa, Masahiro Endo, Hitoshi Koyanagi, Hiroshi Kasanuki
Journal: Circulation (2001)

With the rapid advance of catheter intervention, the direction taken by surgeons is not only to make conventional CABG less invasive but also to pursue better long-term results by using more arterial conduits.Between July 1989 and April 2000, 239 patients (218 men, 21 women) with a mean age of 59.7 (range 39 to 79) years underwent CABG with exclusive use of both internal thoracic arteries (ITAs) and the right gastroepiploic artery (RGEA). ITA grafts were harvested by using the skeletonization technique. Most patients (96%) had either triple-vessel or left main disease. Fifty percent of the patients were diabetic, and 16 were being treated with insulin. The left ventricular ejection fraction was </=40% in 46 patients (19%). Eleven patients (5%) had chronic renal failure and were on hemodialysis. Follow-up was completed in 235 patients (98%). Postoperative follow-up averaged 43 (range 1 to 129) months. Sequential grafting was performed in 64 patients, and the mean number of anastomoses was 3.3. One patient (0.4%) died of mediastinitis on the 53rd postoperative day. Graft patency was confirmed angiographically in 230 patients (96%) 2 to 3 weeks after surgery. The patency rate was 97.1% for the left ITA, 99.6% for the right ITA, and 95.5% for the RGEA. Five-year actuarial survival rate was 92.9%, and the cardiac death-free rate was 97.8%.Complete arterial grafting with both ITAs and RGEA was associated with minimal operative risk, a high early graft patency rate, and excellent long-term results.
Adherence to the Mediterranean Diet Is Inversely Associated With Circulating Interleukin-6 Among Middle-Aged Men
Authors: Jun Dai, Andrew H. Miller, J. Douglas Bremner, Jack Goldberg, Linda Jones, Lucy Shallenberger, Rocky Buckham, Nancy V. Murrah, Emir Veledar, Peter W. Wilson, Viola Vaccarino
Journal: Circulation (2007)

Background— The Mediterranean diet is protective against cardiovascular disease; a proposed mechanism is through a reduction in systemic inflammation. It is unknown to what extent the association between the Mediterranean diet and inflammation is due to genetic or other familial factors. Methods and Results— We administered the Willett food frequency questionnaire to 345 middle-aged male twins and assessed adherence to the Mediterranean diet using a published adherence score. Fasting plasma levels of interleukin-6, C-reactive protein, and known cardiovascular risk factors were measured. Mixed-effect regression analyses were used to examine the relationship between diet score and inflammatory biomarkers after accounting for known cardiovascular risk factors. Adherence to the Mediterranean diet was associated with reduced levels of interleukin-6 ( P &lt;0.001) but not C-reactive protein ( P =0.10) after adjustment for total energy intake, other nutritional factors, known cardiovascular risk factors, and use of supplements and medications. When the overall association of adherence to the diet with interleukin-6 levels was partitioned into between- and within-pair effects, the between-pair effect was not significant ( P =0.9) and the within-pair effect was highly significant ( P &lt;0.0001). A 1-unit within-pair absolute difference in the diet score was associated with a 9% (95% CI, 4.5 to 13.6) lower interleukin-6 level. Conclusions— Shared environmental and genetic factors are unlikely to play a major role in the association between adherence to the Mediterranean diet and systemic inflammation. These results support the hypothesis that reduced inflammation is an important mechanism linking Mediterranean diet to reduced cardiovascular risk.
775-2 Deleterious Effect of Smoking on the Elastic Properties of the Aorta
Authors: Christodoulos Stefanadis, Charalambos Vlachopoulos, Costas Stratos, loannis Kallikazaros, Eleftherios Tsiamis, Stelios Marakas, Assimakis Sideris, Lambros Sioras, Harisios Boudoulas, Pavlos Toutouzas
Journal: Journal of the American College of Cardiology (1995)
The Effect of Selection Environment on the Probability of Parallel Evolution
Authors: Susan F. Bailey, Nicolas Rodrigue, Rees Kassen
Journal: Molecular Biology and Evolution (2015)

Across the great diversity of life, there are many compelling examples of parallel and convergent evolution-similar evolutionary changes arising in independently evolving populations. Parallel evolution is often taken to be strong evidence of adaptation occurring in populations that are highly constrained in their genetic variation. Theoretical models suggest a few potential factors driving the probability of parallel evolution, but experimental tests are needed. In this study, we quantify the degree of parallel evolution in 15 replicate populations of Pseudomonas fluorescens evolved in five different environments that varied in resource type and arrangement. We identified repeat changes across multiple levels of biological organization from phenotype, to gene, to nucleotide, and tested the impact of 1) selection environment, 2) the degree of adaptation, and 3) the degree of heterogeneity in the environment on the degree of parallel evolution at the gene-level. We saw, as expected, that parallel evolution occurred more often between populations evolved in the same environment; however, the extent of parallel evolution varied widely. The degree of adaptation did not significantly explain variation in the extent of parallelism in our system but number of available beneficial mutations correlated negatively with parallel evolution. In addition, degree of parallel evolution was significantly higher in populations evolved in a spatially structured, multiresource environment, suggesting that environmental heterogeneity may be an important factor constraining adaptation. Overall, our results stress the importance of environment in driving parallel evolutionary changes and point to a number of avenues for future work for understanding when evolution is predictable.
Stenting in Chronic Coronary Occlusion (SICCO): A multicenter, randomized, controlled study
Authors: Per A. Simes, Svein Golf, Yngvar Myreng, Per Mo/lstad, Per Albertsson, Håkan Emanuelsson, Magne Brekke, Arild Mangschau, Knut Endresen, John Kjekshus
Journal: Journal of the American College of Cardiology (1996)
Should Parents Speak with a Dying Child about Impending Death?
Authors: Lawrence Wolfe
Journal: New England Journal of Medicine (2004)

In 1985, a reading of Patrick Irvine's essay in the Journal about his participation in the funerals of his patients1 eased concerns of my own about attending the funerals of my young patients who have succumbed to cancer. At these services, I have heard "Suffer the little children . . ." from the New Testament and the 23rd Psalm from the Old Testament many times. These words are regularly chosen to help alleviate the inconsolable grief that follows the death of a child. The presence of the physician at these funerals can honor the struggle of the family and the . . .
Glucoregulation during exercise: hypoglycemia is prevented by redundant glucoregulatory systems, sympathochromaffin activation, and changes in islet hormone secretion.
Authors: D R Hoelzer, G P Dalsky, W E Clutter, S D Shah, J O Holloszy, P E Cryer
Journal: Journal of Clinical Investigation (1986)

During mild or moderate nonexhausting exercise, glucose utilization increases sharply but is normally matched by increased glucose production such that hypoglycemia does not occur. To test the hypothesis that redundant glucoregulatory systems including sympathochromaffin activation and changes in pancreatic islet hormone secretion underlie this precise matching, eight young adults exercised at 55-60% of maximal oxygen consumption for 60 min on separate occasions under four conditions: (a) control study (saline infusion); (b) islet clamp study (insulin and glucagon held constant by somatostatin infusion with glucagon and insulin replacement at fixed rates before, during and after exercise with insulin doses determined individually and shown to produce normal and stable plasma glucose concentrations prior to each study); (c) adrenergic blockage study (infusions of the alpha- and beta-adrenergic antagonists phentolamine and propranolol); (d) adrenergic blockade plus islet clamp study. Glucose production matched increased glucose utilization during exercise in the control study and plasma glucose did not fall (92 +/- 1 mg/dl at base line, 90 +/- 2 mg/dl at the end of exercise). Plasma glucose also did not fall during exercise when changes in insulin and glucagon were prevented in the islet clamp study. In the adrenergic blockade study, plasma glucose declined initially during exercise because of a greater initial increase in glucose utilization, then plateaued with an end-exercise value of 74 +/- 3 mg/dl (P less than 0.01 vs. control). In contrast, in the adrenergic blockade plus islet clamp study, exercise was associated with glucose production substantially lower than control and plasma glucose fell progressively to 58 +/- 7 mg/dl (P less than 0.001); end-exercise plasma glucose concentrations ranged from 34 to 72 mg/dl. Thus, we conclude that: (a) redundant glucoregulatory systems are involved in the precise matching of increased glucose utilization and glucose production that normally prevents hypoglycemia during moderate exercise in humans. (b) Sympathochromaffin activation, perhaps sympathetic neural norepinephrine release, plays a primary glucoregulatory role by limiting glucose utilization as well as stimulating glucose production. (c) Changes in pancreatic islet hormone secretion (decrements in insulin, increments in glucagon, or both) are not normally critical but become critical when catecholamine action is deficient. (d) Glucoregulation fails, and hypoglycemia can develop, both when catecholamine action is deficient and when changes in islet hormones do not occur during exercise in humans.
CARDIAC TROPONIN ELEVATION PATTERN FOLLOWING PERCUTANEOUS CORONARY INTERVENTION FOR PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION.
Authors: Yonatan Buber, Avishag Farkash- Laish, Paul Fefer, Amit Segev, Hanoch Hod, Shlomi Matatzki
Journal: Journal of the American College of Cardiology (2011)
Sulphonamides and Streptomycin in Bacillary Dysentery
Authors: J. Falisevac, Z. Kosutic, M. Galinovic-Weisglass
Journal: BMJ (1959)

<h3>SUMMARY</h3> Despite the discovery of new pathogens and the evolving problem of antibiotic resistance, the basic trends in community-acquired pneumonia remain remarkably constant. This article reviews the common pathogens, new pathogens, their clinical presentations, the diagnostic workup, the decision to hospitalize, antibiotic resistance, and antibiotic choices.
SIMPLE METHODS OF SEWAGE DISPOSAL.Read in the Section of State Medicine, at the Forty-second Annual Meeting of the American Medical Association, Washington, D. C., May 5, 1891.
Authors: C. W. CHANCELLOR
Journal: JAMA (1891)

Among the many problems engaging the attention of sanitary engineers, that which embraces the removal or disposal of household sewage, is perhaps the most important. With the advance of natural sciences, the principles which are recognized as governing health and disease have been gradually developed, until we are now face to face with the fact that if we would be free from filth diseases, it is necessary to remove from our midst those elements which are either their direct cause or agents of transmission.  The question resolves itself into disposing of such matters in a manner best suited to the conditions and locality in which they are produced, having regard:  1. To the sanitary efficiency of the method employed.  2. To the economical attainment of the result aimed at; and  3. To the method of disposal affording some return for the means expended.  The conclusions which naturally follow the foregoing
Immunosuppressive Therapy and Tolerance of Organ Allografts
Authors: Thomas E. Starzl
Journal: New England Journal of Medicine (2008)

In this issue of the Journal, three articles describe several organ-transplant recipients in whom allografts have maintained good function for up to 5 years without immunosuppressive treatment.13 In two articles concerning combined kidney and hematopoietic stem-cell transplantation, the authors attributed the successful outcome in their patients to the cotransplantation of donor stem cells.1,2 The third report, by Alexander et al., concerns a young girl who received a completely HLA-mismatched liver from a deceased male donor but did not receive a donor stem-cell infusion.3 The cause of the fulminant hepatic failure with which the patient presented was never firmly . . .
Human peripheral blood lymphocytes bearing T cell receptor gamma/delta. Expression of CD8 differentiation antigen correlates with the expression of the 55-kD, C gamma 2-encoded gamma chain.
Authors: A Moretta, C Bottino, E Ciccone, G Tambussi, M C Mingari, S Ferrini, G Casorati, P Varese, O Viale, N Migone
Journal: The Journal of Experimental Medicine (1988)

We analyzed the CD3-associated molecules present on peripheral blood-derived TCR-gamma/delta+ clones that express CD8 surface antigens. Clones were derived by limiting dilution from CD3+WT31- FACS-purified populations derived from several donors. Eight of greater than 300 TCR-gamma/delta+ clones analyzed expressed CD8 and reacted with delta-TCS-1 mAb. Cell numbers suitable for more detailed analyses could be obtained from four clones, including one derived from thymus. Analysis of CD3-associated TCR molecules immunoprecipitated by anti-Leu-4 (anti-CD3) mAb under conditions that preserve the CD3/TCR association (1% digitonin) showed a predominant 55-60-kD molecule both under reducing and nonreducing conditions. On the other hand, the delta-TCS-1-reactive molecules immunoprecipitated from 25 CD3+ delta-TCS-1+ CD8- clones, in all instances, displayed a 40-44-kD mol mass. In two-dimensional PAGE, TCR-gamma molecules precipitated from delta-TCS-1+ CD8+ clones appeared more acidic than those of BB3+ or delta-TCS-1+ CD8+ clones. Southern analysis confirmed that this type of non-disulphide-linked TCR-gamma/delta is also coded for by the C gamma 2 gene segment.
The Science behind 25 Years of Ovarian Stimulation for in Vitro Fertilization
Authors: Nick S. Macklon, Richard L. Stouffer, Linda C. Giudice, Bart C. J. M. Fauser
Journal: Endocrine Reviews (2006)

To allow selection of embryos for transfer after in vitro fertilization, ovarian stimulation is usually carried out with exogenous gonadotropins. To compensate for changes induced by stimulation, GnRH analog cotreatment, oral contraceptive pretreatment, late follicular phase human chorionic gonadotropin, and luteal phase progesterone supplementation are usually added. These approaches render ovarian stimulation complex and costly. The stimulation of multiple follicular development disrupts the physiology of follicular development, with consequences for the oocyte, embryo, and endometrium. In recent years, recombinant gonadotropin preparations have become available, and novel stimulation protocols with less detrimental effects have been developed. In this article, the scientific background to current approaches to ovarian stimulation for in vitro fertilization is reviewed. After a brief discussion of the relevant aspect of ovarian physiology, the development, application, and consequences of ovarian stimulation strategies are reviewed in detail.
IMPACT OF LOW LEFT VENTRICULAR EJECTION FRACTION ON MORTALITY AFTER VENTRICULAR TACHYCARDIA ABLATION: A MULTICENTER EXPERIENCE
Authors: Madhu Reddy, Moussa Mansour, Fadi Chalhoub, Luigi Di Biase, Roderick Tung, Vijay Swarup, Srijoy Mahapatra, Thomas Bunch, Larry Chinitz, Hemant Boolani, Namratha Reddy, Sudharani Bommana, Donita Atkins, Raghuveer Dendi, Kalyanam Shivkumar, Andrea Natale, Jeremy Ruskin, Dhanunjaya Lakkireddy
Journal: Journal of the American College of Cardiology (2012)
"SO-CALLED FATAL ANAPHYLAXIS IN MAN"
Authors: August A. Thommen
Journal: JAMA (1930)

ABSTRACT To the Editor: —Comment on several points contained in the commendable article by Dr. R. W. Lamson on So-Called Fatal Anaphylaxis in Man (The Journal, Dec. 7, 1929) appears to be in order. Constitutional reactions are the betes noires of every allergist.An important phase of the production of such general reactions is the entrance into the system of the hypersensitive individual of an amount of allergen which exceeds his particular tolerance at that moment. Quite probably a severe general reaction, resulting even in death, could be produced in many hypersensitive persons if a sufficient quantity of specifically active allergen reached the general circulation. It is doubtful whether this primary conception of the matter will be materially altered by the discovery of the actual mechanism of the general reaction. Consequently, there is but one way of preventing these reactions and that is by exercising the requisite care that an excess
Estimating Prognosis for Nursing Home Residents With Advanced Dementia
Authors: Susan L. Mitchell
Journal: JAMA (2004)

Survival varies for patients with advanced dementia, and accurate prognostic tools have not been developed. A small proportion of patients admitted to hospice have dementia, in part because of the difficulty in predicting survival.To identify factors associated with 6-month mortality in newly admitted nursing home residents with advanced dementia and to create a practical risk score to predict 6-month mortality in this population.This was a retrospective cohort study of data from the Minimum Data Set (MDS). All Medicare or Medicaid licensed nursing homes in New York and Michigan were included. Participants had advanced dementia and were admitted to New York nursing homes between June 1, 1994, and December 30, 1998 (derivation cohort, n = 6799), and to Michigan nursing homes from October 1, 1998, through July 30, 2000 (validation cohort, n = 4631).MDS factors associated with 6-month mortality were determined in the derivation group, and the resulting mortality risk score was evaluated in the validation cohort. Risk score performance was compared with the cut point of 7c on the Functional Assessment Staging (FAST) scale.Among residents with advanced dementia, 28.3% (n = 1922) died within 6 months of nursing home admission in the derivation cohort; 35.1% (n = 1626) died in the validation cohort. The 6-month mortality rate increased across risk scores (possible range, 0-19): 0 points, 8.9% mortality; 1 to 2, 10.8%; 3 to 5, 23.2%; 6 to 8, 40.4%; 9 to 11, 57.0%; and at least 12, 70.0% in the validation cohort. The area under the receiver operating characteristic (AUROC) curve for predicting 6-month mortality was 0.74 and 0.70 in the derivation and validation cohorts, respectively. Our risk score demonstrated better discrimination to predict 6-month mortality (AUROC, 0.64 for a cutoff of > or =6 points vs 0.51 for FAST stage 7c).A risk score based on 12 variables from the MDS estimates 6-month mortality for nursing home residents with advanced dementia with greater accuracy than existing prognostic guidelines.
Nicotine replacement therapy
Authors: Andrew Molyneux
Journal: BMJ (2004)

Although products for nicotine replacement therapy (NRT) have been available for over 20 years, they have been excluded until recently from state or insurance based health service provision in the United Kingdom and many other countries. They have therefore not been widely prescribed by doctors who help smokers wanting to quit. Recent changes in funding policy in the United Kingdom and new guidance from the National Institute for Clinical Excellence (which covers England and Wales) mean that NRT products can and should now be made available to all smokers who want to stop smoking. Like other pharmacological interventions for helping smokers to quit (see the next article in this series), NRT is most effective when used in conjunction with behavioural and other types of non-pharmacological cessation interventions.

The main mode of action of NRT is thought to be the stimulation of nicotinic receptors in the ventral tegmental area of the brain and the consequent release of dopamine in the nucleus accumbens. This and other peripheral actions of nicotine lead to a reduction in nicotine withdrawal symptoms in regular smokers who abstain from smoking.

NRT may also provide a coping mechanism, making cigarettes less rewarding to smoke. It does not completely eliminate the symptoms of withdrawal, however, possibly because none of the available nicotine delivery systems reproduce the rapid and high levels of arterial nicotine achieved when cigarette smoke is inhaled.

All the available medicinal nicotine products rely on systemic venous absorption and do not therefore achieve such rapid systemic arterial delivery. It takes a few seconds for high doses of nicotine from a cigarette to reach the brain; medicinal products achieve lower levels over a period of minutes (for nasal spray or oral products such as gum, inhalator, sublingual tablet, or lozenge) and hours (for transdermal patches).



Rise in blood …
36. Improved Lentiviral Vectors for Systemic Gene Transfer in the Absence of an Immune Response
Authors: Brian D. Brown, Ehud Hauben, Angelo Lombardo, Lucia Sergi Sergi, Maria Grazia Roncarolo, Luigi Naldini
Journal: Molecular Therapy (2005)

Lentiviral vectors (LVs) are an attractive candidate for gene therapy of monogenic diseases such as the hemophilias. LV administration can achieve stable expression of a transgene. Unfortunately, studies in immunocompetent mice indicate that vector delivery of a neo-antigen can result in a transgene-specific immune response. We have previously shown, however, that driving transgene expression from the hepatocyte-specific albumin promoter reduces the probability of triggering an immune response most likely by restricting expression from antigen presenting cells (APCs).