tbuckley/cabot-search huggingface dataset:
Diagnostic value of exercise electrocardiography and thallium myocardial scintigraphy in patients without previous myocardial infarction: a Bayesian approach.
Authors: J A Melin, L J Piret, R J Vanbutsele, M F Rousseau, J Cosyns, L A Brasseur, C Beckers, J M Detry
Journal: Circulation (1981)

The clinical value of combining exertional ECG and postexertional thallium (201T1) scintigraphy was assessed in 160 patients (130 men and 30 women) suspected of having coronary artery disease (CAD) who underwent a coronary arteriography.Based on sex and history, the patients were subdivided in two groups with different prevalences of CAD: Group 1 (high prevalence of CAD = 90%) included 98 men with typical angina pectoris (AP) and group 2 (low prevalence of CAD = 18%) included 32 men and 30 women with atypical AP.Compared with the exertional ECG, myocardial scintigraphy was more sensitive (87% vs 74%) and more specific (89% vs 70%) for the diagnosis of CAD.The combination of the ECG and scintigraphic data was useful if both tests gave concordant results: 100% of true positives (n = 67) and 84% of true negatives (n = 43).In case of discordant results (n = 50), no firm diagnostic conclusion could be made due to the many false-positive (27%) and false-negative (25%) scintigrams.These results are easier to interpret when the prevalence of CAD is taken into account.According to Bayes' theorem, abnormal exercise results confirm CAD when the prevalence is high and normal results rule out CAD when the prevalence is low; also, a normal response to exercise has no predictive value when the prevalence is high.When the prevalence is low, an abnormal ECG or thallium has low predictive value but concordant abnor- mal responses are highly predictive for CAD (100% of true positives).
[478] LARGE POPULATION STUDY IN LIVER STIFFNESS MEASUREMENT: PREVALENCE OF SIGNIFICANT FIBROSIS AND CORRELATION WITH LIVER BIOCHEMISTRY IN CHRONIC HEPATITIS B
Authors: J. Fung, C.L. Lai, J.C. Yuen, O.K. Wong, C.T. Cheng, D.Y. But, M.F. Yuen
Journal: Journal of Hepatology (2007)
Immediate care of the preterm infant
Authors: Peter W Fowlie, William McGuire
Journal: BMJ (2004)

Preparing appropriately for the delivery and immediate care of the preterm infant is essential when time permits and may impact on the eventual outcome for the infant. This article describes the skills and equipment needed for the care and possible resuscitation of these vulnerable babies. The support and advice needed by parents and families at this time is also explored.

When preterm delivery can be anticipated there may be an opportunity for paediatric staff to discuss intrapartum and postnatal care with prospective parents and colleagues from midwifery and obstetrics. Even if detailed discussion is not possible, relevant historical details should be taken to anticipate problems and prepare appropriately for the arrival of the preterm infant.



The “inverted triangle” shows how commonly certain interventions are needed



Broadly, the level of resuscitation that may be needed is inversely related to the gestation of the preterm infant. Usually, the approach taken in resuscitating preterm infants of > 32 completed weeks' gestation is the same as that taken for term infants. Most need only basic measures such as drying and stimulation. Infants of gestation < 32 weeks (or birth weight < 1500 g) require more active support. For infants of < 28 weeks' gestation, this support will probably include endotracheal intubation and assisted ventilation.

View this table:

Equipment for resuscitation of the preterm infant



Ideally, two members of staff who are experienced in the early care of preterm infants should be present at the delivery of each anticipated infant. A senior paediatrician with extensive experience in dealing with preterm babies should be at the delivery of infants of < 28 weeks' gestation. Before delivery, the attending staff should recheck essential equipment for resuscitation.

View this table:

History relevant to preterm delivery



Preterm infants get cold quickly because of their relatively large surface area. Resulting hypothermia reduces surfactant production, may hasten …
Practice of Coronary Angioplasty in California in 1995
Authors: Velisar Rill, David L. Brown
Journal: Circulation (1999)

Background —This study seeks to analyze changes in the practice of PTCA in California between 1989 and 1995 by use of the Office of Statewide Health Planning and Development (OSHPD) data set. Methods and Results —All hospital discharges in 1995 with a procedure code for PTCA or stent were identified. The 1995 PTCA data were compared with previously published data from 1989 obtained from the same database. The number of PTCAs performed increased by 49% between 1989 and 1995, from 24 883 to 37 118. The percentage of female patients increased from 29.8% to 32.7% ( P =0.0001). The percentage of diabetics increased from 14.4% to 21.6% ( P =0.0001) between 1989 and 1995. Procedures on patients with a principal diagnosis of acute myocardial infarction increased from 19.3% of all PTCAs in 1989 to 27.5% of PTCAs in 1995 ( P =0.0001). In-hospital mortality increased from 1.4% in 1989 to 1.9% in 1995 ( P =0.0001). There were 3087 admissions with stent placement in 1995. In-hospital mortality after stent placement was 0.9% ( P =0.0001 versus PTCA). Patients undergoing PTCA in hospitals performing &gt;400 PTCAs in 1995 had a 4% incidence of death or emergency bypass surgery compared with a 6% incidence when PTCAs were performed in hospitals performing ≤400 PTCA in 1995 ( P &lt;0.0001). Patients undergoing stent implantation in hospitals performing &gt;75 stent procedures in 1995 had a 1.3% incidence of death or emergency bypass compared with an incidence of 4% when the procedure was performed in a hospital performing ≤75 stent placements in 1995 ( P &lt;0.0001). Conclusions —The 1995 OSHPD data continue to suggest an inverse relationship between hospital PTCA and stent volume and adverse patient outcomes.
IMPACT OF INTERSTAGE HOME MONITORING AFTER HYBRID PALLIATION OF HYPOPLASTIC LEFT HEART SYNDROME
Authors: Nazia Husain, Karen Texter, Jared Hershenson, robin allen, holly miller-tate, Jamie Stewart, Yongjie Miao, Marco Corridore, mark galantowicz, John Cheatham, Kerry Rosen
Journal: Journal of the American College of Cardiology (2012)
Effect of Rheumatoid Factor on Complement-Mediated Phagocytosis
Authors: F. C. McDuffie, H. W. Brumfield
Journal: Journal of Clinical Investigation (1972)

The frequency and amount of IgM rheumatoid factor (RF) in the blood of patients with rheumatoid arthritis (RA) correlate with the severity of the disease and the number of complications. Though previous studies of RF in subacute bacterial endocarditis have shown that RF inhibits phagocytosis of microorganisms by granulocytes, the presence of low levels of complement (C) in blood and synovial fluid of patients with the highest titers of RF suggests that an interaction between RF and C may contribute to the inflammatory process in RA. We thus employed a quantitative methodology to examine the effect of RF on complement-dependent phagocytosis of sheep erythrocytes by rabbit granulocytes. Addition of 2500 molecules of IgM RF to sheep cells heavily coated with IgG antibody (195,000 molecules per cell) resulted in virtually complete inhibition of uptake of C3 (beta(1c)) and prevention of phagocytosis, an effect resulting from inhibition of uptake of C1 by the cells. When erythrocytes coated with only 34,000 molecules of IgG antibody were employed, phagocytosis was similarly inhibited. However the effect of RF on such cells was shown to be primarily mediated through inhibition of C4 rather than C1 uptake. Although the results do not exclude the participation of an IgM RF of higher avidity, present only in the tissues in rheumatoid inflammation, circulating IgM RF probably does not play a potentiating role in rheumatoid inflammation.
β-Adrenergic Enhancement of Sarcoplasmic Reticulum Calcium Leak in Cardiac Myocytes Is Mediated by Calcium/Calmodulin-Dependent Protein Kinase
Authors: Jerald Curran, Mark J. Hinton, Eduardo Ríos, Donald M. Bers, Thomas R. Shannon
Journal: Circulation Research (2007)

Enhanced cardiac diastolic Ca leak from the sarcoplasmic reticulum (SR) ryanodine receptor may reduce SR Ca content and contribute to arrhythmogenesis. We tested whether β-adrenergic receptor (β-AR) agonists increased SR Ca leak in intact rabbit ventricular myocytes and whether this depends on protein kinase A or Ca/calmodulin-dependent protein kinase II (CaMKII) activity. SR Ca leak was assessed by acute block of the ryanodine receptor by tetracaine and assessment of the consequent shift of Ca from cytosol to SR (measured at various SR Ca loads induced by varying frequency). Cytosolic [Ca] ([Ca] i ) and SR Ca load ([Ca] SRT ) were assessed using fluo-4. β-AR activation by isoproterenol dramatically increased SR Ca leak. However, this effect was not inhibited by blocking protein kinase A by H-89, despite the expected reversal of the isoproterenol-induced enhancement of Ca transient amplitude and [Ca] i decline rate. In contrast, inhibitors of CaMKII, KN-93, or autocamtide-2–related inhibitory peptide II or β-AR blockade reversed the isoproterenol-induced enhancement of SR Ca leak, and CaMKII inhibition could even reduce leak below control levels. Forskolin, which bypasses the β-AR in activating adenylate cyclase and protein kinase A, did not increase SR Ca leak, despite robust enhancement of Ca transient amplitude and [Ca] i decline rate. The results suggest that β-AR stimulation enhances diastolic SR Ca leak in a manner that is (1) CaMKII dependent, (2) not protein kinase A dependent, and 3) not dependent on bulk [Ca] i .
Phosphatidylcholine-Specific Phospholipase C Activation in Epithelial Ovarian Cancer Cells
Authors: Francesca Spadaro, Carlo Ramoni, Delia Mezzanzanica, Silvia Miotti, Paola Alberti, Serena Cecchetti, Egidio Iorio, Vincenza Dolo, Silvana Canevari, Franca Podo
Journal: Cancer Research (2008)

Elucidation of the mechanisms responsible for aberrant phosphatidylcholine (PC) metabolism in cancer cells may allow identification of novel biomarkers of tumor progression and design of new targeted anticancer therapies. We recently reported up-regulation of PC-specific phospholipases in epithelial ovarian cancer cells (EOC) compared with nontumoral (normal or immortalized) counterparts (EONT). In the present study, we focused, in the same cell systems, on levels, subcellular localization, and activity of PC-specific phospholipase C (PC-PLC), for which a key role in cell proliferation, differentiation, and apoptosis has been shown in several mammalian cells. A 66-kDa PC-PLC isoform, detected in nuclear and cytoplasmic compartments of both EOC and EONT cells, accumulated on the external plasma membrane of cancer cells only, where it colocalized with beta1 integrin, in nonraft membrane domains. PC-PLC activity was 3-fold higher in total cell lysates and 5-fold higher in membrane-enriched fractions of EOC compared with EONT cells. Serum deprivation induced in EOC, but not in EONT, cells a 3-fold decrease in PC-PLC activity, associated with a 40% drop in S-phase fraction. The recovery of both variables to their original levels in serum-restimulated (or lysophosphatidic acid-restimulated) EOC cells was strongly delayed, for at least 24 h, in the presence of the PC-PLC inhibitor tricyclodecan-9-yl-potassium xanthate (D609). The S-phase of serum-restimulated EONT cells was not sensitive to D609. These findings warrant further investigations on the role of PC-PLC and on the effects of its inhibition on the pathways responsible for constitutive EOC cell stimulation and cell proliferation.
Studies on the platelet surface‐associated von Willebrand factor
Authors: S. Eric Martin, Margaret M. Johnson, Robert F. Abel
Journal: American Journal of Hematology (1994)

Abstract The contribution of platelets to the prevention and control of bleeding depends not only on the plasma and vessel wall yon Willebrand (vW) factor, but also on the vW factor originating from platelets. Although platelet vW factor is mainly stored in the α‐granules, small amounts of vW factor have been detected on the platelet surface under conditions without direct stimulation. This communication focuses on the small amount of vW factor associated with the surface of platelets. EDTA‐washed platelets in a calcium‐free medium containing prostaglandin E 1 (PGE 1 ) were exposed to anti‐vW factor F(ab') 2 fragments. The platelet‐associated anti‐vW factor antibodies were separated from the free fragments by gel chromatography. Normal platelets were compared to platelets from patients with Bernard Soulier syndrome, Glanzmann's thrombasthenia, and Hermansky‐Pudlak syndrome. These experiments showed that, in the absence of extracellular calcium, vW factor can be detected on the surface of washed platelets independent of glycoproteins lb and llb‐llla, and despite markedly reduced intracellular calcium content. This particular platelet surface expression of vW factor is probably the result of disturbing the platelet during the in vitro manipulation. von Willebrand factor is an extremely important element in the multiple molecular interactions required to stop and anchor the platelet in areas of high flow rates. Mechanical perturbation of platelets leading to surface expression of the vW factor helps increase its availability for such critical interactions. © 1994 Wiley‐Liss, Inc.
The Thrombophilias: Well-Defined Risk Factors with Uncertain Therapeutic Implications
Authors: Kenneth A. Bauer
Journal: Annals of Internal Medicine (2001)

Discovery of the factor V Leiden and prothrombin G20210A mutations has greatly increased the percentage of patients in whom venous thrombosis can be attributed to hereditary thrombophilia. The first step in the diagnostic approach to all patients with venous thrombosis consists of a careful history and physical examination combined with routine laboratory testing to characterize the severity of the thrombotic condition and determine the presence of any of the acquired causes of hypercoagulability. The second step is to consider screening for the causes of hereditary and acquired thrombophilia in selected subsets of patients. The selection of patients for testing, the choice of tests to perform, and the timing of the testing are important and challenging issues to consider. Routine testing would be warranted if the identification of abnormalities led to an alteration in the type or duration of initial anticoagulant therapy or the use of long-term prophylactic anticoagulation. The available data, however, do not yet indicate that most patients with defined thrombophilic states should be managed any differently than patients without identifiable abnormalities. On the basis of relative prevalences of the various thrombophilias, patients can be classified as “strongly” or “weakly” thrombophilic depending on their thrombotic histories. Management considerations and guidelines are offered for patients who are found to have one or more defined abnormalities, hereditary or otherwise. The future identification of additional laboratory abnormalities predisposing patients to thrombosis, coupled with prospective clinical trials, should enable us to better identify patients at high risk for recurrence who will benefit from prolonged anticoagulant prophylaxis.
Bronchodilator reversibility to low and high doses of terbutaline and ipratropium bromide in patients with chronic obstructive pulmonary disease.
Authors: D M Newnham, D P Dhillon, J H Winter, C M Jackson, R A Clark, B J Lipworth
Journal: Thorax (1993)

There is uncertainty regarding the use of monotherapy or combination therapy with beta 2 agonists and anticholinergic drugs in patients with chronic obstructive pulmonary disease (COPD). The measurement of forced expiratory volume in one second (FEV1) or relaxed vital capacity (RVC) in the assessment of reversibility in these patients has also caused considerable debate.Twenty seven patients with COPD were evaluated on two occasions. Patients received the following treatments in sequence: (sequence 1) low dose terbutaline 500 micrograms, high dose terbutaline 5000 micrograms, low dose ipratropium 40 micrograms, high dose ipratropium 200 micrograms; (sequence 2) low dose ipratropium 40 micrograms, high dose ipratropium 200 micrograms, low dose terbutaline 500 micrograms, high dose terbutaline 5000 micrograms. RVC, FEV1 and FVC were measured at baseline and 30 minutes after successive treatments.Values for FEV1 at baseline on the first and second study days were not significantly different: 0.90 (0.87-0.93) 1 v 0.90 (0.87-0.93) 1. Likewise, baseline values for RVC and FVC were not different. The number of patients showing a greater than 330 ml overall improvement in RVC was 20 of 27 for sequence 1 and 22 of 27 for sequence 2; similar trends were observed for FEV1 and FVC. For all three parameters there was a significant difference between mean responses to low and high doses of terbutaline when the latter was given as the first drug in sequence 1. When ipratropium was given first in sequence 2 there was, however, no significant improvement with high dose terbutaline over and above the response to low dose terbutaline. The latter effect was more noticeable with RVC than with either FEV1 or FVC. The total bronchodilator response at the end of each sequence was similar whether ipratropium was given first or second.The measurement of RVC, FEV1, and FVC were equally effective at picking up those patients who had a significant overall bronchodilator response to combined therapy with inhaled beta 2 agonist and anticholinergic medication. There was no significant benefit of adding a higher dose of terbutaline when ipratropium bromide had been given previously, particularly when using RVC as the parameter of response.
THE RÔLE OF FINANCIAL LOSSES IN THE PRECIPITATION OF MENTAL ILLNESS
Authors: WILLIAM C. MENNINGER
Journal: JAMA (1933)

It is the widespread prevalent opinion that the economic strain and material loss of the present financial crisis has been provocative of a great increase in mental ill health. There have been many statements in the lay press and a few in the medical press regarding this relationship, but many of these statements, though of good authority, are opiniated generalities; a few, however, are the result of case studies, and it is in these that we are interested in this paper. Statistics on the number of first admissions to state and government hospitals in the states of New York and Massachusetts are presented by Thom,<sup>1</sup>which show an increase only from 73.6 per hundred thousand of population in 1927 to 76.9 in 1931 in New York, and from 68 per hundred thousand of population in 1927 to 70.8 in 1931 in Massachusetts. It is his conclusion that "there is
Changes in thyroid function tests during short-term salsalate use
Authors: Robert J. McConnell
Journal: Metabolism (1999)

Although long-term administration of salsalate depresses blood levels of both total thyroxine (T4) and total triiodothyronine (T3) and at least transiently decreases serum thyrotropin (TSH), changes in thyroid function tests have not been fully characterized during its short-term use. It is also unclear if the observed changes are solely the result of decreased hormone binding to carrier proteins or if reduced hepatic 5′-monodeiodinase activity is important. Blood was sampled at baseline (day 0) and after 24 hours (day 1) and 72 hours (day 3) in eight subjects taking a therapeutic dose of salsalate 1,500 mg twice daily. Total T4 decreased from 90.1 ± 7.7 nmol/L (mean ± SD) on day 0 to 82.9 ± 8.6 nmol/L on day 1 (P = .1 v baseline) and 68.6 ± 8.7 nmol/L on day 3 (P = .0001). Total T3 decreased from 1.76 ± 0.20 nmol/L to 1.61 ± 0.16 nmol/L on day 1 (P < .05) and 1.31 ± 0.27 nmol/L on day 3 (P = .002). The ratio was 51.7 ± 7.7 at baseline and remained unchanged after 3 days. Levels of reverse T3 (rT3) were reduced from 0.24 ± 0.05 nmol/L to 0.18 ± 0.02 nmol/L on day 3 (P < .05). While the free T4 index (FTI) declined in parallel with total T4, the free T4 level by direct equilibrium dialysis (FTD) was unchanged after 3 days. Serum TSH decreased from 1.47 ± 0.47 mU/L to 0.91 ± 0.27 mU/L after 1 day (P < .05) and remained suppressed after 3 days (0.95 ± 0.49 mU/L, P < .05). In conclusion, (1) therapeutic doses of salsalate significantly decrease serum concentrations of total T4, total T3, and rT3 to about 75% of baseline levels after 3 days without altering the ratio; (2) although the FTD does not change, serum TSH concentrations remain suppressed; and (3) the proportionate decrease in total thyroid hormone levels suggests that inhibition of hormone binding to serum proteins is more important in producing these changes than reduced hepatic 5′-monodeiodinase activity.
Nearly a fifth of cancer patients in England miss 62 day target for starting treatment
Authors: S. Mayor
Journal: BMJ (2015)

Nearly one in five patients does not start treatment for cancer within the 62 day target of a first urgent referral for suspected cancer, and the NHS in England failed to hit the operational standard for this cancer treatment target for a fourth consecutive quarter, figures have shown.

Fran Woodard, director of policy and research at Macmillan Cancer Support, said, “It is deeply concerning that the cancer waiting time targets, which outline the time it should take for …
A CASE OF MONOLATERAL ERYTHROMELALGIA OF APPARENTLY HYSTERICAL ORIGIN
Authors: P. B. MUMFORD
Journal: British Journal of Dermatology (1929)

Journal Article A CASE OF MONOLATERAL ERYTHROMELALGIA OF APPARENTLY HYSTERICAL ORIGIN Get access P. B. MUMFORD, M.D., M.R.C.P P. B. MUMFORD, M.D., M.R.C.P Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology and Syphilis, Volume 41, Issue 12, 1 December 1929, Pages 478–479, https://doi.org/10.1111/j.1365-2133.1929.tb09303.x Published: 01 December 1929
In Defense of a Department of Geriatrics
Authors: Saul B. Gilson
Journal: Annals of Internal Medicine (2001)

Letters3 July 2001In Defense of a Department of GeriatricsSaul B. Gilson, MDSaul B. Gilson, MDNew York, NY 10033 (Gilson)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-1-200107030-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Dr. Cassel writes in support of geriatric medicine (1), which has always been subsumed as a major aspect of internal medicine. She maintains that “geriatricians … must have substantial knowledge of … psychiatry, rehabilitation, ophthalmology, audiology, gynecology, urology, orthopedics” and many other areas. I think her patients would best be served by referral to appropriate specialists in those fields. No evidence is provided that the elderly are better treated by physicians with geriatric training. The conditions Dr. Cassel considers to be “geriatric,” such as congestive heart failure, osteoarthritis, and urinary incontinence, are not restricted to any age ...Reference1. Cassel CK. In defense of a department of geriatrics. Ann Intern Med. 2000;133:297-301. [PMID: 10929172] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: New York, NY 10033 (Gilson) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIn Defense of a Department of Geriatrics Christine K. Cassel In Defense of a Department of Geriatrics Christine K. Cassel Metrics 3 July 2001Volume 135, Issue 1Page: 62KeywordsElderlyGeriatricsHeart failureHospitalizationsOphthalmologyOrthopedicsOsteoarthritisPreventive medicineUrinary incontinenceUrology ePublished: 3 July 2001 Issue Published: 3 July 2001 CopyrightCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...