tbuckley/cabot-search huggingface dataset:
Breast Cancer Screening in Women Younger Than 50 Years of Age: What's Next?
Authors: David M. Eddy
Journal: Annals of Internal Medicine (1997)

Editorials1 December 1997Breast Cancer Screening in Women Younger Than 50 Years of Age: What's Next?David M. Eddy, MD, PhDDavid M. Eddy, MD, PhDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-127-11-199712010-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, a well-constructed cost-effectiveness analysis of screening mammography in women younger than 50 years of age [1] shows that screening in this age group is expensive, costing approximately $150 000 for a year of life saved. Those who do not like this result will no doubt challenge some details of the analysis, but they will not be able to shake its basic conclusion, which is determined by the low incidence of the disease, the relatively small beneficial effect of screening, and the long delay before any benefit appears. Unless the cost of mammography decreases dramatically, screening in younger ...References1. Salzmann P, Kerlikowske K, Phillips K. Cost-effectiveness of extending screening mammography guidelines to include women 40 to 49 years of age. Ann Intern Med. 1997; 127:955-65. Google Scholar2. Fletcher S. Whither scientific deliberation in health policy recommendations? N Engl J Med. 1997; 336:1180-3. Google Scholar3. Ransohoff DF, Harris RP. Lessons from the mammography screening controversy: can we improve the debate? Ann Intern Med. 1997; 127:1029-34. Google Scholar Author, Article, and Disclosure InformationAffiliations: Corresponding Author: David M. Eddy, MD, PhD, 2435 California Street, NW, Washington, DC 20008. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byScreening TestsAuthor’s specialty and conflicts of interest contribute to conflicting guidelines for screening mammographyAspectos éticos sobre el límite de edad de los cribados de cáncerAttitude of the Italian general population towards prevention and screening of the most common tumors, with special emphasis on colorectal malignanciesDisease, Outcomes, and MoneyPerception, paradox, paradigmBreast Cancer ScreeningPostmodern medicineMammography in Asian patients with BRCA1 mutationsThe Breast Cancer Screening Controversy and the National Institutes of Health Consensus Development Conference on Breast Cancer Screening for Women Ages 40-49Challenges in Designing a Randomized Trial of Surveillance Colonoscopy in IBDErnster RepliesTechnology AssessmentSurveillance after Primary Therapy 1 December 1997Volume 127, Issue 11Page: 1035-1036KeywordsAge groupsBreast cancerBreast cancer screeningDecision makingEmotionsHeartMammographyMotivationPublic policy Issue Published: 1 December 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Development and Validation of a Coronary Risk Prediction Model for Older U.S. and European Persons in the Cardiovascular Health Study and the Rotterdam Study
Authors: Michael T. Koller, Maarten J.G. Leening, Marcel Wolbers, Ewout W. Steyerberg, M.G. Myriam Hunink, Rotraut Schoop, Albert Hofman, Heiner C. Bucher, Bruce M. Psaty, Donald M. Lloyd-Jones, Jacqueline C.M. Witteman
Journal: Annals of Internal Medicine (2012)

Background: Risk scores for prediction of coronary heart disease (CHD) in older adults are needed. Objective: To develop a sex-specific CHD risk prediction model for older adults that accounts for competing risks for death. Design: 2 observational cohort studies, using data from 4946 participants in the Cardiovascular Health Study (CHS) and 4303 participants in the Rotterdam Study (RS). Setting: Community settings in the United States (CHS) and Rotterdam, the Netherlands (RS). Participants: Persons aged 65 years or older who were free of cardiovascular disease. Measurements: A composite of nonfatal myocardial infarction and coronary death. Results: During a median follow-up of 16.5 and 14.9 years, 1166 CHS and 698 RS participants had CHD events, respectively. Deaths from noncoronary causes largely exceeded the number of CHD events, complicating accurate CHD risk predictions. The prediction model had moderate ability to discriminate between events and nonevents (c-statistic, 0.63 in both U.S. and European men and 0.67 and 0.68 in U.S. and European women). The model was well-calibrated; predicted risks were in good agreement with observed risks. Compared with the Framingham point scores, the prediction model classified elderly U.S. persons into higher risk categories but elderly European persons into lower risk categories. Differences in classification accuracy were not consistent and depended on cohort and sex. Adding newer cardiovascular risk markers to the model did not substantially improve performance. Limitation: The model may be less applicable in nonwhite populations, and the comparison Framingham model was not designed for adults older than 79 years. Conclusion: A CHD risk prediction model that accounts for deaths from noncoronary causes among older adults provided well-calibrated risk estimates but was not substantially more accurate than Framingham point scores. Moreover, adding newer risk markers did not improve accuracy. These findings emphasize the difficulties of predicting CHD risk in elderly persons and the need to improve these predictions. Primary Funding Source: National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke; The Netherlands Organisation for Scientific Research; and the Netherlands Organisation for Health Research and Development.
The Evolution of the Flagellar Assembly Pathway in Endosymbiotic Bacterial Genomes
Authors: C. Toft, M. A. Fares
Journal: Molecular Biology and Evolution (2008)

Genome shrinkage is a common feature of most intracellular pathogens and symbionts. Reduction of genome sizes is among the best-characterized evolutionary ways of intracellular organisms to save and avoid maintaining expensive redundant biological processes. Endosymbiotic bacteria of insects are examples of biological economy taken to completion because their genomes are dramatically reduced. These bacteria are nonmotile, and their biochemical processes are intimately related to those of their host. Because of this relationship, many of the processes in these bacteria have been either lost or have suffered massive remodeling to adapt to the intracellular symbiotic lifestyle. An example of such changes is the flagellum structure that is essential for bacterial motility and infectivity. Our analysis indicates that genes responsible for flagellar assembly have been partially or totally lost in most intracellular symbionts of gamma-Proteobacteria. Comparative genomic analyses show that flagellar genes have been differentially lost in endosymbiotic bacteria of insects. Only proteins involved in protein export within the flagella assembly pathway (type III secretion system and the basal body) have been kept in most of the endosymbionts, whereas those involved in building the filament and hook of flagella have only in few instances been kept, indicating a change in the functional purpose of this pathway. In some endosymbionts, genes controlling protein-export switch and hook length have undergone functional divergence as shown through an analysis of their evolutionary dynamics. Based on our results, we suggest that genes of flagellum have diverged functionally as to specialize in the export of proteins from the bacterium to the host.
A CASE OF ENTEROSPASM SIMULATING ACUTE OBSTRUCTION
Authors: F. E. Wynne, F. P. Sturm
Journal: BMJ (1909)

S.2_rcgl[EDCLJUN--examined from time to time on the agar films.The mumbers of living and dead corpuscles were counted and .averagestaken.2. The same experiment and control were repeated with 'the blood of persons suffering from acute rheumatism.3. The effect of placing chorea leucocytes in the plas- amata of other patients suffering from chorea was tested against a control.4. The result of adding rheumatic leucocytes to chorea -plasma was observed.
Outcome measures for vulval skin conditions: a systematic review of randomized controlled trials
Authors: R.C. Simpson, K.S. Thomas, R. Murphy
Journal: British Journal of Dermatology (2013)

Journal Article Outcome measures for vulval skin conditions: a systematic review of randomized controlled trials Get access R.C. Simpson, R.C. Simpson Centre of Evidence Based Dermatology, University of Nottingham King's Meadow Campus, Lenton Lane Nottingham NG7 2NR U.K Correspondence R. Simpson. E‐mail: Rosalind.simpson@nottingham.ac.uk Search for other works by this author on: Oxford Academic Google Scholar K.S. Thomas, K.S. Thomas Centre of Evidence Based Dermatology, University of Nottingham King's Meadow Campus, Lenton Lane Nottingham NG7 2NR U.K Search for other works by this author on: Oxford Academic Google Scholar R. Murphy R. Murphy Department of Dermatology Nottingham University Hospitals, Queen's Medical Centre Campus Nottingham NG7 2UH U.K Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 169, Issue 3, 1 September 2013, Pages 494–501, https://doi.org/10.1111/bjd.12391 Published: 01 September 2013
Anesthesiology
Authors: M. T. Jenkins
Journal: JAMA (1970)

The medical profession has a guiding goal—the welfare of mankind—which it implements through medical education, the application of research findings to man, superb individual patient care, and concern for the health of the entire nation. In accomplishing this goal today, the key word throughout organized medicine, and reiterated by individuals in governmental positions, is manpower. Certainly manpower is a major problem and a major responsibility for the specialty of anesthesiology. As a foreboding note, the delivery of anesthesia care to the nation is in a singularly vulnerable position for planning by nonanesthesiologists. Since reasonable anesthesia has been provided by specially trained registered nurses in the past, and since they still function efficiently under skillful medical guidance, there are some opinions that we can establish still another category of personnel to conduct anesthesia under supervision. I am not in agreement with these, even under the flossy description of "innovative programs for
ABC of palliative care: Non-malignant conditions
Authors: T. O'Brien, J. Welsh, F. G Dunn
Journal: BMJ (1998)

Much medical practice is still concerned with control of symptoms rather than cure, and doctors spend considerable time palliating and modifying symptoms associated with incurable disease.

A strong body of opinion argues that the skills and philosophies of palliative care should be extended to all care settings. This is optimally delivered by those working in their own specialty—such as neurology, cardiology, and respiratory medicine. Training in basic palliative care should form part of the undergraduate and postgraduate curricula for healthcare professionals. The success and relevance of palliative care will be judged not by the number of specialist teams but by the capacity to influence the care offered to all patients irrespective of diagnosis and place of care

The role of specialists in palliative medicine is to offer what has been learnt about palliation of malignant disease to those caring for patients with progressive, incurable, non-malignant conditions and to share and exchange best practice. Many symptoms experienced by cancer and non-cancer patients are similar: cancer patients' symptoms may be more severe, but those of non-cancer patients tend to be more prolonged.

#### Symptoms common to malignant and non-malignant conditions

##### Physical

##### Social

##### Psychological

##### Existential

The approach to controlling pain in progressive non-malignant conditions can be adopted from the strategy for managing cancer related pain. After an accurate diagnosis of the pain, appropriate treatment can be started: the principles of the World Health Organisation's analgesic ladder (discussed in the first article of this series) apply equally to non-cancer patients. The strength of analgesia chosen depends on the severity of the pain, and the choice of adjuvant analgesic depends on the pathogenesis of the pain.

Doctors may be concerned about giving opioids to patients with chronic non-malignant pain. This is a …
Contribution of the baroreflex afferent nerves to the production of vasoconstricted hypertension in volume-expanded dogs.
Authors: A Otsuka, T Ogihara, H Mikami, K Kohara, K Katahira, T Tsunetoshi, Y Kumahara
Journal: Circulation Research (1989)

Dextran in lactated Ringer's solution (20 ml/kg) was infused for 1 hour into anesthetized dogs with sinoaortic denervation and vagotomy (deafferentation; n = 10) and dogs treated with hexamethonium (de-efferentation; n = 13) to compare with our previous observation in dogs with an intact autonomic nervous system (control, n = 34). During the infusion, increase in blood pressure associated with increase in cardiac output was observed in all three groups. The increases in blood pressure were larger in the two groups with an impaired autonomic nervous system. In the recovery period, the control dogs and the hexamethonium-treated dogs showed gradual increases in total peripheral resistance and in vasoconstricted hypertension 3 hours after stopping the infusion. In contrast, the dogs with sinoaortic denervation and vagotomy did not show any increase in total peripheral resistance. The vasoconstricted groups showed peaks of natriuresis soon after the infusion, not 3 hours after the infusion when vasoconstriction was observed, although the dogs with deafferentation did not show a significant increase in natriuresis. Norepinephrine (0.5 micrograms/kg) was administered intravenously before and after volume expansion, and the pressor responses in the three groups after volume expansion were enhanced similarly (143%, 128%, and 136%, respectively). These results indicate that the afferent signals from peripheral vessels to the brain contribute to the production of vasoconstricted hypertension after acute volume expansion and that the vasoconstriction is independent of pressor hypersensitivity and is dissociated in time from the natriuresis.
ASSOCIATION BETWEEN TRADITIONAL CHOLESTEROL PARAMETERS, LIPOPROTEIN PARTICLE CONCENTRATION, NOVEL BIOMARKERS AND CAROTID PLAQUES IN RETIRED NATIONAL FOOTBALL LEAGUE PLAYERS
Authors: Salim S. Virani, Andrew E. Lincoln, Reginald E. Dunn, Andrew M. Tucker, Vijay Nambi, Khurram Nasir, Robert A. Vogel, Arthur J. Roberts, Christie M. Ballantyne, Michael E. DeBakey
Journal: Journal of the American College of Cardiology (2011)
An Electron Microscopic Study of Myocardial Ischemia in the Rat
Authors: RICHARD E. BRYANT, WILBUR A. THOMAS, ROBERT M. O'NEAL
Journal: Circulation Research (1958)

Myocardial infarcts were produced in rats by ligating the anterior descending branch of the left coronary artery. After one hour, changes in the ultrastructure of myofibers in the infarcts were readily demonstrated by electron microscopy. These changes became progressively severe with time, and consisted primarily of swelling of mitochrondria and sarcoplasmic reticulum followed by increased lipid droplets and myolysis. Autolysis Atolysis of myocardium was also studied and the changes found to be similar to those of myocardial infarcts, but more uniform and slightly delayed in development. Perhaps the early ultrastructrural changes are related to hyperosmolarity of mitochondria and sarcoplasmic reticulum, especially after cell death. It is hoped that definition of ischemic ultrastructural change will be useful in defining electron microscopic lesions in other forms of myocardial damage.
TCT-626 Comparison of Intravenous Adenosine Infusion and Regadenoson Bolus for Calculating Fractional Flow Reserve: Results of a Pooled Analysis
Authors: Joshua M. Stolker, Luis Guzman, Martin M. Zenni, Dominick Angiolillo, Theodore Bass, Kevin F. Kennedy, Michael Lim
Journal: Journal of the American College of Cardiology (2013)
Use of an index to reflect the aggregate burden of long-term exposure to criteria air pollutants in the United States.
Authors: Amy D Kyle, Tracey J Woodruff, Patricia A Buffler, Devra L Davis
Journal: Environmental Health Perspectives (2002)

Air pollution control in the United States for five common pollutants--particulate matter, ground-level ozone, sulfur dioxide, nitrogen dioxide, and carbon monoxide--is based partly on the attainment of ambient air quality standards that represent a level of air pollution regarded as safe. Regulatory and health agencies often focus on whether standards for short periods are attained; the number of days that standards are exceeded is used to track progress. Efforts to explain air pollution to the public often incorporate an air quality index that represents daily concentrations of pollutants. While effects of short-term exposures have been emphasized, research shows that long-term exposures to lower concentrations of air pollutants can also result in adverse health effects. We developed an aggregate index that represents long-term exposure to these pollutants, using 1995 monitoring data for metropolitan areas obtained from the U.S. Environmental Protection Agency's Aerometric Information Retrieval System. We compared the ranking of metropolitan areas under the proposed aggregate index with the ranking of areas by the number of days that short-term standards were exceeded. The geographic areas with the highest burden of long-term exposures are not, in all cases, the same as those with the most days that exceeded a short-term standard. We believe that an aggregate index of long-term air pollution offers an informative addition to the principal approaches currently used to describe air pollution exposures; further work on an aggregate index representing long-term exposure to air pollutants is warranted.
Impact of the hepatitis B virus genotype and genotype mixtures on the course of liver disease in Vietnam
Authors: Nguyen L. Toan, Le H. Song, Peter G. Kremsner, Dinh N. Duy, Vu Q. Binh, Bernd Koeberlein, Stefan Kaiser, Reinhard Kandolf, Joseph Torresi, C.‐Thomas Bock
Journal: Hepatology (2006)

Eight genotypes (A-H) of hepatitis B virus (HBV) have been identified. However, the impact of different genotypes on the clinical course of hepatitis B infection remains controversial. We investigated the frequency and clinical outcome of HBV genotypes and genotype mixtures in HBV-infected patients from Vietnam, Europe, and Africa. In addition, we analyzed the effects of genotype mixtures on alterations in in vitro viral replication. In Asian patients, seven genotypes (A-G) were detected, with A, C, and D predominating. In European and African patients, only genotypes A, C, D, and G were identified. Genotype mixtures were more frequently encountered in African than in Asian (P = .01) and European patients (P = .06). In Asian patients, the predominant genotype mixtures included A/C and C/D, compared to C/D in European and A/D in African patients. Genotype A was more frequent in asymptomatic compared with symptomatic patients (P < .0001). Genotype C was more frequent in patients with hepatocellular carcinoma (HCC; P = .02). Genotype mixtures were more frequently encountered in patients with chronic hepatitis in comparison to patients with acute hepatitis B (P = .015), liver cirrhosis (P = .013), and HCC (P = .002). Viral loads in patients infected with genotype mixtures were significantly higher in comparison to patients with a single genotype (P = .019). Genotype mixtures were also associated with increased in vitro HBV replication. In conclusion, infection with mixtures of HBV genotypes is frequent in Asia, Africa, and Europe. Differences in the replication-phenotype of single genotypes compared to genotype-mixtures suggest that co-infection with different HBV-genotypes is associated with altered pathogenesis and clinical outcome. (HEPATOLOGY 2006;43:1375–1384.)
Fever: Basic Mechanisms and Management
Authors: Moses Grossman
Journal: JAMA (1997)

The second edition of Dr Mackowiak's comprehensive monograph on fever appears 6 years after the first. This edition is even more comprehensive, containing 37 chapters, compared with 20 in the first edition, and adds chapters on new advances, mainly in molecular biology. Many, but not all, of the clinical chapters have been updated. The initial chapters on the history of thermometry are interesting, informative, and well written and remain pretty much as they were in the first edition. The basic mechanisms portion of the book has been thoroughly updated and is first class. It includes chapters on cytokines as endogenous pyrogens, prostaglandin E<sub>2</sub>, heat shock proteins, and many other entities. Jeffrey Hasday contributes an interesting chapter about the influence of fever on host defense, laying the foundation for discussions in future chapters of whether fever should be treated symptomatically. The references, for the most part, include publications through the
Molecular diagnosis of pancreatobiliary malignancies in brush cytologies of biliary strictures
Authors: T M Gress
Journal: Gut (2004)

Do molecular techniques improve the diagnostic accuracy of brush cytologies of biliary strictures?

Accurate diagnosis of strictures involving the bile duct is essential to the planning of therapy and the choice of the right treatment option, such as surgical resection or endoscopic stenting. However, differentiation of malignant from benign ductal lesions at endoscopic retrograde cholangiopancreatography (ERCP) remains a challenge. Although cholangiographic features may be characteristic for malignant or benign disease, in many cases histological or cytological proof of the diagnosis is required to determine the optimal treatment for each individual patient. Histological and cytological tissue diagnoses may be obtained by several methods, including open biopsy, ultrasound or computed tomography guided fine needle aspiration or core biopsy, endoscopic forceps biopsy, endoscopic brush cytology, and bile aspiration cytology.1–4

Brush cytology performed at ERCP has become the preferred initial method of pursuing tissue diagnosis in many patients with pancreatobiliary strictures.5–9 The technique allows easy and convenient sampling and has a low complication rate.3,9,10 The diagnostic specificity of biliary brush cytology is very high and few false positive diagnoses have been reported. The major limitation of the technique has been the relatively modest diagnostic sensitivity. The sensitivity rates reported in multiple studies are highly variable and range between 30% and 88%, with nearly 100% specificity.3,4,9–12 In general, results of brush cytology for biliary strictures induced by pancreatic malignancies have proved to be inferior (on average 46%) to those observed for biliary malignancies (on average 68%).4

The success rate of brush cytology analyses is largely dependent on two factors: (1) the quality of the cytological material obtained at ERCP and (2) the expertise of the cytopathologist.

The quality of the cytological material is influenced by the processing technique, cellularity, cellular preservation, background, quantity …
Thioridazine Toxicity
Authors: Paul L. Weiden
Journal: JAMA (1973)

A 54-year-old man developed agranulocytosis and hepatitis seven weeks following institution of thioridazine therapy. Agranulocytosis resolved after 14 days without specific therapy, but the hepatitis resulted in deterioration of liver function, hepatic encephalopathy, and cardiac arrest. Following resuscitation and recovery, myasthenia gravis was diagnosed. To the best of our knowledge, this is the first report in the literature of the simultaneous occurrence of agranulocytosis and hepatitis during thioridazine therapy, and of hepatic coma related to the use of this phenothiazine.