tbuckley/cabot-search huggingface dataset:
Hemodynamic Observations One and Two Years after Cardiac Transplantation in Man
Authors: EDWARD B. STINSON, RANDALL B. GRIEPP, JOHN S. SCHROEDER, EUGENE DONG, NORMAN E. SHUMWAY
Journal: Circulation (1972)

Cardiac catheterization studies were performed in eight patients 1 year after cardiac transplantation and in two of these again at 2 years. Intracardiac pressures at rest were normal in all patients, both 1 and 2 years postoperatively. Average cardiac index at rest at 1 year was 2.3 liters/min/m 2 and average heart rate was 90 beats/min. Responses to amyl nitrite, atropine, and tyramine failed to demonstrate efferent autonomic reinnervation of the donor hearts. Findings associated with a 10-min period of submaximal supine bicycle exercise 1 year after transplantation included: (1) a gradual rise in heart rate throughout most of the exercise period; (2) prompt elevation of left ventricular end-diastolic pressure by an average increment of 10 mm Hg, followed by a decrease during late exercise in some patients; (3) a progressive increase in LV systolic pressure throughout the first half of the exercise period; (4) a continuously positive change in LV rate of pressure change (dp/dt) throughout exercise; (5) an average 44% increase in stroke volume; and (6) an average 92% increase in cardiac output. The slope of the regression of cardiac output on oxygen uptake during exercise was within the range of normal. Cardiac output, however, was lower than normal both at rest and during exercise, and the arteriovenous oxygen diflerence was accordingly widened. In one patient studied 1 and 2 years after transplantation, hemodynamic findings were comparable on both occasions. In the other, however, the cardiac output response to exercise was distinctly diminished at 2 years as compared to 1 year, due almost entirely to failure of the stroke volume to increase. Coronary arteriography in this recipient revealed evidence of occlusive coronary disease compatible with graft atherosclerosis. These studies demonstrate the sustained capacity of the transplanted human heart to support normal physical activity late in the postoperative period. Although utilizing atypical adaptive mechanisms characteristic of the denervated heart, the transplanted heart responds in a directionally appropriate manner to the metabolic demands of exercise.
A Trial of Cognitive Analytic Therapy in Poorly Controlled Type I Patients
Authors: Jacqueline A Fosbury, Catherine M Bosley, Anthony Ryle, Peter H Sönksen, Susan L Judd
Journal: Diabetes Care (1997)

This study compared the effect of cognitive analytic therapy (CAT), a focused time-limited psychotherapy, and diabetes specialist nurse education (DSNE) in a controlled trial of 26 chronically poorly controlled adult type I patients.Patients were randomized to either 16 sessions of CAT (treatment) or 14-18 sessions of DSNE (control). Pre- and post-treatment blood glucose control (HbA1), interpersonal difficulties, and diabetes knowledge were measured before and up to 9 months after treatment was completed.Although HbA1 levels improved in the DSNE group, at the end of treatment (mean fall 1.2%, P = 0.004) this was not maintained; so by the 9-month follow-up, the overall net fall was limited to 0.9% (P = 0.03 vs. entry value). There were no significant improvements in interpersonal difficulties in DSNE subjects at any retest point (P > 0.05). In contrast, glycemic control and interpersonal difficulties both improved after CAT. In contrast to DSNE, this improvement continued so that at the 9-month follow-up visit, the changes were significant (mean fall in HbA1 = 2%, P = 0.002 and P = 0.03 for the Inventory of Interpersonal Problems [IIP] scores).These results suggest that although there is no statistical difference between CAT and DSNE, the effects of CAT produce a more prolonged effect on glycemic control. If psychological difficulties underlying problems with self-care in a type I population are addressed, then improvements in diabetes control are likely to continue.
Inadvertent Germline Transmission of AAV2 Vector: Findings in a Rabbit Model Correlate with Those in a Human Clinical Trial
Authors: Joerg Schuettrumpf, Jian-Hua Liu, Linda B. Couto, Kathakaly Addya, Debra G.B. Leonard, Zhu Zhen, Jürg Summer, Valder R. Arruda
Journal: Molecular Therapy (2006)

The risk of germline transmission of vector sequences in humans is a major safety concern, because the enrollment of subjects of reproductive age in early-phase clinical trials of gene transfer continues to increase. In a study of adult men with hemophilia B, adeno-associated virus serotype 2 (AAV2) delivered to the liver via the hepatic artery resulted in unexpected transient vector dissemination to the semen. Here we report that intravenous AAV2 injection in rabbits proved a useful model to assess biologic parameters of vector dissemination to the semen. Detectable vector sequences in semen disappeared in a dose-dependent and time-dependent fashion. AAV infectious particles were present only as long as day 4 after injection and were undetectable thereafter. The kinetics of vector clearance was faster in the semen fractions enriched for motile sperm than in the total semen. In addition, increased frequency of semen sampling accelerated the clearance of vector sequences from semen. Long-term follow-up, spanning hundreds of spermatogenesis cycles, showed that there was no recurrence of detectable vector sequences in semen, thus reducing the probability of inadvertent transduction of early spermatogonia not committed to differentiation at the time of vector injection. We conclude that AAV2 presents minimal germline transmission risk for humans.
Glycosaminoglycans Delay the Progression of Nephropathy in NIDDM
Authors: Anna Solini, Luciana Vergnani, Franco Ricci, Gaetano Crepaldi
Journal: Diabetes Care (1997)

OBJECTIVE To determine the effect of oral administration of glycosaminoglycans on metabolic control and albumin excretion rate (AER) in NIDDM patients with increased urinary albumin excretion. RESEARCH DESIGN AND METHODS Twelve NIDDM hypertensive patients (age 52 ± 3 years, HbA1c 7.7 ± 0.2%) on antihypertensive treatment were enrolled in a double-blind placebo-controlled study, assuming either placebo or sulodexide (100 mg/day) for 4 months; at the end of this period, a crossover was performed. We have evaluated routine biochemical parameters plus AER and coagulative function every 2 months. RESULTS Both plasma fibrinogen (from 4.15 ± 0.32 to 2.77 ± 0.47 mmol/l) and AER (from 128.3 ± 40.6 to 39.6 ± 11.9 μg/min) decreased significantly after treatment with glycosaminoglycans in respect to placebo; moreover, blood pressure control ameliorated, also in the absence of any variation of therapy. CONCLUSIONS Glycosaminoglycan therapy, likely in association with a satisfactory control of blood pressure values, seems to prevent the progression of diabetic nephropathy in NIDDM.
Risk factors for the misdiagnosis of tuberculosis in the UK, 2001–2011
Authors: Debora Pedrazzoli, Ibrahim Abubakar, Helena Potts, Paul R. Hunter, Michelle E. Kruijshaar, Onn Min Kon, Jo Southern
Journal: European Respiratory Journal (2015)

In the past 20 years, following several decades of decline, the number of tuberculosis (TB) cases in the UK has increased. The characteristics of TB cases have changed, from a disease that was predominantly pulmonary and widespread in the population [1], to one that is concentrated in major urban areas affecting immigrants, the homeless, prisoners and drug users [2], with a high proportion of extrapulmonary disease [3]. The signs and symptoms of TB are shared with many other diseases. Therefore, knowledge of the epidemiology of TB and current associated risk factors is essential in informing a diagnosis [4]. The changing epidemiology of TB in low incidence settings has implications for TB diagnosis and therefore elimination <http://ow.ly/KN6Vq>
Italian Medicine Defended
Authors: Stephen C. Suffin
Journal: JAMA (1979)

<h3>To the Editor.—</h3> We wish to comment on certain statements attributed to us in the MEDICAL NEWS article "Viruses Implicated in Naples Epidemic" (241:1445, 1979). It is difficult to reconcile some aspects of the article with the strong admiration we have for our Italian colleagues and their strenuous efforts to define the etiology and mechanism of the fatal illnesses that occurred in infants and young children in Naples during the past year. We do not view the quality of Italian medicine in the manner that the second paragraph of the article might suggest. We received the fullest possible cooperation from our Italian colleagues. Furthermore, we anticipate future collaborative efforts to elucidate further the nature of the outbreak in Naples. In our view, Italian virus laboratories are competent and meet international standards for excellence. The epidemiologic studies performed by the Laboratory of Epidemiology and Biostatistics of the Instuto Superior Di Sanitá
Transurethral microwave treatment for benign prostatic hypertrophy: a randomised controlled clinical trial.
Authors: A S Bdesha, C J Bunce, J P Kelleher, M E Snell, J Vukusic, R O Witherow
Journal: BMJ (1993)

OBJECTIVES--To determine whether transurethral microwave treatment for patients with benign prostatic hypertrophy provides significant symptomatic relief, a reduction in residual urine volumes, and improvements in flow rates compared with sham treatment. DESIGN--Prospective double blind randomised study with follow up at three months. SETTING--Department of Urology in a London teaching hospital. PATIENTS--40 men completed the study: 22 received microwave treatment and 18 received sham treatment. Entry criteria were symptoms of prostatism of at least six months9 duration, a total symptom score &gt; 14, and a peak urine flow rate &lt; 15 ml/s or a residual urine volume &gt; 50 ml. Exclusion criteria were prostatic cancer, a residual urine volume &gt; 200 ml, a very large prostate, an obstructing middle lobe, acute urinary retention, impaired renal function, coexisting urinary tract disease, and previous prostatic surgery. INTERVENTIONS--A single 90 minute transurethral microwave treatment or sham treatment. OUTCOME MEASURES--Patients9 symptoms (including daytime frequency and nocturia) recorded in a self assessment symptom score questionnaire, peak urinary flow rates, and residual urine volumes. RESULTS--The mean total symptom scores of the patients who received microwave treatment fell from 30 to 11 compared with a fall from 31 to 26 for patients who received sham treatment (p &lt; 0.001). Among patients who received microwave treatment daytime frequency fell from 9.4 to 5.5 voids a day and night time frequency from 3.5 to 1.6 voids a night; residual urine volumes fell from 104 ml to 52 ml; and peak urine flow rates increased by 2.3 ml/s. In the control group there was no improvement in any of these features. Treatment preserved sexual function and antegrade ejaculation. CONCLUSIONS--For selected patients with prostatism microwave treatment is effective and has few side effects.
Meeting the Problem
Authors: Symposium Participants
Journal: JAMA (1966)

Dr. Maxwell M. Wintrobe: We have learned that the wise use of drugs involves knowledge, understanding, and awareness. We have been hearing about reactions to drugs and have learned that they may be classified in two categories: by their toxic effects, which are predictable, and in many instances are already known when the drug is introduced from animal studies; then by idiosyncratic or sensitivity reactions, with which we are particularly concerned. Dr. Perera said the real problem in therapy is the physician, not the drug. The first important point, the key word, is awareness: the physician must be aware. The physician also must be alert; this is an essential point in therapy. It also is important that the physician be selective, direct, and specific in therapy, and, when there is a choice, that he use the least potentially dangerous drug. These are the essentials of our problem, and I would
3 Tesla diffusion-weighted MRI for assessing liver fibrosis in nonalcoholic fatty liver disease
Authors: Lavrentios Papalavrentios, Emmanouil Sinakos, Danai Chourmouzi, Prodromos Hytiroglou, Konstantinos Drevelegas, Antonios Drevelegas, Evangelos Akriviadis
Journal: Hepatology (2013)

We read with great interest the meta-analysis by Wang et al.,1 who evaluated the diagnostic accuracy of magnetic resonance elastography (MRE) and diffusion-weighted imaging (DWI) for the staging of hepatic fibrosis. The authors concluded that MRE is more reliable for staging hepatic fibrosis. This is a significant contribution to our knowledge, as recent advances in MRI techniques have made the use of these methods common in clinical practice. In our opinion, attention must also be focused on several technical parameters of MRI methods before physicians can safely interpret the results. The standard MRI scanners currently use a 1.5-Tesla magnetic field. This is also the type of scanner that was used in all the studies included in the meta-analysis by Wang et al. Theoretically, new-generation 3-Tesla scanners could enhance the ability for hepatic fibrosis staging. Especially for DWI, another vital parameter is the apparent diffusion coefficient (ADC) and its b value. ADC reflects diffusion in a quantitative way and b value illustrates the sensitivity of a DWI sequence. The higher the b value, the more sensitive the sequence is to diffusion effects.2 Conflicting results have been published on the optimal b value for hepatic fibrosis staging.3 This was also remarkably reflected in the great variation of b values used in the studies of the meta-analysis. We recently presented our preliminary results on hepatic fibrosis staging in a small cohort of patients with nonalcoholic fatty liver disease (NAFLD) using a 3-Tesla MRI scanner.4 DWI was performed in the axial plane with tridirectional diffusion gradients using three b values: 0, 500, and 1000 s/mm2. Fibrosis stage was poorly associated with ADC at a b value of 500 s/mm2 (r = −0.30, P = 0.27). However, it was significantly associated with ADC at a b value of 1,000 s/mm2 (r = −0.57, P = 0.01). For this b value the area under receiver-operating characteristic curve was 0.93 for fibrosis stage ≥3 and the optimal ADC cutoff value was 1.16 × 10−3 s/mm2 (positive predictive value: 100%, negative predictive value: 90%). To our knowledge there are no published data on liver fibrosis staging with 3-Tesla MRI scanners in patients with NAFLD. The broader availability of this technology might enhance the performance of DWI for fibrosis staging. Given that DWI does not need additional equipment, as opposed to MRE, it might be an attractive option for liver fibrosis staging once all technical parameters like the b value are elucidated. Lavrentios Papalavrentios M.D.*, Emmanouil Sinakos M.D., Ph.D.*, Danai Chourmouzi M.D.*, Prodromos Hytiroglou M.D.*, Konstantinos Drevelegas M.D.*, Antonios Drevelegas M.D., Ph.D.*, Evangelos Akriviadis M.D., Ph.D.*, * University of Thessaloniki, 4th Internal Medicine Unit, Thessaloniki, Greece.
Presenting Plasma HIV RNA Level and Rate of CD4 T-Cell Decline
Authors: Geoffrey S. Gottlieb, Stephen E. Hawes, David C. Nickle, Joshua T. Herbeck, Nancy B. Kiviat, James I. Mullins, Papa Salif Sow
Journal: JAMA (2007)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Familial aggregation of primary glomerulonephritis in an Italian population isolate: Valtrompia study
Authors: C. Izzi, S. Sanna-Cherchi, E. Prati, R. Belleri, A. Remedio, R. Tardanico, M. Foramitti, S. Guerini, B.F. Viola, E. Movilli, I. Beerman, R. Lifton, L. Leone, A. Gharavi, F. Scolari
Journal: Kidney International (2006)
Licensing drugs for diabetes
Authors: R. Lehman, J. S. Yudkin, H. Krumholz
Journal: BMJ (2010)

Surrogate end points are not enough, robust evidence of benefits and harms is needed 

The rosiglitazone (Avandia) story sounds deceptively similar to that of other drugs that have been withdrawn in recent years because of emerging safety concerns, notably rofecoxib (Vioxx). But several of the lessons are importantly different and raise fundamental questions about the criteria for licensing new drugs for diabetes and the way that clinicians use evidence about such drugs to incorporate them into clinical practice.

The additional 80% relative risk of myocardial infarction attributed to rosiglitazone at recent hearings of the US Food and Drug Administration1 2 is probably comparable to that of several non-steroidal anti-inflammatory drugs that are still on the market.3 The scandal of rosiglitazone lies in the fact that we were prescribing the drug to reduce the serious consequences of type 2 diabetes, the most important of which is myocardial infarction. Yet because no licensing body demanded evidence of effect on cardiovascular risk at the time of licensing, 10 years after the release of rosiglitazone we still cannot accurately quantify the harm to which we were exposing our patients. As clinicians we did not increase this risk knowingly, but ignorantly, because we were focused on the wrong end point: glycated haemoglobin (haemoglobin A1c). We had lost sight of the main reason for treating this complex and progressive disease, which is not to reduce glycaemia but to prevent complications.

Rosiglitazone was licensed …
Microalbuminuria in systemic sclerosis.
Authors: A Dawnay, A G Wilson, E Lamb, J D Kirby, W R Cattell
Journal: Annals of the Rheumatic Diseases (1992)

A prospective study was performed to determine urinary albumin excretion in a group of 28 patients with systemic sclerosis. At the initial screen one patient had proteinuria and three had microalbuminuria. One year later these abnormalities persisted and in two of of the patients serum creatinine had significantly increased. In addition, a further three patients had developed microalbuminuria. In a control group of 10 patients with primary Raynaud's disease none had microalbuminuria. In a second control group of 16 patients with unrelated skin diseases one patient had microalbuminuria and one proteinuria, but both these patients had a history of hypertension. It is concluded that microalbuminuria is more common in patients with systemic sclerosis than in patients of equivalent age with other dermatological conditions but no vascular disease.
Acute Systemic Inflammation Impairs Endothelium-Dependent Dilatation in Humans
Authors: Aroon D. Hingorani, Jenny Cross, Rajesh K. Kharbanda, Michael J. Mullen, Kiran Bhagat, Mia Taylor, Ann E. Donald, Miriam Palacios, George E. Griffin, John E. Deanfield, Raymond J. MacAllister, Patrick Vallance
Journal: Circulation (2000)

Background —We tested the hypothesis that endothelial dysfunction underlies the association between an acute inflammatory episode and the transiently increased risk of a cardiovascular event by examining the effects of an experimental inflammatory stimulus on endothelium-dependent vasodilation. Methods and Results — Salmonella typhi vaccine was used to generate a systemic inflammatory response in healthy volunteers. In 12 subjects, dilatation of the brachial artery to flow and to sublingual nitroglycerin (NTG) was recorded (conduit vessel response), and in 6 subjects, venous occlusion plethysmography was used to measure forearm blood flow during intrabrachial infusion of the endothelium-dependent dilators acetylcholine (ACh) and bradykinin (BK) and the endothelium-independent dilators NTG and verapamil (resistance vessel response). Responses were assessed 16 hours before and 8 and 32 hours after vaccination. Vaccination resulted in elevations in white cell count and serum levels of interleukin-6 and interleukin-1 receptor antagonist. Eight hours after vaccination, resistance vessel responses to BK ( P =0.0099) and ACh ( P =0.0414) were markedly attenuated, and brachial artery flow-mediated dilatation was depressed. Resistance vessel responses to verapamil and NTG were unchanged, as was the conduit vessel response to NTG. Thirty-two hours after vaccination, resistance vessel responses to BK and ACh had returned to normal. Conclusions — S typhi vaccine generates a mild inflammatory reaction associated with temporary but profound dysfunction of the arterial endothelium in both resistance and conduit vessels to both physical and pharmacological dilator stimuli. This finding might explain the association between infection and inflammation and the enhanced risk of an acute cardiovascular event.
Left Atrial Size and the Risk of Stroke and Death
Authors: Emelia J. Benjamin, Ralph B. D’Agostino, Albert J. Belanger, Philip A. Wolf, Daniel Levy
Journal: Circulation (1995)

Background The medical literature contains conflicting reports on the association of left atrial (LA) enlargement with risk of stroke. The relation of LA size to risk of stroke and death in the general population remains largely unexplored. Methods and Results Subjects 50 years of age and older from the Framingham Heart Study were studied to assess the relations between echocardiographic LA size and risk of stroke and death. During 8 years of follow-up, 64 of 1371 (4.7%) men and 73 of 1728 (4.2%) women sustained a stroke, and 296 (21.6%) men and 271 (15.7%) women died. Sex-specific Cox proportional-hazards models were adjusted for age, hypertension, diabetes, atrial fibrillation, smoking, ECG left ventricular (LV) hypertrophy, and congestive heart failure or myocardial infarction. After multivariable adjustment, for every 10-mm increase in LA size, the relative risk of stroke was 2.4 in men (95% CI, 1.6 to 3.7) and 1.4 in women (95% CI, 0.9 to 2.1); the relative risk of death was 1.3 in men (95% CI, 1.0 to 1.5) and 1.4 in women (95% CI, 1.1 to 1.7). Adjusting for ECG LV mass/height attenuated the relation of LA size to stroke and death. Conclusions After multivariable adjustment, LA enlargement remained a significant predictor of stroke in men and death in both sexes. The relation of LA enlargement to stroke and death appears to be partially mediated by LV mass.
Ondine's Blessing
Authors: Sam Vee
Journal: JAMA (1980)

"What are you doing on my bed, Ondine?" The comely water sprite might have walked out unchanged from Müller's painting—misty gray eyes shyly smiling, lips half-pursed, hair tousled, shapely legs dangling over the bed's edge, water dripping from toes that barely reached the floor. The dampness that enveloped her was penetrating my nostrils. I sneezed. "Bless you!" she said. "You're out of character, Ondine. You are supposed to curse, not bless." "Whale-wash. I've been maligned for centuries." Ondine was vehement in her denial. "The only man I ever cursed was my unfaithful lover, whom I deprived of automatic breath control. All he had to do was to stay awake and breathe. As it was, exhausted from his dalliance with the other woman, he fell asleep, and, unable to breathe, he died." "If you disclaim responsibility for the curse, then what are you doing here?" "I came to breathe new life