tbuckley/cabot-search huggingface dataset:
Rational Prescribing in Primary Care (RaPP): A Cluster Randomized Trial of a Tailored Intervention
Authors: Atle Fretheim, Andrew D Oxman, Kari Håvelsrud, Shaun Treweek, Doris T Kristoffersen, Arild Bjørndal
Journal: PLoS Medicine (2006)

Background A gap exists between evidence and practice regarding the management of cardiovascular risk factors. This gap could be narrowed if systematically developed clinical practice guidelines were effectively implemented in clinical practice. We evaluated the effects of a tailored intervention to support the implementation of systematically developed guidelines for the use of antihypertensive and cholesterol-lowering drugs for the primary prevention of cardiovascular disease. Methods and Findings We conducted a cluster-randomized trial comparing a tailored intervention to passive dissemination of guidelines in 146 general practices in two geographical areas in Norway. Each practice was randomized to either the tailored intervention (70 practices; 257 physicians) or control group (69 practices; 244 physicians). Patients started on medication for hypertension or hypercholesterolemia during the study period and all patients already on treatment that consulted their physician during the trial were included. A multifaceted intervention was tailored to address identified barriers to change. Key components were an educational outreach visit with audit and feedback, and computerized reminders linked to the medical record system. Pharmacists conducted the visits. Outcomes were measured for all eligible patients seen in the participating practices during 1 y before and after the intervention. The main outcomes were the proportions of (1) first-time prescriptions for hypertension where thiazides were prescribed, (2) patients assessed for cardiovascular risk before prescribing antihypertensive or cholesterol-lowering drugs, and (3) patients treated for hypertension or hypercholesterolemia for 3 mo or more who had achieved recommended treatment goals. The intervention led to an increase in adherence to guideline recommendations on choice of antihypertensive drug. Thiazides were prescribed to 17% of patients in the intervention group versus 11% in the control group (relative risk 1.94; 95% confidence interval 1.49–2.49, adjusted for baseline differences and clustering effect). Little or no differences were found for risk assessment prior to prescribing and for achievement of treatment goals. Conclusions Our tailored intervention had a significant impact on prescribing of antihypertensive drugs, but was ineffective in improving the quality of other aspects of managing hypertension and hypercholesterolemia in primary care.
Nephrogenic Adenomas as Renal Tubular Outposts
Authors: Julie R. Ingelfinger
Journal: New England Journal of Medicine (2002)

Nephrogenic adenomas, which are rare intraurothelial lesions that occur in the bladder, ureter, or urethra, most often present with hematuria or discomfort on voiding. Some patients have no symptoms at all, but occasionally, obstruction develops. These lesions are generally discovered long after an apparent urologic insult or the initiation of immunosuppression, and their origin is enigmatic. The growths consist of tubule-like microstructures, but whether these lesions originate from mesothelial rests, represent squamous metaplasia, or derive from exfoliated renal tubular cells is unclear. In this issue of the Journal, Mazal et al.1 present compelling evidence that these unusual adenomas originate from . . .
Predictors of Abdominal Aortic Aneurysm Sac Enlargement After Endovascular Repair
Authors: Andres Schanzer, Roy K. Greenberg, Nathanael Hevelone, William P. Robinson, Mohammad H. Eslami, Robert J. Goldberg, Louis Messina
Journal: Circulation (2011)

Background— The majority of infrarenal abdominal aortic aneurysm (AAA) repairs in the United States are performed with endovascular methods. Baseline aortoiliac arterial anatomic characteristics are fundamental criteria for appropriate patient selection for endovascular aortic repair (EVAR) and key determinants of long-term success. We evaluated compliance with anatomic guidelines for EVAR and the relationship between baseline aortoiliac arterial anatomy and post-EVAR AAA sac enlargement. Methods and Results— Patients with pre-EVAR and at least 1 post-EVAR computed tomography scan were identified from the M2S, Inc. imaging database (1999 to 2008). Preoperative baseline aortoiliac anatomic characteristics were reviewed for each patient. Data relating to the specific AAA endovascular device implanted were not available. Therefore, morphological measurements were compared with the most liberal and the most conservative published anatomic guidelines as stated in each manufacturer's instructions for use. The primary study outcome was post-EVAR AAA sac enlargement (&gt;5-mm diameter increase). In 10 228 patients undergoing EVAR, 59% had a maximum AAA diameter below the 55-mm threshold at which intervention is recommended over surveillance. Only 42% of patients had anatomy that met the most conservative definition of device instructions for use; 69% met the most liberal definition of device instructions for use. The 5-year post-EVAR rate of AAA sac enlargement was 41%. Independent predictors of AAA sac enlargement included endoleak, age ≥80 years, aortic neck diameter ≥28 mm, aortic neck angle &gt;60°, and common iliac artery diameter &gt;20 mm. Conclusion— In this multicenter observational study, compliance with EVAR device guidelines was low and post-EVAR aneurysm sac enlargement was high, raising concern for long-term risk of aneurysm rupture.
Xeroderma pigmentosum: the role of phototesting
Authors: N. Stone, J. Reed, J. Mahood, N. Hardwick, S. George
Journal: British Journal of Dermatology (2000)

We report three patients newly diagnosed as having xeroderma pigmentosum (XP). Previous photobiological studies have implicated ultraviolet (UV) B as the activating waveband in XP, causing a delayed and prolonged erythemal response. This characteristic reaction pattern has been used as a quick screening test in patients suspected of having XP, while awaiting confirmatory DNA repair studies. Two of our patients showed no abnormal erythemal responses, and one showed severe photosensitivity from 330 to 400 nm but normal UVB responses, with a peak erythema at 24 h. We conclude that the erythemal responses in XP are highly variable and cannot be considered as a reliable screening test in the diagnosis of XP.
BUT ONE PROFESSION OF MEDICINE.
Authors: DUDLEY S. REYNOLDS
Journal: JAMA (1903)

It may be fairly claimed that, prior to 1880, the medical profession embraced the regularly educated regular physicians, the regularly educated homeopathic physicians and the regularly educated eclectic physicians. Infinite varieties of each of these classes, representing all manner of individual peculiarities, were to be found in every community. There were those claiming the inherent hereditary power of healing the sick or some mysterious gift from the Creator of the universe to dissipate disease. Then we had the Thompsonian, the Baunscheidt systems,<i>et id genus omne</i>. In most states any person desiring to engage in the practice of medicine might have his sign painted, issue his cards or publish his announcement in the newspaper and proceed at once to invade the ranks of the credulous. In some places a local license tax was exacted. All this has been changed. The work of the Association of American Medical Colleges has, through the encouragement and support of the medical societies, brought
Resistance to Suppression by Dexamethasone of Plasma 11-O.H.C.S. Levels in Severe Depressive Illness
Authors: B. J. Carroll, F. I. R. Martin, B. Davies
Journal: BMJ (1968)

Use of the midnight dexamethasone suppression test showed that the plasma 11-hydroxycorticosteroid (11-O.H.C.S.) level did not undergo its normal reduction in 14 out of 27 patients with severe depression. Resistance to dexamethasone suppression correlated with the clinical rating of the severity of depression, while recovery from depression was associated with return of normal responsiveness to dexamethasone. The explanation of these findings is unknown.
GASTRIC LESIONS OF LOEFFLER'S SYNDROME
Authors: Sidney A. Portis
Journal: JAMA (1952)

<h3>To the Editor:—</h3> I am very much interested in the article inThe Journal, June 7, 1952, entitled "Gastric Lesion of Loeffler's Syndrome," reported by Ruzic, Dorsey, Huber, and Armstrong, and the findings at operation. I have seen the same lesions of the stomach with the comparable roentgenologic observations due to aureomycin. When therapy with the drug had been discontinued after a period of five to six weeks, the stomach completely returned to normal. In one patient who came under my observation in July, 1949, and who had been given a copious dose of aureomycin, on roentgenologic examination edematous, pseudopolypoid diffused changes were found. These changes were so severe that we were considering gastrectomy. The gallbladder could not be visualized. X-ray examination was again performed on Aug. 9, 1949, and there was a complete disappearance of these pseudopolypoid changes of the stomach. The patient was operated on at the Johns
Immunologic thrombocytopenic purpura as presenting symptom of hepatitis C infection
Authors: Frédéric Bauduer, Fabrice Marty, Marc Larrouy, Louis Ducout
Journal: American Journal of Hematology (1998)

We report on 3 female patients with immunologic thrombocytopenic purpura (ITP) for whom diagnostic procedures evidenced a chronic Hepatitis C virus (HCV) infection. In 2 cases, a transfusion performed more than 10 years ago represented the probable way of contamination. One patient received a course of steroids, which normalized the platelet counts. Another one has been treated with repeated IV immunoglobulins, which induced partial responses of variable duration. HCV is responsible for many autoimmune manifestations and a search for this virus seems warranted for exploring patients with ITP.
Mammography and Breast Diseases
Authors: Franklin S. Alcorn
Journal: JAMA (1971)

In this latest book of Dr. Egan two aspects of mammography, not stressed in his first book in 1964, are presented in detail. The first is a detailed discussion of the methods used in the physical evaluation of the mammographic technique. Experiments are presented demonstrating the failure of conventional x-ray units, designed to operate at or above 50 kilovolt peak, to deliver adequate milliamperage and a satisfactory wave form at low kilovolt peak range. The effects on film quality of smaller focal spots, shorter object-film distances, and off-focus radiation are also presented. The four most important factors affecting roentgenographic detail are motion, object-film distance, columnation, and film type and processing, and Egan presents appropriate tests for evaluating each of these factors. The second aspect and the most important new information in this volume is a detailed discussion of the correlated clinical, radiographic, and pathologic approach to the study of breast
Management of Small Abdominal Aortic Aneurysms
Authors: David A. Katz
Journal: JAMA (1992)

<h3>Objective.</h3> —To compare two clinical strategies for the management of small abdominal aortic aneurysms (AAAs) less than 5 cm in diameter: early surgery (repair small AAAs when diagnosed) and watchful waiting (measure AAA size every 6 months and repair when the diameter reaches 5 cm). <h3>Data Sources.</h3> —We reviewed data from an earlier longitudinal study of patients with small AAAs to estimate incidence rates of rupture or acute expansion. Estimates for other parameters in the model were obtained by searching the medical literature (MEDLINE, 1966 to present). <h3>Data Synthesis.</h3> —We constructed a Markov decision tree to compare early surgery with watchful waiting in patients with asymptomatic AAAs less than 5 cm in diameter, with respect to long-term survival in quality-adjusted life years. The average annual rates of rupture or acute expansion for AAAs with a maximal transverse diameter of less than 4.0,4.0 to 4.9, and at least 5.0 cm, are 0, 3.3, and 14.4 events per 100 patient-years of observation, respectively. At an average rupture rate of 3.3 events per 100 patient-years and an average operative risk for elective surgery (4.6%, 30-day mortality), our model predicts that early surgery improves survival in patients who present with a 4-cm AAA. The benefit of early surgery decreases with increased age at presentation. If the average rupture rate for AAAs less than 5 cm is assumed to be low (eg, 0.4 event per 100 patient-years), watchful waiting is favored, particularly as operative risk increases. The decision in this subgroup, however, is sensitive to possible future increases in operative risk. <h3>Conclusions.</h3> —In the majority of scenarios that we examined, early surgery is preferred to watchful waiting for patients with AAAs less than 5 cm in diameter. Watchful waiting is generally favored, however, for patients with a low risk of AAA rupture or acute expansion, including those patients who present with very small AAAs (eg, &lt;4 cm). More accurate data concerning the rupture risk of AAAs less than 5 cm would improve clinical decision making. (<i>JAMA</i>. 1992;268:2678-2686)
Technique of Celiac Blockade for Relief of Splanchnic Ischemia
Authors: Amos Nahor
Journal: JAMA (1965)

Sustained celiac blockade can be achieved by percutaneous injection of 25 ml of 25% to 50% ethanol, with or without 0.5% lidocaine (Xylocaine) hydrochloride, or by repeated injections of 0.25% lidocaine. The purpose of this blockade is to relieve ischemia in the splanchnic area. Better regional flow results, but whether improved flow will be sustained and serve to prevent death from shock and other disorders in which splanchnic ischemia is a threat to life depends on the reversibility of the damage already present.
Confirmed Previous Infection With <i>Chlamydia pneumoniae</i> (TWAR) and Its Presence in Early Coronary Atherosclerosis
Authors: Michael Davidson, Cho-Chou Kuo, John P. Middaugh, Lee Ann Campbell, San-Pin Wang, William P. Newman, John C. Finley, J. Thomas Grayston
Journal: Circulation (1998)

Chlamydia pneumoniae has been identified in coronary atheroma, but concomitant serum antibody titers have been inconsistently positive and unavailable before the detection of early or advanced atherosclerotic lesions.This retrospective investigation was performed on premortem serum specimens and autopsy tissue from 60 indigenous Alaska Natives at low risk for coronary heart disease, selected by the potential availability of their stored specimens. Serum specimens were drawn a mean of 8.8 years (range, 0.7 to 26.2 years) before death, which occurred at a mean age of 34.1 years (range, 15 to 57 years), primarily from noncardiovascular causes (97%). Coronary artery tissues were independently examined histologically and, for C pneumoniae organism and DNA, by immunocytochemistry (ICC) and polymerase chain reaction (PCR) with species-specific monoclonal antibody and primers. Microimmunofluorescence detected species-specific IgG, IgA, and IgM antibody in stored serum. C pneumoniae, frequently within macrophage foam cells, was identified in coronary fibrolipid atheroma (raised lesions, Stary types II through V) in 15 subjects (25%) and early flat lesions in 7 (11%) either by PCR (14, 23%) or ICC (20, 33%). The OR for C pneumoniae in raised atheroma after a level of IgG antibody > or =1:256 >8 years earlier was 6.1 (95% CI, 1.1 to 36.6) and for all coronary tissues after adjustment for multiple potential confounding variables, including tobacco exposure, was 9.4 (95% CI, 2.6 to 33.8).Serological evidence for C pneumoniae infection frequently precedes both the earliest and more advanced lesions of coronary atherosclerosis that harbor this intracellular pathogen, suggesting a chronic infection and developmental role in coronary heart disease.
Some concerns about the phoneme-like inputs to Merge
Authors: Terrance M. Nearey
Journal: Behavioral and Brain Sciences (2000)

As a proponent of phoneme-like units in speech perception, I am very sympathetic to Merge's use of phoneme-oriented input. However, in the absence of any known way to provide input in exactly the form assumed, further consideration needs to be given to how the variation in the details of the specification of this input might affect Merge's (and Shortlist's) overall behavior.
The Sweeping Wind: A Memoir
Authors: John H. Raach
Journal: JAMA (1962)

In his memoir, Paul de Kruif gives us an autobiography which ranks with the best of these rare forms of literature. In his lifetime he has been in close touch with great events in 20th century medicine and has counted some of the great personages of the American scene among his intimate friends. The manner in which he recounts short anecdotes about many of these people is fascinating. Private conversations and letters, which always intrigue a reader, abound in his story and make it far better reading as a result. For those who have enjoyed de Kruif's novels and articles, this memoir will be a welcome addition to their library of "de Kruifiana." The inimitable style which he has developed is at its best in the first portion of the book. The latter portion is less a story and more a mere recounting of experiences with people and committees. His
THE INCIDENCE OF ARRHYTHMIAS AND CLINICAL ARRHYTHMIC EVENTS IN PATIENTS WITH ACUTE CORONARY SYNDROMES TREATED WITH TICAGRELOR OR CLOPIDOGREL IN THE PLATO TRIAL
Authors: Benjamin M. Scirica, Christopher P. Cannon, Håkan Emanuelsson, Robert A. Harrington, Steen Husted, Stefan K. James, Hugo Katus, Eric L. Michelson, Pais Prem, Raev Dmitar, Jindrich Spinar, Ph Gabriel Steg, Robert F. Storey, Lars Wallentin, None TIMI Study Group
Journal: Journal of the American College of Cardiology (2010)
Predicting Sudden Death in the Population
Authors: Xavier Jouven, Michel Desnos, Claude Guerot, Pierre Ducimetière
Journal: Circulation (1999)

Sudden death was found to share the same set of usual risk factors as coronary events and therefore could not be specifically predicted in the population. It appears, however, that parental history of sudden death has not been investigated yet as a risk factor for sudden death. Therefore, we assessed risk factors, including parental sudden death, associated with the occurrence of sudden death in a long-term cohort study.We included 7746 men employed by the city of Paris who were 43 to 52 years of age in 1967 to 1972 in the Paris Prospective Study I. Each subject underwent a physical examination and an ECG, provided blood for laboratory tests, and answered questionnaires administered by trained interviewers who paid particular attention to family medical history. Men with known ischemic cardiac disease were further excluded from analysis. For 95.5% of the men, vital status was obtained from specific inquiries until retirement, then by death certificates. Resting heart rate, systolic or diastolic blood pressure, tobacco consumption, body mass index, diabetes status, serum cholesterol, and parental history of sudden death were independent factors associated with sudden death during follow-up (23 years on average). When adjusted for confounding variables, including parental history of myocardial infarction, relative risk of sudden death associated with parental sudden death was 1.80 (95% CI, 1.11 to 2.88).Parental sudden death is an independent risk factor for sudden death in middle-aged men. The existence of familial risk factors for sudden death may help provide better identification of subjects at high risk of and early prevention of sudden death.
Abstract 1120: α-Tocopherol protects cells from lipid peroxidation and rescues tumorigenic phenotypes in CS/CSL patients with germline SDHx variants
Authors: Ying Ni, Charis Eng
Journal: Cancer Research (2012)

Abstract Cowden syndrome (CS), a Mendelian autosomal-dominant disorder, predisposes to breast, thyroid, and other cancers. Germline mutations in phosphatase and tensin homolog (PTEN) have been found in 25% of classic CS individuals accrued from the community. Additionally, we have shown that germline variations in succinate dehydrogenase genes (SDHx) occur in 8% of 608 PTEN mutation-negative CS and CS-like (CSL) individuals (SDHvar+), compared to 0/700 controls (p&amp;lt;0.0001, Fisher's 2-tailed exact test). SDHx genes encode for mitochondrial complex II which lies at the crossroads of electron transport and the tricarboxylic acid cycle. We previously showed that SDHx variants result in elevated reactive oxygen species (ROS) and in disruption of such mitochondrial metabolites as flavin adenine dinucleotide (FAD) and nicotinamide adenine dinucleotide (NAD) equilibrium in CS/CSL patient-derived lymphoblastoid cells. Consequently, improper NADH quinone oxidoreductase 1 (NQO1)-p53 interaction results in destabilization of p53 and apoptosis resistance. Here we further demonstrate that elevated ROS production results in higher lipid peroxidation in SDHvar+ cells compared to healthy control cells. This increased oxidative stress led to increased mutation accumulation in mitochondrial hypervariable region II (HVRII) in samples with SDHx variants compared to controls. Interestingly, α-tocopherol treatment, but not other antioxidants, can rescue SDHvar+ cells from apoptosis resistance. This lipid soluble vitamin E, functions as a peroxyl-radical scavenger, protecting SDHvar+ cells from oxidative damage. We observed down regulated lipid peroxidation in SDHvar+ cells after α-tocopherol exposure, as well as recovered p53 expression and FAD/NAD levels. We conclude that α-tocopherol selectively protects SDHvar+ cells from redox stress and downstream tumorigenic reprogramming, which may have intriguing clinical implications such as using vitamin E as a potential preventive adjunct for CS/CSL individuals with SDHx variants. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1120. doi:1538-7445.AM2012-1120