tbuckley/cabot-search huggingface dataset:
Clinical judgment and statistics. Lessons from a simulated randomized trial in coronary artery disease.
Authors: K L Lee, J F McNeer, C F Starmer, P J Harris, R A Rosati
Journal: Circulation (1980)

A simulated randomized clinical trial in coronary artery disease was conducted to illustrate the need for clinical judgment and modern statistical methods in assessing therapeutic claims in studies of complex diseases. Clinicians should be aware of problems that occur when a patient sample is subdivided and treatment effects are assessed within multiple prognostic categories. In this example, 1073 consecutive, medically treated coronary artery disease patients from the Duke University data bank were randomized into two groups. The groups were reasonably comparable and, as expected, there was no overall difference in survival. In a subgroup of 397 patients characterized by three-vessel disease and an abnormal left ventricular contraction, however, survival of group 1 patients was significantly different from that of group 2 patients. Multivariable adjustment procedures revealed that the difference resulted from the combined effect of small imbalances in the distribution of several prognostic factors. Another subgroup was identified in which a significant survival difference was not explained by multivariable methods. These are not unlikely examples in trials of a complex disease. Clinicians must exercise careful judgment in attributing such results to an efficacious therapy, as they may be due to chance or to inadequate baseline comparability of the groups.
Paediatric lung transplantation
Authors: G.B. Mallory, T.L. Spray
Journal: European Respiratory Journal (2004)

Since 1990, lung transplantation has been performed in infants, children and adolescents in small numbers, and the numbers, in comparison with adult transplants, remain small today. The indications for lung transplantation are similar in childhood when compared with adults, but the disease entities are distinct. In children, severe pulmonary vascular disease is most commonly associated with developmental abnormalities or congenital heart disease, as opposed to idiopathic pulmonary hypertension. Cystic fibrosis is the dominant indication for lung transplantation in older childhood and adolescence. The operative approach to lung transplantation in early life differs from that in adults, in that cardiopulmonary bypass is more likely to be utilised and bilateral lung transplantation is strongly preferred to single lung transplantation. Living donor lung transplantation is proportionately more common in children and adolescents than in adults. Post-transplant complications related to viral infection and post-transplant lymphoproliferative disease are more common and more likely to be severe and life-threatening. Bronchiolitis obliterans is the most important complication after paediatric lung transplantation and limits both the quality of life and duration of survival, as in adults.
Take the Rabbits
Authors: William S. Shimp
Journal: Annals of Internal Medicine (2009)

On Being a Doctor1 December 2009Take the RabbitsWilliam S. Shimp, MDWilliam S. Shimp, MDFrom Lonsdale, MN 55046.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-11-200912010-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The news was worse than expected. At laparotomy, the ovarian mass turned out to be a Krukenberg tumor, the largest of her many abdominal metastases from unsuspected gastric cancer.We met in my office a week after her surgery. She could try chemotherapy, I said, but she would be fortunate to get even partial remission for the effort. We made the decision to proceed with the treatments.She would be okay no matter what the outcome, she said, because she had lived a full and a rewarding life, and her strong religious faith would guide her. Given her age of ... Author, Article, and Disclosure InformationAffiliations: From Lonsdale, MN 55046.Corresponding Author: William S. Shimp, MD, 5426 Frontenac Circle, Lonsdale, MN 55046; e-mail, [email protected]com. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 2009Volume 151, Issue 11Page: 820KeywordsChemotherapyChildrenMotivationNauseaNursesOxygenRabbitsShockSurgeryWalking ePublished: 1 December 2009 Issue Published: 1 December 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Junctional epidermolysis bullosa and pyloric atresia: a distinct entity. Clinical and pathological studies in five patients
Authors: M.D. VALAKI, R.J. PHILLIPS, B.D. LAKE, J.I. HARPER
Journal: British Journal of Dermatology (2006)

Junctional epidermolysis bullosa (JEB) associated with pyloric atresia (PA) is a distinct entity which is inherited as an autosomal recessive disorder. We describe five patients with this association; four died in the neonatal period and one is still alive at 4 years of age. The cutaneous lesions in these patients are identical or similar to those in other JEB subtypes. Urinary tract involvement is part of the syndrome and presents a problem for long-term survival. Using the monoclonal antibody GB3 we investigated skin biopsies from three of our patients and showed normal expression in all of them, unrelated to the outcome of their disease. This indicates that the GB3 monoclonal antibody is without prognostic significance in this syndrome. It is clear that JEB with PA is a distinct entity. The molecular basis as yet is unknown.
Body-Mass Index and Symptoms of Gastroesophageal Reflux in Women
Authors: Brian C. Jacobson, Samuel C. Somers, Charles S. Fuchs, Ciarán P. Kelly, Carlos A. Camargo
Journal: New England Journal of Medicine (2006)

Overweight and obese persons are at increased risk for gastroesophageal reflux disease. An association between body-mass index (BMI)--the weight in kilograms divided by the square of the height in meters - and symptoms of gastroesophageal reflux disease in persons of normal weight has not been demonstrated.In 2000, we used a supplemental questionnaire to determine the frequency, severity, and duration of symptoms of gastroesophageal reflux disease among randomly selected participants in the Nurses' Health Study. After categorizing women according to BMI as measured in 1998, we used logistic-regression models to study the association between BMI and symptoms of gastroesophageal reflux disease.Of 10,545 women who completed the questionnaire (response rate, 86 percent), 2310 (22 percent) reported having symptoms at least once a week, and 3419 (55 percent of those who had any symptoms) described their symptoms as moderate in severity. We observed a dose-dependent relationship between increasing BMI and frequent reflux symptoms (multivariate P for trend <0.001). As compared with women who had a BMI of 20.0 to 22.4, the multivariate odds ratios for frequent symptoms were 0.67 (95 percent confidence interval, 0.48 to 0.93) for a BMI of less than 20.0, 1.38 (95 percent confidence interval, 1.13 to 1.67) for a BMI of 22.5 to 24.9, 2.20 (95 percent confidence interval, 1.81 to 2.66) for a BMI of 25.0 to 27.4, 2.43 (95 percent confidence interval, 1.96 to 3.01) for a BMI of 27.5 to 29.9, 2.92 (95 percent confidence interval, 2.35 to 3.62) for a BMI of 30.0 to 34.9, and 2.93 (95 percent confidence interval, 2.24 to 3.85) for a BMI of 35.0 or more. Even in women with a normal baseline BMI, an increase in BMI of more than 3.5, as compared with no weight changes, was associated with an increased risk of frequent symptoms of reflux (odds ratio, 2.80; 95 percent confidence interval, 1.63 to 4.82).BMI is associated with symptoms of gastroesophageal reflux disease in both normal-weight and overweight women. Even moderate weight gain among persons of normal weight may cause or exacerbate symptoms of reflux.
Are nurses better than doctors?
Authors: D. Spence
Journal: BMJ (2012)

Job induction 1993 style—five junior doctors, a whiff of stale cigarettes and sweat, we present for duty in Glasgow casualty department one Sunday morning. We have no trauma experience, no senior supervision, just some old, thumbed textbooks. A “not seen one, not done one—do one” culture, our ignorance was our security blanket. We provided 24 hour cover, seven days a week, with no study leave for six months before we all changed over. How could this dysfunctional system work? Nurses. They held our hands; stopped us; and prompted us in …
Immune-Related Renal Vein Thrombosis in a Renal Allograft
Authors: JOEL GOLDEN
Journal: Annals of Internal Medicine (1976)

A patient developed a renal venous thrombosis 15 months after renal transplantation. In contrast to other cases described in the literature, the thrombosis was not related to vascular surgical trauma, but was immune-complex mediated. The patient's renal function stabilized and the nephrotic syndrome improved over 18 months follow-up during continuous oral anticoagulant therapy.
Risky drinking by both sexes should be tackled
Authors: R. Williamson
Journal: BMJ (2002)

EDITOR—Having read Plant and Plant's letter on drinking by young British women,1 we present data on 12 361 men and 20 534 women aged 20-80 from the genetic environmental nature of emotional states in siblings (GENESiS) study. These data suggest that it is not just drinking by young British women that gives cause for concern: drinking by young British men does too.

The study is a questionnaire study based in the United Kingdom and includes measures on …
Clinical Application of Blood Gases
Authors: E. H. Flewellen
Journal: JAMA (1983)

The purpose of this book is to help the practitioner appropriately interpret and apply information obtained from analysis of arterial blood gases and pH. It is written for a broad audience and would make an excellent textbook for the student respiratory therapist. Additionally, the medical student and resident would benefit by the review of physics and physiology of the cardiorespiratory system, as would the general practitioner. The medical specialist, however, will likely find the basic discussions tedious to read. All readers should benefit from the well-presented practical approach to interpretation of arterial blood gas analysis. This will entail committing to memory several relatively simple rules, such that with a little practical application and minimal knowledge of the patient's history, accurate assessment can be made in a matter of seconds. Obviated is the need for complicated diagrams and tables, which are not easily committed to memory and which rendered previous interpretive
An Approach to Detecting Delayed Effects of Radioactive Contamination on Industrial-Urban-Area Dwellers
Authors: Larissa I. Privalova, Boris A. Katsnelson, Eugene V. Polzik, Vladimir S. Kazantsev, Georgy Ya. Lipatov, Yakov B. Beikin
Journal: Environmental Health Perspectives (1994)

Detecting changes in humans that result from radioactive contamination of the area of residence many years after an incident (i.e., when the radiation has substantially decayed) presents a difficult epidemiological problem. Problems of this kind are even more complicated ina areas where the population is continually exposed to other harmful man-made factors. The city of Kamensk-Uralsky (Sverdlovsk region, Russia) is a good case in point. In 1957, part of Kamensk-Uralsky was contaminated as the result of an accident at the Kyshtym nuclear plant. In addition, the population of the contaminated area is being exposed to atmospheric emissions from several industrial enterprises. Two comparable groups of residents were formed: one in the contaminated are and another in a control area within the same city characterized by similar levels of chemical pollution but substantially lower radioactive contamination. The groups were composed of only those people who had been living in these areas continually since time of the accident and who were under 15 years of age at the time of the accident. The groups were matched by sex, age, and socio-occupational characteristics. For each subject, data were gathered on more than 50 parameters including hematological, immunological, and biochemical indices of the health status. All these data were obtained from blood tests taken in the fall of 1992. Data processing was carried out with the help of a computerized mathematical pattern recognition methodology, which ensured reliable discrimination between the generalized health status in the areas under study. We found that the health status of inhabitants of the area more contaminated with radioactive fallouts was adversely affected by radiation.
Differential Inactivation of CDKN2 and Rb Protein in Non--Small-Cell and Small-Cell Lung Cancer Cell Lines
Authors: M. J. Kelley, K. Nakagawa, S. M. Steinberg, J. L. Mulshine, A. Kamb, B. E. Johnson
Journal: JNCI Journal of the National Cancer Institute (1995)

The CDKN2 gene encodes the human cyclin-dependent kinase 4 inhibitor. This inhibitor protein is believed to be a tumor suppressor that plays an essential role in cell cycle regulation. One half of all cancer cell lines and one fourth of lung cancer cell lines examined to date contain homozygous deletions (i.e., both alleles lost) of CDKN2. However, the relative frequency of homozygous CDKN2 deletions in non-small-cell lung cancers (NSCLC) and in small-cell lung cancers (SCLC) has not been determined. Inactivation or loss of another tumor suppressor encoded by the retinoblastoma gene (the Rb protein) is more common in SCLC than in NSCLC.We measured the frequency of homozygous CDKN2 deletions in 77 NSCLC and in 93 SCLC tumor cell lines. In addition, possible associations were explored between CDKN2 gene loss, the presence or absence of Rb protein, and the clinical status of lung cancer patients.DNA was isolated from each tumor cell line and from the primary tumor and normal tissue of one NSCLC patient. Sequences corresponding to exons 1 and 2 of the CDKN2 gene were amplified by use of the polymerase chain reaction, and the resulting amplification products were analyzed by agarose gel electrophoresis and DNA blotting. Genomic DNA blotting was also used to evaluate CDKN2 gene deletions. The frequency of homozygous CDKN2 loss and the presence or absence of functional Rb protein (reported previously) in the cell lines were compared.Homozygous deletion of CDKN2 was detected in 18 (23%) of 77 cell lines established from patients with NSCLC, compared with one (1%) of 93 cell lines established from patients with SCLC (P < .001). No CDKN2 gene loss was observed in the normal tissue of an NSCLC patient whose tumor cell line showed homozygous deletion of the gene; however, the primary tumor from this patient had evidence of CDKN2 loss. Homozygous CDKN2 deletion was detected in 13 (28%) of 46 tumor cell lines from patients with stage III or stage IV NSCLC, compared with zero of 10 tumor cell lines from patients with stage I or stage II NSCLC. Coincident loss of CDKN2 genes and functional Rb protein was rarely observed (in two of 135 cell lines).The frequency of homozygous CDKN2 gene deletion in NSCLC cell lines is greater than that observed for any other known, or candidate, tumor suppressor gene.Further study of the role of CDKN2 gene alteration in the pathogenesis of NSCLC is needed.
Effect of Cimetidine on Gastric Hypersecretion and Diarrhea in Systemic Mastocytosis
Authors: B. I. HIRSCHOWITZ
Journal: Annals of Internal Medicine (1979)

Two patients had systemic mastocytosis and histamine excess, marked gastric acid and pepsin hypersecretion, and diarrhea. Cimetidine inhibited gastric acid secretion in both, but with only partial initial control of diarrhea. The other manifestations of mastocytosis were only partly controlled, even by combined H-1 and H-2 antagonist therapy. Basal and pentagastrin-stimulated acid and pepsin secretion before and after 5 and 14 months, respectively, of continuous and effective cimetidine therapy were essentially the same. Thus there was no evidence for an increase in the number of H-2 receptors during the long period of blockade or of involution of the parietal or peptic cell mass.
New oral H1 antihistamines in children: facts and unmeet needs
Authors: F. M. De Benedictis, D. De Benedictis, G. W. Canonica
Journal: Allergy (2008)

Background: Second‐generation antihistamines differ from first‐generation ones because of their elevated specificity and affinity for peripheral H1‐receptors and because of their lower penetration to the central nervous system, having fewer sedative effects as a result. Over the last few years, new compounds with different pharmacokinetic properties have been synthesized. More recent improvements of the molecules, generally in the form of active metabolites, led to the synthesis of new‐generation antihistamines. Methods: Recommendations on the minimum criteria that would have to be met for compounds to be classified as new‐generation antihistamines have been recently established by a consensus statement. In the past, the pharmacokinetics and pharmacodynamics of H1 antihistamines have not been optimally investigated in the pediatric population, especially in infants and young children. Results: The pharmacology of second‐generation H1 antihistamines has been investigated relatively deeper than old antihistamines in children. In the pediatric population, clinical studies with new‐generation antihistamines are still limited in number and, with rare exceptions, of brief duration. Comparative trials on the efficacy and safety between different compounds are also lacking. Conclusions: Properly designed, long‐term trials with new‐generation H1 antihistamines need to be performed in single age groups, in order to better define the effects of these drugs in all pediatric population.
Endothelin-1–Induced Release of Thromboxane A <sub>2</sub> Increases the Vasoconstrictor Effect of Endothelin-1 in Postischemic Reperfused Rat Hearts
Authors: Christian E. Zaugg, Pius S. Hornstein, Peili Zhu, David Simper, Thomas F. Lu¨scher, Peter R. Allegrini, Peter T. Buser
Journal: Circulation (1996)

Background The release and vasoconstrictor effect of endothelin-1 (ET-1) are increased after myocardial ischemia, suggesting a role for ET-1 in ischemia/reperfusion injury. However, the mechanisms of the increased vasoconstriction by ET-1 are unknown. The aim of this study was to test whether ET-1–induced release of thromboxane A 2 (TXA 2 ) contributes to the vasoconstrictor effect of ET-1 in nonischemic hearts and whether such release can increase the vasoconstrictor effect of ET-1 in postischemic reperfused hearts. Methods and Results ET-1–induced release of TXA 2 was assessed by measurement of the concentrations of its stable metabolite thromboxane B 2 (TXB 2 ) in the coronary effluent of nonischemic and reperfused isolated rat hearts before and after administration of 0.01 nmol ET-1 using an enzyme immunoassay. The contribution of ET-1–induced release of TXA 2 to the vasoconstrictor effect of ET-1 was assessed by measurement of the effects of ET-1 with and without the cyclooxygenase inhibitor indomethacin or the TXA 2 /endoperoxide receptor antagonist SQ 30,741 using 31 P magnetic resonance spectroscopy. In nonischemic hearts, ET-1 led to a small increase in TXB 2 in the coronary effluent (3.9±1.5 pg/mL; n=3), but neither indomethacin nor SQ 30,741 significantly diminished the vasoconstrictor effects of ET-1 (reduction of coronary flow, 4.0±0.4 and 4.5±0.3 mL/min, respectively, versus 4.9±0.5 mL/min for ET-1 alone; n=8, 6, and 9, respectively). In postischemic reperfused hearts, however, ET-1 led to a greater increase in TXB 2 (13.7±1.5 pg/mL; P &lt;.05 versus nonischemic hearts; n=3), and both indomethacin and SQ 30,741 diminished the vasoconstrictor effects of ET-1 (reduction of coronary flow, 2.6±0.3 and 2.2±0.3 mL/min, respectively, versus 4.0±0.1 mL/min for ET-1 alone; n=8, 8, and 6, respectively; P &lt;.05). Furthermore, indomethacin and SQ 30,741 prevented the detrimental effects of ET-1 on left ventricular developed pressure, intracellular pH, and phosphocreatine during reperfusion. Conclusions ET-1–induced release of TXA 2 does not significantly contribute to the vasoconstrictor effect of ET-1 in nonischemic hearts but can increase the vasoconstrictor effect of ET-1 in postischemic reperfused hearts.
Successful transplantation of human hepatic stem cells with restricted localization to liver using hyaluronan grafts†
Authors: Rachael A. Turner, Eliane Wauthier, Oswaldo Lozoya, Randall McClelland, James E. Bowsher, Claire Barbier, Glenn Prestwich, Edward Hsu, David A. Gerber, Lola M. Reid
Journal: Hepatology (2012)

Cell therapies are potential alternatives to organ transplantation for liver failure or dysfunction but are compromised by inefficient engraftment, cell dispersal to ectopic sites, and emboli formation. Grafting strategies have been devised for transplantation of human hepatic stem cells (hHpSCs) embedded into a mix of soluble signals and extracellular matrix biomaterials (hyaluronans, type III collagen, laminin) found in stem cell niches. The hHpSCs maintain a stable stem cell phenotype under the graft conditions. The grafts were transplanted into the livers of immunocompromised murine hosts with and without carbon tetrachloride treatment to assess the effects of quiescent versus injured liver conditions. Grafted cells remained localized to the livers, resulting in a larger bolus of engrafted cells in the host livers under quiescent conditions and with potential for more rapid expansion under injured liver conditions. By contrast, transplantation by direct injection or via a vascular route resulted in inefficient engraftment and cell dispersal to ectopic sites. Transplantation by grafting is proposed as a preferred strategy for cell therapies for solid organs such as the liver.
Home hemodialysis with subcutaneous arteriovenous fistula
Authors: E. Schupak
Journal: JAMA (1969)

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