tbuckley/cabot-search huggingface dataset:
Differences in Mortality and Use of Revascularization in Black and White Patients With Acute MI Admitted to Hospitals With and Without Revascularization Services
Authors: Ioana Popescu, Mary S. Vaughan-Sarrazin, Gary E. Rosenthal
Journal: JAMA (2007)

Racial differences in the use of coronary revascularization after acute myocardial infarction (AMI) have been widely reported. However, few studies have examined patterns of care for AMI patients admitted to hospitals with and without revascularization services.To compare rates of hospital transfer, coronary revascularization, and mortality after AMI for black and white patients admitted to hospitals with and without revascularization services.Retrospective cohort study of 1,215,924 black and white Medicare beneficiaries aged 68 years and older, admitted with AMI between January 1, 2000, and June 30, 2005, to 4627 US hospitals with and without revascularization services.For patients admitted to nonrevascularization hospitals, transfer to another hospital with revascularization services; for all patients, risk-adjusted rates of 30-day coronary revascularization and 1-year mortality.Black patients admitted to hospitals without revascularization were less likely (25.2% vs 31.0%; P<.001) to be transferred. Black patients admitted to hospitals with or without revascularization services were less likely to undergo revascularization than white patients (34.3% vs 50.2% and 18.3% vs 25.9%; P<.001) and had higher 1-year mortality (35.3% vs 30.2% and 39.7% vs 37.6%; P<.001). After adjustment for sociodemographics, comorbidity, and illness severity, blacks remained less likely to be transferred (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.75-0.81; P<.001) and undergo revascularization (HR, 0.71; 95% CI, 0.69-0.74; P<.001; and HR, 0.68; 95% CI, 0.65-0.70; P<.001 in hospitals with and without revascularization, respectively). Risk-adjusted mortality was lower for blacks during the first 30 days after admission (HR, 0.91; 95% CI, 0.88-0.93; P<.001; and HR, 0.90; 95% CI, 0.87-0.92; P<.001 in hospitals with and without revascularization, respectively) but was higher (P<.001) thereafter.Black patients admitted to hospitals with and without coronary revascularization services are less likely to receive coronary revascularization. The higher long-term mortality of black patients may reflect the lower use of revascularization or other aspects of AMI care.
The additional value of C-reactive protein in patients with intermediate coronary lesions and a normal fractional flow reserve
Authors: Martijn Meuwissen, Robbert J. De Winter, Steven A. Chamuleau, Karel T. Koch, Jan P. ban Straalen, M. Bax, Carl E. Schotborgh, Gerard T. Sanders, Jan G. Tijssen, Jan J. Piek
Journal: Journal of the American College of Cardiology (2003)
Diagnosis and Epidemiology of Condyloma Acuminatum
Authors: Kenneth M. Weiss
Journal: JAMA (1984)

<h3>To the Editor.—</h3> We wish to comment on the recent editorial note concerning the diagnosis and epidemiology of condyloma acuminatum.<sup>1</sup>The Centers for Disease Control analysis of the data collected by the National Disease and Therapeutic Index (NDTI) referred to grossly visible papillomata caused by the human papilloma virus (HPV), occurring in the anogenital region in both sexes. Recently, however, many articles<sup>2-4</sup>have appeared documenting that, at least in women, most HPV lesions are flat, subclinical epithelial proliferations occurring on the cervix or in the vagina that can only be detected by colposcopy. The previously held view that cervical HPV infection was rare has now, as a consequence of improved cytological diagnosis, given way to the recognition that HPV-associated cellular atypia is the most frequent abnormality noted on Papanicolaou smears.<sup>2</sup>Moreover, HPV-associated changes are seen in a substantial proportion of cervical intraepithelial neoplastic lesions. Cytological diagnosis of
Antisickling agents: Effects of carbamyl phosphate or cyanate on survival, erythrocytes, and leucocytes in the mouse
Authors: Lorraine M. Kraus, Howard M. Jernigan, Gordon D. Schrank, Alfred P. Kraus
Journal: American Journal of Hematology (1979)

Abstract Equal mole doses of the anions of disodium carbamyl phosphate (carbamyl P) or sodium cyanate, antisickling agents, have been compared in C57B1 mice. Using 15 mice per group, two groups were given the equivalent ip dose of carbamyl P or cyanate anion (7 mmoles/kg/day) in a divided dose, in the morning and six hours later, for 17–18 days. The control group received sodium chloride (13.8 mmoles of Na + or C1 − /kg/day). Surviving mice per group were sodium chloride, 15/15; disodium carbamyl P, 14/15; and sodium cyanate, 0/15, all mice died by day 2. Surviving mice appeared normal throughout the study, and no abnormalities were seen at necropsy. The hematologic measurements were the same for sodium chloride or disodium carbamyl P, including hemoglobin, packed cell volume, erythrocyte counts, leucocyte counts, and differential counts. The mean hemoglobin carbamylation was 1.24 (±0.06 SE) moles of valine hydantoin/mole of hemoglobin tetramer in mice receiving disodium carbamyl P for 18 days, sufficient for antisickling activity. The enzymatic degradation of carbamyl P to NH 3 , CO 2 , and P i was measured in serial blood samples in additional C57B1 and DBA/2J mice following ip injections of carbamyl P or cyanate. Both NH 3 and P i increased immediately after giving carbamyl P, but no increase occurred after cyanate administration. Thus enzymatic degradation of carbamyl P occurs in vivo and appears to be an important detoxification mechanism. When equivalent mole doses of anion are administered, disodium carbamyl P is less toxic than sodium cyanate in mice.
Eosinophils Respond to Acidic environments with cAMP Generation in a TDAG8-Dependent Manner
Authors: L.C. Kottyan, A.R. Collier, K.A. Niese, C.O. Radu, O.N. Witte, M.E. Rothenberg, N. Zimmermann
Journal: Journal of Allergy and Clinical Immunology (2007)
Differences Between Women and Men in Survival After Myocardial Infarction
Authors: Nicholas H. Fiebach
Journal: JAMA (1990)

To examine the impact of gender on survival after myocardial infarction, we performed a retrospective cohort study of 332 women and 790 men. Women who had a myocardial infarction were older and more often had hypertension, diabetes, previous heart failure, and impaired left ventricular function on admission. Cumulative 3-year mortality and in-hospital mortality rates were significantly higher in women than men, but mortality among hospital survivors was similar. After multivariate adjustment for baseline differences, mortality rates were not significantly different between women and men for in-hospital deaths, and mortality at 3 years among hospital survivors tended to be lower among women. We conclude that higher observed mortality rates following a myocardial infarction in women are related to differences in known risk factors for subsequent mortality and that gender should not be considered an independent risk factor for mortality after myocardial infarction.
Validation of breast cancer biomarkers between a field immunohistochemistry laboratory in Nigeria and its US-based counterpart.
Authors: DO Malaka, A Khramtsov, OA Oluwasola, A Odetunde, AG Falusi, T Grushko, D Huo, OI Olopade
Journal: Cancer Research (2009)

Abstract Abstract #4039 Introduction: The importance of hormone receptor status in assigning treatment and the potential use of HER2 targeted therapy have made it imperative for laboratories to improve detection techniques. As inter-laboratory variability in immunohistochemical (IHC) tests may also affect epidemiologic studies of breast cancer subtypes in different countries, we conducted a validation study of breast cancer biomarkers between a well-established laboratory in the US and a field laboratory at the Institute for Medical Research and Training at the University College Hospital in Ibadan Nigeria.&amp;#x2028; Method: 232 breast tumor blocks were evaluated for ER, PR, and HER2 at both laboratories using tissue micro arrays (TMA) technique. Web-based conferences were held periodically to discuss IHC staining protocols, standardize scoring systems and to resolve discrepant cases. Pathologists used whole slide imaging for joint review and kappa statistic (κ) was used to indicate concordance between the two laboratories. Fluorescence in situ hybridization was carried out to confirm HER2 status in all cases.&amp;#x2028; Results: Initially, concordance analysis revealed an agreement of 91% (κ=0.52) for ER, 85% (κ=0.49) for PR, and 80% (κ=0.39) for HER2 between the two labs. Antigen retrieval techniques and scoring methods were identified as important reasons for discrepancy. After quality assurance and training, the agreement improved to 92% (κ=0.53) for ER, 88% (κ=0.64) for PR, and 94% (κ=0.75) for HER2. To date, florescence in situ hybridization (FISH) has been completed for 67 cases to confirm HER2 status, out of which 16 (24%) were shown to amplify the HER2 gene, 6 out of the 12 discordant HER2 results were resolved by FISH.&amp;#x2028; Conclusion: We found web-based conference with TMA and digital microscopy a useful and cost-effective tool for quality assurance of IHC, consultation and collaboration between distant laboratories. Quality improvement exercises in testing of tumor biomarkers will reduce misclassification in epidemiologic study of breast cancer subtypes and provide much needed capacity building in resource poor field sites.&amp;#x2028; Acknowledgement&amp;#x2028; This study was carried out with the support of Breast SPORE NCI P50 CA125183, Breast Cancer Research Foundation and the Lee Jeans Entertainment Industry Fund. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4039.
Protection by antibiotics against experimental focal cholangitis produced in mice by a schistosomicidal isothiocyanate
Authors: Robert P. Batzinger, Ernest Bueding, Hans Popper
Journal: Hepatology (1981)

Oral administration to mice of high doses of 4-isothiocyano-4'nitrodiphenylamine (amoscanate), a potent antischistosomal drug, produced focal necrotizing lesions of the large intrahepatic and extrahepatic bile ducts and the gallbladder. Coadministration of erythromycin and, to a somewhat lesser degree, of paromomycin, markedly reduced the effects of amoscanate on the biliary tract. These results suggest that amoscanate may be converted to a cholangiotoxic product by one or several constituents of the enteric bacterial flora. Since erythromycin does not affect the antischistosomal activity of amoscanate, coadministration of an antibacterial agent can reduce toxic effects of a drug while full chemotherapeutic activity is maintained. The possibility of toxic effects of metabolites of xenobiotics produced by intestinal bacteria deserves attention and the experimental production of focal intrahepatic and extrahepatic cholangitis by such drug metabolites suggests a possible mechanism in human bile diseases.
P17 Self-reported physical activity levels and attitudes towards a structured exercise programme in adults with difficult asthma
Authors: A. Singapuri, S. Singh, B. Hargadon, M. Shelley, D. Desai, R. Carter, C. Brightling, I. Pavord, P. Bradding, A. Wardlaw, R. Green
Journal: Thorax (2010)

<h3>Background</h3> Patients with difficult-to-treat asthma often have dyspnoea which limits their physical activity. This may lead to progressive deconditioning which may further hamper exercise capacity. We aimed to assess current levels of activity, perceptions of current fitness and interest in a structured exercise programme in patients attending the Glenfield Hospital Difficult Asthma Clinic. <h3>Method</h3> Patients completed the General Practice Physical Activity Questionnaire which provides a simple Physical Activity Index (PAI) and answered structured questions about their satisfaction with current fitness and their interest in participating in an exercise programme. They were also asked to rate their current fitness compared to peers of the same age on a 100 mm visual analogue score. Responses were compared to demographic details and markers of asthma severity and control. <h3>Results</h3> Sixty patients participated (37 female, mean (SD) age 53(13)). Only 15/60 (25%) was classified as 'active' by the PAI. There were no significant differences in age, gender, body mass index or Juniper asthma control scores between those patients who were active compared to the remaining group but active patients had less severe airflow obstruction (post-bronchodilator FEV<sub>1</sub> 83.7(16.5)% predicted vs 68.7(21.8), p=0.04) and better self-reported fitness scores (55.3(27.4) vs 36.7(23.0), p=0.013). There was a statistically significant inverse correlation between fitness scores and Juniper asthma control scores (r = −0.5, p&lt;0.0001) and Hospital Anxiety (r=−0.4, p=0.004) and Depression scores (r=−0.4,p=0.001) but no association with age, BMI or FEV<sub>1</sub>. 65% of patients reported that they had stopped exercising due to their asthma symptoms and 86.7% of patients wanted to be fitter. 71.7% were interested in participating in an exercise programme. Of these 13 (30%) preferred a hospital setting with the remainder preferring a community scheme or an independent programme with support from healthcare professionals. <h3>Conclusion</h3> Many patients with difficult asthma reported concerns about their current fitness and most were not exercising at the recommended level. There appears to be a demand for the development of a community-based structured exercise programme and further work is needed to determine whether this would improve asthma related outcomes for this group of patients.
Accuracy and Power of the Likelihood Ratio Test in Detecting Adaptive Molecular Evolution
Authors: Maria Anisimova, Joseph P. Bielawski, Ziheng Yang
Journal: Molecular Biology and Evolution (2001)

The selective pressure at the protein level is usually measured by the nonsynonymous/synonymous rate ratio (ω = dN/dS), with ω < 1, ω = 1, and ω > 1 indicating purifying (or negative) selection, neutral evolution, and diversifying (or positive) selection, respectively. The ω ratio is commonly calculated as an average over sites. As every functional protein has some amino acid sites under selective constraints, averaging rates across sites leads to low power to detect positive selection. Recently developed models of codon substitution allow the ω ratio to vary among sites and appear to be powerful in detecting positive selection in empirical data analysis. In this study, we used computer simulation to investigate the accuracy and power of the likelihood ratio test (LRT) in detecting positive selection at amino acid sites. The test compares two nested models: one that allows for sites under positive selection (with ω > 1), and another that does not, with the χ2 distribution used for significance testing. We found that use of the χ2 distribution makes the test conservative, especially when the data contain very short and highly similar sequences. Nevertheless, the LRT is powerful. Although the power can be low with only 5 or 6 sequences in the data, it was nearly 100% in data sets of 17 sequences. Sequence length, sequence divergence, and the strength of positive selection also were found to affect the power of the LRT. The exact distribution assumed for the ω ratio over sites was found not to affect the effectiveness of the LRT.
Effects of contrast media on renal function in patients with cirrhosis: A prospective study
Authors: Mònica Guevara, Glòria Fernández-Esparrach, Carlo Alessandria, Aldo Torre, Carlos Terra, Xavier Montañà, Carlos Piera, Maria Luisa Alvarez, Wladimiro Jiménez, Pere Ginès, Vicente Arroyo
Journal: Hepatology (2004)

Patients with cirrhosis are frequently submitted to radiological procedures that require the administration of contrast media. Contrast media is a well-known cause of renal failure, particularly in the presence of some predisposing conditions. However, it is not known whether cirrhosis constitutes a risk factor for contrast media-induced renal failure. The aim of this study was to assess the possible nephrotoxicity of contrast media in patients with cirrhosis. In a first protocol, renal function was evaluated with sensitive methods (glomerular filtration rate using iothalamate I 125 clearance and renal plasma flow using iodohippurate I 131 clearance) before and 48 hours after the administration of contrast media in 31 patients with cirrhosis (20 with ascites, 5 with renal failure). Solute-free water clearance, urine sodium, prostaglandins, and markers of tubular damage were also measured. The administration of contrast media was not associated with significant changes in renal function tests, neither in the whole group of patients nor in patients with ascites or renal failure. Urinary prostaglandin E2 and N-acetyl-beta-D-glucosaminidase increased significantly, but sodium and solute-free water excretion remained unchanged. In a second protocol, a different series of 60 patients with cirrhosis and renal failure were examined prospectively. No patient had renal failure due to contrast media. Only in 1 patient with septic shock was contrast media a possible contributing factor. In conclusion, the administration of contrast media is not associated with adverse effects on renal function in patients with cirrhosis. Cirrhosis does not appear to be a risk factor for the development of contrast media-induced nephrotoxicity.
Pediatricians' Diagnostic Approach to Pharyngitis and Impact of CLIA 1988 on Office Diagnostic Tests
Authors: Benjamin Schwartz
Journal: JAMA (1994)

To determine the factors associated with an optimal diagnostic approach to a child with pharyngitis, characterize office laboratory methods for throat swab culture and group A streptococcal rapid antigen testing, and assess the potential impact of the Clinical Laboratory Improvement Amendments (CLIA) of 1988 on the performance of these tests.Mailed survey to all board-certified primary care pediatricians from seven western states with telephone follow-up for nonrespondents.Differences in practice characteristics and use of office laboratory tests for physicians who usually (> 80%) diagnose pharyngitis using a recommended approach vs those who follow this approach less often (< 50%); characteristics of physicians who indicate that they intend to discontinue office throat culture because of CLIA and those who will continue to perform this test also are compared.Responses from 531 pediatricians were analyzed. Forty-four percent diagnosed pharyngitis appropriately for more than 80% of patients, and 17% did so for fewer than 50%. Optimal diagnosis was significantly more common among physicians who cultured throat swabs in their office (relative risk, 1.40; 95% confidence interval, 1.19 to 1.66) and less common among solo practitioners (relative risk, 0.71; 95% confidence interval, 0.56 to 0.88). Factors that may decrease the sensitivity of office throat culture include short duration of incubation (59%), lack of quality control (51%), and limited education of the persons reading results (6%). With implementation of CLIA, 24% of pediatricians reported that they already have discontinued or will discontinue office throat culture, and 23% have discontinued or will discontinue antigen detection testing for group A streptococci. Those most likely to stop office culture include solo practitioners and practitioners who do not currently perform quality control of culture methods.Office culture for group A streptococci is strongly associated with an optimal diagnostic approach. Implementation of CLIA regulations may substantially decrease the number of physicians who perform this test. The balance between potential improvements in the quality of office culture with CLIA implementation and the decreased availability of this test needs to be assessed.
333 Rat hepatic stellate cells express the intermediate filament anchor protein synemin
Authors: N. Uyama, L. Zhao, C. Eliasson, U. Wilhelmsson, H. Reynaert, D.H. Adams, M. Pinzani, M. Titeux, Z.L. Li, R. Robson, M. Pekny, A. Geerts
Journal: Journal of Hepatology (2004)
Brachial Artery Pressure-Derived Indices are Associated with the Invasive Measurement of Left Ventricular End Diastolic Pressure
Authors: Süleyman Karakoyun, Mustafa Ozan Gürsoy, Kamuran Kalkan, Zakir Lazoğlu, Abdurrezzak Börekçi, Halil İbrahim Tanboğa, Serdar Sevimli
Journal: Journal of the American College of Cardiology (2013)
Successful Treatment of Acquired Hemophilia with Oral Immunosuppressive Therapy
Authors: Linda G. Shaffer, Martin D. Phillips
Journal: Annals of Internal Medicine (1997)

Acquired autoantibodies to factor VIII in patients without hemophilia are rare, but they cause severe illness and death if not eradicated.To examine daily therapy with oral cyclophosphamide and prednisone for acquired hemophilia.Case series.Academic medical center.Nine consecutive patients without hemophilia who had severe hemorrhage caused by high titers of factor VIII inhibitors.Daily oral cyclophosphamide and prednisone. Coagulation factors were used only for bleeding.Plasma titers of factor VIII inhibitor, factor VIII activity, and clinical evidence of bleeding.All patients achieved complete remission, which was defined as loss of residual inhibitor activity and return to a normal titer of factor VIII. Therapy lasted a median of 12 weeks (range, 3 to 37 weeks). Bleeding resolved in a median of 3 weeks (range, 2 to 10 weeks). Median follow-up after discontinuation of therapy was 91 weeks (range, 61 to 164 weeks).Daily administration of oral cyclophosphamide and prednisone without empirical factor VIII therapy seems to be an effective and well-tolerated treatment for acquired hemophilia.
Surgical experience in the management of spontaneous pneumothorax, 1972-82.
Authors: D Weeden, G H Smith
Journal: Thorax (1983)

In the past 11 years 233 patients have undergone 241 parietal pleurectomies for either recurrence of their spontaneous pneumothorax or failure to respond adequately to management by tube drainage. Major complications occurred in 3.7% of cases, with transaxillary apical pleurectomy engendering significantly fewer complications than full pleurectomy through a posterolateral thoracotomy. The significantly larger number of minor complications, however, in patients undergoing full pleurectomy was largely due to the larger number of patients with chronic obstructive lung disease in this group. On the basis of our experience we advocate the use of transaxillary apical pleurectomy for the younger age group with recurrent pneumothoraces and a full pleurectomy in the older age group, who frequently present because of failure to respond satisfactorily to tube drainage during their initial pneumothorax and often have lung disease secondary to chronic obstructive lung disease which is not confined to the apex of the upper lobe.
Another View of the Certificate-of-Need Laws
Authors: A. Daniel Rubenstein
Journal: New England Journal of Medicine (1975)

Elsewhere in this issue Dr. William J. Bicknell, Massachusetts Commissioner of Public Health, and a member of his staff review critically the administration of the certificate-of-need law in Massachusetts. This act has aroused more discussion and controversy among health-care providers, consumers, planners, hospital trustees, and physicians than any other recent single piece of health-related legislation. No one will dispute its primary objective to help contain health-care costs by reducing duplication and encouraging better medical-care planning. It is rather the inflexible regulatory processes involved in administering the law that has aroused the turmoil.Many have expressed the opinion that the Massachusetts . . .