tbuckley/cabot-search huggingface dataset:
Coronary Plaque Erosion Without Rupture Into a Lipid Core
Authors: Andrew Farb, Allen P. Burke, Anita L. Tang, Youhui Liang, Poonam Mannan, John Smialek, Renu Virmani
Journal: Circulation (1996)

Background Coronary thrombosis has been reported to occur most frequently in lipid-rich plaques with rupture of a thin fibrous cap and contact of the thrombus with a pool of extracellular lipid. However, the frequency of coronary artery thrombosis with or without fibrous cap rupture in sudden coronary death is unknown. In this study, we compared the incidence and morphological characteristics of coronary thrombosis associated with plaque rupture versus thrombosis in eroded plaques without rupture. Methods and Results Fifty consecutive cases of sudden death due to coronary artery thrombosis were studied by histology and immunohistochemistry. Plaque rupture of a fibrous cap with communication of the thrombus with a lipid pool was identified in 28 cases. Thrombi without rupture were present in 22 cases, all of which had superficial erosion of a proteoglycan-rich plaque. The mean age at death was 53±10 years in plaque rupture cases versus 44±7 years in eroded plaques without rupture ( P &lt;.02). In the plaque-rupture group, 5 of 28 (18%) were women versus 11 of 22 (50%) with eroded plaques ( P =.03). The mean percent luminal area stenosis was 78±12% in plaque rupture and 70±11% in superficial erosion ( P &lt;.03). Plaque calcification was present in 69% of ruptures versus 23% of erosions ( P &lt;.002). In plaque ruptures, the fibrous cap was infiltrated by macrophages in 100% and T cells in 75% of cases compared with 50% ( P &lt;.0001) and 32% ( P &lt;.004), respectively, in superficial erosions. Clusters of smooth muscle cells adjacent to the thrombi were present in 95% of erosions versus 33% of ruptures ( P &lt;.0001). HLA-DR expression was more often seen in macrophages and T cells in ruptures (25 of 28 cases) compared with expression in macrophages in superficial erosion arteries (8 of 22 cases, P =.0002). Conclusions Erosion of proteoglycan-rich and smooth muscle cell–rich plaques lacking a superficial lipid core or plaque rupture is a frequent finding in sudden death due to coronary thrombosis, comprising 44% of cases in the present study. These lesions are more often seen in younger individuals and women, have less luminal narrowing and less calcification, and less often have foci of macrophages and T cells compared with plaque ruptures.
Heterogeneity of cerebral capillary flow in man and its consequences for estimation of blood-brain barrier permeability.
Authors: M M Hertz, O B Paulson
Journal: Journal of Clinical Investigation (1980)

Blood-brain barrier permeability studies made in man using the indicator dilution method revealed that the extraction of the test substance increases during the upslope of the venous (outflow) dilution curve. The present study aimed to obviate the possibility that this could result from intravascular phenomena, such as interlaminar diffusion (the result of differences in molecular size) and erythrocyte carriage. Several reference substances were employed for the determination of the extraction in order that careful correction could be made for differences in intravascular behavior of the test and reference substance. The test substances studied were D-glucose, L-phenylalanine, water, propranolol, and benzodiazepines, representing both carrier-transported and lipophilic substances. In-diethylenetriamine pentaacetic acid, Na+, Cl-, L-glucose, and L-lysine were employed as reference substances. For all the substances tested, and after correction for intravascular phenomena, the extractions were found to increase during the initial part of the dilution curve. This increasing extraction can be ascribed to heterogeneity of the cerebral circulation; the higher extraction corresponds to longer contact with the blood-brain barrier and indicates a longer transit time. Signs of heterogeneity were also present when blood flow was elevated above normal. Any influence that heterogeneity might have on the mean extraction value can be minimized by using an appropriate calculation of the extraction of the test substance.
Anatomical and Ultrastructural Study of the Electrophysiological Atrioventricular Node of the Rabbit
Authors: LOUIS J. DEFELICE, CYRIL E. CHALLICE
Journal: Circulation Research (1969)

The structure of the tissue forming the atrioventricular node of the rabbit heart was studied with the light and the electron microscope. The observations were correlated and compared with the electrophysiological properties of the region. A technique was developed which allows identification of tissue examined by microscopy with that examined using microelectrode techniques to within 0.5 mm. Although the cells which form the connecting neck between the atrial tissue and the His bundle are basically muscle cells, their development has led to tissue structure different from that of the remaining myocardium. This tissue often displayed structural characteristics similar to those observed in pathological skeletal and cardiac muscle. Variation in the abundance of "tight" intercellular junctions in the region of the node were noted. The possible significance of the morphological characteristics in terms of electrical impulse transmission is discussed, and some tentative suggestions are made concerning the mechanisms by which the slow impulse conduction is effected in this region.
Hospitalization among Workers Compensated for Occupational Asthma
Authors: GARY M. LISS, SUSAN M. TARLO, YOKA MacFARLANE, KA SING YEUNG
Journal: American Journal of Respiratory and Critical Care Medicine (2000)

Occupational asthma (OA) can cause persistent symptoms, but populations with OA have not been followed for the development of serious outcomes such as hospitalization. Subjects receiving compensation for OA during 1980–1993, and a comparison sample of workers with musculoskeletal injuries (INJ) were identified from the Ontario Workers' Compensation Board. We also identified for comparison a group of asthmatic patients (AP) seen at a tertiary care hospital clinic during the same period. The file was matched with the Ontario Ministry of Health data base of hospitalizations through 1996. We compared the frequency of hospitalization of the subgroups with that expected in the general population using standardized morbidity ratios (SMRs), and directly by proportional hazards regression. The study group included 844 OA claimants, 1,556 INJ claimants, and 402 AP. Although admissions for all causes combined and respiratory disease among INJ were less than expected in the general population, admissions for all causes combined exceeded that expected among OA and AP. Admissions for respiratory disease were markedly greater than expected among OA (SMR 9.2) and AP (SMR 17) because of even greater excess admissions for asthma (SMRs 45 and 81, respectively). Compared with those with INJ, those with OA were more likely to be hospitalized for all causes combined (adjusted relative risk [RR] 1.4, 95% confidence interval [CI] 1.2 to 16); cardiovascular disease (RR 1.4, 95% CI 0.9 to 2.0); respiratory disease (RR 5.4, 95% CI 3.8 to 7.7); and asthma (RR 28.1, 95% CI 10.2 to 77.2) but not for malignancies (RR 1.0) or injuries (RR 0.9). Those with OA were admitted to hospital about half as frequently as AP for respiratory disease and asthma (although this was modified by smoking status and sex), but were 30% more likely to be admitted for ischemic heart disease (IHD). Among the OA claimants, factors that were significantly associated with hospitalization for asthma included older age and exposure to agents other than isocyanates. Those with OA became less likely to be hospitalized for asthma with increasing time after onset, particularly after 5 or more years. We conclude that subjects with OA suffer higher rates of hospitalizations for all causes combined, respiratory disease, and asthma than other workers, although less than among AP seen at a tertiary care center.
Maternal Cigarette Smoking and the Ghost of Yerushalmy—Will It Ever Rest?-Reply
Authors: Mary Sexton
Journal: JAMA (1986)

In Reply.—  The major point that Burch and Chesters are concerned about is the inconsistency of our results with those of Donovan. It is a concern that we have pondered ourselves. We have discussed with Donovan, both during and after our study, known and possible differences in the women or elements of the trial. We addressed these issues in the original article. 1 An additional point that might be considered is possible differences in quit rates between the two trials. Although the number of cigarettes smoked at the end of pregnancy seem to be comparable in the two trials, Donovan did not report quit rates. If the women reduced their smoking, as they reported, but did so by cutting down the number of cigarettes instead of quitting altogether, the children might not have realized a benefit. Further analysis of our data has raised the possibility that reduction in smoking is
Heart surgeons are to be rated according to bypass surgery success
Authors: O. Dyer
Journal: BMJ (2003)

Britain's heart surgeons are to be publicly graded on their performance on a three star rating system that classes them according to the survival rates of their patients.

The Society of Cardiothoracic Surgeons says it has opted for the scheme to forestall government plans to introduce performance league tables. The society argues that the government's plans would penalise consultants who take on high risk patients.

Rather than covering all cardiac surgery, the ratings will be based on coronary artery bypass grafts without additional procedures, conducted on adults having cardiac surgery for the first time. The …
Hypokalemic Respiratory Arrest in Diabetic Ketoacidosis
Authors: Richard I. Dorin
Journal: JAMA (1987)

THE OCCURRENCE of life-threatening hypokalemic hypoventilatory respiratory failure requiring intubation and respiratory support in diabetic ketoacidosis (DKA) is exceedingly rare. In none of the reported cases have serum phosphate levels been assessed within 12 hours of respiratory failure and in only one case have serial arterial blood gas measurements been performed to document hypoventilation.<sup>1</sup>The recent documentation of severe hypophosphatemia as a cause of hypoventilation and the fact that decrements in serum phosphate and serum potassium levels frequently parallel one another in DKA call into question the importance of hypokalemia to the respiratory response in DKA. We report a case of DKA in a young, otherwise healthy man whose treatment was complicated by severe hypokalemia and a hypoventilatory respiratory arrest without severe hypophosphatemia. We further discuss issues relating to the assessment and treatment of the hypokalemic patient with DKA at risk for ventilatory failure. <h3>Report of a Case</h3>
Pay as you don’t go
Authors: Kinesh Patel
Journal: BMJ (2008)

“Free at the point of entry”: laudable words, words that we hear time and time again from politicians expounding the “world class” care offered by the NHS. Aside from any debate, though, about whether this is sustainable in the long term, should this actually extend to “free if you don’t enter”?

Working through a clinic, one cannot help but be struck by the number of patients that don’t keep their appointments without even a telephone call. And why should they? There’s always a receptionist at the patient-friendly …
Environmental Exposures and Gene Regulation in Disease Etiology
Authors: Thea M. Edwards, John Peterson Myers
Journal: Environmental Health Perspectives (2007)

ObjectiveHealth or disease is shaped for all individuals by interactions between their genes and environment. Exactly how the environment changes gene expression and how this can lead to disease are being explored in a fruitful new approach to environmental health research, representative studies of which are reviewed here.Data sourcesWe searched Web of Science and references of relevant publications to understand the diversity of gene regulatory mechanisms affected by environmental exposures with disease implications.Data synthesisPharmaceuticals, pesticides, air pollutants, industrial chemicals, heavy metals, hormones, nutrition, and behavior can change gene expression through a broad array of gene regulatory mechanisms. Mechanisms include regulation of gene translocation, histone modifications, DNA methylation, DNA repair, transcription, RNA stability, alternative RNA splicing, protein degradation, gene copy number, and transposon activation. Furthermore, chemically induced changes in gene regulation are associated with serious and complex human diseases, including cancer, diabetes and obesity, infertility, respiratory diseases, allergies, and neurodegenerative disorders such as Parkinson and Alzheimer diseases. One of the best-studied areas of gene regulation is epigenetics, especially DNA methylation. Our examples of environmentally induced changes in DNA methylation are presented in the context of early development, when methylation patterns are initially laid down. This approach highlights the potential role for altered DNA methylation in fetal origins of adult disease and inheritance of acquired genetic change.ConclusionsThe reviewed studies indicate that genetic predisposition for disease is best predicted in the context of environmental exposures. Second, the genetic mechanisms investigated in these studies offer new avenues for risk assessment research. Finally, we are likely to witness dramatic improvements in human health, and reductions in medical costs, if environmental pollution is decreased.
A CASE OF TUBERCULOUS MENINGITIS WITHOUT TUBERCLES
Authors: F. W. Higgs
Journal: BMJ (1909)

c om 5 ggA skiagram showed the dislocation of the right hip into the sciatic notch, and also the fixation of the left hip iii the acetabulum in a position of abduction, a position which compensates for real shortening by a tilting down of the pelvis on that side.[Note.-The dislocated right hip was reduced by manipu- lation under an anaesthetic on April 2nd, and put up in a position of eversion and abduction.]CONCLUSION.I would summarize the points which I have learnt from this case as follows:1.The danger of trusting to an "aseptic " system of surgery when dealing with the region of the groin.I now always use 1 in 2,000 biniodide of mercury as lotion for these cases when asepsis is doubtful.2. The absolute importance of an exact bacteriological diagnosis in every case of suppuration.3. The great gravity of Bacillu pyocyaneus infection.4. The potency of vaccinial treatment of this infection.
The Final Epidemic
Authors: Jane M. Orient
Journal: JAMA (1983)

To the Editor.—  Since the reviewer for JAMA recommended the book The Final Epidemic: Physicians and Scientists on Nuclear War  1  all physicians for their essential reading list (1982;247:3138), I ordered a copy. This basic reference work, while describing many of the possible mechanisms of death from nuclear war, fails to provide any information that might help a physician who has the misfortune of surviving the holocaust. Topics such as the construction and use of a dosimeter, decontamination procedures, the prevention and treatment of typhoid and plague, and elementary sanitation methods for fallout shelters are omitted because all civil defense is called useless and a moral travesty. Whereas some of the recommendations of the Federal Emergency Management Agency deserve the ridicule they receive, the Oak Ridge National Laboratory has actually field-tested many lifesaving measures, including blast shelters of Soviet design. 2 This work is simply not mentioned.  Everyone is
Generation of Tumor-Specific T Lymphocytes for the Treatment of Posttransplant Lymphoma
Authors: J. Michael DiMaio, Peter Van Trigt, J. William Gaynor, R. Duane Davis, Eamonn Coveney, Bryan M. Clary, H. Kim Lyerly
Journal: Circulation (1995)

Background The incidence of lymphoproliferative disease, including B-cell lymphomas (BCL) in patients who have undergone heart or combined heart-lung transplants, has been reported to be as high as 15%. The majority of these tumors contain Epstein-Barr virus (EBV) DNA and regress when immunosuppressive agents are discontinued. This tumor regression is thought to be secondary to cytotoxic T lymphocytes (CTL) reactive to EBV-infected cells whose function is impaired in patients receiving immunosuppressive agents. We hypothesize that EBV-CTL expanded in the absence of these agents may demonstrate an antitumor effect against an EBV-expressing human BCL in vitro and in vivo. Methods and Results An EBV-expressing BCL from a heart transplant recipient was isolated and expanded in culture. EBV-CTL were generated by stimulation of peripheral blood leukocytes with irradiated autologous tumor cells in low-dose interleukin-2. Autologous BCL, HLA-mismatched BCL, lymphokine-activated killer target cell line (Daudi), and the natural killer target cell line (K562) were used in a standard 4-hour cytotoxicity assay using 51 CrO 4 after 7, 14, and 28 days of stimulation. There was significant percent specific lysis of autologous BCL targets (78%) at an effector-to-target ratio as low as 20:1 as compared with control cells. EBV-CTL were then adoptively transferred into SCID mice (provided by Duke University Vivarium) that had been engrafted with autologous BCL 7 days before. There was a significant survival advantage to those mice engrafted with EBV-CTL as compared with control cells. Conclusions The results indicate that ex vivo expansion of EBV-CTL in the absence of immunosuppressive agents results in a population that has significant antitumor activity. This strategy may be useful in the generation of EBV-CTL that might be effective antitumor agents in transplant recipients with EBV-associated lymphomas.
Risk of Thoracentesis
Authors: Donna R. Grogan, Richard S. Irwin
Journal: Annals of Internal Medicine (1991)

Letters1 March 1991Risk of ThoracentesisDonna R. Grogan, MD, Richard S. Irwin, MDDonna R. Grogan, MDSearch for more papers by this author, Richard S. Irwin, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-114-5-431_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editors: We found the article by Godwin and Sahn (1) to be helpful in beginning to define the risks of thoracentesis in mechanically ventilated patients. Pneumothorax, the only complication that the authors provide data for, occurred in 6% of patients. We have recently done a prospective study (2) on the risk of thoracentesis, and we feel compelled to make two comments.First, we believe that one should be cautious in interpreting the results of the study by Godwin and Sahn (1) as demonstrating that the risks of thoracentesis in ventilated patients are similar to those in patients breathing...References1. GodwinSahn JS. Thoracentesis: a safe procedure in mechanically ventilated patients. Ann Intern Med. 1990;113:800-2. LinkGoogle Scholar2. GroganIrwinChannick DRR. Complications associated with thoracentesis: a prospective, randomized study comparing three different methods. Arch Intern Med. 1990;150:873-7. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of Massachusetts Medical Center Worcester MA 01655 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByThoracentesis in Medical ICU Patients: When Is "Safe" Really "Safe Enough"?Malattie della pleura 1 March 1991Volume 114, Issue 5Page: 431-431KeywordsBreathingProspective studies Issue Published: 1 March 1991 PDF DownloadLoading ...
No time to train the surgeons:Royal College of Surgeons of England responds
Authors: Peter J Morris
Journal: BMJ (2004)

EDITOR—The Royal College of Surgeons of England agrees with Chikwe et al that surgical training must be a priority.1 The specialty is facing serious challenges both in delivering services and in training because of the reduction in junior doctors' hours of work. However, some of the enforced changes are to be welcomed: no one can truly regret that trainees are no longer expected to work a total of over 30 …
Identification of high affinity folate binding proteins in human erythrocyte membranes.
Authors: A C Antony, R S Kincade, R S Verma, S R Krishnan
Journal: Journal of Clinical Investigation (1987)

Mature human erythrocyte membranes contained specific, high affinity (Kd 3.3 X 10(-11) M) folate binding moieties. Folate binding was pH, time- and temperature-dependent, saturable, and was much greater for pteroylmonoglutamate and 5-methyltetrahydrofolate than 5-formyltetrahydrofolate and amethopterin. On detergent solubilization of membranes, two peaks of specific folate binding with Mr greater than or equal to 200,000 and 160,000 were identified on Sephacryl S-200 gel filtration chromatography in Triton X-100, and this corresponded to two similar peaks of immunoprecipitated material when solubilized iodinated membranes were probed with anti-human placental folate receptor antiserum. Age-dependent separation of erythrocytes by Stractan density gradients revealed a sevenfold greater folate binding capacity in membranes purified from younger compared with aged erythrocytes. Since this difference was not reflected in proportionately higher immunoreactive folate binding protein, (as determined by a specific radioimmunoassay for these proteins), or differences in affinity in younger than aged cells, these findings indicate that erythrocyte folate binding proteins become progressively nonfunctional at the onset of red cell aging.
Translocation t(1;6)(p35.3;p25.2): a new recurrent aberration in ‘unmutated’ B-CLL
Authors: L Michaux, I Wlodarska, K Rack, M Stul, A Criel, M Maerevoet, S Marichal, H Demuynck, P Mineur, K Kargar Samani, A Van Hoof, A Ferrant, P Marynen, A Hagemeijer
Journal: Leukemia (2004)