tbuckley/cabot-search huggingface dataset:
Analysis of a Clinical Pathway for Elective Gastrectomy
Authors: Min Yong Don, Kim Sungsoo
Journal: Annals of Oncology (2014)

Introduction: Clinical pathways have been developed for operative procedures with documented improvements in length of stay and cost without compromising outcome. This study evaluated a clinical pathway for an elective gastrectomy and examined patient outcomes after implementation of a 9-day discharge pathway.Methods: A 9-day clinical pathway for elective gastrectomy has been applied from 2008 at Chosun university hospital. Retrospectively, we analyzed 252 patients who underwent an elective gastrectomy from January 2009 to April 2013.Results: The completion rate of the clinical pathway was 45.6% (115/252). Mean length of stay was 11.7 ± 8.6 (8–59 days). Readmission rate was 4.4% (11/252). In multivariate analysis, laparoscopic gastrectomy (odds ratio = 0.511) and subtotal gastrectomy (odds ratio = 5.251) were important factors to fail clinical pathway. Causes of failure for clinical pathway were intra-abdominal complications (32.8%), patient factors (29.9%) and wound complications (21.9%).Conclusion: The clinical pathway for an elective gastrectomy might be divided 4 subgroups, according to approach methods and extent of resection in gastric cancer surgery. To reduce a failure of clinical pathway, the proper management of surgical wounds and patients might to be required. Introduction: Clinical pathways have been developed for operative procedures with documented improvements in length of stay and cost without compromising outcome. This study evaluated a clinical pathway for an elective gastrectomy and examined patient outcomes after implementation of a 9-day discharge pathway. Methods: A 9-day clinical pathway for elective gastrectomy has been applied from 2008 at Chosun university hospital. Retrospectively, we analyzed 252 patients who underwent an elective gastrectomy from January 2009 to April 2013. Results: The completion rate of the clinical pathway was 45.6% (115/252). Mean length of stay was 11.7 ± 8.6 (8–59 days). Readmission rate was 4.4% (11/252). In multivariate analysis, laparoscopic gastrectomy (odds ratio = 0.511) and subtotal gastrectomy (odds ratio = 5.251) were important factors to fail clinical pathway. Causes of failure for clinical pathway were intra-abdominal complications (32.8%), patient factors (29.9%) and wound complications (21.9%). Conclusion: The clinical pathway for an elective gastrectomy might be divided 4 subgroups, according to approach methods and extent of resection in gastric cancer surgery. To reduce a failure of clinical pathway, the proper management of surgical wounds and patients might to be required.
Risk Score for Predicting Long-Term Mortality After Coronary Artery Bypass Graft Surgery
Authors: Chuntao Wu, Fabian T. Camacho, Andrew S. Wechsler, Stephen Lahey, Alfred T. Culliford, Desmond Jordan, Jeffrey P. Gold, Robert S.D. Higgins, Craig R. Smith, Edward L. Hannan
Journal: Circulation (2012)

No simplified bedside risk scores have been created to predict long-term mortality after coronary artery bypass graft surgery.The New York State Cardiac Surgery Reporting System was used to identify 8597 patients who underwent isolated coronary artery bypass graft surgery in July through December 2000. The National Death Index was used to ascertain patients' vital statuses through December 31, 2007. A Cox proportional hazards model was fit to predict death after CABG surgery using preprocedural risk factors. Then, points were assigned to significant predictors of death on the basis of the values of their regression coefficients. For each possible point total, the predicted risks of death at years 1, 3, 5, and 7 were calculated. It was found that the 7-year mortality rate was 24.2 in the study population. Significant predictors of death included age, body mass index, ejection fraction, unstable hemodynamic state or shock, left main coronary artery disease, cerebrovascular disease, peripheral arterial disease, congestive heart failure, malignant ventricular arrhythmia, chronic obstructive pulmonary disease, diabetes mellitus, renal failure, and history of open heart surgery. The points assigned to these risk factors ranged from 1 to 7; possible point totals for each patient ranged from 0 to 28. The observed and predicted risks of death at years 1, 3, 5, and 7 across patient groups stratified by point totals were highly correlated.The simplified risk score accurately predicted the risk of mortality after coronary artery bypass graft surgery and can be used for informed consent and as an aid in determining treatment choice.
Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis
Authors: Muhammad Haroon, Phil Gallagher, Oliver FitzGerald
Journal: Annals of the Rheumatic Diseases (2014)

Objectives (1) To investigate the demographic and clinical characteristics contributing to the delay from symptom onset to the first visit to a rheumatologist; (2) to compare clinical, radiographic and patient-reported outcome measures of those who saw a rheumatologist early in their disease course with those who were diagnosed later. Methods All psoriatic arthritis (PsA) patients, fulfilling CASPAR criteria, with an average disease duration of &gt;10 years were invited for detailed clinical evaluation. The total lag time from symptom onset to their first rheumatological encounter was studied. The data were extracted from the referral letters and medical records. Patients were classified as early consulters or late consulters depending on whether they were seen by a rheumatologist within or beyond 6 months of symptom onset. Results 283 PsA patients were studied. Median lag time from the disease onset to the first rheumatological assessment of the cohort was 1.00 years (IQR 0.5–2). 30% (n=86), 53% (n=149) and 71% (n=202) of the cohort were seen by a rheumatologist within 6 months, 1 and 2 years of symptom onset, respectively. PsA patients with low education status (OR 2.09, p=0.02) and Body Mass Index (OR 0.92, p=0.01) were significantly more likely to have a diagnostic delay of &gt;2 years. On multiple stepwise regression analysis, the model predicted significant association of late consulters with the development of peripheral joint erosions (OR 4.25, p=0.001) and worse Health Assessment Questionnaire scores (OR 2.2, p=0.004). Conclusions Even a 6-month delay from symptom onset to the first visit with a rheumatologist contributes to the development of peripheral joint erosions and worse long-term physical function.
do asymmetrical differences in primate brains correspond to cerebral lateralization?
Authors: douglas c. broadfield
Journal: Behavioral and Brain Sciences (2005)

an evolutionarily stable strategy (ess) may apply to characters expressed across species for predation and feeding, because these characters are conservative. however, the evolution of complex, polymorphic behaviors is more difficult to define as an ess. lateralization may be selective for certain simple traits, but lateralization of complex traits is likely the result of coadaptation of otherwise non-lateralized features.
Auditory Hallucinations and the Temporal Cortical Response to Speech in Schizophrenia: A Functional Magnetic Resonance Imaging Study
Authors: Peter W.R. Woodruff, Ian C. Wright, Edward T. Bullmore, Michael Brammer, Robert J. Howard, Steven C.R. Williams, Jane Shapleske, Susan Rossell, Anthony S. David, Philip K. McGuire, Robin M. Murray
Journal: American Journal of Psychiatry (1997)

OBJECTIVE: The authors explored whether abnormal functional lateralization of temporal cortical language areas in schizophrenia was associated with a predisposition to auditory hallucinations and whether the auditory hallucinatory state would reduce the temporal cortical response to external speech. METHOD: Functional magnetic resonance imaging was used to measure the blood-oxygenation-level-dependent signal induced by auditory perception of speech in three groups of male subjects: eight schizophrenic patients with a history of auditory hallucinations (trait-positive), none of whom was currently hallucinating; seven schizophrenic patients without such a history (trait-negative); and eight healthy volunteers. Seven schizophrenic patients were also examined while they were actually experiencing severe auditory verbal hallucinations and again after their hallucinations had diminished. RESULTS: Voxel-by-voxel comparison of the median power of subjects' responses to periodic external speech revealed that this measure was reduced in the left superior temporal gyrus but increased in the right middle temporal gyrus in the combined schizophrenic groups relative to the healthy comparison group. Comparison of the trait-positive and trait-negative patients revealed no clear difference in the power of temporal cortical activation. Comparison of patients when experiencing severe hallucinations and when hallucinations were mild revealed reduced responsivity of the temporal cortex, especially the right middle temporal gyrus, to external speech during the former state. CONCLUSIONS: These results suggest that schizophrenia is associated with a reduced left and increased right temporal cortical response to auditory perception of speech, with little distinction between patients who differ in their vulnerability to hallucinations. The auditory hallucinatory state is associated with reduced activity in temporal cortical regions that overlap with those that normally process external speech, possibly because of competition for common neurophysiological resources. (Am J Psychiatry 1997; 154:1676–1682)
Developmental changes in the functional characteristics and expression of voltage-gated K+ channel currents in rat aortic myocytes
Authors: A Belevych
Journal: Cardiovascular Research (2002)

Objective: Active control of the arterial diameter by vascular smooth muscle is one of the principle mechanisms by which vessels adapt to a significant rise in blood pressure after birth. Although voltage-gated K+ (Kv) channels play an important role in the regulation of excitation–contraction coupling in arteries, very little is known about postnatal modification of Kv channels. We therefore investigated changes in the functional characteristics and expression of Kv channels in rat aortic myocytes (RAMs) during early postnatal development. Methods: Kv currents (IKv) were investigated in single smooth muscle cells freshly dispersed from neonatal (1–3 days) and adult Wistar rat thoracic aorta using the whole-cell patch clamp technique. Results:IKv in neonates had significantly faster activation kinetics and was inactivated at more positive voltages than IKv in adults (half-inactivation potential −24±2 and −40±3 mV and slope factor 4.2±0.4 and 11.1±0.5 mV, respectively). No difference in the steady state activation was found. IKv in neonates was insensitive to a high concentration of tetraethylammonium (TEA, 10 mM) but blocked 4-aminopyridine (4-AP, IC50=0.5±0.1 mM), whereas IKv in adult RAMs was almost completely abolished by 10 mM TEA and was relatively insensitive to low concentrations of 4-AP. IKv in both age groups was insensitive to charybdotoxin (300 nM) or α-dendrotoxin (200 nM). Immunoblot analysis showed that the expression of Kv1.2 α-protein decreased and Kv2.1 increased with development. Conclusion: Significant changes in functional characteristics of the native IKv and the expression of particular Kv channel proteins occurred during postnatal vascular development. These changes could play an important role in adaptation to extrauterine life.
Screening for colorectal cancer: the heart of the matter
Authors: W S ATKIN
Journal: Gut (1999)

<h3>PURPOSE</h3> We wanted to identify risk factors associated with the development of major depressive disorder (MDD) among patients with type 2 diabetes over time. <h3>METHODS</h3> In a noninterventional study, 338 adult patients with type 2 diabetes and no MDD diagnosis at baseline were assessed 3 times during 18 months (9-month intervals) to ascertain predictors of MDD. We tested a model incorporating personal, behavioral, biologic, and psychosocial variables to identify predictors of MDD. Exploratory analyses tested whether current negative affect mediated the relationship between predictors and subsequent MDD. We also conducted a stratified analysis of moderate vs high negative affect to explore whether level of baseline negative affect mediated the relationship between specific predictors and MDD. <h3>RESULTS</h3> Prior MDD and negative affect predicted future development of MDD. In subpopulations stratified by moderate negative affect, negative life events, an elevated body mass index (BMI), prior MDD, and poor control of glycated hemoglobin (hemoglobin A<sub>1c</sub>) each predicted MDD. In subpopulations stratified by elevated negative affect, negative life events and poor control of hemoglobin A<sub>1c</sub> predicted MDD. Current negative affect partially mediated the relationship between prior MDD and subsequent MDD, as well as the relationship between negative life events and subsequent MDD. <h3>CONCLUSIONS</h3> Although negative affect at baseline was the primary predictor of subsequent MDD, when stratified by negative affect, negative life events, BMI, and poor control of hemoglobin A<sub>1c</sub> also predicted MDD. Thus, life stresses and patients’ disease-related concerns are important when understanding what predicts subsequent MDD. Addressing depressive symptoms and broader life context issues expands the scope of a potential intervention to reduce the risk of developing MDD in persons with type 2 diabetes.
Asthma, Hypersensitivity, and Coitus
Authors: Ashok Shah, Chandramani Panjabi
Journal: American Journal of Respiratory and Critical Care Medicine (2004)

Dr. Kuna and colleagues (1) report an uncommon cause of asthma exacerbations after unprotected coitus in a 48-year-old male. The patient had aspirin-sensitive asthma, and the postcoital exacerbation was attributed to the aspirin ingested by his wife. The diagnosis was suspected because symptoms did not occur after condom usage. The objective of this communication is to highlight other manifestations of asthma and hypersensitivity reactions that can be related to coitus. Sexual activity can trigger off asthma in more ways than one (2). Asthma associated with coitus can be categorized as human seminal plasma allergy (HSPA) in female subjects (3), postcoital asthma and/or rhinitis (4), condom-induced asthma (5), and asthma subsequent to transfer of allergens during coitus (1, 3, 6). The latter three can occur in both sexes. In female subjects, HSPA may present as asthma along with other hypersensitivity manifestations (3). This little-known disorder is caused by sensitization to proteins present in the seminal fluid, and occurs during or soon after coitus. The symptoms are thought to be mediated by the classical IgE-mediated pathophysiologic mechanism. Postcoital asthma (“sexercise-induced asthma”) and rhinitis (“honeymoon rhinitis”) are not exercise-induced (athlete’s nose) and cannot be ascribed to any cause other than sexual excitement (4). Anxiety and apprehension are a predominant feature in both patients and their partners. Intense emotional stimuli during sexual intercourse can possibly lead to autonomic imbalance with parasympathetic overreactivity, thereby releasing mediators and provoking symptoms. Condom usage can not only precipitate an asthmatic attack, but can also cause life-threatening anaphylaxis (5). This is caused by allergy to latex and can occur in either partner. Hypersensitivity reactions have occurred following transfer of allergens present in the seminal fluid. Reports have documented postcoital allergic reactions including asthma in female subjects due to ingestion of walnut, vinblastine, thioridazine, and penicillin by the male partner before coitus (3). Transfer of allergenic material from the vaginal fluid to a male partner during coitus has also been reported in a 34-year-old male, who developed a fixed drug eruption following coitus. His wife had ingested trimethoprimsulphamethoxazole, to which he was known to be allergic (6). The untoward consequences of sexual activity described above are yet to receive the attention they deserve. Life-threatening asthma and anaphylaxis have been documented subsequent to coitus (2). These phenomena may easily be overlooked due to patient embarrassment and lack of physician awareness.
Effect of exercise on the proportion of unsaturated fatty acids in serum of untrained middle aged individuals
Authors: V Mougios, E Kouidi, A Kyparos, A Deligiannis
Journal: British Journal of Sports Medicine (1998)

OBJECTIVES: To examine whether prolonged moderate exercising by untrained middle aged individuals of both sexes affects the plasma ratio of unsaturated to saturated (U/S) fatty acids in the non-esterified fatty acid (NEFA) and triacylglycerol (TG) fractions. METHODS: Twenty two healthy untrained volunteers (eleven men and eleven pre-menopausal women), aged 35-55, exercised on bicycles at 50-55% maximal heart rate reserve (estimated 61% maximal oxygen uptake) for one hour. Pre- and post-exercise blood samples were analysed for lactate, glucose, glycerol, individual NEFAs and TG acyl groups, cholesterol, high density lipoprotein cholesterol, urea, cortisol, and testosterone. Biopsy specimens of adipose tissue were analysed for TG acyl group composition. RESULTS: Serum total NEFAs increased significantly whereas total TG decreased significantly in both sexes. Changes in individual fatty acids, in both the NEFA and TG fractions, generally paralleled changes in the total pool but were not proportionate. As a result, U/S NEFAs increased in both sexes, although significantly only in women. The shift was in the direction of the composition of the major source of blood NEFAs--that is, adipose tissue TG. U/S acyl groups of TG also increased in both sexes, although significantly only in men. CONCLUSIONS: Prolonged moderate exercise increases the U/S ratio of serum NEFAs and TG. This may add to the beneficial effects of exercise given the protective role of unsaturated fatty acids against coronary heart disease.
HCV substitutions and IL28B polymorphisms on outcome of peg-interferon plus ribavirin combination therapy
Authors: C. N. Hayes, M. Kobayashi, N. Akuta, F. Suzuki, H. Kumada, H. Abe, D. Miki, M. Imamura, H. Ochi, N. Kamatani, Y. Nakamura, K. Chayama
Journal: Gut (2010)

<h3>Background and aims</h3> A number of recent studies have shown that human polymorphisms near the <i>IL28B</i> type III interferon (IFNλ) gene influence the response to peg-interferon plus ribavirin combination therapy for infection with chronic hepatitis C virus (HCV). Viral polymorphisms, including substitutions within the HCV core and NS5A proteins, have also been shown to influence treatment outcome, but it is not known whether these factors act independently of the IL28B polymorphism or if they reflect the same or a different underlying mechanism. Multiple logistic regression was used to determine whether host and viral polymorphisms independently predict sustained virological response (SVR). <h3>Methods</h3> Two single nucleotide polymorphisms were genotyped in the IL28B locus (rs12979860 and rs8099917) from 817 patients with chronic HCV infection, and substitutions at amino acids 70 and 91 of the HCV core protein and within the NS5A interferon sensitivity-determining region (ISDR) were analysed. <h3>Results</h3> It was found that independent predictors of an SVR included IL28B rs12979860 CC genotype (OR=4.98; p=4.00E-08), core amino acid 70 substitutions (OR=0.53; p=0.016), age and baseline viral load. For non-virological response, the IL28B rs12979860 CT/TT genotype (OR=0.23; p=1.96E-8) and age were independent predictors. IL28B rs12979860 genotype (p=1.4E-8), core amino acid 70 substitutions (p=0.0013), ISDR substitutions (p=0.0019), baseline viral load, γ-glutamyltranspeptidase, alanine aminotransferase and platelet count were independent predictors for change in viral load by week 4 of treatment. <h3>Conclusions</h3> IL28B polymorphisms and HCV core amino acid 70 substitutions contribute independently to an SVR to peg-interferon plus ribavirin combination therapy.
Molecular monitoring of adenovirus in peripheral blood after allogeneic bone marrow transplantation permits early diagnosis of disseminated disease
Authors: Thomas Lion, Rosi Baumgartinger, Franz Watzinger, Susanne Matthes-Martin, Magdalena Suda, Sandra Preuner, Barbara Futterknecht, Anita Lawitschka, Christina Peters, Ulrike Pötschger, Helmut Gadner
Journal: Blood (2003)
Latex allergy from glove powder ‐ an unintended risk with the switch from talc to cornstarch?
Authors: M. Lundberg, K. Wrangsjö, S.G.O. Johansson
Journal: Allergy (1997)

The present study aimed to investigate to what extent glove powders of different origins and brands bind and release latex allergens. One mineral talc and five cornstarch powders were used. The allergenic material was sap of Hevea brasiliensis. The powders were incubated together with the natural rubber latex sap, and four series of experiments were performed. The talc showed the highest tendency to bind isotope‐labeled proteins. When incubated with a latex allergen solution, it reduced free allergen from 100 to 2 units/ml compared to a reduction to 70–98 units/ml for the cornstarch powders. In contrast to the nonstable binding of allergen to cornstarch, the binding to talc was irreversible. The allergen bound to talc was allergenically intact and, when incubated with serum, reduced the concentration of free IgE antibody to latex to 10% of the initial level. Mineral talc had a high capacity to bind latex allergens firmly. In contrast, cornstarch captured the latex allergen, but the binding seemed less pronounced and was unstable. The replacement of talc by cornstarch as glove‐donning powder has coincided with the rapid increase in latex allergy. Mineral talc is heavy and only transiently airborne. Could this difference between talc and cornstarch in latex‐allergen‐binding pattern and the tendency of the latter to be airborne play an important role in the bioavailability of latex allergen and thus in the epidemic of latex sensitization?
Calcium ionophore synergizes with bacterial lipopolysaccharides in activating macrophage arachidonic acid metabolism.
Authors: A A Aderem, Z A Cohn
Journal: The Journal of Experimental Medicine (1988)

LPS, a major component of Gram-negative bacterial cell walls, prime macrophages for greatly enhanced arachidonic acid [20:4] metabolism when the cells are subsequently stimulated. The LPS-primed macrophage has been used as a model system in which to study the role of Ca2+ in the regulation of 20:4 metabolism. The Ca2+ ionophore A23187 (0.1 microM) triggered the rapid release of 20:4 metabolites from LPS-primed macrophages but not from cells not previously exposed to LPS. Macrophages required exposure to LPS for at least 40 min before A23187 became effective as a trigger. A23187 (0.1 microM) also synergized with PMA in activating macrophage 20:4 metabolism. The PMA effect could be distinguished from that of LPS since no preincubation with PMA was required. A23187 greatly increased the amount of lipoxygenase products secreted from LPS-primed macrophages, leukotriene C4 synthesis being increased 150-fold. LPS-primed macrophages, partially permeabilized to Ca2+ with A23187, were used to titrate the Ca2+ concentration dependence of the cyclooxygenase and lipoxygenase pathways. Cyclooxygenase metabolites were detected at an order of magnitude lower Ca2+ concentration than were lipoxygenase products. The data suggest that Ca2+ regulates macrophage 20:4 metabolism at two distinct steps: an increase in intracellular Ca2+ regulates the triggering signal and relatively higher Ca2+ concentrations are required for 5-lipoxygenase activity.
COMPARISON OF AORTIC ROOT GEOMETRY IN PATIENT WITH BICUSPID VERSUS TRICUSPID AORTIC VALVE: A REAL–TIME 3D TRANSESOPHAGEAL ECHOCARDIOGRAPHY STUDY
Authors: Kentaro Shibayama, Kenji Harada, Jun Tanaka, Javier Berdejo, Takahiro Shiota
Journal: Journal of the American College of Cardiology (2013)