tbuckley/cabot-search huggingface dataset:
S16 Detection of sleep-disordered breathing in chronic heart failure patients: utility of heart rate variability versus pulse oximetry?
Authors: N. R. Ward, M. R. Cowie, S. D. Rosen, V. R. Roldao, J. Hooper, T. A. McDonagh, A. K. Simonds, M. J. Morrell
Journal: Thorax (2010)

<h3>Introduction and Objectives</h3> Sleep-disordered breathing (SDB) is a frequent comorbidity in chronic heart failure (CHF). Patients are often asymptomatic and sleep studies may be required for SDB diagnosis. Our department has previously reported that %VLFI component of Heart Rate Variability (HRV) is correlated with apnoea-hypopnoea index (AHI) in CHF (r=0.52). Thus, we tested the hypotheses that %VLFI component of HRV, or pulse oximetry, can be used to rule out SDB in patients with CHF. <h3>Methods</h3> Stable CHF patients attending cardiology clinics were enrolled, irrespective of cause or severity of CHF. Patients were studied using polysomnography, simultaneous ambulatory electrocardiography and pulse oximetry. SDB was defined as AHI ≥15.0/h, measured by polysomnogram. Fourier analysis of the electrocardiogram was used to measure %VLFI component of HRV, with a cutoff ≥2.23% to indicate SDB. The oxygen desaturation index (ODI) ≥3% was measured by pulse oximeter, with a cutoff &gt;7.5 desaturations/h to indicate SDB. Diagnostic performance of %VLFI and ODI≥3% were calculated, with the polysomnogram as reference standard for SDB diagnosis. <h3>Results</h3> 180 CHF patients were studied, seven were excluded due to insufficient sleep (&lt;200 min). In 173 CHF patients (mean (SD) age 66.9 (13.0) years; 86% male; Epworth Sleepiness Scale 7.6 (4.3); NYHA 2.1 (0.6); median (IQR) BNP 118 (55–239) pg/ml), SDB was present in 77 (45%) patients with mean AHI 32.4 (18.2)/h. %VLFI was measured in 77 (45%) patients: in CHF patients with SDB (n=36), mean %VLFI was 3.13% (2.4) compared to 3.25% (2.6) in patients without SDB (n=41). Cardiac pacing, atrial fibrillation and frequent ectopy prevented %VLFI measurement in the remainder. ODI ≥3% was measured in 171 patients: in CHF patients with SDB (n=76), mean ODI ≥3% was 29.2 (17.2)/h compared to 10.2 (6.4)/h in patients without SDB (n=95). <h3>Conclusion</h3> The %VLFI component of HRV has no utility to screen for SDB in patients with CHF. Moreover, it could not be measured in more than half of this cohort of patients. In contrast, the high sensitivity and negative predictive value of the ODI ≥3% suggest pulse oximetry is a valuable tool to rule out SDB in CHF patients.
Randomization in cancer clinical trials: permutation test and development of a computer program.
Authors: Y Ohashi
Journal: Environmental Health Perspectives (1990)

When analyzing cancer clinical trial data where the treatment allocation is done using dynamic balancing methods such as the minimization method for balancing the distribution of important prognostic factors in each arm, conservativeness occurs if such a randomization scheme is ignored and a simple unstratified analysis is carried out. In this paper, the above conservativeness is demonstrated by computer simulation, and the development of a computer program that carries out permutation tests of the log-rank statistics for clinical trial data where the allocation is done by the minimization method or a stratified permuted block design is introduced. We are planning to use this program in practice to supplement a usual stratified analysis and model-based methods such as the Cox regression. The most serious problem in cancer clinical trials in Japan is how to carry out the quality control or data management in trials that are initiated and conducted by researchers without support from pharmaceutical companies. In the final section of this paper, one international collaborative work for developing international guidelines on data management in clinical trials of bladder cancer is briefly introduced, and the differences between the system adopted in US/European statistical centers and the Japanese system is described.
Morton's "Genito-Urinary Diseases."
Authors: Henry H. Morton
Journal: JAMA (1902)

Brooklyn, N. Y., June 20, 1902. <h3>To the Editor:</h3> In looking over The Journal for May 31, 1902, on page 1459, I notice that the reviewer of my book on "Genito-Urinary Diseases and Syphilis," published by F. A. Davis Company, has misquoted me on certain points. He has also criticised the omission of certain matters which I had mentioned, but which he has overlooked in a hurried reading. The points are as follows: With regard to the Harris segregator, I have mentioned its use on page 237 of my book, as an alternative to catheterizing the ureters in pyelitis, in order to determine whether the right or left kidney or both, are diseased, but by a typographical error the instrument is spoken of as the "Harrison Segregator." I did not mention the relief of kidney tension by nephrotomy, because the book was in press at the time that the first
Conservative treatment of injury to the fibular ligaments of the ankle.
Authors: R. Cetti
Journal: British Journal of Sports Medicine (1982)

Fifty-one patients with fibular ligamentous injury of the ankle are presented. The treatment consisted of complete non-weight-bearing of the affected foot by use of elbow crutches for three weeks. All patients were seen at follow-up eighteen months after the accident. The results are discussed in the light of previous literature on conservative and operative treatment of lateral ligament injuries.
Chemotherapy Fall-out
Authors: James R. Cozzarin
Journal: Annals of Internal Medicine (1998)

Ad Libitum1 February 1998Chemotherapy Fall-outJames R. CozzarinJames R. CozzarinPro Ed Communications, Inc.; Beachwood, OH 44122Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-3-199802010-00003 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail “Honey,” ... Author, Article, and Disclosure InformationAffiliations: Pro Ed Communications, Inc.; Beachwood, OH 44122Corresponding Author: James R. Cozzarin, Pro Ed Communications, Inc., Signature Square II, 25101 Chagrin Boulevard, Suite 230, Beachwood, OH 44122. Previousarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 February 1998Volume 128, Issue 3Page: 185KeywordsChemotherapyHoneyShouldersSmell Issue Published: 1 February 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Biological Aging
Authors: Samuel Goldstein
Journal: JAMA (1974)

AGING satisfies the major criterion of a normal physiologic process; it descends inexorably on each and every one of us. Whether this kind of normality is desirable is a debatable point. Teleological approaches are largely unsatisfactory because the nth stage of improved survival is immortality, which implies detrimental effects for the species in perpetuity. Viewed mechanistically, therefore, biological aging is an epilogue of development originating within the genotype and the adaptive norm of the species.<sup>1</sup>Although the basic program is limited by the inherited genetic load, most of us in Western civilization who manage to survive to maturity can usually look forward to several decades of vigorous life before one or more pathologic processes become overt and eventually lethal. Against this backdrop, biomedical science has sought its characteristic goal: to define the fundamental, molecular basis of aging. It is important to distinguish between primary causative mechanisms and secondary and
THE RELATION BETWEEN THE STRUCTURE OF THE EPIDERMIS OF THE RAT AND THE GUINEA PIG, AND THE PROLIFERATIVE POWER OF NORMAL AND REGENERATING EPITHELIAL CELLS OF THE SAME SPECIES
Authors: Kate C. Spain
Journal: The Journal of Experimental Medicine (1915)

1. A comparative study of the resting and regenerating epidermis of the rat, pigeon, and guinea pig shows the connection between the structure of the skin and the proliferating power of the epithelial cells. We may at present distinguish two types of epidermal cells: (a) cells with less proliferative energy (pigeon and rat), and (b) cells with a greater proliferative power (guinea pig); the former provides the element from which the type of a thin epidermis is built up, while from the latter the type of a thick epidermis develops. 2. The cell type with greater proliferative power in the normal skin shows also greater proliferative power during regeneration, and the regenerative stimulus causes approximately the same relative increase in the number and size of cells and nuclei in both kinds of skin during regeneration, provided that we base our determination of the number of mitoses on the same unit number of cells in both skins rather than on the same unit area. The absolute increase in the number of cells during regeneration is greatest in the type with the greatest proliferative power in the normal cell (guinea pig). 3. The number of mitoses and the size of cells and nuclei follow a similar curve in the different species during regeneration. They reach a maximum approximately on the 7th day; remain stationary or show some decline from the 7th day on until the time of the closure of the wound; following the closure a further fall takes place; but the figures remain higher than in the normal epidermis for a considerable period afterwards. There seems, therefore, to exist under the conditions of our experimentation a period of approximately 7 days, at the end of which the regenerative stimulus reaches its maximum effect. The closure of the wound represents probably an additional factor determining the curve of cell proliferation. Failure of the wound to close at an early date seems to make the decline in the number of mitoses sharp after the maximum has been reached. 4. The curve representing the thickness of living regenerating epithelium declines much more slowly than the curve representing cell size and number of mitoses. This indicates probably that even after closure of the wound some push of epithelial cell towards the center of the former wound continues to take place. 5. From the second day the additional growth of the epidermal tongue decreases in each successive period, if we use the length of the tongue at the beginning of each period as the unit of measurement. 6. Retraction and contraction of the wound are factors additional to epithelial movements and epithelial proliferation determining the closure of the wound.
Ionophore A23187 stimulates arachidonic acid release and cyclic GMP accumulation in pig epidermis
Authors: N. KATO, H. SUYA, T. AOYAGI, J.R. TAYLOR, K.M. HALPRIN
Journal: British Journal of Dermatology (1986)

We studied the effect of Ionophore A23187 (A23187) on phospholipid degradation and the accumulation of cyclic GMP in pig epidermis. A23187 stimulated the release of AA, probably partially through the activation of phospholipase A2. A23187 also stimulated the accumulation of epidermal cyclic GMP, but the activity of cyclic GMP-dependent phosphodiesterases was not altered. Mepacrine, an inhibitor of phospholipase A2, inhibited the A23187-stimulated accumulation of cyclic GMP. The results suggest that A23187 stimulates the accumulation of epidermal cyclic GMP by a calcium-dependent process which also requires products of phospholipid degradation.
Accidents Complicating Pelvic Surgery in Women
Authors: Louis E. Phaneuf
Journal: New England Journal of Medicine (1952)

THE danger of accidents occurring during pelvic surgery in women is ever present, but the great advances in surgical technic, especially during the last quarter of a century, have been responsible for reducing these complications to a considerable degree. This has been brought about by better exposure of the operative field, by a suitably long incision, by careful and meticulous dissection before the structures are clamped and cut, by protecting the contiguous organs by proper walling off with moist gauze pads and by the complete relaxation of the abdominal wall and its contents, through the improved methods of anesthesia in . . .
A Comparison of Carbohydrate Metabolism After Sucrose, Sorbitol, and Fructose Meals in Normal and Diabetic Subjects
Authors: Suat Akgün, Norman H Ertel
Journal: Diabetes Care (1980)

Sucrose, sorbitol, and fructose (35 g) were fed to normal and diabetic subjects as a component of a 400-calorie breakfast. In both normal and diabetic subjects, the mean peak increment in plasma glucose was highest after the sucrose meals (44.0 mg/dl for normal subjects; 78.0 mg/dl for diabetic subjects); lowest after sorbitol meals (9.3 mg/dl for normal subjects; 32.3 mg/dl for diabetic subjects); and intermediate after the fructose meals (29.0 mg/dl for normal subjects; 48.0 mg/dl for diabetic subjects). In normal subjects, the mean peak increment of plasma immunoreactive insulin followed a similar pattern, but in diabetic subjects there was no significant difference between the three groups. We conclude that fructose or sorbitol, given as part of a meal, results in lower glucose levels in both normal and diabetic subjects, but that the latter is not related to a difference in insulin release.
Clinical Management of Poisoning and Drug Overdose
Authors: Kenneth W. Kizer
Journal: JAMA (1991)

Medical toxicology has come of age. Events of the past decade, such as the Bhopal and Chernobyl disasters, the "crack" and "ice" epidemics and the "war on drugs," diethylstilbestrol induced cancer, and pesticide-tainted watermelons on the Fourth of July, along with front-page coverage of conditions such as acid rain, cyanide-laced grapes, and lead poisoning of children, have made toxicology a global concern and a household word. "Toxics" have leapt to the forefront of public consciousness, and physicians are being confronted more and more with questions and concerns about toxic exposures and drug safety. The need for reference texts in this area is substantial. When Haddad and Winchester's<i>Clinical Management of Poisoning and Drug Overdose</i>was first published in 1983, it was enthusiastically welcomed as the first major new medical toxicology textbook in years. Since then, toxicology research and the clinical management of poisoning have advanced, and this second edition has
Re: Predictive Value of a Positive Test
Authors: Donald P. Connelly
Journal: JAMA (1986)

<h3>To the Editor.—</h3> Billings and Bernstein<sup>1</sup>reported findings of a survey conducted among physicians, house officers, and medical students to assess the performance of clinicians at calculating the predictive value of a positive test result. The following question, modified from Casscells et al<sup>2</sup>was posed to 30 respondents: "If a test to detect a disease whose prevalence is 1/1,000 has a falsepositive rate of 5%, what is the chance that a person found to have a positive result actually has the disease, assuming that you know nothing about the person's symptoms or signs?" It is surprising that the authors would choose to perpetuate the term, "false-positive rate," which previously generated so much controversy<sup>3-5</sup>and on which terminology even the authors of the original work recommended "a moratorium."<sup>6</sup> Nevertheless, from literature quoted by Billings and Bernstein, the false-positive rate is the quantity 1 minus specificity,<sup>7</sup>ie, the
Mast Cells and Scleroderma-Reply
Authors: Henry N. Claman
Journal: JAMA (1990)

In Reply.—  Chanez and colleagues studied the lungs of patients with scleroderma. They found increased mast cell numbers in bronchoalveolar lavage fluid, but this finding did not correlate with the presence or absence of interstitial lung disease. Bronchoalveolar lavage histamine levels and mast cell numbers in bronchial biopsy specimens were not elevated in patients with scleroderma.  Taken together, these results do not seem to support the hypothesis that mast cell activity is important in the fibrosis of scleroderma and other fibrotic processes. There are some points that need to be considered, and these concern the activity of the disease process. The patients of Chanez et al had been sick for 15 to 29 years, and one cannot tell if they are in the active, the quiescent, or the resolving stage of the disease. If their disease is quiescent, the hypothesis would not predict any increase in mast cell numbers
Parents are not homogeneous
Authors: T. A Laws
Journal: BMJ (2003)

EDITOR—Young et al offer an important insight into the rub between parental desires to protect their offspring from unpleasant news while at the same time recognising their child's autonomy.1 However, the paper falls short in two respects.

Firstly, although Young et al say that they did not address the influence of sex, this factor cannot be simply discounted without explanation. Upholding the …
Call to action: catch The Wave
Authors: J. Dorward, T. Waterston, F. Mortimer, R. Stott, J. Currie
Journal: BMJ (2009)

International environmental health activists have called for public health to take a central role in the UN climate change talks.1 However, despite increasingly dire warnings of the economic and health catastrophes that unabated climate change will cause,2 most health professionals and lay people have not been stirred into the …
Significance of High Plasma Renin Activity in Patients on Maintenance Haemodialysis Therapy
Authors: P. W. Craswell, V. M. Hird, R. A. Baillod, Z. Varghese, J. F. Moorhead
Journal: BMJ (1973)

Blood pressure and plasma renin activity were remeasured after an interval of 8 to 17 months in 16 patients on maintenance haemodialysis previously found to have high renin activity. Continuing intermittent haemodialysis changed the plasma renin activity and blood pressure but no consistent pattern was seen. This confirmed our previous finding that adequate dialysis can control blood pressure in the presence of high renin activity. We therefore conclude that bilateral nephrectomy should be approached with renewed caution.
Adenosine Tc-99m Tetrofosmin SPECT in Differentiation of Ischemic From Nonischemic Cardiomyopathy in Patients With LV Systolic Dysfunction
Authors: Sung Ho Her, Hee Jeoung Yoon, Jong Min Lee, Seung Won Jin, Ho Joong Youn, Ki Bae Seung, Jae Hyung Kim
Journal: Clinical Nuclear Medicine (2008)

The noninvasive differentiation of ischemic from nonischemic cardiomyopathy is clinically important. However, whether adenosine Tc-99m tetrofosmin SPECT can offer clear and accurate information was not known. The aim of this study is to investigate the usefulness of adenosine Tc-99m tetrofosmin SPECT in differentiation of ischemic from nonischemic etiology in patients with mild to severe LV systolic dysfunction and to compare the relationship between patients with mild LV systolic dysfunction and those with severe LV systolic dysfunction.Seventy-five patients with chronic heart failure (LV ejection fraction <or=50%) underwent adenosine Tc-99m tetrofosmin SPECT and coronary angiography to identify ischemia. The patients were divided into 2 groups based on the result of ejection fraction (EF); group I (44 patients) had mild LV dysfunction, LVEF >35%, group II (31 patients) had severe LV dysfunction, LVEF <or=35%. As the result of SPECT, percent abnormal myocardium was categorized into 3 groups: small defect, <10%; medium defect 10% to 20%; and large defects, >or=20%. Myocardial ischemia was defined by >or=70% stenosis in at least one vessel by coronary angiography.: In group I, 4 (30.8%) of 13 patients with small defects, 1 (25.0%) of 5 patients with a medium defect, and 22 (84.6%) of 26 patients with large defects demonstrated myocardial ischemia documented by coronary angiography. The relationship between the extent of the SPECT defect and myocardial ischemia was statistically significant in the group I population (P < 0.001). However, in group II, 1 (33.3%) of 3 patients with small defect, 3 (33.3%) of 9 patients with medium defects, and 7 (36.8%) of 19 patients with large defects demonstrated myocardial ischemia confirmed by coronary angiography. There was no statistical relationship between the extent of the SPECT defect and myocardial ischemia in group II.Adenosine Tc-99m tetrofosmin SPECT is a useful modality to differentiate ischemic from nonischemic etiology in patients with mild LV systolic dysfunction. However, other noninvasive approaches other this SPECT may be considered for confirming the etiology in patients with severe LV systolic dysfunction.
Cognitive impairment in alcoholic and nonalcoholic cirrhotic patients
Authors: David Edwin, Laura Flynn, Andrew Klein, Paul J. Thuluvath
Journal: Hepatology (1999)

Cognitive impairment is common in patients with advanced liver disease. It has been suggested that patients with alcoholic liver disease (ALD) have more impaired cognition than nonalcoholics. The objective of this study was to characterize any differences in cognitive functions between alcoholic cirrhotic patients and non-alcoholic cirrhotic patients of similar age, education, and severity of liver disease. We assessed cognitive functions in 117 patients with alcoholic cirrhosis and 163 patients with nonalcoholic cirrhosis using a brief battery of neuropsychological tests. In addition, all patients had standard psychiatric examinations to assess the effect of the disease severity, alcoholism, anxiety, and depression on the test scores. The study showed a higher proportion of patients with cognitive impairment in the alcoholic group. Alcoholics performed poorly in tests of memory and motor speed compared with nonalcoholics, despite similar premorbid IQ and education. Because patients with alcoholic cirrhosis had more severe liver disease (Child-Pugh score 8.5 +/- 2.2 vs. 7.6 +/- 2.2, P =.03) than nonalcoholics, the results were reanalyzed after adjusting for the linear effects of Child-Pugh score on cognitive test scores. We also used two-way analysis of variance to examine the interaction between Child class and alcoholism. Finally, the test scores were compared within each Child class. These analyses revealed no primary or interaction effect of alcoholism and confirmed that the differences in the test scores observed in alcoholics reflect the greater severity of their liver disease. The severity of cognitive impairment is similar in both alcoholic and non-alcoholic cirrhotic patients when adjusted for the severity of liver disease.
Acyclovir Plus Steroids for Herpes Zoster
Authors: David A. Herbert
Journal: Annals of Internal Medicine (1997)

Letters15 May 1997Acyclovir Plus Steroids for Herpes ZosterDavid A. Herbert, MDDavid A. Herbert, MDFair Oaks, CA 95628-6153Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-10-199705150-00030 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their recent article on herpes zoster, Whitley and colleagues [1] present tables of statistics but almost no clinically useful information. Instead of the number of days it took for their patients to respond, we are given only relative risks. Thus, we know that at 1 month, the relative risk of uninterrupted sleep in the prednisone group compared with the nonprednisone group was 1.65, but we cannot tell if this means that the average time to response was 29 compared with 33 days (no big deal) or 10 compared with 50 days (great news). Even if data ...REFERENCE1. Whitley RJ, Weiss H, Gnann JW Jr, Tyring S, Mertz GJ, Pappas PG, et al. Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. Ann Intern Med. 1996; 125:376-83. Google Scholar Author, Article, and Disclosure InformationAuthors: David A. Herbert, MDAffiliations: Fair Oaks, CA 95628-6153 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 May 1997Volume 126, Issue 10Page: 831KeywordsRelative riskSleepSteroids ePublished: 15 August 2000 Issue Published: 15 May 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...