tbuckley/cabot-search huggingface dataset:
Off-Pump Versus On-Pump Coronary Artery Bypass Graft Surgery
Authors: Edward L. Hannan, Chuntao Wu, Craig R. Smith, Robert S.D. Higgins, Russell E. Carlson, Alfred T. Culliford, Jeffrey P. Gold, Robert H. Jones
Journal: Circulation (2007)

Background— Off-pump coronary artery bypass graft surgery (OPCAB) has been performed for many years, but its use is increasing in frequency, and it remains an open question whether OPCAB is associated with better outcomes than on-pump coronary artery bypass graft (CABG) surgery. Methods and Results— New York State patients who underwent either OPCAB with median sternotomy (13 889 patients) or on-pump CABG surgery (35 941 patients) between 2001 and 2004 were followed up via New York databases. Short- and long-term outcomes were compared after adjustment for patient risk factors and after patients were matched on the basis of significant predictors of type of CABG surgery. OPCAB had a significantly lower inpatient/30-day mortality rate (adjusted OR 0.81, 95% confidence interval [CI] 0.68 to 0.97), lower rates for 2 perioperative complications (stroke: adjusted OR 0.70, 95% CI 0.57 to 0.86; respiratory failure: adjusted OR 0.80, 95% CI 0.68 to 0.93), and a higher rate of unplanned operation in the same admission (adjusted OR 1.47, 95% CI 1.01 to 2.15). In the matched samples, no difference existed in 3-year mortality (hazard ratio 1.08, 95% CI 0.96 to 1.22), but OPCAB patients had higher rates of subsequent revascularization (hazard ratio 1.55, 95% CI 1.33 to 1.80). The 3-year OPCAB and on-pump survival rates for matched patients were 89.4% and 90.1%, respectively ( P =0.20). For freedom from subsequent revascularization, the respective rates were 89.9% and 93.6% ( P &lt;0.0001). Conclusions— OPCAB is associated with lower in-hospital mortality and complication rates than on-pump CABG, but long-term outcomes are comparable, except for freedom from revascularization, which favors on-pump CABG.
HYPERTENSION: Trends in Prevalence, Incidence, and Control
Authors: Ihab Hajjar, Jane Morley Kotchen, Theodore A. Kotchen
Journal: Annual Review of Public Health (2006)

Hypertension is the leading cause of cardiovascular disease worldwide. Prior to 1990, population data suggest that hypertension prevalence was decreasing; however, recent data suggest that it is again on the rise. In 1999-2002, 28.6% of the U.S. population had hypertension. Hypertension prevalence has also been increasing in other countries, and an estimated 972 million people in the world are suffering from this problem. Incidence rates of hypertension range between 3% and 18%, depending on the age, gender, ethnicity, and body size of the population studied. Despite advances in hypertension treatment, control rates continue to be suboptimal. Only about one third of all hypertensives are controlled in the United States. Programs that improve hypertension control rates and prevent hypertension are urgently needed.
Management of rheumatoid neck.
Authors: I Watt, B Cummins
Journal: Annals of the Rheumatic Diseases (1990)

Rheumatoid arthritis of the neck is common but neurological complication occurs only in the minority.Nevertheless, this represents one of the few rheumatological emergencies.Surgery is the only definitive treatment, but diagnosis of this complication is often delayed so that candidates for surgery are frail and disabled, thus jeopardising the outcome.The advent of new forms of imaging, especially magnetic resonance imaging (MRI), when combined with careful clinical examination potentially offers a more efficient way of selecting patients for surgery.This is illustrated in the following case.fossa down to T4. TI weighted (fig IB) and T2 weighted MAST sagittal images were obtained together with TI weighted axial images (fig IC).This confirmed subluxation at the C6/7 level with severe restriction of the thecal sac.In addition there were subaxial subluxations at other levels, particularly obvious on the T2 weighted sagittal views.The axial views showed no evidence of myelomalacia.There was erosion of the odontoid peg but no significant sub- luxation at this level.The increased signal from the vertebral bodies on TI weighted images shown in Fig lB is due to fatty replacement of the marrow, which is typical of fused vertebrae.
PIK3CA Mutations and PTEN Loss Correlate with Similar Prognostic Factors and Are Not Mutually Exclusive in Breast Cancer
Authors: Gizeh Pérez-Tenorio, Liza Alkhori, Birgit Olsson, Marie Ahnström Waltersson, Bo Nordenskjöld, Lars Erik Rutqvist, Lambert Skoog, Olle Stål
Journal: Clinical Cancer Research (2007)

Abstract Purpose: The phosphatidylinositol 3′-kinase/Akt pathway is frequently altered in breast cancer. PTEN, a phosphatase that opposes the effect of phosphatidylinositol 3′-kinase, can be mutated or lost, whereas the PIK3CA gene is mutated. These have been proposed as alternative mechanisms, and their clinicalpathology significance is under discussion. In this study, we aimed to explore whether PIK3CA mutations and PTEN loss are mutually exclusive mechanisms, correlate with other known clinicopathologic markers, or have clinical implication in breast cancer. Experimental Design: Exons 9 and 20 of the PIK3CA gene were analyzed in 270 breast tumors, and mutations were detected by single-stranded conformational analysis followed by sequencing. The expression of PTEN was evaluated by immunohistochemistry in 201 tumors. Results: PIK3CA mutations were found in 24% of the tumors and associated with estrogen receptor+ status, small size, negative HER2 status, high Akt1, and high cyclin D1 protein expression. PTEN was negative in 37% of the cases and PTEN loss was associated with PIK3CA mutations (P = 0.0024). Tumors presenting PTEN loss or both alterations were often estrogen receptor+, small in size, and HER2−. PIK3CA mutations predicted for longer local recurrence-free survival. Moreover, PTEN loss by itself or combined with mutated PIK3CA tended to confer radiosensitivity. In addition, the patients with high S-phase fraction had longer recurrence-free survival if they carried mutations in the PIK3CA gene and/or had lost PTEN, whereas the same alterations were associated with shorter recurrence-free survival among patients with low S-phase fraction. Conclusions: PIK3CA mutations and PTEN loss were not mutually exclusive events and associated with similar prognostic factors.
Effectiveness of Computer-Aided Detection in Community Mammography Practice
Authors: J. J. Fenton, L. Abraham, S. H. Taplin, B. M. Geller, P. A. Carney, C. D'Orsi, J. G. Elmore, W. E. Barlow
Journal: JNCI Journal of the National Cancer Institute (2011)

BackgroundComputer-aided detection (CAD) is applied during screening mammography for millions of US women annually, although it is uncertain whether CAD improves breast cancer detection when used by community radiologists.
Predicting Radiosensitivity Using DNA End-Binding Complex Analysis
Authors: Sheikh M. Ismail, Monica Puppi, Sheela Prithivirajsingh, Anupama Munshi, Uma Raju, Raymond E. Meyn, Thomas A. Buchholz, Michael D. Story, William A. Brock, Luka Milas, Howard D. Thames, Craig W. Stevens
Journal: Clinical Cancer Research (2004)

Abstract Previous reports have suggested that measuring radiosensitivity of normal and tumor cells would have significant clinical relevance for the practice of radiation oncology. We hypothesized that radiosensitivity might be predicted by analyzing DNA end-binding complexes (DNA-EBCs), which form at DNA double-strand breaks, the most important cytotoxic lesion caused by radiation. To test this hypothesis, the DNA-EBC pattern of 21 primary human fibroblast cultures and 15 tumor cell lines were studied. DNA-EBC patterns were determined using a modified electrophoretic mobility shift assay and were correlated with radiosensitivity, as measured by SF2. DNA-EBC analysis identified a rapidly migrating ATM-containing band (identified as “band-A”) of which the density correlated with SF2 (0.02 ≤ SF2 ≤ 0.41) in primary fibroblasts (r2 = 0.77). The DNA-EBC pattern of peripheral blood lymphocytes was identical to that of fibroblasts. In addition, band-A density correlated with SF2 (0.35 ≤ SF2 ≤ 0.80) in 15 human tumor cell lines (r2 = 0.91). Densitometry of other bands, or total DNA-EBC binding, correlated more poorly with SF2 (r2 &amp;lt; 0.45). These data indicate that DNA-EBC analysis may be a practical, clinically relevant predictor of tumor and primary cell radiosensitivity.
Secondary prevention of coronary heart disease
Authors: K. Rees
Journal: BMJ (2002)

Editor—The review by McAlister et al of secondary prevention programmes in coronary heart disease does not adhere to some of the major principals of good practice when conducting systematic reviews of the medical literature.1–3 These include a clearly defined research question, strict inclusion criteria so that the review can be replicated, an exhaustive search of the medical literature to find all relevant studies, and findings that can be interpreted easily by the reader and relate to clinical practice.

McAlister et al, at first glance, have chosen a huge area of the medical literature to review, encompassing both pharmacological and non-pharmacological interventions for the secondary prevention of coronary heart disease. On closer inspection, they say that it is their intention to review the literature concerned with disease management programmes for coronary heart disease. The definition of disease management programmes used is broad and is quoted as that proposed by Hunter et al as a combination of patient education, provider use of practice guidelines, appropriate consultation, and supplies of drugs and ancillary services; from the same source, Hunter et al also say that the spectrum of disease management extends from health promotion and disease prevention, through diagnosis, treatment and rehabilitation to long term care.4 This highlights the need to be absolutely explicit about the inclusion and exclusion criteria applied to a review in this area.

The trials included in the review are a mix of nursing and multidisciplinary team interventions, and also comprehensive cardiac rehabilitation programmes. Single modality rehabilitation programmes were excluded. Many trials of comprehensive cardiac rehabilitation—which should be considered admissible under the umbrella of disease management programmes—are missing from studies included in the review. A recent Cochrane review of exercise based rehabilitation for coronary heart disease, which was not picked up with the search strategy used by McAlister et al, cites at least 17 trials concerned with comprehensive cardiac rehabilitation that could have also been included in the review by McAlister et al.5 Including these trials in the current review results in a pooled odds ratio for all cause mortality of 0.87 (95% confidence interval 0.76 to 1.0).

A precise definition of disease management programmes is problematic, but using the authors' own description, it seems that deficiencies in searching and application of inclusion criteria have resulted in a review that that is difficult to interpret, is not replicable, and is potentially misleading.
Racial Composition of Residential Areas Associates with Access to Pre-ESRD Nephrology Care
Authors: Suma Prakash, Rudolph A. Rodriguez, Peter C. Austin, Refik Saskin, Alicia Fernandez, Louise M. Moist, Ann M. O'Hare
Journal: Journal of the American Society of Nephrology (2010)

Referral to a nephrologist before initiation of chronic dialysis occurs less frequently for blacks than whites, but the reasons for this disparity are incompletely understood. Here, we examined the contribution of racial composition by zip code on access and quality of nephrology care before initiation of renal replacement therapy (RRT). We retrospectively studied a cohort study of 92,000 white and black adults who initiated RRT in the United States between June 1, 2005, and October 5, 2006. The percentage of patients without pre-ESRD nephrology care ranged from 30% among those who lived in zip codes with <5% black residents to 41% among those who lived in areas with >50% black residents. In adjusted analyses, as the percentage of blacks in residential areas increased, the likelihood of not receiving pre-ESRD nephrology care increased. Among patients who received nephrology care, the quality of care (timing of care and proportion of patients who received a pre-emptive renal transplant, who initiated therapy with peritoneal dialysis, or who had a permanent hemodialysis access) did not differ by the racial composition of their residential area. In conclusion, racial composition of residential areas associates with access to nephrology care but not with quality of the nephrology care received.
Dynamic Changes in Matrix Metalloprotienase Activity Within the Human Myocardial Interstitium During Myocardial Arrest and Reperfusion
Authors: Francis G. Spinale, Christine N. Koval, Anne M. Deschamps, Robert E. Stroud, John S. Ikonomidis
Journal: Circulation (2008)

Past studies have clearly established that matrix metalloproteinases (MMPs) contribute to adverse myocardial remodeling with ischemia and reperfusion. However, these studies measured MMP levels in extracted samples, and therefore whether and to what degree actual changes in interstitial MMP activity occur within the human myocardium in the context of ischemia/reperfusion remained unknown.The present study directly quantified MMP interstitial activity within the myocardium of patients (n=14) undergoing elective cardiac surgery during steady-state conditions, as well as during and following an obligatory period of myocardial arrest and reperfusion achieved by cardiopulmonary bypass. Interstitial MMP activity was continuously monitored using a validated MMP fluorogenic substrate, a microdialysis system placed within the myocardium, and in-line fluorescent detection system. MMP activity, as measured by fluorescent emission, reached a stable steady state level by 10 minutes after deployment of the microdialysis system. During initiation of cardiopulmonary bypass, MMP activity increased by 20% from baseline values (P<0.05), and then rapidly fell with cardiac arrest and longer periods of cardiopulmonary bypass. However, with restoration of myocardial blood flow and separation from cardiopulmonary bypass, MMP interstitial activity increased by over 30% from baseline (P<0.05).The present study directly demonstrated that MMP proteolytic activity exists within the human myocardial interstitium and is a dynamic process under conditions such as myocardial arrest and reperfusion.
Clindamycin-resistant, toxin A-negative, toxin B-positive Clostridium difficile strains cause antibiotic-associated diarrhea among children hospitalized in a hematology unit
Authors: H. Pituch, A. van Belkum, N. van den Braak, P. Obuch-Woszczatyñski, A. Sawicka-Grzelak, H. Verbrugh, F. Meisel-Mikołajczyk, Mirosław Łuczak
Journal: Clinical Microbiology and Infection (2003)
Race/Ethnicity and SES Are Predictors Of Allergic Sensitization To Environmental and Food Allergens
Authors: Amina Abdeldaim, Supinda Bunyavanich, Sheryl Rifas-Shiman, Thomas A.E. Platts-Mills, Diane R. Gold, Carlos Camargo, Emily Oken, Matthew Gillman, Augusto A. Litonjua
Journal: Journal of Allergy and Clinical Immunology (2014)
Continuous Distributions of Ventilation-Perfusion Ratios in Normal Subjects Breathing Air and 100% O2
Authors: Peter D. Wagner, Raymond B. Laravuso, Richard R. Uhi, John B. West
Journal: Journal of Clinical Investigation (1974)

A new method has been developed for measuring virtually continuous distributions of ventilation-perfusion ratios (V(A)/Q) based on the steadystate elimination of six gases of different solubilities. The method is applied here to 12 normal subjects, aged 21-60. In nine, the distributions were compared breathing air and 100% oxygen, while in the remaining three, effects of changes in posture were examined. In four young semirecumbent subjects (ages 21-24) the distributions of blood flow and ventilation with respect to V(A)/Q were virtually log-normal with little dispersion (mean log standard deviations 0.43 and 0.35, respectively). The 95.5% range of both blood flow and ventilation was from V(A)/Q ratios of 0.3-2.1, and there was no intrapulmonary shunt (V(A)/Q of 0). On breathing oxygen, a shunt developed in three of these subjects, the mean value being 0.5% of the cardiac output. The five older subjects (ages 39-60) had broader distributions (mean log standard deviations, 0.76 and 0.44) containing areas with V(A)/Q ratios in the range 0.01-0.1 in three subjects. As for the young subjects, there was no shunt breathing air, but all five developed a shunt breathing oxygen (mean value 3.2%), and in one the value was 10.7%. Postural changes were generally those expected from the known effects of gravity, with more ventilation to high V(A)/Q areas when the subjects were erect than supine. Measurements of the shunt while breathing oxygen, the Bohr CO(2) dead space, and the alveolar-arterial oxygen difference were all consistent with the observed distributions. Since the method involves only a short infusion of dissolved inert gases, sampling of arterial blood and expired gas, and measurement of cardiac output and minute ventilation, we conclude that it is well suited to the investigation of pulmonary gas exchange in man.
Cells mediating graft rejection in the mouse. I. Lyt-1 cells mediate skin graft rejection.
Authors: B E Loveland, P M Hogarth, R Ceredig, I F McKenzie
Journal: The Journal of Experimental Medicine (1981)

The Ly phenotype of cells mediating skin graft rejection was determined using monoclonal anti-Lyt-1.1 and Lyt-2.1 antibodies in CBA mice that received CBA lymphoid cells from mice sensitized to C57BL/6; i.e., alloantigenic differences arising from the H-2 and non-H-2 loci. It was clear that graft rejection was due wholly to the presence of Lyt-1 cells in the inoculum and that Lyt-123 or Lyt-23 cells had no effect. Furthermore, no synergism was noted between Lyt-1 and Lyt-2 cells. In this model, both the cytotoxic T cell and cytotoxic lymphocyte precursors were shown to be Lyt-123 and these could be depleted from sensitized Lyt-1 populations that mediated graft rejection. Thus cytotoxic T cells are not responsible for skin graft rejection, but rather, this is mediated by an Lyt-1 cell. Whether this T cell is distinct from other Lyt-1 cells (T helper, T cells mediating delayed hypersensitivity) is not clear at present, but other evidence, and traditional concepts, link graft rejection and delayed type hypersensitivity as being different manifestations of the same mechanism.
Psychiatric Perspectives on T-Groups and the Laboratory Movement: An Overview
Authors: LOUIS A. GOTTSCHALK, E. MANSELL PATTISON
Journal: American Journal of Psychiatry (1969)

The laboratory movement arose in the 1930s as an effort to develop educational action programs that could teach citizens to function more effectively and democratically in a variety of group settings. It has developed in many divergent directions, some of them bearing little or no relationship to the original goals. The instruments developed in the laboratory movement offer powerful potential for effecting human change, as these authors point out. They warn, however, that deficits of training, critical evaluation, or precision of goals among those involved in the use of such instruments may lead to destructive rather than beneficial results.
Radioimmunoscintigraphy of recurrent, metastatic, or occult colorectal cancer with technetium 99m-labeled totally human monoclonal antibody 88BV59: results of pivotal, phase III multicenter studies.
Authors: A N Serafini, J L Klein, B G Wolff, R Baum, A Chetanneau, A Pecking, A J Fischman, H C Hoover, G E Wynant, R Subramanian, D K Goroff, M G Hanna
Journal: Journal of Clinical Oncology (1998)

PURPOSE To assess the performance and potential clinical impact of a totally human monoclonal antibody, 88BV59 (HumaSPECT) (INTRACEL, Corp, Rockville, MD), in 202 assessable presurgical patients with recurrent, metastatic, or occult colorectal cancer. METHODS 88BV59, labeled with technetium Tc 99m (99mTc) (HumaSPECT-Tc), was injected intravenously, and planar and single photon emission tomography (SPECT) images were obtained 14 to 20 hours postinjection. Surgical and pathologic verification of tumor were used as the standard against which the performance of HumaSPECT-Tc imaging and computed tomography (CT) analysis were evaluated. RESULTS All patients entered onto the recurrent disease study had at least one tumor site defined on CT. The sensitivity of HumaSPECT-Tc in those CT-positive patients was 87%. The specificity of HumaSPECT-Tc was 57% compared with 17% for CT and the difference was statistically significant (P &lt; .001). The diagnostic information provided by HumaSPECT-Tc significantly (P &lt; .001) improved the accuracy of the identification of resectable and nonresectable disease over that of CT (80% v 62%). HumaSPECT-Tc scans resulted in a significant (P &lt; .001) reduction versus CT in terms of the proportion of patients understaged (27% v 41%) and overstaged (4% v 26%). In patients with occult disease (increasing carcinoembryonic antigen [CEA] titer, negative diagnostic work-up, negative CT), HumaSPECT-Tc correctly identified disease in 15 of 22 (68%) patients. HumaSPECT-Tc images provided additional clinical data that would have affected patient management decisions in 40 of 202 (19.8%) patients. In 365 patients who received 88BV59, only a single detectable human anti-human antibody (HAHA) response (90 ng/mL) at 9 weeks postinfusion was observed. CONCLUSION HumaSPECT-Tc can provide important and accurate information about the presence and location of disease in patients with a high clinical suspicion of metastatic or recurrent colorectal cancer and either positive (known disease) or negative (occult disease) CT scans.
Microalbuminuria in Adults after Prenatal Exposure to the Dutch Famine
Authors: Rebecca C Painter, Tessa J Roseboom, Gert A van Montfrans, Patrick M M Bossuyt, Raymond T Krediet, Clive Osmond, David J P Barker, Otto P Bleker
Journal: Journal of the American Society of Nephrology (2004)

Maternal undernutrition during gestation is associated with an increase in cardiovascular risk factors in the offspring in adult life. The effect of famine exposure during different stages of gestation on adult microalbuminuria (MA) was studied. MA was measured in 724 people, aged 48 to 53, who were born as term singletons in a university hospital in Amsterdam, the Netherlands, around the time of the Dutch famine 1944 to 1945. Twelve percent of people who were exposed to famine in mid gestation had MA (defined as albumin/creatinine ratio ≥2.5) compared with 7% of those who were not prenatally exposed to famine (odds ratio 2.1; 95% confidence interval 1.0 to 4.3). Correcting for BP, diabetes, and other influences that affect MA did not attenuate this association (adjusted odds ratio 3.2; 95% confidence interval 1.4 to 7.7). The effect of famine was independent of size at birth. Midgestation is a period of rapid increase in nephron number, which is critical in determining nephron endowment at birth. Fetal undernutrition may lead to lower nephron endowment with consequent MA in adult life.