tbuckley/cabot-search huggingface dataset:
Association Between Phonocardiographic Third and Fourth Heart Sounds and Objective Measures of Left Ventricular Function
Authors: Gregory M. Marcus
Journal: JAMA (2005)

The third (S3) and fourth (S4) heart sounds detected by phonocardiography are considered to represent the criterion standards of the gallop sounds, but their test characteristics have not been explored.To determine the diagnostic test characteristics of the S3 and S4 for prediction of left ventricular dysfunction using a computerized heart sound detection algorithm.Prospective study of 90 adult patients undergoing elective left-sided heart catheterization at a single US teaching hospital between August 2003 and June 2004. The mean age was 62 (SD, 13) years (range, 24-90 years) and 61 (68%) were male. Within a 4-hour period, participants underwent computerized heart sound phonocardiographic analysis, cardiac catheterization, transthoracic echocardiography, and blood sampling for assessment of an S3/S4, left ventricular end-diastolic pressure (LVEDP), left ventricular ejection fraction (LVEF), and B-type natriuretic peptide (BNP), respectively.Diagnostic test characteristics of the computerized phonocardiographic S3 and S4 using markers of left ventricular function as criterion standards.Mean (SD) LVEDP was significantly elevated (18.4 [6.9] mm Hg vs 12.1 [7.3] mm Hg; P<.001), mean (SD) LVEF was reduced (49.4% [20.2%] vs 63.6% [14.8%]; P<.001), and median (interquartile range) BNP was elevated (330 [98-1155] pg/mL vs 86 [41-192] pg/mL; P<.001) in those with an S3, S4, or both compared with patients without a diastolic heart sound. The sensitivities of these heart sounds to detect an elevated LVEDP, reduced LVEF, or elevated BNP were 41%, 52%, and 32% for an S3, and 46%, 43%, and 40% for an S4, respectively. For abnormal levels of the same markers of ventricular function, the specificities of the S3 were 92%, 87%, and 92%, while the specificities of the S4 were 80%, 72%, and 78%, respectively.Neither the phonocardiographic S3 nor the S4 is a sensitive marker of left ventricular dysfunction. The phonocardiographic S3 is specific for left ventricular dysfunction and appears to be superior to the moderate specificity of the phonocardiographic S4.
The Dying Experience
Authors: Joanne Lynn
Journal: Annals of Internal Medicine (1997)

Letters1 August 1997The Dying ExperienceJoanne Lynn, MD, Joan Teno, MD, and Albert Wu, MDJoanne Lynn, MDGeorge Washington University; Washington, DC 20037Johns Hopkins University Baltimore, MD 21205Search for more papers by this author, Joan Teno, MDGeorge Washington University; Washington, DC 20037Johns Hopkins University Baltimore, MD 21205Search for more papers by this author, and Albert Wu, MDGeorge Washington University; Washington, DC 20037Johns Hopkins University Baltimore, MD 21205Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-127-3-199708010-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate these respondents' thoughtful comments on our report of what families remember about how loved ones died. Dying is more difficult, and what constitutes optimal care more uncertain, that most have acknowledged. Our findings illuminate potential targets for improvement, but we are all still learning how to achieve that improvement.Reform efforts must test the extent to which citizens want every chance at survival, which Drs. Ainslie, Steinberg, and Palmer suggest may be a strong force, and the extent to which this desire can be tempered by the wish for a peaceful death and a meaningful dying. ...References1. Lynn J, Harrell F, Cohn F, Wagner D, Connors AF. Prognoses of seriously ill hospitalized patients on the days before death: implications for patient care and public policy. New Horizons. 1997; 5:56-61. Google Scholar2. Lynn J, Harrell FE, Cohn F, Hamel MB, Dawson N, Wu AW. Defining the “terminally ill”: Insights from SUPPORT. Duquesne Law Review. 1996; 35:311-36. Google Scholar3. Lynn J, Cohn F, Pickering JH, Smith J, Stoeppelwerth AM. American Geriatrics Society on physician-assisted suicide: brief to the United States Supreme Court. J Am Geriatr Soc. 1997; 45:1-11. Google Scholar4. Berwick DM. Quality comes home. Ann Intern Med. 1996; 125:839-43. Google Scholar Author, Article, and Disclosure InformationAuthors: Joanne Lynn, MD; Joan Teno, MD; Albert Wu, MDAffiliations: George Washington University; Washington, DC 20037Johns Hopkins University Baltimore, MD 21205 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byBecky's Legacy: Personal and Professional Reflections on Loss and HopeThe Comprehensive Care Team: A Description of a Controlled Trial of Care at the Beginning of the End of Life 1 August 1997Volume 127, Issue 3Page: 243KeywordsContinuous quality improvementHealth careHeart failureMedicareQuality of life ePublished: 15 August 2000 Issue Published: 1 August 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Sex Differences in the Prediction of Type 2 Diabetes by Inflammatory Markers
Authors: Barbara Thorand, Jens Baumert, Hubert Kolb, Christa Meisinger, Lloyd Chambless, Wolfgang Koenig, Christian Herder
Journal: Diabetes Care (2007)

Although sex differences have been reported for associations between obesity and inflammation, the question of whether there is an effect modification by sex in the association between inflammation and type 2 diabetes has not been investigated in detail. Therefore, the aim of this study was to compare associations of markers of inflammation with type 2 diabetes risk between men and women.Following a case-cohort design, cases of incident type 2 diabetes were identified from 7,936 subjects aged 35-74 years at baseline who participated in the population-based Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA)/Cooperative Research in the Region of Augsburg (KORA) studies conducted between 1984 and 2002. Concentrations of C-reactive protein (CRP) and interleukin (IL)-6 were measured in 527 cases of incident type 2 diabetes (305 men and 222 women) and 1,698 noncases (889 men and 809 women).After adjustment for age and survey and lifestyle factors including smoking, alcohol intake, and physical activity, elevated concentrations of CRP showed a considerably stronger association with risk of type 2 diabetes in women (hazard ratio comparing tertile extremes 7.60 [95% CI 4.43-13.04]) than in men (1.84 [1.27-2.67]). The P value for the sex interaction was <0.001. Further adjustment for metabolic risk factors considerably attenuated these associations, and they became nonsignificant in men but remained significant in women. IL-6 was also more strongly associated with type 2 diabetes in women, but there was no significant sex interaction.Our data suggest that inflammatory processes may be of particular importance in the pathogenesis of type 2 diabetes in women.
Recombinant apolipoprotein A-I Milano reduces intimal thickening after balloon injury in hypercholesterolemic rabbits.
Authors: S Ameli, A Hultgardh-Nilsson, B Cercek, P K Shah, J S Forrester, H Ageland, J Nilsson
Journal: Circulation (1994)

Several epidemiological studies have shown an inverse relation between high-density lipoprotein (HDL) cholesterol levels and coronary heart disease. Recently, observational studies have suggested a similar inverse relation between HDL and restenosis after coronary balloon angioplasty. Despite these observations, it is unclear whether this inverse relation reflects a direct vascular protective effect of HDL or apolipoprotein (apo) A-I, the major apolipoprotein component of HDL. Therefore, to determine whether HDL directly influences neointima formation, we investigated the effect of recombinant apo A-I Milano (apo A-I M), a mutant of human apo A-I with Arg-173 to Cys substitution, on intimal thickening after balloon injury in cholesterol-fed rabbits.Cholesterol feeding was initiated 18 days before injury and continued until the time of death. Eight rabbits received intravenous injections of 40 mg of apo A-I M linked to a phospholipid carrier on alternate days, beginning 5 days before and continuing for 5 days after balloon injury of femoral and iliac arteries. Eight rabbits received the carrier alone, and four received neither apo A-I M nor the carrier. Three weeks after balloon injury, apo A-I M-treated rabbits had significantly reduced intimal thickness compared with the two control groups (mean +/- SD): 0.49 +/- 0.29 versus 1.14 +/- 0.38 mm2 and 1.69 +/- 0.43 mm2, P < .002 by ANOVA). The intima-to-media ratio was also significantly reduced by apo A-I M (0.7 +/- 0.2 versus 1.5 +/- 0.5 and 2.1 +/- 0.1, P < .002 by ANOVA) compared with the two controls. The fraction of intimal lesion covered by macrophages, as identified by immunohistochemistry using macrophage-specific monoclonal antibody, was significantly less in apo A-I M-treated rabbits compared with carrier-treated animals (25.3 +/- 17% versus 59.4 +/- 12.3%, P < .005). Aortic cholesterol content, measured in an additional 10 rabbits, did not differ significantly between apo A-I M-treated animals (n = 5) and carrier-treated controls (n = 5).Apo A-I M significantly reduced intimal thickening and macrophage content after balloon injury in cholesterol-fed rabbits without a change in arterial total cholesterol content. Although the precise mechanism of action remains to be defined, these findings are consistent with a direct vascular effect of apo A-I, which could have potential therapeutic implications.
Effectiveness of prolonged low dose recombinant tissue-type plasminogen activator for refractory unstable angina
Authors: Francesco Romeo, Giuseppe M.C. Rosano, Eugenio Martuscelli, Michele Comito, Nicola Cardona, Corrado Colistra, Biagio Milano, Cesare Bianco, Vito Rosano
Journal: Journal of the American College of Cardiology (1995)
Traditional herbal medicines for malaria
Authors: Merlin L Willcox, Gerard Bodeker
Journal: BMJ (2004)

Traditional medicines have been used to treat malaria for thousands of years and are the source of the two main groups (artemisinin and quinine derivatives) of modern antimalarial drugs. With the problems of increasing levels of drug resistance and difficulties in poor areas of being able to afford and access effective antimalarial drugs, traditional medicines could be an important and sustainable source of treatment.

The Research Initiative on Traditional Antimalarial Methods (RITAM) was founded in 1999 with the aim of furthering research on traditional medicines for malaria.1 The initiative now has in excess of 200 members from over 30 countries. It has conducted systematic literature reviews and prepared guidelines aiming to standardise and improve the quality of ethnobotanical, pharmacological, and clinical studies on herbal antimalarials and on plant based methods of insect repellence and vector control. We review some of this work and outline what can be learnt from the developing countries on the management and control of malaria.

We carried out searches of relevant articles published up to 2004 through Medline, Embase, CAB, Sociofile, and the central clinical trials database of the Cochrane Library, using the terms “traditional medicine” and “malaria”, “malaria-therapy”, “knowledge,-attitudes,-practice”, “self-medication”, and “drug-utilisation”. We also searched the references of identified articles and handsearched journals on ethnobotany, herbal medicines, and tropical medicine, such as the Journal of Ethnopharmacology, Fitoterapia, Transactions of the Royal Society of Tropical Medicine and Hygiene, Tropical Medicine , and International Health . Authors were contacted for unpublished papers.

#### Summary points

Over 1200 plant species from 160 families are used to treat malaria and fever

On average, a fifth of patients use traditional herbal remedies for malaria in endemic countries

Larger, more rigorous randomised controlled trials are needed with long term follow up

So far only a few studies have reported on side effects from …
Rapid tranquillisation in emergency psychiatric settings
Authors: Chittaranjan Andrade
Journal: BMJ (2007)

Equitable access to health careWe have adequate evidence to improve health services now in less resourced countriesAs the world grapples with the problems of poverty and ill health, most people would agree that urgent action is needed to reduce the unacceptably high number of deaths of children living in resource constrained countries. 13][4] The first study, by Biai and colleagues, is a randomised controlled trial from Guinea Bissau in West Africa.They show that supervising healthcare workers to adhere to standard treatment protocols reduces mortality in children admitted to hospital with severe malaria. 2 This may not seem surprising.What is surprising, though, and of major policy importance, is that a key part of this effective intervention was to provide a small financial incentive to health workers (equivalent to one month's rent).Many agencies, including governments in countries in sub-Saharan Africa with less resources, have been reluctant to give financial incentives to their staff.They have opted instead for non-financial incentives such as acknowledging staff professionalism, offering career development and training, enforcing strict codes of conduct, and setting benchmarks for performance-all to no avail. 5n the 1980s and 1990s the policies of economic structural adjustment and health sector reform saw expenditure on health by many governments in the developing countries drastically reduced, at the behest of the World Bank and the International Monetary Fund.6 Although these policies are no longer in vogue, expenditure on health has not improved substantially, and the hospital wards in many of these countries are best described as pathetic.For example, in the paediatric ward in Guinea Bissau patients are diagnosed by an underpaid doctor who has to supplement his or her income through moonlighting.2 The patients might get the first emergency dose of the prescribed drugs from the hospital if they are lucky.Often however, the parents have to buy the drugs, intravenous cannula, and nasogastric tubes from private pharmacies that have mushroomed around the government run hospitals in the capital cities of these countries.Often, time is lost, and mortality in the first 24 hours is high.7 Several approaches have been tried to redress this situation-tackling the basic causes of ill health such as poverty, training of health staff on standardised cdc
Multiple Myeloma, 2004 — One or Two Transplants?
Authors: Edward A. Stadtmauer
Journal: New England Journal of Medicine (2003)

Contrary to a widely held belief, multiple myeloma is not a rare, rapidly fatal disorder that affects only elderly patients. Instead, it is the second most common hematologic cancer after non-Hodgkin's lymphoma — more than 50,000 patients in the United States alone have the disease. About half of these patients received the diagnosis when they were younger than 60 years of age, and increasingly, the disease is detected in persons under the age of 40. The detection of myeloma in patients who are relatively young and otherwise healthy has allowed the use of increasingly aggressive and potentially more efficacious therapies. . . .
Low Birth Weight Is Associated With Higher Adult Total Cholesterol Concentration in Men
Authors: Anna A. Davies, George Davey Smith, Yoav Ben-Shlomo, Paul Litchfield
Journal: Circulation (2004)

The majority of studies investigating the association between birth weight and adult total cholesterol (TC) concentration have been small and underpowered: not surprisingly, the findings have been inconsistent. We aimed to determine whether birth weight predicted adult TC in a large sample population.Between 1994 and 1996, 132,000 British Telecom employees undertook voluntary occupational health screening. Birth weight and lifestyle factors were self-reported; TC concentration and body size were measured by occupational health nurses. Complete measurements were available for 18,286 men and 7557 women (age range, 17 to 64 years). We found that sex and birth weight significantly interacted to predict adult TC (birth weight/sex interaction term, P=0.002). In men, lower birth weight was associated with higher adult TC levels (a -0.07 reduction in TC for each 1-kg increase in birth weight; 95% CI, -0.09 to -0.04 mmol/L; P<0.001), whereas no association was observed in women. Adjustment for potential confounding factors, including current body size and menopausal status, did not alter the findings. Analysis by SD score showed that in men, a 1-SD decrease in body mass index lowered TC concentration approximately 5-fold more than a 1-SD increase in birth weight.This is the largest study to investigate the association between birth weight and TC and suggests that the association may be dependent on sex. The absence of an association in women was not explained by menopausal status. The influence of fetal environment on adult TC is small compared with the influence of adult adiposity.
Peripheral Expression of Self-MHC-II Influences the Reactivity and Self-Tolerance of Mature CD4+ T Cells
Authors: Avinash Bhandoola, Xuguang Tai, Michael Eckhaus, Hugh Auchincloss, Karen Mason, Steven A Rubin, Kathryn M Carbone, Zvi Grossman, Amy S Rosenberg, Alfred Singer
Journal: Immunity (2002)
Critical effective methods to detect genotoxic carcinogens and neoplasm-promoting agents.
Authors: J H Weisburger, G M Williams
Journal: Environmental Health Perspectives (1991)

Neoplasia in fish can result from contamination of waters with carcinogens and promoters. Cancer in fish, therefore, is a possible indicator of cancer risk to man and serves as a guide to the need for preventive approaches involving improved means of waste disposal and environmental hygiene. Moreover, cancer in fish indicates that this important food source may be contaminated. Detection of genotoxic carcinogens to which fish are exposed can be achieved quickly and efficiently by carefully selected batteries of complementary in vitro and in vivo bioassays. One such battery consists of the Ames test, a reverse mutation assay in prokaryotic Salmonella typhimurium, and the Williams test, involving DNA repair in freshly explanted metabolically highly competent liver cells from diverse species, including humans. Determination of DNA-carcinogen adducts by varied techniques, including 32P-postlabeling, as well as DNA breakage, mammalian cell mutagenicity, chromosome aberrations, sister chromatid exchange, or cell transformation represent additional approaches, each with its own advantages and disadvantages. More research is needed on systems to apprehend neoplasm promoters, but tests to determine interruption of intercellular communications through gap junctions appear promising. Other approaches rely on measurement of enzymes such as ornithine decarboxylase and protein kinase C. Approaches to the definition of risk to fish or humans require characterization of the genotoxic or nongenotoxic properties of a chemical, relative potency data obtained in select, limited rodent bioassays, and knowledge of prevailing environmental concentrations of specific carcinogens.
Mechanism of abnormal septal motion in patients with right ventricular volume overload: a cross-sectional echocardiographic study.
Authors: A E Weyman, S Wann, H Feigenbaum, J C Dillon
Journal: Circulation (1976)

To evaluate the mechanism of paradoxical septal motion in patients with right ventricular volume overload (RVVO), short axis cross-sectional, echocardiographic studies of the left ventricle (LV) and interventricular septum (IVS) were performed in 19 patients with paradoxical septal motion due to RVVO and in 20 normal subjects. Short axis study in normal subjects revealed the left ventricle to be a relatively circular structure during both diastole and systole. In patients with RVVO a change in LC diastolic shape was observed. This change in shape varied from a slight flattening of the LV and IVS during diastole to total reversal of the normal direction of septal curvature such that the IVS became concave toward the RV and convex toward the LV. During systole the LV and IVS returned to their normal relatively circular configuration. This change in LV shape from diastole to systole resulted in net motion of the IVS toward the right ventricle (paradoxically). This study therefore suggests that paradoxical septal motion in patients with right ventricular volume overload is a result of a change in the diastolic shape of the left ventricle.
Sequence similarities among kappa IIIb chains of monoclonal human IgM kappa autoantibodies.
Authors: B Pons-Estel, F Goñi, A Solomon, B Frangione
Journal: The Journal of Experimental Medicine (1984)

Light chains of the serologically and chemically defined V region sub-subgroup kappa IIIb are preferentially associated with several types of human IgM kappa (monoclonal) autoantibodies and are remarkably homologous in primary structure, as evidenced by partial amino acid sequence data. To establish the extent of homology among such proteins, we have determined the complete variable region (V) sequence of the light chains of four monoclonal IgM kappa autoantibodies, of which two (GAR and GOT) are rheumatoid factors (RFs), the third (SON) has anti-apo beta lipoprotein specificity, and the fourth (PIE) binds specifically to intermediate filaments. The region encoded by the V kappa segment gene (positions 1-95) in all four light (L) chains is virtually identical in sequence, differing by only one residue in the FR3 of protein SON and in the first CDR of protein GOT. Further, the CDR3 of kappa chain SON contains an additional residue (prolyl) located at the carboxyl-terminus of the V segment. The region encoded by the J gene (positions 96-108) is identical after position 96 for the two RFs GAR and GOT (J kappa 2), but different in proteins SON (J kappa 4) and PIE (J kappa 1). The amino acid residue at position 96, located in CDR3 at the site of combinatoriaL joining of the V kappa and J kappa gene segments and involved as a contacting residue in the hapten binding site, is different in all four light chains. These results demonstrate the extensive homology in sequence among light chains of IgM kappa autoantibodies and indicate that a particular V kappa germ line gene, kappa IIIb, is expressed as a phylogenetic response to certain self antigens or as part of a selection process by which these autoimmune responses are regulated.
Europe must coordinate its response to common health threats
Authors: Tessa Richards
Journal: BMJ (2005)

European governments must prepare for a pandemic of avian influenza that could strike at any time, warned Markos Kyprianou. The European Union commissioner for health spoke at a press conference held last week during the European Health Forum Gastein, a health “think tank” that meets annually in Bad Gastein in Austria.

“Getting sufficient vaccine presents a major challenge,” he said. “Industry needs financial incentives to increase its output. We have set up a public-private partnership to do this, and EU member states should make use of it now by entering into prepurchase agreements for a vaccine.”

Discussions of fast track approval of a vaccine by the European Medicines Agency are underway, he said, and the EU is contributing to international efforts to help deal with the source of the infection in South East Asia.

Preparations for the arrival of avian flu became more urgent at the weekend when it was announced that infected birds had been discovered in Turkey and Romania. Results of tests to establish if the cases are of the H5N1 strain, …