tbuckley/cabot-search huggingface dataset:
Using Patient Outcomes to Evaluate General Surgery Residency Program Performance
Authors: Neha Bansal, Kristina D. Simmons, Andrew J. Epstein, Jon B. Morris, Rachel R. Kelz
Journal: JAMA Surgery (2015)

<h3>Importance</h3> To evaluate and financially reward general surgery residency programs based on performance, performance must first be defined and measureable. <h3>Objective</h3> To assess general surgery residency program performance using the objective clinical outcomes of patients operated on by program graduates. <h3>Design, Setting, and Participants</h3> A retrospective cohort study was conducted of discharge records from 349 New York and Florida hospitals between January 1, 2008, and December 31, 2011. The records comprised 230 769 patients undergoing 1 of 24 general surgical procedures performed by 454 surgeons from 73 general surgery residency programs. Analysis was conducted from June 4, 2014, to June 16, 2015. <h3>Main Outcomes and Measures</h3> In-hospital death; development of 1 or more postoperative complications before discharge; prolonged length of stay, defined as length of stay greater than the 75th percentile when compared with patients undergoing the same procedure type at the same hospital; and failure to rescue, defined as in-hospital death after the development of 1 or more postoperative complications. <h3>Results</h3> Patients operated on by surgeons trained in residency programs that were ranked in the top tertile were significantly less likely to experience an adverse event than were patients operated on by surgeons trained in residency programs that were ranked in the bottom tertile. Adjusted adverse event rates for patients operated on by surgeons trained in programs that were ranked in the top tertile and those who were operated on by surgeons trained in programs that were ranked in the bottom tertile were, respectively, 0.483% vs 0.476% for death, 9.68% vs 10.79% for complications, 16.76% vs 17.60% for prolonged length of stay, and 2.68% vs 2.98% for failure to rescue (all<i>P</i> &lt; .001). The differences remained significant in procedure-specific subset analyses. The rankings were significantly correlated among some but not all outcome measures. The magnitude of the effect of the residency program on the outcomes achieved by the graduates decreased with increasing years of practice. Within the analyses of surgeons within 20, 10, and 5 years of practice, the relative difference in adjusted adverse event rates across the individual models between the top and bottom tertiles ranged from 1.5% to 12.3% (20 years), 9.1% to 33.8% (10 years), and 8.0% to 44.4% (5 years). <h3>Conclusions and Relevance</h3> Objective data were successfully used to rank the clinical outcomes achieved by graduates of general surgery residency programs. Program rankings differed by the outcome measured. The magnitude of differences across programs was small. Careful consideration must be used when identifying potential targets for payment-for-performance initiatives in graduate medical education.
Kaposi's Sarcoma Causing Pulmonary Infiltrates and Respiratory Failure in the Acquired Immunodeficiency Syndrome
Authors: FREDERICK P. OGNIBENE
Journal: Annals of Internal Medicine (1985)

Although an aggressive form of Kaposi's sarcoma often develops in patients with the acquired immunodeficiency syndrome, most patients die due to opportunistic infections rather than the direct effects of this tumor. Because Kaposi's sarcoma has caused pulmonary dysfunction in a number of our patients, we attempted to characterize features of pulmonary dysfunction induced by Kaposi's sarcoma. In 66 patients with Kaposi's sarcoma treated between 1982 and 1984 there were 30 episodes of pulmonary dysfunction that resulted in a biopsy. Six episodes were due to pulmonary Kaposi's sarcoma alone, and 6 additional episodes were due to Kaposi's sarcoma and associated opportunistic infections. Clinical and radiologic features of pulmonary Kaposi's sarcoma an infection were indistinguishable. Pulmonary Kaposi's sarcoma could only be documented in large tissue sections available from open-lung biopsy or autopsy samples. Because chemotherapy or radiation therapy appears to provide palliation, clinicians should recognize Kaposi's sarcoma as a cause of pulmonary disease in patients with the acquired immunodeficiency syndrome.
Ebstein's anomaly: sixteen years' experience with valve replacement without plication of the right ventricle.
Authors: P Raj Behl, A Blesovsky
Journal: Thorax (1984)

From June 1967 to February 1983 10 patients aged from 13 to 51 years underwent surgery for Ebstein9s anomaly. Nine patients were in class III according to the New York Heart Association (NYHA) classification and one was in class IV. The interatrial communication was closed in all patients; the tricuspid valve was repaired in one patient and replaced in the other nine patients. There were no deaths in hospital but there were two late deaths. One patient died when the tricuspid prosthesis clotted seven years after its insertion. The other patient committed suicide 11 years after surgery. The remaining eight patients have been followed up for periods ranging from six months to 16 years (mean 10 years). Seven of the eight survivors are well and in NYHA class I, the eighth being in class II. Cardiac arrhythmias have been a problem in only one patient. Tricuspid valve replacement combined with closure of interatrial communication without right ventricular plication has given satisfactory clinical results and has improved the quality of life.
Identification and Functional Characterization of Dendritic Cells in the Healthy Murine Kidney and in Experimental Glomerulonephritis
Authors: Thilo Krüger, Dirk Benke, Frank Eitner, Andreas Lang, Monika Wirtz, Emma E. Hamilton-Williams, Daniel Engel, Bernd Giese, Gerhard Müller-Newen, Jürgen Floege, Christian Kurts
Journal: Journal of the American Society of Nephrology (2004)

ABSTRACT. The kidney tubulointerstitium contains numerous bone marrow-derived antigen-presenting cells, which are often referred to as resident tissue macrophages, although several previous studies had demonstrated characteristics of dendritic cells (DC). In this study, we describe a subset of tubulointerstitial cells expressing the DC marker CD11c. A protocol was established to isolate these cells for in vitro analysis. Renal CD11c+ cells resembled splenic DC, but not peritoneal macrophages, in morphology, lysosomal content, phagocytic activity, microbicidal effector functions, expression of T cell costimulatory molecules, and ability to activate T cells. Nevertheless, many CD11c+ renal cells expressed low or intermediate levels of F4/80 and CD11b, indicating that both markers are not absolutely specific for macrophages in the kidney. Subpopulations of renal DC could be distinguished based on their expression of MHC class II and costimulatory molecules and may represent different maturation stages. In nephrotoxic glomerulonephritis, increased numbers of CD11c+ cells showing DC functionality were found in the tubulointerstitium. Focal accumulation was seen within tubulointerstitial mononuclear infiltrates and adjacent to, but not within, inflamed glomeruli. These results are the first to identify and characterize renal CD11c+ cells as DC and to demonstrate marked changes in experimental glomerulonephritis.
Eradication of acute promyelocytic leukemia-initiating cells through PML-RARA degradation
Authors: Rihab Nasr, Marie-Claude Guillemin, Omar Ferhi, Hassan Soilihi, Laurent Peres, Caroline Berthier, Philippe Rousselot, Macarena Robledo-Sarmiento, Valérie Lallemand-Breitenbach, Bernard Gourmel, Dominique Vitoux, Pier Paolo Pandolfi, Cécile Rochette-Egly, Jun Zhu, Hugues de Thé
Journal: Nature Medicine (2008)
Phase I Clinical Trial of Alitretinoin and Tamoxifen in Breast Cancer Patients: Toxicity, Pharmacokinetic, and Biomarker Evaluations
Authors: Julia A. Lawrence, Peter C. Adamson, Rafael Caruso, Catherine Chow, David Kleiner, Robert F. Murphy, David J. Venzon, Margaret Shovlin, Marianne Noone, Maria Merino, Kenneth H. Cowan, Muriel Kaiser, Joyce O’Shaughnessy, JoAnne Zujewski
Journal: Journal of Clinical Oncology (2001)

PURPOSE: To determine the overall and dose-limiting toxicities (DLTs) of alitretinoin (9-cis-retinoic acid) in combination with tamoxifen and the pharmacokinetics of alitretinoin alone and when combined with tamoxifen in patients with metastatic breast cancer. The effect of tamoxifen and alitretinoin on MIB-1, a marker of proliferation, in unaffected breast tissue was explored. PATIENTS AND METHODS: Eligible patients had metastatic breast cancer. Previous tamoxifen therapy was allowed. Planned dose levels for alitretinoin ranged from 50 to 140 mg/m 2 /d with 20 mg/d tamoxifen in all patients after 4 weeks of alitretinoin as a single agent. Plasma concentrations of alitretinoin and retinol were measured at baseline and after 1, 2, and 3 months. Breast core biopsies were obtained at baseline and after 2 months of therapy. RESULTS: Twelve patients with metastatic breast cancer received a total of 86 cycles of therapy. At 90 mg/m 2 /d, three of five patients experienced a DLT: grade 3 headache, grade 3 hypercalcemia, and grade 3 noncardiogenic pulmonary edema. At 70 mg/m 2 /d, one of six patients experienced a DLT (headache), and this level was considered the maximal tolerated dose in this study. Three toxicities occurred that had not been reported previously with alitretinoin: an asymptomatic delay in dark adaptation, a marked decrease in high-density lipoprotein cholesterol, and the occurrence of enthesopathy. Two of the nine assessable patients had a durable clinical response: one partial response and stable disease for 18 months and one complete response in continuous remission for 48+ months. Both responding patients were estrogen receptor–positive and had had previous tamoxifen therapy. There was a high degree of interpatient variability of plasma alitretinoin concentrations, although a significant decline in alitretinoin plasma levels over time was observed. MIB-1 scores declined in four of the eight paired breast specimens obtained. CONCLUSION: The combination of tamoxifen and alitretinoin is well tolerated and has antitumor activity in metastatic breast cancer. The recommended phase II dose is 70 mg/m 2 /d with 20 mg/d tamoxifen.
Non-CF bronchiectasis: does knowing the aetiology lead to changes in management?
Authors: A. M. Li, S. Sonnappa, C. Lex, E. Wong, A. Zacharasiewicz, A. Bush, A. Jaffe
Journal: European Respiratory Journal (2005)

The aim of the current study was to review the aetiology of non-cystic fibrosis (CF) bronchiectasis from two tertiary paediatric respiratory units in order to determine how often making a specific aetiological diagnosis leads to a change in management, and to assess the contribution of computed tomography (CT) in determining the underlying diagnosis. The case records of all patients who were diagnosed as having bronchiectasis by CT, currently being seen at the Royal Brompton Hospital and Great Ormond Street Hospital for Children (London, UK), were reviewed. All patients had undergone extensive investigations, and the underlying aetiology and the area of pulmonary involvement (as seen on CT) were recorded. A total of 136 patients were identified; there were 65 young males and the group median (range) age was 12.1 yrs (3.1–18.1). Immunodeficiency, aspiration and primary ciliary dyskinesia accounted for 67% of the cases. In 77 (56%) children, the identification of a cause led to a specific change in management. There was no association between aetiology and the distribution of CT abnormalities. In conclusion, immunodeficiency and other intrinsic abnormalities account for the majority of cases of non-cystic fibrosis bronchiectasis seen in the current authors' units. Computed tomography scans do not contribute towards identifying the aetiology and, most importantly, a specific aetiological diagnosis frequently leads to a change in management.
Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia
Authors: Oriol Sibila, Eric M. Mortensen, Antonio Anzueto, Elena Laserna, Marcos I. Restrepo
Journal: European Respiratory Journal (2013)

There is controversy regarding the impact of chronic obstructive pulmonary disease (COPD) in clinical outcomes in elderly patients with pneumonia. Comorbidities such as cardiovascular disease have been reported to play an important role in patients with acute exacerbations of COPD. However, limited data are available regarding the impact of cardiovascular disease in elderly COPD patients who require hospitalisation for pneumonia. We examined a cohort of subjects with pneumonia and pre-existing COPD. Prior cardiovascular disease was defined as history of myocardial infarction, congestive heart failure, cardiac arrhythmia, unstable angina or stroke. Outcomes examined included 30-day, 90-day, 6-month and 1-year mortality. We included 17 140 elderly COPD patients who were hospitalised for pneumonia. Prior cardiovascular disease was present in 10 240 (59.7%) patients. Prior cardiovascular disease was independently associated with 90-day mortality (21.3% versus 19.4%; hazard ratio (HR) 1.29, 95% CI 1.02–1.17), 6-month mortality (29.0% versus 26.1%; HR 1.28, 95% CI 1.07–1.50) and 12-month mortality (39.2% versus 34.5%; HR 1.33, 95% CI 1.15–1.54) when compared to no prior cardiovascular disease. The temporal differential effect between groups increases from 1.0% at 30 days to 4.7% at 1 year. Prior cardiovascular disease is associated with increased long-term mortality in elderly COPD patients with pneumonia. Differences in mortality rates increased over time.
Combined Natural Killer T-Cell–Based Immunotherapy Eradicates Established Tumors in Mice
Authors: Michele W.L. Teng, Jennifer A. Westwood, Phillip K. Darcy, Janelle Sharkey, Moriya Tsuji, Richard W. Franck, Steven A. Porcelli, Gurdyal S. Besra, Kazuyoshi Takeda, Hideo Yagita, Michael H. Kershaw, Mark J. Smyth
Journal: Cancer Research (2007)

Abstract A rational monoclonal antibody (mAb)-based antitumor therapy approach has previously been shown to eradicate various established experimental and carcinogen-induced tumors in a majority of mice. This therapy comprised an agonistic mAb reactive with tumor necrosis factor–related apoptosis-inducing ligand receptor (DR5), expressed by tumor cells, an agonistic anti-CD40 mAb to mature dendritic cells, and an agonistic anti-4-1BB mAb to costimulate CD8+ T cells. Because agonists of CD40 have been toxic in patients, we were interested in substituting anti-CD40 mAb with other dendritic cell–maturing agents, such as glycolipid ligands recognized by invariant natural killer T (iNKT) cells. Here, we show that CD1d-restricted glycolipid ligands for iNKT cells effectively substitute for anti-CD40 mAb and reject established experimental mouse breast and renal tumors when used in combination with anti-DR5 and anti-4-1BB mAbs (termed “NKTMab” therapy). NKTMab therapy–induced tumor rejection was dependent on CD4+ and CD8+ T cells, NKT cells, and the cytokine IFN-γ. NKTMab therapy containing either α-galactosylceramide (α-GC) or α-C-galactosylceramide (α-c-GC) at high concentrations induced similar rates of tumor rejection in mice; however, toxicity was observed at the highest doses of α-GC (&amp;gt;250 ng/injection), limiting the use of this glycolipid. By contrast, even very low doses of α-c-GC (25 ng/injection) retained considerable antitumor activity when used in combination with anti-DR5/anti-4-1BB, and thus, α-c-GC showed a considerably greater therapeutic index. In summary, sequential tumor cell apoptosis and amplification of dendritic cell function by NKT cell agonists represents an exciting and novel approach for cancer treatment. [Cancer Res 2007;67(15):7495–504]
Congenital plaque-like glomangioma associated with superficial hypertrichosis
Authors: Marina Rodríguez-Martín, Rosalba Sánchez, Miguel Sáez-Rodríguez, Marta García-Bustínduy, Miriam Sidro, Nuria Pérez, Sorahaya González, Hugo Álvarez, Antonio Noda
Journal: Journal of the American Academy of Dermatology (2008)
Randomised trial of nadolol alone or with isosorbide mononitrate for primary prophylaxis of variceal bleeding in cirrhosis
Authors: C Merkel, R Marin, E Enzo, C Donada, G Cavallarin, P Torboli, P Amodio, G Sebastianelli, D Sacerdoti, M Felder, C Mazzaro, P Beltrame, A Gatta
Journal: The Lancet (1996)
Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: a cluster randomised controlled trial
Authors: Betty R Kirkwood, Alexander Manu, Augustinus HA ten Asbroek, Seyi Soremekun, Benedict Weobong, Thomas Gyan, Samuel Danso, Seeba Amenga-Etego, Charlotte Tawiah-Agyemang, Seth Owusu-Agyei, Zelee Hill
Journal: The Lancet (2013)
Effect of Exercise and Coronary Artery Narrowing on Coronary Collateral Circulation
Authors: RICHARD W. ECKSTEIN
Journal: Circulation Research (1957)

The effect of chronic coronary arterial narrowing on the coronary collateral circulation has been studied in rested and exercised dogs. The data indicate that moderate and severe arterial narrowing results in extensive collateral development proportional to the degree of narrowing, further that exercise leads to even greater anastomoses. The results also show that while mild arterial narlowing fails to initiate collateral growth by itself, the addition of exercise promotes an effective collateral circulation. An attempt is made to define the gross factors in the development of collateral vessels and to correlate them with the concept that exercise may play a beneficial role in building collateral vessels in patients with coronary disease.
Dynamic dead space in face masks used with noninvasive ventilators: a lung model study
Authors: E Saatci, D M Miller, I M Stell, K C Lee, J Moxham
Journal: European Respiratory Journal (2004)

We present a case of endometrioid adenocarcinoma arising from extragonadal endometriosis 18 years after total abdominal hysterectomy with bilateral salpingo-oophorectomy. After the primary surgery the patient received 11 years of unopposed oestrogen hormone replacement therapy. She presented with symptoms of urinary retention and pelvic mass. Following resection, histopathology identified the mass as an endometrioid adenocarcinoma. The association between persistent endometriosis and the development of endometrial cancer are discussed here together with the risks of unopposed oestrogen in the development of such lesions.
Aztreonam for inhalation solution in patients with non-cystic fibrosis bronchiectasis (AIR-BX1 and AIR-BX2): two randomised double-blind, placebo-controlled phase 3 trials
Authors: Alan F Barker, Anne E O'Donnell, Patrick Flume, Philip J Thompson, Jonathan D Ruzi, Javier de Gracia, Wim G Boersma, Anthony De Soyza, Lixin Shao, Jenny Zhang, Laura Haas, Sandra A Lewis, Sheila Leitzinger, A Bruce Montgomery, Matthew T McKevitt, David Gossage, Alexandra L Quittner, Thomas G O'Riordan
Journal: The Lancet Respiratory Medicine (2014)
Thrombocytopenia represents a risk for deterioration of liver function after radiofrequency ablation in patients with hepatocellular carcinoma
Authors: Hyun Seok Lee, Soo Young Park, Sung Kook Kim, Young Oh Kweon, Won Young Tak, Chang Min Cho, Seong Woo Jeon, Min Kyu Jung, Hyun Gu Park, Dong Wook Lee, So Young Choi
Journal: Clinical and Molecular Hepatology (2012)

We evaluated changes in liver function parameters and risk factors for the deterioration of liver function 12 months after percutaneous radiofrequency ablation (RFA) therapy in patients with hepatocellular carcinoma (HCC).The subjects in this retrospective study comprised 102 patients with HCC who had undergone RFA therapy and exhibited no recurrence of HCC 12 months thereafter. Serial changes in serum total bilirubin and albumin, prothrombin time, and Child-Pugh score were evaluated before RFA and 3, 6, 9, and 12 months thereafter. Deterioration of liver function was defined when the Child-Pugh score increased by at least 2 at 12 months after RFA therapy. We determined the factors related to aggravation of liver function after RFA therapy.Liver function had deteriorated 12 months after RFA in 29 patients (28.4%). Serum albumin levels decreased significantly from before (3.7±0.1 g/dL, mean±SD) to 12 months after RFA therapy (3.3±0.1 g/dL, P=0.002). The Child-Pugh score increased significantly during the same time period (from 6.1±0.2 to 7.2±0.3, P<0.001). Pre-RFA thrombocytopenia (≤100,000/mm(3)) was revealed as a significant risk factor for the deterioration of liver function after RFA. However, no patients had episodes of bleeding as a complication of RFA.Among the liver-function parameters, serum albumin level was markedly decreased in HCC patients over the course of 24 months after RFA therapy. A pre-RFA thrombocytopenia represents a major risk factor for the deterioration of liver function.
First Evidence of Genetic Association Between <i>AKT2</i> and Polycystic Ovary Syndrome
Authors: Mark O. Goodarzi, Michelle R. Jones, Yii-Der I. Chen, Ricardo Azziz
Journal: Diabetes Care (2008)

Insulin resistance has been reported in up to 70% of women with polycystic ovary syndrome (PCOS). Physiologic and genetic data currently implicate post-insulin receptor signaling defects in substrates such as glycogen synthase kinase 3beta (GSK3beta). The AKT2 gene was chosen as a candidate for PCOS because its product affects glucose metabolism and mitogenic signaling, interacts with GSK3beta, and mediates cell survival in the ovary.Subjects were recruited from the reproductive endocrinology clinic at the University of Alabama at Birmingham, and control subjects were recruited from the surrounding community; 287 white women with PCOS and 187 white control subjects were genotyped for four single nucleotide polymorphisms (SNPs) in AKT2. Genotyping took place at Cedars-Sinai Medical Center in Los Angeles. SNPs and haplotypes were tested for association with PCOS risk and phenotypic markers of PCOS.Minor allele carriers of SNPs rs3730051 and rs8100018 had increased odds of PCOS (odds ratio [OR] 2.2, P = 0.004, and 2.4, P = 0.001, respectively). The haplotype T-G-C-T was significantly associated with PCOS (OR 2.0, P = 0.01). Carriers of the risk haplotypes for both AKT2 and GSK3B had a further increased odds of PCOS (OR 3.1, P = 0.005).These data suggest that polymorphisms in two components of the insulin signaling pathway, AKT2 and GSK3B, are associated with PCOS. The presence of multiple lesions in a single pathway may confer increased risk.
Hypothyroidism in the Elderly*
Authors: GIUSEPPE ROBUSCHI, MARJORIE SAFRAN, LEWIS E. BRAVERMAN, ANGELO GNUDI, ELIO ROTI
Journal: Endocrine Reviews (1987)

IN THE PAST, decreased thyroid function was believed to accompany the aging process. This was based primarily upon anatomical observations and by studies which evaluated thyroid function by means of function tests. In this review we will present an overview of the information concerning thyroid function in the elderly. Divergent results on thyroid gland volume have been reported. Some studies indicate that, with advancing age, the human thyroid decreases in volume (1). In contrast, others have reported that the thyroid gland increases in weight with age, reaching an average of 35–40 g in subjects aged 70 yr (2). There is a marked increase in microscopic and clinically palpable nodules with age (1). The prevalence of thyroid nodularity has been reported to vary between 25% (3) to as high as 90% in women over the age of 70 yr and 60% in men over the age of 80 yr (4). With advancing age there is progressive fibrosis with scattered lymphocytes and rare plasma cells in the stroma (1, 3). These anatomical changes per se may not be particularly relevant since elderly subjects generally have adequate thyroid hormone production. In fact, in one study it was observed that the weight and histology of the gland did not correlate with thyroid function as evaluated by the free (F) T4 index (I) (3).