tbuckley/cabot-search huggingface dataset:
Major-Histocompatibility-Complex Class I Alleles and Antigens in Hematopoietic-Cell Transplantation
Authors: Effie W. Petersdorf, John A. Hansen, Paul J. Martin, Ann Woolfrey, Mari Malkki, Theodore Gooley, Barry Storer, Eric Mickelson, Anajane Smith, Claudio Anasetti
Journal: New England Journal of Medicine (2001)

Successful engraftment of hematopoietic stem cells from unrelated donors is influenced by disparities between the donor and recipient for HLA-A, B, and C alleles. Disparities between HLA sequence polymorphisms that are serologically detectable are termed antigen mismatches, whereas those that can be identified only by DNA-based typing methods are termed allele mismatches. Whether both kinds of polymorphisms are important in transplantation is not known. We tested the hypothesis that allele mismatches that are detectable only at the DNA level are less immunogenic than those that are serologically detectable and thereby are associated with a lower risk of graft failure after hematopoietic-cell transplantationWe used DNA sequencing to define the HLA-A, B, and C alleles in 471 patients who received bone marrow from unrelated donors for the treatment of chronic myeloid leukemia after myeloablative conditioning therapy. The odds ratios for graft failure were determined for recipients of transplants from donors with a single class I allele mismatch, a single class I antigen mismatch, or two or more class I mismatches, as compared with those with no mismatchA single HLA allele mismatch did not increase the risk of graft failure, whereas a single antigen mismatch significantly increased the risk. The risk was also increased if the recipient was HLA homozygous at the mismatched class I locus or if the donor had two or more class I mismatchesHLA class I antigen mismatches that are serologically detectable confer an enhanced risk of graft failure after hematopoietic-cell transplantation. Transplants from donors with a single class I allele mismatch that is not serologically detectable may be used without an increased risk of graft failure.
Medical Specialty and the Incidence of Divorce
Authors: Bruce L. Rollman, Lucy A. Mead, Nae Yuh Wang, Michael J. Klag
Journal: New England Journal of Medicine (1997)

The demands inherent in certain practice specialties are popularly believed to contribute to the risk of divorce among physicians.1,2 Several demographic and personal factors thought to affect the risk of divorce may also influence medical students' choice of specialty and therefore confound the relation between medical specialty and divorce.3,4 To characterize the risk of divorce associated with medical specialty, we examined data from the Johns Hopkins Precursors Study. We found that the cumulative incidence of divorce among 1118 married physicians was 29 percent after 30 years of marriage and that the choice of specialty was independently associated with . . .
Pathogenesis and Treatment of HIV-Associated Renal Diseases: Lessons from Clinical and Animal Studies, Molecular Pathologic Correlations, and Genetic Investigations
Authors: Paul L. Kimmel, Laura Barisoni, Jeffrey B. Kopp
Journal: Annals of Internal Medicine (2003)

HIV infection is associated with several renal syndromes, including acute renal failure. Chronic renal failure directly linked to HIV infection includes thrombotic microangiopathic renal diseases, immune-mediated glomerulonephritides, and HIV-associated nephropathy. A renal biopsy may be necessary for diagnosis. The development of HIV-associated nephropathy has been definitively linked to renal cellular infection, but the disease affects only a minority of patients, typically men of African descent. Therefore, factors determining disease expression in infected patients must now be emphasized. The pathogenic mechanisms involved in HIV-associated renal disease remain obscure. Genetic factors, as well as renal cellular responses, mediated by HIV proteins (including an immune-activated microenvironment) capable of presenting antigen in susceptible hosts probably explain most cases. HIV-associated nephropathy has a characteristic pathologic phenotype, including glomerular, tubular, and interstitial changes, and ultrastructural findings. Infection of the glomerular epithelial cell, or podocyte, and consequent structural and biochemical changes may be pivotal in pathogenesis. The HIV-1 transgenic mouse is an important model for understanding disease pathogenesis, particularly the role of HIV proteins in mediating renal tissue injury. Rigorously controlled randomized trials have not evaluated treatment, but corticosteroids and angiotensin-converting enzyme inhibitors have been used. Highly active antiretroviral therapy seems to have decreased the incidence of end-stage renal disease related to HIV infection and, in case reports, to have improved renal functional and pathologic outcomes of HIV-associated nephropathy. Outcomes in patients undergoing hemodialysis and peritoneal dialysis have improved, and current research focuses on renal transplantation for treatment of HIV-infected patients.
Demonstration of a Role of Physical Factors as Determinants of the Natriuretic Response to Volume Expansion*
Authors: Joseph A. Martino, Laurence E. Earley
Journal: Journal of Clinical Investigation (1967)

The importance of plasma protein concentration, renal vascular resistance, and arterial pressure as mediators of the natriuretic response to volume expansion was investigated in anesthetized dogs. Saline loading depressed plasma protein concentration and increased arterial pressure but did not decrease renal vascular resistance. Restoring plasma protein concentration by infusing hyperoncotic albumin increased sodium reabsorption and decreased sodium excretion during saline loading despite simultaneous decreases in renal vascular resistance and increases in arterial pressure. Infusion of "plasma" did not depress plasma protein concentration and produced natriuresis associated with increased arterial pressure and marked decreases in renal vascular resistance. Unilateral hemodynamic natriuresis was produced before "plasma" loading by the renal arterial infusion of acetylcholine, and the subsequent infusion of "plasma" resulted in much smaller increases in sodium excretion by the vasodilated kidney than by the control kidney. If perfusion pressure to both kidneys was then reduced by aortic constriction sodium excretion by the vasodilated kidney could be reduced to preloading (vasodilated) levels without reduced glomerular filtration, despite continued natriuresis in control kidneys which underwent vasodilatation in response to the infusion of plasma. Infusion of equilibrated whole blood did not alter plasma protein concentration or the hematocrit, and renal vascular resistance did not decrease. Sodium excretion was increased minimally or not at all by the infusion of blood despite increased arterial pressure and glomerular filtration. However, in kidneys vasodilated before infusing blood sodium excretion increased in response to the infusion in association with increased arterial pressure. This increased excretion of sodium by vasodilated kidneys during infusion of blood could be abolished by reducing perfusion pressure to the preloading level. These observations indicate that changes in plasma oncotic pressure, renal vascular resistance, and arterial pressure either alone or in combination are important variables determining the natriuretic response to volume expansion, and that the relative importance of each of these factors depends on the manner in which volume is expanded (viz., the infusion of saline, plasma, or blood).
Building a Healthier Britain
Authors: Christiane Rehwagen
Journal: BMJ (2005)

BBC Radio 4, 1 November at 9 pm www.bbc.co.uk/radio4/science/buildingahealthierbritain.shtml Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img> Why is type 2 diabetes becoming increasingly common in the United Kingdom? This documentary, the first in a new series of Building a Healthier Britain (the first series was broadcast in May), examined several major population studies that have attempted to answer this question. Using the so called Barker hypothesis as a basis, presenter and former BBC health correspondent Richard Hannaford took listeners on a whistlestop tour of recent epidemiology, guiding them through research into whether there was any association between low … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
No Diphtheria at Brocton.
Authors: H. C. Kerrick
Journal: JAMA (1894)

Brocton, Ill., Dec. 11, 1894. <h3>To the Editor:</h3> —As to the prevalence of diphtheria at Brocton and Five Points, Ill., will say there is not a case at this time that I know of at either place, and I have had charge of most of the cases. Our school at Brocton was closed for three weeks, but has been opened for two weeks since. There were two deaths from diphtheria here, or one physician called it such and the other asserted it was not. I I never saw either of these cases. General health good in this location. Respectfully yours,
Targeting sortilin in immune cells reduces proinflammatory cytokines and atherosclerosis
Authors: Martin B. Mortensen, Mads Kjolby, Stine Gunnersen, Jakob V. Larsen, Johan Palmfeldt, Erling Falk, Anders Nykjaer, Jacob F. Bentzon
Journal: Journal of Clinical Investigation (2014)

Genome-wide association studies have identified a link between genetic variation at the human chromosomal locus 1p13.3 and coronary artery disease. The gene encoding sortilin (SORT1) has been implicated as the causative gene within the locus, as sortilin regulates hepatic lipoprotein metabolism. Here we demonstrated that sortilin also directly affects atherogenesis, independent of its regulatory role in lipoprotein metabolism. In a mouse model of atherosclerosis, deletion of Sort1 did not alter plasma cholesterol levels, but reduced the development of both early and late atherosclerotic lesions. We determined that sortilin is a high-affinity receptor for the proinflammatory cytokines IL-6 and IFN-γ. Moreover, macrophages and Th1 cells (both of which mediate atherosclerotic plaque formation) lacking sortilin had reduced secretion of IL-6 and IFN-γ, but not of other measured cytokines. Transfer of sortilin-deficient BM into irradiated atherosclerotic mice reduced atherosclerosis and systemic markers of inflammation. Together, these data demonstrate that sortilin influences cytokine secretion and that targeting sortilin in immune cells attenuates inflammation and reduces atherosclerosis.
Tissue expansion: 'future of plastic surgery for next 20 years'
Authors: Michael Cherskov
Journal: JAMA (1982)

New tissue stretching devices may enhance the ability of plastic surgeons to treat  defects caused by trauma, cancer, or congenital events.  A two-step surgical technique, outlined by Eric D. Austad, MD, at a recent seminar in Chicago, utilizes expandable silicone shells or bags that are implanted subcutaneously to produce excess tissue around a site of injury. The shells are filled with sodium chloride so that inflation occurs via osmosis at a rate of 5 to 10 cc per day. After a six- to 12-week stretching period, the balloons are removed and the stretched  used in a primary closure.  The procedure minimizes the problems inherent in grafting and muscle flap techniques, namely,  color mismatch and trauma at the grafting site. By use of tissue expansion devices, natural physiological  stretching mechanisms, like those that occur during weight gain or pregnancy, are mimicked.  In such natural processes, skin or
Cor Triatriatum as a Problem of Adult Heart Disease
Authors: LOCKHART B. MCGUIRE, THOMAS B. NOLAN, RICHARD REEVE, J. FRANCIS DAMMANN
Journal: Circulation (1965)

The occurrence of severe pulmonary venous obstruction due to the congenital anomaly known as cor triatriatum in a 19-year-old furniture mover is described. Relentless and massive hemoptysis led to pulmonary edema, and an attempt at surgical correction under unfavorable conditions was not successful. Seven other cases of cor triatriatum in adults are reviewed. The hemodynamic abnormalities closely resemble mitral stenosis, except that pressures in the true left atrium were normal in the presence of elevated pulmonary capillary pressures. The availability of flow across the obstructing membrane during systole as well as diastole is probably the major element in the surprisingly good tolerance of severe degrees of anatomic obstruction for long periods of time. Slow increase in the degree of obstruction could also be a factor. The clinical picture in these patients very closely resembles mitral stenosis. Hemoptysis appeared to be more frequent in cor triatriatum. Features suggestive of the correct diagnosis would include the absence of an opening snap, the absence of a typical murmur of mitral stenosis, regular rhythm, and lesser evidence of left atrial enlargement in the presence of obvious pulmonary hypertension. Five of these patients have undergone successful correction of their disease by operation. Representative films from the first known angiograms in this condition in an adult are reproduced and discussed.
The Heparin-Like Action of Treburon in Abolishing Alimentary Lipemia in Normal Individuals
Authors: ROBERT F. ACKERMAN, D. B. ZILVERSMIT
Journal: Circulation (1953)

The effectiveness of Treburon in clearing alimentary lipemia in young adults has been studied. It is shown that the optical density of plasma at 650 mµ is a satisfactory measure of "physical" lipemia. A significant difference was noted in the extent of alimentary lipemia of young malesand females.
Alcohol Consumption and Risk for Coronary Heart Disease among Men with Hypertension
Authors: Joline W.J. Beulens, Eric B. Rimm, Alberto Ascherio, Donna Spiegelman, Henk F.J. Hendriks, Kenneth J. Mukamal
Journal: Annals of Internal Medicine (2007)

Background: Heavy alcohol consumption increases risk for hypertension, which is in itself a strong risk factor for cardiovascular disease (CVD). However, data on the association between alcohol consumption and CVD among individuals with hypertension are scarce. Objective: To assess whether alcohol consumption is inversely associated with CVD among men with hypertension. Design: Prospective cohort study. Setting: United States. Participants: 11 711 men with hypertension from the Health Professionals Follow-Up Study. Measurements: Alcohol consumption was assessed every 4 years by using a food-frequency questionnaire. Incident cases of nonfatal myocardial infarction (MI), fatal coronary heart disease, and stroke were documented from 1986 to 2002. Results: During follow-up, 653 patients with MI were documented. Compared with patients abstaining from alcohol, the hazard ratio for participants with MI consuming 0.1 to 4.9 grams of alcohol per day was 1.09 (95% CI, 0.86 to 1.37); consuming 5 to 9.9 grams of alcohol per day was 0.81 (CI, 0.60 to 1.08 g/d); consuming 10 to 14.9 grams of alcohol per day was 0.68 (CI, 0.51 to 0.91 g/d); consuming 15 to 29.9 grams of alcohol per day was 0.72 (CI, 0.54 to 0.97 g/d); consuming 30 to 49.9 grams of alcohol per day was 0.67 (CI, 0.48 to 0.94 g/d); and consuming 50 or more grams of alcohol per day was 0.41 (CI, 0.22 to 0.77 g/d) (P < 0.001 for trend). Associations were similar for fatal and nonfatal MI. Alcohol consumption was not associated with total death or death due to CVD. Risks for total and ischemic stroke for patients consuming 10 to 29.9 g of alcohol per day were 1.40 (CI, 0.93 to 2.12) and 1.55 (CI, 0.90 to 2.68) compared with that of abstainers. When corrected for measurement error in alcohol consumption, dietary variables, and body mass index, the hazard ratio for participants with MI per 12.5 grams per day increment of alcohol intake was 0.68 (CI, 0.46 to 1.00). Limitations: Hypertension, alcohol consumption, and CVD risk factors were assessed by self-report. Available data used to correct for measurement error were primarily restricted to dietary variables. Conclusions: In this population of men with hypertension, moderate alcohol consumption was associated with a decreased risk for MI but not with risks for total death or death due to CVD. As in the general population, men with hypertension who drink moderately and safely may not need to change their drinking habits.
Factors Associated With Mortality and Reoperation in 377 Children With Total Anomalous Pulmonary Venous Connection
Authors: Tara Karamlou, Rebecca Gurofsky, Eisar Al Sukhni, John G. Coles, William G. Williams, Christopher A. Caldarone, Glen S. Van Arsdell, Brian W. McCrindle
Journal: Circulation (2007)

We sought to determine era-specific changes in the incidence of mortality and reoperation in children with total anomalous pulmonary venous connection.We reviewed the records of 377 children presenting from 1946 to 2005 with total anomalous pulmonary venous connection. Multivariable parametric regression models determined the incidence and risk factors for death and reoperation after repair. Pulmonary venous connection was supracardiac in 44%, infracardiac in 26%, cardiac in 21%, and mixed in 9%. Pulmonary venous obstruction was present in 48% at presentation, most frequently with infracardiac connection type (P<0.001). In total, 327 patients were repaired (median age, 1.7 months). Overall survival from repair was 65+/-6% at 14 years, with a current survival of 97%. Significant (P<0.01) incremental risk factors for postrepair death were cardiac connection type, earlier operation year, younger age at repair, use of epinephrine postoperatively, and postoperative pulmonary venous obstruction. More recent operation year was associated with younger age at repair (P<0.001), decreased use of deep hypothermic circulatory arrest (P<0.001), and use of specific drugs postoperatively (P<0.001). Risk-adjusted estimated 1-year survival for a patient repaired at birth with unfavorable morphology in 2005 is 37% (95% CI, 8 to 80) compared with 96% (95% CI, 91 to 99) for a patient with favorable morphology repaired at 1 year of age. Freedom from reoperation was 82+/-6% at 11 years after repair, with increased risk associated with mixed connection type (P=0.04) and postoperative pulmonary venous obstruction (P<0.001).Mortality after total anomalous pulmonary venous connection repair has decreased but remains highest in young patients and in those with cardiac connection type or pulmonary venous obstruction. Unfavorable anatomic characteristics remain important determinants of postrepair survival despite improved perioperative care.
FRI0095 Similar clinical outcomes in rheumatoid arthritis with more vs. Less expensive treatment strategies. Results from two rheumatology clinics with standard monitoring of all patients:
Authors: T. Sokka, G. Haugeberg, J. Asikainen, I.J. Widding Hansen, A. Kokko, T. Rannio, D.M. Soldal, P. Hannonen
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> According to a common consensus, remission/low disease activity is the treatment target in RA. Recommendations to reach the target are surprisingly different: ACR recommendations include a combination of conventional DMARDs for RA but EULAR recommendations strictly suggest a conventional monotherapy and addition of a biologic agent if needed. In many countries, it is not possible to adhere to EULAR recommendations due to high expenses of biologic agents to patients and society. <h3>Objectives</h3> To study whether treatment target was reached, which medications were used and how much medications cost, in patients with RA in two Nordic rheumatology clinics in 2010. <h3>Methods</h3> <i>Design:</i> Cross sectional observational clinical data of all patients with RA seen in 2010. <i>Setting:</i> Two Nordic county hospital rheumatology units: Kristiansand, Norway (NOR), and Jyväskylä, Finland (FIN), which both serve a population of about 275,000. Treatment philosophy is to reach remission in both clinics. <i>Patients:</i> All consecutive 1140 patients with RA in NOR and 1240 in FIN. <i>Measures:</i> All data were collected as an infrastructure of the clinic using an identical monitoring system to facilitate clinical decision making. Measures included patient demographic measures, clinical characteristics, disease activity, functional status, and treatments. Annual costs of medications to the society were calculated per 100 patients, using an assumption that a patient is taking current medications for one year. <h3>Results</h3> Patient populations from NOR and FIN were similar according to age (61 vs. 60), gender (69% vs. 71%F), disease duration (10 vs. 11 years), and prevalence of rheumatoid factor and anti-citrullinated antibodies (Table). Disease activity was low and patients' functional status well reserved in both clinics. Almost twice as many patients in NOR than in FIN (33% vs 17%) used biologic agents. A combination of conventional anti-rheumatic drugs was currently used by &lt;1% of patients in NOR and by 37% of patients in FIN. Estimated annual costs of medications per 100 patients were 508,000€ in NOR and 280,000€ in FIN. <h3>Conclusions</h3> Treatment target of remission/low disease activity and good functional status were seen in patients with RA using expensive and less-expensive anti-rheumatic drugs. This observation may be encouraging to rheumatologists in countries where expensive medications cannot be used. <h3>Disclosure of Interest</h3> None Declared
Postoperative pneumonia in elderly patients receiving acid suppressants: a retrospective cohort analysis
Authors: D. A. Redelmeier, F. A. McAlister, C. E. Kandel, H. Lu, N. Daneman
Journal: BMJ (2010)

<b>Objective</b> To test whether gastric acid suppressants are associated with an increased risk of postoperative pneumonia in patients undergoing elective surgery. <b>Design</b> Population-wide retrospective cohort analysis. <b>Setting</b> Canadian acute care hospitals between 1 April 1992 and 31 March 2008. <b>Patients</b> Consecutive patients aged &gt;65 years admitted for an elective operation. <b>Outcome measure</b> Postoperative pneumonia recorded in inpatient postoperative notes. <b>Results</b> A total of 593 265 patients were included, of whom about 21% were taking an acid suppressant (most commonly omeprazole or ranitidine). Overall, 6389 patients developed postoperative pneumonia, with a rate significantly higher for those taking acid suppressants (13 per 1000) than controls (10 per 1000), equivalent to a 30% increase in frequency (odds ratio 1.30 (95% confidence interval 1.23 to 1.38), P&lt;0.001). However, no increase in risk was observed after adjustment for duration of surgery, site of surgery, and other confounders (odds ratio 1.02 (0.96 to 1.09), P=0.48). The general safety of acid suppressants extended to those patients prescribed proton pump inhibitors, experiencing long term treatment, receiving high doses, and undergoing high risk procedures. <b>Conclusion</b> After adjustment for patient and surgical characteristics, acid suppressants are not associated with an increased risk of postoperative pneumonia among elderly patients admitted for elective surgery.