tbuckley/cabot-search huggingface dataset:
Predicting Ejection Fraction after Myocardial Infarction
Authors: Michael J. Zema
Journal: Annals of Internal Medicine (1995)

Letters1 May 1995Predicting Ejection Fraction after Myocardial InfarctionMichael J. ZemaMichael J. ZemaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-9-199505010-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Silver and colleagues [1] describe an algorithm that uses factors derived from patient history and electrocardiographic data and that attempts to reliably identify patients with a resting LVEF of 40% or greater soon after myocardial infarction. This patient group is known to have a better prognosis, to require less initial drug therapy, and to need less specialized testing. Silver and colleagues' “prediction rule” consists of four sequential questions, all of which—if answered negatively—assure a global LVEF of 40% or greater with a predictive accuracy of 99%. Unfortunately, however, 47 of 116 patients (41%) in their “validation set” ...References1. Silver MT, Rose GA, Paul SD, O'Donnell CJ, O'Gara PT, Eagle KA. A clinical rule to predict left ventricular ejection fraction in patients after myocardial infarction. Ann Intern Med. 1994; 121:750-6. Google Scholar2. Zema MJ, Caccavano M, Kligfield P. Detection of left ventricular dysfunction in ambulatory subjects with the bedside Valsalva maneuver. Am J Med. 1983; 75:241-8. Google Scholar3. Zema MJ, Masters AP, Margouleff D. Dyspnea: the heart or the lungs? Differentiation at bedside by use of the simple Valsalva maneuver. Chest. 1984; 85:59-64. Google Scholar4. Zema MJ. Prognosis after myocardial infarction—prediction in ambulatory patients by use of the bedside Valsalva maneuver. Angiology. 1985; 36:96-104. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1995Volume 122, Issue 9Page: 729-730KeywordsAlgorithmsBlood pressureDrug therapyEjection fractionElectrocardiographyHospitalizationsLeft ventricular ejection fractionMyocardial infarctionStenosisSystolic pressure Issue Published: 1 May 1995 CopyrightCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Institute of Medicine Panel Suggests Changes to Revitalize National Institutes of Health
Authors: Charles Marwick
Journal: JAMA (1989)

IF THE INTRAMURAL research program at the National Institutes of Health (NIH), Bethesda, Md, is to continue to attract high-quality scientists and retain leadership in biomedical research, changes need to be made. This is the message delivered by an Institute of Medicine (Washington, DC) committee that was asked to look into the program. The committee, chaired by Harold T. Shapiro, PhD, president of Princeton (NJ) University, urged both Congress and the administration to act. <h3>The Next Step</h3> Having pronounced the dire warnings, the next step is to get at least some of the recommendations implemented. "We're having a dialogue with the staff at the Office of Management and Budget," says the Institute of Medicine's president, Samuel Thier, MD. With a current budget of $700 million, only 11% of the total NIH budget, the intramural program is small by Washington standards. But its facilities include the clinical center where researchers and
Protein-Energy Undernutrition Among Elderly Hospitalized Patients
Authors: D H Sullivan, S Sun, R C Walls
Journal: JAMA (1999)

Numerous studies have identified strong correlations between the severity of nutritional deficits and an increased risk of subsequent morbid events among the hospitalized elderly, but whether inadequate nutrient intake during hospitalization contributes to such nutritional deficits or the risk of adverse outcomes is not known.To identify the distribution of average daily nutrient intake among the nonterminally ill hospitalized elderly, ascertain what factors contribute to persistently low intakes, and determine whether the adequacy of nutrient intake correlates with the risk of mortality.Prospective cohort study conducted from 1994 to 1997.University-affiliated Department of Veterans Affairs hospital.A total of 497 patients 65 years or older (mean [SD] age, 74 [6] years; 97% male; 86% white) with a length of stay of 4 days or more.Daily in-hospital nutrient intake, in-hospital mortality, and 90-day mortality.A total of 102 patients (21%) had an average daily in-hospital nutrient intake of less than 50% of their calculated maintenance energy requirements. Admission illness severity, average length of stay, and admission albumin and prealbumin levels for this low nutrient group did not differ significantly from those of the remaining patients. However, the low nutrient group had lower mean (SD) discharge serum total cholesterol (154 [44] mg/dL [4 [1.1] mmol/L] vs 173 [42] mg/dL [4.5 [1.1] mmol/L]; P=.001), albumin (29.1 [6.7] vs 33.2 [6.1] g/L, P=.001), and prealbumin (162 [69] vs 205 [68] mg/L; P=.001) concentrations and a higher rate of in-hospital mortality (relative risk, 8.0; 95% confidence interval, 2.8-22.6) and 90-day mortality (relative risk, 2.9; 95% confidence interval, 1.4-6.1). Contributing to the problem of inadequate nutrient intake, patients were frequently ordered to have nothing by mouth and were not fed by another route. Neither canned supplements nor nutritional support were used effectively.Throughout their hospitalization, many elderly patients were maintained on nutrient intakes far less than their estimated maintenance energy requirements, which may contribute to an increased risk of mortality. Given the difficulties reversing established nutritional deficits in the elderly, greater efforts should be made to prevent the development of such deficits during hospitalization.
Bone and joint tuberculosis.
Authors: R Lunt
Journal: BMJ (1979)

During my early orthopaedic training, between 1936 and 1939, I failed to appreciate the full horror of bone and joint tuberculosis, with its protracted treatment and crippling results ; I encountered several cases during the war, but it was not until I became superintendent of the Derby County Tuberculosis and Ortho paedic Service in 1947 that this was borne in on me. The Orthopaedic Hospital at Bretby was almost entirely devoted to these disorders, and few interesting orthopaedic cases such as congenital dislocation of the hip, clubfoot and so forth were there to leaven the lump at that time.
Cooperative retrospective study of 144 cases of pneumonia caused by filamentous fungi in haematologic malignancies
Authors: M. Montillo, E. Manso, A. Cenacchi, P. Ricci, A. Bonini, A. Tonso, A. Nosari, L. Pagano, L. Cudillo, L. Melillo, P. Leoni, A. Del Favero, None GIMEMA Infection Program, Italy
Journal: Journal of Infection (1994)
Cardiomyocyte-Specific Transforming Growth Factor β Suppression Blocks Neutrophil Infiltration, Augments Multiple Cytoprotective Cascades, and Reduces Early Mortality After Myocardial Infarction
Authors: Peter P. Rainer, Scarlett Hao, Davy Vanhoutte, Dong Ik Lee, Norimichi Koitabashi, Jeffery D. Molkentin, David A. Kass
Journal: Circulation Research (2014)

Rationale: Wound healing after myocardial infarction involves a highly regulated inflammatory response that is initiated by the appearance of neutrophils to clear out dead cells and matrix debris. Neutrophil infiltration is controlled by multiple secreted factors, including the master regulator transforming growth factor β (TGFβ). Broad inhibition of TGFβ early postinfarction has worsened post–myocardial infarction remodeling; however, this signaling displays potent cell specificity, and targeted suppression particularly in the myocyte could be beneficial. Objective: Our aims were to test the hypothesis that targeted suppression of myocyte TGFβ signaling ameliorates postinfarct remodeling and inflammatory modulation and to identify mechanisms by which this may be achieved. Methods and Results: Mice with TGFβ receptor–coupled signaling genetically suppressed only in cardiac myocytes (conditional TGFβ receptor 1 or 2 knockout) displayed marked declines in neutrophil recruitment and accompanying metalloproteinase 9 activation after infarction and were protected against early-onset mortality due to wall rupture. This is a cell-specific effect, because broader inhibition of TGFβ signaling led to 100% early mortality due to rupture. Rather than by altering fibrosis or reducing the generation of proinflammatory cytokines/chemokines, myocyte-selective TGFβ inhibition augmented the synthesis of a constellation of highly protective cardiokines. These included thrombospondin 4 with associated endoplasmic reticulum stress responses, interleukin-33, follistatin-like 1, and growth and differentiation factor 15, which is an inhibitor of neutrophil integrin activation and tissue migration. Conclusions: These data reveal a novel role of myocyte TGFβ signaling as a potent regulator of protective cardiokine and neutrophil-mediated infarct remodeling.
Time Trends in Autism and in MMR Immunization Coverage in California
Authors: Loring Dales
Journal: JAMA (2001)

Considerable concern has been generated in the lay and medical communities by a theory that increased measles-mumps-rubella (MMR) immunization among young children may be the cause of an apparent marked increase in autism occurrence.To determine if a correlation exists in secular trends of MMR immunization coverage among young children and autism occurrence.Retrospective analyses of MMR immunization coverage rates among children born in 1980-1994 who were enrolled in California kindergartens (survey samples of 600-1900 children each year) and whose school immunization records were reviewed to retrospectively determine the age at which they first received MMR immunization; and of autism caseloads among children born in these years who were diagnosed with autism and were enrolled in the California Department of Developmental Services regional service center system.Measles-mumps-rubella immunization coverage rates as of ages 17 months and 24 months and numbers of Department of Developmental Services system enrollees diagnosed with autism, grouped by year of birth.Essentially no correlation was observed between the secular trend of early childhood MMR immunization rates in California and the secular trend in numbers of children with autism enrolled in California's regional service center system. For the 1980-1994 birth cohorts, a marked, sustained increase in autism case numbers was noted, from 44 cases per 100 000 live births in the 1980 cohort to 208 cases per 100 000 live births in the 1994 cohort (a 373% relative increase), but changes in early childhood MMR immunization coverage over the same time period were much smaller and of shorter duration. Immunization coverage by the age of 24 months increased from 72% to 82%, a relative increase of only 14%, over the same time period.These data do not suggest an association between MMR immunization among young children and an increase in autism occurrence.
An important debate on the GMC
Authors: Kamran Abbasi
Journal: BMJ (2004)

The General Medical Council—the regulatory authority for UK doctors—begins this year in crisis. Dame Janet Smith's inquiry into failures of regulation that allowed Harold Shipman to murder over 200 patients delivered bad tidings to the GMC in the last days of 2004 (see p 10). Richard Smith, close observer of the GMC during his career on this journal, argues that the GMC's failing is that it has put expediency before principle, and that further difficult reforms are essential (see p 1).

Readers may have been under the impression that the GMC was already in the …
The Treatment of Streptococcal Pharyngitis-Reply
Authors: James W. Bass
Journal: JAMA (1987)

<h3>In Reply.—</h3> I welcome the opportunity to respond to the comments of Drs Odio and Eaton. Dr Odio's primary concern appears to be my failure to address the problem of differentiating individuals who have streptococcal pharyngitis from those who are chronic streptococcal carriers. These and other issues mentioned in his letter are important problems, but it was not my intention to cover all aspects of and issues relevant to streptococcal pharyngitis. As implied in the title and stated in the beginning of the review, my intention was to "focus on the landmark studies and developments that have been major contributions in helping us arrive at what we now believe is the optimal antimicrobial treatment of this disease." Dr Odio points out that the three recently published studies I referenced—which now confirm that early treatment of streptococcal pharyngitis can reduce the duration of symptoms to less than 24 hours in most
Prosecution of parents over baby's death raises controversy over diagnosing child abuse
Authors: C. Dyer
Journal: BMJ (2012)

<h3>ABSTRACT</h3> A subset of genes in plant genomes are labeled with DNA methylation specifically at CG residues. These genes, known as gene-body methylated (gbM), have a number of associated characteristics. They tend to have longer sequences, to be enriched for intermediate expression levels, and to be associated with slower rates of molecular evolution. Most importantly, gbM genes tend to maintain their level of DNA methylation between species, suggesting that this trait is under evolutionary constraint. Given the degree of conservation in gbM, we still know surprisingly little about its function in plant genomes or whether gbM is itself a target of selection. To address these questions, we surveyed DNA methylation across eight grass (Poaceae) species that span a gradient of genome sizes. We first established that genome size correlates with genome-wide DNA methylation levels, but less so for genic levels. We then leveraged genomic data to identify a set of 2,982 putative orthologs among the eight species and examined shifts of methylation status for each ortholog in a phylogenetic context. A total of 55% of orthologs exhibited a shift in gbM, but these shifts occurred predominantly on terminal branches, indicating that shifts in gbM are rarely conveyed over time. Finally, we found that the degree of conservation of gbM across species is associated with increased gene length, reduced rates of molecular evolution, and increased gene expression level, but reduced gene expression variation across species. Overall, these observations suggest a basis for evolutionary pressure to maintain gbM status over evolutionary time.
NK cell density in malignant skin tumours—a stereological study
Authors: J. SMOLLE, H-P. SOYER, R. EHALL, H. STETTNER, H. KERL
Journal: British Journal of Dermatology (1987)

We determined the density of natural killer (NK) cells in frozen sections of malignant melanoma (nine cases), squamous cell carcinoma (six cases) and non-neoplastic tonsil (five cases) by immunohistological and stereological methods. The mean density of NK cells in malignant melanoma (5.0 +/- 1.5 X 10(3)/mm3) and in squamous cell carcinoma (5.1 +/- 2.7 X 10(3)/mm3) was significantly lower than in germinal centres of normal human tonsils (5.0 +/- 0.8 X 10(4)/mm3). The NK cell/tumour cell ratio (0.03 +/- 0.015 in malignant melanoma and 0.02 +/- 0.015 in squamous cell carcinoma) is 10(2)-10(4) times lower than that commonly used for in vitro assays. The possible role of NK cells in malignant skin tumours should be viewed with caution.
Nosocomial Transmission of Cryptococcosis
Authors: Cheng-Yi Wang, Huey-Dong Wu, Po-Ren Hsueh
Journal: New England Journal of Medicine (2005)

We appreciate Dr. Grimsley's comments regarding pulse oximetry and methemoglobin.Pulse oximeters estimate oxygen saturation by comparing the absorbance of light at two wavelengths.Infrared light is absorbed by oxyhemoglobin, whereas red light is absorbed by deoxyhemoglobin.The absorbance characteristics of methemoglobin are similar to those of oxyhemoglobin, falsely elevating pulse-oximeter readings. 1,2o-oximeters measure light absorbance at four or more discrete wavelengths, providing accurate measurement of oxygen saturation, methemoglobin, and carboxyhemoglobin.In our patient, the oxygen saturation as measured by co-oximetry was 88.9 percent, the methemoglobin level was 8.8 percent, and the carboxyhemoglobin level was 1.2 percent.A methemoglobin level of 8.8 percent would be expected to yield a pulse-oximeter reading of 92 percent, 3 not 85 percent.A number of factors can impair the function of a pulse oximeter, including motion by the patient, the presence of or an excess of ambient light, increased skin pigmentation, abnormal body temperature, hyperbilirubinemia, and severe anemia. 2,4,5It is possible that one or more of these variables may have contributed to the discrepancy between the predicted oxygen-saturation value and the one recorded in our patient.We agree with Dr. Grimsley that although pulse oximetry provides a useful, noninvasive estimate of oxygen saturation, co-oximetry should be performed in all patients in whom methemoglobinemia is suspected.
Diurnal Blood Pressure Variations in Cerebrovascular Disease
Authors: MAURICE GROSS
Journal: Annals of Internal Medicine (1970)

Serial blood pressure recordings were made over 24-hr periods in 75 men with ischemic cerebrovascular disease in different arterial territories and in 25 controls, using an automatic monitor. A diurnal rhythm of pressure occurred that was similar in patients with cerebrovascular disease and in controls. Pressures were significantly higher in cerebrovascular disease than in controls, and the significant difference was due to the contribution from patients with vertebrobasilar ischemia rather than carotid ischemia. The level of basal pressures was proportional to the level of average daytime pressures in subjects with cerebrovascular disease and in controls. No evidence of exaggerated swings of diurnal pressure was found in subjects with cerebrovascular disease compared with controls to explain the pathogenesis of ischemic episodes, or result from them. Considerably higher than average changes in diurnal pressure were well tolerated in some subjects with major extracranial vascular obstruction without cerebral ischemia developing.
Acquired Circulating Anticoagulant to Factor VIII
Authors: Juan C. Vera
Journal: JAMA (1975)

Hematuria, arthralgias, and bleeding from subcutaneous and soft tissues developed in a 56-year-old man with an allergic background following a course of sulfisoxazole for urinary tract infection, Coagulation studies demonstrated the presence of an inhibitor to factor VIII in high titers. Massive doses of antihemophilic factor concentrate (30,000 to 60,000 units/day), azathioprine, and corticosteroids were followed by an immediate decrease in bleeding and a reduced level of inhibitor units. Three months after the onset of symptoms, the partial thromboplastin time returned to normal and inhibitor units to factor VIII became undetectable.
Clearing house needed for specialist treatments
Authors: J. Wise
Journal: BMJ (1997)

A national clearing house to bring together the best evidence on the cost effectiveness of specialist treatments is needed, says the Audit Commission. It says such a move is needed to reduce the unnecessary duplication of effort and information between health authorities and trusts and to tackle the problem of “treatment by postcode.”

The Audit Commission's report, Higher Purchase , examines how health authorities …
Tennis players and eye injuries
Authors: M. H. Seelenfreund
Journal: JAMA (1976)

The patients described in our article did return to playing tennis, although somewhat hesitantly at first. However, after a few months they were playing fairly regularly again. A few of the patients did begin to wear eye protection such as the device shown in the article. Others decided not to wear any sort of protective device at all. We have encouraged all of them to wear either impact resistant glasses or some other type of eye-protective device in order to prevent another injury. We are hopeful that more players will wear these protective devices, so that the number of injuries will be kept to a minimum.
MPs vote for standardised packaging of tobacco products
Authors: Z. Kmietowicz
Journal: BMJ (2015)

MPs have voted in favour of standardised tobacco packaging across the United Kingdom, with 367 votes in favour and 113 against in a free vote. After the announcement NHS England tweeted, “This is welcome news, a great moment for the nation’s children.”

The regulations will now go before the House of Lords for approval later this month and will require standardised packs to be used for all tobacco products from 2016. Under the proposed regulations all packaging of cigarettes and hand rolling tobacco will be dull brown on the outside and white on the inside. Only specified text such as the brand name and variant name will be allowed and must all be of the same type face, alongside prominent health warnings.

The …
Why Some Conflicts Involving “‘Difficult’ Patients” Should Remain Outside the Province of the Ethics Consultation Service
Authors: Cheryl Cline
Journal: The American Journal of Bioethics (2012)

Click to increase image sizeClick to decrease image size Acknowledgments Cheryl Cline would like to thank Barbara Secker for helpful discussion about “‘difficult’ patient” terminology. Notes One study of nine clinical ethics services found that there was significant variability in how visible each service was in its organization as well as in reporting structures, two key factors that affect how much impact a service can have within an organization (Godkin et al. Citation2005). Having said that, it is possible, in some organizations, that the ethics service is well integrated, with robust organizational ethics structures in place as well as properly trained personnel. In these cases, the ECS may then be the appropriate service to respond. However, I do not believe this is currently the norm in most health care organizations.
Decreased ATPase and Increased Sodium Content of Platelets in Down's Syndrome
Authors: Ernest E. McCoy, David J. Segal, Shirley M. Bayer, Kenneth D. Strynadka
Journal: New England Journal of Medicine (1974)

ATPase activity and sodium and potassium concentrations were studied in platelets from normal subjects and patients with Down's syndrome. Platelet ATPase activity of the patients was significantly decreased (p < 0.001 )-136.8 ± 5.2 (±S.E.M.) nm per hour per 108 platelets as compared to 173.2 ± 7.3 nm per hour per 108 normal platelets. Platelet potassium content of the patients was also decreased, 13.12 ± 0.48 μg per 109 platelets as compared to 19.78 ± 0.72 μg per 109 normal platelets (p < 0.001). Platelet sodium content of the patients was increased, 6.79 ± 0.40 μg per 109 platelets as compared to 3.32 ± 0.21 μg per 109 normal platelets (p < 0.001). The potassium-sodium ratios in the platelets of the patients had no overlap with values obtained in the normal controls. Decreased platelet ATPase activity of patients with Down's syndrome could cause decreased outward sodium transport, resulting in an increased platelet sodium content. Since the transport of serotonin into platelets is coupled to inward sodium transport, we propose that the observed decreased concentration of serotonin in platelets of these patients results from the decreased inward sodium transport. (N Engl J Med 291:950–953, 1974)