tbuckley/cabot-search huggingface dataset:
Abstract 19700: Bystander CPR Saves Lives and Generates the Gift of Life
Authors: Victor Bowers, Marbelly Davila, Jacentha Buggs
Journal: Circulation (2015)

Introduction: A fundamental gap in correlation appears to exist between bystander Cardiopulmonary Resuscitation (CPR) and preservation of the gift of life for people who die each day awaiting organ transplantation. As a result, the incidence of bystander CPR as a bridge to organ donation has not been articulated. Hypothesis: We assessed the hypothesis that kidneys recovered with bystander CPR demonstrate equivalent survival rates with first responder CPR and or no CPR. Methods: We retrospectively analyzed our transplant database from 2008-2013. We also evaluated the nationwide, population-based database from the United Network for Organ Sharing. Results: A total of 643 deceased donors were utilized to sustain life in a sample size of 882 kidney transplant recipients at our center. There were 77 bystander CPR - mean age 49.8 (SEM 1.75), 192 first responder CPR - mean age 52.45 (SEM 1.05), and 613 no CPR - mean age 52.58 (SEM 0.63). The mean length of stay days were 9.42 (SEM 0.64) bystander CPR, 9.03 (SEM 0.51) first responder CPR, and 10.73 (SEM 0.49) no CPR. The mean one year graft survival rate was 97.4% (SEM 0.01, CI 94.85-99.94) bystander CPR, 93.8% (SEM 0.02, CI 90.46-97.03) first responder CPR and 94.1% (SEM 0.01, CI 92.33-95.86). The mean death-censored graft survival days were 2230 (SEM 67.98) bystander CPR, 2351.22 (SEM 38.02) first responder CPR, and 2292.41 (SEM 26.32) no CPR; with a Log rank p-value=0.338. The United States’ data demonstrated 133,369 deceased donors with 44,469 receiving CPR (33.34%). The mean graft survival rate at one year was 92.62% (CI 92.18-93.06) with CPR and 91.54 % (CI 91.21-91.88) no CPR. No distinctions were made regarding the type of CPR in the national database. Conclusions: Bystander CPR saves lives both with the primary return to baseline function and the secondary gain of the gift of life. Intentional effort should be devoted to tracking the results of bystander CPR and the parallel consequence of organ donation.
P268 The role of growth and differentiation factor 15 in smooth muscle cell proliferation in pulmonary hypertension
Authors: B Garfield, D Shao, A Crosby, P Yang, N Morrell, M Polkey, P Kemp, SJ Wort
Journal: Thorax (2015)

<h3>Introduction</h3> Growth and differentiation factor 15 (GDF-15) is a prognostic marker in pulmonary hypertension (PH). Its effects on endothelial cells have been documented, but its mechanism of action and role in the development of PH have not yet been fully investigated. We aimed to define the role and mechanism of action of GDF-15 in the development of PH. <h3>Methods</h3> Rats were treated with moncrotaline (MCT) or vehicle control and euthanized after undergoing cardiovascular monitoring 4 weeks later. The expression of GDF-15 mRNA in the lung was measured by qPCR. Total GDF-15 protein levels in serum and lung were analysed by ELISA. The distribution of GDF-15 in the lung was analysed by immunohistochemistry. GDF-15 signalling in human pulmonary artery smooth muscle cells (HPASMCs) was analysed using western blot, and its role on HPASMC proliferation was measured using a cyquant assay. <h3>Results</h3> GDF-15 mRNA and protein levels were raised in the lung homogenates of the MCT rat compared to controls (p &lt; 0.05). Immunohistochemistry revealed GDF-15 was localised in the endothelial cells and to a lesser extent in the PASMCs of these animal. GDF-15 levels in the serum of the MCT treated rats was higher than that in those treated with vehicle control (771 ± 345 vs. 411 ± 305, p &lt; 0.05). Serum GDF-15 was correlated with RV/LV+S weight in the MCT treated group (Pearson r = 0.66, p &lt; 0.05). Immunohistochemistry also revealed an increase of phospho-TGFβ activated kinase 1 (TAK1) in PASMCs of the MCT rat. In HPASMCs GDF-15 (1 ng/ml) treatment resulted in an increase in proliferation over baseline at 72 h (Figure 1). GDF-15 was also able to induce phosphorylation of TAK1 in HPASMCs. <h3>Conclusions</h3> GDF-15 is over-expressed in the lung vasculature of MCT rats, mimicking human disease. GDF-15 was associated with the degree of right ventricular hypertrophy in these animals. GDF-15 downstream signalling molecule phosphorylated TAK-1 is present in increased levels in the vasculature of the MCT rat. <i>In vitro</i> GDF-15 treatment caused proliferation of HPASMCs and activation of TAK-1. Further investigation of this pathway is required to determine its relevance to human disease.
Abstract 15477: Outpatient Cardiac Rehabilitation and Smoking Cessation in Patients with Acute Myocardial Infarction
Authors: Dominic J Cirillo, Yan Li, Kim G Smolderen, Donna M Buchanan, Phillip A Horwitz, Mark W Vander Weg, Babalola Faseru, Philip G Jones, John Spertus, David A Katz
Journal: Circulation (2012)

Background: Smoking cessation is a cost-effective intervention known to reduce the risk of mortality and recurrent cardiac events in patients with acute myocardial infarction (AMI). Outpatient card...
Influence of Sickle Hemoglobinopathies on Growth and Development
Authors: Orah S. Platt, Wendy Rosenstock, Mark A. Espeland
Journal: New England Journal of Medicine (1984)

To determine the influence of hemoglobinopathy on growth and development, we examined the height, weight, and sexual maturation of 2115 patients 2 to 25 years old who had homozygous sickle-cell disease (SS), SC disease (SC), sickle beta+ thalassemia (S beta+), or sickle beta O thalassemia (S beta O). Using regression analysis of these cross-sectional data to generate growth and maturation curves for each hemoglobinopathy, we found that the curves for all hemoglobinopathy groups were significantly different from published norms for black subjects (P less than 0.001), and that subjects with SS and S beta O were consistently smaller and less sexually developed than those with SC and S beta+ (P less than 0.001). For both sexes and all hemoglobinopathies, low weight was more pronounced than short height and was most apparent in subjects over the age of seven. The median age of the female subjects who had attained at least Tanner Stage V was 17.3 years for those with SS, 17.2 years for S beta O, 16.0 years for SC, and 16.5 years for S beta+; among male subjects the corresponding values were 17.6, 18.8, 16.6, and 16.6 years. Discriminant analysis of menarche status, weight, age, and hemoglobinopathy revealed that the influences of age and weight on menarche were similar regardless of hemoglobinopathy. This relationship suggests a constitutional rather than a primary endocrinologic cause of sexual immaturity in patients with hemoglobinopathies.
Gastritis and Gastroscopic Biopsy
Authors: Sydney Selesnick, Edward D. Kinsella
Journal: New England Journal of Medicine (1953)

IN 1937 Palmer1 hailed Schindler's flexible gastroscope as the instrument that had finally brought the element of objectivity into the diagnosis of disease of the gastric mucosa. In 1947 Schindler2 himself expressed delight at the general acceptance of his diagnostic instrument only fifteen years after its introduction. Benedict,3 in 1948, devised the operating gastroscope; as a result of his experience with biopsies of gastric mucosa obtained with this instrument, he challenges the adequacy of conventional gastroscopy as a diagnostic method. He believes that no gastroscopic examination is complete unless biopsy under direct vision is available.4 The experience of others, using . . .
ATCT-32A PHASE II STUDY OF TEMOZOLOMIDE IN THE TREATMENT OF ADULT PATIENTS WITH SUPRATENTORIAL LOW-GRADE GLIOMA
Authors: Michael Wahl, Johnathan Aicardi, Annette Molinaro, Daphne Haas-Kogan, Nicholas Butowski, Jennifer Clarke, Michael Prados, Joanna Phillips, Mitchel Berger, Susan Chang
Journal: Neuro-Oncology (2015)

INTRODUCTION: Optimal adjuvant management of low-grade gliomas (LGGs) remains controversial.Radiotherapy has been shown to improve progression-free survival compared to observation, but carries the potential for substantial late toxicity.In an effort to delay or obviate the need for radiotherapy, there has been increasing interest in the use of adjuvant chemotherapy in
Enzyme Replacement Therapy of Exocrine Pancreatic Insufficiency in Man
Authors: David Y. Graham
Journal: New England Journal of Medicine (1977)

I assayed 16 commercially available pancreatic extracts (representing capsules, tablets and enteric-coated tablets) for enzyme activities and the relation between the in vitro activities and in vivo potency evaluated in man. Lipase activity ranged from 10 to 3600 units per unit, with 11 preparations containing less than 600 units per unit. The preparations with the highest lipase activities were llozyme, 3600, Kuzyme HP, 2330, Festal, 2073, Cotazym, 2014, and Viokase, 1636 units. Lipase activity in vitro correlated with potency in vivo for tablets and capsules, with tablets and capsules being effective in reducing steatorrhea by 56.1±9 per cent and 48.6±10 per cent (mean ±S.E.M.) respectively, P<0.001. Enteric-coated tablets were less effective (20±13 per cent reduction, P>0.02). The longer the gastric pH remained ≥4 (r = 0.915, P<0.01) and the higher the average duodenal pH (r = 0.966, P<0.01), the more marked the reduction in steatorrhea. (N Engl J Med 296:1314–1317, 1977)
M7 Leading for improvement – an essential ingredient in quality patient care: A Respiratory experience
Authors: S Kumar, M Gittus, A Cracknell, SDW Miller
Journal: Thorax (2015)

<h3>Background and objectives</h3> Many respiratory patients have deranged physiology and can deteriorate rapidly during acute episodes. Consequently, early decision-making is vital to improve outcomes and to ensure patient’s wishes are respected. We aim to improve the care of inpatients who acutely deteriorate through clinical leadership, as part of a quality improvement (QI) collaboration, by improving early decision-making and clinical response. As a pilot project we retrospectively (January 2012–September 2014) analysed all 2222 calls from three respiratory wards (84 beds). Fewer events occurred at the weekend (9.4% per day) compared to weekdays (16.2% per day). More events occurred between0900–1700 (41.1%) compared to out of hours (58.9%). Decision-making was found to be poor with 12.2% patients having cardiopulmonary resuscitation (CPR) decisions in place. <h3>Methods</h3> Following initial data analysis, one ward participated in a QI project to identify areas for improvement and target these through small tests of change. The interventions implemented by the ward team included a staff survey, “deteriorating patient stamp”, post-2222 call debriefing and “safety huddles”. The effectiveness of these interventions was measured through analysis of on-going arrest calls and documentation of decision-making in case-notes. <h3>Results</h3> Reduction in number of 2222 calls on pilot ward between pre-intervention and post-intervention time periods (mean 1.44 vs. 0.56) as shown in Figure 1. Total 2222 calls per bed reduced for the pilot ward (63.6% reduction) compared to non-pilot wards (9.68% increase) during the pre and post-intervention phases. Similar results were shown for cardiac arrests alone (62.5% reduction compared to 26.7% increase). Decision-making was improved through the intervention phase with 75% of inpatients having DNACPR decisions and 46% escalation plans documented. Safety huddles helped improve ward culture and spread lessons learnt from debriefing of the last 3 events. <h3>Conclusion</h3> Early results show there has been a reduction in total 2222 calls in the pilot ward compared to the other wards. We believe this is through improved decision making and empowering frontline staff. This could be scaled-up in other wards to have greater impact on patient care.
P236 Psychological profile of individuals presenting with chronic cough
Authors: K Hulme, S Dogan, V Deary, SM Parker
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> Between 20–40% of patients seen in respiratory clinics with chronic cough have an ‘idiopathic cough’ with persistent symptoms that are refractory to treatment and have no obvious underlying pathology. Adverse consequences of chronic cough are well documented in the literature, but relatively little is known about this patient population. We aimed to investigate the association of psychological factors, identified as important in the medically unexplained, persistent symptom literature, with chronic cough. <h3>Methods</h3> Eighty-nine participants (63 female, mean age = 59) took part. Sixty-seven patients attending a specialist cough clinic (idiopathic; n = 25, explained cough; n = 42) and 22 normal controls were asked to complete questionnaires; all participants completed the Hospital Anxiety and Depression Scale, Big Five Inventory (Personality), Chalder Fatigue Scale and Patient Health Questionnaire-15. Cough patients also completed the Illness Perception Questionaire-Revised. Appropriate statistical analyses were conducted comparing the participant groups. <h3>Results</h3> Idiopathic coughers displayed significantly higher levels of neuroticism (p &lt; 0.05), anxiety (p &lt; 0.05), depression (p &lt; 0.001), fatigue (p &lt; 0.001) and somatic physical symptoms (p &lt; 0.005) than controls. In comparison to explained coughers, significantly higher depression (p &lt; 0.005) and fatigue (p = 0.01) scores were reported by idiopathic coughers, who also had significantly more negative illness perceptions (p &lt; 0.005). Specifically, they had strong beliefs regarding negative consequences, lower illness coherence and higher emotional representations. Explained coughers only differed significantly to the control group in the increased levels of fatigue reported (p &lt; 0.05). <h3>Conclusions</h3> Many psychological factors are associated with chronic cough and seem to differentiate between the two patient groups. The prevalence of neuroticism, negative affect, negative illness beliefs and increased physical symptom reporting suggest a patient profile of idiopathic cough similar to that of other medically unexplained symptoms. This, as well as the novel and significant finding of the prevalence of fatigue, should be considered in consultations and developing novel interventions.
The Mimosa Girdler
Authors: Lewis Thomas
Journal: New England Journal of Medicine (1979)

WE used to believe that consciousness, which is the capacity to think hard about thinking, was a special property of the human brain, a gift dependent on the gift of language, distinguishing us from all lesser breeds. But now there are reasons to believe that dolphins use a kind of beeping language, and the deep thought of whales may turn out to be well over our heads. A bright chimpanzee with an advanced, specialized education can carry on an animated sort of conversation with a human being who also possesses an advanced education and a degree in experimental psychology. The . . .
Phase II study of the clinical and biological activity of cetuximab and celecoxib in patients (pts) with refractory colorectal cancer (CRC)
Authors: E. Chan, N. B. Merchant, B. J. LaFleur, M. L. Rothenberg, R. J. Coffey, J. D. Morrow, G. L. Milne, B. L. Trivedi, A. C. Lockhart, J. D. Berlin
Journal: Journal of Clinical Oncology (2007)

14516 Background: The epidermal growth factor receptor (EGFR) and cyclooxygenase-2 (COX-2) pathways play key roles in colon carcinogenesis. EGFR and COX-2 signaling can be mutually reinforcing. Celecoxib, a selective COX-2 inhibitor, inhibits the EGFR pathway through inhibition of PI3/Akt and NF-κB pathways. This study explores the clinical and biological effects of blockade of complementary pathways of the EGFR by combining cetuximab with celecoxib. Methods: Cetuximab-naive pts with refractory CRC were treated with cetuximab (400 mg/m 2 loading dose followed by weekly cetuximab at 250 mg/m 2 ) and celecoxib (200 mg orally twice daily). Patients were assessed for response every 8 weeks. Urinary PGE-M, a metabolite of PGE-2 which correlates with in vivo COX-2 activity, and serum TGF-a, a ligand that binds to EGFR, were measured to assess the biological effect of COX-2 and EGFR blockade. Results: Seventeen of a planned 40 pts accrued to this study. Currently, data is available on 12 of these patients. Three pts had to stop treatment on 1st infusion due to a grade 3 cetuximab infusion reaction. One pt had a mild infusion reaction and was successfully rechallenged after pre-medication and a slower infusion rate. By RECIST criteria, 1 pt (8.3%) achieved a partial response (PR) and 4 pts (33%) had a best response of stable disease (SD). The mean time on study for the 9 pts without grade 3 infusion reaction was 95.7 days (range 28- 175). Pts with SD or PR were on study for a mean of 135 days (range 107–175 days) and pts with progressive disease (PD) were on study for a mean of 47 days (range 28–56 days). Baseline urinary PGE-M levels in pts with SD or PR were higher than in pts with PD (30.5+17.6 vs 18.1+9.4 ng/mg Cr). Baseline serum TGF-a levels were similar between the two groups (27.1+9.6 vs 25.4+10.3 pg/ml respectively). Conclusions: In preliminary analysis, this regimen resulted in response rates similar to published response rates for single agent cetuximab. Pts with at least SD had higher baseline urinary PGE-M levels, which may serve as a marker for efficacy of this combined therapy. Data on serial TGF-a and PGE-M levels will be presented. Response data on all 17 pts will be presented. Supported by P50 CA95103 and Bristol-Myers Squibb. Celecoxib provided by Pfizer. [Table: see text]
Serum High-Density-Lipoprotein Cholesterol in Women Using Oral Contraceptives, Estrogens and Progestins
Authors: Douglas D. Bradley, John Wingerd, Diana B. Petitti, Ronald M. Krauss, Savitri Ramcharan
Journal: New England Journal of Medicine (1978)

To determine the associations between high-density-lipoprotein cholesterol levels and use of oral contraceptives or of noncontraceptive estrogens and progestins we analyzed the serum levels of this lipid in 4978 women, 21 to 62 years of age. In estrogen users, the mean level was 6.7 to 15.1 mg per deciliter above the nonuser level (P less than 0.001), whereas in a group of progestin users it was 15.8 mg per deciliter below (P less than 0.001). In women using combination oral contraceptives, the level varied with the type and dose of the component steroids, in general increasing with increasing dose of estrogen and decreasing with increasing dose or potency of progestin. Thus, the net effect of use of a combination oral contraceptive on high-density-lipoprotein cholesterol depends on its formulation.
Soundings: Mentioning the war
Authors: Colin Douglas
Journal: BMJ (2002)

Like service doctors thrown together anywhere we chatted and joked and discovered mutual acquaintances. Routines were undemanding, almost token. Morning newspapers were enjoyed at leisure and lunch often stretched towards afternoon tea.

The hospital was all but empty. We were its temporary staff, reservists on UK duties while our regular colleagues—as they put it—went south. We were briefed. We were ready in our fashion. We waited.

For me it was opportune; there was a novel to revise and this was blameless time for it. Others were less content. A couple of London orthopods, perhaps more accustomed to busily knocking hips into duchesses in Harley Street, coped rather badly with having nothing to do. I think they once actually tossed a coin for the privilege of dealing with a sailor's ingrown toenail. Most settled eventually into the routine of idle readiness.

On Sunday in the little Georgian chapel the closing hymn was the usual one: expected and traditional but now something more. Under dusty ensigns and memorial plaques, in a naval hospital that still bore the scars of Luftwaffe bombing, we sang together “Eternal father, strong to save . . .”

Each weekday at six o'clock the medical mess television lounge was full and silent. A civil servant, suddenly a national figure, read bulletins solemn and terse. We heard of ships we knew, with doctors we knew serving in them, being attacked and even sunk. Then we went for a drink.

Each day the empty wards waited. There were plans: complex schemes involving hospital ships, air links, airborne intensive care teams, RAF stations not far away, and then hospitals like ours, and us, with hundreds of beds at the ready.

Ours was the worst case scenario: mass casualties from a troopship or a carrier ravaged by missiles and fire. Days passed. The ships hit were the smaller ones, with good drills and training minimising losses. But each evening we gathered, prepared to hear the worst.

Twenty years on it is clear that different luck, a few more Exocets, even a millimetric adjustment to the fusing of simple bombs, could have made a huge difference. But in 1982 a small miracle of organisation in a former meat processing plant, backed up by the hospital ships and air links, coped astonishingly with the wounded from both sides. We simply watched a far-off war on television each evening, and waited. Nobody came.
Unsuccessful Aspirin Desensitization in Minority Patients with AERD: Association with Increased Eosinophilia and Sinus Surgery Timing
Authors: Elina Jerschow, Teresa Pelletier, Ren Zhen, Robert Tamayev, Waleed Abuzeid, Marvin Fried, Golda Hudes, Esperanza Morales, Krista Nelson, Jonathan Feldman, Victor Schuster, Simon Spivack, David L. Rosenstreich
Journal: Journal of Allergy and Clinical Immunology (2016)