tbuckley/cabot-search huggingface dataset:
Abstract 16851: ST Segment Variability as a Predictor of Clinical Deterioration in Hypoplastic Left Heart Syndrome
Authors: Eric L Vu, Craig G Rusin, Dan J Penny, Kathy K Kibler, Ronald B Easley, Dean Andropoulos, Ken Brady
Journal: Circulation (2014)

Introduction: The interstage mortality rate for hypoplastic left heart syndrome (HLHS) is high at 12%. Modalities to predict clinical decline would be useful in this high risk population. Due to cardiac conduction system anomalies in HLHS, electrocardiogram (ECG) monitoring of the ST segment is confounded. Our aim is to develop a monitor of ST variability that predicts deterioration despite the presence of an abnormal ST segment baseline. Hypothesis: Increased ST variability is associated with clinical deterioration in HLHS. Methods: A prospective, observational study was conducted at Texas Children’s Hospital using interstage recordings of 5 lead ECG. From January 2013 to January 2014, 25 subjects were admitted with HLHS; 21 had requisite ECG data for inclusion. In 11 subjects, there were 17 deterioration events, defined as rapid response team (RRT) activation. Events included 13 instances of respiratory failure with intubation and 4 instances of chest compressions. The control group included 10 subjects with no deterioration. An approach to quantify variability was developed where the ST segment vector was resolved using 3 orthogonal leads (II, V5, and aVF) and variability quantified with two metrics: 1) Displacement: distance between ST vector tips at 30 s intervals and 2) Component range: sum of ST vector tip movement in 3 dimensions over 10 min intervals. Comparison was made with the four hour window prior to RRT activation in the deterioration group against the four hour window prior to ICU discharge in the control group. Results: Four hours prior to clinical deterioration, increased ST variability was noted in both methods. For the 30 s displacement method, subjects with deterioration had a median value of 0.059 mm [IQR: 0.039 - 0.075] compared with 0.037 mm [IQR: 0.025 - 0.053] in the control group (p = 0.023). For the 10 min component range method, subjects with deterioration had a median value of 3.0 mm [IQR: 1.8 - 4.5] compared with 1.9 mm [IQR: 1.0 - 2.8] in the control group (p = 0.031). Conclusions: ST variability is increased in HLHS subjects prior to deterioration. Although conduction abnormalities limit the utility of ST monitoring in this population, quantification of ST variability may have a role in advanced systems to monitor clinical deterioration.
Obesity is blamed for large rise in uterine cancers in UK
Authors: Zosia Kmietowicz
Journal: BMJ (2016)

Rising levels of obesity among women in the United Kingdom have been linked to a 54% increase in uterine cancer rates during the past two decades, figures from Cancer Research UK have shown.

In the early 1990s, roughly 19 women in every 100 000 developed the disease, but this figure rose to 29 women in every 100 000 during 2011 to 2013.

Currently, roughly 9000 women have uterine cancer diagnosed every year in the UK, compared with 4800 …
A Deficiency of Pulmonary Fibrinolysis in Hyaline-Membrane Disease
Authors: Jack Lieberman, Frederick Kellogg
Journal: New England Journal of Medicine (1960)

THE absence of fibrinolytic enzyme activity in the A lungs of newborn infants succumbing to hyaline-membrane disease was recently reported.1 This enzyme abnormality was manifested by an inability of lung preparations to activate plasminogen (profibrinolysin), and could have resulted either from a true absence of the tissue activator or from an excess of inhibitor.As a result of these findings it was postulated that this deficiency of lung plasminogen-activator activity predisposed certain newborn infants to hyaline-membrane formation. A coincident aspiration of amniotic fluid containing thromboplastin and an alveolar effusion of blood plasma, as well as a period of air breathing, . . .
Carcinoembryonic Antigen-Binding Immunoglobulin Isolated From Normal Human Serum by Affinity Chromatography&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: David Pressman, T. Ming Chu, Allan L. Grossberg
Journal: JNCI Journal of the National Cancer Institute (1979)

A human immunoglobulin that binds carcinoembryonic antigen (CEA) was isolated from four individual normal human sera by affinity chromatography with the use of a CEA-Sepharose solid adsorbent. The yield of isolated protein, termed human CEA-binding protein (HCBP), ranged from 1.8 to 10 μg/ml serum. HCBP is a γ-globulin of restricted electrophoretic heterogeneity as shown by immunoelectrophoresis. HCBP was shown to bind radioiodine-labeled CEA both by a radioimmune precipitation assay and by a radioimmunoelectrophoresis assay. This protein was of practical interest because of its potential usefulness as a carrier of radioactivity or therapeutic agents to a CEA-producing tumor for therapeutic or diagnostic purposes.
The Role of Dietary Protein Restriction in Progressive Azotemia
Authors: Robert G. Narins, Pedro Cortes
Journal: New England Journal of Medicine (1994)

In rats, renal diseases progress to the end stage, but the rate of progression can be slowed dramatically by dietary protein restriction1. In humans, most renal diseases also progress to death due to uremia, unless transplantation or dialysis is provided2. Despite several studies to the contrary, the results of the Modification of Diet in Renal Diseases (MDRD) study, reported in this issue of the Journal by Klahr et al., suggest that the progression of renal diseases in humans is only minimally slowed by dietary protein restriction3. What accounts for these differences?In the studies in rats the . . .
S125 Relationship of right heart echo parameters to functional status and pulmonary function in severe COPD
Authors: PSK Liu-Shiu-Cheong, BJ Lipworth, AR Goudie, PM Short, PJ Hopkinson, AD Struthers
Journal: Thorax (2015)

<h3>Introduction</h3> COPD is associated with structural and functional cardiac changes, particularly the right heart. There is little evidence as to whether right heart echo parameters are associated with QOL, health status and pulmonary function. <h3>Methods</h3> We looked at the relationship of right heart function to QOL (SGRQ) and health status (SF-36) and to pulmonary function (spirometry and DLCO) in patients with severe COPD. <h3>Results</h3> 120 patients were included in the analysis: 82 men and 38 women; mean age 69 years; mean FEV<sub>1</sub> 41%; mean FEV1/FVC 0.38; mean PAP 29 mmHg; mean Sa0<sub>2</sub> 95%. Pulmonary vascular resistance was related to 6MW distance (p = 0.008), BODE Index (p = 0.01) as well as FVC% (p = 0.03). RV ejection time (RVET) was related to SGRQ (p = 0.02), SF-36 scores for limitations due to physical problems (PL) (p = 0.03), social functioning (SF) (p = 0.04) and general health perceptions (GH) (p = 0.02) as well as FVC% (p &lt; 0.001) and DLCO (p = 0.001). When comparing pulmonary acceleration time (PAT) &lt;100 ms (n = 68) vs PAT ≥ 100 ms (n = 51), we found a difference in mean SGRQ 59.3 vs 52.1 (p = 0.01) and mean RVET 262 vs 286 ms (p = 0.001). Dynamic lung volumes as FEV<sub>1</sub>%, FVC% and FEV<sub>1</sub>/FVC were significantly related to SGRQ and SF-36 scores for physical function (PF), PL, SF and GH. There were significant differences between GOLD 2 vs GOLD 4 groups for: mean PAP (p = 0.05), mean RVET (p = 0.001) and mean SF-36 scores for PF (p &lt; 0.001), PL (p = 0.009), SF (p = 0.01) and GH (p = 0.001). <h3>Conclusion</h3> In patients with severe COPD, right heart echocardiographic parameters are associated with functional status and dynamic lung volumes.
PTH-108 Predictors of complications after hpb resections
Authors: J Ellis
Journal: Gut (2015)

<h3>Introduction</h3> To identify factors which may predict an increased risk of peri-operative complication in the first 48 h post HPB resection. <h3>Method</h3> Retrospective data collected on 1057 patients who underwent liver or pancreas resection at a single centre between Jan 2011 and Nov 2014 using local database and reporting system. Complications were graded according to the Clavien-Dindo classification (severe – grade I–II, minor III–V). <h3>Results</h3> 801 patients underwent liver resection (major 535, minor 266) with 48 h complication rate of 6.7% (and 25.8% rate within 30 days). Severe complications were associated with increased length of stay on ITU from 1 day (no complication) to 10 days. A number of statistically significant factors were associated with increased risk of complication (age, indication, transfusion, operation time, NorAdrenaline requirement). Multivariable analysis of these factors demonstrated that only Creatinine had any predictive value with post-op day 1 levels of 66.1 (no complication), 76.3 (minor) and 92.2µmol/l (severe). Severe complications had a +9.1% mean rise in Creatinine from pre-op to post-op day 1 (no complications had a fall of -14.5%). ROC curve analysis resulted in an AUROC of 0.65 (p &lt; 0.001) for Creatinine-related factors. 236 patients underwent a Whipples procedure (PPPD or Classical) with a complication rate of 11.3% within 48 h (46.5% within 30 days). Again, severe complications were associated with increased length of stay on ITU (8 days in this group compared to 2 days for no complications). In contrast to the liver data, the only factors with statistical significance associated with severe complications were Creatinine-related. Creatinine levels of 67.3, 79.9 and 82.6µmol/l and changes in Creatinine of -4.5%, +6.0% and +25.4% in the no, minor and severe complication groups respectively were observed. The AUROC was 0.66 (pre-op Creatinine) and 0.7 (change in Creatinine). <h3>Conclusion</h3> Multivariable analysis demonstrated that the only factors predictive of complication in this group of patients were pre-op Creatinine and change in Creatinine. With a low PPV (13.1% and 25.4% for liver and pancreas group respectively) this is not however reliable in identifying patients at risk of all complications, though a sensitivity of 90.0% and 72.7% for severe risk patients does add some value. Most notably the negative predictive value for these tests is &gt;93% for all groups and therefore has reasonable predictive value in identifying patients unlikely to encounter a peri-operative complication. This study demonstrates the difficulty in predicting which patients are at risk of post-operative complications and also provides some novel data on the use of Creatinine as a potential marker of risk. <h3>Disclosure of interest</h3> None Declared.
D-Tri-Iodothyronine Treatment of Hypercholesterolemia in Patients with Heart Disease
Authors: David O. Mintz, Magdalena R. Berenyi, I. N. Rosenberg, Kermit H. Katz
Journal: New England Journal of Medicine (1962)

INTEREST in the possible pathogenetic relation of hypercholesterolemia to coronary atherosclerosis has led to consideration of the thyroid hormones and related compounds as agents that might be useful in decreasing serum cholesterol. Impetus for such a study stems from the well known effect of thyroid in decreasing the serum cholesterol in patients with hypothyroidism. A highly desirable feature of such derivatives would be a substantial hypocholesterolemic effectiveness with little or no calorigenic or other change. The following constitutes a report of a clinical trial in cases of cardiovascular disease of D-3,5,3′-tri-iodothyronine (detrothyronine, DT3),∥ the optical isomer of the naturally occurring . . .
Aureomycin in the Treatment of Diffuse Peritonitis
Authors: Alexander M. Rutenburg, Stanley W. Jacob, Fritz B. Schweinburg, Jacob Fine
Journal: New England Journal of Medicine (1952)

IN A previous communication aureomycin or a combination of aureomycin and penicillin was reported as effective in the treatment of diffuse peritonitis of intestinal origin.1 Our results in 24 cases demonstrated that aureomycin alone was superior to penicillin alone in such infections. This report deals with the effects of aureomycin therapy in 59 additional patients with diffuse peritonitis.Clinical ObservationsThe therapeutic response of 59 patients with diffuse peritonitis of intestinal origin was observed (Table 1). The bacteria isolated from the peritoneal exudate were Escherichia coli in 23, staphylococci in 17, Bacillus proteus vulgaris in 9, Pseudomonas aeruginosa in 8, . . .
Case 5-1993
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Michael Barza, Michael Pins
Journal: New England Journal of Medicine (1993)

Presentation of CaseAn 81-year-old man was admitted to the hospital because of pain and subcutaneous emphysema in the right upper extremity.The patient was in a stable state of health until one day earlier, when he was admitted to another hospital because of the onset of increasingly severe pain in the right shoulder. An electrocardiogram showed sinus tachycardia at a rate of 100, with evidence of anterior subendocardial ischemia and occasional premature ventricular contractions with a single morphologic pattern. A nitroglycerin infusion was begun by vein. Early on the next morning subcutaneous emphysema was observed about the right shoulder . . .
Bone Marrow Transplantation in Severe Combined Immunodeficiency from a Sibling Who Had Received a Paternal Bone Marrow Transplant
Authors: E. Richard Stiehm, Robert L. Roberts, Jean Hanley-Lopez, Mary E. Wakim, Maria G. Pallavicini, Morton J. Cowan, Robert B. Ettenger, Stephen A. Feig
Journal: New England Journal of Medicine (1996)

Bone marrow transplantation to treat autosomal recessive severe combined immunodeficiency was undertaken in a one-month-old girl. The donor was the patient's HLA-mismatched six-year-old sister, who...
Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial
Authors: J L Pépin, R Tamisier, J P Baguet, B Lepaulle, F Arbib, N Arnol, J F Timsit, P Lévy
Journal: Thorax (2016)

<h3>Background</h3> Millions of individuals with obstructive sleep apnoea (OSA) are treated by CPAP aimed at reducing blood pressure (BP) and thus cardiovascular risk. However, evidence is scarce concerning the impact of different CPAP modalities on BP evolution. <h3>Methods</h3> This double-blind, randomised clinical trial of parallel groups of patients with OSA indicated for CPAP treatment compared the efficacy of fixed-pressure CPAP (FP-CPAP) with auto-adjusting CPAP (AutoCPAP) in reducing BP. The primary endpoint was the change in office systolic BP after 4 months. Secondary endpoints included 24 h BP measurements. <h3>Results</h3> Patients (322) were randomised to FP-CPAP (n=161) or AutoCPAP (n=161). The mean apnoea+hypopnoea index (AHI) was 43/h (SD, 21); mean age was 57 (SD, 11), with 70% of males; mean body mass index was 31.3 kg/m<sup>2</sup> (SD, 6.6) and median device use was 5.1 h/night. In the intention-to-treat analysis, office systolic blood pressure decreased by 2.2 mm Hg (95% CI −5.8 to 1.4) and 0.4 mm Hg (−4.3 to 3.4) in the FP-CPAP and AutoCPAP group, respectively (group difference: −1.3 mm Hg (95% CI −4.1 to 1.5); p=0.37, adjusted for baseline BP values). 24 h diastolic BP (DBP) decreased by 1.7 mm Hg (95% CI −3.9 to 0.5) and 0.5 mm Hg (95% CI −2.3 to 1.3) in the FP-CPAP and AutoCPAP group, respectively (group difference: −1.4 mm Hg (95% CI −2.7 to −0.01); p=0.048, adjusted for baseline BP values). <h3>Conclusions</h3> The result was negative regarding the primary outcome of office BP, while FP-CPAP was more effective in reducing 24 h DBP (a secondary outcome). <h3>Trial registration number</h3> NCT01090297.
A Controlled Study of Luteinizing Hormone–Releasing Hormone Agonist (Buserelin) for the Induction of Folliculogenesis before in Vitro Fertilization
Authors: Vivien MacLachlan, Mandy Besanko, Fiona O'Shea, Heidi Wade, Carl Wood, Alan Trounson, David L. Healy
Journal: New England Journal of Medicine (1989)

Treatment with clomiphene citrate and human menopausal gonadotropin (HMG) is often used to induce folliculogenesis before in vitro fertilization, but not all women have an adequate response. It has been hypothesized that abnormally high levels of luteinizing hormone (LH) may contribute to the reduced folliculogenesis. We therefore performed a controlled, open trial in which treatment with buserelin, an agonist of luteinizing hormone–releasing hormone, and HMG was compared with treatment with clomiphene citrate and HMG in 44 consecutive women in whom no oocytes or only one had been produced by standard treatment with clomiphene and HMG. twentynine women received buserelin with HMG, and 15 received clomiphene citrate with HMG. The median number of oocytes per patient recovered from those who received buserelin with HMG was 4 (range, 0 to 19), as compared with 0 (range, 0 to 5) in those who received clomiphene citrate with HMG. The fertilization rates of oocytes recovered from both groups of patients were similar (75.8 percent and 76.5 percent, respectively). Fifty-four percent of patients given buserelin with HMG underwent triple-embryo transfer, as compared with 13 percent of those given clomiphene citrate with HMG. Pregnancy (n = 3) occurred only among the patients receiving buserelin with HMG. In the buserelin–HMG group, significantly fewer oocytes were recovered from patients with occult ovarian failure (infertility and elevated follicular-phase levels of follicle-stimulating hormone, with regular menses) (median, 1; range, 0 to 4) than from those with other causes of infertility (median, 8; range, 0 to 19). Our data suggest that, except in women with occult ovarian failure, buserelin and HMG improve embryologic and clinical outcomes in patients with previously unsatisfactory stimulation of the ovaries for in vitro fertilization. (N Engl J Med 1989; 320:1233–7.)
99PD: Modelling of pulmonary function test changes after stereotactic body radiotherapy for stage I NSCLC
Authors: J. Roesch, B. Stam, J. Belderbos, H. Peulen, M. Flentje, M. Giuliani, A. Hope, M. Werner-Wasik, Y. Hong, I. Grills
Journal: Journal of Thoracic Oncology (2016)
I<sup>125</sup>in the Clinical Evaluation of Thyroid Disease
Authors: G. Riccabona
Journal: New England Journal of Medicine (1965)

ALTHOUGH I131 has gained a firm position in the diagnosis of thyroid disease, in some respects it falls short of being an ideal test substance. Occasionally, there are warnings of possible radiation damage1 even though there is little evidence of such consequences2 after tracer doses of I131. The accuracy and reliability of thyroid scans made with I131 are far from perfect, and only fairly large lesions may be visualized. In metabolic studies on younger people with thyroid disease every investigator is in a dilemma: a satisfactory count rate on plasma samples must be obtained, but he is disinclined to . . .
Initial Management of Ingestions of Toxic Substances
Authors: Jane F. Desforges, Kenneth Kulig
Journal: New England Journal of Medicine (1992)

THE total number of patients who present at emergency departments because of drug overdose is difficult to ascertain, but in many facilities it is inordinately high. In one urban hospital, for example, overdoses and other drug-related emergencies are responsible for 38 percent of visits to the emergency department.1 Toxicologic emergencies may in fact constitute a public health crisis.1 In 1990 the American Association of Poison Control Centers (AAPCC) documented 1,713,465 reports of human exposure to toxins that resulted in consultations with a poison center; 10 percent of these exposures were considered intentional.2 These data do not include drug overdoses that . . .
PWE-331 Impact of the interval between long-course chemoradiotherapy and resection of locally-advanced rectal cancer upon mri down-staging – data from a pilot randomised controlled trial
Authors: J Foster, H Roach, N Francis
Journal: Gut (2015)

<h3>Introduction</h3> The optimal time interval between chemoradiotherapy (CRT) and surgery for rectal cancer has not been clearly defined. A longer interval may facilitate greater tumour down-staging. There is, however a paucity of high-quality evidence, with the majority of published data being from observational studies. <h3>Method</h3> This study explores down-staging of rectal cancer assessed by Magnetic Resonance Imaging (MRI) within a pilot Randomised Controlled Trial (RCT) comparing an interval of six weeks versus an interval of 12 weeks. Patients with rectal cancer requiring long-course CRT from seven sites were randomised to have surgery after an interval of either 6 weeks or 12 weeks following completion of long-course CRT. MRI scans were performed at baseline and at approximately 1 week prior to surgery. Additionally in the 12-week arm an additional “interval” MRI scan was performed approximately 5–6 weeks after completion of CRT. All scans were de-identified and analysed by a single blinded consultant gastrointestinal radiologist. Tumours were staged using the TNM system and the response to CRT by the tumour regression grade (TRG) system. <h3>Results</h3> Fifteen patients were randomised to surgery at 6-weeks and 16 to surgery at 12-weeks. Six patients (40%) from the 6-week arm and seven (50%) from the 12-week arm showed down-staging of the primary tumour by 1 or more stage between baseline and pre-operative MRI scans. Lymph node down-staging was observed for 10 patients (67%) in the 6-week arm and nine patients (64%) in the 12-week arm. No patients had an increase in T stage, although two patients in the 6-week arm had an increase in N stage between baseline and 6 weeks. Three patients (21%) in the twelve week arm showed ongoing down-staging of T stage on MRI between 6 and 12-weeks, and four patients had a reduction of their TRG between scans, indicating ongoing down-staging. <h3>Conclusion</h3> Although limited by small sample size, this analysis of data from a randomised controlled trial demonstrates that ongoing down-staging may continue between six and twelve weeks following completion of CRT. A longer interval might be considered where resection margins are still threatened on MRI at six weeks. <h3>Disclosure of interest</h3> None Declared.
Recruitment into studies assessing optimum duration of treatment must continue
Authors: H. Earl, P. Baker, D. Kerr, M. Lee, R. Gray, M. Baum
Journal: BMJ (1996)

EDITOR,—R D Bulbrook's editorial prejudges the issue of the duration of tamoxifen as adjuvant treatment for breast cancer.1 Its conclusions are based on an announcement by the American National Cancer Institute that the national surgical adjuvant breast and bowel project trial B-14, which compared five with up to 10 years of tamoxifen, was to be stopped on the advice of the data monitoring committee. On the basis of unpublished data from just over 1500 randomised patients from this and a Scottish study …