tbuckley/cabot-search huggingface dataset:
Sex, Clinical Presentation, and Outcome in Patients with Acute Coronary Syndromes
Authors: Judith S. Hochman, Jacqueline E. Tamis, Trevor D. Thompson, W. Douglas Weaver, Harvey D. White, Frans Van de Werf, Phil Aylward, Eric J. Topol, Robert M. Califf
Journal: New England Journal of Medicine (1999)

Studies have reported that women with acute myocardial infarction have in-hospital and long-term outcomes that are worse than those of men.To assess sex-based differences in presentation and outcome, we examined data from the Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb study, which enrolled 12,142 patients (3662 women and 8480 men) with acute coronary syndromes, including infarction with ST-segment elevation, infarction with no ST-segment elevation, and unstable angina.Overall, the women were older than the men, and had significantly higher rates of diabetes, hypertension, and prior congestive heart failure. They had significantly lower rates of prior myocardial infarction and were less likely ever to have smoked. A smaller percentage of women than men had infarction with ST elevation (27.2 percent vs. 37.0 percent, P<0.001), and of the patients who presented with no ST elevation (those with myocardial infarction or unstable angina), fewer women than men had myocardial infarction (36.6 percent vs. 47.6 percent, P<0.001). Women had more complications than men during hospitalization and a higher mortality rate at 30 days (6.0 percent vs. 4.0 percent, P<0.001) but had similar rates of reinfarction at 30 days after presentation. However, there was a significant interaction between sex and the type of coronary syndrome at presentation (P=0.001). After stratification according to coronary syndrome and adjustment for base-line variables, there was a nonsignificant trend toward an increased risk of death or reinfarction among women as compared with men only in the group with infarction and ST elevation (odds ratio, 1.27; 95 percent confidence interval, 0.98 to 1.63; P=0.07). Among patients with unstable angina, female sex was associated with an independent protective effect (odds ratio for infarction or death, 0.65; 95 percent confidence interval, 0.49 to 0.87; P=0.003).Women and men with acute coronary syndromes had different clinical profiles, presentation, and outcomes. These differences could not be entirely accounted for by differences in base-line characteristics and may reflect pathophysiologic and anatomical differences between men and women.
Sudden Death in Epilepsy: An Avoidable Outcome?
Authors: G Y H Lip, M J Brodie
Journal: Journal of the Royal Society of Medicine (1992)

In a retrospective survey of mortality among the first 1000 unselected patients referred to the Epilepsy Research Unit at the Western Infirmary in Glasgow between 1985 and 1990, a total of 18 deaths were identified. Three patients had committed suicide and one each had died of status epilepticus in hospital, a subdural haematoma and a myocardial infarction. The remaining 12 deaths (67%) were sudden (median age 32 years; range 22-68 years). Poor seizure control and poor compliance with antiepileptic drug therapy were recorded in only three (25%) of these patients. There was a change in antiepileptic drug regimen in five (28%) in the month before death. Only two (17%) underwent postmortem examination. In nine of the 12 patients dying suddenly, the primary cause of death was not listed as epilepsy but as asphyxia (3), aspiration (2) and one each of ischaemic heart disease, myocardial infarction, asystole and drowning (in the bath). 'Status epilepticus' was assumed to have been responsible for the other three deaths, two of which were unwitnessed. Sudden death in people with epilepsy is an entity of great concern. Appropriate death certification and mandatory postmortem examination are essential to provide a truer picture of this neglected phenomenon.
A phase 2 clinical trial of AP23573, an mTOR inhibitor, in patients with relapsed or refractory hematologic malignancies
Authors: E. Feldman, F. Giles, G. Roboz, K. Yee, T. Curcio, V. M. Rivera, M. Albitar, R. Laliberte, C. L. Bedrosian
Journal: Journal of Clinical Oncology (2005)

6631 Background: AP23573 (AP) is a non-prodrug rapamycin analog that inhibits mTOR, a downstream effector of the PI3K/Akt and nutrient-sensing pathways. In phase I clinical trials, AP completely inhibited in vivo mTOR activity in PBMCs as measured by decreased phosphorylation levels of the mTOR target protein 4EBP-1. Because the mTOR pathway has been implicated in the pathobiology of hematological malignancies, this study was undertaken in this patient population to determine the safety and efficacy of AP treatment (12.5mg I.V. daily x 5 days, every-2-week). In addition, correlative studies in PBMC and BM samples will examine if tumoral mTOR pathway status predicts clinical response. Methods: Eligible patients with relapsed or refractory hematologic malignancies are being enrolled and stratified into 5 disease specific groups. Enrollment into each group is proceeding according to a Simon’s two-stage design with a minimum of 21 patients per group and an overall total enrollment of up-to 205. Efficacy is being assessed according to standard response criteria at the end of each cycle (4 weeks), except the interval is every 2 cycles for patients with lymphoma. In addition, PD/biomarker sampling for correlative studies are completed during cycle 1 study treatment. Results: At this time, a total of 12 patients have been enrolled in the study, including 6 AML, 3 AMM, 2 ALL, and 1 MDS. The patients include 8 males and 4 females with a median age of 76 years (range 43 - 84). Eleven patients have completed the end-of-Cycle 1 response assessment and 1 (ALL) is too early to assess. Of the 11 patients, 3 (2 AML, 1 AMM) had hematologic improvement -minor responses, 3 pts (2 AML, 1AMM) had stable disease, and 4 (3 AML, 1 AMM) had disease progression. Serious, treatment related adverse events have included hypertriglyceridemia, neutropenic sepsis, and mucositis (1 patient each). Results of correlative studies are in progress. Conclusion: Thus far, AP study treatment has provided minor responses or stable disease among 6 of 11 evaluable patients at the Cycle 1 assessment. Patient enrollment and treatment is continuing to enable response analysis for each histologic group. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Ariad Ariad Ariad
Multiple Congenital Abnormalities Associated with Chromosomal Trisomy
Authors: Leonard Atkins, Murray K. Rosenthal, David A. Flory
Journal: New England Journal of Medicine (1961)

CASES of trisomy involving human chromosomes have recently been summarized.1 It is now established that trisomy of one of the small acrocentric chromosomes (Denver numbering system, Group 21–222) is associated with the clinical syndrome of mongolism.3 4 5 6 Edwards and his co-workers7 have described a female infant with congenital anomalies and trisomy of chromosome No. 17. Two cases of trisomy in Group 16–18 with congenital abnormalities, some of which were similar to those of the patient of Edwards and his associates,7 have been reported by Smith et al.,8 who, in an addendum to their paper, mention 4 additional cases of similar . . .
Stereoscopic Cards in Early 20th Century Dermatologic Education
Authors: Jonathan Kantor
Journal: JAMA Dermatology (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal
Case 14-2001
Authors: Harley A. Haynes, Fiona M. Graeme-Cook, Lisa H. Lerner
Journal: New England Journal of Medicine (2001)

Presentation of CaseA 47-year-old woman was admitted to the hospital for the third time because of a painful, red swelling of the right foot.Nine months before the third admission, the patient had awoken during the night because of pain in the lower left leg; she suspected that she had been bitten by an insect, possibly a spider. The area became erythematous with draining pustules; a culture yielded rare colonies of coagulase-negative Staphylococcus aureus. Cephalexin and amoxicillin–clavulanic acid were ineffective, and the lesion worsened. The temperature rose to 37.9°C, with chilliness and sweats, and the patient was admitted to . . .
Somatic Mutations Modulate Autoantibodies against Galactose-Deficient IgA1 in IgA Nephropathy
Authors: Zhi Qiang Huang, Milan Raska, Tyler J. Stewart, Colin Reily, R. Glenn King, David K. Crossman, Michael R. Crowley, Audra Hargett, Zhixin Zhang, Hitoshi Suzuki, Stacy Hall, Robert J. Wyatt, Bruce A. Julian, Matthew B. Renfrow, Ali G. Gharavi, Jan Novak
Journal: Journal of the American Society of Nephrology (2016)

Autoantibodies against galactose-deficient IgA1 drive formation of pathogenic immune complexes in IgA nephropathy. IgG autoantibodies against galactose-deficient IgA1 in patients with IgA nephropathy have a specific amino-acid sequence, Y 1 CS 3 , in the complementarity-determining region 3 of the heavy chain variable region compared with a Y 1 CA 3 sequence in similar isotype-matched IgG from healthy controls. We previously found that the S 3 residue is critical for binding galactose-deficient IgA1. To determine whether this difference is due to a rare germline sequence, we amplified and sequenced the corresponding germline variable region genes from peripheral blood mononuclear cells of seven patients with IgA nephropathy and six healthy controls from whom we had cloned single-cell lines secreting monoclonal IgG specific for galactose-deficient IgA1. Sanger DNA sequencing revealed that complementarity-determining region 3 in the variable region of the germline genes encoded the Y 1 C(A/V) 3 amino-acid sequence. Thus, the A/V&gt;S substitution in the complementarity-determining region 3 of anti-galactose–deficient-IgA1 autoantibodies of the patients with IgA nephropathy is not a rare germline gene variant. Modeling analyses indicated that the S 3 hydroxyl group spans the complementarity-determining region 3 loop stem, stabilizing the adjacent β-sheet and stem structure, important features for effective binding to galactose-deficient IgA1. Understanding processes leading to production of the autoantibodies may offer new approaches to treat IgA nephropathy.
Cost Effectiveness of Aspirin, Clopidogrel, or Both for Secondary Prevention of Coronary Heart Disease
Authors: Jean-Michel Gaspoz, Pamela G. Coxson, Paula A. Goldman, Lawrence W. Williams, Karen M. Kuntz, M.G. Myriam Hunink, Lee Goldman
Journal: New England Journal of Medicine (2002)

Both aspirin and clopidogrel reduce the rate of cardiovascular events in patients with coronary heart disease. We estimated the cost effectiveness of the increased use of aspirin, clopidogrel, or both for secondary prevention in patients with coronary heart disease.
Reported Incidence of Hypersensitivity Reactions to Non-Steroidal Anti-Inflammatory Drugs in the Electronic Health Record
Authors: Kimberly G. Blumenthal, Kenneth H. Lai, Paige G. Wickner, Foster R. Goss, Diane L. Seger, Sarah P. Slight, Maxim Topaz, Frank Y. Chang, Li Zhou
Journal: Journal of Allergy and Clinical Immunology (2016)
Case 22-1985
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, Betty U. McNeely
Journal: New England Journal of Medicine (1985)

Presentation or Case An 88-year-old man was admitted to the hospital because of a right pleural effusion. He was in a stable state of health until two weeks before admission, when pruritus developed in the left side of the chest, followed by a vesicular eruption; his physician made a diagnosis of shingles. On the day before admission an x-ray film of the chest, obtained elsewhere in connection with a scheduled cataract extraction, showed a large right pleural effusion (Fig. 1). The patient was admitted to the hospital. There was a two-year history of anorexia, with loss of 9 kg in . . .
The Effects of Chloroquine on Serum 1,25-Dihydroxyvitamin D and Calcium Metabolism in Sarcoidosis
Authors: Timothy J. O'Leary, Glenville Jones, Agatha Yip, David Lohnes, Moussa Cohanim, Edmund R. Yendt
Journal: New England Journal of Medicine (1986)

Although corticosteroids are effective in the treatment of hypercalciuria and hypercalcemia in chronic sarcoidosis, complications of their long-term use frequently limit therapy. We studied the efficacy of chloroquine in two patients with sarcoidosis who were unable to tolerate the dosage of corticosteroids required to control hypercalciuria and prevent the formation of renal stones. Over a three-year period, each patient received a 6-month and a 10-month course of oral chloroquine phosphate (500 mg per day) while continuing to receive corticosteroids at a fixed dose. Chloroquine therapy was associated with a significant reduction in levels of serum 1,25-dihydroxyvitamin D (1,25-(OH)2D) and urinary calcium. We observed a direct correlation between serum 1,25-(OH)2D levels and 24-hour urinary calcium excretion, supporting the hypothesis that excessive serum 1,25-(OH)2D is responsible for the hypercalciuria in sarcoidosis. Serum levels of 25-hydroxyvitamin D (25-(OH)D) did not change with therapy, suggesting that chloroquine may act by inhibiting the conversion of 25-(OH)D to 1,25-(OH)2D. Current dosage guidelines and ophthalmologic-surveillance techniques, which allow chloroquine to be administered with little risk of retinopathy, should permit an expanded role for this agent in the treatment of the calcium abnormalities of sarcoidosis. (N Engl J Med 1986; 315: 727–30.)
Case 28-2001
Authors: Raymond T. Chung, Eric C. Sheffer
Journal: New England Journal of Medicine (2001)

Presentation of CaseA 44-year-old woman was admitted to this hospital because of abdominal pain, chills, fever, and jaundice.The patient, a native of southern China, had been treated for intrahepatic stones by lithotripsy five years before admission to this hospital. Two years after the procedure, she immigrated to the United States. Nineteen months before admission to this hospital, abdominal pain developed, with fever and chills. An abdominal computed tomographic (CT) scan obtained at another hospital revealed marked intrahepatic bile-duct dilatation and multiple intrahepatic calculi. Laboratory tests were performed (Table 1 and Table 2).Two weeks later, the patient was admitted to . . .
Hirschsprung's Disease (Aganglionic Megacolon)
Authors: Orvar Swenson
Journal: New England Journal of Medicine (1959)

HIRSCHSPRUNG'S disease has attracted the interest of physicians and surgeons for many years, and a voluminous medical literature has accumulated. The source of this interest was probably the perplexing nature of the disease. The patients' symptoms were those of partial mechanical obstruction; yet at operation or at post-mortem examination, such obstructive lesions were absent. It was generally assumed by surgeons that the massively dilated colon on the left side was the basic abnormality, and this prompted resection of this portion of the colon. Although this operation at times improved the child, the benefits were not lasting, with a gradual recurrence . . .
Iron Overload in Human Disease
Journal: New England Journal of Medicine (2012)

n engl j med 366;16 nejm.org april 19, 2012 1548 clinicians should consider clinical risk factors for fracture when ordering an initial BMD test. However, adjustment for several clinical risk factors had minimal effect on our estimates of the time to transition to osteoporosis, except for a significant trend for age. These results suggest that current BMD T scores and age are the most important determinants of subsequent testing intervals. We strongly agree with Lewiecki and colleagues that too few initial BMD tests are performed in older women.4 An appropriate response to our results would be for primary care physicians to substantially increase the number of initial tests in older women, then to tailor the subsequent BMD screening interval according to BMD T score and age. Because the rate of BMD loss at the hip after age 65 is significantly higher for white women than for nonwhite women,5 our estimated screening intervals are shorter than the expected intervals for nonwhite older women. We expect that most clinicians would choose to apply the shorter screening intervals for white women to all women regardless of race or ethnic background. The data provided by Leslie and colleagues are important and relevant, since the effectiveness of a screening program depends not only on the frequency of the screening test but also on identifying patients who can benefit from and will actually receive treatment. Prospective studies of the clinical effect of BMD screening should include assessment of receipt of treatment.
Significance of changes in serum CA125 level on overall survival in ovarian cancer
Authors: S. Williams, D. Gupta, S. Dahlk, K. E. Dzike, G. M. Lambert, C. A. Lammersfeld
Journal: Journal of Clinical Oncology (2009)

e16546 Background: The role of baseline serum CA125 as a prognostic indicator in ovarian cancer is well documented. However, little is known about the impact of change in CA125 on survival after 3 months of therapy. We conducted survival analysis to answer the question “what is the prognostic impact of change in serum CA125 after 3 months of therapy in ovarian cancer?” Methods: A case series of 170 ovarian cancer patients treated at Cancer Treatment Centers of America between Jan 01 and May 06. Based on CA125 levels at baseline and 3 months, patients were classified into 4 groups: 1) Normal (0–35U/ml) at baseline and three months; 2) High (&gt;35U/ml) at baseline, normal at three months; 3) Normal at baseline, high at 3 months; 4) High at baseline and three months. Kaplan Meier method was used to calculate survival across the 4 categories, which was defined as the time interval between date of patient visit at 3 months from first visit and date of death from any cause or date of last contact. Results: Of 170 patients, 36 were newly diagnosed while 134 had received prior treatment. 25 had stage I disease at diagnosis, 15 stage II, 106 stage III and 14 stage IV. The median age at presentation was 54.2 years (range 23.1 - 82.5 years). At baseline, 31 patients had normal (0–35U/ml) serum CA125 levels while 138 had high (&gt;35U/ml) levels. At 3 months, 59 had normal while 111 had high levels. In this cohort, patients with a reduced CA125 at 3 months (stratum 2) had a significantly better survival than those with increased CA125 at 3 months (stratum 3). Patients with normal values of CA125 at both baseline and 3 months (stratum 1) had the best overall survival. Conclusions: These data show that reduction in CA125 after 3 months of therapy is associated with better overall survival in ovarian cancer. Patients without a significant decline in CA125 after 3 months of therapy have a particularly poor prognosis. [Table: see text] No significant financial relationships to disclose.
Cisplatin resistance and ERCC1 gene regulation
Authors: Qing-Wu Yan, Jing Jie Yu
Journal: Cancer Research (2007)

4569  ERCC1 is a critical gene within the nucleotide excision repair pathway. Overexpression of ERCC1 through promoter-mediating transcription regulation is associated with repair of cisplatin-induced DNA damage and clinical resistance to platinum-chemotherapy. Several transcriptional repressors and activators within the 5’-flanking region of the ERCC1 gene may be involved in the up-regulation of this gene. Minimal promoter region analyzed by CAT assay demonstrated that the region from -220 to -110 was essential to constitutive expression of ERCC1 gene in ovarian cancer cell line A2780/CP70. A more forward upstream region seems to be responsible for cisplatin-induced expression. Identification of functional cis-element in this region by Electrophoretic Mobility Shift Assay revealed that an MZF1-like site as well as an AP1-like site responded to cisplatin stimulation with altered binding activities in a time-dependent manner. MZF1 mRNA in A2780/CP70 cells decreased upon cisplatin exposure as analyzed by real-time PCR, suggesting that MZF1 may mediate cisplatin-invoked gene expression in these cells. EMSA with MZF1 ZN1-4 consensus oligonucleotides suggests that the MZF1 N-terminal domain of zinc finger cluster may bind to the MZF1-like site of the ERCC1 promoter region. Overexpression of MZF1 could repress the ERCC1 promoter activity in a co-transfection assay, which further confirmed that MZF1 might be a repressor in regulation of ERCC1 transcription upon cisplatin exposure in A2780/CP70 cells. In summary, our studies revealed a core promoter region and adjacent drug-responsible region within the ERCC1 promoter. The drug-responsible region contains cis-elements of activator AP1 and repressor MZF1. In response to cisplatin treatment, decreased MZF1 and increased AP1 binding activities appear to be the leading mechanism of up-regulation of ERCC1 expression. Our findings suggest potential therapeutic strategies to antagonize cisplatin resistance in treatment of human ovarian cancer.
Conjunctival and Corneal Calcification in Hypercalcemia
Authors: Felix G. Fleischner, Seymour R. Shalek
Journal: New England Journal of Medicine (1949)

DEPOSITION of calcium or true ossification in the eyeball has been known to the ophthalmologist and pathologist. These conditions occur most commonly in the choroid and are believed to be often caused by injury. Twining and Shanks1 distinguished four groups of intraocular calcifications as seen roentgenologically: calcification of the lens, ossification of the vitreous, calcified atheroma of the ophthalmic artery and a shrunken calcified globe. Kautz and Schwartz2 described, in detail, the x-ray appearance of the ring-shaped calcific deposits in the choroid and also listed and discussed the differential diagnosis of other opacities in the orbit and globe, such as . . .
Infectious Diabetic Gangrene of the Skin of the Neck
Authors: Joseph Millett, Richard T. Darby
Journal: New England Journal of Medicine (1946)

WHEN diabetes mellitus and gangrene are associated, one usually thinks of this combination in relation to the extremities, along with arteriosclerotic peripheral vascular disease. Gangrene of other parts of the body is considered to be a rare complication of diabetes mellitus. Nevertheless a growing, if scattered, literature on this complication is accumulating. There has been reported diabetic gangrene of the nasal septum and turbinates,1 2 3 4 5 the orbit and nares,5 , 6 the nares alone,7 , 8 the right half of the tongue,6 the lip,9 the skin of the entire body,10 the face,5 , 6 , 11 12 13 the lung,14 the vulva15 and the glans penis and urethra.16 It is our . . .