tbuckley/cabot-search huggingface dataset:
Smoking and Its Association With Morbidity in Systemic Lupus Erythematosus Evaluated by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index: Preliminary Data and Systematic Review
Authors: Ricardo A. Montes, Luiz O. Mocarzel, Pedro G. Lanzieri, Lais M. Lopes, Amanda Carvalho, Jorge R. Almeida
Journal: Arthritis & Rheumatology (2015)

Due to the increased availability of effective treatments, patients with systemic lupus erythematosus (SLE) now have longer survival times, and factors involved in cumulative chronic damage in SLE need to be better understood. This study was undertaken to evaluate the relationship between smoking and cumulative chronic damage in SLE patients.A cross-sectional study of SLE patients was performed to investigate the possible association between smoking exposure (ever [previous or current, active or secondhand smokers] or never) and cumulative chronic damage as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). A systematic review of the literature was conducted by cross-searching Medline for the terms lupus and smoking.We enrolled 105 patients with SLE (96% female), with a mean ± SD age of 40.7 ± 11.4 years and a mean followup time of 8.98 years. Of the 105 patients, 74 had an SDI score of 1-10, and 31 had an SDI score of 0. The difference between smoking exposure and no smoking exposure was significant (P = 0.02 by chi-square test in contingency table analysis), and SLE patients who were never exposed to smoking had 0.78 times the risk of progressing toward a cumulative damage status (SDI score of > 0) (95% confidence interval 0.16-0.98) throughout the followup period compared to those who were ever exposed. In the systematic review of the literature, we found only a small number of articles that addressed some aspects of the relationship between smoking exposure and cumulative damage in SLE patients.Our findings indicate that smoking exposure is associated with cumulative chronic damage, as determined by the SDI score, in patients with SLE. Smoking exposure may have deleterious effects on lupus morbidity, and more detailed studies of this association are needed.
Case 26-1999
Authors: Dennis P. Lund, Carolyn C. Compton
Journal: New England Journal of Medicine (1999)

Presentation of CaseA three-week-old girl was admitted to the hospital for the treatment of hypertrophic pyloric stenosis.The infant had been delivered by cesarean section because of an abnormal fetal-heart tracing. She was born at 39 weeks' gestation to a 38-year-old woman (gravida 5, para 2). There were no maternal risk factors for sepsis, and the prenatal screening tests were unremarkable. Hydramnios was noted on a fetal ultrasonographic study performed eight days before delivery. The birth weight was 3115 g; the Apgar scores were 4 at one minute and 8 at five minutes. The mother had received lithium during . . .
A Controlled Clinical Trial of Dichloroacetate for Treatment of Lactic Acidosis in Adults
Authors: Peter W. Stacpoole, Elizabeth C. Wright, Thomas G. Baumgartner, Robert M. Bersin, Scott Buchalter, Stephen H. Curry, Charles A. Duncan, Eloise M. Harman, George N. Henderson, Steven Jenkinson, John M. Lachin, Anthea Lorenz, Stephen H. Schneider, John H. Siegel, Warren R. Summer, Douglas Thompson, Christopher L. Wolfe, Barbara Zorovich
Journal: New England Journal of Medicine (1992)

Mortality is very high in lactic acidosis, and there is no satisfactory treatment other than treatment of the underlying cause. Uncontrolled studies have suggested that dichloroacetate, which stimulates the oxidation of lactate to acetyl-coenzyme A and carbon dioxide, might reduce morbidity and improve survival among patients with this condition.We conducted a placebo-controlled, randomized trial of intravenous sodium dichloroacetate therapy in 252 patients with lactic acidosis; 126 were assigned to receive dichloroacetate and 126 to receive placebo. The entry criteria included an arterial-blood lactate concentration of > or = 5.0 mmol per liter and either an arterial-blood pH of < or = 7.35 or a base deficit of > or = 6 mmol per liter. The mean (+/- SD) arterial-blood lactate concentrations before treatment were 11.6 +/- 7.0 mmol per liter in the dichloroacetate-treated patients and 10.4 +/- 5.5 mmol per liter in the placebo group, and the mean initial arterial-blood pH values were 7.24 +/- 0.12 and 7.24 +/- 0.13, respectively. Eighty-six percent of the patients required mechanical ventilation, and 74 percent required pressor agents, inotropic drugs, or both because of hypotension.The arterial-blood lactate concentration decreased 20 percent or more in 83 (66 percent) of the 126 patients who received dichloroacetate and 45 (36 percent) of the 126 patients who received placebo (P = 0.001). The arterial-blood pH also increased more in the dichloroacetate-treated patients (P = 0.005). The absolute magnitude of the differences was small, however, and they were not associated with improvement in hemodynamics or survival. Only 12 percent of the dichloroacetate-treated patients and 17 percent of the placebo patients survived to be discharged from the hospital.Dichloroacetate treatment of patients with severe lactic acidosis results in statistically significant but clinically unimportant changes in arterial-blood lactate concentrations and pH and fails to alter either hemodynamics or survival.
Enzyme Replacement Therapy for Adenosine Deaminase Deficiency and Severe Combined Immunodeficiency
Authors: Stephen H. Polmar, Robert C. Stern, Alan L. Schwartz, Erica M. Wetzler, Patricia A. Chase, Rochelle Hirschhorn
Journal: New England Journal of Medicine (1976)

To evaluate their role as a form of replacement therapy, frozen irradiated red blood cells were administered to a child with adenosine deaminase deficiency associated with severe combined immunodeficiency disease. In vitro lymphocyte responses to mitogens and allogeneic cells were restored. Subsequently, a "thymus shadow" appeared, and immunoglobulin synthesis was demonstrated. Frozen irradiated plasma, which alone had no effect on lymphocytes numbers or responses, promoted lymphocytosis when given with frozen irradiated red blood cells. The patient received the transfusions with or without irradiated plasma at four-week intervals and remained free of infection for 17 months. The patient's lymphocyte adenosine triphosphate levels were elevated before therapy, which consistently reduced them without altering the lymphocyte adenosine deaminase activity. Enzyme replacement therapy may provide a way to treat patients with adenosine deaminase deficiency associated with severe combined immunodeficiency disease who do not have histocompatible bone-marrow donors.
Serum troponin surveillance to predict cardiotoxicity of doxorubicin in adults with metastatic sarcoma.
Authors: Samuel John Harris, Marco Maruzzo, Juan Martin-Liberal, Attila Kollar, Allison Dunlop, Komel Khabra, Aisha Miah, Robin Lewis Jones, Ian Robert Judson, Alexander R. Lyon, Charlotte Benson
Journal: Journal of Clinical Oncology (2015)

e21516 Background: Doxorubicin (Dox.) (alone or in combination) is the standard first line therapy for metastatic soft tissue sarcoma (STS). Cardiotoxocity is an important complication of dox., and is often defined as left ventricular ejection fraction (LVEF) < 50% or drop of > 10%. Studies in patients treated with high dose chemotherapy have suggested that elevated troponin levels predict the development of cardiotoxicity. However, conflicting data exists for conventional dose chemotherapy. We aimed to evaluate the utility of troponin to predict cardiotoxicity in metastatic STS patients treated with dox. Methods: Over 18 months, all patients with metastatic STS receiving single agent dox. received echocardiograms and serum troponin I (TnI) levels at baseline and following cycles 2, 4 and 6. TnI was measured using the Beckmann Coulter Access 2 assay with a normal range of < 40 ng/L. Results: 41 patients (28 female, 13 males), median age 58 years, were studied. 11 (27%) had cardiac risk factors. Median number of cycles of dox. was 4, with a mean cumulative dose of 237 mg/m2. 13 (31%) patients had a drop in LVEF of > 10%. 5 (12%) patients had a fall of LVEF below 50%, of whom 3 were symptomatic. TnI became elevated in 14 patients. Age > 65 was the only significant risk factor for developing cardiotoxicity (RR 7.74, p = 0.039). Sensitivity, specificity, positive and negative predictive values are summarised in the table below. Conclusions: This is the first study in metastatic STS treated with dox. to evaluate the use of TnI . The incidence of clinically significant early cardiotoxicity was higher than previously reported with 12% of patients developing a fall in LVEF to < 50%. TnI levels had excellent sensitivity for detecting a drop in LVEF below 50% or developing symptomatic cardiac failure and had an excellent negative predictive value. Although requiring prospective confirmation, these results suggest that use of TnI surveillance in STS patients on dox. may be beneficial, potentially allowing early detection and prevention of cardiac damage. TnI > N LVEF <50% LVEF Fall >10% Symptomatic Cardiac Failure Sensitivity 100% 57.1% 100% Specificity 60% 60% 61% Positive Predictive Value 28.6% 42% 28.6% Negative Predictive Value 100% 60% 100%
Is Therapeutic Deception Legal?
Authors: Woodrow W. Weiss
Journal: New England Journal of Medicine (1950)

IS THERAPEUTIC DECEPTION LEGAL?To withhold from a patient the diagnosis, the extent or the dangers of his disease may be not only a matter of good therapeutics but also one of ethics and law. Most physicians view the problem of what to tell a patient suffering with a serious disease from the perspective of the patient's total personality and attempt to protect the emotionally unstable from disastrous psychic trauma. Few practitioners realize that this can lead to a dangerous schism. Doctors are torn between a therapeutic and ethical duty "to do no harm" and a legal duty inherent in . . .
Invasive Assessment of Coronary Physiology Predicts Late Mortality After Heart Transplantation
Authors: Hyoung-Mo Yang, Kiran Khush, Helen Luikart, Kozo Okada, Hong-Seok Lim, Yuhei Kobayashi, Yasuhiro Honda, Alan C. Yeung, Hannah Valantine, William F. Fearon
Journal: Circulation (2016)

The aim of this study is to determine the prognostic value of invasively assessing coronary physiology early after heart transplantation.Seventy-four cardiac transplant recipients had fractional flow reserve, coronary flow reserve, index of microcirculatory resistance (IMR), and intravascular ultrasound performed down the left anterior descending coronary artery soon after (baseline) and 1 year after heart transplantation. The primary end point was the cumulative survival free of death or retransplantation at a mean follow-up of 4.5±3.5 years. The cumulative event-free survival was significantly lower in patients with a fractional flow reserve <0.90 at baseline (42% versus 79%; P=0.01) or an IMR ≥20 measured 1 year after heart transplantation (39% versus 69%; P=0.03). Patients in whom IMR decreased or did not change from baseline to 1 year had higher event-free survival compared with patients with an increase in IMR (66% versus 36%; P=0.03). Fractional flow reserve <0.90 at baseline (hazard ratio, 0.13; 95% confidence interval, 0.02-0.81; P=0.03), IMR ≥20 at 1 year (hazard ratio, 3.93; 95% confidence interval, 1.08-14.27; P=0.04), and rejection during the first year (hazard ratio, 6.00; 95% confidence interval, 1.56-23.09; P=0.009) were independent predictors of death/retransplantation, whereas intravascular ultrasound parameters were not.Invasive measures of coronary physiology (fractional flow reserve and IMR) determined early after heart transplantation are significant predictors of late death or retransplantation.
Case 28-2011
Authors: Eleftherios Mylonakis, Victorine V. Muse, Mari Mino-Kenudson
Journal: New England Journal of Medicine (2011)

A 74-year-old man with pemphigus vulgaris was referred to this hospital for evaluation of lung nodules. Imaging of the chest revealed multiple ill-defined nodules, some with marked 18F-fluorodeoxyglucose avidity. A diagnostic procedure was performed.
The Risk of Breast Cancer after Estrogen and Estrogen–Progestin Replacement
Authors: Leif Bergkvist, Hans-Olov Adami, Ingemar Persson, Robert Hoover, Catherine Schairer
Journal: New England Journal of Medicine (1989)

To examine the risk of breast cancer after non-contraceptive treatment with estrogen, we conducted a prospective study of 23,244 women 35 years of age or older who had had estrogen prescriptions filled in the Uppsala region of Sweden. During the follow-up period (mean, 5.7 years) breast cancer developed in 253 women. Compared with other women in the same region, the women in the estrogen cohort had an overall relative risk of breast cancer of 1.1 (95 percent confidence interval, 1.0 to 1.3). The relative risk increased with the duration of estrogen treatment (P = 0.002), reaching 1.7 after nine years (95 percent confidence interval, 1.1 to 2.7). Estradiol (used in 56 percent of the treatment periods in the cohort) was associated with a 1.8-fold increase in risk after more than six years of treatment (95 percent confidence interval, 0.7 to 4.6). No increase in risk was found after the use of conjugated estrogens (used in 22 percent of the treatment periods) or other types, mainly estriols (used in 22 percent of the treatment periods). Although the numbers of women were smaller, the risk of breast cancer was highest among the women who took estrogen and progestin in combination for extended periods. The relative risk was 4.4 (95 percent confidence interval, 0.9 to 22.4) in women who used only this combination for more than six years. Among women who had previously used estrogens alone, the relative risk after three years or more of use of the combination regimen was 2.3 (95 percent confidence interval, 0.7 to 7.8). We conclude that in this cohort, long-term perimenopausal treatment with estrogens (or at least estradiol compounds) seems to be associated with a slightly increased risk of breast cancer, which is not prevented and may even be increased by the addition of progestins. (N Engl J Med 1989; 321:293–7.)
Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study
Authors: Ravindra L Mehta, Emmanuel A Burdmann, Jorge Cerdá, John Feehally, Fredric Finkelstein, Guillermo García-García, Melanie Godin, Vivekanand Jha, Norbert H Lameire, Nathan W Levin, Andrew Lewington, Raúl Lombardi, Etienne Macedo, Michael Rocco, Eliah Aronoff-Spencer, Marcello Tonelli, Jing Zhang, Giuseppe Remuzzi
Journal: The Lancet (2016)
The B* allele of Glutathione-S-transferase P1 is a risk factor for asthma in Italian children
Authors: F Angelini, P Gravina, M Chianca, A Valentini, R Iannini, A Pierantozzi, Moschese, S Corrente, M La Rocca, S Graziani, G Federici, L Chini, S Bernardini
Journal: Allergy (2008)
Cerebrospinal-Fluid Acid-Base and Electrolyte Changes Resulting from Cerebral Anoxia in Man
Authors: Eugene M. Kalin, William A. Tweed, Joseph Lee, William L. MacKeen
Journal: New England Journal of Medicine (1975)

To study metabolic changes in the central nervous system after profound anoxia, we measured changes in cisternal and lumbar cerebrospinal fluid. Acid-base values and electrolyte concentrations were determined in cisternal and lumbar fluid from 12 severely anoxic patients (cardiac arrest), and from 15 within 24 hours after cardiac resuscitation. In the severely anoxia patients the normal cisternal-lumbar pH gradient was reversed, cisternal fluid was more acid (pH 6.815 vs. 6.953), and cisternal potassium concentration was twice that of lumbar (6.7 vs 3.5 mEq per liter). These findings indicate that during anoxia potassium and hydrogen ion flow from brain cells into the brain extracellular fluid, and that acute changes are reflected more accurately by cisternal than by lumbar fluid. In resuscitated patients cisternal fluid was normal, and normal cisternal-lumbar differences were found; thus, the normal milieu of brain cells is rapidly reestablished after resuscitation.
Results of a phase II trial of cetuximab+XELIRI as first-line therapy of patients with advanced and/or metastatic colorectal cancer
Authors: T. H. Cartwright, P. Kuefler, A. Cohn, W. Hyman, K. A. Boehm, D. Ilegbodu, L. Asmar
Journal: Journal of Clinical Oncology (2006)

13502 Background: We have previously shown that capecitabine/irinotecan (XELIRI) is effective and well-tolerated in metastatic colorectal cancer (mCRC). Cetuximab targets EGFR and is active in mCRC either alone or combined with chemotherapy. This study evaluated potential improved outcomes with cetuximab+XELIRI in first-line treatment of mCRC. Subjects and Methods: Subjects had histologically confirmed colorectal adenocarcinoma with T4 lesions that were deemed unresectable after preoperative chemoradiation and/or metastatic disease. Treatment: capecitabine 1700 mg/m 2 (850 mg/m 2 PO BID Days 1–14), irinotecan 200 mg/m 2 IV Day 1 every 3 weeks, and weekly cetuximab (initial dose 400 mg/m 2 IV over 120 minutes, subsequent doses 250 mg/m 2 over 30 minutes). Toxicity was assessed at each visit. Results: Between February and October 2005, 70 subjects enrolled. Baseline characteristics: 43 males (61%), 79% White, median age 61.5 years (range, 32.2 - 85.4), and ECOG PS 0/1= 66%/34%. 63% of subjects had Stage IV disease at diagnosis; 87% of subjects had adenocarcinoma. Prior therapy: surgery (n=60, 86%), chemotherapy (n=14, 20%), and radiotherapy (n=5, 7%). Grade 3–4 treatment-related toxicities in &gt;1 subject included diarrhea (17%); neutropenia and rash (8.5% each); dehydration (7%); nausea/vomiting (5%); and anorexia, dyspepsia, and hypokalemia (3% each). 30 subjects discontinued due to progressive disease (PD) (n=9), toxicity (n=12), MD decision (n=2), patient request/withdrew consent (n=3), death (n=1) and other (n=3; doses delayed &gt;3 weeks). To date 5 subjects have died; no death was treatment-related. Evaluation of tumor responses is ongoing. Conclusions: The combination of cetuximab+XELIRI is feasible and well-tolerated in first-line mCRC. Updated safety and efficacy data will be presented. Funded in part by Bristol-Myers Squibb, Plainsboro, NJ. [Table: see text]
JBrowse: a dynamic web platform for genome visualization and analysis
Authors: Robert Buels, Eric Yao, Colin M. Diesh, Richard D. Hayes, Monica Munoz-Torres, Gregg Helt, David M. Goodstein, Christine G. Elsik, Suzanna E. Lewis, Lincoln Stein, Ian H. Holmes
Journal: Genome biology (2016)

JBrowse is a fast and full-featured genome browser built with JavaScript and HTML5. It is easily embedded into websites or apps but can also be served as a standalone web page.Overall improvements to speed and scalability are accompanied by specific enhancements that support complex interactive queries on large track sets. Analysis functions can readily be added using the plugin framework; most visual aspects of tracks can also be customized, along with clicks, mouseovers, menus, and popup boxes. JBrowse can also be used to browse local annotation files offline and to generate high-resolution figures for publication.JBrowse is a mature web application suitable for genome visualization and analysis.
Antibodies and Clinical Resistance to Parathyroid Hormone
Authors: Roger A. Melick, John R. Gill, Solomon A. Berson, Rosalyn S. Yalow, Frederic C. Bartter, John T. Potts, G. D. Aurbach
Journal: New England Journal of Medicine (1967)

A HYPOPARATHYROID subject acquired resistance to the effects of parathyroid extract (parathyroid, U.S.P.) during treatment. Resistance developed in association with specific antibody detected as gamma globulin with affinity for binding 131I-labeled parathyroid hormone in soluble complexes. The findings are presented below.Case ReportA.S. (04–75–11), a 39-year-old woman, first noted thyroid enlargement in 1946. In 1954, the thyroid gland began to increase further in size; she became nervous, and lost 4.5 kg. (10 pounds) in weight. A subtotal thyroidectomy was performed in February, 1955; on the 3d or 4th postoperative day she complained of tingling of the lips and . . .
Breast Cancer Incidence Among Atomic Bomb Survivors, Hiroshima and Nagasaki, 1950–69
Authors: D. H. McGregor, C. E. Land, K. Choi, S. Tokuoka, P. I. Liu, T. Wakabayashi, G. W. Beebe
Journal: JNCI Journal of the National Cancer Institute (1977)

Journal Article Breast Cancer Incidence Among Atomic Bomb Survivors, Hiroshima and Nagasaki, 1950–69 Get access D. H. McGregor, D. H. McGregor Search for other works by this author on: Oxford Academic PubMed Google Scholar C. E. Land, C. E. Land Search for other works by this author on: Oxford Academic PubMed Google Scholar K. Choi, K. Choi Search for other works by this author on: Oxford Academic PubMed Google Scholar S. Tokuoka, S. Tokuoka Search for other works by this author on: Oxford Academic PubMed Google Scholar P. I. Liu, P. I. Liu Search for other works by this author on: Oxford Academic PubMed Google Scholar T. Wakabayashi, T. Wakabayashi Search for other works by this author on: Oxford Academic PubMed Google Scholar G. W. Beebe G. W. Beebe Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 59, Issue 3, September 1977, Pages 799–811, https://doi.org/10.1093/jnci/59.3.799 Published: 01 September 1977 Article history Received: 03 December 1976 Accepted: 18 April 1977 Published: 01 September 1977
Blood pressure lowering does not reduce risk of cardiovascular events in patients at intermediate risk
Authors: Ingrid Torjesen
Journal: BMJ (2016)

A major trial on the potential of statins and antihypertensives to reduce cardiovascular events in intermediate risk people has found that blood pressure lowering does not reduce the risk of such events.1

For the Heart Outcomes Prevention Evaluation (HOPE)-3 trial, the results of which have been published in the New England Journal of Medicine , 12 705 intermediate risk patients (men aged at least 55 and women aged at least 60) without cardiovascular disease were randomly assigned to receive cholesterol lowering treatment with rosuvastatin 10 mg a day or placebo. The trial had a 2 x 2 factorial design, so patients …
Survival of Patients Undergoing Chronic Hemodialysis and Renal Transplantation
Authors: Edmund G. Lowrie, J. Michael Lazarus, Altair J. Mocelin, George L. Bailey, Constantine L. Hampers, Richard E. Wilson, John P. Merrill
Journal: New England Journal of Medicine (1973)

Over an eight-year period 172 patients received an allograft from a living, related donor, 112 received cadaveric transplants, and 125 were placed on home dialysis. In a period of three years, 287 patients passed through our center dialysis program. Analysis of survival curves shows that patient survival was significantly better in recipients of transplants from living, related donors and in dialysis patients than in those receiving a cadaver graft. One-year patient survival rates for recipients of parental, sibling and cadaver allografts were 84.2, 89.5 and 68.7 per cent respectively. Survival rates at one and two years for home-dialysis patients were 88.5 and 77.8 per cent, and similar values for center patients were 92.9 and 86.1 per cent. These probabilities should be considered in the choice of which form of therapy to employ in a given patient, and illustrate the need for continued investigation into the prevention of allograft rejection and cadaver-recipient selection, (N Engl J Med 288:863–867, 1973)
Abstract 14100: Oral Anticoagulant Discontinuation in Patients With Nonvalvular Atrial Fibrillation
Authors: Sameer R Ghate, Melissa Hamilton, Xianchen Liu, Xianying Pan, Diana I Brixner, Nassir Marrouche, Joseph Biskupiak
Journal: Circulation (2013)

Objective: To identify factors associated with discontinuation of oral anticoagulants among patients with non-valvular atrial fibrillation (NVAF). Methods: A retrospective cohort study was conducte...