tbuckley/cabot-search huggingface dataset:
Reflections on the Doctor's Anguish
Authors: Michael J. Burran
Journal: Annals of Internal Medicine (1993)

Letters1 January 1993Reflections on the Doctor's AnguishMichael J. Burran, MDMichael J. Burran, MDMethodist Hospital of Indiana; Indianapolis, IN 46202Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-1-199301010-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Drs. Edwards and Tolle [1] describe the emotional and ethical issues in withdrawing mechanical ventilation. They emphasize the conflict between the value of sedation to patient comfort and the medical concern about the decrease in respiratory drive and possible hastening of death.We have found a variation of the “terminal weaning” described by Grenvik [2] to be valuable. Ventilatory support, withdrawn gradually over a few hours using decreasing levels of mechanical ventilation or pressure support, plus small doses of intermediate-duration narcotics and benzodiazepines, allow minimal sedation and respiratory depression consistent with patient comfort. In the fully conscious ...References1. Edwards MJ, Tolle SW. Disconnecting a ventilator at the request of a patient who knows he will then die: the doctor's anguish. Ann Intern Med. 1992; 117:254-6. Google Scholar2. Grenvik A. “Terminal weaning”; discontinuance of life-support therapy in the terminally ill patient. Crit Care Med. 1983; 11:394-5. Google Scholar Author, Article, and Disclosure InformationAffiliations: Methodist Hospital of Indiana; Indianapolis, IN 46202 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 January 1993Volume 118, Issue 1Page: 78-80KeywordsAnalgesiaBloodDecision makingDyspneaEmotionsExtubationSedationVentilatorsVentilatory supportWeaning Issue Published: 1 January 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The distribution of labeled albumin across the rabbit thoracic aorta in vivo.
Authors: R LBratzler, G MChisolm, C KColton, K ASmith, D BZilversmit, R SLees
Journal: Circulation Research (1977)

125I-albumin was injected intravenously into normal conscious rabbits. The rabbits were killed after 10 minutes to 24 hours, and the descending thoracic aorta was excises immediately, opened longitudinally, rinsed, and frozen. Samples of frozen aorta were sectioned paralled to the intimal surface and washed with trichloroacetic acid (TCA) prior to counting. TCA-soluble tissue radioactivity slowly increased with time, suggesting that 125I was cleaved gradually from the labeled albumin within the aortic wall. At up to 4 hours, transmural concentration profiles of TCA-precipitable radioactivity had steep gradients near the intimal surface, moderate gradients near the medial-advential border, and were relatively falt in the middle of the media. After 24 hours, the steep intimal gradient had disappeared. Concentrations were otherwise comparable to those at 4 hours. The rate of accumulation of TCA-precipitable radioactivity was rapid initially (measurable concentrations were found throughout the media after onl...
Electron microscopic immunohistochemical identification of endothelial cells in the rabbit.
Authors: M BStemerman, F APitlick, H MDembitzer
Journal: Circulation Research (1976)

Antibody to tissue factor apoprotein was adsorbed against gamma-globulin and coupled to horseradish peroxidase; this complex was applied to various rabbit tissues. The distribution of the peroxidase marker then was observed by electron microscopy. We examined fixed or frozen sections, as well as breis of aorta, vena cava, brain, heart, lung, liver, spleen, kidney, bone marrow, mesothelial gut lining, erythrocytes, and platelets. All endothelial cells that had been exposed to the antibody complex were positive and in all cases only the endothelial cells showed localization of the electron-dense reaction product. Tissues that had been incubated with complexes prepared with gamma-globulin from animals not immunized with tissue factor apoprotein showed no staining. Prior treatment of the tissue with uncoupled anti-tissue factor gamma-globulin blocked binding by the coupled antibody. In blood vessel preparations that had been specifically designed to expose the media to the anti-tissue factor complex, medial s...
Lack of effect of methylprednisolone on lysosomal and microsomal enzymes after two hours of well-defined canine myocardial ischemia.
Authors: F FKennett, W BWeglicki
Journal: Circulation Research (1978)

Myocardial ischemia was produced for 2 hours by coronary ligation in 11 dogs pretreated with methylprednisolone (MP, 30 mg/kg). Myocardial blood flow (MBF) was measured with microspheres (15 micrometer) in each tissue sample used for enzymatic analysis. Homogenates of these tissue samples were separated by ultracentrifugation into lysosome-rich and microsomal fractions and were analyzed for N-acetyl-beta-glusosaminidase (NAGA), beta-glucuronidase (beta-gluc), rotenone-insensitive-NADH-cytochrome c reductase (RINCR), and cytochrome oxidase. The enzymatic data from centrifugal fractions were grouped according to MBF values for statistical analysis of inter-group effects of ischemia. Significant losses (P less than 0.001) of NAGA and beta-gluc were seen in all MP-treated lysosome-rich particulate fractions that were isolated from zones demonstrating MBF values less than 25% of control (L-ischemia). Similar significant losses (P less than 0.001) of RINCR were seen in microsomal fractions from L-ischemia zones...
Endothelial-dependent relaxation induced by leukotrienes C4, D4, and E4 in isolated canine arteries.
Authors: R JSecrest, B MChapnick
Journal: Circulation Research (1988)

Leukotriene D4 has been shown to possess the capacity to relax canine superior mesenteric and renal arterial rings in an endothelial-dependent manner. The present study was designed to determine if the remaining peptidoleukotrienes, leukotrienes C4 and E4, share this property. In addition, influences of atropine and of inhibitors of cyclooxygenase and lipoxygenase activities on relaxation produced by leukotriene D4 and acetylcholine were determined to characterize further leukotriene D4-induced relaxation and to compare these properties with those of acetylcholine. Vasomotor tone was measured with isometric force transducers. Following induction of tone with norepinephrine, leukotriene C4 and acetylcholine produced concentration-dependent relaxation of renal and superior mesenteric arterial rings in which the endothelium was intact. Only minimal decreases in tone were produced in response to leukotriene E4. Neither acetylcholine nor leukotriene C4 altered tone after endothelium had been intentionally disr...
Children not immunised for measles
Authors: E. Pugh, E Henson
Journal: BMJ (1985)

SIR,-Dr Terry Kemple has highlighted the reasons for children not receiving measles immunisation (11 May, p 1395).He comments that "confusion with the pertussis immunisation" was one of the common categories for not accepting measles vaccine.We have recently performed a study on the measles and pertussis immunisation status of all age eligible children born in four calendar months of 1983, as recorded on the district immunisation and vaccination record card.One of the subgroups studied was the measles immunisation status of children who had received the recommended three courses of diphtheria, tetanus, and polio, with or without pertussis.Companison of pertussis and measles immunisation status in children who completed the recommended diphtheria, tetanus, and polio schedule Immunisation status Measles No measles Total Pertussis
Improved diagnostic performance on the severity of left ventricular hypertrophy with body surface mapping.
Authors: MYamaki, KIkeda, IKubota, KNakamura, KHanashima, KTsuiki, SYasui
Journal: Circulation (1989)

To improve the diagnostic usefulness of electrocardiography (ECG) in determining the severity of left ventricular hypertrophy (LVH) with body surface mapping, 87 unipolar ECGs were recorded from 57 patients with left ventricular (LV) concentric hypertrophy and 30 with LV dilatation. Body surface ECG features due to LVH were evaluated by increase of QRS voltage and delayed local activation. We measured for each lead R voltage, net area of QRS (AQRS), ventricular activation time (VAT), and departure index (DI) of AQRS and VAT (DI = mean/SD). From these measurements, seven parameters were calculated for each patient: Rmax, the maximal R wave voltage; AQRSmax, the maximal AQRS; AQRS-Dmax, the maximal AQRS DI; AQRS-Darea, the area size where DIs of AQRS are more than 2; VATmax, the maximal VAT; VAT-Dmax, the maximal VAT DI; and VAT-Darea, the area size where DIs of VAT are more than 2. Among these parameters, the most effective for diagnosis of LVH were selected by stepwise multiple regression analysis. In the...
104P Fast progression in high PD-L1 NSCLC treated with pembrolizumab in first-line: A prognostic scoring system based on clinical features
Authors: A. Passaro, D. Giannarelli, E. Bria, S. Novello, D. Galetta, A.J. Gelibter, M.L. Reale, S. Carnio, E. Vita, A. Stefani, P. Pizzutilo, V. Stati, I. Attili, F. de Marinis
Journal: Journal of Thoracic Oncology (2021)
Relation between contractile reserve and prognosis in patients with coronary artery disease and a depressed ejection fraction.
Authors: P FCohn, RGorlin, M VHerman, E HSonnenblick, H RHorn, L HCohn, J JCollins
Journal: Circulation (1975)

Postextrasystolic potentiation (PESP) and 1-epinephrine infusion have previously been shown by the ventriculographic technique to augment left ventricular wall motion in patients with coronary artery disease. The present study relates the magnitude of this augmentation to short-term prognosis in 56 patients with coronary artery disease and a factor already identified with reduced life expectancy, i.e., an abnormal ejection fraction (EF less than .50). Forty-two patients received PESP and 14 1-epinephrine infusion. Based on severity of symptoms and technical suitability, 37 were treated surgically and 19 medically. Mean follwo-up times were 11.7 and 14.3 months, respectively. The mean increase in EF induced by PESP or 1-epinephrine infusion was significantly greater in patients who subsequently had good results from either surgical or medical therapy than in those who died or had progressive cardiac deterioration. In addition, those patients with an increase in EF of .10 or greater had a statistically grea...
Bone Marrow-Derived Endothelial Progenitor Cells Participate in Cerebral Neovascularization After Focal Cerebral Ischemia in the Adult Mouse
Authors: Zheng GangZhang, LiZhang, QuanJiang, MichaelChopp
Journal: Circulation Research (2002)

We investigated whether circulating endothelial progenitor cells contribute to neovascularization after stroke. Donor bone marrow cells obtained from transgenic mice constitutively expressing β-galactosidase transcriptionally regulated by an endothelial-specific promoter, Tie2, were injected into adult mice. Focal cerebral ischemia was induced by embolic middle cerebral artery (MCA) occlusion and changes of cerebral blood flow (CBF) were measured by perfusion-weighted magnetic resonance imaging (MRI). Laser scanning confocal microscopy (LSCM), immunohistochemistry and X-gal staining were performed. Perfusion-weighted MRI demonstrated increases in CBF around the boundary of an infarct area 1 month after ischemia. Morphological and 3-dimensional image analyses revealed enlarged and thin-walled blood vessels with sprouting or intussusception at the boundary of the ischemic lesion, which closely corresponded to elevated CBF areas detected on perfusion-weighted MRI, indicating the presence of neovascularizatio...
New consultant contract
Authors: G Johns
Journal: BMJ (1978)

<i>We propose a simplified approach to approximate a variety of heteroskedastic diffusions widely used in finance to describe the evolution of state variables such as equity prices, short interest rates, and others. In contrast to the common approach based on approximating a new homoskedastic process obtained by transforming the original heteroskedastic one, we build up binomial and trinomial trees that directly discretize the initial process. Despite this, the proposed approximation models are based on recombining lattices that converge weakly to the corresponding limiting diffusion. Numerical results show that the proposed algorithms are efficient and that they compute accurate prices.</i> <b>TOPICS:</b>Derivatives, security analysis and valuation, statistical methods
Anti-CLL1 Chimeric Antigen Receptor T-Cell Therapy in Children with Relapsed/Refractory Acute Myeloid Leukemia
Authors: Hui Zhang, Pengfei Wang, Zhuoyan Li, Yingyi He, Wenting Gan, Hua Jiang
Journal: Clinical Cancer Research (2021)

The survival rate of children with refractory/relapsed acute myeloid leukemia (R/R-AML) by salvage chemotherapy is minimal. Treatment with chimeric antigen receptor T cells (CAR T) has emerged as a novel therapy to improve malignancies treatment. C-type lectin-like molecule 1 (CLL1) is highly expressed on AML stem cells, blast cells, and monocytes, but not on normal hematopoietic stem cells, indicating the therapeutic potential of anti-CLL1 CAR T in AML treatment. This study aimed to test the safety and efficacy of CAR T-cell therapy in R/R-AML.Four pediatric patients with R/R-AML were enrolled in the ongoing phase I/II anti-CLL1 CAR T-cell therapy trial. The CAR design was based on an apoptosis-inducing gene, FKBP-caspase 9, to establish a safer CAR (4SCAR) application. Anti-CLL1 CAR was transduced into peripheral blood mononuclear cells of the patients via lentivector 4SCAR, followed by infusion into the recipients after lymphodepletion chemotherapy. Cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, and other adverse events were documented. Treatment response was evaluated by morphology and flow cytometry-based minimal residual disease assays.Three patients with R/R-AML achieved complete remission and minimal residual disease negativity, while the other patient remained alive for 5 months. All these patients experienced low-grade and manageable adverse events.On the basis of our single-institution experience, autologous anti-CLL1 CAR T-cell therapy has the potential to be a safe and efficient alternative treatment for children with R/R-AML, and therefore requires further investigation.
A combination of immunoadjuvant nanocomplexes and dendritic cell vaccines in the presence of immune checkpoint blockade for effective cancer immunotherapy
Authors: Manh-Cuong Vo, Seo-Yeon Ahn, Tan-Huy Chu, Saji Uthaman, Shammer Pillarisetti, Tung Nguyen Thanh Uong, Thangaraj Jaya Lakshmi, Mihee Kim, Ga-Young Song, Sung-Hoon Jung, Deok-Hwan Yang, Jae-Sook Ahn, Hyeoung-Joon Kim, In-Kyu Park, Je-Jung Lee
Journal: Cellular and Molecular Immunology (2021)
Temporal trends and variability of colonoscopy performance in gastroenterology practice
Authors: Colin Rees, Wee Ngu
Journal: Endoscopy (2016)

Colonoscopy is the investigation of choice for assessment of the large bowel. High-quality colonoscopy is essential to ensure maximal pathology detection and has been shown to reduce the incidence of postcolonoscopy colorectal cancer (CRC) [1] [2]. Low complication rates and low incidence of postcolonoscopy CRC are the most important quality outcome measures. Procedures should also be well tolerated by patients, whose colonoscopy experience should be at least acceptable.
Effects of age, sex, and body habitus on QRS and ST-T potential maps of 1100 normal subjects.
Authors: L SGreen, R LLux, C WHaws, R RWilliams, S CHunt, M JBurgess
Journal: Circulation (1985)

Body surface potential maps provide more detailed regional cardiac electrophysiologic information than the standard electrocardiogram. We performed a large-scale study of a normal population to form a comparison base for evaluation of the clinical utility of this technique. We analyzed body surface maps from 1113 normal subjects from 10 to 80 years old to detail map features as a function of age, sex, and body habitus. Maps were analyzed by visual inspection and by a spatial and temporal data reduction technique that allows statistical comparison of map features. On average, both QRS and ST-T potentials decreased with increasing age. Potential pattern distributions remained constant from 10 to 40 years. Beyond age 40, larger numbers of maps from normal subjects showed depolarization patterns consistent with delayed activation of the left anterior fasicle, despite normal 12-lead electrocardiograms. Only minor QRS potential amplitude and distribution differences were noted when male and female subjects were...
Breast Metastasis of Primary Peritoneal Carcinoma Demonstrated on FDG PET/CT
Authors: Serkan Gungor, Rabia Burcin Girgin
Journal: Clinical Nuclear Medicine (2021)

Abstract Primary serous peritoneal carcinomas (PSPCs) are rare, and dissemination other than intraperitoneal implantation is even rarer. Breast is an extremely unusual location of metastasis for PSPC. The distinction of breast metastasis of PSPC from primary breast cancer is crucial because the treatment and the prognosis are entirely different. Here we present a case of breast and axillary lymph node metastases from PSPC that were identified on staging FGD PET/CT.
In older adults without CVD, treating 100 persons with statins for 2.5 y prevents 1 MACE
Authors: Lionel S. Lim
Journal: Annals of Internal Medicine (2021)

Source Citation Yourman LC, Cenzer IS, Boscardin WJ, et al. Evaluation of time to benefit of statins for the primary prevention of cardiovascular events in adults aged 50 to 75 years: a meta-analysis. JAMA Intern Med. 2021;181:179-85. 33196766
Food systems for peace and security in a climate crisis
Authors: Peter Läderach, Grazia Pacillo, Philip Thornton, Diego Osorio, Dan Smith
Journal: The Lancet Planetary Health (2021)

Two thoughts should shape policy on food and peace. The first is that the worldwide increase in hunger is driven primarily by climate change and violent conflicts, and the second is that the availability of food is foundational for peace. Consequently, policies, programmes, and finances to strengthen food systems need to include climate action and conflict mitigation, but this recognition has been taking place slowly among global security and food system agents.
Abstract 12942: Association of Exercise Performance With Hemodynamic and Imaging Parameters in Fontan Patients
Authors: Alyson R Pierick, Michael Kelleman, Megan Stark, Danish Vaiyani, Robert Whitehill, Timothy Slesnick, Christopher Petit
Journal: Circulation (2020)

Introduction: The Fontan operation results in hemodynamic, anatomic and functional alterations in single ventricle (SV) heart disease. Studies have shown that SV patients have reduced exercise capacity. We sought to determine hemodynamic and anatomic associations with exercise capacity in our Fontan cohort. Methods: We performed a retrospective chart review of all patients born 2002-2012 who underwent Fontan palliation and followed in our Fontan Surveillance Program. Surveillance cardiac magnetic resonance (cMR), cardiac catheterization (cath), and exercise stress test (EST) data were collected. Primary analysis was association of cMR and cath data on EST outcomes including percent-predicted maximum oxygen consumption (ppVO 2 max) and oxygen pulse (ppO 2 Pulse). Results: A total of 222 patients were included, 45.5% with a systemic left ventricle (LV). Hypoplastic left heart syndrome was the underlying cardiac diagnosis in 1/3 of patients. The vast majority of the Fontan procedures performed were fenestrated, 44% extracardiac conduits and 42% with a lateral tunnel graft. A total of 185 cMRs, 274 caths, and 136 ESTs were performed. The median respiratory exchange ratio and ppVO 2 max were 1.11 L/sec and 73% respectively, with a preserved ppO 2 Pulse of 93.5%. Results of correlational analysis are shown in the table. Over serial ESTs, patients with a single RV had a more gradual, but not significant decline in ppVO 2 max than patients with a single LV, r s -0.321 and -0.544 respectively (p = 0.28). Conclusions: While hemodynamic parameters do not correlate with EST functional endpoints, anatomic factors such as the Nakata index are associated with EST performance. Surveillance of Fontan patients should include regular cMR to assess for subtle changes in ejection fraction, pulmonary artery diameter and differential pulmonary blood flow. Multicenter longitudinal studies with protocolized timing are needed to further elucidate correlates of good exercise capacity.
Promising Biomarkers Serrated Adenomas of the Colon
Authors: V Vereshchak, I Karasev, T Davydkina, O Malikhova
Journal: Endoscopy (2021)

Aims The exact understanding of the pathogenesis of dentate tumors is not reliably determined, it is obvious that the development of neoplasms is influenced by molecular genetic factors, the microbial composition of the colon, chronic inflammation,chemical and biological carcinogens.
Hemodynamic and electrophysiological actions of cocaine. Effects of sodium bicarbonate as an antidote in dogs.
Authors: K JBeckman, R BParker, R JHariman, J LGallastegui, J IJavaid, J LBauman
Journal: Circulation (1991)

BACKGROUNDCocaine abuse has been implicated as a cause of death due to sudden cardiac arrest.METHODS AND RESULTSWe examined the hemodynamic and electrophysiological effects of cocaine administered as a series of 5-mg/kg i.v. boluses coupled with a continuous infusion in anesthetized dogs. Sodium bicarbonate (50 meq i.v.) was administered as a potential antidote in 11 of 15 dogs, and intravenous 5% dextrose was given in the remaining four. In a dose-dependent fashion, cocaine significantly decreased blood pressure, coronary blood flow, and cardiac output; increased PR, QRS, QT, and QTc intervals and sinus cycle length; and increased ventricular effective refractory period and dispersion of ventricular refractoriness. No afterdepolarizations were noted in the monophasic action potential recording. Nonsustained monomorphic ventricular tachycardia occurred spontaneously in two dogs, and sustained ventricular tachycardia could be induced by programmed stimulation at the end of the dosing protocol in five of 11...
Shall The Journal be Removed to Washington?
Authors: E. H. M. Sell
Journal: JAMA (1891)

<h3>To the Editor:</h3> —As several good reasons have been and can easily be advanced whyThe Journalshould not be removed, and no good reason has yet been given why it should be removed, and since no medical journal has ever yet flourished at the Capital, I cast my vote in favor ofThe Journal<i>remaining at Chicago</i>. 44 West 49th St., New York, March 17, 1891.
Anion manipulation: a new antiarrhythmic approach. Action of substitution of chloride with nitrate on ischemia- and reperfusion-induced ventricular fibrillation and contractile function.
Authors: P DRidley, M JCurtis
Journal: Circulation Research (1992)

The role of anions in the initiation of ischemia- and reperfusion-induced arrhythmias is unknown. We examined the antiarrhythmic effects of isotonic substitution of extracellular Cl- with NO3- by using the rat Langendorff preparation (n = 12 per group). During 30 minutes of regional ischemia, the incidence of ventricular fibrillation (VF) was reduced from 50% in hearts perfused with control solution (containing a Cl-:NO3- ratio of 100:0) to 25%, 0% (p less than 0.05), 0% (p less than 0.05), and 0% (p less than 0.05) by perfusion with solution containing Cl-:NO3- ratios of 75:25, 50:50, 25:75, and 0:100, respectively. The incidence of reperfusion-induced VF was also reduced from 58% to 25%, 8% (p less than 0.05), 8% (p less than 0.05), and 0% (p less than 0.05), respectively. Similar effects were produced in hearts reperfused after briefer durations of ischemia (10 or 15 minutes). Substitution of NO3- for Cl- also facilitated spontaneous termination of VF. Heart rate and occluded zone size were not affecte...