tbuckley/cabot-search huggingface dataset:
Is Syncope Related to Moderate Altitude Exposure?
Authors: Richard Nicholas
Journal: JAMA (1992)

<h3>Study Objective.</h3> —To investigate factors related to syncope occurring on recent ascent to moderate altitude. <h3>Design.</h3> —A 1-year retrospective case-control study, using local acclimatized residents as a control group. <h3>Setting.</h3> —The two main ambulance destinations for Summit County, Colorado (elevation, 2770 m). <h3>Patients.</h3> —All patients with a diagnosis of syncope, near-syncope, or fainting whose medical records were available for review. <h3>Results.</h3> —There was a significant relationship (<sup>P</sup>&lt;.05) between syncope of unknown origin and recent arrival at altitude (&lt;24 hours), and a significant inverse relationship (<i>P</i>&lt;.05) between syncope of unknown origin and arterial oxygen saturation as measured by pulse oximetry. <h3>Conclusions.</h3> —Short-term exposure to moderate altitude may be related to otherwise unexplained syncope in healthy young adults. We suggest the name<i>high-altitude syncope</i>for this entity and encourage further research in this area. (<i>JAMA</i>. 1992;268:904-906)
Regulated Expression and Role of c-Myb in the Cardiovascular-Directed Differentiation of Mouse Embryonic Stem Cells
Authors: Masayoshi Ishida, Omar El-Mounayri, Steven Kattman, Peter Zandstra, Hiroshi Sakamoto, Minetaro Ogawa, Gordon Keller, Mansoor Husain
Journal: Circulation Research (2011)

c-myb null (knockout) embryonic stem cells (ESC) can differentiate into cardiomyocytes but not contractile smooth muscle cells (SMC) in embryoid bodies (EB).To define the role of c-Myb in SMC differentiation from ESC.In wild-type (WT) EB, high c-Myb levels on days 0-2 of differentiation undergo ubiquitin-mediated proteosomal degradation on days 2.5-3, resurging on days 4-6, without changing c-myb mRNA levels. Activin-A and bone morphogenetic protein 4-induced cardiovascular progenitors were isolated by FACS for expression of vascular endothelial growth factor receptor (VEGFR)2 and platelet-derived growth factor receptor (PDGFR)α. By day 3.75, hematopoesis-capable VEGFR2+ cells were fewer, whereas cardiomyocyte-directed VEGFR2+/PDGFRα+ cells did not differ in abundance in knockout versus WT EB. Importantly, highest and lowest levels of c-Myb were observed in VEGFR2+ and VEGFR2+/PDGFRα+ cells, respectively. Proteosome inhibitor MG132 and lentiviruses enabling inducible expression or knockdown of c-myb were used to regulate c-Myb in WT and knockout EB. These experiments showed that c-Myb promotes expression of VEGFR2 over PDGFRα, with chromatin immunopreciptation and promoter-reporter assays defining specific c-Myb-responsive binding sites in the VEGFR2 promoter. Next, FACS-sorted VEGFR2+ cells expressed highest and lowest levels of SMC- and fibroblast-specific markers, respectively, at days 7-14 after retinoic acid (RA) as compared with VEGFR2+/PDGFRα+ cells. By contrast, VEGFR2+/PDGFRα+ cells cultured without RA beat spontaneously, like cardiomyocytes between days 7 and 14, and expressed cardiac troponin. Notably, RA was required to more fully differentiate SMC from VEGFR2+ cells and completely blocked differentiation of cardiomyocytes from VEGFR2+/PDGFRα+ cells.c-Myb is tightly regulated by proteosomal degradation during cardiovascular-directed differentiation of ESC, expanding early-stage VEGFR2+ progenitors capable of RA-responsive SMC formation.
Dichotomy of food and inhalant allergen sensitization in eosinophilic esophagitis
Authors: K. K. N. Sugnanam, J. T. Collins, P. K. Smith, F. Connor, P. Lewindon, G. Cleghorn, G. Withers
Journal: Allergy (2007)

Eosinophilic esophagitis (EE) is an emerging condition where patients commonly present with symptoms of gastroesophageal reflux disease and fail to respond adequately to anti-reflux therapy. Food allergy is currently recognized as the main immunological cause of EE; recent evidence suggests an etiological role for inhalant allergens. The presence of EE appears to be associated with other atopic illnesses.To report the sensitization profile of both food and inhalant allergens in our EE patient cohort in relation to age, and to profile the prevalence of other allergic conditions in patients with EE.The study prospectively analyzed allergen sensitization profiles using skin prick tests to common food allergens and inhalant allergens in 45 children with EE. Patch testing to common food allergens was performed on 33 patients in the same cohort. Comorbidity of atopic eczema, asthma, allergic rhinitis and anaphylaxis were obtained from patient history.Younger patients with EE showed more IgE and patch sensitization to foods while older patients showed greater IgE sensitization to inhalant allergens. The prevalence of atopic eczema, allergic rhinitis and asthma was significantly increased in our EE cohort compared with the general Australian population. A total of 24% of our cohort of patients with EE had a history of anaphylaxis.In children with EE, the sensitization to inhalant allergens increases with age, particularly after 4 years. Also, specific enquiry about severe food reactions in patients presenting with EE is strongly recommended as it appears this patient group has a high incidence of anaphylaxis.
TCT-19 The Impact of Coronary Lesion Severity on Drug-eluting Stent Outcomes in Patients with and without Diabetes Mellitus
Authors: Elvin Kedhi, Philippe Genereux, Tullio Palmerini, Tom McAndrew, Helen Parise, George Dangas, Roxana Mehran, Ori Ben-Yehuda, Gregg Stone
Journal: Journal of the American College of Cardiology (2013)
Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories
Authors: Bernard Vrijens, Gäbor Vincze, Paulus Kristanto, John Urquhart, Michel Burnier
Journal: BMJ (2008)

<b>Objective</b> To describe characteristics of dosing history in patients prescribed a once a day antihypertensive medication. <b>Design</b> Longitudinal database study. <b>Setting</b> Clinical studies archived in database for 1989-2006. <b>Participants</b> Patients who participated in the studies whose dosing histories were available through electronic monitoring. <b>Main outcome measures</b> Persistence with prescribed antihypertensive treatment and execution of their once a day drug dosing regimens. <b>Results</b> The database contained dosing histories of 4783 patients with hypertension. The data came from 21 phase IV clinical studies, with lengths ranging from 30 to 330 days and involving 43 different antihypertensive drugs, including angiotensin II receptor blockers (n=2088), calcium channel blockers (n=937), angiotensin converting enzyme inhibitors (n=665), β blockers (n=195), and diuretics (n=155). About half of the patients who were prescribed an antihypertensive drug had stopped taking it within one year. On any day, patients who were still engaged with the drug dosing regimen omitted about 10% of the scheduled doses: 42% of these omissions were of a single day’s dose, whereas 43% were part of a sequence of several days (three or more days—that is, drug “holidays”). Almost half of the patients had at least one drug holiday a year. The likelihood that a patient would discontinue treatment early was inversely related to the quality of his or her daily execution of the dosing regimen. <b>Conclusions</b> Early discontinuation of treatment and suboptimal daily execution of the prescribed regimens are the most common facets of poor adherence with once a day antihypertensive drug treatments. The shortfalls in drug exposure that these dosing errors create might be a common cause of low rates of blood pressure control and high variability in responses to prescribed antihypertensive drugs.
Oral Contraception and Blood Coagulability
Authors: O. Egeberg, P. A. Owren
Journal: BMJ (1963)

The fact that oral contraception mimics the hormonal effects of pregnancy which is associated with high levels of certain clotting factors prompted the authors to investigate whether changes in blood coagulability might be induced by oral  contraception.  10 normal healthy women aged 22-42 with regular menstruation and no previous hormonal therapy served as volunteers in the study.  5 of the women received oral  (norethynodrel + ethinyloestradiol 3-methyl ether) medication in the standard contraceptive dosage of 5 mg a day from Menstrual Day 5 to be applied for 20 days.  The other 5 women served as controls for analyzing possible physiological variations in blood coagulability during the menstrual cycle.  Plasma samples were prepared according to a standardized technique as described for the methods used and stored at minus 20 degrees centigrade until assayed.  Results of the coagulation study showed no definite changes occurring in the coagulation activities of the blood samples from nontreated women.  Plasma samples from the women on enavid medication showed a shorting of the cephalin time and a definite increase in the activity of the antihemophilic A factor.  The measured proconvertin activity increased slightly but significantly.  These changes developed during the first and second weeks of therapy and the values showed a tendency to return to pretreatment levels soon after the drug was discontinued.  It is noted that the number of women treated was small but the change in coagulability was marked and uniform.
Contribution of acid and duodenogastrooesophageal reflux to oesophageal mucosal injury and symptoms in partial gastrectomy patients
Authors: M F Vaezi, J E Richter
Journal: Gut (1997)

Background —The role of acid and pepsin in causing symptoms and oesophagitis is well established; however, the significance of duodenogastro-oesophageal reflux (DGOR) in this disorder is unclear. Aims —To understand the role of acid and DGOR in causing upper gastrointestinal (GI) symptoms and oesophageal mucosal injury in partial gastrectomy (PG) patients. Methods —Thirty two PG patients with upper GI symptoms were studied. Twenty four hour ambulatory acid and bilirubin measurements were obtained with Bilitec 2000 using glass electrode and fibreoptic sensor. Upper GI symptoms and oesophagitis were correlated with either acid or DGOR. Results —The PG patients were a heterogeneous group: 28% (9/32) had mixed reflux (acid+/DGOR+); 50% (16/32) had only DGOR (acid−/DGOR+); and 22% (7/32) had neither (acid−/DGOR−). Upper GI symptoms were associated with both mixed reflux (69%) and DGOR (24%). Six patients (67%) in the acid+/DGOR+ group had oesophagitis; no acid−/DGOR+ or acid−/DGOR− patients had oesophagitis. Mixed reflux showed a significant (p&lt;0.0001) association with oesophagitis, while DGOR did not (p=0.3). Conclusions —(1) The majority of upper GI symptoms and all cases of oesophagitis in the PG patients occurred in patients who had mixed refluxate (acid and DGOR); (2) DGOR without simultaneous acid reflux may cause symptoms, but was not associated with oesophagitis in this patient group.
Once-daily budesonide aqueous nasal spray (BANS) does not suppress hypothalamic-pituitary-adrenal (HPA) axis function in children 2 to 5 years of age with allergic rhinitis
Authors: K.T. Kim, T. Uryniak, B. Simpson, L. O'Dowd, F. Casty
Journal: Journal of Allergy and Clinical Immunology (2003)
Surgery of the Musculoskeletal System
Authors: Irwin M. Siegel
Journal: JAMA (1984)

Sooner or later it was bound to happen: a book would be written to succeed<i>Campbell's Operative Orthopedics</i>(sixth edition, 1980, The CV Mosby Co) as the definitive work in the field of orthopedic surgical procedure. Now appears<i>Surgery of the</i><i>Musculoskeletal System</i>, a 4,246-page magnum opus, published as a fourvolume set, which weighs in at 27 pounds. This tour-de-force of medical authorship is edited by C. McCollister Evarts (Professor and Chairman of Orthopedics, University of Rochester, NY), assisted by ten section editors and 160 contributors, whose names would, for the most part, be included in a worldwide roster of who's who in surgical orthopedics today. The book features over 180 chapters, divided into 12 sections, which, after an introductory section (historical highlights, musculoskeletal examination, fat embolism, fracture healing, bone grafts, biomechanics, and compartment syndromes), cover the subject matter by anatomic site. Special sections are devoted to conditions not localized
Prevalence and Significance of Retinopathy in Subjects With Type 1 Diabetes of Less Than 5 Years’ Duration Screened for the Diabetes Control and Complications Trial
Authors: John I. Malone, Anthony D. Morrison, Peter R. Pavan, David D. Cuthbertson
Journal: Diabetes Care (2001)

The Diabetes Control and Complications Trial (DCCT) demonstrated the powerlul impact of glycemic control on the progression of diabetic retinopathy. A large number of individuals (2,771) underwent stereoscopic color photography and fluorescein angiography as part of screening for participation in the DCCT. A subgroup of those individuals screened participated in the DCCT and underwent evaluation of their retinal vasculature semiannually for 4-9 years. These data were evaluated to determine how the 2000 American Diabetes Association position statement would apply to the DCCT experience. Specifically, the position statement indicates that the first dilated eye examination should be performed after 3-5 years' duration of diabetes because vision-threatening retinopathy virtually never develops in patients with type 1 diabetes during that intervalWe examined the experience of the DCCT in evaluating retinal photographs in 1,613 patients with type 1 diabetes of <5 years' duration and follow-up photographs every 6 months for 4-9 years in 855 members of that group.Of 1,613 subjects with type 1 diabetes of <5 years' duration screened for the DCCT, 716 (44.4%) had stereo-color photographic evidence of diabetic retinopathy, and 6 had preproliferative or worse pathology. Fluorescein angiography revealed retinopathy in 158 of 713 subjects with no evidence of retinopathy on color photographs. Thus, 874 (54.2%) of the original 1,613 subjects had retinopathy at baseline. DCCT follow-up identified 341 additional individuals in whom retinopathy was developing before 5 years; 1,083 of 1,613 (67.1%) individuals screened for the DCCT had retinopathy before 5 years' duration of diabetes. Those with retinopathy before 5 years had more rapid three-step progression of vascular pathology than those with no retinopathy.Dilated eye examinations and retinal photography should be included in the routine management of type 1 diabetes during the first 5 years to identify the individuals at greatest risk for vision-threatening problems.
Embolic complications associated with endoscopic injection of cyanoacrylate for bleeding duodenal ulcer
Authors: P. Peixoto, P. Ministro, A. Sadio, A. Castanheira, E. Cancela, R. Araújo, A. Silva, A. Caldas
Journal: Endoscopy (2008)

An 87-year-old man with severe cardiac disease, on treatment with an antiplatelet agent, was admitted to our department with acute melena, in a hemodynamically unstable state, and with a hemoglobin level of 6 mg/dL. Emergency endoscopy revealed an extensive ulcer in the anterosuperior bulb wall with pulsatile bleeding. This was initially injected with epinephrine and fibrin glue (as it was a deep ulcerated lesion). When this failed to stop the bleeding, we used a 1 : 0.6 mixture of N-butyl-2-cyanoacrylate (NB2C; Histoacryl) and lipiodol, which did stop it. At second-look endoscopy, a large pulsatile vessel was still present ([Fig. 1 ] a), which was permanently occluded after a second NB2C application ([Fig. 1 ] b). Five days later, the patient developed febrile peaks (40 °C) without complaints but with leukocytosis and a five-fold increase in levels of aminotransferases, amylase, and lipase. A thoracoabdominal computed tomography (CT) scan showed linear opacification of the common hepatic artery ([Fig. 2 ] a), its right branch, and some splenic branches ([Fig. 2 ] b), with a heterogeneous area in the spleen ([Fig. 2 ] b) and in the pancreatic head ([Fig. 3]) highly suggestive of infarction lesions. The patient started treatment with an intravenous broad-spectrum antibiotic, along with nutritional support measures, and the liver test parameters improved considerably. Blood cultures failed to isolate any bacterial strain. The patient was discharged on day 15. Six-month imaging follow-up showed remarkable improvement.
The Alteration of Physicians' Orders by Nonphysicians-Reply
Authors: Albert F. Finn
Journal: JAMA (1988)

In Reply.—  We believe that the choice of laboratory test, or test regimen, must be made by the physician. The purpose of ordering—or, preferably, requesting—a laboratory test is to confirm or exclude clinical impressions with sufficient certainty to ensure that clinical management does more good than harm. This is the essence of laboratory medicine and in our view is best achieved by consultation between clinical pathologist and practicing physician. In recent years we have come to appreciate the concepts of diagnostic value and clinical usefulness as they apply to laboratory testing. 1 Nevertheless, it is important to realize that test strategy may be rendered meaningless if requests are improperly transmitted, blood samples are improperly obtained, analyses are inaccurate or imprecise, or results are reported incorrectly. To ensure the quality of the foregoing requires well-trained and dedicated medical technologists. We agree with Dr Meyer that in the interest of improving laboratory
A RARE FORM OF MALIGNANT TUMOR OF THE TESTICLE.
Authors: WILLIAM A. ROLFE
Journal: JAMA (1907)

The following case is reported as being of interest, more especially from a pathologic viewpoint: <h3>History.</h3> —C. D. R., aged 38, married, of good previous history, noticed in August, 1906, a commencing enlargement of the left testicle. This was thought to be due to a slight injury received while riding a bicycle. The man was first seen in October, at which time he was in good physical condition except for the enlarged testicle, which was moderately painful, and caused considerable discomfort from the dragging sensation along the cord. The patient's paternal grandfather died from cancer of the liver, but otherwise the family history was unimportant. <h3>Examination.</h3> —The testicle was found to be uniformly enlarged, measuring about 8 cm. in length by 6 cm. in diameter. The epididymis could not be clearly made out, and there was an absence of fluid in the scrotal sac. Pressure on the testicle caused much
More women than men become living organ donors
Authors: R. Dobson
Journal: BMJ (2002)

Women are more likely to be living organ donors than men, and one explanation is that they may be more vulnerable to subtle pressures.

Fathers, sons, brothers, or other male family members are all less likely to donate than their female counterparts, and a new report has called for the predominance of women donors to be investigated urgently.

“Instead of simply congratulating …
Immunological and biochemical characterization of recombinant group 1 dust mite allergens
Authors: N.K. Soni, S.T. Lyngstrand, S. Patkar, L.L.H. Christensen, M. Schlein, E.P. Friis, V. Batori, P.S. Skov, L.K. Poulsen, E.L. Roggen, U. Bødtger, H. Draborg
Journal: Journal of Allergy and Clinical Immunology (2005)
Wheeze in preschool children: who is followed-up, who is treated and who is hospitalized?
Authors: DK Luyt, AM Bourke, P Lambert, P Burton, H Simpson
Journal: European Respiratory Journal (1995)

This study determined the proportions of children &lt; or = 5 yrs of age with reported wheeze who were undergoing medical follow-up, receiving anti-asthma medication, or admitted to hospital; and investigated factors important in determining which children would receive these treatments. The symptomatic children represented a wheeze prevalence of 16% of the study sample of 1,422 children. The cumulative incidence of treatment and hospitalization and point prevalence of current medical follow-up were determined using a parent-answered postal questionnaire study of a population-based random sample of 222 children. Odds ratios (OR) were calculated for wheeze severity, environmental, social, familial and demographic factors found to affect the likelihood of these treatment end-points. Among 222 children with wheeze, 99 (35%) were under current medical review, 165 (75%) had received medication, and 48 (22%) reported being hospitalized. Current follow-up was more likely in girls (OR 2.22; 95% confidence interval (95% CI) 1.12-4.38), with more than three attacks of wheeze in the last year (OR 17.44; 95% CI 5.22-58.3), or with a household pet (cat or dog) where inhalants were wheeze precipitants (OR 13.65; 95% CI 3.16-58.94). Treatment became more likely in older children (OR 3.91; 95% CI 1.10-12.71), with inhalants as wheeze precipitants (OR 4.66; 95% CI 1.08-20.14) or with a household pet (OR 2.28; 95% CI 1.04-5.03). Hospitalization was less likely with frequent wheeze (OR 0.30; 95% CI 0.12-0.77), but more likely if shortness of breath occurred with wheeze. Medical follow-up and treatment are related to wheeze severity and exposure to inhaled precipitants, whereas hospital admission occurred in children with attacks causing shortness of breath, and with decreasing frequency of attacks per year.
LASTING IDEALS OF ABRAHAM FLEXNER
Authors: Lewis L. Strauss
Journal: JAMA (1960)

BECAUSE ideals are come by early, it is profitable to look at the circumstances of a man's boyhood and youth when that insight is available. Abraham Flexner lefta revealing and delightfully written account of that early period in his career. He was born in a small Kentucky community, the sixth of nine children, to Jewish parents who had met and married in the United States but who had arrived as immigrants from Europe during the 1850's. His father died before Abraham was 16 years old, but his precept and example left indelible impressions on the growing boy. Although both parents had only limited formal educations, they shared a tremendous respect for culture and made prodigious sacrifices to see that their children received every cultural advantage that the locality offorded.  The father had been successful in business almost from his arrival and until 1873, but he lost what he had accumulated