tbuckley/cabot-search huggingface dataset:
The Consult Guys - Balancing the Medication Portfolio 5 Years After a Heart Attack
Authors: Geno J. Merli, Howard H. Weitz
Journal: Annals of Internal Medicine (2014)

Web Exclusives16 December 2014The Consult Guys - Balancing the Medication Portfolio 5 Years After a Heart AttackFREEGeno J. Merli, MD and Howard H. Weitz, MDGeno J. Merli, MDSearch for more papers by this author and Howard H. Weitz, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G14-3012 SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.For more videos from and information on The Consult Guys, visit www.annals.org/ConsultGuys. Comments 0 Comments Sign In to Submit A Comment Gauranga DharBangladesh Institute of Family Medicine and Research18 August 2015 A patient should get lifelong statin for secondary cardiovascular event prevention Excellent. This patient as per his present condition should continue with low dose aspirin daily (81-162mg) and a statin for whole life. Statin dose may be selected according to ASCVD risk as described by ACC/AHA ATP-IV guideline.I think it is already time to stop “Treat to Target” approach for statin use. If we use “Treat to Target”, question should arise, should I stop statin once target is achieved?Specifically for this patient, statin should be continued indefinitely because he is a patient with established ASCVD, one of the four groups of patients who should get statin as described by ATP-IV guideline. Yehia Y. Mishriki, MD, FACPLehigh Valley Health Network13 January 2015 "Re-balancing" a patient's drug portfolio five years after MI Perhaps obvious but worth mentioning, the beta blocker should be slowly weaned off over the course of at least 2 weeks. In addition, whether one subscribes to the newer hyperlipidemia guidelines or still goes by the "treat to target" approach, one needs to know what type and what dose of the statin the patient is taking. He should be taking a high dose potent statin (newer guidelines) or achieve an LDL of 70 mg/dl or less (treat to target) which would be ideal (rather than the 90 mg/dl which is acceptable). Author, Article, and Disclosure InformationAuthors: Geno J. Merli, MD; Howard H. Weitz, MDDisclosures: Geno J. Merli, MD, reports the following: Research grants/contracts: Bristol-Myers Squibb, Bayer, sanofi-aventis; Consultancies: Bristol-Myers Squibb, Bayer, sanofi-aventis. Howard H. Weitz, MD, reports that he has no financial relationships or interests to disclose. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 16 December 2014Volume 161, Issue 12 Page: CG12 Keywords Disclosure Myocardial infarction Research grants Research reporting guidelines ePublished: 16 December 2014 Issue Published: 16 December 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.Loading ...
French medical students' opinion of psychiatry
Authors: B Samuel-Lajeunesse, P Ichou
Journal: American Journal of Psychiatry (1985)

A questionnaire on attitudes toward psychiatry was submitted to French medical students in their first year of specialized training in psychiatry or in another medical specialty. The findings do not differ from those of previous United States investigations. In France, although psychiatry is a full medical specialty, psychiatrists are perceived as different from other physicians. Both groups of students believed that psychiatric treatment is efficacious but remained unsure of its scientific value.
Effect of Cardiopulmonary Bypass on Cytokine Release and Adhesion Molecule Expression in Alveolar Macrophages
Authors: MASANORI TSUCHIDA, HIROSHI WATANABE, TAKEHIRO WATANABE, HIROYUKI HIRAHARA, MANABU HAGA, HAJIME OHZEKI, JUNICHI HAYASHI, HARUO MIYAMURA, TATSUHIKO HIRONO, TORU ABO, SHOJI EGUCHI
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

Although recent studies have shown that adhesion molecules on alveolar macrophages are important in a variety of pulmonary diseases, there have been few studies on the phenotypic and functional changes of alveolar macrophages during cardiopulmonary bypass. To investigate the possible role of alveolar macrophages in activating pulmonary immunity during cardiopulmonary bypass, we measured the expression of adhesion molecules on alveolar macrophages and peripheral blood monocytes in patients undergoing cardiopulmonary bypass. Antigens were stained with monoclonal antibodies against adhesion molecules, and the expression of antigens was quantified by flow cytometry as the ratio of specific to nonspecific linear fluorescence. On alveolar macrophages obtained after the release of aortic cross-clamp, macrophages as compared with alveolar macrophages obtained before cardiopulmonary bypass, there was a significant enhancement of CD11a, CD11b, CD11c, and CD18. In addition, alveolar macrophages, but not peripheral monocytes, produced higher levels of TNF- α and IL-8 when they were cultured in vitro. A higher expression of CD11 and CD18 on alveolar macrophages and enhanced production of cytokines after release of the aortic cross-clamp may contribute to immune activation in lung by macrophage-lymphocyte interaction.
Underutilization of antithrombotic therapy in atrial fibrillation
Authors: V Adhiyaman, D Kamalakannan, A Oke, I U Shah, A D White
Journal: Journal of the Royal Society of Medicine (2000)

Most patients with atrial fibrillation should be considered for antithrombotic therapy. In a retrospective survey we investigated practice in two hospitals. For patients at high risk, established guidelines recommend warfarin, or aspirin if anticoagulants are contraindicated; for those at medium risk, either may be used. Of 156 with atrial fibrillation (acute, chronic or paroxysmal), 119 were at high risk, mean age 79 years. According to the guidelines, 89 of these were suitable for anticoagulation but only 49 (55%) received warfarin; 27 received aspirin and 13 neither. Of 27 patients at medium risk (mean age 70 years), 6 were not prescribed any antithrombotic therapy. This survey indicates that guidelines on antithrombotic therapy are commonly disregarded and that, in particular, warfarin is underutilized in the group for whom it is most indicated.
Book: Smoking in British Popular Culture 1800-2000
Authors: C. N Martyn
Journal: BMJ (2000)

Matthew Hilton Manchester University Press, £15.99, pp 272 ISBN 0719052572 Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img>![Graphic][4]</img> At the Paris exhibition of 1883, James T Bonsack demonstrated his newly invented cigarette making machine to George and Harry Wills of the Bristol tobacco manufacturer WD and HO Wills. It was a crucial event in making cigarettes available to the mass market. Until Bonsack's invention, cigarettes had been rolled by hand by young women. A skilled worker turned out a few each minute. The machine was a hundred times faster. At five … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif [4]: /embed/inline-graphic-4.gif
Abstract 10455: Left Ventricular Eccentricity Impairs Three-Dimensional Systolic Radial Strain and Torsion in Patients After Repair of Tetralogy of Fallot: A Three-Dimensional Speckle Tracking Analysis
Authors: Shu-na Li, Sophia J Wong, Yiu-fai Cheung
Journal: Circulation (2010)

Background: Left ventricular (LV) systolic dysfunction has been shown to be a predictor of adverse outcomes after tetralogy of Fallot repair. Objectives: Using three-dimensional (3D) speckle tracking that simultaneously interrogates 3D myocardial deformation and torsion of all LV segments, we tested the hypothesis that LV eccentricity may impair LV 3D systolic radial strain and torsion and has implications on LV ejection fraction in postoperative Fallot patients. Methods: Eighteen patients aged 21.5±8.2 years and 12 controls were studied. The 3D volume datasets were acquired (Artida, Toshiba, Japan) for assessment of LV 3D radial strain, time-to-peak strain, twist, torsion (twist/distance from LV base), and ejection fraction. The LV diastolic eccentricity index (EI) and indexed right ventricular end-diastolic area were determined from 2D images. Results: Compared with controls, patients had significantly reduced LV global 3D radial strain (29.3±7.5% vs 36.9±7.4%, p=0.01), twist (6.9±3.2 degree vs 13.8±4.3...
Telecare and technologically mediated nursing consultations - A practice-philosophical analysis of care and digital proximity
Authors: Anne Dichmann Sorknæs, Lise Hounsgaard, Finn Olesen, Peder Jest, Mickael Bech, Birte Østergaard
Journal: European Respiratory Journal (2013)

Telemedicine is increasingly being introduced with the overall expectation that it can solve some of the basic challenges faced by the health system regarding a growing number of chronically ill patients with several service needs. This article focuses on Danish hospital staff nurses’ and discharged patients’ experiences with teleconsultations related to chronic obstructive pulmonary disease. It deals with the effect of teleconsultations on the relationship between nurses and patients, and with some specific characteristics of telemedicine while being part of nursing practice. The Purpose of the study is to explore 1) how technology constitutes, and is constituted by, the relationship between patient and nurse in teleconsultations; and 2) how teleconsultations are perceived by patients and nurses.  The study has been conducted as a postphenomenological analysis of empirical data collected from fieldwork, focusing on telecare consultations between specialist nurses and patients.  Study findings show that patients and nurses alike consider technology-mediated nursing consultations as qualified care, enabling a close relationship between patient and nurse. Technological mediation of nursing practices changes the way nurses perform and it also changes their professional identity. The nurses compensate for a lack of physical presence with patient by amplifying their audio-visual perceptions, communicative skills and by including the patient as their assistant. Correspondingly, their patients take on an active role in observation and measurement of their condition, and their self-image changes accordingly for them to become actively self-managing patients.
Vaccination with LAG-3Ig (IMP321) and Peptides Induces Specific CD4 and CD8 T-Cell Responses in Metastatic Melanoma Patients—Report of a Phase I/IIa Clinical Trial
Authors: Amandine Legat, Hélène Maby-El Hajjami, Petra Baumgaertner, Laurène Cagnon, Samia Abed Maillard, Christine Geldhof, Emanuela M. Iancu, Luc Lebon, Philippe Guillaume, Danijel Dojcinovic, Olivier Michielin, Emanuela Romano, Grégoire Berthod, Donata Rimoldi, Frédéric Triebel, Immanuel Luescher, Nathalie Rufer, Daniel E. Speiser
Journal: Clinical Cancer Research (2015)

Cancer vaccines aim to generate and maintain antitumor immune responses. We designed a phase I/IIa clinical trial to test a vaccine formulation composed of Montanide ISA-51 (Incomplete Freund's Adjuvant), LAG-3Ig (IMP321, a non-Toll like Receptor agonist with adjuvant properties), and five synthetic peptides derived from tumor-associated antigens (four short 9/10-mers targeting CD8 T-cells, and one longer 15-mer targeting CD4 T-cells). Primary endpoints were safety and T-cell responses.Sixteen metastatic melanoma patients received serial vaccinations. Up to nine injections were subcutaneously administered in three cycles, each with three vaccinations every 3 weeks, with 6 to 14 weeks interval between cycles. Blood samples were collected at baseline, 1-week after the third, sixth and ninth vaccination, and 6 months after the last vaccination. Circulating T-cells were monitored by tetramer staining directly ex vivo, and by combinatorial tetramer and cytokine staining on in vitro stimulated cells.Side effects were mild to moderate, comparable to vaccines with Montanide alone. Specific CD8 T-cell responses to at least one peptide formulated in the vaccine preparation were found in 13 of 16 patients. However, two of the four short peptides of the vaccine formulation did not elicit CD8 T-cell responses. Specific CD4 T-cell responses were found in all 16 patients.We conclude that vaccination with IMP321 is a promising and safe strategy for inducing sustained immune responses, encouraging further development for cancer vaccines as components of combination therapies.
Treatment of severe hidradenitis suppurativa with infliximab in combination with surgical interventions
Authors: D.C. Van Rappard, J.R. Mekkes
Journal: British Journal of Dermatology (2012)

Journal Article Treatment of severe hidradenitis suppurativa with infliximab in combination with surgical interventions Get access D.C. Van Rappard, D.C. Van Rappard Department of Dermatology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands E‐mail: d.c.vanrappard@amc.uva.nl Search for other works by this author on: Oxford Academic Google Scholar J.R. Mekkes J.R. Mekkes Department of Dermatology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands E‐mail: d.c.vanrappard@amc.uva.nl Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 167, Issue 1, 1 July 2012, Pages 206–208, https://doi.org/10.1111/j.1365-2133.2012.10807.x Published: 01 July 2012
Plasmacytoid dendritic cell-derived IFN-α promotes murine liver ischemia/reperfusion injury by induction of hepatocyte IRF-1
Authors: Antonino Castellaneta, Osamu Yoshida, Shoko Kimura, Shinichiro Yokota, David A. Geller, Noriko Murase, Angus W. Thomson
Journal: Hepatology (2014)

Plasmacytoid dendritic cells (pDC) constitute the body's principal source of type I interferon (IFN) and are comparatively abundant in the liver. Among various cytokines implicated in liver ischemia and reperfusion (I/R) injury, type I IFNs have been described recently as playing an essential role in its pathogenesis. Moreover, type I IFNs have been shown to up-regulate hepatocyte expression of IFN regulatory factor 1 (IRF-1), a key transcription factor that regulates apoptosis and induces liver damage after I/R. Our aim was to ascertain the capacity of IFN-α released by liver pDC to induce liver damage through hepatic IRF-1 up-regulation after I/R injury. Our findings show that liver pDC mature and produce IFN-α in response to liver I/R. Liver pDC isolated after I/R induced elevated levels of IRF-1 production by hepatocytes compared with liver pDC isolated from sham-operated mice. Notably, hepatic IRF-1 expression was reduced significantly by neutralizing IFN-α. In vivo, IFN-α neutralization protected the liver from I/R injury by reducing hepatocyte apoptosis. This was associated with impaired expression of IRF-1 and proapoptotic molecules such as Fas ligand, its receptor (Fas) and death receptor 5, which are regulated by IRF-1. Furthermore, pDC-depleted mice failed to up-regulate hepatic IFN-α and displayed less liver injury associated with reduced levels of hepatic interleukin (IL)-6, tumor necrosis factor-α, and hepatocyte apoptosis after I/R compared with controls.these data support the hypothesis that IFN-α derived from liver pDC plays a key role in the pathogenesis of liver I/R injury by enhancing apoptosis as a consequence of induction of hepatocyte IRF-1 expression.
Protecting children from armed conflict
Authors: D. Summerfield, C D Cooper, D. Meddings
Journal: BMJ (1998)

Protecting children from armed conflictChildren affected by war must not be stigmatised as permanently damagedEditor-Southall and Abbasi quote Unicef when they state that the psychological consequences of armed conflict on children are so great that they can rarely be repaired. 1Unicef indeed says that "time does not heal trauma," but there is no sound empirical basis for a generalisation that risks stigmatising whole populations of children affected by war as sick or permanently damaged.Even child survivors of Auschwitz did not turn out like this as a general rule, and there are no published studies of children from non-Western war zones to support such a conlusion.Unicef and other agencies need to review such claims and costly interventions based on them; the claims owe more to prevailing sociocultural assumptions in the West than anything else.Over the past 50 years psychological explanations for life events and the medicalisation of distress have grown hugely.Because many people believe, for example, that rape or other criminal violence, childhood abuse, or even persistent bullying at school is an experience that may have lifelong psychological effects it seems unthinkable that war and atrocity should not do this to almost everyone exposed to them.Constructions of "trauma" deployed in the health field are increasingly expansive and undiscriminating. 2 No one wants to play down what children may suffer, or that war may produce clear psychological dysfunction in some (a minority).But it is not to their mental worlds but to their social worlds that survivors direct their attention, and humanitarian agencies should follow suit.The literature of both anthropology and mental health (in the case of mental health, starting with a classic study by Freud and Burlingham 3 ) shows the positive impact of family and community in buffering the short and longer term effects of war.The concept of child trauma is currently fashionable.But it is the social, cultural, and economic rebuilding of worlds shattered by war (including valued institutions such as schools), allied to urgent issues of equity and justice, which will determine the future wellbeing of several million child survivors worldwide. 4For those for whom this does not happen war may indeed mean a life sentence, but this is not trauma.
A cost-effectiveness analysis of trametinib plus dabrafenib as first-line therapy for metastatic BRAF V600-mutated melanoma in the Swiss setting
Authors: K. Matter-Walstra, R. Braun, C. Kolb, Z. Ademi, R. Dummer, B.C. Pestalozzi, M. Schwenkglenks
Journal: British Journal of Dermatology (2015)

Journal Article A cost‐effectiveness analysis of trametinib plus dabrafenib as first‐line therapy for metastatic BRAF V600‐mutated melanoma in the Swiss setting Get access K. Matter‐Walstra, K. Matter‐Walstra Institute of Pharmaceutical Medicine (ECPM) University of Basel Klingelbergstraße 61 Basel CH‐4056 SwitzerlandSAKK Coordinating Centre Bern Switzerland Correspondence Klazien Matter‐Walstra. E‐mail: klazien.matter@unibas.ch Search for other works by this author on: Oxford Academic Google Scholar R. Braun, R. Braun Department of Dermatology University Hospital Zürich Zürich Switzerland Search for other works by this author on: Oxford Academic Google Scholar C. Kolb, C. Kolb SAKK Coordinating Centre Bern Switzerland Search for other works by this author on: Oxford Academic Google Scholar Z. Ademi, Z. Ademi Institute of Pharmaceutical Medicine (ECPM) University of Basel Klingelbergstraße 61 Basel CH‐4056 Switzerland Search for other works by this author on: Oxford Academic Google Scholar R. Dummer, R. Dummer Department of Dermatology University Hospital Zürich Zürich Switzerland Search for other works by this author on: Oxford Academic Google Scholar B.C. Pestalozzi, B.C. Pestalozzi SAKK Coordinating Centre Bern SwitzerlandDepartment of Oncology University Hospital Zürich Zürich Switzerland Search for other works by this author on: Oxford Academic Google Scholar M. Schwenkglenks M. Schwenkglenks Institute of Pharmaceutical Medicine (ECPM) University of Basel Klingelbergstraße 61 Basel CH‐4056 SwitzerlandEpidemiology, Biostatistics and Prevention Institute University of Zürich Zürich Switzerland Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 173, Issue 6, 1 December 2015, Pages 1462–1470, https://doi.org/10.1111/bjd.14152 Published: 01 December 2015
Phase I trial of low-dose, prolonged continuous infusion fluorouracil plus interferon-alfa: evidence for enhanced fluorouracil toxicity without pharmacokinetic perturbation.
Authors: J A Sparano, S Wadler, R B Diasio, R Zhang, Z Lu, E L Schwartz, A Einzig, P H Wiernik
Journal: Journal of Clinical Oncology (1993)

PURPOSE To determine the maximum-tolerable dose (MTD) of fluorouracil (5-FU) administered as a low-dose, prolonged continuous intravenous infusion (PCI) plus interferon-alfa (IFN-alpha) that would permit treatment for at least 28 consecutive days, and to determine the effect of IFN-alpha on 5-FU pharmacokinetics. PATIENTS AND METHODS Twenty-six assessable patients with advanced cancer received low-dose PCI 5-FU (150, 200, 250, and 300 mg/m2/d) plus IFN-alpha, 5 x 10(6) IU/m2 administered subcutaneously (SC) at hour 48 of the 5-FU infusion, then thrice weekly thereafter in cohorts of at least three patients. Treatment continued until treatment-limiting toxicity (TLT) developed, such as mucositis, diarrhea, or fatigue. Escalation to the next 5-FU dose level occurred if none of three or zero to two of six patients developed TLT before day 28. Quantitation of plasma 5-FU concentration by high-performance liquid chromatography was performed in 15 patients. Data were standardized using the Cosinor method and compared before and after IFN-alpha administration using the paired t test. RESULTS The mean number of days of continuous 5-FU therapy for patients receiving 150, 200, 250, and 300 mg/m2/d of 5-FU plus IFN alfa-2a (IFN-alpha 2a) was 75, 54, 37, and 22 days, respectively. The MTD of PCI 5-FU by our criteria that could be combined with IFN-alpha was 250 mg/m2/d. Comparison of the standardized pharmacokinetic data showed no significant effect of IFN-alpha on plasma 5-FU concentration, and no alteration of the normal circadian variation in plasma 5-FU concentration that was evident before IFN-alpha administration. Objective response occurred in patients with adenocarcinoma of the pancreas (n = 3), kidney (n = 2), and lung (n = 1). CONCLUSION IFN-alpha substantially enhanced the gastrointestinal toxicity of low-dose PCI 5-FU without affecting 5-FU pharmacokinetics, contrary to previous reports using alternative 5-FU schedules in which IFN-alpha-related enhancement of 5-FU toxicity was attributable to reduced 5-FU clearance. Our findings suggest that under certain conditions, mechanisms other than altered 5-FU pharmacokinetics may be responsible for the ability of IFN-alpha to enhance the toxic effects of 5-FU.