tbuckley/cabot-search huggingface dataset:
OC-011 Is Coffee Ground Vomiting Important? Findings From A Large Bleeding Unit Database With Outcomes At 30 Days
Authors: JR Schneider, JM Thomson, A Fraser, B Vijayan, JS Leeds
Journal: Gut (2014)

<h3>Introduction</h3> Upper gastrointestinal bleeding (UGIB) is a common reason for admission and “coffee ground vomiting” (CGV) has classically been considered a sign but clinical experience hasn’t always borne this out. There is a paucity of data concerning endoscopic findings and outcomes in patients presenting with CGV. The aim of this study was to analyse endoscopic yield and outcomes at 30 days in patients presenting with CGV alone compared to those with haematemesis or melaena. <h3>Methods</h3> The Aberdeen bleeding unit opened in 1991 and has recorded demographics, presenting symptoms, endoscopic diagnosis and outcomes on all admissions. Endoscopic diagnostic groups were varices, gastric ulcers (GU) or duodenal ulcers (DU), cancer, trivial (e.g. Mallory-Weiss tear (MWT)), no source found, no bleed and colonic. Analysis was performed over the period 1991 to 2005 and three groups identified; CGV alone (group A), haematemesis (group B) and melaena (group C). Endoscopic diagnosis, rebleeding and mortality rate were calculated and using group A as reference, odds ratios calculated (shown in brackets). <h3>Results</h3> 6105 patients were admitted over the study period with suspected UGIB (A, n = 1708 (923 males), B, n = 1663 (968 males) and C, n = 2734 (1640 males)). Trivial, no source found and no bleed diagnoses were found in 1390 (75%) group A, 1291 (50%) group B and 1130 (40%) group C. Group B was younger than groups A and C (mean age 50.4 vs. 64.6 and 64.8 respectively, p &lt; 0.001) therefore groups were stratified into &lt;50 or ≥ 50. In &lt; 50, group B had significantly more varices (OR 2.3) and MWT (OR 2.8) whereas group C had significantly more GU (OR 2.6), DU (OR 9.9) and colonic bleeds (OR 6.9). Only 4 cases had upper GI cancer all presented with melaena. 30 day mortality (&lt;50) for groups A, B and C was 2.7%, 1.6% and 1.9% but rebleeding was significantly higher in group C (OR 3.5). In ≥ 50, group B had significantly more varices (OR 6.9), GU (OR 1.8), gastric cancer (OR 2.4), oesophageal cancer (OR 3.2) and MWT (OR 3.1) whereas group C had significantly more varices (OR 2.9), GU (OR 2.5), DU (OR 3.7), gastric cancer (OR 2.0), and colonic bleeds (OR 6.1). 30 day mortality (≥50) for groups A, B and C was 11.8%, 12.5% and 11.1% but rebleeding was significantly higher in groups B and C (OR 5.3 and OR 5.0 respectively). <h3>Conclusion</h3> Presenting with CGV is associated with the same mortality as haematemesis or malaena but has significantly lower endoscopic yield and rebleeding suggesting a non-gastrointestinal cause. CGV should not be synonymous with UGIB and needs to be considered for investigations other than endoscopy. <h3>Disclosure of Interest</h3> None Declared.
Mycophenolate Mofetil vs Azathioprine for Remission Maintenance in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis
Authors: Thomas F. Hiemstra, Michael Walsh, Alfred Mahr, Caroline O. Savage, Kirsten de Groot, Lorraine Harper, Thomas Hauser, Irmgard Neumann, Vladimir Tesar, Karl-Martin Wissing, Christian Pagnoux, Wilhelm Schmitt, David R. W. Jayne, for the European Vasculitis Study Group (EUVAS)
Journal: JAMA (2010)

<h3>Context</h3>Current remission maintenance therapies for antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) are limited by partial efficacy and toxicity.<h3>Objective</h3>To compare the effects of mycophenolate mofetil with azathioprine on the prevention of relapses in patients with AAV.<h3>Design, Setting, and Participants</h3>Open-label randomized controlled trial, International Mycophenolate Mofetil Protocol to Reduce Outbreaks of Vasculitides (IMPROVE), to test the hypothesis that mycophenolate mofetil is more effective than azathioprine for preventing relapses in AAV. The trial was conducted at 42 centers in 11 European countries between April 2002 and January 2009 (42-month study). Eligible patients had newly diagnosed AAV (Wegener granulomatosis or microscopic polyangiitis) and were aged 18 to 75 years at diagnosis.<h3>Interventions</h3>Patients were randomly assigned to azathioprine (starting at 2 mg/kg/d) or mycophenolate mofetil (starting at 2000 mg/d) after induction of remission with cyclophosphamide and prednisolone.<h3>Main Outcome Measures</h3>The primary end point was relapse-free survival, which was assessed using a Cox proportional hazards model. The secondary end points were Vasculitis Damage Index, estimated glomerular filtration rate, and proteinuria.<h3>Results</h3>A total of 156 patients were assigned to azathioprine (n = 80) or mycophenolate mofetil (n = 76) and were followed up for a median of 39 months (interquartile range, 0.66-53.6 months). All patients were retained in the analysis by intention to treat. Relapses were more common in the mycophenolate mofetil group (42/76 patients) compared with the azathioprine group (30/80 patients), with an unadjusted hazard ratio (HR) for mycophenolate mofetil of 1.69 (95% confidence interval [CI], 1.06-2.70; P = .03). Severe adverse events did not differ significantly between groups. There were 22 severe adverse events in 13 patients (16%) in the azathioprine group and there were 8 severe adverse events in 8 patients (7.5%) in the mycophenolate mofetil group (HR, 0.53 [95% CI, 0.23-1.18]; P = .12). The secondary outcomes of Vasculitis Damage Index, estimated glomerular filtration rate, and proteinuria did not differ significantly between groups.<h3>Conclusions</h3>Among patients with AAV, mycophenolate mofetil was less effective than azathioprine for maintaining disease remission. Both treatments had similar adverse event rates.<h3>Trial Registration</h3>clinicaltrials.gov Identifier: NCT00307645
Mechanical Respirators
Authors: Lester R. Bryant
Journal: JAMA (1967)

Ventilatory support by a mechanical respirator may be required in patients with major trauma, chronic pulmonary disease, nervous system disorders, or following major surgery. An understanding of the characteristics of mechanical ventilators and their principles of operation is essential for proper application to specific problems. Repeated measurement of tidal volume and arterial blood gases is the most reliable method for determining the need for ventilatory support and the adequacy of ventilation once it is initiated. It is the purpose of this report to serve as a primer for those not already familiar with mechanical respirators, including the techniques and hazards of their use.
Collaborating on evolving the future
Authors: David Sloan Wilson, Steven C. Hayes, Anthony Biglan, Dennis D. Embry
Journal: Behavioral and Brain Sciences (2014)

Abstract We thank the commentators for an extraordinarily diverse and constructive set of comments. Nearly all applaud our goal of sketching a unified science of change, even while raising substantive points that we look forward to addressing in our reply, which we group into the following categories: (1) What counts as evolutionary; (2) Ethical considerations; (3) Complexity; (4) Symbotypes, culture, and the future; (5) What intentional cultural change might look like; (6) An evolving science of cultural change; and (7) Who decides?
Rectal hyperpolarization following intestinal bypass for obesity
Authors: J. Rask-Madsen, P. B. Jensen, J. O. Lund
Journal: Gut (1973)

The electrical potential difference across the rectal mucosa in six shunt-operated women was compared with that obtained in 26 normal females. The potential difference was considerably increased in all the patients, whereas the plasma concentrations and the transmural fluxes of sodium, chloride, and potassium were within normal ranges. Based on measurements of plasma renin and plasma aldosterone concentrations in three of the patients, the possibility of secondary hyperaldosteronism could be ruled out.
Cyclin-Dependent KinasesInitial Approaches to Exploit a Novel Therapeutic Target
Authors: Edward A. Sausville, Daniel Zaharevitz, Robert Gussio, Laurent Meijer, Maryse Louarn-Leost, Conrad Kunick, Robert Schultz, Tyler Lahusen, Donna Headlee, Sherman Stinson, Susan G. Arbuck, Adrian Senderowicz
Journal: Pharmacology & Therapeutics (1999)
c-Jun–dependent inhibition of cutaneous procollagen transcription following ultraviolet irradiation is reversed by all-trans retinoic acid
Authors: Gary J. Fisher, Subhash Datta, ZengQuan Wang, Xiao-Yan Li, Taihao Quan, Jin Ho Chung, Sewon Kang, John J. Voorhees
Journal: Journal of Clinical Investigation (2000)

The aged appearance of skin following repeated exposure to solar ultraviolet (UV) irradiation stems largely from damage to cutaneous connective tissue, which is composed primarily of type I and type III collagens. We report here that a single exposure to UV irradiation causes significant loss of procollagen synthesis in human skin. Expression of type I and type III procollagens is substantially reduced within 24 hours after a single UV exposure, even at UV doses that cause only minimal skin reddening. Daily UV exposures over 4 days result in sustained reductions of both type I and type III procollagen protein levels for at least 24 hours after the final UV exposure. UV inhibition of type I procollagen synthesis is mediated in part by c-Jun, which is induced by UV irradiation and interferes with procollagen transcription. Pretreatment of human skin in vivo with all-trans retinoic acid inhibits UV induction of c-Jun and protects skin against loss of procollagen synthesis. We have reported previously that UV irradiation induces matrix-degrading metalloproteinases in human skin and that pretreatment of skin with all-trans retinoic acid inhibits this induction. UV irradiation, therefore, damages human skin connective tissue by simultaneously inhibiting procollagen synthesis and stimulating collagen breakdown. All-trans retinoic acid protects against both of these deleterious effects and may thereby retard premature skin aging.
Notifying contacts of people with HIV infection.
Authors: K. C. Mohanty
Journal: BMJ (1992)

clinic, and an abnormally placed testis should be detected.3As some undescended testes descend spontaneously we suggest that all boys with an undescended testis at 8 months should be reviewed at 1 year and, if the testis has still not descended, referred to a surgeon so that orchidopexy can be arranged during the second year of life.To reduce the toll of testicular cancer better health education is required as this would also benefit all potential victims, 90% of whom have normally descended testes.Self examination should be taught at an early age and may lead to earlier presentation of testicular tumours.
A model for clinical governance in primary care groups
Authors: R. Baker, M. Lakhani, R. Fraser, F. Cheater
Journal: BMJ (1999)

Clinical governance is the core component of the new quality programme for the NHS (see box on next page) announced in the consultation document A First Class Service .1 It is described as "a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish." It will be the central focus for assuring the quality of care and addressing the issue of providing accountability through the Commission for Health Improvement.2 The activities of the commission will reflect national and local priorities as identified by the National Institute of Clinical Excellence and health improvement programmes respectively. Although A First Class Service included details about the structure and functioning of clinical governance in health service trusts, arrangements for primary care groups were not specified. In this paper, we suggest a possible model for clinical governance in primary care groups. Clinical governance is central to the NHS quality programme, but how it will operate in primary care groups remains unclear Although many activities included in the new concept of clinical governance are already being undertaken, these need to be coordinated A model of governance that addresses the core tasks of defining, accounting for, and improving quality and incorporates evidence on effective methods of changing performance is suggested This model can improve professional, practice, and primary care group performance It shows how groups can introduce and develop clinical governance and how health authorities and the Commission for Health Improvement can monitor progress The model is based on three underlying precepts:
Persistence of the Epstein–Barr Virus and the Origins of Associated Lymphomas
Authors: David A. Thorley-Lawson, Andrew Gross
Journal: New England Journal of Medicine (2004)

This review of the life cycle of the Epstein–Barr virus (EBV) explains how EBV establishes lifelong infection in a host with protective immunity against the virus. The authors also discuss the role of EBV in the development of post-transplantation lymphoma, Hodgkin's disease, and Burkitt's lymphoma.
Three autosomal dominant corneal dystrophies map to chromosome 5q
Authors: Edwin M. Stone, William D. Mathers, George O.D. Rosenwasser, Edward J. Holland, Robert Folberg, Jay H. Krachmer, Brian E. Nichols, Peter D. Gorevic, Chris M. Taylor, Luan M. Streb, Jill A. Fishbaugh, Thomas E. Daley, Brian M. Sucheski, Val C. Sheffield
Journal: Nature Genetics (1994)
Beyond attention: The role of amygdala NMDA receptors in fear conditioning
Authors: Jonathan C. Gewirtz, Michael Davis
Journal: Behavioral and Brain Sciences (1997)

Several types of amygdala-dependent learning can be blocked by local infusion of NMDA antagonists into the amygdala. This blockade shows anatomical, pharmacological, temporal, and behavioral specificity, providing a pattern of data more consistent with a role for NMDA receptors in learning than in arousal or attention, and supporting the contention that an “LTP-like” process is a neural substrate for memory formation.
"FRACTURES OF THE NECK OF THE FEMUR"
Authors: Royal Whitman
Journal: JAMA (1923)

To the Editor:  —The paper by Dr. Campbell inThe Journal, October 20, is a most important contribution to the propaganda for reform, of which the first essential is an absolute repudiation of the traditional teaching still supported by many of the textbooks, namely, that fracture of the neck of the femur is an exception to all the injuries of its class, in that its effective treatment  a fracture is both dangerous and futile.  The purpose of this letter is, however, to call attention to what in the author's mind is evidently a minor point. He states that in the treatment of intracapsular fracture the abduction method as described by Whitman has been employed  a routine... with addition, recently, of artificial impaction  advocated by Cotton, which is regulated by a series of roentgenograms on the operating table.  It may be recalled that Dr. Cotton based his operation
Perfusion studies in relation to intestinal absorption.
Authors: G E Sladen
Journal: Gut (1968)

Activation of transcription factor NF-κB involves the signal-dependent degradation of basally phosphorylated inhibitors such as IκBα. In response to proinflammatory cytokines or mitogens, the transduction machinery has recently been characterized, but the activation mechanism upon oxidative stress remains unknown. In the present work, we provide several lines of evidence that NF-κB activation in a T lymphocytic cell line (EL4) by hydrogen peroxide (H<sub>2</sub>O<sub>2</sub>) did not involve phosphorylation of the serine residues 32 and 36 in the amino-terminal part of IκBα. Indeed, mutation of Ser<sup>32</sup> and Ser<sup>36</sup> blocked IL-1β- or PMA-induced NF-κB activation, but had no effect on its activation by H<sub>2</sub>O<sub>2</sub>. Although IκBα was phosphorylated upon exposure to H<sub>2</sub>O<sub>2</sub>, tyrosine residue 42 and the C-terminal PEST (proline-glutamic acid-serine-threonine) domain played an important role. Indeed, mutation of tyrosine 42 or serine/threonine residues of the PEST domain abolished NF-κB activation by H<sub>2</sub>O<sub>2</sub>, while it had no effect on activation by IL-1β or PMA-ionomycin. This H<sub>2</sub>O<sub>2</sub>-inducible phosphorylation was not dependent on IκB kinase activation, but could involve casein kinase II, because an inhibitor of this enzyme (5,6-dichloro-1-β-d-ribofuranosyl-benzimidazole) blocks NF-κB activation. H<sub>2</sub>O<sub>2</sub>-induced IκBα phosphorylation was followed by its degradation by calpain proteases or through the proteasome. Taken together, our findings suggest that NF-κB activation by H<sub>2</sub>O<sub>2</sub> involves a new mechanism that is totally distinct from those triggered by proinflammatory cytokines or mitogens.
Notice of Retraction: Final Resolution
Authors: Eric T. Poehlman
Journal: Annals of Internal Medicine (2005)

Letters3 May 2005Notice of Retraction: Final ResolutionFREEEric T. Poehlman, PhDEric T. Poehlman, PhDFrom Montréal, Québec H2L 3R8, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-9-200505030-00116 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I wish to acknowledge that the Editor of Annals of Internal Medicine appropriately retracted (1) my paper on changes in energy balance and body composition at menopause (2) after receiving notification from the University of Vermont that an investigation had determined that I had falsified and fabricated the reported data.In addition, I request that this letter be published to ensure that the scientific community is notified that I accept full responsibility for this falsification and fabrication, and that my coauthors are publicly exonerated.Eric T. Poehlman, PhDMontréal, Québec H2L 3R8, CanadaReferences1. Sox HC. Notice of retraction. Ann Intern Med. 2003;139:702. [PMID: 14568863] LinkGoogle Scholar2. Poehlman ET, Toth MJ, Gardner AW. Changes in energy balance and body composition at menopause: a controlled longitudinal study. Ann Intern Med. 1995;123:673-5. [PMID: 7574222] LinkGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From Montréal, Québec H2L 3R8, Canada. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoChanges in Energy Balance and Body Composition at Menopause: A Controlled Longitudinal Study Eric T. Poehlman , Michael J. Toth , and Andrew W. Gardner Notice of Retraction Harold C. Sox Notice of Retraction: Final Resolution Harold C. Sox Metrics Cited bySex Hormone Effects on Physical Activity LevelsA Rhetorical Analysis of Apologies for Scientific Misconduct: Do They Really Mean It?Oxidative stress, body fat composition, and endocrine status in pre- and postmenopausal womenReproducible Research: Moving toward Research the Public Can Really TrustChristine Laine, MD, MPH, Senior Deputy Editor, Steven N. Goodman, MD, PhD, MHS, Associate Editor, Michael E. Griswold, PhD, Associate Editor, and Harold C. Sox, MD, EditorResearch Misconduct, Retraction, and Cleansing the Medical Literature: Lessons from the Poehlman CaseHarold C. Sox, MD, Editor and Drummond Rennie, MD 3 May 2005Volume 142, Issue 9Page: 798KeywordsMenopauseResearch design ePublished: 3 May 2005 Issue Published: 3 May 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Should obese women with polycystic ovary syndrome receive treatment for infertility?
Authors: Adam H Balen, Martin Dresner, Eleanor M Scott, James O Drife
Journal: BMJ (2006)

Polycystic ovaries are seen at ultrasound in 20-25% of women, and the prevalence of polycystic ovary syndrome (PCOS) seems to be rising because of the current epidemic of obesity.1 The syndrome accounts for 90-95% of women who attend infertility clinics with anovulation. The considerable risks in pregnancy associated with obesity are not usually appreciated when patients with PCOS attend clinics and request fertility treatment. Is it appropriate to offer treatment or to insist on weight loss? Or does any overweight woman have the right to receive treatment, irrespective of the possible outcome?
Two Wrongs Don't Make a Right
Authors: Michael S. Jellinek
Journal: JAMA (1993)

PRIOR to 1980, mental health coverage was primarily based on fee-for-service reimbursement through indemnity plans. Outpatient benefits varied from minimal to generous; decisions concerning psychiatric hospitalization (and to a great extent length of stay) were based on the psychiatrist's clinical judgment and only somewhat constrained by the paucity of beds. During the past 15 years, the mental health delivery system has undergone a two-stage evolution.<sup>1</sup>The first stage was free-market competitive expansion. As a result, the use of inpatient services increased, especially the for-profit psychiatric hospitalization of adolescents. The second stage was managed care, dramatically decreasing the use of psychiatric hospitalization. The engine for both the first and second set of changes was not innovative treatment or outcome studies; on the contrary, it was profit that filled psychiatric beds in the 1980s, and it is profit that empties them in the 1990s. This profit is eroding the traditional covenant
Oxygen free radicals, reperfusion injury, endothelial cells, and von Willebrand factor
Authors: A D BLANN, H S MIDGLEY, G BURROWS, S MAXWELL, S UTTING, M A WAlTE
Journal: Cardiovascular Research (1993)

Journal Article Oxygen free radicals, reperfusion injury, endothelial cells, and von Willebrand factor Get access A D BLANN, A D BLANN Search for other works by this author on: Oxford Academic PubMed Google Scholar H S MIDGLEY, H S MIDGLEY Search for other works by this author on: Oxford Academic PubMed Google Scholar G BURROWS, G BURROWS Search for other works by this author on: Oxford Academic PubMed Google Scholar S MAXWELL, S MAXWELL Search for other works by this author on: Oxford Academic PubMed Google Scholar S UTTING, S UTTING Search for other works by this author on: Oxford Academic PubMed Google Scholar M A WAlTE M A WAlTE Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, Volume 27, Issue 1, January 1993, Page 141, https://doi.org/10.1093/cvr/27.1.141 Published: 01 January 1993
Equivocal Findings on Cranial CT but Apparent Cerebral Lesion(s) on Conventional Radionuclide Imaging
Authors: WEI-JEN SHIH, FRANK H. DeLAND
Journal: Clinical Nuclear Medicine (1987)

Four patients with different disease entities (multiple cerebral metastases, cerebral infarct, cerebritis, and encephalitis) in whom x-ray computed tomography was either equivocal or negative showed apparent cerebral lesions by radionuclide studies. Equivocal CTs in the patients with multiple cerebral metastases or cerebral infarction may be attributed to the contraindication of contrast media and/or lack of cooperation during the examination procedure. In patients with cerebritis or encephalitis, radionuclide studies have proven to be more sensitive than CT early in the infectious disease process. In certain circumstances it is clinically beneficial and cost effective to evaluate the patient primarily by radionuclide scintigraphy.