tbuckley/cabot-search huggingface dataset:
Management of Respiratory Failure
Authors: Damon M. Fellman
Journal: JAMA (1980)

<h3>To the Editor.—</h3> Newsum et al (242:1650, 1979) provide clinically important information regarding their experience with intubation rather than tracheostomy in the treatment of respiratory failure caused by the Guillain-Barré syndrome. There is another alternative that has received little attention in the medical literature. The iron lung or cuirass respirator can be employed with much less discomfort to the patient. The disadvantage is that suctioning may be more difficult. However, intubation or tracheostomy could be withheld as a possible second step. When intubation is clearly necessary, some patients can be extubated earlier and placed in the iron lung or cuirass respirator before they are ready to breathe entirely on their own. The difference in terms of patient comfort should lead to attempts to use these alternatives whenever possible. Availability of these devices may limit their use, though I have noted that several hospitals have stored away such equipment from the
P192 QVA149 once daily provides superior bronchodilation versus indacaterol, glycopyrronium, tiotropium and placebo: the SHINE study: Abstract P192 Table 1
Authors: N Barnes, E Bateman, N Gallagher, Y Green, R Horton, M Henley, D Banerji
Journal: Thorax (2012)

<h3>Introduction</h3> QVA149 is a novel inhaled once-daily dual bronchodilator containing a fixed-dose combination of the long-acting β<sub>2</sub>-agonist indacaterol and the long-acting muscarinic antagonist NVA237 (glycopyrronium) in development for the maintenance treatment of COPD. This study evaluated the effect of QVA149 on lung function compared with indacaterol, glycopyrronium, open-label tiotropium and placebo in patients with moderate-to-severe COPD. <h3>Methods</h3> This 26 week, multicentre, double-blind, parallel-group, placebo and active controlled (open-label tiotropium) study randomised male or female patients ≥40 years of age with moderate-to-severe COPD (post-bronchodilator FEV1/FVC &lt;0.7 and FEV1 ≥30% to &lt;80% predicted) and smoking history ≥10 pack-years to receive once-daily QVA149 (110/50µg), indacaterol (150µg), glycopyrronium (50µg), placebo (all delivered via the Breezhaler® device) and tiotropium (18µg; delivered via the Handihaler® device) (2:2:2:1:2). The primary objective was to demonstrate superiority in trough FEV1 (mean of 23h 15min and 23h 45min post-dose) of QVA149 versus indacaterol and glycopyrronium at Week 26. We also present results of trough FEV1 at Day 1 and Week 12, serial spirometry for FEV1 and forced vital capacity (FVC) at Day 1, Weeks 12 and 26. <h3>Results</h3> Of the 2144 patients randomised, (QVA149 [n=475]; indacaterol [n=477]; glycopyrronium [n=475]; tiotropium [n=483]; placebo [n=234]), 89.1% completed the study. 75.4% were male; mean age: 63.9 years; mean post-bronchodilator FEV1: 55.2% predicted. At Day 1, Weeks 12 and 26, QVA149 was statistically superior to indacaterol, glycopyrronium, tiotropium and placebo for mean trough FEV1 and trough FVC (all p&lt;0.001, table). Serial spirometry in a subset of patients (QVA149 [n=66]; indacaterol [n=64]; glycopyrronium [n=63]; tiotropium [n=70]; placebo [n=31]) showed statistically significant improvements in FEV<sub>1</sub> with QVA149 versus placebo at all time-points (p&lt;0.001) and versus indacaterol, glycopyrronium and tiotropium at almost all assessed time-points on Day 1, and Weeks 12 and 26. <h3>Conclusion</h3> QVA149 once daily provided significant and clinically meaningful improvements in lung function versus the component monotherapies indacaterol and glycopyrronium, as well as significant improvements versus tiotropium and placebo over 26 weeks in patients with COPD.
Analyses of the <i>NRAMP1</i> and <i>IFN- γ R1</i> Genes in Women with <i>Mycobacterium avium-intracellulare</i> Pulmonary Disease
Authors: JUDY H. HUANG, PETER J. OEFNER, VIRGINIA ADI, KRISHNA RATNAM, STEPHEN J. RUOSS, EDMUND TRAKO, PETER N. KAO
Journal: American Journal of Respiratory and Critical Care Medicine (1998)

Mycobacterium avium-intracellulare (MAI) pulmonary disease causes substantial morbidity in a population of older, HIV-negative women without preexisting lung disease. The cause for disease susceptibility in these patients is unknown, although their relative phenotypic homogeneity suggests the existence of a common, subtle immune deficiency. An investigation was undertaken to determine if these patients have a defect in their natural resistance-associated macrophage protein (NRAMP1) or interferon γ receptor 1 (IFN- γ R1) genes. A point mutation in murine nramp, an autosomal recessive gene controlling resistance to intracellular organisms, correlates with overwhelming Mycobacterium bovis infection in mice. The corresponding region in human NRAMP1, two coding polymorphisms and one promoter NRAMP1 polymorphism, as well as two IFN- γ R1 polymorphisms, were analyzed to determine if an allele was present to correlate with disease. Genomic DNA was purified from eight women with MAI pulmonary disease and four controls. Regions of interest were amplified by PCR; three sites were analyzed by restriction fragment length polymorphisms, and three were analyzed using denaturing high-performance liquid chromatography. The NRAMP1 promoter polymorphism of 18 additional random controls was analyzed by microsatellite sizing. No allelism was found in NRAMP1 corresponding to the murine mutation, or in the two coding regions. In the NRAMP1 promoter microsatellite, 3 of 8 patients were heterozygous for a dinucleotide sequence insertion, as were 10 of 22 controls. None of the patients had either of the two known IFN- γ R1 mutations. In conclusion, in women with MAI pulmonary disease, there is no evidence for a genetic defect in NRAMP1 or IFN- γ R1 to correlate with disease.
Adjuvant Chemotherapy for Breast Cancer
Authors: Stephen E. Jones
Journal: JAMA (1981)

<h3>To the Editor.—</h3> How can there be a "consensus" when all relevant information is not presented? I wish to clarify several points attributed to me in the recent MEDICAL NEWS article (1980;244:1079) on the National Cancer Institute Consensus Conference on Adjuvant Chemotherapy of Breast Cancer.<sup>1</sup> Regarding the use of adjuvant chemotherapy for node-negative (stage I) cases, I reported on the preliminary results of a pilot study wherein two patients have relapsed out of 52 treated with adjuvant chemotherapy. At no time during the conference did I advocate the routine use of adjuvant chemotherapy in this setting—I repeatedly stated that this is an on-going research program and that the preliminary results should be judged on their own merits. Since many larger groups of investigators (eg, cooperative groups) are now just initiating controlled trials for stage I cases, the data we presented from our pilot program might provide some background and
Patient Compliance and Drug Failure in Protease Inhibitor Monotherapy
Authors: Geertrui F. Vanhove
Journal: JAMA (1996)

<h3>To the Editor.</h3> —We conducted a 2-dose study of saquinavir in which 40 human immunodeficiency virus type 1 (HIV-1)positive patients received either three or six 200-mg capsules of saquinavir (Roche Products, Welwyn, United Kingdom) 6 times daily (total dose, 3600 mg/d or 7200 mg/d).<sup>1</sup>Analysis of an early cohort of patients enrolled in the study demonstrated that the duration of the response as measured by HIV-1 plasma RNA copy number varied widely within the 2 groups. This variation was not accounted for by the development of resistant mutations alone. To investigate whether decreased patient compliance with this intensive regimen could explain the observed variation in viral responses, we monitored drug-taking behavior in the remaining patients on their enrollment into the high-dose group for the initial 24 weeks of therapy using medication container closures or caps that record the precise date and time of the opening and closing of the
Communicating risk: Compulsory measures can work
Authors: R. J Geller
Journal: BMJ (2003)

Editor—Thank you for devoting an issue of the BMJ to the important topic of communication and public perception of risk. As a public health doctor, I have long puzzled over the apparent dissonance between statistical and public interpretation of risk.

Risks imposed by others may be less acceptable than risks under individual control. In the examples covered by Bellaby,1 injuries to child passengers could be perceived by parents as under their own control. Measles, mumps, and rubella vaccination2 and variant Creutzfeldt-Jakob disease are, however, perceived as imposed by authority.

When comparing the risk of death from smoking and air travel, statistics tell us that air travel is incredibly safe and that smoking is not. Plane crashes induce enormous public fear, yet some 340 jumbo jets would have to crash every year to equal the toll from smoking in the United Kingdom. The media, and hence the public, seem more frightened by unusual and immediate events. Smoking is an every day occurrence and takes many years to kill. Plane crashes are rare and happen in a matter of hours after take off.

Bellaby argues that in a post-war democracy, compulsion cannot work and concordance through two way communication is the only way forward. Although concordance is preferable, compulsion can work well: seat belt legislation. After it was introduced in 1988 this compulsory, effective health measure did not generate mass riots or failed compliance.3-5 Research into the above issues could contribute to the implementation of effective public health programmes, through better communication, in today's Britain.
Medical Education for the Public
Authors: HENRY GREENBERG
Journal: Annals of Internal Medicine (1974)

Letters1 December 1974Medical Education for the PublicHENRY GREENBERG, M.D.HENRY GREENBERG, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-81-6-859 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: With national health service in one form or another a political certainty, the persistence of adversary positions of patients and physicians or at least their proxies bodes ill for all.Most physicians believe that plans now under discussion will destroy those characteristics of American medicine that make it, at its best, unsurpassed. My concern is that current plans seem to insure erosion of medicine from the inside. An essential ingredient of good medicine is the physician's ability to seek out and assume responsibility and to make decisions as an individual. These attributes attract students, and developing this... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Department of Medicine The Roosevelt Hospital 428 West 59th Street New York, New York 10019 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 1974Volume 81, Issue 6Page: 859-859KeywordsMedical educationMedical services Issue Published: 1 December 1974 PDF DownloadLoading ...
Running the New York marathon with diabetes
Authors: B. Kjeldby
Journal: BMJ (1997)

I have always enjoyed running and keeping in good shape with regular races and had completed several half marathons when I started to work out regularly with other runners who shared my wish to take part in the 1995 New York marathon.

We trained seriously in the preceding year. Sometimes I was accompanied by Tor, my 10 year old son, on his bicycle carrying the necessary water supplies. The distances varied between 10 and 25 km. I made two runs of 30 km. Sometimes I chose swimming instead of running to avoid damage to my leg muscles, and I reduced my body weight by 8 kg.

The run was to take place on 12 November at 11 am local time. We left Norway on 8 November. The time difference between Norway and New York is six hours. I woke at 4 30 am. The early start was in my favour. Usually in early November the temperature in New York is moderate, …
CRYOPRESERVATION OF SEMEN IN MEN WITH TESTICULAR TUMOUR OR HODGKIN'S DISEASE: RESULTS OF ARTIFICIAL INSEMINATION OF THEIR PARTNERS
Authors: G.E. Scammell, J. Stedronska, D.K. Edmonds, N. White, W.F. Hendry, S.L. Jeffcoate
Journal: The Lancet (1985)
Spectroscopic and dynamic light scattering studies of the interaction between pterodontic acid and bovine serum albumin
Authors: Yunfang Li, Guangzhong Yang, Zhinan Mei
Journal: Acta Pharmaceutica Sinica B (2012)

Pterodontic acid (PA) has been isolated from Laggera pterodonta, a Chinese herbal medicine, and shown to possess antibacterial activity in vitro. To facilitate its preclinical development, the interaction between PA and bovine serum albumin (BSA) was studied using a fluorescence quenching technique, ultraviolet–visible spectrophotometry and dynamic light scattering (DLS). At temperatures of 297 K and 310 K and an excitation wavelength of 282 nm, the fluorescence intensity of BSA decreased significantly with increasing concentration of PA attributed to the formation of a PA–BSA complex. The apparent binding constant, number of binding sites and corresponding thermodynamic parameters were calculated and the main intermolecular attraction shown to result from hydrogen bonding and van der Waals forces. Synchronous fluorescence spectrometry revealed that the binding site in the complex approached the microenvironment of Trp and three-dimensional fluorescence spectroscopy showed the binding induced conformational changes in BSA. Using DLS, increasing PA concentration was shown to cause a gradual increase in hydrodynamic diameter and significant aggregation of the complex.
Caesarean section or vaginal birth for breech presentation at term
Authors: M Hannah, W Hannah
Journal: BMJ (1996)

About 3-4% of pregnant women reach term with a fetus in breech presentation, although an active policy of external cephalic version would be expected to lower this incidence somewhat. Over the past 20 years planned caesarean section has increasingly become the favoured approach for the delivery of these infants, despite the absence of good data to support this trend. Indeed, there have been only two randomised controlled trials that have compared the policy of planned caesarean section with that of planned vaginal birth.1 2 Although the trials were too small to have reasonable power to measure clinically important differences in serious neonatal morbidity or mortality, the studies did not find caesarean section to be a better option than planned vaginal delivery.

A meta-analysis of these two trials, undertaken as part of a Cochrane systematic review, found no significant differences between the two approaches in terms of perinatal mortality (excluding malformations) (typical odds ratio 0.22 (95% confidence interval 0.00 to 14.52)) and Apgar score <7 at 5 minutes (0.64 (0.18 …
Serum Cystatin C is a Better Marker of Topotecan Clearance than Serum Creatinine
Authors: Antje Hoppe, Sophie Séronie-Vivien, Fabienne Thomas, Jean-Pierre Delord, Laurence Malard, Pierre Canal, Etienne Chatelut
Journal: Clinical Cancer Research (2005)

Abstract Purpose: To evaluate plasma cystatin level as a covariate to predict topotecan pharmacokinetics. Cystatin C, a member of the cystatin superfamily of cysteine proteinase inhibitors, has been recently proposed as an alternative endogenous marker of glomerular filtration. Renal function is known as a key factor of topotecan clearance. Experimental Design: Data were obtained from 59 patients who underwent drug monitoring for individual dosing of topotecan. Topotecan plasma concentrations versus time were analyzed using a nonlinear mixed effect model according to a two-compartment pharmacokinetic model and a first-order conditional estimation method. A proportional error model was used for residual and interpatient variabilities. Data-splitting was done randomly to create a model-building data set (44 patients) and a model validation data set (15 patients). Results: Using the building data set, four covariates significantly decreased the objective function value and interindividual variability on topotecan clearance (CL) when tested individually: ideal body weight (IBW), serum creatinine, age, and cystatin C level. The best model was: CL (L/hour) = 20.2 [cystatin C (mg/L) / 1.06]−0.60 [IBW (kg) / 57]0.95. Prospective evaluation using the validation data set confirmed that the model based on cystatin C had a better predictive value than the models based on serum creatinine or body surface area. Conclusion: Cystatin C is a marker of drug elimination which is superior to serum creatinine for topotecan. It deserves to be further explored as a promising covariate for drug dosing as well as selection criteria for clinical studies of drugs eliminated mainly or partially by the kidney.
β-Cell Function Preservation After 3.5 Years of Intensive Diabetes Therapy
Authors: Lindsay B. Harrison, Beverley Adams-Huet, Philip Raskin, Ildiko Lingvay
Journal: Diabetes Care (2012)

OBJECTIVE To assess β-cell function preservation after 3.5 years of intensive therapy with insulin plus metformin (INS group) versus triple oral therapy (TOT group) with metformin, glyburide, and pioglitazone. RESEARCH DESIGN AND METHODS This was a randomized trial of 58 patients with treatment-naïve newly diagnosed type 2 diabetes. All patients were treated with insulin and metformin for a 3-month lead-in period followed by random assignment to the INS or TOT group. β-Cell function was assessed using a mixed-meal challenge test at randomization and 6, 12, 18, 30, and 42 months. Analyses were intention to treat and performed with repeated-measures models. RESULTS Completion rates at 3.5 years were 83% in the insulin group and 72% in the TOT group, with good compliance in both groups (87 ± 20% in the INS group vs. 90 ± 15% in the TOT group). β-Cell function was preserved at 3.5 years after diagnosis, with no significant change from baseline or difference between the two groups as measured by area under the curve (AUC) of C-peptide (P = 0.14) or the ratio of C-peptide to glucose AUC (P = 0.7). Excellent glycemic control was maintained in both groups (end-of-study HbA1c 6.35 ± 0.84% in the INS group vs. 6.59 ± 1.94% in the TOT group). Weight increased in both groups over time (from 102.2 ± 24.9 kg to 106.2 ± 31.7 kg in the INS group and from 100.9 ± 23.0 kg to 110.5 ± 31.8 kg in the TOT group), with no significant difference between groups (P = 0.35). Hypoglycemic events decreased significantly over time (P = 0.01) but did not differ between groups (P = 0.83). CONCLUSIONS β-Cell function can be preserved for at least 3.5 years with early and intensive therapy for type 2 diabetes with either insulin plus metformin or triple oral therapy after an initial 3-month insulin-based treatment period.
ICCE Consensus for Inflammatory Bowel Disease
Authors: A. Kornbluth, J. F. Colombel, J. A. Leighton, E. Loftus
Journal: Endoscopy (2005)

This summary represents the current consensus of opinions of the Inflammatory Bowel Disease (IBD) Working Group. We review here the current state of knowledge in comparing capsule endoscopy (CE) to other small-bowel imaging modalities. We address the challenges in studying CE in Crohn's, and propose a design for a prospective study comparing CE to traditional diagnostic techniques, as well as other potential IBD studies.
Activation of mouse peritoneal macrophages by monoclonal antibodies to Mac-1 (complement receptor type 3).
Authors: A Ding, S D Wright, C Nathan
Journal: The Journal of Experimental Medicine (1987)

Several features of activation of mouse peritoneal macrophages were elicited by 1-2-d exposure to submicrogram concentrations of anti-Mac-1 (M1/70), a rat monoclonal antibody that reacts with the alpha chain of complement receptor type 3 (Mac-1). The changes induced included enhanced capacity to secrete H2O2 when triggered with PMA, decreased secretion of proteins, increased expression of Ia antigen and decreased phagocytosis of particles. These changes closely resembled those induced by rIFN-gamma in type, extent, and time course. The concentration of M1/70 IgG resulting in 50% of the maximal activation of macrophage H2O2-releasing capacity averaged 0.18 +/- 0.03 micrograms/ml. This activation was not blocked by anti-FcR mAb, and could be reproduced with M18/2, a mAb against beta chain of Mac-1, suggesting that a direct ligation of Mac-1 with mAb was responsible for the activation. Neither depletion of T cells nor addition of neutralizing Abs to IFN-gamma or TNF-alpha prevented M1/70-mediated macrophage activation. Moreover, F(ab')2 of M1/70, or plating of macrophages on C3bi-coated surfaces, inhibited the activation of macrophages by rIFN-gamma. These findings suggest that Mac-1 (CR3) may play an important role in macrophage activation.
Equations for the calculation of mean ejection pressure
Authors: A. A. WALKER, J. S. JANICKI, K. T. WEBER, R. O. RUSSELL, C. E. RACKLEY
Journal: Cardiovascular Research (1973)

Two simple equations for the calculation of mean ejection pressure (MEP) are described and compared with true MEP determined by manual planimetry. The equations were tested and found to have a high degree of correlation with true MEP over a wide range of peak systolic pressures, pulse pressures, and heart rates in humans and several animal species.
Maternal stress modulates the effects of developmental lead exposure.
Authors: Deborah A Cory-Slechta, Miriam B Virgolini, Mona Thiruchelvam, Doug D Weston, Mark R Bauter
Journal: Environmental Health Perspectives (2004)

Lead exposure is higher among children with low socioeconomic status (SES) compared with other children in the United States. Low SES itself is a known risk factor for various diseases and dysfunctions, effects that have been ascribed to chronic stress and associated elevation of glucocorticoids. Chronically elevated glucocorticoids and Pb provoke similar behavioral changes, and both can act on mesocorticolimbic systems of the brain. In this study we examined the hypothesis that these co-occurring risk factors, Pb and environmental stress, would interact and modulate each others' effects. Using a rodent model, we focused on the specific contributions of maternal stress (restraint) and maternal Pb exposure (150 ppm in drinking water) on corticosterone levels of offspring, as well as on neurotransmitter changes and a behavioral baseline (fixed-interval schedule-controlled performance) with known sensitivities to Pb. We observed interactions of Pb and stress that differed in relation to outcome measure and sex. In addition, potentiated effects (effects of Pb plus stress but showing no changes produced by either alone) were observed more frequently in females. Importantly, Pb alone (in males) and Pb plus stress (in females) permanently elevated corticosterone levels in offspring; even short-term Pb exposure to dams could cause this effect. Such increases could suggest a potential new mechanism by which Pb exposure could directly or indirectly enhance susceptibility to diseases and dysfunctions and induce cognitive deficits. Moreover, the interactive effects of Pb and stress, and particularly the potentiated effects of Pb plus stress, raise questions about whether current risk assessment strategies sufficiently consider the potential for modulation of toxicity that can accrue from intercurrent risk factors.