tbuckley/cabot-search huggingface dataset:
The Second Sentence
Authors: Jonathan Kole
Journal: Annals of Internal Medicine (2014)

On Being a Doctor18 February 2014The Second SentenceJonathan Kole, MD, MBEJonathan Kole, MD, MBEFrom Brown University, Providence, Rhode Island.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M13-0995 Audio Reading - “The Second Sentence” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "The Second Sentence," by J. Kole. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I held the manila folder in my hand, nearly trembling with excitement. My first patient. In the first 2 years of medical school, buried in biochemistry and living in lecture halls, we craved patient contact. Eager to serve and solve with science, we longed for opportunities to put our diagnostic skills to use.I had the great fortune of getting my first patient exposure at a shelter devoted to the protection and empowerment of homeless teenagers. As well as providing food, shelter, and social support, this haven employed a doctor and nurse to run a clinic for youth struggling to ... Author, Article, and Disclosure InformationAffiliations: From Brown University, Providence, Rhode Island.Corresponding Author: Jonathan Kole MD, MBE, Brown University, Physicians Office Building, Suite 122, 593 Eddy Street, Providence, RI 02903; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “The Second Sentence” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "The Second Sentence," by J. Kole. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics Cited byThe Human Person at the Heart of Medicine: Reflections of a Physician with Lymphoma 18 February 2014Volume 160, Issue 4Page: 288KeywordsAdolescentsAntifungalsBiochemistryCandidaDrugsFoodHeroin useNursesRashes ePublished: 18 February 2014 Issue Published: 18 February 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Management of Ventricular Arrhythmias
Authors: David S. Cannom, Eric N. Prystowsky
Journal: JAMA (1999)

ObjectiveTo review evaluation and treatment of patients with ventricular arrhythmias, based on recent studies, with an emphasis on randomized controlled trials.Data SourcesMEDLINE search of English-language publications of ventricular arrhythmias and their references from 1966 through April 27, 1998. References to articles were also scanned to broaden the search.Study SelectionRandomized controlled trials and all large nonrandomized trials of arrhythmias and arrhythmia therapy were reviewed. In addition, studies that led to changes in approach to patients with arrhythmias were reviewed.Data ExtractionWe reviewed articles jointly for pertinent studies and information.Data SynthesisThe goals of treatment of the patient with ventricular arrhythmias are to suppress symptoms and prevent a fatal event. The steps in providing such therapy include defining the cardiac anatomy, assessing arrhythmia risk through noninvasive or invasive testing, and prescribing treatment based on these results. Patients may be separated into high- and low-risk groups to help identify appropriate treatment. While low-risk groups may benefit from reassurance or medications such as β-blockers or verapamil, high-risk groups have been more difficult to treat. Recent randomized trials of implantable cardioverter defibrillators for ventricular arrhythmias suggest that they may provide better protection for high-risk patients than do antiarrhythmic medications.ConclusionsTreatment and understanding of risk from ventricular arrhythmias have advanced substantially in recent years. Classifying patients as being at high or low risk for fatal arrhythmias allows the physician to identify appropriate treatments for the high-risk patient without exposing the low-risk patient to unnecessary treatment-related risks.
Induction of interleukin (IL)-6 by hypoxia is mediated by nuclear factor (NF)-κB and NF-IL6 in cardiac myocytes
Authors: H Matsui
Journal: Cardiovascular Research (1999)

Objectives: We have previously reported that interleukin (IL)-6 is induced by hypoxic stimulation in cardiac myocytes. In the present study, we examined the induction of potent transcription factors of IL-6, nuclear factor (NF)-κB and NF-IL6, in cardiac myocytes subjected to hypoxia. Methods: Five different lengths of IL-6 promoter-luciferase reporter plasmids and three mutant plasmids, in which the binding sites of NF-κB and/or NF-IL6 were disrupted, were transfected into neonatal rat cardiac myocytes. Luciferase activities after hypoxic stimulation were measured. Electrophoretic mobility shift assays were performed using oligonucleotides containing the binding site for NF-κB or NF-IL6 as a probe. Results: Hypoxic stimulation for 4 h increased luciferase activity by 5.7 fold in −179/+12-luciferase reporter plasmid, whereas no significant increase was observed in −60/+12-luciferase plasmid. Decrease in luciferase activity was more prominent when the NF-κB binding site was disrupted rather than when the NF-IL6 binding site was disrupted. Moreover, when both sites were disrupted, luciferase activity increased only by 1.5 fold. Electrophoretic mobility shift assays demonstrated enhanced binding activity to oligonucleotides containing the NF-κB binding site in hypoxic cardiac myocytes, which displayed a supershift with antibody to its subunit, p50 or p65. The binding activity to the NF-IL6 probe also enhanced and displayed a supershift with antibody to NF-IL6. Conclusions: Although hypoxic stimulation induced NF-κB and NF-IL6 in cardiac myocytes, NF-κB may be the primary positive regulator of transcriptional activation of the IL-6 gene in the context of hypoxia.
Treatment of liver failure in rats with end-stage cirrhosis by transplantation of immortalized hepatocytes
Authors: Jin Cai, Masahiro Ito, Hideo Nagata, Karen A. Westerman, Daryl LaFleur, Jayanta Roy Chowdhury, Philippe Leboulch, Ira J. Fox
Journal: Hepatology (2002)

The shortage of organ donors has impeded the development of human hepatocyte transplantation. Immortalized hepatocytes could provide an unlimited supply of transplantable cells. To determine whether immortalized hepatocytes could provide global metabolic support in end-stage liver disease, 35 immortalized rat hepatocyte clones were developed by transduction with the gene encoding the simian virus 40 T antigen (SV40Tag). The SV40Tag sequence and a suicide gene, herpes simplex virus thymidine kinase (HSV-tk), were flanked by lox P sequences so that they could be excised by Cre/ lox recombination. When transplanted into the spleens of portacaval-shunted rats, 3 of the 35 immortalized hepatocyte clones prevented the development of hyperammonemia-induced hepatic encephalopathy. The protection was reversed by treatment with ganciclovir, which kills HSV-tk-expressing cells. Transplantation of alginate-encapsulated, immortalized hepatocytes into the spleens of cirrhotic rats resulted in significant improvement in prothrombin time, serum albumin and bilirubin levels, hepatic encephalopathy score, and duration of survival. The metabolic support provided by the immortalized cells equaled that observed after transplantation of primary rat hepatocytes. In conclusion, immortalized hepatocytes can function as well as primary hepatocytes following transplantation and can be engineered to contain safeguards that could make them clinically useful. Further investigation is warranted regarding the mechanisms of loss of mass or function of the transplanted hepatocytes over time and how the relatively few engrafted hepatocytes can ameliorate liver decompensation in cirrhosis.
Weight loss and hyponatraemia
Authors: N. Othonos, R. Sulaiman, D. D'Costa, R. Gama
Journal: BMJ (2011)

A 60 year old South Asian woman with a one year history of lethargy and anorexia, and 3 kg weight loss was referred by her general practitioner to a medical outpatient department. Medical history included pulmonary tuberculosis, hypothyroidism, psoriasis, and Raynaud's phenomenon. She was taking levothyroxine 100 μg daily, amlodipine 5 mg daily, and applying Polytar liquid 250 ml twice weekly to her scalp. Clinical examination was unremarkable. Chest radiograph, abdominal ultrasound, and serum tissue transglutaminase antibodies, glucose, and thyroid function tests excluded active tuberculosis, coeliac disease, diabetes mellitus, and thyroxine overtreatment. Apart from persisting mild hyponatraemia (serum sodium concentration 128-135 mmol/L), routine haematology, biochemistry, and serum inflammatory markers were normal. The patient was not oedematous or dehydrated. Further investigations showed: Given these results, a short Synacthen test was performed using 0.25 mg Synacthen given intravenously at 0 minutes.⇓ View this table: Table 1 Results of the short Synacthen test
Rosiglitazone in Diabetes Control in Hemodialysis Patients With and Without Viral Hepatitis Infection
Authors: Chih-Kang Chiang, Tai-I. Ho, Yu-Sen Peng, Shih-Ping Hsu, Mei-Fen Pai, Shao-Yu Yang, Kuan-Yu Hung, Kwan-Dun Wu
Journal: Diabetes Care (2006)

Thiazolidinedione (TZD) may provide an additional benefit of cardiovascular protection in diabetic patients through targeting of insulin resistance. However, use of a TZD is hampered by possible effects of fluid retention and hepatotoxicity. In this study we aimed to determine whether the risk of TZD-induced fluid retention or hepatic injury is higher in hemodialysis patients with persistent viral hepatitis infection.This was a prospective, cohort study on hemodialysis patients. Type 2 diabetic patients with A1C levels of >8% were followed for at least 12 months. Rosiglitazone was initiated at 2-4 mg/day. The primary outcome was the target A1C (<7%) achieved and dosages of rosiglitazone. Secondary outcomes included changes in lipid profile and inflammatory biomarkers. Safety evaluations were number of hypoglycemic episodes, changes in liver transaminase levels, cardiothoracic ratio (CTR), fluid status control during dialysis, and events of symptomatic heart failure.A total of 78 patients, including 15.4% (n = 12) hepatitis B surface antigen-positive and 16.7% (n = 13) anti-hepatis C virus (HCV)-positive patients, were enrolled. The mean follow-up period was 15.4 +/- 3.8 months. The diabetic response rate (A1C <7%) to rosiglitazone was 86.1%. The serum triglyceride level was reduced (194 +/- 112.5 to 168 +/- 88 mg/dl, P = 0.037) more significantly than the total cholesterol level (178 +/- 42.1 to 174 +/- 46.5 mg/dl, P = 0.13). High-dose rosiglitazone (8 mg/day) reduced the serum level of C-reactive protein and increased the serum adiponectin level significantly. After rosiglitazone, interdialysis weight gain (2.07 +/- 1.6 to 3.2 +/- 1.2 kg, P < 0.01) and mean CTR (48.2 +/- 5.6 to 50.4 +/- 6.2%, P = 0.0213) of individuals increased significantly. Nevertheless, liver aminotransferase (aspartate aminotransferase and alanine aminotransferase) levels did not show a tendency to increase in patients (n = 25) with viral hepatitis B or C infections.Among regular hemodialysis patients with chronic viral hepatitis infections, rosiglitazone may be safely used for diabetes control. However, one must be aware that a possible effect of its use is a deterioration in cardiovascular reserve.
Abstract 456: Adaptation of cancer cells to hypoxic environments for tumor progression
Authors: Tomoko Mizushima, Kenji Kawai, Chiyoko Nishime, Mitsuyo Ohmura, Eri Hayakawa, Masahiro Matsuyama, Keisuke Asakura, Yotaro Izumi, Hiroshi Suemizu, Yasuyuki Ohnishi, Masato Nakamura, Makoto Suematsu, Masatoshi Wakui
Journal: Cancer Research (2010)

Abstract There have been a number of reports mentioning the significance of adaptation of cancer cells to hypoxic environments in tumor growth, invasion, and metastases. However, understanding of molecular aspects based on in vivo evidence still remains insufficient. We established an in vivo tumor progression model by transfer of human colorectal cancer HCT116 cells cultured under hypoxia to NOD/Shi-scid, IL-2Rγnull (NOG) mouse recipients. The hypoxic culture resulted in invasive proliferation of subcutaneous tumors. Immnohistochemical staining for molecular markers, such as E-cadherin, vimentin and BCRP1, demonstrated that adaptation of HCT116 cells to hypoxia was associated with increased frequencies of epithelial-mesenchymal transition and cancer stem cell-like appearance. To investigate the molecular basis of such effects of hypoxia on tumor progression, biological and molecular profiles of HCT116 cultured under hypoxia were analyzed. The hypoxic culture resulted in slowing cell cycling and increase in the side population cell frequency, suggesting induction of stemness. Capillary electrophoresis-mass spectrometric analysis revealed altered metabolism in hypoxic HCT116 cells, which appeared to be associated with adaptation to hypoxia. Gene expression profiling of the cultured cells under pharmacological inhibition of p53, which is not mutated in HCT116 cells, presented evidence for dependence of the adaptation to chronic mild but not acute severe hypoxia on p53 function. Our results provided insights into molecular basis of tumor progression critically directed by hypoxia. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 456.
Pathobiology Annual, 1971
Authors: Frederick W. Bauer
Journal: JAMA (1972)

The modern era of pathology generally is thought to have begun more than a century ago when Rudolph Virchow first proposed the cellular theory of disease, an achievement made possible chiefly by prior developments in what until then had been separate sciences—anatomy, in which the cellular structure of tissues had been established, and optical physics which had contributed greatly to refining the light microscope. Now, in our more modern epoch, the physicists' development of the electron microscope has led anatomists to confirm the presence of some existing cellular structures as the Golgi apparatus, and to discover the existence of new ones. Out of all this recent molecular hustle and activity a new term, "pathobiology," has been proposed to recognize that for teaching and research purposes fruitful interrelationships can be established among the various sciences. Hence, the title of this series. In his preface to this first volume the editor describes
Treatment of Cushing's disease with low dose radiation therapy.
Authors: S R Ahmed, S M Shalet, C G Beardwell, M L Sutton
Journal: BMJ (1984)

Nineteen patients with Cushing9s disease were treated with low dose external pituitary irradiation (20 Gy (2000 rad) in eight fractions over 10 days). While awaiting the effects of pituitary irradiation all patients were treated with metyrapone. Seven patients had a complete remission of their disease within six to 12 months of irradiation. They did not require any further treatment and were followed up for a mean of three and a half (range one to eight) years. Another patient had a complete remission after a second course of pituitary irradiation. A further two patients showed a significant biochemical improvement after irradiation, although they were not rendered eucorticoid. There were no complications after this dose of irradiation. These results compare favourably with those reported after pituitary irradiation at conventional doses (40-50 Gy (4000-5000 rad) over four or five weeks) but were not associated with any complications. It is therefore recommended that low dose external pituitary irradiation be used as definitive first line treatment for Cushing9s disease.
Tuberculosis in Britain: Author's reply
Authors: C. Skinner
Journal: BMJ (1990)

Dr M S Gatley estimated that the recommendations would mean examining by chest radiography nearly 70% of new employees in his region.' We have estimated from our study of BCG vaccination scars and tuberculin reactivity, assessed by serial Mantoux testing, that if we followed the recom- mendations we would need to examine about half of our new employees in Hampstead Health Authority: 34 of 92 with a scar and 46 of 77 without a scar were "eligible" for chest radiography.2Of those without a scar, 18 of the 77 were Mantoux positive at 1:10000 and none of them had tuberculosis.Retrospective analysis of chest radiographs before employment and tuberculin skin reactivity in our two districts showed no association between the two.The table shows the basic case-control analysis from Hampstead, where cases are those with abnormal radiographs and controls are a random sample of the remainder with normal radiographs.Further analysis showed that the Case-control analysis of abnormal chest radiographs and tuberculin skin reactivity in new employees Tuberculin skin reactivity No (%) negative No (%) positive Cases 10 (15) 58 (85) Controls 42 (20) 170 (80)
A CASE OF SO-CALLED "MUSICAL HEART."
Authors: JOSEPH M. PATTON
Journal: JAMA (1905)

The case here reported is of unusual interest because of its rarity and because of the fact that, during a period of about fifteen years previous to death, the patient had been observed and examined by probably a greater number of physicians and students than any other individual of which we have record. During this period he made a living principally by posing for purposes of demonstration before medical classes, both undergraduates and postgraduates, and on one or two occasions was on public exhibition as "the man with the musical heart." <h3>Patient.</h3> —The patient was 38 years old at death. According to his statement he was of Russian birth and had been exiled to Siberia, but had escaped and emigrated to America about fifteen years ago. Shortly after reaching this country, and while in New York City, he suffered from inflammatory rheumatism and entered Bellevue Hospital. It was while in
PWE-217 Is “push” an effective and safe method for relief of oesophageal food bolus obstruction on endoscopy?: Abstract PWE-217 Table 1
Authors: V Mahesh, M Schoeman
Journal: Gut (2012)

<h3>Introduction</h3> Food bolus obstruction of the oesophagus is not an uncommon acute presentation, but data on safe and effective endoscopic management is limited. Although “push” technique with the endoscope is commonly employed, no data on its safety and efficacy compared to other modalities is available. <h3>Aim</h3> To evaluate the safety and efficacy of various endoscopic modalities for relief of acute oesophageal food bolus obstruction. <h3>Methods</h3> Retrospective study of prospectively collected data. All patients presenting to the department of Gastroenterology at Royal Adelaide hospital, a tertiary centre in South Australia from January 1996 to November 2011 were included in the study. Detailed data on endoscopy, histopathology and complications were collected. <h3>Results</h3> In total 288 patients presented with acute oesophageal food bolus obstruction. 70% male patients (202M:86 F); average age of 58.2 yrs±1.7 yrs at presentation. 150 (52%) patients had procedure with anaesthetic assist (± tracheal intubation), 135 (47%) with intravenous sedation (midazolam and fentanyl) and 3 (1%) with only topical anaesthesia. 44 (15%) patients had food bolus in the proximal, 59 (21%) in the mid and 146 (51%) in the distal oesophagus. In 39 (14%) food bolus had spontaneously cleared the oesophagus at endoscopy. The contributing aetiology for food bolus obstruction is described in Abstract PWE-217 table 1. Incomplete data on the type of food was available, but majority were documented to be meat bolus. Push technique was solely and successfully used in 167 (67%) compared to combination of techniques after failed “push” in 53 (21.2%) patients {forceps ± snare ± overtube ± basket} (p&lt;0.01). Remnant 24 (9.6%) patients had one of the following: overtube/hood 5 (2%), forceps 8 (3.2%), snare 2 (1%), basket 5 (2%), suction 1 (0.4%) and wire guided dilatation 3 (1.2%). In five (2%) patients endoscopy was unsuccessful, one removed via rigid oesophagoscopy, four others passed food bolus spontaneously. Additional therapies like bougie and balloon dilatation was done in 64 (24.7%) patients at the index endoscopy. No complication/s attributable to endoscopy/technique was documented. <h3>Conclusion</h3> This is the first study to clearly show the safety and efficacy of push technique in relief of oesophageal food bolus obstruction. Combination of manoeuvres is the next best option; tracheal intubation to protect airway must be considered. Limitations of the study include retrospective nature and incomplete data on the type of food bolus. <h3>Competing interests</h3> None declared.
Treatment of Impaired Physicians-Reply
Authors: Jerome S. Becker
Journal: JAMA (1983)

<h3>In Reply.—</h3> Dr Robert Larsen has asked a number of questions regarding the<i>JAMA</i>article entitled "The California Experience with a Diversion Program for Impaired Physicians." The following are answers to most of Dr Larsen's questions. Physicians who are referred but do not become participants in the program do not gain admittance for a number of reasons. The program is a voluntary one that may divert physicians from formal disciplinary action by the Board of Medical Quality Assurance (BMQA). While in the beginning there was a larger percentage of board-referred than selfreferred physicians, as months passed, more physicians who applied were self-referred. By self-referred, it is meant that there was no investigation or accusation under way by BMQA. This means that if the physician was self-referred and decided after hearing about the program or having a treatment contract designed for him that he didn't wish to participate, he could decline
Endoscopic Retrograde Pancreatography and Secretin-Pancreozymin Test in Diagnosis of Chronic Pancreatitis: A Comparative Evaluation
Authors: G. Dobrilla, A. Fratton, M. Valentini, I. Vantini, G. Cavallini, G. Angelini, R. Mirachian, R. Mora
Journal: Endoscopy (1976)

A comparative evaluation between endoscopic retrograde pancreatography and secretin-pancreozymin test has been carried out in 23 patients, 6 with suspected chronic pancreatitis and 17 with proven chronic pancreatitis. The results show a good correlation between ERP examinations and S-CCK.PZ test only for patients affected by proven chronic pancreatitis while in patients with suspected chronic pancreatitis discrepancy exists between ERP (normal results) and S-CCK.PZ test (abnormal for the only parameter “low flow”). The principal types of ERP abnormality were: alternate dilatation and stenosis of Wirsung's duct (75%), cystic dilatation of branches (58%), irregular distribution of the branches (41%), calculi in Wirsung's duct (34%). Moreover the time of elimination of the contrast medium was found significantly correlated with the S-CCK.PZ test or with the pancreatographic picture. The complementarity of the two procedures is pointed out in the conclusions.
Overfilling of a Pancreatic Segment in Endoscopic Retrograde Pancreaticography
Authors: J. Drastik, I. Skála, F. Pirk
Journal: Endoscopy (1978)

A case of parenchymal opacification of a segment of the pancreatic head without severe clinical sequelae is described. The authors discuss the pitfalls of the technique of duct filling and wedging of the cannula in a segment of the pancreatic duct. They call attention to the risks of such complications in patients with intolerance to i.v. administration of contrast medium.