tbuckley/cabot-search huggingface dataset:
Heart rate adjustment of exercise-induced ST segment depression. Improved risk stratification in the Framingham Offspring Study.
Authors: P M Okin, K M Anderson, D Levy, P Kligfield
Journal: Circulation (1991)

BACKGROUND Simple heart rate adjustment of ST segment depression during exercise (delta ST/HR index) and the pattern of ST depression as a function of heart rate during exercise and recovery (the rate-recovery loop) have been shown to improve the ability of the exercise electrocardiogram to detect the presence of coronary heart disease (CHD), but the performance of these methods for the prediction of future coronary events remains to be examined. METHODS AND RESULTS We compared the delta ST/HR index and the rate-recovery loop with standard electrocardiographic criteria for prediction of CHD events in 3,168 asymptomatic men and women in the Framingham Offspring Study who underwent treadmill exercise electrocardiography and who, at entry, were free of clinical and electrocardiographic evidence of CHD. After a mean follow-up of 4.3 years, there were 65 new CHD events: four sudden deaths, 24 new myocardial infarctions, and 37 incident cases of angina pectoris. When a Cox proportional hazards model with adjustment for age and sex was used, a positive exercise electrocardiogram by standard criteria (greater than or equal to 0.1 mV horizontal or downsloping ST segment depression) was not predictive of new CHD events (chi 2 = 0.40, p = 0.52). In contrast, stratification according to the presence or absence of a positive delta ST/HR index (greater than or equal to 1.6 microV/beat/min) and a positive (counterclockwise) rate-recovery loop was associated with CHD event risk (chi 2 = 9.45, p less than 0.01) and separated subjects into three groups with varying risks of coronary events: high risk, when both tests were positive (relative risk 3.6; 95% confidence interval, 2.4-5.4); intermediate risk, when either the delta ST/HR index or the rate-recovery loop was positive (relative risk, 1.9; 95% confidence interval, 1.3-2.8); and low risk, when both tests were negative. After multivariate adjustment for age, sex, smoking, total cholesterol level, fasting glucose level, diastolic blood pressure, and electrocardiographic evidence of left ventricular hypertrophy, the combined delta ST/HR index and rate-recovery loop criteria remained predictive of coronary events (chi 2 = 5.45, p = 0.02). CONCLUSIONS Heart rate adjustment of ST segment depression by the delta ST/HR index and the rate-recovery loop during exercise electrocardiography can improve prediction of future coronary events in asymptomatic men and women.
Ethics and Cost Containment
Authors: J. Alexander McMahon
Journal: JAMA (1985)

To the Editor.—  Dr Johnson's article, Life, Death, and the Dollar Sign,1 makes a number of valid and important points about the impact of cost-containment efforts on the ethical decision making of physicians. In fact, the article sheds light on some of the most important questions that physicians and hospitals will face in the near future. However, I find the author's doomsayer attitude distressing and believe your readers should know of the many efforts already under way by hospitals and physicians that address many of the concerns Dr Johnson expresses.  To begin with, Dr Johnson appears to have little faith in the ethical conviction of his colleagues. While it may be true that cost-containment mechanisms may test the medical profession's moral caliber, it is unjustified and unfair to imply that the quality of physicians' decisions in difficult cases involving ethical concerns will deteriorate as a result of such efforts.  To
Dysbiosis in the inflamed intestine
Authors: Sebastian E Winter, Andreas J Bäumler
Journal: Gut Microbes (2014)

The bacterial microbiota of the human large bowel is a complex ecosystem consisting of several hundred, mostly anaerobic, species. To maintain colonization of the gut lumen and maximize growth in the presence of nutritional competitors, highly diverse metabolic pathways have evolved, with each microbe utilizing a different "winning strategy" for nutrient acquisition and utilization. Conditions and diseases leading to intestinal inflammation are accompanied by a severe disruption the microbiota composition characterized by an expansion of facultative anaerobic Enterobacteriaceae. Here, we review evidence that the local inflammatory response creates a unique nutritional environment that is conducive to a bloom of bacterial species whose genomes encode the capability of utilizing inflammation-derived nutrients.
Cobalamin Analogues Are Present in Human Plasma and Can Mask Cobalamin Deficiency because Current Radioisotope Dilution Assays Are Not Specific for True Cobalamin
Authors: J. Fred Kolhouse, Haruki Kondo, Nancy C. Allen, Elaine Podell, Robert H. Allen
Journal: New England Journal of Medicine (1978)

Since R protein binds cobalamin (vitamin B12) and cobalamin analogues, whereas intrinsic factor is highly specific for true cobalamin, we compared the serum cobalamin values obtained with these proteins in radioisotope dilution assays. With R protein, eight of 21 patients with cobalamin deficiency had serum cobalamin levels (mean, 204, range, 85 to 355 pg per milliliter) that overlapped with values for 74 normal subjects (mean, 576, range, 220 to 1230). With intrinsic factor, no patient values (mean, 36, range, <10 to 78 pg per milliliter) overlapped with the normal values (mean, 322, range, 130 to 785). Paper chromatography showed that these differences were due to the presence of cobalamin analogues. R protein constituted 51 to 85 per cent of the cobalamin-binding protein in 10 commercial serum cobalamin assay kits, which were said to contain "intrinsic factor." Human plasma contains cobalamin analogues that can mask cobalamin deficiency with current radioisotope dilution assays. (N Engl J Med 299:785–792, 1978)
FDA Sets Geriatric Drug Use Labeling Deadlines
Authors: Andrew A. Skolnick
Journal: JAMA (1997)

THE FOOD and Drug Administration (FDA) has published its final rule requiring the labeling of pharmaceuticals to include information pertinent to their appropriate use by elderly patients (aged 65 years or older). Although the rule becomes effective 1 year from the date of its publication in the August 27, 1997,<i>Federal Register</i>(62<i>Federal Register</i>45313-45326), its implementation will occur in stages over a 5-year period. The rule will require manufacturers to include a "Geriatric Use" subsection within the "Precautions" information of a drug's labeling. This subsection must describe what is known about the effects of a drug in the elderly and list any limitation, hazard, or monitoring need associated with geriatric use. Specific geriatric indications, if any, must be described in the "Indications and Usage" section and specific geriatric dosing instructions are to be described in the "Dosage and Administration" section. Also, if specific pharmacokinetic or pharmacodynamic studies of
Case 40-1977
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, James A. Schnur, Edward P. Richardson
Journal: New England Journal of Medicine (1977)

Presentation of CaseA 62-year-old right-handed man was admitted to the hospital because of progressive dementia.The patient was a native of the Cape Verde Islands, from which he emigrated to this country at the age of 52 years. There was a history of severe head injury in his twenties that resulted in coma for eight days. Convalescence was prolonged, but he finally improved and was able to return to work as a civil servant fluent in Portuguese and English. Ten years before admission he had a seizure that involved the right extremities, followed by a brief period of speech . . .
Abstract LB-485: Estrogen receptor alpha activation is mediated by both the MAPK and PI3K phosphorylation pathway in hypoxia
Authors: Joon Woo Park, Youngjoo Lee
Journal: Cancer Research (2012)

Abstract The estrogen receptor (ER) plays an important role in breast cancer development and progression. Hypoxia was shown to modulate the level of ERa expression and induce ligand-independent transcriptional activation of ERa, which may be intimately associated with the biology of breast carcinomas. Given that phosphorylation affects the transcriptional activity and stabilization of ERa, we examined the changes in phosphorylation of ERa under hypoxic conditions. Hypoxia induced phosphorylation of ERa at serine residues 118 and 167 in the absence of estrogen. Phosphorylation-defective ERa mutants with serine-to-alanine replacements at residues 118 and 167 had impaired hypoxia-induced ERa activation, showing that serine residues 118 and 167 are involved in hypoxia-induced ERa activation. The hypoxia-induced ERa-mediated transcriptional response was dependent on both the ERK1/2 MAPK and PI3K pathways, but not the p38 pathway, as assessed using chemical inhibitors. These data show that ERa phosphorylation via both the MAPK and PI3K pathways is one mechanism leading to ERa activation under hypoxia. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-485. doi:1538-7445.AM2012-LB-485
Cerebellar Necrosis in a Case of Subarachnoid Haemorrhage
Authors: A. L. Wells
Journal: BMJ (1953)

TRANSFUSED RED CELLS IN SCURVY EDICLJORAL persisted for some days after the beginning of vitamin-C administration.In the remaining three of the nine patients the donor red-cell survival times appeared to be normal, but two of these cases could not be studied adequately, and even the one who was adequately fol- lowed showed a rapid fall in the number of transfused red cells one week after vitamin-C therapy was started.It is possible that the blood transfusion materially increased metabolic demands for vitamin C, and this factor may have contributed to the rapid destruction of donor cells.With this reservation, the results of this investigation support the view that a haemolytic pro- cess is an important factor in the pathogenesis of the anaemia of scurvy.ADDENDUM.-Since this paper was prepared an additional nine Bantu male patients with scurvy and normoblastic bone marrow have been studied by the same methods.Three of these, who were severely anaemic, were transfused with sedimented red cells from 1 pint of blood.All three patients eliminated the transfused red cells very rapidly.In the re- maining six patients 1 pint of blood was first removed; subsequently they were transfused with 1 pint of blood.Red- cell survival was greatly decreased in five of these patients, the sixth patient having a normal red-cell survival time.The sixth patient (and one of the five with diminished red- cell survival) was not anaemic.The other four were anaemic.It appears that the proviso inserted in the main body of the paper that overtransfusion might be playing some part in the abnormal red-cell survival in untreated scurvy is un- necessary.Red-cell survival was abnormal even when a replacement transfusion was substituted for simple trans- fusion.An increase in the protein content of the diet by the addition of thoroughly stewed meat also did not alter the diminished red-cell survival in the last four patients studied.In the combined series there were thus 14 anaemic patients and 2 non-anaemic patients who were maintained on the vitamin-C-free diet for more than seven days.Of the anaemic cases 13 had greatly diminished red-cell sur- vival.Of the non-anaemic cases, red-cell survival was normal in one and diminished in the other.My thanks are due to Professors F.
Long-Term Dicumarol Therapy to Prevent Recurrent Coronary Artery Thrombosis
Authors: E. STERLING NICHOL, JOSEPH F. BORG
Journal: Circulation (1950)

Seventy-eight patients were given long-term dicumarol therapy after one or more attacks of myocardial infarction to see whether recurrent attacks could be warded off. Encouraging results ensued over periods up to five years. Protocols of 12 fatal cases are given, only 4 of whom had recurrent acute coronary thrombosis. Hemorrhagic complications met with are analyzed. Ambulatory treatment is shown to be feasible if patients are painstakingly followed.
Assessing the health benefits of air pollution reduction for children.
Authors: Eva Y Wong, Julia Gohlke, William C Griffith, Scott Farrow, Elaine M Faustman
Journal: Environmental Health Perspectives (2003)

Benefit-cost analyses of environmental regulations are increasingly mandated in the United States. Evaluations of criteria air pollutants have focused on benefits and costs associated with adverse health effects. Children are significantly affected by the health benefits of improved air quality, yet key environmental health policy analyses have not previously focused specifically on children's effects. In this article we present a "meta-analysis" approach to child-specific health impacts derived from the U.S. Clean Air Act (CAA). On the basis of data from existing studies, reductions in criteria air pollutants predicted to occur by 2010 because of CAA regulations are estimated to produce the following impacts: 200 fewer expected cases of postneonatal mortality; 10,000 fewer asthma hospitalizations in children 1-16 years old, with estimated benefits ranging from 20 million U.S. dollars to 46 million U.S. dollars (1990 U.S. dollars); 40,000 fewer emergency department visits in children 1-16 years old, with estimated benefits ranging from 1.3 million U.S. dollars to 5.8 million U.S. dollars; 20 million school absences avoided by children 6-11 years old, with estimated benefits of 0.7-1.8 billion U.S. dollars; and 10,000 fewer infants of low birth weight, with estimated benefits of 230 million U.S. dollars. Inclusion of limited child-specific data on hospitalizations, emergency department visits, school absences, and low birth weight could be expected to add 1-2 billion U.S. dollars (1990 U.S. dollars) to the 8 billion U.S. dollars in health benefits currently estimated to result from decreased morbidity, and 600 million U.S. dollars to the 100 billion U.S. dollars estimated to result from decreased mortality. These estimates highlight the need for increased consideration of children's health effects. Key needs for environmental health policy analyses include improved information for children's health effects, additional life-stage-specific information, and improved health economics information specific for children.
Multiple Intrauterine Transfusions for Erythroblastosis Fetalis
Authors: John T. Queenan
Journal: JAMA (1965)

SELECTIVE preterm delivery and postdelivery exchange tranfusions have been shown to be extremely effective in the management of infants with erythroblastosis fetalis. Spectrophotometric analysis of amniotic fluid has also been helpful in determining the onset of deterioration from erythroblastosis fetalis in the fetus. This has afforded an effective means of selection of fetuses for preterm delivery. In certain instances, unfortunately, the erythroblastosis fetalis is so severe that the fetus begins to deteriorate at a stage too early to survive outside the uterus from the standpoint of maturity alone. It is in this instance that the intrauterine transfusion is crucial. In September 1963, Liley<sup>1</sup>reported the first successful intrauterine transfusion. Following the withdrawal of amniotic fluid, a radiopaque substance was instilled into the amniotic cavity. In addition to delineating the fetal outline, the radiopaque medium was swallowed by the fetus resulting in a demonstration of the small intestine. Using the
Twins with Two Different Fathers Identified by HLA
Authors: Paul I. Terasaki, David Gjertson, Domenico Bernoco, Sondra Perdue, Max R. Mickey, Judy Bond
Journal: New England Journal of Medicine (1978)

WE recently reported 1000 cases of disputed paternity in which the HLA typing test proved to be substantially more powerful than the previously used red-cell tests.1 The remarkable efficacy of HLA typing in paternity determinations is attributable to the fact that all HLA haplotypes are relatively rare in the population. Thus, if a putative father shares a combination of HLA types with a child, it is highly probable that he is in fact the true father. This circumstance of shared rare blood types arises in very few cases with red-cell tests because of the allele frequency distributions in these systems. . . .
Medical 'watchdogs' of Olympics
Authors: P. Gunby
Journal: JAMA (1979)

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Podocyte-associated talin1 is critical for glomerular filtration barrier maintenance
Authors: Xuefei Tian, Jin Ju Kim, Susan M. Monkley, Nanami Gotoh, Ramiro Nandez, Keita Soda, Kazunori Inoue, Daniel M. Balkin, Hossam Hassan, Sung Hyun Son, Yashang Lee, Gilbert Moeckel, David A. Calderwood, Lawrence B. Holzman, David R. Critchley, Roy Zent, Jochen Reiser, Shuta Ishibe
Journal: Journal of Clinical Investigation (2014)

Podocytes are specialized actin-rich epithelial cells that line the kidney glomerular filtration barrier. The interface between the podocyte and the glomerular basement membrane requires integrins, and defects in either α3 or β1 integrin, or the α3β1 ligand laminin result in nephrotic syndrome in murine models. The large cytoskeletal protein talin1 is not only pivotal for integrin activation, but also directly links integrins to the actin cytoskeleton. Here, we found that mice lacking talin1 specifically in podocytes display severe proteinuria, foot process effacement, and kidney failure. Loss of talin1 in podocytes caused only a modest reduction in β1 integrin activation, podocyte cell adhesion, and cell spreading; however, the actin cytoskeleton of podocytes was profoundly altered by the loss of talin1. Evaluation of murine models of glomerular injury and patients with nephrotic syndrome revealed that calpain-induced talin1 cleavage in podocytes might promote pathogenesis of nephrotic syndrome. Furthermore, pharmacologic inhibition of calpain activity following glomerular injury substantially reduced talin1 cleavage, albuminuria, and foot process effacement. Collectively, these findings indicate that podocyte talin1 is critical for maintaining the integrity of the glomerular filtration barrier and provide insight into the pathogenesis of nephrotic syndrome.
Health needs of women who have sex with women
Authors: C. Hughes
Journal: BMJ (2003)

Healthcare workers need to be aware of their specific needs 

The term “women who have sex with women” describes sexual behaviour while lesbian is a term that describes sexual identity. However, sexual identity does not necessarily predict sexual behaviour–most lesbians have a history of sexual intercourse with men.1 Women who have sex with women form a small but important group and have specific health needs. A lack of awareness among healthcare professionals about these needs may lead to ill informed advice and missed opportunities for the prevention of illness.

An unfortunate perception exists among healthcare providers and women who have sex with women that they do not need regular cervical smears. High risk types of genital human papillomavirus are associated with developing high grade cervical intraepithelial neoplasia, and sexual intercourse with men is a powerful risk factor for cervical cancer. However, it is important to counter the erroneous assumption that women who have sex with women are not at risk of catching human papillomavirus. Around one in five women who have never had heterosexual intercourse have human papillomavirus.2

Cytological abnormality in women who have sex with women varies in prevalence between studies but ranges from inflammation to severe dyskaryosis.1 w1 …
ANTIBODY RESPONSE OF HUMAN BEINGS FOLLOWING VACCINATION WITH INFLUENZA VIRUSES
Authors: G. K. Hirst, E. R. Rickard, Loring Whitman, F. L. Horsfall
Journal: The Journal of Experimental Medicine (1942)

Eleven different preparations of influenza virus were used to vaccinate large groups of human beings. The antibody response to these vaccines was measured by means of the in vitro agglutination inhibition test, and the geometric mean titers of sera taken 2 weeks after vaccination were compared. From these comparisons the following conclusions were drawn: 1. There was a wide individual variation in the antibody response of human beings to the same preparation of influenza virus administrated subcutaneously. The amount of antibody produced by a group with a low prevaccination antibody level was very nearly the same as the amount produced by groups that had higher initial levels. 2. The use of the X strain of distemper virus in the preparation of an influenza vaccine did not enhance the antigenicity of the influenza virus present. 3. Within certain limits the mean antibody response of human beings increased as the amount of virus injected was increased. When large amounts of influenza A virus were given, the antibody response was of the same order of magnitude as that which occurred following actual infection by this virus. 4. When the vaccine was prepared from allantoic fluid, there was no significant difference in the antibody response of human beings given active virus, formalin-inactivated virus, heat-inactivated virus, or virus inactivated by the drying process. 5. Ground infected chick embryos, when diluted with infected allantoic fluid, gave a greater antibody response than allantoic fluid alone (when the virus remained active). The antigenicity of such a preparation was diminished when the virus was inactivated by formalin. 6. Antibody levels 6 and 9 weeks after vaccination showed a marked drop from the 2-week postvaccination levels. In a small group the antibody levels at 5 months were still further reduced. Those individuals who possessed the higher titers tended to lose their antibodies faster than did those at a lower level.
Chance, coincidence, serendipity
Authors: R. Aitken
Journal: BMJ (1979)

TIA patients should simply be given daily aspirin, we would urge general practitioners or others who see any TIA patients over the next few years to refer them to one of the neurologists collaborating in the UK TIA aspirin trial, so that reliable information will eventually emerge.We would be pleased to supply inquirers with the name of a nearby collaborator.
Switzerland moves to curb healthcare costs by sending patients abroad
Authors: Clare Chapman
Journal: BMJ (2006)

Switzerland is to introduce reforms to reduce its health service costs and tackle the current funding crisis. The reform package includes sending patients to other countries where treatments are cheaper.

The package also includes allowing health insurers to have smaller financial reserves and will bring into force a deal with pharmaceutical companies to make drugs up to 30% cheaper.

It follows measures already introduced that mean that patients who opt to take …