tbuckley/cabot-search huggingface dataset:
Measles Immunization-Reply
Authors: Carl E. Stracener
Journal: JAMA (1991)

<h3>In Reply.</h3> —The number of cases of measles in the United States has risen from 15 000 in 1983 to a provisional total of 27600 in 1990.<sup>1</sup>Age, race, and geographic location are important variables in determining the likelihood of developing measles. In 1989, for example, over 96% of measles cases in this country occurred in just 23 of the 50 states.<sup>2</sup>The spotty distribution of measles makes observations from a single practice of limited value. Dr Robinson states that he has not seen cases of measles in his practice in spite of having given the MMR vaccine to many children who had colds. Since he offers no information as to whether or not these children were in fact ever exposed to measles, many of them may be susceptible. Robinson questions whether or not lack of seroconversion correlates with susceptibility to infection. Our own studies do not address
Diagnosis and management of idiopathic childhood constipation: summary of NICE guidance
Authors: L. Bardisa-Ezcurra, R. Ullman, J. Gordon
Journal: BMJ (2010)

Constipation is described as "the subjective complaint of passage of abnormally delayed or infrequent passage of dry, hardened faeces, often accompanied by straining and/or pain."1 Constipation is common in childhood, is rarely life threatening, and therefore might be expected to have little effect on healthcare provision. The reality is somewhat different, however. Symptoms become chronic in more than a third of patients, causing great discomfort, and many children need medical treatment and nursing care.2 3 4 5 Lack of understanding about the condition, delayed diagnosis, and suboptimal treatment and support contribute to ongoing symptoms and multiple medical consultations.6 Social costs include children missing school, being excluded from peer group activities, and feeling that they cannot tell their friends about their condition. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the care and management of children and young people with idiopathic constipation.7 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the experience and opinion of the Guideline Development Group (GDG) on what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### Establishing the presence of constipation Establish whether constipation is present during history taking. Two or more of the following findings indicate constipation:
Localized primary AL-type amyloidosis of the jejunum diagnosed by double-balloon enteroscopy
Authors: M. Bellutti, J. Weigt, K. Mönkemüller, C. Röcken, G. Wieners, F. Dombrowski, P. Malfertheiner
Journal: Endoscopy (2007)

A 56-year-old man presented with a 5-month history of upper abdominal pain and vomiting. Physical examination revealed a distended abdomen and high-pitched bowel sounds. Laboratory data were within reference ranges. He underwent abdominal ultrasound and computed tomography, both of which showed significantly thickened jejunal loops. Esophagogastroduodenoscopy and ileocolonoscopy were unremarkable and tissue specimens from the stomach, duodenum, rectum, colon, and ileum showed no abnormalities on histological examination.
Intracellular acidification associated with changes in free cytosolic calcium. Evidence for Ca2+/H+ exchange via a plasma membrane Ca(2+)-ATPase in vascular smooth muscle cells.
Authors: J T Daugirdas, J Arrieta, M Ye, G Flores, D C Battle
Journal: Journal of Clinical Investigation (1995)

The purpose of this study was to define the mechanism whereby agonists that increase free cytosolic calcium (Cai2+) affect intracellular pH (pHi) in smooth muscle. Rat aortic vascular smooth muscle cells grown on coverslips were loaded with BCECF/AM or fura-2/AM for continuous monitoring of pHi or Cai2+, respectively, in a HCO3-/CO2- containing medium. Recovery from rapid increases in Cai2+ produced by 1 microM angiotensin (Ang) II (delta Cai2+ -229 +/- 43 nM) or 1 microM ionomycin (delta Cai2+ -148 +/- 19 nM) was accompanied by a fall in pHi (delta pHi, -0.064 +/- 0.0085 P < 0.01, and -0.05 +/- 0.012 pH units, P < 0.01, respectively). Neither the fall in pHi nor the rise in Cai2+ elicited by Ang II was prevented by pretreatment with agents which block the action of this agonist on pHi via the stimulation of the Cl/HCo3 exchangers (DIDS, 50 microM) or the Na+/H+ antiporter (EIPA, 50 microM). In the presence of DIDS and EIPA, Ang II produced a fall in pHi (delta pHi, -0.050 +/- 0.014, P < 0.01) and a rise in Cai2+ (delta Ca2+ 252 +/- 157 nM, P < 0.01). That the change in pHi was secondary to changes in Cai2+ was inferred from the finding that, when the rise in Cai2+ elicited by Ang II was prevented by preincubation with a Ca2+ buffer, BAPTA (60 microM), the fall in pHi was abolished as well (delta pHi, 0.0014 +/- 0.0046). The pHi fall produced by Ang II and ionomycin was prevented by cadmium at a very low concentration (20 nM) which is known to inhibit plasma membrane Ca(2+)-ATPase activity (delta pHi -0.002 +/- 0.0006 and -0.0016 pH units, respectively). Cadmium also blunted Cai2+ recovery after Ang II and ionomycin. These findings suggest that the fall in pHi produced by these agents is due to H+ entry coupled to Ca2+ extrusion via the plasma membrane Ca(2+)-ATPase. Our results indicate that agonists that increase Cai2+ cause intracellular acidification as a result of Ca2+/H+ exchange across the plasma membrane. This process appears to be mediated by a plasma membrane Ca(2+)-ATPase which, in the process of extruding Ca2+ from the cell, brings in [H+] and thus acidifies the cell.
Lead: a case study in interagency policy-making.
Authors: I H Billick
Journal: Environmental Health Perspectives (1981)

Exposures to low levels of lead in the environment are believed to have potentially significant health effects, especially in children; such exposures to the general population come from many sources. Responsibility for regulating lead exposures has been derived from a multitude of laws passed by the Congress, and thus ultimate protection of people depends on actions taken by several agencies of the federal government. For this reason, the history of efforts to reduce exposures to lead is an excellent case study in the way that federal agencies do or do not work well together. The issue of reduction of lead in gasoline is discussed in relation to the evidence generated by HUD concerning the relationship of blood lead in urban children in New York City to seasonal variations in consumption of leaded gasoline in that area. Some recommendations for developing interagency cooperation in such controversies are presented.
'Hello? Hello?... He Doesn't Seem to Answer'
Authors: Stephen R. Gorfine
Journal: JAMA (1986)

<h3>To the Editor.—</h3> In reference to the cover of the June 6 issue,<sup>1</sup>you describe "[a paramedic] who is holding two defibrillation paddles." If this is in fact the case, the paramedic is about to defibrillate his right ear—not a safe practice. However, if you look more closely, you will see that the paramedic is in fact holding a telephone.
Primary screening for human papillomavirus compared with cytology screening for cervical cancer in European settings: cost effectiveness analysis based on a Dutch microsimulation model
Authors: I. M. C. M. de Kok, J. van Rosmalen, J. Dillner, M. Arbyn, P. Sasieni, T. Iftner, M. van Ballegooijen
Journal: BMJ (2012)

<b>Objectives</b> To investigate, using a Dutch model, whether and under what variables framed for other European countries screening for human papillomavirus (HPV) is preferred over cytology screening for cervical cancer, and to calculate the preferred number of examinations over a woman's lifetime. <b>Design</b> Cost effectiveness analysis based on a Dutch simulation model. Base case analyses investigated the cost effectiveness of more than 1500 different screening policies using the microsimulation model. Subsequently, the policies were compared for five different scenarios that represent different possible scenarios (risk of cervical cancer, previous screening, quality associated test characteristics, costs of testing, and prevalence of HPV). <b>Setting</b> Various European countries. <b>Population</b> Unvaccinated women born between 1939 and 1992. <b>Main outcome measures</b> Optimal screening strategy in terms of incremental cost effectiveness ratios (costs per quality adjusted life years gained) compared with different cost effectiveness thresholds, for two levels of sensitivity and costs of the HPV test. <b>Results</b> Primary HPV screening was the preferred primary test over the age of 30 in many considered scenarios. Primary cytology screening was preferred only in scenarios with low costs of cytology and in scenarios with a high prevalence of HPV in combination with high costs of HPV testing. <b>Conclusions</b> Most European countries should consider switching from primary cytology to HPV screening for cervical cancer. HPV screening must, however, only be implemented in situations where screening is well controlled.
The Protective Efficacy of Immune Serum Globulin in Hepatitis A
Authors: Philip J. Landrigan
Journal: JAMA (1973)

In a community outbreak of hepatitis A (person-to-person transmission) the efficacy of immune serum globulin prophylaxis among patients'family members was between 87% and 98%. Immune serum globulin efficacy was determined by means of a formula used previously to measure live-virus vaccine efficacy in epidemics.
Left Heart Obstructive Lesions and Left Ventricular Growth in the Midtrimester Fetus
Authors: Lisa K. Hornberger, Stephen P. Sanders, Azaria J.J.T. Rein, Philip J. Spevak, Ira A. Parness, Steven D. Colan
Journal: Circulation (1995)

Isolated case reports that suggest the potential for development of left heart hypoplasia late in gestation provide the only information about the in utero natural history of left heart obstructive lesions.We reviewed the prenatal and postnatal echocardiograms of 21 fetuses with left heart obstructive lesions, including 15 with serial antenatal study, to elucidate the antenatal natural history of this spectrum of disease and to identify features indicative of postnatal disease severity. Ventricular, atrioventricular valve, and great artery dimensions were measured and growth curves were developed with comparisons to data from 47 normal fetuses. Fetuses were divided into groups according to whether postnatally the left heart was capable (group 1, n = 10) or incapable (group 2, n = 7) of supporting the systemic circulation in the presence of a patent aortic valve. Group 3 (n = 4) included fetuses with aortic atresia. At the initial examination (21.7 +/- 3.4 weeks' gestation), left heart dimensions were normal or reduced, with the most diminutive measurements in group 3. Three fetuses in group 2 and most in group 1 had normal initial left heart dimensions. Subsequent growth of left heart structures either paralleled normal growth or was reduced, the latter resulting in the development or progression of left heart hypoplasia. All left heart dimensions grew more slowly in group 2 and group 3 than in group 1 (P < .05). Other prenatal features observed only in groups 2 and 3 included reversed (n = 10) or bidirectional (n = 1) foramen ovale flow and retrograde distal arch flow (n = 9). Initial midtrimester mitral valve and ascending aorta z scores and the growth rates of all left heart structures correlated strongly with postnatal left ventricular end-diastolic dimension (P = .0007 to .03, r = .57 to .82) and could be additional indicators of postnatal disease severity. One group 1 fetus developed severe aortic stenosis late in gestation.The potential for the in utero development or progression in severity of left heart obstruction and hypoplasia in left heart obstructive lesions necessitates serial prenatal study in affected fetuses carried to term.
Serum levels of transforming growth factor-α in patients after partial hepatectomy as determined with an enzyme-linked immunosorbent assay
Authors: Tomoaki Tomiya, Kenji Fujiwara
Journal: Hepatology (1993)

A sandwich enzyme-linked immunosorbent assay for measuring serum transforming growth factor-alpha levels was developed with monoclonal IgM and polyclonal IgG antihuman transforming growth factor-alpha antibodies and a system to amplify the activity of the conjugated enzyme. The assay detected serum transforming growth factor-alpha levels as low as 5 pg/ml. Serum transforming growth factor-alpha levels were below the detection limit of the assay in 19% of healthy adults, with a mean (+/- S.D.) detectable level of 22.0 +/- 16.7 pg/ml. In 13 patients who underwent partial hepatectomy, serum transforming growth factor-alpha levels were determined serially after surgery. The levels were increased within 28 days of surgery in all the patients, with a mean maximal level of 118.2 +/- 90.8 pg/ml. The maximal level achieved in each case correlated significantly with the resected volume of the liver and the increased volume of the remaining liver 28 days after hepatectomy (r = 0.59, p < 0.05, and r = 0.71, p < 0.005, respectively). In contrast, serum transforming growth factor-alpha levels showed no increase after laparotomy for nonhepatic surgery. Serum transforming growth factor-alpha levels may vary depending on the regenerative stimulus and reflect the degree to which liver regeneration will occur in patients after partial hepatectomy.
PAM4-Reactive MUC1 Is a Biomarker for Early Pancreatic Adenocarcinoma
Authors: David V. Gold, Zarir Karanjawala, David E. Modrak, David M. Goldenberg, Ralph H. Hruban
Journal: Clinical Cancer Research (2007)

Abstract Purpose: The anti-MUC1 monoclonal antibody (MAb), PAM4, has a high specificity for pancreatic adenocarcinoma compared with other cancers, normal tissues, or pancreatitis. In order to assess its role in early pancreatic cancer development, we examined the expression of the PAM4-reactive MUC1 in the noninvasive precursor lesions, pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasia (IPMN). Experimental Design: Tissue microarrays prepared from formalin-fixed, paraffin-embedded specimens were assessed by immunohistology for expression of the PAM4-reactive, non–variable number of tandem repeats (VNTR), MUC1 epitope, and the VNTR epitope bound by the MA5 MAb. Results: The PAM4-reactive MUC1 epitope was not detected in normal pancreas but was expressed in 87% (48 of 55) of invasive pancreatic adenocarcinomas, including early stage 1 disease: PAM4 labeled 94% (44 of 47) of the earliest PanIN lesions, PanIN-1A and 1B, along with 91% (10 of 11) of PanIN-2, 40% (2 of 5) of PanIN-3, and 86% (31 of 36) of intraductal papillary mucinous neoplasia lesions. A mostly diffuse pattern of labeling was observed. A second, unrelated, anti-MUC1 MAb, MA5, showed considerably less sensitivity with early PanIN-1 lesions; only 61% (25 of 41) were positive and the labeling did not differentiate normal pancreas from PanINs. Conclusions: The results suggest that expression of the PAM4-reactive antigen may represent an early event in the development of invasive pancreatic adenocarcinoma, and is unrelated to the VNTR peptide core epitopes of MUC1. Detection of this biomarker using immunohistology, in vitro immunoassays, and in vivo antibody–based imaging may provide new opportunities for the early detection and improved diagnosis of pancreatic cancer.
Optic Neuritis of Obscure Origin
Authors: Hugh H. Hussey
Journal: JAMA (1974)

In recent issues of theArchives of Ophthalmologyand theArchives of Neurology, Kennerdell et al<sup>1</sup>and Hackett et al,<sup>2</sup>respectively, have reported cases in which what appeared initially to be optic neuritis was the premonitory symptom of a serious underlying disease. The patient described by Kennerdell and his colleagues was a 47-year-old woman who first complained of blurred vision in the right eye accompanied by pain on motion of the globe and deep retro-orbital discomfort. Her visual acuity in the affected eye was best corrected to 20/400, and the optic disc was hyperemic. Based on a presumptive diagnosis of optic neuritis, corticosteroid therapy was administered and led to dramatic visual improvement. Relapse followed within a month, but resumption of corticosteroid therapy again was effective. About a year later, visual acuity was again impaired, now bilaterally, and there was deep suborbital pain on the right. Skull roentgenograms and
Miscellanea: From Mindy's Institute, Broadway
Authors: E. Milne
Journal: BMJ (1985)

A first year medical student recently commented to me that in every lecture he attended he fell asleep after 45 minutes or so.Of course, with my years of experience of medical education I reassured him that with time and some effort he would be able to achieve this in as little as ten minutes or less.Boredom in lectures is a fairly universal problem, and in a recent period of middle distance staring it occurred to me that the entertainment aspect of lectures might be improved if lecturers were to perform their spiel in character.Just to get them on the right track, here-with apologies to Damon Runyan-is a case from one of our colleagues across the Atlantic.If the history is somewhat clinically inaccurate this is a result of teaching appendicitis more than ten minutes into a lecture.
Control of peripheral sympathetic prevertebral ganglion neurones by colonic mechanosensory afferents
Authors: S M Miller
Journal: Gut (2000)

Sympathetic innervation of the gastrointestinal tract arises from abdominal prevertebral ganglia (PVG) comprising the coeliac, superior mesenteric, and inferior mesenteric ganglia. These ganglia are integrating centres between the central nervous system and enteric nervous system and their output regulates intestinal motility, intestinal blood flow, and water and electrolyte secretion.1 Much of the synaptic input to PVG neurones arises from cholinergic mechanosensory neurones whose cell bodies lie in the gut wall and provide the PVG with information about the mechanical state of the gut. The mechanosensory (“intestinofugal”) neurones and their axons constitute the afferent limb of a peripheral reflex between enteric and sympathetic PVG neurones. The efferent limb of the reflex consists of the PVG neurones and their axons, which carry inhibitory sympathetic output back to the gut.2Experiments were performed in vitro to examine the peripheral reflex loop between colonic enteric neurones and sympathetic superior mesenteric ganglion (SMG) neurones in mouse. Preparations consisted of the SMG attached via intermesenteric and colonic nerves to a segment of distal colon.3 The distal end of the colonic segment was attached to a fluid filled reservoir. With this set up, the segment could empty its contents into the reservoir during a contraction …
Reducing Cardiovascular Risk in Patients Undergoing Noncardiac Surgery
Authors: Kim A. Eagle, James B. Froehlich
Journal: New England Journal of Medicine (1996)

The cardiovascular assessment of patients undergoing noncardiac surgery has been intensively investigated over the past 10 years. These studies have culminated in guidelines recently published by a joint task force of the American College of Cardiology and the American Heart Association.1 On the basis of a review of the current scientific evidence, several principles of perioperative evaluation and management have emerged.First, clinical markers identifiable during a careful preoperative history-taking, physical examination, and review of the chest film and electrocardiogram are extremely useful in estimating both the perioperative and the long-term cardiac risk. The risk is highest among patients with . . .
Erythropoietic protoporphyria in the U.K.: clinical features and effect on quality of life
Authors: S.A. Holme, A.V. Anstey, A.Y. Finlay, G.H. Elder, M.N. Badminton
Journal: British Journal of Dermatology (2006)

Background Erythropoietic protoporphyria (EPP) is a rare inherited photodermatosis that causes lifelong painful photosensitivity. Neither its full clinical spectrum nor its impact on quality of life (QoL) has been investigated in a large cohort of patients. Objectives To document the clinical features of EPP and its impact on QoL in a high proportion of all patients with EPP resident in the U.K. Methods Patients with EPP were identified from U.K. clinical databases and assessed by the same clinical investigator over a 7-month period using a standardized proforma and validated adult (Dermatology Life Quality Index, DLQI) and children's (Children's Dermatology Life Quality Index, CDLQI) QoL questionnaires. Results Three hundred and eighty-nine living patients with EPP were identified, of whom 223 [114 females, 109 males; median age 34 years (range: 5–87), from 193 families] were investigated. Total erythrocyte porphyrin (TEP) was higher in males (median: 25·3 μmol L−1) than females (median: 19·3 μmol L−1). The median ages at onset and diagnosis were 1 and 12 years, respectively. Median times for onset of symptoms after sun exposure, onset of signs (oedema, erythema) and resolution of symptoms were 20 min, 6 h and 3 days, respectively. Most patients reported absence of protection by glass (92%), priming (85%), exacerbation by wind (68%), no family history of photosensitivity (56%), no symptoms during winter (56%) and had chronic skin lesions (79%). Symptoms changed little with age but improved during pregnancy in 47% of gravid women. Most patients used protective clothing and a sunscreen; 28% were taking β-carotene and a further 56% had taken it; 29% were not under regular medical care. Two patients (1%) had liver failure and 8% reported gallstone disease. QoL was markedly impaired, with scores similar to those in severe dermatological disease (mean DLQI score 14·0, n = 176; mean CDLQI score 12·8, n = 44), indicating a large effect on patients' lives. DLQI scores correlated weakly with TEP (rs = 0·228; P = 0·002) and time to onset of symptoms (rs = −0·233; P = 0·002) but not with age at onset. Conclusions EPP is a persistent, severely painful, socially disabling disease with a marked impact on QoL. Its diagnosis is often overlooked. None of TEP, age at onset nor time to onset of symptoms is a useful predictor of impaired QoL in individual patients.
Temperature-dependent modulation of blood platelet movement and morphology on poly(N-isopropylacrylamide)-grafted surfaces
Authors: Katsumi Uchida, Kiyotaka Sakai, Etsuko Ito, Oh Hyeong Kwon, Akihiko Kikuchi, Masayuki Yamato, Teruo Okano
Journal: Biomaterials (2000)