tbuckley/cabot-search huggingface dataset:
Further Perspectives on Concierge Medicine
Authors: Christine Harter
Journal: Annals of Internal Medicine (2010)

Letters17 August 2010Further Perspectives on Concierge MedicineChristine Harter, MDChristine Harter, MDFrom Internal Medicine and Headache Care, Phoenix, AZ 85027.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-4-201008170-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In response to Stillman's critique of concierge medicine (1), I, too, am still a “regular” physician. I practice full-time primary care medicine with a part-time focus on a time-consuming specialty: headache medicine. Yet I do not presume to decide for other physicians how they should run their practices, and I am glad that the medical community is still neutral toward concierge medical practices. What should we do, legislate them out of existence? Shall we also legislate how many physicians can go into a lucrative field, such as cosmetic surgery or cosmetic dermatology?And there is a breadth ...Reference1. Stillman M. Concierge medicine: a “regular” physician's perspective. Ann Intern Med. 2010;152:391-2. [PMID: 20231570] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Internal Medicine and Headache Care, Phoenix, AZ 85027.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoConcierge Medicine: A “Regular” Physician's Perspective Michael Stillman Further Perspectives on Concierge Medicine James Bowers Further Perspectives on Concierge Medicine Harry M. Walen Further Perspectives on Concierge Medicine Marcy Zwelling-Aamot Further Perspectives on Concierge Medicine Robert A. Swerlick Further Perspectives on Concierge Medicine Robert P. Fields Metrics 17 August 2010Volume 153, Issue 4Page: 274-275KeywordsConflicts of interestDermatologyHeadachesPatient advocacySurgery ePublished: 17 August 2010 Issue Published: 17 August 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Effects of pravastatin on progression of glucose intolerance and cardiovascular remodeling in a type II diabetes model
Authors: Yang Yu, Koji Ohmori, Yan Chen, Chubun Sato, Hideyasu Kiyomoto, Kaori Shinomiya, Hiroto Takeuchi, Katsufumi Mizushige, Masakazu Kohno
Journal: Journal of the American College of Cardiology (2004)
Transthoracic Needle Biopsy
Authors: Bruce W. Armstrong
Journal: JAMA (1967)

What to do with the patient who shows a pulmonary mass but in whom the usual diagnostic procedures are not particularly helpful? Dr. Dahlgren, a pathologist, and Dr. Nordenstrom, a radiologist, both at the Karolinska Institute, describe the way they avoid any diagnostic impasse by proceeding directly from the stage of negative findings to a needle biopsy. Using a special table and television fluoroscopy, they obtained a satisfactory specimen in 74% of 519 biopsies from 365 cases. Microscopy gave a definitive diagnosis in 316 (87%) of these 365 patients. Regarding complications, the authors state that with a single exception, no signs of air embolism, shock, or other alarming symptoms were noted. In the one exception, a 70-year-old man with a prior myocardial infarct became cold, sweaty, and severely hypotensive about five minutes after the biopsy needle had been withdrawn. The electrocardiogram and transaminase studies indicated that the episode was due
Effects of bile duct ligation on hepatic expression of female-specificCYP2C12 in male and female rats
Authors: Jiezhong Chen, Graham Robertson, Jacqueline Field, Christopher Liddle, Geoffrey C. Farrell
Journal: Hepatology (1998)

Gender differences in hepatic sex steroid and drug metabolism result from hormonal regulation of specific cytochrome P450 genes (CYP). In male rats, bile duct ligation (BDL) is associated with down-regulation of the male-specific genes, CYP2C11 and CYP3A2 , together with a decrease in serum testosterone levels and a two- to threefold increase in serum estradiol concentrations. We anticipated that if estrogen is responsible for down-regulation of male-specific CYPs in BDL male rats, the female-specific CYP2C12, which is not normally present in adult male rat liver, should be up-regulated. We examined this proposal by determining the profile of hepatic cytochrome P450 enzymes in female rats subjected to BDL, and by seeking evidence for expression of CYP2C12 in male rats that do not normally express this gene. In female rats killed 5 days after BDL, total cytochrome P450 content and NADPH-cytochrome P450-reductase (P450-reductase) were decreased to 74% and 58% of control, respectively. Microsomal enzyme activities attributable to CYP2A1, CYP2C6, and CYP2E1 were 50% to 60% of control, but ethylmorphine N -demethylase, which in female liver is catalyzed by CYP2C12 and to a lesser extent CYP2C6, was significantly less affected (81% of control). Likewise, levels of CYP2C6 and P450-reductase proteins were decreased in proportion to the corresponding enzyme activities (50% to 60%), while CYP2C12 protein (and mRNA levels) were not altered in BDL female rat liver. In sham-operated male rats, transcripts for CYP2C12 were rarely detected, but mRNA levels rose to appreciable levels within 24 hours of BDL, and CYP2C12 protein was expressed in hepatic microsomes of BDL male rats. Administration of estradiol to male rats produced a similar elevation of CYP2C12 mRNA, to values ≈40% of female rats. It is concluded that CYP2C12 is up-regulated in male rats with cholestasis caused by BDL, while CYP2C12 protein is preserved in female rats when other microsomal proteins are decreased. These changes may be related to the increase in serum estradiol levels that result from altered hepatic steroid metabolism. The results demonstrate that activities of individual drug-metabolizing enzymes in liver disease can be determined by dysregulation of the constitutive expression of hepatic CYP genes.
RENAL FAILURE BUT NOT DIABETES DETERMINES HOSPITAL MORTALIY IN PATIENTS WITH NSTE-ACS: RESULTS OF THE EURO HEART SURVEY ACS REGISTRY
Authors: Anselm K. Gitt, Matthias Hochadel, Francois Schiele, Wojtek Wojakowski, Michal Tendera, Ralf Zahn, Uwe Zeymer
Journal: Journal of the American College of Cardiology (2013)
A novel cysteine-rich sequence-specific DNA-binding protein interacts with the conserved X-box motif of the human major histocompatibility complex class II genes via a repeated Cys-His domain and functions as a transcriptional repressor.
Authors: Z Song, S Krishna, D Thanos, J L Strominger, S J Ono
Journal: The Journal of Experimental Medicine (1994)

The class II major histocompatibility complex (MHC) molecules function in the presentation of processed peptides to helper T cells. As most mammalian cells can endocytose and process foreign antigen, the critical determinant of an antigen-presenting cell is its ability to express class II MHC molecules. Expression of these molecules is usually restricted to cells of the immune system and dysregulated expression is hypothesized to contribute to the pathogenesis of a severe combined immunodeficiency syndrome and certain autoimmune diseases. Human complementary DNA clones encoding a newly identified, cysteine-rich transcription factor, NF-X1, which binds to the conserved X-box motif of class II MHC genes, were obtained, and the primary amino acid sequence deduced. The major open reading frame encodes a polypeptide of 1,104 amino acids with a symmetrical organization. A central cysteine-rich portion encodes the DNA-binding domain, and is subdivided into seven repeated motifs. This motif is similar to but distinct from the LIM domain and the RING finger family, and is reminiscent of known metal-binding regions. The unique arrangement of cysteines indicates that the consensus sequence CX3CXL-XCGX1-5HXCX3CHXGXC represents a novel cysteine-rich motif. Two lines of evidence indicate that the polypeptide encodes a potent and biologically relevant repressor of HLA-DRA transcription: (a) overexpression of NF-X1 from a retroviral construct strongly decreases transcription from the HLA-DRA promoter; and (b) the NF-X1 transcript is markedly induced late after induction with interferon gamma (IFN-gamma), coinciding with postinduction attenuation of HLA-DRA transcription. The NF-X1 protein may therefore play an important role in regulating the duration of an inflammatory response by limiting the period in which class II MHC molecules are induced by IFN-gamma.
Leukemia cell–targeted STAT3 silencing and TLR9 triggering generate systemic antitumor immunity
Authors: Dewan Md Sakib Hossain, Cedric Dos Santos, Qifang Zhang, Anna Kozlowska, Hongjun Liu, Chan Gao, Dayson Moreira, Piotr Swiderski, Agnieszka Jozwiak, Justin Kline, Stephen Forman, Ravi Bhatia, Ya-Huei Kuo, Marcin Kortylewski
Journal: Blood (2013)
A two-stage validation study for determining sensitivity and specificity.
Authors: T D Tosteson, L Titus-Ernstoff, J A Baron, M R Karagas
Journal: Environmental Health Perspectives (1994)

A two-stage procedure for estimating sensitivity and specificity is described. The procedure is developed in the context of a validation study for self-reported atypical nevi, a potentially useful measure in the study of risk factors for malignant melanoma. The first stage consists of a sample of N individuals classified only by the test measure. The second stage is a subsample of size m, stratified according the information collected in the first stage, in which the presence of atypical nevi is determined by clinical examination. Using missing data methods for contingency tables, maximum likelihood estimators for the joint distribution of the test measure and the "gold standard" clinical evaluation are presented, along with efficient estimators for the sensitivity and specificity. Asymptotic coefficients of variation are computed to compare alternative sampling strategies for the second stage.
Age-related changes in human dermal elastic fibres
Authors: TAKUO TSUJI, TOSHIO HAMADA
Journal: British Journal of Dermatology (1981)

Age-related changes in human dermal elastic fibres were studied by scanning (SEM) and transmission (TEM) electron microscopy. The SEM findings showed an increase in the complexity of shape and arrangement of the fibres including flattening and branching, an increase in the roughness of the surface, and a decrease in interfibrillar areas. The TEM findings showed a decrease in micro-fibrils and amorphous material, and an increase in electron dense inclusions followed by the appearance of vesicular structure.
A FURTHER CASE OF PEMPHIGUS FOLIACEUS, WITH REMARKS
Authors: R. CRANSTON LOW
Journal: British Journal of Dermatology (1911)

Journal Article A FURTHER CASE OF PEMPHIGUS FOLIACEUS, WITH REMARKS Get access R. CRANSTON LOW, M.B., F.R.C.P., Assistant Physician. R. CRANSTON LOW, M.B., F.R.C.P., Assistant Physician. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 23, Issue 1, 1 January 1911, Pages 1–5, https://doi.org/10.1111/j.1365-2133.1911.tb16649.x Published: 01 January 1911
Fundholding practices get preference.
Authors: D E Luxton
Journal: BMJ (1993)

Communicable disease control in LondonEDITOR,-We agree with Bobbie Jacobson that "inner London displays a unique pattern of communicable disease that presents a major public health challenge."'In the London districts of North East Thames Regional Health Authority there have been three recent outbreaks of typhoid fever associated with asymptomatic food handlers.2Between 1987-8 and 1990-1 notifications of food poisoning rose from about 45 to 56 per 100000 population in these districts.During this period community outbreaks of hepatitis A were reported.Difficulties in investigating outbreaks include the division of the local authority environmental health function into neighbourhoods with potential dilution of skill in the environmental hygiene aspects of foodborne and waterbome illness; difficulties in interviewing people whose first language is not English and who may be dispossessed, bewildered, and confused; and difficulties in advertising posts for consultants in communicable disease control and recruiting suitably trained applicants.In the London districts of North East Thames region notifications of tuberculosis (all sites) rose from 27 to 100000 in 1987-8 to 34 in 1990-1.New entrants from areas of high incidence require careful screening and follow up.In up to 40% of cases people who have not been screened at the port of entry cannot be found for follow up at the stated destination address.Cases of cutaneous diphtheria in a traveller from India,' cholera (El for Tor 01) in a recent entrant from Turkey, and Shigella dysenteriae in entrants from Somalia have recently presented in these districts.The demographic and socioeconomic features, proximity to the major ports of entry, and division by administrative boundaries combine to present difficulties for communicable disease control in London.Consultants in communicable disease control, who have responsibility for preventing and con- trolling communicable disease, do not have the power or resources to discharge their function most effectively.The potential for large numbers of people to be exposed to environmental hazards in inner London was shown in an outbreak of legionnaires' disease in Westminster in 1988.
Abstract 162: DNA methylome in familial breast cancer identifies distinct profiles defined by mutation status
Authors: James Flanagan, Sibylle Cocciardi, Nic Waddell, Cameron Johnstone, Stephen Henderson, Peter Simpson, kConFab, Leonard da Silva, Kumkum Khanna, Sunil Lakhani, Chris Boshoff, Georgia Chenevix-Trench
Journal: Cancer Research (2010)

Abstract It is now understood that epigenetic alterations occur frequently in sporadic breast carcinogenesis, but little is known about the epigenetic alterations associated with familial breast tumors. We performed genome-wide DNA methylation profiling on frozen, familial breast cancers (n=33) to identify patterns of methylation specific to the different mutation groups (BRCA1, BRCA2 and BRCAx) or intrinsic subtypes of breast cancer (basal, luminal A, luminal B, HER2-amplified and normal-like). We used methylated DNA immunoprecipitation (meDIP) on Affymetrix promoter chips to interrogate methylation profiles across 25,500 distinct transcripts, and performed technical validation of multiple loci with Epityper. Using a support vector machine classification algorithm, we demonstrated that genome-wide methylation profiles predicted tumor mutation status with estimated error rates of 19% (BRCA1), 31% (BRCA2) and 36% (BRCAx), but did not accurately predict the intrinsic subtypes defined by gene expression with error rates of 43% (basal) and 54% (luminal A). Furthermore, using unsupervised hierarchical clustering we identified a distinct subgroup of BRCAx tumors defined by methylation profiles. We then validated these findings in the original 33 tumours and in an independent set of 47 formalin-fixed, paraffin embedded BRCA1 (n=14), BRCA2 (n=13) and BRCAx (n=20) tumours by Pyrosequencing. “Finally, gene expression profiling and SNP CGH array previously performed on the same samples allowed full integration of methylation, gene expression and copy number data sets. This integrated analysis revealed frequent hypermethylation of genes that also displayed loss of heterozygosity (LOH) compared to the tumors that were diploid for that gene. We also observed frequent hypermethylation of genes that show copy number gains compared to diploid tumors providing a potential mechanism for expression dosage compensation. Together these data show that methylation profiles for familial breast cancers are defined by the mutation status and distinct from the intrinsic subtypes. 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 162.
Tobacco control policies in South Asia are not tough enough on smokeless tobacco
Authors: S. Bagcchi
Journal: BMJ (2014)

Tobacco control policies in India, Bangladesh, Nepal, and Pakistan, either do not deal with smokeless tobacco use adequately or the policies are poorly implemented, a study published in Nicotine and Tobacco Research has found.1

The researchers looked at whether smokeless tobacco featured in the existing tobacco control policies of the four south Asian countries, to what extent the policies were implemented and what were the barriers to implementation. They conducted 11 interviews with representatives of central government responsible for tobacco control and representatives of civil society organisations advocating strong tobacco control policies, and their …
NICE hypertension guideline 2011: evidence based evolution
Authors: R. J. McManus, M. Caulfield, B. Williams
Journal: BMJ (2012)

<b>Richard McManus</b>, <b>Mark Caulfield</b>, <b>Bryan Williams </b>respond to criticisms of the 2011 NICE guideline, arguing that it reflects the reduced costs of generic drugs and new evidence on cardiovascular risk reduction
Controlling Endemic Cholera with Oral Vaccines
Authors: Ira M Longini, Azhar Nizam, Mohammad Ali, Mohammad Yunus, Neeta Shenvi, John D Clemens
Journal: PLoS Medicine (2007)

Although advances in rehydration therapy have made cholera a treatable disease with low case-fatality in settings with appropriate medical care, cholera continues to impose considerable mortality in the world's most impoverished populations. Internationally licensed, killed whole-cell based oral cholera vaccines (OCVs) have been available for over a decade, but have not been used for the control of cholera. Recently, these vaccines were shown to confer significant levels of herd protection, suggesting that the protective potential of these vaccines has been underestimated and that these vaccines may be highly effective in cholera control when deployed in mass immunization programs. We used a large-scale stochastic simulation model to investigate the possibility of controlling endemic cholera with OCVs.
All together now
Authors: J. O. Drife
Journal: BMJ (2012)

Doctors who graduate together have a lasting bond. Or rather they used to have, when classes were smaller. Today, half of the United Kingdom’s medical schools have annual intakes of 250 or more (some many more), and even the most sociable of students must find it hard to know more than a few of their contemporaries.

Mass gatherings become rare as the course progresses, but last month the Leeds third year students came together for their professionalism ceremony. Initiated last year, it celebrates the time when things start to get serious. Fripperies like biochemistry …
Right Middle Lobe Syndrome in Children
Authors: Geza G. Kopstein
Journal: JAMA (1966)

<h3>To the Editor:—</h3> In a recent article, "Right Middle Lobe Syndrome in Children" (<b>197</b>:8, 1966), reference was made to the value of bronchograms in children "whose posteroanterior and lateral x-rays showed... equivocal changes such as blurred heart border, increased bronchovascular markings etc...." No mention was made of films taken in lordotic view which, in my opinion, has proved, both in adults and in children, useful in recognizing or evaluating parenchymal infiltrative pathology in the middle lobe of the right lung. This holds specifically in cases in which the ambiguous or inconclusive signs in the right lower lung field don't allow a more distinct diagnostic approach. In these cases a film taken in lordosis frequently produces a typical wedgeshaped density in the basal central zone of the right lower lung field representing a parenchymal involvement of the middle lobe. Thus the lordotic view should be part of the x-ray examination
Release of Neutrophil Chemotactic Activity during Immediate Hypersensitivity Reactions in Humans
Authors: PAUL C. ATKINS
Journal: Annals of Internal Medicine (1977)

Heat-stable, serum-derived chemotactic activity for neutrophils is shown in a human model of immunoglobulin E-mediated asthma. Twenty-six ragweed-sensitive subjects underwent bronchial provocation challenge using ragweed and Mecholyl®. Increased neutrophil chemotactic activity was found in serum tested from 5 to 30 min after a positive ragweed-inhalation challenge, but not after negative ragweed challenge. The appearance of neutrophil chemotactic activity did not reflect the effects of bronchospasm alone, because it was not found after bronchospastic responses to Mecholyl in the same subjects. There were no accompanying changes of serum complement activity, nor evidence of inhibition of the chemotactic activity by prior exposure to antisera to the third and fifth components of complement. Ultrafiltration of serum showed chemotactic activity contained in fractions of at least 50 000 daltons. This appears to be the first demonstration of neutrophil chemotactic activity liberated during experimentally induced immunoglobulin E-mediated asthma in humans.
Transforming growth factor-beta (TGF-beta) in silicosis.
Authors: J Jagirdar, R Begin, A Dufresne, S Goswami, T C Lee, W N Rom
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

Silicosis is characterized by fibrosing nodular lesions that may eventually develop into progressive massive fibrosis (PMF). Cytokines (interleukin-1beta [IL-1beta], tumor necrosis factor-alpha [TNF-alpha] and growth factors insulin-like growth factor-1 [IGF-1] platelet-derived growth factor [PDGF]) have been implicated in the formation of these lesions. TGF-beta promotes extracellular matrix accumulation by upregulating collagen and fibronectin gene expression, and inhibits matrix degradation by decreasing secretion of proteases and increasing secretion of protease inhibitors. We hypothesized that TGF-beta is associated with matrix deposition and fibrosis in silicosis. To test this hypothesis we studied early and late nodular lesions and PMF (11 cases and two controls) with immunohistochemistry, using rabbit polyclonal antibody to the purified whole molecule of TGF-beta in Bouin's fixed lung tissue. This antibody is reactive with both intra- and extracellular forms of TGF-beta. In the control lungs, small amounts of TGF-beta were present in the bronchial epithelium, macrophages, bronchial and vascular smooth muscle, and bronchial glands. There was minimal to moderate staining in the early silicotic peribronchiolar lesions. In the nodular lesions of silicosis, central hyalinized areas contained the maximum staining for TGF-beta. Fibroblasts in the periphery of the nodular lesions were also positive. In acute silicosis, there was marked staining of hyperplastic alveolar epithelium. Macrophages were markedly positive. In the PMF lesions, large areas of scar tissue contained TGF-beta. These data suggest a major role for TGF-beta in silicosis, particularly in the formation of silicotic nodules and the development of PMF.