tbuckley/cabot-search huggingface dataset:
Protection in the aged heart: preventing the heart-break of old age?
Authors: M JUHASZOVA, C RABUEL, D ZOROV, E LAKATTA, S SOLLOTT
Journal: Cardiovascular Research (2005)

The aged heart has a diminished functional and adaptive reserve capacity, an increased susceptibility to incur damage (e.g., as a result of ischemia), and a limited practical ability for repair/regeneration. Thus, there has been considerable interest to harness the heart's endogenous capacity to resist such damage, known as ischemic preconditioning (IPC), as well as other cardioprotective mechanisms. However, the translation of basic research findings into clinical practice has largely been inadequate because there have been few if any successful implementations in terms of viable therapies activating cardioprotection mechanisms to limit infarct size. Here, we provide an overview of the general mechanisms of cardioprotection, changes in the structure and function of the aged heart, and the current knowledge regarding cardioprotection in aged heart. The problems and opportunities for successful bench-to-bedside translation of cardioprotection in the elderly are discussed.
Idiopathic Pulmonary Fibrosis
Authors: Roland M. du Bois, Steven D. Nathan, Luca Richeldi, Marvin I. Schwarz, Paul W. Noble
Journal: American Journal of Respiratory and Critical Care Medicine (2012)

Idiopathic pulmonary fibrosis causes progressive morbidity and has a worldwide incidence that is increasing. There are a number of promising therapies, one of which has been approved in Europe, parts of Asia, and India, and others that are at various stages of development. Despite this, there continues to be debate about the most appropriate clinical endpoint that should be used in future randomized controlled clinical trials of novel therapies in idiopathic pulmonary fibrosis. In a recent Pulmonary Perspective in this journal, the case for the use of a variety of clinical endpoints was analyzed, and the article concluded that FVC, the endpoint most commonly used recently and in ongoing studies, was not an appropriate option. In this Pulmonary Perspective we present a counterpoint in which we explore the basis on which this conclusion is drawn and present data that strongly and logically support the use of FVC as a valid and robust measure that fulfils the criteria for an ideal clinical endpoint and that is meaningful to patient and clinician alike.
Doctors attack Gordon Brown's plans to regulate medical profession
Authors: Michael Day
Journal: BMJ (2007)

Doctors' leaders and legal experts say that government plans to lower the level of proof needed to convict doctors of professional misconduct are unfair and probably unworkable.

Gordon Brown, the prime minister, last week announced details of a new Health and Social Care Bill, which will be introduced in the next parliament. At the heart of the bill will be a shake-up of the regulation of the medical profession.

The proposed reorganisation was announced by the chief medical officer, Liam Donaldson, a year ago ( BMJ 2006;333:163, doi: 10.1136/bmj.333.7560.163). He proposed that key aspects of the General Medical Council's regulatory role would be diminished. The council would no longer act as prosecutor, …
RGS4 inhibits angiotensin II signaling and macrophage localization during renal reperfusion injury independent of vasospasm
Authors: Paul Pang, Xiaohua Jin, Brandon M. Proctor, Michelle Farley, Nilay Roy, Matthew S. Chin, Ulrich H. von Andrian, Elisabeth Vollmann, Mario Perro, Ryan J. Hoffman, Joseph Chung, Nikita Chauhan, Murti Mistri, Anthony J. Muslin, Joseph V. Bonventre, Andrew M. Siedlecki
Journal: Kidney International (2014)
Association of Perceived Medical Errors With Resident Distress and Empathy
Authors: Colin P. West, Mashele M. Huschka, Paul J. Novotny, Jeff A. Sloan, Joseph C. Kolars, Thomas M. Habermann, Tait D. Shanafelt
Journal: JAMA (2006)

Medical errors are associated with feelings of distress in physicians, but little is known about the magnitude and direction of these associations.To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life, burnout, depression, and empathy using validated metrics.Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester. Data were provided by 184 (84%) of 219 eligible residents. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and linear analog scale assessment of quality of life every 3 months, and the Maslach Burnout Inventory (depersonalization, emotional exhaustion, and personal accomplishment), Interpersonal Reactivity Index, and a validated depression screening tool every 6 months.Frequency of self-perceived medical errors was recorded. Associations of an error with quality of life, burnout, empathy, and symptoms of depression were determined using generalized estimating equations for repeated measures.Thirty-four percent of participants reported making at least 1 major medical error during the study period. Making a medical error in the previous 3 months was reported by a mean of 14.7% of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life (P = .02) and worsened measures in all domains of burnout (P = .002 for each). Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 (95% confidence interval, 1.90-5.64). In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months (P=.001, P<.001, and P=.02 for depersonalization, emotional exhaustion, and lower personal accomplishment, respectively; P=.02 and P=.01 for emotive and cognitive empathy, respectively).Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress. Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.
Effect of tea polyphenols on histamine release from rat basophilic leukemia (RBL-2H3) cells: the structure?inhibitory activity relationship
Authors: N. Matsuo, K. Yamada, K. Shoji, M. Mori, M. Sugano
Journal: Allergy (1997)

We studied the effect of tea polyphenols on histamine release from rat basophilic leukemia (RBL‐2H3) cells. Among tea polyphenols, (‐)‐epigallocatechin gallate (EGCG) most strongly and dose‐dependently inhibited histamine release from cells stimulated with a calcium ionophore, A23187. (‐)‐Epigallocatechin (EGC) and (‐)‐epicatechin gallate (ECG) with a triphenol residue moderately inhibited histamine release, whereas diphenolic (+)‐catechin (C) and (‐)‐epicatechin (EC) did not. The magnitude of the inhibitory effect was in the order EGCG &gt; ECG &gt; EGC. Among simple polyphenols, the triphenol compounds, pyrogallol (PG) and gallic acid (GA) exerted inhibitory activity, but the diphenols, pyrocatechol, hydroquinone, and resorcinol did not. In addition, the mixture of PG and GA inhibited histamine release as strongly as EGCG with two triphenol residues. Similarly, they inhibited histamine release induced by IgE‐antigen complex stimulation more efficiently than that induced by A23187 stimulation. EGCG did not inhibit the increase of intracellular Ca 2+ in RBL‐2H3 cells stimulated with A23187 or IgE antigen. These results indicate that the triphenol structure plays an important role in the inhibitory activity of tea polyphenols. Their activity seemed to be exerted through the metabolic events occurring after the elevation of intracellular Ca 2+ concentration.
The surgeon's prayer
Authors: T. Dalrymple
Journal: BMJ (2009)

W H Auden’s father, like Marcel Proust’s, was a professor of public health. Auden developed an abiding interest in medicine, and also in psychoanalysis, from reading in his father’s library. When Auden was 20 his father published an article on autoerotic strangulation. Proust’s father also published in the field of psychopathology.

In 1935 Auden wrote a play, The Dog Beneath the Skin , in collaboration with Christopher Isherwood, in which appears a surgeon, remarkably like Sir Lancelot Spratt in the 1954 comedy film Doctor in the House and its sequels, called Sir William Spurgeon. It is not easy to summarise the plot, except to say that it is a satire on the state of Britain and, to a lesser extent, of …
Unstable Coronary-Artery Plaques
Authors: Donald D. Heistad
Journal: New England Journal of Medicine (2003)

It is ironic and instructive that in the age of cellular and molecular biology, great advances in our understanding of the pathophysiology of cardiovascular disease continue to be made by pathologists who perform meticulous and imaginative studies. The concept of stable and unstable atherosclerotic plaques and implications for coronary thrombosis and myocardial infarction can be attributed to several great cardiovascular pathologists during the past century.What characterizes an arterial plaque that is vulnerable to rupture? What causes the vulnerable plaque to rupture? How can plaque rupture be prevented? These are critically important questions in cardiovascular medicine, because if the causes . . .
Abstract 2135: Chemoprevention of tobacco carcinogen-induced lung cancer by DFMO and Licofelone administered individually or in combination in female A/J mice
Authors: Jagan Mohan Reddy Patlolla, Levy Kopelovich, Li Qian, Laura Biddick, Yuting Zhang, Michael K. Sadeghi, Dhimant Desai, Shantu Amin, Stan Lightfoot, Vernon E. Steele, Chinthalapally V. Rao
Journal: Cancer Research (2014)

Abstract Lung cancer is the leading cause of cancer death among both men and women in the US. Inflammatory eicosanoids and leukotrienes derived from cyclooxygenase (COX)-2 and 5-lipoxygenase (LOX) pathway positively influences lung tumor growth. Overexpression of ornithine decarboxylase (ODC) enzyme activity and polyamines has been associated with proliferation and progression of lung cancer. Thus, targeting both tumor inflammatory molecules and polyamines synthesis may provide additive/synergistic antitumor effects. To overcome clinical toxicity of high dose difluoromethyl ornithine (DFMO), an inhibitor of ODC; and to target both COX-2/5LOX, we tested low dose DFMO combined with Licofelone, a novel dual inhibitor COX-2/5-LOX, in lung cancer model. At 7 weeks of age, mice (25 mice/group) were treated with 10 μmol 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) /mouse to induce the lung tumors. Three weeks after the NNK treatment, mice were fed either control or experimental diets containing 200, 400 ppm licofelone or 1500 and 3000 ppm DFMO or low-dose combinations of both agents. Mice were killed at 20 weeks (10 mice/group) and/or 36 weeks (15 mice/group) after NNK-treatment for lung tumor evaluation. Administration of 200 and 400 ppm licofelone significantly suppressed lung tumor (adenoma + adenocarcinoma) formation by &amp;gt;32 to 35% (p43 to 47% (p25 to 30% (p44% (p53% (p60% (p&amp;lt;0.0001) respectively at 17 and 34 weeks exposure. These results suggest that low-dose combinations of licofelone and DFMO inhibit the NNK-induced lung adenocarcinoma formation synergistic/additive manner. Immunohistochemistry analysis revealed that lung tumors from mice exposed to licofelone plus DFMO showed significantly reduced proliferating cell nuclear antigen (PCNA)-positive index, increased accumulation of TUNEL positive cells as compared to lung tumors from NNK-treated mice fed with control diet. These results demonstrate the targeting lung tumor COX-LOX with ODC may provide better efficacy when compared to individual targets on tobacco carcinogen-induced lung adenocarcinomas formation. {Supported by NIH, NCI grants NO1-CN-53300 and Kerley-Cade Chair}. Citation Format: Jagan Mohan Reddy Patlolla, Levy Kopelovich, Li Qian, Laura Biddick, Yuting Zhang, Michael K. Sadeghi, Dhimant Desai, Shantu Amin, Stan Lightfoot, Vernon E. Steele, Chinthalapally V. Rao. Chemoprevention of tobacco carcinogen-induced lung cancer by DFMO and Licofelone administered individually or in combination in female A/J mice. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2135. doi:10.1158/1538-7445.AM2014-2135
Perforation with retroperitoneal emphysema after endoscopic submucosal dissection for a rectal carcinoid tumor
Authors: H. Chiba, K. Ohata, A. Ohno, Y. Sekino, T. Ito, Y. Tsuji, T. Ohya, M. Inamori, A. Nakajima, N. Matsuhashi
Journal: Endoscopy (2010)

A 49-year-old woman was admitted to our hospital for treatment of a rectal carcinoid tumor ([Fig. 1]).
Penetration of Clindamycin Phosphate into the Abnormal Human Biliary Tract
Authors: RICHARD B. BROWN
Journal: Annals of Internal Medicine (1976)

Clindamycin phosphate, 600 mg, was given intravenously to 14 patients undergoing biliary tract surgery. Seven had complete obstruction of the common bile duct. Concentrations of total and active (nonesterified) antibiotic were measured in serum, gall bladder and common duct bile, gall bladder wall, and liver. Persons with patent common ducts had high levels of active drug at all hepatobiliary sites; concentrations were two and one half to three times higher in bile and liver than in serum. Persons with obstruction of the common duct had no measurable drug in bile and had reduced levels in gall bladder wall; however, concentrations in the liver were slightly higher than those in the group without obstruction. The results of this study suggest that, even in the presence of common duct obstruction, the concentrations of active clindamycin in the liver may be sufficient to limit the spread of intrahepatic infections due to susceptible organisms.
Relationship Between Intracellular Calcium and Contractile Force in Stunned Myocardium
Authors: Wei Dong Gao, Dan Atar, Peter H. Backx, Eduardo Marban
Journal: Circulation Research (1995)

To elucidate the abnormalities of excitation-contraction coupling in stunned myocardium, we measured [Ca2+]i and force in thin fura 2-loaded ventricular trabeculae from control or stunned (20 minutes ischemia followed by 20 minutes reflow at 37 degrees C) rat hearts. At any given [Ca2+]o, force development was significantly lower in the stunned trabeculae than in control trabeculae. In contrast, there was no difference in the amplitude of Ca2+ transients between the two groups. The steady state force-[Ca2+]i relationship, assessed by tetanization in the presence of ryanodine, revealed both a decrease in maximal Ca(2+)-activated force and an increase in the [Ca2+]i required for 50% activation in stunned trabeculae. Postischemic myocardium also exhibited an accelerated rate of diastolic relaxation that was not due to changes in the rate of Ca2+ transient decay. Destabilization of attached cross-bridges in a quantitative model of cardiac myofibrils accurately reproduced the salient systolic and diastolic features of the stunned phenotype, suggesting an abnormality of the thin filaments. In response to supraphysiological increases in [Ca2+]o, diastolic [Ca2+]i and diastolic tone increased much more in stunned trabeculae than in controls, with the frequent occurrence of aftercontractions. This novel experimental model lends further support to the hypothesis that the primary lesion of excitation-contraction coupling resides at the level of the contractile proteins. The finding of enhanced susceptibility to calcium overload helps to rationalize the functional deterioration of stunned myocardium during intense inotropic stimulation and additionally suggests that stunned myocardium may represent a favorable substrate for triggered arrhythmias.
ABC of palliative care: Care in the community
Authors: B. O'Neill, A. Rodway
Journal: BMJ (1998)

The physical complexities of progressive and life threatening disease, coupled with attendant emotional and psychological consequences, demand careful coordination between primary, secondary, and tertiary care. Across the whole range of health services, an increasing amount of care is being provided on an outpatient basis or independently of hospitals altogether: most terminally ill patients spend most of their time at home.

#### Issues of concern for terminally ill patients

In the planning of care and agreeing a management plan, patients must be given an opportunity to express their wishes and these must be taken into account. Patients can make valid choices between treatment options only if they know what is happening, what help is available, what is likely to happen, and what help will be available in the future.

Patients who make advance statements must be made aware that they cannot authorise or refuse in advance what they could not normally authorise or refuse— unlawful procedures such as euthanasia or futile or inappropriate treatment

It is important to document accurately at each point what a patient's wishes are. Information must be tailored to patients to meet their need for knowledge and given at a pace with which they can cope. Rarely, patients may choose not to be informed. Some patients may wish to complete an advance statement, giving instructions about their wishes in the event of their losing the capacity to decide or to communicate.

#### Equipment and modifications that may be needed for home care of patients

#### Practical equipment

#### Medical equipment

#### Home modification

It can be much easier to care for patients in a hospital, hospice, or nursing home because of the infrastructure and immediate support available. Caring for a patient at home presents a challenge, and sometimes …
Manual of Clinical Problems in Adult Ambulatory Care: with Annotated Key References
Authors: Deborah L. Burnet
Journal: Annals of Internal Medicine (1998)

Medical Writings1 April 1998Manual of Clinical Problems in Adult Ambulatory Care: with Annotated Key ReferencesDeborah L. BurnetDeborah L. BurnetUniversity of Chicago Pritzker School of Medicine, Chicago, IllinoisSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-7-199804010-00040 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 3rd edition. Dornbrand L, Hoole AJ, Fletcher RH; eds. 776 pages. Philadelphia: Lippincott-Raven; 1997. $34.95. ISBN 0316190381. Order phone 800-777-2295.Field of medicine: General internal medicine and family medicine.Audience: Internists, family physicians, nurse practitioners, and physician assistants. Experienced clinicians may find this manual too basic, but it is appropriate for students, housestaff, and beginning practitioners.Purpose: To serve as a practical resource for common problems in primary care, addressing etiology, differential diagnosis, evaluation, and management of problems in adult medicine.Content: The 138 chapters are organized according to organ systems, with additional sections on infectious disease, men's and women's ... Author, Article, and Disclosure InformationAffiliations: University of Chicago Pritzker School of Medicine, Chicago, Illinois PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1998Volume 128, Issue 7Page: 612KeywordsEtiologyHeadachesInfectious diseasesKneesNursesObstetrics and gynecologyOutpatientsParalysisPeptic ulcers ePublished: 15 August 2000 Issue Published: 1 April 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Training Endoscopists to Recognize the Stigmata of Hemorrhage in Bleeding Ulcers
Authors: M. L. Freeman
Journal: Endoscopy (1995)

Correctly assessing the stigmata of recent hemorrhage is critical to providing appropriate endoscopic and medical management in patients with bleeding ulcers. However, the task of training endoscopists to recognize stigmata in ulcers is particularly difficult, for a number of reasons. First, the source of bleeding must be located, and this may be difficult when blood is present or the patient is unstable; second, the ulcer base must be completely examined, sometimes requiring target irrigation or manipulation of the surrounding folds with a device; third, the presence or absence of stigmata must be recognized; and finally, the stigma must be accurately identified. A major problem is that even expert endoscopists and investigators in the field of hemostasis have not achieved a consensus on definitions of stigmata. Nonetheless, the available data suggest that endoscopists can be trained to identify stigmata with reasonable consistency.
Left atrial pacing induces memory and is associated with atrial tachyarrhythmias
Authors: Parag Chandra, Tove S Rosen, Bengt Herweg, Peter Danilo, Michael R Rosen
Journal: Cardiovascular Research (2003)

Objective: Transiently altering the atrial activation sequence induces atrial memory, manifested as an altered atrial gradient as measured in electrocardiographic XYZ leads. We hypothesized that protracted periods of left atrial impulse initiation alter the atrial gradient in a manner predictive of arrhythmias. Methods: A total of 12 chronically instrumented mongrel dogs in complete heart block were paced AV sequentially from the left or right atrium for 7–28 days, and then recovered in normal sinus rhythm for 21 days. Rate histograms were recorded during the entire period, and electrophysiological studies were conducted to note changes in the atrial gradient, effective refractory period and atrial rhythm. No atrial arrhythmias were seen in eight control animals that were instrumented but not paced. Results: Left atrial pacing was associated with a decreased atrial gradient and occurrence of atrial tachycardias that appeared during pacing and persisted during recovery from pacing. In contrast, right atrial pacing did not alter the atrial gradient significantly. Atrial tachycardias occurring during right atrial pacing disappeared after cessation of pacing, when dogs recovered in sinus rhythm. The effective refractory period did not change in either group. Conclusions: Pacing-induced impulse initiation from the left atrium alters the atrial gradient and is associated with atrial tachycardias. These changes in atrial gradient occur in the absence of ERP changes and may be early predictors of an arrhythmogenic substrate.
General Medical Council complaints: swimming against the stream
Authors: Suzie Bailey, Magnus Boyd
Journal: Journal of the Royal Society of Medicine (2006)

The General Medical Council receives over 5000 complaints every year.1 On 17 October 2005 a new procedure came into effect that will mean some complaints will now be referred to the local health service or primary care trust.1 Scaling down the complaints procedure in this way exposes it to claims of unfairness and partiality that could weaken the public's faith in the way complaints are dealt with and undermine their trust in doctors generally.
ON YELLOW FEVER: COMPRISING THE HISTORY OF THAT DISEASE, AS IT APPEARED IN THE ISLAND OF ANTIGUA IN THE YEARS 1835, 1839, AND 1842
Authors: T. Nicholson
Journal: BMJ (1853)

Ti subject of the following essy is that peculiar form of fever, which, under the diferent names of Yellow Fever, Vomito Negro, Vomito Prieto, and Bulam Fever, has been known to the English and Spanish colonists on both sides of the Atlantic for nearly a century