tbuckley/cabot-search huggingface dataset:
Perceptive Deafness in Hypothyroidism
Authors: A. E. Howarth, H. E. D. Lloyd
Journal: BMJ (1956)

~~~~~~~~~~~~~MEDICAL JOURNAL was 2.1, 2.1, 2.3, 3 ml./min.When these tests were repeated after three weeks' treatment the average water excretion was 3, 3.5, 4.5, and 6 ml./min respectively.There was an increase in 17-ketosteroid excretion in all cases.Before treatment the output ranged from 2.8 to 4.7 ml. a day; after treat- ment it was from 5.5 to 11 mg.a day.No significant changes were observed in the levels of serum sodium, potassium, or chlorides, and these levels were usually within normal limits both before and during treatment.Insulin sensitivity tests revealed a hypoglycaemic unresponsiveness in all .cases,and this was unaltered by treatment.No change was produced in the blood picture; in no patient was the anaemia of severe degree.The effect of administration of cortisone over a prolonged period might be worth observing, particularly as it is known that the anaemia of myxoedema responds very slowly to the adminis- tration of thyroid extract. SummaryThe effect of cortisone treatment in five cases of myxoedema has been observed.No change was produced in the physical or biochemical state of these patients.A marked quickening of mental processes was, however, noticed.There does not appear to be any good reason for using cortisone as an adjuvant to thyroid extract in most cases of hypothyroidism.The quickening of mental activity produced in these patients by cortisone might make this drug helpful in those cases of myxoedema in which drowsiness is marked and in which the development of coma is a possibility.
Role of Proopiomelanocortin-Derived Peptides and Their Receptors in the Osteoarticular System: From Basic to Translational Research
Authors: Markus Böhm, Susanne Grässel
Journal: Endocrine Reviews (2012)

Proopiomelanocortin (POMC)-derived peptides such as melanocortins and β-endorphin (β-ED) exert their pleiotropic effects via binding to melanocortin receptors (MCR) and opioid receptors (OR). There is now compelling evidence for the existence of a functional POMC system within the osteoarticular system. Accordingly, distinct cell types of the synovial tissue and bone have been identified to generate POMC-derived peptides like β-ED, ACTH, or α-MSH. MCR subtypes, especially MC1R, MC2R (the ACTH receptor), MC3R, and MC4R, but also the μ-OR and δ-OR, have been detected in various cells of the synovium, cartilage, and bone. The respective ligands of these POMC-derived peptide receptors mediate an increasing number of newly recognized biological effects in the osteoarticular system. These include bone mineralization and longitudinal growth, cell proliferation and differentiation, extracellular matrix synthesis, osteoprotection, and immunomodulation. Importantly, bone formation is also regulated by the central melanocortin system via a complex hormonal interplay with other organs and tissues involved in energy metabolism. Among the POMC-derived peptides examined in cell culture systems from osteoarticular tissue and in animal models of experimentally induced arthritis, α-MSH, ACTH, and MC3R-specific agonists appear to have the most promising antiinflammatory actions. The effects of these melanocortin peptides may be exploited in future for the treatment of patients with inflammatory and degenerative joint diseases.
Alterations in Central Nervous System Serotonergic and Dopaminergic Synaptic Activity in Adulthood after Prenatal or Neonatal Chlorpyrifos Exposure
Authors: Justin E. Aldridge, Armando Meyer, Frederic J. Seidler, Theodore A. Slotkin
Journal: Environmental Health Perspectives (2005)

Exposure to chlorpyrifos (CPF) alters neuronal development of serotonin (5HT) and dopamine systems, and we recently found long-term alterations in behaviors related to 5HT function. To characterize the synaptic mechanisms underlying these effects, we exposed developing rats to CPF regimens below the threshold for systemic toxicity, in three treatment windows: gestational days (GD) 17–20, postnatal days (PN) 1–4, or PN11–14. In early adulthood (PN60), we assessed basal neurotransmitter content and synaptic activity (turnover) in brain regions containing the major 5HT and dopamine projections. CPF exposure on GD17–20 or PN1–4 evoked long-term increases in 5HT turnover across multiple regions; the effects were not secondary to changes in neurotransmitter content, which was unaffected or even decreased. When the treatment window was shifted to PN11–14, there were no long-term effects. Dopamine turnover also showed significant increases after CPF exposure on GD17–20, but only when the dose was raised above the threshold for overt toxicity; however, hippocampal dopamine content was profoundly subnormal after exposures below or above the acute, toxic threshold, suggesting outright neurotoxicity. These results indicate that, in a critical developmental period, apparently nontoxic exposures to CPF produce lasting activation of 5HT systems in association with 5HT-associated behavioral anomalies.
Ischemic preconditioning stimulates sodium and proton transport in isolated rat hearts.
Authors: R Ramasamy, H Liu, S Anderson, J Lundmark, S Schaefer
Journal: Journal of Clinical Investigation (1995)

One or more brief periods of ischemia, termed preconditioning, dramatically limits infarct size and reduces intracellular acidosis during subsequent ischemia, potentially via enhanced sarcolemmal proton efflux mechanisms. To test the hypothesis that preconditioning increases the functional activity of sodium-dependent proton efflux pathways, isolated rat hearts were subjected to 30 min of global ischemia with or without preconditioning. Intracellular sodium (Nai) was assessed using 23Na magnetic resonance spectroscopy, and the activity of the Na-H exchanger and Na-K-2Cl cotransporter was measured by transiently exposing the hearts to an acid load (NH4Cl washout). Creatine kinase release was reduced by greater than 60% in the preconditioned hearts (P < 0.05) and was associated with improved functional recovery on reperfusion. Preconditioning increased Nai by 6.24 +/- 2.04 U, resulting in a significantly higher level of Nai before ischemia than in the control hearts. Nai increased significantly at the onset of ischemia (8.48 +/- 1.21 vs. 2.57 +/- 0.81 U, preconditioned vs. control hearts; P < 0.01). Preconditioning did not reduce Nai accumulation during ischemia, but the decline in Nai during the first 5 min of reperfusion was significantly greater in the preconditioned than in the control hearts (13.48 +/- 1.73 vs. 2.54 +/- 0.41 U; P < 0.001). Exposure of preconditioned hearts to ethylisopropylamiloride or bumetanide in the last reperfusion period limited in the increase in Nai during ischemia and reduced the beneficial effects of preconditioning. After the NH4Cl prepulse, preconditioned hearts acidified significantly more than control hearts and had significantly more rapid recovery of pH (preconditioned, delta pH = 0.35 +/- 0.04 U over 5 min; control, delta pH = 0.15 +/- 0.02 U over 5 min). This rapid pH recovery was not affected by inhibition of the Na-K-2Cl cotransporter but was abolished by inhibition of the Na-H exchanger. These results demonstrate that preconditioning alters the kinetics of Nai accumulation during global ischemia as well as proton transport after NH4Cl washout. These observations are consistent with stimulation of the Na-K-2Cl cotransporter and Na-H exchanger by preconditioning.
UPPER RESPIRATORY INFECTIONS-Reply
Authors: Gordon M. Nunnelly
Journal: JAMA (1960)

To the Editor:—  I thank Dr. Rose for his frank appraisal of my paper. I believe Dr. Rose will agree that the treatment of acute upper respiratory illnesses is extremely divergent and haphazard today. I confess my own consternation at the problem.  I cannot explain whyPseudomonas aeruginosa, Escherichia coli, andKlebsiella pneumoniaewere cultured from these patients. It certainly is not the usual situation. All patients in this study were acutely ill and did respond to therapy as indicated in the paper. No ancillary therapy, other than rest and adequate fluids, was employed. Our methods of culture leave me to believe that these organisms may have been incidental findings in patients suffering from viral infections.  I submit to Dr. Rose's objections on all but one count. He points out that 14 patients in the study responded without benefit of sulfadimethoxine as revealed by resistance on sensitivity studies. Allow me
Increased activity of ionised calcium in gall bladder bile in gall stone disease.
Authors: M Rudnicki, T Jorgensen, J Thode
Journal: Gut (1992)

The actual activity of ionised calcium (Ca2+) in gall bladder bile determined with an ion-selective electrode was significantly higher in patients with gall stone disease (n = 15) than in patients without gall stones (n = 10) (0.43 mmol/kg v 0.31 mmol/kg; p &lt; 0.05). No change in the Ca2+ activity in any of the gall bladder bile samples was observed during equilibration with CO2. During titration with HCl/NaOH, however, the Ca2+ activity fell with increasing pH in a biphasic manner, with the breaking point occurring at a significantly lower median pH in patients with gall stones than in patients without (pH 7.1 v 8.2; p &lt; 0.0001). The combination of a higher activity of calcium in bile and precipitation of bile salts taking place at a lower pH in patients with gall stone disease than in patients without gall stones suggests a major role for calcium and pH in the pathogenesis of gall stones. Strict anaerobic sampling is not necessary for the measurements of Ca2+ in gall bladder bile, because the Ca2+ was not significantly affected by the changes in pCO2. The metabolic studies suggest, however, that simultaneous measurements of the activity of Ca2+ and pH is important in order to interpret data for the calcium activity in gall bladder bile.
Current Surgery of the Heart
Authors: A. J. Crumbley
Journal: JAMA (1987)

In the 30 years since its origin in the early 1950s, open heart surgery has undergone rapid and continuous development. Most congenital defects have become reparable in one stage, early in life. Operative intervention in acquired heart disease is routine for coronary artery disease and valvar lesions, while cardiac pacing has become progresssively more reliable and physiologic. New and exciting developments continue to occur, and these are reviewed by Drs Arthur J. Roberts and C. Richard Conti in<i>Current Surgery of the Heart</i>. The reader will be pleased to find that they have been largely successful in presenting a group of succinct, wellwritten selections with clear illustrations and useful bibliographies. Their manageable lengths are conveniently suited to the short pauses in the schedules of the busy practitioner or harried resident. Unfortunately, chapters on related subjects are distractingly scattered throughout the book without organizational structure. Developments in the technique of coronary
The cytotoxicity of leukocytes and lymphocytes from patients with rheumatoid arthritis for synovial cells.
Authors: D A Person, J T Sharp, M D Lidsky
Journal: Journal of Clinical Investigation (1976)

Unseparated peripheral blood leukocytes obtained from patients with rheumatoid arthritis (RA) were cytotoxic for synovial cells. The cytotoxic reactions produced by RA leukocytes were more frequent and of greater magnitude than cytotoxicity induced by leukocytes from normal persons and patients with other diseases, primarily connective tissue diseases. Furthermore, the cytotoxic activity of RA leukocytes was greater for RA synovial cells than for nonrheumatoid synovial cells, in contrast to the cytotoxicity of other leukocytes, which did not discriminate between synovial cells according to their origin. Tests with purified lymphocytes showed that the cytotoxicity of unseparated leukocytes directed against RA synovial cells was due to lymphocyte cytotoxicity. These data are consistent with the possibility that sensitized lymphocytes from patients with RA recognize a distinctive antigen present on rheumatoid synovial cells.
Comparative Career Earnings
Authors: W. S. Mann
Journal: BMJ (1970)

MEDIBCATOISNALin the Bristol centre" conceals some important facts.Rates marginally better than those described in the document were in- troduced here in September, and proved unacceptable to the deputies.This was mainly because these represented (as far as 90% of the sessions were concerned) only a 5 % increase on previous rates, even though
1053-209 Amiodarone in survivors of life-threatening ventricular arrhythmias: Does it improve outcome? Results of the leiden out of hospital cardiac arrest trial (LOHCAT)
Authors: ppine Kiès, Jeroen J Bax, Alida E Borger van der Burg, Eric Boersma, Marrian tsma, Lieselot van Erven, Ernst E van der Wall, Martin J Schalij
Journal: Journal of the American College of Cardiology (2004)
297 LYING AND STANDING CONTRAST ECHOCARDIOGRAPHY FOR THE DIAGNOSIS OF HEPATOPULMONARY SYNDROME IN PATIENTS UNDERGOING LIVER TRANSPLANTATION
Authors: I. Lenci, R. Steeds, A. Alvior, T.M. Manzia, L. Toti, H. Sandmann, N. Edwards, J. Neuberger
Journal: Journal of Hepatology (2008)
The Struggle between Managed Care and Fee-for-Service Practice
Authors: John K. Iglehart
Journal: New England Journal of Medicine (1994)

In the ongoing struggle in the private marketplace to attract new patients to managed care, health plans continue to score impressive gains over fee-for-service physicians and indemnity insurers. In the political marketplace, however, the American Medical Association (AMA), some medical specialty groups, and like-minded legislators are urging Congress to move cautiously before it embraces managed care as the core mode of delivery in a reformed health care system. The disconnectedness between these two worlds stems from the reluctance of many politicians to limit the freedom of patients to select their own doctors. But it also derives from the gathering panic . . .
956. HSV-1 Amplicon iBAC-FRDA Genomic Locus Delivery for the Treatment of Friedreich's Ataxia
Authors: Richard Wade-Martins, Alfredo Gimenez-Cassina, Javier Diaz-Nido, Filip Lim
Journal: Molecular Therapy (2005)

Friedreich's Ataxia (FA) is the most common recessive ataxia, affecting 1-2 in 50,000 Caucasians. FA is caused by a deficiency in frataxin, a mitochondrial protein encoded by the FRDA gene and involved in iron trafficking-related processes. The main areas affected are the central nervous system (particularly the spinocerebellar system) and cardiac tissue. Although some treatments based upon administration of anti-oxidants have proven to be successful for treating the cardiac condition, therapies aimed at alleviating the neurological degeneration have failed so far.
Anthropometric comparison of cyclists from different events.
Authors: J P Foley, S R Bird, J A White
Journal: British Journal of Sports Medicine (1989)

An anthropometric analysis was conducted upon 36 competitive male cyclists (mean age 23.4 years) who had been competing on average for 8.2 years. Cyclists were allocated to one of four groups; sprint, pursuit, road and time trial according to their competitive strengths. The sample included cyclists who were classified as category 1, 2, 3 or professional (British Cycling Federation and Professional Cycling Association). The sprint cyclists were significantly shorter and more mesomorphic than the other three groups (p less than 0.05). The time trialists were the tallest, most ectomorphic group, having the longest legs (p less than 0.01), the highest leg length/height ratio (p less than 0.05) and the greatest bitrochanteric width (p less than 0.05). The pursuit and road cyclists were found to have similar physiques, which were located between those of the sprinters and time trialists. The biomechanical implications of these differences in physique may be related to the high rate of pedal revolutions required by sprinters and the higher gear ratios used by time trialists.
UPDATE OF CARDIAC I-123 METAIODOBENZYLGUANIDINE IMPROVES THE PREDICTION OF POOR OUTCOME IN PATIENTS WITH CHRONIC HEART FAILURE, IRRESPECTIVE OF CHRONIC KIDNEY DISEASE
Authors: Tadao Fujimoto, Takahisa Yamada, Yuji Okuyama, Takashi Morita, Yoshio Furukawa, Koji Tanaka, Yusuke Iwasaki, Hiromichi Ueda, Masato Kawasaki, Takeshi Okada, Yuki Kuramoto, Takashi Naito, Masatake Fukunami
Journal: Journal of the American College of Cardiology (2011)
The ALLHAT Lipid Lowering Trial—Less Is Less
Authors: Richard C. Pasternak
Journal: JAMA (2002)

The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Lipid Lowering Trial (ALLHAT-LLT),1 published in this issue of THE JOURNAL, is the second-largest lipid-lowering trial yet reported. This randomized trial, a subset of the larger ALLHAT hypertension study,2 followed up 10 355 patients (49% women) who had hypertension and were 55 years or older for a mean of 4.8 years. Patients were randomly assigned to receive 40 mg of pravastatin (open label) vs usual care in 513 clinical centers, the majority of which were community-based. These centers were a subset of the 623 centers that treated patients for the larger (N = 33 357) ALLHAT hypertension study.2 Despite a 28% reduction in low-density lipoprotein cholesterol (LDL-C) from baseline in the pravastatin treatment group, the trial failed to show a benefit in either the primary outcome (all-cause mortality) or the key secondary outcome (combined nonfatal myocardial infarction and . . .
Integrated care pathways
Authors: H. Campbell, R. Hotchkiss, N. Bradshaw, M. Porteous
Journal: BMJ (1998)

Integrated care pathways are structured multidisciplinary care plans which detail essential steps in the care of patients with a specific clinical problem. They have been proposed as a way of encouraging the translation of national guidelines into local protocols and their subsequent application to clinical practice. They are also a means of improving systematic collection and abstraction of clinical data for audit and of promoting change in practice. The degree to which they succeed in realising this potential for improving patient care is still uncertain, but enough evidence exists in their favour to justify more widespread evaluation of their impact. Here we describe integrated care pathways, show how to create and use them, and review the evidence of their effectiveness.

Many initiatives have been introduced in the past two decades to improve clinical effectiveness and thereby patient care. Foremost among these have been clinical guidelines and clinical audit. Concern is regularly expressed, however, that the commitment and enthusiasm of the groups publishing their experience is a major determinant of their success. There are also related concerns about the opportunity costs of audit and guidelines projects.

Guidelines development—literature review, critical appraisal, multidisciplinary consultation, and grading of recommendations by level of evidence—is labour intensive. Support is now available from several sources,1 2 but less attention and support is given to translating established guidelines into local management protocols and their subsequent implementation.3 even though the impact of clinical guidelines in improving clinical practice will largely be determined by progress in these areas. Audit projects often fail to realise their potential because the improved practice identified by the audit is not implemented or, if implemented, its effect is not evaluated.

Integrated care pathways—also known as coordinated care pathways, care maps, or anticipated recovery pathways—are task orientated care plans which detail essential steps …
Giant villous duodenal adenoma with malignant change: an unusual cause of obstructive jaundice
Authors: Lisa Setaffy, Franz Siebert, Jörg Tschmelitsch, Heinz Lackner, Cord Langner
Journal: Endoscopy (2013)

Obstructive jaundice can have various causes, and both neoplastic and non-neoplastic lesions have to be considered. In cases of malignant disease, the tumors are usually located in the extrahepatic bile ducts, the pancreatic head, or the ampulla of Vater [1]. In rare cases, the causative lesion originates from the duodenum [2] [3].
Epidermal growth factor (EGF) in the gastroprotective and ulcer healing actions of colloidal bismuth subcitrate (De-Nol) in rats.
Authors: S J Konturek, A Dembinski, Z Warzecha, W Bielanski, T Brzozowski, D Drozdowicz
Journal: Gut (1988)

One hundred and twenty seven patients were treated by nasobiliary drainage, or stenting, to prevent biliary obstruction after endoscopic failure to clear stones from the common bile duct. At presentation, 91 (72%) patients were jaundiced and 39 (31%) had cholangitis. Placement of either a nasobiliary drain or stent was successful in 124 (98%) patients. One hundred and twenty one (95%) patients were followed up. Clearance was ultimately achieved endoscopically in 52 and surgically in 25 patients after (mean) 2.4 months. Thirty day mortality was 3%. There were no complications of nasobiliary drainage, but two of 39 patients treated by temporary stents developed cholangitis, both successfully managed by endoscopic duct clearance. Forty two patients unfit for surgery or further endoscopic attempts at duct clearance were followed with stents in situ for a mean 15.9 months (range 2.5-37.5). Cholangitis developed in four patients and was successfully managed by stent change. These results indicate that longterm stenting can be useful for poor risk surgical patients and that nasobiliary drainage or temporary stenting permits further elective rather than urgent endoscopic or surgical treatment.
Sartorial eloquence: does it exist in the paediatrician-patient relationship?
Authors: T G Barrett, I W Booth
Journal: BMJ (1994)

<h3>Abstract</h3> <b>Objective</b>: To evaluate children9s and parents9 perceptions of hospital doctors9 attire. <b>Design</b>: Questionnaire study asking children and parents to assign positive and negative attributes to five photographs of a male or female doctor dressed formally and informally. <b>Setting</b>: Outpatient department, Children9s Hospital, Birmingham. Subjects—203 consecutive child-parent pairs attending outpatient clinics over three months. <b>Main outcome measures</b>: Children9s and parents9 preferences, assessed by comparing proportions. <b>Results</b>: 70% (286/406) of children and parents rated doctors9 dress as important; more children rated it "very important" (27% (54/203) v 14% (29/203), P&lt;0.01, 95% confidence interval for difference 5% to 21%). Of the 99 children responding, 44 regarded the man in white coat as most competent (44% v 20% expected by chance, P&lt;0.01, 34% to 54%) and most concerned (32% v 20%, P&lt;0.01, 23% to 41%). Children also regarded the woman in white coat as most competent; however, male and female doctors in white coats rated lower for friendliness. Asians and regular surgical attenders preferred doctors in white coats. The man in polo shirt and trousers was rated as most friendly (40% v 20% expected by chance, P&lt;0.01, 30% to 50%) and most gentle (37% v 20%, P&lt;0.01, 27% to 46%). The woman in tee shirt and slacks also rated most friendly and gentle; however, both casually dressed doctors rated lower for competence. Parents preferred more casual dress but expressed preferences less strongly, and they poorly predicted which outfits their children preferred. <b>Conclusions</b>: Children regard formally dressed doctors as competent but not friendly; they regard casual dress as friendly but not competent.