tbuckley/cabot-search huggingface dataset:
Use of Bone Densitometry Results for Decisions about Therapy for Osteoporosis
Authors: Bruce Ettinger
Journal: Annals of Internal Medicine (1996)

Letters1 October 1996Use of Bone Densitometry Results for Decisions about Therapy for OsteoporosisBruce Ettinger, MD, Paul Miller, MD, and Michael R. McClung, MDBruce Ettinger, MDKaiser Permanente Medical Care Program, Oakland, CA 94611Colorado Center for Bone Research, Lakewood, CO 80227Oregon Osteoporosis Research Center, Portland, OR 97213Search for more papers by this author, Paul Miller, MDKaiser Permanente Medical Care Program, Oakland, CA 94611Colorado Center for Bone Research, Lakewood, CO 80227Oregon Osteoporosis Research Center, Portland, OR 97213Search for more papers by this author, and Michael R. McClung, MDKaiser Permanente Medical Care Program, Oakland, CA 94611Colorado Center for Bone Research, Lakewood, CO 80227Oregon Osteoporosis Research Center, Portland, OR 97213Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-7-199610010-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:With the availability of new pharmacologic agents, the drug industry is currently pressuring the scientific and medical communities to increase drug therapy for osteoporosis. One element of this commercial campaign is to simplify the treatment decision by use of a bone mineral density (BMD) cutoff—a value 2.5 SDs below the BMD of a 30-year-old, normal person ( −2.5 t-score).This plan is ill advised. The −2.5 t-score was developed by the World Health Organization as a diagnostic threshold for population studies to provide a benchmark for estimating the prevalence of osteoporosis in various countries. It was not ... Author, Article, and Disclosure InformationAuthors: Bruce Ettinger, MD; Paul Miller, MD; Michael R. McClung, MDAffiliations: Kaiser Permanente Medical Care Program, Oakland, CA 94611Colorado Center for Bone Research, Lakewood, CO 80227Oregon Osteoporosis Research Center, Portland, OR 97213 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMotivos de consulta en rehabilitación en pacientes con factores de riesgo clínico de osteoporosisA National Random Survey of Bone Mineral Density Reporting in the United StatesThe female athlete triadTHE FEMALE ATHLETE TRIADThe Challenges of Peripheral Bone Density Testing5 How do you know who needs prevention or treatment? 1 October 1996Volume 125, Issue 7Page: 623KeywordsBoneBone densityBone mineral densityDensitometryDrug therapyDrugsGlobal healthOsteoporosis ePublished: 15 August 2000 Issue Published: 1 October 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
1159-195 Spironolactone improves coronary endothelial function in patients with chronic heart failure
Authors: Keishi Saihara, Shuichi Hamasaki, Takashi Yoshitama, Sanemasa Ishida, Akiko Yoshikawa, Tetsuro Kataoka, Koji Orihara, Naoya Oketani, Tsuyoshi Fukudome, Masakazu Ogawa, Hideki Okui, Takuro Shinsato, Shinichi Minagoe, Chuwa Tei
Journal: Journal of the American College of Cardiology (2004)
The Individual vs Society
Authors: David M. Eddy
Journal: JAMA (1991)

Your Hospital Cafeteria: 7:40 AM <h3>Dr Williams:</h3> I need to fill you in on Mrs Smith. <h3>Dr Hart:</h3> Oh, yes, I remember her. Breast cancer, about 2 years ago. I saw her family in the hall yesterday. How is she? <h3>W:</h3> Unfortunately, she's gotten worse. She now has metastases to the liver and bone. <h3>H:</h3> Oh, dear, she's such a lovely woman. What's next? <h3>W:</h3> Well, I want to try high-dose chemotherapy with autologous bone marrow transplantation. I've told her about the 10% treatment mortality, about the high complication rates and side effects, and that there are no controlled trials showing benefit, but it's her only hope. <h3>H:</h3> Will her insurance company cover it? <h3>W:</h3> We're lucky there. Her employer is self-insured. They've agreed to cover the costs from an employee-funded health promotion fund. Apparently they don't want the bad publicity some of the other insurers have gotten when they've
Unraveling the Mystery of Erythropoietin-Stimulating Agents in Cancer Promotion
Authors: Kelly A. May, Fadlo R. Khuri
Journal: Cancer Research (2008)

Abstract Erythropoietin-stimulating agents (ESA) are approved for use in treating chemotherapy-induced anemia in patients with nonmyeloid malignancies. However, recent clinical trials have shown evidence of inferior overall survival and/or locoregional control of tumors in patients receiving ESAs. Given these concerning data, current studies are focused on elucidating the biological mechanisms by which ESAs may contribute to cancer promotion. Evidence suggests that ESAs activate several signaling pathways that are important in altering tumor behavior and response to treatment. Although further research is needed to more precisely elucidate these mechanisms, caution should be exercised in the use of ESAs beyond their approved indication in cancer patients. [Cancer Res 2008;68(11):4013–7]
Effects of Exenatide (Exendin-4) on Glycemic Control Over 30 Weeks in Sulfonylurea-Treated Patients With Type 2 Diabetes
Authors: John B. Buse, Robert R. Henry, Jenny Han, Dennis D. Kim, Mark S. Fineman, Alain D. Baron
Journal: Diabetes Care (2004)

OBJECTIVE—This study evaluated the ability of the incretin mimetic exenatide (exendin-4) to improve glycemic control in patients with type 2 diabetes failing maximally effective doses of a sulfonylurea as monotherapy. RESEARCH DESIGN AND METHODS—This was a triple-blind, placebo-controlled, 30-week study conducted at 101 sites in the U.S. After a 4-week, single-blind, placebo lead-in period, 377 subjects were randomized (60% men, age 55 ± 11 years, BMI 33 ± 6 kg/m2, HbA1c 8.6 ± 1.2% [±SD]) and began 4 weeks at 5 μg subcutaneous exenatide twice daily (before breakfast and dinner; arms A and B) or placebo. Subsequently, subjects in arm B were escalated to 10 μg b.i.d. exenatide. All subjects continued sulfonylurea therapy. RESULTS—At week 30, HbA1c changes from baseline were −0.86 ± 0.11, −0.46 ± 0.12, and 0.12 ± 0.09% (±SE) in the 10-μg, 5-μg, and placebo arms, respectively (adjusted P &amp;lt; 0.001). Of evaluable subjects with baseline HbA1c &amp;gt; 7% (n = 237), 41% (10 μg), 33% (5 μg), and 9% (placebo) achieved HbA1c ≤ 7% (P &amp;lt; 0.001). Fasting plasma glucose concentrations decreased in the 10-μg arm compared with placebo (P &amp;lt; 0.05). Subjects in the exenatide arms had dose-dependent progressive weight loss, with an end-of-study loss in the 10-μg exenatide arm of −1.6 ± 0.3 kg from baseline (P &amp;lt; 0.05 vs. placebo). The most frequent adverse events were generally mild or moderate and gastrointestinal in nature. No severe hypoglycemia was observed. CONCLUSIONS—Exenatide significantly reduced HbA1c in patients with type 2 diabetes failing maximally effective doses of a sulfonylurea. Exenatide was generally well tolerated and was associated with weight loss.
GPs and junkies
Authors: A. Dicker
Journal: BMJ (1998)

The stories which junkies tell about their attempts to get help from primary care present some hazardous options. A few GPs have become expert in managing substance misuse; a few have a go but lack the necessary support; but most NHS GPs refuse to have anything to do with junkies. A small group of doctors see junkies privately for large profits.

The private system works as follows: the doctor takes on the patient with a substance misuse problem and negotiates a prescription. The doctor takes a fee and the junkie pays for the cost of the drugs. The junkies use a proportion of the supply themselves and sell the rest on the street in order to pay the doctor and the pharmacist. The stories of discriminatory and unethical behaviour among doctors are legion.

Within their terms of service GPs can refuse to keep on their lists patients whom they do not wish to treat. This is an …
Breast screening has failed older women
Authors: S. Greengross
Journal: BMJ (1996)

EDITOR,—Gary Rubin, service director of the East Sussex Breast Screening Service, said that invitations to breast screening should not be extended to women aged 65 or over until more information is available on the success rate of the current screening programme and that a lack of staff would limit an immediate expansion.1

Age Concern England's view is that the fundamental issue of the equity …
The Environmental Polymorphism Registry: A Unique Resource that Facilitates Translational Research of Environmental Disease
Authors: Patricia C. Chulada, Enrikas Vainorius, Stavros Garantziotis, Lauranell H. Burch, Perry J. Blackshear, Darryl C. Zeldin
Journal: Environmental Health Perspectives (2011)

Background: Dissecting complex disease has become more feasible because of the availability of large-scale DNA resources and advances in high-throughput genomic technology. Although these tools help scientists identify potential susceptibility loci, subjects with relevant genotypes are needed for clinical phenotyping and toxicity studies.Objective: We have developed a resource of subjects and their DNA to use for translational research of environmental disease.Methods: More than 15,000 individuals of diverse sex, age, race, and ethnicity were recruited from North Carolina. DNA was isolated from their blood and coded with personal identification numbers linked to their identities. This linked resource of subjects and their DNA—the Environmental Polymorphism Registry (EPR)—allows scientists to screen for individuals with genotypes of interest and invite them to participate in follow-up studies.Discussion: The EPR is a phenotype-by-genotype resource designed to facilitate translational studies of environmental disease. Based on their genotypes, subjects are invited to participate at all levels of research, from basic laboratory ex vivo cell phenotyping experiments that require viable tissue to in vivo observational studies and clinical trials. Here we report on progress of the EPR since 2008. We also describe a major effort at the National Institute of Environmental Health Sciences (NIEHS) to investigate susceptibility loci in 87 environmental response genes and gene × environment interactions using EPR resources.Conclusion: The EPR is a unique and novel resource and is ideal for genotype-driven translational research of environmental disease. We expect that it will serve as a model for future resources. Such tools help scientists attain their ultimate goals: to identify at-risk populations and develop strategies for preventing and treating human disease.
To Best Was Always to Worst, but Worse Is Better, if Good and Bad Are Relevant
Authors: Donald Banzhaf
Journal: JAMA (1989)

<h3>To the Editor.—</h3> In the March 24/31 issue of<i>JAMA</i>, there is an article entitled "Cryotherapy in Infants With Retinopathy of Prematurity" and subtitled "A Decision Model for Treating<i>One or Both Eyes</i>[italics added]."1 I gather that the only newborns studied were those who had two eyes, the normal situation. The article goes on to explain that "this study includes four possible choices: treat no eyes, treat the<i>worst</i>eye [italics added], treat the best eye [italics added], or treat both eyes." The decision tree on page 1752 includes the following treatment possibilities: "Treat Worst Eye" and "Treat Best Eye." I believe that a newborn with two eyes can have a<i>worse</i>eye (as opposed to a<i>worst</i>eye), and a<i>better</i>eye (as opposed to a best eye). One would need three or more eyes to have a "worst eye" or a "best eye."
Sign of Leser-Trélat-Reply
Authors: Donald C. Doll
Journal: JAMA (1978)

As Dr Brown points out, the sign of Leser-Trélat is not well fixed in the medical literature; thus, definition of the syndrome is difficult. However, for practical purposes we suggest that the sign of Leser-Trélat refers to the sudden appearance and rapid increase in size and number of seborrheic keratoses associated with internal malignant disease. There may or may not be regression of the keratoses with disappearance of the tumor. The rapid appearance of seborrheic keratoses clinically developed both on erythematous and on normal skin of our patient, who was subsequently found to have a squamous cell carcinoma of the lung. There was regression and/or disappearance of the keratoses with removal of the tumor. We believe he fulfills the criteria for the sign of Leser-Trélat. We question the term "acanthoma," which we think is a nonspecific term when used alone.
Comparison of patients' and providers' severity evaluation of oral mucosal conditions
Authors: Francesca Sampogna, Björn Söderfeldt, Björn Axtelius, Fabio Bergamo, Paolo Gisondi, Cristina Di Pietro, Livia Alessandroni, Calogero Pagliarello, Grazia Zino, Paola Pallotta, Stefano Tabolli, Damiano Abeni
Journal: Journal of the American Academy of Dermatology (2011)
Restoration of Function in Industrial Low Back Injury
Authors: Thomas J. Ruane
Journal: JAMA (1988)

<h3>To the Editor.</h3> —The article by Mayer et al<sup>1</sup>presents the impressive results of their program in returning to work 87% of the patients with chronic low back pain whom they treated. A recent review<sup>2</sup>of the literature in this field estimated from other studies that overall no more than 15% of such patients ever return to work. I wish to make two comments on this study. The first is on the classification of groups used and the second is on the implications of this research for our understanding of the nature of disabling low back pain. Current research seems to require contemporaneous comparison groups, though the outcome data in this study are so extraordinary that this does not seem necessary. For "controls"—the researchers appropriately avoided this term—they used a comparison group whose medical insurance did not entitle them to the rehabilitation program studied. A second comparison group
Abstract 4837: Integrated genome sequence, epigenome, and transcriptome map of bladder cancer development
Authors: Bogdan Czerniak, Taddeusz Majewski, Woonbok Chung, Hu Limei, David Cogdell, Jolanta Bondaruk, Shizhen Zhang, Sangkyou Lee, Sooyong Lee, Li Shen, Caimiao Wei, Suk Young Yoo, Woonyoung Choi, David McConkey, John Weinstein, Keith Baggerly, Jean-Pierre Issa, Wei Zhang, Steve E. Scherer
Journal: Cancer Research (2011)

Abstract Genomic maps that track the development of human cancer from its in situ precursor conditions to invasive disease can facilitate the search for genes and genomic sequences involved in the development of cancer. The identification of those chromosomal regions and their positional target genes as well as non-coding sequences that provide growth advantage for the incipient preneoplastic conditions can provide novel insights on molecular mechanisms of cancer development. Such an approach is also critical for the identification of novel biomarkers as well as targets for preventive and therapeutic strategies. We report on the construction of a high resolution whole-organ histologic and genetic map of bladder cancer development that tracks its progression from in situ precursor conditions to invasive clinically aggressive cancer using exome deep sequencing and 1M SNP-based Illumina genotyping combined with CpG island methylation and cDNA microarray technology platforms. This approach provided a high resolution integrated pattern of structural genome, epigenome, and transcriptome alterations that parallel the development of bladder cancer from early field effects to invasive disease. By analyzing genome-wide patterns of structural genomic (copy loss or gain), epigenomic, and transcriptome changes, we found three major waves of alterations associated with growth advantage of successive clones reflecting a stepwise conversion of normal urothelial cells into cancer cells. In particular, this approach is significant for the identification of specific chromosomal regions as well as epigenetically and transcriptionally modified gene ontologies involved in early clonal expansion of intraurothelial neoplasia and their clonal evolution to carcinoma in situ progressing to invasive cancer. These studies suggest involvement of ras/raf gene network in early clonal expansion of intraurothelial neoplasia. This map represents a prerequisite for specific studies on the mechanisms of incipient phases of bladder cancer development and should have a significant impact on the understanding of human carcinogenesis. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4837. doi:10.1158/1538-7445.AM2011-4837
Antibiotic resistance among enterococci causing endocarditis in the UK: analysis of isolates referred to a reference laboratory
Authors: A. P Johnson, M. Warner, N. Woodford, D. C E Speller, D. M Livermore
Journal: BMJ (1998)

Enterococci account for 5-15% of cases of bacterial endocarditis.1 They are the most resistant bacteria commonly encountered in this type of infection, which is still associated with a mortality of 20-30%.2 The treatment regimen for enterococcal endocarditis recommended by the British Society for Antimicrobial Chemotherapy and the American Heart Association is a synergistic bactericidal combination of a penicillin or glycopeptide with an aminoglycoside, usually gentamicin or streptomycin. 3 4 However, enterococci can acquire high level resistance to aminoglycosides, which abolishes this synergy.1 Enterococci can also exhibit high level resistance to penicillin or to glycopeptides.1 Our laboratory undertakes testing of bacteria from cases of endocarditis as a routine service; we analysed resistance among isolates from 120 cases of enterococcal endocarditis, received over 27 months.

Results of tests for antibiotic susceptibility were analysed for enterococci referred from patients with a clinical diagnosis of endocarditis between January 1995 and March 1998. Isolates exhibiting high …
Mid-gut bleeding due to a chronic splanchnic vascular stricture with secondary portal hypertension after gastric bypass
Authors: Carmen Musala, Jean Closset, Patrizia Loi, Emmanuel Coppens, Jacques Devière, Arnaud Lemmers
Journal: Endoscopy (2015)

A 41-year-old man presented with a 24-hour history of melena and exacerbated epigastric pain 6 years after undergoing a laparoscopic Roux-en-Y gastric bypass for morbid obesity. He had been experiencing recurrent abdominal pain and episodes of melena in the preceding months. His past medical history also included protein C deficiency and a pulmonary embolism treated with anticoagulant therapy, which had been stopped 6 months earlier following bleeding from an anastomotic ulcer.
An hydraulically actuated isolated ventricle
Authors: R. A. LLOYD, E. M. WILSON
Journal: Cardiovascular Research (1974)

An apparatus is described that hydraulically actuates an excised dog ventricle. Cam-operated pumps programme flow through the heart valves to approximate in-vivo blood flow. The intact valves and the tortuous ventricular surface provide the authentic mixing influences that are important for indicator dilution studies. The apparatus is also a useful tool for studying heart valve action.
Different frequencies of angiotensin-converting enzyme genotypes in older hypertensive individuals.
Authors: B J Morris, R Y Zee, A P Schrader
Journal: Journal of Clinical Investigation (1994)

The frequency of the D allele of an insertion/deletion (I/D) polymorphism of the angiotensin I-converting enzyme (ACE) gene has been reported to be elevated in myocardial infarction and other patients. We therefore hypothesized that death rate of DD individuals should be increased in the population as a whole and this should be evident as a decrease in DD frequency with age. This hypothesis was tested in 118 Caucasian subjects who were already at high risk of cardiovascular events by having severe, early onset, familial hypertension (HT). A group of 196 age-, sex- and body mass index-matched normotensives (NTs) was used as a control. In the NT group II, ID, and DD genotype frequencies were similar for different age groups. DD frequency was 0.42 in NTs, but in HTs was 0.28, 0.26, and 0.10 for the age groups < 50, 50-59, and > or = 60 yr, respectively. Corresponding D allele frequencies were 0.52, 0.46, and 0.40 in the respective age groups of HTs, compared with 0.61 in NTs (by chi 2-analysis, P = 0.1, 0.047, and 0.0006, respectively). In HTs aged > or = 60, DD frequency was only 14% of expected. Plasma ACE activity tracked similarly with I/D genotype in HTs (P = 0.027; n = 35) as in NTs (P = 0.0001; n = 94) and Michaelis constant was identical for DD and II. Neither blood pressure, body mass index, nor sex bore any relationship with I/D genotype. In conclusion, in a group of severely HT patients not selected for cardiac pathology, there appeared to be a marked, selective decrease, in subgroups of increasing age, in frequency of the ACE DD genotype. One possibility suggested by this data might be that DD increases risk of premature death, at least in HTs who have two HT parents.
A Tribute to Dr. Samuel Jackson.
Authors: John M. Batten
Journal: JAMA (1889)

<h3>To the Editor:</h3> —The writer, who in the winter of 1862-3 attended the last course of lectures that Dr. Samuel Jackson delivered at the medical department of the University of Pennsylvania, remembers that distinguished lecturer well, and recalls with what feeling he delivered his farewell address to the medical students of the class in the spring of 1863, when he forever bade farewell as a lecturer and retired from the chair of physiology. The tears ran down over his cheeks while he was speaking, and there were few dry eyes in the building. The decrepitude of age had crept upon him in the many years he had lectured in the university. He had lost the use of his lower extremities, so that he had to be carried to and from the chair from which he lectured. His hair was gray and his face wrinkled, but he was still lucid and
Widening access to medical education for under-represented socioeconomic groups: population based cross sectional analysis of UK data, 2002-6
Authors: J. Mathers, A. Sitch, J. L. Marsh, J. Parry
Journal: BMJ (2011)

To determine whether new programmes developed to widen access to medicine in the United Kingdom have produced more diverse student populations.Population based cross sectional analysis.31 UK universities that offer medical degrees.34,407 UK medical students admitted to university in 2002-6.Age, sex, socioeconomic status, and ethnicity of students admitted to traditional courses and newer courses (graduate entry courses (GEC) and foundation) designed to widen access and increase diversity.The demographics of students admitted to foundation courses were markedly different from traditional, graduate entry, and pre-medical courses. They were less likely to be white and to define their background as higher managerial and professional. Students on the graduate entry programme were older than students on traditional courses (25.5 v 19.2 years) and more likely to be white (odds ratio 3.74, 95% confidence interval 3.27 to 4.28; P<0.001) than those on traditional courses, but there was no difference in the ratio of men. Students on traditional courses at newer schools were significantly older by an average of 2.53 (2.41 to 2.65; P<0.001) years, more likely to be white (1.55, 1.41 to 1.71; P<0.001), and significantly less likely to have higher managerial and professional backgrounds than those at established schools (0.67, 0.61 to 0.73; P<0.001). There were marked differences in demographics across individual established schools offering both graduate entry and traditional courses.The graduate entry programmes do not seem to have led to significant changes to the socioeconomic profile of the UK medical student population. Foundation programmes have increased the proportion of students from under-represented groups but numbers entering these courses are small.