tbuckley/cabot-search huggingface dataset:
Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers.
Authors: A I Adler, E J Boyko, J H Ahroni, D G Smith
Journal: Diabetes Care (1999)

OBJECTIVE: To identify risk factors for lower-extremity amputation (LEA) in individuals with diabetes and to estimate the incidence of LEA. RESEARCH DESIGN AND METHODS: This is a prospective study of 776 U.S. veterans in a general medicine clinic in Seattle, Washington. The outcome was first LEA during follow-up. Potential risk factors evaluated in proportional hazards models included, among others, peripheral vascular disease (PVD), sensory neuropathy, former LEA, foot deformities and ulcers, diabetes duration and treatment, and hyperglycemia. RESULTS: Associated with an increased risk for LEA were PVD defined as transcutaneous oxygen &amp;lt; or = 50 mmHg (relative risk [RR] = 3.0, 95% CI 1.3-7.1), insensitivity to monofilament testing (RR = 2.9, odds ratio = 1.1-7.8), lower-extremity ulcers (RR = 2.5, CI 1.1-5.4), former LEA, and treatment with insulin when controlling for duration of diabetes and other factors in the model. PVD defined as absent or diminished lower-extremity pulses or an ankle arm index &amp;lt; or = 0.8 was also associated with a significantly higher risk of LEA in separate models. Foot ulcers were associated with an increased ipsilateral risk of amputation. The age-adjusted incidence among men only for LEA standardized to the 1991 U.S. male diabetic population was 11.3/1,000 patient-years. CONCLUSIONS: This prospective study shows that peripheral sensory neuropathy, PVD, foot ulcers (particularly if they appear on the same side as the eventual LEA), former amputation, and treatment with insulin are independent risk factors for LEA in patients with diabetes.
Hospital readmission after cardioverter defibrillator implantation: single chamber versus dual chamber devices
Authors: Ahmad Abdul-Karim, Nassir F. Marrouche, Soufian Almahameed, David O. Martin, Niranjan Seshadri, Robert A. Schweikert, Walid Saliba, Bruce Wilkoff, Patrick Tchou, Andrea Natale
Journal: Journal of the American College of Cardiology (2002)
Load sensitivity of relaxation in the foetal and newborn rabbit heart
Authors: J A HOERTER, Y LECARPENTIER
Journal: Cardiovascular Research (1984)

Differences in the mechanism of cardiac relaxation and the influence of changes in the stimulation frequency were studied in foetal and newborn rabbit hearts. In the foetal rabbit heart which lacks a well developed sarcoplasmic reticulum, load sensitivity of relaxation was investigated and compared with that observed in the newborn. Load sensitivity was studied by measuring force and shortening length in twitches with increasing afterloads and also when load clamp steps were rapidly imposed during the twitch. Quantification of the load sensitivity was achieved by the measurement of the time to relaxation "tRi" which was linearly related to the relative developed force. The slope (S) of this linear relation quantifies the load sensitivity: the higher the slope, the more load sensitive is the relaxation. At a frequency of 24 beats X min-1, S was respectively 0.24 in the foetal heart and 0.36 in the newborn heart showing at both ages the existence of a load sensitivity and its significant increase at birth. No further increase in load sensitivity was observed from 1 day to 21 days after birth. Reducing the stimulation frequency from 24 to 10 beats X min-1 abolished the load sensitivity in foetal hearts (S = 0.05) while, in the newborn, a significant load sensitivity could still be observed (S = 0.25). Thus, in rabbit myocardium, the load sensitivity of cardiac relaxation depended upon the age and the stimulation frequency showing a perinatal development of the structures involved in the control of myocardial relaxation.
Clotted false lumen: reappraisal of indications for medical management of acute aortic dissection.
Authors: C J Sanderson, S Rich, P A Beere, C E Anagnostopoulos, J M Levett, J M Lawrence
Journal: Thorax (1981)

Evidence of a clotted false lumen in patients with acute aortic dissection has been considered to be a primary indication for medical rather than surgical therapy. A review of recent publications shows that 14 of 15 such patients survived with medical management. We present three patients who had radiographic, surgical, or necropsy evidence of acute aortic dissection with a clotted false lumen, who suffered further dissection in spite of adequate medical therapy. Our experience indicates that this condition is not as stable as it has been considered in the past. Consequently, we believe that great caution should be exercised in the application of medical therapy and in the follow-up of patients who demonstrate evidence of a clotted false lumen in an acute aortic dissection. Surgical treatment is indicated at the earliest sign of clinical or radiographic deterioration during medical therapy.
Hepatitis c virus-specific t-cell-derived transforming growth factor beta is associated with slow hepatic fibrogenesis
Authors: Shaoyong Li, Lianne E.M. Vriend, Imad A. Nasser, Yury Popov, Nezam H. Afdhal, Margaret J. Koziel, Detlef Schuppan, Mark A. Exley, Nadia Alatrakchi
Journal: Hepatology (2012)

Hepatitis C virus (HCV)-specific immune effector responses can cause liver damage in chronic infection. Hepatic stellate cells (HSC) are the main effectors of liver fibrosis. TGFβ, produced by HCV-specific CD8+ T cells, is a key regulatory cytokine modulating HCV-specific effector T cells. Here we studied TGFβ as well as other factors produced by HCV-specific intrahepatic lymphocytes (IHL) and peripheral blood cells in hepatic inflammation and fibrogenesis. This was a cross-sectional study of two well-defined groups of HCV-infected subjects with slow (≤0.1 Metavir units/year, n = 13) or rapid (n = 6) liver fibrosis progression. HCV-specific T-cell responses were studied using interferon-gamma (IFNγ)-ELISpot ±monoclonal antibodies (mAbs) blocking regulatory cytokines, along with multiplex, enzyme-linked immunosorbent assay (ELISA) and multiparameter fluorescence-activated cell sorting (FACS). The effects of IHL stimulated with HCV-core peptides on HSC expression of profibrotic and fibrolytic genes were determined. Blocking regulatory cytokines significantly raised detection of HCV-specific effector (IFNγ) responses only in slow fibrosis progressors, both in the periphery (P = 0.003) and liver (P = 0.01). Regulatory cytokine blockade revealed HCV-specific IFNγ responses strongly correlated with HCV-specific TGFβ, measured before blockade (R = 0.84, P = 0.0003), with only a trend to correlation with HCV-specific IL-10. HCV-specific TGFβ was produced by CD8 and CD4 T cells. HCV-specific TGFβ, not interleukin (IL)-10, inversely correlated with liver inflammation (R = −0.63, P = 0.008) and, unexpectedly, fibrosis (R = −0.46, P = 0.05). In addition, supernatants from HCV-stimulated IHL of slow progressors specifically increased fibrolytic gene expression in HSC and treatment with anti-TGFβ mAb abrogated such expression. Conclusion: Although TGFβ is considered a major profibrogenic cytokine, local production of TGFβ by HCV-specific T cells appeared to have a protective role in HCV-infected liver, together with other T-cell-derived factors, ameliorating HCV liver disease progression. (HEPATOLOGY 2012;56:2094–2105)
Coenzyme A Reductase Inhibitors and Stroke
Authors: John R. Crouse III
Journal: Annals of Internal Medicine (1998)

Letters15 July 1998Coenzyme A Reductase Inhibitors and StrokeJohn R. Crouse III, MDJohn R. Crouse III, MDWake Forest University School of Medicine; Winston Salem, NC 27157-1047Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-2-199807150-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The article by Bucher and coworkers [1] confirms previous contributions that have identified an effect of statins to reduce stroke [2, 3]. However, it also raises several questions.First, the article reviewed only 8 of 15 published trials of statins that provide information on stroke [2, 3]. The criteria that led to the exclusion of these other available clinical trials would be of interest. This is important because 7 of the 8 statin trials reviewed by Bucher and coworkers are studies of the secondary prevention of cardiovascular disease. Our own work [2] and that of others [3] ...References1. Bucher HC, Griffith LE, Guyatt GH. Effect of HMGcoA reductase inhibitors on stroke. A meta-analysis of randomized, controlled trials. Ann Intern Med. 1998; 128:89-95. Google Scholar2. Crouse JR III, Byington RP, Hoen HM, Furberg CD. Reductase inhibitor monotherapy and stroke prevention. Arch Intern Med. 1997; 157:1305-10. Google Scholar3. Hebert PR, Gaziano JM, Chan KS, Hennekens CH. Cholesterol lowering with statin drugs, risk of stroke, and total mortality. JAMA. 1997; 278:313-21. Google Scholar4. Atkins D, Psaty BM, Koepsell TD, Longstreth WT, Larson EB. Cholesterol reduction and the risk for stroke in men. Ann Intern Med. 1993; 119:136-45. Google Scholar5. Hebert PR, Gaziano JM, Hennekens CH. An overview of trials of cholesterol lowering and risk of stroke. Arch Intern Med. 1995; 155:50-5. Google Scholar Author, Article, and Disclosure InformationAffiliations: Wake Forest University School of Medicine; Winston Salem, NC 27157-1047 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 July 1998Volume 129, Issue 2Page: 161KeywordsCardiovascular diseasesCholesterolClinical trialsCoenzymesCoronary heart diseaseStable coronary artery diseaseStatinsStroke Issue Published: 15 July 1998 CopyrightCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Children are three times as likely to try e-cigarettes as tobacco products, study finds
Authors: J. Wise
Journal: BMJ (2014)

A study funded by the Welsh government has found that 6% of children aged 10-11 have tried electronic cigarettes, three times as many as have tried smoking tobacco.1 The researchers from Cardiff University said that e-cigarettes seem to be an increasingly popular way for children to experiment with nicotine and could be a gateway into smoking, with the proportion of children saying they might take up smoking being higher in children who had tried e-cigarettes.

E-cigarette use is more common among children …
Effects of hypoglycemia and prolonged fasting on insulin and glucagon gene expression. Studies with in situ hybridization.
Authors: L Chen, I Komiya, L Inman, J O'Neil, M Appel, T Alam, R H Unger
Journal: Journal of Clinical Investigation (1989)

In situ hybridization of proinsulin and proglucagon mRNA was performed in rat pancreas to assess prohormone gene expression during various glucopenic conditions. During a 4-d fast mean blood glucose declined by 48 mg/dl; proinsulin mRNA signal density remained normal while proglucagon mRNA signal density more than doubled. At the end of a continuous 12-d insulin infusion blood glucose averaged 53 +/- 12 mg/dl; proinsulin mRNA signal density declined to 30% of controls while proglucagon mRNA signal density more than doubled. In insulinoma-bearing NEDH rats blood glucose averaged 34 +/- 3.5 mg/dl; the proinsulin mRNA signal was virtually undetectable and proglucagon mRNA signal density was more than twice the controls. There was no detectable change in either beta-cell area or islet number in rats subjected to fasting or insulin infusion, but in insulinoma-bearing rats beta cell area was markedly reduced. Thus compensation during 4 d of starvation involves an increase in glucagon gene expression without change in insulin gene expression or beta cell mass. In moderate insulin-induced hypoglycemia glucagon gene expression is increased and insulin gene expression decreased. In more profound insulinoma-induced hypoglycemia, in addition to the foregoing changes in hormone gene expression, there is a profound reduction in the number of insulin-expressing cells.
TRICUSPID REGURGITATION IS AN INDEPENDENT PREDICTOR OF FAILURE OF AV NODE ABLATION
Authors: Arun Kanmanthareddy, Madhu Reddy, Pramod Janga, Sudharani Bommana, Ajay Vallakati, Jayasree Pillarisetti, Raghuveer Dendi, Loren Berenbom, Rhean Linette Pimentel, Martin Emert, Dhanunjaya Lakkireddy
Journal: Journal of the American College of Cardiology (2014)
Two-dimensional echocardiographic assessment of electrocardiographic criteria for right atrial enlargement.
Authors: W C Reeves, W Hallahan, E J Schwiter, T J Ciotola, E Buonocore, W Davidson
Journal: Circulation (1981)

Right atrial (RA) size was determined with two-dimensional echocardiography using the apical four-chamber view in 45 adult patients with various echocardiographic criteria for RA enlargement and in 25 normal controls. RA size varied from 11.4-24.0 cm2 (mean 16.1 cm2) in controls. RA enlargement (greater than or equal to 25 cm2) was found in only two of 11 patients with P pulmonale (predictive value [PV] = 18%) and one of five with prominent positive P-wave forces in lead V1 (PV = 20%). However, RA enlargement ws found in eight of eight patients with a qR pattern in lead V1 in the absence of clinical indications of coronary artery disease (PV = 100%). RA enlargement was also found in 13 of 28 patients with a total QRS amplitude in lead V1 of 6 mm or less and a threefold or greater ratio of total QRS amplitude in lead V2 relative to that in V1(V2/V1 greater than or equal to 3) (PV = 48%). A V2/V1 ratio of 4 or more detected 11 of 13 patients with RA enlargement, with six false-positive diagnoses (sensitivity = 85%, specificity = 60%, PV = 65%). The combination of total QRS amplitude in V1 of 4 mm or less, together with a V2/V1 ratio of 5 or more, detected six of 11 with RA enlargement, with one false-positive diagnosis (sensitivity = 46%, specificity = 93%, PV = 86%). We conclude that ECG criteria for RA enlargement that primarily use increased P-wave amplitude have a limited PV. The qR pattern in lead V1 appears to be extremely accurate in detecting RA enlargement. ECG criteria in leads V1 and V2 using decreased amplitude in leads V1 and a V2/V1 greater than or equal to 3 are of some value in detecting RA enlargement.
Iatrogenic Intraspinal Epidermoid Tumors
Authors: Solomon Batnitzky
Journal: JAMA (1977)

Intraspinal epidermoid tumors may be congenital or acquired in origin. Lumbar punctures performed with needles without stylets or with ill-fitting stylets are responsible for the implantation of epidermal fragments into the spinal canal and the resultant iatrogenic intraspinal epidermoid tumors. Pain in the back or lower extremities is a striking clinical feature in these cases. Myelography should be considered for every patient who has pain in the lower extremities or back and who has had previous lumbar punctures.
Patellar tendinosis as an adaptive process: a new hypothesis: Figure 1
Authors: B Hamilton, C Purdam
Journal: British Journal of Sports Medicine (2004)

Background: Patellar tendinosis (PT), or “jumper’s knee” is a common condition in athletes participating in jumping sports, and is characterised by proximal patellar tendon pain and focal tenderness to palpation. Hypoechoic lesions observed in the proximal patellar tendon associated with the tendinosis are typically described as being a result of degenerative change or “failed healing”. We propose a new model for the development of the hypoechoic lesion observed in PT, in which the aetiology is an adaptive response to differential forces within the tendon. Methods: We assessed the clinical, histopathological, and biomechanical literature surrounding the patellar tendon and integrated this with research into the response of tendons to differential forces. Results and conclusions: We propose that the hypoechoic lesion commonly described in PT is the result of adaptation or partial adaptation of the proximal patellar tendon to a compressive load. We postulate that the biomechanics of the patellar–patellar tendon interface creates this compressive environment. Secondary failure of the surrounding tensile adapted tendon tissue may result in tissue overload and failure, with resultant stimulation of nociceptors. We believe that this “adaptive model” of patellar tendinosis is consistent with the clinical and histological findings.
THE RÔLE OF PEDIATRICS IN PREVENTIVE MEDICINE
Authors: THOMAS S. SOUTHWORTH
Journal: JAMA (1910)

Since my paper deals with no narrow specialty, but one which involves the application to youthful subjects of all the rapidly growing wealth of medical knowledge, I am aware that it will be a difficult matter to present the rôle of pediatrics in preventive medicine without trenching somewhat on the field of other speakers. As a specialty, it can scarcely be said to have been recognized in this country before the creation of a separate department for our distinguished colleague, Dr. Jacobi, at the College of Physicians and Surgeons of New York, in the year 1860. Before that time, and too largely thereafter, it was linked to obstetrics and diseases of women, with which subjects it had only a quasi connection, and in consequence its study was contracted and neglected. Having broken its bonds, however, and emerged from overshadowing obscurity, pediatrics to-day stands for the application of the same scientific
Pill with high potency progestogen protects against cancer
Authors: D. Spurgeon
Journal: BMJ (2002)

Oral contraceptives with a higher progestogen potency lead to a greater reduction of risk of ovarian cancer than those with lower progestogen potency, says a new study in the US Journal of the National Cancer Institute (2002;94:32-6). This was regardless of the oestrogen content in the pills and how long they were used for.

The study, from Duke University Medical Centre in …
Sleep: A Comprehensive Handbook
Authors: Eyad Almasri, Lewis R. Kline
Journal: Annals of Internal Medicine (2007)

Medical Writings: Book Notes20 March 2007Sleep: A Comprehensive HandbookEyad Almasri, MD and Lewis R. Kline, MDEyad Almasri, MDFrom the Center for Sleep Disorders, Western Pennsylvania Hospital, Temple University School of Medicine, Pittsburgh, Pennsylvania.Search for more papers by this author and Lewis R. Kline, MDFrom the Center for Sleep Disorders, Western Pennsylvania Hospital, Temple University School of Medicine, Pittsburgh, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-6-200703200-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Lee-Chiong T. 1096 pages. Hoboken, NJ: J Wiley; 2006. $175. ISBN 047168371X. Order at www.wiley.com.Field of medicine: Primary care physicians and various medical subspecialists.Format: Hardcover book.Audience: Primary care physicians who diagnose and treat sleep-related disorders. Pulmonologists, psychiatrists, neurologists, and sleep medicine physicians will also appreciate the book.Purpose: To “cover the entire field of sleep medicine.”Content: The textbook successfully presents the whole spectrum of sleep medicine, starting with a brief introduction to the science, physiology, and function of sleep. Important topics, such as insomnia, excessive sleepiness, circadian disorders, parasomnias, and psychiatric disorders, are all succinctly described ... Author, Article, and Disclosure InformationAffiliations: From the Center for Sleep Disorders, Western Pennsylvania Hospital, Temple University School of Medicine, Pittsburgh, Pennsylvania. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 20 March 2007Volume 146, Issue 6Page: 472KeywordsCardiovascular diseasesHospital medicineMedical conditionsPregnancyPrimary care physiciansSleepSleep apneaSleep disordersSoftware toolsSub-specialty care ePublished: 20 March 2007 Issue Published: 20 March 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Genetic basis for a lower prevalence of deficient CYP2D6 oxidative drug metabolism phenotypes in black Americans.
Authors: W E Evans, M V Relling, A Rahman, H L McLeod, E P Scott, J S Lin
Journal: Journal of Clinical Investigation (1993)

Debrisoquin hydroxylase (CYP2D6) is a cytochrome P450 enzyme that catalyzes the metabolism of > 30 commonly prescribed medications. Deficiency in CYP2D6 activity, inherited as an autosomal recessive trait, was found to be significantly less common in American blacks (1.9%) than whites (7.7%). To determine the genetic basis for this difference, inactivating CYP2D6 mutations were assessed by allele-specific PCR amplification and RFLP analyses of genomic DNA from 126 unrelated whites and 127 unrelated blacks. Blacks had a twofold lower frequency (8.5 versus 23%, P = 0.001) of the CYP2D6(B) mutation (point mutation at intron 3/exon 4 splice site), while complete deletion of the CYP2D6 gene (5.5% blacks, 2.4% whites), and the CYP2D6(A) mutation (single nucleotide deletion in exon 5; 0.24% blacks, 1.4% whites) were not different between the two groups. The prevalence of heterozygous genotypes was significantly lower in blacks (25 versus 42% of extensive metabolizers, P = 0.009), consistent with the observed prevalence of the deficient trait in blacks and whites. We conclude that the same CYP2D6 mutations lead to a loss of functional expression in blacks and whites, but American blacks have a lower prevalence of the deficient trait due to a lower frequency of the CYP2D6(B) mutation. This could explain racial differences in drug effects and disease risk.
Renal Failure in Acute Pancreatitis
Authors: D. Gordon, R. Y. Calne
Journal: BMJ (1972)

In three patients with acute pancreatitis complicated by renal failure recovery followed dialysis and treatment of associated complications. The records of cases of pancreatitis treated at Addenbrooke9s Hospital, Cambridge, suggest that renal failure is a grave and not infrequent complication of acute pancreatitis.
Differential Effects of Adiposity on Pharmacodynamics of Basal Insulins NPH, Glargine, and Detemir in Type 2 Diabetes Mellitus
Authors: Francesca Porcellati, Paola Lucidi, Paolo Rossetti, Paola Candeloro, Anna Marinelli Andreoli, Stefania Marzotti, Patrizia Cioli, Geremia B. Bolli, Carmine G. Fanelli
Journal: Diabetes Care (2011)

To assess the role of adiposity on the pharmacodynamics of basal insulins NPH, detemir, and glargine in type 2 diabetes mellitus (T2DM), as estimated by glucose infusion rate (GIR) and endogenous glucose production (EGP) rate in the euglycemic clamp.We examined the variables that best predicted GIR and EGP in 32-h clamp studies after treatment with subcutaneous injection of 0.4 units/kg NPH, detemir, and glargine in 18 T2DM subjects (crossover).A multiple regression analysis revealed that BMI best predicted GIR variation during the clamp. BMI was inversely correlated with GIR in all three insulin treatments, but was statistically significant in detemir treatment only. BMI correlated positively with residual suppression of EGP in detemir, but not with glargine and NPH treatments.Adiposity blunts the pharmacodynamics of all basal insulins in T2DM. However, as adiposity increases, the effect of detemir is lower versus NPH and glargine.
Caffeine — Filtering the Facts
Authors: Brenda Eskenazi
Journal: New England Journal of Medicine (1999)

The article by Klebanoff and colleagues1 in this issue of the Journal adds to the growing body of literature examining the association of caffeine intake with adverse pregnancy outcomes and developmental problems. This study reports an association between spontaneous abortions, primarily in the second trimester, and unusually high levels of consumption of caffeine, equivalent to more than six cups of coffee a day.Unlike previous studies, in which exposure was estimated from the women's reports of the amount of caffeinated beverages they consumed, Klebanoff et al. used a biologic marker of caffeine intake, the levels of the caffeine metabolite paraxanthine . . .