tbuckley/cabot-search huggingface dataset:
MADIT-CRT — Breathtaking or Time to Catch Our Breath?
Authors: Mariell Jessup
Journal: New England Journal of Medicine (2009)

Cardiac-resynchronization therapy (CRT) received Food and Drug Administration approval for use in selected patients with left ventricular systolic dysfunction in 2001. Since that time, CRT has been embraced as a recommended approach to achieve meaningful clinical improvement in patients who have heart failure with a reduced left ventricular ejection fraction (LVEF) and who continue to have symptoms despite optimal medical therapy.1 A number of pivotal randomized trials and scores of additional safety and effectiveness trials have consistently shown that CRT improves the LVEF, quality of life, and functional status in symptomatic patients with an LVEF of less than 35% and . . .
Moving towards true integration
Authors: Richard G A Feachem, Neelam K Sekhri
Journal: BMJ (2005)

Considerable action will be needed to get maximum benefits from the lessons learnt about integrated health care Any comparison between the UK and US healthcare systems as a whole will inevitably conclude that the high costs and the lack of universal coverage in the United States make it extremely unattractive from any European perspective. Indeed, the United States can learn a great deal from the United Kingdom about the provision of universal access to health services at a much lower cost by reforming its health financing system. In the other direction, much has been gained in recent years from examining parts of the US experience and exploring how they might, with appropriate adaptation, be of benefit in the United Kingdom. Some of the lessons could be taken further. Our comparison between the US managed care organisation Kaiser Permanente and the NHS generated interest, debate, and subsequent studies.1 Several visits by ministers, managers, and clinicians have followed to see what might be learnt from US healthcare organisations. Interestingly, the increased international interest in Kaiser and similar systems has also stimulated debate about the possibilities of extending this model more broadly within the United States.2 We identified several factors that might explain performance differences between Kaiser and the NHS, and other researchers have investigated these in more detail.3 The most important of these, in our view, was achieving true integration, a view subsequently supported by Light and Dixon among others.3–5 This integration has several components, including:
Epigenetics in liver disease
Authors: Derek A. Mann
Journal: Hepatology (2014)

Epigenetics is a term that encompasses a variety of regulatory processes that are able to crosstalk in order to influence gene expression and cell phenotype in response to environmental cues. A deep understanding of epigenetics offers the potential for fresh insights into the basis for complex chronic diseases and improved diagnostic and prognostic tools. Moreover, as epigenetic modifications are highly plastic and responsive to the environment, there is much excitement around the theme of epigenetic therapeutics, including not only new drugs but also more informed patient advice on lifestyle choices and their impact on pathology. This review briefly explains the molecular nature of the individual regulatory process that constitute epigenetics, including DNA methylation, histone modifications, chromatin remodeling, transcriptional control, and noncoding RNAs. The ways in which these epigenetic mechanisms influence liver physiology and disease will be considered in detail, particularly in the context of cancer, fibrosis, and nonalcoholic steatohepatitis. The current limitations associated with epigenetic profiling and therapeutics in liver disease are discussed, as is the intriguing possibility that environmental-induced epigenetic changes may become stable and heritable. Conclusion : The aim of the review is to inform hepatologists of the emerging key epigenetic ideas of relevance to liver diseases that are highly likely to form a component of patient management and care in the next decade. (Hepatology 2014;60:1418–1425)
Phyllanthus urinaria ameliorates the severity of nutritional steatohepatitis both in vitro and in vivo
Authors: Bo Shen, Jun Yu, Shiyan Wang, Eagle S.H. Chu, V. W.S. Wong, Xin Zhou, Ge Lin, Joseph J.Y. Sung, Henry L.Y. Chan
Journal: Hepatology (2007)

Hepatic oxidative stress plays a critical role in metabolic forms of steatohepatitis. Phyllanthus urinaria, an herbal medicine, has been reported to have potential antioxidant properties. We tested the effects of P. urinaria on nutritional steatohepatitis both in vitro and in vivo . Immortalized normal hepatocytes (AML-12) or primary hepatocytes were exposed to control, the methionine-and-choline-deficient (MCD) culture medium, in the presence or absence of P. urinaria for 24 hours. Hepatocyte triglyceride, release of alanine aminotransferase, lipoperoxides, and reactive oxygen species production were determined. Age-matched C57BL/6 and db/db mice were fed control or MCD diet for 10 days with or without P. urinaria . Hepatic steatosis, necroinflammation, triglycerides, and lipid peroxide levels were determined. Hepatic expression of inflammatory factors and lipid regulatory mediators were assayed. P. urinaria reduced steatosis and alanine aminotransferase (ALT) levels in culture of hepatocytes in a dose-dependent manner. Phyllanthus prevented MCD-induced hepatic fat accumulation and steatohepatitis in mice. This effect was associated with repressed levels of hepatic lipid peroxides, reduced expression of cytochrome P450-2E1, pro-inflammatory tumor necrosis factor alpha, interleukin-6, dampened activation of inflammatory c-Jun N-terminal kinase (JNK) and nuclear factor kappa B (NF-κB), increased expression of lipolytic cytochrome P450 (Cyp4a10), and suppressed transcriptional activity of lipogenic CCAAT/enhancer binding protein β (C/EBPβ). Hepatic acyl co-enzyme A oxidase that regulated hepatic beta-oxidation of fatty acid and other lipid regulators were not affected by P. urinaria . In conclusion, P. urinaria effectively alleviated the steatohepatitis induced by the MCD, probably through dampening oxidative stress, ameliorating inflammation, and decreasing lipid accumulation. (Hepatology 2008.)
Acute Myeloid Leukemia or Myelodysplastic Syndrome in Randomized Controlled Clinical Trials of Cancer Chemotherapy With Granulocyte Colony-Stimulating Factor: A Systematic Review
Authors: Gary H. Lyman, David C. Dale, Debra A. Wolff, Eva Culakova, Marek S. Poniewierski, Nicole M. Kuderer, Jeffrey Crawford
Journal: Journal of Clinical Oncology (2010)

To evaluate the risk of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) and overall mortality in patients receiving chemotherapy with or without granulocyte colony-stimulating factor (G-CSF), a systematic review of randomized controlled trials (RCTs) was conducted.Electronic databases searched through October 2008 identified 3,794 articles for initial screening. Eligibility included solid tumor or lymphoma patients randomly assigned to chemotherapy with or without G-CSF support, > or = 2 years of follow-up, and reporting AML/MDS or all second malignancies. Dual blinded data extraction was performed. Relative risk (RR) and absolute risk (AR) estimates +/- 95% CIs were calculated by the Mantel-Haenszel method.In the 25 eligible RCTs, 6,058 and 6,746 patients were randomly assigned to receive chemotherapy with and without initial G-CSF support, respectively. At mean and median follow-up across studies of 60 and 53 months, respectively, AML/MDS was reported in 22 control patients and 43 G-CSF-treated patients, with an estimated RR of 1.92 (95% CI, 1.19 to 3.07; P = .007) and AR increase of 0.41% (95% CI, 0.10% to 0.72%; P = .009). Deaths were reported in 1,845 patients randomly assigned to G-CSF and in 2,099 controls, for estimates of RR and AR decrease of 0.897 (95% CI, 0.857 to 0.938; P < .001) and 3.40% (95% CI, 2.01% to 4.80%; P < .001), respectively. Greater RR reduction for mortality was seen for both larger studies (P = .05) and greater chemotherapy dose-intensity (P = .012).Delivered chemotherapy dose-intensity and risk of AML/MDS are increased but all-cause mortality is decreased in patients receiving chemotherapy with G-CSF support. Greater reductions in mortality were observed with greater chemotherapy dose-intensity.
White pupillary reflex in a 3 year old boy
Authors: P. Masaoutis, C. Koutsandrea, T. Paraskevopoulos, I. Georgalas
Journal: BMJ (2014)

A 3 year old boy was referred to our department by his general practitioner because of a “white reflex of his right eye” that had been noted in recent family photos. Direct ophthalmoscopy performed by his GP reported clear optical media (cornea, aqueous humour, crystalline lens, and vitreous) and a possible white retinal lesion in the right posterior pole. He had no medical history of note. His best corrected visual acuity after refraction was 20/100 in the right eye and 20/20 in the left eye. Cycloplegic refraction—a procedure used to determine the refractive error after temporarily paralysing the ciliary body with cycloplegic eye drops—showed a 4.00 dioptre difference in hypermetropia between his eyes (more pronounced in the right eye than in the left). Slit lamp examination showed a white pupillary reflex (leucocoria) in the right eye, but no inflammatory cells or proteins in the anterior chamber (no anterior chamber reaction). Gonioscopy was used to visualise the iridocorneal angle and applanation tonometry (Perkins tonometer) was used to determine intraocular pressure under general anaesthesia. Intraocular pressure was 12 mm Hg in both eyes and the iridocorneal angle was within normal limits in both eyes. Fundoscopic examination showed a yellow-white round mass, 5 mm in diameter and temporal to the fovea, in the right eye, with a clear vitreous (figure⇓). There were no pathological features in the left eye. B scan ultrasonography showed a right hyperechogenic mass with areas of calcification. The poor vision in his right eye was mainly attributed to his previously undetected hypermetropic anisometropia (the condition in which the hypermetropic refractive error differs greatly between the two eyes). However, subtle macular changes (slit subretinal fluid or atrophic changes of the outer layers) as a result of the nearby tumour could not be excluded.
The Autohemolysis Test
Authors: D. Prager
Journal: JAMA (1967)

The purpose of this communication is not to present any original material, but to bring further attention to a laboratory screening procedure that is easy to perform and which yields useful information in the study of patients with hemolytic anemia. It is recognized that the nonspherocytic congenital hemolytic anemias are composed of a variety of syndromes with similar red blood cell (RBC) morphology. In 1954, the autohemolysis test was described,<sup>1</sup>and helped to categorize the nonspherocytic congenital hemolytic anemias. The precise method of performing the autohemolysis test is described elsewhere.<sup>2</sup>Briefly, the patient's blood is collected in a sterile manner and defibrinated. Two milliliters of the sterile defibrinated blood is added to sterile screw-capped vials. Sterility is important, for bacterial contamination will hemolyze RBC. Glucose is added to one vial and to another, adenosine triphosphate is added. One vial of the sterile defibrinated blood has no additive. All three
Concentration and Clearance of Tc-99m-Pyridoxylidene Isoleucine By a Hepatoma
Authors: KYOICHI UENO, YUICHI HASEDA
Journal: Clinical Nuclear Medicine (1980)

Usually hepatic tumors show focal defects on both Tc-99m-colloid liver and Tc-99m-hepatobiliary imaging. This report involves a rare case in which a hepatoma did not take up Tc-99m-phytate, but concentrated and cleared a Tc-99m-hepatobiliary agent, Tc-99mpyridoxylidene isoleucine.
Pneumatic Rupture of the Colon
Authors: Mordechai Gemer
Journal: JAMA (1975)

COMPRESSED gases are used with increasing frequency in daily industrial work, in laboratories, and in gas stations. Improper usage of compressed gas equipment may lead to pneumatic rupture of the colon, which may demonstrate two stages of symptoms. <h3>Report of a Case</h3> A 14-year-old boy was admitted to the hospital with severe, diffuse, abdominal pain and two episodes of vomiting. Symptoms occurred soon after the release of compressed air through a nozzle held in apposition to his anus while he was fully dressed. The accident was the result of a prank. On admission 30 minutes after the incident, the boy was slightly disoriented, pulse rate was 72 beats per minute, blood pressure 110/70 mm Hg, and abdomen mildly tender with normal peristaltic sounds. The results of the rest of the physical examination were within normal limits. Upright x-ray films of the abdomen showed the entire colon to be greatly distended
Milk and Peptic Ulcer
Authors: WILLIAM S. HAUBRICH
Journal: Annals of Internal Medicine (1976)

Comments and Corrections1 July 1976Milk and Peptic UlcerWILLIAM S. HAUBRICH, M.D.WILLIAM S. HAUBRICH, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-85-1-133_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: It is important to be reminded (Ann Intern Med84:286-289, 1976) that dietary milk in its various forms does not suppress or inhibit gastric-acid secretion. However, the data furnished by Ippoliti and colleagues might be misconstrued as implying that the ingestion of milk is somehow harmful to the patient with acid-peptic disease. The investigators made an unfortunate choice in the volume of the milk challenge (240 ml). This is at least twice the volume of milk usually used in an hourly feeding regimen (120 ml). The larger volume would be expected to provoke gastrin by the mechanism...References1. IPPOLITI A, MAXWELL V, and ISENBERG J: The effect of various forms of milk on gastric-acid secretion. Ann Intern Med 84: 286-289, 1976 LinkGoogle Scholar2. KIRSNER J and PALMER W: Effect of various antacids on the hydrogen-ion concentration of the gastric contents. Am J Dig Dis 7:85-93, 1940 CrossrefGoogle Scholar3. FORDTRAN J: Acid rebound. N Engl J Med 279:900-905, 1968 CrossrefMedlineGoogle Scholar4. SANDWEISS D: The sippy treatment for peptic ulcer—fifty years later. Am J Dig Dis 6:929-937, 1961 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: WILLIAM S. HAUBRICH, M.D. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe nutritional and physiological impact of milk in human nutrition 1 July 1976Volume 85, Issue 1Page: 133-134KeywordsGastrinIngestionMilkPeptic ulcers ePublished: 1 December 2008 Issue Published: 1 July 1976 PDF downloadLoading ...
The changing face of liver biospy in clinical practice
Authors: D. S. Mandair, H. Bridgestock, D. Mutimer, D. Freshwater
Journal: Gut (2011)

<h3>Introduction</h3> As liver biopsy remains on the GI Curriculum we audited practice in University Hospital Birmingham before and after the introduction of Fibroscan, and practice in other Trusts in the region. <h3>Methods</h3> An online survey was sent to all gastroenterology consultants and trainees in the West Midlands. Liver biopsies were audited at UHB before and after introduction of Fibroscan, excluding targeted, transjugular and time-zero biopsies. <h3>Results</h3> 174 biopsies were performed Feb 2008–July 2008 (M102/F74), age range 18–77. 88 blind, 86 USS guided. 123 biopsies were performed Feb 2009–July 2009 (M76/F47) age range 20–82. 54 blind, 69 USS guided. Blind biopsies fell from 50.6% to 43.9%. Hep C biopsies fell from 14.3% to 4.9%. Failed blind biopsies rose from 6 to 12. 55 people responded to the survey (12 consultants/43 trainees). Only 17/55 had made any request for blind liver biopsies in the last 12 months. 77.4% had preformed last than 10 biopsies in the last year while 30% had performed less than 10 lifelong. 59.4% still felt that blind percutaneous biopsy was still an important technique. <h3>Conclusion</h3> Fibroscan reduced the number of Liver biopsies performed. Blind percutenous liver biopsy experience is decreasing, and should no longer be a requirement in regional training programs.
Ectopic Pregnancy after Pelvic Tuberculosis
Authors: W. Mills
Journal: BMJ (1958)

This article addresses stock selection modeling and portfolio selection and implementation in EMs. The authors view EM investing as a special case of global investing, demonstrating how stock-selection models in EMs with price momentum and forecast earnings acceleration factors can enhance returns. The authors construct index-enhanced portfolios for EMs that offer superior return-to-risk ratios relative to domestic portfolios. On the basis of back test and in real-time performance, the authors show how an EM portfolio using forecast earnings and price momentum anomalies can be developed, estimated, and implemented to generate statistically significant excess returns.
ELECTROLYTE BALANCE STUDIES IN ADRENALECTOMIZED DOGS WITH PARTICULAR REFERENCE TO THE EXCRETION OF SODIUM
Authors: Robert F. Loeb, Dana W. Atchley, Ethel M. Benedict, Jessica Leland
Journal: The Journal of Experimental Medicine (1933)

1. Balance studies have been made on three dogs before and after adrenalectomy, performed in two stages. 2. It has been shown that the sodium concentration of the blood decreases in adrenalectomized dogs, as is true in patients suffering from Addison's disease and in cats experimentally adrenalectomized. 3. There are also decreases in the chloride and bicarbonate concentrations which together are approximately equivalent to the decrease in sodium. 4. An increase in the potassium concentration of the blood occurs after adrenalectomy, as reported in other studies. There is no obvious correlation of this change with changes in potassium balances. 5. The balance studies show a striking loss of sodium from the body during the development of adrenal insufficiency. This loss of Na results from an increased excretion of sodium in the urine and is not complicated by loss of base as a result of vomiting or diarrhea. 6. Following adrenalectomy, both the total amount of sodium and its concentration in the urine are markedly increased. This increase in concentration of sodium occurs in spite of an augmented urine volume. 7. The behavior of the chloride ion following adrenalectomy parallels that of the sodium ion, but the loss is not equivalent. 8. During the period of accumulation of non-protein nitrogen in the blood, the rate of water excretion by the kidney is even greater than before removal of the adrenal glands. 9. The possibility of a regulatory effect of the adrenal glands upon sodium metabolism and renal function has been discussed.
Effect of Fenfluramine on Human Growth Hormone Release
Authors: W. R. Sulaiman, R. H. Johnson
Journal: BMJ (1973)

In order to investigate the effect of fenfluramine on hormonal and metabolic changes with exercise, five normal volunteers have been studied during and after 20 minutes of steady exercise on a bicycle ergometer after injection of fenfluramine (20 mg intravenously). Fenfluramine abolished the rise of plasma human growth hormone (HGH) which occurred in control investigations. Fenfluramine also affected plasma insulin, blood glucose, and ketone body levels. The acute effect of fenfluramine on the release of growth hormone was examined further by studying its effect in patients with acromegaly. A marked depression of growth hormone occurred both at rest and with exercise. These observations indicate that fenfluramine has a direct effect on pathways controlling growth hormone release. We also suggest that this action may have practical use in the medical treatment of acromegaly.
Foetal Malformation and Cortisone Therapy
Authors: P. Malpas
Journal: BMJ (1965)

are at present also studying the antitoxin response following tetanus toxoid injections in various other circumstances.These studies will be reported in full in due course.Our preliminary results show that in over 80 cases who had had standard courses of tetanus toxoid in the past high (i.e., protective) antitoxin titres were present one week after a boosting dose of tetanus toxoid (fluid or adsorbed).In 72 cases the last tetanus toxoid injection had been given over five years previously, and in 25 of these the interval varied from 15 to 20 years after injection.We would suggest, therefore, that with adequate evidence of a past course of three or more injections of tetanus toxoid a booster dose in the form of 0.2 ml. of adsorbed tetanus toxoid given parenterally is all that is required even though 20 years may have elapsed since that course.We realize that adequate evidence may not always be easy to obtain, but consider that the search is justified if prolonged protection can be so easily renewed and the use of anti- tetanus serum avoided.
Fixed-Effects Models and Diagnosing Psychiatric Disorders
Authors: Jeffrey Sonis
Journal: JAMA Psychiatry (2014)

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