tbuckley/cabot-search huggingface dataset:
Angina Pectoris: Pathophysiology, Evaluation, and Treatment
Authors: STEPHEN E. EPSTEIN
Journal: Annals of Internal Medicine (1971)

Accurate assessment of the effects and mechanisms of action of any intervention altering exercise performance of patients with angina pectoris caused by coronary artery disease requires use of a carefully designed exercise protocol. Using such a protocol, we found that conditions tending to precipitate ischemic pain (meals, exposure to cold) usually are associated with circulatory changes that may increase myocardial oxygen consumption. Interventions causing symptomatic improvement (nitroglycerin, isosorbide dinitrate, beta blockade, physical training, and carotid sinus nerve stimulation) produce opposing effects. In addition to these studies, we review the evidence suggesting that angina or myocardial infarction may occur in patients with normal coronary arteries. Finally, we present an overall approach to the medical and operative treatment of patients with coronary artery disease.
Epidemiology of Respiratory Viruses in Persons with and without Asthma and COPD
Authors: Arnold S. Monto
Journal: American Journal of Respiratory and Critical Care Medicine (1995)

The occurrence of respiratory viruses in persons with asthma and COPD must be viewed against the behavior of the viruses in persons without these conditions. There are multiple agents involved, and reinfections with the same virus are frequent. Infections and illnesses generally decrease in frequency with increasing age. Thus, it can be expected that infections among children, with or without asthma, will be more frequent than among adults in general. Evaluation of studies of viral activity in persons with asthma and COPD should differentiate between increased susceptibility and production of exacerbations. The latter may simply indicate the potential for greater severity, but not a higher frequency, of infections. Whatever viruses are circulating at a particular time can produce exacerbations; the studies are most conclusive for asthma in children, probably because infections in general are more common in this age group. Data also suggest increased susceptibility, although results are less clear than for exacerbations. Therefore, persons with chronic respiratory diseases should be considered a risk group for current and developmental vaccines and antiviral medications.
Quinine and Chloroform Administration
Authors: E. Jepson
Journal: BMJ (1904)

<b>1564</b> <h3><b>Objectives</b></h3> To use dual time point <sup>18</sup>F-AV-45 PET image exploring the association of MMSE scores to perfusion index measured by early phase pAV-45 image and amyloid deposition calculated from <sup>18</sup>F-AV-45 image in patients with mild cognitive impairment (MCI) and Alzheimer9s disease (AD). <h3><b>Methods</b></h3> Ten healthy controls, 16 MCI and 27 AD were included in this study. The patients were further divided into 4 symptom groups according to MMSE scores including 7, 15, 12, and 9 patients with MMSE score&gt;24, 20-24, 15-19 and &lt;15 respectively. All subjects underwent both T1 MRI and dual time point <sup>18</sup>F-AV-45 PET scans (1-6 min post-injection as pAV-45 image and 50-60 min as amyloid image). Each PET image was spatially normalized to MNI template aided from corresponding MR image. The SUVRs of PET images were calculated from the ratios of mean SUV for 8 cerebral cortical VOIs to the mean SUV of whole cerebellum. Linear and segmental linear regression models were used to calculate the best fitting model between quantitative parameters and MMSE scores. Voxelwise analysis to evaluate perfusion decline and amyloid accumulation of patients from different severity groups was performed by SPM5. <h3><b>Results</b></h3> The cortical perfusion gradually decreases as MMSE score declines, and the best correlation model between pAV-45 SUVR and MMSE score is linear regression model (r=0.6635, p&lt;0.0001). The degree of amyloid accumulation slightly increased in patients with MMSE score above 24, and then saturated in the groups of MMSE score below 20. The optimal regression model to present the relation of <sup>18</sup>F-AV-45 SUVR and MMSE score was segmental regression model (r=0.5477; transition point: MMSE score=23). <h3><b>Conclusions</b></h3> MMSE scores correlated well to pAV-45 SUVRs from all subjects and <sup>18</sup>F-AV-45 SUVRs from the subjects with MMSE score &gt;23. Thus, the dual function of pAV-45 and amyloid deposition from <sup>18</sup>F-AV-45 imaging provides a potential joint biomarker to estimate disease state in MCI and AD. <h3><b>Research Support</b></h3> 1. Chang-Gung Memorial Hospital, Taiwan (Grant No. CMRPD1C0382) 2. Ministry of Science and Technology, Taiwan (Grant MOST 103-2314-B-182-010-MY3, and 103-2314-B-182A-009)
Metformin ameliorates acetaminophen hepatotoxicity via Gadd45β-dependent regulation of JNK signaling in mice
Authors: Yong-Hoon Kim, Jung Hwan Hwang, Kyoung-Shim Kim, Jung-Ran Noh, Dong-Hee Choi, Don-Kyu Kim, Surendar Tadi, Yong-Hyeon Yim, Hueng-Sik Choi, Chul-Ho Lee
Journal: Journal of Hepatology (2015)
Pin1 induction in the fibrotic liver and its roles in TGF-β1 expression and Smad2/3 phosphorylation
Authors: Jin Won Yang, Tran Thi Hien, Sung Chul Lim, Dae Won Jun, Hong Seok Choi, Jung-Hoon Yoon, Il Je Cho, Keon Wook Kang
Journal: Journal of Hepatology (2014)
Treatment intensity significantly influencing fibrosis in bone marrow independently of the cytogenetic response: meta-analysis of the long-term results from two prospective controlled trials on chronic myeloid leukemia
Authors: G Buesche, M Freund, R Hehlmann, A Georgii, A Ganser, H Hecker, H Heimpel, C Fonatsch, B Heinze, M Pfirrmann, S Holgado, A Schmeil, A Tobler, J Hasford, T Buhr, H-H Kreipe
Journal: Leukemia (2004)
Ascending venous thrombosis from the middle hepatic vein to the left pulmonary artery as a complication of endoscopic Histoacryl sealing of a bile leak after blunt liver injury
Authors: A. Tomazic, V. Mlinaric, A. Pleskovic
Journal: Endoscopy (2006)

Biliary leaks can be effectively closed by endoscopic application of N-butyl-2-cyanoacrylate (Histoacryl) [1]. We describe here a young woman who developed a thrombus of the middle hepatic vein, which ascended to the right atrium, after sealing of a bile leak that had developed following blunt liver injury. The 21-year-old woman was injured as a result of a fall from a second-floor level. Computed tomography revealed that liver segments VI and VII were ruptured (Figure [1]) and both segments were found to be avulsed at the time of surgery.
Coronary Artery Obstruction After the Arterial Switch Operation for Transposition of the Great Arteries in Newborns
Authors: Philipp Bonhoeffer, Damien Bonnet, Jean-FranÇois Piéchaud, Oliver Stümper, Yacine Aggoun, Elizabeth Villain, Jean Kachaner, Daniel Sidi
Journal: Journal of the American College of Cardiology (1997)
Pharma and CME: View from the US
Authors: S. Fletcher
Journal: BMJ (2008)

In the United States, commercial support for continuing medical education has grown steadily over the past decade. In 2006 it provided more than half, about $1.5bn (£0.75bn, €0.95bn) or 60%, of the income for educational programmes doctors must take to maintain their medical licences. 1 Evidence shows that commercial support distorts what doctors learn.

In 2007 I chaired the Josiah Macy, Jr conference on Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning ( www.josiahmacyfoundation.org). A major recommendation emerging from the conference was that organisations providing accredited continuing education should not receive commercial support from drug or medical device companies. 

The Macy report, from the conference, summarised the ethical concerns. Commercial support places doctors and nurses who teach continuing education activities in the untenable position of being paid, directly or indirectly, by the manufacturers of healthcare products about which they teach. Commercial entities have an …
Safety and efficacy of TNFalpha blockade in relapsing vasculitis
Authors: A D Booth
Journal: Annals of the Rheumatic Diseases (2002)

Blockade of tumour necrosis factor alpha (TNFα) using infliximab, a chimeric monoclonal antibody against TNFα, is an effective treatment in rheumatoid arthritis and Crohn's disease. 1 2 Sifikakis reported success using infliximab in sight threatening Behçet's disease. 3 A preliminary study has also reported clinical improvements in the primary systemic vasculitis, Wegener's granulomatosis, with the soluble TNFα receptor etanercept. 4 The benefit of lenercept, a soluble p55 TNFα receptor fusion protein, on digital vasculitis in rheumatoid arthritis has also been reported. 5 We report the compassionate treatment of six patients with refractory vasculitis using infliximab.Diagnoses were Wegener's granulomatosis in three and microscopic polyangiitis in three.Three patients were positive for proteinase-3 antineutrophil cytoplasmic antibodies (PR3-ANCA) and one for myeloperoxidase (MPO)-ANCA.Four were female, with a mean age of 58 years (range 23-77) and mean disease duration of 3.5 years.All had had at least three clinical relapses and had received prolonged treatment with corticosteroids and at least four immunosuppressive drugs.At the time of infliximab treatment the eyes were affected in four patients and the lung in three; in addition, five had profound constitutional symptoms.The mean prednisolone dose was 17 mg.Three intravenous doses of infliximab 200 mg were given at monthly intervals for three months.One patient complained of fatigue, myalgia, and blurred vision 24 hours after the first infusion, which did not recur on rechallenge.Infliximab was otherwise well tolerated.Five patients had remission of their disease, four within two weeks of treatment.This allowed steroid withdrawal in three and reduction by more than 50% in two.Disease activity assessed by the Birmingham Vasculitis Activity Scores (BVAS) improved from a mean of 6.3 to 0.8 at three months (fig 1). 6 One patient receiving continued infliximab for six months relapsed when the treatment interval was extended to two months.Mean falls in erythrocyte sedimentation rate and C reactive protein were 17 mm/1st h and 13 mg/l, respectively.The ANCA status was unchanged.Anti-TNFα treatment heralds a new wave of specifically targeted biological interventions of potential value in the treatment of vasculitis.It offers the hope of improved therapeutic efficacy over current agents and the possibility of reducing exposure to steroids and immunosuppressive drugs.Further studies are warranted to confirm these observations and explore the role of infliximab as a component of initial protocols.. . . . . .
Enzyme Profiles in the Evaluation of Pulmonary Infarction
Authors: Eugene L. Coodley
Journal: JAMA (1969)

The diagnosis of pulmonary infarction is dependent upon the use of multiple diagnostic criteria. These include clinical findings, electrocardiographic changes, pulmonary function changes, serial enzyme change, and radiographic techniques. Increased specificity in the diagnosis of pulmonary infarction was found with a profile of enzyme studies including determinations of creatine phosphokinase, serum lactic acid dehydrogenase, and hydroxy butyrate dehydrogenase. The values obtained from a study of this combination of enzymes eliminated patients whose symptomatology simulated pulmonary infarction but actually represented myocardial infarction. The use of isoenzymes was of minimal value in differential diagnosis of this condition.
Prognostic and Therapeutic Significance of Myeloma Genetics and Gene Expression Profiling
Authors: A. Keith Stewart, Rafael Fonseca
Journal: Journal of Clinical Oncology (2005)

Molecular diagnostic tools and novel therapeutics now offer the potential for accurate prognostic and personalized treatment road maps for patients with multiple myeloma (MM). We will review the evidence and provide specific recommendations for routine clinical molecular genetic testing and use of such information to guide therapeutic decision making. In particular, the negative prognostic impact of specific IgH translocations such as the t(4;14), t(14;16), chromosome 13 deletion by conventional cytogenetics and loss of 17p13 by interphase fluorescence in situ hybridization are now established. Preliminary gene expression profiling studies have also demonstrated that individual genes (CSK1-B) or groups of genes can define prognosis with greater accuracy than conventional genetic markers and can provide pharmacogenomic and biologic insight into the pathophysiology, therapeutics, and future targets of myeloma. Importantly, we recommend that all clinical trials now adopt routine genetic testing and risk stratification.
Intensive Insulin Therapy in Hospitalized Patients: A Systematic Review
Authors: Devan Kansagara, Rongwei Fu, Michele Freeman, Fawn Wolf, Mark Helfand
Journal: Annals of Internal Medicine (2011)

Background: The benefits and harms of intensive insulin therapy (IIT) titrated to strict glycemic targets in hospitalized patients remain uncertain. Purpose: To evaluate the benefits and harms of IIT in hospitalized patients. Data Sources: MEDLINE and Cochrane Database of Systematic Reviews from 1950 to January 2010, reference lists, experts, and unpublished sources. Study Selection: English-language randomized, controlled trials comparing protocols titrated to strict or less strict glycemic targets. Data Extraction: Two reviewers independently abstracted data from each study on sample, setting, glycemic control interventions, glycemic targets, mean glucose levels achieved, and outcomes. Results were grouped by patient population or setting. A random-effects model was used to combine trial data on short-term mortality (≤28 days), long-term mortality (90 or 180 days), infection, length of stay, and hypoglycemia. The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate the overall body of evidence for each outcome. Data Synthesis: In a meta-analysis of 21 trials in intensive care unit, perioperative care, myocardial infarction, and stroke or brain injury settings, IIT did not affect short-term mortality (relative risk, 1.00 [95% CI, 0.94 to 1.07]). No consistent evidence showed that IIT reduced long-term mortality, infection rates, length of stay, or the need for renal replacement therapy. No evidence of benefit from IIT was reported in any hospital setting, although the best evidence for lack of benefit was in intensive care unit settings. Data combined from 10 trials showed that IIT was associated with a high risk for severe hypoglycemia (relative risk, 6.00 [CI, 4.06 to 8.87]; P < 0.001). Risk for IIT-associated hypoglycemia was increased in all hospital settings. Limitations: Methodological shortcomings and inconsistencies limit the data in perioperative care, myocardial infarction, and stroke or brain injury settings. Differences in insulin protocols and patient and hospital characteristics may affect generalizability across treatment settings. Conclusion: No consistent evidence demonstrates that IIT targeted to strict glycemic control compared with less strict glycemic control improves health outcomes in hospitalized patients. Furthermore, IIT is associated with an increased risk for severe hypoglycemia. Primary Funding Source: U.S. Department of Veterans Affairs Health Services Research and Development Service.
Right and left ventricular compliance in the hereditary cardiomyopathy of the Syrian hamster
Authors: A. MASS-SCHWARTZ, R. S. WEINSTOCK, R. L. WAGNER, W. H. ABELMANN
Journal: Cardiovascular Research (1977)

Ventricular pressure-volume curves were examined in 10 pre-oedematous cardiomyopathic Syrian hamsters, aged 120 d, and 10 oedematous cardiomyopathic hamsters, aged 210 d, and compared with 10 and 8 age-matched controls, respectively. Previous studies had shown filling pressures and cardiac output to be normal in the pre-oedematous stage. In contrast, the oedematous stage was characterised by elevated filling pressures and increased cardiac output, raising the question whether this stage represents true myocardial failure or circulatory congestion associated with decreased ventricular compliance. Compliance, defined as dV/dP, was derived simultaneously for both ventricles from post-mortem pressure-volume curves from 0 to 2.66 kPa (0 to 20 mmHg). Left ventricular tissue elastic modulus, E, defined as dσ/d∊ or the incremental stress (σ) for an increment of strain (∊), was derived from the compliance curves and certain linear dimensions of the heart. At isobaric intervals, compliance did not differ between control and myopathic ventricles. At pressures corresponding to previously measured, naturally prevailing end-diastolic pressures, the myopathic ventricles were significantly dilated in both stages; end-diastolic compliance was normal in pre-oedematous hamsters, but was significantly decreased in the oedematous animals. Left ventricular elastic modulus was elevated at all values of σ, in both groups of myopathic animals.
O154 PROSTAGLANDIN E2 MEDIATES IMMUNOSUPPRESSION IN ACUTELY DECOMPENSATED CIRRHOSIS
Authors: A. O'Brien, J. Fullerton, G. Auld, S. James, J. Newson, E. Karra, K. Massey, W. Alazawi, A. Winstanley, C. Juan, R. Garcia-Marquez, A. Nicolaou, D. Gilroy
Journal: Journal of Hepatology (2014)
Gut Hormones, Obesity, Polycystic Ovarian Syndrome, Malignancy, and Lipodystrophy Syndromes
Authors: Zachary T. Bloomgarden
Journal: Diabetes Care (2007)

Perspectives on the News commentaries are now part of a new, free monthly CME activity. The Mount Sinai School of Medicine, New York, New York, is designating this activity for 2.0 AMA PRA Category 1 credits. If you wish to participate, review this article and visit www.diabetes.procampus.net to complete a posttest and receive a certificate. The Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians .

This is the third in a series of four articles on presentations at the World Congress on the insulin resistance syndrome (IRS), reviewing relationships between insulin resistance and gut hormones, obesity, polycystic ovarian syndrome, malignancy, and lipodystrophy syndromes.

Steve Bloom (London, U.K.) discussed satiety signals, noting that obesity is “key to the [insulin resistance] syndrome” and that it ultimately is caused by overeating. Childhood obesity is on the rise, with 40% of children expected to be overweight by 2010. He asked, what explains the reduction in hunger after a meal? Bulk in the stomach and nutrients in the circulation appear not to be the cause. There must be specific signals from the gut to the brain, neural and/or hormonal. It appears that, when stimulated, a small area in the proximal gastric fundus, near the esophagus, sends vagal signals mediating satiety. Studies have attempted to replicate gut hormonal signals by infusion, with cholecystokinin (CCK) decreasing food intake but causing pancreatitis and acting as a growth factor for pancreatic acinar cells, which could cause increased pancreatic cancer risk. Ghrelin decreases after meals and may be a negative satiety signal, as its direct effect is to stimulate food intake. Pancreatic polypeptide may be a factor, and the distal small bowel and colon produce glucagon-like peptide (GLP)-1, oxyntomodulin, and peptide YY (PYY), additional candidate …
Immunoglobin G4-hepatopathy: Association of immunoglobin G4-bearing plasma cells in liver with autoimmune pancreatitis
Authors: Takeji Umemura, Yoh Zen, Hideaki Hamano, Shigeyuki Kawa, Yasuni Nakanuma, Kendo Kiyosawa
Journal: Hepatology (2007)

Autoimmune pancreatitis (AIP) is characterized by high serum immunoglobin (Ig) G4 concentrations, lymphoplasmacytic inflammation, and a favorable response to corticosteroid treatment. Since liver dysfunction is frequently seen in AIP patients, we investigated hepatic histopathology and its clinical significance in patients with AIP. We examined the clinical features, histology, and immunoglobin G (IgG)4-bearing plasma cell infiltration of liver biopsies from 17 patients with AIP and 63 patients with either autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, or chronic viral hepatitis and histological changes in the 7 of 17 livers before and after glucocorticoid therapy. The liver histology of AIP was classified into 5 patterns: evident portal inflammation with or without interface hepatitis (6 cases), large bile-duct obstructive features (8 cases), portal sclerosis (8 cases), lobular hepatitis (5 cases), and canalicular cholestasis (4 cases); some of the histological features coexisted in the same liver. The number of IgG4-bearing plasma cells was significantly higher in AIP patients than controls (P < 0.01), and was significantly correlated with serum IgG4 concentration (P = 0.0014, r = 0.709). Glucocorticoid therapy reduced IgG4-bearing plasma cell infiltration in the liver (P = 0.031) and ameliorated other histological findings. In conclusion, virtually all AIP liver biopsies showed evidence of various pathological changes and infiltration of IgG4-bearing plasma cells. These features were ameliorated by steroid therapy, suggesting that the liver is concurrently affected in AIP, and that liver biopsies can provide significant information in the clinical evaluation and diagnosis of AIP.
Colonoscopy for Small Adenomas
Authors: Kenneth W. Stubbs
Journal: Annals of Internal Medicine (1999)

Letters20 April 1999Colonoscopy for Small AdenomasKenneth W. Stubbs, MDKenneth W. Stubbs, MDInternal Medicine Associates of Natchez; Natchez, MI 39120 (Stubbs)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-8-199904200-00008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I was hoping you could reconcile the apparent contradictions contained in separate articles in the 15 August 1998 issue of Annals.Wallace and colleagues (1) conclude that diminutive adenomatous polyps found at sigmoidoscopy do not indicate a need for colonoscopy. In contrast, the Update in Gastroenterology by Greenberger (2) states that patients with diminutive rectosigmoid adenomas need colonoscopy because some 29% were found to have proximal neoplasms.I was a bit surprised that no editorial addressed these obvious contradictions. This problem is commonly encountered in everyday practice; if cancer was inappropriately overlooked in the proximal colon, it ...References1. Wallace MB, Kemp JA, Trnka YM, Donovan JM, Farraye FA. Is colonoscopy indicated for small adenomas found by screening flexible sigmoidoscopy? Ann Intern Med. 1998;129:273-8. LinkGoogle Scholar2. Greenberger NJ. Update in gastroenterology. Ann Intern Med. 1998;128:309-16. LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Kenneth W. Stubbs, MDAffiliations: Internal Medicine Associates of Natchez; Natchez, MI 39120 (Stubbs) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIs Colonoscopy Indicated for Small Adenomas Found by Screening Flexible Sigmoidoscopy? Michael B. Wallace , James Alan Kemp , Yvona M. Trnka , Joanne M. Donovan , and Francis A. Farraye Colonoscopy for Small Adenomas Thomas E. Read , Julie D. Read , and Lynn F. Butterly Colonoscopy for Small Adenomas Norton J. Greenberger Colonoscopy for Small Adenomas Michael B. Wallace , Francis A. Farraye , and James Alan Kemp Colonoscopy for Small Adenomas James C. Hurowitz Metrics 20 April 1999Volume 130, Issue 8Page: 700KeywordsAdenomasColonColonoscopy ePublished: 15 August 2000 Issue Published: 20 April 1999 Copyright & PermissionsCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...