tbuckley/cabot-search huggingface dataset:
P9 Determining the appropriate D-dimer cut-off to exclude pulmonary emboli in an ambulatory care setting using different thresholds based on pre-test probability
Authors: R. M. Ladwa, E. Bailie, Y. Vali, R. H. Green, J. A. Bennett, C. M. Free
Journal: Thorax (2011)

<h3>Introduction</h3> Currently the same threshold value is used to identify a positive D-dimer result for all patients presenting to our ambulatory clinic with suspected pulmonary emboli (PE). It has been suggested that adjusting the threshold value according to the pre-test probability would exclude PE in more patients than using the same cut-off point regardless of clinical probability. <h3>Methods</h3> Data from 362 consecutive patients presenting to the ambulatory PE clinic was collected. A pre-test probability of PE was recorded for all patients and those with a high pre-test probability had radiological investigations. Patients with a low or intermediate pre-test probability had a latex agglutination D-dimer test. If this result was =0.5 μg/ml they had further investigations, otherwise they were discharged. The diagnosis of PE was made if a VQ scan showed ventilation/perfusion mismatch or CTPA report demonstrated PE. Receiver operating characteristic curve analysis was performed separately for patients with low and intermediate probability and the optimum cut-off value to exclude PE determined. Sensitivity, specificity, negative predictive value and positive predictive value for different cut-off points were determined. <h3>Results</h3> 362 patients were included in the analysis, 207 (57%) had low, 129 (36%) intermediate and 26 (7%) high pre-test probability. Prevalence of PE was 2% in the low probability group, 14% in the intermediate probability group and 42% in the high probability group. No patients with a D-dimer of &lt;0.5 μg/ml who were discharged without further tests have re-presented with similar symptoms. In the low pre-test probability group, a cut-off point of 1.07 improved the specificity from 64% to 89% while maintaining a sensitivity of 100% and negative predictive value of 100%. Analysis in patients in the intermediate risk group suggested that a cut-off of 0.5 μg/ml was appropriate. By adjusting the D-dimer threshold to &gt;1.0 μg/ml in the low probability group, a further 53 patients could have been discharged home without need for radiological investigation. <h3>Conclusion</h3> The diagnostic accuracy of D-dimer testing may be improved in patients with a low pre-test probability by adjusting the cut-off threshold.
Reform of the WHO depends on next week's vital budget debate
Authors: F. Godlee
Journal: BMJ (1998)

As the World Health Organisation prepares to celebrate its 50th birthday, one woman looks set to prove that you can teach an old dog new tricks. According to commentators in Geneva, Dr Gro Harlem Brundtland, due to be confirmed next week as the WHO's new director general, has already transformed the atmosphere of the organisation. But how much she can achieve in her first term could depend on the outcome of a debate about the budget at next week's meeting of the World Health Assembly.

Soon after her nomination by WHO's executive board in January, Dr Brundtland commissioned a five person “transition team” to coordinate analyses of WHO's activities, structure, and processes. Based in Geneva, the team is funded by the Norwegian government and led …
Link between antihyperglycemic drugs and cancer is unproved, US endocrinologists say
Authors: M. McCarthy
Journal: BMJ (2013)

Current evidence linking the use of antihyperglycemic drugs with a raised risk of developing cancer is “limited and conflicting,” say the American Association of Clinical Oncologists and the American College of Endocrinology. Their consensus statement says that clinicians “can continue to confidently prescribe all FDA-approved antihyperglycemic medications for the management of hyperglycemia.”1 

The statement was developed in response to growing concerns about the possible association between obesity, diabetes, and, in particular, the …
AIDS: global lessons from a global epidemic.
Authors: J Mann, M E Wilson
Journal: BMJ (1993)

reasons.Farmers demanded weather forecasts because adverse weather could lead to economic doom if crops were not harvested before a hail storm.International maritime cooperation was stimulated with one of the first economic analyses, which showed that marine meteorological charts produced annual savings in the 1800s of between $40m and $60m worldwide.5Airlines recognised the importance of accurate weather forecasts for safety and profit.In contrast, governments, industry, and the public have not clamoured for better forecasting of disease as the economic importance of im- proved prediction may not be obvious.But, given the current costs of care, information concerning current and future disease patterns are critical for planning individual and industrial strategy.Moreover, the accurate monitoring of disease is important for governments as they have to decide how to allocate their scant resources for health care.We are fast approaching the twenty first century with techniques towards monitoring and forecasting disease patterns that have changed little since the 1800s.These need revamping: the model of weather forecasting may be the way forward.
Goodbye, Bicentennial: The Recurrent Crises of Medical Education
Authors: Rosemary A. Stevens
Journal: New England Journal of Medicine (1976)

It is the duty of the historian to spy order in the chaotic march of events. Numerous presentations in this Bicentennial year have displayed admirably the rise of American medical education from its humble beginnings as the calling of amateurs, through the apprenticeship of one individual to another, to an age of massive educational institutions. Medical education today glitters in the context of its past events: in its massive research institutions, in hospitals that are shrines to technical achievement; in the educational preparation and the social background of its students; in its role as a Mecca for foreign physicians; and . . .
Induction of interferon gamma production by natural killer cell stimulatory factor: characterization of the responder cells and synergy with other inducers.
Authors: S H Chan, B Perussia, J W Gupta, M Kobayashi, M Pospísil, H A Young, S F Wolf, D Young, S C Clark, G Trinchieri
Journal: The Journal of Experimental Medicine (1991)

We previously reported that natural killer cell stimulatory factor (NKSF), a heterodimeric lymphokine purified from the conditioned medium of human B lymphoblastoid cell lines, induces interferon gamma (IFN-gamma) production from resting peripheral blood lymphocytes (PBL) and synergizes with interleukin 2 in this activity. In this study, we show that human NKSF induces IFN-gamma production from both resting and activated human PBL and from freshly isolated murine splenocytes. Human T and NK cells produce IFN-gamma in response to NKSF, but resting PBL require the presence of nonadherent human histocompatibility leukocyte antigens DR+ (HLA-DR+) accessory cells to respond to NKSF. The mechanism(s) by which NKSF induces IFN-gamma production results in accumulation of IFN-gamma mRNA, is insensitive to cyclosporin A, and synergizes with those mediated by phytohemagglutinin, phorbol diesters, anti-CD3 antibodies, and allogeneic antigens, but not by Ca2+ ionophores. The ability of NKSF to directly induce IFN-gamma production and to synergize with other physiological IFN-gamma inducers, joined with the previously described ability to enhance lymphocyte cytotoxicity and proliferation, indicates that this lymphokine is a powerful immunopotentiating agent.
Pregnancy and Coarctation of the Aorta
Authors: Curtis L. Mendelson
Journal: JAMA (1965)

<h3>To the Editor:—</h3> Drs. J. D. Mortensen and Homer S. Ellsworth discuss "Coarctation of the Aorta and Pregnancy" (<i>JAMA</i><b>191</b>:596-598 [Feb 15] 1965) stating: "Although medical literature contains approximately 150 case reports describing the occurrence of pregnancy in women with coarctation of the aorta, most such reports have been concerned with complications in the mother of a single such pregnancy, hence giving little statistical information as to the overall incidence of either obstetrical or cardiovascular complications when these two circumstances coexist. Furthermore, no reports are available describing the course of pregnancies in women who have had coarctation of the aorta repaired surgically." I should respectfully like to point out that my monograph<sup>1</sup>published in 1960 contains an analysis of 40 cardiovascular complications in 200 unoperated cases of coarctation in pregnancy and an analysis of maternal and fetal outcomes associated with surgical correction (50 performed prior to pregnancy and
688. Adno-Associated Virus (AAV)-Mediated Catalase Overexpression Protects the Extensor Digitorum Longous Muscle from Contraction-Induced Injury
Authors: Mingju Liu, Yongping Yue, Dongsheng Duan
Journal: Molecular Therapy (2005)

Free radical injury is known to affect normal muscle contraction. Recent studies suggest that it also plays a critical role in the muscle aging process and in the pathogenesis of muscle diseases such as muscular dystrophy. Antioxidant gene therapy holds great promise in improving muscle function. Catalase decomposes hydrogen peroxide, a highly reactive oxygen species, to water and oxygen. In this study, we examined whether recombinant adeno-associated virus (rAAV)-mediated catalase over-expression could effect muscle contraction in the extensor digitorum longous (EDL) muscle in normal mice. To facilitate the transgene detection, we also engineered an HA tag in the C-terminal end of the catalase gene. Transfection of the AAV catalase proviral plasmid (pcisRSV.CatHA) in 293 cells yielded 2.4-fold higher catalase activity than that from a control proviral plasmid carrying the EGFP reporter gene. Western blot with both anti-catalase and anti-HA antibodies confirmed the ectopic catalase expression. To determine whether AV.RSV.CatHA can mediate efficient catalase expression in muscle, we delivered 1011 genome particles of AAV-7 catalase viruses to the left anterior tibialis (TA) muscle of 3-m-old BL10 mouse. The contra-lateral TA muscle was infected with an AAV-7 virus carrying the alkaline phosphatase reporter gene. Immunofluoresecnece staining and Western blot at one-month post-infection revealed high-level catalase expression in AV.RSV.CatHA infected muscle. The test whether catalase overexpression could enhance muscle function, we delivered 1011 genome particles of AAV-7 catalase viruses to the left EDL muscle of 3-m-old BL10 mice. The right EDL muscle was mocked infected with saline. At three months later, the catalase activity in AAV infected EDL muscle reached 1178 161 Ku/g while in saline injected muscle it only reached 463 42 Ku/g. The enhanced catalase activity in AAV infected muscle was further confirmed by zymogram assay. Despite AAV-mediated catalase overexpression, we did not detect any significant change in muscle weight, cross sectional area, the twitch and isometric tension. Forced lengthening during eccentric contraction has been shown to generate reactive oxygen species. To test whether AAV-mediated catalase overexpression could reduce free radical injury during eccentric contraction, we applied a total of 10 cycles of eccentric contraction on the EDL muscle. In mock-infected muscle, the isometric tension dropped to 92%, 69% and 56% of the starting level after the first, fifth and ninth eccentric contraction. While AV.RSV.CatHA infected muscle was significantly protected from the injury. The isometric tension only dropped to 96%, 74% and 62% of the starting levels, respectively. On average, catalase overexpression provided a 7.2% protection. In summary, our results suggest that AAV-mediated catalase over-expression represents a viable approach to reduce free radical injury and enhance muscle function.
Letter: Care of the coronary patient.
Authors: M E Benaim
Journal: BMJ (1974)

Novem,ber, p. 449). In this department we have used frusemide successfully in the treatment of 13 cases of acute renal failure in which the oliguria was of more than 48 hours duration.'Failure was post-obstetric in 10 cases, post-surgical in one, traumatic in one, and due to myocardial infarction in one.The doses used were mod-est compared with those used by Professor Cantarovich and his colleagues, except in one case in which a total dose of 6g was given in addition to dialysis.No side effects have been noticed.We strongly feel that frusemide is safe and should be given priority in a country like Pakistan where economic limitations may not allow th-e use of more sophisticated method of treatment.The drug should be used early to avoid irreversible renal damage.This, we feel, is a new role of frusemide on a prophylactic basis.-Iam, etc.,
Tennessee's state funded health care faces crisis
Authors: F. Charatan
Journal: BMJ (1999)

Tennessee's healthcare programme for low income people, Tenncare, is facing a severe budget crunch which is set to affect 1.3 million beneficiaries—one quarter of the state's total population of 5.3million.

Tennessee withdrew from the federal Medicaid programme of fee for service payments in favour of offering managed care through health maintenance organisations (HMOs) in …
The Press and Health Care
Authors: Daniel S. Greenberg
Journal: New England Journal of Medicine (1977)

An angry physician telephoned me recently. Just back from a hard day with his patients, he said, he had read — I'd say, misread — a newspaper article I had written about health care. Though he wasn't mentioned in the article, he wanted to know, as he more or less put it, why the press is hostile to his profession.He explained that he does not defraud Medicare or Medicaid, does not subject his patients to needless operations or engage in any of the many other practices for which medicine is now routinely lambasted in print and on the airwaves. . . .
Iron Absorption and Blood Loss in Patients with Hiatus Hernia
Authors: J. M. Holt, F. G. H. Mayet, G. T. Warner, S. T. Callender, A. J. Gunning
Journal: BMJ (1968)

Iron absorption was measured in 28 patients, 19 of whom were anaemic. The mean absorption in the anaemic patients was 39% and in the non-anaemic patients 8%. Gastrointestinal blood loss was then measured in 26 of these patients. The mean estimated blood loss in the anaemic patients was 15 ml. a day and in the non-anaemic patients 3 ml. a day. In 16 of the 19 anaemic patients symptoms of anaemia were either the sole or the major complaint.
Pityriasis rosea–like eruption during treatment with imatinib mesylate: Description of 3 cases
Authors: Valeria Brazzelli, Francesca Prestinari, Elena Roveda, Tania Barbagallo, Eleonora Bellani, Camilla Vassallo, Ester Orlandi, Francesco Passamonti, Giovanni Borroni
Journal: Journal of the American Academy of Dermatology (2005)
Abstract 847: Resolvin D1 stimulates efferocytosis through p50/p50-mediated suppression of tumor necrosis factor-α
Authors: Ha-Na Lee, Joydeb Kumar Kundu, Jun-Wan Shin, Young-Nam Cha, Young-Joon Surh
Journal: Cancer Research (2011)

Abstract Phagocytosis of apoptotic neutrophils by macrophages, called efferocytosis, is critical to resolution of inflammation as this process prevents the exposure of surrounding tissues at the inflammatory site to the toxic contents of lytic cells. Docosahexaenoic acid-derived resolvin D1 (RvD1), endogenously generated during resolution of inflammation, is known to stimulate efferocytosis, but little is known about the mechanism of its action. In the present study, we found that lipopolysaccharide (LPS; 200 μg/ml) suppressed efferocytosis by murine macrophage-like RAW264.7 cells, and RvD1 (50 nM) restored the phagocytic ability of these cells by down-regulating TNF-α expression. The inhibitory effect of RvD1 on LPS-induced TNF-α expression was associated with enhanced nuclear localization of p50/p50 homodimer and concomitant reduction in the nuclear levels of p65/p50 heterodimer. RvD1 triggered extracellular signal-regulated kinase (ERK)- and Akt-mediated nuclear factor κB1 (NF-κB1) p105 degradation and subsequently translocation of p50/p50 homodimer to nucleus in RAW264.7 cells. In contrast, LPS-induced nuclear translocation and DNA binding of p65/p50 heterodimer were attenuated by RvD1 treatment through inhibition of IκBα degradation. siRNA knockdown of NF-κB p50 abolished RvD1-mediated suppression of TNF-α expression and resulted in impaired efferocytosis, suggesting that the replacement of p65/p50 with p50/p50 homodimer is an essential event for RvD1-mediated stimulation of efferocytosis. In a murine peritonitis model, intraperitoneal administration of RvD1 (300 ng) abrogated zymosan A (30 mg/kg)-induced TNF-α production, thereby reactivating efferocytosis. In addition, RvD1 significantly reduced polymorphonuclear leukocyte infiltration while it increased monocyte infiltration. Taken together, these findings indicate that RvD1 expedites resolution of inflammation via p50/p50-mediated repression of TNF-α production. 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 847. doi:10.1158/1538-7445.AM2011-847
Genetic Ablation of the Amplified-in-Breast Cancer 1 Inhibits Spontaneous Prostate Cancer Progression in Mice
Authors: Arthur C-K. Chung, Suoling Zhou, Lan Liao, Jean Ching-Yi Tien, Norman M. Greenberg, Jianming Xu
Journal: Cancer Research (2007)

Abstract Although the amplified-in-breast cancer 1 (AIB1; SRC-3, ACTR, or NCoA3) was defined as a coactivator for androgen receptor (AR) by in vitro studies, its role in AR-mediated prostate development and prostate cancer remained unexplored. We report here that AIB1 is expressed in the basal and stromal cells but not in the epithelial cells of the normal mouse prostates. AIB1 deficiency only slightly delayed prostate growth and had no effect on androgen-dependent prostate regeneration, suggesting an unessential role of AIB1 in AR function in the prostate. Surprisingly, when prostate tumorigenesis was induced by the SV40 transgene in transgenic adenocarcinoma of the mouse prostate (TRAMP) mice, AIB1 expression was observed in certain epithelial cells of the prostate intraepithelial neoplasia (PIN) and well-differentiated carcinoma and in almost all cells of the poorly differentiated carcinoma. After AIB1 was genetically inactivated in AIB1−/−/TRAMP mice, the progression of prostate tumorigenesis in most AIB1−/−/TRAMP mice was arrested at the well-differentiated carcinoma stage. Wild-type (WT)/TRAMP mice developed progressive, multifocal, and metastatic prostate tumors and died between 25 and 34 weeks. In contrast, AIB1−/−/TRAMP mice only exhibited PIN and early-stage well-differentiated carcinoma by 39 weeks. AIB1−/−/TRAMP prostates showed much lower cell proliferation than WT/TRAMP prostates. Most AIB1−/−/TRAMP mice could survive more than 35 weeks and died with other types of tumors or unknown reasons. Our results indicate that induction of AIB1 expression in partially transformed epithelial cells is essential for progression of prostate tumorigenesis into poorly differentiated carcinoma. Inhibition of AIB1 expression or function in the prostate epithelium may be a potential strategy to suppress prostate cancer initiation and progression. [Cancer Res 2007;67(12):5965–75]
BUPA and consultants over 70
Authors: J Luder
Journal: BMJ (1993)

patients with extensive psoriasis who applied 200 g of calcipotriol for one week followed by 300 g for a second week.Mean serum calcium concentration rose from 2 26mmol/1 to 2-33mmolQ (p<0-01; normal values 2 1-2-6mmolI/) and mean urinary calcium excretion from 4-79 mmol/24 h to 7-27mmol/24h (p<0-01).None ofthem developed hypercalcaemia, and in all of them changes in serum calcium concentration were seen within the first two weeks of treatment, values falling rapidly (two weeks) after withdrawal of calcipotriol.This is to be expected given the rapid systemic metabolism of calcipotriol and the inactivity of its metabolites.5We suggest that delayed hypercalcaemia in the two patients of Hardman and colleagues is an unexpected event.On the basis of these two cases the authors recommend monitoring serum calcium concentration routinely in patients using calcipotriol.Before this recommendation can be accepted other causes of hypercalcaemia must be excluded in these cases.All other available evidence indicates that serum calcium concentra- tion remains unaltered with a dose of less than lOOg of calcipotriol a week.At the upper limit of the recommended dose there is a small effect on calcium homoeostasis.This is detectable by measuring urinary calcium excretion but serum calcium concentration is unchanged.
Medical Mystery, Medical Humility
Authors: Gordon Mehler
Journal: Annals of Internal Medicine (2009)

On Being a Patient18 August 2009Medical Mystery, Medical HumilityGordon Mehler and Ariel ZwangGordon MehlerFrom Law Offices of Gordon Mehler, PLLC, Safe Horizon, New York, NY 10017.Search for more papers by this author and Ariel ZwangFrom Law Offices of Gordon Mehler, PLLC, Safe Horizon, New York, NY 10017.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-4-200908180-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail “To be a good doctor, sometimes you must envision yourself as slightly stupid.” When a physician friend told us this after our 9-year-old, Grace, mysteriously got very sick, the thought was hardly comforting. After all, good doctors are supposed to have answers to medical problems. But when various specialists were stumped by our daughter's condition, we gradually came to understand what he meant.Our learning experience began when Grace became listless after a bout of vomiting that we assumed was caused by a minor, school-acquired virus. Her continued vomiting quickly dehydrated her, causing her to be hospitalized twice in the ... Author, Article, and Disclosure InformationAffiliations: From Law Offices of Gordon Mehler, PLLC, Safe Horizon, New York, NY 10017.Corresponding Author: Gordon Mehler, 747 Third Avenue, 32nd Floor, New York, NY 10017; e-mail, [email protected]com. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 August 2009Volume 151, Issue 4Page: 283-284KeywordsAntibioticsBloodBrainCentral nervous systemInfectious diseasesMycoplasmaPediatric infectionsSteroidsVomitingWalking ePublished: 18 August 2009 Issue Published: 18 August 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...