tbuckley/cabot-search huggingface dataset:
Determinants and importance of stress hyperglycaemia in non-diabetic patients with myocardial infarction.
Authors: G A Oswald, C C Smith, D J Betteridge, J S Yudkin
Journal: BMJ (1986)

Determinants of plasma glucose concentrations were studied in patients on admission to hospital with confirmed acute myocardial infarction but without previous glucose intolerance as evidenced by raised concentrations of glycosylated haemoglobin (HbAlc). Mortality in hospital increased significantly with increasing plasma concentrations of glucose in patients with both normal (p less than 0.0001, n = 311) and borderline (p less than 0.02, n = 70) concentrations of HbAlc. There was a weak relation between plasma glucose concentrations and infarct size as estimated by peak aspartate transaminase activity in both HbAlc groups (rs = 0.26, n = 101 and rs = 0.41, n = 35 respectively). A correlation was found between adrenaline and plasma glucose concentrations (r = 0.47, n = 27) and cortisol and plasma glucose concentrations (r = 0.75, n = 19), but the relation of plasma noradrenaline and plasma glucose suggested a threshold effect. Concentrations of adrenaline, but not those of noradrenaline or cortisol, correlated with infarct size as measured both by peak aspartate transaminase activity and cumulative release of creatine kinase MB isoenzyme. Multiple regression analysis showed that concentrations of cortisol, adrenaline, and noradrenaline (but not the concentration of HbAlc, infarct size, or age) are the main determinants of plasma glucose concentration measured in non-diabetic patients when admitted to hospital after acute myocardial infarction.
Cardiac PET Improves Image Interpretation for Patient With Connected Extracardiac Activity in Cardiac SPECT
Authors: Bailing Hsu, Chia-Hung Kao, Guang-Uei Hung
Journal: Clinical Nuclear Medicine (2010)

High extracardiac activity connected to the myocardium in cardiac single photon emission computed tomography (SPECT) frequently interferes with the reader's interpretation confidence as a result to reduce the diagnostic accuracy. Limitations are recognized as low spatial resolution of SPECT with parallel-hole collimation and large scatter component from liver or bowel that mainly affects interpretation for defects in the inferior wall. Cardiac positron emission tomography (PET) with higher spatial resolution and more robust scatter correction clinically is an alternative for nuclear myocardial perfusion test and can be further considered as the solution for the patient with a difficult SPECT study. In this article, we demonstrate the role of PET by directly comparing SPECT images with PET images on the same patient.
An Electronic Case Manager for Diabetes Control
Authors: Luigi F Meneghini, A Michael Albisser, Ronald B Goldberg, Daniel H Mintz
Journal: Diabetes Care (1998)

OBJECTIVE To evaluate the usage and safety of an electronic case manager (ECM) system designed to facilitate the task of glycemic control. Sustained improvement in blood glucose control is the proven treatment outcome that will reduce or eliminate the long-term complications of diabetes. RESEARCH DESIGN AND METHODS A customized microcomputer system served as the ECM. Located at the clinic, this voice-interactive system required the remote patient to need only a touch-tone telephone. Patients accessed the system to report daily selfmeasured glucose levels or hypoglycemic symptoms together with associated lifestyle events. System beta-testing was in an open-case series (n = 184) in an academic diabetes center with the goal of evaluating the ECM in terms of utilization, frequency of crises, and fiscal matters. RESULTS Of the patients, 58% (n = 107) actively used the ECM for their daily diabetes care, accumulating 788 patient-months of follow-up. Over 45,000 telephone calls were received by the ECM during the start-up year. Each call was processed instantly and automatically. Patients benefited from having 24-h access to the ECM. Prevalence of diabetes-related crises (hyperglycemia =400 mg/dl [22 mmol/1] or hypoglycemia &amp;lt;50 mg/dl [2.8 mmol/1]) decreased approximately threefold (P &amp;lt; 0.05), with a concomitant statistically significant decrease in HbA1c of 0.8% at 6 months (n = 45, P = 0.024) and 0.9% at 12 months (n = 30, P = 0.044). The ECM provided 24-h on-line assistance in adjusting daily insulin and/or tablet therapy, automatic generation of standardized medical reports, electronic medical-legal documentation, as well as a marked reduction in the time spent on the phone with patients. Clinic visits in managing complex diabetes were reduced approximately twofold (P &amp;lt; 0.0001), and the effort spent by case managers was estimated. CONCLUSIONS Patients with diabetes who accessed the ECM system received timely, cost-effective, and reliable medical intervention. This reduced the incidence of diabetic crises and the need for frequent clinic visits. The ECM empowers case managers to provide safer and superior diabetes care.
Diagnosis in Urinary Frequency-Reply
Authors: F. A. Fried
Journal: JAMA (1978)

<h3>In Editor.—</h3> Dr Burnett is correct in reminding us that the hypertrophied bladder muscle associated with benign prostatic hyperplasia can produce symptoms of urgency and frequency. I did not include this in my response, as it appeared that the urological evaluation performed eliminated this as a possibility. A micturition flow study is certainly simple to obtain and noninvasive. However, it is nonspecific and will probably not permit making a more specific diagnosis.
A Speech Recognition (SR) Reminder System Improves Adherence to ICS Among Pediatric Asthma Patients
Authors: P.J. Cvietusa, D.J. Magid, G. Goodrich, N. Wagner, R. Lowe, H. Nuanes, S. Shetterly, C. Tacinas, F.S. Wamboldt, S. Xu, B.G. Bender
Journal: Journal of Allergy and Clinical Immunology (2012)
Dostoevsky and the Healing Art: An Essay in Literary and Medical History
Authors: Frederick Butzen
Journal: JAMA (1986)

In his book<i>Six Armies in Normandy</i>, John Keegan describes the exploits of SGT Harrison Summers of the First Airborne Division of the US Army. Soon after his unit had parachuted behind German lines during the Normandy invasion, it was endangered by gunfire from a cluster of stone farmhouses occupied by German troops. Accompanied by only two other men, Summers attacked them. Keegan describes the attack as follows: Summers charged... and kicked the door open to find inside, inexplicably deaf to the fight raging around them, 15 German artillerymen seated at mess tables eating breakfast. He paused neither to reason why nor think of mercy; battle-crazed, he shot them all down in their places. When the battle was over, Summers collapsed from exhaustion. When someone asked how he felt, he replied, "Not very good. It was kind of crazy." If one puts aside for a moment considerations of Summers' bravery
TCT-670 Impact of Moderate and Severe Coronary Calcification on 1-Year Outcomes after PCI with DES: A Pooled Analysis of 11,651 Patients from 14 Randomized Trials
Authors: Philippe Genereux, Ajay Kirtane, Sorin Brener, Akiko Maehara, Tullio Palmerini, Martin Fahy, Roxana Mehran, Gregg Stone
Journal: Journal of the American College of Cardiology (2012)
X-linked protocadherin 19 mutations cause female-limited epilepsy and cognitive impairment
Authors: Leanne M Dibbens, Patrick S Tarpey, Kim Hynes, Marta A Bayly, Ingrid E Scheffer, Raffaella Smith, Jamee Bomar, Edwina Sutton, Lucianne Vandeleur, Cheryl Shoubridge, Sarah Edkins, Samantha J Turner, Claire Stevens, Sarah O'Meara, Calli Tofts, Syd Barthorpe, Gemma Buck, Jennifer Cole, Kelly Halliday, David Jones, Rebecca Lee, Mark Madison, Tatiana Mironenko, Jennifer Varian, Sofie West, Sara Widaa, Paul Wray, John Teague, Ed Dicks, Adam Butler, Andrew Menzies, Andrew Jenkinson, Rebecca Shepherd, James F Gusella, Zaid Afawi, Aziz Mazarib, Miriam Y Neufeld, Sara Kivity, Dorit Lev, Tally Lerman-Sagie, Amos D Korczyn, Christopher P Derry, Grant R Sutherland, Kathryn Friend, Marie Shaw, Mark Corbett, Hyung-Goo Kim, Daniel H Geschwind, Paul Thomas, Eric Haan, Stephen Ryan, Shane McKee, Samuel F Berkovic, P Andrew Futreal, Michael R Stratton, John C Mulley, Jozef Gécz
Journal: Nature Genetics (2008)
Employment-Seeking Experiences of Resident Physicians Completing Training During 1996
Authors: Rebecca S. Miller
Journal: JAMA (1998)

Context.—Studies analyzing the physician workforce have concluded that the United States is verging on a physician oversupply, yet we lack persuasive evidence that this is resulting in physician underemployment and/or unemployment.Objective.—To determine the degree to which graduating residents have difficulty finding or are unable to find employment in their primary career choices.Design.—Two 1-page surveys sent separately to residents and to program directors to collect information on the employment status of residents who were completing a graduate medical education program at the end of the 1995-1996 academic year.Setting.—A total of 25067 resident physicians scheduled in the spring of 1996 to complete a residency program accredited by the Accreditation Council on Graduate Medical Education, and 4569 program directors in 31 specialties and subspecialties.Main Outcome Measure.—Both the graduates' employment status and the degree of difficulty they experienced securing a practice position, as reported by resident physicians and program directors.Results.—After 6 months of data collection, 12135 (48.4%) of 25067 resident physicians responded to the survey. Of the respondents, 11200 had completed their training, and 7628 (68.1%) were attempting to enter the workforce, 28.4% were seeking additional training, and 3.5% were fulfilling their military obligations. Of the 7628 resident physicians who sought employment, 67.3% obtained clinical practice positions in their specialties, 15.5% took academic positions, 5.0% found clinical positions in other specialties, 5.1% had other plans, and 7.1% did not yet have positions but were actively looking. In addition, 22.4% of resident physicians who found clinical positions reported significant difficulty finding them. The subgroup reporting greater difficulty finding clinical positions included international medical graduates (more than 40%), those completing programs in the Pacific or East North Central region, and those in several specialties. The 1996 graduating residents reported significantly higher rates of difficulty finding suitable employment than program directors reported for their graduates (22.4% vs 6.0%); however, the percentage of graduates reported by both groups as entering the workforce was the same (68.1%). Program directors reported an unemployment rate of only 1.2%, for their 1996 graduates, which was less than the rate reported by the resident physicians (7.1%).Conclusions.—Resident physicians' direct reports of their employment-seeking experiences differ from what program directors report. Program directors accurately determined the number of residents pursuing further training; however, they did not have complete information about the employment difficulties experienced by their graduates. Based on graduates' reports, we conclude that employment difficulties are greatest among international medical graduates and vary by specialty and geographic region.
Lack of Effect of Guideline Changes on LDL Cholesterol Reporting and Control for Diabetes Visits in the U.S., 1995–2004
Authors: Y. Richard Wang, G. Caleb Alexander, David O. Meltzer
Journal: Diabetes Care (2005)

e studied the effects of guideline changes on LDL cholesterol reporting and control for diabetes visits compared with coronary heart disease (CHD) visits in the U.S. between 1995 and 2004.In January 1998, the American Diabetes Association (ADA) advocated an LDL cholesterol goal of Ͻ100 mg/dl for patients with diabetes (1).Subsequently, in May 2001, the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults published its third report (Adult Treatment Panel III [ATP III]) that designated diabetes as a CHD risk equivalent, with the same LDL cholesterol goal of Ͻ100 mg/dl (2). RESEARCH DESIGN AND METHODS -The publication of the ADA and ATP III guidelines provides an opportunity to assess the effect of guideline changes on LDL cholesterol reporting and control for diabetes visits.The publication of guidelines does not ensure timely communication to the practicing physician let alone the adoption into patient care.As the treatment strategy for CHD remained unchanged (2), we used CHD visits as the control group for the time trends of LDL cholesterol reporting and control.
Immunologic tolerance in lymphatic filariasis. Diminished parasite-specific T and B lymphocyte precursor frequency in the microfilaremic state.
Authors: C L King, V Kumaraswami, R W Poindexter, S Kumari, K Jayaraman, D W Alling, E A Ottesen, T B Nutman
Journal: Journal of Clinical Investigation (1992)

To explore the mechanisms of antigen-specific immune unresponsiveness seen in microfilaremic patients with bancroftian filariasis, T and B cell precursor frequency analysis was performed using PBMC from individuals with either asymptomatic microfilaremia (MF, n = 7) or chronic lymphatic obstruction (CP, n = 20). Highly purified CD3+ cells were partially reconstituted with adherent cells and their proliferative response to parasite antigens determined in cultures of T cells by limiting dilution analysis. A filter immunoplaque assay also assessed the frequency of both total and parasite-specific Ig-producing B cells. While the lymphocyte proliferation to mitogens and to a nonparasite antigen (Streptolysin-O, [SLO]) were similar in all groups of patients, the frequency of parasite-specific CD3+ T cells was significantly lower (geometric mean [GM], 1/3,757) in MF patients when compared to that in CP patients (GM 1/1,513; P less than 0.001). Similarly, the proportion of lymphocytes producing parasite-specific IgE or IgG was significantly lower in MF patients (IgE mean, 0.2%; IgG mean, 0.33%) compared with CP patients (IgE mean, 3.2%; IgG mean, 1.76%; P less than 0.05 for both comparisons). These observations imply that low numbers of parasite-specific T and B lymphocytes may be partially responsible for the severely diminished capacity of lymphocytes from patients with MF to produce parasite-specific antibody and to proliferate to parasite antigen in vitro. Such differences in parasite-specific lymphocyte responses suggest that tolerance by clonal anergy may be a critical mechanism for maintaining the microfilaremic state.
Cultural and reproductive success in industrial societies: Testing the relationship at the proximate and ultimate levels
Authors: Daniel Pérusse
Journal: Behavioral and Brain Sciences (1993)

Abstract In most social species, position in the male social hierarchy and reproductive success are positively correlated; in humans, however, this relationship is less clear, with studies of traditional societies yielding mixed results. In the most economically advanced human populations, the adaptiveness of status vanishes altogether; social status and fertility are uncorrelated. These findings have been interpreted to suggest that evolutionary principles may not be appropriate for the explanation of human behavior, especially in modern environments. The present study tests the adaptiveness of social status with actual mating and reproductive data in a representative sample of males from an industrial society. Reproductive success, even when assessed by a more reliable measure of actual male fertility than the one commonly used, fails to correlate with social status. In striking contrast, however, status is found to be highly correlated with potential fertility, as estimated from copulation frequency. Status thus accounts for as much as 62% of the variance in this proximate component of fitness. This pattern is remarkably similar to what is found in many traditional societies and would result in a substantial positive relationship between cultural and reproductive success in industrial populations were it not for the novel conditions imposed by contraception and monogamy. Various underlying mechanisms are suggested for these findings, illustrating the value of current behavioral and reproductive data in the study of adaptation. It is concluded that evolutionary explanations of human behavior remain entirely relevant in modern societies.
Vascular dysfunction induced by elevated glucose levels in rats is mediated by vascular endothelial growth factor.
Authors: R G Tilton, T Kawamura, K C Chang, Y Ido, R J Bjercke, C C Stephan, T A Brock, J R Williamson
Journal: Journal of Clinical Investigation (1997)

The purpose of these experiments was to investigate a potential role for vascular endothelial growth factor (VEGF) in mediating vascular dysfunction induced by increased glucose flux via the sorbitol pathway. Skin chambers were mounted on the backs of Sprague-Dawley rats and 1 wk later, granulation tissue in the chamber was exposed twice daily for 7 d to 5 mM glucose, 30 mM glucose, or 1 mM sorbitol in the presence and absence of neutralizing VEGF antibodies. Albumin permeation and blood flow were increased two- to three-fold by 30 mM glucose and 1 mM sorbitol; these increases were prevented by coadministration of neutralizing VEGF antibodies. Blood flow and albumin permeation were increased approximately 2.5-fold 1 h after topical application of recombinant human VEGF and these effects were prevented by nitric oxide synthase (NOS) inhibitors (aminoguanidine and N(G)-monomethyl L-arginine). Topical application of a superoxide generating system increased albumin permeation and blood flow and these changes were markedly attenuated by VEGF antibody and NOS inhibitors. Application of sodium nitroprusside for 7 d or the single application of a calcium ionophore, A23187, mimicked effects of glucose, sorbitol, and VEGF on vascular dysfunction and the ionophore effect was prevented by coadministration of aminoguanidine. These observations suggest a potentially important role for VEGF in mediating vascular dysfunction induced by "hypoxia-like" cytosolic metabolic imbalances (reductive stress, increased superoxide, and nitric oxide production) linked to increased flux of glucose via the sorbitol pathway.
Management of sepsis
Authors: Iain Mackenzie, Andrew Lever
Journal: BMJ (2007)

This is the second of two reviews—the first discussed the definition, epidemiology, and diagnosis of sepsis, whereas this one focuses on management and outcome. Management of sepsis can conveniently be divided into general supportive measures and specific treatment.

#### Summary points

Circulatory compromise arises from the combination of vasodilatation, capillary leak, and reduced myocardial contractility, and needs early correction. Whether crystalloids or colloids are better for volume resuscitation remains unresolved. Few people now use human albumin after a controversial meta-analysis concluded that albumin was associated with a 6% excess mortality.1 A subsequent randomised controlled trial found no difference in any of the outcome measures examined, including mortality.2 Another question is how to gauge the adequacy of fluid resuscitation. The pulmonary artery catheter has not been shown to be associated with either harm or benefit,3 4 and its use is declining. Clinical end points (box 1) remain useful, although some centres are also using oesophageal Doppler or pulse contour analysis. These methods provide information on the effect of fluid loading on cardiac output and stroke volume. In ventilated patients, variation in stroke volume can be used as an index of preload.

#### Box 1 Clinical and functional end points for titration of fluid resuscitation

Catecholamines are needed when fluids are insufficient to …
Confocal laser endomicroscopy: technical status and current indications
Authors: A. Hoffman, M. Goetz, M. Vieth, P. Galle, M. Neurath, R. Kiesslich
Journal: Endoscopy (2006)

Confocal laser endomicroscopy is a newly introduced endoscopic tool that makes it possible to carry out confocal microscopic examination of the mucosal layer during ongoing endoscopy. Different types of tissue and diseases can be diagnosed immediately, facilitating early diagnosis of gastrointestinal cancer. Analysis of the in vivo microarchitecture is helpful in targeting biopsies to relevant areas. In addition, subsurface imaging can unmask microscopic diseases - (microscopic colitis) or bacterial infection (Helicobacter pylori), for example. Molecular imaging is becoming feasible, and this will shortly open the door to new indications in gastrointestinal endoscopy (e.g., in vivo receptor analysis).
Something Fishy Going on in the Heart
Authors: James de la Torre, Julius Bishop
Journal: New England Journal of Medicine (2002)

Figure 1. An important component of the second-year pathology course at medical school is becoming familiar with the microscopical manifestations of pathologic processes. While examining tissue from a patient with a subendocardial myocardial infarction at a two-headed microscope, students identified a blood vessel that looked a little fishy. This slide demonstrates myocardial fibrosis after a subendocardial infarction. Fibrotic tissue is apparent around remaining viable myofibers. The labeled blood vessel (arrow) is cut in such a way that it has a familiar appearance that is particularly appetizing to proponents of n–3 fatty acids.
Extraordinarily High F-18 FDG Uptake Caused by a Pleomorphic Adenoma of the Parotid Gland
Authors: Keh-Bin Wang, Guang-Uei Hung, Wan-Yu Lin
Journal: Clinical Nuclear Medicine (2006)

A 53-year-old man received an FDG-PET scan as a follow-up study for previous colon polyps. The FDG-PET scan revealed an area of extraordinary high FDG uptake at the left parotid region. Computed tomography (CT) showed a 1.6-cm contrast-enhancing nodule in the left parotid gland and the nodule was surgically removed. The histopathologic report confirmed the lesion was a pleomorphic adenoma (benign mixed tumor) of the left parotid gland.
Lipoprotein Lipase Mutations, Plasma Lipids and Lipoproteins, and Risk of Ischemic Heart Disease
Authors: Hans H. Wittrup, Anne Tybjærg-Hansen, Børge G. Nordestgaard
Journal: Circulation (1999)

Background —We assessed in meta-analyses the effect of the Gly188Glu, Asp9Asn, Asn291Ser, and Ser447Ter substitutions in lipoprotein lipase in the heterozygous state on lipid metabolism and risk of ischemic heart disease (same order used below). Methods and Results —In 29 separate studies, 20 903 white subjects were screened for ≥1 of these substitutions; each meta-analysis included only some of these individuals. In population-based studies, heterozygote frequencies ranged from 0.04% to 0.2%, 2% to 4%, 1% to 7%, and 17% to 22% for the respective substitutions. Postheparin plasma lipoprotein lipase activity decreased 53% (95% CI, 31% to 75%) (only 1 study), 30% (22% to 37%), and 22% (8% to 35%) and was unchanged at 4% (−10% to 19%), respectively. Plasma triglycerides increased 78% (95% CI, 64% to 92%), 20% (9% to 33%), and 31% (20% to 43%) and decreased 8% (4% to 11%), respectively. HDL cholesterol decreased 0.25 mmol/L (0.18 to 0.32), 0.08 mmol/L (0.04 to 0.12), and 0.12 mmol/L (0.10 to 0.15) and increased 0.04 mmol/L (0.02 to 0.06), respectively. Odds ratios for ischemic heart disease were 4.9 (95% CI, 1.2 to 20) (only 1 study), 1.4 (0.8 to 2.4), 1.2 (0.9 to 1.5), and 0.8 (0.7 to 1.0), respectively. Subgroup analysis indicated that women with the Asn291Ser substitution may have an increased risk of ischemic heart disease. Conclusions —These meta-analyses suggest that compared with noncarriers, carriers of the Gly188Glu, Asp9Asn, and Asn291Ser substitutions have an atherogenic lipoprotein profile, whereas carriers of the Ser447Ter substitution have a protective lipoprotein profile. Accordingly, risk of ischemic heart disease in heterozygous carriers is increased for Gly188Glu carriers; at most, the increase is borderline for Asp9Asn and Asn291Ser carriers; and risk is possibly decreased for Ser447Ter carriers.