tbuckley/cabot-search huggingface dataset:
Clinical significance of azathioprine metabolites for the maintenance of remission in autoimmune hepatitis
Authors: Harpreet K. Dhaliwal, Rory Anderson, Elizabeth L. Thornhill, Sarah Schneider, Elaine McFarlane, Dermot Gleeson, Lynne Lennard
Journal: Hepatology (2012)

Azathioprine (AZA) is used to maintain remission in autoimmune hepatitis (AIH), but up to 18% of patients are unresponsive. AZA is a prodrug, and the formation of active thioguanine nucleotide (TGN) metabolites varies widely. We aimed to assess the relationship between AZA metabolite concentrations (i.e., TGNs and methylmercaptopurine nucleotides [MeMPNs]), thiopurine methyltransferase (TPMT) activity, therapeutic response, and toxicity in adult patients with AIH prescribed a stable dose of AZA for the maintenance of remission. Red blood cell (RBC) TGNs and MeMPNs were measured in serial blood samples over a 2-year period. The average TGNs (avTGNs) and MeMPNs (avMeMPNs) concentrations for each patient were used for analysis. Therapeutic response was defined as the ability to maintain remission, defined as a normal serum alanine aminotransferase (ALT) level (ALT <33 IU/mL). Patients who maintained remission (n = 53), compared to those who did not (n = 17), tended to be on lower doses of AZA (1.7 versus 2.0 mg/kg/day; P = 0.08), but had significantly higher concentrations of avTGN (237 versus 177 pmol/8 × 108 RBCs; P = 0.025). There was no difference in MeMPN concentrations or TPMT activities between the two groups. There was a negative correlation between ALT and avTGN (rs = −0.32; P = 0.007). An avTGN concentration of >220 pmol/8 × 108 RBCs best predicted remission, with an odds ratio of 7.7 (P = 0.003). There was no association between TGN, MeMPN, or TPMT activity and the development of leucopenia. Two patients developed AZA-induced cholestasis and the avMeMPN concentration was higher in those patients, compared to those who did not (14,277 versus 1,416 pmol/8 × 108 RBCs). Conclusion: TGN concentrations of >220 pmol/8 × 108 RBCs are associated with remission. TGN measurement may help identify inadequate immunosupression. AZA-induced cholestasis was associated with increased MeMPN concentrations. (HEPATOLOGY 2012)
Intimate partner violence affects men as well as women
Authors: S. Bhattacherjee
Journal: BMJ (2014)

O’Doherty and colleagues’ meta-analysis of the effectiveness of screening women for intimate partner violence highlights the sex bias in the reporting of, and research into, this subject.1 Domestic violence is widely presented as, and perceived to be, a women’s health problem, and the authors make no reference to men who are victims of such violence.

The most …
Switzerland holds referendum on genetic engineering
Authors: A. Mach
Journal: BMJ (1998)

The Swiss public will decide in a referendum on 7 June whether to endorse an initiative banning the production and distribution of transgenic animals, field trials with genetically modified organisms of any sort, and the patenting of genetically modified animals and plants. The ramifications for Swiss biotechnology research, university teaching, clinical patients, and the national economy are unprecedented.

Given that biotechnology is one of Switzerland's key industries, with two of the world's most successful pharmaceutical companies, Novartis and Roche, based in the country, it is small wonder that there has been wide public debate.

Feature articles fill the Swiss papers, call-in radio programmes abound, and emotionally manipulative placards fill the streets: “Genetic engineering saves lives: don't kill their hopes. Vote NO to the initiative to prohibit genetic engineering,” countered a few metres farther on by another poster …
Medical Diagnosis through Semiotics: Giving Meaning to the Sign
Authors: John F. Burnum
Journal: Annals of Internal Medicine (1993)

Physicians are engaged in incorporating quantitative methods for making clinical decisions into their practices. An acquaintance with semiotics, the doctrine of signs, may complement this project. A sign stands for something. We communicate indirectly through signs, and by interpreting what signs mean we make sense of our world and diagnose and understand our patients. Thus, through association and inference, we transform flowers into love, Othello into jealousy, and staring eyes into thyrotoxicosis. Characteristically in diagnosis, beginning with an unstable inference, we test and otherwise ask questions likely to produce signs that support (or discredit) our hypothesis. In a literary sense, we join with the author to clarify and rewrite the text; creative interpretation is the key. Diagnosis is concluded through narration, by the meaning that is revealed by telling the story of the patient. Diagnosis will succeed only to the extent that we respect the principles and caveats of sign interpretation. The sign is both the key to the unknown and the master impersonator. The sign and its meaning are usually not the same; meaning has to be inferred. Because interpretations are made subjectively, they are circumscribed by the experience and bias of the clinician. Moreover, the contexts in which the sign appears shape the meaning of the sign and may change it altogether.
Including post-discharge mortality in calculation of hospital standardised mortality ratios: retrospective analysis of hospital episode statistics
Authors: M. E. Pouw, L. M. Peelen, K. G. M. Moons, C. J. Kalkman, H. F. Lingsma
Journal: BMJ (2013)

<b>Objectives</b> To assess the consequences of applying different mortality timeframes on standardised mortality ratios of individual hospitals and, secondarily, to evaluate the association between in-hospital standardised mortality ratios and early post-discharge mortality rate, length of hospital stay, and transfer rate. <b>Design</b> Retrospective analysis of routinely collected hospital data to compare observed deaths in 50 diagnostic categories with deaths predicted by a case mix adjustment method. <b>Setting</b> 60 Dutch hospitals. <b>Participants</b> 1 228 815 patients discharged in the period 2008 to 2010. <b>Main outcome measures</b> In-hospital standardised mortality ratio, 30 days post-admission standardised mortality ratio, and 30 days post-discharge standardised mortality ratio. <b>Results</b> Compared with the in-hospital standardised mortality ratio, 33% of the hospitals were categorised differently with the 30 days post-admission standardised mortality ratio and 22% were categorised differently with the 30 days post-discharge standardised mortality ratio. A positive association was found between in-hospital standardised mortality ratio and length of hospital stay (Pearson correlation coefficient 0.33; P=0.01), and an inverse association was found between in-hospital standardised mortality ratio and early post-discharge mortality (Pearson correlation coefficient −0.37; P=0.004). <b>Conclusions</b> Applying different mortality timeframes resulted in differences in standardised mortality ratios and differences in judgment regarding the performance of individual hospitals. Furthermore, associations between in-hospital standardised mortality rates, length of stay, and early post-discharge mortality rates were found. Combining these findings suggests that standardised mortality ratios based on in-hospital mortality are subject to so-called "discharge bias." Hence, early post-discharge mortality should be included in the calculation of standardised mortality ratios.
Noninvasive Monitoring of Tumors
Authors: Joan H. Schiller
Journal: New England Journal of Medicine (2008)

The treatment of non–small-cell lung cancer has made limited but clinically significant progress during the past two decades of clinical research. Through carefully designed clinical trials, investigators have identified several chemotherapeutic drugs to combat this disease. Many questions have been asked and answered. Which combinations work best? How frequently should they be given and for how long? And which patients should be treated?1 Nonetheless, such advances have been limited, and the prognosis for patients with advanced disease remains grim.Despite the modest results achieved with conventional cytotoxic chemotherapeutic agents, the past several decades of basic cancer research have started to . . .
Orthopaedic consultant is responsible in hip fracture
Authors: Paul Diggory
Journal: BMJ (2007)

Anwar and Ahmed highlight the difficulties making cardiopulmonary resuscitation (CPR) decisions for elderly people with hip fracture.1 Published guidance and the law are confusing,2 3 but there is a logical approach to using them. 

It is not practicable to make a resuscitation decision on everybody in hospital. If an arrest is ‘‘foreseeable,'' guidelines supported by common law and common sense dictate that a decision needs …
Administrative Data Feedback for Effective Cardiac Treatment
Authors: Christine A. Beck, Hugues Richard, Jack V. Tu, Louise Pilote
Journal: JAMA (2005)

ContextHospital report cards are increasingly being implemented for quality improvement despite lack of strong evidence to support their use.ObjectiveTo determine whether hospital report cards constructed using linked hospital and prescription administrative databases are effective for improving quality of care for acute myocardial infarction (AMI).DesignThe Administrative Data Feedback for Effective Cardiac Treatment (AFFECT) study, a cluster randomized trial.Setting and PatientsPatients with AMI who were admitted to 76 acute care hospitals in Quebec that treated at least 30 AMI patients per year between April 1, 1999, and March 31, 2003.InterventionHospitals were randomly assigned to receive rapid (immediate; n = 38 hospitals and 2533 patients) or delayed (14 months; n = 38 hospitals and 3142 patients) confidential feedback on quality indicators constructed using administrative data.Main Outcome MeasuresQuality indicators pertaining to processes of care and outcomes of patients admitted between 4 and 10 months after randomization. The primary indicator was the proportion of elderly survivors of AMI at each study hospital who filled a prescription for a β-blocker within 30 days after discharge.ResultsAt follow-up, adjusted prescription rates within 30 days after discharge were similar in the early vs late groups (for β-blockers, odds ratio [OR], 1.06; 95% confidence interval [CI], 0.82-1.37; for angiotensin-converting enzyme inhibitors, OR, 1.17; 95% CI, 0.90-1.52; for lipid-lowering drugs, OR, 1.14; 95% CI, 0.86-1.50; and for aspirin, OR, 1.05; 95% CI, 0.84-1.33). In addition, adjusted mortality was similar in both groups, as were length of in-hospital stay, physician visits after discharge, waiting times for invasive cardiac procedures, and readmissions for cardiac complications.ConclusionsFeedback based on one-time, confidential report cards constructed using administrative data is not an effective strategy for quality improvement regarding care of patients with AMI. A need exists for further studies to rigorously evaluate the effectiveness of more intensive report card interventions.
Silent Parathyroid Adenoma Mistakenly Interpreted on FDG-PET as Thyroid Cancer Metastasis in a Patient With Elevated Thyroglobulin and Negative I-131 Whole Body Scan and Removed by Radioguided Minimally Invasive Surgery
Authors: Paolo L. Mendoza, Eduardo E. S. Ongkeko, Jonas F. Y. Santiago
Journal: Clinical Nuclear Medicine (2008)

Detection of recurrent and metastatic thyroid cancer remains a considerable challenge in patients presenting with rising thyroglobulin levels but with negative I-131 whole body scintigraphy. Such is the case in this patient with follicular thyroid cancer in whom subsequent FDG PET scanning showed a solitary hypermetabolic cervical lesion. With definitive management and multidisciplinary approach in mind, radioguided surgical excision came into play through the use of Tc-99m sestamibi, leading to successful removal of the lesion. Histopathology, however, revealed a parathyroid adenoma. This highlights the importance of considering differential diagnoses in apparent cases of recurrence to avoid potential pitfalls.
Predictors of Tampon Use in Adolescents After Media Coverage of Toxic Shock Syndrome
Authors: CHARLES E. IRWIN
Journal: Annals of Internal Medicine (1982)

Adolescents who use tampons represent the population most susceptible to toxic shock syndrome. We surveyed 714 adolescents from two high schools and three hospital-based clinics to examine patterns of tampon use before and after media coverage on toxic shock syndrome. Predictors of behavior change in adolescent users of tampons were examined in the context of a theoretical model of preventive health behavior. Subjects were 168 adolescents, ages 13 to 19 (mean age, 15.19; mean gynecologic age, 3.4); 50% of the subjects were white; 19%, Asian; 16% black; 7%, Hispanic; and 6%, other. After extensive publicity on toxic shock syndrome, 33.9% of the subjects changed their habits of tampon use; 27.5% stopped using tampons and 6% decreased their use of tampons. Linear logistic regression analyses identified two factors that distinguished adolescents who decreased or stopped use of tampons after publicity on toxic shock syndrome from those who did not: greater likelihood of Rely tampon (Procter & Gamble) use before publicity (p = 0.014) and the belief that they were especially susceptible to toxic shock syndrome (p = 0.013).
Neonatal granulocytosis is a postpartum event which is seen in the liver as well as in the blood
Authors: T Kawamura, S Toyabe, T Moroda, T Iiai, H Takahashi-Iwanaga, M Fukada, H Watanabe, H Sekikawa, S Seki, T Abo
Journal: Hepatology (1997)

In a recent series of studies, we demonstrated that stress in humans and animals, with resultant sympathetic nerve strain, induces severe granulocytosis, because granulocytes carry adrenergic receptors on the surface. Because activated granulocytes produce free radicals and superoxides, they sometimes induce tissue damage if the stress is too strong or continuous. Human neonates are also known to show high levels of granulocytes in the peripheral blood. In this study, we investigated whether such neonatal granulocytosis are a stress-associated response at birth. Both human and mouse materials, before and after birth, were used. The number of leukocytes in the blood, as well as some other factors in the serum, were measured. Although levels of granulocytes were found to be low in fetal humans and mice, they increased sharply after birth. In parallel with this postpartal granulocytosis, transaminases in sera increased transiently. In reference to results of a transient elevation in the levels of catecholamines at birth in mice, all these phenomena resemble stress-associated responses. Indeed, fatty liver and hematopoietic destruction in the liver were also observed in mice and humans. At this time, the production of inducible nitric oxide synthase (iNOS) by granulocytes in the liver was evident. These results suggest that neonatal granulocytosis is a postpartum event which results from various stresses (e.g., oxygen stress) at birth. This event may be responsible for such well-known neonatal phenomena as the termination of fetal hematopoiesis in the liver and as neonatal jaundice.
'Icebreaker' Clears Way for Gun Control Efforts
Authors: Charles Marwick
Journal: JAMA (1994)

AT ITS December meeting, the American Medical Association took its toughest stand yet on the issue of violence, particularly as it relates to guns, calling for restrictions on the purchase of weapons and ammunition. The House of Delegates reaffirmed its support for the Brady bill, which requires a 5-day interval between purchase and pickup of a handgun, and called for restrictions on the sale of assault weapons. These were just a few steps in the growing national momentum for gun control efforts. The Brady bill signed into law at the end of November is, in the view of antigun lobbyists, just the beginning of increased pressure for gun control laws. "We intend to push for some very aggressive gun control legislation," says Richard Aborn, president of Handgun Control Inc, one of the more assertive gun control lobbying groups in the nation's capital. "To us, the Brady bill is the political
Marked and persistent eosinophilia in the absence of clinical manifestations
Authors: Yun-Yun K. Chen, Paneez Khoury, JeanAnne M. Ware, Nicole C. Holland-Thomas, Jennifer L. Stoddard, Shakuntala Gurprasad, Amy J. Waldner, Amy D. Klion
Journal: Journal of Allergy and Clinical Immunology (2013)
American Indian Medicine: Paternalism and Pluralism-Reply
Authors: Marsha F. Goldsmith
Journal: JAMA (1986)

In Reply.—  I appreciate Dr Smith's comments, particularly because they so admirably make the point that even in what she is pleased to consider our melting pot society considerable difference of opinion exists on the best way to solve many problems—the provision of good health care for American Indians among them.  That Dr Smith gets tired of hearing about the destruction of Native American culture is beside the point. Facts are facts, and the fact that the culture of every Indian tribe, however one may characterize the varieties, was vastly altered by this continent's settlement is indisputable.  Members of the Association of American Indian Physicians (AAIP) are very well aware of the pluralistic nature of the various tribes, and the association does not purport to represent them in all their diversity. What it represents is a collective concern over the gap in health status between Indian and non-Indian persons in
TRENDS IN INFECTIVE ENDOCARDITIS (IE) INCIDENCE AND MICROBIOLOGY BEFORE AND AFTER 2007 IDSA/ACC/AHA IE PROPHYLAXIS GUIDELINES CHANGE
Authors: Sadip Pant, Abhishek Deshmukh, Kathan Mehta, Nileshkumar Patel, Neeraj Shah, Apurva Badheka, Smith Giri, Naga Venkata Pothineni, Ankit Chothani, Kaustubh Dabhadkar, Jawahar Mehta
Journal: Journal of the American College of Cardiology (2014)
Contribution of abnormal sarcoplasmic reticulum ATPase expression in heart failure due to volume overload in mitral regurgitation model
Authors: P. Leszek, P. Trouve, J. Korewicki, A. Browarek, A. Biederman, A. Klisiewicz, J. Janas, D. Charlemagne
Journal: European Journal of Heart Failure (2000)
Testosterone-Secreting Adrenal Adenoma in a Peripubertal Girl
Authors: Themis C. Kamilaris
Journal: JAMA (1987)

A 15-year-old girl who presented with primary amenorrhea and virilization had an adrenocortical adenoma that secreted predominantly testosterone. To our knowledge, she is the first peripubertal and second youngest patient with a testosterone-secreting adrenal tumor described. Serum dehydroepiandrosterone sulfate and urinary 17-ketosteroid and 17-hydroxycorticosteroid levels were normal. A tumor was located by a computed tomographic (CT) scan and by uptake of 6-beta-[75Se] selenomethylnorcholesterol. Microscopic examination of the tumor showed typical features of an adrenocortical adenoma with no histologic features characteristic of Leydig cells. Postoperatively, her hirsutism regressed, she rapidly went through puberty, and regular monthly menstruation started four months later. Finding the source of testosterone in a virilized patient can be difficult. Eleven of the 14 previously described patients with testosterone-secreting adrenal tumors initially underwent misdirected surgery on the ovaries. Review of these cases revealed that results of hormone stimulation and suppression tests are unreliable and that these tumors are usually large. Therefore, CT scanning of the adrenal glands is recommended in all patients suspected of having a testosterone-secreting tumor. If the adrenal glands on CT scan are normal, then surgery directed at the ovaries can be undertaken. Adrenal and ovarian vein catheterization is rarely necessary.
Abstract A01: Long noncoding RNA H19 regulates growth factor signaling in breast cancer cells
Authors: Constance Vennin, Fatima Dhamani, Nathalie Spruyt, Eric Adriaenssens
Journal: Cancer Research (2013)

Abstract H19 is one of the earliest identified, and the most studied, long noncoding RNAs. H19 gene is submitted to genomic imprinting and expressed only from the maternal allele and has no protein associated to its transcription. It has been proposed that H19 RNA function as a riboregulator. H19 is essential for development regulation but is also associated with carcinogenesis in many organs. However, biological functions and regulatory mechanisms of this conserved non coding RNA remain largely undecipher. Previously, we have shown that H19 is overexpressed in 70% of human breast cancers. In addition, its over-expression promotes cells invasion and angiogenesis. H19, positively regulated by E2F1, promotes cell cycle progression and G1/S transition. Altogether, these data support oncogenic function in breast tumor genesis of H19. Recently, H19 has been showed to be a microRNA precursor of miR-675-5p and miR-675-3p. MicroRNAs are small non-coding RNA that regulate expression of up to 60% of genes. However, miR-675 targets have not yet been identified in breast cancer cells. H19 gene expression is positively regulated by several growth factors, in peculiar hepatocyte growth factor / scatter factor (HGF/SF). HGF/SF stimulates proliferation of epithelial cells and increases both their motility and morphogenesis. In the present study, in order to explain these phenotypes, we have searched for miR-675 targets in breast cancer cells. We demonstrate that H19, through its microRNA miR-675-5p, regulates negatively the expression of ubiquitin ligase E3 proteins: c-Cbl and Cbl-b. Both these proteins are involved in tyrosine kinase receptor degradation. In all breast cancer cells tested, c-Cbl and Cbl-b expression was significantly decreased after H19 or miR-675 over-expression. This downregulation promotes stability of growth factor receptors (EGFR, c-Met) that sustains and amplifies activation of downstream signaling pathways (Akt, MAP-kinase). Furthermore, we have shown that H19 overexpression increases breast cancer cells migration and invasion. Our data demonstrate that H19 gene overexpression increases HGF/SF receptor signaling as well as associated phenotypes. Our work propose a mechanism of action of H19 in breast cancer in increasing cell invasion and metastasis in this organ. H19 could also be involved in the mechanism of tumor resistance to treatment by increasing paracrine phenomena. Citation Format: Constance Vennin, Fatima Dhamani, Nathalie Spruyt, Eric Adriaenssens. Long noncoding RNA H19 regulates growth factor signaling in breast cancer cells. [abstract]. In: Proceedings of the Third AACR International Conference on Frontiers in Basic Cancer Research; Sep 18-22, 2013; National Harbor, MD. Philadelphia (PA): AACR; Cancer Res 2013;73(19 Suppl):Abstract nr A01.