tbuckley/cabot-search huggingface dataset:
Biosynthetic Human Proinsulin: Review of Chemistry, in Vitro and in Vivo Receptor Binding, Animal and Human Pharmacology Studies, and Clinical Trial Experience
Authors: John A Galloway, Susan A Hooper, C Thomas Spradlin, Daniel C Howey, Bruce H Frank, Ronald R Bowsher, James H Anderson
Journal: Diabetes Care (1992)

To describe the rationale for the preclinical and clinical developmental course of human proinsulin (HPI), the second product after human insulin for the treatment of diabetes mellitus to be manufactured by DNA technology.The relevant and available published and unpublished preclinical and clinical information generated on pork proinsulin and human proinsulin has been integrated to demonstrate how certain clinically attractive features of pork proinsulin (a soluble intermediate-acting and possibly hepatospecific insulin agonist) led to the development of HPI.Clinical pharmacology studies demonstrated that HPI was definitely, although marginally, hepatospecific. More striking was the finding that the intrasubject/patient coefficient of variation of response to HPI was significantly less than that observed with NPH insulin. However, the fact that unique efficacy in controlled multicenter studies was not demonstrated suggested that these pharmacological features were not translated into clinical benefit. In one multicenter new patient study there were six myocardial infarctions, including two deaths, in patients treated for greater than or equal to 1 yr with HPI and none in the control group.To obtain an independent review of the risks and benefits of HPI, in February 1988, Lilly convened a consultant group that examined all relevant information on HPI available. These experts shared our concerns about the safety of HPI in light of the failure to demonstrate unique efficacy. Accordingly, clinical trials with HPI were suspended in February 1988. Experience with HPI demonstrates the challenge associated with the development of new drugs in general and insulin agonists in particular.
Food peptides. A new class of hormones?
Authors: J. E. Morley
Journal: JAMA (1982)

THE CONCEPT of chemical messengers or "hormones" was first recognized with the pioneering studies of Bayliss and Starling<sup>1</sup>in 1902 when they showed that perfusion of the intestine with acid resulted in pancreatic secretion, and that injections of crude extracts of duodenal mucosa produced a similar stimulation of the pancreas. Classically, a hormone has been defined as "any substance normally produced in the cells of some part of the body and carried by the blood to distant parts, which it affects for the good of the organism as a whole."<sup>1</sup>With the increasing recognition that many hormones act locally as well as at distant sites, hormones have been operationally defined as "chemical messengers which are dissolved in extracellular fluid and carry information between cells."<sup>2</sup>Recent studies have suggested that we may have to modify further our concept of what a hormone is and how it reaches its
A137: Appropriateness of Rheumatology Lab Studies and Referrals among General Pediatricians
Authors: Colleen K. Correll, Logan G. Spector, Lei Zhang, Bryce A. Binstadt, Richard K. Vehe
Journal: Arthritis & Rheumatology (2014)

Background/Purpose:

Rheumatology lab tests are often of low diagnostic utility when ordered by primary care physicians, and may lead to erroneous referrals. No prior studies have investigated pediatricians' reasons for ordering these tests. We surveyed pediatricians in three states of the Upper Midwest regarding their ordering of rheumatology lab tests and reasons for referral to pediatric rheumatology (PR).



Methods:

A web-based survey was emailed to general pediatricians practicing in Minnesota, North Dakota, and South Dakota. The rheumatology tests queried included antinuclear antibody (ANA), anti-double-stranded DNA antibody (anti-dsDNA), rheumatoid factor (RF), anti-citrullinated peptide antibodies (anti-CCP), and HLA-B27. Basic descriptive analysis was performed. Subgroup analysis was performed to assess the relationship between the pediatrician's experience with PR (defined as years since completion of residency training, whether or not the training program had a PR division, time spent in a PR clinic during training and completion of continued medical education focused on PR in the last three years) and the appropriateness of lab tests and PR referrals.



Results:

The response rate was 15.3% (93/609). Eighty-nine percent (83/93) of the respondents had ordered ANA, for reasons including abnormal joint exam (72%), musculoskeletal (MSK) pain with a normal exam (52%), concern for juvenile idiopathic arthritis (JIA) (47%), rash (41%), concern for systemic lupus erythematosus (39%), fatigue (35%), and fever (35%). Fifty-nine percent (54/92) had ordered anti-dsDNA, and the distribution of reasons paralleled that of ANA. Seventy-three percent (67/92) had ever ordered RF, most commonly for abnormal joint exam (67%), joint pain with a normal exam (60%), concern for JIA (42%), and fever (30%). Only 8% (7/92) had ordered anti-CCP. Forty-two percent (39/92) had ordered HLA-B27, primarily for back pain (59%). Of those who had ever referred a patient to a pediatric rheumatologist, 44% (37/85) did so for a positive ANA of unclear significance, 14% (12/85) for positive RF of unclear significance, and 9% (8/85) for anti-dsDNA of unclear significance. Positive HLA-B27 and anti-CCP were less common referral reasons. Subgroup analysis did not show significant differences between experience level and appropriateness of lab tests and referrals to PR.



Conclusion:

Inappropriate ordering of rheumatology lab tests with subsequent referral to PR is common among pediatricians in the Upper Midwest and likely elsewhere. The correctness of lab test utilization and referral to PR did not obviously improve with increased experience in PR. New educational interventions are needed to improve general pediatricians' understanding and utilization of rheumatology lab tests and to decrease unnecessary referrals to PR.
Association of Emergency Department Length of Stay With Safety-Net Status
Authors: Christopher Fee, Helen Burstin, Judith H. Maselli, Renee Y. Hsia
Journal: JAMA (2012)

Context-Performance measures, particularly pay-for-performance, may have unintended consequences for safety-net institutions caring for disproportionate shares of Medicaid or uninsured patients.Objective-Describe emergency department (ED) compliance with proposed length of stay measures for admissions (8 hours) and discharges, transfers, and observations (4 hours) by safetynet status.Design, Setting, and Participants-2008 National Hospital Ambulatory Medical Care Survey (NHAMCS) ED data were stratified by safety-net status (CDC definition) and disposition (admission, discharge, observation, transfer).The 2008 NHAMCS is a national probability sample of 396 hospitals (90.2% unweighted response rate) and 34,134 patient records.Visits were excluded for age <18, missing length of stay, or dispositions of: missing, "other", left against medical advice, dead on arrival.Median and 90 th percentile ED lengths of stay were calculated for each disposition and admission/discharge subcategories (critical care, psychiatric, routine) stratified by safety-net status.Multivariate analyses determined associations with length of stay measure compliance.Results are presented as odds ratios with 95% confidence intervals.Main Outcome-ED length of stay measure compliance by disposition and safety-net status.Results-27.87% of the 2008 ED visits from the weighted NHAMCS dataset were excluded leaving 72.13% for analysis.Of these, 42.3% were to safety-net and 57.7% to non-safety-net EDs.
Denver's Mental Health Program
Authors: David L. Cowen
Journal: JAMA (1971)

A nyone engaged in or interested in the delivery of health care cannot help but be aware of the gentle apocalypse that is threatening to upset our medical care delivery system. The demand of citizens for health care and the ability of the health care establishment to deliver are on a collision course. While few would disagree with this evaluation, many point to the fact that we are, to a large degree, creatures of our own history, and that we should have seen the problems coming. These people contend that our history has produced today's problems, and maintain that within this history exist many guides to the solutions of these problems. The field and history of mental health have been blessed with many far-sighted individuals who have much to say regarding our current problems. In 1919, Edwin E. Southard, MD, then president of the American Psychiatric Association, concluded from his
Violence in America: Time to Bite the Bullet Back
Authors: Roger Menendez
Journal: JAMA (1992)

<h3>To the Editor.</h3> —After reading the June 10, 1992, issue of<i>JAMA</i>, it is clear that a consensus seems to be emerging on how to solve the epidemic of firearm violence sweeping our country. The message is that gun control, and possibly destruction of anything that shoots, is the cure. Clearly, this will be a bitter pill to swallow for many sectors of our society, such as people living in rural areas where there are more cows than gang members. There also will be strong opposition from groups that promote civic, responsible, and sporting use of firearms such as the NRA, the National Shooting Sports Foundation, and the US Olympic Committee. But drastic times require drastic cures as stated by Koop and Lundberg: "Firearms are intended to be lethal weapons."<sup>1</sup>Research into why, in present-day society, guns turn people into killers is needed but must await more pressing "public
Erratum: Corrigendum: Sarcoidosis is associated with a truncating splice site mutation in the gene BTNL2
Authors: R Valentonyte, J Hampe, K Huse, P Rosenstiel, M Albrecht, A Stenzel, M Nagy, K I Gaede, A Franke, R Haesler, A Koch, T Lengauer, D Seegert, N Reiling, S Ehlers, E Schwinger, M Platzer, M Krawczak, J Müller-Quernheim, M Schürmann, S Schreiber
Journal: Nature Genetics (2005)
Oral Administration of Prostaglandins for the Induction of Labour
Authors: S. M. M. Karim, S. D. Sharma
Journal: BMJ (1971)

Prostaglandins E(2) and F(2)alpha administered by mouth were used to induce labour in 100 patients between 35 and 44 weeks of gestation. The usual effective dose of prostaglandin E(2) was 0.5 and of F(2)alpha 5 mg. These were repeated every two hours until labour was established. Induction was successful in 79 out of 80 women treated with oral prostaglandin E(2) and in 16 out of 20 women treated with F(2)alpha
Radiographic Examination in Blunt Abdominal Trauma
Authors: Leland E. Kellerhouse
Journal: JAMA (1967)

This fast-reading 250 page text has an apt title. Primarily designed for radiologists, the book should interest any physician who frequently deals with trauma. While it is chiefly oriented toward radiographic interpretation of the plain abdominal film, special techniques, including injection of intraperitoneal air or contrast media and arteriography, are also presented but not emphasized. To demonstrate radiographic signs already evident on the plain abdominal film, the author presents illustrative cases utilizing special techniques.  For his case material the author draws principally on his experience at the Santa Clara County Hospital, California. While he uses only a minimum amount of clinical information approaching film interpretation, he does emphasize the relative frequency of each clinical problem. When available, he gives data from his own cases but without attempting statistical accuracy. The result is a practical approach to traumatic problems, including emphasis on automobile trauma.  The initial chapters discuss general signs of
Familial Factors, Ventilatory Control, and Sudden Infant Death
Authors: John V. Weil
Journal: New England Journal of Medicine (1980)

Are familial factors a determinant of the risk of sudden death in infants? An article in this issue of the Journal by Schiffman and his co-workers suggests that in some cases the answer is yes. This important study showed that parents of victims of the sudden-infant-death syndrome (SIDS) had reduced ventilatory responsiveness to hypercapnia and reduced compensatory response to added resistive respiratory loads as compared with parents of normal infants. These findings add to the growing evidence that familial and perhaps genetic factors may be important in determining breathing and sometimes survival in infants and adults.Despite numerous theories, no . . .
Simple Digital Clubbing Characteristic Bone Scan Appearance
Authors: MARY C. FRATES, ELIZABETH OATES
Journal: Clinical Nuclear Medicine (1990)

Clubbing is a well-recognized entity that heralds intrathoracic disease. Clinically, characteristic soft tissue changes involve both the fingers and toes, most often together. Although clubbing may be an isolated finding, as in the case presented here, the syndrome of hyper-trophic pulmonary osteoarthropathy (HPO) includes clubbing, hypertrophy of the upper and lower extremities, joint pain and swelling, neurovascular disturbances, and bilateral proliferative periostitis. While HPO is almost always related to chest malignancy, simple clubbing, which may progress to HPO, is associated with malignant tumors in only 15–20% of cases. The scintigraphic appearance of digital clubbing is characteristic and distinctive from the pericortical pattern of HPO.
AN EXPERIMENTAL STUDY OF THE ANTISEPTIC VALUE IN THE URINE OF THE INTERNAL USE OF HEXAMETHYLENAMIN
Authors: FRANK HINMAN
Journal: JAMA (1913)

Since 1895, when Nicolaier<sup>1</sup>first demonstrated formaldehyd in the urine as a decomposition product of hexamethylenamin, the use of hexamethylenamin as a urinary antiseptic has been almost universal. Churchman<sup>2</sup>indicated in 1906 its antiseptic value with the conclusion that its effects in the urine are expressed in an inhibition of bacterial development rather than in a destruction of bacterial life. Nothing more definite appeared until last year, when Burnam<sup>3</sup>upset our ideas somewhat by stating that on the customary doses of from 5 to 10 grains three times a day not more than two patients out of ten would show any decomposition of the drug into formaldehyd at all, while only 60 per cent. would show it on a dosage of from 20 to 30 grains every four hours. These findings were quickly confirmed by L'Esperance<sup>4</sup>and Jenness,<sup>5</sup>the former finding 52 per cent. formaldehyd-containing
Radiolabeled γ-polyglutamic acid complex as a nano-platform for sentinel lymph node imaging
Authors: Kohei Sano, Yuriko Iwamiya, Tomoaki Kurosaki, Mikako Ogawa, Yasuhiro Magata, Hitoshi Sasaki, Takashi Ohshima, Minoru Maeda, Takahiro Mukai
Journal: Journal of Controlled Release (2014)
Somatic diversification and selection of immunoglobulin heavy and light chain variable region genes in IgG+ CD5+ chronic lymphocytic leukemia B cells.
Authors: S Hashimoto, M Dono, M Wakai, S L Allen, S M Lichtman, P Schulman, V P Vinciguerra, M Ferrarini, J Silver, N Chiorazzi
Journal: The Journal of Experimental Medicine (1995)

Chronic lymphocytic leukemia (CLL) is characterized by the clonal expansion of CD5-expressing B lymphocytes. Most studies have found that these leukemic CD5+ B cells, like their normal counterparts, use immunoglobulin (Ig) variable (V) region genes that exhibit minimal, if any, somatic diversity. These and other observations have suggested that CD5+ B cells may be incapable of generating Ig V gene diversity, and therefore may not be able to develop higher affinity binding sites that could be selected by antigen. However, most of the studies of CLL and normal CD5+ B cells have focused on IgM-producing cells. Since somatic mutations are most often seen in B cells that have undergone an isotype class switch, we analyzed the Ig heavy (H) and light (L) chain variable region genes of seven IgG+CD5+ CLL B cells to determine if somatic diversification and antigen selection had occurred. The data derived provide evidence for skewed use, somatic diversification, and antigenic selection of the Ig V region genes. Nonrandom use of both H and L chain V region genes was manifested by an overrepresentation of VH4 and VKI family genes and the underrepresentation of the JH4 gene segment. Furthermore, VH4 gene use was restricted to only two family members (4.21 and 4.18). In four of the seven cases, the VH and VL genes displayed &amp;gt; or = 5% difference from the most homologous known germline counterparts. Polymerase chain reaction and Southern blot analyses performed in two of these patients demonstrated that their unique VH CDR2 and adjacent sequences were not present in their germline DNA. In addition, a significant level of diversity was seen in the rearranged DJH segments and at the VL-JL junctions of every patient that occurred both at the time of recombination and subsequently. The localization of replacement changes to complementarity determining regions of some patients suggested that antigen selection had occurred. Furthermore, the mutations identified in the VH and VL genes of each individual patient were strikingly similar, both in number and location. Collectively, the data indicate that a subset of CD5+ CLL B cells can display Ig V region gene mutations. In addition, they are consistent with the notions that in some cases antigen selection of these mutations may have occurred, and that antigen stimulation may be a promoting factor in the evolution of certain CLL clones.
Fine-Needle Aspiration Biopsy of the Thyroid Gland
Authors: WARNER BURCH
Journal: Annals of Internal Medicine (1983)

Letters and Corrections1 June 1983Fine-Needle Aspiration Biopsy of the Thyroid GlandWARNER BURCH, M.D.WARNER BURCH, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-98-6-1023_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Fine-needle aspiration biopsy of the thyroid is quite helpful in the management of the patient with thyroid nodule (1). The patient usually is supine while the physician holds a pistol-gripped syringe and directs the needle into the nodule (1, 2). Yet most thyroid nodules are most easily palpated when the patient is sitting or standing. I describe a technique that optimizes palpation of thyroid nodules so that nodules 1 cm in size can be easily aspirated (3).This procedure is done with the patient sitting upright in a chair. The area of the neck over the thyroid...References1. VAN HERLE AJ RICH P LJUNG BME ASHCRAFT MW SOLOMON DH . The thyroid nodule. Ann Intern Med. 1982;96:221-32. LinkGoogle Scholar2. FRABLE W. Fine Needle Aspiration Biopsy. Philadelphia: W. B. Saunders; 1983. Google Scholar3. BURCH W. A method of aspirating thyroid cysts. Surg Gynecol Obstet. 1979;148:95-6. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: WARNER BURCH, M.D.Affiliations: Duke University Medical Center Durham, NC 27710 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTests of thyroid function 1 June 1983Volume 98, Issue 6Page: 1023-1024KeywordsBiopsyThyroid ePublished: 1 December 2008 Issue Published: 1 June 1983 PDF downloadLoading ...
Geographic Variation in Physicians' Responses to a Reimbursement Change
Authors: Mireille Jacobson, Craig C. Earle, Joseph P. Newhouse
Journal: New England Journal of Medicine (2011)

In 2005, Medicare began reimbursing for physician-administered drugs at the average manufacturer's sales price plus 6%, to remedy frequent overpayment. Oncologists' response varied geographically, with some states substantially increasing treatment rates.
Communicable Disease Nursing
Authors: Sara P. Aronson
Journal: JAMA (1942)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Pediatrics HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Pediatrics journal
Serum levels of BAFF are increased in bullous pemphigoid but not in pemphigus vulgaris
Authors: N. Asashima, M. Fujimoto, R. Watanabe, H. Nakashima, N. Yazawa, H. Okochi, K. Tamaki
Journal: British Journal of Dermatology (2006)

BAFF [B-cell activating factor belonging to the tumour necrosis factor (TNF) family] is a member of the TNF superfamily that regulates B-lymphocyte proliferation and survival. It has been demonstrated that increased levels of soluble BAFF are associated with systemic autoimmunity in patients with systemic lupus erythematosus, rheumatoid arthritis and Sjögren's syndrome, and in animal models of spontaneous autoimmune diseases. However, the significance of circulating BAFF in autoimmune bullous diseases is unknown.To examine whether BAFF levels are elevated in the autoimmune blistering diseases pemphigus vulgaris (PV) and bullous pemphigoid (BP).We examined sera obtained from 21 patients with PV, 39 patients with BP and 22 healthy donors. We performed enzyme-linked immunosorbent assays for soluble BAFF and each disease-specific antibody: antidesmoglein-3 antibody for PV and anti-BP180 antibody for BP.Significant elevations of serum BAFF levels were found in the patients with BP, but not with PV. There was apparently no significant association between the serum BAFF levels and titres of anti-BP180 antibodies in the patients with BP. However, serum BAFF levels tended to be more elevated in patients with a shorter disease duration. There was a tendency that BAFF levels increased before the anti-BP180 antibody levels increased at the onset of BP and quickly decreased in response to treatment.BAFF may be a useful marker for early activation of an autoimmune diathesis and may play a critical role in triggering activation of self-antigen-driven autoreactive B cells in BP.