tbuckley/cabot-search huggingface dataset:
Role and Management of Exercise in Diabetes Mellitus
Authors: Edward S Horton
Journal: Diabetes Care (1988)

As more is understood about the physiology of exercise, in both normal and diabetic subjects, its role in the treatment of diabetes is becoming better defined. Whereas people with diabetes may derive many benefits from regular physical exercise, there are also several hazards that make exercise difficult to manage. In type I (insulin-dependent) diabetes, there are risks of hypoglycemia during or after exercise or of worsening metabolic control if insulin deficiency is present. Type II (non-insulin-dependent) diabetic patients treated with sulfonylureas are also at some increased risk of developing hypoglycemia during or after exercise, although this poses less of a problem than with insulin treatment. In individuals treated by diet alone, regulation of blood glucose during exercise is usually not a significant problem and exercise can be used as an adjunct to diet to achieve weight loss and improved insulin sensitivity. When obese type II diabetic patients are treated with very low calorie diets, adequate amounts of carbohydrate must be provided to ensure maintenance of normal muscle glycogen content, particularly if individuals wish to participate in high-intensity exercise that places a heavy workload on specific muscle groups. On the other hand, moderate-intensity exercise such as vigorous walking can be tolerated by individuals on very low calorie, carbohydrate-restricted diets after an appropriate period of adaptation. A number of strategies can be employed to avoid hypoglycemia in type I diabetic patients, and both type I and II diabetic patients should be examined carefully for long-term complications of their disease, which may be made worse by exercise. These considerations have led many diabetologists to consider exercise beneficial in the management of diabetes for some individuals but not recommended for everyone as a necessary part of diabetes treatment as in the past. The goals should be to teach patients to incorporate exercise into their daily lives if they wish and to develop strategies to avoid the complications of exercise. The rationale for the use of exercise as part of the treatment program in type II diabetes is much more clear than for type I diabetes; regular exercise may be prescribed as an adjunct to caloric restriction for weight reduction and as a means to improve insulin sensitivity in the obese insulin-resistant individual.
Uptake of oleate from albumin solutions by rat liver. Failure to detect catalysis of the dissociation of oleate from albumin by an albumin receptor.
Authors: R A Weisiger, W L Ma
Journal: Journal of Clinical Investigation (1987)

The hepatic removal of albumin-bound substances from plasma requires that they dissociate from albumin. Using indirect methods, we and others have proposed that dissociation may be catalyzed by interaction of albumin with the liver cell surface. This study looked for direct evidence of catalysis by comparing the rate of dissociation of oleate from albumin in vitro with the rate observed within the sinusoids of perfused rat liver. No evidence for catalysis was found. The rate of hepatic oleate removal from dilute albumin solutions did not exceed but instead closely paralleled the rate predicted from the in vitro dissociation rate constant (0.14s-1). These results suggest that under some conditions the liver can remove unbound material from the sinusoids faster than it can be replenished by dissociation from albumin, resulting in dissociation-limited removal. However, dissociation of oleate does not appear to be catalyzed by the liver.
FRACTURES OF THE NECK OF THE FEMUR
Authors: E. W. H. Groves
Journal: BMJ (1935)

It is just six years since I had the honour of opening the discussion1 on this subject in London (July 4th, 1929) at the joint meeting of the British and American Ortho paedic Associations. At that meeting Smith-Petersen first demonstrated his new pin or nail and gave an account of his early work. I do not think that many who heard him were greatly impressed by either the theory or the practice he proposed. Certainly none of us realized that his proposition was going to dominate the whole situation in a few years. To-day I have as my first duty to pay an honest tribute to the genius of Smith-Petersen, and then to direct inquiry into the way in which his invention has modified our ideas of practice and prognosis. I wish that some kind of fracture register existed by which we could estimate at any time the number of different fractures that are presented for treatment. It is evident, however, that fractures of the femoral neck are both common and important ; this may be learned in the wards of any of the large municipal hospitals, where these cases are commonly  dumped, and where many of them remain for months or years. The fracture is of common occurrence ; it often requires a long period of treatment, and only too frequently results in permanent disability.
Protective immunogenicity and T lymphocyte specificity of a trivalent hybrid peptide containing NH2-terminal sequences of types 5, 6, and 24 M proteins synthesized in tandem.
Authors: E H Beachey, J M Seyer, J B Dale
Journal: The Journal of Experimental Medicine (1987)

The protective immunogenicity of a hybrid peptide containing tandem copies of types 5, 6, and 24 M protein epitopes was investigated. An NH2-terminal peptide of type 24 M protein was chemically synthesized and then extended to include NH2-terminal peptides of types 6 and 5 M proteins yielding a 34-residue hybrid peptide containing a cysteine residue at its COOH-terminus. When conjugated via the cysteine residue to keyhole limpet hemocyanin (KLH), emulsified in CFA, and injected into rabbits, the synthetic hybrid evoked opsonic antibodies against types 5, 6, and 24 streptococci without stimulating tissue crossreactive immunity. The trivalent hybrid also was capable of priming T lymphocytes in vivo that responded to each of the native serotypes of M protein as well as to the synthetic hybrid peptide in vitro. The primed T cells failed to respond to the individual component peptides contained in the hybrid peptide, suggesting that the hybrid peptide confers conformations resembling the presentations of each of the subpeptides in the respective serotypes of M protein. The brisk immune responses to the type 6 peptide contained in the middle of the tandem hybrid indicates that with judicious placement between proline residues, potentially hidden peptides are readily accessible to the immune system. These results suggest that synthetic tandem peptides can be tailored in a fashion in which each of the component sets of protective epitopes can be made optimally immunoaccessible and immunogenic.
Ombudsman will be given new powers Doctors' performance bill receives royal assent BMA wants a bill to protect young people from tobacco Part time working has implications for GP manpower Dispensing threatened in Northern Ireland
Authors: L. Beecham
Journal: BMJ (1995)

# Ombudsman will be given new powers {#article-title-2}

Legislation to extend the jurisdiction of the health service ombudsman to cover clinical complaints aginst NHS staff and all complaints against general practitioners is to be introduced by the government during the current session of parliament, which opened with the Queen's speech on Wednesday. At present complaints concerning the exercise of clinical judgment are excluded from the ombudsman's remit. He is also restricted in hearing complaints against family health service providers--general practitioners, dentists, pharmacists, and opticians. These restrictions will be lifted. Of the formal complaints against family doctors, currently outside the ombudsman's scope, almost half relate to failure to visit or failure to diagnose.

In its response to the Wilson committee on complaints procedures, the government announced in March that it would seek legislative time to extend the ombudsman's jurisdiction “to all complaints by, or on behalf of, NHS patients.” It added that the ombudsman would need access to appropriate professional advice in undertaking these new responsibilities. As a rule complainants would not be able to complain to the ombudsman before they had exhausted the internal complaints system. A Commons select committee reported in 1993 that the extensions would add considerably to the ombudsman's work and possibly mean the separation of the offices of parliamentary and health service ombudsmen. About 25% of complaints to the ombudsman are rejected because they concern clinical judgment.

Another bill in the new session will permit local authorities to make direct payments to disabled people as part of their community care plan, …
A 28-Year-Old Woman With Panic Disorder
Authors: Jack Matthew Gorman
Journal: JAMA (2001)

DR BURNS: Ms M is a 28-year-old woman with symptoms of palpitations and chest discomfort. She is a full-time student and works 2 jobs. She has Massachusetts free care insurance coverage and receives her primary care from Dr G, a general internist at the Beth Israel Deaconess Medical Center.
Cystic fibrosis presenting as acute upper airway obstruction
Authors: J Davies
Journal: Thorax (2005)

Cystic fibrosis presenting as acute upper airway obstructionA 2 year old girl undergoing investigation for recurrent respiratory infections and failure to thrive presented acutely with neck and face swelling, tongue protrusion, and extreme difficulty in breathing.Examination showed extensive surgical emphysema over her chest, neck and face confirmed on the chest radiograph, which also revealed a pneumomediastinum (fig 1).While being prepared for emergency intubation the symptoms began to resolve, allowing her to be managed conservatively without ventilation or chest drains.A CT scan (fig 2) showed a moderate anterior pneumomediastinum (thin arrow) without a pneumothorax in addition to some bronchial wall thickening (bold arrow) but no bronchiectasis.Culture of bronchoalveolar lavage fluid was negative (while on broad spectrum antibiotics), but she has since been diagnosed with cystic fibrosis (CF) on the basis of sweat testing and genetic analysis.Such air leaks, while not uncommon in advanced CF, 1 are extremely rare in young children, the youngest in the literature being aged 4 years. 2The pneumomedistinum in this child was presumably caused by transient peaks in alveolar pressure related to a combination of coughing, airway wall inflammation, and mucus plugging.The avoidance of positive pressure ventilation was probably a contributing factor in her rapid recovery.
Altered response to ibutilide in a heart failure model
Authors: S Chugh
Journal: Cardiovascular Research (2001)

Objective: Despite the frequent use of anti-arrhythmic drugs in the general population, the electrophysiologic effects of these agents have not been elucidated in congestive heart failure (CHF). Methods: To examine the impact of left ventricular dysfunction on actions of type III anti-arrhythmic drugs, we evaluated the actions of ibutilide in a canine model of pacing-induced dilated cardiomyopathy. Following ablation of the atrioventricular node, effects on action potential duration at 90% (APD90) were compared in vivo, between eight CHF animals and seven controls. Monophasic action potential recordings were obtained from right and left ventricular endocardium/epicardium during and after three doses of ibutilide (0.01, 0.02 and 0.05 mg/kg), at pacing cycle lengths of 300–1000 ms. Results: APD90 prolongation with ibutilide (0.01 mg/kg) was significantly greater in CHF vs. controls (P = 0.0026, ANOVA). However, plasma ibutilide levels at this dose, were not significantly different between the two groups. In CHF, maximal effects were observed at the lowest dose, whereas effects were gradual and dose-dependent in controls. With ibutilide administration (0.01 mg/kg), an increased dispersion of left–right ventricular APD90 was observed in CHF, but not in controls (P = 0.03). A trend was observed, for increased incidence of non-sustained polymorphic ventricular tachycardia in CHF. Conclusions: In the presence of CHF, the actions of ibutilide are altered significantly. These findings may reflect altered tissue effects, as a consequence of myocardial electrical remodeling in CHF.
Résultats finaux d'une étude prospective sur le traitement endoscopique des pseudokystes pancréatiques à partir d'un algorithme décisionnel
Authors: M Barthet, G Lamblin, M Gasmi, V Vitton, C Subtil, A Desjeux, JC Grimaud
Journal: Endoscopy (2007)

Le traitement endoscopique des pseudokystes pancréatiques (PK) est devenu un traitement de première intention mais ses modalités restent à définir. Le but de cette étude était de connaître l'apport du drainage sous échoendoscopie en terme d'efficacité ou de morbidité.
Screening Mammography and the “R” Word
Authors: Robert D Truog
Journal: New England Journal of Medicine (2009)

The new recommendations from the U.S. Preventive Services Task Force on screening for breast cancer1 were front-page news for several consecutive days, and they sent the Obama administration scrambling to reassure the public that these guidelines were not a prelude to the rationing of health care, notwithstanding Republican critics' assertions to the contrary.The most controversial recommendation of the Task Force is to delay the onset of routine screening mammography from 40 to 50 years of age. Many observers were concerned that this move away from intensive screening might signal a shift away from the war on cancer, posing a . . .
Born with Two Mothers
Authors: Richard E Ashcroft
Journal: BMJ (2005)

Channel 4, 21 April at 9 pm Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img>![Graphic][4]</img> T his remarkable drama told the fictional story of two couples who had tried for years without success to conceive through in vitro fertilisation. When one woman became pregnant it was discovered that the embryo that had been implanted had in fact been conceived with the other couple's gametes. A further complication was that the birth mother and her husband were white, while the genetic parents were black. The story began at the point where both couples were trying to conceive, took us through the pregnancy and the discovery that the wrong embryo had been implanted, and concluded with a family court hearing to determine whether the boy, then 10 months old, would continue to be raised by his birth mother or would be taken to live with his genetic parents. The couples were played by actors, but the doctors, lawyers, social workers, and the judge were all real life professionals acting as they would if this were a real case. … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif [4]: /embed/inline-graphic-4.gif
The Future General Internist
Authors: Sam J. Sugar
Journal: Annals of Internal Medicine (1995)

Letters15 July 1995The Future General InternistSam J. SugarSam J. SugarSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-2-199507150-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Several inconsistencies are inherent in the paradigm proposed in the position paper on the role of the future general internist [1]. Item 5 indicates that a general internist should be an expert equally effective in the office and the hospital. This seems an unobtainable goal. If managed care is to be the way we practice in the future, internists can expect to spend little or no time in the hospital practicing medicine. In fact, in many managed plans, an inpatient physician manager is now assigned to manage all inpatient rounds and orders; the attending internist makes social ...REFERENCE1. American College of Physicians. The role of the future general internist defined. Ann Intern Med. 1994; 121:616-22. Google Scholar Author, Article, and Disclosure InformationAuthors: Sam J. Sugar PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 July 1995Volume 123, Issue 2Page: 156-158KeywordsDermatologyForecastingHospital medicineInpatientsOrthopedicsOtorhinolaryngologyPrimary care physiciansTraditional medicine ePublished: 15 August 2000 Issue Published: 15 July 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Clinical scores in the differential diagnosis of acute stroke
Authors: J P S Burn
Journal: BMJ (1995)

Parental awareness was high EDITOR,-We wish to report the results of an observational study that a group of us under- took recently as part of our community medicine attachment.We chose the topic of measles immunisation because it was a current issue.'There had also been public concern that the campaign contained information contradicting that given in the previous measles, mumps, and rubella campaign, launched in October 1988.At that time the parliamentary secretary for health, Mrs Edwina Curry, stated that "It [measles, mumps, and rubella vaccine] provides life-long protection against all three infections with a single jab."2A third point of interest was the controversy surrounding the rubella component of the vaccine.
Television and the Epileptic Child
Authors: H. Paul Johnson
Journal: JAMA (1963)

To the Editor:  —With regard to the editorial, Television and the Epileptic Child ( JAMA  183 :592 [Feb 16] 1963), I do not believe that light, per se, is the basic factor in the precipitation of seizures in the epileptic child. It is rather the difficulty of maintaining the position of convergence on shifting images. Disjunctive functions are the most difficult ones which the eyes are called upon to perform, and they are, therefore, not likely to sustain good alignment when the object which they are viewing is subject to flicker. Flicker produces difficulty in nervously tense or fatigued individuals since it makes the shift from binocular single vision to monocular less easy to perform. The symptomatology may cover a wide range from actual diplopia to headache to nausea and vomiting. According to the late Dr. James Watson White, an international authority in this field, car sickness is very frequently the
Frequency and prognostic impact of casein kinase 1A1 mutations in MDS patients with deletion of chromosome 5q
Authors: M Heuser, M Meggendorfer, M M A Cruz, J Fabisch, S Klesse, L Köhler, G Göhring, C Ganster, K Shirneshan, A Gutermuth, S Cerny-Reiterer, J Krönke, V Panagiota, C Haferlach, C Koenecke, U Platzbecker, C Thiede, T Schroeder, G Kobbe, S Ehrlich, K Stamer, K Döhner, P Valent, B Schlegelberger, N Kroeger, A Ganser, D Haase, T Haferlach, F Thol
Journal: Leukemia (2015)
Thyroid Peroxidase Autoantibodies Predict Poor Metabolic Control and Need for Thyroid Treatment in Pregnant IDDM Women
Authors: Luisa Fernandez-Soto, Amalia Gonzalez, Jose Antonio Lobón, Jose Antonio Lopez, Charles M Peterson, Fernando Escobar-Jiménez
Journal: Diabetes Care (1997)

OBJECTIVE To study whether the presence of antithyroid peroxidase antibodies (TPO-Abs) before gestation in IDDM affects thyroid function and metabolic control during pregnancy and early postpartum as well as neonatal outcome. RESEARCH DESIGN AND METHODS A prospective study at an outpatient endocrine-obstetric unit was carried out in 20 pregnant IDDM women. Free T4 (thyroxine), thyroid-stimulating hormone (TSH), TPO-Abs, and HbA1c were assayed before gestation; during the first, second, and third trimester of pregnancy; and 3 months postpartum. RESULTS HbA1c was significantly higher in TPO-Ab+ women than in those who were TPO-Ab− during the second (P &amp;lt; 0.01) and third (P &amp;lt; 0.05) trimesters. HbA1c levels significantly decreased in TPO-Ab− patients when the second (P &amp;lt; 0.01) and third (P &amp;lt; 0.05) trimesters were compared with before the pregnancy and the first trimester. There was a significant increase in the dosage of insulin for TPO-Ab+ versus TPO-Ab− patients during the second (P &amp;lt; 0.05) and third (P &amp;lt; 0.01) trimesters and 3 months postpartum (P &amp;lt; 0.05). TSH was significantly increased in the second (P &amp;lt; 0.001) and third (P &amp;lt; 0.05) trimesters and 3 months postpartum (P &amp;lt; 0.01) when compared with TPO-Ab− patients; 7.6% of the TPO-Ab− group and 29% in the TPO-Ab+ group presented postpartum thyroid dysfunction, and 42% of the TPO-Ab+ women required thyroid treatment. CONCLUSIONS Pregnant women with IDDM who have a positive test for TPO-Abs before gestation have poorer glucose control and a high prevalence of hypothyroidism. Therefore we recommend that prepregnant IDDM patients be screened for anti-TPO-Abs. Those with a positive result should be followed with serial monitoring of free T4 and TSH levels during each trimester as well as the postpartum period.
Candidate Genes for Insulin Resistance
Authors: David E Moller, Christian BjørbæK, Antonio Vidal-Puig
Journal: Diabetes Care (1996)

Insulin resistance confers increased susceptibility to NIDDM, atherosclerotic cardiovascular disease, ovarian hyperandrogenism, and possibly hypertension. Insulin resistance is largely inherited, in rare cases as a monogenic disorder or more commonly as a complex trait. The search for insulin resistance genes relies mainly on two complementary approaches: 1) positional cloning using random DNA markers present throughout the genome; and 2) the analysis of specific candidate genes. This report briefly summarizes the candidate gene approach to insulin resistance. Progress related to the analysis of genes encoding molecules that participate in insulin action is reviewed. In addition, the spectrum of potential genetic defects that might contribute to insulin resistance, both at the level of the target cell and secondarily (e.g., obesity genes), is discussed.
Attitude to Nursing Among Intelligent Schoolgirls
Authors: T. O. Thompson
Journal: BMJ (1964)

BRIC JOS 1463 weight rapidly, which, curiously enough, has provoked some nurses and doctors to argue that this might in some way be detrimental, but the evident success of the method usually overcomes the objections.Certainly if one told a farmer that his young livestock were growing and gaining weight too fast he would laugh in one's face !But then, Sir, he has the advantage of having his feet placed firmly on the good earth.-Iam, etc., Stock, Essex.IAN G. WICKES.SIR,-I was astonished to see no reference at all to the development of the teeth in Dr. D. MacCarthy's article (21 November, p. 1309).Surely one of the main advantages of breast-feeding is that the teeth in later life will be harder and more durable than they would be with artificial feeding.Recently I went to see a girl who happened to be out.The mother said she had an appointment with her dentist; she complained that she was always there, whereas her two sons never needed any dental treatment.I said that was an easy one: the girl had been artificially fed and the boys had been breastfed.This proved to be the case.It would be interesting to have a dental surgeon's opinion.-Iam, etc.,
Betulin - a plant-derived cytostatic drug - enhances antitumor immune response
Authors: Kathrin Pfarr, Corina Danciu, Cristina Dehelean, Josef M Pfeilschifter, Heinfried H Radeke
Journal: Journal for ImmunoTherapy of Cancer (2014)

Meeting abstracts Conventional cytostatic cancer treatments are rarely curative. New therapeutic strategies are more promising by targeting the tumor microenvironment, inhibiting angiogenesis and antagonizing the immunosuppressive activity of established tumors. Along these lines, plants provide a