tbuckley/cabot-search huggingface dataset:
Could neutrophilic airway inflammation in obese people be more due to obstructive sleep apnoea syndrome than to asthma?
Authors: Giovanna Elisiana Carpagnano, Maria Pia Foschino-Barbaro, Pierluigi Carratu, Donato Lacedonia, Onofrio Resta
Journal: European Respiratory Journal (2012)

Acute exacerbations of COPD: it's the weekend but it can't wait until MondayTo the Editors:In a large nationwide study in Spain, BARBA et al. [1] recently reported that patients admitted for treatment of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) over a weekend showed poorer in-hospital survival compared to those admitted on weekdays.The data suggest that this effect is independent of confounders such as age, sex, comorbidity and respiratory failure.The authors elaborate on the possibility that limited healthcare availability during the weekends may be an explanation for their findings.However, we believe that the data of BARBA et al.[1] support an additional explanation.Chronic obstructive pulmonary disease patients with respiratory distress during the weekend may tend to wait until the Monday to contact health services.While the level of symptoms would allow a patient with mild AECOPD to do so without running a significant risk, patients with severe AECOPD ultimately are left no choice but to contact health services during the weekend.Consequently, this shift towards fewer but more severe AECOPD patients presenting during the weekends may contribute to the explanation of the ''weekend effect''.Indeed, BARBA et al. [1] reported the lowest proportion of admissions at weekends and the highest on Mondays, and the latter had the lowest risk of mortality.Also, patients admitted over the weekends had respiratory failure more often.Although the effect of weekends on mortality remained significant after adjusting for respiratory failure, the lack of data on blood gas analyses, oxygen therapy, medication prescribed and intensive care unit admissions precluded a detailed analysis on the effect of AECOPD severity in this context.We recommend providing patients with a written action plan [2] with clear instructions and contact details in order to better prepare the patient for the occurrence of an AECOPD, especially outside office hours.
Endometriosis
Authors: Gordon F. Madding, Paul A. Kennedy
Journal: JAMA (1963)

THE PRESENCE of endometrial tissue apart from its normal location is termed "endometriosis." External endometriosis or ectopic endometrium— endometrial tissue growing elsewhere than in the uterine musculature—is a major gynecological problem, and it has been estimated that there is proved incidence of endometriosis in one of four of all women operated on for pelvic conditions. The disorder may be divided into internal and external types. In the former the islands are found in the myometrium proper, whereas in the latter they appear on the ovaries, tubes, and peritoneum. Their presence in more distant sites such as the skin of the arm and the thigh has been reported.<sup>1</sup> The histogenesis of endometriosis, long a matter of conjecture, remains far from settled. The various theories which attempt to explain endometriosis fall largely into three categories: first, transportation of endometrial tissue from the uterus to its ectopic location either by transtubal regurgitation
Incidence of drug-induced hepatic injuries: A French population-based study
Authors: Catherine Sgro, François Clinard, Kader Ouazir, Henry Chanay, Christian Allard, Christian Guilleminet, Claude Lenoir, Alain Lemoine, Patrick Hillon
Journal: Hepatology (2002)

The incidence of hepatic adverse drug reactions (ADRs) remains unknown in the general population. The goal of this population-based study was to assess the incidence and seriousness of hepatic ADRs. All new cases of symptomatic drug-induced hepatic injuries were collected by 139 trained physicians (general practitioners [GPs] and specialists) between November 1997 and November 2000 in an area containing 81,301 inhabitants who could not go elsewhere for medical care. Over 3 years, 34 cases of hepatic ADRs were collected, 82% of them in outpatients. Global crude annual incidence rate was 13.9 ± 2.4 per 100,000 inhabitants; corresponding standardized annual global rate was 8.1 ± 1.5. There was no difference between urban and rural areas. Standardized incidence female/male ratio was 0.86 (0.26-2.90) until 49 years of age and 2.62 (1.00-6.92) after this age. Diagnosis was carried out by GPs in half of the cases. The outcome was recovery for 32 patients and death for 2. The main drugs implicated were anti-infectious, psychotropic, hypolipidemic agents, and nonsteroidal anti-inflammatory drugs (NSAIDs). Our results suggest that the number of hepatic ADRs in the French population would be 16 times greater than the number noted by spontaneous reporting to French regulatory authorities. In conclusion, the incidence and seriousness of drug-induced hepatitis are largely underestimated in the general population. These results may be useful for further evaluation of drug-induced hepatotoxicity.
Curricular Factors Associated With Medical Students’ Practice of the Skin Cancer Examination
Authors: Amit Garg, Joyce Wang, Shalini B. Reddy, Jennifer Powers, Reza Jacob, Michael Powers, Katie Biello, Rachael Cayce, Stephanie Savory, Leah Belazarian, Erik Domingues, Adam Korzenko, Lindsay Wilson, Jane M. Grant-Kels, Paul George, Leslie Robinson-Bostom, Shannon C. Trotter, Alan C. Geller
Journal: JAMA Dermatology (2014)

As medical school curricula become progressively integrated, a need exists to optimize education related to the skin cancer examination (SCE) for melanoma, a relevant competency gap that influences secondary prevention efforts. To identify curricular factors associated with medical students' confidence, intent, and performance regarding the SCE. Survey-based cross-sectional study from the Integrated Skin Exam Consortium at accredited US medical schools among a volunteer sample of second-year students representing 8 geographically varied public and private institutions. Students were administered a questionnaire to assess characteristics, curricular exposures, and educational and practical experiences related to skin cancer, as well as knowledge of melanoma risk and a detection method. Primary outcomes were confidence in performing the SCE, intent to perform an integrated skin examination, and actual performance of the SCE. Physical diagnosis session and clinical encounter were most predictive of confidence in performance of the SCE (odds ratios [ORs], 15.35 and 11.48, respectively). Other curricular factors associated with confidence included instruction time of at least 60 minutes on skin cancer (OR, 6.35), lecture on the SCE (OR, 7.54), knowledge of melanoma risk (OR, 3.71), and at least 1 opportunity to observe the SCE (OR, 2.70). Physical diagnosis session and at least 4 opportunities to observe the SCE were most predictive of intent to perform an integrated skin examination (ORs, 4.84 and 4.72, respectively). Other curricular factors associated with intent included knowledge of melanoma risk (OR, 1.83), clinical encounter (OR, 2.39), and at least 1 opportunity to observe the SCE (OR, 1.95). Clinical encounter, physical diagnosis session, and at least 1 opportunity to observe the SCE were most predictive of performance of the SCE (ORs, 21.67, 15.48, and 9.92, respectively). Other curricular factors associated with performance included instruction time of at least 60 minutes on skin cancer (OR, 2.42) and lecture on the SCE (OR, 5.04). To augment the practice of the SCE among medical students, course directors may design an integrated curriculum that includes at least 60 minutes of instruction related to melanoma and the SCE, a description of the integrated skin examination as part of the physical diagnosis course, and education on high-risk demographic groups and anatomic sites specific to men and women and on the ABCDEs of melanoma, and at least 1 opportunity to observe the SCE.
Current and Future State of the US Nursing Workforce
Authors: Peter I. Buerhaus
Journal: JAMA (2008)

DESPITE A RECENT STRENGTHENING OF THE REGIStered nurse (RN) workforce, the US health care delivery system needs to prepare for an aging population of RNs and a coming wave of retirements. Over the next 20 years, the average age of RNs will increase, and the size of the workforce will plateau as large numbers of RNs retire. Because the demand for RNs is expected to increase steadily during this same period, a large and prolonged shortage of RNs is expected to develop in the latter half of the next decade, threatening access and quality and increasing health care costs. The question looming over the nursing profession, employers, nursing educators, physicians, other health professionals, and health care policy makers is what can be done to mitigate these developments.
Oesophageal Ulceration Due to Emepronium Bromide
Authors: I.G. Barrison, P.N. Trewby, S.P. Kane
Journal: Endoscopy (1980)

Four cases of oesophageal damage associated with ingestion of the urinary anti-spasmodic agent emepronium bromide are described. All the patients presented with severe retrosternal pain worsened by swallowing food and drink, and in every case fibre-optic endoscopy revealed ulceration of the midoesophagus. Symptoms disappeared rapidly following cessation of emepromium bromide therapy. The means whereby this agent might injure oseophageal mucosa are discussed.
Intestinal microbiota in patients with nonalcoholic fatty liver disease
Authors: Marialena Mouzaki, Elena M. Comelli, Bianca M. Arendt, Julia Bonengel, Scott K. Fung, Sandra E. Fischer, Ian D. McGilvray, Johane P. Allard
Journal: Hepatology (2013)

Despite evidence that the intestinal microbiota (IM) is involved in the pathogenesis of obesity, the IM composition of patients with nonalcoholic fatty liver disease (NAFLD) has not been well characterized. This prospective, cross-sectional study was aimed at identifying differences in IM between adults with biopsy-proven NAFLD (simple steatosis [SS] or nonalcoholic steatohepatitis [NASH]) and living liver donors as healthy controls (HC). Fifty subjects were included: 11 SS, 22 NASH, and 17 HC. One stool sample was collected from each participant. Quantitative real-time polymerase chain reaction was used to measure total bacterial counts, Bacteroides/Prevotella (herein referred to as Bacteroidetes), Clostridium leptum, C. coccoides, bifidobacteria, Escherichia coli and Archaea in stool. Clinical and laboratory data, food records, and activity logs were collected. Patients with NASH had a lower percentage of Bacteroidetes (Bacteroidetes to total bacteria counts) compared to both SS and HC (P = 0.006) and higher fecal C. coccoides compared to those with SS (P = 0.04). There were no differences in the remaining microorganisms. As body mass index (BMI) and dietary fat intake differed between the groups (P < 0.05), we performed linear regression adjusting for these variables. The difference in C. coccoides was no longer significant after adjusting for BMI and fat intake. However, there continued to be a significant association between the presence of NASH and lower percentage Bacteroidetes even after adjusting for these variables (P = 0.002; 95% confidence interval = -0.06 to -0.02).There is an inverse and diet-/BMI-independent association between the presence of NASH and percentage Bacteroidetes in the stool, suggesting that the IM may play a role in the development of NAFLD.
The Plasma Membrane, with Notes on the History of Botany
Authors: HOMER W. SMITH
Journal: Circulation (1962)

The origin of the concept of the plasma membrane is rather ambiguously identified. It antedated Pfeffer and deVries, and, after searching the literature, the writer attributes it to Carl Nägeli (1855), who had been working with algae, fungi, mosses, and unicellular plants. He noted particularly that the surface of discontinuity of the cell is impermeable to pigments contained within the cytoplasm or added to the solution around the cell. He found the protoplasmic surface to be more dense, viscous, and otherwise distinguishable from the cytoplasm, and hence he called the surface layer the plasma membrane . From experiments on osmosis he concluded that the plasma membrane endows the cell with its osmotic properties.
Epigenetic Inactivation of <i>SFRP</i> Genes and TP53 Alteration Act Jointly as Markers of Invasive Bladder Cancer
Authors: Carmen J. Marsit, Margaret R. Karagas, Angeline Andrew, Mei Liu, Hadi Danaee, Alan R. Schned, Heather H. Nelson, Karl T. Kelsey
Journal: Cancer Research (2005)

Abstract In the United States each year, almost 13,000 deaths are attributable to bladder cancer, with the majority of these deaths related to higher stage, muscle-invasive solid tumors. Epigenetic silencing of the secreted frizzled receptor proteins (SFRP), antagonists of the WNT pathway, leads to constitutive WNT signaling, altering cell morphology and motility. Identifying alterations in this pathway in bladder cancer may prove useful for defining the invasive phenotype and provide targets for guiding therapy. Using a population-based study of bladder cancer (n = 355), we examined epigenetic alterations, specifically gene promoter hypermethylation, of four SFRP genes in addition to immunohistochemical staining of TP53, which has been previously shown to be a predictor of invasive disease. We observed a significant linear trend (P &amp;lt; 0.0004) in the magnitude of the risk of invasive disease with the number of SFRP genes methylated. Both TP53 alteration and SFRP gene methylation showed significant independent associations with invasive bladder cancer. Strikingly, in examining the joint effect of these alterations, we observed a &amp;gt;30-fold risk of invasive disease for patients with both altered SFRP gene methylation and intense TP53 staining (odds ratio, 32.1; P &amp;lt; 10−13). Overall patient survival was significantly poorer in patients with any SFRP genes methylated (P &amp;lt; 0.0003) and in proportional hazards modeling, patients with methylation of any SFRP gene had significantly poorer overall survival (hazard ratio, 1.78; P &amp;lt; 0.02) controlled for TP53 staining intensity and other survival-associated factors. Classifying tumors based on SFRP methylation status and TP53 protein staining intensity may be a clinically powerful predictor of invasive, deadly disease.
Raccoon epithelium – a new allergen source
Authors: P. Stöger, P. Schmid‐Grendelmeier, S. G. O. Johansson, B. Wüthrich
Journal: Allergy (1994)

We report the case of a 39‐year‐old asthmatic patient who developed acute rhinoconjunctivitis, Quincke's edema, and asthma after repeated exposure to a raccoon ( Procyon lotor ) which a friend kept at home. Skin prick and scratch tests with native raccoon hair and epithelium, as well as RAST, were clearly positive. Elimination of contact with the raccoon and avoiding the home of his friend led to a cessation of the patient's acute exacerbations.
Case 37-1977
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, Peter C. Block, John T. Fallon
Journal: New England Journal of Medicine (1977)

Presentation of CaseA 38-year-old woman was admitted to the hospital because of a pericardial effusion.Nine years earlier she was told that she had asymptomatic aortic stenosis and slight cardiac enlargement. She remained free of symptoms until three weeks before entry, when a dry cough developed, and her temperature rose to 38.9°C. Nine days before admission she entered another hospital, where examination disclosed an aortic murmur and a pericardial friction rub. The spleen was not felt. The hemoglobin was 8.7 g per 100 ml. X-ray films of the chest showed cardiac enlargement. Penicillin was administered, after which samples were . . .
Defective bile salt biosynthesis and hydroxylation in mice with reduced cytochrome P450 activity
Authors: Cindy Kunne, Alexandra Acco, Simon Hohenester, Suzanne Duijst, Dirk R. de Waart, Alaleh Zamanbin, Ronald P.J. Oude Elferink
Journal: Hepatology (2012)

Abstract The difference in bile salt (BS) composition between rodents and humans is mainly caused by formation of muricholate in rodents as well as by efficient rehydroxylation of deoxycholic acid. The aim of this study was to characterize bile formation in a mouse model ( Hrn mice) with hepatic disruption of the cytochrome p450 (CYP) oxidoreductase gene, encoding the single electron donor for all CYPs. Bile formation was studied after acute BS infusion or after feeding a BS-supplemented diet for 3 weeks. Fecal BS excretion in Hrn mice was severely reduced to 7.6% ± 1.8% of wild-type (WT), confirming strong reduction of (CYP-mediated) BS synthesis. Hrn bile contained 48% ± 18% dihydroxy BS, whereas WT bile contained only 5% ± 1% dihydroxy BS. Upon tauroursodeoxycholate infusion, biliary BS output was equal in WT versus Hrn , indicating that canalicular secretion capacity was normal. In contrast, taurodeoxycholic acid (TDC) infusion led to markedly impaired bile flow and BS output, suggesting onset of cholestasis. Feeding a cholate-supplemented diet (0.1%) resulted in a completely restored bile salt pool in Hrn mice, with 50% ± 9% TDC and 42% ± 10% taurocholic acid in bile, as opposed to 2% ± 1% and 80% ± 3% in WT mice, respectively. Under these conditions, biliary cholesterol secretion was strongly increased in Hrn mice, whereas serum alanine aminotransferase levels were decreased. Conclusion : Hrn mice have strongly impaired bile salt synthesis and (re)hydroxylation capacity and are more susceptible to acute TDC-induced cholestasis. In this mouse model, a more-human BS pool can be instilled by BS feeding, without hepatic damage, which makes Hrn mice an attractive model to study the effects of human BS.
Consequences of a family history of type 1 and type 2 diabetes on the phenotype of patients with type 2 diabetes.
Authors: H Li, B Isomaa, M R Taskinen, L Groop, T Tuomi
Journal: Diabetes Care (2000)

OBJECTIVE: To investigate the impact of a family history of type 1 and type 2 diabetes on the phenotype of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: In a population-based study, we compared the phenotype in 3 groups of patients with type 2 diabetes. The first group had no family history of diabetes (FH-, n = 148); the second group had a family history of type 2 diabetes only (FH+(TYPE2), n = 1,211); and the third group had a family history of both type 1 and type 2 diabetes (FH+(MIXED), n = 240). Furthermore, we studied the frequency of GAD antibodies (GADabs), HLA-DQB1 risk genotypes, and the presence of coronary heart disease (CHD) according to family history in unrelated patients with type 2 diabetes from 787 families (148 FH-, 546 FH+(TYPE2) and 93 FH+(MIXED)). RESULTS: Patients with no family history of diabetes were older at the onset of the disease, had a better beta-cell function (P = 0.004), and had higher HDL cholesterol concentrations (P = 0.006) than patients with a family history of diabetes. Patients with a family history of only type 2 diabetes had higher BMI and fasting C-peptide concentrations (P = 0.031) but lower frequency of GADab (11 vs. 23%, P = 0.001) and DQB1 risk genotypes (37 vs. 54%, P = 0.003) compared with patients with a family history of both type 1 and type 2 diabetes. In addition, hypertension (P = 0.05) and CHD (P = 0.031) were more common in FH+(TYPE2) than in FH+(MIXED) patients. In patients &amp;lt;60 years old, a family history of type 1 diabetes was associated with a reduced risk of CHD independent of age, hypertension, and HDL cholesterol concentrations. The results were similar when the GADab+ patients were excluded from the analysis. CONCLUSIONS: A family history of both type 1 and type 2 diabetes had a profound influence on the phenotype of patients with type 2 diabetes, which suggests a genetic interaction between type 1 and type 2 diabetes.
Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement
Authors: Gregorios Paspatis, Jean-Marc Dumonceau, Marc Barthet, Søren Meisner, Alessandro Repici, Brian Saunders, Antonios Vezakis, Jean Gonzalez, Stine Turino, Zacharias Tsiamoulos, Paul Fockens, Cesare Hassan
Journal: Endoscopy (2014)

This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures. <b>Main recommendations</b> <b>1</b> ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforation, including the definition of procedures that carry a high risk of this complication. This policy should be shared with the radiologists and surgeons at each center. <b>2</b> In the case of an endoscopically identified perforation, ESGE recommends that the endoscopist reports: its size and location with a picture; endoscopic treatment that might have been possible; whether carbon dioxide or air was used for insufflation; and the standard report information. <b>3</b> ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be carefully evaluated and documented, possibly with a computed tomography (CT) scan, in order to prevent any diagnostic delay. <b>4</b> ESGE recommends that endoscopic closure should be considered depending on the type of perforation, its size, and the endoscopist expertise available at the center. A switch to carbon dioxide insufflation, the diversion of luminal content, and decompression of tension pneumoperitoneum or tension pneumothorax should also be done. <b>5</b> After closure of an iatrogenic perforation using an endoscopic method, ESGE recommends that further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of the iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.
Quantitative Estimation of Systemic Glucose Production in Normal and Diabetic Pregnancy
Authors: Satish C Kalhan, Peter A J Adam
Journal: Diabetes Care (1980)

Fasting during pregnancy is accompanied by a decline in plasma glucose and glycogenic amino acid concentration and an early recruitment of alternate fuel by mobilizing fatty acids from adipose tissue stores. Systemic glucose production rates were measured in normal, gestationally diabetic, and juvenile-onset diabetic subjects using (1-13C)glucose and (6,6-2H2)glucose tracers according to the constant-rate infusion technique. Even though the plasma glucose concentration during normal pregnancy had declined after an overnight fast, as compared with the nonpregnant subject (P &amp;lt; 0.0005), the systemic glucose production rate was 16% greater, a rate sufficient to provide the glucose requirement of the fetus at term gestation. The decline in glucose concentration could be the result of an increase in apparent volume of distribution of glucose. Systemic glucose production rates in well-regulated gestationally diabetic and insulin-dependent diabetic subjects were similar to those in normal pregnant subjects. These data suggest that the early disturbance in diabetes is the inability to assimilate exogenously administered glucose and other nutrients. Hormonal-fuel relationship during pregnancy suggests that during fasting, the insulin/glucagon molar ratio is maintained similar to that in nonpregnant subjects. Adrenal catecholamines do not appear to play a significant role in the regulation of hepatic glucose production. However, their role may be important in the early recruitment of alternate fuels.