tbuckley/cabot-search huggingface dataset:
Health care of physically handicapped young adults
Authors: M. C O Bax, D. P L Smyth, A. P Thomas
Journal: BMJ (1988)

Little is known about the health needs of physically handicapped young adults after they become too old for the paediatric service. To assess these needs 104 young people with physical handicaps were given a medical examination and interviewed. They had diverse physical handicaps, many of which were rare (41 subjects); 45 had cerebral palsy and 18 spina bifida. Mental handicap (42 subjects) and a need for special education (28) were also diagnosed. The state of health of all subjects was generally poor. Sixty one subjects had contractures of the lower joints and almost a quarter contractures of the upper joints; 26 had deformed feet. Consequently, many subjects (41) could not walk; only 13 could walk without difficulty. Urinary and bowel incontinence were prevalent (58 and 55 subjects, respectively) and with contractures and pressure sores resulted in skin problems (35 subjects). Kyphoscoliosis was present in 30 subjects, particularly those with spina bifida (10 out of 18), of whom one third had respiratory problems and almost half cardiac problems. Thirty one subjects had epilepsy. Many subjects (49) had difficulty communicating or some visual defect (27). Although over half the subjects had health problems that were severe enough to warrant intervention, less than a third were receiving any form of regular hospital care; regular contact with physiotherapists, speech therapists, and dentists was also poor. Moreover, the original diagnoses and prescriptions had not been reviewed regularly. Teams for handicapped adults should be set up in all district health authorities to provide a clinical and coordination service for all adults with physical and mental handicaps.
New Treatment for Struvite Urinary Stones
Authors: Lynwood H. Smith
Journal: New England Journal of Medicine (1984)

Struvite calculi (MgNH4PO4 · 6H2O) that form within the urinary tract are a result of the action of the bacterial enzyme urease, which is produced by bacteria, such as proteus species, that may infect the urinary tract.1 This enzyme metabolizes urea, producing ammonium and hydroxyl ions that alkalinize the urine so that the pH is commonly above 7.5. This alkalinization increases the free ion activity of phosphate and carbonate, inducing a supersaturation state in the urine for several crystal systems, including struvite, carbonate apatite, and hydroxyapatite. The so-called infection stone that results in this setting . . .
Quantification of idiopathic pulmonary fibrosis using computed tomography and histology.
Authors: H O Coxson, J C Hogg, J R Mayo, H Behzad, K P Whittall, D A Schwartz, P G Hartley, J R Galvin, J S Wilson, G W Hunninghake
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

We used computed tomography (CT) and histologic analysis to quantify lung structure in idiopathic pulmonary fibrosis (IPF). CT scans were obtained from IPF and control patients and lung volumes were estimated from measurements of voxel size, and X-ray attenuation values of each voxel. Quantitative estimates of lung structure were obtained from biopsies obtained from diseased and normal CT regions using stereologic methods. CT density was used to calculate the proportion of tissue and air, and this value was used to correct the biopsy specimens to the level of inflation during the CT scan. The data show that IPF is associated with a reduction in airspace volume with no change in tissue volume or weight compared with control lungs. Lung surface area decreased two-thirds (p < 0.001) and mean parenchymal thickness increased tenfold (p < 0.001). An exudate of fluid and cells was present in the airspace of the diseased lung regions and the number of inflammatory cells, collagen, and proteoglycans was increased per 100 g of tissue in IPF. We conclude that IPF reorganized lung tissue content causing a loss of airspace and surface area without increasing the total lung tissue.
The 'interferon paradox' as a predictor of non-response to anti-viral therapy: novel association with apolipoprotein E and hepatitis C virus (HCV) lipoviralparticles (LVP).
Authors: D. Sheridan, S. Bridge, D. Felmlee, S. T. Robinson, H. Thomas, G. Toms, D. Neely, M. Bassendine
Journal: Gut (2011)

<h3>Introduction</h3> Identification of factors that influence response to treatment are important for individualised care in the era of direct acting antivirals. Interferon-γ inducible protein-10 (IP10) is one of hundreds of interferon stimulated genes (ISGs). Paradoxically, high ISGs, notably IP10 are associated with poor treatment response. Although HCV hijacks the VLDL pathway in its life cycle, another paradox is that high LDL cholesterol is a marker of favourable outcome. We have shown that infectious HCV LVP correlate with insulin resistance and that high LVP ratio (LVP ratio = LVP/LVP + non LVP) is associated with lower EVR.1 <h3>Aim</h3> To evaluate the interactions between LVP, IP10 and lipid profiles. <h3>Methods</h3> Fasting samples were collected from 71 consecutive HCV G1 patients. LVP and LVP ratio were determined as previously described.1 Fasting lipids, apoB and apoE were measured using automated enzymatic methods. IP10 was measured using a commercially available ELISA (R&amp;D Systems, Abingdon, UK). <h3>Results</h3> Univariate analysis demonstrated a relationship between IP10 and LVP ratio (r=0.31, p=0.028) but not between total viral load and IP10 (r=0.005, p=0.973). IP10 levels inversely correlated with LDL cholesterol (r=-0.302, p=0.017) and apoB (r=-0.295, p=0.015). IP10 levels also strongly positively correlated with apoE (r=0.444 p&lt;0.001). ApoE positively correlated with LVP ratio (r=0.498, p=0.001) but not with total viral load (r=0.035, p=0.826). When apoE and IP10 were included in the multivariate model as predictors of LVP ratio, IP10 was no longer a significant correlate with LVP ratio (p=0.446) suggesting that the relationship between IP10 and LVP ratio is mediated via apoE. <h3>Conclusion</h3> This data indicates there is a close link between ISGs and lipoprotein metabolism. High IP10 correlates with apoE which is an exchangeable lipoprotein that transfers from HDL to triglyceride-rich lipoprotein remnants where it mediates clearance via LDLR, a candidate HCV receptor. ApoE is important in HCV replication/assembly and is a constituent of infectious LVP. Hence the effect of the endogenous interferon response on lipids is favourable to the virus by promoting LVP. This provides a possible explanation for the interferon paradox.
Higher Levels of HDL Cholesterol Are Associated With a Decreased Likelihood of Albuminuria in Patients With Long-Standing Type 1 Diabetes
Authors: Bogna Wierusz-Wysocka, Dorota A. Zozulinska, Aleksandra Araszkiewicz, Dorota Pisarczyk-Wiza
Journal: Diabetes Care (2006)

We read with great interest the article by Molitch et al. (1), concerning the association between high levels of HDL cholesterol and albuminuria in type 1 diabetes. We have found similar results in a group of 157 patients with long-standing type 1 diabetes but in relation to retinopathy, which seems to be a more objective marker of microangiopathy than albuminuria in diabetes. Retinopathy was assessed by two experienced ophthalmologists using direct ophthalmoscopy on dilated pupils, …
Methotrexate polyglutamation in relation to infliximab pharmacokinetics in rheumatoid arthritis
Authors: Thierry Dervieux, Michael E Weinblatt, Alan Kivitz, Joel M Kremer
Journal: Annals of the Rheumatic Diseases (2012)

Objective The combination of methotrexate (MTX) with infliximab can modify infliximab pharmacokinetics and lower the incidence of antibodies against infliximab (ATIs). We hypothesised that the pharmacokinetic interaction between MTX and infliximab is related to activation of MTX to immunosuppressive MTX polyglutamates (MTXPGs). Methods Adult patients with rheumatoid arthritis receiving weekly MTX with infliximab for more than 3 months were enrolled in a cross-sectional study. Blood was collected at trough before the infusion of infliximab. Red blood cell (RBC) MTXPGs were measured using liquid chromatography, and circulating levels of infliximab were measured using a cell-based assay. ATIs were measured using enzyme immunoassays. Statistical analyses consisted of multiple regression and Wilcoxon tests. Results In the 61 patients enrolled in the study, ATIs were detected in 11 (18%). Regression analyses revealed that lower infliximab levels (median 3.3 µg/ml) were associated with the presence of ATIs and lower RBC MTXPG levels (median 28 nmol/l) (p&lt;0.05). Logistic regression revealed that RBC MTXPG levels above 25 nmol/l were associated with a 4.7-fold lower likelihood of having ATIs (OR=4.7; 95% CI 1.1 to 20.8; p=0.02). None of the 12 patients with RBC MTXPG levels above 50 nmol/l tested positive for ATIs. Conclusions These hypothesis-generating data indicate that MTXPGs are associated with infliximab pharmacokinetics and ATI formation.
Pattern of differential vasoconstriction in response to acute and chronic low-output states in the conscious dog
Authors: C. B. HIGGINS, S. F. VATNER, D. FRANKLIN, E. BRAUNWALD
Journal: Cardiovascular Research (1974)

The extent to which the mesenteric, renal, and iliac beds respond with vasoconstriction to the low-output state of chronic failure was studied in conscious dogs with experimental heart failure produced by tricuspid insufficiency and pulmonary stenosis. While intense vasoconstriction occurred in the mesenteric and iliac beds, the renal circulation was relatively spared. A similar pattern of response was observed in a second group of normal conscious dogs when cardiac output and arterial pressure were acutely decreased by partial occlusion of the inferior vena cava.
Intracellular ionic consequences of dietary salt loading in essential hypertension. Relation to blood pressure and effects of calcium channel blockade.
Authors: L M Resnick, R K Gupta, B DiFabio, M Barbagallo, S Mann, R Marion, J H Laragh
Journal: Journal of Clinical Investigation (1994)

To study the ionic basis of salt sensitivity in hypertension, 19F-, 13P-, and 23Na-nuclear magnetic resonance techniques were used to measure cytosolic free calcium (Cai), pH (pHi), free magnesium (Mgi), and sodium (Nai) in erythrocytes of essential hypertensive subjects (n = 19). Individuals were studied for 2 mo each on low- (UNaV < 50 meq/d) and high- (UNaV > 200 meq/d) salt diets, with the concomitant administration of nifedipine (10 mg t.i.d.) or placebo tablets for 1 mo of each diet. Salt loading elevated Cai and Nai while suppressing Mgi and pHi; these changes occurred predominantly in salt-sensitive subjects (n = 9). Nifedipine blunted the pressor response to salt loading > 50% (delta diastolic BP [high-low salt vs placebo] = 5 +/- 2 vs 14 +/- 2 mmHg, P < 0.05) and reversed salt-induced ionic changes, lowering Cai and elevating Mgi and pHi. Regardless of the definition of salt sensitivity, continuous relationships were observed between the pressure response to salt loading, the levels of Cai (r = 0.726, P < 0.001), Nai (r = 0.747, P < 0.001), and pHi (r = -0.754, P < 0.001), and the salt-induced change in Mgi (r = -0.757, P < 0.001). Altogether, these results emphasize the reciprocal and coordinate nature of intracellular ionic changes in response to dietary salt loading and calcium channel blockade in essential hypertension. They suggest that salt sensitivity is mediated by cellular calcium accumulation from the extracellular space, in association with magnesium depletion and acidification. Lastly, interpretation of intracellular ion measurements in the future will require concurrent assessment of dietary salt intake.
Association of Copeptin and N-Terminal proBNP Concentrations With Risk of Cardiovascular Death in Older Patients With Symptoms of Heart Failure
Authors: Urban Alehagen
Journal: JAMA (2011)

Measurement of plasma concentrations of the biomarker copeptin may help identify patients with heart failure at high and low risk of mortality, although the value of copeptin measurement in elderly patients is not fully known.To evaluate the association between plasma concentrations of copeptin, a surrogate marker of vasopressin, combined with concentrations of the N-terminal fragment of the precursor to B-type natriuretic peptide (NT-proBNP), and mortality in a cohort of elderly patients with symptoms of heart failure.Primary health care population in Sweden enrolling 470 elderly patients with heart failure symptoms between January and December 1996. Clinical examination, echocardiography, and measurement of peptide concentrations were performed, with follow-up through December 2009.All-cause mortality and cardiovascular mortality.After a median follow-up of 13 years, there were 226 deaths from all causes, including 146 deaths from cardiovascular causes. Increased concentration of copeptin was associated with increased risk of all-cause mortality (fourth quartile vs first quartile: 69.5% vs 38.5%, respectively; hazard ratio [HR], 2.04 [95% confidence interval {CI}, 1.38-3.02]) and cardiovascular mortality (fourth quartile vs first quartile: 46.6% vs 26.5%; HR, 1.94 [95% CI, 1.20-3.13]). The combination of elevated NT-proBNP concentrations and elevated copeptin concentrations also was associated with increased risk of all-cause mortality (copeptin fourth quartile: HR, 1.63 [95% CI, 1.08-2.47]; P = .01; NT-proBNP fourth quartile: HR, 3.17 [95% CI, 2.02-4.98]; P < .001). Using the 2 biomarkers simultaneously in the evaluation of cardiovascular mortality, there was a significant association for copeptin in the presence of NT-proBNP (log likelihood trend test, P = .048) and a significant association for NT-proBNP (fourth quartile: HR, 4.68 [95% CI 2.63-8.34]; P < .001).Among elderly patients with symptoms of heart failure, elevated concentrations of copeptin and the combination of elevated concentrations of copeptin and NT-proBNP were associated with increased risk of all-cause mortality.
Instantaneous Increase in Mean Circulatory Pressure and Cardiac Output at Onset of Muscular Activity
Authors: Arthur C. Guyton, Ben H. Douglas, Jimmy B. Langston, Travis Q. Richardson, Barry Abernathy
Journal: Circulation Research (1962)

In dogs with their spinal cords cut, sudden maximal muscular contraction in the lower half of the body caused the mean circulatory pressure to rise instantaneously to three times normal and the cardiac output to rise to an average of 40 per cent above normal. This instantaneous effect was not blocked by sympathetic blockade with hexamethonium but was blocked by skeletal muscle blockade with decamethonium. Furthermore, because of the transected cord, no cardiac reflex effects were observed. Therefore, it was concluded that skeletal muscle activity compresses the intra-muscular and intra-abdominal vessels and thereby increases the mean circulatory pressure. Evidence is presented to show that this, in turn, translocates blood into the heart and that the heart then responds in conformity with Starling's principle of cardiac adaptation to increase the cardiac output.
Targeting asthma care in general practice using a morbidity index.
Authors: K. P. Jones, I. H. Charlton, M. Middleton, W. J. Preece, A. P. Hill
Journal: BMJ (1992)

To evaluate a morbidity index as a postal surveillance tool in defining previously diagnosed asthmatic patients needing extra education or management; to determine the accuracy of a computerised asthma register in general practice.Postal questionnaire survey of asthmatic patients identified from a computer register. Questionnaire comprised three morbidity questions, two questions about current asthma status, and one about treatments.Urban general practice of 8400 patients linked to academic unit.853 asthmatic patients of all ages.Numbers of patients with low, medium, and high morbidity; associations of these groups with age, asthma status, and drugs taken.Two mailings yielded 621 replies (73%); 28 patients (5%) had moved away, leaving 593 for analysis. Attempts were subsequently made to contact 20% sample of non-respondents. 234 respondents (40%) were in the "low morbidity" group, 149 (25%) in the "medium morbidity" group, and 210 (35%) in the "high morbidity" category. 53% of patients perceiving themselves as currently asthmatic (193/362) were in the high morbidity group, but 7% (11/153) who said they were no longer asthmatic and 8% (6/78) who did not believe they had ever been asthmatic were also in that group. High morbidity was also found in 10% (18/185) of those on no treatment, 38% (59/154) of those on bronchodilators alone, and 54% (119/220) of those on inhaled corticosteroids. 25 patients (4%) were wrongly identified as asthmatic; when combined with returns marked "gone away" this gave a disease register accuracy of 91%.This exercise identified subgroups of previously diagnosed asthmatic patients with high morbidity in general practice who might benefit from extra education and management and revealed some misclassification on the asthma disease register.
Endocrine Outcomes for Children With Embryonal Brain Tumors After Risk-Adapted Craniospinal and Conformal Primary-Site Irradiation and High-Dose Chemotherapy With Stem-Cell Rescue on the SJMB-96 Trial
Authors: Stephen J. Laughton, Thomas E. Merchant, Charles A. Sklar, Larry E. Kun, Maryam Fouladi, Alberto Broniscer, E. Brannon Morris, Robert P. Sanders, Matthew J. Krasin, John Shelso, Zang Xiong, Dana Wallace, Amar Gajjar
Journal: Journal of Clinical Oncology (2008)

To estimate the cumulative incidence of specific hormone deficiencies and the influence of hypothalamic-pituitary (HP) axis radiation dose in a cohort of children with embryonal brain tumors treated with risk-adapted craniospinal irradiation (CSI), conformal primary site irradiation, and high-dose chemotherapy.Clinical data and HP axis radiation dosimetry data were obtained from 88 eligible children. All patients received regular endocrine follow-up that included screening tests of thyroid function and stimulation testing for growth hormone deficiency (GHD), and adrenocorticotropin hormone deficiency.The cumulative incidence of GHD, thyroid-stimulating hormone (TSH) deficiency, adrenocorticotropic hormone deficiency, and primary hypothyroidism at 4 years from diagnosis was 93% +/- 4%, 23% +/- 8%, 38% +/- 6%, and 65% +/- 7%, respectively. Radiation dosimetry to the HP axis was associated only with the development of TSH deficiency; the 4-year cumulative incidence was 44% +/- 19% and 11% +/- 8% (P = .014) for those receiving more or less than the median dose to the hypothalamus (>or= 42 v < 42 Gy), respectively. The median dose of CSI for the average-risk (AR) patients was 23.4 and 39.6 Gy (36 to 40.5 Gy) for the high-risk patients. The estimated mean decline in height Z-score after radiation therapy was greater in high-risk patients (-0.65 units/yr) when compared with AR patients (-0.54 units/yr; P = .039).Pediatric patients with CNS embryonal tumors are at high risk for treatment-related hormone deficiencies. GHD and primary hypothyroidism were diagnosed in a majority of subjects relatively soon after the completion of therapy. Radiation dose to the hypothalamus in excess of 42 Gy was associated with an increase in the risk of developing TSH deficiency.
Caring for the Poor
Authors: Robert L. Harris
Journal: JAMA (1988)

<h3>To the Editor.</h3> —The article by Dr Hilfiker<sup>1</sup>and the editorial by Dr Lundberg and Mr Bodine<sup>2</sup>in the Dec 4 issue ofThe JOURNALshould be applauded by every physician. If we can no longer care for the helpless, the poor, and the unfortunates in our society, then we have truly lost our way. I have no disagreement with the content either of the article or of the editorial, but I would like to offer an addendum. Dr Hilfiker pleads with us to open 15% of our practices to those who cannot afford our full fee. He asks us to accept Medicaid, with all its paperwork, discounts, and headaches, to serve this population. I suggest that it would be much more in keeping with the ideals and the traditions of our profession to see these people free of charge without any bills submitted to Medicaid. Idealism aside,
Efficacy of captopril in postponing nephropathy: Author's reply
Authors: E. Mathiesen
Journal: BMJ (1991)

prospective or retrospectivc -representative of the majority of' births is clearly difficult.Because of the large numb11hcr of births in lower age groups and the tiny proportion of these which wvill be affected by Down's svndrome, only a very large study could pn)vide sufficient cases for evalluation (although cost could presumably be redLuced by conducting this study in one of the regions alreadv providing the triple test on the NHS) In commenting on Cuckle et al's article I did not intend to suggest that netitrophil alkaline phosphatase activity will not prove to be a highly valuable additional marker- only that it may have been premature in a leaflet sent directly to pregnant women to contrast the efficiencv of the triple and triple plus tests before all of the necessary evidence is in.
DIFFERENCE IN THE FREQUENCY OF PROCEDURAL COMPLICATIONS RELATED TO PERCUTANEOUS CORONARY INTERVENTION OF CHRONIC TOTAL OCCLUSIONS BETWEEN VIA RETROGRADE APPROACH VS. VIA ANTEGRADE APPROACH
Authors: Hirotomo Sato, Masashi Kimura, Taku Ichihashi, Shuichi Ishizuka, Atsuko Kodama, Masanori Yamamoto, Maoto Habara, Tomohiko Teramoto, Kenya Nasu, Yoshihisa Kinoshita, Etsuo Tsuchikane, Mitsuyasu Terashima, Tetsuo Matsubara, Takahiko Suzuki
Journal: Journal of the American College of Cardiology (2014)
Angiotensin I—converting enzyme and angiotensinogen gene polymorphisms in non—insulin-dependent diabetes mellitus. Lack of relationship with diabetic nephropathy and retinopathy in a caucasian mediterranean population
Authors: C. Gutiérrez, J. Vendrell, R. Pastor, C. Llor, C. Aguilar, M. Broch, C. Richart
Journal: Metabolism (1997)
Molecular basis of antithrombin deficiency in four Japanese patients with antithrombin gene abnormalities including two novel mutations
Authors: Mayu Kyotani, Kaoru Okumura, Akira Takagi, Takashi Murate, Koji Yamamoto, Tadashi Matsushita, Motoi Sugimura, Naohiro Kanayama, Takao Kobayashi, Hidehiko Saito, Tetsuhito Kojima
Journal: American Journal of Hematology (2007)

Abstract We analyzed the antithrombin ( AT ) gene in four unrelated Japanese patients with an AT deficiency, and individually identified four distinct mutations in the heterozygous state. There were two novel mutations, 2417delT leading to a frameshift with a premature termination at amino acid –3 (FS‐3Stop) and C2640T resulting in a missense mutation (Ala59Val). Previously reported mutations, T5342C (Ser116Pro) and T72C (Met‐32Thr), were also found in the other two patients. To understand the molecular basis responsible for the AT deficiency in these patients, in vitro expression experiments were performed using HEK293 cells transfected with either wild type or respective mutant AT expression vector. We found that –3Stop‐AT and –32Thr‐AT were not secreted into the culture media, whereas 116Pro‐AT and 59Val‐AT were secreted normally. We further studied the heparin cofactor activity and the binding to heparin of each recombinant AT molecule. Ser116Pro mutation significantly impaired the binding affinity to heparin resulting in a reduced heparin cofactor activity. In contrast, we found that Ala59Val mutant AT unexpectedly showed a normal affinity to heparin, but severely impaired the heparin cofactor activity. Our findings suggested that FS‐3Stop and Met‐32Thr mutations are responsible for type I AT deficiency, whereas Ser116Pro and Ala59Val mutations contribute to type II AT deficiency, confirming that there were diverse molecular mechanisms of AT deficiency depend upon discrete AT gene abnormalities as reported previously. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.