tbuckley/cabot-search huggingface dataset:
Supervision, Not Regulation of Hours, Is the Key to Improving the Quality of Patient Care
Authors: Bertrand M. Bell
Journal: JAMA (1993)

This week's issue ofThe Journalhas an article by Laine et al,<sup>1</sup>which elegantly demonstrates how to study the effect changes in the working hours of residents will have on residency programs. The publication of this article is also evidence of wide interest in the 19-month study of a New York committee, the Bell Committee. The study produced a series of recommendations<sup>2</sup>that led to changes in the New York State Health Code,<sup>3</sup>regulating not only the working conditions of residents, but also their supervision.<sup>4</sup> See also p 374. The need to rationalize the hours that house staff are scheduled to work, which has made sleep deprivation and chronic fatigue features of graduate medical education both in our country and in other countries, is a need whose time clearly has come.<sup>5</sup>In the United Kingdom, the Ministerial Group on Junior Doctors' Hours has accepted
CARBON-14 UREA BREATH TEST TO DETECT HELICOBACTER PYLORI INFECTION IN GASTRITIS AND ULCER DISEASE
Authors: E M Smith, R E OʼMora, W Y Chey
Journal: Clinical Nuclear Medicine (1995)

*Division of Nuclear Medicine, University of Rochester Medical Center, Rochester, New York **Center for Digestive and Liver Diseases, University of Rochester Medical Center, Rochester, New York.
Triamterene with Hydrochlorothiazide in the Treatment of Hypertension
Authors: William C. Heath
Journal: JAMA (1963)

Triamterene, a new potassium-sparing pteridine diuretic was found to have a weaker saluretic effect than the benzothiadiazines in nonedematous patients. However, a combination of 50 mg of triamterene plus 25 mg of hydrochlorothiazide, while continuing to prevent potassium loss, exhibited saluretic potency equivalent to 50 mg of hydrochlorothiazide alone. In 32 hypertensive outpatients, crossover therapeutic trials revealed that the combination just mentioned was as effective in controlling blood pressure as full doses of hydrochlorothiazide alone, whereas hypokalemia was prevented. No toxic effects, attributable to triamterene, were detected during the course of these studies.
First thalidomide clinical trial in multiple myeloma: a decade
Authors: Frits van Rhee, Madhav Dhodapkar, John D. Shaughnessy, Elias Anaissie, David Siegel, Antje Hoering, Jerome Zeldis, Bonnie Jenkins, Seema Singhal, Jayesh Mehta, John Crowley, Sundar Jagannath, Bart Barlogie
Journal: Blood (2008)
THE INTERLEUKIN-12/INTERLEUKIN-12-RECEPTOR SYSTEM: Role in Normal and Pathologic Immune Responses
Authors: Maurice K. Gately, Louis M. Renzetti, Jeanne Magram, Alvin S. Stern, Luciano Adorini, Ueli Gubler, David H. Presky
Journal: Annual Review of Immunology (1998)

▪ Abstract Interleukin-12 (IL-12) is a heterodimeric cytokine that plays a central role in promoting type 1 T helper cell (Th1) responses and, hence, cell-mediated immunity. Its activities are mediated through a high-affinity receptor composed of two subunits, designated β1 and β2. Of these two subunits, β2 is more restricted in its distribution, and regulation of its expression is likely a central mechanism by which IL-12 responsiveness is controlled. Studies with neutralizing anti-IL-12 antibodies and IL-12-deficient mice have suggested that endogenous IL-12 plays an important role in the normal host defense against infection by a variety of intracellular pathogens. However, IL-12 appears also to play a central role in the genesis of some forms of immunopathology. Inhibition of IL-12 synthesis or activity may be beneficial in diseases associated with pathologic Th1 responses, such as multiple sclerosis or Crohn's disease. On the other hand, administration of recombinant IL-12 may have utility in the treatment of diseases associated with pathologic Th2 responses such as allergic disorders and asthma.
Airway Smooth Muscle, Tidal Stretches, and Dynamically Determined Contractile States
Authors: JEFFREY J. FREDBERG, DAVID INOUYE, BRETT MILLER, MADHAVI NATHAN, SAMAH JAFARI, SOUFIA HELIOUI RABOUDI, JAMES P. BUTLER, STEPHANIE A. SHORE
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

In the classic theory of airway lumen narrowing in asthma, active force in airway smooth muscle is presumed to be in static mechanical equilibrium with the external load against which the muscle has shortened. This theory is useful because it identifies the static equilibrium length toward which activated airway smooth muscle would tend if given enough time. The corresponding state toward which myosin-actin interactions would tend is called the latch state. But are the concepts of a static mechanical equilibrium and the latch state applicable in the setting of tidal loading, as occurs during breathing? To address this question, we have studied isolated, maximally contracted bovine tracheal smooth muscle subjected to tidal stretches imposed at 0.33 Hz. We measured the active force (F) and stiffness (E), which reflect numbers of actin-myosin interactions, and hysteresivity ( η ), which reflects the rate of turnover of those interactions. When the amplitude of imposed tidal stretch ( ε ) was very small, 0.25% of muscle optimal length, the steady-state value of F approximated the isometric force, E was large, and η was small. When ε was increased beyond 1%, however, F and E promptly decreased and η promptly increased. The muscle could be maintained in these steady, dynamically determined contractile states for as long as the tidal stretches were sustained; when ε subsequently decreased back to 0.25%, F, E, and η returned slowly toward their previous values. The provocative stretch amplitude required to cause active force or muscle stiffness to fall by half, or hysteresivity to double, was slightly greater than 2%. These observations are consistent with a direct effect of stretch upon bridge dynamics in which, with increasing tidal stretch amplitude, the number of actin-myosin interactions decreases and their rate of turnover increases. We conclude that the interactions of myosin with actin are at every instant tending toward those that would prevail in the isometric steady state, but tidal changes of muscle length cause an excess in the rate of detachment. These stretch-induced detachment events can come so fast compared with the rate of attachment that static equilibrium conditions are never attained. If so, then airway lumenal narrowing and the underlying contractile state would be governed by a dynamic mechanical process rather than by a mechanical equilibrium of static forces.
Mechanism of cardiac defibrillation in open-chest dogs with unipolar DC-coupled simultaneous activation and shock potential recordings.
Authors: F X Witkowski, P A Penkoske, R Plonsey
Journal: Circulation (1990)

The automatic implantable cardioverter-defibrillator has been shown to dramatically improve survival. The future refinement of these devices requires a clear understanding of their mechanism of action. We performed the following study to test two hypotheses: 1) When defibrillation is successful, fibrillating activity must be annihilated in a critical mass of both ventricles; and 2) when defibrillation is unsuccessful, at least one area of the ventricular mass has been left fibrillating. Unipolar Ag/AgCl sintered electrodes were directly coupled from triangular arrays at 40 epicardial locations (total, 120 recording sites) that covered both right and left ventricular surfaces and were designed to measure the voltage gradient generated by the shock at each triangular array as well as the underlying myocardial electrical activity before and immediately after the shock. An algorithm was developed and tested that reliably scored whether a postshock activation was a continuation of the immediately previous fibrillating activity. This technique was applied to 203 defibrillation attempts in six open-chest dogs during electrically induced ventricular fibrillation. There were 139 successful defibrillation attempts and 64 unsuccessful attempts. Monophasic truncated exponential 10-msec defibrillation shocks (0.5-35 J) were delivered through an anodal patch on the right atrium and a cathodal patch on the left ventricular apex. In all cases of unsuccessful defibrillation, at least one ventricular site could be clearly identified that failed to be defibrillated. In cases of successful defibrillation two distinct patterns were observed: 1) complete annihilation of fibrillating activity at all sites or 2) nearly complete cessation of fibrillating activity with a single area of persistent fibrillation that subsequently self-extinguished within one to three activations. This single site in the second form of successful defibrillation was located in the region of minimum voltage gradient produced by the defibrillating waveform and was occasionally accompanied by dynamic encapsulation with refractory tissue as a result of a wavefront emanating from a region that had undergone successful defibrillation. These results support the hypothesis that a critical mass of myocardium must be affected for successful defibrillation and that unsuccessful defibrillation is always accompanied by residual fibrillating activity in at least one site. The results also demonstrate that the size of the critical mass required for successful defibrillation can be less than 100%.
TCT-523 Therapeutic Potential Of Sustained Release Sodium Nitrite For Critical Limb Ischemia In The Setting Of Metabolic Syndrome
Authors: Traci T. Goodchild, David J. Polhemus, Jessica M. Bradley, Carlos C. Chang, Kazi N. Islam, Tony Giordano, David J. Lefer
Journal: Journal of the American College of Cardiology (2014)
Judicial review will decide trainees' future
Authors: Owen Dyer
Journal: BMJ (2007)

The professional futures of thousands of junior doctors throughout England could hinge on the result of a judicial review of the government's web based medical training application service, known as MTAS.

The MTAS website has been closed since April, and was last week abandoned by health secretary Patricia Hewitt. Its flawed software failed to select the best applicants for jobs and permitted serious security breaches. In some cases doctors were able to read each other's personal data and applications.

Although the decision to abandon MTAS was widely welcomed, no agreement has been reached on what to do with the thousands of applications that have already led to interviews.

An MTAS review group appointed by the government, in which the BMA participated, …
International Consultation on Urologic Diseases and the European Association of Urology International Consultation on Locally Advanced Renal Cell Carcinoma
Authors: Vitaly Margulis, Viraj A. Master, Nicholas G. Cost, Bradley C. Leibovich, Steven Joniau, Markus Kuczyk, Peter F. Mulders, Ziya Kirkali, Manfred P. Wirth, Yoshihiko Hirao, Sudhir Rawal, Tsung Wen Chong, Christopher G. Wood
Journal: European Urology (2011)
The Function of the Appendix.
Authors: Robert T. Morris
Journal: JAMA (1901)

New York, Sept. 20, 1901. <h3>To the Editor:</h3> —On page 852 ofThe Journalfor Sept. 28, 1901, I find a report of a paper read by Dr. E. P. Hershey, Denver, dealing with the question of the function of the appendix. Dr. Hershey apparently believes that the secretions of the appendix are important in their influence on bowel contents, but we know that such secretions are trifling in amount and not different from those of the cecum. Most of the appendices upon which I have operated have had their function already destroyed by bacteria. Further than that, we know that during middle life the appendix is prone to undergo normal involution changes, so that in later life there is little if any secreting surface left. Dr. Hershey says of the cecum: "This cul-de-sac is the most inviting place for the accumulations of feces. The mass remains here and would
When to test women for human papillomavirus: Take this opportunity to screen for anal cancer too
Authors: Awori J Hayanga
Journal: BMJ (2006)

Peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) is a relatively rare condition in Australia. Here, we report a case of PTCL, NOS in a patient who presented with persistent fever and progressive pancytopenia on a background of mediastinal lymphadenopathy, initially presumed reactive and hepatosplenomegaly with deranged liver function tests. The diagnosis was challenging, with multiple negative blood cultures and inconclusive bone marrow studies, and it required extensive investigations that ultimately revealed the characteristic clinical, histopathological and immunophenotypic features of PTCL, NOS. The patient underwent multiple rounds of multiagent chemotherapy after the diagnosis. This case highlights the difficulty in diagnosing PTCL, NOS and the importance of including it as a differential diagnosis in younger patients who present with constitutional symptoms and hepatosplenomegaly.
Metastatic Prostate Cancer to the Optic Canal
Authors: Jorge C. Kattah, Georgia C. Chrousos, Joan Roberts, Martin Kolsky, Lorenz Zimmerman, Herbert Manz
Journal: Ophthalmology (1993)

Optic neuropathies represent a common cause of blindness among patients with cancer. The authors present the clinical and imaging findings and discuss the management of optic nerve involvement from metastatic prostate cancer to the optic canal.Five patients with advanced metastatic prostate cancer had visual loss. Neuro-ophthalmologic examination and pre- and post-gadolinium orbital and brain magnetic resonance imaging (MRI) were performed. Compressive optic neuropathy secondary to extensive optic canal involvement was demonstrated in all of the patients. Neuropathologic examination was accomplished in two cases. A combination of steroid and focal radiation therapy was used for treatment in four patients.Imaging and neuropathologic findings demonstrated a compressive optic neuropathy secondary to both epidural metastases and to deformity and hypertrophy of the optic canal due to metastatic cancer. Treatment was of benefit in three cases.Acute and subacute unilateral or bilateral optic neuropathy in patients with prostate cancer may be the result of optic canal metastases. Magnetic resonance imaging shows a characteristic pattern of bone hypertrophy and deformity with optic nerve compression. Early combination steroid and radiation therapy may induce long-lasting improvement.
Factors regulating tumor pressure in hepatocellular carcinoma and implications for tumor spread
Authors: T Tanaka, N Yamanaka, T Oriyama, K Furukawa, E Okamoto
Journal: Hepatology (1997)

This study was performed to investigate factors determining tumor pressure (TP) in hepatocellular carcinoma (HCC) and a correlation of pressure gradient between TP and portal vein pressure (PVP) with tumor spread. TP and hepatic tissue pressure (HTP) were measured in 70 patients who underwent hepatic resection for HCC. Changes in TP after hepatic artery occlusion (HAO) or portal vein occlusion (PVO) were observed. HTP was elevated with worsening chronic liver disease, and exhibited a significant positive correlation with PVP. The TP was significantly higher in the encapsulated and the nonnecrotic HCCs. The pressure gradient (TP-PVP) was significantly greater in the encapsulated HCCs, especially in those with microscopic portal vein invasion (vp) or intrahepatic metastasis (im). HAO caused a greater decrease in TP than did PVO, with the decrease being particularly marked in the encapsulated HCCs. The TP of HCC was found to be regulated mainly by the presence or absence of a tumor capsule or necrosis, and partly by the hepatic arterial flow and PVP. Our study suggests that TP increases with capsule formation and that the pressure gradient between TP and PVP may be a causal factor in the dispersement of tumor cells into the portal vein.
Use of biological drugs in elderly cancer patients: A sustainable reality? A mono-institutional experience
Authors: L. Fratino, D. Crivellari, M. Spina, A. Bearz, C. Simonelli, M. Berretta, M. G. Michieli, L. Dal Maso, M. G. Trovò, U. Tirelli
Journal: Journal of Clinical Oncology (2007)

19665 Background: Several new biological anti-cancer drugs have been recently licensed, and some of them have shown impressive positive results particularly in tumors that express the targets for these agents (e.g., ERBB2 receptor in breast cancer, KIT mutations in gastrointestinal tumors, and the CD20 expression in NHL). However, the use of these drugs in elderly cancer patients is a matter of debate. The aim of this study was to quantify the use of biological drugs according to age and type of cancer. Methods: We analyzed data regarding patients diagnosed with metastatic breast cancer, NSCLC or colo-rectal cancer and NHL treated with biological drugs (i.e., bevacizumab, cetuximab, rituximab, trastuzumab, erlotinib, geftinib) at the National Cancer Institute of Aviano, North-east Italy, between 2002 and 2006. Patients were stratified according to age (i.e., &lt;=69 years or &gt;=70 years) and type of biological agent used. Results: Overall, 687 patients were treated with biological agents (360 with rituximab, 149 with trastuzumab, 114 with geftinib, 23 with bevacizumab, 21 with erlotinib and 20 with cetuximab). Older patients (n=103) had a median age of 74 years (range: 70–86 years): they represented 17.5% of those treated with rituximab, 7.4% of those treated with trastuzumab, 20.2% of those treated with geftinib. Moreover, one elderly cancer patient in each of the three groups of drugs less frequently used (i.e., bevacizumab, erlotinib and cetuximab) was treated with biological agents. Conclusions: In our Institute, nearly 20% of cancer patients is aged 70 years or older. Our findings suggest that elderly cancer patients are not denied biological therapies because of their age. This is particularly true for NHL patients treated with rituximab (17.5%) and for patients with NSCLC treated with geftinib. The low percentage of elderly women treated with trastuzumab is likely to depend from the biological (e.g. hormonal receptors) and clinical characteristics (e.g., pre-existing cardiovascular conditions and life expectancy) of breast cancer in elderly women. The increasing number of cancer in the elderly, asks for a proper selection of patients who should have access to biological agents according to clinical studies and cost-effectiveness evaluation. No significant financial relationships to disclose.
Fatigue in Hemodialysis Patients With and Without Diabetes: Results From a Randomized Controlled Trial of Two Glucose-Containing Dialysates
Authors: Jochen G. Raimann, Anja Kruse, Stephan Thijssen, Viktoriya Kuntsevich, Jose A. Diaz-Buxo, Nathan W. Levin, Peter Kotanko
Journal: Diabetes Care (2010)

In hemodialysis (HD), dialysate glucose concentrations differ worldwide between 0 and 200 mg/dl and can, if above the serum glucose levels, lead to diffusive glucose shifts into the patient (1). The effects of glucose (2) and insulin (3) on the autonomic nervous system, as well as during HD with different glucose concentrations, (4) have been reported. However the effect of dialysate glucose on fatigue has not been studied. This study investigated fatigue in chronic HD subjects treated with 100 mg/dl (G100) versus 200 mg/dl dialysate glucose (G200).

In this randomized, crossover, multicenter study (www.clinicaltrials.gov, NCT00618033), diabetic and nondiabetic patients were enrolled in a 1:1 fashion. Diabetes was defined as either requiring oral antidiabetic medication or insulin or having random blood glucose levels above 200 mg/dl during the preceding 12 months. The study protocol …
Rediscovery and the cognitive aspects of toolmaking: Lessons from the handaxe
Authors: William H. Calvin
Journal: Behavioral and Brain Sciences (2002)

Long before signs of staged toolmaking appeared, Homo erectus made symmetrical tools. The handaxe is a flattened tear-drop shape, but often with edges sharpened all around. Before we assign their obsession with symmetry to an aesthetic judgment, we must consider whether it is possible that the symmetry is simply very pragmatic for one particular use in the many suggested.
IODINE IN TUBERCULOSIS
Authors: John Ritter
Journal: JAMA (1926)

To the Editor:  —To one who has administered tincture of iodine in tuberculosis for a number of years, the reading of material on this subject in recent issues ofThe Journalhas been of deep interest. Concerning the work done by H. W. Butler on guinea-pigs, to which Dr. Edwards (The Journal, August 14, p. 509) refers, particularly the one pig that received a single dose of tincture of iodine for fourteen days, it is questionable whether one-fifteenth grain (4 mg.) of iodine in a drop of tincture of iodine U. S. P., or the drop of pure alcohol, killed the pig. Every one who has done experimental work on guinea-pigs knows quite well that tincture of iodine cannot be given to guinea-pigs satisfactorily. The guinea-pig is extremely sensitive to the most minute quantities of alcohol, and alcohol administered to the animal in any form is highly and quickly toxic.
Irreversible Status Asthmaticus
Authors: Louis R. Baker
Journal: JAMA (1966)

To the Editor:—  From the interesting article by Beam et al ( 194 :968, 1965), one would infer that theirs is the first use in this condition and age group both of intermittent positive pressure ventilation (IPPV) and of IPPV together with myoneural blockade. The application of IPPV has been reported by Swensson 1 and by Bates. 2 IPPV together with myoneural blockade has been reported by Downes. 3 In all fairness to the authors of the article inThe Journal, however, it would have been difficult for them to know of this prior work.  The use of IPPV together with narcotic and barbiturate sedation instead of myoneural blockade has also been described by Downes. 3 Although this method appears to be less satisfactory, it may be safer in hospitals in which the intensive care of apneic patients is limited.
ABC of oral health: Oral cancer
Authors: C. Scully
Journal: BMJ (2000)

Robert Veatch and others have questioned whether there are internal moral rules of medicine. This paper examines the legal regulatory model for governing professions as the autonomous exercise of professional skills and asks whether there is a theoretical basis for this model. Taking John Rawls's distinction between the justification of a practice and justification of the rules internal to the practice, this paper argues that the autonomous exercise of professional skills is justified so long as it benefits society. In opposition to Christopher Boorse, it is argued that medicine is pathocentric and that physicians exercise skills in treating pathologies. The autonomous treatment of pathologies is justified because non-interference with physicians will lead to greater treatment of pathologies and so benefit society. Finally, the analysis of medicine as the autonomous exercise of skills in treating pathologies yields the rule that physicians not be forced to cause pathologies.