tbuckley/cabot-search huggingface dataset:
Understanding Premature Skin Aging
Authors: Jouni Uitto
Journal: New England Journal of Medicine (1997)

Dermatologists see many patients seeking help because of skin aging. Sagging and wrinkling of the skin can be the signs of time spent on the beach in younger years or on the golf course in middle years or just a visible reminder of the inescapable aging process. The problems associated with skin aging range from minor cosmetic problems to major disfigurement with profound psychosocial consequences.Cutaneous aging is a complex biologic process affecting various layers of the skin, but the major changes are seen in the dermis.1 There are two clinically and biologically independent aging processes that occur simultaneously. The . . .
OC-050 The Ugib-dops: Improving Training In Gi Bleed Management In The Endoscopy Unit
Authors: L China, G Johnson
Journal: Gut (2014)

<h3>Introduction</h3> The 2007 GI Bleed Audit highlighted significant deficiencies and inconsistencies in service provision and care of patients presenting with UGIB. There is a pressure on UK hospitals to provide a 24/7 endoscopy service to meet NICE guidance on timely endoscopic intervention in upper GI bleeding (UGIB), resulting in an urgent need to determine an endoscopist's competence. JAG provide quality assurance in UK endoscopy by using compulsory summative assessment in diagnostic endoscopy and more recently polypectomy. There is currently no structured, formal tool or criteria with which to assess and provide feedback for the specific generic and endoscopic skills required for effective management of UGIB. DOPS are used as a tool to assess endoscopic skills by providing a framework for experts to observe, assess and provide feedback on a procedure. We developed a new DOPS tailored to the specific aspects of therapeutic endoscopic management of UGIB to improve training, with a view to developing the tool for use in summative assessment for JAG accreditation. <h3>Methods</h3> A working group of expert endoscopists was formed at University College London Hospital. UGIB task deconstruction was undertaken and, after multiple revisions, consensus was reached on the individual aspects of management, and then to define what was considered a satisfactory endoscopic performance in each of these domains. The performance rating scale was based on the degree of independence demonstrated by the trainee in each performance domain. These aspects of performance, definitions of standards and rating scales were then used to construct the UGIB-DOPS. We evaluated the feasibility, validity and educational impact of UGIB-DOPS using 8 trainees paired with trainers using questionnaires and semi-structured interviews. <h3>Results</h3> The trainee cohort displayed a range of experience from novices (n = 2) to trainees who had managed &gt;80 cases (n = 2). Qualitative assessment of the educational impact of UGIB-DOPS found universal agreement that the tool's defined assessment criteria facilitated structured feedback and it was perceived the overall grade awarded reflected trainee's current competence. Thematic interview analysis revealed recurring concepts of how UGIB-DOPS facilitated training: creation of an observed teaching event, knowledge of the required standards and concrete formulation of action plans. All found UGIB-DOPS feasible to use and the rating scale more transparent than currently used DOPS. <h3>Conclusion</h3> Creation of the UGIB-DOPS has for the first time introduced defined assessment standards in UK UGIB management facilitating formative assessment leading to a feasible improvement in workplace training. A larger pilot is now required to determine the reliability of UGIB-DOPS prior to considering its use as part of the summative assessment of endoscopist's competence. <h3>Disclosure of Interest</h3> None Declared.
Heat Shock Response Inhibits Cytokine–Inducible Nitric Oxide Synthase Expression in Rat Hepatocytes
Authors: M E de Vera, Y M Kim, H R Wong, Q Wang, T R Billiar, D A Geller
Journal: Hepatology (1996)

During sepsis or inflammation, the liver expresses various protective phenotypes such as the acute phase response or the heat shock response (HSR). Inducible nitric oxide synthase (NOS2) is also expressed in the liver in these conditions and may protect the liver under some circumstances and promote injury in others. We have previously reported that the acute phase response and NOS2 expression are differentially regulated, though both can be expressed simultaneously. The HSR is known to prevent expression of other genes, but its effects on NOS2 expression in the liver is unknown. Therefore, we examined how the HSR influences NOS2 expression in primary rat hepatocytes. Sodium arsenite (Ars) or hyperthermia (43 degrees C) induced the synthesis of hsp72 messenger RNA (mRNA) and protein in hepatocytes, indicating activation of the HSR. In the absence of the HSR, combinations of interleukin– 1β (IL–1β), tumor necrosis factor α (TNF–α), and interferon γ (IFN–γ) stimulated high levels of NOS2 mRNA and nitric oxide (NO) synthesis. However, treatment with Ars or heat shock significantly attenuated cytokine–induced NOS2 mRNA and NO production. The addition of the nuclear factor κB (NF–κB) inhibitor pyrrolidine dithiocarbamate also inhibited NOS2 expression, suggesting a role for NF–κB in the cytokine induction of NOS2 in hepatocytes. Cytokines induced the appearance of an NF–κB complex as shown in gel retardation assays; however, induction of the HSR by Ars partially prevented cytokine–induced formation of this band while hyperthermia had a more complete inhibition. Furthermore, preinduction of the HSR prevented the activation of the NOS2 promoter construct in hepatocytes transfected with a 1.6 kilobase NOS2 promoter linked to luciferase. These findings show that NO production in stressed cells can be modulated by the HSR, possibly through repression of NOS2 gene transcription via the inhibition of NF–κB.
The Anglo-American Medical Association.
Authors: Albert J. Mayer
Journal: JAMA (1904)

Berlin, Feb. 3, 1904. <h3>To the Editor:</h3> —The Anglo-American Medical Association of Berlin desires you to inform the profession of its organization and purposes. Realizing the difficulties which beset the path of the stranger the association places its services at the disposal of physicians who intend to study in Berlin. Such are cordially invited to attend the meetings which are held weekly, and any information concerning the work to be had here will be gladly given to any member of the profession who will communicate, on his arrival in Berlin, with Dr. J. H. Honan, president, Lützen Strasse 78, or with the undersigned committee. Albrecht Strasse 22. <h3>Note.</h3> —Further particulars of this association were given inThe JournalJan. 30, 1904, p. 320.—Ed.
Prostatic Cancer, Hypogonadism, and Insulin Resistance: A case report
Authors: J. A. Kiayias
Journal: Diabetes Care (2006)

A 47-year-old Greek diabetic man presented with erectile dysfunction and a decrease in sexual desire. The patient had type 2 diabetes for the previous 8 years and was on treatment with rosiglitazone and metformin with strict glycemic control (HbA1c 5.8%). No symptoms or signs of neuropathy were present. Hypogonadotrophic hypogonadism was found.

His plasma testosterone level was very low (100 ng/dl [reference range 300–1,000]) and there was no luetinizing hormone response to luetinizing hormone–releasing hormone (LHRH) test. Further work-up with a magnetic resonance imaging scan and hypophyseal function tests did not reveal any space-occupying lesions of the hypothalamic pituitary site.

The process led to the diagnosis of idiopathic hypogonadotropic hypogonadism. On further work-up, the patient was found to have a prostatic carcinoma. …
Aging in India
Authors: Aarti Patil
Journal: Annals of Internal Medicine (2010)

On Being a Doctor6 April 2010Aging in IndiaAarti Patil, BSAarti Patil, BSFrom Mount Sinai School of Medicine, New York, New York, 10029.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-152-7-201004060-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail They say a medical student is never more dangerous than at the end of his or her second year. The first 4 grueling semesters of medical school are crammed full of high-pressure exams, of mastering minutiae by sheer force of will, of a whirlwind tour of the human body. After 2 years of cadavers, lectures, and textbooks, second-year medical students have studied the anatomy, physiology, pathology, and pathophysiology of every system of the human body; they know all the facts but have insufficient experience to temper those facts with reality. It is at this point in my medical career that ... Author, Article, and Disclosure InformationAffiliations: From Mount Sinai School of Medicine, New York, New York, 10029.Corresponding Author: Aarti Patil, BS, Mount Sinai School of Medicine, 50 East 98th Street, New York, NY 10029; e-mail, aarti.[email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 6 April 2010Volume 152, Issue 7Page: 472-473KeywordsAgingBlood pressureDietFearGeriatricsHealth careHeart rateQuality of lifeSurgeonsTea ePublished: 6 April 2010 Issue Published: 6 April 2010 Copyright & PermissionsCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Phenylketonuria and the Practice of Medicine
Authors: Warren J. Warwick
Journal: JAMA (1969)

If one can learn all of medicine from the detailed study of one disease, may we not also learn some truth about all of medical practice from careful study of the changes in medical practice concerning one disease? The intervention of over 80% of the state legislatures into the patient-doctor relationship, with legal directions to the physicians, has produced interesting changes, worthy of juxtaposition for analysis.  Consider who is the better physician—the one who recognizes signs of retarded development in a young, fair-haired child and selectively orders laboratory studies to establish the diagnosis of phenylketonuria; or the physician who receives a note in the mail that one of his newborn patients has hyperphenylalanemia and who then refers his patient to a doctor at a special center for diagnosis and treatment of phenylketonuria? Who would argue with the conclusion that the diagnostician is the better physician since the second physician's referral
Massachusetts Nursing Homes Today
Authors: Alfred L. Frechette, Samuel Levey
Journal: New England Journal of Medicine (1965)

AS in many other parts of the country, nursing homes in Massachusetts are experiencing a period of rapid transition. Significant developments affecting the number, structure and composition of nursing homes are under way, with important consequences for patients and their needs.Every nursing home in the Commonwealth, regardless of type of ownership, is subject to regulation by several public agencies. The Department of Public Health has the basic responsibility for licensure, and the licenses it issues are renewable each year. Before it will consider a license application, the Department requires written approval from the local board of health, the local . . .
Overtraining--what do lactate curves tell us?
Authors: A E Jeukendrup, M K Hesselink
Journal: British Journal of Sports Medicine (1994)

In a cyclist, competing at national and international level, submaximal lactate concentrations were initially interpreted as improved endurance capacity. However, 2 weeks later, a test in which maximal lactate was measured showed that maximal lactate was decreased as well. Together with the complaints of deteriorating performance and subjective complaints of irritability and sleep disturbances, overtraining was diagnosed. After decreasing the training load, performance was gradually restored. This example indicates that athletes should be carefully questioned on their ability to perform their regular training programme, their motivation, possible sleeping disorders and eating problems. This case serves as a reminder to interpret lactate curves carefully and shows how important it is to obtain maximal lactate from a graded exercise test.
Insulin resistance and cardiovascular disease
Authors: Henry N. Ginsberg
Journal: Journal of Clinical Investigation (2000)

Clearly, insulin resistance is not simply a problem of deficient glucose uptake in response to insulin, but a multifaceted syndrome that increases significantly the risk for cardiovascular disease. The links between insulin resistance and the associated dyslipidemia, hypertension, hypercoagulability, and atherosclerosis are numerous and complex. This complexity derives both from the almost certain multiple causes of the insulin resistance syndrome and from the interaction of genes predisposing to insulin resistance with other genes that have their own, independent impact on lipid metabolism, blood pressure regulation, coagulation, and artery wall biology. Nonetheless, I suggest that dysregulation of fatty acid metabolism plays a central role in the development of this phenotype. Thus, the association between insulin resistance and dyslipidemia is clearly initiated by increased FFA release from, or defective uptake of FFAs into, adipocytes. Recent studies linking fatty acids to endothelial dysfunction, together with the clear role of VLDL in the stimulation of PAI-1, further support the view that dysregulation of fatty acid metabolism sits close to the center of the pathophysiology of the insulin resistance syndrome, at least as it relates to risk for cardiovascular disease.
THE SALICYLATES IN THE TREATMENT OF LICHEN PLANUS.SOME UNUSUAL FORMS OF THIS AFFECTION.
Authors: M. B. HARTZELL
Journal: JAMA (1907)

Perhaps the most generally useful internal remedy in the treatment of lichen planus is arsenic, which, when associated with appropriate local applications, in most cases produces improvement within a reasonable time and eventually a cure. In a not inconsiderable minority, however, arsenic fails to exert a favorable influence on the disease, or may even aggravate it and materially increase the patient's discomfort. In these cases I have recently employed with more or less success the various salicylates, which, so far as I know, have not yet found a place in the text-books as approved remedies in this disease, although a closely related drug—salicin—has been recommended by Crocker. Although the number of cases in which I have used them is yet small, the relief afforded in some instances was so immediate and decided that I have thought it worth while to call attention to these remedies with the hope that they
Association of Vitamin D With Insulin Resistance and β-Cell Dysfunction in Subjects at Risk for Type 2 Diabetes
Authors: Sheena Kayaniyil, Ravi Retnakaran, Julia A. Knight, Ying Qi, Bruce A. Perkins, Stewart B. Harris, Bernard Zinman, Anthony J. Hanley
Journal: Diabetes Care (2010)

We thank Muscogiuri et al. (1) for their insightful comments regarding our study and appreciate the opportunity to address them. Muscogiuri et al. suggest that our study sample primarily consisted of obese subjects, as the mean BMI of our subjects was 30.5 kg/m2. In fact, BMI ranged from 18.2 to 60.1 kg/m2, and 28% had a BMI <27 kg/m2. Thus, our study subjects represented a broad range of body mass.

Muscogiuri et al. further suggest that …
The Impact of Disease on American History
Authors: Howard N. Simpson
Journal: New England Journal of Medicine (1954)

ALTHOUGH there are medical histories dealing with America as well as the rest of the world medical histories, for the most part, are drab accounts of scientific discoveries, dreary biographic sketches of obscure or eponymous physicians or descriptions of epidemics as they affected the course of medical knowledge. None of them deal with the over-all effect of disease on the history of this nation.A useful premise at this point is that before the white man invaded the North American continent it was a healthful place to live in. There is a good deal of evidence to support this claim. . . .
Surgical removal of asymptomatic pulmonary metastases: time for better evidence
Authors: T. Treasure, M. Utley
Journal: BMJ (2013)

Surgical removal of blood borne deposits of disseminated cancer in the lung is widely believed to benefit patients. <b>Tom Treasure</b> and <b>Martin Utley</b> analyse the evidence for pulmonary metastasectomy in sarcoma and call for a randomised trial
Randomised controlled trials: understanding effect sizes
Authors: P. Sedgwick
Journal: BMJ (2015)

Researchers assessed whether a multimodal group exercise intervention had physiological, functional, and emotional benefits for patients with cancer. A randomised controlled trial was performed. The intervention was supervised exercise comprising high intensity cardiovascular and resistance training, relaxation and body awareness training, and massage. The intervention was delivered for nine hours weekly for six weeks in addition to conventional care. The control treatment was conventional care alone. Participants were 269 patients with cancer undergoing adjuvant chemotherapy or treatment for advanced disease. The primary outcome was fatigue at six weeks as assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30); scores range from 0 to 100 and higher scores represent higher levels of fatigue. Secondary outcomes included measures of physical capacity, general wellbeing, physical activity, and quality of life.1 At six weeks of follow-up, the fatigue score was significantly lower in the intervention group than in the control group (adjusted difference 6.6 points, 95% confidence interval 0.9 to 12.3; P=0.02). The difference between treatment groups in outcome was adjusted for baseline fatigue score, disease, and demographic covariates. The observed reduction in fatigue after the intervention compared with the control had an effect size of 0.33. The researchers also reported that the intervention significantly improved vitality, aerobic capacity, muscular strength, emotional wellbeing, and physical and functional activity. No significant effect was seen for quality of life. Which of the following statements, if any, are true?
Reply to V. Pitini et al
Authors: Erica L. Mayer, Nancy U. Lin
Journal: Journal of Clinical Oncology (2013)

We appreciate the comments of Pitini et al 1 regarding our recent report of 7-year follow-up of cardiac function in National Surgical Adjuvant Breast and Bowel Project protocol B-31, 2 which is evaluating the benefits and risks of adding trastuzumab to standard chemotherapy for the adjuvant treatment of women with early stage human epidermal growth factor receptor 2-positive breast cancer.We agree that a dynamic evaluation of cardiac function, for example by echocardiogram, provides more detailed assessment of myocardial function than multigated acquisition (MUGA) scans, and clearly all imaging modalities carry a margin of error.It is worth pointing out that for the first 1,000 patients enrolled onto B-31, the primary end point of the protocol was not the clinical efficacy of trastuzumab but cardiac safety.As such, patients with any significant cardiac condition were excluded from participation, including those with any arrhythmia requiring medication.The cardiac risk score applies only to those patients who would have met the eligibility requirements of the protocol from which it was developed.As we mentioned in the Methods section, MUGA scans were chosen over echocardiograms in order to write rules for holding or stopping trastuzumab and to minimize observer variability across institutions.We also agree that the accuracy of the baseline left ventricular ejection fraction (LVEF) measurement is critical, not only for the cardiac risk score, but also because it serves as the comparison point for subsequent LVEF measurements in determining whether to hold or continue trastuzumab.For instance, if a patient is dehydrated when her baseline LVEF study is performed, the value obtained may be higher than a true reflection of her level of systolic function, and the difference between baseline and subsequent measurements then may be exaggerated, in some cases potentially affecting decisions about whether to hold or continue trastuzumab.Finally, we welcome the important work that is being done using biomarkers such as ultrasensitive troponin, and we cite two such studies in our discussion.In the end, however, any indicators of potential cardiac risk, whether by risk score, biomarkers, or genetics, must be integrated into clinical decision algorithms regarding optimal use of trastuzumab in the treatment of patients with breast cancer.
NEW MEXICO AS A HEALTH RESORT.
Authors: GEO. M. KELLOGG
Journal: JAMA (1896)

The Rocky Mountain region, especially the mountains and the upland plains of New Mexico, is a land lifted up by nature into the pure serene for the general invigoration of the race. New Mexico belonging to the Rocky Mountain crest, its eastern slope and a larger portion of Arizona belonging to their western slope, has perhaps, the most equable climate known. There are no extremes of winter cold or of summer heat; while there is a notable absence of dampness in air and earth. Little moisture is left for this region after the hot winds of the Southern Pacific are wrung dry by the coast ranges. The elevation of this country from four to eight thousand feet is just sufficient to prevent that oppressiveness of summer heat which otherwise would be severely felt in these latitudes from 32 to 37 degrees north. The winter months throughout this region owing to
Anastomose cholédoco-bulbaire ou hépatico-gastrique par échoendoscopie thérapeutique: une alternative pour drainer les voies biliaires après échec de CPRE
Authors: L Poincloux, J Privat, T Khuong, E Buc, D Pezet, A Abergel, M Dapoigny, G Bommelaer
Journal: Endoscopy (2008)

But: La possibilité de ponctionner sous échoendoscopie une voie biliaire extra ou intrahépatique gauche en cas de dilatation autorise la mise en place dans le même temps de stents transduodénaux ou transgastriques pour un drainage biliaire. L'objectif de ce travail était d'évaluer la faisabilité et l'efficacité des anastomoses cholédoco-bulbaires (ACB) ou hépaticogastriques (AHG), réalisées par écho-endoscopie après échec de CPRE pour un ictère obstructif néoplasique.