tbuckley/cabot-search huggingface dataset:
Substance Use Rates Among Medical Students and Resident Physicians
Authors: Joe Westermeyer
Journal: JAMA (1991)

Hughes et al<sup>1</sup>and Baldwin et al<sup>2</sup>have provided a valuable service to the profession and to the community at large through their surveys of substance use among American senior medical students and resident physicians published in this issue ofThe JournalLike corporate leaders, airline pilots, and others whose substance use affects the public's well-being, physicians must be accountable to society. In this time of epidemic substance abuse, our colleagues are not immune to this disorder. Thus, we are obliged to monitor ourselves unless we are willing to pass that responsibility on to others.<sup>3</sup>Since substance abuse among physicians often begins in the training years, yet surfaces to clinical recognition a decade or two later,<sup>4</sup>surveys of medical students and resident physicians can alert us to future substance abuse patterns among practicing physicians. Thus informed ahead of time, we have the opportunity to initiate preventive
Different Mismatch Repair Deficiencies All Have the Same Effects on Somatic Hypermutation
Authors: Nayun Kim, Grazyna Bozek, James C. Lo, Ursula Storb
Journal: The Journal of Experimental Medicine (1999)

Somatic hypermutation of Ig genes is probably dependent on transcription of the target gene via a mutator factor associated with the RNA polymerase (Storb, U., E.L. Klotz, J. Hackett, Jr., K. Kage, G. Bozek, and T.E. Martin. 1998. J. Exp. Med. 188:689-698). It is also probable that some form of DNA repair is involved in the mutation process. It was shown that the nucleotide excision repair proteins were not required, nor were mismatch repair (MMR) proteins. However, certain changes in mutation patterns and frequency of point mutations were observed in Msh2 (MutS homologue) and Pms2 (MutL homologue) MMR-deficient mice (for review see Kim, N., and U. Storb. 1998. J. Exp. Med. 187:1729-1733). These data were obtained from endogenous immunoglobulin (Ig) genes and were presumably influenced by selection of B cells whose Ig genes had undergone certain mutations. In this study, we have analyzed somatic hypermutation in two MutL types of MMR deficiencies, Pms2 and Mlh1. The mutation target was a nonselectable Ig-kappa gene with an artificial insert in the V region. We found that both Pms2- and Mlh1-deficient mice can somatically hypermutate the Ig test gene at approximately twofold reduced frequencies. Furthermore, highly mutated sequences are almost absent. Together with the finding of genome instability in the germinal center B cells, these observations support the conclusion, previously reached for Msh2 mice, that MMR-deficient B cells undergoing somatic hypermutation have a short life span. Pms2- and Mlh-1-deficient mice also resemble Msh2-deficient mice with respect to preferential targeting of G and C nucleotides. Thus, it appears that the different MMR proteins do not have unique functions with respect to somatic hypermutation. Several intrinsic characteristics of somatic hypermutation remain unaltered in the MMR-deficient mice: a preference for targeting A over T, a strand bias, mutational hot spots, and hypermutability of the artificial insert are all seen in the unselectable Ig gene. This implies that the MMR proteins are not required for and most likely are not involved in the primary step of introducing the mutations. Instead, they are recruited to repair certain somatic point mutations, presumably soon after these are created.
Popping a multivitamin daily can keep disease at bay
Authors: D. Josefson
Journal: BMJ (2002)

Nearly all adult Americans have dietary deficiencies in one or more vitamins and should be taking multivitamin supplements, a new paper has asserted ( JAMA 2002;287:3116-29).

Drs Robert Fletcher and Kathleen Fairfield of the Harvard Medical School's departments of public health, ambulatory medicine, and epidemiology, reached these conclusions after reviewing the literature on …
Cooperative signaling between cytokine receptors and the glucocorticoid receptor in the expansion of erythroid progenitors: molecular analysis by expression profiling
Authors: Andrea Kolbus, Montserrat Blázquez-Domingo, Sebastian Carotta, Walbert Bakker, Susanna Luedemann, Marieke von Lindern, Peter Steinlein, Hartmut Beug
Journal: Blood (2003)
Mechanisms of alpha 1-adrenergic vascular desensitization in conscious dogs.
Authors: K Kiuchi, D E Vatner, N Uemura, M Bigaud, N Hasebe, D M Hempel, R M Graham, S F Vatner
Journal: Circulation Research (1992)

To investigate the mechanisms of alpha 1-adrenergic vascular desensitization, osmotic minipumps containing either saline (n = 9) or amidephrine mesylate (AMD) (n = 9), a selective alpha 1-adrenergic receptor agonist, were implanted subcutaneously in dogs with chronically implanted arterial and right atrial pressure catheters and aortic flow probes. After chronic alpha 1-adrenergic receptor stimulation, significant physiological desensitization to acute AMD challenges was observed, i.e., pressor and vasoconstrictor responses to the alpha 1-adrenergic agonist were significantly depressed (p &lt; 0.01) compared with responses in the same dogs studied in the conscious state before pump implantation. However, physiological desensitization to acute challenges of the neurotransmitter norepinephrine (NE) (0.1 micrograms/kg per minute) in the presence of beta-adrenergic receptor blockade was not observed for either mean arterial pressure (MAP) (30 +/- 7 versus 28 +/- 5 mm Hg) or total peripheral resistance (TPR) (29.8 +/- 4.9 versus 28.9 +/- 7.3 mm Hg/l per minute). In the presence of beta-adrenergic receptor plus ganglionic blockade after AMD pump implantation, physiological desensitization to NE was unmasked since the control responses to NE (0.1 micrograms/kg per minute) before the AMD pumps were now greater (p &lt; 0.01) than after chronic AMD administration for both MAP (66 +/- 5 versus 32 +/- 2 mm Hg) and TPR (42.6 +/- 10.3 versus 23.9 +/- 4.4 mm Hg/l per minute). In the presence of beta-adrenergic receptor, ganglionic, plus NE-uptake blockade after AMD pump implantation, desensitization was even more apparent, since NE (0.1 micrograms/kg per minute) induced even greater differences in MAP (33 +/- 5 versus 109 +/- 6 mm Hg) and TPR (28.1 +/- 1.8 versus 111.8 +/- 14.7 mm Hg/l per minute). The maximal force of contraction induced by NE in the presence or absence of endothelium was significantly decreased (p &lt; 0.05) in vitro in mesenteric artery rings from AMD pump dogs compared with saline control dogs. Furthermore, alpha 1-adrenergic receptor density, as determined by [3H]prazosin binding in membrane preparations from vessels in the mesentery, was decreased (8.2 +/- 1.0 versus 18.4 +/- 1.4 fmol/mg protein, p &lt; 0.001) without any change in Kd in the AMD pump dogs compared with the saline pump dogs.(ABSTRACT TRUNCATED AT 400 WORDS)
Restricted immunoglobulin junctional diversity in neonatal B cells results from developmental selection rather than homology-based V(D)J joining.
Authors: A Pandey, L W Tjoelker, C B Thompson
Journal: The Journal of Experimental Medicine (1993)

The mechanism by which coding ends are joined during immunoglobulin (Ig) recombination is poorly understood. Recently, short sequence similarities (2-6 bp) observed at the ends of certain variable (V), diversity (D), and joining (J) gene segments of Ig have been correlated with limited junctional diversity observed in coding exons assembled from these elements. However, it is unclear whether these sequence homologies play any direct role in favoring coding joint formation by influencing the V(D)J recombination process. In this report, we demonstrate that coding sequence similarities do not influence the position of coding joints during V(D)J recombination in vivo. Instead, during embryonic development, B cells with certain joining products undergo progressive selection. Developmental selection is completed before exposure to external antigens and appears to be determined by the amino acid sequence encoded by the coding joint. We conclude that the nucleotide sequences of the coding regions do not play a major role in directing V(D)J recombination. Instead, we propose that limited Ig junctional diversity results from prenatal developmental selection of B cells based on the protein sequence of their surface Ig antigen-binding site. Sequence identities at the ends of coding segments may have evolved because they increase the likelihood that a selectable antigen-binding site is created during a random recombination process.
GUNSHOT WOUND OF SPINAL CORD AND TRACHEA: RECOVERY
Authors: G. W. Thompson, G. W. Stanley
Journal: BMJ (1916)

fJULY 15, I9I6 All cases should be treated at the earliest possible moment.Chloroform is better than otlher general anaesthetics for this purpose, because it produces definite stages of anaesthesia wlhiclh can be readily prolonged as required.Cases which have been cured by abnormal experiences, such as an abdominal operation, or a sllipwreck, would probably lhave been cured earlier by suggestion under chloroform.
On the normalization of coherent contrast and the semantics of synchronization
Authors: Darragh Smyth
Journal: Behavioral and Brain Sciences (1997)

This commentary describes some extensions of the Phillips &amp; Singer model of contextual interactions to cater for the contrast- and extent-dependency of surround facilitation and suppression. I also comment briefly on some semantic problems with what exactly the role of synchronization might be: input preprocessing or output postprocessing?
Bone disease after liver transplantation.
Authors: M S Losowsky, S H Hussaini
Journal: Gut (1996)

Leading articleBone disease after liver transplantation It is well known that bone problems occur in patients with chronic liver disease, both cholestatic and non- cholestatic.'-3Bone disorders associated with chronic liver disease may be classified on a histological basis into osteomalacia, a reduction in mineralisation of bone matrix and osteoporosis, a reduction in total bone mass but with normal mineralisation.Osteomalacia in patients with liver disease occurs particularly with cholestatic disease, is associated with vitamin D deficiency, and responds to administration of vitamin D in any form.4The vitamin D deficiency is probably multifactorial.It might be anticipated that hydroxylation in the liver would be deficient but this seems rarely to be the case.6 Malabsorption of vitamin D, especially in cholestatic disease, is a possible factor.7 8 Lack of exposure to sunlight may be a factor in severely ill patients.9Abnormal metabolism of vitamin D or its metabolites seems to play a part in hepatic osteomalacia.7Recent attention has centred much more on osteoporosis because osteomalacia is a generalised disease and is readily diagnosed and can be successfully treated.The pathogenesis of osteoporosis in liver disease is not understood but many factors have been invoked.'0Hypogonadism and cirrhosis" are independent predictors of osteoporosis.Indeed hypogonadism was strongly associ- ated with osteoporosis in patients with idiopathic haemo- chromatosis.'2Chronic intestinal malabsorption of calcium may induce hepatic osteoporosis.'3 14Inactivity, and espe- cially bed rest as a consequence of severe liver disease also contribute to osteoporosis.Alcohol ingestion is also a factor in osteoporosis.'5 16Steroid treatment is a well authenticated cause of osteoporosis.'7Corticosteroid therapy reduces bone mineral density in patients with autoimmune chronic active hepatitis'8 19 and primary biliary cirrhosis.2021
The Health of China
Authors: Pin C. Wan
Journal: JAMA (1983)

<i>The Health of China</i>presents a wealth of information on the changes and present status of health care in the People's Republic of China. The authors' four visits to China have given them excellent insight into the philosophy, politics, and practice of Chinese medicine. Ruth Sidel is an associate professor of sociology at Hunter College of the University of New York and Victor W. Sidel is chairman of the Department of Social Medicine at Montefiore Medical Center and professor of community health at Albert Einstein College of Medicine. Thirty-two years after the Bolshevik Revolution, the Chinese liberation resulted in the founding of the People's Republic of China. Over the next 32 years, philosophical and political changes greatly affected the practice of medicine in China. The evolution of Chinese medicine is traced during the past 4,000 years, outlining the development of Chinese traditional medicine, the influence of Western medicine, and the
Carrier Screening for Gaucher Disease
Authors: Ernest Beutler
Journal: JAMA (2007)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
More studies show human insulin's benefit
Authors: John Henahan
Journal: JAMA (1983)

The X he advantage of  insulin? It may be less immunogenic than animal  It may be the drug of choice for the subpopulation of diabetics that becomes allergic to animal insulins.  So concluded Philip Fireman, MD, of the University of Pittsburgh School of Medicine at the 11th Congress of the International Diabetes Federation in Nairobi following a symposium on the clinical potential of human insulin made either by recombinant DNA techniques or by a novel method: enzymatic conversion of porcine insulin.  In a prospective study of the serum IgE antibody responses to insulin of 90 newly diagnosed insulin-dependent diabetics who received either purified porcine insulin or  insulin prepared by recombinant DNA techniques, Fireman found that the antibodies were present more frequently in the sera of patients who had received animal   Specifically, he found that after a year of taking one or the other preparation, insulin-specific IgE
Spontaneous Release of Histamine from Basophils and Histamine-Releasing Factor in Patients with Atopic Dermatitis and Food Hypersensitivity
Authors: Hugh A. Sampson, Kenneth R. Broadbent, Jan Bernhisel-Broadbent
Journal: New England Journal of Medicine (1989)

Patients with hypersensitivity to food documented by a double-blind, placebo-controlled oral food challenge have been reported to have a high rate of release of histamine from basophils in vitro. To determine whether patients with atopic dermatitis and food hypersensitivity had similar high rates of spontaneous histamine release in vitro, whether dietary elimination of relevant food antigens affected this release, and whether a cytokine, histamine-releasing factor, could account for it, we evaluated 63 patients with atopic dermatitis and food hypersensitivity (38 of whom had eliminated the offending foods from their diets), 20 patients with atopic dermatitis without food hypersensitivity, and 18 normal volunteers. Patients with atopic dermatitis and food hypersensitivity were found to have higher rates of spontaneous release of histamine from basophils than controls (mean ±SE, 35.1±3.9 percent vs. 2.3±0.2 percent; P<0.001). Those who had eliminated the offending food allergen from the diet for an extended period had a significantly lower rate of histamine release (3.7±0.5 percent; P<0.001). In patients with atopic dermatitis without food hypersensitivity, the rate (1.8±0.2 percent) did not differ from that in normal controls. Mononuclear cells from persons with food allergies spontaneously produced a histamine-releasing factor in vitro that provoked the release of histamine from the basophils of other food-sensitive persons, but not from those of normal controls. Patients who adhered to a restricted diet had a decline in the rate of spontaneous generation of the factor by their mononuclear cells. The histamine-releasing factor was found to activate basophils through surface-bound IgE. We conclude that in patients with food hypersensitivity, exposure to the relevant antigens produces a cytokine (histamine-releasing factor) that interacts with IgE bound to the surface of basophils, causing them to release histamine. (N Engl J Med 1989; 321:228–32.)
Treatment target of 18 weeks is incompatible with "choice" agenda, says BMA
Authors: Z. Kmietowicz
Journal: BMJ (2009)

The electronic hospital appointments system that was meant to increase choice for patients does not have the capacity to fulfil its promise, says the BMA.

The electronic Choose and Book referral service, part of the government’s strategy to increase choice for patients in England, is intended to give NHS patients a choice of place, date, and time for their first outpatient appointment. 

But a BMA survey of NHS staff members’ experience of Choose and Book in one London primary care trust found a mixed response. Interviews with 19 GPs, consultants, managers, and administrative staff from Hammersmith and Fulham Primary Care Trust who used Choose and Book found that although some doctors …
Cases may have been missed
Authors: J. Lamb
Journal: BMJ (2010)

Chronic meningitis is defined as the persistence of clinical symptoms and signs of meningitis, with or without abnormal cerebrospinal fluid, for more than four weeks. In as many as one third of cases, no cause is found. In the remainder, infective, neoplastic and so-called aseptic disorders may be identified. Important infective causes include partially treated bacterial (pyogenic), tuberculous, syphilitic, Lyme and fungal meningitis. Sarcoidosis, Behçet’s disease, vasculitis and drugs are major non-infective, non-malignant causes. The definitive diagnosis of the cause of chronic meningitis may be made only after extensive investigation. This review describes the clinical features and causes of chronic and recurrent meningitis, and provides an algorithm for investigation and treatment.
A Consensus-Based Approach To Providing Palliative Care to Patients Who Lack Decision-Making Capacity
Authors: Jason H.T. Karlawish
Journal: Annals of Internal Medicine (1999)

Making palliative care decisions for a patient who lacks decision-making capacity presents several challenges. Other people, such as family and caregivers, must choose for the patient. The goals and values of these decision makers may conflict with those of each other and with those of the patient, who now lacks the capacity to participate in the decision. This paper presents a case study of a patient with severe Alzheimer disease who has two common clinical problems: neurogenic dysphagia and aspiration pneumonia. The case study describes a consensus-based decision-making strategy that keeps what is known about the patient's wishes and values in the foreground but also expects guidance from the physician and elicits input from family members and other people who care for and have knowledge about the patient. The steps of this process, including key clinical prompts and potential transition statements, are outlined and described. The overall goal of the case commentary is to demonstrate that physicians can guide a highly emotional and personal process in a structured manner that has meaning for the patient, family, physician, and other caregivers.
Two-dimensional echocardiography and infarct size: relationship of regional wall motion and thickening to the extent of myocardial infarction in the dog.
Authors: A N Lieberman, J L Weiss, B I Jugdutt, L C Becker, B H Bulkley, J G Garrison, G M Hutchins, C A Kallman, M L Weisfeldt
Journal: Circulation (1981)
Pathological Fracture of Proximal Humerus
Authors: Otto E. Aufranc, William N. Jones, William H. Harris
Journal: JAMA (1964)

Dr. William H. Harris: A 61-year-old woman came to the orthopedic outpatient department of the Massachusetts General Hospital because of pain in her right shoulder. Her discomfort had existed for three months and had not been relieved by injections of hydrocortisone into her shoulder and earlier injections into her buttocks. She had not injured her arm but she had had a similar episode of pain in this shoulder 20 years previously which had subsided spontaneously and had not recurred until the time of this complaint. She gave no history of cough, hemoptysis, or weight loss, and had no other symptoms. Her past medical history included a total hysterectomy in 1937, pyelonephritis in the right kidney in 1939, incision and drainage of the dilated right renal calyx in 1940, anterior and posterior vaginal repair in 1953, and sigmoid diverticulosis in 1957.
Intraventricular Conduction Delay as a Determinant of Atrial Echo Beats
Authors: P. JACOB VARGHESE, ANTHONY N. DAMATO, ANTONIO R. CARACTA, JOHN J. GALLAGHER, MARK E. JOSEPHSON, SUN H. LAU
Journal: Circulation (1974)

Re-entry within the atrioventricular (A-V) node is a common cause of atrial echo beats and paroxysmal atrial tachycardia. This report deals with observations made in four patients in whom the determining factor for atrial echo beats appeared to be a critical conduction delay occurring within the His-Purkinje system and not within the A-V node. The evidence in support of this conclusion is as follows: 1) at a constant A-V nodal delay, echo beats only occurred when a critical His-Purkinje delay was reached; 2) in the presence of different intraventricular conduction times, atrial echoes were dependent on a requisite His-Purkinje conduction delay; 3) at variable A-V nodal conduction times, echo beats appeared only when a requisite delay in His-Purkinje conduction developed; 4) at a constant premature coupling interval atrial echo beats could be abolished when refractoriness within the His-Purkinje system was decreased by decreasing the cycle length of the basic drive; and 5) at constant A-V nodal conduction times, a reciprocal relationship existed between the magnitude of the His-Purkinje delay and the "echo interval" defined as the interval between the onset of ventricular depolarization and the echo beat.
Approaches toward the genetic analysis of complex traits: asthma and atopy
Authors: David G Marsh
Journal: Allergy (1999)

With the challenges emerging from the analysis and interpretation of the human genome, and the specific issues pertinent to pursuing the Genome Project itself, it is truly an exciting time in the development of the biological sciences. The occasion is certainly ripe for the emergence of new concepts and ideas, as the theories of complexity, natural selection, and reductionism become integrated into a new whole. We need to learn how to approach the analyses of the complex data sets that will be generated by the Genome Project and address, more generally, the problems inherent in the analysis of the complex diseases such as asthma. Finally, we need to consider how the recent advances in genetics and genomics will affect biomedical research reaching into the next millennium and beyond.