tbuckley/cabot-search huggingface dataset:
Reducing the use of benzodiazepines in general practice
Authors: J W Tiller
Journal: BMJ (1994)

Some reports have suggested that triglyceride concentration may be a more important risk factor in women than men, but this seems to be true only in univariate analyses.Most studies that adjust for high density lipoprotein cholesterol and other lipids do not support an independent association between serum triglyceride concentrations and coronary heart disease in women.6 " What, then, can one fairly conclude?Has measurement of triglyceride concentrations a role in preventing cardiovascular disease?Despite the numerous studies, the use of triglyceride concentration in screening or in guiding lipid lowering treatment must still be seen as experimental.Precise measurements will be needed iftriglyceride concentration is to be used to help identify people at high risk of coronary heart disease, but any such use seems limited-because of the greater convenience and predictive accuracy of measurements of high density lipoprotein cholesterol.Possibly measurements of triglyceride will identify people who would benefit from aggressive cholesterol lowering treatment or point to the best class of drugs for treating patients with hypercholesterolaemia.Both of these uses for measurement of triglycerides are speculative, however, and in both cases the test needs to be done only in someone found to have a raised cholesterol concentration.As far as screening is concerned, measuring triglycerides is less convenient than measuring high density lipoprotein cholesterol or total cholesterol, and current evidence suggests that its value in risk classification would at best be limited.Even if the test gave additional information about risk it would not necessarily lead to better treatment decisions.Despite the many clinical trials of reducing raised concentra- tions of cholesterol, the application of total and low density lipoprotein cholesterol to treatment decisions remains controversial.14There is far less evidence supporting the use oftriglyceride concentrations.Concern about resources for health care has raised the standards of evidence required for any general screening strategy.The useful screening test-as is well known-has to be safe, convenient, inexpensive, and to discriminate between those who do and do not benefit from further diagnostic evaluation or treatment.Further evidence may someday enable triglyceride concentration to meet these standards, but not yet.
Henry James Eastes
Authors: P. Brunyate
Journal: BMJ (2009)

Henry James Eastes died in December 2008 having given 70 years of his life to his patients and the community of Marshfield, the rural village where he spent all his professional life. This alone is not remarkable as many before him and since have done the same. However, he was archetypal of the general practitioner of his era who inherited the traditions of the past but lived through and developed the enormous changes in medicine that have taken general practice to the position it is in today.

Henry and his wife, Zeta, also a doctor, arrived in Marshfield in December 1939. The incumbent doctor had died and his widow was happy to sell the practice to the Eastes. The price included a house and dispensary that had been a doctor’s residence for the previous 80 years.

Consultations took place in the dispensary, a narrow corridor of a room with room for only two hard chairs for the patients to sit on while the doctor stood. Through a thin wall was the waiting room, which led out into the street. There was no facility for examining patients lying down. If one wished to do that they were sent home and visited later. Medicines for collection were left out in the waiting room, which was open 24 hours a day. Surgery hours were morning and evening with a let up on Saturday evenings and Sundays. However, the doctor was permanently on call (especially during the five years of the second world war) and holidays were rare. Telephones were not common as it was not a wealthy community so the doctor would be fetched by someone calling at the house to ring the bell or, at night, blow down the speaking tube which terminated in the …
Orf in London
Authors: I. S. Hodgson-Jones
Journal: BMJ (1951)

COURSE 8 C.S.E.NORMAL _ = INTRATHECAL+INTRAMUSCULAR = = INTRAMUSCULAR ONLYChart showing periods during which streptomycin was given for relapse.The criteria of C.S.F.normality have been: cells-not more than 5 per c.mm.; protein-not more than 40 mg.per 100 ml.; chlorides-not less than 720 mg. per 100 ml.; sugarnot less than 45 mg. per 100 ml.
Abstract 1071: Impact of AR activation status on the DNA damage response.
Authors: Jonathan F. Goodwin, Matthew J. Schiewer, Felix Y. Feng, Karen E. Knudsen
Journal: Cancer Research (2013)

Abstract Recent evidence implicates the androgen receptor (AR) as a critical modulator of the DNA damage response in prostate cancer. Treatment for locally advanced disease depends on combined radiation therapy and ablation of AR function, and clinical evidence strongly supports the contention that active AR reduces the response to radiotherapy. Moreover, it was reported in vitro that AR activation can induce DNA damage at sites of active transcription, thus providing additional evidence for crosstalk between the DNA damage response and AR pathways. Despite these observations, the underpinning mechanism by which AR alters the response to DNA damage remains unknown. Several lines of evidence will be discussed which illuminate a role for AR in the response to DNA damage. First, investigation in a battery of hormone-therapy sensitive prostate cancer cells (in which AR activity remains dependent on ligand binding) and in castrate resistant tumor cells (reflecting advanced disease wherein AR activity is enhanced) showed that androgen depletion enhances the response to ionizing radiation. Restoration of dihydrotestosterone reduced the response to radiation, thus demonstrating that ligand-induced AR activity promotes a resistance to radiation. Second, the mechanism by which AR promotes radioresistance was addressed. Preliminary findings indicate that in the presence of DNA damage, AR dramatically alters the rate of DNA damage repair independent of significant effects on cell cycle. Moreover, these studies uncovered an unexpected role for androgen-activated AR to alter expression and subsequent activity of genes critical for the DNA damage response, possibly through differential recruitment of AR to loci of key players in the response to damage. Finally, a series radioresistant prostate cancer model systems were developed, wherein the impact of AR on acquired radioresistance is under investigation; early studies in these models indicate that altered AR output is associated with acquired radioresistance. Combined, the studies to be presented reveal novel functions of androgen and AR in controlling the molecular and cellular response to DNA damage, and provide the basis for future studies directed at targeting DNA-damage specific AR activity in the course of human disease. Citation Format: Jonathan F. Goodwin, Matthew J. Schiewer, Felix Y. Feng, Karen E. Knudsen. Impact of AR activation status on the DNA damage response. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1071. doi:10.1158/1538-7445.AM2013-1071
ABC of mental health: Mental health in old age
Authors: A J D Macdonald
Journal: BMJ (1997)

Psychiatric care of elderly people can be more interesting than that of younger patients. Successful treatment of elderly patients requires a demanding mélange of psychological, medical, social, political, and managerial skills—an epitome of modern medicine. Important biological symptoms of depression in old age are change in sleep patterns (especially reduced sleep and early morning wakening); decline in appetite and weight loss; regular variation of mood over day (especially worse in early morning); constipation; physical and mental slowing not accountable by other disorders; and suicidal thoughts. The prevalence of depression among people aged over 65 is 15% in the general community, 25% in general practice patients, and ≥30% in residential homes View this table: Chances of depressed patient responding to treatment #### Criteria for hospital admission of elderly patients with depression Those who are likely to benefit from treatment and who View this table: Treatment regimen for dothiepin in elderly patients The central question for doctors is whether a depressive state will respond to treatment (including electroconvulsive therapy); all other questions are either peripheral or secondary to medical practice. Social engineering is not the doctor's role. Even deciding to admit a patient to hospital is secondary to treatability: there is little point in admission if the patient, however suicidal, is unlikely to improve; better to reserve your place in the coroner's court and concentrate on more treatable patients. The categories of depression in elderly people that respond well to treatment are
Sézary syndrome cells overexpress syndecan-4 bearing distinct heparan sulfate moieties that suppress T-cell activation by binding DC-HIL and trapping TGF-β on the cell surface
Authors: Jin-Sung Chung, Lisa H. Shiue, Madeleine Duvic, Amit Pandya, Ponciano D. Cruz, Kiyoshi Ariizumi
Journal: Blood (2011)
Suppression of eicosanoid biosynthesis during coronary angioplasty by fish oil and aspirin.
Authors: G A Braden, H R Knapp, G A FitzGerald
Journal: Circulation (1991)

BACKGROUND Percutaneous transluminal coronary angioplasty (PTCA) is an acute, localized stimulus to platelet and vascular function. Periprocedural cardiovascular complications are reduced by moderate-dose aspirin (ASA), presumably due to inhibition of thromboxane (TX) A2. METHODS AND RESULTS Excretion of TXA2 and prostacyclin (PGI2) metabolites in urine increased during PTCA. Pretreatment for 3 days with either moderate- (325 mg/day) or low-dose (80 mg/day) ASA inhibited the increase in both eicosanoids. Pretreatment for 3 weeks with fish oil (10 g/day) only partially suppressed TXA2. Formation of trienoic eicosanoids and accumulation of omega-3 fatty acids in platelet membranes confirmed fish oil ingestion. Although basal PGI2 was not inhibited, the PTCA-related increment was suppressed. CONCLUSIONS PTCA results in an acute, transient alteration of eicosanoid biosynthesis consistent with accelerated platelet-vascular interactions. Pretreatment for 3 days with moderate or low doses of ASA suppresses TXA to a similar extent during PTCA, and their effects on acute cardiovascular complications of this procedure are likely to be comparable. It is unlikely that even prolonged pretreatment with fish oil can substitute for the platelet inhibitory action of ASA during PTCA. Suppression of PGI2 may contribute to the residual acute periprocedural complication rate in patients taking ASA.
Dynamics of the cellular and humoral components of the inflammatory response elicited in skin blisters in humans.
Authors: D B Kuhns, E DeCarlo, D M Hawk, J I Gallin
Journal: Journal of Clinical Investigation (1992)

Skin blisters induced by suction on the forearm of normal volunteers provide a convenient model to study the inflammatory response in vivo in man. In our study, after removal of the roof of the blister, i.e., the epidermis, the exposed floor of the blister (dermal-epidermal interface) was bathed with 70% autologous serum using a multiwell skin chamber. Migration of leukocytes (90-95% neutrophils) into the chamber fluid was detectable within 3 h, and appeared to plateau at 16-24 h. Sampling of the dermal-epidermal interface revealed primarily mononuclear cells during the first 8 h of the inflammatory response; however, their prevalence at 24 h was greatly diminished due to neutrophil infiltration. Accompanying the cellular immune response was the accumulation of inflammatory mediators in the bathing medium. The accumulation of IFN-gamma reached a plateau within 3 h; significant accumulations of the complement fragment, C5a, and of leukotriene B4 were also detected at 3 h. The accumulation of C5a did not peak until 5 h, whereas leukotriene B4 continued to accumulate through 24 h. IL-6 and IL-8 concentrations were minimal at 3-8 h but dramatic by 24 h while IL-1 beta, tumor necrosis factor-alpha, and granulocyte-macrophage colony-stimulating factor were undetectable within 3-8 h, but markedly elevated by 24 h. There was little accumulation of IL-4 and no accumulation of IL-1 alpha or IL-2 during the 24-h period. The sequential appearance of mediators at an inflammatory focus suggests that a carefully regulated dynamic system is responsible for controlling the evolution of the inflammatory response.
Breast tumor kinase/protein tyrosine kinase 6 (Brk/PTK6) activity in normal and neoplastic biliary epithelia
Authors: Yoshiaki Mizuguchi, Susan Specht, Kumiko Isse, Eizaburo Sasatomi, John G. Lunz, Toshihiro Takizawa, Anthony J. Demetris
Journal: Journal of Hepatology (2015)
Violence in Intimate Relationships
Authors: Elaine J. Alpert
Journal: Annals of Internal Medicine (1996)

Letters1 September 1996Violence in Intimate RelationshipsElaine J. Alpert, MD, MPHElaine J. Alpert, MD, MPHBoston University School of Medicine, Boston, MA 02118Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-5-199609010-00033 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:I cannot agree more that every patient should be screened for ongoing violence during routine primary care and should also be queried directly in other appropriate circumstances, such as during the work-up of such chronic conditions as the irritable bowel syndrome. Although partner violence appears to be more prevalent in young, poor, and unmarried women who present for ambulatory care [1], it is regularly seen in women of all ethnic and economic backgrounds who present in primary care settings [2, 3]. Indeed, routine screening should extend to a venue of care in which screening issues are not often ...References1. McCauley J, Kern DE, Kolodner K, Dill L, Schroeder AF, DeChant HK, et al. The “battering syndrome”: prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Intern Med. 1995; 123:737-46. Google Scholar2. Gin NE, Rucker L, Frayne S, Cygan R, Hubbell FA. Prevalence of domestic violence among patients in three ambulatory care internal medicine clinics. J Gen Intern Med. 1991; 6:317-22. Google Scholar3. Freund KM, Bak SM, Blackhall L. Identifying domestic violence in primary care practice. J Gen Intern Med. 1996; 11:44-6. Google Scholar4. Abbott J, Johnson R, Koziol-McLain J, Lowenstein SR. Domestic violence against women: incidence and prevalence in an emergency department population. JAMA. 1995; 273:1763-7. Google Scholar Author, Article, and Disclosure InformationAffiliations: Boston University School of Medicine, Boston, MA 02118 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1996Volume 125, Issue 5Page: 426-427KeywordsEmergency departmentFearHealth promotionIntimate partner violenceIrritable bowel syndromeMedical educationPatient advocacyPrevention, policy, and public healthPrimary careSafety Issue Published: 1 September 1996 CopyrightCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Colloid Shift in Technetium-99m Sulfur Colloid Liver-Spleen Scans of Trauma Patients
Authors: HEE KYUNG LEE, SAMUEL KAJUBI
Journal: Clinical Nuclear Medicine (1987)

To assess the radiosulfur colloid distribution in the liver–spleen scans of trauma patients, 73 trauma patients (age: 4–74 years, mean: 32 years) who had Tc-99m sulfur colloid liver–spleen scans for trauma workup were studied and compared with the livers–pleen scans of 87 control patients (age: 2–64 years, mean: 36 years). Radiocolloid distribution was visually assessed by two physicians independently, and the areas of the greatest density in the liver and spleen on the posterior view that included both organs were compared. The scans were grouped into three grades: Grade I, liver density greater than spleen density; Grade II, both organs showing equal density; and Grade III, splenic density greater than liver density (colloid shift). Forty-three of the trauma patients (59%) were in Grade III, 22 (30%) in Grade I, and 2 (11%) in Grade II. The control group had 12 (14%) patients in Grade III, 54 (62%) in Grade I, and 21 (24%) in Grade II. When the young adults and children of the trauma patients (age: 4–20 years, mean: 14 years) were looked at separately, 17 of 20 (85%) showed colloid shift (Grade III). It is concluded that there is a significantly higher incidence of colloid shift in trauma patients compared to control patients (P < .01).
Anaphylactic reaction to low-molecular-weight porcine factor VIII concentrates.
Authors: J G Erskine, J F Davidson
Journal: BMJ (1981)

Accuracy of measurements of crown-rump length and biparietal diameter made by inexperienced operators using a real-time scanner Ultrasonic measurements of crown-rump length and biparietal diameter in the first two trimesters of pregnancy give an accurate gestational age.' 2 Measurements obtained with real-time scanners and conventional compound B-scanners correlate well,4 5 as do measurements obtained by operators with differing experience using a real-time scanner.:'I carried out a study to compare measurements made by staff with and without scanning experience.
ROENTGEN-RAY THERAPY IN PITUITARY TUMOR
Authors: Ira I. Kaplan
Journal: JAMA (1925)

Tumors of the hypophysis, because of their uncertainty of origin and the clinical phenomena associated with them, form one of the most interesting of all groups of neoplasms.<sup>1</sup> According to the portion of the gland involved, the pituitary tumors vary in their pathology and clinical course. The anterior lobe is usually involved in the malignant and in the adenomatous types. Many cases are simple hyperplasias. Heteroplastic tumors are always associated with hypopituitarism, and manifest themselves by compression on the gland. The simple hyperplasias may or may not be associated with acromegaly, gigantism or obesity. These may go on to malignant change or may spontaneously regress. No case of acromegaly, however, has been associated with a heteroplastic tumor except one in which a glandular hyperplasia and a cerebellar cyst were coexistent.<sup>2</sup>These tumors often interfere with neighboring structures, and give rise to pressure on the optic chiasm. The visual
Temporal Variation in Incidence of IDDM in Canterbury, New Zealand
Authors: Russell S Scott, Laurie J Brown, Brain A Darlow, Louisa V Forbes, M Peter Moore
Journal: Diabetes Care (1992)

Objective To establish the statistical significance of observed variations over the last decade in the incidence of insulin-dependent diabetes mellitus (IDDM) in the 0- to 19-yr-old age-group and to determine whether incidence has increased in Canterbury, New Zealand. Research Design and Methods The Canterbury, New Zealand, Diabetes Registry has recorded all incidence cases of diabetes mellitus prospectively since 1982. All IDDM subjects aged 0–19 yr at diagnosis and using insulin are included in the study. Ascertainment is believed to be 100%. Prevalence was recorded at 1 January 1982 and 1 January 1990. Annual incidence for 1982–1990 was determined using age and sex cross-sectional census population denominators. The statistical significance of temporal, age, sex, and seasonal variations in incidence rates was ascertained by Poisson regression models (GLIM statistical software). Results Prevalence on 1 January 1990 was 115/100,000. Incidence rates during the 9 yr were periodic, with two major peaks—one in the early 1980s, the other in 1989 continuing into 1990. The temporal variation (P &amp;lt; 0.02) was not age or sex specific. Incidence rates for boys were three- to fourfold higher during peak versus trough years, with a peak level of 20.7/100,000 in 1990. For girls, there was less variation, with a peak rate of 21.6/100,000 in 1990. There has been no significant increase in IDDM incidence over time. The mean rate of incidence across all age-groups for 1982–1990 was 12.7/100,000 person-yr. A significant seasonal association to the onset of IDDM was found only in boys, with incidence rates being significantly higher in winter than in summer (P &amp;lt; 0.01). Conclusions IDDM in Canterbury, New Zealand, presents in cycles of incidence peaks and troughs, each spanning 2–3 yr.
Glucocorticoid-mediated repression of cytokine gene transcription in human arteritis-SCID chimeras.
Authors: A Brack, H L Rittner, B R Younge, C Kaltschmidt, C M Weyand, J J Goronzy
Journal: Journal of Clinical Investigation (1997)

Giant cell arteritis (GCA) is a vasculitic syndrome that preferentially affects medium and large-sized arteries. Glucocorticoid therapy resolves clinical symptoms within hours to days, but therapy has to be continued over several years to prevent disease relapses. It is not known whether and how glucocorticoids affect the function of the inflammatory infiltrate or why the disease persists subclinically despite chronic treatment. GCA is self-sustained in temporal arteries engrafted into SCID mice, providing a model in which the mechanisms of action and limitations of glucocorticoid therapy can be examined in vivo. Administration of dexamethasone to temporal artery-SCID chimeras for 1 wk induced a partial suppression of T cell and macrophage function as indicated by the reduced tissue concentrations of IL-2, IL-1beta, and IL-6 mRNA, and by the diminished expression of inducible NO synthase. In contrast, synthesis of IFN-gamma mRNA was only slightly decreased, and expression of TGF-beta1 was unaffected. These findings correlated with activation of the IkappaBalpha gene and blockade of the nuclear translocation of NFkappaB in the xenotransplanted tissue. Dose-response experiments suggested that steroid doses currently used in clinical medicine are suboptimal in repressing NFkappaB-mediated cytokine production in the inflammatory lesions. Chronic steroid therapy was able to deplete the T cell products IL-2 and IFN-gamma, whereas the activation of tissue-infiltrating macrophages was only partially affected. IL-1beta transcription was abrogated; in contrast, TGF-beta1 mRNA synthesis was steroid resistant. The persistence of TGF-beta1-transcribing macrophages, despite paralysis of T cell function, may provide an explanation for the chronicity of the disease, and may identify a novel therapeutic target in this inflammatory vasculopathy.