tbuckley/cabot-search huggingface dataset:
Children in the United States with Discontinuous Health Insurance Coverage
Authors: Lynn M. Olson, Suk-fong S. Tang, Paul W. Newacheck
Journal: New England Journal of Medicine (2005)

Estimates of the number of uninsured people in the United States usually exclude those with discontinuous coverage. The effects of gaps in insurance coverage for children on access to and use of ambulatory care are poorly understood.We analyzed a sample of 26,955 children under 18 years of age from the 2000 and 2001 National Health Interview Surveys. Children with discontinuous health insurance coverage were compared with those who were uninsured all year and with those who had public or private full-year coverage.During the last 12 months before they were interviewed, 6.6 percent of children in the United States had no insurance and an additional 7.7 percent had gaps in insurance. Children who had full-year insurance coverage (private or public) had low rates of unmet health care needs and good access to care (delayed care, unmet medical care, and unfilled prescriptions were reported in <3 percent, and <5 percent had no usual place of care). Access to care was much worse for children who were uninsured for part of the year and for those who were uninsured for the full year (delayed care, 20.2 percent and 15.9 percent, respectively; unmet medical care, 13.4 percent and 12.6 percent, respectively; unfilled prescriptions, 9.9 percent and 10.0 percent, respectively; P<0.01 for all comparisons with children with full-year, private insurance coverage). In multivariate analyses adjusting for age, income, race or ethnic group, region, citizenship, family structure, parental employment, and health status, the differences in access to care persisted. As compared with the parents of children with full-year, private insurance, parents of children uninsured for the full year were far more likely to report delaying care (adjusted odds ratio, 12.65; 95 percent confidence interval, 9.45 to 16.94), as were parents of children uninsured for part of the year (adjusted odds ratio, 13.65; 95 percent confidence interval, 10.41 to 17.90).Children with gaps in health insurance coverage commonly do not seek medical care, including preventive visits, and do not get prescriptions filled. These findings are important for both research and policy and point to the need for more encompassing and sensitive measures of the situation of being uninsured.
Gene therapy in the treatment of autoimmune diseases
Authors: George C. Tsokos, Gerald T. Nepom
Journal: Journal of Clinical Investigation (2000)

Complex pathogenic processes lead to heterogeneous manifestations in autoimmune diseases. Except for rare patients in whom a single genetic defect — in genes for the Fas ligand or for the complement factors C4, C2, or C1q — is associated with autoimmune manifestations, these diseases are multifactorial. Complex genetic, environmental, and immunoregulatory factors appear to play out in a process that we understand in only a fragmentary sense and that we have little ability to influence (1). Therefore, gene therapy involving the reconstitution of a single missing gene should be expected to be of minimal help in treating these diseases. Our current practice of helping patients symptomatically, or at best by indiscriminate suppression of the immune system, is obviously inadequate. Correction of the identified immunoregulatory aberrations has become the mainstay of the efforts to treat autoimmune disorders in a rational manner.

Therapeutic intervention in autoimmune disease faces formidable challenges, since it requires a balance between the control of ongoing pathogenic immune responses and the maintenance of essential immune surveillance functions. Therapies directed at general pathways of immune activation or amplification are antigen-nonspecific and may allow for widespread application across multiple diseases, but they also carry the risk of global immunosuppression. Antigen-specific therapeutics, on the other hand, are potentially much more selective and less deleterious, but they require a priori knowledge of precise immunologic targets relevant in each autoimmune setting. Cytokines, cytokine antagonists, anti–T cell monoclonal antibodies, inhibitors of signal transduction, and conventional pharmacologic agents fall into the former group, whereas specific peptide antigens, antagonists, and MHC-antigen complexes fall into the latter group of treatments. Table ​Table11 summarizes many of the approaches that have been tested in mouse models of various autoimmune disorders. In this issue of the JCI, articles by Agarwal et al. (2) and Lawson et al. (3) apply novel forms of gene therapy to introduce directed immune therapeutics in autoimmune animals, illustrating both antigen-nonspecific and antigen-specific strategies.



Table 1

Gene therapy in the treatment of autoimmune diseases
Effect of immunotherapy on asthma progression, BHR and sputum eosinophils in allergic rhinitis
Authors: R. Polosa, F. Li Gotti, G. Mangano, G. Paolino, C. Mastruzzo, C. Vancheri, N. Lisitano, N. Crimi
Journal: Allergy (2004)

Background: Bronchial hyperresponsiveness (BHR) and airway inflammation are frequently associated with allergic rhinitis, and may be important risk factors for the development of asthma. Specific immunotherapy (SIT) reduces symptom in subjects with allergic rhinitis, but the mechanisms are not clear. Aims of the study: To assess the effect of Parietaria ‐SIT on asthma progression, rhinitic symptoms, BHR, and eosinophilic inflammation. Methods: Nonasthmatic subjects with seasonal rhinitis were randomly assigned to receive Parietaria pollen vaccine ( n = 15) or matched placebo ( n = 15). Data on symptoms and medication score, BHR to methacholine, eosinophilia in sputum were collected throughout the 3‐year study. Results: By the end of the study, in the placebo group, symptoms and medication scores significantly increased by a median (interquartile range) of 121% (15–280) and 263% (0–4400) respectively ( P &lt; 0.01), whereas no significant difference was observed in the SIT group. We found no significant changes in sputum eosinophils and BHR to methacholine in both groups throughout the study. Nine of 29 participants developed asthma symptoms during the study; of these, only two subjects (14%) in the SIT‐treated group ( P = 0.056). Conclusions: Parietaria ‐SIT reduces symptom and rescue medication scores, but no changes in BHR to methacholine or sputum eosinophilia were observed. Moreover, Parietaria ‐SIT appears to prevent the natural progression of allergic rhinitis to asthma, suggesting that SIT should be considered earlier in the management of subjects with allergic rhinitis.
Three jailed in bribery and prescription fraud scandal
Authors: X. Bosch
Journal: BMJ (1999)

A doctor and two drug company managers have been jailed in a bribery and prescription fraud scandal in Spain.

Luis Bahamonde-Falcon, manager of the pharmaceutical firm Kendall Institute, Barcelona, was found guilty of attempting to bribe numerous doctors to prescribe two of the company's drugs, Inkamil (ciprofloxacin) and Kenesil (nimodipine).

He was also found guilty of instructing another manager, Agustin Mancheno-Llorente, the company's agent in Madrid, to pay doctors their conference expenses and cash to carry out bogus follow up studies on the effects of …
Recent insights into coronary collateral circulation.
Authors: S Sasayama, M Fujita
Journal: Circulation (1992)

The functional significance of coronary collaterals in humans has been debated for many years. Correlations have now been made between the anatomic appearance of coronary collateral vessels visualized at the time of intracoronary thrombolytic therapy during the acute phase of myocardial infarction and the creatine kinase time--activity curve, infarct size, and aneurysm formation. These studies demonstrate a protective role of collaterals in hearts with coronary obstructive disease, showing smaller infarcts, less aneurysm formation, and improved ventricular function compared with patients in whom collaterals were not visualized. There is ample evidence that collaterals respond to myocardial ischemia by opening preexistent channels. When the cardiac myocyte is rendered ischemic, collaterals develop actively by growth with DNA replication and mitosis of endothelial and smooth muscle cells. Heparin-binding growth factors are present in the heart, but their biological activity is quiescent under normal physiological conditions. Once ischemia develops, these factors are activated and become available for receptor occupation, which may initiate angiogenesis after exposure to exogenous heparin. This characteristic of heparin to potentiate the mitogenic activity of acidic fibroblast growth factor has recently been used in the clinical setting as a possible therapeutic modality in patients with coronary artery disease. Patients performing 20 rounds of exercise serially after receiving intravenous injection of heparin showed significantly greater increases in exercise capacity and improvement of clinical symptoms compared with the control group who performed the same exercise without heparin. Further study of neovascularization may lead to a new therapeutic strategy for ischemic heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)
Multiple Organ Failure: Patient Care and Prevention
Authors: Robert F. Wilson
Journal: JAMA (1991)

This is an extremely interesting and informative textbook, based primarily on Dr Baue's experience for 12 years as editor of the<i>Archives of Surgery</i>. This broad editorial experience has helped him provide an important historical perspective on the book's topic. He starts off with descriptions of surgical homeostasis, discussing first the metabolic and neuroendocrine responses to injury, then the various mediators; however, he only goes to interleukin-2. (It is impossible for any textbook to keep up with all the interleukins.) He includes most of the classic references for each of the topics that he discusses, and this, in itself, can be a great help to many readers and investigators. Dr Baue then describes methods for improving preoperative, operative, and postoperative care. The chapter on postoperative care describes in detail many ways to help prevent a wide variety of complications, including pulmonary insufficiency, deep venous thrombosis, and cardiovascular failure. The complications
Home Cultures as an Aid in the Diagnosis of Streptococcal Respiratory Infection
Authors: Benedict F. Massell, Jacqueline Amezcua, J. Gabriel Michael
Journal: New England Journal of Medicine (1964)

THROAT cultures, when evaluated in conjunction with clinical manifestations, are a valuable aid in the diagnosis of streptococcal respiratory infections, and follow-up cultures in such infections are helpful in assessing the results of therapy. In spite of their value throat cultures are used only infrequently by most physicians in their practice of medicine. Because of this fact a study was conducted to determine whether it would be feasible for parents to culture the throats of their children and for adults to culture their own throats. Special culture kits were assembled so that cultures obtained at home, together with a check . . .
Predictive Value of Metabolic Tumor Volume Measured by 18F-FDG PET for Regional Lymph Node Status in Patients With Esophageal Cancer
Authors: Ho Seok I, Seong-Jang Kim, In Joo Kim, Keunyoung Kim
Journal: Clinical Nuclear Medicine (2012)

The aim of the current study was to investigate the predictive value of metabolic tumor volume (MTV) measured by (18)F-FDG PET/CT for regional lymph node (rLN) metastasis in patients with esophageal cancer.A retrospective review identified 54 patients with surgically resected esophageal cancer who received (18)F-FDG PET/CT at diagnosis of cancer. The (18)F-FDG PET/CT findings for all primary cancer and rLN involvement were compared with the pathologic diagnosis within 5 weeks after surgical resection. The pathologic diagnoses of rLN state were confirmed by surgical resection. Univariate and multivariate analyses were used to analyze the associations among the pathologic rLN status and age, sex, T stage, location, differentiation, maximum standardized uptake value (SUV(max)), MTV2.5, and MTV3.The rLN(+) group showed statistically significant higher value of SUVmax than the rLN(-) group (P = 0.0011). The rLN(+) group showed statistically significant higher value of MTV2.5 (P = 0.0004) and MTV3 (P = 0.0005) than the rLN(-) group. In receiver operating characteristic analysis, the SUV(max), MTV2.5, and MTV3 did not show the statistical differences for the prediction of pathologic rLN involvement in esophageal cancer. In univariate analysis, T stage, SUV(max), MTV2.5, and MTV3 were factors significantly associated with pathologic rLN involvement. However, in multivariate analysis, the MTV2.5 and MTV3 were factors significantly associated with pathologic rLN involvement in esophageal cancer.Based on the presented results, the MTV measured by (18)F- FDG PET/CT is a useful method for the prediction of pathologic rLN status in esophageal cancer patients. Further studies are needed to confirm these results and improve statistical accuracy.
HIV testing of patients with end stage renal failure.
Authors: M A Mansell
Journal: BMJ (1991)

prospective or retrospectivc -representative of the majority of' births is clearly difficult.Because of the large numb11hcr of births in lower age groups and the tiny proportion of these which wvill be affected by Down's svndrome, only a very large study could pn)vide sufficient cases for evalluation (although cost could presumably be redLuced by conducting this study in one of the regions alreadv providing the triple test on the NHS) In commenting on Cuckle et al's article I did not intend to suggest that netitrophil alkaline phosphatase activity will not prove to be a highly valuable additional marker- only that it may have been premature in a leaflet sent directly to pregnant women to contrast the efficiencv of the triple and triple plus tests before all of the necessary evidence is in.
Severe Anaemia due to Diaphragmatic Hernia
Authors: N. J. Roussak, S. Eden
Journal: BMJ (1947)

MEDICAL JOU_AL (3.74 kg.).On Aug. 25 a partial resuture of the abdomen was required, but otherwise the patient made an excellent recovery, and was discharged on Oct. 24, 1940.Her weight was then 11 lb. 4 oz.(5.12 kg.).
S132 Airway dysfunction and inflammation in pool and non-pool based elite endurance athletes
Authors: N. Martin, M. R. Lindley, B. Hargadon, W. Monteiro, I. D. Pavord
Journal: Thorax (2010)

<h3>Introduction</h3> Previous studies have suggested that eosinophilic airway inflammation is common in elite swimmers; the chemical pool environment often blamed. We set out to address this question in a cross-sectional study of 109 international athletes from a variety of sporting backgrounds. <h3>Methods</h3> All had symptoms suggesting exercise-induced asthma and were either inhaled corticosteroid naïve or withdrew these for &gt;4 weeks. β<sub>2</sub>-agonists, exercise and caffeine were withheld for 8 h prior to testing. Symptoms were assessed using the Juniper ACQ, airways dysfunction using the eucapnic voluntary hyperventilation (EVH) test and airways inflammation using exhaled nitric oxide (FE<sub>NO</sub>) and induced sputum eosinophil % (eos). Athletes were classed as pool based if they exercised in an indoor pool environment for &gt;5 h per week, and non-pool based if they exercised in a pool for &lt;1/2 h per week. <h3>Results</h3> Demographic details were similar. Mean (±SEM) % fall in FEV<sub>1</sub> post EVH was 18.96±1.701 (n=47) in pool and 11.39±1.249 (n=62) in non-pool athletes (mean difference 7.569; 95% CI 3.480 to 11.66; p=0.0004), 76% of pool and 39% of non-pool athletes had a positive test (&gt;10% fall). The geometric mean (log SD) eos (pool 2.667 (0.797)), non-pool 3.060 (0.867), p=0.802), and FE<sub>NO</sub> (pool 25.05 (1.570), non-pool 28.06 (1.475) ppb, p=0.914) was no different between groups; 14.9% of pool and 12.9% of non-pool athletes had eos &gt;3%. % fall in FEV1 had good correlation with log eos (r=0.551, p&lt;0.0001); a 25% fall being the optimum (AUC 0.89, p&lt;0.0001, sens 79%, spec 93%). Log FE<sub>NO</sub> and log eos correlated strongly (r=0.644, p&lt;0.0001); FE<sub>NO</sub> of &gt;47 being most predictive of eos&gt;3% (AUC 0.912, p&lt;0.0001, sens 78%, spec 92%). Symptoms correlated poorly with either airways dysfunction or inflammation. <h3>Conclusions</h3> Individual athletes with symptoms vary markedly in the levels of airways dysfunction and inflammation expressed. There is more airway dysfunction in pool athletes but not more eosinophilic airways inflammation suggesting that the pool environment if anything predisposes to airways dysfunction. Exhaled nitric oxide is a promising non-invasive means of assessing eosinophilic airways inflammation in all elite athletes.
Allogeneic hematopoietic cell transplantation for hematologic malignancy: relative risks and benefits of double umbilical cord blood
Authors: Claudio G. Brunstein, Jonathan A. Gutman, Daniel J. Weisdorf, Ann E. Woolfrey, Todd E. DeFor, Theodore A. Gooley, Michael R. Verneris, Frederick R. Appelbaum, John E. Wagner, Colleen Delaney
Journal: Blood (2010)
Adenosine as a vasodilator in primary pulmonary hypertension.
Authors: J M Morgan, D G McCormack, M J Griffiths, C J Morgan, P J Barnes, T W Evans
Journal: Circulation (1991)

BACKGROUND The acute administration of vasodilator drugs to patients with primary pulmonary hypertension has been advocated to identify those with reversible pulmonary vasoconstriction. Unfortunately, the usefulness of the drugs currently available is limited by accompanying systemic hypotension. A vasodilator with effects confined to the pulmonary circulation would therefore be advantageous in such patients. METHODS AND RESULTS The purine nucleoside adenosine was infused into the pulmonary artery in seven patients with primary pulmonary hypertension (baseline pulmonary vascular resistance [PVR], 442-1,295 dyne/cm/sec-5) to determine its effect on PVR. In all patients, there was a dose-dependent and significant reduction (mean maximal percent decrease from baseline, 38.9%; p less than 0.001) in PVR mediated through a decrease in pulmonary artery pressure and an increase in cardiac output. Systemic vascular resistance (SVR) also decreased, but the ratio of PVR to SVR decreased (maximal mean percent decrease from baseline) by 10.5% (p less than 0.025), indicating that adenosine has a preferential vasodilator effect on the pulmonary circulation when administered in this manner. CONCLUSIONS Because of its pharmacokinetic and vasodilator properties, adenosine may have a specific role in the investigation of primary pulmonary hypertension.
Sulfadoxine specific lymphocyte transformation in a patient with eosinophilic pneumonia induced by sulfadoxine-pyrimethamine (Fansidar).
Authors: P T Daniel, J Holzschuh, P A Berg
Journal: Thorax (1989)

A patient developed eosinophilic peripheral pulmonary infiltrates while receiving malaria prophylaxis with sulfadoxine-pyrimethamine (Fansidar). Withdrawal of Fansidar and treatment with corticosteroids led to rapid recovery. No exacerbation occurred after cessation of corticosteroids. Lymphocyte transformation testing gave a positive result in the presence of sulfadoxine but not pyrimethamine. It is concluded that drug hypersensitivity to sulfadoxine was the cause of the eosinophilic pneumonia in this patient.
Malignant Melanoma Imaging with Tl-201
Authors: NAOTO WATANABE, MASASHI SHIMIZU, GAKUTO TOMIZAWA, SHINICHIRO TOYOSHIMA, MASANARI KAGEYAMA, HIKARU SETO
Journal: Clinical Nuclear Medicine (1998)

Two patients with malignant melanoma were evaluated using Tl-201 scintigraphy. Planar scintigraphy showed tumor accumulation, and SPECT Tl-201 imaging revealed exact tumor localization. The findings indicate the utility of Tl-201 to detect the primary lesion and to identify postoperative recurrence in malignant melanoma.
We don't need an "evidence base" for a smoking ban in outdoor spaces
Authors: P. Barber
Journal: BMJ (2015)

I support the right of local authorities and institutions to impose and police a ban on any “managed” outdoor spaces visited by the public.1 With the indoor ban (which also generated opposition and the constant invocation of “personal freedom”) in place, the air in some public spaces, especially thresholds, is heavily contaminated with cigarette smoke.

A ban in outdoor public places would build on the incredible success of the …
Keeping Up with the Medical Literature
Authors: TODD H. GOLDBERG
Journal: Annals of Internal Medicine (1987)

Letters and Corrections1 March 1987Keeping Up with the Medical LiteratureTODD H. GOLDBERG, M.D.TODD H. GOLDBERG, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-106-3-481 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The final article of the recent series "How to Keep Up with the Medical Literature" (1) was thought provoking and a pleasure to read because of the authors' breezy writing style. Like many physicians with large, growing article collections and little storage space, I have found the problem of storing and retrieving articles worth keeping to be a thorny one.In this information age, a personal computer has become indispensable for keeping track of and optimally using one's collection of medical literature. However, I would maintain that expensive or complicated software need not be bought for this...Reference1. HAYNES R, MCKIBBON K, FITZGERALD D, GUYATT G, WALKER C, and SACKETT D. HOW to keep up with the medical literature: VI. How to store and retrieve articles worth keeping. Ann Intern Med. 1986;105:978-84. LinkGoogle Scholar1. HAYNES R, MCKIBBON K, FITZGERALD D, GUYATT G, WALKER C, and SACKETT D. How to keep up with the medical literature: VI. How to store and retrieve articles worth keeping. Ann Intern Med. 1986;105:978-84. LinkGoogle Scholar2. SINGER K. Where did I see that article? JAMA. 1979;241:1492-3. CrossrefMedlineGoogle Scholar3. RODNAN G and SCHUMACHER H, eds. Primer on the Rheumatic Diseases. 8th ed. Atlanta: Arthritis Foundation; 1983. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: TODD H. GOLDBERG, M.D.Affiliations: Hospital of the University of Pennsylvania Philadelphia, PA 19104 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 March 1987Volume 106, Issue 3Page: 481-482KeywordsPersonal computers ePublished: 1 December 2008 Issue Published: 1 March 1987 PDF downloadLoading ...
Corticosteroid‐induced lymphocytopenia in man: Absence of splenic influence and effect of recipient serum
Authors: G. Peter Beardsley, Harvey Jay Cohen
Journal: American Journal of Hematology (1978)

Abstract Pharmacologic doses of corticosteroids produce a profound, transient lymphocytopenia in man. We have studied the role of the spleen and possible induction of cytolytic factors in the generation of this effect. A 200 mg IV dose of hydrocortisone‐21‐hemisuccinate was administered to five normal subjects and five subjects whose spleens had been removed as a result of trauma. Sequential peripheral blood lymphocyte counts and subpopulations were then determined, and the effect of serum (obtained from the recipients at several time points after steroid administration) on autologous lymphocyte viability was assessed in vitro. The asplenic subjects experienced the same marked lymphocytopenia as normal individuals, and post‐steroid serum was not cytotoxic to autologous lymphocytes. The in vitro results support the view that corticosteroid‐induced lymphocytopenia is not the result of lymphocytolysis in man. If lymphocyte redistribution is the cause, as has been suggested, our in vivo results directly demonstrate that the spleen does not play a major role.