tbuckley/cabot-search huggingface dataset:
Deficiency of vitamin E in the alveolar fluid of cigarette smokers. Influence on alveolar macrophage cytotoxicity.
Authors: E R Pacht, H Kaseki, J R Mohammed, D G Cornwell, W B Davis
Journal: Journal of Clinical Investigation (1986)

Cigarette smoking produces oxidant-mediated changes in the lung important to the pathogenesis of emphysema. Since vitamin E can neutralize reactive oxygen species and prevent peroxidation of unsaturated lipids, it may constitute an important component of the lung's defense against oxidant injury. To better characterize the antioxidant protective role of vitamin E, young asymptomatic smokers and nonsmokers were evaluated by bronchoalveolar lavage before and immediately after a 3-wk course of oral vitamin E (2,400 IU/d). Smoker alveolar fluid at baseline was relatively deficient in vitamin E compared with nonsmoker fluid (3.1 +/- 0.7 ng/ml vs. 20.7 +/- 2.4 ng/ml, P less than 0.005). Although smoker alveolar fluid vitamin E levels increased to 9.3 +/- 2.3 ng/ml after supplementation, the levels remained significantly lower than nonsmoker baseline levels (P less than 0.01). This deficiency was explained, in part, by the increased oxidative metabolism of vitamin E to the quinone form in the lungs of smokers compared with nonsmokers. Although the significance of a lower concentration of alveolar fluid vitamin E is unclear, it may compromise the antioxidant protection afforded by the alveolar fluid as it coats the lung's epithelial surface. The protective role of vitamin E was assessed by cytotoxicity experiments, which demonstrated that the killing of normal rat lung parenchymal cells by smoker alveolar macrophages was inversely related to the vitamin E content of the parenchymal cells. These findings suggest that vitamin E may be an important lower respiratory tract antioxidant, and that the deficiency seen in young smokers may predispose them to an enhanced oxidant attack on their lung parenchymal cells.
Serum Uric Acid and Cardiovascular Mortality
Authors: Jing Fang, Michael H. Alderman
Journal: JAMA (2000)

ContextAlthough many epidemiological studies have suggested that increased serum uric acid levels are a risk factor for cardiovascular mortality, this relationship remains uncertain.ObjectiveTo determine the association of serum uric acid levels with cardiovascular mortality.Design and SettingCross-sectional population-based study of epidemiological follow-up data from the First National Health and Nutrition Examination Survey (NHANES I) from 1971-1975 (baseline) and data from NHANES I Epidemiologic Follow-up Study (NHEFS).ParticipantsA total of 5926 subjects who were aged 25 to 74 years and had serum uric acid level measurements at baseline.Main Outcome MeasuresIschemic heart disease mortality, total cardiovascular mortality, and all-cause mortality, compared by quartiles of serum uric acid level.ResultsIn an average of 16.4 years of follow-up, 1593 deaths occurred, of which 731 (45.9%) were ascribed to cardiovascular disease. Increased serum uric acid levels had a positive relationship to cardiovascular mortality in men and women and in black and white persons. Deaths due to ischemic heart disease in both men and women increased when serum uric acid levels were in the highest quartile compared with the lowest quartile (men, &gt;416 vs &lt;321 µmol/L; risk ratio, 1.77 [95% confidence interval {CI}, 1.08-3.98]; women, &gt;333 vs &lt;238 µmol/L; risk ratio, 3.00 [95% CI, 1.45-6.28]). Cox regression analysis showed that for each 59.48-µmol/L increase in uric acid level, cardiovascular mortality and ischemic heart disease mortality increased. Hazard ratios for men were 1.09 (95% CI, 1.02-1.18) and 1.17 (95% CI, 1.06-1.28), and for women were 1.26 (95% CI, 1.16-1.36) and 1.30 (95% CI, 1.17-1.45), respectively, after adjustment for age, race, body mass index, smoking status, alcohol consumption, cholesterol level, history of hypertension and diabetes, and diuretic use. Further analysis, stratifying by cardiovascular risk status, diuretic use, and menopausal status, confirmed a significant association of uric acid and cardiovascular mortality in all subgroups except among men using diuretics (n=79) and men with 1 or more cardiovascular risk factors (n=1140).ConclusionOur data suggest that increased serum uric acid levels are independently and significantly associated with risk of cardiovascular mortality.
Communication Patterns of Primary Care Physicians
Authors: Debra L. Roter, Moira Stewart, Samuel M. Putnam, Mack Lipkin, William Stiles, Thomas S. Inui
Journal: JAMA (1997)

To use audiotape analysis to describe communication patterns in primary care, to relate these to ideal relationship types as described in the literature, and to explore the patterns' relationships with physician and patient characteristics and satisfaction.Description of routine communication in primary care based on audiotape analysis and patient and physician exit questionnaires.A total of 11 ambulatory clinics and private practices.The participants were 127 physicians and 537 patients coping with ongoing problems related to disease.Roter Interactional Analysis System (RIAS) and patient and physician exit satisfaction questionnaires.Cluster analysis revealed 5 distinct communication patterns: (1) "narrowly biomedical," characterized by closed-ended medical questions and biomedical talk occurring in 32% of visits; (2) "expanded biomedical," like the restricted pattern but with moderate levels of psychosocial discussion occurring in 33% of the visits; (3) "biopsychosocial," reflecting a balance of psychosocial and biomedical topics (20% of the visits); (4) "psychosocial," characterized by psychosocial exchange (8% of visits); and (5) "consumerist," characterized primarily by patient questions and physician information giving (8% of visits). Biomedically focused visits were used more often with more sick, older, and lower income patients by younger, male physicians. Physician satisfaction was lowest in the narrowly biomedical pattern and highest in the consumerist pattern, while patient satisfaction was highest in the psychosocial pattern.Primary care communication patterns range from narrowly biomedical to consumerist patterns and parallel the ideal forms of patient-physician relationships described in the literature.
Health Care Leaders Form Drug Policy Group
Authors: Charles Marwick
Journal: JAMA (1997)

SAYING THEY ARE "impressed by the growing body of evidence that enhanced medical and public health approaches are the most effective method of reducing harmful use of illegal drugs," a group of 38 distinguished physicians have formed a group called Physician Leadership on National Drug Policy. The aim is to develop general agreement on dealing with illicit drugs through new policies that are "medically, scientifically, and legally exemplary," says the group's consensus statement, developed and adopted unanimously at a July 8 meeting at the New York Academy of Sciences. The group released the statement at a press conference in New York the next day. While the statement includes the members' belief that "the use of tobacco and alcohol is also a critically important national problem," the group goes on to explain that "we are focusing our attention on illicit drugs because of the need for a fundamental shift in policy."
A Proteomic Survey of Chlamydomonas reinhardtii Mitochondria Sheds New Light on the Metabolic Plasticity of the Organelle and on the Nature of the -Proteobacterial Mitochondrial Ancestor
Authors: A. Atteia, A. Adrait, S. Brugiere, M. Tardif, R. van Lis, O. Deusch, T. Dagan, L. Kuhn, B. Gontero, W. Martin, J. Garin, J. Joyard, N. Rolland
Journal: Molecular Biology and Evolution (2009)

Mitochondria play a key role in the life and death of eukaryotic cells, yet the full spectrum of mitochondrial functions is far from being fully understood, especially in photosynthetic organisms. To advance our understanding of mitochondrial functions in a photosynthetic cell, an extensive proteomic survey of Percoll-purified mitochondria from the metabolically versatile, hydrogen-producing green alga Chlamydomonas reinhardtii was performed. Different fractions of purified mitochondria from Chlamydomonas cells grown under aerobic conditions were analyzed by nano-liquid chromatography-electrospray ionization-mass spectrometry after protein separation on sodium dodecyl sulfate polyacrylamide gel electrophoresis or on blue-native polyacrylamide gel electrophoresis. Of the 496 nonredundant proteins identified, 149 are known or predicted to reside in other cellular compartments and were thus excluded from the molecular and evolutionary analyses of the Chlamydomonas proteome. The mitochondrial proteome of the photosynthetic alga reveals important lineage-specific differences with other mitochondrial proteomes, reflecting the high metabolic diversity of the organelle. Some mitochondrial metabolic pathways in Chlamydomonas appear to combine typical mitochondrial enzymes and bacterial-type ones, whereas others are unknown among mitochondriate eukaryotes. The comparison of the Chlamydomonas proteins to their identifiable homologs predicted from 354 sequenced genomes indicated that Arabidopsis is the most closely related nonalgal eukaryote. Furthermore, this phylogenomic analysis shows that free-living alpha-proteobacteria from the metabolically versatile orders Rhizobiales and Rhodobacterales better reflect the gene content of the ancestor of the chlorophyte mitochondria than parasitic alpha-proteobacteria with reduced and specialized genomes.
Possible Value of Baclofen in Myoclonus
Authors: M. K. Menon
Journal: JAMA (1980)

<h3>To the Editor.—</h3> Myoclonus, characterized by repetitive involuntary movements of skeletal muscle, is observed in several neurological conditions.<sup>1,2</sup>The anatomic origin of the neurochemical aspects of myoclonus is not fully understood. Certain forms of myoclonus are effectively treated with the serotonin precursor tryptophan<sup>3</sup>or by antianxiety drugs belonging to the benzodiazepine group.<sup>4</sup>The nonavailability of a suitable animal model restricted the development of new drugs in the treatment of myoclonus. Recently we observed that administration of the putative γ-aminobutyric acid (GABA) agonist muscimol, 3 mg/kg, intraperitoneally resulted in the development of myoclonic jerks in male Swiss mice. These jerks involving their hindquarter developed within ten minutes after injection, were rhythmic, and occurred at a rate of 50 to 76 per minute and lasted for 60 to 90 minutes. Both the serotonin precursor 5-hydroxytryptophan, 200 mg/ kg, intraperitoneally, in mice pretreated with a decarboxylase inhibitor, benserazide, 50 mg/kg
Asthma symptoms and airway hyperresponsiveness are lower during treatment with nedocromil sodium than during treatment with regular inhaled albuterol
Authors: Stephen I. Wasserman, Clifton T. Furukawa, Stuart I. Henochowicz, J.Paul Marcoux, Bruce M. Prenner, Steven R. Findlay, Garry N. Gross, Leonard D. Hudson, Debra J. Myers, Paul Steinberg
Journal: Journal of Allergy and Clinical Immunology (1995)
A massive haematemesis
Authors: K. L Nash, G. M Hirschfield
Journal: BMJ (2010)

A 31 year old man was brought by ambulance to the emergency department of his local hospital having vomited several basins full of bright red blood. He had no medical history but admitted to a decade long history of excess alcohol intake, consuming 60-70 units a week. On examination he was pale, sweaty, and restless with a marked tremor. His pulse was 110 beats per minute and blood pressure was 90/50 mm Hg. He was not jaundiced, but his abdomen was distended with shifting dullness in the flanks. The liver could not be palpated, but the spleen was palpable 5 cm below the costal margin.

Blood results showed haemoglobin 80 g/l, international normalised ratio 1.8, platelets 45×109/l, bilirubin 14 μmol/l, creatinine 77 μmol/l.

While being assessed he had a further large haematemesis, vomiting more than a litre of fresh blood, and he became drowsy and uncooperative.



### 1 What is the most likely diagnosis?

#### Short answer

Decompensated alcoholic liver disease with portal hypertension leading to haemorrhage from gastro-oesophageal varices.

#### Long answer

The most likely diagnosis is that he has developed cirrhosis as a consequence of long standing alcohol use. In the United Kingdom, alcohol is the main cause of liver disease, and it accounts for more than half of liver related admissions to hospital. The problem is increasing, with hospital admissions for alcohol related liver disease having doubled in the past 10 years.1 The spectrum of alcohol associated liver disease spans steatosis, steatohepatitis, and cirrhosis.2

Sinusoidal hypertension results from compression of the portal venous channels in the fibrotic liver and leads to the development of portosystemic anastomoses. The anastomosis at …
Cost-Effectiveness of Rhythm versus Rate Control in Atrial Fibrillation
Authors: Deborah A. Marshall, Adrian R. Levy, Humberto Vidaillet, Elisabeth Fenwick, April Slee, Gordon Blackhouse, H. Leon Greene, D. George Wyse, Graham Nichol, Bernie J. O'Brien
Journal: Annals of Internal Medicine (2004)

Background: Atrial fibrillation is the most common type of sustained cardiac arrhythmia, but recent trials have identified no clear advantage of rhythm control over rate control. Consequently, economic factors often play a role in guiding treatment selection. Objective: To estimate the cost-effectiveness of rhythm-control versus rate-control strategies for atrial fibrillation in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM). Design: Retrospective economic evaluation. Nonparametric bootstrapping was used to estimate the distribution of incremental costs and effects on the cost-effectiveness plane. Data Sources: Data on survival and use of health care resources were obtained for all 4060 AFFIRM participants. Unit costs were estimated from various U.S. databases. Target Population: Patients with atrial fibrillation who were 65 years of age or who had other risk factors for stroke or death, similar to those enrolled in AFFIRM. Time Horizon: Mean follow-up of 3.5 years. Perspective: Third-party payer. Interventions: Management of patients with atrial fibrillation with antiarrhythmic drugs (rhythm control) compared with drugs that control heart rate (rate control). Outcome Measures: Mean survival, resource use, costs, and cost-effectiveness. Results of Base-Case Analysis: A mean survival gain of 0.08 year (P = 0.10) was observed for rate control. Patients in the rate-control group used fewer resources (hospital days, pacemaker procedures, cardioversions, and short-stay and emergency department visits). Rate control costs $5077 less per person than rhythm control. Results of Sensitivity Analysis: Cost savings ranged from $2189 to $5481 per person. Rhythm control was more costly and less effective than rate control in 95% of the bootstrap replicates over a wide range of cost assumptions. Limitations: Resource use was limited to key items collected in AFFIRM, and the results are generalizable only to similar patient populations with atrial fibrillation. Conclusion: Rate control is a cost-effective approach to the management of atrial fibrillation compared with maintenance of sinus rhythm in patients with atrial fibrillation similar to those enrolled in AFFIRM. †Deceased. A complete list of the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) investigators has been published elsewhere (Am Heart J. 2002;143:991-1001). *For a list of the Cardiac Outcomes and Research in Economics (CORE) investigators, see the Appendix.
Converging paradigms for environmental health theory and practice.
Authors: Margot Parkes, Ruth Panelli, Philip Weinstein
Journal: Environmental Health Perspectives (2003)

Converging themes from the fields of environmental health, ecology and health, and human ecology highlight opportunities for innovation and advancement in environmental health theory and practice. In this commentary we outline the role of research and applied programs that integrate biophysical and social sciences with environmental health practice in order to address deficiencies in each field when taken on its own. New opportunities for environmental health protection and promotion are outlined based on the three converging themes: integrated approaches to research and policy, methodological acknowledgment of the synergies between the social and biophysical environments, and incorporation of core ecosystem principles into research and practice. These converging themes are discussed in relation to their implications for new types of intervention to achieve health gains across different spatial and temporal scales at the interface between biophysical and social environments.
Potassium Deficiency in Anorexia Nervosa, with Reference to Renal Tubular Vacuolation
Authors: R. D. Wigley
Journal: BMJ (1960)

The case is presented of a patient with sarcoidosis and hypercalcaemia in whom decreased tubular reabsorption of phosphate was demonstrated, producing a biochemical resemblance to primary hyperparathyroidism.The differential diagnosis between the two conditions is discussed, and it is concluded that tests of phosphate excretion may be misleading, but that the response to cortisone gives valuable information.We thank Dr. A. D. Everett for referring the patient to us, Dr. A. Gordon Signy for his help with the histological and biochemical investigations, Dr. F.
Postischemic Antiarrhythmic Effects of Angiotensin-Converting Enzyme Inhibitors
Authors: Friedrich Brunner, Walter R. Kukovetz
Journal: Circulation (1996)

ACE inhibitors improve reperfusion function in several animal models. We tested the hypothesis that ACE inhibitor-induced coronary protection and inhibition of reperfusion arrhythmias are mediated by suppression of cardiac endothelin-1 (ET-1) secretion and action.The effects of two ACE inhibitors on ET-1 secretion and mechanical function during ischemia and reperfusion were studied in perfused rat hearts. Drugs were infused during the control (60 minutes), ischemic (60 minutes), and reperfusion (30 minutes) period. ET-1 appearing in coronary effluents and the interstitium was analyzed by radioimmunoassay. We observed (1) in hearts treated with ramiprilat (100 nmol/L) or captopril (5 mumol/L), a significant reduction of ET-1 secretion under all three experimental conditions and fewer ventricular extrasystoles during reperfusion; (2) increased ET-1 secretion and numerous tachyarrhythmic events in the presence of ACE inhibitor and a bradykinin B2 receptor antagonist, icatibant (100 nmol/L); (3) an almost-complete suppression of reperfusion arrhythmias when an ET receptor antagonist, ie, SB 209670 (5 mumol/L) or PD 142893 (200 nmol/L), was infused together with ACE inhibitor and icatibant; and (4) SB 209670 alone to be equally antiarrhythmic as ACE inhibitors. Exogenous ET-1 (40 pmol/L) was proarrhythmic, whereas exogenous bradykinin (100 nmol/L) reduced ET-1 secretion and improved cardiac rhythm.ACE inhibitors suppress endogenous ET-1 secretion, which results in improved coronary function and stabilization of cardiac rhythm after ischemia in this model. Suppression of ET-1 results from both removal of endogenous angiotensin II and accumulation of endogenous bradykinin/nitric oxide. ET receptor antagonists may be prime antiarrhythmic drugs worthy of testing in cardiac patients, either alone or together with ACE inhibitors.
Rise in life expectancy is marred by widening inequality gap
Authors: I. Torjesen
Journal: BMJ (2012)

Life expectancy in England as a whole is continuing to rise, but the gap in life expectancy between the richest and poorest groups of society is widening, show figures published this week.

The figures, from the Institute of Health Equity at University College London, show that life expectancy rose by 0.3 years for men and for women between 2007-8 and 2008-9. However, inequalities in life expectancy increased among men in 104 of 150 local authorities and among women in 92 local authorities.

The biggest difference in life expectancy in men was in the London borough of Westminster, where the difference between the richest and poorest men was 16.9 years, while the London borough of Hackney had the lowest difference, at 3.1 years. Inequalities in women’s life expectancy were not quite as marked.

Michael Marmot, director of the Institute of Health Equity, said, …
Hepatitis after arterial embolization for hepatocellular carcinoma: Viral reactivation or ischemia?
Authors: Teh‐Ia Huo, Shou‐Dong Lee, Jaw‐Ching Wu
Journal: Hepatology (2006)

To the Editor: We read with interest the article by Jang et al. in a recent issue of Hepatology.1 The authors conducted a randomized study to evaluate the benefit of pre-emptive therapy of lamivudine for patients with hepatitis B virus (HBV)-related hepatocellular carcinoma undergoing transarterial chemo-lipiodolization (TACL). They found that patients in the lamivudine group had a lower risk of hepatitis due to HBV reactivation during the treatment course. However, because patients undergoing TACL may invariably develop ischemic hepatitis that is directly related to the treatment procedure, the authors' findings should be interpreted with caution before concluding that lamivudine induces a beneficial response by decreasing the incidence of hepatitis from viral reactivation. Hepatocyte ischemia in tumoral and nontumoral areas usually occurs immediately after embolization. The incidence of ischemic hepatitis, defined as an elevation of serum ALT levels to more than 5 times the upper limit of normal after arterial embolization, has previously been reported to be as much as 45%.2 Whereas ischemic hepatitis typically occurs within 1 to 2 days of arterial embolization and persists for a variable period of time, it is much more difficult to judge the temporal relationship in hepatitis that is attributable to viral reactivation, unless an upsurge of HBV DNA levels can be clearly demonstrated before the occurrence of clinical hepatitis.3 Therefore, overt hepatitis may be due to either ischemia or viral reactivation, depending on the time point of serum biochemistry measurement, and both components may occur simultaneously in a substantial proportion of patients. Moreover, patients with viral reactivation after TACL may not necessarily have overt ALT elevation or flares that predispose to hepatic decompensation. In this regard, the therapeutic advantage of lamivudine aimed to suppress HBV reactivation may not be clinically significant. In the Jang et al. series, patients with hepatitis due to viral reaction and hepatitis from other causes seem to be completely separable, as shown in their Table 2.1 However, in the usual clinical setting, we believe the cause of overt hepatitis after TACL is likely multifactorial. Lastly, the factor of lamivudine therapy should be entered into the multivariate logistic regression analysis together with all other variables to determine if it is an independent factor associated with a favorable clinical outcome. Teh-Ia Huo*, Shou-Dong Lee*, Jaw-Ching Wu , * Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan.