tbuckley/cabot-search huggingface dataset:
Blood pressure self monitoring: questions and answers from a national conference
Authors: R. J McManus, P. Glasziou, A. Hayen, J. Mant, P. Padfield, J. Potter, E. P Bray, D. Mant
Journal: BMJ (2008)

#### Summary points

Self measurement of blood pressure was introduced in the 1930s and is now practised by almost 10% of the general population of the United Kingdom.1 2 Because blood pressure monitors are now readily available and cheap (as little as £10; $15; €11.8), self monitoring is likely to increase—in the United States and Europe up to two thirds of people with hypertension self monitor.3 At present we have insufficient evidence to make use of multiple blood pressure readings generated from home monitoring in clinical care. This review—which is based on available evidence from randomised trials, systematic reviews, and expert consensus—discusses the clinical importance of self measurement of blood pressure in establishing the diagnosis of hypertension, in subsequent titration of drugs, and in longer term monitoring.

#### Sources and selection criteria

We extracted key studies from a Medline search for randomised controlled trials and systematic reviews to the end of 2007. These were supplemented by data from the personal references of study group members. After an open conference in early July 2008, at which the main data from the literature were presented, the group held a writing day to distil what was known and unknown for a series of questions for self monitoring of hypertension.

Self monitoring of blood pressure is when a person (or carer) measures their own blood pressure outside the clinic—at home, in the workplace, or elsewhere.4 Self monitoring allows multiple measurements and therefore provides a more precise …
Gene Dosage of the Common Variant 9p21 Predicts Severity of Coronary Artery Disease
Authors: Sonny Dandona, Alexandre F.R. Stewart, Li Chen, Kathryn Williams, Derek So, Ed O'Brien, Christopher Glover, Michel LeMay, Olivia Assogba, Lan Vo, Yan Qing Wang, Marino Labinaz, George A. Wells, Ruth McPherson, Robert Roberts
Journal: Journal of the American College of Cardiology (2010)
Neonates With Short Bowel Syndrome
Authors: Erica M. Fallon, Paul D. Mitchell, Deepika Nehra, Alexis K. Potemkin, Alison A. O’Loughlin, Kathleen M. Gura, Mark Puder
Journal: JAMA Surgery (2014)

The introduction of hepatoprotective strategies and multidisciplinary management has significantly improved the outcome of neonates with short bowel syndrome (SBS) who require parenteral nutrition (PN).To determine the probability of weaning from PN based on intestinal length in neonates with SBS amidst the new era of hepatoprotective strategies and multidisciplinary management.Retrospective medical record review at a single-center academic institution. Neonates with no more than 100 cm of small intestine at a corrected gestational age of no more than 30 days who were diagnosed with a surgical gastrointestinal disease and PN dependent for at least 2 weeks were included. Data were collected from January 1, 2004, through June 1, 2012.Neonates with SBS requiring PN.The probability of wean from PN without reinitiation for at least 1 year, as determined by logistic regression. Predictors of wean were evaluated using exact conditional logistic regression. Predictors of time to wean were determined by Cox proportional hazards regression.Sixty-three patients with a median (25th percentile, 75th percentile [interquartile range (IQR)]) gestational age of 31 (27, 35) weeks, birth weight of 1423 (895, 2445) g, small intestinal length of 41.0 (24.0, 65.0) cm, and predicted length of 29.0% (17.1%, 45.5%) underwent analysis. Fifty-one patients (81%) received a fish oil-based lipid emulsion (1 g/kg/d), 40 (63%) were weaned, 11 (17%) remained PN dependent, 4 (6%) underwent transplant, and 8 (13%) died while on PN. Excluding patients who underwent transplant or died, the median (IQR) small intestinal length was 55.0 (28.0, 75.0) cm in weaned and 26.0 (14.0, 41.0) cm in PN-dependent patients (P = .006), with 40 of 51 (78%) weaned by study end. The cumulative probability of wean for patients with at least 50 cm of small intestine was 88% after 12 and 96% after 24 months. Patients with less than 50 cm of small intestine had a cumulative probability of wean of 23% after 12, 38% after 24, and 71% after 57 months. Small intestinal length was found to be the primary predictor of wean. Notable predictors of time to wean included the amount of small intestine remaining (hazard ratio, 1.94 [95% CI, 1.45-2.58] per 20 cm of intestine; P < .001), entirety of care within our institution (3.27 [1.59-6.72]; P = .001), and intestinal lengthening procedure (0.19 [0.04-0.84]; P = .03).The majority of patients will wean from PN despite short intestinal length, likely as a result of new management strategies combined with a multidisciplinary team approach.
Draft of Clinton's health reform plan draws cheers, boos, polite applause
Authors: A. A. Skolnick
Journal: JAMA (1993)

NOT UNEXPECTEDLY, the preliminary draft of President Clinton's plan for reforming the nation's health care system—which was widely leaked nearly a week before the president officially presented the plan—drew mixed reactions. Although some health experts refrained from commenting on the draft until the president addressed Congress on September 22, others had a lot to say. "We think the president has done a good job and that he's off to a good start," says Robert Graham, MD, executive vice president, American Academy of Family Physicians, Kansas City, Mo. "We think that it is a very comprehensive and competent document and that it is exactly what is needed to initiate the debate in the Congress to get us a reform package. Like most groups, we don't necessarily agree with every approach and nuance of the proposed plan, but we will reserve our comments about specific strategies until we see the legislative specs."
Influence of diabetes mellitus on early and late clinical outcomes in saphenous vein graft stenting
Authors: Javed M Ahmed, Mun K Hong, Roxana Mehran, George Dangas, Gary S Mintz, Augusto D Pichard, Lowell F Satler, Kenneth M Kent, Hongsheng Wu, Gregg W Stone, Martin B Leon
Journal: Journal of the American College of Cardiology (2000)
Resistance Artery Mechanics, Structure, and Extracellular Components in Spontaneously Hypertensive Rats
Authors: Hope D. Intengan, Gaétan Thibault, Jin-Sheng Li, Ernesto L. Schiffrin
Journal: Circulation (1999)

Background —Altered vascular mechanics resulting from changes in collagen and integrins may influence resistance artery structure and function and, therefore, peripheral resistance and blood pressure in spontaneously hypertensive rats (SHR). Methods and Results —Effects of age, angiotensin-converting enzyme inhibition (fosinopril, 10 to 30 mg/kg per day), and AT 1 -receptor antagonism (irbesartan, 50 mg/kg per day) on vascular structure, mechanics, and composition were assessed in SHR. Systolic blood pressure was elevated in young SHR (130±2 mm Hg) compared with Wistar-Kyoto (WKY) rats (106±2 mm Hg). In adult SHR, the rise in systolic blood pressure (44±3 mm Hg) was blunted by fosinopril (18±1 mm Hg) and irbesartan (9±3 mm Hg). Lumen diameter of mesenteric resistance arteries was smaller and media/lumen ratio was greater in young and adult SHR versus WKY rats. Growth index was 24% in untreated adult SHR versus WKY rats; these values were −35% for fosinopril-treated and −29% for irbesartan-treated SHR versus untreated SHR. Isobaric wall stiffness was normal despite increased stiffness of wall components in adult SHR vessels. Irbesartan partially prevented stiffening of wall components in SHR. The collagen/elastin ratio was greater in adult SHR vessels (6.5±1.3) than in WKY (3.2±0.4) vessels. Expression of α v β 3 and α 5 β 1 integrins was increased in SHR aged 20 versus 6 weeks. Expression of α 5 β 1 integrins was lower in young SHR, and α v β 3 integrins were overexpressed in adult SHR versus WKY rats. Irbesartan and fosinopril attenuated differences in the collagen/elastin ratio and integrin expression. Conclusions —Wall components of mesenteric resistance arteries stiffen with age in SHR. Interrupting the renin-angiotensin system has normalizing effects on integrin expression and composition, stiffness, and growth of the arterial wall.
241. Gene Expression in the Striatum of HPRT Knockout Mice
Authors: Song Shaochun, Friedmann Theodore
Journal: Molecular Therapy (2005)

Mutations of the gene encoding the human purine biosynthetic enzyme hypoxanthine guanine ribosyltransferase (HPRT) result in the complex metabolic and neuro-behavioral Lesch Nyhan Disease. There is very little understanding of the molecular mechanisms responsible for the major CNS biochemical hallmark of the disorder in the human and in the HPRT knockout mouse |[ndash]| aberrant function of the dopamine pathway in the basal ganglia. To determine if secondary genetic aberrations may contribute to aspects of the neurological defects, we are examining global gene expression in the striatum of wild type and HPRT knockout mice, using the Affymetrix oligonucleotide microarray platform. To date, the most consistent and reproducible expression changes have have been found in several members of a gene family uncertain function with sequence similarity to phosphatidylserine decarboxylase (PSD). However, the phospholipid content and distribution in the striata of wild type and knockout mice are indistinguishable by thin layer chromatography and 31P-NMR. If further studies confirm a biochemical or molecular role of these aberrantly expressed genes in HPRT deficiency, such gene expression and related proteomic studies may indicate that the mechanisms of pathogenesis in this monogenic disease are multigenic and more complex than previously thought.
Two- and three-year results of the thrombolysis in myocardial infraction (TIMI) phaes II clinical trial
Authors: Michael L Terrin, David O Williams, Neal S Kleiman, MD Willerson, Hiltrud S Mueller, Patrice Desvigne-nickens, Sandra A Forman, Genell L Knatterud, Eugune Braunwald
Journal: Journal of the American College of Cardiology (1993)
Urinary metallothionein as an indicator of cadmium body burden and of cadmium-induced nephrotoxicity.
Authors: Z A Shaikh, C Tohyama
Journal: Environmental Health Perspectives (1984)

There is a need to identify specific biological indicator(s) of cadmium exposure so that the renal damage can be prevented. Towards this end, we have examined the usefulness of urinary metallothionein as an indicator of cadmium body burden. It is found that, in both animals and humans, urinary metallothionein level is related to the hepatic and renal cadmium burdens. Significant correlations are also found between the urinary metallothionein and urinary cadmium and beta 2-microglobulin. Furthermore, it is noted that cadmium-exposed individuals with renal dysfunction excrete significantly more metallothionein than those with normal renal function. Thus it appears that there is merit to include metallothionein among the clinical parameters monitored in cadmium-exposed individuals. More tests are needed to define a critical concentration of metallothionein in urine which is related to the onset of renal dysfunction.
Natriuretic Peptides, Heart, and Adipose Tissue: New Findings and Future Developments for Diabetes Research
Authors: Gabriella Gruden, Andrea Landi, Graziella Bruno
Journal: Diabetes Care (2014)

Natriuretic peptides (NPs) play a key role in cardiovascular homeostasis, counteracting the deleterious effects of volume and pressure overload and activating antibrotic and antihypertrophic pathways in the heart. N-terminal B-type NP (NT-proBNP) also is a promising biomarker of global cardiovascular risk in the general population, and there is increasing interest on its potential use in diabetic patients for screening of silent cardiovascular abnormalities, cardiovascular risk stratification, and guided intervention. Recently, both atrial NP (ANP) and B-type NP (BNP) have emerged as key mediators in the control of metabolic processes including the heart in the network of organs that regulate energy usage and metabolism. Epidemiological studies have shown that ANP and BNP are reduced in people with obesity, insulin resistance, and diabetes, and this deficiency may contribute to enhance their global cardiovascular risk. Moreover, ANP and BNP have receptors in the adipose tissue, enhance lipolysis and energy expenditure, and modulate adipokine release and food intake. Therefore, low ANP and BNP levels may be not only a consequence but also a cause of obesity, and recent prospective studies have shown that low levels of NT-proBNP and midregional proANP (MR-proANP) are a strong predictor of type 2 diabetes onset. Whether ANP and BNP supplementation may result in either cardiovascular or metabolic benefits in humans remains, however, to be established.
THE DISTRIBUTION IN THE SKIN OF SYSTEMICALLY ADMINISTERED TETRACYCLINE
Authors: R. MARKS, M. J. DAVIES
Journal: British Journal of Dermatology (1969)

SUMMARY. Tetracycline's property of fluorescence has been used to detect the presence of this drug within the epidermis after its injection into rats. Thick cryostat tissue sections were examined with a fluorescence microscope and fluorescence was demonstrated in the basal layer of the epidermis, in the hair follicle epithelium and in the sebaceous glands. There was patchy fluorescence in keratin in sections from the tails of the rats and it is suggested that tetracycline is also preferentially concentrated in parakeratotic areas. A similar distribution of fluorescence was seen in 2 biopsy specimens of lesions from patients with psoriasis treated with tetracycline. The mode of action of tetracycline in acne and rosacea is discussed.
"THE STATUS OF BLOOD TRANSFUSION"
Authors: Richard Lewisohn
Journal: JAMA (1923)

To  Editor:  —In an editorial on  status of blood transfusion (The Journal, September 29, p. 1114), discussing  citrate method of blood transfusion, it is stated that the added chemical also develops anticomplementary properties in  plasma, and reduces  phagocytic and opsonic powers of  blood. These facts would naturally argue against  use of  citrate method in  general infections when a resistance action is sought. The corpuscles are said to become more friable—a result particularly undesirable in combating certain forms of anemia.  These statements as to  action of sodium citrate on  blood are based on a paper by Unger (The Deleterious Effect of Sodium Citrate Employed in Blood Transfusion,The Journal, Dec. 31, 1921, p. 2107).  In order to correct  erroneous impression created by  editorial, as if this deleterious action of sodium citrate on  various constituents of  blood
Idiopathic pulmonary haemosiderosis revisited
Authors: O.C. Ioachimescu, S. Sieber, A. Kotch
Journal: European Respiratory Journal (2004)

Idiopathic pulmonary haemosiderosis is a rare cause of diffuse alveolar haemorrhage of unknown aetiology. It occurs most frequently in children, has a variable natural history with repetitive episodes of diffuse alveolar haemorrhage, and has been reported to have a high mortality. Many patients develop iron deficiency anaemia secondary to deposition of haemosiderin iron in the alveoli. Examination of sputum and bronchoalveolar lavage fluid can disclose haemosiderin-laden alveolar macrophages (siderophages), and the lung biopsy shows numerous siderophages in the alveoli, without any evidence of pulmonary vasculitis, nonspecific/granulomatous inflammation, or deposition of immunoglobulins. Contrary to earlier reports, corticosteroids alone or in combination with other immunosuppressive agents may be effective for either exacerbations or maintenance therapy of idiopathic pulmonary haemosiderosis.
Norepinephrine analog detects pheochromocytoma
Authors: Barbara Bolsen
Journal: JAMA (1982)

Investigators at the University of Michigan Medical School, Ann Arbor, have developed a radiopharmaceutical agent that permits the identification of pheochromocytomas—hypertension-causing tumors of the sympathetic autonomic nervous system—by scintigraphy. The drug,<sup>131</sup>I-metaiodobenzylguanadine (<sup>131</sup>I-MIBG), is structurally similar to the neurotransmitter norepinephrine and follows its pathway to the sympathetic nerves, according to James C. Sisson, MD, professor of internal medicine. "The drug is avidly taken up by sympathetic nervous tissue," Sisson said, but in greater concentrations by the tumors than by small nerves or the adrenal glands. Thus, "we see no normal tissues; we look only at pheochromocytomas." Using<sup>131</sup>I-MIBG and scintigraphy, Sisson and co-workers located the vascular tumors in all but three of 40 patients with difficult-to-locate lesions. In comparison, computed tomography (CT) successfully located tumors in fewer than half of the same group, Sisson said at a recent American Cancer Society seminar. Most pheochromocytomas are located in
Involving patients in a primary care research meeting worked well
Authors: W. R Phillips
Journal: BMJ (2003)

EDITOR—Patients rarely participate in the planning, conduct, or interpretation of medical research.1 2 We explored involving patients in a primary care research meeting, through the PARTNERS (Patients and Researchers Together at NAPCRG Evaluating Research Studies) project. We invited six patients to participate in the annual meeting of the North American primary care research group. They varied by age, sex, …
How Many Acute Beds Do We Really Need?
Authors: M. Wheeler
Journal: BMJ (1972)

At the end of 1972 two new "best-buy" district general hospitals should open at Bury St. Edmunds and Frimley, eventually serving their catchment areas at a ratio of two acute beds per 1,000 population. This study shows that one of these areas is already operating below this projected target as a result of a considerable decline in the bed ratio over the past decade. Drastic shortening of the average length of stay has permitted an increase in admission rates from 60 to 79 per 1,000 population over the decade, while costs per case measured at constant prices have fallen. These changes have taken place more rapidly than in the U.K. generally. The evidence points to the pattern of clinical management as the main reason for this and suggests that similar gains could be achieved on a national scale, even without waiting for new buildings and expanded community services.
Screening for hearing loss
Authors: A F Bisset
Journal: BMJ (1994)

EDITOR, - The National Deaf Children's Society launched its document Quality Standards in Paediatric Audiology at a one day conference on the early identification of hearing impairment in children.1 The conference was a tribute to the determination of this voluntary society to raise standards in screening of hearing but did not make clear that the standards cover only sensorineural hearing impairment. (Sensorineural hearing loss affects about 1-5/1000 …
Risk of malaria in British residents returning from malarious areas.
Authors: P A Phillips-Howard, A Radalowicz, J Mitchell, D J Bradley
Journal: BMJ (1990)

OBJECTIVES--To identify which British residents travelling abroad are at greatest risk of malaria infection, and to determine the efficacy of malaria chemoprophylaxis for preventing P falciparum infections in tropical Africa. DESIGN--Prospective cohort study (case-base linkage) with routine national surveillance systems. Denominators (base population) were obtained from monitoring a random sample of returning British travellers with the international passenger survey. Numerators (cases) were obtained from reports of malaria infections in British residents, through the Malaria Reference Laboratory network. SETTING--International passenger survey conducted at passport control of international airports in Britain. Malaria reports received nationally were collated centrally in London. SUBJECTS--2948 British residents (0.2%) returning to Britain in 1987 randomly selected and questioned and 1052 British residents with microscopically confirmed malaria infections in 1987, whose case reports were reviewed and on whom additional data were collected by postal survey. MAIN OUTCOME MEASURES--Annual incidence subdivided by categories of risk. Chemoprophylactic efficacy for east and west Africa by principal regimens and compliance. RESULTS--Annual rates of reported infection per 100,000 travellers to Oceania were 4100; to west and east Africa were 375 and 172 respectively; to Latin America, the Far East, and the Middle East were 12, 2, and 1 respectively. Immigrants visiting friends and relatives in Ghana and Nigeria were at greatest risk (1303 and 952 per 100,000 respectively) in west Africa. Business travellers to Kenya experienced the highest attack rates in east Africa (465 per 100,000). Age-sex specific attack rates varied by region. No prophylaxis was reported to have been used by 23% of British visitors to west Africa, 17% to east Africa, 46% to central or southern Africa, and 58% visiting south Asia. The efficacy of chloroquine plus proguanil against P falciparum infection was 73% and 54% in west and east Africa respectively. Lower values were obtained for chloroquine alone and proguanil alone. The efficacy of Maloprim (pyrimethamine-dapsone) was 61% in west Africa, but only 9% in east Africa. Visitors to west Africa who did not comply with their chemoprophylactic regimen were at a 2.5-fold higher risk of infection than fully compliant users. Non-compliant visitors to east Africa had similar rates of infection as non-drug users. CONCLUSIONS--In 1987 chloroquine plus proguanil was the preferred chemoprophylactic regimen for P falciparum infection in Africa; antimalarial drugs must be taken regularly to be effective.
Doctor who helped locate bin Laden family is sentenced to 33 years in jail
Authors: N. Hawkes
Journal: BMJ (2012)

Minimal short-term benefits with oral physostigmine have been reported in Alzheimer9s disease. We examined long-term oral physostigmine therapy in 14 patients with probable Alzheimer9s disease in an extended double-blind crossover trial in which they received physostigmine for five intervals of 4 to 6 weeks in length and placebo for one interval determined at random. At each interval a Selective Reminding Test was administered and three indexes were examined: total recall, long-term recall, and intrusions. As a group, patients9 memory test scores were significantly better during the drug period. Two patients who previously had performed worse on drug than on placebo in a short-term trial continued to do so. Nine of the remaining 12 patients performed better on two or more measures on physostigmine compared with placebo. In some cases scores improved up to 50% over placebo values. This improvement was not predicted by response to medication in the earlier short-term trial. Seven patients completed an additional six-interval crossover trial. All but one continued to have improved performance with oral physostigmine and, in grouped data, memory measures remained significantly improved. These results suggest that long-term administration of physostigmine in Alzheimer9s disease may be more effective than short-term. This benefit can be sustained for up to a year in some patients.