tbuckley/cabot-search huggingface dataset:
Role of cholinesterase inhibitors in dementia care: NICE's economic analysis has limitations
Authors: Richard J Phillips, Nick Bosanquet
Journal: BMJ (2006)

A prescription for better prescribing Medical education is a continuumEditor-The editorial by Aronson et al raises important concerns about the preparedness of newly qualified doctors to prescribe safely and effectively, but fails to provide evidence to support the claims that are made. 1 Importantly, the authors assume that the number of curricular hours equates to learning.The General Medical Council issues and regularly updates requirements for the content and outcomes of undergraduate medical education and the first foundation year.We deliberately do not tell medical schools how many hours must be spent on a particular subject: it is the acquisition of our learning objectives that is important.Medical education is a continuum.With respect to prescribing, as with so many other areas of medical education, we expect principles to be learnt and understood at medical school and then put into practice, under supervision, during the F1 year.Our requirements are laid out clearly in Tomorrow's Doctors and The New Doctor and include very clear expectations about the quality and extent of knowledge about the safe and effective use of drugs.Despite the strength of views expressed in the editorial, the authors have not presented robust and generally applicable evidence to show serious inadequacies in the learning of clinical pharmacology in the undergraduate medical curriculum.We look forward, however, to engaging with all interested parties to clarify the issues surrounding this very important subject.
Central insulin action regulates peripheral glucose and fat metabolism in mice
Authors: Linda Koch, F. Thomas Wunderlich, Jost Seibler, A. Christine Könner, Brigitte Hampel, Sigrid Irlenbusch, Georg Brabant, C. Ronald Kahn, Frieder Schwenk, Jens C. Brüning
Journal: Journal of Clinical Investigation (2008)

Insulin resistance is a hallmark of type 2 diabetes, and many insights into the functions of insulin have been gained through the study of mice lacking the IR. To gain a better understanding of the role of insulin action in the brain versus peripheral tissues, we created 2 mouse models with inducible IR inactivation, 1 in all tissues including brain (IRDeltawb), and 1 restricted to peripheral tissues (IRDeltaper). While downregulation of IR expression resulted in severe hyperinsulinemia in both models, hyperglycemia was more pronounced in IRDeltawb mice. Both strains displayed a dramatic upregulation of hepatic leptin receptor expression, while only IRDeltaper mice displayed increased hepatic Stat3 phosphorylation and Il6 expression. Despite a similar reduction in IR expression in white adipose tissue (WAT) mass in both models, IRDeltawb mice had a more pronounced reduction in WAT mass and severe hypoleptinemia. Leptin replacement restored hepatic Stat3 phosphorylation and normalized glucose metabolism in these mice, indicating that alterations in glucose metabolism occur largely as a consequence of lipoathrophy upon body-wide IR deletion. Moreover, chronic intracerebroventricular insulin treatment of control mice increased fat mass, fat cell size, and adipose tissue lipoprotein lipase expression, indicating that CNS insulin action promotes lipogenesis. These studies demonstrate that central insulin action plays an important role in regulating WAT mass and glucose metabolism via hepatic Stat3 activation.
FGF-8 in the ventral pharynx alters development of myocardial calcium transients after neural crest ablation
Authors: Michael J. Farrell, Jarrett L. Burch, Kathleen Wallis, Linda Rowley, Donna Kumiski, Harriet Stadt, Robert E. Godt, Tony L. Creazzo, Margaret L. Kirby
Journal: Journal of Clinical Investigation (2001)

Cardiac neural crest ablation results in depressed myocardial calcium transients and elevated proliferation in myocardium at a stage when cardiac neural crest cells are not in contact with the myocardium. To test the hypothesis that cardiac neural crest–derived cells, which migrate into the caudal, ventral pharynx at stage 14, block a signal from the ventral pharynx, we cultured stage 12 chick heart tube or myocardial strips in the presence or absence of ventral pharynx. We found that myocardium cultured with ventral pharynx that had not yet contacted neural crest cells had significantly reduced calcium transients and an increased rate of proliferation. Ventral pharynx from intact embryos at a stage when neural crest–derived cells had reached the pharynx had no effect on myocardial calcium transients. Ventral pharynx from neural crest–ablated embryos continued to suppress myocardial calcium transients at this later stage. Myocardium cultured with FGF-2 also showed a significant reduction in calcium transients. An FGF-2–neutralizing Ab reversed the deleterious effect of the ventral pharynx on myocardial calcium transients and proliferation. We therefore examined the expression of FGF-2 and similar FGFs in the ventral pharynx. Only FGF-8 was expressed in a temporospatial pattern that made it a viable candidate for altering the myocardial calcium transient during stages 14–18. In explant cultures, neutralizing Ab for FGF-8 rescued development of the myocardial calcium transient in neural crest–ablated chick embryos.
Abrupt Withdrawal of Cardiovascular Drugs
Authors: John G. Gerber, Alan S. Nies
Journal: New England Journal of Medicine (1979)

The human body adapts remarkably to environmental insults and maintains its status quo. This adaptability is especially apparent in the cardiovascular reflexes that maintain arterial pressure. Pressure-sensitive receptors are strategically located in the vasculature of vital organs, such as the brain and the kidney, and are ready to be activated when compensatory mechanisms are necessary to return perfusion pressure to normal. Thus, when blood pressure declines, the carotid sinus signals the brain to activate the sympathetic nervous system and to deactivate the parasympathetic nervous system, in an attempt to increase cardiac output and peripheral vascular resistance, thereby restoring the blood . . .
Tc-99m MDP Uptake in Retroperitoneal Malignant Peripheral Nerve Sheath Tumor and Its Metastases
Authors: Lin Li, Anren Kuang, Shaoqun Sheng
Journal: Clinical Nuclear Medicine (2005)

Extraosseous uptake of Tc-99m MDP has been reported in various pathologic conditions. Because of the opportunity of make an additional diagnosis, extraskeletal distribution of tracer should be inspected in every case. Malignant peripheral nerve sheath tumor (MPNST) is a rare type of neurogenic tumor. Its main clinical manifestation is a mass with or without pain. MPNST can be seen in all 4 extremities, the trunk, head and neck regions, but most commonly occur in the thigh, buttocks, and supraclavicular regions. Presented here is a rare case of MPNST in which Tc-99m MDP uptake by the primary lesion and metastases were clearly demonstrated on bone scintigraphy.
Uterine Fibroids.—A Correction.
Authors: Franklin H. Martin
Journal: JAMA (1893)

<h3>To the Editor:</h3> —In my letter in theJournalof Dec. 23, 1893, two errors occur, caused by carelessness in copying the original manuscript. The errors are important, inasmuch as they involve dates which make my articles appear as having been published subsequent to Profs. Gottschalk's and Küstner's, when in fact my articles were published several months before theirs. My letter makes Prof Küstner's article in the<i>Centralblatt f Gynäkologie</i>appear Aug. 19, 1892, when the date should have been Aug. 19, 1893, and Prof. Gottschalk's article which reads in the letter Sept. 30, 1892, should have been Sept. 30,1893. Yours very truly,
Transesophageal Intrahepatic Portosystemic Shunts Compared with Sclerotherapy
Authors: Arun J. Sanyal
Journal: Annals of Internal Medicine (1998)

Letters1 January 1998Transesophageal Intrahepatic Portosystemic Shunts Compared with SclerotherapyArun J. Sanyal, MDArun J. Sanyal, MDMedical College of Virginia; Richmond, VA 23298Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-1-199801010-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Granados and colleagues and Dr. Owens for their interest in our work. They raise several important issues. We agree with Dr. Owens that Doppler ultrasonography is not as sensitive as angiography for the detection of stent stenosis. In 1991, when our study begin, almost nothing was known about the natural history of portal hypertension after TIPS creation. As reported in our paper, we therefore did Doppler ultrasonography 1 and 7 days after TIPS and 1 month and every 3 months thereafter. Angiography was performed every 6 months or if clinical ultrasonographic evidence of recurrent portal hypertension ...References1. Sanyal AJ, Freedman AM, Luketic VA, Purdum PP 3d, Shiffman ML, De Meo J, et al. The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts. Gastroenterology. 1997; 112:889-98. Google Scholar2. Sanyal AJ, Freedman AM, Purdum PP, Shiffman ML, Tisnado J, Cole PE. Transjugular intrahepatic portosystemic shunts for patients with active variceal hemorrhage unresponsive to sclerotherapy. Gastroenterology. 1996; 111:138-46. Google Scholar Author, Article, and Disclosure InformationAffiliations: Medical College of Virginia; Richmond, VA 23298 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 January 1998Volume 128, Issue 1Page: 72KeywordsAngiographyHemorrhagePortal hypertensionSalvage antiretroviral therapySepsisSpecificityStenosisStent implantationSurgeryUltrasound imaging Issue Published: 1 January 1998 CopyrightCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
It takes two to tango: mast cell and Schwann cell interactions in neurofibromas
Authors: David H. Viskochil
Journal: Journal of Clinical Investigation (2003)

Neurofibromas are benign tumors comprised primarily of Schwann cells and fibroblasts. Mast cell infiltration is a well-known phenomenon; however, their role in tumor pathogenesis has been enigmatic. In an elegant set of experiments using cells derived from a murine model of neurofibromatosis 1 (NF1), Yang et al. dissect the molecular pathways involved in mast cell migration to neurofibromin-deficient Schwann cells. These results set the stage for rational development of therapeutics that could influence the multicellular microenvironment of neurofibromas to inhibit the development and/or progression of these tumors in human NF
Time to show unity against SARS
Authors: D. Chao
Journal: BMJ (2003)

At the time of writing, more than a thousand people in Hong Kong have so far developed severe acute respiratory syndrome (SARS). About 20% of patients have been discharged from hospitals; about 3% have died. Most of the deaths have been of people with a history of chronic diseases or those who sought treatment at a relatively late stage of infection. There are estimates that about 15% of affected patients might need intensive care. A number of frontline healthcare professionals, including doctors and nurses, have already been infected.

Not only does SARS affect the patients and their relatives, but also everyone in the street and at home. Wearing masks, frequent handwashing, and avoiding crowded places have all become part of our daily routines.

The sudden demand arising from SARS is testing the healthcare system—from prevention …
A Case of Chronic Membranous Colitis of over Ten Years' duration Cured by Right Inguinal Colotomy and Subsequent Closure of the Artificial Anus
Authors: J. Macpherson
Journal: BMJ (1898)

CASES in which membranous colitis has been treated by colotomy are sufficiently rare to induce me to record the following.It was only while looking up the literature of the subject for this purpose that I discovered I was not the first to carry out this treatment:
Metabolism of 125I-labelled trypsin in man: evidence of recirculation.
Authors: G Lake-Bakaar, C E Rubio, S McKavanagh, B J Potter, J A Summerfield
Journal: Gut (1980)

125I-labelled human trypsin metabolism has been investigated in man. Three subjects received 125I-trypsin and 131I-albumin intravenously. Against a background secretin infusion (1 U/kg/h), trypsin decayed biexponentially from the serum with half-lives of 17.5, 21, and 24 minutes for the rapid disappearance phase and 520, 540, and 560 minutes for the slow phase. Between 13% and 38% of the 125I injected was recovered from duodenal juice aspirated continously over 300 minutes. In contrast, less than 1% of the 131I-albumin injected was recovered. When bile and pure pancreatic juice were collected at endoscopic retrograde cholangiopancreatography after intravenous 125I-trypsin in a fourth subject 125I radioactivity was found to be secreted via both these routes. After 125I-trypsin infusion into the duodenum 11% of the total dose was found to be present in the circulation after 75 minutes. These results support the concept that recirculation of trypsin exists in man.
NICE Work — Providing Guidance to the British National Health Service
Authors: Michael D Rawlins
Journal: New England Journal of Medicine (2004)

When the British National Health Service (NHS) was established in 1947, its clinical standards were aligned with those of individual clinicians and their professional organizations. If the emerging NHS had tried to challenge the traditional freedom of clinicians, the medical profession would have walked away from it.Almost 60 years later, however, attitudes have changed. Medical practice based on evidence, rather than on anecdote and opinion, has gained credence. Yet studies during the 1990s showed that the results of clinical research were poorly incorporated into routine care and that inappropriate variations in the standards of clinical practice abounded, in the . . .
Adolescents Who Attempt Suicide
Authors: Joan Kaufman
Journal: JAMA (1991)

To the Editor.—  The article Adolescent Suicide Attempters: Response to Suicide-Prevention Programs, by Shaffer et al 1 has received considerable public attention. Problems in the selection of outcome measures, however, limit the use of research findings for prevention planning purposes.  The aims of the study were to determine (1) whether there was a high-risk group of children with distorted attitudes about suicide; (2) if the intervention was effective for the group in greatest need; and (3) if exposure to the program led to distress or imitation of behavior in students who had not previously attempted suicide, with imitation expected to occur most often among symptomatic adolescents.  The first goal of the study was achieved. A number of adolescents were identified who had made previous suicide attempts, and these students also reported distorted attitudes regarding suicide. However, firm conclusions cannot be drawn concerning the latter two goals of the study. Findings
USEFULNESS OF INTRAVASCULAR ULTRASOUND IN FEMORO-POPLITEAL STENTING FOR TASC II CLASS A TO C LESIONS IN PERIPHERAL ARTERIAL DISEASE
Authors: Osamu iida, Yoshimitsu Soga, Kenji Suzuki, keisuke hirano, Daizo Kawasaki, Yoshiaki Shintani, Nobuhiro Suematsu, Terutoshi Yamaoka, Masaaki Uematsu
Journal: Journal of the American College of Cardiology (2014)
ROENTGENOGRAPHIC BONE CHANGES IN A SECOND CASE OF OLD POLIOMYELITIS
Authors: George B. Hassin
Journal: JAMA (1925)

In a case of an old poliomyelitis reported by one of us, 1 the bones of the lower extremities exhibited changes that almost paralleled those in the peripheral nerves and muscles involved. The paralysis in that case was of thirty-seven years' duration. In a second case here recorded, the duration of the paralysis was fifty-nine years and affected only one lower extremity.  REPORT OF CASE  History.  —A man, aged 61, was admitted to the neurologic service (Dr. Hassin), March 2, 1925, on account of a left sided hemiplegia and weakness in the right lower extremity. He had been a patient of Cook County Hospital in 1918, suffering from weakness and numbness in the right upper extremity. After six weeks he was discharged and was in his usual health until four days prior to his second admission to the hospital, when he suffered an apoplectic stroke.  His mother told him that
Efficacy and Safety of Apixaban Compared With Warfarin at Different Levels of Predicted International Normalized Ratio Control for Stroke Prevention in Atrial Fibrillation
Authors: Lars Wallentin, Renato D. Lopes, Michael Hanna, Laine Thomas, Anne Hellkamp, Sunil Nepal, Elaine M. Hylek, Sana M. Al-Khatib, John H. Alexander, Marco Alings, John Amerena, Jack Ansell, Philip Aylward, Jozef Bartunek, Patrick Commerford, Raffaele De Caterina, Cetin Erol, Veli-Pekka Harjola, Claes Held, John D. Horowitz, Kurt Huber, Steen Husted, Matyas Keltai, Fernando Lanas, Liu Lisheng, John J.V. McMurray, Byung-Hee Oh, Mårten Rosenqvist, Witold Ruzyllo, Philippe Gabriel Steg, Dragos Vinereanu, Denis Xavier, Christopher B. Granger
Journal: Circulation (2013)

Background— In the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial, apixaban compared with warfarin reduced stroke and systemic embolism, major bleeding, and mortality. We evaluated treatment effects in relation to 2 predictions of time in therapeutic range (TTR). Methods and Results— The trial randomized 18 201 patients with atrial fibrillation to apixaban 5 mg twice daily or warfarin for at least 12 months. For each patient, a center average TTR was estimated with the use of a linear mixed model on the basis of the real TTRs in its warfarin-treated patients, with a fixed effect for country and random effect for center. For each patient, an individual TTR was also predicted with the use of a linear mixed effects model including patient characteristics as well. Median center average TTR was 66% (interquartile limits, 61% and 71%). Rates of stroke or systemic embolism, major bleeding, and mortality were consistently lower with apixaban than with warfarin across center average TTR and individual TTR quartiles. In the lowest and highest center average TTR quartiles, hazard ratios for stroke or systemic embolism were 0.73 (95% confidence interval [CI], 0.53–1.00) and 0.88 (95% CI, 0.57–1.35) ( P interaction =0.078), for mortality were 0.91 (95% CI, 0.74–1.13) and 0.91 (95% CI, 0.71–1.16) ( P interaction =0.34), and for major bleeding were 0.50 (95% CI, 0.36–0.70) and 0.75 (95% CI, 0.58–0.97) ( P interaction =0.095), respectively. Similar results were seen for quartiles of individual TTR. Conclusions— The benefits of apixaban compared with warfarin for stroke or systemic embolism, bleeding, and mortality appear similar across the range of centers’ and patients’ predicted quality of international normalized ratio control. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00412984.
Legal Protection of Life of Unborn and Newly Born
Authors: G. L. Williams
Journal: BMJ (1964)

to a deformed child.Fortunately two more cases have occurred since, Bergmann and Ferguson,4 and Newton,' as a result of which it is now confirmed beyond doubt that thera- peutic abortion is justifiable legally if it is carried out " in good faith for the purposes of preserving the life or health of the woman.When I say health I mean not only her physical health but also her mental health " (Ashworth J. in Newton).>The most aston- ishing fact of all is that neither of these later cases was officially reported, in spite of pleas entered in legal journals6 ' at the time.Need- less to say, they were fully and accurately reported in the British Medical 7ournal, but lawyers cannot be expected to look for their law in a medical journal, however eminent.-Iam, etc.,
Estimating the effects of toxicants on ecosystem services.
Authors: J Cairns, B R Niederlehner
Journal: Environmental Health Perspectives (1994)

Numerous functions of ecosystems are essential to the quality of human life, including the provision of food, the decomposition of sewage, the provision of portable water, and the replacement of breathable air. Although attributes of ecosystems directly of use to human societies are not the only ones worth protecting, emphasizing their services may be the most effective means of communicating risks of toxicants to the general public. However, although spatial and temporal scales of experiments to assess risk vary relatively little, actual spatial scales vary considerably, from local environments to global ecosystems. Generally, models are used to bridge these gaps in scale. In this paper, we examine ways in which toxicity test endpoints have been developed to describe effects of pollutants on essential ecosystem functions and the ways in which results are then extrapolated to scales that risk managers can use.
Undulant Fever in Connecticut with Reports of Three Cases
Authors: T. P. MURDOCK
Journal: Annals of Internal Medicine (1928)

Article1 December 1928Undulant Fever in Connecticut with Reports of Three CasesT. P. MURDOCK, M.D., F.A.C.P., W. E. HALL, M.D.T. P. MURDOCK, M.D., F.A.C.P.Search for more papers by this author, W. E. HALL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-2-6-545 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptUndulant fever, known also as Malta fever, Mediterranean fever, and Gibraltar fever, is characterized by continued fever, or fever with short remissions and relapses, neuralgic pains, joint swelling, orchitis, and profuse perspiration.DISTRIBUTIONText books state that undulant fever has not been reported north of latitude 45°N. or south of 40°S. latitude. It is known to have occurred in every part of the island of Malta.Orr and Huddleson (1) have reported sixteen cases of undulant fever occurring in Michigan from June 1926 to October 1927. Cases of undulant fever due to theBacillus abortushave been reported in New...Bibliography(1) ORRHUDDLESON PFIF: An epidemiological study of Undulant Fever in Michigan, Amer. Journal of Public Health, 1927, xvii:1242. CrossrefGoogle Scholar(2) CARPENTER CM: Undulant Fever from Brucella Abortus. J.A.M.A., 1926, lxxxvii:16. Google Scholar(3) KEEFER CS: Report of a case of Malta Fever originating in Baltimore, Maryland. Johns Hopkins Bulletin, 1924, xxxv:6. Google Scholar(4) SENSENICHGIORDANO RLAS: Brucella abortus infection. J.A.M.A., 1928, xc:22. Google Scholar(5) Personal communication from the Connecticut State Board of Health. Google Scholar(6) EVANS AC: Malta Fever, Public Health Reports, 1924, vol. xxxix. Google Scholar(7) MCALPINEMICKLE JGFL: Bacterium abortus infection in man. American Journal of Public Health, 1928, xviii:5609. Google Scholar(8) OLIVERMASOT DM: On the diagnosis of Malta Fever by the intradermal reaction. Marseille Med., 1924, lxi:1206-1211. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: T. P. MURDOCK, M.D., F.A.C.P.; W. E. HALL, M.D.Affiliations: Meriden, Connecticut PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byUndulant Fever in the United States*GEORGE BLUMER 1 December 1928Volume 2, Issue 6Page: 545-549KeywordsArthralgiaBacillusFeversInflammationOrchitisSweat ePublished: 1 December 2008 Issue Published: 1 December 1928 PDF downloadLoading ...