tbuckley/cabot-search huggingface dataset:
Implications of the EU directive on clinical trials for emergency medicine
Authors: E. A Singer
Journal: BMJ (2002)

A laudable attempt by the European Union to implement good clinical practice in the conduct of clinical trials on drugs for human use will, unless amended, make impossible a range of potentially life saving studies after May 2004.

Directive 2001/20/EC, adopted in April last year, is an important and comprehensive document.1 It is a cornerstone of a Europe-wide harmonisation of the provisions governing clinical trials and can be expected to foster and facilitate multinational clinical research. It will be adopted by member states before 1 May 2003, and its provisions will be applied from 1 May 2004 at the latest.

Several articles in the directive deal with the protection of clinical trial subjects. Article 5 outlines the conditions for research in incapacitated patients unable to give informed consent. The article, however, is framed to address the needs of individuals who are incapacitated for long periods, many even permanently. A clinical trial can only be done if “informed consent of the legal representative has been obtained.” …
Myocardial structure in patients with exercise-induced ischemia.
Authors: O M Hess, J Schneider, H Nonogi, J D Carroll, K Schneider, M Turina, H P Krayenbuehl
Journal: Circulation (1988)

Myocardial structure of left ventricular segments with recurrent myocardial ischemia was evaluated by morphometry and compared with that of segments with normal blood supply in 15 patients with exercise-induced myocardial ischemia. Left ventricular high-fidelity pressure measurements and simultaneous biplane angiocardiography were performed in patients at rest and during supine bicycle exercise. Left ventricular transmural biopsy samples were obtained during open heart surgery in a normally contracting region and in a region with exercise-induced de novo wall motion abnormalities. Transmural and endocardial and epicardial left ventricular muscle fiber diameter and interstitial nonmuscular tissue were determined by morphometry. Eight patients were restudied 8 months after successful bypass grafting. Heart rate and left ventricular end-diastolic pressure increased significantly preoperatively and postoperatively during exercise. However, left ventricular end-diastolic pressure was significantly higher preoperatively (33 mm Hg) during exercise than postoperatively (19 mm Hg; p less than .01). Left ventricular ejection fraction dropped significantly during exercise (63% vs 54%; p less than .001) before surgery but remained unchanged (64% vs 66%; NS) after revascularization. Regional axis shortening of the normokinetic region increased slightly during exercise pre- and postoperatively, but decreased in the hypokinetic region from 42% at rest to 25% during exercise (p less than .001) before surgery and from 47% at rest to 41% during exercise (p less than .05) after revascularization. Transmural muscle fiber diameter (normal less than or equal to 23 microns) was significantly larger in regions with exercise-induced ischemia (29.3 microns, p less than .025) than in normally contracting regions (27.3 microns). Interstitial nonmuscular tissue (normal less than or equal to 10%) was significantly increased in regions with exercise-induced wall motion abnormalities (19.8%) compared with normally contracting regions (15.5%; p less than .05). In the endocardial half of left ventricular segments with recurrent myocardial ischemia interstitial tissue was significantly increased (23.7%; p less than .01) compared with that in the epicardial half of the same segment (17.5%). It is concluded that structural alterations of the myocardium (muscle fiber hypertrophy and increased interstitial nonmuscular tissue) develop especially in the endocardial layers of the transiently ischemic myocardium with normal function at rest.(ABSTRACT TRUNCATED AT 400 WORDS)
Early heart failure as a cause of growth and tissue disorders in children with congenital heart disease.
Authors: D Baum, R Beck, A Kodama, B Brown
Journal: Circulation (1980)

Height, weight, total body fat, lean body mass, size of fat cells and total number of lipid-containing fat cells were compared in two groups of children, ages 2-6 years, with congenital heart disease. Twelve children who developed heart failure in infancy made up one group and 14 asymptomatic patients made up the other. No patient was cyanotic or had undergone surgical repair. Patients with heart failure were shorter and lighter than asymptomatic patients. Whereas both fat and lean tissues were less in the heart failure group, reduction in body fat was more important in producing underweight. Although there was no difference in the size of fat cells, the number of lipid-laden fat cells was diminished in the children who had early heart failure. Thus hypocellularity of fat cells appeared to be the major determinant of diminished body fat with heart failure. Because shortness and decreased lean tissue were associated with these adipose tissue abnormalities, it is likely that widespread changes are caused by early heart failure. As previously reported with hypoxemia, the early development of heart failure seems to produce tissue changes that handicap growth.
Vertical gradients of lung density in healthy supine men.
Authors: A B Millar, D M Denison
Journal: Thorax (1989)

Computed tomography was used to determine the vertical gradient of physical density in peripheral lung tissue of 12 healthy supine subjects, at total lung capacity and residual volume. At total lung capacity the mean (SD) density of peripheral lung tissue at the level of the mid right atrium was 0.0715 (0.017) g/cm3 and the vertical gradient of density was slight. At residual volume the density of peripheral tissue at the same level was 0.272 (0.067) g/cm3 and the vertical density gradient was curvilinear and more pronounced. Predictions of the gradient at residual volume were made on the basis of the known compliance of the lung and measured effects were attributed to the action of gravity on blood vessel distensibility at total lung capacity. These predictions agreed closely with the actual density gradient measured at residual volume and provide a basis for forecasting the vertical density gradient that would exist in healthy lungs at any degree of inflation. Departure from these gradients would imply local abnormalities of lung compliance, distribution of mechanical stress, or distensibility of vessels.
Hideo Nishimura, MD
Authors: Sey Nishimura
Journal: JAMA (1996)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
The neuropsychology of schizophrenia
Authors: J. A. Gray, J. Feldon, J. N. P. Rawlins, D. R. Hemsley, A. D. Smith
Journal: Behavioral and Brain Sciences (1991)

Abstract A model is proposed for integrating the neural and cognitive aspects of the positive symptoms of acute schizophrenia, using evidence from postmortem neuropathology and neurochemistry, clinical and preclinical studies of dopaminergic neurotransmission, anatomical connections between the limbic system and basal ganglia, attentional and other cognitive abnormalities underlying the positive symptoms of schizophrenia, specific animal models of some of these abnormalities, and previous attempts to model the cognitive functions of the septohippocampal system and the motor functions of the basal ganglia. Anatomically, the model emphasises the projections from the septohippocampal system, via the subiculum, and the amygdala to nucleus accumbens, and their interaction with the ascending dopaminergic projection to the accumbens. Psychologically, the model emphasises a failure in acute schizophrenia to integrate stored memories of past regularities of perceptual input with ongoing motor programs in the control of current perception. A number of recent experiments that offer support for the model are briefly described, including anatomical studies of limbic-striatal connections, studies in the rat of the effects of damage to these connections, and of the effects of amphetamine and neuroleptics, on the partial reinforcement extinction effect, latent inhibition and the Kamin blocking effect; and studies of the latter two phenomena in acute and chronic schizophrenics.
Physicians' Perspectives on Caring for Patients in the United States, Canada, and West Germany
Authors: Robert J. Blendon, Karen Donelan, Robert Leitman, Arnold Epstein, Joel C. Cantor, Alan B. Cohen, Ian Morrison, Thomas Moloney, Christian Koeck, Samuel W. Levitt
Journal: New England Journal of Medicine (1993)

The United States is considering enacting a national health plan and global health care budget similar to those in other countries. There are few data on the effects of such policies on physicians and patients.
Hepatocyte Growth Factor Ameliorates the Progression of Experimental Autoimmune Myocarditis
Authors: Hideki Futamatsu, Jun-ichi Suzuki, Shinya Mizuno, Noritaka Koga, Susumu Adachi, Hisanori Kosuge, Yasuhiro Maejima, Kenzo Hirao, Toshikazu Nakamura, Mitsuaki Isobe
Journal: Circulation Research (2005)

Hepatocyte growth factor (HGF) plays a role in cell protection, antiapoptosis, antifibrosis, and angiogenesis. However, the role of HGF in the immune system is not well defined. We examined the influence of HGF on T cells and the effects of HGF therapy in acute myocarditis. Lewis rats were immunized on day 0 with cardiac myosin to establish experimental autoimmune myocarditis (EAM). Human HGF gene with hemagglutinating virus of the Japan-envelope vector was injected directly into the myocardium on day 0 or on day 14 (two groups of treated rats). Rats were killed on day 21. Expression of c-Met/HGF receptor in splenocytes and myocardial infiltrating cells was confirmed by immunohistochemical staining or FACS analysis. Myocarditis-affected areas were smaller in the treated rats than in control rats. Cardiac function in the treated rats was markedly improved. An antigen-specific T cell proliferation assay was done with CD4-positive T cells isolated from control rats stimulated with cardiac myosin. HGF suppressed T cell proliferation and production of IFN-gamma and increased production of IL-4 and IL-10 secreted from CD4-positive T cells in vitro. Additionally, TUNEL assay revealed that HGF reduced apoptosis in cardiomyocytes. HGF reduced the severity of EAM by inducing T helper 2 cytokines and suppressing apoptosis of cardiomyocytes. HGF has potential as a new therapy for myocarditis.
How to define remission in ankylosing spondylitis?
Authors: Joachim Sieper
Journal: Annals of the Rheumatic Diseases (2012)

The new term axial spondyloarthritis (SpA) covers both patients with ankylosing spondylitis (AS) according to the modified New York criteria, for which the presence of radiographic sacroiliitis is mandatory, and patients with non-radiographic axial disease. The latter group can be defined either by the presence of active inflammatory sacroiliitis on MRI or by the presence of clinical parameters in addition to a positive human leucocyte antigen-B27 testing. This classification according to the new ‘Assessment in SpondyloArthritis international Society’ (ASAS) criteria1 allows an earlier diagnosis of these patients before chronic changes visible by x-ray examination have already occurred. The question of remission should therefore be discussed for the whole group of patients with axial SpA, especially because remission might be reached more easily if patients are treated earlier.

Remission can be divided into (1) clinical remission; (2) absence of objective inflammation such as a raised C-reactive protein (CRP) or active inflammation on MRI shown on a short τ inversion recovery (STIR) sequence; (3) reaching normal function; (4) prevention of (further) structural damage and (5) remission of extra-articular manifestations/associated diseases such as uveitis, psoriasis or inflammatory bowel disease (IBD).

Several clinical scores are available for the measurement of clinical activity. The ‘Bath Ankylosing Spondylitis Disease Activity Index’ (BASDAI)2 grades fatigue, back pain, swelling/pain of peripheral joints and morning stiffness on a mean scale between 0 and 10 (or between 0 and 100). Although the BASDAI is widely used in clinical practice, no remission criteria have been defined for this index. However, the ASAS group defined clinical remission criteria in 2001 using the domains patient global, patient pain, function (applying the Bath Ankylosing Spondylitis Functional Index, BASFI) and inflammation (using the two morning stiffness questions from the BASDAI). Clinical remission is reached when the score for each of the four domains …
412. A Novel Friedreich's Ataxia Model and In Vivo Gene Rescue Using HSV-1 Amplicon Vectors in Transgenic Mice
Authors: Filip Lim, Gloria Palomo, Christina Mauritz, Alfredo Gimenez, Belen Illana, Francisco Wandosell, Javier Diaz-Nido
Journal: Molecular Therapy (2006)

There is currently no effective cure or treatment for Friedreich's ataxia (FA), the most common of the hereditary ataxias. The disease is caused by mutations in FRDA, the frataxin gene, which result in drastically reduced expression levels. In whole animal models, one of the key difficulties in mimicking the human disease is obtaining the precise levels of frataxin expression with the appropriate tissue distribution to provoke pathology but not result in lethality. In order to develop strategies to circumvent these problems, conditional (floxed) frataxin transgenic mice have been generated by the laboratory of Helene Puccio and Michel Koenig (Strassbourg). We have generated CRE-expressing HSV-1 amplicon vectors and present results showing loss of frataxin protein levels in neurons from these loxP[frda] mice infected by these vectors. Using stereotactic injection, we have also achieved in vivo delivery of these CRE-expressing vectors into the olivocerebellar circuit of loxP[frda] mice to generate a localised gene knockout model. These mice develop a behavioural deficit in the rotarod assay detectable after 4 weeks, and with a stable difference with respect to lacZ vector-injected control mice up to the latest time point measured (16 weeks). We have also generated viral vectors expressing human frataxin cDNA and present results showing correction of this ataxic phenotype in our novel FA model. When frataxin-expressing vectors were injected into mice rendered ataxic 4 weeks previously, behavioural recovery was detectable as soon as 4 weeks after the second injection and with a stable difference up to 12 weeks with respect to mice re-injected with lacZ vector. Our novel FA mouse model and our successful in vivo gene rescue strategy will serve to rapidly and specifically address the neurological aspects of this neurodegenerative disease, both in understanding the pathogenic mechanisms as well as developing therapies.
On the Comparative Immunity from Small-Pox of those Who have been under the Influence of Cow-Pox
Authors: G. Rigden
Journal: BMJ (1857)

retisicitation by the plan of the late Dr. Mnrshall Hall, so mmInv cc '1;As have now been c recorled, that it seems almtiost necc\ns.t-y to apologise for reportingr anyv more.Yet, on 't sattOlr of suichi inpUrtance, it were well that we slhouil(l not entirciv avoid its discussion unritil the puiblic are fully acquainted witlh ti scientific principles on which the " readty nie-tllod" is fountde;(d, aiol everyv iman and wvominn prepared to exercise the p1ysician,'s fuinctionl in the revivifying of an unifortuinate fellow- creatre w1ho, from sonme inauspicious circumstance, nmay have falleni ijuto a state of suspen(led aniimation.Thon-lih the lready metlhod" will not always he attenled with suedc'sg;, it may fairly lie considered the hest and simplest of all ktovn means for reliudling the vital spark, and the facilitv of its applicationk waill renlder its adoption universal, whleni t'e public coIm1e to uinderstanid and appreciate the discovery.It o-curred to me the other day.wlhile attending the third case.to be hereafter mentioned, to give a little clinic to the nuirses in attendance; and if the like were done by, our asso- ciates and miedcical b,retlhren in general at every av-ailable op- portuttitV, there would soonA be a largc section of the com- munity conipetent to act in anyi-emergency.Rl'ecentl-, a little child was (dtowned in a pond in this nleiglhbourl-hoo(l.Assist- ance was immiii-lediately sought; the body was recovered, and takenl lhonme as dead: an(u who will venture to assert that the pulsation of its heart might not have been re-established, its parents saved the mourning of so untimely and unnatural a death, andL the coroner cheated of his fee, hadl the proper meails beein taken at the nmoment of the childl's removal to the land ?CASEI I. Early in the morning of February 5th last, I was summon-ied to a Mrs. B., of this town, whom I dlelivered of seven miionth twins, male and female, the latter being the elder by ten minutes.The boy-presented at the feet, and was pulseless when born; but bein, by far the finer child of the two, and the sc-x wished for by its father, I determin-ed to
The Effect of Low-Fat Diet on Lipid Levels
Authors: Edward Siguel
Journal: JAMA (1996)

<h3>To the Editor.</h3> —The study by Dr Schaefer and colleagues<sup>1</sup>fills a major gap in understanding the effect of low-fat diets on lipid levels. During their study (approximately 3 months), two (6.9%) of the 29 subjects developed evidence of heart disease; one had a myocardial infarction. At this rate, approximately 25% of subjects would develop evidence of heart disease every year. In our clinical experience we found that low-fat diets using processed low-fat and nonfat foods deprived of essential fatty acids (EFAs) decrease high-density lipoprotein (HDL) levels and increase triglyceride levels. Some patients feel more tired and complain that they lack energy. We have been warning physicians that such low-fat diets increase the ratio of total cholesterol to HDL cholesterol, and deplete plasma and red blood cell EFA levels when used as maintenance diets (ie, without weight loss).<sup>2,3</sup>Numerous studies show that low levels of polyunsaturated fatty acids
Sleep Apnea and Sinus Node Dysfunction
Authors: Michael J. Thorpy, Arthur J. Spielman, M. L. Abbott
Journal: JAMA (1984)

<h3>To the Editor.—</h3> I read with interest the recent article by Drs Alpert and Flaker<sup>1</sup>on sinus node dysfunction. However, I was surprised to find no mention of a relatively common, easily treatable condition that is associated with reversible sinus arrhythmias. Obstructive sleep apnea commonly produces the bradycardia/ tachycardia syndrome, bradycardia, or sinus arrest.<sup>2,3</sup>The associated sinus arrhythmias that, in our experience, have produced episodic sinus arrest for periods as long as 12 s are readily reversible by surgical treatment of the obstructive sleep apnea.<sup>2</sup>This cause of sinus node dysfunction warrants special mention, since it does not appear to be readily recognized by physicians, including cardiologists, as we have documented two cases in which the diagnosis of obstructive sleep apnea was missed by others and the associated sinus arrhythmia treated by implantation of a permanent pacemaker. Specific treatment of the underlying obstructive sleep apnea is regarded as
A Staunch Defender.
Authors: None Virtus
Journal: JAMA (1895)

Atlanta, Ga. <h3>To the Editor:</h3> —The sanious exudation from a gangrenous ulcer does not indicate more clearly its true character, than does the utter disregard of correct principle show the reviewership of the communication in your number of August 24, headed, " The Code, Once More," and signed " Amicus Veritatis." It should have had for a caption, "No Code," and for signature," Vox Asini." Respectfully,
Effect of amiodarone on serum triiodothyronine, reverse triiodothyronine, thyroxin, and thyrotropin. A drug influencing peripheral metabolism of thyroid hormones.
Authors: A Burger, D Dinichert, P Nicod, M Jenny, T Lemarchand-Béraud, M B Vallotton
Journal: Journal of Clinical Investigation (1976)

2-n-Butyl-3-(4'-diethylaminoethoxy-3',5'-diiodobenzoyl)-benzofurane (amiodarone), a drug used in arrythmias and angina pectoris, contains 75 mg of organic iodine/200 mg active substance. Four studies were performed to test its effect on thyroid hormone metabolism: (a) nine male subjects were treated with 400 mg of amiodarone for 28 days; (b) five male subjects received, for the same period of time, 150 mg of iodine in the form of Lugol's solution; (c) five subjects received 300 mug L-thyroxine (T4) for 16 days; from the 10th to the 16th day, 400 mg of amiodarone was added; and (d) five euthyroid subjects received 300 mug L-T4 for 16 days. The changes in serum thyroid-stimulating hormone (TSH), serum total T4, 3,5,3'-triiodothyronine (T3), free T3, and 3,5',3'-triiodothyronine (reverse T3, rT3) were measured, and the pituitary reserve in TSH was evaluated by a thyrotropin-releasing hormone (TRH) test. The results show that amiodarone induced a decrease in serum T3 (28+/-5.1 ng/100 ml, mean+/-SEM, P less than 0.0S and 82.7+/-9.3 ng rT3/100 ml, P less than 0.01). The control study with an equal amount of inorganic iodine did not induce these opposite changes but slightly lowered serum rT3, T3, and T4. In the third study, serum rT3 increased as under amiodarone treatment, thereby proving that these changes were peripheral. It is suggested that amiodarone changes thyroid hormone metabolism, possibly by reducing deiodination of T4 to T3 and inducing a preferential production of rT3. Amiodarone also increased the response of TSH to TRH. The maximal increment of serum TSH above base line was 32+/-4.5 muU/ml under treatment and 20+/-3 muU/ml before treatment (P less than 0.01). During this test, the serum T3 increase was more pronounced than during the control period (83+/-13 and 47+/-7.4 ng/100 ml, P less than 0.05).
The First Successful Endoscopic Retrograde Laser Lithotripsy of Common Bile Duct Stones in Man using a Pulsed Neodymium-YAG Laser
Authors: G. Lux, Ch. Ell, J. Hochberger, D. Müller, L. Demling
Journal: Endoscopy (1986)

Lumen-filling calculi in the common bile duct are frequently inaccessible to endoscopic treatment. With the aid of a flash lamp pulsed Nd:YAG laser, endoscopic retrograde lithotripsy of such calculi has now been successfully accomplished for the first time in man.
Multidisciplinary investigation of a multicountry outbreak of Salmonella Stanley infections associated with turkey meat in the European Union, August 2011 to January 2013
Authors: P Kinross, L van Alphen, J Martinez Urtaza, M Struelens, J Takkinen, D Coulombier, P Mäkelä, S Bertrand, W Mattheus, D Schmid, E Kanitz, V Rücker, K Krisztalovics, J Pászti, Z Szögyényi, Z Lancz, W Rabsch, B Pfefferkorn, P Hiller, K Mooijman, C Gossner
Journal: Eurosurveillance (2014)

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