tbuckley/cabot-search huggingface dataset:
Is hirudin a potential therapeutic agent for arthritis?
Authors: K Scott
Journal: Annals of the Rheumatic Diseases (2002)

Blockade of tumour necrosis factor alpha (TNFα) using infliximab, a chimeric monoclonal antibody against TNFα, is an effective treatment in rheumatoid arthritis and Crohn's disease. 1 2 Sifikakis reported success using infliximab in sight threatening Behçet's disease. 3 A preliminary study has also reported clinical improvements in the primary systemic vasculitis, Wegener's granulomatosis, with the soluble TNFα receptor etanercept. 4 The benefit of lenercept, a soluble p55 TNFα receptor fusion protein, on digital vasculitis in rheumatoid arthritis has also been reported. 5 We report the compassionate treatment of six patients with refractory vasculitis using infliximab.Diagnoses were Wegener's granulomatosis in three and microscopic polyangiitis in three.Three patients were positive for proteinase-3 antineutrophil cytoplasmic antibodies (PR3-ANCA) and one for myeloperoxidase (MPO)-ANCA.Four were female, with a mean age of 58 years (range 23-77) and mean disease duration of 3.5 years.All had had at least three clinical relapses and had received prolonged treatment with corticosteroids and at least four immunosuppressive drugs.At the time of infliximab treatment the eyes were affected in four patients and the lung in three; in addition, five had profound constitutional symptoms.The mean prednisolone dose was 17 mg.Three intravenous doses of infliximab 200 mg were given at monthly intervals for three months.One patient complained of fatigue, myalgia, and blurred vision 24 hours after the first infusion, which did not recur on rechallenge.Infliximab was otherwise well tolerated.Five patients had remission of their disease, four within two weeks of treatment.This allowed steroid withdrawal in three and reduction by more than 50% in two.Disease activity assessed by the Birmingham Vasculitis Activity Scores (BVAS) improved from a mean of 6.3 to 0.8 at three months (fig 1). 6 One patient receiving continued infliximab for six months relapsed when the treatment interval was extended to two months.Mean falls in erythrocyte sedimentation rate and C reactive protein were 17 mm/1st h and 13 mg/l, respectively.The ANCA status was unchanged.Anti-TNFα treatment heralds a new wave of specifically targeted biological interventions of potential value in the treatment of vasculitis.It offers the hope of improved therapeutic efficacy over current agents and the possibility of reducing exposure to steroids and immunosuppressive drugs.Further studies are warranted to confirm these observations and explore the role of infliximab as a component of initial protocols.. . . . . .
David Lionel Gullick
Authors: John Havard
Journal: BMJ (2008)

<h3>Objective</h3> To explore the perspectives of general practitioners (GPs) concerning the risk of opioid misuse in people with cancer and pain and related clinical considerations. <h3>Design</h3> A qualitative approach using semistructured telephone interviews. Analysis used an integrative approach. <h3>Setting</h3> Primary care. <h3>Participants</h3> Australian GPs with experience of prescribing opioids for people with cancer and pain. <h3>Results</h3> Twenty-two GPs participated, and three themes emerged. Theme 1 (<i>Misuse is not the main problem</i>) contextualised misuse as a relatively minor concern compared with pain control and toxicity, and highlighted underlying systemic factors, including limitations in continuity of care and doctor expertise. Theme 2 (<i>‘A different mindset’ for cancer pain</i>) captured participants’ relative comfort in prescribing opioids for pain in cancer versus non-cancer contexts, and acknowledgement that compassion and greater perceived community acceptance were driving factors, in addition to scientific support for mechanisms and clinical efficacy. Participant attitudes towards prescribing for people with cancer versus non-cancer pain differed most when cancer was in the palliative phase, when they were unconcerned by misuse. Participants were equivocal about the risk–benefit ratio of long-term opioid therapy in the chronic phase of cancer, and were reluctant to prescribe for disease-free survivors. Theme 3 (<i>‘The question is always, ‘how lazy have you been?’</i>) captured participants’ acknowledgement that they sometimes prescribed opioids for cancer pain as a default, easier option compared with more holistic pain management. <h3>Conclusions</h3> Findings highlight the role of specific clinical considerations in distinguishing risk of opioid misuse in the cancer versus non-cancer population, rather than diagnosis per se. Further efforts are needed to ensure continuity of care where opioid prescribing is shared. Greater evidence is needed to guide opioid prescribing in disease-free survivors and the chronic phase of cancer, especially in the context of new treatments for metastatic disease.
Evaluation of Hydronephrosis With Tubeless Cutaneous Ureterostomy Using Tc-99m MAG3 Diuretic Renography
Authors: Chul Jang Kim, Keita Takimoto, Keiji Tomita, Takashi Osafune, Nobuyuki Nishikawa, Kazuyoshi Johnin, Yusaku Okada
Journal: Clinical Nuclear Medicine (2009)

To assess hydronephrosis of tubeless cutaneous ureterostomy using Tc-99m mercaptoacetyltriglycine (MAG3) diuretic renogram.Cutaneous ureterostomy with a unilateral stomal creation was performed in 15 patients (27 renal units) with a minimum follow-up period of 6 months. Stomal obstruction was evaluated with Tc-99m MAG3 diuretic renography 3 months after the surgery. The data analyses were performed with half-times to tracer clearance (T1/2) after furosemide (0.5 mg/kg) administration.T1/2 means were 7.27 +/- 7.11, 5.69 +/- 4.63, and 8.96 +/- 8.37 minutes for total, ipsilateral, and contralateral kidneys, respectively, in side relationships between ureter and stoma. There were no statistical differences among the groups. Six months after the surgery, of 26 renal units (96.3%) that had achieved a tubeless condition, and 25 renal units (92.6%) had no hydronephrosis. T1/2 was within 20 minutes in these 25 renal units, and of 25 renal units 23 (92%) revealed less than 15 minutes in T1/2, suggesting that the upper limit of T1/2 for nonobstructed systems after construction of a cutaneous ureterostomy might be 15 minutes. Mild hydronephrosis without the need for intervention was present in 1 renal unit (T1/2, 31.70 minutes). Catheterization was performed in one renal unit (T1/2, 21.04 minutes) due to acute pyelonephritis and persistence of grade 2 hydronephrosis 5 months after the surgery. Only these 2 renal units showed more than 20 minutes in T1/2, resulting in an obstructive pattern on diuretic renography.Tc-99m MAG3 diuretic renography with T1/2 assessment is useful to evaluate stomal stenosis in tubeless cutaneous ureterostomy.
Release of ceramide after membrane sphingomyelin hydrolysis decreases the basolateral secretion of triacylglycerol and apolipoprotein B in cultured human intestinal cells.
Authors: F J Field, H Chen, E Born, B Dixon, S Mathur
Journal: Journal of Clinical Investigation (1993)

The effect of sphingomyelin hydrolysis on triacylglycerol-rich lipoprotein secretion was examined in the human intestinal cell line, CaCo-2. Addition of sphingomyelinase decreased sphingomyelin and phosphatidylethanolamine by 60 and 20%, respectively. Sphingomyelin hydrolysis decreased the basolateral secretion of triacylglycerol mass, newly synthesized triacylglycerol, and apo B mass. Pulse-chase experiments with [35S]methionine demonstrated a decrease in apo B synthesis and a marked decrease in apo B100 and apo B48 secretion without altering apo A1 secretion. Sphingomyelin hydrolysis did not change apo B mRNA levels nor apo B turnover. Phosphatidylcholine-specific phospholipase C did not decrease apo B synthesis or its basolateral secretion. Membrane protein kinase C (PKC) activity was decreased twofold after sphingomyelin hydrolysis. The PKC inhibitor staurosporine decreased apo B mass and newly synthesized apo B secretion. Sphingomyelinase and staurosporine together caused an additional decrease in apo B secretion suggesting that sphingomyelin hydrolysis decreased apo B secretion independently of its effect on PKC activity. Moreover, conditions that increase PKC activity did not increase apo B secretion. Cell-permeable analogs of ceramide decreased immunoreactive apo B secretion. Sphingosine was without effect. The hydrolysis of membrane sphingomyelin by intestinal or pancreatic neutral sphingomyelinase may lead to the accumulation of cellular ceramide, which, in turn, could inhibit triacylglycerol-rich lipoprotein secretion.
Arsenic in Fly-Papers
Authors: W. M. Ord
Journal: BMJ (1878)

THE following case is recorded with the object of drawing attention to a source of poisoning not commonly known, namely, the presence of a soluble form of arsenic in many of the sheets sold under the name of "fly-papers".A boy of eight years was admitted to Charity Ward, St. Thomas's Hospital, at 7.15 P.M. on the 18th May last, unconscious, and( to all appearance suffering from belladonna-poisoning. It was asserted that the symptoms had come on at about 5 P.l.; and, as the friends had already suspected poisoning, three explanations were offered by them for the information of the hospital officials.
Coronary Artery Anatomy in Left Bundle Branch Block
Authors: HENRY DE MOTS, JOSEF RÖSCH, SHAHBUDIN H. RAHIMTOOLA
Journal: Circulation (1973)

It has previously been reported that the length of the left main coronary artery is short in patients with left bundle branch block (LBBB) and that an unexpectedly large number of LBBB patients had dominant left coronary arterial distribution. The present coronary arteriographic study of 13 patients with LBBB revealed a mean length of the left main coronary artery ( ± 1 sd ) of 10.9 ± 6.0 mm, a measurement which was not significantly different ( P &gt; 0.5) from that of the left coronary arteries in 78 patients in a control group (10.0 ± 3 mm). The arterial distribution patterns showed a contribution of the right coronary artery to the posterior descending artery in 12 of the 13 patients with LBBB. Coronary artery anatomy does not appear related to the presence of LBBB.
Male doctors, doctors over 50, and doctors qualifying overseas are more likely to raise concerns about performance
Authors: J. Wise
Journal: BMJ (2009)

Male doctors and older doctors are more likely to be referred to the National Clinical Assessment Service and are also more likely to experience exclusion or suspension from work, a statistical review of eight years of casework has found.

The study of concerns relating to the performance of doctors and dentists in the United Kingdom also found that, within the hospital and community care sector, non-white practitioners who qualified outside the UK were more likely to be referred to the service than other groups. 

But non-white practitioners who qualified in the UK were no more likely to be referred, suspended, or excluded than the rest of the sample. It was not possible to study any associations between referral rates and ethnicity in …
A cross-over comparison of the effect of morphine, pethidine, pentazocine, and phenazocine on biliary pressure
Authors: G. Economou, J. N. Ward-McQuaid
Journal: Gut (1971)

The effects on biliary pressure of pentazocine, morphine, pethidine, and phenazocine were compared by direct measurement through a ;T' tube after choledochotomy. In two within-patient comparisons, the mean increases in biliary pressure following intramuscular morphine were significantly greater than those following pentazocine. When pethidine and phenazocine were compared with pentazocine, the mean increases were lower following pentazocine but not to a statistically significant extent. Pentazocine appears to be the most appropriate strong analgesic in biliary and pancreatic disease.
Doppler ultrasonographic characteristics of superficial and deep-flow signals in the knee joint pannus of patients with rheumatoid arthritis
Authors: R. Kasukawa, K. Shio, Y. Kanno, A. Sato, A. Takahashi, Y. Yamadera, T. Kanno
Journal: Annals of the Rheumatic Diseases (2007)

<b>Aims:</b> To review the process and outcome of education and training visits to paediatric departments by the RCPCH. <b>Methods:</b> Retrospective audit of visits reports (1997–2001) against the RCPCH criteria for general professional training. Hospital and/or community child health departments who were responsible for training paediatric senior house officers were visited to assess whether RCPCH criteria of education were being met. Follow up visits were undertaken where limited education and training approval was given. Reports were received from 214 of 242 (88%) hospital and/or community based departments in England, Wales, and Northern Ireland. <b>Results:</b> Satisfactory achievement of the 12 training criteria by departments varied widely: 39–95% (median 66%) achieved. Follow up visits reported significant improvements in most departments. Criteria which departments struggled to achieve reasonable standards were: (1) ensuring SHOs were performing educationally appropriate duties (39% achieved); and (2) satisfactory outpatient experience (41% achieved). Twenty four per cent of hospital based departments did not have a paediatrician with 12 months or more experience of paediatrics resident on call. <b>Conclusions:</b> The visiting process highlighted areas of good practice, encouraged change to meet the criteria, and recommended increased resources and staffing where necessary to improve training and hence the service. The need for continuing approval for education and training in these departments encouraged significant efforts on the part of trainers and managers to meet the requirements, and consequently the quality of service to children has been enhanced.
Sustainability of medical imaging
Authors: Eugenio Picano
Journal: BMJ (2004)

Doctors and patients should be more aware of the long term risks of radiological investigations Contemporary medicine relies heavily on radiological and mediconuclear investigations and procedures.However, the often essential information derived from such investigations is obtained at a risk that few doctors are fully aware of.Increased awareness among both doctors and patients would help reduce the number of inappropriate examinations and the avoidable biological burden on current and future generations.In this article, I outline the effect of ionising testing in our society, review the possible detrimental public health effect based on current estimates of risk, and discuss simple ways of achieving a more cautious approach.
South African government to withdraw antiretrovirals for pregnant mothers
Authors: P. Sidley
Journal: BMJ (2003)

South Africa's first AIDS conference got off to a painful start last weekend. At the opening of the conference, AIDS activists stood in silent protest at the health minister, Dr Manto Tshabalala Msimang, while others booed her loudly.

   ![][1] 

Zackie Achmat (left) with protesters at the AIDS conference

Credit: AP

Days before the opening, the government once more delivered bad news to the AIDS community and devastating news to the hundreds of thousands of HIV positive women who may become pregnant.

Nevirapine, …

 [1]: /embed/graphic-1.gif
Survival After Out-of-Hospital Cardiac Arrest
Authors: Harrison J. Kornfield
Journal: JAMA (1992)

To the Editor.  —Your interesting report on out-of-hospital cardiac arrest by Valenzuela et al1is lacking in two respects: there is no indication of the ultimate outcome of the survivors, and there is no mention of the cost of treatment. I believe it is necessary to look at every medical report with an eye to the effects of the therapies described.  Previous reports have indicated that less than 10% of patients discharged from hospitals who have suffered a cardiac arrest will be alive at 6-month follow-up. In this report, there were only 22 patients available for such study, and follow-up should have been easy.  Furthermore, cost analysis should separate prehospital costs, emergency department and/or resuscitation costs, and costs after hospital admission to determine the cost benefit ratio of treating cardiac arrest. A large amount of volunteer time and money is spent on training nonphysicians in resuscitation measures for cardiac
Abstract A3: The human epidermal growth factor receptors in gastric carcinomas: A study using fluorescence <i>in situ</i> hybridization and immunohistochemistry
Authors: Emy Fukuda, Fernando Soares, Jose H. Fregnani, Maria D. Begnami
Journal: Clinical Cancer Research (2010)

Abstract The human epidermal growth factor receptors (EGFR) family consists of four members: ErbB-1 (HER1), ErbB-2 (HER2), ErbB-3 (HER3) and ErbB-4 (HER4). These receptors activate numerous downstream pathways in response of extracellular ligands, regulating diverse processes including differentiation, migration, proliferation, and survival. Alterations in EGFR family members play a role in the development and progression of many human cancers. In gastric carcinomas (GC), HER1 and HER2 overexpressions are thought to be prognostic factors and targets of novel biological agents. The effect of HER3 or HER4 expression in GC has not been sufficiently studied. HER3 expression is observed frequently in advanced GC with poor prognosis and HER4 gene expression seems to be higher in GC tissue in comparison with adjacent gastric mucosa. In this study, we explored gene and protein expression of the EGFR family in GC in order to establish new potentially prognostic factors. Immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) were carried out in 221 GC using tissue microarray. IHC positivity for EGFR was defined by score 2+ or 3+ according with intensity and frequency of membranous staining. In addition, the intensity of the cytoplasm staining was also determined for HER3 and HER4 overexpression. HER1, HER2, HER3, and HER4 overexpression was found in 3/197 (1.5%), 24/207 (12%), 121/193 (64%) and 41/183 (22%) cases respectively. FISH assay was performed according to the protocol previous described. In each case, 100 tumor nuclei were evaluated. Cases showing a gene/CEN fluorescence ratio ≥ 2 were considered positive for gene amplification. FISH detected HER1 and HER2 amplification in 1.3% and 8% of the cases. Amplifications for HER3 and HER4 were not observed. Overall, alterations of the 4 members of EGFR were significantly associated with parameters involved with tumor progression, including the depth of tumor invasion, involved lymph nodes, and tumor stage. We herein showed a strong correlation between HER2, HER3 and HER4 overexpression and low-grade tumors, corresponding to the intestinal type GC according to Lauren's classification. In addition, HER2 amplification was significantly related with worse survival. These results reveal that members of EGFR family are activated in GC. The exact molecular mechanisms involved in the HER3 or HER4 alterations in gastric cancer, especially in the intestinal type, remain unclear since amplifications of these genes were not found. Gaining further understanding into the oncogenic mechanism of EGFR family may not only help in the development of targeted therapy in gastric patients but might accelerate the acceptance of a novel taxonomy of cancer which is based on the genomic perturbations in cancer genes and cancer gene families and their response to targeted agents. Citation Information: Clin Cancer Res 2010;16(14 Suppl):A3.
Elevated Serum Triglyceride Levels and Long-Term Mortality in Patients With Coronary Heart Disease
Authors: Moti Haim, Michal Benderly, Daniel Brunner, Solomon Behar, Eran Graff, Henrietta Reicher-Reiss, Uri Goldbourt
Journal: Circulation (1999)

The association between elevated blood triglyceride levels and subsequent mortality risk in patients with established coronary heart disease (CHD) has been investigated rarely. The aim of the present study was to investigate this association.We evaluated mortality over a mean follow-up time of 5. 1 years among 9033 male and 2499 female CHD patients who were screened for participation in the Bezafibrate Infarction Prevention (BIP) Study. A stepwise increase in mortality with increasing serum triglyceride levels was observed in patients with desirable or elevated serum total cholesterol levels and in patients with either desirable or abnormally low HDL cholesterol levels. Multivariate adjustment for factors other than HDL cholesterol yielded a slightly increased adjusted mortality risk with a 1-natural-log-unit elevation of triglyceride levels in men (hazard ratio [HR] 1.14, 95% CI 1.00 to 1.30) and women (HR 1.37, 95% CI 1.04 to 1.88). Excess covariate-adjusted risk was noted among patients with elevated total and LDL cholesterol and in women with HDL cholesterol levels >45 mg/dL. After additional adjustment for HDL cholesterol, the risk of mortality with a 1-natural-log-unit elevation of triglycerides declined in men (HR 1.09, 95% CI 0.94 to 1.26) and in women (HR 1.10, 95% CI 0.80 to 1.50). A trend for increased mortality risk remained in patients with elevated total and LDL cholesterol and in women with HDL cholesterol >45 mg/dL.Elevated triglyceride levels were associated with a small, independent increased mortality risk in CHD patients. This risk may be increased among subgroups of patients with elevated total cholesterol and LDL cholesterol levels.
CDC Director Invites Participation in Disease Control and Prevention
Authors: Charles Marwick
Journal: JAMA (1999)

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
Evaluation and Economic Exigency in the NICU
Authors: L. Joseph Butterfield
Journal: New England Journal of Medicine (1981)

The first premature infant center was established in Chicago in 1923, and thereafter special-care units for the sick newly born have gradually appeared all over the world.Since the crusade for regionalization of modern neonatal intensive care units (NICUs) began in this country in the late 1960s, advocates of the perinatal-care movement have promoted their programs in the lay and scientific press. Almost daily, a miracle baby is proclaimed by the media.Missing from the litany of success stories has been a close look at the effectiveness of the NICU. There are those who are repulsed by the term "cost-benefit . . .
Reclaiming the placebo effect
Authors: Fiona Godlee
Journal: BMJ (2008)

Where do doctors add most value? Larry Brilliant—a public health doctor who has worked on programmes to eradicate smallpox, blindness, and polio—has found his niche as executive director of Google.org (p 986; doi: 10.1136/bmj.39548.369977.AD). Through an initiative called Predict and Prevent, launched earlier this year as one of five core initiatives that will focus Google’s philanthropic efforts over the next 5-10 years, Brilliant is building a global system to detect new disease outbreaks or disasters quickly and enable rapid responses. Compared to the one to one doctor-patient relationship, he says this role was harder and more …