tbuckley/cabot-search huggingface dataset:
Hormonal profiles after the menopause.
Authors: S Chakravarti, W P Collins, J D Forecast, J R Newton, D H Oram, J W Studd
Journal: BMJ (1976)

The endocrinological changes of the climacteric have been defined by studying the concentrations of follicle-stimulating hormone (FSH), luteinising hormone (LH), androstenedione, testosterone, oestrone, and oestradiol in 60 normal postmenopausal women of different menopausal ages. The women were studied in six groups, according to the number of years since their menopause. One year after the menopause androstenedione, oestrone, and oestradiol concentrations were reduced to about 20% of the values recorded during the early proliferative phase of the menstrual cycle. At the same time the mean concentration of FSH had risen by a factor of 13-4 and that of LH by a factor of 3-0. Concentrations of both gonadotrophins reached a peak of 18-4 and 3-4 times the proliferative phase value respectively after two to three years, and then gradually declined in the next three decades to values that were 40-50% of these maximal levels. Testosterone concentrations remained mostly in the normal range for premenopausal women but were depressed to 60% of these levels two to five years after the menopause, and the mean androstenedione levels showed a significant increase in the same group of women. The concentrations of both oestrone and oestradiol remained consistently low for 10 years after the menopause, but oestradiol concentrations inexplicably increased in the last two decades, with levels at the lower end of normal range for reproductive women in six patients.
Letter: Levodopa and growth hormone secretion.
Authors: C F Colucci, B D'Alessandro, A Bellastella, R Gasbarro
Journal: BMJ (1973)

bined with oestrogen.'6Phenothiazines have been shown to increase plasma prolactin'5 and might possibly be associated with an in- creased incidence of breast cancer.16Male patients with gynaecomastia, except when associated with drugs like phenothiazines, do not have raised prolactin levels,"3 so that this hormone may not be necessary for breast growth (normal or abnormal) in humans.In summary, we agree that breast cancer response to hormones is a most complex subject.However, we suggest that the theory of different clones within one tumour or its metastases adequately explains variable re- sponses to endocrine manipulation.-Weare, etc.,
THE IDENTIFICATION OF THE STREPTOCOCCUS OF SCARLET FEVER
Authors: RUTH TUNNICLIFF
Journal: JAMA (1926)

In 1920, I<sup>1</sup>reviewed the literature on agglutination of streptococci found in scarlet fever and showed by means of immune sheep serums that 92 per cent of the streptococci in the acute stage of scarlet fever and 100 per cent of those from erysipelas belonged to distinct biologic groups, which could be differentiated from one another and from the hemolytic streptococci in other infections. These conclusions were reached by the study of opsonification, agglutination, absorption and protection experiments. These and later studies demonstrated that the streptococci specific for scarlet fever began to disappear as early as the second week of the disease, but that they persisted much longer (six weeks) in patients with discharges. It was found that complications beginning after the third week were generally not due to scarlatinal streptococci. Specific scarlet fever streptococci were also isolated from the pus of infections (finger, burn, vaccination lesion and lochia
Health and economic policy
Authors: P. Draper, H. Crombie
Journal: BMJ (1995)

The health sector should be contributing to the development of economic policy

The idea that the health sector should collaborate in the development of policies in other sectors, such as transport, housing, or energy, is nowadays widely accepted in principle, if insufficiently in practice. “Intersectoral policy” is firmly in the books and worthy declarations not just of the World Health Organisation but of many countries.1 In Britain, Glasgow, Belfast, Camden, and Liverpool have developed and implemented intersectoral policies through WHO's healthy cities project, and many other communities are participating in similar activities through the UK Health for All Network.

Intersectoral policy is not a bid for health to dictate policy in other sectors; it is an attempt to influence decisions so that avoidable casualties are prevented. For example, treatment services clearly have a role in dealing with the respiratory or other casualties of road traffic, but it is little consolation for the accident surgeon (and even less for the patient) to know that the best has been done after a road accident when a more sensible transport policy should have prevented the accident.2

But what about macroeconomic policy, which largely determines widening differences in …
Hormone Therapy and Risk of Alzheimer Disease
Authors: Susan M. Resnick, Victor W. Henderson
Journal: JAMA (2002)

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
Recombinant Staphylokinase Variants With Altered Immunoreactivity
Authors: De´sire´ Collen, Ria Bernaerts, Paul Declerck, Frans De Cock, Edward Demarsin, Stephane Jenne´, Yves Laroche, Henri R. Lijnen, Karen Silence, Maria Verstreken
Journal: Circulation (1996)

Background Recombinant staphylokinase offers promise for thrombolytic therapy in acute myocardial infarction, but it is immunogenic. Although reduced immunogenicity of heterologous proteinaceous drugs by protein engineering has not previously been reported, an attempt was made to achieve this in staphylokinase by site-specific mutagenesis. Methods and Results Biospecific interaction analysis of a panel of 17 murine monoclonal antibodies against recombinant staphylokinase (SakSTAR variant) identified three nonoverlapping immunodominant epitopes, two of which could be eliminated by substitution mutagenesis of clusters of two or three charged amino acids with alanine. Circulating anti-staphylokinase antibodies elicited in patients by treatment with SakSTAR were incompletely (&lt;90%) absorbed by these mutants. Therefore, the combination variants K35A,E38A,K74A,E75A,R77A (SakSTAR.M38) and K74A,E75A,R77A,E80A,D82A (SakSTAR.M89) were constructed, expressed in Escherichia coli, highly purified by ion-exchange and hydrophobic interaction chromatography, and characterized. These variants had specific activities that were approximately half that of SakSTAR, and they combined the reduced reactivity with the panels of monoclonal antibodies of their parent molecules. Absorption of circulating antibodies elicited in patients by treatment with SakSTAR was incomplete in 13 of 16 patients (median values, 68% and 65% with SakSTAR.M38 and SakSTAR.M89, respectively). Conclusions SakSTAR contains three immunodominant epitopes, two of which were eliminated by site-directed mutagenesis, yielding combination mutants with relatively maintained specific activities that were not recognized by a significant fraction of the antibodies elicited in patients by treatment with wild-type SakSTAR. These mutants appear to be suitable for more detailed investigation of their thrombolytic and antigenic properties.
Hepatic oval cell activation in response to injury following chemically induced periportal or pericentral damage in rats
Authors: Bryon E. Petersen, Valerie F. Zajac, George K. Michalopoulos
Journal: Hepatology (1998)

Administration of 2-acetylaminofluorene (2-AAF) given before partial hepatectomy (PHx) results in suppression of hepatocyte proliferation and stimulation of oval cell proliferation. Our objective in this study was to examine the oval cell response and associated α-fetoprotein (AFP) gene expression by combining 2-AAF with selective damage of centrilobular regions (carbon tetrachloride [CCl 4 ]) or periportal regions (allyl alcohol [AA]). Centrilobular damage results in a more enhanced oval cell response and AFP gene expression than periportal damage. Conversely, more intense proliferation of intraportal bile duct epithelia was seen with 2-AAF/AA than with 2-AAF/CCl 4 . The oval cell response and AFP gene expression was ranked as 2-AAF/CCl 4 ≥ 2-AAF/PHx &gt; 2-AAF/AA. AFP mRNA expression was also examined in an acute AA and CCl 4 injury. We found very little AFP gene expression compared with the 2-AAF/hepatic injury models. To see a true oval cell response, the hepatocytes must be inhibited from proliferating. In addition, the results presented with the 2-AA/AA model suggest that the periportal matrix may be as important as the cells that populate the area.
Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program
Authors: J. B. Sussman, D. M. Kent, J. P. Nelson, R. A. Hayward
Journal: BMJ (2015)

<b>Objective</b> To determine whether some participants in the Diabetes Prevention Program were more or less likely to benefit from metformin or a structured lifestyle modification program. <b>Design</b> Post hoc analysis of the Diabetes Prevention Program, a randomized controlled trial. <b>Setting</b> Ambulatory care patients. <b>Participants</b> 3060 people without diabetes but with evidence of impaired glucose metabolism. <b>Intervention</b> Intervention groups received metformin or a lifestyle modification program with the goals of weight loss and physical activity. <b>Main outcome measure</b> Development of diabetes, stratified by the risk of developing diabetes according to a diabetes risk prediction model. <b>Results</b> Of the 3081 participants with impaired glucose metabolism at baseline, 655 (21%) progressed to diabetes over a median 2.8 years' follow-up. The diabetes risk model had good discrimination (C statistic=0.73) and calibration. Although the lifestyle intervention provided a sixfold greater absolute risk reduction in the highest risk quarter than in the lowest risk quarter, patients in the lowest risk quarter still received substantial benefit (three year absolute risk reduction 4.9% <i>v</i> 28.3% in highest risk quarter; numbers needed to treat of 20.4 and 3.5, respectively). The benefit of metformin, however, was seen almost entirely in patients in the top quarter of risk of diabetes. No benefit was seen in the lowest risk quarter. Participants in the highest risk quarter averaged a 21.4% three year absolute risk reduction (number needed to treat 4.6). <b>Conclusions</b> Patients at high risk of diabetes have substantial variation in their likelihood of receiving benefit from diabetes prevention treatments. Using this knowledge could decrease overtreatment and make prevention of diabetes far more efficient, effective, and patient centered, provided that decision making is based on an accurate risk prediction tool.
Denotation of Dyspnea
Authors: John H. Dirckx
Journal: JAMA (1978)

<h3>To the Editor.—</h3> In a letter published recently inThe Journal(239:928, 1978) E. D. Morton, MD, asks what dyspnea means and whether it refers to a subjective symptom or an objective sign. Since etymological or historical arguments showing what a word ought to mean are out of style, the answers to these questions should be sought through observation of the word in use. A review of numerous current textbooks, medical dictionaries, and other reference works shows that dyspnea is all but universally understood as a subjective experience. The term is variously defined as labored breathing, difficult breathing, shortness of breath, uncomfortable awareness of one's breathing, a feeling of suffocation, a consciousness of the need for more respiratory effort than seems called for by the level of activity, and a feeling of inability to draw a full breath. The fact that dyspnea can be inferred by an observer from such
Genomics and HCV infection: Progression of fibrosis and treatment response
Authors: Emilie Estrabaud, Michel Vidaud, Patrick Marcellin, Tarik Asselah
Journal: Journal of Hepatology (2012)

HCV infection is a global health problem that affects 170 million people worldwide. The severity of the disease varies from asymptomatic chronic infection to cirrhosis and hepatocellular carcinoma (HCC). Recently, the standard of care for genotype 1 patients has greatly improved with the addition of protease inhibitors (telaprevir or boceprevir) to pegylated interferon (PegIFN) and ribavirin (RBV). The prediction of fibrosis progression and the response to antiviral treatment are two major issues in the management of patients with chronic hepatitis C. Differential expression of mRNAs was first analyzed for both progression of fibrosis and treatment response. Specific polymorphisms, associated with either fibrosis or viral response, were identified thanks to major improvements in genome scanning technologies. Since 2009, several independent genome wide association studies (GWAS) have reported an association between genetic polymorphisms within the IL-28B promoter and both natural and treatment-induced clearance in genotype 1 infected patients. These different studies showed the strong association and the importance of IL-28B polymorphisms in the treatment response. Combining the different genetic factors could improve their predictive value and help identify patients at a high risk of progression of fibrosis as well as those with a lower chance of responding to treatment. The aim of this review was to discuss the genomic factors (mRNAs, miRNAs, and SNPs) and HCV infection with clinical implications for either progression of fibrosis or treatment response. Recent findings on the IL-28B polymorphism and its application in clinical practice will also be discussed.
RELATIONSHIP BETWEEN CARDIAC MASS AND LEFT VENTRICULAR FRACTIONAL ANISOTROPY AS ASSESSED WITH EX-VIVO DIFFUSION TENSOR MAGNETIC RESONANCE IMAGING
Authors: Wendy Tsang, Xiaodong Guo, Farid Dahi, Michael Bateman, Paul Iaizzo, Michael W. Vannier, Victor Mor-Avi, Roberto Lang, Amit Patel
Journal: Journal of the American College of Cardiology (2012)
Hepatitis C virus and liver disease: Global transcriptional profiling and identification of potential markers
Authors: Maria W. Smith, Zhaoxia N. Yue, Marcus J. Korth, Hao A. Do, Loreto Boix, Nelson Fausto, Jordi Bruix, Robert L. Carithers, Michael G. Katze
Journal: Hepatology (2003)

Microarray analysis of RNA from hepatitis C virus (HCV)-infected cirrhotic livers was performed to identify a gene expression signature of liver disease. The expression levels of approximately 13600 genes were analyzed using surgical material and core biopsy specimens from HCV-infected cirrhotic liver explants in comparison with reference samples of normal nondiseased liver. In addition, normal liver samples were compared with each other to determine normal physiologic variation in gene expression. A set of genes, including some associated with stress, acute-phase immune response, and hepatic stellate cell activation, had variable expression levels in normal livers. These genes were subtracted from the sets of genes differentially expressed in cirrhotic livers. To exclude cancer-related genes from our marker sets, we subtracted genes that also were expressed differentially in hepatocellular carcinomas. The resultant HCV- and liver disease-associated gene set provided a molecular portrait of several processes occurring in the HCV-infected liver. It included (1). genes expressed in activated lymphocytes infiltrating the cirrhotic liver, and activated liver macrophages; (2). genes involved in remodeling of extracellular matrix-cell and cell-cell interactions associated with cytoskeleton rearrangements; (3). genes related to the anti-apoptotic pathway of Bcl-2 signaling; and (4). genes involved with the interferon response and virus-host interactions. In conclusion, our microarray analysis identified several potential gene markers of HCV-associated liver disease and contributed to our rapidly expanding database of experiments describing HCV pathogenesis.
Care of the suddenly bereaved.
Authors: D W Yates, G Ellison, S McGuiness
Journal: BMJ (1990)

The hospice movement was established over 20 years ago to care for and support the dying and their relatives and now makes an important contribution to the management of patients with terminal illnesses.Over one third of people who die in hospital, however, do so within a few hours of arrival, often in the accident and emergency department and usually after a brief illness or an accident.Many of them are young, and most die outside normal working hours.Medical staff are not trained to manage the suddenly bereaved.Nursing staff, who usually have more experience in this, are often working under consider- able pressure.The first contact relatives have with hospital staffis just before or at the time of the patient's death, and there is rarely any subsequent support of the type recommended by the hospice movement.Yet the impact of a sudden death on relatives is often more pronounced than that of a death after a prolonged illness, during which the relatives have had time to prepare themselves.We describe some of the problems encountered by the suddenly bereaved and present the experience of a counselling support service that has been developed in this accident and emergency department over six years.
Uterus in a male.
Authors: A Mitra, K Das
Journal: BMJ (1970)

Uterus in a Male SIR,-A man aged 40 was admitted in July 1967 with a reducible right inguinal hernia and an undescended left testis.The right testis, normal in size and consistency, was present in the scrotum.Exploration of the right inguinal canal revealed a completely patent processus vaginalis with the testis inside the sac.On applying traction to the testis, an oval mass,
Gross oedema occurring during treatment for depression.
Authors: A Goonewardene, P J Toghill
Journal: BMJ (1977)

Cirrhosis and haemolysis complicating methyldopa treatmentHaemolysis is a recognised complication of methyldopa treatment.'Chronic hepatitis may also be induced by methyldopa and progress to cirrhosis if the drug is continued.2We describe here a patient who developed severe haemolytic anaemia after two years on methyldopa and was also found to have active cirrhosis. Case reportA 68-year-old English woman had suffered from psoriasis for many years.It was usually mild and had needed intermittent treatment with various topical ointments, including betamethasone.A severe exacerbation had occurred four years before admission and had responded to an 11-month course of oral prednisolone.She had never taken methotrexate.Twenty-six months before admission she had presented with symptoms and signs of right and left ventricular failure and had been found to have a blood pressure of 200/120 mm Hg.Treatment-She had responded rapidly to treatment with methyldopa, 1 5 g/day, frusemide 40 mg,/day, and digoxin 0 25 mg day.Four months later an acute generalised eczematous reaction had occurred.All drugs had been stopped for three weeks but the rash had persisted and her heart failure rapidly become more severe.Treatment had been restarted with the same drugs in the same doses.The rash had responded rapidly to topical fluocin- onide, and she had left hospital much improved 11 days later.She had taken the methyldopa, frusemide, and digoxin regularly during the next 21 months, and had remained reasonably well and active until the onset of jaundice.
Driving Fatalities on US Presidential Election Days
Authors: Donald A. Redelmeier
Journal: JAMA (2008)

is correct, however, to raise the question of organ donation.In the actual case, the family did consider but in the end declined to donate-a point that was not raised in the Grand Rounds.Dr McCollough does not disagree with the article's conclusion or grounds: that the medical treatment of a dead body is a farce that violates professional integrity, hinders the acceptance of brain death, and is an unreasonable expenditure of public resources and professional effort.Rather, he objects that our discussion is not needed because the ethics of this case are straightforward.In contrast, the Grand Rounds discussant (Dr Applbaum) wondered why so many thoughtful, smart, and conscientious physicians and ethicists-not one of whom questioned that brain death is death-thought it a hard case and why others thought it a straightforward case in the other direction.Hence, we saw the need for an analysis McCullough finds unnecessary."Patient" in the article usually is a definite description referring to the young woman, not to her normative status, role, or relation, and "life support" is a noun, not a successverb.So disconnecting a dead patient from life support is no more contradictory than unzipping a dead sailor from a life vest.The philosophical issue is not one of definitions.The case presents an open normative question: are physicians ever permitted or required to treat those declared dead on neurological criteria?Calling the entity at issue a cadaver (we ourselves call it on occasion a corpse) does not settle the matter.Finally, we rejected the view that decency requires treating the father's false beliefs in the medical benefits of a Chinese remedy for his dead child as true.Indeed, our central claim is that individuals are not entitled to have others act as if they are alive when by public criteria they are dead.Rather, we allow that, under integrity-preserving and nonburdensome circumstances, it is decent for physicians to accommodate some false medical beliefs of living patients, and physicians are permitted to accommodate the religious beliefs of dead patients when doing so would not be construed as endorsing false medical beliefs or denying public criteria of death.It would indeed be disrespectful to insincerely express endorsement of another's false beliefs.But the article asks about action, not expression.Respect for autonomy often requires that we not thwart, and sometimes even requires that we assist, the mistaken plans of others.
Marked Disparity Between Trabecular and Cortical Bone Loss with Age in Healthy Men
Authors: DIANE E. MEIER
Journal: Annals of Internal Medicine (1984)

To define age-related changes in bone mineral content in normal men, we measured radial (proximal and distal) and vertebral bone mineral content in 62 men aged 30 to 92 years. Radial bone mineral content (largely cortical bone) was measured by single photon absorptiometry, and trabecular vertebral content (T12, L1 to L3) by computed tomography. Radial bone mineral content fell gradually (2% to 3.4% per decade) with age, but vertebral trabecular content fell more rapidly (12% per decade). Body size was not associated with the rate of bone loss from the distal radial and vertebral sites, but men with lower surface areas lost bone more rapidly at the predominantly cortical proximal radial site. The fact that radial cortical bone mineral content falls much less rapidly than vertebral trabecular content with age and is also associated with surface area indicates that trabecular and cortical bone compartments may be independently modulated. Age-related bone loss should not be considered a homogeneous process.