tbuckley/cabot-search huggingface dataset:
Orexinergic System Dysregulation, Sleep Impairment, and Cognitive Decline in Alzheimer Disease
Authors: Claudio Liguori, Andrea Romigi, Marzia Nuccetelli, Silvana Zannino, Giuseppe Sancesario, Alessandro Martorana, Maria Albanese, Nicola Biagio Mercuri, Francesca Izzi, Sergio Bernardini, Alessandra Nitti, Giulia M. Sancesario, Francesco Sica, Maria G. Marciani, Fabio Placidi
Journal: JAMA Neurology (2014)

<h3>Importance</h3> Nocturnal sleep disruption develops in Alzheimer disease (AD) owing to the derangement of the sleep-wake cycle regulation pathways. Orexin contributes to the regulation of the sleep-wake cycle by increasing arousal levels and maintaining wakefulness. <h3>Objectives</h3> To study cerebrospinal fluid levels of orexin in patients with AD, to evaluate the relationship of orexin cerebrospinal fluid levels with the degree of dementia and the cerebrospinal fluid AD biomarkers (tau proteins and β-amyloid 1-42), and to analyze potentially related sleep architecture changes measured by polysomnography. <h3>Design, Setting, and Participants</h3> We conducted a case-control study from August 1, 2012, through May 31, 2013. We included 48 drug-naive AD patients referred to the Neurological Clinic of the University Hospital of Rome Tor Vergata. Based on the Mini-Mental State Examination score, 21 patients were included in mild AD group (score, ≥21), whereas 27 were included in the moderate to severe AD group (score, &lt;21). The control group consisted of 29 nondemented participants of similar age and sex. <h3>Exposure</h3> Laboratory assessment of cerebrospinal fluid levels of orexin, tau proteins, and β-amyloid 1-42 and polysomnographic assessment of sleep variables. <h3>Main Outcomes and Measures</h3> Levels of orexin, tau proteins, and β-amyloid 1-42; macrostructural variables of nocturnal sleep (total sleep time, sleep efficiency, sleep onset and rapid eye movement [REM] sleep latencies, non-REM and REM sleep stages, and wakefulness after sleep onset); and Mini-Mental State Examination scores. <h3>Results</h3> Patients with moderate to severe AD presented with higher mean (SD) orexin levels compared with controls (154.36 [28.16] vs 131.03 [26.55];<i>P</i> &lt; .01) and with more impaired nocturnal sleep with respect to controls and patients with mild AD. On the other hand, in the global AD group, orexin levels were positively correlated with total tau protein levels (<i>r</i> = 0.32;<i>P</i> = .03) and strictly related to sleep impairment. Finally, cognitive impairment, as measured by the Mini-Mental State Examination, was correlated with sleep structure deterioration. <h3>Conclusions and Relevance</h3> Our results demonstrate that, in AD, increased cerebrospinal fluid orexin levels are related to a parallel sleep deterioration, which appears to be associated with cognitive decline. Therefore, the orexinergic system seems to be dysregulated in AD, and its output and function appear to be overexpressed along the progression of the neurodegenerative process. This overexpression may result from an imbalance of the neurotransmitter networks regulating the wake-sleep cycle toward the orexinergic system promoting wakefulness.
The Freeman Hospital.
Authors: J Laurance
Journal: BMJ (1991)

Earlier this year we visited four parts of the NHS -two districts, a trust hospital, and a GP fundholder-as they made their preparations for the introduction ofthe internal market on I April.This summer we revisited them to see how thefirstfew months had gone.We start this week with 3'eremy Laurance's account of how the Freeman Hospital in Newcastle is faring as a selfgoverning trust.
Public Health Care and Health Insurance Reform — Varied Preferences, Varied Options
Authors: Mark V. Pauly
Journal: New England Journal of Medicine (2009)

Health care and health insurance reform will surely require a mixture of public and private efforts for different population groups in different settings. One feature that might help with the choices Americans make as consumers, voters, and taxpayers is a menu of insurance plans managed by both public and private organizations for all population groups. People will end up with insurance they like better and that works better for them if they can select a plan from a large variety of options. Such an arrangement caters to the variability of consumers' preferences about insurance: how they want their insurer to . . .
Satisfaction of the uncertainty principle in cancer clinical trials: retrospective cohort analysis
Authors: Steven Joffe, David P Harrington, Stephen L George, Ezekiel J Emanuel, Lindsay A Budzinski, Jane C Weeks
Journal: BMJ (2004)

<h3>Abstract</h3> <b>Objective</b> To assess whether publicly funded adult cancer trials satisfy the uncertainty principle, which states that physicians should enrol a patient in a trial only if they are substantially uncertain which of the treatments in the trial is most appropriate for the patient. This principle is violated if trials systematically favour either the experimental or the standard treatment. <b>Design</b> Retrospective cohort study of completed cancer trials, with randomisation as the unit of analysis. <b>Setting</b> Two cooperative research groups in the United States. <b>Studies included</b> 93 phase III randomised trials (103 randomisations) that completed recruitment of patients between 1981 and 1995. <b>Main outcome measures</b> Whether the randomisation favoured the experimental treatment, the standard treatment, or neither treatment; effect size (outcome of the experimental treatment compared with outcome of the standard treatment) for each randomisation. <b>Results</b> Three randomisations (3%) favoured the standard treatment, 70 (68%) found no significant difference between treatments, and 30 (29%) favoured the experimental treatment. The average effect size was 1.20 (95% confidence interval 1.13 to 1.28), reflecting a slight advantage for the experimental treatment. <b>Conclusions</b> In cooperative group trials in adults with cancer, there is a measurable average improvement in disease control associated with assignment to the experimental rather than the standard arm. However, the heterogeneity of outcomes and the small magnitude of the advantage suggest that, as a group, these trials satisfy the uncertainty principle.
Comparison of B-Type Natriuretic Peptides for Assessment of Cardiac Function and Prognosis in Stable Ischemic Heart Disease
Authors: Mark Richards, M. Gary Nicholls, Eric A. Espiner, John G. Lainchbury, Richard W. Troughton, John Elliott, Christopher M. Frampton, Ian G. Crozier, Timothy G. Yandle, Robert Doughty, Stephen MacMahon, Norman Sharpe
Journal: Journal of the American College of Cardiology (2005)
TYPES OF CHILDREN.
Authors: W. S. CHRISTOPHER
Journal: JAMA (1904)

For many years—indeed, since the advent of the more exact scientific methods in medical research—it has been, to say the least, unfashionable to refer to "diatheses" and "temperaments." It is not difficult to find why these terms have dropped into disuse, and the reasons are good. Not only are the general terms themselves illy defined, but the attempts made to differentiate their subdivisions and parts are equally inchoate and confusing. They become, therefore, an easy refuge for inexact thinking, a condition obnoxious to modern medical methods. And yet we owe so much to the fathers, and have such great reason to admire the genius with which they brought to light many fundamental truths when surrounded by vicious methods of reasoning and faulty, inexact and incomplete methods of investigation, that it becomes a duty to give respectful attention to and make careful investigation of their dicta, even when adherence to them
Results of Immunochemotherapy with Interleukin-2, Interferon-&amp;alpha;&lt;sub&gt;2&lt;/sub&gt; and 5-Fluorouracil in the Treatment of Metastatic Renal Cell Cancer
Authors: Dirk Samland, Frank Steinbach, Frank Reiher, Uwe Schmidt, Achim Gruss, Ernst P. Allhoff
Journal: European Urology (1999)
Pancreatic Pseudocysts
Authors: Charles M. Caravati
Journal: JAMA (1966)

Pancreatic pseudocysts often present as a multifaceted clinical picture which is frequently misinterpreted by the clinician because of lack of appreciation of many of the clinical signs and laboratory findings. The purpose of this report is to review our experience with 42 cases of pancreatic pseudocysts and to emphasize major points of diagnostic importance. The cases reviewed include 19 at three metropolitan Richmond, Va, hospitals (Richmond Memorial, Johnston-Willis, and the Medical College of Virginia) and 23 at the McGuire Veterans Hospital seen from 1950 through 1964. Diagnosis was confirmed by surgery in 35 cases, by autopsy in 1, and in 6 cases the clinical features were so classical that the diagnosis of pseudocyst seems practically unequivocal. <h3>Definition</h3> Pseudocysts of the pancreas are so designated because they do not contain an epithelial lining and therefore are not true cysts. Pancreatic ductal epithelium does not migrate over the surface of these "cysts";
Intravenous Morphine and Topical Tetracaine for Treatment of Pain in Preterm Neonates Undergoing Central Line Placement
Authors: Anna Taddio
Journal: JAMA (2006)

There is limited evidence of the analgesic effectiveness of opioid analgesia or topical anesthesia during central line placement in neonates, and there are no previous studies of their relative effectiveness.To determine the effectiveness and safety of topical tetracaine, intravenous morphine, or tetracaine plus morphine for alleviating pain in ventilated neonates during central line placement.Randomized, double-blind, controlled trial enrolling 132 ventilated neonates (mean gestational age, 30.6 [SD, 4.6] weeks at study entry) and conducted between October 2000 and July 2005 in 2 neonatal intensive care units in Toronto, Ontario.Prior to central line insertion, neonates were randomly assigned to receive tetracaine (n = 42), morphine (n = 38), or both (n = 31); a separate nonrandomized group of 21 neonates receiving neither tetracaine nor morphine was used as a control group.The primary outcome measure was a pain score for the proportion of time neonates displayed facial grimacing (brow bulge) during different phases of the procedure (skin preparation, needle puncture, and recovery). In randomized neonates, safety assessments included blood pressure, ventilatory support, and local skin reactions.Compared with no treatment, pain scores were lower in the morphine and tetracaine-morphine groups during skin preparation (mean difference, -0.22; 95% confidence interval [CI], -0.4 to -0.04; P = .02 and -0.29; 95% CI, -0.49 to -0.09; P = .01, respectively), and needle puncture (mean difference, -0.35; 95% CI, -0.57 to -0.13; P = .003 and -0.47; 95% CI, -0.71 to -0.24; P<.001, respectively), but pain scores did not differ statistically for tetracaine alone vs no treatment. Pain scores were lower for morphine and tetracaine-morphine vs tetracaine during the skin preparation phase and for tetracaine-morphine vs tetracaine during needle puncture. Compared with neonates without morphine, morphine-treated neonates required larger increases in ventilation rate in the first 12 hours (mean difference, 3.9/min; 95% CI, 1.3-6.5/min; P = .003). Local skin reactions occurred in 30% of neonates given tetracaine vs 0% for morphine (risk difference, 0.30; 95% CI, 0.19-0.41; P<.001).In this study of ventilated neonates undergoing central line placement, morphine and tetracaine plus morphine provided superior analgesia to tetracaine; however, morphine caused respiratory depression and tetracaine caused erythema.Clinical Trials Registration ClinicalTrials.gov Identifier: NCT00213200.
Adaptation of Medical Education to Regional Needs
Authors: J. F. Brock
Journal: New England Journal of Medicine (1964)

THE medical school of the University of Cape Town celebrated its fiftieth anniversary in 1963.‡ Its traditions developed from the medical schools of Great Britain and particularly from those of Scotland, where many members of the early medical staff were recruited. Its students had been prepared at secondary schools very similar to those of Scotland so that comparatively little regional adaptation was, in theory, required.The training before registration follows closely that of the British tradition — that is, six full years (only a short summer break) from high school to qualifying degree (M.B., Ch.B.), followed by a compulsory intern . . .
Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample
Authors: T S Han, E M van Leer, J C Seidell, M E J Lean
Journal: BMJ (1995)

<h3>Abstract</h3> Objective: To determine the frequency of cardiovascular risk factors in people categorised by previously defined “action g126 levels” of waist circumference. Design: Prevalence study in a random population sample. Setting: Netherlands. Subjects: 2183 men and 2698 women aged 20-59 years selected at random from the civil registry of Amsterdam and Maastricht. Main outcome measures: Waist circumference, waist to hip ratio, body mass index (weight (kg)/height (m<sup>2</sup>)), total plasma cholesterol concentration, high density lipoprotein cholesterol concentration, blood pressure, age, and lifestyle. Results: A waist circumference exceeding 94 cm in men and 80 cm in women correctly identified subjects with body mass index of &gt;/=25 and waist to hip ratios &gt;/=0.95 in men and &gt;/=0.80 in women with a sensitivity and specificity of &gt;/=96%. Men and women with at least one cardiovascular risk factor (total cholesterol &gt;/=6.5 mmol/l, high density lipoprotein cholesterol &lt;/=0.9 mmol/l, systolic blood pressure &gt;/=160 mm Hg, diastolic blood pressure &gt;/=95 mm Hg) were identified with sensitivities of 57% and 67% and specificities of 72% and 62% respectively. Compared with those with waist measurements below action levels, age and lifestyle adjusted odds ratios for having at least one risk factor were 2.2 (95% confidence interval 1.8 to 2.8) in men with a waist measurement of 94-102 cm and 1.6 (1.3 to 2.1) in women with a waist measurement of 80-88 cm. In men and women with larger waist measurements these age and lifestyle adjusted odds ratios were 4.6 (3.5 to 6.0) and 2.6 (2.0 to 3.2) respectively. Conclusions: Larger waist circumference identifies people at increased cardiovascular risks.
Retrograde BMP Signaling Controls Synaptic Growth at the NMJ by Regulating Trio Expression in Motor Neurons
Authors: Robin W. Ball, Maude Warren-Paquin, Kazuya Tsurudome, Edward H. Liao, Fatima Elazzouzi, Chelsea Cavanagh, Beum-Soo An, Tian-Tian Wang, John H. White, A. Pejmun Haghighi
Journal: Neuron (2010)
Scientists discover how helicobacter survives gastric acid
Authors: A. Berger
Journal: BMJ (2000)

The puzzle of how Helicobacter pylori manages to live happily in the hostile acidic environment of the stomach has been solved. Scientists at the University of California in Los Angeles, have discovered that H pylori has a unique, acid gated membrane channel, which effectively controls the amount of alkali produced by the bacterium to combat gastric acid, allowing it to survive and grow in gastric acid.

They have also identified the gene that encodes …
Fundamentals of Clinical Hematology
Authors: Mehdi Tavassoli
Journal: JAMA (1985)

The corpulence of the body of medical knowledge is well reflected in the corpulence of our textbooks. Since their first editions in 1892, 1927, and 1942, Osler's (now Harvey's)<i>The Principles and Practice of Medicine</i>, Cecil's<i>Texbook of Medicine</i>, and Wintrobe's<i>Clinical Hematology</i>have grown 50%, 100%, and 250%, respectively, with pages now numbering in the thousands. In earlier years, such works did indeed serve as textbooks, and students could read several in their entirety during their medical school years. In our time, however, textbooks have attained encyclopedic dimensions and serve primarily as reference sources. No medical student does or is expected to read cover to cover the textbooks for subjects in their curriculum. In response a new genre has arisen: introductory volumes of manageable size, intended to bring the reader the essentials of a particular subject. In fact, they often carry in their titles such designations as "fundamental," "essential,"
On the Health Consequences of Bereavement
Authors: Malcolm P. Rogers, Peter Reich
Journal: New England Journal of Medicine (1988)

The death of a spouse and, perhaps even more, the death of a child have been widely viewed as the most stressful of all human experiences. The belief that such stresses have adverse effects on health is so embedded in folklore that the relative lack of scientific support for such a belief has often been overlooked.In fact, bereavement offers an unusually good opportunity to study a stressful life event in terms of its consequences for health. By nature, bereavement lends itself to the rigorous experimental design of long-term, prospective, epidemiologic studies. Furthermore, the grief reaction has been the subject . . .
Aspirin, Heparin, and Fibrinolytic Therapy in Suspected Acute Myocardial Infarction
Authors: Rory Collins, Richard Peto, Colin Baigent, Peter Sleight
Journal: New England Journal of Medicine (1997)

In this article, we review the randomized clinical trials of aspirin, of heparin, and of fibrinolytic therapy in patients with suspected acute myocardial infarction to determine which of these treatments have been shown to improve survival and other major clinical outcomes.AspirinBenefits of Aspirin during and after Suspected Myocardial InfarctionThe Second International Study of Infarct Survival (ISIS-2) demonstrated conclusively the substantial value of aspirin therapy in patients with suspected acute myocardial infarction1 (and other studies have shown the value of aspirin in patients with unstable angina2). In the ISIS-2 trial, assignment to one month of treatment with . . .
Treatment options for trigeminal neuralgia
Authors: A. F A Merrison
Journal: BMJ (2003)

The evidence is poor for most non-drug options, but such treatments are needed 

Patients describe the sudden and severe pain of trigeminal neuralgia as a “red hot needle” or “forked lightning” pain in the face. The French term “tic doloreux” emphasises the suddenness of the pain that may be triggered by touch or cold. This characteristic pain affects four to five people in 100 000. It occurs in bouts lasting weeks or months, with periods of remission of months or years. Evidence is increasing that in most patients trigeminal neuralgia is caused by compression of the trigeminal nerve root, close to its entry into the pons, by an aberrant arterial or venous loop.1 Other compressive lesions are responsible in a few patients. About 2% of patients with trigeminal neuralgia have multiple sclerosis. Standard first line treatment is carbamazepine.2 3 Other drugs including lamotrigine, phenytoin, gabapentin, oxcarbazepine, topiramate, baclofen, and clonazepam have some effect, although studies are more limited.3 Many patients fail to have …
CALCIFICATION OF THE SUPRARENAL GLANDS OF CATS
Authors: David Marine
Journal: The Journal of Experimental Medicine (1926)

Calcification of the fascicular zone of the cortex has been observer in 64 of 257 cats. It is always calcification and never ossification It is more common in young animals and in our experience is associated with distemper. In its severe forms it may be recognized clinically. The symptoms resemble those seen in cats surviving double suprarenalectomy for 2 to 3 weeks. The toxin producing the focal degeneration is dearly a very specific one since attempts to produce such lesions by several types of experimental injury have failed. The sequence of events appears to be similar to that present in other degenerative processes associated with calcification, namely cell injury and necrosis, deposition of calcium at first as fatty compounds which later change to carbonate and phosphate. It is suggested that this lesion should be considered in interpreting experiments in which cats are used.
Diagnostic potential of cardiac natriuretic peptides in dialysis patients
Authors: Francesca Mallamaci, Carmine Zoccali, Giovanni Tripepi, Francesco A. Benedetto, Saverio Parlongo, Alessandro Cataliotti, Sebastiano Cutrupi, Giuseppe Giacone, Ignazio Bellanuova, Benedetta Stancanelli, Lorenzo S. Malatino, None on behalf of the CREED INVESTIGATORS
Journal: Kidney International (2001)
1155 INTERPRETABILITY AND REFERENCE VALUES OF LIVER INJURY BIOMARKERS FIBROTEST AND ACTITEST (FT-AT). A GLOBAL ANALYSIS OF 354,143 CONSECUTIVE ASSESSMENTS
Authors: T. Poynard, M. Munteanu, O. Deckmyn, Y. Ngo, F. Drane, D. Messous, V. Ratziu, J.M. Castille, C. Housset, F. Imbert-Bismut
Journal: Journal of Hepatology (2010)
<i>Herpesvirus hominis</i>Encephalitis in Michigan
Authors: David C. Nolan, Mary M. Carruthers, A. Martin Lerner
Journal: New England Journal of Medicine (1970)

Of 13 patients who had Herpesvirus hominis encephalitis in Michigan during a 30-month period six were seen within 13 months at a single medical center and treated with idoxuridine. In four patients cerebrospinal fluids were normal, but the electroencephalogram was abnormal in every patient. Biopsies of the brain in five patients revealed H. hominis in two and intranuclear inclusions in one. Therapy was based on a presumptive clinical diagnosis, later confirmed by a striking rise in complement-fixing antibodies. Four of the six treated patients have recovered and resumed all their usual activities. Idoxuridine appears to be effective therapy for this devastating form of encephalitis.