tbuckley/cabot-search huggingface dataset:
n–3 Fatty Acids and Cardiovascular Events after Myocardial Infarction
Authors: Daan Kromhout, Erik J. Giltay, Johanna M. Geleijnse
Journal: New England Journal of Medicine (2010)

Results from prospective cohort studies and randomized, controlled trials have provided evidence of a protective effect of n-3 fatty acids against cardiovascular diseases. We examined the effect of the marine n-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and of the plant-derived alpha-linolenic acid (ALA) on the rate of cardiovascular events among patients who have had a myocardial infarction.In a multicenter, double-blind, placebo-controlled trial, we randomly assigned 4837 patients, 60 through 80 years of age (78% men), who had had a myocardial infarction and were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy to receive for 40 months one of four trial margarines: a margarine supplemented with a combination of EPA and DHA (with a targeted additional daily intake of 400 mg of EPA-DHA), a margarine supplemented with ALA (with a targeted additional daily intake of 2 g of ALA), a margarine supplemented with EPA-DHA and ALA, or a placebo margarine. The primary end point was the rate of major cardiovascular events, which comprised fatal and nonfatal cardiovascular events and cardiac interventions. Data were analyzed according to the intention-to-treat principle, with the use of Cox proportional-hazards models.The patients consumed, on average, 18.8 g of margarine per day, which resulted in additional intakes of 226 mg of EPA combined with 150 mg of DHA, 1.9 g of ALA, or both, in the active-treatment groups. During the follow-up period, a major cardiovascular event occurred in 671 patients (13.9%). Neither EPA-DHA nor ALA reduced this primary end point (hazard ratio with EPA-DHA, 1.01; 95% confidence interval [CI], 0.87 to 1.17; P=0.93; hazard ratio with ALA, 0.91; 95% CI, 0.78 to 1.05; P=0.20). In the prespecified subgroup of women, ALA, as compared with placebo and EPA-DHA alone, was associated with a reduction in the rate of major cardiovascular events that approached significance (hazard ratio, 0.73; 95% CI, 0.51 to 1.03; P=0.07). The rate of adverse events did not differ significantly among the study groups.Low-dose supplementation with EPA-DHA or ALA did not significantly reduce the rate of major cardiovascular events among patients who had had a myocardial infarction and who were receiving state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy. (Funded by the Netherlands Heart Foundation and others; ClinicalTrials.gov number, NCT00127452.).
Emancipation of Nurses — Medical Exhibitions — Postscript
Authors: John Lister
Journal: New England Journal of Medicine (1953)

THE emancipation of the hospital nurse has lagged far behind that of the rest of her sex. Not so long ago the nursing student was not allowed to speak to the medical student in the ward except when the conversation strictly concerned the patient. The ward sister (head nurse) was normally regarded as the spoil sport who could arrange to have moved to another part of the hospital any student nurse who appeared too friendly with one of the doctors and who would ensure that the regulations concerning the headgear and dress of her nurses were enforced so that the . . .
De subitaneis mortibus. XXVI. Fatal electrical instabiltiy of the heart associated with benign congenital polycystic tumor of the atrioventricular node.
Authors: T N James, I Galakhov
Journal: Circulation (1977)

Benign congenital polycystic tumors of the atrioventricular (A-V) node are an unusual but not very rare cause of heart block. Two such cases are presented and discussed in conjunction with the reported experience of other. The tumor is always within and only very near the A-V node, seldom involves more than the proximal end of the His bundle, and has not been reported to occur in the sinus node. Although sudden death has been reported in conjunction with these tumors, a surprising number of other patients have lived to old age and died of causes unrelated to the A-V nodal tumor. As a corollary it is important to consider a diagnosis of A-V nodal tumor in any patient of any age who presents with otherwise unexplained heart block or syncope. From accumulated experience it appears that such patients do not tolerate electronic pacing safely and some possible explanations for this are discussed. Escape rhythm in all reported cases has been characterized by QRS complexes which are narrow and a ventricular rate which is from half to two-thirds of the sinus rate. Reasons why an A-V junctional rhythm which is 66% of sinus rate may be especially stable are discussed.
Benign Intracranial and Neck Bruits in an Adult
Authors: J. NORMAN BERRY
Journal: Annals of Internal Medicine (1965)

Case Studies1 October 1965Benign Intracranial and Neck Bruits in an AdultJ. NORMAN BERRY, M.D., F.A.C.P.J. NORMAN BERRY, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-63-4-661 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough intracranial bruits of benign origin are common in infants and younger children, such bruits when found in adults are nearly always of pathologic origin. The purpose of the present report is to cite an example of benign intracranial and neck bruits in an adult and to speculate on their possible mechanisms of origin.CASE REPORTA 36-year-old Caucasian housewife was admitted to Piedmont Hospital in December, 1961, for investigation of seizures. These were precipitated by abrupt meprobamate withdrawal in the presence of a lowered seizure threshold and will be discussed in detail elsewhere (1). The initial examination disclosed: [1]...References1. BERRY JN: Latent epilepsy unmasked by abrupt meprobamate withdrawal. Submitted for publication. Google Scholar2. WADIAMONCKTON NHG: Intracranial bruits in health and disease. Brain 80: 492, 1957. CrossrefMedlineGoogle Scholar3. HAMMONDEISINGER JHRP, Carotid bruits in 1,000 normal subjects. Arch. Intern. Med. 109: 563, 1962. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Atlanta, GeorgiaFrom the Piedmont Hospital, Atlanta, Ga.Requests for reprints should be addressed to J. Norman Berry, M.D., 6363 Roswell Rd., N.E., Atlanta, Ga. 30328. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byClinical Evaluation of Cerebrovascular Physiology 1 October 1965Volume 63, Issue 4Page: 661-663KeywordsChildrenEpileptic seizuresInfantsYoung adults Issue Published: 1 October 1965 PDF downloadLoading ...
Effect of Antecedent Glucose Control on Cerebral Function During Hypoglycemia
Authors: Stephanie A Amiel, Richard C Pottinger, Helen R Archibald, Gary Chusney, David TF Cunnah, Pamela F Prior, Edwin AM Gale
Journal: Diabetes Care (1991)

Objective The incidence of both severe and asymptomatic hypoglycemia is increased threefold in intensively treated diabetic patients. To examine whether this reflects cerebral adaptation to low blood glucose levels, we investigated the effect of preceding glycemic experience on hormonal, EEG, and evoked potential responses to experimentally induced hypoglycemia with the slow-fall clamp. Research Design and Methods Three groups were examined: well-controlled diabetic patients and patients with insulinoma (group 1), poorly controlled diabetic patients (group 2), and nondiabetic subjects (group 3). Results The glucose threshold for epinephrine release was lower in group 1 (2.3 ± 0.1 vs. 3.0 ± 0.3 and 3.1 ± 0.1 mM, P &amp;lt; 0.02), and the peak epinephrine response was reduced (1.29 ± 0.36 vs. 5.48 ± 1 and 5.62 ± 1.2 nM, P &amp;lt; 0.01) compared with groups 2 and 3, whereas symptoms were not perceived until a lower blood glucose level had been reached (2.0 ± 0.2 vs. 3.3 ± 0.4 and 2.6 ± 0.2 mM, P &amp;lt; 0.01). Other counterregulatory responses were similarly delayed and diminished. In contrast, EEG changes that were compatible with hypoglycemia were detected in all subjects in group 1 (blood glucose 1.9 ± 0.1 mM) but in only two in group 2 and none in group 3, despite similar blood glucose nadirs. Conclusions The glycemic threshold for hormonal responses to hypoglycemia falls in individuals with intensively treated diabetes or insulinomas, but these patients are more likely to develop EEG abnormalities during hypoglycemia. This disparity helps explain the increased vulnerability of intensively treated patients to severe hypoglycemia.
Commentary: Diagnosing ovarian cancer--more problems than answers
Authors: Robin Fox
Journal: BMJ (2009)

The primary care based case-control study by Hamilton and colleagues (doi:10.1136/bmj.b2998) identified seven symptoms associated with ovarian cancer: abdominal distension, urinary frequency, abdominal pain, postmenopausal bleeding, loss of appetite, rectal bleeding, and abdominal bloating. The report of the first three of these symptoms at least six months before diagnosis was significantly associated with ovarian cancer. The positive predictive values were below 1%, except for abdominal distension, which had a positive predictive value of 2.5%. This study adds to the evidence base derived from primary care of red flag symptoms for several cancers.1 This is important as most patients in the United Kingdom present initially to primary rather than secondary care.

These findings are broadly concordant with the recent …
Colon carcinoma cell interaction with liver sinusoidal endothelium inhibits organ-specific antitumor immunity through interleukin-1-induced mannose receptor in mice
Authors: Beatriz Arteta, Nerea Lasuen, Aritz Lopategi, Baldur Sveinbjörnsson, Bård Smedsrφd, Fernando Vidal-Vanaclocha
Journal: Hepatology (2010)

Mannose receptor (ManR)-mediated liver sinusoidal endothelial cell (LSEC) endocytosis plays a role in antigen presentation and innate immunity, but its role in hepatic metastasis is unknown. We studied ManR-mediated endocytosis during C26 colorectal cancer cell interaction with LSECs and its implications in metastasis. Uptake of labeled ManR ligands (mannan and ovalbumin) and immunohistochemistry were used to study ManR endocytosis and expression. Several interleukin (IL)-1 inhibitors and the cyclooxygenase-2 (COX-2) inhibitor celecoxib were used to analyze the role of IL-1 and COX-2 in ManR regulation. Anti-mouse ManR antibodies and ManR knockout (ManR(-/-)) mice were used to identify ManR-dependent mechanisms during antitumor immune response of liver sinusoidal lymphocytes (LSLs) interacting with tumor-activated LSECs. ManR expression and endocytosis increased in tumor-activated LSECs through a two-step mechanism: (1) Release of COX-2-dependent IL-1-stimulating factors by lymphocyte function-associated antigen-1-expressing C26 cells in response to intercellular adhesion molecule-1 (ICAM-1), which was expressed and secreted by tumor-activated LSECs; and (2) widespread up-regulation of ManR in LSECs through tumor-induced IL-1. In addition, LSLs that had interacted with tumor-activated LSECs in vivo decreased their antitumor cytotoxicity and interferon (IFN)-gamma secretion while they increased IL-10 release ex vivo. IFN-gamma/IL-10 ratio also decreased in the hepatic blood from tumor-injected mice. Immunosuppressant effects of tumor-activated LSECs on LSLs were abrogated in both LSECs from ManR(-/-) mice and tumor-activated LSECs given anti-mouse ManR antibodies. ICAM-1-induced tumor COX-2 decreased antitumor activity during hepatic metastasis through IL-1-induced ManR. ManR constituted a common mediator for prometastatic effects of IL-1, COX-2, and ICAM-1. A rise in hepatic IFN-gamma/IL-10 ratio and antitumor cytotoxicity by way of ManR blockade is consistent with the antimetastatic effects of IL-1, COX-2, and ICAM-1 inhibitors. These data support ManR and ManR-stimulating factors as targets for hepatic colorectal metastasis therapy.
Prosthetic joint infection by cat scratch
Authors: J. Ciampolini, J. Timperley, M. Morgan
Journal: Journal of the Royal Society of Medicine (2004)

and the eye is treated with topical steroids. 3,4The condition is well reported in patients whose M. avium complex infection is HIV-associated, but immunocompetent individuals have also been affected. 5There seems to be a dose effect, with higher incidence and earlier onset with 600 mg than with 300 mg-cumulative risk at seven months 48% and 13%.With rifabutin withdrawal, uveitis lasted 4 days; with rifabutin continuation it persisted for nearly seven weeks.Low body weight increased the risk. 6he mechanism of rifabutin-associated uveitis is unknown.Some workers have proposed a Jarisch-Herxheimer-like reaction due to release of toxins by lysed bacteria.Against this hypothesis is the fact that, in M. avium infection, uveitis develops long after sterilization has been achieved whereas Herxheimer reactions occur soon after the start of treatment.Also, uveitis is not a side-effect of other drugs (such as clarithromycin) active against this infection.In the two published studies on Crohn's disease treated with rifabutin, 1,2 the incidence of uveitis was 4/46 and 1/7.Gastroenterologists and others using rifabutin for this purpose need to be aware of this side-effect and warn the patient.
PTU-082 Faecal Incontinence in Inflammatory Bowel Disease: we Don’T ask and they don’t Tell
Authors: J Duncan, G Sebepos-Rogers, O Poole-Wilson, C To, J B Canavan, V Kariyawasam, M Ward, R Goel, K Patel, A Stanton, M Sastrillo, S Anderson, K Taylor, J Sanderson, P Irving
Journal: Gut (2013)

<h3>Introduction</h3> The deleterious effect of faecal incontinence (FI) on quality of life (QOL) is well documented. People with FI experience stigma, embarrassment and social exclusion, and report adverse effects on activities and relationships. Restoration of continence is associated with improvement in QOL. Diarrhoea is associated with increased prevalence of FI and, therefore, people with inflammatory bowel disease (IBD) are at risk. <h3>Methods</h3> To investigate how frequently health care professionals (HCPs) assess FI in a cohort of patients with IBD we performed a cross sectional survey of 380 adults attending a tertiary referral IBD clinic. Patient surveys were: the validated ICIQ-B questionnaire, detailing frequency and severity of bowel pattern, control and quality of life; and the non-validated Bowel Leakage Questionnaire, detailing any prior interventions by health care professionals. Demographics of age, gender, diagnosis, Montreal classification, St Mark’s Continence Score and disease activity were also recorded. Data was entered into a database and analysed using SPSS statistical package. <h3>Results</h3> 229/380 (60%) had Crohn’s Disease (CD) and 180/380 (47%) were female. Median age was 38 years (IQR:31–50) with a median disease duration of 8.7 years (3.4–15.1). 343/380 (90%) had experienced incontinence of flatus or faeces while 255/380 (67%) reported FI. Only 136/380 (36%) had been asked about FI during an encounter with a HCP. Of the people who had been asked about FI, the vast majority had been asked in IBD clinics (130/136, 96%). Fewer enquiries were made by HCPs in a primary care setting with 42/136 (31%) people having been asked by a family doctor and 12/136 (9%) by a practise nurse. A minority of patients spontaneously volunteered information about incontinence to a healthcare professional (146/380, 39%). Of the people who had discussed continence issues with a HCP, 55 (38%) were offered specific advice or referral for treatment. Those who volunteered information regarding continence had worse ICIQ-B control scores (9 (6–14) vs 3 (1–8), p &lt; 0.0001)) and quality of life scores (16 (11–20) vs 9 [6–14], p &lt; 0.0001), reflecting greater burden of disease. <h3>Conclusion</h3> Faecal incontinence is common in IBD. It is both under-reported by patients and under-recognised by healthcare professionals. Because symptoms and QOL can be significantly improved with appropriate intervention, HCPs need to enquire about FI as part of routine assessment. <h3>Disclosure of Interest</h3> None Declared
Determinants of postprandial triglyceride and glucose responses after two consecutive fat-rich or carbohydrate-rich meals in normoglycemic women and in women with type 2 diabetes mellitus: the Hoorn Prandial Study
Authors: Marjan Alssema, Roger K. Schindhelm, Jacqueline M. Dekker, Michaela Diamant, Giel Nijpels, Tom Teerlink, Peter G. Scheffer, Piet J. Kostense, Robert J. Heine
Journal: Metabolism (2008)
Talking with Younger Patients
Authors: DONALD J. HOLMES
Journal: Annals of Internal Medicine (1970)

Perspective1 January 1970Talking with Younger PatientsDONALD J. HOLMES, M.D.DONALD J. HOLMES, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-72-1-123 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTalking with younger people is not the formidable, at times seemingly impossible, labor that many of us are apt to consider it.When adolescents and college-age youngsters tell me about the communications problems they have with their parents, there are times when I lose control of my impulses and blurt out: "Gap! There must be a better name for it than that—more like a gulf—an unspannable chasm!"But seldom is it really that bad. Many of these garden variety conflicts do not stem from any fundamental disagreements between the young and old about moral values. It is just that a... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Ann Arbor, Michigan▸From the Neuropsychiatric Institute, The University of Michigan Medical Center, Ann Arbor, Mich. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 January 1970Volume 72, Issue 1Page: 123-127KeywordsAdolescents Issue Published: 1 January 1970 PDF downloadLoading ...
A Novel Drug for Treatment of Necrotizing Soft-Tissue Infections
Authors: Eileen M. Bulger, Ronald V. Maier, Jason Sperry, Manjari Joshi, Sharon Henry, Frederick A. Moore, Lyle L. Moldawer, Demetrios Demetriades, Peep Talving, Martin Schreiber, Bruce Ham, Mitchell Cohen, Steven Opal, Irit Segalovich, Greg Maislin, Raymond Kaempfer, Anat Shirvan
Journal: JAMA Surgery (2014)

Necrotizing soft-tissue infections (NSTI) have high morbidity and mortality rates despite aggressive surgical debridement and antibiotic therapy. AB103 is a peptide mimetic of the T-lymphocyte receptor, CD28. We hypothesized that AB103 will limit inflammatory responses to bacterial toxins and decrease the incidence of organ failure. To establish the safety of AB103 in patients with NSTI and evaluate the potential effects on clinically meaningful parameters related to the disease. A prospective, randomized, placebo-controlled, double-blinded study was performed in 6 academic medical centers in the United States. Participants included adults with NSTI. Of 345 patients screened, 43 were enrolled for the intent-to-treat analysis, and 40 met criteria for the modified intent-to-treat analysis; 15 patients each were included in the high-dose and low-dose treatment arms, and 10 in the placebo arm. Single intravenous dose of AB103 (0.5 or 0.25 mg/kg) within 6 hours after diagnosis of NSTI. Change in the Sequential Organ Failure Assessment score within 28 days, intensive care unit-free and ventilator-free days, number and timing of debridements, plasma and tissue cytokine levels at 0 to 72 hours, and adverse events. Baseline characteristics were comparable in the treatment groups. The Sequential Organ Failure Assessment score improved from baseline in both treatment groups compared with the placebo group at 14 days (change from baseline score, -2.8 in the high-dose, -2 in the low-dose, and +1.3 in the placebo groups; P = .04). AB103-treated patients had a similar number of debridements (mean [SD], 2.2 [1.1] for the high-dose, 2.3 [1.2] for the low-dose, and 2.8 [2.1] for the placebo groups; P = .56). There were no statistically significant differences in intensive care unit-free and ventilator-free days or in plasma and tissue cytokine levels. No drug-related adverse events were detected. AB103 is a safe, promising new agent for modulation of inflammation after NSTI. Further study is warranted to establish efficacy. clinicaltrials.gov Identifier: NCT01417780.
Meta-Analysis: Accuracy of Quantitative Ultrasound for Identifying Patients with Osteoporosis
Authors: Smita Nayak, Ingram Olkin, Hau Liu, Michael Grabe, Michael K. Gould, I. Elaine Allen, Douglas K. Owens, Dena M. Bravata
Journal: Annals of Internal Medicine (2006)

There is increased interest in quantitative ultrasound for osteoporosis screening because it predicts fracture risk, is portable, and is relatively inexpensive. However, there is no consensus regarding its accuracy for identifying patients with osteoporosis.To determine the sensitivity and specificity of calcaneal quantitative ultrasound for identifying patients who meet the World Health Organization's diagnostic criteria for osteoporosis. Dual-energy x-ray absorptiometry (DXA) was used as the reference standard.MEDLINE (1966 to October 2005), EMBASE (1993 to May 2004), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (1952 to March 2004), and the Science Citation Index (1945 to April 2004).English-language articles that evaluated the sensitivity and specificity of calcaneal quantitative ultrasound for identifying adults with DXA T-scores of -2.5 or less at the hip or spine.Two authors independently reviewed articles and abstracted data.The authors identified 1908 potentially relevant articles, of which 25 met the inclusion criteria, and calculated the sensitivity and specificity of quantitative ultrasound over a range of thresholds. For the quantitative ultrasound index parameter T-score cutoff threshold of -1, sensitivity was 79% (95% CI, 69% to 86%) and specificity was 58% (CI, 44% to 70%) for identifying individuals with DXA T-scores of -2.5 or less at the hip or spine. For a T-score threshold of 0, sensitivity improved to 93% (CI, 87% to 97%) but specificity decreased to 24% (CI, 10% to 47%). At a pretest probability of 22% (for example, a 65-year-old white woman at average risk), the post-test probability of DXA-determined osteoporosis was 34% (CI, 26% to 41%) after a positive result and 10% (CI, 5% to 12%) after a negative result when using a T-score cutoff threshold of -1. Analysis of other quantitative ultrasound parameters (for example, broadband ultrasound attenuation) revealed similar estimates of accuracy.The relatively small number of included studies limited the authors' ability to evaluate the effects of heterogeneous study characteristics on the diagnostic accuracy of quantitative ultrasound.The currently available literature suggests that results of calcaneal quantitative ultrasound at commonly used cutoff thresholds do not definitively exclude or confirm DXA-determined osteoporosis. Additional research is needed before use of this test can be recommended in evidence-based screening programs for osteoporosis.
Maintenance of Sinus Rhythm and Survival in Patients With Heart Failure and Atrial Fibrillation
Authors: Mario Talajic, Paul Khairy, Sylvie Levesque, Stuart J. Connolly, Paul Dorian, Marc Dubuc, Peter G. Guerra, Stefan H. Hohnloser, Kerry L. Lee, Laurent Macle, Stanley Nattel, Ole D. Pedersen, Lynne Warner Stevenson, Bernard Thibault, Albert L. Waldo, D. George Wyse, Denis Roy
Journal: Journal of the American College of Cardiology (2010)