tbuckley/cabot-search huggingface dataset:
Osteopathy, Chiropractic, and Spinal Manipulation
Authors: Gregory Plaugher
Journal: Annals of Internal Medicine (1993)

Letters15 April 1993Osteopathy, Chiropractic, and Spinal ManipulationGregory Plaugher, MDGregory Plaugher, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-8-199304150-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their excellent meta-analysis of the literature on spinal manipulation for the treatment of low-back pain, Shekelle and colleagues [1] distinguish between long-lever rotational manipulations of the lumbar spine and the specific short-lever arm techniques more common to chiropractic practice. All studies in the meta-analysis were done in the medical or physiotherapeutic setting, and most appeared to involve long-lever rotational manipulation of the lumbar spine. The implication that all manipulation has equal value is not consistent with the diverse techniques available.Although the study by Meade and colleagues [2] received the fourth highest quality score and involved ...References1. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH. Spinal manipulation for low-back pain. Ann Intern Med. 1992; 117:590-8. Google Scholar2. Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ. 1990; 300:1431-7. Google Scholar3. Arkuszewski Z. The efficacy of manual treatment in low back pain: a clinical trial. Manual Medicine. 1987; 2:68-71. Google Scholar4. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Park RE, Phillips RB, et al. The appropriateness of spinal manipulation for low-back pain: indications and ratings by an all-chiropractic expert panel. R-4025/3-CCR/FCER. Santa Monica, California: RAND; 1991. Google Scholar Author, Article, and Disclosure InformationAuthors: Gregory Plaugher, MD PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 April 1993Volume 118, Issue 8Page: 651-653KeywordsChiropracticClinical trialsOsteopathyPatientsSciatic nervesSpine ePublished: 15 August 2000 Issue Published: 15 April 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Placebo-Controlled Trials in Osteoporosis — Proceeding with Caution
Authors: Clifford J. Rosen, Sundeep Khosla
Journal: New England Journal of Medicine (2010)

The authors suggest that placebo-controlled trials in osteoporosis can, with appropriate safeguards, benefit some patients with osteoporosis and can be informative, provided that appropriate guidelines are used to exclude high-risk patients.
Diagnosis and Initial Management of Parkinson's Disease
Authors: John G. Nutt, G. Frederick Wooten
Journal: New England Journal of Medicine (2005)

A 62-year-old man presents with an intermittent tremor in his left hand and some vague discomfort in the left arm. Physical examination shows a minimal rest tremor in the left hand that disappears with use of the limb, mild rigidity at the left wrist and elbow, slowness of finger tapping with the left hand, and decreased arm swing on the left while walking. How should he be evaluated and treated?
Early Lung Cancer Action Project: overall design and findings from baseline screening
Authors: Claudia I Henschke, Dorothy I McCauley, David F Yankelevitz, David P Naidich, Georgeann McGuinness, Olli S Miettinen, Daniel M Libby, Mark W Pasmantier, June Koizumi, Nasser K Altorki, James P Smith
Journal: The Lancet (1999)

BackgroundThe Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. We report the baseline experience.MethodsELCAP has enrolled 1000 symptom-free volunteers, aged 60 years or older, with at least 10 pack-years of cigarette smoking and no previous cancer, who were medically fit to undergo thoracic surgery. After a structured interview and informed consent, chest radiographs and low-dose CT were done for each participant. The diagnostic investigation of screen-detected non-calcified pulmonary nodules was guided by ELCAP recommendations, which included short-term high-resolution CT follow-up for the smallest non-calcified nodules.FindingsNon-calcified nodules were detected in 233 (23% [95% CI 21-26]) participants by low-dose CT at baseline, compared with 68 (7% [5-9]) by chest radiography. Malignant disease was detected in 27 (2·7% [1·8–3·8]) by CT and seven (0·7% [0·3–1·3]) by chest radiography, and stage I malignant disease in 23 (2·3% [1·5–3·3]) and four (0·4% [0·1–0·9]), respectively. Of the 27 CT-detected cancers, 26 were resectable. Biopsies were done on 28 of the 233 participants with non-calcified nodules; 27 had malignant non-calcified nodules and one had a benign nodule. Another three individuals underwent biopsy against the ELCAP recommendations; all had benign non-calcified nodules. No participant had thoracotomy for a benign nodule.InterpretationLow-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage. Although false-positive CT results are common, they can be managed with little use of invasive diagnostic procedures.
Targeting development of incretin-producing cells increases insulin secretion
Authors: Natalia Petersen, Frank Reimann, Johan H. van Es, Bernard M. van den Berg, Chantal Kroone, Ramona Pais, Erik Jansen, Hans Clevers, Fiona M. Gribble, Eelco J.P. de Koning
Journal: Journal of Clinical Investigation (2014)

Glucagon-like peptide-1–based (GLP-1–based) therapies improve glycemic control in patients with type 2 diabetes. While these agents augment insulin secretion, they do not mimic the physiological meal-related rise and fall of GLP-1 concentrations. Here, we tested the hypothesis that increasing the number of intestinal L cells, which produce GLP-1, is an alternative strategy to augment insulin responses and improve glucose tolerance. Blocking the NOTCH signaling pathway with the γ-secretase inhibitor dibenzazepine increased the number of L cells in intestinal organoid–based mouse and human culture systems and augmented glucose-stimulated GLP-1 secretion. In a high-fat diet–fed mouse model of impaired glucose tolerance and type 2 diabetes, dibenzazepine administration increased L cell numbers in the intestine, improved the early insulin response to glucose, and restored glucose tolerance. Dibenzazepine also increased K cell numbers, resulting in increased gastric inhibitory polypeptide (GIP) secretion. Using a GLP-1 receptor antagonist, we determined that the insulinotropic effect of dibenzazepine was mediated through an increase in GLP-1 signaling. Together, our data indicate that modulation of the development of incretin-producing cells in the intestine has potential as a therapeutic strategy to improve glycemic control.
THE PROBLEM OF OTOSCLEROSIS
Authors: G. Chubb
Journal: BMJ (1936)

found radiographic changes in the bones and joints in 95 per cent. of all cases of leprosy.The changes affect mainly the distal ends of the extremities.They are of a destructive nature.They appear under two different forms: (1) local osteoporosis, seen mainly in persons of the hyposthenic type ; (2) osteo-articular destruction, seen only in pronounced cases of leprosy of the nervous system.
Impact of the Mexican Program for Education, Health, and Nutrition (Progresa) on Rates of Growth and Anemia in Infants and Young Children
Authors: Juan A. Rivera, Daniela Sotres-Alvarez, Jean-Pierre Habicht, Teresa Shamah, Salvador Villalpando
Journal: JAMA (2004)

Malnutrition causes death and impaired health in millions of children. Existing interventions are effective under controlled conditions; however, little information is available on their effectiveness in large-scale programs.To document the short-term nutritional impact of a large-scale, incentive-based development program in Mexico (Progresa), which included a nutritional component.A randomized effectiveness study of 347 communities randomly assigned to immediate incorporation to the program in 1998 (intervention group; n = 205) or to incorporation in 1999 (crossover intervention group; n = 142). A random sample of children in those communities was surveyed at baseline and at 1 and 2 years afterward. Participants were from low-income households in poor rural communities in 6 central Mexican states. Children (N = 650) 12 months of age or younger (n = 373 intervention group; n = 277 crossover intervention group) were included in the analyses.Children and pregnant and lactating women in participating households received fortified nutrition supplements, and the families received nutrition education, health care, and cash transfers.Two-year height increments and anemia rates as measured by blood hemoglobin levels in participating children.Progresa was associated with better growth in height among the poorest and younger infants. Age- and length-adjusted height was greater by 1.1 cm (26.4 cm in the intervention group vs 25.3 cm in the crossover intervention group) among infants younger than 6 months at baseline and who lived in the poorest households. After 1 year, mean hemoglobin values were higher in the intervention group (11.12 g/dL; 95% confidence interval [CI], 10.9-11.3 g/dL) than in the crossover intervention group (10.75 g/dL; 95% CI, 10.5-11.0 g/dL) who had not yet received the benefits of the intervention (P =.01). There were no differences in hemoglobin levels between the 2 groups at year 2 after both groups were receiving the intervention. The age-adjusted rate of anemia (hemoglobin level <11 g/dL) in 1999 was higher in the crossover intervention group than in the intervention group (54.9% vs 44.3%; P =.03), whereas in 2000 the difference was not significant (23.0% vs 25.8%, respectively; P =.40).Progresa, a large-scale, incentive-based development program with a nutritional intervention, is associated with better growth and lower rates of anemia in low-income, rural infants and children in Mexico.
Meshing Glenberg with Piaget, Gibson, and the ecological self
Authors: Richard A. Carlson
Journal: Behavioral and Brain Sciences (1997)

Glenberg's rethinking of memory theory seems limited in its ability to handle abstract symbolic thought, the selective character of cognition, and the self. Glenberg's framework can be elaborated by linking it with theoretical efforts concerned with cognitive development (Piaget) and ecological perception (Gibson). These elaborations point to the role of memory in specifying the self as an active agent.
A False-positive lndium-111 Labeled Leukocyte Scintigram in a Patient with a Painful Hip Prosthesis
Authors: NATHAN FELDMAN, P TODD MAKLER, ABASS ALAVI
Journal: Clinical Nuclear Medicine (1986)

A Tronzo hip prosthesis is designed to elicit an inflammatory reaction in order to promote prosthesis stability. A three-phased bone scan and Ga-67 imaging in conjunction with physical examination and laboratory findings failed to demonstrate evidence for osteomyelitis in a patient with a painful hip prosthesis, in whom images obtained with in-111-labeled leukocytes were positive. This observation demonstrated that the interpretation of the latter technique in demonstrating inflammation can cause a false impression of an infectious process.
The PowerPoint presentation
Authors: David Isaacs, Stephen Isaacs, Dominic Fitzgerald
Journal: BMJ (2007)

The main purpose of a PowerPoint presentation is entertainment. Intellectual content is an unwarranted distraction. In preparing a PowerPoint presentation, aesthetics should transcend substance.

The background colour scheme and logo for your slides should be selected for maximum emetogenic potential. The first inverse ridicule rule of PowerPoint presentation states: “The more lines of writing that can be coerced onto a slide and the smaller the font, the lower the …
Decompression sickness in fish farm workers: a new occupational hazard.
Authors: J D Douglas, A H Milne
Journal: BMJ (1991)

Fish farming is a new industry that needs divers to maintain the cages in which the fish are kept. Dead fish in a cage provide a focus of infection for healthy fish and must be cleared out regularly. Some fish farmers think that the most effective method of clearing dead fish is with divers, but this new diving practice also has its problems. We report three anomalous cases of decompression sickness
Predictors of clinical course, coronary anatomy and left ventricular function after recovery from acute myocardial infarction.
Authors: G J Taylor, J O Humphries, E D Mellits, B Pitt, R A Schulze, L S Griffith, S C Achuff
Journal: Circulation (1980)

Patients who survive an acute myocardiac infarction (AMI) have significant coronary disease and are at risk for angina pectoris, recurrent myocardiac infarction and sudden death. This study provides data gathered prospectively for 106 patients surviving myocardial infarction who had coronary arteriography, left ventriculography and 24-hour electrocadiographic recordings before hospital discharge and were followed 30 months. Univariate analysis showed that low ejection fraction, proximal left anterior descending coronary disease and significant disease in all three coronary arteries were associated with a high risk of sudden cardial death. The ECG location or type of infarction was not helpful in predicting mortality, reinfarction or continuing angina. Multivariate analysis of 30 clinical and laboratory variables identified previous myocardial infarction and an ejection fraction less than 40% as the best predictors of mortality; all 13 patients who died were identified by these two variables. Three-vessel coronary artery disease, proximal left coronary disease and complicated late hospital-phase ventricular arrhythmias did not provide additional information about mortality once the information provided by the first two variables was considered. Multivariate analysis identified hypertension, three-vessel coronary disease, postinfarction angina pectoris and previous AMI as significant predictors of recurrent AMI during the 30 month follow-up.
Management of Dyslipidemia in Adults With Diabetes
Authors: Steven M Haffner
Journal: Diabetes Care (1998)

Subjects with diabetes have a greatly increased risk of CHD, which is only partially related to their elevated glucose. Other factors such as insulin resistance and dyslipidemia are likely to be important. The type of dyslipidemia that is most characteristic of type 2 diabetic subjects is elevated triglycerides and decreased HDL cholesterol levels, although all lipoproteins have compositional abnormalities. Surprisingly few good prospective studies of lipoprotein levels in relation to CHD have been done in diabetic subjects. Available studies suggest that low HDL cholesterol may be the most important risk factor for CHD in observational studies. In studies in which total cholesterol and triglyceride were done, cholesterol and triglycerides were risk factors for CHD, although triglycerides were often a stronger predictor. However, the strength of triglyceride as a risk factor for CHD may depend partially on its association with other variables (e.g., hypertension, plasminogen activator inhibitor 1 [PAI-1], etc.). In clinical trials in diabetic subjects, LDL reduction with statins has led to significant reductions in CHD incidence. In addition, overall mortality was reduced with statin therapy, although the results were not statistically significant. Gemfibrozil has led to reductions in CHD incidence in diabetic subjects, although the results were not statistically significant perhaps because of low sample size. Regarding lipoproteins and CHD risk in diabetic patients, the very positive results of statin trials point to LDL cholesterol being more important than previous realized. Apparently, having a borderline high LDL cholesterol (between 130 and 160 mg/dl) in a diabetic patient is equivalent to a much higher LDL cholesterol in terms of CHD risk for a nondiabetic subject. Therefore, the primary target of therapy in diabetic patients is lowering LDL cholesterol (or possibly, non-HDL cholesterol). Statins are the preferred pharmacological agent in this situation. Once LDL cholesterol levels have been lowered, attention can be given to treatment of residual hypertriglyceridemia and low HDL. The goal here is weight reduction and increased exercise. However, for selected patients, combining a fibric acid (or low-dose nicotinic acid) with a statin also can be considered. Reduction of LDL levels should take priority over reduction of triglycerides in combined hyperlipidemia because of the proven safety of the statin class of drugs as well as greater reduction in CHD incidence.
Why the Cost of Fast Food Matters
Authors: Mitchell H. Katz
Journal: JAMA Internal Medicine (2014)

Katie A. Meyer, ScD; David K. Guilkey, PhD; Shu Wen Ng, PhD; Kiyah J. Duffey, PhD; Barry M. Popkin, PhD; Catarina I. Kiefe, MD; Lyn M. Steffen, PhD; James M. Shikany, DrPH; Penny Gordon-Larsen, PhD
NICE issues the first of 150 quality standards for the NHS
Authors: D. Cohen
Journal: BMJ (2010)

Patients who have had a stroke should be offered at least 45 minutes of active therapy for at least five days a week, new guidance to drive up the quality of care in dementia, stroke, and venous thromboembolism has said.

The guidance, from the National Institute for Health and Clinical Excellence (NICE), is the first of 150 evidence based quality standards in different areas of health care, developed as part of NICE’s new Quality Standards Programme. Its guidance on neonatal care is expected in the autumn.

Other measures include ensuring people with dementia receive care from health and social care staff who have been adequately trained in dementia care. And patients and carers receive verbal and written information and advice on venous …
PREVENTION AND TREATMENT OF CANCER OF THE UTERUS.
Authors: A. LAPTHORN SMITH
Journal: JAMA (1899)

It takes a long time to get rid of an idea which has been handed down to us for many generations, and which has grown up with us from our earliest years of professional knowledge. Two of the most striking instances of the tenacity with which traditions cling to us are the belief in the heredity of consumption and of cancer. Notwithstanding that every physician can remember cases in his own practice, of both these diseases occurring in patients whose fathers, mothers, grandfathers and grandmothers were absolutely free from any cancerous or tubercular taint, still the constant assertion of. its heredity by the insurance companies and the text-books has kept us from seeing what has been evident to many of the laity during the last twenty years, that these diseases are not hereditary, but that they are on the contrary among the most contagious known.
Protein Kinase A Hyperphosphorylation Increases Basal Current but Decreases β-Adrenergic Responsiveness of the Sarcolemmal Na <sup>+</sup> -Ca <sup>2+</sup> Exchanger in Failing Pig Myocytes
Authors: Shao-kui Wei, Abdul Ruknudin, Stephen U. Hanlon, John M. McCurley, Dan H. Schulze, Mark C.P. Haigney
Journal: Circulation Research (2003)

The sodium-calcium exchanger (NCX) protein is the major cardiac calcium extrusion mechanism and is upregulated in heart failure (HF). NCX expression level and functional activity as regulated by beta-adrenergic receptor (beta-AR) stimulation in swine with and without tachycardia-induced heart failure were studied. The Ni2+-sensitive NCX current was measured in myocytes from HF and control animals in the basal state or in the presence of isoproterenol, forskolin, 8-Br-cAMP, okadaic acid, or protein phosphatase type 1. Western blot analysis revealed a significant increase in both the 120-kDa (29%) and 80-kDa (69%) fragments in HF (P<0.05 versus control). Despite this modest increase in protein, the basal peak outward NCX current was increased almost 5-fold in HF (P<0.05 versus control). Stimulation with isoproterenol, however, increased the control currents to a significantly greater extent than HF (500% increase in control versus 100% increase in HF, P<0.01); peak stimulated current was not different in HF and control. This reduction in responsiveness to beta-AR stimulation was refractory to forskolin, 8-Br-cAMP, or okadaic acid stimulation. In vitro protein kinase A back-phosphorylation revealed higher phosphorylation capacity of NCX protein in control versus HF, consistent with increased phosphorylation in vivo (hyperphosphorylation) in HF. Protein phosphatase type 1 exposure resulted in a significant reduction (73%) in peak basal current in HF (compared with no significant difference in controls), confirming that the increased basal NCX current in HF is predominantly attributable to hyperphosphorylation. NCX expression and activity are thus increased in HF, although beta-AR responsiveness is decreased because of NCX hyperphosphorylation.
Powder administration of pure budesonide for the treatment of seasonal allergic rhinitis
Authors: B. Pedersen, B. BUNDGAARD Larsen, R. Dahl, N. Lindqvist, N. Mygind
Journal: Allergy (1991)

The objective of this study was to compare the efficacy and safety of a pure powder formulation of budesonide, delivered from a new multi‐dose dispenser for nasal drug application, with the commercially available budesonide pressurized aerosol, and with placebo. Of 116 patients with grass pollen‐induced allergic rhinitis, 112 finished the study, which comprised a 4‐week treatment period, preceded by a 1‐week run‐in period. The patients were randomized to four parallel treatment groups: budesonide powder 400 Hg daily; budesonide powder 800 μg daily; budesonide aerosol 400 μg daily; and placebo Powder. Treatment was given once daily in the morning. The study was double‐blind regarding comparison between budesonide powder and Placebo. Assessment of efficacy, made by comparing mean scores of nasal symptoms and use of rescue medication, showed equal efficacy of all three budesonide groups compared with placebo. There were no differences between budesonide‐and placebo‐treated groups with regard to side effects. Budesonide treatment had no demonstrable effect on the HPA‐axis assessed by measurement of 24‐h urine cortisol. We conclude that budesonide, delivered as pure powder from a multi‐dose dispenser, is effective and safe for the treatment of seasonal allergic rhinitis. This new formulation is a good alternative to the commercially available preparations, as it does not contain carrier gas, preservatives or lubricants.