tbuckley/cabot-search huggingface dataset:
Scientific Basis of Clinical Neurology
Authors: Joseph Fermaglich
Journal: JAMA (1986)

For many years, progress in scientific and clinical neurology was impeded by limited technologies, which restricted investigation of the central and peripheral nervous systems. Most observations were anecdotal rather than analytic. Within the last 20 years, scientific and clinical neurology has harnessed rapidly developed sophisticated technology in an unprecedented manner. Thus, computers, electron microscopy, histochemistry, immunology, tissue culture, pharmacology, and a variety of microtechniques have been utilized to study the normal and disordered central and peripheral nervous system. The results have been spectacular. In their textbook<i>Scientific Basis of Clinical Neurology</i>, Swash and Kennard have collated the works of distinguished investigators whose scientific efforts and clinical applications are at the cutting edge of neurology. The volume is organized into seven sections, each of which addresses a different area of neural function. It begins with central control of motor activity; the discussion then turns logically to sensory activity followed by higher
The Changing Treatment of Breast Cancer-Reply
Authors: Bruce A. Mann
Journal: JAMA (1988)

In Reply.—  We appreciate the comments by Drs Hermann, Grundfest-Broniatowski, and Esselstyn and recognize the Cleveland Clinic's important role in the evolution of breast-conserving surgery. 1   In our article, we did not attempt to define the optimal approach to breast cancer surgery, an area in which some controversy seems to remain. Rather, we describe treatments actually being given to patients and comment on the relationship of these treatments to the treatment options available during the period of study.  Hermann and colleagues question our description of breast-conserving surgery without irradiation as being non-definitive therapy. They offer their substantial experience at the Cleveland Clinic as evidence that partial mastectomy alone is adequate in selected patients. 2 While their patients who were treated in this manner had good results, their experience does not represent a randomized, controlled trial and they did not test the effect of adding radiation therapy to the limited surgical
P-glycoprotein-mediated drug efflux is a resistance mechanism of chronic myelogenous leukemia cells to treatment with imatinib mesylate
Authors: T Illmer, M Schaich, U Platzbecker, J Freiberg-Richter, U Oelschlägel, M von Bonin, S Pursche, T Bergemann, G Ehninger, E Schleyer
Journal: Leukemia (2004)
Case Report: Insulin Edema and Acute Renal Failure
Authors: Suzanne Laroche, Hélène Wucher, Yên-Lan Nguyen, José Timsit, Etienne Larger
Journal: Diabetes Care (2013)

Generalized edema due to insulin is a rare phenomenon. We report a 35-year-old woman with newly diagnosed type 1 diabetes who presented with generalized edema, serous effusions, and acute renal failure a few hours after starting insulin.

The patient presented with diabetic ketoacidosis after a 12-month history of polydipsia and polyuria. She had lost 2 kg over a 2-month period and weighed 47 kg, BMI 18 kg/m2. Blood pressure was 131/84 mmHg. Clinical examination showed Kussmaul dyspnea, but was otherwise normal. Biological findings were consistent with severe diabetic ketoacidosis: pH 6.80, bicarbonate 1.4 mmol/L. Plasma glucose was 23 mmol/L and HbA1c 13.3% (122 mmol/mol). Serum creatinine concentration was 90 μmol/L. The patient received a total of 15 L of intravenous fluids …
Diagnosis of deep venous thrombosis. A prospective study comparing duplex scanning to contrast venography.
Authors: L A Killewich, G R Bedford, K W Beach, D E Strandness
Journal: Circulation (1989)

Duplex scanning has been proposed as a safe alternative to contrast venography for diagnosing deep venous thrombosis, but its accuracy has not been proved. In this prospective, double-blind study of 47 patients, the sensitivity and specificity of duplex scan criteria were determined relative to contrast venography for lower extremity deep venous thrombosis. Criteria considered to show the presence of deep venous thrombosis included visualization of thrombus (T), absence of spontaneous flow by Doppler ultrasonography (F), absence of phasicity of flow with respiration (P), and incompressibility of the vein with probe pressure (VC). When analyzed individually, the variables T and F had low sensitivities (50% and 76%) but high specificities (92% and 100%). VC had low values for both (79% and 67%, respectively). The best single variable was P (sensitivity and specificity = 92%). The best combinations of variables were T+P (sensitivity = 95%, specificity = 83%), T+F+P (sensitivity = 95%, specificity = 83%), F+P (sensitivity and specificity = 92%), and F+T (sensitivity = 92%, specificity = 87%). The low specificity of vein incompressibility was secondary to cases in which normal veins were difficult to compress in the thigh. All false-negative cases were from isolated calf vein thrombi. We conclude that isolated criteria from duplex scanning should not be used to diagnose deep venous thrombosis. In cases of suspected calf vein thrombosis, repeat duplex examination should be obtained in 3-4 days to determine the most appropriate therapy. In equivocal cases of proximal vein thrombosis, a contrast venogram should be obtained.
Patients are waiting longer for tests and treatment as pressure on NHS grows
Authors: I. Torjesen
Journal: BMJ (2011)

NHS waiting lists in England are creeping up slowly and could rise further under the pressure of winter illness and the effects of the required efficiency savings, a leading healthcare think tank has warned.

The second quarterly monitoring report by the King’s Fund, published last week, shows some worrying underlying trends. It points out that in June the proportion of patients waiting more than the 18 week target for inpatient and outpatient treatment in hospital was higher than at the same time last year.⇓



In May 2010 92.9% of inpatients and 98.2% of outpatients were seen within 18 weeks, but in May 2011 these proportions were, respectively, 90.8% and 97.7%.

The report also warns: “The overall trend in median waiting times for diagnostics seems to be gradually upwards.” Department of Health data show that the proportion of patients waiting more than six weeks for results of diagnostic …
Matrix metalloproteinase-2 and -9 exacerbate arterial stiffening and angiogenesis in diabetes and chronic kidney disease
Authors: Ada W.Y. Chung, H.H. Clarice Yang, Mhairi K. Sigrist, Genevieve Brin, Elliott Chum, William A. Gourlay, Adeera Levin
Journal: Cardiovascular Research (2009)

Chronic kidney disease (CKD) and diabetes are the prominent risk factors of cardiovascular disease (CVD). Matrix metalloproteinase (MMP)-2 and -9 regulate vascular structure by degrading elastic fibre and inhibit angiogenesis by generating angiostatin. We hypothesized that MMP-2 and -9 were up-regulated in the arterial vasculature from CKD patients with diabetes, compared with those without diabetes. During living donor transplantation procedures, arteries from donors (n = 8) and recipients (non-diabetic, n = 8; diabetic, n = 8; matched in age, gender, and dialysis treatments) were harvested. Diabetic arteries had increased MMP-2 and -9 activities by 42 and 116% compared with non-diabetic ones. Diabetic arteries were the stiffest, and the stiffness measurement was highly correlated with the summation of MMP-2 + MMP-9 activities (r = 0.738, P = 0.0002). Pulse wave velocity measurements correlated with MMP activity (r = 0.683, P = 0.005). Elastic fibre degradation and calcification were worst in diabetic vessels. The phosphate level, which was 25% higher in diabetic patients, correlated with MMP activity (r = 0.513, P = 0.04) and in vitro stiffness (r = 0.545, P = 0.03), respectively. Angiostatin expression was doubled, whereas vascular endothelial growth factor was 50% reduced in diabetic compared with non-diabetic vessels. Microvascular density in diabetic vessels was 48% of that in non-diabetic ones, and it was strongly associated with MMP activity (r = −0.792, P < 0.0001) and vasorelaxation (r = 0.685, P = 0.0009). Using a matched case–control design, we report up-regulation of MMP-2 and -9 in diabetic CKD arteries and correlate those with stiffening, impaired angiogenesis, and endothelial dysfunction. These findings may help to explain the high susceptibility of CVD in diabetic and non-diabetic CKD patients.
Pay-for-Performance Programs in Family Practices in the United Kingdom
Authors: Tim Doran, Catherine Fullwood, Hugh Gravelle, David Reeves, Evangelos Kontopantelis, Urara Hiroeh, Martin Roland
Journal: New England Journal of Medicine (2006)

In 2004, after a series of national initiatives associated with marked improvements in the quality of care, the National Health Service of the United Kingdom introduced a pay-for-performance contract for family practitioners. This contract increases existing income according to performance with respect to 146 quality indicators covering clinical care for 10 chronic diseases, organization of care, and patient experience.We analyzed data extracted automatically from clinical computing systems for 8105 family practices in England in the first year of the pay-for-performance program (April 2004 through March 2005), data from the U.K. Census, and data on characteristics of individual family practices. We examined the proportion of patients deemed eligible for a clinical quality indicator for whom the indicator was met (reported achievement) and the proportion of the total number of patients with a medical condition for whom a quality indicator was met (population achievement), and we used multiple regression analysis to determine the extent to which practices achieved high scores by classifying patients as ineligible for quality indicators (exception reporting).The median reported achievement in the first year of the new contract was 83.4 percent (interquartile range, 78.2 to 87.0 percent). Sociodemographic characteristics of the patients (age and socioeconomic features) and practices (size of practice, number of patients per practitioner, age of practitioner, and whether the practitioner was medically educated in the United Kingdom) had moderate but significant effects on performance. Exception reporting by practices was not extensive (median rate, 6 percent), but it was the strongest predictor of achievement: a 1 percent increase in the rate of exception reporting was associated with a 0.31 percent increase in reported achievement. Exception reporting was high in a small number of practices: 1 percent of practices excluded more than 15 percent of patients.English family practices attained high levels of achievement in the first year of the new pay-for-performance contract. A small number of practices appear to have achieved high scores by excluding large numbers of patients by exception reporting. More research is needed to determine whether these practices are excluding patients for sound clinical reasons or in order to increase income.
Inflammatory cellular influx follows capsaicin nasal challenge.
Authors: G Philip, A M Sanico, A Togias
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

Capsaicin is a specific activator of sensory nerve endings. In rodents, mucosal application of capsaicin causes cells to infiltrate the tissue. To examine whether inflammatory-cell influx follows sensory-nerve activation in human airways, we delivered capsaicin (200 microM) nasal spray into the nares of 20 subjects (10 with allergic rhinitis and 10 normal), and measured the total leukocyte content of nasal lavage fluid obtained from 10 min to 4 h after the capsaicin challenge. Vehicle spray (1% EtOH in 0.9% saline) served as a control. Capsaicin challenge caused significant increases from prechallenge leukocyte counts at 10 min (p<0.03), 30 min (p<0.01), and 4 h (p<0.03) after challenge, but not at 1 h after challenge (p = 0.68). Vehicle challenge did not increase leukocyte counts. Differential counts (performed on the 13 of 20 subjects from whom adequate specimens for differential counts were obtained) showed that neutrophils, eosinophils, and mononuclear cells increased at 10 min, 30 min, and 4 h (all p < 0.04), but not at 1 h after capsaicin challenge. Comparing the rhinitic to the normal subjects, we found no significant differences in the cellular response to capsaicin. These data support a nonspecific inflammatory effect of sensory nerve activation in the human nose. Consequently, this work provides evidence that neurogenic inflammation can be induced in the human airway in vivo.
Sex Chromatin in Prednisone-treated Children
Authors: K. T. Shetty, N. L. Sharma, K. M. Wahal
Journal: BMJ (1966)

Acute Back Syndrome-Dillane et al. MEDICALJOURNALwith the index attack, and for patients with no further attack the corresponding proportion was 21.6 % (x2 = 1.95 ; 1 d.f. ; not significant).This result is in keeping with Kellgren's (1938) finding that referred pain can arise from superficial structures in the back, and does not therefore mean that there is pressure on nerve roots.Of the 85 patients with referred pain, only 9 (10.6%) had a "proved disc."Moreover, 14 (61%) of the 23 patients with "proved disc" did not experience referred pain.
Diagnosis of biliary cystadenoma by peroral video cholangioscopy
Authors: S. Watanabe, T. Sato, K. Hosono, N. Kobayashi, I. Endo, T. Nakayama, Y. Inayama, A. Nakajima, K. Kubota
Journal: Endoscopy (2013)

A 31-year-old woman with jaundice was admitted to our hospital. Computed tomography, magnetic resonance cholangiopancreatography, and endoscopic retrograde cholangiography suggested the presence of a solitary cystic lesion in the common bile duct (CBD) ([Fig. 1 a, b, c]). Subsequent endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS) showed a multilocular cystic tumor with cyst-in-cyst pattern in the CBD ([Fig. 1 d]; [Fig. 2]).
Peanut allergy prevalence among school-age children in a US cohort not selected for any disease
Authors: Supinda Bunyavanich, Sheryl L. Rifas-Shiman, Thomas A.E. Platts-Mills, Lisa Workman, Joanne E. Sordillo, Matthew W. Gillman, Diane R. Gold, Augusto A. Litonjua
Journal: Journal of Allergy and Clinical Immunology (2014)
Pulmonary Alveolar Microlithiasis
Authors: Vincent M Brandenburg, Henning Schubert
Journal: New England Journal of Medicine (2003)

A 28-year-old patient was admitted to the hospital with mild pleuritic chest pain. A posterior–anterior chest radiograph showed bilateral diffuse, nodular (“sandstorm-like”) calcifications in both lungs, predominantly in the middle zones (Panel A). A high-resolution computed tomographic scan demonstrated multiple bilateral diffuse micronodular, calcific, and ground-glass opacities throughout both lungs (Panel B). On transbronchial biopsy, the diagnosis of massive parenchymal and alveolar calcification was confirmed. Abdominal ultrasonography revealed medullary nephrocalcinosis. On the basis of these findings, the diagnosis of pulmonary alveolar microlithiasis with concomitant idiopathic medullary nephrocalcinosis was established. Pulmonary alveolar microlithiasis is a rare and slowly progressive disease; the . . .
Another Health Care Idea: Disease Management
Authors: Charles Marwick
Journal: JAMA (1995)

MANAGE the disease, not the health care system that handles it. This is the recipe for providing effective, affordable health care, say the proponents of a rapidly burgeoning concept known as disease management. Their argument is that because the US health care system is highly fragmented, providers and payers view components of care from their own perspective, based on what they deliver or pay for, without regard for optimal care or total cost. Disease management is a strategy largely led by pharmaceutical companies. For a fee that varies with the service provided, the firms that endorse the concept offer to help their customers reduce the total cost of the health care they provide and improve their patients' clinical results. "Incentives in fee-for-service environments can lead to overutilization of health care resources. At the same time, services in capitated programs can lead to underutilization. We believe a comprehensive, integrated, system-wide approach
Progress in Psychiatry
Authors: H. M. Flanagan
Journal: BMJ (1960)

<h3>Abstract</h3> This study aimed to test the efficacy of transcranial direct current stimulation (tDCS) during laparoscopic skill training to determine if it has the capacity to accelerate technical skill acquisition. tDCS is a non-invasive brain stimulation technique that delivers constant, low electrical current resulting in changes to cortical excitability and prior work suggests it may enhance motor learning. We evaluate for the first time the potential of tDCS, coupled with motor skill training, to accelerate the development of laparoscopic technical skills. In this pre-registered, double-blinded and sham-controlled study, 60 healthy subjects were randomized into sham or active tDCS in either bilateral primary motor cortex (bM1) or supplementary motor area (SMA) electrode configurations. All subjects practiced the Fundamental of Laparoscopic Surgery Peg Transfer Task during a pre-test, six 20-minute training sessions, and a post-test. The primary outcome was change in laparoscopic skill performance over time, quantified by improvement in performance according to a seconds-per-object calculated score accounting for errors. Sixty participants were randomized equally into the three training cohorts (active bM1, active SMA, sham). The active groups had significantly greater improvement in performance from pre-test to post-test compared to the sham groups (108 vs 76 seconds, <i>p</i> = 0.018). Both bM1 and SMA active cohorts had significantly greater improvement in learning (<i>p</i> &lt; 0.01), achieving the same skill level in 4 sessions compared to the 6 sessions required of the sham cohort. The SMA cohort had more variability in performance compared to the bM1 and control cohorts. Laparoscopic skill training with active, bM1 or SMA, tDCS exhibited significantly greater learning relative to training with sham tDCS. The potential for tDCS to enhance the training of surgical skills merits further investigation to determine if these preliminary results may be replicated.
Abstract 3568: Induction of aberrant breast acinar morphogenesis by deregulation of an estrogen receptor alpha circadian circuit.
Authors: Stefano Rossetti, Francesca Corlazzoli, Alex Gregorski, Nicoletta Sacchi
Journal: Cancer Research (2013)

Abstract Altered estrogen receptor alpha (ERA) signaling and altered circadian rhythms are both features of breast cancer. ERA mRNA oscillates in a circadian fashion in ERA-positive breast epithelial cells, but not in ERA-positive breast cancer cells (Rossetti et al., 2012a). Interestingly, we identified a circuit consisting of ERA and an estrogen-regulated loop consisting of PER2 and BMAL1, two circadian clock genes, in entrained ERA-positive breast epithelial cells. This estrogen-regulated circuit is apparently necessary for breast epithelial acinar morphogenesis, and its disruption by ERA knock down negatively affects both the estrogen-sustained circadian PER2-BMAL1mechanism and the formation of acini in three-dimensional (3D) culture on basement membrane. Conversely, knock down of either PER2 or BMAL1, by hampering the PER2-BMAL1 loop of the circadian clock, negatively affects both ERA circadian oscillations and 3D breast acinar morphogenesis (Rossetti et al., 2012b). This is the first evidence that a circuit comprising ERA and key circadian clock components is implicated in the acinar developmental processes of breast epithelial cells. Acknowledgments: this work was supported by the Department of Defense (DOD) Concept Award W81XWH0610657 (NS), the Breast Cancer Coalition of Rochester (NS), and the Friends for an Earlier Test for Breast Cancer Foundation (NS). Rossetti, S, Esposito, J, Corlazzoli, F, Gregorski, A, and Sacchi, N. (2012a). Entrainment of breast (cancer) epithelial cells detects distinct circadian oscillation patterns for clock and hormone receptor genes. Cell Cycle 11, 350-360. Rossetti, S, Corlazzoli, F, Gregorski, A, Azmi, NH, and Sacchi, N. (2012b). Identification of an estrogen-regulated circadian mechanism necessary for breast acinar morphogenesis. Cell Cycle 11, 3691-3700. Citation Format: Stefano Rossetti, Francesca Corlazzoli, Alex Gregorski, Nicoletta Sacchi. Induction of aberrant breast acinar morphogenesis by deregulation of an estrogen receptor alpha circadian circuit. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3568. doi:10.1158/1538-7445.AM2013-3568
Clinical Outcomes of Bivalirudin for Ischemic Heart Disease
Authors: David F. Kong, Eric J. Topol, John A. Bittl, Harvey D. White, Pierre Théroux, Vic Hasselblad, Robert M. Califf
Journal: Circulation (1999)

Background —Current treatment strategies for percutaneous coronary revascularization and acute coronary syndromes incorporate thrombin inhibition with either unfractionated or fractionated heparin. The peptide bivalirudin (Hirulog) is a direct thrombin inhibitor whose pharmacological properties differ from those of heparin. We conducted a systematic overview (meta-analysis) to assess the effect of bivalirudin on 4 end points: death, myocardial infarction, major hemorrhage, and the composite of death or infarction. Methods and Results —Six trials (5674 patients) represent the randomized, controlled bivalirudin experience, including 4603 patients undergoing elective percutaneous coronary revascularization and 1071 patients with acute coronary syndromes. ORs for the 4 clinical end points were calculated for each trial. Four trials (4973 patients) that compared bivalirudin with heparin were combined with the use of a random-effects model. In these trials, bivalirudin was associated with a significant reduction in the composite of death or infarction (OR 0.73, 95% CI 0.57 to 0.95; P =0.02) at 30 to 50 days, or 14 fewer events per 1000 patients so treated. There also was a significant reduction in major hemorrhage for the same trials (OR 0.41, 95% CI 0.32 to 0.52; P &lt;0.001, or 58 fewer events per 1000 patients so treated). A similar analysis combined 2 dose-ranging trials (701 patients) that compared therapeutic (activated partial thromboplastin time more than twice the control time) with subtherapeutic bivalirudin anticoagulation (activated partial thromboplastin time less than twice the control time). Conclusions —Bivalirudin is at least as effective as heparin, with clearly superior safety. Thus, it provides an unprecedented net clinical benefit over heparin in patients with ischemic heart disease.
Relation of tissue Doppler derived myocardial velocities to myocardial structure and beta-adrenergic receptor density in humans
Authors: Kesavan Shan, Roger J Bick, Brian J Poindexter, Sarah Shimoni, George V Letsou, Michael J Reardon, Jimmy F Howell, William A Zoghbi, Sherif F Nagueh
Journal: Journal of the American College of Cardiology (2000)