tbuckley/cabot-search huggingface dataset:
Endoscopic ultrasound-directed transgastric ERCP (EDGE) for Roux-en-Y anatomy: a novel technique
Authors: Prashant Kedia, Nikhil Kumta, Jessica Widmer, Subha Sundararajan, Mark Cerefice, Monica Gaidhane, Reem Sharaiha, Michel Kahaleh
Journal: Endoscopy (2015)

<b>Background:</b> Patients with Roux-en-Y gastric bypass (RYGB) anatomy pose challenges when endoscopic retrograde cholangiopancreatography (ERCP) is required. Deep enteroscopy-assisted ERCP can allow pancreaticobiliary intervention in these patients, but with limited success. This case series describes endoscopic ultrasound-directed transgastric ERCP (EDGE) for patients following RYGB. <b>Methods: </b>Patients with RYGB anatomy undergoing EDGE at a tertiary care center were included in this prospective single-arm feasibility study. All procedures were performed in two stages. First a 16-Fr percutaneous endoscopic gastrostomy (PEG) was placed in the excluded stomach using endoscopic ultrasound (EUS) guidance. Second, ERCP was performed through the newly fashioned gastrostomy and a transcutaneous fully covered metal esophageal stent. <b>Results:</b> Six patients (5 women, 1 man) with RYGB anatomy underwent EDGE. EUS-guided PEG placement was successful in all six patients (100 %). Antegrade ERCP was successful in all six patients (100 %) with the stages being separated by a mean of 5.8 days. The mean procedure times for the two stages were 81 minutes and 98 minutes. Two patients (33 %) had localized PEG site infections that were managed with oral antibiotics. There were no adverse events related to ERCP. <b>Conclusions:</b> EDGE is both feasible and safe to perform in RYGB patients. Given the high success rates of our recent experience, we suspect that this technique can be performed as a one-stage procedure to provide a cost-effective, minimally invasive option for a common problem in a growing patient population.
Oral Glucose Tolerance Curve and Hypoglycemias in the Fed State
Authors: Norbert Freinkel, Boyd E. Metzger
Journal: New England Journal of Medicine (1969)

Classes of Hypoglycemic DisordersBECAUSE of the intermittency of our eating pattern, all human intermediary metabolism can be subdivided into two categories: the fed state and the fasted state. The fed state begins whenever we eat, and regulation is designed to provide efficient, rapid and synchronized disposition of exogenous fuels for oxidation and storage. When levels of circulating fuels have returned to pre-eating values, the fasted state is initiated. Regulatory processes are then structured to provide fuels from endogenous resources in a manner that is parsimonious and yet appropriate to prevailing energy needs.1 In Western society, where three meals a . . .
Variability in Activity May Precede Diabetic Foot Ulceration
Authors: David G. Armstrong
Journal: Diabetes Care (2004)

We greatly appreciate the opportunity to reply to the very thoughtful and insightful letter by LeMaster, Mueller, and Sinacore (1). We believe that the comments raised are very important and deserve this sort of forum.

As to the first suggestion that waist-mounted accelerometers may not be robust enough to capture short shuffling steps taken by many of our less active patients with diabetes, our only response is that we agree. While the devices we used were highly sensitive and could be very finely calibrated, they do not approach the ability of ankle-worn devices to capture very …
Abstract 17063: Use of Inhibitors of Renin-Angiotensin-Aldosterone System in Elderly Patients with Acute Decompensated Heart Failure and Depressed Left Ventricular Systolic Function
Authors: Seung-Jae Joo, Joon-Hyuk Choi, Song-Yi Kim, Ki-Seok Kim
Journal: Circulation (2012)

Purpose Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) were shown to improve the prognosis of patients with acute decompensated heart failure (ADHF) and dep...
Endoscopic treatment of Zenker’s diverticulum using a hook knife
Authors: H. Heinrich, P. Bauerfeind
Journal: Endoscopy (2009)

Zenker’s diverticulum most often occurs between the seventh and eighth decade of life; the incidence is between 0.01 % and 0.11 % with a predominance in men. The diverticulum is located in Killian’s triangle, between the inferior pharyngeal constrictor and the cricopharyngeus muscle. Its pathogenesis remains disputed, but impaired function of the upper esophageal sphincter, resulting in increased intrabolus pressure, has been implicated in the formation of the diverticulum. Patients with Zenker’s diverticulum present with dysphagia, regurgitation of undigested food, and halitosis. With enlargement of the pouch, aspiration and consequent pneumonia, malnutrition, weight loss, and cervical borborygmi can occur. The clinical symptoms and barium swallow lead to diagnosis [1].
Retinoic acid uses divergent mechanisms to activate or suppress mitogenesis in rat aortic smooth muscle cells.
Authors: S Chen, D G Gardner
Journal: Journal of Clinical Investigation (1998)

In different experimental models, retinoid has been shown to stimulate or suppress mitogenesis in cultured cells. The mechanisms underlying this seemingly paradoxical activity remain only partially understood. We have examined the ability of all-trans retinoic acid (ATRA), as well as a number of synthetic retinoids, either alone or in the presence of a mitogenic stimulus (i.e., endothelin), to regulate DNA synthesis and cell replication in cultured rat aortic smooth muscle cells. ATRA alone stimulates [3H]thymidine incorporation (approximately twofold) and increases cell number (approximately twofold) in these cultures but suppresses [3H]thymidine incorporation and reduces cell number in cultures treated with endothelin. The reduction in endothelin-stimulated DNA synthesis correlates closely with the ability of ATRA to inhibit endothelin-stimulated extracellular signal-regulated kinase but not c-Jun NH2-terminal kinase activity. Activation of mitogenesis, seen in the presence of ATRA alone, was independent of extracellular signal-regulated kinase activation but correlated well with increased expression of cyclin D1 mRNA and protein. Concomitant activation of the cdk inhibitor p21 led to truncation of ATRA's mitogenic activity at higher doses of ligand. Collectively, these data indicate that the role of retinoids in the regulation of mitogenesis in vascular smooth muscle is complex. Under quiescent conditions they activate mitogenesis, while in the presence of growth stimulation, as is frequently seen with vasculopathic conditions, they suppress mitogenesis. It appears that independent circuitry is involved in signaling each of these effects.
Viewing child pornography does not seem to increase risk of abusing children, study concludes
Authors: S. Mayor
Journal: BMJ (2009)

Viewing child pornography does not, in itself, seem to be a major risk factor for committing physical sexual abuse of children in the future, concludes a follow-up study of men who were convicted in a Swiss child pornography investigation but who had no convictions for hands-on sex offences (offences involving physical contact with the victim) against children.

“There is ongoing debate about whether people who view child pornography pose a risk of committing sex offences against children,” explained a member of the research group, Frank Urbaniok, a forensic psychiatrist with the Canton of Zurich Department of Justice. “And there have previously been few studies looking at the association between consumption of child pornography and subsequent sex offences.”

It is generally assumed that people who download child pornography are paedophiles, said Jerome Endrass, head of the research department at the Criminal Justice System …
Autumn Books: After dinner Cookebook
Authors: R. Holland
Journal: BMJ (1986)

Hooray and hallelujah, you had it coming' to ya" was my first thought.Here is a layman telling the professions what the rest of us think about them.Revenge at last for the insolence of office, conspiracies against the laity, and professional fouls of all kinds.Such bloodthirsty instincts are not, however, going to be satisfied by The Patient has the Floor.Its truths are more homespun than home, and its tone is civilised and gentlemanly, which is not surprising as it is written by Alistair Cooke.A collection of after dinner speeches given to various professional bodies in Britain and the United States, it demonstrates that, layman though he may be to such audiences, Cooke is himself a master of several professions:
Artificial Maintenance of the Systemic Circulation without Participation of the Right Ventricle
Authors: WILLIAM L. JAMISON, WILLIAM GEMEINHARDT, JAHANGIR ALAI, CHARLES P. BAILEY
Journal: Circulation Research (1954)

A pump of 50 cc. reservoir capacity, only 10 cm. in diameter, was placed in the systemic circuit between the left auricular appendage and the left common carotid artery in each of 10 dogs so that the systemic circulation was maintained by the pump during complete cardiac arrest resulting from experimentally produced ventricular fibrillation. All dogs recovered completely.
Vasodilator Effect of Commercial 5% Plasma Protein Fraction Solutions
Authors: John H.L. Bland
Journal: JAMA (1973)

Hypotension exceeding 24% of mean arterial blood pressure, including one episode of complete circulatory collapse, occurred in two awake and eight anesthetized patients after infusion of 100 to 250 ml of 5% plasma protein fraction (PPF). To establish the cause of the hypotension, 50 ml of 5% albumin and of three preparations of 5% PPF was administered to 11 patients during constant-flow complete cardiopulmonary bypass, when changes in arterial pressure represent changes in systemic vascular resistance. No significant change occurred after administration of 5% albumin. A decrease, which exceeded the 99% confidence limit for 5% albumin, was observed in 3, 4, and 11 of 11 patients after the three preparations of 5% PPF.
Urban children healthier than rural children in developing world
Authors: Roger Dobson
Journal: BMJ (2007)

The metalloproteinase ADAM17 plays a pivotal role in initiating inflammation by releasing TNF from its precursor. Prolonged TNF release causes many chronic inflammatory diseases, indicating that tight regulation of ADAM17 activity is essential for resolution of inflammation. In this study, we report that the endogenous ADAM17 inhibitor TIMP-3 inhibits ADAM17 activity only when it is bound to the cell surface and that cell surface levels of TIMP-3 in endotoxin-activated human macrophages are dynamically controlled by the endocytic receptor LRP1. Pharmacological blockade of LRP1 inhibited endocytic clearance of TIMP-3, leading to an increase in cell surface levels of the inhibitor that blocked TNF release. Following LPS stimulation, TIMP-3 levels on the surface of macrophages increased 4-fold within 4 h and continued to accumulate at 6 h, before a return to baseline levels at 8 h. This dynamic regulation of cell surface TIMP-3 levels was independent of changes in TIMP-3 mRNA levels, but correlated with shedding of LRP1. These results shed light on the basic mechanisms that maintain a regulated inflammatory response and ensure its timely resolution.
Explosive Epidemic of Sonne Dysentery
Authors: C. A. Green, M. C. MacLeod
Journal: BMJ (1943)

years after.There are as yet only a few records in the literature of cases followed up for as long as five years, but enough exist to show that for shorter periods the prognosis compares favourably with that of the surgery of cancer of most other organs.It should be remembered that, although occasional untreated patients may live for as long as one or two years, the average expectation of life is generally accepted as being about six months.The results in my own 21 survivors of operation are as follows:Patients still alive and well after operation ( 14): After 441 years.1 3 2 24.I .,2,, .3.... .. . . ..2 3 .2 .. .... . . . . 2 1year or less .5 Deaths from, recurrence (7): Lived 24 years.,year.1 9 months 2 2 2The two patients who died from recurrence two months after operation had soft, rapidly growing, poorly differentiated tumours.There is little doubt that if this type can definitely be recognized without operation it should be submitted to deep x-ray therapy in preference to pneumonectomy. 4. How Much can the Patient do After Successful Pneumonectomy ?REFERENCES
Plasma C3d Levels and Ischemic Heart Disease in Type II Diabetes
Authors: A Figueredo, J L Ibarra, J Bagazgoitia, A Rodriguez, A M Molino, A Fernandez-Cruz, R Patino
Journal: Diabetes Care (1993)

OBJECTIVE To test the hypothesis that the complement system may be activated in patients with type II diabetes and CAD. RESEARCH DESIGN AND METHODS The plasma C3d concentration was measured in 106 type II diabetic patients and 25 nondiabetic control subjects. The patient group was subdivided according to AER, and the groups were adjusted for age, sex, and known duration of diabetes. For the assignment to a given subgroup, normoalbuminuria was defined as AER &amp;lt; 15 μm/min, microalbuminuria as AER 16–250 μg/min, and macroalbuminuria as AER &amp;gt; 250 μg/min. The presence or absence of coronary disease was assessed through clinical examination, ECG, and coronary angiography. An RIA system was used for measurement of urinary albumin levels, and the plasma C3d concentrations were measured by ELISA. RESULTS Within each of the AER-defined subgroups, the plasma C3d levels were significantly higher in patients with IHD than in those without. Thus, in the normoalbuminuric group, plasma C3d levels were 16.3 AU/ml (95% CI 13.9–19) in patients with IHD vs. 11.6 AU/ml (95% CI 10.5–12.7) in those without (P &amp;lt; 0.001). The corresponding data for the microalbuminuric and macroalbuminuric groups were 21.8 (95% CI 18.1–26.3) vs. 13.6 (95% CI 12.3–15.1) and 31.6 (95% CI 24.9–40) vs. 17.5 (13.6–22.6) AU/ml (P &amp;lt; 0.01), respectively. Patients with IHD also had significantly higher plasma C3d levels than normal control subjects, regardless of AER subgroup. A multiple logistic regression analysis demonstrated an association between the plasma C3d concentration and IHD and AER. CONCLUSIONS Activation of the complement system may play a role in the development of macrovascular disease in type II diabetes.
UK government announces review of consultants' bonus payments
Authors: S. Mayor
Journal: BMJ (2010)

The UK government has announced a review of bonuses paid to consultants, to make the system more transparent and consistent with other public sector pay schemes.

The review will be undertaken by the independent Review Body on Doctors’ and Dentists’ Remuneration, alongside other NHS organisations, the British Medical Association, and the committees that make the awards in England, Wales, Scotland, and Northern Ireland.

The review will firstly consider whether bonuses on top of basic pay are necessary “in order to recruit, retain, and motivate the necessary supply of consultants.” It will look at the international medical job market; and one aim will be to maintain a comprehensive provision of consultants across the NHS. It has been asked to consider total compensation levels for consultants and “to make observations (rather than recommendations) on basic pay scales.”

Secondly, the review will consider the need for incentives to encourage and reward excellent quality of …
Cross-presentation of the oncofoetal tumor antigen 5T4 from irradiated prostate cancer cells - a key role for Hsp70
Authors: Josephine C Salimu, Lisa K Spary, Saly Al-Taei, Aled Clayton, Malcolm Mason, John Staffurth, Zsuzsanna Tabi
Journal: Journal for ImmunoTherapy of Cancer (2014)

Meeting abstracts Immune responses contribute to the success of radiation therapy of solid tumors; however, the mechanism of triggering CD8+ T cell responses is poorly understood. Antigen cross-presentation from tumor cells by dendritic cells (DC) is a likely dominant mechanism to achieve CD8+ T
FETAL DEATH FROM LOOPING OF CORD.
Authors: HERBERT C. JONES
Journal: JAMA (1905)

When we consider the conditions present in the uterus during pregnancy, it should not be a matter of surprise that complications arise, in the relation of the movable contents, but rather that such complications are not more frequent. There is a developing fetus with more or less freedom of movement floating in an ovoid sac of fluid, and attached at its center by a long loose cord to the uterine wall. Let it not be forgotten that the permeability of this rope of blood vessels is at all times essential to fetal existence, and if the evidence of the prospective mother is to be accepted, this selfsame fetus is seldom still, day or night, during the latter half of intrauterine life. I agree with the statement of obstetric writers that once in every five or six labors this cord is found looped about some portion of the newborn infant, usually
VICIOUS CIRCLES ASSOCIATED WITH DISORDERS OF THE HEART
Authors: J. B. Hurry
Journal: BMJ (1908)

LoGicImNs apply the expression "viclous circle" to a fallacy (argume'stun in ciriulo) In which a propositton is used to establish a concluston and is afterwards proved by that same conclusion, so that, as in a clrcle, there is no starting point.Many years ago the expressIon was transferred into medical nomenclature to Indicate a morbtd condition In which cause and effect act reciprocally on each other.tVicious circles are very numerous and play a more important part in the procesees of disease than has hitherto'been recognized.Many of them result from a failure of Nature's efforts at compensation, and are there- fore of interest both-to clinician and to pathologist.Elsewhere' I have suggested a classification based on etiology (organic, mechanical, chemical, Infective, neurotic circles, etc.), and have gtven examples of vicious circles affecting the various organs of the b3dy.The study of the subject as affecting a single organ possesses even greater advantage, since the inter-relations of such circles come more clearly into view.The organ best suited for the purpoee is probably the heart, since the vital and mechanical phenomena presented by cardiac lesions are unique in their variety and interest.The heart, moreover, has maladies ot local origin and maladies of peripberal origin, thus supplying an extensive field for observation.At the same time, modern methods of pbysical diagnosis have thrown so much light on the pathology of cardiac lesions that probably nowhere else can that Interaction of forces with which we are concerned be so readily studied.For the sake of clearness vicious circles associated with disorders of the heart may be arranged In the following group3:Group I.-Circles aRfoclated with the myocardium.Group 11.-Circles assoclated with the endocardlum.G'roup ITT.-Circles associated with the perloardiam.Group IV. -Circles associated with neuroses.Group V.-Clrcles associated with a fall in blood pressure. GROUP I.Circles Associated with the Myocardium.Striking examples are met with as a result of arterial hypertonus In the pulmonary and the systemic circuits.Thui in the case of the right side of the heart various conditions, 'such as chronic bronchitis and emphysema, increase the resistance to the flow of blood through the lungs and necessitate greater driving power by the rlght ventricle, leading to Its hyperiropby and dilatation.These * Re%d before the Reading Pathological Society.tDr. (afterwards 8ir H.) Holland, 'R.S. (ifedical Notes and Refler-tion8, p. 99), gives an excellent dsscription of a vicious circle in 1839, and there are probably still earlier references.
"THE COMMERCIAL TAINT IN MEDICAL ADVERTISING"
Authors: Richard Kovacs
Journal: JAMA (1924)

To the Editor:  —Your editorial comment, July 5, on this subject is pertinent. As you rightly state, no decent man in the medical profession will think of adding to his armamentarium merely for financial gain, and some manufacturers of physical therapeutic apparatus are making a gross mistake in their advertisements by stressing the commercial gains to be derived from the use of their apparatus. In my recent paper (The Journal, July 12, p. 99) I wrote: It is an unfortunate fact that nowadays chiropractors and physical cultists are very good buyers of electrotherapy apparatus, although it would seem that some restraint could be put on manufacturers' advertising and selling through medical publications.  This brings up the question of censoring the advertising literature of these manufacturers. The Council on Pharmacy and Chemistry is doing splendid work in checking up claims of the drug manufacturers as to the composition and therapeutic action
PEANUT IN THE LOWER AIR PASSAGES
Authors: Samuel Salinger
Journal: JAMA (1923)

The dangers attending the lodgment of a foreign body in the lower air passages are greatly enhanced when the body in question happens to be of a friable nature. Peanuts are particularly dangerous for several reasons: 1. Owing to its size and shape, a peanut may effectually plug a bronchus so as to produce bronchiectasis affecting a major portion or even an entire lobe. 2. Being smooth, it is liable to frequent displacement from its original location, giving rise to continued irritation of the bronchial mucosa, with attendant swelling and profuse secretion. 3. Being permeable to the roentgen ray, it cannot be located by fluoroscopy. 4. It is frequently inhaled in fragments, which scatter through the various fine bronchioles where they can neither be located nor removed, and where they set up a fatal pneumonia. 5. Being speedily softened by the secretions, they offer no resistance to the grasping forceps,
Who should care for people with learning disabilities?
Authors: W. Sellar
Journal: BMJ (2000)

The medical care of people with learning disabilities in the United Kingdom is largely the responsibility of psychiatrists, for whom it has become a recognised subspecialty. This responsibility has been inherited because, in the past, many people with learning disabilities were condemned to asylums for psychiatric patients as both groups of patients had behaviour that was unaccepted in the wider community and which seemed to be untreatable.

However, although people with learning disability have an increased incidence of psychiatric disorder, most people with mental handicap are now recognised as not having psychiatric illness. So why are they still managed by psychiatrists?

> Many adults with learning disabilities disappear anonymously into the community 

Psychiatrists may argue that they are best placed to understand, differentiate, interpret, or treat the altered behaviour of those with learning disability who may find difficulty expressing themselves. Neurotic or challenging behaviour may indicate …