tbuckley/cabot-search huggingface dataset:
Differential Characteristics of Neural Circulatory Control
Authors: Philippe van de Borne, Jolanta Neubauer, Mohsen Rahnama, Jean-Luc Jansens, Nicola Montano, Alberto Porta, Virend K. Somers, Jean Paul Degaute
Journal: Circulation (2001)

Background Reappearance of low-frequency (LF) (±0.10 Hz) oscillations in RR interval (RR) after cardiac transplantation is indicative of sympathetic efferent reinnervation. We hypothesized that restored LF oscillations in RR in heart transplant recipients (HTRs) are linked to oscillations in muscle sympathetic nerve traffic (MSNA). Methods and Results RR, RR variability, and MSNA were recorded 5±2 months (n=7, short-term HTRs) and 138±8 months (n=7, long-term HTRs) after heart transplantation and compared with matched hypertensive patients (n=7). A coherence function determined the coupling between LF oscillations in MSNA and RR. RR variance did not differ between short-term and long-term HTRs. However, LF variability was only 1±0.5 ms 2 in the short-term HTRs but was 15±8 ms 2 in the long-term HTRs ( P &lt;0.05). Normalized LF variability was also higher in the long-term HTRs (40±14 normalized unites) versus the short-term HTRs (6±3 normalized united, P &lt;0.05) but did not differ from the LF variability of the hypertensive patients. Long-term HTRs were taking less cyclosporine ( P &lt;0.01) but had higher MSNA than the short-term HTRs (62±7 versus 31±7 burst/min, respectively, P &lt;0.05). Coherence between LF oscillations in MSNA and RR was similar in the long-term HTRs (0.59±0.11) and the hypertensive patients (0.60±0.07) and was 3-fold greater than in the short-term HTRs (0.20±0.06, P &lt;0.05). Conclusions Cardiac reinnervation after long-term heart transplantation is characterized by a restoration of the coherence between LF oscillations in RR and MSNA. Higher MSNA in long-term than in short-term HTRs suggests that time elapsed after cardiac transplantation may be a major determinant of sympathetic excitation in heart transplant recipients.
Which Drug for the Pregnant Woman with Epilepsy?
Authors: Torbjörn Tomson
Journal: New England Journal of Medicine (2009)

Approximately 25,000 children are born in the United States each year to mothers with epilepsy.1 Most of these women need to continue taking medication during pregnancy, since uncontrolled seizures may be harmful to the women as well as to the fetuses.2 The challenge to physicians is to prescribe a treatment that is effective in controlling seizures but has minimal associated risks.More than 40 years have passed since the first report on increased rates of birth defects in the offspring of women with epilepsy.3 Subsequent research has clarified that this is related to the antiepileptic drugs rather than the underlying . . .
Relationships with the drug industry: Collaboration to improve care
Authors: G. Coutts
Journal: BMJ (2009)

The relationship between the drug industry, academia, healthcare professionals, and patients has reached an all time low and few doubt that it is in the interests of all parties to improve it. A recent report from the Royal College of Physicians attempts to define a path towards achieving a more productive relationship. Here we set out five contrasting views on what the ideal relationship between industry and prescribers and patients should be and what steps need to be taken to achieve it (doi:10.1136/bmj.b222, doi:10.1136/bmj.b211, doi:10.1136/bmj.b252, doi:10.1136/bmj.b234)
Levothyroxine and Potassium Iodide Are Both Effective in Treating Benign Solitary Solid Cold Nodules of the Thyroid
Authors: Giacomo L. La Rosa
Journal: Annals of Internal Medicine (1995)

Objective: To determine the effectiveness of levothyroxine and potassium iodide in treating patients with benign solitary cold thyroid nodules. Design: Randomized controlled study. Setting: Outpatient clinic at a university hospital. Patients: 80 patients with solitary solid cold thyroid nodules found to be benign at cytologic examination were randomly assigned to no treatment, suppressive levothyroxine (thyroid-stimulating hormone level, <0.3 mU/L), or low-dose potassium iodide (2 mg every 2 weeks). Seventy patients completed the 1-year study. After 1 year, patients receiving treatment discontinued drug therapy and were re-evaluated 4 months later; patients receiving no treatment were given levothyroxine and were followed for a second year. Measurements: Nodule volume was measured by ultrasonography at 4-month intervals by an observer masked to treatment assignment. Results: Mean nodule volume decreased by 40% of the basal volume in the 23 patients receiving levothyroxine (P < 0.001) and by 23% of the basal volume in the 25 patients receiving potassium iodide (P = 0.053). Volume slightly increased in the 22 untreated patients (P = 0.085). A clinically relevant reduction in nodule volume (≥ 50%) was observed in 9 of 23 patients treated with levothyroxine, in 5 of 25 patients treated with potassium iodide, and in none of 22 untreated patients (P = 0.004). Only nodules with a volume of 10 mL or less were reduced; nodules with volumes of 5 mL or less shrank most frequently. Nodule volume did not relevantly increase in treated patients but did increase in 3 of the 22 untreated patients. Drug withdrawal resulted in an increased mean nodule volume (P = 0.004) after 4 months. Conclusions: Levothyroxine and, to a lesser extent, potassium iodide are effective in arresting the growth or in reducing the volume of benign solitary solid cold thyroid nodules, especially small ones; discontinuation of therapy may result in resumed nodule growth.
Deterrents to Drug Abuse
Authors: Sheldon Krantz
Journal: JAMA (1968)

Never in our history has it been quite as important to reassess the role of law in controlling the misuse of drugs as it is today. There is a present cynicism about the validity of many of the restrictions and penalties imposed by federal and state drug laws, particularly among youth, that parallels the attitude toward the Volstead Act during the prohibition era.  Much of this cynicism may be warranted. Many of the drug abuse laws which have been enacted both by the US Congress and by state legislatures have not been the result of careful analysis, but rather have been the result of an emotional response to what is, admittedly, a serious problem. Possibly even more disturbing is the fact that it is often difficult to convince legislative bodies to update laws or rectify old mistakes, even though substantial evidence exists that such change is desperately needed.  The role
Ventriculophasic Modulation of Atrioventricular Nodal Conduction in Humans
Authors: Allan C. Skanes, Anthony S. L. Tang
Journal: Circulation (1998)

Background —Baroreceptor-mediated phasic changes in vagal tone have been hypothesized to cause ventriculophasic sinus arrhythmia (VPSA). The objectives of this study were to demonstrate ventriculophasic modulation of AV nodal conduction and to substantiate the role of the baroreflex on ventriculophasic AV nodal conduction (VPAVN) by pharmacological perturbation of parasympathetic tone. Methods and Results —Twelve patients with infra-Hisian second-degree heart block and VPSA were studied. Incremental atrial pacing was performed until AV nodal Wenckebach block at baseline, after phenylephrine infusion, and after atropine. AV nodal conduction curves were constructed for each phase and compared. At baseline, VPAVN was present in 9 of 12 patients on the steep portion of the AV nodal conduction curves. Phenylephrine increased systolic blood pressure from 149±33 to 177±22 mm Hg ( P &lt;0.001) and sinus cycle length from 844±169 to 1010±190 ms ( P &lt;0.001) and shifted the AV nodal conduction curves up and to the right. Phenylephrine induced VPAVN in 2 of 3 patients in whom it was not present at baseline and in 11 of 12 total. Atropine abolished both VPSA and VPAVN in all patients. Conclusions —VPAVN was demonstrated in patients with infra-Hisian second-degree AV block. It was accentuated by phenylephrine and abolished by atropine, suggesting a baroreflex mechanism for VPSA and VPAVN.
Effect of the 16-Hour Work Limit on General Surgery Intern Operative Case Volume
Authors: Samuel I. Schwartz, Joseph Galante, Amy Kaji, Matthew Dolich, David Easter, Marc L. Melcher, Kevin Patel, Mark E. Reeves, Ali Salim, Anthony J. Senagore, Danny M. Takanishi, Christian de Virgilio
Journal: JAMA Surgery (2013)

The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction.To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience.A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included.Total, major, first-assistant, and defined-category case totals.As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P < .001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P = .008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases.The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.
The roles of signaling by the p42/p44 mitogen-activated protein (MAP) kinase pathway; a potential route to radio- and chemo-sensitization of tumor cells resulting in the induction of apoptosis and loss of clonogenicity
Authors: P Dent, WD Jarvis, MJ Birrer, PB Fisher, RK Schmidt-Ullrich, S Grant
Journal: Leukemia (1998)
Association of Fibrinolytic Parameters With Early Atherosclerosis
Authors: V. Salomaa, V. Stinson JD, J.D. Kark, A.R. Folsom, C.E. Davis, K.K. Wu
Journal: Circulation (1995)

Background Thrombosis, provoked by a rupture of an atherosclerotic plaque, plays a crucial role in precipitating a coronary heart disease event. Its role at the early stage of atherosclerosis has, however, been unclear, but it has been hypothesized that thrombosis or defective fibrinolysis contributes to the progression of atherosclerotic lesions. Methods and Results We studied the association of plasminogen activator inhibitor antigen (PAI-1), tissue-type plasminogen activator antigen (TPA), and D-dimer with early atherosclerosis in a cross-sectional case-control study involving 457 pairs chosen from the biracial cohort of the Atherosclerosis Risk in Communities (ARIC) Study. As examined by B-mode ultrasound, patients (cases) had intima-media thickness of carotid arteries above the 90th percentile and control subjects had thickness below the 75th percentile of the ARIC cohort. Persons with a history of heart disease, stroke, or claudication were excluded from the case-control selection. PAI-1, TPA, and D-dimer were higher in patients than in control subjects ( P ≤.001, Wilcoxon signed rank statistic). In conditional logistic regression analyses, the odds ratios of carotid atherosclerosis were, for PAI-1, for example, 1.22, 1.54, and 1.60 in the second, third, and fourth quartiles compared with the first quartile ( P &lt;.0001, test of linear trend, adjusting for age, systolic blood pressure, total cholesterol, acetylsalicylic acid use, and time of blood draw). Corresponding tests for D-dimer and TPA also showed an increasing trend ( P &lt;.0001). Conclusions The findings support the hypothesis that thrombosis and fibrinolysis play a role at the early stage of the atherosclerotic process.
CAMPHOR-MENTHOL IN CATARRHAL DISEASES.Read at the Seventeenth Annual Meeting of the Misssisippi Valley Medical Association, held at St. Louis, Mo., Oct. 14-16, 1891.
Authors: SETH S. BISHOP
Journal: JAMA (1891)

While engaged in experimenting on an improved inhaler for catarrhal patients I observed that menthol crystals and camphor gum formed a clear, oleaginous liquid on coming into contact with each other. It occurred to me that such a combination ought to have a beneficial action in catarrhal affections of the nose and throat. I mixed equal parts by weight of camphor and menthol, and combined 20 per cent, of the resulting fluid with 80 per cent, of lavoline. Discussion on the Levels of the Lakes as affected by the proposed Lakes and Gulf Waterway by Messrs. Wisner, Cooley, Haupt, Herschel. The first case in which I tried its effects was onle from which I had removed hypertrophied tissues from the right nasal cavity and used the cautery in order to open the passage way, not only for breathing purposes, but in order to facilitate the introduction of the Eustachian catheter.
Tespa1 negatively regulates FcεRI-mediated signaling and the mast cell–mediated allergic response
Authors: Di Wang, Mingzhu Zheng, Yuanjun Qiu, Chuansheng Guo, Jian Ji, Lei Lei, Xue Zhang, Jingjing Liang, Jun Lou, Wei Huang, Bowen Dong, Songquan Wu, Jianli Wang, Yuehai Ke, Xuetao Cao, Yi Ting Zhou, Linrong Lu
Journal: The Journal of Experimental Medicine (2014)

Antigen-mediated cross-linking of IgE on mast cells triggers a signaling cascade that results in their degranulation and proinflammatory cytokine production, which are key effectors in allergic reactions. We show that the activation of mast cells is negatively regulated by the newly identified adaptor protein Tespa1. Loss of Tespa1 in mouse mast cells led to hyper-responsiveness to stimulation via FcεRI. Mice lacking Tespa1 also displayed increased sensitivity to IgE-mediated allergic responses. The dysregulated signaling in KO mast cells was associated with increased activation of Grb2-PLC-γ1-SLP-76 signaling within the LAT1 (linker for activation of T cells family, member 1) signalosome versus the LAT2 signalosome. Collectively, these findings show that Tespa1 orchestrates mast cell activation by tuning the balance of LAT1 and LAT2 signalosome assembly.
Legal considerations of clinical guidelines
Authors: S M White
Journal: Journal of the Royal Society of Medicine (2003)

In their otherwise excellent review Dr Samanta and his colleagues (March 2003 JRSM1) assert that ‘clinical guidelines are systematically developed, evidence-based, clinically workable statements that aim to provide consistent and high quality care for patients’, and that because ‘guidelines from NICE... may be seen as the creme de la creme of authoritative bodies' it follows that their pronouncements are increasingly likely to inform the standard of care in negligence’. This is a dangerously illogical assumption to make: for all the diversity of lay and medical expertise available to NICE, the content of their guidelines is becoming increasingly proscriptive, and, in some cases, advocates a radical departure from pragmatic medical practice. The recent furore over the use of ultrasound locating devices for placing central venous catheters is a case in point.2, 3, 4 There are any number of criticisms that could be made of this document and its practical implementation,5 but with regard to the quasilegal nature of the guidelines, several important questions arise. Who owes the duty of informing doctors of new guidelines? Who is responsible for their execution—the hospital, the doctor, or both? Who is responsible for failing to follow the guidelines—the doctor, the hospital (either primarily, or vicariously), or both? Does obtaining specific consent from the patient vitiate the pseudo-legal requirement to follow the guideline? What is the legal recourse open to doctors who do not accept that the guidelines are ‘systematically developed, evidence-based or clinically workable’? Finally, should the courts be asked in every case to determine whether the guidelines are reasonable and rational before relying on them as the standard of acceptable medical practice?

NICE and CHAI are valuable agencies for improving the quality of care in the NHS, but their authority depends on the soundness of their decrees. It is ultimately for the courts to decide, case by case, whether such decrees should inform the standard of care in negligence. Guidelines should continue to inform, rather than prescribe, medical practice.
Quality of Care
Authors: George D. Lundberg
Journal: JAMA (1996)

Of the many elemental management objectives of American health system reform, 3 have always stood out: control of cost, promotion of quality, and access for all to basic medical care. Many of us hoped to achieve all 3 of these major objectives in a comprehensive, organized, and timely way while preserving necessary patient and physician autonomy, promoting prevention, and emphasizing primary care, among other factors.<sup>1</sup> Alas, such was not to be. What has happened? Cost control has been achieved in many sectors in large part because of the managed care revolution. Access has worsened. And quality is now under attack.<sup>2,3</sup> The<i>JAMA</i>Editorial Board and senior staff and the editors of the<i>Archives</i>Journals have completed their annual Delphi process to identify and rank the most important topics for our journals to address in the upcoming year. Near the top was quality of care. Since quality cuts across
AIDS and the Common Man
Authors: James F. Burris
Journal: Annals of Internal Medicine (1993)

On Being a Doctor15 May 1993AIDS and the Common ManJames F. Burris, MDJames F. Burris, MDGeorgetown University Medical Center, Washington, DC 20007.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-10-199305150-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Johnny was my first patient on the day after New Year's. He had made a marginal living scalping tickets and driving a tow truck for an auto repossession company. In his younger days he had been addicted to alcohol and downers, but when he tried speed once he developed severe chest pain. The resulting hospital evaluation revealed severe hypertension, which brought him to me 2 years ago. About 6 months after his initial visit, Johnny asked me to help him find a dentist for his friend Lindaa dentist who would accept HIV-infected patients.Linda was an IV heroin user. While ... Author, Article, and Disclosure InformationAffiliations: Georgetown University Medical Center, Washington, DC 20007.Corresponding Author: James F. Burris, MD, NE 120 Med-Dent, Georgetown University Medical Center, 3900 Reservoir Road NW, Washington, DC 20007. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 May 1993Volume 118, Issue 10Page: 819KeywordsAIDSDrug therapyDrugsErythropoietinHIVHeroinHospitalizationsHypertensionIschemiaPneumonia Issue Published: 15 May 1993 CopyrightCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Granuloma Inguinale with Perianal Involvement
Authors: Joseph Berkowitz
Journal: New England Journal of Medicine (1947)

GRANULOMA inguinale is an unusual skin disease found preponderantly in Negroes. The lesion begins as an ulceration in the groin or about the genitals and over a period of years, if untreated, spreads locally and progresses to a chronic inflammatory granulomatous stage. A gram-negative encapsulated bacillus appearing as a rod-like structure (Donovan body) in large mononuclear cells is the etiologic organism.1 , 2 Involvement about the anus is rare, and yet within the past year 2 cases with perianal disease have been described in Negro soldiers stationed at a camp in Massachusetts.3 In the ulcerative stage the chief complaints are pain and . . .
Critical flicker frequency for quantification of low-grade hepatic encephalopathy
Authors: Gerald Kircheis, Matthias Wettstein, Lars Timmermann, Alfons Schnitzler, Dieter Häussinger
Journal: Hepatology (2002)

Subclinical hepatic encephalopathy (SHE) is currently diagnosed by psychometric tests or neurophysiologic techniques. In view of its sociomedical relevance, simple and reproducible tests for routine diagnosis are required. This study evaluates critical flicker-frequency thresholds for quantification of low-grade hepatic encephalopathy. A total of 115 patients (92 with cirrhosis, 23 controls) were analyzed for HE severity (mental state, computerized psychometric tests), and the threshold frequencies at which light pulses are perceived as fused (fusion frequency) or flickering light (critical flicker frequency [CFF]). CFF was a highly reproducible parameter with little age, day-time, and training dependency. CFFs in cirrhotic patients without HE (HE 0) were not different from those found in noncirrhotic controls. Significantly lower CFFs were found in cirrhotic patients with subclinical or manifest HE, and the various HE groups separated from each other at a high level of significance ( P &lt; .01). By using a CFF cut-off value of 39 Hz, a 100% separation of patients with manifest HE from noncirrhotic controls and HE 0 cirrhotic patients was obtained. SHE patients separated from HE 0 cirrhotic patients with high sensitivity (55%) and specificity (100%). The HE severity-dependent differences were found in both, alcoholic and posthepatitic cirrhosis. Statistically significant correlations ( P &lt; .01) were found between CFFs and individual psychometric tests. Aggravation of preexisting HE after transjugular intrahepatic portosystemic stent shunt (TIPS) implantation was accompanied by a corresponding decrease of CFF, whereas improvement of HE increased CFF. In conclusion, CFF is a sensitive, simple, and reliable parameter for quantification of low-grade HE severity in cirrhotic patients and may be useful for the detection and monitoring of SHE.
Oral Respiratory Stimulants in Chronic Respiratory Failure
Authors: W. McC. Nelson, W. F. M. Wallace
Journal: BMJ (1965)

acquired valvular heart disease, 59 cases of congenital heart disease, and 10 cases of non-coronary cardiomyopathy were discovered.In addition, 58 cases of other forms of heart disease were found.The value, difficulties encountered, and limitations of this method of detecting heart disease are discussed.The factors necessary for success in an exercise of this type are mentioned.From the experience gained in this survey it is thought worth while to attempt the detection of heart disease in com- bination with a survey for the discovery of chest diseases.We are indebted to the general practitioners of East Suffolk for their help and co-operation in this survey and to the administrative staff of the East Suffolk Community X-ray Survey Unit for their help in carrying it out ; to Miss J. L. Bond for clerical and secre- tarial help ; to Dr. S. T. Gray, M.O.H. for East Suffolk, for his support and co-operation; to