tbuckley/cabot-search huggingface dataset:
An Official Multi-Society Statement: The Role of Clinical Research Results in the Practice of Critical Care Medicine
Authors: Mark R. Tonelli, J. Randall Curtis, Kalpalatha K. Guntupalli, Gordon D. Rubenfeld, Alejandro C. Arroliga, Laurent Brochard, Ivor S. Douglas, David D. Gutterman, Jesse R. Hall, Brian P. Kavanagh, Jordi Mancebo, Cheryl J. Misak, Steven Q. Simpson, Arthur S. Slutsky, Anthony F. Suffredini, B. Taylor Thompson, Lorraine B. Ware, Arthur P. Wheeler, Mitchell M. Levy
Journal: American Journal of Respiratory and Critical Care Medicine (2012)

While the results of clinical research are clearly valuable in the care of critically ill patients, the limitations of such information and the role of other forms of medical knowledge for clinical decision making have not been carefully examined.The leadership of three large professional societies representing critical care practitioners convened a diverse group representing a wide variety of views regarding the role of clinical research results in clinical practice to develop a document to serve as a basis for agreement and a framework for ongoing discussion.Consensus was reached on several issues. While the results of rigorous clinical research are important in arriving at the best course of action for an individual critically ill patient, other forms of medical knowledge, including clinical experience and pathophysiologic reasoning, remain essential. No single source of knowledge is sufficient to guide clinical decisions, nor does one kind of knowledge always take precedence over others. Clinicians will find clinical research compelling for a variety of reasons that go beyond study design. While clinical practice guidelines and protocols based upon clinical research may improve care and decrease variability in practice, clinicians must be able to understand and articulate the rationale as to why a particular protocol or guideline is used or why an alternative approach is taken. Making this clinical reasoning explicit is necessary to understand practice variability.Understanding the strengths and weaknesses of different kinds of medical knowledge for clinical decision making and factors beyond study design that make clinical research compelling to clinicians can provide a framework for understanding the role of clinical research in practice.
Polypoid esophageal and gastric metastases of recurrent hepatocellular carcinoma after liver transplantation
Authors: K.-F. Hsu, T.-Y. Hsieh, C.-L. Yeh, M.-L. Shih, C.-B. Hsieh
Journal: Endoscopy (2009)

Gastrointestinal tract involvement in hepatocellular carcinoma (HCC) is rare and poor outcomes have been reported [1]. HCC with metastasis to the esophagus is extremely rare and most cases have been diagnosed at postmortem [2]; only a few cases have been visible at endoscopy [3] [4] [5]. We present here a rare case of premortem diagnosis of esophageal and gastric metastases from recurrent HCC, in a liver transplant patient.
Abstract 3716: Household Car and Television Ownership are associated with an increased risk of Myocardial Infarction: Results from the INTERHEART Study
Authors: Claes Held, Romaina Iqbal, Sumathy Rangarajan, Shofiqul Islam, Salim Yusuf
Journal: Circulation (2007)

Introduction: The association between duration of television viewing as well as vehicle miles traveled and obesity in adults has been confirmed in various studies. We assessed the relationship between household ownership of goods i.e. car, bicycle, motorbike, computer, TV, and radio, as a substitute for physical activity measure with the risk of myocardial infarction (MI) globally. Design: INTERHEART is a standardized case-control study of acute MI involving 27,098 participants in 52 countries. We restricted our analysis to 10,043 cases of first MI and 14,217 controls that did not report previous angina or physical disability. Ownership of household goods was assessed as a categorical question. Logistic regression analysis was conducted with MI status as the dependent and ownership data being the independent variable. Multivariable adjustments were made for confounders including age, BMI, sex, region, smoking, alcohol intake, household income, education, hypertension, diabetes, psychosocial factors, fruit...
Home-made cider: source of lead-poisoning.
Authors: A. D. Walls
Journal: BMJ (1969)

MEDICALJORA temporary porphyrinuria after ethanol administration.I feel that my patient manifested Zieve's syndrome and a variety of secondary acquired porphyria with abdominal pain, paraes- thesia, and porphyrinuria, and that this may be responsible for the abdominal pain in Zieve's syndrome.Clearly future patients with Zieve's syndrome need to be investigated for abnormalities of porphyrin metabolism.
Monoclonal immunoglobulin M lambda coagulation inhibitor with phospholipid specificity. Mechanism of a lupus anticoagulant.
Authors: P Thiagarajan, S S Shapiro, L De Marco
Journal: Journal of Clinical Investigation (1980)

Prolongation of all phospholipid-dependent coagulation tests was found in a patient with macroglobulinemia, despite absence of bleeding manifestations. The purified monoclonal IgM lambda protein and its Fabmu tryptic fragment induced similar changes in normal plasma. Patient IgM and Fabmu completely inhibited Ca++-dependent binding of radiolabeled prothrombin and Factor X to mixed phospholipid micelles. The patient's IgM lambda paraprotein reacted with phosphatidylserine and, to a lesser extent, with phosphatidylinositol and phosphatidic acid, but not with phosphatidylcholine or phosphatidylethanolamine. Prior incubation of phospholipid with patient Fabmu blocked the positive reactions. Substitution of washed platelets for phospholipid led to normalization of patient coagulation tests and corrected all abnormalities produced in normal plasma by patient IgM. Furthermore, binding of 125I-Factor Xa to thrombin-treated platelets was entirely normal in the presence of patient IgM. These studies support the concept that platelets, rather than phospholipid micelles, are the primary locus of prothrombin and Factor X activation in normal hemostasis.
The miracle of “sudden renal failure”
Authors: Mario Rüdiger
Journal: BMJ (2005)

One of the advantages of being a neonatologist is that former patients come to visit the clinic even many years after their initial stay, and I can follow up their development. However, sometimes a visiting patient can also bring a bad conscience back.

A few months ago, a lovely 8 year old boy visited our neonatal intensive care unit with his parents. He seemed impressed by the sight of the little babies and could not imagine that he, too, had once been as small. The parents were pleased to see me since, as they told their son, I was “the doctor who was in charge of you.” Only after talking to the parents for some time did I start to remember the family, but when the …
Assessment of Cardiac Performance
Authors: Michael A. Nevins
Journal: JAMA (1971)

To the Editor.—  The indirect measurement of left ventricular ejection time intervals for assessment of myocardial function was recently reviewed in an editorial ( 216 :2007, 1971). Many reports have verified the sensitivity of this technique and its good correlation with more elaborate cardiac function tests. A potential application not suggested heretofore is the employment of serial measurements of left ventricular ejection time (LVET) as a quantitative office or clinic test for changes in myocardial performance.  The overlap between normal and abnormal values of LVET limits the value of a single determination for cardiac diagnostic screening. However, when patients with known heart disease are studied serially, the absolute value is relatively less than the changes of LVET which reflect alterations in myocardial function. Thus, the patient acts as his own control.  Spodick et al have shown that with an inexpensive modification (less than $300) a standard single channel electrocardiograph can be
Nurse Practitioner Programs
Authors: Benjamin Burrows, Gayle A. Traver
Journal: Annals of Internal Medicine (1974)

Editorials1 February 1974Nurse Practitioner ProgramsBENJAMIN BURROWS, M.D., GAYLE A. TRAVER, M.S.N.BENJAMIN BURROWS, M.D.Search for more papers by this author, GAYLE A. TRAVER, M.S.N.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-80-2-268 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe paper by Sackett and colleagues (1), in this issue, commendably provides scientific validation of the effectiveness and safety of nurse practitioners in a suburban general practice. Other reports (2, 3) have also favorably evaluated nurse practitioner programs in terms of medical care provided, patient satisfaction, cost, and other aspects. It is important to avoid unwarranted generalizations from those studies. Many different types of new nursing roles are being introduced into clinical practice. Although these roles are frequently grouped under the heading of "nurse practitioner," they are each quite specialized and differ widely in training required, area of responsibility, and...References1. SACKETTSPITZERGENT DWM: The Burlington randomized trial of the nurse practitioner: health outcomes of patients. Ann Intern Med 80:137-142, 1974 LinkGoogle Scholar2. LEWISRESNIK CB: Nurse clinics and progressive ambulatory patient care. N Engl J Med 277:1236-1241, 1967 CrossrefMedlineGoogle Scholar3. COLLENMADEROSOGHIKIAN FBK: Kaiser-Permanente experiment in ambulant care. Am J Nurs 71:1371-1374, 1971 MedlineGoogle Scholar4. BATES B: Doctor and nurse: changing roles and relations. N Engl J Med 283:129-134, 1970 CrossrefMedlineGoogle Scholar5. TRAVER G: Respiratory care: roles of allied health professionals. Med Clin North Am 57:793-800, 1973 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byObesity: Behavior Therapy with Computer-Feedback Versus Traditional Starvation Treatment 1 February 1974Volume 80, Issue 2Page: 268-270KeywordsNursesPatientsPrimary careSafety ePublished: 1 December 2008 Issue Published: 1 February 1974 PDF downloadLoading ...
Abstract 2152: The influence of didox on the efficacy and toxicity of doxorubicin.
Authors: Fahad A. Al-Abbasi, Gihan F. Assad, Ahmed M. Al-Abd, Ashraf B. Abdel-Naim
Journal: Cancer Research (2013)

Abstract Didox, possess antioxidant propertieson the top of its DNA synthesis and repair inhibiting ability. Doxorubicin (DOX) is a major chemotherapy for liver cancer; however it evokes severe cardiotoxic effect which is attributed to DOX derived free radicals. Herein, we assessed the effect didox in enhancing DOX efficacy in liver cancer cells while protecting against its cardiotoxic effects. Combination with didox significantly reduced in the IC50 of DOX in Huh7 and HepG2 liver cancer cell lines. The combination index between DOX and didox indicated additive type interaction (CI-value of 0.81-0.9). Both DOX and didox significantly blocked the cell cycle in S-phase and their combination significantly aggravated that block. In addition, didox with DOX showed higher caspase-3 level compared to DOX alone. This enhancement effect might be attributed to didox induced PARP enzyme inhibition. On the other hand, didox (150 mg/kg daily) significantly protected the cardiomyocyte and decreased the intra cardiac reactive oxygen species induced by DOX treatment (15 mg/kg). This effect was coupled with reverting DOX induced cardiomegaly and cardio-pathological features. Didox significantly prolonged the median survival of DOX treated mice and reduced their mortality risk by 3.7 folds. In conclusion, didox significantly improved the cytotoxic effect of DOX in liver cancer cells and protected from its cardiotoxic side effects. Citation Format: Fahad A. Al-Abbasi, Gihan F. Assad, Ahmed M. Al-Abd, Ashraf B. Abdel-Naim. The influence of didox on the efficacy and toxicity of doxorubicin. [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 2152. doi:10.1158/1538-7445.AM2013-2152
The Chloride-Phosphate Ratio in Hypercalcemia
Authors: FRED J. PALMER
Journal: Annals of Internal Medicine (1974)

Serum chloride and phosphate concentrations were measured in 52 hypercalcemic patients. The chloride values were higher (mean, 107 meq/litre) and phosphate, lower (mean, 2.6 mg/100 ml) in the 25 hyperparathyroid patients, whereas the chloride concentrations were lower (mean, 98 meq/litre) and phosphate, higher (mean, 4.5 mg/100 ml) in the 27 patients with hypercalcemia from other causes. The chloride-to-phosphate ratio ranged from 31.8 to 80 in hyperparathyroidism, with 96% more than 33, and from 17.1 to 32.3 in those with hypercalcemia from other causes, with 92% less than 30. The chloride-to-phosphate ratio differentiated well between these two groups of hypercalcemic patients.
Cyclical mechanical stretch and AAV2 mediated gene transfer to cultured human vascular cells
Authors: Sabyasachi Sen, Jeff S. Bartlett, Yvonne Birney, Paul Cahill, Timothy O'Brien
Journal: Molecular Therapy (2004)

Background: Vascular cells are exposed to haemodynamic forces in vivo, which can be mimicked by the in vitro cyclical stretch model. Studies have demonstrated that cyclical stretch induces expression of genes such as VEGF and Fibronectin, in cardiac myocytes and vascular smooth muscle cells. Furthermore, it has been shown that stretch may reorganise microtubules in smooth muscle cells, which may have a profound effect on integrin-mediated signalling. We hypothesised that stretch induced changes in gene expression would enhance AAV2 mediated gene delivery to vascular cells. Objective: To determine the effects of cyclical stretch on AAV2 mediated gene transfer to human coronary smooth muscle cells (HCSMC) and human umbilical vein endothelial cells (HUVEC). Methods: HCSMC and HUVEC were grown on Pronectin coated 6-well Bioflex plates and exposed to 0–15% equi-biaxial cyclic stretch at 60cycles/min. Cells were stetched for 24hrs immediately prior to transduction with AAV-2 (MOI-105based on IU Titre) and the effect on gene transfer was noted at 72hrs post transduction.
All cracked up
Authors: P McCrory
Journal: British Journal of Sports Medicine (2003)

One hobby of mine is knuckle cracking. I don’t know why I do this. Perhaps some American TV show set a bad role model for me at a vulnerable age. Certainly I have had my fair share of criticism over the years on this point. Not least from my mother.

There is a myth or old wives tale that osteoarthritis of the fingers is a certain …
Abstract B58: CD40 combined toll-like receptor 3 ligation restore morphine-induced reducing dendritic cells-mediating immunity and antitumor effect.
Authors: Ming-Cheng Chang, Yu-Li Chen, Wei-Zen Sun, Wen-Fang Cheng
Journal: Cancer Research (2013)

Abstract Morphine has been regarded as a kind of medications with great effective for the management of postoperative pain in surgery and cancer pain with compromising host immunity. However, the mechanisms of how morphine influences the host immunity are still unclear. Our previous study has revealed that morphine could promote effector T cell apoptosis and suppress anti-tumor effect enhanced by antigen-specific DNA vaccine. In current study, we evaluated how morphine interrupted host immunity especially on dendritic cells (DCs) and the possible mechanisms. Morphine could delay the differentiation and maturation of the bone marrow monocyte (BMM)-derived DCs. Furthermore, morphine could inhibit the secretion of IL-6 and TNF-α; but stimulate the excretion of IL-10 from BMM-derived DCs. Besides, morphine could suppress the maturation processes of BMM-DC via the activation of MAPK and down-regulation of P38. When mice administrated with an adjuvant mixture containing the TLR3 ligand-poly (I:C) and agonistic anti-CD40 antibodies, a significant increase DCs property, antigen presenting activity and MAPK/ERK/p38 protection effects were observed. Finally, the TLR3 ligand-poly(I:C) and anti-CD40 Ab vaccinated mice treated with morphine could maintain the anti-tumor effects. Our findings reveal that morphine treatment suppressed DCs maturation and TLR3 ligand-poly(I:C) with anti-CD40 Ab administration may serve as a useful approach to treat the profound immunosuppressive function and prevent tumorigenesis after long-term morphine treatment. Citation Format: Ming-Cheng Chang, Yu-Li Chen, Wei-Zen Sun, Wen-Fang Cheng. CD40 combined toll-like receptor 3 ligation restore morphine-induced reducing dendritic cells-mediating immunity and antitumor effect. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology: Multidisciplinary Science Driving Basic and Clinical Advances; Dec 2-5, 2012; Miami, FL. Philadelphia (PA): AACR; Cancer Res 2013;73(1 Suppl):Abstract nr B58.
Nitric oxide mediates flow-dependent epicardial coronary vasodilation to changes in pulse frequency but not mean flow in conscious dogs.
Authors: J M Canty, J S Schwartz
Journal: Circulation (1994)

BACKGROUND Although epicardial coronary arteries dilate in response to changes in flow, the mechanisms responsible for this and the mechanical stimuli that are sensed by the endothelium are not completely defined. We performed the present study to determine the importance of nitric oxide in eliciting epicardial dilation to sustained changes in mean flow and pulse frequency in the coronary circulation of conscious dogs. METHODS AND RESULTS Dogs were chronically instrumented with a circumflex coronary occluder, piezoelectric crystals to measure epicardial diameter, and a coronary artery catheter placed distal to the crystals for intracoronary drug infusion. Studies were conducted in dogs in the conscious state. We inhibited nitric oxide production by administering the arginine analog N omega-nitro-L-arginine methyl ester (L-NAME, 10 mg/kg IV), which attenuated the epicardial artery diameter changes to left atrial infusions of acetylcholine (10 micrograms/min) from 140 +/- 23 (+/- SEM) to 46 +/- 20 microns (P &lt; .05). Epicardial dilation to sustained increases in mean coronary artery at a constant heart rate. Intracoronary adenosine increased mean flow to the same extent (180 +/- 21 versus 177 +/- 24 mL/min after L-NAME, P = NS), but inhibiting nitric oxide production had no effect on flow-mediated epicardial dilation, with coronary diameter increasing by 264 +/- 36 microns under control conditions and 294 +/- 67 microns after L-NAME (P = NS). In contrast, when pulse frequency was increased by pacing to a rate of 200 beats per minute, mean coronary flow increased to a similar level (78 +/- 9 versus 75 +/- 9 mL/min after L-NAME), but the epicardial diameter change to pacing was attenuated from 170 +/- 29 microns under control conditions to 54 +/- 23 microns after L-NAME (P &lt; .01). CONCLUSIONS These results demonstrate that in vivo, nitric oxide production is primarily responsible for eliciting epicardial coronary vasodilation to endothelium-dependent agonists and changes in coronary flow pulse frequency. The failure of L-NAME to affect epicardial vasodilation during sustained increases in mean flow when pulse frequency is held constant suggests that additional mechanisms are involved in flow-mediated vasodilation of epicardial coronary arteries.
X-Linked G6PD Deficiency Protects Hemizygous Males but Not Heterozygous Females against Severe Malaria
Authors: Aldiouma Guindo, Rick M Fairhurst, Ogobara K Doumbo, Thomas E Wellems, Dapa A Diallo
Journal: PLoS Medicine (2007)

Glucose-6-phosphate dehydrogenase (G6PD) is important in the control of oxidant stress in erythrocytes, the host cells for Plasmodium falciparum. Mutations in this enzyme produce X-linked deficiency states associated with protection against malaria, notably in Africa where the A- form of G6PD deficiency is widespread. Some reports have proposed that heterozygous females with mosaic populations of normal and deficient erythrocytes (due to random X chromosome inactivation) have malaria resistance similar to or greater than hemizygous males with populations of uniformly deficient erythrocytes. These proposals are paradoxical, and they are not consistent with currently hypothesized mechanisms of protection.We conducted large case-control studies of the A- form of G6PD deficiency in cases of severe or uncomplicated malaria among two ethnic populations of rural Mali, West Africa, where malaria is hyperendemic. Our results indicate that the uniform state of G6PD deficiency in hemizygous male children conferred significant protection against severe, life-threatening malaria, and that it may have likewise protected homozygous female children. No such protection was evident from the mosaic state of G6PD deficiency in heterozygous females. We also found no significant differences in the parasite densities of males and females with differences in G6PD status. Pooled odds ratios from meta-analysis of our data and data from a previous study confirmed highly significant protection against severe malaria in hemizygous males but not in heterozygous females. Among the different forms of severe malaria, protection was principally evident against cerebral malaria, the most frequent form of life-threatening malaria in these studies.The A- form of G6PD deficiency in Africa is under strong natural selection from the preferential protection it provides to hemizygous males against life-threatening malaria. Little or no such protection is present among heterozygous females. Although these conclusions are consistent with data from at least one previous study, they have not heretofore been realized to our knowledge, and they therefore give fresh perspectives on malaria protection by G6PD deficiency as an X-linked trait.
Post-mortem study of the hip joint. II. Histological basis for limited and progressive cartilage alterations.
Authors: P D Byers, C A Contepomi, T A Farkas
Journal: Annals of the Rheumatic Diseases (1976)

This histological study is based on a macroscopical study of post-mortem hip joints (Byers, Contepomi, and Farkas, 1970) in which two categories of articular cartilage alterations, in addition to osteophytes, were described. One category consisted of 'limited' alterations which occurred frequently, had several subcategories, and rarely led to joint deformity. The other consisted of progressive alterations which caused bone exposure and joint deformity. Histological sections from both groups, including all the subcategories of the first, were studied. Initially the mechanisms that destroy cartilage were determined, and then their prevalence was assessed. Six mechanisms were found, all occurring in the group of limited alterations with varying prevalence and in varying combinations. Only one, fibrillation, occurred in the progressive group.