tbuckley/cabot-search huggingface dataset:
Clinical Crossroads: A 36-Year-Old Woman Recuperating From Stroke
Authors: Jeffrey A. Kuller
Journal: JAMA (1997)

To the Editor.  —We read with interest Dr Alexander's Clinical Crossroads, which discussed a 36-year-old woman recuperating from a stroke,1but we are surprised that, despite advising the patient to increase activities at home, including resumption of her sex life, there is no discussion of contraception issues in this married, apparently fertile woman with 4 previous pregnancies. Pregnancy prevention is particularly important in this patient recuperating from a life-threatening event. In addition, warfarin is a teratogen; 15% to 20% of infants exposed to coumarin derivatives in the first trimester develop the fetal warfarin embryopathy syndrome.1  Contraceptive issues in this patient are complex. Certainly barrier methods would be considered safe. An intrauterine device would be another reasonable option. Oral contraceptives should be considered with caution since the risk of both ischemic and hemorrhagic stroke is slightly increased in older users of combined oral contraceptive agents.2,3Male or female sterilization is another reasonable
Serum Lipids and Survival in Coronary Heart Disease: A Ten Year Study.
Authors: H. M. Shanoff
Journal: Annals of Internal Medicine (1964)

s1 April 1964Serum Lipids and Survival in Coronary Heart Disease: A Ten Year Study.H. M. Shanoff, M.D. (Associate), J. A. Little, M.D., Adele Csima, M.A.H. M. Shanoff, M.D. (Associate)Search for more papers by this author, J. A. Little, M.D.Search for more papers by this author, Adele Csima, M.A.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-60-4-713_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMany previous investigations, both retrospective and prospective, have demonstrated that patients with coronary heart disease have significantly higher mean serum lipid levels than controls. The present study examines the relationship between the concentration of the serum lipids and survival over a 10-year period.The coronary group consisted of 120 male patients, age 30 to 80, who had experienced a myocardial infarction and were free of hypertension, diabetes, and other complicating diseases. The serum lipids determined at the initial examination, and annually thereafter, included cholesterol, phospholipids and standard Sf0-12, 12-20, 20-100 and 100-400. Cumulative survival was calculated by the life... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: H. M. Shanoff, M.D. (Associate); J. A. Little, M.D.; Adele Csima, M.A.Affiliations: Toronto, Ontario, PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1964Volume 60, Issue 4Page: 713-713KeywordsAttentionCholesterolCoronary heart diseaseHypertensionLipidsLongitudinal studiesMyocardial infarctionPhospholipids ePublished: 1 December 2008 Issue Published: 1 April 1964 PDF downloadLoading ...
Physicians' Information Needs: Analysis of Questions Posed during Clinical Teaching
Authors: Jerome A. Osheroff, Diana E. Forsythe, Bruce G. Buchanan, Richard A. Bankowitz, Barry H. Blumenfeld, Randolph A. Miller
Journal: Annals of Internal Medicine (1991)

Objective: To describe information requests expressed during clinical teaching. Setting: Residents' work rounds, attending rounds, morning report, and interns' clinic in a university-based general medicine service. Subjects: Attending physicians, medical house staff, and medical students in a general medicine training program. Methods: An anthropologist observed communication among study subjects and recorded in field notes expressions of a need for information. We developed a coding scheme for describing information requests and applied the coding scheme to the data recorded. Based on assigned codes, we created a subset of strictly clinical requests. Measurements: Five hundred nineteen information requests recorded during 17 hours of observed clinical activity were selected for detailed analysis. These requests related to the care of approximately 90 patients by 24 physicians and medical students. Sixty-five requests were excluded because they were not strictly clinical, leaving a subset of 454 clinical questions for analysis. Main Results: On average, five clinical questions were raised for each patient discussed. Three hundred thirty-seven requests (74%) concerned patient care. Of these 337 questions, 175 (52%) requested a fact that could have been found in a medical record. Seventy-seven (23%) of these questions, motivated by the needs of patient care, were potentially answerable by a library, a textbook, a journal, or MEDLINE. Eighty-eight (26%) of the questions asked for patient care required synthesis of patient information and medical knowledge. Conclusions: Clinicians in the study settings requested information frequently. Many of these information needs required the synthesis of patient information and medical knowledge and thus were potentially difficult to satisfy. A typology is proposed that characterizes information needs as consciously recognized, unrecognized, and currently satisfied.
Towards better health of children
Authors: A. Jain
Journal: BMJ (2014)

Let’s give ourselves a pat on the back. I’m sure, like me, many of you have contributed to making India polio free. Selflessly advised, and sometimes coerced parents; gone door to door to weed out the virus from every nook and cranny ; and chased children on national immunisation days to administer them “ Do Boond Zindagi Ke ” [two drops of life (indicating Oral Polio Vaccine)], made popular through an advertising campaign by filmstar Amitabh Bachchan. Completing the final mile in this crusade against polio has required mammoth efforts, as Patrlakeha Chatterjee outlines in this feature (doi:10.1136/bmj.f3378), off which has evolved an intricate public health machinery ready to take …
Oncogenic β-catenin triggers an inflammatory response that determines the aggressiveness of hepatocellular carcinoma in mice
Authors: Marie Anson, Anne-Marie Crain-Denoyelle, Véronique Baud, Fanny Chereau, Angélique Gougelet, Benoit Terris, Satoshi Yamagoe, Sabine Colnot, Mireille Viguier, Christine Perret, Jean-Pierre Couty
Journal: Journal of Clinical Investigation (2012)

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Its pathogenesis is frequently linked to liver inflammation. Gain-of-function mutations in the gene encoding β-catenin are frequent genetic modifications found in human HCCs. Thus, we investigated whether inflammation was a component of β-catenin–induced tumorigenesis using genetically modified mouse models that recapitulated the stages of initiation and progression of this tumoral process. Oncogenic β-catenin signaling was found to induce an inflammatory program in hepatocytes that involved direct transcriptional control by β-catenin and activation of the NF-κB pathway. This led to a specific inflammatory response, the intensity of which determined the degree of tumor aggressiveness. The chemokine-like chemotactic factor leukocyte cell–derived chemotaxin 2 (LECT2) and invariant NKT (iNKT) cells were identified as key interconnected effectors of liver β-catenin–induced inflammation. In genetic deletion models lacking the gene encoding LECT2 or iNKT cells, hepatic β-catenin signaling triggered the formation of highly malignant HCCs with lung metastasis. Thus, our results identify inflammation as a key player in β-catenin–induced liver tumorigenesis. We provide strong evidence that, by activating pro- and antiinflammatory mediators, β-catenin signaling produces an inflammatory microenvironment that has an impact on tumoral development. Our data are consistent with the fact that most β-catenin–activated HCCs are of better prognosis.
Lin28b Is Sufficient to Drive Liver Cancer and Necessary for Its Maintenance in Murine Models
Authors: Liem H. Nguyen, Daisy A. Robinton, Marc T. Seligson, Linwei Wu, Lin Li, Dinesh Rakheja, Sarah A. Comerford, Saleh Ramezani, Xiankai Sun, Monisha S. Parikh, Erin H. Yang, John T. Powers, Gen Shinoda, Samar P. Shah, Robert E. Hammer, George Q. Daley, Hao Zhu
Journal: Cancer Cell (2014)
Epigenetic Signatures of Familial Cancer Are Characteristic of Tumor Type and Family Category
Authors: Emmi I. Joensuu, Wael M. Abdel-Rahman, Miina Ollikainen, Salla Ruosaari, Sakari Knuutila, Päivi Peltomäki
Journal: Cancer Research (2008)

Tumor suppressor genes (TSG) may be inactivated by methylation of critical CpG sites in their promoter regions, providing targets for early detection and prevention. Although sporadic cancers, especially colorectal carcinoma (CRC), have been characterized for epigenetic changes extensively, such information in familial/hereditary cancer is limited. We studied 108 CRCs and 63 endometrial carcinomas (EC) occurring as part of hereditary nonpolyposis CRC, as separate familial site-specific entities or sporadically, for promoter methylation of 24 TSGs. Eleven genes in CRC and 6 in EC were methylated in at least 15% of tumors and together accounted for 89% and 82% of promoter methylation events in CRC and EC, respectively. Some genes (e.g., CDH13, APC, GSTP1, and TIMP3) showed frequent methylation in both cancers, whereas promoter methylation of ESR1, CHFR, and RARB was typical of CRC and that of RASSF1(A) characterized EC. Among CRCs, sets of genes with methylation characteristic of familial versus sporadic tumors appeared. A TSG methylator phenotype (methylation of at least 5 of 24 genes) occurred in 37% of CRC and 18% of EC (P = 0.013), and the presence versus absence of MLH1 methylation divided the tumors into high versus low methylation groups. In conclusion, inactivation of TSGs by promoter methylation followed patterns characteristic of tumor type (CRC versus EC) and family category and was strongly influenced by MLH1 promoter methylation status in all categories. Paired normal tissues or blood displayed negligible methylation arguing against a constitutional methylation abnormality in familial cases.
Weight change and risk of fracture in postmenopausal women
Authors: J. Compston
Journal: BMJ (2015)

Weight loss and weight gain are both implicated, at different sites

The skeleton adapts to changes in mechanical loading, altering its mass and structure to modify bone strength.1 Bone mineral density is positively related to body mass index (BMI), and alterations in body weight are accompanied by changes in bone mass that reflect the new loading environment. Low BMI is a well recognised risk factor for fracture, but obesity also increases the risk of fracture at some sites.2

A linked paper by Crandall and colleagues (doi:10.1136/bmj.h25)3 confirms and extends previous studies that showed that weight loss in postmenopausal women increases the risk of hip and other fragility fractures.4 5 6 7 In over 120 000 postmenopausal women followed for a mean of 11 years, weight loss of ≥5% between baseline and year three was associated with a 65% increase in incident hip fracture, 9% increase in upper limb fracture, and 30% increase in central body fracture (hip, pelvis, or spine) compared with women in whom weight was stable. Both unintentional and intentional weight loss were associated with increased risk, although this differed between sites. The risk of hip and vertebral fracture was increased in women with …
The behavior of sonicated albumin microbubbles within the microcirculation: a basis for their use during myocardial contrast echocardiography.
Authors: M W Keller, S S Segal, S Kaul, B Duling
Journal: Circulation Research (1989)

The purpose of this study was to determine whether the behavior of sonicated albumin microbubbles accurately mimics red blood cell flow in the microcirculation and is thus consistent with their use as in vivo tracers of red blood cell flow during myocardial contrast echocardiography. Accordingly, microbubbles prepared from fluorescein-conjugated albumin and fluorescently labeled red blood cells were injected intravascularly in eight golden hamsters. Their intravascular distribution, velocities, arteriolar-to-venular transit and flux ratios at branch points were determined in the microcirculation of the cheek pouch. Albumin microbubbles (mean diameter, 4.9 +/- 3.6 microns) and red blood cells displayed a similar frequency of distribution across the arteriolar lumen (33% in the central 20% of the arterioles), and their arteriolar velocities were also similar (2.5 +/- 0.7 mm/sec and 2.3 +/- 0.7 mm/sec,p = NS). The mean velocities of microbubbles correlated well with those of red blood cells at baseline and after adenosine application (r = 0.97 and r = 0.89, respectively), as did the calculated maximum velocity (r = 0.98 and r = 0.80, baseline and adenosine, respectively). The velocity profiles across the lumen of the vessels for albumin microbubbles and red blood cells were similar at baseline and after adenosine-induced velocity changes. The flux ratios at branch points also correlated well (r = 0.92, p less than 0.001). Arteriolar-to-venular transit times of albumin microbubbles were similar to those of red blood cells in vessels ranging in size from 22 microns to 45 microns. We conclude that the behavior of albumin microbubbles in the microcirculation mimics that of red blood cells and supports their use as intravascular tracers of red blood cell flow during myocardial contrast echocardiography.
Association of Exposure to Cow's Milk Protein and β-Cell Autoimmunity-Reply
Authors: Desmond A. Schatz
Journal: JAMA (1996)

In Reply.  —As we had concluded in our Editorial, nothing short of a prospective clinical trial will definitively confirm or reject the hypothesis that the early introduction of cow's milk to infants positively influences the subsequent appearance of IDDM. The letters of Dr Dosch and Dr Johnston and Ms Spear agree with our position that the conclusions of the study of Norris et al1are limited by the relatively small cohort studied. They also question the use of autoantibodies as a surrogate endpoint marker of the autoimmune disease process leading to IDDM.  It is generally accepted that the triggering event that leads to the autoimmune process that culminates in IDDM occurs early in early childhood and can be detected by the subsequent presence of islet-reactive autoantibodies comprising ICA, insulin autoantibody (IAA), GAD65A, and IA-2 and IA2βA. The information on the natural history of the temporal appearance of these autoantibodies
Integrated genomic approaches implicate osteoglycin (Ogn) in the regulation of left ventricular mass
Authors: Enrico Petretto, Rizwan Sarwar, Ian Grieve, Han Lu, Mande K Kumaran, Phillip J Muckett, Jonathan Mangion, Blanche Schroen, Matthew Benson, Prakash P Punjabi, Sanjay K Prasad, Dudley J Pennell, Chris Kiesewetter, Elena S Tasheva, Lolita M Corpuz, Megan D Webb, Gary W Conrad, Theodore W Kurtz, Vladimir Kren, Judith Fischer, Norbert Hubner, Yigal M Pinto, Michal Pravenec, Timothy J Aitman, Stuart A Cook
Journal: Nature Genetics (2008)
Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH) in the Urine of Prepubertal Children*
Authors: Arleen B. Rifkind, Howard E. Kulin, Griff T. Ross
Journal: Journal of Clinical Investigation (1967)

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) have been measured by specific bioassays in pooled urine samples from prepubertal children, aged 2-6 yr, and from male adults. For children the mean urinary excretion of FSH was 2.2 U 2nd International Reference Preparation (2nd IRP) per liter and the mean urinary excretion of LH was 0.44 U 2nd IRP per liter. For adults the mean FSH excretion was 5.6 U 2nd IRP per liter and the mean LH excretion was 4.7 U 2nd IRP per liter. Our data show a 2.5-fold increase of FSH, a 10.7-fold increase of LH, and a consequent decrease in the FSH: LH ratio from 5 to 1 between childhood and adulthood. FSH and LH in urine from three patients with gonadal abnormalities have also been studied. The results from normal children, adults, and abnormal patients form a spectrum and reveal that sexual maturity is accompanied by a marked increase in the excretion of LH with relatively smaller increases in FSH.
Risk factors associated with exercise associated muscle cramping (EAMC) - a prospective cohort study in ironman triathletes
Authors: M Schwellnus, M Collins, N Drew
Journal: British Journal of Sports Medicine (2011)

Background Despite the high prevalence of Exercise Associated Muscle Cramping (EAMC) in endurance athletes, the aetiology and risk factors for this condition are not fully understood. Objective The objective of this prospective cohort study was to identify risk factors associated with EAMC in endurance triathletes. Setting Field study during an international Ironman triathlon. Participants 210 triathletes competing in an Ironman triathlon. Assessment Prior to the race, subjects completed a detailed validated questionnaire and blood samples were taken for serum electrolytes. Immediately before the race, pre-race body weight was obtained. Body weight and blood samples for serum electrolyte concentrations were obtained immediately post-race. Clinical data on EAMC experienced during or immediately after the race were also collected. Main outcome measurements Training data, serum electrolyte and body weight changes were compared between 44 triathletes who reported EAMC (CR group) and 166 triathletes who did not report EAMC (NC group). A regression analysis was conducted to determine independent risk factors for EAMC in triathletes. Results There were no significant differences between groups in any pre-post race serum electrolyte concentrations and body weight changes. The development of EAMC was associated with faster predicted race times and faster actual race times, despite similarly matched preparation and performance histories in subjects from both groups. A regression analysis identified faster overall race time (and cycling time) and a past history of cramping (in the last 10 races) as the only two independent risk factors for EAMC. Conclusion The results from this study add to the evidence that dehydration and altered serum electrolyte balance are not causes for EAMC. Rather, endurance runners competing at a fast pace, which suggests that they exercise at a high intensity, are at risk for EAMC.
De Novo purine biosynthesis by two pathways in Burkitt lymphoma cells and in human spleen
Authors: Gabrielle H. Reem
Journal: Journal of Clinical Investigation (1972)

This study was designed to answer the question whether human lymphocytes and spleen cells were capable of de novo purine biosynthesis. Experiments were carried out in cell-free extracts prepared from human spleen, and from a cell line established from Burkitt lymphoma. Burkitt lymphoma cells and human spleen cells could synthesize the first and second intermediates of the purine biosynthetic pathway. Cell-free extracts of all cell lines studied contained the enzyme systems which catalyze the synthesis of phosphoribosyl-1-amine, the first intermediate unique to the purine biosynthetic pathway and of phosphoribosyl glycinamide, the second intermediate of this pathway. Phosphoribosyl-1-amine could be synthesized in cell-free extracts from alpha-5-phosphoribosyl-1-pyrophosphate (PRPP) and glutamine, from PRPP and ammonia, and by an alternative pathway, directly from ribose-5-phosphate and ammonia. These findings suggest that extrahepatic tissues may be an important source for the de novo synthesis of purine ribonucleotide in man. They also indicate that ammonia may play an important role in purine biosynthesis. The alternative pathway for the synthesis of phosphoribosyl-1-amine from ribose-5-phosphate and ammonia was found to be subject to inhibition by the end products of the purine synthetic pathway, particularly by adenylic acid and to a lesser degree by guanylic acid. The alternative pathway for phosphoribosyl-1-amine synthesis from ribose-5-phosphate and ammonia may contribute significantly towards the regulation of the rate of de novo purine biosynthesis in the normal state, in metabolic disorders in which purines are excessively produced and in myeloproliferative diseases.
EU updates its plan to reduce drug misuse
Authors: R. Watson
Journal: BMJ (2008)

The European Commission has updated its drugs action plan, which it is looking to implement from the beginning of next year. The strategy will focus on the twin targets of reducing demand for and supply of drugs.

The package, which includes health and law enforcement measures, is the responsibility of Jacques Barrot, the commissioner responsible for justice, freedom, and security rather than his public health colleague Androulla Vassiliou.

Presenting the plan on 18 September, Mr Barrot said, “With up to two million problem drug users in the European Union, …
Homelessness Among Individuals With Psychotic Disorders Hospitalized for the First Time: Findings From the Suffolk County Mental Health Project
Authors: Daniel B. Herman, Ezra S. Susser, Lina Jandorf, Janet Lavelle, Evelyn J. Bromet
Journal: American Journal of Psychiatry (1998)

OBJECTIVE: Although data suggest that homelessness among persons with severe mental disorders is both distressing and common, several important epidemiologic questions remain unanswered. This study reports on the occurrence of homelessness in a quasi-representative sample of persons newly hospitalized with psychotic disorders. The authors also compared rates of homelessness in different diagnostic groups and among groups with differing symptom profiles. METHOD: The study was based on data from 237 first-admission patients hospitalized at 10 of the 12 inpatient facilities in eastern Long Island, N.Y. Consensus diagnoses were derived from multiple sources of information, including the Structured Clinical Interview for DSM-III-R. Patients were followed over a 24-month period after initial interview. Homelessness histories were based on subject self-reports. RESULTS: Fifteen percent of the patients had experienced at least one episode of homelessness before or within 24 months of their first psychiatric hospitalization. In more than two-thirds of these cases, the initial homeless episode had occurred before the first hospitalization. There were no significant differences in the risk of homelessness among diagnostic groups. Among subjects diagnosed with schizophrenia and related disorders, those with high levels of negative symptoms had a significantly greater risk of prehospitalization homelessness than those with low symptom levels. CONCLUSIONS: The high rate of homelessness observed must be viewed with profound concern by clinicians, consumers, and policymakers alike. The findings support the importance of intervening early in the course of disorder, particularly for persons diagnosed with psychotic illnesses. (Am J Psychiatry 1998; 155:109–113)
Abnormal sarcoplasmic reticulum Ca2+ release in heart failure
Authors: M Yano
Journal: Cardiovascular Research (2000)

We thank Drs. Diaz, Trafford, O’Neill and Eisner for their comments on our paper. We have shown in our article that the Ca2+ release function of cardiac ryanodine receptor (RyR) was indeed altered in heart failure induced by chronic rapid ventricular pacing [1]. Responding to our article, Diaz et al. raised a question as to the idea that the expression or the properties of the RyR are involved in changes of contractility observed in cardiac hypertrophy or failure. They showed that caffeine increased the open probability of the RyR and also increased the magnitude of both the systolic Ca2+ transient and the contraction. However, they also mentioned that this potentiation was completely transient because of the mechanism by which intracellular Ca2+ homeostasis is maintained toward a steady state, i.e. extrusion of Ca2+ …