tbuckley/cabot-search huggingface dataset:
Controlled trial of ligation plus nadolol versus nadolol alone for the prevention of first variceal bleeding
Authors: Gin-Ho Lo, Wen-Chi Chen, Huay-Min Wang, Ching-Chang Lee
Journal: Hepatology (2010)

Both nadolol and ligation have proved to be effective in the prophylaxis of first variceal bleeding. This study was conducted to evaluate the effects and safety of combining nadolol with ligation. Cirrhotic patients with high-risk esophageal varices but without a bleeding history were considered for enrolment. Eligible patients were randomized to receive band ligation plus nadolol (Combined group, 70 patients) or nadolol alone (Nadolol group, 70 patients). In the Combined group multiligators were applied. Patients received regular ligation treatment at an interval of 4 weeks until variceal obliteration. Nadolol was administered at a dose to reduce 25% of the pulse rate in both the Combined group and the Nadolol group. Both groups were comparable in baseline data. In the Combined group 50 patients (71%) achieved variceal obliteration. The mean dose of nadolol was 52 ± 16 mg in the Combined group and 56 ± 19 mg in the Nadolol group. During a median follow-up of 26 months, 18 patients (26%) in the Combined group and 13 patients (18%) in the Nadolol group experienced upper gastrointestinal bleeding ( P = NS). Esophageal variceal bleeding occurred in 10 patients (14%) in the Combined group and nine patients (13%) in the Nadolol group ( P = NS). Adverse events were noted in 48 patients (68%) in the Combined group and 28 patients (40%) in the Nadolol group ( P = 0.06). Sixteen patients in each group died. Conclusion: The addition of ligation to nadolol may increase adverse events and did not enhance effectiveness in the prophylaxis of first variceal bleeding. (Hepatology 2010)
Personalized Estimates of Benefit From Preventive Care Guidelines
Authors: Glen B. Taksler, R. Scott Braithwaite
Journal: Annals of Internal Medicine (2014)

Letters21 January 2014Personalized Estimates of Benefit From Preventive Care GuidelinesGlen B. Taksler, PhD and R. Scott Braithwaite, MD, MScGlen B. Taksler, PhDFrom New York University School of Medicine, New York, New York. and R. Scott Braithwaite, MD, MScFrom New York University School of Medicine, New York, New York.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L14-5001-2 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Matthys that combinations of interventions may have synergies (that is, greater-than-additive effects) when delivered together, which the editorial that accompanied our article also mentioned (1). We chose cautious language because combinations of interventions may confer not only greater-than-additive effects but also less-than-additive effects.Reference1. Owens DK, Goldhaber-Fiebert JD. Prioritizing guideline-recommended interventions [Editorial]. Ann Intern Med. 2013;159:223-4. [PMID: 23922066] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Glen B. Taksler, PhD; R. Scott Braithwaite, MD, MScAffiliations: From New York University School of Medicine, New York, New York.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2938. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPersonalized Estimates of Benefit From Preventive Care Guidelines Glen B. Taksler , Melanie Keshner , Angela Fagerlin , Negin Hajizadeh , and R. Scott Braithwaite Personalized Estimates of Benefit From Preventive Care Guidelines Jan Matthys Metrics Cited byComparative Effectiveness of Personalized Lifestyle Management Strategies for Cardiovascular Disease Risk Reduction 21 January 2014Volume 160, Issue 2 Page: 140 Keywords Conflicts of interest Disclosure Preventive medicine ePublished: 21 January 2014 Issue Published: 21 January 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
I can no longer "ration"
Authors: D. Mathews
Journal: BMJ (1995)

CD4<sup>+</sup>CD8<sup>+</sup> double-positive (DP) T cells represent a minor subpopulation of T lymphocytes found in the periphery of adult rats. In this study, we show that peripheral DP T cells appear among the first T cells that colonize the peripheral lymphoid organs during fetal life, and represent ∼40% of peripheral T cells during the perinatal period. Later their proportion decreases to reach the low values seen in adulthood. Most DP T cells are small size lymphocytes that do not exhibit an activated phenotype, and their proliferative rate is similar to that of the other peripheral T cell subpopulations. Only 30–40% of DP T cells expresses CD8β chain, the remaining cells expressing CD8αα homodimers. However, both DP T cell subsets have an intrathymic origin since they appear in the recent thymic emigrant population after injection of FITC intrathymically. Functionally, although DP T cells are resistant to undergo apoptosis in response to glucocorticoids, they show poor proliferative responses upon CD3/TCR stimulation due to their inability to produce IL-2. A fraction of DP T cells are not actively synthesizing the CD8 coreceptor, and they gradually differentiate to the CD4 cell lineage in reaggregation cultures. Transfer of DP T lymphocytes into thymectomized SCID mice demonstrates that these cells undergo post-thymic maturation in the peripheral lymphoid organs and that their CD4 cell progeny is fully immunocompetent, as judged by its ability to survive and expand in peripheral lymphoid organs, to proliferate in response to CD3 ligation, and to produce IL-2 upon stimulation.
Hepatocellular uptake of taurocholate in the dog.
Authors: S Erlinger
Journal: Journal of Clinical Investigation (1975)

The purpose of this study was to examine the hepatocellular extraction of taurocholate and to determine the kinetic characteristics of the uptake process. The uptake of taurocholate by the liver of the intact dog was studied by the multiple-indicator dilution method. 51Cr-labeled red blood cells (a vascular indicator), 125I-labeled albumin (an extravascular reference), and [14C]taurocholate were injected into the portal vein. Different doses of unlabeled taurocholate were included in the injection mixture. Hepatic venous dilution curves were obtained. As a consequence of the hepatic uptake, the outflow recovery of [14C]taurocholate was much reduced when compared to that of albumin, but its recovery increased with increasing doses of taurocholate, suggesting a progressive saturation of the uptake process. The analysis of the dilution curves fitted a three-compartment model system well and no return of the extracted taurocholate to the extracellular space could be detected. The initial space of distribution of taurocholate was 1.22 plus or minus 0.12 (SD) times greater than that of albumin. Analysis of the data for uptake was consistent with Michaelis-Menten kinetics. The calculated initial maximal velocity of uptake (Vmax) was 4.53 mumol times s--1 times 100 g of liver--1 and the dose yielding half-maximal velocity (DK) was 7.11 mumol times 100 g of liver--1. These results are consistent with the hypothesis that the uptake of taurocholate is carrier-mediated. The maximal vilocity of uptake was about six times the known maximal capacity of biliary secretion of taurocholate in the dog.
Reply to Peter L. Steinberg's Letter to the Editor re: Karim Bensalah, Margaret Pearle and Yair Lotan. Cost-Effectiveness of Medical Expulsive Therapy Using Alpha-Blockers for the Treatment of Distal Ureteral Stones. Eur Urol 2008;53:411–9
Authors: Yair Lotan
Journal: European Urology (2008)
Screening for Silent Coronary Heart Disease in Type 2 Diabetes
Authors: Julia Kharlip, Rosalie Naglieri, Braxton D. Mitchell, Kathleen A. Ryan, Thomas W. Donner
Journal: Diabetes Care (2006)

Patients with type 2 diabetes suffer twice the cardiovascular mortality of patients without the disease (1,2). In 1998, the American Diabetes Association (ADA) published guidelines for early detection of coronary heart disease (CHD) in asymptomatic patients with diabetes, with a specific focus on patients with multiple cardiovascular risk factors (3). Patients that fulfill any criteria are to be further risk stratified with stress testing. The criteria include 1 ) typical or atypical cardiac symptoms; 2 ) resting electrocardiograph suggestive of ischemia or infarction; 3 ) peripheral or carotid occlusive disease; 4 ) sedentary lifestyle, aged ≥35 years, and plans to begin a vigorous exercise program; and 5 ) more than two of the following risk factors in addition to diabetes: total cholesterol ≥240 mg/dl, LDL cholesterol ≥160 m/dl, or HDL cholesterol  140/90 mmHg; smoking; family history of premature coronary artery disease; or micro-/macroalbuminuria.

However, there are limited data available evaluating the performance of these guidelines in a clinical setting. We determined the proportion of patients in our clinic with type 2 diabetes that satisfied the ADA screening criteria and prevalence of CHD in these patients using stress testing and cardiac catheterization.

In 1999, records of patients ( n = 2,226) in the Joslin Center at the University of Maryland Medical Center …
Parasitism and Mutualism in Wolbachia: What the Phylogenomic Trees Can and Cannot Say
Authors: S. R. Bordenstein, C. Paraskevopoulos, J. C. Dunning Hotopp, P. Sapountzis, N. Lo, C. Bandi, H. Tettelin, J. H. Werren, K. Bourtzis
Journal: Molecular Biology and Evolution (2008)

Ecological and evolutionary theories predict that parasitism and mutualism are not fixed endpoints of the symbiotic spectrum. Rather, parasitism and mutualism may be host or environment dependent, induced by the same genetic machinery, and shifted due to selection. These models presume the existence of genetic or environmental variation that can spur incipient changes in symbiotic lifestyle. However, for obligate intracellular bacteria whose genomes are highly reduced, studies specify that discrete symbiotic associations can be evolutionarily stable for hundreds of millions of years. Wolbachia is an inherited obligate, intracellular infection of invertebrates containing taxa that act broadly as both parasites in arthropods and mutualists in certain roundworms. Here, we analyze the ancestry of mutualism and parasitism in Wolbachia and the evolutionary trajectory of this variation in symbiotic lifestyle with a comprehensive, phylogenomic analysis. Contrary to previous claims, we show unequivocally that the transition in lifestyle cannot be reconstructed with current methods due to long-branch attraction (LBA) artifacts of the distant Anaplasma and Ehrlichia outgroups. Despite the use of 1) site-heterogenous phylogenomic methods that can overcome systematic error, 2) a taxonomically rich set of taxa, and 3) statistical assessments of the genes, tree topologies, and models of evolution, we conclude that the LBA artifact is serious enough to afflict past and recent claims including the root lies in the middle of the Wolbachia mutualists and parasites. We show that different inference methods yield different results and high bootstrap support did not equal phylogenetic accuracy. Recombination was rare among this taxonomically diverse data set, indicating that elevated levels of recombination in Wolbachia are restricted to specific coinfecting groups. In conclusion, we attribute the inability to root the tree to rate heterogeneity between the ingroup and outgroup. Site-heterogenous models of evolution did improve the placement of aberrant taxa in the ingroup phylogeny. Finally, in the unrooted topology, the distribution of parasitism and mutualism across the tree suggests that at least two interphylum transfers shaped the origins of nematode mutualism and arthropod parasitism. We suggest that the ancestry of mutualism and parasitism is not resolvable without more suitable outgroups or complete genome sequences from all Wolbachia supergroups.
Letter: Intracardiac short circuit.
Authors: R Sutton, L Briers, J Norman
Journal: BMJ (1975)

<b>Background:</b> Distinct risk factors for asthma death have not been identified in developing communities. This study was conducted to distinguish risk factors for severe life threatening asthma (SLTA), a proxy for asthma death, in a developing country. <b>Methods:</b> A case-control study was performed at a University Hospital serving developing communities in the Western Cape Province, South Africa, over the period October 1997 to April 2000. Thirty consecutive patients with SLTA admitted to the intensive care unit (ICU) were compared with 60 chronic asthmatic patients, without a history of SLTA, who had attended the hospital outpatient respiratory clinic over the same period. <b>Results:</b> The risk of SLTA in comparison with controls increased with female sex (odds ratio (OR) 3.3, 95% CI 1.2 to 9.6, p = 0.02), rural residence (OR 8.1, 95% CI 2.6 to 25.3, p = 0.0005), and absence of a formal income (OR 5.7, 95% CI 2 to 16.6, p = 0.002). Cases were more likely to have had more than one hospital admission in the previous year (OR 8, 95% CI 2.5 to 25.2, p = 0.0009) and more than one emergency room visit in the previous year (OR 4.4, 95% CI 1.19 to 16.4, p = 0.04). Patients with SLTA were less likely to use inhaled corticosteroids (OR 5.6, 95% CI 1.9 to 16.5, p = 0.003) and more likely to use inhaled fenoterol (OR 6, 95% CI 2.2 to 16.2, p = 0.0004). Patients with SLTA also had lower mean (SE) forced expiratory volume in 1 second (FEV<sub>1</sub>) measurements (66.9 (9.5)% predicted <i>v</i> 82.5 (4.0)% predicted; p = 0.03) and lower FEV<sub>1</sub>/FVC ratios (60.7 (4.1)% predicted <i>v</i> 69.6 (1.9)% predicted; p = 0.05) documented before the episode of SLTA. <b>Conclusions:</b> Risk factors for SLTA that are mainly analogous to those distinguished in other environments have been identified in a geographical area characterised by a third world socioeconomic context. Rural residence and poverty may increase the risk of SLTA.
Geriatric medicine remains a specialty
Authors: C. E Yelland
Journal: BMJ (2008)

Should geriatric medicine remain a specialty is a curious question.1 2 Should we be asking if neurology or cardiology or any other medical specialty is still necessary?

Geriatricians have not questioned the basis for other specialties but continue to be challenged to justify their own existence. We are quite clear what we doâhow we …
[638] INFLUENCE OF INSULIN RESISTANCE AND RIBAVIRIN DOSAGE IN VIRAL DYNAMICS OF PATIENTS WITH CHRONIC HEPATITIS C GENOTYPE 1 TREATED WITH PEGINTERFERON AND RIBAVIRIN
Authors: L. Grande, A. Madrazo, M.M. Viloria, M.C. Nogales, R. Corpas, I. Camacho, D. Sanchez-Munoz, E. Martin-Mazuelos, M. Romero-Gomez
Journal: Journal of Hepatology (2007)
Intercellular adhesion molecule-1 and CD36 synergize to mediate adherence of Plasmodium falciparum-infected erythrocytes to cultured human microvascular endothelial cells.
Authors: C J McCormick, A Craig, D Roberts, C I Newbold, A R Berendt
Journal: Journal of Clinical Investigation (1997)

We have compared the adhesion of Plasmodium falciparum-infected erythrocytes to human dermal microvascular endothelial cells (HDMEC) and human umbilical vein endothelial cells (HUVEC) and have assessed the relative roles of the receptors CD36 and intercellular adhesion molecule-1 (ICAM-1). HUVEC (a cell line that expresses high levels of ICAM-1 but no CD36) mediate low levels of adhesion, whereas HDMEC (which constitutively express CD36) mediate high levels of adhesion even before ICAM-1 induction ICAM-1 expression leads to yet greater levels of adhesion, which are inhibited both by anti-ICAM-1 and CD36 mAbs, despite no increase in the expression of CD36. The results indicate the presence of a substantial population of infected cells that require the presence of both receptors to establish adhesion. Synergy between these receptors could be demonstrated using a number of parasite lines, but it could not be predicted from the binding of these same parasite lines to purified ICAM-1 and CD36. This phenomenon could not be reproduced using either purified receptors presented on plastic, or formalin-fixed HDMEC, suggesting that receptor mobility is important. This is the first study to demonstrate receptor synergy in malaria cytoadherence to human endothelial cells, a phenomenon necessary for parasite survival and associated with disease severity.
Persistent nocardemia following renal transplantation. Association with pulmonary nocardiosis
Authors: M. M. Avram
Journal: JAMA (1978)

Pulmonary nocardiosis occurred in a renal homotransplant patient and was diagnosed by persistently positive blood cultures. Infection developed at a time when efforts were being made with moderate dosages of immunosuppressive drugs to prevent rejection of the transplant. The subsequent nocardemia lasted for one week. The remaining kidney function was preserved, and the patient had a very favorable outcome because of early diagnosis and prompt treatment with sulfisoxazole. (<i>JAMA</i>239:2779-2780, 1978)
Government proposes fines for bars that have "all you can drink" offers
Authors: J. Wise
Journal: BMJ (2010)

The government has proposed a mandatory code for alcohol retailers in England and Wales that bans “all you can drink” promotions but fails to crack down on the sale of cheap alcohol in supermarkets.

The move has disappointed campaigners, such as the Royal College of Physicians, who have called for a minimum price for a unit of alcohol. Earlier this month a report from the House of Commons health select committee estimated that a minimum price of 50p (€0.6; $0.8) per unit of alcohol would prevent 3000 deaths a year ( BMJ 2010;340:c136, 12 Jan, doi:10.1136/bmj.c136).

Speaking on Radio 4’s Today programme, Alan Johnson, the home secretary, …
Furious Rabies after an Atypical Exposure
Authors: Heiman F. L Wertheim, Thai Q Nguyen, Kieu Anh T Nguyen, Menno D de Jong, Walter R. J Taylor, Tan V Le, Ha H Nguyen, Hanh T. H Nguyen, Jeremy Farrar, Peter Horby, Hien D Nguyen
Journal: PLoS Medicine (2009)

atient 1.A 48-year-old male construction worker, with no preceding medical illnesses, was admitted to the intensive care unit of a hospital in Hanoi.For a few days prior to admission he experienced pain and numbness in both forearms and a flushed sensation throughout his body.He also reported increased perspiration and increased libido.At presentation, the patient was lucid but markedly agitated, and was unable to swallow due to involuntary inspiratory muscle spasms when he was presented with a glass of water (Video S1) or when he felt a breeze.On examination he was afebrile, and had a dry mouth, normal heart rate and blood pressure, and a Glasgow Coma Score of 15.He had no focal neurological signs and no neck stiffness, and Kernig's sign was negative.Neither the patient nor his wife recalled that he had been bitten by a dog, cat, bat, or other mammal in the preceding months, and his skin showed no evidence of recent bite injuries or cuts.Patient 2. A 37-year-old male farmer, without any prior medical history, presented himself to a Hanoi outpatient clinic with increased perspiration, intermittent muscle spasms of both legs, and the inability to drink normally due to involuntary inspiratory muscle spasms when he was presented with a glass of water or felt a breeze.Disease onset was several days before admission.On examination, the patient had a normal body temperature, heart rate, and blood pressure, and a Glasgow Coma Score of 15.The patient was lucid with periods of agitation.There were no focal neurological signs and no neck stiffness, and Kernig's sign was negative.He had bilateral pupil dilatation (~5 mm) with weak direct and consensual light reflexes.There were no signs of recent bites or other skin injuries, but the patient reported that he had been bitten in the heel by a pet dog one month prior to presentation.The dog had remained healthy since the bite.The families of the patients in this
Occupational causes of disorders in the upper limbs.
Authors: J. M. Porter, P. Buckle, J. C. Robertson
Journal: BMJ (1992)

drugs should aim at an even larger number of patients and continue longer.The planning of this study started in 1985 after our first results2 were available; at this time there were no human data suggesting a renal protective effect of angiotensin converting enzyme inhibitors.Peter T Sawicki and Michael Berger seem to recommend a comparison of enalapril and metoprolol treatments during the follow up period from six months onwards, and that only patients with follow up times of one year or more be included.A total of 18 patients treated with enalapril and 13 treated with metoprolol are evaluable in this respect.During this period the mean (SD) rate of change in glomerular filtration rate was 0-8 (4 7) ml/min/year in the enalapril treated and -3 3 (4 2) ml/min/year in the metoprolol treated patients (p= 0 016).The mean arterial blood pressures (mean of supine and standing pressures) were 102 (5) mm Hg and 103 (4) mm Hg, respectively.Multiple regression analysis shows that enalapril or metoprolol treatment was correlated to the rate of fall in glomerular filtration rate (p=002) but mean arterial blood pressure was not (p=0 8).If supine or standing mean arterial blood pressure is used, neither result is significant (p=026 and 0-4, respectively).Thus, in our enalapril treated patients there was no fall in glomerular filtration rate after the first six months.Blood pressure was less important for the prognosis of renal function than type of antihypertensive treatment in these patients with well controlled blood pressure.
Consultation Planning to Help Breast Cancer Patients Prepare for Medical Consultations: Effect on Communication and Satisfaction for Patients and Physicians
Authors: Karen R. Sepucha, Jeffrey K. Belkora, Stephanie Mutchnick, Laura J. Esserman
Journal: Journal of Clinical Oncology (2002)

PURPOSE: To measure the prevalence of communication barriers between breast cancer patients and their physicians and to present the results of a study evaluating the impact of two visit preparation techniques on communication and satisfaction for breast cancer patients and their physicians. PATIENTS AND METHODS: We recruited 132 breast cancer patients from two outpatient cancer centers in a sequential, controlled trial. Ninety-four consented and completed the trial. Patients were assigned to one of two visit preparation interventions before their appointment with either a surgeon or a medical oncologist. In the control intervention, called Productive Listening, a researcher listened to and prompted patients to reflect on their experiences communicating with physicians. In the experimental intervention, called Consultation Planning, a researcher elicited questions and concerns, generated a printed agenda for the upcoming consultation, and engaged patients in techniques to improve communication with their physicians. Valid and reliable surveys measured communication barriers, satisfaction with the intervention, and patients’ and physicians’ satisfaction with the consultation. RESULTS: Sixty-four percent of the patients reported three or more communication barriers. Patients reported a significant reduction in communication barriers after both the intervention and the control session. Patients reported significantly higher satisfaction after the Consultation Planning sessions. Physicians reported significantly higher satisfaction with those patients who had participated in a Consultation Planning session. CONCLUSION: Visit preparation sessions help patients prepare for medical consultations and reduce barriers to communication. Consultation Planning sessions, in which a researcher solicited the patient’s agenda, were more satisfying to patients and physicians than the Productive Listening sessions.