tbuckley/cabot-search huggingface dataset:
Mechanisms of rosette formation.
Authors: I Siegel
Journal: BMJ (1972)

<h3>Objectives</h3> The primary objective of this study was to determine whether intramuscular depot medroxyprogesterone acetate (IM DMPA) given at the time of misoprostol administration, 24–48 hours after mifepristone, affects the rate of continuing pregnancy. In addition, the study explored factors predictive of continuing pregnancy. <h3>Design</h3> Case-control study based on database review of women who underwent early medical abortion (EMA) over a 4-year period. <h3>Setting</h3> Single abortion service in Scotland. <h3>Participants</h3> 5122 women who underwent an EMA within the timeframe of this study. <h3>Main outcome measures</h3> Continuing pregnancies among women receiving IM DMPA were compared with those choosing other hormonal methods of contraception, non-hormonal contraception or no contraception at the time of misoprostol administration. Logistic regression was performed to assess the effects of demographic characteristics, gestation at presentation and method of contraception provided, on outcome of pregnancy. <h3>Results</h3> A total of 4838 women with complete data were included, of which there were 20 continuing pregnancies (0.4%); 284 women were excluded due to missing data. There was no increased risk of a continuing pregnancy among women who initiated IM DMPA at the time of misoprostol administration (24–48 hours after mifepristone) compared with women who initiated no hormonal contraception at this time (RR 0.48; 95% CI 0.06 to 3.81). Gestation ≥8 weeks and previous terminations were factors associated with increased likelihood of continuing pregnancy. <h3>Conclusions</h3> Women choosing IM DMPA after EMA can be reassured that IM DMPA can be safely initiated at the time of misoprostol administration 24–48 hours after mifepristone without an increase in the risk of a continuing pregnancy. Both increasing gestation and previous termination were factors associated with an increased likelihood of continuing pregnancy following an EMA.
Neonatal MRI to Predict Neurodevelopmental Outcomes in Preterm Infants
Authors: Lianne J. Woodward, Peter J. Anderson, Nicola C. Austin, Kelly Howard, Terrie E. Inder
Journal: New England Journal of Medicine (2006)

Very preterm infants are at high risk for adverse neurodevelopmental outcomes. Magnetic resonance imaging (MRI) has been proposed as a means of predicting neurodevelopmental outcomes in this population.We studied 167 very preterm infants (gestational age at birth, 30 weeks or less) to assess the associations between qualitatively defined white-matter and gray-matter abnormalities on MRI at term equivalent (gestational age of 40 weeks) and the risks of severe cognitive delay, severe psychomotor delay, cerebral palsy, and neurosensory (hearing or visual) impairment at 2 years of age (corrected for prematurity).At two years of age, 17 percent of infants had severe cognitive delay, 10 percent had severe psychomotor delay, 10 percent had cerebral palsy, and 11 percent had neurosensory impairment. Moderate-to-severe cerebral white-matter abnormalities present in 21 percent of infants at term equivalent were predictive of the following adverse outcomes at two years of age: cognitive delay (odds ratio, 3.6; 95 percent confidence interval, 1.5 to 8.7), motor delay (odds ratio, 10.3; 95 percent confidence interval, 3.5 to 30.8), cerebral palsy (odds ratio, 9.6; 95 percent confidence interval, 3.2 to 28.3), and neurosensory impairment (odds ratio, 4.2; 95 percent confidence interval, 1.6 to 11.3). Gray-matter abnormalities (present in 49 percent of infants) were also associated, but less strongly, with cognitive delay, motor delay, and cerebral palsy. Moderate-to-severe white-matter abnormalities on MRI were significant predictors of severe motor delay and cerebral palsy after adjustment for other measures during the neonatal period, including findings on cranial ultrasonography.Abnormal findings on MRI at term equivalent in very preterm infants strongly predict adverse neurodevelopmental outcomes at two years of age. These findings suggest a role for MRI at term equivalent in risk stratification for these infants.
Fatigue among Clinicians and the Safety of Patients
Authors: David M Gaba, Steven K Howard
Journal: New England Journal of Medicine (2002)

Clinicians, especially physicians in training, often work long hours and get inadequate sleep. The implications of fatigue among clinicians for the quality of medical care have not been adequately studied, but sleep deprivation is likely to cause medical errors. This article reviews the effect of fatigue on performance, as well as current policies regulating residents' hours of work and options for new regulations governing residency shifts. The authors argue that reform is needed because the long work hours of clinicians adversely affect the quality of health care.
Robert Stanley Rihan
Authors: David Thomas, Wing Lien, Peter Hillenbrand
Journal: BMJ (2006)

Pioneer of powered prosthetic limbs and fetal heart monitorsDavid Simpson, who was disabled by a war wound, retrained from accountancy to physics to devise solutions for medical problems.In the 1950s, when orthopaedic engineering was in its infancy, he pioneered the design and manufacture of controllable artificial limbs.He designed monitoring
Antitussives in Jeopardy
Authors: William R. Barclay
Journal: JAMA (1973)

In the Federal Register , Feb 9, 1973, the Food and Drug Administration (FDA) published a notice to withdraw from the market certain antitussive combinations. Named in the withdrawal notice are the following preparations:  Novrad With ASA  Coricidin With Codeine Phosphate  Phenergan Expectorant With Codeine  Phenergan Expectorant  Phenergan VC Expectorant  Phenergan VC Expectorant With Codeine  Pediatric Phenergan Expectorant  Phenergan Expectorant Troches  Phenergan Expectorant Troches With Codeine  Dimetane Expectorant  Dimetane Expectorant-DC  Omni-Tuss suspension  Tussionex tablets  Ulogesic tablets  Ulominic Syrup  Coditrate Syrup  Methajade liquid  Thephorin Expectorant  Actifed-C Expectorant  Clistin Expectorant  Tuss-Ornade liquid  Tuss-Ornade Spansules  Benylin Expectorant  Ambenyl Expectorant  Cothera Compound  Pyribenzamine Expectorant  Pyribenzamine Expectorant With Codeine and Ephedrine  However, other products of similar compositions will also be affected even though they are not specifically cited.  The FDA is basing this action on regulations established by the 1962 Harris-Kefauver amendments to the Food, Drug, and Cosmetic Act of 1938 and on the National Academy
Medicine, Metrication, and SI Units
Authors: William R. Barclay
Journal: JAMA (1980)

PUBLIC Law 94-168, the Metric Conversion Act of 1975, specifies that the transition to a metric system of measurements in the United States be a voluntary process rather than a conversion in a fixed period of time by government regulation. To assist voluntary conversion to the metric system of weights and measures, and in particular, to SI units (Système International d'Unités), a private, nonprofit organization, the American National Metric Council, was formed in 1973. It is supported by annual dues from its member organizations and from subscriptions to its journal, the<i>Metric Reporter</i>. The American Medical Association joined the National Metric Council in 1978 and initiated the formation of a biomedical sector committee to develop recommendations on the reporting of measurements in the field of clinical medicine. This section has been redesignated the "Medicine and Health Coordinating Group" and will receive recommendations from all the major specialty societies in medicine
Influence of Preservation Solution on Early Graft Failure in Clinical Lung Transplantation
Authors: GABRIEL THABUT, ISABELLE VINATIER, OLIVIER BRUGIÈRE, GUY LESÈCHE, PHILIPPE LOIRAT, ALAIN BISSON, JEAN MARTY, MICHEL FOURNIER, HERVÉ MAL
Journal: American Journal of Respiratory and Critical Care Medicine (2001)

The aim of this study was to assess the influence of preservation solution type and extra- or intracellular composition on the occurrence of early graft dysfunction after clinical lung transplantation. For 170 patients who underwent a single (n = 124) or bilateral (n = 46) lung transplantation in two centers in Paris between 1988 and 1999, the preservation technique applied to the donor lung was single-flush perfusion of the pulmonary artery with one of several solutions of intracellular (Euro-Collins, n = 61; University of Wisconsin, n = 24) or extracellular composition (Cambridge, n = 64; Celsior, n = 21). The early postoperative outcome of these patients was reviewed. Reimplantation edema occurred in 48% of all patients, and the overall 1-mo survival rate was 84%. No significant difference in the incidence of edema, duration of mechanical ventilation, and 1-mo survival rate was observed between the four groups or between intra- and extracellular groups. After adjustment for graft ischemic time by means of multivariate analysis, the use of extracellular preservation fluid was associated with a lower incidence of reimplantation edema without effect on 1-mo mortality. Graft ischemic time was associated with both edema occurrence and 1-mo survival rate (p = 0.02 and p = 0.01, respectively). We conclude that extracellular-type solutions are associated with better lung preservation than intracellular-type solutions in clinical transplantation.
Splenomegaly and chronic disseminated intravascular coagulation in Osler-Weber-Rendu disease: A case report
Authors: A. Notoya, T. Bohgaki, M. Mukai, M. Kohno, H. Sato, K. Sawada
Journal: American Journal of Hematology (2000)

A 45-year-old Japanese woman with splenomegaly and thrombocytopenia was referred to our hospital. The diagnosis of Osler–Weber–Rendu disease (Osler's disease) was made because of spotty telangiectasia on her tongue, recurrent epistaxis since childhood, and a diathesis indicated by her family history. The patient's laboratory examination revealed anemia, thrombocytopenia, and other data consistent with chronic disseminated intravascular coagulation (DIC). Bone marrow examination was normal. Abdominal computed tomography showed marked enlargement of the spleen with deformity and calcified plaque, not homogeneously enhancing. Hypersplenism was not observed. Platelet scintigraphy indicated a remarkable uptake in the spleen. She was diagnosed as having chronic DIC associated with vascular lesions of Osler's disease in the spleen. Splenectomy was performed and the subsequent pathological findings indicated that fragility of the fine vascular architecture of the splenic red pulp might have been responsible for pathogenesis. The large pooling of blood with coagulation was thought to be secondary. Am. J. Hematol. 65:315–318, 2000. © 2000 Wiley-Liss, Inc.
Schizophreniform Psychosis of Childhood
Authors: KENT JORDAN, DANE G. PRUGH
Journal: American Journal of Psychiatry (1971)

Twenty-two children were studied who had symptoms that closely correspond to the 1966 GAP description of schizophreniform psychosis: extensive fantasies, impaired reality testing, hallucinations, paranoia, fluctuating ego functioning, and intensely dependent attachments to adults, especially the mother. Unlike most childhood psychoses, this disorder did not appear until early latency. If early psychotherapy, lasting a year or more, was carried out, the prognosis was good. The authors stress the importance of early recognition and treatment of this disorder and urge an end to its neglect in the literature.
Sport, Sex Segregation, and Sex Testing: Critical Reflections on This Unjust Marriage
Authors: Shari L. Dworkin, Cheryl Cooky
Journal: The American Journal of Bioethics (2012)

We extend appreciation to Karkazis, Jordan-Young, Davis, and Camporesi for their outstanding article. They argue that the legitimacy of the new policies on hyperandrogenism in elite female athletes...
Amyloidosis--a Complication of Pustular Psoriasis
Authors: P. A. Berger
Journal: BMJ (1969)

Two patients with generalized pustular psoriasis developed amyloidosis with a fatal outcome. It is suggested that generalized pustular psoriasis may predispose to the development of secondary amyloidosis either by prolonged stimulation of the reticuloendothelial system or through abnormal immunoglobulin synthesis.
HAPTEN-SPECIFIC IgE ANTIBODY RESPONSES IN MICE
Authors: Toshiyuki Hamaoka, David H. Katz, Baruj Benacerraf
Journal: The Journal of Experimental Medicine (1973)

The present studies have established conditions for the demonstration of cooperative interactions between specific T and B lymphocyte populations in the development of IgE antibody responses in vivo in mice. This has been accomplished by utilizing a system which permits the successful adoptive transfer to irradiated recipients of DNP-specific secondary IgE responses with spleen cells from suitably primed syngeneic donor mice. Thus, adoptively transferred DNP-KLH or DNP-ASC-primed spleen cells produced high levels of anti-DNP antibodies of both IgE and IgG antibody classes in response to challenge with the appropriate homologous priming conjugate but failed to develop more than meager responses to the reciprocal heterologous conjugate. However, when spleen cells from donors primed to the second carrier were concomitantly transferred with hapten-primed lymphocytes, secondary IgE ant-DNP responses were consistently obtained upon challenge with the heterologous conjugate. Moreover, we have been able to elicit augmented primary IgE anti-DNP antibody responses to either DNP-ASC or DNP-KLH after adoptive transfer of spleen cells from donors primed only to the carrier, ASC or KLH, respectively. This adoptive transfer system has enabled us to provide direct proof for the participation of θ-bearing T lymphocytes in antibody responses of the IgE class. Thus, the capacity of ASC-primed spleen cells to effectively cooperate with the DNP-KLH-primed lymphocytes in the adoptive secondary response to DNP-ASC could be abolished by in vitro treatment of such cells with anti-θ serum plus complement. This was true not only for the anti-DNP response of the IgG antibody class, but for the IgE antibody class as well. These studies have, furthermore, demonstrated the capacity to stimulate secondary anti-DNP antibody production in vivo by the concomitant administration of the DNP and relevant carrier determinants on separate molecules. This was more readily seen in the IgE than in the IgG antibody class. Thus, DNP-ASC-primed cells developed significant IgE, but more variable IgG, anti-DNP responses upon challenge with DNP-KLH plus unconjugated ASC. Antibody responses of both classes elicited in this manner were appreciably improved by the transfer of additional carrier (ASC)-primed cells. These and other results presented herein suggest that IgE B lymphocyte precursors may be inherently more sensitive than IgG B cells to at least certain of the functions of T lymphocytes concerned with regulatory mechanisms involved in antibody production.
Sympathetic Blockade in Treatment of Hypertension
Authors: C. P. Lowther, R. W. D. Turner
Journal: BMJ (1960)

Ten years ago, in papers on medical sympathectomy and the clinical use of methonium compounds, early experience in this unit with ganglion-blocking drugs was recorded (Turner, 1950, 1951). Recently the indications for treatment, method of administration, and the problems of tolerance and side-effects were reviewed (Turner, 1959). At an early stage it was decided that to initiate life long treatment with potent and potentially dangerous drugs was a major decision and that it was best first to make a detailed and standardized assessment of each patient in hospital. If treatment was indicated we tried to achieve a steady state with the appropriate drug, and then further treatment was supervised on a long-term basis in a special clinic organized for the purpose. This procedure has helped to ensure the proper and uniform selection of patients suitable for treatment, has facili tated the maintenance of good control over the blood pressure as well as the collection and correlation of data, and has made possible comparative assessments of different drugs. Numerous ganglion-blocking agents have been investigated, all potent in lowering the blood pressure, but none free from difficulties of administra tion, particularly as regards tolerance and side-effects. None, in fact, has been satisfactory. Although the blood-pressure can be reduced to almost any desired level this can rarely be achieved without troublesome side-effects from concomitant parasympa thetic blockade. Some improvement results from combining the ganglion-blocking drug with chloro thiazide or rauwolfia, but in some degree most patients complain of constipation, dryness of the mouth, diffi culty with accommodation, delay in micturition, or impotence. In many individuals these effects are asso ciated with a feeling of general malaise. Because of all this, physicians have looked forward to the day when research workers would be rewarded by the finding of a compound with selective blocking action on the sympathetic nervous system. Recently, in the laboratories of the Wellcome Founda tion in England and the Ciba Foundation in Switzer land, compounds have been isolated which do selectively block the peripheral sympathetic nervous system by accumulating in sympathetic ganglia and post-ganglionic fibres. The first of these has been given the name of bretylium tosylate ( darenthin ), and has the formula N-o-bromobenzyl-N-ethyl : N : N-dimethylammonium p toluenesulphonate. The second substance has been given the name of guanethidine ( ismelin ) and has the formula 2-(octahydro-L-azocinyl-ethyl) guanidine sulphate. This paper is principally concerned with a clinical trial of bretylium, which we have used for 15 months in the treatment of 43 patients with hypertension.
The global burden of hepatitis E virus genotypes 1 and 2 in 2005
Authors: David B. Rein, Gretchen A. Stevens, Jordan Theaker, John S. Wittenborn, Steven T. Wiersma
Journal: Hepatology (2011)

Abstract We estimated the global burden of hepatitis E virus (HEV) genotypes 1 and 2 in 2005. HEV is an emergent waterborne infection that causes source-originated epidemics of acute disease with a case fatality rate thought to vary by age and pregnancy status. To create our estimates, we modeled the annual disease burden of HEV genotypes 1 and 2 for 9 of 21 regions defined for the Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2010 Study), which represent 71% of the world's population. We estimated the seroprevalence of anti-HEV antibody and annual incidence of infection for each region using data from 37 published national studies and the DISMOD 3, a generic disease model designed for the GBD Study. We converted incident infections into three mutually exclusive results of infection: (1) asymptomatic episodes, (2) symptomatic disease, and (3) death from HEV. We also estimated incremental cases of stillbirths among infected pregnant women. For 2005, we estimated 20.1 (95% credible interval [Cr.I.]: 2.8–37.0) million incident HEV infections across the nine GBD Regions, resulting in 3.4 (95% Cr.I.: 0.5–6.5) million symptomatic cases, 70,000 (95% Cr.I.: 12,400–132,732) deaths, and 3,000 (95% Cr.I.: 1,892–4,424) stillbirths. We estimated a probability of symptomatic illness given infection of 0.198 (95% Cr.I.: 0.167–0.229) and a probability of death given symptomatic illness of 0.019 (95% Cr.I.: 0.017–0.021) for nonpregnant cases and 0.198 (95% Cr.I.: 0.169–0.227) for pregnant cases. Conclusion : The model was most sensitive to estimates of age-specific incidence of HEV disease. (Hepatology 2012)
Is obesity an independent risk factor for hepatocellular carcinoma in cirrhosis?
Authors: Satheesh Nair, Andrew Mason, James Eason, George Loss, Robert P. Perrillo
Journal: Hepatology (2002)

Recently, several epidemiologic observations have suggested that obesity might be an independent risk factor for certain malignancies such as breast cancer, colon cancer, renal cell carcinoma, and esophageal adenocarcinoma. However, there are no studies examining the risk of hepatocellular carcinoma (HCC) in obesity. The aim of the present study was to determine whether obesity is an independent risk factor for HCC in patients with cirrhosis. Explanted liver specimens from a national database on patients undergoing liver transplantation were examined for HCC, and the incidence was compared among patients with varying body mass indices according to the etiology of cirrhosis. A multivariate analysis was used for controlling other potentially confounding variables such as age and sex. Among 19,271 evaluable patients, the overall incidence of HCC was 3.4% (n = 659) with a slightly higher prevalence among obese patients compared with lean patients. Obesity was an independent predictor for HCC in patients with alcoholic cirrhosis (odds ratio [OR], 3.2; 95% CI, 1.5-6.6; P =.002) and cryptogenic cirrhosis (OR, 11.1; 95% CI, 1.5-87.4; P =.02). Obesity was not an independent predictor in patients with hepatitis C, hepatitis B, primary biliary cirrhosis, and autoimmune hepatitis. The higher risk of HCC in obese patients is confined to alcoholic liver disease and cryptogenic cirrhosis. In conclusion, more frequent surveillance for HCC may be warranted in obese patients with alcoholic and cryptogenic cirrhosis. However, as this study is based on patients with advanced cirrhosis, our findings need to be confirmed in a broader population of individuals with cirrhosis.
Serum autotaxin is increased in pruritus of cholestasis, but not of other origin, and responds to therapeutic interventions
Authors: Andreas E. Kremer, Remco van Dijk, Pamela Leckie, Frank G. Schaap, Edith M.M. Kuiper, Thomas Mettang, Katrin S. Reiners, Ulrike Raap, Henk R. van Buuren, Karel J. van Erpecum, Nathan A. Davies, Christian Rust, Andreas Engert, Rajiv Jalan, Ronald P.J. Oude Elferink, Ulrich Beuers
Journal: Hepatology (2012)

Pruritus is a seriously disabling symptom accompanying many cholestatic liver disorders. Recent experimental evidence implicated the lysophospholipase, autotaxin (ATX), and its product, lysophosphatidic acid (LPA), as potential mediators of cholestatic pruritus. In this study, we highlight that increased serum ATX levels are specific for pruritus of cholestasis, but not pruritus of uremia, Hodgkin's disease, or atopic dermatitis. Treatment of patients with cholestasis with the bile salt sequestrant, colesevelam, but not placebo, effectively reduced total serum bile salts and fibroblast growth factor 19 levels, but only marginally altered pruritus intensity and ATX activity. Rifampicin (RMP) significantly reduced itch intensity and ATX activity in patients with pruritus not responding to bile salt sequestrants. In vitro , RMP inhibited ATX expression in human HepG2 hepatoma cells and hepatoma cells overexpressing the pregnane X receptor (PXR), but not in hepatoma cells in which PXR was knocked down. Treatment of severe, refractory pruritus by the molecular adsorbents recirculation system or nasobiliary drainage improved itch intensity, which, again, correlated with the reduction of ATX levels. Upon reoccurrence of pruritus, ATX activity returned to pretreatment values. Conclusion : Serum ATX activity is specifically increased in patients with cholestatic, but not other forms of, systemic pruritus and closely correlates with the effectiveness of therapeutic interventions. The beneficial antipruritic action of RMP may be explained, at least partly, by the PXR-dependent transcriptional inhibition of ATX expression. Thus, ATX likely represents a novel therapeutic target for pruritus of cholestasis. (Hepatology 2012)