tbuckley/cabot-search huggingface dataset:
Is this patient pregnant? Can you reliably rule in or rule out early pregnancy by clinical examination?
Authors: L. A. Bastian
Journal: JAMA (1997)

This review addresses a common problem facing the clinician: "When treating or evaluating a woman of childbearing years, what is the value of historical or physical examination features in determining the probability of early pregnancy?" We focus on the clinical examination findings that may help the clinician rule in or rule out early pregnancy. Generally accepted indicators of pregnancy include amenorrhea, morning sickness, tender or tingling breasts, and, after 8 weeks' gestational age, an enlarged uterus with a soft cervix. We reviewed the value (ie, sensitivity and specificity) of these indicators, as well as home pregnancy test results, as predictors of the diagnosis of early pregnancy. The available evidence suggests that some historical features, when absent, are fair but not reliable for ruling out pregnancy. When diagnosing early pregnancy, the clinician should not rely on the clinical examination or a home pregnancy test-a laboratory test should be requested.
The Gq/G11-mediated signaling pathway is critical for autocrine potentiation of insulin secretion in mice
Authors: Antonia Sassmann, Belinda Gier, Hermann-Josef Gröne, Gisela Drews, Stefan Offermanns, Nina Wettschureck
Journal: Journal of Clinical Investigation (2010)

A variety of neurotransmitters, gastrointestinal hormones, and metabolic signals are known to potentiate insulin secretion through GPCRs. We show here that beta cell-specific inactivation of the genes encoding the G protein alpha-subunits Galphaq and Galpha11 resulted in impaired glucose tolerance and insulin secretion in mice. Interestingly, the defects observed in Galphaq/Galpha11-deficient beta cells were not restricted to loss of muscarinic or metabolic potentiation of insulin release; the response to glucose per se was also diminished. Electrophysiological recordings revealed that glucose-induced depolarization of isolated beta cells was impaired in the absence of Galphaq/Galpha11, and closure of KATP channels was inhibited. We provide evidence that this reduced excitability was due to a loss of beta cell-autonomous potentiation of insulin secretion through factors cosecreted with insulin. We identified as autocrine mediators involved in this process extracellular nucleotides such as uridine diphosphate acting through the Gq/G11-coupled P2Y6 receptor and extracellular calcium acting through the calcium-sensing receptor. Thus, the Gq/G11-mediated signaling pathway potentiates insulin secretion in response to glucose by integrating systemic as well as autocrine/paracrine mediators.
Prospective Evaluation of Risk Factors for Bloodstream Infection in Patients Receiving Home Infusion Therapy
Authors: Jerome I. Tokars, Susan T. Cookson, Margaret A. McArthur, Cindy L. Boyer, Allison J. McGeer, William R. Jarvis
Journal: Annals of Internal Medicine (1999)

Intravenous therapy in the outpatient and home settings is commonplace for many diseases and nutritional disorders. Few data are available on the rate of and risk factors for bloodstream infection among patients receiving such therapy.To determine rates of and risk factors for bloodstream infection among patients receiving home infusion therapy.Prospective, observational cohort study.Cleveland, Ohio, and Toronto, Ontario, Canada.Patients receiving home infusion therapy through a central or midline catheter.Primary laboratory-confirmed bloodstream infection.Among 827 patients (988 catheters), the most common diagnoses were infections other than HIV (67%), cancer (24%), nutritional and digestive disease (17%), heart disease (14%), receipt of bone marrow or solid organ transplants (11%), and HIV infection (7%). Sixty-nine bloodstream infections occurred during 69,532 catheter-days (0.99 infections per 1000 days). In a Cox regression model with time-dependent covariates, independent risk factors for bloodstream infection were recent receipt of a bone marrow transplant (hazard ratio, 5.8 [95% CI, 3.0 to 11.3]), receipt of total parenteral nutrition (hazard ratio, 4.1 [CI, 2.3 to 7.2]), receipt of therapy outside the home (for example, in an outpatient clinic or physician's office) (hazard ratio, 3.6 [CI, 2.2 to 5.9]), use of a multilumen catheter (hazard ratio, 2.8 [CI, 1.7 to 4.7]), and previous bloodstream infection (hazard ratio, 2.5 [CI, 1.5 to 4.2]). Rates of bloodstream infection per 1000 catheter-days varied from 0.16 for patients with none of these 5 risk factors to 6.77 for patients with 3 or more risk factors. Centrally inserted venous catheters were associated with a higher risk than implanted ports were, but the difference was not statistically significant.Bloodstream infections seem to be infrequent among outpatients receiving infusions through central and midline catheters. However, the rate of infection increases with bone marrow transplantation, parenteral nutrition, infusion therapy in a hospital clinic or physician's office, and use of multilumen catheters. Compared with implanted ports or peripherally inserted catheters, centrally inserted venous catheters may confer greater risk for bloodstream infection.
Should the Health Care Forest Be Selectively Thinned by Physicians or Clear Cut by Payers?
Authors: H. Gilbert Welch
Journal: Annals of Internal Medicine (1991)

▪ As the need to set limits in health care becomes more generally accepted, physicians and policymakers need to consider who can best decide how to allocate medical resources among patients. This commentary focuses on the two obvious candidates: payers and physicians. Although payer-based allocation has the advantage of allowing physicians to act strictly on behalf of their patients, it lacks precision and flexibility. Physician-based allocation places allocation decisions in the hands of individuals better positioned and better equipped to make choices that maximize health outputs. To preserve clinical freedom and minimize micromanagement of individual patients, physicians should expand their advocacy role beyond individual patients and recognize their responsibility to populations. In doing so, physicians would acknowledge that societal and patient interests differ and that health care is just one of many important social goods. For physicians willing to make these choices, five general guidelines are offered. Finally, mechanisms to encourage physician-based allocation are considered.
The Incidence of IDDM in Seoul From 1985 to 1988
Authors: Kwang W Ko, Sei W Yang, Nam H Cho
Journal: Diabetes Care (1994)

OBJECTIVE To determine insulin-dependent diabetes mellitus (IDDM) incidence rates for the first time in Seoul, Korea, from 1985 to 1988. RESEARCH DESIGN AND METHODS A mail survey was conducted among all hospitals, a total of 136, with &amp;gt; 80 beds in the Seoul area. Of these, (15.4%) hospitals reported patients with newly diagnosed IDDM. RESULTS The average incidence rate of IDDM from 1985 to 1988 was 0.70/100,000 (95% confidence interval [CI]: 0.55–0.89). When stratified by gender, the average incidence rate in boys was 0.58/100,000 (95% CI: 0.42–0.9), and in girls it was 0.78/100,000 (95% CI: 0.56–1.07). The age at onset was similar to that reported in other countries, i.e., more than 50% of the cases were diagnosed between the ages of 10 and 14. The incidence of IDDM increased in parallel with the age-group (0–4 &amp;lt; 5–9 &amp;lt; 10–14 years). Onset seasonality was also similar to that in other reported countries with the most cases occurring during the winter months and the least number of cases during the summer months. CONCLUSIONS The incidence rate of IDDM in Seoul is the lowest reported in the world. This might be effectively considered a baseline incidence rate before exposure to environment or other risk factors. The similar pattern of onset characteristics in Korea to those in other countries suggests that the same etiological factors are operative.
Stem Cell Pathways Contribute to Clinical Chemoresistance in Ovarian Cancer
Authors: Adam D. Steg, Kerri S. Bevis, Ashwini A. Katre, Angela Ziebarth, Zachary C. Dobbin, Ronald D. Alvarez, Kui Zhang, Michael Conner, Charles N. Landen
Journal: Clinical Cancer Research (2011)

Abstract Purpose: Within heterogeneous tumors, subpopulations often labeled cancer stem cells (CSC) have been identified that have enhanced tumorigenicity and chemoresistance in ex vivo models. However, whether these populations are more capable of surviving chemotherapy in de novo tumors is unknown. Experimental Design: We examined 45 matched primary/recurrent tumor pairs of high-grade ovarian adenocarcinomas for expression of CSC markers ALDH1A1, CD44, and CD133 using immunohistochemistry. Tumors collected immediately after completion of primary therapy were then laser capture microdissected and subjected to a quantitative PCR array examining stem cell biology pathways (Hedgehog, Notch, TGF-β, and Wnt). Select genes of interest were validated as important targets using siRNA-mediated downregulation. Results: Primary samples were composed of low densities of ALDH1A1, CD44, and CD133. Tumors collected immediately after primary therapy were more densely composed of each marker, whereas samples collected at first recurrence, before initiating secondary therapy, were composed of similar percentages of each marker as their primary tumor. In tumors collected from recurrent platinum-resistant patients, only CD133 was significantly increased. Of stem cell pathway members examined, 14% were significantly overexpressed in recurrent compared with matched primary tumors. Knockdown of genes of interest, including endoglin/CD105 and the hedgehog mediators Gli1 and Gli2, led to decreased ovarian cancer cell viability, with Gli2 showing a novel contribution to cisplatin resistance. Conclusions: These data indicate that ovarian tumors are enriched with CSCs and stem cell pathway mediators, especially at the completion of primary therapy. This suggests that stem cell subpopulations contribute to tumor chemoresistance and ultimately recurrent disease. Clin Cancer Res; 18(3); 869–81. ©2011 AACR.
Esophageal Visible Vessel as a Cause of Massive Upper Gastrointestinal Hemorrhage
Authors: T. Bozkurt, P. C. Lederer, G. Lux
Journal: Endoscopy (1991)

Besides peptic ulcers, erosions, esophageal varices, tumors and non-variceal esophageal lesions, vascular abnormalities lead to an upper gastrointestinal hemorrhage in 1-5% of cases. Among 581 emergency esophagogastro-duodenoscopies for acute gastrointestinal bleeding performed in our institution between 1987 and 1989, an esophageal visible vessel was found to be the source of massive hemorrhage in five patients. All patients were males with ages ranging from 37 to 84 years. Esophageal visible vessel was localized in one patient in the middle third and in four patients in the distal portion of the esophagus. Using the Forrest classification, endoscopy revealed an oozing hemorrhage (Ib) in two patients and a protruding vessel (IIa) in three patients. Definitive hemostasis could be achieved in all patients by local injection of adrenaline combined with heater probe thermocoagulation. In some patients with recurrent upper gastrointestinal bleeding, visible esophageal vessel is a rare source of bleeding that has not yet been described.
Increased interleukin-32 expression in chronic hepatitis B virus-infected liver
Authors: Qihuan Xu, Xingfei Pan, Xin Shu, Hong Cao, Xuejun Li, Ka Zhang, Jianxi Lu, Yong Zou, Xueling Li, Hongcan Liu, Yeqiong Zhang, Daofeng Yang, Qin Ning, Guanxin Shen, Gang Li
Journal: Journal of Infection (2012)
Suicide by Physicians on Probation
Authors: Martin J. Valaske
Journal: JAMA (1981)

the Editor.—  The otherwise fine article on An Epidemic of Suicide Among Physicians on Probation (243:1915, 1980) was seriously marred as a resource for physicians like myself working on medical society committees on physician impairment.  First, To protect survivors, case histories will not be published. This decision left us with no specifics against which to weigh the worth of the six conclusions and the six additional recommendations presented by the authors.  Second, although the authors assert that  had a history of serious, formally diagnosed psychiatric disturbance before probation status, they provided no listing of these diagnoses by patient. Specific treatment efforts made are not noted nor, although all were labeled drug abusers, no suggestion of alcoholism or addiction as a possible primary entity (treated or untreated) was given; this despite their stated recognition of the great importance of drug abuse in these physicians' psychopathology, and the recognition that
THE EFFECTS OF SALT RESTRICTION ON THE RENAL CONCENTRATING OPERATION IN NORMAL, HYDROPENIC MAN*
Authors: Richard M. Stein, Barrie H. Levitt, Marvin H. Goldstein, Jerome G. Porush, Gilbert M. Eisner, Marvin F. Levitt
Journal: Journal of Clinical Investigation (1962)

diuresis was established with a hypertonic mannitol infusion in subjects maintained on both high and low salt diets. In those of Group II, subjects prepared as in Group I received intravenous aminophylline during a mannitol diuresis at high levels of solute clearance. In those of Group III, similarly prepared subjects received aminophylline at low levels of solute clearance during a mannitol diuresis. Maximal hydropenia was established in all subjects by
The Efficacy of Zidovudine Is Time Limited-Reply
Authors: Jens D. Lundgren
Journal: JAMA (1994)

<h3>In Reply.</h3> —We appreciate the interest in the results presented in our recent publication. Drs Berman and Wenglin are correct in their interpretation of our results insofar as zidovudine seems to have a beneficial influence on survival when it is initiated in patients with advanced human immunodeficiency virus (HIV) infection. As also pointed out in the "Comment" section of our article, the results agree with the only placebo-controlled study<sup>1</sup>and several observational studies<sup>2</sup>in patient groups with similar advanced HIV infection as in our population (ie, a survival benefit within the first months after starting zidovudine). However, because of the large number of patients studied, we were also able to suggest whether the effect persisted for extended periods of time; we found this not to be true. Whether optimal dosage and combination antiretroviral therapy will eventually affect survival of AIDS patients, as suggested by Berman and Wenglin, awaits
Contraindications to the use of metformin
Authors: G C Jones
Journal: BMJ (2003)

According to the United Kingdom prospective diabetes study, patients with type 2 diabetes randomised to intensive treatment with metformin, sulphonylurea, or insulin had similar degrees of glycaemic control and significantly reduced microvascular end points.1 The study showed that the use of metformin in obese patients reduced cardiovascular events. The group treated with metformin had no hypoglycaemia and less weight gain. Treatment with metformin rather than diet alone produced a significant reduction in relative risk in all cause mortality (36%, P=0.011), diabetes related deaths (42%, P=0.017), any diabetes related end point (32%, P=0.0023), and myocardial infarction (39%, P=0.01). Metformin is the only oral hypoglycaemic agent proved to reduce cardiovascular risk and is now recognised as the treatment of choice in overweight patients with type 2 diabetes.

Lactic acidosis associated with metformin is a rare condition with an estimated prevalence of one to five cases per 100 000.2 Although classically lactic acidosis associated with metformin has been thought of as lactic acidosis secondary …
Micro‐/Nanometer Rough Structure of a Superhydrophobic Biodegradable Coating by Electrospraying for Initial Anti‐Bioadhesion
Authors: Changmin Hu, Shen Liu, Bin Li, Huilin Yang, Cunyi Fan, Wenguo Cui
Journal: Advanced Healthcare Materials (2013)

A novel superhydrophobic biodegradable coating with micro-/nanometer rough structure, fabricated by co-electrospraying poly(L-lactide) (PLLA) and modified silica nanoparticles (MSNs), exhibits good anti-adhesion behavior towards bacteria and cells in the initial culturing phase, which makes it a promising technology for preparing medical device coatings.
Effects of Child Development Accounts on Early Social-Emotional Development
Authors: Jin Huang, Michael Sherraden, Youngmi Kim, Margaret Clancy
Journal: JAMA Pediatrics (2014)

This study, based on Oklahoma's statewide Child Development Accounts (CDAs) program, presents findings from the first experimental test of the hypothesis that creating lifelong savings accounts for children at birth promotes their long-term well-being.To examine the effects of CDAs, an innovative social policy to encourage lifelong saving and asset building for long-term development, on parent-reported social-emotional development in early childhood.A statewide randomized experiment of CDAs was conducted in 2008, drawing a probability sample of 7328 children from all infants born in two 3-month periods in Oklahoma (April 1 through June 30 and August 1 through October 31, 2007). After agreeing to participate in the experiment, caregivers of 2704 infants completed a baseline survey and were randomly assigned to treatment (n = 1358) and control groups (n = 1346). Approximately 84% of participants completed a follow-up survey in the spring of 2011.The intervention offered CDAs, built on the existing Oklahoma 529 college-savings plan, to treatment participants. It also provided additional financial incentives and information.The primary outcome-child social-emotional development-is measured by scores from a 17-item version of the Ages and Stages Questionnaire: Social-Emotional. Caregivers completed it in the 3-year follow-up survey. Lower scores indicate better functioning.The CDAs have positive effects on social-emotional development for children at approximately age 4 years. The nonweighted treatment-control difference is -1.56 (90% CI, -2.87 to -0.22; P = .06), but the weighted difference is nonsignificant. The effects appear to be greater for disadvantaged subsamples, such as low-income households (weighted mean difference, -2.21; 90% CI, -4.01 to -0.42; P = .04).As a complement to other early education and health interventions, CDAs may improve social-emotional development in early childhood. Their effects may be explained as a mediating process that influences parents. Child Development Accounts may influence parental attitudes, behaviors, expectations, and involvement; in turn, these may affect child development.
THE PSYCHODYNAMICS OF THE "DRY DRUNK"
Authors: J. A. FLAHERTY, H. T. MCGUIRE, ROBERT L. GATSKI
Journal: American Journal of Psychiatry (1955)

Our study of the responses of the 52 respondents to the questionnaire on the dry drunk leads us to the following conclusions: 1. The dry drunk is experienced by the majority of alcoholics who have maintained sobriety over a long period. 2. The occupation of an alcoholic has no statistical significance in maintaining sobriety. 3. A number of alcoholics will drink from 10 to 20 years before they begin to maintain sobriety. 4. Dry drunks generally occur within the first year of sobriety ( occasionally during the early months). 5. This symptom occurs irregularly and with diminishing intensity as the period of sobriety lengthens. 6. The dry drunk is characterized by a feeling of deep depression and frustration and by indecision regarding taking a drink. 7. "Inner life" is largely responsible for precipitating a dry drunk. 8. The dry drunk often is preceded by the same feelings. 9. The principal feelings after a dry drunk are relief and thankfulness at not drinking during this period of craving. 10. Drugs are not used to combat the moods and feelings of a dry drunk nor to produce similar feelings. 11. Alcoholics are irritable, restless, and impatient during a dry drunk. 12. After a dry drunk one's thoughts, feelings, and behavior return to normal. 13. A. A. members are the persons most helpful during a dry drunk while spouses, other members of the family, and former drinking companions are the least helpful. 14. Dry drunks may be prevented by contacts with A. A. and efforts to keep the mind off the drinking problem. 15. Dry drunks are generally related to one's mood swings 16. The financial status generally improves when sobriety is maintained over an extended period. 17. The dry drunks described by our respondents have a number of the same characteristics as the " late withdrawal symptoms" described by Wellman. We feel that this study has been useful in clarifying our thinking on the dry drunk, in indicating sources of help for persons who are experiencing or may suffer dry drunks, and in pointing out areas for further study. We are impressed with the thoughtful, painstaking way in which the questionnaires were answered and with the willingness of the respondents to elaborate in detail on their experiences.
Infant leukemia: An analysis of nine chinese patients
Authors: Wen‐Min Chuu, Huei‐Fang Tien, Dong‐Tsamn Lin, Kai‐Hsin Lin, Ih‐Jen Su, Bow‐Wen Chen, Kuo‐Sin Lin, Der‐Cherng Liang
Journal: American Journal of Hematology (1990)

Abstract A study was made of the cellular and molecular characteristics of nine Chinese infants, consecutively presenting with acute leukemia. Five cases were acute lymphoblastic leukemia (ALL); four were acute nonlymphoblastic leukemia (ANLL). Hyperleukocytosis, hepatosplenomegaly, and poor response to conventional therapy were common features, and CNS involvement was detected at diagnosis in three cases. The blast cells from all five cases with ALL expressed early B‐cell markers, i.e., HLA‐DR+, CD19 +, but CD10‐. Terminal deoxynucleotidyl transferase (TdT) was present in blasts from four of the five cases and periodic acid‐Schiff staining in blasts from two patients only. The leukemic cells of one patient also showed positive nonspecific esterase activity and expressed myeloid‐associated antigens CD33 (My9), CD11 (OkM1), and CD14 (My4 and Mo2). Molecular analysis of leukemic cell DNA from this and two other patients showed rearrangement of the immunoglobulin (Ig) heavy‐chain genes, but without any evidence of kappa light‐chain gene rearrangement. T‐cell receptor (TCR) genes remained in the germline configuration in these cases. Cytogenetic analysis showed translocation t(4;11) (q21;q23) in all four cases studied. In the group of ANLL, three cases belonged to the M4 and one to the M2 subtype. Chromosomal abnormality involving 11q23 was also detected in two patients: t(11;17)(q23;q11) and del(11)(q14q23) in each case respectively. Neither lg nor TCR gene rearrangement was present in blast cells from patients with ANLL. The data indicate that chromosomal rearrangement of band 11q23 was quite common in Chinese infants with either form of leukemia, a finding that may have pathogenetic implications.
Simultaneous Positron Emission Tomography/Magnetic Resonance Imaging Identifies Sustained Regional Abnormalities in Cardiac Metabolism and Function in Stress-Induced Transient Midventricular Ballooning Syndrome
Authors: Tareq Ibrahim, Stephan G. Nekolla, Nicolas Langwieser, Christoph Rischpler, Philipp Groha, Karl-Ludwig Laugwitz, Markus Schwaiger
Journal: Circulation (2012)
Relationship between Fluorescein Pooling and Optical Coherence Tomographic Reflectivity of Cystoid Spaces in Diabetic Macular Edema
Authors: Takahiro Horii, Tomoaki Murakami, Kazuaki Nishijima, Tadamichi Akagi, Akihito Uji, Naoko Arakawa, Yuki Muraoka, Nagahisa Yoshimura
Journal: Ophthalmology (2012)