tbuckley/cabot-search huggingface dataset:
Slow Glucose Removal Rate and Hyperinsulinemia Precede the Development of Type II Diabetes in the Offspring of Diabetic Parents
Authors: James H. Warram
Journal: Annals of Internal Medicine (1990)

Objective: To determine whether insulin resistance or insulin deficiency is primary in the pathogenesis of type II diabetes. Design: Cohort analytic study of persons with normal glucose tolerance but with a high risk for developing type II diabetes (average follow-up time, 13 years). Setting: Outpatients had an intravenous glucose tolerance test and were contacted periodically to ascertain diagnoses of diabetes. Participants: One hundred and fifty-five normal offspring, ranging in age from 16 to 60 years, of two parents with type II diabetes and 186 normal control subjects in the same age range who had no family history of diabetes. Measurements and Main Results: Two phenotypic characteristics distinguished the offspring of diabetic parents from control subjects. They had slower glucose removal rates (Kg) (P < 0.01) and higher insulin levels (fasting and during the second phase of insulin response to intravenous glucose; P < 0.0001) than did control subjects, even after adjustment for differences in obesity. Sixteen percent of the offspring developed type II diabetes. Mean Kg at baseline was 1.7%/min among offspring who subsequently developed diabetes, 2.2%/min among offspring who remained nondiabetic, and 2.3%/min among control subjects. Corresponding means for first-phase insulin were 498, 354, and 373 pM, respectively, whereas second-phase insulin means were 329, 117, and 87 pM, respectively. In multivariate analysis, low Kg and high serum insulin levels independently increased the risk for developing diabetes among the offspring of diabetic parents. Conclusions: One to two decades before type II diabetes is diagnosed, reduced glucose clearance is already present. This reduced clearance is accompanied by compensatory hyperinsulinemia, not hypoinsulinemia, suggesting that the primary defect is in peripheral tissue response to insulin and glucose, not in the pancreatic beta cell.
Comparative Bronchodilatory Effects of Formoterol Dry-Powder Inhaler (DPI) Versus the Combination of Formoterol and Budesonide Pressurized Metered-Dose Inhaler (pMDI)
Authors: W.S. Mezzanotte, C.J. Miller, S. Senn
Journal: Journal of Allergy and Clinical Immunology (2007)
United Kingdom back pain exercise and manipulation (UK BEAM) trial
Authors: Torill H Tveito, Hege R Eriksen
Journal: BMJ (2005)

Developing primary palliative care Continuity of care is paramount but needs to be tailored individuallyEditor-Riley suggests that completion of a form detailing palliative care management should be mandatory for general practitioners. 1 I have spent a great deal of time promoting palliative medicine in primary care, with variable success.Much depends on the individual practitioner's experience and interest, which probably accounts for the variable success of handover forms to communicate with out of hours services.Making this a compulsory part of general practice might bring all practice to the same level.But the initial answer to the question, "Would I be surprised if my patient died in the next 12 months?"would then make the difference.Cynical practitioners would probably answer no for nearly all of their patients, for the longer you practise the less often you are surprised.But, in truth, for many patients in general practice the answer to this question would be no: many elderly patients who live in nursing or residential homes, nearly all patients with chronic disease, including heart disease, chronic obstructive pulmonary disease, neurological disease, and so on.The workload in handing these patients over to the out of hours service would be huge, more so for the out of hours service than the individual practice.Continuity of care for patients who most need it is paramount, including all those with chronic disease.However, more sophisticated systems are needed to meet patient needs: perhaps different systems for different diseases, possibly different systems for each stage of a disease.Whatever the system, it must meet the needs of the individual patient.This entails dialogue between primary care (including out of hours), secondary care, and tertiary care to thrash out the detail.
Enhanced expression of inflammatory cytokines and activation markers in T-cells from patients with chronic heart failure
Authors: A Yndestad
Journal: Cardiovascular Research (2003)

Objective: Increasing evidence supports a role for inflammation in chronic heart failure (CHF). However, the source and the mechanism for this immune activation are unknown. To address this issue we investigated the gene expression of cytokines and the surface expression of activity markers in T-cells and monocytes from CHF patients and healthy controls. Methods: Gene expression of cytokines was analysed by real-time RT-PCR and activation markers by flow cytometry in 14 CHF patients and nine healthy controls. Surface expression of activation markers for T-cells and monocytes were analysed by flow cytometry. Results: T-cells from CHF patients showed enhanced gene expression of chemokines, ligands in the tumor necrosis factor superfamily, as well as the inflammatory cytokines interferon-γ and interleukin-18 with similar pattern in ischemic (n = 5) and idiopathic cardiomyopathy (n = 9). In contrast, no differences in cytokine gene expression were found comparing monocytes from CHF patients and controls. Moreover, T-cells from CHF patients had enhanced surface expression of the activation markers CD69 and CD25, while there was no upregulation of the monocyte activation marker CD32 in these patients. Conclusion: T-cells may be a part of the inflammatory response during CHF independent of the etiology of the disorder. Intervention preventing unwanted T-cell activation could represent a new target in the treatment of CHF.
Why not chimpanzees, lions, and hyenas too?
Authors: Richard Schuster
Journal: Behavioral and Brain Sciences (2005)

Examples are cited of group hunting in chimpanzees, lions, and hyenas consistent with evidence for intentionality, organization, and coordination. These challenge the claim for shared intentionality as uniquely human. Even when rarely performed in this way, the significance of such behaviors should not be minimized, especially if this level of “intelligent” action emerges spontaneously in the wild.
The evidence base: rock of certainty or shifting sands?
Authors: John Dewhurst
Journal: BMJ (2004)

I have a problem with evidence based medicine. This I know is a serious confession and could amount to professional misconduct, but in mitigation let me explain. The case I have is my own, so I will presume to tell you a little about myself.

After some years as a principal in general practice I joined the pharmaceutical industry. My medical history is unremarkable apart from two episodes of major depression, the first in my early thirties. For this I was given amitriptyline. The drug had no perceptible effect on the depression, but I became completely unable to concentrate, and my short term memory was seriously impaired. I had always done a lot of woodwork, but I found now that in the few seconds between taking a measurement and applying it to a piece of wood I had forgotten it.

> My problem is not so much with evidence based medicine as with its users

However, the most disabling effect—one that I have never seen described—was a distancing from …
P28 The impact of patient information leaflets in sleep clinic
Authors: S. Huq, D. Price, S. Sureshkumar, S. Kalidindi, M. Walshaw, J. Hadcroft
Journal: Thorax (2011)

<h3>Background</h3> Sleep apnoea can result in traffic accidents, and the British Lung Foundation9s (BLF) “Snoring and Sleep Apnoea” and the Driver and Vehicle Licensing Agency9s (DVLA) “Think! Tiredness can kill” leaflets are commonly used to inform patients about this. We wished to assess the impact of such knowledge on the general understanding and motivation of patients undergoing formal assessment for sleep apnoea in a sleep clinic. <h3>Methods</h3> In a prospective survey, patients were provided with the above leaflets when they underwent the sleep study, and completed a structured questionnaire when attending the results clinic several weeks later. <h3>Results</h3> 125 consecutive patients (92 male) with a mean (SD) age of 51 (14) years, BMI of 33.6 (6.9) and Epworth Sleepiness Scale of 10 (6) completed the questionnaire. 51 (41%) were eventually diagnosed with significant obstructive sleep apnoea/hypopnoea syndrome (OSAHS) requiring referral for continuous positive airway pressure therapy. 105 patients (84%) read the BLF leaflet and 91 (87%) assumed they understood about sleep apnoea from it. 28 (27%) believed they had sleep apnoea, 26 (25%) believed they did not, while the remainder (48%) were unsure. Although 28 (27%) became more worried about themselves, 56 (53%) were more keen to undertake the tests but 5 (5%) were not. 92 participants (74%) were current drivers and 84 (91%) read the DVLA leaflet. Only 10 of these (12%) thought they might have a disorder that could impact on their driving abilities although 38 (45%) were concerned they might not be allowed to drive in future. However, only 4 (5%) were discouraged to undertake the tests because of this. Overall, most patients (80%) found these leaflets informative and easy to understand. <h3>Conclusions</h3> These leaflets appear to improve patients9 understanding of OSAHS and its implications, particularly regarding driving. Although they can engender concern and anxiety among some, the majority of patients felt motivated to undertake the tests. Improving the level of patient education and awareness through such leaflets may positively influence their involvement in overall management, potentially improving compliance and outcomes in the long term.
Functional Polymorphisms in the Promoter Region of Macrophage Migration Inhibitory Factor and Atopy
Authors: Nobuyuki Hizawa, Elsuro Yamaguchi, Daisuke Takahashi, Jun Nishihira, Masaharu Nishimura
Journal: American Journal of Respiratory and Critical Care Medicine (2004)

Macrophage migration inhibitory factor (MIF) is a pleiotrophic lymphocyte and macrophage cytokine; it is likely to play an important role in innate immunity. Genome-wide search for atopy susceptibility genes recently identified human chromosome 22q11, where the gene encoding MIF resides, as a region of interest for atopic traits. Both the −173G/C and −794 [CATT]5–8 repeat polymorphisms in the MIF promoter region are associated with altered levels of MIF gene transcription in vitro. We, therefore, hypothesized that these potentially functional polymorphisms may influence susceptibility to atopy and asthma. A case–control analysis examined the genetic influence of these promoter polymorphisms on the development of atopy and asthma in a Japanese population (n = 584). Evidence for significant association between the −173G/C and −794 [CATT]5–8 repeat polymorphisms and atopy was found; odds ratio for homozygotes of −173C allele was 3.67 (compared with homozygotes of −173G allele, 95% confidence interval = 1.43–9.46, p < 0.01), and odds ratio for noncarriers of the −794 [5-CATT] allele was 3.51 (compared with 5-CATT repeat homozygotes, 95% confidence interval = 1.82–6.78, p < 0.0005). No associations with asthma were detected. These results indicate that promoter polymorphisms in the MIF promoter region are risk factors for atopy and implicate MIF in the pathogenesis of atopy in a Japanese population.
Single-Beat Noninvasive Imaging of Cardiac Electrophysiology of Ventricular Pre-Excitation
Authors: Thomas Berger, Gerald Fischer, Bernhard Pfeifer, Robert Modre, Friedrich Hanser, Thomas Trieb, Franz X. Roithinger, Markus Stuehlinger, Otmar Pachinger, Bernhard Tilg, Florian Hintringer
Journal: Journal of the American College of Cardiology (2006)
Juvenile Polyposis and Gastrointestinal Carcinoma
Authors: THOMAS J. STEMPER
Journal: Annals of Internal Medicine (1975)

A kindred contained at least 10 members with single or multiple juvenile polyps of the stomach and large intestine. Several additional polyps had both adenomatous and juvenile features. Eleven members of the kindred have had gastrointestinal carcinoma of the stomach, duodenum, pancreas, or proximal colon. The pattern of inheritance in this kindred suggests either a single or two closely linked autosomal dominant determinants for gastrointestinal carcinoma and polyposis. Management of this kindred is complicated due to the occurrence of gastrointestinal carcinoma without polyposis.
Electrocardiographic abnormalities and 30-year mortality among white and black men of the Charleston Heart Study.
Authors: S E Sutherland, P C Gazes, J E Keil, G E Gilbert, R G Knapp
Journal: Circulation (1993)

BACKGROUND The long-term predictive significance of a single ECG tracing for mortality was explored among the white and black men of the Charleston Heart Study. METHODS AND RESULTS The 1960 baseline tracings of men ages 35 to 74 in the Charleston Heart Study cohort were coded according to the Minnesota classification. Tracings were categorized as being normal or having minor or major abnormalities. The 30-year vital status was ascertained for the cohort, and the association between ECG findings and coronary and all-cause mortality was evaluated. The proportion of black men with major abnormalities at the 1960 baseline examination was almost twice that of white men. Rates of all-cause mortality increased with severity of abnormalities for white and black men. The absolute excess risk for black men with major abnormalities was 23.3 per 1000 person-years and 12.8 for white men. The excess risk for coronary mortality was 7.3 for white men and 6.5 for black men. CONCLUSIONS Many of the findings in this study confirm earlier associations derived from studies of white populations and extend the observations to black men. However, the magnitude of the relative risk for mortality was different for white and black men. After controlling for traditional coronary disease risk factors and minor abnormalities, white men with major abnormalities were 2.72 (95% confidence interval, 1.47, 5.04) times more likely to die of coronary disease compared with black men, who were 1.95 (95% confidence interval, 0.93, 4.11) times more likely to die of coronary disease.
Assessment of risk for severe hypoglycemia among adults with IDDM: validation of the low blood glucose index.
Authors: B P Kovatchev, D J Cox, L A Gonder-Frederick, D Young-Hyman, D Schlundt, W Clarke
Journal: Diabetes Care (1998)

OBJECTIVE: To evaluate the clinical/research utility of the low blood glucose index (LBGI), a measure of the risk of severe hypoglycemia (SH), based on self-monitoring of blood glucose (SMBG). RESEARCH DESIGN AND METHODS: There were 96 adults with IDDM (mean age 35+/-8 years, duration of diabetes 16+/-10 years, HbA1 8.6+/-1.8%), 43 of whom had a recent history of SH (53 did not), who used memory meters for 135+/-53 SMBG readings over a month, and then for the next 6 months recorded occurrence of SH. The SMBG data were mathematically transformed, and an LBGI was computed for each patient. RESULTS: The two patient groups did not differ with respect to HbA1, insulin units per day, average blood glucose (BG) and BG variability. Patients with history of SH demonstrated a higher LBGI (P &amp;lt; 0.0005) and a trend to be older with longer diabetes duration. Analysis of odds for future SH classified patients into low- (LBGI &amp;lt;2.5), moderate- (LBGI 2.5-5), and high- (LBGI &amp;gt;5) risk groups. Over the following 6 months low-, moderate-, and high-risk patients reported 0.4, 2.3, and 5.2 SH episodes, respectively (P = 0.001). The frequency of future SH was predicted by the LBGI and history of SH (R2 = 40%), while HbA1, age, duration of diabetes, and BG variability were not significant predictors. CONCLUSIONS: LBGI provides an accurate assessment of risk of SH. In the traditional relationship history of SH-to-future SH, LBGI may be the missing link that reflects present risk. Because it is based on SMBG records automatically stored by many reflectance meters, the LBGI is an effective and clinically useful on-line indicator for SH risk.
Injurious ventilatory strategies increase cytokines and c-fos m-RNA expression in an isolated rat lung model.
Authors: L Tremblay, F Valenza, S P Ribeiro, J Li, A S Slutsky
Journal: Journal of Clinical Investigation (1997)

We examined the effect of ventilation strategy on lung inflammatory mediators in the presence and absence of a preexisting inflammatory stimulus. 55 Sprague-Dawley rats were randomized to either intravenous saline or lipopolysaccharide (LPS). After 50 min of spontaneous respiration, the lungs were excised and randomized to 2 h of ventilation with one of four strategies: (a) control (C), tidal volume (Vt) = 7 cc/kg, positive end expiratory pressure (PEEP) = 3 cm H2O; (b) moderate volume, high PEEP (MVHP), Vt = 15 cc/kg; PEEP = 10 cm H2O; (c) moderate volume, zero PEEP (MVZP), Vt = 15 cc/kg, PEEP = 0; or (d) high volume, zero PEEP (HVZP), Vt = 40 cc/kg, PEEP = 0. Ventilation with zero PEEP (MVZP, HVZP) resulted in significant reductions in lung compliance. Lung lavage levels of TNFalpha, IL-1beta, IL-6, IL-10, MIP-2, and IFNgamma were measured by ELISA. Zero PEEP in combination with high volume ventilation (HVZP) had a synergistic effect on cytokine levels (e.g., 56-fold increase of TNFalpha versus controls). Identical end inspiratory lung distention with PEEP (MVHP) resulted in only a three-fold increase in TNFalpha, whereas MVZP produced a six-fold increase in lavage TNFalpha. Northern blot analysis revealed a similar pattern (C, MVHP < MVZP < HVZP) for induction of c-fos mRNA. These data support the concept that mechanical ventilation can have a significant influence on the inflammatory/anti-inflammatory milieu of the lung, and thus may play a role in initiating or propagating a local, and possibly systemic inflammatory response.
On Writing and Publishing Medical Fiction
Authors: Marshall Goldberg
Journal: Annals of Internal Medicine (1997)

Medical Writings1 September 1997On Writing and Publishing Medical FictionMarshall Goldberg, MDMarshall Goldberg, MDJefferson Medical College; Philadelphia, PA 19107Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-127-5-199709010-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Who among today's practicing physicians will replace the Anton Chekhovs and Arthur Conan Doyles, the great medical fiction writers of yesteryear? Until recently, we had Walker Percy and Richard Seltzer to carry on the tradition. But now, with Percy deceased and Seltzer in retirement, the dearth of worthy successors seems particularly lamentable. Certainly every physician, whether just starting out or nearing retirement, has stories to tell. So why aren't more of us trying to compete with the impressive number of lawyers whose novels make the bestseller list? Is it merely a matter of finding the time, or is it something ...References1. Bone RC. As I was dying. An exam nation of classic literature and dying. Ann Intern Med. 1996; 124:1091-3. Google Scholar Author, Article, and Disclosure InformationAffiliations: Jefferson Medical College; Philadelphia, PA 19107Corresponding Author: Marshall Goldberg, MD, Jefferson Medical College, Room 902, 1015 Chestnut Street, Philadelphia, PA 19107. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byOn writing medical history 1 September 1997Volume 127, Issue 5Page: 413-415KeywordsBoneCreativityDrugsForecastingGraduate medical educationInternetNervesPhysicistsVeinsWalking Issue Published: 1 September 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Points from Letters: Infectious Mononucleosis
Authors: M. A. C. Heavens, M. J. Wellings
Journal: BMJ (1973)

JouRNAL 28 juLY 1973 already being made, and I would anticipate a successful outcome in due course.(2) So far as women doctors are con- cerned, they are in an unusual position in that for all service prior to March 1972 they will on retirement receive a substantial lump sum in lieu of a widower's pension.This lump sum is not received by a mar- ried man and pays for a half-pension for his widow.In the vast majority of cases the lump sum, received by the woman doctor and properly used, is worth more to the possible widower than the alternative pen- sion which might have been paid on the death of the woman doctor.(3) All this applies to service prior to March 1972, and the situation is quite different for service after March 1972, since for this the lump payment will not be de-
Influence of Renal Function on the Hemodynamic and Clinical Responses to Long-Term Captopril Therapy in Severe Chronic Heart Failure
Authors: Milton Packer, Wai Hung Lee, Norma Medina, Madeline Yushak
Journal: Annals of Internal Medicine (1986)

To evaluate the influence of renal function on the efficacy of converting-enzyme inhibition in patients with severe chronic heart failure, we measured the long-term hemodynamic and clinical responses to Captopril in 101 consecutive patients with heart failure grouped according to pretreatment serum creatinine concentration (group I, < 1.4 mg/dL; group II, 1.4 to 2.8 mg/dL; and group III, > 2.8 mg/dL). After 1 to 3 months of treatment, patients with preserved renal function (group I) had greater increases in stroke volume index and greater decreases in left ventricular filling pressure and systemic vascular resistance than did patients with renal impairment (groups II and III) (p < 0.05). Clinical improvement paralleled these hemodynamic benefits; only 2 of 12 patients with severe renal insufficiency (group III) improved clinically compared with 29 of 40 patients with preserved renal function (group I) and 29 of 49 patients with mild-to-moderate renal impairment (group II), (p < 0.005). Therapy-limiting rash and dysgeusia occurred most frequently in patients with renal impairment. Our findings support an important role for the kidneys in mediating the beneficial actions of Captopril in patients with severe congestive heart failure.
The development of low-grade cerebral edema in cirrhosis is supported by the evolution of 1H-magnetic resonance abnormalities after liver transplantation
Authors: Juan Córdoba, Juli Alonso, Alex Rovira, Carlos Jacas, Francesc Sanpedro, Lluı́s Castells, Vı́ctor Vargas, Carles Margarit, Jaime Kulisewsky, Rafael Esteban, Jaume Guardia
Journal: Journal of Hepatology (2001)
INTRANASAL ADMINISTRATION OF CHICK EMBRYO FIBROBLAST EDMONSTON-ZAGREB MEASLES VACCINE
Authors: Ratko Vlatkovic, Stanislav Smerdel, Borivoj Gvojić, Teodor Manhalter, Miroslav Beck, Renee Weisz-Maleček, Nataša Delimar
Journal: The Lancet (1985)
Atypical presentations of Sweet's syndrome in patients with MDS/AML receiving combinations of hypomethylating agents with histone deacetylase inhibitors
Authors: Cristina Alencar, Matthew Abramowtiz, Samir Parekh, Ira Braunshweig, Mark Jacobson, Lewis Silverman, Amit Verma
Journal: American Journal of Hematology (2009)