tbuckley/cabot-search huggingface dataset:
Jugular versus Femoral Short-Term Catheterization and Risk of Infection in Intensive Care Unit Patients. Causal Analysis of Two Randomized Trials
Authors: Jean-François Timsit, Lila Bouadma, Olivier Mimoz, Jean-Jacques Parienti, Maïté Garrouste-Orgeas, Serge Alfandari, Gaétan Plantefeve, Régis Bronchard, Gilles Troche, Remy Gauzit, Marion Antona, Emmanuel Canet, Julien Bohe, Marie-Christine Herrault, Carole Schwebel, Stéphane Ruckly, Bertrand Souweine, Jean-Christophe Lucet
Journal: American Journal of Respiratory and Critical Care Medicine (2013)

When subclavian access is not possible, controversy exists between the internal jugular and femoral sites for the choice of central-venous access in intensive care unit patients.To compare infection and colonization rates of short-term jugular and femoral catheters.Using data from two multicenter studies, we compared femoral and internal jugular for the risks of catheter-related bloodstream infection, major catheter-related infection, and catheter-tip colonization. We also compared the rates of dressing disruption and skin colonization. We used marginal structural models with inverse probability of treatment weighting to adjust on indication bias.We included 2,128 patients (2,527 catheters and 19,481 catheter-days). We found no difference in catheter-related bloodstream infection (internal jugular 1.0 vs. femoral 1.1 per 1,000 catheter-days; hazard ratio [HR], 0.63 [0.25-1.63]; P = 0.34), major catheter-related infection (internal jugular 1.8 vs. femoral 1.4 per 1,000 catheter-days; HR, 0.91 [0.38-2.18]; P = 0.34), and colonization (internal jugular 11.6 vs. femoral 12.9 per 1,000 catheter-days; HR, 0.80 [0.25-1.63]; P = 0.15). However, colonization was higher with femoral for female (HR, 0.39 [0.24-0.63]; P < 0.001) and, at the significance limit, catheter maintained for more than 4 days (HR, 0.73 [0.53-1.01]; P = 0.05). The absence of benefit of internal jugular before Day 5 was related to a higher skin colonization at the internal jugular site for catheters removed before Day 5. After the fourth day, dressing disruption became more frequent with femoral catheters and may explain the subsequent risk of catheter colonization. Differences in cutaneous and catheter colonization between internal jugular and femoral was suppressed by the use of chlorhexidine-impregnated dressings.Femoral and internal jugular accesses lead to similar risks of catheter infection. Internal jugular might be preferred for female, nonchlorhexidine-impregnated dressings users, and when catheters are left in place more than 4 days. Both sites are acceptable when a subclavian approach is not feasible. Clinical trial registered with www.clinicaltrials.gov (NCT00417235 and NCT01189682).
UK Liberal Democrats promise a statutory public interest defence to libel
Authors: C. Dyer
Journal: BMJ (2010)

Whichever party wins the general election in the United Kingdom on 6 May—and even if, as seems increasingly likely, the result is a hung parliament—libel reform is probably on the cards. All three parties have put the issue in their manifestos, though some more strongly and in more detail than others.

Dissatisfaction with English libel laws and their chilling effect on freedom of speech has been rumbling away at a low level for years. The credit for moving it up the political agenda must go in part to the high profile campaign waged by the Coalition for Libel Reform, made up of English PEN, Index on Censorship, and Sense about Science.

A spate of libel actions against scientists has focused attention on the potential for self censorship to close down debate on health and public safety issues, even in peer reviewed journals.

The campaign highlighted the libel action against the science writer Simon Singh by the British Chiropractic Association over a comment piece in the Guardian newspaper …
New Treatments for Brittle Bones
Authors: Susan Ott
Journal: Annals of Internal Medicine (2004)

Letters7 September 2004New Treatments for Brittle BonesSusan Ott, MDSusan Ott, MDFrom University of Washington, Seattle, WA 98195.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-5-200409070-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The recent article about treatment of osteoporosis makes several excellent points but perpetuates an important common misconception about the action of bisphosphonates. The author states that “bisphosphonates slow bone resorption without lowering bone formation” (1). In fact, bone biopsy studies from patients treated with risedronate or alendronate show that the mineralizing surface, which is forming bone, decreases 80% to 96% after 3 years of treatment. The bone volume, however, does not significantly change (2, 3).Many people believe that these drugs are “bone builders,” but the evidence shows that they are actually “bone hardeners.” The mineral inside ...References1. Wilson JF. New treatments for growing scourge of brittle bones. Ann Intern Med. 2004;140:153-6. [PMID: 14734352] LinkGoogle Scholar2. Chavassieux PM, Arlot ME, Reda C, Wei L, Yates AJ, Meunier PJ. Histomorphometric assessment of the long-term effects of alendronate on bone quality and remodeling in patients with osteoporosis. J Clin Invest. 1997;100:1475-80. [PMID: 9294113] CrossrefMedlineGoogle Scholar3. Eriksen EF, Melsen F, Sod E, Barton I, Chines A. Effects of long-term risedronate on bone quality and bone turnover in women with postmenopausal osteoporosis. Bone. 2002;31:620-5. [PMID: 12477578] CrossrefMedlineGoogle Scholar4. Boivin GY, Chavassieux PM, Santora AC, Yates J, Meunier PJ. Alendronate increases bone strength by increasing the mean degree of mineralization of bone tissue in osteoporotic women. Bone. 2000;27:687-94. [PMID: 11062357] CrossrefMedlineGoogle Scholar5. Mashiba T, Turner CH, Hirano T, Forwood MR, Johnston CC, Burr DB. Effects of suppressed bone turnover by bisphosphonates on microdamage accumulation and biomechanical properties in clinically relevant skeletal sites in beagles. Bone. 2001;28:524-31. [PMID: 11344052] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Washington, Seattle, WA 98195. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNew Treatments for Growing Scourge of Brittle Bones Jennifer Fisher Wilson Metrics Cited ByMedication-Related Osteonecrosis of the JawsLow-Energy Femoral Fractures Associated with the Long-Term Use of Bisphosphonates 7 September 2004Volume 141, Issue 5Page: 406-407KeywordsBoneBone densityBone resorptionDrugsHalf lifeIleumOsteoporosisPhoton absorptiometrySkeletonSpine ePublished: 7 September 2004 Issue Published: 7 September 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Recipients' Estates: A Source of Revenue for Medicaid?
Authors: Jose J. Escarce
Journal: Annals of Internal Medicine (1990)

Editorials15 May 1990Recipients' Estates: A Source of Revenue for Medicaid?Jose J. Escarce, MD, AM, Risa Lavizzo-Mourey, MD, MBAJose J. Escarce, MD, AMSearch for more papers by this author, Risa Lavizzo-Mourey, MD, MBASearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-10-725 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMedicaid is a major source of financing for nursing-home care. In 1986, nursing-home care for elderly and disabled persons cost $38 billion. Patients and their families paid approximately 50% and Medicaid paid 41%. Coverage of nursing-home care accounts for almost two fifths of total Medicaid expenditures (1).For many years, persons needing nursing-home care could give away their assets and obtain Medicaid coverage without concern about repayment (2). In 1982, through provisions in the Tax Equity and Fiscal Responsibility Act (TEFRA), Congress authorized states to restrict the Medicaid eligibility of persons transferring assets to others at less than fair market...References1. . Medicaid Source Book: Background Data and Analysis. Washington, DC: U.S. Government Printing Office; 1988. Google Scholar2. . Medicaid Estate Recoveries: National Program Inspection. Washington, DC: U.S. Department of Health and Human Services; 1988. Google Scholar3. NeuschlerGill EC. Medicaid eligibility for the elderly in need of long term care. Health Policy Studies, Center for Policy Research, National Governors' Association. Washington, DC: Congressional Research Service; 1987: CRS Contract no. 86-26. Google Scholar4. Medicaid: Recoveries from Nursing Home Residents' Estates Could Offset Program Costs. Washington, DC: General Accounting Office; 1989: GAO/HRD-89-56. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Ralston-Penn Center Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia, PA 19104 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 May 1990Volume 112, Issue 10Page: 725-726KeywordsAgingElderlyTaxes Issue Published: 15 May 1990 PDF downloadLoading ...
Circulating levels of IgG1 and IgG4 Anti‐IgE antibodies and asthma severity
Authors: F. Shakib, J. Sihoe, S. J. Smith, P. Wilding, M. M. Clark, A. Knox
Journal: Allergy (1994)

In this paper, we have determined the levels of IgG1 and IgG4 anti‐IgE in the sera of 66 asthma patients suffering from mild ( n = 24), moderate ( n = 23), or severe ( n = 19) symptoms, and 20 nonatopic, healthy subjects. The study has revealed that although asthma patients have significantly elevated levels of IgG1 and IgG4 anti‐IgE antibodies, the concentration of these autoantibodies is not related to the severity of asthma. This conclusion may be related to the known heterogeneity of autoanti‐IgE antibodies in terms of their ability to trigger basophil histamine release.
Antibiotics for the Prevention of Preterm Birth
Authors: Ronnie F. Lamont
Journal: New England Journal of Medicine (2000)

Preterm birth is the greatest cause of perinatal mortality and morbidity in the developed world. The cause of spontaneous preterm birth is multifactorial, but infection has been implicated in up to 40 percent of cases.1 Historically, the approach for preventing preterm birth has been to wait until a woman is admitted to the hospital in preterm labor before administering tocolytic agents. Making the association between infection and spontaneous preterm labor may be of little help once labor has begun, because by that time there may be irreversible changes in the cervix uteri that make attempts to reverse the process unsuccessful. . . .
Interleukin-8 Release during Early Reperfusion Predicts Graft Function in Human Lung Transplantation
Authors: MARC DE PERROT, YASUO SEKINE, STEFAN FISCHER, THOMAS K. WADDELL, KAREN McRAE, MINGYAO LIU, DENNIS A. WIGLE, SHAF KESHAVJEE
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

Cytokines have been shown to play an important role in promoting inflammation in the setting of ischemia-reperfusion injury. However, their role in human lung transplantation has not been systematically explored. This study was undertaken to examine the kinetics of cytokine release in 18 consecutive human lung transplantation procedures and to examine the relationships between their levels and donor factors, length of ischemic time, and allograft function. TNF-alpha, IFN-gamma, IL-10, IL-12, and IL-18 were found at higher levels during the ischemic time, whereas IL-8 predominantly increased after reperfusion. IL-8 levels after 2 h of reperfusion correlated with lung function assessed by the Pa(O2 )/FI(O(2)) ratio, the mean airway pressure, and the APACHE score during the first 24 postoperative hours. The length of ICU stay also correlated with IL-8 levels after 2 h of reperfusion. Longer ischemic time was associated with significantly higher levels of IL-18 before reperfusion, and older donors had significantly lower levels of IL-10 after reperfusion. We have demonstrated the importance of IL-8 in predicting early graft function after human lung transplantation. In addition, we showed that donor age and ischemic time may influence release of specific cytokines during ischemia-reperfusion.
S64 Understanding better the pathophysiology of aspiration pneumonia
Authors: A. Vaishnavi, I. Satia, D. Balasubramanian, R. Sundar
Journal: Thorax (2011)

<h3>Background</h3> Aspiration of oropharyngeal or gastric contents into the lower airways can cause a number of syndromes including chemical and bacterial pneumonia, although the pathophysiology of each entity is different.1 Data from Dr Foster9s Guide and our local coding department revealed a high incidence and mortality from aspiration pneumonia alerting us to study those patients. <h3>Methods</h3> Retrospective analysis of 53 patients coded as aspiration pneumonia from February 2010 to March 2011. Analysis of presentation, investigations, management, pre-disposing factors and outcome was undertaken. <h3>Results</h3> Average Age 78, M/F ratio (1:1). Out of 53 coded as aspiration pneumonia, 2 were re-coded to an alternative diagnosis. Out of 51 patients, 36 died (71%) and 15 survived but 17/51 (23%) had chest x-rays which were not suggestive of aspiration pneumonia. Of the 36 patients that died, 67% showed positive x-ray changes, while the 15 survivors had 80% x-rays suggesting pneumonia. Abstract S64 table 1 shows the list of clinical presentations and potential risk factors. On average each patient had 4 out of the 7 clinical features positive. 23/51 (45%) had either a basic swallow or SALT assessment of whom only 2/23 (9%) passed. 0/51 (0%) proceeded to mechanical ventilation. 51/51 (100%) had oxygen, intravenous fluids and antibiotics. <h3>Conclusion</h3> Aspiration pneumonia has a high mortality, particular in those with a history of aspiration living in residential or nursing facilities. 23% of patients with a good clinical history of aspiration did not show x-ray changes to suggest pneumonia. It may suggest a difference in the pathophysiology of lung injury in these patients who aspirate acidic gastric contents causing a chemical injury without x-ray changes of pneumonia. Although the treatment at present is no different, research needs to be incorporated into guidelines to diagnose, prevent and treat the different types of aspiration.
Disorders of the shoulder in elderly people
Authors: T. McAlindon, P. Dieppe
Journal: BMJ (1990)

factors may affect the myocyte but challenges the idea that a chronic defect of the mvocvte is a common feature.The authors also state that mortality is greater than two fifths within two years of diagnosis of dilated cardiomyopathy.That figure depends critically on the time of referral and on the circumstances in which patients reach the attention of investigators.In the Framingham study' the mortality from heart failure of any cause was 500,) at four years.In patients with heart failure due to viral myocarditis the prognosis is considerably better.5Conventional treatment is said to make "very little difference to survival."'Conventional treat- ment is primarily with diuretics to prevent ac- cumulation of fluid but is unlikely to be subjected to a clinical trial with an end point of survival.The report of the cooperative north Scandinavian enalapril survival study (CONSENSUS) showed that angiotensin converting enzyme inhibitors were beneficial in severe heart failure, but only 15% of the patients studied had cardiomyopathy.Over 50O of patients studied in a Veterans Ad- ministration cooperative trial of vasodilator drugs in chronic congestive heart failure' lacked coronary artery disease, and statistical analysis did not confirm a differential effect in those with and those without coronary heart disease.These data suggest that angiotensin converting enzyme inhibitors are of some benefit in cardiomyopathy, even if the evidence falls short of definitive proof.Arrhythmias are common in heart failure, and Dr Caforio and colleagues imply that treating ventricular tachycardia might be advantageous.The only controlled trial reported' studied patients taking amiodarone, which had no effect on mortality.4Furthermore, the terminal rhythm in most patients with severe heart failure due to idiopathic dilated cardiomyopathy appears to be asystole,"' not ventricular tachycardia, in contrast to that in patients with atheromatous ischaemic heart disease.
Evidence from milk casein genes that cetaceans are close relatives of hippopotamid artiodactyls
Authors: J. Gatesy, C. Hayashi, M. A. Cronin, P. Arctander
Journal: Molecular Biology and Evolution (1996)

The inferred transition from terrestrial hoofed mammal to fully aquatic cetacean has been intensively studied with fossil evidence. However, large sections of this remarkable evolutionary sequence are missing. Phylogenetic analysis of extant taxa may help to fill in some of these gaps. In this report, kappa-casein (exon 4) and beta-casein (exon 7) milk protein genes from cetaceans and other placental mammals were PCR-amplified, sequenced, and aligned to previously published sequences. Phylogenetic analyses of the casein data suggest that hippopotamid artiodactyls are more closely related to cetaceans than to other artiodactyls (even-toed hoofed mammals). An analysis of the nuclear casein sequences combined with published mitochondrial cytochrome b DNA sequences also supports the Cetacea/Hippopotamidae sister group. This affinity implies that some of the aquatic traits of cetaceans were derived in the common ancestor of Cetacea and Hippopotamidae. An extant "missing link" to Cetacea may have been overlooked by science since the description of the semiaquatic Hippopotamus in 1758. Paleontological information is grossly inconsistent with this hypothesis. If the casein phylogeny is accurate, large gaps in the fossil record as well as extensive morphological reversals and convergences must be acknowledged.
Diagnostic Criteria For Electrophoretic Patterns of Serum and Urinary Proteins in Multiple Myeloma
Authors: Robert A. Kyle
Journal: JAMA (1960)

Of 165 electrophoretic patterns of serum proteins in 165 patients with multiple myeloma, 126 were considered diagnostic of "myeloma proteins" because either the abnormal protein component in the pattern had a height:width ratio of 4:1 or greater, with the method used, or had a significant peak of height:width ratio of 3:1 or greater with an electrophoretic mobility faster than that of gamma globulin. By these criteria, 30 additional patterns were definitely abnormal, though not diagnostic, while only 9 were regarded as essentially normal. Thirty-seven of 62 urine electrophoretic patterns had a significant abnormal globulin component. No patient with multiple (disseminated) myeloma had a normal serum electrophoretic pattern in the absence of proteinuria. Only 15 of 6,051 serum electrophoretic patterns in non-myeloma patients were indistinguishable from the typical pattern of multiple myeloma. These included macroglobulinemia, amyloidosis, and lymphoma.
Novel Chemical Suppressors of Long QT Syndrome Identified by an In Vivo Functional Screen
Authors: David S. Peal, Robert W. Mills, Stacey N. Lynch, Janet M. Mosley, Evi Lim, Patrick T. Ellinor, Craig T. January, Randall T. Peterson, David J. Milan
Journal: Circulation (2010)

Background— Genetic long QT (LQT) syndrome is a life-threatening disorder caused by mutations that result in prolongation of cardiac repolarization. Recent work has demonstrated that a zebrafish model of LQT syndrome faithfully recapitulates several features of human disease, including prolongation of ventricular action potential duration, spontaneous early afterdepolarizations, and 2:1 atrioventricular block in early stages of development. Because of their transparency, small size, and absorption of small molecules from their environment, zebrafish are amenable to high-throughput chemical screens. We describe a small-molecule screen using the zebrafish KCNH2 mutant breakdance to identify compounds that can rescue the LQT type 2 phenotype. Methods and Results— Zebrafish breakdance embryos were exposed to test compounds at 48 hours of development and scored for rescue of 2:1 atrioventricular block at 72 hours in a 96-well format. Only compounds that suppressed the LQT phenotype in 3 of 3 fish were considered hits. Screen compounds were obtained from commercially available small-molecule libraries (Prestwick and Chembridge). Initial hits were confirmed with dose-response testing and time-course studies. Optical mapping with the voltage-sensitive dye di-4 ANEPPS was performed to measure compound effects on cardiac action potential durations. Screening of 1200 small molecules resulted in the identification of flurandrenolide and 2-methoxy-N-(4-methylphenyl) benzamide (2-MMB) as compounds that reproducibly suppressed the LQT phenotype. Optical mapping confirmed that treatment with each compound caused shortening of ventricular action potential durations. Structure activity studies and steroid receptor knockdown suggest that flurandrenolide functions via the glucocorticoid signaling pathway. Conclusions— Using a zebrafish model of LQT type 2 syndrome in a high-throughput chemical screen, we have identified 2 compounds, flurandrenolide and the novel compound 2-MMB, as small molecules that rescue the zebrafish LQT type 2 syndrome by shortening the ventricular action potential duration. We provide evidence that flurandrenolide functions via the glucocorticoid receptor–mediated pathway. These 2 molecules and future discoveries from this screen should yield novel tools for the study of cardiac electrophysiology and may lead to novel therapeutics for human LQT patients.
REVERSIBLE INACTIVATION OF THE SUBSTANCE INDUCING TRANSFORMATION OF PNEUMOCOCCAL TYPES
Authors: Maclyn McCarty
Journal: The Journal of Experimental Medicine (1945)

1. The transforming substance of Pneumococcus Type III is inactivated by treatment with ascorbic acid. This effect of ascorbic acid is catalyzed by traces of cupric ion and is prevented by the presence of sulfhydryl compounds. 2. Under certain conditions, the activity of transforming substance treated with ascorbic acid can be restored by the use of glutathione and other sulfhydryl compounds. 3. Other compounds, such as catechol, hydroquinone, and p-phenylenediamine, which undergo autoxidation similar to that of ascorbic acid, have an analogous effect on the transforming substance. 4. The effect of these compounds on the transforming substance is nullified by exclusion of oxygen or by the use of catalase. 5. It is concluded that inactivation of the transforming substance is probably oxidative in character and depends on the formation of peroxides in the course of autoxidation of ascorbic acid or related compounds. 6. The relation of this phenomenon to that of the inactivation of other biologically active substances by ascorbic acid is discussed.
Poetry and the art of medicine
Authors: R Phillipp, K Coppell, H Freeman
Journal: BMJ (1994)

EDITOR, - Poetry has been likened to medicine in that “like the physician, the poet tries first to grasp, then to control, the reality of the human predicament.”1 In support of this likeness anthologies of poems by doctor-poets have been published, such as Apollo, published by the BMJ in 1990 as part of the celebrations for its 150th …