tbuckley/cabot-search huggingface dataset:
Inflammatory response in the early prediction of severity in human acute pancreatitis.
Authors: J A Viedma, M Perez-Mateo, J Agullo, J E Dominguez, F Carballo
Journal: Gut (1994)

The role of the inflammatory response in acute pancreatitis and its relation with the clinical course was examined. This study examined if the serial measurement of polymorphonuclear granulocyte (PMN) elastase/A1PI complex, phospholipase A catalytic activity, C reactive protein, and other acute phase proteins, and the protease inhibitor alpha 2-macroglobulin, provides meaningful information for prognosis. Eighty non-consecutive patients with acute pancreatitis, classified according to their clinical outcome into mild (n = 40) and severe pancreatitis (n = 40), were followed up daily. Between 48 hours, median values of PMN-elastase, C reactive protein--and most of the acute phase proteins--and phospholipase A activity, were significantly higher in the severe pancreatitis group. PMN elastase shows a dynamic course and it reaches an early peak value at days 1-2, followed by C reactive protein (days 2-4) phospholipase A (day 3), and a negative peak for alpha 2-macroglobulin (days 4-5). PMN elastase (day 1) and C reactive protein (day 2) were selected by discriminant analysis as the most useful variables studied to allow the early accurate prediction of severity (sensitivity 100%, specificity 95%). Little or no predictive additional value was found for all other variables studied. These results strongly suggest a close relation between inflammatory parameters and clinical course in acute pancreatitis, and discriminant analysis of these variables provides a useful method to classify severity.
Urinary 20-Hydroxyeicosatetraenoic Acid Is Associated With Endothelial Dysfunction in Humans
Authors: Natalie C. Ward, Jennifer Rivera, Jonathan Hodgson, Ian B. Puddey, Lawrie J. Beilin, John R. Falck, Kevin D. Croft
Journal: Circulation (2004)

20-hydroxyeicosatetraenoic acid (20-HETE) is a cytochrome P450 (omega-hydroxylase) metabolite of arachidonic acid with vasoconstrictor activity that may be involved in the pathogenesis of hypertension. In humans, there are few data relating 20-HETE to vascular pathophysiology. This study aimed to determine whether urinary 20-HETE excretion is related to blood pressure or vascular endothelial function in humans.Sixty-six subjects (37 males, 29 females), including 29 with untreated hypertension, had urinary 20-HETE excretion measured by gas chromatography/mass spectrometry. There was no significant difference for 20-HETE excretion between hypertensive and normotensive subjects. 20-HETE excretion was positively related to body mass index and sodium excretion. There was a significant inverse association between urinary 20-HETE and endothelium-dependent vasodilation measured by flow-mediated dilation of the brachial artery (P=0.006). There was no association with vasodilator responses to nitroglycerin. In multiple regression analysis, 20-HETE remained an independent predictor of endothelium-dependent vasodilation after adjustment for age, body mass index, and blood pressure. When gender was included in the model, the relationship between 20-HETE and flow-mediated dilation was attenuated. Separate analysis by gender revealed that in women, hypertensive subjects had significantly higher 20-HETE excretion than normotensive subjects, but this was not seen in men. In women, 20-HETE was positively related to diastolic and systolic blood pressure. In men, 20-HETE was positively related to body mass index.This is the first demonstration of an association between 20-HETE excretion and in vivo vascular function in humans. Given the negative modulatory role of nitric oxide on omega-hydroxylase, the present results suggest a potentially important role for 20-HETE in human vascular physiology.
Letter by Liu et al Regarding Article, “Rosiglitazone and Outcomes for Patients With Diabetes Mellitus and Coronary Artery Disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial”
Authors: Wei Liu, Mao Chen, De-jia Huang
Journal: Circulation (2014)

In a recent issue of Circulation, Bach et al for the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Investigators 1 investigated rosiglitazone use and cardiovascular events among patients with diabetes mellitus and coronary artery disease based on the BARI 2D trial.A lower incidence of stroke and composite death, myocardial infarction, and stroke was found; no difference was observed on mortality, myocardial infarction, and congestive heart failure.The authors concluded that neither on-treatment nor propensity-matched analysis supported an association of rosiglitazone treatment with an increase in major ischemic cardiovascular events.This work was fantastic, and echoed the recent US Food and Drug Administration (FDA) Panel Recommends. 2 However, this work was a cross-sectional analysis, and the general limitation of this analysis is that observed associations might be the sum of overlying effects.Although the authors used the Cox proportional hazards and Kaplan-Meier analyses that included propensity matching, 1 the residual confounding still should not be overlooked attributed to the inability of these methods to fully adjust for unmeasured patient difference.Recently, the use of falsification hypotheses has been highlighted to assess for residual confounding in observation studies. 3The importance of falsification hypotheses had been studied by Neil J. Wimmer and colleagues. 4However, the original article didn't report the falsification end points.Basically, all techniques processing cross-sectional analysis are to simulate randomization.Unfortunately, there's no substitute for randomization.Neil J. Wimmer and colleagues 4 found that the outcomes of observation studies were significantly different with randomized, controlled trials.Before the original article, a large number of randomized, controlled trials had been published. 5Their pooled outcomes showed a higher incidence of myocardial infarction, 5 which was the opposite of the original article. 1 This difference may be attributable to the residual confounding of the original article.Therefore, we should interpret the results in this article carefully.
Pulmonary Hypertension after Splenectomy?
Authors: Marius M. Hoeper
Journal: Annals of Internal Medicine (1999)

Background: A high prevalence of asplenia has been observed in patients with unexplained pulmonary hypertension. Objective: To describe the clinical and histopathologic characteristics of patients with postsplenectomy pulmonary hypertension and to compare the prevalence of surgical asplenia in patients with idiopathic pulmonary hypertension and patients with other pulmonary diseases. Design: Case series and case–control study. Setting: University hospital in Hannover, Germany. Patients: 61 patients with pulmonary hypertension and 151 lung transplant recipients. Results: The prevalence of asplenia in patients with pulmonary hypertension was 11.5% (95% CI, 4.7% to 22.2%) compared with 0% (CI, 0% to 3.2%) in those without pulmonary hypertension (P < 0.001). Histopathologic examination of lung specimens from patients with postsplenectomy pulmonary hypertension showed intimal fibrosis, plexiform lesions, and abundant thrombotic lesions. Conclusion: Patients who have had splenectomy may be at increased risk for developing pulmonary hypertension.
Clinical Experience With Theophylline
Authors: Myron H. Jacobs
Journal: JAMA (1976)

Relationships between theophylline dosage, serum theophylline concentration, and theophylline toxicity were evaluated retrospectively in 47 hospitalized adults. The amount of theophylline administered daily varied more than sixfold, from 6 to 38 mg/kg. The serum theophylline concentrations, however, varied 24-fold from 2 to 49μg/ml. The relationship between daily dosage and serum concentration was unpredictable in an individual patient. Fourteen patients (30%) had a toxic reaction to theophylline. Toxic symptoms, which were not always gastrointestinal, occurred commonly with serum concentrations over 25μg/ml but were not noted with concentrations below 15μg/ml. High serum theophylline concentrations and a toxic reaction developed just as often with the oral route as when the drug was given intravenously. In six patients, measurement of serum theophylline concentration disclosed subtherapeutic concentrations. Serum theophylline determination appears to be important clinically in guiding effective and safe usage of theophylline. (<i>JAMA</i>235:1983-1986, 1976)
Dental Amalgam Exposure and Urinary Mercury Levels in Children: The New England Children’s Amalgam Trial
Authors: Nancy Nairi Maserejian, Felicia L. Trachtenberg, Susan F. Assmann, Lars Barregard
Journal: Environmental Health Perspectives (2007)

Urinary mercury (U-Hg) excretion is a commonly used biomarker for mercury exposure from dental amalgam restorations.Our goal was to determine the most efficient measure of dental amalgam exposure for use in analyses concerning U-Hg in children.We analyzed time-sensitive longitudinal amalgam exposure data in children randomized to amalgam restorations (n = 267) during the 5-year New England Children's Amalgam Trial. We calculated 8 measures of amalgam, evaluating current versus cumulative exposure, teeth versus surfaces, and total versus posterior occlusal amalgams. Urine samples collected during follow-up years 3-5 were analyzed for mercury excretion. Multivariate models for current and cumulative U-Hg excretion estimated associations between exposures and U-Hg.At the end of follow-up, the average (+/- SD) cumulative exposure was 10.3 +/- 6.1 surfaces and 5.7 +/- 2.9 teeth ever filled with amalgam, corresponding to 30 +/- 21 surface-years. Amalgam measures and U-Hg were moderately correlated. Of amalgam exposure measures, the current total of amalgam surfaces was the most robust predictor of current U-Hg, whereas posterior occlusal surface-years was best for cumulative U-Hg. In multivariate models, each additional amalgam surface present was associated with a 9% increase in current U-Hg, and each additional posterior occlusal surface-year was associated with a 3% increase in cumulative U-Hg excretion (p < 0.001).One single measure of amalgam exposure is insufficient. Studies of cumulative effects of mercury from amalgam exposure in children are likely to have improved validity and precision if time-sensitive amalgam exposure measures are used. In contrast, simple counts of current amalgam fillings are adequate to capture amalgam-related current U-Hg.
Genetic and Environmental Determinants of Type II Diabetes in Mexican Americans: Is There a “Descending Limb” to the Modernization/Diabetes Relationship?
Authors: Michael P Stern, J Ava Knapp, Helen P Hazuda, Steven M Haffner, Judith K Patterson, Braxton D Mitchell
Journal: Diabetes Care (1991)

Evidence from migrant population studies and secular trend data indicates that environmental factors play a role in the etiology of non-insulin-dependent (type II) diabetes. These environmental factors appear to be concomitants of the process whereby traditional populations become “modernized” or “westernized” and include increased intake of total calories, fat, and sucrose, decreased intake of total and complex carbohydrates, including fiber, and decreased physical exercise. There also appears to be a “postmodernization” process, which we have characterized as the “descending limb of the curve.” In Mexican Americans in San Antonio, the prevalence of type II diabetes declines with acculturation to the values, attitudes, and behaviors of “postmodernized” American society. However, examination of the dietary and exercise concomitants of this process revealed a mixed picture. There was some suggestion that Mexican-American women, although not men, had entered onto the descending limb of the curve. However, Native American genetic admixture in Mexican Americans also covaried with affluence and acculturation in such a way that the declining prevalence of diabetes could as easily be due to genetic factors as to environmental factors. The “pancreatic exhaustion” theory holds that resistance to insulin action is a principal lesion leading to hypersecretion of insulin, hyperinsulinemia, and eventual islet cell failure and clinical diabetes. This theory predicts that prediabetic subjects will be hyperinsulinemic. In conformity with this theory, we have shown that subgroups of the Mexican-American population, defined on the basis of family history of diabetes, who would be expected a priori to be enriched with prediabetic subjects, are hyperinsulinemic as predicted.(ABSTRACT TRUNCATED AT 250 WORDS)
Commentary: Antenatal screening and targeting should be sufficient in some countries
Authors: P. P Mortimer, E. Miller
Journal: BMJ (1997)

Van Damme and colleagues criticise some European countries for failing to integrate hepatitis B vaccine into national immunisation policies as recommended by WHO. But does their analysis really apply to countries which, like Britain, have hepatitis B virus carrier rates as low as 0.3%1 and report yearly incidences of acute infection of about 1/100 000?2 And is the inclusion of three doses of vaccine in infant schedules, or an attempt to deliver three doses to all adolescents, the most cost effective preventive approach for these countries? We doubt it and suggest that at present it would be preferable to concentrate on reinforcing existing strategies.

The most important step is to stop maternal transmissions of hepatitis B virus, with their high risk of long term carriage developing in the newborn. Thus, in Britain the Departments of Health advise that “antenatal clinics should … consider offering [HBsAg] screening to all antenatal patients” and that neonates born to positive mothers should be fully immunised. Even if, as Van Damme et al suggest, there was a universal immunisation programme for infants, those born to women infected with hepatitis B would still have to be identified and immediately given hepatitis B immunoglobulin or vaccine, or both, at birth, with at least …
THE CARDIOVASCULAR RESPONSE IN EXPERIMENTAL NEPHRITIS
Authors: F. W. HARTMAN
Journal: JAMA (1927)

The problem of hypertension and hypertrophy of the heart as related to renal disease is one that has claimed an increasing amount of clinical and experimental research. Knowledge of the subject has been broadened but unfortunately has produced two directly opposite and apparently irreconcilable views. These are typified by the recently expressed opinions of Kylin<sup>1</sup>on the one hand, who says, "All attempts to explain any hypertension secondary to kidney insufficiency are a failure," and of Romberg,<sup>2</sup>on the other, who says, "In every case where the maximum pressure is constantly 160 or higher, kidney disease may be the cause irrespective of the diastolic pressure." Fahr's<sup>3</sup>view is similar to that of Romberg,<sup>2</sup>and in explanation he says that hypertension is a compensatory mechanism which prevents or diminishes kidney symptoms but that kidney injury does exist. It is further pointed out that it is necessary to
Light-chain nephropathy in patient with renal carcinoma.
Authors: G Enia, S Maringhini, A L'Abbate, C Zoccali, Q Maggiore
Journal: BMJ (1981)

Paraneoplastic syndromes are often associated with renal parenchymal tumours. This report describes a case of renal-cell carcinoma with kappa-chain nephropathy. The patient, a 60-year-old man, had renal tubular dysfunction, shown by low serum concentrations of urate and phosphate. Kappa-chains were found in both serum and urine, but no lambda-chains were found. Investigations showed a clear-cell carcinoma, and the patient underwent a radical nephrectomy. Two years after operation serum phosphate and urate concentrations had returned to normal, and kappa-chains were undetectable in serum or urine. The absence of lambda-chains indicates that the light-chain proteinuria was due to overproduction of the M component, and the disappearance of kappa-chains after the operation suggests a causal relation between the renal tumour and the overproduction of the M component.
Medical School at Southampton
Authors: E. D. Acheson
Journal: BMJ (1969)

When Southampton University admits medical students for the first time in October 1971 it will be the second medical school to come into being in Britain since 'the beginning of the century.Its development comes at a particularly opportune time when medical education, the organization of the Health Service, and the role in society of the medical man himself are under more active and searching review than at any time for many years.Advantage has been taken of these discussions and in particular of the report of the Royal Commission on Medical Education in drawing up the plans for the medical school and in the design of the curriculum, of which an out- line already exists.
Effect of paediatric retrieval service on clinical activity
Authors: T Sajjanhar, M J Marsh, I A Murdoch
Journal: BMJ (1996)

EDITOR,-The report of the Interdepartmental Working Group on sensible drinking' has aroused critical comment.2The core recommendation is an increase in the safe limits for drinking from 21 units a week to 3-4 units a day for men and from 14 units a week to 2-3 units a day for women.The apparent aims are to discourage binge drinking and to promote health through moderate daily consumption.3We investigated how drinkers had interpreted the new guidelines and what effect the guidelines would have on their drinking.Over the Christmas period we interviewed 100 randomly chosen people in 12 pubs in four areas of England.Ninety were aware that the guidelines on drinking had changed and were interviewed further.Of these, all believed that safe drinking limits had been increased.When asked to quote the new guidelines 47 gave the correct weekly totals; they all, however, gave a weekly, not a daily, limit.Nearly all the subjects (97%) said that the new guidelines would not affect the amount they drank or the pattern of their drinking.The others were occasional drinkers who said that they might increase their drinking because of the health benefits.When asked if the new guidelines would make them spread out their drinking more, only 3% said that they would.We conclude from our survey that, whatever the intended effect of the guidelines, they have been widely misinterpreted.Despite this, nearly all our subjects denied that the guidelines would change their drinking habits.
Parity, Ponderosity, and the Paradox of a Weight-Preoccupied Society
Authors: JoAnn E. Manson
Journal: JAMA (1994)

The epidemic of obesity in America shows no sign of abating. In contrast to a favorable secular trend in other coronary risk factors, the prevalence of obesity continues to escalate in the United States.<sup>1,2</sup>At present, one quarter to one third of US adults are overweight,<sup>3</sup>and at least 34 million can be classified as obese, defined as the equivalent of weight 20% or more above desirable levels.<sup>4</sup>Women and minorities, including African Americans, Hispanics, American Indians, and Pacific Islanders, are at particular risk of obesity.<sup>5</sup>The prevalence of obesity in the United States is higher than that in Canada, Europe, Australia, and most other regions.<sup>6</sup>The relative contributions of cultural and economic factors, educational attainment, diet, physical activity patterns, parity levels, and differences in perceptions about health risks are unclear and require elucidation. Although obesity commonly emerges in traditional societies See also p 1747.
Post-cricoid Carcinoma: Regional Incidence in England and Wales
Authors: A. Jacobs
Journal: BMJ (1963)

MEDICAL JOURAThe ratio between the mortality and the incidence rates shows marked variation with age.Mortality is low compared with incidence at ages under 15 years (5%) and at ages 15 to 24 years (4%), but subsequently it increases with age.This corresponds with the pathological finding that papillary carcinoma is the predominant type in childhood and anaplastic carcinoma the predominant type in old age.Follow-up of patients reported under the national cancer registration scheme confirms that the early prognosis is good in youth and becomes progressively worse in adult life.Data obtained from three studies in the U.S.A. show a similar change with age in the ratio between mortality and incidence.The ratio is somewhat lower at ages 20 to 69 years in the U.S.A., suggesting that the incidence in England and Wales may be slightly underestimated.We are most grateful to the Registrar General of England
Hale Nui, Schofield Barracks: A Community Mental Health Program
Authors: ROBERT L. PETTERA, HELEN FECENKO
Journal: American Journal of Psychiatry (1972)

The authors describe a community-oriented treatment modality called "Hale Nui," in use in a military community in Hawaii. A graduated program stressing group therapy and activity—social as well as therapeutic—encourages the individual to practice using his strengths and assets. Graduation from the program occurs as members gain mutual trust and self-confidence and use community resources appropriately.
Fantasy, females, sexuality, and testosterone
Authors: Theodore D. Kemper
Journal: Behavioral and Brain Sciences (1998)

(1) Mazur &amp; Booth do not explain precontest rise in testosterone. Anticipatory T rise may result from fantasized dominance scenarios. (2) Mazur &amp; Booth conclude that females do not experience the dominance–T rise effect. The data are insufficient for this judgment. (3) Mazur &amp; Booth misstate my position on T and sexuality. I offer an emendation and correction.
Chest Pain with Normal Coronary Angiograms
Authors: Richard O. Cannon
Journal: New England Journal of Medicine (1993)

Coronary angiograms are found to be normal in approximately 10 to 20 percent of patients undergoing cardiac catheterization to evaluate angina-like chest pain. Although their prognosis is good,1 most of these patients continue to experience chest pain despite reassurance that they do not have obstructive coronary disease; the pain results in continued hospitalizations, more cardiac catheterizations, and diminished quality of life and ability to work2. The mechanisms of pain in these patients, even those with ischemic-appearing electrocardiographic responses to exercise (sometimes referred to as syndrome X), continue to be controversial, as evidenced by numerous studies with often conflicting results, . . .