tbuckley/cabot-search huggingface dataset:
ABERRANT PANCREAS: A CAUSE OF DUODENAL SYNDROME
Authors: Maurice Feldman
Journal: JAMA (1952)

The anomaly of aberrant pancreas of the duodenum has been inadequately studied and is of sufficient clinical importance to merit more than passing interest. A consideration of this subject was stimulated by our autopsy experience concerning the high incidence of pancreatic tissue observed in the duodenum. There also seems to be a compelling need for the elucidation of the clinical significance of this condition, especially when it involves the duodenum. The accessory pancreas is a common anomalous embryological development, apparently occurring with greater frequency than may be inferred from a survey of the literature. According to the literature its incidence is comparatively low. In recorded studies the incidence varied from 0.04% to 2%. In 1,970 autopsies Duff and co-workers<sup>1</sup>found 21 instances of aberrant pancreatic tissue, an incidence of 1%. In our 410 autopsy studies an unusually high incidence of this condition was observed, especially in the duodenum. In
Sickness certification system in the United Kingdom
Authors: Mansel Aylward
Journal: BMJ (2004)

Editor—Hussey et al produce similar findings to other recent studies about general practitioners' advice on fitness for work,1-3 but in his editor's choice Smith concludes that much of this work is philosophically untenable. General practitioners have been poorly trained in this important and undoubtedly difficult aspect of their day to day work, a challenge that the Department for Work and Pensions is anxious to address.

Smith also perpetuates the myth that general practitioners are acting solely as agents for the department, presumably in the same way that they are agents of the NHS when they issue a prescription?

Advice on fitness to work is an integral part of the clinical management of patients of working age. The obligation to record the advice on a statement (such as Form Med 3) does not detract from the doctor's overriding concern for the best clinical outcome for the patient. Good professional practice may sometimes mean challenging the patient's view, much as a general practitioner may do when requested to prescribe a drug. But it is an extremely narrow view of advocacy to believe that a skilled professional should simply accede to the patient's wishes without any negotiation.

The government has recognised the need for reforms in the area of incapacity for work, including many of the changes called for by Hussey et al.4,5 Employers need to take greater ownership of managing absence and avoiding inappropriate medicalisation. But general practitioners' position in frontline health care inevitably means that they will remain a key source of advice and influence for working patients for the foreseeable future.

General practitioners' educators should urgently recognise the need for a change in thinking about this aspect of vocational training and continuing professional development. To support them in this task, the Department of Work and Pensions already provides a range of relevant training resources, evidence based guidance, online training, and a national network of medical officers (www.dwp.gov.uk/medical).
Obesity and Underweight Are Associated with an Increased Risk of Death after Lung Transplantation
Authors: David J. Lederer, Jessie S. Wilt, Frank D'Ovidio, Matthew D. Bacchetta, Lori Shah, Shankari Ravichandran, Jenny Lenoir, Brenda Klein, Joshua R. Sonett, Selim M. Arcasoy
Journal: American Journal of Respiratory and Critical Care Medicine (2009)

Obesity is considered a relative contraindication to lung transplantation, based on studies that have not accounted for key confounders. Little is known about the risk of death for underweight candidates after transplantation.
Headaches Caused by Nasal Obstruction
Authors: R. C. B. Macrae
Journal: BMJ (1953)

JOLURNALsamples: this served as a control for the second test.(2) The titre of anti-B was 1: 8 in the pre-transfusion sample, and 1:2 in the post-transfusion sample, indicating the absorption of large quantities of circulating anti-B on the
Impaired Chronotropic Response to Exercise Stress Testing as a Predictor of Mortality
Authors: Michael S. Lauer, Gary S. Francis, Peter M. Okin, Fredric J. Pashkow, Claire E. Snader, Thomas H. Marwick
Journal: JAMA (1999)

ContextChronotropic incompetence, an attenuated heart rate response to exercise, is a predictor of all-cause mortality in healthy populations. This association may be independent of exercise-induced myocardial perfusion defects.ObjectiveTo examine the prognostic significance of chronotropic incompetence in a low-risk cohort of patients referred for treadmill stress testing with thallium imaging.DesignProspective cohort study conducted between September 1990 and December 1993.SettingTertiary care academic medical center.PatientsConsecutive patients (1877 men and 1076 women; mean age, 58 years) who were not taking β-blockers and who were referred for symptom-limited treadmill thallium testing.Main Outcome MeasuresAssociation of chronotropic incompetence, defined as either failure to achieve 85% of the age-predicted maximum heart rate or a low chronotropic index, a heart rate response measure that accounts for effects of age, resting heart rate, and physical fitness, with all-cause mortality during 2 years of follow-up.ResultsThree hundred sixteen patients (11%) failed to reach 85% of the age-adjusted maximum heart rate, 762 (26%) had a low chronotropic index, and 612 (21%) had thallium perfusion defects. Ninety-one patients died during the follow-up period. After adjustment for age, sex, thallium perfusion defects, and other confounders, failure to reach 85% of the age-predicted maximum heart rate was associated with increased risk of death (adjusted relative risk [RR], 1.84; 95% confidence interval [CI], 1.13-3.00; P=.01), as was a low chronotropic index (adjusted RR, 2.19; 95% CI, 1.43-3.44; P&lt;.001).ConclusionAmong patients with known or suspected coronary disease, chronotropic incompetence is independently predictive of all-cause mortality, even after considering thallium perfusion defects. Incorporation of chronotropic response into the routine interpretation of stress thallium studies may improve the prognostic power of this test.
Roentgenographic Recognition of Pleural Effusion
Authors: Vernon A. Vix
Journal: JAMA (1974)

THE presence of pleural effusion often suggests a diagnosis, indicates the need for further study, or, through thoracentesis, provides material for direct diagnostic studies. This article will review the many roentgenographic manifestations of pleural effusion. The Table gives a morphological classification of these effusions. <h3>Upright Roentgenogram</h3> On the upright chest roentgenogram, pleural effusion is usually seen as a density on the diaphragm, with a concave meniscus along the chest wall. Approximately 250 ml of fluid must be present to obliterate the costophrenic sinus. Unless other roentgenograms show a recent change, a costophrenic sinus obliterated by pleural thickening may be indistinguishable from one obliterated by fluid. Roentgenograms taken in the supine or decubitus positions will allow differentiation: fluid will gravitate to the dependent part of the pleural space. <h3>Lateral Decubitus View</h3> This accumulation of fluid in the dependent areas of the chest is the basis for the use of the lateral
Prediction of Working Memory Performance in Schizophrenia by Plasma Ratio of Clozapine to <i>N</i>-Desmethylclozapine
Authors: Tarek K. Rajji, Benoit H. Mulsant, Simon Davies, Sawsan M. Kalache, Christopher Tsoutsoulas, Bruce G. Pollock, Gary Remington
Journal: American Journal of Psychiatry (2015)

Objective: Clozapine's potent antagonism of muscarinic M1 receptors is thought to worsen working memory deficits associated with schizophrenia. In contrast, its major metabolite, N-desmethylclozapine (NDMC), is thought to enhance working memory via its M1 receptor agonist activity. The authors hypothesized that the ratio of serum clozapine and NDMC concentrations would be inversely associated with working memory performance in schizophrenia. Method: Thirty patients with schizophrenia or schizoaffective disorder who were receiving clozapine monotherapy at bedtime completed the MATRICS Consensus Cognitive Battery (MCCB) on the day their blood was collected to assess concentrations of clozapine and NDMC as well as serum anticholinergic activity. Results: The clozapine/NDMC ratio was significantly and negatively associated with working memory performance after controlling for age, gender, education, and symptom severity. No significant associations were found between individual clozapine and NDMC concentrations and working memory performance. Serum anticholinergic activity was significantly associated with clozapine concentration, but not with working memory performance or NDMC concentration. No significant associations were found between any pharmacological measure and performance on other MCCB cognitive domains. Conclusions: This hypothesis-driven study confirms that clozapine/NDMC ratio is a strong predictor of working memory performance in patients with schizophrenia. This finding suggests that manipulating the clozapine/NDMC ratio could enhance cognition in patients with schizophrenia treated with clozapine. It also supports the study of procholinergic agents, such as M1 receptor-positive allosteric modulators, to enhance cognition in schizophrenia.
Is there any association between referral indications for open-access upper gastrointestinal endoscopy and endoscopic findings?
Authors: L. van Kerkhoven, S. van Rijswijck, L. van Rossum, R. Laheij, E. Witteman, A. Tan, J. Jansen
Journal: Endoscopy (2007)

The total number of upper gastrointestinal endoscopies is increasing, and despite guidelines for endoscopy referral for general practitioners, the proportion of patients found to have no endoscopic abnormalities is still up to 60% (and increasing). The aim of this study was to assess the association between general practitioners' referral indications and endoscopic findings.General practitioners of patients referred for an open-access endoscopy between January 2002 and December 2004 were asked to specify the reason for referral on a specially designed form. The relative frequency of patients actually having an endoscopic abnormality was assessed for each referral indication.A total of 1298 people were included in the study. A relevant endoscopic abnormality was found in 48% of patients. Patients with an endoscopic abnormality were not more often referred with "alarm" symptoms or failure of empirical treatment than patients without an abnormal endoscopic finding (31% with an endoscopic abnormality vs. 30% without an endoscopic abnormality had alarm symptoms; 57% of people in both groups experienced failure of empirical treatment). Referral with alarm symptoms had a positive predictive value of 4% for cancer (prevalence 2%; P < 0.01), and referral with reflux-like symptoms had a positive predictive value of 33% for finding reflux esophagitis (prevalence 22%; P < 0.01).General practitioners' referral indications for open-access endoscopy did not add any relevant predictive value for endoscopic findings in comparison with what might have been expected from overall prevalence. Only alarm symptoms slightly increased the probability of finding cancer and only reflux-like symptoms slightly increased the probability of finding reflux esophagitis.
Observations on idiopathic proctitis
Authors: J. E. Lennard-Jones, G. W. Cooper, A. C. Newell, C. W. E. Wilson, F. A. Jones
Journal: Gut (1962)

This paper presents the natural history of idiopathic proctitis and concludes that this disease and idiopathic procto-colitis are two manifestations of one disease differing only in the extent of the colon involved.
Position Paper on Acquired Immunodeficiency Syndrome
Authors: JAMES L. LEVENSON
Journal: Annals of Internal Medicine (1986)

Letters and Corrections1 September 1986Position Paper on Acquired Immunodeficiency SyndromeJAMES L. LEVENSON, M.D.JAMES L. LEVENSON, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-105-3-466_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The recent position paper on the acquired immunodeficiency syndrome (AIDS) provides timely and appropriate guidance in many respects (1). I strongly disagree, however, with Position 5, on confidentiality and reporting. It advises, "Beyond mandated reporting requirements to the appropriate public health authority . . . the occurrence of a confirmed positive result in a serologic test for antibody to HTLV-III [human T-lymphotropic virus type III; now human immunodeficiency virus, HIV] should not be communicated by health professionals to any other party except the patient whose blood has been tested."Physicians do have an obligation to protect their...Reference1. . Acquired immunodeficiency syndrome [Position paper]. Ann Intern Med. 1986;104:575-81. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: JAMES L. LEVENSON, M.D. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCOVID-19 Ethics: What Interventional Radiologists Need to KnowConfidentiality Limits With Clients Who Have HIV: A Review of Ethical and Legal Guidelines and Professional Policies 1 September 1986Volume 105, Issue 3Page: 466-467KeywordsAIDSHematologic testsHIVPrevention, policy, and public health ePublished: 1 December 2008 Issue Published: 1 September 1986 PDF downloadLoading ...
Suppressor of cytokine signaling-3 (SOCS-3) and a deficit of serine/threonine (Ser/Thr) phosphoproteins involved in leptin transduction mediate the effect of fructose on rat liver lipid metabolism
Authors: Laia Vilà, Núria Roglans, Marta Alegret, Rosa María Sánchez, Manuel Vázquez-Carrera, Juan Carlos Laguna
Journal: Hepatology (2008)

Abstract There is controversy regarding whether fructose in liquid beverages constitutes another dietary ingredient of high caloric density or introduces qualitative changes in energy metabolism that further facilitate the appearance of metabolic diseases. Central to this issue is the elucidation of the molecular mechanism responsible for the metabolic alterations induced by fructose ingestion. Fructose administration (10% wt/vol) in the drinking water of Sprague-Dawley male rats for 14 days induced hyperleptinemia and hepatic leptin resistance. This was caused by impairment of the leptin-signal transduction mediated by both janus-activated kinase-2 and the mitogen-activated protein kinase pathway. The subsequent increase in activity in the liver of the unphosphorylated and active form of the forkhead box O1 nuclear factor, which transrepresses peroxisome proliferator-activated receptor α activity, and a lack of activation of the adenosine monophosphate-activated protein kinase, led to hypertriglyceridemia and hepatic steatosis. These alterations are attributable to two key events: (1) an increase in the amount of suppressor of cytokine signaling-3 protein, which blocks the phosphorylation and activation of janus-activated kinase-2 and Tyr985 on the long form of the leptin receptor; and (2) a common deficit of phosphorylation in serine/threonine residues of key proteins in leptin-signal transduction pathways. The latter is probably produced by the early activation of protein phosphatase 2A, and further sustained by the accumulation in liver tissue of ceramide, an activator of protein phosphatase 2A, due to incomplete oxidation of fatty acids. Conclusion: Our data indicate that fructose ingestion as a liquid solution induces qualitative changes in liver metabolism that lead to metabolic diseases. (Hepatology 2008.)
717-4 Balloon Valvotomy for Non-Ideal Commissurotomy Candidates
Authors: Ted Feldman, Howard C. Herrmann, John D. Carroll, K. Ramaswamy, Jonathan M. Tobis, J. Kevin Harrison, Augusto D. Pichard, David R. Holmes, Donald A. Rothbaum, Gerald Dorres, Steven R. Bailey, Robert Feldman, James R. Margolis, Stephen R. Ramee
Journal: Journal of the American College of Cardiology (1995)
A Step Closer to Meeting the Threat of Avian Influenza
Authors: Stacey Schultz-Cherry, Jonathan A McCullers
Journal: PLoS Medicine (2006)

In recent years, highly pathogenic avian influenza A viruses of the H5N1 subtype have crossed the species barrier and infected humans in many parts of the world. These strains continue to evolve and expand their host range, and have been associated with greater than 50 percent mortality [1]. No vaccines directed against H5N1 strains are commercially available for humans, and the development of effective H5N1 vaccines poses a number of challenges on both the basic science and manufacturing levels [2].

Several strategies have been explored to produce effective H5 vaccines. These include: preparation of an inactivated vaccine using a heterotypic (see Glossary), low-pathogenicity avian influenza virus that is antigenically related to the H5N1 circulating strains [3]; use of a recombinant H5 hemagglutinin (HA) expressed in baculovirus [4]; an inactivated subvirion vaccine [5]; or the production of attenuated seed viruses with the H5 HA modified through reverse genetics [6–8]. Unfortunately, many of these approaches have been found to be poorly immunogenic, require high doses of antigen, or require the use of an adjuvant [1,9]. An alternative approach under development is the use of live attenuated cold-adapted H5 vaccines.

Live attenuated cold-adapted vaccines are attractive for the prevention of pandemic influenza due to the stimulation of an immune response following a single dose of vaccine, an excellent safety profile, induction of cross-reactive immune responses, and efficacy in children [10]. Although the cold-adapted virus is live, it does not replicate to high titers and fails to readily infect naive people [11]. Through the use of reverse genetics, a cold-adapted H9 influenza virus–specific seed virus has already been produced and is available for clinical evaluation and use should the need arise [12]. A new study in PLoS Medicine now describes the generation of live, attenuated H5N1 influenza viruses that may be suitable candidates for use in humans [13].
TCT-356 Circumferential Therapeutic Ultrasound for the Treatment of Resistant Hypertension: Preliminary Results of Human Feasibility Study (SOUND-ITV)
Authors: Peter Neuzil, Jan Petru, Dagmar Vondrakova, Karel Kopriva, Milan Chovanec, Lucie Sediva, Jacob Koruth, Srinivas Dukkipati, Andre d'Avila, Vivek Reddy
Journal: Journal of the American College of Cardiology (2012)
Thrombin-induced endothelial microparticle generation: identification of a novel pathway involving ROCK-II activation by caspase-2
Authors: Cédric Sapet, Stéphanie Simoncini, Béatrice Loriod, Denis Puthier, José Sampol, Catherine Nguyen, Françoise Dignat-George, Francine Anfosso
Journal: Blood (2006)
Refocusing the System
Authors: Barbara Starfield
Journal: New England Journal of Medicine (2008)

The editors asked several experts to share their perspectives on the crisis in U.S. primary care. Their articles, which address this crisis from six different angles, follow. We also brought the five U.S. contributors together for a roundtable discussion of the problems and potential solutions for training, practice, compensation, and systemic change. A video of the discussion and reader comments can be seen at www.nejm.org.Robust evidence shows that patient care delivered with a primary care orientation is associated with more effective, equitable, and efficient health services. Countries more oriented to primary care have residents in better health at lower costs. Health is better in U.S. regions that have more primary care physicians, whereas several aspects of health are worse in areas with the greatest supply of specialists. People report better health when their regular source of care performs primary care functions well. In addition to features promoting effectiveness and efficiency, there are fewer disparities in health across population subgroups in primary care–oriented health systems. . . .
Magnetic Resonance Imaging Contrast Agent Targeted Toward Activated Platelets Allows In Vivo Detection of Thrombosis and Monitoring of Thrombolysis
Authors: C. von zur Muhlen, D. von Elverfeldt, J.A. Moeller, R.P. Choudhury, D. Paul, C.E. Hagemeyer, M. Olschewski, A. Becker, I. Neudorfer, N. Bassler, M. Schwarz, C. Bode, K. Peter
Journal: Circulation (2008)

Platelets are the key to thrombus formation and play a role in the development of atherosclerosis. Noninvasive imaging of activated platelets would be of great clinical interest. Here, we evaluate the ability of a magnetic resonance imaging (MRI) contrast agent consisting of microparticles of iron oxide (MPIOs) and a single-chain antibody targeting ligand-induced binding sites (LIBS) on activated glycoprotein IIb/IIIa to image carotid artery thrombi and atherosclerotic plaques.Anti-LIBS antibody or control antibody was conjugated to 1-microm MPIOs (LIBS MPIO/control MPIO). Nonocclusive mural thrombi were induced in mice with 6% ferric chloride. MRI (at 9.4 T) was performed once before and repeatedly in 12-minute-long sequences after LIBS MPIO/control MPIO injection. After 36 minutes, a significant signal void, corresponding to MPIO accumulation, was observed with LIBS MPIOs but not control MPIOs (P<0.05). After thrombolysis, in LIBS MPIO-injected mice, the signal void subsided, indicating successful thrombolysis. On histology, the MPIO content of the thrombus, as well as thrombus size, correlated significantly with LIBS MPIO-induced signal void (both P<0.01). After ex vivo incubation of symptomatic human carotid plaques, MRI and histology confirmed binding to areas of platelet adhesion/aggregation for LIBS MPIOs but not for control MPIOs.LIBS MPIOs allow in vivo MRI of activated platelets with excellent contrast properties and monitoring of thrombolytic therapy. Furthermore, activated platelets were detected on the surface of symptomatic human carotid plaques by ex vivo MRI. This approach represents a novel noninvasive technique allowing the detection and quantification of platelet-containing thrombi.