tbuckley/cabot-search huggingface dataset:
Era of Personalized Medicine May Herald End of Soaring Cancer Costs
Authors: B. Keogh
Journal: JNCI Journal of the National Cancer Institute (2011)

P ersonalized medicine promises to drastically improve quality and longevity in the coming decades by custom-tailoring a patient ’ s treatment for cancer or other diseases to his or her particular genetic makeup. It may also become the saving grace of developed countries with massive debts and bloated budgets by cutting soaring health care costs by tens of billions of dollars per year. At least, that ’ s the hope. Using advancements in genomics and proteomics, researchers have developed diagnostics targeting an individual ’ s unique genetic makeup, potentially eliminating unnecessary treatments, reducing adverse reactions to drugs, and improving health outcomes — while lowering costs, or at least retarding their rapid increase. “In a sense, it ’ s the holy grail, being able to treat every person ’ s disease as their own,” said Richard Sullivan , a professor at King ’ s College London and lead author of a recent Lancet report on the cost of cancer care. “If you ’ re going to see real affordability, if you ’ re going to see real cost savings, and high-quality evidence-based care, you have to do it across the board; you can ’ t simply say it ’ s all about medicines.” The worldwide cost of cancer attributable to premature death and disability reached an estimated $895 billion in 2008, notes the Lancet Oncology Commission report titled “Delivering Affordable Cancer Care in High-Income Countries,” published Sept. 26. U.S. cancer spending grew to $90 billion in 2008 from $27 billion in 1990 and is projected to soar to $157 billion by 2020. In the UK, total spending on breast cancer care has increased 10% annually for the past 4 years. Some form of cancer affected an estimated 12.4 million new patients in 2008, with 7.6 million deaths, fi gures that may jump to 26.4 million and 17 million, respectively, by 2030, according to the International Agency for Research on Cancer.
Cholesterol and nonalcoholic fatty liver disease: Renewed focus on an old villain
Authors: Thomas A. Kerr, Nicholas O. Davidson
Journal: Hepatology (2012)

Nonalcoholic fatty liver disease (NAFLD) is associated with increased cardiovascular and liver-related mortality. NAFLD is characterized by both triglyceride and free cholesterol (FC) accumulation without a corresponding increment in cholesterol esters. The aim of this study was to evaluate the expression of cholesterol metabolic genes in NAFLD and relate these to disease phenotype. NAFLD was associated with increased SREBP-2 maturation, HMG CoA reductase (HMGCR) expression and decreased phosphorylation of HMGCR. Cholesterol synthesis was increased as measured by the circulating desmosterol:cholesterol ratio. miR-34a, a microRNA increased in NAFLD, inhibited sirtuin-1 with downstream dephosphorylation of AMP kinase and HMGCR. Cholesterol ester hydrolase was increased while ACAT-2 remained unchanged. LDL receptor expression was significantly decreased and similar in NAFLD subjects on or off statins. HMGCR expression was correlated with FC, histologic severity of NAFLD and LDL-cholesterol. These data demonstrate dysregulated cholesterol metabolism in NAFLD which may contribute to disease severity and cardiovascular risks.
Drug Addiction as a Brain Disorder or Disease
Authors: Nelson Borelli
Journal: JAMA (2009)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
HbA<sub>1c</sub>levels had low sensitivity but high specificity for screening for diabetes
Authors: Lorraine Lipscombe
Journal: Annals of Internal Medicine (2011)

ACP Journal Club19 April 2011HbA1c levels had low sensitivity but high specificity for screening for diabetesLorraine Lipscombe, MD, MSc, FRCPCLorraine Lipscombe, MD, MSc, FRCPCWomen’s College Hospital, Toronto, Ontario, Canada (L.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-154-8-201104190-02009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationOlson DE, Rhee MK, Herrick K, et al. Screening for diabetes and pre-diabetes with proposed A1c-based diagnostic criteria. Diabetes Care. 2010;33:2184-9. https://pubmed.ncbi.nlm.nih.gov/20639452Clinical Impact RatingsGIM/FP/GP: Endocrinology: References1 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011;34 Suppl 1:S62-9. [PMID: 21193628] Google Scholar2 Selvin E, Steffes MW, Gregg E, Brancati FL, Coresh J. Performance of A1C for the classification and prediction of diabetes. Diabetes Care. 2011;34:84-9. [PMID: 20855549] Google Scholar3 Bloomgarden ZT. A1C: recommendations, debates, and questions. Diabetes Care. 2009;32:e141-7. [PMID: 19940210] Google Scholar4 Cavagnolli G, Comerlato J, Comerlato C, et al. HbA(1c) measurement for the diagnosis of diabetes: is it enough? Diabet Med. 2011;28:31-5. [PMID: 21210540] Google Scholar Author, Article, and Disclosure InformationAuthors: Lorraine Lipscombe, MD, MSc, FRCPCAffiliations: Women’s College Hospital, Toronto, Ontario, Canada (L.L.)This article was published at Annals.org on 5 April 2011. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byImproving Detection of Prediabetes in Children and Adults: Using Combinations of Blood Glucose Tests 19 April 2011Volume 154, Issue 8 Page: JC4-9 Keywords Blood plasma Glucose HbA1c Health surveys Hemoglobin Likelihood ratio Oral glucose tolerance test Population statistics Specificity Veteran care ePublished: 19 April 2011 Issue Published: 19 April 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Letter: Dementia associated with clonidine therapy.
Authors: P Lavin, C P Alexander
Journal: BMJ (1975)

Patients ToxicNon-toxic Controls (n = 9) (n = 71) (n = 22) Plasma digoxin 2-91 i 090 1-42 ±0-82 (nmol/l) Plasma magnesium 0-885 ± 011 0-83 ± 011 0-855 0-06 (mmol/l) Erythrocyte magnesium 2-215 0-345 2-32 ± 0-365 2-085 0-225 (mmol/l) Conversion: SI to Traditional Units-Plasma digoxin: 1 nmol/l 0-78 ng/ml.Plasma and erythrocyte magnesium: 1 mmol/l 2 mEq/l.
Cables Links Cdk5 and c-Abl and Facilitates Cdk5 Tyrosine Phosphorylation, Kinase Upregulation, and Neurite Outgrowth
Authors: Lawrence R Zukerberg, Gentry N Patrick, Margareta Nikolic, Sandrine Humbert, Chin-Lee Wu, Lorene M Lanier, Frank B Gertler, Marc Vidal, Richard A Van Etten, Li-Huei Tsai
Journal: Neuron (2000)
PLASMA AND TISSUE METABOLOMIC PROFILING IN A PORCINE ISCHEMIA-REPERFUSION MODEL REVEALS NOVEL EARLY MARKERS OF MYOCARDIAL INJURY
Authors: Renato Lopes, E. Marc Jolicoeur, Svati H. Shah, Mark Y. Chan, Tracy Y. Wang, Robert D. Stevens, Brett R. Wenner, Olga R. Ilkayeva, James R. Bain, Jean-Francois Tanguay, Christopher B. Newgard, L. Kristin Newby
Journal: Journal of the American College of Cardiology (2010)
Use of Oral Contraceptives by Women With Epilepsy-Reply
Authors: Richard H. Mattson
Journal: JAMA (1986)

<h3>In Reply.—</h3> Dr Elkington makes two important comments in his letter discussing our article. All antiepileptic drugs have teratogenic potential, and neural tube defects may be more likely with valproic acid ingestion. The use of valproic acid was recommended in conjunction with oral contraceptives because it is not an enzyme inducer and women using these two drugs are highly unlikely to become pregnant, so the teratogenic risk is small. As for the use of alternative oral contraceptives in breakthrough bleeding, our practice has been to begin by elevating the estrogen dose over the minimum level used in the general population. The concept is to use breakthrough bleeding as a guide for contraceptive efficacy. Although we have avoided the use of progestins to overcome what is seen as a failure of estrogen effect<sup>1</sup>and because progestins may have their own ill effects,<sup>2</sup>we cannot quarrel with avoidance of the
T Helper 1 (Th1) and Th2 Characteristics Start to Develop During T Cell Priming and Are Associated with an Immediate Ability to Induce Immunoglobulin Class Switching
Authors: Kai-Michael Toellner, Sanjiv A. Luther, Daniel M.-Y. Sze, Richard K.-W. Choy, Dale R. Taylor, Ian C.M. MacLennan, Hans Acha-Orbea
Journal: The Journal of Experimental Medicine (1998)

The respective production of specific immunoglobulin (Ig)G2a or IgG1 within 5 d of primary immunization with Swiss type mouse mammary tumor virus [MMTV(SW)] or haptenated protein provides a model for the development of T helper 1 (Th1) and Th2 responses. The antibody-producing cells arise from cognate T cell B cell interaction, revealed by the respective induction of Cγ2a and Cγ1 switch transcript production, on the third day after immunization. T cell proliferation and upregulation of mRNA for interferon γ in response to MMTV(SW) and interleukin 4 in response to haptenated protein also starts during this day. It follows that there is minimal delay in these responses between T cell priming and the onset of cognate interaction between T and B cells leading to class switching and exponential growth. The Th1 or Th2 profile is at least partially established at the time of the first cognate T cell interaction with B cells in the T zone. The addition of killed Bordetella pertussis to the hapten–protein induces nonhapten-specific IgG2a and IgG1 plasma cells, whereas the anti-hapten response continues to be IgG1 dominated. This indicates that a Th2 response to hapten–protein can proceed in a node where there is substantial Th1 activity.
Effective thrombolysis without marked plasminemia after bolus intravenous administration of vampire bat salivary plasminogen activator in rabbits.
Authors: S J Gardell, D R Ramjit, I I Stabilito, T Fujita, J J Lynch, G C Cuca, D Jain, S P Wang, J S Tung, G E Mark
Journal: Circulation (1991)

The use of recombinant tissue-type plasminogen activator (t-PA) in thrombolytic therapy is frequently associated with significant fibrinogenolysis. In contrast, recombinant vampire bat salivary plasminogen activator (Bat-PA) displays strict fibrin specificity, an attribute that could be desirable in a fibrinolytic agent.The efficacy and fibrin selectivity of Bat-PA was evaluated and compared with that of t-PA using a rabbit model of femoral arterial thrombosis. Administration of 8.1, 14, and 42 nmol Bat-PA/kg by bolus intravenous injection restored flow in 50%, 75%, and 80% of the rabbits, respectively. The incidence of reperfusion after bolus intravenous injection of 14 and 42 nmol t-PA/kg was 15% and 78%, respectively. The maximal femoral artery reperfusion flows were equivalent after treatment with 42 nmol Bat-PA/kg or 42 nmol t-PA/kg, but the time to reach maximal flow for Bat-PA was approximately one half that of t-PA. Furthermore, the rapid restoration of flow by 42 nmol Bat-PA/kg, in contrast to equimolar t-PA, was accomplished without fibrinogenolysis and with only small decreases in the plasminogen and alpha 2-antiplasmin levels. Equipotent doses of Bat-PA and t-PA both resulted in approximate 2.5-fold increases in the template bleeding times of aspirin-pretreated rabbits. The clearance of Bat-PA from rabbits exhibited biexponential elimination kinetics; approximately 80% was cleared by the relatively slow beta phase (half-life of 17.1 minutes). Overall, Bat-PA was cleared approximately fourfold slower than t-PA.Bolus intravenous administration of Bat-PA would facilitate prompt initiation of thrombolytic therapy, and the avoidance of plasminemia could result in fewer and less severe bleeding complications.
Canadian health ministry faces criticism for its secrecy
Authors: Barbara Kermode-Scott
Journal: BMJ (2004)

According to the Canadian Association of Journalists, Canada's federal health ministry, Health Canada, is the most secretive government department in Canada. On 9 May the association awarded Health Canada its fourth annual “code of silence” award for showing “remarkable zeal in suppressing information” and “concealing vital data about dangerous drugs.”

“Government officials everywhere hide vital information that they think might embarrass them, their departments, or their political leaders,” said the association's president, Paul Schneidereit. The code of silence award honours government officials' efforts to “shroud open government.”

According to …
Lead Encephalopathy simulating Cerebral Tumoar
Authors: A. M. Nussey, I. Drybrough-Smith
Journal: BMJ (1940)

MEDCL JOURHAL 379 know.As yotu see, we start with twenty-seven cases and rapidly drop month by month until at the end of seven months there are only five survivors.Patients tire of being prodded five times a day, and they get positively rebellious when their clothes won't meet in front.I'm afraid my practice is to promise: "This nuisance shall stop when you have gained another 7, 9, 12-or whatever it is-pounds."More often than not I have to keep my word when this is accomplished, and have to be satisfied if they retain that weight subsequently.Of course, those who proceed to lose it-and they never lose it as fast as they gained it-are coaxed to undergo another course.Realizing the possible significance of loss of weight, they are not reluctant.Incidentally, there was one other respect in which the treated patients' differed from the controls: none of them had extra milk.They simply had no time to fit it in. SummaryThe relation between variation in body weight and progress in cases of pulmonary tuberculosis is discussed.The technique of administering insulin with a high carbo- hydrate diet is fully described.Analysis of the results of this regime is found to compare favourably with controls regarding (a) increase of body weight and (b) improvement in the sedimentin index.
Combined Ventricular Hypertrophy
Authors: ALEXANDER J. MUSTER, MILTON H. PAUL
Journal: Circulation (1965)

An attempt has been made to uncover the vectorcardiographic spectrum of combined ventricular hypertrophy by studying a group of 82 patients with cyanotic tetralogy of Fallot representing right ventricular hypertrophy with normal or less than normal left ventricular muscle mass and 140 patients with tetralogy of Fallot and surgically created systemic-pulmonary shunts representing right ventricular hypertrophy combined with varying degrees of increased left ventricular muscle mass. An analysis of the spatial orientation of the maximal QRS vectors has demonstrated a continuum of vectorcardiographic patterns. These extend starting with severe right ventricular hypertrophy through a series of ventricular hypertrophy patterns representing right ventricular hypertrophy with progressively increasing left ventricular potentials toward dominant left ventricular hypertrophy patterns of combined ventricular hypertrophy. An estimate of the relative contribution of the two ventricles to a given vectorcardiographic pattern of combined ventricular hypertrophy is possible by analysis of the direction of maximal spatial QRS vectors.
DOSAGE IN CHLOROFORM ANESTHESIA.
Authors: A. S. v. MANSFELDE
Journal: JAMA (1900)

By way of introduction, I quote from one of our honored confrères, a truism, which can not be too strongly emphasized: "The greatest among us does not lower his dignity when he places the patient on the confines of death, safely holds him there, dead to pain and consciousness, whilst the surgeon wields his knife, and then restores him to life." (R. M. Stone.) As we go along, it will become convincingly clear to you that "the greatest among us" should approach the responsibility of administering an anesthetic with fear and trembling; he will even insist that his knowledge is far from being comprehensive enough to grasp all the factors concerned in this grave undertaking. To him this is not simply a question of the cessation of respiration, or of the heart's action, or which shall first succumb. He will crave the need of a profound knowledge of what takes
TREATMENT OF A COMMON COLD.
Authors: FRANK WOODBURY
Journal: JAMA (1900)

When a patient tells us that he has "a bad cold," or that he is "suffering with a cold," we at once understand him to mean that a group of symptoms are present, which are the usual results of an exposure to cold, or which frequently follow a chill, or a lowering of the surface temperature of the body, with insufficient reaction. Characteristic of this condition are muscular soreness, or actual pain on motion—muscular rheumatism—in different parts of the body; a general feeling of heaviness and indisposition to effort; more or less difficulty of breathing; partial obstruction of the nasal chambers, owing to the swelling of the mucous membrane; frequent sneezing; and a free discharge of a thin watery secretion from the nasal chambers and associated sinuses, often accompanied by a slight febrile condition. The tonsils may become inflamed, especially if they have been the site of former attacks. Other
Upper Airway Sleep-Disordered Breathing in Women
Authors: Christian Guilleminault
Journal: Annals of Internal Medicine (1995)

Objective: To investigate the various clinical presentations of sleep-disordered breathing in women. Design: A retrospective case–control study. Setting: A sleep disorders clinic. Patients: 334 women, aged 18 years and older, seen between 1988 and 1993, who were diagnosed with upper airway sleep-disordered breathing. Controls were 60 women with insomnia and 100 men with sleep-disordered breathing. Measurements: Clinical, anatomic, and polygraphic information. Results: The mean lag time (±SD) in women between the appearance of symptoms and a positive diagnosis was 9.7 ±3.1 years; among participants 30 to 60 years of age, the duration of untreated symptoms differed (P <0.001) between women and men. Sleep-disordered breathing was blamed for divorce or social isolation by 40% of the case patients. Abnormal maxillomandibular features were noted in 45% of the women with disordered breathing. Dysmenorrhea and amenorrhea (which disappeared after treatment with nasal continuous positive airway pressure) were reported in 43% of premenopausal women compared with 13% of persons in the control group of women with insomnia. Thirty-eight women (11.4%) with upper airway sleep-disordered breathing had a respiratory disturbance index of less than 5 and were significantly younger, had a smaller neck circumference, and had a lower body mass index than women with a respiratory disturbance index of 5 or more. Conclusion: Physicians should revise their understanding of upper airway sleep-disordered breathing so that they notice women with certain craniofacial features, a low body mass index, a small neck circumference, and a respiratory disturbance index of less than 5. These revisions may enable more rapid diagnosis and treatment of women with sleep-disordered breathing.
Rationing in general practice: Commentary: Guidelines for rationing resemble process of family decision making
Authors: D. C Thomasma
Journal: BMJ (1996)

The origin of the verb “to ration” comes from the Latin ratio to reason. Rationing, or providing guidelines for the use of resources, is a profoundly human activity, arising from our capacity to reason, especially our capacity to reason with an eye to the future and plan accordingly. Because rationing is a human act, it participates in the moral character of all such acts. Therefore the effort to ration resources can be unjust, morally neutral, or a virtue, depending on the motives of those rationing, the qualities of the item to be rationed, and the goals and purposes of providing a plan for allocating resources. In all three instances, rationing arouses the most complex concerns about being fair to others with whom we live in community.

I take unjust rationing to be any …
Cefoperazone and Prothrombin Time
Authors: Myron S. Cohen, H. E. Washton
Journal: Annals of Internal Medicine (1987)

Letters and Corrections1 May 1987Cefoperazone and Prothrombin TimeMYRON S. COHEN, M.D., H. E. WASHTON, M.D.MYRON S. COHEN, M.D.Search for more papers by this author, H. E. WASHTON, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-106-5-778_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In their article on the relationship between beta-lactam antibiotics and coagulopathy, Sattler and colleagues (1) cited our results (2) from a multicenter trial of cefoperazone sodium done in 1982 and 1983. We subsequently examined the effects of cefoperazone sodium on prothrombin time in greater detail (3). The trial included 894 patients. Most patients received 2 g of cefoperazone sodium twice per day. Data on prothrombin time was adequate for analysis in 695 (78%) of patients enrolled in the study. Prothrombin time was abnormal in 12 patients (1.7%) before therapy; was changed by less than 2 seconds during...References1. SATTLERWEITKAMPBALLARD FMJ. Potential for bleeding with new beta-lactam antibiotics. Ann Intern Med. 1986;105:924-31. LinkGoogle Scholar2. COHENWASHTONBARRANCO MHS. Multicenter trial of cefoperazone sodium in the United States. Am JMed. 1984;77(1B):35-41. Google Scholar3. COHENWASHTON MH. Effects of cefoperazone sodium on prothrombin time and clinical consequences (abstract 774). In: Proceedings of the IXth International Congress on Infectious and Parasitic Diseases. Munich, 1986. Google Scholar4. SATTLERCOLGOCAPUTOSCHOOLWERTH FDGA. Cefoperazone for empiric therapy in patients with impaired renal function. Am J Med. 1986;87:229-36. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCefoperazone plus tobramycin versus ticarcillin plus tobramycin in febrile granulocytopenic cancer patients 1 May 1987Volume 106, Issue 5Page: 778-778KeywordsAntibioticsCoagulopathyProthrombin timeSodium Issue Published: 1 May 1987 PDF downloadLoading ...