tbuckley/cabot-search huggingface dataset:
Asthma and the atmosphere
Authors: J Ayres
Journal: BMJ (1994)

Journalists and the public have become increasingly concerned about the possible effects of the weather and air pollution on health. This anxiety has been exacerbated in Britain by the recent hot weather, the advent of warnings about air quality, and the availability of measurements of air quality on Ceefax. What sensible advice can be given to people about their response to episodes of air pollution?

The first challenge is to identify just who is at risk during these episodes. Most of the relevant research has come from two types of study. Panel studies take a group of people and follow up symptoms and lung function for a period during which air quality is thought likely to become poor. Event studies report effects of unusual episodes of pollution on a group of patients already recording symptoms or peak flow, or both, daily. Most of the studies conducted in North America have been of children attending summer camps, where the exposures were to ozone, acid aerosols, and particulates - …
Advanced techniques in medical thoracoscopy
Authors: G. F. Tassi, R. J. O. Davies, M. Noppen
Journal: European Respiratory Journal (2006)

For expert pulmonologists, advanced procedures in medical thoracoscopy are the nonroutine and more complex applications of the method. The main current indications are the treatment of infected pleural space, forceps lung biopsy and sympathectomy. In parapneumonic effusions and empyema, medical thoracoscopy is as a drainage procedure, intermediate between tube thoracostomy and video-assisted thoracoscopic surgery (VATS), which is efficient, significantly lower in cost and avoids surgical thoracoscopy under general anaesthesia. It is essential that it is performed early in the course of the disease and is particularly advisable for frail patients at high surgical risk. The efficacy of forceps lung biopsy has been demonstrated in diffuse lung diseases, whereas results in localised lung diseases and chest-wall lesions have been less positive. However, VATS is currently the preferred approach for these indications. The technique still maintains its efficacy for visceral pleura and peripheral lung biopsy, in particular in the presence of pleural effusion and lung disorders. At the present time, thoracoscopic sympathectomy is minimally invasive and is an accepted intervention for patients with a variety of autonomous nervous system disturbances. Essential hyperhidrosis patients, and well-selected patients with other disorders, can be helped with this procedure, which can also be performed by interventional pulmonologists.
Direct Effects, Compensation, and Recovery in Female Fathead Minnows Exposed to a Model Aromatase Inhibitor
Authors: Daniel L. Villeneuve, Nathaniel D. Mueller, Dalma Martinović, Elizabeth A. Makynen, Michael D. Kahl, Kathleen M. Jensen, Elizabeth J. Durhan, Jenna E. Cavallin, David Bencic, Gerald T. Ankley
Journal: Environmental Health Perspectives (2008)

BackgroundSeveral chemicals in the environment have the potential to inhibit aromatase, an enzyme critical to estrogen synthesis.ObjectivesThe objective of this study was to provide a detailed characterization of molecular and biochemical responses of female fathead minnows to a model aromatase inhibitor, fadrozole (FAD).MethodsFish were exposed via water to 0, 3, or 30 μg FAD/L for 8 days and then held in clean water for 8 days, with samples collected at four time points during each 8-day period. We quantified ex vivo steroid production, plasma steroids, and plasma vitellogenin (Vtg) concentrations and analyzed relative transcript abundance of 10 key regulatory genes in ovaries and 3 in pituitary tissue by real-time polymerase chain reaction.ResultsEx vivo 17β-estradiol (E2) production and plasma E2 and Vtg concentrations were significantly reduced after a single day of exposure to 3 μg or 30 μg FAD/L. However, plasma E2 concentrations recovered by the eighth day of exposure in the 3-μg/L group and within 1 day of cessation of exposure in the 30-μg/L group, indicating concentration- and time-dependent physiologic compensation and recovery. Concentration-dependent increases in transcripts coding for aromatase (A isoform), cytochrome P450 side-chain cleavage, steroidogenic acute regulatory protein, and follicle-stimulating hormone receptor all coincided with increased E2 production and recovery of plasma E2 concentrations.ConclusionsResults of this research highlight the need to consider compensation/adaptation and recovery when developing and interpreting short-term bioassays or biomarkers or when trying to predict the effects of chemical exposures based on mode of action.
c-erbB-2 Oncogene Expression in Prostatic Intraepithelial Neoplasia: Mounting Evidence for a Precursor Role
Authors: D. G. Bostwick
Journal: JNCI Journal of the National Cancer Institute (1994)

The search for the precursor of invasive prostatic adenocarcinoma has intensified in recent years, focusing on the spectrum of histopathologic changes referred to as high-grade prostatic intraepithelial neoplasia. This microscopic finding, considered to be the most likely precursor of invasive carcinoma (7), is characterized by cellular proliferations within pre-existing ducts and glands, with cytologic changes mimicking cancer, including nuclear and nucleolar enlargement. Prostatic intraepithelial neoplasia coexists with cancer in more than 85% of cases but retains an intact or fragmented basal cell layer, unlike cancer that lacks a basal cell layer (2). The clinical importance of recognizing prostatic intraepithelial neoplasia is based on its strong association with prostatic carcinoma. Prostatic intraepithelial neoplasia has a high predictive value as a marker for adenocarcinoma, and its identification in biopsy specimens of the prostate warrants further search for concurrent invasive carcinoma. Studies, to date, have not determined whether prostatic intraepithelial neoplasia remains stable, regresses, or progresses, although the implication is that it can progress (2). The identification of specific and consistent molecular changes in prostatic intraepithelial neoplasia, such as pl60 erbB3 and pl85erbB~2 overexpression, adds further support to the expanding body of evidence indicating the premalignant nature of this lesion.
Vasculitis and renal disease in nail-patella syndrome: case report and literature review.
Authors: A D Croock, M Bashar Kahaleh, J M Powers
Journal: Annals of the Rheumatic Diseases (1987)

A 57 year old man with nail-patella syndrome (NPS) and associated renal disease is described who developed an inflammatory polyarthropathy and polyarteritis-like vasculitis. Vasculitis and serum complement abnormalities have not previously been reported in NPS. NPS is a rare autosomal dominant connective tissue disorder affecting both mesenchymal and ectodermal tissue. The condition is reviewed with particular reference to its renal pathology, including the distinctive electron microscopic (EM) finding of collagen deposition in the glomerular basement membrane (GBM). The possibility of the underlying collagen abnormality acting as a trigger for immune-inflammatory changes is discussed.
A Meta-analysis of Alcohol Consumption in Relation to Risk of Breast Cancer
Authors: Matthew P. Longnecker
Journal: JAMA (1988)

Epidemiologic findings regarding the relation between alcohol consumption and risk of breast cancer have been inconsistent. We performed a meta-analysis (a quantitative review) of the available data. To evaluate whether there was a dose-response relation between alcohol consumption and risk of breast cancer, we fitted mathematical models to the pooled data. There was strong evidence to support a dose-response relation in both the case-control and follow-up epidemiologic data. Using the dose-response curves that we calculated, the risk of breast cancer at an alcohol intake of 24 g (1 oz) of absolute alcohol daily (about two drinks daily) relative to nondrinkers was 1.4 (95% confidence interval, 1.0 to 1.8) in the case-control data and was 1.7 (95% confidence interval, 1.4 to 2.2) in the follow-up data. We interpret these findings not as proof of causality, but as strongly supportive of an association between alcohol consumption and risk of breast cancer.
Immune response towards lipid peroxidation products as a predictor of progression of non-alcoholic fatty liver disease to advanced fibrosis
Authors: E Albano
Journal: Gut (2005)

<b>Aims:</b> Factors responsible for the progression of non-alcoholic fatty liver disease (NAFLD) to more severe liver injury are poorly understood. In the present study, we investigated the association between immune reactions triggered by oxidative stress and stage of NAFLD. <b>Methods:</b> Titres of IgG against human serum albumin adducted with malondialdehyde (MDA-HSA) or arachidonic acid hydroperoxide (AAHP) and against oxidised cardiolipin (Ox-CL) were measured in 167 NAFLD patients with steatosis only (n = 79), steatohepatitis (n = 74), or steatosis plus cirrhosis (n = 14), and in 59 age and sex matched controls. <b>Results:</b> Circulating IgG against lipid peroxidation products was significantly higher (p&lt;0.001) in NAFLD patients than in controls. Oxidative stress dependent immune responses were not associated with obesity, type 2 diabetes, or with serum cholesterol, ferritin, or aminotransferase levels. Titres of lipid peroxidation related antibodies were also independent of the extent of steatosis and were similarly distributed in patients with and without necroinflammation. In contrast, the same antibodies were significantly increased in patients with advanced fibrosis or cirrhosis. Logistic regression analysis confirmed that anti-MDA antibodies were independently associated with progression of NALFD and that NAFLD patients with titres of anti-MDA-HSA antibodies above the control threshold value had a threefold (relative risk 2.82 (95% confidence interval 1.35–5.90); p = 0.007) higher risk of having advanced fibrosis/cirrhosis than patients whose antibody titres were within the control range. <b>Conclusions:</b> These results indicate that the presence of immune reactions triggered by oxidative stress can be an independent predictor of progression of NAFLD to advanced fibrosis.
Geographic Variations in the Use of Health Care Services
Authors: Richard W. Starrett
Journal: JAMA (1988)

To the Editor.  —Three Procedures Overdone, Study of Medicare Charges was the front-page headline in my local newspaper this Friday the 13th. I am not surprised. In the article entitled, Does Inappropriate Use Explain Geographic Variations in the Use of Health Care Services? 1 the authors conclude that differences among sites in levels of appropriateness were small and that differences in appropriateness cannot explain geographic variations in the use of these procedures. Specifically regarding carotid endarterectomy, they implied that an astounding proportion, 65%, of the carotid procedures performed on Medicare patients studied in 1981 were either questionably indicated or inappropriate.  An alternative interpretation might well be that the criteria on which the authors based their conclusions about carotid endarterectomy are flawed. The surgeons who performed these procedures in each geographic location that was studied apparently differed with the experts on the appropriateness of surgical indications in the majority (65%) of
How Much Time Do Physicians Spend Providing Care Outside of Office Visits?
Authors: Jeffrey Farber, Albert Siu, Patricia Bloom
Journal: Annals of Internal Medicine (2007)

Background: People with chronic illness require care outside of office visits, much of which is not reimbursed under current Medicare guidelines. Objective: To describe the amount of time geriatricians spend and the nature of care they provide outside of office visits. Design: Cross-sectional study on the time spent by physicians in clinical interactions outside of patient visits during 3 randomly sampled, 1-week periods. Setting: An academic geriatric medicine ambulatory practice. Participants: 16 physicians. Measurements: Information on the method, content, outcome, and participants in clinical interactions outside of office visits was collected on a structured form. Results: There were 472 discrete interactions, representing 296 episodes of care for 226 patients. Fifty-four percent of interactions were linked as multistep episodes, whose mean duration (range; 25th, 75th percentiles) was 18.9 minutes (3 to 70 minutes; 9, 21 minutes). Thirty-six percent of episodes involving a new medical symptom resulted in medication use, 27% resulted in an office visit, and 9% resulted in a referral to another physician. Mean time spent per physician per week was 112.2 minutes (range, 36 to 260 minutes), which represents an additional 6.7 minutes (range, 1.7 to 13.8) of care provided outside of office visits for every 30 minutes of time spent scheduled to see ambulatory patients. For a full-time physician scheduled to see 14 patients per day in 30-minute visits over a 5-day workweek, this would represent an extra 7.8 hours of clinical work per week. Limitation: Data were self-reported and were limited to an academic geriatric medicine practice. Conclusion: Physicians spend a considerable amount of time providing care outside of office visits for patients with chronic illness. This study suggests that collecting empirical data on the amount and nature of nonreimbursed care activities is feasible and should be done in more generalizable settings to inform debates about reimbursement reform.
Conquering old age
Authors: F. Godlee
Journal: BMJ (2008)

“Old age,” said Confucius, “is a good and pleasant thing. It is true you are gently shouldered off the stage, but then you are given such a comfortable front stall as a spectator.” Nigel Hawkes invokes the ancient sage this week to question the decision of the UK’s General Medical Council to start charging an annual retention fee from doctors who are over 65 (p 145; doi: 10.1136/bmj.a809). The GMC may be helping to make old age less good for some, but since a key objective of modern medicine and public health is that more of us should reach old age, we should do all we can to make it as …
Autobiblio: A Set of Bibliography Programs for the Apple Macintosh™ Computer
Authors: Stanley Samuels
Journal: JAMA (1988)

Luddites was the name given to organized bands of English textile workers who in 1812 destroyed the machinery that they perceived as taking away their livelihood. The thoughts of the first reviewer, when sitting down to review this disk, went out to these Luddites: books I understand, but disks, floppy or hard, regrettably were outside my sphere of reference. It was then I enlisted the aid of a computer-sensitive colleague to help me understand what must surely be a revolution in educational tools. In reviewing, several questions arose: (1) What is the function of this particular piece of software? (2) How easy is it to use? (3) Does it fulfill its stated function?   Autobiblio is a set of programs that may be used with an Apple Macintosh computer to automate bibliographic chores for individuals preparing manuscripts for publication. With any word processor, the user prepares a list of complete citations
Long-Term Comparison of the Implantable Cardioverter Defibrillator Versus Amiodarone
Authors: Fayez Bokhari, David Newman, Mary Greene, Victoria Korley, Iqwal Mangat, Paul Dorian
Journal: Circulation (2004)

The implantable cardioverter defibrillator (ICD) is superior to amiodarone for secondary prophylaxis of sudden cardiac death. However, the magnitude of this benefit over long-term follow-up is not known. Thus, our objective was to evaluate the long-term consequences of using amiodarone versus an ICD as first-line monotherapy in patients with a prior history of sustained ventricular tachycardia/ventricular fibrillation or cardiac arrest.A total of 120 patients were enrolled at St Michael's Hospital in the Canadian Implantable Defibrillator Study (CIDS) and were randomly assigned to receive either amiodarone (n=60) or an ICD (n=60). The treatment strategy was not altered after the end of CIDS unless the initial assigned therapy was not effective or was associated with serious side effects. After a mean follow-up of 5.6+/-2.6 years, there were 28 deaths (47%) in the amiodarone group, compared with 16 deaths (27%) in the ICD group (P=0.0213). Total mortality was 5.5% per year in the amiodarone group versus 2.8% per year in the ICD group (hazard ratio of amiodarone: ICD, 2.011; 95% confidence interval, 1.087 to 3.721; P=0.0261). In the amiodarone group, 49 patients (82% of all patients) had side effects related to amiodarone, of which 30 patients (50% of all patients) required discontinuation or dose reduction; 19 patients crossed over to ICD because of amiodarone failure (n=7) or side effects (n=12).In a subset of CIDS, the benefit of the ICD over amiodarone increases with time; most amiodarone-treated patients eventually develop side effects, have arrhythmia recurrences, or die.
Patients’ Fantasies about Physical Illness
Authors: Michael Blumenfield
Journal: Psychotherapy and Psychosomatics (1983)

All patients with physical illness have an underlying fantasy concerning why they became sick. This fantasy can be elicited by the consulting psychiatrist and the treating physician. The meaning of the fantasy is consistent with the psychodynamic theory of human behavior. Also, once the fantasy is understood, it can be applied in the patient's therapy.
S34 Bmpr-ii Deficiency Leads To An Increase In Lung Egg Deposition, Pulmonary Vascular Remodelling And An Abnormal Liver Vasculature In Mice Chronically Infected With S. Mansoni
Authors: A. Crosby, E. Soon, F. Jones, M. Southwood, L. Haghighat, M. Toshner, T. Raine, I. Horan, P. Yang, A. Davenport, S. Moore, P. Wright, D. Dunne, N. Morrell
Journal: Thorax (2014)

<h3>Rationale and objectives</h3> Schistosomiasis is the world-wide leading cause of pulmonary arterial hypertension (PAH) and is particularly prevalent in developing countries. More than 80% of patients with familial PAH in the western-world have a mutation in bone morphogenetic protein type-II receptor (BMPR-II), which is a member of the transforming growth receptor-beta (TGF-b) superfamily and is important in cell proliferation and differentiation. The aim of the study was to determine if mice with a heterozygous null mutation in BMPR-II are more susceptible to pulmonary vascular remodelling induced by <i>S. mansoni</i> infection, compared with wild-type littermates. <h3>Methods</h3> Wild-type (BMPR-II+/+) and BMPR-II heterozygous (BMPR-II+/-) C57/BL6 mice were infected percutaneously with <i>S. mansoni</i>. Seventeen weeks post-infection right ventricular systolic pressure (RVSP), right ventricular hypertrophy (RVH), liver and lung egg counts were measured. Pulmonary vascular remodelling and liver histology were assessed by morphometry, following immunohistochemistry. Lung, liver and serum cytokines were also measured. A macrophage phagocytosis assay and <i>in vivo</i> bead assay were also performed. <h3>Measurements and main results</h3> At 17 weeks post-infection there was a significant increase in pulmonary vascular remodelling associated with a significant increase in egg deposition and cytokines in the lung, in BMPR-II+/- mice. Furthermore, there was a positive correlation between lung egg deposition and pulmonary vascular wall thickness. Additionally, there was a significant dilatation of the central hepatic vein in the BMPR-II+/- infected mice compared with the BMPR-II+/+ infected mice. However, no differences in RVSP, RVH or liver egg deposition were found. <h3>Conclusions</h3> This study has shown that mice deficient in BMPR-II are more susceptible to pulmonary vascular remodelling induced by <i>S. mansoni</i> which is directly correlated to an increase in egg burden in these mice. Additionally, we have shown that BMPR-II+/- mice have an abnormal liver vasculature, which may be responsible for increased egg shunting into the lungs.
THE SOUTHERN SURGICAL AND GYNECOLOGICAL ASSOCIATION.—ITS ORIGIN, OBJECTS AND AIMS.THE PRESIDENT'S ADDRESS. Delivered at the Annual Meeting, held at New Orleans, La., Nov. 14, 15 and 16, 1893,
Authors: BEDFORD BROWN
Journal: JAMA (1893)

Six years ago a small band of earnest, brave and determined Southern surgeons assembled in the city of Birmingham, Ala., with Dr. Haggard as President, amidst doubts, anxieties and misgivings for the future, to found and organize a Southern Surgical and Gynecological Association, and in this effort to build up an organization that would meet the advanced requirements of the times, and that should rank in point of talent, efficiency and high-toned character with the other great institutions of the kind, in this and other countries. Under the circumstances we fully appreciated the difficulties ahead of us, and measured accurately the herculean task that had to be accomplished. Many of the most eminent and experienced surgeons of our section regarded the enterprise of doubtful propriety, while others equally distinguished believed that the object would never succeed. But notwithstanding the stupendous difficulties we had to encounter, the vast labor expended and
Should Postprandial Glucose Be Measured and Treated to a Particular Target? Yes.
Authors: Jaime Davidson
Journal: Diabetes Care (2003)

In August 2001, the American College of Endocrinology (ACE) published its recommendations for glycemic targets in the management of diabetes. Included in those recommendations was a target for 2-h postprandial glucose (PPG) of <140 mg/dl; current American Diabetes Association (ADA) guidelines do not include a PPG target, nor have they for several years. The European Association for the Study of Diabetes (EASD/IDF-Europe) have a postprandial target of <7.5 mmol/l (135 mg/dl) as well.

Ever since ACE presented its recommendations to the health care community, there has been considerable debate about the appropriateness of recommending a PPG target to the health care community and lay public. Should PPG be monitored and treated? If so, what should the goal be?

The purpose of this report is to answer some central questions regarding the evidence and rationale that support the use of a 2-h postprandial target of <140 mg/dl. The goal is to provide health care providers and other interested parties with the information they need to make informed decisions about patient care.

It is important to note that although this debate has been broadened to include issues regarding the frequency of testing, no organization has proposed any form of recommendation for “routine” PPG testing.

Epidemiological studies have shown very significant correlations between glycemic status and both microvascular and macrovascular complications (1). Furthermore, tight glycemic control in interventional studies unequivocally delayed, and possibly prevented, the development and progression of the microvascular complications (2–4). Additionally, there is no glycemic threshold for risk reduction, even into the normal range; the lower the A1C, the less risk of complications (1).

Despite new advances in therapies and glucose monitoring technology, combined with our growing understanding of diabetes and its complications, we have been unsuccessful in achieving tight glycemic control in our patients using the …
The adaptor TRAF5 limits the differentiation of inflammatory CD4+ T cells by antagonizing signaling via the receptor for IL-6
Authors: Hiroyuki Nagashima, Yuko Okuyama, Atsuko Asao, Takeshi Kawabe, Satoshi Yamaki, Hiroyasu Nakano, Michael Croft, Naoto Ishii, Takanori So
Journal: Nature Immunology (2014)