tbuckley/cabot-search huggingface dataset:
Use of 3x2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies
Authors: G. M. Schuetz, P. Schlattmann, M. Dewey
Journal: BMJ (2012)

<b>Objective</b> To determine whether a 3×2 table, using an intention to diagnose approach, is better than the “classic” 2×2 table at handling transparent reporting and non-evaluable results, when assessing the accuracy of a diagnostic test. <b>Design</b> Based on a systematic search for diagnostic accuracy studies of coronary computed tomography (CT) angiography, full texts of relevant studies were evaluated to determine whether they could calculate an alternative 3×2 table. To quantify an overall effect, we pooled diagnostic accuracy values according to a meta-analytical approach. <b>Data sources</b> Medline (via PubMed), Embase (via Ovid), and ISI Web of Science electronic databases. <b>Eligibility criteria </b>Prospective English or German language studies comparing coronary CT with conventional coronary angiography in all patients and providing sufficient data for a patient level analysis. <b>Results</b> 120 studies (10 287 patients) were eligible. Studies varied greatly in their approaches to handling non-evaluable findings. We found 26 studies (including 2298 patients) that allowed us to calculate both 2×2 tables and 3×2 tables. Using a bivariate random effects model, we compared the 2×2 table with the 3×2 table, and found significant differences for pooled sensitivity (98.2 (95% confidence interval 96.7 to 99.1) <i>v</i> 92.7 (88.5 to 95.3)), area under the curve (0.99 (0.98 to 1.00) <i>v</i> 0.93 (0.91 to 0.95)), positive likelihood ratio (9.1 (6.2 to 13.3) <i>v</i> 4.4 (3.3 to 6.0)), and negative likelihood ratio (0.02 (0.01 to 0.04) <i>v</i> 0.09 (0.06 to 0.15); (P&lt;0.05)). <b>Conclusion</b> Parameters for diagnostic performance significantly decrease if non-evaluable results are included by a 3×2 table for analysis (intention to diagnose approach). This approach provides a more realistic picture of the clinical potential of diagnostic tests.
The Irritable Bowel Syndrome: Mechanisms and a Practical Approach to Management
Authors: Michael Camilleri, Charlene M. Prather
Journal: Annals of Internal Medicine (1992)

Objective: To develop a practical strategy that facilitates the management of patients with the irritable bowel syndrome (IBS). Study Selection and Data Extraction: Review of the pertinent literature published in major English-language journals for the last 25 years, describing the pathophysiology and treatment of subgroups of patients with IBS. Results: A stepwise approach for practical management of patients with suspected IBS is identified. The first step includes combination of positive diagnosis of symptoms with limited investigations to exclude underlying structural or biochemical disorders. In the second step, therapeutic trials focus on alleviating the predominant symptoms. For patients with intractable symptoms, the third step combines novel tests to assess altered function and therapeutic trials to correct the dysfunction identified in the individual patient. Conclusions: A practical approach has been developed for management of IBS. It is based on advances in our understanding of the mechanisms resulting in IBS and on targeting therapy to correct the dysfunctions in these patients.
Role of Cardiac Nerves in the Cardiovascular Response to Cocaine in Conscious Dogs
Authors: Richard P. Shannon, Michael A. Mathier, You-tang Shen
Journal: Circulation (2001)

Background —Although the cardiovascular toxicity of cocaine is well recognized, considerable controversy remains as to the relative contribution of local norepinephrine reuptake inhibition versus central stimulatory effects of cocaine in eliciting its cardiovascular actions. The purpose of the present study was to determine the role of cardiac nerves in mediating the left ventricular (LV) and coronary hemodynamic responses to cocaine. Methods and Results —We studied the cardiovascular response to acute cocaine administration (1 mg/kg) in 10 intact, conscious dogs and 6 dogs with ventricular denervation (VD). There were no significant differences in baseline hemodynamic parameters or plasma catecholamines between the 2 groups. In response to acute cocaine, LV and coronary hemodynamic responses were enhanced in the VD dogs. The enhanced systemic pressor and heart rate responses in VD dogs suggest that cardiac nerves mitigate the response to cocaine through ventricular mechanoreceptors rather than mediating the responses. Conclusions —These data suggest that peripheral blockade of norepinephrine reuptake is not the principal mechanism of the acute cardiac effects of cocaine. Rather, cardiac nerves modulate the effects of cocaine through baroreflex mechanisms. Thus, individual differences in baroreflex sensitivity may explain the hemodynamic variability observed in response to cocaine.
Developmental and tissue-specific expression of nuclear proteins that bind the regulatory element of the major histocompatibility complex class I gene.
Authors: P A Burke, S Hirschfeld, Y Shirayoshi, J W Kasik, K Hamada, E Appella, K Ozato
Journal: The Journal of Experimental Medicine (1989)

Expression of MHC class I genes varies according to developmental stage and type of tissues. To study the basis of class I gene regulation in tissues in vivo, we examined binding of nuclear proteins to the conserved cis sequence of the murine H-2 gene, class I regulatory element (CRE), which contains two independent factor-binding sites, region I and region II. In gel mobility shift analyses we found that extracts from adult tissues that express class I genes, such as spleen and liver, had binding activity to region I. In contrast, extracts from brain, which does not express class I genes, did not show region I binding activity. In addition, fetal tissues that express class I gene at very low levels, also did not reveal region I binding activity. Binding activity to region I became detectable during the neonatal period when class I gene expression sharply increases. Most of these tissues showed binding activity to region II, irrespective of class I gene expression. Although region II contained a sequence similar to the AP-1 recognition site, AP-1 was not responsible for the region II binding activity detected in this work. These results illustrate a correlation between region I binding activity and developmental and tissue-specific expression of MHC class I genes. The CRE exerts an enhancer-like activity in cultured fibroblasts. We evaluated the significance of each factor binding to CRE. Single 2-bp mutations were introduced into the CRE by site-directed mutagenesis and the ability of each mutant to elicit the enhancer activity was tested in transient CAT assays. A mutation that eliminated region I protein binding greatly impaired enhancer activity. A mutation that eliminated region II binding also caused a lesser but measurable effect. We conclude that region I and region II are both capable of enhancing transcription of the class I gene. These results indicate that in vivo regulation of MHC class I gene expression is mediated by binding of trans-acting factors to the CRE.
Phosphorylation-dependent Alteration in Myofilament Ca<sup>2 +</sup> Sensitivity but Normal Mitochondrial Function in Septic Heart
Authors: BENOÎT TAVERNIER, ALEXANDRE MEBAZAA, PHILIPPE MATEO, STANISLAS SYS, RENÉE VENTURA-CLAPIER, VLADIMIR VEKSLER
Journal: American Journal of Respiratory and Critical Care Medicine (2001)

The subcellular mechanisms responsible for myocardial depression during sepsis remain unclear. Recent data suggest a role for impaired energy generation and utilization, resulting in altered contractile function. Here, we studied the energetic and mechanical properties of skinned fibers isolated from rabbit ventricle in a nonlethal but hypotensive model of endotoxemia. Thirty-six hours after lipopolysaccharide (LPS) injection (in the presence of altered myocardial contractility), mitochondrial respiration, coupling between oxidation and phosphorylation, and creatine kinase function were similar in preparations from endotoxemic (LPS) and control animals. The maximal Ca2 +-activated force was similar in LPS and control preparations. However, the Ca2 + concentration corresponding to half-maximal force (pCa50, where pCa = − log10[Ca2 +]) was 5.55 ± 0.01 (n = 11) in LPS fibers versus 5.61 ± 0.01 (n = 10) in control fibers (p < 0.01). Both protein kinase A (PKA) and alkaline phosphatase treatment led to the disappearance in the difference between control and LPS pCa50 values. Incubation of control fibers with the nitric oxide donor S-nitroso-N-acetylpenicillamine (SNAP) did not change the Ca2 + sensitivity after subsequent skinning, whereas isoproterenol decreased pCa50 from 5.62 ± 0.01 to 5.55 ± 0.01 (p < 0.01). These data suggest that during sepsis, cardiac mitochondrial and creatine kinase systems remain unaltered, whereas protein phosphorylation decreases myofibrillar Ca2 + sensitivity and may contribute to the depression of cardiac contractility.
NICE issues guidance on using coronary artery stents
Authors: L. Beecham
Journal: BMJ (2000)

Patients who have angina or have had a heart attack should normally be given a coronary artery stent—as well as balloon angioplasty, if the latter is clinically appropriate—according to new guidance from the National Institute for Clinical Excellence (NICE).

The guidance, which covers England and Wales, also recommends that if a patient is suitable for both balloon angioplasty and a coronary artery bypass graft it may be considered preferable for them to undergo a balloon angioplasty with a coronary artery stent, instead of a coronary artery bypass graft.

A stent should normally be …
CASE OF LEAD POISONING WITH ONSET SIMULATING TRIGEMINAL NEURALGIA
Authors: Lee Foshay
Journal: JAMA (1926)

This case is reported because it presented a difficult problem in diagnosis and because the character and sequence of symptoms are considered sufficiently rare to arouse interest. A Croatian, aged 44, occupied as a general laborer in a nearby shipyard, came to the dispensary, Jan. 13, 1925, for relief from excruciating pains, of three weeks' duration, in the right side of the face. He had been perfectly well until Christmas Day, 1924, when suddenly he experienced in the right side of the face a severe, burning pain. He described this as a "hot, jumping toothache in every tooth in the right side." It lasted all day, with severe acute exacerbations, and was so severe at night that he was unable to sleep. During the night he noticed that he began to have intermittent pains in the right arm, originating in the shoulder and radiating down the posterolateral aspect of the
Vitamin C in Treatment of Whooping-cough
Authors: D. Gairdner
Journal: BMJ (1938)

MEDICA, IORNAL view that the modifications in treatment since 1936 have increased the chances of success both in suitable and in unfavourable eyes.Maintenance of Improvement after Corneal Grafting Perhaps one can best obtain the facts necessary to estimate the chances of maintaining the results of corneal grafting by considering the thirty-two eyes operated on up to 1936 and then reported.The patients were
Prevalence and risk factors of latex sensitization in an unselected pediatric population☆☆☆★
Authors: Roberto Bernardini, Elio Novembre, Anna Ingargiola, Marinella Veltroni, Luca Mugnaini, Antonella Cianferoni, Enrico Lombardi, Alberto Vierucci
Journal: Journal of Allergy and Clinical Immunology (1998)
L-dopa treatment failure: explanation and correction.
Authors: L. Rivera-Calimlim, C. A. Dujovne, J. P. Morgan, L. Lasagna, J. R. Bianchine
Journal: BMJ (1970)

range (mean ± 2 standard deviations) for age for each immunoglobulin is given in parentheses and is derived from the data of Allanamith, McClellan, Butter- worth, and Maloney (1968).
Genetic versus Nongenetic Affective Disorder
Authors: GEORGE WINOKUR, S. RUANGTRAKOOL
Journal: American Journal of Psychiatry (1966)

The role of genetic factors in affective illness is examined in this study of patients hospitalized for affective disorders. On the basis of a number of clinical variables, there were only negligible differences between those patients who had a positive family history of affective disorder and those with a negative history.
Defective natural immunity: an early manifestation of human immunodeficiency virus infection.
Authors: H Ullum, P C Gøtzsche, J Victor, E Dickmeiss, P Skinhøj, B K Pedersen
Journal: The Journal of Experimental Medicine (1995)

Cytotoxicity mediated by natural killer (NK) and lymphokine-activated killer (LAK) cells may be of significance in host defense against viral infections. This study included 347 patients infected with human immunodeficiency syndrome virus (HIV) type 1 and 110 controls. The NK cell activity, either unstimulated or stimulated with interferon-alpha (IFN-alpha) or interleukin-2 (IL-2), and the LAK cell activity were suppressed in patients, but the NK/LAK cell activity did not differ between patients with AIDS and patients without AIDS. However, the IFN-alpha-stimulated NK cell activity and LAK cell activity were reduced in patients with symptoms of HIV disease (CDCIV) when compared with asymptomatic patients (CDCII+III). When the data were analyzed by multiple linear regression, the percentage of CD4+ cells had a positive effect on these two parameters in patients without AIDS, whereas the percentage of CD4+ cells had no significant effect on unstimulated and IL-2-stimulated NK cell activity in these patients. In controls and AIDS patients, the percentage of CD4+ cells had no effect on NK/LAK cell activity in multiple linear models. The total number of CD16+ cells was low in patients compared to controls, whereas the percentages of CD16+, CD56+, and CD16+CD56+ were either normal or elevated. Therefore, the decrease in NK cell subpopulations did not contribute to the observed depression in NK/LAK cell activity in vitro. It is concluded that natural immunity is suppressed in HIV-seropositive patients primarily because of a qualitative defect of the NK/LAK cells. This qualitative defect includes a reduced responsiveness to IFN-alpha, which is progressive until the onset of symptoms, and possibly related to the loss of CD4+ cells.
898 CLOSE ASSOCIATION OF ARREST DEFECTIVE PROTEIN 1 MRNA OVEREXPRESSION WITH MICROVASCULAR INVASION IN HEPATOCELLULAR CARCINOMA
Authors: J.H. Shim, Y.-H. Chung, J.A. Kim, D.-J. Yoo, Y.-J. Jin, D. Lee, D.D. Seo, S.H. Kim, S.H. Ryu, S.H. Yang, E. Yu, Y.J. Lee
Journal: Journal of Hepatology (2010)
Beyond Health Care — Socioeconomic Status and Health
Authors: Lisa Berkman, Arnold M. Epstein
Journal: New England Journal of Medicine (2008)

The article by Mackenbach et al. in this issue of the Journal 1 documents the extraordinary pervasiveness of socioeconomic inequalities in health as well as the varying magnitude of risks among countries. The compilation of data from western and eastern European countries on mortality, morbidity, smoking, and obesity in relation to socioeconomic status allows the authors to provide the broadest international portrait to date of the association between socioeconomic status and health. The link between socioeconomic disadvantage and poor health has been observed repeatedly,2 but until now we have lacked data that would permit us to make consistent comparisons of these . . .
The incidence and clinical implications of coronary artery spasm.
Authors: R A Chahine, A E Raizner, T Ishimori, R J Luchi, H D McIntosh
Journal: Circulation (1975)

The total incidence of coronary artery spasm during coronary angiography has been reported to be between 0.26% and 0.93%. The rarity of this phenomenon has been invoked to minimize its clinical significance. Review of a one-year experience in our catheterization laboratory showed that coronary spasm occurred in eight of 274 coronary angiograms (2.93%). In three instances, spasm could not be ascribed to catheter tip irrigation, and was considered to be spontaneous. Since multiple factors during coronary arteriography might inhibit the occurrence of coronary spasm, it is believed that the incidence of spontaneous spasm may be higher than can be documented during angiography. Coronary spasm may have important clinical significance in various chest pain syndromes and greater methodical attention should be directed toward this phenomenon.
The Excess Mortality of Black Adults in the United States
Authors: Lawrence L. Sanders
Journal: JAMA (1990)

<h3>To the Editor.—</h3> Otten et al<sup>1</sup>are to be commended for their study examining the disparity in health status between blacks and whites in the United States. We would like to comment on their interpretation of the study results and what policy options should be employed to narrow the gap in mortality rates between blacks and whites. The authors present two models to explain the disparity in mortality between blacks and whites. One model relies on the link between behavioral risk factors and mortality. This explanation is contrasted with a second model in which low income and environment are primary factors for increased mortality in blacks. Health status is, however, affected by the interrelationship of both factors. The Secretary's Task Force on Black and Minority Health states that "health status is influenced by the interaction of physiological, cultural, psychological and societal factors."<sup>2</sup>It should be of no surprise
Authors' Self-Declared Financial Conflicts of Interest Do Not Impact the Results of Major Cardiovascular Trials
Authors: Ashish Aneja, Ricardo Esquitin, Kshitij Shah, Rupa Iyengar, Rosane Nisenbaum, Magda Melo, Shiny Matthewkutty, Sanjum S. Sethi, Muhammad Mamdani, Michael E. Farkouh
Journal: Journal of the American College of Cardiology (2013)
THE ENDOMETRIUM OF THE MENSTRUATING UTERUS
Authors: EMIL NOVAK
Journal: JAMA (1924)

The investigations of Hitschmann and Adler,<sup>1</sup>which have been confirmed in all essential respects by subsequent workers, have established quite definitely the histologic changes occurring in the endometrium at various phases of the menstrual cycle. There is little or no difference of opinion at the present day concerning the histologic characteristics of the postmenstrual, the interval, and the premenstrual stages. With reference to the menstrual phase, i. e., the phase of actual menstrual bleeding, opinion is not nearly so unanimous. Knowing the picture just before the onset of the period as well as that found just after its close, one might logically assume that the chief feature of the menstrual phase is a transition from the premenstrual high point of development to the low point so characteristic of the postmenstrual phase. Since both the premenstrual and the postmenstrual stages are characterized by an intact endometrial surface, one might further
Profile: James Drife
Authors: Kay Brennan
Journal: BMJ (2002)

Not many people can say that they are a star act at the Edinburgh fringe. Now add being a famous researcher and prominent professor on top of that. Kay Brennan talks to the man who fits the bill

“I nearly fainted at my first delivery,” admits the professor of obstetrics and gynaecology, describing his introduction to obstetrics as a medical student at Edinburgh University. “Perhaps because we were called out after spending an evening at the local hostelry.”



But the experience didn't discourage him, and he became a senior house officer in obstetrics and gynaecology straight after his preregistration year. “I've no regrets about entering the field so young,” he says. “It is such a broad specialty that it gives you experience of the whole range of medicine from psychiatry to surgery.”

As a young doctor James formed the Abracadabarets, a stand up comedy act, with some college friends. “The show was very non-medical. We weren't trying to trade on being doctors. It was more a send up of Edinburgh and a parody of popular radio shows at the time,” he recalls. They soon gained local celebrity status at the Edinburgh fringe, the free for all relation of the festival, which picks out new talent. “We chose the name as it would mean we'd be top of the bill in the alphabetical listings. It's all about word of mouth at the …
Chemoprophylaxis of malaria in Africa.
Authors: L J Bruce-Chwatt
Journal: BMJ (1982)

Professor L J Bruce-Chwatt successfully underlined the complexity of the problem of drug-resistant malaria and showed that some conflicting opinions exist among members of the medical profession regarding the antimalarial drugs to be used for chemoprophylaxis.Resistance of Plasmodium falciparum to chloroquine in Africa, especially in East Africa, must be recognised as an established fact.It has been found
The Etiology of Enteric Fever
Authors: S. J. Sharkey
Journal: BMJ (1880)

<h3>Abstract</h3> <h3>Objectives</h3> The emergence of new SARS-CoV-2 variants is a major challenge in the management of Covid-19 pandemic. A crucial issue is to quantify the number of variants which may represent a potential risk for public health in the future. <h3>Methods</h3> We fitted the data on the most relevant SARS-CoV-2 variants recorded by the World Health Organization (WHO). The function exploited for the fit is related to the total number of infected subjects in the world since the start of the epidemic. <h3>Results</h3> We found that the number of relevant SARS-CoV-2 variants up to November 2021 was about 44. Moreover, the number of new relevant variants per ten million cases turned out to be 1.64 in November 2021, slightly decreased in comparison to the value of 2.29 in March 2020. <h3>Conclusions</h3> Our simple mathematical model can evaluate the number of relevant SARS-CoV-2 variants as the cumulative number of cases increase worldwide and may represent a useful tool in planning strategies to effectively contrast the pandemic.
Outbreak of Illness in a School Chorus
Authors: Gary W. Small, Jonathan F. Borus
Journal: New England Journal of Medicine (1983)

WHENEVER people under stress gather together, the potential for mass hysteria exists. School-children seem particularly prone to this phenomenon, and 60 per cent of the epidemics of hysteria reported in the English-language literature this century have occurred in schools.1 2 3 4 5 Controversy regarding the cause of such sudden outbreaks of illness can persist long after their occurrence, with arguments generally focusing on whether the epidemic was physical or psychological in origin.2 , 4 5 6 7 8 9 10 With public alarm about environmental pollution increasing during the past decade,11 , 12 attempts to find toxic causes for these epidemics have intensified.Mass hysteria is defined as the occurrence in a group . . .