tbuckley/cabot-search huggingface dataset:
Proposed Establishment of Ryukyu University Medical School in Okinawa
Authors: Sohei Akiyama
Journal: JAMA (1965)

<h3>To the Editor:—</h3> The population of Okinawa, some 920,000, has one doctor to every 2,500 people. Most of them are concentrated in the urban cities of Naha and Koza. During the writer's stay in Okinawa, he learned that a newly built tuberculosis sanatorium was inoperative because sufficient doctors and nurses could not be found to staff it. In the outlying villages and smaller islands, male nurses are appointed by the government to treat patients free of charge. At present, one of the major problems considered by the civil administrators of Okinawa is health insurance. When this comes about, as it ultimately must, the need for more doctors will become even greater. The writer earnestly hopes the difficulties of medical education on Okinawa will evoke a sympathetic understanding of the problems by American doctors, and will eventually bring about the establishment of a university medical school along the lines of those
A NEW HEMOSTATIC FORCEPS.
Authors: WELLER VAN HOOK
Journal: JAMA (1903)

It is rare to find a hemostatic forceps, as supplied in the ordinary instrument shops, which will last through more than a dozen ordinary operations without extensive repair. The selection of the proper instrument is frequently impossible because most of the instrument dealers carry in stock only the poorest constructed instruments, made by large factories in Germany. The models selected by these manufacturers are frequently such as have many excellent points, but, owing to failure in some minor particular, the instrument soon deteriorates. I have had an artery forceps made which seems to combine a number of useful qualities. The forceps are made in two sizes. The dimensions of the smaller size are the following: total length, 5¼ inches; distance from lock to point, 1¾ inches; distance from lock to proximal end, 3½ inches. The dimensions of the larger forceps are:
Topical and Systemic Antimicrobial Therapy for Venous Leg Ulcers
Authors: Susan O’Meara, Rachel Richardson, Benjamin A. Lipsky
Journal: JAMA (2014)

Is treatment with topical or systemic antimicrobial agents associated with better venous leg ulcer healing compared with usual care (dressings and bandages without antimicrobials) or an alternative topical or systemic antimicrobial agent?Available evidence, from underpowered pooled data, neither supports nor refutes an association of systemic antibiotic therapy with improved venous leg ulcer healing. Among topical antimicrobials, cadexomer iodine may be associated with better healing compared with usual care.
Reimbursement Issues in Diabetes
Authors: Pomeroy Sinnock, Deborah Wright Bauer
Journal: Diabetes Care (1984)

Third-party reimbursement for outpatient education services and for new health care technologies in diabetes is an issue of concern to educators, administrators, and others in the diabetes health care system. Reimbursement for outpatient education has been obtained from 11 Blue Cross/Blue Shield plans in nine states, six commercial insurance companies in four states, Medicare in five states, and Medicaid in one state. Despite these successes, third-party payers still must be approached on an individual basis. We review approaches taken by different states and diabetes control programs and make recommendations on how to request third-party reimbursement for outpatient education services. Third-party reimbursement of diabetes-related technologies/services and equipment is found to be dependent on the type of coverage the individual has, the state in which he or she is located, and the item or procedure covered. Many third-party payers do not have stated policies on reimbursement of a particular piece of equipment such as the insulin pump, or they do not have consistent, well-communicated standards for determining coverage.
Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack
Authors: Yongjun Wang, Yilong Wang, Xingquan Zhao, Liping Liu, David Wang, Chunxue Wang, Chen Wang, Hao Li, Xia Meng, Liying Cui, Jianping Jia, Qiang Dong, Anding Xu, Jinsheng Zeng, Yansheng Li, Zhimin Wang, Haiqin Xia, S. Claiborne Johnston
Journal: New England Journal of Medicine (2013)

Stroke is common during the first few weeks after a transient ischemic attack (TIA) or minor ischemic stroke. Combination therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin alone.In a randomized, double-blind, placebo-controlled trial conducted at 114 centers in China, we randomly assigned 5170 patients within 24 hours after the onset of minor ischemic stroke or high-risk TIA to combination therapy with clopidogrel and aspirin (clopidogrel at an initial dose of 300 mg, followed by 75 mg per day for 90 days, plus aspirin at a dose of 75 mg per day for the first 21 days) or to placebo plus aspirin (75 mg per day for 90 days). All participants received open-label aspirin at a clinician-determined dose of 75 to 300 mg on day 1. The primary outcome was stroke (ischemic or hemorrhagic) during 90 days of follow-up in an intention-to-treat analysis. Treatment differences were assessed with the use of a Cox proportional-hazards model, with study center as a random effect.Stroke occurred in 8.2% of patients in the clopidogrel-aspirin group, as compared with 11.7% of those in the aspirin group (hazard ratio, 0.68; 95% confidence interval, 0.57 to 0.81; P<0.001). Moderate or severe hemorrhage occurred in seven patients (0.3%) in the clopidogrel-aspirin group and in eight (0.3%) in the aspirin group (P=0.73); the rate of hemorrhagic stroke was 0.3% in each group.Among patients with TIA or minor stroke who can be treated within 24 hours after the onset of symptoms, the combination of clopidogrel and aspirin is superior to aspirin alone for reducing the risk of stroke in the first 90 days and does not increase the risk of hemorrhage. (Funded by the Ministry of Science and Technology of the People's Republic of China; CHANCE ClinicalTrials.gov number, NCT00979589.).
Genetically Elevated C-Reactive Protein and Ischemic Vascular Disease
Authors: Jeppe Zacho, Anne Tybjærg-Hansen, Jan Skov Jensen, Peer Grande, Henrik Sillesen, Børge G. Nordestgaard
Journal: New England Journal of Medicine (2008)

Elevated levels of C-reactive protein (CRP) are associated with increased risks of ischemic heart disease and ischemic cerebrovascular disease. We tested whether this is a causal association.We studied 10,276 persons from a general population cohort, including 1786 in whom ischemic heart disease developed and 741 in whom ischemic cerebrovascular disease developed. We examined another 31,992 persons from a cross-sectional general population study, of whom 2521 had ischemic heart disease and 1483 had ischemic cerebrovascular disease. Finally, we compared 2238 patients with ischemic heart disease with 4474 control subjects and 612 patients with ischemic cerebrovascular disease with 1224 control subjects. We measured levels of high-sensitivity CRP and conducted genotyping for four CRP polymorphisms and two apolipoprotein E polymorphisms.The risk of ischemic heart disease and ischemic cerebrovascular disease was increased by a factor of 1.6 and 1.3, respectively, in persons who had CRP levels above 3 mg per liter, as compared with persons who had CRP levels below 1 mg per liter. Genotype combinations of the four CRP polymorphisms were associated with an increase in CRP levels of up to 64%, resulting in a theoretically predicted increased risk of up to 32% for ischemic heart disease and up to 25% for ischemic cerebrovascular disease. However, these genotype combinations were not associated with an increased risk of ischemic vascular disease. In contrast, apolipoprotein E genotypes were associated with both elevated cholesterol levels and an increased risk of ischemic heart disease.Polymorphisms in the CRP gene are associated with marked increases in CRP levels and thus with a theoretically predicted increase in the risk of ischemic vascular disease. However, these polymorphisms are not in themselves associated with an increased risk of ischemic vascular disease.
Septic arthritis due to Bacteroides fragilis in a wrist affected by rheumatoid arthritis
Authors: C. A. Hart, V. M. Godfrey, J. C. Woodrow, A. Percival
Journal: Annals of the Rheumatic Diseases (1982)

AbstractThe first case of septic arthritis due to Bacteroides fragilis in a wrist joint is described together with its successful treatment.
Crohn's Disease of the Gastrointestinal Tract
Authors: J. Rhodes
Journal: Gut (1982)

Benorylate (4-acetamidophenyl 2-acetoxybenzoate) is a new esterified aspirin preparation whose antirheumatic properties are reported to be as good as those of aspirin. Gastrointestinal blood loss, measured with <sup>51</sup>Cr-labelled red cells, during benorylate therapy was compared with that during therapy with soluble aspirin in 15 subjects, a simplified crossover procedure being used. Mean blood loss during benorylate therapy was 1·7 ml/day which was significantly less than that during therapy with soluble aspirin (5·1 ml/day; P &lt;0·001). In 12 of the 15 patients blood loss with benorylate was less than 2·5 ml/day. Benorylate appears to be a definite improvement on current formulations of aspirin and should be a useful drug for the treatment of patients with chronic rheumatic disorders.
Indications for referral and assessment in adultliver transplantation: a clinical guideline
Authors: J Devlin, J O'Grady
Journal: Gut (1999)

This document, on the indications and referral of patients for liver transplantation, was commissioned by the British Society of Gastroenterology (BSG) as part of a wider initiative to develop guidelines for clinicians in several areas of clinical practice.The role of transplantation in end stage liver disease has reached a period of stability following a phase of rapid development over the past two decades.Emerging from an experimental high risk procedure to one where survival and rehabilitation is anticipated, it is appropriate to review the present evidence and synthesise this into a framework document for referring clinicians.Guidelines are not rigid protocols and they should not be construed as interfering with local clinical judgement.Hence, they do not represent a directive of prescribed routes but a basis upon which clinicians can consider the option of transplantation more clearly. GRADING OF RECOMMENDATIONSRecommendations are based upon the level of evidence presented in support and are graded accordingly.A Requires at least one randomised controlled trial of good quality addressing the topic of recommendation.B Requires the availability of clinical studies without randomisation on the topic of recommendation.
Enteral Nutritional Support and Use of Diabetes-Specific Formulas for Patients With Diabetes
Authors: Marinos Elia, Antonio Ceriello, Heiner Laube, Alan J. Sinclair, Meike Engfer, Rebecca J. Stratton
Journal: Diabetes Care (2005)

OBJECTIVE—The aim of this systematic review was to determine the benefits of nutritional support in patients with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS—Studies utilizing an enteral nutritional support intervention (oral supplements or tube feeding) were identified using electronic databases and bibliography searches. Comparisons of interest were nutritional support versus routine care and standard versus diabetes-specific formulas (containing high proportions of monounsaturated fatty acids, fructose, and fiber). Outcomes of interest were measures of glycemia and lipid status, medication requirements, nutritional status, quality of life, complications, and mortality. Meta-analyses were performed where possible. RESULTS—A total of 23 studies (comprising 784 patients) of oral supplements (16 studies) and tube feeding (7 studies) were included in the review, and the majority compared diabetes-specific with standard formulas. Compared with standard formulas, diabetes-specific formulas significantly reduced postprandial rise in blood glucose (by 1.03 mmol/l [95% CI 0.58–1.47]; six randomized controlled trials [RCTs]), peak blood glucose concentration (by 1.59 mmol/l [86–2.32]; two RCTs), and glucose area under curve (by 7.96 mmol · l−1 · min−1 [2.25–13.66]; four RCTs, i.e., by 35%) with no significant effect on HDL, total cholesterol, or triglyceride concentrations. In addition, individual studies reported a reduced requirement for insulin (26–71% lower) and fewer complications with diabetes-specific compared with standard nutritional formulas. CONCLUSIONS—This systematic review shows that short- and long-term use of diabetes-specific formulas as oral supplements and tube feeds are associated with improved glycemic control compared with standard formulas. If such nutritional support is given long term, this may have implications for reducing chronic complications of diabetes, such as cardiovascular events.
Gold and ring finger
Authors: E. A BELT, K. KAARELA;, R D SITUNAYAKE
Journal: Annals of the Rheumatic Diseases (1998)

<h3>OBJECTIVE:</h3> To study the clinical characteristics, electroencephalographic and computerized axial tomography profile in Saudi children with cerebral palsy who suffer epilepsy in a university referral center. <h3>METHODS:</h3> A total of 113 patients with cerebral palsy and epilepsy was seen (67 boys, 46 girls) with an over all mean age 5.3 years (range .2-12 years) during the study period (January 1998 - December 1999). They all had clinical evaluation and standardized electroencephalographic studies interpreted by the same examiner. <h3>RESULTS:</h3> The main clinical features were language delay (61%), hypotonia (45%), hypertonia (38%), and behavioral abnormalities (41%). Seizure types included generalized in 96 (85%), and partial and complex partial with or without secondary generalization in 17 (15%). None of the patients had simple partial seizures. The generalized seizures were non-convulsive in 4 patients (3.5%), tonic/clonic 73 (65%), atonic 3 (3%), myoclonic 16 (14%), and mixed 2 (2%). Inter-ictal electroencephalographic abnormalities were epileptiform activity, generalized in 65 (57.5%) and focal 18 (16%), slow-wave activity in 58 (51%) and hypsarrythmia pattern in 6 (5%). Only 9 patients had normal electroencephalogram. The cranial computerized tomography findings were normal in 11.5%. The main abnormalities were cerebral atrophy (65%), hydrocephalus (8%) and agenesis of the corpus callosum (8%). <h3>CONCLUSION:</h3> The pattern of seizure type in patients with cerebral palsy and types of electroencephalogram abnormalities electroencephalogram and cranial computerized tomography are comparable to the results from studies in other clinical settings and environments.
Lysyl oxidase-like 2 is critical to tumor microenvironment and metastatic niche formation in hepatocellular carcinoma
Authors: Carmen Chak-Lui Wong, Aki Pui-Wah Tse, Yan-Ping Huang, Yan-Ting Zhu, David Kung-Chun Chiu, Robin Kit-Ho Lai, Sandy Leung-Kuen Au, Alan Ka-Lun Kai, Joyce Man-Fong Lee, Larry Lai Wei, Felice Ho-Ching Tsang, Regina Cheuk-Lam Lo, Jue Shi, Yong-Ping Zheng, Chun-Ming Wong, Irene Oi-Lin Ng
Journal: Hepatology (2014)

Poor prognosis of cancers, including hepatocellular carcinoma (HCC), is mainly associated with metastasis; however, the underlying mechanisms remain poorly understood. This article investigates the role of lysyl oxidase-like 2 (LOXL-2) in the biology of HCC metastasis. First, we showed that HCC metastasis relies on a collagen-modifying enzyme, LOXL2, which was significantly overexpressed in tumorous tissues and sera of HCC patients, indicating that LOXL2 may be a good diagnostic marker for HCC patients. Second, we delineated a complex, interlinked signaling network that involves multiple regulators, including hypoxia, transforming growth factor beta (TGF-β), and microRNAs (miRNAs), converging to control the expression of LOXL2. We found not only that LOXL2 was regulated by hypoxia/hypoxia-inducible factor 1 alpha (HIF-1α), but also that TGF-β activated LOXL2 transcription through mothers against decapentaplegic homolog 4 (Smad4), whereas two frequently underexpressed miRNA families, miR-26 and miR-29, cooperatively suppressed LOXL2 transcription through interacting with the 3' untranslated region of LOXL2. Third, we demonstrated the imperative roles of LOXL2 in modifying the extracellular matrix components in the tumor microenvironment and metastatic niche of HCC. LOXL2 promoted intrahepatic metastasis by increasing tissue stiffness, thereby enhancing the cytoskeletal reorganization of HCC cells. Furthermore, LOXL2 facilitated extrahepatic metastasis by enhancing recruitment of bone-marrow–derived cells to the metastatic site. Conclusion : These findings integrate the clinical relevance, molecular regulation, and functional implications of LOXL2 in HCC metastasis. (Hepatology 2014;60:1645–1658)
Increased B lymphopoiesis in genetically sex steroid-deficient hypogonadal (hpg) mice.
Authors: G Smithson, W G Beamer, K L Shultz, S W Christianson, L D Shultz, P W Kincade
Journal: The Journal of Experimental Medicine (1994)

Interleukin 7 (IL-7) responsive B lineage precursors were greatly expanded in genetically hypogonadal female (HPG/Bm-hpg/hpg) mice that have a secondary deficiency in gonadal steroidogenesis. Estrogen replacement in these mice resulted in a dose-dependent reduction in B cell precursors. More modest increases were documented in genetically normal mice that were surgically castrated. These findings complement other recent observations that B lymphopoiesis selectively declines in pregnant or estrogen-treated animals. Sex steroids have long been known to influence such disparate processes as bone physiology and tumor growth, in addition to their importance for reproductive function. We now show that these hormones are important negative regulators of B lymphopoiesis.
Effects of alendronate on bone mineral density and bone metabolic markers in postmenopausal asthmatic women treated with inhaled corticosteroids
Authors: Soji Kasayama, Mari Fujita, Kayoko Goya, Hiroyasu Yamamoto, Kimie Fujita, Yasuhiko Morimoto, Ichiro Kawase, Akihiko Miyatake
Journal: Metabolism (2004)
Changing Patterns of Medical Practice: Protein Restriction for Chronic Renal Failure
Authors: Alan G. Wasserstein
Journal: Annals of Internal Medicine (1993)

The use of dietary protein restriction for renal failure has fluctuated during the past 125 years. These fluctuations reflect not only the state of medical knowledge but also social, economic, and cultural factors. Factors inhibiting use of dietary treatment have been its status as an aspect of hygiene rather than as active therapy; the opinions of dominant practitioners and scientists around midcentury, including a presumption that renal adaptation to a high-protein diet must be appropriate; fear of malnutrition and a cultural belief in the virtue of dietary protein; unwillingness by physicians and patients to restrict consumption or lifestyle; and professional identification with the technologies of dialysis and renal transplantation. Factors promoting dietary treatment have been rediscovery of previous work on protein-induced renal injury; a sense that homeostatic compensations could have adverse consequences; federal incentives to curb consumption of scarce resources such as renal dialysis; and the integration of research on, and therapeutic use of diet into scientific medicine. A large ongoing study of dietary protein restriction to limit renal injury will add to our knowledge of this treatment; its application will surely be informed by social and cultural considerations.
Converting Enzyme Inhibition in Hypertensive Emergencies
Authors: CHARLES P. TIFFT
Journal: Annals of Internal Medicine (1979)

The diagnostic and therapeutic value of the angiotensin converting enzyme inhibitor teprotide (SQ 20881) was assessed in 18 patients with hypertensive emergencies. Mean blood pressure fell 31 +/- 18 mm Hg in the 10 subjects who responded to 1 mg/kg body weight administered intravenously, whereas it fell 5 +/- 3 mm Hg in the eight nonresponders. In patients who had received no previous drug treatment, log baseline plasma renin activity and change in mean blood pressure after SQ 20881 correlated significantly (r = 0.651, P less than 0.05). After acute therapy with SQ 20881, the patients who had a satisfactory response to the drug were treated with propranolol and a relatively normal sodium intake (88 meq/day). Nonresponders were treated with diuretics and sodium restriction (10 meq/day), and intermediate responders were given combination therapy. Mean blood pressure responded favorably within 24 h to the chosen regimen for each group from 152 +/- 47 to 102 +/- 31 mm Hg. SQ 20881 allows prompt evaluation of the role of renin in hypertensive emergencies and permits early choice of appropriate therapy based on the prevailing mechanism.
A LID ELEVATOR FOR CATARACT OPERATION.
Authors: EDWARD SWASEY
Journal: JAMA (1907)

In an operation for removal of cataract it is a serious situation if the patient suddenly attempts to close the eye while the speculum is still in place under the lids. Many an eye has been lost by this accident after the corneal section has been completed; for the lens may be forced out, followed by a serious loss of vitreous. Some of our most skilful and experienced operators have entirely done away with the use of the speculum for this reason, and in its place use the thumb and fingers to keep the lids open, or they have a trained assistant to do this, or use a lid elevator. But not all operators can have such an assistant and at all times. Others remove the speculum as soon as the corneal section is finished and the capsule opened.  To avoid this source of danger as far as possible, and
Reasons for optimism not disillusionment
Authors: Ronald L Krall, Frank Rockhold
Journal: Journal of the Royal Society of Medicine (2006)

Ezzati et al. (May 2006 JRSM 1 ) misplace their confidence by a wide margin in claiming to have reached the first 'unbiased' estimates of state and national levels and trends of obesity in the USA.To do so, they claim to have calculated rates of self-reporting biases using data from the NHANES (National Health and Nutrition Examination Survey) and Behavioral Risk Factor Surveillance System (BRFSS) surveys of the US Center for Disease Control and Prevention, which were assumed to be representative of the USA population on the basis of the original sampling design.In reality the assumption is questionable, the response rates being about 80% for NHANES and 45% for BRFSS.If nothing else, such a discrepancy sets a distance between what the two surveys may represent, also considering that the surveys represent different samples.In a crucial decision, Ezzati et al. excluded subjects who did not participate in both surveys-an exclusion that inevitably invalidates any claim that the bias estimates reached could be representative of the USA population or of individual state populations.Such elementary flaws lead to ask how scarce resources could be approved for such a wanting study design.