tbuckley/cabot-search huggingface dataset:
Coeliac disease in primary care
Authors: Roger Jones
Journal: BMJ (2007)

Is common, underdiagnosed, and can present with non-specific symptoms

Coeliac disease affects around 1% of the general population, but most cases are unrecognised and diagnosis is often delayed considerably.1 2 This is surprising, given how common the disease is and how serious its effects can be.1 3 4 Several possible reasons exist for this delay; the most important is that most patients with coeliac disease do not have typical symptoms of malabsorption. Even if these symptoms are present their non-specific nature may not trigger diagnostic suspicion of coeliac disease. Other atypical presentations can occur, especially in older patients,5 and the disease may even be seen in obese people.6

In this week's BMJ , Hopper and colleagues report a validated clinical prediction rule to determine an effective diagnostic method of detecting all cases of coeliac disease in people referred for gastroscopy. People with positive tissue transglutaminase antibodies and “low risk symptoms,” as well as those with the high risk symptoms of diarrhoea, weight loss, and anaemia, were investigated with duodenal biopsy, while those with a negative antibody result and low risk symptoms were …
Effect of blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study
Authors: P. M. Short, S. I. W. Lipworth, D. H. J. Elder, S. Schembri, B. J. Lipworth
Journal: BMJ (2011)

<b>Objective</b> To examine the effect of β blockers in the management of chronic obstructive pulmonary disease (COPD), assessing their effect on mortality, hospital admissions, and exacerbations of COPD when added to established treatment for COPD. <b>Design</b> Retrospective cohort study using a disease specific database of COPD patients (TARDIS) linked to the Scottish morbidity records of acute hospital admissions, the Tayside community pharmacy prescription records, and the General Register Office for Scotland death registry. <b>Setting</b> Tayside, Scotland (2001–2010) <b>Population</b> 5977 patients aged &gt;50 years with a diagnosis of COPD. <b>Main outcome measures</b> Hazard ratios for all cause mortality, emergency oral corticosteroid use, and respiratory related hospital admissions calculated through Cox proportional hazard regression after correction for influential covariates. <b>Results</b> Mean follow-up was 4.35 years, mean age at diagnosis was 69.1 years, and 88% of β blockers used were cardioselective. There was a 22% overall reduction in all cause mortality with β blocker use. Furthermore, there were additive benefits of β blockers on all cause mortality at all treatment steps for COPD. Compared with controls (given only inhaled therapy with either short acting β agonists or short acting antimuscarinics), the adjusted hazard ratio for all cause mortality was 0.28 (95% CI 0.21 to 0.39) for treatment with inhaled corticosteroid, long acting β agonist, and long acting antimuscarinic plus β blocker versus 0.43 (0.38 to 0.48) without β blocker. There were similar trends showing additive benefits of β blockers in reducing oral corticosteroid use and hospital admissions due to respiratory disease. β blockers had no deleterious impact on lung function at all treatment steps when given in conjunction with either a long acting β agonist or antimuscarinic agent <b>Conclusions</b> β blockers may reduce mortality and COPD exacerbations when added to established inhaled stepwise therapy for COPD, independently of overt cardiovascular disease and cardiac drugs, and without adverse effects on pulmonary function.
Is ascites caused by impaired hepatic inactivation of blood borne endogenous opioid peptides?
Authors: J R Thornton, H Dean, M S Losowsky
Journal: Gut (1988)

Methionine enkephalin and catecholamines were measured in carefully collected plasma samples from 25 patients with cirrhosis and ascites, and 25 with cirrhosis without ascites, 15 disease and 15 healthy controls. Methionine enkephalin was invariably raised in the ascites group, the median value being 4.6-6.9 times that of the other three groups. Similarly, in the ascites group, median noradrenaline was increased 2.5-4.2 and median adrenaline 1.8-2.5 times that of the other groups. Plasma methionine enkephalin is considerably raised in patients with cirrhotic ascites and has actions which could enable it to be an initiating factor of ascites formation.
Projected use in two general practices of services by the elderly at home.
Authors: N J Vetter, D A Jones, C R Victor
Journal: BMJ (1984)

OBJECTIVE:To investigate the expression of membrane glucocorticoid receptors (mGCR) on peripheral blood mononuclear cells (PBMC) in patients with ankylosing spondylitis (AS). METHODS: We used high sensitivity immunofluorescence with magnetofluorescent liposomes for the detection of mGCR on PBMC from patients with AS (n = 26) and healthy controls (n = 11). RESULTS: The frequency of mGCR+ monocytes and B lymphocytes was significantly higher in patients with AS than in controls (monocytes 12.5 +/- 9.9% vs 4.8 +/- 1.4%, B lymphocytes 8.7 +/- 6.3% vs 4.4 +/- 3.6%). We did not find mGCR on T lymphocytes. The frequency of mGCR+ cells did not correlate with variables of AS disease activity [C-reactive protein, erythrocyte sedimentation rate, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), BASDAI 6, or numerical rating scales]. CONCLUSION: mGCR are upregulated in monocytes and B lymphocytes of patients with AS. This upregulation does not correlate with the humoral or overall disease activity. mGCR are not present on T lymphocytes. Our findings may be related to the limited benefit of low-dose and the efficacy of high-dose (intravenous pulse or intraarticular) glucocorticoid treatment in AS. Drugs binding selectively to mGCR may be a new therapeutic option for AS.
Pituitary-like proopiomelanocortin transcripts in human Leydig cell tumors.
Authors: Y de Keyzer, F Lenne, J F Massias, D Vieau, J P Luton, A Kahn, X Bertagna
Journal: Journal of Clinical Investigation (1990)

Proopiomelanocortin is a polypeptide precursor molecule, the processing of which generates ACTH, beta-endorphin, the beta- and gamma-lipotropins, the joining peptide, and the NH2-terminal fragment. Anterior pituitary corticotrophs are the major site of proopiomelanocortin gene expression in man and the predominant, if not sole source of circulating ACTH. Recent data have established that proopiomelanocortin gene expression also occurs in various normal nonpituitary tissues, one of the best studied being the testis. In this latter organ the dominant gene products are short transcripts of approximately 800 nucleotides, which lack the first two exons of the gene and cannot encode a complete proopiomelanocortin molecule. In this report we show that the mode of proopiomelanocortin gene expression is occasionally modified in human Leydig cell tumors: a 1,200-nucleotide mRNA species identical to that in the pituitary is produced. It results from the usual (pituitary) start site of transcription and thus can encode the complete proopiomelanocortin molecule. In two out of six tumors, large amounts of the 1,200-nucleotide transcript led to a dramatic increase of approximately 1,000-fold in proopiomelanocortin peptide concentrations as compared with the normal and peritumoral testis. Proopiomelanocortin processing in these tumors generates various peptide fragments including ACTH. These results may help to understand the mechanism of proopiomelanocortin expression in nonpituitary tumors and have implications for the more general phenomenon of ectopic hormone secretion.
Abstract 4783: Identification of a novel TAA, SPARC, as a target for immunotherapy of various cancers
Authors: Mitsuhiro Inoue, Shinya Hirata, Satoru Senju, Yoshiaki Ikuta, Yuki Hayashida, Takuya Tsunoda, Yoichi Furukawa, Yusuke Nakamura, Yasuharu Nishimura, HIdeo Baba
Journal: Cancer Research (2010)

Abstract It is important to identify Tumor-associated antigens (TAAs) to direct the immune system to attack cancer in order to establish efficient anti-cancer-immunotherapy. We analyzed the gene expression profiles of gastric cancers by using the genome wide cDNA microarray consisting of probes for 20,340 genes, and found that SPARC (Secreted Protein Acidic and Rich in Cysteine) gene was overexpressed in diffuse-type gastric cancer tissues at higher levels in comparison to adjacent normal gastric tissues. The levels of expression of SPARC in pancreatic cancer and colorectal cancer tissues were also higher than those of normal counterparts. On the other hand, the expression of SPARC among the normal tissue specimens was detected only in limited tissue specimens at very low levels. Therefore, we evaluated the possibility of SPARC as a target antigen for anticancer immunotherapy. This study attempted to identify HLA-A24 (A*2402)-restricted and SPARC derived CTL epitopes. To identify the SPARC-derived and HLA-A24-restricted CTL epitopes, we selected a total of 4 different candidate 9- or 10- amino acid peptides that were expected to have a higher binding affinity to HLA-A24 (A*2402) by the HLA Peptide Binding Predictions in the BIMAS software program. The H-2 Kd-binding peptide motif is comparable to that of HLA-A24 binding peptide. Thus, we examined CTL response of BALB/c mice to these SPARC-derived epitopes. We found that two SPARC derived peptides elicited high magnitude of CTL response in BALB/c mice in an H-2Kd-restricted manner. Therefore, we attempted to generate SPARC-specific CTLs from the PBMCs of healthy donors and various cancer patients positive for HLA-A24 by stimulation of PBMCs with these two peptides. SPARC peptides-reactive CTLs were successfully induced from PBMCs by in vitro stimulation with these two peptides in HLA-A24 (A*2402) positive healthy donors and cancer patients. Moreover the SPARC-reactive CTLs established from PBMCs derived from cancer patients by stimulation with these two peptides, exhibited cytotoxicity to the cancer cells expressing both HLA-A24 and endogenous or transgene-derived SPARC. On the other hand, the CTLs did not kill the cells which were negative for either HLA-A24 or SPARC. Furthermore, the adoptive transfer of the SPARC-specific CTLs could inhibit the tumor growth in NOD/SCID mice bearing human cancer cells expressing both HLA-A24 (A*2402) and SPARC. These findings suggest that SPARC is a potentially useful target candidate for cancer immunotherapy. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 4783.
Effect of Mouthpiece Breathing on Cardiorespiratory Response to Intense Exercise
Authors: Konrad E. Bloch, Jürg Barandun, Marvin A. Sackner
Journal: American Journal of Respiratory and Critical Care Medicine (1995)

Use of mouthpiece and noseclips alter breathing pattern at rest and during moderate exercise. Our purpose was to extend observations on mouthpiece breathing to its effects on the cardiorespiratory response to intense exercise and to develop and validate an algorithm for computer-assisted analysis of breathing pattern recorded with respiratory inductive plethysmography. Six normal men performed incremental bicycle exercise to volitional exhaustion on two occasions with and without mouthpiece and noseclip. ECG and breathing pattern recorded with a respiratory inductive plethysmograph were analyzed manually and with computer assistance. Mouthpiece breathing increased tidal volume and respiratory cycle time by up to 63 and 33% respectively (p < 0.02) during mild exercise, but it did not alter performance, heart rate, or breathing pattern at maximal exercise. Mean differences between inductive plethysmographic and spirometric tidal volumes were < 5% during validation at rest and maximal exercise. Application of the proposed algorithm for semiautomatic breathing pattern analysis provided significant time savings with no loss in precision compared with manual analysis. In conclusion, in normal men, performance and breathing pattern during maximal exercise are not altered by a mouthpiece and noseclip, and accurate computer-assisted measurement of ventilation from external transducers may be performed even during intense exercise.
'Rip van Winkle period' ends for puerperal psychiatric problems
Authors: Terra Ziporyn
Journal: JAMA (1984)

A young woman gave birth to her first infant in a fairly routine delivery but five days later started having delusions, hallucinations, and nightmares. Soon afterward, she grew extremely depressed. Days passed, and delirium alternated with depression, accompanied by weakness, excessive sweating, and, weeks later, menstrual irregularities. To the relief of her perplexed physician, however, after several months this new mother suddenly recovered, completely resuming all normal activities. That happened in 1858. If it had happened today— and similar scenarios do—the obstetrician might well have referred the woman to a psychiatrist. Although the French physician Louis V. Marcé wrote a treatise on madness after childbirth in 1858, and physicians since Hippocrates have noted similar behavior, official medical recognition of specifically puerperal psychiatric problems went into the deep freeze years ago, and only now have some psychiatrists begun thawing it out. "For three quarters of the 20th century, psychiatrists lay down
Prophylactic Use of Hydrochlorothiazide in Pregnancy
Authors: Gary W. Kraus
Journal: JAMA (1966)

A randomized double-blind investigation of the early, continuous, prophylactic use of hydrochlorothiazide (50 mg daily) was undertaken with 1,030 obstetrical patients. Twenty-eight percent of the patients were teenagers and 39% were nulliparas. Hypokalemia and hyperuricemia were significantly increased in the hydrochlorothiazide group, but the patients were asymptomatic. The total incidence of hypertension was 19.6% in the hydrochlorothiazide group and 21.8% in the placebo group. Preeclampsia occurred in 3% of the former group and in 3.8% of the latter. Excessive weight gain was evident in 13.9% of the placebo group as compared to 7.7% of the hydrochlorothiazide group (<i>P</i>= 0.002). The average fetal weight and the incidence of prematurity, congenital anomalies, and perinatal mortality were similar in both groups. No complications related to thiazides were encountered in the 1,040 newborns. The data demonstrated that long-term, prophylactic use of hydrochlorothiazide in pregnancy did not alter the incidence of preeclampsia, hypertension, prematurity, congenital anomalies, or perinatal mortality.
Incremental cost-effectiveness of drug-eluting stents compared with a third-generation bare-metal stent in a real-world setting: randomised Basel Stent Kosten Effektivitäts Trial (BASKET)
Authors: Christoph Kaiser, Hans Peter Brunner-La Rocca, Peter T Buser, Piero O Bonetti, Stefan Osswald, André Linka, Alain Bernheim, Andreas Zutter, Michael Zellweger, Leticia Grize, Matthias E Pfisterer
Journal: The Lancet (2005)
Occupational Health Services: A Practical Approach
Authors: Roy L. DeHart
Journal: JAMA (1990)

medicine provides not only an intellectual challenge and a professionally stimulating branch of medicine, but administrative and managerial challenges as well. Dr Guidotti and his coauthors have produced a text that addresses the latter while leaving the former for others. No other text has accomplished this task as well.   book serves as a guide through the maze of issues that may entrap any physician planning to enter the practice of occupational medicine, either fully or shared with other clinical activities. A physician may enter this maze unfamiliar with its complexities, nuances, or consequences.   path is suggested by the section headings selected by the authors: The  Health Care System, Occupational Health Care Delivery, Office Administration, Program Management, and Occupational Health Services.  stated objective of the book is to provide general guidelines for creating, developing and managing a sound program of high quality occupational health care delivery....
BILATERAL SACRO-ILIAC OBLITERATION
Authors: S. C. WOLDENBERG
Journal: JAMA (1924)

It has long been known that a certain amount of motion in the pelvic articulations is normal, and that an increased mobility of these articulations occurs physiologically during pregnancy. Little attention was given to this, however, until the publication of the article on pelvic articulations by Goldthwaite and Osgood in May, 1905. Albee, in 1909, stated that the sacro-iliac articulations are true joints having all the common joint structures, and are therefore subject to the same diseases and injuries as other joints. In view of these facts, it is remarkable that injuries and inflammation of these joints are not more frequently observed. This may be due to the fact that such diagnosis requires very careful roentgen-ray examination and interpretation. This study was made on a series of ex-service men with so-called spine cases, and included very careful histories, thorough clinical and roentgen-ray examinations, and careful search to rule out infections
Cumulative Probability of False-Positive Recall or Biopsy Recommendation After 10 Years of Screening Mammography
Authors: Rebecca A. Hubbard, Karla Kerlikowske, Chris I. Flowers, Bonnie C. Yankaskas, Weiwei Zhu, Diana L. Miglioretti
Journal: Annals of Internal Medicine (2011)

Background: False-positive mammography results are common. Biennial screening may decrease the cumulative probability of false-positive results across many years of repeated screening but could also delay cancer diagnosis. Objective: To compare the cumulative probability of false-positive results and the stage distribution of incident breast cancer after 10 years of annual or biennial screening mammography. Design: Prospective cohort study. Setting: 7 mammography registries in the National Cancer Institute–funded Breast Cancer Surveillance Consortium. Participants: 169 456 women who underwent first screening mammography at age 40 to 59 years between 1994 and 2006 and 4492 women with incident invasive breast cancer diagnosed between 1996 and 2006. Measurements: False-positive recalls and biopsy recommendations stage distribution of incident breast cancer. Results: False-positive recall probability was 16.3% at first and 9.6% at subsequent mammography. Probability of false-positive biopsy recommendation was 2.5% at first and 1.0% at subsequent examinations. Availability of comparison mammograms halved the odds of a false-positive recall (adjusted odds ratio, 0.50 [95% CI, 0.45 to 0.56]). When screening began at age 40 years, the cumulative probability of a woman receiving at least 1 false-positive recall after 10 years was 61.3% (CI, 59.4% to 63.1%) with annual and 41.6% (CI, 40.6% to 42.5%) with biennial screening. Cumulative probability of false-positive biopsy recommendation was 7.0% (CI, 6.1% to 7.8%) with annual and 4.8% (CI, 4.4% to 5.2%) with biennial screening. Estimates were similar when screening began at age 50 years. A non–statistically significant increase in the proportion of late-stage cancers was observed with biennial compared with annual screening (absolute increases, 3.3 percentage points [CI, −1.1 to 7.8 percentage points] for women age 40 to 49 years and 2.3 percentage points [CI, −1.0 to 5.7 percentage points] for women age 50 to 59 years) among women with incident breast cancer. Limitations: Few women underwent screening over the entire 10-year period. Radiologist characteristics influence recall rates and were unavailable. Most mammograms were film rather than digital. Incident cancer was analyzed in a small sample of women who developed cancer. Conclusion: After 10 years of annual screening, more than half of women will receive at least 1 false-positive recall, and 7% to 9% will receive a false-positive biopsy recommendation. Biennial screening appears to reduce the cumulative probability of false-positive results after 10 years but may be associated with a small absolute increase in the probability of late-stage cancer diagnosis. Primary Funding Source: National Cancer Institute.
Efficacy of Sertraline in the Treatment of Children and Adolescents With Major Depressive Disorder&lt;SUBTITLE&gt;Two Randomized Controlled Trials&lt;/SUBTITLE&gt;
Authors: Karen Dineen Wagner, Paul Ambrosini, Moira Rynn, Christopher Wohlberg, Ruoyong Yang, Michael S. Greenbaum, Ann Childress, Craig Donnelly, Deborah Deas
Journal: JAMA (2003)

ContextThe efficacy, safety, and tolerability of selective serotonin reuptake inhibitors (SSRIs) in the treatment of adults with major depressive disorder (MDD) are well established. Comparatively few data are available on the effects of SSRIs in depressed children and adolescents.ObjectiveTo evaluate the efficacy and safety of sertraline compared with placebo in treatment of pediatric patients with MDD.Design and SettingTwo multicenter randomized, double-blind, placebo-controlled trials were conducted at 53 hospital, general practice, and academic centers in the United States, India, Canada, Costa Rica, and Mexico between December 1999 and May 2001 and were pooled a priori.ParticipantsThree hundred seventy-six children and adolescents aged 6 to 17 years with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–defined MDD of at least moderate severity.InterventionPatients were randomly assigned to receive a flexible dosage (50-200 mg/d) of sertraline (n = 189) or matching placebo tablets (n = 187) for 10 weeks.Main Outcome MeasuresChange from baseline in the Children's Depression Rating Scale–Revised (CDRS-R) Best Description of Child total score and reported adverse events.ResultsSertraline-treated patients experienced statistically significantly greater improvement than placebo patients on the CDRS-R total score (mean change at week 10, –30.24 vs –25.83, respectively; P = .001; overall mean change, –22.84 vs –20.19, respectively; P = .007). Based on a 40% decrease in the adjusted CDRS-R total score at study end point, 69% of sertraline-treated patients compared with 59% of placebo patients were considered responders (P = .05). Sertraline treatment was generally well tolerated. Seventeen sertraline-treated patients (9%) and 5 placebo patients (3%) prematurely discontinued the study because of adverse events. Adverse events that occurred in at least 5% of sertraline-treated patients and with an incidence of at least twice that in placebo patients included diarrhea, vomiting, anorexia, and agitation.ConclusionThe results of this pooled analysis demonstrate that sertraline is an effective and well-tolerated short-term treatment for children and adolescents with MDD.