tbuckley/cabot-search huggingface dataset:
The Dilemmas of Mothers Who Are Physicians and of Physicians Who Are Mothers
Authors: R. F. Sanke
Journal: JAMA (1986)

To the Editor.—  The disappointment experienced by Anonymous is evident. So also is her resentment, but against what? The medical profession? Society? Her feminine sex? Her situation is an obvious example of the reality that life, as well as one's professional path, is a series of choices made. I do not expect this statement of the obvious to lessen her dissatisfaction, but neither is it fair to transfer the fault to anyone or anything else.  Every human being makes choices in life, and past choices establish our present status. Should I be a physician or an accountant? A major in biology or chemistry? Attend an unknown but concerned school or a renowned yet cold and distant one? And so on throughout life.  The fact that the final and often distant outcome of our choice can only be guessed at and cannot be known with certainty is an immutable fact of
Downregulation of vascular endothelial growth factor receptors by tumor necrosis factor-alpha in cultured human vascular endothelial cells.
Authors: C Patterson, M A Perrella, W O Endege, M Yoshizumi, M E Lee, E Haber
Journal: Journal of Clinical Investigation (1996)

Vascular endothelial growth factor (VEGF) potently stimulates angiogenesis, whereas TNF-alpha has both pro- and anti-angiogenic activity. By measuring thymidine uptake, we found that TNF-alpha blocked a 2.3-fold increase in DNA synthesis induced by VEGF in human endothelial cells. To explore the possibility that the two interact to regulate endothelial cell proliferation, we examined the effect of TNF-alpha on VEGF receptor expression. In venous and arterial endothelial cells, TNF-alpha potently reduced mRNA transcripts of the two VEGF receptors (KDR/flk-1 and flt-1) in a dose- and time-dependent fashion. TNF-alpha at 1 ng/ml induced maximal inhibition of mRNA expression, which fell by approximately 70% after 24 h. TNF-alpha treatment did not significantly affect the KDR/flk-1 half-life but did decrease its rate of transcription to 40% of control. The decrease in KDR/flk-1 mRNA depended partially on new protein synthesis and was abolished by phorbol ester pretreatment. TNF-alpha decreased the amount of 35S-labeled KDR/flk-1 immunoprecipitated by an antibody specific for KDR/flk-1 to 18% of control. We conclude that TNF-alpha downregulates expression of both VEGF receptors in human endothelial cells and that this effect is transcriptional (at least for KDR/flk-1). These data support the hypothesis that TNF-alpha exerts its antiangiogenic effect in part by modulating the VEGF-specific angiogenic pathway.
Facing a “Slow-Motion Disaster” — The UN Meeting on Noncommunicable Diseases
Authors: Lisa Rosenbaum, Daniela Lamas
Journal: New England Journal of Medicine (2011)

In September, representatives from 192 countries met at a UN conference on noncommunicable diseases, turning international attention from the devastation wrought by well-known epidemics such as those of AIDS and malaria to a quieter, though no less dangerous, threat.
Consent for Publication-Reply
Authors: Barry Weiss
Journal: JAMA (1982)

<h3>In Reply.—</h3> Dr Murray, in discussing the publication of case reports of unusual genetic diseases, brings up the point that such cases are often unique and that maintaining the anonymity of patients may be impossible. He provides some excellent guidelines for dealing with these situations in such a way that publication of the case record is of value both to the patient involved and to the medical community in general. I would suggest that similar guidelines be applied to the publication of all case reports, even when the patient's identity can be adequately concealed. In particular, this would include the suggestions to obtain consent from the patient before submission for publication and providing the patient with a reprint of the article. These measures would serve to enhance doctor-patient communication, since, currently, most patients do not think that cases are published in medical journals. The opportunity for patients to learn about
901-93 Selective Inhibition of Epicardial Function Reduces Left Ventricular Endocardial Torsion and Principal Strain: A Magnetic Resonance Imaging Study Using Tissue Tagging
Authors: Sam A. Buffer, Sheng-Jing Dong, Paul S. Hees, Rafael Beyar, Frank E. Rademakers, Haim Azhari, James L. Weiss, Edward P. Shapiro
Journal: Journal of the American College of Cardiology (1995)
THE NECESSITY OF SANITARY SUPERVISION OF SCHOOLS.
Authors: GEORGE H ROHÉ
Journal: JAMA (1889)

It is well known to physicians and others who have devoted attention to the subject, that many of the most disabling, painful and destructive maladies owe their origin or intensification to certain injurious influences of school life. Inasmuch as a good system of intellectual training should endeavor to avoid injury to bodily health, it becomes worth while to inquire what these injurious influences are, and whether they can be avoided, mitigated or removed. Authorities in school hygiene assert that bad construction of school-houses, defective lighting and ventilation, inefficient removal of the bodily excretions or of the pernicious gases generated by their decomposition, improper school furniture and furnishings, such as seats, desks, blackboards, books, etc., deficient facilities for drying wet clothing, want of elementary knowledge of hygiene on the part of the teacher, over-study, carelessness on the part of parents or attending physicians, and many other causes needless to specify, are
Infant Mental Development Index: Hu et al. Respond
Authors: Howard Hu, Martha María Téllez-Rojo, Héctor Lamadrid-Figueroa, Adriana Mercado-García, Mauricio Hernández-Avila, David Bellinger, Donald Smith, Adrienne S. Ettinger, Joel Schwartz, Lourdes Schnaas
Journal: Environmental Health Perspectives (2007)

Risk of Lymphohematopoietic Malignancies in Uranium MinersR ˇer ˇicha et al. (2006) analyzed data from Czech uranium miners with respect to incidence of malignancies of the lymphohematopoietic system.Their results, however, do not correspond with those of two recent studies on German uranium miners (Kreuzer et al. 2004; Möhner et al. 2006).R ˇer ˇicha et al. ( 2006) used a casecohort design, in which the subcohort was stratified by attained age and duration of employment.Stratification by age is a standard approach in case-cohort studies to optimize data ascertainment in the subcohort.However, stratification by duration of employment is problematic, because in occupational epidemiology it should be assumed that the duration of employment is highly correlated with cumulative exposure.Therefore, this kind of stratification contradicts the general demand for a random selection of controls with respect to exposure under study.Comparing the ratios of sampling fractions (< 12 months vs. ≥ 12 months duration of employment) between age groups results in a heterogeneous picture (Table 1).It is not uncommon in occupational cohort studies to include only subjects with a duration of employment of at least a certain number of months into the cohort.An analysis of only those miners with an employment duration of at least 12 months would be in line not only with the standard methodology but also with earlier published results of the authors (R ˇer ˇicha et al. 1998).Hence, the authors should have at least explained their reasoning for including the remaining miners in a second set of strata.In addition, they should have presented separate results for both duration strata to validate the result of the combined analysis.Given the above-mentioned assumption concerning the relationship between duration of employment and cumulative exposure, I calculated crude incidence rate ratios using data from Table 1 of R ˇer ˇicha et al. (2006).The age-specific odds ratios cover a wide range (0.29-7.16), and a corresponding test yields only borderline homogeneity.Consequently, completeness of matching with the cancer registry needs to be discussed.According to the study design, the time period between last exposure and begin of follow-up can span up to 27 years; therefore, the healthy-worker survivor effect could be an important issue in this study (R ˇer ˇicha et al. 2006).In light of the discussion on the magnitude of the latency period for leukemia, more detailed results would be useful to get an impression on, for example, the effect of the year of last exposure.
Counting the costs of children's smoking
Authors: J. Foulds, C. Godfrey
Journal: BMJ (1995)

The recent publication of the 1994 OPCS survey of smoking among secondary school children confirmed that the Health of the Nation target for children's smoking (a reduction in regular smoking from 8% in 1988 to less than 6% in 1994) has not been achieved. In 1994, 12% of English schoolchildren aged 11-15 were regular smokers (as were 12% in Scotland, 9% in Wales, and 12.5% in Northern Ireland). In 1994 the government spent around 10 million pounds on initiatives to prevent smoking, but received around 8643 million pounds in tax receipts from tobacco sales, about 108 million pounds of which was tax receipts from the illegal sale of cigarettes to children under 16 years old. The tobacco industry spent an estimated 100 million pounds on promotional activities. Improving current trends in children's smoking by the year 2000 will require decisive action by the government. The government should legislate to ban tobacco advertising and should use the 108 million pounds taken each year in taxes from smoking children to fund smoking cessation and prevention initiatives.
Do antihypertensive drugs precipitate diabetes?
Authors: C Bengtsson, G Blohme, L Lapidus, O Lindquist, H Lundgren, E Nystrom, K Petersen, J A Sigurdsson
Journal: BMJ (1984)

A longitudinal population study of 1462 women aged 38-60 was carried out from 1968-9 to 1980-1 in Gothenburg, Sweden. The initial and follow up examinations included questions concerning history of diabetes and antihypertensive treatment. A considerably increased risk of developing diabetes was observed for subjects with hypertension taking diuretics (895 patient years), subjects taking beta blockers (682 patient years), and subjects taking a combination of diuretics and beta blockers (281 patient years) compared with subjects not taking antihypertensive drugs (13 855 control years). When diuretics and beta blockers were compared no difference was found in relative risk. Despite this increased risk, and because little is known about the relation between other forms of antihypertensive treatment and diabetes, diuretics and beta blockers should remain the treatments of choice in arterial hypertension.
Sexually transmitted diseases and anal papillomas: Author's reply
Authors: B Goorney
Journal: BMJ (1992)

taken.'They also, however, noted a rise in the number of cases of homosexually acquired gonorrhoea in 1990, with a rate of rectal infection of 6 9%.In the three genitourinary medicine clinics in Riverside Health Authority 59 episodes of confirmed anorectal gonococcal infection occurred in 57 homosexual or bisexual men attending between 30 March and 8 October this year.Of these 57 men, 17 were known to be HIV seropositive and 19 HIV seronegative and 21 were untested for HIV antibodies.Thus while the rate of detection of rectal gonorrhoea in homosexual and bisexual men attending genitourinary medicine departments in this area is much lower than in the era before AIDS, there are no grounds for complacency as these men, regardless of their HIV status, are presumably continuing to have unprotected anal sex or failure of barrier methods.
469. Induction of Donor Specific Tolerance Using Gene Therapy and Sublethal Conditioning
Authors: Daron Forman, Chaorui Tian, John Iacomini
Journal: Molecular Therapy (2005)

Top of pageAbstract
Introduction: Induction of molecular chimerism following genetic engineering of autologous hematopoietic stem cells can be used to induce transplantation tolerance following reconstitution of myeloablated hosts. In this study we set out to determine the minimum conditioning requirements to induce molecular chimerism and achieve donor-specific tolerance.

Methods: B10.AKM (H-2Kk, Ik, Dq) mice received either 3, 6 or 10 Gy of whole body irradiation and were reconstituted the next day with either 4|[times]|106 mock or VSV-Kb (VSV-G enveloped retroviruses carrying the gene encoding H-2Kb (Kb)) transduced syngeneic bone marrow. In addition, recipient mice received 0.5 mg of anti-CD154 mAb (MR1) on the day of reconstitution and a second dose 3 days later. Reconstituted mice were then examined to determine expression of Kb on bone marrow derived cells and whether donor specific tolerance was induced by analyzing Kb-specific T cell responses using cytokine ELISPOT and CTL assays and by grafting with both donor-type and third party skin.

Results: sixty percent of mice treated with 6 Gy of irradiation alone became chimeric and expressed Kb on 1.8 |[plusmn]| 1.7% of their peripheral blood leukocytes (PBL). The addition of anti-CD154 mAb allowed stable, multi-lineage chimerism to develop with as little as 3 Gy of irradiation, and increased both the percentage of mice that became chimeric (100%) as well as the percentage of Kb expression in the PBL (5.3 |[plusmn]| 2.6 %). T cells from mice conditioned with 3 Gy, anti-CD154 and VSV-Kb transduced bone marrow were unable to lyse targets expressing Kb, and contained substantially fewer Kb-reactive IL-2 and IFN-|[gamma]| producing CD4 T cells. Furthermore, this sublethal conditioning regimen induced donor specific tolerance in chimeric recipients as evidenced by the permanent survival of MHC class I disparate B10.MBR (H-2Kb, Ik, Dq) skin grafts. All mice promptly rejected third party BALB/c (H-2Kd) skin grafts.

Conclusions: Sublethal conditioning and costimulation molecule blockade combined with genetic manipulation of autologous bone marrow is a new and potent way to induce donor specific tolerance. The use of genetically modified autologous bone marrow eliminates the possibility of inducing graft versus host disease which is encountered in allogeneic bone marrow transplants.
Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies
Authors: E. Lavigne, E. J. Holowaty, S. Y. Pan, P. J. Villeneuve, K. C. Johnson, D. A. Fergusson, H. Morrison, J. Brisson
Journal: BMJ (2013)

<b>Objectives</b> To evaluate whether the stage distribution among women diagnosed as having breast cancer differs between those who have received breast implants for cosmetic purposes and those with no implants and to evaluate whether cosmetic breast augmentation before the detection of breast cancer is a predictor of post-diagnosis survival. <b>Design</b> Systematic review of observational studies with two meta-analyses. <b>Data sources</b> Systematic search of the literature published before September 2012 conducted in Medline, Embase, Global health, CINAHL, IPAB, and PsycINFO. <b>Study selection</b> Eligible publications were those that included women diagnosed as having breast cancer and who had had augmentation mammaplasty for cosmetic purposes. <b>Results</b> The overall odds ratio of the first meta-analysis based on 12 studies was 1.26 (95% confidence interval 0.99 to 1.60; P=0.058; I<sup>2</sup>=35.6%) for a non-localized stage of breast cancer at diagnosis comparing women with implants who had breast cancer and women without implants who had breast cancer. The second meta-analysis, based on five studies, evaluated the relation between cosmetic breast implantation and survival. This meta-analysis showed reduced survival after breast cancer among women who had implants compared with those who did not (overall hazard ratio for breast cancer specific mortality 1.38, 95% confidence interval 1.08 to 1.75). <b>Conclusions</b> The research published to date suggests that cosmetic breast augmentation adversely affects the survival of women who are subsequently diagnosed as having breast cancer. These findings should be interpreted with caution, as some studies included in the meta-analysis on survival did not adjust for potential confounders. Further investigations are warranted regarding diagnosis and prognosis of breast cancer among women with breast implants.
The Bamako initiative.
Authors: P. Garner
Journal: BMJ (1989)

Under the Bamako initiative UNICEF will provide free drugs to participating countries for the 1st few years; drugs will be sold to patients; and communities will control the finances.  The aims are to establish a revolving drug fund to pay for future drug supplies and to use leftover money to maintain and improve primary health care services.  Several problems with the initiative are foreseen.  Firstly charging users may reduce utilization by the poor.  Although UNICEF agrees that provision of free service for indigents in necessary systematic identification of these people may be difficult.  Secondly financing will be difficult to implement given the rarity of managerial skills and the poor quality of local supervision.  The sustainability of the initiative is also in doubt.  UNICEF initially proposed large mark ups on the basic cost of the drugs; now partial recovery of the cost is proposed although how charges will be set is unclear.  The question of whether services will be dependent when the free drugs stop remains to be answered.  A further objection to the scheme is the almost inevitable deterioration of rational prescribing; paying patients will feel justified in demanding drugs and injections.  UNICEFs solutions and strategies for implementation of policy remain vague and lack attention to detail.  For instance initial training courses aide community management of drug funds but there is no commitment to continued support and local evaluation.  Other sources of funding need to be considered.  Host governments should commit to continued financial and supervisory input and to maintaining control over their own health services.  Communication between staff and government should be established and maintained.  Gradual and sensitive introduction with careful monitoring of equity utilization and rational drug use is essential to prevent failure of this important proposal.
The molecular site of action of KATP channel inhibitors determines their ability to inhibit iNOS-mediated relaxation in rat aorta
Authors: A Wilson
Journal: Cardiovascular Research (2002)

Objective: ATP-sensitive potassium (KATP) channels are important modulators of vascular tone. Abnormal activation of these channels via over production of nitric oxide (NO) has been implicated in endotoxin-induced hypotension. However, based on studies with the sulphonylurea KATP channel inhibitor, glibenclamide, there is little evidence to support their role in mediating vasorelaxation to endotoxin in isolated blood vessels. In the present study, we investigated whether NO derived from inducible NO synthase (iNOS) modulates KATP channel function in rat aorta. Methods: Using standard organ bath techniques, the effects of structurally unrelated KATP channel inhibitors on the vasorelaxant responses to l-arginine (iNOS substrate), NO, levcromakalim (KATP channel opener) and forskolin were investigated in endothelium-denuded aortic rings exposed to endotoxin (lipopolysaccharide) for 4 h. Results: Relaxation evoked by l-arginine was unaffected by glibenclamide and the pinacidil-derived inhibitor, PNU-99963, but was significantly attenuated by the iNOS inhibitor, 1400W, as well as by PNU-37883A, Ba2+, 4-aminopyridine and tetraethylammonium, all known inhibitors of the KATP channel pore. In addition, endotoxin potentiated responses to levcromakalim and markedly reduced the efficacy of glibenclamide, and to a much lesser extent, PNU-37883A. Forskolin responses were unaffected by glibenclamide or PNU-37883A under control conditions, but were significantly potentiated following endotoxin treatment, an effect reversed by PNU-37883A, but not glibenclamide. Conclusion: KATP channels contribute to iNOS-mediated relaxation. However, the ability of sulphonylurea receptor-binding agents, but not those binding directly to the pore, to inhibit KATP channels, is greatly diminished in the presence of endotoxin.
Angiotensin Blockade in Hypertension
Authors: DAVID H. P. STREETEN
Journal: Annals of Internal Medicine (1977)

Editorials1 March 1977Angiotensin Blockade in HypertensionDAVID H. P. STREETEN, M.B., D.PHIL., GUNNAR H. ANDERSON JR., M.D.DAVID H. P. STREETEN, M.B., D.PHIL.Search for more papers by this author, GUNNAR H. ANDERSON JR., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-86-3-353 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptFor many years it has been known that plasma renin activity was elevated in some forms of human hypertension and that angiotensin II, the end-product of the reactions initiated by renin, could be the cause of such types of hypertension. Because the blood pressure has not always been raised when plasma renin activity was above normal, however, as in Bartter's syndrome or cirrhosis with ascites, it has been difficult to know what role, if any, was played by renin and angiotensin excess in the genesis of hypertension. The recent use of angiotensin blockade with competitive antagonists of angiotensin II, like...References1. BRUNNERGAVRASLARAGH HHJ: Angiotensin-II blockade in man by sar1-ala8-angiotensin II for understanding and treatment of high blood-pressure. Lancet 2:1045-1048, 1973 CrossrefMedlineGoogle Scholar2. STREETENANDERSONFREIBERG DGJ: Use of an angiotensin II antagonist (saralasin) in the recognition of "angiotensinogenic" hypertension. N Engl J Med 292:657-662, 1975 CrossrefMedlineGoogle Scholar3. STREETENANDERSONDALAKOS DGT: Angiotensin blockade: its clinical significance. Am J Med 60:817-824, 1976 CrossrefMedlineGoogle Scholar4. GAVRASRIBEIROGAVRAS HAI: Reciprocal relation between renin dependency and sodium dependency in essential hypertension. N Engl J Med 295:1278-1283, 1976 CrossrefMedlineGoogle Scholar5. CASEWALLACEKEIM DJH: Estimating renin participation in hypertension: superiority of converting enzyme inhibitor over saralasin. Am J Med 61:790-796, 1976 CrossrefMedlineGoogle Scholar6. ANDERSONFREIBERGDALAKOS GJT: Effects of an angiotensin II analogue on hypertensive patients (abstract). Clin Res 22:628A, 1974 Google Scholar7. ANDERSONSTREETENDALAKOS GDT: Pressor response to 1-sar-8-ala-angiotensin II (saralasin) in hypertensive subjects. Circ Res, in press. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Section of Endocrinology Department of Medicine State University of New York Upstate Medical Center Syracuse, New York PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByHypertonie8 Renin in essential hypertension 1 March 1977Volume 86, Issue 3Page: 353-354KeywordsAscitesBlood pressureCirrhosisHypertensionPlasma renin activity Issue Published: 1 March 1977 PDF DownloadLoading ...