tbuckley/cabot-search huggingface dataset:
Does This Adult Patient Have a Blunt Intra-abdominal Injury?
Authors: Daniel K. Nishijima, David L. Simel, David H. Wisner, James F. Holmes
Journal: JAMA (2012)

Blunt abdominal trauma often presents a substantial diagnostic challenge. Well-informed clinical examination can identify patients who require further diagnostic evaluation for intra-abdominal injuries after blunt abdominal trauma.To systematically assess the precision and accuracy of symptoms, signs, laboratory tests, and bedside imaging studies to identify intra-abdominal injuries in patients with blunt abdominal trauma.We conducted a structured search of MEDLINE (1950-January 2012) and EMBASE (1980-January 2012) to identify English-language studies examining the identification of intra-abdominal injuries. A separate, structured search was conducted for studies evaluating bedside ultrasonography.We included studies of diagnostic accuracy for intra-abdominal injury that compared at least 1 finding with a reference standard of abdominal computed tomography, diagnostic peritoneal lavage, laparotomy, autopsy, and/or clinical course for intra-abdominal injury. Twelve studies on clinical findings and 22 studies on bedside ultrasonography met inclusion criteria for data extraction.Critical appraisal and data extraction were independently performed by 2 authors.The prevalence of intra-abdominal injury in adult emergency department patients with blunt abdominal trauma among all evidence level 1 and 2 studies was 13% (95% CI, 10%-17%), with 4.7% (95% CI, 2.5%-8.6%) requiring therapeutic surgery or angiographic embolization of injuries. The presence of a seat belt sign (likelihood ratio [LR] range, 5.6-9.9), rebound tenderness (LR, 6.5; 95% CI, 1.8-24), hypotension (LR, 5.2; 95% CI, 3.5-7.5), abdominal distention (LR, 3.8; 95% CI, 1.9-7.6), or guarding (LR, 3.7; 95% CI, 2.3-5.9) suggest an intra-abdominal injury. The absence of abdominal tenderness to palpation does not rule out an intra-abdominal injury (summary LR, 0.61; 95% CI, 0.46-0.80). The presence of intraperitoneal fluid or organ injury on bedside ultrasound assessment is more accurate than any history and physical examination findings (adjusted summary LR, 30; 95% CI, 20-46); conversely, a normal ultrasound result decreases the chance of injury detection (adjusted summary LR, 0.26; 95% CI, 0.19-0.34). Test results increasing the likelihood of intra-abdominal injury include a base deficit less than -6 mEq/L (LR, 18; 95% CI, 11-30), elevated liver transaminases (LR range, 2.5-5.2), hematuria (LR range, 3.7-4.1), anemia (LR range, 2.2-3.3), and abnormal chest radiograph (LR range, 2.5-3.8). Symptoms and signs may be most useful in combination, particularly in identification of patients who do not need further diagnostic workup.Bedside ultrasonography has the highest accuracy of all individual findings, but a normal result does not rule out an intra-abdominal injury. Combinations of clinical findings may be most useful to determine which patients do not require further evaluation, but the ideal combination of variables for identifying patients without intra-abdominal injury requires further study.
Capillary Resistance to Suction in Hypertension
Authors: K. R. Gough
Journal: BMJ (1962)

In hypertensive vascular disease much attention has been directed towards the lesions in the large blood-vessels, the arteries, and the arterioles.Abnormalities of these vessels, however, do not explain all the clinical manifestations that may arise, particularly in the malignant phase of the disease.Little is known of the role of the small vessels, the terminal arterioles, capillaries, and venules in this condition.Attempts have been made to devise experimental techniques to measure functional changes in the capillaries of hypertensive patients.One of these is the capillary "fragility" or capillary " resistance " test.Such tests have been used in clinical medicine for more than fifty years but have fallen into disrepute because it is still uncertain that a function of the capillary is, in fact, being measured.Furthermore, numerous anatomical, physiological, and environmental factors are known to affect the result in both health and disease.Many of these variable factors are eliminated in the method used in this investigation.Results are presented in 240 normal controls and in 234 patients with hypertension, grouped according to the appearances of their optic fundi.
Pulmonary hypertension associated with sickle cell disease: Clinical and laboratory endpoints and disease outcomes
Authors: Laura M. De Castro, Jude C. Jonassaint, Felicia L. Graham, Allison Ashley‐Koch, Marilyn J. Telen
Journal: American Journal of Hematology (2007)

Abstract Screening for pulmonary hypertension (pHTN) has not yet become routine in sickle cell disease (SCD), despite clinical evidence of its high prevalence and associated mortality. Our objectives are to identify clinical conditions and laboratory findings predictive of/or associated with pHTN. One hundred twenty‐five adult outpatients with Hb SS, SC, SOArab, Sβ 0 , or Sβ + thalassemia, who underwent echocardiography and/or right heart catheterization due to cardiorespiratory symptoms, were studied. pHTN was identified in 36% (28/77) of SS/Sβ 0 and in 25% (12/48) of SC/SOArab/Sβ + patients studied. In SS/Sβ 0 patients, pHTN was associated with low hemoglobin, low GFR, increasing age, no history of treatment with hydroxyurea and a history of leg ulcers, with trends for associations with higher total bilirubin, LDH levels, systolic systemic blood pressure, history of avascular necrosis, seizures, and cerebrovascular events. Twelve (40%) of the SS/Sβ 0 patients with pHTN had ≥1+ proteinuria. ( P &lt; 0.039). The presence of proteinuria correlated with lower GFR and had a high positive predictive value (0.60) for pHTN in subjects with SS/Sβ 0 . The data also provided evidence that pHTN in this population is associated with right heart failure, with echocardiographic evidence of right ventricle enlargement and pericardial effusion. This study confirmed that even relatively mild elevations in pulmonary pressure are associated with high prospective mortality (hazard ratio: 15.9). We concluded that pHTN has a high prevalence in all Hb S related syndromes and is associated with increased mortality in SS/Sβ 0 . Kidney dysfunction, as indicated by proteinuria or decreased GFR, also represents sufficient reason to screen for pHTN. Am. J. Hematol., 2008. © 2007 Wiley‐Liss, Inc.
Case-control study of oral contraceptives and risk of thromboembolic stroke: results from international study on oral contraceptives and health of young women
Authors: L. A J Heinemann, M. A Lewis, M. Thorogood, W. O Spitzer, I. Guggenmoos-Holzmann, R. Bruppacher
Journal: BMJ (1997)

<h3>Abstract</h3> <b>Objective:</b> To determine the influence of oral contraceptives (particularly those containing modern progestins) on the risk for ischaemic stroke in women aged 16–44 years. <b>Design:</b> Matched case-control study. <b>Setting:</b> 16 centres in the United Kingdom, Germany, France, Switzerland, and Austria. <b>Subjects:</b> Cases were 220 women aged 16–44 who had an incident ischaemic stroke. Controls were 775 women (at least one hospital and one community control per case) unaffected by stroke who were matched with the corresponding case for 5 year age band and for hospital or community setting. Information on exposure and confounding variables were collected in a face to face interview. <b>Main outcome measures:</b> Odds ratios derived with stratified analyses and unconditional logistic regression to adjust for potential confounding. <b>Results:</b> Adjusted odds ratios (95% confidence intervals) for ischaemic stroke (unmatched analysis) were 4.4 (2.0 to 9.9), 3.4 (2.1 to 5.5), and 3.9 (2.3 to 6.6) for current use of first, second, and third generation oral contraceptives, respectively. The risk ratio for third versus second generation was 1.1 (0.7 to 2.0) and was similar in the United Kingdom and other European countries. The risk estimates were lower if blood pressure was checked before prescription. <b>Conclusion:</b> Although there is a small relative risk of occlusive stroke for women of reproductive age who currently use oral contraceptives, the attributable risk is very small because the incidence in this age range is very low. There is no difference between the risk of oral contraceptives of the third and second generation; only first generation oral contraceptives seem to be associated with a higher risk. This small increase in risk may be further reduced by efforts to control cardiovascular risk factors, particularly high blood pressure. <h3>Key messages</h3> This study shows a slightly increased relative risk of thromboembolic stroke in women currently using oral contraceptives compared with women not using them. The high dose oestrogen pills carry a higher risk than the low dose formulations, irrespective of the type of progestin The absolute risk of occlusive stroke for women who currently use modern oral contraceptives is very small—that is, the incidence in this age range is very low and not different between second and third generation oral contraceptives This small increase in risk can be controlled by avoiding prescription of oral contraceptives to women who have evidence of cardiovascular disease, in particular high blood pressure
Hyperornithinaemia- hyperammonaemia- homocitrullinuria syndrome is caused by mutations in a gene encoding a mitochondrial ornithine transporter
Authors: Jose A. Camacho, Cassandra Obie, Barbara Biery, Barbara K. Goodman, Chien-An Hu, Shlomo Almashanu, Gary Steel, Robin Casey, Marie Lambert, Grant A. Mitchell, David Valle
Journal: Nature Genetics (1999)
Abstract 631: Association between dietary calcium intake and lung cancer risk in female non-smokers: A report from the Shanghai Women's Health Study
Authors: Yumie Takata, Xiao Ou Shu, Gong Yang, Honglan Li, Qi Dai, Jing Gao, Qiuyin Cai, Wong-Ho Chow, Yutang Gao, Wei Zheng
Journal: Cancer Research (2012)

Abstract Calcium has been implicated in carcinogenesis, especially through cell signaling and cell cycle regulation. Previous epidemiologic studies reported associations of calcium intake with the risk of colorectal, breast or prostate cancer. However, the studies investigating the association with lung cancer risk are limited, particularly among non-smokers. We evaluated the association of dietary calcium and other minerals that affect the calcium absorption with the risk of incident lung cancer among female non-smokers in the Shanghai Women's Health Study, a population-based cohort study of 74,941 women aged 40-70 years at enrollment (March 1997 to May 2000). Included in this analysis were 71,267 women who had never smoked and no prior history of cancer at baseline. Dietary intake was assessed using a validated quantitative food frequency questionnaire administered in person by trained interviewers. Cancer incidence and vital status were ascertained through annual linkage to the Shanghai Cancer Registry and Shanghai Vital Statistics data bases and biennial home visits. This analysis included 428 incident lung cancer cases accrued among the cohort members between April 1998 and December 2009 after the study enrollment. Cox proportional hazard regression was used to calculate the risk of lung cancer by quartiles of intake of calcium, magnesium, phosphorus or the calcium to magnesium (Ca: Mg) or calcium to phosphorus (Ca: P) ratios and by the use of calcium supplement, while adjusting for age, total caloric intake, income, occupation, passive smoking, history of asthma and body mass index. Intakes of calcium and phosphorus and the Ca: Mg and Ca: P ratios were inversely associated with the lung cancer risk; the corresponding risk reduction at the highest quartile comparing with the lowest was 34% for calcium, 45% for phosphorus, 38% for the Ca: Mg ratio and 25% for the Ca: P ratio (p for trend = 0.007, 0.02, 0.003 and 0.03, respectively). Calcium supplement was also associated with 33% significantly decreased risk. No association was observed for dietary magnesium intake (p for trend = 0.51). Our study provides one of the first evidence suggesting a possible role of calcium in lung cancer prevention among female non-smokers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 631. doi:1538-7445.AM2012-631
Intracellular Signaling Pathways Involved in the Cell Growth Inhibition of Glioma Cells by Melatonin
Authors: Vanesa Martín, Federico Herrera, Pilar Carrera-Gonzalez, Guillermo García-Santos, Isaac Antolín, Jezabel Rodriguez-Blanco, Carmen Rodriguez
Journal: Cancer Research (2006)

Abstract Melatonin is an indolamine mostly produced in the pineal gland, soluble in water, and highly lipophilic, which allows it to readily cross the blood-brain barrier. Melatonin possesses antioxidant properties and its long-term administration in rodents has not been found to cause noteworthy side effects. In the present work, we found that millimolar concentrations of this indolamine reduced cell growth of C6 glioma cells by 70% after 72 hours of treatment, inhibiting cell progression from G1 to S phase of the cell cycle. Intraperitoneal administration of 15 mg/kg body weight of melatonin to rats previously injected in the flank with C6 glioma cells reduces tumor growth by 50% 2 weeks after the implant. Inhibition of cell growth does not depend on melatonin membrane receptor activation whereas it seemingly relates to the reduction of intracellular basal free radical levels by 30%. Increase of basal redox state of the cells and constitutive activation of tyrosine kinase receptor [receptor tyrosine kinase (RTK)] pathways, including the extracellular signal–regulated kinase 1/2 (ERK1/2) and the Akt and protein kinase C (PKC) signaling pathways, contribute to the progression of the gliomas leading to the constitutive activation of the redox-dependent survival transcription factor nuclear factor κB (NF-κB). The antioxidant effect of melatonin in C6 cells is associated to inhibition of NF-κB and Akt, but not of ERK1/2. The antiproliferative effect of the indolamine on these cells is partially abolished when coincubated with the PKC activator 12-O-tetradecanoylphorbol-13-acetate, thus indicating that the ability of melatonin to change cellular redox state may be inactivating the pathway RTK/PKC/Akt/NF-κB. (Cancer Res 2006; 66(2): 1081-8)
Evaluating new screening tests for breast cancer
Authors: Les Irwig, Nehmat Houssami, Bruce Armstrong, Paul Glasziou
Journal: BMJ (2006)

trial should now be made publicly available immediately.Lives are at stake and there can be no possible reason, save liability, for secrecy.We have been assured repeatedly that proper procedures were followed, when the real question is whether they were the right procedures.This tragedy creates one more imperative for an open culture in medical research, a culture that many fear is increasingly losing its way. [9][0][11] There must be an immediate moratorium on CD28 research in humans until we have a better understanding of the potential for harm.Furthermore, only an independent inquiry can restore public and professional confidence: the MHRA is compromised by its own role in regulating trials.Such an inquiry must have a broad remit, including the social, political, legal, and economic forces shaping new drug development.Its recommendations should consider mechanisms for an immediate centralised response to unexpected events-such as those at Northwick Park-from the global scientific community.
Steroid Therapy in Severe Viral Hepatitis
Authors: Peter B. Gregory, C. Michael Knauer, Richard L. Kempson, Rupert Miller
Journal: New England Journal of Medicine (1976)

The efficacy of corticosteroid therapy in severe viral hepatitis has never been demonstrated in a controlled clinical trial. For this reason, patients with severe viral hepatitis were randomly assigned to methyl-prednisolone or placebo treatment groups. The two groups were comparable in clinical findings, laboratory results and the presence of bridging necrosis on liver biopsy. Seven of the 14 patients assigned to methyl-prednisolone and two of the 15 assigned to placebo died during the 16-week study period. Although the apparent excess mortality in the steroid-treated patients is not quite statistically significant (P = 0.08), the trend persists when only patients positive for hepatitis B surface antigen (P = 0.04) are analyzed separately. Methyl-prednisolone does not enhance survival in patients with severe viral hepatitis, and it may be detrimental.
Cytochrome Oxidase Activity and Mitochondrial Gene Expression in Skeletal Muscle of Patients with Chronic Obstructive Pulmonary Disease
Authors: JAUME SAULEDA, FRANCISCO GARCÍA-PALMER, RUDOLF J. WIESNER, SALVADOR TARRAGA, INGA HARTING, PURIFICACIÓN TOMÁS, CRISTINA GÓMEZ, CARLES SAUS, ANDREU PALOU, ALVAR G. N. AGUSTÍ
Journal: American Journal of Respiratory and Critical Care Medicine (1998)

Several recent studies have suggested that skeletal muscle bioenergetics are abnormal in patients with chronic obstructive pulmonary disease (COPD). This study investigates the activity of cytochrome oxidase (COX), the terminal enzyme in the mitochondrial electron transport chain, and the expression of two mitochondrial DNA genes related to COX (mRNA of subunit I of COX [COX-I] and the RNA component of the 12S ribosomal subunit [12S rRNA]), in quadriceps femoris muscle biopsies obtained from COPD patients with various degrees of arterial hypoxemia, and from healthy sedentary control subjects of similar age. The activity of COX was measured spectrophotometrically in fresh tissue at 37 ° C with excess substrate. RNA transcripts were measured using reverse transcription and polymerase chain reaction. The measurements of mRNA COX-I and 12S rRNA were normalized to the mRNA of actin, which is a housekeeping gene not influenced by hypoxia. We found that, compared with control subjects, COPD patients with chronic respiratory failure (PaO2 < 60 mm Hg) showed increased COX activity (p < 0.05). Further, the activity of COX was inversely related to arterial Po 2 value (Rho − 0.59, p < 0.01). The COX-I mRNA content was not different between patients and control subjects but patients with chronic respiratory failure had higher levels of 12S rRNA (p < 0.05), which were again inversely related to PaO2 (Rho − 0.49, p < 0.05). These results indicate that the activity of COX is increased in skeletal muscle of patients with COPD and chronic respiratory failure, and they suggest that this is likely regulated at the translational level by increasing the number of mitochondrial ribosomes.
TREATMENT OF ATOPIC DERMATITIS WITH CORTISONE
Authors: Thomas H. Sternberg
Journal: JAMA (1952)

Soon after corticotropin (ACTH) and cortisone became available for clinical investigation, it was noted that they were effective against a wide variety of dermatoses,<sup>1</sup>including the atopic diathesis.<sup>2</sup>Initial reports of the use of these drugs in atopic dermatitis were enthusiastic and, in general, created the hope that the therapeutic solution of this perplexing problem was at hand. However, as clinical experience accumulated, it was noted that the pattern of response in atopic dermatitis<sup>3</sup>is similar to that observed in rheumatoid arthritis,<sup>4</sup>lupus erythematosus,<sup>5</sup>and certain other diseases,<sup>6</sup>in that it is characterized by marked initial improvement, followed by a relapse when therapy is discontinued. The present study was initiated for the purpose of determining the therapeutic value of cortisone in a group of patients with atopic dermatitis, when given for a prolonged period of time and under conditions permitting detailed observation. In order
Nodal Clearance and Detection
Authors: John W. Pickren
Journal: JAMA (1975)

IN CURATIVE resections for carcinoma of the colon, rectum, and anus, the extent of metastasis of cancer cells into the resected lymph nodes is an important factor in predicting the eventual outcome in terms of whether the cancer will reappear as a distant metastasis. For example, the 5-year cure rate for surgical resection is twice as high in patients with colon carcinoma that<i>has not</i>metastasized to the resected lymph nodes, as the rate in those patients with colon carcinoma that<i>has</i>metastasized to the resected lymph nodes. When the regional lymph nodes are not involved, approximately 70% to 80% of patients undergoing a curative type of resection will be free of disease for a period of five years; but when the regional lymph nodes contain metastatic foci of cancer, the curative operative procedure will yield a disease-free period of five years in only 20% to 40% of the patients.
OC-036 Peripheral oedema is associated with poor outcomes following emergency abdominal surgery
Authors: P G Vaughan-Shaw, S Jones, J A Saunders, M A Stroud, T R Smith, A T King
Journal: Gut (2012)

<h3>Introduction</h3> Peripheral oedema is frequently observed in critically ill patients following surgery and is commonly attributed to poor nutritional status and associated with worse outcomes. This study assesses the prevalence of generalised oedema following emergency abdominal surgery and the value of early post-operative oedema measurement in predicting clinical outcome. <h3>Methods</h3> A prospective cohort study of patients undergoing emergency abdominal surgery at a university surgical unit over a 2-month period was undertaken. Nutritional status data were collected and oedema measured in the early post-operative period. Clinical outcome data were collected until discharge and at subsequent outpatient consultations. <h3>Results</h3> 55 patients were included, median age 66. Post-operative complications included ileus (n=9), sepsis (n=6) and death (n=10). Post-operative oedema was present in 19 patients (35%) and associated with prolonged peri-operative fasting (4 vs 1 days, p=0.009) but not BMI (24 vs 27 kg/m<sup>2</sup>, p=0.16) or pre-admission weight loss (5% vs 3%, p=0.9). Oedema was associated with prolonged hospitalisation (24 vs 10 days, p=0.0004), complications and/or death (68% vs 31%, p=0.007) and a trend towards increased artificial nutritional support (42% vs 22%, p=0.07). Presence of oedema independently predicted death (p=0.016), median follow-up 155.5 days. <h3>Conclusion</h3> Generalised oedema is common after emergency abdominal surgery but not predicted by commonly used markers of nutritional status such as BMI or recent weight loss in. Increased peri-operative fasting and subsequent intravenous fluid administration may be a significant contributor to post-operative oedema. Measurement of post-operative oedema may offer utility in identifying those at risk of poor clinical outcome or those requiring artificial nutritional support. <h3>Competing interests</h3> None declared.
Exploratory and Aggressive Behaviour in Rats with and without Experimental Hypertension
Authors: J.J. Groen, A. Welner, Ben Ishay
Journal: Psychotherapy and Psychosomatics (1970)

Rats from two strains, inbred for their sensitivity or resistance to experimental hypertension, showed marked differences in behaviour in certain standardized experimental situations. Rats from the resistant strain explored the environment of their cage more, crossed over more frequently into an adjacent cage and behaved more aggressively to another rat after a painful stimulus, than rats from the sensitive strain. Although it is too early to define in exact terms the relationship between these behavioural differences and the mechanisms of the experimental hypertension in one strain and the resistance in the other, these observations support the hypothesis that central nervous functions play a role in the pathogenesis of human 'essential' hypertension.