tbuckley/cabot-search huggingface dataset:
The Yin and Yang of Perioperative Medicine
Authors: Prashant Vaishnava, Kim A. Eagle
Journal: New England Journal of Medicine (2014)

The past four decades have seen remarkable progress in establishing best perioperative practices.1 One of the challenges in improving perioperative care, however, is rooted in the interplay of the myriad interdependent, often opposing, mechanisms that contribute to perioperative myocardial infarction — excess bleeding, dramatic fluid shifts, unrelenting tachycardia, myocardial stress with fixed coronary obstruction, profound hypotension or hypertension, coronary plaque rupture, and coronary spasm. Strategies that mitigate one mechanism may lead to another. Devereaux et al. now report on two such strategies in the Journal — the perioperative use of aspirin and the perioperative use of clonidine in patients undergoing . . .
Hepatic insulin signaling regulates VLDL secretion and atherogenesis in mice
Authors: Seongah Han, Chien-Ping Liang, Marit Westerterp, Takafumi Senokuchi, Carrie L. Welch, Qizhi Wang, Michihiro Matsumoto, Domenico Accili, Alan R. Tall
Journal: Journal of Clinical Investigation (2009)

Type 2 diabetes is associated with accelerated atherogenesis, which may result from a combination of factors, including dyslipidemia characterized by increased VLDL secretion, and insulin resistance. To assess the hypothesis that both hepatic and peripheral insulin resistance contribute to atherogenesis, we crossed mice deficient for the LDL receptor (Ldlr–/– mice) with mice that express low levels of IR in the liver and lack IR in peripheral tissues (the L1B6 mouse strain). Unexpectedly, compared with Ldlr–/– controls, L1B6Ldlr–/– mice fed a Western diet showed reduced VLDL and LDL levels, reduced atherosclerosis, decreased hepatic AKT signaling, decreased expression of genes associated with lipogenesis, and diminished VLDL apoB and lipid secretion. Adenovirus-mediated hepatic expression of either constitutively active AKT or dominant negative glycogen synthase kinase (GSK) markedly increased VLDL and LDL levels such that they were similar in both Ldlr–/– and L1B6Ldlr–/– mice. Knocking down expression of hepatic IR by adenovirus-mediated shRNA decreased VLDL triglyceride and apoB secretion in Ldlr–/– mice. Furthermore, knocking down hepatic IR expression in either WT or ob/ob mice reduced VLDL secretion but also resulted in decreased hepatic Ldlr protein. These findings suggest a dual action of hepatic IR on lipoprotein levels, in which the ability to increase VLDL apoB and lipid secretion via AKT/GSK is offset by upregulation of Ldlr.
322 COMPARISON OF FIBROSIS DEGREE CLASSIFICATION ACCURACY BY LIVER BIOPSY AND NON-INVASIVE TESTS IN CHRONIC HEPATITIS C
Authors: J. Boursier, S. Bertrais, F. Oberti, Y. Gallois, I. Fouchard-Hubert, N. Dib, M.-C. Rousselet, J.-P. Zarski, P. Calès
Journal: Journal of Hepatology (2011)
Relation of Abnormal Cytological Smears and Carcinoma of Cervix Uteri to Husband's Occupation
Authors: J. Wakefield, R. Yule, A. Smith, A. M. Adelstein
Journal: BMJ (1973)

An analysis of the cytological records of almost 300,000 women in the Manchester area shows that the rates of positive/suspicious findings from population screening are highly correlated with the rates of mortality from cancer of the cervix when both are distributed according to the occupation of the husband. The correlation holds for various occupational groupings and for all the individual occupation units in which there are more than 1,000 women. This evidence strengthens the case for believing that the condition revealed by a positive smear is a stage in the development of invasive cancer of the uterine cervix.
Platelet-Rich Plasma Injections in Acute Muscle Injury
Authors: Gustaaf Reurink, Gert Jan Goudswaard, Maarten H Moen, Adam Weir, Jan A N Verhaar, Sita M A Bierma-Zeinstra, Mario Maas, Johannes L Tol
Journal: New England Journal of Medicine (2014)

In this randomized trial involving athletes with acute hamstring muscle injuries, injection of platelet-rich plasma did not result in shortening of the time until patients could resume their sports activity or in a reduction in reinjury rates, as compared with placebo.
Coughing can reduce pain of injection, study shows
Authors: Roger Dobson
Journal: BMJ (2004)

So, how can patients be distracted from the pain of an injection? Many tactics have been tried,including cartoons, hypnosis, music, jokes, and counter-pressure, but doctors now report high success rates with a simple cost-free, and risk-free strategy, that requires no specialist equipment—coughing.

As the needle comes into contact with the skin, the patient is urged to cough vigorously. That cough, say the doctors, in an article published online ahead of print in the British Journal ofPlastic Surgery (www.bjps.com), may provide distraction and momentarily increase blood pressure. The authors say that it has been established …
Frequency of Uterine Contractions and the Risk of Spontaneous Preterm Delivery
Authors: Jay D. Iams, Roger B. Newman, Elizabeth A. Thom, Robert L. Goldenberg, Eberhard Mueller-Heubach, Atef Moawad, Baha M. Sibai, Steve N. Caritis, Menachem Miodovnik, Richard H. Paul, Mitchell P. Dombrowski, Gary Thurnau, Donald McNellis
Journal: New England Journal of Medicine (2002)

The measurement of the frequency of uterine contractions has not been useful for reducing the rate of preterm delivery in randomized trials. Nonetheless, ambulatory monitoring of contractions continues to be used in clinical practice.
Controversies over hypertension guidelines
Authors: F. Godlee
Journal: BMJ (2012)

The proper management of hypertension is arguably one of modern medicine's most effective preventive interventions.It's also one for which we have lots of clinical trial data, as well as a good number of well done meta-analyses.Yet as this week's BMJ shows, controversy about how best to diagnose and treat hypertension in adults is still alive and well.The 2011 guidance from the UK's National Institute for Health and Clinical Excellence (NICE) has been met with a blast of criticism.This week we present two different critiques: the first suggesting that the guidelines are overcomplicated, the second that they are insufficiently evidence based.In a third article, the guidelines' authors respond.
Development of a 32P-postlabeling assay for 7-methylguanines in human DNA.
Authors: R Mustonen, A Försti, P Hietanen, K Hemminki
Journal: Environmental Health Perspectives (1993)

The application of a 32P-postlabeling assay for 7-methylguanines in DNA was studied either by labeling the imidazole ring-opened dinucleotide derivatives or by using strong-anion-exchange column chromatography for the adduct enrichment from normal nucleotides. Data showed that 7-methylguanines can be efficiently labeled as dinucleotides when in vitro methylated DNA was first imidazole ring-opened and then digested to the dinucleotide level with deoxyribonuclease I, snake venom phosphodiesterase, and prostatic acid phosphatase. When using ion exchange chromatography for the adduct enrichment, DNA was digested with micrococcal nuclease and spleen phosphodiesterase. Anion exchange chromatography was applied for 7-methylguanine measurements in white blood cell DNA of healthy nonsmokers (n = 17) and patients (n = 4) treated with the methylating drugs procarbazine and decarbazine. We found that the mean level of 7-methylguanine residues in nonsmokers was 2.5 per 10(7) nucleotides. The corresponding level in the patient samples immediately after the drug treatment was 57 per 10(7) nucleotides.
Diagnostic accuracy of the Multistix 8 SG reagent strip in diagnosis of spontaneous bacterial peritonitis
Authors: Jean‐Baptiste Nousbaum, Jean‐François Cadranel, Pierre Nahon, Eric Nguyen Khac, Richard Moreau, Thierry Thévenot, Christine Silvain, Christophe Bureau, Olivier Nouel, Christophe Pilette, Thierry Paupard, Geoffroy Vanbiervliet, Frédéric Oberti, Thierry Davion, Vincent Jouannaud, Bruno Roche, Pierre‐Henri Bernard, Sandrine Beaulieu, Odile Danne, Dominique Thabut, Carinne Chagneau‐Derrode, Victor de Lédinghen, Philippe Mathurin, Arnaud Pauwels, Jean‐Pierre Bronowicki, François Habersetzer, Armand Abergel, Jean‐Christian Audigier, Thierry Sapey, Jean‐Didier Grangé, Albert Tran
Journal: Hepatology (2007)

Recent studies have shown that the diagnosis of spontaneous bacterial peritonitis (SBP) can be rapidly obtained using leukocyte esterase reagent strips. However, published studies were restricted to one or two centers, and the number of patients with SBP was thus limited. The aims of the current prospective multicenter study were: (1) to assess the diagnostic accuracy of the Multistix 8SG urine test for the diagnosis of SBP; and (2) to assess the prevalence of SBP. From January to May 2004, 2 reactive strips were tested independently in inpatients with cirrhosis and in outpatients undergoing paracentesis. Cultures of ascitic fluid were performed at the bedside using aerobic and anaerobic blood culture bottles. Two thousand one hundred twenty-three paracenteses were performed in 1,041 patients from 70 centers. One hundred seventeen samples, obtained from 91 patients, had ascites polymorphonuclear cell (PMN) counts ≥250/μl (range, 250–34,000), among which 56 were associated with positive ascitic fluid cultures. The prevalence of SBP was 5.5% in the whole population, 9% in inpatients, and 1.3% in outpatients (P < 0.0001). The prevalence of SBP was 0.57% in asymptomatic outpatients versus 2.4% in symptomatic outpatients (P = 0.04). Using a threshold of 2+ for positivity of the reagent strip, sensitivity was 45.3% for the diagnosis of SBP, specificity was 99.2%, positive predictive value was 77.9%, and negative predictive value was 96.9%. Conclusion: This study confirms the low prevalence of SBP in asymptomatic outpatients according to a priori defined criteria, and indicates an absence of diagnostic efficacy for this specific strip test. (HEPATOLOGY 2007;45:1275–1281.)
Report proposes alternative to practice based commissioning
Authors: A. Cole
Journal: BMJ (2009)

Practice based commissioning in England is not working and should be replaced by a system of new groups spanning primary and secondary care with bigger budgets and greater powers, suggests a report published on 24 November. 

The report, from the Nuffield Trust and the NHS Alliance, says that a growing body of research indicates that practice based commissioning is “at best under-developed and at worst in need of major overhaul.”

It proposes instead the creation of a network of “local clinical partnerships,” consisting of GPs, community staff, and secondary care specialists, which would be responsible for providing and commissioning services and would have full accountability for their …
"Smoker's Ulcer"
Authors: Deepak Chopra
Journal: JAMA (1971)

<h3>To the Editor.—</h3> The findings of Jacobson et al (<b>218</b>:180, 1971) do not warrant the conclusion that "correlation between smoking and the occurrence of duodenal ulcers, may be at least partly explained by the simple lack of buffer." Wilkinson and Johnston<sup>1</sup>found a significant inhibition of pentagastrin-stimulated gastric acid secretion in humans after they had smoked a single cigarette. Therefore, if smoking causes significant reduction of acid secretion, obviously less buffer will be required to maintain the same pH.
Childhood and advances in human tool use
Authors: Mark Nielsen
Journal: Behavioral and Brain Sciences (2012)

Human life history incorporates childhood, a lengthy post-weaning period of dependency. This species-specific period provides an opportunity for extensive learning and for sophisticated cultural behaviors to develop, including crucial tool use skills. Although I agree that no individual cognitive trait singularly differentiates humans from other animals, I suggest here that without childhood, the traits that are key to human tool use would not emerge.
Validation of the urine column measurement as an estimation of the intra-abdominal pressure
Authors: Herjan van der Steeg, Jesse P. van Akkeren, Saskia Houterman, Rudi M. H. Roumen
Journal: Intensive Care Medicine (2009)

To evaluate the efficacy of the urine column (UC) measurement compared to the intra-vesicular pressure (IVP) measurement as an estimation of intra-abdominal pressure (IAP) in patients with IAP up to 30 mmHg.Fifteen patients undergoing a laparoscopic cholecystectomy were studied. All patients were catheterized. IVP measurements were performed using a pressure transducer connected to the culture aspiration port. UC measurements were done by holding up the tubing against a measuring rod. The symphysis pubis was used as the zero-reference. IAP was raised from 0 to 30 mmHg using increments of 5 mmHg, during which first the IVP and then UC measurement series were recorded end-expiratory. Fifty and 100 ml of saline were used as a priming volume.The IVP and UC measurements showed a significant correlation with IAP. Comparing IVP and UC showed a correlation of 0.91 (p < 0.001) for 50 ml and 0.87 (p < 0.001) for 100 ml of saline as a priming volume. Using 50 ml of saline, UC was 0.68 mmHg higher than IVP (95% CI -7.21 to +5.85 mmHg). For 100 ml of saline, UC was 1.23 mmHg lower than IVP (95% CI -7.41 to +9.87 mmHg).UC measurement shows significant correlation to IVP measurement as an estimation of the IAP. Further study needs to be done to conclude whether UC measurement is a reliable clinical alternative to IVP measurement.
Science Needs Vigilance Not Vigilantes
Authors: Patricia K. Woolf
Journal: JAMA (1988)

The author maintains that due process was not observed in two recent Congressional inquiries into allegations of misconduct in science. Committees in both hearings did not ask for testimony from either the scientists who were accused of misconduct or from the universities that were charged with failure to respond adequately to those accusations; allegations of scientific error were also accidentally, or possibly deliberately, confounded with suspicions of scientific fraud. The reliance of Congress upon the testimony of two scientists who are not part of the National Institutes of Health's official system for reporting misconduct deters the acquisition of sound, scientific knowledge.
Gallium-67 Uptake in Tuberous Sclerosis
Authors: FOUAD A. RASHAD, FLORO D. MIRALDI, ERROL M. ELLON
Journal: Clinical Nuclear Medicine (1979)

RASHAD, FOUAD A. M.D.; MIRALDI, FLORO D. M.D., ScD.; BELLON, ERROL M. M.D. Author Information
Gamal Serour of the International Federation of Gynecology and Obstetrics (FIGO) replies to Fiona Godlee
Authors: G. Serour
Journal: BMJ (2012)

I read with great interest Fiona Godlee’s Editor’s choice “Promoting cosmetic surgery,”1 and I welcome the opportunity to correct some of the misapprehensions it contains.

Professor Adam Ostrzenski was not personally invited by the International Federation of Gynecology and Obstetrics (FIGO) to present his work during the triennial FIGO world congress. He was invited only in the universal sense that all members of the gynaecological and obstetrics communities were invited to respond to the call for submissions issued by the scientific committee in preparation for FIGO’s 2012 world congress. Professor Ostrzenski, with many others, submitted a request to organise a session. His request was reviewed by the …
Effects of galactose feeding on aldose reductase gene expression.
Authors: R R Wu, P A Lyons, A Wang, A J Sainsbury, S Chung, T N Palmer
Journal: Journal of Clinical Investigation (1993)

Aldose reductase (AR) is implicated in the pathogenesis of the diabetic complications and osmotic cataract. AR has been identified as an osmoregulatory protein, at least in the renal medulla. An outstanding question relates to the response of AR gene expression to diet-induced galactosemia in extrarenal tissues. This paper shows that AR gene expression in different tissues is regulated by a complex multifactorial mechanism. Galactose feeding in the rat is associated with a complex and, on occasions, multiphasic pattern of changes in AR mRNA levels in kidney, testis, skeletal muscle, and brain. These changes are not in synchrony with the temporal sequence of changes in tissue galactitol, galactose, and myoinositol concentrations. Moreover, galactose feeding results in changes in tissue AR activities that are not related, temporally or quantitatively, to the alterations in tissue AR mRNA or galactitol levels. It is concluded that AR gene expression and tissue AR activities are regulated by mechanisms that are not purely dependent on nonspecific alterations in intracellular metabolite concentrations. This conclusion is supported by the finding that chronic xylose feeding, despite being associated with intracellular xylitol accumulation, does not result in alterations in AR mRNA levels, at least in the kidney.
Is Quality Improvement Improving Quality? A View from the Doctor's Office
Authors: Mark Vonnegut
Journal: New England Journal of Medicine (2007)

During the time I have been practicing medicine, the dominant ethos seems to have changed. We have gone from doing the right thing for the patient no matter what to doing the right thing for the patient as long as it doesn't hurt our hospital or practice or the insurance company too much.Years ago, I started receiving report cards from insurers that told me how I was doing relative to other practitioners in terms of hospital utilization, medications, referrals to specialists, and other cost measures. My numbers were usually good, and I could pat myself on the back for . . .
Infiltration of cervical lymph nodes by B‐ and T‐cell non‐Hodgkin's lymphoma and Hodgkin's lymphoma: Preliminary ultrasonic findings
Authors: Satomi Asai, Hayato Miyachi, Chikako Kawakami, Mitsuhiro Kubota, Yuko Kato, Kazuo Shimamura, Yasuhiko Ando
Journal: American Journal of Hematology (2001)

Ultrasonography has been used in the evaluation of enlarged lymph nodes in patients with malignant lymphoma, which comprises a variety of histopathological subtypes. We assessed ultrasonic findings of infiltration in cervical lymph nodes of 47 patients with previously untreated malignant lymphoma and correlated them with histopathological subtypes. Common findings among various histopathological subtypes were hypoechoic masses, spot and/or line echoes, involvement of multiple nodes, and posterior enhancement. In addition, each histopathological subtype showed characteristic findings: Hodgkin's disease had a contour with a lobular pattern (9/10 cases), septum-like echo (9/10 cases), and tubular structure (9/10 cases) in the internal echo, reflecting histopathologically fibrous connective tissue surrounding lymph nodes and small vessels. In B-cell lymphoma, there was characteristically a tendency for lymph node fusion (19/28 cases) and spot and/or line echoes (17/28 cases), reflecting histopathological replacement and destruction of the structure of lymph node and capsule by proliferation of lymphocytes. These findings were strengthened in diffuse large B-cell lymphoma. T-cell lymphoma was distinguished from other types of lymphoma by the presence of a hilum-like echo (6/9 cases), reflecting histopathologically prominent vascularization in lymph nodes accompanied by a dilated hilum area. In summary, this preliminary study suggests that ultrasonic findings of infiltration of cervical lymph nodes in major subtypes of malignant lymphoma could reflect characteristic histopathological structures, therefore providing information helpful for differentiating them.
A Rash Hypothesis
Authors: Anne Y. Liu, Robert C. Lowe, Bruce D. Levy, Joel T. Katz, Joseph Loscalzo
Journal: New England Journal of Medicine (2010)

A 40-year-old woman presented with diarrhea, reporting to her physician that she had been having loose stools for 2 years, with 4 to 5 bowel movements per day, progressing over the previous 6 months to 15 large-volume, watery stools daily, including nocturnal stools.
CALCIUM METABOLISM IN IDIOPATHIC HYPOPARATHYROIDISM
Authors: Alfred Goerner
Journal: JAMA (1934)

Although Salvesen<sup>1</sup>concluded from his work on parathyroidectomized animals that the resulting calcium deficiency in the blood was due to an increased excretion of this element, especially in the intestine, Greenwald and Gross<sup>2</sup>shortly found conclusive evidence that calcium excretion was in fact decreased after parathyroidectomy. They<sup>3</sup>also showed that administration of the hormone increased the amount of the metal to be excreted. The latter result is directly opposed to Salvesen's idea that the internal secretion of the parathyroid aids in the absorption of calcium. Albright and Ellsworth,<sup>4</sup>in their study of calcium metabolism in a person having an idiopathic hypoparathyroidism, confirmed Greenwald's results. This study is interesting in that most other studies of calcium metabolism in parathyroid deficiency were made on animals with the glands removed or on human beings whose deficiency set in after a thyroidectomy. Albright, Bauer, Ropes and Aub<sup>5</sup>also showed
Relevance in Gross Anatomy Teaching
Authors: D.J. Moffatt
Journal: JAMA (1972)

To the Editor.—  For the past four years, the gross anatomy course for medical students at the University of Iowa has been increasingly centered on the use of the student's  motivation. 1 Course objectives have been carefully selected on the basis of the skills the student is likely to need either to facilitate his studies in medical school or his work after graduation. 2 Once weekly, an eminent practicing physician has talked to the class about his everyday tasks and in doing so has demonstrated his use of anatomy in them. Weekly sessions have been used to teach some of the basic skills of physical diagnosis in so far as they can be used to demonstrate the normal anatomy of his colleagues. Clinical problems, dependent for their solutions on basic anatomy, have been made available in simulated form on teaching machines for the students to examine at their leisure.