tbuckley/cabot-search huggingface dataset:
Tackling health inequalities in primary care
Authors: L. Smeeth, I. Heath
Journal: BMJ (1999)

The adverse health effects of social inequality are enormous. In the United Kingdom death rates at all ages are two to three times higher among people in social class V than among those in social class I. 1 2Poor socioeconomic status also erodes social, psychological, and physical health.3 Reducing health inequalities is central to the United Kingdom government's recently outlined health policy,4 a commitment confirmed by the positive reception given to the recently published Acheson report on inequalities in health.5 However, in spite of their importance both to the overall health care of individuals and in health policy, socioeconomic factors are not routinely assessed in clinical practice.

The power of the socioeconomic determinants of ill health requires that we should adapt the traditional medical model. We now understand that diseases have both biological and societal causes, yet our interventions remain focused on the biological.1 We need to begin to take histories which routinely include the eliciting and recording of societal risk factors, and we need …
Evening Insulin Strategy
Authors: Matthew C Riddle
Journal: Diabetes Care (1990)

A series of regimens based on intermediate-acting insulin given in the evening have been proposed as an alternative to conventional insulin therapy for non-insulin-dependent diabetes mellitus (NIDDM). This concept dates back to the earliest use of sustained-action insulin and has a rationale strengthened by recent physiological insights. Specifically, the predominance of fasting over postprandial hypoglycemia and occurrence of the dawn phenomenon in NIDDM argue for carefully timed overnight delivery of insulin. High nocturnal concentrations of free fatty acids in NIDDM may contribute to hepatic insensitivity to insulin and fasting hyperglycemia and can be suppressed by evening insulin. Although several clinical studies suggest that evening insulin regimens are safe and effective, their role in clinical practice is not yet established. Further study of this approach may clarify not only its proper use but also the best use of conventional strategies.
Therapeutic Gastrointestinal Endoscopy
Authors: Ann Ouyang
Journal: JAMA (1987)

This book discusses the indications for, and the techniques of, a number of therapeutic endoscopic procedures. According to the editor, it is aimed at endoscopists with expertise in diagnostic endoscopy and trainees in the latter years of education. It is a multiauthored book, with chapters written by recognized experts and innovators in their areas of expertise. Some of the techniques are being rapidly improved, and some of the discussion is therefore already outdated, but it is one of the few books covering this important area.  The chapters are organized by the organ of interest, starting with the esophagus and working down. The first chapter discusses the management of esophageal strictures. I would take exception to the recommendation that the procedure in patients complaining of dysphagia who have a normal esophagogram and appear normal on an upper endoscopic examination should be dilation with a large mercury-filled bougie. A number of esophageal
Reconstitution of laminin-111 biological activity using multiple peptide coupled to chitosan scaffolds
Authors: Kentaro Hozumi, Ayano Sasaki, Yuji Yamada, Dai Otagiri, Kazuki Kobayashi, Chikara Fujimori, Fumihiko Katagiri, Yamato Kikkawa, Motoyoshi Nomizu
Journal: Biomaterials (2012)
Prevention of Recurrent Idiopathic Venous Thromboembolism
Authors: Samuel Z. Goldhaber
Journal: Circulation (2004)

Idiopathic venous thromboembolism (VTE), unassociated with surgery or trauma, is a chronic illness that warrants the implementation of strategies to prevent recurrence over a lifetime. Clinical trials show that the benefit associated with extended anticoagulation therapy ≤1 year in patients with idiopathic VTE is not maintained over the long term once treatment is discontinued. Controlled trials have established the efficacy of indefinite-duration anticoagulation, even if the therapy used is a novel agent that is not a coumarin derivative. The PREVENT, ELATE, and THRIVE III trials demonstrate that a strategy of long-term anticoagulation in patients with idiopathic VTE, including those with isolated calf deep vein thrombosis, is safe and effective. This successful strategy appears beneficial across all subgroups, regardless of the presence of an identified thrombophilic state. These include both young and old patients of both sexes, those with factor V Leiden or the prothrombin gene mutation, and those with first-time or recurrent VTE. Thus, the default strategy for idiopathic VTE should be universal anticoagulation unless contraindicated. Implementing this proven approach on a population basis would enable prevention of VTE recurrence with minimal individualization of treatment. Because lifelong therapy can exact a psychological and medical cost on the patient as well as the health care provider, future research should be directed to risk stratification of those most susceptible to recurrence. Avenues of investigation currently being evaluated include measurement of d - dimer levels, examination of residual venous thrombosis on ultrasound, and application of risk nomograms.
A Humoral Influence on Cardiovascular Adjustments to Acute and Chronic Posthemorrhagic Anemia in Dogs
Authors: D. W. JUSTUS, R. W. CORNETT, J. D. HATCHER
Journal: Circulation Research (1957)

The possibility that the increased cardiac output observed in severe anemia is due to a humoral mechanism was investigated by an assay procedure in which blood from anemic donor dogs was infused into normal assay dogs. Blood removed from anemic donors during the period of augmented cardiac output and infused into assay dogs produced cardiovascular changes which were statistically different from the changes observed with infusions of normal blood or blood removed from anemic donors when the cardiac output was not elevated.
Alveolar macrophage interaction with air pollution particulates.
Authors: C A Goldsmith, C Frevert, A Imrich, C Sioutas, L Kobzik
Journal: Environmental Health Perspectives (1997)

We applied flow cytometric analysis to characterize the in vitro response of alveolar macrophages (AM) to air pollution particulates. Normal hamster AM were incubated with varying concentrations of residual oil fly ash (ROFA) or concentrated ambient air particulates (CAP). We found a dose-dependent increase in AM-associated right angle light scatter (RAS) after uptake of ROFA (e.g., mean channel number 149.4 +/- 6.5, 102.5 +/- 4.1, 75.8 +/- 3.5, and 61.0 +/- 4.6 at 200, 100, 50, and 25 mg/ml, respectively) or CAP. A role for scavenger-type receptors (SR) in AM uptake of components of ROFA and CAP was identified by marked inhibition of RAS increases in AM pretreated with the specific SR inhibitor polyinosinic acid. We combined measurement of particle uptake (RAS) with flow cytometric analysis of intracellular oxidation of dichlorofluorescin. Both ROFA and CAP caused a dose-related intracellular oxidant stress within AM, comparable to that seen with phorbol myristate acetate (PMA) (e.g., fold increase over control, 6.6 +/- 0.4, 3.6 +/- 0.4, 4.6 +/- 0.5, 200 mg/ml ROFA, 100 mg/ml ROFA, and 10(-7) M PMA, respectively). We conclude that flow cytometry of RAS increases provides a useful relative measurement of AM uptake of complex particulates within ROFA and CAP. Both ROFA and CAP cause substantial intracellular oxidant stress within AM, which may contribute to subsequent cell activation and production of proinflammatory mediators.
The brain as part of an enactive system
Authors: Shaun Gallagher, Daniel D. Hutto, Jan Slaby, Jonathan Cole
Journal: Behavioral and Brain Sciences (2013)

Abstract The notion of an enactive system requires thinking about the brain in a way that is different from the standard computational-representational models. In evolutionary terms, the brain does what it does and is the way that it is, across some scale of variations, because it is part of a living body with hands that can reach and grasp in certain limited ways, eyes structured to focus, an autonomic system, an upright posture, etc. coping with specific kinds of environments, and with other people. Changes to any of the bodily, environmental, or intersubjective conditions elicit responses from the system as a whole. On this view, rather than representing or computing information, the brain is better conceived as participating in the action.
Lung Tissue Concentrations of Nebulized Amikacin during Mechanical Ventilation in Piglets with Healthy Lungs
Authors: IVAN GOLDSTEIN, FREDERIC WALLET, JEROME ROBERT, MARIE-HELENE BECQUEMIN, CHARLES-HUGO MARQUETTE, JEAN-JACQUES ROUBY
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

The tissue concentration of aminoglycosides in lung parenchyma is the main determinant of bactericidal efficiency. The aim of the study was to compare the lung deposition of amikacin administered either by an ultrasonic nebulizer or by intravenous infusion during mechanical ventilation. Eighteen healthy ventilated piglets received a single daily dose of amikacin by intravenous infusion (15 mg · kg− 1) and 18 by aerosol (1 g in 12 ml). The amount of aerosolized amikacin reaching the tracheobronchial tree represented 40 ± 5% of the initial dose with an aerodynamic size distribution showing 50% of particles ranging between 0.5 and 5 μ m mass median diameter. Animals were killed at different time intervals after the second dose. Tissue concentrations of amikacin were determined on cryomixed multiple lung specimen by an immunoenzymatic method. The lung concentrations of nebulized amikacin, peaking at 208 ± 76 μ g · g− 1, were more than 10-fold higher than the lung concentrations of intravenous amikacin and were homogeneously distributed throughout the lung parenchyma. Amikacin plasma concentrations lower than 5 mmol · l− 1 were measured after the sixth hour after the nebulization. In conclusion, the ultrasonic nebulization of amikacin resulted in high tissue concentrations, far above the minimal inhibitory concentrations of most gram-negative strains.
Correction: Hypocitraturia in Patients with Gastrointestinal Malabsorption
Authors: W. D. Armstrong, D. Rudman, J. L. Dedonis, M. H. Kutner
Journal: New England Journal of Medicine (1981)

To the Editor: The report of the extensive investigation by Rudman et al. (September 18 issue) of hypocitraturia in patients with gastrointestinal malabsorption contains some errors pertaining to factors used to convert data and results, given in one unit, to another unit. Also, the results of analyses of urine for citric acid were incorrectly calculated to produce milliequivalent amounts per day, giving values in the authors' tables that are too high. In Table 1 it is stated (second footnote) that milliequivalents of urinary calcium and magnesium may each be converted to milligrams by multiplication by 20. This factor is correct . . .
Prenatal Dichlorodiphenyldichloroethylene (DDE) and Asthma in Children
Authors: Jordi Sunyer, Maties Torrent, Laura Muñoz-Ortiz, Núria Ribas-Fitó, Daniel Carrizo, Joan Grimalt, Josep M. Antó, Paul Cullinan
Journal: Environmental Health Perspectives (2005)

Prevalence of asthma increases with increasing dichlorodiphenyldichloroethylene (DDE) levels. However, the effect of early-life exposure, the fundamental window of exposure, is unknown. We assessed the association between prenatal DDE and other organochlorine compounds, and atopy and asthma during infancy. All women presenting for antenatal care in Menorca (Spain) over 12 months starting in mid-1997 were invited to take part in a longitudinal study; 482 children were subsequently enrolled, and 468 (97.1%) provided complete outcome data up to the fourth year of study. Prenatal exposure of organochlorine compounds was measured in cord serum in 405 (83%) children. Asthma was defined on the basis of wheezing at 4 years of age, persistent wheezing, or doctor-diagnosed asthma. We measured specific immunoglobulin-E (IgE) against house dust mite, cat, and grass in sera extracted at 4 years of age. DDE (median = 1.03 ng/mL) was detected in all children, as well as hexachlorobenzene (0.68 ng/mL) and polychlorobiphenyls (0.69 ng/mL). Wheezing at 4 years of age increased with DDE concentration, particularly at the highest quartile [9% in the lowest quartile (< 0.57 ng/mL) vs. 19% in the highest quartile (1.90 ng/mL); relative risk = 2.63 (95% confidence interval 1.19-4.69), adjusting for maternal asthma, breast-feeding, education, social class, or other organochlorines]. The association was not modified by IgE sensitization and occurred with the same strength among nonatopic subjects and among those with persistent wheezing or diagnosed asthma. DDE was not associated with atopy alone. Prenatal exposure to DDE residues may contribute to development of asthma.
Abstract P6-11-08: Risk of CNS relapse following adjuvant trastuzumab therapy – Updated literature-based meta-analysis
Authors: A Mathew, AM Brufsky
Journal: Cancer Research (2013)

Abstract Background: Randomized trials of adjuvant trastuzumab in HER2-positive early breast cancer observed an increased risk for central nervous system (CNS) as site of first relapse. A meta-analysis of three trials with a total of 6752 patients followed up for a median of 2 years found an 82% increased risk for CNS relapse as first disease free survival (DFS) event with adjuvant trastuzumab use. It is thought that the greater risk for CNS as first relapse site is due to the lack of penetration of trastuzumab through the blood-brain barrier combined with better disease control in other visceral sites rather than the drug itself predisposing patients to CNS disease. Therefore, we hypothesize that the effect size of this association will decrease with increasing duration of follow-up. Methods: A comprehensive literature search was performed. Updated results from the three randomized trials of adjuvant trastuzumab were identified. The NSABP B-31 and the NCCTG N9831 trials compared four cycles of doxorubicin and cyclophosphamide (AC) followed by four cycles of Paclitaxel (T) with the same regimen combined with trastuzumab for a year. The HERA trial compared one or two years of adjuvant trastuzumab with observation. We abstracted the number of CNS relapse events in these trials and performed a meta-analysis with fixed-effect model using Mantel-Haenzel method. Results: Out of a total of 7456 patients included in the analysis, CNS DFS events occurred in 98 patients receiving trastuzumab compared to 68 patients in the control group over a median follow-up period of 4 years. We found a 43% increased risk for CNS relapse as first DFS event in patients who received adjuvant trastuzumab compared to the group that did not receive the drug (RR 1.43; 95% confidence interval 1.06, 1.95). We found no inconsistency in risk ratio estimates between the three trials (I2 = 0%). Discussion: Adjuvant trastuzumab is associated with a higher risk for CNS as first relapse site despite an increase in duration of follow-up. The reduction in effect size from the previously reported 82% increased risk observed with a 2 year follow-up period, to 43% with 4 years of follow-up adds to the body of evidence that the drug itself does not predispose a patient to CNS recurrence. On the contrary, the reduction in effect size could also be attributed to the crossover study design in HERA trial, where nearly 50% of patients in the control group eventually received trastuzumab. In summary, we propose that the adjuvant trials of the newer HER2 targeted therapy should be designed to look into CNS disease as not only first site of recurrence but also gather additional data on all CNS recurrences to further elucidate the mechanism of CNS disease with HER2 directed therapy. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-08.
The SUPPORT project and improving care for seriously ill patients
Authors: W. J. Donnelly
Journal: JAMA (1996)

To the Editor.  —A $28 million,15-hospital clinical trial failed [t]o improve end-of-life decision making and reduce the frequency of a mechanically supported, painful, and prolonged process of dying.2The study's investigators concluded: Enhancing opportunities for more patient-physician communication, although advocated as the major method for improving patient outcomes, may be inadequate to change established practices.  But how did the investigators try to enhance patient-physician communication? [A] skilled nurse augmented the care team to elicit patient preferences, provide prognoses, enhance understanding, enable palliative care, and facilitate advance planning. These nurses were given the responsibility for initiating and continuing conversations with patients or families about, for example, CPR and reporting information about patient preferences to attending physicians. However, there was no requirement for them [attending physicians] to share or discuss the information with the patient or family.  It seems hardly surprising that the study's intervention did not improve patient-physician
Genetics and Disease
Authors: Lester S. King
Journal: JAMA (1965)

Genetics, which integrates basic concepts of biology with clinical medicine, is assuming progressively increased importance in the understanding of disease. The medical community should be pleased, therefore, when new books on genetics appear, to fill the undoubted need for information. However, authors should keep in mind the audience for which they write. Medical students will have lectures and other didactic exercises to elaborate the material in a book. Practicing physicians, however, do not ordinarily have lectures to fall back on. And practicing physicians comprise several groups, those whose knowledge of genetics is quite shaky, those who have had some training in the field, and those with substantial knowledge and sophistication. We may designate these groups as possessing elementary, intermediate, and advanced knowledge. For whom is Dr. Knudson writing? His emphasis throughout lies on disease, rather than on the exposition of genetic principles. He keeps the clinical significance constantly in the
693 PREVENTION OF CHOLESTEROL GALLSTONES FORMATION BY TWO EXTRACTS OF Raphanus sativus L. var niger IN MICE
Authors: I.G. Castro-Torres, J.A. López-Velázquez, V. Sa'nchez-Valle, M. Martínez-Vázquez, M. Uribe, N. Méndez-Sa'nchez
Journal: Journal of Hepatology (2013)
Do-it-yourself cardioversion
Authors: Clive McGavin, Jamie Davies, John Beer
Journal: BMJ (2006)

quality adjusted survival, such as elderly patients or those with chronic disability, are likely to prove less cost effective to treat.To allow discrimination on these grounds would seem analogous to determining treatment on the basis of deservedness.This is the basis of much of the recent controversy regarding the guidance from NICE regarding drugs for Alzheimer's disease 5 ; as well, some would challenge the over-reliance on conventional QALY (quality adjusted life year) measures for assessing the cost effectiveness of interventions in an elderly and chronically disabled population. 6
The effects of the changes of the circadian body rhythm on the sportshooter.
Authors: L. C. Antal
Journal: British Journal of Sports Medicine (1975)

Most men live in a world dominated by a single periodicity, the alternation of light and darkness.This alternation adheres closely to a period of 24 hours, and all our life is geared to it.We wake and sleep, work and rest, eat and fast in a pattern which conforms to this alternation of light and darkness.The chief consequence of technological advance, is that now it is possible, by means of modern transport, to travel rapidly through several time zones and upset the physiological pattern which is known as the circadian rhythm of the human body.I had a unique opportunity to study the effects of long distance travel, and traversing of time zones, had on sportshooters when I travelled with the English shooting team to the British Commonwealth Games in Christchurch, New Zealand.I was able to collect information on the subject, not only from the members of the English team but from those of the Welsh, Scottish and Northern Irish contingent.
Growth control and differentiation in mammary epithelial cells.
Authors: F Borellini, T Oka
Journal: Environmental Health Perspectives (1989)

Growth and differentiation of the mammary gland are controlled by various hormones and other environmental factors. The role of hormones and growth factors in mammary development is discussed with regard to animal species, physiological stages, and the various experimental systems in vitro. In the female embryo, mammary morphogenesis is induced by the mesenchyme and is hormone independent, whereas androgens cause the partial necrosis of mammary epithelium in the male. Ductal growth during adolescence requires estrogen and prolactin or growth hormone. During pregnancy, progesterone participates in the development of the lobuloalveolar structure of the gland. After parturition, changes in the hormonal environment lead to production and secretion of milk. Proliferation and differentiation of mammary epithelium can be induced in culture systems. Insulin and epidermal growth factor (EGF) stimulate mammary cell proliferation in vitro. EGF is required for the optimal growth of the mammary gland during pregnancy. EGF also appears to play an important role in mammary tumorigenesis in certain mouse strains. Production of milk proteins can be induced in vitro by the synergistic interactions of prolactin, insulin, and glucocorticoids and is inhibited by EGF and progesterone. Complete or partial sequencing of several milk protein genes and comparative analysis have led to identification of a sequence of high homology and conservation in the 5' flanking region that is likely to be involved in the regulation of milk protein gene expression.
Cell growth cycle block of T cell hybridomas upon activation with antigen.
Authors: J D Ashwell, R E Cunningham, P D Noguchi, D Hernandez
Journal: The Journal of Experimental Medicine (1987)

Stimulation of antigen-specific T cell hybridomas with the appropriate antigen/MHC combination, at concentrations that resulted in the secretion of the lymphokine interleukin 2, resulted in a dose-dependent decrease in both [3H]thymidine incorporation and cell growth. Flow cytometric studies demonstrated that stimulation with antigen resulted in a cell cycle block that was most evident at the G1/S border, and mixing studies revealed that bystander T cells of different antigen specificities were not affected. For at least the large majority of T cells, the G1/S cell cycle block appeared to be irreversible after 24 h of exposure to antigen. This cell cycle block may be useful as a rapid and quantitative measure of T cell hybridoma activation, as a means of selecting T cell hybridomas that have functional alterations in the reception of stimulatory signals, and may serve as a model of the induction of tolerance in immature T cells.
Primary Hepatocellular Carcinoma
Authors: Jack R. Wands, Hubert E. Blum
Journal: New England Journal of Medicine (1991)

Primary hepatocellular carcinoma is one of the most common tumors in the world, with an estimated 500,000 to 1 million new cases a year. It is particularly common in certain regions of Asia and sub-Saharan Africa,1 where the annual incidence ranges up to 500 cases per 100,000 population. The principal reason for such a high incidence is chronic infection with hepatitis B virus (HBV) and possibly hepatitis C virus (HCV). It has been estimated that approximately 300 million people are chronically infected with HBV, and most reside in these two regions of the world.2 The identification of HCV has prompted . . .