tbuckley/cabot-search huggingface dataset:
Goals of Palliative Care
Authors: Thomas E. Finucane
Journal: Annals of Internal Medicine (2014)

Letters6 May 2014Goals of Palliative CareThomas E. Finucane, MDThomas E. Finucane, MDFrom Johns Hopkins Bayview Medical Center, Baltimore, Maryland.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L14-5009-6 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Broxterman's essay (1) describes the unexpected and wonderful recovery of a 73-year-old man who had been found unconscious. His large, expanding subdural hematoma led to partial uncal herniation. The patient was receiving propofol and fentanyl infusions to achieve standard palliative care goals (that is, “to ensure that the patient [was] comfortable and symptoms [were] well-managed”). When this therapy was discontinued and as the patient recovered, he wrote, “My throat hurts.” Later, he “showed signs of fatigue, so [the narrator] restarted low-dose fentanyl so that [the patient] could rest.” Even under the flag of palliative care, using propofol ...Reference1. Broxterman JT. Miracle on 39th Street. Ann Intern Med. 2013;159:854-5. [PMID: 24490271] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Johns Hopkins Bayview Medical Center, Baltimore, Maryland.Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0081. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMiracle on 39th Street Jane T. Broxterman Goals of Palliative Care Jane T. Broxterman Goals of Palliative Care Jane T. Broxterman Metrics 6 May 2014Volume 160, Issue 9Page: 656KeywordsDisclosureFatiguePalliative carePharyngitisPharynx ePublished: 6 May 2014 Issue Published: 6 May 2014 CopyrightCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Daily determination of individual serum bile acids allows early detection of hepatic allograft dysfunction
Authors: Samy A. Azer, Geoffrey W. McCaughan, Neill H. Stacey
Journal: Hepatology (1994)

Acute graft rejection is still a major cause of morbidity after orthotopic liver transplantation, and its diagnosis necessitates an invasive liver biopsy. Our aim has been to determine whether changes in individual serum bile acid levels after engraftment are sensitive, specific and reliable indicators of graft function and whether these changes can antedate other biochemical indicators of hepatic allograft rejection. Individual bile acids in 200 serum samples taken serially from eight adult liver transplant patients were measured. Patients with biopsy-confirmed graft dysfunction due to rejection or nonrejection causes (n = 6 episodes) had significantly higher serum concentrations of glycocholate plus glycochenodeoxycholate and taurocholate/taurochenodeoxycholate ratios than did noncomplicated grafts (n = 3). These changes antedated any other conventional biochemical parameters by at least 48 hr and were 100% sensitive and specific. None of the conventional liver function tests could match this. Acute rejection episodes (n = 3) were then compared with nonrejection causes of graft dysfunction (n = 3). In acute rejection we noted a significant increase in the concentration of glycodeoxycholate plus deoxycholate and a significant decrease in the cholate/chenodeoxycholate ratio compared with that in nonrejection graft malfunction. Both of these changes antedated any other biochemical parameters by 24 hr. In conclusion, individual serum bile acid assays, after orthotopic liver transplantation, can detect graft dysfunction resulting from any cause at an earlier time than routine biochemical tests, and they are sensitive, specific and reliable for early detection of graft dysfunction. In addition, acute rejection can be distinguished from other causes of graft dysfunction.
Effect of combined lamivudine and interferon alpha treatment on the T-cell response to HBV core peptides in patients with chronic hepatitis B virus infection
Authors: Mhairi Cavers, Marion Aw, Umesh Sharma, Lorenzo D'Antiga, Roger William, Alison Moorat, Martin Greensmith, Mark Atkins, Giorgina Mieli-Vergani, Diego Vergani
Journal: Journal of Hepatology (2002)
Points from Letters: Loose Spectacle Lenses
Authors: J. G. H. Cooper
Journal: BMJ (1947)

patients.The validity of coupons would, of course, have to be confined to the area in which they were issued in order to avoid excessive travelling to Harley Street in search of health, though possibly the nationalization of transport would itself in time prevent people from leaving their birth-place without adequate reason.However, a few starred coupons could be included in each book to allow of consultations with titled specialists.Extra coupons could easily be included for those in occupations having a high sickness rate.Leucotomy coupons could be provided for those engaged in economic planning, and euthanasia coupons for those who, owing to possible visual field defects, can see no future to the left of the left.The whole scheme has the great merit of being simple and easily understood.Book-keeping would be reduced to a mnimum, the cost of the service would be known in advance and could not be exceeded, and all the doctors and consultants would have to do would be to cut out the coupons and affix them to a gummed sheet.
Phenotypic and genotypic characterization of Hodgkin's disease
Authors: P. R. K. Koduru, M. Susin, P. Schulman, D. Catell, J. C. Goh, L. Karp, J. D. Broome
Journal: American Journal of Hematology (1993)

Although a few studies have reported clonal cytogenetic changes in Hodgkin's disease (HD), their correlation with histologic groups is poorly defined. This is because of insufficient numbers of clonally abnormal cases ascertained in each of these studies, an inherent problem associated with the cytogenetic studies of HD. In this report we present results of pathologic, phenotypic, and genetic studies on 29 HD tumors consecutively ascertained by us and the results of a comprehensive analysis of the cytogenetic data available in the literature. In our series 75% of the tumors were positive for Epstein-Barr virus (EBV) by polymerase chain reaction (PCR) assay. A higher frequency of EBV-positive tumors showed clonal karyotypic abnormalities than the EBV-negative tumors. Unlike the case in the previous reports, none of the 24 tumors studied by PCR showed the presence of t(14;18) (q32;q21)-carrying cells. From the comprehensive analysis of the literature, we identified recurring nonrandom numerical changes, deletions, and chromosome breaks in HD. Some of these are associated either with nodular sclerosis or with mixed cellular histologies. A comparison of the pattern of these nonrandom cytogenetic changes in HD and those reported for non-Hodgkin's lymphomas (NHL) identified common deletions and breaks between them. These common genetic lesions probably play a role in disease evolution.
Postprandial Glucose Improves the Risk Prediction of Cardiovascular Death Beyond the Metabolic Syndrome in the Nondiabetic Population
Authors: Hung-Ju Lin, Bai-Chin Lee, Yi-Lwun Ho, Yen-Hung Lin, Ching-Yi Chen, Hsiu-Ching Hsu, Mao-Shin Lin, Kuo-Liong Chien, Ming-Fong Chen
Journal: Diabetes Care (2009)

OBJECTIVE With increasing evidence about the cardiovascular risk associated with postprandial nonfasting glucose and lipid dysmetabolism, it remains uncertain whether the postprandial glucose concentration increases the ability of metabolic syndrome to predict cardiovascular events. RESEARCH DESIGN AND METHODS This was an observational study of 15,145 individuals aged 35–75 years without diabetes or cardiovascular diseases. Postprandial glucose was obtained 2 h after a lunch meal. Metabolic syndrome was diagnosed using the criteria of the U.S. National Cholesterol Education Program Adult Treatment Panel III. Cardiovascular and all-cause deaths were primary outcomes. RESULTS During a median follow-up of 6.7 years, 410 individuals died, including 82 deaths from cardiovascular causes. In a Cox model adjusting for metabolic syndrome status as well as age, sex, smoking, systolic blood pressure, LDL, and HDL cholesterol levels, elevated 2-h postprandial glucose increased the risk of cardiovascular and all-cause death (per millimole per liter increase, hazard ratio 1.26 [95% CI 1.11–1.42] and 1.10 [1.04–1.16], respectively), with significant trends across the postprandial glucose quintiles. Including 2-h postprandial glucose into a metabolic syndrome–included multivariate risk prediction model conferred a discernible improvement of the model in discriminating between those who died of cardiovascular causes and who did not (integrated discrimination improvement 0.4, P = 0.005; net reclassification improvement 13.4%, P = 0.03); however, the improvement was only marginal for all-cause death. CONCLUSIONS Given the risk prediction based on metabolic syndrome and established cardiovascular risk factors, 2-h postprandial glucose improves the predictive ability to identity nondiabetic individuals at increased risk of cardiovascular death.
A time for courage
Authors: Fiona Godlee
Journal: BMJ (2006)

More than a decade ago, in an editorial entitled “Where now for the NHS reforms?” Chris Ham asked “what is the purpose of a national health service?” ( BMJ 1994;309: 351-2) This week Neville Goodman says it's a question that governments refuse to ask (p 363). Until it is answered, he says, “we will stagger from crisis to crisis, pressure groups forcing the government to give in on expensive but dubious therapies, while the government imagines that all it needs is the next big restructuring to get things right.”

It all sounds depressingly familiar. A range of news and views in this week's BMJ …
Dietary protein effects on cadmium and metallothionein accumulation in the liver and kidney of rats.
Authors: N W Revis, T R Osborne
Journal: Environmental Health Perspectives (1984)

The relationship of dietary protein to cadmium absorption and tissue deposition was studied in male Sprague-Dawley rats exposed to different levels of cadmium in the drinking water. In animals fed a high-protein or low-protein diet and drinking water containing 25 or 50 ppm cadmium, liver and kidney cadmium and metallothionein were both significantly higher in rats fed the high-protein diet for 2 to 4 months. These differences may possibly be explained by the concentration of cysteine observed between these two diets. When cysteine was added to the low-protein diet to the level observed in the high-protein diet and fed to rats receiving 25 ppm cadmium in the drinking water, significant dietary differences in liver and kidney cadmium and metallothionein were not observed. The importance of dietary protein to cadmium-induced toxicity was also assessed in these studies. The activity of catechol-o-methyltransferase was used as a measure of cadmium-induced toxicity. The activity of this enzyme in the lung, liver and heart was significantly lower in rats fed a low-protein diet than those fed the high-protein diet and 50 ppm cadmium. Metallothionein concentration in the lung and liver from low-protein-fed rats was approximately half the level observed in rats fed the high-protein diet, which suggests a relationship between cadmium-induced toxicity and metallothionein concentrations. These results illustrate the importance of considering dietary protein (and possibly cysteine) when studying cadmium metabolism in experimental animals.
Altered focal adhesion regulation correlates with cardiomyopathy in mice expressing constitutively active rac1
Authors: Mark A. Sussman, Sara Welch, Angela Walker, Raisa Klevitsky, Timothy E. Hewett, Robert L. Price, Erik Schaefer, Karen Yager
Journal: Journal of Clinical Investigation (2000)

The ras family of small GTP-binding proteins exerts powerful effects upon cell structure and function. One member of this family, rac, induces actin cytoskeletal reorganization in nonmuscle cells and hypertrophic changes in cultured cardiomyocytes. To examine the effect of rac1 activation upon cardiac structure and function, transgenic mice were created that express constitutively activated rac1 specifically in the myocardium. Transgenic rac1 protein was expressed at levels comparable to endogenous rac levels, with activation of the rac1 signaling pathway resulting in two distinct cardiomyopathic phenotypes: a lethal dilated phenotype associated with neonatal activation of the transgene and a transient cardiac hypertrophy seen among juvenile mice that resolved with age. Neither phenotype showed myofibril disarray and hypertrophic hearts were hypercontractilein working heart analyses. The rac1 target p21-activated kinase translocated from a cytosolic to a cytoskeletal distribution, suggesting that rac1 activation was inducing focal adhesion reorganization. Corroborating results showed altered localizations of src in dilated cardiomyopathy and paxillin in both cardiomyopathic phenotypes. This study, the first examination of rac1-mediated cardiac effects in vivo, demonstrates that dilation and hypertrophy can share a common molecular origin and presents evidence that both timing and concurrent signaling from multiple pathways can influence cardiac remodeling.
Measuring urinary tubular biomarkers in type 2 diabetes does not add prognostic value beyond established risk factors
Authors: Bryan R. Conway, Deepika Manoharan, Divya Manoharan, Sara Jenks, James W. Dear, Stela McLachlan, Mark W.J. Strachan, Jackie F. Price
Journal: Kidney International (2012)

Tubulointerstitial disease plays an important role in the pathophysiology of diabetic kidney disease. To determine whether biomarkers of tubular injury could predict renal outcome and mortality in patients with type 2 diabetes, we measured urinary levels of kidney injury molecule-1 (KIM-1) and glycoprotein non-metastatic melanoma B (Gpnmb), both normalized to the urinary creatinine, in 978 individuals from the Edinburgh Type 2 Diabetes Study. At baseline, 238 patients had an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m2 while 147 and 15 patients had microalbuminuria or overt proteinuria, respectively. Both the urine KIM-1 and Gpnmb to creatinine ratios correlated with the urinary albumin to creatinine ratio, the duration of diabetes, and the stringency of glycemic control but not with blood pressure or baseline eGFR. Higher ratios of each marker were associated with a faster decline in kidney function during 4 years of follow-up; however, this was not independent of the urinary albumin to creatinine ratio. Higher KIM-1, but not Gpnmb ratios were associated with an increased risk of mortality, but this association was no longer significant after adjustment for other risk factors, in particular albuminuria. Thus, tubular injury in persons with type 2 diabetes may contribute to the decline in kidney function; however, measuring the urinary concentration of these two tubular biomarkers does not confer additional prognostic information beyond established risk factors.
<i>Cogito Ergo Sum</i>by MRI
Authors: Allan H. Ropper
Journal: New England Journal of Medicine (2010)

What is left of the human being when the brain is badly damaged has been a question for philosophers and theologians. Now, however, an imaginative series of experiments using functional magnetic resonance imaging (MRI) of the brain, culminating in the article by Monti and colleagues in this issue of the Journal, 1 has revealed a form of preserved cognition in ostensibly unconscious patients.The unfortunate term "vegetative" has been used to describe patients whose eyes open after a period of coma but who lack any meaningful responses to stimuli. Open eyes give the impression of normal alertness, but the patient's behavioral . . .
How the Oral Contraceptives Came to be Developed
Authors: Joseph W. Goldzieher
Journal: JAMA (1974)

IT IS an appealing and romantic notion to think that great discoveries spring fullblown from the brow of genius, catalyzed by trivial events such as an overflowing bathtub or a falling apple; indeed, some great discoveries may have happened in this way. However, in today's world, with its virtually instant information access and the living presence of nine tenths of all the scientists who ever existed, discoveries are more likely to arise from a coincidence of information, technological advances, intellectual and societal timeliness, and financial support. The development of hormonal contraceptives is one of the epochal events of the 20th century. Its direct and remote effects on moral, social, and other cultural values; on the interaction of population, resources, and environment; and thus on the ultimate state of the human condition remain for future historians to assess. <h3>The Idea</h3> It has been said that every idea has a pedigree. The
468 ALCOHOL INDUCED LIVER INJURY MOBILISES HAEMATOPOIETIC STEM CELLS THAT CONTRIBUTE TO HEPATIC FIBROSIS
Authors: E. Dalakas, P.N. Newsome, S. Boyle, A. Pryde, W.A. Bickmore, P.C. Hayes, D.J. Harrison, J.N. Plevris
Journal: Journal of Hepatology (2008)
OUTCOMES OF PATIENTS WITH ATRIAL FIBRILLATION AND SIGNIFICANT VALVULAR LESIONS: COMPARISON OF THE EFFECTS OF RIVAROXABAN AND WARFARIN IN THE ROCKET AF TRIAL
Authors: Guenter Breithardt, Scott Berkowitz, Helmut Baumgartner, Anne Hellkamp, Jonathan Piccini, Susanna Stevens, Yuliya Lokhnygina, Manesh Patel, Jonathan Halperin, Daniel Singer, Graeme Hankey, Werner Hacke, Richard Becker, Christopher Nessel, Kenneth Mahaffey, Robert Califf, Keith Fox
Journal: Journal of the American College of Cardiology (2013)
A Functional Approach to Neuroanatomy
Authors: Lawrence C. Parish
Journal: JAMA (1960)

The general outline of most of the chapters includes where applicable: external anatomy, internal structure, embryology, function, reflex, clinical application, and summary with tables. One of the important considerations in the format is the tabular summary which permits the reader to locate readily information at the end of each chapter. Another point worthy of comment are the illustrations. Whether the drawings be suggested by fresh specimens or from other sources, Pansky has done a commendable job. Whereas most medical illustrators are so intent upon including every intricate detail, this artist has simplified his illustrations, without omitting any necessary aspect of neuroanatomy. Because of this type of pen and ink drawing, the student will experience little difficulty in mentally projecting the illustrations to wet material and from there to memory. The authors have succeeded when they said, "It is our hope that the student will be able to direct his efforts
THE USE OF "PATENT REMEDIES" BY TUBERCULOUS PATIENTS
Authors: LINSLY R. WILLIAMS
Journal: JAMA (1930)

How great a menace is the "patent medicine" man to the consumptive of today? This is a question that can probably never be answered with any degree of accuracy. So far as we have been able to ascertain, no study of the extent to which packaged medicines, put up under trade-marked names for self-medication, have been used by any specific group has been made in the past. It is probably fair to assume, however, that in years gone by, before the passage of the Food and Drugs Act made it illegal for a nostrum to carry a false and misleading label on the package, the use of quack remedies was widespread. While the passage of the act materially reduced the sale of many remedies that had been making claims impossible of fulfilment, it left the way open for a continuance of false and misleading statements in newspapers and other mediums.
Blood Lead Secular Trend in a Cohort of Children in Mexico City (1987–2002)
Authors: Lourdes Schnaas, Stephen J. Rothenberg, María-Fernanda Flores, Sandra Martínez, Carmen Hernández, Erica Osorio, Estela Perroni
Journal: Environmental Health Perspectives (2004)

We determined the secular trend in blood lead levels in a cohort of 321 children born in Mexico City between 1987 and 1992. Blood lead level was measured every 6 months during a 10-year period. We modeled the effect of yearly air lead concentration nested within the calendar year in which the child was born, family use of lead-glazed pottery, socioeconomic status, year in which the child was born, age of the child at the time of blood lead measurement, place of residence, and an indicator variable for subjects with complete or incomplete blood lead values. The yearly mean of air lead of the Valley of Mexico decreased from its highest level of 2.80 microg/m3 in 1987 to 0.07 microg/m3 in 2002. The contribution of air lead to blood lead according to year of birth was strongest for subjects born in 1987 and fell to nearly zero for children born in 1992. The geometric mean of the entire cohort rose from 8.4 microg/dL in the first year of life to 10.1 microg/dL in the second and decreased thereafter until it reached 6.4 microg/dL at 10 years of age. Children of families who used lead-glazed ceramics had blood lead levels 18.5% higher than did children of nonusing families. Children who belonged to the lowest socioeconomic levels had blood lead levels 32.2% higher than did those of highest socioeconomic levels. Children who lived in the northeast part of the city had blood lead levels 10.9% higher compared with those who lived in the southwest.
Abstract 2959: Celarstrol enhances TNF-induced neuroblastoma cells death by promoting ROS-mediated programmed necrosis.
Authors: Ming Zhao, Song Lin, Xiang Cheng, Guozhu Chen, Xiaodan Yu
Journal: Cancer Research (2013)

Abstract Celastrol is an active ingredient of the traditional Chinese medicinal plant Tripterygium Wilfordii, which exhibits significant antitumor activity in different cancer models in vitro and in vivo. Previous studies have showed that celastrol kills cancer cells by inducing apoptosis, in this study, we reported that celastrol has potential to enhance TNF-induced necroptosis in SH-SY5Y neuroblastoma cells. Low dose of TNFα plus celastrol induced remarkable cell death which could be prevented by RIP1 kinase inhibitor Necrostatin-1, but exacerbated by caspase inhibitor Z-VAD-FMK. The mechanism for celastrol to enhance TNF-induced necroptosis involves promoting prolonged JNK activation and inducing ROS accumulation. TNFα plus celastrol induced cell death and mitochondrial outer membrane permeabilization (MOMP) could be reversed by ROS scavenger BHA. In addition, Mdivi-1, an inhibitor of mitochondrial fission protein Drp-1, could also block TNFα plus celastrol induced cell death and MOMP, which is consistent with previous elucidation that RIP1/RIP3 mediated cell death signal through Drp-1 to induced necroptosis. The effect of celastrol on enhancing cancer cells programmed necrosis may provide a new way to overcome the resistance chemotherapy induced by evading apoptosis in some cancer cells. Citation Format: Ming Zhao, Song Lin, Xiang Cheng, Guozhu Chen, Xiaodan Yu. Celarstrol enhances TNF-induced neuroblastoma cells death by promoting ROS-mediated programmed necrosis. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2959. doi:10.1158/1538-7445.AM2013-2959 Note: This abstract was not presented at the AACR Annual Meeting 2013 because the presenter was unable to attend.