tbuckley/cabot-search huggingface dataset:
Randomized Controlled Trial of Insulin Supplementation for Correction of Bedtime Hyperglycemia in Hospitalized Patients With Type 2 Diabetes
Authors: Priyathama Vellanki, Rachel Bean, Festus A. Oyedokun, Francisco J. Pasquel, Dawn Smiley, Farnoosh Farrokhi, Christopher Newton, Limin Peng, Guillermo E. Umpierrez
Journal: Diabetes Care (2015)

OBJECTIVE Clinical guidelines recommend point-of-care glucose testing and the use of supplemental doses of rapid-acting insulin before meals and at bedtime for correction of hyperglycemia. The efficacy and safety of this recommendation, however, have not been tested in the hospital setting. RESEARCH DESIGN AND METHODS In this open-label, randomized controlled trial, 206 general medicine and surgery patients with type 2 diabetes treated with a basal-bolus regimen were randomized to receive either supplemental insulin (n = 106) at bedtime for blood glucose (BG) &amp;gt;7.8 mmol/L or no supplemental insulin (n = 100) except for BG &amp;gt;19.4 mmol/L. Point-of-care testing was performed before meals, at bedtime, and at 3:00 a.m. The primary outcome was the difference in fasting BG. In addition to the intention-to-treat analysis, an as-treated analysis was performed where the primary outcome was analyzed for only the bedtime BG levels between 7.8 and 19.4 mmol/L. RESULTS There were no differences in mean fasting BG for the intention-to-treat (8.8 ± 2.4 vs. 8.6 ± 2.2 mmol/L, P = 0.76) and as-treated (8.9 ± 2.4 vs. 8.8 ± 2.4 mmol/L, P = 0.92) analyses. Only 66% of patients in the supplement and 8% in the no supplement groups received bedtime supplemental insulin. Hypoglycemia (BG &amp;lt;3.9 mmol/L) did not differ between groups for either the intention-to-treat (30% vs. 26%, P = 0.50) or the as-treated (4% vs. 8%, P = 0.37) analysis. CONCLUSIONS The use of insulin supplements for correction of bedtime hyperglycemia was not associated with an improvement in glycemic control. We conclude that routine use of bedtime insulin supplementation is not indicated for management of inpatients with type 2 diabetes.
Automatic Injection Syringe and Cassette Changer for Cerebral Angiography
Authors: Kurt Amplatz
Journal: JAMA (1963)

Radiographic demonstration of minute vascular detail during cerebral angiography is of paramount diagnostic importance. Commercially available seriographs are not wholly satisfactory for this purpose. To overcome some of the technical difficulties such as vibration and poor screen-film contact, an extremely light, disposable vacuum cassette was constructed. The radiographic film and intensifying screens are placed into a disposable polyethylene bag which is evacuated and heat sealed. These light-weight cassettes are changed in a simple automatic device at a rate of two per second. The device used for injection is a 30 cc glass syringe which has been fitted with a special plunger to reduce friction and make sure of smooth injection at pressures from 1 kg/sq cm to 2 kg/sq cm (14 to 28 lb/sq in).
Early angiotensin-converting enzyme inhibition in Alport syndrome delays renal failure and improves life expectancy
Authors: Oliver Gross, Christoph Licht, Hans J. Anders, Bernd Hoppe, Bodo Beck, Burkhard Tönshoff, Britta Höcker, Simone Wygoda, Jochen H.H. Ehrich, Lars Pape, Martin Konrad, Wolfgang Rascher, Jörg Dötsch, Dirk E. Müller-Wiefel, Peter Hoyer, Bertrand Knebelmann, Yves Pirson, Jean-Pierre Grunfeld, Patrick Niaudet, Pierre Cochat, Laurence Heidet, Said Lebbah, Roser Torra, Tim Friede, Katharina Lange, Gerhard A. Müller, Manfred Weber
Journal: Kidney International (2011)
Bone Marrow–Derived Cardiomyocytes Are Present in Adult Human Heart
Authors: Arjun Deb, Shaohua Wang, Kimberly A. Skelding, Dylan Miller, David Simper, Noel M. Caplice
Journal: Circulation (2003)

Recent studies have identified cardiomyocytes of extracardiac origin in transplanted human hearts, but the exact origin of these myocyte progenitors is currently unknown.Hearts of female subjects (n=4) who had undergone sex-mismatched bone marrow transplantation (BMT) were recovered at autopsy and analyzed for the presence of Y chromosome-positive cardiomyocytes. Four female gender-matched BMT subjects served as controls. Fluorescence in situ hybridization (FISH) for the Y chromosome was performed on paraffin-embedded sections to identify cells of bone marrow origin with concomitant immunofluorescent labeling for alpha-sarcomeric actin to identify cardiomyocytes. A total of 160 000 cardiomyocyte nuclei were analyzed approximating 20 000 nuclei per patient. The mean percentage of Y chromosome-positive cardiomyocytes in patients with sex-mismatched BMT was 0.23+/-0.06%. Not a single Y chromosome-positive cardiomyocyte was identified in any of the control patients. Immunofluorescent costaining for laminin and chromosomal ploidy analysis with FISH showed no evidence of either pseudonuclei or cell fusion in any of the chimeric cardiac myocytes identified.These data establish for the first time human bone marrow as a source of extracardiac progenitor cells capable of de novo cardiomyocyte formation.
Serum uric acid correlates with extracellular superoxide dismutase activity in patients with chronic heart failure
Authors: Hernan Alcaino, Douglas Greig, Mario Chiong, Hugo Verdejo, Rodrigo Miranda, Roberto Concepcion, José Luis Vukasovic, Guillermo Diaz‐Araya, Rosemarie Mellado, Lorena Garcia, Daniela Salas, Leticia Gonzalez, Ivan Godoy, Pablo Castro, Sergio Lavandero
Journal: European Journal of Heart Failure (2008)
Free Clinics
Authors: Kevin C. Kelleher
Journal: JAMA (1991)

FREE CLINICS have formed nationwide as a grass-roots effort to provide health care to a largely indigent and disenfranchised target population. Born in the radical 1960s, free clinics have evolved into well-respected health care centers providing outpatient services primarily to the working poor. Their current success is testimony to their broad-based community support and to the voluntarism of the medical community. With no federal support and little local governmental support, there are over 200 free clinics in the United States, many with 15-year histories. They are functioning with little networking and have developed independent solutions to the problem of providing care to the uninsured. These solutions are surprisingly uniform. First, free clinics are based in neighborhoods where there is need. Access and transportation are big problems for the uninsured, and accessibility is limited by any other solution. Familiarity also encourages use. Also, a strong identification occurs with a neighborhood clinic
Public awareness of hypertension declines in US
Authors: S. Gottlieb
Journal: BMJ (1999)

Public awareness of the dangers of high blood pressure and the importance of controlling it to prevent heart disease and stroke has declined, according to a new study (Hypertension 1999;35:423-30).

The study evaluated the prevalence, awareness, and treatment of hypertension in Olmsted County, Minnesota, a community in which the incidence of stroke …
Breast-Cancer Stromal Cells with<i>TP53</i>Mutations and Nodal Metastases
Authors: Attila Patocs, Li Zhang, Yaomin Xu, Frank Weber, Trinidad Caldes, George L. Mutter, Petra Platzer, Charis Eng
Journal: New England Journal of Medicine (2007)

The importance of cross-talk between a cancer and its microenvironment has been increasingly recognized. We hypothesized that mutational inactivation of the tumor-suppressor gene TP53 and genomic alterations in stromal cells of a tumor's microenvironment contribute to the clinical outcome.We performed TP53 mutation analysis and genomewide analysis of loss of heterozygosity and allelic imbalance on DNA from isolated neoplastic epithelial and stromal cells from 43 patients with hereditary breast cancer and 175 patients with sporadic breast cancer. Compartment-specific patterns and TP53 mutations were analyzed. Associations between compartment-specific TP53 status, loss of heterozygosity or allelic imbalance, and clinical and pathological characteristics were computed.TP53 mutations were associated with an increased loss of heterozygosity and allelic imbalance in both hereditary and sporadic breast cancers, but samples from patients with hereditary disease had more frequent mutations than did those from patients with sporadic tumors (74.4% vs. 42.3%, P=0.001). Only 1 microsatellite locus (2p25.1) in stromal cells from hereditary breast cancers was associated with mutated TP53, whereas there were 66 such loci in cells from sporadic breast cancers. Somatic TP53 mutations in stroma, but not epithelium, of sporadic breast cancers were associated with regional nodal metastases (P=0.003). A specific set of five loci linked to an increased loss of heterozygosity and allelic imbalance in the stroma of sporadic tumors was associated with nodal metastases in the absence of TP53 mutations. No associations were found between any of the clinical or pathological features of hereditary breast cancer with somatic TP53 mutations.Stroma-specific loss of heterozygosity or allelic imbalance is associated with somatic TP53 mutations and regional lymph-node metastases in sporadic breast cancer but not in hereditary breast cancer.
Maintenance of insulin release from pancreatic islets stored in the cold for up to 5 weeks.
Authors: B J Frankel, E Gylfe, B Hellman, L A Idahl
Journal: Journal of Clinical Investigation (1976)

Insulin content and release were measured from hand-dissected pancreatic islets from noninbred ob/ob mice after 1-5 wk storage in tissue culture medium 199 at various temperatures and glucose concentrations. After storage of islets for 1 wk at 37 degrees, 22 degrees, or 8 degrees C in 18 mM glucose medium and preincubation with 1 mM glucose, glucose-stimulated insulin release during the subsequent incubation was only 20-35% of that of fresh islets. The addition of a 4-h period at 37 degrees C with 18 mM glucose between the cold storage and perincubation restored glucose-stimulated insulin release from 8 degrees C stored islets to fresh-islet levels. Release throughout the 1-18 mM glucose range was strikingly parallel to that of fresh islets. Exposure of fresh islets to the same 4-h period increased basal release but did not affect maximal release. When islets were stored at 8 degrees C with 18 mM glucose for more than 1 wk, a short period at 37 degrees C every week was necessary for maintenance of release. After 5 wk of this procedure, glucose-stimulated insulin release was one-third that of fresh islets, or similar to that of islets stored for only 1 wk at 37 degrees C. Storage at 8 degrees C for 1 wk with 3 mM glucose, or continuously for 3 or 5 wk with 18 mM glucose, maintained islet insulin content, whereas release was lost. Thus, glucose-stimulated insulin release is best maintained by storage of pancreatic islets in tissue culture medium with a high concentration of glucose at 8 degrees C with short weekly periods at 37 degrees C.
Tetanus immunization in adults
Authors: D. J. Balestra
Journal: JAMA (1994)

<h3>In Reply.</h3> —I appreciate the opportunity to respond to Dr Johnson and Dr Radecki. As far as the accuracy of the emergency physician numbers, we believe there are two main explanations. It is my understanding that the ACEP estimate of 27000 is on a full-time-equivalent (FTE) basis, and there may be circumstances where individuals do more than one shift, making the FTE contribution greater than the master file head counts. In addition, it is likely that some of those FTEs are provided by physicians of other specialties in the emergency service setting. I would welcome ACEP validation of these suggestions, as well as elaboration of the range of appropriate emergency service staffing models with emergency physicians, other generalist and specialist physicians, and nonphysician providers. I could not agree more with Radecki on the issue of refinements to using head counts as the primary basis for research and analysis and indicated
The 42nd David A. Karnofsky Memorial Award Lecture: Understanding
Authors: Herbert M. Pinedo
Journal: Journal of Clinical Oncology (2015)

The Dutch philosopher Baruch Spinoza (1632 to 1677) taught us in the 17th century that “there is no method without a preexisting idea.” Apart from inspiring me throughout my career, Spinoza has been a central figure in my life and the work I conducted for the largest part of my career at the VU University Medical Center (VUMC) in Amsterdam. In Spinoza, my family background and the city of Amsterdam come together. My ancestors and Spinoza lived not far apart on the same street, Houtgracht, in ancient Amsterdam. Quite recently, I discovered that my mother was a direct descendent of Spinoza. I am therefore proud of my background and the NWO (Netherlands Organisation for Scientific Research) Spinoza Prize, which I received in 1997 in recognition of our translational cancer research at the VUMC in Amsterdam. Translational research has been the focal point of our research endeavors over the past decades and continues to be so. Translational research means establishing a bridge between basic research and clinical oncology and crossing that bridge—back and forth—with the aim of taking diagnostics and treatment from bench to bedside, and vice versa. Translational research is geared toward understanding at the molecular level the cellular changes occurring in our patients. Therefore, we need to study the patient’s blood, other body fluids, tumor fluids, liquid biopsies (circulating tumor cells and DNA), and tissues in the laboratory, in a multidisciplinary patient-centered approach. In doing so, we have to stay open minded and observant, and allow ourselves to be triggered by unexpected findings that call for further investigation, and be ready to move away from rigid guidelines if our results so dictate, on the way to truly personalized medicine. In this article, I will review some of our achievements in five domains of cancer research and management of patients with cancer to illustrate how translational research may contribute to our understanding of the patient, the disease, and the treatment. I will present a number of individual patients from whom we have learned a lot, who have taught us precious lessons and led us to formulate new working hypotheses to be tested in future studies. “Each patient is a pearl”; we should treat each patient as a pearl using our translational research capabilities.
Progress in Anti-Cancer Chemotherapy
Authors: Gerhson Y. Locker
Journal: Annals of Internal Medicine (1998)

Medical Writings1 February 1998Progress in Anti-Cancer ChemotherapyGerhson Y. Locker, MDGerhson Y. Locker, MDNorthwestern University Medical School, Chicago, IllinoisSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-128-3-199802010-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Khayat D, Hortobagyi GN; eds. 227 pages. Boston: Blackwell Science; 1997. $75.00. ISBN 0865425647. Order phone 800-759-6102.Field of medicine: Oncology.Format: Hardcover book.Audience: Cancer researchers and clinicians who wish to review topics outside their areas of expertise. Several chapters might interest a general medicine audience.Purpose: This collection of essays is the first of an annual series designed to “present succinct, high-level, up-to-date information on the many specialties involved in the care of cancer patients.” The emphasis is on publishing advances more quickly than might be possible with a textbook.Content: The book is organized into five parts, ... Author, Article, and Disclosure InformationAffiliations: Northwestern University Medical School, Chicago, Illinois PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 February 1998Volume 128, Issue 3Page: 252KeywordsChemopreventionChemotherapyClinical immunologyColorectal cancerHead and neck cancersImmunologyLesionsLung and intrathoracic tumorsMelanomaPatients ePublished: 15 August 2000 Issue Published: 1 February 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Obamacare's rocky road
Authors: D. Kamerow
Journal: BMJ (2013)

Is there more good than bad here? Who benefits and who suffers?



Health reform has been in US headlines almost every day for months. In September and October the scuttling of “Obamacare” was the major bargaining chip the Republicans tried to use in their battle with the Democrats over shutting down the federal government and raising the debt ceiling. When that failed and they had to relent and reopen the government, the Republicans changed their focus from killing Obamacare to spotlighting the problems people have had trying to sign up for it through the HealthCare.gov website.

Given all that has happened, can the Patient Protection and Affordable Care Act (Obamacare) actually protect patients and make care more affordable?

To answer that question a bit of background is in order. Obamacare was enacted in 2010, with no Republican support and no fine tuning of the law between the two houses of Congress.1 As a result, the mammoth law, which was enormously complex and comprehensive at best, is full of minor (and some major) problems and inconsistencies.

Then the Supreme Court …
A Point in the Treatment of Purulent Ophthalmia
Authors: E. A. Browne
Journal: BMJ (1885)

followed by temporary inflammatory swelling, Nwhich, hiowever, soon subsides.The average interval I have allowed to elapse between each opera.tion, has varied from five days to a fortniglht, and the quantity of blood abstracted from one to three drachms.Smearing the surface with vaseline, and protecting from the outer air, especially in cold weather, is the only additional treatment ineeded, besides such internal remedies, saline aperienlts, alteratives, etc., as the general condition of the patient may indicate.I may add, I have seen no complication, or untoward symptom, result from this method.The use of alcohol must be emphatically denied.I repeat, in all instances, lasting and satisfactory results have been procured, and are attributable to the local depletion, which allows recovery of tone of vessels, the contractibility of which has not been permanently destroyed, and also to the invisible scarring which, by after-contraction, reduces the vascularity of the skin.This after- scarring is' hardly discernible.I regaid this method as capable of preventing cellular, and fibro- cellular, hypertrophy, which results from long continued passive vascular congestion of the nose.CASE I.-Elizabeth W., aged 42, single.Duration, five years.She had frequently taken spirits for alleged "'weak heaft."Debility, dyspepsia, and dysmenorrhcea.Total, 15,750 punctures, distributed over fifteen sittings, and a period of seven months.Commenced Jan- uary 1883.IResult permanent and satisfactory.CASE i. -A surgeon, suffering from acne rosacea and vascular hyper- trophy.Duration, eighteen years; commencing at the age of 15.He had suffered from atonic dyspepsia.In twelve separate sittings, extend- ing over a period of seven months, 11,150 punietures ; commenced January 1882.Result permanent and satisfactory.
F-18 FDG PET-CT Findings in Mikulicz Disease and Systemic Involvement of IgG4-Related Lesions
Authors: Kazuyoshi Suga, Yasuhiko Kawakami, Atsuto Hiyama, Kenji Hori, Megumi Takeuchi
Journal: Clinical Nuclear Medicine (2009)

A 72-year-old woman with Mikulicz disease with pathogically proven sclerosing sialadenitis showed systemic abnormal F-18 FDG uptake in the bilateral lacrimal and submandibular glands, pancreas, abdominal aortic wall, and a retroperitoneal fibroid mass on PET/CT scan, with marked elevation of the serum IgG4 level. This case supports Mikulicz disease being included as 1 of the disorders associated with a new clinical entity of systemic IgG4-related plasmacytic syndrome. A whole-body FDG-PET/CT scan can be expected as a useful tool for detecting systemic involvement in systemic IgG4-related plasmacytic syndrome.
Points: The politics of contraception
Authors: E. Elliott
Journal: BMJ (1980)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following Points: The politics of contraception Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
CARCINOMA CUTIS IN AN ANTHRACENE FACTORY
Authors: W.J. O'DONOVAN
Journal: British Journal of Dermatology (1921)

Journal Article CARCINOMA CUTIS IN AN ANTHRACENE FACTORY Get access W.J. O'DONOVAN, O.B.E., M.D., M.R.C.P. W.J. O'DONOVAN, O.B.E., M.D., M.R.C.P. First Assistant, Dermatological Department, London Hospital Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology and Syphilis, Volume 33, Issue 8-9, 1 August 1921, Pages 291–297, https://doi.org/10.1111/j.1365-2133.1921.tb09053.x Published: 01 August 1921
OPEN SAFETY PIN IN THE STOMACH OF A TWO MONTHS OLD BABY
Authors: Harry Otten
Journal: JAMA (1933)

A baby girl, aged 2 months, swallowed an open safety pin, Oct. 4, 1932. The child had been crying, and to quiet it the mother pressed it against her bosom. As she did so the child's open mouth was pressed against the safety pin in the mother's dress. It promptly swallowed the pin. The use of the roentgenograph the next day and of the fluoroscope each succeeding day for six days showed the open safety pin in the cardiac end of the stomach in the same position as when swallowed. During these days the child was regularly nursed and was given bread and milk, potatoes, and cooked cereals. In addition, a barium meal was given definitely to locate the safety pin in the stomach, and it was also hoped that the barium might carry the pin out of the stomach with it. October 10, it was decided to use operative
The taxes of sin. Do smokers and drinkers pay their way?
Authors: W. G. Manning
Journal: JAMA (1989)

We estimate the lifetime, discounted costs that smokers and drinkers impose on others through collectively financed health insurance, pensions, disability insurance, group life insurance, fires, motor-vehicle accidents, and the criminal justice system. Although nonsmokers subsidize smokers' medical care and group life insurance, smokers subsidize nonsmokers' pensions and nursing home payments. On balance, smokers probably pay their way at the current level of excise taxes on cigarettes; but one may, nonetheless, wish to raise those taxes to reduce the number of adolescent smokers. In contrast, drinkers do not pay their way: current excise taxes on alcohol cover only about half the costs imposed on others.
Patients given LSD may be able to claim compensation
Authors: C. Dyer
Journal: BMJ (1995)

Solicitors acting for dozens of British people who were given lysergide (LSD) in psychiatric hospitals in the late 1950s and early 1960s have won legal aid to investigate a possible claim for compensation. The law firm Alexander Harris, in Sale, Cheshire, has 56 clients who were given the hallucinogenic drug. Mr Edward Myers, a partner, took on the cases after being approached by Mr Ken Purchase, Labour MP for Wolverhampton North East, who has compiled a dossier of nearly 80 such cases. “The more I looked into this, the more I was concerned about what had happened to people,” Mr Purchase said.

Psychiatrists gave LSD to an estimated 4500 patients in Britain in the 1950s and 1960s, mainly those with symptoms of depression. The firm says that many were admitted …