tbuckley/cabot-search huggingface dataset:
The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials
Authors: J J Brugts, T Yetgin, S E Hoeks, A M Gotto, J Shepherd, R G J Westendorp, A J M de Craen, R H Knopp, H Nakamura, P Ridker, R van Domburg, J W Deckers
Journal: BMJ (2009)

<b>Objectives</b> To investigate whether statins reduce all cause mortality and major coronary and cerebrovascular events in people without established cardiovascular disease but with cardiovascular risk factors, and whether these effects are similar in men and women, in young and older (&gt;65 years) people, and in people with diabetes mellitus. <b>Design</b> Meta-analysis of randomised trials. <b>Data sources</b> Cochrane controlled trials register, Embase, and Medline. <b>Data abstraction</b> Two independent investigators identified studies on the clinical effects of statins compared with a placebo or control group and with follow-up of at least one year, at least 80% or more participants without established cardiovascular disease, and outcome data on mortality and major cardiovascular disease events. Heterogeneity was assessed using the Q and I<sup>2</sup> statistics. Publication bias was assessed by visual examination of funnel plots and the Egger regression test. <b>Results</b> 10 trials enrolled a total of 70 388 people, of whom 23 681 (34%) were women and 16 078 (23%) had diabetes mellitus. Mean follow-up was 4.1 years. Treatment with statins significantly reduced the risk of all cause mortality (odds ratio 0.88, 95% confidence interval 0.81 to 0.96), major coronary events (0.70, 0.61 to0.81), and major cerebrovascular events (0.81, 0.71 to 0.93). No evidence of an increased risk of cancer was observed. There was no significant heterogeneity of the treatment effect in clinical subgroups. <b>Conclusion</b> In patients without established cardiovascular disease but with cardiovascular risk factors, statin use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events.
GPs battling in "David versus Goliath" over out-of-hours tenders, says RCGP
Authors: G. Iacobucci
Journal: BMJ (2015)

GPs who want to run local out-of-hours services in their area should not have to compete with large private companies in “David versus Goliath” battles, the Royal College of General Practitioners has argued.

A new report from the RCGP said that many GPs in England wanted to be more involved in providing out-of-hours services but were being held back by tendering processes that made it difficult for small providers to compete with larger organisations on cost.1 It said that general practices risked being “priced out” of the market …
Reviews and Notes: Essentials of Internal Medicine
Authors: John Collins Harvey
Journal: Annals of Internal Medicine (1995)

Literature of Medicine15 January 1995Reviews and Notes: Essentials of Internal MedicineJohn Collins Harvey, MD, PhDJohn Collins Harvey, MD, PhDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-2-199501150-00030 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Essentials of Internal MedicineSecond edition. William N. Kelley; ed. 826 pages. Philadelphia: J. B. Lippincott; 1994. $32.95.This is one of many major textbooks of medicine on the market today. To be useful to medical students and to younger physicians in their residency training, such texts must now fill several needs. They must be authoritative and well written in a style that is acceptable to the U.S. medical culture. They must be encyclopedic and must contain individual articles concise enough to be readable in a fairly short period of time. They must contain not only comprehensive descriptions of the ... Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 January 1995Volume 122, Issue 2Page: 159KeywordsAlgorithmsResidency Issue Published: 15 January 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The prevalence of IgE sensitization to formaldehyde in asthmatic children
Authors: S. Doi, S. Suzuki, M. Morishita, M. Yamada, Y. Kanda, S. Torii, T. Sakamoto
Journal: Allergy (2003)

Background: Formaldehyde (FA) is well documented as a cause of occupational asthma. Recently, attention has been paid to FA as an allergen and a pollutant that enhances allergic sensitization. We have investigated the prevalence of FA‐specific IgE in asthmatic children and the correlation between IgE sensitization to FA and the severity of asthma. Methods: One hundred and fifty‐five children were investigated, 122 of them asthmatic and 33 nonallergic. Specific IgE against FA was measured by CAP RAST. In addition, the patients answered a questionnaire, containing questions on clinical features of their asthma, their living conditions, and symptoms of mucosal irritation. Results: Of all the subjects assessed, FA‐specific IgE was detected in only two asthmatics, and their IgE levels of FA were low (0.42 and 0.46 UA/ml). One of the two patients with FA‐specific IgE had severe asthma and frequent symptoms of mucosal irritation, but the other had mild asthma and only rare symptoms of mucosal irritation. Conclusions: The prevalence of IgE sensitization to FA appears very low in Japanese children, whether or not they have asthma. Therefore, it appears likely that FA is not one of the major allergens causing childhood asthma.
Christmas picture quiz
Authors: C. R. L. H. Cheung, C. L. Johnston
Journal: BMJ (2011)

<h3>Abstract</h3> <h3>Introduction</h3> A lot of research is available about clear cell renal carcinomas (ccRCC). But there are lesser known facts about other subtypes of renal malignancies. With advances in immunohistochemical and cytogenetic techniques, new variants of renal tumors are being increasingly reported. The treatment and prognosis of such rare malignancies is still an enigma. We performed this study to analyze the incidence, clinico-pathological features, surgical treatment, and survival of non-clear cell RCC at our institution. <h3>Materials and Methods</h3> The histopathological reports of 77 Nephrectomy specimens who underwent surgical treatment for suspected renal tumors from 2013-2018 were retrospectively reviewed. 19 (24%) of patients had documented uncommon histologic variants of RCC. The clinical, demographic, and histologic characteristics of these patients were analyzed, and survival was evaluated. The characteristic light microscopy and immunohistochemical features of these lesions were documented. <h3>Results</h3> Mean age was 45 years (21-67 years). Out of 19 patients, 14 (73.6%) were males, and 5 (26.4%) were females. Mean tumor size was 12 (6-31) cm in the largest dimension. 17 (22%) patients underwent radical nephrectomy, and 2 (2.5%) were treated with partial nephrectomy. Patients with collecting duct, synovial sarcoma, and primitive neuro-ectodermal tumor (PNET) had associated inferior vena caval thrombus and underwent venous thrombectomy. Adjuvant treatment in the form of chemotherapy was instituted in collecting duct, adult Wilms and pure sarcomas. There was no mortality in the papillary carcinoma, and the worst prognosis was encountered in <h3>Conclusion</h3> Sarcomatoid and collecting duct variants were associated with worse prognosis. Presently, aggressive surgical extirpation is the mainstay in the management of these histologic variants. Adjuvant chemotherapy and TKI inhibitors have a limited role.
Training the General Internist
Authors: FREDERIC W. PLATT
Journal: Annals of Internal Medicine (1977)

Letters and Corrections1 September 1977Training the General InternistFREDERIC W. PLATT, M.D.FREDERIC W. PLATT, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-87-3-379_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Those of us who are engaged in the training of internists appreciate any help we can get to better understand the attributes of the general internists and appropriate educational programs. Thus, I read "Attributes of the General Internist and Recommendations for Training" (Ann Intern Med 86:472-473, 1977) with interest. I am impressed with the thoughtful nature of the article but am distressed by two missing features.First, the essay is essentially anonymous: the authors are identified only as the Council on General Internal Medicine of the American Board of Internal Medicine. Because the essay presents conclusions rather... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: FREDERIC W. PLATT, M.D.Affiliations: Presbyterian Medical Center 1719 E. 19th Ave. Denver, CO 80218 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1977Volume 87, Issue 3Page: 379-379 ePublished: 1 December 2008 Issue Published: 1 September 1977 PDF downloadLoading ...
Toward the effective surveillance of hypospadias.
Authors: Helen Dolk, Martine Vrijheid, John E S Scott, Marie-Claude Addor, Bev Botting, Catherine de Vigan, Hermien de Walle, Ester Garne, Maria Loane, Anna Pierini, Sixto Garcia-Minaur, Nigel Physick, Romano Tenconi, Awi Wiesel, Elisa Calzolari, David Stone
Journal: Environmental Health Perspectives (2003)

Concern about apparent increases in the prevalence of hypospadias--a congenital male reproductive-tract abnormality--in the 1960s to 1980s and the possible connection to increasing exposures to endocrine-disrupting chemicals have underlined the importance of effective surveillance of hypospadias prevalence in the population. We report here the prevalence of hypospadias from 1980 to 1999 in 20 regions of Europe with EUROCAT (European Surveillance of Congenital Anomalies) population-based congenital anomaly registers, 14 of which implemented a guideline to exclude glanular hypospadias. We also report data from the England and Wales National Congenital Anomaly System (NCAS). Our results do not suggest a continuation of rising trends of hypospadias prevalence in Europe. However, a survey of the registers and a special validation study conducted for the years 1994-1996 in nine EUROCAT registers as well as NCAS identified a clear need for a change in the guidelines for registration of hypospadias. We recommend that all hypospadias be included in surveillance, but that information from surgeons be obtained to verify location of the meatus, and whether surgery was performed, in order to interpret trends. Investing resources in repeated special surveys may be more cost-effective than continuous population surveillance. We conclude that it is doubtful whether we have had the systems in place worldwide for the effective surveillance of hypospadias in relation to exposure to potential endocrine-disrupting chemicals.
Inhibition of T Cell and Promotion of Natural Killer Cell Development by the Dominant Negative Helix Loop Helix Factor Id3
Authors: Mirjam H.M. Heemskerk, Bianca Blom, Garry Nolan, Alexander P.A. Stegmann, Arjen Q. Bakker, Kees Weijer, Pieter C.M. Res, Hergen Spits
Journal: The Journal of Experimental Medicine (1997)

Bipotential T/natural killer (NK) progenitor cells are present in the human thymus. Despite their bipotential capacity, these progenitors develop predominantly to T cells in the thymus. The mechanisms controlling this developmental choice are unknown. Here we present evidence that a member(s) of the family of basic helix loop helix (bHLH) transcription factors determines lineage specification of NK/T cell progenitors. The natural dominant negative HLH factor Id3, which blocks transcriptional activity of a number of known bHLH factors, was expressed in CD34+ progenitor cells by retrovirus-mediated gene transfer. Constitutive expression of Id3 completely blocks development of CD34+ cells into T cells in a fetal thymic organ culture (FTOC). In contrast, development into NK cells in an FTOC is enhanced. Thus, the activity of a bHLH transcription factor is necessary for T lineage differentiation of bipotential precursors, in the absence of which a default pathway leading to NK cell development is chosen. Our results identify a molecular switch for lineage specification in early lymphoid precursors of humans.
Restless Legs Syndrome, with Particular Reference to its Occurrence After Gastric Surgery
Authors: N. K. Banerji, L. J. Hurwitz
Journal: BMJ (1970)

There is a higher incidence of restless legs syndrome (Ekbom's syndrome) in patients after gastric surgery (11.3%) and with diabetes mellitus (17.0%) and uraemia (17.3%) than in patients who have been diagnosed as having a psychonoeurosis (4.0%) and in controls (2.0%). Three patients with malabsorption syndrome complained of restless legs, but these patients had abnormal neurological signs. The incidence after gastric surgery and in diabetes mellitus and uraemia remained high even when patients with any abnormal neurological signs were excluded.
Endoscopic Appearance of the Normal Biliary System
Authors: K. A. Lennert
Journal: Endoscopy (1989)

Both rigid and flexible instruments can be used for endoscopic examination of the biliary tract. The approach is via the cystic duct or by means of a choledochotomy. The stump of the ductus cysticus will be useful if it is necessary to clarify a pathological finding in the distal bile duct or in the region of the papilla of Vater. Usually, however, the instrument is introduced by means of a choledochotomy. First of all, the distal region including the papilla of Vater and then the proximal part of the biliary system are closely examined. The normal biliary duct wall appears yellowish-red without showing the vascular structure. The papilla of Vater region presents a honeycomb appearance. Special emphasis in endoscopic examination is on papilla function, i.e. the opening or closing of the papilla if liquid is allowed to flow in. Results of 935 endoscopic examinations are reported.
Nepal boosts distribution of iodised salt in bid to eradicate iodine deficiency disorders
Authors: K. Dahal
Journal: BMJ (2009)

Nepal’s health ministry plans to make iodised salt available to 90% of the country’s population by 2010 in a bid to eradicate iodine deficiency disorders in the country by the end of 2011. 

Govinda Prasad Ojha, director general of the Department of Health Services, said, “The situation of salt distribution has improved in urban areas and transportation accessible areas, but a lot needs to be done to improve iodised …
Chymopapain Chemonucleolysis In Lumbar Disk Disease
Authors: A. S. Russell
Journal: JAMA (1975)

<h3>To the Editor.—</h3> Wiltse et al have given us an excellent review of chymopapain chemonucleolysis in lumbar disk disease (231:474, 1975). Although they themselves have performed this procedure in 1,200 cases of lumbar disk disease, it is disappointing that all they can conclude is that "chemonucleolysis appears to be as good as laminectomy in properly selected cases." It is unfortunate to find that despite the many thousands of patients treated with this agent, Wiltse et al cannot quote a single example where the correct study has been performed, ie, comparison of the effect of therapy with the active agent, chymopapain, to that of either no treatment at all or an appropriate placebo. In their study, Wiltse and co-workers note that 48.2% of the patients treated did not achieve their optimal result until at least four months after therapy. This looks remarkably like the natural history of lumbar disk disease. The
Withholding parenteral nutrition during critical illness increases plasma bilirubin but lowers the incidence of biliary sludge
Authors: Yoo-Mee Vanwijngaerden, Lies Langouche, Richard Brunner, Yves Debaveye, Marijke Gielen, Michael Casaer, Christopher Liddle, Sally Coulter, Pieter J. Wouters, Alexander Wilmer, Greet Van den Berghe, Dieter Mesotten
Journal: Hepatology (2013)

Cholestatic liver dysfunction (CLD) and biliary sludge often occur during critical illness and are allegedly aggravated by parenteral nutrition (PN). Delaying initiation of PN beyond day 7 in the intensive care unit (ICU) (late PN) accelerated recovery as compared with early initiation of PN (early PN). However, the impact of nutritional strategy on biliary sludge and CLD has not been fully characterized. This was a preplanned subanalysis of a large randomized controlled trial of early PN versus late PN (n = 4,640). In all patients plasma bilirubin (daily) and liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST], gamma-glutamyl transpeptidase [GGT], alkaline phosphatase [ALP], twice weekly; n = 3,216) were quantified. In a random predefined subset of patients, plasma bile acids (BAs) were also quantified at baseline and on days 3, 5, and last ICU-day (n = 280). Biliary sludge was ultrasonographically evaluated on ICU-day 5 (n = 776). From day 1 after randomization until the end of the 7-day intervention window, bilirubin was higher in the late PN than in the early PN group ( P &lt; 0.001). In the late PN group, as soon as PN was started on day 8 bilirubin fell and the two groups became comparable. Maximum levels of GGT, ALP, and ALT were lower in the late PN group ( P &lt; 0.01). Glycine/taurine-conjugated primary BAs increased over time in ICU ( P &lt; 0.01), similarly for the two groups. Fewer patients in the late PN than in the early PN group developed biliary sludge on day 5 (37% versus 45%; P = 0.04). Conclusion : Tolerating substantial caloric deficit by withholding PN until day 8 of critical illness increased plasma bilirubin but reduced the occurrence of biliary sludge and lowered GGT, ALP, and ALT. These results suggest that hyperbilirubinemia during critical illness does not necessarily reflect cholestasis and instead may be an adaptive response that is suppressed by early PN. (Hepatology 2014;60:202–210)
Painful Carotid Artery
Authors: WILLIAM A. KERN
Journal: Annals of Internal Medicine (1974)

Letters1 March 1974Painful Carotid ArteryWILLIAM A. KERN JR., M.D., F.A.C.P.WILLIAM A. KERN JR., M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-80-3-417_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: I have observed a syndrome of painful carotid artery in myself and in five patients during the past 2 years.It first came to my attention 2 years ago when, at age 40, I developed a disagreeable pain in the right side of my neck, arising in a tender carotid artery in the region of the bifurcation. This tenderness lasted 5 days and subsided spontaneously. Five months later the pain recurred on the opposite side, with radiation of the deep aching pain to the jaw. There was no fever, carotid bruit, temporal artery pain, or headache; and...References1. FAY T: Atypical facial neuralgia, a syndrome of vascular pain. Ann Otol 41:1030-62, 1932 Google Scholar2. WOLFF H: Headache and other Head Pain. New York, Oxford University Press, 1963, pp. 505-507 Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: WILLIAM A. KERNJR., M.D., F.A.C.P. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byOtorhinolaryngologic Causes of HeadacheHydroformylation Oxo Synthesis, Roelen Reaction 1 March 1974Volume 80, Issue 3 Page: 417-417 Keywords Arteries Carotid arteries Fevers Headaches ePublished: 1 December 2008 Issue Published: 1 March 1974 PDF downloadLoading ...
Contrasting Theories of Interaction in Epidemiology and Toxicology
Authors: Gregory J. Howard, Thomas F. Webster
Journal: Environmental Health Perspectives (2012)

Epidemiologists and toxicologists face similar problems when assessing interactions between exposures, yet they approach the question very differently. The epidemiologic definition of "interaction" leads to the additivity of risk differences (RDA) as the fundamental criterion for causal inference about biological interactions. Toxicologists define "interaction" as departure from a model based on mode of action: concentration addition (CA; for similarly acting compounds) or independent action (IA; for compounds that act differently).We compared and contrasted theoretical frameworks for interaction in the two fields.The same simple thought experiment has been used in both both epidemiology and toxicology to develop the definition of "noninteraction," with nearly opposite interpretations. In epidemiology, the "sham combination" leads to a requirement that noninteractive dose-response curves be linear, whereas in toxicology, it results in the model of CA. We applied epidemiologic tools to mathematical models of concentration-additive combinations to evaluate their utility.RDA is equivalent to CA only for linear dose-response curves. Simple models demonstrate that concentration-additive combinations can result in strong synergy or antagonism in the epidemiologic framework at even the lowest exposure levels. For combinations acting through nonsimilar pathways, RDA approximates IA at low effect levels.Epidemiologists have argued for a single logically consistent definition of interaction, but the toxicologic perspective would consider this approach less biologically informative than a comparison with CA or IA. We suggest methods for analysis of concentration-additive epidemiologic data. The two fields can learn a great deal about interaction from each other.