tbuckley/cabot-search huggingface dataset:
Effect of tiotropium on sputum and serum inflammatory markers and exacerbations in COPD
Authors: D. J. Powrie, T. M. A. Wilkinson, G. C. Donaldson, P. Jones, K. Scrine, K. Viel, S. Kesten, J. A. Wedzicha
Journal: European Respiratory Journal (2007)

Chronic obstructive pulmonary disease (COPD) patients experiencing frequent exacerbations demonstrate increased stable-state airway inflammation. Tiotropium has been shown to reduce exacerbation frequency, but its effect on airway inflammation is unknown. The aim of the present study was to investigate the effect of tiotropium on sputum inflammatory markers and exacerbation frequency. Patients (n = 142) were randomised to receive tiotropium or placebo in addition to their usual medication for 1 yr. Sputum and serum cytokines were assayed by ELISA and exacerbation frequency calculated using a symptom-based diary. There was no difference in the area under the curve for sputum interleukin (IL)-6 or myeloperoxidase between the groups, but sputum IL-8 level was increased in the tiotropium arm. There was no difference between start and end of study in serum IL-6 or C-reactive protein level. Tiotropium was associated with a 52% reduction in exacerbation frequency (1.17 versus 2.46 exacerbations·yr −1 ). Of patients on tiotropium, 43% experienced at least one exacerbation, compared with 64% on placebo. The total number of exacerbation days was reduced compared with placebo (17.3 versus 34.5 days). Tiotropium reduces exacerbation frequency in chronic obstructive pulmonary disease, but this effect does not appear to be due to a reduction in airway or systemic inflammation.
Libraries face higher costs for academic journals
Authors: S. Mayor
Journal: BMJ (2003)

Growing numbers of university librarians are reporting difficulties in continuing agreements to pay for increasingly expensive academic journals that their budgets can no longer afford.

Academic librarians and publishers attending the annual meeting of the UK Serials Group (a professional interest group on scholarly communication) last week said that the organisation and funding of research publications would have to change.

“The budgets of academic libraries have not kept pace with the increasing number and price of journals their users want to use,” said Dr Fytton Rowland, senior lecturer in information science at Loughborough University.

The underlying problem is that journals are monopolies, argued Mr …
Left ventricular hypertrophy and morphology in familial hypertrophic cardiomyopathy associated with mutations of the beta-myosin heavy chain gene
Authors: Scott D. Solomon, Simonetta Wolff, Hugh Watkins, Paul M. Ridker, Patricia Come, William J. McKenna, Christine E. Seidman, Richard T. Lee
Journal: Journal of the American College of Cardiology (1993)
Recent Progress in the Understanding and Management of Postoperative Right Ventricular Outflow Tract Dysfunction in Patients With Congenital Heart Disease
Authors: Doff B. McElhinney
Journal: Circulation (2012)

alliative surgery for conotruncal congenital cardiovascu- lar defects such as tetralogy of Fallot and truncus arteriosus includes reconstruction of the right ventricular (RV) outflow tract (RVOT).Depending on patient age, anatomy, and other factors, a variety of techniques, prosthetic materials, and valves are used to reconstruct the RVOT, but essentially all become dysfunctional over time, with obstruction, pulmonary regurgitation (PR), or both.One of the challenges of managing patients with dysfunction of a surgically reconstructed RVOT has been balancing the risks of ongoing RVOT dysfunction against the risks and benefits of open heart surgery to replace the pulmonary valve.This calculus is complicated by the fact that the replacement valve will have a finite lifespan that is substantially shorter than the life expectancy of the patient, so the "wait-or-intervene" dilemma will recur again and again.In general, the information used to populate these risk-benefit calculations has been limited and confounded by a variety of factors, so clinicians caring for these patients have often been tasked with making recommendations that are based on inadequate or conflicting data.Moreover, there is such wide and often unexplained variability between patients in how the RV remodels in response to dysfunction of the RVOT that it is difficult to systematize practice and to serve all patients optimally.Given the expanding population of adults with tetralogy of Fallot and other disorders associated with RVOT dysfunction, who constitute a large proportion of adults with significant congenital heart disease, 1 this clinical problem will only continue to grow.In recent years, there have been numerous advances in our understanding of and methods for evaluating the physiological and clinical sequelae of RVOT dysfunction, as well as in the conceptual and technical aspects of managing such dysfunction and in therapeutic technologies.Although these advances have not resolved the difficulties that clinicians encounter in managing these patients, they have helped clarify and address some of the uncertainty.The purpose of this review is to summarize some of the fundamental dimensions of this evolution.
Relationships Between Control and Serum Lipids in Juvenile-onset Diabetes
Authors: Allen M Glasgow, Gilbert P August, Wellington Hung
Journal: Diabetes Care (1981)

The relationship between control and serum lipids was examined in 147 children with juvenile-onset diabetes (JOD). Control was assessed by fasting blood glucose, 24-h urine glucose, and fast hemoglobin. There was a significant positive correlation (P less than 0.001) between each of the measures of control. Serum cholesterol (P less than 0.001), triglycerides (P less than 0.001), and low-density lipoprotein plus very low-density lipoprotein cholesterol (P less than 0.001) were strongly positively correlated with control for the whole group of patients. High-density lipoprotein was not significantly correlated with control when the data for the whole group were analyzed but was significantly positively correlated with fasting blood glucose when patients were analyzed individually.
Hemospray treatment is effective for lower gastrointestinal bleeding
Authors: I. Holster, Enric Brullet, Ernst Kuipers, Rafel Campo, Alberto Fernández-Atutxa, Eric Tjwa
Journal: Endoscopy (2013)

Acute lower gastrointestinal bleeding (LGIB) is diverse in origin and can be substantial, requiring urgent hemostasis. Hemospray is a promising novel hemostatic agent for upper gastrointestinal bleeding (UGIB). It has been claimed in a small series that the use of Hemospray is also feasible in LGIB. We aimed to expand our knowledge of the application of Hemospray for the treatment of LGIB in a wider range of conditions to further define the optimal patient population for this new therapeutic modality. We analyzed the outcomes of nine unselected consecutive patients with active LGIB treated with Hemospray in two major hospitals in Europe. Initial hemostasis was achieved after Hemospray application in all patients. Rebleeding occurred in two patients (22 %) who were on acetyl salicylic acid and presented with spurting bleeds. These preliminary data show that Hemospray can be effective in the management of LGIB, but suggest cautious use for patients on antithrombotic therapy and spurting bleeds.
A SUMMARY OF THE THERAPEUTIC FIELD FOR THE PAST YEAR.CHAIRMAN'S ADDRESS BEFORE THE SECTION ON PHARMACOLOGY AND THERAPEUTICS AT THE FIFTY-SEVENTH ANNUAL SESSION OF THE AMERICAN MEDICAL ASSOCIATION, BOSTON, JUNE 5-8, 1906.
Authors: THOMAS F. REILLY
Journal: JAMA (1906)

lar changes take place in the posterior roots.According to H. K. Anderson,9 section of the sciatica nerve in young animals checks the development of the corre- sponding ganglia and posterior roots and of the cells in Clarke's column of the same side.These observations furnish ample proof that at the time of incipient recovery the central connections of the cut nerve are not in normal condition, Avhieh makes it probable that their function also is altered.If we as- sume, for instance, that through the degeneration proc- ess the connections of neurons are loosened, it seems quite likely that after the operation stronger stimuli are needed to evoke sensations than under normal condi- tions, and that the irritation once established is little changeable as regards intensity and irradiation, which means that summation and localization are very imperfect.The assumption is the more probable since it is knoAvn that certain drugs act in a similar way.I be- lieve, therefore, that the many interesting points brought forward by Dr. Head can be accounted for by reference to certain well-established physiologic and pharmacologie data.It seems, therefore, at least for the present, not necessary to introduce a hypothesis to which exist- ing physiologic and psychologic data do not lend sup- port.I am quite aAvare that the explanation that I propose, like his, is more or less a hypothetical one.Still it has the advantage, as I believe, of being consistent with all the observations as yet knoAvn.Of course, every hypothesis is by itself transient and has to be changed as experience grows.That is the reason why I have wished to bring
Availability of activated CD4+ T cells dictates the level of viremia in naturally SIV-infected sooty mangabeys
Authors: Nichole R. Klatt, Francois Villinger, Pavel Bostik, Shari N. Gordon, Lara Pereira, Jessica C. Engram, Ann Mayne, Richard M. Dunham, Benton Lawson, Sarah J. Ratcliffe, Donald L. Sodora, James Else, Keith Reimann, Silvija I. Staprans, Ashley T. Haase, Jacob D. Estes, Guido Silvestri, Aftab A. Ansari
Journal: Journal of Clinical Investigation (2008)

Naturally SIV-infected sooty mangabeys (SMs) remain asymptomatic despite high virus replication. Elucidating the mechanisms underlying AIDS resistance of SIV-infected SMs may provide crucial information to better understand AIDS pathogenesis. In this study, we assessed the determinants of set-point viremia in naturally SIV-infected SMs, i.e., immune control of SIV replication versus target cell limitation. We depleted CD4+ T cells in 6 naturally SIV-infected SMs by treating with humanized anti-CD4 mAb (Cdr-OKT4A-huIgG1). CD4+ T cells were depleted almost completely in blood and BM and at variable levels in mucosal tissues and LNs. No marked depletion of CD14+ monocytes was observed. Importantly, CD4+ T cell depletion was associated with a rapid, significant decline in viral load, which returned to baseline level at day 30–45, coincident with an increased fraction of proliferating and activated CD4+ T cells. Throughout the study, virus replication correlated with the level of proliferating CD4+ T cells. CD4+ T cell depletion did not induce any changes in the fraction of Tregs or the level of SIV-specific CD8+ T cells. Our results suggest that the availability of activated CD4+ T cells, rather than immune control of SIV replication, is the main determinant of set-point viral load during natural SIV infection of SMs.
World Bank conference debates how to reach the poor
Authors: Jocalyn Clark
Journal: BMJ (2004)

Health services designed to favour the poor do not necessarily reach the most needy in societies. That was the conclusion of a group of World Bank policy makers and programme officers working in developing and transitional countries who met last week in Washington, DC, to discuss better ways to reach the most vulnerable people.

Described as “taking stock” of how well the bank's programmes are reaching the poor, the conference reflected growing awareness …
Cost of Teaching Medical Students
Authors: Richard J. Sperry
Journal: JAMA (1995)

<h3>To the Editor.</h3> —I applaud the recent article on costs of third-year clerkships at nonuniversity teaching hospitals.<sup>1</sup>The cost of medical education is an important issue and has not been well defined. This study represents a step in the right direction. While I applaud the study in general, I take issue with the section titled "Replacement Costs." In this section the authors analyze the value of the contribution of volunteer physicians to the education of clinical clerks. They impute an average value of $14112 per student per year and then state that this is what it would cost a university teaching center to replace the volunteer physicians. The authors likewise imply that it would cost a university teaching center an average total of $45 888 per student per year to replace the teaching function of the nonuniversity teaching hospitals. The analysis in this section is incorrect for two reasons.
IgM-producing chronic lymphocytic leukemia cells undergo immunoglobulin isotype-switching without acquiring somatic mutations.
Authors: D G Efremov, M Ivanovski, F D Batista, G Pozzato, O R Burrone
Journal: Journal of Clinical Investigation (1996)

The malignant B cells in chronic lymphocytic leukemia (CLL) typically express low-density membrane IgM or IgM/IgD. In vitro experiments have shown that the CLL cells can be induced to differentiate into cells that secrete immunoglobulin (Ig) and can occasionally undergo heavy (H) chain class switching. We now show that the CLL cells also undergo isotype-switching in vivo, since gamma and/or alpha H chain transcripts with identical FW3/CDR3/FW4 regions as the mu CLL transcripts were detected in all of the 13 investigated patients with IgM+ CLL. In most cases switching had occurred to alpha1 and gamma3, but CLL transcripts corresponding to the other gamma chain isotypes were also detected. In one case both the productively and nonproductively rearranged allele were found to undergo H chain class switching. CLL gamma transcripts were also present in surface IgG+ sorted B cells, demonstrating that a small subset of the CLL cells express membrane IgG. In addition, transcripts encoding secretary gamma2 and gamma3 H chains were detected in two cases, which suggests that some serum IgG could be produced by the leukemic clone. Analysis of sorted PBL showed that isotype-switching occurs in CLL cells that express the CD5 antigen. Finally, nucleotide sequence analysis showed that the mu, alpha, and gamma CLL transcripts are identical, demonstrating that the CLL cells do not accumulate somatic mutations in their variable region genes after the H chain class switching. These data provide in vivo evidence that isotype-switching is a frequent phenomenon in CLL, and indicate that a subset of the CLL lymphocytes progress to later stages of B cell differentiation.
Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the Studies of Left Ventricular Dysfunction (SOLVD).
Authors: G S Francis, C Benedict, D E Johnstone, P C Kirlin, J Nicklas, C S Liang, S H Kubo, E Rudin-Toretsky, S Yusuf
Journal: Circulation (1990)

Neuroendocrine activation is known to occur in patients with congestive heart failure, but there is uncertainty as to whether this occurs before or after the presence of overt symptoms. In the Studies of Left Ventricular Dysfunction (SOLVD), a multicenter study of patients with ejection fractions of 35% or less, we compared baseline plasma norepinephrine, plasma renin activity, plasma atrial natriuretic factor, and plasma arginine vasopressin in 56 control subjects, 151 patients with left ventricular dysfunction (no overt heart failure), and 81 patients with overt heart failure before randomization. Median values for plasma norepinephrine (p = 0.0001), plasma atrial natriuretic factor (p less than 0.0001), plasma arginine vasopressin (p = 0.006), and plasma renin activity (p = 0.03) were significantly higher in patients with left ventricular dysfunction than in normal control subjects. Neuroendocrine values were highest in patients with overt heart failure. Plasma renin activity was normal in patients with left ventricular dysfunction without heart failure who were not receiving diuretics and was significantly increased (p less than 0.05) in patients on diuretic therapy. We conclude that neuroendocrine activation occurs in patients with left ventricular dysfunction and no heart failure. Neuroendocrine activation is further increased as overt heart failure ensues and diuretics are added to therapy.
Ventricular function in noncardiacs with alcoholic fatty liver: role of ethanol in the production of cardiomyopathy
Authors: Timothy J. Regan, Gilbert E. Levinson, Henry A. Oldewurtel, Martin J. Frank, Allen B. Weisse, Christos B. Moschos
Journal: Journal of Clinical Investigation (1969)

Since many patients with cardiomyopathy have a history of chronic ethanolism often associated with malnutrition, we have evaluated left ventricular (LV) function in alcoholics with fatty liver, who had no clinical evidence of cardiac or nutritional disease. During an afterload test of LV function the pressor response to angiotensin evoked a threefold rise of enddiastolic pressure in the alcoholic group which was substantially greater than the 4 mm Hg rise in control subjects. The stroke volume and stroke work response in the noncardiac alcoholic was significantly less than in controls. Diminished LV function was corroborated in the noncardiac alcoholic at rest, using a contractility index. To evaluate the dose-response relationship of ethanol in the production of cardiac malfunction, two groups of noncardiac alcoholic subjects were studied acutely at low and moderate dose levels. After 6 oz, ventricular function, myocardial blood flow, and metabolism were not significantly affected. After 12 oz, there was a progressive rise of end-diastolic pressure and decrease of stroke output at a mean blood alcohol level of 150 mg/100 ml, reverting toward control by 4 hr. The coronary effluent transiently evidenced leakage of cell constituents, despite an increase of coronary blood flow, suggesting a direct but reversible cardiac injury. Myocardial extraction of triglyceride was enhanced, whereas FFA uptake was reduced. A possible role of myocardial triglyceride accumulation in heart muscle was considered in pathogenesis. Chronic ingestion of 16 oz of Scotch daily by an alcoholic subject while on a normal diet produced, after 12 wk, a progressive increase of heart rate and size, circulation time, and venous pressure, and a ventricular diastolic gallop. Normal values were restored within 7 wk after interrupting alcohol. These several studies suggest that the cumulative effects of repeated ingestion of ethanol in intoxicating doses can produce diminished LV function before clinical evidence of cardiac abnormality, or heart disease not necessarily related to malnutrition.
Compelling Evidence for Public Health Action to Reduce Salt Intake
Authors: Lawrence J. Appel, Cheryl A.M. Anderson
Journal: New England Journal of Medicine (2010)

Health care reform remains a point of focus on the U.S. political agenda. Actively debated are fundamental changes to the health care delivery system, which largely focuses on the diagnosis and treatment of existing disease. Prevention of disease, commonly accomplished through public health interventions, appears to be an afterthought, perhaps because the benefits are mistakenly perceived as small and the cost savings delayed.In this issue of the Journal, Bibbins-Domingo and colleagues1 document a public health intervention designed to reduce dietary salt intake that can have huge benefits. In brief, the authors project that a national effort to reduce daily . . .
Pituitary ablation for diabetic retinopathy. II. Results of yttrium 90 implantation in the pituitary gland
Authors: B. S. Ray
Journal: JAMA (1968)

The implantation of yttrium 90 into the pituitary gland as an alternate to surgical hypophysectomy for treatment of diabetic retinopathy was employed in 22 patients whose conditions did not meet the more rigid requirements used in selecting patients for craniotomy. Complications related to the procedure developed in about half of the patients and five patients died in the period of seven weeks to 11 months as a result of these complications. Among the survivors 75% had improvement or arrest of progressive retinopathy, approximately the same as after surgical hypophysectomy. But since destruction of the pituitary gland was less certain by the use of yttrium 90, sustained benefit may prove to be less than that following surgical removal.
Overview of a Workshop on Quantitative Models for Developmental Toxicity Risk Assessment
Authors: Carole A. Kimmel, Dorothy G. Wellington, William Farland, Philip Ross, Jeanne M. Manson, Neil Chernoff, John F. Young, Sherry G. Selevan, Norman Kaplan, Chao Chen, Laurence D. Chitlik, Cheryl L. Siegel-Scott, Georgia Valaoras, Suzanne Wells
Journal: Environmental Health Perspectives (1989)

A workshop was held to discuss potential advancements to improve the precision of risk estimates for developmental toxicity. This paper presents an overview of the discussions at the workshop, focusing on the risk assessment process and science policy considerations important in the use of quantitative models. Some of the pertinent biological considerations are reviewed, particularly those related to the repair capacity of the developing organism and how this affects the concept of a threshold for developmental toxicity effects, as well as the maternal and litter influences on developmental toxicity outcomes. Finally, the current status of use of quantitative approaches is described, possible short-term approaches are discussed, and future research needs in this area are outlined.
Physicians and Joint Negotiations
Authors: Gary H. Oberlender
Journal: Annals of Internal Medicine (2002)

Letters7 May 2002Physicians and Joint NegotiationsGary H. Oberlender, MDGary H. Oberlender, MDMediation & Arbitration Services of VirginiaRoanoke, VA 24018Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-136-9-200205070-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The ACP–ASIM position paper on physicians and joint negotiations correctly cites alternative dispute resolution as a viable option for conflict resolution (1). However, physicians should understand that alternative dispute resolution, and in particular mediation, may provide the most effective and least adversarial forum for parties to more fully understand each other's needs and ultimately reach mutually satisfactory agreements.Mediation is a voluntary, nonbinding process that is particularly well suited for parties who will continue to work together long after the issues at hand have been resolved. The mediation process is designed to allow all parties full opportunity ...Reference1. . Physicians joint negotiations. American College of Physicians–American Society of Internal Medicine. Ann Intern Med. 2001;134 9 Pt 1 Pt 1 787-92. [PMID: 11329239] MedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Gary H. Oberlender, MDAffiliations: Mediation & Arbitration Services of VirginiaRoanoke, VA 24018 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPhysicians and Joint NegotiationsPhysicians and Joint NegotiationsPhysicians and Joint Negotiations Johnathon S. Ross Physicians and Joint Negotiations Jack Ginsburg Physicians and Joint Negotiations Allan R. Glass Metrics 7 May 2002Volume 136, Issue 9Page: 710KeywordsHealth care ePublished: 7 May 2002 Issue Published: 7 May 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...