tbuckley/cabot-search huggingface dataset:
Acute Respiratory Distress Syndrome after Bacteremic Sepsis Does Not Increase Mortality
Authors: Philippe Eggimann, Stephan Harbarth, Bara Ricou, Stephane Hugonnet, Karin Ferriere, Peter Suter, Didier Pittet
Journal: American Journal of Respiratory and Critical Care Medicine (2003)

To determine whether acute respiratory distress syndrome (ARDS) complicating bacteremic sepsis independently affects mortality in critically ill patients, we conducted a 3-year retrospective cohort study in a surgical intensive care unit. We included all consecutive patients with blood culture–positive sepsis and measured organ dysfunctions and mortality. Among 4,530 admissions, 196 cases of bacteremic sepsis were recorded. ARDS occurred in 31 (16%) of these patients. The case fatality rate was 58% in patients with ARDS compared with 31% in patients without ARDS. Using Cox proportional hazards regression with time-dependent variables, the unadjusted hazard ratio for death was 1.8 (95% confidence interval [CI], 1.0–3.2). After adjusting for comorbid factors that were present before the onset of sepsis, the hazard ratio was 2.2 (95% CI, 1.2–3.9). After further adjustment was made for nonpulmonary organ dysfunctions and microbiologic factors that were independently associated with mortality, the adjusted hazard ratio for ARDS was 0.6 (95% CI, 0.3–1.2). Among critically ill surgical patients, ARDS complicating bacteremic sepsis remains common, but it is not independently associated with short-term mortality, after adjusting for severity of illness and nonpulmonary organ dysfunctions evolving after the onset of sepsis.
THE PROBLEM OF GRADUATE INSTRUCTION IN CLINICAL MEDICINE
Authors: GEORGE E. SHAMBAUGH
Journal: JAMA (1927)

The demands for graduate instruction in clinical medicine come from men engaged in general practice who desire to piece out the shortcomings in undergraduate preparation or who wish to keep abreast of more recent advances, and from those graduates in medicine who desire preparation for special practice. These are two quite distinct problems in medical education. The one calling for short review courses for men engaged in general practice has been met in part though not in a very satisfactory manner by work offered in postgraduate schools. The other, that of preparing men for special practice, has in this country received very little serious attention, and with the increasing tendency to specialization constitutes an outstanding problem in medical education. Men seeking preparation for special practice have usually had to rely on short, intensive courses suitable especially as review work for those in general practice, with the result that the special
No Easy Fixes
Authors: Viviany R. Taqueti
Journal: New England Journal of Medicine (2013)

Ms. D. has received 10 drug-eluting stents, primarily for atypical chest discomfort, with one stenting begetting another. In our system, it's somehow easier to provide 10 state-of-the-art stents than access to a generic pill and social, financial, and psychiatric support.
Coffee Consumption and Coronary Heart Disease in Women
Authors: Walter C. Willett
Journal: JAMA (1996)

<h3>Objective.</h3> —To assess the relationship between coffee consumption and risk of coronary heart disease (CHD) among women. <h3>Design.</h3> —Prospective cohort study with coffee consumption measured in 1980, 1984, and 1986, and follow-up through 1990. <h3>Setting.</h3> —Female registered nurses in the United States. <h3>Participants.</h3> —A total of 85747 US women 34 to 59 years of age in 1980 and without history of CHD, stroke, or cancer. <h3>Main Outcome Measure.</h3> —Ten-year incidence of CHD (defined as nonfatal myocardial infarction or fatal CHD). <h3>Results.</h3> —During 10 years of follow-up we documented 712 cases of CHD. After adjustment for age, smoking, and other CHD risk factors, we found no evidence for any positive association between coffee consumption and risk of subsequent CHD. For women drinking six or more cups of caffeine-containing coffee per day in 1980, the relative risk was 0.95 (95% confidence interval, 0.73 to 1.26) compared with women who did not consume this beverage. Similarly, there was no association when the first 4 years of follow-up were excluded, when nonfatal and fatal CHD end points were examined separately, or when we updated coffee consumption in 1984 or 1986 and examined only CHD during the next 2-year interval. Further, there was no association with caffeine intake from all sources combined or with decaffeinated coffee consumption. <h3>Conclusions.</h3> —These data indicate that coffee as consumed by US women is not an important cause of CHD. (<i>JAMA</i>. 1996;275:458-462)
Shortage of Chemotherapeutic Agents in Iraq and Outcome of Childhood Acute Lymphocytic Leukemia, 1990–2002
Authors: Haydar Frangoul, Mazin F. Al-Jadiry, Yu Shyr, Fei Ye, Bashar Shakhtour, Salma A. Al-Hadad
Journal: New England Journal of Medicine (2008)

These authors determined the effect of the shortage of chemotherapeutic agents on the outcome of acute lymphoblastic leukemia in Iraqi children during the period of UN sanctions (1990–2002). Many of the children received less than 50% of the prescribed chemotherapy, which was associated with a significantly worse outcome.
Hepatobiliary transport of bile acid amino acid, bile acid peptide, and bile acid oligonucleotide conjugates in rats
Authors: Ernst Petzinger, Annette Wickboldt, Peter Pagels, Dieter Starke, Werner Kramer
Journal: Hepatology (1999)

Uptake of drugs by bile acid carriers could account for the selectivity of drug actions in the gut and liver. We have previously shown that conjugation of xenobiotics with bile acids facilitates their transfer to hepatocytes and ileal enterocytes. In this study L-alanine and 2 biooligomers, the tetrapeptide L-(ala)(4) and a 15 mer oligodeoxynucleotide (ODN) were coupled covalently via linker molecules to the 3-position of bile acids. The L-alanine-coupled bile acid conjugates were rapidly taken up by the liver and efficiently eliminated into bile. These compounds mimicked hepatic transport of bile acids. Also in case of the tetrapeptide (ala)(4), bile acid conjugation significantly improved hepatic and intestinal cell uptake and rendered the peptide conjugate resistant to peptidases. Because uptake by isolated hepatocytes was not dependent on sodium ions and was blocked by ochratoxin A, we assume basolateral transport by an oatp-type bile acid carrier. In the case of the 15 mer ODN, normal and bile acid-conjugated oligodeoxynucleotide appeared intact in bile but without marked improvement of hepatocellular uptake and biliary elimination. We conclude that bile acids can deliver small peptides to gut and parenchymal liver cells via bile acid transport pathways, whereas in the case of oligonucleotides an attached bile acid was not sufficient to shuttle them successfully into hepatocytes.
The sight test fee Potential to spread alarm
Authors: K D Phillips
Journal: BMJ (1994)

and colleagues describe the effect of the introduction of the sight test fee on the number of referrals to Bristol Eye Hospital.'They use the numbers of referrals for 1984-8 to predict the expected numbers of referrals in 1989- 92.This use of their data would have been appropriate if the introduction of the fee on 1 April 1989 had been made without prior warning.The government's proposal for the sight test fee had, however, been made public on 25 November 1987.2This announcement (and subsequent con- firmations) would be expected to have had two effects.Firstly, the high figure for referrals in 1988 may partly simply be due to the increased general publicity about sight tests.Secondly, some people who would have had an eye test after 1 April 1989 may have decided to have one beforehand instead.These "early" sight tests would have increased the figure for referrals in 1988 and reduced that in 1989.The authors consider whether early referrals received in 1988 could account for a reduction in referrals from 1989 onwards.They reject this idea on the grounds that the number of referrals in 1988 was a mere 343 (5 6%) above that expected.Ifthese 343 are regarded as early referrals and are taken from the total for 1988 and added to the total for 1989, however, then the fall in referrals from 1988 to 1989 is not by 15-1% but by only 4-8%.Whether this transfer of numbers of referrals is valid is clearly arguable, but this manoeuvre illustrates that a more cautious analysis might have been appropriate in the study.In particular, it would have been preferable not to have used data for 1988 (the year before introduction of the fee) to predict the numbers of referrals afterwards.If the figure for 1988 is omitted from the analysis the actual numbers of referrals for 1989-92 all fall within the recalculated 95% confidence intervals for the predicted numbers.
Hepatitis B Vaccine Administered to Chronic Carriers of Hepatitis B Surface Antigen
Authors: JULES L. DIENSTAG
Journal: Annals of Internal Medicine (1982)

We administered up to 6 monthly doses of hepatitis B vaccine to 16 chronic carriers of hepatitis B surface antigen (HBsAg) in an attempt to eliminate the antigen. The HBsAg in this vaccine differs from native antigen. No patient had elimination of HBsAg, but one of 10 no longer carried hepatitis B e antigen (HBeAg). Of 13 patients without preexisting antibody to HBsAg (anti-HBs), none acquired the antibody; two of three patients with preexisting heterotypic anti-HBs had transient, low-level increases in anti-HBs titers. Serum alanine aminotransaminase (ALT) levels fell in eight patients, remained unchanged in six, and increased transiently in two. Decreased ALT and HBeAg clearance, however, did not seem to be related to vaccination, and the transient ALT elevations appeared to represent sporadic, acute non-A, non-B hepatitis. No adverse effects other than sore arm and joint pain were seen. Immunization of chronic HBsAg carriers with hepatitis B vaccine, although ineffective in eliminating HBsAg, appeared to be safe. Such safety, if confirmed, would simplify the design of hepatitis B vaccination programs.
The proteinase-antiproteinase balance in alpha-1-proteinase inhibitor-deficient lung transplant recipients.
Authors: M B King, E J Campbell, B H Gray, M I Hertz
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

We examined the proteinase-antiproteinase balance in the bronchoalveolar lavage (BAL) fluid from alpha-1-proteinase inhibitor (alpha 1PI)-deficient lung transplant recipients to determine whether they would derive benefit from intravenous augmentation therapy with alpha 1PI. BAL fluid from 11 alpha 1PI-deficient lung transplant recipients and eight control subjects was assayed for free neutrophil elastase activity, immunoreactive alpha 1PI, and elastase inhibitory capacity. Samples were obtained during intervals of health and respiratory illness. BAL fluid from healthy alpha 1PI-deficient lung transplant recipients had minimal or unmeasurable free elastase activity, which was not different from that of control subjects. alpha 1PI concentrations in BAL fluid from alpha 1PI-deficient lung transplant recipients were reduced when compared with those of control subjects. Despite this observation, all but one alpha 1PI-deficient patient had the ability to inhibit exogenous elastase. During respiratory illness, however, three of seven alpha 1PI-deficient lung transplant recipients had measurable free elastase activity, which was inhibited ex vivo by addition of alpha 1PI. We conclude that alpha 1PI-deficient lung transplant recipients demonstrate free elastase activity in BAL fluid during severe lower respiratory tract inflammation, which is not present during health. Intravenous supplementation of alpha 1PI-deficient lung transplant recipients with exogenous alpha 1PI during respiratory tract inflammation may be indicated to inhibit elastase-mediated injury to the transplanted lung.
Air travel in women with lymphangioleiomyomatosis
Authors: S. Pollock-BarZiv, M. M Cohen, G. P Downey, S. R Johnson, E. Sullivan, F. X McCormack
Journal: Thorax (2006)

The safety of air travel in patients with pneumothorax-prone pulmonary diseases, such as lymphangioleiomyomatosis (LAM), has not been studied to any great extent. A questionnaire-based evaluation of air travel in patients with LAM was conducted to determine experiences aboard commercial aircraft.A survey was sent to women listed in the US LAM Foundation registry (n = 389) and the UK LAM Action registry (n = 59) to assess air travel, including problems occurring during flight. Women reporting a pneumothorax in flight were followed up to ascertain further details about the incident.327 (73%) women completed the survey. 308 women answered the travel section, of whom 276 (90%) had "ever" travelled by aeroplane for a total of 454 flights. 95 (35%) women had been advised by their doctor to avoid air travel. Adverse events reported included shortness of breath (14%), pneumothorax (2%, 8/10 confirmed by chest radiograph), nausea or dizziness (8%), chest pain (12%), unusual fatigue (11%), oxygen desaturation (8%), headache (9%), blue hands (2%), haemoptysis (0.4%) and anxiety (22%). 5 of 10 patients with pneumothorax had symptoms that began before the flight: 2 occurred during cruising altitude, 2 soon after landing and 1 not known. The main symptoms were severe chest pain and shortness of breath.Adverse effects occurred during air travel in patients with LAM, particularly dyspnoea and chest pain. Hypoxaemia and pneumothorax were reported. The decision to travel should be individualised; patients with unexplained shortness of breath or chest pain before scheduled flights should not board. Patients with borderline oxygen saturations on the ground should be evaluated for supplemental oxygen therapy during flight. Although many women had been advised not to travel by air, most travelled without the occurrence of serious adverse effects.
Gastric Mucosal Mast Cells in the Common Laboratory Animals and Man
Authors: Herzl Ragins
Journal: JAMA (1968)

The mast-cell content of the gastric corpus and antrum mucosa of the frog, mouse, rat, hamster, guinea pig, rabbit, cat, dog, and man was studied with an improved method which increases the specificity of the toluidine blue stain for mast cells. Great variability in the density and distribution of gastric mucosal mast cells was noted in the different species. There appears to be no relationship between the known sensitivity of the stomach of a given species to histamine stimulation and its mast-cell content. None of the species demonstrated a topographic association between mucosal mast cells and parietal cells. The notion that endogenous histamine released frommucosalmast cells ultimately causes acid secretion cannot be supported by our data. It is more likely that non-mast-cell histamine is the physiologically active agent.
A patient who changed our lives: It all began with a small lump
Authors: V. Graves
Journal: BMJ (1997)

In the early 1950s my husband and I, not long qualified, were working in a rural Essex practice. Our education at the end of the war had been scamped and included little on infectious diseases. Such postgraduate teaching as we had was entirely in teaching hospitals and had little relevance.

Late one Saturday night a young farmer came to the door: a Scotsman whose family had migrated to East Anglia in the depressed 1930s. He had little time for doctors, but had this nasty thing …
Drug Therapy in Renal Failure: Dosing Guidelines for Adults
Authors: William M. Bennett, Richard S. Muther, Richard A. Parker, Peter Feig, Gail Morrison, Thomas A. Golper, Irwin Singer
Journal: Annals of Internal Medicine (1980)

Data are presented in tabular form that provide guidelines for drug use in adult patients with renal insufficiency. The data are derived from the current medical literature. If specific information about a drug is unavailable or conflicting, emphasis is given to normal pharmacokinetic variables in arriving at recommendations for therapy. Nephrotoxicity or adverse effects in patients with renal disease are noted and adjustments for dialysis suggested.
End top-down changes to NHS, says think tank
Authors: Z. Kmietowicz
Journal: BMJ (2014)

Politicians should loosen their grip on the day to day management of the NHS and allow organisations to initiate improvement from within, a new report from the health policy think tank the King’s Fund has urged.1

Chris Ham, the think tank’s chief executive and the author of the report, argued that intervening in management of the NHS and prescribing health service changes from the centre of government had hampered rather than nurtured reform.

The report said that the intentions in the Health and Social Act 2012 to distance ministers from the operational management of the NHS have failed to be realised.

“Regardless of which political party is in government, there appears to be an irresistible tendency for ministers to want to be seen to be leading …
Unpredictable zero drift in intravascular micromanometer tipped catheters during long term pulmonary artery pressure recording: implications for catheter design
Authors: J S. R GIBBS, D. CUNNINGHAM, J. SPARROW, P. A POOLE-WILSON, K. M FOX
Journal: Cardiovascular Research (1989)

Journal Article Unpredictable zero drift in intravascular micromanometer tipped catheters during long term pulmonary artery pressure recording: implications for catheter design Get access J SIMON R GIBBS, J SIMON R GIBBS **From the National Heart Hospital, Westmoreland Street, London W1, Dovehouse Street, London SW3†From the National Heart and Lung Institute, Dovehouse Street, London SW3 Address for correspondence and reprints: Dr J S R Gibbs, National Heart Hospital, Westmoreland Street, London WIM 8BA. Search for other works by this author on: Oxford Academic PubMed Google Scholar DAVID CUNNINGHAM, DAVID CUNNINGHAM **From the National Heart Hospital, Westmoreland Street, London W1, Dovehouse Street, London SW3 Search for other works by this author on: Oxford Academic PubMed Google Scholar JANE SPARROW, JANE SPARROW **From the National Heart Hospital, Westmoreland Street, London W1, Dovehouse Street, London SW3 Search for other works by this author on: Oxford Academic PubMed Google Scholar PHILIP A POOLE-WILSON, PHILIP A POOLE-WILSON †From the National Heart and Lung Institute, Dovehouse Street, London SW3 Search for other works by this author on: Oxford Academic PubMed Google Scholar KIM M FOX KIM M FOX **From the National Heart Hospital, Westmoreland Street, London W1, Dovehouse Street, London SW3 Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, Volume 23, Issue 2, February 1989, Pages 152–158, https://doi.org/10.1093/cvr/23.2.152 Published: 01 February 1989 Article history Accepted: 10 October 1988 Published: 01 February 1989
Glutamatergic Neurons in Rodent Models Respond to Nanoscale Particulate Urban Air Pollutants <i>in Vivo</i> and <i>in Vitro</i>
Authors: Todd E. Morgan, David A. Davis, Nahoko Iwata, Jeremy A. Tanner, David Snyder, Zhi Ning, Winnie Kam, Yu-Tien Hsu, Jeremy W. Winkler, Jiu-Chiuan Chen, Nicos A. Petasis, Michel Baudry, Constantinos Sioutas, Caleb E. Finch
Journal: Environmental Health Perspectives (2011)

Inhalation of airborne particulate matter (PM) derived from urban traffic is associated with pathology in the arteries, heart, and lung; effects on brain are also indicated but are less documented.We evaluated rodent brain responses to urban nanoscale (< 200 nm) PM (nPM).Ambient nPM collected near an urban freeway was transferred to aqueous suspension and reaerosolized for 10-week inhalation exposure of mice or directly applied to rat brain cell cultures.Free radicals were detected by electron paramagnetic resonance in the nPM 30 days after initial collection. Chronic inhalation of reaerosolized nPM altered selected neuronal and glial activities in mice. The neuronal glutamate receptor subunit (GluA1) was decreased in hippocampus, whereas glia were activated and inflammatory cytokines were induced [interleukin-1α (IL-1α), tumor necrosis factor-α (TNFα)] in cerebral cortex. Two in vitro models showed effects of nPM suspensions within 24-48 hr of exposure that involved glutamatergic functions. In hippocampal slice cultures, nPM increased the neurotoxicity of NMDA (N-methyl-d-aspartic acid), a glutamatergic agonist, which was in turn blocked by the NMDA antagonist AP5 [(2R)-amino-5-phosphonopentanoate]. In embryonic neuron cultures, nPM impaired neurite outgrowth, also blocked by AP5. Induction of IL-1α and TNFα in mixed glia cultures required higher nPM concentrations than did neuronal effects. Because conditioned media from nPM-exposed glia also impaired outgrowth of embryonic neurites, nPM can act indirectly, as well as directly, on neurons in vitro.nPM can affect embryonic and adult neurons through glutamatergic mechanisms. The interactions of nPM with glutamatergic neuronal functions suggest that cerebral ischemia, which involves glutamatergic excitotoxicity, could be exacerbated by nPM.
Elongation Factor 1-Alpha Sequences Alone Do Not Assist in Resolving the Position of the Acoela Within the Metazoa
Authors: D. Timothy J. Littlewood, Peter D. Olson, Maximilian J. Telford, Elisabeth A. Herniou, Marta Riutort
Journal: Molecular Biology and Evolution (2001)

Following years of debate, and thanks largely to molecular systematic studies, the long-held idea that the phylum Platyhelminthes is the most basal branch of the bilaterian Metazoa has been widely abandoned (e.g., Haszprunar 1996; Carranza, Baguna, and Riutort 1997; Hausdorf 2000). This new status quo has been upset by a recent paper that has suggested that the Platyhelminthes are polyphyletic and that a single ‘‘flatworm’’ clade, the Acoela, is the most basal extant bilaterian lineage distinct from the other platyhelminths (Ruiz-Trillo et al. 1999). The potential importance of the acoels being confirmed as the outgroup to all other bilaterians is that they would then be instrumental in determining the character states of the ancestral Bilateria through outgroup comparison and thus greatly further our understanding of the evolution of the animals. The currently recognized outgroup—the diploblasts—are generally too evolutionarily and phenotypically distant for this sort of comparison to be informative. Although recent data support the molecular results (Henry, Martindale, and Boyer 2000), some systematists distrust the findings based on 18S rDNA and have claimed that long-branch attraction (LBA; Felsenstein 1978) affected the final analysis of these data (e.g., Adoutte et al. 2000). Furthermore, according to the same 18S rDNA study (Ruiz-Trillo et al. 1999), the supposed sister group of the acoels, the nemertodermatids (Smith and Tyler 1985; Smith, Tyler, and Rieger 1986; Tyler 2001), do not unite with the acoels at the base of the Bilateria, but instead fall within the turbellarian flatworms. This has suggested that the more controversial position of their sister group, the acoels, was erroneous. Recently, it has been proposed that the published putative nemertodermatid sequence used by Ruiz-Trillo et al. (1999) (Nemertinoides elongatus, accession number U70083; Carranza, Baguna, and Riutort 1997) that grouped among the Rhabditophora may have been misidentified (Jondelius et al. 2000). Berney, Pawloski, and Zaninetti (2000) directly contradict the basal position of the Acoela based on