tbuckley/cabot-search huggingface dataset:
Automatic Control of Pressure Support Mechanical Ventilation Using Fuzzy Logic
Authors: TADASHI NEMOTO, GEORGE E. HATZAKIS, C. WILLIAM THORPE, RONALD OLIVENSTEIN, SANDRA DIAL, JASON H. T. BATES
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

There is currently no universally accepted approach to weaning patients from mechanical ventilation, but there is clearly a feeling within the medical community that it may be possible to formulate the weaning process algorithmically in some manner. Fuzzy logic seems suited this task because of the way it so naturally represents the subjective human notions employed in much of medical decision-making. The purpose of the present study was to develop a fuzzy logic algorithm for controlling pressure support ventilation in patients in the intensive care unit, utilizing measurements of heart rate, tidal volume, breathing frequency, and arterial oxygen saturation. In this report we describe the fuzzy logic algorithm, and demonstrate its use retrospectively in 13 patients with severe chronic obstructive pulmonary disease, by comparing the decisions made by the algorithm with what actually transpired. The fuzzy logic recommendations agreed with the status quo to within 2 cm H2O an average of 76% of the time, and to within 4 cm H2O an average of 88% of the time (although in most of these instances no medical decisions were taken as to whether or not to change the level of ventilatory support). We also compared the predictions of our algorithm with those cases in which changes in pressure support level were actually made by an attending physician, and found that the physicians tended to reduce the support level somewhat more aggressively than the algorithm did. We conclude that our fuzzy algorithm has the potential to control the level of pressure support ventilation from ongoing measurements of a patient's vital signs.
Treatment of Diphtheria.
Authors: E. E. DeGrofft
Journal: JAMA (1896)

Camden, N. J., Oct. 19, 1896. <h3>To the Editor:</h3> —In the formula of my antiseptic solution in theJournal, Oct. 17, 1896, just to hand, an important misprint has occurred. It should be in the formula<i>five</i>drops of carbolic acid instead of one drop. Will you kindly and promptly correct the same in your next issue. Also I send you two letters which are of great interest in connection with my method of treating diphtheria. Please give them space. Yours very sincerely, D.Benjamin, M.D. Camden, N. J., July 16, 1896. <h3>Dr. D. Benjamin, My Dear Doctor:</h3> —In reference to your Antiseptic Treatment for Diphtheria, will say that I have used your treatment for the past three years in at least seventy-five cases of true diphtheria, without a death. The membrane disappeared so quickly in certain cases that reporting the case to the board of health seemed unnecessary. In
Airborne Multidrug-Resistant Bacteria Isolated from a Concentrated Swine Feeding Operation
Authors: Amy Chapin, Ana Rule, Kristen Gibson, Timothy Buckley, Kellogg Schwab
Journal: Environmental Health Perspectives (2004)

The use of nontherapeutic levels of antibiotics in swine production can select for antibiotic resistance in commensal and pathogenic bacteria in swine. As a result, retail pork products, as well as surface and groundwaters contaminated with swine waste, have been shown to be sources of human exposure to antibiotic-resistant bacteria. However, it is unclear whether the air within swine operations also serves as a source of exposure to antibiotic-resistant bacterial pathogens. To investigate this issue, we sampled the air within a concentrated swine feeding operation with an all-glass impinger. Samples were analyzed using a method for the isolation of Enterococcus. A total of 137 presumptive Enterococcus isolates were identified to species level using standard biochemical tests and analyzed for resistance to erythromycin, clindamycin, virginiamycin, tetracycline, and vancomycin using the agar dilution method. Thirty-four percent of the isolates were confirmed as Enterococcus, 32% were identified as coagulase-negative staphylococci, and 33% were identified as viridans group streptococci. Regardless of bacterial species, 98% of the isolates expressed high-level resistance to at least two antibiotics commonly used in swine production. None of the isolates were resistant to vancomycin, an antibiotic that has never been approved for use in livestock in the United States. In conclusion, high-level multidrug-resistant Enterococcus, coagulase-negative staphylococci, and viridans group streptococci were detected in the air of a concentrated swine feeding operation. These findings suggest that the inhalation of air from these facilities may serve as an exposure pathway for the transfer of multidrug-resistant bacterial pathogens from swine to humans.
Re: Willem Oosterlinck, Ziya Kirkali, Richard Sylvester, et al. Sequential Intravesical Chemoimmunotherapy with Mitomycin C and Bacillus Calmette-Guérin and with Bacillus Calmette-Guérin Alone in Patients with Carcinoma in Situ of the Urinary Bladder: Results of an EORTC Genito-Urinary Group Randomized Phase 2 Trial (30993). Eur Urol 2011;59:438–46
Authors: Wei Ling Ooi, Martin Stockler, Dickon Hayne
Journal: European Urology (2011)
Chronic inflammation in asthma: a contest of persistence <i>vs</i> resolution
Authors: C. L. Van Hove, T. Maes, G. F. Joos, K. G. Tournoy
Journal: Allergy (2008)

Recent investigations have highlighted that endogenous anti‐inflammatory mediators and immune regulating mechanisms are important for the resolution of inflammatory processes. A disruption of these mechanisms can be causally related not only to the initiation of unnecessary inflammation, but also to the persistence of several chronic inflammatory diseases. In asthma, chronic Th‐2 driven eosinophilic inflammation of the airways is one of the central abnormalities. To date, elucidating the role of the different pro‐inflammatory mediators involved in orchestrating the inflammatory processes in asthma has been the subject of intense research in both humans and animal models. However, the counter‐regulatory mechanisms that co‐determine the outcome in the contest of resolution vs persistence of the eosinophilic airway inflammation remain poorly understood. These are currently being investigated in animal models of chronic asthma. Elucidating these mechanisms is of relevance, since it can give rise to a new therapeutic approach in the treatment of chronic airway inflammation in asthmatics. This novel concept of treatment involves the stimulation of endogenous anti‐inflammatory pathways, rather than solely antagonising the various pro‐inflammatory mediators. Here, we review and discuss the current knowledge about these endogenous anti‐inflammatory mediators in clinical and experimental asthma.
A Clinical Consultation-Liaison Experience in a Rehabilitation Service
Authors: Marco Rigatelli, Massimo Marcon, Antonia Morritti
Journal: Psychotherapy and Psychosomatics (1989)

Consultation-liaison psychiatry, which seeks to make a clinical and cultural contribution to medical problems, is the subject of considerable debate at a theoretical level. Moreover, at least in Italy, it is far removed from total actualization in practical terms. On the basis of a clinical experience, the authors underscore how a fully articulated and complete consultation and liaison program can facilitate a thrid form of collaboration provided by the psychiatrist, i.e. on-going training. The authors define this as the process of focusing in on the casework and psychotherapeutic competencies of the medical staff.
Treatment of ankylosing spondylitis with infliximab
Authors: C A BOEGER
Journal: Annals of the Rheumatic Diseases (2001)

In January 2000 a 35 year old man presented with severe ankylosing spondylitis (AS), diagnosed in 1981. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 6.0, the Bath Ankylosing Spondylitis Functional Index (BASFI) was 3.0, and on a 1–10 visual analogue scale (VAS) for pain in the previous two months he had a score of 6.

Schober's test was 0 cm (normal 4 cm), Ott's test 1 cm (normal 2 cm), finger-floor distance 16 cm, lateral flexion 3 cm, tragus-wall distance 21 cm, cervical rotation 30°.

C reactive protein (CRP) was 41 mg/l (normal <5), erythrocyte sedimentation rate (ESR) was 25 mm/1st h (normal <15), and HLA-B27 genotype was positive.

Conventional radiography showed typical signs of AS. Magnetic resonance imaging (MRI) detected inflammatory activity in …
Control of Health-Care Costs in the 1980's
Authors: Walter J. McNerney
Journal: New England Journal of Medicine (1980)

FOR approximately 20 years there has been growing public concern over the cost and accessibility of health services. Public debate in the mid-1970's centered on comprehensive national health insurance that addressed both concerns. In the past two or three years, concern with costs has become so widespread in both the public and private sectors that it is now a motivating force behind many legislative proposals and decisions about purchasing health services by groups and by individuals. Reflecting changes in the economy, the health-care debate has focused on costs; more specifically, it has assessed the relative merits of competition and regulation . . .
Identification of mesenchymal stem cells in aorta-gonad-mesonephros and yolk sac of human embryos
Authors: Xiao-Yan Wang, Yu Lan, Wen-Yan He, Lei Zhang, Hui-Yu Yao, Chun-Mei Hou, Ying Tong, Yuan-Lin Liu, Guan Yang, Xiao-Dan Liu, Xiao Yang, Bing Liu, Ning Mao
Journal: Blood (2007)
Physician, treat thyself
Authors: Erle C H Lim, Raymond C S Seet
Journal: BMJ (2006)

As a neurologist whose subspecialty is movement disorders, one of us (ECHL) regularly administers injections of botulinum toxin (botox) to treat patients for spasticity, dystonia, hemifacial spasms, and hyperhidrosis. While injecting the palms of a patient with hyperhidrosis, I casually remarked how much I admired her stoicism, adding that I couldn't imagine going through the procedure myself. I had earlier mentioned to her that I, too, had palmar hyperhidrosis. We had laughed at how people surreptitiously find various methods to “casually” wipe their hands on a convenient strip of fabric soon after shaking hands with us, acknowledging that it usually made us burn with embarrassment. “Why don't you get it done?” she asked, adding …
Acylation of monocyte and glomerular mesangial cell proteins. Myristyl acylation of the interleukin 1 precursors.
Authors: S L Bursten, R M Locksley, J L Ryan, D H Lovett
Journal: Journal of Clinical Investigation (1988)

Acylation of cellular proteins with the fatty acids myristate or palmitate represents an important mechanism for the co- or posttranslational modification of proteins. Lipid A, the biologically active component of bacterial endotoxin, exerts a number of biochemical effects on responsive cell types. Evidence is presented that lipid A stimulates the synthesis and subsequent myristyl acylation of intracellular monocyte and glomerular mesangial cell proteins. Two of the myristylated monocyte proteins were identified by specific immunoprecipitation as the 33-kD IL 1 alpha and beta precursors; a similar myristylated protein was found in mesangial cells. The 17-kD secretory form of monocyte IL 1 beta did not contain covalently linked myristate. Myristyl acylation of the IL 1 precursor proteins may facilitate the processing or membrane localization of these proteins, which lack characteristic hydrophobic signal sequences. The acylated 33-kD IL 1 alpha may remain preferentially associated with the membrane in an active form, whereas limited proteolysis may convert the biologically inactive IL 1 beta precursor into the extracellular, nonacylated, active 17-kD protein.
Charity calls for ban on tobacco industry funding of research
Authors: M. Gould
Journal: BMJ (2002)

Cancer Research UK wants educational and research bodies to agree a blanket ban on donations from tobacco companies. And it is threatening to stop funding research at institutions receiving money from the tobacco industry.

The charity has issued a code of practice for universities on accepting money from the tobacco industry, which is now out for consultation. It says the evidence that tobacco causes cancer is “irrefutable,” yet the tobacco …
Effects of intravenous magnesium in suspected acute myocardial infarction: overview of randomised trials.
Authors: K K Teo, S Yusuf, R Collins, P H Held, R Peto
Journal: BMJ (1991)

OBJECTIVE--To investigate the effect of intravenous magnesium on mortality in suspected acute myocardial infarction. DESIGN--Systematic overview of all available randomised trials in which patients were allocated to receive either intravenous magnesium or otherwise similar treatment without magnesium. SETTING--Coronary care units of several hospitals. PATIENTS--1301 patients in seven randomised trials. MAIN OUTCOME MEASURE--Short term mortality. RESULTS--Considering the seven trials collectively there were 25 (3.8%) deaths among 657 patients allocated to receive magnesium and 53 (8.2%) deaths among 644 patients allocated control, generally during hospital follow up. This represents a 55% reduction in the odds of death (p less than 0.001) with 95% confidence intervals ranging from about one third to about two thirds. 70 of 648 patients allocated magnesium compared with 109 of 641 controls had serious ventricular arrhythmias, suggesting that magnesium reduces the incidence, though the definition varied among trials. Other adverse effects were rare in the limited number of patients for whom this data were available. CONCLUSION--Despite the limited number of patients randomised this overview suggests that intravenous magnesium therapy may reduce mortality in patients with acute myocardial infarction. Further large scale trials to confirm (or refute) these findings are desirable.
Heterogeneous Sympathetic Innervation in German Shepherd Dogs With Inherited Ventricular Arrhythmia and Sudden Cardiac Death
Authors: Michael W. Dae, Randall J. Lee, Philip C. Ursell, Michael C. Chin, Carol A. Stillson, N. Sydney Moise
Journal: Circulation (1997)

Background Recently, a colony of German shepherd dogs with inherited spontaneous cardiac arrhythmias and associated sudden death has been developed and characterized. Due to the median age of onset of the arrhythmia (4.5 months), the tendency for the arrhythmia to occur during REM sleep or after exercise, and the absence of structural heart disease, we hypothesized a developmental abnormality of the sympathetic innervation to the heart. Methods and Results We studied 11 dogs from this colony, ranging in age from 6 months to 6 years, and four 7-month-old German shepherd dogs unrelated to the colony as controls. We imaged the distribution of functional myocardial sympathetic innervation and perfusion with [ 123 I]metaiodobenzylguanidine (MIBG) and 201 Tl, respectively. Sympathetic nerve distribution was evaluated morphologically by immunocytochemical localization of tyrosine hydroxylase. All of the hearts showed evidence of a regional decrease in MIBG uptake, ranging from 5.3% to 53.4% of the myocardium, whereas control dogs showed homogeneous MIBG uptake. Immunocytochemical studies on sections from regions with decreased MIBG uptake showed a striking paucity of nerves compared with regions with normal MIBG uptake, confirming denervation. When the dogs were grouped into those with (n=6) and without (n=5) evidence of ventricular tachycardia on ambulatory ECG, the group with ventricular tachycardia showed 35±16.5% denervation, whereas the group without ventricular tachycardia showed 12±5.6% denervation ( P &lt;.02). Conclusions Abnormal heterogeneous sympathetic innervation exists in these dogs with inherited ventricular arrhythmia and sudden cardiac death. Mechanisms relating the presence and extent of regional denervation to the incidence of ventricular arrhythmia remain to be defined.
Hepatic Disease and Psychiatric Illness: Relationships and Treatment
Authors: Jambur Ananth, Randy Swartz, Karl Burgoyne, Rangaswamy Gadasally
Journal: Psychotherapy and Psychosomatics (1994)

A relationship between hepatic diseases and psychiatric symptoms has long been speculated. While liver detoxication makes the exogenous substances harmless for the body, there are occasions where the liver may convert a harmless substance into a more toxic substance. With such an important role, the liver protects all the organs of the body. When liver is malfunctioning, toxic metabolites injurious to the brain may be produced. As the brain receives a high blood supply, a large amount of metabolites reach this organ. Hence, the metabolic function of the liver keeps a delicate reciprocal relationship between the two organs. In addition, a number of psychiatric medications affect liver functions. Another perplexing clinical problem is the difficulty in treating psychiatric symptoms in patients with liver disease. For example, benzodiazepines which do not affect the liver function in physically healthy psychiatric patients, may induce hepatic coma in patients with liver disease. Benzodiazepine antagonists produce dramatic and temporary improvement in patients with hepatic coma. Clinically, many psychoactive drugs produce hepatic complications. The very same drugs which produce hepatic side effects are required for the treatment of psychiatric symptoms in patients with hepatic disorders. To appropriately handle these situations, a thorough knowledge of the side effects of these drugs is necessary.
Overexpression of CD44 on alveolar eosinophils with high concentrations of soluble CD44 in bronchoalveolar lavage fluid in patients with eosinophilic pneumonia
Authors: S. Katoh, H. Taniguchi, N. Matsumoto, S. Matsukura, Y. Matsubara, J. Kadota, S. Kohno, K. Fukushima
Journal: Allergy (1999)

Background: High levels of interleukin‐5 (IL‐5) are found in the alveolar space of patients with eosinophilic pneumonia (EP). IL‐5 promotes the growth and differentiation of eosinophils, as well as activating these cells. IL‐5 also induces the expression of CD44 on eosinophils in vitro . To evaluate the contribution of CD44 to the pathogenesis of EP, we examined the expression of CD44 on eosinophils in bronchoalveolar lavage fluid (BALF) and measured the concentration of soluble CD44 (sCD44) in BALF from patients with EP. Methods: The concentrations of IL‐5, sCD44, and hyaluronic acid (HA) were measured in BALF. The expression levels of CD44 on eosinophils in BALF and peripheral blood in patients with EP were compared. Results: The expression of CD44 on alveolar eosinophils and the concentration of sCD44 were increased in BALF of patients with EP. There was a significant correlation between IL‐5 and sCD44 in BALF. A high concentration of HA was observed in BALF of EP patients. Conclusions: Our results suggest that the high expression of CD44 on eosinophils probably results from upregulation by IL‐5 and could be important in the pathogenesis of EP.
Mutation accumulation in transfer RNAs: molecular evidence for Muller's ratchet in mitochondrial genomes
Authors: M. Lynch
Journal: Molecular Biology and Evolution (1996)

The accumulation of deleterious mutations is thought to be a major factor preventing the long-term persistence of obligately asexual lineages relative to their sexual ancestors. This phenomenon is also of potential relevance to sexual species that harbor asexually propagating organelle genomes. A comparative study of the transfer RNA genes in animal mitochondrial and nuclear genomes demonstrates that the former accumulate nucleotide substitutions much more rapidly than do the latter, and several lines of evidence are consistent with the idea that the excess substitutions are mildly deleterious. First, the average binding stability between complementary strands in the stems of mitochondrial tRNAs is less than half that in nuclear tRNAs. Second, most loop sizes in the mitochondrial tRNAs have experienced a net reduction in size over evolutionary time, and they are nearly 50 times more variable in the mitochondrial than in the nuclear genome. Third, although nearly 20% of the nucleotides in nuclear tRNA genes (particularly those involved in tertiary interactions) are invariant across all animal taxa and all tRNA species, there are no invariant sites in the mitochondrial tRNAs. These observations, as well as results from recent laboratory experiments, are consistent with the hypothesis that nonrecombining organelle genomes are subject to gradual loss of fitness due to the cumulative chance fixation of mildly deleterious mutations.
Haiti's cholera outbreak could spread to neighbours
Authors: S. Arie
Journal: BMJ (2010)

Haiti’s cholera outbreak is likely to spread to neighbouring Dominican Republic and may reach the rest of the Americas, the Pan American Health Organization has warned.

“Now that cholera has established itself with a strong foothold in Haiti it’s probably clear to us that this will not go away for several years,” said the organisation’s deputy director, Jon Andrus, days after the first cases were reported.

“During the last epidemic in the Americas, which broke out in Peru in 1991, there were more than 500 000 cases reported over a two year period,” he said. From Argentina to Canada, almost every …
Tetracycline-resistant Streptococci in South-west Essex: a Continuing Survey
Authors: M. H. Robertson
Journal: BMJ (1968)

Studies of beta-haemolytic streptococci isolated in material received from patients in South-west Essex for a further period of three years showed that the overall percentage of tetracycline resistance has remained almost stationary, varying from 28% in 1963 through 35% in 1965 to 27% in 1967.Ear, sound, and skin infections retain a high incidence of resistant strains, while sputa are still a relatively minor source of such organisms. Organisms isolated from throat swabs have an incidence of resistance closest to the mean.
Complications of Band-Aid Surgery For Sterilization
Authors: Rajindar K. Wadhwa
Journal: JAMA (1972)

To the Editor.—  Since the article on Band-Aid surgery for female sterilization was published inLifemagazine (July 28, 1972), more and more women are approaching their obstetricians and gynecologists for this procedure.  In one major hospital in western Pennsylvania, laparoscopies have increased from 20 to 40 per month. Many enthusiasts among our gynecological colleagues regard this as a relatively simple procedure of a look see, do type, and all seem impressed by the excellent condition of the patient postoperatively. Hospital stay is reduced, and patients can be discharged in 24 to 48 hours without an unsightly abdominal scar.  The procedure sounds attractive to the uninformed public, but a serious complication rate exists. In our institution, return for further surgery, averaged monthly, varies from 1.5% to 6.45%. Four cases—two bowel perforations, one hemorrhage, and one pulmonary embolism—were noted in 62 procedures done during the month of August 1972. Three of
Shock, Physiological Surgery, and George Washington Crile: Medical Innovation in the Progressive Era
Authors: Claude E. Welch
Journal: JAMA (1981)

The author began this fascinating story as a historical study of shock. He discovered that from 1890, for almost 30 years, the career of George W. Crile was inextricably entangled with investigations into the causes and therapy of this mysterious syndrome. The book thus has two purposes: it is a description of changing concepts of shock and a biography of this unusual and distinguished surgeon. The details of Crile's life are portrayed with great sensitivity. His humble education, his great intelligence and enthusiasm, his astonishing energy, and his reliance on physiology based on clinical observations, parallel in a striking way the attention paid to shock. In 1880, little was known about it; the development of major operations led to clinical studies and intense interest, which reached their culmination in World War I. Meanwhile, the evolution of academic physiologists with new theories provided tension and controversy. Finally, the theory of Crile's