tbuckley/cabot-search huggingface dataset:
Increasing Incidence of the Neonatal Abstinence Syndrome in U.S. Neonatal ICUs
Authors: Veeral N. Tolia, Stephen W. Patrick, Monica M. Bennett, Karna Murthy, John Sousa, P. Brian Smith, Reese H. Clark, Alan R. Spitzer
Journal: New England Journal of Medicine (2015)

The incidence of the neonatal abstinence syndrome, a drug-withdrawal syndrome that most commonly occurs after in utero exposure to opioids, is known to have increased during the past decade. However, recent trends in the incidence of the syndrome and changes in demographic characteristics and hospital treatment of these infants have not been well characterized.Using multiple cross-sectional analyses and a deidentified data set, we analyzed data from infants with the neonatal abstinence syndrome from 2004 through 2013 in 299 neonatal intensive care units (NICUs) across the United States. We evaluated trends in incidence and health care utilization and changes in infant and maternal clinical characteristics.Among 674,845 infants admitted to NICUs, we identified 10,327 with the neonatal abstinence syndrome. From 2004 through 2013, the rate of NICU admissions for the neonatal abstinence syndrome increased from 7 cases per 1000 admissions to 27 cases per 1000 admissions; the median length of stay increased from 13 days to 19 days (P<0.001 for both trends). The total percentage of NICU days nationwide that were attributed to the neonatal abstinence syndrome increased from 0.6% to 4.0% (P<0.001 for trend), with eight centers reporting that more than 20% of all NICU days were attributed to the care of these infants in 2013. Infants increasingly received pharmacotherapy (74% in 2004-2005 vs. 87% in 2012-2013, P<0.001 for trend), with morphine the most commonly used drug (49% in 2004 vs. 72% in 2013, P<0.001 for trend).From 2004 through 2013, the neonatal abstinence syndrome was responsible for a substantial and growing portion of resources dedicated to critically ill neonates in NICUs nationwide.
Sodium Fluoride Therapy of Postmenopausal Osteoporosis
Authors: MICHAEL KLEEREKOPER, DANIEL BERNARD MENDLOVIC
Journal: Endocrine Reviews (1993)

SODIUM fluoride (NaF) has been shown repeatedly and reproducibly to increase spinal bone mass in a dosedependent manner. Yet, despite numerous studies, NaF has never been convincingly demonstrated to reduce the vertebral fracture rate (VFR) in established spinal osteoporosis, even when bone mass has been increased to above the theoretical fracture threshold. In this review we will discuss what is known about the basic mechanisms whereby NaF increases bone mass and supply possible explanations for the failure of this increase in bone mass to translate into a decrease in VFR. We will also review the effects of NaF on appendicular bone mass and the side-effects that complicate NaF therapy. A recurring theme throughout this review is the paucity of definitive data in many areas of NaF research in osteoporosis. The several areas where seemingly well conducted research has yielded conflicting conclusions will also be apparent. In this framework of knowledge gaps and uncertainty, we have attempted to formulate unbiased opinions. We realize that we have not always been successful.
Serum Levels of Phosphorus, Parathyroid Hormone, and Calcium and Risks of Death and Cardiovascular Disease in Individuals With Chronic Kidney Disease
Authors: Suetonia C. Palmer
Journal: JAMA (2011)

<h3>Context</h3>Clinical practice guidelines on the management of mineral and bone disorders due to chronic kidney disease recommend specific treatment target levels for serum phosphorus, parathyroid hormone, and calcium.<h3>Objective</h3>To assess the quality of evidence for the association between levels of serum phosphorus, parathyroid hormone, and calcium and risks of death, cardiovascular mortality, and nonfatal cardiovascular events in individuals with chronic kidney disease.<h3>Data Sources</h3>The databases of MEDLINE (1948 to December 2010) and EMBASE (1947 to December 2010) were searched without language restriction. Hand searches also were conducted of the reference lists of primary studies, review articles, and clinical guidelines along with full-text review of any citation that appeared relevant.<h3>Study Selection</h3>Of 8380 citations identified in the original search, 47 cohort studies (N = 327 644 patients) met the inclusion criteria.<h3>Data Extraction</h3>The characteristics of study design, participants, exposures, and covariates together with the outcomes of all-cause mortality, cardiovascular mortality, and nonfatal cardiovascular events at different levels of serum phosphorus, parathyroid hormone, and calcium were analyzed within studies. Data were summarized across studies (when possible) using random-effects meta-regression.<h3>Data Synthesis</h3>The risk of death increased 18% for every 1-mg/dL increase in serum phosphorus (relative risk [RR], 1.18 [95% confidence interval {CI}, 1.12-1.25]). There was no significant association between all-cause mortality and serum level of parathyroid hormone (RR per 100-pg/mL increase, 1.01 [95% CI, 1.00-1.02]) or serum level of calcium (RR per 1-mg/dL increase, 1.08 [95% CI, 1.00-1.16]). Data for the association between serum level of phosphorus, parathyroid hormone, and calcium and cardiovascular death were each available in only 1 adequately adjusted cohort study. Lack of adjustment for confounding variables was not a major limitation of the available studies.<h3>Conclusions</h3>The evidentiary basis for a strong, consistent, and independent association between serum levels of calcium and parathyroid hormone and the risk of death and cardiovascular events in chronic kidney disease is poor. There appears to be an association between higher serum levels of phosphorus and mortality in this population.
The involvement of Neuropilin-1 and immune Semaphorin's in lupus nephritis
Authors: V. Zahava, B.-I. Ofer, B. Jacob, S. Edmond, S. Shimon, T. Elias
Journal: Annals of the Rheumatic Diseases (2011)

<h3>Background and objectives</h3> Neuropilin-1(NP-1), a known vascular endothelial growth factor (VEGF) receptor, is important to the interaction between activated DCs and resting T cells. It is also expressed on Treg cells, thereby contributing to the development of peripheral tolerance. Semaphorins, a family of axon guidance molecules during nervous system development, have recently found to be involved in regulating the immune system. To explore the possible involvement of NP-1 and Semaphorin9s in the development of lupus nephritis (LN). <h3>Methods</h3> Twelve kidney biopsies from LN patients (8 – diffuse proliferative and 4 – focal) and five normal biopsies were enrolled in this study. They were subjected to immunohistochemistry staining with anti VEGF, NP-1, Semaphorin 3A, 4A and 4D. The histological slides were scanned by Olympus BX51 microscope and digitised using a digital camera. The Image Pro-Plus 6.3 program was used to measure the intensity and extent of staining. The correlation between the staining and the clinical variables (serum creatinine, proteinuria, activity and chronicity index) was evaluated. <h3>Results</h3> NP-1 and Semaphorin9s, were stained with significantly higher intensity in the LN group (diffuse more than focal) than the control group. VEGF staining in the glomeruli slightly increased compared to the control group. In focal LN, NP-1 deposition was found to be limited to diseased glomerular area, whereas in diffuse proliferative LN, NP-1 was diffusely expressed. NP-1 was found to be correlation with clinical parameters (statistical trend), whereas Semaphorin9s were found in inverse statistically significant correlations. <h3>Discussion</h3> This is the first study to reporting on the involvement of NP-1 and immune Semaphorin9s in LN. NP-1 is suggested to become a histological marker for focal versus diffuse LN. In addition it is a reliable marker for LN severity. Being present in normal glomeruli, but slightly increased in LN, VEGF could be considered as a compensatory protective factor during inflammation. As a functional VEGF receptor, one can assume that increased NP-1 expression in LN is meant to intensify the possible protective effect of VEGF on the glomerular endothelial cells, aiming to prevent their damage and apoptosis. Semaphorin 3A a known destabiliser of glomerular barrier and a VEGF competitor (a NP-1 ligand), reducing thereby its protective effects and enhancing proteinuria. The inverse correlation could be the result of the altered ability of kidneys to secrete Semaphorin9s during advanced renal damage. Further work is needed in order to explore the entire scenario of the involvement of the NP-1 and Semaphorin9s in LN.
Streptomycin and Isoniazid in Acute Miliary Tuberculosis
Authors: J. H. Lawson, A. W. Lees, G. W. Allan, P. McKenzie
Journal: BMJ (1954)

Nil 21-0%working quite independently, have, I think you will agree, produced results which compare favourably with any other method of delivery, and in so doing have avoided many caesarean section operations. ConclusionCaesarean section has, in the last 15 years, become a boon.Let us avoid the pitfalls of the past and let us prevent this operation from falling into disrepute and be- coming the first resort of the lazy obstetrician, the escape of the timid obstetrician, and the cloak of the incompetent.Let us use it wisely without holding it like the sword of Damocles over the head or body of the mother, whose only fault is that her pelvis lacks by a centimetre or so the proportions which would normally ensure natural child- birth. SummaryChanges which have occurred during the last fifty yrars in the methods of managing labour in patients with contracted pelvis are outlined.It is shown that the destructive operation has now almost disappeared and that classical caesarean section has been largely superseded by the lower segment operation.Reference is made to the alteration in the severity of contracted pelvis during the last fifty years, and the importance of the rachitic factor in the production of present-day pelvic contraction is mentioned.The role of the minor degrees of pelvic contraction as a cause of dystocia in labour is emphasized.The tendency towards an ever-increasing elective caesarean section rate is fully discussed and criticized, and an attempt has been made to justify the use of trial of induction of premature labour in specially selected cases.Where there is a minor degree of pelvic contraction premature surgical induction may initiate labour at a point where disproportion is minimal.or non-existent.
Enhancement of Docetaxel-Induced Cytotoxicity by Blocking Epidermal Growth Factor Receptor and Cyclooxygenase-2 Pathways in Squamous Cell Carcinoma of the Head and Neck
Authors: Mi Sun Choe, Zhuo Chen, Carmen M. Klass, Xin Zhang, Dong M. Shin
Journal: Clinical Cancer Research (2007)

Abstract Purpose: The addition of molecular targeted agents to enhance the cytotoxicity of chemotherapeutic agents is a promising strategy in cancer treatment. The combination of cyclooxygenase-2 inhibitors and epidermal growth factor receptor tyrosine kinase inhibitors, such as celecoxib and ZD1839 (gefitinib), was reported to achieve synergistic cell growth inhibition in squamous cell carcinoma of the head and neck. Therefore, we postulated that the addition of celecoxib and ZD1839 to docetaxel, a cytotoxic agent, might further increase antitumor activity. Experimental Design: The combination of celecoxib, ZD1839, and docetaxel was studied for its effect on cell growth and apoptosis by cell growth inhibition and Annexin V assays. The relevant molecular targets of these agents and apoptotic markers were examined by immunoblotting analyses in the presence or absence of these three drugs. Morphologic changes of the microtubule cytoskeleton, a known target of docetaxel, were also evaluated by staining for α-tubulin after the combination treatment. Results: We showed that this triple combination significantly enhanced cell growth inhibition and docetaxel-induced apoptosis. Docetaxel mainly induced caspase-8 activation, whereas the addition of celecoxib and ZD1839 augmented the caspase-8 activation and enhanced caspase-9 activation. One of the underlying mechanisms for augmentation of docetaxel-induced apoptosis by celecoxib and ZD1839 is to further inhibit the activation of prosurvival pathway molecules, such as extracellular signal-regulated kinase and AKT, and the promotion of aberrant apoptosis. Conclusions: Our studies suggest that the combination of docetaxel with a cyclooxygenase-2 inhibitor and an epidermal growth factor receptor tyrosine kinase inhibitor may further improve efficacy of docetaxel and other taxane-based therapies in squamous cell carcinoma of the head and neck.
Effects of atrial and ventricular tachycardia on systemic and coronary circulations, and myocardial oxygen consumption in control dogs and in dogs with adrenergic blockade
Authors: J. Nakano, R. B. McCloy
Journal: Cardiovascular Research (1970)

Atrial or ventricular tachycardia caused markedly greater cardiovascular deteriorations in dogs with adrenergic blockade than in control dogs. This is because the reflex stimulation of the beta adrenergic receptors in the heart plays an important role in the compensatory cardiovascular regulation during tachycardia.
The Physiological Castration Syndrome in Breast Cancer
Authors: G. J. Hadfield, J. A. G. Holt
Journal: BMJ (1956)

The treatment of metastatic breast cancer is still rather empirical.It can be put finally on a scientific basis only when specific tests for the various factors which influ- ence the growth of breast cancer can be easily per- formed.At present, however, clinical observation of these cases under treatment can yield valuable informa- tion on the course of the disease.This paper describes clinical observations on a series of cases of metastatic breast cancer treated by a variety of methods.An overall picture of the course of the disease is available, as they are for the most part com- pleted cases.
Shock-Wave Lithotripsy
Authors: Albert G. Mulley
Journal: New England Journal of Medicine (1986)

Just two years ago the first device designed to fragment kidney stones with shock waves generated outside the body was delivered to the United States by its German manufacturer, Dornier Systems. Soon, six American centers were participating in premarketing trials. Within 10 months, during which American experience corroborated German results,1 the Food and Drug Administration approved the Dornier device for marketing in the United States. FDA approval was announced with much fanfare; the secretary of Health and Human Services participated along with the FDA administrator and hailed extracorporeal shock-wave lithotripsy as "an authentic modern miracle," certain to enhance the quality . . .
Zinc absorption in Crohn's disease.
Authors: G C Sturniolo, M M Molokhia, R Shields, L A Turnberg
Journal: Gut (1980)

Zinc deficiency is a potential complication of Crohn9s disease and we have searched for evidence of this and assessed the possibility that malabsorption of zinc might be a cause. Serum zinc concentrations in 33 patients suffering from Crohn9s disease were significantly lower than in 58 normal control subjects (9 . 18 +/- 2 . 3 mumol compared with 13 . 6 +/- 1 . 73 mumol, P &lt; 0 . 0005). Serum zinc correlated well with serum albumin concentrations and the low serum zinc may simply reflect the low serum albumin. Thus its value as an indicator of zinc deficiency is poor. We studied zinc absorption in seven patients with Crohn9s disease and compared it with the results obtained previously in five normal subjects using a new technique involving a short-lived isotope of zinc (69mZn). Plasma appearance curves, constructed after an oral dose of isotope, and disappearance curves, after an intravenous dose, were used in a deconvolution computer programme to calculate zinc absorption. Compared with normal subjects, zinc absorption was considerably impaired in patients with Crohn9s disease (range 9--45%, compared with 38--75%). This abnormality is a potential cause of zinc deficiency in patients with Crohn9s disease.
Rheumatic Fever in Adults
Authors: FRANCISCO G. AGUILAR-TORRES
Journal: Annals of Internal Medicine (1979)

Letters and Corrections1 June 1979Rheumatic Fever in AdultsFRANCISCO G. AGUILAR-TORRES, M.D., LEON J. JACKSON, M.D.FRANCISCO G. AGUILAR-TORRES, M.D.Search for more papers by this author, LEON J. JACKSON, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-90-6-989_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: We read with interest the article by McDanald and Weisman in the December 1978 issue (1) on articular manifestations of rheumatic fever in adults. During our early medical training we saw patients with classic clinical presentation of rheumatic fever. During our first years of postgraduate training in the United States we saw acute rheumatic fever in an older-age-group population, in which the lack of Jones* criteria and minimal if any cardiac manifestations were the rule. We report here the case of an adult patient in whom aseptic meningitis was the initial clinical manifestation of rheumatic fever.A...References1. MCDANALDWEISMAN EM: Articular manifestations of rheumatic fever in adults. Ann Intern Med 89:917-920, 1978 LinkGoogle Scholar2. SELLERS T: An epidemiologic view of rheumatic fever. Prog Cardiovasc Dis 16:303-322, 1973 CrossrefGoogle Scholar3. MUND D: Rheumatic fever in adults (letter). Ann Intern Med 90:435, 1979 LinkGoogle Scholar4. FEINSTEINSPAGNUOLO AM: The clinical patterns of acute rheumatic fever: a reappraisal. Medicine (Baltimore) s41:279-305, 1962 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: St. Francis Hospital Milwaukee, WI 53215 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAseptic meningitis as initial presentation of rheumatic fever in an adult man: an extraordinary rare manifestation 1 June 1979Volume 90, Issue 6Page: 989-990KeywordsMeningitisResidencyRheumatic fever Issue Published: 1 June 1979 PDF downloadLoading ...
Effects of Aging and Hypoxia-Inducible Factor-1 Activity on Angiogenic Cell Mobilization and Recovery of Perfusion After Limb Ischemia
Authors: Marta Bosch-Marce, Hiroaki Okuyama, Jacob B. Wesley, Kakali Sarkar, Hideo Kimura, Ye V. Liu, Huafeng Zhang, Marianne Strazza, Sergio Rey, Lindsey Savino, Yi Fu Zhou, Karin R. McDonald, Youn Na, Scott Vandiver, Alireza Rabi, Yuval Shaked, Robert Kerbel, Theresa LaVallee, Gregg L. Semenza
Journal: Circulation Research (2007)

Ischemia is a stimulus for production of angiogenic cytokines that activate local vascular cells and mobilize angiogenic cells to the circulation. These responses are impaired in elderly patients with peripheral arterial disease. Hypoxia-inducible factor (HIF)-1 mediates adaptive responses to ischemia, including production of angiogenic cytokines. In this study, we demonstrate that aging and HIF-1 loss-of-function impair the expression of multiple angiogenic cytokines, mobilization of angiogenic cells, maintenance of tissue viability, and recovery of limb perfusion following femoral artery ligation. We show that HIF-1 directly activates transcription of the gene encoding stem cell factor and that mice lacking the cognate receptor C-KIT have impaired recovery from ischemia. Administration of AdCA5, an adenovirus encoding a constitutively active form of HIF-1α, improved the recovery of perfusion in older mice to levels similar to those in young mice. Injection of AdCA5 into nonischemic limb was sufficient to increase the number of circulating angiogenic cells. These results indicate that HIF-1 activity is necessary and sufficient for the mobilization of angiogenic cells and that HIF-1α gene therapy can counteract the pathological effects of aging in a mouse model of limb ischemia.
Myocardial stretch stimulates phosphatidylinositol turnover.
Authors: R von Harsdorf, R E Lang, M Fullerton, E A Woodcock
Journal: Circulation Research (1989)

The mammalian myocardium responds to stretch by increasing both contractility and the release of atrial natriuretic peptide. These effects are observed in isolated perfused heart preparations as well as in vivo. That atrial natriuretic peptide release can be stimulated by activation of the phosphatidylinositol turnover pathway suggests a possible mechanism by which stretch might activate a biological response. Accordingly, experiments were performed to examine the effect of dilatation of the right atrium on the phosphatidylinositol turnover pathway measured in isolated perfused hearts. Dilatation of the right atrium caused a stimulation of the phosphatidylinositol turnover pathway as measured by an increase in the accumulation of inositol phosphates. In right atria, increases were detected after 1 minute of dilatation, and maximal increases were observed after 10 minutes. Dilatation for 10 minutes caused an increase in inositol monophosphate, inositol bisphosphate, and inositol trisphosphate from 23.3 +/- 0.9, 15.4 +/- 0.4, and 9.5 +/- 0.3 cpm/mg tissue (mean +/- SEM, n = 7) to 74.6 +/- 2.3, 20.2 +/- 1.3, and 13.6 +/- 1.5 cpm/mg tissue (n = 8), respectively (p less than 0.01 for all inositol phosphates). Smaller increases were observed in the other chambers of the hearts. Perfusion with propranolol, prazosin, and atropine (all 1 microM) did not alter the inositol phosphate response to dilatation, indicating that it was not secondary to release of norepinephrine or acetylcholine. Dilatation of the right ventricle also caused a stimulation of inositol phosphate accumulation, but this was lower than after dilatation of the right atrium. These results show that the myocardium can respond to dilatation by an activation of the phosphatidylinositol turnover pathway.(ABSTRACT TRUNCATED AT 250 WORDS)
Commissioners must monitor Serco out of hours service in Cornwall more closely, says watchdog
Authors: J. Wise
Journal: BMJ (2013)

The public spending watchdog has strongly criticised the out of hours GP service in Cornwall provided by the private contractor Serco. Staffing levels were too low, it said, and the service fell unacceptably short of essential standards of quality and safety.1

The report by the National Audit Office recommends that out of hours contracts should be reviewed so that financial incentives are linked more clearly to quality requirements. It also calls for greater protection of whistleblowers, saying that they had an important role in highlighting concerns about Serco.

The parliamentary Public Accounts Committee asked the National Audit Office to investigate Serco’s performance. Margaret Hodge, the committee’s chairwoman, said that Serco’s performance was shocking and disgraceful. “Serco needs to raise its game and demonstrate that it is accurate and honest in reporting its performance. The primary care trust and, from April, the clinical commissioning group need to monitor every …