tbuckley/cabot-search huggingface dataset:
Association between Clean Delivery Kit Use, Clean Delivery Practices, and Neonatal Survival: Pooled Analysis of Data from Three Sites in South Asia
Authors: Nadine Seward, David Osrin, Leah Li, Anthony Costello, Anni-Maria Pulkki-Brännström, Tanja A. J. Houweling, Joanna Morrison, Nirmala Nair, Prasanta Tripathy, Kishwar Azad, Dharma Manandhar, Audrey Prost
Journal: PLoS Medicine (2012)

Background Sepsis accounts for up to 15% of an estimated 3.3 million annual neonatal deaths globally. We used data collected from the control arms of three previously conducted cluster-randomised controlled trials in rural Bangladesh, India, and Nepal to examine the association between clean delivery kit use or clean delivery practices and neonatal mortality among home births. Methods and Findings Hierarchical, logistic regression models were used to explore the association between neonatal mortality and clean delivery kit use or clean delivery practices in 19,754 home births, controlling for confounders common to all study sites. We tested the association between kit use and neonatal mortality using a pooled dataset from all three sites and separately for each site. We then examined the association between individual clean delivery practices addressed in the contents of the kit (boiled blade and thread, plastic sheet, gloves, hand washing, and appropriate cord care) and neonatal mortality. Finally, we examined the combined association between mortality and four specific clean delivery practices (boiled blade and thread, hand washing, and plastic sheet). Using the pooled dataset, we found that kit use was associated with a relative reduction in neonatal mortality (adjusted odds ratio 0.52, 95% CI 0.39–0.68). While use of a clean delivery kit was not always accompanied by clean delivery practices, using a plastic sheet during delivery, a boiled blade to cut the cord, a boiled thread to tie the cord, and antiseptic to clean the umbilicus were each significantly associated with relative reductions in mortality, independently of kit use. Each additional clean delivery practice used was associated with a 16% relative reduction in neonatal mortality (odds ratio 0.84, 95% CI 0.77–0.92). Conclusions The appropriate use of a clean delivery kit or clean delivery practices is associated with relative reductions in neonatal mortality among home births in underserved, rural populations. Please see later in the article for the Editors' Summary
Angiotensin II signaling and HB-EGF shedding via metalloproteinase in glomerular mesangial cells
Authors: Yoko Uchiyama-Tanaka, Hiroaki Matsubara, Yoshihisa Nozawa, Satoshi Murasawa, Yasukiyo Mori, Atsushi Kosaki, Katsuya Maruyama, Hiroya Masaki, Yasunobu Shibasaki, Soichiro Fujiyama, Atsuko Nose, Osamu Iba, Takamasa Hasagawa, Eriko Tateishi, Shigeki Higashiyama, Toshiji Iwasaka
Journal: Kidney International (2001)
Europe is urged to develop more transnational cancer research projects
Authors: Rory Watson
Journal: BMJ (2007)

European policy makers face two challenges in funding cancer research. They need to do more about the major differences in spending between the European Union's 27 member states, instead of trying to bridge the gap with the United States, and give more thought to closer cooperation among different projects and the creation of transnational research programmes.

This advice is contained in the second report from the European Cancer Research Managers Forum, published this week. Established in 2001, the forum has two main aims: to promote better understanding and cooperation among the …
Sir Charles Scarburgh.
Authors: C Newman
Journal: BMJ (1975)

Sir Charles Scarburgh was an important person in his own day because he was a great practising doctor and physician to Charles II, to James II, and to William and Mary.Even in that respect he has a place in history, because he was so generally respected that it was his word, after he had been chief physician at the death-bed of Charles II, which exonerated James II from the widely-held suspicion that he had poisoned his brother.But he was lastingly important for three reasons: his influence on mathematics, his influence on the Royal Society, and as the collector of a great library.He came of a Norfolk family, at North Walsham, where the remains of the house ultimately became a girls' school, but he was born in London, where he was left behind when his father emigrated to America to found a family there.This domestic disintegration did not, in those days, lead the boy to turn into a juvenile delinquent.On the contrary, he did well at St. Paul's School and proceeded to Caius College in 1634, where he held a scholarship until 1640, when he was made a Fellow.He worked at mathematics with Seth Ward (the future Bishop of Salisbury), of Emmanuel College,
Going from evidence to recommendations
Authors: Gordon H Guyatt, Andrew D Oxman, Regina Kunz, Yngve Falck-Ytter, Gunn E Vist, Alessandro Liberati, Holger J Schünemann
Journal: BMJ (2008)

The GRADE system classifies recommendations made in guidelines as either strong or weak. This article explores the meaning of these descriptions and their implications for patients, clinicians, and policy makers
In the treatment of flares of inflammatory bowel disease, intravenous hydrocortisone causes greater falls in blood potassium and more severe episodes of hypokalaemia than methylprednisolone
Authors: A. Wiles, F. Bredin, B. Chukualim, S. Middleton
Journal: Gut (2011)

Introduction Corticosteroids are important treatments for acute exacerbations of inflammatory bowel disease (IBD). In severe flares, or when oral steroid has proven unsuccessful, high dose intravenous steroid can be given in a hospital setting. Two intravenous corticosteroids are in common usage: hydrocortisone (HC) and methylprednisolone (MP). As well as the therapeutic glucocorticoid effect, both agents have mineralocorticoid effect. The mineralocorticoid effect of HC is greater than MP at the doses commonly used. It has been noted that high dose HC can cause life threatening hypokalaemia. To the authors' knowledge, the effects of MP and HC on serum potassium levels have not been assessed for a group of patients being treated for flares of IBD. Methods The case notes of patients with IBD were studied and details of admissions requiring intravenous steroid were noted. Blood potassium (K) levels on admission and throughout the inpatient stay were recorded. Disease extent and severity on admission was noted. Length of admission, length of steroid course, and whether the patient had surgical intervention or started ciclosporin or biologic therapy was also noted. Results There were 126 patients; 81 with Ulcerative colitis (UC) and 45 with Crohn's (CD). 170 admissions required intravenous steroid. HC was administered on 99 occasions and MP on 71. There was no significant difference between the average length of steroid course; 7.52 days for HC and 7.21 for MP. Similarly for length of stay; 13.62 days for HC and 12.86 for MP. Of all the admission episodes, 37 had no drop in serum potassium (37/170=21.8%). Of these, 9 were patients on HC (9/99=9.1%, while 28 were patients on MP (28/71=39.4%). The average drop in potassium measured during steroid courses was 0.814 (SD=0.497) for HC and 0.321 (SD=0.350) for MP, p<0.0001, that is, highly significant. The greatest fall in serum K was 2.2 for HC and 1.4 for MP. The mean lowest K reached was 3.24 for HC, 3.85 for MP. The number of patients who became hypokalaemic, that is, serum K<3.5 was significantly greater for HC than MP; 68/99=69% for HC, 8/71=11% for MP, p<0.0001. The number of patients requiring K supplementation, was greater for patients on HC than for those on MP, 67.7% of HC patients needed K supplementation, while only 11.3% of MP patients had supplementation prescribed. Conclusion The authors have shown that Hydrocortisone causes increased incidence of hypokalaemia compared to methylprednisolone when used to treat exacerbations of IBD. Given for possible adverse effects of hypokalaemia, intravenous methylprednisolone should be the treatment of choice in these patients.
Endoscopic retrieval of a migrated esophageal stent in the cecum
Authors: M. Shah, K. Jajoo
Journal: Endoscopy (2010)

A 38-year-old woman with a history of total gastrectomy in 2006 for adenocarcinoma presented with complaints of severe right-sided abdominal pain and dysphagia. The patient had experienced progressive intolerance to solid foods and a 50-lb weight loss over 1 year. Work-up at an outside institution revealed recurrent cancer at the esophago-enteric anastomosis, and a 23 mm × 100 mm Wallflex partially covered esophageal stent (Boston Scientific, Natick, Massachusetts, USA) was placed at that time. The patient noted rapid recurrence in dysphagia and concomitant abdominal discomfort after 2 days.
STUDIES ON ANTIGENICITY
Authors: Bernard B. Levine, Baruj Benacerraf
Journal: The Journal of Experimental Medicine (1964)

The enzymatic degradation of fluorescein conjugates of poly-L-lysine, poly-D-lysine, and exhaustively succinylated poly-L-lysine by aqueous extracts of spleens from "responder" (guinea pigs which can develop immune responses to hapten-poly-L-lysine conjugates) and "non-responder" guinea pigs was investigated. The in vivo degradation of H3-tagged dinitrophenyl conjugates of these synthetic polyamino acids was also studied by measuring urinary excretion of radioactive low molecular weight degradation products of these conjugates after their intraperitoneal injection. It was found that both responder and non-responder guinea pigs can degrade succinylated and unsuccinylated poly-L-lysine conjugates into small molecular fragments, but they cannot degrade hapten-poly-D-lysine conjugates. These studies demonstrate that in addition to the known requirements for antigenicity of macromolecules, i.e. the presence of antigenic determinants, and their capacity to be degraded by immunological tissues, the resulting degradation products must undergo certain additional, as yet unidentified, specific metabolic steps in order to induce an immune response.
Outcomes and charges of elderly patients with acute myeloid leukemia
Authors: Laura M. Katz, Jamie B. Howell, John J. Doyle, Lee S. Stern, Lisa C. Rosenblatt, Catherine Tak Piech, Marya D. Zilberberg
Journal: American Journal of Hematology (2006)

A retrospective database analysis was conducted to evaluate hospitalization outcomes and charges among elderly acute myeloid leukemia (AML) patients. The data source was a longitudinal (2000–2003) inpatient database from 28 US hospitals. Data on 275 AML patients aged 60 and older were analyzed for demographic and treatment characteristics, hospital mortality, length of stay (LOS), overall days of stay (DOS), and charges across multiple admissions. Multivariate modeling was performed to determine factors that influenced outcomes. Overall, 115 (41.8%) patients received inpatient chemotherapy (CT); most (90.4%) received it on the first admission. Of all initial CT regimens 40.9% consisted of a single agent. The mean LOS for initial hospitalization was 23.0 (SD 21.8) days for patients who received CT and 6.7 (SD 7.5) days for those who did not. One quarter (25.3%) of initial hospitalizations resulted in death. On initial hospitalization, mean total charges were $113,118 (SD $220,417) for patients who received CT and $43,999 (SD $190,533) for those who did not; for both groups mean charges were higher than respective subsequent admission charges. Overall, in-hospital mortality did not differ significantly between on-CT and off-CT groups (43.5 and 38.8%, respectively). In multivariate modeling, CT was significantly associated (P < 0.0001) with increased charges and LOS. Elderly patients with AML incurred substantial hospital charges and inpatient mortality. The highest charges and a substantial number of deaths occurred during first admission. Although treatment with CT was associated with increased charges and days in-hospital, inpatient mortality in the two groups was found to be similar. Am. J. Hematol., 2006. © 2006 Wiley-Liss, Inc.
Hepatic Fibrosis After Long-Term Administration of Ethanol and Moderate Vitamin A Supplementation in the Rat
Authors: Maria Anna Leo, Charles S. Lieber
Journal: Hepatology (1983)

Rats were fed up to 9 months diets supplemented with vitamin A in an amount that, by itself, had no apparent adverse effect on the liver. When associated with chronic ethanol administration, vitamin A supplementation strikingly exacerbated ethanol–induced abnormalities: fat accumulation was increased and numerous giant mitochondria were observed. Furthermore, lesions appeared which ethanol alone does not produce in rats, namely necrosis, inflammation, and fibrosis. Vitamin A supplementation increased the number of fat storing cells (lipocytes) which positively correlated with vitamin A accumulation in the liver. However, when vitamin A supplementation was combined with ethanol administration, vitamin A levels in the liver and the number of fat storing cells decreased and numerous myofibroblasts appeared in association with abundant collagen fibers. There was also hepatic inflammation and necrosis, accompanied by a rise in serum glutamate dehydrogenase, SGOT, and SGPT and a decrease in retinol binding protein and vitamin A. We conclude that amounts of vitamin A, which by themselves appear harmless, may produce severe liver lesions when associated with chronic ethanol consumption.
Asthma: pathophysiology of the bronchial obstruction
Authors: R. Maselli, G. Paciocco
Journal: Allergy (2000)

From a pathophysiologic perspective, the changes that occur in asthma are multiple, diverse, and complex. Assessment of the mechanical properties of the ventilatory apparatus provides several different types of information, depending on the gravity of the bronchial obstruction. During asthma, or induced bronchial obstruction, the function of the muscles is altered, causing changes in respiratory timing. Expiratory duration decreases more than inspiratory duration, and the functional residual capacity (FRC) increases, due to mechanical changes within the airways that lead to air trapping. The related hypoventilation is responsible for hypoxemia and hypercapnia, but it does not severely affect the diffusion capacity of the alveolocapillary membrane. We describe the pathophysiology of the bronchial obstruction in asthmatic patients, underlining the critical function of the respiratory muscles. Moreover, we clarify the relations between the ventilatory changes and gas‐exchange alteration.
Liver resection of transplantation for hepatocellular carcinoma?
Authors: Jacques Michel, Bertrand Suc, Françoise Montpeyroux, Sadia Hachemanne, Pierre Blanc, Jacques Domergue, Jean Mouiel, Christian Gouillat, Christian Ducerf, Jean Saric, Yves Patrice Le Treut, Gilles Fourtanier, Jean Escat
Journal: Journal of Hepatology (1997)
Location-specific effect of microbiota and MyD88-dependent signaling on Wnt/β-catenin pathway and intestinal stem cells
Authors: Shirin Moossavi
Journal: Gut Microbes (2013)

Intestinal homeostasis depends on the proper activity of the intestinal stem cells (ISCs) and an appropriate host response to the normal resident microbiota. The question on the effect of microbiota on ISCs behavior has not been addressed yet. Canonical Wnt pathway and ISC gene expression signature was compared in germfree vs. conventional and MyD88−/− vs. Myd88+/+ mice based on publicly available gene expression data sets. Microbiota and MyD88-dependent signaling have distinct effects on the Wnt pathway and ISC at gene expression level. In addition, the effect of microbiota and MyD88-dependent signaling on Wnt pathway and ISCs show regional variation. The net effect of microbiota on Wnt pathway and ISCs cannot be inferred from the available data. Nonetheless, the data are suggestive of a potential regulatory mechanism of the Wnt pathway by the microbiota and plausibly by any alteration in the microbiota composition.
Negative Regulation of Soluble Flt-1 and Soluble Endoglin Release by Heme Oxygenase-1
Authors: Melissa Cudmore, Shakil Ahmad, Bahjat Al-Ani, Takeshi Fujisawa, Heather Coxall, Kunal Chudasama, Luke R. Devey, Stephen J. Wigmore, Allyah Abbas, Peter W. Hewett, Asif Ahmed
Journal: Circulation (2007)

Background— Preeclampsia is characterized clinically by hypertension and proteinuria. Soluble Flt-1 (sFlt-1; also known as soluble vascular endothelial growth factor receptor-1 [VEGFR-1]) and soluble endoglin (sEng) are elevated in preeclampsia, and their administration to pregnant rats elicits preeclampsia-like symptoms. Heme oxygenase-1 (HO-1) and its metabolite carbon monoxide (CO) exert protective effects against oxidative stimuli. Thus, we hypothesized that HO-1 upregulation may offer protection against preeclampsia by inhibiting sFlt-1 and sEng release. Methods and Results— Preeclamptic villous explants secreted high levels of sFlt-1 and sEng. Adenoviral overexpression of HO-1 in endothelial cells inhibited VEGF-mediated sFlt-1 release and interferon-γ– and tumor necrosis factor-α–induced sEng release, whereas HO-1 inhibition potentiated sFlt-1 and sEng production from endothelial cells and placental villous explants. Consistent with these findings, mice lacking HO-1 produced higher levels of sFlt-1 and sEng compared with wild-type mice. Using selective ligands (VEGF-E and placental growth factor) and a receptor-specific inhibitor (SU-1498), we demonstrated that VEGF-induced sFlt-1 release was VEGFR-2 dependent. Furthermore, CO–releasing molecule-2 (CORM-2) or CO decreased sFlt-1 release and inhibited VEGFR-2 phosphorylation. Treatment of endothelial cells with statins upregulated HO-1 and inhibited the release of sFlt-1, whereas vitamins C and E had no effect. Conclusions— The present study demonstrates that the HO-1/CO pathway inhibits sFlt-1 and sEng release, providing compelling evidence for a protective role of HO-1 in pregnancy, and identifies HO-1 as a novel target for the treatment of preeclampsia.
Principles and Practice of Pediatric Oncology
Authors: Richard J. Labotka
Journal: JAMA (1997)

"I will always remember four days in my life: the birth of each of my children, the day President Kennedy was shot, and the day my younger son was diagnosed with leukemia. That day will always be frozen in my mind." So goes a line from my favorite chapter in<i>Principles and Practice of Pediatric Oncology</i>. Indeed, few things in life are as devastating to a family as the diagnosis of cancer in a beloved child. Yet, in the midst of this devastation springs hope, and justifiably so, for the development of effective treatment for pediatric malignancies ranks as one of the major achievements of 20th-century medicine. Modern treatment of children with cancer is complex and requires a multidisciplinary approach, generally in the setting of a major medical center participating in national clinical research trials. In this third edition, Pizzo and Poplack, along with 133 contributors, have attempted to address
Serum Levels and Digoxin Toxicity
Authors: David H. Spodick
Journal: JAMA (1981)

<h3>To the Editor.—</h3> The otherwise useful review of digitalis in heart failure by Sodums and colleagues (1981;246:158) is flawed by the recommendation that a "maximal effective, yet safe, dose may be attained by measuring serum levels while considering the factors affecting loading and maintenance doses." One should, of course, consider the factors noted, but the use of serum levels tends to be misleading. The wide overlap in plasma levels of digoxin between patients experiencing toxic effects and those who do not is well known. Moreover, the recent work of Goren and Denes (<i>Chest</i>1981; 79:555) indicates that rhythms potentially owing to digitalis intoxication are frequently observed during 24-hour monitoring in hospitalized patients and "are frequently unrelated to the serum level of digoxin, and appear unlikely to reflect true digitalis intoxication." Estimating the level of digitalis glycosides can, of course, confirm that the patient is actually taking one or another agent.
Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial
Authors: S Bhattacharya, K Harrild, J Mollison, S Wordsworth, C Tay, A Harrold, D McQueen, H Lyall, L Johnston, J Burrage, S Grossett, H Walton, J Lynch, A Johnstone, S Kini, A Raja, A Templeton
Journal: BMJ (2008)

<b>Objective</b> To compare the effectiveness of clomifene citrate and unstimulated intrauterine insemination with expectant management for the treatment of unexplained infertility. <b>Design</b> Three arm parallel group, pragmatic randomised controlled trial. <b>Setting</b> Four teaching hospitals and a district general hospital in Scotland. <b>Participants</b> Couples with infertility for over two years, confirmed ovulation, patent fallopian tubes, and motile sperm. <b>Intervention</b> Expectant management, oral clomifene citrate, and unstimulated intrauterine insemination. <b>Main outcome measures</b> The primary outcome was live birth. Secondary outcome measures included clinical pregnancy, multiple pregnancy, miscarriage, and acceptability. <b>Results</b> 580 women were randomised to expectant management (n=193), oral clomifene citrate (n=194), or unstimulated intrauterine insemination (n=193) for six months. The three randomised groups were comparable in terms of age, body mass index, duration of infertility, sperm concentration, and motility. Live birth rates were 32/193 (17%), 26/192 (14%), and 43/191 (23%), respectively. Compared with expectant management, the odds ratio for a live birth was 0.79 (95% confidence interval 0.45 to 1.38) after clomifene citrate and 1.46 (0.88 to 2.43) after unstimulated intrauterine insemination. More women randomised to clomifene citrate (159/170, 94%) and unstimulated intrauterine insemination (155/162, 96%) found the process of treatment acceptable than those randomised to expectant management (123/153, 80%) (P=0.001 and P&lt;0.001, respectively). <b>Conclusion</b> In couples with unexplained infertility existing treatments such as empirical clomifene and unstimulated intrauterine insemination are unlikely to offer superior live birth rates compared with expectant management. <b>Trial registration</b> ISRCT No: 71762042
Editorial: No mandatory retirement from therapy
Authors: S. Vaisrub
Journal: JAMA (1975)

Many who are approaching 60 to 65 dread their impending mandatory retirement. Even those who looked forward to it with joyful anticipation often find that neither the pleasures of leisure, nor the pursuit of hobbies, nor an ersatz second career makes for the good life. Unfortunately, the anguish associated with forced retirement has not received the deserved attention by employers in either the public or the private sector. Despite complaints and protests, the active older man is still denied the opportunity to pursue his vocation—his only key to meaningful life. One can draw a parallel between this denial and the denial of major surgery at the cutoff age. Benefits of drastic surgical procedures are often withheld from the older patient because of considerations of increased risk and decreased life expectancy. However important these considerations may be, they do not conceal an element of rationalization. One can detect an underlying assumption