tbuckley/cabot-search huggingface dataset:
Association Between Remission of Macroalbuminuria and Preservation of Renal Function in Patients With Type 2 Diabetes With Overt Proteinuria
Authors: Hiroki Yokoyama, Shin-ichi Araki, Jun Honjo, Shinichiro Okizaki, Daishiro Yamada, Ryushi Shudo, Hitoshi Shimizu, Hirohito Sone, Tatsumi Moriya, Masakazu Haneda
Journal: Diabetes Care (2013)

Studies on the rate of remission of macroalbuminuria in patients with type 2 diabetes mellitus (T2DM) and the effects of reduction in albuminuria on renal prognosis in a primary care setting are absolutely lacking.A total of 211 T2DM patients with albuminuria≥300 mg/g were enrolled in a prospective observational study (mean of 4.5 years). The incidence of patients with remission of macroalbuminuria at every 1-year study time point after starting intensified diabetes treatment and the factors associated with remission were evaluated. The association of reduction in albuminuria with renal events (doubling of serum creatinine and end-stage renal disease) was also investigated.During the 5-year study period, remission to microalbuminuria occurred in 116 patients and the 5-year cumulative incidence was 58.3%. Notably, most cases (82.8%) obtained remission at the 1-year study time point. The remission rate increased with achieving therapeutic targets for blood pressure and blood glucose. Remission and reduction in albuminuria of ≥50% were associated with preservation of renal function. In particular, patients who obtained both remission and 50% reduction at the 1-year study time point exhibited a significantly reduced risk for renal events as compared with those with no remission and no reduction (adjusted hazard ratio 0.30 [95% CI 0.12-0.76]).Remission of macroalbuminuria occurs frequently and is associated with the preservation of renal function in T2DM patients. The initial adequate diabetes treatment aimed at reducing albuminuria may lead to improved renal prognosis in the primary care setting.
THE INFLUENCE OF WAR SURGERY ON TREATMENT OF FRACTURES IN GREAT BRITAIN
Authors: W. ROWLEY BRISTOW
Journal: JAMA (1927)

In order to assess the influence of the late war on the treatment of fractures in Great Britain, it is necessary to consider what was the state of affairs before the war. In the nineties, and in the first decade of the present century, the vast new fields of surgery which opened up—made possible by the work of Pasteur and Lister—had attracted surgeons so largely that the treatment of fractures had been allowed to fall into the background. There was so much to discover, so much that was new, that the incentive for a man to put his best efforts into the field of abdominal surgery was very real. There can be no doubt, looking back to this time, that fractures were neglected by the generality of surgeons, and this of necessity was reflected in the paucity of the teaching. The discovery of roentgen rays in 1895 had to a
Diagnosing human African trypanosomiasis in Angola using a card agglutination test: observational study of active and passive case finding strategies
Authors: Walter O Inojosa, Inacio Augusto, Zeno Bisoffi, Teofile Josenado, Paulo M Abel, August Stich, Christopher J M Whitty
Journal: BMJ (2006)

To assess the operational feasibility of detecting human African trypanosomiasis by active and passive case finding using the card agglutination test with serial dilution of serum to guide treatment.Trypanosomiasis control programme in the Negage focus, northern Angola, during a period of civil war.Observational study.359 patients presenting themselves to health centres with symptoms (passive case finding) and 14,446 people actively screened in villages.Whole blood and serological tests at different dilutions using the card agglutination test, and detection of parasites by microscopy.Active case finding identified 251 people with a positive card agglutination test result, 10 of whom had confirmed parasites. In those presenting for investigation 34 of 51 with a positive card agglutination test result at the dilution of 1:8 or more used to guide treatment had parasites in blood, lymph node fluid, or cerebrospinal fluid, compared with 10 of 76 in those detected by active case finding: positive predictive values of 67% for passive case detection and 13% for active case detection. Only at a cut-off dilution more than 1:32 was the positive predictive value in active case detection reasonable (46%) and at this dilution 40% of microscopically proved cases were missed.The card agglutination test is useful for initial screening in active detection of cases with human African trypanosomiasis but, given the toxicity of the drugs, serology using the card agglutination test should be not used alone to guide treatment after active case finding. A second confirmatory test is needed.
Full time forensic pathology service needs to be established
Authors: C. Milroy, B. Hunt
Journal: BMJ (2001)

EDITOR—The investigation of deaths in England and Wales has not been attracting positive headlines recently. Events surrounding Alan Shipman, Alder Hey, Bristol, and the Marchioness incident have all put a question mark over the processes of investigation and have prompted various inquiries, including consideration of the role of coroners.

Currently, coroners may be medical practitioners or lawyers of at least five years' standing.1 Many work part time, with small jurisdictions. Despite this, if a complex death or …
Analysis of hepatitis C virus resistance to silibinin <i>in vitro</i> and <i>in vivo</i> points to a novel mechanism involving nonstructural protein 4B
Authors: Katharina Esser-Nobis, Inés Romero-Brey, Tom M. Ganten, Jérôme Gouttenoire, Christian Harak, Rahel Klein, Peter Schemmer, Marco Binder, Paul Schnitzler, Darius Moradpour, Ralf Bartenschlager, Stephen J. Polyak, Wolfgang Stremmel, François Penin, Christoph Eisenbach, Volker Lohmann
Journal: Hepatology (2013)

Intravenous silibinin (SIL) is an approved therapeutic that has recently been applied to patients with chronic hepatitis C, successfully clearing hepatitis C virus (HCV) infection in some patients even in monotherapy. Previous studies suggested multiple antiviral mechanisms of SIL; however, the dominant mode of action has not been determined. We first analyzed the impact of SIL on replication of subgenomic replicons from different HCV genotypes in vitro and found a strong inhibition of RNA replication for genotype 1a and genotype 1b. In contrast, RNA replication and infection of genotype 2a were minimally affected by SIL. To identify the viral target of SIL we analyzed resistance to SIL in vitro and in vivo. Selection for drug resistance in cell culture identified a mutation in HCV nonstructural protein (NS) 4B conferring partial resistance to SIL. This was corroborated by sequence analyses of HCV from a liver transplant recipient experiencing viral breakthrough under SIL monotherapy. Again, we identified distinct mutations affecting highly conserved amino acid residues within NS4B, which mediated phenotypic SIL resistance also in vitro. Analyses of chimeric viral genomes suggest that SIL might target an interaction between NS4B and NS3/4A. Ultrastructural studies revealed changes in the morphology of viral membrane alterations upon SIL treatment of a susceptible genotype 1b isolate, but not of a resistant NS4B mutant or genotype 2a, indicating that SIL might interfere with the formation of HCV replication sites.Mutations conferring partial resistance to SIL treatment in vivo and in cell culture argue for a mechanism involving NS4B. This novel mode of action renders SIL an attractive candidate for combination therapies with other directly acting antiviral drugs, particularly in difficult-to-treat patient cohorts.
Active observation in management of acute abdominal pain in childhood.
Authors: P F Jones
Journal: BMJ (1976)

Out of 363 children admitted to a surgical unit with acute abdominal pain only 126 (35%) had an operation. Of these, 20 first underwent a period of "active observation." This procedure, used to help reach a diagnosis or decision in doubtful cases, is safe and useful and may be applied at home or in hospital.
Informing Selection of Nanomaterial Concentrations for ToxCast <i>in Vitro</i> Testing Based on Occupational Exposure Potential
Authors: Sumit Gangwal, James S. Brown, Amy Wang, Keith A. Houck, David J. Dix, Robert J. Kavlock, Elaine A. Cohen Hubal
Journal: Environmental Health Perspectives (2011)

Background: Little justification is generally provided for selection of in vitro assay testing concentrations for engineered nanomaterials (ENMs). Selection of concentration levels for hazard evaluation based on real-world exposure scenarios is desirable.Objectives: Our goal was to use estimates of lung deposition after occupational exposure to nanomaterials to recommend in vitro testing concentrations for the U.S. Environmental Protection Agency's ToxCast™ program. Here, we provide testing concentrations for carbon nanotubes (CNTs) and titanium dioxide (TiO2) and silver (Ag) nanoparticles (NPs).Methods: We reviewed published ENM concentrations measured in air in manufacturing and R&D (research and development) laboratories to identify input levels for estimating ENM mass retained in the human lung using the multiple-path particle dosimetry (MPPD) model. Model input parameters were individually varied to estimate alveolar mass retained for different particle sizes (5–1,000 nm), aerosol concentrations (0.1 and 1 mg/m3), aspect ratios (2, 4, 10, and 167), and exposure durations (24 hr and a working lifetime). The calculated lung surface concentrations were then converted to in vitro solution concentrations.Results: Modeled alveolar mass retained after 24 hr is most affected by activity level and aerosol concentration. Alveolar retention for Ag and TiO2 NPs and CNTs for a working-lifetime (45 years) exposure duration is similar to high-end concentrations (~ 30–400 μg/mL) typical of in vitro testing reported in the literature.Conclusions: Analyses performed are generally applicable for providing ENM testing concentrations for in vitro hazard screening studies, although further research is needed to improve the approach. Understanding the relationship between potential real-world exposures and in vitro test concentrations will facilitate interpretation of toxicological results.
Isolated Aldosterone Deficiency in Man: Acquired and Inborn Errors in the Biosynthesis or Action of Aldosterone*
Authors: JOHANNES D. VELDHUIS, JAMES C. MELBY
Journal: Endocrine Reviews (1981)

The combined efforts of clinical investigation and biochemical research have provided substantive insights into the homeostatic mechanisms that maintain concentrations of monovalent cations within a narrow physiological range in body fluids. For example, more precise knowledge of biochemical pathways subserving mineralocorticoid production in man has derived from recent detailed studies of certain “experiments in nature,” which comprise discrete inborn errors in aldosterone biosynthesis. Such conditions are biochemically and genetically distinct from congenital end-organ resistance to mineralocorticoid action (so-called pseudohypoaldosteronism). In addition, more comprehensive characterization has been attained of acquired, isolated defects in mineralocorticoid production in association with various clinical disorders. However, under any of these pathological conditions, defective hormonal regulation of sodium and potassium balance has created a spectrum of clinical disorders, ranging from life-threatenin...
What we have to explain in foreign language learning
Authors: Robert Bley-Vroman
Journal: Behavioral and Brain Sciences (1996)

Abstract While child language development theory must explain invariant “success,” foreign language learning theory must explain variation and lack of success. The fundamental difference hypothesis (FDH) outlines such a theory. Epstein et al. ignore the explanatory burden, mischaracterize the FDH, and underestimate the resources of human cognition. The field of second language acquisition is not divided into camps by views on “access” to UG.
The association between atopy and asthma in a semirural area of Tanzania (East Africa)
Authors: J. Sunyer, J. Torregrosa, J. M. Anto, C. Menendez, C. Acosta, D. Schellenberg, P. L. Alonso, C. Acosta, D. Schellenberg, E. Kahigwa, E. Kahigwa
Journal: Allergy (2000)

Background: Atopy is consistently associated with asthma, except in a study in Africa. We assessed the association between atopy and asthma in women from a semirural area of Tanzania (East Africa). Methods: All pregnant women delivering at the district hospital during a 1‐year period were recruited ( n =658, 60.6% of those selected). Asthma was investigated by a standard questionnaire and atopy by specific IgE (immunoglobulin E) antibodies to Dermatophagoides pteronyssinus (Der p 1) and cockroach. Results: The prevalence of wheezing chest was 10.7%; of asthma, 3.5%. Levels of specific IgE of &gt;0.35 kU/l (73%) and high levels of total IgE (62% higher than 1000 kU/l) were highly prevalent. Specific IgE antibody levels in sera were not associated with asthma (3.8% of women with negative specific IgE to any antigen had asthma in comparison to 4.0% of women with positive specific IgE; odds ratio [OR]=1.06, 0.35–3.22). Total IgE was not different between women with asthma and women without asthma ( P =0.36). Conclusions: In tropical regions, the association between allergy and asthma is complex, and specific IgE reactivity to environmental allergens may not be related to asthma.
Onset heart rate of microvolt-level T-wave alternans provides clinical and prognostic value in nonischemic dilated cardiomyopathy
Authors: Hidetsuna Kitamura, Yoshio Ohnishi, Katsunori Okajima, Akihiko Ishida, ErdulfoJavier Galeano, Kazumasa Adachi, Mitsuhiro Yokoyama
Journal: Journal of the American College of Cardiology (2002)
Teaching the Person with Diabetes: Experience with a Follow-up Session
Authors: Fred W Whitehouse, Iris J Whitehouse, Joellen Smith, Richard D Hohl
Journal: Diabetes Care (1979)

We studied 371 diabetic patients who attended an outpatient follow-up session after completing an in-patient diabetes education program. Identified gaps in information on diabetes care included problems with understanding the prescribed diet (155 patients), incorrect urine testing (30 patients), and unacceptable technics of insulin administration (26 patients). We also reviewed 178 consecutive patients who had been invited to this follow-up session to ascertain how often readmission to the hospital occurred. 88 of these patients attended a follow-up session while 90 patients did not attend. Over the ensuing 5 yr, the latter group had a significantly higher readmission rate (P &amp;lt; 0.01), yet readmissions for education-related reasons (ketoacidosis, foot infections, and hypoglycemia) were not significantly different. Even when diabetic patients have recently attended education sessions on living with diabetes, attendance at regular follow-up sessions is encouraged to reinforce learning and to identify persisting gaps in information.
Rapid Optimization of Gene Delivery by Parallel End-modification of Poly(β-amino ester)s
Authors: Gregory T Zugates, Weidan Peng, Andreas Zumbuehl, Siddharth Jhunjhunwala, Yu-Hung Huang, Robert Langer, Janet A Sawicki, Daniel G Anderson
Journal: Molecular Therapy (2007)

Poly(β-amino ester)s are cationic degradable polymers that have significant potential as gene delivery vectors. Here we present a generalized method to modify poly(β-amino ester)s at the chain ends to improve their delivery performance. End-chain coupling reactions were developed so that polymers could be synthesized and tested in a high-throughput manner, without the need for purification. In this way, many structural variations at the polymer terminus could be rapidly evaluated. End-modification of the terminal amine structure of a previously optimized poly(β-amino ester), C32, significantly enhanced its in vitro transfection efficiency. In vivo, intraperitoneal (IP) gene delivery using end-modified C32 polymers resulted in expression levels over one order of magnitude higher than unmodified C32 and jet-polyethylenimine (jet-PEI) levels in several abdominal organs. The rapid end-modification strategy presented here has led to the discovery of many effective polymers for gene delivery and may be a useful method to develop and optimize cationic polymers for gene therapy.
Competency Assessment of Primary Care Physicians as Part of a Peer Review Program
Authors: Geoffrey R. Norman
Journal: JAMA (1993)

<h3>Objective.</h3> —To design and test a program that assesses clinical competence as a second stage in a peer review process and to determine the program's reliability. <h3>Design and Setting.</h3> —A three-cohort study of Ontario primary care physicians. <h3>Participants.</h3> —Reference physicians (n=26) randomly drawn from the Hamilton, Ontario, area; volunteer, self-referred physicians (n=20); and physicians referred by the licensing body (n=37) as a result of a disciplinary hearing or peer review. <h3>Main Outcome Measures.</h3> —Standardized patients, structured oral examinations, chart-stimulated recall, objective structured clinical examination, and multiplechoice examination. <h3>Results.</h3> —Test reliability was high, ranging from 0.73 to 0.91, and all tests discriminated among subgroups. Demographic variables relating to the final category were age, Canadian or foreign graduates, and whether or not participants were certified in family medicine. <h3>Conclusions.</h3> —The study demonstrated the feasibility, reliability, and validity of a multicomponent examination in the peer review process. (<i>JAMA</i>. 1993;270:1046-1051)
Corticosteroids in bacterial meningitis.
Authors: R G Finch, C Mandragos
Journal: BMJ (1991)

compared with men who got jobs; the unemployed men consulted general practitioners 57% more often about 13% more illnesses, were referred to hospital outpatient depart- ments 63% more often, and visited hospital twice as often.'3These results fit with data from the general household survey showing that men seeking work consult general practitioners 80% more than those in employment, and those who have been out of work for five years or more consult even more often.'" How should health workers respond to this hardening evidence on the harm of unemployment?They must place it before politicians because the appalling human cost of unemployment must not be forgotten in the economic discussions that Worswick's study shows to be less certain than some monetarist economists might pretend.2Training and temporary employment are crucially important, and the evidence is that the government's employment training scheme is not working well: more than halfofthose completing the scheme are unemployed, three months later.'5Social security payments should be improved because poverty is one of the main mediators of the damage caused to health by unemployment.Doctors need to be sensitive in their consultations with the unemployed and encourage independence rather than dependence on prescription drugs.Fineman suggests that this may be done in a book published last year. 16 Finally, it may be that the contracts of the new health service could provide mechanisms for responding to the health problems of the unemployed.
Focal liver lesions: a plan for management.
Authors: J N Thompson, R Gibson, A Czerniak, L H Blumgart
Journal: BMJ (1985)

A management plan for patients with suspected focal liver lesions which avoids early biopsy includes routine laboratory investigations, ultrasound scanning, and assessment for evidence of extrahepatic metastases and non-hepatic primary tumours. Angiography and computed tomography may also be indicated, and laparotomy or laparoscopy is undertaken to assess any potentially resectable focal liver lesions. The plan requires modification to suit individual circumstances.
SOME HYPOTHESES CONCERNING THE ROLE OF SYMPATHOMIMETIC AMINES IN PSYCHIATRIC CONDITIONS
Authors: SOLOMON GARB, NATHURAM M. TIWARI, LORING F. CHAPMAN
Journal: American Journal of Psychiatry (1957)

The following hypotheses are suggested concerning the possible roles of sympathomimetic amines in psychiatric conditions: 1. Isuprel, or a similar substance, may be an important chemical mediator in anxiety. 2. Another amine, possibly nor-epinephrine, may be an important chemical mediator in aggression and hostility. 3. When a patient experiences approximately equal quantities of hostility and anxiety, equipotent concentrations of Isuprel and the other amine may be liberated, producing depression, by a mechanism similar to that whereby a mixture of 2 amines depresses the isolated mammalian auricle, although either amine alone has a stimulant action. An additional possibility suggested by continuing studies in this field is that the depression of rate and force observed with the mixture of amines is produced by an intermediate metabolite, formed within 1 or 2 minutes.
Screening Clinic for the Presurgical Patient
Authors: Richard Collens
Journal: JAMA (1973)

To the Editor.—  Janis and Downs (223: 692, 1973) point out the usefulness of the anesthesia screening clinic as a potential for expansion to include preadmission evaluation of patients to be admitted to the hospital for elective surgery....  The Ambulatory Care Service and the Department of Anesthesiology at the Bronx Municipal Hospital Center have had just such a service since July 1972. Since that time, 559 patients scheduled for elective general, gynecological, or urological surgical procedures have been evaluated in the Screening Clinic of the Center within two to seven days prior to their scheduled day of admission.  We plan to present our data later this year, but preliminary review indicates a significant reduction in the number of preoperative hospital days. This program allows for better bed utilization and will be an integral part of our Ambulatory Surgical Unit currently under development in this institution.
Characteristics of frequency content of atrial signal-averaged electrocardiograms during sinus rhythm in patients with paroxysmal atrial fibrillation
Authors: Takahisa Yamada, Masatake Fukunami, Masaharu Ohmori, Kazuaki Kumagai, Akihiko Sarai, Nobuhiko Kondoh, Tetsuo Minamino, Noritake Hoki
Journal: Journal of the American College of Cardiology (1992)
Demystifying the Law: An Introduction for Professionals
Authors: Glyn G. Caldwell
Journal: JAMA (1991)

The author of this small book has undertaken the daunting task of simplifying and summarizing the United States' legal system for nonlawyer professionals. The book has succeeded in summarizing the primary aspects of the law in 21 chapters grouped into three major sections: "The American Legal System and the Role of Law in Society," "Administrative Law and Judicial Review," and "Some Specific Legal Issues." The first part outlines the law's historical basis from Anglo-Saxon common law and the Constitution through the constant changes resulting from treaties, statutes, and court decisions. The organization and jurisdictions of the different courts are nicely outlined. Part 2 involves administrative rules, rule making, and actions, along with the judicial review process. Many of the ideas found in this area will be of interest to administrators, rule writers, and professionals who must interpret and comply with the final rules. The book will not make you a