tbuckley/cabot-search huggingface dataset:
Dying we live
Authors: C. Douglas
Journal: BMJ (2003)

On the stairs an evocative odour lingers. The anatomy department has gone but its lecture theatre remains: blackboard, dusty skylight, and tiered half-circle of fiercely uncomfortable benches exactly as they were. Even decades on there is a flicker of the bad-dream feeling of being trapped back in school, ignorant and accountable. The brachial plexus? The decussation of the pyramids? The foramen of Monro?

But someone has kindly removed the skeleton that stood sentinel on the hundreds of …
Outpatient Insulin Therapy in Type 1 and Type 2 Diabetes Mellitus
Authors: Dawn E. DeWitt, Irl B. Hirsch
Journal: JAMA (2003)

Newer insulin therapies, including the concept of physiologic basal-prandial insulin and the availability of insulin analogues, are changing clinical diabetes care. The key to effective insulin therapy is an understanding of principles that, when implemented, can result in improved diabetes control.To systematically review the literature regarding insulin use in patients with type 1 and type 2 diabetes mellitus (DM).A MEDLINE search was performed to identify all English-language articles of randomized controlled trials involving insulin use in adults with type 1 or type 2 DM from January 1, 1980, to January 8, 2003. Bibliographies and experts were used to identify additional studies.Studies were included (199 for type 1 DM and 144 for type 2 DM, and 38 from other sources) if they involved human insulins or insulin analogues, were at least 4 weeks long with at least 10 patients in each group, and glycemic control and hypoglycemia were reported. Studies of insulin-oral combination were similarly selected.Twenty-eight studies for type 1 DM, 18 for type 2 DM, and 48 for insulin-oral combination met the selection criteria. In patients with type 1 DM, physiologic replacement, with bedtime basal insulin and a mealtime rapid-acting insulin analogue, results in fewer episodes of hypoglycemia than conventional regimens. Rapid-acting insulin analogues are preferred over regular insulin in patients with type 1 DM since they improve HbA1C and reduce episodes of hypoglycemia. In patients with type 2 DM, adding bedtime neutral protamine Hagedorn (isophane) insulin to oral therapy significantly improves glycemic control, especially when started early in the course of disease. Bedtime use of insulin glargine results in fewer episodes of nighttime hypoglycemia than neutral protamine Hagedorn regimens. For patients with more severe insulin deficiency, a physiologic insulin regimen should allow lower glycemic targets in the majority of patients. Adverse events associated with insulin therapy include hypoglycemia, weight gain, and worsening diabetic retinopathy if hemoglobin A1C levels decrease rapidly.Many options for insulin therapy are now available. Physiologic insulin therapy with insulin analogues is now relatively simple to use and is associated with fewer episodes of hypoglycemia.
Polymorphisms in pulmonary surfactant protein A1 (SP-A1) and A2 (SP-A2) genes and susceptibility to high altitude pulmonary edema (HAPE)*1
Authors: S. Saxena, R. Kumar, T. Madan, V. Gupta, K. Muralidhar, P.U. Sarma
Journal: Journal of Allergy and Clinical Immunology (2004)
Judge upholds doctors' "do not resuscitate" recommendation in event of patient's condition getting worse
Authors: C. Dyer
Journal: BMJ (2012)

A High Court judge has upheld the decision by several doctors not to resuscitate or ventilate a 55 year old Muslim man in a “minimally conscious state” should his condition worsen, over-riding the objections of his family.

The father of eight from Greater Manchester, named only as “Mr L,” was severely brain damaged after a third cardiac arrest in July and was initially thought to be …
Philosophy of Medicine
Authors: John Collins Harvey
Journal: JAMA (2012)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
High Mallampati score and nasal obstruction are associated risk factors for obstructive sleep apnoea
Authors: G. Liistro, Ph. Rombaux, C. Belge, M. Dury, G. Aubert, D.O. Rodenstein
Journal: European Respiratory Journal (2003)

Induced nasal obstruction can cause obstructive apnoeas in healthy subjects during sleep, but the relationship between nasal resistance measured during wakefulness and obstructive sleep apnoea syndrome (OSAS) is weak. It was postulated that if the subjects could not breathe through the nose, the oral airway must be used, but if this airway is narrowed as well, then it could precipitate sleep-disordered breathing (SDB). Nasal patency, Mallampati score (MS), neck circumference and body mass index were measured in 202 subjects referred to the authors' hospital to undergo a full-night polysomnography for suspicion of SDB. A significant correlation was found between the MS and apnoea/hypopnoea index measured during sleep. However, the relationship between these parameters was only significant in patients with nasal obstruction. The relative risk of having OSAS with a MS of III or IV was 1.95 for the whole group and 2.45 in patients with nasal obstruction. In conclusion, a high Mallampati score represents a predisposing factor for obstructive sleep apnoea syndrome, especially if it is associated with nasal obstruction. These patients merit special attention from both the sleep physician and the anaesthetist.
Imbalance in distribution of functional autologous regulatory T cells in rheumatoid arthritis
Authors: F. Behrens, A. Himsel, S. Rehart, J. Stanczyk, B. Beutel, S. Y Zimmermann, U. Koehl, B. Moller, S. Gay, J. P Kaltwasser, J. M Pfeilschifter, H. H Radeke
Journal: Annals of the Rheumatic Diseases (2007)

<b>Objectives:</b> Regulatory T cells (Tregs) exert their anti-inflammatory activity predominantly by cell contact-dependent mechanisms. A study was undertaken to investigate the regulatory capacity of autologous peripheral blood Tregs in contact with synovial tissue cell cultures, and to evaluate their presence in peripheral blood, synovial tissue and synovial fluid of patients with rheumatoid arthritis (RA). <b>Methods:</b> 44 patients with RA and 5 with osteoarthritis were included in the study. The frequency of interferon (IFN)γ-secreting cells was quantified in synovial tissue cell cultures, CD3-depleted synovial tissue cell cultures, synovial tissue cultures co-cultured with autologous CD4+ and with CD4+CD25+ peripheral blood T cells by ELISPOT. Total CD3+, Th1 polarised and Tregs were quantified by real-time PCR for CD3ε, T-bet and FoxP3 mRNA, and by immunohistochemistry for FoxP3 protein. <b>Results:</b> RA synovial tissue cell cultures exhibited spontaneous expression of IFNγ which was abrogated by depletion of CD3+ T cells and specifically reduced by co-culture with autologous peripheral blood Treg. The presence of Treg in RA synovitis was indicated by FoxP3 mRNA expression and confirmed by immunohistochemistry. The amount of FoxP3 transcripts, however, was lower in the synovial membrane than in peripheral blood or synovial fluid. The T-bet/FoxP3 ratio correlated with both a higher grade of synovial tissue lymphocyte infiltration and higher disease activity. <b>Conclusion:</b> This study has shown, for the first time in human RA, the efficacy of autologous Tregs in reducing the inflammatory activity of synovial tissue cell cultures ex vivo, while in the synovium FoxP3+ Tregs of patients with RA are reduced compared with peripheral blood and synovial fluid. This local imbalance of Th1 and Treg may be responsible for repeated rheumatic flares and thus will be of interest as a target for future treatments.
THE COMPARATIVE EFFICIENCY OF LOCAL ANESTHETICS
Authors: TORALD SOLLMANN
Journal: JAMA (1918)

The average size of the indurated areola in the nega¬ tive cases, moreover, was 3.9 mm., whereas in the positive it was 4.75 mm.There is also apparently some evidence that the more persistent carriers gave the more intense reaction.We present these findings with all reserve as to their significance.It would seem certain that with more extended bactériologie examinations the relation between a positive intradermal test to the meningo¬ coccus and the presence of the meningococcus in the throat would become more evident.The duration of the localized infection would doubtless affect the result.The significance of this relation, if it proves usual, would be to indicate systemic reaction on the part of the carriers, and probably postulate some degree of acquired resistance.Whether this reaction would serve a diagnostic purpose in the detection of meningococcus carriers must only be suggested for future investigations.
Diethylcarbamazine Therapy in Tropical Eosinophilia
Authors: K. Nath, S. N. Pandeya
Journal: BMJ (1960)

Bochdalek hernia occurs from a congenital defect of the diaphragm, allowing the passage of abdominal structures into the thoracic cavity, limiting lung expansion and ventilatory function. Bochdalek hernia is common in neonates but rarely occur in adults; there are only 4 documented cases in the elderly population. We present a case of an 88-year-old woman with severe hypoxia and respiratory failure that required ventilatory support, in whom bilateral Bochdalek hernias progressed over the years and severely invaded the thoracic cavity, causing acute decompensation. This is a rare condition in adults but can cause substantial morbidity when the involvement of the thoracic cavity is severe.
The First Kidney Stone
Authors: Jaime Uribarri
Journal: Annals of Internal Medicine (1989)

The proper approach to diagnosis and management in patients with a first episode of a calcium-containing kidney stone is controversial, and we have reviewed the literature in a search for objective information. Six large retrospective studies show the "natural cumulative recurrence rate of renal stones" to be 14% at 1 year, 35% at 5 years, and 52% at 10 years. Randomized studies of the use of either thiazides or allopurinol suggest a modest beneficial effect of about 35% over placebo. Considering that the risk of this specific therapy is about 5%, the morbidity associated with renal stones is limited, and relatively less invasive procedures can often replace nephrolithotomy, we conclude that use of specific drug therapy, namely thiazides or allopurinol, is not warranted in patients with a first kidney stone and, therefore, that extensive metabolic evaluation is unnecessary.
Current approaches toward chemical mixture studies at the National Institute of Environmental Health Sciences and the U.S. National Toxicology Program.
Authors: J R Bucher, G Lucier
Journal: Environmental Health Perspectives (1998)

The National Institute of Environmental Health Sciences (NIEHS) has several new initiatives involving chemical mixtures and has recognized the need to develop new experimental approaches to enhance our efforts in this area. Responding to recent increases in nominations of complex occupational exposures for toxicologic assessment by the U.S. National Toxicology Program, the NIEHS and the National Institute for Occupational Safety and Health have begun a program to characterize exposures through field studies, identify biomarkers of exposure in workers, and recreate relevant mixed exposures in a laboratory setting. A second initiative with the National Center for Environmental Health/Centers for Disease Control and Prevention will examine blood samples from the U.S. National Health and Nutrition Examination Survey population surveys for selected endocrine-disrupting agents and for common patterns of persistent xenobiotics, providing critical information for the design of animal studies to assess risks of relevant chemical mixtures to humans. New toxicology testing methods (lower cost, faster) will enhance our ability to study chemical mixtures (e.g., dioxin and dioxinlike chemicals, combination AIDS therapies). Ongoing method development efforts involve in vitro functional toxicology assays, screens for estrogenic activity, and carcinogenesis studies in transgenic mice. A major scientific initiative with mixtures involves studies of individual and mixtures of dioxin and dioxinlike chemicals to determine if toxic equivalence factors predict carcinogenic potency in traditional and transgenic bioassays. Complementing these studies is an increased emphasis on physiologically based pharmacokinetic modeling, an activity central to the proper interpretation of chemical mixture studies.
Eight Canadian provinces are to sue tobacco industry for healthcare costs
Authors: David Spurgeon
Journal: BMJ (2005)

Eight Canadian provinces are preparing litigation against tobacco firms in what a tobacco company vice president has described in the Canadian Medical Association's journal as possibly “the biggest case in the history of Canadian jurisprudence” ( CMAJ 2005;173:1307).

The provinces' actions follow a ruling in September that British Columbia's suit to recover billions of dollars in tobacco related healthcare costs was constitutional. Seven other provinces already have or are preparing legislation for the same purpose. Cynthia Callard, of Physicians for a Smoke-free Canada, said …
Long term opioid use in 3.1% of patients after surgery may be appropriate
Authors: P. Desai, T. Shaikh
Journal: BMJ (2014)

We agree that the inappropriate administration of opioids is harmful,1 2 but likening opioids to “smarties” on the basis of long term opioid use in 3.1% of patients after surgery may be sensationalising an appropriate rate.

Around 10-30% of patients have some chronic postoperative pain,3 with higher rates after thoracotomy. Do opioids have …
Treatment of Chronic Non-specific Diarrhoea
Authors: A. M. Connell, T. D. Kellock
Journal: BMJ (1959)

were male.In his female case he first of all carried out transurethral resection of the bladder neck, which had only a slight effect on the residual urine, but considerable benefit was found after removal of two-thirds of the distended bladder.This case suggests that the primary pathology may be in the bladder itself. DiscussionIt is suggested that there are two types of bladder atony, the myogenic and the neurogenic, or possibly a combination of the two, in which some muscle as well as nerve degeneration takes place in the bladder wall.Crabtree and Muellner, and later Houtappel, found, as we did in Case 1, that an increase in fibrous tissue around the smooth-muscle bundles is absolutely characteristic of the histology of the resected bladder wall.The absence of nerve-ganglion cells also seen in Case 1 may be of significance here.The theory is advanced that there is either a nerve degeneration or a muscle degeneration in the bladder wall in these cases, and that atony and distension occur simultaneously so that no renal back-pressure effects are seen.In our experience the condition is predominantly found in females; most of the male cases reported have had either prostatism or some organic obstructive lesion.We have, in fact, experience of one male patient, aged 54, whose bladder contained on occasion as much as 80 oz.(2,275 ml.) of urine, but who micturated quite normally and could be catheterized easily.The absence of full investigations in this case, however, precludes its inclusion with confidence in the present series.It is generally agreed that the ideal treatment in these cases, after careful exclusion of any of the common factors causing bladder distension, is subtotal cystectomy, removing two-thirds or three-quarters of the redundant bladder wall.-Transurethralresection of the bladder neck by itself has no effect on the residual urine.There appears to be some chance of the residual urine increasing slightly in amount after partial cystectomy. Summary and ConclusionsFour female cases of a hitherto neglected condition -primary atony of the urinary bladder-are described.Most of the sparse literature on the subject is quoted.The classical clinical picture of the condition is a palpable distended bladder with large residual urine and often little in the way of symptoms except occasionally frequency.The patient really has an overflow retention.On cystoscopy no obstruction of the bladder neck is to be found, and a bladder wall thrown into numerous smooth folds is typical.The absence of hydronephrosis or hydro-ureter on pyelography and the absence of disturbance of blood chemistry or blood pressure are also constant features.Subtotal cystectomy is the treatment of choice, and this was done in one case, but no great harm appears to result if the condition is left in the older patients, as no progressive renal damage is likely to occur.Cystometric findings are also characteristic in these cases.There is no obvious reason why a comparable condition should not occur in the male.
Abstract 1147: microRNA expression profiling in cisplatin resistant human non-small cell lung cancer cell lines
Authors: Toshihiro Suzuki, Ai Irisawa, Kazuto Nishio, Tadayasu Togawa, Hitoshi Sakuraba
Journal: Cancer Research (2011)

Abstract Cisplatin combination chemotherapy is one of the important treatments for many cancers including lung cancer. Despite impressive initial clinical responses, the majority of patients eventually develop some degree of resistance to cisplatin-based therapy. To understand the clinically relevant mechanisms of resistance, many studies have been aimed at clarifying the biochemical/molecular alterations of cisplatin-resistant cells. However, cellular resistance mechanisms of cisplatin are still unclear. MicroRNA (miRNA) is small noncoding RNA that function to control gene expression. These small RNAs have been shown to contribute to the control of cell growth, differentiation and apoptosis, important features related to cancer development progression and sensitivity of chemotherapy. However, the interaction between the development of cisplatin resistance and miRNA has not been previously explored. In this study we utilized a miRNA array to compare the differentially expressed miRNAs in cisplatin-resistant cell lines, PC-9/CPr and PC-14/CPr and their parental cell lines, PC-9 and PC-14. We verified that miR-7, miR-106 and miR-181 were up-regulated in cisplatin-resistant non-small cell lung cancer cells by means of real-time PCR and discusses the potential of these miRNAs as biomarkers for cisplatin sensitivity in combination chemotherapy. We further investigated the role and mechanisms of miR-181 in cisplatin resistance. We found that specific miR-181 precursor (Pre-miR-181) transfection significantly acquired cisplatin resistance. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1147. doi:10.1158/1538-7445.AM2011-1147
STRYCHNINE POISONING IN CHILDREN
Authors: A. J. Roberts
Journal: JAMA (1931)

To the Editor:  —I read with much interest an article inThe Journal, November 29, by Dr. Aikman on strychnine poisoning in  I hope that his suggestions will lead to some change in the formulas of the cathartic pills and tablets now in common use. However, I take issue to one statement in that article: If pills and tablets containing strychnine were uncoated the resulting unpleasant taste would prevent serious accidental poisoning in children. It is well known that many children under 2 years of age show complete disregard of the taste of things that they put in their mouths.  I knew one child to macerate several Aiken tonic pills in her mouth with fatal result, and with that black bitter mass in her mouth to reach for more pills. Two other children barely recovered after eating uncoated tablets containing aloes and strychnine. I recall another fatality that resulted
Priority in Technic of Tubercle Bacilli Recognition.
Authors: Walter S. Haines
Journal: JAMA (1903)

Chicago, March 30, 1903. <h3>To the Editor:</h3> —In your issue of March 28, I notice an abstract of a paper which appeared in the "Deutsche Zeitschrift für Chirurgie" by Forssell on an "Improved Method of Determining the Presence of Tubercle Bacilli in the Urine." I would direct your attention to the fact that the process described is identical in every essential feature with the method introduced by Dr. J. E. Skinner and myself a number of years ago and described by us in an article published inThe Journalof the American Medical Association, Jan. 29, 1898. Our process, as described in this paper, consists in separating the sediment from a considerable volume of urine by gravity (preferably in a tapering glass vessel like a percolator), drawing off the deposit, and reducing it to a very small bulk by centrifuging. Forssell's method, as will be seen by consulting the abstract
Insulin-Stimulated Cyclic Guanosine Monophosphate Inhibits Vascular Smooth Muscle Cell Migration by Inhibiting Ca/Calmodulin-Dependent Protein Kinase II
Authors: Sui Zhang, Yu Yang, Bruce C. Kone, Julius C. Allen, Andrew M. Kahn
Journal: Circulation (2003)

Insulin resistance is associated with vascular disease. Physiological concentrations of insulin inhibit cultured vascular smooth muscle cell (VSMC) migration in the presence of nitric oxide, and the failure to do so in insulin-resistant states may aggravate vascular disease. We sought to determine the molecular mechanisms by which insulin inhibits VSMC migration.Insulin at 1 nmol/L stimulated cGMP production in cultured rat VSMCs that were induced to express inducible nitric oxide synthase (iNOS). VSMC migration was measured in a wound-closure assay, and the platelet-derived growth factor-AB (PDGF-AB)-stimulated component of VSMC migration after wounding was inhibited by insulin, 8-Br-cGMP, and 1-[N-0-bis(5-isoquinolinesulfonyl)-N-methyl-L-tyrosyl]-4-phenylpiperazine (KN-62), a selective inhibitor of calcium/calmodulin-dependent protein kinase II (CaM kinase II). Wounding alone or incubating cells with only PDGF-AB stimulated CaM kinase II activity in an insulin- and 8-Br-cGMP-inhibitable manner. Transfecting VSMCs with a constitutively active CaM kinase II mutant blocked the inhibition by insulin of both wound-induced and wound plus PDGF-AB-induced VSMC migration. High intracellular Ca2+ ([Ca]i)-stimulated CaM kinase II activity was inhibited by 8-Br-cGMP by an okadaic acid-sensitive mechanism.We conclude that in cultured rat VSMCs expressing iNOS, insulin, via stimulation of cGMP production, inhibits both wound alone-induced and the PDGF-AB-stimulated component of VSMC migration by inhibiting CaM kinase II activity. cGMP inhibits CaM kinase II at a post-[Ca]i step by a protein phosphatase-dependent mechanism.