tbuckley/cabot-search huggingface dataset:
Ottawa ankle rules for the injured ankle
Authors: J Heyworth
Journal: British Journal of Sports Medicine (2003)

Useful clinical rules save on radiographs and need to be used widely

What could possibly be more straightforward than the assessment of an injured ankle? Patients with ankle injuries, usually sustained recreationally or in a simple fall, attend emergency departments throughout the world in their hundreds of thousands every year. Most of these patients will have sustained simple injury to ligamentous soft tissue or a small avulsion fracture of no clinical significance. A minority will have sustained more serious fractures, requiring immobilisation or internal fixation. Patients with ankle injury constitute approximately 5% of all patients who visit emergency departments, although fewer than 15% of these patients will have clinically significant fractures.

Differentiating between these two groups of patients is not always easy, particularly for relatively inexperienced clinicians. The safety net for indeterminate examination has always been recourse to radiography. However, such an unselective policy has resulted in inestimable numbers of unnecessary exposures …
Open label study of intranasal sumatriptan (Imigran) for footballer’s headache
Authors: P McCrory, J Heywood, A Ugoni
Journal: British Journal of Sports Medicine (2005)

To study the efficacy and practicality of treating headache in professional footballers with intranasal sumatriptan.An open label drug trial was performed in elite Australian footballers using intranasal sumatriptan (20 mg) treatment for acute headache. The main outcome measures were treatment response at 30 minutes, two hours, and 24 hours using two criteria: (a) initial severity moderate or severe to nil or mild; (b) stricter criteria of initial severity moderate to severe to subsequent nil headache.Thirty eight attacks were analysed. The two hour response showed that 86% of attacks of migraine with aura and all of the attacks of migraine without aura responded to treatment with sumatriptan nasal spray. Complete relief of headache at two hours was reported by 71% of players with migraine with aura and 90% of those without aura. Recurrence rates were generally low, with 0% of migraine headaches and 25% non-migraine attacks recurring at 24 hours. Minor side effects were reported in 28 attacks.This pilot open label trial suggests that sumatriptan nasal spray may be a valuable, effective, and convenient treatment of headache in professional sport. There are potential risks of this drug that need to be considered.
Is Treatment for Substance Abuse Effective?
Authors: A. Thomas McLellan
Journal: JAMA (1982)

Few studies have assessed adequately the effectiveness of alcohol and drug abuse treatments using an appropriate range of reliable outcome measures, a representative sample of alcohol and drug abuse treatment modalities, or more than one perspective on treatment effectiveness. This article evaluates substance abuse treatment using a sample of 742 patients treated in six programs and evaluated at six-month follow-up. The following three major questions were addressed: (1) do patients improve following treatment; (2) are improvements confined to alcohol or drug use, or are they more pervasive; and (3) are these improvements a result of treatment? The results indicated significant and pervasive improvements in virtually all areas for both alcoholics and drug addicts. Major changes were seen in alcohol and drug use, employment, criminal behavior, and psychological function. Patients undergoing long-term treatment showed greater improvement and better six-month outcomes than those undergoing short-term therapy on 12 of 18 criteria. The data provide evidence for the therapeutic benefit of substance abuse treatments.
Patient Education for Colon Cancer Screening: A Randomized Trial of a Video Mailed before a Physical Examination
Authors: Jane G. Zapka, Stephenie C. Lemon, Elaine Puleo, Barbara Estabrook, Roger Luckmann, Stephen Erban
Journal: Annals of Internal Medicine (2004)

Background: Colorectal cancer screening is underused, and primary care clinicians are challenged to provide patient education within the constraints of busy practices. Objective: To test the effect of an educational video, mailed to patients' homes before a physical examination, on performance of colorectal cancer screening, particularly sigmoidoscopy. Design: Randomized, controlled trial. Setting: 5 primary care practices in central Massachusetts. Participants: 938 patients age 50 to 74 years who were scheduled for an upcoming physical examination, had no personal history of colorectal cancer, and were eligible for lower-endoscopy screening according to current guidelines. Intervention: Participants were randomly assigned to receive usual care (n = 488) or a video about colorectal cancer, the importance of early detection, and screening options (n = 450). Measurements: Baseline and 6-month follow-up telephone assessments were conducted. A dependent variable classified screening since baseline as 1) sigmoidoscopy with or without other tests, 2) another test or test combination, or 3) no tests. Results: Overall screening rates were the same in the intervention and control groups (55%). In regression modeling, intervention participants were nonsignificantly more likely to complete sigmoidoscopy alone or in combination with another test (odds ratio, 1.22 [95% CI, 0.88 to 1.70]). Intervention dose (viewing at least half of the video) was significantly related to receiving sigmoidoscopy with or without another test (odds ratio, 2.81 [CI, 1.85 to 4.26]). Recruitment records showed that at least 23% of people coming for periodic health assessments were currently screened by a lower-endoscopy procedure and therefore were not eligible. Limitations: The primary care sample studied consisted primarily of middle-class white persons who had high screening rates at baseline. The results may not be generalizable to other populations. The trial was conducted during a period of increased health insurance coverage for lower-endoscopy procedures and public media attention to colon cancer screening. Conclusions: A mailed video had no effect on the overall rate of colorectal cancer screening and only modestly improved sigmoidoscopy screening rates among patients in primary care practices.
A Randomized, Controlled Proof-of-Concept Trial of an Internet-Based, Therapist-Assisted Self-Management Treatment for Posttraumatic Stress Disorder
Authors: Brett T Litz, Charles C Engel, Richard A Bryant, Anthony Papa
Journal: American Journal of Psychiatry (2007)

The authors report an 8-week randomized, controlled proof-of-concept trial of a new therapist-assisted, Internet-based, self-management cognitive behavior therapy versus Internet-based supportive counseling for posttraumatic stress disorder (PTSD).Service members with PTSD from the attack on the Pentagon on September 11th or the Iraq War were randomly assigned to self-management cognitive behavior therapy (N=24) or supportive counseling (N=21).The dropout rate was similar to regular cognitive behavior therapy (30%) and unrelated to treatment arm. In the intent-to-treat group, self-management cognitive behavior therapy led to sharper declines in daily log-on ratings of PTSD symptoms and global depression. In the completer group, self-management cognitive behavior therapy led to greater reductions in PTSD, depression, and anxiety scores at 6 months. One-third of those who completed self-management cognitive behavior therapy achieved high-end state functioning at 6 months.Self-management cognitive behavior therapy may be a way of delivering effective treatment to large numbers with unmet needs and barriers to care.
THE MECHANISM OF FORMATION OF OSMOTICALLY CONCENTRATED URINE DURING THE ANTIDIURETIC STATE 1
Authors: George A. Zak, Claus Brun, Homer W. Smith
Journal: Journal of Clinical Investigation (1954)

The present study is concerned with the opera- tion by which the kidney, during antidiuresis, conserves water for the body by elaborating a urine osmotically more concentrated than the blood.It is appropriate to emphasize that in the mam- mals the osmotic pressure of the plasma and the interstitial fluid is one of the most closely guarded of all the homeostatic states, and that the kidney is chiefly responsible for the regulation of this os- motic pressure within narrow limits.Osmotic dilution of the plasma is normally offset by the excretion of a urine osmotically more dilute than the plasma, as in water diuresis, while an increase in osmotic concentration of the plasma is offset by the excretion of urine osmotically more concen- trated than the plasma.The present paper is concerned only with the mechanism of the excretion of a hypertonic urine.That no osmotic concentration is achieved in the separation of the glomerular filtrate is established, to the satisfaction of all investigators, by the well known micropuncture studies of Richards and his coworkers in the Amphibia, and Walker, Oliver, and their coworkers in the guinea pig, rat and opossum.These studies have also demonstrated, at least under the recorded experimental conditions, that the urine remains isosmotic with the plasma, ,or nearly so, throughout the length of the proximal segment, at a time when the bladder urine may be concentrated osmotically to a considerable extent.Unfortunately, such icropuncture studies as are
Heat Shock Protein B8, a Cyclin-Dependent Kinase–Independent Cyclin D1 Target Gene, Contributes to Its Effects on Radiation Sensitivity
Authors: Sally Trent, Chuanwei Yang, Cuiqi Li, Mary Lynch, Emmett V. Schmidt
Journal: Cancer Research (2007)

Abstract Overexpression of cyclin D1 is associated with many cancers, and its overexpression is especially associated with a poor prognosis in breast cancer. Paradoxically, cyclin D1 is known to enhance radiation sensitivity, a finding that has not yet been therapeutically exploited. Proposed cyclin D1 functions that could be involved in this effect include cyclin-dependent kinase (CDK)–dependent phosphorylation of retinoblastoma gene product (pRb), titration of p21/p27 complexes, and less well-characterized effects on gene expression. In this report, we sought to clarify the functions of cyclin D1 that might contribute to enhanced radiation sensitivity. Breast cancer cells stably overexpressing a cyclin D1 mutant (KE) that cannot interact with its CDK partners to phosphorylate pRb were as radiation sensitive as those expressing wild-type D1. Although cyclin D1 has been proposed to affect radiation sensitivity through interactions with p21, a cyclin D1 mutant defective for p21 interactions also increased radiation sensitivity. Cyclin D1 overexpression is generally confined to hormone receptor–positive breast cancers, wherein standard therapies include both radiation and hormonal therapies. Among several proposed CDK-independent cyclin D1 targets, we have identified heat shock protein B8 (HSPB8) as a target particularly associated with cyclin D1 and ER-positive tumors. We therefore evaluated its potential contribution to radiation sensitivity. Overexpression of HSPB8 markedly increased radiation sensitivity, and HSPB8 small interfering RNA blocked cyclin D1's enhancement of radiation sensitivity. Taken together, our results show that some of cyclin D1's effects on radiation sensitivity are CDK and p21 independent and identify HSPB8 as a candidate CDK-independent cyclin D1 target that can mediate its effects. [Cancer Res 2007;67(22):10774–81]
Disease Progression and Changes in Physical Activity in Patients with Chronic Obstructive Pulmonary Disease
Authors: Benjamin Waschki, Anne M. Kirsten, Olaf Holz, Kai-Christian Mueller, Miriam Schaper, Anna-Lena Sack, Thorsten Meyer, Klaus F. Rabe, Helgo Magnussen, Henrik Watz
Journal: American Journal of Respiratory and Critical Care Medicine (2015)

Little is known about the role of physical activity in the course of chronic obstructive pulmonary disease (COPD).To assess changes in physical activity in COPD in relation to severity stages and changes in other disease components, and to evaluate the longitudinal association between sustained physical inactivity and disease progression.In this prospective cohort study, we measured physical activity (multisensory armband), airflow obstruction (FEV1), health status (St. George's Respiratory Questionnaire), exercise capacity (6-min-walk distance [6MWD]), muscle mass (fat-free mass [FFM]), and systemic inflammation (fibrinogen and high-sensitivity C-reactive protein) over a 3-year period in 137 patients with COPD and 26 with chronic bronchitis (normal spirometry).Independent of baseline disease severity, steps per day, total daily energy expenditure, and (daily) physical activity level (PAL) decreased by 393, 76 kcal, and 0.04 per year, respectively. The decline in PAL was significantly associated with a decline in FEV1 and an increase in St. George's Respiratory Questionnaire total score. Changes in 6MWD, FFM, and inflammatory markers were not associated with changes in PAL. Independent of FEV1, sustained physical inactivity (i.e., PAL(T0andT1) < 1.40) was related to a greater decline in 6MWD and FFM compared with that in patients with some level of activity (i.e., PAL(T0and/orT1) ≥ 1.40; difference, 17 m/yr and 0.87 kg/yr, respectively).Over time, physical activity substantially decreases across all severity stages of COPD, and this decline is paralleled by a worsening of lung function and health status. Sustained physical inactivity is associated with a progression of exercise intolerance and muscle depletion.
Angiogenesis modifications related with cetuximab plus irinotecan as anticancer treatment in advanced colorectal cancer patients
Authors: B. Vincenzi, D. Santini, A. Russo, M. Silletta, M. Gavasci, F. Battistoni, G. Di Cuonzo, L. Rocci, N. Gebbia, G. Tonini
Journal: Annals of Oncology (2006)
Efficacy and Safety of Dulaglutide Added Onto Pioglitazone and Metformin Versus Exenatide in Type 2 Diabetes in a Randomized Controlled Trial (AWARD-1)
Authors: Carol Wysham, Thomas Blevins, Richard Arakaki, Gildred Colon, Pedro Garcia, Charles Atisso, Debra Kuhstoss, Mark Lakshmanan
Journal: Diabetes Care (2014)

OBJECTIVE To compare the efficacy and safety of dulaglutide, a once-weekly GLP-1 receptor agonist, with placebo and exenatide in type 2 diabetic patients. The primary objective was to determine superiority of dulaglutide 1.5 mg versus placebo in HbA1c change at 26 weeks. RESEARCH DESIGN AND METHODS This 52-week, multicenter, parallel-arm study (primary end point: 26 weeks) randomized patients (2:2:2:1) to dulaglutide 1.5 mg, dulaglutide 0.75 mg, exenatide 10 μg, or placebo (placebo-controlled period: 26 weeks). Patients were treated with metformin (1,500–3,000 mg) and pioglitazone (30–45 mg). Mean baseline HbA1c was 8.1% (65 mmol/mol). RESULTS Least squares mean ± SE HbA1c change from baseline to the primary end point was −1.51 ± 0.06% (−16.5 ± 0.7 mmol/mol) for dulaglutide 1.5 mg, −1.30 ± 0.06% (−14.2 ± 0.7 mmol/mol) for dulaglutide 0.75 mg, −0.99 ± 0.06% (−10.8 ± 0.7 mmol/mol) for exenatide, and −0.46 ± 0.08% (−5.0 ± 0.9 mmol/mol) for placebo. Both dulaglutide doses were superior to placebo at 26 weeks (both adjusted one-sided P &amp;lt; 0.001) and exenatide at 26 and 52 weeks (both adjusted one-sided P &amp;lt; 0.001). Greater percentages of patients reached HbA1c targets with dulaglutide 1.5 mg and 0.75 mg than with placebo and exenatide (all P &amp;lt; 0.001). At 26 and 52 weeks, total hypoglycemia incidence was lower in patients receiving dulaglutide 1.5 mg than in those receiving exenatide; no dulaglutide-treated patients reported severe hypoglycemia. The most common gastrointestinal adverse events for dulaglutide were nausea, vomiting, and diarrhea. Events were mostly mild to moderate and transient. CONCLUSIONS Both once-weekly dulaglutide doses demonstrated superior glycemic control versus placebo and exenatide with an acceptable tolerability and safety profile.
Multistage endobronchial valve treatment of emphysema
Authors: Amarilio Macedo, Enio do Valle, Silvia de Oliveira, Sergio Pinto Ribeiro, Hugo de Oliveira
Journal: European Respiratory Journal (2011)

Of 59 patients with emphysema treated with endobronchial valves (EBV) at our institution, nine were submitted to multistage strategies with placement of additional valves at varying intervals to complement initial treatment or compensate for the natural decline associated with aging in this chronic disorder. All had severe emphysema with heterogeneity > 15% as measured by parenchymal density <-950HU. Three types of multistage strategies were used: bilateral (left/right), replacement (removal and reinsertion of valves), and progressive (nonlobar to lobar exclusion, upper/lower). Advantages of multistaging include protection from abrupt physiological changes and pneumothorax. Also, in the absence of clear clinical signs to predict response, multistaging allows a change in treatment approach, and clearly demonstrates the safety of EBVs.

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Multistage endobronchial valve treatment of patients with severe emphysema





Multistage strategies should be considered in all valve patients as part of their routine follow-up.
5-Fluorouracil as protracted continuous intravenous infusion can be added to full-dose docetaxel (Taxotere®)–cisplatin in advanced gastric carcinoma: a phase I–II trial
Authors: A.D. Roth, R. Maibach, N. Fazio, C. Sessa, R. Stupp, R. Morant, R. Herrmann, M.M. Borner, A. Goldhirsch, F. de Braud
Journal: Annals of Oncology (2004)
Clinical and Genetic Studies of Renal Cell Carcinomas in a Family with a Constitutional Chromosome 3; 8 Translocation: Genetics of Familial Renal Carcinoma
Authors: Frederick P. Li
Journal: Annals of Internal Medicine (1993)

Objective: To describe the clinical course and genetic studies of renal carcinoma in members of a family with the constitutional chromosome translocation, t(3; 8) (p14; q24). Design: A follow-up study that updates our 1979 report of renal carcinoma in 10 of these relatives. Setting: A cancer center and university hospital. Patients: Members of the family, including five carriers of the 3; 8 translocation who were in remission of renal cancer. Measurements: Clinical follow-up of the family and genetic analyses of the renal cancer specimens of three patients. Results: Renal carcinoma recurred in all five patients in the family at 1 to 16 years of follow-up. Three patients have died of renal cancer, and two are in a second remission. The renal cancers from three family members consistently reveal loss of the entire derivative chromosome 8, which bears the chromosome 3p segment spanning band p14 to the telomere. In contrast, no genetic change was detected in the derivative chromosome 3 or in normal chromosomes 3 and 8. Conclusions: This family illustrates the importance of clinical follow-up of patients with a hereditary cancer that can develop at multiple foci and recur over time. The inherited 3; 8 translocation and loss of the translocated distal chromosome 3p in tumor specimens of family members may help localize the gene or genes involved in the pathogenesis of both familial and sporadic renal carcinoma.
Cloning and characterization of a new isoform of the interleukin 1 receptor antagonist.
Authors: M Muzio, N Polentarutti, M Sironi, G Poli, L De Gioia, M Introna, A Mantovani, F Colotta
Journal: The Journal of Experimental Medicine (1995)

By reverse transcriptase polymerase chain reaction on messenger RNA from human polymorphonuclear cells, we have isolated a sequence identical to the cDNA coding for intracellular interleukin 1 receptor antagonist (icIL-1ra), but containing an additional in-frame 63-bp sequence located three codons downstream of the translation start of icIL-1ra. This additional sequence is inserted between the first and second exon of the intracellular form, the latter of which is colinear with part of the first exon of the secreted form of IL-1ra. The additional sequence is coded by an extra exon located 2 kb downstream the first icIL-1ra-specific exon. The complementary DNA sequence of the alternatively spliced form of icIL-1ra shows that the predicted protein differs from classical icIL-1ra in the NH2 terminus by insertion of a leaderless sequence of 21 amino acids rich in glycine and glutamic acid residues. Transcripts coding for this new form of icIL-1ra were detected in activated fibroblasts, keratinocytes, and at low levels in myelomonocytic cells. The recombinant protein expressed in COS cells had an apparent molecular mass in sodium dodecyl sulfate polyacrylamide gel electrophoresis of 25 kD compared to 22 kD of classical icIL-1ra, and was mostly intracellular. The ability of this new form of icIL-1ra to inhibit IL-1 activity, in terms of induction of E-selectin and human immunodeficiency virus replication, was comparable to that of classical icIL-1ra. We propose to refer to this new form of icIL-1ra as icIL-1ra type II.
LETTER FROM CINCINNATI.
Authors: None MC. K.
Journal: JAMA (1889)

(FROM OUR OWN CORRESPONDENT.) Commencement Exercises at the Medical and Dental Colleges—Cincinnati Academy of Medicine. The Cincinnati College of Pharmacy held its seventeenth annual Commencement at Musik Verein Hall on the evening of March 14. After the exercises the usual banquet was given. There were eighteen graduates from the College of Pharmacy this year. The Commencement exercises of the Cincinnati College of Medicine and Surgery were held in the Scottish Rite Cathedral February 26, where they graduated thirty-two Doctors of Medicine. This is the largest class to leave this institution for some years. Dr. R. C. Stockton Reed made the address of the Dean, and the valedictory address was given by Dr. C. A. L. Reed. The Commencement of the Ohio College of Dental Surgery was largely attended at College Hall on the evening of March 4. Sixty-five Doctors of Dental Surgery were graduated. The address was made and degrees
Pregnancy-associated Malaria and the Prospects for Syndrome-specific Antimalaria Vaccines
Authors: Joseph D. Smith, Kirk W. Deitsch
Journal: The Journal of Experimental Medicine (2004)

Aided by the Plasmodium falciparum genome project, recent discoveries regarding the molecular basis of malaria pathogenesis have led to a better understanding of the interactions between host and parasite. Although vaccines that prevent infection by malaria parasites remain only hopes for the future, there are now more immediate prospects for vaccines that protect against specific disease syndromes. Here, we discuss the latest advances in the development of a vaccine that specifically targets pregnancy-associated malaria (PAM).