tbuckley/cabot-search huggingface dataset:
The Racist Patient
Authors: David A. Nardone
Journal: Annals of Internal Medicine (2013)

Letters6 August 2013The Racist PatientDavid A. Nardone, MDDavid A. Nardone, MDFrom Hillsboro, Oregon.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-3-201308060-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:As I read Jain's article (1), I felt considerable anxiety and concern for his situation. However, I believe that institutions have major responsibilities to their patients, providers, and staff to proactively anticipate, address, and resolve these incidents, because conflicts in health care are common. Leaving clinicians to their own coping mechanisms, guidance from mentors, and peer support relationships is not adequate.Bonds between patients and providers are based on mutual trust and the ability of both parties to communicate candidly and respectfully. Relationships can be strained because of severe illness; confrontational and destructive behaviors, as Jain experienced; ...References1. Jain SH. The racist patient. Ann Intern Med. 2013;158:632 LinkGoogle Scholar2. Portland VA runs unique program to deal with difficult patients. From the Field. Spring 2002:1. Accessed at www.ethics.va.gov/docs/bkissues/Newsletter_2002Spring_From_The_Field.pdf on 21 April 2013. Google Scholar3. Carlson MJ and Baker LH. Difficult, dangerous, and drug seeking: the 3D way to better patient care. Am J Public Health. 1998;88:1250-2. [PMID: 9702164] MedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: David A. Nardone, MDAffiliations: From Hillsboro, Oregon.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Racist Patient Sachin H. Jain The Racist Patient Michael Nakao The Racist Patient Sachin H. Jain The Racist Patient Christine Laine and Michael A. LaCombe The Racist Patient Mitchel Galishoff The Racist Patient Sunil K. Sahai Metrics 6 August 2013Volume 159, Issue 3Page: 227KeywordsAnxietyBehaviorDrugsHealth care providersMotivationPatientsSubstance abuse ePublished: 6 August 2013 Issue Published: 6 August 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Release behavior and intra-articular biocompatibility of celecoxib-loaded acetyl-capped PCLA-PEG-PCLA thermogels
Authors: Audrey Petit, Marjan Sandker, Benno Müller, Ronald Meyboom, Paul van Midwoud, Peter Bruin, Everaldo M. Redout, Marjan Versluijs-Helder, Chris H.A. van der Lest, Sytze J. Buwalda, Leo G.J. de Leede, Tina Vermonden, Robbert Jan Kok, Harrie Weinans, Wim E. Hennink
Journal: Biomaterials (2014)
Transferrin receptor gene expression and transferrin-bound iron uptake are increased during postischemic rat liver reperfusion
Authors: Lorenza Tacchini, Daniela Fusar Poli, Aldo Bernelli-Zazzera, Gaetano Cairo
Journal: Hepatology (2002)

Iron-catalyzed production of reactive oxygen species is a cause of liver injury after ischemia/reperfusion (I/R). The aim of the present study was to address the regulation of transferrin receptor (TfR), which mediates cellular iron uptake, during I/R. The molecular mechanisms controlling TfR gene expression in vivo during I/R of rat liver were investigated by molecular biology procedures. We also analyzed transferrin-bound iron uptake into surviving liver slices. Increased amounts of TfR protein and messenger RNA (mRNA) were found 2 to 6 hours after reestablishment of blood supply. RNA bandshift analysis showed that iron regulatory protein (IRP) activity was decreased in the first hours of reperfusion, thus indicating that IRP-mediated mRNA stabilization was not involved in early TfR upregulation. On the contrary, increased transcription of the TfR gene in isolated nuclei was observed during reperfusion; during the ischemic phase this was preceded by enhanced binding of hypoxia inducible factor (HIF-1) to a DNA sequence derived from the TfR promoter. TfR2 mRNA levels were also enhanced after reperfusion. The increased expression of TfR at the cell surface resulted in increased uptake of transferrin-bound-iron into surviving liver slices; however, iron was not incorporated into ferritin. In conclusion, HIF-1 mediated activation of TfR gene transcription and IRP-mediated increase of TfR mRNA stability ensure a steady induction of TfR, and hence higher iron uptake in reperfused rat liver. TfR-mediated entry of the metal into liver cells may represent a source of catalitically active iron, which may play a role in reperfusion damage.
Metastatic extramammary Paget's disease successfully controlled with tumour dormancy therapy using docetaxel
Authors: Y. Fujisawa, Y. Umebayashi, F. Otsuka
Journal: British Journal of Dermatology (2005)

Conflicts of interest: none declared. Sir, Extramammary Paget's disease (EMPD) is fatal once the tumour invades the dermis and metastasizes to the visceral organs. As no significantly effective treatment has yet been established, it is still extremely difficult to treat patients in the advanced stages of this disease. We report a patient with multiple bone and lung metastases of EMPD who was treated with weekly docetaxel. The patient was a 69‐year‐old man who had developed a large papillomatous tumour in the inguinal region and scrotum which was treated by wide local excision and bilateral groin lymph node dissection in April 2000. Histopathological examination showed the tumour cells to be those of EMPD. There was no recurrence or metastasis for about 4 years, but the patient began to suffer from lower back pain in January 2004. Computed tomography (CT) revealed multiple osteolytic lesions in the vertebrae and ilium with multiple nodules in the lungs, and the patient was admitted to Tsukuba University Hospital the following month for treatment. On admission, the symptoms were found to be derived from nerve root disturbance: severe lumbago, dysaesthesia in the toes, and lower limb paralysis. Magnetic resonance imaging (MRI) indicated not only multiple metastases in the vertebrae and ilium but also severe destruction of the 9th−11th thoracic vertebrae; the vertebral canal was almost completely surrounded by the tumour. Laboratory examination indicated elevated serum alkaline phosphatase and carcinoembryonic antigen (CEA, 65 ng dL−1). It is well known that CEA level correlates with tumour progression in advanced EMPD;1 nevertheless, as the patient had been surgically treated for EMPD 4 years earlier, the possibility that the metastatic disease arose from another primary site had to be excluded. Therefore, CT and MRI of the colon, rectum, stomach, pancreas and prostate, as well as tests for occult blood in the stool and prostate‐specific antigen were performed. Based on the negative results of the examinations, we eventually diagnosed this case as metastatic EMPD.
THE POTENCY OF SOME COMMON DIGITALIS AND STROPHANTHUS PREPARATIONS
Authors: G. F. STRONG
Journal: JAMA (1923)

It has frequently been emphasized that it makes little difference what type of digitalis preparation is used, as long as it is active and is given in dosage sufficient to produce its physiologic effects. Not very long ago the digitalis in general use was of low strength, and the results obtained from it clinically were naturally disappointing. Pratt, 1 in 1910, examined some of the common digitalis preparations of that time, and found them very weak. We knew that because of the large amount of work, both clinical and experimental, dealing with digitalis therapy that has appeared recently, greater attention has been given to the problem of supplying active digitalis preparations. We felt that it would be of some interest to make a survey at this time of some of the commoner types of digitalis preparations to determine their potency. We chose for this purpose particularly those preparations that are
Coronary Arteries in Fetuses, Infants, and Juveniles
Authors: HENRY D. MOON
Journal: Circulation (1957)

The coronary arteries of young individuals ranging from fetuses to young adults were studied. Sclerotic lesions were not demonstrated in the coronary arteries of fetuses. In infants the early stages of arteriosclerosis were frequently present and consisted of rupture, degeneration and regeneration of the internal elastic membrane, deposition of mucopolysaccharide, and proliferation of endothelial cells and fibroblasts. These alterations were most prominent in infants of 3 to 4 months. In older individuals there was an apparent decrease in the rate of intimal fibrosis. The lesions of the coronary arteries of young individuals were identical with the early phases of arteriosclerosis in adults.
Advances in Our Electronic Pages
Authors: Edward W. Campion, Kent Anderson, Jeffrey M. Drazen
Journal: New England Journal of Medicine (2002)

LTHOUGH we view the paper and electronic versions of the Journal as complementary, the electronic version can offer services to readers and authors that are simply not possible on paper.Today the personal digital assistant (PDA) is taking the place of the fat little notebook in coat pockets of many physicians.Recognizing this widely used new technology and its role in medicine, we are adding two new services compatible with the Palm operating system.First, a new Web-synchronized application allows users to load automatically from computer to PDA the latest Journal table of contents and abstracts.Second, those with wireless PDAs can browse collections of articles published since 1996 and arranged according to 51 topics.They will see titles, citation information, and summaries.Subscribers can then select a title and request the full text of the article.The electronic file (PDF) of that article will be sent automatically to the subscriber's e-mail address that we have on file or to another address that the subscriber enters.This new feature allows subscribers to order an article by wireless PDA, and the PDF of that article will be waiting in their e-mail box when they return to their home base.Subscribers can download these two new applications from our Web site.Because we realize that our readers often need background information not found in our pages, articles on our Web site now include links to the on-line version of the 15th edition of Harrison's Principles of Internal Medicine .Subscribers to both the Journal and Harrison's Online can access the full text of both sites through these links.During a trial period, we will offer free access to Harrison's until April 1, 2002.We will be offering links to other high-quality sources of information, such as other medical textbooks, reference collections, and information data bases, as time and circumstances permit.For example, this fall, as we all witnessed the horror of bioterrorism, links to Harrison's and the Centers for Disease Control and Prevention were added to the Journal' s Web site to provide authoritative and up-to-date clinical information for practitioners.Two other new features should be of special interest to our academic audience.First, subscribers can download the color figures from our Advances in Immunology series in a format designed for use in Microsoft PowerPoint.We hope that our readers will find these images of value in their teaching mission.
Histologic Observations After Closed Chest Ablation of the Atrioventricular Conduction System
Authors: Giuseppe Critelli
Journal: JAMA (1984)

Postmortem examination of the heart was done in a case with disabling supraventricular tachyarrhythmia successfully treated by closed-chest ablation of the His bundle. A ventricular aneurysm developed as a result of a previous myocardial infarction, and death occurred suddenly five months after the procedure. Histologic studies of the atrioventricular (AV) junctional tissue demonstrated severe damage to the nearby AV node and penetrating His bundle. No damage to the branching His bundle or either bundle branch was observed. (<i>JAMA</i>1984;252:2604-2606)
Biomarkers of Environmental Tobacco Smoke in Preschool Children and Their Mothers
Authors: F. G. Crawford, J. Mayer, R. M. Santella, T. B. Cooper, R. Ottman, W.-Y. Tsai, G. Simon-Cereijido, M. Wang, D. Tang, F. P. Perera
Journal: JNCI Journal of the National Cancer Institute (1994)

Adverse health effects attributable to environmental tobacco smoke (ETS) include respiratory illness and lung cancer in nonsmokers. There is accumulating evidence that children may be at heightened risk of cancer later in life as a result of exposure to carcinogens during their early development. It is of concern that as many as 9 million American children under the age of 5 years may be exposed to ETS.Our goal was to assess whether levels of cotinine and polycyclic aromatic hydrocarbon-albumin (PAH-albumin) are associated with ETS exposure in children and in women of reproductive age, after accounting for background exposures to PAHs in the diet, workplace, and the home environment.The study cohort was composed of 87 Hispanic and African-American mothers and 87 of their preschool children (2-5 years of age). Plasma cotinine was analyzed by gas chromatography; PAH-albumin adducts in peripheral blood were analyzed by enzyme-linked immunosorbent assay. Exposure data were obtained by interview-administered questionnaires.Both cotinine and PAH-albumin were significantly higher in the children whose mothers smoked than in the children of nonsmoking mothers (P < .001 and P < .05, respectively). Among the children of nonsmoking mothers, cotinine levels were also significantly higher in those who had ETS exposure from others in the household compared with the unexposed children. By regression analysis, after adjustment for ethnicity, there was a significant dose-response relationship between cotinine and the number of cigarettes smoked per day by the mother, both in the children (partial r2 = .23; P = .01) and in the mothers (partial r2 = .22; P = .01). Among the nonsmoking mothers, regression of biomarkers against total passive smoking exposure also showed a significant association with cotinine (r2 = .25; P = .04). PAH-albumin did not show the same dose-related response with the smoking variables. Mothers' cotinine levels were significantly correlated with those of their children (r = .76; P < .001) as were PAH-albumin adducts (r = .27; P = .014).ETS exposure of young children via their mothers' smoking is associated with increases not only in the internal dose of ETS (cotinine), which has been previously reported, but also in the biologically effective dose of the carcinogenic (PAH) components of ETS (PAH-albumin adducts). This observation underscores the carcinogenic and public health hazard of ETS.Given the relatively low level of ETS exposure in this study, these results reinforce the need for effective programs aimed at smoking prevention and cessation among women, particularly women of reproductive age and minorities.
Aplastic anemia associated with systemic lupus erythematosus
Authors: Shin‐Ichi Sumimoto, Masahiko Kawai, Yoshiki Kasajima, Torata Hamamoto
Journal: American Journal of Hematology (1991)

Hematologic complications of systemic lupus erythematosus (SLE) usually involve peripheral destruction of blood cells. We report a case of aplastic anemia associated with SLE observed during the remission phase of SLE 3 months after the beginning of treatment. CD8+ T cells in the patient's bone marrow may have suppressed maturation of hematopoietic progenitor cells, which may have induced the aplastic anemia associated with SLE. Repeated therapy with high-dose methylprednisolone resulted in lasting remission.
Transforming growth factor-β gene expression signature in mouse hepatocytes predicts clinical outcome in human cancer
Authors: Cédric Coulouarn, Valentina M. Factor, Snorri S. Thorgeirsson
Journal: Hepatology (2008)

Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. The clinical heterogeneity of HCC, and the lack of good diagnostic markers and treatment strategies, has rendered the disease a major challenge. Patients with HCC have a highly variable clinical course, indicating that HCC comprises several biologically distinctive subgroups reflecting a molecular heterogeneity of the tumors. Transforming growth factor beta (TGF-beta) is known to exhibit tumor stage dependent suppressive (that is, growth inhibition) and oncogenic (that is, invasiveness) properties. Here, we asked if a TGF-beta specific gene expression signature could refine the classification and prognostic predictions for HCC patients. Applying a comparative functional genomics approach we demonstrated that a temporal TGF-beta gene expression signature established in mouse primary hepatocytes successfully discriminated distinct subgroups of HCC. The TGF-beta positive cluster included two novel homogeneous groups of HCC associated with early and late TGF-beta signatures. Kaplan-Meier plots and log-rank statistics indicated that the patients with a late TGF-beta signature showed significantly (P < 0.005) shortened mean survival time (16.2 +/- 5.3 months) compared to the patients with an early (60.7 +/- 16.1 months) TGF-beta signature. Also, tumors expressing late TGF-beta-responsive genes displayed invasive phenotype and increased tumor recurrence. We also showed that the late TGF-beta signature accurately predicted liver metastasis and discriminated HCC cell lines by degree of invasiveness. Finally, we established that the TGF-beta gene expression signature possessed a predictive value for tumors other than HCC.These data demonstrate the clinical significance of the genes embedded in TGF-beta expression signature for the molecular classification of HCC.
HIV-specific mucosal and cellular immunity in HIV-seronegative partners of HIV-seropositive individuals
Authors: Sandra Mazzoli, Daria Trabaironi, Sergio Lo Caputo, Stefania Piconi, Claudio Blé, Francesca Meacci, Stefania Ruzzante, Alessanda Salvi, Francesca Semplici, Renato Longhi, Maria Luisa Fusi, Nadia Tofani, Mara Biasin, Maria Luisa Villa, Francesco Mazzotta, Mario Clerici
Journal: Nature Medicine (1997)
The Resource-Based Relative Value Scale
Authors: Rodger Bodoia
Journal: JAMA (1989)

To the Editor. —  The determination by Hsiao et al1of the resource-based relative value (RBRV) of a given medical service can be summarized as:  RBRV = (TW)(1 +RPC)(1 +AST) whereTWis the total work input by the physician,RPCis an index of relative specialty practice costs, andASTis an index of amortized value for the opportunity cost of specialty training.  Logically, one would assume that, on the whole, theRPCfactors for a given specialty should reflect the cost of providing the work of that specialty, in the same way thatTWrepresents the work provided by that specialty. Instead, Hsiao et al have built their scheme on anRPCfactor that represents the cost of generating a given amount of revenue in 1983. A problem arises in that anRPCbased on the fraction of 1983 gross revenues will be meaningless and inapplicable
Inhibition of Rat Mammary Gland Carcinogenesis by Simultaneous Targeting of Cyclooxygenase-2 and Peroxisome Proliferator-activated Receptor γ
Authors: Alaa F. Badawi, Mazen B. Eldeen, Yingying Liu, Eric A. Ross, Mostafa Z. Badr
Journal: Cancer Research (2004)

Abstract We examined the effect of celecoxib, a cyclooxygenase-2 (COX-2) inhibitor, and N-(9-fluorenyl-methyloxycarbonyl)-l-leucine (F-l-Leu), a peroxisome proliferator-activated receptor γ (PPARγ) agonist, separately and combined, on the development of methylnitrosourea (MNU)-induced rat mammary gland carcinogenesis. Celecoxib and F-l-Leu significantly reduced tumor incidence and multiplicity (P &amp;lt; 0.05). Combining both agents exerted higher (synergistic) cancer inhibition than separate treatments (P &amp;lt; 0.05). The effects of the test drugs on COX-2 and PPARγ expression and on the synthesis of prostaglandin E2 (PGE2) and 15-deoxy-Δ12,14-PGJ2 (15d-PGJ2) were examined in rat mammary normal (MNU-untreated), uninvolved, and tumor (MNU-treated) tissues. Celecoxib and F-l-Leu, separately, inhibited COX-2 and up-regulated PPARγ expression. These effects were paralleled by inhibition of PGE2 synthesis and up-regulation of 15d-PGJ2. Combined treatment resulted in higher alterations in COX-2 and PPARγ transcripts and PG synthesis compared with separate administrations. The effect of the test agents on Bcl2, BAX, and protein kinase Cα expression levels were examined in the rat mammary gland and the pro-(BAX:Bcl2) and anti-[PKCα*(Bcl2/BAX)] apoptotic ratios were evaluated. Each drug increased the proapoptotic ratio by 2- to 7-fold and reduced the antiapoptotic ratio by 2- to &amp;gt;8-fold in all tissues. Combined treatment, however, resulted in &amp;gt;9- to 14-fold up-regulation in the proapoptotic processes and 15- to &amp;gt;30-fold down-regulation in the antiapoptotic ones. Analyses were also carried out on the drug-induced modulation of cell cycle regulators and proliferation markers (cyclin-dependent kinase 1 and proliferating cell nuclear antigen). F-l-Leu and celecoxib each reduced the cyclin-dependent kinase 1 and proliferating cell nuclear antigen expression in the tumor. Higher down-regulation was attained in all tissues by combined treatment where cyclin-dependent kinase 1 and proliferating cell nuclear antigen almost retained the expression levels observed in the normal glands. In conclusion, simultaneous targeting of COX-2 and PPARγ may inhibit mammary cancer development more effectively than targeting each molecule alone. COX-2 inhibitors and PPARγ agonists coordinately mediate their anticancer effect via both COX-dependent (inhibition of COX-2, activation of PPARγ, and modulation PG synthesis) and COX-independent (induction of proapoptotic factors and inhibition of cell proliferation) pathways.
Epidermal naevi associated with trichilemmal cysts and chromosomal mosaicism
Authors: M.E. IGLESIAS ZAMORA, F.J. VÁZQUEZ-DOVAL
Journal: British Journal of Dermatology (1997)

We present the case of a 29-year-old woman who has had a widespread epidermal naevus since birth, located on the left side of her body, upon which multiple trichilemmal cysts developed several years later. The karyotype of peripheral blood lymphocytes revealed chromosomal mosaicism 46, XX, t (1;9) (p36:q34). The possible pathogenic mechanisms include paracrinopathy, germinal or somatic mutation in the multipotential embryo cells, or a combination of the two.
Unusual Type of Growth Hormone-Producing Pituitary Tumor in Acromegaly
Authors: Satoshi Yamagata, Kazunori Kageyama, Satoru Sakihara, Shozo Yamada, Shinobu Takayasu, Shinji Chikazawa, Naoko Inoshita, Toshiaki Sano, Toshihiro Suda
Journal: Endocrine Pathology (2012)
Validation of a flow cytometric assay detecting in vitro basophil activation for the diagnosis of muscle relaxant allergy☆☆☆
Authors: Nisen Abuaf, Bakoliarisoa Rajoely, Ezzedine Ghazouani, David A. Levy, Catherine Pecquet, Habib Chabane, Francisque Leynadier
Journal: Journal of Allergy and Clinical Immunology (1999)
Histopathology and medical laboratory scientific officers
Authors: T G Ashworth
Journal: BMJ (1995)

216 7 (33-1) mmHg; P=0 07) in patients who presented in March.Our findings are in keeping with a seasonal variation in arterial blood pressure as it is known that higher blood pressures are recorded in winter than in summer.'4There was, however, no seasonal pattern to the incidence of malignant phase hyper- tension.