tbuckley/cabot-search huggingface dataset:
Efficacy and safety of dual blockade of the renin-angiotensin system: meta-analysis of randomised trials
Authors: H. Makani, S. Bangalore, K. A. Desouza, A. Shah, F. H. Messerli
Journal: BMJ (2013)

<b>Objective</b> To compare the long term efficacy and adverse events of dual blockade of the renin-angiotensin system with monotherapy. <b>Design</b> Systematic review and meta-analysis. <b>Data sources</b> PubMed, Embase, and the Cochrane central register of controlled trials, January 1990 to August 2012. <b>Study selection</b> Randomised controlled trials comparing dual blockers of the renin-angiotensin system with monotherapy, reporting data on either long term efficacy (≥1 year) or safety events (≥4 weeks), and with a sample size of at least 50. Analysis was stratified by trials with patients with heart failure versus patients without heart failure. <b>Results</b> 33 randomised controlled trials with 68 405 patients (mean age 61 years, 71% men) and mean duration of 52 weeks were included. Dual blockade of the renin-angiotensin system was not associated with any significant benefit for all cause mortality (relative risk 0.97, 95% confidence interval 0.89 to 1.06) and cardiovascular mortality (0.96, 0.88 to 1.05) compared with monotherapy. Compared with monotherapy, dual therapy was associated with an 18% reduction in admissions to hospital for heart failure (0.82, 0.74 to 0.92). However, compared with monotherapy, dual therapy was associated with a 55% increase in the risk of hyperkalaemia (P&lt;0.001), a 66% increase in the risk of hypotension (P&lt;0.001), a 41% increase in the risk of renal failure (P=0.01), and a 27% increase in the risk of withdrawal owing to adverse events (P&lt;0.001). Efficacy and safety results were consistent in cohorts with and without heart failure when dual therapy was compared with monotherapy except for all cause mortality, which was higher in the cohort without heart failure (P=0.04 <i>v</i> P=0.15), and renal failure was significantly higher in the cohort with heart failure (P&lt;0.001 <i>v</i> P=0.79). <b>Conclusion</b> Although dual blockade of the renin-angiotensin system may have seemingly beneficial effects on certain surrogate endpoints, it failed to reduce mortality and was associated with an excessive risk of adverse events such as hyperkalaemia, hypotension, and renal failure compared with monotherapy. The risk to benefit ratio argues against the use of dual therapy.
Erythropoietin attenuates acute kidney dysfunction in murine experimental sepsis by activation of the β-common receptor
Authors: Sina M. Coldewey, Areeg I. Khan, Amar Kapoor, Massimo Collino, Mara Rogazzo, Michael Brines, Anthony Cerami, Peter Hall, Michael Sheaff, Julius E. Kieswich, Muhammed M. Yaqoob, Nimesh S.A. Patel, Christoph Thiemermann
Journal: Kidney International (2013)
Technetium-99m Sulfur Colloid Diffuse Lung Uptake and its Resolution in Acute Fatty Liver of Pregnancy
Authors: L HABELSON WILF, HARVEY A. ZIESSMAN, LESTER I. MARION, JESSE BALSEIRO, JOHN W. KEYES
Journal: Clinical Nuclear Medicine (1987)

This case report describes a patient with acute fatty liver of pregnancy (AFLP) who, at the height of her severe illness, had the scintigraphic pattern of diffuse lung uptake on a Tc-99m sulfur colloid (SC) liver–spleen scan. The lung uptake completely resolved on a follow-up scan after her recovery. This case report and a review of the literature suggests that Tc-99m SC lung uptake is a manifestation of serious underlying disease of various causes. However, the prognosis is dependent on the nature of the underlying disease process and the patient's subsequent clinical course.
Doctors shun Canada's blood inquiry
Authors: D. Spurgeon
Journal: BMJ (1996)

Some doctors critical of Canada's blood system in the current inquiry into contaminated blood products have refused to take part in lawsuits aimed at preventing the inquiry chief from reporting findings of wrongdoing (17 February p 398).

The doctors are among those who have been most critical of the blood system and who are thus anxious to see the commissioner's report published. Mr Justice Horace Krever's report is due next September but could …
Polyunsaturated fatty acid deficiency reverses effects of alcohol on mitochondrial energy metabolism
Authors: Marie-Astrid Piquet, Michel Roulet, Véronique Nogueira, Céline Filippi, Brigitte Sibille, Isabelle Hourmand-Ollivier, Marianne Pilet, Vincent Rouleau, Xavier M. Leverve
Journal: Journal of Hepatology (2004)
What did you do about climate change Mum?
Authors: Fiona Godllee
Journal: BMJ (2006)

Ignorance is bliss. Sadly, when it comes to climate change we no longer have the luxury of ignorance. We know that the world is getting hotter and that carbon emissions are almost certainly to blame. We know that global warming means rising sea levels, floods, droughts, storms, and inconceivably large numbers of displaced people. We know that these changes are likely over the next few decades and have huge implications for human health. More importantly we know that there are things we can do, individually and collectively, nationally and internationally (p 1397). Knowing this means that we must act now if …
Progression of borderline abnormalities on cervical smear testing.
Authors: K. A. Hussein, D. M. Parham
Journal: BMJ (1992)

producing an increase in violent deaths, so that despite a small reduction in coronary deaths the total mortality in people taking such drugs was no lower than that in a control group.2Singh and colleagues carried out their trial in 406 patients with suspected acute myocardial infarction.All of the patients were advised to follow a fat reduced diet; one half was also advised to eat more fruit, vegetables, nuts, and grain products.Detailed records of their diets were made before entry into the trial and at the end of the one year.During the year the group taking the stricter diet experienced about 40% fewer cardiac events and 40% fewer cardiac deaths.The table shows how the trial diet differed from the habitual diet.Differences occurred not only in the quantity and type of the fats but also in the energy and dietary components.The greatest changes were in the intakes of some of the micronutrients: three increased by more than 200% and three by 50% or more.The chief changes in the main nutritional components were in animal protein, vegetable protein, refined carbohydrate (presumably sucrose), saturated fatty acids, and monounsaturated fatty acids.The non-nutritional item caffeine was considerably reduced.Differences in composition of trial diet compared with
Comparison of treatment of renal calculi by open surgery, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.
Authors: C R Charig, D R Webb, S R Payne, J E Wickham
Journal: BMJ (1986)

This study was designed to compare different methods of treating renal calculi in order to establish which was the most cost effective and successful. Of 1052 patients with renal calculi, 350 underwent open surgery, 350 percutaneous nephrolithotomy, 328 extracorporeal shockwave lithotripsy (ESWL), and 24 both percutaneous nephrolithotomy and ESWL. Treatment was defined as successful if stones were eliminated or reduced to less than 2 mm after three months. Success was achieved in 273 (78%) patients after open surgery, 289 (83%) after percutaneous nephrolithotomy, 301 (92%) after ESWL, and 15 (62%) after percutaneous nephrolithotomy and ESWL. Comparative total costs to the NHS were estimated as 3500 pounds for open surgery, 1861 pounds for percutaneous nephrolithotomy, 1789 pounds for ESWL, and 3210 pounds for both ESWL and nephrolithotomy. ESWL caused no blood loss and little morbidity and is the cheapest and quickest way of returning patients to normal life.
NHS will not pay for drugs that offer little clinical benefit, says cancer fund boss
Authors: Z. Kmietowicz
Journal: BMJ (2015)

The head of the fund that pays for cancer drugs that are not approved for use on the NHS in England has defended the decision to delist some of the drugs it currently finances because they don’t offer patients sufficient clinical benefit.

Peter Clark, chairman of the Cancer Drugs Fund and a practising oncologist, said, “We need to get maximum value for every pound we spend through the CDF [Cancer Drugs Fund]. We can no longer sustain a position where we are funding drugs that don’t offer sufficient clinical benefit when drugs that will do more for patients are coming on stream.”

He was responding to criticism of the Cancer Drugs Fund by two drug companies that have had their drugs removed from the list that the fund will finance. Since …
Vertical T cell immunodominance and epitope entropy determine HIV-1 escape
Authors: Michael K.P. Liu, Natalie Hawkins, Adam J. Ritchie, Vitaly V. Ganusov, Victoria Whale, Simon Brackenridge, Hui Li, Jeffrey W. Pavlicek, Fangping Cai, Melissa Rose-Abrahams, Florette Treurnicht, Peter Hraber, Catherine Riou, Clive Gray, Guido Ferrari, Rachel Tanner, Li-Hua Ping, Jeffrey A. Anderson, Ronald Swanstrom, CHAVI Core B, Myron Cohen, Salim S. Abdool Karim, Barton Haynes, Persephone Borrow, Alan S. Perelson, George M. Shaw, Beatrice H. Hahn, Carolyn Williamson, Bette T. Korber, Feng Gao, Steve Self, Andrew McMichael, Nilu Goonetilleke
Journal: Journal of Clinical Investigation (2012)

HIV-1 accumulates mutations in and around reactive epitopes to escape recognition and killing by CD8+ T cells. Measurements of HIV-1 time to escape should therefore provide information on which parameters are most important for T cell–mediated in vivo control of HIV-1. Primary HIV-1–specific T cell responses were fully mapped in 17 individuals, and the time to virus escape, which ranged from days to years, was measured for each epitope. While higher magnitude of an individual T cell response was associated with more rapid escape, the most significant T cell measure was its relative immunodominance measured in acute infection. This identified subject-level or "vertical" immunodominance as the primary determinant of in vivo CD8+ T cell pressure in HIV-1 infection. Conversely, escape was slowed significantly by lower population variability, or entropy, of the epitope targeted. Immunodominance and epitope entropy combined to explain half of all the variability in time to escape. These data explain how CD8+ T cells can exert significant and sustained HIV-1 pressure even when escape is very slow and that within an individual, the impacts of other T cell factors on HIV-1 escape should be considered in the context of immunodominance.
Michigan's Sensible Living Will
Authors: Arnold S. Relman
Journal: New England Journal of Medicine (1979)

AN elderly patient in a nursing home, hopelessly incapacitated by an incurable disease, has a fever that is most likely due to pneumonia or some other serious infection. Should the physician in charge respond with the usual diagnostic or therapeutic measures, or should treatment be limited to the relief of symptoms, thus allowing the infection to take its probably fatal course?In the survey published by Brown and Thompson in this issue of the Journal, a decision was evidently made not to treat actively in about 40 per cent of the cases, and the majority of those patients died. . . .
Thrombolytic Therapy for Pulmonary Embolism
Authors: Joshua A. Beckman
Journal: JAMA (2014)

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
Optical coherence tomography in the diagnosis of coeliac disease: a preliminary report
Authors: E Masci, B Mangiavillano, L Albarello, A Mariani, C Doglioni, P A Testoni
Journal: Gut (2006)

Coeliac disease (CD) is a common condition with many atypical manifestations and an estimated worldwide prevalence of 1 in 266.1 It often goes unrecognised because characteristic histopathological abnormalities must be found to confirm the diagnosis. Endoscopic signs of CD are described in the literature but cannot be relied upon for detection of the disease because their sensitivity and specificity are not high. To investigate CD in every patient undergoing oesophagogastroduodenoscopy (OGD) for dyspeptic symptoms is not realistic, especially if we consider the significant costs of histological handling. Therefore, a way of detecting CD is selection of patients in which biopsies of the duodenal mucosa must be performed.

A useful new medical technique, optical coherence tomography (OCT), that combines the principles of ultrasound and infrared backscattering light, …
Epidermal Growth Factor Receptor-Related Tumor Markers and Clinical Outcomes with Erlotinib in Non-small Cell Lung Cancer: An Analysis of Patients from German Centers in the TRUST Study
Authors: Claus-Peter Schneider, David Heigener, Kathrin Schott-von-Römer, Sylvia Gütz, Eckart Laack, Werner Digel, Wolf-Rüdiger Guschall, Andreas Franke, Heinrich Bodenstein, Claudia Schmidtgen, Martin Reck
Journal: Journal of Thoracic Oncology (2008)
O. W. Holmes Answers His Question
Authors: J. EDWARD ROSENTHAL
Journal: Annals of Internal Medicine (1972)

Letters, Comments, and Corrections1 July 1972O. W. Holmes Answers His QuestionJ. EDWARD ROSENTHAL, M.D.J. EDWARD ROSENTHAL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-77-1-152 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In the March 1972 issue of the ANNALS, on page 396 under the title "Oliver Wendell Holmes: Shakespeare or Surgery?", you quote from Holmes' book, Our Hundred Days in Europe, concerning his conversation with Dr. Lawson Tait. I might add that Sir William Osler was also interested in the question proposed by Holmes. In Harvey Cushing's biography of Osler (1), I have come across a quotation from the Montreal Medical Journal in which Osler writes, and I quote:"I know of no man who could so well make answer to this question as the Autocrat himself. Would...Reference1. CUSHING H: The Life of Sir William Osler. Oxford University Press, 1940, pp. 301, 302 Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 July 1972Volume 77, Issue 1Page: 152-153KeywordsSurgery ePublished: 1 December 2008 Issue Published: 1 July 1972 PDF downloadLoading ...
Enhanced Hepatocyte Growth Factor Signaling by Type II Transforming Growth Factor-β Receptor Knockout Fibroblasts Promotes Mammary Tumorigenesis
Authors: Nikki Cheng, Anna Chytil, Yu Shyr, Alison Joly, Harold L. Moses
Journal: Cancer Research (2007)

Transforming growth factor-beta (TGF-beta) plays complex dual roles as an inhibitor and promoter of tumor progression. Although the influence of the stromal microenvironment on tumor progression is well recognized, little is known about the functions of TGF-beta signaling in the stroma during tumor progression. Using cre-lox technology, expression of the type II TGF-beta receptor was selectively knocked out in fibroblasts (Tgfbr2(FspKO)). In a co-xenograft model, we show that Tgfbr2(FspKO) fibroblasts enhance mammary carcinoma growth and metastasis in mice while increasing hepatocyte growth factor (HGF) expression and c-Met signaling downstream pathways including signal transducers and activators of transcription 3 (Stat3) and p42/44 mitogen-activated protein kinase (MAPK). Treatment of tumor-bearing mice with a pharmacologic inhibitor (EXEL-7592) of c-Met blocks tumor progression and reduces levels of phospho-Stat3 and phospho-p42/44 MAPK. Similarly, small interfering RNA knockdown of c-Met expression in mammary tumor cells reduces metastasis and c-Met signaling caused by Tgfbr2(FspKO) fibroblasts. The results show that TGF-beta signaling in fibroblasts suppresses tumor metastasis by antagonizing HGF/c-Met signaling within tumor epithelial cells. Furthermore, this co-xenograft model represents a unique context to study stromal TGF-beta and HGF signaling in mammary tumorigenesis.
Decrypting the role of Cripto in tumorigenesis
Authors: Michael M. Shen
Journal: Journal of Clinical Investigation (2003)

The cell-surface associated molecule Cripto is overexpressed in a wide range of epithelial cancers, yet little is known about potential mechanisms by which Cripto expression might enhance tumorigenesis. A new study reveals that binding of Cripto to the TGF-β ligand Activin B can block Activin B–mediated suppression of cell proliferation. Furthermore, this study also demonstrates that antibody blockade of Cripto function may prove useful in the inhibition of tumorigenesis.
Secondary polycythaemia in chronic respiratory insufficiency.
Authors: D Vanuxem, C Guillot, E Fornaris, P J Weiller, C Grimaud
Journal: Thorax (1977)

The relationship between polycythaemia, P50 and SaCO (saturation in carboxyhaemoglobin) has been studied in 50 patients who were hypoxaemic due to chronic respiratory insufficiency. These patients were divided into two groups according to their haemoglobin concentration and haematocrit: 21 polycythaemic patients with haemoglobin greater than or equal to 16 g/dl and haematocrit greater than or equal to 50% and 29 patients without polycythaemia. PaO2, PaCO2, plasma and erythrocyte pH, haemoglobin, haematocrit, and carbon monoxide saturation and intraerythrocytic 2-3 diphosphoglycerate concentration were measured during steady-state ventilation. All polycythaemic patients were smokers and their carbon level was significantly higher than that observed in patients without polycythaemia. Additionally, their P50 and 2-3 DPG concentration were significantly lower than in patients without polycythaemia. The correlations between P50 and HbCO and between Hb and HbCO were significant (r=--0-672; r=0-552 respectively: P less than 0-001). Eleven non-polycythaemic patients who were smokers had a high level of HbCO but normal P50. A group of 29 normoxic subjects was also studied, 14 non-smokers and 15 smokers with a high HbCO level. The mean value of P50 was lower in smokers and their haematocrit was higher although the difference was not significant for the latter. The HbCO increase by tobacco seems to be a factor in the occurrence of polycythaemia in patients with chronic respiratory insufficiency. The level of increase of HbCO and/or its duration and perhaps other individual factors and explain why all patients with high HbCO level and hypoxaemia were not polycythaemic.
UTILITY OF DELAYED 24 HOUR REDISTRIBUTION ON SPECT THALLIUM-201 MYOCARDIAL PERFUSION STUDIES
Authors: H. A. Ziessman, C. J. Sigler, T. M. Wells, L. M. Fox, C. E. Green, S. M. Fox, S. R. Patel, J. W. Keyes
Journal: Clinical Nuclear Medicine (1988)

Stress Tl-201 cardiac perfusion studies are valuable in differentiating viable (ischemic and potentially salvagable) from non-viable infarcted myocardium. The post-exercise study is typically compared to a “rest” study obtained 2–4 hours post Tl-201 Injection. We have occasionally seen patients with delayed redistribution, e.g. fixed defect at 4 hours, but redistribution at 24 hours. The purpose of this study was to evaluate the frequency and significance of delayed redistribution. Thirty (30) patients with either partial or no redistribution at 4 hours post Tl-201 injection had SPECT imaging repeated 12–48 hours later. Studies were interpreted by a consensus of at least 2 experienced observers. The quality of the delayed studies was usually quite good; 29/30 were judged interpretable. Some change in the relative perfusion pattern from 4 to 24 hours was seen in 21/29 pts. This change in perfusion was felt to be clinically important in 9/29 (31%). In 6/9 the 24 hour study demonstrated reversible ischemia when the 4 hour study showed a fixed defect, in 3/9 partial redistribution at 4 hours became complete redistribution at 24 hours. Of these 9 pts, 5 had 3, 3 had 2, and 1 had single vessel CAD. All 9 had stenoses ≥50% in the ischemic region. However, neither the percent stenosis nor the number of diseased vessels correlated well with the presence or absence of delayed redistribution. Patients with 24 hour delayed redistribution had a lower mean exercise double product (19.8) compared to patients who had complete redistribution at 4 hours (26.5) (p < .05). In conclusion, 24 hour delayed SPECT Tl-201 studies have proven quite helpful in diagnosing reversible myocardial ischemia and potentially treatable coronary artery disease.
A primary health care project in the Amazonian jungle of northern Peru.
Authors: N C Hewett, F E Duggan
Journal: BMJ (1986)

lumbar puncture was not performed.She had no signs ofcongenital syphilis.She had been married twice, the second time to a sailor, and had been sexually abused by a cousin at the age of 8.She had had one miscarriage but no children.Although not relevant in this case, it is known that syphilis may result from sexual abuse of elderly patients.2A course of tetracycline (the patient was allergic to penicillin) resulted in resolution of the pain and ulceration over four months.There was no Herxheimer reaction. DiscussionThis patient, with peripheral vascular disease evident on arterio- graphy, had skin ulcers typical of a severely ischaemic leg, which were in fact probably gummatous lesions.Only a minority of patients with untreated syphilis develop late sequelae, about 15% having gummatous lesions with skin and bone among the possible sites.3The tibia is the bone most commonly affected.4Syphilitic osteomyelitis starts in the metaphysis, and the earliest radiological change is a periostitis.5The periosteal reaction causes a build up of new bone on the anterior border of the tibia, resulting in a sabre tibia appearance.As the disease progresses to the cortex and medulla lytic areas of bone destruction develop.There is a variable degree of new bone formation, which results in dense areas of sclerosing osteitis.The degree of sclerosis may reflect relative ischaemiua due to syphilitic arteritis.5Clinically, local pain and variable swelling are seen.'The osteomyelitis may penetrate to the skin and produce a punched out ulcer with bone in the base, but the lesion may be superficial or even heal up and mnay be easily confused with venous ulcers.'This case emphasises the importance of making a precise diagnosis in all cases of intractable leg ulceration before embarking on surgical or prolonged medical treatment for the ulcer.