tbuckley/cabot-search huggingface dataset:
A Prospective Study of Aspirin Use and Primary Prevention of Cardiovascular Disease in Women
Authors: JoAnn E. Manson
Journal: JAMA (1991)

<h3>Objective.</h3> —The aim of the study was to examine prospectively the association between regular aspirin use and the risk of a first myocardial infarction and other cardiovascular events in women. <h3>Design.</h3> —Prospective cohort study including 6 years of follow-up. Setting.—Registered nurses residing in 11 US states. <h3>Participants.</h3> —US registered nurses (n = 87 678) aged 34 to 65 years and free of diagnosed coronary heart disease, stroke, and cancer at baseline. Follow-up was 96.7% of total potential person-years of follow-up. <h3>Main Outcome Measures.</h3> —Incidence of myocardial infarction, stroke, cardiovascular death, and all important vascular events. <h3>Results.</h3> —During 475 265 person-years of follow-up, we documented 240 nonfatal myocardial infarctions, 146 nonfatal strokes, and 130 deaths due to cardiovascular disease (total, 516 important vascular events). Among women who reported taking one through six aspirin per week, the age-adjusted relative risk (RR) of a first myocardial infarction was 0.68 (95% confidence interval [CI], 0.52 to 0.89; P =.005), as compared with those women who took no aspirin. After simultaneous adjustment for risk factors for coronary disease, the RR was 0.75 (95% CI, 0.58 to 0.99; P =.04). For women aged 50 years and older, the age-adjusted RR was 0.61 (95% CI, 0.45 to 0.84; P =.002) and the multivariate RR was 0.68 (95% CI, 0.50 to 0.93; P =.02). We observed no alteration in the risk of stroke (multivariate RR = 0.99; P =.94). The multivariate RR of cardiovascular death was 0.89 (P =.56) and of important vascular events was 0.85 (P =.12). When examined separately, the results were nearly identical for the subgroups who took one through three and four though six aspirin per week. Among women who took seven or more aspirin per week, there were no apparent reductions in risk. <h3>Conclusions.</h3> —The use of one through six aspirin per week appears to be associated with a reduced risk of a first myocardial infarction among women. A randomized trial in women is necessary, however, to provide conclusive data on the role of aspirin in the primary prevention of cardiovascular disease in women. (<i>JAMA</i>. 1991;266:521-527)
Psychological aspects of the management of chronic renal failure.
Authors: W. A. Cramond, P. R. Knight, J. R. Lawrence, B. A. Higgins, J. H. Court, F. M. MacNamara, A. R. Clarkson, C. D. Miller
Journal: BMJ (1968)

Gastroscopy with Biopsy-Williams et al.M 539 benign tumour, and it is relevant that both biopsy and cyto- logical examination did not suggest malignancy.In the remain- ing 19 cases evidence of malignancy was not found, though one subsequently proved to have a reticulum-cell sarcoma.Among 20 patients referred with a clinical and radiological diagnosis of benign gastric ulcer three were found to have malignant disease.Among 16 patients with symptoms suggestive of peptic ulcer but a negative or inconclusive barium meal, three were found to have a gastric ulcer, two to have erosions, and five to have superficial gastritis.In 46 patients from whom biopsy and cytological specimens were taken there was agreement between the gastroscopic and the microscopical diagnosis in 41 (89%).In most instances the biopsy specimen and cytological preparation served to confirm the gastroscopic diagnosis, but occasionally they corrected a mistaken gastroscopic diagnosis.This combined method of examination represents a powerful diagnostic approach to the diagnosis of gastric disease.It does not replace radiological examination, to which it is comple- mentary.We are indebted to the Nuffield Committee for making a grant to one of us (S. C. T.) for the purchase of the G.F.B. fibrescope.One of us (D.G. W.) was
Unusual Application of Obstetrical Forceps
Authors: Samuel P. Burre
Journal: JAMA (1969)

To the Editor:—  This reports a proctologic procedure wherein a petroleum jelly jar was delivered from the rectum with the assistance of obstetrical forceps.  Report of a Case:—  At 9 AM, a 67-year-old man of average intelligence was massaging his rear end with a jar of petroleum jelly to relieve a bothersome itch. He coughed and sneezed at the same time, which caused the rectum to relax and allowed the jar to slip in as he sat down at the edge of the bed. After this Rube Goldberg-chain reaction-rectal jar syndrome, the patient encountered difficulty in passing the newly adopted contents. After drinking copious amounts of sauerkraut juice, all that was accomplished was the discharge of watery movements, plus pain. After four hours of labor (breech presentations can cause problems), the patient notified me by phone that he had had a rectal accident and needed urgent care.  Digital rectal examination
Measurement of the chemotactic complement fragment C5a in rheumatoid synovial fluids by radioimmunoassay: role of C5a in the acute inflammatory phase.
Authors: P J Jose, I K Moss, R N Maini, T J Williams
Journal: Annals of the Rheumatic Diseases (1990)

Evidence suggests that complement is activated in rheumatoid joints. A sensitive radioimmunoassay for the activation fragment of C5, C5a, which is a potent chemoattractant for neutrophils, was therefore developed. A mean C5a concentration in 22 rheumatoid joint fluids of about 2.5 x 10(-9) mol/l was found. This concentration of C5a is sufficient to induce two of the characteristic features of the acute inflammatory phases of rheumatoid arthritis: neutrophil accumulation and microvascular plasma protein leakage. In animal models it has been shown that C5a is a potent inducer of inflammatory oedema by a neutrophil dependent mechanism. A striking feature of the acute inflammatory phases of rheumatoid arthritis is the appearance of high numbers of neutrophils in the synovial fluid. It is suggested that C5a might have a role in mediating neutrophil accumulation and, as a consequence, may be important in acute joint swelling and pain.
Tales from the gene pool: a genomic view of infectious disease
Authors: Karen Honey
Journal: Journal of Clinical Investigation (2009)

Research into the pathogenesis, prevention, and control of infectious and parasitic diseases remains a global priority, as these scourges continue to be a substantial cause of mortality and morbidity. The plethora of molecular tools that are now readily available has facilitated a genome-wide approach to studying the pathogenesis of such diseases, with direct implications for disease prevention and treatment. The articles in this Review Series describe how genome-wide approaches have provided insight into a range of human pathogens, leading to greater understanding of the human diseases that they cause, and highlight some of the challenges that must be overcome if we are to maximize what we learn from the wealth of genomic information now available.
Percutaneous Mitral Valvuloplasty
Authors: Alain Delabays, Jean-Jacques Goy
Journal: New England Journal of Medicine (2001)

Percutaneous Mitral ValvuloplastyA 27-year-old woman was admitted to the hospital with dyspnea on exertion and with orthopnea.She was four months pregnant and otherwise healthy.Her history was unremarkable except for rheumatic fever during childhood.On examination, she had no signs of left-sided or right-sided heart failure.Her heart rate was regular, at 85 beats per minute.Cardiac auscultation suggested tight mitral stenosis, with a loud first heart sound, an early opening click, and a diastolic rumble.The diagnosis was confirmed by transthoracic echocardiography.The area of the mitral valve was calculated to be 1.1 cm 2 (by planimetry and measurement of the pressure half-time), with a mean pressure gradient of 9 mm Hg.There was trace mitral insufficiency, and the valve was considered suitable for valvuloplasty.The procedure was performed while the patient was under general anesthesia; transesophageal echocardiographic guidance was used for interatrial septal puncture.A 30-mm Inoue balloon was passed through the valve, its distal end was inflated (arrowheads in Panel A, left), and under traction, the whole balloon was expanded (Panel A, right).The mean pressure gradient measured by catheter fell from 11 to 4 mm Hg (Panel B; LV denotes left ventricular pressure, and PCW pulmonary-capillary wedge pressure).The transesophageal probe was used to construct a three-dimensional image of the mitral valve before and after the procedure.A view during diastole from the left atrium before valvuloplasty (Panel C, left) showed commissural fusion, with limited opening of the valve (the single asterisk denotes the posterior mitral leaflet, the double asterisk the anterior mitral leaflet, LAA left atrial appendage, and AOV aortic valve).After dilation (Panel C, right), the anterior commissure was wide open (top arrowhead), whereas the posterior commissure was still partially fused (bottom arrowhead).The posterior leaflet was fixed.The area of the mitral valve increased from 1.1 to 2.3 cm 2 .There was grade 1 mitral regurgitation after the procedure according to ventriculography and echocardiography.The patient recovered uneventfully and delivered a 3180-g female infant with Apgar scores of 9 and 10 at one and five minutes, respectively.After the delivery the patient remained asymptomatic.
Diagnosis and Surgery of High-pressure Venous Leaks in the Leg
Authors: F. B. Cockett
Journal: BMJ (1956)

Varicose veins have often been referred to as the Cinderella of surgery.This has been an apt simile, for she was apparently a drudge and few people took the trouble to take a really good look at her.When they did look at her, as the prince found out, she was found to be fascinating and attractive.The key to the understanding of varicose veins and their effects lies first in knowing the physiology of venous return from the leg, and only then can we appreciate the disordered physiology which results in varicose veins and venous ulcers.Following on this, the key to proper diagnosis and surgical treatment is a com- plete knowledge of the venous anatomy.The applica- tion of certain new operative methods and new instruments, and an awareness of the supreme importance of post-operative care in these patients, have each added their quota towards Cinderella's transforma- tion. PhysiologyThe venous return from the legs of a man lying horizontal is by a completely different mechanism to that of a man in his more usual vertical position.With the legs hori- zontal at or above heart level, the .k E/ 'VEIN vis .% g cil @ a tergo is all that ~~~is required to re- >'S J/^'> ~8 turn the venous /S Mt t : blood, and all veins
Identifying the Tuberculous Infected
Authors: Carroll E. Palmer
Journal: JAMA (1968)

While the tuberculin test has long been a most useful tool for identifying the tuberculous infected in a population, it has the limitation that it may elicit cross-reactions in persons infected with other (nontuberculous) mycobacteria. One approach toward improving the identification of persons with tuberculous infection, is a dual-test technique, using an atypical mycobacterial antigen together with tuberculin. In 1958, the Public Health Service and the US Navy instituted a cooperative program designed to study skin-test sensitivity and related tuberculosis morbidity among navy recruits. Preliminary results from this program provide striking evidence that the use of another mycobacterial purified protein derivative (PPD) in addition to tuberculin significantly improves the identification of the the tuberculous infected in a population.
A consultation that changed my practice
Authors: Sanju George
Journal: BMJ (2006)

Doctors often get so set in their roles that they fail to see matters from their patients' perspective. Hence, an occasional role reversal has its benefits, as I learnt from my recent consultation with my dentist. The treatment itself was uneventful, but what struck me when I sat in the patient's chair—on the “other side of the table”—was the many gifts from drug companies that adorned his desk and walls, mostly by the manufacturer of a particular brand of toothpaste, X. “Nothing …
Meeting Spiritual Needs: What Is an Oncologist to Do?
Authors: Betty Ferrell
Journal: Journal of Clinical Oncology (2007)

The original report by Balboni and colleagues regarding spiritual support is not a subtle message about a possible need for a few patients with cancer. It is a strong statement of a seriously unmet need in the vast majority of patients in our care. The authors found that 47% of the study patients with advanced cancer reported unmet spiritual needs by religious communities and 72% reported unmet spiritual needs by the health care system. If these figures were reported for any other dimension of patient care, cancer care settings concerned with quality would respond. How should we respond to patient needs for spiritual support? The topic of spirituality is a reminder of another topic raised in the 1970s to 1980s in oncology, which was also a subject to be avoided—that of sexuality in cancer patients. Controversies of that era asked similar questions: do patients really care about this? Do they want us to talk about it? What if their preferences are different from my own? If I ask about it, what do I do when they voice concerns? The authors of this research are to be commended for providing a comprehensive discussion about the implications of their findings. They conclude that physicians can participate in improved care by recognizing spiritual needs and by advocating for attention to religious and spiritual needs as a routine part of cancer care. This global recommendation is indisputable. Spiritual needs, like sexuality needs, will exist regardless of if we elect to address or ignore them. So what is an oncologist to do? At a time of unprecedented time constraints and demands of complex patients, diminished staff resources, managed care demands, and the struggle to address even the most basic of disease and treatment concerns—where do spiritual concerns fit in? To build on the general recommendations provided by Balboni and colleagues, I offer three specific suggestions.
Public Perceptions of Medicine
Authors: David Mechanic
Journal: New England Journal of Medicine (1985)

Two thirds of the American public now believe that people are beginning to lose faith in doctors.1 The growth of public disillusionment with physicians as a professional group has accompanied magnificent medical advances. In some sense, Aaron Wildavsky's catchy phrase "doing better but feeling worse"2 characterizes the situation.The picture that emerges is different when people are questioned about their experiences with their personal physicians and their most recent medical encounters. Patients typically assume that their physicians are technically competent, but they look for warmth and interest in the patient as an individual, particularly in the presence of frightening or . . .
Putting young people's behaviour in perspective
Authors: L. D. Hudson, T. Stephenson, D. Christie, R. Viner
Journal: BMJ (2011)

The health status and economic prospects of our young people are poor. Comparative studies by Unicef show that child and adolescent wellbeing is lower in Britain than in other wealthy countries,1 and that 22% of children live in relative poverty in the UK—higher than any economically comparable country in Europe.1 Youth unemployment is higher …
Regulation of follistatin messenger ribonucleic acid levels in the rat pituitary.
Authors: U B Kaiser, W W Chin
Journal: Journal of Clinical Investigation (1993)

Follistatin is a glycoprotein, originally isolated from the gonads, that specifically inhibits follicle-stimulating hormone (FSH) biosynthesis and secretion. We have previously detected follistatin mRNA in rat pituitary gonadotropes. To assess the potential physiologic role of follistatin in the rat pituitary, we have investigated the effects of gonadectomy (GDX) and of sex steroid replacement on pituitary follistatin gene expression. Follistatin mRNA levels in individual rat pituitaries were measured by a quantitative reverse transcription-polymerase chain reaction assay. Female and male rats 21 d old underwent surgical GDX and were then killed 21 d after GDX. Follistatin mRNA levels in rat pituitary increased 3.2 +/- 1.5-fold (P < 0.01) in GDX female rats and 8.2 +/- 2.0-fold (P < 0.005) in GDX male rats, compared with intact female and male controls, respectively. Replacement therapy with 17 beta-estradiol-3-benzoate (10 micrograms/100 g body weight) subcutaneously daily for 7 d in GDX female rats resulted in a slight further increase in follistatin mRNA levels compared to GDX females. In contrast, therapy with testosterone propionate (500 micrograms/100 g body weight) subcutaneously daily for 7 d in GDX male rats resulted in a decrease in follistatin mRNA levels, towards but not completely back to baseline levels in intact males. Time-course studies in adult male and female rats showed that the increase in follistatin mRNA levels after GDX is rapid, with significant increases occurring within 24 h after GDX, and parallels or precedes increases in FSH beta mRNA levels and FSH secretion. The regulation of follistatin mRNA levels in the rat pituitary by GDX and by sex steroids suggests that follistatin may be important as an autocrine or paracrine factor in the regulation of FSH.
Glutamate accumulation in the photoreceptor-presumed final common path of photoreceptor cell death
Authors: Makoto Tamai
Journal: Behavioral and Brain Sciences (1995)

Abstract Genetic abnormalities of three factors related to the photoreceptor mechanism have been reported in both animal models and humans. Apoptotic mechanism has also been suggested as a final common pathway of photoreceptor cell death. Our findings of increased level of glutamate in photoreceptor cells in rds mice suggest that amino acid might mediate between these two pathological mechanisms.
Scope of FDA surveillance of its employees is higher than previously thought, journalists say
Authors: B. Roehr
Journal: BMJ (2012)

Electronic surveillance of its employees by the US Food and Drug Administration has been far greater than originally thought, an investigation by the New York Times has found.

More than 80 000 pages of electronic documents have been gathered on an “enemies list” of employees by their superiors, says the newspaper, which published the story on the front page of its Sunday edition on 15 July.1

The FDA’s investigation of its own scientists began in early 2010 over the possible leaking of confidential information on medical devices under review. It quickly expanded to include “21 agency employees, Congressional officials, …
Evidence that the HLA DQA1*03 allele confers protection from chronic HCV-infection in Northern European Caucasoids
Authors: C Tibbs
Journal: Hepatology (1996)

In the search for factors which may influence susceptibility to and outcome from chronic hepatitis C virus (HCV) infection, few studies have considered the influence of host genes. In the present investigation we have performed HLA DRB1, DQA1, DQB1, and DPB1 genotyping on 104 northern European patients with chronic HCV infection and 177 racially and geographically matched controls. Three HLA class II alleles, DRB1*0403, DQA1*03, and DQB1*0302 were present at a significantly lower frequency in patients compared with controls (4.9% vs. 13%, 20.7% vs. 41.2%, and 11.4% vs. 30.5%, respectively) though only two DQB1*0302 and DQA1*03 were significant after correction for multiple testing (pc = 0.038, and pc = 0.046, respectively). No further HLA associations with chronic HCV infection were observed and there was no correlation between stage of disease and HLA genotype. These data provide the first suggestion that susceptibility to chronic HCV infection may be influenced by the hosts' HLA DQ alleles.
Prevention of Myocardial Damage during Cardiac Operations
Authors: John W. Kirklin, Vincent R. Conti, Eugene H. Blackstone
Journal: New England Journal of Medicine (1979)

WHEN the cardiopulmonary-bypass technic for cardiac operations began to evolve in the mid-1950's, there was wide enthusiasm for its potential benefits. It soon became apparent, however, that some operations resulted in early postoperative deaths and that most were due to some form of acute cardiac failure, usually manifested by low cardiac output. These deaths, it was assumed, happened because the patients had serious heart disease. Only recently has it been realized that death from acute cardiac failure soon after cardiac operations is usually related to new, and often extensive, perioperative (during or within 24 hours of the procedure) myocardial necrosis . . .
Lapaquistat Acetate
Authors: Evan A. Stein, Harold Bays, Dennis O'Brien, Jim Pedicano, Edward Piper, Andrea Spezzi
Journal: Circulation (2011)

Lapaquistat acetate is a squalene synthase inhibitor investigated for the treatment of hypercholesterolemia.This report summarizes the phase 2 and 3 results from the lapaquistat clinical program, which was halted at an advanced stage as a result of potential hepatic safety issues. Efficacy and safety data were pooled from 12 studies (n=6151). These were 6- to 96-week randomized, double-blind, parallel, placebo- or active-controlled trials with lapaquistat monotherapy or coadministration with other lipid-altering drugs in dyslipidemic patients, including a large (n=2121) 96-week safety study. All studies included lapaquistat 100 mg daily; 5 included 50 mg; and 1 included 25 mg. The main outcome measures were the percent change in low-density lipoprotein cholesterol, secondary lipid/metabolic parameters, and overall safety. Lapaquistat 100 mg significantly decreased low-density lipoprotein cholesterol by 21.6% in monotherapy and by 18.0% in combination with a statin. It also reduced other cardiovascular risk markers, such as C-reactive protein. Total adverse events were higher for lapaquistat than placebo, although individual events were generally similar. At 100 mg, there was an increase in alanine aminotransferase value ≥3 times the upper limit of normal on ≥2 consecutive visits (2.0% versus 0.3% for placebo in the pooled efficacy studies; 2.7% versus 0.7% for low-dose atorvastatin in the long-term study). Two patients receiving lapaquistat 100 mg met the Hy Law criteria of alanine aminotransferase elevation plus increased total bilirubin.Squalene synthase inhibition with lapaquistat acetate, alone or in combination with statins, effectively lowered low-density lipoprotein cholesterol in a dose-dependent manner. Elevations in alanine aminotransferase, combined with a rare increase in bilirubin, presented potential hepatic safety issues, resulting in termination of development. The lapaquistat experience illustrates the current challenges in lipid-altering drug development.URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00487994, NCT00143663, NCT00143676, NCT00864643, NCT00263081, NCT00286481, NCT00249899, NCT00249912, NCT00813527, NCT00256178, NCT00268697, and NCT00251680.
Aseptic Technic—Bacteriologic Examination of Hands.
Authors: W. W. Keen
Journal: JAMA (1904)

Rochester, Minn., July 9, 1904. <h3>To the Editor:</h3> —InThe Journal, July 2, in the report of the American Surgical Association your reporter has made a slight error, which I beg leave to correct. He reports me as saying that in 213 bacteriologic examinations of the hands in my clinic at the Jefferson Medical College Hospital only three times were the hands infected. It should have been 7, i. e., about 3 per cent, instead of 3 cases.