tbuckley/cabot-search huggingface dataset:
Interventions in Primary Care to Promote Breastfeeding: An Evidence Review for the U.S. Preventive Services Task Force
Authors: Mei Chung
Journal: Annals of Internal Medicine (2008)

Background: Evidence suggests that breastfeeding decreases the risk for many diseases in mothers and infants. It is therefore important to evaluate the effectiveness of breastfeeding interventions. Purpose: To systematically review evidence for the effectiveness of primary care–initiated interventions to promote breastfeeding with respect to breastfeeding and child and maternal health outcomes. Data Sources: Electronic searches of MEDLINE, the Cochrane Central Register of Controlled Trials, and CINAHL from September 2001 to February 2008 and references of selected articles, restricted to English-language publications. Study Selection: Randomized, controlled trials of primary care–initiated interventions to promote breastfeeding, mainly in developed countries. Data Extraction: Characteristics of interventions and comparators, study setting, study design, population characteristics, the proportion of infants continuing breastfeeding by different durations, and infant or maternal health outcomes were recorded. Data Synthesis: Thirty-eight randomized, controlled trials (36 in developed countries) met eligibility criteria. In random-effects meta-analyses, breastfeeding promotion interventions in developed countries resulted in significantly increased rates of short- (1 to 3 months) and long-term (6 to 8 months) exclusive breastfeeding (rate ratios, 1.28 [95% CI, 1.11 to 1.48] and 1.44 [CI, 1.13 to 1.84], respectively). In subgroup analyses, combining pre- and postnatal breastfeeding interventions had a larger effect on increasing breastfeeding durations than either pre- or postnatal interventions alone. Furthermore, breastfeeding interventions with a component of lay support (such as peer support or peer counseling) were more effective than usual care in increasing the short-term breastfeeding rate. Limitations: Meta-analyses were limited by clinical and methodological heterogeneity. Reliable estimates for the isolated effects of each component of multicomponent interventions could not be obtained. Conclusion: Evidence suggests that breastfeeding interventions are more effective than usual care in increasing short- and long-term breastfeeding rates. Combined pre- and postnatal interventions and inclusion of lay support in a multicomponent intervention may be beneficial.
Minimising critical organ irradiation in limited stage Hodgkin lymphoma: a dosimetric study of the benefit of involved node radiotherapy
Authors: B.A. Campbell, C. Hornby, J. Cunninghame, M. Burns, M. MacManus, G. Ryan, E. Lau, J.F. Seymour, A. Wirth
Journal: Annals of Oncology (2011)
Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study
Authors: Paul Little, Martina Dorward, Greg Warner, Katharine Stephens, Jane Senior, Michael Moore
Journal: BMJ (2004)

<h3>Abstract</h3> <b>Objective</b> To assess how pressures from patients on doctors in the consultation contribute to referral and investigation. <b>Design</b> Observational study nested within a randomised controlled trial. <b>Setting</b> Five general practices in three settings in the United Kingdom. <b>Participants</b> 847 consecutive patients, aged 16-80 years. <b>Main outcomes measures</b> Patient preferences and doctors9 perception of patient pressure and medical need. <b>Results</b> Perceived medical need was the strongest independent predictor of all behaviours and confounded all other predictors. The doctors thought, however, there was no or only a slight indication for medical need among a significant minority of those who were examined (89/580, 15%), received a prescription (74/394, 19%), or were referred (27/125, 22%) and almost half of those investigated (99/216, 46%). After controlling for patient preference, medical need, and clustering by doctor, doctors9 perceptions of patient pressure were strongly associated with prescribing (adjusted odds ratio 2.87, 95% confidence interval 1.16 to 7.08) and even more strongly associated with examination (4.38, 1.24 to 15.5), referral (10.72, 2.08 to 55.3), and investigation (3.18, 1.31 to 7.70). In all cases, doctors9 perception of patient pressure was a stronger predictor than patients9 preferences. Controlling for randomisation group, mean consultation time, or patient variables did not alter estimates or inferences. <b>Conclusions</b> Doctors9 behaviour in the consultation is most strongly associated with perceived medical need of the patient, which strongly confounds other predictors. However, a significant minority of examining, prescribing, and referral, and almost half of investigations, are still thought by the doctor to be slightly needed or not needed at all, and perceived patient pressure is a strong independent predictor of all doctor behaviours. To limit unnecessary resource use and iatrogenesis, when management decisions are not thought to be medically needed, doctors need to directly ask patients about their expectations.
Addiction, Molecules and Morality: Disease Does Not Obviate Responsibility
Authors: Peter J. Cohen
Journal: The American Journal of Bioethics (2007)

Click to increase image sizeClick to decrease image size Acknowledgments I thank Cynthia B. Cohen, PhD, JD, Faculty Affiliate, Kennedy Institute of Ethics, Georgetown University for her (always) thoughtful and perceptive comments and suggestions as well as her continued help and encouragement.
Hypersensitivity to bacteria in eczema
Authors: ESTHER WELBOURN, R.H. CHAMPION, W.E. PARISH
Journal: British Journal of Dermatology (1976)

Seven patients with a macroscopic response resembling an Arthus reaction, and occurring 2-4 h after intracutaneous injections of staphylococcal particulate antigens or total staphylococcal extract, were examined for the appropriate specific antibodies that activate complement, and by immunofluorescence for antigen, immunoglobulin and complement in the reaction site. Four of the patients had serum antibody, and skin reactions with the typical features of early Arthus reactions and containing immunoglobulin, complement and antigen. Three patients had apparently 'non-allergic' responses. They lacked appropriate antibody in serum and immunoglobulin deposits in the lesions, though all except one had complement deposits in reaction sites. One of the three nevertheless had histological changes typical of an Arthus response. Lymphocytes teased from the reaction site skin of one patient with a 'non-allergic' 4 h response comprised 35 B cells bearing IgG out of 200 counted. The nature of the 'non-allergic' response reaching a maximum size at about 4 h macroscopically and in some instances microscopically resembling an Arthus response, is still to be determined but it illustrates the caution necessary in interpretation of skin tests with bacterial antigens.
Pseudomonas arthritis treated with parenteral and intra-articular ceftazidime.
Authors: K Walton, R C Hilton, R A Sen
Journal: Annals of the Rheumatic Diseases (1985)

A 73-year-old diabetic presented with septic arthritis of the knee; Pseudomonas aeruginosa was isolated. She was successfully treated with a combination of parenteral and intra-articular ceftazidime, after failure to eradicate the organism with adequate serum levels of gentamicin and full doses of azlocillin.
Explaining differential effects of tiotropium on mortality in COPD
Authors: Brian J Lipworth, Philip M Short
Journal: Thorax (2013)

Explaining differential effects of tiotropium on mortality in COPDThe editorial by Jenkins and Beasley 1 makes a speculative recommendation that tiotropium Respimat should not be prescribed in the treatment of chronic obstructive pulmonary disease (COPD), being primarily based on meta-analysis where mortality was not the primary end point.The meta-analysis by Singh et al 2
Absence of the mdr1a P-Glycoprotein in mice affects tissue distribution and pharmacokinetics of dexamethasone, digoxin, and cyclosporin A.
Authors: A H Schinkel, E Wagenaar, L van Deemter, C A Mol, P Borst
Journal: Journal of Clinical Investigation (1995)

We have previously shown that absence of the mouse mdr1a (also called mdr3) P-glycoprotein in mdr1a (-/-) "knockout" mice has a profound effect on the tissue distribution and elimination of vinblastine and ivermectin, and hence on the toxicity of these compounds. We show here that the mouse mdr1a and the human MDR1 P-glycoprotein actively transport ivermectin, dexamethasone, digoxin, and cyclosporin A and, to a lesser extent, morphine across a polarized kidney epithelial cell layer in vitro. Injection of these radio-labeled drugs in mdr1a (-/-) and wild-type mice resulted in markedly (20- to 50-fold) higher levels of radioactivity in mdr1a (-/-) brain for digoxin and cyclosporin A, with more moderate effects for dexamethasone (2- to 3-fold) and morphine (1.7-fold). Digoxin and cyclosporin A were also more slowly eliminated from mdr1a (-/-) mice. Our findings show that P-glycoprotein can be a major determinant for the pharmacology of several medically important drugs other than anti-cancer agents, especially in the blood-brain barrier. These results may explain a range of pharmacological interactions observed between various drugs in patients.
Community-acquired pneumonia in outpatients: aetiology and outcomes
Authors: Catia Cillóniz, Santiago Ewig, Eva Polverino, Maria Angeles Marcos, Elena Prina, Jacobo Sellares, Miquel Ferrer, Mar Ortega, Albert Gabarrús, Josep Mensa, Antoni Torres
Journal: European Respiratory Journal (2012)

The purpose of this study was to establish the microbial aetiology and outcomes of patients with community-acquired pneumonia (CAP) treated as outpatients after presenting to a hospital emergency care unit. A prospective observational study was carried out in the Hospital Clinic of Barcelona (Barcelona, Spain). All consecutive cases of CAP treated as outpatients were included. 568 adult outpatients with CAP were studied (mean± sd age 47.2±17.6 yrs; 110 (19.4%) were aged ≥65 yrs). Aetiological diagnoses were established in 188 (33.1%) cases. Streptococcus pneumoniae was the most frequent pathogen followed by Mycoplasma pneumoniae and respiratory viruses. Legionella was detected in 13 (2.3%) cases. More than one causative agent was found in 17 (9.0%) patients. Mortality was low (three (0.5%) patients died) and other adverse events were rare (30 (5.2%) patients had complications, 13 (2.3%) were re-admitted and treatment failed in 13 (2.3%)). Complications were mostly related to pleural effusion and empyema, and re-admissions and treatment failures to comorbidities. Outpatients with CAP have a characteristic microbial pattern. Regular antipneumococcal coverage remains mandatory. Treatment failures and re-admissions are rare and may be reduced by increased attention to patients requiring short-term observation in the emergency care unit and in the presence of pleural effusion and comorbidities.
The expressed class II alpha-chain genes of the marsupial major histocompatibility complex belong to eutherian mammal gene families.
Authors: R W Slade, W E Mayer
Journal: Molecular Biology and Evolution (1995)

The major histocompatibility complex (Mhc) is a multigene family found in vertebrates. Mhc genes code for heterodimeric cell-surface molecules involved in presentation of peptides to T-lymphocytes. There are two classes of Mhc, and in eutherian mammals four main families of class II genes have been recognized; DR, DQ, DP, and DN/DO. Each class II family contains genes that code for one or more alpha and beta chains. Do the class II genes of marsupial mammals belong to any of these eutherian mammal class II families? The results to date are conflicting. The expressed class II beta-chain genes could not be satisfactorily assigned to any eutherian class II gene family and were designated as new gene families, while, conversely, a partial sequence of an expressed alpha-chain gene was clearly very similar to the DNA gene of eutherian mammals. The aim of this study was to conduct a more thorough analysis of the alpha-chain genes in a marsupial by obtaining full-length sequences of all the expressed alpha-chain genes in the red-necked wallaby, Macropus rufogriseus. Two class II alpha-chain genes were isolated from a spleen-derived cDNA library, and both have the potential to code for fully functional MHC molecules. Phylogenetic analysis indicated they belonged to previously identified eutherian class II families and are designated as Maru-DRA and Maru-DNA. Northern blot data indicated processed transcript sizes of approximately 1.6 kb for Maru-DRA and approximately 2.5 kb for Maru-DNA and that the latter was expressed at a lower level than the former. The phylogeny shows that the DR, DQ, DP, and DN/DO gene families diverged prior to the divergence of the marsupial and eutherian mammal lineages.
Atrap Deficiency Increases Arterial Blood Pressure and Plasma Volume
Authors: Mona Oppermann, Bernhard Gess, Frank Schweda, Hayo Castrop
Journal: Journal of the American Society of Nephrology (2010)

The angiotensin receptor-associated protein (Atrap) interacts with angiotensin II (AngII) type 1 (AT1) receptors and facilitates their internalization in vitro, but little is known about the function of Atrap in vivo. Here, we detected Atrap expression in several organs of wild-type mice; the highest expression was in the kidney where it localized to the proximal tubule, particularly the brush border. There was no Atrap expression in the renal vasculature or juxtaglomerular cells. We generated Atrap-deficient (Atrap-/-) mice, which were viable and seemed grossly normal. Mean systolic BP was significantly higher in Atrap-/- mice compared with wild-type mice. Dose-response relationships of arterial BP after acute AngII infusion were similar in both genotypes. Plasma volume was significantly higher and plasma renin concentration was markedly lower in Atrap-/- mice compared with wild-type mice. (125)I-AngII binding showed enhanced surface expression of AT1 receptors in the renal cortex of Atrap-/- mice, accompanied by increased carboanhydrase-sensitive proximal tubular function. In summary, Atrap-/- mice have increased arterial pressure and plasma volume. Atrap seems to modulate volume status by acting as a negative regulator of AT1 receptors in the renal tubules.
The Renal Handling of Insulin*
Authors: M. J. Chamberlain, L. Stimmler
Journal: Journal of Clinical Investigation (1967)

The renal handling of insulin was studied by insulin immunoassay in arterial blood, renal venous blood, and urine of fasting patients with normal renal function and in peripheral venous blood and urine of normal subjects and patients with renal disease before and after an oral glucose load. A renal arteriovenous insulin concentration difference of approximately 29% was found and suggests that in normal subjects renal insulin clearance is significantly in excess of glomerular filtration rate. The insulin excreted in the urine of normal individuals at no time exceeded 1.5% of the load filtered at the glomerulus. This contrasts with the finding of a urinary insulin clearance approaching glomerular filtration rate in patients with severely impaired renal tubular function. It is suggested that insulin is normally filtered at the glomerulus and then almost completely reabsorbed or destroyed in the proximal tubule. If reabsorption occurs, as seems more likely, reabsorbed insulin does not return to the renal vein and is presumably utilized in renal metabolism together with insulin taken up directly from the blood. Caution is advised in the use of urinary insulin concentration or excretion as an index of serum insulin level or insulin secretion because a very small and variable proportion of filtered insulin appears in the urine in normal subjects, and major changes in urinary insulin excretion may arise as a result of minor tubular defects.
Continuous short-wave (radio-frequency) diathermy.
Authors: G C Goats
Journal: British Journal of Sports Medicine (1989)

Continuous shortwave diathermy is the technique of choice when uniform marked elevation of temperature is required in the deep tissues. This heating can be targeted accurately by using an appropriate applicator positioned correctly. SWD also allows superficial structures to be heated selectively, although for this the various methods of surface heating are usually preferable. Sub-acute or chronic conditions respond best to continuous shortwave diathermy which, when used properly, can be as effective as ultrasound. Acute lesions are better treated with pulsed shortwave diathermy. Continuous shortwave diathermy can help to relieve pain and muscle spasm, resolve inflammatory states and reduce swelling, promote vasodilation, increase the compliance of connective tissue, increase joint range and decrease joint stiffness.
Markedly Blunted Metabolic Effects of Fructose in Healthy Young Female Subjects Compared With Male Subjects
Authors: Caroline Couchepin, Kim-Anne Lê, Murielle Bortolotti, Joana Amarante da Encarnaçao, Jean-Baptiste Oboni, Christel Tran, Philippe Schneiter, Luc Tappy
Journal: Diabetes Care (2008)

OBJECTIVE—To compare the metabolic effects of fructose in healthy male and female subjects. RESEARCH DESIGN AND METHODS—Fasting metabolic profile and hepatic insulin sensitivity were assessed by means of a hyperglycemic clamp in 16 healthy young male and female subjects after a 6-day fructose overfeeding. RESULTS—Fructose overfeeding increased fasting triglyceride concentrations by 71 vs. 16% in male vs. female subjects, respectively (P &amp;lt; 0.05). Endogenous glucose production was increased by 12%, alanine aminotransferase concentration was increased by 38%, and fasting insulin concentrations were increased by 14% after fructose overfeeding in male subjects (all P &amp;lt; 0.05) but were not significantly altered in female subjects. Fasting plasma free fatty acids and lipid oxidation were inhibited by fructose in male but not in female subjects. CONCLUSIONS—Short-term fructose overfeeding produces hypertriglyceridemia and hepatic insulin resistance in men, but these effects are markedly blunted in healthy young women.
Systemic inflammation and lung function in young adults
Authors: R. J Hancox, R. Poulton, J. M Greene, S. Filsell, C. R McLachlan, F. Rasmussen, D R. Taylor, M. J A Williams, A. Williamson, M. R Sears
Journal: Thorax (2007)

<h3>Background:</h3> Impaired lung function is associated with systemic inflammation and is a risk factor for cardiovascular disease in older adults. It is unknown when these associations emerge and to what extent they are mediated by smoking, chronic airways disease, and/or established atherosclerosis. We explored the association between the forced expiratory volume in one second (FEV<sub>1</sub>) and the systemic inflammatory marker C-reactive protein (CRP) in young adults. <h3>Methods:</h3> Associations between spirometric lung function and blood CRP were assessed in a population based birth cohort of approximately 1000 New Zealanders at ages 26 and 32 years. Analyses adjusted for height and sex to account for differences in predicted lung function and excluded pregnant women. <h3>Results:</h3> There were significant inverse associations between FEV<sub>1</sub> and CRP at both ages. Similar results were found for the forced vital capacity. These associations were similar in men and women and were independent of smoking, asthma, and body mass index. <h3>Conclusions:</h3> Reduced lung function is associated with systemic inflammation in young adults. This association is not related to smoking, asthma, or obesity. The reasons for the association are unexplained, but the findings indicate that the association between lower lung function and increased inflammation predates the development of either chronic lung disease or clinically significant atherosclerosis. The association between poor lung function and cardiovascular disease may be mediated by an inflammatory mechanism.
Pilot Study of Concurrent Etoposide and Cisplatin Plus Accelerated Hyperfractionated Thoracic Radiotherapy Followed by Irinotecan and Cisplatin for Limited-Stage Small Cell Lung Cancer: Japan Clinical Oncology Group 9903
Authors: Kaoru Kubota, Yutaka Nishiwaki, Takahiko Sugiura, Kazumasa Noda, Kiyoshi Mori, Masaaki Kawahara, Shunichi Negoro, Koshiro Watanabe, Fumio Imamura, Tomohide Tamura, Nagahiro Saijo
Journal: Clinical Cancer Research (2005)

Abstract Purpose: Irinotecan and cisplatin (IP) significantly improved survival compared with etoposide and cisplatin (EP), in patients with extensive-stage small cell lung cancer (SCLC) in a previous Japan Clinical Oncology Group (JCOG) randomized trial. JCOG9903 was conducted to evaluate the safety of sequentially given IP following concurrent EP plus twice-daily thoracic irradiation (TRT) for the treatment of limited-stage SCLC (LSCLC). Experimental Design: Between October 1999 and July 2000, 31 patients were accrued from 10 institutions. Thirty patients were assessable for toxicity, response, and survival. Treatment consisted of etoposide 100 mg/m2 on days 1 to 3, cisplatin 80 mg/m2 on day 1, and concurrent twice-daily TRT of 45 Gy beginning on day 2. The IP regimen started on day 29 and consisted of irinotecan 60 mg/m2 on days 1, 8, and 15 and cisplatin 60 mg/m2 on day 1, with three 28-day cycles. Results: There were no treatment-related deaths. The response rate was 97% (complete response, 37%; partial response, 60%). Median overall survival was 20.2 months; 1-, 2-, and 3-year survival rates were 76%, 41%, and 38%, respectively. Of the 24 patients who started the IP regimen, 22 received two or more cycles. Hematologic toxicities of grade 3 or 4 included neutropenia (67%), anemia (50%), and thrombocytopenia (4%). Nonhematologic toxicities of grade 3 or 4 included diarrhea (8%), vomiting (8%), and febrile neutropenia (8%). Of the 20 patients with recurrence, none had local recurrence alone and only two had both local and distant metastasis as the initial sites of disease progression. Conclusions: IP following concurrent EP plus twice-daily TRT is safe with acceptable toxicities. A randomized phase III trial comparing EP with IP following EP plus concurrent TRT for LSCLC is ongoing (JCOG0202).
Management of occupational asthma: cessation or reduction of exposure? A systematic review of available evidence
Authors: O. Vandenplas, H. Dressel, D. Wilken, J. Jamart, D. Heederik, P. Maestrelli, T. Sigsgaard, P. Henneberger, X. Baur
Journal: European Respiratory Journal (2011)

Reduction of exposure to sensitising agents causing occupational asthma has been proposed as an alternative to total avoidance in order to minimise the adverse socio-economic impact of the condition. The aim of this systematic review was to compare the effects of these two management options on asthma and socio-economic outcomes. A bibliographic search was conducted to identify studies examining the outcome of workers with occupational asthma after reduction or cessation of exposure to the causal agent. The changes in asthma symptoms and nonspecific bronchial hyperresponsiveness after reduction or cessation of exposure were described in nine and five studies, respectively. The meta-analysis of pooled data showed that a reduction of exposure was associated with a lower likelihood of improvement (OR 0.16, 95% CI 0.03–0.91) and recovery (OR 0.30, 95% CI 0.11–0.84) of asthma symptoms and a higher risk of worsening of the symptoms (OR 10.23, 95% CI 2.97–35.28) and nonspecific bronchial hyperresponsiveness (OR 5.65, 95% CI 1.11–28.82), compared with complete avoidance of exposure. This systematic review indicates that reduction of exposure cannot be routinely recommended as an alternative to cessation of exposure in the management of occupational asthma. However, further investigations are required before drawing evidence-based conclusions on the cost-effectiveness of this approach.