tbuckley/cabot-search huggingface dataset:
THE ROLE OF THE PSYCHIATRIST IN TEACHING COMPREHENSIVE MEDICAL CARE
Authors: DONALD C. GREAVES
Journal: American Journal of Psychiatry (1957)

The concept of a Comprehensive Care Clinic, to which consultants in the medical specialities are attached, is relatively new. The part of such programs that is unique, and has the greatest implication for medical education in general and psychiatric education in particular, is the functioning of the student as a family physician for a period (22½ weeks in the Cornell program, 32 weeks in the Oklahoma program). Such an experience probably parallels the practice of medicine as nearly as is possible during medical school. The importance of psychiatric participation in such a program is obvious and is firmly established. Since it is so firmly established, there is no need for the psychiatrist to be apologetic about his contribution, and there is no excuse for his allowing it to become a student elective. The medical educator, regardless of his particular field of interest, has the obligation to train physicians in the best way possible. Part of this obligation is to make his subject matter palatable and attractive, but an equally important part is to see that his teaching reaches and is assimilated by all students under his charge, whether or not the individual student expects to find the subject matter interesting or worthwhile. Possibly there is a place in undergraduate psychiatric education for group psychotherapeutic experiences which are designed to break down the student's resistances, but it can in no way replace organized instruction for which students are held responsible. It is too early to evaluate completely comprehensive care and training programs and the role such programs should play in the training of physicians. The conclusion of most of those who have participated in them is that they are training better physicians, and as a direct result of this training, leading to better and more complete medical care of patients. Where these experiences are used as a guide to future programs in other schools, it should be emphasized that fulltime psychiatric participation in the planning and execution is absolutely necessary in achieving the desired goals. The psychiatrist can function in a number of specific ways within the clinic setting. He can be available as a consultant for the individual student and his patient, and this will be an important part of his activities. In addition, the curriculum should be so organized that the psychiatrist has time and opportunity to reach all the students. Regularly scheduled seminars with small groups of students, and active participation in the home care program, in my experience are 2 of the most successful means of achieving this goal.
Estrogen Receptor α and Endothelial Nitric Oxide Synthase Are Organized Into a Functional Signaling Module in Caveolae
Authors: Ken L. Chambliss, Ivan S. Yuhanna, Chieko Mineo, Pingsheng Liu, Zohre German, Todd S. Sherman, Michael E. Mendelsohn, Richard G. W. Anderson, Philip W. Shaul
Journal: Circulation Research (2000)

Abstract —Estrogen causes nitric oxide (NO)-dependent vasodilation due to estrogen receptor (ER) α-mediated, nongenomic activation of endothelial NO synthase (eNOS). The subcellular site of interaction between ERα and eNOS was determined in studies of isolated endothelial cell plasma membranes. Estradiol (E 2 , 10 –8 mol/L) caused an increase in eNOS activity in plasma membranes in the absence of added calcium, calmodulin, or eNOS cofactors, which was blocked by ICI 182,780 and ERα antibody. Immunoidentification studies detected the same 67-kDa protein in endothelial cell nucleus, cytosol, and plasma membrane. Plasma membranes from COS-7 cells expressing eNOS and ERα displayed ER-mediated eNOS stimulation, whereas membranes from cells expressing eNOS alone or ERα plus a myristoylation-deficient mutant eNOS were insensitive. Fractionation of endothelial cell plasma membranes revealed ERα protein in caveolae, and E 2 caused stimulation of eNOS in isolated caveolae that was ER-dependent; noncaveolae membranes were insensitive. Acetylcholine and bradykinin also activated eNOS in isolated caveolae. Furthermore, the effect of E 2 on eNOS in caveolae was prevented by calcium chelation. Thus, a subpopulation of ERα is localized to endothelial cell caveolae where they are coupled to eNOS in a functional signaling module that may regulate the local calcium environment. The full text of this article is available at http://www.circresaha.org.
Activation of Hepatic Stem Cell Marker EpCAM by Wnt–β-Catenin Signaling in Hepatocellular Carcinoma
Authors: Taro Yamashita, Anuradha Budhu, Marshonna Forgues, Xin Wei Wang
Journal: Cancer Research (2007)

Abstract The heterogeneous nature of hepatocellular carcinoma (HCC) and the lack of appropriate biomarkers have hampered patient prognosis and treatment stratification. Using a gene expression profiling approach, we recently identified a novel prognostic HCC subtype that resembles hepatic progenitor cells with the activation of stem cell markers and Wnt–β-catenin signaling, based on EpCAM (epithelial cell adhesion molecule, a hepatic stem cell marker) expression. In this study, we investigated whether the activation of the Wnt–β-catenin pathway regulates EpCAM expression. We found that nuclear accumulation of β-catenin induced, whereas the degradation of β-catenin or inhibition of Tcf/β-catenin complex formation reduced EpCAM gene expression in cultured normal human hepatocytes and HCC cell lines. We identified two Tcf binding elements in the EpCAM promoter that specifically bound to Tcf-4 in an electrophoretic mobility shift assay. EpCAM promoter luciferase activity was down-regulated by the degradation of β-catenin or inhibition of Tcf/β-catenin complex formation. Furthermore, we found that EpCAM-positive HCC is much more sensitive to Tcf/β-catenin binding inhibitors than EpCAM-negative HCC in vitro. Taken together, our data indicate that EpCAM is a Wnt–β-catenin signaling target gene and may be used to facilitate HCC prognosis by enabling effective stratification of patients with predicted pharmacologic responses to Wnt–β-catenin signaling antagonists. [Cancer Res 2007;67(22):10831–9]
Bone marrow biopsy imprints (touch preparations) for assessment of iron stores
Authors: Donald Pasquale, G. Chikkappa
Journal: American Journal of Hematology (1995)

Abstract Noninvasive evaluation for iron deficiency is compromised in many individuals due to the presence of chronic inflammatory processes and/or malignancy, thus necessitating bone marrow examination for definitive diagnosis. However, bone marrow aspiration is not obtainable or is inadequate for interpretation (dry tap) in some individuals, and decalcified bone marrow biopsies require 24‐48 hr to prepare, and may falsely indicate absence of iron. We evaluated the accuracy of bone marrow biopsy imprints (touch preparations) compared with aspirate particle smears for semiquantitation of bone marrow iron stores. Results indicate that Prussian blue‐stained bone marrow biopsy imprints accurately reflect the quantity of iron, compared with bone marrow aspirate particle smears, allowing for rapid determination of iron stores in individuals in whom a bone marrow aspirate cannot be obtained. © 1995 Wiley‐Liss, Inc.
Positron Emission Tomography/Computed Tomography Identification of Clear Cell Renal Cell Carcinoma: Results From the REDECT Trial
Authors: Chaitanya R. Divgi, Robert G. Uzzo, Constantine Gatsonis, Roman Bartz, Silke Treutner, Jian Qin Yu, David Chen, Jorge A. Carrasquillo, Steven Larson, Paul Bevan, Paul Russo
Journal: Journal of Clinical Oncology (2012)

A clinical study to characterize renal masses with positron emission tomography/computed tomography (PET/CT) was undertaken. This was an open-label multicenter study of iodine-124 ((124)I) -girentuximab PET/CT in patients with renal masses who were scheduled for resection. PET/CT and contrast-enhanced CT (CECT) of the abdomen were performed 2 to 6 days after intravenous (124)I-girentuximab administration and before resection of the renal mass(es). Images were interpreted centrally by three blinded readers for each imaging modality. Tumor histology was determined by a blinded central pathologist. The primary end points-average sensitivity and specificity for clear cell renal cell carcinoma (ccRCC)-were compared between the two modalities. Agreement between and within readers was assessed. (124)I-girentuximab was well tolerated. In all, 195 patients had complete data sets (histopathologic diagnosis and PET/CT and CECT results) available. The average sensitivity was 86.2% (95% CI, 75.3% to 97.1%) for PET/CT and 75.5% (95% CI, 62.6% to 88.4%) for CECT (P = .023). The average specificity was 85.9% (95% CI, 69.4% to 99.9%) for PET/CT and 46.8% (95% CI, 18.8% to 74.7%) for CECT (P = .005). Inter-reader agreement was high (κ range, 0.87 to 0.92 for PET/CT; 0.67 to 0.76 for CECT), as was intrareader agreement (range, 87% to 100% for PET/CT; 73.7% to 91.3% for CECT). This study represents (to the best of our knowledge) the first clinical validation of a molecular imaging biomarker for malignancy. (124)I-girentuximab PET/CT can accurately and noninvasively identify ccRCC, with potential utility for designing best management approaches for patients with renal masses.
Role of Science in the Treatment of Breast Cancer When Tumor Multicentricity is Present
Authors: B. Fisher
Journal: JNCI Journal of the National Cancer Institute (2011)

During the past 100 years, there have been two major controversies with regard to the treatment of primary breast cancer. The first controversy, which occurred approximately 35 years ago, questioned the performance of radical mastectomy, as originally proposed by Halsted in the 1890s. That controversy was resolved by the use of laboratory and clinical research, hypothesis formulation, and evaluation of the efficacy of the latter through the conduct of randomized clinical trials. A second major controversy arose when magnetic resonance imaging began to detect the presence of tumor multicentricity in many breast cancer patients, resulting in a resurgence in mastectomy in women who could have been treated with breast-preserving surgery. Because the use of science resolved the first controversy, I investigated whether there was scientific evidence to justify the current reversion to mastectomy. Extensive examination of the vast amount of recent medical literature related to that subject, that is, individual articles, review articles, and reports from the use of clinical trials, demonstrated that many physicians are not familiar with the scientific method, and thus, were unable to present, in those articles, credible evidence to support mastectomy in the presence of tumor cell multicentricity. Aside from the randomized clinical trial conducted by the National Surgical Adjuvant Breast and Bowel Project begun in 1976, which demonstrated no statistically significant difference in disease-free survival, distant disease-free survival, and overall survival between mastectomy and lumpectomy with or without radiation therapy, there has been no information in any of the few recently conducted studies involving multicentricity to justify the current resurgence in mastectomy.
Empyema of the gall bladder.
Authors: R A Gonzaga
Journal: Gut (1984)

Empyema of the gall bladder Sir, The excellent article written by Dr Thornton and colleagues about empyema of the gall bladder (Gut 1983; 24: 1183-5) raises the problem of distinguishing cholecystitis from gall bladder empyema.The whitish, purulent-like fluid often found in a gall bladder with cholecystitis, composed of calcium and bilirubin precipitates, debris, and a few white blood cells, often with bacteria, is not very different from pus collected from a gall bladder with empyema, which often contains remarkably few
Comment on: Morbidity and mortality associated with the restrictive spirometric pattern: a longitudinal study
Authors: S. Scarlata, C. Pedone, F. L. Fimognari, V. Bellia, F. Forastiere, R. A. Incalzi
Journal: Thorax (2010)

We read with interest the paper by Guerra et al 1 profiling the demographic/clinical characteristics and prospectively assessing the prognosis of subjects with a restrictive spirometric pattern enrolled in the TESAOD population-based study. The manuscript has the merit of following up a large number of patients for 14 years and investigating how selected co-morbidities are relevant to survival.2

The results of this study deserve comparison with those published in 2008 by our research group on 1265 subjects aged 65–97 years.3 First, in an older population (mean age 73.4 …
The Lessons of SARS
Authors: Ezekiel J. Emanuel
Journal: Annals of Internal Medicine (2003)

Given the low mortality and morbidity of the severe acute respiratory syndrome (SARS) compared with other public health scourges, is the attention devoted to it misdirected? The SARS experience has provided at least 4 enduring lessons. First, by providing a test of the capacity of each part of the public health system, from national to local and hospital responses, it has better prepared the world for the anticipated and much-feared next real pandemic. Second, SARS has reemphasized that from housing, sexual practices, and slaughtering techniques to health care capacity, the situation in other, especially developing, countries affects us. Global cooperation is necessary not only for justice but to ensure our own health. Third, despite trends toward commercialization, easier lives, and self-centered individualism, the response of health care professionals to SARS reaffirmed dedication to caring for the sick even at great personal risks as the core ethical principle of medicine. Finally, SARS also emphasized the importance of the duty of health care administrators and senior physicians to rapidly institute procedures to maximize the safety of frontline physicians and nurses. These lessons will be valuable far beyond the SARS episode.
Overview of the 2007 Food and Drug Administration Circulatory System Devices Panel Meeting on Patent Foramen Ovale Closure Devices
Authors: Tina L. Pinto Slottow, Daniel H. Steinberg, Ron Waksman
Journal: Circulation (2007)

Patent foramen ovales (PFOs) are common congenital cardiac defects that are more prevalent among patients experiencing cryptogenic stroke than among those with strokes of known origin. Medical treatment for these processes is often considered inadequate, and mechanical closure of the PFO is an attractive, albeit controversial, alternative. Although it is plausible that percutaneous PFO closure will reduce the rate of recurrent stroke in these patients, randomized trials examining the efficacy of devices in this setting have not been completed. In 2007, the Food and Drug Administration convened a meeting of the Circulatory System Devices Panel to discuss the necessity of randomized trials, as well as obstacles to trial enrollment and completion.
Does This Patient With a Pericardial Effusion Have Cardiac Tamponade?
Authors: Christopher L. Roy, Melissa A. Minor, M. Alan Brookhart, Niteesh K. Choudhry
Journal: JAMA (2007)

Cardiac tamponade is a state of hemodynamic compromise resulting from cardiac compression by fluid trapped in the pericardial space. The clinical examination may assist in the decision to perform pericardiocentesis in patients with cardiac tamponade diagnosed by echocardiography.To systematically review the accuracy of the history, physical examination, and basic diagnostic tests for the diagnosis of cardiac tamponade.MEDLINE search of English-language articles published between 1966 and 2006, reference lists of these articles, and reference lists of relevant textbooks.We included articles that compared aspects of the clinical examination to a reference standard for the diagnosis of cardiac tamponade. We excluded studies with fewer than 15 patients. Of 787 studies identified by our search strategy, 8 were included in our final analysis.Two authors independently reviewed articles for study results and quality. A third reviewer resolved disagreements.All studies evaluated patients with known tamponade or those referred for pericardiocentesis with known effusion. Five features occur in the majority of patients with tamponade: dyspnea (sensitivity range, 87%-89%), tachycardia (pooled sensitivity, 77%; 95% confidence interval [CI], 69%-85%), pulsus paradoxus (pooled sensitivity, 82%; 95% CI, 72%-92%), elevated jugular venous pressure (pooled sensitivity, 76%; 95% CI, 62%-90%), and cardiomegaly on chest radiograph (pooled sensitivity, 89%; 95% CI, 73%-100%). Based on 1 study, the presence of pulsus paradoxus greater than 10 mm Hg in a patient with a pericardial effusion increases the likelihood of tamponade (likelihood ratio, 3.3; 95% CI, 1.8-6.3), while a pulsus paradoxus of 10 mm Hg or less greatly lowers the likelihood (likelihood ratio, 0.03; 95% CI, 0.01-0.24).Among patients with cardiac tamponade, a minority will not have dyspnea, tachycardia, elevated jugular venous pressure, or cardiomegaly on chest radiograph. A pulsus paradoxus greater than 10 mm Hg among patients with a pericardial effusion helps distinguish those with cardiac tamponade from those without. Diagnostic certainty of the presence of tamponade requires additional testing.
National imperatives could override local priorities of health and wellbeing boards, survey indicates
Authors: A. O'Dowd
Journal: BMJ (2012)

The new bodies that will bring together the NHS, public health, and local authorities to coordinate health services in England could be the perfect catalyst for integrated care, claims a leading health think tank.

However, fears have been raised that budgets for the new health and wellbeing boards could be too small and that their locally agreed priorities could be overruled by national imperatives.

The King’s Fund published a report on Thursday 12 April about the progress so far of shadow health and wellbeing boards across England, which shows that the people involved are generally positive about the future role of the boards.

The report, which is based on interviews with 50 local authorities across England and detailed case studies …
Drugs' rapid payoffs distort evaluation of their instrumental uses
Authors: George Ainslie
Journal: Behavioral and Brain Sciences (2011)

Abstract Science has needed a dispassionate valuation of psychoactive drugs, but a motivational analysis should be conducted with respect to long-term reward rather than reproductive fitness. Because of hyperbolic overvaluation of short-term rewards, an individual's valuation depends on the time she forms it and the times she will revisit it, sometimes making her best long-term interest lie in total abstinence.
Expression of Apoptosis-Related Genes and Proteins in Experimental Chronic Renal Scarring
Authors: BIN YANG, TIMOTHY S. JOHNSON, GRAHAM L. THOMAS, PHILIP F. WATSON, BART WAGNER, NICHOLAS J. SKILL, JOHN L. HAYLOR, A. MEGUID EL NAHAS
Journal: Journal of the American Society of Nephrology (2001)

Abstract. Apoptosis has been proposed to play an important role in the progression of renal scarring. The mechanisms that determine whether a cell enters the apoptotic program are complex. Bax and Bcl-2 are recognized modulators of this event; their relative levels determine the fate of cells. A role for apoptosis in the progression of renal scarring in the remnant kidneys of rats submitted to subtotal nephrectomy (SNx) has been described. This study investigated the expression (protein and mRNA) of Bax and Bcl-2 in remnant kidneys between day 7 and day 120 post-SNx. Northern blot analysis showed that bax mRNA was increased in remnant kidneys from day 7 (150% of control; P &lt; 0.05), whereas bcl-2 mRNA was decreased from day 15 (23% of control; P &lt; 0.05) resulting in a 14-fold increase in the ratio of bax to bcl-2 mRNA by day 120. Western blot analysis showed similar changes in Bax and Bcl-2 protein in remnant kidneys, resulting in a 147-fold increase in the ratio of Bax to Bcl-2 on day 120. Immunohistochemistry showed increases in Bax to be located predominantly in tubules in SNx kidneys. Interstingly, Bcl-2 immunostaining increased in some epithelial cells within atrophic tubules despite the overall decrease in Bcl-2 protein and mRNA. The overall renal apoptotic cells correlated closely with the ratio of bax to bcl-2 at both the mRNA and protein levels ( r = 0.594 and 0.308, respectively; P &lt; 0.05). Furthermore, tubular apoptosis correlated positively with the mRNA level of bax ( r = 0.471; P &lt; 0.01) and negatively with the mRNA and protein levels of bcl-2 ( r = -0.443 and -0.607, respectively; P &lt; 0.01). The increase in the ratio of the death inducer (Bax) to the death repressor (Bcl-2) at the mRNA and protein levels may control the apoptosis associated with the progression of tubular atrophy and chronic renal fibrosis within remnant rat kidneys. These observations may have prognostic and therapeutic implications in chronic renal failure.
Metabolic enzyme activity in the quadriceps femoris muscle in patients with severe chronic obstructive pulmonary disease.
Authors: J Sauleda, F J García-Palmer, A Palou, A G Agusti
Journal: American Journal of Respiratory and Critical Care Medicine (1995)

"Metabolic enzyme activity in the quadriceps femoris muscle in patients with severe chronic obstructive pulmonary disease.." American journal of respiratory and critical care medicine, 152(3), pp. 1137–1138
The Phylogenetic Position of the Talpidae Within Eutheria Based on Analysis of Complete Mitochondrial Sequences
Authors: Suzette K. Mouchaty, Anette Gullberg, Axel Janke, Ulfur Arnason
Journal: Molecular Biology and Evolution (2000)

The complete mitochondrial (mt) genome of the mole Talpa europaea was sequenced and included in phylogenetic analyses together with another lipotyphlan (insectivore) species, the hedgehog Erinaceus europaeus, and 22 other eutherian species plus three outgroup taxa (two marsupials and a monotreme). The phylogenetic analyses reconstructed a sister group relationship between the mole and the fruit bat Artibeus jamaicensis (order Chiroptera). The Talpa/Artibeus clade constitutes a sister clade of the cetferungulates, a clade including Cetacea, Artiodactyla, Perissodactyla, and Carnivora. A monophyletic relationship between the hedgehog and the mole was significantly rejected by maximum parsimony and maximum likelihood. Consistent with current systematic schemes, analyses of complete cytochrome b genes including the shrew Sorex araneus (family Soricidae) revealed a close relationship between Talpidae and Soricidae. The analyses of complete mtDNAs, along with the findings of other insectivore studies, challenge the maintenance of the order Lipotyphla as a taxonomic unit and support the elevation of the Soricomorpha (with the families Talpidae and Soricidae and possibly also the Solenodontidae and Tenrecidae) to the level of an order, as previously proposed in some morphological studies.