tbuckley/cabot-search huggingface dataset:
Racial and ethnic differences in glycemic control of adults with type 2 diabetes.
Authors: M I Harris, R C Eastman, C C Cowie, K M Flegal, M S Eberhardt
Journal: Diabetes Care (1999)

To evaluate glycemic control in a representative sample of U.S. adults with type 2 diabetes.The Third National Health and Nutrition Examination Survey included national samples of non-Hispanic whites, non-Hispanic blacks, and Mexican Americans aged > or = 20 years. Information on medical history and treatment of diabetes was obtained to determine those who had been diagnosed with type 2 diabetes by a physician before the survey (n = 1,480). Fasting plasma glucose and HbA1c were measured, and the frequencies of sociodemographic and clinical variables related to glycemic control were determined.A higher proportion of non-Hispanic blacks were treated with insulin and a higher proportion of Mexican Americans were treated with oral agents compared with non-Hispanic whites, but the majority of adults in each racial or ethnic group (71-83%) used pharmacologic treatment for diabetes. Use of multiple daily insulin injections was more common in whites. Blood glucose self-monitoring was less common in Mexican Americans, but most patients had never self-monitored. HbA1c values in the nondiabetic range were found in 26% of non-Hispanic whites, 17% of non-Hispanic blacks, and 20% of Mexican Americans. Poor glycemic control (HbA1c > 8%) was more common in non-Hispanic black women (50%) and Mexican-American men (45%) compared with the other groups (35-38%), but HbA1c for both sexes and for all racial and ethnic groups was substantially higher than normal levels. Those with HbA1c > 8% included 52% of insulin-treated patients and 42% of those taking oral agents. There was no relationship of glycemic control to socioeconomic status or access to medical care in any racial or ethnic group.These data indicate that many patients with type 2 diabetes in the U.S. have poor glycemic control, placing them at high risk of diabetic complications. Non-Hispanic black women, Mexican-American men, and patients treated with insulin and oral agents were disproportionately represented among those in poor glycemic control. Clinical, public health, and research efforts should focus on more effective methods to control blood glucose in patients with diabetes.
Well shaped ST segment and risk of cardiovascular mortality.
Authors: E. G. Schouten, J. M. Dekker, J. Pool, F. J. Kok, M. L. Simoons
Journal: BMJ (1992)

OBJECTIVE--To investigate the prognostic value of frequently occurring slight variations in the ST segment for cardiovascular mortality in healthy subjects. DESIGN--Follow up study of mortality in relation to variations in ST segment level in a cohort over the 28 years from 1953 to 1981. A case-cohort sampling design was applied to limit the number of electrocardiograms that had to be coded by hand. SETTING--General health examination carried out in 1953 of civil servants in Amsterdam and assessment of subsequent mortality. SUBJECTS--Apparently healthy civil servants aged 40 to 65 years: 1583 men and 1508 women. MAIN OUTCOME MEASURES--Relative risk of variations in ST segment level for mortality from all causes, cardiovascular disease, and coronary heart disease. RESULTS--In men the multivariate relative risks of 15 year mortality from cardiovascular disease and coronary heart disease of slight ST elevation at 80 ms past the J point (compared with isoelectric ST segment) were 0.5 (95% confidence interval 0.3 to 0.9) and 0.4 (0.2 to 0.8), respectively. As expected, ST segment depression (greater than 0.25 mm) was associated with increased risk: 1.9 (1.1 to 3.0) and 2.2 (1.2 to 3.9), respectively. In women associations were weaker. The full 28 year period showed a similar pattern of somewhat weaker associations for men; among women, however, no predictive value was apparent. CONCLUSION--These results are empirical evidence for the intuitive opinion among doctors that a curved, upward sloping ST segment, resulting in slight ST elevation at 80 ms, indicates low risk compared with the isoelectric flat, stretched ST segment.
Surgical implications of the new IASLC/ATS/ERS adenocarcinoma classification
Authors: P.E. Van Schil, H. Asamura, V.W. Rusch, T. Mitsudomi, M. Tsuboi, E. Brambilla, W.D. Travis
Journal: European Respiratory Journal (2011)

A new adenocarcinoma classification was recently introduced by a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS). A distinction is made between pre-invasive lesions, and minimally invasive and invasive adenocarcinoma. The confusing term “bronchioloalveolar carcinoma” is not used any more and new subcategories include adenocarcinoma in situ and minimally invasive adenocarcinoma. Due to a renewed interest in screen-detected nodules and early-stage lung cancers of &lt;2 cm, this classification also has profound implications for thoracic surgeons. In this article, surgical topics are discussed: the role of a minimally invasive approach, especially video-assisted thoracic surgery, limited resection for early-stage lung cancer, the extent of lymph node dissection, the accuracy of intraoperative frozen section analysis, management of multiple lung nodules and prognostic factors in operated patients. Specific key issues are presented based on the current evidence and areas of surgical uncertainty are defined providing a basis for further studies. Thoracic surgeons will play a major role in the application and global introduction of this new adenocarcinoma classification. The remaining controversies regarding the precise diagnosis and management of early-stage lesions will have to be resolved by multidisciplinary and international collaboration.
Can the king's score and apri be used to identify hepatocellular carcinoma in chronic hepatitis C infected patients?
Authors: V. Snowdon, A. Quaglia, P. Harrison, T. Cross
Journal: Gut (2011)

<h3>Introduction</h3> Hepatocellular carcinoma (HCC) is a recognised complication of chronic hepatitis C (CHC) cirrhosis. Currently, cirrhotic patients undergo HCC surveillance using 6 monthly liver ultrasound and serum α-feta protein (AFP) measurement. Yet, up to 40% of HCC patients do not secrete AFP, limiting its utility as a screening tool. There is a need for further tests that identify patients with HCC. The King9s score (KS) and AST-platelet ratio-index (APRI) have been validated to accurately predict cirrhosis in patients with CHC. <h3>Aim</h3> To determine if KS and APRI have utility in identifying patients with HCC. <h3>Methods</h3> A retrospective analysis of CHC patients managed at King9s College Hospital, London between January 2000 and March 2007. The KS ((age × aspartate aminotransferase × international normalised ratio)/platelets) and APRI ((AST/ULN)/platelets ×100) were calculated. Patients with HCC were identified from the CHC database and the diagnostic accuracy of KS and APRI were assessed by area under the ROC curve (AUROC). An AUROC curve ≥0.8 implies that the test has clinical utility. <h3>Results</h3> 702 patients were included in the analysis. 57/702 (8.1%) had HCC. 72.6% of documented genders were male. The genotype was available in 476 patients: Genotype 1 (51.1%), 2 (11.8%), 3 (29.2%), 4 (7.4%), 5 (0.5%) and 6 (0.2%). 204/699 (29.2%) had cirrhosis. The AUROC for predicting HCC for the King9s score was 0.83 (95% CI 0.77 to 0.88, p&lt;0.0001) and for the APRI 0.79 (95% CI 0.73 to 0.85, p&lt;0.0001). A KS of 16.7 had the highest OR of 22.5 (95% CI 8.0 to 63.23) for prediction of HCC. A KS &gt;30 and 50 had ORs for HCC detection of 7.7 (4.2 to 14.2) and 9.3 (5.2 to 16.9) respectively. <h3>Conclusion</h3> The KS has clinical utility in identifying patients with HCC. The optimal cut off was the same as for cirrhosis (≥16.7), but a KS &gt;50 has a greater likelihood of HCC than KS &gt;30 suggesting higher scores are associated with a greater risk of underlying HCC. KS could be incorporated into screening regimens for HCC in CHC infected patients.
Treatment of Idiopathic Membranous Nephropathy
Authors: Meryl Waldman, Howard A. Austin
Journal: Journal of the American Society of Nephrology (2012)

Exciting progress recently has been made in our understanding of idiopathic membranous nephropathy, as well as treatment of this disease. Here, we review important advances regarding the pathogenesis of membranous nephropathy. We will also review the current approach to treatment and its limitations and will highlight new therapies that are currently being explored for this disease including Rituximab, mycophenolate mofetil, and adrenocorticotropic hormone, with an emphasis on results of the most recent clinical trials.
Diagnosis and pharmacological management of Parkinson's disease: summary of SIGN guidelines
Authors: D G Grosset, G J A Macphee, M Nairn
Journal: BMJ (2010)

Parkinson's disease is a common neurodegenerative disease diagnosed in 1% of people aged over 65 years. It has a considerable impact on patients and their families as well as healthcare and social care systems. With an ageing population, the number of cases in Scotland may increase by 30% in the next 25 years.1 Accurate diagnosis can be difficult, particularly at first presentation. As the disease progresses, treatment with complex combinations of drugs often becomes the norm. This article summarises the recommendations from the Scottish Intercollegiate Guideline Network (SIGN) on the diagnosis and drug management of Parkinson's disease.2 SIGN recommendations are based on systematic reviews of best available evidence. The strength of the evidence is graded as A, B, C, or D (fig 1⇓), but the grading does not reflect the clinical importance of the recommendation. Recommended best practice ("good practice points"), based on the clinical experience of the Guideline Development Group, is also indicated (as GPP). Explanation of SIGN grades of recommendations ### Diagnosis
Being open to basics
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2014)

A cardiothoracic surgeon called me recently to discuss publishing a series of articles in JRSM. He wanted short pieces with clear messages. He wanted to take over a whole issue of the journal. I resisted. It isn't in the best interests of readers, I argued. JRSM has a multispecialty readership and it would be unfair to burden these Bohemian souls with a full edition on the performance of cardiothoracic surgeons. His retort, a reasonable one, was that cardiothoracic surgeons have been at the forefront of public engagement with performance data, and that other specialists would be interested. I still resisted, judging that a whole issue devoted to one theme was still too indulgent for a monthly journal.

Perhaps I'm wrong? Perhaps readers would prefer themed issues, like those more often seen in weekly journals, although even weekly journals tend to shy away from full themed issues for the reason I've mentioned. Nonetheless, it might be something to experiment with? A successful themed issue in any journal requires a good idea and a dedicated guest editor. Any readers who fulfil both of those criteria are invited to write in.

This issue, though, is something of a departure, and I'd welcome your feedback. Our clinical review on advances in motor neurone disease explains that the last decade has been one of major improvements in patient care and rapid scientific advances.1 So much so that new therapies now seem possible. Much of this advance is based on genetic discoveries, making genetic as well as risk stratification more feasible. The clinical possibilities of these genetic advances are easily understood, but the departure for JRSM is this month's research paper on the detection of a human endogenous retrovirus protein in human tissues.2 Chen Fei et al. explain that these retroviruses are believed to contribute to human evolution but scientists have struggled to detect them in specific human cells and tissues, a challenge that forms the basis of their JRSM paper. There are no immediate clinical implications of this research. Is it too far removed from the interests of JRSM readers or does opening your mind to a little science nourish and stimulate? I'd welcome your views.

Indeed, science is opening up with the rise of open access journals. Authors and readers need to instantly identify the type of journal that they are either submitting their article to or reading. Is it an open access journal or is it one that retains a traditional publishing model? JRSM has an open access companion publication that caters for articles that JRSM cannot accommodate but are of interest to clinicians. From 2014, the name of this companion journal will change from JRSM Short Reports to JRSM Open to better reflect the opportunities it offers authors for open access publishing. The nature and variety of articles published by JRSM Open will remain unchanged.3
Integrated care for asthma: matching care to the patient
Authors: LM Osman, MI Abdalla, IT Russell, J Fiddes, JA Friend, JS Legge, JG Douglas
Journal: European Respiratory Journal (1996)

The purpose of the present study was to investigate whether criteria associated with assignment of asthma patients between general practice (GP) care alone, integrated care (shared between GP care and hospital clinic) or conventional specialist review could be identified, and whether outcomes for these patients differed over the next 12 months. Seven hundred and sixty four patients with a diagnosis of asthma and previously assigned to either integrated care or clinic care were reviewed after 1 year and reassigned. These patients were then followed for another 12 months and clinical data were collected over this time. After 12 months in clinic care or integrated care, assignment to integrated care was predicted by previous participation in integrated care (OR 2.94), patient preference for integrated care (OR 3.7), no admission (OR 1.56), fewer steroid courses during the previous year (OR 0.88) and nonattendance at review (OR 0.43) in the previous 12 months. Patient discharge to GP care was predicted by higher level of forced expiratory volume in one second (FEV1) (OR 1.49), lower number of GP consultations for troublesome asthma (OR 0.78), and nonattendance for review in the preceding year (OR 2.15). In the following 12 months, the three groups of patients differed significantly in hospital admissions (Discharged = 0.008; Integrated = 0.12; Clinic = 0.31), bronchodilators prescribed (Discharged = 8.5; Integrated = 10.2; Clinic = 13.9), GP consultations (Discharged = 1.3; Integrated = 3.0; Clinic = 4.1) and oral steroid courses (Discharged = 0.62; Integrated = 1.7; Clinic = 2.4). Patients assigned to integrated care, clinic care or discharged to general practice care form three distinct patient populations differing retrospectively and prospectively in morbidity and admission risk. In particular, patients assigned to integrated care fall midway in risk and morbidity between those discharged or those retained in clinic care. These results suggest that integrated care provides general practitioners with a system of management for asthma patients, for whom they do not wish frequent specialist review but who they do not believe can safely be discharged to general practice care only.
Lower sedentary metabolic rate in women compared with men.
Authors: R Ferraro, S Lillioja, A M Fontvieille, R Rising, C Bogardus, E Ravussin
Journal: Journal of Clinical Investigation (1992)

Since females have a greater prevalence of obesity compared with males, the question arises whether females have lower metabolic rate than males after adjusting for differences in body weight and composition. 24-h energy expenditure (24EE), basal metabolic rate (BMR), and sleeping metabolic rate (SMR) were measured in a respiratory chamber in 235 healthy, nondiabetic Caucasian subjects (114 males, 121 females). Body composition was determined by hydrodensitometry. 24EE was 124 +/- 38 kcal/d (P less than 0.002) higher in males than females after adjusting for differences in fat-free mass, fat mass, and age. Spontaneous physical activity was not significantly different between males and females. Since adjusted 24EE was 106 +/- 39 kcal/d (P less than 0.01) higher in females during the luteal phase of the menstrual cycle compared with females during the follicular phase, energy expenditure was analyzed in a subset (greater than 50 yr) to minimize the confounding effect of menstrual status. 24EE (160 +/- 66 kcal/d; P less than 0.03), BMR (116 +/- 45; P less than 0.02), and SMR (208 +/- 68 kcal/d; P less than 0.005) were higher in males compared with females of the older subset after adjusting for differences in body composition, age, and activity. In summary, sedentary 24EE is approximately 5-10% lower in females compared with males after adjusting for differences in body composition, age, and activity.
Tumor necrosis factor alpha and interleukin 1beta are responsible for in vitro myocardial cell depression induced by human septic shock serum.
Authors: A Kumar, V Thota, L Dee, J Olson, E Uretz, J E Parrillo
Journal: The Journal of Experimental Medicine (1996)

Previous studies have demonstrated the presence of myocardial depression in clinical and experimental septic shock. This depression is associated with the presence of a circulating myocardial depressant substance with physical characteristics consistent with cytokines. The present study utilized an in vitro myocardial cell assay to examine the role of various human recombinant cytokines, including tumor necrosis factor (TNF)alpha and interleukin (IL)1beta, in depression of cardiac myocyte contractile function induced by serum from humans with septic shock. The extent and velocity of electrically paced rat cardiac myocytes in tissue culture was quantified by a closed loop video tracking system. Individually, TNF-alpha and IL-1beta each caused significant concentration-dependent depression of maximum extent and peak velocity of myocyte shortening in vitro. In combination, TNF-alpha and IL-1beta induced depression of myocardial cell contractility at substantially lower concentrations consistent with a synergistic effect. Using immunoabsorption, removal of both TNF-alpha and IL-1beta (but not either alone) from the serum of five patients with acute septic shock and marked reversible myocardial depression resulted in elimination of serum myocardial depressant activity. IL-2, -4, -6, -8, -10, and interferon gamma failed to cause significant cardiac myocyte depression over a wide range of concentrations. These data demonstrate that TNF-alpha and IL-1beta cause depression of myocardial cell contraction in vitro and suggest that these two cytokines act synergistically to cause sepsis-associated myocardial depression in humans.
Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis
Authors: Geoff Der, G David Batty, Ian J Deary
Journal: BMJ (2006)

<h3>Abstract</h3> <b>Objective</b> To assess the importance of maternal intelligence, and the effect of controlling for it and other important confounders, in the link between breast feeding and children9s intelligence. <b>Design</b> Examination of the effect of breast feeding on cognitive ability and the impact of a range of potential confounders, in particular maternal IQ, within a national database. Additional analyses compared pairs of siblings from the sample who were and were not breast fed. The results are considered in the context of other studies that have also controlled for parental intelligence via meta-analysis. <b>Setting</b> 1979 US national longitudinal survey of youth. <b>Subjects</b> Data on 5475 children, the offspring of 3161 mothers in the longitudinal survey. <b>Main outcome measure</b> IQ in children measured by Peabody individual achievement test. <b>Results</b> The mother9s IQ was more highly predictive of breastfeeding status than were her race, education, age, poverty status, smoking, the home environment, or the child9s birth weight or birth order. One standard deviation advantage in maternal IQ more than doubled the odds of breast feeding. Before adjustment, breast feeding was associated with an increase of around 4 points in mental ability. Adjustment for maternal intelligence accounted for most of this effect. When fully adjusted for a range of relevant confounders, the effect was small (0.52) and non-significant (95% confidence interval −0.19 to 1.23). The results of the sibling comparisons and meta-analysis corroborated these findings. <b>Conclusions</b> Breast feeding has little or no effect on intelligence in children. While breast feeding has many advantages for the child and mother, enhancement of the child9s intelligence is unlikely to be among them.
Guidelines of the French Society for Digestive Endoscopy (SFED)
Authors: L. Beaugerie
Journal: Endoscopy (2005)

Microscopic colitis is defined as a combination of chronic diarrhea, normal mucosa at colonoscopy, and chronic inflammation of the mucosa at histology 1. Two main histological types of microscopic colitis 2 3 are described: lymphocytic colitis and collagenous colitis. The following histological abnormalities are common to both types of microscopic colitis:- Loss of integrity of the superficial epithelium- Increased numbers of intraepithelial lymphocytes- Infiltration of the lamina propria with inflammatory cells and predominantly mononuclear cells An increase in the thickness of the subepithelial collagen band (> 10 µm when measured) is the hallmark of collagenous colitis. The main characteristics of the two types of microscopic colitis (patient’s general status, possible causes, natural history, response to treatment) are similar. The incidence of both types of microscopic colitis is similar to that of ulcerative colitis and Crohn’s disease 4. In up to 40 % of cases, microscopic colitis starts acutely, like gastroenteritis. Microscopic colitis tends to affect women over 50 years of age, and is often associated with autoimmune disorders (such as celiac disease) or inflammatory disorders (such as rheumatoid polyarthritis). Microscopic colitis is usually idiopathic. Nevertheless, a number of drugs taken on a long-term basis, the list of which is growing steadily, may be responsible for microscopic colitis. In this setting, colitis is reversible when the treatment is discontinued 5. The possible relevance of all long-term treatments taken in patients diagnosed with microscopic colitis must therefore be considered. In addition, it now seems likely that microscopic colitis may be triggered by a bacterial infection, in particular by Yersinia spp. Microscopic colitis is responsible for chronic diarrhea, often of variable intensity, over the whole day, which may not respond to the usual antidiarrheic agents. The patient’s general condition is maintained, but weight loss is possible. The blood hydrosodium balance may be deficient, and hypokalemia is possible. The anatomical and clinical activity of microscopic colitis tends to diminish spontaneously with time. Most cases of lymphocytic colitis and a large number of cases of collagenous colitis tend to have disappeared before the third anniversary of the disorder. Budesonide is the only agent that has been evaluated in placebo-controlled randomized studies for use during the chronic diarrhea phase, when symptomatic treatments are ineffective 6. In more severe and refractory cases, the use of azathioprine 1 or even proctocolectomy with ileoanal anastomosis may be considered.