tbuckley/cabot-search huggingface dataset:
Managing seizures in the casualty department
Authors: M S Christian
Journal: BMJ (1990)

factors may affect the myocyte but challenges the idea that a chronic defect of the mvocvte is a common feature.The authors also state that mortality is greater than two fifths within two years of diagnosis of dilated cardiomyopathy.That figure depends critically on the time of referral and on the circumstances in which patients reach the attention of investigators.In the Framingham study' the mortality from heart failure of any cause was 500,) at four years.In patients with heart failure due to viral myocarditis the prognosis is considerably better.5Conventional treatment is said to make "very little difference to survival."'Conventional treat- ment is primarily with diuretics to prevent ac- cumulation of fluid but is unlikely to be subjected to a clinical trial with an end point of survival.The report of the cooperative north Scandinavian enalapril survival study (CONSENSUS) showed that angiotensin converting enzyme inhibitors were beneficial in severe heart failure, but only 15% of the patients studied had cardiomyopathy.Over 50O of patients studied in a Veterans Ad- ministration cooperative trial of vasodilator drugs in chronic congestive heart failure' lacked coronary artery disease, and statistical analysis did not confirm a differential effect in those with and those without coronary heart disease.These data suggest that angiotensin converting enzyme inhibitors are of some benefit in cardiomyopathy, even if the evidence falls short of definitive proof.Arrhythmias are common in heart failure, and Dr Caforio and colleagues imply that treating ventricular tachycardia might be advantageous.The only controlled trial reported' studied patients taking amiodarone, which had no effect on mortality.4Furthermore, the terminal rhythm in most patients with severe heart failure due to idiopathic dilated cardiomyopathy appears to be asystole,"' not ventricular tachycardia, in contrast to that in patients with atheromatous ischaemic heart disease.
Brain tumor stem cells maintain overall phenotype and tumorigenicity after in vitro culturing in serum-free conditions
Authors: Einar Osland Vik-Mo, Cecilie Sandberg, Havard Olstorn, Mercy Varghese, Petter Brandal, Jon Ramm-Pettersen, Wayne Murrell, Iver Arne Langmoen
Journal: Neuro-Oncology (2010)

Traditional in vitro culturing of tumor cells has been shown to induce changes so that cultures no longer represent the tumor of origin. Serum-free culturing conditions are used in a variety of cancers to propagate stem-like cells in vitro. Limited reports, however, exist on the effects of such propagation. We have compared cells from brain tumor biopsies cultivated under serum-free conditions at passages 2 and 10 to describe the effects of in vitro culturing. We were able to establish cell lines from 7 of 10 biopsies from patients with glioblastoma. The cell lines adapted to conditions and had 2.2 times increased population doubling rate at later passages. Karyotyping and comparative genomic hybridization analysis revealed that all examined cell lines had cytogenetic aberrations commonly found in glioblastomas, and there were only minor differences between tumor and early and late passages in the same culture. Whole-transcriptome analysis shows that tumors had interindividual differences. Changes in the overall expression patterns through passaging were modest, with a significant change in only 14 genes; the variation among cultures was, however, reduced through passages. The ability to differentiate differed among tumors but was maintained throughout passaging. The cells initiated tumors upon transplantation to immunodeficient mice with differing phenotypes, but a given cell culture maintained tumor phenotype after serial cultivation. The cultures established maintained individual characteristics specific to culture identity. Thus, each cell culture reflects an image of the tumor—or a personalized model—from which it was derived and remains representative after moderate expansion.
Detection of HIV DNA in Cervical and Vaginal Secretions
Authors: D B Clemetson, G B Moss, D M Willerford, M Hensel, W Emonyi, K K Holmes, F Plummer, J Ndinya-Achola, P L Roberts, S Hillier
Journal: JAMA (1993)

<h3>Objective.</h3> —Factors that influence heterosexual transmission of the human immunodeficiency virus (HIV), including sexually transmitted diseases, contraceptive practices, sexual practices, HIV-related immunosuppression, and presence of cervical ectopy and the penile foreskin, have been identified through cross-sectional and prospective cohort epidemiologic studies. To more directly characterize factors that influence infectivity, we conducted a study of HIV shedding from the genital tract in women. <h3>Design.</h3> —Ninety-seven HIV-seropositive women attending a sexually transmitted disease clinic in Nairobi, Kenya, completed a questionnaire and underwent a physical examination and an evaluation for sexually transmitted diseases. Cervical and vaginal secretions were obtained for HIV DNA detection using polymerase chain reaction amplification. <h3>Results.</h3> —Human immunodeficiency virus DNA was detected by polymerase chain reaction in 28 (33%) of 84 cervical samples and 13 (17%) of 77 vaginal samples. The prevalence of HIV was higher in specimens from the endocervix than from the vaginal wall (<i>P</i>=.002), and there was no correlation between presence of virus at the two sites. After adjusting for age, cervical HIV shedding was independently associated with oral contraceptive pill use (odds ratio [OR], 11.6; 95% confidence interval [CI], 1.7 to 77.6), cervical mucopus (OR, 6.2; 95% CI, 0.9 to 41.4;<i>P</i>=.05), cervical ectopy (OR, 5.0; 95% CI, 1.5 to 16.9), and pregnancy (OR, 4.5; 95% CI, 1.2 to 16.3). <h3>Conclusions.</h3> —Human immunodeficiency virus was detected in one third of cervical samples and one sixth of vaginal samples. The presence of HIV DNA in cervical secretions was significantly associated with oral contraceptive pill use, cervical ectopy, and pregnancy. There was a marginally significant association with cervical mucopus. The identification of factors that increase the infectivity of women suggests potential strategies for reducing heterosexual transmission of HIV. (<i>JAMA</i>. 1993;269:2860-2864)
American Society of Clinical Oncology Policy Statement: Opportunities in the Patient Protection and Affordable Care Act to Reduce Cancer Care Disparities
Authors: Beverly Moy, Blase N. Polite, Michael T. Halpern, Steven K. Stranne, Eric P. Winer, Dana S. Wollins, Lisa A. Newman
Journal: Journal of Clinical Oncology (2011)

Patients in specific vulnerable population groups suffer disproportionately from cancer. The elimination of cancer disparities is critically important for lessening the burden of cancer. The Patient Protection and Affordable Care Act provides both opportunities and challenges for addressing cancer care disparities and access to care. The American Society of Clinical Oncology (ASCO) advocates for policies that ensure access to cancer care for the underserved. Such policies include insurance reform and the reduction of economic barriers to quality health care. Building on ASCO's prior statement on disparities in cancer care (2009), this article summarizes elements of the health care law that are relevant to cancer disparities and provides recommendations for addressing major provisions in the law. It outlines specific strategies to address insurance reform, access to care, quality of care, prevention and wellness, research on health care disparities, and diversity in the health care workforce. ASCO is committed to leading efforts toward the improvement of cancer care among the most vulnerable patients.
Loss of IRF-4–binding protein leads to the spontaneous development of systemic autoimmunity
Authors: Jessica C. Fanzo, Wen Yang, So Young Jang, Sanjay Gupta, Qinzhong Chen, Ayesha Siddiq, teven Greenberg,, Alessandra B. Pernis
Journal: Journal of Clinical Investigation (2006)

IFN regulatory factor 4-binding (IRF-4-binding) protein (IBP) is a novel type of activator of Rho GTPases that is recruited to the immunological synapse upon TCR stimulation. Here we demonstrate that loss of IBP leads to the spontaneous development of a systemic autoimmune disorder characterized by the accumulation of effector/memory T cells and IgG+ B cells, profound hypergammaglobulinemia, and autoantibody production. Similar to human SLE, this syndrome primarily affects females. T cells from IBP-deficient mice are resistant to death in vitro as well as in vivo and exhibit selective defects in effector function. In the absence of IBP, T cells respond suboptimally to TCR engagement, as demonstrated by diminished ERK1/2 activation, decreased c-Fos induction, impaired immunological synapse formation, and defective actin polymerization. Transduction of IBP-deficient T cells with a WT IBP protein, but not with an IBP mutant lacking the Dbl-like domain required for Rho GTPase activation, rescues the cytoskeletal defects exhibited by these cells. Collectively, these findings indicate that IBP, a novel regulator of Rho GTPases, is required for optimal T cell effector function, lymphocyte homeostasis, and the prevention of systemic autoimmunity.
Outcome Measures for Practice
Authors: Jason L. Whipple, Michael J. Lambert
Journal: Annual Review of Clinical Psychology (2011)

The current review targets efforts to use outcome measures in routine care for the purpose of enhancing psychotherapy outcome, particularly for patients who are predicted to have a negative treatment outcome. The place of outcome measures in solving the negative effects problem is emphasized, with a narrow focus on one set of measures that is relatively well advanced in its clinical utility. This clinical innovation relies on research-based clinical decision tools that provide psychotherapists with timely warnings and problem-solving strategies when a patient deviates from an expected treatment response. Summary of a meta-analytic review using this patient feedback methodology suggests that measuring, monitoring, predicting treatment failure, and providing clinical support tools to clinicians enhance treatment outcome for patients who have an early negative treatment response. Other measures are then briefly reviewed before we turn to future directions. Clinicians are encouraged to employ these methods in routine practice.
NFκB Promotes Inflammation, Coagulation, and Fibrosis in the Aging Glomerulus
Authors: Jocelyn E. Wiggins, Sanjeevkumar R. Patel, Kerby A. Shedden, Meera Goyal, Bryan L. Wharram, Sebastian Martini, Matthias Kretzler, Roger C. Wiggins
Journal: Journal of the American Society of Nephrology (2010)

The peak prevalence of ESRD from glomerulosclerosis occurs at 70 to 79 years. To understand why old glomeruli are prone to failure, we analyzed the Fischer 344 rat model of aging under ad libitum-fed (rapid aging) and calorie-restricted (slowed aging) conditions. All glomerular cells contained genes whose expression changed "linearly" during adult life from 2 to 24 months: mesangial cells (e.g., MMP9), endothelial cells (e.g., ICAM and VCAM), parietal epithelial cells (e.g., ceruloplasmin), and podocytes (e.g., nephrin and prepronociceptin). Patterns of aging glomerular gene expression closely resembled atherosclerosis, including activation of endothelial cells, epithelial cells, and macrophages, as well as proinflammatory pathways related to cell adhesion, chemotaxis, blood coagulation, oxidoreductases, matrix metalloproteinases, and TGF-β activation. We used a nonbiased data-mining approach to identify NFκB as the likely transcriptional regulator of these events. We confirmed NFκB activation by two independent methods: translocation of NFκB p50 to glomerular nuclei and ChIP assays demonstrating NFκB p50 binding to the κB motif of target genes in old versus young glomeruli. These data suggest that old glomeruli exhibit NFκB-associated up-regulation of a proinflammatory, procoagulable, and profibrotic phenotype compared with young glomeruli; these distinctions could explain their enhanced susceptibility to failure. Furthermore, these results provide a potential mechanistic explanation for the close relationship between ESRD and atherosclerotic organ failure as two parallel arms of age-associated NFκB-driven processes.
A Randomized Controlled Trial Comparing Motivational Interviewing in Education to Structured Diabetes Education in Teens With Type 1 Diabetes
Authors: Yu-Chi Wang, Sunita M. Stewart, Marsha Mackenzie, Paul A. Nakonezny, Deidre Edwards, Perrin C. White
Journal: Diabetes Care (2010)

OBJECTIVE To compare motivational interviewing–based education (MI) and structured diabetes education (SDE) for improving A1C and psychosocial measures in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS This study was a 9-month randomized controlled trial comparing MI (n = 21) to SDE (n = 23). Interventions were at baseline (T0) and 3 months (T1), with A1C and psychosocial measures obtained at 6 months (T2) and 9 months (T3). RESULTS Over the 6 months of follow-up, the SDE group had lower adjusted mean A1C value (least squares mean 10.31, SE 0.32) than the MI group (least squares mean 11.35, SE 0.34) (P = 0.03, d = −0.66). There were no differences on any of the psychosocial measures. CONCLUSIONS SDE is effective at improving metabolic control in adolescents with type 1 diabetes. Diabetes educators were proficient in learning MI.
Short duration combination chemotherapy in the treatment of small cell lung cancer.
Authors: A J Dorward, S W Banham, A W Hutcheon, S Ahmedzai, D Cunningham, A Gregor, M Soukop, B H Stack, N S Mackay, S B Kaye
Journal: Thorax (1986)

Ninety five patients (57 with limited disease and 38 with extensive disease) with previously untreated small cell lung cancer were entered into a study of short duration combination chemotherapy with intravenous cyclophosphamide (750 mg/m2) on day 1, adriamycin (40 mg/m2) on day 1, and etoposide VP-16 (100 mg/m2) on days 1, 2, and 3, with the addition on day 10 of methotrexate 50 mg/m2 with folinic acid rescue and vincristine 2 mg. The treatment was repeated on day 22 and only three courses were given. No maintenance chemotherapy was given, though patients with a complete response received radiotherapy (30-40 Gy (3000-4000 rads] to the primary site in most cases. Forty nine patients (86%) with limited disease achieved a response, with 26 (46%) complete remissions. Twenty five patients (66%) with extensive disease had a response, but only eight (21%) had a complete response. Actuarial survival analysis for the whole patient population showed a median survival of 13 months for patients with limited disease and seven months for those with extensive disease. The median survival was 14 months for those patients with limited disease who achieved a complete response, but only 10 months for non-responders. Myelosuppression was the major expression of toxicity. There were three deaths related to treatment and seven patients had febrile episodes during neutropenia that required antibiotics. Mucositis, which was usually mild, occurred in 49% of patients. The primary site was the main site of initial relapse in 56% of the patients who relapsed. Among patients with limited disease who achieved a complete response, relapses at the primary site were less common in those who received radiotherapy (five out of 12) than in those who did not (all eight). The results indicate that this short duration chemotherapy in small cell lung cancer gives response rates and the potential for long term survival similar to those obtained in other series while allowing patients the maximum time free from treatment.
The isolated artery: An intrahepatic arterial pathway that can bypass the lobular parenchyma in mammalian livers
Authors: Wichai Ekataksin
Journal: Hepatology (2000)

Controversy persists concerning the distribution of intrahepatic arterial termination. Apart from nourishing structures in the portal tract, several authors have suggested arterial supply to some isolated vascular beds that bypass the parenchyma, but this was not verified morphologically. In the present study, the existence of an isolated hepatic artery unaccompanied by a portal vein or a bile duct was shown in livers of pigs and other mammals including the dog, seal, ox, horse, and man. After colored media injection, liver blocks were sampled near the hepatic capsule and hepatic vein and subject to histologic assessment. The hepatic artery dissociated from superficial portal tract, ramified, and anastomosed extensively, forming a capsular plexus that drained at places into peripheral sinusoids in which resistive structural elaborations were observed. The artery also dissociated and fed an intramural plexus (vasa vasorum) of hepatic veins. This was collected into a vessel that penetrated the intima into the vein’s lumen. In smaller sublobular veins, the plexus emptied into adjacent sinusoids; in central veins, the plexus was poorly developed. In canine and phocine livers, which have a special throttling musculature in sublobular veins, the isolated arterioles were numerous; in bovine and equine livers, which have a thick fibrous investment, the capsular plexus was well-developed. Occurrence of the isolated artery also was confirmed in the human but not in the rodent liver. In conclusion, the isolated artery is responsible for isolated vascular beds, in which the transintimal pathway can bypass the lobular sinusoids.
<i>BRCA</i> Mutations in Women with Ductal Carcinoma <i>In situ</i>
Authors: Karen Lisa Smith, Muriel Adank, Noah Kauff, Kelly Lafaro, Jeff Boyd, Johanna B. Lee, Clifford Hudis, Kenneth Offit, Mark Robson
Journal: Clinical Cancer Research (2007)

The strength of the association between ductal carcinoma in situ (DCIS) and BRCA mutations has not been defined.Mutation frequency was compared in three groups: (1) a prevalent series of women with DCIS, (2) an incident series of women with DCIS, and (3) a clinic-based series of women with DCIS referred for hereditary cancer risk assessment. In groups 1 and 2, limited to Ashkenazi Jewish (AJ) cases, mutation frequency was compared with that in age-matched AJ controls with invasive breast cancer (IBC).In group 1, 3 of 62 (4.8%) women with DCIS and 15 of 130 (11.5%) controls with IBC had BRCA mutations. In group 2, 0 of 58 (0%) women with DCIS and 6 of 116 (5.2%) controls with IBC had BRCA mutations [combined odds ratios (OR) in groups 1 and 2: 3.64, 95% confidence interval (95% CI), 1.06-12.46; P=0.04]. In group 3, deleterious mutations were identified in 10 of 79 (12.7%) probands with DCIS, similar to the frequency in IBC probands. In group 3, mutations were associated with family history of ovarian cancer (OR, 13.35; 95% CI, 2.48-71.94; P=0.003) or early onset breast cancer (OR, 16.23; 95% CI, 1.68-157.01; P=0.02) but not with AJ ethnicity or age at diagnosis.BRCA mutations were less frequent in women with DCIS not selected for family history or age at diagnosis than in women with IBC. Nonetheless, mutations were found in a significant proportion of women with DCIS who presented for hereditary risk assessment.
Regulation and Functions of Blimp-1 in T and B Lymphocytes
Authors: Gislâine Martins, Kathryn Calame
Journal: Annual Review of Immunology (2008)

B lymphocyte–induced maturation protein-1 (Blimp-1), discovered 16 years ago as a transcriptional repressor of the IFNβ promoter, plays fundamentally important roles in many cell lineages and in early development. This review focuses on Blimp-1 in lymphocytes. In the B cell lineage, Blimp-1 is required for development of immunoglobulin-secreting cells and for maintenance of long-lived plasma cells (LLPCs). Direct targets of Blimp-1 and the transcriptional cascades Blimp-1 initiates to trigger plasmacytic differentiation are described. Blimp-1 also affects the homeostasis and function of CD4 + , CD8 + , and regulatory CD4 + T cells, and Blimp-1 levels are highest in antigen-experienced T cells. Blimp-1 attenuates T cell proliferation and survival and modulates differentiation. Roles for Blimp-1 in Th1/Th2 specification, regulatory T cell function, and CD8 differentiation and function are under investigation. Signals that induce Blimp-1 in B cells include Toll-like receptor ligands and cytokines; in T cells, T cell receptors and cytokines induce Blimp-1. In spite of some commonalities, different targets and regulators of Blimp-1 in B and T cells suggest intriguing evolutionary divergence of this regulatory machinery.
A comparative study of whole body vibration training and conventional training on knee proprioception and postural stability after anterior cruciate ligament reconstruction
Authors: A Moezy, G Olyaei, M Hadian, M Razi, S Faghihzadeh
Journal: British Journal of Sports Medicine (2008)

Objective: To compare the effect of a whole body vibration training (WBVT) programme with a conventional training (CT) programme on knee proprioception and postural stability after anterior cruciate ligament (ACL) reconstruction. Methods: Twenty athletes with unilateral ACL reconstruction were randomly assigned to the WBVT or CT group; all participants received 12 sessions of WBVT or conventional training. Absolute error in joint repositioning for two target angles (30° and 60°) was measured with the Biodex dynamometer; bilateral dynamic postural stability (anteroposterior, mediolateral and overall stability indices) was measured with the Biodex Stability System pre-intervention and post-intervention. Results: The improvement in postural stability in the WBVT group was significantly greater than that in the CT group (p⩽0.05). The p values of the changing scores of open overall, open anteroposterior, open mediolateral, closed overall, closed anteroposterior and closed mediolateral stability indices were 0.002, 0.010, 0.0001, 0.001, 0.0001 and 0.046, respectively. In addition, there were significant differences in all averages of absolute angular error at 60° and 30° between the WBVT and CT groups in both knees (p = 0.001 in healthy knees and p = 0.001 and p = 0.0001 in reconstructed knees), apart from the healthy knees at the 30° target position, which was not significant (p = 0.131). Conclusions: Whole body vibration training improved proprioception and balance in athletes with reconstructed ACL.
Patient use of a mixed appointment system in an urban practice.
Authors: B Taylor
Journal: BMJ (1984)

The number of practices that run appointment systems has sharply increased recently. Such practices may have difficulty in fitting in urgent or extra consultations. A study was made of 639 patients who attended a practice whose surgeries are run on a mixed system of open access and by appointment. There were important differences in the type of patient and problem seen in the two types of surgeries, notably in age, social class, and presenting complaint. Some patients may be disadvantaged by surgeries that are run by appointment only.