tbuckley/cabot-search huggingface dataset:
Hydralazine and isosorbide dinitrate: comparative central and regional hemodynamic effects when administered alone or in combination.
Authors: C B Leier, R D Magorien, C E Desch, M J Thompson, D V Unverferth
Journal: Circulation (1981)

Central and regional hemodynamic studies were performed before and after the oral administration of 75 mg of hydralazine and/or 20 mg of isosorbide dinitrate in 15 patients with low-output congestive heart failure. Hydralazine increased mean cardiac output 17-25%, mean renal blood flow 19%, and limb blood flow 17% (all p &lt; 0.05). Mean hepatic blood flow did not change significantly with hydralazine. Except for a small increase in cardiac output (6%, p &lt; 0.05) at 30 minutes, isosorbide dinitrate did not significantly alter central, renal, hepatic or limb blood flow. Combining isosorbide dinitrate and hydralazine effected similar increases in cardiac output (17-24%, p &lt; 0.05), renal (17%, p &lt; 0.05) and limb (20%, p &lt; 0.05) blood flow as those elicited by hydralazine alone. The combination did not significantly alter mean hepatic blood flow. Hydralazine, alone or combined with isosorbide dinitrate, increases renal and limb blood flow in congestive heart failure in proportion to the augmented cardiac output; isosorbide dinitrate alone does not alter blood flow to these regions. Neither drug (or combination) changes hepatic blood flow in this clinical setting.
The epidemiological impasse
Authors: F.A.A. Mohamed Hoesein, P. Zanen
Journal: European Respiratory Journal (2011)

The epidemiological impasseTo the Editors:We read with interest the letter of QUANJER et al. [1] persuading the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee to abandon the fixed ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ,0.70 in favour of the lower limit of normal (LLN).We feel that, in the current debate, some basic epidemiological principles have been overlooked.We will briefly address these principles in an attempt to clear up the discussion. QUANJER et al.[1] point out that numerous studies have reported a higher prevalence of chronic obstructive pulmonary disease (COPD) when using the fixed FEV1/FVC ,0.70 criterion when compared with the LLN.They interpret this as an ''overdiagnosis'' of COPD [2].However, this neither implies nor ascertains that the LLN is the superior diagnostic.Conversely, one can state that the LLN leads to ''underdiagnosis'' of COPD.As long as either the fixed criterion or the LLN are not compared with a gold standard of COPD (when possible, a test with specificity and sensitivity approaching 100%), one should realise that it is impossible to label either criterion as superior.The only valid conclusion of comparative studies lacking that gold standard is that both criteria differ.How then to solve the issue?COPD is and remains a clinical diagnosis and therefore a panel decision on its absence or presence by taking into account all relevant clinical factors, such as age, respiratory complaints, smoking history, etc., is the classical approach.The fixed FEV1/FVC ,0.70 criterion and the LLN should subsequently be compared with that panel diagnosis of COPD and the sensitivity/specificity evaluated.Unfortunately, we are unaware of any such studies and, in the mean time, any discussion and debate about the superiority/inferiority of a particular spirometric threshold will remain unproductive.In conclusion, with the currently available literature it is impossible to label either threshold as superior or suitable.
Prevalence of Diabetes Mellitus in Alaskan Eskimos, Indians, and Aleuts
Authors: Cynthia D Schraer, Anne P Lanier, Edward J Boyko, Dorothy Gohdes, Neil J Murphy
Journal: Diabetes Care (1988)

The prevalence of diabetes mellitus in Alaska Natives has been thought to be low, but no survey of this condition in all natives has been conducted. Medical records from 1979 to 1985 were reviewed to determine the prevalence of diagnosed diabetes mellitus in Alaska Natives. Computerized outpatient and inpatient medical record data and clinician reports were used to identify cases. As of December 1985, 610 living Alaska Natives fulfilled diagnostic criteria for diabetes. Type II diabetes mellitus was found in 564 subjects, type I diabetes was found in 15 subjects, and unspecified type of diabetes was found in 31 subjects. The overall age-adjusted prevalence of diabetes mellitus, 15.7/1000, was lower than the overall United States rate of 24.7/1000. However, age-adjusted prevalence varied considerably by ethnic group; the prevalence was 27.2/1000 among Aleuts, 22.0/1000 among Alaskan Indians, and 8.8/1000 among Alaskan Eskimos. Rates within the Eskimo subgroups varied by a factor of four. Compared with previous reports, the prevalence of diabetes mellitus in Alaskan Eskimos appears to have increased. Diabetes mellitus is no longer a rare condition among Alaska Natives.
The 1995 Albert Lasker Medical Research Award. Helicobacter pylori. The etiologic agent for peptic ulcer
Authors: B J Marshall
Journal: JAMA (1995)

UNRAVELING the puzzle of<i>Helicobacter pylori</i>and its pivotal role in gastric disease was not done in isolation. Many of the pieces were already available but dispersed over 100 years in journals of different languages and subspecialties. The prevailing dogma was that the stomach was sterile and that bacteria could not survive in gastric acid, but there were articles describing gastric spiral bacteria as far back as 1886.<sup>1</sup>Even after the advent of endoscopy, descriptions of the presence of curved organisms on the surface of the gastric mucosa were ignored by mainstream medicine. <h3>REDISCOVERY OF H PYLORI</h3> Fourteen years have passed since my work on<i>H pylori</i>began. In 1981, Robin Warren at Royal Perth Hospital in Western Australia first showed me the spiral bacteria he had discovered in patients with gastritis. Together we embarked on an attempt to culture the organisms by taking gastric biopsy specimens from patients
The Ventricular Electrokymogram
Authors: L. C. AKMAN, A. J. MILLER, E. N. SILBER, J. A. SCHACK, L. N. KATZ
Journal: Circulation (1950)

Over 200 left ventricular electrokymographic tracings were obtained in 32 normal adults, averaging more than six sites explored per individual. Records were analyzed with respect to the relationship of certain designated points to simultaneously recorded heart sounds. Considerable variability was demonstrated in these relationships both in tracings from different ventricular sites in the same individual and between comparable tracings from different individuals. The meaning of the ventricular electrokymogram and its clinical applicability are discussed in the light of these findings.
Effect of extracellular ATP on the Na+ current in rat ventricular myocytes.
Authors: F Scamps, G Vassort
Journal: Circulation Research (1994)

Extracellular ATP concentration can rise because of its release by nerve terminals and by damaged cells during ischemia. After the activation of P2-purinergic receptors, ATP induces a positive inotropic effect and increases the L-type Ca2+ current via activation of a Gs protein but without cAMP production. In addition, ATP shifts the voltage characteristics of Ca2+ current toward hyperpolarized potentials. If ATP produced similar effects on the Na+ current (INa), this compound should also affect cardiac excitability and conduction. Using the whole-cell patch-clamp to record INa in rat ventricular cells, we show that extracellular application of ATP induced hyperpolarizing shifts in the current-voltage relation and the availability of INa. The ED50 for the shifts in both conductance and availability was obtained with 0.7 mumol/L ATP. Maximal shifts in conductance and availability were respectively 9.7 +/- 0.6 and 10.6 +/- 0.7 mV. The leftward shift of the availability curve is responsible for the decrease of INa amplitude at less polarized holding potentials. These effects were not cholera toxin sensitive and thus cannot be attributed to activation of the Gs protein. At 100 mumol/L, ATP gamma S and alpha,beta-methylene ATP could induce shift, whereas UTP and beta,gamma-methylene ATP as well as ADP and adenosine were without effect. Thus, depending on the resting membrane potential, ATP should either enhance excitability or favor slow conduction and weaken cardiac electrical homogeneity and consequently favor arrhythmia.
Breast Cancer Mortality Trends in the United States According to Estrogen Receptor Status and Age at Diagnosis
Authors: Ismail Jatoi, Bingshu E. Chen, William F. Anderson, Philip S. Rosenberg
Journal: Journal of Clinical Oncology (2007)

Since 1990, overall breast cancer mortality rates in the United States decreased 24%. This decline has been attributed to mammography screening and adjuvant systemic therapy. However, the efficacy of these modalities may depend on estrogen receptor (ER) expression and age. We therefore examined breast cancer mortality trends in the United States according to ER status and age.Using the Surveillance, Epidemiology, and End Results (SEER) program (1990-2003), we calculated trends in incidence-based mortality (IBM), annual hazard rates for breast cancer deaths after diagnosis, and relative hazard rates for women with ER-positive and ER-negative tumors. Relative hazard rates were assessed with Cox proportional hazards models, adjusted for stage and grade, and stratified by age at diagnosis.During the study period, IBM and annual hazard rates for breast cancer deaths decreased among women with ER-positive and ER-negative tumors, although declines were greater for those with ER-positive tumors. Among women younger than 70 years, relative hazard rates declined 38% for those with ER-positive tumors versus 19% for those with ER-negative tumors. Among women 70 years or older, relative hazard rates declined 14% for those with ER-positive tumors versus no significant decline for those with ER-negative tumors.In the United States, breast cancer mortality rates have declined among women with ER-positive and ER-negative tumors, with greater declines among younger women and those with ER-positive tumors. Although mortality in all groups remains unacceptably high, additional emphasis should be placed on improving outcomes of breast cancer patients older than 70 years and those of all ages with ER-negative tumors.
Heterosexual Co-transmission of Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV)
Authors: M E Eyster, H J Alter, L M Aledort, S Quan, A Hatzakis, J J Goedert
Journal: Annals of Internal Medicine (1991)

Objectives: To determine the prevalence of antibodies to hepatitis C virus (HCV) in female sexual partners of multitransfused men with hemophilia and to compare the frequency of transmission of HCV and human immunodeficiency virus (HIV). Study Design: Cross-sectional measurement of HCV and HIV antibodies. Setting: Ten hemophilia treatment centers. Patients: A total of 234 female sexual partners of 231 multitransfused men with hemophilia. Measurements and Main Results: The prevalence of antibodies to HCV (anti-HCV) among female sexual partners of HCV-positive men was 5 of 194 (2.6%). Anti-HIV prevalence among female sexual partners of HIV-positive men was 25 of 196 (12.8%). Five (3%) of the 164 female sexual partners of HIV-positive/HCV-positive men were infected with HCV compared with none of the 30 female sexual partners of HIV-negative/HCV-positive men. Twenty-one (13%) of the 164 female sexual partners of HIV-positive/HCV-positive men were infected with HIV compared with 4 (13%) of 32 female sexual partners of HIV-positive/HCV-indeterminate men. The co-infected men were five times more likely to transmit both viruses than would be expected by chance (P = 0.01). When a single virus was transmitted to a female sexual partner, it was more often HIV than HCV (18 of 164 compared with 2 of 164, P = 0.001; odds ratio, 8.5; 95% Cl, 2.2 to 33.1). Conclusions: The higher prevalence of HCV in female sexual partners of men with hemophilia than in blood donor and other low-risk groups suggests that there is a low level of sexual transmission. Male to female sexual transmission of HCV is less efficient than that of HIV. The frequency of HCV transmission to sexual partners is five times higher when HIV is also transmitted, suggesting that HIV may be a cofactor for the sexual transmission of HCV.
Structural change in health care: what’s the attraction?
Authors: Donald R Coid, Huw Davies
Journal: Journal of the Royal Society of Medicine (2008)

'Modern western management practice is undergoing change slowly and painfully, recognizing that the quick solutions on which it has relied for so many years do not work. One of the reasons [for the failure of quick solutions] lies in ignoring the invisible world - the spiritual, the collective unconscious, the underlying order of things.
Mechanism of Inducible Regional Dysfunction During Dipyridamole Stress
Authors: Jian-Ping Bin, Elizabeth Le, Robert A. Pelberg, Matthew P. Coggins, Kevin Wei, Sanjiv Kaul
Journal: Circulation (2002)

Background — We hypothesized that increased myocardial oxygen demand resulting from hypotension and reflex tachycardia unmasking a reduced endocardial myocardial blood flow (MBF) reserve is the mechanism of dipyridamole-induced regional dysfunction in chronic coronary artery disease. Methods and Results — Ameroid constrictors were placed around the proximal coronary arteries and their major branches in 15 dogs to create chronic coronary stenosis. Seven days later, radiolabeled microsphere–derived MBF and 2-dimensional echocardiography–derived percent wall thickening (%WT) were measured at rest and after 0.56 mg/kg dipyridamole. Dipyridamole caused an increase (mean, 21%) in the rate-pressure product secondary to reflex tachycardia resulting from mild systemic hypotension. %WT in myocardial segments with an endocardial MBF reserve (dipyridamole/resting MBF) of 1.5 to 2.5 (n=35) did not change after dipyridamole, whereas it decreased in segments with an endocardial MBF reserve of &lt;1.5 (n=30) and increased in those with an endocardial MBF reserve of ≥2.5 (n=45) ( P &lt;0.05). Most (80%) segments with endocardial MBF reserve of &lt;1.5 and 14% with an endocardial MBF reserve of 1.5 to 2.5 showed inducible dysfunction after dipyridamole, whereas none of the segments with an endocardial MBF reserve of ≥2.5 showed this finding. A sigmoid relation ( y =−6.74/[1+exp (19.9 · [ x −1.84])]+1.35 · x , r =0.93, P &lt;0.0001) was noted between endocardial MBF reserve and Δ%WT. In contrast, neither the epicardial MBF reserve nor the endocardial/epicardial MBF ratio during hyperemia was associated with inducible regional dysfunction. Conclusions — Increased myocardial oxygen demand resulting from hypotension and reflex tachycardia unmasking a reduced endocardial MBF reserve is the primary mechanism of dipyridamole-induced regional dysfunction in chronic coronary artery disease.
Consultation-Liaison Psychiatry: Contributions to Medical Practice
Authors: Donald S Kornfeld
Journal: American Journal of Psychiatry (2002)

Consultation-liaison psychiatry has recently been recommended for subspecialty status by the American Board of Psychiatry and Neurology with a name change to "psychosomatic medicine." Final approval by the American Board of Specialties is expected. Therefore, this is a propitious time to review what the author considers the significant contributions of consultation-liaison psychiatry to the practice of medicine, the education of its practitioners, and future opportunities and challenges. The articles mentioned have been published primarily in medical and surgical journals in which their authors believed they would have the greatest impact. Therefore, this is a body of work that is probably unknown to most psychiatrists outside of this field.
Relationship Between Modifiable Health Risks and Short-term Health Care Charges
Authors: Nicolaas P. Pronk
Journal: JAMA (1999)

If physical inactivity, obesity, and smoking status prove to contribute significantly to increased health care charges within a short period of time, health plans and payers may wish to invest in strategies to modify these risk factors. However, few data are available to guide such resource allocation decisions.To examine the relationship of modifiable health risks to subsequent health care charges after controlling for age, race, sex, and chronic conditions.Cohort study of a stratified random sample of 5689 adults (75.5% of total sample of 7535) aged 40 years or older who were enrolled in a Minnesota health plan and completed a 60-item questionnaire.Resource use as measured by billed health care charges from July 1, 1995, to December 31, 1996, compared by health risk (physical activity, body mass index [BMI], and smoking status).The mean annual per patient charge in the total study population was $3570 (median, $600), and 15% of patients had no charges during the study period. After adjustment-for age, race, sex, and chronic disease status, physical activity (4.7% lower health care charges per active day per week), BMI (1.9% higher charges per BMI unit), current smoking status (18% higher charges), and history of tobacco use (25.8% higher charges) were prospectively related to health care charges over 18 months. Never-smokers with a BMI of 25 kg/m2 and who participated in physical activity 3 days per week had mean annual health care charges that were approximately 49% lower than physically inactive smokers with a BMI of 27.5 kg/m2.Our data suggest that adverse health risks translate into significantly higher health care charges within 18 months. Health plans or payers seeking to minimize health care charges may wish to consider strategic investments in interventions that effectively modify adverse health risks.
Effects of metabolic blockade on intracellular calcium concentration in isolated ferret ventricular muscle.
Authors: G L Smith, D G Allen
Journal: Circulation Research (1988)

Tension and intracellular free calcium concentration [( Ca2+]i) were measured in isolated ferret papillary muscles. When both anaerobic glycolysis and oxidative phosphorylation were prevented (metabolic blockade), there was a rapid decline of both developed tension and systolic [Ca2+]i signals. Subsequently, resting tension increased, and after a further delay, resting [Ca2+]i also rose. When oxidative metabolism was restarted after a period of metabolic blockade that was sufficient to elevate both resting tension and [Ca2+]i, a variable recovery of mechanical function occurred. In preparations that showed recovery, resting tension declined toward control level, and there was considerable recovery of developed tension. [Ca2+]i initially fell, but it then rose to a level similar to that at the end of the preceding period of metabolic blockade and exhibited large variations in amplitude with frequency components in the range 0.2-1 Hz. This elevated [Ca2+]i gradually declined. Arrhythmias were often present during this recovery period and appeared to be triggered by the spontaneous increases in [Ca2+]i. In preparations that failed to recover, resting tension remained elevated or increased, and developed tension showed little recovery. Such preparations showed larger rises in [Ca2+]i both during and after metabolic blockade, and [Ca2+]i continued to rise when oxidative metabolism was restarted. In experiments in which Na-Ca exchange was inhibited (by replacement of sodium by lithium or by the application of nickel), the rise of [Ca2+]i when oxidative metabolism was restarted was reduced, but recovery of mechanical function was improved. The correlation between elevated [Ca2+]i on reactivation of oxidative metabolism and failure of recovery of mechanical function suggests that elevated [Ca2+]i has a direct role in preventing the recovery of mechanical function.
Genetic Variants In Interferon Regulatory Factor 2 (irf2) Are Associated With Atopic Dermatitis And Eczema Herpeticum In Populations Of European And African Descent
Authors: P.S. Gao, D.Y. Leung, N.M. Rafaels, T. Hand, M. Boguniewicz, T. Hata, L. Schneider, J.M. Hanifin, R.L. Gallo, L. Gao, T.H. Beaty, L. Beck, K.C. Barnes
Journal: Journal of Allergy and Clinical Immunology (2010)
Fluorouracil and high-dose leucovorin in previously untreated patients with advanced adenocarcinoma of the pancreas: results of a phase II trial.
Authors: J A DeCaprio, R J Mayer, R Gonin, S G Arbuck
Journal: Journal of Clinical Oncology (1991)

Forty-two previously untreated patients with advanced, measurable adenocarcinoma of the pancreas were treated with weekly fluorouracil (5-FU; 600 mg/m2 intravenous [IV]) and leucovorin 500 mg/m2 IV for 6 weeks followed by a 2-week rest. A median of 11 (range, one to 76) doses were given. There were three partial responses (three of 42 [7%]; exact 95% confidence interval, 1% to 19%) and no complete responses. Median survival was 6.2 months, with seven patients surviving longer than 12 months. The most common toxicity was diarrhea; there was one treatment-related death. Despite promising results in patients with advanced colorectal cancer, this dose schedule of 5-FU and leucovorin does not appear to be superior to 5-FU alone for the treatment of advanced pancreatic cancer. Alternative investigative approaches are needed.
Choledochoduodenal fistula complicating chronic duodenal ulcer in Nigerians.
Authors: E A Lewis, S P Bohrer
Journal: Gut (1969)

Peptic ulceration wasthought toberareinNigerians until the1930s whenAitken (1933) andRose(1935) reported onthis condition. Chronic duodenal ulcers, inparticular, arebeing reported withincreasing frequency (Ellis, 1948; Konstam, 1959). Thesymptomsandcomplications ofduodenal ulcers in Nigerians arethesameaselsewhere, buttherelative incidence ofthese complications differs markedly. Pyloric stenosis isthecommonestcomplication followed byhaematemesis andmalaena inthat order (Antia andSolanke, 1967;Solanke andLewis, 1968). Perforation though present isnotverycommon. A remarkable complication foundinsomeofour patients withduodenal ulcer who present themselves forradiological examination istheformation ofafistulous communication between theduodenum andthebiliary system. Thisfinding hasprompted evaluation ofthese cases inorder tocompare them withreports ofsimilar findings intheAmerican andtheEuropean literature. METHOD
Priority actions for the non-communicable disease crisis
Authors: Robert Beaglehole, Ruth Bonita, Richard Horton, Cary Adams, George Alleyne, Perviz Asaria, Vanessa Baugh, Henk Bekedam, Nils Billo, Sally Casswell, Michele Cecchini, Ruth Colagiuri, Stephen Colagiuri, Tea Collins, Shah Ebrahim, Michael Engelgau, Gauden Galea, Thomas Gaziano, Robert Geneau, Andy Haines, James Hospedales, Prabhat Jha, Ann Keeling, Stephen Leeder, Paul Lincoln, Martin McKee, Judith Mackay, Roger Magnusson, Rob Moodie, Modi Mwatsama, Sania Nishtar, Bo Norrving, David Patterson, Peter Piot, Johanna Ralston, Manju Rani, K Srinath Reddy, Franco Sassi, Nick Sheron, David Stuckler, Il Suh, Julie Torode, Cherian Varghese, Judith Watt
Journal: The Lancet (2011)