tbuckley/cabot-search huggingface dataset:
Abstract 132: General Ward Cardiopulmonary Resuscitation Events Are Becoming Near "Never Events": A Report from the Get With The Guidelines--Resuscitation Registry
Authors: Robert M Sutton, Richard Holubkov, J M Dean, Kathleen Meert, Frank Moler, Carol Nicholson, Vinay M Nadkarni, Robert A Berg
Journal: Circulation (2012)

Introduction: The aim of this study was to evaluate whether the proportion of pediatric in-hospital CPR events occurring in intensive care units (ICUs) compared to general wards has increased over the last decade using a large national registry database.  Hypothesis: The proportion of pediatric CPR provided in ICUs vs. general wards has increased over the past decade and this shift is associated with improved survival.  Methods: We evaluated pediatric subjects   Results: There were 5870 pediatric CPR events in the GWTG-R database between 2000-2010, of which 5477 (93.3%) occurred in ICUs compared to 393 (6.7%) on inpatient wards. Over time, significantly more of these CPR events occurred in the ICU compared to the wards (test for trend: p  Conclusions: The proportion of pediatric CPR provided in the ICU vs. inpatient wards has increased significantly over the past decade. Survival to hospital discharge for index pediatric in-hospital CPR events increased concomitantly with the shift to the ICU.
Lehrbuch der urologischen Diagnostik.
Authors: Leopold Casper, Edwin Picard
Journal: JAMA (1931)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Poster Session 4: HCV: Virology, Pathogenesis, and Immunology
Authors: Anja Ernst, Henrik Krarup
Journal: Hepatology (2014)

Background: Single nucleotide polymorphisms (SNPs) located within the IL-28B gene promoter (IFN-λ3) (rs12979860) was discovered to be a strong predictor for hepatitis C virus (HCV) clearance by combination therapy of IFN-α, ribavirin and protease inhibitors.The mechanism of how the IL-28B gene polymorphisms relates to HCV clearance is unclear.Aim: To investigate the molecular mechanisms by which IL-28B gene promoter polymorphisms and the IFN-λ signaling play a role at the regulation of HCV translation inhibition by interferons.Methods: Ten different human hepatoma cell lines with different SNP rs12979860 of IL28B gene: three CC, three TT, four CT were transfected with either HCV IRES-luc or HCV IRES-GFP reporter plasmids using Fugene 6 method.Inhibition of HCV IRES after treatment with Type I (IFN-α), Type III (IL-29) and ribavirin was quantitatively measured.The activation of JAK-STAT pathway and various ISGs after IFN-treatment was investigated by Western blot analysis.Results: Our results indicate that all three TT cell lines show significantly less inhibition of HCV IRES translation by IFN-α or IFN-λ, and express a higher IFN-λ (IL-28B and IL-29) protein level compared to the CC genotype cell line.The investigation of the JAK-STAT pathways induced by IFN-α, and IFN-λ1 treatment showed a high level of PKR in TT cell line compared to the CC but the phosphorylation of PKR and eIF2α seems to be less induced in TT cell lines which could explain the difference of HCV IRES translation inhibition between the two genotypes.Conclusion: These results suggest that the poor response to IFN-α/Ribavirin treatment among chronic HCV patients with unfavorable genotypes may at the level of mechanisms of HCV IRES translation inhibition impairing by the IFN-λ signaling.
Das Wesen der Krebskrankheit und ihre kausale Behandlung.
Authors: Rudolf Roosen
Journal: JAMA (1933)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Papers of Charles V. Chapin, M.D.: A Review of Public Health Realities
Authors: Frederic P. Gorham, Clarence L. Scamman
Journal: JAMA (1934)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Correlation of CA-125 and RECIST evaluation in recurrent ovarian cancer (ROC): Results from a randomized phase III study of trabectedin (T) with pegylated liposomal doxorubicin (PLD) versus PLD alone
Authors: T. J. Herzog, J. B. Vermorken, E. Pujade-Lauraine, J. Li, E. Bayever, J. Gomez, A. Yovine, B. J. Monk
Journal: Journal of Clinical Oncology (2009)

5550 Background: OVA-301, an open-label, multicenter, randomized phase III study comparing the combination of T and PLD to PLD alone in 672 ovarian cancer patients, showed significant prolongation in Progression-Free Survival (PFS) and higher Objective Response (OR) in the combination arm (T-PLD) by three separate assessments, investigator assessment (IA), independent radiology (IR) and oncology review (IO). The purpose of this analysis is to examine: 1) the impact of early changes in CA-125 over the subsequent best OR by RECIST; 2) the concordance between best OR determined by CA-125 and RECIST; 3) the value of CA-125 to predict radiological response. Methods: Tumor assessments by imaging and CA-125 were performed at baseline, and every 8 weeks during study in both arms. Radiological tumor assessment, regardless of CA-125 changes, determined the study conduct. Early CA-125 changes were those assessed at the first and second evaluation. Analyses were based on “all randomized patients.” Results: Response rate by RECIST (IR)/CA-125 was 28%/48% for T-PLD vs. 19%/33% for PLD. The association between CA-125 and RECIST response was stronger for IA relative to IR/IO, with 79% concordance for both arms, 65% overall positive predictive value (PPV) and 89% negative predictive value (NPV) for IA and 74%/75% concordance, 46%/49% PPV and 93%/92% NPV for IR/IO. Early CA-125 changes were assessed in 514 patients. Early ≥25% CA-125 decreases in the first/second evaluation occurred in 85%/95% of RECIST responders in the T-PLD arm and in 81/82% responders treated with PLD. Conclusions: The predictive value of CA-125 response was high and similar in both arms. The addition of T to PLD resulted in superior efficacy in this patient population as assessed by IA, IR and IO, with a favorable trend for CA-125 response assessment. RECIST response was preceded by a significant CA-125 decrease in a high proportion of patients. [Table: see text]
Lanreotide Reduces Liver Volume, But Might Not Improve Muscle Wasting or Weight Loss, in Patients With Symptomatic Polycystic Liver Disease
Authors: Frederik Temmerman, Thien Ahn Ho, Ragna Vanslembrouck, Walter Coudyzer, Jaak Billen, Fabienne Dobbels, Jos van Pelt, Bert Bammens, Yves Pirson, Frederik Nevens
Journal: Clinical Gastroenterology and Hepatology (2015)
A Surgeon's Views of the Treatment of Peptic Ulcer
Authors: David Cheever
Journal: Annals of Internal Medicine (1929)

Article1 August 1929A Surgeon's Views of the Treatment of Peptic UlcerDAVID CHEEVER, M.D.DAVID CHEEVER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-3-2-144 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptNo man and no method have any monopoly of the successful treatment of peptic ulcer and in proof of this I am going to show this patient, Bennie Wean, who must be regarded as illustrating the unsuccessful treatment of ulcer by both medical and surgical means. The patient first came under observation on December 6, 1927. He is a Russian Jew, an upholsterer by trade, thirty years of age, and is married and has two children living and well. His family and previous history are both negative except for two attacks of tonsillitis fifteen years ago. His habits are good—he... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts*Clinic before the American College of Physicians at the Peter Bent Brigham Hospital, Boston, April 11, 1929. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 August 1929Volume 3, Issue 2Page: 144-152KeywordsChildrenHabitsHospitalsJewish peoplePeptic ulcers ePublished: 1 December 2008 Issue Published: 1 August 1929 PDF downloadLoading ...
Endoscopic Hemoclipping Using a Transparent Cap in Technically Difficult Cases
Authors: J I Kim, S S Kim, S Park, J Han, J K Kim, S W Han, K Y Choi, I S Chung, K W Chung, H S Sun
Journal: Endoscopy (2003)

Background and Study Aims: Technical difficulties have been experienced in endoscopic hemoclipping on the posterior wall of the body of the stomach because the angle of approach is tangential. It has been suggested that the use of a transparent cap on the tip of the endoscope could help to solve this problem. The purpose of this study was to examine the efficacy of endoscopic hemoclipping using a transparent cap over the tip of the endoscope. Patients and Methods: A total of 74 patients with a bleeding peptic ulcer or stigmata of recent hemorrhage underwent endoscopic hemoclipping. Technical difficulty in hemoclipping was experienced in 18 patients and the transparent cap was used in these cases. We therefore conducted a nonrandomized prospective study to compare bleeding control with the hemoclip with and without the aid of a transparent cap. Results: There were no statistically significant differences between the patients treated with the cap and those treated without the cap with regard to the initial hemostasis rate (94.4 % vs. 91.1 %), the rebleeding rate (11.7 % vs. 11.8 %), or the permanent hemostasis rate (94.4 % vs. 96.4 %). Conclusions: Although there was no statistically significant difference between patients treated with or without a transparent cap, hemoclipping with the aid of the cap made it possible to clip a lesion too tangential to be clipped without it. However, this study did not compare conventional hemoclipping with hemoclipping using a cap because the cap was only used in cases in which conventional clipping had failed.
Abstract P055: Diet, Lifestyle And Blood Pressure of Non-alcohol Drinkers and Alcohol Drinkers in The Intermap Study
Authors: Queenie Chan, Jeremiah Stamler, Ian Brown, Martha L Daviglus, Linda Van Horn, Katsuyuki Miura, Liancheng Zhao, Paul Elliott
Journal: Circulation (2012)

Background: Non-drinkers and alcohol drinkers differ in social and cultural traits, lifestyle habits (e.g., smoking, exercise, diet) and blood pressure (BP). Objective: Assess whether differences in lifestyle traits, particularly food intake, among non-alcohol drinkers, moderate and heavy alcohol drinkers account for higher BP of heavy drinkers. Methods: The INTERMAP Study is a cross-sectional epidemiologic investigation of 4,680 men and women ages 40–59 years from 17 population samples in China, Japan, United Kingdom and United States. With standardized quality-controlled methods, four 24-hour dietary recalls, 2 timed 24-hour urine collections, 8 BP measurements and questionnaire data were accrued. Data on lifetime alcohol use and daily alcohol consumption over the previous 7 days were obtained at two visits (14 days total). Results: Heavy alcohol drinkers (&gt;26 g alcohol/day for men; &gt;13 g alcohol/day for women) were more likely to be cigarette smokers, and had lower age-sex-sample adjusted mean body mass index (BMI) and higher adjusted total energy intake than moderate and non-alcohol drinkers (P&lt;0.001). Heavy alcohol drinkers had mean systolic and diastolic BP higher by 3.2/2.1 mm Hg (P&lt;0.001) compared to non/moderate drinkers adjusted for sex, population sample, age, years of education, cigarette smoking, physical activity, employment, marital status, family history of hypertension, cardiovascular disease and diabetes mellitus diagnosis, supplement intake, and special diet. With additional adjustment for BMI, the BP differences between non/moderate drinkers and heavy drinkers increased 8% to 3.5 mm Hg for systolic and 2.3 mm Hg for diastolic (P&lt;0.001). Heavy drinkers had significantly lower intakes of pasta and rice, bread, cereals, milk, ice-cream, table spread, vegetable oil, fresh fruits, fruit juices, raw vegetables, cooked vegetables, sweet snacks and non-alcoholic beverages, and higher intakes of meat, fish, shellfish and nuts compared to non-drinkers and moderate drinkers. Of 17 foods with significantly different intakes between heavy drinkers and non/moderate drinkers had little or no influence on the higher BP of heavy drinkers (range from 0.00 to 0.16 mm Hg, 0 to 5% changes). With adjustment for possible confounders and multiple foods, the adjusted mean BP differences between non/moderate drinkers and heavy drinkers were 3.2 mm Hg for systolic (P&lt;0.001) and 2.1 mm Hg for diastolic (P&lt;0.001). Results were similar for men and women analysed separately. Conclusions: Differences in food intake did not account for the significantly higher BP among heavy drinkers suggesting that other lifestyle traits may operate, and/or that heavy drinking per se is the responsible trait.
Der Kokainismus. Geschichte, Pathologie, medizinische und behördliche Bekämpfung.
Authors: Hans W. Maier
Journal: JAMA (1926)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Abstract P285: Impaired Recovery of Left Ventricular Function After Acute Myocardial Reperfusion Injury Is Rescued by the Anti-inflammatory Peptide Annexin-A1 ex Vivo
Authors: Rebecca H Ritchie, Keith Buxton, Salvatore Pepe, Anh H Cao, Kylie Venardos, Jane Love, Yuan Yang, Eric Morand, David Kaye
Journal: Circulation Research (2011)

The glucocorticoid-regulated protein annexin-A1 (ANX-A1) is a key effector molecule of anti-inflammatory glucocorticoid actions. We have shown that the N-terminal derived peptide ANX-A1(2–26) preserves cardiomyocyte viability after metabolic inhibition in vitro. Our hypothesis was that ANX-A1 preserves the myocardium post-ischemic injury. ANX-A1(2–26)(0.3μM) prevented adult rat cardiomyocyte injury, whether present for hypoxia-reoxygenation (LDH release reduced from 4.1±0.7- to 1.1±0.2-fold n=11 P&lt;0.001) or only on reoxygenation (LDH release reduced to 1.4±0.4-fold n=11, P&lt;0.001). Similar protection at both time points was also evident on cardiomyocyte viability (trypan blue exclusion). The recovery of post-ischemic left ventricular (LV) function in intact rodent hearts was also protected. After 20mins reperfusion, the recovery of LV developed pressure (LVDP) remained significantly impaired in untreated rat hearts (47±5% baseline, n=11) whereas addition of ANX-A1(2–26)(0.3μM) on reperfusion improved LVDP recovery (to 66±7% baseline, n=13, p&lt;0.05). Phosphorylation of both Akt (1.9±0.2-fold, P&lt;0.05) and phospholamban (3.4±0.4-fold, P&lt;0.05) was also enhanced by ANX-A1(2–26). Similar ANX-A1(2–26)-induced rescue of LV function was observed in mouse hearts after acute myocardial reperfusion injury (57±7% of baseline, n=11 untreated hearts vs 78±8% baseline, n=6 ANX-A1(2–26)-treated hearts, p&lt;0.05). ANX-A1(2–26) cardioprotection was associated with attenuated cardiac enzyme release (LDH, CK) and Akt phosphorylation (3.1±0.8-fold, P&lt;0.005). In contrast, deficiency of endogenous ANX-A1 further exacerbated recovery of post-ischemic LV function, across LVDP (to 29±4% baseline, P&lt;0.001), LV end-diastolic pressure (to 5.5±1.0-fold baseline, P&lt;0.001), LV+dP/dt (to 33±4% baseline, P&lt;0.001), LV-dP/dt (to 36±4% baseline, P&lt;0.001) and rate-pressure product (to 24±4% baseline, P&lt;0.001). This is the first evidence that ANX-A1 or its mimetic ANX-A1(2-26) preserve post-ischemic recovery of LV function. ANX-A1 is thus an endogenous regulator of LV function. Furthermore, ANX-A1-based therapies may thus represent a novel clinical approach for the prevention and treatment of reperfusion injury.
Enhanced Ca<sup>2+</sup>-Dependent Proteolysis Associated with Adriamycin®-Resistant HL-60 Cells
Authors: Angelo Aquino, Marian Johnson-Thompson, Robert I. Glazer
Journal: Cancer Communications (1990)

Adriamycin-resistant HL-60 (HL-60/ADR) cells possess high constitutive levels of the proteolytically generated catalytic fragment of protein kinase C, M-kinase, resulting in the generation of pp130 in vitro. In this report, we have demonstrated the presence of a Ca2(+)-activated protease in extracts from HL-60/ADR cells, but not in wild-type cells, which resulted in the generation of 26 and 86 kDa phosphoproteins in vitro, as well as in the reduction of pp130. The formation of pp26 and pp86 and the reduction in pp130 were prevented by the serine/cysteine protease inhibitor, leupeptin. A 26 kDa phosphoprotein with a similar isoelectric point was also evident in both cell lines following metabolic labeling in vivo, although the phosphorylation of pp26 was much greater in resistant cells. These data suggest that the presence of Ca2(+)-dependent protease activity is a phenotypic characteristic of this multidrug resistant cell line.
Die Regulierung der Atmung gleichzeitig ein Beitrag zur Physiologie des vegetativen Nervensystems.
Authors: W. R. Hess
Journal: JAMA (1931)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Traité de climatologie: Biologique et médicale
Authors: Marius Piéry
Journal: JAMA (1935)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal