tbuckley/cabot-search huggingface dataset:
New bill offers control for mentally disordered offenders
Authors: D J Thompson
Journal: BMJ (1997)

Gulf war illness Why it took so long to decide to investigateEditor-As it is now six years since the Gulf war, it is reasonable to ask why the problem of Gulf war syndrome has not been resolved. 1 As surgeon general in 1991-4 I want to comment on the unravelling timetable during these six years.At no time have we denied that Gulf veterans have been ill-indeed, whenever possible we have actively recommended their appropriate medical management.Secondly, despite press reports, we have always kept an open mind on the presence of a specific Gulf war syndrome.The Gulf conflict in 1990-1 itself was short, casualties mercifully few, and the sickness rates unremarkable; likewise, when troops returned to the UK the daily sickness rate did not increase.Also at that stage little evidence existed of psychiatric illness or post-traumatic stress syndrome.Some 18 to 24 months later, however, we became aware of a campaign by lawyers to recognise a specific Gulf illness.Up to 200 people were on their books, but despite widespread appeals for them to come forward, including two television appeals, only 15 approached the armed forces medical services.Not surprisingly, among these 15 no pattern of illness emerged.They were all managed appropriately.As we were keen to solve the problem, in October 1993 we appointed a single consultant physician, Group Captain Coker, to see all such patients.At first only a trickle of patients came forward-even by June 1994 (three and half years later) he had seen only 30 patients.Over the next two years, however, these numbers increased so that by January 1997, 1100 had been registered, 920 had been seen and fully investigated, and results had been completed and analysed in 519.A preliminary paper in the summer of 1996 concluded: "From our small database it would not appear that there is a unique cluster of symptoms which would suggest a new pattern of illness in veterans." 2 There was, however, a higher than normal incidence of psychiatric and stress related illness.A large battery of tests was uniformly performed on all the patients, with further investigations as necessary.Now it has been agreed that full epidemiological studies are to be undertaken into the incidence of ill health among UK Gulf war veterans and into their reproductive health.In answering the criticism that these expensive studies should have been instigated earlier, I have tried to show how difficult it has been to decide exactly when this decision could have been made.Early on there were very few patients and no evidence of a syndrome.At all stages we have liaised with our counterparts in the United States.They embarked a little earlier on similar studies as they had similar results to their investigations but dealt with greater numbers.An important reason for writing this letter is because our armed forces may well be placed in similar alien environments in future and we owe it to them to provide the best medical support, which of course includes planned protective and scientifically justified measures against likely threats to their health.
EXSECTION OF THE KNEE-JOINT, WITH REPORT OF A CASE OF COMPLETE DISLOCATION OF THE KNEE, OF NINE YEARS' STANDING, AND WITH SPECIAL REFERENCE TO METHODS OF FIXATION.
Authors: S. F. FORBES
Journal: JAMA (1895)

Early in May, 1894, Maggie D., a wholesome young girl of German parentage, came under my care for a slight malarial trouble. In the course of the attendance, which was only three or four days, I discovered that the girl was severely crippled in her left leg; She was otherwise a healthy, robust, well-formed young woman, of 21 years of age; but she was utterly unable to move a step, even about the house, from chair to chair, without the aid of a crutch, which she kept constantly at her side. In attempts at locomotion, or standing, with this leg, the toes of the foot only touched the ground, and the body sank down a foot or more, and gave the appearance as if falling. Her story was, that nine years before, when 12 years of age, while running on the frozen ground, her left foot fastened in a hole
Diabetes and the quality and outcomes framework
Authors: Colin Kenny
Journal: BMJ (2005)

tory tract infection: this possible link to stroke now needs to be investigated.This theory is supported by data from the Newcastle Heart Project showing that plasma concentrations of IgG and staphylococcal toxin are significantly higher in South Asian than European white populations. 12 13 Although smoking is common in Bangladeshi men and almost certainly contributes to explaining some of the high risk, it is uncommon in Bangladeshi women. 2 6 Chewing tobacco as paan (betel leaf) is common in both sexes, however, and in future epidemiological studies researchers should ascertain total tobacco consumption, as well as using more stringent methods than hitherto for collecting accurate data. 14e propose that the explanation for high rates of stroke in Bangladeshis lies in their heavier burden of some established risk factors, their socioeconomic deprivation, and some novel risk factors that are yet to be characterised.Pending deeper understanding of the causes, doctors should be aware of the high risk of stroke and stroke fatality in Bangladeshis even in the absence of raised blood pressure.
Abstract A18: p53 regulates epithelial-mesenchymal transition through microRNAs targeting ZEB1 and ZEB2
Authors: Taewan Kim, Tae Jin Lee, Young-Jun Jeon, Pascal Pineau, Anne Dejean, Carlo Maria Croce
Journal: Cancer Research (2012)

Abstract p53 suppresses tumor progression and metastasis. Epithelial-mesenchymal transition (EMT) is a key process in tumor progression and metastasis. The transcription factors ZEB1 and ZEB2 promote EMT. Here we show that p53 suppresses EMT by repressing expression of ZEB1 and ZEB2. By profiling 92 primary hepatocellular carcinomas (HCCs) and 9 HCC cell lines, we found that p53 upregulates microRNAs including miR-200 and miR-192 family members. The miR-200 family members transactivated by p53 then repress ZEB1/2 expression. p53-regulated miR-192 family members also repress ZEB2 expression. Inhibition or over-expression of the microRNAs affects p53-regulated EMT by altering ZEB1 and ZEB2 expression. Our findings indicate that p53 can regulate EMT, and that p53-regulated microRNAs are critical mediators of p53-regulated EMT. Citation Format: Taewan Kim, Tae Jin Lee, Young-Jun Jeon, Pascal Pineau, Anne Dejean, Carlo Maria Croce. p53 regulates epithelial-mesenchymal transition through microRNAs targeting ZEB1 and ZEB2 [abstract]. In: Proceedings of the AACR Special Conference on Noncoding RNAs and Cancer; 2012 Jan 8-11; Miami Beach, FL. Philadelphia (PA): AACR; Cancer Res 2012;72(2 Suppl):Abstract nr A18.
Cyanosis attributable to right to left shunt in the carcinoid syndrome.
Authors: D Pitcher, P Fletcher, G Laszlo, G Keen, J R Rees
Journal: BMJ (1986)

Cyanosis attributable to right to left shunt in the carcinoid syndrome SIR,-Dr G W Stewart and colleagues (1 March, p 589) described an interesting case of pronounced arterial hypoxaemia in a patient with the carcinoid syndrome.In the absence ofpulmonary metastases they attributed the hypoxaemia to intrapulmonary shunting through microscopic arteriovenous fistulas.The data presented, however, do not exclude an alternative explanation-right to left shunting through a patent foramen ovale.Although right to left shunting through the foramen ovale is well recognised in patients with pulmonary hypertension,'"3 it may also occur in the presence of normal pulmonary artery and right heart pressures, apparently as a result of reduced right atrial compliance.4Thus though mean left atrial pressure may exceed mean right atrial pressure, during atrial filling right atrial pressure rises disproportionately, causing phasic shunting across the interatrial septum.Right atrial compliance
The Motility of Interposition in Patients With Esophageal Carcinoma After Reconstructive Esophageal Surgery
Authors: CHIA-HUNG KAO, SHYH-JEN WANG, CHIH-YI CHEN, CHUN-LIEH CHEN, SHIN-HWA YEH
Journal: Clinical Nuclear Medicine (1993)

This study evaluated the motility of interposition in patients with esophageal carcinoma after different reconstructive operations of the esophagus using an esophageal radionuclide transit test. A modified standard method was used to calculate total mean transit time (MTT), residual fraction (RF), and retrograde index (RI) in the supine position at least 6 months after the reconstructive operations of the esophagus. Eleven patients with esophagogastrostomy (EG), 7 patients with esophagoiliocolostomy (EIC), and 25 normal volunteers with a similar distribution of ages were included in this study for comparison. The values of the scintigraphic parameters in patients with esophageal reconstruction were significantly worse than in normal volunteers (P< 0.05). In addition, the MTT and RF in patients with EG were higher than in patients with EIC (P < 0.05), but no significant difference in RI was demonstrated. In conclusion, the motility of interposition became worse after reconstructive operations, but reconstruction with the colon can preserve better motility than with the stomach
ASPIRATION OF BARIUM FACILITATING DEATH IN A DEBILITATED PATIENT
Authors: S. J. Sullivan
Journal: JAMA (1934)

This case is reported because of the relative rarity of fatalities in connection with gastro-intestinal roentgenograms of persons who do not have fistulas between the alimentary and the respiratory tract.  REPORT OF CASE  Mrs. C., aged 70, admitted to the hospital, March 1, 1934, following forty-eight hours of severe vomiting, had had a cerebral hemorrhage in 1929. She was icteric in color, with symptoms of gallbladder disease, a chronic myocarditis and an advanced arteriosclerosis. Dizzy spells and loss of weight had been increasing complaints for the past five years. The blood chemistry showed an increased nonprotein nitrogen and the urine showed a trace of albumin and casts. The blood pressure was 118 systolic, 78 diastolic, and there was a leukocytosis of 13,000 with 86 per cent polymorphnuclears.  The vomiting had produced an extreme dehydration and debility and was caused by any food or liquid. It was spasmodic. Subcutaneous fluids and
Extensive spontaneous plasticity of corticospinal projections after primate spinal cord injury
Authors: Ephron S Rosenzweig, Gregoire Courtine, Devin L Jindrich, John H Brock, Adam R Ferguson, Sarah C Strand, Yvette S Nout, Roland R Roy, Darren M Miller, Michael S Beattie, Leif A Havton, Jacqueline C Bresnahan, V Reggie Edgerton, Mark H Tuszynski
Journal: Nature Neuroscience (2010)
Anticoagulant therapy and central nervous system complications in patients with prosthetic valve endocarditis.
Authors: W R Wilson, J E Geraci, G K Danielson, R L Thompson, J A Spittell, J R Washington, E R Giuliani
Journal: Circulation (1978)

Among 52 cases of prosthetic valve endocarditis, adequate anticoagulant therapy was administered in 38 and discontinued or given in subtherapeutic dosage in 14. Our data suggest that anticoagulant therapy does not appreciably increase morbidity or mortality in patients with prosthetic valve endocarditis. On the contrary, in our patients the incidence of major clinical CNS (central nervous system) complications was increased and the mortality was higher if anticoagulant therapy was discontinued. CNS complications occurred in 10 of the 14 patients without adequate anticoagulant therapy and in three of the 38 with adequate anticoagulant therapy. Mortality was 57% among those treated without adequate anticoagulation and 47% among those with adequate anticoagulation. At autopsy, CNS complications were thought to be the primary cause of five of the eight deaths in cases without adequate anticoagulation.
Alveolization: does “A” stand for appropriate morphometry?
Authors: H. Fehrenbach
Journal: European Respiratory Journal (2004)

To the Editor: 

In a recent issue of the European Respiratory Journal , Hind and Maden 1 reported a series of well-designed experiments conducted to further enlighten the role of retinoic acid in alveolar regeneration. The ability of retinoic acid to rescue emphysematous lungs, which was initially reported by Massaro and Massaro 2, has attracted great attention. However, the potential of retinoic acid is still controversially discussed 3. Unquestionably, the study of Hind and Maden 1 added important new data to our knowledge of the role of retinoic acid in alveolization, as was emphasised in an accompanying editorial 4. In their editorial, Torday and Rehan 4 ask “Does “A” stand for alveolization?”. Can this question be answered on the basis of the data presented?

In the context of lung development, alveolization is recognised as the process of subdivision of lung saccules by outgrowing secondary septa, which results in an increased number of smaller …
Costs of Home Versus Inpatient Treatment for Fever and Neutropenia: Analysis of a Multicenter Randomized Trial
Authors: Ann M. Hendricks, Elizabeth Trice Loggers, James A. Talcott
Journal: Journal of Clinical Oncology (2011)

For patients with cancer who have febrile neutropenia, relative costs of home versus hospital treatment, including unreimbursed costs borne by patients and families, are poorly characterized. We estimated costs from a randomized trial of patients with low-risk febrile neutropenia for whom outpatient care was feasible, comparing inpatient treatment with discharge to home care after inpatient observation.We collected direct medical and self-reported indirect costs for 57 inpatient and 35 outpatient treatment episodes of patients enrolled in a randomized trial from 1996 through 2000. Charges from hospital bills were converted to costs using Medicare cost-to-charge ratios. Patients kept daily logs of out-of-pocket payments and time spent by informal caregivers providing care. Dollar amounts were standardized to June 2008.Mean total charges for the hospital arm were 49% higher than for the home treatment arm ($16,341 v $10,977; P < .01). Mean estimated total costs for the hospital arm were 30% higher ($10,143 v $7,830; P < .01). Inspection of sparse available data suggests that payments made were similar by treatment arm. Inpatients and their caregivers spent more out of pocket than their outpatient counterparts (mean, $201 v $74; P < .01). Informal caregivers for both treatment arms reported similar time caring and lost from work.Home intravenous antibiotic treatment was less costly than continued inpatient care for carefully selected patients with cancer having febrile neutropenia without significantly increased indirect costs or caregiver burden.
Pregnancy is contraindication for rubella vaccination still
Authors: P. Tookey
Journal: BMJ (2001)

Many orthopaedic surgeons do not think of patients just as malfunctioning elbowsEditor-As an orthopaedic surgeon specialising entirely in elbow and shoulder disorders I could not let the editor's choice on restoring the soul of medicine slip by without comment. 1Unlike the orthopaedic surgeon you refer to, I do read the BMJ each week (although I confess that my wife, a paediatrician, pays the subscription).I also note that in the editorial from the previous week on shoulder pain at work the one year prevalence of shoulder pain in the general population was estimated to be 20-50%, but only 40-50% of those affected consult a primary care physician, let alone an orthopaedic surgeon. 2 Most musculoskeletal complaints are influenced, if not caused, by circumstances of daily life.This is not just physical activity but psychosocial factors, including job pressures and stress at home.The commonest elbow complaint is tennis elbow.It is a considerable problem to those who have it; symptoms are undoubtedly influenced by a range of factors, and it is eminently suited to an integrated management approach.Those affected should consider changing the pattern of their lives, reduce stress, and seek advice and help from complementary and conventional practitioners, and they may even benefit from seeing an orthopaedic surgeon.Orthopaedic surgeons should read the BMJ, but equally the BMJ should be aware that many orthopaedic surgeons do not think of patients just as malfunctioning elbows.
Alzheimer's Disease: Unskilled Vulgarity Decays Into Stunning Artistic Genius-Reply
Authors: Judith M. Zarit
Journal: JAMA (1988)

<h3>In Reply.</h3> —We appreciate the interest shown in our article by Drs Wright and Abis dla Clara. We too noted the impressionistic appearance of the painting produced by the patient with Alzheimer's disease after five years of illness and we mentioned it in our original report. A key feature distinguishing his style from that of Van Gogh is its inadvertence. The patient with Alzheimer's disease was pleased with his original productions and was striving to reproduce their quality. He was unable to appreciate any change in his ability as his disease progressed and he discussed all his art (even the latest highly degenerated sketches) with equal enthusiasm. In contrast to our patient's unintended impressionistic style that stemmed from his inability to achieve his former level of perspective, color choice, and definition, the style of Van Gogh was highly determined and was executed with genius. The productions by our patient might
Innovation in Health Care Leadership
Authors: David Blumenthal, Amy Compton-Phillips, Delos M. Cosgrove, Gregory D. Curfman, Thomas Delbanco, Thomas H. Lee, Vivian S. Lee, Steven H. Lipstein, Pravene A. Nath, Meredith B. Rosenthal
Journal: New England Journal of Medicine (2014)

A growing demand for transparency has brought innovation in many areas of health care. In a video roundtable, three expert panels discuss the benefits and the challenges of these innovations, examining transparency in provider-driven quality data, in pricing, and in medical records.
The FDA, E-Cigarettes, and the Demise of Combusted Tobacco
Authors: Nathan K. Cobb, David B. Abrams
Journal: New England Journal of Medicine (2014)

The FDA has announced its intention to regulate e-cigarettes as tobacco products. As it moves forward, the agency, with help from tobacco-control advocates, state governments, and Congress, can drive a wedge between regulated clean-nicotine products and combustible cigarettes.
Cell-mediated immunity in iron- and vitamin-deficient children.
Authors: C Bhaskaram, V Reddy
Journal: BMJ (1975)

DiscussionAcrodermatitis enteropathica presents in early infancy with alopecia, diarrhoea, and a pustular, bullous, or eczematous eruption.The face, extremities, and areas around the orifices are most severely affected.Additional features include nail dystrophy, dental caries, and retar- dation of growth and sexual development.It is thought to be inherited as an autosomal recessive.The course is intermittent but progressive and if untreated is usually fatal within three years.3Treatment with di-iodohydroxyquinoline, first described in 1953,4 was the mainstay until 1973, when zinc deficiency was proposed as the basis of the disorder and success was described with zinc sulphate.This suggestion was supported by similarities between the disorder and zinc deficiency in animals.5 Zinc sulphate is of minimal toxicity as compared with di-iodohydroxyquinoline, and this, allied to its dramatic effectiveness, makes it the treatment of choice.The serum zinc estimation were performed by the National Occupational Hygiene Service, Manchester.
BLOOD PRESSURE REDUCTION WITH THE NOVEL DUAL-ACTING ANGIOTENSIN RECEPTOR NEPRILYSIN INHIBITOR LCZ696: A RANDOMIZED, MULTICENTER, DOUBLE-BLIND, PLACEBO-CONTROLLED, ACTIVE-COMPARATOR STUDY
Authors: Michael Bö;hm, Luis M. Ruilope, Yves Lacourciere, Andrej Dukat, Jim Gong, Martin Lefkowitz
Journal: Journal of the American College of Cardiology (2010)
Sensitization to self (virus) antigen by in situ expression of murine interferon-gamma.
Authors: M S Lee, M von Herrath, H Reiser, M B Oldstone, N Sarvetnick
Journal: Journal of Clinical Investigation (1995)

Autoimmune disease results from inflammatory destruction of tissues by aberrant self-reactive lymphocytes. We studied the autoimmune potential of T lymphocytes immunologically ignorant of viral antigens acting as self antigens and whether the host defense molecule IFN-gamma could stimulate these cells to cytotoxic competency. For this purpose, we produced double transgenic mice expressing pancreatic IFN-gamma as well as lymphocytic choriomeningitis virus (LCMV) nucleoprotein (NP) or glycoprotein (GP) antigen. 100% of the NP+/IFN-gamma+ mice became diabetic before 2 mo of age, while none of the NP single transgenic littermates and only 10% of IFN-gamma single transgenic littermates did. Strikingly, NP+/IFN-gamma+ mice spontaneously developed cytotoxic T lymphocyte activity on LCMV-infected targets and vaccinia virus-NP-infected ones without prior LCMV infection but NP+/IFN-gamma- mice did not, which indicates specific sensitization to the viral antigen by IFN-gamma. These results suggest that lymphocytes ignorant of self antigens can be activated by IFN-gamma released after immunologic stimulation such as viral infection. This mechanism may account for the loss of apparent tolerance to self antigens in autoimmune diseases such as insulin-dependent diabetes mellitus.
The Case of Mr. Cassan
Authors: W. A. Carline
Journal: BMJ (1884)

<h3>Introduction</h3> Patients aged 60 or over account for over half of the severely injured trauma patients and a traumatic brain injury is the most common injury sustained. Many of these patients are taking antiplatelet medications but there is clinical equipoise about the role of platelet transfusion in patients with traumatic intracranial haemorrhage (ICH) taking prior antiplatelet medications. <h3>Method</h3> A prepiloted survey was designed to explore a range of clinical issues in managing patients taking antiplatelet medications admitted with a traumatic brain injury. This was sent via email to consultants and specialty registrar members of a variety of relevant UK societies and working groups in the fields of emergency medicine, critical care, neurosurgery and haematology. <h3>Results</h3> 193 responses were received, mostly from colleagues in emergency medicine, neurosurgery, anaesthesia and haematology. Respondents indicated that there is a lack of evidence to support the use of platelet transfusion in this patient population but also lack of evidence of harm. Results also demonstrate uncertainties as to whether platelets should be given to all or some patients and doubt regarding the value of viscoelastic testing. <h3>Discussion</h3> Our survey demonstrates equipoise in current practice with regards to platelet transfusion in patients with a traumatic ICH who are taking antiplatelet medication. There is support for additional trials to investigate the effect of platelet transfusion in this rising population of older, high-risk patients, in order to provide a better evidence-base for guideline development.