tbuckley/cabot-search huggingface dataset:
Local confidential inquiry into avoidable factors in deaths from stroke and hypertensive disease.
Authors: J N Payne, P C Milner, C Saul, I R Bowns, D R Hannay, L E Ramsay
Journal: BMJ (1993)

OBJECTIVE--To audit avoidable deaths from stroke and hypertensive disease. DESIGN--Details of care before death were obtained from general practitioners and other doctors, anonymised, and assessed by two experts against agreed minimum standards of good practice for detecting and managing hypertension. SETTING--Health authority with population of 250,000. SUBJECTS--All patients under 75 years who died of stroke, hypertensive disease, or hypertension related causes during November 1990 to October 1991. MAIN OUTCOME MEASURES--Presence of important avoidable factors and departures from minimum standards of good practice. RESULTS--Adequate information was obtained for 88% (123/139) of eligible cases. Agreement between the assessors was mostly satisfactory. 29% (36/123, 95% confidence interval 21% to 37%) of all cases and 44% (36/81, 34% to 55%) of those with definite hypertension had avoidable factors that may have contributed to death. These were most commonly failures of follow up and continuing smoking. Assessment against standards of minimum good practice showed that care was inadequate but not necessarily deemed to have contributed to death, in a large proportion of patients with definite hypertension. Common shortcomings were inadequate follow up, clinical investigation, and recording of smoking and other relevant risk behaviours. CONCLUSIONS--This method of audit can identify shortcomings in care of patients dying of hypertension related disease.
Prevention by DV-7028, a selective 5-HT2 receptor antagonist, of the formation of coronary thrombi in dogs
Authors: Y. Morishima, T. Tanaka, K. Watanabe, T. Igarashi, M. Yasuoka, T. Shibano
Journal: Cardiovascular Research (1991)

Study objective — The aim was to determine the role of 5-HT derived from activated platelets in the formation of intracoronary thrombi in dogs. Design — Canine coronary thrombi were produced by inserting a small catheter filled with collagen powder into the endothelial-injured partially occluded left anterior descending coronary artery. The effects of intravenous DV-7028, a selective 5-HT2 receptor antagonist (bolus of 0.1 mg·kg−1, followed by 0.3 mg·kg−1·h−1 by infusion), and intravenous aspirin (1 mg·kg−1, followed by 3 mg·kg−1·h−1) in this experimental thrombus model were examined. Subjects — 43 dogs of either sex were used. In experiment A, DV-7028 (n = 12) or saline (n = 11) was given. In experiment B, aspirin (n = 10) or saline (n = 10) was given. Measurements and main results — DV-7028 significantly reduced the formation of coronary thrombi by 51% and attenuated the decrease in coronary blood flow without affecting systemic blood pressure and heart rate. There was a significant relationship between the thrombus weight and the decrease in coronary blood flow (p<0.005). Aspirin failed to prevent the formation of coronary thrombi. Conclusion — The results suggest that 5-HT is involved in the platelet thrombosis and that inhibitory effect of DV-7028, a 5-HT2 receptor antagonist, on coronary thrombus formation was superior to that of aspirin.
Prioritizing Oregon's hospital resources. An example based on variations in discretionary medical utilization
Authors: E. S. Fisher
Journal: JAMA (1992)

<h3>Objective.</h3> —To provide an alternative to Oregon's treatment-specific approach to rationing, we propose a prioritization based on the local hospital resources invested in discretionary medical admissions. <h3>Design.</h3> —We used 1988 Oregon hospital discharge data to determine age- and sex-adjusted per-capita rates of inpatient days for discretionary medical admissions (for high-variation medical conditions) in each of 33 hospital service areas. Potential ceiling rates were defined based on prevailing utilization rates for discretionary medical admissions in each hospital service area. Savings were calculated under the assumption that resources allocated for inpatient treatment of these conditions in areas that exceed the ceiling rates were reduced accordingly. <h3>Setting.</h3> —Nonfederal, acute-care hospitals used by Oregon residents. <h3>Study population.</h3> —Oregon residents. <h3>Main Outcome Measures.</h3> —Savings were defined in terms of patient days, hospital beds, hospital charges, and average costs. <h3>Results.</h3> —Among the 16 largest hospital service areas, patient-day rates for discretionary medical admissions ranged from 188 to 335 patient days per thousand. Potential savings from applying different ceiling rates ranged from $0.4 million to $94.7 million per year. If the rate in the state capital (Salem) were used as the ceiling (218 days per thousand), then 238 beds could be closed in 20 hospital service areas, for an estimated cost savings of $47.3 million. <h3>Conclusions.</h3> —Hospital resources invested in discretionary admissions in high-rate areas represent an important potential source of funds for reallocation to meet other defined health care needs. Setting limits based on units of health care supply (eg, beds, capital equipment, and physicians) should be considered as an option for resource reallocation within health care. (<i>JAMA</i>. 1992;267:1925-1931)
Rescue thrombolysis may work even though primary thrombolysis has failed
Authors: J. P H Drenth, A. Uppelschoten, T. E H Hooghoudt, E. J P Lamfers
Journal: BMJ (1998)

EDITOR—Gershlick and More discuss the new therapeutic options for myocardial infarction and suggest that patients in whom thrombolysis fails should receive rescue angioplasty.1 We challenge this view and propose that rescue thrombolysis might be considered in cases in which primary thrombolysis has failed.

Two trials have compared rescue angioplasty with conservative management, with equivocal results. 2 3 One trial randomised patients with an occluded artery three hours after the onset of symptoms; it detected a non-significant reduction in mortality in the angioplasty group …
Prevention of variceal rebleeding during the course of endoscopic injection sclerotherapy (EIS): A randomized pilot trial testing nadolol (N)
Authors: G. Fornaciari, C. Gumina, G. Bertoni, C. Bassi, R. Conigliaro, M. Giglioli, G. Giovannini, M.G. Mortilla, E. Ricci, G. Bedogni
Journal: Journal of Hepatology (1990)
602 ASSOCIATION BETWEEN HCV INFECTION CONTROL AND DEVELOPMENT OF A SPECIFIC CYTOTOXIC CELLULAR RESERVOIR PD1 NEGATIVE
Authors: S. Benito, J.R. Larrubia, E. Sanz-de-Villalobos, M. Calvino, M.L. Garcia-Buey, F. Gonzalez-Mateos, A. Gonzalez-Praetorius, J. Miquel, A. Bienvenido, T. Parra
Journal: Journal of Hepatology (2008)
Randomized Placebo Controlled Study of Ciclesonide in Preschool Children with Recurrent Wheeze and a Positive Asthma Predictive Index or Atopy
Authors: P.L.P. Brand, K. Jagannath, M.L. Garcia-Garcia, A. Morison, J.H. Vermeulen, H.C. Weber
Journal: Journal of Allergy and Clinical Immunology (2011)
PEPCK Gene as Model of Inhibitory Effects of Insulin on Gene Transcription
Authors: Richard M O'Brien, Daryl K Granner
Journal: Diabetes Care (1990)

Regulation of gene transcription is a major action of insulin. Most of the &amp;gt;20 examples of this effect involve the stimulation of transcription, but a few involve an inhibition. The inhibition of transcription of the phosphoenolpyruvate carboxykinase (PEPCK) gene has been studied in detail. Most of this effect is exerted at the level of transcription initiation. Hormone effects on transcription are thought to be mediated through cisacting DNA sequences located in the 5'-flanking sequence adjacent to the transcription initiation site. The techniques of transient and stable transfection of fusion genes containing various segments of the PEPCKgene promoter are being used to locate the insulinresponsive sequences.
The rationing debate: Maximising the health of the whole community. The case against: what the principal objective of the NHS should really be
Authors: J. Harris
Journal: BMJ (1997)

Patients rationally want three things from health care. They want the treatment that will give them maximum life expectancy coupled with the best quality of that life, and above all they want the best possible opportunity of getting the combination of quantity and quality of life available to them given their personal health status. I believe that each citizen has an equal claim on the protection of the community as expressed by its public healthcare system, and this means that each is entitled to an equal chance of having his or her, necessarily individual, health needs respected by any publicly funded healthcare system.

It is common ground I suppose that we have to think about the ethics both of means and of ends. Even if it were to be accepted that the healthcare system ought principally to aim at maximising aggregate health gain, it does not follow that the most effective ways of achieving this are legitimate. If all seriously ill people were to be allowed to die this might dramatically improve the aggregate health of the community at large. I hope such a policy would not seem ethically defensible. Yet this is precisely what measures which use quality adjusted life years, or similar mechanisms, do: they systematically accord preference to those who have better health prospects, and, by selecting against those with worse prospects, tend to improve the aggregate health status of the whole community at the expense of the life chances of those with poorer prognosis.

We should notice that to make aggregate improvements a principal objective, even if not the only objective, is to imply the subordination of the health needs of individuals to something very abstract, and in some circumstances something very trivial indeed–namely, the improved health status of the whole community. For this could imply …
Leukotriene C<sub>4</sub> and histamine in early allergic reaction in the nose
Authors: H. Bisgaard, C. Robinson, F. Rømeling, N. Mygind, M. Church, S. T. Holgate
Journal: Allergy (1988)

We have examined the measurements of LTC4 and histamine in nasal lavage fluids and blown secretions as a possible model of the early mediator events during nasal allergy. A nasal challenge with grass pollen extract was undertaken on two separate occasions in 20 patients with a history of seasonal rhinitis and a positive immediate skin test to grass pollen. A 2 ml nasal lavage was performed before allergen challenge, and blown secretion collected separately 15 min after the provocation, followed by a final 2 ml nasal lavage. The dilution of nasal secretion by the lavage fluid was determined using 99mTc-labelled albumin as an exogenous marker added to the fluid. The amounts of admixture in the nasal lavages did not correlate to the concentrations of LTC4 and histamine, indicating that the variable amounts of nasal secretion in nasal lavage do not constitute a confounding variable for measurements of LTC4 and histamine. In the pre-challenge lavages, the median concentrations, of LTC4 and histamine were 1.7 and 52 nmol/l respectively. Following allergen challenge neither LTC4 nor histamine measured in nasal lavage showed any significant change from pre-challenge baseline values. However, measurements of both mediators in the blown secretion showed a significantly higher concentration than in the pre- or post-challenge lavage samples, compatible with transitory release during the acute allergic reaction. However, it seems doubtful whether measurements of LTC4 or histamine can be compared between blown secretion and nasal lavage fluid, even if the dilution factor is disregarded.(ABSTRACT TRUNCATED AT 250 WORDS)
Onset of acute myocardial infarction - circadian variation and triggers
Authors: M. C Cohen, J. E Muller
Journal: Cardiovascular Research (1992)

Journal Article Onset of acute myocardial infarction – circadian variation and triggers Get access Mylan C Cohen, Mylan C Cohen Institute for Prevention of Cardiovascular Disease, Harvard Medical School, Kennedy 5, New England Deaconess Hospital, 1 Autumn Street, Boston, MA 02215, USA: M C Cohen, J E Muller. Correspondence to Dr Cohen. Search for other works by this author on: Oxford Academic PubMed Google Scholar James E Muller James E Muller Institute for Prevention of Cardiovascular Disease, Harvard Medical School, Kennedy 5, New England Deaconess Hospital, 1 Autumn Street, Boston, MA 02215, USA: M C Cohen, J E Muller. Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, Volume 26, Issue 9, September 1992, Pages 831–838, https://doi.org/10.1093/cvr/26.9.831 Published: 01 September 1992 Article history Received: 19 March 1992 Accepted: 27 May 1992 Published: 01 September 1992
The antiandrogenic effect of progesterone on the hamster flank organ
Authors: A. J. M. VERMORKEN, C. M. A. A. GOOS, H. M. J. ROELOFS
Journal: British Journal of Dermatology (1980)

Progesterone, topically applied, prevents the stimulation of the hamster flank organ by testosterone, but not by dihydrotestosterone. 5 alpha-Dihydroprogesterone does not prevent stimulation by either of the two androgenic hormones. Neither progesterone nor 5 alpha-dihydroprogesterone stimulate the flank organ to any extent. Implications on the use of progesterone in acne therapy are discussed.
CLINICAL REPORT ON SERUM DIAGNOSIS IN TYPHOID FEVER.
Authors: E. BATES BLOCK
Journal: JAMA (1897)

The work upon serum diagnosis in typhoid fever, which I shall report, was begun with Dr. Camac in October 1896, at a time when most of the cases in the Hospital were either far advanced in the disease or convalescent, so that my first experience was with cases in which the diagnosis had been previously definitely determined. In some of these cases the blood was given to me for examination without any knowledge on my part of the clinical diagnosis, while in the majority of the cases I was thoroughly familiar with the clinical course of the disease before the tests were made. I have since had occasion to test many cases in which the diagnosis was uncertain. I thought it best to omit in this report the examinations of specmens sent me from cases outside of the hospital, as I can not in every case be sure of the
Authors' reply to Moylett
Authors: J. A. Smith, N. Mays
Journal: BMJ (2012)

As our paper made clear,1 evidence points to the importance of sufficient and high quality management support for clinical commissioning groups (CCGs). However, we had to choose which aspects could be discussed meaningfully in a short article.2 The Framework for Procuring External Support for Commissioners was not taken up by primary care trusts to …
The need for a consensus on the definition of remission of autoimmune pancreatitis after steroid treatment
Authors: Myung-Hwan Kim, Sung-Hoon Moon
Journal: Gut (2010)

We congratulate Kamisawa et al on their recent study1 in which they report the rate of remission and relapse after steroid treatment in autoimmune pancreatitis (AIP). However, we are uncertain that the definition of remission is clear in their study. The authors defined remission as the ‘disappearance of clinical symptoms and resolution of the pancreatic and/or extrapancreatic manifestations on imaging studies’ in their ‘Methods’ section. However, they contradictorily stated that irregularity of the pancreatic ducts and/or bile duct stenosis remained in some patients at remission in their ‘Results’ section.

The treatment …
Focus: Westminster Consultants blamed about consultants' complaints
Authors: J. Warden
Journal: BMJ (1997)

Recalcitrant … devoid of compassion or humility … a shame to their profession. Consultants in the NHS, or a minority of them, are sometimes suspected of failing in their duties. But seldom have they been subjected to such an indictment as last week by a Commons select committee.

What towering scandal of medical malpractice could have provoked such an attack? In fact there was no such scandal. The select committee was angry about the cavalier attitude some consultants adopt towards complaints about non-clinical mishaps. This causes them to fall foul of the health service ombudsman and, inevitably, the parliamentary select committee which monitors his …
Bacterial protease inhibitors
Authors: Claudiu T. Supuran, Andrea Scozzafava, Brian W. Clare
Journal: Medicinal Research Reviews (2002)

Abstract Serine‐, cysteine‐, and metalloproteases are widely spread in many pathogenic bacteria, where they play critical functions related to colonization and evasion of host immune defenses, acquisition of nutrients for growth and proliferation, facilitation of dissemination, or tissue damage during infection. Since all the antibiotics used clinically at the moment share a common mechanism of action, acting as inhibitors of the bacterial cell wall biosynthesis or affecting protein synthesis on ribosomes, resistance to these pharmacological agents represents a serious medical problem, which might be resolved by using new generation of antibiotics, possessing a different mechanism of action. Bacterial protease inhibitors constitute an interesting such possibility, due to the fact that many specific as well as ubiquitous proteases have recently been characterized in some detail in both gram‐positive as well as gram‐negative pathogens. Few potent, specific inhibitors for such bacterial proteases have been reported at this moment except for some signal peptidase, clostripain, Clostridium histolyticum collagenase, botulinum neurotoxin, and tetanus neurotoxin inhibitors. No inhibitors of the critically important and ubiquitous AAA proteases, degP or sortase have been reported, although such compounds would presumably constitute a new class of highly effective antibiotics. This review presents the state of the art in the design of such enzyme inhibitors with potential therapeutic applications, as well as recent advances in the use of some of these proteases in therapy. © 2002 Wiley Periodicals, Inc. Med Res Rev, 22, No. 4, 329–372, 2002; Published online in Wiley InterScience ( www.interscience.wiley.com ). DOI 10.1002/med.10007
Dual Functionality of Cyclooxygenase-2 as a Regulator of Tumor Necrosis Factor–Mediated G <sub>1</sub> Shortening and Nitric Oxide–Mediated Inhibition of Vascular Smooth Muscle Cell Proliferation
Authors: Asifa Haider, Irene Lee, Jerzy Grabarek, Zbigniew Darzynkiewicz, Nicholas R. Ferreri
Journal: Circulation (2003)

Cyclooxygenase (COX)-2 contributes to vascular smooth muscle cell (VSMC) proliferation induced by tumor necrosis factor (TNF) and angiotensin II. The present study demonstrates, however, that depending on prevailing conditions, COX-2-derived prostanoids may also inhibit VSMC proliferation.TNF-alpha stimulated proliferation of VSMCs by shortening the G1 phase of the cell cycle. This effect was abolished by NS-398, a selective COX-2 inhibitor. Addition of TNF did not affect the protein-to-DNA ratio, measured by flow cytometry, suggesting that TNF does not induce VSMC hypertrophy. Inhibition of nitric oxide synthase (NOS) activity attenuated TNF-mediated increases in prostaglandin (PG) I2 synthesis, whereas thromboxane (TX) A2 production and COX-2 protein expression were unaffected. Moreover, inhibition of NOS activity increased TNF-mediated proliferation by approximately 23%. Thus, NO preferentially stimulates PGI2 production, suggesting that production of NO by VSMCs challenged with TNF limits the ability of the cytokine to increase proliferation. NO donors increased COX-2 protein expression and PGI2 synthesis, had no effect on TXA2 production, and decreased cell numbers by 50%, indicating that expression of COX-2 per se might not be sufficient to support proliferation. The effects of NO donors were prevented when COX-2 activity was inhibited with NS-398.The COX-2-dependent proliferative response of VSMCs to TNF was modulated in an NO-dependent manner, and PGI2 derived from COX-2 might contribute to the antiproliferative effect of NO donors.
Rebleeding prophylaxis improves outcomes in patients with hepatocellular carcinoma. A multicenter case-control study
Authors: Cristina Ripoll, Joan Genescà, Isis K. Araujo, Isabel Graupera, Salvador Augustin, Marta Tejedor, Isabel Cirera, Carles Aracil, Margarita Sala, Manuel Hernandez-Guerra, Elba Llop, Angels Escorsell, Maria Vega Catalina, Nuria Cañete, Agustin Albillos, Càndid Villanueva, Juan G. Abraldes, Rafael Bañares, Jaime Bosch
Journal: Hepatology (2013)

Outcome of variceal bleeding (VB) in patients with hepatocellular carcinoma (HCC) is unknown. We compared outcomes after VB in patients with and without HCC. All patients with HCC and esophageal VB admitted between 2007 and 2010 were included. Follow-up was prolonged until death, transplantation, or June 2011. For each patient with HCC, a patient without HCC matched by age and Child-Pugh class was selected. A total of 292 patients were included, 146 with HCC (Barcelona Classification of Liver Cancer class 0-3 patients, A [in 25], B [in 29], C [in 45], and D [in 41]) and 146 without HCC. No differences were observed regarding previous use of prophylaxis, clinical presentation, endoscopic findings, and initial endoscopic treatment. Five-day failure was similar (25% in HCC versus 18% in non-HCC; P = 0.257). HCC patients had greater 6-week rebleeding rate (16 versus 7%, respectively; P = 0.025) and 6-week mortality (30% versus 15%; P = 0.003). Fewer patients with HCC received secondary prophylaxis after bleeding (77% versus 89%; P = 0.009), and standard combination therapy was used less frequently (58% versus 70%; P = 0.079). Secondary prophylaxis failure was more frequent (50% versus 31%; P = 0.001) and survival significantly shorter in patients with HCC (median survival: 5 months versus greater than 38 months in patients without HCC; P < 0.001). Lack of prophylaxis increased rebleeding and mortality. On multivariate analysis Child-Pugh score, presence of HCC, portal vein thrombosis, and lack of secondary prophylaxis were predictors of death.Patients with HCC and VB have worse prognosis than patients with VB without HCC. Secondary prophylaxis offers survival benefit in HCC patients.
Human red blood cells at work: identification and visualization of erythrocytic eNOS activity in health and disease
Authors: Miriam M. Cortese-Krott, Ana Rodriguez-Mateos, Roberto Sansone, Gunter G. C. Kuhnle, Sivatharsini Thasian-Sivarajah, Thomas Krenz, Patrick Horn, Christoph Krisp, Dirk Wolters, Christian Heiß, Klaus-Dietrich Kröncke, Neil Hogg, Martin Feelisch, Malte Kelm
Journal: Blood (2012)
Some People Are Dead When They're Cold and Dead
Authors: Paul S. Auerbach
Journal: JAMA (1990)

Extreme environmental hypothermia is a complication of harsh conditions encountered during mountaineering, Nordic skiing, polar exploration, scuba diving, and remote river expeditions. Its physiological complexities have only recently been fully appreciated and have generated enthusiasm for new therapies. Because patients with extreme hypothermia often appear to be lifeless, dramatic reports of survival following profound hypothermia have stimulated medical authors to support the notion that "no one is dead until warm and dead."<sup>1-4</sup>Furthermore, most recommendations currently support therapeutic maneuvers such as extracorporeal blood warming or peritoneal dialysis, although there are no compelling data to show that survival is enhanced by these techniques.<sup>5</sup>There is considerable expense generated by a rigorous resuscitative effort. The costs for transport, cardiopulmonary bypass, and intensive care unit habitation are acceptable only if survival advantage and reasonable hope can be demonstrated.<sup>6</sup>Despite occasional successful efforts at reanimation, the aphorism may require modification. Prognostic