tbuckley/cabot-search huggingface dataset:
What is the main cause of avoidable harm to patients?
Authors: G. Caldwell
Journal: BMJ (2010)

As a hospital consultant I lead a team that helps patients to recover from illnesses such as myocardial infarction, pulmonary embolism, and gastrointestinal haemorrhage. I do not want to harm patients, make their illnesses worse, or unnecessarily prolong their stays in hospital.

Since attending the International Forum on Quality and Safety in Healthcare in Berlin in March 2009 I have been thinking and working hard to improve the care that my team of doctors and nurses give to inpatients. We have used a “considerative checklist” to ensure that we do everything we can to reduce the chances of pulmonary embolism, septicaemia from meticillin resistant Staphylococcus aureus , and diarrhoea from Clostridium difficile , among several other types of avoidable harm. We have greatly improved our attention to detail and safety in writing prescription charts. All this has helped us to be more careful to avoid harming patients during treatment.

However, I …
The "Doctor's Lady"
Authors: Grosvenor W. Bissell
Journal: JAMA (1971)

<h3>To the Editor.—</h3> I was fascinated to see the beautiful color picture of a copy of an antique Chinese diagnostic doll on the cover ofThe Journalfor July 26, 1971. I first became interested in this subject some years ago after reading Major's<i>History of Medicine</i>, vol 1, p 86, which has a photograph of such a model. Shortly after this, while visiting San Francisco's Chinatown, I bought a copy from the collection (Figure) of a venerable Chinese merchant. He assured me he had obtained it from the Chinese mainland before the Communist take-over. I believe your "Cover Story" (Amagrams, p 391) is substantially correct, except for one detail: "As traditional modesty demanded that women's feet be covered at all times, the dolls always wear shoes." Either the copy I possess is a fake (which I doubt), or (which I think more likely) she is a copy of an
Mitochondrial DNA mutations activate the mitochondrial apoptotic pathway and cause dilated cardiomyopathy
Authors: D Zhang
Journal: Cardiovascular Research (2002)

Objective: To determine whether low frequency mitochondrial DNA (mtDNA) mutations are pathogenic. Methods: We studied mice that express a proofreading-deficient mitochondrial DNA polymerase in the heart and develop cardiac mtDNA mutations. Results: At 4 weeks of age, when point mutation levels had risen to on average two per mitochondrial genome, these mice developed severe dilated cardiomyopathy. Interstitial fibrosis first became apparent at 4 weeks of age and progressed with age. Sporadic myocytic death occurred in all regions of the heart, apparently due to apoptosis as assessed by histological analysis and TUNEL staining. The frequency of TUNEL-positive cells peaked at 4–5 weeks of age and then gradually declined. While mitochondrial respiratory function, ultrastructure, and number remained normal, cytochrome c was released from mitochondria, a known apoptotic signal. Conclusion: mtDNA mutations therefore are pathogenic, and seem to trigger apoptosis through the mitochondrial pathway.
Echocardiographic Determination of Mitral Disc Valve Excursion
Authors: MICHAEL L. JOHNSON, JOSEPH H. HOLMES, BRUCE C. PATON
Journal: Circulation (1973)

Disc excursion and opening and closing velocities of prosthetic disc valves can be measured accurately by diagnostic echocardiography. The ultrasound beam is projected along the longitudinal axis of the valve and the echoes arising from the struts, disc, and suture ring are displayed on the oscilloscope. Twenty-four patients with normally functioning mitral Beall valves of various sizes and three patients with prosthetic valve dysfunction (one Beall, two Kay-Shiley) were studied. Table 1 lists the disc excursions with standard deviations of Beall valves measured by ultrasound. The 0.06-0.09 cm difference in excursion between models no. 103 and no. 104 valves was detected by ultrasound without prior knowledge of change in design of the valve and demonstrates the extreme accuracy of this technic. The opening and closing disc velocity averaged 22 cm/sec and 40 cm/sec, respectively. Decrease in expected disc excursion and abnormal motion patterns were found in three patients with prosthetic dysfunction secondary to thrombus formation, and verified at operation. With continuous changes in valve designs it is important to obtain a baseline excursion and motion pattern for each patient immediately postoperatively. Echocardiography is a useful, noninvasive, reproducible technic for accurate assessment of prosthetic mitral disc valve movement.
Delayed effects of head injuries in children
Authors: O G Brooke
Journal: BMJ (1988)

In summary, patients who present with a suspected acute myocardial infarction should receive an infusion of intravenous nitrate.If myocardial ischaemia persists and symptoms begin within four hours the patient should be given thrombolytic treatment and possibly a Pi blocker.Subsequent short term anticoagulation with heparin is justified, though long term treatment with warfarin has little scientific basis; aspirin may be a suitable alternative.Patients should be referred to a cardiac unit if they develop surgical complications or episodes of postinfarct angina.
Emergency Endoscopy after Gastrointestinal Haemorrhage in 50 Patients with Portal Hypertension
Authors: R. Waldram, M. Davis, H. Nunnerley, R. Williams
Journal: BMJ (1974)

Endoscopy was carried out in 50 patients with oesophageal varices within 24 hours of a major haematemesis or melaena. Sources of bleeding were identified in 42 of the cases and in only 19 patients was bleeding due to oesophageal varices. Bleeding from gastric varices was present in 11 patients, and a variety of acute and chronic lesions made up the remainder. In contrast with previous series haemorrhage from erosive gastric lesions was seen in only five patients and was no more common in 23 patients with alcoholic cirrhosis than in the group as a whole.
Hypoperfusion-induced acute renal failure in the rat: an evaluation of oxidant tissue injury.
Authors: R A Zager
Journal: Circulation Research (1988)

Reactive oxygen species (ROS) have been reported to be critical cellular mediators of experimental ischemic acute renal failure (ARF). This conclusion is based on observations that in the renal artery occlusion (RAO) model of ARF, antioxidant drugs confer protection and that renal malondialdehyde (MDA) concentrations, an index of lipid peroxidation, rise in the postischemic period. Human ischemic ARF is most often due to hypoperfusion, not to total blood flow interruption. Therefore, the goal of this study was to determine whether ROS also mediate hypoperfusion-induced renal injury. Renal hypoperfusion was induced in rats by suprarenal partial aortic ligation, lowering renal perfusion pressure to 20-25 mm Hg for 45 minutes. Renal MDA concentrations were measured 15 minutes after ligation release. Renal function and morphology were assessed 24 hours after hypoperfusion in control rats and in rats pretreated with antioxidant agents (allopurinol, superoxide dismutase, dimethyl-thiourea, glutathione, and catalase), a majority of which have been shown to lessen RAO-induced ARF. Hypoperfusion caused no rise in renal MDA concentrations (p = 0.54). Control ARF rats developed significant azotemia (blood urea nitrogen 119 +/- 6 mg/dl; creatinine 3.3 +/- 0.37 mg/dl) and widespread tubular necrosis by 24 hours after surgery. None of the antioxidants, administered singly or in combination, lessened the ischemic damage. Therefore, renal MDA concentrations do not rise in hypoperfusion ARF, and antioxidants do not confer protection. This indicates that previous evidence for ROS as mediators of ischemic renal injury is restricted to the RAO model of ARF, which does not closely simulate most human ischemic renal injury.
Treatment of Depression-Reply
Authors: Mortimer Ostow
Journal: JAMA (1983)

<h3>In Reply.—</h3> Dr Jones dissents not so much from the substance of my recommendation as from the fact that it was offered on the basis of clinical experience alone, without confirmation by extensive trials. Extensive systematic studies, in which observations are made and recorded by paramedical personnel, with or without questionnaires or rating devices, and the results of which are analyzed by statistical procedures, have become a shibboleth in modern phenomenological psychiatry. Extensive studies are demanded by academicians and institutionally based psychiatrists rather than clinicians in the private practice of psychiatry because the former see fewer patients on an intensive basis and are in a better position to conduct extensive studies. And since academicians edit most of the journals and select peer reviewers primarily from the ranks of academia, extensive studies are favored by psychiatric journals. Under the influence of these teachers, the younger generation of psychiatrists has come to
Splint renal function after captopril in unilateral renal artery stenosis.
Authors: G J Wenting, H L Tan-Tjiong, F H Derkx, J H de Bruyn, A J Man in't Veld, M A Schalekamp
Journal: BMJ (1984)

The renal extraction ratios of 131I-sodium iodohippurate (131I-Hippuran) and 125I-thalamate were greatly reduced on the affected side by 50 mg captopril in seven out of 14 patients with unilateral renal artery stenosis. With long term captopril 150 mg daily the uptake of 99mTc-diethylenetriaminepenta-acetic acid by the affected kidney, which was determined by scintillation camera renography, became almost zero in these seven patients, indicating severe reduction of the glomerular filtration rate. Function of the affected kidney returned on discontinuing treatment. The reduced extraction of sodium iodohippurate probably reflected a shortened plasma transit time through the kidney due to intrarenal vasodilatation. The reduced extraction of thalamate reflected a low filtration fraction, suggesting that the vasodilatation was, at least in part, at the level of the postglomerular arterioles. Captopril had little effect on the contralateral kidney and on the kidneys of 17 patients with essential hypertension, and serum creatinine concentrations showed minor changes. Radioisotope renography should be performed after beginning captopril treatment in patients with renal artery stenosis. This is also recommended for patients given captopril as a third line drug when renal artery stenosis has not been excluded. Hypertension is these patients is often severe and difficult to control. Renal artery disease is not rare in this difficult group and finding seriously impaired renal function on one side during captopril treatment may be diagnostic.
Specific immunotherapy prevents increased levels of allergen‐specific IL‐4‐ and IL‐13‐producing cells during pollen season
Authors: S. Gabrielsson, A. Söderlund, S. Paulie, T.C.T.M. Van Der Pouw Kraan, M. Troye‐Blomberg, S. Rak
Journal: Allergy (2001)

Background: Specific allergen immunotherapy (SIT) is effective for treatment of IgE‐mediated diseases; however, the mechanisms of action still remain unclear. Earlier, we showed that IL‐4 and IL‐13 are produced in response to specific allergens. The aim of this study was to investigate whether these cytokine responses were affected by allergen SIT, and, furthermore, to evaluate the effect of SIT on allergen‐specific IgE and IgG4 levels. Methods: Blood samples from pollen‐sensitized individuals were collected before the pollen season (before treatment) and during the pollen season (after SIT or placebo treatment). Peripheral blood mononuclear cells were activated in vitro with allergens and the numbers of IL‐4‐, IL‐13‐, IL‐10‐, and IFN‐γ‐producing cells were determined by ELISPOT. Serum levels of allergen‐specific IgE and IgG4 were measured by RAST and ELISA, respectively. Results: The numbers of IL‐4‐ and IL‐13‐producing cells were shown to be increased in the placebo group during the pollen season, an increment which was absent in patients receiving allergen SIT. We found an increase in allergen‐specific IgG4 in the SIT‐treated individuals, but not in the placebo group. Both groups displayed elevated specific IgE levels during the pollen season. Conclusions: Taken together, our data show a downregulation of IL‐4‐ and IL‐13‐producing cells in peripheral blood after SIT, suggesting induction of nonresponsiveness/tolerance or a redistribution of these cells. Furthermore, we demonstrate that SIT acts on antibody production by increasing the specific IgG4 levels.
Quercetin up-regulates paraoxonase 1 gene expression via sterol regulatory element binding protein 2 that translocates from the endoplasmic reticulum to the nucleus where it specifically interacts with sterol responsive element–like sequence in paraoxonase 1 promoter in HuH7 liver cells
Authors: Mamatha Garige, Maokai Gong, Ravi Varatharajalu, M. Raj Lakshman
Journal: Metabolism (2010)
Prescription pricing databases should include more details to assess prescribing rationality
Authors: H. McGavock
Journal: BMJ (2001)

EDITOR—Campbell et al's study on prescribing indicators for general practices in the United Kingdom showed how difficult it is to conduct quality assurance of prescribing by using the existing prescription pricing databases in the United Kingdom.1 The authors selected 41 proxies of rational prescribing from prescribing analysis and cost (PACT) data, the English system. Only seven of these were rated as valid for economic rationality (cost) and five for scientific rationality (quality). …
TCT-751 Aortic Stenosis in the Elderly: number of TAVR candidates
Authors: Ruben L.J. Osnabrugge, Darren Mylotte, Stuart J. Head, Nicolas M Van Mieghem, Vuyisile T. Nkomo, Corinne Le Reun, Ad J. Bogers, Nicolo Piazza, A. Pieter Kappetein
Journal: Journal of the American College of Cardiology (2013)
PSYCHOTIC DEPRESSIVE REACTIONS IN SOLDIERS WHO ACCIDENTALLY KILLED THEIR BUDDIES
Authors: AARON T. BECK, SIGMUND VALIN
Journal: American Journal of Psychiatry (1953)

1. A clinical study was made of 5 soldiers who experienced psychotic depressive reactions after shooting and killing their buddies. 2. These patients showed many distortions in their basic character makeup which in most of the cases could be classified as predominantly hysterical with ingrained patterns of action-oriented behavior. 3. The patients uniformly revealed a history of borderline adjustment in civilian life, poor identifications, unstable family backgrounds, and highly ambivalent relationships with other people. 4. The severity of the reaction to the traumatic situation was explained as being related to the presence of unconscious hostility towards the buddy, which produced overwhelming guilt, and their poorly integrated, highly vulnerable personalities. The sources of the unconscious hostility were discussed. 5. The defense mechanisms utilized by the patients were discussed in terms of their efficacy, sequence, and dynamic significance.
Production of heparin binding epidermal growth factor-like growth factor in the early phase of regeneration after acute renal injury. Isolation and localization of bioactive molecules.
Authors: M Sakai, M Zhang, T Homma, B Garrick, J A Abraham, J A McKanna, R C Harris
Journal: Journal of Clinical Investigation (1997)

We have recently reported that heparin-binding epidermal growth factor-like growth factor (HB-EGF) mRNA is induced in the rat kidney after acute ischemic injury. The present studies were designed to investigate whether bioactive HB-EGF protein is also produced in response to renal injury induced by either ischemia/reperfusion or aminoglycosides. Heparin-binding proteins were purified from kidney homogenates by heparin affinity column chromatography using elution with a 0.2-2.0 M gradient of NaCl. A single peak of proteins that eluted at 1.0-1.2 M NaCl was detected in the postischemic kidney within 6 h of injury. This eluate fraction stimulated DNA synthesis in quiescent Balb/c3T3, RIE, and NRK-52E cell lines, all of which are responsive to the epidermal growth factor family of mitogenic proteins. The EGF receptor of A431 cells was also tyrosine phosphorylated by this eluate peak. Furthermore, immunoblotting with a polyclonal antibody against rat HB-EGF indicated that the eluate peak contained immunoreactive proteins of 22 and 29 kD mol wt, consistent with the reported sizes of the secreted form and membrane anchored form of HB-EGF, respectively. Immunohistochemical studies revealed that HB-EGF was produced predominantly in distal tubules in kidneys injured either by ischemia/reperfusion or aminoglycoside administration. We also found that during metanephric development immunoreactive HB-EGF was detected in the ureteric bud as early as E14.5 and persisted in structures arising from the ureteric bud throughout embryogenesis. These results suggest that in response to acute injury, HB-EGF is produced predominantly in distal tubules and that endogenous HB-EGF may be an important growth factor involved in renal epithelial cell repair, proliferation, and regeneration in the early stages of recovery after acute renal injury, as well as in nephrogenesis.
ARE GENDER OR PHARMACOLOGIC STRESS-SPECIFIC REFERENCE NORMAL DATABASES NECESSARY FOR QUANTITATIVE ANALYSIS OF STRESS N-13 AMMONIA PET IMAGES?
Authors: S Khanna, M DeGroof, G Porenta, J Czernin, M Di Carli, R Brunken, A Kim, M Phelps, R Hawkins, H Schelbert, J Maddahi
Journal: Clinical Nuclear Medicine (1992)

DeGroof, S. M.; Porenta, G.; Czernin, J.; Carli, M. Di; Drunken, R.; Kim, A.; Phelps, M.; Hawkins, R.; Schelbert, H.; Maddahi, J. Author Information
T1796A BRAF mutation is absent in Merkel cell carcinoma
Authors: M. Worda, C.S. Sreevidya, H.N. Ananthaswamy, L. Cerroni, H. Kerl, P. Wolf
Journal: British Journal of Dermatology (2005)

Conflicts of interest: none declared. Sir, Merkel cell carcinoma (MCC) is a rare, aggressive carcinoma of the skin that occurs predominantly in elderly people in sun‐exposed areas and is assumed to arise from Merkel cells. Merkel cells are neuroendocrine cells of the epidermis, hair follicles and mucosa with epithelial characteristics. Their presumed function, in combination with existing nerve endings, is that of a slowly adapting mechanoreceptor.1 Clinical and histological differentiation of MCC from malignant melanoma (MM), especially the rare small‐cell variant, may sometimes be difficult, requiring immunohistochemical markers.2, 3 Concerning clinical features, MCC spreads in much the same way as MM, first locally, with satellite nodules, then regional lymph node metastasis followed by disseminated disease involving the liver, lungs, bone and brain.4 Neural crest derivation is known for MM and suspected for MCC. The origin of Merkel cells and MCC from the neural crest is supported by interspecies embryonic transplantation models in birds and by the detection of cytogenetic changes in chromosome 1 as well as by the expression of transcription factors in MCC similar to neoplasms of neural crest derivation, but the precise origin of MCC is still unproven.5–7 On the other hand, MM (except lentigo maligna) and MCC differ markedly from one another in their distribution by age, race and anatomical site.8
THE TREATMENT OF PERMANENT PARALYSIS OF THE DELTOID MUSCLE
Authors: S. L. HAAS
Journal: JAMA (1935)

Permanent paralysis of the deltoid muscle causes a crippling, disabling deformity of the arm with the resultant loss of power of abduction of the involved extremity. When conservative treatment, extending over a period of one year, has failed there remain several methods of surgical treatment by which, if successful, varying degrees of function may be restored to the paralyzed member. The results of neurotization and nerve transference with anastomosis are of doubtful value. There are two methods, namely, arthrodesis and muscle transposition, that have established their practicability, as evidenced by a number of successful results. Each of these methods has its advantages and disadvantages. In favor of arthrodesis is the greater likelihood of success and the greater strength and power of the functional force at the shoulder, at the expense of mobility. In favor of muscle transposition is the possibility of greater range of motion at the shoulder but with
Diabetes Risk Potentially Underestimated in Youth and Children Receiving Antipsychotics
Authors: Katherine Samaras, Christoph U. Correll, Alex J. Mitchell, Marc De Hert
Journal: JAMA Psychiatry (2014)

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Bone Scan Findings with Radiographic, Clinical, and Surgical Correlation in Extensive Osteomyelitis: A Case Report
Authors: Dennis L. Hemingway, Carl M. Lieberman
Journal: Clinical Nuclear Medicine (1980)

A case of chronic osteomyelitis is presented in which bone scintigraphy with Tc-99m-MDP provided more accurate information than radiography in demonstrating the extent of the sequestrum and the involucrum response. Surgical and microscopic descriptions are included.
Detection of familial dysalbuminaemic hyperthyroxinaemia.
Authors: M S Croxson, B N Palmer, I M Holdaway, P A Frengley, M C Evans
Journal: BMJ (1985)

A simple test of in vitro thyroxine binding to serum proteins was used to screen serum samples from euthyroid patients with unexplained increases in the free thyroxine index. A diagnosis of familial dysalbuminaemic hyperthyroxinaemia was presumed in 14 unrelated subjects and six first degree relatives. Increased binding of thyroxine to thyroxine binding prealbumin was diagnosed in one woman with four unaffected relatives. Seven patients with familial dysalbuminaemic hyperthyroxinaemia had been treated for presumed thyrotoxicosis: two had typical Graves9 disease and one subacute thyroiditis. Four other patients had been mistakenly treated with radioactive iodine or antithyroid drugs. In previously treated patients familial dysalbuminaemic hyperthyroxinaemia was suspected from the combination of a high serum thyroid stimulating hormone concentration and a normal but invalid free thyroxine index. Physicians should be cautious in accepting a diagnosis of thyrotoxicosis based mainly on a raised serum thyroxine concentration.
Cigarette Smoke Impairs Clearance of Apoptotic Cells through Oxidant-dependent Activation of RhoA
Authors: Tiffany R. Richens, Derek J. Linderman, Sarah A. Horstmann, Cherie Lambert, Yi-Qun Xiao, Robert L. Keith, Darren M. Boé, Konosuke Morimoto, Russell P. Bowler, Brian J. Day, William J. Janssen, Peter M. Henson, R. William Vandivier
Journal: American Journal of Respiratory and Critical Care Medicine (2009)

Cigarette smoke (CS) is the primary cause of chronic obstructive pulmonary disease (COPD), an effect that is, in part, due to intense oxidant stress. Clearance of apoptotic cells (efferocytosis) is a critical regulator of lung homeostasis, which is defective in smokers and in patients with COPD, suggesting a role in disease pathogenesis.