tbuckley/cabot-search huggingface dataset:
Antihypertensive therapy. To stop or not to stop?
Authors: R. E. Schmieder
Journal: JAMA (1991)

The benefits of continuous antihypertensive therapy have been extensively documented. However, lack of compliance with the prescribed regimen, excessive cost, and troublesome adverse effects of some antihypertensive agents led to the consideration of intermittent therapy or even complete discontinuation of therapy as an effective alternative to lifelong medication. Prospective studies dealing with this subject reported inconsistent results. Nevertheless, they allowed us to identify selection criteria of candidates for step-down or discontinuation of antihypertensive therapy. Such candidates include patients with mild essential hypertension who have one or more of the following characteristics: young age, normal body weight, low salt intake, no alcohol consumption, low pretreatment blood pressure, successful therapy with one drug only, and no or only minimal signs of target organ damage. Stopping antihypertensive therapy without subsequent rise in arterial pressure was shown to be possible in a subset of patients with mild essential hypertension for a period of months to years. This approach appears to be safe, provided that blood pressure is monitored frequently, and may improve compliance, save treatment costs, and reduce adverse effects of certain drugs, although its long-term consequences for morbidity and mortality remain to be determined. (<i>JAMA</i>. 1991;265:1566-1571)
Anatomical arrangement of muscle tissue in the anterior mitral leaflet in man
Authors: R. J. BOUCEK, B. BOUCKOVA, S. LEVY
Journal: Cardiovascular Research (1978)

Muscle tissue in atrioventricular (A-V) cardiac valve leaflets was studied in 35 human hearts and was found to be more prominent in the anterior leaflet of the mitral (MAL) than in the other valve leaflets. From serial sectioning and wax model reconstruction, the anatomic arrangement of the muscle in the MAL indicates bundles passing from the two commissural regions towards the mid-zone of the valve. Age did not appear to reduce the mass of muscle tissue in the MAL. The possibility of muscle contraction in the MAL increasing leaflet tension and accelerating post-atrial movements received support by comparisons of the anterior and posterior leaflets of the mitral valve in their movements towards closure.
Subsidiary class III effects of beta blockers? A comparison of atenolol, metoprolol, nadolol, oxprenolol and sotalol
Authors: B S. MANLEY, D. ALEXOPOULOS, G. J ROBINSON, S. M COBBE
Journal: Cardiovascular Research (1986)

The electrophysiological effects of various concentrations of atenolol, metoprolol, nadolol, D-oxprenolol, L-oxprenolol, and D, L-oxprenolol and D-sotalol, L-sotalol, and D, L-sotalol were compared in rabbit right ventricular papillary muscle studied in vitro using intracellular microelectrodes. An assessment of the relative beta blocking effects of D-sotalol and D, L-sotalol against the inotropic action of isoprenaline was made in the same preparation. Of the drugs tested, only oxprenolol and sotalol showed prolongation of action potential duration and effective refractory period (class III action), with oxprenolol showing, in addition, depression of maximal upstroke velocity and the presence of post-repolarisation refractoriness (class I action). When contrasted at clinically relevant concentrations, only sotalol retained a class III effect, without any actions on variables related to fast inward current. The effects of oxprenolol and sotalol were not found to be stereospecific. The mechanical experiments indicate that, in this preparation, D-sotalol has approximately one-fourteenth of the beta blocking potency of the racemic compound. It therefore merits further consideration as a useful alternative class III antiarrhythmic agent, which would be free from the side effects of beta receptor blocking treatment.
Officials watch events in southern hemisphere as swine flu rates in UK slow down
Authors: O. Mashta
Journal: BMJ (2009)

Experts are closely monitoring how A/H1N1 influenza in the southern hemisphere, where the death rate from the virus is rising in some countries, to help predict what might happen in the United Kingdom over the winter months.

The first wave of swine flu in England has passed its peak in recent days, indicate figures from the Health Protection Agency that show a substantial decrease in the overall number of new cases, doctors’ consultations, and use of the pandemic flu service.

But in his weekly briefings on Thursday on …
Work and ill-health
Authors: Aurelia Butcher
Journal: Journal of the Royal Society of Medicine (2011)

The article by Henderson et al.1 regarding work and common psychiatric disorders raises awareness of this important issue. Complex, interwoven strands of environment, occupational influences and factors individual to the employee contributing to ‘worklessness’ are discussed at length.

In this era of ‘Austerity Britain’ however, with public sector spending cuts and high unemployment rates,2 I would like to have seen discussion/comment on the effects of unemployment on our patients; examining the problem from the opposite angle: that the losing of a job by an individual in itself undermines their health (including mental) and welfare.

There is much in the literature regarding this: Fryers3 discussed the contribution of work to a person's identity, while Bartley4 attempted to understand the relationship between unemployment and ill-health.

Work can boost self-esteem and helps to mould an individual's identity; take that away and, understandably, it follows that he/she suffers. From our own practice, as well as from the literature, we have known for a long time that consultation rates in primary care are higher in the unemployed.5 But which is ‘chicken’ and which ‘egg’? Are redundancy and consultation rates higher because of ill-health or vice versa? Beale studied just this, and found that GP consultation rates increased significantly after a group of factory workers were made redundant, and that those workers with worse prospects for future job-tenure continued to attend at a higher rate even years later, while those that had better job prospects gradually attended their GP less over time.

In the murky waters of unemployment, ill-health, benefit-seeking, et cetera, one thing, to me, seems clear: keeping people in work helps not only their own health and finances, but those of society as a whole.

Henderson et al. cited an aim to stimulate debate; I hope to have added some fuel to this fire.
Large bowel cancer: causation and management.
Authors: M B McIllmurray, M J Langman
Journal: Gut (1975)

Progress report Large bowel cancer: Causation and managementThe death rate from large bowel cancer in England and Wales has tended to fall recently' but the change, which is slight, is probably accounted for by improvements in surgical and anaesthetic techniques.In contrast, incidence rates, if not actually rising are probably stationary.For a disease which is commonly considered curable, the five-year mortality rate, which is usually in excess of 60%, is disappointingly high.Simple technical advances in sur- gical management seem unlikely to contribute more than marginally to lower- ing death rates further since the scope for radical changes seems very limited.Hope for the future seems to depend upon progress in three fields: the identification of predisposing factors, the development of better diagnostic techniques, and the introduction of effective chemotherapy.The incidence of large bowel cancer varies by approximately ten-fold from one part of the world to another, and broadly speaking its frequency is greater in developed countries, especially in western Europe and North
Enhanced cough response to hyperpnea with cold air challenge in chronic cough patients showing increased cough sensitivity to inhaled capsaicin
Authors: Y. S. Cho, S. Y. Park, C.‐K. Lee, E. Y. Lee, J.‐H. Shin, B. Yoo, H.‐B. Moon
Journal: Allergy (2003)

Although many chronic cough patients have complained of an induced cough by cold air contact, the clinical relevance of cold air to inducing a cough and the diagnostic value of a hyperpnea with cold air (HCA) challenge to detect a hyperreactive cough reflex have not yet been investigated.Recordings of cough counts after a 2-min HCA challenge were performed in 49 chronic cough patients and 15 healthy controls. Capsaicin cough provocation tests, which determine the threshold concentration of capsaicin that induces five or more consecutive coughs (C5), were also administered.After comparing the results from the capsaicin cough provocation tests of the patients and the controls, the chronic cough patients were divided into two groups: an increased cough sensitivity (ICS) group (n = 28) (C5 < 32 micromol/l) and a normal cough sensitivity (NCS) group (n = 21) (C5 >or= 32 micromol/l). The median value of induced cough counts after a HCA challenge was 11 coughs in patients with ICS and was a significantly enhanced cough response compared to that of the patients with NCS and healthy controls (four coughs, respectively).A simple cough provocation test using a HCA challenge may be useful for detecting ICS. It also suggests that hyperreactive cough reflexes may be one of the mechanisms of inducing chronic cough.
Response to Letters Regarding Article “Determinants of Surgical Outcome in Patients With Isolated Tricuspid Regurgitation”
Authors: Yong-Jin Kim, Dong-A Kwon, Hyung-Kwan Kim, Jin-Shik Park, Kyung-Hwan Kim, Ki-Bong Kim, Dae-Won Sohn, Hyuk Ahn, Byung-Hee Oh, Young-Bae Park, Seokyung Hahn
Journal: Circulation (2010)
Role of Mast Cell and Basophil in Cold Urticaria with Associated Systemic Reactions
Authors: Lennart Juhlin
Journal: JAMA (1961)

THE INCREASING interest in the auto-immune state has refocused the medical view on the patient who is sensitive to cold. This is the individual who reacts to his own tissue upon cooling. A drop in skin temperature, whether it be produced by a breeze, contact with a cool object, or entering an air-conditioned room, may be followed by erythema, pruritus, and even urticaria. Such cold urticaria, because of its obviousness, is a diagnostic hallmark of the cold hypersensitive state, but it is still only one of a galaxy (Table 1)1-4of signs and symptoms which may occur. Such patients experience frightening dysphagia after ingesting ice water or chilled foods. Moreover, cold showers, a chilling rain, and the winter wind are particular hazards that they soon learn to avoid also. But as Horton, Brown, and Roth 1 pointed up 25 years ago, swimming in cold water poses the ultimate
802. Use of Chemokine Expression at a Tumor Site to Enhance Immune Cell Trafficking for Melanoma Therapy
Authors: Uma Thanarajasingam, Laura Sanz, Rosa Maria Diaz, Jill Thompson, Michael Gough, Richard Vile
Journal: Molecular Therapy (2005)

In order to generate antitumor immunity through direct in situ modification of an established primary tumor, it will be necessary to recruit antigen presenting cells to the tumor site, release tumor antigens in an immunostimulatory, rather than tolerogenic form, and then promote the trafficking of effector T cells back to the tumor site. To model the coordinated steps of immune cell recruitment, loading/activation and trafficking, we generated stable cell lines and recombinant adenoviral vectors expressing the chemokines CCL3, CCL20 and CCL21. By in vitro chemotactic assays, CCL21 was the most potent chemoattractant for naive and activated OT-1 T cells, as well as for mature dendritic cells; in contrast, CCL3 was more effective for the migration of macrophages and immature dendritic cells. To investigate the relevance of these findings in vivo, we studied the capacity of the chemokines to (i) recruit immune cells to a tumor site in vivo, and (ii) to enhance the efficacy of adoptively transferred OT-1 T cells as a tumor therapy. Our data show that intratumoral injections of recombinant adenoviral vectors expressing the chemokines CCL3 and CCL20, lead to transient recruitment of a variety of immune cell populations including immature dendritic cells. However, this combination of chemokine-mediated recruitment plus the intrinsic immunogenicity of the adenoviral vector was insufficient to clear established tumors or generate appreciable evidence of anti tumor immunization. However, in a metastatic model of melanoma, stable expression of CCL21 significantly prolonged survival of mice seeded with B16ova-CCL-21 expressing tumors compared to those seeded with B16ova tumors. The combination of CCL21 expression, along with adoptive transfer of a suboptimal dose of activated OT-1 T cells, led to greater survival advantages compared to treatment of B16ova tumors with OT-1 alone, or expression of CCL-21 alone in B16ova. Therefore, although the transient recruitment of antigen presenting cells to a tumor is itself insufficient to induce an effective anti-tumor response in the absence of additional signals such as tumor cell killing, intratumoral expression of chemokines can be effective in the context of recruiting endogenously activated, or adoptively transferred, T cells to tumors. We are now studying the effects of further combinations of immune cell recruitment, along with additional signals such as T cell activating signals, to improve the therapy of local tumors and the concomitant priming of anti tumor immunity through intratumoral immunotherapy.
Chronic otitis media: a new extra-articular manifestation in ankylosing spondylitis?
Authors: A E Camilleri, I R Swan, E Murphy, R D Sturrock
Journal: Annals of the Rheumatic Diseases (1992)

Following a study reporting a fourfold increase in the occurrence of chronic otitis media in patients with ankylosing spondylitis, this prospective study examines this association with respect to severity, duration of disease, and acute phase in ankylosing spondylitis. Forty two consecutive patients with classical ankylosing spondylitis seen at the rheumatology clinic of a teaching hospital where the features of ankylosing spondylitis were recorded had an otological examination by an otolaryngologist. The occurrence of chronic otitis media (all categories) was 12/42 (29%). The acute phase serum markers (C reactive protein and IgG) were increased in patients with active or inactive chronic otitis media. Extra-articular manifestations were significantly more common in the chronic otitis media group than in those with no history of chronic otitis media. The results of this study suggest that chronic otitis media may be another extra-articular manifestation of ankylosing spondylitis. Alternative explanations, however, include similar aetiological factors for the two conditions or a previously unrecognised increased occurrence of HLA-B27 in patients with chronic otitis media.
Prenatal Phthalate Exposures and Neurobehavioral Development Scores in Boys and Girls at 6–10 Years of Age
Authors: Roni W. Kobrosly, Sarah Evans, Amir Miodovnik, Emily S. Barrett, Sally W. Thurston, Antonia M. Calafat, Shanna H. Swan
Journal: Environmental Health Perspectives (2014)

There is concern over potential neurobehavioral effects of prenatal phthalate exposures, but available data are inconsistent.
Complement in the Pathophysiology of Human Disease
Authors: Michael M. Frank
Journal: New England Journal of Medicine (1987)

ALMOST exactly 100 years ago it was noted that certain types of bacteria sensitized with specific antibody would lyse in fresh normal serum.1 That observation led to the discovery of the proteins that constitute the complement system. It is now clear that those proteins not only act to lyse target cells, but also have a broad role in the development of the inflammatory response.Complement activity results from the sequential interaction of a large number of plasma and cell-membrane interactive proteins — the complement system — whose number is now thought to approach 25. There is now a considerable body . . .
Injury and attention deficit hyperactivity disorder
Authors: M. Zwi, P. Clamp
Journal: BMJ (2008)

The cause of attention deficit hyperactivity disorder (ADHD) is uncertain and has provoked considerable debate. The Department of Health in the United Kingdom is currently commissioning a systematic review of its causation. In the linked retrospective cohort study (doi: 10.1136/bmj.a1984), Keenan and colleagues examine the hypothesis that head injury in young children might be a causative factor in the development of ADHD. Language: en
TUBO-OVARIAN ABSCESS, INTESTINAL OBSTRUCTION, AND URETERIC OBSTRUCTION: SIX ABDOMINAL SECTIONS: RECOVERY
Authors: J. D. Malcolm
Journal: BMJ (1915)

A CASE in whlich thiree operations-tlhe first, second, and fiftlh-were urgently needed to save life witlin two years seems wortlhy of record, and it is also of interest that,
Biofeedback as a Medical Treatment
Authors: Julius Segal
Journal: JAMA (1975)

FOLLOWING a recent meeting of the Biofeedback Research Society, one optimistic writer reported in the popular press that "biofeedback provides those suffering from functional disorders of all types with a viable alternative to the combination of drugs and surgery offered by traditional Western medicine." That statement-and dozens more like it—reflect the<i>furor therapeuticus</i>that has arisen of late about a field of research whose clinical applications are still uncertain, but that has raised dazzling prospects for healing, among professionals and laymen alike. The term "feedback" was coined by mathematician Norbert Weiner to mean "a method of controlling the system by reinstating into it the results of its past performance." In 1969, at the first meeting of the Biofeedback Research Society, the term was given its physiological context, referring to any technique using instrumentation intended to give a person immediate and continuing signals of changes in a bodily function of which
Neural substrates of visual percepts, imagery, and hallucinations
Authors: Stephen Grossberg
Journal: Behavioral and Brain Sciences (2002)

Recent neural models clarify many properties of mental imagery as part of the process whereby bottom-up visual information is influenced by top-down expectations, and how these expectations control visual attention. Volitional signals can transform modulatory top-down signals into supra-threshold imagery. Visual hallucinations can occur when the normal control of these volitional signals is lost.
Intubation of the trachea in the critical care setting
Authors: C. B. Watson
Journal: JAMA (1985)

<h3>In Reply.—</h3> Both letters express concerns that elderly persons actually move from high altitude for reasons other than our finding of poor health. The questions raise the point that the cause of migration from high altitude is not known. The reason we under-took our study was to determine the reason(s) in actual high-altitude populations. Dr Slater asks whether the study participants migrated due to isolation rather than to the effects of high altitude. Dr Popp suggests that dislike of climate was the cause of migration. Both of these factors were among those we investigated in the study. We interviewed a large number of persons (349 residents and 139 migrants at low altitude, 252 residents and 93 migrants at high altitude) from towns that were matched for degree of geographic isolation, climate, economic base, and availability of medical facilities. To determine reasons for migration, we asked the open-ended questions, "Why did
ST-RESOLUTION FOLLOWING PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN ACUTE MYOCARDIAL INFARCTION IS ASSOCIATED WITH EARLY RECOVERY OF VAGAL REFLEXES.
Authors: Gaetano Maria De Ferrari, Antonio Sanzo, Grazia M. Castelli, Annalisa Turco, Fabio Badilini, Peter J. Schwartz
Journal: Journal of the American College of Cardiology (2010)
The Radiology of Primary Atypical Pneumonia
Authors: P. W. Verco
Journal: Thorax (1949)

<b>Background:</b> Nitric oxide in exhaled air (FE<sub>NO</sub>) is a marker of eosinophilic airway inflammation. A study was undertaken to determine whether FE<sub>NO</sub> predicts asthma relapse in asymptomatic asthmatic children in whom inhaled corticosteroids are discontinued. <b>Methods:</b> Forty children (21 boys) of mean age 12.2 years on a median dose of 400 μg budesonide or equivalent (range 100–400) were included. FE<sub>NO</sub> was measured before and 2, 4, 12, and 24 weeks after withdrawal of steroids. A relapse was defined as more than one exacerbation per month, or need for β agonist treatment on 4 days per week for at least 2 weeks, or diurnal peak flow variability of &gt;20%. FE<sub>NO</sub> measurements were performed online with an expiratory flow of 50 ml/s. <b>Results:</b> Nine patients relapsed. Two and 4 weeks after withdrawal of steroids geometric mean FE<sub>NO</sub> in children who were about to relapse was higher than in those who did not relapse: 35.3 ppb <i>v</i> 15.7 ppb at 2 weeks (ratio 2.3; 95% CI 1.2 to 4.1; p = 0.01) and 40.8 ppb <i>v</i> 15.9 ppb at 4 weeks (ratio 2.6; 95% CI 1.3 to 5.1). An FE<sub>NO</sub> value of 49 ppb at 4 weeks after discontinuation of steroids had the best combination of sensitivity (71%) and specificity (93%) for asthma relapse. <b>Conclusion:</b> FE<sub>NO</sub> 2 and 4 weeks after discontinuation of steroids in asymptomatic asthmatic children may be an objective predictor of asthma relapse.
STANDARDIZATION OF SCARLET FEVER ANTISTREPTOCOCCUS SERUMS
Authors: A. B. WADSWORTH
Journal: JAMA (1926)

At present, the antitoxic titer of scarlet fever antistreptococcus serums is determined by the blanching of the rash in scarlet fever patients, following the intracutaneous injection of serum, as developed first by Dochez 1 and later also by Blake and Trask, 2 or by the reactions induced in susceptible persons by mixtures of toxin and serum injected intracutaneously, as developed by the Dicks. 3 Attempts to devise a satisfactory in vitro method have not been successful.  While the tests on human subjects have been essential in establishing definite standards for measuring the antitoxic value of the serums, they are proving impracticable as routine procedures for standardization. Toxin-antitoxin tests on normal persons are impracticable for the following reasons: the difficulty of securing subjects susceptible to the toxin but not hypersensitive to horse serum; the objection to the repeated injection of foreign serum; the large number of injections that should be made
In vivo formation of H2O2 in red cells during exposure to hyperoxia
Authors: William P. Johnson, Devenia Jefferson, Charles E. Mengel
Journal: Journal of Clinical Investigation (1972)

Chow-fed and tocopherol-deficient mice were given aminotriazole (AT), exposed to 100% O(2) at 60 pounds per square inch absolute for 1 hr (OHP), and red blood cells were assayed for catalase activity and lipid peroxide levels. A decrease of catalase activity (CA) in the presence of AT can be taken as evidence of excess formation or accumulation of H(2)O(2). No differences of CA were observed among chow-fed mice, with or without AT and/or OHP. Tocopherol-deficient mice with AT had lower CA (0.174+/-0.040) than chow-fed mice with AT (0.225+/-0.028) P < 0.01. Tocopherol-deficient mice with AT exposed to OHP had even lower CA, 0.137+/-0.024, P < 0.01.The data are consistent with the hypothesis that H(2)O(2) is formed or accumulated in excess in red cells of tocopherol-deficient mice, an effect that is enhanced in the presence of hyperoxia. They imply that tocopherol plays a role in the detoxification of H(2)O(2).