tbuckley/cabot-search huggingface dataset:
Chronic stable angina: treatment options
Authors: L. O'Toole
Journal: BMJ (2003)

In patients with chronic stable angina, the factors influencing the choice of coronary revascularisation therapy (percutaneous coronary intervention or coronary artery bypass surgery) are varied and complex. The severity of symptoms, lifestyle, extent of objective ischaemia, and underlying risks must be weighed against the benefits of revascularisation and the patient's preference, as well as local availability and expertise. Evidence from randomised trials and large revascularisation registers can guide these decisions, but the past decade has seen rapid change in medical treatment, bypass surgery, and percutaneous intervention. Therefore, thought must be given to whether older data still apply to contemporary practice.

View this table:

Major factors influencing risks and benefits of coronary revascularisation





Top: Diagrams of saphenous vein and left internal mammary artery grafts for coronary artery bypass surgery. Bottom: Three completed grafts—(1) left internal mammary artery (LIMA) to left anterior descending artery (LAD), and saphenous vein grafts (SVG) to (2) diagonal artery (DG) and (3) obtuse marginal artery (OM) 



Patients with chronic stable angina have an average annual mortality of 2-3%, only twice that of age matched controls, and this relatively benign prognosis is an important consideration when determining the merits of revascularisation treatment. Certain patients, however, are at much higher risk. Predictors include poor exercise capacity with easily inducible ischaemia or a poor haemodynamic response to exercise, angina of recent onset, previous myocardial infarction, impaired left ventricular function, and the number of coronary vessels with significant stenoses, especially when disease affects the left main stem or proximal left anterior descending artery. Although the potential benefits of revascularisation must be weighed against adverse factors, those most at risk may have the most to gain.

### Medical treatment

Anti-ischaemic drugs improve symptoms and quality of life, but have not been shown to reduce mortality or myocardial infarction. βblockers may improve survival in hypertension, in heart failure, and …
Epidemiology of whiplash
Authors: L. BARNSLEY;
Journal: Annals of the Rheumatic Diseases (2000)

Space restrictions prohibit a comprehensive refutation of the uneven treatment of the whiplash literature presented by Ferrari and Russell.1 They fiercely interrogate research that does not support their view, yet uncritically embrace literature favouring their preconceptions. Central to their argument is the assertion that there are different rates of chronic whiplash in different countries, and that “chronic injury related damage cannot account for the wide differences”.

A valid comparison between the prevalence of any condition in two places would require that it is measured in the same way. Balla's study comparing Singapore and Australia was little more than anecdotal from interviews of selected Singaporean doctors compared with the data from Australia.2 Such data may be fatally corrupted by recall, case selection, sampling, and expectation bias.

Caution should be observed in comparing insurance claim rates between countries. There is no international consistency in notification of accidents or insurance or compensation procedures. Conclusions drawn from such comparisons3 are unsustainable and subject to the ecological fallacy. The frailty of using insurance claims as a surrogate for the incidence of injury does not seem to have been considered by Ferrari and Russell. A claim is a behaviour arising from a combination of motivation, enabling circumstances, perceived benefits, costs, social norms, peer and family pressure, and fear of current or future pain and disability—all factors extraneous to the injury itself. The Victorian experience in Australia is particularly pertinent. Fewer claims for whiplash were noted after the introduction of legislation creating bureaucratic barriers, disincentives, and up-front costs for potential claimants. Some then concluded that whiplash is a behaviour and not an injury.4 A more sober view is that if it is harder to make a claim, fewer people will make one. To extrapolate beyond this is unjustifiable: the apparent change in incidence …
Longitudinal genome-wide analysis of patients with chronic lymphocytic leukemia reveals complex evolution of clonal architecture at disease progression and at the time of relapse
Authors: E Braggio, N E Kay, S VanWier, R C Tschumper, S Smoley, J E Eckel-Passow, T Sassoon, M Barrett, D L Van Dyke, J C Byrd, D F Jelinek, T D Shanafelt, R Fonseca
Journal: Leukemia (2012)
Medical aid still "absolutely necessary" in Haiti, says top WHO official
Authors: J. Zarocostas
Journal: BMJ (2010)

International assistance—especially medical doctors—is still absolutely necessary in Haiti to help deliver essential services to the devastated population, says the World Health Organization.

“Our concern is to ask the biggest partners to leave aid there at least six months, or as long as possible, especially the large NGOs [non-governmental organisations],” Henriette Chamouillet, the WHO’s representative in Haiti, told reporters.

Dr Chamouillet said this was “absolutely necessary” because hospitals had been damaged and the population had also been dispersed and help needs to go to the provinces.

She told the BMJ that the medical aid groups need to stay: “We want them to be self sufficient, accept some coordination, and work with the ministry of health of Haiti as a partner.”

Meanwhile, on 18 …
Primary Coronary Intervention for Acute Myocardial Infarction
Authors: Ellen C. Keeley
Journal: JAMA (2004)

DESPITE DRAMATIC IMPROVEments in the treatment of acute ST-segment elevation myocardia l infarct ion (STEMI) during the past decade, approximately 1 in 10 patients still die of this disease. Three critical factors in the immediate management of patients with STEMI result in reduced mortality: prompt diagnosis, immediate treatment with aspirin, and rapid reestablishment of blood flow in the infarctrelated artery. The latter aim may be achieved either pharmacologically, with administration of thrombolytic therapy, or mechanically, with percutaneous coronary intervention (PCI). Primary PCI refers to the strategy of emergent angiography followed by mechanical recanalization of the occluded artery with a balloon catheter, without prior administration of thrombolytic therapy. In its early years, the data regarding primary PCI were limited to observational studies from specialized centers. With the publication of randomized controlled trials (RCTs)comparingPCIwith thrombolytic therapy, however, primary PCI has become accepted as part of the standard armamentarium in the treatment of STEMI. The most recent RCTs on this topic have begun to examine the role of primary PCI in specific subsets of patients with STEMI and the role of adjunctive therapies in patients undergoing primary PCI. Pathophysiology of STEMI ST-segment elevation myocardial infarction is the clinical correlate of fullthickness ischemia and infarction of myocardium and is the result of sudden thrombotic occlusion of its blood supply. The transition from a diseased but patent coronary artery to one that is occluded by thrombus begins with either rupture or erosion of a coronary atherosclerotic plaque. The cellular and molecular events within the plaque that lead to its disruption remain incompletely understood but are clearly unrelated to the severity of the preexisting luminal stenosis. In fact, the majority of STEMI evolve from mild to moderate stenoses. Plaque disruption results in exudation of its lipid-rich core into the lumen and adherence of platelets to the arterial subendothelium. The platelets become activated and develop high affinity for fibrinogen, causing their crosslinking and degranulation. Simultaneously, the release of tissue factor from the lipid-rich core results in activation of the coagulation cascade and generation of thrombin. The result is a luminal thrombus consisting of aggregated platelets, cross-linked fibrin strands, and entrapped red blood cells (FIGURE 1). The enlarging thrombus can interrupt blood flow and lead to an imbalance between oxygen supply and demand that, if severe and persistent, causes transmural infarction of the myocardium.
Current trends in tuberculosis mortality in England and Wales.
Authors: M Nisar, P D Davies
Journal: Thorax (1991)

To determine current trends in mortality from tuberculosis according to age the published data on notification and deaths from tuberculosis from 1974 to 1987 have been analysed. The ratio of deaths to notifications per year was assessed over this period as a measure of case fatality from tuberculosis. The mean annual decline in the ratio for each age group was as follows: 0-14 years 6.7% (95% confidence interval 4.00 to 9.6%), 15-34 years 1.4% (-0.2 to 3.0%), 35-54 years 4.5% (2.2 to 6.9%), 55-74 years 2.8% (1.8 to 3.7%), and 75+ years 3.2% (2.1 to 4.2%). Because the incidence of disease in the 75+ group has declined much more slowly than in the rest of the population and because the size of this age group has increased in relation to the other groups, the overall annual mortality from tuberculosis has declined by only 0.13% (95% CI -1.3 to 1.3%). The total number of deaths from tuberculosis declined from 996 in 1974 to 430 in 1987, whereas deaths in the 75+ age group remained relatively constant at around 200 a year.
Tranexamic acid cuts deaths in trauma patients at risk of major bleeding
Authors: P. Wilson
Journal: BMJ (2010)

Of 716 men attending consecutively a dermatovenereological clinic in Riyadh, Saudi Arabia, over a period of a year 70·1% had non-specific genital infection, a figure which is four times that for gonorrhoea and 13 times that for syphilis. Most of the patients were single men aged between 20 and 29 years and had acquired their infections abroad. Although Riyadh is a cosmopolitan city with a large foreign population 79% of the infections occurred in local inhabitants.
European E coli outbreak claims further victims
Authors: R. W. a. A. Tuffs
Journal: BMJ (2011)

As the BMJ went to press on Tuesday, European public health authorities were still trying to determine the source of the Escherichia coli outbreak, which has killed 23 people, made hundreds sick, and damaged the livelihoods of thousands of vegetable producers.

Most cases have a link with northern Germany—Schleswig-Holstein, Lower Saxony, North-Rhine-Westphalia, and Hamburg—with the latter considered to be the epicentre. Initial suggestions that imported Spanish cucumbers were the cause were found to be incorrect. As we go to press, a second theory linking the outbreak to a beansprout farm in the area is also looking unlikely after no trace of the bacteria was found in 23 out of 40 samples.

The …
Endoscopic Ultrasonography–Guided Fine-Needle Aspiration Biopsy of Suspected Pancreatic Cancer
Authors: Frank Gress, Klaus Gottlieb, Stuart Sherman, Glen Lehman
Journal: Annals of Internal Medicine (2001)

In many institutions, computed tomography (CT)-guided percutaneous fine-needle aspiration (FNA) has become the procedure of choice for biopsies of pancreatic mass lesions. This method of biopsy and others, such as endoscopic retrograde cholangiopancreatography (ERCP) cytology, are problematic because of a substantial false-negative rate.To investigate the yield of endoscopic ultrasonography-guided FNA biopsies in patients who had negative results on CT-guided biopsy or negative cytologic findings on ERCP sampling.Prospective cohort study.Tertiary care university medical center.102 patients (median age, 65 years; 58 men and 44 women) with suspected pancreatic cancer who fulfilled the above criteria were prospectively identified and underwent endoscopic ultrasonography-guided FNA biopsy.The operating characteristics of endoscopic ultrasonography-guided FNA for diagnosing pancreatic masses were determined. Surgical pathology or long-term follow-up (median, 24 months) was used to identify false-positive or false-negative results.Median mass size was 3.5 cm x 2.7 cm. A median of 3.4 passes were performed. Cytologic results on endoscopic ultrasonography-guided FNA biopsy were positive in 57 patients, negative in 37, and inconclusive or nondiagnostic in 8. No false-positive results were observed. A diagnosis of pancreatic cancer was subsequently confirmed in 3 patients who had tested negative (false-negative results) and 1 of the 8 patients with nondiagnostic results. Of these 4 patients, 3 had cytologic evidence of chronic pancreatitis on endoscopic ultrasonography-guided FNA biopsy. The 95% CI for the likelihood ratio for a positive test result contained all values greater than or equal to 9.7. The likelihood ratio for a negative test result was 0.05 (CI, 0.02 to 0.15). The posterior probability of pancreatic cancer after a definitely positive result was at least 93.5% by a conservative lower 95% confidence limit; after a definitely negative test result, it was 6.9%. The prevalence of pancreatic cancer was 59.8% (61 of 102 patients). Self-limited complications occurred in 3 of the 102 patients (2.9% [CI, 0.6% to 8.4%]).Endoscopic ultrasonography-guided FNA biopsy may play a valuable role in the evaluation of a pancreatic mass when results on other biopsy methods are negative but pancreatic cancer is suspected.
On Understanding Poverty: Perspectives From the Social Sciences
Authors: Marjorie C. Meehan
Journal: JAMA (1969)

<b>On Fighting Poverty: Perspectives From Experience,</b>edited by James L. Sundquist, 288 pp, $8.50, New York: Basic Books, Inc., 1969. No longer can the problem of poverty be dismissed with Jesus' remark, "Ye have the poor with you always." Today, everyone, rich or poor, physicians or laymen, black-power advocates and white racists, must pay attention to the problems of the poor and the programs designed to solve them. Almost everyone feels qualified to express opinions, but few of us are well informed. In an effort to gather reliable information and significant ideas, the American Academy of Arts and Sciences organized a seminar. During the academic year 1966-1967, outstanding social scientists and officials in government programs met for ten weekends and discussed their viewpoints and experiences. These two volumes contain the fruit of their conferences. <i>On Understanding Poverty</i>includes 12 papers about the nature and causes of poverty. Is poverty a
Effects of minoxidil 2% vs. cyproterone acetate treatment on female androgenetic alopecia: a controlled, 12-month randomized trial
Authors: P. Vexiau, C. Chaspoux, P. Boudou, J. Fiet, C. Jouanique, N. Hardy, P. Reygagne
Journal: British Journal of Dermatology (2002)

Journal Article Effects of minoxidil 2% vs. cyproterone acetate treatment on female androgenetic alopecia: a controlled, 12‐month randomized trial Get access P. Vexiau, P. Vexiau Endocrinology Service P.Vexiau, MD. Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital St‐Louis, 1, avenue Claude Vellefaux, 75475 Paris cedex 10, France. E‐mail: patrick.vexiau@sls.ap‐hop‐paris.fr Search for other works by this author on: Oxford Academic Google Scholar C. Chaspoux, C. Chaspoux Endocrinology Service Search for other works by this author on: Oxford Academic Google Scholar P. Boudou, P. Boudou Hormone Biochemistry Laboratory Search for other works by this author on: Oxford Academic Google Scholar J. Fiet, J. Fiet Hormone Biochemistry Laboratory Search for other works by this author on: Oxford Academic Google Scholar C. Jouanique, C. Jouanique Dermatology Service, Hôpital St Louis, 75010 Paris, France Search for other works by this author on: Oxford Academic Google Scholar N. Hardy, N. Hardy Endocrinology Service Search for other works by this author on: Oxford Academic Google Scholar P. Reygagne P. Reygagne Dermatology Service, Hôpital St Louis, 75010 Paris, France Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 146, Issue 6, 1 June 2002, Pages 992–999, https://doi.org/10.1046/j.1365-2133.2002.04798.x Published: 01 June 2002 Article history Accepted: 08 January 2002 Published: 01 June 2002
TREATMENT OF CHRONIC OTORRHEA.
Authors: FRANK ALLPORT
Journal: JAMA (1901)

The subject of chronic tympanic suppuration is an important topic of aural surgery. The purpose of this paper, however, is not to introduce novel procedures for its relief, but rather to summarize our knowledge and endeavor to ascertain the crystallized sentiment of otological experience. For, be it remembered, unanimity by no means exists concerning relief measures for this troublesome and dangerous pathological condition, its treatment ranging all the way from the time-honored syringe to the radical mastoid operation. If concrete opinions concerning curative measures prevailed, no excuse would exist for this paper, but the discrepant views entertained by eminent authorities on both sides of the Atlantic furnish ample provocation for an endeavor to produce order from apparently chaotic conditions. A professional classification according to expressed views might be designated as follows: The ultraconservatives, conservatives and radicals. 1. The ultraconservatives are those still possessing an abiding faith in the syringe. cleanliness,
Identification of a new marker of hepatocellular carcinoma by serum protein profiling of patients with chronic liver diseases
Authors: Valérie Paradis, Francoise Degos, Delphine Dargère, Nanou Pham, Jacques Belghiti, Claude Degott, Jean-Louis Janeau, Annie Bezeaud, Dominique Delforge, Myriam Cubizolles, Ingrid Laurendeau, Pierre Bedossa
Journal: Hepatology (2004)

Surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF MS) is a proteomic technique that enables the profiling of proteins present in any biological material studied. We used this approach to identify new biomarkers of hepatocellular carcinoma (HCC) in the sera of patients with cirrhosis. Sera from 82 patients with cirrhosis, either without (n = 38) or with (n = 44) HCC, were analyzed by SELDI-TOF MS, and the results of the two groups were compared. The most efficient protein peaks leading to discrimination of patients with HCC were selected (receiver operative characteristic curves). The highest-scoring peak combination was established in a first group of serum samples (multinomial regression) and was tested in an independent group. The protein corresponding to the highest discrimination was purified and characterized further. The intensity of 30 protein peaks significantly differed between cirrhotic patients with and without HCC. An algorithm including the six highest-scoring peaks allowed correct classification (presence or absence of HCC) of 92.5% of patients in the test sample set and 90% in the validation sample set. The highest discriminating peak (8,900 Da) was purified further and was characterized as the C-terminal part of the V10 fragment of vitronectin. An in vitro study suggested that the increase of the 8,900-Da fragment in the serum of patients with HCC may proceed from the cleavage of native vitronectin with metalloproteases, a family of enzymes whose activity is enhanced in HCC. In conclusion, global protein profiling is an efficient approach that enabled us to identify a catalytic fragment of vitronectin as a new serum marker of HCC in patients with chronic liver diseases. (Hepatology 2005;41:40–47.)
Human T-lymphocytes are affected by notch ligands in vitro
Authors: Thomas Zöggeler, Kathrin Watzinger, Christian Kähler
Journal: European Respiratory Journal (2014)

Notch signaling is believed to be engaged in the pathophysiology of lung cancer and PAH. More recently, a significant increase of the perivascular number of T cells, cytotoxic T cells (CD8) and helper T cells (CD4) in vessels of IPAH lungs was shown. The aim of this study was to uncover, which influence the Notch-signaling pathway has on the migratory behaviour of human T-cells, in vitro.  T-cells were isolated from EDTA-anticoagulated venous blood, taken from healthy donors. The isolation was carried out according to a standardized MACS protocol. For chemotaxisexperiments, a microchemotaxis chamber was used. Freshly isolated T-cells migrated through a 5µm pore sized cellulose membrane filter for 90 min in a humidified atmosphere. Migration depth of the cells in the filter was quantified microscopically by measuring the distance from the surface of the filters to the leading front of the cells. Blocking experiments were performed with the metalloprotease ADAM17.  DLL4 and Jag1 significantly stimulated migration of T cells in a dose-dependent manner, revealing a maximal effect at 100ng/ml. Also preincubation with the Notch ligands for different time periods revealed a time dependent stimulation of migration. The maximal migratory response was observed after preincubation for 5 min. ADAM 17 significantly inhibited the migration of both human CD4+ and CD8+ T-cells towards DLL4 and Jag1 in a dose-dependent manner, revealing a maximal inhibition at 10 -4  M.  T cells may play a key role in the pathogenesis of pulmonary hypertension. Our data suggest a role for the Notch pathway in eliciting migration of T cells to areas of inflammation in the lung. Targeting this pathway may be a promising target in the near future.
Drugs and Narcotics in History
Authors: M. Farrell
Journal: BMJ (1995)

Ed Roy Porter, Mikulas Teich Cambridge University Press, £30, pp 227 ISBN 0 521 43163 8

As drug problems get worse we look to the past for answers. The interpretation of this past often depends on the lesson that the historian or policy advocate wishes to abstract. Drugs and Narcotics in History is a nice, somewhat random, selection of papers which includes aspects of the history of pharmaceutical regulation and pharmaceutical research—a welcome combination of two streams of work that rarely meet.

Virginia Berridge in a thought provoking chapter asks about the role of history in policy on AIDS and drugs. Is history to be used as a …
Is It All IgG?
Authors: Edward L. Binkley
Journal: JAMA (1974)

<h3>To the Editor.—</h3> The newborn infant is protected from infection for many months by maternal IgG. This is the accepted version. We have come to question this. IgG does not seem the answer for the complete protection with which the young are blessed. They are not only seemingly protected against<i>bacteria, but also viruses and fungi</i>. IgG just does not seem to be able to do all of this. Oral thrush and diaper rash typical of candidiasis have been seen with greater frequency in our practice during the past few years. There is a pattern with these cases—usually the mother has had symptoms of a candidiasis, vaginal discharge before birth, itchy eyes, itchy ears, coated tongue, and symptoms of a pathogenic body mold. Often the father has signs and symptoms; then, the whole family is a problem. Is this a deficit of cell-mediated immunity secondary to transfer-factor inadequacy? Therefore, are
Data on results of using different antiepileptic drugs do exist
Authors: M. J Brodie
Journal: BMJ (1997)

Editor—Anthony Marson and colleagues have challenged me to produce “hard empirical evidence” in support of a mechanistic hypothesis in the management of epilepsy.1 The best data come from a recently presented, as yet unpublished, double blind substitution study.2 In this, 7% of 215 patients reporting a median of five partial seizures a month when taking monotherapy with …
PCBs Are Endocrine Disruptors: Mixture Affects Reproductive Development in Female Mice
Authors: Victoria McGovern
Journal: Environmental Health Perspectives (2006)

Polychlorinated biphenyls (PCBs) are a broad group of chemicals that includes 209 aromatic chlorinated hydrocarbons used for products ranging from fluorescent light fixtures to coolant fluids Old equipment poses new problem.Old gas regulators that contain mercury can present a potential health hazard to residents if care is not taken when they are replaced.From cadmium to canes?New data show that even low-level exposure to cadmium may contribute to osteoporosis.