tbuckley/cabot-search huggingface dataset:
Dutch GPs agree to refer fewer patients to hospital and prescribe more generic drugs
Authors: T. Sheldon
Journal: BMJ (2012)

The long running dispute between the Dutch ministry of health and Netherlands general practitioners is over in a deal seen as guaranteeing stability and growth for the profession, defining their position as the gatekeepers of care.

But in return for annual budget growth and extra funding for modernisation and innovation, GPs must realise savings worth millions of euros from generic prescribing and refer fewer patients to more expensive hospital care.

The minister of health, Edith Schippers, and the GPs Association chair, Steven van Eijck, signed the “covenant” barely eight months after almost two thirds of the Netherlands general practitioners had demonstrated …
Argentine randomized trial of percutaneous transluminal coronary angioplasty versus coronary artery bypass surgery in multivessel disease (ERACI): In-hospital results and 1-year follow-up
Authors: Alfredo Rodriguez, Fernando Boullon, Nestor Perez-Baliño, Claudia Paviotti, Maria I.Sosa Liprandi, Igor F. Palacios
Journal: Journal of the American College of Cardiology (1993)
THE ENHANCEMENT OF PERIPHERAL GLUCOSE UTILIZATION BY GLUCAGON
Authors: H. Elrick, C. J. Hlad, T. Witten, T. M. Bow, Y. Arai, A. Smith
Journal: Journal of Clinical Investigation (1955)

These subjects received glucose infusion alone at one constant rate.Data treated as in Tables I andII.t A-Capillary blood sugar (mg.per cent), V-Antecubital vein sugar (mg.per cent).
Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study
Authors: M. May, M. Gompels, V. Delpech, K. Porter, F. Post, M. Johnson, D. Dunn, A. Palfreeman, R. Gilson, B. Gazzard, T. Hill, J. Walsh, M. Fisher, C. Orkin, J. Ainsworth, L. Bansi, A. Phillips, C. Leen, M. Nelson, J. Anderson, C. Sabin
Journal: BMJ (2011)

<b>Objectives </b>To estimate life expectancy for people with HIV undergoing treatment compared with life expectancy in the general population and to assess the impact on life expectancy of late treatment, defined as CD4 count &lt;200 cells/mm<sup>3</sup> at start of antiretroviral therapy. <b>Design </b>Cohort study. <b>Setting </b>Outpatient HIV clinics throughout the United Kingdom. <b>Population </b>Adult patients from the UK Collaborative HIV Cohort (UK CHIC) Study with CD4 count ≤350 cells/mm<sup>3</sup> at start of antiretroviral therapy in 1996-2008. <b>Main outcome measures </b>Life expectancy at the exact age of 20 (the average additional years that will be lived by a person after age 20), according to the cross sectional age specific mortality rates during the study period. <b>Results </b>1248 of 17 661 eligible patients died during 91 203 person years’ follow-up. Life expectancy (standard error) at exact age 20 increased from 30.0 (1.2) to 45.8 (1.7) years from 1996-9 to 2006-8. Life expectancy was 39.5 (0.45) for male patients and 50.2 (0.45) years for female patients compared with 57.8 and 61.6 years for men and women in the general population (1996-2006). Starting antiretroviral therapy later than guidelines suggest resulted in up to 15 years’ loss of life: at age 20, life expectancy was 37.9 (1.3), 41.0 (2.2), and 53.4 (1.2) years in those starting antiretroviral therapy with CD4 count &lt;100, 100-199, and 200-350 cells/mm<sup>3</sup>, respectively. <b>Conclusions </b>Life expectancy in people treated for HIV infection has increased by over 15 years during 1996-2008, but is still about 13 years less than that of the UK population. The higher life expectancy in women is magnified in those with HIV. Earlier diagnosis and subsequent timely treatment with antiretroviral therapy might increase life expectancy.
Cholinergic blockade in the prevention of exercise-induced asthma.
Authors: J P Hartley, B H Davies
Journal: Thorax (1980)

The contribution of vagal mechanisms to exercise-induced asthma has been studied in 10 adult asthmatic patients using the anticholinergic drug ipratropium bromide. Exercise tests were performed for eight minutes on a cycle ergometer and each individual9s tests were standardised by matching oxygen uptake. Two tests were done on each of three study days, the first being without previous medication, and the second preceded by inhalation of ipratropium bromide, 0.1, or 1 mg or saline placebo given 90 minutes beforehand. The mean falls in FEV1 and PEFR after the initial tests were very similar on the three study days. The mean falls in FEV1 after the second test were 22.3%, 19.5%, and 12.5% with placebo, 0.1 mg, and 1 mg ipratropium bromide respectively. Only the higher dose was significantly better than placebo. The results were also analysed using a protection index to compare the first and second tests each day and 1 mg ipratropium bromide was significantly better than both 0.1 mg and placebo. Similar results were obtained using PEFR. Equal bronchodilatation was produced by the two doses of drug. We conclude that conventional doses of anticholinergic drugs are not effective in preventing exercise-induced asthma, while large doses may do so in the same group of subjects.
Short-Term Effects of Carbon Monoxide on Mortality: An Analysis within the APHEA Project
Authors: Evangelia Samoli, Giota Touloumi, Joel Schwartz, Hugh Ross Anderson, Christian Schindler, Bertil Forsberg, Maria Angela Vigotti, Judith Vonk, Mitja Košnik, Jiri Skorkovsky, Klea Katsouyanni
Journal: Environmental Health Perspectives (2007)

We investigated the short-term effects of carbon monoxide on total and cardiovascular mortality in 19 European cities participating in the APHEA-2 (Air Pollution and Health: A European Approach) project.
Hypersensitivity pneumonitis and metalworking fluids contaminated by mycobacteria
Authors: C.M. Barber, C. Burton, E. Robinson, B. Crook, G. Evans, D. Fishwick
Journal: European Respiratory Journal (2011)

We read with interest the article published by relating to hypersensitivity pneumonitis (HP) in French automobile workers exposed to metalworking fluids (MWFs).Our group was involved in the UK outbreak investigation referenced in their article [2,3], and have a clinical and research interest in this area.
A better understanding of inference can reconcile constructivist and direct theories
Authors: Myron L. Braunstein
Journal: Behavioral and Brain Sciences (2002)

The attempt to relate distinctions in perceptual theory to different physiological systems leads to numerous exceptions and inconsistencies. A more promising approach to the reconciliation of constructivist theory and direct perception is to recognize that perception does involve inference, as the constructivists insist, but that inference is a process in logic that does not require unconscious reasoning and need be no more thought-like than resonance.
Mental Illness and American Society, 1875-1940
Authors: Marjorie C. Meehan
Journal: JAMA (1984)

In recent years many social scientists and historians have written about mental hospitals and society's ways of coping with the mentally ill. Almost all the authors seemed to have had some ax to grind—to attack capitalist society, or psychiatry, or psychoanalysis. One of the least hostile historians is Gerald Grob, professor of history at Rutgers University, who in 1973 published the book entitled<i>Mental Institutions in America: Social Policy to 1875</i>. Now he presents its sequel, to 1940. This is a scholarly work, clearly written, obviously carefully researched, and well documented—93 pages of notes and 321 pages of text. Grob shows that the care of the mentally ill was originally the responsibility of their community—city or county—but gradually the responsibility was transferred to the states. This led to the ever-increasing size of state hospitals which, for several reasons, steadily accumulated more and more elderly and chronic cases who needed custodial
Screening may not reduce suicide in later life
Authors: Steve Iliffe, Jill Manthorpe
Journal: BMJ (2004)

EDITOR—O'Connell et al are wise to warn against a reductionist approach to the complex topic of suicide in older people since an epidemiological perspective makes older people who commit suicide into objects of disease processes rather than subjects struggling to control their lives.1 They also prescribe vigorous screening and aggressive …
Fatty-acid metabolism and the pathogenesis of hepatocellular carcinoma: Review and hypothesis
Authors: Robert K. Ockner, Raja M. Kaikaus, Nathan M. Bass
Journal: Hepatology (1993)

Despite increasing understanding of the genetic control of cell growth and the identification of several involved chemical and infectious factors, the pathogenesis of clinical and experimental hepatocellular carcinoma remains unknown. Available evidence is consistent with the possibility that selected changes in the hepatocellular metabolism of long-chain fatty acids may contribute significantly to this, process. Specifically, studies of the peroxisome proliferators, a diverse group of xenobiotics that includes the fibrate class of hypolipidemic drugs, suggest that increased fatty acid oxidation by way of extramitochondrial pathways (i.e., omega-oxidation in the smooth endoplasmic reticulum and beta-oxidation in the peroxisomes) results in a corresponding increase in the generation of hydrogen peroxide and, thus, oxidative stress. This in turn leads to alterations in gene expression and in DNA itself. We also review evidence supporting a potentially decisive influence of particular aspects of hepatocellular fatty acid metabolism in determining the activity of the extramitochondrial pathways. Moreover, certain intermediates of extramitochondrial fatty acid oxidation (e.g., the long-chain dicarboxylic fatty acids) impair mitochondrial function and are implicated as modulators of gene expression through their interaction with the peroxisome proliferator-activated receptor. Finally, the occurrence of hepatic tumors in type I glycogen storage disease (glucose-6-phosphatase deficiency) may exemplify this general mechanism, which may also contribute to nonneoplastic liver injury and to tumorigenesis in other tissues.
Utility of Lens culinaris Agglutinin-Reactive Fraction of α-Fetoprotein and Des-Gamma-Carboxy Prothrombin, Alone or in Combination, as Biomarkers for Hepatocellular Carcinoma
Authors: Richard K. Sterling, Lennox Jeffers, Fredric Gordon, Alan P. Venook, K. Rajender Reddy, Shinji Satomura, Futoshi Kanke, Myron E. Schwartz, Morris Sherman
Journal: Clinical Gastroenterology and Hepatology (2008)
BMA meeting: BMA representatives vote to ban homoeopathy from the NHS
Authors: D. Cohen
Journal: BMJ (2010)

Homoeopathic hospitals and remedies should not be funded on the NHS, given the absence of valid scientific evidence of benefit, voted representatives at the BMA’s annual conference in Brighton this week.

They also voted that no UK training post should include a placement in homoeopathy and that pharmacists should remove homoeopathic remedies from their shelves indicating they are drugs: they should place them on shelves clearly labelled “placebos.”

About 50 pro-homoeopathy protestors gathered outside the Brighton conference centre to urge representatives to support the provision of homoeopathy on the NHS. Hamish Meldrum, chairman of the BMA, also said that members had written in to say …
Intraprostatic Botulinum Toxin Type A Injection in Patients Unfit for Surgery Presenting with Refractory Urinary Retention and Benign Prostatic Enlargement. Effect on Prostate Volume and Micturition Resumption
Authors: João Silva, Carlos Silva, Luis Saraiva, André Silva, Rui Pinto, Paulo Dinis, Francisco Cruz
Journal: European Urology (2007)
Selective changes in natriuretic peptide and early response gene expression in isolated rat atria following stimulation by stretch or endothelin-1
Authors: B. G Bruneau, A. J De Bold
Journal: Cardiovascular Research (1994)

Objective: Important physiological and pathophysiological conditions are associated with changes in secretion and synthesis of atrial natriuretic factor (ANF) and brain natriuretic peptide (BNP). The aim of this study was to examine the effects of mechanical stretch and endothelin-1 on ANF and BNP secretion and gene expression in isolated adult rat atria, as paradigms for mechanical and endocrine stimulation of atrial tissue. The expression of the early response genes c-fos, c-jun, Egr-1, and c-myc was also studied, since their protein products may be involved in controlling natriuretic peptide gene expression. Methods: Isolated rat atria were stimulated by stretch (5 g) or endothelin-1 (10−7 M) for 30 min, 2 h, or 4 h. ANF and BNP secretion was measured by radioimmunoassay, and relative mRNA levels were determined by northern blotting. Results: Atrial stretch resulted in an immediate 1.8-fold increase in ANF release, which returned to basal levels after 160 min. Endothelin-1 caused a gradual increase in ANF release, up to 2.3 times basal levels, and thereafter returned towards basal levels. BNP secretion was increased threefold by endothelin-1, and remained significantly raised for 90 min. BNP mRNA levels were transiently increased by 33% after 2 h of endothelin-1 stimulation. Stretch increased c-fos mRNA levels (+55%) and Egr-1 mRNA levels (+70%) after 2 h, and increased c-myc mRNA levels (+69%) after 4 h. Endothelin-1 increased Egr-1 mRNA levels up to +767% after 4 h. Conclusions: Endothelin-1 stimulates BNP secretion from rat atria; this is followed by an increase in BNP mRNA levels. Conversely, acute secretion of ANF by stretch or endothelin-1 is not accompanied by changes in ANF mRNA levels. Atrial stretch results in changes in the expression of the early response genes c-fos, Egr-1, and c-myc, while endothelin-1 stimulates Egr-1 expression. The specific changes in natriuretic peptide and early response gene expression reveal distinct mechanisms of modulation of atrial gene expression by mechanical and endocrine stimuli. Cardiovascular Research 1994;28:1519-1525
Successful chemotherapy in a male patient with malignant lymphoma and Leber's hereditary optic neuropathy (LHON)
Authors: Stefanie Zanssen, Gerhard Buse
Journal: American Journal of Hematology (2003)

Abstract Leber's hereditary optic neuropathy (LHON) is a bilateral subacute optic neuropathy caused by hereditary missense mutations of the mitochondrial genome. Primary mutations are located at nucleotide positions 11778, 3460, and 14484 in genes encoding subunits of complex I of the respiratory chain. It has been suggested that degenerative changes in the optic nerve might be mediated by apoptosis. Therefore, we hypothesized that patients affected with LHON might show altered sensitivity to cytotoxic drugs. Here we report the case of a LHON patient carrying the 11778 mutation who required chemotherapy for malignant lymphoma. Using in vitro assays, we found that the patient's peripheral blood mononuclear cells did not show altered vulnerability to cytotoxic drugs. The patient was treated with combination chemotherapy and consolidating radiotherapy, leading to complete remission without inappropriately severe acute or chronic side effects. These data indicate that the 11778 mutation does not change cellular response to cytotoxic drugs in a clinically apparent manner. Am. J. Hematol. 72:263–266, 2003. © 2003 Wiley‐Liss, Inc.
Iron Hydrogenases and the Evolution of Anaerobic Eukaryotes
Authors: David S. Horner, Peter G. Foster, T. Martin Embley
Journal: Molecular Biology and Evolution (2000)

Hydrogenases, oxygen-sensitive enzymes that can make hydrogen gas, are key to the function of hydrogen-producing organelles (hydrogenosomes), which occur in anaerobic protozoa scattered throughout the eukaryotic tree. Hydrogenases also play a central role in the hydrogen and syntrophic hypotheses for eukaryogenesis. Here, we show that sequences related to iron-only hydrogenases ([Fe] hydrogenases) are more widely distributed among eukaryotes than reports of hydrogen production have suggested. Genes encoding small proteins which contain conserved structural features unique to [Fe] hydrogenases were identified on all well-surveyed aerobic eukaryote genomes. Longer sequences encoding [Fe] hydrogenases also occur in the anaerobic eukaryotes Entamoeba histolytica and Spironucleus barkhanus, both of which lack hydrogenosomes. We also identified a new [Fe] hydrogenase sequence from Trichomonas vaginalis, bringing the total of [Fe] hydrogenases reported for this organism to three, all of which may function within its hydrogenosomes. Phylogenetic analysis and hypothesis testing using likelihood ratio tests and parametric bootstrapping suggest that the [Fe] hydrogenases in anaerobic eukaryotes are not monophyletic. Iron-only hydrogenases from Entamoeba, Spironucleus, and Trichomonas are plausibly monophyletic, consistent with the hypothesis that a gene for [Fe] hydrogenase was already present on the genome of the common, perhaps also anaerobic, ancestor of these phylogenetically distinct eukaryotes. Trees where the [Fe] hydrogenase from the hydrogenosomal ciliate Nyctotherus was constrained to be monophyletic with the other eukaryote sequences were rejected using a likelihood ratio test of monophyly. In most analyses, the Nyctotherus sequence formed a sister group with a [Fe] hydrogenase on the genome of the eubacterium Desulfovibrio vulgaris. Thus, it is possible that Nyctotherus obtained its hydrogenosomal [Fe] hydrogenase from a different source from Trichomonas for its hydrogenosomes. We find no support for the hypothesis that components of the Nyctotherus [Fe] hydrogenase fusion protein derive from the mitochondrial respiratory chain.
Detection of Primary Melanoma in Individuals at Extreme High Risk
Authors: Fergal J. Moloney, Pascale Guitera, Elliot Coates, Nikolas K. Haass, Kenneth Ho, Ritta Khoury, Rachel L. O'Connell, Leo Raudonikis, Helen Schmid, Graham J. Mann, Scott W. Menzies
Journal: JAMA Dermatology (2014)

<h3>Importance</h3> The clinical phenotype and certain predisposing genetic mutations that confer increased melanoma risk are established; however, no consensus exists regarding optimal screening for such individuals. Early identification remains the most important intervention in reducing melanoma mortality. <h3>Objective</h3> To evaluate the impact of full-body examinations every 6 months supported by dermoscopy and total-body photography (TBP) on all patients and sequential digital dermoscopy imaging (SDDI), when indicated, on detecting primary melanoma in an extreme-risk population. <h3>Design, Setting, and Participants</h3> Prospective observational study from February 2006 to February 2011, with patients recruited from Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia who had a history of invasive melanoma and dysplastic nevus syndrome, history of invasive melanoma and at least 3 first-degree or second-degree relatives with prior melanoma, history of at least 2 primary invasive melanomas, or a<i>CDKN2A</i>or<i>CDK4</i>gene mutation. <h3>Exposures</h3> Six-month full-body examination compared with TBP. For equivocal lesions, SDDI short term (approximately 3 months) or long term (≥6 months), following established criteria, was performed. Atypical lesions were excised. <h3>Main Outcomes and Measures</h3> New primary melanoma numbers, characteristics, and cumulative incidence in each patient subgroup; effect of diagnostic aids on new melanoma identification. <h3>Results</h3> In 311 patients with a median (interquartile range [IQR]) follow-up of 3.5 (2.4-4.2) years, 75 primary melanomas were detected, 14 at baseline visit. Median (IQR) Breslow thickness of postbaseline incident melanomas was in situ (in situ to 0.60 mm). Thirty-eight percent were detected using TBP and 39% with SDDI. Five melanomas were greater than 1 mm Breslow thickness, 3 of which were histologically desmoplastic; the other 2 had nodular components. The benign to malignant excision ratio was 1.6:1 for all lesions excised and 4.4:1 for melanocytic lesions. Cumulative risk of developing a novel primary melanoma was 12.7% by year 2, with new primary melanoma incidence during the final 3 years of follow-up half of that observed during the first 2 years (incidence density ratio, 0.43 [95% CI, 0.25-0.74];<i>P</i> = .002). <h3>Conclusions and Relevance</h3> Monitoring patients at extreme risk with TBP and SDDI assisted with early diagnosis of primary melanoma. Hypervigilance for difficult-to-detect thick melanoma subtypes is crucial.
Creating a Basis for Good Outcomes
Authors: Rebecca Voelker
Journal: JAMA (1995)

FROM OUTWARD appearances, it might seem that the outcomes research revolution is well under way. Study results are published regularly in the medical literature and clinical outcomes data have helped produce dozens of practice guidelines. But when outcomes research is scrutinized more closely, it appears that the revolution is still very much an evolution. "Is this just another passing fad or is it providing something that's not available through standard clinical trials or certain kinds of process measures?" asked Sheldon Greenfield, MD, director of the Primary Care Outcomes Research Institute at the New England Medical Center in Boston, Mass. Greenfield discussed varying aspects of outcomes research during Prevention 95, the annual meeting sponsored by the American College of Preventive Medicine and the Association of Teachers of Preventive Medicine. Outcomes research has become a critical topic for specialists in preventive medicine. Their emphasis on bringing clinical preventive services to the masses
Low Molecular Weight Heparin After Mechanical Heart Valve Replacement
Authors: Gilles Montalescot, Valérie Polle, Jean P. Collet, Pascal Leprince, Agnès Bellanger, Iradj Gandjbakhch, Daniel Thomas
Journal: Circulation (2000)

Background —Patients with mechanical heart valves require life-long anticoagulation. We report here the first large and comparative series of consecutive patients anticoagulated with low molecular weight heparin (LMWH) after mechanical heart valve replacement. Methods and Results —In this comparative, nonrandomized study, 208 consecutive patients who underwent a single or double heart valve replacement with mechanical prostheses were anticoagulated subcutaneously with unfractionated heparin (UH) in the first period (n=106) and LMWH in the second phase (n=102) of the study. Baseline characteristics were similar in the 2 groups. The mean durations of UH and LMWH treatments were 13.6±0.5 and 14.1±0.6 days, respectively (not significant). On the second day of treatment, 87% of patients treated with LMWH had an anti-Xa activity within the range of efficacy (0.5 to 1 IU/mL), but only 9% of UH-treated patients had an activated partial-thromboplastin time value within the therapeutic range (1.5 to 2.5 times control, P &lt;0.0001 between the 2 groups). On the last day of prescription, all LMWH-treated patients had anti-Xa activity above 0.5 IU/mL, but 19% were above 1 IU/mL. In the UH group, 27% of patients had an activated partial-thromboplastin time above 1.5 times control, but 62% were overanticoagulated. Two major bleedings occurred in each group, and one stroke occurred in the UH group. Conclusions —In this first comparative study, anticoagulation with LMWHs after mechanical heart valve replacement appears feasible, provides adequate biological anticoagulation, and compares favorably with UH anticoagulation. Randomized studies are now needed to further evaluate this new therapeutic approach.