tbuckley/cabot-search huggingface dataset:
Medical Decision Making in Patients with Chest Pain
Authors: Kim A. Eagle
Journal: New England Journal of Medicine (1991)

Medical decision making in patients who present with chest pain or other symptoms suggestive of acute coronary disease continues to evolve amid new forms of technology and treatment, limitations on resources, and substantial local variation in the number and types of intensive care unit beds. Recent work has ranged from the development of predictive instruments to assist in decisions about hospital admission to the development and testing of consensus guidelines for use in decisions about admission and transfer for patients in advanced care units.The principles underlying these instruments and guidelines are based on information traditionally used by doctors in . . .
HPV vaccination as a national health priority: no easy answers
Authors: A. Jain
Journal: BMJ (2013)

The path (no pun intended) to adoption of human papillomavirus (HPV) vaccine is mired in controversy again. Back in 2010, an HPV vaccine study conducted in the states of Andhra Pradesh and Gujarat by the international non-profit Program for Appropriate Technology in Health (PATH) was stalled amid allegations of ethical violations. More than 23 000 girls aged 10-14 years were given the HPV vaccine under this project, which health activists assert was “tantamount to using Indians as guinea pigs” (doi:10.1136/bmj.c1775).

A parliamentary panel investigating the matter confirms serious shortcomings in the protocol and execution of this study. In a report submitted earlier this month, they document misleading information given to parents …
Points from Letters: Osteopaths
Authors: O. S. Kohnstamm
Journal: BMJ (1964)

BRITIH 845£4,000 or more.This is a far greater differ- ential than that said to exist between the " average " general practitioner and the fulltime consultant.The remedy for the ills of general practice may well lie in better conditions of service, and in a fairer distribution of the Pool, what- ever the future size of the latter.-Iam, etc., Cardiff.N. G. SANERKIN.SIR,-Before we have the spectacle of our learned and erstwhile dignified profession indulging in intramural arguments of our relative worths, let us quickly stop the correspondence along the lines of Drs. A. P.
Overlap and Effective Size of the Human CD8 <sup>+</sup> T Cell Receptor Repertoire
Authors: Harlan S. Robins, Santosh K. Srivastava, Paulo V. Campregher, Cameron J. Turtle, Jessica Andriesen, Stanley R. Riddell, Christopher S. Carlson, Edus H. Warren
Journal: Science Translational Medicine (2010)

Deep sequencing of the T cell receptor repertoires of seven healthy adults reveals that the adaptive immune system is far less diverse than expected and the person-to-person overlap is thousands of times larger.
OBSERVATIONS ON THE PRESENCE OF A TOXIC SUBSTANCE IN THE BLOOD AND URINE OF PATIENTS WITH SCARLET FEVER
Authors: James D. Trask, Francis G. Blake
Journal: The Journal of Experimental Medicine (1924)

A series of observations on the blood of patients acutely ill with scarlet fever has shown that a toxic substance can be demonstrated in the serum by means of intracutaneous injections of the serum in persons who have not had scarlet fever and whose serums fail to blanch the rash in scarlet fever. The reaction caused by this substance consists of a bright red local erythema, varying from 20 to 70 mm. in diameter, of 1 to 4 days duration. The severer reactions are moderately indurated and tender, and are followed bypigmentation and desquamation. Control injections in persons whose serums blanch the rash in scarlet fever cause no reaction. The toxic substance is not neutralized by mixture with a human serum which gives a negative blanching test but is readily neutralized by a human serum which gives a positive blanching test. It is not neutralized by normal horse serum, but is completely neutralized by Dochez's scarlatinal antistreptococcic serum. In a limited number of observations on the urine of patients with scarlet fever a similar toxic substance has been found in two out of five cases studied. Since the toxic substance described appears to resemble the toxic substance found in the filtrates of scarlatinal hemolytic streptococcus cultures by Dick and Dick and since it is neutralized not only by a blanching human serum but also by Dochez's scarlatinal antistreptococcic horse serum, the experiments reported support the conception that scarlet fever is a local infection of the throat by a particular type of Streptococcus haemolyticus capable of producing a toxin which is absorbed and is the cause of the general manifestations of the disease.
Avascular (Aseptic) Bone Necrosis Associated with Systemic Lupus Erythematosus
Authors: Edmund L. Dubois
Journal: JAMA (1960)

Eleven patients in a series of 400 cases of systemic lupus erythematosus developed a new complication of that disease, namely, avascular bone necrosis. The femoral head was involved bilaterally in eight patients and unilaterally in one. Two patients had bilateral damage to the femoral condyle. The average age of onset of bone symptoms was 36 years with a mean of 5.1 years after the appearance of the underlying disease. There was no relationship between corticosteroid therapy and the appearance of osseous pain. The disease process when once started was insidiously progressive in all cases but one, and led eventually, in 8 patients, to destruction of the joint with loss of mobility. Although therapy may yield symptomatic relief there was no radiographic evidence of improvement. The appearance of bilateral avascular necrosis should suggest systemic lupus erythematosus as a possible etiological factor.
Estimated Effects of a Delay in the Recommended Vaccination Schedule for Diphtheria and Tetanus Toxoids and Pertussis Vaccine
Authors: Ann W. Funkhouser
Journal: JAMA (1987)

The occurrence of adverse events temporally associated with diphtheria and tetanus toxoids and pertussis vaccine (DTP) has led to consideration of a delay in the schedule of initial vaccination. We developed an inferential model estimating the changes in pertussis- and DTP-associated health outcomes that might occur if initial DTP administration were delayed from 2, 4, and 6 months to 8, 10, and 12 months of age. An additional 636 cases of pertussis--115 of which would be associated with complications, including two encephalopathies--were projected to occur under the proposed as compared to the current schedule. Adverse medical events attributable to the vaccine were assumed to remain unchanged following the change in schedule. We projected 353 fewer chance associations with sudden infant death syndrome but 1311 more chance associations between DTP and seizures. These estimates suggest that the current schedule of vaccinating infants at 2, 4, and 6 months of age is casually associated with less morbidity and should be continued.
β-Blockers and Reduction of Cardiac Events in Noncardiac Surgery
Authors: Andrew D. Auerbach, Lee Goldman
Journal: JAMA (2002)

Recent studies suggest that β-blockers administered perioperatively may reduce the risk of adverse cardiac events and mortality in patients who have cardiac risk factors and undergo major noncardiac surgery. The objective of this article is to provide practicing physicians with examples of perioperative β-blocker use in practice by using several hypothetical cases. Although current evidence describing the effectiveness of perioperative β-blockade may not address all possible clinical situations, it is possible to formulate an evidence-based approach that will maximize benefit to patients. We describe how information from several sources can be used to guide management of patients with limited exercise tolerance, those at highest risk for perioperative cardiac events, patients who are taking β-blockers long-term, and those with relative contraindications to β-blockade. Even though fine points of their use remain to be elucidated, perioperative β-blocker use is important and can be easily applied in practice by any physician involved with the care of patients perioperatively.
The BMJ and sponsorship
Authors: F. Godlee
Journal: BMJ (2014)

Last year we asked for your views on whether the BMJ should accept sponsorship for some of its content and activities. We realised that doing this was taking a bit of a risk—even raising the issue might be seen as suggesting that we were about to relax our rules. But we were hoping to get a sense from you about how much you were bothered by such things, whether we as editors were right to fret, and whether we should keep turning down sponsorship requests. At the time, we were actively seeking ways to fund new activities at the journal, such as BMJ Spotlights (collections of articles on a topical but non-clinical …
Hemoglobin Creteil: Oxygen Transport by Erythrocytes
Authors: C. POYART
Journal: Annals of Internal Medicine (1978)

Hemoglobin (Hb) Creteil α2 β289 (F5) Ser → Asn is a high oxygen-affinity variant that has a low cooperativity, a decreased Bohr effect, and does not interact with diphosphoglycerate (DPG) (1). This hemoglobin variant was silent by routine electrophoresis. Careful analyses of the oxygen dissociation curves of erythrocytes, determined at varying pH and PCO2 in fresh and DPG-depleted cells, gave extensive information on the abnormal function of the mutant hemoglobin. From the O2 dissociation curves of the erythrocytes of the heterozygous subject it appeared that Hb Creteil is inappropriate for O2 transport to the tissues because it remained completely saturated with O2 at normal physiologic levels of PO2. In-vivo measurements showed that only one half of the total hemoglobin present actually participated in oxygen transport. Polycythemia should therefore be maintained within clinically tolerable limits because it helps to keep arterial PO2 and PVO2 close to their normal values and thus protects the individual from a permanent increase in blood flow.
S5 Prevalence Of Ige Sensitisation To 'improver Mix' Enzymes Among Symptomatic Bakers Working In Uk Scratch Bakeries
Authors: M. Jones, J. Welch, J. Turvey, J. Cannon, B. Fitzgerald, J. Szram, P. Cullinan
Journal: Thorax (2014)

<h3>Introduction and objectives</h3> Bakers working in supermarket scratch bakeries in the UK are exposed not only to flour and fungal alpha amylase but also other enzymes, incorporated in a pre-mixed bag of ‘dough improvers’. Bakers and their employers are usually unaware of which enzymes are being used within the ‘improver mix’. We have examined the question of whether supermarket bakers develop sensitisation to ‘improver mix’ enzymes other than fungal alpha amylase. <h3>Methods</h3> We assayed specific IgE sensitisation in 300 bakers employed by one of two large UK supermarkets who, at routine health surveillance, had declared work related upper or lower respiratory symptoms. Sensitisation was determined using radioallergosorbent assay to enzymes contained within the specific ‘improver’ mix used by the employing supermarket; each mix contained eight individual enzymes which were not necessarily common to both supermarkets. <h3>Results</h3> Bakers were sensitised to each of the individual ‘improver’ enzymes with a prevalence ranging from 1.8% to 23.9%; the frequency did not appear to be associated with the quantity of enzyme incorporated in the mix. Sensitisation was far more likely if a baker was sensitised also to either flour or fungal alpha amylase; but a small proportion (5%) of bakers who were sensitised to neither flour nor fungal alpha amylase had specific IgE to one or more of the ‘improver mix’ enzymes. <h3>Conclusions</h3> Bakers working in UK supermarket bakeries can become sensitised to improver enzymes other than fungal alpha amylase. The clinical significance of this remains unclear but the message is important both in the diagnosis of bakers with work-related respiratory symptoms and in any programme of immunological surveillance.
Course of virologic breakthroughs (VBTs) under lamivudine (LAM) therapy in patients (PTS) with precore mutant HBV related chronic liver disease (CLD)
Authors: G.V. Papatheodoridis, E. Dimou, V. Papadimitropoulos, A. Laras, S. Hadziyannis
Journal: Journal of Hepatology (2001)
What happened to care?
Authors: I. Capstick
Journal: BMJ (1995)

EDITOR,—Brian Livesley asks rhetorically, “Has the heart of medicine become miserly and has the concept of care finally disappeared?”1 The answer must be a qualified affirmative—qualified because I still believe that doctors, nurses, and other vocationally trained health care professionals do care about their patients. Unfortunately, the newly reorganised NHS is in danger of losing its way, being dominated by the appealing logistics of numbers and quantity; by a system that seems to ignore patient choice, autonomy, and quality of care. …
The Construction of Tissue‐Engineered Blood Vessels Crosslinked with Adenosine‐Loaded Chitosan/β‐Cyclodextrin Nanoparticles using a Layer‐by‐Layer Assembly Method
Authors: Wen Chen, Wen Zeng, Yangxiao Wu, Can Wen, Li Li, Ge Liu, Lei Shen, Mingcan Yang, Ju Tan, Chuhong Zhu
Journal: Advanced Healthcare Materials (2014)

A tissue-engineered blood vessel (TEBV) modified with CS/β-CD nanoparticles is constructed, effectively controling the release of adenosine, and this type of TEBV can keep open for over 6 months. This study also demonstrates for the first time that adenosine promotes endothelial progenitor cell (EPC) mobilization and homing via energy conversion, achieving rapid endothelialization of TEBV. As a service to our authors and readers, this journal provides supporting information supplied by the authors. Such materials are peer reviewed and may be re-organized for online delivery, but are not copy-edited or typeset. Technical support issues arising from supporting information (other than missing files) should be addressed to the authors. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
New oral anticoagulants for thromboprophylaxis in patients having hip or knee arthroplasty
Authors: J. W. Eikelboom, J. I. Weitz
Journal: BMJ (2011)

The newest oral anticoagulants, dabigatran etexilate (hereafter referred to as dabigatran) and rivaroxaban, have been approved in more than 70 countries for prevention of venous thromboembolism after elective hip or knee arthroplasty. Dabigatran targets thrombin (factor IIa) and rivaroxaban targets factor Xa1 (figure⇓).



Sites of action of the new oral anticoagulants. By targeting thrombin, thrombin inhibitors (such as dabigatran) block thrombin mediated conversion of fibrinogen to fibrin, which leads to clot formation, as well as thrombin mediated feedback activation of coagulation factors V and VIII. Factor Xa inhibitors (such as rivaroxaban and apixaban) block the conversion of prothrombin to thrombin by the prothrombinase complex (the complex of factor Xa and factor Va bound to the surface of the activated platelet). Heparin targets thrombin and factor Xa equally well, whereas low molecular weight heparin targets factor Xa to a greater extent than thrombin, and fondaparinux targets only factor Xa. Vitamin K antagonists, such as warfarin, reduce the levels of factors II, VII, IX, and X as well as protein C and S



#### Case scenario

A 78 year old woman has had an elective left hip arthroplasty and on discharge her orthopaedic surgeon prescribes a further, 28 day postoperative course of anticoagulant prophylaxis. She sees her general practitioner a week later, concerned that these “blood thinners” are tablets, whereas she had daily injections after her knee replacement three years ago. Her general practitioner explains that the tablets have recently become available and that guidelines recommend them as an alternative to injections as they are as effective, more convenient, and safe.

Evidence based guidelines recommend anticoagulant thromboprophylaxis with subcutaneous agents such as low molecular weight heparin or fondaparinux or oral agents such as warfarin, dabigatran, or rivaroxaban for at least 10 days after knee arthroplasty and for up to 35 days after …
Defective regulation of gap junctional coupling in cystic fibrosis pancreatic duct cells
Authors: Marc Chanson, Isabelle Scerri, Susanne Suter
Journal: Journal of Clinical Investigation (1999)

The cystic fibrosis (CF) gene encodes a cAMP-gated Cl– channel (cystic fibrosis transmembrane conductance regulator [CFTR]) that mediates fluid transport across the luminal surfaces of a variety of epithelial cells. We have previously shown that gap junctional communication and Cl– secretion were concurrently regulated by cAMP in cells expressing CFTR. To determine whether intercellular communication and CFTR-dependent secretion are related, we have compared gap junctional coupling in a human pancreatic cell line harboring the ΔF508 mutation in CFTR and in the same cell line in which the defect was corrected by transfection with wild-type CFTR. Both cell lines expressed connexin45 (Cx45), as evidenced by RT-PCR, immunocytochemistry, and dual patch-clamp recording. Exposure to agents that elevate intracellular cAMP or specifically activate protein kinase A evoked Cl– currents and markedly increased junctional conductance of CFTR-expressing pairs, but not in the parental cells. The latter effect, which was caused by an increase in single-channel activity but not in unitary conductance of Cx45 channels, was not prevented by exposing CFTR-expressing cells to a Cl– channel blocker. We conclude that expression of functional CFTR restored the cAMP-dependent regulation of junctional conductance in CF cells. Direct intercellular communication coordinates multicellular activity in tissues that are major targets of CF manifestations. Consequently, defective regulation of gap junction channels may contribute to the altered functions of tissues affected in CF.
Efficient Marking of Murine Long-Term Repopulating Stem Cells Targeting Unseparated Marrow Cells at Low Lentiviral Vector Particle Concentration
Authors: Peter Kurre, Ponni Anandakumar, Michael A Harkey, Bobbie Thomasson, Hans-Peter Kiem
Journal: Molecular Therapy (2004)

HIV-1-derived lentivirus vectors offer unique biological properties for gene delivery to hematopoietic stem cells and, when used at high multiplicities of infection (m.o.i.), permit efficient gene transfer after minimal target cell stimulation. However, such a strategy has been shown to promote multicopy proviral integration, potentially increasing the risk of insertional mutagenesis. To minimize cell manipulation, we targeted unseparated marrow and demonstrated that transduction at an m.o.i. of 1 resulted in up to 12% vector-modified peripheral blood leukocytes and successful repopulation of secondary recipients with vector-marked cells. Real-time PCR showed on average 1.8 proviral integrants per GFP-marked cell. By comparison, a cohort of animals transplanted with cells transduced at m.o.i. of 10 under otherwise unchanged conditions showed up to 45% marking with an average of 7 copies per GFP-expressing cell. Both m.o.i. groups demonstrated sustained proviral expression with stable GFP fluorescence intensity. In summary, we have identified conditions for lentiviral gene transfer involving minimal ex vivo target cell manipulation and have shown that the m.o.i. is a critical determinant of proviral copy number in lentivirus-transduced murine long-term repopulating cells. Thus, gene transfer efficiencies may be limited when single-copy integration is desired and additional strategies such as in vivo selection may be required to improve the frequency of gene-modified cells.
Self-reported immunological and familial links in individuals who perceive they have sensitive skin
Authors: M.A. Farage
Journal: British Journal of Dermatology (2008)

Journal Article Self‐reported immunological and familial links in individuals who perceive they have sensitive skin Get access M.A. Farage M.A. Farage The Procter and Gamble Company, Winton Hill Business Center, 6110 Center Hill Road, Box 136, Cincinnati, OH 45224, U.S.A. E‐mail: farage.m@pg.com Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 159, Issue 1, 1 July 2008, Pages 237–238, https://doi.org/10.1111/j.1365-2133.2008.08585.x Published: 01 July 2008
Cyclin D1 Induction through IκB Kinase β/Nuclear Factor-κB Pathway Is Responsible for Arsenite-Induced Increased Cell Cycle G1-S Phase Transition in Human Keratinocytes
Authors: Weiming Ouyang, Qian Ma, Jingxia Li, Dongyun Zhang, Zheng-gang Liu, Anil K. Rustgi, Chuanshu Huang
Journal: Cancer Research (2005)

Abstract Environmental and occupational exposure to arsenite is associated with an increased risk of human cancers, including skin, urinary bladder, and respiratory tract cancers. Although much evidence suggests that alterations in cell cycle machinery are implicated in the carcinogenic effect of arsenite, the molecular mechanisms underlying the cell cycle alterations are largely unknown. In the present study, we observed that exposure of human keratinocyte HaCat cells to arsenite resulted in the promotion of cell cycle progression, especially G1-S transition. Further studies found that arsenite exposure was able to induce cyclin D1 expression. The induction of cyclin D1 by arsenite required nuclear factor-κB (NF-κB) activation, because the inhibition of IκB phosphorylation by overexpression of the dominant-negative mutant, IKKβ-KM, impaired arsenite-induced cyclin D1 expression and G1-S transition. The requirement of IκB kinase β (IKKβ) for cyclin D1 induction was further confirmed by the findings that arsenite-induced cyclin D1 expression was totally blocked in IKKβ knockout (IKKβ−/−) mouse embryo fibroblasts. In addition, knockdown of cyclin D1 expression using cyclin D1–specific small interference RNA significantly blocked arsenite-induced cell cycle progression in HaCat cells. Taken together, our results show that arsenite-induced cell cycle from G1 to S phase transition is through IKKβ/NF-κB/cyclin D1–dependent pathway.