tbuckley/cabot-search huggingface dataset:
Hospital bed utilisation in the NHS and Kaiser Permanente
Authors: Chris Ham, Nick York, Rob Shaw, Steve Sutch
Journal: BMJ (2004)

Editor—We agree with Black that improved bed management is not expensive and with Badrinath that other evidence supports our argument that the NHS can learn from Kaiser. Like Evans, we were sceptical of the claims made by Feachem et al in their original paper,1 but as the evidence has changed we have been willing to change our minds.

Ebrahim et al claim that incidence figures for stroke are not available. They seem to have overlooked evidence that shows that the incidence is only marginally lower in the United States than in England (362 per 100 000 compared with 379 per 100 000).2 As admission rates for stroke are also marginally lower in Kaiser than in the NHS, it is difficult to sustain their argument that Kaiser has much higher rates of readmission. In view of the lower mortality in the United States cited by Ebrahim et al it is also hard to argue that quality of stroke care is lower in that country.

Kaiser's lower use of acute beds results mainly from big differences in length of stay. In the case of stroke, Kaiser does not skimp on effective clinical interventions but chooses to provide these in non-acute care settings. Most acute hospitals are not well suited to provide several hours a day of intensive rehabilitation, and Kaiser's use of skilled nursing facilities for this purpose enables it to make much less use of acute beds.

We agree with Mallet that it would be valuable to distinguish between the time patients spend in an acute hospital and the time spent in community hospitals and similar facilities. This was identified in our paper as one of the limitations of the data we had available. Despite this, there are important lessons from Kaiser about the scope for reducing the time patients with stroke stay in the acute hospital by providing care in alternative settings.

Another correspondent on bmj.com reports improvements in performance in Lambeth and Southwark applying principles similar to those used in Kaiser.3 Like her, we believe the appropriate response to the analysis we have undertaken is not to deny these differences or seek to explain them away, but to ask how can we do better.
Intestinal perforation: a rare complication of percutaneous endoscopic jejunostomy removal
Authors: N. Zschau, N. Nguyen, W. Tam, M. Schoeman
Journal: Endoscopy (2008)

Direct endoscopic percutaneous jejunostomy (DPEJ) was first described by Shike et al. 1987 [1] and since then has become increasingly popular [2]. Successful placement is achieved in up to 72 % of patients. Immediate complications such as bowel perforation and serious bleeding have been reported in up to 22 % of patients [3]. Currently, reports of complications during replacement of DPEJ are lacking. We report two cases of intestinal perforation related to the removal and replacement of DPEJ.
The promotion of siRNA delivery to breast cancer overexpressing epidermal growth factor receptor through anti-EGFR antibody conjugation by immunoliposomes
Authors: Jie Gao, Wei Liu, Yu Xia, Wei Li, Jing Sun, Huaiwen Chen, Bohua Li, Dapeng Zhang, Weizhu Qian, Yanchun Meng, Li Deng, Hao Wang, Jianming Chen, Yajun Guo
Journal: Biomaterials (2011)
Totally implantable vascular access for long term chemotherapy.
Authors: A E Young, D R Allen, K Harrop-Griffiths, W A Corbett, M Lambert
Journal: BMJ (1985)

Systeme comportant un catheter implante dans une serie centrale et une chambre d'acier suturee en position sous-cutanee comportant une paroi de silicone qui se referme apres chaque ponction. Le systeme est utilise chez 40 malades avec de bons resultats, les 2 seuls cas d'infection sont dus a un manque d'asepsie lors des injections
Book: Medicine's Strangest Cases
Authors: B. Twisselmann
Journal: BMJ (2003)

Michael O'Donnell Robson Books, £8.99, pp 316 ISBN 1 86105 563 3 Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img> This humorous tome by a former doctor, writer, and broadcaster is an enjoyable tour through medical history. It relates sometimes hilariously funny, sometimes barely credible, bizarre, amusing, or mischievous cases and incidents. O'Donnell's source material included his own collection of doctors' letters sent to him when he … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
Quality of Lyme Disease Tests
Authors: Louis A. Magnarelli
Journal: JAMA (1989)

In this issue ofThe Journal, Schwartz and colleagues<sup>1</sup>report interlaboratory differences in serological test results for Lyme disease. Their findings confirm earlier results<sup>2</sup>and show that the rising number of tests performed in areas endemic for this disease can be very high. Lyme disease continues to receive major attention by the news media. Consequently, with the knowledge that the characteristic skin lesion erythema migrans may not always develop and that there is potential for long-term disorders that may be confused with other maladies, the public and the medical community have relied heavily on serum antibody tests for diagnosis. When patients are in the later stages of Lyme disease, marked by neurological or arthritic disorders, clinicians sometimes are faced with great difficulty in making a diagnosis. Like many other laboratory tests, assays for Lyme disease are less than perfect, and, as expressed by Schwartz et al,<sup>1</sup>some
Design, synthesis and antitumor activity of C3/C3 bis-fluoroquonolones cross-linked with [1,2,4]triazolo[3,4-b] [1,3,4]thiadiazole
Authors: Guo-qiang Hu, Yong Yang, Lei Yi, Guo-qiang Wang, Nan-nan Duan, Xiao-yi Wen, Tie-yao Cao, Song-qiang Xie, Wen-Long Huang
Journal: Acta Pharmaceutica Sinica B (2011)

To contribute to the development of an efficient method for the conversion of antibacterial fluoroquinolones to antitumor fluoroquinolones, a series of C3/C3 bis-fluoroquinolone fused heterocycles cross-linked with a [1,2,4]-triazolo[3,4-b] [1,3,4]-thiadiazole core as a common bioisostere of two carboxylic acid groups was designed and synthesized as their hydrochloride salts. Structures were characterized by elemental analysis and spectral data and their in vitro antitumor activity against L1210, CHO and HL60 cell lines was screened by determination of their IC50 values in the methylthiazole trazolium (MTT) assay. Two compounds were highly potent against the HL60 cell line and represent promising lead compounds for future development.
Nosocomial Legionnaires' disease. Epidemiologic demonstration of cooling towers as a source
Authors: P. L. Garbe
Journal: JAMA (1985)

Investigation of a recent outbreak of nosocomial legionnaires' disease—initially thought to be due to the documented presence of<i>Legionella pneumophila</i>in the hospital potable water—showed that aerosols from one or more cooling towers were the actual source of infection. From June 27 to Aug 25, 1983, nosocomial legionnaires' disease developed in 15 persons at a hospital in Rhode Island. Twelve (80%) of 15 case-patients occupied rooms in building 1, unit B, compared with eight (28%) of 29 control patients (odds ratio=10.8; 95% confidence interval=1.4 to 85.6). Subsequent investigation demonstrated that water in a cooling tower located 100 ft upwind of unit B was heavily contaminated with<i>L pneumophila</i>, serogroup 1, subgroup 1, 2, 4, 5. The same strain was isolated from nine of the patients and from the make-up water for the tower. Active surveillance during the ten months following decontamination of the cooling tower identified no additional cases of nosocomial legionnaires' disease, although the hospital potable water had not been treated. While recommendations have been made for controlling nosocomial legionnaires' disease by heating or hyperchlorination of hospital potable water, this outbreak demonstrates the importance of an adequate epidemiologic-environmental investigation in choosing the appropriate control strategy. (<i>JAMA</i>1985;254:521-524)
Steroid dependent asthma: Authors' reply
Authors: R J Shiner, D. M Geddes
Journal: BMJ (1989)

initial removal has been incomplete.The half life of parathyroid hormone is three to four minutes,34 and so it disappears rapidly from serum after successful parathyroidectomy.Results can be available within one hour.Even in mild hyperparathyroidism there is considerable mortality and morbidity.'Surgical re-exploration of Dr Sultan and colleagues' second patient with serum parathyroid hormone measure- ments would be appropriate.
Functional Interaction of Tumor Suppressor DLC1 and Caveolin-1 in Cancer Cells
Authors: Xiaoli Du, Xiaolan Qian, Alex Papageorge, Aaron J. Schetter, William C. Vass, Xi Liu, Richard Braverman, Ana I. Robles, Douglas R. Lowy
Journal: Cancer Research (2012)

Deleted in liver cancer 1 (DLC1), a tumor suppressor gene frequently inactivated in non-small cell lung cancer (NSCLC) and other malignancies, encodes a multidomain protein with a RhoGTPase-activating (RhoGAP) domain and a StAR-related lipid transfer (START) domain. However, no interacting macromolecule has been mapped to the DLC1 START domain. Caveolin-1 (CAV-1) functions as a tumor suppressor in most contexts and forms a complex with DLC1. Here, we have mapped the region of DLC1 required for interaction with CAV-1 to the DLC1 START domain. Mutation of the DLC1 START domain disrupted the interaction and colocalization with CAV-1. Moreover, DLC1 with a START domain mutation failed to suppress neoplastic growth, although it negatively regulated active Rho. CAV-1 and DLC1 expression levels were correlated in two public datasets of NSCLC lines and in two independent publicly available mRNA expression datasets of NSCLC tumors. Clinically, low DLC1 expression predicted a poor clinical outcome in patients with lung cancer. Together, our findings indicate that complex formation between the DLC1 START domain and CAV-1 contributes to DLC1 tumor suppression via a RhoGAP-independent mechanism, and suggest that DLC1 inactivation probably contributes to cancer progression.
Hyporesponsiveness to PegIFNα2B plus ribavirin in patients with hepatitis C-related advanced fibrosis
Authors: Gian Maria Prati, Alessio Aghemo, Maria Grazia Rumi, Roberta D’Ambrosio, Stella De Nicola, Maria Francesca Donato, Elisabetta Degasperi, Massimo Colombo
Journal: Journal of Hepatology (2011)
Insulin resistance is associated with steatosis in nondiabetic patients with genotype 1 chronic hepatitis C
Authors: Calogero Cammà, Savino Bruno, Vito Di Marco, Danilo Di Bona, Mariagrazia Rumi, Maria Vinci, Chiara Rebucci, Agostino Cividini, Giuseppe Pizzolanti, Ernesto Minola, Mario U. Mondelli, Massimo Colombo, Giovanbattista Pinzello, Antonio Craxfì
Journal: Hepatology (2005)

Conflicting data exist regarding the relationship between hepatitis C virus genotype 1 and hepatic steatosis as well as the latter's role in the progression of fibrosis and treatment response. We assessed factors associated with hepatic steatosis in genotype 1 chronic hepatitis C and the impact of hepatic fat on fibrosis development and interferon responsiveness. Two hundred ninety-one non-diabetic patients with genotype 1 chronic hepatitis C were examined for the presence of steatosis and its correlation with clinical, virological, and biochemical data, including insulin resistance (IR), evaluated by the homeostasis model assessment (HOMA) score. Steatosis was graded as mild (1%-20% of hepatocytes involved), moderate (21%-40% of hepatocytes involved), and severe (>40% of hepatocytes involved). Steatosis was mild in 110 of 291 (37.8%) and moderate/severe in 55 of 291 (18.9%) subjects. By logistic regression, moderate/severe steatosis was independently associated with the female sex (odds ratio [OR] 2.74; 95% CI 1.40-5.35), high gamma-glutamyltransferase levels (OR 1.52; 95% CI 1.22-1.91), and HOMA-score (OR 1.076; 95% CI 1.001-1.26). By logistic regression, moderate/severe steatosis (OR 2.78; 95% CI 1.21-6.4), and platelet counts (OR 0.97; 95% CI 0.96-0.98) were independent predictors of advanced fibrosis. Patients with moderate/severe steatosis had an OR of 0.52 (95% CI 0.30-0.90) for sustained virological response compared with patients with mild/absent steatosis. In conclusion, in nondiabetic European patients with genotype 1 hepatitis C at low risk for the metabolic syndrome, the prevalence of steatosis was nearly 60%. IR is a risk factor for moderate/severe steatosis, especially in men. Moderate/severe steatosis has clinical relevance, being associated with advanced fibrosis and hyporesponsiveness to antiviral therapy.
miR-3151 interplays with its host gene BAALC and independently affects outcome of patients with cytogenetically normal acute myeloid leukemia
Authors: Ann-Kathrin Eisfeld, Guido Marcucci, Kati Maharry, Sebastian Schwind, Michael D. Radmacher, Deedra Nicolet, Heiko Becker, Krzysztof Mrózek, Susan P. Whitman, Klaus H. Metzeler, Jason H. Mendler, Yue-Zhong Wu, Sandya Liyanarachchi, Ravi Patel, Maria R. Baer, Bayard L. Powell, Thomas H. Carter, Joseph O. Moore, Jonathan E. Kolitz, Meir Wetzler, Michael A. Caligiuri, Richard A. Larson, Stephan M. Tanner, Albert de la Chapelle, Clara D. Bloomfield
Journal: Blood (2012)
Oxygen Tension in the Gut
Authors: Michael D. Levitt
Journal: New England Journal of Medicine (1970)

A recent article1 re-examines a long-standing controversy in helminthology — does the ascaris lead an aerobic or an anaerobic existance in the human intestine. According to traditional teaching, there is insufficient oxygen in the bowel to maintain oxidative metabolism for an organism as large as Ascaris lumbricoides. However, Smith1 has marshaled evidence that the ascaris is an aerobic animal specially adapted to live at a low oxygen tension (Po2). Unfortunately, since there are practically no data concerning the oxygen tension of the human bowel, Smith was forced to rely upon measurements of Po2 in the small intestine . . .
Rheumatic Fever and Rheumatic Heart Disease
Authors: EDWARD F. BLAND, DUCKETT JONES
Journal: Circulation (1951)

Herewith is presented an interim report on a long-term study of 1000 patients followed since their childhood rheumatism. The dominant role of rheumatic recurrences and the fatal features are reviewed. The benign nature of uncomplicated chorea is stressed, the disappearance of physical signs of heart disease in some patients is contrasted with the delayed and even remote appearance of valvular deformity in others, and finally, the favorable course to date in the majority of cases is emphasized.
Faulty logic justifies aspirin use for primary prevention of cardiovascular disease
Authors: S. J. Thornley, F. Barzi
Journal: BMJ (2013)

We are sceptical about the use of the polypill as a “panacea.” In studies that justify the use of the individual constituents of the pill, optimism about the drugs’ beneficial effects sometimes contradicted the statistical evidence presented.1 

For example, a paper published 12 years ago in Heart is cited widely to support the use of aspirin for the prevention …
Binding of a monoclonal anti-DNA autoantibody to identical protein(s) present at the surface of several human cell types involved in lupus pathogenesis.
Authors: L Jacob, M A Lety, D Louvard, J F Bach
Journal: Journal of Clinical Investigation (1985)

A monoclonal anti-DNA antibody PME77, spontaneously produced in autoimmune B/W mice, has been found to recognize identical protein(s) present at the surface of several human cell types involved in the pathogenesis of systemic lupus erythematosus: glomeruli, platelets, erythrocytes, T and B cells, and neuronal tissue. Data indicate that protein(s) could represent a major stimulus or the target of anti-DNA autoimmunity and could account for tissue lesions observed in this disease.
Association Between Coronary Vascular Dysfunction and Cardiac Mortality in Patients With and Without Diabetes Mellitus
Authors: Venkatesh L. Murthy, Masanao Naya, Courtney R. Foster, Mariya Gaber, Jon Hainer, Josh Klein, Sharmila Dorbala, Ron Blankstein, Marcelo F. Di Carli
Journal: Circulation (2012)

Diabetes mellitus increases the risk of adverse cardiac outcomes and is considered a coronary artery disease (CAD) equivalent. We examined whether coronary vascular dysfunction, an early manifestation of CAD, accounts for increased risk among diabetics compared with nondiabetics.A total of 2783 consecutive patients (1172 diabetics and 1611 nondiabetics) underwent quantification of coronary flow reserve (CFR; CFR=stress divided by rest myocardial blood flow) by positron emission tomography and were followed up for a median of 1.4 years (quartile 1-3, 0.7-3.2 years). The primary end point was cardiac death. Impaired CFR (below the median) was associated with an adjusted 3.2- and 4.9-fold increase in the rate of cardiac death for diabetics and nondiabetics, respectively (P=0.0004). Addition of CFR to clinical and imaging risk models improved risk discrimination for both diabetics and nondiabetics (c index, 0.77-0.79, P=0.04; 0.82-0.85, P=0.03, respectively). Diabetic patients without known CAD with impaired CFR experienced a rate of cardiac death comparable to that for nondiabetic patients with known CAD (2.8%/y versus 2.0%/y; P=0.33). Conversely, diabetics without known CAD and preserved CFR had very low annualized cardiac mortality, which was similar to patients without known CAD or diabetes mellitus and normal stress perfusion and systolic function (0.3%/y versus 0.5%/y; P=0.65).Coronary vasodilator dysfunction is a powerful, independent correlate of cardiac mortality among both diabetics and nondiabetics and provides meaningful incremental risk stratification. Among diabetic patients without CAD, those with impaired CFR have event rates comparable to those of patients with prior CAD, whereas those with preserved CFR have event rates comparable to those of nondiabetics.
Perforation of a Nonobstructing Gastro-Oesophageal Carcinoma by Oblique-Viewing Endoscopic Ultrasound Videoscope: A Need for a Safe Technique
Authors: M. V. Chandrashekar, D. L. Richardson, S. Preston, D. Karat, S. M. Griffin
Journal: Endoscopy (2002)

Endoscopic ultrasound (EUS) is the gold standard investigation for assessing the T and N stages of oesophageal carcinoma [1]. The standard EUS probe is mounted on a side-viewing endoscope, making intubation of the oesophagus a more complex procedure. The recently developed EUS video scope, although oblique-viewing, provides a view almost as good as the standard endviewing endoscope. This apparent improvement in design can mislead the endoscopist and may increase the risk of perforation. We report a case of perforation of a nonobstructing oesophageal cancer with the new EUS scope.
Corticotropin Stimulation of Urethral Cornification
Authors: Hector Castellanos
Journal: JAMA (1963)

THERE IS NEED for a simple clinical procedure to determine whether or not the adrenal glands are elaborating biologically significant amounts of estrogenic hormones in the postmenopausal patient and to determine their ability to increase this estrogenic hormone production after the specific stimulation of disease, "stress," or adrenocorticotropic hormone (corticotropin). This need arises because of the proven ability of the adrenals to synthesize estrogenic hormones that contribute to the continued growth of advanced cancer of the breast and because of the availability of surgical adrenalectomy or medicinal suppression of adrenal cortical activity in the treatment of this disease. The question of whether or not a specific carcinoma of the breast is stimulated by estrogens on the one hand, or is best treated by their massive administration on the other, is one that cannot easily be settled on the basis of present methods of study. An "estrogen stimulation test" has been
Solitary Peutz-Jeghers Type Polyp of the Stomach
Authors: A. Grisendi, A. Lonardo
Journal: Endoscopy (1990)

See also: Solitary Peutz-Jeghers Type Polyp of the Stomach in the Absence of Familial Polyposis Coli in a Teenage BoyEndoscopy 1989; 21(04): 188-190DOI: 10.1055/s-2007-1012939
Independent Associations of Bacterial Vaginosis and Chlamydia trachomatis Infection With Adverse Pregnancy Outcome
Authors: Michael G. Gravett, H. Preston Nelson, Timothy DeRouen, Cathy Critchlow, David A. Eschenbach, King K. Holmes
Journal: JAMA (1986)

We prospectively studied the relationship of pregnancy outcome to bacterial vaginosis, an anaerobic vaginal condition, and to other selected genital pathogens among 534 gravid women. Bacterial vaginosis was presumptively diagnosed by gas-liquid chromatographic identification of microbial organic acid metabolites in 102 women (19%), and cervical infection with Chlamydia trachomatis was found in 47 (9%) of the women. Although women with and without bacterial vaginosis had similar demographic and obstetric factors, neonates born to women with bacterial vaginosis had lower mean birth weight than did neonates born to women without bacterial vaginosis (2960 +/- 847 g vs 3184 +/- 758 g). Bacterial vaginosis was significantly associated with preterm premature rupture of the membranes (odds ratio [OR], 2.0; 95% confidence interval [Cl], 1.1 to 3.7), preterm labor (OR, 2.0; Cl, 1.1 to 3.5), and amniotic fluid infection (OR, 2.7; Cl, 1.1 to 6.1), but not with birth weight below 2500 g (OR, 1.5; Cl, 0.8 to 2.0). Cervical infection with C trachomatis was independently associated with preterm premature rupture of the membranes, preterm labor, and low birth weight (OR, 1.5; Cl, 0.8 to 2.0).
SOME MECHANICAL PROBLEMS IN THE OPERATIVE CURE OF INGUINAL HERNIA.
Authors: B. B. DAVIS
Journal: JAMA (1896)

It is customary to think of the abdominal viscera as making unrestrained pressure in every direction in their efforts to escape from the cavity in which they are enclosed. If this were literally true, hernia to the extent of total disability would be the rule. In the normal condition the relationship is such that when the omentum, the small intestine or the large intestine has pressed about so far in any given direction, it can go no farther, not because of the resistance met in front, but because of the restraint offered by the mesentery, the mesocolon, or other attachments. This restraining force does not manifest itself by a sudden pull like the jerk when the end of an elastic cord is reached, but by the gentle traction of an elastic tether, which causes the organ to glide away from the danger point over the slippery peritoneal surface. From these
Gambling Near-Misses Enhance Motivation to Gamble and Recruit Win-Related Brain Circuitry
Authors: Luke Clark, Andrew J. Lawrence, Frances Astley-Jones, Nicola Gray
Journal: Neuron (2009)

"Near-miss" events, where unsuccessful outcomes are proximal to the jackpot, increase gambling propensity and may be associated with the addictiveness of gambling, but little is known about the neurocognitive mechanisms that underlie their potency. Using a simplified slot machine task, we measured behavioral and neural responses to gambling outcomes. Compared to "full-misses," near-misses were experienced as less pleasant, but increased desire to play. This effect was restricted to trials where the subject had personal control over arranging their gamble. Near-miss outcomes recruited striatal and insula circuitry that also responded to monetary wins; in addition, near-miss-related activity in the rostral anterior cingulate cortex varied as a function of personal control. Insula activity to near-misses correlated with self-report ratings as well as a questionnaire measure of gambling propensity. These data indicate that near-misses invigorate gambling through the anomalous recruitment of reward circuitry, despite the objective lack of monetary reinforcement on these trials.