tbuckley/cabot-search huggingface dataset:
Signs of increased leakage over the jejunal mucosa during gliadin challenge of patients with coeliac disease.
Authors: B Lavo, L Knutson, L Loof, B Odlind, R Hallgren
Journal: Gut (1990)

Intestinal secretion rates of albumin, hyaluronan, and beta 2-microglobulin (beta 2-micro) were determined under basal conditions and after gliadin challenge of coeliac patients and healthy controls by the use of a jejunal perfusion technique. A new tube system was used where a jejunal segment is isolated between balloons and then perfused with a balanced salt solution. Under basal conditions the secretion rate of albumin was similar in the patients and controls while the secretion rate of the glycosaminoglycan hyaluronan, a high molecular weight connective tissue component, was increased more than two times in coeliac patients. Beta 2-micro was secreted in on average three-fold rates in coeliacs compared with controls. All three substances were secreted at a higher rate in patients with active disease than in those with inactive disease defined by morphological damage in small bowel biopsies. The concentrations in jejunal perfusion fluids relative to serum levels in the coeliac patients were for albumin 0.0007, beta 2-micro 0.10, and for hyaluronan 1.94. Challenge with a single dose of gliadin into the jejunal segment gave within 60 min a significant, about two-fold, increase of the secretion rates of all three measured substances. The appearance of hyaluronan could reflect a gliadin induced mucosal oedema with an enhanced leakage from the interstitial/lymph fluid, rich in this glycosaminoglycan. The observed parallel increases in the jejunal secretion of albumin and beta 2-micro after gliadin challenge are best explained by a similar mechanism.
Quantification of platelet retention in aortocoronary femoral vein bypass graft in dogs treated with dipyridamole and aspirin.
Authors: M K Dewanjee, M Tago, M Josa, V Fuster, M P Kaye
Journal: Circulation (1984)

Autologous femoral vein segments were implanted as aortocoronary bypass grafts in 50 dogs, 25 of which were treated with dipyridamole and aspirin to inhibit platelet deposition and 25 that were not. Autologous platelets labeled with indium-111 were injected into some dogs 48 hr before they were killed on the first day after surgery; other dogs were injected 24 hr before they were killed (3, 7, 30, and 90 days after surgery). Radioactivity on the grafts and on control specimens of contralateral femoral veins was converted to quantification of platelets adhering to the vessel wall (platelets/cm2). The treated group had fewer graft platelets per square centimeter than the untreated group on postoperative days 3, 7 (p less than .01), and 30 (p less than .05). Graft and control vein platelets per square centimeter were nearly equal by day 90. Comparison of graft and control specimens by scanning electron microscopy nearly equal by day 90. Comparison of graft and control specimens by scanning electron microscopy revealed deendothelialization at 1 and 7 days after grafting and reendothelialization at 30 and 90 days. The data suggest that indefinite prolongation of therapy to inhibit platelet deposition after bypass grafting may be unnecessary (although other atherosclerotic vessels may benefit from therapy).
Effect of prolonged and exclusive breast feeding on risk of allergy and asthma: cluster randomised trial
Authors: Michael S Kramer, Lidia Matush, Irina Vanilovich, Robert Platt, Natalia Bogdanovich, Zinaida Sevkovskaya, Irina Dzikovich, Gyorgy Shishko, Bruce Mazer
Journal: BMJ (2007)

<b>Objective</b> To assess whether exclusive and prolonged breast feeding reduces the risk of childhood asthma and allergy by age 6.5 years. <b>Design</b> Cluster randomised trial. <b>Setting</b> 31 Belarussian maternity hospitals and their affiliated polyclinics. <b>Participants</b> A total of 17 046 mother-infant pairs were enrolled, of whom 13 889 (81.5%) were followed up at age 6.5 years. <b>Intervention</b> Breastfeeding promotion intervention modelled on the WHO/UNICEF baby friendly hospital initiative. <b>Main outcome measures</b> International study of asthma and allergies in childhood (ISAAC) questionnaire and skin prick tests of five inhalant antigens. <b>Results</b> The experimental intervention led to a large increase in exclusive breast feeding at 3 months (44.3% <i>v</i> 6.4%; P&lt;0.001) and a significantly higher prevalence of any breast feeding at all ages up to and including 12 months. The experimental group had no reduction in risks of allergic symptoms and diagnoses or positive skin prick tests. In fact, after exclusion of six sites (three experimental and three control) with suspiciously high rates of positive skin prick tests, risks were significantly increased in the experimental group for four of the five antigens. <b>Conclusions</b> These results do not support a protective effect of prolonged and exclusive breast feeding on asthma or allergy. <b>Trial registration</b> Current Controlled Trials ISRCTN37687716.
Percutaneous interventional electrophysiology
Authors: G. C Kaye
Journal: BMJ (2003)

Before the 1980s, cardiac electrophysiology was primarily used to confirm mechanisms of arrhythmia, with management mainly by pharmacological means. However, recognised shortcomings in antiarrhythmic drugs spurred the development of non-pharmacological treatments, particularly radiofrequency ablation and implantable defibrillators.



Mechanism of a re-entry circuit. An excitation wave is propagated at a normal rate down path A, but slowly down path B. An excitation wave from an extrasystole now encounters the slow pathway (B), which is still refractory, creating unidirectional block. There is now retrograde conduction from path A, which coincides with the end of the refractory period in path B. This gives rise to a persistent circus movement 



The two major mechanisms by which arrhythmias occur are automaticity and re-entrant excitation. Most arrhythmias are of the re-entrant type and require two or more pathways that are anatomically or functionally distinct but in electrical contact. The conduction in one pathway must also be slowed to a sufficient degree to allow recovery of the other so that an electrical impulse may then re-enter the area of slowed conduction.



Classification of arrhythmias 



Intracardiac electrophysiological studies give valuable information about normal and abnormal electrophysiology of intracardiac structures. They are used to confirm the mechanism of an arrhythmia, to delineate its anatomical substrate, and to ablate it. The electrical stability of the ventricles can also be assessed, as can the effects of an antiarrhythmic regimen.

View this table:

Indications for electrophysiological studies



### Atrioventricular conduction

Electrodes positioned at various sites in the heart can give only limited data about intracardiac conduction during sinus rhythm at rest. “Stressing” the system allows more information to be generated, particularly concerning atrioventricular nodal conduction and the presence of accessory pathways.



Diagrams showing position of pacing or recording electrodes in the heart in the right anterior oblique and left anterior oblique views (views from the right and left …
A variant of SCID with specific immune responses and predominance of T cells
Authors: S. Ehl
Journal: Journal of Clinical Investigation (2005)

We describe here a patient with a clinical and molecular diagnosis of recombinase activating gene 1-deficient (RAG1-deficient) SCID, who produced specific antibodies despite minimal B cell numbers. Memory B cells were detected and antibodies were produced not only against some vaccines and infections, but also against autoantigens. The patient had severely reduced levels of oligoclonal T cells expressing the alphabeta TCR but surprisingly normal numbers of T cells expressing the gammadelta TCR. Analysis at a clonal level and TCR complementarity-determining region-3 spectratyping for gammadelta T cells revealed a diversified oligoclonal repertoire with predominance of cells expressing a gamma4-delta3 TCR. Several gammadelta T cell clones displayed reactivity against CMV-infected cells. These observations are compatible with 2 non-mutually exclusive explanations for the gammadelta T cell predominance: a developmental advantage and infection-triggered, antigen-driven peripheral expansion. The patient carried the homozygous hypomorphic R561H RAG1 mutation leading to reduced V(D)J recombination but lacked all clinical features characteristic of Omenn syndrome. This report describes a new phenotype of RAG deficiency and shows that the ability to form specific antibodies does not exclude the diagnosis of SCID.
1,25(OH)2D2 production by T lymphocytes and alveolar macrophages recovered by lavage from normocalcemic patients with tuberculosis.
Authors: J Cadranel, M Garabedian, B Milleron, H Guillozo, G Akoun, A J Hance
Journal: Journal of Clinical Investigation (1990)

To compare extra-renal 1,25(OH)2D3 production in different types of granulomatous disease, and to identify the cell types responsible, we have evaluated the conversion of 25(OH)D3 in 1,25(OH)2D3 by uncultured cells recovered by bronchoalveolar lavage and blood mononuclear cells from normocalcemic patients with sarcoidosis and tuberculosis. 1,25(OH)2D3 was produced both by lavage cells (12/12 tuberculosis patients, 2/6 sarcoidosis patients) and blood mononuclear cells (3/5 tuberculosis patients, 0/3 sarcoidosis patients) from patients but not controls, but significantly greater amounts were produced by lavage cells from tuberculosis patients than those of sarcoidosis patients (P less than 0.001). 1,25(OH)2D3 production by lavage cells from tuberculosis patients correlated with the number of CD8+ T lymphocytes present but not other cell types. T lymphocytes appeared to be an important source of 1,25(OH)2D3 production, since purified T lymphocytes from all patients with tuberculosis produced 1,25(OH)2D3, and 1,25(OH)2D3 production by these cells correlated closely with that produced by unseparated lavage cells. Because 1,25(OH)2D3 can improve the capacity of macrophages to kill mycobacteria, our results support the conclusion that macrophage-lymphocyte interactions, mediated at least in part by 1,25(OH)2D3, may be an important component of a successful antituberculous immune response.
S24 Incidence of persistent perfusion defects following pulmonary embolism: impact on pulmonary artery systolic pressure at 6 months
Authors: S. Fagerbrink, B. Mukherjee, D. Sirisena, N. Salooja, L. Howard
Journal: Thorax (2011)

<h3>Background</h3> The incidence of pulmonary hypertension (PH) after an episode of acute pulmonary embolism (PE) is thought to be up to 4%. The incidence of persistent clot without PH is less clear. We evaluated the incidence of persistent perfusion defects in patients followed up after PE and assessed the impact on pulmonary arterial pressure measured by echocardiography. <h3>Methods</h3> The clinical pathway for outpatient follow-up of patients with PE includes a nuclear medicine ventilation-perfusion scan at 5 months post PE. When this is positive, an echocardiogram is requested to look for evidence of PH. A retrospective study of consecutive patients attending outpatient follow-up was carried out to determine the incidence of persistent perfusion defects and echocardiographic findings suggestive of PH. <h3>Results</h3> Ninety-three patients were identified between February 2009 and July 2011 and their clinical data were studied retrospectively. 59 patients (63%) had persistent perfusion defects at 6 months. Of these 49 (83%) underwent echocardiography of which 12 had undetectable tricuspid regurgitation (TR). In the remaining 37, pulmonary artery systolic pressure (PASP) could be estimated from the TR velocity. Results are shown in Abstract S24 figure 1 and are skewed due to the presence of patients with PH. Median PASP (with IQR) was 32 mm Hg (26–39). The shaded area shows the 95% CIs for the normal PASP (28±9.8 mm Hg, mean ± 2SD). Fourteen patients had estimated PASP above the normal range. Six patients were investigated with cardiac catheterisation and two were found to have chronic thromboembolic pulmonary hypertension (CTEPH). Borderline patients were kept under observation. <h3>Conclusions</h3> Although the number of patients with CTEPH was in the expected range, the incidence of persistent perfusion defects following PE was surprisingly high in our cohort. Many of these patients fall in to a grey zone with borderline elevated pressures on echocardiography. The long-term outcomes of these patients and the physiological implications of their persistent perfusion defects are yet to be established and require further evaluation.
Tuberculosis Infection After Bronchoscopy
Authors: Richard P. Wenzel
Journal: JAMA (1997)

One hundred years ago Gustan Killian, a German physician, successfully used a primitive bronchoscope to remove a small piece of bone from the right main-stem bronchus of a 63-year-old timber sawyer with dyspnea and hemoptysis.<sup>1,2</sup>An electric headlight provided illumination for the rigid scope.<sup>2</sup>Earlier, in an 1870 address to the Royal Society, an Englishman named John Tyndall had described the optical properties of glass fibers: light travels through thin glass filaments even when they are twisted or bent.<sup>2</sup>This remarkable physical property was appreciated and eventually exploited by those interested in refining the mechanics of visualizing the airways. Thus, in 1964, the first flexible fiberoptic bronchoscope was introduced by Shigeto Ikeda of Japan, who had incorporated glass fibers to transmit light in a curved path.<sup>3</sup>Ikeda's landmark demonstration marked a major technical advance in the diagnosis and management of many pulmonary disorders. See also pp
Phenotypic and functional characterisation of ovine mesenchymal stem cells: application to a cartilage defect model
Authors: D Mrugala, C Bony, N Neves, L Caillot, S Fabre, D Moukoko, C Jorgensen, D Noel
Journal: Annals of the Rheumatic Diseases (2007)

<h3>Background:</h3> Multipotent mesenchymal stromal cells (MSC) are of particular interest for their potential clinical use in cartilage engineering, but a consistent model is missing in large animals. <h3>Objective:</h3> In the absence of any detailed study reporting a complete characterisation of the mesenchymal cells isolated from sheep bone marrow, we fully characterised adherent stromal cells and developed a pre-clinical model of cartilage engineering by implantation of autologous MSC in the Merinos sheep. <h3>Methods:</h3> Ovine MSC (oMSC) were isolated from bone marrow, expanded and further characterised according to the recently proposed definition of the MSC. The experimental model consists of partial-thickness lesions created in the inner part of the patellae of the posterior legs. Lesions were filled with oMSC with or without chitosan, with or without transforming growth factor (TGF)β-3, in a fibrin clot. <h3>Results:</h3> oMSC were shown to display the three main characteristics of MSC: adherence to plastic, phenotypic profile (positive for CD44, CD105, vimentin and negative for CD34 and CD45), and trilineage differentiation potential. We also report two other important functional characteristics of MSC: support of long-term haematopoiesis and immunosuppressive capacity. In vivo, 2 months after implantation the histological analysis revealed chondrocyte-like cells surrounded by a hyaline-like cartilaginous matrix that was integrated to the host cartilage when oMSC were combined with chitosan and TGFβ-3. <h3>Conclusions:</h3> This study provides for the first time a strong characterisation of oMSC and establishes the basis for a model of cartilage engineering in a large animal.
Multidrug resistant tuberculosis in France 1992-4: two case-control studies
Authors: V. Schwoebel, B. Decludt, A.-C. de Benoist, S. Haeghebaert, G. Torrea, V. Vincent, J. Grosset
Journal: BMJ (1998)

that 26% of the enterococci in this study were highly resistant to both gentamicin and streptomycin.Aminoglycosides have no therapeutic benefit in infections involving such strains, and unnecessarily expose patients to possible ototoxic or nephrotoxic side effects.A further 28% of the isolates were highly resistant to either gentamicin or streptomycin, emphasising the value of testing both of these compounds in determining appropriate treatment.Current guidelines recommend that endocarditis caused by enterococci with high level resistance to aminoglycosides should be treated with high dose amoxycillin or ampicillin for 6-12 weeks. 2 3 However, 11% of the enterococci were E faecium, which typically is resistant to ampicillin.Moreover, amoxycillin or ampicillin would be unsuitable for patients allergic to penicillin.This latter constraint applies to other proposed regimens that combine ampicillin with imipenem or ciprofloxacin.Although glycopeptides may be considered in place of penicillin, the finding of glycopeptide resistance in several isolates, including three of the E faecium isolates, means that their efficacy cannot be guaranteed.The picture revealed is disturbing, with frequent resistance to the recommended synergistic combinations.Evaluation in endocarditis of unconventional regimens-for example, ampicillin plus carbapenems, ampicillin plus ciprofloxacin, or ciprofloxacin plus co-trimoxazole-is desirable, although the use of such broad spectrum agents may risk selecting resistance in the body microflora.Also desirable is early evaluation, in endocarditis, of novel narrow spectrum anti-Gram positive agents, such as streptogramins, oxazolidinones, and everninomycins.We thank Dr Ty Pitt and his colleagues in the Epidemiological Typing Unit at the Laboratory of Hospital Infection in the Central Public Health Laboratory for confirming the species of the isolates studied.
Lung function testing in adults with preferential nasal breathing.
Authors: C F Stanford, B Martin, D P Nicholls, D Watson
Journal: Thorax (1992)

Three adult patients with asthma with preferential nasal breathing were found to have a typical pattern of lung function test results with substantial between test variation. This condition can be identified as a cause of unsatisfactory performance in respiratory tests by observing the patient9s reaction after the nostrils have been occluded.
CME, GMC, and Florence Nightingale
Authors: T. Delamothe
Journal: BMJ (2010)

This week sees the launch of a brand new, free service for BMJ readers: certified CME credits for reading research articles and answering a linked series of multiple choice questions. It marks the first phase of a collaboration between the journal and the Cleveland Clinic. In their accompanying editorial, Steven Kawczak and Kirsten Patrick explain the mechanics and the outcome: credits towards the American Medical Association’s Physicians Recognition Award (doi:10.1136/bmj.c2410). We’ll be linking roughly one article a week to a CME module, but in this inaugural week we’re kicking off with three. While US doctors will immediately appreciate their value, we’re seeking accreditations elsewhere. In the meantime, answering the questions should help all doctors with their continuing learning needs. We hope UK doctors will find the initiative useful when …
996 Combination therapy of peginterferon alfa-2A (40KD) (PEGASYS(R)) and ribavirin (COPEGUS(R)) significantly enhance sustained virological and biochemical response rate in chronic hepatitis C genotype 4 patients in Saudi Arabia
Authors: O SHOBOKSHI, F SEREBOUR, L SKAKNI, N ALJASSER, A TANTAWI, A SABAH, T DINISH, M ALQUAIZ, K QAHTANI, A SANDOKJI
Journal: Hepatology (2003)
Twelve months of deputising: 100 000 patient contacts with eighteen services.
Authors: R A Dixon, B T Williams
Journal: BMJ (1977)

An analysis of a 1-in-5 sample of nearly 500 000 patients contacts with 18 deputising services showed considerable variation in the way cells were handled. Telephonists, usually work on shifts including at least one operator who was a trained nurse handled, without sending a deputy, between 3% of new calls at one service and 19% at another. In one service, 19% of visits were made by deputies who were general practitioners; in another, 78%. At least 42% of patients visited by one service were apparently seen within one hour; 74% by another service. The proportions referred to hospital varied from 9% to 16%. The use of deputising services continues to grow; there is as yet no substantiated evidence of shortcomings in the care they provide. The possibility of reviewing the activity of the services, with the use of such indices as those described, might enable present limitations on their use to be lifted.
Relationship between circulating anti-Ro/SS-A antibody levels and skin disease activity in subacute cutaneous lupus erythematosus
Authors: S.M. PURCELL, T.S. LIEU, B.M. DAVIS, R.D. SONTHEIMER
Journal: British Journal of Dermatology (1987)

Anti‐Ro/SS‐A antibody levels in 80 serum specimens from 12 patients with subacute cutaneous lupus erythematosus (SCLE) were determined by immunodiffusion and enzyme‐linked immunosorbent assay in order to examine the changes in this autoantibody response with time and to study the relationship between levels of this antibody and SCLE skin disease activity. Anti‐Ro/SS‐A antibody levels were found to vary considerably over time in a given patient when measured by both assays. Several patients who did not have detectable levels of this antibody at the time of their initial examination were found to be antibody positive at follow‐up examinations. However, no significant relationship was found between antibody levels in either assay and SCLE skin disease activity. While not ruling out a pathogenetic vole for this antibody in the elicitation of SCLE skin lesions, these results would suggest that other factors are likely to be involved.
785. Cell-Permeable Peptides Mediated Gene Delivery in Hepatocytes In Vitro and In Vivo
Authors: Zhenping Shen, Carol H. Miao
Journal: Molecular Therapy (2005)

Background and Aim: Gene therapy is still hampered by its lack of an ideal vector that can efficiently deliver therapeutic genes into target cells and, at the same time, without causing severe side effects. Cell-permeable peptides (CPPs) are some short polybasic peptides that are capable of penetrating cell or nucleus membrane in a receptor- and energy- independent way. Although several CPPs have successfully mediated gene delivery into different cells in vitro and in vivo, their application in hepatocytes is scarce. The aim of this study is to design and test prospective CPPs to mediate efficient gene delivery into hepatocytes in vitro and in vivo.
Senior citizens to get part of drug costs paid under new plan
Authors: S. Gottlieb
Journal: BMJ (2003)

The US Senate seems ready to approve a Medicare package, worth $400bn (£239bn; €338bn), that would promise partial coverage for prescription drugs for Medicare patients. The plan also envisages a new network of privately run comprehensive health plans that would compete with the government in providing coverage for medical services for older people.

Both the House and the Senate are currently considering plans to add a drug benefit for the 39 million senior citizens currently enrolled in Medicare, the public health insurance system that pays for most of the medical costs for American senior citizens.

So far, law makers in the Senate seem to stop short of adopting an original proposal that would have steered more beneficiaries towards privately run managed care plans so that they could …