tbuckley/cabot-search huggingface dataset:
Observer variation and discriminatory value of biopsy features in inflammatory bowel disease.
Authors: A Theodossi, D J Spiegelhalter, J Jass, J Firth, M Dixon, M Leader, D A Levison, R Lindley, I Filipe, A Price
Journal: Gut (1994)

<h3>Objectives</h3> Serious adverse effects, including arrhythmia and cardiac arrest, result from rapid intravenous high concentration of potassium chloride (KCl). We aimed to eliminate prescription of undiluted KCl and encourage dilution of KCl to 400 mEq/L and 40 mEq/L in the intensive care units (ICUs) and general and outpatient departments, respectively. <h3>Methods</h3> Before the first intervention, we collected data regarding high-concentration KCl and interviewed representatives of physicians prescribing high-concentration KCl. Based on the guidelines in other countries on safely used concentrations of KCl (400 mEq/L), we negotiated with physicians to dilute KCl below 400 mEq/L. In the first intervention, we made rules based on surveys above. In the second intervention, we revised the rules based on opinions from physicians and pharmacists and investigated the change in the number of prescriptions of KCl concentration in each department. Continuing efforts with the safety manager ensured compliance of the rules by physicians and nurses in all departments. <h3>Results</h3> After the first and second interventions, prescriptions for undiluted KCl in ICUs and general wards were eliminated (median=0). Prescriptions for &lt;400 mEq/L KCl increased to 110 (median) after the first intervention and to 137 (median) after the second. In the general ward, 7 months after the first intervention, prescriptions for &lt;400 mEq/L KCl had not increased. Compliance with our rules was high, and more than 72% of physicians and nurses were aware of the rules. <h3>Conclusions</h3> The rules for administration of high-dose KCl successfully eliminated prescription of undiluted KCl, which was maintained using two plan-do-study-act cycles. Our intervention process could be useful in countries where prediluted formulations are unavailable or where prescriptions are not matched and undiluted ampules are used.
ABC of Rheumatology: PAIN IN THE FOOT
Authors: S G West, J Woodburn
Journal: BMJ (1995)

Abnormally pronated feet with Haglund's deformity of heel (left); abnormally supinated feet (right).Foot pain is common, whether local to the foot or due to systemic disease, mechanical dysfunction, degeneration, or inflammation.In general a multidisciplinary approach to treatment is best, and this is reflected in increasingly close liaison between podiatry, rheumatology, and orthopaedics.Podiatrists (chiropodists) offer a range of treatments from surgery to orthoses.To understand dysfunction, clinicians should be familiar with the normal development and anatomical variants of the foot. Characteristics of child's footNormal foot Abnormal foot * Flexible foot structure (may look flat with a valgus heel) * Inflexible * Rigid valgus or pronated heel * Medial longitudinal arch forms when child stands on tiptoe * High arch foot with toe retraction and tight extensor tendons * Heel to toe walking * Toe walking * Delay or difficulty in walking or running * Forefoot in line with rear foot * Abducted or adducted forefoot relative to heel * Mobile joints with pain free motion and no swelling * Pain, swelling, or stiffness of joints * Adopts adult morphology by about 8 years of age * Lesser toe deformities 0 Hallux deformity Pain in the forefoot (metatarsalgia) This is one ot the most common torms ot toot pain and has several possible causes.Morton's metatarsalgia (interdigital neuroma) This normally affects the proximal part of the plantar digital nerve and accompanying plantar digital artery.Trauma to these structures leads to histological changes including inflammatory oedema, microscopic changes in the neurolemma, fibrosis, and, later, degeneration of the nerve.Clinicalfeatures include a gradual onset with sudden attacks of neuralgic pain or paraesthesia during walking, often in the third and fourth toe.Examination may reveal lesser toe deformities and slight splaying of the forefoot, abnormal pronation, and hallux valgus.These often occur in women who wear court shoes.Compression of the cleft or laterally across the metatarsal heads may produce acute pain and the characteristic "Mulder's click."Treatment-Patients should be advised about suitable footwear and possibly be given orthoses to control abnormal pronation.Injections of local anaesthetic and hydrocortisone around the nerve or surgical excision can be helpful.
Anxiolytic drug targets: beyond the usual suspects
Authors: Joshua A. Gordon
Journal: Journal of Clinical Investigation (2002)

Individuals suffering from anxiety experience an unpleasant emotional state defined by psychological and physiological responses to the anticipation of real or imagined danger. Physical manifestations include increased heart rate, altered respiration, sweating, trembling and fatigue, while psychological concomitants include feelings of powerlessness, apprehension, and potential danger. Many effective treatments for anxiety target the primary inhibitory neurotransmitter, γ-aminobutyrate (GABA). Within the brain, there are two principal subtypes of GABA receptor complexes: GABAA and GABAB. The subunits of the pentameric GABAA receptor form a tight group enclosing a chloride channel whereby GABA activation induces channel opening and subsequent influx of chloride ions (Cl–) into the intracellular medium. The increase in negative charge causes neuronal membrane hyperpolarization and a resultant inhibition of neurotransmitter release. In this way, GABA agonists can induce anxiolysis, sleep, and anesthesia.
RENAL SUPPURATION, CATARRHAL, SPECIFIC AND TRAUMATIC, AND THE VALUE OF MICRO-URANALYSIS OF THE URINARY SEDIMENT AS AN AID TO DEFINITE DIAGNOSIS OF IT.
Authors: THOMAS H. MANLEY
Journal: JAMA (1897)

A peculiar clinical experience during the past year, has led me to the investigation of a class of lesions commonly enough encountered by most practitioners with fair opportunities for observation; but certainly in a considerable proportion of cases they are not understood, nor their clinical manifestations correctly interpreted. I refer to kidney abscess or pyonephrosis; of late, also designated  kidney, for the reason that it is supposed that the lesion admits of relief or cure only by surgical measures, which is only correct, however, in exceptional cases.  Much diversity of opinion has arisen, in consequence of the confusion of terms employed by different authors, in describing the various types of renal suppuration; and, on the other hand, by an attempt at an over-refinement and irrational differentiation of pathologic conditions.  Thus we will note, that one speaks of renal suppuration as pyonephritis, another as pyonephrosis, another as pyelitis, and another
Clinical Utility of Single-Beat E/e′ Obtained by Simultaneous Recording of Flow and Tissue Doppler Velocities in Atrial Fibrillation With Preserved Systolic Function
Authors: Kenya Kusunose, Hirotsugu Yamada, Susumu Nishio, Noriko Tomita, Toshiyuki Niki, Koji Yamaguchi, Kunihiko Koshiba, Shusuke Yagi, Yoshio Taketani, Takashi Iwase, Takeshi Soeki, Tetsuzo Wakatsuki, Masashi Akaike, Masataka Sata
Journal: JACC. Cardiovascular imaging (2009)
Long-term outcomes after unprotected left main coronary artery stenting
Authors: Yoshinori Yoshida, Takeshi Kimura, Takashi Tamura, Shinichi Shirai, Kei Nishiyama, Kenji Ando, Satoshi Shizuta, Kazuaki Kaitani, Masashi Iwabuchi, Hiroyoshi Yokoi, Yoshihisa Nakagawa, Naoya Hamasaki, Katsumi Inoue, Hideyuki Nosaka, Masakiyo Nobuyoshi
Journal: Journal of the American College of Cardiology (2002)
Neuroethics and Neuroimaging: Moving Toward Transparency
Authors: Joseph J. Fins
Journal: The American Journal of Bioethics (2008)

Without exaggeration, it could be said that we are entering a golden age of neuroscience. Informed by recent developments in neuroimaging that allow us to peer into the working brain at both a structural and functional level, neuroscientists are beginning to untangle mechanisms of recovery after brain injury and grapple with age-old questions about brain and mind and their correlates neural mechanisms and consciousness. Neuroimaging, coupled with new diagnostic categories and assessment scales are helping us develop a new diagnostic nosology about disorders of consciousness which will likely improve prognostication and suggest therapeutic advances. Historically such diagnostic refinement has yield therapeutic advances in medicine and there is no reason to doubt that this will be the case for disorders of consciousness, perhaps bringing relief to a marginalized population now on the periphery of the therapeutic agenda. In spite of this promise, the translation of research findings into the clinical context will be difficult. As we move from descriptive categories about disorders of consciousness, like the vegetative or minimally conscious states, to ones further specified by integrating behavioral and neuroimaging findings, humility not hubris should be the virtue that guides the ethical conduct of research and practice.
The fast and slow components of the force-length curve in cardiac muscle
Authors: R C REEVES, D N S REEVES, A A WALKER, L L HEFNER
Journal: Cardiovascular Research (1985)

Journal Article The fast and slow components of the force-length curve in cardiac muscle Get access R C REEVES, R C REEVES From the Division of Cardiology, Department of Medicine, The University of Alabama at Birmingham Search for other works by this author on: Oxford Academic PubMed Google Scholar D N S REEVES, D N S REEVES From the Division of Cardiology, Department of Medicine, The University of Alabama at Birmingham Search for other works by this author on: Oxford Academic PubMed Google Scholar A A WALKER, A A WALKER From the Division of Cardiology, Department of Medicine, The University of Alabama at Birmingham Search for other works by this author on: Oxford Academic PubMed Google Scholar L L HEFNER L L HEFNER From the Division of Cardiology, Department of Medicine, The University of Alabama at Birmingham Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, Volume 19, Issue 9, September 1985, Page 520, https://doi.org/10.1093/cvr/19.9.520 Published: 01 September 1985
Inoperable aortic stenosis in the elderly: benefit from percutaneous transluminal valvuloplasty
Authors: I R Starkey, J S Fleming, D C Cumberland, G D G Oakley
Journal: BMJ (1987)

not stated, but when asked if this might have been due to unrelieved aortic stenosis they declined to comment.In addition, and as in the present report, most patients had significant residual aortic stenosis.Clearly these results are not as good as those which can be expected with current surgical techniques.The presenter of the French experience then went on to claim that he had not referred a patient for surgery for over a year.The mortality for this group, and the functional results, were not available.This widening indication for valvuloplasty in the absence ofverifiable data and in the light of published surgical results over many years concerns us.As a caveat we would like to point out from our own intraoperative studies that if this technique is to be used a balloon inflation time of one minute is not necessary, and is probably dangerous.4Prolonged obstruction to ventricular outflow must result in further dilatation of an already over- stretched myocardium.It has been known for many years that this may cause irreversible damage.Several of the reported deaths with this technique appear to have been due to this mechanism.We found that an initial inflation time of 15 seconds was sufficient to open the valve orifice by a measurable amount.Further short periods of inflation could then be used.This problem may in part be avoided by the use oftrefoil shaped balloons.We are anxious to join with Dr Jackson and coUeagues to counsel against the uncontrolled and unrestricted spread of this procedure to the detri- ment of patients with aortic stenosis in Britain.
Educating practice staff about chlamydia boosts detection in young adults
Authors: Z. Kmietowicz
Journal: BMJ (2013)

Teaching general practice staff about screening for chlamydia helped to increase testing rates and diagnoses among 16-24 year olds, a study has found.1

The intervention programme was developed by Public Health England and tested in 76 practices in southwest England, which were compared with 81 control practices that received the usual support from the national chlamydia screening programme (a single telephone contact or visit, availability to answer any queries by telephone, provision of testing kits when they were needed, and partner notification). 

Although 60% of young people in England attend their general practice every year, only 16% of the 136 000 tests for chlamydia are delivered through primary care.

The intervention aimed to change …
Comparative Study of District and Community Hospitals
Authors: J. W. Smith, J. B. O'Donovan, G. Hoyle, D. F. G. Clegg, T. Khalid
Journal: BMJ (1973)

Opinions conflict on whether there is a place in the Health Service for general practitioner (community) hospitals in which the patients' treatment is mainly the responsibility of their family doctors. The authors therefore analysed a sample of the patients admitted in the course of a year to a group of two general district hospitals with a comparable sample of the patients admitted to a general practitioner hospital. The aim was to analyse the type of care provided in the general practitioner hospital, to assess whether it was appropriate for the type of cases treated, and to decide whether the patients would have been better off in the district general hospital (and vice versa). The main conclusions are that a district hospital is best for serious illnesses needing skilled decisions and assessments but that most of the work of these hospitals is not of this kind and a community hospital staffed by general practitioners offers many advantages to patients-provided the work being done is constantly under critical assessment. The authors plead for special refresher courses under the N.H.S. for general practitioners working in community hospitals.
Patterns of urinary excretion of gold in patients with rheumatoid arthritis undergoing chrysotherapy.
Authors: M J Heath, A J Swannell, C R Williams, T Palmer
Journal: Annals of the Rheumatic Diseases (1987)

Thirty patients receiving gold therapy for rheumatoid arthritis (RA) were studied for the urinary excretion of gold. Statistical analysis of all the urine specimens passed over a period of four days by each patient showed that a definite rhythm of gold excretion exists for each patient which is possibly related to water excretion but not to creatinine excretion. The study indicates possible reasons for the inability of earlier workers to relate gold excretion to the general body gold status of patients and suggests that as the study of 24 hour excretions of gold may be an insensitive marker of gold excretion, closer examination of individual patient rhythms of gold excretion could possibly provide a more useful method of analysis.
Health care USA: don't make a drama out of a crisis
Authors: J. P Kassirer
Journal: BMJ (2008)

<h3>Abstract</h3> SidE family of <i>Legionella</i> effectors catalyze non-canonical phosphoribosyl-linked ubiquitination (PR-ubiquitination) of host proteins during bacterial infection. SdeA localizes predominantly to ER and partially to the Golgi apparatus, and mediates serine ubiquitination of multiple ER and Golgi proteins. Here we show that SdeA induces fragmentation of the Golgi stacks due to its ubiquitin ligase activity. The Golgi tethering factors GRASP55 and GRASP65 are PR-ubiquitinated on multiple serine residues, thus preventing their ability to cluster and form oligomeric structures. In addition, we found that the functional consequence of Golgi fragmentation is not linked to the recruitment of Golgi membranes to the growing <i>Legionella</i>-containing vacuoles. Instead, it affects the secretory pathway, including cytokine release in cells. Taken together, our study sheds light on the Golgi manipulation strategy by which <i>Legionella</i> hijacks the secretory pathway and promotes bacterial infection.
Adenoviral delivery of low-density lipoprotein receptors to hyperlipidemic rabbits: Receptor expression modulates high-density lipoproteins
Authors: David R. Brown, Margaret E. Brousseau, Robert D. Shamburek, Glenda D. Talley, Susan Meyn, Stephen J. Demosky, Silvia Santamarina-Fojo, H.Bryan Brewer, Jeffrey M. Hoeg
Journal: Metabolism (1996)
Factors affecting the increased accuracy of heart rate adjusted ST depressions for predicting triple vessel — left main disease
Authors: Marco Bobbio, Robert Detrano, Andras Janosi, Alberto Righetti, Matthias Pfisterer, Walter Steinbrunn, Kern H. Guppy, Jaap W. Deckers, Johann-Jakob Schmid
Journal: Journal of the American College of Cardiology (1990)
Incretin therapy: should adverse consequences have been anticipated?
Authors: E. Gale
Journal: BMJ (2013)

Transparency is what we need

In a linked investigation (doi:10.1136/bmj.f3680), Cohen shines a spotlight on the safety of the incretins—drugs for the treatment of diabetes that mimic or enhance the biological effects of glucagon-like peptide-1 (GLP-1).1 Her investigation raises important questions as to the nature of the dialogue between drug companies and the regulators, and the extent to which potentially harmful effects of these drugs have been hidden from prescribers and patients. 

The drugs that have transformed the modern treatment of chronic illness—β blockers, angiotensin converting enzyme inhibitors, and statins—are typically inhibitors of defined molecular pathways, with consequences that are relatively predictable. By contrast, the incretins are agonists that act on multiple targets with multiple effects. They are “magic shotguns” rather than “magic bullets.” 

The thiazolidinediones—nuclear receptor agonists that modulate the activity of numerous genes—are good examples of this. They were introduced with great fanfare, but unwanted effects such as weight gain, fluid retention, and osteopenia have limited their use in the management of diabetes. Troglitazone, the first in class, was withdrawn because of hepatic injury; rosiglitazone was withdrawn from most countries in 2011 because of cardiovascular problems; and pioglitazone has been implicated in bladder cancer. 

In each case the potential problem was spotted early in development but the regulatory response …
Using mobile phones in hospitals: Risks were worth running during SARS epidemic
Authors: Peter K K Au-Yeung
Journal: BMJ (2005)

Childhood cancer and power linesWhat do the data mean?Editor-Draper et al used distance of mother's home from high voltage overhead transmission lines (predominantly 275 kV and 400 kV) at the time of her child's birth as a proxy for her child's subsequent exposure to power-frequency magnetic fields (reviewed by Ahlbom et al). 1 2 As they acknowledge, this is a crude estimate since, in contrast to other reports, 2 no household measurements were taken, no data on more prevalent low voltage distribution sources were collected, no information from other time points in the child's life was obtained, variations during the 33 years period studied were not considered, and no validatory home visits were carried out.A recent report into residential exposures to magnetic fields in the United Kingdom estimated that proximity to high voltage lines, 275 kV and above, explained only 9% of those with measurements ≥ 0.2 microtesla ( T). 3 National data on the distribution of houses in relation to high voltage lines in the UK were provided (J Swanson, National Grid Transco, personal communication, 2000) to the UK Childhood Cancer Study (UKCCS) Group for its study of power lines and childhood cancer, to assess the representativeness of study subjects. 4 An equivalent comparison using National Grid data spanning the far longer period investigated in the paper by Draper et al was not undertaken.The assessments of distance to power lines in the UKCCS were made for all registered controls, who have been shown to represent the general population. 5plot of the distributions of the leukaemia and non-leukaemia cases and controls in the study by Draper et al, national populations, and UKCCS populations by distance from high voltage lines (figure) seems to show that the leukaemia controls used in the analysis presented by Draper et al are systematically different.Their positive result over 100 m may therefore be explained not by an excess of cases but by a deficit of controls in the early years of the study.
Treatment of Vocal Cord Carcinoma
Authors: James A. Koufman
Journal: JAMA (1983)

<h3>To the Editor.—</h3> The lead topic in the MEDICAL NEWS section ofThe Journalin the March 11 issue (1983;289:1241) was somewhat misleading. One hundred seventy-seven patients were treated during a 26-year period at the Department of Radiation Oncology, Washington University School of Medicine, St Louis, for vocal cord carcinoma. The results are indeed excellent and the authors compared their results with surgical results and include information on cost-effectiveness. The authors may or may not be aware that the advent of the carbon dioxide surgical laser has allowed the endoscopic removal of T1 lesions of the larynx with similar cure rates, decreased cost, and comparable survival rates. During the last four years, I have treated 16 patients with T1 carcinomas of the larynx. Each of these patients was in the hospital for less than 48 hours, and the total charges for the surgeon and hospitalization were considerably less than $2,920,
Oestrogen and androgen receptors in breast cancer and response to endocrine therapy.
Authors: J P Persijn, C B Korsten, E Engelsman
Journal: BMJ (1975)

of the impacted safety pin had clearly ceased.Also the pin had caused epigastric pain and a small haemorrhage, and required removal.In view of the previous abnormalities in the right upper abdomen and the patients' cardiac status, laparotomy and duodenotomy would have been technically difficult and of considerable risk to the patient.Fibre-optic endoscopy has found a number of diagnostic and therapeutic applications in diseases of the upper digestive tract.Although the second part of the duodenum is accessible using the endoscope, the special devices marketed for the removal of foreign bodies were of little use in this case because of the extreme flexion of the tip required.Fortunately, the biopsy forceps fitted the loop of the ingested safety pin and the pin was lying the appropriate way for its retrograde removal.The advantages of endoscopic removal in this case are clear, but the obviation of general anaesthesia, laparotomy, and a period of postoperative recovery apply equally to the fit patient.If the patient had presented at hospital while the pin was still in the stomach its removal would have been much easier.Ingested foreign bodies that are likely to impact in the bowel should be removed from the stomach as a matter of urgency when endoscopy is to be used.