tbuckley/cabot-search huggingface dataset:
High prevalence of hypertension in sleep apnea patients independent of obesity.
Authors: J T Carlson, J A Hedner, H Ejnell, L E Peterson
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

The relative influence of body mass index (BMI) and sleep apnea (SA) on blood pressure and prevalence of hypertension was investigated in 377 consecutive subjects admitted to a sleep laboratory. Among patients, 124 (33%) had SA, 153 (41%) were obese, and 93 (25%) had systemic hypertension. Both oxygen desaturation (OD) and minimal oxygen saturation (SaO2min) were related to BMI (p < 0.001) in patients without antihypertensive medication. Systolic and diastolic blood pressures were related to BMI and disease severity. Moreover, casual blood pressure, frequency of hypertension as well as OD and SaO2min were all significantly related to age. In a multivariate logistic regression analysis, age, BMI, and SA were all identified as independent predictors of hypertension. The relative risk associated with age was 4.3 (40 to 59 yr), with obesity 2.7 (> or = kg/m2) and with SA 2.1 (> 30 desaturation/6 h). The relative risk for hypertension increased with increasing age and BMI. In SA, however, the relative risk was unchanged in patients with a higher number of desaturations (OD > or = 60, 2.2). Combined obesity and SA resulted in a 3.9 times increase in hypertension prevalence. We concluded that age, SA, and overweight represent both independent and additive risk factors for development of systemic hypertension.
The Lucifer Effect
Authors: A. Hall
Journal: BMJ (2010)

The Lucifer Effect explores questions that society would rather not ask: “What makes previously moral individuals act immorally?” Or, in Philip Zimbardo’s attention grabbing prose, “How can good people become evil?” This topic proves pertinent to medical practice in the wake of modern scandals from Rugby Union’s “bloodgate” furore ( BMJ 2009;339:b3873, doi:10.1136/bmj.b3873) to research falsification.

The first section of Zimbardo’s book engages the reader with a synopsis of the Stanford prison experiment of 1971 from the first person perspective of its lead researcher, one Philip Zimbardo. Through his eyes we witness the developments of a psychology research project that runs horribly awry.

He describes how groups of volunteer students behaved when split into two randomised …
Role of C3 Cleavage in Monocyte Activation During Extracorporeal Circulation
Authors: Christine S. Rinder, Henry M. Rinder, Kirk Johnson, Michael Smith, David L. Lee, Jayne Tracey, Glenda Polack, Paul Higgins, C. Grace Yeh, Brian R. Smith MD
Journal: Circulation (1999)

Background —We previously demonstrated that inhibiting formation of terminal complement components (C5a and C5b-9) prevents platelet and neutrophil (PMN) but not monocyte activation during simulated extracorporeal circulation (SECC). This study examined whether earlier complement inhibition during SECC, blocking C3a formation, would additionally prevent monocyte activation. Methods and Results —SECC was established by recirculating heparinized whole blood from human volunteers on a membrane oxygenator. CAB-2, a chimeric protein constructed from genes encoding the complement regulatory proteins CD46 and CD55, inactivates the C3/C5 convertases and blocks in vitro generation of C3a, C5a, and C5b-9. CAB-2 was used in 4 experiments at a final concentration of 300 μg/mL and 4 experiments at 30 μg/mL; 4 control runs used vehicle alone. Samples were assayed for C3a and C5b-9, monocyte activation (CD11b upregulation), PMN activation (CD11b upregulation and elastase release), and platelet activation (P-selectin expression and monocyte-platelet conjugate formation). CAB-2 at both doses significantly inhibited formation of C3a and C5b-9 during SECC. High-dose CAB-2 significantly blocked monocyte and PMN CD11b upregulation and PMN elastase release. CAB-2 also inhibited formation of platelet activation–dependent monocyte–platelet conjugates. Conclusions —Blockade of complement activation early in the common pathway inhibited monocyte CD11b upregulation during SECC, suggesting that early complement components contribute most to monocyte activation during SECC. As expected, PMN and platelet activation were blocked by terminal complement inhibition. This investigation further elucidates the relation between complement and blood cell activation during simulated cardiopulmonary bypass.
Nationwide Survey of Drug-Resistant Tuberculosis in the United States
Authors: Alan B. Bloch
Journal: JAMA (1994)

To determine antituberculosis drug resistance patterns, geographic distribution, demographic characteristics, and risk factors of reported tuberculosis (TB) patients in the United States.Survey of reported TB cases in the United States. For culture-positive cases reported to the Centers for Disease Control and Prevention, we asked health departments to provide drug susceptibility test results from initial Mycobacterium tuberculosis isolates.Culture-positive TB cases in the United States reported during the first quarter of 1991.Individual TB case reports submitted to the Centers for Disease Control and Prevention and drug susceptibility test results.Resistance to one or more antituberculosis drugs was found in 14.2% of cases. Resistance to isoniazid and/or rifampin was found in 9.5% of cases whose isolates were tested against one or both drugs; such cases were found in 107 counties in 33 states. Resistance to both isoniazid and rifampin (multidrug-resistant [MDR] TB) was found in 3.5% of cases whose isolates were tested against both drugs; such cases were found in 35 counties in 13 states. New York City accounted for 61.4% of the nation's MDR TB cases. The 3-month population-based incidence rate of MDR TB in New York City was 52.4 times (95% confidence interval [CI], 35.5 to 78.3) that of the rest of the nation (9.559 vs 0.182 cases per million population). Compared with the rate in non-Hispanic whites in the rest of the nation (0.032 cases per million), the relative risk of MDR TB in New York City non-Hispanic whites was 39.0 (95% CI, 8.1 to 164.5), 299.3 (95% CI, 112.5 to 927.1) in Hispanics, 420.9 (95% CI, 121.0 to 1515.8) in Asian/Pacific Islanders, and 701.0 (95% CI, 296.4 to 2018.1) in non-Hispanic blacks.With nearly 10% of TB patients resistant to isoniazid and/or rifampin, greater use of four-drug regimens and directly observed therapy is indicated. Aggressive intervention to prevent the further spread of MDR TB is needed to find every TB patient and to provide optimal patient management to ensure completion of chemotherapy.
Effects on health of work in hospitals
Authors: A. A Spence
Journal: BMJ (1977)

proved results, their criticism is potentially valid for any study taking place over a period of time.We agree with the Cardiff workers that the value of induction of labour should be tested in a large, prospective, randomised trial.In view of the conflicting opinions regard- ing the place of induction of labour we feel that such a trial would be entirely ethical.We would be grateful to hear from any obstetrician willing to co-operate in a multi- centre trial based on the model previously operated by Cole et al.
Significance of Potassium in Genesis of Arrhythmias in Induced Cardiac Ischaemia
Authors: P. Taggart, J. D. H. Slater
Journal: BMJ (1971)

Paired biopsy specimens from the right or left atrial appendage have been taken from patients undergoing cardiopulmonary bypass surgery after various periods of intermittent coronary artery occlusion and analysed for potassium, sodium, and chloride content, total tissue water, and extracellular fluid volume.Tissue potassium content is reduced after coronary artery occlusion, and potassium loss bears an apparently linear relationship to the duration of occlusion. After 150 minutes of occlusion the potassium content had decreased by nearly 50%.For the first 50 minutes of occlusion the myocardial cells swelled at the expense of the extracellular fluid volume. Thereafter there was movement of water in the opposite direction, with subsequent cell shrinkage.The loss of potassium and the alteration in cellular hydration exert profound effects on the calculated gradient of potassium across the cell membrane. This is discussed in relation to the arrhythmias and low cardiac output after myocardial ischaemia. An attempt to rationalize treatment is made.
Local control over foundation trusts is “rhetoric”
Authors: Madeleine Brettingham
Journal: BMJ (2005)

Primary care trusts are running elections that would be considered “disgraceful” if they took place in local government, a study funded by the Nuffield Trust has said. The report, written by Patricia Day, a senior research fellow, and Rudolf Klein, emeritus professor, at Bath University's Centre for the Analysis of Social Policy, casts doubt on the government's claim that foundation trusts hand power to local people and represent “a new form of social ownership.”

The six month study examined government discussions before the policy was unveiled in December 2002. As well as information made available by the trusts themselves, the researchers found unsettling evidence of …
Heterogeneous transmural distribution of beta-adrenergic receptor subtypes in failing human hearts.
Authors: S L Beau, T K Tolley, J E Saffitz
Journal: Circulation (1993)

BACKGROUND Downregulation of myocardial beta-adrenergic receptor density does not occur in a spatially uniform distribution in patients with congestive heart failure. Rather, it results primarily from loss of receptors in the subendocardium. In patients with dilated cardiomyopathy, beta 1-receptors have been found to be downregulated selectively. These observations suggest that considerable transmural heterogeneity in the distribution of beta-adrenergic receptor subtypes exists in the failing human heart. The present study was designed to test this hypothesis. METHODS AND RESULTS We used quantitative autoradiography of radioligand binding sites to measure the distribution of beta-adrenergic receptor subtypes in transmural sections of left ventricular myocardium obtained from cardiac transplant patients with ischemic (n = 13) and idiopathic dilated (n = 12) cardiomyopathy and from 4 subjects with no history of cognitive heart failure. Analysis of radioligand binding isotherms revealed a significant reduction in total beta-adrenergic receptor density in hearts of patients with ischemic and idiopathic cardiomyopathy (20.3 +/- 1.9 and 18.2 +/- 2.0 fmol/mg protein, respectively, versus 40.0 +/- 11.4 in control subjects; P &lt; .01 for both). Loss of the beta 1-subtype accounted for 86% of the total reduction in beta-receptor density in failing hearts. Despite the significant decreases in overall tissue receptor content, the densities of total beta-receptors and beta-receptor subtypes in subepicardial myocytes were equivalent in failing and control hearts. However, in contrast to control hearts, in which the transmural distribution of total and beta 1-receptors was uniform (endocardial: epicardial receptor density ratios, 0.97 +/- 0.14 and 1.0 +/- 0.2, respectively), hearts of patients with ischemic and idiopathic dilated cardiomyopathy had significantly lower total beta-receptor and beta 1-receptor densities in the subendocardium (ratios, 0.66 +/- 0.06 and 0.46 +/- 0.09 for total and beta 1-receptors, respectively, in ischemic cardiomyopathy and 0.60 +/- 0.08 and 0.52 +/- 0.11 in dilated cardiomyopathy; P &lt; .001 for all values compared with a ratio of 1). Thus, beta 1: beta 2 receptor density ratios were markedly decreased in the subendocardium of ischemic and idiopathic dilated left ventricles compared with control hearts. CONCLUSIONS A significant transmural gradient in the density of myocardial beta 1-adrenergic receptors exists in the hearts of patients with ischemic and dilated cardiomyopathy, resulting in a markedly altered beta 1: beta 2 receptor density ratio in the subendocardium.
AIDS and the New Orphans: Coping With Death
Authors: Monnie B. Callan
Journal: JAMA (1995)

This book is as timely as today's newspaper. For example, the<i>New York Times</i>front page article of March 4,1995, "Difficult custody decisions being complicated by AIDS," states, As AIDS becomes more prevalent among heterosexuals, AIDS cases among women are growing by seventeen percent a year, according to the Federal Centers for Disease Control and Prevention, compared with three percent for the general population. Nationwide, experts estimate that as many as 125,000 children will lose their mothers to AIDS by the year 2000. Eighty percent of those children are from Latino and African-American families. In the early days of the AIDS epidemic, doctors in the Bronx encountered some women who had contracted the disease solely through heterosexual contact, usually with drug users. Their reports were met with skepticism because many scientists believed that "drug addicts only relate to drug addicts." It took considerable persuasion to convince them that their preconceptions
Eye Changes in Ichthyosis
Authors: Raymond J. Sever
Journal: JAMA (1968)

Examination of the eyes of a series of patients with four distinct types of ichthyosis disclosed that ectropion secondary to involvement of the skin of the lower eyelid was found only in patients with lamellar ichthyosis. Deep corneal dystrophy was present in all patients with X-linked ichthyosis and in most of the female carriers of this disorder. No deep corneal changes were noted in patients with lamella ichthyosis or epidermolytic hyperkeratosis. The examination of the cornea is useful in distinguishing males with X-linked ichthyosis from those with lamellar ichthyosis and ichthyosis vulgaris and in identifying female carriers of X-linked ichthyosis.
Iron metabolism in the erythrophagocytosing Kupffer cell
Authors: Hitoshi Kondo, Kainosuke Saito, Joseph P. Grasso, Philip Aisen
Journal: Hepatology (1988)

Like the peritoneal macrophage, the isolated Kupffer cell is capable of processing and releasing iron acquired by phagocytosis of immunosensitized homologous red blood cells. When erythrophagocytosis is restrained to levels which do not affect cell viability, or less than 1.5 red cells/macrophage (phagocytic index of 150%), over 40% of iron acquired from red cells is released within 24 hr. More active erythrophagocytosis results in greater release of iron but progressive deterioration in cell viability. Iron release is temperature-dependent, the rate at 37° C being nearly 5-fold greater than at 4° C. Inclusion of either desferrioxaminine or apotransferrin in the culture medium augments iron release by 25 to 30%, with both agents together having an almost additive effect. Despite its effect on iron release, apotransferrin is not found in sonicates of Kupffer cells, while desferrioxamine appears to chelate iron within the cells. Ascorbate also enhances iron release, but at the expense of cell viability. Neither chloroquine nor colchicine at concentrations which do not affect cell viability influence iron release. The inflammatory state, characterized by hypoferremia due to impaired processing or release of iron by the reticuloendothelial system, may be modeled in vitro when serum from rats bearing turpentine-induced abscesses is included in the culture medium. Attempts to delineate the humoral agent responsible for this effect have not been successful, iron release being insensitive to the presence of interleukin-1, γ-interferon and tumor necrosis factor.
In the elderly the impact on disability and quality of life is similar in heart failure with preserved versus impaired systolic ventricular function
Authors: G. Pulignano, D. Del Sindaco, A.P. Maggioni, M.L. Pugolotti, L. Rossi, E. Scotti, M. Binotto, P. De Biaggio, C. Piemontese, C. Opasich
Journal: European Journal of Heart Failure (2000)
Intramyocardial Bone Marrow Cell Injection for Chronic Myocardial Ischemia
Authors: Jan van Ramshorst, Jeroen J. Bax, Saskia L. M. A. Beeres, Petra Dibbets-Schneider, Stijntje D. Roes, Marcel P. M. Stokkel, Albert de Roos, Willem E. Fibbe, Jaap J. Zwaginga, Eric Boersma, Martin J. Schalij, Douwe E. Atsma
Journal: JAMA (2009)

Previous studies have suggested that bone marrow cell injection may improve myocardial perfusion and left ventricular (LV) function in patients with chronic myocardial ischemia.To investigate the effect of intramyocardial bone marrow cell injection on myocardial perfusion and LV function in patients with chronic myocardial ischemia.Randomized, double-blind, placebo-controlled trial at a Netherlands university hospital, May 1, 2005-March 3, 2008 (6-month follow-up ended September 2008) of 50 patients with chronic myocardial ischemia (mean age [SD], 64 [8] years; 43 men).severe angina pectoris despite optimal medical therapy and myocardial ischemia. All patients were ineligible for conventional revascularization.Intramyocardial injection of 100 x 10(6) autologous bone marrow-derived mononuclear cells or placebo solution.Primarily, the summed stress score, a 17-segment score for stress myocardial perfusion assessed by Tc-99m tetrofosmin single-photon emission computed tomography (SPECT). Secondary included LV ejection fraction (LVEF), Canadian Cardiovascular Society (CCS) class, and Seattle Angina Questionnaire quality-of-life score (mean difference >5% considered clinically significant).After 3-month follow-up, the summed stress score (mean [SD]) improved from 23.5 (4.7) to 20.1 (4.6) (P < .001) in the bone marrow cell group, compared with a decrease from 24.8 (5.5) to 23.7 (5.4) (P = .004) in the placebo group. In the bone marrow cell-treated patients who underwent magnetic resonance imaging (MRI), a 3% absolute increase in LVEF was observed at 3 months (95% CI, 0.5% to 4.7%; n = 18), but the placebo group showed no improvement. CCS angina score improved significantly in the bone marrow cell group (6-month absolute difference, -0.79; 95% CI, -1.10 to -0.48; P < .001) compared with no significant improvement in the placebo group. Quality-of-life score increased from 56% (9%) to 64% (12%) at 3 months and 69% (12%) at 6 months in bone marrow cell-treated patients, compared with a smaller increase in the placebo group from 57% (11%) to 61% (14%) to 64% (17%). The improvements in CCS class and quality of life score were significantly greater in bone marrow cell-treated patients than in placebo-treated patients (P = .03 and P = .04, respectively).In this short-term study of patients with chronic myocardial ischemia refractory to medical treatment, intramyocardial bone marrow cell injection resulted in a statistically significant but modest improvement in myocardial perfusion compared with placebo. Further studies are required to assess long-term results and efficacy for mortality and morbidity.trialregister.nl Identifier: NTR400 and isrctn.org Identifier: ISRCTN58194927.
Meta-analysis. A quantitative approach to research integration
Authors: S. B. Thacker
Journal: JAMA (1988)

Meta-analysis is being used with increasing frequency in clinical medicine as an attempt to improve on traditional methods of narrative review by systematically aggregating information and quantifying its impact. Combining data from several studies using meta-analysis can increase statistical power, provide insight into the nature of relationships among variables, and increase generalizability of results more rigorously than less quantitative review methods. Like all review methods, meta-analysis can be limited by sampling bias, inadequate data, and biased outcome interpretation. Still, the advantages noted above make meta-analysis a methodology that warrants testing and empirical evaluation.
Half of doctors investigated over Mid Staffs have faced no action, says GMC
Authors: C. Dyer
Journal: BMJ (2013)

Four doctors involved with Mid Staffordshire NHS Foundation Trust, three of them in management roles, are facing a fitness to practise hearing before the Medical Practitioners Tribunal Service.

The news emerged after publication of the report of the public inquiry into lessons to be learnt from “appalling” care experienced by patients at the trust, in what has been called the biggest scandal to hit the NHS.1

The inquiry, by Robert Francis QC, uncovered what he described as “a story of appalling and unnecessary suffering of hundreds of people” in a system that “ignored the warning signs and put corporate self interest and cost control ahead of patients and their safety.” He said the evidence had shown “that an unhealthy and dangerous culture pervaded not only the trust . . . …
Strong government accountability is crucial to meeting millennium development goals, UN assembly is told
Authors: A. Gulland
Journal: BMJ (2013)

The introduction of accountability and oversight at government level is key to achieving the millennium development goals (MDGs), a meeting at the United Nations General Assembly has heard.

Joy Phumaphi, who co-chairs a group tasked by the UN with looking at accountability in relation to the MDGs, said that the few countries that were due to meet targets on both infant and maternal mortality had all introduced strong oversight and accountability mechanisms.

“It’s clear that the use of an oversight and accountability mechanism has been central to the achievement of results and impact in these countries. In those countries…that are on track to achieve both MDG …
Regulatory B Cells Inhibit Antitumor Immunity
Authors: Satoshi Inoue, Dorothy Scott, Basil Golding, Wolfgang W. Leitner
Journal: Cancer Research (2007)

In Response:Depleting B cells as part of a tumor-therapy regimen is an idea that becomes increasingly attractive as more studies show an apparent inhibitory role of host B cells on antitumor immune responses. However, it seems that Shah et al. (1) and our results (2) suggest different mechanisms responsible for the suppression of antitumor immunity by B cells. Our own study had been designed to investigate the regulatory role of B cells in antitumor immunity. B cells including regulatory B cells (Breg cells) exist in large numbers in the marginal zone of the mouse spleen (3). Therefore, we had isolated B cells from mouse spleen using a monoclonal antibody specific for the commonly used B cell marker CD19. Our data clearly showed that interleukin-10 (IL-10) produced by Breg cells reduced the IFN-γ production from CTL and natural killer cells partially in a CD40-CD154–dependent manner in vitro (2). In contrast, Shah et al. suggested that the inhibitory effect of B cells on tumor rejection may not be associated with CD40 expression on B cells due to the inconsistent results between in vitro and in vivo studies (1). Why do these results seem to be conflicting with our findings? We believe that the answer can be found in experimental details of these studies. Shah et al. purified B cells from mouse spleen by negative selection using anti-CD43 antibody, which is frequently used for B cell enrichment because this molecule is not expressed on conventional B cells (3). However, CD43 may be expressed on Breg cells (4) and, thus, such regulatory B cells may have been excluded from their experiments.In our experiments, we used neither CD40-CD154–inhibiting antibody nor CD40-deficient B cells for in vivo experiments to avoid experimental artifacts due to the critical role the binding of CD40 to CD154 plays outside the predicted B cell-tumor cell interaction. Based on our studies, we do believe that the interaction between CD40 on Breg cells and CD154 on tumor cells is associated with the mechanism by which antitumor immunity is enhanced in the absence of B cells. Whatever the precise mechanism may be, we agree that B cell depletion by rituximab could provide beneficial effects on cancer immunotherapy (1, 2), although the specific depletion of Breg cells may be the more promising and more desirable approach.