tbuckley/cabot-search huggingface dataset:
Perforation of chronic peptic ulcers after cimetidine.
Authors: W A Wallace, C M Orr, A R Bearn
Journal: BMJ (1977)

form of treatment on cardiovascular morbidity and mortality.Although disappointing, this is not altogether surprising in view of the overwhelming preponderance of the blood pressure level as the major risk factor for cardiovascular morbidity and mortality in this group.Some workers have found that the blood pressure is a more significant risk factor for arterial disease among established diabetics than among non-diabetics. 15 Possibly hypotensive treatment should therefore be more readily used in people who also have glucose intolerance or diabetes.The only other conventional risk factor which also had some predictive power in borderline diabetics was the plasma cholesterol concentration.The implication of this finding is that diets aimed at lowering plasma cholesterol might be more appropriate than simply low-carbohydrate or low-calorie diets, as we have discussed more fully elsewhere.'The study and our participation in the Whitehall survey was financed by a grant from the Department of Health and Social Security.M McCartney is
Effects of estrogen on circulating "free" and total 1,25-dihydroxyvitamin D and on the parathyroid-vitamin D axis in postmenopausal women.
Authors: C Cheema, B F Grant, R Marcus
Journal: Journal of Clinical Investigation (1989)

We evaluated the effect of estrogens on "free" and total calcitriol levels and on the calcitriol response to a hypocalcemic challenge in 12 postmenopausal women, age 55-74 yr. Endogenous calcitriol production was induced by intravenous Na-EDTA before and after conjugated estrogens, 1.25 mg/d for 30 d. Free calcitriol was determined by centrifugal ultrafiltration and by the molar ratio of calcitriol to vitamin D-binding protein (DBP). Estrogen increased fasting total calcitriol from 38.5 +/- 3.8 to 62.3 +/- 7.0 pg/ml (P less than 0.05). This was accompanied by a rise in free calcitriol from 104.5 +/- 11.4 to 158.7 +/- 16.4 fg/ml (P less than 0.05). Vitamin D-binding protein increased from 348 +/- 16 to 428 +/- 12 micrograms/ml (P less than 0.001), and the ratio of calcitriol/DBP increased from 1.50 +/- 0.14 to 1.94 +/- 0.18 (P less than 0.005), confirming the rise in free calcitriol. Increases in free calcitriol and in calcitriol/DBP ratios were significantly correlated, r = 0.72. Hypocalcemia led to a rapid increase in circulating immunoreactive parathyroid hormone, and to a rise in calcitriol at 24 h. The hypocalcemia-induced rise in total and free calcitriol was similar before and after estrogen, whether expressed as increments or as percent changes. We conclude that estrogen increases circulating levels of biologically active free calcitriol in postmenopausal women, but that a 30-d period of estrogen administration does not apparently improve the renal 1 alpha-hydroxylase response to a PTH challenge.
Intermittent perfusion of ischemic myocardium. Possible mechanisms of protective effects on mechanical function in isolated rat heart.
Authors: M Tani, J R Neely
Journal: Circulation (1990)

Intermittent restoration of coronary flow during ischemia reduced myocardial damage and improved recovery of function. The mechanisms of the protective effects of intermittent perfusion were investigated in isolated rat hearts. Ventricular function was assessed as the product of developed pressure (left ventricular systolic pressure minus end-diastolic pressure) and heart rate. Recovery of function was calculated by division of the product at the end of reperfusion by that before ischemia. After 40 minutes of sustained global ischemia, intracellular Na+ (Nai) increased from 11 to 74 mumol/g dry wt. During 30 minutes of reperfusion, these hearts took up a large amount of 45Ca2+ (10 mumol/g dry wt), recovered only 24% of preischemic function, and had an increased left ventricular end-diastolic pressure (48 mm Hg). When the 40-minute period of ischemia was interrupted at 10-minute intervals by intermittent perfusion (three periods of 3 minutes) with either oxygenated or hypoxemic buffer, Nai increased to only 12 or 17 mumol/g dry wt, and reperfusion resulted in much lower 45Ca2+ uptake (0.5 and 0.5 mumol/g dry wt, respectively). Recovery of function was 100% of the preischemic value. When hypoxemic buffer without glucose was used for intermittent perfusion, Nai increased to 50 mumol/g dry wt, ATP was depleted, and reperfusion resulted in reduced recovery of function (76%) and moderately increased 45Ca2+ uptake (2.1 mumol/g dry wt). The role of Na(+)-K+ pump activity in maintaining low Nai was assessed by removing K+ from oxygenated or hypoxemic buffers used during intermittent perfusion. Under these conditions, Nai rose to 64 or 102 mumol/g dry wt, 45Ca2+ uptake increased to 4.4 or 9.4 mumol/g dry wt, and recovery of function was poor. There was a highly significant correlation between Nai during ischemia and reperfusion Ca2+ overload (r = 0.87) or impaired recovery of function (r = 0.96). These results indicate that prevention of an increase in Nai by maintenance of Na(+)-K+ pump activity is associated with a reduction of Ca2+ overload through Na+/Ca2+ exchange.
Hormonal and metabolic responses of untrained, moderately trained, and highly trained men to three exercise intensities
Authors: P.A. Deuster, G.P. Chrousos, A. Luger, J.E. DeBolt, L.L. Bernier, U.H. Trostmann, S.B. Kyle, L.C. Montgomery, D.L. Loriaux
Journal: Metabolism (1989)
Orthopaedic gorillas no more
Authors: Tony Delamothe
Journal: BMJ (2007)

It seems like only yesterday, but the brief run of less than entirely complimentary Christmas articles about orthopaedic surgeons was over by 1990. Yet some orthopaedic surgeons, like elephants, never forget. One recently set a medical student the task of testing his hypothesis that orthopaedic surgeons had been singled out for especially negative treatment in Christmas issues of the BMJ .

Journal etiquette demands that I can’t tell you what Tracy Sorkin found because we rejected her article. But in her efforts to …
Analyzing the genes and peptide growth factors expressed in lung cells in vivo consequent to asbestos exposure and in vitro.
Authors: A R Brody, J Y Liu, D Brass, M Corti
Journal: Environmental Health Perspectives (1997)

Inhalation of fibrogenic particles causes injury to the bronchiolar-alveolar epithelium. Consequently, there is a rapid proliferative response as the epithelium recovers and interstitial mesenchymal cells divide and produce connective tissue. In our model of brief (5-hr) exposure to chrysotile asbestos (approximately 1000 fibers/cc) in rats and mice, these events result in focal scarring at the bronchiolar-alveolar duct junctions in a histopathologic pattern identical to that seen in asbestos-exposed individuals. After 3 consecutive days of exposure, these lesions persist for at least 6 months postexposure. We postulate that cell proliferation and production of extracellular matrix is mediated in large part by three peptide growth factors, transforming growth factors alpha and beta (TGF-alpha and -beta), and platelet-derived growth factor (PDGF) A- and B-chains. To test this hypothesis in part, we have asked whether the genes that code for these growth factor proteins are activated at sites of asbestos-induced lung injury. If these genes were not activated, it would be reasonable to suspect that other potent growth factors and cytokines released during lung injury could be the primary mediators of fibroproliferative lung disease. In the studies reported here, we show, by in situ hybridization (ISH) and immunohistochemistry, that the four genes and their concomitant proteins are expressed within 24 hr in the bronchiolar-alveolar epithelium and underlying mesenchymal cells. RNase protection assay and ISH showed that the PDGF gene was upregulated during the first 5 hr of exposure and all the gene products remained above control levels for at least 2 weeks postexposure. TGF-alpha is a potent mitogen for epithelial cells, whereas the PDGF isoforms are potent growth factors for mesenchymal cells. TGF-beta retards fibroblast growth but stimulates extracellular matrix synthesis. Further studies using gene knockouts, appropriate antibodies, or antisense technology will be necessary to prove whether any of the growth factors are playing a significant role in fibrogenic lung disease. In addition, we have carried out a series of studies using type II alveolar epithelial cells purified from adult mouse lungs and maintained for up to 8 weeks in serum-free culture. These cells exhibit high transepithelial resistance values and they release TGF-beta 1 and -beta 2. This cell type also has been cultured from TGF-alpha knockout mice, resulting in monolayers with increased transepithelial resistance. This combination of studies in vivo and in vitro will allow us to pursue the mechanisms through which growth factors mediate lung fibrosis.
Therapy of hepatitis C: Alpha interferon and ribavirin
Authors: O Reichard, R Schvarcz, O Weiland
Journal: Hepatology (1997)

Ribavirin is a nucleoside analogue that has been evaluated as a therapy of chronic hepatitis C alone and in combination with alpha interferon. Ribavirin is well absorbed orally and is typically given in doses of 1,000 to 1,200 mg/d. Three randomized, placebo-controlled studies comprising more than 150 patients have shown that therapy with ribavirin alone for 24 to 48 weeks resulted in a significant reduction in serum alanine aminotransferase (ALT) levels during therapy. However, ribavirin therapy did not lead to a substantial reduction in hepatitis C virus (HCV) RNA levels; almost all patients remained viremic, and serum aminotransferase levels increased to pretreatment values when therapy was stopped. The most common adverse event was a moderate and reversible hemolysis during treatment that caused a decrease in hemoglobin by 10% to 20% of baseline levels. Combination therapy of ribavirin with alpha interferon has demonstrated promise both in pilot studies and a recently completed randomized controlled trial. Ribavirin in standard doses combined with alpha interferon in doses of 3 million units (MU) three times weekly for 6 months was found to significantly improve the sustained biochemical and virological response rates compared with interferon alone. Combination therapy offers a promise to become standard therapy for patients with nonsustained response to alpha interferon alone, because the majority of such patients achieve a durable response after treatment with combination therapy. However, nonresponders to alpha interferon alone rarely achieve a sustained beneficial response to combination treatment. For interferon-naive patients, combination therapy is superior to therapy with alpha interferon alone in achieving sustained biochemical and virological responses, but the combination demonstrates clear-cut superiority only in patients with unfavorable profiles for a response to interferon, in particular patients with high levels of HCV RNA. The optimal use and regimen of combination therapy awaits further investigation. New antiviral agents are still needed for the proportion of patients who do not respond to alpha interferon, even in combination with ribavirin.
Mechanisms of postprandial abdominal bloating and distension in functional dyspepsia
Authors: Emanuel Burri, Elizabeth Barba, Jose Walter Huaman, Daniel Cisternas, Anna Accarino, Alfredo Soldevilla, Juan-R Malagelada, Fernando Azpiroz
Journal: Gut (2013)

<h3>Objective</h3> Patients with irritable bowel syndrome and abdominal bloating exhibit abnormal responses of the abdominal wall to colonic gas loads. We hypothesised that in patients with postprandial bloating, ingestion of a meal triggers comparable abdominal wall dyssynergia. Our aim was to characterise abdominal accommodation to a meal in patients with postprandial bloating. <h3>Design</h3> A test meal (0.8 kcal/ml nutrients plus 27 g/litre polyethylenglycol 4000) was administered at 50 ml/min as long as tolerated in 10 patients with postprandial bloating (fulfilling Rome III criteria for postprandial distress syndrome) and 12 healthy subjects, while electromyographic (EMG) responses of the anterior wall (upper and lower rectus, external and internal oblique via bipolar surface electrodes) and the diaphragm (via six ring electrodes over an oesophageal tube in the hiatus) were measured. Means +/− SD were calculated. <h3>Results</h3> Healthy subjects tolerated a meal volume of 913±308 ml; normal abdominal wall accommodation to the meal consisted of diaphragmatic relaxation (EMG activity decreased by 15±6%) and a compensatory contraction (25±9% increase) of the upper abdominal wall muscles (upper rectus and external oblique), with no changes in the lower anterior muscles (lower rectus and internal oblique). Patients tolerated lower volume loads (604±310 ml; p=0.030 vs healthy subjects) and developed a paradoxical response, that is, diaphragmatic contraction (14±3% EMG increment; p&lt;0.01 vs healthy subjects) and upper anterior wall relaxation (9±4% inhibition; p&lt;0.01 vs healthy subjects). <h3>Conclusions</h3> In functional dyspepsia, postprandial abdominal distension is produced by an abnormal viscerosomatic response to meal ingestion that alters normal abdominal accommodation.
Factors Predictive of Maternal-Fetal Transmission of HIV-1
Authors: Pamela J. Boyer
Journal: JAMA (1994)

To assess maternal risk factors potentially influencing vertical transmission of human immunodeficiency virus, type 1 (HIV-1), including maternal CD4 cell count; presence of immune complex dissociated (ICD) p24 antigen; maternal zidovudine therapy during pregnancy and/or delivery; complications of pregnancy, such as preterm labor and birth; and obstetric events during labor and delivery, such as duration of labor, mode of delivery, chorioamnionitis, and maternal blood exposure.A nonrandomized prospective cohort study at a university medical center and two general hospital affiliates.Sixty-three HIV-1-seropositive pregnant women and their 68 infants.Twenty-six mothers received zidovudine therapy during pregnancy and/or during labor and delivery.HIV-1 infection status of the infant.Thirteen of the 68 infants were vertically infected with HIV-1. Mothers with events involving fetal exposure to maternal blood were more likely to transmit infection (four [31%] of 13 vs three [5%] of 55, P = .02), as were women with plasma ICD p24 antigenemia at delivery (six [67%] of nine vs 11 [25%] of 44, P = .02). Zidovudine treatment was associated with a significant reduction in vertical transmission (one [4%] of 26 mothers treated with zidovudine vs 12 [29%] of 42 mothers not treated with zidovudine, P = .01). There was a significant protective effect of zidovudine treatment despite lower mean absolute CD4 cell counts (0.37 x 10(9)/L) in the 24 zidovudine-treated nontransmitters and in the nine non-zidovudine-treated transmitters (0.37 x 10(9)/L) than in the 24 non-zidovudine-treated nontransmitters (0.62 x 10(9)/L) (P = .008).Maternal-fetal HIV-1 transmission is multifactorial, with increased risk associated both with ICD p24 antigenemia at term and with intrapartum events that increase fetal exposure to maternal blood. Zidovudine therapy given during pregnancy and/or labor and delivery was associated with a significant reduction in vertical transmission. These data suggest that the beneficial effects of zidovudine therapy in reducing maternal-fetal HIV-1 transmission recently found in protocol 076 of the placebo-controlled Acquired Immunodeficiency Syndrome Clinical Trials Group Study may extend to women with lower CD4 cell counts and suggest that prolonged treatment of infants may not be necessary.
Should youth mental health become a specialty in its own right? No
Authors: P. Birleson
Journal: BMJ (2009)

Mental illness often develops in adolescence and young adulthood. <b>Patrick McGorry</b> (doi:10.1136/bmj.b3373) believes the best way to ensure early treatment is to have dedicated services, but <b>Peter Birleson </b>argues that integration with existing systems is more important
Position related analysis of the appearance of and relationship between post-match physical and mental fatigue in university rugby football players
Authors: T Mashiko, T Umeda, S Nakaji, K Sugawara
Journal: British Journal of Sports Medicine (2004)

The relationship between physical and mental fatigue in rugby players after a match was examined, taking into account the position played.The Profile of Mood State (POMS) test, blood biochemical parameters, and serum opsonic activity were measured for 37 university rugby football players before and after a match.There were no differences in parameter changes except for blood urea nitrogen (a marker for protein catabolism) between the forwards and the backs. Regarding correlation between physical and mental fatigue, in forwards, changes in POMS scores showed a positive correlation with changes in the levels of enzymes of skeletal muscle origin, such as glutamate oxaloacetic transaminase (GOT) and lactate dehydrogenase (LDH), and free fatty acid (FFA) level and white blood cell count (for example, in the Total Mood Disturbance (TMD) score, Spearman's correlation coefficient was 0.417 and p<0.05 with GOT, 0.413 and p<0.05 with LDH, 0.462 and p<0.05 with FFA, and 0.442 and p<0.05 with white blood cell count). In backs, changes in the POMS scores showed a positive correlation with changes in the levels of lipid related parameters such as FFA and total cholesterol (for example, as regards the TMD score, Spearman's correlation coefficient was 0.481 and p<0.05 with FFA, and 0.550 and p<0.05 with total cholesterol), and showed a negative correlation with change in blood glucose level (TMD score, -0.517 and p<0.05).The different exercise loading of the position played during a rugby match may cause differences in the relationship between physical and mental fatigue.
Activation of the p70 S6 kinase by all-trans-retinoic acid in acute promyelocytic leukemia cells
Authors: Lakhvir Lal, Yongzhong Li, Jessica Smith, Antonella Sassano, Shahab Uddin, Simrit Parmar, Martin S. Tallman, Saverio Minucci, Nissim Hay, Leonidas C. Platanias
Journal: Blood (2004)
Anyone linked with trafficking human organs will be punishable under new convention
Authors: R. Watson
Journal: BMJ (2015)

Healthcare professionals are at the heart of a new international move launched by the Council of Europe to stamp out the illicit removal of human organs. The United Kingdom and 13 other countries became the first to sign up to the Strasbourg based organisation’s Convention against Trafficking in Human Organs when it was opened for signature in Santiago de Compostela on 25 March.

The convention, once incorporated into countries’ domestic law, criminalises illicit organ trading even when there is no human trafficking. It provides for a raft of new offences and places special emphasis on support for victims. It is the first international treaty empowering countries to deal specifically with …
GP surgeries were hard to contact over Christmas
Authors: A. Rouse
Journal: BMJ (1999)

EDITOR—Accident and emergency departments were overwhelmed with patients during the Christmas period. The health minister, Frank Dobson, believes that a flu epidemic precipitated this problem. A more likely explanation is that the general practice service in England and Wales broke down; people could not contact their general practitioners during the holiday period.

As part of a pharmacological research project, I was involved with a telephone survey of general practitioners. We selected a simple random …
Minister wants more generic prescribing
Authors: L Beecham
Journal: BMJ (1994)

Appearing before the Commons health committee last week, health minister Dr Brian Mawhinney said that although the BMA had agreed in principle to generic substitution as far back as 1983 it had not been possible to make progress. General practitioners now recognised that changes were taking place. “They have a greater degree of confidence in the quality of generic drugs and have had the opportunity of seeing them used and to be reassured,” he said. The proportion of generic drugs precribed by doctors is now about 45%, but the potential is 65%. There are currently no generic substitutes for the remaining one third of drugs.

The minister will open discussions with the General Medical Services Committee and pharmacists to see if they could find a way forward which was broadly acceptable to everyone.

A spokesman for the Association of the British Pharmaceutical Industry said the organisation was “absolutely livid” at Dr Mawhinney's announcement, of which it had no prior notice. He said generic substitution would have a devastating effect on the industry and deprive British companies of sales.

In the week when the cost of NHS prescriptions was increased by 50p to pounds sterling4.75 an item from April, Dr Mawhinney clashed with Conservative MPs on the committee. They argued that the charge now exceeded the cost of many drugs and could be lower if there were fewer exemptions. The minister surprised MPs by saying that although the charge was against the provision of medicines, patients were not paying for the drugs but were making a contribution to the NHS according to what the government of the day thought was proper.

He also …
DEGREE OF MENTAL DEFICIENCY RESULTING FROM CONGENITAL SYPHILIS
Authors: NEIL A. DAYTON
Journal: JAMA (1926)

Various factors have produced the prevailing opinion that congenital syphilis is of serious import as a cause of mental deficiency. In the main, this thought is traceable to early writings on the subject just subsequent to the introduction of the Wassermann reaction and preceding the standardization of the technic. The greater part of these reports are from the medical literature of Europe and consist chiefly of small groups of selected cases. The inclusion of these reports with others gave an incidence of 7.8 per cent for congenital syphilis in the feebleminded.<sup>1</sup>Doubt of these early reports prompted the assembling of data based exclusively on American statistics. Here the defects mentioned did not exist, as the reports, for the most part, embraced entire institution populations tested between 1910 and 1925. Five and three tenths per cent of the feebleminded in this country were found to have congenital syphilis. The comparison
Letter: Patient-satisfaction in general practice.
Authors: D Craddock
Journal: BMJ (1975)

sPecial consideration concerming suscepti- bility to malaria and infection with some species of babesia in patients who have undergone ;splenectomy for haematological disorders.Research work on apes and monkeys has shown that when these animals have acquired immuunity to malaria they can be reinfected with the same .strain of tthe same species of parasite if, before reinfection, the recommence a drug which he rightly believes could have killed him.-Iam, etc.,
Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation
Authors: Andreas Goette, Thorsten Staack, Christoph Röcken, Marco Arndt, J.Christoph Geller, Christof Huth, Siegfried Ansorge, Helmut U Klein, Uwe Lendeckel
Journal: Journal of the American College of Cardiology (2000)