tbuckley/cabot-search huggingface dataset:
How to tackle the NHS funding crisis? Levy charges
Authors: N. Hawkes
Journal: BMJ (2014)

Top class healthcare and social care aren’t possible without private payment



The hunt for money to sustain the NHS in England is verging on the ridiculous. I thought that the Barker Commission, assembled by the think tank the King’s Fund to work out how to pay for merging health and social care,1 had hoovered up the very scrapings of the barrel. But then I heard Ed Miliband, the Labour leader, conjuring up farfetched ways to target unpopular people—mansion owners, tobacco companies, hedge funds—to keep the show on the road.2 And I knew that the game was up.

Neither recipe will raise enough for the NHS to continue on its present course, never mind trying to add social care to the mix. And there’s something demeaning in Miliband pretending that a few changes that won’t hurt anybody you know but that will bear heavily on a few you don’t know will solve a really major problem. It’s on a par with Chancellor George Osborne’s plan to tax Cornish pasties, which earned him well deserved scorn.

Kate Barker, who chaired the King’s Fund commission, at least laid some of the costs on service users through a flat rate prescription charge (with no exemptions) and “hotel charges” (for …
Treatment of Lead Poisoning
Authors: Robert J. Nadig
Journal: JAMA (1990)

To  Editor.—  The article by Dr Rempel 1 addresses important concerns with regard to  diagnosis, surveillance, and management of lead poisoning in adults. However, no references are given for  explanation of  edetate disodium calcium lead-mobilization test, and this explanation appears to set new alternative criteria for reaching  conclusion that  lead-mobilization test indicates a high body burden. Dr Rempel must explain further  basis for and  utility of  statement that the lead-mobilization test indicates a high body burden of lead if  urine level doubles. Does  author mean that a rise from 0.05 μmol/d to 0.10 μmol/d (to convert to micrograms per 24 hours, multiply by 207.21) is a positive test result? This would lead to an erroneous conclusion. Both lead excretions are within  normal limits and, in fact,  difference between  0.05-μmol/d and  0.10-μmol/d level may well
Reply to John Heesakkers and Fawzy Farag's Letter to the Editor re: Jürgen Pannek: Mozart, the Brain, and the Bladder: Clinical Usefulness of Near-Infrared Spectroscopy for the Detection of Detrusor Overactivity. Eur Urol 2011;59:763–4
Authors: Jürgen Pannek
Journal: European Urology (2011)
Gamma-interferon inhibits collagen synthesis in vivo in the mouse.
Authors: R D Granstein, G F Murphy, R J Margolis, M H Byrne, E P Amento
Journal: Journal of Clinical Investigation (1987)

Subcutaneous implantation of osmotic pumps into CAF1 mice resulted in the formation of thick fibrous capsules around the pumps. When pumps were loaded with recombinant murine gamma-interferon (rMuIFN-gamma) to deliver 2 X 10(3) U/h for 14 d, there was a marked decrease in thickness and collagen content of the capsules from rMuIFN-gamma-treated animals compared with capsules from animals receiving diluent alone. The collagen content of the capsules was estimated by hydroxyproline analysis of the tissue and by quantitative electron microscopy of collagen bundles. Heat-inactivated rMuIFN-gamma failed to reduce the fibrotic response in this assay. These results provide compelling evidence that gamma-interferon can down-regulate collagen synthesis in vivo and suggest the possibility that this lymphokine may be useful in the treatment of disease states characterized by excessive fibrosis.
Polymeric photosensitizer-embedded self-expanding metal stent for repeatable endoscopic photodynamic therapy of cholangiocarcinoma
Authors: Byoung-chan Bae, Su-Geun Yang, Seok Jeong, Don Haeng Lee, Kun Na, Joon Mee Kim, Guido Costamagna, Richard A. Kozarek, Hiroyuki Isayama, Jacques Deviere, Dong Wan Seo, D. Nageshwar Reddy
Journal: Biomaterials (2014)
Currency conversion is not only issue in effectiveness studies
Authors: L. E Basskin
Journal: BMJ (2002)

EDITOR—Gosden and Torgerson mention that currency conversions make the use of foreign pharmacoeconomic analyses of questionable value.1 I agree that currency conversion is a difficult task, particularly when the euro to dollar exchange rate has gone from 1:0.80 to 1:1.08 in less than two years. But the problem of external validity or usefulness in other settings goes far beyond currency conversion issues.

Even in the same country, published analyses tend to be of little value because the underlying prices or costs of the …
Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study.(Clinical report)
Authors: Katherine L. O'brien, Orin S. Levine, Cynthia G. Whitney, Tamar Pilishvili, Monica M. Farley, William Schoffner, Allen S. Craig, Ruth Lynfield, Ann-Christine Nyquist, Kenneth A. Gershman, Marietta Vazquez, Nancy M. Bennett, Arthur Reingold, Ann Thomas, Mary P. Glode, Elizabeth R. Zell, James H. Jorgensen, Bernard Beall, Anne Schuchat
Journal: The Lancet (2006)
Antigenic modulation of Friend virus erythroleukemic cells in vitro by serum from mice with dormant erythroleukemia.
Authors: E V Genovesi, P A Marx, E F Wheelock
Journal: The Journal of Experimental Medicine (1977)

Friend leukemia virus (FLV) erythroleukemic cells cultured in medium containing FLV-immune serum from dormant FLV-infected mice undergo modulation of FLV cell surface antigens. Modulation was determined by an increased resistance to FLV antibody-mediated complement-dependent lysis and was associated temporally with the capping of FLV-immune complexes at the cell surface. Modulated cells regained their susceptibility to FLV antibody-mediated complement-dependent lysis when transferred to medium containing normal mouse serum. After 48 h of culture in FLV-immune serum, 26% of the FLV erythroleukemic cells were devoid of FLV cell surface antigens as demonstrated by immunofluoresence. Antigenic modulation occurred to a greater extent in cells maintained in logarithmic growth than in cells in GO or resting phase. FLV-antigenic modulation is discussed as a possible mechanism by which antibody induces and maintains FLV-transformed cells in a dormant state.
Kallistatin, a new and reliable biomarker for the diagnosis of liver cirrhosis
Authors: Zhiyun Cheng, Yinghui Lv, Suqiu Pang, Ruyu Bai, Mingxi Wang, Shuyu Lin, Tianwen Xu, Duncan Spalding, Nagy Habib, Ruian Xu
Journal: Acta Pharmaceutica Sinica B (2015)

Kallistatin, which protects organs and cells against inflammation, fibrosis and oxidative stress, is mainly synthesized and secreted in liver. However, its relationship to human liver disease remains unclear. The purpose of this study was to explore the relationship between serum kallistatin and clinical evidence of both cirrhosis and hepatocellular carcinoma (HCC), and to determine if serum kallistatin levels could be used as a diagnostic indicator of hepatic health status, especially human liver cirrhosis (LC). Our cohort consisted of 115 patients with clinically proven liver fibrosis (LF), LC, or HCC by liver biopsies, and 31 healthy controls (CON). Serum kallistatin levels were quantified by ELISA. Results of the present study demonstrated that irrespective of the underlying etiology, serum kallistatin levels were significantly lower in the LF/LC group when compared with the CON group. A decrease in serum kallistatin levels appeared to reflect the extent of cirrhosis, with the lowest levels associated with higher grades of cirrhosis. Patients with LC had a noticeable correlation between serum kallistatin levels and other serum biochemical indicators. The area under the curve (AUC) for LC, viral liver cirrhosis (VLC) and alcoholic liver cirrhosis (ALC) was 0.845, 0.757 and 0.931, respectively. In conclusion, our findings demonstrated that kallistatin, a plasma protein produced by the liver, can be a useful and reliable diagnostic indicator of hepatic health status, especially for LC.
Analysis of Endocrine Disruption in Southern California Coastal Fish Using an Aquatic Multispecies Microarray
Authors: Michael E. Baker, Barbara Ruggeri, L. James Sprague, Colleen Eckhardt-Ludka, Jennifer Lapira, Ivan Wick, Laura Soverchia, Massimo Ubaldi, Alberta Maria Polzonetti-Magni, Doris Vidal-Dorsch, Steven Bay, Joseph R. Gully, Jesus A. Reyes, Kevin M. Kelley, Daniel Schlenk, Ellen C. Breen, Roman Šášik, Gary Hardiman
Journal: Environmental Health Perspectives (2008)

Endocrine disruptors include plasticizers, pesticides, detergents, and pharmaceuticals. Turbot and other flatfish are used to characterize the presence of chemicals in the marine environment. Unfortunately, there are relatively few genes of turbot and other flatfish in GenBank, which limits the use of molecular tools such as microarrays and quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) to study disruption of endocrine responses in sentinel fish captured by regulatory agencies.We fabricated a multigene cross-species microarray as a diagnostic tool to screen the effects of environmental chemicals in fish, for which there is minimal genomic information. The array included genes that are involved in the actions of adrenal and sex steroids, thyroid hormone, and xenobiotic responses. This microarray will provide a sensitive tool for screening for the presence of chemicals with adverse effects on endocrine responses in coastal fish species.We used a custom multispecies microarray to study gene expression in wild hornyhead turbot (Pleuronichthys verticalis) collected from polluted and clean coastal waters and in laboratory male zebrafish (Danio rerio) after exposure to estradiol and 4-nonylphenol. We measured gene-specific expression in turbot liver by qRT-PCR and correlated it to microarray data.Microarray and qRT-PCR analyses of livers from turbot collected from polluted areas revealed altered gene expression profiles compared with those from nonaffected areas.The agreement between the array data and qRT-PCR analyses validates this multispecies microarray. The microarray measurement of gene expression in zebrafish, which are phylogenetically distant from turbot, indicates that this multispecies microarray will be useful for measuring endocrine responses in other fish.
Inhibition of nitric oxide synthesis protects the isolated working rabbit heart from ischaemia-reperfusion injury
Authors: R. Schulz, R. Wambolt
Journal: Cardiovascular Research (1995)

Nitric oxide (NO) exerts both protective and detrimental actions in a variety of biological systems. During acute reperfusion following myocardial ischaemia, a rapid overproduction of free radicals, including NO, may occur. We investigated the effects of the NO synthase inhibitors NG-nitro-L-arginine methyl ester (L-NAME) and NG-monomethyl-L-arginine (L-NMMA), and the substrate for NO synthesis, L-arginine, on heart function during ischaemia and reperfusion injury.Spontaneously beating, isolated working rabbit hearts, perfused with modified Krebs-Henseleit buffer containing 1.2 mM palmitate bound to 3% bovine serum albumin, were subjected to 15 min of aerobic perfusion followed by 35 min of global, no-flow ischaemia and 30 min of aerobic reperfusion.Throughout the reperfusion period there was a marked impairment in the recovery of mechanical function, measured as the product of heart rate x peak systolic pressure (rate-pressure product). Addition of L-NAME (3 microM) prior to the onset of ischaemia, but not at reperfusion, caused an immediate and significant increase in the recovery of mechanical function throughout the reperfusion period. The protective action of L-NAME was abolished by L- (but not D-) arginine (100 microM). L-NAME did not cause ischaemia as it did not alter glycogen or lactate content of aerobically perfused hearts. Furthermore, it did not prevent glycogen loss or lactate accumulation during 35 min of ischaemia, suggesting that the effects of L-NAME were not due to metabolic alterations during ischaemia itself. L-NMMA (30 microM) added prior to ischaemia, but not at reperfusion, also had a protective effect which was seen later in the reperfusion period. Addition of L- (but not D-) arginine (100 microM) prior to the onset of ischaemia resulted in an improved recovery of mechanical function only at 15 min of reperfusion.These results suggest that: (1) the recovery of mechanical function of hearts subjected to ischaemia-reperfusion injury can be improved by modulation of myocardial NO synthesis, (2) inhibition of NO synthesis (with L-NAME or L-NMMA) may offer prolonged protection whereas its stimulation (with L-arginine) provides only brief protection, and (3) the reasons for the pharmacological effectiveness of these divergent strategies may be due to the formation of peroxynitrite from NO and superoxide anion during reperfusion.
A 41 year old man with an itchy rash
Authors: R. Salgo, W.-H. Boehncke
Journal: BMJ (2011)

A 41 year old man presented with a widespread rash that had been recurrently itchy and uncomfortable for 20 years. He also had stiff and painful fingers, mainly during the morning and most pronounced towards the fingertips; these symptoms had got worse over the past few months.

On examination, he showed disseminated, sharply demarcated, red, scaly plaques; these were accentuated over his elbows, knees, and trunk (fig 1⇓). He was 166 cm tall, weighed 98 kg, and had been obese since adolescence. He had been taking zuclopenthixol because of depression for the past five years, had smoked one pack of cigarettes a day for many years, and had a daily alcohol intake of 1-2 L of beer. He had no other relevant medical history.





### 1 What is your diagnosis regarding the patient‘s skin disease?

#### Short answer

The patient has plaque-type psoriasis.

#### Long answer

Psoriasis is a chronic recurrent immune mediated inflammatory skin disease with a prevalence of 2-3% in Europe and northern America.1

Several different types exist. The most common manifestation, plaque-type psoriasis, is characterised by sharply demarcated red plaques covered by silvery scaling (fig 2⇓). Lesions are typically located at the knees, elbows, lower back, and head but may at times affect the whole body surface. Children often develop rashes consisting of small red papules on the trunk, known as guttate psoriasis (fig 3⇓), which may be triggered by …
Time to publication of studies was not affected by whether results were positive
Authors: M. L Callaham, E. Weber, G. Young, R. Wears, C. Barton
Journal: BMJ (1998)

Education and debate p 1519

EDITOR—The time to publication measured by Stern and Simes began with approval of the project by the ethics committee; thus the interval embraced all phases of research and analysis.1 This interval differs from that used by several other ethics committees cited 2 3 and in most previous reports of time to publication, which have begun with an analysis of completed data, not approval by the ethics committee.4



Relation of effect size ratio of studied treatment to speed …
Didanosine Resistance in HIV-infected Patients Switched from Zidovudine to Didanosine Monotherapy
Authors: Michael J. Kozal
Journal: Annals of Internal Medicine (1994)

Objective: To determine the frequency and pattern of development of specific drug resistance mutations for human immunodeficiency virus (HIV) reverse transcriptase in patients switched from zidovudine to didanosine therapy and to examine the relation of the didanosine resistance mutation at codon 74 of the HIV reverse-transcriptase gene to CD4+ T-cell changes and virus burden. Design: Retrospective analysis of all patients enrolled at Stanford University in protocols where patients were switched from zidovudine to didanosine monotherapy. Setting: A university hospital. Patients: 64 patients infected with HIV who were switched from zidovudine to didanosine monotherapy. Patients had the acquired immunodeficiency syndrome (AIDS), AIDS-related complex, or were asymptomatic (mean [±SD] starting CD4+ T-cell count of 129 ±88 cells/mm3). Measurements: Serial serum specimens were tested for the didanosine resistance mutation at codon 74 of the HIV reverse-transcriptase gene and for a zidovudine resistance mutation at codon 215 using selective polymerase chain reactions (PCR). Serum HIV RNA levels were determined by quantitative PCR. CD4+ T-cell counts were determined at serial time points. Results: By 24 weeks of didanosine therapy, the proportion of patients with the didanosine resistance mutation at codon 74 increased from 0% to 56% (36 of 64). In contrast, the proportion of patients with the zidovudine resistance mutation at codon 215 decreased from 84% at the start to 59% after 24 weeks of didanosine therapy (a 25% decrease, 95% lower CI, 15%; P < 0.0001). Patients who developed the codon 74 mutation had a greater decrease in CD4+ T cells after the development of the mutation than did patients without the mutation (P < 0.001). In addition, after 24 weeks of didanosine, patients who developed the codon 74 mutation had a greater serum HIV RNA burden than patients who remained wild type (did not have the mutation) at codon 74 (225 000 compared with 82 400 HIV RNA copies/mL serum; P = 0.01). Conclusions: Among patients infected with HIV who had advanced disease and were switched from zidovudine to didanosine therapy, more than one half developed the didanosine resistance mutation at codon 74 by 24 weeks of didanosine therapy. Patients who developed the codon 74 mutation had a greater decline in CD4+ T cells after the development of the mutation and had a greater serum virus burden than did patients without the codon 74 mutation.
Respiratory Virus Infections in Hospital and in General Practice, 1954-6
Authors: N. R. Grist, R. G. Sommerville
Journal: BMJ (1957)

In continuation of previous laboratory studies of respira- tory illness, tests for a wider range of virus infections were made in a series of patients admitted to hospital and also in cases of milder illness seen in general prac- tice during the winter seasons of 1954-5 and 1955-6.This paper presents evidence of infections with influenza viruses of types A, B, and C, an agent related to the Sendai strain of newborn pneumonitis virus (" influenza D," Jensen et al., 1955), and the adenovirus group (Rowe et al., 1953). MethodsThe population investigated included 167 patients admitted to pneumonia wards of Ruchill Hospital from July, 1954, to April, 1955, 70 admitted to baby pneumonia wards from November, 1954, to May, 1955, and 98 adults and 44 children under 2 years old admitted to these wards from November, 1955, to April, 1956, inclusive.Tests were also conducted in 105 cases of suspected influenza seen in general practice from December, 1954, to April, 1955, and in 92 similar cases seen in the corresponding five months a year later in the course of schemes for the detection of influenza in the com- munity during vaccine trials of the Medical Research Council (M.R.C.Committee, 1955).A number of additional cases were examined in the course of investigations of outbreaks of respiratory illness.Serum samples were taken during the early and late stages of illness.Garglings for attempted virus isolation were collected with autoclaved skimmed milk or saline with added broth.During the 1955-6 season, respiratory secretions of infants were collected from the nose or throat by sterile cotton-tipped swabs which were sub- sequently extracted each in a few millilitres of broth for one hour at 370 C.In general, the cultural and serological techniques were those described in previous papers (Grist, 1955; Grist and Landsman, 1955).For attempted virus isolation, embryonated eggs were inoculated by the amniotic route; at least two passages were made before specimens were regarded as negative.Sera were examined by small-volume complement-fixation (C.F.) tests and by haemagglutination-inhibition (H.I.) tests.Soluble antigens were used in C.F. tests for influenza A and B; in some experiments soluble antigens prepared from locally isolated strains of virus were used.A fixation period of 90 minutes at 370 C. was employed with adult sera, but with sera from infants the cold overnight method was used.Antigens from several of the following strains of virus were used for H.I. tests: PR8 (type A), A/Scotland/1/53, A/Scot- land/26/54, A/Scotland/31/56, Lee (type B), B/England/52, B/Scotland/28/55, and the 1233 strain of type C virus (Taylor, 1949).The Sendai strain of newborn pneumonitis virus was received from the World Influenza Centre of the World Health Organization.Allantoic-fluid antigens of this virus were used in C.F. and H.I. tests; positive and negative control sera for C.F. tests were received from the Virus
Rescreening of Persons With a Negative Colonoscopy Result: Results From a Microsimulation Model
Authors: Amy B. Knudsen, Chin Hur, G. Scott Gazelle, Deborah Schrag, Elizabeth G. McFarland, Karen M. Kuntz
Journal: Annals of Internal Medicine (2012)

Background: Persons with a negative result on screening colonoscopy are recommended to repeat the procedure in 10 years. Objective: To assess the effectiveness and costs of colonoscopy versus other rescreening strategies after an initial negative colonoscopy result. Design: Microsimulation model. Data Sources: Literature and data from the Surveillance, Epidemiology, and End Results program. Target Population: Persons aged 50 years who had no adenomas or cancer detected on screening colonoscopy. Time Horizon: Lifetime. Perspective: Societal. Intervention: No further screening or rescreening starting at age 60 years with colonoscopy every 10 years, annual highly sensitive guaiac fecal occult blood testing (HSFOBT), annual fecal immunochemical testing (FIT), or computed tomographic colonography (CTC) every 5 years. Outcome Measures: Lifetime cases of colorectal cancer, life expectancy, and lifetime costs per 1000 persons, assuming either perfect or imperfect adherence. Results of Base-Case Analysis: Rescreening with any method substantially reduced the risk for colorectal cancer compared with no further screening (range, 7.7 to 12.6 lifetime cases per 1000 persons [perfect adherence] and 17.7 to 20.9 lifetime cases per 1000 persons [imperfect adherence] vs. 31.3 lifetime cases per 1000 persons with no further screening). In both adherence scenarios, the differences in life-years across rescreening strategies were small (range, 30 893 to 30 902 life-years per 1000 persons [perfect adherence] vs. 30 865 to 30 869 life-years per 1000 persons [imperfect adherence]). Rescreening with HSFOBT, FIT, or CTC had fewer complications and was less costly than continuing colonoscopy. Results of Sensitivity Analysis: Results were sensitive to test-specific adherence rates. Limitation: Data on adherence to rescreening were limited. Conclusion: Compared with the currently recommended strategy of continuing colonoscopy every 10 years after an initial negative examination, rescreening at age 60 years with annual HSFOBT, annual FIT, or CTC every 5 years provides approximately the same benefit in life-years with fewer complications at a lower cost. Therefore, it is reasonable to use other methods to rescreen persons with negative colonoscopy results. Primary Funding Source: National Cancer Institute.
ACUTE PERFORATION OF THE GALL BLADDER: WITH AN ACCOUNT OF SIX CASES
Authors: L. R. Braithwaite
Journal: BMJ (1913)

1913, his red corpuscles numbered 3,900,000 per cubic millimetre, the haemoglobin equalled 86 per cent., and the colour index was 1.1.This is one of the most successful cases I have had.CASE XI.