tbuckley/cabot-search huggingface dataset:
Prehypertension and chronic kidney disease: the ox or the plow?
Authors: John P. Middleton, Steven D. Crowley
Journal: Kidney International (2012)

Nearly ten years ago, practice recommendations supported use of the clinical classification of 'prehypertension' for people with systolic blood pressure of 120-139 mm Hg or diastolic pressure of 80-89 mm Hg. This recommendation was based on observations that these ranges of blood pressure were associated with enhanced cardiovascular and cerebrovascular risks compared with blood pressure less than 120/80 mm Hg. Recent observations, including the report by Yano and colleagues, also suggest that prehypertension is an important risk factor for the development of chronic kidney disease.
ACUTE PELVIC ABSCESS FOLLOWED BY ACUTE OBSTRUCTION
Authors: E. Leach
Journal: BMJ (1907)

After microscopical examination it was considered to be a retroperitoneal pelvic multilocular cystoma, quite unconnected with the uterus,-ovaries, or tubes, the cysts being lined with a single layer of cylindrical epithelium, with isolated muscle fibres and glands occurring in the wall, such as might arise from remains of the Wolffian body. Cystoma (Pamlhiferous) (Winternitz').Winternitz removed a retroperitoneal pelvic growth, which proved to be .apapillary cystoma, presenting the appearance of an ovarian cyst, although no ova or follicles could be found in its walls.He considered it as originating from some aberrant cells or ova, as there was no reason to infer the presence of a third ovary.
Reliability and validity of a new measure of patient satisfaction with out of hours primary medical care in the united kingdom: development of a patient questionnaire
Authors: R. K McKinley, T. Manku-Scott, A. M Hastings, D. P French, R. Baker
Journal: BMJ (1997)

<h3>Abstract</h3> <b>Objective:</b> To develop a reliable, valid measure of patient satisfaction with out of hours care suitable for large scale service evaluation. <b>Design:</b> Focus group meetings and semistructured interviews with patients to identify issues of importance to patients and possible questionnaire items; interviews and two pilot studies to test and identify new questionnaire items; modification or removal of items to eliminate ambiguity and reduce non-response and skewed responses; questionnaire survey of out of hours care. <b>Setting:</b> Greater Manchester and Leicester. <b>Subjects:</b> 11 general practice patients participated in the focus groups and 28 in the semistructured interviews; 41 in the preliminary interviews; 41 and 378 in the postal pilots; and 1466 in the survey of out of hours care. <b>Results:</b> A 32 item questionnaire was developed. Component analysis indicated seven scales (satisfaction with communication and management, doctor9s attitude, continuity of care, delay until visit, access to out of hours care, initial contact person, telephone advice) related to overall satisfaction and containing issues identified as important to patients. Levels of reliability were satisfactory, Cronbach9s α correlation coefficient exceeding 0.60 for all scales. <b>Conclusion:</b> A reliable, valid measure of patient satisfaction has been developed, suitable for large scale evaluation of out of hours care. <h3>Key messages</h3> The provision of out of hours primary medical care is changing, and these changes need to be evaluated and monitored Patient satisfaction is an important measure of the outcome of health care A reliable and valid measure of patient satisfaction with out of hours primary medical care has been developed Development of such scales is demanding on time and experience but is feasible Ad hoc measures of satisfaction should be avoided and when possible reliable, valid scales used
Ayurveda in ankylosing spondylitis and low back pain
Authors: A Falkenbach
Journal: Annals of the Rheumatic Diseases (2003)

reuil et al reported on a patient with Erdheim-Chester disease. 1 We would like to add our experience in a patient who had a good response to steroids.A 46 year old housewife, born in Maceio (Brazil), complained of pain in her legs for a period of eight months, which interfered with her sleep; there were no constitutional symptoms, such as weight loss, asthenia, or fever.On physical examination, there was no systemic involvement or bone inflammation, except for tenderness on palpation of both tibiae.An x ray examination showed bilateral and symmetrical cortical osteosclerosis of the diaphysial regions of the tibiae, which was better illustrated with magnetic resonance imaging (MRI) which showed a low signal on T 1 and a high signal on T 2 of the medullar canal (fig 1).Bone scintigraphy showed intense hypercapitation at the upper and medial regions of the right tibia and the medial region of the left tibia (fig 2).Other MR images (brain, thorax, and abdomen) were normal.A bone biopsy showed only osteosclerosis, which has been described in this disease. 2 She was treated with steroids for six months (prednisone 20 mg/day) and responded well, being asymptomatic and receiv-ing no treatment since December 2000.As bone pain is the first symptom of this xanthogranulomatosis, rheumatologists should be able to recognise the disease in an early phase when treatment gives a better outcome.. . . .
A Novel Oral Neutrophil Elastase Inhibitor (ONO-6818) Inhibits Human Neutrophil Elastase-induced Emphysema in Rats
Authors: Takashige Kuraki, Masayoshi Ishibashi, Masanori Takayama, Motokimi Shiraishi, Minoru Yoshida
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

We investigated the effects of a novel oral neutrophil elastase inhibitor (ONO-6818) on acute lung injury and pulmonary emphysema induced by human neutrophil elastase (HNE). Young male Wistar rats were divided into four treatment groups: (1) control group (saline); (2) HNE group (HNE 200 U + 0.5% carboxymethyl-cellulose [solution for ONO-6818]); (3) low-dose ONO-6818 group (HNE 200 U + ONO-6818 10 mg/kg); and (4) high-dose ONO-6818 group (HNE 200 U + ONO-6818 100 mg/kg). Saline and HNE were applied via the trachea using a microsprayer. ONO-6818 was administered orally 1 hour before HNE application. Six hours after HNE application, neutrophil counts and hemoglobin concentration in bronchoalveolar lavage fluid and lung tissue myeloperoxidase activity were determined. Eight weeks after the application, FRC, TLC, lung compliance, and mean linear intercept were estimated. ONO-6818 attenuated dose-dependently HNE-induced increases in lung myeloperoxidase activity, hemoglobin, and neutrophil count in bronchoalveolar lavage fluid. Furthermore, it significantly attenuated HNE-induced increases in FRC, TLC, lung compliance, and mean linear intercept. ONO-6818 inhibited acute lung injury induced by HNE by minimizing lung hemorrhage and accumulation of neutrophils in the lung. ONO-6818 also inhibited the development of HNE-induced emphysematous changes including lung hyperinflation, degradation of elastic recoil, and airspace enlargement.
Inpatients in an accident unit.
Authors: P G Stableforth
Journal: BMJ (1976)

A one-year prospective study was undertaken in the 79-bed accident unit of the Bristol Royal Infirmary to define reasons for continuing inpatient care. This showed that, of a consecutive series of 466 patients staying in hospital for over two weeks, 35% lengthened their stay beyond that needed for acute nursing or continued medical care. A combination of factors usually led to total social dependence, the major problem being the absence of a caring relative. Other factors included pre-existing locomotor disorder or mental infirmity, unmanageable incontinence of urine after catheterisation, and institutional disorientation. If the pattern of management of elderly patients after injury is not changed and beds are to be kept available for the newly injured the unit will need about 50 new long-stay beds each year.
The permissible use of placebo
Authors: E. C H Lim, R. C S Seet
Journal: Journal of the Royal Society of Medicine (2007)

Whilst we agree with Professor Ernst that there is scant original research supporting the use of the placebo test (JRSM 2007;100:165),1 we maintain that it is useful. Provocation, cessation or amelioration of seizures2 and movement disorders3 with placebo use is often a diagnostic criterion (amongst others) for psychogenic disease. In addition, placebo therapy has been used to treat psychogenic diseases.3

Our work highlighted the potential diagnostic or therapeutic benefits of placebo use whilst emphasizing the ethical concerns mitigating against its casual use (JRSM 2007;100:60-61),4 but we acknowledge its potentially deceptive nature.1,2 We advocate that physicians managing patients with psychogenic disease practice knowledge framing,4 providing a neurobiological explanation for the disease, including the possibility of a psychological basis for the patients' attacks.2 As doctors are not averse to using placebos5—even while they publicly decry them—we feel that it is timely that we reach a consensus on the acceptability and utility of placebo use.
Hereditary Elliptocytosis: Selected Studies in Genetics and Anemia.
Authors: Stuart R. Bless
Journal: Annals of Internal Medicine (1968)

s1 May 1968Hereditary Elliptocytosis: Selected Studies in Genetics and Anemia.Stuart R. Bless, M.D., Paul R. McCurdy, M.D., F.A.C.P.Stuart R. Bless, M.D.Search for more papers by this author, Paul R. McCurdy, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-68-5-1164_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptBecause of the limited knowledge of the events leading to hyperhemolysis in a small proportion of patients with hereditary elliptocytosis (HE), 19 affected members of 8 negro families were examined, and 10 members of 3 families were studied in detail. Genetic studies, red blood cell (RBC) life-spans, fragility studies, and 8-µ Millipore® filtrations as well as routine hematological procedures were performed. Three other genetic defects were found in one family—glucose 6-phosphate dehydrogenase deficiency, Marfan's syndrome, and sickle trait, all segregating independently. Most patients were mildly anemic. Reticulocyte counts were normal or slightly elevated. A family with probable linkage between HE... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Stuart R. Bless, M.D.; Paul R. McCurdy, M.D., F.A.C.P.Affiliations: Arlington, Virginia, and Washington, D. C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1968Volume 68, Issue 5Page: 1164-1165KeywordsAnemiaDehydrogenasesGeneticsHematology and oncologyMarfan syndromeRed blood cellsReticulocytes ePublished: 1 December 2008 Issue Published: 1 May 1968 PDF downloadLoading ...
Erosion healing in rheumatoid arthritis after anakinra treatment
Authors: R Rau
Journal: Annals of the Rheumatic Diseases (2003)

Disruption of the cortical plate and erosive destruction of the subchondral bone are characteristic features of active rheumatoid arthritis (RA), potentially leading to progressive damage. Until recently, damage progression as documented on radiographs has been regarded as an irreversible process. However, several case reports now indicate that this process may be stopped or even reversed, leading to healing or repair of bone lesions. Under physiological conditions there is a balance between bone resorption by osteoclasts and bone formation by osteoblasts. In a state of active inflammation, bone resorption usually exceeds new bone formation, resulting in bone destruction. However, as soon as the inflammatory process has been stopped in an individual joint, osteoblastic activity may exceed bone resorption, leading to new bone formation and repair. This process is regulated by osteoprotegerin.1,2 Because bone formation takes time, reparative changes can be expected to be clearly visible on radiographs only 6–12 months after distinct clinical improvement occurred. These may present as reappearance of the cortical plate or filling in of erosions. As clinical remission rarely occurs within the timeframe of clinical trials, and as patients experiencing remission outside clinical trials often do not visit their rheumatologist, x ray pictures showing healing phenomena have only occasionally been reported.3–11 Recent clinical trials with tumour necrosis factor α inhibitors12–15 indicate that clinical improvement and halting of radiographic progression occur earlier than with conventional disease modifying antirheumatic drugs (DMARDs). They have also shown a reduction in the radiographic scores in a considerable number of patients, probably indicating repair if measurement error can be excluded. As interleukin 1 (IL1) plays an important part in bone destruction, its inhibition might also result in a preponderance of repair over further destruction in eroded joints.

We wish to demonstrate here an example of healing during …
Restoration of normal reflex responses to orthostatic stress during felodipine therapy in congestive heart failure
Authors: A D TIMMIS, J F KENNY, P SMYTH, S CAMPBELL, S A KERKEZ, D E JEWITT
Journal: Cardiovascular Research (1984)

The mechanisms underlying the abnormal responses to orthostatic stress in congestive heart failure are ill defined and little is known about the effects of specific therapy. In the present study intravascular pressures and plasma noradrenaline levels were measured in nine patients with heart failure subjected to 45 degrees and 90 degrees upright tilt. Studies were repeated during 4 weeks of vasodilator therapy with felodipine and again after felodipine withdrawal. Before the introduction of vasodilator therapy, tilt did not activate orthostatic reflexes despite significant reductions in left ventricular filling pressure and cardiac output. Thus, plasma noradrenaline, heart rate and systemic vascular resistance were unaffected and blood pressure fell. Felodipine resulted in a rapid and sustained improvement in left ventricular function but restoration of orthostatic reflexes was delayed and could be detected only after 48 h therapy. At this time, and during the subsequent 4 weeks, tilt-induced reductions in ventricular filling and cardiac output produced a normal rise in plasma noradrenaline and heart rate. A postural drop in blood pressure, however, was not averted because the direct action of felodipine on vascular smooth muscle prevented adrenergically-mediated increments in systemic vascular resistance. Felodipine withdrawal led to a prompt deterioration in left ventricular function. Orthostatic reflexes, however, were still intact 48 h later when tilt elicited a completely normal pattern of responses. These observations confirm that the abnormal responses to orthostatic stress in congestive heart failure are due principally to impairment of autonomic control mechanisms and are not related to the absence of venous pooling. Importantly the autonomic dysfunction is reversible with felodipine therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
Doctor struck off after vaccines scandal
Authors: Owen Dyer
Journal: BMJ (2006)

A doctor who gave children expired and mishandled vaccines and falsified test results to indicate that patients had been properly immunised has been struck off by the UK General Medical Council.

David Pugh, aged 56 years, was medical director of Lifeline Care, a limited company that provided single dose vaccinations against measles, mumps, and rubella from two private clinics in Elstree and Sheffield. He developed a protocol for handling vaccines, and told his staff to follow it …
Development of a rational practice of therapeutics.
Authors: M D Rawlins
Journal: BMJ (1990)

Unit of Clinical One hundred and fifty years ago most treatments were Pharmacology, developed either from a naive (and often erroneous) Department of view of disease processes and aetiologies or from Pharmacological Sciences,.-Ph.aS s anecdotal observations of the beneficial effects of University of Newcastle upon Tyne, Newcastle particular remedies in individual patients.Treatment upon Tyne NE1 7RU was thus based on a combination of hypothesis and Michael D Rawlins, FFPM, empiricism.professor ofclinical Professional scepticism and public concern about pharmacology the state of therapeutics emerged around the turn of the century and underwent its catharsis in 1909. In
CREB Mediates UTP-Directed Arterial Smooth Muscle Cell Migration and Expression of the Chemotactic Protein Osteopontin via Its Interaction with Activator Protein-1 Sites
Authors: Sandra Jalvy, Marie-Ange Renault, Laetitia Lam Shang Leen, Isabelle Belloc, Annabel Reynaud, Alain-Pierre Gadeau, Claude Desgranges
Journal: Circulation Research (2007)

The transcription factor cAMP responsive element-binding protein (CREB) has been found to be involved in arterial smooth muscle cell (SMC) migration. We previously demonstrated that osteopontin (OPN) expression is a key step for UTP-mediated migration of arterial SMCs and that activator protein (AP)-1, nuclear factor κB, and upstream stimulatory transcription factors are involved in this OPN expression. The present study aims to determine the role of CREB in UTP-induced migration and OPN expression in cultured SMCs. We found that CREB is activated by UTP via extracellular signal-regulated kinase 1/2 and p38 mitogen-activated protein kinase pathways but not by protein kinase A. Both overexpression of a dominant negative CREB and CREB small interfering RNA treatment suppressed UTP-induced OPN expression and SMC migration. Gel-shift and chromatin immunoprecipitation assays revealed that CREB binds 2 AP-1 sites (−1870 and −76) and a cAMP responsive element–like site (−1403) on the OPN promoter. Mutations of these sites showed that only the 2 AP-1 sites were required for UTP-induced OPN expression. Moreover, gel-supershift and sequential chromatin immunoprecipitation assays suggested that CREB was associated with c-Fos on the AP-1 sites of the OPN promoter. These results demonstrate that CREB participates in the induction of UTP-activated OPN expression via its binding to 2 AP-1 sites and is thus involved in UTP-mediated SMC migration.
Manpower imbalance in obstetrics and gynaecology
Authors: T. McFarlane
Journal: BMJ (1983)

<b>Background and aims:</b> Barrier dysfunction is an important feature contributing to inflammation and diarrhoea in Crohn’s disease (CD). Recently, tumour necrosis factor α (TNF-α) antibodies were recognised as effective in steroid refractory CD. The aim of this study was to characterise the effects of this therapy on the epithelial barrier. <b>Patients and methods:</b> Forceps biopsies were obtained from the sigmoid colon before and 14 days after TNF-α antibody therapy in 11 patients treated for chronic active CD (Crohn’s disease activity index &gt;150). Epithelial apoptoses were measured after terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labelling (TUNEL) and 4′,6-diamidino-2-phenylindole staining. Epithelial resistance was determined by alternating current impedance analysis in miniaturised Ussing chambers. Occludin, claudin 1, and claudin 4 expression was quantified in immunoblots. <b>Results:</b> The epithelial apoptotic ratio was 2.1 (0.2)% in controls and increased to 5.3 (1.0)% in CD. TNF-α antibody therapy decreased the apoptotic ratio to 2.9 (1.0)% (normalised in 10 of 11 patients). In parallel, epithelial resistance was lower in CD than in controls (24 (3) <i>v</i> 42 (3) Ω×cm<sup>2</sup>) and improved to 34 (3) Ω×cm<sup>2</sup> after therapy. Occludin, claudin 1, and claudin 4 were not affected by TNF-α antibody therapy. In support of a functional role of epithelial apoptoses in CD, a similar decrease in resistance of −40% was observed when the apoptotic rate was selectively upregulated from 2.6% to 5.4% with camptothecin in HT-29/B6 cells. <b>Conclusions:</b> Epithelial apoptoses were upregulated in the colon in CD and restored to normal in 10 of 11 patients by TNF-α antibody therapy. This is the structural correlate of epithelial barrier dysfunction measured as epithelial resistance while expression of tight junction proteins did not contribute to this therapeutic effect.
Tissue-type plasminogen activator increases the binding of glu-plasminogen to clots.
Authors: C Tran-Thang, E K Kruithof, F Bachmann
Journal: Journal of Clinical Investigation (1984)

Porcine tissue-type plasminogen activator (t-PA) increases the binding of 125I-glu-plasminogen to clots made from human plasma or purified fibrinogen in a time and t-PA concentration dependent fashion. The accumulation of plasminogen was faster and greater on noncrosslinked plasma clots than on clots which had been crosslinked by Factor XIIIa. Furthermore, the uptake of plasminogen to crosslinked fibrin clots occurred at a slower rate in the presence of alpha 2-plasmin inhibitor (alpha 2 PI) than in its absence. The kinetics of the uptake of 125I-plasminogen were analyzed using SDS-polyacrylamide gel electrophoresis and radioautography of solubilized plasma clots formed in the presence of t-PA. During the initial phase there was a decrease of clot-bound glu-plasminogen; simultaneously, there was a slight increase in clot-bound glu-plasmin and in plasmin complexed to alpha 2 PI that was crosslinked to alpha-chain polymers of fibrin. This was followed by a marked increase in clot-bound plasminogen having glutamic acid as NH2-terminal (glu-plasminogen) and gluplasmin. t-PA-induced enhancement of glu-plasminogen uptake appears to be mediated by plasmin but does not require the conversion of glu-plasminogen to plasminogen having lysine or methionine as NH2-terminal. The described mechanism assures an adequate supply of clot-bound plasmin, which is the enzyme ultimately involved in the degradation of fibrin.
Letter: Familial trends in low birth weight.
Authors: M Ounsted
Journal: BMJ (1974)

SIR,-Your leading article (21 September, p. 701) highlights the problems of Negro patients who may have repeated screening tests for sickle-cell disease.Now that the existence of sickle-cell disease in Britain has been recognized and well publicized I feel that the need for screening should be put in the right per- spective on a par with other potentially dangerous problems associated with anaes- thesia and surgery.It is advisable to perform routine screening for haemoglobinopathies on hospital attendance, but should the absence of a sickle-cell test in fit and nonanaemic adults and older children of possible Negro descent be a contraindication to general anaesthesia?This is certainly not the practice anywhere in Africa.The sutgestion that medical cards be carried by these patients is the obvious solution, but logically medical cards should be advisable for most patients and should include not only haemoglobinopathies but other relevant information, such as blood group, drug allergy, therapy with steroids, anticoagulants, etc. for the same reasons as suggesved in the article.
Bronchial Reactivity to Cigarette and Cigar Smoke
Authors: D. G. Robertson, D. A. Warrell, J. S. Newton-Howes, C. M. Fletcher
Journal: BMJ (1969)

The change in specific airway conductance produced by smoking a cigarette under standard conditions was measured in 91 heavy smokers. Subsequently 19 of the most reactive subjects smoked two cigarettes with different filters and another containing cigar tobacco. The results indicated that reactivity to cigarette smoke was reduced significantly by increasing the retention efficiency of the filter and that reactivity to inhaled cigar-tobacco smoke was no less than that to cigarette smoke.