tbuckley/cabot-search huggingface dataset:
Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients
Authors: R J Dockhorn
Journal: Thorax (2000)

<h3>BACKGROUND</h3> Montelukast, a leukotriene receptor antagonist, improves parameters of asthma control including forced expiratory volume in one second (FEV<sub>1</sub>) when given orally to patients aged six years or older. This study was undertaken to compare the effect on FEV<sub>1</sub> of intravenous and oral montelukast and placebo during the 24 hour period following administration. <h3>METHODS</h3> Fifty one asthmatic patients (FEV<sub>1</sub> 40–80% predicted and<i>⩾</i>15% improvement after inhaled β agonist) were enrolled in a double blind, single dose, three period, crossover study to receive intravenous montelukast (7 mg), oral montelukast (10 mg), or placebo in a randomised fashion. The primary end point was area under the curve (AUC)<sub>0–24 h</sub> of the percentage change from baseline in FEV<sub>1</sub>. Additional end points were maximum percentage change in FEV<sub>1</sub> and percentage change at different time points. <h3>RESULTS</h3> Compared with placebo, intravenous and oral montelukast significantly increased the AUC<sub>0–24 h</sub> (means of 20.70%, 15.72%, and 7.75% for intravenous, oral and placebo, respectively; no statistical difference between intravenous and oral). The difference in least square means from placebo for intravenous montelukast was 13.27% (95% CI 7.07 to 19.46), p&lt;0.001 and for oral montelukast was 7.44% (95% CI 1.20 to 13.68), p = 0.020. The maximum percentage change in FEV<sub>1</sub>was not significantly different for intravenous and oral montelukast (difference in least square means 6.78% (95% CI –0.59 to 14.15), p = 0.071). The mean percentage change in FEV<sub>1</sub> for intravenous montelukast was greater than for oral montelukast within the first hour (15.02% vs 4.67% at 15 min, p⩽0.001; 18.43% vs 12.90% at one hour, p&lt;0.001 for intravenous and oral montelukast, respectively (placebo 3.05% at 15 minutes, 7.33% at one hour). Intravenous and oral montelukast were similar to placebo in the frequency of adverse events. <h3>CONCLUSIONS</h3> The onset of action for intravenous montelukast was faster than for oral montelukast and the improvement in airway function lasted over the 24 hour observation period for both treatments. Although not well understood, there was a trend toward a greater improvement in FEV<sub>1</sub> with intravenous than with oral montelukast. These findings suggest that leukotriene receptor antagonists should be investigated as a treatment for acute severe asthma.
Standards are needed for quality of life clinical trials
Authors: A. Bottomley
Journal: BMJ (2002)

EDITOR—Jefferson and Demicheli say that health economics studies must come under a high level of scrutiny.1 There are parallels with the field of quality of life in clinical trials, and it is equally important that the BMJ considers developing guidelines concerning this for authors and peer reviewers.

An increasing number of clinical trials assessing quality of life are being …
Epileptics and Contact Sports
Authors: Richard W. Corbitt
Journal: JAMA (1974)

It is logical that anyone with seizures should not subject himself to repetitive head trauma. Unfortunately, when considering the issue of contact sports for epileptics, there is little more to go on than this apparent logic. Most physicians, in addition to regular anticonvulsive therapy, empirically recommend rest, good food, and physical and mental activity; also, they urge parents and associates to treat the patient as normally as possible. On the basis of such recommendations, the Committee on the Medical Aspects of Sports took the position in 1968 that, after a thorough medical evaluation and after medical control of the seizure disorder had been established, young people with convulsive disorders could participate in sports. The Committee, at that time, had taken the position that contact sports such as boxing, tackle football, ice hockey, diving, soccer, rugby, lacrosse, and other sports involving chronic recurring head trauma should be avoided. This advice was
Hewitt accuses some Muslim GPs of betraying confidentiality
Authors: Michael Day
Journal: BMJ (2007)

s health secretary, has said that some Muslim GPs may be divulging details of the sexual health of female Muslim patients to family members.Her comments drew an angry response from Muslim GPs, who said that her claims were based only on anecdotal evidence.However, Mrs Hewitt, who represents a constituency in Leicester with a large ethnic minority community, said, "I have had Muslim women give me chapter and verse on very distressing breaches of confidentiality by Muslim GPs."Some women patients in some Muslim communities are feeling they can't trust their own GP, who is from the same community and knows their extended family."If they go for particular situations, such as a sexual health problem or domestic violence, they fear they will share that information with other members of the family or community."Mrs Hewitt made her comments in an interview with the magazine for GPs Pulse (29 Mar, p 2).Vijoy Singh, chairman of the Leicestershire and Rutland local medical committee, which covers Ms Hewitt's constituency, said, "No GP would break confidentiality, because if they break it they are liable to be sued.She's out of touch."Mrs Hewitt cited a report published in November last year by the Muslim Women's Network, which was based on conversations with Muslim women throughout the country, as further evidence of her concerns.The report, She Who Disputes (www.thewnc.org.uk/pubs/shewhodisputesnov06.pdf),noted: "Health services were criticised for being insensitive and there was repeated concern that GPs from within the community could not be trusted to maintain patient confidentiality." Hewitt says some Muslim GPs breach confidentialityUK NEWS Safety agency prioritises better use of anticoagulants, p714 World NEWS drugs are as goo�� as ���� in stable coronary artery ��isease, stu��y s�o�s, p71� drugs are as goo�� as ���� in stable coronary artery ��isease, stu��y s�o�s, p71� , p71� bmj.com o�for�� ra��cliffe �ospitals tol�� to impro�e team�or� o�for�� ra��cliffe �ospitals tol�� to impro�e team�or�
Annulus Paradoxus
Authors: Jong-Won Ha, Jae K. Oh, Lieng H. Ling, Rick A. Nishimura, James B. Seward, A. Jamil Tajik
Journal: Circulation (2001)

Background The early diastolic velocity of the mitral annulus (E′) is reduced in patients with diastolic dysfunction and increased filling pressures. Because transmitral inflow early velocity (E) increases progressively with higher filling pressures, E/E′ has been shown to have a strong positive relationship with pulmonary capillary wedge pressure (PCWP) and left ventricular end-diastolic pressure. However, previous studies have primarily involved patients without a pericardial abnormality. In constrictive pericarditis (CP), E′ is not reduced, despite increased filling pressures. This study evaluated the relationship between E/E′ and PCWP in patients with CP. Methods and Results We studied 10 patients (8 men; mean age, 64±7 years) with surgically confirmed CP. Doppler echocardiography was performed to measure early and late diastolic transmitral flow velocities. Tissue Doppler echocardiography was performed to measure E′. PCWP was measured with right heart catheterization. All patients were in sinus rhythm. Mean E and E′ were 91±15 cm/s and 11±4 cm/s, respectively. Mean PCWP was 25±6 mm Hg. E′ was positively correlated with PCWP ( r =0.69, P =0.027). There was a significant inverse correlation between E/E′ and PCWP ( r =−0.74, P =0.014). Despite high left ventricular filling pressures, E/E′ (mean, 9±4) was &lt;15 in all but 1 patient. Conclusions Paradoxical to the positive correlation between E/E′ and PCWP in patients with myocardial disease, an inverse relationship was found in patients with CP.
Thermal Value of Food
Authors: W. H. O'Leary
Journal: BMJ (1868)

ril ajumes that the cholera poion is always swallowed, and never in- halMed; but I would ask Mr. Simon, and those who agree with him, to refer to any analogous poison remaining in contact with the alimentary canal, without entenng the blood as an essential condition ofits poisonous operation, and giving inse to analogous symptoms by a merely nervous m-pathy.Mr. Simon does not deny that the blood is poisoned during cholera.In proof that it is so poisoned, he refers to numerous recorded cases in which the intrauterine offspring has been killed by the cholera ison conveyed to it, as Mr. Simon admits, through the maternal lood, and exciting the characteristic rice-water discharges into the ali- mentary canal.But he asks, " Is there any reason to suppose that the cholera contagium in the mother's blood was not a secondary product of disease-was not let into her circulation from the ferment-seething interior of her bowels ?"I would ask, Is there any reason to suppose that there exists such an essential difference between the pnrmary poison which conveys the disease to the mother, and the secondary product which imparts the same disease to her offspring, that, while one is ab- solutely excluded from the maternal circulation, the other is freely ad- mitted?But the difficulty does not end here.It is manifest that, be- fore the poison can act upon the alimentary canal of the foetus, not only must it have entered the blood of the mother, but it must also have passed through the circulation of her offspring.If it were true, as Mr. Simon believes, that " cholera begins as a bowel-disease, producible b direct contagion, without even the passive intervention of the blood, then the foetns in utero would be absolutely safe from the operation of the poison, which could not, under the assumed conditions, be brought into contact with its alimentary canal.As the intrauterine offspning
Ethics, audit, and research: all shades of grey
Authors: Derick T Wade
Journal: BMJ (2005)

Decisions about the need for ethical review should be based on the morality of all actions rather than arbitrary distinctions between audit and research

Ethical considerations should apply to all medical practice, but many people act as if they apply only to research. For example, all research studies have to be scrutinised by an ethics committee (institutional review board in the United States), but most ethics committees specifically exclude audit studies from their remit. Similarly, journal editors and funding agencies will require evidence of ethical review before accepting research for publication or funding but do not require this for audit studies. Consequently, the distinction between audit and research can have important implications, and the temptation to label research as audit is considerable.1 Unfortunately, the distinction is at best difficult. This article reviews the distinction between audit and research, and the nature of ethics.

Research and audit have many similarities. They both start with a question, both expect the answer to change or influence clinical practice, both require formal data collection on patients, and both depend on using an appropriate method and design to reach sound conclusions. The standards expected of audit in terms of design, data collection, and analysis should be at least as high as for research, if only because audit potentially leads to change more often than research does and often much greater change. It is also clear that both audit and research differ from normal clinical practice because clinical practice rarely achieves a high standard of data collection and analysis.

The major bureaucratic distinction drawn between audit and research is that research investigates what should be done, whereas audit investigates whether it is being done (and if not, why not).2 Guidance on making the distinction between audit and research is available,3 4 but the …
Novel Soy Germ Pasta Enriched in Isoflavones Ameliorates Gastroparesis in Type 2 Diabetes
Authors: Kenneth D.R. Setchell, Elisabetta Nardi, Pier-Maria Battezzati, Stefania Asciutti, Danilo Castellani, Gabriele Perriello, Carlo Clerici
Journal: Diabetes Care (2013)

To determine the effect of soy germ pasta enriched in biologically active isoflavone aglycons on gastric emptying in type 2 diabetic patients with gastroparesis.
Thoracic veins and the mechanisms of non-paroxysmal atrial fibrillation
Authors: P Chen
Journal: Cardiovascular Research (2002)

Objective: The purpose of this article is to review the importance of thoracic veins in the maintenance of sustained (non-paroxysmal) atrial fibrillation (AF).Methods: Thoracic veins, including the pulmonary veins (PVs), vein of Marshall (VOM) and the superior vena cava (SVC), have muscle sleeves that connect to the atria.It is well known that electrical activities can be recorded within these venous structures.In some incidences, these thoracic veins may serve as the trigger and / or the substrate for paroxysmal AF.The importance of thoracic veins in chronic (sustained) AF is less well appreciated.Therefore, we review the literature to determine if thoracic veins are important in the maintenance of sustained AF.Results: Our recent study demonstrated that repetitive rapid electrical activities are present in the PVs and in the VOM during pacing-induced sustained AF in dogs.Because of these repetitive rapid activities, these thoracic veins have shorter activation cycle lengths than that of the left atrium, which, in turn, has shorter cycle lengths than that of the right atrium.Others have demonstrated that PV isolation in humans can result in a cure of sustained human AF in .80% of patients undergoing concomitant surgery.Conclusion: These findings suggest that repetitive rapid activities within the thoracic veins may be responsible for the maintenance of non-paroxysmal (sustained) AF.
The Cerebrovascular Accident and Coronary Occlusion in Anesthesia
Authors: Richard B. Knapp
Journal: JAMA (1962)

A study was made to estimate the anesthetic risk in a patient with a previous coronary occlusion or cerebrovascular accident and to answer the question, "How long should one wait following an occlusion before elective surgery could be performed with reasonable safety?" A group of 8,984 male surgical patients over 50 years of age were evaluated for preoperative coronary occlusions and cerebrovascular accidents, and for postoperative recurrences. Of the 427 patients with preoperative coronary occlusions, 26 suffered a postoperative occlusion, with a mortality of 15. Of the 8,557 patients with no preoperative occlusion, 59 suffered postoperative complications and 11 died. The incidence of recurrence of a coronary occlusion following surgery is definitely diminished if the occlusion has occurred 2 years or more before surgery, and is no higher than in the population with no preoperative coronary occlusion.
Comparison of Neuropathy-Inducing Effects of Eribulin Mesylate, Paclitaxel, and Ixabepilone in Mice
Authors: Krystyna M. Wozniak, Kenichi Nomoto, Rena G. Lapidus, Ying Wu, Valentina Carozzi, Guido Cavaletti, Kazuhiro Hayakawa, Satoru Hosokawa, Murray J. Towle, Bruce A. Littlefield, Barbara S. Slusher
Journal: Cancer Research (2011)

Chemotherapy-induced neurotoxicity is a significant problem associated with successful treatment of many cancers. Tubulin is a well-established target of antineoplastic therapy; however, tubulin-targeting agents, such as paclitaxel and the newer epothilones, induce significant neurotoxicity. Eribulin mesylate, a novel microtubule-targeting analogue of the marine natural product halichondrin B, has recently shown antineoplastic activity, with relatively low incidence and severity of neuropathy, in metastatic breast cancer patients. The mechanism of chemotherapy-induced neuropathy is not well understood. One of the main underlying reasons is incomplete characterization of pathology of peripheral nerves from treated subjects, either from patients or preclinically from animals. The current study was conducted to directly compare, in mice, the neuropathy-inducing propensity of three drugs: paclitaxel, ixabepilone, and eribulin mesylate. Because these drugs have different potencies and pharmacokinetics, we compared them on the basis of a maximum tolerated dose (MTD). Effects of each drug on caudal and digital nerve conduction velocity, nerve amplitude, and sciatic nerve and dorsal root ganglion morphology at 0.25 × MTD, 0.5 × MTD, 0.75 × MTD, and MTD were compared. Paclitaxel and ixabepilone, at their respective MTDs, produced significant deficits in caudal nerve conduction velocity, caudal amplitude and digital nerve amplitudes, as well as moderate to severe degenerative pathologic changes in dorsal root ganglia and sciatic nerve. In contrast, eribulin mesylate produced no significant deleterious effects on any nerve conduction parameter measured and caused milder, less frequent effects on morphology. Overall, our findings indicate that eribulin mesylate induces less neuropathy in mice than paclitaxel or ixabepilone at equivalent MTD-based doses.
“Window on the Heart” Technique for Diagnosis of Recent Myocardial Infarction Using Tc-99m Pyrophosphate SPECT Subtraction Imaging
Authors: DOUGLAS HOWARTH, DAMIEN COOTE
Journal: Clinical Nuclear Medicine (1995)

Detection of acute myocardial infarction by SPECT with Tc-99m pyrophosphate is complicated by overlying bony structures, such as the ribs and sternum. The authors report a technique using volume rendered rotating SPECT images with digital subtraction of overlying ribs. The technique is described and illustrated by case reports in which the diagnostic accuracy was improved with its use. This technique has diagnostic use in difficult clinical cases, and where avid radiotracer uptake in the ribs or sternum obscures the underlying myocardium.
Non-addictive psychoactive drug use: Implications for behavioral addiction
Authors: Mark D. Griffiths
Journal: Behavioral and Brain Sciences (2011)

Abstract The newly proposed framework for non-addictive psychoactive substances postulated by Müller &amp; Schumann (M&amp;S) provides an interesting and plausible explanation for non-addictive drug use. However, with specific reference to the relevant behavioral addiction literature, this commentary argues that the model may unexpectedly hold utility not only for non-addictive use of drugs, but also for non-addictive use of other potentially addictive behaviors.
Ambulatory Glucose Profile: Representation of Verified Self-Monitored Blood Glucose Data
Authors: Roger S Mazze, David Lucido, Oded Langer, Klaus Hartmann, David Rodbard
Journal: Diabetes Care (1987)

Sixty-nine individuals with diabetes (23 with type I, 15 with pregestational, and 31 with gestational) used specially modified reflectance meters containing memory chips enabling the instruments to store 440 individual blood glucose values with corresponding time and date. These data were organized into 14-day periods and then collapsed into a graphic depiction, the Ambulatory Glucose Profile (AGP), which was represented as the pattern of the 25th, 50th, and 75th percentiles of blood glucose values. These three curves illustrate the median level of control and provide an index of variability in control at each hour of a “typical day.” We observed distinctive AGPs related to the variability in metabolic control and the type of diabetes. Comparisons between diagnostic groups showed consistent differences between groups, independent of level of glycemic control. Review of serial AGPs obtained for sequential 2-wk periods for 23 non-pregnant individuals with type I diabetes and 10 women with gestational diabetes revealed changes in AGP corresponding to alterations in regimen. The AGP provides a new approach to the evaluation of glycemic control, with applications to patient and physician education, clinical investigation, and individual patient care.
Lipoprotein(a) vascular accumulation in mice. In vivo analysis of the role of lysine binding sites using recombinant adenovirus.
Authors: S D Hughes, X J Lou, S Ighani, J Verstuyft, D J Grainger, R M Lawn, E M Rubin
Journal: Journal of Clinical Investigation (1997)

Although the mechanism by which lipoprotein(a) [Lp(a)] contributes to vascular disease remains unclear, consequences of its binding to the vessel surface are commonly cited in postulated atherogenic pathways. Because of the presence of plasminogen-like lysine binding sites (LBS) in apo(a), fibrin binding has been proposed to play an important role in Lp(a)'s vascular accumulation. Indeed, LBS are known to facilitate Lp(a) fibrin binding in vitro. To examine the importance of apo(a) LBS in Lp(a) vascular accumulation in vivo, we generated three different apo(a) cDNAs: (a) mini apo(a), based on wild-type human apo(a); (b) mini apo(a) containing a naturally occurring LBS defect associated with a point mutation in kringle 4-10; and (c) human- rhesus monkey chimeric mini apo(a), which contains the same LBS defect in the context of several additional changes. Recombinant adenovirus vectors were constructed with the various apo(a) cDNAs and injected into human apoB transgenic mice. At the viral dosage used in these experiments, all three forms of apo(a) were found exclusively within the lipoprotein fractions, and peak Lp(a) plasma levels were nearly identical (approximately 45 mg/dl). In vitro analysis of Lp(a) isolated from the various groups of mice confirmed that putative LBS defective apo(a) yielded Lp(a) unable to bind lysine-Sepharose. Quantitation of in vivo Lp(a) vascular accumulation in mice treated with the various adenovirus vectors revealed significantly less accumulation of both types of LBS defective Lp(a), relative to wild-type Lp(a). These results indicate a correlation between lysine binding properties of Lp(a) and vascular accumulation, supporting the postulated role of apo(a) LBS in this potentially atherogenic characteristic of Lp(a).
Australian health authorities' response criticised after adverse events related to influenza vaccination in children
Authors: M. Sweet
Journal: BMJ (2010)

Australian health authorities failed to respond quickly and appropriately after a spike in febrile convulsions and other adverse events among children given seasonal influenza vaccination, said a review released this week.

The review was conducted by Professor Bryant Stokes, clinical professor of surgery at the University of Western Australia, for the state government of Western Australia, which is the only Australian state to publicly fund flu vaccination of young children and was the site of most of the adverse events reported.

The vaccination programme was introduced in 2008 after the highly publicised deaths of young children from flu and because of concerns that children aged …
European bioethics convention signed
Authors: R. Watson
Journal: BMJ (1997)

Western Europe moved a step nearer to internationally binding legal rules on bioethics last week, when almost a score of countries signed the first ever convention on human rights and biomedicine.

Drafted by the Strasbourg based Council of Europe–which has no connection with the better known European Union–the convention is intended to establish common standards as research continues to expand across national boundaries. These will be translated into domestic legislation by the signatories and will provide for legal sanctions and compensation for people who are damaged after any medical treatment or research.



The interests of people come before those of science or society

BSIP, LECA/SCIENCE PHOTO LIBRARY



The convention, which took almost six years to draft, starts from the premise that the interests of human beings come before those of science or …