tbuckley/cabot-search huggingface dataset:
Primary Angioplasty Compared with Thrombolysis: New Issues in the Era of Glycoprotein IIb/IIIa Inhibition and Intracoronary Stenting
Authors: C. Michael Gibson
Journal: Annals of Internal Medicine (1999)

The past decade has witnessed a dramatic expansion in the scope of both mechanical and pharmacologic methods for opening occluded arteries in patients with acute myocardial infarction. Although the relative merits of conventional balloon angioplasty and thrombolysis have been evaluated, this old debate is being eclipsed by new comparisons. New device technologies, such as intracoronary stenting; more potent and more fibrin-specific thrombolytic agents; and new antithrombotic and antiplatelet agents all offer the potential for improved outcomes. But despite these recent developments, the time-dependent open artery hypothesis—which states that the achievement of early, full, and sustained reperfusion is associated with better outcomes—remains essentially unchanged. This article reviews data on the ability of six revascularization strategies—stand-alone thrombolysis, conventional percutaneous transluminal coronary angioplasty, stenting, glycoprotein IIb/IIIa inhibitors plus thrombolytic agents, glycoprotein IIb/IIIa inhibitors plus interventions, and the combination of pharmacologic and mechanical interventions—to produce early, full, and sustained reperfusion.
Hemoglobin southampton (Casper): Characterization of the base mutation
Authors: Nicholas H. Heintz, Phillip L. Howard
Journal: American Journal of Hematology (1989)

Abstract Hemoglobin Casper is characterized by the substitution of cytidine for thymidine in condon 106 of the beta globin gene. This substitution results in the creation of a new restriction site for Msp I but not for the isoschizimer Hpa II. The restriction pattern following digestion with Msp I reveals a 9.9‐kb fragment not seen in normal individuals or following digestion of Casper DNA with Hpa II. This finding confirms the predicted base mutation and indicates that the cytidine in the newly acquired CpG site is methylated.
P145 Effect of pulmonary rehabilitation on waist circumference and waist-hip ratio
Authors: K. A. Ingram, R. P. Fowler, A. L. Clark, P. L. Marns, M. S. Patel, S. S. C. Kon, J. L. Canavan, W. D. C. Man
Journal: Thorax (2011)

<h3>Background</h3> Patients with chronic obstructive pulmonary disease (COPD) have increased cardiovascular risk. In selected COPD patients, recent studies have shown that pulmonary rehabilitation (PR) may improve markers of cardiovascular risk, such as arterial stiffness, blood pressure and fasting cholesterol. Waist circumference and waist-hip ratio are related to increased risk of cardiovascular disease, type II diabetes and mortality. We investigated the effect of PR on waist circumference and waist-hip ratio in an unselected population referred for PR. <h3>Methods</h3> 256 consecutive patients (181 COPD; 117F:139M; median age 69; median FEV<sub>1</sub> 49% predicted) completing an eight week outpatient PR programme were analysed. Waist circumference, waist-hip ratio and body mass index (BMI) were measured immediately before and after PR. Wilcoxon signed rank test was used to test the effect of PR. <h3>Results</h3> Following PR, there were significant improvements in incremental shuttle walk (ISW) and chronic respiratory disease questionnaire (CRDQ) score (Abstract P145 table 1). There were very small, but statistically significant, reductions in weight, BMI and waist circumference but no changes in waist-hip ratio. <h3>Conclusions</h3> An 8-week outpatient PR programme has no clinically meaningful effect upon waist circumference or waist-hip ratio.
Functional specialization of gut CD103<b>+</b> dendritic cells in the regulation of tissue-selective T cell homing
Authors: Bengt Johansson-Lindbom, Marcus Svensson, Oliver Pabst, Caroline Palmqvist, Gabriel Marquez, Reinhold Förster, William W. Agace
Journal: The Journal of Experimental Medicine (2005)

Gut-associated lymphoid tissue (GALT) dendritic cells (DCs) display a unique ability to generate CCR9+α4β7+ gut-tropic CD8+ effector T cells. We demonstrate efficient induction of CCR9 and α4β7 on CD8+ T cells in mesenteric lymph nodes (MLNs) after oral but not intraperitoneal (i.p.) antigen administration indicating differential targeting of DCs via the oral route. In vitro, lamina propria (LP)–derived DCs were more potent than MLN or Peyer's patch DCs in their ability to generate CCR9+α4β7+ CD8+ T cells. The integrin α chain CD103 (αE) was expressed on almost all LP DCs, a subset of MLN DCs, but on few splenic DCs. CD103+ MLN DCs were reduced in number in CCR7−/− mice and, although CD8+ T cells proliferated in the MLNs of CCR7−/− mice after i.p. but not oral antigen administration, they failed to express CCR9 and had reduced levels of α4β7. Strikingly, although CD103+ and CD103− MLN DCs were equally potent at inducing CD8+ T cell proliferation and IFN-γ production, only CD103+ DCs were capable of generating gut-tropic CD8+ effector T cells in vitro. Collectively, these results demonstrate a unique function for LP-derived CD103+ MLN DCs in the generation of gut-tropic effector T cells.
Longitudinal study of gall stone prevalence at necropsy.
Authors: T Bates, M Harrison, D Lowe, C Lawson, N Padley
Journal: Gut (1992)

A prospective study of the prevalence of gall stone disease at necropsy in a stable population has been undertaken over a 10 year period up to June 1988. In women, the prevalence of gall stone disease remained static but in men aged 50-59 years it rose from 7% (n = 148) in the first three years to 18% (n = 138) in the last three years (p less than 0.01) and in men aged 60-69 it rose from 12% (n = 370) to 20% (n = 366, p less than 0.01). In the latter age group the female: male ratio fell from 2:1 to 0.8:1. The proportion of deaths from coronary heart disease in men fell slightly in those over 70 during the study period. There was a fall in deaths from coronary heart disease in all age groups in women. Men with gall stones were less likely to have had a cholecystectomy than women, and overall 88% of gall stones remained in situ. In a parallel clinical study, the number of cholecystectomies carried out in the same district fell by 18% over the 10 years without any apparent change in the provision of resources. Cholecystectomy remained almost three times more frequent in women. National data indicate that there have been major changes in the average diet before and during the period of study in favour of reducing coronary heart disease. There has been no change in mortality from coronary heart disease in young men but if the observed increase in the prevalence of gall stones in men and the decrease in deaths from coronary heart disease in women are real phenomena, it seems likely that they are diet related.
What, where, and how “big” is a word?
Authors: Elke Kalbe, Alexander Thiel
Journal: Behavioral and Brain Sciences (1999)

Hebb's theory of cell assemblies is a precursor of the neural network approach used as an implicit hypothesis by most contemporary neuroscientists. Applying this model to language representation leads to demanding predictions about the organization of semantic categories. Other implications of a Hebbian approach to language representation, however, may prove problematic with respect to both neurolinguistic concepts and the results of neuroimaging studies.
Regional Variation of and Association of US Birthplace With Vitiligo Extent
Authors: Jonathan I. Silverberg, Mishal Reja, Nanette B. Silverberg
Journal: JAMA Dermatology (2014)

IMPORTANCE Little is known about population-based risk factors and regional differences for vitiligo.OBJECTIVE To determine the impact of place of birth and residence on vitiligo extent.DESIGN, SETTING, AND PARTICIPANTS A prospective questionnaire-based study using an online questionnaire with 2786 adults (72.2%of whom resided in the United States) with a history of physician-diagnosed vitiligo.EXPOSURES Regions of birth and residence.MAIN OUTCOMES AND MEASURES Body surface area (BSA) of vitiligo lesions.RESULTS Patients with vitiligo who were born outside the United States had lower odds of vitiligo-affected BSA greater than 25%, even after controlling for race/ethnicity, sex, and current age (logistic regression; adjusted odds ratio [aOR], 0.57 [95%CI, 0.46-0.60]).Birthplace in all continents was associated with lower odds of affected BSA greater than 25%than was birthplace in North America. Adults born outside the United States had less affected BSA whether they resided inside (aOR, 0.58 [96%CI, 0.41-0.81]) or outside the United States(aOR, 0.60 [95%CI, 0.48-0.76]). Birthplace and residence at latitudes closer to the equator were associated with lower rates of affected BSA greater than 25%(P .002). The prevalence of affected BSA greater than 25%varied greatly by state of residence (range,27.3%in Maryland to 100% in North Dakota, South Dakota, and Wyoming) (global Moran index = 0.37; P < .001; G statistic = 0.62; P < .001). Spatial regression models that controlled for the regional variation were constructed and confirmed that birthplace outside the United States was associated with lower odds of affected BSA greater than 25%(aOR, 0.61 [95%CI,0.45-0.83]) but not race/ethnicity.CONCLUSIONS AND RELEVANCE There was significant statewide and intercontinental variation for rates of extensive vitiligo. These results suggest that previously unrecognized regional environmental risk factors, especially early in life, play an important role in vitiligo. Additional studies are needed to confirm these early findings and identify such risk factors.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01401374
Barbiturates and fractures
Authors: F. Wells
Journal: BMJ (1977)

sented, with 4 ' overall and none in the 2 pm-10 pm group.This at first sight implies that barbiturates protect against daytime fractures, but this would be ridiculous.Non- barbiturate hypnotics were under-represented in the nocturnal group and over-represented in the day groups with 216 cases (79 %).If the
PTH-120 Coeliac Disease And Double-balloon Enteroscopy: What Can We Achieve? The Experience Of Two European Tertiary Referral Centres
Authors: PD Mooney, C Tomba, F Branchi, DS Sanders, R Sidhu, M Locatelli, D Conte, MT Bardella, L Elli
Journal: Gut (2014)

<h3>Introduction</h3> The indications for and efficacy of device-assisted enteroscopy is not standardised in coeliac disease (CD). We present the largest study to date to evaluate the clinical role of double-balloon enteroscopy (DBE) in complicated CD. <h3>Methods</h3> DBE findings in CD patients with suspected small bowel complications were retrospectively evaluated in two tertiary referral centres (Milan and Sheffield). Demographic data of the studied cohort were compared with a database of 1000 non complicated CD patients. <h3>Results</h3> Findings from 14 oral and seven anal DBE in 19 CD cases (11 males p = 0.003<i> vs</i> control database) were reviewed. Mean age at CD diagnosis (37 ± 19 vs. 27 ± 18) and at small bowel evaluation (49 ± 15 vs. 38 ± 13) was significantly higher in the DBE group compared to controls (p &lt; 0.001). Indications for DBE were the follow up of known refractory coeliac disease (RCD) (#7), suspicion of small bowel complications due to gastrointestinal symptoms (#4), severe iron deficiency anaemia (#6) and long standing poor dietary adherence (#2). All DBE were performed after small bowel capsule endoscopy, except for one case. 3 patients from the known RCD group had evidence of TCRg monoclonality on biopsy (type 2 RCD). One of these patients had jejunal ulceration whilst the other 2 cases had areas with small white raised patches. A further RCD case had evidence of jejunal ulceration however biopsies didn’t show any evidence of TCRg monoclonality. A single RCD case had distally worsening atrophy. Patchy small bowel atrophy was observed in all the non adherent patients and in 2 patients with persistent gastrointestinal symptoms who had only been on a gluten free diet for a short time. Two jejunal adenocarcinomas and an ileal neuroendocrine tumour were detected. All 3 of these patients presented with iron deficiency anaemia. <h3>Conclusion</h3> This is the largest international DBE outcomes study in CD patients. Even minor mucosal lesions seen at DBE may be associated with significant pathology. Evaluation of non-responsive/refractory symptoms by DBE was associated with older patients (p &lt; 0.001) and a higher proportion of males (p = 0.003) than an uncomplicated CD population. Further studies are needed to better understand the clinical relevance of the small bowel endoscopic features and to optimise DBE indications. <h3>Disclosure of Interest</h3> None Declared.
Thallium Imaging of Benign Cardiac Tumor
Authors: RALPH BLUMHARDT, ROBERT J. TELEPAK, MICHAEL F. HARTSHORNE, LIDA A. CROOKS
Journal: Clinical Nuclear Medicine (1983)

BLUMHARDT, RALPH M.D.*; TELEPAK, ROBERT J. LTC MC†; HARTSHORNE, MICHAEL F. MAJ MC†; CROOKS, LIDA A. CPT MC‡ Author Information
Methicillin-Resistant &lt;emph type="ital"&gt;Staphylococcus aureus&lt;/emph&gt; Central Line–Associated Bloodstream Infections in US Intensive Care Units, 1997-2007
Authors: Deron C. Burton
Journal: JAMA (2009)

Concerns about rates of methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections have prompted calls for mandatory screening or reporting in efforts to reduce MRSA infections.To examine trends in the incidence of MRSA central line-associated bloodstream infections (BSIs) in US intensive care units (ICUs).Data reported by hospitals to the Centers for Disease Control and Prevention (CDC) from 1997-2007 were used to calculate pooled mean annual central line-associated BSI incidence rates for 7 types of adult and non-neonatal pediatric ICUs. Percent MRSA was defined as the proportion of S aureus central line-associated BSIs that were MRSA. We used regression modeling to estimate percent changes in central line-associated BSI metrics over the analysis period.Incidence rate of central line-associated BSIs per 1000 central line days; percent MRSA among S. aureus central line-associated BSIs.Overall, 33,587 central line-associated BSIs were reported from 1684 ICUs representing 16,225,498 patient-days of surveillance; 2498 reported central line-associated BSIs (7.4%) were MRSA and 1590 (4.7%) were methicillin-susceptible S. aureus (MSSA). Of evaluated ICU types, surgical, nonteaching-affiliated medical-surgical, cardiothoracic, and coronary units experienced increases in MRSA central line-associated BSI incidence in the 1997-2001 period; however, medical, teaching-affiliated medical-surgical, and pediatric units experienced no significant changes. From 2001 through 2007, MRSA central line-associated BSI incidence declined significantly in all ICU types except in pediatric units, for which incidence rates remained static. Declines in MRSA central line-associated BSI incidence ranged from -51.5% (95% CI, -33.7% to -64.6%; P < .001) in nonteaching-affiliated medical-surgical ICUs (0.31 vs 0.15 per 1000 central line days) to -69.2% (95% CI, -57.9% to -77.7%; P < .001) in surgical ICUs (0.58 vs 0.18 per 1000 central line days). In all ICU types, MSSA central line-associated BSI incidence declined from 1997 through 2007, with changes in incidence ranging from -60.1% (95% CI, -41.2% to -73.1%; P < .001) in surgical ICUs (0.24 vs 0.10 per 1000 central line days) to -77.7% (95% CI, -68.2% to -84.4%; P < .001) in medical ICUs (0.40 vs 0.09 per 1000 central line days). Although the overall proportion of S. aureus central line-associated BSIs due to MRSA increased 25.8% (P = .02) in the 1997-2007 period, overall MRSA central line-associated BSI incidence decreased 49.6% (P < .001) over this period.The incidence of MRSA central line-associated BSI has been decreasing in recent years in most ICU types reporting to the CDC. These trends are not apparent when only percent MRSA is monitored.
Contamination with Hepatitis B Virus DNA in Gastrointestinal Endoscope Channels: Risk of Infection on Reuse after On-Site Cleaning
Authors: Y. Ishino, K. Ido, K. Sugano
Journal: Endoscopy (2005)

Background and Study Aims: The incidence of viral contamination in the air, water and suction/accessory channels of gastrointestinal endoscopes was examined in order to evaluate the risk of infection. Materials and Methods: After endoscopic examinations, including biopsy procedures, in 17 patients who were positive for hepatitis B virus surface antigen and eight patients who were positive for hepatitis C virus antibody, the endoscopes were cleaned on site by suctioning and flushing the air and water channels with an enzyme detergent. First samples were then collected by flushing 5 ml of sterile water through each channel. After mechanical reprocessing, second samples were collected in the same way. Virological studies were carried out with real-time polymerase chain reactions for hepatitis B virus DNA and hepatitis C virus RNA. Results: Hepatitis B virus DNA was detected in five of the first samples recovered from the suction/accessory channels of the endoscopes (titers of 1.3 × 104 to 2.5 × 105 copies/ml), while no contamination was detected after reprocessing (P = 0.0445). The first samples from one water channel and three air channels were also positive for hepatitis B virus DNA, but were negative after reprocessing (P > 0.5, P = 0.227, respectively). No hepatitis C virus RNA was detected in any of the samples. Conclusions: These results indicate that all of the channels were potential sources of viral infection.
Sickness certification system in the United Kingdom
Authors: James N Hardy
Journal: BMJ (2004)

Editor—Doctors are agents of social control and get paid accordingly. And you'd better believe it because it ain't about to change.

A cold ain't a cold until you say it is. A person ain't fit to drive until you say they are, and nobody ain't fit to go back to work until you say they are.

Enter the patient. There are the driven folk, those without insight, who want you to look under the bonnet, twiddle a few knobs, and send them magically repaired back on their way. These are the people you encourage to take time off work because it's all you can do, and often they take no notice.

Then you have the amorphous dispossessed. Those who have to work and don't feel up to it; those who experience the drudgery of manual work when there is depression or pain; those out of work and under pressure to take jobs that are even worse than the ones they've lost. These people create the dialogue of uncertainty that is so accurately illustrated in Hussey et al's paper.1​1




Figure 1



GPs are in best position to issue sickness certificates

Credit: JOSH SHER/SPL




In the face of this uncertainty we create terms and phrases that obfuscate. We write sick notes unthinkingly and inconsistently, doing so with good grace for those we like and more grudgingly for those who make us feel angry or uncomfortable.

There is anarchy in all this that we rather enjoy, but we do so irresponsibly. In one of the focus groups a doctor had written nothing in the space provided for diagnostic detail and boasted that in four months no one had taken him to task for it.

This is the point: there is no redress for anything you write, but imagine the chaos you can create for the honest employer, the small business with a shoestring workforce stripped of a couple of indispensable workers for two weeks.
Of Menses—Pills and IUDs— Neisseria—and Flings— (With Apologies to Lewis Carroll)
Authors: John C. Hume
Journal: JAMA (1982)

For quite some time, there have been two unresolved questions claiming the interest of those involved in the management of the sexually transmitted diseases (STDs) in the female patient. One concerns the possibility that the rate of positive cultures for<i>Neisseria gonorrhoeae</i>obtained from the cervix varies in relation to the point in the menstrual cycle at which the specimen is secured. This matter has been under study since 1947 when Koch<sup>1</sup>published her finding that the rate of the recovery of gonococci in cultures taken during the latter part of the cycle (days 22 to 25) was lower than when the specimens were obtained on other days, speculating that this was due to an inhibitory effect of progesterone and was correlated with the lower pH of the cervical secretions. The other was related to the possibility that oral contraceptives increase the susceptibility of women to gonococcal infection. Juhlin
Mechanisms responsible for defective human T-lymphocyte sheep erythrocyte rosette function associated with hepatitis B virus infections.
Authors: F V Chisari, J A Routenberg, T S Edgington
Journal: Journal of Clinical Investigation (1976)

The expression of selected lymphocyte surface-membrane markers was evaluated in 37 patients with acute viral hepatitis B, 10 of whom were studied serially through the resolving and convalescent phases of disease. Bone marrow-derived (B) lymphocytes were identified by reference to surface immunoglobulin, whereas normal thymus-derived (T) lymphocytes were assayed by their capacity to form spontaneous nonimmune rosettes with sheep erythrocytes (E rosettes, ER). During the acute and resolving phases of viral hepatitis B, the relative and absolute number of ER-positive lymphocytes was significantly reduced, whereas the number of surface immunoglobulin-positive lymphocytes and the absolute lymphocyte count remained normal. This resulted in the appearance of a third population of cells, deficient in respect to both surface immunoglobulin and ER markers. Such cells accounted for nearly 25% of peripheral blood lymphocytes, approximately 5 x 105ml blood. Depression of the number of ER-positive lymphocytes occurred at least once during the course of disease in every patient studied serially, and was observed in 55 of 67 individual assays of the 37 cases of acute viral hepatitis B. Lymphocytes from some patients reacquired ER function when cultured in fetal calf serum but not in the presence of autologous serum. Such autologous serum was capable of suppressing ER function of lymphocytes from normal donors. The extrinsic suppression of er function by a serum factor (designated as the Rosette Inhibitory Factor), was found to be time dependent, characterized by a 4-h latent period and requiring approximately 18 h for maximum attenuation of ER function. The Serum Rosette Inhibitory Factor was: (a) heat and freeze-thaw stable, (b) nondialyzable, (c) physically separable from hepatitis B surface antigen, (d) not a lymphocytotoxic antibody, and (e) had the buoyant density of a lipoprotein. This extrinsic mechanism was observed in 41.8% of patients with reduced numbers of ER-positive lymphocytes. The Rosette Inhibitory Factor was not detectable in the serum of the remaining 58.2% of the cases of acute and resolving viral hepatitis B despite the presence of reduced numbers of ER-positive lymphocytes. The lymphocytes from these cases did not reacquire ER function when cultured in the absence of autologous serum. The mechanisms responsible for the suppression of normal ER function in these cases appears to be intrinsic to the lymphocytes and not the result of a humoral factor. The T lymphocyte lineage of cells deficient in respect to ER function, whether of intrinsic or extrinsic type, was demonstrated by their capacity to form spontaneous rosettes with neuraminidase-treated sheep erythrocytes. Both intrinsic and extrinsic suppression of T lymphocyte ER function commonly occurred during the first 4 wk of acute viral hepatitis B.9 of the 10 patients followed serially continued to manifest defective ER function at 12 wk...
Should journals stop publishing research funded by the drug industry?
Authors: R. Smith, P. C. Gotzsche, T. Groves
Journal: BMJ (2014)

The <i>BMJ</i> no longer publishes research funded by tobacco companies. <b>Richard Smith</b> and <b>Peter Gøtzsche</b> say that research funded by drug companies is also flawed and published to encourage sales, but <b>Trish Groves</b> says that the industries are fundamentally different and that moves are afoot to increase integrity