tbuckley/cabot-search huggingface dataset:
Harm, hype and evidence: ELSI research and policy guidance
Authors: Timothy Caulfield, Subhashini Chandrasekharan, Yann Joly, Robert Cook-Deegan
Journal: Genome Medicine (2013)

There has been much investment in research on the ethical, legal and social issues (ELSI) associated with genetic and genomic research. This research should inform the development of the relevant policy. So far, much of the relevant policy - such as in the areas of patents, genetic testing and genetic discrimination - seems to be informed more by speculation of harm and anecdote than by available evidence. Although a quest for evidence cannot always be allowed to delay policy choice, it seems axiomatic to us that policy options are improved by the incorporation of evidence.
Hepatic and renal metabolism before and after portasystemic shunts in patients with cirrhosis.
Authors: O E Owen, M A Mozzoli, F A Reichle, T H Kreulen, R S Owen, G Boden, M Polansky
Journal: Journal of Clinical Investigation (1985)

Hepatic cirrhosis with portal hypertension and gastroesophageal hemorrhage is a disease complex that continues to be treated by surgical portasystemic shunts. Whether or not a reduction or diversion of portal blood flow to the liver adversely affects the ability of the liver to maintain fuel homeostasis via gluconeogenesis, glycogenolysis, and ketogenesis is unknown. 11 patients with biopsy-proven severe hepatic cirrhosis were studied before and after distal splenorenal or mesocaval shunts. Hepatic, portal, and renal blood flow rates and glucose, lactate, pyruvate, glycerol, amino acids, ketone bodies, free fatty acids, and triglyceride arteriovenous concentration differences were determined to calculate net precursor-product exchange rates across the liver, gut, and kidney. The study showed that hepatic contribution of glucose and ketone bodies and the caloric equivalents of these fuels delivered to the blood was not adversely affected by either a distal splenorenal or mesocaval shunt. In addition to these general observations, isolated findings emerged. Mesocaval shunts reversed portal venous blood and functionally converted this venous avenue into hepatic venous blood. The ability of the kidney to make a substantial net contribution of ketone bodies to the blood was also observed.
Effective oral treatment of unconjugated hyperbilirubinemia in Gunn rats
Authors: Anja M. Hafkamp, Rick Havinga, Maarten Sinaasappel, Henkjan J. Verkade
Journal: Hepatology (2005)

We sought to develop an oral treatment for unconjugated hyperbilirubinemia. In the Gunn rat model of unconjugated hyperbilirubinemia, dietary supplementation with the lipase inhibitor orlistat (Orl) or with calcium phosphate (CaP) decreases plasma unconjugated bilirubin (UCB) levels. We determined whether Orl, CaP, or their combination is superior to phototherapy, the conventional treatment, and whether the effects of Orl and CaP are influenced by dietary fat content. Gunn rats were treated with Orl (200 mg/kg chow), CaP (20 g/kg chow), Orl + CaP, or continuous phototherapy (19 μW/cm2/nm) during a low-fat (LF) diet (13 energy%) or high-fat (HF) diet (35 energy%). Plasma UCB and fecal fat excretion were measured before, during, and/or at the end of treatment. Orl treatment for 2 weeks (HF diet) reduced plasma UCB concentrations similar to phototherapy (−34% and −28%, respectively); the combination of both was more effective than either treatment alone (−48%; P < .001). After 3 weeks of a HF diet, plasma UCB was 46% lower compared with the LF diet (P < .001). Plasma UCB concentrations were negatively correlated with fecal fat excretion (r = −0.96; P < .001). Irrespective of dietary fat content, 3 weeks of combined treatment (Orl + CaP) decreased plasma UCB by approximately 50% (P < .01) and was more effective than phototherapy (P < .05) at the intensity provided. In conclusion, plasma UCB concentrations in Gunn rats are negatively related to fecal fat excretion and dietary fat content. Orlistat is equally effective as phototherapy for the treatment of unconjugated hyperbilirubinemia in Gunn rats, and combined oral treatment with Orl + CaP is more effective than phototherapy. The present results support the feasibility of an efficient oral treatment of unconjugated hyperbilirubinemia. (HEPATOLOGY 2005;41:526–534.)
A controlled study of stanozolol in primary Raynaud's phenomenon and systemic sclerosis.
Authors: M I Jayson, C D Holland, A Keegan, K Illingworth, L Taylor
Journal: Annals of the Rheumatic Diseases (1991)

A double blind, crossover study of fibrinolytic enhancement treatment using stanozolol has been performed in primary Raynaud9s phenomenon and in systemic sclerosis. The outcome criteria included subjective evaluation, clinical examination, physiological measurements of peripheral blood flow, and fibrinolytic measurements. Nineteen patients entered and 11 completed the study of primary Raynaud9s phenomenon. There was nonsignificant evidence of improvement in peripheral blood flow. Twenty four patients entered and 17 completed the study of systemic sclerosis. There was marked objective but not subjective evidence of improvement in the peripheral microcirculation during the stanozolol treatment period. There was also a nonsignificant improvement in dermal sclerosis. There were improvements in fibrinolytic activity during the stanozolol treatment period. There was no alteration in fibrinolytic reserve as measured by 1-desamino-8-D-arginine vasopressin stimulation, however. Although adverse events were common in both treatment periods, withdrawals predominantly occurred during the period of treatment with stanozolol and were principally due to anabolic problems. There does not seem to be any indication for the use of stanozolol in primary Raynaud9s phenomenon. Fibrinolytic enhancement with stanozolol does appear useful in treating the microvascular features of systemic sclerosis.
Wanted: A Heisenberg for an Orwell
Authors: David G. Dibbell
Journal: JAMA (1980)

To the Editor.—  The serious reader scarcely knows whether to be pleased or appalled at the discourse of Robert M. Veatch, PhD, Voluntary Risks to Health: The Ethical Issues (243:50, 1980)—pleased, that somewhere, someone is grappling with such thorny problems—appalled at the unstated and implied assumptions over which Dr Veatch has glossed.  Let us start with the simplest criticism.  Does Dr Veatch seriously suggest that a multicausal health-tax model could work in a practical way? Does he believe that some omniscient body could define the plethora of health factors (we certainly had problems defining the missile gap and the physician shortage); could rate these factors in terms of social cost; (the danger of bonbons and television vs climbing Mt McKinley); determine to what financial degree they should be penalized; and finally exempt specific risk factors for their social utility (ie, firemen, radiology technicians, inhabitants of Gary, Ind).  Does he believe
Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in man.
Authors: K Y Ho, J D Veldhuis, M L Johnson, R Furlanetto, W S Evans, K G Alberti, M O Thorner
Journal: Journal of Clinical Investigation (1988)

Studies in man have shown that the episodic release of growth hormone (GH) is infrequent and erratic, and unlike that in the rat does not appear to have discernible ultradian periodicities. However, these observations in nonfasted subjects may be invalid since mixed nutrients have unpredictable effects on GH release. Moreover, in the fed state basal GH levels are frequently undetectable, thus rendering the identification of low amplitude pulses unreliable. Accordingly, the 24-h pulsatile pattern of GH secretion obtained from repetitive venous sampling in six normal adult male subjects was examined during a control fed day and during the first and fifth days of a 5-d fast. The GH data were analyzed using two distinct methods: a discrete pulse detection algorithm (Cluster analysis) and Fourier expansion time-series, which allows fixed periodicities of secretory activity to be resolved. The 5-d fast resulted in a significant increase in discrete GH pulse frequency (5.8 +/- 0.7 vs. 9.9 +/- 0.7 pulses/24 h, P = 0.028), 24 h integrated GH concentration (2.82 +/- 0.50 vs. 8.75 +/- 0.82 micrograms.min/ml; P = 0.0002), and maximal pulse amplitude (5.9 +/- 1.1 vs. 12.3 +/- 1.6 ng/ml, P less than 0.005). While multiple low-amplitude sinusoidal periodicities were present on the control fed day, time-series analysis revealed enhancement of circadian and ultradian cycles on the first and fifth days of fasting. Concomitantly, fasting resulted in a decline (day 1 vs. day 5) in serum concentrations of somatomedin C (1.31 +/- 0.22 vs. 0.77 +/- 0.18 U/ml) and glucose (4.9 +/- 0.2 vs. 3.2 +/- 0.2 mmol/liter), and a marked rise in free fatty acid (0.43 +/- 0.12 vs. 1.55 +/- 0.35 mmol/liter) and acetoacetate (35 +/- 6 vs. 507 +/- 80 nmol/liter). We conclude that the acute nutritional status is an important determinant of spontaneous pulsatile GH secretion in man. Fast-induced enhancement of GH release is achieved through combined frequency (discrete pulses) and amplitude (sinusoidal periodicities) modulation. Such alterations in somatotropic hormone release may play an important role in substrate homeostasis during starvation.
ABC of labour care: Labour in special circumstances
Authors: G. Chamberlain, P. Steer
Journal: BMJ (1999)

About two thirds of labours are normal. In the rest, increased surveillance—and sometimes action—is required to prevent maternal or fetal problems. All primary care givers need to be able to recognise such variations and either take appropriate action or refer to an obstetrician for advice and assistance. This may require transfer to hospital if the woman is in labour at home or in a freestanding general practitioner unit. A paediatrician should be called to attend if any problems are anticipated.

The commonest problem in childbirth is a labour that is progressing slowly 



Descent of the fetal head into the pelvis is checked by abdominal examination when the head is imagined in segments of one fifth. Engagementwhen the maximum diameter of the fetal head has entered the pelviscorresponds with only two fifths of the head being palpable through the abdomen



The fundamental process of labour is progressive dilatation of the cervix. The woman herself usually diagnoses labour when she has recurrent painful uterine contractions. However, such contractions may be ripening the cervix (the latent phase) before rapid cervical dilatation (the active phase) occurs. Midwives and doctors judge progress by assessing the descent of the fetal presenting part on abdominal palpation and advancement of the fetus on vaginal examination (position of the presenting part relative to the ischial spines). These may be imprecise measurements, but a series of careful assessments by the same observer is usually informative.



The concept of the fetal head descending through the pelvis in labour is checked by vaginal examination when the level of the presenting part is assessed against the level of the ischial spines (in centimetres) vertically



Labour is usually diagnosed by the professional when there are regular contractions or when the cervix has reached 3 cm dilatation in the presence of contractions. At this point, …
Erythromycin in whooping cough
Authors: G. Tornese, F. Patarino, F. Marchetti
Journal: BMJ (2009)

Erythromycin is no longer considered the first choice in contact prophylaxis for whooping cough.1 According to a Cochrane review,2 the best regimens for microbiological clearance and for contact prophylaxis, with fewer side effects, are …
In heart failure, automatic implant-based telemonitoring reduced a composite of cardiac events and mortality
Authors: Lauren B. Cooper, Adrian F. Hernandez
Journal: Annals of Internal Medicine (2014)

Source Citation Hindricks G, Taborsky M, Glikson M, et al; IN-TIME study group. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet. 2014;384:583-90. 25131977
Don't be an ostrich
Authors: J. Harris
Journal: BMJ (2008)

Spence’s sceptical reaction to the quality and outcomes framework (QOF) will have hit home with many general practitioners.1 Few of us spontaneously welcome the nagging computer prompts that interrupt our consultations, reduce our work to protocols and guidelines, and ignore the subtle, immeasurable aspects of the job. Nor do we like to acknowledge how …
Clinical Toxicology: Principles &amp; Mechanisms
Authors: Jason Payne-James
Journal: Journal of the Royal Society of Medicine (2004)

What is clinical toxicology? Frank Barile begins with the traditional definition—the discipline within toxicology concerned with the toxic effect of agents whose intent is to treat, ameliorate, modify, or prevent disease states, or the effect of drugs which, at one time, were intended to be used as such. But he expands it to include agents used with non-therapeutic intent—for example, alcohol and drugs of misuse and chemical byproducts of industrial development. This liberal definition is appropriate in a book that not only explores mechanisms of action but also goes into clinical findings and management.

The contents are divided into three parts. Part I offers a fascinating read for the non-toxicologist, clearly laying out and defining the principles of toxicology. A slight drawback for Europeans is the North American orientation (in terms of regulation) but no matter—the information is all there. Professionals in primary care would be well-advised to read the chapters on the classification of toxins and the effects of these agents in man (persisting disagreements about certain classifications have little relevance to the practising clinician). Parts II and III respectively explore the toxicity of therapeutic and non-therapeutic agents. For the former a typical chapter offers historical background, the clinical role, the metabolism, the mechanisms of toxicity, the signs and symptoms of toxicity and the clinical management of acute overdose. The extent of each section varies from agent to agent but each provides enough information, or sources of further information, to allow appropriate management.

My criticisms? Barile is not a clinician (his background is pharmacy, pharmacology and toxicology) and other ‘contributors’ are predominantly from his own department. Sometimes the book does not indicate the source of input on clinical management and I think this should be flagged more clearly. The book contains the now almost obligatory section on terrorism by radiation, toxins or biological agents; it does not disappoint but I did get the impression, from the lack of hard data, that these chapters were tagged on as afterthoughts. Finally, the production: my reservations apply, I am afraid, to many books from CRC Press. The layout is unadventurous, with paragraph numbering that drives me mad. No colour images are included (and few even in black and white)—a particular shame in relation to physical signs which, once seen, would be instantly recognized in the clinical setting. Nevertheless, I recommend this work as a source of reference for anyone working in primary care or emergency medicine.
Librarians, Catalogers, Searchers
Authors: Laurie L. Thompson
Journal: JAMA (1988)

<h3>To the Editor.</h3> —In the Dec 11, 1987, issue of<i>JAMA</i>, Dr Zylke<sup>1</sup>presents an up-to-date view of modern medical libraries. Librarians increasingly use computer technology to ease their day-to-day tasks as well as to facilitate the dissemination of information to the health professional. However, as a librarian and former cataloger at the National Library of Medicine, I would like to clarify Dr Zylke's statement that "some of the librarian's traditional tasks are being done on computers. Original cataloging, for example, is not done by librarians, but by specially trained professionals and then made widely available to libraries on-line." Original cataloging is still being done by librarians. In fact, the National Library of Medicine has 21 librarians who, in 1986, provided original cataloging for 20 285 books, journals, audiovisual programs, and computer software published in the United States and abroad. While computers facilitate entry of data into a bibliographic
Type 2 diabetes is more common among Indians who stay in India than in those who migrate to US, study finds
Authors: C. Travasso
Journal: BMJ (2015)

People of Indian origin who live in the United States have a lower prevalence of diabetes than those who live in India, a study published in Diabetes Care has found.

These differences were seen after adjusting for age, sex, systolic blood pressure, and waist circumference, indicating that other factors may be linked to the high prevalence of type 2 diabetes seen in Asian Indians.1 Previously, when the prevalence of type 2 diabetes in India was lower, studies had shown that Asian Indians had a higher risk of type 2 diabetes after immigration.

Unjali Gujral, lead author of the new study, noted that India has seen …
Verrucose "Snuff Dipper's" Carcinoma of the Oral Cavity
Authors: Raymond H. Stecker, Kenneth D. Devine, Edgar G. Harrison
Journal: JAMA (1964)

A 71-year-old man who had practiced snuff dipping (placing a small amount of tobacco snuff in the gingivobuccal groove and leaving it there for extended periods of time) for 40 years had a shaggy white tumor which occupied the posterior surface of the lower lip, replaced the alveolar process, and filled much of the floor of the mouth. Examination of a frozen section of part of the lesion revealed infiltrating, verrucose, squamous carcinoma. Although a bilateral suprahyoid dissection of the neck was carried out, wide local removal of such tumors, without dissection, should constitute adequate therapy. This is based on the known biologic behavior of oral verrucose carcinoma as evidenced by records of 55 patients treated at Mayo Clinic.
Embryonic abnormalities at medical termination of pregnancy
Authors: M. Jarmulowicz, S. Quenby, G. Blanch, J. Neilson
Journal: BMJ (1998)

Editor—I have serious doubts about the validity of the data reported by Blanch et al on embryonic abnormalities at medical termination of pregnancy.1 In my experience, embryos are delicate and can be readily disrupted even during careful handling. Although the authors state that “strict criteria were used to distinguish structural abnormalities from traumatic damage,” they give no details of these criteria and whether they have been generally accepted as distinguishing between trauma and abnormality in delicate embryonic tissue. I believe that it is important to specify in how many cases traumatic damage was seen.

Although Blanch et al state that macroscopically abnormal embryos were further examined histologically, they do not report the histological findings and I was surprised that a pathologist was not included as an author. Were all the neural tube and abdominal wall defects confirmed histologically? It is easy to envisage how compression of a delicate embryo during delivery might induce rupture of both the abdomen and central nervous system.

An anembryonic pregnancy rate of 23% (48 in 206 cases) before 9 weeks of pregnancy is high in comparison with the rate of 16% found in a study of 38 abnormal early pregnancies2 and that of 1% in an ultrasound study of 17 820 normal pregnancies (albeit 10-13 weeks’ gestation).3 Such a discrepancy must be explained. 

I believe that the unexpected finding of a 34% non-viable pregnancy rate can be explained by misinterpretation of macroscopic appearances.
THE RED CELL DISTRIBUTION WIDTH AND THE CBC RISK SCORE MEASURED PRIOR TO LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION PREDICT POST-IMPLANT SURVIVAL
Authors: Santhosh R. Mannem, Benjamin Horne, Omar Saeed, bdallah Kfoury, Sampath Gunda, Jason Salamon, Deborah Budge, Manoj Bhandari, Rami lharethi, Muhammad Iqbal, Jeremy Mazurek, Bruce B. Reid, Daniel Goldstein, Ronald Zolty
Journal: Journal of the American College of Cardiology (2014)
Concurrent induction of necrosis, apoptosis, and autophagy in ischemic preconditioned human livers formerly treated by chemotherapy
Authors: Marie-Charlotte Domart, Davide Degli Esposti, Mylène Sebagh, Natalia Olaya, Francis Harper, Gérard Pierron, Brigitte Franc, Kenneth K. Tanabe, Brigitte Debuire, Daniel Azoulay, Catherine Brenner, Antoinette Lemoine
Journal: Journal of Hepatology (2009)
Anaphylaxis after oral penicillin.
Authors: J Simmonds, S Hodges, F Nicol, D Barnett
Journal: BMJ (1978)

Case reportA 56-year-old research engineer presented to the Hammersmith Hospital in 1972 with deteriorating balance, speech, and writing for nine months.Family history was negative.Examination showed titubation, slurred speech, horizontal nystagmus, cerebellar ataxia in the arms, and ataxia of gait.Tendon reflexes and sensation were normal.A cervical myelogram and vertebral arteriogram were normal.Air encephalography showed slight dilatation of the third ventricle and of cerebral cortical sulci.Malignancy, hypothyroidism, and other systemic diseases were excluded by full investi- gation, and late-onset idiopathic cerebellar degeneration was diagnosed.He deteriorated slowly over the next six years.By 1978 he could walk only with a stick.He was given choline chloride 1 g four times daily by mouth.There was a dramatic improvement.He could walk without a stick even over irregular surfaces outdoors, which had been impossible for many years.More detailed observations were therefore made of his motor function both on and off choline.Without choline he walked on a wide base and needed a stick for support.He could not stand with his feet together, let alone perform Romberg's test or tandem standing.Within two days of starting choline he Helices drawn with wrist unsupported.Left, untreated, right, on choline.could do all these things and could hop on either foot alone.Ataxia
Combined Brief Dynamic Therapy and Pharmacotherapy in the Treatment of Major Depressive Disorder: A Pilot Study
Authors: Giuseppe Maina, Gianluca Rosso, Chiara Crespi, Filippo Bogetto
Journal: Psychotherapy and Psychosomatics (2007)

&lt;i&gt;Background:&lt;/i&gt; The relative efficacy of supplemental psychotherapy in the treatment of depression is still a matter of debate. Moreover, the superiority of brief dynamic therapy (BDT) over supportive psychotherapies is not well established. The aim of this study is to compare the efficacy of BDT added to medication with that of brief supportive psychotherapy (BSP) added to medication in the treatment of major depressive disorder. &lt;i&gt;Method:&lt;/i&gt; A 12-month randomized clinical trial compared BDT (n = 18) with BSP (n = 17) combined with antidepressants in outpatients with major depressive disorder. Both psychotherapies were added during the first 6 months of the trial; all patients continued to be treated with only pharmacotherapy (paroxetine or citalopram) in the following 6-month continuation phase. Efficacy was assessed using the 17-item Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety and the Clinical Global Impression (CGI). The data analysis was conducted on two samples: the per-protocol (PP) sample and the observed-cases (OC) sample. &lt;i&gt;Results:&lt;/i&gt; Thirty-two patients completed the study. Although at the end of the combined therapies (T2) no differences emerged between the two treatment approaches, the group of patients treated with BDT showed a further clinical improvement at the end of the study (T3): a significant reduction in symptomatology emerged on the HAM-D (PP sample: F = 75.154, p = 0.03; OC sample: F = 67.149, p = 0.022) and on the CGI total scores (PP sample: F = 78.527, p = 0.016; OC sample: F = 74.104, p = 0.007). The difference in remission rates on the HAM-D (75 vs. 12.5% at T3) is statistically significant favoring BDT. &lt;i&gt;Conclusions:&lt;/i&gt; BDT combined with antidepressants is preferable to supportive psychotherapy combined with medication in the treatment of outpatients with major depression.