tbuckley/cabot-search huggingface dataset:
Bilateral Internal Drainage of Biliary Hilar Malignancy via a Single Percutaneous Track. Role of Percutaneous Transhepatic Cholangioscopy
Authors: Y. Kubota, T. Seki, T. Yamaguchi, K. Tani, T. Mizuno, K. Inoue
Journal: Endoscopy (1992)

Strictures of the hepatic bifurcation were bilaterally drained via a single percutaneous tract in 24 patients with hilar cholangiocarcinoma. This was achieved under percutaneous transhepatic cholangioscopic (PTCS) guidance which allowed for an excellent manipulation of the guidewire. Placement of two guidewires, one in the contralateral hepatic duct and the other in the common duct, was successful in 19 (79%) of patients at the first attempt. In the remaining cases the better accessible stricture was dilated, followed by negotiation of the other stricture under direct cholangioscopic control. After placement of guidewires into both hepatic ducts, bilateral drainage with a single Y-shaped catheter could be achieved in all 24 patients. There were no procedure-related complications. We conclude that this technique might be useful also for application of other intraluminal adjuvant treatment modalities.
Influence of a nurse practitioner on non-attendance rate for barium enema
Authors: M. Scott, S. Allen, A. Bamford, M. Walshe, C. I. Clark
Journal: Journal of the Royal Society of Medicine (2002)

Non-attendance for barium enema investigation wastes resources, prolongs waiting times and delays diagnosis of colorectal carcinoma. In an inner-city hospital with a previous non-attendance rate of over 20% for barium enema we investigated the value of systematic personal contact with a nurse practitioner at the time of booking. We compared two groups of patients, all of whom received an explanation of the procedure from the referring clinician. Patients referred from the colorectal clinic were accompanied by the colorectal nurse practitioner to the radiology department for booking, an appointment being sent later by mail. The nurse practitioner reiterated the details of the procedure, provided supplementary information, confirmed the patient's contact details and provided a telephone number in case further information or assistance was needed. Patients referred from the gastroenterology clinic were managed as previously, making their own way to the radiology department and receiving supplementary information only on request. The patients referred from the two clinics were closely similar; however, the non-attendance rate for the intervention (colorectal) clinic was 4/157 (2.5%) compared with 17/110 (15.5%) for the comparison clinic (P < 0.001). A year previously the non-attendance rates in these clinics had been 23% and 20%, respectively. These results indicate that personal contact, with supplementary information, can substantially reduce the non-attendance rate for barium enema.
The benefits of a cross channel flight
Authors: Seamus J Murphy
Journal: BMJ (2004)

Florence was the sickest patient with primary biliary cirrhosis whom I had ever seen when I clerked her in that night. Her notes revealed that her liver disease had long been stable, but her deeply jaundiced condition proclaimed that something was now amiss. Then, as a post-membership senior house officer, I put liver cancer top of the list of possibilities. However, all scans were normal, and blood tests, apart from confirming that her liver enzymes were elevated, were unrevealing. Florence waited patiently each day for news of a diagnosis, but we held up our hands at the ward rounds and looked baffled. We contacted King's College …
A1.7 Serum cytokine changes in rituximab-treated rheumatoid arthritis patients
Authors: T D de Jong, S Vosslamber, W de Jager, H Raterman, A E Voskuyl, K A Gelderman, C L Verweij
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Although B cell depletion therapy with rituximab is successful in the majority of rheumatoid arthritis (RA) patients, 30–40% of patients do not respond. The mechanism behind this is yet unknown, as B cell depletion generally takes place in all patients. This study aims to explore changes in serum cytokines during rituximab therapy in established RA patients. <h3>Methods</h3> Serum was collected from 18 established RA patients before and after 1, 3, 6, 9 and 12 months of rituximab therapy. A panel of thirty-four cytokines was measured in a multiplex immunoassay. Patients with a change in disease activity score (∆DAS28) &gt;1.2 after 6 months were considered responders. <h3>Results</h3> During rituximab therapy, CXCL13 significantly decreased in all patients (median 1.9-fold decrease (IQR 1.4-3.3)), irrespective of responder status. This coincided with B cell depletion, suggesting that CXCL13 reflects B cell levels in the circulation. No differences were observed between responders and non-responders after 1 and 3 months of therapy. However, at 6, 9 and 12 months, CXCL10 dynamics differed significantly between responders and non-responders (R vs. NR, T6/T0 p = 0.004, T9/T0 p = 0.003, T12/T0 p = 0.001). Non-responders showed an increase compared to baseline, whereas responders did not. The change in CXCL10 correlated to the ∆DAS28 at 6 months, indicating that this reflects disease activity rather than a mechanistic effect of rituximab. Most strikingly, IL-12 was undetectable in most non-responders until 6 months, but showed a substantial increase after 9 months of therapy, which did not occur in the responders (R vs. NR T9/T6 p = 0.030, Fisher’s exact p = 0.049). The change in IL-12 did not correlate to ∆DAS28. <h3>Conclusions</h3> This study shows that during rituximab therapy, cytokine changes occur in the patient serum, both related and unrelated to the clinical response. CXCL13 seems to reflect B cells levels in the circulation, whereas the dynamics of CXCL10 and IL-12 during therapy are regulated differently between responders and non-responders during rituximab treatment. These findings indicate different pharmacological effects of rituximab between responders and non-responders. This research was supported by the Center for Translational Molecular Medicine (CTMM) and the Dutch Arthritis Foundation (TRACER).
Additional Artificial Heart Studies Funded
Authors: Timothy F. Kirn
Journal: JAMA (1988)

IN THE LATE 1990s, potential transplant patients may be able to choose among at least four new permanent artificial hearts. The National Heart, Lung, and Blood Institute, Bethesda, Md, has awarded separate contracts, each worth about $5.6 million, to four separate groups for the development of a permanent, wholly implantable artificial heart. Robert T. V. Kung, PhD, vice president, research and development, at ABIOMED Inc, Danvers, Mass, one of the recipient companies, suggests the contracts demonstrate that the heart institute is committed to developing a permanent artificial heart. There has been some debate about the future of artificial heart programs, and some have questioned whether these hearts will ever be used as anything more than a "bridge" to sustain a patient until a suitable donor organ is found. Other groups awarded contracts are the University of Utah Institute of Biomedical Engineering, Salt Lake City; Pennsylvania State University Medical Center, Hershey;
Multifunctional, self-assembling anionic peptide-lipid nanocomplexes for targeted siRNA delivery
Authors: Aristides D. Tagalakis, Do Hyang D. Lee, Alison S. Bienemann, Haiyan Zhou, Mustafa M. Munye, Luisa Saraiva, David McCarthy, Zixiu Du, Conrad A. Vink, Ruhina Maeshima, Edward A. White, Kenth Gustafsson, Stephen L. Hart
Journal: Biomaterials (2014)

Formulations of cationic liposomes and polymers readily self-assemble by electrostatic interactions with siRNA to form cationic nanoparticles which achieve efficient transfection and silencing in vitro.However, the utility of cationic formulations in vivo is limited due to rapid clearance from the circulation, due to their association with serum proteins, as well as systemic and cellular toxicity.These problems may be overcome with anionic formulations but they provide challenges of self-assembly and transfection efficiency.We have developed anionic, siRNA nanocomplexes utilizing anionic PEGylated liposomes and cationic targeting peptides that overcome these problems.Biophysical measurements indicated that at optimal ratios of components, anionic PEGylated nanocomplexes formed spherical particles and that, unlike cationic nanocomplexes, were resistant to aggregation in the presence of serum, and achieved significant gene silencing although their non-PEGylated anionic counterparts were less efficient.We have evaluated the utility of anionic nanoparticles for the treatment of neuronal diseases by administration to rat brains of siRNA to BACE1, a key enzyme involved in the formation of amyloid plaques.Silencing of BACE1 was achieved in vivo following a single injection of anionic nanoparticles by convection enhanced delivery and specificity of RNA interference verified by 5 0 RACE-PCR and Western blot analysis of protein.
Rwanda denies plan to forcibly sterilise people with learning difficulties
Authors: P. Moszynski
Journal: BMJ (2009)

The Rwandan parliament is considering a draft bill on reproductive health that would require the sterilisation of all people with intellectual disabilities and mandate compulsory HIV testing of people about to marry, says the US based group Human Rights Watch. 

The group cautions that the provisions in the bill, which it has seen, are “deeply flawed” and violate the government’s obligations to uphold and protect human rights. But a government spokesman has dismissed the group’s claims as rumour, saying that the proposals are to go no further.

“Compulsory HIV testing and forced sterilisation are counterproductive to the Rwandan government’s goal of improved reproductive health,” said Joe Amon, director of health and human rights at Human Rights Watch. “Provisions in the current bill that increase stigma, rely on coercion, and deny …
Comparative survival after permanent ventricular and dual chamber pacing for patients with chronic high degree atrioventricular block with and without preexistent congestive heart failure
Authors: Martin A. Alpert, Jack J. Curtis, John F. Sanfelippo, Greg C. Flaker, Joseph T. Walls, Vaskar Mukerji, Daniel Villarreal, S.K. Katti, Niall P. Madigan, Ryszard B. Krol
Journal: Journal of the American College of Cardiology (1986)
Magnetic Resonance Imaging of the Brain and Spine
Authors: DANIEL L. KENT
Journal: Annals of Internal Medicine (1988)

Evaluation of demonstrated clinical efficacy of magnetic resonance (MR) imaging in the central nervous system.Information synthesis of studies before January 1987.Reports were classified by the level of clinical efficacy studied (technical capacity, diagnostic impacts, and therapeutic or patient outcome impacts) and were judged by the validity of their methods, especially avoidance of diagnosis review, test review, and work-up biases.Magnetic resonance imaging probably is superior to computed tomography for detection and characterization of posterior fossa lesions and spinal cord myelopathies, imaging in multiple sclerosis, detecting lesions in patients with refractory partial seizures, and detailed display for guiding complex therapy, as for brain tumors. In other diseases, the efficacy of MR imaging is similar to that of computed tomography (cerebrovascular, radiculopathy, and infection). Magnetic resonance imaging is less invasive than intrathecal or intravenous contrast-enhanced computed tomography and costs 20% to 300% more than computed tomography, although avoidance of hospital stays may offset some costs. Generally, the quality of MR images probably exceeds that of computed tomographic (CT) scans. However, published evidence does not show that the clinical efficacy of MR imaging is generally superior to that of existing imaging modalities such as computed tomography. Only six studies avoided major methodologic biases, and lower true-positive rates for MR imaging were reported in these studies than reported in multiply biased studies. Few studies of the potential of MR imaging for false-positive diagnosis have been done.Use of standards for quality of evidence leads to more conservative conclusions than those of reports describing the clinical potential of MR imaging. Some applications of MR imaging were confirmed by rigorous studies, whereas others were not well supported by reports free of methodologic biases. If the diagnostic alternative is invasive (for example, myelography and cisternography), MR imaging is preferred, but adequate diagnosis for many conditions (head trauma, simple stroke, and dementia) may not require the detail of an MR imaging study. In general, more rigorous clinical research studies are needed for new technologies such as MR imaging. Because the field of MR imaging is changing, review of its clinical efficacy will need to be revised frequently.
Watchdog could close hospitals in a day to tackle infections
Authors: Helen Mooney
Journal: BMJ (2007)

People who are acutely ill out of hours should have easy access to a wider range of innovative medical services in the community to improve their care and reduce unnecessary hospital visits, a report by the Royal College of Physicians recommends.The report, Acute Medical Care: The Right Person, in the Right Setting, First Time, argues that current out of hours care is generally inadequate and inflexible, so patients with acute illness go to hospitals because there is no alternative.It recommends that provision of acute, unscheduled medical care in the community should expand with a range of different levels of emergency care, offering extended opening times and direct access to competent staff.New options might include urgent care centres in the community; rapid access medical outpatient clinics; and specialist outreach services from hospitals for acute deterioration of long term illness.These services must be evidence based, and the professionals delivering them must have the same competencies in acute medical care as hospital providers, it says.Competent decision making requires diagnostic support, says the report, which calls for improved availability of these services.The task force that developed the recommendations, based on a review of available evidence, wants to replace "see and greet"-in which services provide an initial assessment before referring on-with "see and treat"-providing accurate assessment and delivery of treatment at the first contact.Bryan Williams, professor of medicine at the University of Leicester, and chairman of the task force, said, "Getting it right for acute medical care needs changes in the way care is organised to get the most and the best out of staff and local resources and to provide fast and efficient care for patients.It needs changes in the way we work as professionals across the board, to provide wider and more flexible access to clinical decision makers."Big acute hospitals that serve local regions should provide the most intensive level of emergency and complex acute medical care in each area.They should have emergency departments located close to acute medical and critical care units, ideally as part of an emergency floor.To ensure that people are aware of the range of services, the report recommends developing local navigation hubs, each with a single, well publicised access telephone number distinct from 999, the emergency services number.
Bacteriology of the Lower Respiratory Tract in Health and Chronic Diseases
Authors: David V. Pecora, Diran Yegian
Journal: New England Journal of Medicine (1958)

MANY publications have appeared indicating that chronic infection of the lower respiratory tract is a common occurrence.1 2 3 4 5 6 7 8 9 10 Usually, the bacteriology has been determined by aerobic culture of expectorated sputum. Occasionally, it has been derived from secretions aspirated at bronchoscopy.11 Rarely have cultures been obtained directly from the tissues, and usually these studies have been performed post mortem.12 There appears to be little doubt that acute infections occur frequently in the lung and bronchi. However, our experience suggests that except for cases of pulmonary abscess and possibly bronchiectasis, chronic infection with organisms other than mycobacteria or fungi is relatively rare. It . . .
Six-Month Androgen Suppression Plus Radiation Therapy Compared With Radiation Therapy Alone for Men With Prostate Cancer and a Rapidly Increasing Pretreatment Prostate-Specific Antigen Level
Authors: Anthony V. D'Amico, Marian Loffredo, Andrew A. Renshaw, Brittany Loffredo, Ming-Hui Chen
Journal: Journal of Clinical Oncology (2006)

We evaluated whether treatment with 6 months of androgen-suppression therapy (AST) and radiation therapy (RT) compared with RT was associated with the time to prostate-specific antigen (PSA) recurrence, prostate cancer-specific mortality (PCSM), and all-cause mortality (ACM) in men with a pretreatment PSA velocity more than 2 ng/mL/yr.The study cohort comprised 241 men with clinically localized or locally advanced prostate cancer treated with RT and AST or RT from 1989 to 2002. Cox regression and Gray's formulation were used to assess whether treatment was associated significantly with the time to PSA recurrence or ACM and PCSM, respectively, adjusting for known prognostic factors.Despite the significantly longer median follow-up, younger age at diagnosis, higher proportion of Gleason score 7 to 10, and advanced T-category cancers, significantly lower estimates of PSA recurrence (P < .001), PCSM (P = .007), and ACM (P < .001) were observed in men who were treated using RT and AST compared with RT. Treatment with RT and AST compared with RT was associated with a longer time to PSA recurrence (adjusted hazard ratio [HR], 0.22; 95% CI, 0.14 to 0.35; P < .001), PCSM (HR, 0.23, 95% CI, 0.09 to 0.64; P = .005), and ACM (HR, 0.30; 95% CI, 0.16 to 0.58; P < .001).Treatment using 6 months of AST and RT compared with RT in men with a pretreatment PSA velocity greater than 2 ng/mL/yr was associated with a longer time to PSA recurrence, PCSM, and ACM.
Regulation of Interleukin (IL)-12 Receptor β2 Subunit Expression by Endogenous IL-12: A Critical Step in the Differentiation of Pathogenic Autoreactive T Cells
Authors: John T. Chang, Ethan M. Shevach, Benjamin M. Segal
Journal: The Journal of Experimental Medicine (1999)

The interleukin (IL)-12 receptor (R)β2 subunit is the critical molecule involved in maintaining IL-12 responsiveness and controlling T helper cell type 1 lineage commitment. We demonstrate that IL-12 and interferon (IFN)-γ play separate, but complementary, roles in regulating IL-12Rβ2 expression on antigen-specific CD4+ T cells. These results are consistent with our previous observation that IL-12 can promote autoimmune disease through IFN-γ–independent as well as –dependent pathways. Therefore, we compared the induction of IL-12 by, and the expression of the IL-12Rβ2 subunit on, myelin basic protein (MBP)-specific T cells from experimental allergic encephalomyelitis (EAE)-susceptible SJL (H-2s) mice and from EAE- resistant B10.S mice (H-2s). B10.S mice had an antigen-specific defect in their capacity to upregulate the IL-12Rβ2 subunit. Defective expression was not secondary to the production of suppressive cytokines, but to a failure of B10.S MBP-specific T cells to upregulate CD40 ligand expression and to induce the production of IL-12. IL-12Rβ2 expression as well as encephalitogenicity of these cells could be restored by the addition of IL-12. These results suggest that the development of immunotherapies that target the IL-12Rβ2 subunit may be useful for the treatment of autoimmune diseases.
Intravenous Acyclovir for the Treatment of Primary Genital Herpes
Authors: LAWRENCE COREY
Journal: Annals of Internal Medicine (1983)

Thirty-one patients with first episodes of genital herpes were randomized in a double-blind fashion to intravenous treatment with saline placebo or acyclovir, 5 mg/kg body weight at 8-hour intervals, for 5 days. The median duration of viral shedding from genital lesions after the onset of therapy was significantly shorter for patients given acyclovir (2 days) than for those given placebo (13 days), p < 0.001. Viral shedding from the pharynx, cervix, urethra, and urine were also shorter in acyclovir-treated patients. (p < 0.01 for each comparison). Local and systemic symptoms were shortened by a mean of 5 days and healing of genital lesions by a mean of 12 days in acyclovir-treated patients. (p < 0.01). Complications during treatment, such as extragenital lesions or urinary retention requiring catheterization, developed in four patients given placebo and in none given acyclovir. (p < 0.05). Intravenous acyclovir substantially decreases the symptoms, duration of lesions, and complications of primary genital herpes.
Dietary n-3 fatty acid effects on neutrophil lipid composition and mediator production. Influence of duration and dosage.
Authors: F H Chilton, M Patel, A N Fonteh, W C Hubbard, M Triggiani
Journal: Journal of Clinical Investigation (1993)

Healthy volunteers supplemented their usual Western diets with Promega fish oil supplement (eicosapentaenoic acid [EPA], 0.28 g; docosahexaenoic acid [DCHA], 0.12 g; other n-3 fatty acids 0.10 g per capsule) using three protocols. Initial experiments (protocol 1 and 2) investigated the kinetics of incorporation of n-3 fatty acids into serum and neutrophil lipids after 10 capsules/d of Promega. EPA was rapidly detected in both serum and neutrophil lipids; the arachidonic acid (AA) to EPA ratio in neutrophil phospholipids showed a maximal reduction of 49:1 to 8:1 within 1 wk of beginning supplementation. EPA was preferentially incorporated into phosphatidyl-ethanolamine and phosphatidylcholine but not phosphatidylinositol. Long-term supplementation for up to 7 wk did not influence the AA/EPA ratio or the distribution of EPA among neutrophil phospholipids in a manner that was not observed after the first week. Neutrophils produced similar quantities of platelet-activating factor and slightly lower quantities of leukotriene B4 during long-term supplementation when compared with presupplementation values. Experiments examining the influence of Promega dosage indicated that the AA/EPA ratio in neutrophil lipids decreased in a dose-dependent manner. Only when the dose was increased to 15 capsules/d was there a reduction in the AA/DCHA ratio in neutrophil lipids. The quantity of AA in neutrophil lipids remained relatively constant at all supplement doses. Taken together, the current study demonstrates the capacity of n-3 fatty acids provided with a Western diet to be rapidly incorporated into neutrophil lipids. However, dietary n-3 fatty acids appear not to significantly reduce arachidonate content within neutrophil phospholipids. Constant arachidonate levels may account for the lack of large reductions in the biosynthesis of lipid mediators by neutrophils after fish-oil supplementation.
Plasmapheresis Operations in the United States—1968
Authors: James B. Hartney
Journal: JAMA (1970)

The AMA Committee on Transfusion and Transplantation identified 173 facilities conducting plasmapheresis in the United States during 1968. Nearly 389 million ml of plasma were obtained from over 90,000 individual donors at 560,000 donor visits to these facilities. Incidence of donor reactions was in the range of 2% to 3%. In approximately 28% of the establishments providing data, there may be no physician present during the procedure of withdrawing whole blood from the donor, and separating and reinfusing the erythrocytes. Blood fractions obtained from the separated plasma will play an increasingly important role in direct and indirect patient care. Development of uniform criteria for donor selection and standards for donor care appears desirable.