tbuckley/cabot-search huggingface dataset:
The Good Euthanasia Guide 2004: Where, What, and Who in Choices in Dying
Authors: Tony Sheldon
Journal: BMJ (2004)

Dispel any ideas of choice this title conveys: euthanasia cannot be selected like a pub or restaurant. Euthanasia and assisted suicide enjoy varying degrees of legality in the Netherlands, Belgium, the state of Oregon, and Switzerland, but only the last allows foreigners to access euthanasia services. There, only one group, the Zurich based Dignitas, is prepared to help. This has courted a controversy. Suicide may be legal, but helping with it generally isn't.

Humphry, originally a journalist, has an eye for a catchy title, but this subject is hot enough by itself. The campaigner for the right …
Linear endosonographic appearance of esophageal intramural pseudodiverticulosis
Authors: K.-H. Lok, P. Vilmann
Journal: Endoscopy (2008)

A 72-year-old lady presented for evaluation of dysphagia and endoscopic ultrasound (EUS) staging of lung cancer. Upper endoscopy showed a short-segment, nontraversable stricture at the upper third of the esophagus. Examination after balloon dilation revealed inflamed mucosa with adherent whitish plaques, and multiple tiny diverticular orifices throughout the esophagus ([Fig. 1]).
Osler's Writing Style
Authors: Charles G. Roland
Journal: JAMA (1969)

It may not be considered revelatory to state that the young William Osier was at best a pedestrian writer, and that his vastly improved style in later years indicates the self-education of a determined self-critic. Yet this is my view, and certainly comforting to me, also somewhat preoccupied with self-criticism as a writer and editor. Perhaps others will be similarly encouraged. By his John's Hopkins years Osler "had learned to conceal the effort which all good writing requires, even in the gifted."<sup>1</sup> <h3>Early Osier</h3> In 1875, when he was 26 years old, Osler delivered an address on behalf of the medical faculty to the graduating class at McGill University. The speech was not only one of his earliest but also one of his poorest efforts. The major problem is the lack of a coherent theme. Though it is short, the address switches from the importance of continued study, to
124 IMPACT OF PNPLA3 (RS738409 C&gt;G) POLYMORPHISM ON FIBROSIS PROGRESSION AND STEATOSIS IN CHRONIC HEPATITIS C
Authors: E. Trépo, P. Pradat, A. Potthoff, T. Gustot, A. Lemmers, E. Quertinmont, P. Berthillon, J. Deviére, M. Manns, C. Trépo, H. Wedemeyer, D. Franchimont, C. Moreno
Journal: Journal of Hepatology (2011)
Dementia and marital status at midlife and late life
Authors: C. Helmer
Journal: BMJ (2009)

Risk is increased in people who are unmarried, especially if they are widowed

Marital status late in life has been related to the risk of dementia or cognitive decline in the next 3-10 years. People who were classified as unmarried,1 single,2 3 and single living alone4 are at increased risk of dementia or cognitive decline. This association was true even after adjustment for activities, social engagement, and living conditions and was independent of other risk factors for dementia.

Marital status seems to be only one risk factor among others, with a relatively small contribution to the development of dementia (relative risk 1.5-2.5). A change in marital status for cognitive reasons is probably rare in late life, but reverse causation cannot be excluded because of the long prodromal phase of dementia, particularly Alzheimer’s disease.5

In the linked study (doi:10.1136/bmj.b2462, Hakansson and colleagues evaluated marital status more than 20 years before the onset of dementia or cognitive impairment and thus dealt with the problem of …
Government advisers' suggestions for NHS savings don't add up
Authors: R. Jones
Journal: BMJ (2012)

Policy makers would do well to read Glasziou and colleagues’ excellent article on pay for performance as an object lesson in how to analyse the potential costs of change before committing to targets.1 Two recently published policy documents make extravagant claims for the savings to be made by adopting apparently mundane IT solutions in the NHS. The Department of Health report “The Power of Information” forecasts total savings of £2.865bn ($4.56bn; €3.6bn) from a revitalised NHS information strategy, of which £2.43bn is saved by giving patients direct access to medical records.2 A report by management consultants Transform, entitled “Digital by Default: the Delivery Choice for England’s Population,” proposes £2.9bn of savings from 10 so called easy wins, including £1.1bn savings by sending negative test results to patients by text message.3 All of these figures can be challenged.

Aside from potential double counting, digging behind these headline figures is revealing. “The Power of Information” provides financial spreadsheets that purport to give the evidence behind the claims.4 The £2.43bn saving is …
Observations on Antibiotics in the Treatment of Hepatic Coma and on Factors Contributing to Prognosis
Authors: James M. Stormont, Joseph E. Mackie, Charles S. Davidson
Journal: New England Journal of Medicine (1958)

STRIKING advances in the diagnosis, treatment and prognosis of hepatic coma have been made in recent years. Adams and Foley1 precisely described impending hepatic coma allowing early recognition of the clinical syndrome with the characteristic triad of flapping tremor, mental confusion and electroencephalographic changes. The importance of orally administered nitrogenous substances in the genesis of hepatic coma was emphasized by Phillips et al.2 and Gabuzda, Phillips and Davidson3 in 1952, reviving a concept that had remained dormant since the early 1930's.4 5 6 During the next several years, many investigators confirmed the role of nitrogenous substances in hepatic coma, and further elucidated . . .
Iron regulates phosphorylation of Smad1/5/8 and gene expression of Bmp6, Smad7, Id1, and Atoh8 in the mouse liver
Authors: Léon Kautz, Delphine Meynard, Annabelle Monnier, Valérie Darnaud, Régis Bouvet, Rui-Hong Wang, Chiuxia Deng, Sophie Vaulont, Jean Mosser, Hélène Coppin, Marie-Paule Roth
Journal: Blood (2008)
The modification of biophysical and endotoxic properties of bacterial lipopolysaccharides by serum.
Authors: R J Ulevitch, A R Johnston
Journal: Journal of Clinical Investigation (1978)

Normal rabbit serum reduces the buoyant density of lipopolysaccharide (LPS) from Escherichia coli 0111:B4 (d = 1.44 g/cm3) and Salmonella minnesota R595 (d = 1.38 g/cm3) to a value less than g/cm3. This density shift is associated with the inhibition of a number of endotoxic activities of the LPS; namely, the pyrogenic activity, the ability to produce an immediate neutropenia in rabbits, lethality in adrenalectomized mice, and anticomplementary activity. A qualitatively similar change in buoyant density was observed to occur after intravenous injection of the LPS into rabbits. Preliminary evidence suggests that the density shift does not occur as a result of the degradation of the glycolipid backbone of the LPS. These data suggest that the interactions of LPS with plasma (or serum) components leading to reduction in buoyant density may account for a major pathway of LPS detoxification.
Why less is worse for lupus
Authors: Hema Bashyam
Journal: The Journal of Experimental Medicine (2008)

Neutrophils need just enough copies of a gene for an antibody-binding receptor, say Willcocks et al. (page 1573). Whereas too few copies can contribute to lupus, too many can predispose to vasculitis.






Figure 1

Neutrophils with fewer copies of FCGR3B bind poorly to IgG complexes.




Cells can have as many as four copies of this gene, FCGR3B, which encodes the FcγRIIIb receptor, but some lupus patients have fewer than two. Willcocks et al. now find that this scarcity leads to fewer receptors on neutrophils, which thus fail to bind and destroy inflammation-causing antibody clusters. The paucity of receptors did not impair other neutrophil functions such as the production of oxygen radicals.

Some healthy individuals also had fewer copies of the gene and thus similarly defective neutrophils. But these individuals do not develop lupus, most likely because they lack other genetic defects required to cause disease. The compensatory influence of other genes might also explain why low copy number of FCGR3B is not a risk factor for lupus among all populations.

Having more FcγRIIIb receptors, however, doesn't guarantee good health. The group found that a high copy number of FCGR3B was associated with vasculitis—a disease in which neutrophils release damaging oxygen radicals in response to cross-linking of FcγRIIIb receptors on blood vessel walls.
Mean platelet volume as a marker of increased cardiovascular risk in patients with nonalcoholic steatohepatitis
Authors: Naim Alkhouri, Gaurav Kistangari, Carla Campbell, Rocio Lopez, Nizar N. Zein, Ariel E. Feldstein
Journal: Hepatology (2011)

Nonalcoholic fatty liver disease (NAFLD) has emerged as the most common cause of chronic liver disease in Western countries.1 NAFLD is frequently associated with obesity, diabetes, metabolic syndrome, and increased cardiovascular risk. Moreover, patients with the aggressive form of NAFLD, nonalcoholic steatohepatitis (NASH), may be at higher risk of atherosclerosis than patients with simple steatosis due to increased oxidative stress and systemic inflammation.2-4 Mean platelet volume (MPV) is a marker of platelet activation and a validated predictor of cardiovascular risk.5 Larger platelets are enzymatically more active than small platelets, produce more thromboxane A2, and have an increased propensity to thrombosis.6 The aim of this study was two-fold: first, to assess MPV levels in patients with biopsy-proven NAFLD, and second, to determine the relationship between the histological features of NASH and MPV. Our cohort consisted of 100 consecutive patients undergoing liver biopsy for clinical suspicion of NAFLD. Patients were divided into three groups: NASH (n = 52), simple steatosis (n = 25), and normal biopsy (n = 21). We measured MPV in blood samples collected at the time of liver biopsy. The mean age was 49.8 years (± 10.6 years), and the mean body mass index was 31.4 kg/m2 (± 4.8 kg/m2). The majority of patients were white (86%), and 48% were female. There was a stepwise significant increase in MPV levels from patients with normal biopsies to patients with simple steatosis to patients with NASH (9.5 fL, 10.2 fL, and 11.3 fL, respectively; P < 0.005) (Fig. 1). Moreover, there was a significant correlation between MPV levels and the individual histological features of NASH on liver biopsy, including inflammation (rho = 0.64), steatosis (rho = 0.65), ballooning (rho = 0.60), and fibrosis (rho = 0.61) (P < 0.001 for all). Stepwise significant increase in MPV levels from patients with normal biopsies to patients with simple steatosis to patients with NASH. The box represents the interquartile range (25th and 75th percentiles) from the median (the horizontal line), the bars represent the 95% confidence interval. We conclude that in adult patients with biopsy proven NAFLD, the histological severity of liver injury and inflammation is strongly associated with higher MPV levels and therefore potentially increased cardiovascular risk. The study has some limitations, including the cross-sectional design, small sample size, and relatively young patient population. Thus, a correlation between increasing MPV levels or NAFLD severity and previously documented cardiovascular events was not established. Larger studies are needed to validate our findings. Naim Alkhouri M.D.*, Gaurav Kistangari M.D.*, Carla Campbell R.N., SRNA*, Rocio Lopez M.D.*, Nizar N. Zein M.D.*, Ariel E. Feldstein M.S.*, * Digestive Disease Institute, Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH.
Dendritic Cells Are Responsible for the Capacity of CpG Oligodeoxynucleotides to Act as an Adjuvant for Protective Vaccine Immunity Against <i>Leishmania major</i> in Mice
Authors: Javeed A. Shah, Patricia A. Darrah, David R. Ambrozak, Tara N. Turon, Susana Mendez, Joanna Kirman, Chang-You Wu, Nicolas Glaichenhaus, Robert A. Seder
Journal: The Journal of Experimental Medicine (2003)

Vaccination with leishmanial Ag and CpG oligodeoxynucleotides (ODN) confers sustained cellular immunity and protection to infectious challenge up to 6 mo after immunization. To define the cellular mechanism by which CpG ODN mediate their adjuvant effects in vivo, the functional capacity of distinct dendritic cell (DC) subsets was assessed in the lymph nodes (LNs) of BALB/c mice, 36 h after immunization with the leishmanial antigen (LACK) and CpG ODN. After this immunization, there was a striking decrease in the frequency of the CD11c+B220+ plasmacytoid DCs with a proportionate increase in CD11c+CD8-B220- cells. CD11c+CD8+B220- cells were the most potent producers of interleukin (IL)-12 p70 and interferon (IFN)-gamma, while plasmacytoid DCs were the only subset capable of secreting IFN-alpha. In terms of antigen presenting capacity, plasmacytoid DCs were far less efficient compared with the other DC subsets. To certify that DCs were responsible for effective vaccination, we isolated CD11c+ and CD11c- cells 36 h after immunization and used such cells to elicit protective immunity after adoptive transfer in naive, Leishmania major susceptible BALB/c mice. CD11c+ cells but not 10-fold higher numbers of CD11c- cells from such immunized mice mediated protection. Therefore, the combination of LACK antigen and CpG ODN adjuvant leads to the presence of CD11c+ DCs in the draining LN that are capable of vaccinating naive mice in the absence of further antigen or adjuvant.
Determination of Measles, Mumps, and Rubella Immunization Status Using Oral Fluid Samples
Authors: Thomas Thieme
Journal: JAMA (1994)

<h3>Objective.</h3> —To determine if oral fluid samples can be used to reliably assess protective blood levels of antibodies to measles, mumps, and rubella. <h3>Design.</h3> —A comparison of matched serum and oral fluid samples from asymptomatic subjects in enzyme-linked immunosorbent assays for measles, mumps, and rubella antibodies. A longitudinal study compared matched serum and oral fluid samples from 11 subjects after measles-mumps-rubella vaccination. <h3>Setting.</h3> —Five US clinical sites with samples tested at the reporting laboratory. <h3>Participants.</h3> —A total of 157 asymptomatic subjects including 55 subjects younger than 18 years. <h3>Main Outcome Measures and Results.</h3> —The presence of antibodies in oral fluid specimens correlated with that in serum with the following levels of sensitivity and specificity: measles, 97% and 100%, respectively; mumps, 94% and 94%, respectively; rubella, 98% and 98%, respectively. Longitudinal studies of subjects after vac cination showed similar seroconversion profiles in oral fluid and serum samples. <h3>Conclusion.</h3> —Protective blood levels of antibodies to measles, mumps, and rubella can be assessed by means of an oral fluid sample with good reliability. (<i>JAMA</i>. 1994;272:219-221)
Angiotensin Amide Skin Test
Authors: John F. Mullane
Journal: JAMA (1964)

<h3>To the Editor:—</h3> In their article on angiotensin amide skin tests (<i>JAMA</i><b>186</b>:507 [Nov 2] 1963) Dr. Hazelrig and his associates based their conclusion that the test was a nonspecific reaction on an unwarranted assumption that all tests above 30 minutes were positive. They failed to establish their own normal mean and compare it with that of the hypertensive group. I have used the angiotensin skin test on both dogs and humans, having performed 1,300 tests on 120 dogs and an additional 50 on humans. After repeated tests on 41 dogs, I found the average value to be 29 minutes ± 21, and in preliminary studies on 20 normal humans, the average value was 59 minutes ± 36. In dogs, I found the skin test to be significantly prolonged by ascites secondary to common bile duct ligation, by pregnancy, and temporarily, up to two weeks, by constriction of the
Ascending pneumonia complicating endoscopic therapy of a pancreatic abscess
Authors: A. Umgelter, C. Prinz, J. Gaa, W. Huber
Journal: Endoscopy (2007)

A 71-year-old man with multiorgan failure caused by necrotizing pancreatitis was discharged from the intensive care unit after a 6-week stay. Two weeks later he developed a spiking fever, abdominal tenderness, and an abdominal mass. Computed tomography revealed a large pancreatic abscess that was compressing the duodenum and gastric wall ([Fig. 1]). Because of the interposition of bowel, transcutaneous drainage was risky and an endoscopic approach was chosen. After transmural duodenocystic puncture and dilation, a 7-Fr double-pigtail stent and a nasocystic tube were inserted ([Fig. 2]). Two days after the cystogastrostomy the patient developed dyspnea and hypoxia, became drowsy, and had to be intubated and mechanically ventilated. Chest radiography revealed patchy infiltrates in the lower lobe of the right lung and bronchoalveolar lavage was performed. Cultures grew Klebsiella oxytoca, Enterococcus faecium, and Candida glabrata, and these organisms were also grown from cultures of the aspirate from the pancreatic abscess. The patient died of septic multiorgan failure after a long period of intensive-care treatment.
Acute Renal Failure Due to Bilateral Renal Artery Emboli: Case Report
Authors: A. M. Joekes, K. Owen, T. Sherwood
Journal: BMJ (1964)

Background: Prognosis of patients with metastatic pancreatic cancer is dismal. Recently, two first-line combination chemotherapy regimens have shown a survival benefit over single-agent gemcitabine. Patients and Methods: A 57-year old metastatic pancreatic cancer patient from our department (Eastern Cooperative Oncology Group performance status (ECOG PS): 0, baseline carbohydrate antigen (CA) 19-9 level: 2,900 U/ml) received 12 cycles of first-line chemotherapy with nab-paclitaxel and gemcitabine until disease progression within the pivotal Metastatic Pancreatic Adenocarcinoma Clinical Trial (MPACT). Results: Treatment with nab-paclitaxel and gemcitabine resulted in a partial response by Response Evaluation Criteria in Solid Tumors (RECIST), a rapid biochemical CA 19-9 response, a progression-free survival of 13 months and an overall survival of 20 months. Leukopenia grade 3 prompted dose reduction by two dose levels. Non-hematological toxicities included alopecia, skin rash, nail changes and peripheral neuropathy (all grade 2 or less). Conclusion: First-line combination chemotherapy with nab-paclitaxel and gemcitabine is an effective and manageable treatment option for patients with metastatic pancreatic cancer with the potential for long-term disease control.
Campaigners call for libel law changes that promote open debate in science
Authors: C. Dyer
Journal: BMJ (2011)

A clear and effective public interest defence, restrictions on corporate bodies suing for defamation, and an end to libel tourism must form part of the forthcoming defamation bill for England and Wales, say campaigners.

Publication of the bill was imminent as the Libel Reform Campaign launched its demands at the Houses of Parliament on 10 March. The government has accepted that the draconian libel laws need reform, but the final shape of the bill is still unclear.

Critics, including senior judges, say the current law, which favours defendants, and the huge costs of libel actions in England, operate to chill free speech on matters of public interest. …
Differential Expression of S100A2 and S100A4 During Progression of Human Prostate Adenocarcinoma
Authors: Sanjay Gupta, Tajamul Hussain, Gregory T. MacLennan, Pingfu Fu, Jigar Patel, Hasan Mukhtar
Journal: Journal of Clinical Oncology (2002)

To establish the clinical significance of calcium binding proteins S100A2 and S100A4 during progression of human prostate adenocarcinoma.Expression pattern of S100A2 and S100A4 was determined in normal human prostate epithelial cells (NHPE); virally transformed prostate epithelial cells (PZ-HPV-7); several human prostate carcinoma cells (22Rv1, DU145, LNCaP, and PC3); tissue samples obtained during transuretheral prostatic resection from patients with benign prostate hyperplasia (BPH), prostatitis, and adenocarcinoma; and paraffin-embedded sections from pair-matched benign and cancer specimens of different tumor grade.High constitutive protein expression of S100A2 was observed in NHPE and PZ-HPV-7 cells, whereas its complete absence was observed in 22Rv1, DU145, LNCaP, and PC3 cells. Tissue samples of BPH and prostatitis exhibited higher mRNA and protein levels of S100A2 than low-grade cancer (Gleason score <or= 6), whereas a complete loss was observed in high-grade cancer specimens (Gleason score > 6). Immunohistochemical analysis further confirmed high levels of S100A2 in benign tissues and a progressive loss with increasing tumor grade. The protein level of S100A4 was significantly higher in all carcinoma cells compared with NHPE and PZ-HPV-7 cells. The mRNA and protein level of S100A4 was significantly higher in high-grade cancer specimens compared with BPH, prostatitis, and low-grade cancer. The high levels of S100A4 observed in cancer tissue correlated with increasing tumor grade.Loss of S100A2 and increased expression of S100A4 may be an important event during progression of prostate cancer in humans.
Network is set up to champion independent sector treatment centres
Authors: Madeleine Brettingham
Journal: BMJ (2006)

A new body representing 11 independent healthcare organisations working with the NHS was launched last week.

Representatives of the NHS Partners Network (www.nhspartnersnetwork.org) met the prime minister, Tony Blair, at Downing Street last week in an attempt to combat bad publicity over plans to expand the network of independent sector treatment centres. Currently 21 such centres—privately run clinics that are commissioned to perform routine operations on NHS patients—operate in England.

Mark Smith, chairman of the new network, said that the group was determined to end the “sterile debate” between the public and private healthcare sectors and wanted to counter the fears voiced by some doctors and about the …
Culture, Illness, and Care
Authors: ARTHUR KLEINMAN
Journal: Annals of Internal Medicine (1978)

Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such concepts is described and illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capable of translating concepts from cultural anthropology into clinical language for practical application. The implementation of this approach in medical teaching and practice requires more support, both curricular and financial.
A Note on Twenty-Seven Cases of Perin Aeorraphy
Authors: F. Barnes
Journal: BMJ (1885)

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