tbuckley/cabot-search huggingface dataset:
Medical Inquiry and the Law
Authors: Paul D. Lipsitt
Journal: New England Journal of Medicine (1967)

AS inquiry broadens into the human condition, conflict develops in the gray area of individual rights and social benefit. An irony of the free society is that the value of free inquiry may usurp the equally important value of individual freedom.Resolution of conflicting issues has traditionally been the domain of the law as balancing agent between the rights of the individual and the benefits for society. In modern times society has placed high value on the quest for knowledge, as well as human dignity and freedom. Thus, in the scientific arena, the extent and nature of the intrusion must . . .
Treatment of Sore Throat-Reply
Authors: Anthony L. Komaroff
Journal: JAMA (1978)

Dr Ravenel and I both agree that the available evidence suggests that penicillin treatment produces only a modest acceleration in the resolution of symptoms. For reasons I will describe, I wonder if the available evidence is applicable to current practice. If it is not, we may never have the relevant evidence, since a controlled trial of penicillin therapy at this point in history would raise ethical questions. The study by Denny et al<sup>1</sup>and another report from the Warren Air Force Base by Brink et al<sup>2</sup>are pertinent. Both report controlled trials of penicillin therapy in young adult men with exudative pharyngitis, most of whom had streptococcal infection. In both studies history and physical examination data were collected meticulously. At the same time, certain limitations of these studies should be noted. Both are almost 30 years old and were performed at a time when the severity
The Rab11a GTPase Controls Toll-like Receptor 4-Induced Activation of Interferon Regulatory Factor-3 on Phagosomes
Authors: Harald Husebye, Marie Hjelmseth Aune, Jørgen Stenvik, Eivind Samstad, Frode Skjeldal, Øyvind Halaas, Nadra J. Nilsen, Harald Stenmark, Eicke Latz, Egil Lien, Tom Eirik Mollnes, Oddmund Bakke, Terje Espevik
Journal: Immunity (2010)
NHS must enlist the help of patients in redesigning the service
Authors: C. White
Journal: BMJ (2012)

The NHS must recruit patients to “work” for it, in the same way that banks and other commercial bodies capitalise on consumers’ free labour, if it is to redesign services effectively and save much needed cash, experts have claimed.

The concept, known as “co-production” or “privatising citizens’ labour,” entails devolving some element of care to patients, and maximising their expertise and experience.

At a panel discussion at the NHS Confederation annual conference in Manchester last week, Rob Webster, chief executive of Leeds Community Health NHS Trust, explained that there was “no alternative” to service redesign.

Without it, the current system would be unsustainable within five years and unable to meet the needs of the people who use it, he said. …
Blood and Water
Authors: D. J. Bonnington
Journal: JAMA (1972)

<h3>To the Editor.—</h3> Victims of crucifixion frequently died of rupture of the myocardium with a resultant pericardial tamponade. The Roman soldiers were not likely to puncture the bladder, as Dr. Crosby suggests, but were experts with the short sword and lance in seeking unerringly the heart itself. The pooled blood having separated in the pericardial sac resulted in the emission of the Biblical "blood and water."
Polyneuropathy and Anasarca: Evidence for a New Connective-Tissue Syndrome and Vasculopathic Contribution
Authors: David E. Trentham, Alfonse T. Masi, Howard W. Marker
Journal: Annals of Internal Medicine (1976)

A 41-year-old woman manifested a polyneuropathy, anasarca, pseudotumor cerebri, hyperhidrosis and hyperpigmentation of the skin, generalized lymphadenopathy, distal esophageal dysphagia, pleuritis, platelike pulmonary atelectasis, fluctuating renal insufficiency, hepatosplenomegaly, amenorrhea, and slight fever suggesting a connective-tissue disorder. Extensive clinical and laboratory evaluation did not support the initial impression of progressive systemic sclerosis or systemic lupus erythematosus but did show nonnecrotizing vascular changes, mild polyclonal gammopathy, and low thyroxin levels similar to the syndrome of polyneuropathy and endocrine disturbances recently reported from Japan. The impressive response to moderate-dose corticosteroids and exacerbation on withdrawal require diagnostic awareness of this insidiously progressive multisystem disorder. A bland vasculopathic process resulting from metabolic or immunologic disturbances appears to be the best explanation for this new syndrome, which has previously been recognized only in Japan.
Kidney failure with a diagnostic chest radiograph
Authors: W. G. Herrington, D. A. Lewis
Journal: BMJ (2012)

An 87 year old woman presented with breathlessness, which was worse on exertion and when she was lying flat. She had a longstanding history of hypertension, hypercholesterolaemia, and cigarette smoking. She had been referred to a nephrologist two years earlier and was found to have a creatinine of 270 μmol/L, with 2+ proteinuria on urine dipstick, a normal albumin (45 g/L), and no oedema. She was lost to follow-up before investigations were complete. On re-presentation, she described new shoulder and lower back pain. Her pulse was 80 beats/min and regular, blood pressure was 130/60 mm Hg, and jugular venous pressure was raised with bibasal inspiratory crepitations and peripheral oedema. Urine dipstick showed 3+ proteinuria and a trace of blood (recent protein:creatinine ratio 850 mg/mmol; reference value <15 mg/mmol). Her urea was 35 mmol/L (2.5-6.7), creatinine 357 μmol/L (54-145), albumin 32 g/L (35-50), haemoglobin 80 g/L (120-150; normocytic picture), and kidney bipolar length was 10 cm on both sides. Serum and urine protein electrophoresis was performed and immunoglobulins, antineutrophil cytoplasmic antibodies, antineutrophil antibodies, and complement components were measured. After a week of diuretics her urea and creatinine increased to 53 mmol/L and 601 μmol/L, respectively, with ongoing oedema. She started haemodialysis. A chest radiograph obtained at re-presentation is shown in fig 1⇓. Fig 1 Chest radiograph
An Approach to the Ideal Stethoscope
Authors: David Littmann
Journal: JAMA (1961)

AN IDEAL stethoscope should be able to deliver to the ears, without important loss or distortion, all audible physiological phenomena. These sounds normally fall in the acoustic range of 60-600 cycles per second, with some unimportant components of mitral diastolic murmurs below 60 and a few pulmonary rhonchi and rales as high as 1,000 cycles. Popular conceptions notwithstanding, no acoustic stethoscope amplifies or increases the original sounds. The very best ones transmit them to the examiner's ears with relatively few losses. Since its introduction by Laennec, in 1819, the stethoscope has undergone many alterations and refinements, and it now consists of a number of interdependent elements. There are one or more chest pieces—the collectors or accumulators of sounds—a binaural with spring and ear pieces, and connecting lengths of flexible tubing. The natural characteristics of these components have been investigated and can be summarized as follows: The accumulator, or chest
Effects of abrupt changes in cycle length on refractoriness of the His-Purkinje system in man.
Authors: S Denker, M Shenasa, C J Gilbert, M Akhtar
Journal: Circulation (1983)

Abrupt changes in cycle length (CL) occur frequently in the clinical setting of atrial fibrillation. However, the effects of such changes on the His-Purkinje system (HPS) have not previously been considered during aberrant ventricular conduction (VAb). In 12 patients who manifested VAb with atrial premature stimulation (A2) during sinus rhythm, the relative refractory period (RRP) of the HPS was evaluated during a constant atrial CL (method I) and during abrupt changes in the CL (method II), wherein the A2 was coupled to an atrial CL (last A1A1) comparable to method I. This last A1A1 during method II was preceded by a series of constant atrial CLs 100-200 msec longer (method IIA) in 11 of 12 patients, or 109-300 msec shorter (method IIB) in all 12 patients. Although abrupt changes in the atrial CL using method IIA resulted in a longer HH interval (by 0-30 msec; mean 13.2 +/- 9.2 msec) preceding the A2, the RRP-HPS was 5-20 msec shorter (mean 9.3 +/- 5.3 msec) compared with method I in eight patients. The effect of abrupt changes was further evaluated in nine patients using method III, with a constant atrial CL, with a duration equal to the last H1H1 interval of method IIA. The VAb that occurred with method III was not manifested with method IIA in seven of nine patients, and in two patients the RRP-HPS was the same or less. Conversely, method IIB resulted in a shorter HH interval (by 0.110 msec; mean 28.9 +/- 21.1 msec) preceding A2, but in 10 patients, RRP-HPS was 5-40 msec longer (mean 20.7 +/- 10.5 msec) than that of method I and in two, VAb was only manifested using method IIB. Further scanning with method III, derived from the HH interval immediately preceding A2 of method IIB, was performed in seven patients and compared with method IIB. Prolongation in the RRP-HPS was shown using the latter method. The results indicate that abrupt changes in CL influence the functional behavior of the HPS in a manner not anticipated. Such changes may have important implications in determining the occurrence of VAb during atrial fibrillation.
Accurate Prediction of the Outcome of Pediatric Intensive Care
Authors: Murray M. Pollack, Urs E. Ruttimann, Pamela R. Getson
Journal: New England Journal of Medicine (1987)

Abstract We surveyed nine pediatric intensive care units (ICUs) to compare patient populations and to test prospectively the hypothesis that differences in mortality rates were due to differences in severity of illness. Age, clinical service, the reason for admission (emergency or scheduled), and the seriousness of the underlying chronic disease were recorded on admission. The severity of illness was assessed on the day of admission with a physiology-based measure, the Physiologic Stability Index. The resulting score was used to group patients according to mortality risk. The observed numbers of ICU survivors and nonsurvivors in each mortality-risk group from eight of the pediatric ICUs were compared with the predicted numbers of survivors and nonsurvivors calculated from a mathematical function (logistic model) derived earlier from data on 822 patients at one of the institutions. Patient populations in the ICUs differed significantly with respect to age (range of medians, 15 to 36 months; P<0.0001), medical admissions (range, 39 to 81 percent; P<0.0001), emergency admissions (range, 53 to 91 percent; P<0.0001), and the percentage of patients with serious underlying chronic disease (range, 18 to 48 percent; P<0.0001). Mortality rates also differed significantly (range, 3.0 to 17.6 percent; P<0.0001), as did the Physiologic Stability Index scores (P<0.0001). The mathematical function based on the Physiologic Stability Index score and on age reliably predicted the outcomes in all ICUs. We conclude that differences in mortality rates among pediatric ICUs can be explained by differences in the severity of illness. (N Engl J Med 1987;316:134–9.)
OBRA Regulations for Nursing Homes—Enhancing Paperwork or Patient Care?
Authors: Joseph G. Ouslander
Journal: Annals of Internal Medicine (1994)

Letters1 November 1994OBRA Regulations for Nursing Homes—Enhancing Paperwork or Patient Care?Joseph G. Ouslander, MD and Dan Osterweil, MDJoseph G. Ouslander, MDSearch for more papers by this author and Dan Osterweil, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-121-9-199411010-00036 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Both Drs. Portnoi and Jameson view OBRA 1987 as an unnecessary and counterproductive bureaucratic intrusion into the practice of geriatric care in nursing homes. Although promoting OBRA was not a primary objective of our review, we do believe that when viewed in proper context, these regulations will foster improved care for nursing home residents. We recognize that many caring physicians like Drs. Portnoi and Jameson struggle to provide high-quality, cost-effective care to nursing home residents in the face of seemingly endless paperwork, needless regulations enforced by often overzealous and sometimes adversarial inspectors, and limited resources.The OBRA legislation ...References1. Ouslander JG. Reducing the hospitalization of nursing home patients (Editorial). J Am Geriatr Soc. 1988; 36:171-3. Google Scholar2. Ouslander JG, Schnelle JF. Research in nursing homes: practical aspects. J Am Geriatr Soc. 1993; 41:182-7. Google Scholar3. Schnelle JF, Ouslander JG, Osterweil D, Blumenthal S. Total quality management: administrative and clinical application in nursing homes. J Am Geriatr Soc. 1993; 41:1259-66. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1994Volume 121, Issue 9Page: 724-725KeywordsAgingGeriatric careHealth care facilitiesHealth care qualityHealth services researchHospitalizationsLegislationMotivationNursing homesPatients Issue Published: 1 November 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Abstract 577: Equol enhances tamoxifen's antitumor effect by induction of caspase-mediated apoptosis in MCF-7 breast cancer cells
Authors: Christiana Charalambous, Andreas I. Constantinou
Journal: Cancer Research (2012)

Abstract Soy phytoestrogens, such as daidzein and its metabolite equol, have been proposed to be responsible for the low breast cancer rate in Asian women. However, since these compounds possess both estrogenic and anti-estrogenic properties, it remains unknown whether they provide protection against tumor development and progression. Since the majority of estrogen receptor positive (ER+) breast cancer patients are treated with the selective estrogen receptor modulator tamoxifen, the basic objective of this project is to determine whether equol enhances or inhibits tamoxifen's anti-tumor effect and to identify the molecular mechanisms involved. For this purpose, we examined the individual and combined effects of equol and tamoxifen on the ER+ breast cancer cell line MCF-7 (ERα+/−Rα+). We found that equol at concentrations higher than 10 μM significantly reduced the viability of MCF-7 cells. Furthermore, the combination of equol (100 μM) and 4-hydroxytamoxifen (4-OHT; 10 μM) reduced MCF-7 cell viability and induced apoptosis more effectively than each compound alone. Subsequent treatment of MCF-7 cells with the pan-caspase inhibitor Z-VAD-FMK and the calpain/cathepsin inhibitor ALLN demonstrated that equol and 4-OHT induce apoptosis via both caspase-depended and -independed mechanisms. In order to further investigate the apoptotic pathways employed by equol, 4-OHT and their combination, we evaluated the expression of key proteins involved in apoptosis such as PARP, α-fodrin, AIF, bcl-2, bax, p21 and p53 using Western blot analysis. The combination of 4-OHT and equol induced PARP and α-fodrin cleavage which was inhibited by Z-VAD-FMK indicating that their combination induces caspase-depended apoptosis. This was accompanied by reduced bcl-2:bax ratio confirming a pro-apoptotic effect. The combination of equol and 4-OHT induced caspase-7 cleavage indicating a significant role for caspase-7 in equol- and tamoxifen-induced apoptosis. Finally, upon determination of the effect of equol and tamoxifen on estrogen receptor expression in MCF-7 cells, it was found that equol reduces the ERα:ERα ratio, while 4-OHT increases it. When cells were treated with both compounds we observed that the effect of equol prevailed, providing an additional explanation for the beneficial combined effects of equol and tamoxifen. In conclusion, the effects of equol in potentiating tamoxifen's anti-tumor effect may be explained by the induction of the caspase-mediated apoptotic pathway and the reduction of the ERα:ERα ratio. These results can find applications in clinical or pre-clinical cancer chemoprevention studies against breast cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 577. doi:1538-7445.AM2012-577
Prescription practice of biological drugs in rheumatoid arthritis during the first 3 years of post-marketing use in Denmark and Norway: criteria are becoming less stringent
Authors: E Hjardem, M L Hetland, M Østergaard, N S Krogh, T K Kvien
Journal: Annals of the Rheumatic Diseases (2005)

<b>Background:</b> The study was based on the Danish DANBIO and the Norwegian NOR-DMARD databases. <b>Objective:</b> To investigate changes in prescription practice during the first 3 years of post-marketing use of biological drugs, and to determine the proportion of patients who would not have received tumour necrosis factor (TNF) blocking agents if the prescription guidelines of the UK and the Netherlands had been applied. <b>Methods:</b> Patients with rheumatoid arthritis (RA) receiving TNF blocking agents from Denmark (n = 823, median age 56.0, 72.2% women) and Norway (n = 371, median age 52.5, 75.4% women) were studied. Prescription guidelines in the UK and the Netherlands were applied to the data. <b>Results:</b> Baseline disease activity and number of previous DMARDs declined significantly during the 3 years (median baseline DAS28 decreased from 5.8 to 5.2 in Denmark (p&lt;0.001) and from 6.0 to 5.6 in Norway (p&lt;0.01)). 47.9% and 41.3% of the Norwegian and Danish patients, respectively, did not meet the UK criteria for using TNF blocking agents, and 10.5% and 5.7% did not meet the Dutch criteria. <b>Conclusion:</b> Danish and Norwegian prescription practices of biological treatments in RA were similar, and became less stringent from 2000 to 2003. Prescriptions agreed well with the Dutch guidelines, but almost half the patients did not meet the UK guidelines.
The Harveian Oration on THE BIRTH OF CHEMICAL BIOLOGY
Authors: J. B. Leathes
Journal: BMJ (1930)

The thoracic cage appears to be large during attacks of asthma. Lung volume measurements by body plethysmography and helium dilution have suggested that total lung capacity may be increased during an acute attack of asthma, but doubt has been cast on the accuracy of these measurements in the presence of airflow obstruction. The change in total lung capacity has therefore been investigated during and after an acute attack of severe asthma in 32 patients by a radiographic technique. There was a small decrease (0.29 l) in mean total lung capacity between admission and follow up, though a quarter of the subjects showed a slight increase. There was no correlation between change in total lung capacity and change in expiratory flow rates, arterial carbon dioxide tension on admission, body mass index, and length of stay in hospital. Our findings agree with previous reports of a decrease in total lung capacity with improving airway obstruction, but the changes were small and inconsistent.
NON-CULPRIT PLAQUES IN PATIENTS WITH ACUTE CORONARY SYNDROME (ACS) HAVE MORE VULNERABLE FEATURES COMPARED TO THOSE WITH NON-ACS: A 3 VESSEL OCT STUDY
Authors: Koji Kato, Taishi Yonetsu, Soo-Joong Kim, Lei Xing, Iris McNulty, Robert Yeh, Rahul Sakhuja, Hang Lee, Shaosong Zhang, Shiro Uemura, Bo Yu, Kyoichi Mizuno, Ik-Kyung Jang
Journal: Journal of the American College of Cardiology (2012)
Deficiency of T Helper Cells in Transient Hypogammaglobulinemia of Infancy
Authors: R. Lawrence Siegel, Thomas Issekutz, Jerrold Schwaber, Fred S. Rosen, Raif S. Geha
Journal: New England Journal of Medicine (1981)

We studied 17 patients with transient hypogammaglobulinemia of infancy to define the immunologic defect responsible for this disorder. The number of circulating B cells in these patients was normal, as was the ability of the B cells to synthesize immunoglobulins when stimulated with Epstein-Barr virus, a direct B-cell activator. However, the capacity of the B cells to synthesize IgG in response to pokeweed mitogen, a T-cell-dependent B-cell activator, was depressed. Experiments with cultured lymphocytes indicated that excess suppressor-cell activity was not present in these patients, but that their T cells were deficient in providing help to B cells from their normal parents. A numerical deficiency in T4-positive (T4+) helper cells was found. Patients who had recovered from the disorder had a normal number of T4+ helper cells. Our results indicate that a numerical, as well as a functional, deficiency in helper T cells underlies the deficiency in IgG production in transient hypogammaglobulinemia of infancy.
Induced rearrangement of kappa genes in the BLIN-1 human pre-B cell line correlates with germline J-C kappa and V kappa transcription.
Authors: D Martin, R Q Huang, T LeBien, B Van Ness
Journal: The Journal of Experimental Medicine (1991)

The human pre-B acute lymphoblastic leukemia cell line, BLIN-1, has been previously shown to undergo kappa light chain rearrangement in vitro, making it a valuable resource for analyzing pre-B to B cell differentiation. We have examined the recombination potential of BLIN-1 by characterizing several independently derived kappa-expressing subclones for DNA rearrangement and V kappa gene usage. Analysis of five kappa-expressing subclones (all having the same heavy chain rearrangement) demonstrated independent kappa light chain rearrangement events by DNA hybridization analysis. Northern blot analysis using probes recognizing the four different V kappa families revealed that two subclones used the most proximal V kappa (V kappa IV), one subclone used a V kappa I, and one subclone used a V kappa II. By polymerase chain reaction analyses, we detected transcripts from rearranged V-J-C kappa genes as well as transcripts from germline J-C kappa and V kappa in BLIN-1 cells induced to rearrange the kappa locus. kappa germline transcripts were also detected in normal developing B cell populations in fetal liver and bone marrow. Our collective results indicate that: (a) BLIN-1 can be induced to rearrange the kappa locus, and this correlates with the expression of germline kappa locus transcripts that may play a role in activating or targeting gene rearrangement; and (b) active rearrangement and usage of V genes representing different kappa families suggest that, like in the mouse, repertoire diversification in humans occurs in the presence of a fixed heavy chain rearrangement.
Emotional Profiles of Families with a Heart-Operated Patient: A Pilot Study
Authors: Giordano Invernizzi, Cinzia Bressi, Paolo Bertrando, Alberto Passerini, Andrea Giannelli, Massimo Clerici, Paolo Biglioli, Carlo L. Cazzullo
Journal: Psychotherapy and Psychosomatics (1991)

Family interaction is a basic factor in determining the quality of life of patients undergoing heart surgery. The present study investigates the emotional attitudes in the relatives of 10 heart-operated patients. The results indicate that a high amount of relatives' emotional overinvolvement and warmth tends toward a correlation with lower anxiety and depression scores, and with a better 12-month outcome of the illness.