tbuckley/cabot-search huggingface dataset:
Clinics may not have to consider child's “need for a father” when offering IVF
Authors: Clare Dyer
Journal: BMJ (2006)

The government is poised for a rethink of the law on in vitro fertilisation (IVF), which is expected to abolish the requirement of clinics to consider a child's “need for a father” when deciding who to treat.

The change would give lesbians and single mothers the same access to infertility services as mothers with male partners.

The present law governing licensed clinics, the Human Fertilisation and Embryology Act 1990, says that a woman may not be given treatment unless account has been taken of the welfare of the …
Demonstration of Dual A-V Nodal Pathways in Patients with Paroxysmal Supraventricular Tachycardia
Authors: PABLO DENES, DELON WU, RAMESH C. DHINGRA, RUBEN CHUQUIMIA, KENNETH M. ROSEN
Journal: Circulation (1973)

Electrophysiological evidence suggestive of dual atrioventricular (A-V) nodal pathways is presented in two patients with normal P-R interval and reentrant paroxysmal supraventricular tachycardia (PSVT). His bundle recordings and atrial stimulation were used to obtain this electrophysiological evidence. Refractory periods were measured with the atrial extra-stimulus technique. Plotting of H 1 -H 2 responses against A 1 -A 2 coupling intervals revealed that as A 1 -A 2 decreased, H 1 -H 2 decreased appropriately. At a critical A 1 -A 2 , a sudden marked increase in H 1 -H 2 occurred, suggesting failure of fast pathway, (defining the fast pathway effective refractory period ERP). Further shortening of A 1 -A 2 defined a second H 1 -H 2 curve. The longest A 1 -A 2 with no H 2 response was defined as the slow pathway ERP. Echo zones coincided with A 1 -A 2 intervals equal to or less than the fast pathway ERP. These results provide the first electrophysiological demonstration of dual A-V nodal pathways in patients with normal P-R interval and PSVT, as manifest by dual A-V nodal conduction times and refractory periods. Antegrade failure of the fast pathway with subsequent availability for retrograde conduction could allow A-V nodal reentry. These findings provide a basis for reentrance in some patients with reentrant PSVT.
Edinburgh primary care depression study: treatment outcome, patient satisfaction, and cost after 16 weeks.
Authors: A. I. Scott, C. P. Freeman
Journal: BMJ (1992)

OBJECTIVE--To compare the clinical efficacy, patient satisfaction, and cost of three specialist treatments for depressive illness with routine care by general practitioners in primary care. DESIGN--Prospective, randomised allocation to amitriptyline prescribed by a psychiatrist, cognitive behaviour therapy from a clinical psychologist, counselling and case work by a social worker, or routine care by a general practitioner. SUBJECTS AND SETTING--121 patients aged between 18 and 65 years suffering depressive illness (without psychotic features) meeting the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition for major depressive episode in 14 primary care practices in southern Edinburgh. MAIN OUTCOME MEASURES--Standard observer rating of depression at outset and after four and 16 weeks. Numbers of patients recovered at four and 16 weeks. Total length and cost of therapist contact. Structured evaluation of treatment by patients at 16 weeks. RESULTS--Marked improvement in depressive symptoms occurred in all treatment groups over 16 weeks. Any clinical advantages of specialist treatments over routine general practitioner care were small, but specialist treatment involved at least four times as much therapist contact and cost at least twice as much as routine general practitioner care. Psychological treatments, especially social work counselling, were most positively evaluated by patients. CONCLUSIONS--The additional costs associated with specialist treatments of new episodes of mild to moderate depressive illness presenting in primary care were not commensurate with their clinical superiority over routine general practitioner care. A proper cost-benefit analysis requires information about the ability of specialist treatment to prevent future episodes of depression.
Evidence-Based Diagnostic Strategies for Evaluating Suspected Allergic Rhinitis
Authors: Karna Gendo, Eric B. Larson
Journal: Annals of Internal Medicine (2004)

Allergic rhinitis is an increasingly common disease, with a prevalence of at least 10% to 25% in the United States. Diagnostic allergy tests, such as skin tests and in vitro tests, can assist clinicians in determining whether nasal symptoms are allergic in origin. In addition, safe and effective medications are available to treat allergic rhinitis. The initial strategy should be to determine whether patients should undergo diagnostic testing or receive empirical treatment. This paper reviews the test characteristics of the history, skin tests, and in vitro tests in diagnosing allergic rhinitis from the perspective of decision thresholds. A combination of pertinent medical history features in a practice with a high baseline prevalence of allergic rhinitis justifies the common practice of empirical treatment since allergy medication has minimal toxicity and side effects. The situation is more complex when the patient needs a diagnostic test, because reported sensitivities and specificities of skin tests and in vitro tests vary widely. As a result, it is difficult to calculate the post-test probability of allergic rhinitis with any confidence. The decision to initiate diagnostic testing must rely on clinical judgment to select patients who would benefit most from determining their allergic status while minimizing unnecessary testing and medications. Diagnosing allergy to a specific antigen allows patients to avoid the allergen and makes them candidates for allergen immunotherapy, which can decrease the need for medications.
The Doctor's Perspective: Physicians View Their Patients and Practice
Authors: Sanford A. Franzblau
Journal: JAMA (1968)

The central element in medical practice is the interaction between the doctor and the patient. In this book, social scientists and physicians use their combined talents to take a critical look at this interaction. They have chosen as their study-sample physicians who practice medicine in Cleveland. Doctors, chosen at random from the American Medical Association's directory listings for that city, were asked to respond to a carefully constructed and pretested questionnaire. Excluded from the sample were physicians who had little patient contact (administrators, laboratory types, anesthesiologists, etc). Also excluded were interns and residents. Responses were obtained from 178 of the 250 physicians selected. These responses form the material from which the data were subsequently drawn. The book, whose format reminds one of a PhD thesis, is a thoughtful work, carefully prepared and meticulously presented. There is the usual historical review, the developmental story of the study, the methodology, the analysis
Meperidine and General Anesthesia
Authors: Richard S. Ryan
Journal: JAMA (1970)

<h3>To the Editor.—</h3> It seems to me a very simple answer to the query in QUESTIONS AND ANSWERS (<b>210:</b>2402, 1969), on supplemental use of meperidine hydrochloride in general anesthesia, would be to run a postoperative urine test (chromatography) for meperidine. This should indicate if and how much meperidine had been used with the thiopental.
Exposing Unethical Human Research
Authors: Howard M. Spiro
Journal: Annals of Internal Medicine (2012)

Letters15 May 2012Exposing Unethical Human ResearchHoward M. Spiro, MDHoward M. Spiro, MDFrom Yale School of Medicine, New Haven, CT 06510.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-10-201205150-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Gaw's report (1) of the Beecher–Pappworth correspondence deserves widespread discussion. Unless academic physicians discuss the sins of the past over and over again, how can we hope to prevent them in the future?As a 1947 graduate of Harvard Medical School and intern at the Peter Bent Brigham Hospital in the 1940s, I remember learning of an unspoken though implicit medical compact between ward patients and hospital doctors: We took care of them for free, and in return they gave us their bodies to study.Did I “learn” that—did someone say it out loud—or was it in ...Reference1. Gaw A. Exposing unethical human research: the transatlantic correspondence of Beecher and Pappworth. Ann Intern Med. 2012;156:150-5. [PMID: 22250147] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Howard M. Spiro, MDAffiliations: From Yale School of Medicine, New Haven, CT 06510.Dr. Spiro passed away on 11 March 2012.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoExposing Unethical Human Research: The Transatlantic Correspondence of Beecher and Pappworth Allan Gaw Metrics 15 May 2012Volume 156, Issue 10Page: 754KeywordsConflicts of interestForecastingGraduate medical educationPatientsPernicious anemia ePublished: 15 May 2012 Issue Published: 15 May 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Prevalence of Calcification in the Pedal Arteries in Diabetes Complicated by Foot Disease
Authors: Anish Sharma, Brigitte E. Scammell, K. Julia Fairbairn, Michael J. Seagrave, Frances L. Game, William J. Jeffcoate
Journal: Diabetes Care (2010)

Medial arterial calcification (MAC) typically affects the distal vasculature, probably because of a causative relationship with peripheral and autonomic neuropathies. The complex processes involved have recently been reviewed (1). Classic surveys reported that MAC was particularly common in Charcot disease (2,3), suggesting that it might be a specific feature of the condition. However, it is equally possible that it may represent a less specific response to local inflammation. The aim of the present study was to determine the prevalence of MAC in patients with Charcot disease as well as other disorders of the foot such as osteomyelitis and uncomplicated foot ulcers.

Cases were identified from a clinic database, for which ethical approval is not …
Role of neutrophils and nitric oxide in lung alveolar injury from smoke inhalation.
Authors: H Ischiropoulos, I Mendiguren, D Fisher, A B Fisher, S R Thom
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

We examined potential mechanisms responsible for the parenchymal lung injury seen in an animal model of smoke inhalation with concurrent inflammation. Rats injected with sterile glycogen and exposed to smoke generated by the nonflaming pyrolysis of combined Douglas fir wood and polyvinylchloride showed a 74% increase in 125I-albumin lung permeability and a fivefold increase in lung myeloperoxidase (MPO) compared with control rats. There was also a significant increase in plasma indices of oxidative injury in these animals. Compared with control animals, plasma concentrations of thiobarbituric acid reactive substances (TBARS) were elevated by 62%, the concentrations of reduced sulfhydryl groups declined by 37%, and the levels of dinitrophenylhydrazine-reactive proteins (DNPH-RP) were doubled. In addition, the plasma concentrations of nitrate (NO3-) in rats exposed to glycogen plus smoke were increased three times that of control animals. Injection of the nitric oxide synthase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME), immediately after smoke exposure or induction of neutropenia using either nitrogen mustard or antineutrophil antiserum, abolished the increase in concentrations of circulating NO3-, and prevented changes in plasma concentrations of TBARS, DNPH-RP, lung MPO activity, and tissue permeability index. These data suggest that neutrophil activation and the production of nitric oxide-derived oxidants contribute to the lung and plasma indices of oxidative injury in this smoke inhalation model.
Down-regulation of CXCR2 on Neutrophils in Severe Sepsis Is Mediated by Inducible Nitric Oxide Synthase–derived Nitric Oxide
Authors: Fabrício Rios-Santos, José C. Alves-Filho, Fabrício Oliveira Souto, Fernando Spiller, Andressa Freitas, Celina Monteiro C. Lotufo, Milena Botelho Pereira Soares, Ricardo Ribeiro dos Santos, Mauro M. Teixeira, Fernando de Queiroz Cunha
Journal: American Journal of Respiratory and Critical Care Medicine (2006)

The failure of neutrophils to migrate to an infection focus during severe sepsis is an important determinant of the inability of a host to deal with an infectious insult. Our laboratory has shown that inducible nitric oxide synthase (iNOS) induction and NO production contribute to the failure of neutrophils to migrate in the context of sepsis.We investigated whether CXCR2 expression contributed to the failure of neutrophils to migrate during severe sepsis and the role of NO in modulating CXCR2 expression on neutrophils in mice subjected to nonsevere (NS) or severe (S) cecal ligation and puncture (CLP).Neutrophil migration to the infection focus was deficient in S-CLP mice, a phenomenon prevented by pharmacologic (aminoguanidine, l-canavanine) or genetic (iNOS gene deletion) inhibition of iNOS. The expression of CXCR2 on neutrophils from S-CLP mice was significantly reduced when compared with neutrophils from NS-CLP or sham-operated mice. CXCR2 expression was reestablished by pharmacologic and genetic inhibition of iNOS. Immunofluorescence and confocal analysis revealed that iNOS blockade reduced neutrophil CXCR2 internalization. Adhesion and emigration of neutrophils in macrophage inflammatory protein-2-stimulated mesentery microcirculation were reduced in S-CLP mice, compared with NS-CLP mice, and reestablished by pretreatment with aminoguanidine or l-canavanine. The NO donor S-nitroso-N-acetyl-d,l-penicillamine inhibited CXCL8-induced human neutrophil chemotaxis and CXCR2 expression on human and murine neutrophils.These results highlight evidences that the failure of neutrophils to migrate to an infection focus during severe sepsis is associated with excessive NO production and NO-dependent regulation of the expression of CXCR2 on the neutrophil surface.
How to avoid unnecessary interventions
Authors: F. Godlee
Journal: BMJ (2009)

Continuing our theme that less medicine is more ( BMJ 2009;338:b2561, doi:10.1136/bmj.b2561), several articles in this week’s journal seek to help doctors cut rates of unnecessary intervention. Nick Francis and colleagues have evaluated a simple way to reduce reconsulting and prescribing of antibiotics in children with upper respiratory tract infection: an eight page, evidence based booklet used during the consultation and taken home afterwards (doi:10.1136/bmj.b2885). GPs were trained to use the booklet, and children with suspected pneumonia, asthma, or serious concomitant illness were excluded. Parents who received the booklet were less likely to feel the need to consult their GP again under …
Dual pH durability studies of man-made vitreous fiber (MMVF).
Authors: J F Bauer, B D Law, T W Hesterberg
Journal: Environmental Health Perspectives (1994)

Dissolution of fibers in the deep lung may involve both extracellular and intracellular mechanisms. This process was modeled in vitro for each environment using an experimental flow-through system to characterize both total dissolution and specific chemical changes for three representative MMVF's: a glasswool, a slagwool, and a refractory ceramic fiber (RCF). Synthetic physiological fluids at pH 4 and at pH 7.6 were used to simulate macrophage intraphagolysosomal, and extracellular environments, respectively. Actual commercial fiber, sized to rat-respirable dimension, having an average fiber diameter of 1 micron and an average length between 15 and 25 microns, was used in the experiments. Fiber dissolution was monitored through change in chemistry of the fluid collected after percolation at a constant rate through a thin bed of sample. There are great differences in total fiber dissolution rates for the different fibers. Slagwool and RCF dissolve more rapidly at pH 4 than at pH 7.6, while the reverse is true for glasswool. Dissolution is sometimes accompanied by a noticeable change in fiber morphology or dimension, and sometimes by no change. There is strong dependency on pH, which affects not only total fiber dissolution, but also the leaching of specific chemical components. This effect is different for each type of fiber, indicating that specific fiber chemistry largely controls whether a fiber dissolves or leaches more rapidly under acidic or neutral conditions. Both total dissolution rates and calculated fiber composition changes are valuable guides to interpreting in vivo behavior of man-made vitreous fibers, and demonstrate the usefulness of in vitro acellular experiments in understanding overall fiber persistence.
The Spondylitis of Juvenile Rheumatoid Arthritis
Authors: Robert E. Barkin, J. Sydney Stillman, Theodore A. Potter
Journal: New England Journal of Medicine (1955)

SPINAL involvement in rheumatoid arthritis in children has occasionally been noted in the literature, but never emphasized or adequately described. At the Robert Breck Brigham Hospital in Boston, an institution devoted largely to rheumatic diseases, we have for some time been impressed with the large number of cases of clinical spondylitis in these children. We have therefore undertaken a survey of all cases of juvenile rheumatoid arthritis seen over the past forty years, to determine the incidence and nature of the spondylitis. The older material has not always been adequate. Thanks to the formerly popular "focus-of-infection" search many x-ray films . . .
Abstract P6-11-01: Intermittent High Dose Proton Pump Inhibitor Improves Progression Free Survival as Compared to Standard Chemotherapy in the First Line Treatment of Patients with Metastatic Breast Cancer
Authors: X Hu, B Wang, S Sun, A Chiesi, J Wang, J Zhang, S Fais
Journal: Cancer Research (2012)

Abstract Purpose: High dose proton pump inhibitor (PPI) has proved to be potentially effective when combined with chemotherapy in preclinical data. This study (NCT01069081) was designed to investigate whether the efficacy of chemotherapy could be improved with the addition of proton pump inhibitor (PPI) in patients with metastatic breast cancer. Patients and Methods: Females elder than 18 years old with histologically confirmed metastatic breast cancer were eligible for participation. Patients enrolled were randomly assigned to three arms: Arm A, docetaxol 75 mg/m2 on d4, followed by cisplatin 75 mg/m2 on d4, repeated every 21 days until maxinum 6 cycles or presence of disease progression or intolerable toxicity; Arm B, the same chemotherapy plus esomeprazole 80 mg p.o. bid three days on and the subsequent four days off, beginning on d1 repeated weekly up to disease progression, intolerable toxicity, patient's withdrawal, or a maximum of 66 weeks; Arm C, the same as Arm B with the only difference being dose of esomeprazole at 100 mg p.o. bid. The primary endpoint was progression free survival (PFS), and the secondary endpoints were time to progression (TTP), objective response rate (ORR), safety profile, and overall survival (OS). Results: From Aug. 2009 to Dec. 2011, 100 women signed informed consent form (ICF) and 94 patients have undergone at least one injection of chemotherapy. Three patients had severe hypersensitivity reactions, two occurring after the first injection of docetaxol and one in the second cycle. After a median follow up of 17 months, 68 (72.3%) patients got disease progression and 23 (24.5%) patients died. Median PFS for the whole group (n = 94), arm A (n = 33), arm B (n = 30), arm C (n = 31) were 8.9, 7.5, 10.9, and 9.5 months, respectively (p = 0.082). A significant difference was observed between patients who had taken PPI and who not with median PFS of 9.5 and 7.5 months, respectively (p = 0.030). Among 17 patients with triple negative breast cancer, this difference was bigger with median PFS of 9.5 and 3.3 months, respectively (p = 0.014). The overall response rates for the whole group, arm A, arm B, arm C were 58.5%, 51.5%, 63.3%, 61.3%, respectively. Conclusion: This trial is the first randomized study to demonstrate antitumor effects of intermittent high dose PPI in patients with metastatic breast cancer. Docetaxel and cisplatin doublet is comparable to the other first-line chemotherapeutical regimens and the addition of proton pump inhibitor to the doublet improves efficacy with no adding toxicity, especially in patients with triple negative breast cancer. Key Words Proton Pump Inhibitor (PPI), Triple Negative Breast Cancer (TNBC), Phase II Study, Metastatic Breast Cancer, Chemotherapy Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-11-01.
Co-delivery of daunomycin and oxaliplatin by biodegradable polymers for safer and more efficacious combination therapy
Authors: Haihua Xiao, Wenliang Li, Ruogu Qi, Lesan Yan, Rui Wang, Shi Liu, Yonghui Zheng, Zhigang Xie, Yubin Huang, Xiabin Jing
Journal: Journal of Controlled Release (2012)
Transcardiac serotonin concentration is increased in selected patients with limiting angina and complex coronary lesion morphology.
Authors: E K van den Berg, J M Schmitz, C R Benedict, C R Malloy, J T Willerson, G J Dehmer
Journal: Circulation (1989)

Serotonin is released by activated platelets and may act as a mediator to initiate or sustain certain unstable syndromes of ischemic heart disease in humans. To determine whether or not serotonin concentration increases across the coronary bed in patients with severe, limiting angina, we measured central aortic and coronary sinus serotonin concentrations by a sensitive radioenzymatic assay in 39 patients with coronary artery disease and 13 patients with minimal or no coronary artery lesions as detected by arteriography. Although no difference existed in the mean aortic or coronary sinus serotonin concentrations between these two groups, elevated coronary sinus serotonin concentrations were detected in 23% of those with coronary artery disease. The coronary sinus and aortic serotonin concentration difference was greater in patients with significant coronary artery disease (0.6 +/- 6.62 ng/ml) compared with patients without significant coronary artery disease (-5.6 +/- 10.32 ng/ml) (mean +/- SD) (p less than 0.05). Further analysis revealed that patients with eccentric, irregular coronary artery lesions or intraluminal filling defects had a significantly elevated coronary sinus and aortic serotonin difference (3.1 +/- 5.54 ng/ml) compared with those with smooth concentric lesions (-1.9 +/- 6.61 ng/ml) (p less than 0.02). These data suggest that serotonin is released into the coronary circulation of some patients with coronary artery disease, especially those with frequent angina and complex coronary lesions. Although serotonin may be released in some patients with coronary artery disease, the specific pathophysiologic role of serotonin in the development or perpetuation of certain coronary syndromes in humans remains to be determined.