tbuckley/cabot-search huggingface dataset:
Why active euthanasia and physician assisted suicide should be legalised
Authors: L. Doyal, L. Doyal
Journal: BMJ (2001)

Last month Diane Pretty was refused the legal right to choose the circumstances of her own death.1 She suffers from motor neurone disease and is experiencing the disintegration of her body. She faces a death that she believes will entail indignity and suffering and physically cannot kill herself. The court has denied her request that her husband be allowed to help her. This decision may be consistent with legal precedent but is morally wrong. That is why the law should be changed.

Suppose that Mrs Pretty became permanently and severely incompetent as a result of brain damage and that her life was being sustained by medical technology. If her doctors believed that medical treatment could provide no benefit because of her inability ever to engage in any self directed activity, then legally they could withdraw life sustaining treatments, including hydration and nutrition.2 In such circumstances they would foresee that she would die as a result of their failure to perform what would ordinarily be their duty to protect life and health. In most other circumstances clinicians are not allowed this discretion to accelerate foreseeable deaths through inaction.

Against the background of the duty to care, the moral and legal status of not saving a life through failing to treat can be the same as actively taking that life. 3 4 For example, a doctor who knowingly allows a patient who could be saved to bleed to death in emergency care might be accused of murder. What is deemed to be morally and legally important here …
Clinics in Rheumatic Diseases: Arthritis in the Elderly
Authors: D. Bossingham
Journal: Annals of the Rheumatic Diseases (1987)

found granular, globular, or spindle shaped deposits in the joint capsule, synovial membrane, and/or extra-articular tissue.The material was located extracellularly and/or in macrophages and the synovial lining cells.Occasional deposits were found within blood vessels and lymphatics, in the vessel wall, or perivascularly.The material showed negative reaction for amyloid, calcium, iron, and urate.Being often strongly basophilic, it resembled the haema- toxylin bodies found in systemic lupus erythematosus.Although it showed a negative reaction with ethidium bromide, its nuclear origin cannot be excluded since the binding sites of DNA could be denatured or masked by the nuclear antibodies.We found a positive correlation between the presence of these deposits and the intensity of the arthritis.Since the arthritis often began without deposits, and an association between them was found only in a proportion of joints, we concluded that the deposits do not have a causal role in the arthritis, but enhance it.
Impact of Environmental Chemicals on Lung Development
Authors: Mark D. Miller, Melanie A. Marty
Journal: Environmental Health Perspectives (2010)

BackgroundDisruption of fundamental biologic processes and associated signaling events may result in clinically significant alterations in lung development.ObjectivesWe reviewed evidence on the impact of environmental chemicals on lung development and key signaling events in lung morphogenesis, and the relevance of potential outcomes to public health and regulatory science.Data sourcesWe evaluated the peer-reviewed literature on developmental lung biology and toxicology, mechanistic studies, and supporting epidemiology.Data synthesisLung function in infancy predicts pulmonary function throughout life. In utero and early postnatal exposures influence both childhood and adult lung structure and function and may predispose individuals to chronic obstructive lung disease and other disorders. The nutritional and endogenous chemical environment affects development of the lung and can result in altered function in the adult. Studies now suggest that similar adverse impacts may occur in animals and humans after exposure to environmentally relevant doses of certain xenobiotics during critical windows in early life. Potential mechanisms include interference with highly conserved factors in developmental processes such as gene regulation, molecular signaling, and growth factors involved in branching morphogenesis and alveolarization.ConclusionsAssessment of environmental chemical impacts on the lung requires studies that evaluate specific alterations in structure or function—end points not regularly assessed in standard toxicity tests. Identifying effects on important signaling events may inform protocols of developmental toxicology studies. Such knowledge may enable policies promoting true primary prevention of lung diseases. Evidence of relevant signaling disruption in the absence of adequate developmental toxicology data should influence the size of the uncertainty factors used in risk assessments.
The man with the IT plan
Authors: Geoff Watts
Journal: BMJ (2005)

<i>Assailed by critics, battered by rising costs, and investigated by the National Audit Office, the multibillion pound attempt to utilise 21st century information technology in storing patients9 records, booking appointments, and handling prescriptions is not having an easy ride. The man ultimately responsible for the scheme is <b>Richard Granger</b></i>
Effects of milrinone on coronary hemodynamics and myocardial energetics in patients with congestive heart failure.
Authors: E S Monrad, D S Baim, H S Smith, A Lanoue, E Brauwald, W Grossman
Journal: Circulation (1985)

To examine the effect of milrinone on myocardial energetics in patients with congestive heart failure, we measured systemic, pulmonary, and coronary hemodynamics in 18 patients before and after intravenous administration of milrinone (125 +/- 36 micrograms/kg). There was a 45% increase in cardiac index (2.1 +/- 0.5 to 3.0 +/- 0.6 liters/min/m2; p = .0001), a 39% fall in the pulmonary capillary wedge pressure (28 +/- 8 to 17 +/- 8 mm Hg; p = .0001), and a 42% increase in left ventricular external work (3758 +/- 1419 to 5340 +/- 1598 g-m/min; p = .0001). Both the heart rate-blood pressure product (9624 +/- 2272 to 9380 +/- 2428 mm Hg-beats/min; p = NS) and regional left ventricular myocardial oxygen consumption (7.6 +/- 2.9 to 8.1 +/- 3.1 ml O2/min; p = NS) were unchanged after milrinone, resulting in a 45% increase in calculated left ventricular external efficiency (p = .004). Although myocardial oxygen consumption did not change, regional great cardiac venous blood flow increased significantly (73 +/- 32 to 85 +/- 34 ml/min; p = .02) as a result of a 30% reduction in regional coronary vascular resistance (1.32 +/- 0.99 to 0.93 +/- 0.54 mm Hg-min/ml; p = .004), a decrease comparable to the concurrent 37% and 38% falls seen in systemic and pulmonary vascular resistance, respectively. These changes were associated with an 11% fall in the transcoronary arterial-venous oxygen difference (111 +/- 24 to 99 +/- 21 ml/O2/liter; p = .0001), which is consistent with a primary coronary vasodilator effect of milrinone.(ABSTRACT TRUNCATED AT 250 WORDS)
Chronic Hepatitis Treated with Methionine and Choline
Authors: D. G. Cameron, M. L. Newhouse
Journal: BMJ (1948)

MEDICALJOvURNAL 253 larger doses for a comparatively longer period to those with normal thyroid activity than to those with hyperthyroid activity.Since this paper was written Cases 2 and 3 have developed myxoedema and have recovered as rapidly as Case 1 did.Summary Three cases of angina of effort are reported.Treatment with methylthiouracil was successful in either abolishing or markedly reducing the frequency of attacks.On the whole, comparatively large doses were required.This treatment has possibilities in that patients may be restored to their former earning capacity.I wish to thank Dr. A.
Effects of Initiating Insulin and Metformin on Glycemic Control and Inflammatory Biomarkers Among Patients With Type 2 Diabetes
Authors: Aruna D. Pradhan, Brendan M. Everett, Nancy R. Cook, Nader Rifai, Paul M Ridker
Journal: JAMA (2009)

As diabetes is in part an inflammatory condition, the initiation of insulin and/or metformin may beneficially reduce levels of inflammatory biomarkers such as high-sensitivity C-reactive protein (hsCRP).To determine whether insulin alone or combined with metformin lowers levels of hsCRP, IL-6, and soluble tumor necrosis factor receptor 2 (sTNFr2) in patients with recent-onset type 2 diabetes mellitus.Randomized 2 x 2 factorial trial of open-label insulin glargine and placebo-controlled metformin in 500 adults with type 2 diabetes (median time from diagnosis, 2.0 years), suboptimal glycemic control, and elevated hsCRP levels. Patients were recruited from US office-based practices between October 2006 and December 2008.Random allocation to 1 of 4 treatments (placebo metformin only, placebo metformin and insulin glargine, active metformin only, or active metformin and insulin glargine) with dose titration targeting fasting blood glucose less than 110 mg/dL.Change in hsCRP level (primary end point) and change in IL-6 and sTNFr2 levels (secondary end points) from baseline to 14 weeks.Levels of glucose and glycated hemoglobin (HbA(1c)) were significantly reduced with active treatment vs placebo (all P values <.001). Levels of hsCRP were reduced in all 4 groups. There was no significant difference in hsCRP reduction among those allocated to insulin (-11.8%; 95% CI, -18.7% to -4.4%) or to no insulin (-17.5%; 95% CI, -23.9% to -10.5%) (P for difference = .25), or among those allocated to active metformin (-18.1%; 95% CI, -24.4% to -11.1%) or placebo metformin (-11.2%; 95% CI, -18.1% to -3.7%) (P for difference = .17). In the individual treatment groups, despite a differential impact on glucose control, reductions in hsCRP in the metformin (-16.1%; 95% CI, -25.1% to -6.1%) and metformin plus insulin (-20.1%; 95% CI, -28.8% to -10.4%) groups were no different than reductions with placebo alone (-19.0%; 95% CI, -27.8% to -9.1%; P = .67 and .87 vs placebo, respectively). By contrast, hsCRP reduction was attenuated with insulin alone (-2.9%, 95% CI, -13.2% to 8.6%; P = .03 vs placebo). Similar findings were noted for levels of IL-6 and sTNFr2.In patients with recent-onset type 2 diabetes, treatment with insulin or metformin compared with placebo did not reduce inflammatory biomarker levels despite improving glucose control.clinicaltrials.gov Identifier: NCT00366301.
Altaf Hussain Syed
Authors: T. A Mahmood
Journal: BMJ (2003)

Associate specialist in urology Western General Hospital, Edinburgh (b Kashmir, India, 1954; q Srinagar 1977; MS, FRCS), died from myxoid leiomyosarcoma of the stomach on 10 September 2003.​2003.




Figure 1




After postgraduate training in India Altaf worked as a chief resident in general surgery in Saudi Arabia for two years before coming to the United Kingdom in 1988 to pursue his postgraduate training. He worked as a junior doctor in Manchester, Doncaster, and Fife. He was appointed as staff grade urologist at Western General Hospital, Edinburgh, in 1994 and became an associate specialist in 2002. Latterly he became involved in the running of incontinence/urodynamic clinics, a prostate open access assessment unit, and a fast track haematuria clinic. He leaves a wife, Kauseer Parveen, and two sons.
Sugar Consumption and Acne
Authors: S. Bourne
Journal: BMJ (1967)

Sugar Consumption and Acne SIR,-I was interested in the study by Dr. D. G. G. Bett and others (15 July, p. 153) in which they found raised sugar consumption in patients with seborrhoeic dermatitis but not in those with acne.In a study of 2,720 soldiers it was estab- lished that there is no correlation between the incidence or severity of acne and dandruff.'There was also no correlation between acne and obesity in men under 20 years old--the age group studied by Bett et al.However, in older men (age 20-40) there was a signifi- cant correlation between acne and obesity.It appears, therefore, that perhaps Bett et al. should extend their study to see if there is raised sugar intake in this older group before it can be settled that sugar intake in acne is not raised.-Iam, etc.,
120 IFN-G INHIBITS HEPATIC PROGENITOR CELL ACTIVATION IN CHRONIC LIVER DAMAGE
Authors: H.-L. Weng, S. Radaeva, Y. Liu, Q. Li, H. Shen, R. Müllenbach, V. Zimmer, F. Lammert, P. Mertens, S. Zakhari, S. Dooley, B. Gao
Journal: Journal of Hepatology (2011)
Abnormalities of chest wall motion in patients with chronic airflow obstruction.
Authors: J J Gilmartin, G J Gibson
Journal: Thorax (1984)

Forty patients with severe chronic stable airflow obstruction and hyperinflation were studied to assess patterns of abnormal chest wall motion and their frequency. Dimensional changes were measured during tidal breathing, four pairs of magnetometers being used to record anteroposterior diameters of ribcage and abdomen and two lateral diameters of the ribcage. Chest wall movements were qualitatively normal in only five patients. Three main types of abnormality were found and 13 subjects had two or more abnormal patterns. Lateral ribcage paradox was present in 31 of the 40 patients and was recognised clinically in all except one. Inspiratory indrawing of the lower sternum was recorded in 12 patients, paradoxical inspiratory motion of the abdomen was present in four patients and in six there was a biphasic expiratory pattern of abdominal movement. Analysis of variance showed no significant group differences in severity of airflow obstruction or hyperinflation between the patients with qualitatively normal motion and those with different types of abnormal motion. Relationships between the tidal displacement of each dimension and severity of airflow obstruction and hyperinflation were examined. In general, patients with more severe hyperinflation showed less abdominal movement and those with severe airflow obstruction had less lateral expansion of the ribcage, but the correlations were weak. It is concluded that abnormal motion of the chest wall is very common in patients with airflow obstruction and hyperinflation, that clinical recognition of abnormal motion other than lateral ribcage paradox is easily overlooked, and that quantitative relationships between abnormal motion and disease severity are weak.
Quantitative serum HBV DNA levels during different stages of chronic hepatitis B infection
Authors: C Chu
Journal: Hepatology (2002)

The goals of this retrospective study were to determine whether there is a threshold hepatitis B virus (HBV) DNA value associated with spontaneous or antiviral therapy-related hepatitis B e antigen (HBeAg) clearance. We also investigated whether there is an HBV DNA value that can be used for differentiating inactive carriers from patients with HBeAg-negative chronic hepatitis B. HBV DNA levels in sequential serum samples of 165 Chinese patients with different stages of chronic HBV infection were quantified by a polymerase chain reaction (PCR)-based assay. Our results showed that almost all of the patients (89%) who remained HBeAg-positive had HBV DNA levels that were persistently above 10(5) copies/mL. Serum HBV DNA levels decreased by a mean of 3 log(10) in patients with HBeAg loss, but 51% had levels above 10(5) copies/mL at the time HBeAg first became undetectable. Mean serum HBV DNA levels were significantly lower in HBeAg-negative patients. HBV DNA value above 10(5) copies/mL would exclude all inactive carriers, but 45% of patients with HBeAg-negative chronic hepatitis would also be excluded if testing were only performed at presentation and 30% would be excluded if testing were performed on 3 occasions. In conclusion, serum HBV DNA levels decreased significantly in patients with HBeAg loss, but there was no threshold HBV DNA level associated with HBeAg clearance. Given the fluctuating course of HBeAg-negative chronic hepatitis, it is not possible to define a single cutoff HBV DNA value for differentiating inactive carriers from patients with HBeAg-negative chronic hepatitis.
The hospital bed: on its way out?
Authors: J. Appleby
Journal: BMJ (2013)

John Appleby examines trends in the number of hospital beds and wonders how low we can go

In 1967 the King Edward’s Hospital Fund for London, now known as the King’s Fund, published a new specification for the design of a “hospital bedstead.”1 This had followed an evaluation of various bed designs in collaboration with Bruce Archer, an engineering designer at London’s Royal College of Art.2 As Lawrence notes, the evaluation was intensive and “relied on extensive data collection, mathematical modelling of solutions, and field trials . . . 1000 hospitals completed a televisual survey on beds, and . . . 20 prototype beds were installed for three months at Chase Farm Hospital, Enfield. Trained observers recorded all bed-related activities from 0600 h to 2200 h daily.” The project cost £35 000—over £500 000 (€580 000; $750 000) at today’s prices.3 Over time the King’s Fund bed came to replace the many hundreds of different bed …
Hemodynamic Evaluation of Intra-Aortic Balloon Pumping in Man
Authors: MORTIMER J. BUCKLEY, ROBERT C. LEINBACH, JOHN A. KASTOR, JOHN D. LAIRD, ARTHUR R. KANTROWITZ, PETER N. MADRAS, CHARLES A. SANDERS, W. GERALD AUSTEN
Journal: Circulation (1970)

Intra-aortic balloon pumping is effective in reducing left ventricular peak systolic pressure and increasing cardiac output in patients with severe cardiogenic shock secondary to acute myocardial infarction. Associated with these effects is a reduction in intravenous catecholamine requirements and increased sensitivity to diuretics. Reduction in left ventricular end-diastolic pressure is implied by improvement in arterial blood gas saturation (reduced arterioalveolar gradient) and was shown directly in one patient. Total myocardial oxygen consumption is probably reduced by counterpulsation. Platelet levels have not fallen significantly with adequate heparinization and the slow infusion of low molecular weight dextran. No complications have occurred related to femoral artery cannulation, nor has there been significant damage to the aorta. The findings suggest that this system is a safe means of assisting the failing left ventricle. The high mortality in this series (seven of eight patients) is related to the extent of irreversible myocardial damage which may be reduced by more aggressive, earlier application of counterpulsation.
Apoptosis and p53 protein expression increase in the process of burn wound healing in guinea-pig skin
Authors: M Nagata, H Takenaka, R Shibagaki, S Kishimoto
Journal: British Journal of Dermatology (1999)

Journal Article Apoptosis and p53 protein expression increase in the process of burn wound healing in guinea‐pig skin Get access M Nagata, M Nagata Department of Dermatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyo‐Ku, Kyoto 602‐0841, Japan Search for other works by this author on: Oxford Academic Google Scholar H Takenaka, H Takenaka Department of Dermatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyo‐Ku, Kyoto 602‐0841, Japan Search for other works by this author on: Oxford Academic Google Scholar R Shibagaki, R Shibagaki Department of Dermatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyo‐Ku, Kyoto 602‐0841, Japan Search for other works by this author on: Oxford Academic Google Scholar S Kishimoto S Kishimoto Department of Dermatology, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyo‐Ku, Kyoto 602‐0841, Japan Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 140, Issue 5, 1 May 1999, Pages 829–838, https://doi.org/10.1046/j.1365-2133.1999.02811.x Published: 01 May 1999
Human cytochromes P450: evolution and cDNA-directed expression.
Authors: F J Gonzalez, H V Gelboin
Journal: Environmental Health Perspectives (1992)

As the first step in the process of carcinogenesis, most chemical carcinogens require metabolic activation by cytochromes P450 for conversion to highly reactive electrophiles that bind covalently to DNA. Studies in rodents suggest that low or high levels of expression of a single P450 can determine susceptibility or resistance to chemically induced cancer. Although rodent systems have been used to explore the molecular basis of chemical carcinogenesis and to identify chemicals capable of damaging genes and causing cancer, it has been understood that marked species differences exist in the expression, regulation, and catalytic activities of different P450s. Thus, large efforts are underway to study the catalytic activities of human P450s directly by expression of their cDNAs in cultured cells. Two systems are being used: a) transient high-level P450 production in HepG2 cells for analysis of catalytic activities, and b) stable expression in human B-lymphoblastoid cells to study promutagen and procarcinogen activation. These studies define the relative contributions of individual P450 forms to the activation of various chemical carcinogens. The B-lymphoblastoid cDNA expression system can also be used to determine whether a chemical will be hazardous or toxic to humans. The most intriguing aspects of P450s are the occurrence of human genetic polymorphisms in P450 expression, which could be a risk factor for chemical carcinogenesis. The best-studied P450 genetic polymorphism is the debrisoquine/sparteine polymorphism which is due to mutant CYP2D6 alleles. Four mutant alleles have been characterized that account for most of the defective CYP2D6 genes in Caucasians. These can be detected by polymerase chain reaction assays.(ABSTRACT TRUNCATED AT 250 WORDS)
National Trends in the Mental Health Care of Children, Adolescents, and Adults by Office-Based Physicians
Authors: Mark Olfson, Carlos Blanco, Shuai Wang, Gonzalo Laje, Christoph U. Correll
Journal: JAMA Psychiatry (2013)

Despite evidence of the increasing use of psychotropic medications, little is known about the broader changes in the delivery of outpatient mental health treatment to children, adolescents, and adults.To assess national trends and patterns in the mental health care of children, adolescents, and adults in office-based medical practice.Outpatient visits to physicians in office-based practice from the 1995-2010 National Ambulatory Medical Care Surveys (N = 446 542). Trends (1995-2010) in visits with mental health care indicators are first compared between youths (<21 years) and adults (≥21 years) and then between children (0-13 years) and adolescents (14-20 years). Background and clinical characteristics of recent visits (2007-2010) resulting in a mental disorder diagnosis are also compared among children, adolescents, and adults.Visits resulting in mental disorder diagnoses, prescription of psychotropic medications, provision of psychotherapy, or psychiatrist care.Between 1995-1998 and 2007-2010, visits resulting in mental disorder diagnoses per 100 population increased significantly faster for youths (from 7.78 to 15.30 visits) than for adults (from 23.23 to 28.48 visits) (interaction: P < .001). Psychiatrist visits also increased significantly faster for youths (from 2.86 to 5.71 visits) than for adults (from 10.22 to 10.87 visits) (interaction: P < .001). Psychotropic medication visits increased at comparable rates for youths (from 8.35 to 17.12 visits) and adults (from 30.76 to 65.90 visits) (interaction: P = .13). While psychotherapy visits increased from 2.25 to 3.17 per 100 population for youths, they decreased from 8.37 to 6.36 for adults (interaction: P < .001). In 2007-2010, 27.4% of child visits, 47.9% of adolescent visits, and 36.6% of adult visits resulting in a mental disorder diagnosis were to a psychiatrist.Compared with adult mental health care, the mental health care of young people has increased more rapidly and has coincided with increased psychotropic medication use. A great majority of mental health care in office-based medical practice to children, adolescents, and adults is provided by nonpsychiatrist physicians calling for increased consultation and communication between specialties.