tbuckley/cabot-search huggingface dataset:
Myocardial metabolic and morphometric changes during canine endotoxin shock before and after glucose-insulin-potassium
Authors: W BRONSVELD, A A V. LAMBALGEN, D V. VELZEN, G C V. D. BOS, P. KOOPMAN, L G THIJS
Journal: Cardiovascular Research (1985)

Glucose-insulin-potassium (GIK) improves myocardial function during endotoxin shock but the mechanism of this action is not clear. We have studied in open chest dogs the effects of GIK (n=9) on haemodynamics, myocardial biochemistry (repeated drill biopsies; glucose-6-phosphate, G-6-P; fructose-6-phosphate, F-6-P; adenosine triphosphate, ATP; creatinine phosphate, CP; glycogen) and myocardial histomorphometry. The animals were anaesthetised (etomidate 4 mg·kg−1·h−1) and artificially ventilated (N2O:O2=2:l). After endotoxin (1.5 mg·kg−1) cardiac output (CO) and mean arterial pressure (MAP) fell rapidly, with a temporary recovery followed by gradual circulatory collapse. Coronary blood flow (cbf; radioactive microspheres) decreased, but this was not significant. G-6-P tended to fall, as did ATP levels while CP levels were unaltered. Histomorphometrical analysis showed myocardial cell swelling with compression of capillaries and decreased interstitial volume. GIK infusion (50% glucose, 2 g·kg−1bw, 8 mmol KCI and 3 U insulin kg−1bw) increased CO and coronary blood flow. Glycogen and G-6-P levels did not change, while F-6-P tended to increase. ATP levels were not influenced by ATP/CP ratio decreased. Myocardial cell swelling markedly decreased; average capillary cross-sectional area, as an index of capillary compression, returned to control value. In two dogs, which died before the end of the experiment, myocardial oedema, with disturbed capillary volume and reduced interstitial volume was unaltered after GIK. The initial effects of GIK are most likely due to restoration of myocardial perfusion. Improved perfusion, and the influence of elevated serum osmolality and insulin levels on excitation-contraction coupling may help to improve myocardial function.
Randomized Trial of Simple Versus Complex Drug-Eluting Stenting for Bifurcation Lesions
Authors: David Hildick-Smith, Adam J. de Belder, Nina Cooter, Nicholas P. Curzen, Tim C. Clayton, Keith G. Oldroyd, Lorraine Bennett, Steve Holmberg, James M. Cotton, Peter E. Glennon, Martyn R. Thomas, Philip A. MacCarthy, Andreas Baumbach, Niall T. Mulvihill, Robert A. Henderson, Simon R. Redwood, Ian R. Starkey, Rodney H. Stables
Journal: Circulation (2010)

Background— The optimal strategy for treating coronary bifurcation lesions remains a subject of debate. With bare-metal stents, single-stent approaches appear to be superior to systematic 2-stent strategies. Drug-eluting stents, however, have low rates of restenosis and might offer improved outcomes with complex stenting techniques. Methods and Results— Patients with significant coronary bifurcation lesions were randomized to either a simple or complex stenting strategy with drug-eluting stents. In the simple strategy, the main vessel was stented, followed by optional kissing balloon dilatation/T-stent. In the complex strategy, both vessels were systematically stented (culotte or crush techniques) with mandatory kissing balloon dilatation. Five hundred patients 64±10 years old were randomized; 77% were male. Eighty-two percent of lesions were true bifurcations (&gt;50% narrowing in both vessels). In the simple group (n=250), 66 patients (26%) had kissing balloons in addition to main-vessel stenting, and 7 (3%) had T stenting. In the complex group (n=250), 89% of culotte (n=75) and 72% of crush (n=169) cases were completed successfully with final kissing balloon inflations. The primary end point (a composite at 9 months of death, myocardial infarction, and target-vessel failure) occurred in 8.0% of the simple group versus 15.2% of the complex group (hazard ratio 2.02, 95% confidence interval 1.17 to 3.47, P =0.009). Myocardial infarction occurred in 3.6% versus 11.2%, respectively ( P =0.001), and in-hospital major adverse cardiovascular events occurred in 2.0% versus 8.0% ( P =0.002), respectively. Procedure duration and x-ray dose favored the simple approach. Conclusions— When coronary bifurcation lesions are treated, a systematic 2-stent technique results in higher rates of in-hospital and 9-month major adverse cardiovascular events. This difference is largely driven by periprocedural myocardial infarction. Procedure duration is longer, and x-ray dose is higher. The provisional technique should remain the preferred strategy in the majority of cases. Clinical Trial Registration Information— URL: http://www.clinicaltrials.gov. Unique identifier: NCT 00351260.
Laboratory Detection of Marijuana Use
Authors: Edward P. Fody
Journal: JAMA (1985)

To the Editor.—  Schwartz and Hawks have provided an excellent discussion of the laboratory's role in the detection of marijuana use. 1 However, their statement that false-positive results of the homogeneous enzyme immunoassay technique (EMIT) and radioimmunoassay are rare when the tests are performed under optimal conditions requires clarification.  Frederick et al 2 were unable to confirm by gas chromatography— mass spectrometry (GC-MS) the positive results obtained using the EMIT-d.a.u. (drugs of abuse in urine) on three of 42 urine specimens. Another study, using high-performance liquid chromatography and high-efficiency thin-layer chromatography, confirmed only 72% of the EMIT results that were positive at a lower cutoff of 20 ng/mL of 11-nor-Δ 9 -tetrahydrocannabinol-9-carboxylic acid (9-carboxy-THC). 3 The confirmation rate rose to 91% when 75 ng/mL was used as the lower detection limit.  In a multicenter study, it was found that 2% of the results obtained from the EMIT single-test and EMIT-d.a.u.
Working long hours and health
Authors: J M Harrington
Journal: BMJ (1994)

Working long hours and healthNo unequivocal scientific evidence to support or refute a 48 hour week Whether working long hours adversely affects health has been debated for many years.A recent European Council directive on working time (93/1 04/EC) has heightened the controversy.Its proposals include a minimum daily rest period of 11 consecutive hours in each 24 hour period, at least one rest day a week, four weeks' annual leave, and a restriction on night work to a maximum of eight hours on average.With some exceptions (including doctors in training), employees would, under the directive, have the legal right to refuse to work more than 48 hours a week.The directive would be implemented under article 1 1 8A of the Treaty of Rome, which requires the directive to be based on health and safety considerations and not general employment conditions.The British government disputes that this is a health and safety measure and is challenging its legal basis before the European Court of Justice.The topic has attracted further attention recently with the death of a junior hospital doctor after an extended period on duty, and again in the aftermath of the untimely death of the leader of the Labour party.So what is the evidence linking working hours and health?The explanatory memorandum that accompanies the directive should help, and there is certainly no shortage of scientific papers.Unfortunately, neither of these sources provides an un- equivocal answer.The explanatory memorandum is particu- larly unhelpful.Most of the references are German: this is not a reflection of the world literature; many are obscure, and some are untraceable.It is not possible to examine, let alone support, assertions on health and working hours from this standpoint.A general literature search uncovers hundreds of papers since my review of the subject in 1978.1 Three recent reviews are particularly good.2-4In addition, over 20 reviews have concentrated on specific concerns such as sleep, fatigue, performance, and the scheduling ofhours ofwork.
Human Parvovirus B19–Associated Myocarditis
Authors: Claus-Thomas Bock, Karin Klingel, Reinhard Kandolf
Journal: New England Journal of Medicine (2010)

To the Editor: Viral and postviral myocarditis are the major causes of acute and chronic dilated cardiomyopathy.1 To gain insight into the pathogenesis of parvovirus B19–associated myocarditis as an endothelial-cell–mediated disease (Figure 1A), we measured viral loads in endomyocardial biopsy specimens obtained from 498 patients (341 men and 157 women; mean [±SD] age, 46.93±15.85 years) with myocarditis2 or chronic dilated cardiomyopathy who were positive for parvovirus B19 on immunohistologic analysis. A total of 91 noninflamed normal hearts obtained from autopsies served as controls. We found that parvovirus B19 genomes were significantly more likely to be detected in the endomyocardial biopsy . . .
I don't believe in excellence
Authors: Ditch Townsend
Journal: BMJ (1999)

“Who's a nice chimp, then?” It has been several years coming and is not fully worked out. But it is continually gnawing away at the back of my mind. Now I have been pushed over the edge by the British government's two new initiatives for the English NHS: National Institute for Clinical Excellence (NICE) and Commission for Health Improvement (CHIMP). It seems a wondrous coincidence that these initiatives tie in so well with my weft: “I don't believe in excellence,” and my weave, “I don't believe in progress.”

“I would like to see the poor handed the means to stand up to us” 

I have been involved in AIDS related development projects in South East Asia for the past four years. I left medicine after my house jobs in the United Kingdom six years ago. It has gone far beyond “a refreshing change.” It is hard to describe the passion I now feel …
Coexistence of two discordant B-cell lymphomas in the skin and lymph node: report of a case with primary cutaneous follicle-center lymphoma and nodal mantle-cell lymphoma
Authors: G. Goteri, S. Rupoli, D. Stramazzotti, G. Discepoli, A.R. Scortechini, A. Giacchetti, D. Morichetti, A. Tassetti, S. Pulini, S. Mulattieri, A. Stronati, P. Leoni
Journal: British Journal of Dermatology (2007)

Journal Article Coexistence of two discordant B‐cell lymphomas in the skin and lymph node: report of a case with primary cutaneous follicle‐center lymphoma and nodal mantle‐cell lymphoma Get access G. Goteri, G. Goteri Anatomia Patologica Search for other works by this author on: Oxford Academic Google Scholar S. Rupoli, S. Rupoli Clinica di Ematologia Search for other works by this author on: Oxford Academic Google Scholar D. Stramazzotti, D. Stramazzotti Anatomia Patologica Search for other works by this author on: Oxford Academic Google Scholar G. Discepoli, G. Discepoli Servizio di Genetica, Ospedali Riuniti di Ancona, Via Conca 71, 60020 Torrette di Ancona, Ancona, Italy Search for other works by this author on: Oxford Academic Google Scholar A.R. Scortechini, A.R. Scortechini Clinica di Ematologia Search for other works by this author on: Oxford Academic Google Scholar A. Giacchetti, A. Giacchetti Dermatology Unit, INRCA Hospital, Ancona, Italy Search for other works by this author on: Oxford Academic Google Scholar D. Morichetti, D. Morichetti Anatomia Patologica Search for other works by this author on: Oxford Academic Google Scholar A. Tassetti, A. Tassetti Clinica di Ematologia Search for other works by this author on: Oxford Academic Google Scholar S. Pulini, S. Pulini Clinica di Ematologia Search for other works by this author on: Oxford Academic Google Scholar S. Mulattieri, S. Mulattieri Clinica di Ematologia Search for other works by this author on: Oxford Academic Google Scholar ... Show more A. Stronati, A. Stronati Clinica di Ematologia Search for other works by this author on: Oxford Academic Google Scholar P. Leoni P. Leoni Clinica di Ematologia Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 157, Issue 3, 1 September 2007, Pages 629–631, https://doi.org/10.1111/j.1365-2133.2007.08034.x Published: 01 September 2007
Time for History
Authors: Jack Poland
Journal: JAMA (1985)

<h3>To the Editor.—</h3> I would truly like to believe that Norman Cousins' plea for legislators to acknowledge the physician's need to take a complete and relevant history from a patient would ensure such a doctor-patient exchange.<sup>1</sup> My experience suggests that practicing physicians quickly abandon the careful and complete historical investigation learned as students, in favor of a short-form version composed of the chief complaint, a quick review of systems, and a family history. Unless the patient suspects their importance and volunteers the information, cultural factors, exposure to sources of infectious disease, and even a precise time of onset of symptoms are often not established until a laboratory finding prompts a reappraisal of these highly significant background data. This failure to obtain the necessary historical information can hardly be blamed on governmental or legislative refusal to proffer remuneration for the physician's time. It is, however, possible that the physician's own
Left-to-right atrial shunting after percutaneous mitral valvuloplasty. Incidence and long-term hemodynamic follow-up.
Authors: A Cequier, R Bonan, A Serra, I Dyrda, J Crépeau, M Dethy, D Waters
Journal: Circulation (1990)

To assess the incidence and long-term evolution of left-to-right atrial shunting (AS) after the performance of percutaneous mitral valvuloplasty (PMV), venovenous indicator dilution curves and right heart oximetric measurements were obtained in 68 consecutive patients before and after successful PMV. The procedure increased the mitral valve area (p less than 0.0001) and decreased the mitral gradient (p less than 0.0001). No AS was detected before PMV, but it was detected immediately after PMV. Oximetry identified AS in 17 patients (25%), and dilution curves identified AS in an additional 25 (total, 62%). The ratio of mean pulmonary to systemic blood flow (Qp/Qs) was 1.31 +/- 0.2, and in six patients (9%), the ratio was 1.5 or greater. Among nine clinical, 20 hemodynamic, and six procedural variables, stepwise logistic regression analysis selected the following as independent predictors of AS: smaller increases in valve area (p = 0.01) after PMV, absence of previous surgical commissurotomy (p = 0.02), mitral valve calcification (p = 0.02), and smaller left atria (p = 0.06). Among the 33 patients recatheterized at 6 months, oximetry had detected AS in 10, and dilution curves detected AS in an additional nine (total, 58%) immediately after PMV. At 6 months, AS had decreased or disappeared in 14 of these patients (74%), had increased in three (16%), and was unchanged in two (10%). Overall, at 6 months, oximetry identified AS in three patients, and dilution curves identified AS in an additional 13 (total, 48%). AS was detected at 6 months in only three patients but was not detected immediately after PMV. Although AS is very frequent immediately after PMV, Qp/Qs is usually less than 1.5. The appearance of shunting correlates with patient characteristics and with less improvement in valve area after PMV. Atrial shunting usually persists at 6 months, but its severity almost always decreases.
Dispensing of Electronically Discontinued Medications
Authors: Adrienne S. Allen
Journal: Annals of Internal Medicine (2013)

Letters2 April 2013Dispensing of Electronically Discontinued MedicationsAdrienne S. Allen, MD, MPHAdrienne S. Allen, MD, MPHFrom North Shore Physicians Group, Danvers, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-7-201304020-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We kindly thank Dr. Villier for his comments. We agree that automated dispensing by pharmacies may facilitate inappropriate medication filling. Patients may be prompted to pick up medications that have been discontinued or changed. However, automated dispensing has some benefits.The automated system reminds patients to continue important medications. Dose changes and medication substitutions represent another high-risk area. Many patients use multiple pharmacies, making the creation of an active central medication list that can be accessed by all of the patient's caregivers even more important. This central list could help reduce much of the guesswork involved in investigating ... Author, Article, and Disclosure InformationAuthors: Adrienne S. Allen, MD, MPHAffiliations: From North Shore Physicians Group, Danvers, Massachusetts.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1182. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPharmacy Dispensing of Electronically Discontinued Medications Adrienne S. Allen and Thomas D. Sequist Dispensing of Electronically Discontinued Medications James A. Villier Metrics 2 April 2013Volume 158, Issue 7 Page: 571-572 Keywords Caregivers Conflicts of interest Disclosure ePublished: 2 April 2013 Issue Published: 2 April 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Thymic Stromal Lymphopoetin-Induced Expression of the Endogenous Inhibitory Enzyme SLPI Mediates Recovery from Colonic Inflammation
Authors: Colin Reardon, Matthias Lechmann, Anne Brüstle, Mélanie G. Gareau, Naomi Shuman, Dana Philpott, Steven F. Ziegler, Tak W. Mak
Journal: Immunity (2011)
Korotkoff's Sounds
Authors: William Dock
Journal: New England Journal of Medicine (1980)

Previously reported experiments have shown that sounds identical to heart sounds recorded from the precordium can be evoked from the valves obtained at autopsy and suddenly drawn taut near a microphone in a small tank of water.1 2 3 In an effort to complete such studies of the genesis of vascular sounds, the noise heard over the brachial artery when estimating blood pressure by Korotkoff's method has now been reproduced in isolated arterial segments by production of a sudden rise in perfusion pressure. Similar sounds can be heard over the femoral arteries in patients with various diseases that cause low diastolic and . . .
Junior doctors take heart: you do everything as well as we did
Authors: A. Cohn
Journal: BMJ (2012)

You junior doctors are now probably beginning to settle into your new job, and your initial exuberance may be somewhat muted by the reality of what the life of a junior doctor is really about. I hope that you can get through some of the inevitable drudgery and feelings of isolation, because I still believe that medicine must be the best profession in the world. I can honestly say that I enjoy coming to work every day and hope that you share this feeling.

I wanted specifically to let you know how things were in the past compared with now. I am sure you have heard your seniors telling you how hard they worked, how they never left the hospital, and how professional they were compared to you, who are either implicitly, or often explicitly, stupid, disorganised, uninterested, and more focused on finishing your shift than working on it.

I am too young to have experienced myself the house jobs where the doctor was resident for the entire six months—compensated, however, …
Effect of synthetic oestrogens and progestagens in oral contraceptives on bile lipid composition.
Authors: R H Down, M J Whiting, J M Watts, W Jones
Journal: Gut (1983)

The prevalence of cholesterol gall stones in young women has increased since the introduction of oral contraceptives. The synthetic female sex hormones used in these preparations, increase the degree of cholesterol saturation in bile. To determine whether oestrogens, progestagens, or both, are responsible for the change in biliary cholesterol saturation index, a prospective randomised, controlled study was performed. A significant increase in the cholesterol saturation index of bile was observed when either 30 micrograms ethinyloestradiol plus 150 micrograms norgestrel (p = 0.01) or 50 micrograms ethinyloestradiol plus 250 micrograms norgestrel (p less than 0.01) were ingested daily for two months. No change in the cholesterol saturation index was observed when 30 micrograms ethinyloestradiol alone, or 30 micrograms ethinyloestradiol plus 2.5 mg norethisterone were used. The mechanism for the increase in cholesterol saturation index did not appear to involve bile acid metabolism. These results indicate that the progestagen, norgestrel, and not as previously thought the oestrogen, ethinyloestradiol, is responsible for the increase in cholesterol saturation of bile which accompanies the use of oral contraceptives.
Cell Migration: Tunable Substrates Unveil Chemical Complementation of a Genetic Cell Migration Defect (Adv. Healthcare Mater. 8/2013)
Authors: Janina Kristin Hellmann, Nadine Perschmann, Joachim P. Spatz, Friedrich Frischknecht
Journal: Advanced Healthcare Materials (2013)

Sporozoite motility is essential for malaria transmission and constitutes the first target for intervention within the human body. On page 1162 J. P. Spatz, F. Frischknecht, and co-workers use a set of tunable substrates with changed ligand spacing and elasticity to show that a small chemical compound that stabilizes the actin cytoskeleton can compensate the motility defects of parasites that lack a surface protein important for substrate adhesion.
Preliminary results of the Puff City Program for urban teens with asthma
Authors: C.L.M. Joseph, S. Stringer, D.R. Ownby, E. Peterson, S. Hoerauf, W. Gibson-Scipio, C.C. Johnson, J. Elston-Lafata, E. Saunders, U. Pallonen, J. Caison-Sorey, N.M. Clark, M. Dereski, K. Wildenhaus, R. Vinuya, V. Strecher
Journal: Journal of Allergy and Clinical Immunology (2005)
Shifting the balance from secondary to primary care
Authors: A. Coulter
Journal: BMJ (1995)

Countries with more highly developed systems of primary care tend to have lower health care costs,1 and policies designed to shift the balance from secondary to primary care have therefore been a common theme in health service reforms. But financial motives are not the only reason. Starfield's definition of primary care—“first-contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease or organ system”1—encapsulates the main elements that such policies aim to preserve. A health care system dominated by secondary, tertiary, and emergency care will tend to be fragmented, discontinuous, uncoordinated, and costly.

In Britain, boundaries are already shifting. Some procedures are being transferred from hospital to community settings. For example, triage systems and hospital at home schemes are being established to avoid hospital admissions and facilitate early discharge; attempts are being made to reduce the number of patients referred inappropriately to specialist services by developing and implementing referral guidelines; general practitioners and community nurses are being encouraged to develop new skills and new practice based facilities; shared care schemes are being introduced for chronic disease management, paediatrics, mental health, and maternity care; and some general practitioners and specialists are experimenting …
Hydrothorax after Central Venous Catheterization
Authors: C. J. Rudge, M. Bewick, I. McColl
Journal: BMJ (1973)

Three patients are described who developed hydrothorax as a complication of central venous catheterization. Respiratory distress associated with physical signs of fluid in the chest should arouse suspicion that the venous catheter has perforated the wall of the vein.The complications of central venous catheterization are reviewed and three cases of hydrothorax are presented. Comments on the prevention of these complications, their diagnosis and treatment if they occur, are made.
Adverse prognostic significance of concentric remodeling of the left ventricle in hypertensive patients with normal left ventricular mass
Authors: Paolo Verdecchia, Giuseppe Schillaci, Claudia Borgioni, Antonella Ciucci, Massimo Battistelli, Carlo Bartoccini, Antonella Santucci, Carla Santucci, Gianpaolo Reboldi, Carlo Porcellati
Journal: Journal of the American College of Cardiology (1995)