tbuckley/cabot-search huggingface dataset:
Ventricular arrhythmias in the subacute myocardial infarction period. High-resolution activation and refractory patterns of reentrant rhythms.
Authors: M Restivo, W B Gough, N el-Sherif
Journal: Circulation Research (1990)

Patterns of activation, functional conduction block, and effective refractory periods during reentrant activation were investigated in a 4-day postinfarction canine model using a 64-channel high-resolution (1 mm) bipolar electrode array. Lower resolution (3-10 mm) isochronal activation maps of the entire epicardial surface were constructed from 126 sites during the initiation and sustenance of reentry and showed reentrant wave fronts that circulated around arcs of functional conduction block. During initiation of reentry by premature stimulation, high-density recordings from these same regions showed that conduction block occurred abruptly, within 1 mm, and without prior decrement of the impulse. Electrograms recorded in proximity to the arc of block were comprised of two deflections: a local activation potential and an electrotonic potential reflecting activation 1 mm away; the reverse order of activation and electrotonus was observed on the opposite side of the arc of block. The occurrence of functional conduction block during premature stimulation in this model was correlated with abrupt increases in effective refractory periods of 10-120 msec (27 +/- 24 msec; mean +/- SD) within 1 mm or less. Neither the abrupt change of refractoriness nor functional conduction block appeared to depend on differences in excitability, the geometrical characteristics of the surviving epicardial layer, or the orientation of the myocardial fibers. During sustained reentrant activation, high-density recordings along the arcs of block showed split electrograms comprised of local activation and electrotonus, which were identical in morphology to those recorded during the initiation of reentry. The interval between the deflections was shorter at the ends of the arc and increased to a maximum value at the center of the arc. The activation potentials corresponded in time with activation of large isochronal regions on either side of the arc of block. There was evidence that at least part of the arc of block during sustained reentry represented thin discrete zones of constant block due to electrotonic influences of impulse penetration from both sides of the arc. Our results strongly suggest that continuous arcs of functional conduction block are a necessary prerequisite for both the initiation and the sustenance of reentrant activation in subacute canine myocardial infarction. Functional conduction block during the initiation of reentry was due to abrupt changes in refractoriness, within a distance of 1 mm or less.
Skin necrosis after heparin injection.
Authors: P Isaacs, D Vollum, T M Price
Journal: BMJ (1982)

The results are, however, in contrast with the observation2 that a raised fluoride con- centration in drinking water or supplementary fluoride intake increases the fluoride content of milk in lactating women; in this study the fluoride content of human milk was increased by about 15-40", of daily supplements of 5 mg sodium fluoride.Though the dose of daily supplements employed was higher (5 mg) than the 1-5 mg used by Dr Ekstrand and others, the results of this study contradict their conclusion that fluoride is not transferred from plasma to breast milk.Therefore further studies employing higher (more than 1-1 5 mg/day) dosages of sodium fluoride need to be undertaken to see if transfer of fluoride from plasma to breast milk is a dose-dependent phenomenon.Such studies will also simulate the natural conditions under which the newborn children are breast-fed in regions where water is very rich in fluoride.Dr Ekstrand and his colleagues have reported that fluoride does not bind to any constituent of breast milk.But there is evidence3 that fluoride in milk is not totally diffusible as it is bound to fat, the albumin- globulin fraction, and casein, which contains a quarter of the total fluoride in whole milk.This discrepancy in the observations also needs evaluation.
Increased levels of soluble ICAM‐1 in the plasma of sickle cell patients are reversed by hydroxyurea
Authors: Nicola Conran, André Fattori, Sara T.O. Saad, Fernando F. Costa
Journal: American Journal of Hematology (2004)

Abstract Increased adhesive events between the blood vessel endothelium and red and white cells play a central role in the initiation of vasoocclusive crisis in sickle cell disease (SCD). Soluble VCAM‐1 levels are increased in the plasma of sickle cell patients and may be reduced during hydroxyurea (HU) therapy. Reports regarding any changes in soluble ICAM‐1 (sICAM‐1) levels in sickle cell patients, however, are conflicting, and as yet no beneficial effect of HU upon levels has been observed. Thus, we sought to thoroughly investigate changes in sICAM‐1 levels in SCD patients and the effect of HU therapy (20–30 mg/kg/day). Plasma sVCAM‐1 levels were significantly higher in steady‐state SCD patients than in normal controls (766 ± 86 ng/mL vs. 325 ± 38 ng/mL, respectively, P &lt; 0.0001). sVCAM‐1 levels were decreased in patients on HU therapy (543 ± 69 ng/mL) compared to those not taking HU; however, this difference was not significant. Plasma sICAM‐1 levels were significantly increased in steady‐state SCD patients compared to normal individuals (285 ± 20 ng/mL vs. 202 ± 16 ng/mL, respectively, P = 0.002), and HU therapy significantly reduced sICAM‐1 levels in patients (217 ± 12, P = 0.027) to levels approaching those of healthy individuals. sVCAM‐1 levels inversely correlated with fetal hemoglobin levels in SCD patients, while a nonsignificant inverse trend was observed between sICAM‐1 levels and fetal hemoglobin. In conclusion, plasma sICAM‐1 levels were significantly increased in SCD patients, and this increase was reversed by hydroxyurea therapy, possibly reflecting reduced endothelial activation in patients taking HU. Such an event may benefit patients by reducing adhesive interactions between white cells and the endothelium. Am. J. Hematol. 76:343–347, 2004. © 2004 Wiley‐Liss, Inc.
Drug Use and Laboratory Values in the Elderly
Authors: Joseph V. Levy
Journal: JAMA (1988)

<h3>To the Editor.</h3> —The article by Levinstein et al<sup>1</sup>that analyzes the yield of routine annual laboratory tests in a nursing home population, while informative, fails to provide the data we need to interpret laboratory findings in a geriatric population, since abnormal findings of laboratory tests in any age group, particularly the elderly, may be markedly affected by current drug therapy. There now is convincing evidence<sup>2-4</sup>that many drugs that are commonly administered to or prescribed for the geriatric patient may alter laboratory test results because of methodological, physiological, or pharmacologic (toxic) effects of the agents. Thus, of the reported 17% of tests that yielded abnormal results, one might predict that many were due to drug interference rather than to an intrinsic underlying organ dysfunction or disease. Nowhere in the article do the authors state, even in general terms, the medication profiles of the 121 patients. While the
Pediatric, elderly, and emerging adult‐onset peaks in Burkitt's lymphoma incidence diagnosed in four continents, excluding Africa
Authors: Sam M. Mbulaiteye, William F. Anderson, Jacques Ferlay, Kishor Bhatia, Cindy Chang, Philip S. Rosenberg, Susan S. Devesa, Donald M. Parkin
Journal: American Journal of Hematology (2012)

Burkitt's lymphoma (BL) in the general population and immunosuppressed persons with AIDS in the United States was characterized by three age-specific incidence peaks near 10, 40, and 70 years. We hypothesized that BL from different geographical areas may exhibit pediatric, adult, and elderly age incidence peaks. We investigated this hypothesis using data on 3,403 cases obtained from the International Agency for Research on Cancer (1963-2002). Data from Africa were sparse or incomplete, and thus were excluded. Age-standardized rates (ASRs) and age-specific incidence rates were calculated, supplemented with the calculations performed using age-period-cohort (APC) models. The ASR rose 5.3% (95% confidence interval [CI], 5.0-5.6) per year in males and 4.6% (95% CI, 4.5-4.8) in females. The ASR increased gradually in children, steeply in adults and most rapidly in the elderly both in males and in females. Overall, BL male/female ASR ratio was 2.5, but it declined from 3.1 (95% CI, 3.0-3.3) for pediatric BL to 2.3 (95% CI, 2.2-2.4) for adult BL and 1.5 (95% CI, 1.4-1.6) for elderly BL. Age-specific incidence peaks occurred near 10 and 70 years in all regions and periods. A peak near 40 years of age emerged in the mid-1990s, particularly in men. Findings using APC models confirmed those based on the standard analyses. Our findings, based on the international BL cases, support our hypothesis that BL is multimodal and that BL peaks at different ages may be clues to differences in the etiology and/or biology of BL at those ages.
Study Reveals Genetic Variations Linked with Lipid Levels
Authors: Tracy Hampton
Journal: JAMA (2013)

A recent search has uncovered 157 genetic variations that modify levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, and total cholesterol (Global Lipids Genetics Consortium et al. Nat Genet. 2013;45[11]:1274-1283).
Local medical committee conference
Authors: L Beecham
Journal: BMJ (1994)

Local medical committee conference PCG deal wins overwhelming supportRepresentatives of Britain's GPs have given their support to the government's reassurances on primary care groups (PCGs) and resolved that they form an acceptable basis for GPs' involvement.Last week's local medical committee (LMC) conference congratulated the GP leaders on their negotiations, which resulted in reassurances on freedom, funding, and control.These were set out in a letter from the health minister, Mr Alan Milburn, and were welcomed by the General Medical Services Committee at an emergency meeting last month (27 June, p 1927).
Hemophilia Polymorphism — The Genetic Plot Thickens
Authors: Donald I. Feinstein, Samuel I. Rapaport
Journal: New England Journal of Medicine (1969)

Hemophilia was recognized as a profound bleeding disorder transmitted as a sex-linked recessive trait in the nineteenth century. By the turn of the century it was clear that the fault lay with the blood and not the blood vessels. By the late 1930's, it was established that the hemophilic patient lacked a plasma activity (antihemophilic globulin, AHG, or factor VIII) needed to generate a prothrombin activator. The early 1950's held a surprise: whereas about 85 per cent of hemophilic patients lacked factor VIII activity, about 15 per cent lacked a different activity (plasma thromboplastin component, PTC, or factor IX) needed . . .
Not all self help groups discourage sick doctors from being members
Authors: E. Armstrong
Journal: BMJ (1997)

The real ethics of rationing Purchasers, not surgeons, control waiting listsEditor-I applaud the BMJ's efforts to bring the important issue of rationing to the fore, but I cannot allow one aspect of Light's contribution to go without challenge. 1Under the heading "parasitic privatisation" he says, "to top it off, the surgeons control the waiting lists" (to encourage patients into the private sector).I despair that someone of his academic stature should show such a lack of understanding of the purchaser-provider split that we have had in the NHS for the past six years.In the vast majority of cases we as surgeons have a contract with purchasers that places an upper limit on the number of patients on whom we can operate.Thus surgeons have no control over the number of patients having surgery and therefore, by definition, over the waiting list.The role of the surgeon is to prioritise, on clinical grounds, within the contracted number.If surgeons are to operate on more patients then purchasers must contract for more operations.The onus to reduce waiting time, and therefore encourage patients not to use the private sector, lies solely with the purchasers.
The scientific basis of health services
Authors: R. Smith
Journal: BMJ (1995)

Needs a better balance between original and evaluative research

The relation between science and health services has until recently been too casual, said Alan Langlands, chief executive of the National Health Service (NHS), at last week's London conference on the scientific basis of health services. The primary job of medical research has been to understand the mechanisms of disease and produce new treatments, not to worry about the effectiveness of the new treatments or their implementation. As a result many new treatments have taken years to become part of routine practice, ineffective treatments have been widely used, and medicine has been opinion rather than evidence based. “There has been,” said Sam Their, president of the Massachusetts General Hospital, “a failure of leadership in health research and too little investment in assessing new technologies.”

Yet in the United States the new congress is proposing to increase the $11.25 billion budget of the National Institutes of Health (primarily original research) by 5.7% and slash the $159 million budget of the Agency for Health Care Policy and Research (primarily evaluative research) to $64 million. This is a mistake: one of Britain's most prominent biological researchers Mark Ferguson, dean of the school of biological sciences in Manchester, said at last week's conference: “Development has been limited by the rate of discovery, but now it's limited by …
Laparoscopic Cholecystectomy, Intraoperative Cholangiograms, and Common Duct Injuries
Authors: Karl Y. Bilimoria, Jeanette Chung, Nathaniel J. Soper
Journal: JAMA (2013)

In the late 1980s, laparoscopic cholecystectomy was quickly adopted because it reduced the morbidity associated with the operation and had a relatively straightforward learning curve. However, compared with the open procedure, laparoscopic cholecystectomy was also associated with an increased incidence of common duct injuries, generally due to misinterpretation of the biliary anatomy during the operation. Common duct injuries can have devastating consequences. Although common duct injury rates have decreased slightly through the years, they have not been eliminated and remain a serious risk. 1-3 Observational studies of intraoperative cholangiography (which involves placing a catheter into the cystic duct, injecting contrast material, and obtaining radiographs) have examined whether intraoperative cholangiography may reduce the risk of common duct injury during cholecystectomy, but the results of these studies have not been consistent. 4-7 In this issue of JAMA, Sheffield and coauthors 8 used an instrumental variable analysis to estimate the association between intraoperative cholangiography use and common duct injury. Examining Texas Medicare data, they found 40.4% of 92 932 patients undergoing laparoscopic cholecystectomy had an intraoperative cholangiogram. Common duct injury occurred in 0.21% of patients who underwent intraoperative cholangiography and in 0.36% of patients who did not. After adjustment for the variables available in the database using multilevel logistic regression, the risk of common duct injury for cholecystectomies performed without intraoperative cholangiography was increased compared with those performed with it (odds ratio [OR], 1.79 [95% CI, 1.35-2.36], P < .001). After further adjustment for unmeasured confounders using instrumental variable analysis, the association between cholecystectomy performed without intraoperative cholangiography and common duct injury was no longer significant (OR, 1.26 [95% CI, 0.81-1.96]; P = .31). Estimating treatment effects in observational studies (ie,
The Surgical Significance of Melena in Childhood
Authors: William E. Ladd
Journal: New England Journal of Medicine (1937)

or are given but little emphasis. I imagine that in the case of physicians or surgeons whose main interest lies in adult practice, blood in the stools brings to mind conditions commonly found in the adult rather than those occurring more frequently in children. Would it not be correct to say that melena suggests to the practitioner hemorrhoids, anal fissure, cancer of the rectum or colon, dysenteries of various types, blood diseases such as hemophilia and purpura, portal congestion from diseases of the heart or liver, and gastric or duodenal ulcer or carcinoma? While it is true that many of these conditions may occasionally occur in the child, they are not the common causes of melena in this age group, nor are they the ones possessing surgical significance. It would serve no useful purpose to try to include in a paper of this length all possible causes of bleeding from the alimentary tract; so let it suffice to consider some of the commoner causes, as well as some of those which are rarer but have particular surgical interest. These conditions or diseases are, in the order of their interest, intussusception, Meckel's diverticulum, intestinal duplications, polyps, idiopathic ulcerative colitis, hemorrhagic disease of the newborn, purpura, splenomegaly with hematemesis, anal fissure, foreign body, and certain other rare diseases. Intussusception is a common disease of infancy, and one in which a correct early diagnosis and prompt surgical intervention are of paramount importance. In an analysis of the records of 434
Abnormal arachidonate distribution in low-density lipoprotein and thoracic aorta in hyperinsulinemia
Authors: Kenji Okumura, Mitsuhiko Kikuchi, Hideo Matsui, Kenshin Naruse, Kiyokazu Shimizu, Yukio Toki, Hidekazu Hashimoto, Takayuki Ito
Journal: Metabolism (1995)
Endotoxin Impairs Agonist-induced Calcium Mobilization in Rat Mesangial Cells
Authors: PATRICK T. MURRAY, MARK E. WYLAM, JASON G. UMANS
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

We hypothesized that endotoxin would impair agonist-induced calcium (Ca2 +) mobilization in rat mesangial cells, owing to the induction of nitric oxide synthase (NOS) and augmented nitric oxide (NO) synthesis. We measured basal and bradykinin-induced peak free cytosolic Ca2 + concentrations through microspectrofluorimetry with fura-2 in confluent mesangial cells, and assayed conditioned medium for nitrite accumulation. Prior to measurement, cells were incubated overnight in serum-supplemented medium, with or without endotoxin, L-arginine, indomethacin, meclofenamate, or Nω-nitro-L-arginine methyl ester (L-NAME). Endotoxin (1 mg/ml) decreased bradykinin-induced peak Ca2 + responses by 35 to 60% (p < 0.0001) and increased nitrite accumulation > 6-fold (p < 0.01). Arginine supplementation further ( > 9-fold, p < 0.0001) increased nitrite accumulation without changing the effect on Ca2 +. Inhibition of NOS abolished increments in nitrite concentration but had no effect on impaired Ca2 + responses. Cyclooxygenase (COX) inhibitors, present during incubation with endotoxin, but not afterward, normalized bradykinin-stimulated calcium responses. Thrombin-stimulated Ca2 + responses were similarly affected. We conclude that neither NO nor prostaglandins act directly to impair agonist-induced Ca2 + mobilization following endotoxin exposure; however, this effect may be an indirect effect of COX products, including reactive oxygen intermediates.
Transparency campaigners welcome new rules for clinical trials in Europe
Authors: Z. Kmietowicz
Journal: BMJ (2014)

Members of the European Parliament have voted overwhelmingly to introduce a raft of legal measures to increase the transparency of clinical trials in Europe.

Campaigners for increased transparency have hailed the move as a step towards ensuring that future treatments are based on all the evidence, increasing the likelihood that licensed drugs are more effective and safer than before. 

However, they said that their job was not yet done, as the complete evidence base for most drugs in current use remained undisclosed and should also be made publicly available.

From 2016, when the new clinical trials law is expected to come into force, all trials will have to be registered on a publicly accessible EU clinical trials register before they can begin, and a …
Protection against the transmission of hepatitis B virus in dental practitioners: Better gloves, earlier vaccination, or both?
Authors: Raymond S. Koff
Journal: Hepatology (1989)

A survey of 434 oral surgeons was conducted to examine risk factors for hepatitis B virus (HBV) infection. Overall, 112 (26%) of the participants demonstrated serologic evidence of past or current infection with HBV. Seropositivity was significantly associated with age, number of years in practice, and year of graduation from dental school but not with other variables examined, such as the number of patients seen annually or the number of patients seen who were at high risk of HBV infection. The strong correlation between years in practice and seropositivity was unaffected by reported use of gloves, face masks, or eye shields. The use of gloves and other protective devices does not appear to offer substantial protection against HBV exposure in oral surgeons, and all oral surgeons should receive HBV vaccine.
Human basophil degranulation test in diagnosis of hydatidosis.
Authors: F Leynadier, H Luce, A Abrego, M Huguier, J Dry, C L Huget
Journal: BMJ (1980)

Protein and energy malnutrition and iron-deficiency anaemia are widespread among preschool children in India.Because of a poor antibody response in severely malnourished children admitted to hospital it has been suggested that mass vaccination programmes would not be effective in populations where malnutrition is widespread.Earlier studies by this institute, however, have shown that most children in the community who suffer from mild or moderate protein and energy malnutrition respond well to conventional immunisation programmes.25 Our present findings show that antibody production is also unaffected by iron deficiency.Thus conventional immunisation programmes may be effective even in undernourished communities.
Thyroid disease and sebaceous function.
Authors: S K Goolamali, D Evered, S Shuster
Journal: BMJ (1976)

Sebum excretion rates (SER) were measured before and after treatment in patients with hypothyroidism and thyrotoxicosis. The mean SER in the former was significantly less than that in normal controls but there was no correlation between SER and the severity of the disease as indicated by serum thyroid-stimulating hormone levels. After treatment with L-thyroxine the SER increased but remained subnormal. By contrast the SER was not increased in patients with thyrotoxicosis and it was unaffected by treatment. The human sebaceous gland seems to respond to thyroid hormone mainly in the hypothyroid range.