tbuckley/cabot-search huggingface dataset:
Discharge rules from medium secure units in Wales to be reviewed after stabbing
Authors: Roger Dobson
Journal: BMJ (2004)

Arrangements for planning discharges at medium secure units in Wales are to be reviewed after an investigation into the case of psychiatric patient, Paul Khan, who fatally stabbed a stranger. The investigation identified a series of system failures—including a failure to apply a “12 hour missing” rule, which would have alerted the Home Office to the disappearance of 35 year old Mr Khan.

The inquiry team also said that they had difficulty understanding how Mr Khan, who had been admitted to Ashworth Maximum Security Hospital, Merseyside, seven years previously for an unprovoked knife attack, …
Functional impact of NOTCH1 mutations in chronic lymphocytic leukemia
Authors: F Arruga, B Gizdic, S Serra, T Vaisitti, C Ciardullo, M Coscia, L Laurenti, G D'Arena, O Jaksic, G Inghirami, D Rossi, G Gaidano, S Deaglio
Journal: Leukemia (2013)
A Possible Role for the Adenylcyclase System in Insulin Secretion*
Authors: W. J. Malaisse, F. Malaisse-Lagae, D. Mayhew
Journal: Journal of Clinical Investigation (1967)

A possible role for adenylcyclase in insulin secretion was investigated. Isoproterenol, a predominantly β-adrenergic agent, when mixed with an α-adrenergic blocking agent (phenoxybenzamine), stimulated insulin secretion from pieces of the rat's pancreas in vitro. Theophylline, caffeine, 3′5′-cyclic AMP, glucagon, adrenocorticotropin (ACTH), and thyrotropin (TSH), all of which are thought to act through the adenylcyclase systems in the liver and adipose tissue, also stimulated insulin secretion in vitro; oxytocin and vasopressin, which do not stimulate lipolysis in adipose tissue, were inactive. In all cases, stimulation of insulin secretion could not be detected when glucose was absent or present in only low concentrations (less than 100 mg/100 ml) and was maximal at high levels of glucose (300 mg/100 ml). When pancreatic tissue was obtained from normoglycemic rats and contained no detectable glycogen in the Islets, the stimulant effects of glucose and of theophylline were reduced or abolished by mannoheptulose and 2-deoxyglucose. When tissue was derived from rats infused for 8-10 hr with glucose and contained glycogen, theophylline, even in the absence of glucose, stimulated secretion and this effect was reduced by 2-deoxyglucose but not by mannoheptulose. It is suggested that the β-cell contains an adenylcyclase system through which phosphorylase and possibly phosphofructokinase could be activated; and that insulin secretion could depend upon and be regulated by hormones and other substances which influence the rate at which glycolysis proceeds within the β-cell.
Addendum to “Personal and Public Safety Issues Related to Arrhythmias That May Affect Consciousness: Implications for Regulation and Physician Recommendations: A Medical/ Scientific Statement From the American Heart Association and the North American Society of Pacing and Electrophysiology” Public Safety Issues in Patients With Implantable Defibrillators A Scientific Statement From the American Heart Association and the Heart Rhythm Society
Authors: Andrew E. Epstein, Christina A. Baessler, Anne B. Curtis, N.A. Mark Estes, Bernard J. Gersh, Blair Grubb, L. Brent Mitchell
Journal: Circulation (2007)

In 1996, the American Heart Association developed a scientific statement entitled "Personal and Public Safety Issues Related to Arrhythmias That May Affect Consciousness: Implications for Regulation and Physician Recommendations." Since then, multiple trials have established the role of implantable cardioverter-defibrillators (ICDs) for the primary prevention of sudden cardiac death in patients at risk for life-threatening ventricular arrhythmias.The issue of driving for patients with ICDs implanted for primary prevention was briefly discussed in the original statement, with the recommendation that such patients not be restricted from driving beyond the initial phase of healing. This scientific statement has been developed to extend the original 1996 recommendations and to provide specific recommendations on driving for individuals with ICDs implanted for primary prevention.(1) Patients receiving ICDs for primary prevention should be restricted from driving a private automobile for at least 1 week to allow for recovery from implantation of the defibrillator. Thereafter, these driving privileges should not be restricted in the absence of symptoms potentially related to an arrhythmia. (2) Patients who have received an ICD for primary prevention who subsequently receive an appropriate therapy for ventricular tachycardia or ventricular fibrillation, especially with symptoms of cerebral hypoperfusion, should then be considered to be subject to the driving guidelines previously published for patients who received an ICD for secondary prevention. (3) Patients with ICDs for primary prevention must be instructed that impairment of consciousness is a possible future event. (4) These recommendations do not apply to the licensing of commercial drivers.
The E3 Ligase MuRF1 Degrades Myosin Heavy Chain Protein in Dexamethasone-Treated Skeletal Muscle
Authors: Brian A. Clarke, Doreen Drujan, Monte S. Willis, Leon O. Murphy, Richard A. Corpina, Elena Burova, Sergey V. Rakhilin, Trevor N. Stitt, Cam Patterson, Esther Latres, David J. Glass
Journal: Cell Metabolism (2007)
Thalidomide Babies: Management of Limb Defects
Authors: L. Gillis
Journal: BMJ (1962)

From observations of the recent cases of congenital limb deformities attributed to thalidomide administered during the early weeks of pregnancy (that is, fifth and sixth weeks) it would seem that there is a fairly clearly defined clinical syndrome (see Smithells, 1962; Leck and Millar, 1962).There is, commonly, a haemangioma situated centrally on the forehead.Often another is seen on the upper lip and sometimes on the cheek or the tip of the nose.These fade completely in time.Associated with this
Congenital Perceptive Deafness: Role of Intrauterine Rubella
Authors: S. M. Gumpel, K. Hayes, J. A. Dudgeon
Journal: BMJ (1971)

Rubella antibody was detected in 85 (61%) of 139 children aged from 6 months to 7 years with congenital perceptive deafness. Of the 112 children who were aged under 4 years 61 (54%) had rubella antibody (seropositive) compared with 7·1% in randomly selected children of the same age. A close correlation was found between the presence of antibody in children with perceptive deafness and (1) a maternal history of rash or contact in early pregnancy, and (2) with the presence of other rubella-type defects. Intrauterine rubella was thought to be the cause of the deafness in 82 (59%) of the 139 children, in 60 of whom deafness was the only rubella defect detected. Thus intrauterine rubella should be considered a likely cause of congenital perceptive deafness in a child under 4 years in whom rubella antibody is present.
Food Avoidance Following Physician Diagnosis Of Food Allergy: Results From A Canadian Study
Authors: L. Soller, J. Fragapane, M. Ben-Shoshan, D. Harrington, R. Alizadehfar, L. Joseph, Y. St-Pierre, S. Godefroy, S.J. Elliott, A.E. Clarke
Journal: Journal of Allergy and Clinical Immunology (2011)
Brief Home Visits by the Clinic Therapist in the Treatment of Lower-Class Patients
Authors: MANFRED I. BEHRENS
Journal: American Journal of Psychiatry (1967)

Brief and occasional home visits by the therapist have not only proved feasible but have had notably successful results in the treatment of lower-class clinic patients. They provide a better understanding of family dynamics and result in the development of improved patient-therapist relationships. They may also aid in the prevention of hospitalization. The home visit is of greatest value when made by the person directly responsible for patient care and not by an intermediary.
Childhood insulin dependent diabetes: Oxford may not be representative
Authors: J J Rangasami, D C Greenwood, B McSporran, P J Smail, C C Patterson, N R Waugh
Journal: BMJ (1998)

Editor—Gardner et al present results from the Oxford health region showing a considerable rise in the incidence of childhood insulin dependent diabetes since 1985, particularly among children under the age of 5.1

We have recently published similar …
Increased vascular sensitivity and connexin43 expression after sympathetic denervation
Authors: David P. Slovut, Shyamal H. Mehta, Anne M. Dorrance, Frank C. Brosius, Stephanie W. Watts, R. Clinton Webb
Journal: Cardiovascular Research (2004)

Following denervation, arteries demonstrate a heightened sensitivity to alpha-adrenergic agonists and increased oscillatory contractions that may partly result from increased gap junction expression. Hence, we wanted to study the effect of sympathetic denervation on connexin43 (Cx43) expression and agonist-induced contractility in the vascular smooth muscle (VSM).Effects of denervation with reserpine (3 mg/kg/day, i.p.) or topical 5% phenol-glycerol on VSM contractions and expression of the gap junction Cx43 mRNA by reverse transcriptase polymerase chain reaction (RT-PCR) and Western blotting for Cx43 protein were examined. Wistar-Kyoto (WKY) rat tail arteries were exposed to norepinephrine (NE) (10(-9)-10(-5) M). Reactivity was also examined in the carotid arteries and thoracic aortas from Cx43 heterozygote deficient (KO) mice.The concentration for NE-induced contraction was lower in reserpine- and phenol-treated vessels than controls (p<0.05). NE-induced oscillatory activity (OA) was seen in 5/5 reserpine- and 5/8 phenol-treated vessels vs. 0/12 controls (p<0.05). Spontaneous OA was observed more frequently in carotid and aortic rings from WT than Cx43 KO rings. Cumulative OA in response to alpha-adrenergic stimulation was significantly greater in WT carotid (429+/-101 vs. 128+/-7 mN s, p<0.05) and aortic rings (337+/-85 vs. 134+/-11 mN s, p<0.05) than in Cx43 KO rings. Following denervation, RT-PCR showed significantly increased levels of Cx43 mRNA (p<0.05). Western blot analysis revealed near doubling of Cx43 protein (p<0.05).We conclude that sympathetic denervation results in increased expression of Cx43, which in turn, contributes to increased spontaneous and agonist-induced OA in VSM.
Hepatic distribution of E2 component of pyruvate dehydrogenase complex after transplantation
Authors: James Neuberger, Lorraine Wallace, Ruth Joplin, Stefan Hubscher
Journal: Hepatology (1995)

We have examined the distribution of the E2 component of pyruvate dehydrogenase complex in the liver of patients with native primary biliary cirrhosis (PBC), and after transplantation, using affinity-purified anti-E2 antibodies. In the posttransplantation group, we studied biopsy specimens from patients grafted for conditions other than PBC (n = 6) and those grafted for PBC with (n = 6) and without (n = 5) histological features suggestive of PBC recurrence. Features suggestive of PBC recurrence included portal tract granulomas, bile duct damage, ductopenia, and lymphoid aggregates. In the native liver from patients with PBC, there was increased staining of E2 on the biliary epithelial cells compared with hepatocytes, as previously described. However, in liver biopsy specimens from patients after transplantation, the pattern of staining of E2 was similar to that of normal, control liver in all three groups studied. These findings suggest that E2 overexpression on bile duct cells may not be important in the perpetuation of the bile duct damage in PCB, that expression in the allograft may be modified by immunosuppression, or that PBC does not recur in the allograft.
Practice Variations: A Challenge for Physicians
Authors: John H. Dawson
Journal: JAMA (1987)

Variation in the utilization rates of medical treatments and surgical procedures has been shown to occur across both large regions and small areas. In this issue ofTHE JOURNAL, a series of studies<sup>1-3</sup>examines the hypothesis that levels of inappropriate use explain geographic variations. In particular, they test the hypothesis that areas exhibiting relatively high levels of utilization also experience a higher percentage of inappropriate care. In examining this hypothesis, the appropriateness of the application of coronary angiography, carotid endarterectomy, and upper gastrointestinal tract endoscopy was examined and correlated with rates of utilization across 13 treatment sites in 1981. The findings of the study did not "support the hypothesis that areas with high use of medical and surgical procedures exhibit these high rates primarily or to any meaningful extent, because physicians in these areas perform procedures more often for inappropriate indications than their counterparts in areas of lower use."
EXPERIMENTS ON THE CAUSE OF THE RABBIT CARCINOMAS DERIVED FROM VIRUS-INDUCED PAPILLOMAS
Authors: William E. Smith, John G. Kidd, Peyton Rous
Journal: The Journal of Experimental Medicine (1952)

Three out of four carcinomas arising from rims-induced, rabbit papillomas have grown well after transplantation to sucklings. Two were propagated serially, and it seems likely that all could have been maintained indefinitely had litters been available of newborn animals of the sort in which they arose. These successes are the more worthy of note because of the well-nigh uniform failure of similar growths on transfer to adults. The tumors enlarged with great rapidity in the sucklings, were extraordinarily destructive, and two of them metastaslzed within a few weeks. Many efforts were made to extract causative agents from the three carcinomas, on the assumption that these might be due to variants of the Shope virus. Highly favorable conditions for the demonstration of this latter were provided in the tests; yet their outcome was wholly negative although all of the cancers derived from papillomas caused by "recoverable" strains of virus, and although one of them appeared to be consequent upon only the slightest of alterations toward malignancy on the part of the papilloma from which it came. Extracts of another of the cancers, an anaplastic, squamous-cell carcinoma devoid of any morphological sign of the influence of the Shope virus, yielded typical virus papillomas on several occasions. The wholly negative results with the third cancer must be considered in the light of the fact that the "recoverable" strain of virus causing the papilloma from which it originated could no longer be recovered from such growths on collateral test.
RACE AND LEFT VENTRICULAR STRUCTURE IN CHRONIC KIDNEY DISEASE: THE CHRONIC RENAL INSUFFICIENCY COHORT (CRIC)
Authors: Faraz Ahmad, Katherine Kunkel, Jason Roy, Kaixiang Tao, Alan Go, Matthew Budoff, Jiang He, Dominic S. Raj, Ana Ricardo, Julie Wright, Jackson Wright, Amanda H. Anderson, John W. Kusek, James P. Lash, Martin St. John Sutton, Martin Keane
Journal: Journal of the American College of Cardiology (2013)
Patients and medical power
Authors: R. Canter
Journal: BMJ (2001)

After the announcement of the Alder Hey report into retained organs after postmortem examinations the health secretary, Alan Milburn, said he wanted the balance of power to move away from doctors and “shift decisively in favour of the patient.” He suggested that patients should be offered free choices to make up their own minds about treatment options. Many assumptions underpin such an idea, including the belief that medical “power” is a currency that can be transferred from doctor to patient, so that the patient becomes “free” to choose. It is not as simple as this.

Power is the means by which A gets B to do something, and many models exist to explain how A might do this. The medical profession sees itself, and is seen, as expert in understanding and managing disease. However, expert power is only part of the picture. The concept of power also includes reward, coercive, legitimate, and charismatic power.1 Individual clinicians may exercise elements of each of these types of power in different proportions so that each has his or her own distinctive consultation style.

Perhaps Mr Milburn really means that the medical profession should …
Racial and Regional Differences in Venous Thromboembolism in the United States in 3 Cohorts
Authors: Neil A. Zakai, Leslie A. McClure, Suzanne E. Judd, Monika M. Safford, Aaron R. Folsom, Pamela L. Lutsey, Mary Cushman
Journal: Circulation (2014)

Background— Blacks are thought to have a higher risk of venous thromboembolism (VTE) than whites. However, prior studies are limited to administrative databases that lack specific information on VTE risk factors or have limited geographic scope. Methods and Results— We ascertained VTE from 3 prospective studies: the Atherosclerosis Risk in Communities Study (ARIC), the Cardiovascular Health Study (CHS), and the Reasons for Geographic and Racial Differences in Stroke study (REGARDS). We tested the association of race with VTE using Cox proportional hazard models adjusted for VTE risk factors. Over 438 090 person-years, 916 incident VTE events (302 in blacks) occurred in 51 149 individuals (17 318 blacks) who were followed up. In risk factor–adjusted models, blacks had a higher rate of VTE than whites in the CHS (hazard ratio, 1.81; 95% confidence interval, 1.20–2.73) but not ARIC (hazard ratio, 1.21; 95% confidence interval, 0.96–1.54). In REGARDS, there was a significant region-by-race interaction ( P =0.01): Blacks in the Southeast had a significantly higher rate of VTE than blacks in the rest of the United States (hazard ratio, 1.63; 95% confidence interval, 1.08–2.48) that was not seen in whites (hazard ratio, 0.83; 95% confidence interval, 0.61–1.14). Conclusions— The association of race with VTE differed in each cohort, which may reflect the different time periods of the studies or different regional rates of VTE. Further studies of environmental and genetic risk factors for VTE are needed to determine which underlie racial and perhaps regional differences in VTE.
Waiting times for x ray results in England are increasing, figures show
Authors: S. Mayor
Journal: BMJ (2015)

Waiting times for patients in England to receive the results of imaging examinations are increasing, latest figures have shown,1 as nearly 333 000 patients waited more than a month for x ray results.

The Royal College of Radiologists surveyed radiology departments at all NHS trusts in England on 26 February and asked how many imaging examinations, including x rays, CT (computed tomography) scans, and MRI (magnetic resonance imaging) scans, were unreported on their systems and had been waiting …
Efficacy, Safety, and Dose-Response Characteristics of Glipizide Gastrointestinal Therapeutic System on Glycemic Control and Insulin Secretion in NIDDM: Results of two multicenter, randomized, placebo-controlled clinical trials
Authors: Donald C Simonson, Ione A Kourides, Mark Feinglos, Harry Shamoon, Christine T Fischette
Journal: Diabetes Care (1997)

To investigate the efficacy, safety, and dose-response characteristics of an extended-release preparation of glipizide using the gastrointestinal therapeutic system (GITS) on plasma glucose, glycosylated hemoglobin (HbA1c), and insulin secretion to a liquid-mixed meal in NIDDM patients.Two prospective, randomized, double-blind, placebo-controlled, multicenter clinical trials were performed in 22 sites and 347 patients with NIDDM (aged 59 +/- 0.6 years; BMI, 29 +/- 0.3 kg/m2; known diabetes duration, 8 +/- 0.4 years) were studied. Each clinical trial had a duration of 16 weeks with a 1-week washout, 3-week single-blind placebo phase, 4-week titration to a fixed dose, and 8-week maintenance phase at the assigned dose. In the first trial, once-daily doses of 5, 20, 40, or 60 mg glipizide GITS were compared with placebo in 143 patients. In the second trial, doses of 5, 10, 15, or 20 mg of glipizide GITS were compared with placebo in 204 patients. HbA1c, fasting plasma glucose (FPG), insulin, C-peptide, and glipizide levels were determined at regular intervals throughout the study. Postprandial plasma glucose (PPG), insulin, and C-peptide also were determined at 1 and 2 h after a mixed meal (Sustacal).All doses of glipizide GITS in both trials produced significant reductions from placebo in FPG (range -57 to -74 mg/dl) and HbA1c (range -1.50 to -1.82%). Pharmacodynamic analysis indicated a significant relationship between plasma glipizide concentration and reduction in FPG and HbA1c over a dose range of 5-60 mg, with maximal efficacy achieved at a dose of 20 mg for FPG and at 5 mg for HbA1c. PPG levels were significantly lower, and both postprandial insulin and C-peptide levels significantly higher in patients treated with glipizide GITS compared with placebo. The percent reduction in FPG was comparable across patients with diverse demographic and clinical characteristics, including those with entry FPG > or = 250 mg/dl, resulting in greater absolute decreases in FPG and HbA1c in patients with the most severe hyperglycemia. Despite the forced titration to a randomly assigned dose, only 11 patients in both studies discontinued therapy because of hypoglycemia. Glipizide GITS did not alter lipids levels or produce weight gain.The once-daily glipizide GITS 1) lowered HbA1c, FPG, and PPG over a dose range of 5-60 mg, 2) was maximally effective at 5 mg (using HbA1c) or 20 mg (using FPG) based on pharmacokinetic and pharmacodynamic relationships, 3) maintained its effectiveness in poorly controlled patients (those with entry FPG > or = 250 mg/dl), 4) was safe and well tolerated in a wide variety of patients with NIDDM, and 5) did not produce weight gain or adversely affect lipids.
Abstract P3-12-04: RAD51 135G&amp;gt;C Does Not Modify Breast Cancer Risk in Non-BRCA1/2 Mutation Carriers: Evidence from a Meta-Analysis of 12 Studies
Authors: K-D Yu, Z-M. Shao
Journal: Cancer Research (2010)

Abstract A single-nucleotide polymorphisms (SNP) in the 5'-untranslated region (UTR) of RAD51, 135G&amp;gt;C (rs1801320), was reported to be associated with an increased risk of breast cancer among BRCA2 as well as BRCA1 carriers. A few studies have also investigated the genetic contribution of RAD51 135G&amp;gt;C to the risk of sporadic breast cancers or breast cancer in non-BRCA1/2 carriers, though the results are yet controversial andinconclusive. We in this study performed a more precise estimation of the relationship between 135G&amp;gt;C and breast cancer among non-BRCA1/2 mutation carriers by meta-analyzing the currently available evidence from literature. A total of 12 studies involving 7,065 cases and 6,981 controls were identified. Crude odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of association. When all the studies were pooled into the meta-analysis, there was no evidence for a significant association between 135G&amp;gt;C and breast cancer risk in non-BRCA1/2 mutation carriers (for CC vs. GG: OR = 0.995, 95% CI: 0.741-1.336; for GC vs. GG: OR = 0.959, 95% CI: 0.869-1.057; for dominant model: OR = 0.988, 95% CI: 0.902-1.082; and for recessive model: OR = 1.037, 95% CI: 0.782-1.376). We also performed subgroup analysis by ethnicity (Caucasian) as well as did analysis using the studies fulfilling Hardy-Weinberg equilibrium, and the results did not change. In summary, the present meta-analysis suggests that the RAD51 135G&amp;gt;C does not modify breast cancer risk in non-BRCA1/2 mutation carriers. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-12-04.
Points from Letters: Doctor, Driver, and the Courts
Authors: N. I. Spriggs
Journal: BMJ (1964)

BRTSw=Hcomings of others-presumably they hope their own virtues will show up better by contrast; but, really, 800 purple hearts a day are too much for any of us to swallow, literally or figuratively.No details have been given, so far as I know, of how many were in the family or how long the tablets were supposed to last, or whether the circum- stances justified the prescribing of purple hearts in any quantity.This statement has been so damaging to the profession in lay eyes and so surprising and shocking to the vast majority of doctors in general practice who never prescribe more than two Drinamyl a day-and these with some diffidence-that the Ministry should justify the statement of the official by supply- ing details to the profession by way of Prescribers' Notes or in the B.M.7.