tbuckley/cabot-search huggingface dataset:
How best to organise acute hospital services?
Authors: R. Smith
Journal: BMJ (2001)

The Royal College of Physicians and the NHS Confederation have announced a working group to rethink the delivery of acute emergency services in hospitals. It is, says their press release, “one of the biggest problems faced by the NHS.” And, says George Alberti, college president: “We need completely new thinking to solve the problem—not just refinements of the present system.”

The current arrangement of acute hospital services in Britain becomes ever less efficient and more dangerous. Yet the political cost of reorganisation is rising. The government lost a safe parliamentary seat in Wyre Forest because of its plans to close Kidderminster Hospital.1 A current minister, Yvette Cooper, faces potentially the same problem in her constituency. So the time has clearly come to think differently, and a recent meeting in Cambridge of the Eastern Region of the NHS on acute services heard a radical proposal to reverse current thinking. Instead of the current fashion for ever larger acute hospitals with local hospitals taking patients discharged from the large hospital, patients with emergencies might go first to the local hospital—but to one very different from now. …
On the Risk of Multiple Sclerosis According to Age at Immigration to South Africa
Authors: G. Dean, J. F. Kurtzke
Journal: BMJ (1971)

In a national prevalence study of multiple sclerosis (M.S.) in the Republic of South Africa based on census day 1960 there were 118 individuals with M.S. who were born in Northern Europe (United Kingdom and other parts of North and Central Europe) and who had emigrated to the Republic by 1960. Their prevalence rate was 49 per 100,000 immigrants in comparison with a prevalence of 11 per 100,000 among native-born English-speaking white South Africans.To study the possible effect of age at immigration it was necessary to relate the M.S. immigrants to the appropriate denominator-the population at risk according to age at immigration. The population at risk by age at immigration has been estimated by two methods in an indirect fashion with the assistance of the Bureau of Census (1960) and by surveys of the population at risk 1968-9. Both studies suggest that the risk of developing M.S. was reduced to less than a third of the expected risk among those who immigrated under the age of 15 or 16.This study is further evidence that M.S. is an acquired exogenous disease, the precise nature of which is still not certain but, according to present knowledge, has as its leading contender the class of slow, latent, or temperate viruses.
Edward James Moran Campbell
Authors: Jack Howell, John Dickinson, John Hamilton
Journal: BMJ (2004)

Moran Campbell was one of the foremost clinical scientists of his generation. In 1950 he accepted an invitation to the newly created post of lecturer in physiological medicine at Middlesex Hospital, London. He became interested in, but sceptical, of the claims of physiotherapists that they could train patients to control the diaphragm and expand the lung bases differentially and reduce the risk of post-operative infection. This led him to study the respiratory muscles and the mechanics of breathing, the subject of his PhD thesis.

After a year at Johns Hopkins Hospital, Baltimore, he returned to the professorial medical unit at the Middlesex, where he studied respiratory failure in patients with chronic bronchitis and emphysema and developed rational approaches for their management. He developed a bedside rebreathing method for measuring PCO2, and invented a simplified Haldane gas analyser with which clinicians in the remotest hospitals could assess the ventilatory status of patients and manage them rationally. His studies highlighted the need to administer oxygen in controlled concentrations, but there being no simple method of doing so, he invented the Ventimask, still used worldwide.

In the late 1950s he co-edited the ground-breaking undergraduate textbook Clinical Physiology. In 1958 he initiated a whole new field of quantitative study of respiratory sensations, from which he derived the length-tension inappropriateness theory of breathlessness.

By 1968 he was the most chair-worthy clinical academic in the United Kingdom without a chair, probably because his academic brilliance was offset by his ability to be outrageously frank. However, this frankness did not deter the selection committee of the innovative new medical school at McMaster University at Hamilton, Ontario, when they were seeking their first chairman of medicine. Moran rapidly became a major figure as R Samuel McLoughlin professor of medicine, developing a department of medicine of the highest calibre.

Any account of Moran Campbell would be incomplete if it did not include his episodes of mood swings associated with bipolar depression. These were not noticeable until he took up his post at McMaster, where the pressure and excitement of the work seemed to precipitate “highs” and “lows.”

He leaves a wife, Diana; and four children.

Edward James Moran Campbell, R S McLoughlin professor of medicine McMaster University Medical School, Hamilton, Ontario, Canada (b 1925; q Middlesex Hospital, London, 1949; OC, FRSC, FRCP), died from colon cancer on 12 April 2004.
IMPACT OF TRANSMYOCARDIAL LASER REVASCULARIZATION VERSUS MEDICAL MANAGEMENT IN MYOCARDIAL PERFUSION.
Authors: S. N. Chatziioannou, W. H. Moore, K. Kadipasaoglu, O. H. Frazier, P. V. Ford, R. D. Dhekne, D. A. Cooley
Journal: Clinical Nuclear Medicine (1999)

Scientific Abstracts And Posters From The 44Th Annual Meeting Of The Southwestern Chapter Of The Society Of Nuclear Medicine, And From The 12Th Northeastern Regional Scientific Meeting Of The New England And New York Chapters Of The Society Of Nuclear Medicine
Abstract 3109: Myc confers aggressive medulloblastoma phenotypes by regulating cell migration and adhesion genes
Authors: Daniel J. Picard, Limei Zhou, Yaqi Hu, Meihua Li, David Shih, Duncan Stearns, Susan Cohn, Cynthia E. Hawkins, James T. Rutka, Michal D. Taylor, Annie Huang
Journal: Cancer Research (2010)

Abstract Mechanisms by which Myc confers aggressive phenotypes and adverse outcomes in medulloblastoma remain largely unknown. In this study, we demonstrate using 2 medulloblastoma cell line models that high Myc expression increases cell migration/invasion and induces metastatic orthotopic tumors which recapitulate the aggressive histology of primary anaplastic medulloblastoma. Using ChIP-chip and expression analysis on Myc transformed medulloblastoma cell lines, we identified a subset of cell migration and adhesion genes as direct Myc repressed transcriptional targets. These include ING4, PVRL3, PPAP2B and Tsp-1/THBS1, a potent tumor suppressor not previously implicated in medulloblastoma. Tsp-1 expression in medulloblastoma cell lines and primary tumors were consistently and significantly diminished in the presence of high Myc (n=101, p=0.032). Using ChIP and reporter assays we confirmed Myc and Max co-localization to a basal Tsp-1 promoter and decreased Tsp-1 transcription in the presence of Myc. Our analyses also revealed that JPO2, a Myc interacting protein linked to metastatic medulloblastoma, directly binds the Tsp-1 promoter and augments Myc-mediated Tsp-1 repression. Interestingly, we observed that stable Tsp-1 expression significantly diminished soft agar growth and drastically decreased cell invasion/migration in high-Myc expressing medulloblastoma cell lines without effects on cellular proliferation. Our collective findings highlight a novel and important role for Tsp-1 in Myc- induced metastatic medulloblastoma phenotypes and suggest Tsp-1 agonists may represent attractive, therapeutics for primary metastatic medulloblastoma. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3109.
Keeping up to date.
Authors: J M Longmore
Journal: BMJ (1979)

Despair and consternation almost crush a doctor's curiosity as he watches the pile of medical information grow and grow.The doctor feels that it is his duty to keep up with it, but it all seems too much, whatever his specialty, and all the more so if he has no specialty.Some doctors give up altogether.There was once a general practitioner, the story goes, who every summer lent his house to a faithful locum with generous instruc- tions to use the tennis court, the swimming pool, the billiard table-anything."Do what you like, except on no account are you to open the cupboard under the stairs.That and that alone is private."The locum obeyed these instructions year after year, but one summer, overcome by curiosity, he opened the for- bidden cupboard and there, neatly arranged on shelves, were 30 years' worth of Lancets-all unopened.The variation on this old chestnut is that the journals were BMJs.His was an extreme case: most of us try a little harder to placate our consciences by at least reading the obituaries before discarding the journal we pay for or get free as part of our membership privileges.This then, is the first lesson: a sense of duty on its own will not take a doctor very far.Keeping up to date must be fun, exciting, and productive.For self-help in keeping up to date Samuel Smiles has provided us with the following dictum: "System, economy, and efficiency."
Ulcerative colitis complicated by renal cell carcinoma: a series of three patients.
Authors: J Satsangi, J Marshall, D Roskell, D Jewell
Journal: Gut (1996)

The typical macroscopic features of Crohn9s disease have been well described and are widely regarded as sufficient to diagnose the disease at laparotomy. We report six patients undergoing laparotomy for symptomatic Crohn9s disease, shown radiologically, who were found to have macroscopically normal small bowel despite careful examination of the bowel by an experienced surgeon. In four cases resection was deferred, but all subsequently deteriorated and required further surgery. Minor abnormalities found by balloon examination of the terminal ileum prompted resection in two further patients. Histology showed an unusually superficial distribution of inflammation, which could explain the negative findings at laparotomy. We conclude that normal laparotomy findings alone do not exclude a diagnosis of clinically important small bowel Crohn9s disease. Crohn9s disease should be considered in patients with persisting symptoms after negative laparotomy.
Hospital trust director is cleared of dishonesty in case of misdiagnosed diabetes
Authors: C. Dyer
Journal: BMJ (2011)

The medical director of an NHS trust who signed a defence to a clinical negligence claim wrongly stating that a diagnosis given to a 20 year old patient who died was correct has been found guilty of serious misconduct but cleared of dishonesty.

A General Medical Council fitness to practise panel found that Gerard Murphy’s conduct was misleading and likely to bring the profession into disrepute, both in signing the defence in 2001 and in making a witness statement to the High Court in 2005.

But the panel, which heard the case in Manchester, decided that he was not dishonest and that his fitness to practise was not currently impaired as a result of his conduct. It issued a formal warning, which will remain …
Inhibition of Ly-6A antigen expression prevents T cell activation.
Authors: P M Flood, J P Dougherty, Y Ron
Journal: The Journal of Experimental Medicine (1990)

Antisense oligonucleotides complementary to the 5' end of the mRNA encoding the Ly-6A protein were used to block the expression of that protein. Using this approach we could inhibit the expression of Ly-6A by 60-80% in antigen-primed lymph node (LN) T cells as well as in the D10 T cell clone. Inhibition of Ly-6 expression resulted in the inability to restimulate in vitro, antigen-primed T cells. It also blocked the activation of normal spleen cells by Con A, monoclonal antibody (mAb) to CD3, and mAb to Ly-6. In contrast, stimulation of normal spleen cells with the pharmacological agents PMA + ionomycin were unaffected by the inhibition of Ly-6 expression. Similar results were obtained with the D10 T cell clone; stimulation with Con A + interleukin 1 (IL-1), antigen-presenting cells (APC), or the clonotypic antibody + IL-1 was greatly reduced in the presence of antisense oligonucleotides to Ly-6. Stimulation with PMA + ionomycin was again unaffected. We also studied the effect of antisense oligonucleotides on stimulation of preactivated D10 cells. Preactivation of D10 cells with Con A + IL-1 renders them receptive to secondary stimulation by other lymphokines. In this case, antisense oligonucleotides to Ly-6 had no effect on secondary activation with IL-2, IL-4 + IL-1, or PMA + ionomycin. We conclude from these studies that Ly-6 expression is required for T cell receptor (TCR)-mediated T cell activation.
Short-Term Insulin Therapy and Normoglycemia: Effects on erythrocyte lipid peroxidation in NIDDM patients
Authors: Evelyne Peuchant, Marie Christine Delmas-Beauvieux, Anne Couchouron, Liliane Dubourg, Marie José Thomas, Annie Perromat, Michel Clerc, Henri Gin
Journal: Diabetes Care (1997)

OBJECTIVE To evaluate erythrocyte lipid peroxidation (LPO) before and after an adaptive short-term insulin therapy in NIDDM patients who were chronically hyperglycemic. RESEARCH DESIGN AND METHODS Twenty-six patients with NIDDM (mean HbA1c, 11.28%) aged 53.04 ± 2.03 years were submitted for 3 days to constant intravenous glucose and continuous insulin perfusion at an adaptable rate to maintain glycemia within the normal range. An evaluation of LPO at baseline and after euglycemic insulin therapy was determined by erythrocyte free and total malondialdehyde (MDA) levels, polyunsaturated fatty acid (PUFA) percentage, vitamin E and glutathione content, and the following antioxidant enzymatic activity determinations: glutathione peroxidase (GPX), superoxide dismutase (SOD) and catalase (CAT). Fasting serum glucose, HbA1c, triglycerides, cholesterol, and HDL cholesterol levels were also determined at these time points. RESULTS At baseline, erythrocyte free and total MDA were significantly higher in NIDDM patients than in control subjects (11.14 ± 0.80 vs. 1.74 ± 0.11 nmol/g Hb [P &amp;lt; 0.0001] for free MDA; 18.04 ± 1.79 vs. 7.85 ± 0.55 nmol/g Hb [P &amp;lt; 0.0001] for total MDA). PUFAs, particularly C20:4 and C22:5, were increased (14.69 ± 0.34 vs. 12.03 ± 0.31 and 2.31 ± 0.04 vs. 1.71 ± 0.03% of total fatty acids, respectively). Vitamin E and glutathione were reduced significantly (6.16 ± 0.61 vs. 14.84 ± 0.64 nmol/g Hb and 0.42 ± 0.04 vs. 0.97 ± 0.06 mmol/l, respectively). No difference was observed for the enzymatic activities. After euglycemic insulin therapy, triglycerides significantly decreased compared with baseline concentrations (1.55 ± 0.13 vs. 2.42 ± 0.22 mmol/l; P &amp;lt; 0.001), whereas other lipidic parameters were unchanged. Free MDA significantly decreased (8.60 ± 0.76 vs. 11.14 ± 0.80 nmol/g Hb [P &amp;lt; 0.01]), while vitamin E increased (7.93 ± 0.73 vs. 6.16 ± 0.61 nmol/g Hb [P &amp;lt; 0.05]). No difference was observed for PUFAs, glutathione, or total MDA. CONCLUSIONS The observed erythrocyte LPO in NIDDM decreased after a short-term adaptive insulin therapy. This decrease could be principally attributed to the normalized glycemia that reduces reactive oxygen species (ROS) production, which in turn may explain the increase in erythrocyte membrane vitamin E and the decrease in MDA. This study shows the value of a euglycemic environment in NIDDM to reduce LPO and, at long range, to minimize clinical diabetes complications.
Management of a patient with a mechanical aortic valve and antibodies to both thrombin and factor V after repeat exposure to fibrin sealant
Authors: Marc S. Zumberg, John M. Waples, K.J. Kao, Richard Lottenberg
Journal: American Journal of Hematology (2000)

We describe a patient who developed a markedly prolonged PT, PTT, and thrombin time 13 days after repeat exposure to fibrin sealant during coronary artery bypass grafting and aortic valve replacement. Evaluation revealed an inhibitor to bovine thrombin that cross-reacted with human thrombin. In addition an inhibitor to human coagulation factor V was identified. Despite coagulation abnormalities there was no evidence of bleeding. Nevertheless, effective anticoagulation was required to minimize the thrombotic complications associated with the patient's prosthetic valve. We elected to take a conservative approach and not utilize pharmacologic anticoagulation until there was diminution in the effect of the acquired inhibitors. We report on our patient's course and review the available literature addressing the management of patients demonstrating inhibitors to blood coagulation factors after repeat exposure to fibrin sealants. Am. J. Hematol. 64:59–63, 2000. © 2000 Wiley-Liss, Inc.
Self-care of Physicians Caring for Patients at the End of Life
Authors: Michael K. Kearney, Radhule B. Weininger, Mary L. S. Vachon, Richard L. Harrison, Balfour M. Mount
Journal: JAMA (2009)

Physicians providing end-of-life care are subject to a variety of stresses that may lead to burnout and compassion fatigue at both individual and team levels. Through the story of an oncologist, we discuss the prodromal symptoms and signs leading to burnout and compassion fatigue and present the evidence for prevention. We define and discuss factors that contribute to burnout and compassion fatigue and consider factors that may mitigate burnout. We explore the practice of empathy and discuss an approach for physicians to maximize wellness through self-awareness in the setting of caring for patients with end-stage illness. Finally, we discuss some practical applications of self-care in the workplace.
Performance Measures for Cardiology Focus on Improving Patient Outcomes
Authors: Mike Mitka
Journal: JAMA (2011)

M. Schwartz, MD, MS, of Dartmouth Medical School in Hanover, NH, have noted that while the FDA has been criticized for being too close to industry, its reviews are a unique source of published and unpublished data about drug performance (a search page for FDA reviews of drugs is available at http://www .accessdata.fda.gov/scripts/cder /drugsatfda/index.cfm), and readers can learn of the reviewers’ opinions of the drugs they evaluated (Woloshin S and Schwartz LM. Arch Intern Med. 2009; 169[21]:1985-1987). However, they also noted that the FDA should make its reviewers’ knowledge more accessible through standardized executive summaries of drug reviews. Other critics point out that the FDA does not make available unpublished clinical trial data that are not discussed at advisory committee meetings. “The FDA is now somewhat more transparent, but it’s not transparent enough,” said Steven Nissen, MD, chair of the department of cardiovascular medicine at the Cleveland Clinic. “For reasons I can’t understand, it still keeps information secret,” he added. The FDA recently formed an internal Transparency Task Force to develop recommendations for making information about FDA activities and decision making more readily available while protecting confidential information (http: //tinyurl.com/3mazd5q). According to Avorn, this initiative focuses primarily on access to reports of adverse events that are spontaneously provided by physicians and patients after a drug has been approved. “Of greater concern are adverse events identified by drug companies during the clinical trials that they conduct,” he said. “This is more relevant information, but it is also where company ownership of data often comes into conflict with the public’s right to know, and the public often loses that battle.”
Oxidative stress markers are increased in patients with mastocytosis
Authors: S. Gangemi, P. L. Minciullo, D. Magliacane, S. Saitta, S. Loffredo, A. Saija, M. Cristani, G. Marone, M. Triggiani
Journal: Allergy (2015)

Mastocytosis is characterized by clonal proliferation of mast cells limited to the skin (cutaneous mastocytosis: CM and mastocytosis in the skin: MIS) and/or involving internal organs (systemic mastocytosis: SM). Oxidative stress occurring in various inflammatory and neoplastic disorders causes molecular damage with the production of advanced oxidation protein products (AOPPs) and advanced glycation end products (AGEs). We evaluated these markers of oxidative stress in patients with CM/MIS and SM and correlated their levels with the presence of symptoms related to mast cell activation.Serum levels of AOPPs and AGEs in 34 patients with mastocytosis (23 CM/MIS and 11 SM) and 27 healthy controls were measured by spectrofluorimetric and spectrophotometric methods. Serum tryptase levels were measured by immunofluorescence.Serum AOPPs, but not AGEs, were significantly higher in patients with mastocytosis as compared to healthy controls. While serum tryptase levels were higher in patients with SM as compared to those with CM/MIS, there was no difference in AOPP and AGE concentrations between these two groups of patients. Patients with recurrent mediator-related symptoms had lower AOPPs and AGEs as compared to patients without symptoms. AOPPs and AGEs were inversely correlated with the severity of symptoms, and in patients with symptoms, AOPPs correlated with tryptase levels.Our data show that mastocytosis is associated with a state of increased oxidative stress that, in patients with mediator-related symptoms, correlates with mast cell burden as assessed by tryptase. Patients with symptoms presumably have an adaptive response resulting in lower blood levels of AOPPs and AGEs.
What have I achieved?
Authors: H. Watson
Journal: BMJ (1997)

Although the Psychology of Military Incompetence by Norman Dixon was published 20 years ago the tenet remains true today. I took this book, among others, to a Caribbean island where we celebrated our 40th wedding anniversary. An unwise choice. Those who suffer from chronic low self esteem will understand the insidious depression that overcame me under the warm blue Caribbean sky. The cheerful, indigenous population was no match for the gloom that to some extent spoilt our holiday.

While I could not honestly say that I had been responsible for the deaths of hundreds or thousands of brave soldiers as a result of incompetent planning or intelligence, it did occur to me that I had been brought up in a rigid hierarchy of “them and us.” A dismal lack of lateral thinking, an inability to see the other chap's point of view. Decisions of narrow, thoughtless, ponderous conceit.

The further I got into the book, the more I realised that every chapter described my lamentable personality. As an only child I was thoroughly spoilt, damaged from an early age for a successful …
Cisapride restores the decreased lower oesophageal sphincter pressure in reflux patients.
Authors: P Ceccatelli, J Janssens, G Vantrappen, S Cucchiara
Journal: Gut (1988)

The effect of the new prokinetic drug cisapride on the resting lower oesophageal sphincter pressure and on the strength of peristaltic contractions was studied in 10 healthy controls and in 10 reflux patients with abnormally low (less than 10 mm Hg) basal lower oesophageal sphincter pressure. A slow intravenous injection of cisapride 10 mg significantly increased the sphincter pressure in the controls but even more in the patients in whom it almost doubled the resting lower oesophageal sphincter pressure of 8.7 (0.5) mm Hg to between 15 and 20 mm Hg for at least 90 min. Results are expressed as mean (SE). Cisapride also significantly increased the amplitude of peristaltic contractions in controls and reflux patients. Therefore, cisapride might be useful in the treatment of reflux.