tbuckley/cabot-search huggingface dataset:
Transitional care for elderly people
Authors: Martin J Connolly
Journal: BMJ (2005)

Editor—Crotty et al show that off-site “transitional care” facilities for elderly patients already assessed as needing residential care placement, only reduce length of hospital stay at the expense of delaying eventual transfer to a long term care facility.1 However, their assertion that such transfer resulted in no difference in mortality, rates of readmission, or the proportion of patients who eventually returned to their own homes is potentially misleading, as the study was not powered to detect such differences. Sample size was calculated only to detect “a mean reduction in length of stay of 10 days (SD 25) in the treatment group”—that is, to test the hypothesis that opening a new off-site facility and transferring inpatients to this facility would reduce length of stay (arguably a “given”).

Over the four month follow-up, patients in the treatment group had a 12% relative increase in readmissions (28% in treatment group v 25% in the control group), a 22% relative reduction in chances of returning to their own home (7% treatment v 9% controls) and nearly 4% relative “excess” mortality (28% treatment v 27% controls). As these (and other) potentially adverse outcomes are the basis of much of the controversy that surrounds this area, the results by Crotty et al contribute to the debate in terms of the design, and powering, of future studies.
Worsening of cerebral hyperemia by the administration of terlipressin in acute liver failure with severe encephalopathy
Authors: Debbie L. Shawcross, Nathan A. Davies, Rajeshwar P. Mookerjee, Peter C. Hayes, Roger Williams, Alistair Lee, Rajiv Jalan
Journal: Hepatology (2004)

There is increasing evidence that terlipressin is useful in patients with cirrhosis and hepatorenal syndrome, but there are no data of its use in patients with acute liver failure (ALF) in whom hepatorenal syndrome is common. Although terlipressin produces systemic vasoconstriction, it produces cerebral vasodilatation and may increase cerebral blood flow (CBF). Increased CBF contributes to intracranial hypertension in patients with ALF. The aim of this study was to evaluate the safety of terlipressin in patients with ALF with respect to cerebral hemodynamics. Six successive patients with ALF were ventilated electively for grade IV hepatic encephalopathy. Patients were monitored invasively and CBF was measured (Kety-Schmidt technique). Measurements were made before and at 1, 3, and 5 hours after intravenous (single bolus) administration of terlipressin (0.005 mg/kg), median, 0.25 mg (range, 0.2-0.3 mg). There was no significant change in heart rate, mean arterial pressure, or cardiac output. CBF and jugular venous oxygen saturation both increased significantly at 1 hour (P = 0.016). Intracranial pressure increased significantly at 1 hour (P = 0.031), returning back to baseline values at 2 hours. In conclusion, administration of terlipressin, at a dose that did not alter systemic hemodynamics, resulted in worsening of cerebral hyperemia and intracranial hypertension in patients with ALF and severe hepatic encephalopathy. These data suggest the need to exercise extreme caution in the use of terlipressin in these patients in view of its potentially deleterious consequences on cerebral hemodynamics.
Accelerated Induction of Two-Kidney Hypertension in Rats and Renin-Angiotensin Sensitivity
Authors: THOMAS W. SKULAN, Armand C. Brousseau, Kathleen A. Leonard
Journal: Circulation Research (1974)

Studies were performed to substantiate the hypothesis that a physiological change, apart from the rise in blood pressure, occurs in two-kidney hypertensive rats. Both the slow development of hypertension following renal arterial constriction versus its rapid reversal following removal of the constriction and the early increase in plasma renin activity which subsides in the chronic hypertensive phase suggest such a progressive change. We studied the development of hypertension following initial renal arterial constriction (clipping) and after reclipping in rats that had been relieved of two-kidney hypertension by unclipping for 2 or 21 days. Full hypertensive blood pressure levels were established within 1-2 hours after reclipping in 2-day unclipped rats, but similar levels were not reached in either of the other two groups for at least 1 week. These changes in response to renal arterial constriction were paralleled by differences in responsiveness to hog renin and angiotensin infusions. Plasma renin activity 1 hour after clipping or reclipping was adequate to account for the observed blood pressure increases in all groups. These data suggest that (1) a physiological change resulting in increased vasoresponsiveness to renin and angiotensin occurs concomitantly with the development of two-kidney hypertension and (2) this type of hypertension is dependent on both renin and increased sensitivity to angiotensin. Moreover, we suggest that study of recently unelipped, normotensive rats may help to uncover the causes for the angiotensin sensitivity change.
Where has the tumor gone? The characteristics of cases of negative pathologic diagnosis after endoscopic mucosal resection
Authors: E. Kim, S. Jeon, S. Park, Y. Park, Y. Chung, S. Yoon, S. Lee, J. Park, H. Bae, C. Cho, W. Tak, Y. Kweon, S. Kim, Y. Choi
Journal: Endoscopy (2009)

Discrepancies can occur between the histopathological findings from forceps biopsy and endoscopic mucosal resection (EMR), and occasionally in embarrassing cases tumorous tissue is not found at EMR. The aim of the present study was to evaluate the clinical, endoscopic, and histological features of gastric tumors in patients with pathololgically negative findings at EMR.We retrospectively reviewed data from all patients with gastric tumor treated with EMR or endoscopic submucosal dissection (ESD) between August 1999 and April 2007 at our institution, and enrolled into the study patients with no tumor tissue found at mucosal resection. Their biopsy and EMR specimen slides were reviewed by a single pathologist. Patient characteristics, including demographic and clinical features, and the endoscopic appearance of mucosal lesions were evaluated.Out of 633 patients treated with EMR or ESD, 20 patients (3.2 %) were included. The mean +/- SD maximal dimension of the mucosal lesions was 6.40 +/- 2.19 mm (range 3 - 10). Mean number of forceps biopsy fragments was 3.80 +/- 1.96 and mean sampling ratio was 2.08 +/- 1.07 mm/fragment. Before resection, histological findings from forceps biopsy were: 13 low grade dysplasias (65.0 %), 2 high grade dysplasias (10.0 %), and 5 intramucosal carcinomas (25.0 %).In the case of pathologically negative findings at EMR, tumors might have been small enough to have been removed by the previous forceps biopsy. However, the possibility of sampling error or of a different location should be considered. Furthermore, appropriate communication between endoscopists and pathologists is essential.
Myeloperoxidase-Mediated Iodination by Granulocytes INTRACELLULAR SITE OF OPERATION AND SOME REGULATING FACTORS
Authors: Richard K. Root, Thomas P. Stossel
Journal: Journal of Clinical Investigation (1974)

The intracellular site of operation of the myeloperoxidase-H2O2-halide antibacterial system of granulocytes has been determined by utilizing measurements of the fixation of iodide to trichloracetic acid (TCA) precipitates of subcellular fractions, including intact phagocytic vesicles. Na125I was added to suspensions of guinea pig granulocytes in Krebs-Ringer phosphate buffer, and they were then permitted to phagocytize different particles. Phagocytic vesicles were formed by allowing cells to ingest a paraffin oil emulsion (POE) and collected by flotation on sucrose after homogenization. Measurement of 125I bound to TCA precipitates of the different fractions and the homogenates disclosed that the lysosome-rich fraction obtained by centrifugation from control (nonphagocytizing) cells accounted for a mean 93.1% of the total cellular activity. With phagocytosis of POE, TCA-precipitable iodination increased two- to sevenfold, and the lysosomal contribution fell to a mean 36.9% of the total. The appearance of activity within phagocytic vesicles accounted for almost the entire increase seen with phagocytosis (a mean 75.7%), and iodide was bound within these structures with high specific activity. More iodide was taken up by cells than fixed, regardless of iodide concentration, and was distributed widely throughout the cell rather than selectively trapped within the vesicles.
Generation of Rituximab Polymer May Cause Hyper-Cross-linking–Induced Apoptosis in Non-Hodgkin's Lymphomas
Authors: Nan Zhang, Leslie A. Khawli, Peisheng Hu, Alan L. Epstein
Journal: Clinical Cancer Research (2005)

Abstract Purpose: Although Rituximab has produced significant tumor regressions in lymphoma patients, only 50% respond. Clinically, it has been shown that the major mechanism of action of Rituximab is antibody-dependent cytotoxicity requiring presentation by Fc-bearing cells. To improve the clinical efficacy of Rituximab for the treatment of CD20+ lymphomas, we now describe a new formulation of Rituximab, which, on direct binding to target, can induce apoptosis. Methods: In this report, enhanced apoptosis was observed by treating CD20+ lymphoma cells with a new polymer formulation of Rituximab. The polymer was produced by formation of a peptide bond using the sugar moiety of dextran (MW 6,000) to generate a clinically relevant reagent for use in vivo. Results: Comparison of Rituximab with a previously described dimer and the newly generated polymer shows that the polymer induced apoptosis more effectively in CD20+ cells as shown by the terminal deoxyribonucleotidyl transferase–mediated dUTP nick end labeling assay (Rituximab, 3%; dimer, 3%; polymer, 58%). Consistent with these results, the polymer produced marked regression in CD20+ lymphoma xenografts, whereas the dimer and monomer reagents showed little effect. In addition, we were able to show that the level of apoptosis induced in human lymphoma cell lines was in accordance with the extent of both surface CD20 clustering and caspase-3 activation. Conclusions: These data suggest that hyper-cross-linking–induced apoptosis can be simulated by the use of a dextran polymer of Rituximab, which, when used in vivo, can directly kill CD20+ lymphoma cells and improve the clinical efficacy of this important therapeutic for human B-cell lymphomas.
TAHITI FROM A MEDICAL STANDPOINT.
Authors: N. SENN
Journal: JAMA (1904)

<h3>PREVAILING DISEASES.</h3> The average temperature of the inhabited part of the island, which can not be much less than 78 to 80 F., has a relaxing influence on the natives, and much more so on the small contingent of whites. The Europeans and Americans find it necessary every three to five years to seek for a few months a cooler climate to restore their energies and vigor. The government officials and officers are not obliged to serve for more than the same length of time, when they are relieved. It is this relaxation which, to a certain extent at least, is responsible for the great mortality of comparatively mild acute infectious diseases and the acuity of pulmonary tuberculosis among the natives. Tuberculosis of the lymphatic glands, skin, bones and joints appears to be extremely rare. The moisture-laden atmosphere and the suddenness with which the cool land and ocean breezes
The UK quality and outcomes framework
Authors: H. Lester
Journal: BMJ (2008)

Has improved quality of care and reduced health inequalities

In the linked study (doi:10.1136/bmj.a2030), Ashworth and colleagues report on the relation between the quality and outcomes framework and health inequalities in general practice in the United Kingdom by assessing the effects of social deprivation on levels of blood pressure monitoring and control.1 Tackling health inequalities has been a consistent part of the political rhetoric in the UK for more than a decade, with primary care seen as a key player in improving life expectancy in areas with the worst health record and highest deprivation.2

Perhaps the most substantive government intervention in primary care in recent years has been the renegotiation of the general practitioner contract in 2003, which included—at its heart—a system of financial incentives for delivering quality care. This pay for performance scheme—the quality and outcomes framework—now links achievement on 129 indicators covering clinical domains; organisational domains; and additional services domains, such as contraception and patients’ experience, to the practice’s income. The framework was originally designed …
Screening for chronic kidney disease
Authors: B. Kiberd
Journal: BMJ (2010)

Cannot be recommended in people without risk factors

In the linked study (doi:10.1136/bmj.c5869), Manns and colleagues assess the cost effectiveness of using the estimated glomerular filtration rate (GFR) to screen the general population for chronic kidney disease.1 Screening to prevent disease is a topic that consistently generates debate, with mammography being a prime example.2 Screening recommendations pit clinical epidemiologists who specialise in screening evaluation against special interest groups and their key opinion leaders, with health policy makers and sometimes even the law making the decisions. Ironically, debates become the most heated when the net benefits are the smallest. Although screening for kidney disease has lacked the publicity of breast cancer screening, the principles and arguments are similar but the impact may be greater⇓.



Axis-Shield UK

Preventing the progression of kidney disease may reduce the expense and clinical consequences of end stage renal disease and prevent premature death from cardiovascular disease. Several recent articles have highlighted independent and significant relative risks associated with albuminuria and low estimated glomerular filtration rate for both end stage renal disease and mortality.3 4 These reports have already generated renewed …
Genital Herpes Simplex Virus Infections: Current Concepts in Diagnosis, Therapy, and Prevention
Authors: COREY LAWRENCE
Journal: Annals of Internal Medicine (1983)

Genital herpes simplex virus infection is the commonest cause of genital ulcerations in persons in industrialized nations. Overlap in the clinical manifestations of genital herpes with other infectious and noninfectious causes of genital ulcerations often requires clinicians to seek laboratory confirmation of the cause of a genital ulcer. The sensitivity of any laboratory procedure for detecting herpes simplex virus infection differs with the stage of the disease. Isolation of the herpes simplex virus in tissue culture is the most sensitive and specific laboratory test for the confirmation of genital herpes; cytologic and antigen detection techniques are approximately 50% and 70% as sensitive as viral isolation. The antiviral compound acyclovir is the first medication useful for the management of persons with genital herpes. Prevention of transmission of infection and recurrences of disease, however, has not been achieved. Description of the clinical manifestations of disease, its variable recurrence rate, and potential for future infectivity are issues that physicians should discuss with patients who have genital herpes.
IN WOMEN WITH SYMPTOMS OF CARDIAC ISCHEMIA, NONOBSTRUCTIVE CORONARY ARTERIES AND MICROVASCULAR DYSFUNCTION, ACE INHIBITION IS ASSOCIATED WITH IMPROVED MICROVASCULAR FUNCTION: A DOUBLE-BLIND RANDOMIZED ANCILLARY STUDY FROM THE NHLBI WOMEN’S ISCHEMIA SYNDROME EVALUATION (WISE)
Authors: Daniel F. Pauly, B. Delia Johnson, R. David Anderson, Eileen M. Handberg, Karen M. Smith, Rhonda M. Cooper-DeHoff, Keith E. Muller, George Sopko, Barry M. Sharaf, Sheryl F. Kelsey, C. Noel Bairey Merz, Carl J. Pepine
Journal: Journal of the American College of Cardiology (2010)
The use of cationic nanogels to deliver proteins to myeloma cells and primary T lymphocytes that poorly express heparan sulfate
Authors: Kozo Watanabe, Yumiko Tsuchiya, Yoshinori Kawaguchi, Shin-ichi Sawada, Hirohito Ayame, Kazunari Akiyoshi, Takeshi Tsubata
Journal: Biomaterials (2011)
Candida Infection as a Complication of Heart Surgery
Authors: Paul W. Sanger
Journal: JAMA (1962)

Bacterial endocarditis following cardiac surgery is a well-known clinical entity. Recent reports indicate a number of Candida endocarditis cases have been seen as a complication of cardiac surgery. The literature is reviewed, and 2 additional cases of Candida endocarditis are reported. One patient developed a mycotic aneurysm of the aorta following open operation for correction of aortic stenosis. This patient had widespread mycotic emboli and died suddenly following rupture of the mycotic aneurysm of the aorta. The second patient developed a Candida blood stream infection following repair of a ventricular septal defect. This patient recovered after treatment with amphotericin-B. Possible portals of entry of the infection are cardiac catheterization, cardiopulmonary by-pass, and prolonged intravenous fluids.
Benign melanocytic naevi as a risk factor for malignant melanoma.
Authors: A J Swerdlow, J English, R M MacKie, C J O'Doherty, J A Hunter, J Clark, D J Hole
Journal: BMJ (1986)

Examination of 180 patients with cutaneous malignant melanoma and 197 control patients in a case-control study showed that the risk of melanoma is strongly related to numbers of benign melanocytic naevi (moles). Some unusual features of naevi--a diameter exceeding 7 mm, colour variation, and irregular lateral outline--also showed a strong association with the risk of melanoma, but the relation of numbers of naevi to risk was present even in the group of patients whose naevi had none of these unusual features. Biopsy of clinically atypical naevi from several of the patients at highest risk generally did not show dysplastic histology. Thus a group of people at high risk of melanoma may be identified by using simple clinical assessment of naevi.
Skin and systemic pharmacokinetics of tacrolimus following topical application of tacrolimus ointment in adults with moderate to severe atopic dermatitis
Authors: N.A. Undre, F.J. Moloney, S. Ahmadi, P. Stevenson, G.M. Murphy
Journal: British Journal of Dermatology (2008)

Journal Article Skin and systemic pharmacokinetics of tacrolimus following topical application of tacrolimus ointment in adults with moderate to severe atopic dermatitis Get access N.A. Undre, N.A. Undre Department of Pharmacokinetics, Astellas Pharma GmbH, 81673 Munich, Germany Correspondence: Nasrullah Undre. E‐mail: nas.undre@eu.astellas.com Search for other works by this author on: Oxford Academic Google Scholar F.J. Moloney, F.J. Moloney Faculty of Medicine, University of Sydney, Sydney, NSW, Australia Search for other works by this author on: Oxford Academic Google Scholar S. Ahmadi, S. Ahmadi Beacon Consultant Clinic, Dublin, Ireland Search for other works by this author on: Oxford Academic Google Scholar P. Stevenson, P. Stevenson Department of Pharmacokinetics, Astellas Pharma GmbH, 81673 Munich, Germany Search for other works by this author on: Oxford Academic Google Scholar G.M. Murphy G.M. Murphy Beaumont Hospital, Dublin, Ireland Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 160, Issue 3, 1 March 2009, Pages 665–669, https://doi.org/10.1111/j.1365-2133.2008.08974.x Published: 01 March 2009
American guidelines on managed care are not the answer
Authors: R. Evans
Journal: BMJ (1996)

EDITOR,—If, in their editorial on clinical guidelines in the independent sector, Gillian Fairfield and Rhys Williams are suggesting that the guidelines used by American managed care organisations to authorise care are evidence based then they are misguided.1 In a national poll Group Health in Seattle was recently acknowledged to be “one of the best [managed care companies] at monitoring health, risk behaviors and disease outcomes.”2 Group Health has clinical guidelines that are strongly based on the effectiveness literature. They total just 13. Some health maintenance …
Expression of the immunoglobulin VH gene 51p1 is proportional to its germline gene copy number.
Authors: E H Sasso, T Johnson, T J Kipps
Journal: Journal of Clinical Investigation (1996)

51p1 is an immunoglobulin VH gene that is frequently expressed in B cell chronic lymphocytic leukemia and early in B cell ontogeny. The 51p1 gene locus is highly polymorphic, consisting of 13 alleles that can be classified as being either 51p1-related or hy1263-related, based on distinctive sequence motifs in the second complementarity determining region. Two of the 51p1-related genes usually occur as a linked pair on the same haopltype, resulting from gene duplication. Consequently, a person can have a total of zero to four copies of 51p1-related genes. These genes are detectable in genomic DNA by sequence-specific RFLP analysis using oligonucleotide probes. Ig encoded by nonmutated 51p1-related genes can be detected by G6, a murine antiidiotypic mAb. We have now studied lymphocytes from 35 human tonsils to examine the relation between the number of 51p1-related germlime gene copies and the proportion of IgD-bearing tonsillar B cells that react with G6. All subjects who had zero copies of 51p1-related genes lacked any G6-reactive B cells, whereas those with four copies of 51p1-related genes had the highest proportions of G6-positive IgD B cells, up to 11.4%. Subjects with intermediate gene doses had intermediate proportions of G6-reactive B cells. Over the entire data set, the percentage of IgD-bearing B cells that reacted with G6 was proportional to the 51p1-related gene copy number (r = 0.92, p < 0.001), with each copy accounting for 2.4-4.0% of the IgD-bearing B cells. We conclude that 51p1-related genes are expressed by a relatively large percentage of IgD+ tonsillar B cells and this percentage is proportional to the germline copy number of 51p1-related genes.
NOTE ON ANTIHAEMOLYTIC (HAEMOSOZIC) SERUM
Authors: M. A. Ruffer, M. Crendiropoulo
Journal: BMJ (1903)

ANTIHAEMOLITIC SERUM. [JULY 18, I903.8 cases diagnosed as tuberculous, 5 gave a positive and 3 gave a negative result.The positive results estimated upon the total number of cases examined amounted to nearly 36 per cent.If the cases diagnosed as tuberculous are eliminated, it will be seeni that 5 of the 20 inon-tuberculous cases contained virulenit tubercle bacilli in the mesenteric glands, and that in these cases the positive results were equal to 25 per cent.As regards the otlher glands of tlhe body examinied, the following results were obtained: The bronelial glands gave a positive result in i out of 4 cases examined-namely, a case of general tuberculosis.The tubercle bacillus was found in the mesenteric glands, and likewise in the cervical glands of the same case.As regards the IO positive results obtained by inoculation experiments, the mesenteric glanids were also examined microscopically in nine instances.Of the latter, in seven instances whilst the aniimal experiment was positive, the microscopic examination was negative.TABLE.O Post-nortemn Report.e s 5 Zle i F. 24 mths.Old empyema; no obvious tubercu-Negative Negative.losis 2 F. 4 yrs.Tuberculous meningitis Negative Positive.3 F. 7 niths.