tbuckley/cabot-search huggingface dataset:
Gastrointestinal complications following percutaneous coronary intervention (PCI)
Authors: G. E. Dolman, C. M. Wijayasekara, J. R. F. Cummings
Journal: Gut (2011)

<h3>Introduction</h3> Percutaneous Coronary Intervention (PCI) is widely used in the emergency and elective setting. If drug-eluting stents are deployed, dual antiplatelet therapy must continue for 12 months. Antiplatelet agents are a recognised cause of overt and occult gastrointestinal (GI) bleeding. The aim of this study was to determine the rate of GI complications following PCI in a tertiary cardiothoracic centre. <h3>Methods</h3> A cohort of 604 patients, who underwent coronary stenting in a 6-month period, was identified from cardiology records. 369 patients were tertiary referrals and so excluded from analysis as follow-up data was unavailable. The electronic notes of 235 patients were reviewed to identify GI complications in the year after PCI. These were classified as overt GI bleeding, anaemia or dyspeptic symptoms. <h3>Results</h3> The patients were aged 39-73 years (median 64 years). 78% were male and 97% were Caucasian. 80% of patients were on aspirin and clopidogrel for at least 12 months after PCI. 14% of patients were anaemic prior to PCI, defined by a local laboratory reference range of haemoglobin (Hb) &lt;125g/L. It was not standard practice to monitor Hb in the year after PCI, but 97% of patients had Hb tested for another reason, 33% of whom had microcytosis. In the year post-PCI, 45 (19%) patients were anaemic on at least one test, with no obvious cause, such as surgery. Of these, only 16% were tested for iron deficiency anaemia (IDA). 5 of 7 patients tested had definite IDA. Prior to PCI, only 3% of the cohort were anaemic to a degree that would have prompted referral for investigation, based on Department of Health guidelines for suspected lower GI cancer (Hb &lt;11g/dL in men, Hb &lt;10g/dL in postmenopausal women). During treatment with aspirin and clopidogrel, this proportion rose significantly to 10% (p=0.006) Within 12 months of PCI, 10 patients had a gastroscopy, 2 patients had upper and lower GI endoscopy, and 3 had lower GI endoscopy only. The indications in these 15 patients included overt bleeding (5 patients), IDA (4 patients) and GI symptoms (4 patients). 7 of 12 patients had endoscopic signs of upper GI inflammation, with findings of oesophagitis, gastritis or duodenitis. 4 OGDs were normal and another identified Barrett9s oesophagus. Significant lower GI diagnoses included rectal cancer, a sigmoid ischaemic ulcer and diverticular disease. <h3>Conclusion</h3> These results suggest dual antiplatelet therapy increases the prevalence of anaemia, which may be due to iron deficiency. Hb and iron status are not routinely monitored in the year post-PCI. Iron deficiency can cause significant symptoms of fatigue, even in the absence of anaemia and IDA may herald a more sinister underlying pathology. We suggest a review of practice post-PCI, as identification of iron deficiency may prompt timely treatment and investigation.
Efficacy and safety of topical calcitriol (1,25-dihydroxyvitamin D<sup>3</sup> ) for the treatment of psoriasis
Authors: A. PEREZ, T.C. CHEN, A. TURNER, R. RAAB, J. BHAWAN, P. POCHE, M.F. HOLICK
Journal: British Journal of Dermatology (1996)

Plaque-type psoriasis has been successfully treated with topical calcitriol, but there has been no long-term follow-up study of the safety and efficacy of this calciotropic hormone. In a single-centre study, patients with plaque or erythrodermic psoriasis were enrolled in a double-blind, right/left comparison, placebo-controlled study, and received 1.5 micrograms of calcitriol (15 micrograms/g of Vaseline) per day, or a placebo consisting of Vaseline alone. A subset of these patients (n = 22), with at least 25% involvement, applied 0.1 g of calcitriol ointment/50 cm2 on an area of from 2,500 to 5,000 cm2. Of the 84 patients enrolled in the double-blind control study, 96.5% responded to topical calcitriol therapy, compared with 15.5% whose lesions improved with Vaseline alone, after 2.4 months. After completion of the double-blind study, 22 patients applied calcitriol ointment (15 micrograms/g Vaseline) to all of their lesions (up to 10 g of calcitriol ointment; 150 micrograms calcitriol lesions showed either excellent or moderate clearing in 90.9% of all cases. The remaining 9.1% of cases showed slight improvement of their lesions. No abnormalities in calcium metabolism were noted in any of the patients using topical calcitriol. None of the patients experienced any local cutaneous side-effects, including six patients who applied calcitriol ointment to the face. Topical calcitriol is safe and effective for the treatment of psoriasis.
Latest UK figures show increase in prostate cancer diagnoses and falling death rate
Authors: S. Mayor
Journal: BMJ (2012)

The latest figures show that the number of men in the United Kingdom receiving a diagnosis of prostate cancer has risen to more than 40 000 a year, mainly because of greater use of prostate specific antigen (PSA) testing.

Cancer Research UK reported that 40 841 cases of prostate cancer were recorded in 2009, the most recent year for which incidence figures are available. The data were collected by regional cancer registries in England and the three national cancer registries in Wales, Scotland, and Northern Ireland.

The incidence of prostate cancer has increased markedly over the past 20 years, rising from around 14 000 cases in 1989. Analysis of the …
Report of Fifteen Cases of Arsenical Poisoning with Unusual Symptoms
Authors: J. Morley
Journal: BMJ (1873)

5. In all classes where the boys change places, the height of the seat is to be regulated in proportion to the average height of the pupils.6.In all girls' schools, in all those boys' schools where the children do not change places, in boarding schools, and in private school-rooms, the seat of each child should be accurately regulated in proportion to its height.To make this important arrangement practicable, I have invented a chair, the seat of which can be raised and lowered by means of a screw, while at the same time the back is brought forward in proportion.Such a chair will be a suitable seat for either a child or a grown-up person at the same desk, will follow the growth of the child, and enable it to be, whether reading or writing, in a comfortable and healthy position, which facilitates instruction and discipline.
Allopurinol and Cytotoxic Agents
Authors: George M. Lyon
Journal: JAMA (1974)

<h3>To the Editor.—</h3> The publication of "Allopurinol and Cytotoxic Drugs," (227:1036, 1974) raised a number of questions concerning the use of allopurinol with cytostatic agents. The article described an increased incidence of "bone marrow depression" in patients with nonleukemic forms of malignancies who received allopurinol in combination with cytotoxic agents. The criteria were leukopenia or thrombocytopenia or both, and whether or not the physician believed there was an adverse effect. Cytotoxic drugs, by definition, cause depression of rapidly proliferating tissues, most commonly those elements cited in the article, leukocytes and thrombocytes. Some degree of leukopenia should be present to assure the clinician that optimal levels of the toxic drug are reaching the tumor. When results of toxicity studies are reported in which the base-line drugs are themselves cytotoxic, the magnitude of the leukopenia or thrombocytopenia in each group must be compared. Oncology is a clinical science that relies heavily on
Rituximab Therapy for Refractory Biliary Strictures in Immunoglobulin G4–Associated Cholangitis
Authors: Mark Topazian, Thomas E. Witzig, Thomas C. Smyrk, Jose S. Pulido, Michael J. Levy, Patrick S. Kamath, Suresh T. Chari
Journal: Clinical Gastroenterology and Hepatology (2008)
THE SYMPTOMATIC ADOLESCENT: PSYCHIATRIC ILLNESS OR ADOLESCENT TURMOIL?
Authors: JAMES F. MASTERSON, ANTONIA WASHBURNE
Journal: American Journal of Psychiatry (1966)

This paper details a method of selecting a group of relatively healthy adolescents, describes their characteristics and compares them with adolescents who are psychiatrically ill. Using the traditional psychiatric concept of health, i.e., freedom from significant symptoms and impairment of functioning, we selected relatively healthy (R.H.) and psychiatrically ill (P.I.) adolescents by clinical review of two larger groups. The latter included 101 patients, ages 12-18, and 101 controls matched to the patients for six criteria and selected by random sampling. We selected a P.I. group of 93 and an R.H. group of 41. Although the latter had some symptomatology it was subclinical and did not impair functioning. Systematic data are presented to highlight the marked differences between the two groups in symptomatology, functioning, demographic factors and family relationships. The relatively healthy adolescents, although they may be in turmoil, did not show symptoms that simulate a psychiatric illness and differed quite distinguishably from those with a psychiatric illness. This suggests that adolescent symptomatology may not be as confusing as theory implies and that it may be more possible than previously thought to identify psychiatric illness in adolescence.
Heavy Particle Radiation Treatment of Pituitary Tumors
Authors: John H. Lawrence
Journal: JAMA (1970)

<h3>To the Editor.—</h3> Recently, criticism of the dangers of heavy particles has appeared (<i>New Eng J Med</i>,<b>282</b>: 1434, 1970). It is important for us to clarify the picture because of our long experience in the use of heavy particles in therapy with excellent results. Readers often equate one form of radiation therapy with another without consideration of the particle used, the dose administered, the rate of delivery, the stereotaxic method employed in the delivery, and, of most importance, the exact dose distribution. A detailed discussion of 13 years experience using the 910-mev a-particle beam from the 184-inch cyclotron to treat 131 patients with acromegaly has just been published.<sup>1</sup> All of the patients with acromegaly have been treated with the plateau portion of the a-particle beam using precise alignment and biplanar rotational techniques<sup>2,3</sup>with the exception of five patients. These five were selected for Bragg-peak therapy because they
Report of research assessment exercise should have focused on British medical schools
Authors: K. Peters
Journal: BMJ (1997)

Interferon beta in multiple sclerosis Reducing frequency and severity of relapses will be of great clinical benefitEditor-Richard G Richards's editorial on interferon beta in multiple sclerosis deals with the "clinical cost effectiveness" of the drug in the disease, but it lacks a fair balance, emphasising the cost effectiveness and minimising the clinical effectiveness of the drug. 1 Richards states that "the studies showed no evidence of any reduction in the more clinically relevant endpoint-the progression of disability, which should be the goal of treatment."This is his personal judgment and does not reflect the needs and wishes of patients with multiple sclerosis and their families.Multiple sclerosis is a distressing, humiliating, and often long drawn out disease with no cure.For this reason, quality of life, for the patients and their families, is paramount.A drug that can reduce the frequency and severity of relapses, whether or not it diminishes the progression of the disease, will be of great clinical benefit to many patients, improving their situation physically, psychologically, and socially.Surely happiness, feeling better, and increased health have great value.This is what many of us believe that the practice of our profession is about.
Effect of an iPod Video Intervention on Consent to Donate Organs
Authors: J. Daryl Thornton, Marilyn Alejandro-Rodriguez, Janeen B. León, Jeffrey M. Albert, Evelyn L. Baldeon, Liza M. De Jesus, Ana Gallardo, Sabina Hossain, Elba Adriana Perez, Jovana Y. Martin, Susan Lasalvia, Kristine A. Wong, Margaret D. Allen, Mark Robinson, Charles Heald, Gordon Bowen, Ashwini R. Sehgal
Journal: Annals of Internal Medicine (2012)

Background: The gap between the supply of organs available for transplantation and demand is growing, especially among ethnic groups. Objective: To evaluate the effect of a video designed to address concerns of ethnic groups about organ donation. Design: Cluster randomized, controlled trial. Randomization was performed by using a random-number table with centralized allocation concealment. Participants and investigators assessing outcomes were not blinded to group assignment. (ClinicalTrials.gov registration number: NCT00870506) Setting: Twelve branches of the Ohio Bureau of Motor Vehicles in northeastern Ohio. Participants: 952 participants aged 15 to 66 years. Intervention: Video (intervention; n = 443) or usual Bureau of Motor Vehicles license practices (control; n = 509). Measurements: The primary outcome was the proportion of participants who provided consent for organ donation on a newly acquired driver's license, learner's permit, or state identification card. Secondary outcomes included willingness to make a living kidney donation to a family member in need and personal beliefs about donation. Results: More participants who viewed the video consented to donate organs than control participants (84% vs. 72%; difference, 12 percentage points [95% CI, 6 to 17 percentage points]). The video was effective among black participants (76% vs. 54%; difference, 22 percentage points [CI, 9 to 35 percentage points]) and white participants (88% vs. 77%; difference, 11 percentage points [CI, 5 to 15 percentage points]). At the end of the trial, fewer intervention than control participants reported having insufficient information about organ donation (34% vs. 44%; difference, −10 percentage points [CI, −16 to −4 percentage points]), wanting to be buried with all of their organs (14% vs. 25%; difference, −11 percentage points [CI, −16 to −6 percentage points]), and having conflicts with organ donation (7% vs. 11%; difference, −4 percentage points [CI, −8 to −2 percentage points]). Limitation: How the observed increases in consent to donate organs might translate into a greater organ supply in the region is unclear. Conclusion: Exposure to a brief video addressing concerns that ethnic groups have about organ donation just before obtaining a license, permit, or identification card increased consent to donate organs among white and black participants. Primary Funding Source: National Institutes of Health and the Robert Wood Johnson Foundation.
Effects of carrageenin on human synovial cells in vitro: morphology, hyaluronic acid production, growth, and the lysosomal system.
Authors: B J Clarris, J R Fraser, E Baxter, L P Malcolm
Journal: Annals of the Rheumatic Diseases (1979)

Some in-vitro effects of the arthritogenic polysaccharide carrageenin were studied on cells from human synovium. Synovial cells were isolated from intact human knee joints, and cell lines were developed by passaging with trypsin. Carrageenin was ingested by the cells but did not significantly affect cell growth, numbers of lysosomes, intracellular lysosomal enzyme activity (N-acetyl-beta-D-glucosaminidase), or release of lysosomal enzyme from cells. Carrageenin produced a reduction in net hyaluronic acid synthesis. It also induced a striking morphological change in a high proportion of synovial cells, characterised by increased spreading over the culture surface and apparent condensation of the cytoplasm into a pattern of ridges. Nonrheumatoid and rheumatoid synovial cells behaved similarly to one another.
Circulating Nucleases and Disease
Authors: Richard A. Cox
Journal: JAMA (1977)

<h3>To the Editor.—</h3> Human viral and autoimmune disorders may be affected by serum nuclease activity. Man, unlike many other species, is resistant to oncornavirus infection, apparently lysing RNA tumor viruses via a complement reaction that does not involve antibody.<sup>1</sup>The viral RNA can then be destroyed by the relatively high serum ribonuclease activity. However, serum deoxyribonuclease (DNase) levels are quite low in man<sup>2</sup>and are further decreased in patients with systemic lupus erythematosus (SLE) and anti-nuclear antibodies by an inhibitor released from platelets.<sup>3</sup>This decreased nuclease activity would allow the persistence of circulating DNA, which could then stimulate peripheral B lymphocytes specific for native DNA. Such cells exist in normal persons,<sup>4</sup>and the corresponding antigen, native DNA, is also present in human and animal circulation in some disease states. Mice given endotoxin release large amounts of DNA into the circulation and later form anti-DNA antibodies.<sup>2</sup>
Autoimmunity and Immunotherapy for Cancer
Authors: Henry Koon, Michael Atkins
Journal: New England Journal of Medicine (2006)

Adjuvant treatment for patients after resection of high-risk and regionally metastatic melanoma remains suboptimal. Despite the Food and Drug Administration's approval of high-dose interferon alfa-2b, the substantial toxicity of the therapy and the fact that its benefit is limited to 20 to 30 percent of patients at risk have hindered its general acceptance.Attempts to identify patients who benefit from adjuvant treatment with interferon alfa-2b have been disappointing to date. Although analyses of individual studies suggest that the benefit of high-dose interferon alfa-2b might be restricted to certain subgroups of patients, on the basis of the number of melanoma-involved lymph . . .
Jumping on bandwagons: taking the right clinical message from research
Authors: Jill Cook
Journal: British Journal of Sports Medicine (2008)

<h3>ABSTRACT</h3> <h3>Introduction</h3> Depression and diabetes are highly disabling diseases with a high prevalence and high rate of comorbidity, particularly in low-income ethnic minority patients. Though comorbidity increases the risk of adverse outcomes and mortality, most clinical interventions target these diseases separately. Increasing physical activity might be effective to simultaneously lower depressive symptoms and improve glycemic control. Self-management apps are a cost-effective, scalable and easy access treatment to increase physical activity. However, cutting-edge technological applications often do not reach vulnerable populations and are not tailored to an individual’s behavior and characteristics. Tailoring of interventions using machine learning methods likely increases the effectiveness of the intervention. <h3>Methods and analysis</h3> In a three-arm randomized controlled trial we will examine the effect of a text-messaging smartphone application to encourage physical activity in low-income ethnic minority patients with comorbid diabetes and depression. The adaptive intervention group receives messages chosen from different messaging banks by a reinforcement learning algorithm. The uniform random intervention group receives the same messages, but chosen from the messaging banks with equal probabilities. The control group receives a weekly mood message. We aim to recruit 276 adults from primary care clinics aged 18 to 75 years who have been diagnosed with current diabetes and show elevated depressive symptoms (PHQ-8 &gt;5). We will compare passively collected daily step counts, self-report PHQ-8 and most recent HbA1c from medical records at baseline and at intervention completion at 6-month follow-up. <h3>Ethics and dissemination</h3> The Institutional Review Board at the University of California San Francisco approved this study (IRB: 17-22608). We plan to submit manuscripts describing our User Designed Methods and testing of the adaptive learning algorithm and will submit the results of the trial for publication in peer-reviewed journals and presentations at (inter)-national scientific meetings. <h3>Registration</h3> clinicaltrials.gov: NCT03490253; pre-results <h3>Article Summary</h3> <h3>Strengths and Limitations</h3> Novel approach of targeting diabetes and depressive symptoms using a smartphone application Ability to compare adaptive messaging for increasing physical activity to messages delivered with equal probabilities Testing of a smartphone application integrated within primary care settings in a low-income vulnerable patient population Longitudinal design with 6-month follow-up enables assessing intervention effects over time Challenges of this trial include supporting users in key behavior change in an automated manner with minimal in-person support
Atrial Tachysystole with Block
Authors: STUART WARREN ROSNER
Journal: Circulation (1964)

Two patients are reported who demonstrated bouts of rapid atrial activity with associated AV block at times unrelated to the administration of digitalis. The criteria of Lown and Levine for the differentiation of PAT with block from atrial flutter are examined. The application of atrial rate in the region of the arbitrary borderline is not a useful criterion. Determination of P-wave direction in leads II and III cannot be made in the presence of an undulating baseline. Identification, when possible, is not sufficient evidence for distinguishing the two arrhythmias. The appearance of the baseline may not warrant the decisive weight commonly given to it. A combination of recording instrument characteristics, the appearance of atrial repolarization at critical rates, as well as subjective factors may explain the undulatory baseline rather than denote a special electrocardiographic entity. Alternation of the P-P cycle length in PAT with block occurs inconstantly and is not an intrinsic property of the arrhythmia. Digitalis, which has a vagal effect, may contribute to the presence of this [see figure in the PDF file] phenomenon. The occurrence of ventricular premature contractions, response to carotid sinus pressure, and the AV ratio are nonspecific findings. The mode of termination of the arrhythmia may also lack specificity. Restoration of sinus rhythm following potassium administration will be, at times, coincidental. Moreover, the successful outcome of such a therapeutic trial is evidence of digitalis intoxication not proof of a specific arrhythmia. Experimental and clinical evidence has firmly established that digitalis is capable of producing an atrial arrhythmia attended by AV block. This report does not contest the observation. A critical review of the contrasting features of atrial flutter and PAT with block and an analysis of the data in the present cases suggest that the electrocardiogram does not provide a means for the clear-cut separation of atrial tachycardia from flutter in certain cases and questions the existence of such a division. The term atrial tachysystole with block is offered as a designation for such tracings.
Interleukin-12, Dendritic Cells, and the Initiation of Host-protective Mechanisms against <i>Toxoplasma gondii </i>
Authors: Lawrence L. Johnson, Peter C. Sayles
Journal: The Journal of Experimental Medicine (1997)

The principal job of the immune system is to provide protection against infectious pathogens. One of the immunologist's goals is to determine how the cellular and cytokine components of the immune system are functionally organized to provide this protection. In vitro studies can suggest which