tbuckley/cabot-search huggingface dataset:
Rarity of Hepatic Metastases in Cirrhosis — A Misconception
Authors: Edwin R. Fisher
Journal: JAMA (1960)

An analysis of 2,865 consecutive autopsies revealed, contrary to current belief, that the incidence of hepatic metastases from primary extrahepatic carcinoma of various sites was not statistically different in persons with Laennec's or nutritional cirrhosis from that encountered in non-cirrhotics. The rarity of the association of extrahepatic carcinoma in persons with Laennec's cirrhosis as well as the dilution of this coincidence with carcinomas which exhibit little propensity for hepatic metastases may be largely responsible for this misconception. A significant number of cirrhotics probably fail to achieve a sufficient span of life to develop such extrahepatic carcinomatous lesions. The mean age at time of death of cirrhotics without extrahepatic carcinoma was significantly lower than that of cirrhotics in whom this coincidence was present. The evidence indicates that the cirrhotic liver represents a fertile soil for the development of metastases.
Endothelial Microparticle–Mediated Transfer of MicroRNA-126 Promotes Vascular Endothelial Cell Repair via SPRED1 and Is Abrogated in Glucose-Damaged Endothelial Microparticles
Authors: Felix Jansen, Xiaoyan Yang, Marion Hoelscher, Arianna Cattelan, Theresa Schmitz, Sebastian Proebsting, Daniela Wenzel, Sarah Vosen, Bernardo S. Franklin, Bernd K. Fleischmann, Georg Nickenig, Nikos Werner
Journal: Circulation (2013)

Repair of the endothelium after vascular injury is crucial for preserving endothelial integrity and preventing the development of vascular disease. The underlying mechanisms of endothelial cell repair are largely unknown. We sought to investigate whether endothelial microparticles (EMPs), released from apoptotic endothelial cells (ECs), influence EC repair.Systemic treatment of mice with EMPs after electric denudation of the endothelium accelerated reendothelialization in vivo. In vitro experiments revealed that EMP uptake in ECs promotes EC migration and proliferation, both critical steps in endothelial repair. To dissect the underlying mechanisms, Taqman microRNA array was performed, and microRNA (miR)-126 was identified as the predominantly expressed miR in EMPs. The following experiments demonstrated that miR-126 was transported into recipient human coronary artery endothelial cells by EMPs and functionally regulated the target protein sprouty-related, EVH1 domain-containing protein 1 (SPRED1). Knockdown of miR-126 in EMPs abrogated EMP-mediated effects on human coronary artery endothelial cell migration and proliferation in vitro and reendothelialization in vivo. Interestingly, after simulating diabetic conditions, EMPs derived from glucose-treated ECs contained significantly lower amounts of miR-126 and showed reduced endothelial repair capacity in vitro and in vivo. Finally, expression analysis of miR-126 in circulating microparticles from 176 patients with stable coronary artery disease with and without diabetes mellitus revealed a significantly reduced miR-126 expression in circulating microparticles from diabetic patients.Endothelial microparticles promote vascular endothelial repair by delivering functional miR-126 into recipient cells. In pathological hyperglycemic conditions, EMP-mediated miR-126-induced EC repair is altered.
Effect of HIV on survival in patients with non-small-cell lung cancer in the era of highly active antiretroviral therapy: a population-based study
Authors: Ramesh Rengan, Nandita Mitra, Kaijun Liao, Katrina Armstrong, Anil Vachani
Journal: The Lancet Oncology (2012)

BackgroundHIV-infected patients with lung cancer have been reported to have poorer survival than uninfected patients. Whether this outcome holds true in the era of highly active antiretroviral therapy (HAART) is unclear. We examined the effect of HIV infection on clinical outcome in patients with lung cancer who are also receiving HAART.MethodsPatients diagnosed with non-small-cell lung cancer (NSCLC) from Jan 1, 2000, to Dec 31, 2005, with or without HIV infection were identified by querying the Surveillance, Epidemiology, and End Results registry and the Medicare lung cancer database. Survival analysis by stage and treatment delivered comparing the HIV-infected patients with uninfected controls was done with Kaplan-Meier and Cox models with propensity score adjustments.Findings71 976 patients with NSCLC were identified as uninfected controls and 322 patients with NSCLC were identified in the HIV group; median age was 75 years for both groups. Median overall survival for all stages was 7·0 months (95% CI 7·0–7·0) for uninfected controls versus 8·0 months (6·0–10·0) for the HIV group (p=0·16); for those with stage I/II disease it was 37·0 months (36·0–39·0) versus 43·0 months (26·0–58·0; p=0·37); for those with stage IIIA/IIIB disease it was 7·0 months (7·0–7·0) versus 3·0 months (2·0–8·0; p=0·051); and for those with stage IV disease it was 3·0 months for both groups (95% CI 3·0–3·0 for controls; 2·0–5·0 for HIV group; p=0·77). After propensity score adjustment, the survival difference in stage IIIA/IIIB was no longer seen (hazard ratio 0·88; 95% CI 0·71–1·09). The median survival for HIV infected patients with stage I or II NSCLC who underwent surgical resection was 58·0 months (95% CI 57·0–60·0) for uninfected controls versus 50·0 months (42·0 to unestimable) for the HIV group (p=0·88).InterpretationWe noted no significant difference in clinical outcome between patients with HIV and uninfected controls with NSCLC. Survival after curative surgical resection in early-stage patients was similar in HIV-infected individuals and uninfected controls. These data suggest that HIV status should not affect therapeutic decision making in NSCLC.FundingUS National Cancer Institute (award number UC2CA148310).
Jaccoud's arthropathy. A case report and necropsy study.
Authors: F L Girgis, A W Popple, F E Bruckner
Journal: Annals of the Rheumatic Diseases (1978)

We present a case of Jaccoud's arthropathy in a 59-year-old woman. She developed painless correctable ulnar deviation at the metacarpophalangeal joints of both hands following 4 attacks of rheumatic fever. Radiology did not show the hook lesions previously described, but we do not consider this sign essential for the diagnosis. There was no clinical evidence of rheumatoid arthritis. We were able to examine 3 complete joints from the left little finger at necropsy. Pathological examination of this kind has been possible only once before. The histological findings were fibrous thickening of the joint capsule, secondary degenerative changes, presumably due to longstanding joint deformity, and no evidence of significant synovial pathology.
Impact of Simultaneous Pancreas and Kidney Transplantation on Progression of Coronary Atherosclerosis in Patients With End-Stage Renal Failure due to Type 1 Diabetes
Authors: J. Wouter Jukema, Yves F. C. Smets, Johan W. van der Pijl, Aeilko H. Zwinderman, Hubert W. Vliegen, Jan Ringers, Johan H. C. Reiber, Herman H. P. J. Lemkes, Ernst E. van der Wall, Johan W. de Fijter
Journal: Diabetes Care (2002)

OBJECTIVE—Mortality in type 1 diabetic patients with end-stage renal failure is high and dominated by coronary atherosclerotic events. With regard to prognosis, simultaneous transplantation of pancreas and kidney (SPK) may be superior to kidney transplantation alone (KTA) in type 1 diabetic patients, because normalization of blood glucose levels may reduce progression of coronary atherosclerosis and because it is well known that progression of coronary atherosclerosis is one of the major factors that determines clinical prognosis. However, no data are available on progression of coronary atherosclerosis after SPK. RESEARCH DESIGN AND METHODS—We performed an observational angiographic study comparing progression of coronary atherosclerosis, analyzed with quantitative coronary angiography, in patients with (n = 26) and those without (n = 6) a functioning pancreas graft after SPK, to test the hypothesis that normalization of blood glucose levels by SPK may indeed reduce progression of coronary atherosclerosis in type 1 diabetic patients and thereby improve prognosis. RESULTS—Mean follow-up was 3.9 years. Average glucose control was significantly worse for the patients without a pancreas graft than for patients with a functioning pancreas graft: 11.3 (SD 3.5) vs. 5.9 mmol/l (SD 1.1) (P = 0.03). Mean segment diameter loss (progression of diffuse coronary atherosclerosis) was 0.024 mm/year (SD 0.067) in patients with a functioning pancreas graft, compared with 0.044 mm/year (SD 0.038) in patients in whom the pancreas graft was lost. Minimum obstruction diameter loss (progression of focal coronary atherosclerosis) was 0.037 mm/year (SD 0.086) in patients with a functioning pancreas graft compared with 0.061 mm/year (SD 0.038) in patients in whom the pancreas graft was lost. Regression of atherosclerosis occurred in 38% of patients with a functioning pancreas graft compared with 0% of patients of whom the pancreas graft was lost (P = 0.035). CONCLUSIONS—Our study provides, for the first time, evidence that in patients who have undergone SPK, progression of coronary atherosclerosis in patients with a functioning pancreas graft is reduced compared with patients with pancreas graft failure. Our observation is an important part of the explanation for the observed improved mortality rates reported in type 1 diabetic patients with end-stage renal failure after SPK compared with KTA. In light of these findings described above, SPK must to be carefully considered for all diabetic transplant candidates.
PMO-118 The effects of th17 cytokines on liver parenchymal cells shape the microenvironment for local generation of TH17/TC17 in inflammatory liver disease
Authors: E Humphreys, R Bhogal, M Munir, G Muirhead, B Eksteen, S Afford, Y Oo, D Adams
Journal: Gut (2012)

<h3>Introduction</h3> IL-17 secreting T cells have been implicated in autoimmunity, inflammatory disease and provide a link between the innate and adaptive immune responses. High numbers of IL-17-producing T cells which also secrete IL-21 and IL-22 are found in close proximity to bile ducts in several liver diseases. T<sub>h17</sub> related cytokines have multiple effects and may be involved in both effector responses and repair and regeneration. <h3>Methods</h3> Primary human parenchymal cells were assessed for cytokine receptor expression by western blotting. The effects of stimulation with recombinant IL-17, IL-21, IL-22, TNFa or IFN-g alone or in combination were compared for apoptosis using annexin staining, proliferation was measured by in situ Ki67 staining and adhesion molecule expression was assessed by flow cytometry. Secretion of IL-1b, IL-6, IL-23 and TGF-b1 was assessed by ELISA. <h3>Results</h3> All parenchymal cells expressed IL-17R, IL-21R and IL-22R. T<sub>h17</sub> related cytokines did not cause apoptosis but led to parenchymal cell proliferation. Cholangiocytes and hepatocytes responded best to IL-17, whereas sinusoidal endothelial cells were responsive to IL-22. Endothelial cells upregulated adhesion molecules in response to T<sub>h17</sub> related cytokines. Cholangiocytes responded to T<sub>h17</sub> cytokines by secreting high levels of IL-1b, IL-6, IL-23 and TGF-b1 all cytokines that support the survival of T<sub>h17</sub> and T<sub>c17</sub> cells. <h3>Conclusion</h3> Liver parenchymal cells express IL-17, IL-21 and IL-22 receptors and proliferate in response to T<sub>h17</sub> cytokines. Upregulation of adhesion molecules by sinusoidal endothelial cells promotes lymphocyte recruitment and retention. Cholangiocytes also respond by secreting T<sub>h17</sub>/T<sub>c17</sub> polarising cytokines. Therefore T<sub>h17</sub> related cytokines secreted by infiltrating lymphocytes may activate the epitheliome to generate a local environment characterised by cholangiocyte proliferation and T<sub>h17</sub>/T<sub>c17</sub> cell survival, thus contributing to bile duct proliferation and persistent chronic inflammation that characterises many liver diseases. <h3>Competing interests</h3> None declared.
Autoimmune Diseases and Severe Infections as Risk Factors for Mood Disorders
Authors: Michael E. Benros, Berit L. Waltoft, Merete Nordentoft, Søren D. Østergaard, William W. Eaton, Jesper Krogh, Preben B. Mortensen
Journal: JAMA Psychiatry (2013)

Mood disorders frequently co-occur with medical diseases that involve inflammatory pathophysiologic mechanisms. Immune responses can affect the brain and might increase the risk of mood disorders, but longitudinal studies of comorbidity are lacking.To estimate the effect of autoimmune diseases and infections on the risk of developing mood disorders.Nationwide, population-based, prospective cohort study with 78 million person-years of follow-up. Data were analyzed with survival analysis techniques and adjusted for calendar year, age, and sex.Individual data drawn from Danish longitudinal registers.A total of 3.56 million people born between 1945 and 1996 were followed up from January 1, 1977, through December 31, 2010, with 91, 637 people having hospital contacts for mood disorders.The risk of a first lifetime diagnosis of mood disorder assigned by a psychiatrist in a hospital, outpatient clinic, or emergency department setting. Incidence rate ratios (IRRs) and accompanying 95% CIs are used as measures of relative risk.A prior hospital contact because of autoimmune disease increased the risk of a subsequent mood disorder diagnosis by 45% (IRR, 1.45; 95% CI, 1.39-1.52). Any history of hospitalization for infection increased the risk of later mood disorders by 62% (IRR, 1.62; 95% CI, 1.60-1.64). The 2 risk factors interacted in synergy and increased the risk of subsequent mood disorders even further (IRR, 2.35; 95% CI, 2.25-2.46). The number of infections and autoimmune diseases increased the risk of mood disorders in a dose-response relationship. Approximately one-third (32%) of the participants diagnosed as having a mood disorder had a previous hospital contact because of an infection, whereas 5% had a previous hospital contact because of an autoimmune disease.Autoimmune diseases and infections are risk factors for subsequent mood disorder diagnosis. These associations seem compatible with an immunologic hypothesis for the development of mood disorders in subgroups of patients.
"VIA PADUA"-Reply
Authors: Egidio Meneghetti
Journal: JAMA (1960)

As far as "Senatus Populusque Padovensis" is concerned, the Latinists of this University consider the diction incorrect. The proper word is "Patavinus" (from Patavium). "Paduensis" (from Padua) could eventually be used. I appreciate your interest for Padua.
Pneumococcal Vaccination: When in Doubt, Go Ahead-Reply
Authors: David S. Fedson
Journal: JAMA (1991)

<h3>In Reply. —</h3> It should be noted that our study did not call for universal pneumococcal vaccination of all persons. We studied a population of elderly Medicare enrollees. We suggested that immunization at the time of hospital discharge would be a useful strategy for ensuring that the majority of elderly persons otherwise destined to be hospitalized with pneumonia receive pneumococcal vaccine. The Immunization Practices Advisory Committee (ACIP) goes even further in its recommendation for universal pneumococcal vaccination for all persons aged 65 years or older, regardless of whether they have had a recent episode of hospital care. Dr Temianka is concerned about the possible increased risk of adverse reactions following inadvertent revaccination of patients who previously have received pneumococcal vaccine. In 1989,<sup>1</sup>the ACIP summarized all previously published reports and included the results of an unpublished randomized, controlled trial evaluating the risks of increased adverse reactions following revaccination with
A pilot study of the CY-1899 T-cell vaccine in subjects chronically infected with hepatitis B virus
Authors: Jenny Heathcote, John McHutchison, Samuel Lee, Myron Tong, Kent Benner, Gerald Minuk, Teresa Wright, John Fikes, Brian Livingston, Alex Sette, Robert Chestnut
Journal: Hepatology (1999)

Clinical observations suggest that eradication of the hepatitis B virus (HBV) is immune-mediated. Vigorous cytotoxic T lymphocyte (CTL) activity directed at HLA class I-bound viral epitopes are detected during acute hepatitis B, but not in chronic hepatitis B carriers. A CTL epitope derived from the hepatitis B core protein amino acids 18-27 has been incorporated into a vaccine also comprised of a T-helper cell epitope and 2 palmitic acid residues (CY-1899). The aim of this study was to determine whether repeated doses of CY-1899 given to patients with chronic hepatitis B could initiate in vivo CTL activity and viral clearance. Patients with chronic hepatitis B received up to 4 doses (ranging from 0.05 mg to 15 mg) 6 weeks apart. Following vaccination, patients were monitored for hepatitis B surface antigen and "e" status, HBV-DNA levels, liver biochemistry, CTL activity, and any adverse events. Ninety patients with chronic hepatitis B infection received CY-1899. Mean CTL responses were all low but were maximal following vaccination with 5 mg CY-1899. Peak CTL responses never exceeded 10 lytic units (LU) regardless of vaccine dose, this value being well below that seen following resolution of acute hepatitis B. No significant changes in liver biochemistry or viral serology were observed during follow-up. No serious adverse events were noted. Administration of the single-epitope vaccine, CY-1899, initiated CTL activity, but of a magnitude lower than that observed during spontaneous HBV clearance. This low-level CTL activity was not associated with viral clearance.
Use of Read codes in development of a standard data set
Authors: N Smith, A Wilson, T Weekes
Journal: BMJ (1995)

General practice has a wealth of data that could be used for purposes such as assessing health needs, planning, and audit. If this potential is to be realised appropriate data must be easily accessible and of high quality. This article describes the experience of an information project team in developing and coding a standard data set, with the aim of meeting the needs of commissioners, public health, and general practitioners. The Read coding classification seemed the logical choice for the standard data set because Read codes are the basis of a standard classification of general practice data. However, the coding structure has several weaknesses that were difficult to resolve, and the standard data set had to be changed to match available codes. This paper may prove helpful to similar project teams attempting to develop and use a standard data set.
A memorable patient: The patient's best interest?
Authors: G. L Campbell-Hewson
Journal: BMJ (1997)

Making a correct early diagnosis is not always in the best interests of the patient.While working as an emergency medicine registrar in Australia some years ago I saw a 12 year old boy who had been referred to the casualty department. The general practitioner had attempted to drain a scalp haematoma, which had formed after the child had fallen and struck his head. The …
Putting patients at the heart of quality
Authors: H. Jaques
Journal: BMJ (2012)

Helen Jaques looks at what patients can bring to the quality improvement process

A key catch phrase to emerge during the Health and Social Care Act’s tumultuous passage into law was “no decision about me without me.” The principle behind the phrase is that giving patients more choice and control will help to make sure services are designed around them and are more responsive to their needs.

Patients can certainly bring a different perspective to the quality improvement process. Patients see every step of the care pathway for a certain condition whereas professionals tend to see only one episode, which means that patients can see shortcomings in care that professionals might be blind to. “Healthcare professionals don’t know what the patient had to go through to get to them or what is actually awaiting them after they have finished,” points out Anna Gregor, clinical lead for the Scottish patient safety programme fellowship at Healthcare Improvement Scotland.

Patients are also likely to prioritise different aspects of care to clinicians. Patients tend to focus on the interpersonal and amenity aspects of care, such as communication with healthcare staff and quality of the food, rather than the technical and clinical aspects. In some cases doctors might …
Microbiota Controls the Homeostasis of Glial Cells in the Gut Lamina Propria
Authors: Panagiotis S. Kabouridis, Reena Lasrado, Sarah McCallum, Song Hui Chng, Hugo J. Snippert, Hans Clevers, Sven Pettersson, Vassilis Pachnis
Journal: Neuron (2015)

The intrinsic neural networks of the gastrointestinal tract are derived from dedicated neural crest progenitors that colonize the gut during embryogenesis and give rise to enteric neurons and glia. Here, we study how an essential subpopulation of enteric glial cells (EGCs) residing within the intestinal mucosa is integrated into the dynamic microenvironment of the alimentary tract. We find that under normal conditions colonization of the lamina propria by glial cells commences during early postnatal stages but reaches steady-state levels after weaning. By employing genetic lineage tracing, we provide evidence that in adult mice the network of mucosal EGCs is continuously renewed by incoming glial cells originating in the plexi of the gut wall. Finally, we demonstrate that both the initial colonization and homeostasis of glial cells in the intestinal mucosa are regulated by the indigenous gut microbiota.
Incidence of Unsuspected Urinary-Tract Infection in Normal Pregnant and Toxemic Patients
Authors: Frank A. Finnerty, Gloria DeCarlo Massaro, Nikos Kakaviatos, Victor Chupkovich
Journal: New England Journal of Medicine (1961)

PREVIOUS studies from this clinic1 , 2 have suggested that toxemia is a catchall diagnosis for a variety of syndromes characterized by elevation in arterial pressure, edema and proteinuria. Whereas these findings are consistent with toxemia they are not diagnostic, being observed also in pregnant patients with hypertensive vascular disease, pyelonephritis, glomerulonephritis or any combination of these diseases. From the standpoint of long-term prognosis it is obviously important to make an accurate diagnosis. From the practical point of view, however, it actually makes little difference whether hypertensive vascular disease, glomerulonephritis or toxemia is present since the most important therapy in each of . . .