tbuckley/cabot-search huggingface dataset:
Provision of first contact care out of hours in four urban areas in England.
Authors: B T Williams, R A Dixon, J P Nicholl
Journal: BMJ (1985)

In a typical two week period in 1984 in three urban areas with general practitioner deputising services roughly 40% of first contact patient encounters out of hours were with hospital accident and emergency departments, and only a quarter were with general practitioner deputising services, although 47%, 64%, and 97% of general practitioners in the areas had permission to use such services. Roughly a third only of the encounters were with the practices themselves, and even fewer occurred overnight (11 pm-7 am). In a fourth urban area where 68% of general practitioners formed an out of hours cooperative rota a third of the encounters were with the accident and emergency department and half (more overnight) were with the rota. The presence of a woman principal in a practice and large partnerships of four principals or more were associated with an increased proportion of encounters with the practice itself. Undue prominence may have been given to the role of deputising services in out of hours care. Paradoxically, the use of general practitioner cooperatives may result in even less personal care being given by the patient9s own practice.
Poland: collaboration or advice?
Authors: M H Dominiczak, S. Smellie, W C. Love
Journal: BMJ (1992)

different scales are used.In such a case the intraclass correlation coefficient computed for each method will indicate which is the more reliable, provided each method of measurement uses the same population, as in a dataset we recently examined.'In summary, we agree with Chinn when she says that "the intraclass correlation coefficient should be used only for comparative purposes.The within-subject standard deviation or 95 per cent range for change should be calculated as the absolute measure of repeatability."2
Ping-Pong Gaze
Authors: Marcello Moccia, Roberto Allocca, Roberto Erro, Paolo Barone, Carmine Vitale
Journal: JAMA Neurology (2014)

An 84-year-old man with an acute and progressive disorder of consciousness presented with ping-pong gaze1 (Video and Figure , A-C) and CheyneStokes breathing, suggestive of metabolic or toxic cause. However, a midrange pupil not responsive to light indicated a lesion involving the brainstem. Metabolic or toxic causes were excluded by blood tests. At 6 hours from symptom onset, a computed tomographic scan showed a hypodense lesion in the midbrain tectum at the collicular level, suggestive of ischemic stroke (Figure, D). The patient died a few hours later, after the onset of decerebrate rigidity, according to Sherrington’s original description of cats with the brainstem’s collicular section.2
CONTINUOUS MEASUREMENTS OF INTRAVASCULAR OXYGEN TENSION IN NORMAL ADULTS*
Authors: Steve T. Koeff, M. U. Tsao, Attila Vadnay, Thomas O. Wilson, James L. Wilson
Journal: Journal of Clinical Investigation (1962)

The purpose of this report is to record our studies on the degree of normal fluctuation of oxygen tension in arterial and venous blood of healthy adults while they breathed room air and during the administration of oxygen.These changes were measured by an oxygen electrode, which records blood oxygen tension continuously and responds immediately to changes in the tension.The electrode was devised by two of the authors, Tsao and Vadnay, in this laboratory (1).Until the recent development of continuously recording oxygen electrodes, investigations involving direct measurement of oxygen tension in blood depended on the findings from isolated single blood specimens.Interpretation of such data was limited to that oxygen tension present in the blood vessel during the actual moment of blood withdrawal.It was assumed that such findings represented a mean oxygen tension for the individual under the conditions studied and that fluctuations around this mean would be trivial.Because of variations that can occur normally in the respira- tory pattern, it was our belief that these changes might be reflected in the arterial oxygen tension.This would result in a range of fluctuation of the level of arterial oxygen tension such that a single measurement might be of less significance than had been thought.The advantage of the direct measurement of oxygen tension over its estimation from the meas- urem-ienit of hemoglobin saturation is obvious.Under the conditions of most studies the measure- ments of hemoglobin saturation occur at the flat upper portion of a hemoglobin-oxygen dissociation curve, where changes of oxygen tension do not significantly change the percentage of hemoglobin
Management of Clinical Tetanus
Authors: Henry Brown
Journal: JAMA (1968)

<h3>To the Editor:—</h3> The reference for terms aluminum phosphate adsorbed toxoid and alum toxoid is given (Levine, et al:<i>New Eng J Med</i><b>274</b>:186, 1966). As explained, these toxoids precipitated by aluminum phosphate or hydroxide are by custom referred as "alum toxoids." Their action is the same clinically. In tetanus prophylaxis in a nonimmunized patient when human hyperimmune serum is not available, from a practical standpoint one thoroughly cleanses and debrides the wound. There is then no devascularized or devitalized tissue to harbor clostridia. One must administer antibiotics before bacterologic reports are available, recognizing, as in all infections, that some strains may be resistant. Usually within 24 hours one can obtain human sera. It is customary to repeat antiserum in treating clinical tetanus because one cannot be certain more organisms are not present, and particularly with animal sera, one cannot be certain how long such antibodies will remain in
P17.26 * IS NICU MANDATORY AFTER SURGERY IN ADULT HGG? A SINGLE CENTER EXPERIENCE
Authors: R. Fornaro, A. Agnoletti, C. Condello, A. Rivera, R. Altieri, D. Garbossa, M. Lanotte, A. Ducati
Journal: Neuro-Oncology (2014)

Surgery in high grade gliomas (HGG) is often related to peri-operative complications, that may require neurocritical intensive care unit (NICU) admittance. Actually there is no consensus whether there is real need for NICU for this patients; often the possibility is related to surgeon preferences. In literature there are still little data on clinical parameters associated with long-term outcome after neurocritical care. We retrospectively analyzed 175 patients, that underwent surgical resection for HGG in our division; 15 of which needed NICU admittance after surgery. We compare this group with a homogeneous control group of 15 patients that did not need NICU after surgery. Statistical analysis (p value set at 0.05) did not show any statistical difference between the two groups and we suggest that NICU should not always be used after craniotomy for supratentorial HGG.
AN AUTOMATIC LIGATURE-PASSING FORCEPS
Authors: E. Pierre Mallett
Journal: JAMA (1913)

This instrument is designed for the passing of ligatures through any structure desired to be ligated and removed, but particularly for those situated deply in the pelvis where it is difficult to use the needle or one of the ordinary ligature-passing devices. The great advantage and the additional factor for safety from crushing the tissue of any structure before ligating. as suggested and practiced Dr. Murphy, become evident to us all. In this instrument I have successfully combined the crushing and ligature-passing features, so that with one application of the forceps the pedicle is crushed and the ligature passed and left in position to tie. The<i>modus operandi</i>is simple. A ligature is laid in the groove in the lower blade and the ends fastened in the catch of the handle, or held by the fingers of the right hand as the forceps is
The Epstein–Barr virus nuclear antigen-1 promotes telomere dysfunction via induction of oxidative stress
Authors: S A Kamranvar, M G Masucci
Journal: Leukemia (2011)

The Epstein–Barr virus (EBV) nuclear antigen (EBNA)-1 promotes the accumulation of chromosomal aberrations in malignant B cells by inducing oxidative stress. Here we report that this phenotype is associated with telomere dysfunction. Stable or conditional expression of EBNA1 induced telomere abnormalities including loss or gain of telomere signals, telomere fusion and heterogeneous length of telomeres. This was accompanied by the accumulation of extrachromosomal telomeres, telomere dysfunction-induced foci (TIFs) containing phosphorylated histone H2AX and the DNA damage response protein 53BP1, telomere-associated promyelocytic leukemia nuclear bodies (APBs), telomeric-sister chromatid exchanges and displacement of the shelterin protein TRF2. The induction of TIFs and APBs was inhibited by treatment with scavengers of reactive oxygen species (ROS) that also promoted the relocalization of TRF2 at telomeres. These findings highlight a novel mechanism by which EBNA1 may promote malignant transformation and tumor progression.
Induction of excessive B cell proliferation and differentiation by an in vitro stimulus in culture in human systemic lupus erythematosus.
Authors: N Suzuki, T Sakane
Journal: Journal of Clinical Investigation (1989)

B cell hyperactivity present in the body in patients with systemic lupus erythematosus (SLE) can be detectable via almost any measure of B cell function. Nonetheless, the basis for the B cell hyperactivity is difficult to study in vitro. In this study, we have obtained the resting B cells from patients with entirely inactive SLE by collecting them sedimenting in a high density fraction on a Percoll density gradient. These resting SLE B cells proliferated in vitro at a higher rate than normal B cells when exposed to Staphylococcus aureus Cowan I (SAC). In addition, significant proliferation was observed earlier in the course of culture in SLE patients than in normal controls. Moreover, the SLE resting B cells, once triggered by SAC produced abnormally high numbers of immunoglobulin-secreting cells in response to T cell-derived soluble factors. There was less frequency of circulating Leu 1+ B cells in the SLE patients than in normal controls. Moreover, not only Leu 1+ B cells but also Leu 1- B cells of SLE patients were more responsive to SAC than those of normal controls. The results indicate that the B cell hyperactivity in human SLE can be induced by in vitro stimuli, and may not be limited to the Leu 1+ B cell subset.
TRAPEZIUS TRANSPLANTATION IN THE TREATMENT OF DELTOID PARALYSIS
Authors: DEAN D. LEWIS
Journal: JAMA (1910)

Although muscle and tendon transplantation has been used extensively during the past fifteen years to correct motor disturbances following paralysis of a muscle or group of muscles, but few cases are reported in which the procedure has been used to correct the motor disturbances associated with deltoid paralysis. Hoffa<sup>1</sup>reported three cases and Gersuny<sup>2</sup>one in 1906 in which the trapezius was transplanted into the paralyzed deltoid, and during the past year Kiliani<sup>3</sup>has reported another. The results in two of Hoffa's cases were very satisfactory. The third case could not be traced. In Gersuny's case the arm could be raised to the horizontal in four months and at the end of six months the range of motion approached the normal, but the movements were not carried out with much power. Kiliani's patient had a fair degree of motion after three months. Of the five patients operated
Life expectancy in HIV
Authors: E. Losina, K. A. Freedberg
Journal: BMJ (2011)

Better, but not good enough

More than 33 million people are infected with HIV worldwide.1 Over the past 30 years, mortality from HIV and the life expectancy of people who are infected have improved dramatically. With major advances in biomedical research, increased awareness, and dedicated funding, HIV has been transformed from an untreatable and almost always fatal disease to a chronic one. For patients diagnosed promptly and treated with combination antiretroviral therapy (ART), life expectancy is now several decades.2 In the linked cohort study (doi:10.1136/bmj.d6016), May and colleagues estimate specific life expectancy for people in the United Kingdom with HIV undergoing treatment compared with life expectancy in the general population.3

Gains in life expectancy have increased steadily over time, with the availability of more effective and better tolerated regimens. But these gains have not been seen in everyone with HIV. Factors associated with worse outcomes include late presentation to healthcare services, suboptimal adherence to drugs, premature discontinuation of treatment, mental illness, and behavioural risk factors such as use of injected drugs and alcohol dependence.4

Data from the …
Defective synthesis or association of T-cell receptor chains underlies loss of surface T-cell receptor–CD3 expression in enteropathy-associated T-cell lymphoma
Authors: Jennifer M. L. Tjon, Wieke H. M. Verbeek, Yvonne M. C. Kooy-Winkelaar, Binh H. Nguyen, Arno R. van der Slik, Allan Thompson, Mirjam H. M. Heemskerk, Marco W. J. Schreurs, Liesbeth H. A. Dekking, Chris J. Mulder, Jeroen van Bergen, Frits Koning
Journal: Blood (2008)
Bronchial responsiveness to histamine: relationship to diurnal variation of peak flow rate, improvement after bronchodilator, and airway calibre
Authors: G Ryan, K. Latimer, J Dolovich, F. Hargreave
Journal: Thorax (1982)

Features of asthma include increases in both bronchial responsiveness and variability of airflow rates. We examined the relationship between bronchial responsiveness to histamine and the variation of peak expiratory flow rate (PFR) during the day and in response to salbutamol (200 μg), and the initial FEV<sub>1</sub> at the time of the histamine test and FEV<sub>1</sub> response to salbutamol. Bronchial responsiveness to histamine was expressed as the provocation concentration causing a fall in FEV<sub>1</sub> of 20% (PC<sub>20</sub>). PC<sub>20</sub> ranged between 13·9 and 130 mg/ml in nonasthmatic subjects, between 10·5 and 59·9 mg/ml in five asymptomatic asthmatics, and between 0·03 and 20·8 mg/ml in 27 asthmatics with symptoms controlled by medication. The lower the PC<sub>20</sub> (the greater the bronchial responsiveness) the lower the morning PFR (r = 0·79), the greater the increase in PFR after salbutamol (morning r = −0·75, evening r = −0·80), and the greater the difference between the highest and lowest PFR each day (r = −0·81). Measurements of PFR were abnormal, compared with those in nonasthmatic subjects, in all subjects with a PC<sub>20</sub> less than 2 mg/ml—that is, moderate or severe increase in nonspecific bronchial responsiveness—and in none with a PC<sub>20</sub> greater than 21 mg/ml—that is, normal responsiveness; five of nine asthmatics with controlled symptoms had abnormal PFR measurements when PC<sub>20</sub> was between 2 and 21 mg/ml—that is, mild hyperresponsiveness. In contrast, FEV<sub>1</sub> at the time of the histamine test was greater than 80% predicted in all subjects with a PC<sub>20</sub> greater than 2 mg/ml and was not less than this in 10 of 18 subjects with a PC<sub>20</sub> less than 2 mg/ml. When improvement in FEV<sub>1</sub> was 20% or more after salbutamol, the PC<sub>20</sub> was usually moderately or severely increased (less than 0·4 mg/ml). The results identify a close relationship between nonspecific bronchial responsiveness to histamine and the variability in flow rates which occurs spontaneously and after bronchodilator. In addition, they raise the possibility that increased airflow obstruction in asthma may be a consequence of increased responsiveness.
ELECTRON MICROSCOPIC OBSERVATIONS ON THE DEVELOPMENT OF HERPES SIMPLEX VIRUS
Authors: Councilman Morgan, Harry M. Rose, Margaret Holden, Ellyn P. Jones
Journal: The Journal of Experimental Medicine (1959)

Study of the J.M. strain of herpes simplex virus in human amnionic and HeLa cell tissue cultures revealed the presence of intranuclear crystals composed of viral particles with a single membrane enclosing a central body. Randomly dispersed virus with double coats was seen in the nuclear matrix and between multiple membranes at the nuclear periphery. The majority of intracytoplasmic viral particles were within walled vacuoles. It is suggested that this strain of virus differentiates and frequently crystallizes at template sites which are characterized by aggregates of granules near the nuclear margin; that particles, either singly or occasionally in small groups, become enclosed by a second peripheral membrane while still within the nucleus; that the virus can pass into the cytoplasm through reduplications of the nuclear membrane which are deposited behind the virus in such a manner as to prevent rupture of the nucleus; that most of the intracytoplasmic virus is contained within sacks formed by nuclear membranes; and that rupture of these sacks at the cell surface results in extrusion of virus without disruption of the cell. No evidence was obtained to support the hypothesis that virus develops in the cytoplasm. Examination of the H.R. and C.G. strains of herpes simplex virus in identical cell lines grown under similar conditions failed to show viral crystals, but reduplication of the nuclear membranes was evident. Study of the J.M. strain in cells of chicken embryo chorioallantoic membranes indicated that the basic mechanisms of viral development and release did not differ from those operating in HeLa and human amnionic cells.
Association of Plasma Natriuretic Peptide Levels With Metabolic Risk Factors in Ambulatory Individuals
Authors: Thomas J. Wang, Martin G. Larson, Michelle J. Keyes, Daniel Levy, Emelia J. Benjamin, Ramachandran S. Vasan
Journal: Circulation (2007)

Experimental studies suggest that the natriuretic peptides influence lipid and fatty acid metabolism. Although it has been shown that obese individuals have reduced natriuretic peptide levels, conflicting data exist on the relation of natriuretic peptide levels to other metabolic risk factors.We examined the association of plasma levels of B-type natriuretic peptide and N-terminal pro-atrial natriuretic peptide with metabolic risk factors, the metabolic syndrome, and insulin resistance in 3333 Framingham study participants free of heart failure (mean age, 58 years; 54% women). Regression analyses were performed, with adjustment for clinical and echocardiographic variables. Plasma natriuretic peptide levels were inversely associated with all components of the metabolic syndrome except for elevated blood pressure. Adjusted natriuretic peptide levels were lower in persons with the metabolic syndrome compared with those without the metabolic syndrome: In men, B-type natriuretic peptide was 24% lower (P<0.001) and N-terminal pro-atrial natriuretic peptide was 16% lower (P<0.001); in women, B-type natriuretic peptide was 29% lower (P<0.001) and N-terminal pro-atrial natriuretic peptide was 18% lower (P<0.001). Individuals with insulin resistance, as indicated by an elevated homeostasis model assessment (HOMA-IR) index, had lower levels of B-type natriuretic peptide (P=0.009 in men, P<0.001 in women) and N-terminal pro-atrial natriuretic peptide (P<0.001 in men, P=0.001 in women).Having several metabolic risk factors is associated with low circulating natriuretic peptide levels, even after adjustment for body mass index. These findings raise the possibility that reduced natriuretic peptide activity is a manifestation of the metabolic syndrome, which may have important clinical and pathophysiological implications.
Quantitative planar rest-redistribution 201Tl imaging in detection of myocardial viability and prediction of improvement in left ventricular function after coronary bypass surgery in patients with severely depressed left ventricular function.
Authors: M Ragosta, G A Beller, D D Watson, S Kaul, L W Gimple
Journal: Circulation (1993)

BACKGROUND Although many patients with multivessel coronary artery disease (CAD) and severely depressed left ventricular (LV) function will benefit from coronary artery bypass graft surgery (CABG), surgeons may be reluctant to perform CABG on these patients without evidence of myocardial viability in regions of severe asynergy. We hypothesized that quantitative planar rest-redistribution 201Tl imaging would identify viable myocardium and predict improved regional and global function after revascularization in patients with depressed LV function and CAD. METHODS AND RESULTS Twenty-one patients (mean LV ejection fraction, 0.27 +/- 0.05) were studied. Regional and global LV functions were evaluated before and 8 weeks after CABG with radionuclide ventriculography. Segments were prospectively classified as showing normal, mildly reduced, or severely reduced viability on the basis of quantitative analysis of defect severity and redistribution on planar resting 201Tl imaging. By 201Tl criteria, 90% of hypokinetic segments were classified with normal or mildly reduced viability. Among akinetic or dyskinetic segments, 20% had normal 201Tl uptake, 53% had mildly reduced viability, and only 27% had severely reduced viability. 201Tl viability criteria identified segments that improved function after CABG. Sixty-two percent of severely asynergic segments with normal viability and 54% with mildly reduced viability improved function after surgery, but only 23% with severely reduced viability improved function (p = 0.002). When only adequately revascularized segments were considered, the predictive value of a positive preoperative viability scan for functional improvement was 73%. The greatest improvement in global LV function after CABG occurred in patients with the greatest number of asynergic segments classified as viable before surgery (p &lt; 0.01). In 10 patients with more than seven viable, asynergic segments, mean LV ejection fraction increased significantly after CABG (0.29 +/- 0.07 to 0.41 +/- 0.11, p = 0.002). In 11 patients with seven or fewer viable, asynergic segments, mean LV ejection fraction remained unchanged after revascularization (0.27 +/- 0.05 to 0.30 +/- 0.08, p = NS). CONCLUSIONS In patients with CAD and severely depressed LV function, preoperative quantitative planar rest-redistribution. 201Tl imaging identifies viability in many asynergic myocardial segments, and these segments frequently improve function after CABG. The presence of numerous asynergic but viable myocardial segments before surgery correlated significantly with improvement in global LV function after bypass surgery.
Babesia microti Infection in Man
Authors: Michael F. Parry
Journal: JAMA (1977)

ALTHOUGH infections caused by members of the protozoan genus Babesia have been recognized in animals since the 19th century, the first human case of babesiosis was not described until 1957. 1 A total of 12 human infections have been reported in the literature to date 2 ; three of these have been fatal. We report here a case of Babesia microti infection acquired on Long Island, NY.  Report of a Case  A 57-year-old man was admitted to the hospital in July 1976 with a three-week history of chills, fever, easy fatigability, anorexia, and a 4-kg weight loss. Chills, fever, and malaise occurred with a 48-hour periodicity.  Prior to his illness, the patient had been in excellent health. A trip to Mexico in 1970 was his only visit to an endemic malarial country. He traveled to Florida three months prior to admission and made weekly visits to his home on Montauk, Long