tbuckley/cabot-search huggingface dataset:
Medical Education for Tomorrow
Authors: Maurice B. Strauss
Journal: New England Journal of Medicine (1974)

Abstract Government, which increasingly supports all medical education, will exert financial leverage so that the medical needs of the public are satisfied. Although the total number of physicians required in the future is controversial, the proportion of specialists will decline in favor of physicians trained to provide primary care. To train such physicians, medical schools must not sacrifice quality or try to turn out two classes of physicians. Rather, students must continue to be educated in the scientific method, but they should also have a clinical indoctrination oriented to the care of ambulatory rather than hospitalized patients. Thus, on graduation, they will be equipped to enter either postgraduate training programs for primary physicians or programs for specialists as determined by the needs of the public. (N Engl J Med 291:553–556, 1974)
Intranasal beclomethasone inhibits antigen-induced nasal hyperresponsiveness to histamine
Authors: Fuad M. Baroody, Alvaro A. Cruz, Lawrence M. Lichtenstein, Anne Kagey-Sobotka, David Proud, Robert M. Naclerio
Journal: Journal of Allergy and Clinical Immunology (1992)

To determine whether intranasal steroid treatment inhibits the increased sensitivity to histamine that occurs 24 hours after nasal antigen challenge, 12 allergic volunteers were entered into a double-blind study comparing placebo or 164 micrograms of beclomethasone dipropionate twice a day for 7 days. Beclomethasone dipropionate partially reduced the early mediator response to antigen and the influx of eosinophils 24 hours later. Comparing the initial histamine challenge with that done 24 hours after antigen with the subjects on placebo, there was a significant increase in sneezes, TAME-esterase activity, and albumin. Pretreatment with intranasal beclomethasone dipropionate resulted in a reduced response to histamine 24 hours after antigen challenge. A positive correlation occurred between the number of eosinophils in the lavage before histamine challenge and the level of TAME-esterase activity (rs = 0.67, p = 0.03) during the histamine challenge that followed antigen with the subjects on placebo. We thus confirmed the increase in nonspecific nasal airway responsiveness 24 hours after antigen challenge, with a concomitant increase in eosinophils, and demonstrate its inhibition by pretreatment with intranasal steroids.
The Demand for Documentation for Medicare Payment
Authors: Lisa I. Iezzoni
Journal: New England Journal of Medicine (1999)

Sometime in 1998, as ably chronicled by Brett,1 a long-simmering disagreement over an arcane administrative construct — documentation guidelines for physicians to use in coding evaluation and management services billed to Medicare — was transformed into a pitched battle. Before long, the struggle deteriorated into high melodrama.1,2 Against the backdrop of several nationally publicized cases of fraudulent billing, the Health Care Financing Administration (HCFA) drew the battle lines, backed by federal regulatory, investigative, and punitive clout. Taking the rhetorical high road, HCFA aimed to protect the public purse against avaricious doctors bent on waste, fraud, and abuse.Along with . . .
In vitro enhancement of immunoglobulin gene expression in chronic lymphocytic leukemia.
Authors: J Cossman, L M Neckers, R M Braziel, J B Trepel, S J Korsmeyer, A Bakhshi
Journal: Journal of Clinical Investigation (1984)

B cell chronic lymphocytic leukemia (CLL) cells appear to be arrested in their differentiation so that little immunoglobulin is secreted in most cases. To determine their capacity for further differentiation we stimulated cells from a series of 10 cases of CLL with a phorbol ester and assayed for production of immunoglobulin protein, accumulation of immunoglobulin mRNA, and alterations in cell surface markers. We found that cells from all cases were induced to secret monoclonal immunoglobulin of the same heavy and light chain type as the surface membrane immunoglobulin type. Immunoglobulin secretion was preceded by a rapid increase in the levels of mRNA coding for IgM, predominantly the secretory form, mu s-mRNA, rather than the membrane form, mu m-mRNA. A similar selection of mu s- over mu m-mRNA is known to occur in plasma cells by a mechanism of differential processing of mRNA from a single mu-chain gene. Except for a decline in the expression of surface IgD, cell surface determinants remained unaffected both in terms of the percentage of positive cells and the relative number of sites per cell. In contrast to previous studies, these results indicate that CLL cells consistently retain the capacity to further differentiate toward plasma cells and secrete immunoglobulin. The immunoglobulin secretion is mediated, at least in part, by a developmentally regulated increment in mu s-mRNA.
Distinct response of liver myeloid dendritic cells to endotoxin is mediated by IL-27
Authors: Yun Chen, Guoping Jiang, Horng-Ren Yang, Xiaodong Gu, Lianfu Wang, Ching-Chuan Hsieh, Hong-Shiue Chou, John J. Fung, Shiguang Qian, Lina Lu
Journal: Journal of Hepatology (2009)
Left Ventricular Contractile Effects of Inducible Nitric Oxide Synthase in the Human Allograft
Authors: Walter J. Paulus, Stefanie Kästner, Pénélope Pujadas, Ajay M. Shah, Helmut Drexler, Marc Vanderheyden
Journal: Circulation (1997)

Myocardial expression of inducible (i) nitric oxide (NO) synthase (iNOS) gene has been reported in transplant recipients and in dilated cardiomyopathy. NO derived from NO donor or from coronary endothelium has previously been shown in the human heart to reduce end-systolic left ventricular (LV) pressure, especially during beta-adrenoreceptor stimulation, because of earlier onset of LV relaxation. The present study investigated in transplant recipients whether a similar cardiodepressant effect could be attributed to NO derived from iNOS.In 16 transplant recipients who were free of rejection or graft vasculopathy, microtip LV pressure recordings, LV angiograms, and endomyocardial biopsies were obtained at annual coronary angiography. In 8 transplant recipients, microtip LV pressure recordings were obtained during intravenous dobutamine (5 microg x kg(-1) x min(-1)). Competitive reverse transcription-polymerase chain reaction of iNOS mRNA was performed on the endomyocardial biopsies, and the intensity of iNOS mRNA expression was quantified on a scale ranging from 0 to 5+. All measures of baseline LV function were comparable in transplant recipients with low (< or = 2+) or high myocardial iNOS mRNA. During intravenous dobutamine infusion, there was a significant correlation between the abbreviation of LV electromechanical systole time (LVEST is the time from onset of QRS to dP/dt(min)) and the rise of LV dP/dt(max) (r=.79; P<.02). By use of a multiple regression analysis, addition of the intensity of iNOS mRNA expression as an independent variable significantly (P<.005) improved the correlation between deltaLVEST and deltaLV dP/dt(max) (P<.001; r=.97), implying a larger abbreviation of LV contraction for a similar rise in LV dP/dt(max), when myocardial iNOS mRNA was higher. The larger abbreviation of LV contraction in-patients with high iNOS mRNA was associated with a decrease in LV end-systolic pressure (-31+/-16 mm Hg).Myocardial iNOS gene expression in the human allograft influences the LV contractile response to beta-adrenergic stimulation through earlier onset of LV relaxation and reduction of LV end-systolic pressure. These effects are similar to the LV contractile effects of NO derived from NO donor or from coronary endothelium.
Abstract B14: Minimum effective concentration of paclitaxel improves the effectivity of dendritic cells transfected with tumor RNA.
Authors: Marcela Rodrigues Camargo, Cecília Pessoa Rodrigues, Carolina Mendonça Gorgulho, Fabiana Albani Zambuzi, Victória Elizabeth Galvão, Juliana Cristina Longo Frederico, Marcimara Penitenti, Ramon Kaneno
Journal: Cancer Research (2013)

Abstract The central role of dendritic cells (DCs) in antigen presentation and induction of antitumor immunity supported the development of antitumor vaccines based on these cells. In previous studies, we have observed that treatment with ultra-low doses of paclitaxel (PAC) modulated human DCs to express the phenotype of mature and activated cells, and stimulated their antigen presentation activity. At the same time, tumor cells treated with low concentrations of drugs became more immunogenic and more susceptible to the lytic activity of cytotoxic T lymphocytes in vitro. Therefore, we aimed to verify if the transfection of DCs with drug-treated tumor cells RNA enhances the effectiveness of DC-based vaccines and if the in vitro effects are reproducible in vivo. Murine colon tumor cells (MC-38) were subcutaneously inoculated in C57Bl/6 mice. At the 10th and 17th days after inoculation, they received a DC vaccine transfected with RNA of MC-38 cells pre-treated with minimum effective concentration of PAC. These DCs expressed 12% higher levels of CD40 and were able to delay the tumor growth when compared with non-treated animals. Although the differences were not significant, our results suggest that the treatment of tumor cells with low concentration of PAC can enhance the immunogenicity of tumor cells, which is transfered for DCs by RNA transfection, and delay tumor growth. Financial support: FAPESP 2009/18331-8; FAPESP 2010/06013-9. Citation Format: Marcela Rodrigues Camargo, Cecília Pessoa Rodrigues, Carolina Mendonça Gorgulho, Fabiana Albani Zambuzi, Victória Elizabeth Galvão, Juliana Cristina Longo Frederico, Marcimara Penitenti, Ramon Kaneno. Minimum effective concentration of paclitaxel improves the effectivity of dendritic cells transfected with tumor RNA. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Immunology: Multidisciplinary Science Driving Basic and Clinical Advances; Dec 2-5, 2012; Miami, FL. Philadelphia (PA): AACR; Cancer Res 2013;73(1 Suppl):Abstract nr B14.
Goblet Cell Hyperplasia and Epithelial Inflammation in Peripheral Airways of Smokers with Both Symptoms of Chronic Bronchitis and Chronic Airflow Limitation
Authors: MARINA SAETTA, GRAZIELLA TURATO, SIMONETTA BARALDO, ANNALISA ZANIN, FAUSTO BRACCIONI, CRISTINA E. MAPP, PIERO MAESTRELLI, GIORGIO CAVALLESCO, ALBERTO PAPI, LEONARDO M. FABBRI
Journal: American Journal of Respiratory and Critical Care Medicine (2000)

To quantify the number of goblet cells and inflammatory cells in the epithelium of peripheral airways in smokers with both symptoms of chronic bronchitis and chronic airflow limitation, we examined surgical specimens obtained from 25 subjects undergoing lung resection for localized pulmonary lesions: 10 smokers with symptoms of chronic bronchitis and chronic airflow limitation, six asymptomatic smokers with normal lung function, and nine nonsmoking control subjects. Peripheral airways were examined with histochemical methods to identify goblet cells and with immunohistochemical methods to identify total leukocytes (CD45+ cells), neutrophils, macrophages, CD4+ and CD8+ cells in the epithelium. When compared with nonsmokers, smokers with both symptoms of chronic bronchitis and chronic airflow limitation had an increased number of goblet cells (p < 0.01), CD45+ cells (p < 0.01), macrophages (p < 0.05), and CD8+ cells (p < 0.01) in the epithelium of peripheral airways. When all the smokers were grouped together, they showed an increased number of neutrophils (p < 0.05) along with an increased number of goblet cells, CD45+ cells, macrophages and CD8+ cells (p < 0.05) compared with nonsmokers. In conclusion, smokers with both symptoms of chronic bronchitis and chronic airflow limitation have an increased number of goblet cells and inflammatory cells in the epithelium of peripheral airways. Saetta M, Turato G, Baraldo S, Zanin A, Braccioni F, Mapp CE, Maestrelli P, Cavallesco G, Papi A, Fabbri LM. Goblet cell hyperplasia and epithelial inflammation in peripheral airways of smokers with both symptoms of chronic bronchitis and chronic airflow limitation.
Clonality of acquired primary pure red cell aplasia
Authors: Michihiko Masuda, Hiroshi Saitoh, Hideaki Mizoguchi
Journal: American Journal of Hematology (1999)

Acquired primary pure red cell aplasia (PRCA) has frequently been shown to be associated with T cells that inhibit marrow erythropoiesis. A 41-year-old female presented with anemia in December 1985. Bone marrow examination revealed 1.8% erythroid cells. A diagnosis of PRCA was made. She received prednisolone, and her hemoglobin level recovered to 12 g/dl. In February 1995, her hemoglobin level decreased to 5.8 g/dl, and acquired primary PRCA recurred. Surface markers of peripheral blood mononuclear cells demonstrated CD4/8 ratio inversion. The T-cell receptor (TCR)-β chain gene showed germ line configuration by Southern blot analysis of the mononuclear cells in peripheral blood. However, stepdown polymerase chain reaction analysis revealed that the TCR-β gene of peripheral blood mononuclear cells was rearranged. With highly sensitive polymerase chain reaction analysis, clonality of T cells was confirmed. We propose that some acquired primary PRCA patients have a T-cell clonal disorder, similar to some PRCA patients with large granular lymphocytes leukemia or thymoma. Am. J. Hematol. 62:193–195, 1999. © 1999 Wiley-Liss, Inc.
Intestinal permeability in patients with atopic eczema
Authors: A. BARBA, D. SCHENA, M.C. ANDREAUS, G. FACCINI, F. PASINI, G. BROCCO, G. CAVALLINI, L.A. SCURO, G.C. CHIEREGATO
Journal: British Journal of Dermatology (1989)

Passive intestinal permeability was measured in 15 adult patients with atopic eczema. Values in the patients did not differ significantly from those in 12 healthy control subjects. These results suggest that altered intestinal permeability is not important in the pathogenesis of atopic eczema in adults.
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary
Authors: Rick A. Nishimura, Catherine M. Otto, Robert O. Bonow, Blase A. Carabello, John P. Erwin, Robert A. Guyton, Patrick T. O’Gara, Carlos E. Ruiz, Nikolaos J. Skubas, Paul Sorajja, Thoralf M. Sundt, James D. Thomas
Journal: Circulation (2014)
Prophylaxis Against Venous Thromboembolism After Hip Surgery
Authors: J. Chell, D. Clark, P. W. Howard
Journal: JAMA (1995)

<h3>To the Editor.</h3> —The article by Drs Imperiale and Speroff<sup>1</sup>contains important errors that result in a considerable understatement of the efficacy of adjusted-dose warfarin sodium in preventing PE. The 10 articles cited (Table) yield 994 patients receiving warfarin (not 864 as stated in their article) with nine definite PEs (not 23). Thus, the crude incidence of PE would be 0.91%, not 2.7%. This is almost the same incidence as with LMWH. Second, the analysis includes a series by Fordyce et al<sup>2</sup>that used fixed minidose warfarin (1 mg daily, irrespective of the prothrombin time). This method of prophylaxis was shown to be completely ineffective by Fordyce et al, is entirely different from adjusted-dose warfarin, and should be put in a group by itself. With this series excluded, the crude incidence of proven PE decreases to just 0.43%, half that with LMWH. These errors completely alter the findings
Syndecan-1 deficiency aggravates anti-glomerular basement membrane nephritis
Authors: A.L. Rops, M. Götte, M.H. Baselmans, M.J. van den Hoven, E.J. Steenbergen, J.F. Lensen, T.J. Wijnhoven, F. Cevikbas, L.P. van den Heuvel, T.H. van Kuppevelt, J.H. Berden, J. van der Vlag
Journal: Kidney International (2007)
Non-Hodgkin’s Lymphoma Arising in Bone in Children and Adolescents Is Associated With an Excellent Outcome: A Children’s Cancer Group Report
Authors: Mark A. Lones, Sherrie L. Perkins, Richard Sposto, Nicole Tedeschi, Marshall E. Kadin, Carl R. Kjeldsberg, John F. Wilson, David L. Zwick, Mitchell S. Cairo
Journal: Journal of Clinical Oncology (2002)

PURPOSE: Non-Hodgkin’s lymphoma (NHL) arising in bone is a heterogeneous histologic type of NHL that includes large-cell lymphoma, lymphoblastic lymphoma, and small noncleaved-cell lymphoma. NHL arising in bone is well recognized in adults but is less well characterized and infrequent in children and adolescents. PATIENTS AND METHODS: We performed a retrospective review of Children’s Cancer Group (CCG) studies treating children and adolescents with NHL over a 20-year period (CCG-551, CCG-501, CCG-502, CCG-503, CCG-552, CCG-5911, and CCG-5941) and determined the response and event-free survival (EFS) rates in 31 patients with NHL arising in bone. RESULTS: The patients ranged in age from 3 to 17 years (median, 11 years; mean, 11 years), and 64.5% were male. All 31 (100%) patients achieved complete response. For 31 patients with NHL arising in bone, the product-limit estimated 5-year EFS was 83.8% ± 6.7%. EFS in 17 patients with localized disease (Murphy stages I and II) was 94.1% ± 5.7%, and EFS in 14 patients with disseminated disease (Murphy stage III) was 70.7% ± 12.4% (log-rank P = .10). EFS in 17 patients treated with chemotherapy and radiation was 70.1% ± 11.2%, and EFS in 14 patients treated with chemotherapy without radiation was 100% (P = .03). EFS in 26 patients with histology-directed treatment (LSA2-L2 or ADCOMP for lymphoblastic, other therapy for nonlymphoblastic) was 92.2% ± 5.3%, and in five patients with nonhistology-directed treatment it was 40.0% ± 21.9% (P &lt; .001). CONCLUSION: NHL arising in bone is a heterogeneous type of NHL that makes up approximately 2.0% of NHL in children and adolescents on CCG studies. Response and survival in this young age group seem superb, with histology-directed treatment protocols without radiation in both localized and disseminated disease.
A woman with hypophosphataemia and raised alkaline phosphatase
Authors: J. K Y Lam, K. S L Lam, K. C B Tan, W.-S. Chow, A. W K Tso, A. W C Kung
Journal: BMJ (2010)

A 73 year old woman was referred because of hypophosphataemia and raised serum alkaline phosphatase. She was a chronic hepatitis B carrier and regular monitoring had shown a persistently raised alkaline phosphatase (415-495 U/l; normal range 47-124). All other liver enzymes were within the normal range, and ultrasound of the liver was unremarkable.

Further assessment showed low serum phosphate (0.51-0.63 mmol/l; 0.88-1.45), but normal albumin adjusted calcium (2.53-2.63 mmol/l; 2.24-2.63) and creatinine (40 µmol/l; normal 49-82). Her serum parathyroid hormone was extremely high at 689 ng/l (normal 9-52), serum calcidiol (25-hydroxyvitamin D) was low at 23.5 nmol/l (normal >50), and serum calcitriol (1,25-dihydroxycalciferol) was raised at 240.5 pmol/l (60.2-158.6).

She was diagnosed with vitamin D insufficiency with secondary hyperparathyroidism and was prescribed cholecalciferol 800 IU/day. After three months of treatment, serum phosphate remained persistently low at 0.52 mmol/l and she had developed hypercalcaemia (albumin adjusted calcium 2.73 mmol/l). Her 24 hour urine for calcium was normal (7.1 mmol/day; 2.0-7.4) and parathyroid hormone remained raised at 691 ng/l.



### 1 What is the most likely diagnosis?

#### Short answer

The patient has primary hyperparathyroidism; vitamin D replacement seemed to unmask the hypercalcaemia.

#### Long answer

Primary hyperparathyroidism is a common endocrine disorder. Up to 80% of patients have no symptoms of hypercalcaemia and only a small proportion present with associated complications such as hypercalciuria, renal stones, osteoporosis, and fractures.

Vitamin D insufficiency is also a common problem worldwide, which often goes unrecognised. A serum calcidiol concentration of below 50 nmol/l is suggestive of vitamin D insufficiency. Recently, the National Institute of Health of the United States recommended a calcidiol value of greater than 75 nmol/l to reduce fracture risk, improve lower extremity function, and protect against development of colorectal cancer. …
518 UNFAVORABLE IMPACT OF HCV INFECTION ON TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA IN PATIENTS WITH COMPENSATED LIVER DISEASE: INSIGHTS FROM THE LIVER MATCH COHORT STUDY
Authors: M. Angélico, T. Marianelli, U. Cilio, S. Fagiuoli, A. Gasbarrini, C. Gavrila, R. Romagnoli, M. Strazzabosco, A. Nardi
Journal: Journal of Hepatology (2011)
Nafcillin-Induced Agranulocytosis
Authors: Sheldon M. Markowitz
Journal: JAMA (1975)

ADVERSE REACTIONS to the penicillins are relatively common<sup>1</sup>and are clinically expressed in various ways,<sup>2</sup>probably through different mechanisms.<sup>3</sup>An infrequent complication of penicillin therapy is agranulocytosis, first reported with the semisynthetic penicillin, methicillin.<sup>4</sup>Nafcillin (6-[2-ethoxy-l-naphthamido] penicillin) is structurally similar to methicillin. However, to our knowledge, reports of agranulocytosis resulting from nafcillin have not been published. <h3>Report of a Case</h3> A 44-year-old housewife was admitted to the Medical College of Virginia Hospitals on Sept 23, 1974, with a partially treated<i>Staphylococcus aureus</i>endocarditis with tricuspid-valve involvement and septic pulmonary emboli. On physical examination she appeared weak, but well nourished and in no acute distress. Her temperature was 39.2 C (102.6 F); blood pressure, 105/70 mm Hg; and pulse rate, 110 beats per minute. Prominent jugular pulsations ("v" waves) were noted. A grade 3/6 harsh systolic murmur was heard at the second left intercostal space. The rest