tbuckley/cabot-search huggingface dataset:
SOME POINTS IN THE MANAGEMENT OF THE NEURASTHENIC.
Authors: JAMES H. McBRIDE
Journal: JAMA (1902)

The term neurasthenia has not the wide application it had ten years ago. A more accurate clinical observation has narrowed its meaning, and in many cases that would formerly have been called neurasthenia, and which would have been treated as such, are now recognized as nervous features due to some bodily derangement not primarily nervous. Chronic disorder of internal organs may, and often does, predispose to neurasthenia and by interference with nutrition, by exhaustion, or by toxemic states, the resistive capacity of the nervous system is lowered so that it more easily succumbs to the ordinary stress of life. There is, of course, stress in every life; every man, whether he drives a dray or runs a bank, is subject to stress of mind and body, and that which befalls the man of low capacity and rude life may be relatively to his strength and his outlook on the world
Infections of the Intervertebral Disk in Children
Authors: Francis P. Milone
Journal: JAMA (1962)

Data are presented on 7 children with an infectious process of the intervertebral disk and on 1 child with involvement of the sacroiliac joint. Culture of material obtained by needle or open biopsy of the lesion, performed on 5 patients, revealed Staphylococcus aureus . There has been much speculation as to the identity of the responsible organism in this condition, but to the best of the authors' knowledge no series of cases has yet been presented in which the etiologic agent has been identified. The early roentgenogram was characterized by narrowing of the intervertebral disk, followed by localized destruction of the adjacent vertebral margins. Later x-ray findings included vertebral-body sclerosis and reactive bone formation. Methods of therapy are evaluated. Complete relief of symptoms followed rest in bed or application of a body cast or brace.
CIITA-regulated plexin-A1 affects T-cell–dendritic cell interactions
Authors: Athena W Wong, W June Brickey, Debra J Taxman, Hendrick W van Deventer, William Reed, Jian Xin Gao, Pan Zheng, Yang Liu, Ping Li, Janice S Blum, Karen P McKinnon, Jenny P-Y Ting
Journal: Nature Immunology (2003)
Pyogenic liver abscess.
Authors: T J Butler, C F McCarthy
Journal: Gut (1969)

At the turn of the century, the mortality from liver abscess was 100%.Surgical drainage reduced the mortality to 50 to 75% by 1930.Antibiotics led to a further reduction but there was little change in the mortality during the next 25 years until recently when the adoption of special localization techniques promised a great improvement.In the nineteenth century a common cause of liver abscess was undiagnosed appendicitis.This has been corrected, so eliminating deaths in the young age groups.The condition now affects predominantly the aged and enfeebled but it remains a condition with a high mortality and morbidity despite diagnostic aware- ness and therapeutic improvements.Liver abscess is sometimes only one manifestation of severe infection elsewhere.The initial features of the disease may be non-specific and the fully developed picture is late in appearing.Consequently there may be delay or failure in diagnosis.Inadequate drainage of multi- loculated abscesses or failure to drain secondary abscesses adds to the problem.Few see many cases and this stresses the need for a continual review of the condition in all its aspects.MATERIAL During the 10-year period 1957-66, 48 patients with liver abscess were admitted to two Bristol hospitals, and have been classified as follows:TYPE 1 (17 PATIENTS) In this group presentation was acute in immediate continuity with some other acute abdominal pathology.The abscesses were usually multiple, but in general there was no diagnostic problem.Table I summarizes the cases in this group.TYPE 2 (31 PATIENTS) This group constituted the main problem and forms the basis of the paper.The abscesses were usually solitary with a 'chronic' presentation.There was no such time relationship as in type 1 and a prolonged search, often fruitless, AGE INCIDENCE This is illustrated in Fig. 1, together with an indication of mortality.The increasing incidence with age is shown, 50 % of the patients being over the age of 60 years.on July 16,
Abstract 4464: Elucidation of crizotinib resistance in NCI-H3122 and strategies to circumvent bypass resistance.
Authors: Nathan V. Lee, Joan Cao, Timothy Scheffelin, Lars Engstrom, Stephen Huang, Maruja Lira, Scott Garza, Jing Yuan, Blake Enyart, James Christensen, Julie Kan
Journal: Cancer Research (2013)

Abstract The Anaplastic Lymphoma Kinase (ALK) fusion proteins such as EML4-ALK act as oncogenic drivers in approximately 5-7% of non-small cell lung carcinomas (NSCLC). The rationale for targeting this kinase as a means of treatment has been validated by the clinical efficacy and subsequent approval of the ALK inhibitor, crizotinib (Xalkori ®). The overall response rate of 61% suggests potential intrinsic resistance to crizotinib. In addition, like many tyrosine kinase inhibitors, acquired resistance inevitably leads to treatment refractory cancers. To better understand resistance mechanisms (both intrinsic and acquired), and circumvent resistance to crizotinib, we developed in vitro resistance models through prolonged crizotinib exposure. We isolated resistance clones and characterization identified different resistance mechanisms, including pathway bypass as well as an ALK kinase mutation (G1269A), similar to those that have been reported from refractory patient samples. The majority of the resistance clones escaped crizotinib suppression via pathway bypass. In several resistance clones, simultaneous activation of EGFR and IGF1R receptors limited the efficacy of double combination strategies and required triple combinations. In addition, phospho-proteomic analysis revealed simultaneous activation of different receptor tyrosine kinases, suggesting that combination treatment with inhibitors of downstream mediators such as PI3K and MEK may be effective strategies. Our resistance models demonstrate the heterogeneity of cancers and reveal the multiplicity of escape mechanisms. Our results provide support for the evaluation of combination therapy with downstream mediator inhibitors as a way to restore as well as enhance sensitivity to crizotinib. Citation Format: Nathan V. Lee, Joan Cao, Timothy Scheffelin, Lars Engstrom, Stephen Huang, Maruja Lira, Scott Garza, Jing Yuan, Blake Enyart, James Christensen, Julie Kan. Elucidation of crizotinib resistance in NCI-H3122 and strategies to circumvent bypass resistance. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4464. doi:10.1158/1538-7445.AM2013-4464
Association Between Use of Bleeding Avoidance Strategies and Risk of Periprocedural Bleeding Among Patients Undergoing Percutaneous Coronary Intervention
Authors: Steven P. Marso, Amit P. Amin, John A. House, Kevin F. Kennedy, John A. Spertus, Sunil V. Rao, David J. Cohen, John C. Messenger, John S. Rumsfeld
Journal: JAMA (2010)

Bleeding complications with percutaneous coronary intervention (PCI) are associated with adverse patient outcomes. The association between the use of bleeding avoidance strategies and post-PCI bleeding as a function of a patient's preprocedural risk of bleeding is unknown.To describe the use of 2 bleeding avoidance strategies, vascular closure devices and bivalirudin, and associated post-PCI bleeding rates in a nationally representative PCI population.Analysis of data from 1,522,935 patients undergoing PCI procedures performed at 955 US hospitals participating in the National Cardiovascular Data Registry (NCDR) CathPCI Registry from January 1, 2004, through September 30, 2008.Periprocedural bleeding.Bleeding occurred in 30,654 patients (2%). Manual compression, vascular closure devices, bivalirudin, or vascular closure devices plus bivalirudin were used in 35%, 24%, 23%, and 18% of patients, respectively. Bleeding events were reported in 2.8% of patients who received manual compression, compared with 2.1%, 1.6%, and 0.9% of patients receiving vascular closure devices, bivalirudin, and both strategies, respectively (P < .001). Bleeding rates differed by preprocedural risk assessed with the NCDR bleeding risk model (low risk, 0.72%; intermediate risk, 1.73%; high risk, 4.69%). In high-risk patients, use of both strategies was associated with lower bleeding rates (manual compression, 6.1%; vascular closure devices, 4.6%; bivalirudin, 3.8%; vascular closure devices plus bivalirudin, 2.3%; P < .001). This association persisted following adjustment using a propensity-matched and site-controlled model. Use of both strategies was used least often in high-risk patients (14.4% vs 21.0% in low-risk patients, P < .001).In a large national PCI registry, vascular closure devices and bivalirudin were associated with significantly lower bleeding rates, particularly among patients at greatest risk for bleeding. However, these strategies were less often used among higher-risk patients.
Paclitaxel-Eluting or Sirolimus-Eluting Stents to Prevent Restenosis in Diabetic Patients
Authors: Alban Dibra, Adnan Kastrati, Julinda Mehilli, Jürgen Pache, Helmut Schühlen, Nicolas von Beckerath, Kurt Ulm, Rainer Wessely, Josef Dirschinger, Albert Schömig
Journal: New England Journal of Medicine (2005)

Drug-eluting stents are highly effective in reducing the rate of in-stent restenosis. It is not known whether there are differences in the effectiveness of currently approved drug-eluting stents in the high-risk subgroup of patients with diabetes mellitus.We enrolled 250 patients with diabetes and coronary artery disease: 125 were randomly assigned to receive paclitaxel-eluting stents, and 125 to receive sirolimus-eluting stents. The primary end point was in-segment late luminal loss. Secondary end points were angiographic restenosis (defined as in-segment stenosis of at least 50 percent at follow-up angiography) and the need for revascularization of the target lesion during a nine-month follow-up period. The study was designed to show noninferiority of the paclitaxel stent as compared with the sirolimus stent, defined as a difference in the extent of in-segment late luminal loss of no more than 0.16 mm.The extent of in-segment late luminal loss was 0.24 mm (95 percent confidence interval, 0.09 to 0.39) greater in the paclitaxel-stent group than in the sirolimus-stent group (P=0.002). In-segment restenosis was identified on follow-up angiography in 16.5 percent of the patients in the paclitaxel-stent group and 6.9 percent of the patients in the sirolimus-stent group (P=0.03). Target-lesion revascularization was performed in 12.0 percent of the patients in the paclitaxel-stent group and 6.4 percent of the patients in the sirolimus-stent group (P=0.13).In patients with diabetes mellitus and coronary artery disease, use of the sirolimus-eluting stent is associated with a decrease in the extent of late luminal loss, as compared with use of the paclitaxel-eluting stent, suggesting a reduced risk of restenosis.
THE MATHEMATICAL POINT OF REVERSAL IN SKIASCOPY.
Authors: SWAN M. BURNETT
Journal: JAMA (1905)

Of all the objective methods for determining the refractive state of the eye, the shadow test is not only the most reliable, but, up to a certain point, the easiest to apply practically. In view of these facts it seems unaccountable that concerning the laws underlying the method, there should be such a lack of clear and positive proof offered, even by those who are supposed to deal with the subject in an authoritatively scientific manner. The ordinary text-books for students and general practitioners, without exception, I believe, pass over the theoretical part very superficially, giving attention wholly to the signification of shadow movements "with" and "against," mentioning the "point of reversal" only casually, with a matter of course assumption that everybody knows where it is. It is not my intention to charge these writers with ignorance of the laws on which the phenomena are based, but they certainly
Tuberculosis as a Manifestation of the Acquired Immunodeficiency Syndrome
Authors: J. Guarner, C. del Rio, B. Slade
Journal: JAMA (1986)

<h3>To the Editor.—</h3> Our experience at Grady Memorial Hospital in Atlanta confirms the observation of Sunderam et al<sup>1</sup>that infection with<i>Mycobacterium tuberculosis</i>can be a frequent complication of the acquired immunodeficiency syndrome (AIDS). However, we have observed the combination of human immunodeficiency virus (HIV) infection and tuberculosis not only among Haitians and intravenous drug abusers but also among American-born homosexual men who do not abuse drugs. <h3>Study.—</h3> In 1985 at Grady Memorial Hospital, mycobacterial cultures were performed on 1536 patients, including 76 patients who met Centers for DiseaseControl criteria for AIDS or AIDS-related complex (ARC). In the non-AIDS/ARC group, there were 152 (10.4%) patients with positive cultures, with<i>M tuberculosis</i>as the most frequent isolate (87%). Twenty-four (31.6%) of the 76 patients with AIDS/ ARC had positive mycobacterial cultures. Culture isolates included 15<i>M tuberculosis</i>, seven<i>Mycobacterium avium-intracellulare</i>(MAI), one<i>Mycobacterium xenopi</i>, and one rapid grower
List size and patient contact in general medical practice.
Authors: D Wilkin, D H Metcalfe
Journal: BMJ (1984)

One hundred and ninety nine general practitioners collected data on consultations with patients for a representative sample of recording days. The number of consultations and amount of time spent in patient contact were positively correlated with the number of registered patients (list size), whereas the consultation rate and the amount of time spent with each patient were negatively correlated. These relations, however, were not too strong, and there was considerable variation among doctors, particularly for those with lower list sizes. These findings have implications for issues concerning quality of care and the potential effects of reductions in patient list size.
The Role of Extended Cervical Mediastinoscopy in Staging of Non-small Cell Lung Cancer of the Left Lung and a Comparison with Integrated Positron Emission Tomography and Computed Tomography: Does Integrated Positron Emission Tomography and Computed Tomography Reduce the Need for Invasive Procedures?
Authors: Muzaffer Metin, Necati Citak, Adnan Sayar, Atilla Pekcolaklar, Huseyin Melek, Abdulaziz Kök, Atilla Gurses
Journal: Journal of Thoracic Oncology (2011)
Case of Pterygium Crassum in Both Eyes, Treated Successfully by Ligature and Subsequent Iridectomy
Authors: H. Penfold
Journal: BMJ (1876)

plained of pain in the abdomen.On examining the abdomen, a distinct, hard, oblong tumour, about two inches and a half long and an inch and a quarter wide, and painful on palpation, was discovered in the right iliac region, about the situation of the ileo-coecal valve.A second smaller tumour was also present, about one inch to the left of the umbilicus.He was ordered milk and lime-water, hot fomenta- tions to the abdomen, and an enema of soap and water.The enema was soon returned, mixed with blood and mucus, and smelling very feculent; but there was no feculent matter.My suspicions were now confirmed that this was a case of intussusception at the ileo-caecal valve.He was ordered four minims of tincture of opium every four hours while in pain.July 15th.The tongue was coated; vomiting was incessant; there were borborygmi and great thirst.The tumour was larger and painful.The skin and pulse were natural.After elevating his pelvis and depressing his shoulders, I injected a quart of water mixed with oil, and then tried to dislodge the invaginated bowel by friction towards the diaphragm.The enema returned, and was again mixed with blood and mucus.In the evening, I made a second attempt to disengage the bowel by manipulation; and this time the enema brought away a lump of faeces of the size of a walnut.The smaller tumour had dis- appeared.July i6th.As there was no improvement, a third attempt was made to reduce the bowel, but without success.Finding that the obstruction still continued, all hope of displacing the intussusception by manipulation was now abandoned.I now trusted to opium, fomenta- tions, and nutrient enemata; and ordered his thirst to be relieved by a little iced water (he would not take ice).July I7th.The vomiting now became distinctly faecal, and signs of prostration began to set in-sunken eyes, feeble pulse, etc.The abdo- men was swollen to an enormous size, so that one could count in tiers the coils of intestines.July 17th to 22nd.He continued much in the same state just de- scribed, but gradually became weaker.The enemata were retained for two or three hours, and then returned.They had a faecal odour, but there was no feculent matter.July 23rd.The vomiting began to diminish.The child looked much better.The abdomen was less tympanitic, and flatus was passed per anum.July 24th.He was still improving.The swelling was nearly gone;the tumour was just perceptible.There was no vomiting, and a small loose evacuation took place without any blood in it.
Steroid‐sparing effect of subcutaneous SQ‐standardised specific immunotherapy in moderate and severe house dust mite allergic asthmatics
Authors: G. Blumberga, L. Groes, L. Haugaard, R. Dahl
Journal: Allergy (2006)

Background: The present study evaluated the steroid‐sparing effect of subcutaneous SQ‐standardized specific immunotherapy (SIT) in moderate and severe house dust mite (HDM) allergic asthmatics. Methods: Fifty‐four adult asthmatics allergic to HDM requiring at least inhaled corticosteroids (ICS) doses equivalent to 500 μ g fluticasone propionate daily were randomized to subcutaneous SIT or placebo injections for a period of 3 years. The minimum required ICS dose, 4 week diary of asthma symptom score, use of rescue medication, peak expiratory flow (PEF) measurements and visual analog scale for asthma symptoms were assessed before start of treatment and after 1, 2 and 3 years of treatment. Results: In patients with moderate and severe asthma, the reduction in ICS was statistical significant after 2 years of treatment ( P = 0.03) but not after 3 years. The median reductions were 82% and 42% after the third year for active and placebo respectively. In patients with moderate persistent asthma the reduction was statistical significant larger for those treated with SIT compared with placebo after year 2 and year 3. The median reductions after 3 years were 90% for SIT and 42% for placebo ( P = 0.04). Despite significant steroid reduction, there was no difference in asthma assessments between the two groups. No serious reactions related to SIT injections were seen. Conclusion: This study shows that SIT with a SQ‐standardized HDM extract is safe. An ICS sparing effect was evident in patients with moderate persistent asthma.
Are Medical Journals Obsolete?
Authors: Alfred Soffer
Journal: JAMA (1977)

The world of multimedia engulfs us. The medical profession has been particularly receptive to innovations in communications, including audiotapes and videotapes. Physicians eagerly embrace newer educational techniques such as the use of the computer as an integral element of workshops and lecture programs. The teacher and the practitioner are beguiled daily by advertisements extolling the virtues of multimedia packages with self-assessment features. These packages range from elaborate motion pictures and filmstrip programs to relatively unsophisticated devices such as hand-held viewers and workbooks with exotic self-quiz techniques.  Many of these innovations are positive contributions to the physician's learning process. However, in the current national explosion of education programs, technique rather than content threatens to assume a primary role. Participants in national symposia have suggested that audiotapes and videotapes have made the position of the medical periodical untenable. Were we to believe some enthusiasts, the traditional role of medical periodicals has been
Spontaneous Autoimmune Diabetes in Monoclonal T Cell Nonobese Diabetic Mice
Authors: Joan Verdaguer, Dennis Schmidt, Abdelaziz Amrani, Brad Anderson, Nuzhat Averill, Pere Santamaria
Journal: The Journal of Experimental Medicine (1997)

It has been established that insulin-dependent diabetes mellitus (IDDM) in nonobese diabetic (NOD) mice results from a CD4+ and CD8+ T cell–dependent autoimmune process directed against the pancreatic beta cells. The precise roles that beta cell–reactive CD8+ and CD4+ T cells play in the disease process, however, remain ill defined. Here we have investigated whether naive beta cell–specific CD8+ and CD4+ T cells can spontaneously accumulate in pancreatic islets, differentiate into effector cells, and destroy beta cells in the absence of other T cell specificities. This was done by introducing Kd– or I-Ag7–restricted beta cell–specific T cell receptor (TCR) transgenes that are highly diabetogenic in NOD mice (8.3- and 4.1-TCR, respectively), into recombination-activating gene (RAG)-2–deficient NOD mice, which cannot rearrange endogenous TCR genes and thus bear monoclonal TCR repertoires. We show that while RAG-2−/− 4.1-NOD mice, which only bear beta cell–specific CD4+ T cells, develop diabetes as early and as frequently as RAG-2+ 4.1-NOD mice, RAG-2−/− 8.3-NOD mice, which only bear beta cell–specific CD8+ T cells, develop diabetes less frequently and significantly later than RAG-2+ 8.3-NOD mice. The monoclonal CD8+ T cells of RAG-2−/− 8.3-NOD mice mature properly, proliferate vigorously in response to antigenic stimulation in vitro, and can differentiate into beta cell–cytotoxic T cells in vivo, but do not efficiently accumulate in islets in the absence of a CD4+ T cell–derived signal, which can be provided by splenic CD4+ T cells from nontransgenic NOD mice. These results demonstrate that naive beta cell– specific CD8+ and CD4+ T cells can trigger diabetes in the absence of other T or B cell specificities, but suggest that efficient recruitment of naive diabetogenic beta cell–reactive CD8+ T cells to islets requires the assistance of beta cell–reactive CD4+ T cells.