tbuckley/cabot-search huggingface dataset:
Management of tuberculosis in HIV infection: where T-cells matter
Authors: M. Sester, C. Giehl, U. Sester, A. Meyerhans
Journal: European Respiratory Journal (2010)

Even 127 years after Robert Koch's identification of Mycobacterium tuberculosis as the causative agent of tuberculosis (TB), the diagnosis of active disease still depends in many parts of the world on the same tools that Koch has used: specifically staining of the bacilli and visual observation by microscopy 1. Thirty years later, von Pirquet developed the tuberculin skin-test (TST), which, instead of observing the pathogenic microbe itself, measures the immunological response to it 2. We now know that the specific induration in the skin-test is mediated by specifically activated T-lymphocytes that elicit a delayed-type hypersensitivity (DTH) response via production of a variety of inflammatory cytokines. While both test systems are still widely used, their sensitivity is highly variable and ranges from 20 to 60% for microscopy 3, 4, and 67 to 80% for skin-testing 5, 6. In patients with HIV infection and other forms of immunosuppression, the sensitivity is even worse and far beyond being adequate for a modern diagnostic test 7, 8.

In their recent manuscript, Leidl et al. 9 now compare the performance …
Prevalent expression of the immunostimulatory MHC class I chain–related molecule is counteracted by shedding in prostate cancer
Authors: Jennifer D. Wu, Lily M. Higgins, Alexander Steinle, David Cosman, Kathy Haugk, Stephen R. Plymate
Journal: Journal of Clinical Investigation (2004)

The MHC class I chain–related molecules (MICs) have previously been shown to be induced on most epithelial tumor cells. Engagement of MIC by the activating immune receptor NKG2D triggers NK cells and augments antigen-specific CTL anti-tumor immunity. The MIC-NKG2D system was proposed to participate in epithelial tumor immune surveillance. Paradoxically, studies suggest that tumors may evade MIC-NKG2D–mediated immunity by MIC shedding–induced impairment of effector cell function. Here we demonstrate the first evidence to our knowledge of a significant correlation of MIC shedding and deficiency in NK cell function with the grade of disease in prostate cancer. MIC is widely expressed in prostate carcinoma. The presence of surface target MIC, however, is counteracted by shedding. A significant increase in serum levels of soluble MIC (sMIC) and deficiency in NK cell function was shown in patients with advanced cancer. Finally, the deficiency in NK cell function can be overcome by treatment with IL-2 or IL-15 in vitro. Our results suggest that (a) deficiency in MIC-NKG2D immune surveillance may contribute to prostate cancer progression, (b) sMIC may be a novel biomarker for prostate cancer, and (c) using cytokines to restore MIC-NKG2D–mediated immunity may have clinical significance for prostate cancer in cell-based adaptive immunotherapy.
An Outbreak of Shigella dysenteriae Type 2 Among Laboratory Workers Due to Intentional Food Contamination
Authors: Shellie A. Kolavic
Journal: JAMA (1997)

<h3>Context.</h3> —<i>Shigella dysenteriae</i>type 2 is rare in the United States, and outbreaks associated with this pathogen are uncommon. <h3>Objective.</h3> —To determine the magnitude and source of an outbreak of<i>S dysenteriae</i>type 2. <h3>Design.</h3> —Retrospective cohort. <h3>Setting.</h3> —Laboratory of a large medical center. <h3>Patients.</h3> —Case patients were identified as laboratory workers who had diarrhea on or after October 28 and a positive stool culture or temperature greater than 37.8°C. Laboratory workers with diarrhea only were probable case patients. <h3>Main Outcome Measures.</h3> —We interviewed laboratory staff and performed identification, serotyping, and pulsed-field gel electrophoresis on isolates from case patients, implicated food, and laboratory stock culture. <h3>Results.</h3> —From October 29 through November 1, a total of 12 (27%) of 45 laboratory staff developed severe, acute diarrheal illness; 8 had<i>S dysenteriae</i>isolated from stool and 4 were hospitalized. All case patients reported having eaten muffins or doughnuts placed in the staff break room on October 29. Pulsed-field gel electrophoresis showed stool isolates from 9 case patients were indistinguishable from<i>S dysenteriae</i>type 2 recovered from an uneaten muffin and from the laboratory's stock strain, a portion of which was missing. <h3>Conclusions.</h3> —The source of the outbreak was most likely the laboratory's stock culture, which was used to contaminate the pastries. Results of this investigation underscore the need for adequate precautions to prevent inadvertent or intentional contamination from highly pathogenic laboratory specimens.
Phase changes in membrane lipids in sickle red cell shed-vesicles and sickle red cells
Authors: Maxwell P. Westerman, Lillie Unger, Omer Kucuk, Peter Quinn, Leonard J. Lis
Journal: American Journal of Hematology (1998)

Lipid phase transformations may occur in the membranes of sickle red cell shed-vesicles and sickle red cells. The presence of such phase changes could be important in sickle cell disease since membrane phase changes appear to contribute to the generation of antiphospholipid antibodies that are thrombophilic and occur in sickle cell disease. In the present study, we have evaluated sickle red cell shed-vesicles and sickle red cells for the presence of non-bilayer lipid phases using 31P-NMR spectroscopy. Results show that the spectra of both the shed-vesicles and the sickle red cells are compatible with the occurrence of non-bilayer phases in the membrane bilayers. The findings support the concept that these membranes could contribute to the generation of antiphospholipid antibodies in sickle cell disease.
How long should patients with suspected myocardial infarction be under observation in hospital?
Authors: A Poukkula, E Huhti
Journal: BMJ (1980)

Out of 368 patients admitted to hospital for chest pain and suspected acute myocardial infarction, 267 were discharged within 24 hours on the basis of the clinical picture, electrocardiogram, and serum activities of aspartate transaminase, alpha-hydroxybutyrate dehydrogenase, and creatine phosphokinase. The patients were followed up for 28 days, during which 17 were readmitted, two of them twice and one three times. Two of the patients were readmitted with non-fatal acute myocardial infarction, and two died. The patients had been primarily divided into two groups: those admitted with presumably non-coronary chest pain (77 patients) formed group 1 and those with obvious coronary chest pain (190 patients) group 2. Both deaths occurred in patients in group 2 but the incidences of events during the follow-up period were otherwise similar in the two groups, and some patients in both groups may have had small acute myocardial infarctions when first admitted. The decision to keep in hospital or discharge a patient with chest pain of recent onset can be made within 24 hours of admission. To discharge the patient acute myocardial infarction need not necessarily be excluded and conventional tests are enough to enable a decision to be made.
Some uncanny tales
Authors: T. Dalrymple
Journal: BMJ (2011)

The writer Arthur Machen (1863–1947) wanted to be a doctor but failed at the first hurdle, and his parents were too poor to fund further attempts on his part. Perhaps his thwarted wish to join the profession explains why his stories are so heavily populated by doctors.

Machen wrote tales of the uncanny that enjoyed a considerable vogue in the 1920s and have had their literary admirers, John Betjeman and Jorge Luis Borges among them; but, except by a coterie of devotees, he is largely forgotten now.

The strange thing about Machen’s uncanniness is that it exerts its influence largely by physical means. For example, in The Novel of the White Powder (hands up all those who …
UK insurers agree five year ban on using genetic tests
Authors: S. Mayor
Journal: BMJ (2001)

Insurance companies and the British government have agreed a five year extension of the moratorium on the use of results of DNA tests for insurance purposes.

The agreement with the Association of British Insurers, which represents most insurance companies in the United Kingdom, imposes a five year moratorium on the general use of genetic test results by insurers from 1 November 2001, except in specific circumstances.

Genetic test results will be used only when authorised by the government's …
Concordance of Physician Ratings With the Appropriate Use Criteria for Coronary Revascularization
Authors: Paul S. Chan, Ralph G. Brindis, David J. Cohen, Philip G. Jones, Elizabeth Gialde, Richard G. Bach, Jeptha Curtis, Charles F. Bethea, Marc E. Shelton, John A. Spertus
Journal: Journal of the American College of Cardiology (2011)
Bone mineral density and histology in distal renal tubular acidosis
Authors: Somnuek Domrongkitchaiporn, Chonlatrip Pongsakul, Wasana Stitchantrakul, Vorachai Sirikulchayanonta, Boonsong Ongphiphadhanakul, Piyanuch Radinahamed, Patcharee Karnsombut, Narin Kunkitti, Chatuporn Ruang-Raksa, Rajata Rajatanavin
Journal: Kidney International (2001)
Stunned vs Hibernating Myocardium-Reply
Authors: Hooshang Bolooki
Journal: JAMA (1990)

In Reply.—  Dr Gbur correctly points out the problem of nomenclature in describing a jeopardized myocardium that does not contract because of an ischemic or reperfusion insult. Based on experimental data, the rate of function recovery time is used retrospectively to segregate the stunned myocardium (postreperfusion) from the hibernating myocardium (caused by hypoperfusion).1The two terms, at times, are used interchangeably because myocardial segments frequently contain jeopardized myocytes that may remain viable with adequate or inadequate perfusion.  The dissociation between cardiac function, pathology, and reperfusion has been known for some time.2It is seen daily in cardiac surgery patients, in whom myocardial stunning, lasting from a few seconds to days, occurs after restoration of coronary perfusion. This is especially true in hearts after cardiac transplantation. As pointed out in my article, continued reperfusion (with high flow and pressure) remains the key factor in restoration of contractility in
Myofibroblast specific gene expression signature in systemic sclerosis, more than TGF- induced activation
Authors: G. Abignano, H. Hermes, J. Gillespie, S. A. Jimenez, P. Emery, F. D. Galdo
Journal: Annals of the Rheumatic Diseases (2011)

<h3>Background and objectives</h3> The key cells in the pathogenesis of tissue fibrosis are myofibroblasts. It is widely accepted that myofibroblasts are increased in SSc skin and their number correlates with the skin fibrosis. The mechanisms underlying their number and variability are unknown. The heterogeneity in the myofibroblasts number may explain the variability of some in vitro studies published on systemic sclerosis (SSc) fibroblast biology and may mirror the clinical heterogeneity of SSc patients both in natural history and severity of skin fibrosis. Our purpose was to unravel the specific myofibroblasts transcriptome of SSc skin biopsies. <h3>Materials and methods</h3> Four patients with early diffuse SSc, before any immunosuppression, were enrolled in the study. Skin biopsy on forearm was performed and the fibroblasts subcultured for three passages. 250 acetone fixed α-SMA positive cells were isolated by laser capture microdissection (LCM) for mRNA analysis by Affymetrix Gene array and qRT-PCR validation. Pathway analysis was performed according to David-NIH software. Immunofluorescence (IF), followed by confocal laser scanning microscopy (CLSM), was conducted. Normal dermal fibroblasts were utilised to evaluate the effects of TGF-β stimulation both at mRNA and protein level. <h3>Results</h3> qRT-PCR for α-SMA showed a 3.7 fold increased expression of α-SMA in the LCM captured cells. Microarray analysis identified 269 genes upregulated more than two fold in the myofibroblasts: 24 were clearly reconducible to profibrotic activation; 16 were ribosomial genes; 14 were genes involved in oxidative phosphorylation, 28 in cell to cell adhesion and 7 in antigen processing and presentation. The remaining genes were not classifiable in any specific functional pathway and comprised tropomyosin, reticulocalbin 1, caldesmon 1 and neuroblastome breakpoint family (NBPF). IF studies followed by CLSM confirmed the expression, never shown before, of NBPF in dermal fibroblasts. Functional studies on normal dermal fibroblasts indicated that NBPF was not inducible by 24 or 48 h stimulation with TGF-β neither at mRNA or protein level. IF followed by CLSM of α-SMA positive versus negative cells showed a specific expression profile for procollagen-1, caveolin-1, β-catenin and phospho-RB whereas SMAD3, SMAD1, SMAD5 and NF-κB did not differ between α-SMA positive or negative cells. <h3>Conclusions</h3> Myofibroblast transcriptome displayed, besides predictable genes involved in the increased ECM production and TGF-β pathway activation, genes involved in several pathways not known to be specific of myofibroblasts or inducible by TGF-β. The specific expression of these genes may reflect either a specific metabolic status or a specific differentiation lineage of myofibroblasts.
Screening for Hypertension
Authors: Graham W. Ward
Journal: JAMA (1976)

<h3>To the Editor.—</h3> The National High Blood Pressure Education Program sincerely appreciates the editorial, "Hypertension: A Major Medical Care Challenge," by Dr Barclay (235:2327, 1976). We believe, however, that two statements regarding screening are subject to misinterpretation and may lead to inappropriate action and misinvestment of community health care resources. Dr Barclay notes that hypertension control requires a system of mass screening and that children should be encouraged to participate in mass screening programs. Our concern arises from the popular connotation of the term mass screening. Among the bulk of the lay public, most health care system managers and many health care providers, this term carries an image of supermarket, shopping mall, and church basement activity. We believe these approaches are not cost effective for case-finding or achieving control. Mass screening should be used only among populations that are grossly medically underserved or among well-served populations, at most, every five
Akhenaten and the Strange Physiques of Egypt's 18th Dynasty
Authors: Irwin M. Braverman
Journal: Annals of Internal Medicine (2009)

Akhenaten was one of Egypt's most controversial pharaohs, in part because of his strange appearance in images produced after he had declared Aten, the Sun-disc, his one-and-only god. Whether these were symbolic representations or realistic ones that indicate a deforming genetic disorder is the subject of continuing debate. The authors present evidence that the bizarre physical features portrayed in these images are not only realistic but were shared by many members of Egypt's 18th Dynasty. The features are best explained by either 2 different familial disorders—the aromatase excess syndrome and the sagittal craniosynostosis syndrome—or a variant of the Antley–Bixler syndrome caused by a novel mutation in one of the genes controlling the P450 enzymes, which regulate steroidogenesis and cranial bone formation.
Gustatory Sweating and Pilomotion
Authors: A. Herxheimer
Journal: BMJ (1958)

OBESE CHILDREN MEDICALJRSHNAL undernourished owing to anorexia, and one of whom had sprue.They found a decrease in all glandular activity, and concluded that the functional activity of the pituitary gland may be greatly impaired by starvation.This functional hypopituitarism was reversed in one case by refeeding.In children the results of underfeeding afford a direct contrast to the changes noted in obese children.Under- nourished children are small and thin, and skeletal and sexual maturation may be retarded.Signs of decreased pituitary activity can result, in children, from malnutrition, the intensity of the signs being roughly proportional to the degree of undernutrition (Talbot et al., 1952). SpeculationThere is abundant evidence that undernutrition produces hypopituitarism.The converse, that overnutrition produces hyperpituitarism, would explain the observations made on obese children.Increased growth, earlier puberty, and in- creased adrenocortical activity could be explained on the basis of this hypothesis.The change in 17-ketogenic steroid excretion described in this paper might be due to an alteration in pituitary activity resulting from the change from overnutrition to undernutrition.This hypothesis might reconcile the views of those who consider obesity in childhood to be entirely nutritional in origin and those who consider the condition to be an endo- crine disorder. SummaryThe case histories are recorded of four patients- children and adolescents-who suffered from obesity.Each patient initially had a raised urinary excretion of 17-ketogenic steroid, which became normal after weight reduction due to dietary restriction.In one patient this phenomenon was observed on two occasions.Obesity in childhood is briefly discussed, and it is suggested that overnutrition may produce functional hyperpituitarism.
Rnai-Mediated Silencing of Rap1B Gene Expression in Esophageal Squamous Cell Carcinoma Inhibits Tumor Growth and Invasion
Authors: Mingxin Zhang, Lingmin Zhang, Wenguang Ye, Qinglin Yao, Suna Zhou, Qinsheng Wen, Jingjie Wang
Journal: Annals of Oncology (2013)
Non-parametric statistical tests for two independent groups: numerical data
Authors: P. Sedgwick
Journal: BMJ (2014)

Researchers described the outcomes at one year for a national cohort of infants with gastroschisis. A prospective cohort study design was used. Participants were 301 liveborn infants with gastroschisis between October 2006 and March 2008 from all 28 paediatric surgical centres in the United Kingdom and Ireland. The aim of the study was to describe outcomes at one year, comparing infants with simple gastroschisis (intact, uncompromised, and continuous bowel) with those with complex gastroschisis (bowel perforation, necrosis, or atresia). The main outcome measures included duration of parenteral nutrition and length of stay in hospital.1

The duration of parenteral nutrition and length of stay in hospital did not follow a normal distribution. Therefore, the groups of infants were compared using non-parametric statistical tests. Infants with complex gastroschisis had a significantly longer duration of parenteral nutrition than those with simple gastroschisis (median 51 days (interquartile range 29-92) v 23 days (16-38); P<0.001). Those with complex gastroschisis also needed a significantly longer stay in hospital (median 84 days (47-197) v 36 days (23-57); P<0.001).

The researchers concluded that the national cohort provided a benchmark against …
Die angeborenen Fehlbildungen der Hand und ihre operative Behandlung
Authors: John L. Bell
Journal: JAMA (1966)

Written by orthopedic surgeons, this book deals concisely with the causes, the classification, and the operative management of congenital abnormalities of the hand. It begins with a brief resume of normal development. Next, there is a comprehensive section on various factors responsible for anomalies of the hand, followed by a list of 168 references. The detailed classification of these deformities is illustrated by excellent line drawings of the skeletal framework of typical examples. The general indications for operation are covered in a short chapter. This is followed by a 57-page section which describes the specific operative procedures for 15 types of congenital malformations of the hand. In addition to the line drawings, there are well-selected preoperative and postoperative photographs and clear reproductions of roentgenograms to amply supplement the text. The volume concludes with a bibliography which contains approximately 300 titles of articles and books, and a detailed index.
Ambulatory Blood-Pressure Monitoring in Clinical Practice
Authors: William B. White
Journal: New England Journal of Medicine (2003)

Ambulatory blood-pressure monitoring provides automated measurements of brachial-artery pressure over a 24-hour period while patients are engaging in their usual activities. This method has been used for more than 30 years in clinical research on hypertension. Initially, it was performed in cardiovascular research units with the use of direct intraarterial recordings during physical activity, work, rest, and sleep. These studies demonstrated that blood pressure has a highly reproducible circadian profile, with higher values when the patient is awake and mentally and physically active, much lower values during rest and sleep, and an early-morning surge lasting three to five hours during . . .
THE MECHANISM AND DIAGNOSIS OF TRAUMATIC CEREBRAL LESIONS.
Authors: JOHN W. PERKINS
Journal: JAMA (1896)

In this paper I wish to review the mechanism by which traumatic lesions in the brain are produced, and the means by which an exact diagnosis of the seat of the lesions must be made. Until recently it has been considered justifiable for the surgeon, after having made a gross diagnosis of fracture of the base, "compression" or "concussion," to stand by and see his patient die, or become the subject of epilepsy, insanity or permanent paralysis. Medical literature is filled with cases illustrating the natural results of these injuries, following the "expectant" treatment. From them, one quickly learns how slowly and imperfectly nature repairs the lesions, and how far reaching are the after effects. Some have questioned whether a cerebral injnry is ever completely recovered from.<sup>3</sup>The evidence is now complete, that various forms of insanity, in many cases, originate in and are directly caused by a neglected
Pertussis Infection in Adults With Persistent Cough
Authors: S W Wright, K M Edwards, M D Decker, M H Zeldin
Journal: JAMA (1995)

<h3>Objective.</h3> —To determine the prevalence of<i>Bordetella pertussis</i>infection in adult patients with persistent cough. <h3>Design.</h3> —Prospective case series. <h3>Setting.</h3> —Urban university hospital emergency department. <h3>Patients.</h3> —Convenience sample of 75 patients aged 18 years or older with a cough lasting 2 weeks or longer. Serum specimens from 67 patients without respiratory complaints were used to develop reference values. <h3>Interventions.</h3> —In patients with cough, nasopharyngeal culture and direct fluorescent antibody testing for<i>B pertussis</i>were performed and serum samples were obtained at the first visit and 1 month later. Serum specimens were assayed for antibody to pertussis toxin (PT) and filamentous hemagglutinin (FHA). <h3>Main Outcome Measures.</h3> —A subject with one or more of the following was defined as having a pertussis infection: a positive<i>B pertussis</i>culture result, a fourfold change in PT or FHA titer, and/or a single PT or FHA titer at least 2 SDs greater than the geometric mean of the control group. <h3>Results.</h3> —No subject tested culture positive for<i>B pertussis</i>. Sixteen (21%) (95% confidence interval [CI], 13% to 32%) of 75 subjects met the serologic criteria for pertussis infection; for 13 (81%; 95% CI, 54% to 96%) of the 16, the criteria were met by the initial serum specimen. In contrast, the geometric mean levels of antibody to PT and FHA for the remaining 59 subjects with cough did not differ from those of the control group. Clinical symptoms and the lymphocyte count did not differentiate patients with pertussis from those without the disease. <h3>Conclusion.</h3> —Pertussis is a common cause of persistent cough in adults and should be considered in the differential diagnosis. Clinical symptoms, pertussis culture, direct fluorescent antibody testing, and lymphocytosis are of limited value in making the diagnosis. (<i>JAMA</i>. 1995;273:1044-1046)