tbuckley/cabot-search huggingface dataset:
Need for an improved vaccination rate in primary immune thrombocytopenia patients exposed to rituximab or splenectomy. A nationwide population‐based study in France
Authors: Guillaume Moulis, Maryse Lapeyre‐Mestre, Matthieu Mahévas, Jean‐Louis Montastruc, Laurent Sailler
Journal: American Journal of Hematology (2014)

International guidelines on immune thrombocytopenia (ITP) management recommend vaccination against Streptococcus pneumoniae (S.p.), Haemophilus influenza b (Hib) and Neisseiria meningitidis (N.m.) before splenectomy. French guidelines also recommend these vaccinations before rituximab. The aim of this study was to assess the application of these recommendations. The French Adult ITP: a French pHarmacoepidemiological study (FAITH, n°ENCEPP 4574) is aimed at following in the French national health insurance system database (SNIIRAM) the cohort of all incident and persistent or chronic primary ITP adults treated in France. We assessed vaccine exposure in the 1,106 patients who entered the FAITH cohort between 2009 and 2011. Vaccination was said "recommended" if performed at least 2 weeks before rituximab or splenectomy accordingly with French guidelines. Among the 423 non-splenectomized patients exposed to rituximab, vaccination rates against S.p., Hib and N.m. were respectively 32.4%, 18.9%, and 3.8%. It was recommended in 12.8%, 6.6%, and 1.2% of the patients, respectively. Among the 178 splenectomized patients, vaccination rates were 70.2%, 47.0%, and 11.9%, respectively (recommended: 60.1%, 35.7%, and 9.5%). Among the splenectomized patients previously exposed to rituximab (n = 67), 53.3% of the vaccinations occurred during the semester following a rituximab infusion that is during the maximal B-cell depletion period. In multivariate analyses, a disease duration exceeding 3 months was the sole factor associated to recommended vaccination in rituximab-treated patients as well as in splenectomized patients. This study stresses the need of better and earlier vaccination of ITP patients.
Preferential inhibition of the mRNA expression of p38 mitogen-activated protein kinase regulated cytokines in psoriatic skin by anti-TNFα therapy
Authors: C. Johansen, H. Vinter, L. Soegaard-Madsen, L.R. Olsen, T. Steiniche, L. Iversen, K. Kragballe
Journal: British Journal of Dermatology (2010)

Anti-TNFα therapies are well established for severe psoriasis; however, their mechanism of action in disease resolution is not fully understood. p38 mitogen-activated protein kinase (MAPK) is a kinase known to play a key role in the pathogenesis of psoriasis.To elucidate the early effects of adalimumab, a human monoclonal anti-TNFα antibody, on the expression of interleukins in psoriatic skin.Biopsies from patients with psoriasis were examined before and after the start of adalimumab therapy. mRNA expression of cytokines were measured with quantitative polymerase chain reaction. p38 MAPK and signal transducer and activator of transcription 3 (STAT3) were analysed by Western blotting and immunofluorescence analyses, and IL-17A and IL-17C were examined with immunohistochemistry.The increased mRNA level of IL-1β, IL-8, IL-17C and IL-20 in lesional psoriatic skin was already significantly reduced 4 days after the start of adalimumab treatment, i.e. before clinical and histological improvement was detectable. The mRNA expression of the Th17-derived cytokines IL-17A, IL-17F and IL-22 as well as the dendritic cell product IL-23/IL-12 (p40) were not significantly reduced until 2 weeks after the start of treatment, whereas the mRNA expression of IL-23 (p19) and the Th1 cytokines IFN-γ and IL-2 were reduced late in disease resolution. IL-1β, IL-8 and IL-20 are all known to be regulated by p38 MAPK. IL-17C was produced by cultured human keratinocytes and this production was also mediated by a p38 MAPK dependent mechanism. Moreover, the early effects of adalimumab included the phosphorylation of p38 MAPK, but not STAT3 phosphorylation.This study indicates that an important mechanism of action of anti-TNFα therapy in psoriasis is a reduction in p38 MAPK phosphorylation and a subsequent decrease in the expression of p38 MAPK regulated genes.
Tasking the “Self” in the Self-governance of Medicine
Authors: Jordan J. Cohen
Journal: JAMA (2015)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Acquired digital arteriovenous malformation: a report of six cases
Authors: T. Kadono, A. Kishi, Y. Onishi, K. Ohara
Journal: British Journal of Dermatology (2000)

Arteriovenous malformation (AVM) is usually congenital, but an acquired type is also known, of which most are due to a previous injury. We report six patients with acquired digital AVM, all having a small patch of AVM localized to the tip of one finger, and therefore quite different from ordinary AVM which consists of a large pulsatile mass. Histologically, dilated venous and arterial vessels were present in the dermis. Tumour-like growth was absent; thus, these six cases could be differentiated from arteriovenous haemangioma. Because of the characteristic anatomical site, unique clinical manifestations and histology, this appears to be a new and distinctive entity.
The man who was afraid to die
Authors: Donald W MacCorquodale
Journal: BMJ (2003)

From BMJ USA 2002;Dec:677 

When I started to practice medicine in 1950, I was terrified. I had never owed a dime in my life, and suddenly I found myself in debt for a house, a new Chevrolet sedan, an examining table, and some odds and ends of medical equipment. Furthermore, my wife was pregnant.

How ridiculous it seems today to look back at that time long ago and recall that I was uncomfortable about being young. Every now and again when I was making a house call on a new family, the man who opened the door would look a bit surprised and say, “Doctor, we were expecting an older man.” I used to pat him on the shoulder and assure him I was growing a bit older every day.

One of the first people I met was a florid-faced, likable fellow some years my senior by the name of “Swede,” the only name by which I can remember him today. Actually, I met his wife first when she became my patient. Swede's wife was one of those women who had weighed life and found it wanting. I suspect she suffered from mild depression, and she certainly suffered from a lot of anxiety.

Swede's wife never succeeded in telling me exactly what was wrong. She would burst into tears every time she came into my office. Then, when I asked her what was wrong, she would protest tearfully that she really didn't know but she just didn't feel good. I used to listen quietly for fifteen …
Allergic reactions to raw, pasteurized, and homogenized/pasteurized cow milk: a comparison
Authors: A. Høst, E.‐G. Samuelsson
Journal: Allergy (1988)

Five children aged 12‐40 months with IgE‐mediated adverse reactions to cow milk (immediate onset clinical pattern of cow milk allergy) were orally challenged double‐blind in random order with three different milk preparations processed from the same batch of milk 1) raw untreated cow milk, 2) pasteurized cow milk, 3) homogenized and pasteurized cow milk, and 4) Nutramigen®(a commercial hypoallergenic infant formula based on hydrolysed casein) as placebo. Skin prick tests with the same preparations were also performed. On oral challenge the three different processed milk types provoked significant and similar allergic reactions in each child, and no adverse reactions followed the challenge with placebo (Nutramigen). Skin prick test with the same milk products were positive in all children and comparable to the results with an extract of purified raw cow milk protein (Soluprickreg;), whereas Nutramigen did not elicit any skin reactions. A tendency towards a lower threshold of reaction and larger skin reactions induced by the processed milk preparations might indicate an increased ability of pasteurized and homogenized/pasteurized milk to evoke allergic reactions in patients allergic to milk.
Age matters in the prevalence and clinical significance of ultra-high-risk for psychosis symptoms and criteria in the general population: Findings from the BEAR and BEARS-kid studies
Authors: Benno G. Schimmelmann, Chantal Michel, Alexandra Martz-Irngartinger, Caroline Linder, Frauke Schultze-Lutter
Journal: World Psychiatry (2015)

Early detection of psychosis is an important topic in psychiatry. Yet, there is limited information on the prevalence and clinical significance of high-risk symptoms in children and adolescents as compared to adults. We examined ultra-high-risk (UHR) symptoms and criteria in a sample of individuals aged 8-40 years from the general population of Canton Bern, Switzerland, enrolled from June 2011 to May 2014. The current presence of attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BLIPS) and the fulfillment of onset/worsening and frequency requirements for these symptoms in UHR criteria were assessed using the Structured Interview for Psychosis Risk Syndromes. Additionally, perceptive and non-perceptive APS were differentiated. Psychosocial functioning and current non-psychotic DSM-IV axis I disorders were also surveyed. Well-trained psychologists performed assessments. Altogether, 9.9% of subjects reported APS and none BLIPS, and 1.3% met all the UHR requirements for APS. APS were related to more current axis I disorders and impaired psychosocial functioning, indicating some clinical significance. A strong age effect was detected around age 16: compared to older individuals, 8-15-year olds reported more perceptive APS, that is, unusual perceptual experiences and attenuated hallucinations. Perceptive APS were generally less related to functional impairment, regardless of age. Conversely, non-perceptive APS were related to low functioning, although this relationship was weaker in those below age 16. Future studies should address the differential effects of perceptive and non-perceptive APS, and their interaction with age, also in terms of conversion to psychosis.
Abstract P301: Menopausal Characteristics and Chronic Kidney Disease in the Women’s Health Initiative
Authors: Katharine L Cheung, Jessica Kubo, Marcia Stefanick, Matthew A Allison, Erin S LeBlanc, Mara Z Vitolins, Wolfgang C Winkelmayer, Manjula Kurella Tamura
Journal: Circulation (2014)

Introduction: Vasomotor symptoms (VMS) are common menopausal symptoms and the timing of these symptoms, specifically onset of late VMS, has recently been linked with cardiovascular risk factors. Chronic kidney disease (CKD) affects 13% of all women in the US and carries high risk for cardiovascular disease (CVD). The association between CKD and VMS has not been studied. Hypothesis: We hypothesized that the timing of VMS would differ between women with CKD compared to women without CKD. We also hypothesized that CKD would modify the effect of VMS on all-cause mortality, coronary heart disease and stroke. Methods: We studied the Women’s Health Initiative (WHI) biomarker cohort, which is comprised of all black and Hispanic participants in the WHI observation study and clinical trials plus a subset of white WHI participants such that the biomarker cohort reflects the age distribution of the HT population. CKD was defined as estimated glomerular filtration rate &lt;60 mL/min/1.73m 2 and VMS was defined as self-report of hot flushes and night sweats. We used polytomous logistic regression to determine the cross-sectional associations (unadjusted, demographics-adjusted and multivariable-adjusted between CKD and reported VMS categories (none, early, late, persistent). We used Cox proportional hazards models with an interaction term to determine whether the association between late VMS and all-cause mortality or incident CVD was modified by CKD. Results: Among the 18,024 WHI participants, 1281 women (5.86%) had CKD. VMS were less common in women with CKD versus without CKD (37.6% vs 45.8%, p&lt;0.001). Prevalent CKD was associated with an OR of 0.85 (95% CI: 0.72, 1.00) for early VMS, OR 0.80 (95% CI: 0.66, 0.97) for late VMS, and OR 0.59 (95% CI: 0.50, 0.70) for persistent VMS, as compared to having no VMS. The overall association of CKD was not significant after adjusting for potential confounders (p=0.17). CKD was associated with increased risk for mortality (HR 1.72, 95% CI: 1.52, 1.95), coronary heart disease (HR 1.60, 95% CI: 1.33, 1.92) and stroke (HR 1.49, 95% CI: 1.18, 1.87). Late VMS were associated with increased all-cause mortality (HR 1.16, 95%CI 1.04, 1.30) but not significantly associated with coronary heart disease or stroke. No significant interactions were found between late VMS and CKD on any of the endpoints studied. Conclusions: In this multiethnic cohort, VMS were less common in women with CKD and CKD did not appear to modify the association between VMS and either incident CVD or total mortality.
Abstract 3424: Deciphering the genomic heterogeneity and evolution in malignant melanoma by genomic profiling of clonal tumor populations
Authors: Thomas Lorber, Tanja Dietsche, Valeria Perrina, Michael Barret, Kathrin Glatz, Christian Ruiz, Lukas Bubendorf
Journal: Cancer Research (2014)

Abstract Background With the recent improvements in genomic analysis tools, research groups all over the world are intensively deep-sequencing different tumor entities, including malignant melanomas. However, most of these studies are using only a single biopsy per patient, providing only limited insights into genomic tumor evolution. In this study, we performed genomic profiling of sorted clonal tumor populations from several specimens per patient in order to infer genomic heterogeneity in malignant melanomas and genomic evolution during tumor progression. Methods A multi-parameter sorting approach was used to flow-sort multiple biopsies from individual melanoma patients. Therefore nuclei were extracted from frozen and FFPE tissues and sorted according to DNA ploidy. SOX10 was used as an additional melanoma parameter to ensure sorting of pure tumor populations. Resulting clonal tumor populations were genomically characterized by usage of high resolution aCGH and deep-sequencing with NGS technologies. Results Array CGH and NGS performed on flow-sorted clonal tumor populations (DNA and SOX10) revealed the clonal relationship between multiple tumor biopsies from individual patients. The tumor marker SOX10 allowed us to uncover and sort pure tumor populations, excluding the risk of contribution of non-neoplastic cells in downstream analysis with aCGH and NGS. Taken together the information of ploidy, aCGH and NGS data, we were able to detect chromosome imbalances and allelic frequencies from these populations. Our approach allows us to track the evolution of clonal populations across time and organs and in the context of therapeutic interventions. Conclusions Human malignant melanomas are composed of different clonal populations with population-specific genomic aberrations and mutations. The use of SOX10 allowed unraveling of pure tumor populations within the diploid peaks, which would have been obscured by the use of DNA content alone. NGS and aCGH helped to characterize these sorted clonal tumor populations. Further bioinformatic analyses of these sorted clonal tumor populations are fundamental for the understanding of the clonal relationship and genomic heterogeneity and their potential impact on metastasis and therapy response in malignant melanoma. Citation Format: Thomas Lorber, Tanja Dietsche, Valeria Perrina, Michael Barret, Kathrin Glatz, Christian Ruiz, Lukas Bubendorf. Deciphering the genomic heterogeneity and evolution in malignant melanoma by genomic profiling of clonal tumor populations. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3424. doi:10.1158/1538-7445.AM2014-3424
Racial Differences in Mortality Among Patients With Acute Ischemic Stroke
Authors: Ying Xian, Robert G. Holloway, Katia Noyes, Manish N. Shah, Bruce Friedman
Journal: Annals of Internal Medicine (2011)

The mechanism for the better survival of black patients than white patients after stroke is unknown. This study of 5319 black patients and 18 340 white patients with acute stroke found that black p...
Ex Vivo Fluorescence Confocal Microscopy of Eccrine Syringomatous Carcinoma
Authors: Caterina Longo, Moira Ragazzi, Stefano Gardini, Elvira Moscarella, Giuseppe Argenziano
Journal: JAMA Dermatology (2015)

Such rare, atypical forms of orf are frequently associated with the use of posttransplantation immunosuppressants, 3,6 such as glucocorticoids, cyclosporine, and tacrolimus.Clinically, the patients often present with pyogenic granuloma like lesions, 3,6 as noted in our case.Treatment of giant orf tumors in immunocompromised individuals typically relies on surgical excision, which is often followed by rapid postoperative recurrence. 2,3To spare patients unnecessary surgeries, a number of topical medications such as idoxuridine, 3 cidofovir, 4 and imiquimod 5,6 have been documented.Among them, imiquimod cream alone or as an adjuvant with surgery appears to have lower recurrence rates, making it the most commonly used topical treatment in recent years.In the present case, our new, nonsurgical, combined antiviral strategy was based on the following information: (1) Both idoxuridine and acyclovir are nucleoside analogues that competitively inhibit viral DNA polymerases; thus they are used as common antiviral drugs for treatment of different herpesvirus infections.(2) Interferon alpha, in addition to its wellknown antiviral properties, has strong antiproliferative and antiangiogenic effects by downregulating vascular endothelial growth factor, which makes it a strong candidate to treat our patient with highly vascularized orf tumors.In view of this information, we started treating the patient with the experimental combined therapy of oral acyclovir and intralesional interferon alpha-2b.This strategy is minimally invasive and has mild adverse effects.Our patient experienced only low-grade (<38°C), manageable fever at the first night of each injection.Furthermore, the combined therapy took only 6 weeks to completely clear the lesions-one of the shortest recovery periods reported to date (compare several recent imiquimod cream studies, which have reported complete resolution within 6-17 weeks 5,6 ).Nevertheless, further follow-up will be important to find possible signs of orf relapse.More studies are required to confirm the actual effectiveness of acyclovir to inhibit orf virus.
The papulonecrotic tuberculide.
Authors: J. G. L. MORRISON, E. D. FOURIE
Journal: British Journal of Dermatology (1974)

Ninety-one cases of papulonecrotic tuberculide were seen by the Department of Dermatology during the past 17 years. A focus of tuberculosis was found in 38%. Associated clinical phenomena included tuberculous arteritis with gangrene and the development of lupus vulgaris from papulonecrotic tuberculides. It is suggested that these tuberculides begin as an Arthus reaction which is followed by a delayed hypersensitivity response. The latter will prevent local proliferation of Mycobacterium tuberculosis in most cases, but in rare cases local multiplication of the organisms may lead to the development of lupus vulgaris. All patients improved rapidly on antituberculous treatment.
Abstract 17489: Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Once-Daily ZS-9 for Treatment of Hyperkalemia: Achievement and Maintenance of K+ in Subgroup Analysis of Patients with Heart Failure not on RAAS Inhibitors
Authors: Bhupinder Singh, Henrik S Rasmussen, Philip T Lavin, Alex Yang, David K Packham
Journal: Circulation (2014)

Introduction: RAAS inhibitors (RAASi) have demonstrated improved outcomes for HF patients (pts) when given at high doses, but optimal treatment is limited by hyperkalemia (HK), eg, spironolactone withdrawal for K + &gt;5.0 mEq/L (per package insert). Thus, HF pts do not benefit from these life-saving therapies due to HK. Current HK therapies (ie, SPS) have inconsistent and questionable efficacy and carry significant GI intolerability. ZS-9, a nonabsorbed cation exchanger that selectively traps K + in the gut, acutely restored and maintained K + in HK pts in a large Phase 3 study. To evaluate pts for whom HK was potentially RAASi-limiting, HF pts not on RAASi were evaluated. Methods: Pts (N=753) with K + 5.0-6.5 mEq/L were randomized (1:1:1:1:1) to ZS-9 (1.25, 2.5, 5 or 10g) or placebo (PBO) orally 3x/day for 48hr (acute phase). Following this phase, pts with K + 3.5-5.0 mEq/L (n=542) were randomized 1:1 to the same ZS-9 acute phase dose or PBO 1x/day on Days 3-15 (extended phase). Unpaired t-tests were used to compare serum K + in pts treated with ZS-9 vs PBO. Results: Of 753 pts, 83 (11%) had HF and were not on RAASi; 13 were in the 10g dose group. Mean baseline (BL) K + for these pts was 5.3 mEq/L. At 48hr (acute phase), K + declined significantly, compared with BL (-0.73 mEq/L; p&lt;0.05). In the extended phase, pts who remained on ZS-9 (n=6) maintained K + (BL: 4.5 mEq/L, Day 15: 4.6 mEq/L; Figure). Of note, 86.4% of pts in the 10g dose group were normokalemic at 48hr, compared with only 47.8% of pts in the PBO group. Conclusions: In HF pts not on RAASi, ZS-9 was effective at restoring and maintaining normokalemia, suggesting that these patients were potential candidates for RAASi. The high percentage of pts on PBO who did not restore normokalemia is representative of real-life pts for whom HK may limit optimal RAASi. To support the potential for ZS-9 to enable optimal cardio-and renoprotection by RAASi, further studies that evaluate the ability to challenge HF pts with RAASi after HK resolution are warranted.