tbuckley/cabot-search huggingface dataset:
Escape from collective denial: HIV transmission during surgery.
Authors: A G Bird, S M Gore, A J Leigh-Brown, D C Carter
Journal: BMJ (1991)

information is put to and to whom it is revealedalways assuming, of course, that no one else's welfare is at stake here.Even if the records, as physical objects, are government property it does not follow that this is true also of the information that they contain.Personal information disclosed in a consultation should perhaps be seen as effectively "on trust" to the doctor for the period of treatment, or for the period in which that doctor continues to have the person as a patient.(The whole issue of ownership of information is one that would merit more attention from moral philosophers.)Other arguments of a more pragmatic character will no doubt be advanced in favour of maintaining the status quo.One should be reluctant, it may be said, to advocate any new system that would add to the administrative burden under which hard pressed general practitioners and the NHS generally, currently labour.Some sacrifice of patient autonomy may be justified on the basis that it is a relatively small price to pay in return for the very great benefits of the present system, which allows the use of information collected over a long time to be used whenever required in a consultation.But even in therapeutic terms there could be much to be gained by a system that gave patients greater control over their own records; it might well serve to encourage greater openness, enhanced trust, and a greater spirit of cooperation between doctor and patient.We find it difficult to believe that a system more respectful of confidentiality and of the patient's wishes could not be made to work successfully if there was a sufficient will so to do.
Type B Hepatitis after Transfusion with Blood Containing Antibody to Hepatitis B Core Antigen
Authors: Jay H. Hoofnagle, Leonard B. Seeff, Zelma Buskell Bales, Hyman J. Zimmerman
Journal: New England Journal of Medicine (1978)

We tested the hypothesis that donor blood containing antibody to hepatitis B core antigen (anti-HBc) but lacking detectable hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) might transmit Type B hepatitis by examining donor and recipient serums from a Veterans Administration study of post-transfusion hepatitis. Donor blood was available from three patients with Type B hepatitis and from one patient with hepatitis B virus infection (development of anti-HBs and anti-HBc) without symptomatic disease. All four had received 1 unit of blood with high titer of anti-HBc but lacking HBsAg and anti-HBs. In contrast, no such units had been transfused into nine patients with an "immunization-like" response (development of anti-HBs without anti-HBc) or into 26 control patients. These data stress the importance of anti-HBc as an indicator of hepatitis B virus infection and support the hypothesis that high-titer anti-HBc-positive blood might be infectious. (N Engl J Med 298:1379–1383, 1978)
Heart transplants in interferon-gamma, interleukin 4, and interleukin 10 knockout mice. Recipient environment alters graft rejection.
Authors: A Räisänen-Sokolowski, P L Mottram, T Glysing-Jensen, A Satoskar, M E Russell
Journal: Journal of Clinical Investigation (1997)

To study the role of cytokines in long-term cardiac allografts we have used recipient mice with targeted gene deletions (-/-) in IFN-gamma, IL-4, or IL-10. In wild-type and IL-4 -/- recipients immunosuppressed with a 30-d course of anti-CD4 and anti-CD8, graft survival was > 87 d. This time was significantly reduced in IFN-gamma -/- (62 +/- 19 d, P < 0.05) and IL-10 -/- recipients (55 +/- 4 d, P < 0.0001). Histology showed mononuclear cell infiltration, patchy necrosis, fibrosis, and vascular thickening in all groups. Intragraft transcript levels measured by 32P-reverse transcriptase PCR showed different inflammatory patterns. IFN-gamma -/- recipients had higher IL-2 transcripts and selective alteration in macrophage activation that may have contributed to decreased graft survival. Decreased graft survival in IL-10 -/- recipients was associated with increases in iNOS and IFN-gamma-driven responses. Finally, in grafts from IL-4 -/- recipients, there were increases in CD3 transcripts concurrent with TNF-alpha levels. This increase suggests that IL-4 may regulate T cell infiltration through TNF-alpha-mediated inflammatory cell recruitment. Concurrent evaluation of these three isolated cytokine deletions has shown that the recipient environment caused distinct graft modifications.
Pilot study of the roles of personality, references, and personal statements in relation to performance over the five years of a medical degree * Commentary: How to derive causes from correlations in educational studies
Authors: Eamonn Ferguson, David James, Fiona O'Hehir, Andrea Sanders, I C McManus
Journal: BMJ (2003)

To compare the power of three traditional selection procedures (A levels, personal statements, and references) and one non-traditional selection procedure (personality) to predict performance over the five years of a medical degree.Cohort study over five years.Nottingham medical school.Entrants in 1995.A level grades, amounts of information contained in teacher's reference and the student's personal statement, and personality scores examined in relation to 18 different assessments.Information in the teacher's reference did not consistently predict performance. Information in the personal statement was predictive of clinical aspects of training, whereas A level grades primarily predicted preclinical performance. The personality domain of conscientiousness was consistently the best predictor across the course. A structural model indicated that conscientiousness was positively related to A level grades and preclinical performance but was negatively related to clinical grades.A teacher's reference is of no practical use in predicting clinical performance of medical students, in contrast to the amount of information contained in the personal statement. Therefore, simple quantification of the personal statement should aid selection. Personality factors, in particular conscientiousness, need to be considered and integrated into selection procedures.
Financial Relationships between Institutional Review Board Members and Industry
Authors: Eric G. Campbell, Joel S. Weissman, Christine Vogeli, Brian R. Clarridge, Melissa Abraham, Jessica E. Marder, Greg Koski
Journal: New England Journal of Medicine (2006)

Little is known about the nature, extent, and consequences of financial relationships between industry and institutional review board (IRB) members in academic institutions. We surveyed IRB members about such relationships.
Transthoracic Cardioversion of Atrial Fibrillation
Authors: Suneet Mittal, Shervin Ayati, Kenneth M. Stein, David Schwartzman, Doris Cavlovich, Patrick J. Tchou, Steven M. Markowitz, David J. Slotwiner, Marc A. Scheiner, Bruce B. Lerman
Journal: Circulation (2000)

Background —Clinical studies have shown that biphasic shocks are more effective than monophasic shocks for ventricular defibrillation. The purpose of this study was to compare the efficacy of a rectilinear biphasic waveform with a standard damped sine wave monophasic waveform for the transthoracic cardioversion of atrial fibrillation. Methods and Results —In this prospective, randomized, multicenter trial, patients undergoing transthoracic cardioversion of atrial fibrillation were randomized to receive either damped sine wave monophasic or rectilinear biphasic shocks. Patients randomized to the monophasic protocol (n=77) received sequential shocks of 100, 200, 300, and 360 J. Patients randomized to the biphasic protocol (n=88) received sequential shocks of 70, 120, 150, and 170 J. First-shock efficacy with the 70-J biphasic waveform (60 of 88 patients, 68%) was significantly greater than that with the 100-J monophasic waveform (16 of 77 patients, 21%, P &lt;0.0001), and it was achieved with 50% less delivered current (11±1 versus 22±4 A, P &lt;0.0001). Similarly, the cumulative efficacy with the biphasic waveform (83 of 88 patients, 94%) was significantly greater than that with the monophasic waveform (61 of 77 patients, 79%; P =0.005). The following 3 variables were independently associated with successful cardioversion: use of a biphasic waveform (relative risk, 4.2; 95% confidence intervals, 1.3 to 13.9; P =0.02), transthoracic impedance (relative risk, 0.64 per 10-Ω increase in impedance; 95% confidence intervals, 0.46 to 0.90; P =0.005), and duration of atrial fibrillation (relative risk, 0.97 per 30 days of atrial fibrillation; 95% confidence intervals, 0.96 to 0.99; P =0.02). Conclusions —For transthoracic cardioversion of atrial fibrillation, rectilinear biphasic shocks have greater efficacy (and require less energy) than damped sine wave monophasic shocks.
Milrinone Facilitates Resuscitation From Cardiac Arrest and Attenuates Postresuscitation Myocardial Dysfunction
Authors: James T. Niemann, Daniel Garner, Emad Khaleeli, Roger J. Lewis
Journal: Circulation (2003)

Left ventricular (LV) dysfunction with a low cardiac index after successful CPR contributes to early death attributable to multiorgan failure, and an effective treatment has not been identified. The purpose of this study was to investigate the use of milrinone, a selective phosphodiesterase III inhibitor, as treatment for LV dysfunction after resuscitation.Ventricular fibrillation (VF) was induced electrically in 32 swine. After 5 minutes of VF, CPR was initiated and animals were randomized to receive either saline (control group, n=16) as a bolus and infusion or milrinone 50 microg/kg as a bolus and then 0.5 microg/kg per min for 60 minutes (treatment group, n=16). After 2 minutes of CPR (total VF time, 7 minutes), countershocks were given. Coronary perfusion pressures during CPR were similar for the groups (24+/-2 versus 21+/-4 mm Hg). All animals were defibrillated; 6 of 16 control animals developed refractory postcountershock pulseless electrical activity compared with 0 of 16 treated animals (P=0.018). At 30 minutes after restoration of spontaneous circulation, stroke volume (16+/-3 versus 26+/-7 mL, P<0.01) and LV dp/dt (793+/-197 versus 1108+/-316 mm Hg/s, P<0.02) were higher in the treatment group. Similar differences were observed 60 minutes after restoration of spontaneous circulation. Significant differences in heart rates between groups were not observed, and peripheral vascular resistance was significantly greater in the control group 30 and 60 minutes after resuscitation.Milrinone facilitates resuscitation from prolonged VF and attenuates LV dysfunction after resuscitation without worsening major determinants of myocardial oxygen demand.
Statins for stroke should be considered in biologically fit people over 75
Authors: J Kelly
Journal: BMJ (2000)

EDITOR—Oliver suggests that statin use after a stroke should be restricted to patients under 75.1 Although trials showing the benefits of these drugs have excluded patients above this age, evidence suggests that these data may reasonably be extrapolated to older patients.

Firstly, the relative benefits of statins in the 4S (Scandinavian simvastatin survival study,) CARE (cholesterol and recurrent events), and LIPID (long term intervention with pravastatin in ischaemic disease) trials were similar above and below the age of 65.2 An …
The Nonpsychiatrist Physician as a Liaison Teacher of Psychiatry
Authors: JOHN R. WOLFF, PAUL E. NIELSON
Journal: American Journal of Psychiatry (1967)

The nonpsychiatrist physician, working in collaboration with a psychiatrist and participating in a supervised program of training in principles of psychiatry, is an effective liaison teacher of psychiatry to members of his own specialty. A liaison teaching program within the specialty of obstetrics and gynecology is described. The broad participation of members of both specialties in the program has resulted in multidisciplinary research as well as increased understanding of mutual problems.
DERMOID CYST OF THE PLEURAL CAVITY
Authors: F. J. Schleier
Journal: JAMA (1925)

This case is reported because I am under the impression that it is rather an unusual one. Although my search has not been very thorough, I have been unable to find in the textbooks or literature available to me anything concerning a similar case. Dermoids, as we know, are rather common; but the peculiar location is the striking factor in this particular case. The case first came under my observation during the latter part of May, 1922, and the history was taken, July 18, 1922, at the time of the patient's admission to St. Joseph's Hospital. <h3>History.</h3> —K., a white woman, aged 23, who was born in Iowa, and who weighed 132 pounds (60 kg.), complained of pain on the right side along the lower costal border. She was well developed and well nourished. Her family history was essentially negative. The father, mother, three brothers and three sisters were all
"Drinking Water Arsenic in Utah...": Response
Authors: Denise Riedel Lewis, Rebecca L. Calderon, J. Wanless Southwick, Rita Ouellet-Hellstrom, Jerry Rench
Journal: Environmental Health Perspectives (1999)

ConclusionsThe letter written by Heinze (1) has seri- ous shortcomings.Heinze wrote that There is not a single study of healthy men from any fertility center or sperm bank that has reported a decline in sperm counts in the United States.This is not true.A number of such studies exist.Leto and Frensilli (2) documented a decline in sperm counts in potential sperm donors from all over the United States in a longitudinal study.Heinze stated thatA study by MacLeod and Wang (3) indicates that sperm counts have remained constant in New York since 1938.That study was dated 1979 and was on men ascertained at a fertility center.Although their sperm counts were stable over the years preceding 1979, it does not necessarily follow that sperm counts of fertile men were stable too.
AN IMPROVED AND ACCURATE METHOD OF LOCATING FOREIGN BODIES WITH THE ROENTGEN RAY.
Authors: ROBERT CAROTHERS
Journal: JAMA (1907)

There are living to-day many veterans of the Civil War who have carried bullets within their bodies all these years and who have experienced little or no discomfort from them. But while a foreign body within the anatomy is not always a menace to good health and it does not become necessary and imperative that it should be removed, it is undoubtedly true that foreign bodies do at times cause trouble that calls for their removal. In these days of neuroses it becomes, at times, imperative to remove a foreign body for the relief of neurasthenia, although it must be admitted that such removal does not always relieve the condition. Since the introduction of the Roentgen ray this reason for removal is on the increase. An individual who is the recipient of a foreign body does not go far before some one, either on solicitation or otherwise, makes a radiogram
Changes in Esophageal Variceal Pressure after Transcatheter Arterial Embolization for Hepatocellular Carcinoma
Authors: K. Okada, M. Koda, Y. Murawaki, H. Kawasaki
Journal: Endoscopy (2001)

The aim of this study was to investigate the influence of transcatheter arterial embolization on esophageal variceal pressure and portal hemodynamics.Out of 18 cirrhotic patients with hepatocellular carcinoma, 12 underwent transcatheter arterial embolization and the remaining six patients underwent angiography alone as a control. We examined esophageal variceal pressure with an endoscopic pneumatic pressure sensor and portal blood flow with Doppler ultrasonography immediately before and 3 days after transcatheter arterial embolization or angiography.Angiography alone did not influence esophageal variceal pressure or portal blood flow. Transcatheter arterial embolization resulted in an increase in variceal pressure in five (42%) of the 12 patients and in a marked increase in portal blood flow in eight (88.9%) of nine patients, although no change in the endoscopic variceal findings was observed after transcatheter arterial embolization. The change in esophageal variceal pressure did not correlate with the change in portal blood flow. We could not find predictive factors for the elevation of variceal pressure after transcatheter arterial embolization.Our study demonstrated that transcatheter arterial embolization resulted in an increase in esophageal variceal pressure in about half of the patients, bearing little relation to portal hemodynamic parameters.
Does Simple “Reassurance” Work in Patients with Medically Unexplained Physical Symptoms?
Authors: Javier I Escobar
Journal: PLoS Medicine (2006)

The humanistic principles of the medical profession are nicely condensed in Oliver Wendell Holmes's old maxim stating that the key role of the physician is “to comfort always.” Thus, beyond the specificity of diagnoses and the effectiveness of treatments, the traditional practice of medicine gave high importance to bedside manner and interpersonal issues.

In contrast, 21st century medicine, with its reliance on technology and the changes in practice patterns (e.g., managed care), leaves little time for face-to-face interactions, gradually eroding the doctor–patient relationship. In this transition towards technological medicine, it would appear that we have switched from “comforting” our patients (where “to comfort” means “to give strength and hope; to ease the grief or trouble; to cheer” [1]) to simply “reassuring” them (where “to reassure” means “to assure anew; or restore to confidence” [1]). In this modern context, “reassurance” simply means to let patients know that their symptoms do not appear to be caused by physical disease.

In primary care, the de facto mental health system [2], large numbers of patients with common mental disorders such as depression or anxiety present with medically unexplained physical symptoms (MUPS). These somatic presentations have been well documented throughout the years, have always baffled the medical establishment, and metamorphose with cultural evolution and the changing perspectives of medical paradigms [3]. In all their forms, patients presenting with MUPS are the bane of modern medicine. Not fitting anywhere, they land in the vortex of the centuries-old mind–body debate.

In primary and specialty care nowadays, a number of “functional labels” [4] are a convenient though imprecise way to frame certain types of MUPS. These functional labels seem more acceptable to patients than receiving no diagnosis or having their symptoms attributed to a mental disorder, often viewed as a moral infirmity. MUPS add complexity to other physical or psychiatric disorders and lead to additional impairment and complications, so it is imperative that these presenting symptoms be properly addressed.

Patients presenting with medically unexplained physical symptoms are the bane of modern medicine.
ATR Inhibitors VE-821 and VX-970 Sensitize Cancer Cells to Topoisomerase I Inhibitors by Disabling DNA Replication Initiation and Fork Elongation Responses
Authors: Rozenn Jossé, Scott E. Martin, Rajarshi Guha, Pinar Ormanoglu, Thomas D. Pfister, Philip M. Reaper, Christopher S. Barnes, Julie Jones, Peter Charlton, John R. Pollard, Joel Morris, James H. Doroshow, Yves Pommier
Journal: Cancer Research (2014)

Abstract Camptothecin and its derivatives, topotecan and irinotecan, are specific topoisomerase I (Top1) inhibitors and potent anticancer drugs killing cancer cells by producing replication-associated DNA double-strand breaks, and the indenoisoquinoline LMP-400 (indotecan) is a novel Top1 inhibitor in clinical trial. To develop novel drug combinations, we conducted a synthetic lethal siRNA screen using a library that targets nearly 7,000 human genes. Depletion of ATR, the main transducer of replication stress, came as a top candidate gene for camptothecin synthetic lethality. Validation studies using ATR siRNA and the ATR inhibitor VE-821 confirmed marked antiproliferative synergy with camptothecin and even greater synergy with LMP-400. Single-cell analyses and DNA fiber combing assays showed that VE-821 abrogates the S-phase replication elongation checkpoint and the replication origin–firing checkpoint induced by camptothecin and LMP-400. As expected, the combination of Top1 inhibitors with VE-821 inhibited the phosphorylation of ATR and Chk1; however, it strongly induced γH2AX. In cells treated with the combination, the γH2AX pattern changed over time from the well-defined Top1-induced damage foci to an intense peripheral and diffuse nuclear staining, which could be used as response biomarker. Finally, the clinical derivative of VE-821, VX-970, enhanced the in vivo tumor response to irinotecan without additional toxicity. A key implication of our work is the mechanistic rationale and proof of principle it provides to evaluate the combination of Top1 inhibitors with ATR inhibitors in clinical trials. Cancer Res; 74(23); 6968–79. ©2014 AACR.
Gene-mediated Restoration of Normal Myofiber Elasticity in Dystrophic Muscles
Authors: Stefania Puttini, Małgorzata Lekka, Olivier M Dorchies, Damien Saugy, Tania Incitti, Urs T Ruegg, Irene Bozzoni, Andrzej J Kulik, Nicolas Mermod
Journal: Molecular Therapy (2008)
Alternatives to hospital care: what are they and who should decide?
Authors: J. Coast, A. Inglis, S. Frankel
Journal: BMJ (1996)

<h3>Abstract</h3> <b>Objective</b>: To examine potential for alternatives to care in hospitals for acute admissions, and to compare the decisions about these alternatives made by clinicians with different backgrounds. <b>Design</b>: Standardised tool was used to identify patients who could potentially be treated in an alternative form of care. Information about such patients was assessed by three panels of clinicians: general practitioners without experience of general practitioner beds, general practitioners with experience of general practitioner beds, and consultants. <b>Setting</b>: One hospital for acute admissions in a rural area of the South and West region of England. <b>Subjects</b>: Of 620 patients admitted to specialties of general medicine and care of the elderly, details of 112 were assessed by panels. <b>Main outcome measures</b>: Proportion of hospitalised patients who could have received alternative care and identification of most appropriate alternative form of care. <b>Results</b>: Both general practitioner panels estimated that between 51 and 89 of the hospitalised patients could have received alternative care (equivalent to 8-14% of all admissions). Consultants estimated that between 25 and 55 patients could have had alternative care (5.5-9% of all admissions). General practitioner bed and urgent outpatient appointment were the main alternatives chosen by all three panels. <b>Conclusion</b>: About 10% of admissions to general hospital might be suitable for alternative forms of care. Doctors with different backgrounds made similar overall assessments of most appropriate forms of care.
A Case of Retropharyngeal Soft-Tissue Swelling: The Definitive Diagnosis Revealed
Authors: Michael D. Jensen
Journal: JAMA (1986)

<h3>To the Editor.—</h3> In a recent issue, a patient with neck tenderness, fever, and retropharyngeal swelling was described.<sup>1</sup>The diagnosis of subacute thyroiditis was made on the basis of an increased erythrocyte sedimentation rate, thyroid tenderness, and a markedly depressed thyroid uptake of radioiodine. Treatment with antibiotics and corticosteroids resulted in resolution of the symptoms. The authors made a diagnosis of subacute thyroiditis. Such a conclusion is not supported by the information given. Infectious thyroiditis not uncommonly results in a decreased thyroid radioiodine uptake.<sup>2</sup>Because the patient received antibiotics (although for only two days), infectious thyroiditis remains a possibility. A negative result on examination of a fine-needle aspirate is not sufficient to rule out infectious thyroiditis. Fine-needle aspiration of the thyroid can provide a definitive diagnosis of subacute thyroiditis,<sup>3</sup>and only if cytologic or histologic evidence of subacute thyroiditis is obtained can the authors' claim be accepted.