tbuckley/cabot-search huggingface dataset:
A far off place.
Authors: J North
Journal: BMJ (1987)

It would make a good viva question.  are at an altitude of 5400 m (18 000 ft) and a member of an expedition to which you are the doctor. You are in a snowscape; the only sights are snow covered peaks, and the only sounds the crackle of ice and the rumble of distant avalanches. Three hours before one man has collapsed with a severe headache of sudden onset; he is semiconscious, dysarthric, has signs of severe meningism, and is developing a hemiplegia. Greatly helped by his partner he has abseiled down the mountain face and walked for an hour to his present location, where he has finally collapsed. The nearest roadhead is two days away and the nearest hospital three days away. You are in Peru. What would you do, doctor? Geoff s almost dead, I said, clear, decisive, cutting through the dead wood, but, on the whole, not boosting morale. The expedition had been going well until this point; we had had few problems. All the climbers had acclimatised well and I had been allowed to move up to the col of Mount Apalmayo to make a summit bid the following day. We were a 13 man expedition gaining high altitude experience in the Huscuaran region of the Peruvian Andes; the aim was for all the members to climb Mount Alpamayo. At this time we were split into two groups using a common base camp, and five members of the expedition were climbing Mount Artesonraju. Four of us had spent a relaxing afternoon at the col. Let's practise crevasse rescue, somebody had joked. Andy, go and jump in that crevasse. As things turned out it was a poor joke.
Senate Panel Forms Working Group on Electronic Health Records
Authors: Rita Rubin
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
Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants
Authors: Matthew A. Rysavy, Lei Li, Edward F. Bell, Abhik Das, Susan R. Hintz, Barbara J. Stoll, Betty R. Vohr, Waldemar A. Carlo, Seetha Shankaran, Michele C. Walsh, Jon E. Tyson, C. Michael Cotten, P. Brian Smith, Jeffrey C. Murray, Tarah T. Colaizy, Jane E. Brumbaugh, Rosemary D. Higgins
Journal: New England Journal of Medicine (2015)

Between-hospital variation in outcomes among extremely preterm infants is largely unexplained and may reflect differences in hospital practices regarding the initiation of active lifesaving treatment as compared with comfort care after birth. We studied infants born between April 2006 and March 2011 at 24 hospitals included in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Data were collected for 4987 infants born before 27 weeks of gestation without congenital anomalies. Active treatment was defined as any potentially lifesaving intervention administered after birth. Survival and neurodevelopmental impairment at 18 to 22 months of corrected age were assessed in 4704 children (94.3%). Overall rates of active treatment ranged from 22.1% (interquartile range [IQR], 7.7 to 100) among infants born at 22 weeks of gestation to 99.8% (IQR, 100 to 100) among those born at 26 weeks of gestation. Overall rates of survival and survival without severe impairment ranged from 5.1% (IQR, 0 to 10.6) and 3.4% (IQR, 0 to 6.9), respectively, among children born at 22 weeks of gestation to 81.4% (IQR, 78.2 to 84.0) and 75.6% (IQR, 69.5 to 80.0), respectively, among those born at 26 weeks of gestation. Hospital rates of active treatment accounted for 78% and 75% of the between-hospital variation in survival and survival without severe impairment, respectively, among children born at 22 or 23 weeks of gestation, and accounted for 22% and 16%, respectively, among those born at 24 weeks of gestation, but the rates did not account for any of the variation in outcomes among those born at 25 or 26 weeks of gestation. Differences in hospital practices regarding the initiation of active treatment in infants born at 22, 23, or 24 weeks of gestation explain some of the between-hospital variation in survival and survival without impairment among such patients. (Funded by the National Institutes of Health.).
Practical Genetic Counselling.
Authors: Peter S. Harper
Journal: Annals of Internal Medicine (1981)

General Aspects of Genetic Counselling Genetic Counselling: an Introduction Genetic Counselling in Mendelian Disorders Common Disorders and Genetic Counselling Chromosome Abnormalities Molecular Genetics and Genetic Counselling Dysmorphology and Genetic Syndromes Carrier Testing and Genetic Prediction Prenatal Diagnosis and Reproductive Aspects of Medical Genetics Special Issues in Genetic Counselling The Genetic Counselling Clinic Genetic Counselling: Specific Organ Systems Neuromuscular Disorders Central Nervous System Disorders Disorders of Mental Function Disorders of Bone and Connective Tissue Oral and Craniofacial Disorders The Skin The Eye Deafness Cardiovascular and Respiratory Disorders The Gastrointestinal Tract Renal and Urinary Tract Disease Endocrine and Reproductive Disorders Inborn Errors of Metabolism Disorders of Blood and Immune Function Genetic Risks in Cancer Environmental Hazards Genetic Counselling: the Wider Picture Population Aspects of Genetic Counselling and Genetic Screening Genetics and Society Appendix: Useful Information in Connection with Genetic Counselling
Dermoscopy is useful for the recognition of benign-malignant compound tumours
Authors: P. Zaballos, A. Llambrich, S. Puig, J. Malvehy
Journal: British Journal of Dermatology (2005)

Journal Article Dermoscopy is useful for the recognition of benign–malignant compound tumours Get access P. Zaballos, P. Zaballos Dermatology Department, Hospital de Sant Pau i Santa Tecla, 43003 Tarragona, Spain *Melanoma Unit, Dermatology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain Pedro Zaballos Diego. E‐mail: pzaballos@aedv.es Search for other works by this author on: Oxford Academic Google Scholar A. Llambrich, A. Llambrich Dermatology Department, Hospital de Sant Pau i Santa Tecla, 43003 Tarragona, Spain *Melanoma Unit, Dermatology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain Search for other works by this author on: Oxford Academic Google Scholar S. Puig, S. Puig Dermatology Department, Hospital de Sant Pau i Santa Tecla, 43003 Tarragona, Spain *Melanoma Unit, Dermatology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain Search for other works by this author on: Oxford Academic Google Scholar J. Malvehy J. Malvehy Dermatology Department, Hospital de Sant Pau i Santa Tecla, 43003 Tarragona, Spain *Melanoma Unit, Dermatology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 153, Issue 3, 1 September 2005, Pages 653–656, https://doi.org/10.1111/j.1365-2133.2005.06717.x Published: 01 September 2005 Article history Accepted: 12 February 2005 Published: 01 September 2005
Abstract 128: Evolution of Clinical Diagnosis in Patients Presenting with Unexplained Cardiac Arrest
Authors: Jeff S Healey, Martin Gardner, Jean Champagne, David H Birnie, Michael H Gollob, Vijay Chauhan, Chris Simpson, Shubhayan Sanatani, Mario Talajic, Kam Ahmad, Andrew Krahn
Journal: Circulation (2011)

Background Systematic evaluation of patients with unexplained cardiac arrest can lead to a diagnosis in 50% of cases. However; evolution of clinical phenotype, identification of new disease-causing...
Abstract 5507: Toll Like Receptor 4 Activation Elicits Pro-atherogenic Gene Activation In Monocytes In Humans
Authors: Suthesh Sivapalaratnam, Rosienne Farrugia, Max Nieuwdorp, A Gusnanto, Nick A Watkins, Jaap-Jan Zwaginga, Willem H Ouwehand, Mieke D Trip, Erik S Stroes, John J Kastelein
Journal: Circulation (2008)

Introduction: Inflammatory activation of both circulating blood cells as well as vessel wall cells is a hallmark of atherogenesis. Agonists of the Toll-like receptor 4 pathway, present on white blood cells as well as endothelial cells, have been associated with a pro-atherogenic state. Recently, standardized inflammatory challenge models using lipopolysaccharide (LPS) have been suggested to mimick these atherogenic changes. However, similarity between circulating pathways and ’vessel wall’ pathways need further validation. Therefore, we evaluated the effects of in vivo LPS challenge on circulating monocytes in humans. Methods: A bolus of Escherichia coli endotoxin (LPS 1 ng/kg bodyweight) or NaCl was infused intravenously in healthy male volunteers (n=13). Blood was drawn at 0, 1 and 4 hours after the challenge. The monocytes (CD14+ cells) were isolated using positive MACS selection. Subsequently, mRNA sample extraction using RnaseBee was performed. cDNA was prepared, amplified, labeled and then hybridized onto spotted oligonucleotide microarrays before scanning. Data were analyzed using R-project version 2.2.0. Validation Taqman took place. Results: Following LPS challenge, CD14+ count dropped by 48% in the first hour due to margination of monocytes, followed by normalization at 4 hours. Purity of CD14+ fraction approximated 90%. LPS was associated with upregulation of a series of pro-atherogenic genes (BID, DIPA, FRA-1, HSP27, HSP70, ILRN, MIP-1a, MIP1b, S100A9, SLA1, TIMPS, TLR2), immune system related genes (CLP1, DF, CD45-AP, HLA-DPB1, BATF, C3AR1, CD14) as well as a series of unrelated genes. No genes were differentially expressed during saline control experiments. RT-PCR confirmed upregulation of CD14, SLA1, BATF, C3AR1, MIP-B, TLR-2, VCAN and ILRN. Conclusion: TLR4 activation following LPS challenge is associated with potent activation of monocytic pathways involved in chemotaxis and immune activation. These activation patterns bear great resemblance to those reported in atherogenic vessel wall. It is tempting to speculate that circulating cells (’vulnerable blood’) can be used as a surrogate to detect high-risk vessel wall lesions (vulnerable patient).
Abstract 17341: A 19-Year-Old Female with Recurrent Chylopericardium
Authors: Cheng-Han Chen, Angela Kleiber, Christine Megerdichian, Gregg C Fonarow, Arnold S Baas
Journal: Circulation (2014)

A 19-year-old female initially presented to an outside hospital with worsening shortness of breath over the course of hours. Echocardiogram revealed a large pericardial effusion with tamponade physiology. An urgent pericardiocentesis followed by a pericardial window yielded 600cc of cloudy fluid, and work-up for infectious, auto-immune, and malignant etiologies was unrevealing. She was discharged home, but over the next four weeks developed a repeat pericardial effusion requiring another pericardiocentesis yielding 750cc of cloudy fluid. She then presented to our hospital two weeks later with progressive shortness of breath. Echocardiogram revealed a large pericardial effusion with evidence of early tamponade physiology. Our differential diagnosis for her recurrent pericardial effusions remained broad, with infectious and malignant etiologies at the top of consideration. Computed tomography of the chest demonstrated the pericardial effusion and mild mediastinal adenopathy. She underwent another pericardial window with removal of 600cc of milky fluid, and fluid analysis was notable for a markedly elevated triglyceride level consistent with a diagnosis of chylopericardium. Work-up for malignancy as an etiology for recurrent chylopericardium was negative. A percutaneous lymphangiogram was then performed, which revealed a significant leak in the superior aspect of the thoracic duct into the pericardial space. Percutaneous embolization of the thoracic duct was performed using detachable coils along with embolic glue, resulting in resolution of the leak. She has since remained asymptomatic, and follow-up echocardiogram was without recurrence of any pericardial effusion. This case of idiopathic recurrent chylopericardium as the cause for pericardial effusion represents a rare manifestation of a relatively common cardiac condition. It illustrates the importance of routine pericardial fluid analysis for triglycerides, as this led to her correct diagnosis of chylopericardium. The use of percutaneous thoracic duct embolization has only recently been reported as a novel approach for treatment of chylous leak, and may emerge as a useful alternative to surgery for recurrent chylopericardium.
Abstract 4358: MicroRNA-198 inhibits non-small cell lung cancer migration and invasion through targeting OTX1 and VCP
Authors: Jin-Ah Kim, Junguk Yang, Yeong Nang Jo, Chang Woo Lee, Ok-Jun Lee, Song-Yi Choi, Jong Soon Kang, Jieun Yun
Journal: Cancer Research (2014)

Abstract Lung cancer is the leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for the majority of cases. In previous studies, microRNA-198 (miR-198) was shown to be significantly downregulated in lung adenocarcinoma-associated malignant pleural effusion and suggested as a diagnostic biomarker. Herein, we show that miR-198 regulates migration and invasion of NSCLS cells by directly targeting orthodenticle homeobox 1 (OTX1) and valosin containing protein (VCP). Expression of miR-198 suppressed migration and invasion of NSCLS cells, whereas inhibition of miR-198 expression increased the invasive efficiency of the cancer cells. MiR-198 directly targets 3′UTR of OTX1 and VCP, thus regulates their protein level. Furthermore, we found reduced levels of miR-198 in human NSCLS tissue samples compared to adjacent normal tissues. Our findings indicate that miR-198 regulates NSCLC cell migration and invasion, partially via the down-regulation of OTX1 and VCP. Thus, miR-198 may represent a potential therapeutic target for NSCLC intervention. Citation Format: Jin-Ah Kim, Junguk Yang, Yeong Nang Jo, Chang Woo Lee, Ok-Jun Lee, Song-Yi Choi, Jong Soon Kang, Jieun Yun. MicroRNA-198 inhibits non-small cell lung cancer migration and invasion through targeting OTX1 and VCP. [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 4358. doi:10.1158/1538-7445.AM2014-4358
Efficacious immunomodulatory activity of the chemokine stromal cell–derived factor 1 (SDF-1): local secretion of SDF-1 at the tumor site serves as T-cell chemoattractant and mediates T-cell–dependent antitumor responses
Authors: Kyriaki Dunussi-Joannopoulos, Krystyna Zuberek, Kathlene Runyon, Robert G. Hawley, Anthony Wong, Jamie Erickson, Steve Herrmann, John P. Leonard
Journal: Blood (2002)
Eating Disorders in General Practice
Authors: M B King
Journal: Journal of the Royal Society of Medicine (1990)

A total of 748 patients who attended four south London group practices were screened using the eating attitudes test; 1% of women had bulimia nervosa and a further 3% a partial syndrome eating disorder. Eating and weight control behaviour and psychiatric indicators for an eating disorder were analysed. Patients with bulimia nervosa and partial syndromes were remarkably similar. They were mainly women, from the middle to upper classes, in the normal weight range but having had considerable weight fluctuation in the past, more likely to have had a history of menstrual irregularity, often psychologically troubled, and tended to have more family psychopathology.
Total Cardiovascular Disease Burden: Comparing Intensive With Moderate Statin Therapy
Authors: Matti J. Tikkanen, Michael Szarek, Rana Fayyad, Ingar Holme, Nilo B. Cater, Ole Faergeman, John J.P. Kastelein, Anders G. Olsson, Mogens Lytken Larsen, Christina Lindahl, Terje R. Pedersen
Journal: Journal of the American College of Cardiology (2009)
Abstract 18989: Periprocedural Heparin Requirement in Patients Undergoing Atrial Fibrillation Ablation Stratified by Different Baseline Anticoagulation Regimens: Evidence for a Prothrombotic State With Interrupted Dabigatran
Authors: Daniel Benhayon, Pasquale Santangeli, Erica Zado, John Ryan, David Callans, Francis Marchlinski
Journal: Circulation (2014)

Introduction: Thromboembolic (TE) and bleeding complications represent the most common adverse events during atrial fibrillation (AF) ablation. In order to prevent TE, unfractionated heparin (UFH) is recommended throughout the procedure, with a target ACT of 350-400 sec. In this study we compared periprocedural heparin requirements during different pre-procedure anticoagulation regimens and the potential clinical implications. Methods: We retrospectively analyzed every case of AF ablation performed at our institution over the last 2 years, including only first time ablations, and collected the amount of UFH per kilogram needed to achieve the target ACT. The groups were compared based on the periprocedural anticoagulation strategy (warfarin vs. dabigatran vs. rivaroxaban), and the number of doses held before the procedure. Patients on warfarin were all on uninterrupted warfarin, but for comparison we further subdivided this group into INR tertiles, based on INR at time of procedure. Results: We included 584 patients. Of those 391 (67%) were on warfarin, 162 (28%) were receiving dabigatran and 31 (5%) rivaroxaban. Baseline characteristics were not significantly different between the groups, including procedural duration and baseline creatinine. 54.1% had paroxysmal AF and 5.3% had a prior TIA/stroke. Patients that held ≥2 doses of dabigatran needed significantly more UFH-per-kilogram-per-procedure, as compared to patients on warfarin with INR &lt;1.5. (15% more; p=0.029). See figure. No differences were observed between those on warfarin with INR ≤1.5 and those holding ≥2 doses rivaroxaban (p=0.56). No significant differences were observed in the rate of bleeding or TE complications between groups (P=0.18). Conclusions: Interrupted dabigatran is associated with significantly increased need for UFH compared to those functionally off warfarin, which may suggest a slight rebound procoagulant effect due to dabigatran interruption.
Lineer Ig A Dermatozun Sıradışı Klinik Görünümü:İki Olgu Bildirisi
Authors: Karla Cauza, Gabriele Hinterhuber, Barbara Sterniczky, Karin Brugger, Friederike Pieczkowski, Franz Karlhofer, Klaus Wolff, veDagmar FoedingeraVienna, Austria
Journal: Journal of the American Academy of Dermatology (2004)
Abstract 19204: Symptoms of Depression and Posttraumatic Stress Disorder are Associated with Differential Autonomic Influences to Standing
Authors: Amit J Shah, Ayman Alkhoder, Malik Obideen, Ronnie Ramadan, Kobina Wilmot, Ibhar Al Mheid, Michael Kutner, Arshed A Quyyumi, J. Douglas Bremner, Viola Vaccarino
Journal: Circulation (2014)

Introduction: Depression and posttraumatic stress disorder (PTSD) are associated with impaired baroreflex sensitivity, a risk factor for sudden death. Unlike depression, PTSD is associated with hyperarousal. We hypothesized that, in patients with CAD, depressive and PTSD symptoms associate with different autonomic responses to standing (baroreflex response). Methods: We examined 178 patients with CAD for autonomic dysfunction with the ANSAR test (ANX 3.0, ANSAR Inc. Philadelphia, PA) in which heart rate variability was measured in both sitting (5 minutes) and standing (5 minutes) positions. Sympathetic (SNS) and parasympathetic (PNS) nervous system activity was measured using continuous wavelet transform and log-transformed. PTSD symptoms were assessed using the PTSD checklist scale (PCL), and depressive symptoms were assessed using the Beck Depression Inventory-II (BDI). Both BDI and PCL were examined in multivariate models simultaneously, adjusting for CAD risk factors, beta blockers, and antidepressants. Results: The mean (SD) age, BDI, and PCL scores were 62.4 (9.1), 7.2 (7.6), and 26.2 (10.2), respectively. For the group as a whole, the mean baseline SNS and PNS tones were -0.49 and -0.60 log beats per minute squared (log BPM 2 ). In multivariable models, PCL score associated with higher baseline SNS tone (β=0.03, p=0.046). With standing, PCL score associated with decrease in the levels of SNS tone (β=-0.02, p=0.02) vs. sitting, and BDI associated with an increased PNS tone (β=0.03, p=0.03) vs. sitting. In both cases, these responses are the opposite of the expected autonomic response to standing, which is an increase in SNS tone and decrease in PNS tone vs. sitting. Conclusion: Depressive and PTSD symptoms have opposite autonomic pathologies in CAD patients. While PTSD symptoms are associated with higher SNS tone at baseline, they are also associated with lower sympathetic activation with standing. Depressive symptoms, on the other hand, are associated with reduced vagal withdrawal with standing. This suggests that both depressive and PTSD symptoms are associated with an abnormal baroreceptor function, but through different autonomic pathways.
Diagnostic accuracy of endobronchial ultrasonography using a guide sheath for peripheral lung cancer with ground-glass opacity
Authors: Mariko Okamoto, Noriaki Kurimoto, Masamichi Mineshita, Teruomi Miyazawa
Journal: European Respiratory Journal (2013)

Background: Endobronchial ultrasonography using a guide sheath (EBUS-GS) is a method established for pulmonary lesions however, there are only few reports regarding lesions with ground glass opacity (GGO).  Objective: To assess the diagnostic accuracy of GS for lesions with GGO.  Methods: Between January 2010 and January 2013, 48 patients with a confirmed diagnosis of lung cancer underwent either surgery or GS. GS was performed using an endoscopic ultrasound system, which was equipped with a 20-MHz mechanical radial-type probe with an external diameter of 1.4 mm with GS. Bronchoscope with a working channel diameter of 2.0 mm was used. Three to 5 biopsy and brushing samples were taken for all patients. Subjects were then categorized by the ratio of solid area and GGO (longest diameter of tumor with mediastinal window / longest diameter of tumor with lung window ×100) on CT as pure GGO or mixed GGO ( 50%).  Results: The total diagnostic yield of GS in patients with GGO was 77.1%. Cytological diagnosis was 54.2%, and tissue diagnosis was 70.8%. The diagnostic accuracy when the position of the probe was outside the lesion was invisible was 0%, adjacent to the lesion was 71.4%, and within the lesion was 83.9%. The diagnostic accuracy visualized as typeIIa (hyperechoic points without open vessels) was 77.3%, typeIIb (hyperechoic points with open vessels) was 82.6%.  Conclusions: GS for the diagnostic yield in patients with GGO was 77.1%. Increasing the solid part in the lesion, the population of typeIIb, within, and diagnostic yield increased.