tbuckley/cabot-search huggingface dataset:
22-year-old woman with acute-on-chronic ankle pain
Authors: Bippan Sangha, Julia Grebenyuk, Teri Fisher, Bruce B Forster
Journal: British Journal of Sports Medicine (2010)

A 22-year-old woman with a history of chronic right ankle pain for 8 years presented with pain exacerbation over the right talus over the previous 7 months. There was no recent history of trauma. The pain was aggravated by not wearing orthotics. No alleviating factors were identified. There was no history of instability or clicking. Past treatments included physiotherapy and ibuprofen.

Physical examination revealed pes planus with normal gait, normal weight bearing and normal range of motion. No skin changes or pain on palpation was identified. Focused neurovascular examination was normal. The anterior drawer, talar tilt and tibial torsion tests were all normal.

Ankle radiographs (figures 1 and 2) were obtained.



Figure 1 
Anteroposterior radiograph of the right ankle.





Figure 2 
Lateral radiograph of the right ankle.



What is your diagnosis?

Talocalcaneal tarsal coalition.

### Anteroposterior radiograph of right ankle

No abnormality is appreciable on this anteroposterior radiograph.

This image demonstrates a complete C-sign with osseous bridging. There is narrowing of the posterior subtalar facet, a short talar neck and a small dorsal subtalar beak.

The magnetic resonance images demonstrate bone marrow oedema across the middle subtalar joint, cortical irregularity and small subchondral cysts, in keeping with fibrous coalition.

Tarsal coalition is an abnormal union between two or more tarsal bones. The coalition can be osseous, fibrous or cartilaginous. Tarsal coalition is relatively common on autopsy, with an incidence of up to 1% of the population; although the majority of these are thought to be asymptomatic.1 Most cases of tarsal coalition …
The platelet activating factor receptor antagonist WEB 2170 improves glomerular hemodynamics and morphology in a proliferative model of mesangial cell injury.
Authors: R A Stahl, F Thaiss, G Oberle, H M Brecht, W Schoeppe, U Wenzel, U M Helmchen
Journal: Journal of the American Society of Nephrology (1991)

Rats were treated with the platelet activating factor receptor antagonist WEB 2170 (15 mg/kg/day) in three different protocols to evaluate a possible role of platelet activating factor in an experimental proliferative model of glomerular disease. The glomerular immune injury was initiated by the i.v. administration of a rabbit anti-rat thymocyte antiserum. Anti-rat thymocyte antiserum induces a proliferative glomerulonephritis with reduction of glomerular filtration rate (614 +/- 94) compared with controls (1,120 +/- 192 microL/min/100 g body wt) when studied at day 7. Treatment of rats with WEB 2170 over 8 days (starting at day -1; protocol 1) ameliorated the loss in glomerular filtration rate (936 +/- 82 microL/min/100 g body wt) in nephritic rats at day 7; however, it had no effect on controls (1,142 +/- 104 microL/min/100 g body wt). Interventional treatment with WEB 2170 (starting at day 4 after anti-rat thymocyte antiserum; protocol 2) also improved glomerular function when glomerular filtration rate was already reduced (410 +/- 41 microL/min/100 g body wt) at day 4. The platelet activating factor receptor antagonist given at day 7 after induction of disease (protocol 3) did not improve impaired glomerular filtration rate. Preinterventional and interventional treatment with WEB 2170 reduced the infiltration of polymorphonuclear granulocytes in glomeruli. Interventional treatment with WEB 2170 also reduced glomerular morphologic damage in nephritic glomeruli. The data demonstrate a beneficial effect of the platelet activating factor receptor antagonist in this animal model of proliferative glomerulonephritis which suggests that platelet activating factor might play an important role in the mediation of this disease.
Management of Hypopharyngeal Carcinoma: A 6-Year Review
Authors: R G Wight, M A Birchall, N D Stafford, R de L Stanbridge
Journal: Journal of the Royal Society of Medicine (1992)

A retrospective review of 16 consecutive cases of squamous carcinoma of the hypopharynx treated by pharyngo-laryngo-oesophagectomy (PLO) and gastric transposition with a thoracotomy as part of the surgical technique is presented. An operative mortality of 6% and a hospital mortality of 12% occurred. Other complications are discussed. No significant morbidity or mortality occurred as a result of the thoracotomy. A comparison is made with the extra-thoracic technique of gastric transposition.
Commentary: Strength and importance of the relation of dietary salt to blood pressure
Authors: A. R Dyer, P. Elliott, M. Marmot, H. Kesteloot, R. Stamler, J. Stamler
Journal: BMJ (1996)

Geoge Davey Smith and Andrew Phillips raise some issues concerning methods used in correcting for regression dilution in Intersalt but offer no judgment on the crucial issue of the strength and importance of the relation of dietary salt to blood pressure. To assess this matter properly, in the context of Intersalt findings, three judgments must be made: firstly, on the aetiological significance of the salt-blood pressure relation; secondly, on the probable underestimate of the size of this relation in Intersalt analyses of individuals; and thirdly, on the soundness of Intersalt's updated estimates “revisiting” the strength of this relation, both from its within population and its cross population analyses.1 Davey Smith and Phillips deal not at all with the first and second of these points, and only partially and inconsistently with the third. Much of their commentary deals with generalities, not with specifics of the salt-blood pressure relation and Intersalt results. As a consequence, their commentary neither sheds light on the substantive matter nor contributes positively to public policy.

Davey Smith and Phillips state that corrections for regression dilution and other biases “could as well be applied to spurious associations as to causal ones…. Judgment has to be applied to decide if an association is causal.” They make no such judgment on the salt-blood pressure relation, the subject of their commentary. In fact, the totality of the evidence—the only sound basis for judgment on this matter—supports the conclusion that this association is causal. The significant independent findings on the sodium-blood pressure relation in Intersalt's within population and cross population analyses1 are components of that total evidence. Independent expert groups, national and international, have repeatedly concluded that the extensive, concordant, strong data from all disciplines—clinical investigation, randomised controlled trials, animal experimentation, epidemiological research …
Oscillations and Noise
Authors: JOHN R. HOTCHKISS, ALEXANDER B. ADAMS, MARY K. STONE, DAVID J. DRIES, JOHN J. MARINI, PHILIP S. CROOKE
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

Pressure support ventilation (PSV) is almost universally employed in the management of actively breathing ventilated patients with acute respiratory failure. In this partial support mode of ventilation, a fixed pressure is applied to the airway opening, and flow delivery is monitored by the ventilator. Inspiration is terminated when measured inspiratory flow falls below a set fraction of the peak flow rate (flow cutoff); the ventilator then cycles to a lower pressure and expiration commences. We used linear and nonlinear mathematical models to investigate the dynamic behavior of pressure support ventilation and confirmed the predicted behavior using a test lung. Our mathematical and laboratory analyses indicate that pressure support ventilation in the setting of airflow obstruction can be accompanied by marked variations in tidal volume and end-expiratory alveolar pressure, even when subject effort is unvarying. Unstable behavior was observed in the simplest plausible linear mathematical model and is an inherent consequence of the underlying dynamics of this mode of ventilation. The mechanism underlying the observed instability is “feed forward” behavior mediated by oscillatory elevation in end-expiratory pressure. In both mathematical and mechanical models, unstable behavior occurred at impedance values and ventilator settings that are clinically realistic.
Clinical significance of bcl2 and p53 protein expression in diffuse large B-cell lymphoma: a population-based study.
Authors: M H Kramer, J Hermans, J Parker, A D Krol, J C Kluin-Nelemans, H L Haak, K van Groningen, J H van Krieken, D de Jong, P M Kluin
Journal: Journal of Clinical Oncology (1996)

PURPOSE We studied the prognostic significance of bcl2 and p53 protein expression in relation to clinical and pathologic characteristics in patients with diffuse large B-cell lymphoma (LCL). PATIENTS AND METHODS Three hundred seventy-two patients with LCL were retrieved from a population-based registry for non-Hodgkin's lymphoma (NHL). bcl2 and p53 protein expression was studied on paraffin-embedded tumor tissue by immunohistochemistry in relation to clinical factors. Response to therapy and survival were analyzed in 165 patients who were uniformly staged and treated and for whom all prognostic data were available according to the International Prognostic Index (IPI). RESULTS Forty-five percent of tumors showed strong expression of the bcl2 protein (bcl2++), with a higher frequency in patients with primary nodal involvement. Disease-free survival (DFS) was significantly better in bcl2-negative/intermediate (bcl2-/+) cases as compared with bcl2++ cases (P = .0011). At 5 years, bcl2-/+ patients showed a DFS rate of 74%, in contrast to bcl2++ patients with a DFS rate of 41% (P = .002). Bcl2 was the strongest independent prognostic value in a multivariate analysis, with a relative risk (RR) of 3.0 in comparison to p53 expression and the clinical factors of the IPI. Overall survival (OS) was not significantly influenced by bcl2 protein expression. p53 protein expression was found in 13% of cases, with a higher frequency in patients with extensive disease. p53 expression did not influence the chance to achieve complete remission (CR) and survival. CONCLUSION bcl2 protein is frequently expressed in LCL and is a strong independent prognostic factor for DFS. p53 expression is related with high tumor burden, but is not an independent risk factor for CR and survival.
Virtual bronchoscopic navigation combined with endbronchial ultrasound for diagnosing small peripheral pulmonary lesions
Authors: Masafumi Misawa, Haruki Kobayashi, Kei Nakashima, Nobuhiro Asai, Naoko Katsurada, Hideki Makino, Norihiro Kaneko, Masahiro Aoshima
Journal: European Respiratory Journal (2012)

Background:  Flexible fiberoptic bronchoscope may be a valuable procedure to evaluate pulmonary nodules. However, a diagnostic yield has been reported as low as 34% for peripheral lesions less than 2 cm in size.  Objectives:  This case series study evaluated the value of the virtual bronchoscopic navigation (VBN) combined with endobronchial ultrasound (EBUS) for diagnosing peripheral pulmonary lesions.  Methods:  Enrolled subjects were patients with pulmonary lesions which were deemed too small and peripheral for a conventional bronchoscopic sampling, who were referred to Kameda Medical Center for diagnostic bronchoscopy between September 2010 and February 2012. VBN was utilized to produce a pathway into the target lesion. Once the fiberoptic bronchoscope was advanced as far as possible in this pathway, a guide sheath with EBUS probe was then advanced to the target lesion under fluoroscopy guidance. After visualization of the lesion by EBUS, the probe was removed leaving the guide sheath in place. Samplings were then performed through the guide sheath under fluoroscopic guidance.  Results:  Study subjects included 58 patients with 62 lesions, mean age 68 years. The mean lesion size was 20 mm in diameter. Bronchi seen on VB image were highly consistent with the actual structure. The sensitivity for diagnosing malignancy was 43% and negative predictive value was 61%. Overall accuracy for diagnosis of all lesions was 69%.  Conclusion:  VBN combined with EBUS is useful method for collecting samples from small peripheral pulmonary lesions and may help increase the diagnostic yield of transbronchial samplings in diagnosing small peripheral pulmonary lesions.
COL3A1 mutation leading to acrogeria (Gottron type)
Authors: T. Jansen, A. De Paepe, L. Nuytinck, G. Plewig
Journal: British Journal of Dermatology (2000)

Journal Article COL3A1 mutation leading to acrogeria (Gottron type) Get access T. Jansen, T. Jansen Department of Dermatology, Ludwig‐Maximilians‐University of Munich, Frauenlobstraße 9–11, D‐80337 Munich, Germany Search for other works by this author on: Oxford Academic Google Scholar A. De Paepe, A. De Paepe Search for other works by this author on: Oxford Academic Google Scholar L. Nuytinck, L. Nuytinck Department of Medical Genetics, University of Gent, De Pintelaan 185, B‐9000 Gent, Belgium Search for other works by this author on: Oxford Academic Google Scholar G. Plewig G. Plewig Department of Dermatology, Ludwig‐Maximilians‐University of Munich, Frauenlobstraße 9–11, D‐80337 Munich, Germany Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 142, Issue 1, 1 January 2000, Pages 178–180, https://doi.org/10.1046/j.1365-2133.2000.03266.x Published: 01 January 2000
Recommendations for the Standardization and Interpretation of the Electrocardiogram
Authors: Paul Kligfield, Leonard S. Gettes, James J. Bailey, Rory Childers, Barbara J. Deal, E. William Hancock, Gerard van Herpen, Jan A. Kors, Peter Macfarlane, David M. Mirvis, Olle Pahlm, Pentti Rautaharju, Galen S. Wagner
Journal: Journal of the American College of Cardiology (2007)
The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics
Authors: Stefan Aschauer, Andreas A. Kammerlander, Caroline Zotter‐Tufaro, Robin Ristl, Stefan Pfaffenberger, Alina Bachmann, Franz Duca, Beatrice A. Marzluf, Diana Bonderman, Julia Mascherbauer
Journal: European Journal of Heart Failure (2015)
Changes in body composition are associated with corticosteroid use in adult asthma
Authors: Bronwyn Berthon, Lesley MacDonald-Wicks, Peter Gibson, Lisa Wood
Journal: European Respiratory Journal (2013)

Introduction  Obesity and asthma have been strongly linked. Body fat distribution varies by gender and disease state. Corticosteroids, the mainstay of asthma pharmacotherapy, may be a risk factor for obesity. The impact of corticosteroids on regional body composition in asthma is unknown.  Aims and objectives  To explore relationships between inhaled and oral corticosteroid use, body composition and clinical asthma outcomes in adults with asthma.  Methods  Cross-sectional study of adults with stable asthma (n=42, age 52yrs ±14(SD), BMI 29.8 ±5.9(SD)), at the John Hunter Hospital Newcastle, Australia. Demographic details and corticosteroid dose over 2 years were collected; spirometry and airway responsiveness to hypertonic saline and body composition using dual-energy X-ray absorptiometry (GE, Lunar) were measured.  Results  In regression analyses controlled for age, gender and BMI, current inhaled corticosteroid dose was positively associated with total body % fat, gynoid region % fat and thoracic region % fat (p=0.021, p=0.009, p=0.050), and negatively associated with total body % lean, gynoid region lean tissue and thoracic lean tissue (p=0.029, p=0.036, p=0.050). Oral corticosteroid dose over 2 years was positively associated with gynoid region % fat (p=0.009) and negatively associated with gynoid region lean tissue (p=0.032).  Conclusions  Use of corticosteroids in adults with asthma is associated with detrimental effects on body composition, including increased fat, decreased lean and regional tissue composition changes, which may contribute to adverse clinical outcomes. This suggests the need for targeted interventions to increase muscle and reduce fat mass in those on higher corticosteroid regimes.
Dose calculation of anticancer drugs: a review of the current practice and introduction of an alternative.
Authors: H Gurney
Journal: Journal of Clinical Oncology (1996)

PURPOSE To review the current dose-calculation practice and propose a non-body-surface area (BSA)-based dose-calculation method. METHODS Data that supported the introduction of BSA-based dose calculation in the late 1950s were reviewed. Data on 18 drugs that correlated pharmacokinetic (PK) variables for cytotoxic drugs with BSA were examined. Other methods of dose calculation, such as therapeutic drug monitoring (TDM) and adaptive control, were also examined. RESULTS The BSA-based method of dose calculation was adopted without adequate investigation of its accuracy. BSA fails to standardize the marked interpatient variation in PK for most cytotoxic drugs. A definite correlation was found between PK variables and BSA for only one drug (docetaxel). PK parameters correlate with toxicity, as well as response in some tumors, but do not completely explain the variation in drug effect between individuals. The complexities of TDM may make its universal use impractical. A non-BSA-based dose calculation method is proposed that defines three mandatory steps: prime dose, modified dose, and toxicity-adjusted dose (PMT dosing). Prime dose is the fixed dose of a drug used alone or in combination and is derived from the reanalysis of phase I/II studies and from clinical practice. Modified dose is an adjustment of the prime dose before administration, based on dose-adjustment guidelines that predict the drug-handling ability of an individual. Population pharmacodynamic studies may be used for the development of these guidelines. Subsequent doses are adjusted in each patient according to a target toxicity, such as nadir neutrophil count or other objective toxicity, that serves as a surrogate marker for potential antitumor effect (toxicity-adjusted dose). Patients who are predicted to have very abnormal drug handling should be excluded from such a dosing scheme and TDM may be more suitable. CONCLUSION The routine use of BSA for dose calculation should be reevaluated. Other methods of dose calculation should be investigated. TDM may be impractical in all patients and remains unvalidated. PMT dosing ensures that the condition of each individual is considered, to predict drug effects better. Clinical dose-calculation systems such as PMT dosing should be evaluated prospectively.
Characteristics of patients with chronic obstructive pulmonary disease (COPD) discharged from the emergency department – Improving the care pathway for acute exacerbations of COPD
Authors: Santino Capocci, David Turner, Robert Pinate, Myra Stern, Louise Restrick
Journal: European Respiratory Journal (2011)

Introduction: This study characterized COPD-patients attending an Emergency Department (ED) who are discharged.

Methods: Retrospective records-review of COPD-patients discharged from ED (04/2009-03/2010) included demographics, symptoms, spirometry, treatment (pre-ED and discharge), ED attendances/hospital admissions & deaths in the subsequent 90 days.

Results: 49/53 episodes coded COPD-ED-discharges in 45 patients were compatible with AECOPD (11% of total 387 AECOPD presentations). 30/49 presented outside 9-5, Monday–Friday. Obstructive spirometry was recorded for 28/45: mean (SD) FEV1 1.21 (0.55)litres. Patients on GP-COPD registers included 2 with restrictive spirometry; 2 had no spirometry; 11 a new COPD diagnosis. Symptoms were increased breathlessness (42/47), cough (38/48) & changing sputum (15/48). Mean (range) symptom duration was 4 (0-28)days (n=40), but <1 day in 21/40. 8/46 started corticosteroids and 10/46 antibiotics before attending ED. At discharge, 34/49 received/continued corticosteroids; 16/49 antibiotics. 2 patients died. 15/49 episodes resulted in hospital admission within 90 days, 6/15 within 2 weeks.

Conclusions: Patients discharged from ED with AECOPD account for 11% of COPD hospital presentations ( 50% presented within 24h of symptoms, 60% outside working-hours. In >20%, diagnosis was not confirmed by spirometry. Only 20% started exacerbation treatment before attending; 30% not given corticosteroids on discharge. Readmission rates were high despite moderately severe COPD. Optimal management of ED-COPD discharges should include corticosteroids, followed by GP-review within 7 days.
Microalbuminuria in chronic obstructive pulmonary disease
Authors: Emel Bulcun, Mehmet Ekici, Aydanur Ekici
Journal: European Respiratory Journal (2012)

Introduction: We investigated levels of microalbuminuria and the factors determining in patient with COPD

Method: 66 patients with COPD and 40 subjects as control group were included. The presence of microalbuminuria (MAB) was defined when the urinary albumin creatinin ratio (UACR) was between 20 mg/g in men and 30 m/g in women.

Results: Pearson correlation showed that there were inverse associations between UACR and PO2, FEV1%, FVC% and positive relation between UACR and BODE index. In linear regression model, the UARC showed inverse association with PO2 while positive association with MRCI, and BODE index.

View this table:

Table 1: The predictors of urinary albumin/kreatinin ratio in all subjects





In logistic regression model, the presence of MAB showed associations with severity of COPD, PO2, BODE index, PO2 and age.

View this table:

Table 2 : The predictors of presence of MAB in all subjects





Conclusion: Microalbuminuria may be seen in patints with COPD depending on severity of disease and hypoxemia.
Relationship between circulating Th2 prevalence and asthma control in pregnant asthmatics
Authors: Andras Bikov, Noemi Eszes, Aniko Bohacs, Aron Cseh, Gergely Toldi, Veronika Muller, Janos Rigo, Barna Vasarhelyi, Gyorgy Losonczy, Lilla Tamasi, Ildiko Horvath
Journal: European Respiratory Journal (2011)

Introduction:  Asthma is one of the most common diseases complicating pregnancy and a risk factor for several maternal and fetal complications. It was previously shown that altered systemic inflammation present in pregnant asthmatics may contribute to the outcome of the pregnancy; however less has been known about the relationship between circulating T cell profiles and clinical characteristics of asthma in pregnant patients.   Aim:  The aim of this study was to assess the relationship between various T cell profiles and clinical variables in asthma during gestation, including lung function, exhaled nitric oxide, and asthma control.   Methods:  The prevalence of Th1, Th2, and Treg lymphocyte subsets was identified by cell surface markers and intracellular FoxP3 staining in 22 pregnant women in the second or third trimester suffering from persistent allergic asthma. FENO, Asthma Control Test (ACT) total score and lung function were also evaluated.   Results:  A significant negative relationship was observed between Th2 cell prevalence and ACT total scores (r=-0.48, p=0.03), while no relationship was found between Th2 prevalence and FENO or lung function parameters. However, none of the other T cell subsets were correlated to any of the clinical characteristics (FENO, lung function, or ACT; p>0.05).   Conclusions:  The level of asthma control related to blood Th2 cell prevalence suggests a direct relationship between symptoms and cellular mechanisms of asthma in pregnant patients.  The study was supported by OTKA 68808.