tbuckley/cabot-search huggingface dataset:
Botulism Surveillance and Emergency Response
Authors: Roger L. Shapiro
Journal: JAMA (1997)

Botulism is a neuroparalytic disease caused by a neurotoxin produced from an anaerobic spore-forming bacterium known as<i>Clostridium botulinum</i>.<sup>1</sup>The lethal potency of this toxin has mandated intensive surveillance and control measures in the United States. Recent outbreaks of botulism have raised questions regarding the international supply and therapeutic use of botulism antitoxin, and reports that national governments<sup>2</sup>and terrorist groups<sup>3</sup>have stockpiled botulism toxin have increased levels of concern regarding global preparedness for an intentional episode of botulism poisoning. It is estimated that as little as 1 g of aerosolized botulism toxin has the potential to kill at least 1.5 million people, and modern techniques of aerosolization via tactical ballistic missiles or aeronautical spraying may be capable of disseminating up to 60% of this dosage to a target population.<sup>4</sup> A description of the clinical features of aerosolized botulism toxin poisoning appears elsewhere in this issue.
Absorption and Metabolism of Aspirin Administered in Enteric-Coated Tablets
Authors: Jack R. Leonards
Journal: JAMA (1965)

Variations in the absorption pattern of aspirin in enteric-coated tablets and in solution were compared between subjects and between doses in any one subject. Absorption of enteric-coated tablets was complete but the rate was extremely variable. On the other hand, administration of aspirin in solution was not only complete, but also yielded well-reproducible salicylate plasma levels. The variable absorption of drugs in enteric-coated tablets appears to be due to wide differences in gastric retention time of solid objects. Since this aspect of gastrointestinal physiology is not affected by the type and quality of the tablets or the medicinal agent, it constitutes an inherent limitation in the absorption efficacy of all enteric-coated tablets. There was no significant difference in the metabolic fate of aspirin administered in solution or in the enteric-coated tablets used in this study.
Localization of tumor necrosis factor–stimulated DNA synthesis in the liver
Authors: Kenneth R. Feingold, Mary E. Barker, Albert L. Jones, Carl Grunfeld
Journal: Hepatology (1991)

Tumor necrosis factor and other cytokines mediate the body's response to infection and inflammation. Long-term administration of tumor necrosis factor causes liver hypertrophy, and our laboratory has shown that tumor necrosis factor acutely increases hepatic DNA synthesis. The purpose of this study was to determine which specific cell types in the liver undergo DNA synthesis in response to tumor necrosis factor. Light microscopic autoradiographs of 3H-thymidine incorporation demonstrate that tumor necrosis factor stimulates DNA synthesis in nonparenchymal cells, whereas the low level of DNA synthesis normally found in hepatocytes remains unaffected. Tumor necrosis factor increased labeling in sinusoidal cells that appeared to be Kupffer cells and in cells localized to the portal tracts. With electron microscopy and histochemical staining for endogenous peroxidase, the sinusoidal cells were clearly identified as Kupffer cells. The exact identity of the cells in the portal tract is less certain, but some of the cells shared the characteristics of bile duct precursors. With long-term administration of tumor necrosis factor, a striking proliferation of bile ducts was seen. The functional role of the proliferation of bile ducts in response to tumor necrosis factor is unclear, and it is not known whether the increase is a beneficial or deleterious response. The increased DNA synthesis in Kupffer cells could result in a potentially beneficial response to infection by increasing an animal's ability to phagocytize and clear microorganisms. However, under some circumstances, an expansion of the number of Kupffer cells could be deleterious by increasing an animal's ability to produce tumor necrosis factor and other cytokines that in large quantities can have toxic effects.
Prevalence of nonspecific cutaneous vascular lesions and association with antiphospholipid antibodies in patients with systemic lupus erythematosus
Authors: T. Hawro, M. Maurer, A. Sysa-Jędrzejowska, A. Woźniacka
Journal: British Journal of Dermatology (2012)

Funding sources: this work was supported by the Medical University of Lodz [grant number 503/1‐152‐01/503‐01]. Madam, Lupus nonspecific vascular skin lesions are widely expressed in systemic lupus erythematosus (SLE), but are also found in other diseases. Their distribution, prevalence and association with antiphospholipid antibodies in SLE remain to be characterized in detail. Underlying vasculitic or thromboembolic pathologies are considered.1 The aim of this study was to evaluate clinical correlations of lupus nonspecific vascular skin manifestations in patients with SLE and to investigate the relationship between particular skin lesions that are vascular in type, and antiphospholipid antibodies. The cross‐sectional study included 68 consecutive patients (63 women) recruited from a dermatology clinic. The mean age of the patients was 42·6 ± 12·1 years. All patients fulfilled at least four revised American College of Rheumatology classification criteria for SLE.2 The mean disease duration was 8·1 ± 8·6 years. The mean SLE activity measured using the Systemic Lupus Activity Measure3 was 10·6 ± 6·0. The lupus anticoagulant assay was performed according to the Scientific and Standardization Committee of the International Society of Thrombosis and Haemostasis.4 None of subjects received anticoagulants. Anticardiolipin and anti‐β2‐glycoprotein‐I (anti‐β2GPI) antibodies (IgG, IgM, IgA) were assessed by immunoassay using 99 percentile cut‐off values determined in the control group. Assays for antiphospholipid antibodies were performed twice for each patient with an interval of at least 12 weeks, according to the Sydney classification criteria.5 Only patients positive in both assessments were considered as positive for further analyses. The same blood tests were performed in a control group (to establish reference values), which consisted of 69 age‐ and sex‐matched healthy volunteers. In this group the antiphospholipid assay was performed once. Statistical analyses were performed with SPSS v17·0 (SPSS Inc., Chicago, IL, U.S.A.). The differences in disease activity were assessed using the nonparametric Mann–Whitney test. Qualitative differences were analysed by the Fisher exact test. To estimate the odds ratio (OR) for the occurrence of nonspecific skin lesions in the presence of antiphospholipid antibodies, a logistic regression model was employed.
Letter from Brasilia: Some primitive peoples of the tropics
Authors: P D Marsden
Journal: BMJ (1994)

Few “primitive” peoples now exist, as Western communications, material goods, and forms of transport have swept the globe. Through studying malaria I came into contact with several primitive tribes, including the people of Wingei and Wam in the Sepik area of New Guinea and the Brazilian Indians of the Amazon. The Brazilian Indians are true environmental ecologists, wasting nothing and knowing how to conserve stocks of fish, animals, and fruits. All these primitive groups seemed to suffer from tinea imbricata, caused by Trichophyton concentricum and characterised by whirled fungal scales over the skin and often a smell of gorgonzola cheese.

“Primitive” people are rapidly disappearing as Homo sapiens creates a global monoculture based on such material values as television, refrigeration, and transport modes. My first contact with tribal primitive man was while driving through the Congo basin rainforest in 1963. On a straight stretch of dirt road I saw a man lying prone in the path of my Volkswagen. He seemed to be dead so I stopped and went forward on foot. Suddenly he sat up and at that signal more than a hundred pygmies emerged from the forest and surrounded my car. They were naked except for a small genital cover and carried spears and …
VLA-4 antagonist WAY160103 (WAY) inhibits VCAM-1 activated eosinophil (EOS) respiratory burst but promotes eosinophil derived neurotoxin (EDN) degranulation*1
Authors: A.M. Brooks, J.B. Sedgwick, K.J. Jansen, H. Kita, D. Squillace, J.D. Kennedy, W.W. Busse
Journal: Journal of Allergy and Clinical Immunology (2004)
Vascular Klotho Deficiency Potentiates the Development of Human Artery Calcification and Mediates Resistance to Fibroblast Growth Factor 23
Authors: Kenneth Lim, Tzong-Shi Lu, Guerman Molostvov, Christina Lee, F.T. Lam, Daniel Zehnder, Li-Li Hsiao
Journal: Circulation (2012)

Klotho is known to function as a cofactor for the phosphatonin, fibroblast growth factor (FGF)-23 at the kidney. FGF-23 levels rise in chronic kidney disease (CKD) despite progression of accelerated vascular calcification. There are currently conflicting data on whether FGF-23 may exhibit direct vasculoprotective effects in CKD.In this study, we describe for the first time endogenous Klotho expression in human arteries and human aortic smooth muscle cells. We show that CKD is a state of vascular Klotho deficiency promoted by chronic circulating stress factors, including proinflammatory, uremic, and disordered metabolic conditions. Mechanistic studies demonstrated that Klotho knockdown potentiated the development of accelerated calcification through a Runx2 and myocardin-serum response factor-dependent pathway. Klotho knockdown studies further revealed that vascular cells are a Klotho-dependent target tissue for FGF-23. FGF-23 mediated cellular activation of p-ERK, p-AKT, and cellular proliferative effects, which were abrogated following Klotho knockdown. We next showed that vascular Klotho deficiency driven by procalcific stressors could be restored by vitamin D receptor activators, in vitro and further confirmed using human arterial organ cultures from CKD patients, in vivo. Furthermore, restoration of suppressed Klotho expression by vitamin D receptor activators conferred human aortic smooth muscle cells responsive to FGF-23 signaling and unmasked potential anticalcific effects.Chronic metabolic stress factors found in CKD promote vascular Klotho deficiency. Mechanistic studies revealed a bifunctional role for local vascular Klotho, first, as an endogenous inhibitor of vascular calcification and, second, as a cofactor required for vascular FGF-23 signaling. Furthermore, vitamin D receptor activators can restore Klotho expression and unmask FGF-23 anticalcific effects.
Ambulance Diversion and Survival Among Patients With Acute Myocardial Infarction
Authors: O. A. Soremekun, D. F. M. Brown, J. M. Pines
Journal: JAMA (2011)

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
Gastric Intramucosal Carcinoma in a Small Hyperplastic Foveolar Polyp
Authors: A. Okano, H. Takakuwa, Y. Matsubayashi
Journal: Endoscopy (2004)

Figure 1 In this patient, upper gastrointestinal endoscopy revealed a 6-mm sessile elevated lesion in the greater curvature of the middle gastric body. The surface of the lesion was lobulated, and an erosion was noticed on the top. It was removed by electrosurgical snare polypectomy.
Prospective cohort studies: advantages and disadvantages
Authors: P. Sedgwick
Journal: BMJ (2013)

Researchers investigated the association between opium use and subsequent risk of death. A prospective cohort study design was used. Participants were 50 045 people in north-eastern Iran aged 40-75 years at baseline. Recruitment took place between January 2004 and June 2008, and participants were followed until May 2011. The median length of follow-up was 4.7 years per participant. The main outcomes were death from all causes, plus all major subcategories.1

Information about opium use was collected at baseline. Participants were asked their age when they started using opium and subsequent length of use, typical amount used, frequency of use, and routes of administration. Information about exposure to a wide variety of other risk factors, including tobacco smoking and alcohol consumption, was also collected at baseline. During follow-up, participants were contacted annually by telephone with detailed questions about their health status and any hospital admissions or outpatient procedures. Opium use and exposure to other risk factors were not systematically updated.

The study concluded that opium users have an increased risk of death from multiple causes compared with non-users. Increased risks were also seen in people who had used low amounts of opium for a long period, plus those who had no major illness before use.

Which of the following statements, if any, are true?

Statement a , b , and d …
A patient with hypertrophic cardiomyopathy undergoing non-cardiac surgery
Authors: T. C. N. Elias, J. S. L. Partridge, S. A. McCorkell, J. K. Dhesi
Journal: BMJ (2013)

A 73 year old woman with hypertension who presented with exertional chest pain was found to have a harsh ejection systolic murmur, with features of left ventricular hypertrophy on electrocardiography. Coronary angiography showed normal coronary arteries and transthoracic echocardiography detected concentric thickening of the left ventricular wall, with hyperdynamic systolic function. These findings were thought to be secondary to hypertension, which was managed with ramipril 10 mg and amlodipine 5 mg.

Three years later she returned with breathlessness, and further transthoracic echocardiography suggested severe obstruction of the left ventricular outflow tract owing to systolic anterior motion of the anterior mitral leaflet, with an outflow gradient of up to 160 mm Hg. She was diagnosed with hypertrophic cardiomyopathy and was managed with bisoprolol 5 mg. Her symptoms improved and no arrhythmias were found on 24 hour electrocardiography (figure⇓).

Two years later she developed painful abdominal distension with anaemia. Computed tomography demonstrated bilateral ovarian masses. She was listed for a total abdominal hysterectomy and bilateral salpingo-oophorectomy. The indication for surgery was symptom relief and suspected cancer.



Electrocardiogram with some typical features of hypertrophic cardiomyopathy





### 1 What are the pathophysiological changes of hypertrophic cardiomyopathy?

#### Short answer

Hypertrophic cardiomyopathy is an autosomal dominant genetic disorder characterised by left ventricular hypertrophy, impaired diastolic filling, and abnormalities of the mitral valve. These features can cause dynamic obstruction of the left ventricular outflow tract, diastolic dysfunction, myocardial ischaemia, and an increased risk of supraventricular and ventricular tachyarrhythmias.

#### Long answer

It is thought that a genetic mutation in one of …
Entitlement to Veteran's Medical Benefits
Authors: D. L. Elliot
Journal: JAMA (1983)

<h3>To the Editor.—</h3> Economic times have forced many veterans to inquire about their entitlement to medical care through the Veterans Administration. Lack of knowledge about entitlement for VA medical benefits results in expense and inconvenience for the veteran and his physician. Although detailed in VA pamphlets available on request, this information has not appeared in the medical literature. Entitlement to medical care is based on many factors, including time since discharge, percent of serviceconnected (SC) disability, pension rating, period of service, and gender. Claims for disability must be filed by the veteran, whose claim will be evaluated and adjudicated by the VA. The categories of VA entitlement are given in the Table. Veterans are considered to be SC on a prima facie basis for six months after their discharge from military service. A decision is made by a VA physician whether the condition to be treated could reasonably be related
Management of blood loss in children of Jehovah's Witnesses
Authors: J. A Morecroft, R. A Wheeler, D. P Drake, V. M Wright
Journal: BMJ (1996)

sion of HIV can be reduced to less than 5% is almost unbelievable-but he does not stop there.He then wags a righteous finger at women who do not know they have HIV infection for not finding out, by not having themselves tested antenatally, in spite of all the known reasons why women do not get tested antenatally.The Department of Health had a consultation with a large group of women from a range of voluntary organisations involved in HIW/AIDS work in January 1994, in which the problematic issues of antenatal testing were thoroughly aired.It seems that the message-that the supposed benefits to both mother and baby are not at all clear cut-has been lost.One hospital, Steer says, emphasises to women that "knowing their HIV status may save their baby's life."In so many words, he is saying that 95 out of 100 babies of HIV positive women need no longer be at risk of H1V infection.This is patently false.It is ridiculous and dangerous to reduce the situation in this manner, especially since someone might believe him.
Education, occupation, and Alzheimer's disease
Authors: C. I. Cohen
Journal: JAMA (1994)

To the Editor.  —Dr Stern and colleagues 1 propose that increased educational and occupational attainment may reduce the incidence of AD. However, because the authors fail to consider seriously the effects of poverty on exacerbating or complicating the course of AD, I believe that their conclusion may be premature. In their study, the low education/low occupation group had the highest rate of dementia. This group had an incidence of dementia of 24.9% during the follow-up period (roughly two thirds of this group were seen between 1 and 2.9 years after baseline). For a sample with a mean age of 75 years, this incidence rate is strikingly high. 2 Because low education/low occupation is likely associated with low income, it seems warranted to hypothesize that lifestyle, physical illness, health care, and environmental factors associated with poverty may contribute to diminishing the cerebral reserve of persons with AD. Thus, those who are
Fibrotic disorders in the eye: Targets of gene therapy
Authors: Shizuya Saika, Osamu Yamanaka, Takayoshi Sumioka, Takeshi Miyamoto, Ken-ichi Miyazaki, Yuka Okada, Ai Kitano, Kumi Shirai, Sai-ichi Tanaka, Kazuo Ikeda
Journal: Progress in Retinal and Eye Research (2007)
Immunotherapy of a murine tumor with interleukin 2. Increased sensitivity after MHC class I gene transfection.
Authors: J S Weber, G Jay, K Tanaka, S A Rosenberg
Journal: The Journal of Experimental Medicine (1987)

We have shown that two weakly immunogenic MCA sarcomas developed in our laboratory that are sensitive to high-dose IL-2 immunotherapy express class I MHC in vivo and in vitro. Two nonimmunogenic MCA sarcomas are relatively insensitive to IL-2 therapy and express minimal or no class I MHC molecules in vivo and in vitro. To study the role of MHC in the therapy of tumors with IL-2, a class I-deficient murine melanoma, B16BL6, was transfected with the Kb class I gene. Expression of class I MHC rendered B16BL6 advanced pulmonary macrometastases sensitive to IL-2 immunotherapy. 3-d micrometastases of CL8-2, a class I transfected clone of B16BL6, were significantly more sensitive to IL-2 therapy than a control nontransfected line. Expression of Iak, a class II MHC molecule, had no effect on IL-2 therapy of transfectant pulmonary micrometastases in F1 mice. By using lymphocyte subset depletion with mAbs directed against Lyt-2, therapy of class I transfectant macrometastases with high-dose IL-2 was shown to involve an Lyt-2 cell. In contrast, regression of micrometastases treated with low-dose IL-2 involved Lyt-2+ cells, but regression mediated by high doses of IL-2 did not. We hypothesize that both LAK and Lyt-2+ T cells effect IL-2-mediated elimination of micrometastases, but only Lyt-2+ T cells are involved in macrometastatic regression. Low doses of IL-2 stimulate Lyt-2+ cells to eliminate class I-expressing micrometastases, but high doses of IL-2 can recruit LAK cells to mediate regression of micrometastases independent of class I expression. Only high-dose IL-2, mediating its effect predominantly via Lyt-2+ cells, is capable of impacting on MHC class I-expressing macrometastases. Macrometastases devoid of class I MHC antigens appear to be resistant to IL-2 therapy.
1035 Does harvesting the median hepatic vein in right hepatectomy for living-donor liver transplantation increase the risk for the donors?
Authors: O SCATTON, F DONDERO, D GOERE, R KIANMANESH, D SOMMACALE, M PLASSE, A SAUVANET, F DURAND, O FARGES, J BELGHITI
Journal: Hepatology (2003)

With the extensive use of living donor liver grafts in adult patients, controversy over small-for-size syndrome has escalated in recent years. Although several symptoms have been suggested as manifestations of the syndrome, small-for-size syndrome remains difficult to diagnose because these symptoms are neither specific nor inevitable. The occurrence of small-for-size syndrome also seems to depend on a number of recipient and graft factors. Potential pathogenic mechanisms include persistent portal hypertension and portal overperfusion. At present, several techniques are being explored in an attempt to ameliorate the impact of small-for-size syndrome. Recent experience suggests that the occurrence of small-for-size syndrome is multifactorial and that complications relating to small-for-size grafts should be examined in relation to a variety of graft, recipient, and technical factors. (Liver Transpl 2003;9:S29-S35.)
PRIMARY TUMOR OF THE THYMUS ASSOCIATED WITH TUBERCULOSIS
Authors: HENRY C. SWEANY
Journal: JAMA (1923)

Ewing<sup>1</sup>classifies primary tumors of the thymus in three groups: (1) lymphosarcoma, or thymoma; (2) carcinoma, and (3) spindle-cell sarcoma (very rare). By far the greatest number fall within the first class. There seems to be considerable question whether the so-called carcinomas of the thymus are carcinomas or merely a variety of the first group. The lymphosarcoma of the thymus, or, more truly, the thymoma, presents a condition almost identical with that presented by the lymphosarcoma of the lymph glands. Clinically, they are indistinguishable; but histologically, there are certain well established differences, which may be roughly comparable to the differences between the structures of the lymph and of the thymus glands. The one outstanding point of difference in the primary tumor of the thymus is the fact that the reticular cells are larger and more nearly polyhedral, and they originate from the endoderm rather than from the mesoderm, as