tbuckley/cabot-search huggingface dataset:
Serum immunoreactive trypsin in cystic fibrosis.
Authors: P Dandona, M Hodson, J Bell, L Ramdial, I Beldon, J C Batten
Journal: Thorax (1981)

Serum immunoreactive trypsin (IRT) concentrations were measured blind in sera from 33 patients with cystic fibrosis and in 32 age-matched controls. Thirty-two patients had abnormal trypsin concentrations. In 30 of these patients the level of IRT was very low whereas in the other two (the youngest of the group) it was extremely high. All 30 patients with low IRT concentrations had clinical or biochemical evidence of malabsorption. Serum IRT concentration may thus be a useful diagnostic test for cystic fibrosis. In view of the recent observation that neonates with cystic fibrosis consistently have raised IRT concentrations, and the fact that the youngest two patients in our series also had markedly increased IRT, it would appear that the initial elevation of IRT reflects early damage to the pancreas with release of enzyme/zymogen; this is thereafter superseded by a progressive destruction of the pancreas resulting in low IRT concentrations in adults with cystic fibrosis.
Humanitarian groups boost aid to assist casualties and civilians displaced in Libyan conflict
Authors: J. Zarocostas
Journal: BMJ (2011)

International relief agencies and charity groups have stepped up the flow of humanitarian supplies—including medicines and food—to assist casualties, and tens of thousands of civilians displaced by the escalation of hostilities in Libya between government forces and opposition rebels.

The surge in aid includes efforts to distribute urgently needed medical supplies in cities where fierce fighting is ongoing, especially in the western part of the country, and where, according to some estimates, up to 700 000 people could have limited access to health services.

Aid groups are looking at various ways to dispatch urgently needed drugs …
Cocaine-Packet Ingestion
Authors: Dennis S. Caruana, Bernard Weinbach, David Goerg, Laurence B. Gardner
Journal: Annals of Internal Medicine (1984)

We treated 50 patients who ingested packets of cocaine and developed a protocol for conservative medical management. Of the 50 patients, only 3 required emergency surgery. Surgery was precipitated by signs and symptoms of bowel obstruction in all cases. Six patients chose elective surgery. The rest of the patients passed the packets without signs of cocaine toxicity or other complications. This finding is in contrast to that of previous reports. Asymptomatic patients who have ingested packets of cocaine can be safely observed and managed conservatively.
Control of blood pressure in Scotland: the rule of halves.
Authors: W C Smith, A J Lee, I K Crombie, H Tunstall-Pedoe
Journal: BMJ (1990)

OBJECTIVE--Audit of detection, treatment, and control of hypertension in adults in Scotland. DESIGN--Cross sectional survey with random population sampling. SETTING--General practice centres in 22 Scottish districts. SUBJECTS--5123 Men and 5236 women aged 40-59 in the Scottish heart health study, randomly selected from 22 districts throughout Scotland, of whom 1262 men and 1061 women had hypertension (defined as receiving antihypertensive treatment or with blood pressure above defined cut off points). MAIN OUTCOME MEASURE--Hypertension (assessed by standardised recording, questionnaire on diagnosis, and antihypertensive drug treatment) according to criteria of the World Health Organisation (receiving antihypertensive treatment or blood pressure greater than or equal to 160/95 mm Hg, or both) and to modified criteria of the British Hypertension Society. RESULTS--In half the men with blood pressure greater than or equal to 160/95 mm Hg hypertension was undetected (670/1262, 53%), in half of those in whom it had been detected it was untreated (250/592, 42%), and in half of those receiving treatment it was not controlled (172/342, 50%). In women the numbers were: 486/1061, 46%; 188/575, 33%; and 155/387, 40% respectively. Assessment of blood pressure according to the British Hypertension Society9s recommendations showed an improvement, but in only a quarter of men and 42% of women was hypertension detected and treated satisfactorily (142/561, 215/514 respectively). IMPLICATIONS--The detection and control of hypertension in Scotland is unsatisfactory, affecting management of this and other conditions, such as high blood cholesterol concentration, whose measurement is opportunistic and selective and depends on recognition of other risk factors.
Superiority of Letrozole Over Tamoxifen in the First-Line Treatment of Metastatic Breast Cancer Patients With Normal Serum <i>HER-2/neu</i> Levels: Question of Tamoxifen Resistance
Authors: Kadri Altundag, Ozden Altundag
Journal: Journal of Clinical Oncology (2003)

Quality of Life After Treatment for Prostate Cancer: No Difference Between Surgery and Radiotherapy?To the Editor: We read with great interest the recent article by Penson et al, 1 reporting on general health-related quality of life (HRQOL) outcomes in a cohort of 2,306 assessable patients, diagnosed in 1994 and 1995, 2 years after treatment with either radical prostatectomy (RP), radiotherapy (RT), hormone ablation, or watchful waiting.The main results were that no significant differences between the various treatment modalities were detected, and that impaired urinary and sexual function and the resulting bother were associated with significantly reduced scores in the majority of general HRQOL domains assessed.Such studies comparing quality of life between different modalities of prostate cancer treatment are of great importance, given that the rates of tumor control appear to be remarkably similar between different treatment approaches, as supported by a recent interspecialty comparison of data from leading centers. 2Penson et al 1 confirm prospectively previous findings that the profile of organ toxicity is treatment-specific and that this toxicity has an impact on general HRQOL domains. 3,4 Despite repeatedly stating that there are no significant differences in general HRQOL between treatment groups, the article by Penson et al 1 does not convince us that HRQOL was equal after surgery and RT.It appears striking that although they give scores for each HRQOL domain by subgroup (good v poor urinary function, etc), the authors do not present such raw data for the different treatment groups, but rather show only global means for the overall cohort.Also, the different grouping of patients at baseline (eg, "any urinary leak" v "total cohort") and at 2 years ("frequent leakage/no control" v "occasional leakage/total control") prevents the reader from estimating the true impact of each treatment on organ function.Despite this limitation, the effect of RP on urinary function ("any leak" at baseline, 12%; "frequent leakage/no control" at 2 years, 21.5%) compares unfavorably to that of RT ("any leak" at baseline, 25%; "frequent leakage/no control" at 2 years, 3.3%).This observation in conjunction with the impact of urinary function on HRQOL in the overall cohort would make us suspect that there should be at least a trend toward better HRQOL after RT than after RP.Considering the large size of the cohort, it would be of great interest to present the HRQOL data for each treatment modality in order to avoid any bias in data interpretation.Any conclusion from possible HRQOL differences between treatment approaches for current clinical practice will have to be drawn with care, as advances in both surgical and radiotherapeutic techniques since the mid-1990s have been shown to decrease organ toxicity and improve quality of life. 5,6
Sorting Out Breast-Cancer Gene Signatures
Authors: Joan Massagué
Journal: New England Journal of Medicine (2007)

The advent of technology for the analysis of human tissue samples for the activity of the entire genome initiated a quest for the molecular profiling of tumors. The aim of this quest was a better system for classifying cancers, a clarification of the origin of these diseases, a more accurate prognostic capacity than was previously available, and an improved ability to choose among possible therapies. Progress in the molecular profiling of solid tumors began with the identification of sets of genes whose expression can be used to classify breast cancers into five so-called intrinsic subtypes.1 Soon thereafter, two independent comparisons . . .
Competition and the Cost of Hospital Care
Authors: Allan Blackman
Journal: JAMA (1987)

<h3>To the Editor.—</h3> Robinson and Luft<sup>1</sup>have done us a service by confirming the hypothesis that nonprice competition increased hospital per admission and per diem costs during the 1970s. Nonetheless, their data and their conclusions are both premature. In most parts of the country, price competition did not really take hold until after 1982. Significant changes in the incentives built into government and private health insurance plans, the development of preferred provider organizations, and effective demands for discounts from hospitals did not take place until the last two or three years. So we are only now beginning to see some real price competition among hospitals, and it is certainly too soon to know what its effect will be on hospital costs. Per admission and per diem costs are poor measures of the impact of competition on hospital costs. As insurance plans succeed in getting physicians to reduce their use
The Nazi Doctors: Medical Killing and the Psychology of Genocide
Authors: Burton C. Einspruch
Journal: JAMA (1987)

If a lexicon were compiled of the greatest inhumanities man has visited on his fellows, the Holocaust would surely be the preeminent subject. The Nazi "final solution," promulgated in January 1942 at the Wansee Conference, was dedicated to the permanent eradication of Judaism. It was not a conceptual reshuffling of religious identity by conversion but rather a physical destruction. This genocidal purging was deemed a necessary program to rid the world, and more specifically the Aryan people, of the genetic reservoir of polluting Jewish genes. How this monstrous endeavor could be conceived and accomplished is the subject of Robert Jay Lifton's<i>The Nazi Doctors</i>. Dr Lifton, a renowned psychiatrist and author, spent a decade interviewing Nazi doctors and concentration camp survivors to piece together the horrifying process by which German physicians aided (for the most part willingly) in the destruction of 6 million innocent men, women, and children. Dr Lifton
RELATIONSHIP BETWEEN POSITIVE REMODELED LESIONS ON CTA AND THE PRESENCE OF VULNERABLE PLAQUE ON VH IVUS
Authors: Eleanore S. Kroner, Joella E. van Velzen, Mark J. Boogers, Hans-Marc Siebelink, Martin Schalij, Lucia Kroft, Albert de Roos, Ernst E. van der Wall, J Wouter Jukema, Johan H. Reiber, Joanne D. Schuijf, Jeroen J. Bax
Journal: Journal of the American College of Cardiology (2011)
Inhibition of Angiotensin-Converting Enzyme for Diagnosis of Renal-Artery Stenosis
Authors: Richard Re, Robert Novelline, Marie-Therese Escourrou, Christos Athanasoulis, James Burton, Edgar Haber
Journal: New England Journal of Medicine (1978)

To determine its utility as an aid in diagnosis of renovascular hypertension, we administered nonapeptide converting-enzyme inhibitor (CEI) (which inhibits conversion of angiotensin I to angiotensin II) (0.25 mg per kilogram) to 14 unselected hypertensive patients undergoing bilateral renal-vein catheterization. In seven (Group I) predominantly unilateral disease was discovered by angiography (renal-artery stenosis in six and hydronephrosis in one); in the remaining seven (Group II) no renal-artery abnormality was found. In Group I, mean (±S.E.) ratio of involved to uninvolved renal-vein plasma renin activity (PRA) increased from 2.94±0.91 before to 8.36±2.94 after CEI (P<0.01). In Group II, the ratio (of the initially higher to the lower side) was 1.99±0.49 before and 1.17±0.07 after CEI (P>0.2). Post-CEI PRA was predicted by pretreatment PRA. Mean blood pressure fell in both groups after CEI, and the decrement was predicted by pre-CEl PRA. These data suggest that CEI can be of use at the time of renal-vein catheterization, serving to increase diagnostic accuracy by increasing the difference in PRA between the two sides when there is unilateral disease. (N Engl J Med 298:582–586, 1978)
Expression of the hepatocellular chloride-dependent sulfobromophthalein uptake system in Xenopus laevis oocytes.
Authors: E Jacquemin, B Hagenbuch, B Stieger, A W Wolkoff, P J Meier
Journal: Journal of Clinical Investigation (1991)

The expression of the basolateral chloride-activated organic anion uptake system of rat hepatocytes has been studied in Xenopus laevis oocytes. Injection of oocytes with rat liver poly(A)+RNA resulted in the functional expression of chloride-dependent sulfobromophthalein (BSP) uptake within 3-5 d. This expressed chloride-dependent BSP uptake system exhibited saturation kinetics (apparent Km approximately 6.2 microM) and efficiently extracted BSP from its binding sites on BSA. Furthermore, the chloride-activated portion of BSP uptake was inhibited by bilirubin (10 microM; inhibition 53%), 4,4'-diisothiocyano-2,2-disulfonic acid stilbene (DIDS, 100 microM; 80%), taurocholate (100 microM; 80%), and cholate (200 microM; 95%). In contrast to results with total rat liver mRNA, injection of mRNA derived from the Na+/bile acid cotransporter cDNA (Hagenbuch, B., B. Stieger, M. Foguet, H. Lübbert, and P. J. Meier. 1991. Proc. Natl. Acad. Sci. USA. In press.) had no effect on BSP uptake into oocytes. Size fractionation of total rat liver mRNA revealed that a 2.0- to 3.5-kb size-class mRNA was sufficient to express the hepatic chloride-dependent BSP uptake system. These data indicate that "expression cloning" in oocytes represents a promising approach to ultimately clone the cDNA coding for the hepatocyte high affinity, chloride-dependent organic anion uptake system. Furthermore, the results confirm that the Na+/bile acid cotransport system does not mediate BSP uptake.
<i>BRCA1/2</i> Genetic Testing in the Community Setting
Authors: Wendy Y. Chen, Judy E. Garber, Suzanne Higham, Katherine A. Schneider, Katie B. Davis, Amie M. Deffenbaugh, Thomas S. Frank, Rebecca S. Gelman, Frederick P. Li
Journal: Journal of Clinical Oncology (2002)

BRCA1/2 genetic testing has been commercially available in the United States since 1996. Most published reports described BRCA1/2 testing as research studies at large academic centers, but less is known about testing in the community. This study evaluates the process and early outcomes of BRCA1/2 genetic testing as a clinical service in the community setting.Surveys were mailed to women in the United States whose health care providers ordered BRCA1/2 genetic testing from Myriad Genetic Laboratories from August 1998 through July 2000. Women tested at 149 large academic centers were excluded. Main outcome measures were demographic characteristics, recall of and satisfaction with the genetic testing process, and likelihood of pursuing cancer prevention strategies.Among the 646 respondents, 414 (64%) had a personal history of cancer and 505 (78%) had at least one first-degree relative with breast and/or ovarian cancer. Most subjects (82%) recalled discussions of informed consent before testing (median time, 30 minutes). Genetic results were conveyed during an office visit (57%), by telephone (39%), or by mail (3%). More than 75% of respondents were "very satisfied with the counseling received." Cancer-free subjects with a germline mutation were more likely to consider prevention strategies after receiving the genetic results.Virtually all respondents had a personal and/or family history of breast/ovarian cancer. Although pretest and posttest communications were not standardized, overall satisfaction with clinical breast cancer genetic testing was high. Additional follow-up will provide data on future cancer prevention practices and cancer incidence.
Pitch side combined assessment for suspected ankle fractures
Authors: H Pechlivanidis, N Malliaropoulos, D Christodoulou
Journal: British Journal of Sports Medicine (2011)

Objective To assess the sensitivity of two musculoskeletal tests as primary examination for on site use. Methods I searched through electronic search engines for articles ranging from 2000 to 2010. I used the key words: ankle injuries, ankle examination, ankle assessment and tuning fork. Data synthesis Ankle injuries are a common injury in sport accounting for 15–45% of all sport injuries. 85% of all ankle injuries concern the lateral ankle complex. However differential diagnosis suggests the examination of fractures such as at the malleolus, fifth metatarsal, navicular, anterior calcaneus process and at the midtarsal bones. During sport events in the misfortune incidence of an ankle injury physicians are required to assess their athletes. However according to each games rules and situation they are required to assess in shortest time possible. Ottawa ankle rules (OAR) have been suggested to have a high sensitivity to detect to assess fractures (Northrup et al 2005; Papacostas et al 2001). Papacostas et al (2001) examined 122 patients and found 100% sensitivity for maleolar and midfoot fractures when applied the OAR. Leddy et al (2002) found 100% sensitivity in 217 patients applying the OAR-Buffalo modification. Moore (2009) found high sensitivity (n=10) using a tuning fork for the detection of transverse fractures. Further is suggested that the use of a tuning fork is an fast and reliable method to assess possible fractures (Moore 2009). Conclusion We believe that the combination of those two tools can provide a clear and fast initial evaluation during an event. Nevertheless in a clinical or on site setting can further increase reliability for assessing fractures where x-ray is not available. However, further investigation is required regarding the reliability of the tuning fork in assessing fractures, reliability of the examiner and time required to complete the progressive examination.
Salt and asthma.
Authors: A J Knox
Journal: BMJ (1993)

Danish Medical Association she said that she had sent a delegation to London to test the seriousness of the British demand to exempt doctors in training from the directive.6Britain threatened to vote against the directive unless doctors in training were exempted. (As it was, Britain abstained from voting.)The British government advanced no specific arguments for its position."We were in the position either of exempting doctors in training or of abandoning the directive," said Ms Andersen."And since here we are talking only about a directive that sets up minimum requirements and does not change our options for maintaining the previous positions or improving them, we accepted."Later in the interview she said that the directive applied the moment a doctor finished his or her training: "It is exclusively doctors undergoing training who are exempted."If her interpretation is correct the doctors in training grade posts who have completed their specialist training would be covered under the terms of the directive.According to rumours circulating in Brussels before the meeting, British officials had reportedly estimated the cost of not exempting British doctors in training as being 100m.Money therefore seems the most likely explanation why junior doctors will not be covered by protective regulations that apply to other professionals in the health sector and to most other European employees.The Permanent Working Group of European Junior Hospital Doctors believes that it is unreasonable to exclude doctors in training, or anybody else in the health sector, from protective regulation when the only argument for doing so is cost.Junior doctors should be covered by the draft directive because it is in their interests and those of their patients.
Selective turnover and shedding of H-2K and H-2D antigens is controlled by the major histocompatibility complex. Implications for H-2-restricted recognition.
Authors: S G Emerson, D B Murphy, R E Cone
Journal: The Journal of Experimental Medicine (1980)

Lactoperoxidase-catalyzed cell surface radioiodination and incorporation of [3H]-leucine were employed to radiolabel H-2K and H-2D antigens of murine spleen cells. The fate of H-2 antigens was monitored by in vitro culture of labeled cells and isolation of labeled antigens from detergent lysates of the cells and culture supernates obtained at different times during culture. H-2Kk antigens were found to be rapidly turned over and shed by CBA/J cells, whereas the turnover of H-2Dk antigens was extremely slow. Analysis of the membrane residence times of surface-labeled H-2K and H-2D antigens on spleen cells from various H-2-congenic and -recombinant strains demonstrated variations in the shedding rates of H-2K and H-2D antigens, which were controlled by genes mapping in the major histocompatibility complex. These variations show a striking correlation with published, genetically controlled quantitative variations in the cytotoxic response of T lymphocytes to chemically modified or virus-infected syngeneic cells.
Reassessing hospital readmission penalties
Authors: D. Kamerow
Journal: BMJ (2013)

Will Obamacare’s reductions in hospital readmissions improve the quality of care?



The Patient Protection and Affordable Care Act of 2010 is midway through its four year implementation period. The centerpiece of the law is the requirement for near universal healthcare insurance coverage. It becomes effective in 2014.

So much for the patient protection part of “Obamacare.” What about the affordable care aspect: cutting the hugely expensive costs in the US healthcare system? The act has always been weaker in that regard, but it does have some cost cutting measures. One that has already raised a ruckus is section 3025, the Hospital Readmissions Reduction Program.

Under this program the Centers for Medicare and Medicaid Services (CMS) began reducing payments to hospitals with excess readmissions of patients with certain conditions in October last year. CMS began with three sentinel conditions—heart failure, myocardial infarction, and pneumonia—and is penalizing hospitals whose 30 day rates of readmission of patients with these diagnoses are higher than would be expected from each hospital’s case mix. In the first year of the program 2000 hospitals will lose about $300m (£194m; …
Arterioesophageal fistula secondary to rupture of an aberrant right subclavian artery aneurysm: a rare differential diagnosis in upper gastrointestinal bleeding
Authors: B. Lehmann, I. Clemetson, A. Fantin, P. Henning, B. Kipfer, R. Mühlethaler, G. Vetsch, H.-P. Dinkel
Journal: Endoscopy (2006)

A 78-year-old man was admitted to hospital due to massive, bright red hematemesis. As he was hemodynamically unstable, vigorous resuscitation procedures were initiated. Esophagogastroduodenoscopy (EGD) showed a large Mallory-Weiss lesion and a necrotic polypoid lesion about 4 cm below the upper esophageal sphincter (Figure [1]). No active bleeding was visible. Six hours later, there was again an abrupt onset of torrential, bright red hematemesis. The bleeding did not stop before the insertion of a Sengstaken-Blakemore tube into the upper esophagus. Angiography of the thoracic aorta revealed a ruptured aneurysm in an aberrant right subclavian artery (ARSA). Because of the expected high mortality of a surgical intervention in this situation, all treatment efforts were withdrawn, and the patient died 14 h after admission. The autopsy showed a ruptured aneurysm of an ARSA with an arterioesophageal fistula (Figure [2]).
Block the zinc, starve the virus
Authors: Hema Bashyam
Journal: The Journal of Experimental Medicine (2007)

![Graphic][1] 

EVERs keep zinc out of the nucleus by trapping zinc transporters (green) at the ER (red). Zinc might strengthen our immune systems and fortify our bones, but it also helps a cancer-causing skin virus take hold, according to Lazarczyk et al. (page 

[35][2]).

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