tbuckley/cabot-search huggingface dataset:
Royal college recommends national system to recognise deteriorating patients
Authors: N. Hawkes
Journal: BMJ (2012)

All acutely ill adult patients in NHS hospitals should be assessed by the same standardised clinical dataset to help detect those who are deteriorating rapidly and who need more intensive support, a working party from the Royal College of Physicians of London has recommended. 

The national early warning score (NEWS) would be used to assess acute illness, detect deterioration in a patient’s condition, and prompt a timely and competent clinical response. Such a “track and trigger” system, implemented to a common pattern nationally, would make for a step change in the care of acute illness, said Richard Thompson, the college’s president.

Many hospitals already have such systems in place, admitted Bryan Williams, professor of medicine at University College London, who chaired the group responsible for the recommendation. These systems represent a lot of work, and their originators are firmly wedded to them, …
Medical Education and Practice in Israel
Authors: Alex M. Burgess
Journal: New England Journal of Medicine (1960)

MEDICINE in the State of Israel must be viewed against the background of a desperate struggle for existence and the Herculean task of assimilation of great numbers of Jews from all over the world. The number of Jews in Israel in May, 1948, when independence was achieved, was 649,683. At the end of 1957 it was 1,762,741. They then constituted 89.3 per cent of the total population of 1,975,954 ("Health Services in Israel 1948–1958"). These immigrants represent many ethnic groups with varied habits and cultures. Intellectual or ignorant, from relatively pleasant surroundings in Europe or slums in Oriental cities, maimed, . . .
Surgeons in the United States
Authors: Walter W. Hauck
Journal: JAMA (1976)

In a national surgical manpower questionnaire survey, 76% of those MD and DO surgeons who were contactable returned questionnaires that included a log diary reporting details of their daily activities. Comparisons were made of allocation of professional time, number of operations performed, and net income of respondents by physician classification (including certification), specialty, practice arrangement, age, and census division. The mean professional workweek was estimated at 46 hours for all respondents. More than two thirds of the total professional time was spent in direct patient care; about half the surgeon's time was spent in the hospital, with nearly 20% in the operating room. The median annual work load of respondents was 170 operations. Their median annual net income was $45,700.
Regression of coronary aneurysms in patients with Kawasaki syndrome.
Authors: M Takahashi, W Mason, A B Lewis
Journal: Circulation (1987)

Coronary aneurysms were demonstrated echocardiographically in 34 of 186 patients who presented with Kawasaki syndrome between 1979 and 1983. The aneurysms were confirmed by selective coronary angiography in 27 patients and by postmortem examination in one. The 27 surviving patients with proven aneurysms were followed for 2 to 40 months (mean 15), during which they received low dose (5 to 10 mg/kg) aspirin daily. Progressive improvement and resolution of aneurysms were observed by serial echocardiography in 18 patients and confirmed by angiography in 14. Coronary aneurysms persisted, however, in nine other patients for 14 to 40 months (mean 25.7). The incidence of aneurysm resolution was higher in children less than 1 year of age at the onset of the illness than in patients older than 1 year (100% vs 50%; p less than .001). Aneurysms were more likely to resolve in girls than in boys (100% vs 42%; p less than .001). Fusiform aneurysms tended to resolve more frequently than saccular lesions (80% vs 18%; p less than .025). Aneurysms located distally in the coronary arteries appear to regress more rapidly than proximal ones. We conclude that an age of less than 1 year at the onset of Kawasaki syndrome, female sex, and fusiform aneurysm morphology are significant factors that favor resolution of coronary artery aneurysms. However, important questions remain with regard to the long-term fate and functional capabilities of these healed lesions.
Joint hypermobility syndrome
Authors: J. Ross, R. Grahame
Journal: BMJ (2011)

Joint hypermobility syndrome (JHS), previously known as benign joint hypermobility syndrome (BJHS), is a heritable disorder of connective tissue that comprises symptomatic hypermobility predisposing to arthralgia, soft tissue injury, and joint instability.1 It is indistinguishable from the hypermobility type of Ehlers-Danlos syndrome.2 Complications may include autonomic dysfunction, proprioceptive impairment, premature osteoarthritis, intestinal dysmotility, and laxity in other tissues causing hernias or uterine or rectal prolapse. Symptoms are often minimal or mild, but 168 out of 700 patients with joint hypermobility syndrome (24%) attending the UCH Hypermobility Clinic already had an established chronic pain syndrome at the time of their first outpatient attendance. These patients were experiencing serious pain, disability, and impairment of the quality of life, some patients becoming chairbound or even bedbound.3 #### Case scenario A 30 year old project manager, who is new to your general practice, presents with right anterior knee pain after slipping and landing on his knee three months ago. Imaging shows no abnormality, but he describes a long history of recurrent shoulder subluxation, and many soft tissue problems and joint pains, often after similarly trivial trauma, and he states that imaging and blood tests "for arthritis" have always been normal. You note that he has no signs of inflammation but that he is hypermobile according to the Beighton score (see box 1), and looking up the Brighton criteria, which includes and extends the older Beighton score (see box 2), you mention he fulfils the criteria for joint hypermobility syndrome, and he expresses relief there is an explanation for his symptoms. #### Box 1 Nine-point Beighton score for joint hypermobility syndrome4 One point is gained for each side of the body for the first four manoeuvres listed below, such that the hypermobility score is a maximum of 9 if all are positive.
The role of endogenous opioids in congestive heart failure: effects of nalmefene on systemic and regional hemodynamics in dogs.
Authors: C S Liang, N Imai, C K Stone, P D Woolf, S Kawashima, R R Tuttle
Journal: Circulation (1987)

We studied the role of endogenous opiates and their interrelationships with the sympathetic nervous system in an experimental preparation of right-sided congestive heart failure (CHF) produced by surgical tricuspid avulsion and progressive pulmonary arterial constriction. Three groups of dogs with CHF and one group of sham-operated dogs were studied. One group of dogs with CHF was given normal saline as pretreatment, while the other two groups were pretreated with either propranolol alone (beta-blockade) or propranolol plus prazosin (alpha- plus beta-blockade). CHF was characterized by weight gain, ascites, elevated right atrial pressure, tachycardia, and reduced cardiac output. Compared with sham-operated animals, animals with CHF exhibited significantly higher baseline levels of plasma beta-endorphin and cortisol. Furthermore, only the animals with CHF responded to the opiate receptor-antagonist nalmefene with significant increases in plasma beta-endorphin, cortisol, and adrenocorticotropic hormone. Administration of nalmefene increased aortic blood pressure, cardiac output, left ventricular dP/dt and dP/dt/P, and blood flow to the myocardium, skeletal muscle, and kidneys in dogs with CHF, but had no appreciable effects in sham-operated dogs. beta-Receptor blockade abolished the increase in cardiac output, left ventricular performance, and blood flow produced by nalmefene, but had no effect on the pressor response to nalmefene. The increase in mean aortic pressure in the beta-blockade group was accompanied by an increase in skeletal muscle vascular resistance. Addition of prazosin in the alpha- plus beta-blockade group abolished the increases in mean aortic pressure and skeletal muscle vascular resistance, suggesting that the changes after propranolol probably resulted from unmasking of alpha-receptor-mediated vasoconstriction.(ABSTRACT TRUNCATED AT 250 WORDS)
Abstract 5025: Dissecting the dynamics of anti-PD1 immunotherapy in preclinical tumor models
Authors: Venkataraman Sriram, Michael E. Bigler, Holly Cherwinski, Erin Murphy, Terrill K. McClanahan, Joseph H. Phillips
Journal: Cancer Research (2014)

Abstract MK-3475 is an antagonistic humanized IgG4 anti-PD1 antibody currently in late stage clinical development for the treatment of cancer. MK-3475 exerts its anti-tumor effect through blocking the interaction of the immune inhibitory molecule PD-1 with its ligands. MK-3475 does not bind to mouse PD-1. Therefore, we generated a surrogate antibody, mDX400 for use in preclinical rodent models. In multiple syngeneic tumor models, treatment with mDX400 murinized anti-mouse antibody results in complete and durable tumor regression. We have used mDX400 as a mouse equivalent of MK-3475 to aid in our understanding of the cellular and molecular dynamics of anti-PD1 immunotherapy. In the current study, we examined peripheral and intratumoral lymphoid compartments pre- and post-mDX400 treatment. The data indicated that: 1. Anti-tumor efficacy was primarily driven by the level of PD-1 receptor blockade in tumor, but not blood. 2. An altered molecular signature, including significant upregulation of genes involved in monocyte, B- and T-cell activation and differentiation, was observed post-treatment in the tumors, but not peripheral blood or draining lymph nodes, of responding animals. 3. Tumor-specific immune memory was evident, as assessed by ultrahigh-throughput DNA sequencing of TCR CDR3 region, following successful treatment with mDX400. These data provide insights into the molecular dynamics following anti-PD1 immunotherapy and will guide hypothesis generation for biomarkers to inform our clinical strategy. In addition, the cellular and molecular pathways that predominate in preclinical tumor models insensitive to anti-PD1 immunotherapy are being evaluated. These types of studies may inform us on potential therapies that can be combined with MK-3475 to expand the therapeutic benefit of this biologic. Citation Format: Venkataraman Sriram, Michael E. Bigler, Holly Cherwinski, Erin Murphy, Terrill K. McClanahan, Joseph H. Phillips. Dissecting the dynamics of anti-PD1 immunotherapy in preclinical tumor models. [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 5025. doi:10.1158/1538-7445.AM2014-5025
Patient-Centered Care and Preference-Sensitive Decision Making
Authors: Carla C. Keirns
Journal: JAMA (2009)

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
Comparison of gene expression profiles between<i>Opisthorchis viverrini</i>and<i>non-Opisthorchis viverrini</i>associated human intrahepatic cholangiocarcinoma
Authors: Natini Jinawath, Yaovalux Chamgramol, Yoichi Furukawa, Kazutaka Obama, Tatsuhiko Tsunoda, Banchob Sripa, Chawalit Pairojkul, Yusuke Nakamura
Journal: Hepatology (2006)

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary cancer in the liver, and its incidence is highest in the northeastern part of Thailand. ICCs in this region are known to be associated with infection with liver flukes, particularly Opisthorchis viverrini (OV), as well as nitrosamines from food. To clarify molecular mechanisms of ICC associated with or without liver flukes, we analyzed gene expression profiles of OV-associated ICCs from 20 Thai patients and compared their profiles with those of 20 Japanese ICCs that were not associated with OV, by means of laser microbeam microdissection and a cDNA microarray containing 27,648 genes. We identified 77 commonly upregulated genes and 325 commonly downregulated genes in the two ICC groups. Unsupervised hierarchical cluster analysis separated the 40 ICCs into two major branches almost completely according to the fluke status. The putative signature of OV-associated ICC exhibited elevated expression of genes involved in xenobiotic metabolism (UGT2B11, UGT1A10, CHST4, SULT1C1), whereas that of non–OV-associated ICC represented enhanced expression of genes related to growth factor signaling (TGFBI, PGF, IGFBP1, IGFBP3). Additional random permutation tests identified a total of 49 genes whose expression levels were significantly different between the two groups. We also identified genes associated with macroscopic type of ICCs. In conclusion, these data may not only contribute to clarification of common and OV-specific mechanisms underlying ICC, but also may serve as a starting point for the identification of novel diagnostic markers or therapeutic targets for the disease. (HEPATOLOGY 2006;44:1025–1038.)
559. A Pseudo-Exon Derived from an Intronic Insertion Is Responsible for Duchenne-Like Muscular Dystrophy in the Welsh Corgi Dog
Authors: Bruce F. Smith, Joseph N. Kornegay
Journal: Molecular Therapy (2006)

Duchenne Muscular Dystrophy (DMD) is the most common X- linked inherited disease, with an incidence of 1 in 3500 male births. This disease is relentlessly progressive and usually fatal by early adulthood. A wide range of mutations in the dystrophin gene have been characterized for DMD, as well as the less severe form, Becker's Muscular Dystrophy. DMD presents gene therapy challenges due to the size of the gene and resulting cDNA and the wide variety and complexity of the mutations involved. Animal models for DMD have been described in the mouse, cat and dog. The disease in mice and cats is significantly less severe than that seen in humans, while the canine disease, characterized by muscle hypertrophy, followedby muscle loss, fibrosis and death, closely mimics disease progression in affected humans. As is expected from the frequency of mutation in the human population, DMD has been recognized in several breeds of dogs including the Golden Retriever, German Short-Haired Pointer, Rottweiler, Labrador Retriever, West Highland White and Welsh Corgi. Where the mutation has been determined, each breed has demonstrated a new mutation. Here we report the identification of the mutation responsible for DMD in the Welsh Corgi. Affected dogs can be recognized at, or shortly after, birth by increased serum creatine kinase levels. These dogs show progressive muscle atrophy and fibrosis, stunted growth, contractures and consequent debilitation. However, several of the affected males have lived to sexual maturity. Muscle biopsies from affected Corgis show that most fibers remain unstained for dystrophin, while rare fibers show dystrophin staining using a variety of antibodies. Sequence analysis of the cDNA indicates a 166 base insertion between exons 13 and 14, based on the human exon structure. The inserted sequence shows a high degree of sequence similarity to a canine LINE-1 element. Sequence analysis of intron 13, which is approximately 25kb, indicates that there is an insertion in the intron. The insertion is immediately downstream of an AG dinucleotide pair and contains the 166 bases seen in the cDNA followed by a GT dinucleotide pair and additional inserted sequence. Thus the insertion utilizes a putative intronic 3' splice acceptor site and a 5' splice donor to form a novel exon, which is spliced into the mature mRNA. An in-frame stop codon in this novel exon results in a truncated dystrophin protein, which is non-functional. Staining of occasional fibers with antibodies to epitopes located downstream of this insertion indicates that this exon may be skipped or that alternative splicing and/or promoter use may produce a product. This large animal model, with its defined mutation, will be useful in a variety of ways, including the use of gene repair approaches to skip the inserted exon, studies of spicing mechanisms in dystrophin, and studies of other gene therapy approaches.
SKELETAL TRACTION IN TREATMENT OF FRACTURES OF SHAFT OF TIBIA AND FIBULA
Authors: W. K. WEST
Journal: JAMA (1933)

The most important points to be considered in the treatment of fractures of the tibia and fibula are: First, general condition of the patient. Second, extent of resulting permanent disability. Third, length of temporary total disability. Fourth, cost of medical care. In the consideration of these four major problems, I agree that the general condition of the patient is most important, but that phase of the subject cannot well be discussed here. Therefore, from a technical standpoint, the first real problem is the prevention of permanent partial disability. It should be the most important consideration; more important than the temporary total disability, with its resulting loss of time and loss of wages; also more important than the cost of medical care. Provided as good results could be expected in all cases of severe fractures of the tibia and fibula as are expected in the cases of simple transverse fractures, a
Physical Examination for Entrance to West Point.
Authors: Charles F. Mason
Journal: JAMA (1907)

Washington, D. C., May 29, 1907. <h3>To the Editor:</h3> —Boards of medical officers for the physical examination of candidates for admission to West Point are appointed each year by the Secretary of War at various military posts, scattered over the country, and so situated as to be nearest the homes of the respective candidates. These boards consist of one or more medical officers of experience in the service and with practical knowledge of the requirements for officers of the Army. When candidates are rejected by the boards they are often taken at once by parents or friends to more or less prominent civilian practitioners, usually specialists, and it frequently happens that these physicians give certificates flatly contradicting the findings of the boards of medical officers of the Army. While there is no question of the integrity and honesty of purpose of these civilian practitioners, it does not seem quite fair
100 Apples Divided by 15 Red Herrings: A Cautionary Tale from the Mid-19th Century on Comparing Hospital Mortality Rates
Authors: Lisa I. Iezzoni
Journal: Annals of Internal Medicine (1996)

In 1863, Florence Nightingale argued that London hospitals were dangerous, especially compared with provincial facilities. She bolstered this contention with statistics published in William Farr's Registrar-General report which claimed that 24 London hospitals had mortality rates exceeding 90%, whereas rural hospitals had an average mortality rate of 13%. Farr had calculated mortality rates by dividing the total number of patients who died throughout the year by the number of inpatients on a single day. When calculated as the annual number of deaths divided by the total number of inpatients during the year, the mortality rate of London hospitals was 10%. A raucous debate erupted in the London medical press over how best to calculate hospital mortality rates. Critics claimed that Farr had not adjusted for differences in severity of illness between urban and rural hospitals and that his figures would mislead the public. Farr and Nightingale, in turn, criticized the poor quality of hospital data. This story reinforces the need to understand the methodologic derivation of statistics intended to compare provider quality.
99mTc-Pertechnetate Scintigraphy and Endoscopy in Assessment of Caustic-Induced Gastric Mucosal Injury
Authors: Bhagwant Rai Mittal, Amit Bhoil, Raghava Kashyap, Anish Bhattacharya, Usha Dutta, Rakesh Kochhar
Journal: Clinical Nuclear Medicine (2013)

Endoscopy is the gold standard for evaluating caustic-induced gastric mucosal injury. Injuries ≥2b (confluent ulceration or charring) are associated with perforation and cicatrisation. Grade 1–2a injuries recover without intervention. Grade 2b and 3 injuries require observation and may need intervention. 99mTc-pertechnetate imaging can assess gastric viability after caustic injury. We correlated 99mTc-pertechnetate SPECT/CT with endoscopic findings in 4 patients with increasing grades of caustic-induced gastric mucosal injury.
Campylobacter enteritis: a "new" disease.
Authors: M B Skirrow
Journal: BMJ (1977)

By selective culture campylobacters (C jejuni and C coli) were isolated from the faeces of 57 (7-1%) out of 803 unselected patients with diarrhoea; none were isolated from 194 people who had not got diarrhoea. Specific agglutinins were found in the sera of 31 out of 38 patients with campylobacter enteritis and 10 of them had a rising titre. Half the patients were aged 15 to 44 years, but the incidence was highest in young children. All the patients with campylobacters had a distinctive clinical illness with severe abdominal pain. Campylobacters are a relatively unrecognised cause of acute enteritis, but these findings suggest that they may be a common cause. Spread of infection was observed within 12 out of 29 households, and in these cases children were usually implicated. Several patients were apparently infected from chickens, both live and dressed, and poultry may be the primary source of the organism. In two cases dogs with diarrhoea were found to be infected with strains indistinguishable from their human contacts. Ten patients acquired their infections while travelling abroad.