tbuckley/cabot-search huggingface dataset:
Sharing of uncertainty can unnerve patients
Authors: R. Dobson
Journal: BMJ (2002)

“Let's see what happens,” is not a good phrase to use during consultations with patients.

Nor is it conducive to a patient's confidence to remark, “I haven't come across this before,” or to say, “I don't know.”

The phrases have come top of a league of behaviours and words that undermine patients' confidence which are used by GPs during their consultations.

Just a few little words of uncertainty from a GP can dent confidence, and new research concludes that doctors need to …
Acquired Tamoxifen Resistance: Correlation With Reduced Breast Tumor Levels of Tamoxifen and Isomerization of Trans-4-Hydroxytamoxifen
Authors: C. K. Osborne, E. Coronado, D. C. Allred, V. Wiebe, M. DeGregorio
Journal: JNCI Journal of the National Cancer Institute (1991)

Acquired tamoxifen resistance represents a major cause of treatment failure in breast cancer. We implanted estrogen receptor-positive MCF-7 human breast cancer cells in athymic nude BALB/c mice as a model to study in vivo acquired tamoxifen resistance. After 4-6 months of tumor growth suppression by trans-tamoxifen, tumor progression was observed despite continued tamoxifen administration. Acquired resistance was not due to loss of estrogen receptors, to alterations in serum or tumor estrogen levels, or to changes in tamoxifen or its major metabolites in serum. Tamoxifen-resistant tumors remained estrogen dependent in vivo. However, resistance was also associated with the ability of tamoxifen to stimulate tumor growth. Resistant tumors were characterized by markedly lower intracellular tamoxifen levels and by isomerization of the potent antiestrogenic metabolite trans-4-hydroxy-tamoxifen to the less potent cis isomer. Metabolic tolerance, as manifested by alterations in cellular concentrations of tamoxifen and its metabolites, may thus be one mechanism for acquired tamoxifen resistance in breast cancer.
N-Terminal–Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients
Authors: Paulo Bettencourt, Ana Azevedo, Joana Pimenta, Fernando Friões, Susana Ferreira, António Ferreira
Journal: Circulation (2004)

Heart failure (HF) is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal-pro-brain natriuretic peptide (NT-proBNP) in predicting death or hospital readmission after discharge of HF patients.We included 182 patients consecutively admitted to hospital because of decompensated HF. Patients were followed up for 6 months. The primary end point was death or readmission. Twenty-six patients died in hospital. The median admission NT-proBNP level was 6778.5 pg/mL, and the median level at discharge was 4137.0 pg/mL (P<0.001). Patients were classified into 3 groups: (1) decreasing NT-proBNP levels by at least 30% (n=82), (2) no significant modifications on NT-proBNP levels (n=49), and (3) increasing NT-proBNP levels by at least 30% (n=25). The primary end point was observed in 42.9% patients. Variables associated with an increased hazard of death and/or hospital readmission in univariate analysis were length of hospitalization, heart rate, signs of volume overload, no use of ACE inhibitors, higher NYHA class at discharge, admission and discharge NT-proBNP, and the change in NT-proBNP levels. The variation in NT-proBNP was the strongest predictor of an adverse outcome. Independent variables associated with an increased risk of readmission or death were signs of volume overload and the change in NT-proBNP levels.Variations in NT-proBNP levels are related to hospital readmission and death within 6 months. NT-proBNP levels are potentially useful in the evaluation of treatment efficacy and might help clinicians in planning discharge of HF patients. Whether therapeutic strategies aimed to lower NT-proBNP levels modify prognosis warrants future investigation.
Painful crises in sickle cell disease--patients' perspectives.
Authors: N. Murray, A. May
Journal: BMJ (1988)

One hundred and two patients returned structured questionnaires sent to clinics for sickle cell disease in the United Kingdom in order to gain greater insight into the patients' perception of painful crises. Most patients who suffer pain crises experience a prodromal stage that should be investigated further to find out if prophylaxis is possible. Cold, exertion, and tiredness were the most important precipitating factors. Despite the increase in the amount of knowledge about sickle cell disease in recent years, and though 29 out of 88 patients (30-40%) believed that medical services were improving, 33 out of 88 (30-40%) were still experiencing long delays in being treated in hospital. A third of patients do not seem to receive adequate pain relief.
Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomised controlled trial
Authors: M. J. Spink, H. B. Menz, M. R. Fotoohabadi, E. Wee, K. B. Landorf, K. D. Hill, S. R. Lord
Journal: BMJ (2011)

<b>Objective</b> To determine the effectiveness of a multifaceted podiatry intervention in preventing falls in community dwelling older people with disabling foot pain. <b>Design</b> Parallel group randomised controlled trial. <b>Setting</b> University health sciences clinic in Melbourne, Australia. <b>Participants</b> 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to a multifaceted podiatry intervention and 152 to routine podiatry care, with 12 months' follow-up. <b>Interventions</b> Multifaceted podiatry intervention consisting of foot orthoses, advice on footwear, subsidy for footwear ($A100 voucher; £65; €74), a home based programme of foot and ankle exercises, a falls prevention education booklet, and routine podiatry care for 12 months. The control group received routine podiatry care for 12 months. <b>Main outcome measures</b> Proportion of fallers and multiple fallers, falling rate, and injuries resulting from falls during follow-up. <b>Results</b> Overall, 264 falls occurred during the study. 296 participants returned all 12 calendars: 147 (96%) in the intervention group and 149 (98%) in the control group. Adherence was good, with 52% of the participants completing 75% or more of the requested three exercise sessions weekly, and 55% of those issued orthoses reporting wearing them most of the time. Participants in the intervention group (n=153) experienced 36% fewer falls than participants in the control group (incidence rate ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01). The proportion of fallers and multiple fallers did not differ significantly between the groups (relative risk 0.85, 0.66 to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One fracture occurred in the intervention group and seven in the control group (0.14, 0.02 to 1.15, P=0.07). Significant improvements in the intervention group compared with the control group were found for the domains of strength (ankle eversion), range of motion (ankle dorsiflexion and inversion/eversion), and balance (postural sway on the floor when barefoot and maximum balance range wearing shoes). <b>Conclusions</b> A multifaceted podiatry intervention reduced the rate of falls in community dwelling older people with disabling foot pain. The components of the intervention are inexpensive and relatively simple to implement, suggesting that the programme could be incorporated into routine podiatry practice or multidisciplinary falls prevention clinics. <b>Trial registration</b> Australian New Zealand Clinical Trials Registry ACTRN12608000065392.
Sudden onset double vision
Authors: Nicholas R Plummer, Thomas Thorp, Sulaiman Sultan
Journal: BMJ (2014)

An 83 year old woman was admitted to the acute stroke unit with sudden onset double vision that had lasted for three hours. She had a medical history of monoclonal gammopathy of uncertain significance and atrial fibrillation, for which she was not receiving anticoagulation because of an adverse reaction to warfarin. She had no history of transient ischaemic attack or stroke. She had diplopia only when looking through her right. On examination she was unable to adduct her left eye, with nystagmus in her right eye when she attempted to do this. Her neurological examination was otherwise normal. Computed tomography of the head on admission was normal, as was magnetic resonance imaging of the head, which was requested the next day. Figure 1⇓ shows T2 weighted (A) and diffusion weighted (B) sequences at the level of the upper pons.





### 1. What is this eye lesion called, and what is its pathological basis?

#### Short answer

Left internuclear ophthalmoplegia. It is caused by impairment of conjugate eye movements owing to injury to the medial longitudinal fasciculus on the side of the impaired eye.

#### Long answer

Internuclear opthalmoplegia (INO) is caused …
Utility of SPECT/CT as an Adjunct to Planar Whole Body I-131 Imaging
Authors: Demetrios J. Agriantonis, Lance Hall, Michael A. Wilson
Journal: Clinical Nuclear Medicine (2009)

One of the major limitations of planar I-131 imaging is its lack of anatomic precision. SPECT/CT offers the benefit of precise anatomic localization that planar imaging lacks. Whether for confirmation of physiologic uptake or true pathology, SPECT/CT has an important role to play in clarifying equivocal findings. We present a case of papillary thyroid cancer metastatic to the liver, a relatively rare scenario. SPECT/CT allowed definitive lesion characterization at the time of the patient's visit to the nuclear medicine department.
Rheumatic Fever in the Adult
Authors: Irving J. Adatto
Journal: JAMA (1965)

The clinical manifestations of acute rheumatic fever were evaluated in a study of 35 adult patients. Migratory polyarthritis occurred in all but one. None had chorea, erythema marginatum, or subcutaneous nodules. Carditis occurred in eight, manifested by pericarditis in four and by development of new significant murmurs in four. Two patients died during their acute attacks, and nine exhibited new valve damage on follow-up. The results of the study indicate that rheumatic fever represents a continuous spectrum from childhood to adulthood, in which the incidence of carditis, though diminishing, remains significant. In addition, cardiac involvement may occur de novo in the adult, resulting in permanent damage or even death. This would have important implications regarding penicillin prophylaxis.
Matrix Metalloproteinases 2, 9, and 13, and Tissue Inhibitors of Metalloproteinases 1 and 2 in Experimental Lung Silicosis
Authors: JULIA PÉREZ-RAMOS, M. de LOURDES SEGURA-VALDEZ, BEATRIZ VANDA, MOISÉS SELMAN, ANNIE PARDO
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

Exposure to silica induces granulomatous lung inflammation evolving to fibrosis through yet unclear pathogenic mechanisms. We examined the expression of extracellular matrix remodeling molecules: collagenase 3, gelatinases A and B, and TIMP-1 and TIMP-2 in experimental lung silicosis. Rats were instilled with 50 mg of silica and sacrificed after 15 and 60 d. At 60 d a significant increase in lung collagen content was found (170.2 ± 34.4 versus 88.2 ± 20.8 μ g/mg in controls, p = 0.01). Gelatin zymography of bronchoalveolar lavage fluid (BALF) from 15 and 60 d revealed bands of progelatinase A and progelatinase B, and lung tissue zymograms showed in addition, the active gelatinase A form at 15 d. By in situ hybridization and immunohistochemistry, early silicotic granulomas exhibited intense staining for all matrix metalloproteinases (MMPs) and TIMPs assayed. Labeling was restricted inside granulomas and surrounding areas. Late silicotic granulomas at 60 d showed lower MMP expression than did early lesions, and in highly fibrotic nodules scarce signal was usually found. TIMP-1 and TIMP-2 showed a moderate reduction in 60-d silicotic nodules. These findings suggest that an imbalance in the expression of MMPs and TIMPs may be implicated in extracellular matrix remodeling and basement membrane disruption during experimental lung silicosis.
Curtailing Diversion and Abuse of Opioid Analgesics Without Jeopardizing Pain Treatment
Authors: Nora D. Volkow
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
Hypernatremia Due to Hypodipsia and Elevated Threshold for Vasopressin Release
Authors: James H. Mahoney, A. David Goodman
Journal: New England Journal of Medicine (1968)

A woman previously operated for craniopharyngioma has chronic hypernatremia without polyuria or polydipsia. The hypernatremia appears to be due both to derangement of the thirst mechanism and to an elevation of the osmotic threshold for antidiuretic-hormone secretion. Long-term administration of hydrochlorothiazide has kept the serum sodium within normal limits, primarily by limiting renal free water clearance. Chlorpropamide and tolbutamide also proved to be strikingly effective in correcting the hypernatremia, by markedly increasing urinary osmolality. It is speculated that the sulfonylureas increase the concentration of cyclic adenosine monophosphate in the renal medulla as well as in the pancreatic beta cells, and that this accounts for their effects on urinary concentration and insulin secretion.
[384] REGULATION VIA NUCLEAR RECEPTOR OF THE HUMAN UDP-GLUCURONOSYLTRANSFERASE (UGT) 1A3
Authors: T.T. Erichsen, T.O. Lankisch, U. Ehmer, T.C. Gillman, R.P. Remmel, M.P. Manns, C.P. Strassburg
Journal: Journal of Hepatology (2007)
Increased numbers of T lymphocytes with gamma delta-positive antigen receptors in a subgroup of individuals with pulmonary sarcoidosis.
Authors: B Balbi, D R Moller, M Kirby, K J Holroyd, R G Crystal
Journal: Journal of Clinical Investigation (1990)

Individuals with sarcoidosis were evaluated for preferential usage of T cells with the gamma delta-positive (+) type of T cell antigen receptor. Compared with normal subjects (n = 19), the group with sarcoidosis had increased numbers of CD3+ alpha beta-negative (-) T cells in the blood (normal, 58 +/- 12 cells/microliters; sarcoid, 192 +/- 45 cells/microliters, P less than 0.05) and in the epithelial lining fluid of the lung (normal, 78 14 cells/microliters; sarcoid, 240 +/- 60 cells/microliters, P less than 0.04) and a concomitant elevated number of blood and lung CD3+ gamma delta+ T cells, owing to a striking increase in the number of CD3+ gamma delta+ T cells in a subgroup (7 of 20) of sarcoid individuals. The elevated numbers of sarcoid blood gamma delta+ T lymphocytes were mostly Ti gamma A+ and delta TCS1-, a pattern also seen in normal individuals, consistent with the majority of gamma delta+ T cells expressing one gamma-chain variable region, V gamma 9. The observation of an increase in the total gamma delta+ T cell numbers in a sarcoid subgroup suggests that various specific stimuli may trigger the expansion of different T cell subpopulations within different groups of individuals with sarcoidosis.
The Prevention and Treatment of Missing Data in Clinical Trials
Authors: Roderick J. Little, Ralph D'Agostino, Michael L. Cohen, Kay Dickersin, Scott S. Emerson, John T. Farrar, Constantine Frangakis, Joseph W. Hogan, Geert Molenberghs, Susan A. Murphy, James D. Neaton, Andrea Rotnitzky, Daniel Scharfstein, Weichung J. Shih, Jay P. Siegel, Hal Stern
Journal: New England Journal of Medicine (2012)

Missing data in clinical trials can have a major effect on the validity of the inferences that can be drawn from the trial. This article reviews methods for preventing missing data and, failing that, dealing with data that are missing.
New vaccines may provide full coverage
Authors: Hema Bashyam
Journal: The Journal of Experimental Medicine (2008)

On page 117, Giefing et al. report the discovery of two new vaccine candidates that might protect humans against all 90 versions of a deadly bacterium.

This bacterium, Pneumococcus, invades the lungs, blood, and eventually brain to cause pneumonia, sepsis, and meningitis, respectively. Surface proteins from this bug are currently being used as vaccines to induce the body to produce protective antibodies. But these vaccines, which comprise proteins from only a few types of Pneumococcus, are not effective against other variants, due to extreme sequence diversity in the surface proteins.

Giefing et al. now identify two bacterial antigens that are nearly identical among all pneumococcal strains and that induce potent antibodies in vivo. The authors hunted for conserved bacterial antigens that would be exposed on the pathogen during disease. Antibodies isolated from exposed but healthy humans and from those recovering from infection were used to identify pneumococcal proteins that were targeted by the protective antibody response.

Both of the newly identified antigens induced antibodies that protected immunized mice against several other pneumococcal variants. The antigens might be potent targets because they come from a protein that is essential for bacterial growth and survival and thus unlikely to mutate. The team is currently testing their vaccines in clinical trials.
Baby's penis reattached after botched circumcision
Authors: J. Siegel-Itzkovich
Journal: BMJ (2000)

Antigen stimulation of IgE-sensitized rat basophilic leukemia RBL-2H3 cells induced activation of c-Jun N-terminal kinase (JNK) within a few minutes with maximum activity attained 40 min later. The increase in JNK activity was accompanied with an increase in phosphorylation of c-Jun in the cells. The Ag-induced JNK activation was inhibited by the phosphatidylinositol 3-kinase inhibitors wortmannin (10–100 nM) and LY 294002 (100 μM) but not by the protein kinase C inhibitors calphostin C (1 and 3 μM) and Ro 31-8425 (1 and 3 μM). Pretreatment with dexamethasone (10 and 100 nM) for 18 h inhibited the Ag-induced increase in JNK activity in a concentration-dependent manner. At least 6 h of preincubation with dexamethasone was necessary to inhibit the Ag-induced JNK activation. The phosphorylation of c-Jun induced by the Ag stimulation was reduced by pretreatment with dexamethasone without reduction of the content of c-Jun protein. The Ag-induced activation of the JNK kinase kinase mitogen-activated protein kinase-extracellular signal-regulated kinase kinase-1 was also inhibited by pretreatment with dexamethasone at 10 and 100 nM. These findings indicate that dexamethasone reduces JNK protein level and inhibits the Ag-induced activation of JNK resulting in the inhibition of c-Jun phosphorylation.
FIRST- VERSUS SECOND- GENERATION DRUG-ELUTING STENTS IN THE TREATMENT OF ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION
Authors: Danny Dvir, Israel Barbash, Rebecca Torguson, Zhenyi Xue, Gabriel Sardi, Salem Badr, Ana Laynez Carnicero, Itsik Ben-Dor, Lowell Satler, Augusto Pichard, Ron Waksman
Journal: Journal of the American College of Cardiology (2012)
Concealed Conduction
Authors: RICHARD LANGENDORF, ALFRED PICK
Journal: Circulation (1956)

Recognition of concealed conduction of the cardiac impulse is shown to be indispensable for the understanding of many cardiac arrhythmias. After a historical review of the concept of concealed conduction, records are presented to demonstrate established, as well as hitherto undescribed, aspects of concealed A-V conduction. Then, the manifestations of concealed intraventricular conduction are pointed out and, finally, the relationship of the phase of concealed conduction to the supernormal phase is discussed.
Characterisation of soluble and cell associated phospholipase A2 from rheumatoid synovial fluid.
Authors: H Gonzalez-Buritica, D.M Smith, R.A Turner
Journal: Annals of the Rheumatic Diseases (1989)

The hydrolysis of radiolabelled Escherichia coli phospholipids, and micellar dispersions of phosphatidylethanolamine and phosphatidylcholine, were used to characterise the phospholipase A2 activity in synovial fluid from patients with rheumatoid arthritis. Cell free fractions of synovial fluid contain a phospholipase A2 enzyme that preferentially releases [14C]oleic acid from E coli biomembranes (specific activity 291.3 (SEM 27.6) pmol/min/mg). This enzyme requires calcium and is optimally active at neutral pH. Purified dispersions of phosphatidylethanolamine are also readily degraded by the soluble enzyme, but it is not active against phosphatidylcholine. The substitution of [14C]oleic acid by [3H]arachidonic acid for the labelling of E coli allowed differentiation between the soluble phospholipase A2 and the cell associated phospholipase A2 present in sonicates of mononuclear cells and neutrophils from peripheral blood and synovial fluid. The cell associated phospholipase A2 preferentially releases [3H]arachidonic acid from E coli cardiolipin. In this paper the phospholipid substrate specificity of phospholipase A2 from rheumatoid synovial fluid, the optimal assay conditions for its detection, and a standardised expression of activity in terms of pmol per minute per mg of protein are established.
US colon cancer rate dropped 30% among over 50s in past decade
Authors: M. McCarthy
Journal: BMJ (2014)

The incidence of colon cancer among people aged 50 or older in the United States fell 30% over the past decade, say a pair of reports from the American Cancer Society.1 2

The reports credit the decline in incidence on the widespread uptake of colonoscopy screening, which almost tripled among adults aged 50-75 years, from 19% in 2000 to 55% in 2010.

Screening allows the detection and removal of polyps that if untreated can progress to cancer.

The decline in incidence was …
Intraperitoneal Fluid Infusion in Children with Gastroenteritis
Authors: O. Ransome-Kuti, O. Elebute, T. Agusto-Odutola, S. Ransome-Kuti
Journal: BMJ (1969)

In a study of 91 babies with dehydration as a result of gastroenteritis the intraperitoneal route was found to be safe and effective in those with mild or moderate dehydration, but not in those who were severely dehydrated. The fluids found to be most effective in the intraperitoneal technique were normal saline with 28 mEq of potassium chloride per litre, or for hypertonically dehydrated babies half-strength Darrow9s solution. This technique can be carried out by a nurse working single-handed if the baby is premedicated with promazine.
975-79 The Effects of Pressure Recovery and Subvalvular Acceleration May Explain the Discrepancy Between Catheterlsation and Echocardlographlc Pressure Gradients in Children with Aortic Valve Disease
Authors: William Gotsis, Jay S. Meisner, Jamshid Shirani, Edward G. Cape, Joel A. Strom
Journal: Journal of the American College of Cardiology (1995)