tbuckley/cabot-search huggingface dataset:
Is Any Test 100% Specific and 100% Sensitive for Serious Injury?
Authors: Martin A. Schreiber
Journal: JAMA Surgery (2014)

Resnickandcolleagues1haveperformedaprospectiveobservational trial during a 17-month period assessing the accuracy of cervical spine computed tomography (CT) in the evaluation of patients with blunt trauma. The population included patientsata level I traumacenter with persistent cervical tenderness or a focal neurologic deficit. They have also evaluated theusefulnessofperformingmagnetic resonance imaging(MRI) inthesepatients.TheauthorsboldlyconcludethatadvancedgenerationalCTscanning is 100%sensitiveand100%specific indetecting significant cervical spine injuries and thatMRI is of no useexceptmaybe inpatientswith focalmotordeficits.Noneof thepatientsevaluatedinthisstudyhadfocalmotordeficits.This is a very important study because it suggests that MRI is not needed inthispatientpopulation,whichsignificantlysimplifies their care.However, several issuesneedtobeconsideredbefore accepting the authors’ conclusions at face value. Thiswas a very select population ofminimally injured patients with amean Injury Severity Score of 3.3. No patient had anAbbreviated Injury Score greater than 3, andno patient had anInjurySeverityScoregreater than25.Theseresultscannotbe generalized tomoresignificantly injuredpatients.Thevastmajority of patients admitted to level 1 trauma centers would not beincludedinthisstudybecausetheyaremoreseverely injured. The definition of significant injuries was the need for surgical intervention, a halo, or a hard cervical collar for ligamentous injury. Forty-two of 100 MRIs performed showed a ligamentous injury, and the treatment used for these patients is not clear. Five patients with a negative CT who had ligamentous injuries received a cervical collar. However, these patients were not included in the significantly injured group for analysis, and why they were excluded is not clearly presented in the Methods section of the article. Most (61.0%) MRIs were performed as a result of equivocal CT results, and only 26.0%were performed for evaluation of cervical tenderness or focal neurologic findings. This study ismore focusedonequivocalCT findings thanonhowtoevaluate patients with persistent tenderness or a focal neurologic deficit. Finally, theauthorsdonot address theevaluationandcare of patientswithmotor deficits andpotential cervical spine injuries because there were none in the study. This fact remains a significant limitation of the study. Although it would be ideal to dispense with MRI as a diagnostic test in patients with potential cervical spine injuries, this study leavesmanyunansweredquestions. I look forward to more prospective data on this topic from this group of investigators.
The Physician and the Family
Authors: Larry B. Mauksch
Journal: Annals of Internal Medicine (1989)

Letters and Corrections15 May 1989The Physician and the FamilyLarry B. Mauksch, MEdLarry B. Mauksch, MEdSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-110-10-848_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor:In their recent article, Hahn, Feiner, and Bellin (1) note accurately that patients will attempt to engage physicians in relationships to compensate for deficits in their families. Physicians are drawn into these "dysfunctional compensatory alliances" and inadvertently function with the patient and the patient's family to maintain family dynamics. Eventually physicians involved in these situations may feel anger, frustration, and impotence as the patient's symptoms remain the same. But is it only the patient and his or her family who pursue these dysfunctional alliances? Are physician's feelings always the result of interacting with dysfunctional patient-family systems? What...References1. HahnFeinerBellin SJE. The doctor-patient-family relationship: a compensatory alliance. Ann Intern Med. 1988;109:884-9. LinkGoogle Scholar2. Mengel M. Physician ineffectiveness due to family of origin issues. Fam Systems Medicine. 1987;5:176-90. CrossrefGoogle Scholar3. Bowen M. Family Therapy in Clinical Practice. New York: Jason Aronson; 1978. Google Scholar4. MengelMauksch ML. Disarming the family ghost: a family of origin experience. Family Medicine. 1989;21(1):45-9. MedlineGoogle Scholar5. Crouch M. Working with one's own family: another path for professional development. Family Medicine. 1986;18(2):93-8. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of Washington School of Medicine Seattle, Washington 98195 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 May 1989Volume 110, Issue 10Page: 848-849KeywordsEmotionsErectile dysfunction Issue Published: 15 May 1989 PDF DownloadLoading ...
Relapsed childhood high hyperdiploid acute lymphoblastic leukemia: presence of preleukemic ancestral clones and the secondary nature of microdeletions and RTK-RAS mutations
Authors: J Davidsson, K Paulsson, D Lindgren, H Lilljebjörn, T Chaplin, E Forestier, M K Andersen, A Nordgren, R Rosenquist, T Fioretos, B D Young, B Johansson
Journal: Leukemia (2010)
Review: SSRIs somewhat improve dependence and disability after stroke
Authors: Howard S. Kirshner
Journal: Annals of Internal Medicine (2013)

ACP Journal Club19 March 2013Review: SSRIs somewhat improve dependence and disability after strokeHoward S. Kirshner, MDHoward S. Kirshner, MDVanderbilt University Medical Center, Nashville, Tennessee, USA (H.S.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-6-201303190-02012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationMead GE, Hsieh CF, Lee R, et al. Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery. Cochrane Database Syst Rev. 2012;(11):CD009286. https://pubmed.ncbi.nlm.nih.gov/23152272Clinical Impact RatingsGIM/FP/GP: Mental Health: Neurology: References1 Chen Y, Guo JJ, Zhan S, Patel NC. Treatment effects of antidepressants in patients with post-stroke depression: a meta-analysis. Ann Pharmacother. 2006;40:2115-22. [PMID: 17119102]. Google Scholar2 Chollet F, Tardy J, Albucher J-F, et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurology. 2011;10:123−30. [PMID: 21216670] Google Scholar Author, Article, and Disclosure InformationAuthors: Howard S. Kirshner, MDAffiliations: Vanderbilt University Medical Center, Nashville, Tennessee, USA (H.S.K.)This article was published at Annals.org on 5 March 2013. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 19 March 2013Volume 158, Issue 6Page: JC12KeywordsClinical trialsDatabasesDisabilitiesNumber needed to treatPsychiatry and mental healthResearch fundingRisk ratioSelective serotonin reuptake inhibitorsStroke ePublished: 19 March 2013 Issue Published: 19 March 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The role of specific antibody in alternative complement pathway-mediated opsonophagocytosis of type III, group B Streptococcus.
Authors: M S Edwards, A Nicholson-Weller, C J Baker, D L Kasper
Journal: The Journal of Experimental Medicine (1980)

The native capsular polysaccharide antigen of type III, group B Streptococcus contains a terminal sialic acid residue on each repeating unit that masks all end-group galactopyranose residues and prevents alternative pathway complement activation by adult human sera in the absence of type-specific antibody. The critical role of the sialic acid residues in allowing the organism to evade activating the alternative complement pathway was shown when neuraminidase treatment of the organism converted the bacteria to activators of the alternative pathway as assessed in agammaglobulinemic serum. The requirement for specific antibody in permitting alternative pathway activation by the fully sialated bacteria was shown when sera that contained low levels of specific antibody failed to activate this pathway, and when prior absorption of serum that contained higher type-specific antibody levels with the capsular antigen failed to activate this pathway. The use of C2-deficient sera showed that the calssical pathway was not required for antibody-dependent alternative pathway activation. The use of isotonic, pH 7.5, veronal-NaCl buffer that contained 1% gelatin and that was supplemented to 4 mM Mg++ and 16 mM EGTA and adjusted to pH 7.5 (MgEGTA) ruled out the participation of the C1-bypass pathway. The presence of sialic acid on the bacterial surface is one means of evading an important mechanism of natural immunity, namely activation of complement by the alternative pathway. Only specific antibody, i.e., acquired immunity, can overcome this virulence factor.
Antagonism of thyroid hormone action by amiodarone in rat pituitary tumor cells.
Authors: M F Norman, T N Lavin
Journal: Journal of Clinical Investigation (1989)

A thyroid hormone antagonist has not been previously described. A number of thyroid hormone analogues have been shown to compete with [125I]triiodothyronine ([125I]T3) for binding to the intranuclear thyroid hormone receptor and to have agonist activity proportional to their affinities for the receptors. We report that the benzofuran amiodarone acts as a competitive antagonist to thyroid hormone action as defined by its dose-dependent ability to (a) bind to the thyroid hormone receptor and (b) inhibit T3-induced increases in growth hormone mRNA levels in a cultured rat pituitary cell line, GC cells. Like T3 itself, amiodarone also decreases transport of [125I]T3 across GC cell membranes. An analysis of the amiodarone structure suggests that this compound has certain similarities to T3. These findings hold promise for the development of other thyroid hormone antagonists for clinical use and for understanding thyroid hormone action.
In vivo targeting of colonic dysplasia on fluorescence endoscopy with near-infrared octapeptide
Authors: Zhongyao Liu, Sharon J Miller, Bishnu P Joshi, Thomas D Wang
Journal: Gut (2012)

<h3>Objective</h3> To demonstrate a near-infrared (NIR) peptide that is highly specific for colonic adenomas on fluorescence endoscopy in vivo. <h3>Design</h3> A 3 mm diameter endoscope was adapted to deliver 671 nm illumination and collect NIR fluorescence (696–736 nm). Target (QPIHPNNM) and control (YTTNKH) peptides were labelled with Cy5.5, a NIR dye, and characterised by mass spectra. The peptides were topically administered separately (100 μM) through the endoscope9s instrument channel into the distal colon of <i>CPC;Apc</i> mice, genetically engineered to spontaneously develop adenomas. After 5 min for incubation, the unbound peptides were rinsed off, and images were collected at a rate of 10 frames/s. Regions of interest were identified around the adenoma and adjacent normal-appearing mucosa on white light. Intensity measurements were made from these same regions on fluorescence, and the target-to-background ratio (TBR) was calculated. <h3>Results</h3> An image resolution of 9.8 μm and field of view of 3.6 mm was achieved at a distance of 2.5 mm between the distal end of the instrument and the tissue surface. On mass spectra, the experimental mass-to-charge ratio for the Cy5.5-labelled target and control peptides agreed with expected values. The NIR fluorescence images of adenomas revealed individual dysplastic crypts with distorted morphology. By comparison, only amorphous surface features could be visualised from reflected NIR light. The average TBR for adenomas was found to be 3.42±1.30 and 1.88±0.38 for the target and control peptides, respectively, p=0.007. <h3>Conclusion</h3> A NIR peptide was shown to be highly specific for colonic adenomas on fluorescence endoscopy in vivo and to achieve sub-cellular resolution images.
Trends in management of acute cholecystitis.
Authors: A Mitchell, P J Morris
Journal: BMJ (1982)

A retrospective review has been carried out of the management of acute cholecystitis in one hospital from 1974 to 1978. The policies and outcome are compared with those of the same centre during 1953-62. In the intervening period there has been a move towards early cholecystectomy. Overall mortality has fallen from 7.7% to 1.6%. The results of early surgery are comparable with those of delayed operations. The data also compare favourably with those of controlled clinical trials and support the adoption of early cholecystectomy for acute cholecystitis in routine practice. The saving of resources, however, may not be as great as is suggested by the results of clinical trials.
Naloxegol for Opioid-Induced Constipation in Patients with Noncancer Pain
Authors: William D. Chey, Lynn Webster, Mark Sostek, Jaakko Lappalainen, Peter N. Barker, Jan Tack
Journal: New England Journal of Medicine (2014)

Opioid-induced constipation is common and debilitating. We investigated the efficacy and safety of naloxegol, an oral, peripherally acting, μ-opioid receptor antagonist, for the treatment of opioid-induced constipation.In two identical phase 3, double-blind studies (study 04, 652 participants; study 05, 700 participants), outpatients with noncancer pain and opioid-induced constipation were randomly assigned to receive a daily dose of 12.5 or 25 mg of naloxegol or placebo. The primary end point was the 12-week response rate (≥3 spontaneous bowel movements per week and an increase from baseline of ≥1 spontaneous bowel movements for ≥9 of 12 weeks and for ≥3 of the final 4 weeks) in the intention-to-treat population. The key secondary end points were the response rate in the subpopulation of patients with an inadequate response to laxatives before enrollment, time to first postdose spontaneous bowel movement, and mean number of days per week with one or more spontaneous bowel movements.Response rates were significantly higher with 25 mg of naloxegol than with placebo (intention-to-treat population: study 04, 44.4% vs. 29.4%, P=0.001; study 05, 39.7% vs. 29.3%, P=0.02; patients with an inadequate response to laxatives: study 04, 48.7% vs. 28.8%, P=0.002; study 05, 46.8% vs. 31.4%, P=0.01); in study 04, response rates were also higher in the group treated with 12.5 mg of naloxegol (intention-to-treat population, 40.8% vs. 29.4%, P=0.02; patients with an inadequate response to laxatives, 42.6% vs. 28.8%, P=0.03). A shorter time to the first postdose spontaneous bowel movement and a higher mean number of days per week with one or more spontaneous bowel movements were observed with 25 mg of naloxegol versus placebo in both studies (P<0.001) and with 12.5 mg of naloxegol in study 04 (P<0.001). Pain scores and daily opioid dose were similar among the three groups. Adverse events (primarily gastrointestinal) occurred most frequently in the groups treated with 25 mg of naloxegol.Treatment with naloxegol, as compared with placebo, resulted in a significantly higher rate of treatment response, without reducing opioid-mediated analgesia. (Funded by AstraZeneca; KODIAC-04 and KODIAC-05 ClinicalTrials.gov numbers, NCT01309841 and NCT01323790, respectively.).
"The American Medical Association."
Authors: J. F. Jenkins
Journal: JAMA (1896)

Tecumseh, Mich., April 20, 1896. <h3>To the Editor:</h3> —"TheAmerican Medical Association— what is it?" A " Correspondent " asks the<i>Record</i>the above inquiry (see p. 843). It would be a difficult matter to state whether or not the above paragraph emanated from the brain of the editor of the<i>Medical Record</i>or the printer's devil; it is unworthy of the former and scarcely worthy of the latter. Permit me to state for the benefit of the<i>Medical Record</i>that theAmerican Medical Associationis the only association that represents the medical profession in this country; that it is large enough to hold the brainy editor of the<i>Record</i>, and that it is even worthy of every "effort that he may make to get there"; that it possesses the best medical journal in America, and its editor knows how to run it. Very respectfully,
Lack of Response to Recombinant Hepatitis B Vaccine in Nonresponders to the Plasma Vaccine
Authors: Joy Y. Weissman
Journal: JAMA (1988)

Yeast recombinant hepatitis B vaccine was administered to 25 nonresponders to the plasma-derived hepatitis B vaccine. After three 10-micrograms doses, nine subjects (36%) produced levels of antibodies to hepatitis B surface antigen (anti-HBs) of less than 2.1 sample ratio units (SRU) (nonresponders), and five (20%) developed anti-HBs of 2.1 to 9.9 SRU (hyporesponders); anti-HBs levels of 10 SRU or greater were detected at least once in 11 vaccinees (44%), but by the sixth and 12th months after the last vaccination, only three and one of these "responders," respectively, still maintained anti-HBs values of 10 SRU or greater. In these 25 subjects HLA subtyping showed a high prevalence of DR7, B8, and the combinations of DR3 and DR7 and DR4 and DR7. Our findings indicate that the yeast recombinant hepatitis B vaccine was not effective in eliciting a sustained anti-HBs response in nonresponders to the plasma hepatitis B vaccine.
Three Cases of Non-Malignant Tumour of the Uterus, Accompanied by the Usual Symptoms of Cancer of the Uterus
Authors: E. J. Shearman
Journal: BMJ (1847)

UTERUS. __34326th.Going on farourably, and from this date till the4th of May, had the ether three times daily, and once daily till the 17th.Pills given every fourth hour.
Neovascular Age-Related Macular Degeneration Risk Based on CFH, LOC387715/HTRA1, and Smoking
Authors: Anne E Hughes, Nick Orr, Chris Patterson, Hossein Esfandiary, Ruth Hogg, Vivienne McConnell, Giuliana Silvestri, Usha Chakravarthy
Journal: PLoS Medicine (2007)

Background Age-related macular degeneration (AMD) is the major cause of blindness in the elderly. Those with the neovascular end-stage of disease have irreversible loss of central vision. AMD is a complex disorder in which genetic and environmental factors play a role. Polymorphisms in the complement factor H (CFH) gene, LOC387715, and the HTRA1 promoter are strongly associated with AMD. Smoking also contributes to the etiology. We aimed to provide a model of disease risk based on these factors. Methods and Findings We genotyped polymorphisms in CFH and LOC387715/HTRA1 in a case–control study of 401 patients with neovascular AMD and 266 controls without signs of disease, and used the data to produce genetic risk scores for the European-descent population based on haplotypes at these loci and smoking history. CFH and LOC387715/HTRA1 haplotypes and smoking status exerted large effects on AMD susceptibility, enabling risk scores to be generated with appropriate weighting of these three factors. Five common haplotypes of CFH conferred a range of odds ratios (ORs) per copy from 1 to 4.17. Most of the effect of LOC387715/HTRA1 was mediated through one detrimental haplotype (carriage of one copy: OR 2.83; 95% confidence interval [CI] 1.91–4.20), with homozygotes being at particularly high risk (OR 32.83; 95% CI 12.53–86.07). Patients with neovascular macular degeneration had considerably higher scores than those without disease, and risk of blinding AMD rose to 15.5% in the tenth of the population with highest predicted risk. Conclusions An individual's risk of developing AMD in old age can be predicted by combining haplotype data with smoking status. Until there is effective treatment for AMD, encouragement to avoid smoking in those at high genetic risk may be the best option. We estimate that total absence of smoking would have reduced the prevalence of severe AMD by 33%. Unless smoking habits change or preventative treatment becomes available, the prevalence of AMD will rise as a consequence of the increasing longevity of the population.
Knockdown of ezrin causes intrahepatic cholestasis by the dysregulation of bile fluidity in the bile duct epithelium in mice
Authors: Ryo Hatano, Kaori Akiyama, Atsushi Tamura, Shigekuni Hosogi, Yoshinori Marunaka, Michael J. Caplan, Yoshiyuki Ueno, Sachiko Tsukita, Shinji Asano
Journal: Hepatology (2014)

Cholangiopathies share common features, including bile duct proliferation, periportal fibrosis, and intrahepatic cholestasis. Damage of biliary epithelium by autoimunne disorder, virus infection, toxic compounds, and developmental abnormalities causes severe progressive hepatic disorders responsible for high mortality. However, the etiologies of these cholestatic diseases remain unclear because useful models to study the pathogenic mechanisms are not available. In the present study, we have found that ezrin knockdown (Vil2(kd/kd) ) mice develop severe intrahepatic cholestasis characterized by extensive bile duct proliferation, periductular fibrosis, and intrahepatic bile acid accumulation without developmental defects of bile duct morphology and infiltration of inflammatory cells. Ezrin is a membrane cytoskeletal cross-linker protein, which is known to interact with transporters, scaffold proteins, and actin cytoskeleton at the plasma membrane. We found that the normal apical membrane localizations of several transport proteins including cystic fibrosis transmembrane conductance regulator (CFTR), anion exchanger 2 (AE-2), aquaporin 1 (AQP1), and Na(+) /H(+) exchanger regulatory factor were disturbed in bile ducts of Vil2(kd/kd) mice. Stable expression of a dominant negative form of ezrin in immortalized mouse cholangiocytes also led to the reduction of the surface expression of CFTR, AE-2, and AQP1. Reduced surface expression of these transport proteins was accompanied by reduced functional expression, as evidenced by the fact these cells exhibited decreased CFTR-mediated Cl(-) efflux activity. Furthermore, bile flow and biliary HCO3 (-) concentration were also significantly reduced in Vil2(kd/kd) mice.Dysfunction of ezrin mimics important aspects of the pathological mechanisms responsible for cholangiopathies. The Vil2(kd/kd) mouse may be a useful model to exploit in the development and testing of potential therapies for cholangiopathies.
A NEW ANTERIOR CHAMBER SYRINGE.Read in the Section of Ophthalmology at the Forty-first Annual Meeting of the American Medical Association, Nashville, Tenn., May, 1890.
Authors: J. A. LIPPINCOTT
Journal: JAMA (1890)

At the last meeting of the American Ophthalmological Society, in a paper on "Irrigation of the Anterior Chamber," I described a syringe which I had employed in fifteen cases of cataract extraction and in two cases of hypopyon. Since that meeting I have continued this method of cleansing the anterior chamber in the two classes of cases referred to, with what I am inclined to think very favorable results. A large majority of the cases of hypopyon which we see in Pittsburgh, judging at least from my own experience, arise in connection with corneal wounds produced by pieces of coal. Whether owing to some malignant quality in this substance, or to malnutrition incident to the occupation of the miner, hypopyon thus originating is a very serious affection, and its tendency is to destroy the function and even the appearance of the eye. Notwithstanding the most conscientious applica tion of the
Esophageal leaks: extending our toolbox?
Authors: P. Eisendrath
Journal: Endoscopy (2010)

Traumatic or iatrogenic esophageal leaks are always associated with high morbidity and mortality. Besides intensive medical support and administration of broad-spectrum antibiotics, until the 1990 s surgery was almost the only solution for treatment of large leakages. One could divide the treatment principles into two categories, the first goal being to ensure closure of the defect. This could be done either directly through primary repair, if necessary reinforced by tissue interposition as muscle or gastric fundoplication, or through a delayed reconstruction after diversion (cervical esophagostomy and gastro/jejunostomy). The second goal was to ensure cleaning of the mediastinal or pleural space through surgical debridement and drainage.