tbuckley/cabot-search huggingface dataset:
Consultation in Internal Medicine
Authors: Stanford Wessler
Journal: JAMA (1990)

This concise, softcover volume has 25 contributors, all of whom either have or have had appointments at the Tufts Medical School or the New England Medical Center. It offers a unique twist amid the burgeoning publications for the young primary care internist and also, in this instance, the young surgeon. Within 54 essays on selected areas are covered, according to the author, 90% of the issues internist consultants are called upon to see in hospital practice. For these 54 essays there are several major sections: cardiology, infectious disease, gastroenterology, nephrology, pulmonary disease, hematology and oncology, and chronic diseases. Endocrinology and rheumatology sections are intentionally omitted, as "most of these patients are cared for on an outpatient basis." Diabetes, however, is reviewed in the chronic disease section. The individual essays are predominantly expositional, remarkably current, simply worded, intensely practical, and accompanied by only occasional, clearly prepared tables, rarely a graph or
NICE uses wrong comparator to assess cost effectiveness of new drugs, report says
Authors: N. Hawkes
Journal: BMJ (2014)

Patients may be denied access to new drugs and medical innovation may be stalled by the way the National Institute for Health and Care Excellence assesses medicines for cost effectiveness, a report from the University College London School of Pharmacy has claimed.1

Licensed to Cure? said that in around a quarter of the cost effectiveness assessments of new medicines that NICE carried out from 2008 to the end of 2013 the manufacturers were asked to provide data on a non-licensed alternative against which their product could be compared. David Taylor, one of the authors of the report, said that the use of low cost non-licensed medicines as comparators was wrong and could create a false perception of the true value of a new medicine.

“If you were to compare the cost of a new Volvo against an old banger, it’s very unlikely the Volvo would …
Tampons could be used to diagnose STDs
Authors: S. Gottlieb
Journal: BMJ (2000)

Tampons can be used to detect some sexually transmitted diseases with greater efficacy than traditional swab methods, according to the results of a new study.

Specimens collected during invasive speculum examination have long been necessary for the conventional laboratory diagnosis of vaginal discharge diseases. Recently, the emphasis has been on molecular diagnosis of vaginal discharge diseases on non-invasive, self collected specimens to enable screening of large populations. …
Increased risk of solid renal tumors in lithium-treated patients
Authors: Mohamad Zaidan, Fabien Stucker, Bénédicte Stengel, Viorel Vasiliu, Aurélie Hummel, Paul Landais, Jean-Jacques Boffa, Pierre Ronco, Jean-Pierre Grünfeld, Aude Servais
Journal: Kidney International (2014)
Tumour susceptibility and spontaneous mutation in mice deficient in Mlh1, Pms1 and Pms2 DMA mismatch repair
Authors: Tomas A. Prolla, Sean M. Baker, Allie C. Harris, Jen-Lan Tsao, Xiang Yao, C. Eric Bronner, Binhai Zheng, Melissa Gordon, Jeffrey Reneker, Norman Arnheim, Darryl Shibata, Allan Bradley, R. Michael Liskay
Journal: Nature Genetics (1998)
HMMR Maintains the Stemness and Tumorigenicity of Glioblastoma Stem-like Cells
Authors: Jessica Tilghman, Hao Wu, Yingying Sang, Xiaohai Shi, Hugo Guerrero-Cazares, Alfredo Quinones-Hinojosa, Charles G. Eberhart, John Laterra, Mingyao Ying
Journal: Cancer Research (2014)

Abstract Glioblastoma (GBM) stem cells (GSC) are a subpopulation of tumor cells that display stem-like characteristics (stemness) and play unique roles in tumor propagation, therapeutic resistance, and tumor recurrence. Therapeutic targets in GSCs are a focus of increasing interest to improve GBM therapy. Here we report that the hyaluronan-mediated motility receptor (HMMR) is highly expressed in GBM tumors, where it supports the self-renewal and tumorigenic potential of GSCs. HMMR silencing impairs GSC self-renewal and inhibits the expression of GSC markers and regulators. Furthermore, HMMR silencing suppresses GSC-derived tumor growth and extends the survival of mice bearing GSC xenografts. Conversely, HMMR overexpression promotes GSC self-renewal and intracranial tumor propagation. In human GBM tumor specimens, HMMR expression is correlated positively with the expression of stemness-associated markers and regulators. Our findings identify HMMR as a candidate therapeutic target to GSCs as a GBM treatment strategy. Cancer Res; 74(11); 3168–79. ©2014 AACR.
Splenectomy Does Not Cure the Thrombocytopenia of Systemic Lupus Erythematosus
Authors: Stephen Hall, John L. McCORMICK, Philip R. Greipp, Clement J. Michet, Charles H. McKENNA
Journal: Annals of Internal Medicine (1985)

Fourteen patients with systemic lupus erythematosus had splenectomies done between 1960 and 1982 for treatment of severe thrombocytopenia. Thrombocytopenia persisted or recurred within 1 month postoperatively in five patients and within 6 months in three others. Three patients had late recurrence (18, 30, and 54 months after splenectomy); in two it was probably related to withdrawal of immunosuppressive agents or corticosteroids. Median lowest platelet count before splenectomy and median platelet count at relapse or failure of splenectomy were both 8000/microL. Only two patients maintained normal platelet counts without need for corticosteroids or other treatment. These results differ from those in patients with idiopathic thrombocytopenic purpura. Other treatments should be tried before splenectomy is done for thrombocytopenia in patients with systemic lupus erythematosus.
Effects of reduced left ventricular mass on chamber architecture, load, and function: a study of anorexia nervosa.
Authors: M G St John Sutton, T Plappert, L Crosby, P Douglas, J Mullen, N Reichek
Journal: Circulation (1985)

We investigated the effects of reduction in left ventricular mass on cavity geometry, afterload, pump function, and exercise performance in 17 patients with anorexia nervosa and in 10 age-and sex-matched normal subjects. Left ventricular mass index determined by two-dimensional echo-cardiography was significantly lower than that in normal subjects (53 +/- 15 vs 79 +/- 18 g/m2; p less than .005). Left ventricular end-diastolic and end-systolic volume indexes were also reduced in patients with anorexia nervosa compared with normal subjects (49 +/- 11 vs 65 +/- 17 ml/m2, p less than .005; 14 +/- 5 vs 19 +/- 4 ml/m2, p less than .025). In spite of the reductions in left ventricular mass and volume indexes, left ventricular chamber architecture described as h/R ratio, mass to volume ratio, and short/long left ventricular axis ratio were normal. Left ventricular afterload assessed as end-systolic meridional and circumferential wall stress was normal (59 +/- 18 vs 79 +/- 19 dyne/cm2 X 10(3) and 170 +/- 26 vs 167 +/- 23 dyne/cm2 X 10(3)). Ejection fraction, percent fractional shortening, and the relationship between end-systolic wall stress and ejection fraction were all within normal limits. In seven patients restudied after a 15% to 20% weight gain, left ventricular mass and volume indexes increased significantly but end-systolic wall stress and ejection fraction did not change. Ten patients with anorexia nervosa and resting heart rates and systolic blood pressures significantly lower than control values underwent treadmill testing. Exercise duration, peak heart rate, peak systolic blood pressure, and peak oxygen consumption in these patients were all significantly lower than normal. The hypotensive effect of fasting resulted in an initial decrease in afterload, which was the stimulus for reduction in left ventricular mass. The left ventricular remodeling associated with the mass reduction occurred in such a way that (1) orthogonal, meridional, and circumferential wall stresses were normalized, (2) normal chamber shape and architecture were maintained, and (3) chamber function and stress-shortening relationships were preserved. Thus down-regulation of left ventricular mass per se, like up-regulation of left ventricular mass, is not associated with abnormal left ventricular function.
Consultant Surgeons and Vasectomy
Authors: L. N. Jackson
Journal: BMJ (1973)

Besides being free of charge, the service is readily available without a waiting list.Under these circumstances, from our 13,000 patients, we have in the first year performed 100 vasectonies; in 1972 there were 75 and this year so far the demand is again at the rate of 100 per year.Projected throughout the country these figures suggest a continuiin demand for vasectomy, approaching half a million per annum.Mrs. Waite's paper underlines the still considerable lag in meeting this demand.-I am, etc.,
Tumor Spread through Air Spaces is an Important Pattern of Invasion and Impacts the Frequency and Location of Recurrences after Limited Resection for Small Stage I Lung Adenocarcinomas
Authors: Kyuichi Kadota, Jun-ichi Nitadori, Camelia S. Sima, Hideki Ujiie, Nabil P. Rizk, David R. Jones, Prasad S. Adusumilli, William D. Travis
Journal: Journal of Thoracic Oncology (2015)

IntroductionTumor invasion in lung adenocarcinoma is defined as infiltration of stroma, blood vessels, or pleura. Based on observation of tumor spread through air spaces (STAS), we considered whether this could represent new patterns of invasion and investigated whether it correlated with locoregional versus distant recurrence according to limited resection versus lobectomy.MethodsWe reviewed resected small (less than or equal to 2 cm) stage I lung adenocarcinomas (n = 411; 1995–2006). Tumor STAS was defined as tumor cells—micropapillary structures, solid nests, or single cells—spreading within air spaces in the lung parenchyma beyond the edge of the main tumor. Competing risks methods were used to estimate risk of disease recurrence and its associations with clinicopathological risk factors.ResultsSTAS was observed in 155 cases (38%). In the limited resection group (n = 120), the risk of any recurrence was significantly higher in patients with STAS-positive tumors than that of patients with STAS-negative tumors (5-year cumulative incidence of recurrence, 42.6% versus 10.9%; P < 0.001); the presence of STAS correlated with higher risk of distant (P = 0.035) and locoregional recurrence (P = 0.001). However, in the lobectomy group (n = 291), the presence of STAS was not associated with either any (P = 0.50) or distant recurrence (P = 0.76). In a multivariate analysis, the presence of tumor STAS remained independently associated with the risk of developing recurrence (hazard ratio, 3.08; P = 0.014).ConclusionThe presence of STAS is a significant risk factor of recurrence in small lung adenocarcinomas treated with limited resection. These findings support our proposal that STAS should formally be recognized as a pattern of invasion in lung adenocarcinoma.
Sudden deaths among Finnish conscripts.
Authors: K Koskenvuo
Journal: BMJ (1976)

The epidemiology of sudden deaths was studied among conscripts in Finland in 1948-72 (660 000 man-years) and among Finnish men aged 15-24 years in 1969-70 (900 000 man-years). The incidence of sudden deaths among the conscripts was 6-8/100 000 man-years. The onset of acute symptoms occurred during strenuous exercise in a third of the conscripts but in only a few of the other young men. Cardiovascular diseases caused two-thirds of the deaths in both groups. Sudden death tended to be more common among conscripts than among other young men during the corresponding period, but overall non-violent deaths were less common among conscripts than among other young men. On the basis of health records an attempt was made to separate the sudden deaths among conscripts from those among the controls by multiple discriminant analysis. For all practical purposes, however, the separation power proved poor.
Effects of diastolic transseptal pressure gradient on ventricular septal position and motion.
Authors: I Kingma, J V Tyberg, E R Smith
Journal: Circulation (1983)

Despite the clinical prevalence of paradoxic interventricular septal (IVS) motion, its pathogenesis remains unclear. To assess the influence of the end-diastolic transseptal pressure gradient, we studied eight open-chest dogs during right ventricular (RV) volume loading (induced by opening a Dacron shunt between the pulmonary artery [PA] and right atrium), RV pressure loading (constriction of PA), and left bundle branch block (RV pacing). Ultrasonic crystals in the IVS and on the RV and left ventricular (LV) free walls (FW) allowed measurement of RV septal-to-free wall (S-FW) and LVS-FW diameters. Another set measured the anteroposterior (AP) diameter of the LV (LVAP). Two-dimensional and M mode echocardiograms confirmed IVS shape and motion pattern, respectively. RV volume load caused a reduction in mean transseptal end-diastolic pressure gradient from 2.1 to -2.6 mm Hg (p less than .001), with a concomitant increase in mean end-diastolic RVS-FW diameter of 2.5 mm (p less than .001) and a decrease in LVS-FW diameter of 2.8 mm (p less than .001). LVAP was unchanged. Echocardiograms confirmed a leftward IVS shift during diastole with paradoxic systolic motion. PA constriction and RV pacing caused similar directional changes in transseptal end-diastolic pressure gradients and diameters. Compared with control values, shunt opening and PA constriction also caused a small leftward shift of IVS at end-systole. Normalized data from all eight dogs revealed significant (p less than .001) correlations between reduction in LV-RV end-diastolic pressure gradients and increases in RVS-FW (r = .85) and decreases in LVS-FW (r = .80) diameters.(ABSTRACT TRUNCATED AT 250 WORDS)
Hepatitis A—New information on an old virus
Authors: Chris J. Dickinson
Journal: Hepatology (1992)

ABSTRACT An outbreak of hepatitis A virus (HAV) infection in a neonatal intensive care unit (NICU) provided the opportunity to examine the duration of HAV excretion in infants and the mechanisms by which HAV epidemics are propagated in NICUs. The outbreak affected 13 NICU infants (20%), 22 NICU nurses (24%), 8 other staff caring for NICU infants, and 4 household contacts; 2 seropositive infants (primary cases) received blood transfusions from a donor with HAV infection. Risk factors for infection among nurses were care for a primary infant–case (relative risk [RR], 3.2), drinking beverages in the unit (odds ratio [OR], ∞), and not wearing gloves when taping an intravenous line (OR, 13.7). Among infants, risk factors were care by a nurse who cared for a primary infant–case during the same shift (RR, 6.1). Serial stool samples from infantcases were tested for HAV antigen (HAV–Ag) by enzyme immunoassay and HAV RNA by nucleic acid amplification using the polymerase chain reaction. Infantcases excreted HAV–Ag ( n = 2) and HAV RNA ( n = 3) 4-5 months after they were identified as being infected. Breaks in infection control procedures and possibly prolonged HAV shedding in infants propagated the epidemic in a critical care setting.
Why Physicians Strike
Authors: Roy J. Popkin
Journal: JAMA (1964)

<h3>To the Editor:—</h3> The medical profession has gone through a difficult time in its strike in Belgium. Although it was a local Belgium problem, the profession even in this country was subjected to criticism. Revolt by physicians is a particularly difficult concept for the public to grasp, but it is just as difficult for most of the profession throughout the world to accept. Interestingly enough, the public does not complain when it is the individual physician who protests. Indeed, they often sympathize and agree with him. It is the organized action of the profession which they fear. News commentators and popular magazine writers have had their field day making sneering remarks about the lack of dedication of the modern-day physician. I believe that it is our time to answer. We have developed and fostered the concept of dedication until it has become a vulnerable point for attack. The picture of
Blurred vision and epistaxis
Authors: K. Shirley, F. P. McNicholl
Journal: BMJ (2014)

A 34 year old man presented with a three month history of blurred vision. He also mentioned nose bleeds, worsening headaches, and pain in the right knee. He had experienced some weight loss and tiredness but had been previously healthy and took no drugs on a regular basis. His general practitioner carried out full blood tests in light of the recurrent epistaxis: haemoglobin was 127 g/L (reference range 130-180), platelets 111×109/L (140-400), white cell count 275×109/L (3.6-11.0), neutrophils 107×109/L (1.8-7.5), lymphocytes 11×109/L (1.0-4.0), monocytes 5.52×109/L (0.2-0.8), eosinophils 8×109/L (0.1-0.4), and basophils 0×109/L (0.02-0.1). He was subsequently admitted to hospital for investigations. On admission he was apyrexic and his blood pressure was 130/76 mm Hg. His spleen was not palpable, but ultrasonography of his abdomen showed splenomegaly of 16 cm. His coagulation screen was normal: prothrombin time 12.4 s (11-14), activated partial thromboplastin time 27.7 s (26-39), and fibrinogen 18 µmol/L (4.4-11.8). Renal function was slightly impaired, with a creatinine concentration of 136 µmol/L (58-110) and an estimated glomerular filtration rate of 52 mL/min/1.73m2. Uric acid was increased, at 510 µmol/L (200-430). The lactate dehydrogenase concentration was noticeably increased, at 2458 IU/L (105-133), the vitamin B12 level was increased, at >1500 pmol/L (110-664), and C reactive protein was 4.2 mg/L (<5). Visual acuity was 6/9 in the right eye and 6/24 in the left eye. Fundal examination revealed bilateral changes, as shown in the fundal photograph of the left eye (fig 1⇓). Fig 1 Fundal photograph of left eye
Self tolerance to T cell receptor V beta sequences.
Authors: F Falcioni, D Vidović, E S Ward, D Bolin, G Singh, H Shah, B Ober, Z A Nagy
Journal: The Journal of Experimental Medicine (1995)

T cell tolerance to self is achieved by deletion or inactivation of clones recognizing peptides of self proteins presented by major histocompatibility complex molecules. A considerable fraction of self proteins accessible to the immune system is contributed by the system itself, for example, the receptors used for antigen recognition (antibodies and T cell receptors [TCRs]). Thus far, it has remained unclear, whether antigen receptors are subject to self tolerance, or on contrary, engage into network interactions implying immunity rather than tolerance. In this study, we demonstrate self tolerance to synthetic peptides corresponding to the first hypervariable region of the V beta 8.1 and V beta 8.2 TCR proteins. We also show that the tolerogenic synthetic peptide corresponds to a fragment produced by processing of the V beta protein, and conversely, that a V beta peptide not produced by processing is also not subject to self tolerance. Thus, the rules of tolerance seem to apply to antigen receptors, at least to their germline-encoded portions, in a similar fashion as to other self proteins. This finding has important implications for studies of natural and artificially induced immune networks.
Interleukin 2 activation of natural killer cells rapidly induces the expression and phosphorylation of the Leu-23 activation antigen.
Authors: L L Lanier, D W Buck, L Rhodes, A Ding, E Evans, C Barney, J H Phillips
Journal: The Journal of Experimental Medicine (1988)

IL-2 potentiates both growth and cytotoxic function of T lymphocytes and NK cells. Resting peripheral blood NK cells can respond directly to rIL-2, without requirement for accessory cells or cofactors, and enhanced cytotoxicity can be measured within a few hours after exposure to this lymphokine. In this study, we describe an activation antigen, Leu-23, that is rapidly induced and phosphorylated after IL-2 stimulation of NK cells and a subset of low buoyant density T lymphocytes. Previously, it has been uncertain whether all NK cells or only a subset are responsive to IL-2. Since within 18 h after exposure to IL-2, essentially all NK cells express Leu-23, these findings indicate that all peripheral blood NK cells are responsive to stimulation by IL-2. The Leu-23 antigen is a disulfide-bonded homodimer, composed of 24-kD protein subunits with two N-linked oligosaccharides. Appearance of this glycoprotein on NK cells is IL-2 dependent and closely parallels IL-2-induced cytotoxicity against NK-resistant solid tumor cell targets.
Endarterectomy in Carotid Artery Disease
Authors: David B. Matchar
Journal: JAMA (1987)

Carotid endarterectomy is being performed with increasing frequency, now over 100,000 times annually in the United States. We used the methods of decision analysis to examine the question of when to perform carotid endarterectomy. We developed a model that simulates the possible outcomes for a cohort of patients at risk for stroke. Estimates of surgical risk, surgical efficacy, annual stroke rate, and nonstroke mortality were derived from the literature. Using sensitivity analysis, we found that surgical risk, surgical efficacy, and stroke risk are the most important factors in determining when surgery is appropriate. By examining a series of clinical scenarios, we constructed guidelines for carotid endarterectomy based on the estimated risk of future stroke. The analysis suggests that for patients with a risk of less than 3% per year, surgery is not indicated. For patients with risk between 3% and 5% per year, low-risk surgery can be expected to provide a benefit of at most three months of quality life, depending on the efficacy of surgery. For stroke risk between 5% and 10% per year, even high-risk surgery is favored if surgical efficacy is above 30%. Above a stroke risk of 10% per year, even high-risk, low-efficacy surgery should be considered. The challenge to advocates of carotid endarterectomy is to develop a cost-effective strategy for identifying patients at high risk for stroke.
Effect of Diurnal Variation on Debrisoquine Metabolic Phenotyping
Authors: G. L. Shaw, R. T. Falk, N. E. Caporaso, H. J. Issaq, R. G. Kase, S. D. Fox, M. A. Tucker
Journal: JNCI Journal of the National Cancer Institute (1990)

Journal Article Effect of Diurnal Variation on Debrisoquine Metabolic Phenotyping Get access Gail L. Shaw, Gail L. Shaw * Environmental Epidemiology Branch, National Cancer InstituteBethesda Md * Correspondence to: Gail L. Shaw, M.D., Executive Plaza North, Ste. 439, National Institutes of Health, Bethesda, MD 20892 Search for other works by this author on: Oxford Academic PubMed Google Scholar Roni T. Falk, Roni T. Falk Environmental Epidemiology Branch, National Cancer InstituteBethesda Md Search for other works by this author on: Oxford Academic PubMed Google Scholar Neil E. Caporaso, Neil E. Caporaso Environmental Epidemiology Branch, National Cancer InstituteBethesda Md Search for other works by this author on: Oxford Academic PubMed Google Scholar Haleem J. Issaq, Haleem J. Issaq Program Resources, Inc.Frederick, Md Search for other works by this author on: Oxford Academic PubMed Google Scholar Ron G. Kase, Ron G. Kase Westat, Rockville, Md Search for other works by this author on: Oxford Academic PubMed Google Scholar Stephen D. Fox, Stephen D. Fox Program Resources, Inc.Frederick, Md Search for other works by this author on: Oxford Academic PubMed Google Scholar Margaret A. Tucker Margaret A. Tucker Environmental Epidemiology Branch, National Cancer InstituteBethesda Md Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 82, Issue 19, 3 October 1990, Pages 1573–1575, https://doi.org/10.1093/jnci/82.19.1573 Published: 03 October 1990 Article history Received: 18 July 1990 Revision received: 25 July 1990 Accepted: 30 July 1990 Published: 03 October 1990