tbuckley/cabot-search huggingface dataset:
Cortisone and ACTH in Pregnancy
Authors: Lawrence Katzenstein, Allston J. Morris
Journal: New England Journal of Medicine (1954)

EXPERIMENTAL evidence suggests that the administration of cortisone and ACTH to animals during pregnancy may be dangerous to the fetus. Yet, in the few cases in which this therapy has been given to pregnant women, there has been no harm to the offspring. Because of this apparent contradiction, the following case of dermatitis herpetiformis of pregnancy, treated for six months with cortisone and ACTH, with delivery of a normal baby, is presented.Case ReportT. H., a 36-year-old woman, was first seen on February 18, 1952, complaining of an itching eruption of the arms and legs of about 1 week's . . .
Combination therapy of an anticancer drug with the FNIII14 peptide of fibronectin effectively overcomes cell adhesion-mediated drug resistance of acute myelogenous leukemia
Authors: T Matsunaga, F Fukai, S Miura, Y Nakane, T Owaki, H Kodama, M Tanaka, T Nagaya, R Takimoto, T Takayama, Y Niitsu
Journal: Leukemia (2007)
The effect of relaparotomy timing on wound healing in an animal model
Authors: Melih Akinci, Zafer Ergul, Murat Kantarcioglu, Serkan Tapan, Mehmet Ozler, Armagan Gunal, Hakan Kulacoglu, Tayfun Ide, Ahmet Sayal, Mehmet Eryilmaz, Orhan Kozak
Journal: International Journal of Surgery (2014)
An unconstrained mind: Explaining belief in the afterlife
Authors: Philip Robbins, Anthony I. Jack
Journal: Behavioral and Brain Sciences (2006)

Bering contends that belief in the afterlife is explained by the simulation constraint hypothesis: the claim that we cannot imagine what it is like to be dead. This explanation suffers from some difficulties. First, it implies the existence of a corresponding belief in the “beforelife.” Second, a simpler explanation will suffice. Rather than appeal to constraints on our thoughts about death, we suggest that belief in the afterlife can be better explained by the lack of such constraints.
Bronchial Thermoplasty in Refractory Asthma: Interim Results in a Severe Asthma Population (Research in Severe Asthma (RISA) Trial)
Authors: R. Niven, I. Pavord, M. Laviolette, N. Thomson, P. Corris, G. Cox, K. Fan-Chung, A. Sperb-Rubin
Journal: Journal of Allergy and Clinical Immunology (2007)
CCN3/Nephroblastoma Overexpressed Matricellular Protein Regulates Integrin Expression, Adhesion, and Dissemination in Melanoma
Authors: Viviana Vallacchi, Maria Daniotti, Francesca Ratti, Delia Di Stasi, Paola Deho, Annamaria De Filippo, Gabrina Tragni, Andrea Balsari, Antonino Carbone, Licia Rivoltini, Giorgio Parmiani, Noureddine Lazar, Bernard Perbal, Monica Rodolfo
Journal: Cancer Research (2008)

Abstract CCN3/nephroblastoma overexpressed belongs to the CCN family of genes that encode secreted proteins associated with the extracellular matrix (ECM) and exert regulatory effects at the cellular level. Overexpression of CCN3 was shown in metastatic melanoma cells compared with cells of the primary tumor from the same patient. Analysis of short-term cultures from 50 primary and metastatic melanomas revealed a heterogeneous expression pattern of both the 46-kDa full-length cytoplasmic/secreted protein and the 32-kDa nuclear-truncated form. The different protein expression patterns were not associated with gene alterations or polymorphisms. Like the metastatic cells expressing high levels of the 46-kDa CCN3, cells transfected to overexpress CCN3 showed increased adhesion to ECM proteins, whereas inhibition of CCN3 expression by small interfering RNA decreased adhesion to laminin and vitronectin. CCN3 overexpression induced increased expression of laminin and vitronectin integrin receptors α7β1 and αvβ5 by increasing their mRNA production. Moreover, CCN3 secreted by melanoma cells acted as an adhesion matrix protein for melanoma cells themselves. Analysis of CCN3 protein expression with respect to melanoma progression detected the protein in all visceral metastases tested and in most nodal metastases from relapsing patients but in only a few nodal metastases from nonrelapsing patients and cutaneous metastases. Consistently, xenotransplantation in immunodeficient mice showed a higher metastatic potential of melanoma cells overexpressing CCN3. Together, these data indicate a role for CCN3 in melanoma cell interaction with the ECM by regulating integrin expression, resulting in altered cell adhesion and leading melanoma progression to aggressive disease. [Cancer Res 2008;68(3):715–23]
Staging of Breast Cancer and Survival Rates-Reply
Authors: Paul Meier
Journal: JAMA (1983)

In Reply.—  We are grateful to Drs Sutherland and Mather for their comments on our use of relative survival to measure the effectiveness of primary therapy for breast cancer. As they point out, the approximate parallelism (when displayed on a logarithmic scale) of the survival curve beyond a given time implies that the future mortality risk for the patients who survive at least that long is substantially the same as that for comparable members of the population. In this sense, it is proper to say that these breast cancer survivors no longer have mortality risk related to their diagnosis and that, for these patients, therapy has achieved all of the survival benefit that there was reason to hope for. The fraction of patients falling into this category is, thus, a highly plausible measure of the effectiveness of therapy.  As in any comparison not based on random allocation to treatment, questions
Transformed Non-Hodgkin Lymphoma Demonstrated on Thallium-201 and Gallium-67 Scintigraphy
Authors: Andrew F. Robertson, Robert Mansberg, Paul J. Roach
Journal: Clinical Nuclear Medicine (2006)

A 65-year-old man with follicular B-cell low-grade non-Hodgkin lymphoma (NHL) was referred for combined Tl-201 and Ga-67 scintigraphy. Discordant uptake of Tl-201 and Ga-67 raised the possibility of local transformation to a higher grade disease. Biopsy of Ga-67-avid lymph nodes confirmed diffuse large B-cell intermediate-grade NHL. This case demonstrates that the combined use of Tl-201 and Ga-67 can determine sites of local transformation of low-grade NHL to higher grade disease. Any sites of discordant tracer uptake can be used to guide further biopsy to confirm the diagnosis and can significantly alter the management of the patient.
Autonomic Symptoms and Diabetic Neuropathy
Authors: Phillip A. Low, Lisa M. Benrud-Larson, David M. Sletten, Tonette L. Opfer-Gehrking, Stephen D. Weigand, Peter C. O’Brien, Guillermo A. Suarez, Peter J. Dyck
Journal: Diabetes Care (2004)

OBJECTIVE—The prevalence of autonomic symptoms and deficits in certain systems is known, but a comprehensive autonomic symptom profile in diabetes is not available. We aimed to estimate this using a laboratory evaluation of autonomic function and a validated self-report measure of autonomic symptoms in patients and matched control subjects from the population-based Rochester Diabetic Neuropathy Study. RESEARCH DESIGN AND METHODS—Participants included 231 patients with diabetes (type 1, n = 83; type 2, n = 148) and 245 healthy age-matched control subjects. We assessed symptoms using a validated self-report instrument (Autonomic Symptom Profile) and evaluated the severity and distribution of autonomic deficits (cardiovagal, sudomotor, adrenergic) with the objective, laboratory-based Composite Autonomic Severity Score (CASS). RESULTS—Autonomic symptoms were present more commonly in type 1 than in type 2 diabetes, with symptoms of orthostatic intolerance, secretomotor, urinary control, diarrhea, and sleep disturbance and pupillomotor, vasomotor, and erectile dysfunction significantly increased over healthy control subjects in type 2 diabetic patients. The prevalence of autonomic impairment was 54% in type 1 and 73% in type 2 diabetic patients. Severity of autonomic failure was mild overall (mean CASS 2.3; maximum 10), with orthostatic hypotension occurring in 8.4 and 7.4% of type 1 and 2 diabetic patients, respectively. Fourteen percent of patients had a CASS ≥5, indicating moderate to severe generalized autonomic failure. The correlation of symptoms with autonomic deficits (CASS) was better in type 1 than type 2 diabetic subjects and was weak overall. CONCLUSIONS—These findings indicate that autonomic symptoms and deficits are common in diabetes, but mild in severity, and that the correlation between symptom scores and deficits is overall weak in mild diabetic neuropathy, emphasizing the need to separately evaluate autonomic symptoms.
PTU-167 Barrett’s Oesophagus Surveillance Study (boss) Update: Successful Recruitment To A Long Follow-up Rct
Authors: OJ Old, C Stokes, S Woods, C Foy, J Hapeshi, H Barr
Journal: Gut (2014)

<h3>Introduction</h3> Current BSG guidelines advise routine endoscopic surveillance for patients with Barrett’s oesophagus to enable early detection of oesophageal adenocarcinoma. However, evidence for improved outcomes from surveillance is weak and remains the subject of debate. To address these concerns, BOSS aims to compare the benefits of 2-yearly surveillance endoscopy against endoscopy on an ‘at need’ basis only. As a large, multicentre trial with 10 year follow-up, this ambitious project faced a number of challenges to recruitment, particularly the acceptability of randomising to a control arm with no routine endoscopy, especially in sites where surveillance had been established. <h3>Methods</h3> Multi-centre randomised controlled trial (ISRCTN54190466). Inclusion criteria: patients over 18 with endoscopic and histologically proven Barrett’s oesophagus &gt;1 cm. Exclusion criteria: patients unable to consent, unfit for endoscopy, high-grade dysplasia or cancer, or participation in AspECT trial. Target sample size: 3400. Recruitment: patients identified at local centres with new diagnosis, or existing diagnosis of Barrett’s and endoscopy within last 2 years. Follow-up will be for 10 years. Intervention arm will receive 2-yearly surveillance endoscopy, control arm will receive endoscopy on an ‘at need’ basis if symptomatic. Primary outcome: all cause mortality. <h3>Results</h3> Recruitment began March 2009, target of 3400 was reached ahead of schedule in October 2011. 3469 consented to be randomised (58.4% of eligible screened patients): 1739 in 2-yearly surveillance, 1730 in ‘at need’ arm. 127 hospitals were open to recruitment, though 3 withdrew from the study, recruitment was closed in one centre by the trial team, and 11 did not recruit any patients. 3780 screened patients did not enter: 1309 ineligible, 2471 declined. Most common reasons for patients to decline were: preference for surveillance, preference not to have endoscopies and a family history of cancer. As of January 2014, 111 patients were no longer in their originally randomised treatment groups: 55 due to patient/clinician decision, 56 for other reasons. For 107 of those 111 patients, data continues to be collected. <h3>Conclusion</h3> The successful recruitment to BOSS strongly supports the acceptability of randomisation to the control arm, and patients’ willingness to participate in a long follow-up RCT. The large number of centres and enthusiastic principal investigators have shown continued success, and great promise for BOSS to answer key questions on Barrett’s surveillance. <h3>Reference</h3> Fitzgerald RC, <i>et al</i>.<i> Gut</i> 2014:63:7–42 <h3>Disclosure of Interest</h3> None Declared.
MORPHOLOGICAL STUDIES IN EXPERIMENTAL CRETINISM
Authors: Arthur L. Tatum
Journal: The Journal of Experimental Medicine (1913)

In summarizing the findings of this paper it may be said that degenerative changes have been noted in practically every parenchymatous organ. Among these the most striking has been that of serous imbibition by the most active cells of these organs. In regard to the changes in the glands of internal secretion, the findings corroborate the statements of Cushing in regard to hypophysectomy, that removal of one gland of internal secretion results in changes in all the other glands. In this case, degenerative changes predominate in the hypophysis, thymus, ovary, and testis, while hyperplasia is seen in the islands of Langerhans and the medullas of the adrenal glands. Finally, in the rabbit athyroidism is responsible for grave degenerative changes in practically all organs and tissues of the body, and many of the symptoms of cretinism have an anatomical basis in organic cellular changes.
Outcomes in Patients With De Novo Left Main Disease Treated With Either Percutaneous Coronary Intervention Using Paclitaxel-Eluting Stents or Coronary Artery Bypass Graft Treatment in the Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) Trial
Authors: Marie-Claude Morice, Patrick W. Serruys, A. Pieter Kappetein, Ted E. Feldman, Elisabeth Ståhle, Antonio Colombo, Michael J. Mack, David R. Holmes, Lucia Torracca, Gerrit-Anne van Es, Katrin Leadley, Keith D. Dawkins, Friedrich Mohr
Journal: Circulation (2010)

The prospective, multinational, randomized Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial was designed to assess the optimal revascularization strategy between percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), for patients with left main (LM) and/or 3-vessel coronary disease.This observational hypothesis-generating analysis reports the results of a prespecified powered subgroup of 705 randomized patients who had LM disease among the 1800 patients with de novo 3-vessel disease and/or LM disease randomized to PCI with paclitaxel-eluting stents or CABG in the SYNTAX trial. Major adverse cardiac and cerebrovascular event rates at 1 year in LM patients were similar for CABG and PCI (13.7% versus 15.8%; Delta2.1% [95% confidence interval -3.2% to 7.4%]; P=0.44). At 1 year, stroke was significantly higher in the CABG arm (2.7% versus 0.3%; Delta-2.4% [95% confidence interval -4.2% to -0.1%]; P=0.009]), whereas repeat revascularization was significantly higher in the PCI arm (6.5% versus 11.8%; Delta5.3% [95% confidence interval 1.0% to 9.6%]; P=0.02); there was no observed difference between groups for other end points. When patients were scored for anatomic complexity, those with higher baseline SYNTAX scores had significantly worse outcomes with PCI than did patients with low or intermediate SYNTAX scores; outcomes for patients with CABG did not correlate with baseline SYNTAX score, but baseline EuroSCORE significantly predicted outcomes for both treatments.Patients with LM disease who had revascularization with PCI had safety and efficacy outcomes comparable to CABG at 1 year; longer follow-up is required to determine whether these 2 revascularization strategies offer comparable medium-term outcomes in this group of complex patients.
The Need for Science in the Practice of Public Health
Authors: Nicole Lurie
Journal: New England Journal of Medicine (2009)

When H5N1 avian influenza emerged in 1997, much of the world began planning for an eventual pandemic. Most planners expected the pandemic to begin in Asia and believed the virus would be highly lethal. In the United States, planning efforts for pandemic influenza escalated again in November 2005, with the publication of the National Strategy for Pandemic Influenza.1 The H1N1 pandemic that emerged in the spring of 2009 did not conform to prior planning assumptions. It began in Mexico rather than Asia and to date has not been as lethal as first feared. Since 2005, global influenza surveillance has vastly . . .
Management outcome and follow-up of fetal tachycardia
Authors: Andries D. van Engelen, Olga Weijtens, Joel I. Brenner, Charles S. Kleinman, Joshua A. Copel, Philip Stoutenbeek, Erik J. Meijboom
Journal: Journal of the American College of Cardiology (1994)

Objectives. The aim of this study was to evaluate fetal tachycardia and the efficacy of maternally administered antiarrhythmic agents and the effect of this therapy on delivery and postpartum management. Background. Sustained fetal tachycardia is a potentially lifethreatening condition in which pharmacologic therapy is reported to be effective. There is ongoing discussion about optimal management. Methods. A group of 51 patients with M-mode echocardiographically documented tachycardia was retrospectively. Results. Thirty-three fetuses had supraventricular tachycardia; 15 had atrial flutter; 1 had two episodes of both; and 2 had ventricular tachycardia. Fetal hydrops was seen in 22 patients. Thirty-four feluses received maternal therapy with either digoxin or flecainide as the first administered drug (additional drugs were given in 12). Drug treatment was successful in establishing acceptable rhythm control in 82% (84% without, 80% with hydrops). In the latter group the median number of drugs and number of days to conversion were higher. Three patients with fetal hydrops died. In 50% of cases, tachycardia reappeared at delivery: 9 neonates presented with atrial flutter, 14 with supraventricular tachycardia and 1 with ventricular tachycardia. Seventy-eight percent of the group had pharmacologic therapy by 1 month of age and 14% by 3 years. Conclusions. Fetal tachycardia can be treated adequately in the majority of patients, even in the presence of hydrops, and therefore emergency delivery might not be indicated. Digoxin and flecainide were drugs of first choice and produced no serious adverse effects in this series of patients. The majority of patients do not require prolonged therapy.
132 ALLOGRAFT EXPRESSION OF INNATE IMMUNITY GENES INFLUENCES LIVER FIBROSIS PROGRESSION AND ACUTE CELLULAR REJECTION IN LIVER TRANSPLANTED PATIENTS
Authors: E. Fumolo, S. Boninsegna, P. Brun, S. Bignulin, D. Bitetto, E. Fornasiere, A. Cussigh, E. Fontanini, S. Cmet, E. Falleti, C. Fabris, R. Minisini, M. Pirisi, P. Toniutto
Journal: Journal of Hepatology (2010)
FDA Warning: Phony Ebola Treatments Being Sold Online
Authors: Bridget M. Kuehn
Journal: JAMA (2014)

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Treatment of Cystoid Macular Edema with Octreotide
Authors: Robert W.A.M. Kuijpers, Seerp Baarsma, P. Martin van Hagen
Journal: New England Journal of Medicine (1998)

To the Editor: In their report on the results of a doseresponse trial of sustained-release bupropion for smoking cessation, Hurt et al. (Oct.23 issue) 1 "recommend using the 300-mg dose (150 mg twice a day) as the target dose for most patients, given the favorable side-effect profile and the fact that there was less weight gain during the medication phase with this dose."We believe an initial dose of 150 mg a day may be more reasonable.Safety is a concern because of dose-related risks of seizures (1 case per 1000), anaphylactoid reactions (1 to 3 cases per 1000), and insomnia (in 34.6 percent of cases).In addition, if a million people (2 percent of U.S. smokers) used bupropion, the difference in cost between 150 mg a day and 300 mg a day would be $45 million to $60 million a year (assuming a cost of $90 to $120 for seven weeks of therapy with the 300-mg dose).At one year, the point-prevalence cessation rates for the 150-mg and 300-mg doses were 22.9 percent and 23.1 percent, respectively.At the end of treatment, the rates were 38.6 percent and 44.2 percent -not a significant difference.The suggestion that a higher dose should be used because it is associated with less weight gain is curious; at the end of treatment, the difference in the mean 1.
Epidermal cell necrosis with direct epidermal infiltration of Epstein–Barr virus (EBV)-encoded small nuclear RNA-positive T lymphocytes in a patient with EBV-associated haemophagocytic syndrome
Authors: Y. Kawachi, M. Itoh, Y. Fujisawa, J. Furuta, Y. Nakamura, T. Banno, T. Takahashi, F. Otsuka
Journal: British Journal of Dermatology (2007)
Regulating the regulators
Authors: S. Dewar
Journal: BMJ (2002)

The British government has plans for a new council to oversee the eight statutory regulators of health professionals (see box). The plans went out for consultation in the summer1 and are included in a bill currently before parliament.2 Proposals for the new overarching council were mooted in the NHS plan and backed by the recent Kennedy report into children's heart surgery at the Bristol Royal Infirmary. 3 4

Under the proposals the new Council for the Regulation of Health Care Professionals will “build and manage” a coordinated and consistent framework for regulation across health professions. It will put patients first and ensure open, transparent, and consistent procedures within each regulatory body. The council will comprise representatives of the public, the professional regulatory bodies, and government appointees (to be in a majority of one) including members of the public, and health service managers. It will be led by a chairperson appointed, for the first term, by the secretary of state. The council will be able to require regulators to change their procedures; refer their decisions on individual cases to the high court when it judges such an appeal to be in the public interest; and investigate claims of maladministration.

The council is a …
The acute abdomen
Authors: B. H. van Duren, M. Moghul, S. G. Appleton, G. I. v. Boxel
Journal: BMJ (2013)

A 45 year old woman presented to the emergency department with an eight hour history of sudden onset abdominal pain. The pain was severe, sharp, and worse on movement. She felt nauseous but had not vomited. She had last opened her bowels earlier that day, passing a small amount of hard stool. Her medical history included osteogenesis imperfecta, which caused hip pain, and for which she took 140 mg of oxycodone daily.

On examination she was in obvious distress. She was tachypnoeic at 22 breaths/min and tachycardic at 110 beats/min. Blood pressure, peripheral oxygen saturation, and temperature were all in the normal range. Her abdomen was exquisitely tender to palpation, with maximum tenderness in the right iliac fossa, localised guarding, and percussion tenderness. Digital rectal examination identified hard faeces in the rectum. Bowel sounds were absent. Initial blood tests showed haemoglobin 14.5 g/L (reference range 12.0-15.0), white cell count 17.5×109/L (4.0-11.0), C reactive protein 5.5 mg/L (0-8). Urea, electrolytes, and liver function tests were normal. A venous blood gas showed a raised lactate of 4.2 mmol/L (0.5-2.0; 1 mmol/L=9.01 mg/dL). Urgent chest radiography (in the erect position) was performed (fig 1⇓).





### 1 What abnormality is apparent on the erect chest radiograph?

#### Short answer

The erect chest radiograph shows a pneumoperitoneum with free gas under the diaphragm bilaterally.

#### Long answer

The erect chest radiograph shows crescentic collections of gas under the diaphragm bilaterally. The right hemidiaphragm is clearly delineated, with gas above and below (fig 2⇓). In addition, the gas indicated by the broken arrows may be under the central tendon of the diaphragm, but may also …