tbuckley/cabot-search huggingface dataset:
A143: Barriers to Referral to Pediatric Rheumatology among General Pediatricians in the Upper Midwest
Authors: Colleen K. Correll, Logan G. Spector, Lei Zhang, Bryce A. Binstadt, Richard K. Vehe
Journal: Arthritis & Rheumatology (2014)

Background/Purpose:

Access to pediatric rheumatology (PR) care is limited. An average of 28 fellows graduate from PR training programs annually, and there are 224 board-certified pediatric rheumatologists in the United States. Eleven states have no pediatric rheumatologist and 24 states have two or fewer. Furthermore, the mean distance to a certified pediatric rheumatologist is 60 miles. The impact that limited access to PR has on general pediatricians has not been studied.



Methods:

A web-based survey was emailed to general pediatricians practicing in Minnesota (MN), North Dakota (ND), and South Dakota (SD). The email databases were obtained from the MN and ND state medical licensing boards and from the SD chapter of the American Academy of Pediatrics. The goal of the survey was to define barriers to access to PR care and the consequences of limited access. Basic descriptive analysis was performed and responses were summarized.



Results:

The overall response rate was 15.3% (93/609). Responders were younger than non-responders (mean age 48 yo versus 53 yo, p = 0.0006) and had been in practice a shorter period of time (mean 22 y versus 27 y, p = 0.0051). Forty percent (37/92) of the clinics were urban, 40% (37/92) suburban, and 20% (18/92) rural. Twenty-nine percent (27/92) of respondents' clinics were at least two hours by car from a pediatric rheumatologist, and 9% (8/92) were more than 6 hours away. Ninety-two percent (85/92) had referred a patient to PR at least once, but 89% (83/93) had experienced a situation at least once in which they considered a referral to PR but ultimately did not. Reasons for not referring varied. When asked, “In cases in which you considered a PR referral but did not refer a patient to a pediatric rheumatologist, please indicate your reasons for doing so. (Select all that apply),” many had referred to other subspecialists instead: 29% (24/83) to pediatric infectious disease, 20% (17/83) to adult rheumatology, and 12% (10/83) to pediatric orthopedics, while 34% (28/83) managed the patient themselves. Although not a pre-specified choice in the survey, 9% (3/32) of pediatricians added wait-time as the reason for not referring to PR. Thirty-five percent (32/60) had referred a pediatric patient to an adult rheumatologist, most commonly for distance (47%), while physician preference was never selected as a reason.



Conclusion:

Pediatricians often refer children with possible rheumatic disease to specialists other than PR due to reasons of distance and wait-time. Referral to adult rheumatologists occurs, but not based on pediatrician preference. These findings suggest that the PR workforce is inadequate to meet demand, at least in the Upper Midwest. Interventions are needed to improve access to care in PR.
COPEPTIN LEVELS IN THE TRIAGE OF PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH CHEST PAIN: A COLLABORATIVE META-ANALYSIS
Authors: Michael Lipinski, Ricardo Escarcega Alarcon, Fabrizio D'Ascenzo, Marco Magalhaes Pereira, Nevin Baker, Rebecca Torguson, Fang Chen, Stephen Epstein, Oscar Miro, Pere Llorens, Evangelos Giannitsis, Ulrich Lotze, Sophie Lefebvre, Mustapha Sebbane, Jean-Paul Cristol, Camille Chenevier-Gobeaux, Christophe Meune, Kai Eggers, Sandrine Charpentier, Raphael Twerenbold, Christian Mueller, Giuseppe Biondi-Zoccai, Ron Waksman
Journal: Journal of the American College of Cardiology (2014)
THE MEANING OF Q WAVE ON ELECTROCARDIOGRAM AT THE PRESENTATION OF ST SEGMENT ELEVATED MYOCARDIAL INFARCTION
Authors: Min Kyu Kang, Jong-Seon Park, you min kim, won jong park, sangwook kang, sang hee lee, Ung Kim, Geu-Ru Hong, Dong-Gu Shin, Young-Jo Kim
Journal: Journal of the American College of Cardiology (2012)
The DNA-Binding Protein CTCF Limits Proximal Vκ Recombination and Restricts κ Enhancer Interactions to the Immunoglobulin κ Light Chain Locus
Authors: Claudia Ribeiro de Almeida, Ralph Stadhouders, Marjolein J.W. de Bruijn, Ingrid M. Bergen, Supat Thongjuea, Boris Lenhard, Wilfred van IJcken, Frank Grosveld, Niels Galjart, Eric Soler, Rudi W. Hendriks
Journal: Immunity (2011)
CD4+ T cells mediate cytotoxicity in neurodegenerative diseases
Authors: Stanley H. Appel
Journal: Journal of Clinical Investigation (2008)

Neuroinflammation, characterized by activated microglia and infiltrating T cells, is a prominent pathological feature in neurodegenerative diseases. However, whether this inflammation contributes to neuronal injury or is a late consequence of neuronal injury is unclear. In this issue of the JCI, Brochard et al. report that CD4+ T cells are cytotoxic in a mouse model of Parkinson disease (PD) (see the related article beginning on page 182). Specifically, invading T lymphocytes contributed to neuronal cell death via the Fas/FasL pathway. The results implicate the adaptive immune system in the pathogenesis of Parkinson neurodegeneration and provide a meaningful rationale for immune-based therapies for PD.
Reduced Mortality after Allogeneic Hematopoietic-Cell Transplantation
Authors: Ted A. Gooley, Jason W. Chien, Steven A. Pergam, Sangeeta Hingorani, Mohamed L. Sorror, Michael Boeckh, Paul J. Martin, Brenda M. Sandmaier, Kieren A. Marr, Frederick R. Appelbaum, Rainer Storb, George B. McDonald
Journal: New England Journal of Medicine (2010)

Over the past decade, advances have been made in the care of patients undergoing transplantation. We conducted a study to determine whether these advances have improved the outcomes of transplantation.We analyzed overall mortality, mortality not preceded by relapse, recurrent malignant conditions, and the frequency and severity of major complications of transplantation, including graft-versus-host disease (GVHD) and hepatic, renal, pulmonary, and infectious complications, among 1418 patients who received their first allogeneic transplants at our center in Seattle in the period from 1993 through 1997 and among 1148 patients who received their first allogeneic transplants in the period from 2003 through 2007. Components of the Pretransplant Assessment of Mortality (PAM) score were used in regression models to adjust for the severity of illness at the time of transplantation.In the 2003-2007 period, as compared with the 1993-1997 period, we observed significant decreases in mortality not preceded by relapse, both at day 200 (by 60%) and overall (by 52%), the rate of relapse or progression of a malignant condition (by 21%), and overall mortality (by 41%), after adjustment for components of the PAM score. The results were similar when the analyses were limited to patients who received myeloablative conditioning therapy. We also found significant decreases in the risk of severe GVHD; disease caused by viral, bacterial, and fungal infections; and damage to the liver, kidneys, and lungs.We found a substantial reduction in the hazard of death related to allogeneic hematopoietic-cell transplantation, as well as increased long-term survival, over the past decade. Improved outcomes appear to be related to reductions in organ damage, infection, and severe acute GVHD. (Funded by the National Institutes of Health.).
PAPERS PRESENTED AT THE FRANCO—BRITISH REUNION, TUESDAY 28 JUNE 1983.
Authors: M. Jeanmougin, D. Bonvalet, J. Civatte, C. Renaud-Vilmer
Journal: British Journal of Dermatology (1983)

Journal Article PAPERS PRESENTED AT THE FRANCO‐BRITISH REUNION, TUESDAY 28 JUNE 1983 Get access British Journal of Dermatology, Volume 109, Issue s24, 1 July 1983, Pages 9–13, https://doi.org/10.1111/j.1365-2133.1983.tb11547.x Published: 01 July 1983
Abstract B15: Invasive breast cancer amplifies lymphangiogenic signals in tumor microenvironment through integrin beta4 expressing cancer-associated fibroblasts
Authors: Baek Gil Kim, Yoon Pyo Choi, Suki Kang, Joo Hyun Lee, Nam Hoon Cho
Journal: Cancer Research (2013)

Abstract Lymphangiogensis is widely acknowledged as a major route of breast cancer metastasis and a critical alteration of tumor microenvironment (TME) for tumor progression. But, most of it has remained still unknown. Previously, we found that invasive ductal carcinoma (IDC), not ductal carcinoma in situ (DCIS), upregulates integrin alpha6beta4 in the fibrosis adjacent to tumor burden, and that MDA-MB-231 induces integrin beta4 neoexpression in cancer-associated fibroblasts (CAFs) via cell-to-cell contract. Integrin (alpha6)beta4 overexpression is often detected in malignant tumors and negatively associated with patient survivor. In addition, integrin alpha6beta4 was reported to regulate eIF-4E activity leading to vascular endothelial growth factor (VEGF) translation in cancer cells. It is, therefore, plausible that invasive breast cancer cells increase lymphangiogenic signals in TME through driving integrin beta4 expression in CAFs. To verify our hypothesis, we induced integrin beta4 overexpression in CAFs using co-culture with MDA-MB-231 or transfection with pRK5_beta4 plasmid, and then observed tube formation of human dermal lymphatic endothelial cells (HDLEC) by integrin beta4-expressing CAFs in 3D co-culture model. VEGF-D, known as a major factor of lymphangiogenesis, was highly upregulated in integrin beta4-expressing CAFs, which promoted tube formation of HDLEC compared to normal CAFs and MDA-MB-231. Interestingly, the level of VEGF-D expression in MDA-MB-231 was much lower than that of integrin beta4-expressing CAFs before and after co-culture. Taken together, invasive breast cancer may amplify lymphangiogenic signals in TME by inducing integrin beta4-expressing CAFs, and integrin beta4 neoexpression in CAFs by breast cancer may be a pivotal process for lymphangiogensis. Citation Format: Baek Gil Kim, Yoon Pyo Choi, Suki Kang, Joo Hyun Lee, Nam Hoon Cho. Invasive breast cancer amplifies lymphangiogenic signals in tumor microenvironment through integrin beta4 expressing cancer-associated fibroblasts. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Invasion and Metastasis; Jan 20-23, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;73(3 Suppl):Abstract nr B15.
ABC of monitoring drug therapy. Lithium.
Authors: J. K. Aronson, D. J. Reynolds
Journal: BMJ (1992)

Lithium is used in the treatment of acute mania and in the prophylaxis of bipolar and unipolar affected disorders Monitoring serum lithium concentrations is an important part of treatment in patients with acute mania as the drug's toxic:therapeutic ratio is very low and its pharmacokinetics vary from person to person, making accurate prediction of dosage difficult.The variation is due to differences in absorption, distribution, and elimination.Absorption of lithium is highly variable, depending on the formulation used.The rate and extent of absorption varies between modified release and conventional formulations, but there is also variability from one modified release formulation to another.The variations in the clearance and apparent volume of distribution of lithium result in variation in its half life from 7 hours to 41 hours.In this article we apply to lithium the criteria which must be fulfilled in part or in full before measurement of its plasma concentration can be considered worth while. Criteria for measurementThe higher the serum lithium concentration the greater the likelihood of a therapeutic response.In this case of acute mania the chance of a therapeutic response continued to improve up to relatively high serum concentrations.* Gastrointestinal symptoms-
Successful treatment of enterovirus-infected mice by 2-(alpha-hydroxybenzyl)-benzimidazole and guanidine.
Authors: H J Eggers
Journal: The Journal of Experimental Medicine (1976)

Echo virus 9- or Coxsackie A 9-infected newborn mice are protected from paralysis and death by combined treatment with nontoxic concentrations of HBB plus guanidine. HBB alone also protects Coxsackie A 9, but not echo virus 9-infected animals, whereas guanidine alone is ineffective in either case. Protection is due to inhibition of virus multiplication via the antiviral activity of these selective inhibitors. Treatment must be begun at the latest 48 h after virus inoculation. 3 days of treatment are sufficient if started at the time of virus inoculation. Failure of protection after treatment with one compound alone is not due to rapid development of drug-resistant virus mutants. Infected, successfully treated mice may develop a solid immunity.
ACUTE NON-INVASIVE CARDIAC OUTPUT MEASUREMENTS FOLLOWING CARDIAC RESYNCHRONIZATION THERAPY PREDICT LEFT VENTRICULAR REVERSE REMODELING AT 6 MONTHS AND LONG TERM SURVIVAL
Authors: Fakhar Z. Khan, Munmohan S. Virdee, David Begley, John Hutchinson, Beverley Smith, Philip A. Read, Peter J. Pugh, Simon P. Fynn, David P. Dutka
Journal: Journal of the American College of Cardiology (2011)
Malignant lymphoma presenting as cutaneous granulomatous vasculitis
Authors: L. Astudillo, C. Recher, F. Launay, L. Lamant, P. Brousset, E. Arlet-Suau
Journal: British Journal of Dermatology (2005)

Journal Article Malignant lymphoma presenting as cutaneous granulomatous vasculitis Get access L. Astudillo, L. Astudillo Departments of Internal Medicine, Haematology Search for other works by this author on: Oxford Academic Google Scholar C. Recher, C. Recher Departments of Internal Medicine, Haematology Search for other works by this author on: Oxford Academic Google Scholar F. Launay, F. Launay Dermatology Search for other works by this author on: Oxford Academic Google Scholar L. Lamant, L. Lamant Pathology, University Hospital Purpan, Unité J.Tapie, 1 place du Dr Baylac, 31059 Toulouse cedex, France E‐mail: astudillo.l@chu‐toulouse.fr Search for other works by this author on: Oxford Academic Google Scholar P. Brousset, P. Brousset Pathology, University Hospital Purpan, Unité J.Tapie, 1 place du Dr Baylac, 31059 Toulouse cedex, France E‐mail: astudillo.l@chu‐toulouse.fr Search for other works by this author on: Oxford Academic Google Scholar E. Arlet‐Suau E. Arlet‐Suau Departments of Internal Medicine, Haematology Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 152, Issue 4, 1 April 2005, Pages 820–821, https://doi.org/10.1111/j.1365-2133.2005.06516.x Published: 01 April 2005
Need for Corneal Donors
Authors: William R. Schlichtemeier
Journal: JAMA (1982)

To the Editor.—  More corneal donors are needed. Corneal transplantation is a common and successful operation. The backlog of patients needing suitable donor material is substantial. We have many patients who must wait an unreasonable time for a donor cornea.  For these donors we must rely on the general public and our fellow physicians to help us obtain donor material. Good donor material is hard to come by. Many of my patients who need corneas are young patients who have had a blinding illness or injury, and a corneal transplant would return their sight. However, not all cases of blindness can be reversed by such a transplant.  Some people have the misconception that since they wear eyeglasses, their eyes would be unsuitable for donation. This is not so. The entire eye is used. The cornea is used for transplantation, and the sclera is used to repair eyes and eyelids in
Bortezomib plus intermediate‐dose dexamethasone and thalidomide in elderly untreated patients with multiple myeloma: A Chinese experience
Authors: Hongfeng Guo, Xin Zhou, Yuanqiang Jiang, Guohua Yang, Chao Sun, Yun Zhuang, Hongli Sun, Mize Lu, Xifeng Qian, Feng Chen, Jingjue Mao, Heng Chen, Jun Xia, Yunfeng Shen
Journal: American Journal of Hematology (2010)

Bortezomib has proven to be active in patients with multiple myeloma (MM), including elderly patients. The aim of this study was to evaluate the efficacy and toxicity of bortezomib in combination with intermediate-dose dexamethasone (Dex) and thalidomide in untreated MM patients aged > or =65 years in a Chinese single center. In this study, 18 patients were treated with bortezomib at 1.3 mg/m(2) IV on Days 1, 4, 8, and 11 and Dex at 20 mg/day IV on Days 1-4 and 8-11 simultaneously. Thalidomide at dose of 100 mg/day was given everyday. The mean number of cycles of bortezomib treatment was 2.06. Three patients (17%) achieved a complete response (CR), four (22%) a very good partial response (VGPR), and nine (50%) a PR, resulting in an overall response rate of 89%. The median time to response was 22 days (range 14-50 days). The duration of response was significantly longer in patients achieving a CR/VGPR with respect to those achieving only a PR (8.5 vs. 4.2 months, P = 0.03). Grade 3-4 toxicities occurring in patients comprised weakness, thrombocytopenia, diarrhea, infection, and neuropathy. Only one patient suffered from deep vein thrombosis. This preliminary experience in Chinese patients indicated that bortezomib-Dex-thalidomide is highly effective in elderly untreated patients with MM, even in patients with poor prognostic features.
Treatment of Kawasaki Syndrome
Authors: Ralph D. Feigin, Karyl S. Barron
Journal: New England Journal of Medicine (1986)

Mucocutaneous lymph node syndrome (Kawasaki syndrome) is an acute febrile syndrome of unknown origin recognized predominantly in children under nine years of age. The disease was first recognized as a clinical entity in Japan in 1961, by Tomisaku Kawasaki, who reported it in 1967.1 However, Kawasaki syndrome has now been recognized throughout the world. Local geographic and temporal clustering of cases has been reported frequently.Because the first cases were seen in Japanese children and American children of predominantly Japanese background, Kawasaki syndrome was initially presumed to occur most commonly in the Japanese. That assumption has not been disproved. The . . .
Clinical, light and electron microscopic features of recessive congenital ichthyosis type I
Authors: K.-M. NIEMI, L. KANERVA, K. KUOKKANEN, J. IGNATIUS
Journal: British Journal of Dermatology (1994)

Based on electron microscopic features, recessive congenital ichthyoses have recently been divided into four subgroups designated ichthyosis congenita (IC) types I, II, III and IV. Type II is characterized by cholesterol clefts in the horny cells, type III by perinuclear elongated membranes in the granular and horny cells, and type IV by masses of lipid membranes in granular and horny cells. Clear electron microscopic criteria for type I are lacking, although the presence of lipid droplets in the horny cells has been suggested as a criterion. In the present study we included ichthyosis patients with (i) recessive inheritance, (ii) erythrodermic fine scaling, (iii) lack of fine structural markers of IC types II-IV. Patients with ichthyotic syndromes were excluded. The case material consisted of 21 patients from 14 families. Eight were collodion babies at birth, but three were normal. Nine had ectropion, the flexures were affected in 12, and the palms and soles were thickened in all but one patient. On electron microscopy lipid vacuoles in the horny cells were common, but were absent in four patients. Changes in other lipid-related structures, including keratinosomes, were common. We conclude that currently type I can be diagnosed only by excluding the other types of ichthyosis. Clinically, IC type I corresponds to classical non-bullous congenital ichthyosiform erythroderma, but there is marked heterogeneity among affected individuals.
Validation of an anti-sphingosine-1-phosphate antibody as a potential therapeutic in reducing growth, invasion, and angiogenesis in multiple tumor lineages
Authors: Barbara Visentin, John A. Vekich, Bradley J. Sibbald, Amy L. Cavalli, Kelli M. Moreno, Rosalia G. Matteo, William A. Garland, Yiling Lu, Shuangxing Yu, Hassan S. Hall, Vikas Kundra, Gordon B. Mills, Roger A. Sabbadini
Journal: Cancer Cell (2006)
EXPERIMENTAL TRANSMISSION OF INFLUENZA VIRUS INFECTION IN MICE
Authors: Jerome L. Schulman
Journal: The Journal of Experimental Medicine (1967)

Immunization of mice by infection or intraperitoneal injection with homotypic A(2), heterotypic A(0), or recombinant A(0)A(2) virus have differing effects on transmission of influenza A(2) virus infection. Immunization by infection with A(2) virus resulted in refractoriness to reinfection either by artificial aerosols or by exposure to infected cage-mates. Immunization by inoculation with inactivated A(2) virus vaccine resulted in a decreased susceptibility to transmitted infection in immunized contacts, but following A(2) virus challenge, transmission of infection by immunized infectors was not altered. Immunization by infection with influenza A(0) virus or recombinant A(0)A(2) virus resulted in a decreased susceptibility to transmitted A(2) virus infection in immunized contacts, and to decreased transmission after A(2) virus infection in immunized infector mice. These differing effects on transmission of infection are attributed to differences in specific local immunologic responses following the various immunization procedures.
Endocrinology: A Logical Approach for Clinicians
Authors: Sheldon S. Stoffer
Journal: JAMA (1986)

This book was designed as an introductory text for medical students, house staff, and clinicians who wish to review their general knowledge of endocrine diagnosis and management. The author has attempted to write a text that provides a practical pathophysiological approach to basic endocrine problems. The author has also attempted to instill in the reader an awareness of the increasing cost of medical care by focusing on the importance of ordering tests wisely and, where appropriate, recommending a specific therapeutic approach. Case studies have been added to this edition of the text and provide an informative academic exercise. In addition, there are numerous helpful tables and illustrations throughout the book. A reasonably recent bibliography is provided at the conclusion of each chapter. In general, the author has succeeded in that this text is well written and conceptually sound. As a thyroidologist, I was especially interested in reading chapter 4, "The
Six in 10 heart attack patients in England are treated with primary angioplasty
Authors: Z. Kmietowicz
Journal: BMJ (2010)

For the first time, patients in England who have had a heart attack are more likely to be treated with primary angioplasty than with thrombolysis, show results from a national audit.

Figures from the 9th annual MINAP audit (Myocardial Ischaemia National Audit Project) show that 63% (12 459 of 19 638) of eligible patients had primary angioplasty in 2009/10, compared with 44% (8107 of 18 497) in 2008/9. In Wales the use of primary angioplasty increased from 11% in …
Correlation of a Precipitin Reaction to an RNA-Protein Antigen and a Low Prevalence of Nephritis in Patients with Systemic Lupus Erythematosus
Authors: Morris Reichlin, Martha Mattioli
Journal: New England Journal of Medicine (1972)

Original Article from The New England Journal of Medicine — Correlation of a Precipitin Reaction to an RNA-Protein Antigen and a Low Prevalence of Nephritis in Patients with Systemic Lupus Erythematosus
A leap of faith?
Authors: A. Cameron
Journal: BMJ (2002)

Imagine this: I am standing on a narrow ledge on the side of a suspension bridge. In a moment I am going to jump off, trusting that the elastic rope attached to my ankles will stop me plunging to certain death in the river 43 metres (142 feet) below.

Such bungee jumping derives from the harvest celebrations in Vanuatu in the South Pacific when men leapt from 20 m platforms with vines attached to their ankles. The Oxford dangerous sports club used elastic rope to jump from the Clifton suspension bridge—and were promptly arrested. The “sport” was popularised in New Zealand from the very bridge that I was on.

I am an otherwise rational 52 year old general surgeon, so what possessed me to do such a thing?

> I have learnt a new respect for those who entrust their lives to us in theatre

Firstly, I have always been scared of heights, not only because of the fear of falling but also partly because of the fatal attraction of actually jumping off. This must be some atavistic impulse since many …