tbuckley/cabot-search huggingface dataset:
Taking the sting out of needles
Authors: H. Seeley
Journal: Journal of the Royal Society of Medicine (2005)

I cannot, unfortunately, claim to be the wise mentor who taught Dr Yentis the seven principles of ensuring painless venous cannulation (April 2005 JRSM1): I can, however, claim that from 1978 I was teaching cohorts of medical students and anaesthetic novices the importance of using local anaesthesia before cannulation in conscious patients.

Of the reasons he puts forward for why doctors do not do what is known to work I suspect the third is correct: they accept the evidence but choose to disregard it. This is well summed up in the old adage 'That's a good idea: we won't implement it'. Other examples could be quoted. Before drugs such as ranitidine were introduced into obstetric anaesthesia it was often recommended that the patient's stomach should be emptied before inducing general anaesthesia. Holdsworth2 showed, somewhat surprisingly, that vomiting induced by apomorphine injection was considered much pleasanter by patients than the passage of a stomach tube. The two methods were equally effective and apomorphine had no deleterious effect on the baby. Nevertheless, the use of apomorphine was never widely accepted. Nott and Hughes3 showed that the use of an intranasal spray of lignocaine significantly reduced the discomfort caused by insertion of a nasogastric tube, but as far as I am aware this simple manoeuvre has not been universally adopted.

Patients remember staff who are kind and procedures that are painful or distressing. Wards and clinics provide a rich source of simple research projects that could enhance the comfort of patients and the CVs of doctors.
How should one analyse and interpret clinical trials in which patients don't take the treatments assigned to them?
Authors: Curt D Furberg
Journal: Journal of the Royal Society of Medicine (2010)

‘Obviously it is not practically possible to preselect two large strictly random groups of children who are representative of the general population and to insure that every child in one group receives the vaccine while every child in the other group receives no vaccine during the observation period. Children in the general population have the prerogative to refuse vaccine offered and the liberty to obtain other vaccine when desired. In these premises there is no known way of changing the two groups so that one would include only children actually vaccinated, and the other include only children not vaccinated, without destroying the randomness of the selection and to that extent possibly invalidating the answer to the question asked. After it has been established that the vaccine confers protection, then questions concerning the amount and duration of such protection might in part demand direct comparison of the experience of the children actually vaccinated with those not vaccinated, providing adequate data are at hand to equalize the two groups with respect to attributes which apparently influence the occurrence of the disease. For this report, the approach to the primary problem involved the preselection of two large strictly random groups of children and the subsequent injection of a large proportion of only one group with the vaccine. All analyses herein presented are a comparison of the experience of such preselected groups regardless of their actual status with respect to receiving the vaccine. The difficulties encountered in this approach are chronologically described in detail so that the reader may evaluate any possible errors involved.’
Authors' reply (Denmark)
Authors: J. H Olsen, A. Nielsen, G. Schulgen
Journal: BMJ (1994)

EDITOR,--In regard to Alasdair Philips's first point, all inhabitants of industrialised nations are exposed to some extent to magnetic fields in the 50 Hz range, but people who live close to 50-400 kV power lines and substations have prolonged, uniform exposure to field levels clearly above the average. Electricity distribution installations below 50 kV were not included in our study. In Denmark, lines at these levels are either buried or constructed as three phase, symmetrical overhead lines. Therefore, unlike certain other countries (such …
Efficacy of rituximab (anti-CD20) for refractory systemic lupus erythematosus involving the central nervous system
Authors: M. Tokunaga, K. Saito, D. Kawabata, Y. Imura, T. Fujii, S. Nakayamada, S. Tsujimura, M. Nawata, S. Iwata, T. Azuma, T. Mimori, Y. Tanaka
Journal: Annals of the Rheumatic Diseases (2006)

<b>Aim:</b> Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious treatment-resistant phenotype of systemic lupus erythematosus. A standard treatment for NPSLE is not available. This report describes the clinical and laboratory tests of 10 patients with NPSLE before and after rituximab treatment, including changes in lymphocyte phenotypes. <b>Methods:</b> Rituximab was administered at different doses in 10 patients with refractory NPSLE, despite intensive treatment. <b>Results:</b> Treatment with rituximab resulted in rapid improvement of central nervous system-related manifestations, particularly acute confusional state. Rituximab also improved cognitive dysfunction, psychosis and seizure, and reduced the SLE Disease Activity Index Score at day 28 in all 10 patients. These effects lasted for &gt;1 year in five patients. Flow cytometric analysis showed that rituximab down regulated CD40 and CD80 on B cells and CD40L, CD69 and inducible costimulator on CD4+ T cells. <b>Conclusions:</b> Rituximab rapidly improved refractory NPSLE, as evident by resolution of various clinical signs and symptoms and improvement of radiographic findings. The down regulation of functional molecules on B and T cells suggests that rituximab modulates the interaction of activated B and T cells through costimulatory molecules. These results warrant further analysis of rituximab as treatment for NPSLE.
It's Only 50 Cents
Authors: Nancy R. Angoff
Journal: Annals of Internal Medicine (2002)

Letters1 October 2002It's Only 50 CentsNancy R. Angoff, MDNancy R. Angoff, MDYale University School of Medicine; New Haven, CT 06510 (Angoff)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-7-200210010-00027 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I was moved by Daniel C.R. Chen's essay, “It's Only 50 Cents” (1), and plan to use it to teach medical students about the many ways in which they can care for patients and relieve suffering with very little medical knowledge. I am struck, however, by Dr. Chen's statement that when the patient he wrote about cried, “We [the physicians] didn't know how to respond. It was a humanizing moment and we cried with him, although not openly.”Why are physicians so reluctant (afraid?) to cry openly? Crying, after all, is an honest (and clearly human) response ...References1. Chen DC. It's only 50 cents. Ann Intern Med. 2001;135:1087-8. [PMID: 11747389] LinkGoogle Scholar2. Angoff NR. A piece of my mind: crying in the curriculum. JAMA. 2001;286:1017-8. [PMID: 11559278] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Nancy R. Angoff, MDAffiliations: Yale University School of Medicine; New Haven, CT 06510 (Angoff) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIt's Only 50 Cents Daniel C.R. Chen Metrics 1 October 2002Volume 137, Issue 7Page: 623KeywordsEmotionsPatients ePublished: 1 October 2002 Issue Published: 1 October 2002 Copyright & PermissionsCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The<i>In vivo</i>Expansion Rate of Properly Stimulated Transferred CD8+ T Cells Exceeds That of an Aggressively Growing Mouse Tumor
Authors: Leroy N. Hwang, Zhiya Yu, Douglas C. Palmer, Nicholas P. Restifo
Journal: Cancer Research (2006)

Abstract It has been hypothesized that rapidly dividing tumor cells can outpace adoptively transferred antitumor lymphocytes when tumors are large. However, this hypothesis is at odds with clinical observations indicating that bulky tumors can be destroyed by small numbers of adoptively transferred antitumor T cells. We sought to measure the relative growth rates of T cells and tumor cells in a model using transgenic CD8+ T cells specific for the gp10025-33 H-2Db epitope (called pmel-1) to treat large, well-established s.c. B16 melanoma. We tested the effect of the immunization using an altered peptide ligand vaccine alone or in combination with interleukin-2 (IL-2) by analyzing the kinetics of T-cell expansion using direct enumeration. We found that pmel-1 T cells proliferated explosively during a 5-day period following transfer. Calculations from net changes in population suggest that, at the peak of cell division, pmel-1 T cells divide at a rate of 5.3 hours per cell division, which was much faster than B16 tumor cells during optimal growth (24.9 hours per cell division). These results clearly indicate that the notion of a kinetic “race” between the tumor and the lymphocyte is no contest when adoptively transferred cells are stimulated with immunization and IL-2. When appropriately stimulated, tumor-reactive T-cell expansion can far exceed the growth of even an aggressively growing mouse tumor. (Cancer Res 2006; 66(2): 1132-8)
Software for Reading and Grading Diabetic Retinopathy
Authors: Namperumalsamy Perumalsamy, Noela M. Prasad, Shankar Sathya, Kim Ramasamy
Journal: Diabetes Care (2007)

OBJECTIVE—To evaluate the validity and reproducibility of software for reading digital images and grading diabetic retinopathy. RESEARCH DESIGN AND METHODS—A prospective, comparative observational study was conducted on a series of patients with type 2 diabetes who presented at the retina clinic of a tertiary care center in India. A total of 210 eyes of 105 patients were allocated to one of three ophthalmologists, who performed dilated indirect and direct ophthalmoscopy and subsequently assessed the digital images of the same group of patients who were masked to the patient's identity. The interobserver and intertest agreement between clinical assessments and grading of diabetic retinopathy using the software was estimated. RESULTS—Moderate nonproliferative diabetic retinopathy (NPDR) was most frequently diagnosed, both clinically and on evaluating digital images. The overall agreement between the clinical grading of diabetic retinopathy and the grading of images was 81.3% (κ = 0.69, SE 0.04, P &amp;lt; 0.0001); there was good agreement (81.3%) for NPDR (κ = 0.61, SE 0.05, P &amp;lt; 0.0001), but agreement was not as good (54.6%) for proliferative diabetic retinopathy (κ = 0.29, SE 0.11, P = 0.005). Clinically significant macular edema was diagnosed in 33.3% (70 of 210) of eyes clinically and in 40.2% (84 of 209) of eyes by grading images, and there was good agreement (89.5%) between the two (κ = 0.77, SE 0.07, P &amp;lt; 0.0001). CONCLUSIONS—Aravind Diabetic Retinopathy Screening 3.0 is a simple and valid tool to assist in the detection of sight-threatening retinopathy and could supplement dilated fundus examinations by ophthalmologists on patients to detect diabetic retinopathy.
Carvedilol seems no better than metoprolol for heart failure
Authors: S. Gottlieb
Journal: BMJ (1999)

The newest drug on the market for treating congestive heart failure is no more effective than older β blockers which cost only a third as much, a study has found (Circulation 1999;99:2645-51).

Forty six men and 21 women aged 29 to 97 who had symptomatic stable heart failure were randomly allocated to treatment with either carvedilol, …
Altered enteric microbiota ecology in interleukin 10-deficient mice during development and progression of intestinal inflammation
Authors: Nitsan Maharshak, Christopher D. Packey, Melissa Ellermann, Sayeed Manick, Jennica P. Siddle, Eun Young Huh, Scott Plevy, R. Balfour Sartor, Ian M. Carroll
Journal: Gut Microbes (2013)

Inflammatory bowel diseases (IBD) result from dysregulated immune responses toward microbial and perhaps other luminal antigens in a genetically susceptible host, and are associated with altered composition and diversity of the intestinal microbiota. The interleukin 10-deficient (IL-10 (-/-) ) mouse has been widely used to model human IBD; however the specific alterations that occur in the intestinal microbiota of this mouse model during the onset of colonic inflammation have not yet been defined. The aim of our study was to define the changes in diversity and composition that occur in the intestinal microbiota of IL-10 (-/-) mice during the onset and progression of colonic inflammation. We used high throughput sequencing of the 16S rRNA gene to characterize the diversity and composition of formerly germ-free, wild-type and IL-10 (-/-) mice associated with the same intestinal microbiota over time. Following two weeks of colonization with a specific pathogen-free (SPF) microbiota we observed a significant increase in the diversity and richness of the intestinal microbiota of wild-type mice. In contrast, a progressive decrease in diversity and richness was observed at three and four weeks in IL-10 (-/-) mice. This decrease in diversity and richness was mirrored by an increase in Proteobacteria and Escherichia coli in IL-10 (-/-) mice. An increase in E. coli was also observed in conventionally raised IL-10 (-/-) mice at the point of colonic inflammation. Our data reports the sequential changes in diversity and composition of the intestinal microbiota in an immune-mediated mouse model that may help provide insights into the primary vs. secondary role of dysbiosis in human IBD patients.
A case of Björnstad syndrome caused by novel compound heterozygous mutations in the<i>BCS1L</i>gene
Authors: T. Yanagishita, K. Sugiura, Y. Kawamoto, K. Ito, Y. Marubashi, N. Taguchi, M. Akiyama, D. Watanabe
Journal: British Journal of Dermatology (2013)

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Cardiovascular sex differences influencing microvascular exchange
Authors: V. H. Huxley, J. Wang
Journal: Cardiovascular Research (2010)

The vital role of the cardiovascular (CV) system is maintenance of body functions via the matching of exchange to tissue metabolic demand. Sex-specific differences in the regulatory mechanisms of CV function and the metabolic requirements of men and women, respectively, have been identified and appreciated. This review focuses on sex differences of parameters influencing exchange at the point of union between blood and tissue, the microvasculature. Microvascular architecture, blood pressure (hydrostatic and oncotic), and vascular permeability, therefore, are discussed in the specific context of sex in health and disorders. It is notable that when sex differences exist, they are generally subtle but significant. In the aggregate, though, they can give rise to profoundly different phenotypes. The postulated mechanisms responsible for sex differences are attributed to genomics, epigenetics, and sex hormones. Depending on specific circumstances, the effect of the combined factors can range from insignificant to lethal. Identifying and understanding key signalling mechanisms bridging genomics/sex hormones and microvascular exchange properties within the scope of this review holds significant promise for sex-specific prevention and treatment of vascular barrier dysfunction.
Antibiotic prophylaxis in hematopoietic stem cell transplantation. A meta-analysis of randomized controlled trials.
Authors: Shun-ichi Kimura, Yu Akahoshi, Hirofumi Nakano, Tomotaka Ugai, Hidenori Wada, Ryoko Yamasaki, Yuko Ishihara, Koji Kawamura, Kana Sakamoto, Masahiro Ashizawa, Miki Sato, Kiriko Terasako-Saito, Hideki Nakasone, Misato Kikuchi, Rie Yamazaki, Shinichi Kako, Junya Kanda, Aki Tanihara, Junji Nishida, Yoshinobu Kanda
Journal: Journal of Infection (2014)
The Role of the Physician as a Patient Advocate
Authors: Harold M. Schoolman
Journal: New England Journal of Medicine (1977)

IN Western civilization the physician has assumed many roles. At present, these roles are being critically re-examined. The purpose of this paper is to identify the functions for which the physician is indispensable. Such an identification could have great importance for medical education.In spite of medicine's obvious involvement with a broad array of social and health issues, the physician's unique contribution lies in the care of the sick. In identifying the care of the patient as the role for which the physician is indispensable, the physician's role in clinical research and education is not being ignored. Indeed, it is . . .
Meta-Analysis: Computed Tomographic Colonography
Authors: Brian P. Mulhall, Ganesh R. Veerappan, Jeffrey L. Jackson
Journal: Annals of Internal Medicine (2005)

Background: Computed tomographic (CT) colonography, also called virtual colonoscopy, is an evolving technology under evaluation as a new method of screening for colorectal cancer. However, its performance as a test has varied widely across studies, and the reasons for these discrepancies are poorly defined. Purpose: To systematically review the test performance of CT colonography compared to colonoscopy or surgery and to assess variables that may affect test performance. Data Sources: The PubMed, MEDLINE, and EMBASE databases and the Cochrane Controlled Trials Register were searched for English-language articles published between January 1975 and February 2005. Study Selection: Prospective studies of adults undergoing CT colonography after full bowel preparation, with colonoscopy or surgery as the gold standard, were selected. Studies had to have used state-of-the-art technology, including at least a single-detector CT scanner with supine and prone positioning, insufflation of the colon with air or carbon dioxide, collimation smaller than 5 mm, and both 2-dimensional and 3-dimensional views during scan interpretation. The evaluators of the colonogram had to be unaware of the findings from use of the gold standard test. Data Abstraction: Data on sensitivity and specificity overall and for detection of polyps less than 6 mm, 6 to 9 mm, and greater than 9 mm in size were abstracted. Sensitivities and specificities weighted by sample size were calculated, and heterogeneity was explored by using stratified analyses and meta-regression. Data Synthesis: 33 studies provided data on 6393 patients. The sensitivity of CT colonography was heterogeneous but improved as polyp size increased (48% [95% CI, 25% to 70%] for detection of polyps <6 mm, 70% [CI, 55% to 84%] for polyps 6 to 9 mm, and 85% [CI, 79% to 91%] for polyps >9 mm). Characteristics of the CT colonography scanner, including width of collimation, type of detector, and mode of imaging, explained some of this heterogeneity. In contrast, specificity was homogenous (92% [CI, 89% to 96%] for detection of polyps <6 mm, 93% [CI, 91% to 95%] for polyps 6 to 9 mm, and 97% [CI, 96% to 97%] for polyps >9 mm). Limitations: The studies differed widely, and the extractable variables explained only a small amount of the heterogeneity. In addition, only a few studies examined the newest CT colonography technology. Conclusions: Computed tomographic colonography is highly specific, but the range of reported sensitivities is wide. Patient or scanner characteristics do not fully account for this variability, but collimation, type of scanner, and mode of imaging explain some of the discrepancy. This heterogeneity raises concerns about consistency of performance and about technical variability. These issues must be resolved before CT colonography can be advocated for generalized screening for colorectal cancer.
Complete Transection of the Aorta
Authors: Robert J. Wilder, Ronald H. Fishbein
Journal: JAMA (1964)

PROMPT RECOGNITION and surgical therapy for patients with traumatic rupture or transection of the thoracic aorta have been emphasized in recent years.<sup>1,2</sup>It has been stated that 10% to 20% of patients with traumatic aortic rupture survive long enough for surgical intervention, if the diagnosis can be made. In those patients who do not die of immediate exsanguination, a perivascular hematoma usually develops with rupture occurring hours or weeks later. In a few, false aneurysms develop which may remain asymptomatic for indefinite periods. In 1958, a 46-year-old white male was admitted to the Baltimore City Hospitals accident room after an automobile accident. He complained of weakness and chest pain. A labile blood pressure ranging from 110/60 to 80/50 mm Hg was noted. X-ray examination revealed minimal fluid in the left pleural cavity. The patient was finally discharged at his own insistence after many hours of observation. That same day
Ectopic expression of MITF, a gene for Waardenburg syndrome type 2, converts fibroblasts to cells with melanocyte characteristics
Authors: Masayoshi Tachibana, Kazuhisa Takeda, Yoshitaka Nobukuni, Kazunori Urabe, Jason E. Long, Kimberly A. Meyers, Stuart A. Aaronson, Toru Miki
Journal: Nature Genetics (1996)
Injury by Thermometer
Authors: S. K. Dikshit
Journal: BMJ (1965)

BEITOSH 1377 febrile convulsions are extremely rare in the newborn.What is meant by " febrile con- vulsions" ?Do we really know enough about the cause of the first seizure in any patient to be so precise about treatment ?Are we so advanced in understanding the mode of action of anticonvulsant drugs to use them at the time of the first seizure, whatever its cause might have been ?-Iam, etc.,
Angiotensin-Converting Enzyme and Apolipoprotein E Genotypes and Restenosis After Coronary Angioplasty
Authors: Frank M. van Bockxmeer, Cyril D. S. Mamotte, Frances A. Gibbons, Valerie Burke, Roger R. Taylor
Journal: Circulation (1995)

An insertion/deletion (I/D) polymorphism in the gene for angiotensin-converting enzyme (ACE) has been associated with myocardial infarction and other cardiac pathology. There is evidence for a role of the renin-angiotensin system in cell growth and in the repair of damaged arterial walls, so the ACE gene was postulated to be a candidate gene affecting the important clinical problem of restenosis after percutaneous transluminal balloon coronary angioplasty (PTCA). Because restenosis is influenced by the apolipoprotein E (apoE) genotype, the possibility of a relation between ACE and apoE genotypes and restenosis was also sought.Subjects (< 70 years of age) were prospectively followed and had coronary angiography 6 months after PTCA to determine the presence or absence of restenosis. Those who had angiography earlier and did not have restenosis (> or = 50% loss of gain at PTCA plus > or = 50% luminal diameter stenosis) also had angiography at 6 months. The whole group (n = 207) had a higher DD genotype frequency than did 136 population control subjects (38% versus 26%, P < .02); in PTCA patients, the frequency was the same in those with and without prior myocardial infarction. The distribution of ACE genotypes was not different in the 88 patients with and 119 patients without restenosis, while the epsilon 4/4 genotype was more frequent in those with restenosis (8 of 88 versus 3 of 118, P < .05). There was no effect of the ACE genotype in noncarriers of the epsilon 4 allele, but there was a significant effect in epsilon 4 carriers (P < .005). The combined D and epsilon 4 carrier state showed a 16-fold increase in the odds ratio for restenosis (P < .02). Multiple linear regression examining the loss of lumen as a continuous variable showed significant independent effects of the ACE and apoE genotypes.Overall, the ACE genotype had no clear influence on restenosis, but there was an interaction between ACE and apoE genotypes. The combined carrier state for the D and apoE epsilon 4 alleles substantially increased restenosis. For loss of lumen as a continuous variable, there were significant effects of both ACE and apoE genotypes. While the observations may not affect current management, they no doubt have implications in pathophysiology.