tbuckley/cabot-search huggingface dataset:
THE SNOWBOUND "CITY OF SAN FRANCISCO"
Authors: Walter H. Roehll
Journal: JAMA (1952)

To the Editor:—  The westbound City of San Francisco became snowbound the morning of Jan. 13, 1952, in the high Sierra Mountains at Yuba Pass. An unprecedented snowfall had occurred, and shortly before noon the diesel engine of the streamliner was struck by a snow slide that brought the train to an abrupt stop. The snowfall continued for several days and was estimated to be between 14 and 18 feet, with drifts of 20 to 25 feet, in places even higher. During this time the outside temperature was about 20 degrees above zero, and winds between 40 and 50 miles per hour were recorded.  Very little actual concern was felt for the passengers during the first few hours after the stopping of the train; however, medical problems developed rather rapidly.  In the afternoon of Jan. 13, word reached me that the engineer of an eastbound train had been injured that
Ethics in sports medicine--some medico-legal considerations.
Authors: P. G. Ford
Journal: British Journal of Sports Medicine (1980)

The cerebral cholinergic system is centrally involved in memory formation. Studies in rodents suggest that cholinergic stimulation may facilitate encoding of new information but may interfere with retrieval. We investigated the effect of cholinergic stimulation on encoding and retrieval of episodic memory in humans. We also tested whether the putative benefit of cholinergic stimulation on memory function depends on individual baseline performance. Since such effects were expected to be greatest in an older population resulting from an age-related degeneration of the cholinergic system, we recruited 22 healthy older subjects (51–68 years) for an event-related functional magnetic resonance imaging experiment. In two separate scanning sessions, subjects encoded and retrieved items and their spatial context under cholinergic stimulation or placebo with the acetylcholine-esterase inhibitor physostigmine or saline being administered intravenously in a double-blind cross-over design. Baseline performance was recorded at a separate occasion without scanning. Cholinergic stimulation enhanced neural activity for successful versus unsuccessful spatial context encoding in the right hippocampus but reduced activity for successful versus unsuccessful spatial context retrieval in the right amygdala. These data may bridge the gap between rodent and human studies by showing that also in man cholinergic stimulation enhances encoding but interferes with retrieval on a neural level. Furthermore, baseline performance negatively correlated with the effect of cholinergic stimulation. Thus, participants who were worse at baseline benefited more from cholinergic stimulation than those who had better baseline values, indicating that a cholinergic deficit contributes to the memory decline even in healthy older subjects.
Cost effectiveness analysis of early zidovudine treatment of HIV infected patients.
Authors: E Z Oddone, P Cowper, J D Hamilton, D B Matchar, P Hartigan, G Samsa, M Simberkoff, J R Feussner
Journal: BMJ (1993)

OBJECTIVE--To compare cost effectiveness of early and later treatment with zidovudine for patients infected with HIV. DESIGN--Markov chain analysis of cost effectiveness based on results of use of health care and efficacy from a trial of zidovudine treatment. SETTING--Seven Veterans Affairs medical centres in the United States. SUBJECTS--338 patients with symptomatic HIV infection and a lymphocyte count of 200 x 10(6) to 500 x 10(6) CD4 cells/l. INTERVENTIONS--Zidovudine 1500 mg/day started either at recruitment to the trial or when CD4 cell count fell below 200 x 10(6)/l. MAIN OUTCOME MEASURES--Health care costs and rates of disease progression between six clinical states of HIV infection. RESULTS--Patients given early treatment with zidovudine remained without AIDS for an extra two months at a cost of $10,750 for each extra month without AIDS (at 1991 costs). Cost effectiveness ratio was most sensitive to the cost of zidovudine and to the quality of life of patients receiving early treatment. At treatment of 500 mg/day the cost effectiveness ratio for early treatment was $5432 for each extra month without AIDS. Patients given early treatment experienced more side effects, and if their quality of life was devalued by 8% compared with patients treated later the two treatments were equivalent in terms of quality adjusted months of life without AIDS. CONCLUSIONS--Early treatment with zidovudine is expensive and is very sensitive to the cost of zidovudine and to potential reductions in quality of life of patients who experience side effects. Doctors should reconsider early treatment with zidovudine for patients who experience side effects that substantially compromise their quality of life.
Minimally invasive cardiac surgery
Authors: B. Glenville
Journal: BMJ (1999)

<h3>Abstract</h3> <b>Objective</b>: To assess recruitment to and workload associated with methadone maintenance clinics in general practice; to investigate the characteristics of patients and outcomes associated with treatment. <b>Design</b>: Study of case notes. <b>Setting</b>: Methadone maintenance clinics run jointly by general practitioners and drug counsellors in two practices in Glasgow. <b>Participants</b>: 46 injecting drug users receiving methadone maintenance during an 18 month period, 31 of whom were recruited to clinic based methadone maintenance treatment and 15 of whom were already receiving methadone maintenance treatment from the general practitioners. Mean (SD) age of patients entering treatment was 29.6 (5.5) years; 29 were male. They had been injecting opiates for a mean 9.9 (5.1) years, and most had a concurrent history of benzodiazepine misuse. Average reported daily intake of heroin was approximately 0.75 g. Participants in treatment had high levels of preexisting morbidity, and most stated that they committed crime daily. <b>Results</b>: 2232 patient weeks of treatment were studied. Mean duration of treatment during the study period was 50.7 (21.1) weeks and retention in treatment at 26 weeks was 83%. No evidence of illicit opiate use was obtained at an average of 78% of patients9 consultations where methadone had been prescribed in the previous week; for opiate injection the corresponding figure was 86%. <b>Conclusions</b>: Providing methadone maintenance in general practice is feasible. Although costs are considerable, the reduction in drug use, especially of intravenous opiates, is encouraging. Attending clinics also allows this population, in which morbidity is considerable, to receive other health care.
Soluble Fibrin Is the Main Mediator of <i>Staphylococcus aureus</i> Adhesion to Platelets
Authors: Silke Niemann, Nicola Spehr, Hugo Van Aken, Eberhard Morgenstern, Georg Peters, Mathias Herrmann, Beate E. Kehrel
Journal: Circulation (2004)

Background— Infective endocarditis (IE) caused by Staphylococcus aureus is associated with significant morbidity and mortality rates. Platelets play a dual role as adhesive cells forming associates with bacteria as well as specialized inflammatory cells. The specific role of the various factors involved in bacteria-platelet association has not yet been fully elucidated. Methods and Results— We observed a dramatic increase in the capability to bind S aureus when platelets were activated with thrombin (from 5% to 30%, P &lt;0.001). To pinpoint platelet-binding sites involved in the interaction, platelets from knockout mice and from patients with selective inherited deficiency of membrane proteins or of granules were used. CD36, GPIIb/IIIa, and P-selectin were excluded as receptors for S aureus . Platelets from patients with α-δ–storage pool disease and Gray platelet syndrome indicate the requirement of α-granule contents. Platelet activation by ADP did not promote platelet– S aureus associate formation, although these platelets were covered with bound fibrinogen. Only small numbers of associates between fibrinogen-covered bacteria and ADP-activated platelets were observed. Formation of fibrin alone was also not sufficient to induce association. Only when fibrin formation and platelet activation occurred together were large numbers of associates formed ( P &lt;0.001). A potential receptor for fibrin on S aureus is clumping factor A. Addition of thrombospondin-1 to control platelets increased the number of associates ( P =0.02). Conclusions— Soluble fibrin but not fibrinogen is the main mediator of platelet– S aureus association. In addition, platelet activation and the release of α-granule contents, particularly thrombospondin-1, is a requirement for platelet– S aureus association.
Relevance of the electronic computer to hospital medical records
Authors: Jere H Mitchell
Journal: BMJ (1969)

During the past 30 years an “information explosion” has completely changed patterns of illness. Unit files of individual patients have become so large that they are increasingly difficult both to store physically and to assimilate mentally. We have reached a communications barriers which poses a major threat to the efficient practice of clinical medicine. At the same time a new kind of machine, the electronic digital computer, which was invented only 26 years ago, has already come to dominate large areas of military, scientific, commercial, and industrial activity. Its supremacy rests on its ability to perform any data procedure automatically and incredibly quickly. Computers are being employed in clinical medicine in hospitals for various purposes. They can act as arithmetic calculators, they can process and analyse output from recording devices, and they can make possible the automation of various machine systems. However, in the field of case records their role is much less well defined, for here the organization of data as a preliminary to computer input is the real stumbling-block. Data banks of retrospective selected clinical information have been in operation in some centres for a number of years. Attempts are now being made to design computerized “total information systems” to replace conventional paper records, and the possibility of automated diagnosis is being seriously discussed. In my view, however, the medical profession is in danger of being dazzled by optimistic claims about the usefulness of computers in case record processing. The solution to the present problems of record storage and handling is very simple, and does not involve computerization.
BTS randomised feasibility study of active symptom control with or without chemotherapy in malignant pleural mesothelioma: ISRCTN 54469112
Authors: M F Muers
Journal: Thorax (2004)

<b>Background:</b> The incidence of mesothelioma is rising rapidly in the UK. There is no generally accepted standard treatment. The BTS recommends active symptom control (ASC). It is not known whether chemotherapy in addition prolongs survival or provides worthwhile palliation with acceptable toxicity. Palliation as recorded by patients has been fully reported for only two regimens: mitomycin, vinblastine, and cisplatin (MVP), and vinorelbine (N). The BTS and collaborators planned to conduct a phase III randomised trial comparing ASC only, ASC+MVP, and ASC+N in 840 patients with survival as the primary outcome measure. The aim of the present study was to assess the acceptability of the trial design to patients and the suitability of two standard quality of life (QL) questionnaires for mesothelioma. <b>Methods:</b> Collaborating centres registered all new patients with mesothelioma. Those eligible and giving informed consent completed EORTC QLQ-C30+LC13 and FACT-L QL questionnaires and were randomised between all three or any two of (1) ASC only, (2) ASC+4 cycles of MVP, and (3) ASC+12 weekly doses of N. <b>Results:</b> During 1 year, 242 patients were registered of whom 109 (45%) were randomised (55% of the 197 eligible patients). Fifty two patients from 20 centres were randomised to an option including ASC only. This translates into a rate of 312 per year from 60 centres interested in collaborating in the phase III trial. The EORTC QL questionnaire was superior to FACT-L in terms of completeness of data and patient preference. Clinically relevant palliation was achieved with ASC. <b>Conclusion:</b> The planned phase III trial is feasible.
ACUTE EPIDEMIC DYSENTERY.
Authors: LAWRENCE B. PILSBURY
Journal: JAMA (1905)

The history of the study of the dysentery bacillus began with the discovery by Shiga, in 1897, of an organism whose presence he was able to demonstrate in every one of a large number of cases of acute dysentery. This bacillus differed from the colon bacillus especially in that it did not ferment glucose with the formation of visible quantities of gas, that it did not produce indol, and was motile only when freshly isolated from the intestine. It reacted with the serum of those sick with dysentery and usually for months after convalescence, and did not react in the trials made with the serum of those who had not had dysentery. There were more than 89,000 cases of dysentery in Japan in 1897, and Shiga has demonstrated that in the majority of these cases the bacillus described by him is the exciting factor. Following Shiga's investigations, Flexner examined bacteriologically
Detection of functional iron deficiency during erythropoietin treatment: a new approach.
Authors: I. C. Macdougall, I. Cavill, B. Hulme, B. Bain, E. McGregor, P. McKay, E. Sanders, G. A. Coles, J. D. Williams
Journal: BMJ (1992)

TABLE VIIIt-Comparison of risk estimates from studies of Japanese atomic bomb survivors, National for Radiation Workers provide valuable evidence, and Registry for Radiation Workers, and combined cohort ofnuclear workers in United States future analysis of the registry, which will incorporate all registered cohorts and updated dose histories (in- National cluding internal doses) and have a longer follow up, Atomic homb survivors"0 Registry for Radiation American will provide a firmer basis for deriving risk estimates Whole cohort Doses <_500 mSv Workers workers* from low dose and low dose rate exposures.Cohort size 75 991 95 217 35 933 Person years 2
Decreased Serum Salicylate Concentrations in Children with Rheumatic Fever Treated with Antacid
Authors: Gerhard Levy, Tara Lampman, Burde L. Kamath, L.K. Garrettson
Journal: New England Journal of Medicine (1975)

To determine if the common practice of giving antacids to patients on salicylate therapy has an effect on serum salicylate concentrations, we gave a widely used antacid, aluminum and magnesium hydroxide, and aspirin concomitantly to three children with rheumatic fever. Urinary pH increased appreciably, and serum salicylate concentrations decreased by 30 to 70 per cent. In five healthy adult volunteers concomitant administration of antacid had no effect on the bioavailability of aspirin. Pharmacokinetic analysis revealed that the antacid-induced decrease of serum salicylate concentrations was due to increased renal clearance of salicylate caused by the rise in urinary pH. (N Engl J Med 293:323–325,1975)
Comprehensive Approaches to the Burned Person
Authors: Joseph Upton
Journal: JAMA (1984)

The effects of a severe body burn can be devastating. Victims of burns present one of the most difficult care problems in clinical medicine and are best managed by comprehensive teams that cut across many specialized disciplines. Edited by a psychiatrist and a plastic surgeon, this book offers more than the usual "cookbook" approach to burn care as each contributor outlines an area of expertise while placing emphasis on a personal sense of involvement, frustrations, and challenges. The reader gains real insight into what a nurse, physical therapist, or priest experiences when dealing with a helpless burn victim. The importance of humanistic care and the true art of medicine are recurrent themes. Personal and moral issues such as life as a disfigured person, termination of care, self-image, and marital relationships are as important as early resuscitation and wound coverage. Pain management, comprehensive nursing, nutrition, physical therapy, recreation, education, and social
The Indiscriminate Use of IPPB
Authors: Alvan L. Barach
Journal: JAMA (1975)

THE ENORMOUS increase in the use of intermittent positive pressure breathing (IPPB) devices for the delivery of therapeutic aerosols for inpatient and outpatient hospital clinics and home use appears to be related to our pursuit of technical innovations and liberal health support measures, which in a sense, provides the "economic prescription" that most patients require for their rental or purchase. The insistence on the prescription of this technique frequently creates a feeling of false security that only by employing such expensive units for the aerosol therapy will the patient be optimally treated. Many investigators, however, have reached the conclusion that nebulized bronchodilator aerosols administered with IPPB are no more effective than nebulized bronchodilator solutions administered simply with hand bulb nebulizers or via air pumps and oxygen delivery systems, when employed for the routine management of bronchospasm in patients with acute or chronic airway obstructive disease. Miller et al<sup>1</sup>recently
The identification of irreversible rituximab-resistant lymphoma caused by CD20 gene mutations
Authors: Y Mishima, Y Terui, K Takeuchi, Y Matsumoto-Mishima, S Matsusaka, R Utsubo-Kuniyoshi, K Hatake
Journal: Blood Cancer Journal (2011)

C-terminal mutations of CD20 constitute part of the mechanisms that resist rituximab therapy. Most CD20 having a C-terminal mutation was not recognized by L26 antibody. As the exact epitope of L26 has not been determined, expression and localization of mutated CD20 have not been completely elucidated. In this study, we revealed that the binding site of L26 monoclonal antibody is located in the C-terminal cytoplasmic region of CD20 molecule, which was often lost in mutated CD20 molecules. This indicates that it is difficult to distinguish the mutation of CD20 from under expression of the CD20 protein. To detect comprehensive CD20 molecules including the resistant mutants, we developed a novel monoclonal antibody that recognizes the N-terminal cytoplasm region of CD20 molecule. We screened L26-negative cases with our antibody and found several mutations. A rituximab-binding analysis using the cryopreserved specimen that mutation was identified in CD20 molecules indicated that the C-terminal region of CD20 undertakes a critical role in presentation of the large loop in which the rituximab-binding site locates. Thus, combination of antibodies of two kinds of epitope permits the identification of C-terminal CD20 mutations associated with irreversible resistance to rituximab and may help the decision of the treatment strategy.
US health experts discuss setting up a centre for effectiveness
Authors: Bob Roehr
Journal: BMJ (2007)

The government has admitted that it will have to wait years before it discovers whether there are real productivity gains from the new consultants' contract.NHS leaders also told the House of Commons Committee of Public Accounts last week that lessons had been learnt from mistakes made when the contract was introduced, such as not piloting it before implementation.They were giving evidence as part of the committee's inquiry into the consultants' contract.The session was prompted by the publication earlier this month of a report from the government's
Combination of clonidine and sotalol in hypertension.
Authors: H Saarimaa
Journal: BMJ (1976)

loin.His initially raised blood pressure soon returned to normal, and no other abnormal features were noted on physical examination.Investigations showed: haemoglobin 10-7 g/dl; leucocytes 6-8 x 109/1; platelets 169 x 109/1; sternal marrow, active haemopoiesis with no increase in plasma cells; blood urea 34 mmol/I (204 mg/100 ml); serum creatinine 1350 1mol/l (15 mg/ 100 ml); serum potassium 7-1 mmol/l (7-1 mEq/l); serum albumin 3-4 g/l; creatinine clearance 1 ml/min; and 24-hour urine output 150 ml.Serum electrophoresis in cellulose acetate was normal but immunoelectrophoresis of plasma and urine showed free kappa light chains.There was mild im- munoparesis (IgA 63 x I03 IU/l; IgG 81 x 103 IU/I; IgM 64 x 103 IU/1), and the serum complement (C3) was 1-58 g/l.Radiography showed a soft-tissue mass embracing the bodies of the eighth to tenth thoracic vert- brae.Bronchoscopy, mediastinoscopy, barium swallow, and skeletal survey were non-contributory.At thoracotomy two tumours were found in the posterior mediastinum.Histologically there was dense plasma cell infiltration with many binucleate and multinucleate cells.High-dose intravenous pyelography with nephrotomography showed poorly functioning, normal sized kidneys.Ascending ureterograms were normal.Renal biopsy showed the characteristic histology of a myeloma kidney, with brittle, laminated casts and tubules surrounded by multinucleate giant cells.The patient was maintained on haemodialysis twice a week using a hollow fibre dialyser.At the time of writing he had survived for 14 months.During that time he had had more than 100 dialyses, an initial three-week course of radiotherapy to the mediastinum (total dose 3070 rads), five courses of melphalan 5 mg daily for not longer than seven days, infrequent blood transfusions, and the routine management of chronic renal failure.Although his weight had decreased from 81 to 58 kg, his general condition was satis- factory apart from some transient subcutaneous swellings, particularly at the site of the arteriovenous fistula.Blood pressure remained normal.Latterly fragmented erythocytes appeared in the peripheral blood but coagulation studies showed no evidence of intravascular coagulation.Recent skeletal survey showed no lytic lesions or generalised decalcification, and bone marrow biopsy of the posterior iliac crest showed active haemo- poiesis with no increase in plasma cells.Free kappa light chains were detected in the serum on five occasions and the mild immunoparesis persisted.
Abstract 5577: ERG enhances prostate cancer growth by upregulating neurotransmitter receptors
Authors: Seungtae On
Journal: Cancer Research (2014)

Abstract Almost 50% of prostate cancer (PCa) cases exhibit a gene fusion between TMPRSS2 and the ETS transcription factor ERG. ERG is suspected to promote the acceleration and progression of prostate cancer. However, the mechanisms whereby ERG exerts its affects growth and development of the prostate cancer cell is are poorly understood. We aimed to identify and characterize ERG-related changes using a prostate tumor cell as a model. We profiled the transcription and metabolomics of cell lines induced to express ERG, and used RT-PCR, calcium influx, proliferation and phosphorylation assays to test our in silico observations. Genome-wide gene expression and metabolite profiling revealed a significantly increased representation of neuronal receptors and metabolites in the ERG+ cells. Specifically, ERG+ cells overexpressed several nicotinic, adrenergic and glutamate receptors. Out of all three receptors, nicotinic receptors were predominently upregulated compared to others. To test the function of these receptors, cells expressing ERG were treated with neuronal receptor agonists nicotin, epinephrine and glutamate. Interestingly, ERG+ cells responded with increased calcium influx, and phosphorylation of pAKT and GSK3b. Nicotine increased cellular growth in ERG+ cells, but had no effect on the ERG- cells. Similar expression of these receptors was found in human PCa samples. Furtheremore, our analysis using the EDRN tissue bank identified a positive correlation between smoking and tumor size among TMRPSS2:ERG expressing PCa patients. Collectively, our findings suggest a correlation between neurotransmitter receptors and cellular proliferation of ERG-expressing Pca, and identify GSK3b and pAKT as the possible underlying signaling mediators. Citation Format: Seungtae On. ERG enhances prostate cancer growth by upregulating neurotransmitter receptors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5577. doi:10.1158/1538-7445.AM2014-5577