tbuckley/cabot-search huggingface dataset:
Disappearing teaspoons: Spoon solutions
Authors: Trevor Watts
Journal: BMJ (2006)

Good quality monitoring is crucial for informed choiceEditor-In accordance with the patient choice scheme, all 303 primary care trusts in England were obliged from January 2005 to offer patients a choice of at least two providers for cataract surgery. 1 The scheme allows patients to be involved in how, where, and when they are treated.Providers can be NHS trusts, diagnostic and treatment centres, or independent sector providers from the UK or overseas.By February 2005 13 000 extra operations had already been performed under the independent sector treatment programme. 2However, concern was raised about variations in clinical safety between different providers. 3 We sent a postal questionnaire to the leaders of patient choice for each of the primary care trusts in England asking how they monitor the quality of care from their providers.The table shows the replies from 125 trusts.The quality monitoring of providers by primary care trusts is poorly structured and variable.Who then should monitor standards and what variables should they use?Traditionally, NHS providers have used audit and clinical governance to measure their performance.Should it now be the role of the Strategic Health Authority, the provider, or the purchaser in the form of primary care trusts to monitor the product offered to the patient?Information technology exists to collect accurate data about adverse events in addition to visual acuity and refractive outcomes.The public expect that safe cataract care should be commissioned for them, 4 and robust methods of monitoring need to be agreed and implemented so that patients can make a truly informed choice.These decisions need to be made not only for cataract surgery but also for other elective procedures that will increasingly be made available to patients through the patient choice scheme.
The Mixed Promise of Genetic Medicine
Authors: Carl Elliott
Journal: New England Journal of Medicine (2007)

In the early decades of the 20th century, most Americans considered cosmetic surgery to be just a few steps removed from quackery. Many observers saw the desire for cosmetic surgery as a mark of vanity, and physicians tended to believe that such surgery violated their ethical injunction to do no harm. Yet by the end of the century, cosmetic surgery had become a multibillion-dollar business, and it is now an accepted part of mainstream medicine, with its own professional journals and associations. Cosmetic-surgery clinics are sponsored by elite academic centers such as Stanford, Johns Hopkins, and the Mayo Clinic. Even . . .
Intestinal ganglioneuromatosis and multiple endocrine neoplasia type 2B: implications for treatment
Authors: V V Smith, C Eng, P J Milla
Journal: Gut (1999)

Three infants, who presented with intestinal obstruction due to diffuse transmural intestinal ganglioneuromatosis, are described. Mutation analysis of exon 16 of the<i> RET</i>proto-oncogene revealed germline M918T and thus, a molecular diagnosis of multiple endocrine neoplasia type 2B (MEN 2B). Two infants developed medullary carcinoma of the thyroid. The third had a prophylactic thyroidectomy despite no obvious thyroid masses and normal calcitonin concentrations, but microscopic multifocal medullary carcinoma was found on histological examination. Early recognition of intestinal ganglioneuromatosis with germline<i>RET</i> M918T mutation in pseudo-Hirschsprung's disease is an indication for prophylactic thyroidectomy.
Signaling through estrogen receptors modulates telomerase activity in human prostate cancer
Authors: Simona Nanni, Michela Narducci, Linda Della Pietra, Fabiola Moretti, Annalisa Grasselli, Piero De Carli, Ada Sacchi, Alfredo Pontecorvi, Antonella Farsetti
Journal: Journal of Clinical Investigation (2002)

Sex steroid hormone receptors play a central role in all stages of prostate cancer. Here, we tested whether estrogen receptor (ER) signaling contributes to telomerase activation, an early event in prostate tumorigenesis. Following 17β-estradiol (E2) treatment, both mRNA encoding the catalytic subunit of human telomerase (hTERT) and telomerase activity were promptly induced in human prostate normal epithelial cells, fresh explants from benign prostate hyperplasia, and prostate cancer explants and cell lines. Reporter expression studies and in vivo chromatin immunoprecipitation assays revealed E2-dependent hTERT promoter induction and showed that both ERα and ERβ bound this sequence. Crucially, addition of the anti-estrogen 4-hydroxytamoxifen caused a differential recruitment in vivo of ERα and ERβ onto the hTERT promoter and inhibited telomerase activity. Treatment with the aromatase inhibitor letrozole, which prevented testosterone-mediated interaction between ER and the hTERT estrogen response element, resulted in a negative regulation of telomerase activity. Thus, intracellular conversion of androgens to estrogens may contribute to the etiopathogenesis of prostate cancer. Given the present evidence for direct control of hTERT gene expression and telomerase activity in the prostate by the ER, we suggest that this transcriptional regulator represents a possible therapeutic target in prostate cancer.
Fifth Week of Desert Storm Fighting Brings New Challenges for Medicine
Authors: Phil Gunby
Journal: JAMA (1991)

AS ANTICIPATED, Desert Storm ground fighting is bringing a new set of challenges in terms of prompt evacuation and treatment of wounded allied soldiers.  When Iraqi forays into Saudi Arabia brought a start to ground fighting 3 weeks ago, the situation also highlighted the importance of US military medical planning. This includes self- or buddy-care by US troops who are trained in some essential emergency medical procedures such as control of bleeding, additional procedures (such as airway clearance) by a combat lifesaver in the squad with additional training and equipment ( JAMA . 1991;265:557-559), help from Advanced Trauma Life Support-certified corpsmen, and eventually attention from a physician.  As also was expected, evacuation of the wounded is challenging along this flat terrain where would-be rescuers are vulnerable to enemy groundfire. Helicopters are much less likely to be used for frontline medical evacuation (than they were used, for instance, in the Southeast Asian theater
Trisomy 8 in an allogeneic stem cell transplant recipient representative of a donor‐derived constitutional abnormality
Authors: Noelle V. Frey, Christopher E. Leid, Peter C. Nowell, Ewa Tomczak, Honore T. Strauser, Margaret Kasner, Steven Goldstein, Alison Loren, Edward Stadtmauer, Selina Luger, Elizabeth Hexner, Joanne Hinkle, David L. Porter
Journal: American Journal of Hematology (2008)

Abstract Trisomy 8 is a common cytogenetic abnormality in myeloid malignancies. It can also be present constitutionally and is associated with a wide range of phenotypes. We report a case of a 20‐year‐old woman with acute myelogenous leukemia associated with the 11q23/MLL translocation who underwent allogeneic hematopoietic stem cell transplantation (HSCT) from a healthy, unrelated 26‐year‐old female. Cytogenetics on a bone marrow biopsy and aspirate performed 71 days after transplant to evaluate pancytopenia identified trisomy 8 in 6 of 7 cells examined. The bone marrow was hypocellular but normal by morphology and flow cytometry. Fluorescent in situ hybridization (FISH) for the original 11q23/MLL translocation was negative. Chimerism analysis using multiplex polymerase chain reaction to amplify an informative short tandem repeat demonstrated 97% donor cells. These findings were confirmed by repeat bone marrow biopsies at Day 110 after transplant and 1 year after transplant. With resolution of comorbid illness, the patient's peripheral blood counts recovered and remained normal at 1 year after HSCT. FISH analysis of a cryopreserved sample of the donor graft showed trisomy 8 in 120 of 200 cells examined. This represents the first reported case of a person with constitutional trisomy 8 mosaicism serving as a stem cell donor. The case illustrates the importance of identifying donor‐derived constitutional abnormalities to avoid the assumption that these cytogenetic abnormalities after HSCT are representative of malignant disease. Am. J. Hematol., 2008. © 2008 Wiley‐Liss, Inc.
Autoimmune Disease and Histocompatibility Antigen
Authors: MARC C. HOCHBERG
Journal: Annals of Internal Medicine (1977)

Comments and Correction1 May 1977Autoimmune Disease and Histocompatibility AntigenMARC C. HOCHBERG, M.D.MARC C. HOCHBERG, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-86-5-660_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The report by Van Thiel and associates (1) is an excellent example of a thorough family study, and adds the syndrome of selective immunoglobulin A deficiency with malabsorption and diabetes mellitus to the list of disorders associated with the histocompatibility antigens, HLA-B8 and DW3. The authors list glutensensitive enteropathy, chronic active hepatitis, and the autoimmune endocrine disorders of diabetes mellitus, Grave's disease, and idiopathic Addison's disease as other conditions associated with these HLA antigens.Another disorder characterized by autoantibody production as well as autoimmune glandular dysfunction is Sjögren's syndrome. Patients with Sjögren's syndrome have an increased incidence...References1. VANTHIELSMITHRABIN DWB: A syndrome of immunoglobulin A deficiency, diabetes mellitus, malabsorption and a common HLA haplotype. Ann Intern Med 86:10-19, 1977 LinkGoogle Scholar2. WHALEYWILLIAMSONCHISHOLM KJD: Sjögren's syndrome: clinical associations and immunological phenomena. Q J Med 42:513-548, 1973 MedlineGoogle Scholar3. FYETERASAKIMOUTSOPOULOS KPH: Association of Sjögren's syndrome with HLA-B8. Arthritis Rheum 19:883-886, 1976 CrossrefMedlineGoogle Scholar4. GERSHWINTERASAKIGRAW MPR: Increased frequency of HL-A8 in Sjögren's syndrome. Tissue Antigens, in press Google Scholar5. CHUSEDKASSANMOUTSOPOULOS TSH: Sjögren's syndrome associated with the lymphocyte-defined antigen HLA-DW3 (abstract). Arthritis Rheum 20, in press Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: MARC C. HOCHBERG, M.D.Affiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byConnective Tissue Diseases 1 May 1977Volume 86, Issue 5Page: 660-660KeywordsAntigensAutoantibodiesAutoimmune diseasesAutoimmune hepatitisDiabetes mellitusEnteropathiesGrave's diseaseHuman leukocyte antigenMajor histocompatibility antigens ePublished: 1 December 2008 Issue Published: 1 May 1977 PDF downloadLoading ...
Positive selection of mouse NK1+ T cells by CD1-expressing cortical thymocytes.
Authors: A Bendelac
Journal: The Journal of Experimental Medicine (1995)

Mouse NK1+ T cells constitute a subset of alpha/beta TCR+ T cells that specialize in the rapid production of cytokines, in particular IL-4, and may promote the differentiation of Th2-type CD4 T cells. Their TCRs, like those of a homologous subset of human T cells, use an invariant TCR alpha chain and were recently shown to be specific for the beta 2-microglobulin-associated, MHC class I-like CD1 molecules, which are encoded outside the MHC. In contrast to mainstream thymocytes, which recognize their positively selecting MHC ligand on thymic epithelial cells, positive selection of NK1+ T cells requires their CD1 ligand to be expressed on bone marrow-derived cells. To investigate the nature of the bone marrow-derived cell involved, chimeric mice were constructed with tissues from normal, SCID, and MHC-deficient mice, so that CD1 could be selectively expressed by different subsets of bone marrow-derived cells in the thymus. CD1 expression was also directly assessed using an anti-CD1 mAb, and a CD1-specific T cell hybridoma. The results suggest that immature (CD4+8+ double-positive) cortical thymocytes are the source of CD1 presentation for positive selection of NK1+ T cells.
Aminoglycosides in patients with impaired renal function
Authors: P. Noone
Journal: BMJ (1978)

given that of five patients with deteriorating renal function, three were on gentamicin alone and two on gentamicin plus a cephalosporin.Of the three on gentamicin alone they say, "All three patients were also suffering from transplant rejection and toxaemia, and interpretation of these results is therefore difficult."Of the two on gentamicin plus a cephalosporin they say, "Although in both cases rejection was occurring, we could not exclude nephrotoxicity."They do not present any evidence to explain why in the one situation they conclude, "attributable nephrotoxicity not observed," while in the other they conclude, "may have produced nephrotoxicity."Furthermore, in view of the accumulating evidence that gentamicin appears to be potentially more nephrotoxic than some other aminoglycosidesl-3 attention might have been drawn to the fact that, whether or not it was attributable, all five patients who showed deteriorating renal function were actually receiving gentamicin and not one of the other aminoglycosides included in the study.
Nasal cancer in woodworkers.
Authors: M. J. Ball
Journal: BMJ (1968)

<h3>Objective</h3> To assess the effectiveness of solution-focused therapy (SFT) on fatigue and quality of life (QoL) in patients with fatigued inflammatory bowel disease (IBD). <h3>Design</h3> Randomised controlled trial in two Dutch hospitals. Patients with IBD with quiescent IBD and with a Checklist Individual Strength—Fatigue (CIS—fatigue) score of ≥35 were enrolled. Patients were 1:1 randomised to receive SFT or care as usual (CAU) for 3 months. Patients were followed for a further 6 months after the SFT. Primary endpoint was defined as changes in fatigue and QoL during follow-up. Secondary endpoints included change in anxiety and depression, medication use, side effects to medication, disease activity, laboratory parameters (C-reactive protein, leucocytes and haemoglobin) and sleep quality. <h3>Results</h3> Ninety-eight patients were included, of whom 63% were women, mean age was 40.1 years. After the SFT course, 17 (39%) patients in the SFT group had a CIS-fatigue score below 35 compared with eight (18%) of patients in the CAU group (p=0.03). The SFT group also showed a greater reduction in fatigue across the first 6 months compared with the CAU group (CIS-fatigue: p=&lt;0.001 and CIS-total: p=0.001). SFT was associated with a significant higher mean IBD questionnaire change at 3 months (p=0.020). At 9 months, no significant differences between the two groups were observed. <h3>Conclusions</h3> SFT has a significant beneficial effect on the severity of fatigue and QoL in patients with quiescent IBD. However, this effect diminished during follow-up.
A shed form of LDL receptor–related protein–1 regulates peripheral nerve injury and neuropathic pain in rodents
Authors: Alban Gaultier, Sanja Arandjelovic, Xiaoqing Li, Julie Janes, Nikola Dragojlovic, George P. Zhou, Jenny Dolkas, Robert R. Myers, Steven L. Gonias, W. Marie Campana
Journal: Journal of Clinical Investigation (2008)

Injury to the peripheral nervous system (PNS) initiates a response controlled by multiple extracellular mediators, many of which contribute to the development of neuropathic pain. Schwann cells in an injured nerve demonstrate increased expression of LDL receptor–related protein–1 (LRP1), an endocytic receptor for diverse ligands and a cell survival factor. Here we report that a fragment of LRP1, in which a soluble or shed form of LRP1 with an intact α-chain (sLRP-α), was shed by Schwann cells in vitro and in the PNS after injury. Injection of purified sLRP-α into mouse sciatic nerves prior to chronic constriction injury (CCI) inhibited p38 MAPK activation (P-p38) and decreased expression of TNF-α and IL-1β locally. sLRP-α also inhibited CCI-induced spontaneous neuropathic pain and decreased inflammatory cytokine expression in the spinal dorsal horn, where neuropathic pain processing occurs. In cultures of Schwann cells, astrocytes, and microglia, sLRP-α inhibited TNF-α–induced activation of p38 MAPK and ERK/MAPK. The activity of sLRP-α did not involve TNF-α binding, but rather glial cell preconditioning, so that the subsequent response to TNF-α was inhibited. Our results show that sLRP-α is biologically active and may attenuate neuropathic pain. In the PNS, the function of LRP1 may reflect the integrated activities of the membrane-anchored and shed forms of LRP1.
Deficiency of skeletal membrane protein band 4.1 in homozygous hereditary elliptocytosis. Implications for erythrocyte membrane stability.
Authors: G Tchernia, N Mohandas, S B Shohet
Journal: Journal of Clinical Investigation (1981)

Erythrocytes from three patients with severe hemolytic anemia, marked erythrocyte fragmentation, and elliptocytic poikilocytosis, were studied in terms of both their membrane protein composition and their mechanical characteristics. Erythrocytes from the patients' parents and one minimally affected and one normal sibling were also studied. Morphologic observations implied that the severely affected patients suffered from homozygous hereditary elliptocytosis because erythrocytes of both parents and the one minimally affected sibling showed moderate elliptocytosis on smear, whereas those of an unaffected sibling had normal morphology. The parallel findings of markedly reduced levels of band 4.1 in the erythrocyte membrane proteins of the patients and an intermediate reduction in the cells of the parents and the putative heterozygous sibling, suggest that the elliptocytic shape of the cells was related to the reduced levels of band 4.1. Additional studies showed marked abnormalities in cellular deformability and membrane fragility in the erythrocytes from the homozygous patients. Importantly, these changes were also closely proportional to the reduced levels of band 4.1, suggesting a central role for this protein in the maintenance of normal membrane stability and normal cell shape. It seems likely that this role for band 4.1 is intimately related to its known biochemical connection to the "membrane skeleton" through its linkage with spectrin and actin.
Continuing Screening Mammography in Women Aged 70 to 79 Years
Authors: Karla Kerlikowske, Peter Salzmann, Kathryn A. Phillips, Jane A. Cauley, Steve R. Cummings
Journal: JAMA (1999)

Mammography is recommended and is cost-effective for women aged 50 to 69 years, but the value of continuing screening mammography after age 69 years is not known. In particular, older women with low bone mineral density (BMD) have a lower risk of breast cancer and may benefit less from continued screening.To compare life expectancy and cost-effectiveness of screening mammography in elderly women based on 3 screening strategies.Decision analysis and cost-effectiveness analysis using a Markov model.General population of women aged 65 years or older.The analysis compared 3 strategies: (1) Undergoing biennial mammography from age 65 to 69 years; (2) undergoing biennial mammography from age 65 to 69 years, measurement of distal radial BMD at age 65 years, discontinuing screening at age 69 years in women in the lowest BMD quartile for age, and continuing biennial mammography to age 79 years in those in the top 3 quartiles of distal radius BMD; and (3) undergoing biennial mammography from age 65 to 79 years.Deaths due to breast cancer averted, life expectancy, and incremental cost-effectiveness ratios.Compared with discontinuing mammography screening at age 69 years, measuring BMD at age 65 years in 10000 women and continuing mammography to age 79 years only in women with BMD in the top 3 quartiles would prevent 9.4 deaths and add, on average, 2.1 days to life expectancy at an incremental cost of $66773 per year of life saved. Continuing mammography to age 79 years in all 10000 elderly women would prevent 1.4 additional breast cancer deaths and add only 7.2 hours to life expectancy at an incremental cost of $117689 per year of life saved compared with only continuing mammography to age 79 years in women with BMD in the top 3 quartiles.This analysis suggests that continuing mammography screening after age 69 years results in a small gain in life expectancy and is moderately cost-effective in those with high BMD and more costly in those with low BMD. Women's preferences for a small gain in life expectancy and the potential harms of screening mammography should play an important role when elderly women are deciding about screening.
Abstract P3-09-14: Using lean methods to increase access to support services in younger breast cancer survivors
Authors: DK Mayer, T Kinley, A Gerstel, M Jackson, T Shea, RL Donald, MB Lawrence
Journal: Cancer Research (2013)

Abstract Background: A variety of ‘structured support services’ (services) are available to patients (e.g. genetics, fertility, counseling, physical functioning, nutrition). Many of these services have value for breast cancer survivors (survivors) as they are often likely to face issues regarding genetic factors, fertility, parenting, relationships, work, and financial hard-ships. As part of an ongoing CDC-funded initiative, we report about barriers to services use for survivors. Methods: We used lean techniques to analyze system complexity including: process mapping; inventorying support services, providers/staff, and referral methods; stake holder leadership events; and Kaizen events to facilitate system improvements. Results: We identified several barriers to patients getting services which reflect the complexity of cancer care delivery in an academic cancer center including: varying care pathways, lack of standard processes; lack of staff awareness of available service (hospital staff are located in 5 different clinics and include physicians, APPs, clinic nurses, nurse navigators, and patient schedulers); numerous different contact and referral methods to services (tribal knowledge of staff necessary to make SS referrals). We initially identified 7 and found 38 services through inventorying and mapping systems. We implemented a number of systematic and non-systematic interventions to address these barriers. Systematic implementations include assisting in the development and piloting new patient orientation binders to include services, implementation of a revised scheduling form to streamline referrals, created and disseminated a quick reference referral guide to educate staff for how to make referrals. Non-systematic interventions included hosting services fair for breast cancer providers to meet and learn about them and advertising services on waiting room TVs. Conclusions: Patients and providers both perceive many challenges accessing support services. Applying improvements in a complex health care system is difficult and incrementally addresses identified barriers. We will now be measuring the impact of these changes on the receipt of support services in breast cancer survivors. Funding: CDC Grant 1U58DP003414 (PI Marks, L.). Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-14.