tbuckley/cabot-search huggingface dataset:
Illustrations of the Orthopaedic Apparatus, Referred to at a Demonstration of Modern Orthopaedic Methods
Authors: N. Smith
Journal: BMJ (1888)

profuse diarrhoea.At the end of three days she was seized with severe stabbing pain in the same situation, almost causing her to faint.Similar paroxysms oceurredl sulbsequently, while in the in- terals betwveen these paroxysms thse buirning pain continued.All these symptonms ^-were aggravated(l (Iriing the nmontlhs of preg- nancy, whilch terminated prematturely at the eiglhtlh month in tile birth of a stillborn child.This was in Deceiuber, 1881$5.Imme- diately after this occurreciee she experienced a new pain in tiie riht side of the abdomen of a gnawing character.Sh;e referred this to a point aboit midway between the anterior superior iliac spine and the umnbilicuis of the right side.These symptoms were present when she was admitted to hospital.D)uring her stay in hospital previous to operation shie had frequient attacks of the paroxysmal pain, beginning at the lack over the riglht renal region, anid shooting throughi to the front under the right costal arch, "anthough a needle were being driven through from be- hind."This pain radiated across the abdomen, and more latelv passed down to thei hip, sometimes posteriorly, sometimes in front and down to the inside of the thigh.When an attack came on
Complete remission in multiple myeloma examined as time-dependent variable in terms of both onset and duration in Total Therapy protocols
Authors: Antje Hoering, John Crowley, John D Shaughnessy, Klaus Hollmig, Yazan Alsayed, Jackie Szymonifka, Sarah Waheed, Bijay Nair, Frits van Rhee, Elias Anaissie, Bart Barlogie
Journal: Blood (2009)
Adding social services to US clinical care makes "good business sense," report argues
Authors: M. McCarthy
Journal: BMJ (2014)

Changes in the way US healthcare providers are paid have meant that it now makes “good business sense” for them to address patients’ social needs as well as their medical problems when they attend a clinic, a foundation sponsored report has argued.1

“What was once a path pursued by a handful of mission driven providers and grant funded social services organizations may soon become the standard of care, demanded by payers, policymakers, and consumers alike,” the report said. Addressing Patients’ Social Needs: An Emerging Business Case for Provider Investment was prepared by the consulting company Manatt Health Solutions and was funded by the Commonwealth Fund, the Skoll Foundation, and the Pershing Square Foundation.

Traditionally, US healthcare providers have been paid primarily for visits, tests, and procedures on a fee …
Prevalence of Desmin Mutations in Dilated Cardiomyopathy
Authors: Matthew R.G. Taylor, Dobromir Slavov, Lisa Ku, Andrea Di Lenarda, Gianfranco Sinagra, Elisa Carniel, Kurt Haubold, Mark M. Boucek, Debra Ferguson, Sharon L. Graw, Xiao Zhu, Jean Cavanaugh, Carmen C. Sucharov, Carlin S. Long, Michael R. Bristow, Philip Lavori, Luisa Mestroni
Journal: Circulation (2007)

Background— Desmin-related myofibrillar myopathy (DRM) is a cardiac and skeletal muscle disease caused by mutations in the desmin ( DES ) gene. Mutations in the central 2B domain of DES cause skeletal muscle disease that typically precedes cardiac involvement. However, the prevalence of DES mutations in dilated cardiomyopathy (DCM) without skeletal muscle disease is not known. Methods and Results— Denaturing high-performance liquid chromatography was used to screen DES for mutations in 116 DCM families from the Familial Dilated Cardiomyopathy Registry and in 309 subjects with DCM from the Beta-Blocker Evaluation of Survival Trial (BEST). DES mutations were transfected into SW13 and human smooth muscle cells and neonatal rat cardiac myocytes, and the effects on cytoskeletal desmin network architecture were analyzed with confocal microscopy. Five novel missense DES mutations, including the first localized to the highly conserved 1A domain, were detected in 6 subjects (1.4%). Transfection of DES mutations in the 2B domain severely disrupted the fine intracytoplasmic staining of desmin, causing clumping of the desmin protein. A tail domain mutation (Val459Ile) showed milder effects on desmin cytoplasmic network formation and appears to be a low-penetrant mutation restricted to black subjects. Conclusions— The prevalence of DES mutations in DCM is between 1% and 2%, and mutations in the 1A helical domain, as well as the 2B rod domain, are capable of causing a DCM phenotype. The lack of severe disruption of cytoskeletal desmin network formation seen with mutations in the 1A and tail domains suggests that dysfunction of seemingly intact desmin networks is sufficient to cause DCM.
TCT-79 Reclassification of Coronary Revascularization Strategy With Fractional Flow Reserve (FFR) at time of diagnostic angiography: Insights from a Large French Multicenter FFR Registry (R3F)
Authors: Eric Van Belle, Gilles Rioufol, Christophe Pouillot, Thomas Cuisset, Emmanuel Teiger, Didier Barreau, Michel Hanssen, Loic Belle, Cyril Besnard, Christophe Bretelle, Patrick Dupouy
Journal: Journal of the American College of Cardiology (2013)
Hard water, food fibre, and silicon.
Authors: T J Bassler
Journal: BMJ (1978)

and invited confirmation, though the mech- anism of action was unknown.We gave 5 g of cholestyramine or methyl- celluose twice daily in a double-blind crossover trial to five patients receiving chronic haemo- dialysis, using the same grading of pruritus.The daily pruritus score was calculated and the mean scores before, during four weeks of cholestyramine, and during four weeks of placebo treatment were compared.The results are shown in the accompanying table.Mean pruritus scores before and during treatment with placebo and cholestyramine
General practitioners' referrals to specialist outpatient clinics. II. Locations of specialist outpatient clinics to which general practitioners refer patients.
Authors: A. Coulter, A. Noone, M. Goldacre
Journal: BMJ (1989)

Although linkage by computer of hospital administration systems across all clinics in a health district is becoming a practical possibility, complete records of general practitioners9 referrals to outpatient clinics will be difficult to achieve. Data from a large study of general practitioners9 referrals to such clinics were used to calculate the proportion of referrals that crossed district boundaries, the proportion that were made to the private sector; and the number of locations that each practice referred patients to. Of the 17,601 referrals from practices in Oxford Regional Health Authority, 13,857 (78.7%) were made to NHS outpatient clinics within practices9 own districts, 1524 (8.7%) to clinics in other districts in the same region, 420 (2.4%) to NHS clinics in other regions, and 1800 (10.2%) to the private sector; but these proportions varied considerably among the practices. The mean number of different NHS hospitals or clinics that each practice referred patients to was 15.8 (range 4-42).
A Magnesium-Deficient Patient Presenting with Hypocalcemia and Hyperphosphatemia
Authors: Ramon Medalle, Christine Waterhouse
Journal: Annals of Internal Medicine (1973)

A patient with hypomagnesemia caused by chronic alcoholism presented with tetany, hypocalcemia, and hyperphosphatemia. The biochemical abnormality was associated with refractory hypokalemia and was readily corrected by oral administration of magnesium hydroxide (milk of magnesia). It is suggested that magnesium deficiency be considered in patients with hypocalcemia and hyperphosphatemia, in addition to the classic differential diagnosis of hypoparathyroidism, pseudohypoparathyroidism and renal failure.
Sacral stress fracture in a runner.
Authors: M B Bottomley
Journal: British Journal of Sports Medicine (1990)

A female 10,000 metre runner, aged 28, presented with a 10 day history of pain of insidious onset in the right buttock.She had, 2 weeks before presenting, competed in a track race for selection to an international representative team, which she achieved.Five days after the race she had a 400 metre interval training session, following which she was conscious of the pain in the right buttock.She continued with her road training, but was aware that her stride was shortened due to the pain which worsened over the subsequent week.She was due to compete internationally some 6 weeks later.On examination there was a small degree of pelvic tilt, the left side being lower than the right.There was slight compensatory lumbar scoliosis, concave to the right.Clinically, the right leg appeared longer than the left by not more than one half of an inch (1.25 cm).Movement of the lumbar spine was full and equal in all directions.There was no localized spinal tender- ness.Both sacroiliac joints were tender.There was acute and very localized tenderness in the upper, outer quadrant of the right buttock.No abnormality was found in the hips, other than passive extension of the right hip was slightly limited by comparison with the left.The pain could not be reproduced by passive or resisted movements of the hip.
Hexamethylene Diisocyanate Exposed Workers Are Less Likely to Have Confirmed Occupational Asthma than Workers Exposed to Other Isocyanates
Authors: A.M. Smith, P. Campo, Z.L. Lummus, A. Cartier, J. Malo, L. Boulet, D.I. Bernstein
Journal: Journal of Allergy and Clinical Immunology (2006)
Authors' reply to Rayter
Authors: J. M. Dixon, E. Rutgers, K. K. Hunt
Journal: BMJ (2015)

Rayter raises concerns about our editorial on intraoperative assessment of axillary nodes.1 2 He believes that the meta-analysis of one step nucleic acid amplification (OSNA) is seriously flawed, that it contains a mathematical error, and that the positive predictive value (PPV) should be 0.86 not 0.79.3 The PPV of 0.79 is statistically correct. When calculating the PPV of a relatively rare event its prevalence must be taken into account.4 He has not done this. The PPV of OSNA was even lower in a paper by Rayter’s group. Of …
The Forefoot-to-Rearfoot Plantar Pressure Ratio Is Increased in Severe Diabetic Neuropathy and Can Predict Foot Ulceration
Authors: Antonella Caselli, Hau Pham, John M. Giurini, David G. Armstrong, Aristidis Veves
Journal: Diabetes Care (2002)

We have previously demonstrated that high plantar pressures can predict foot ulceration in diabetic patients. The aim of the present study was to evaluate both the relationship between forefoot and rearfoot plantar pressure in diabetic patients with different degrees of peripheral neuropathy and their role in ulcer development.Diabetic patients of a 30-month prospective study were classified according to the neuropathy disability score: scores of 0, 1-5, 6-16, and 17-28 are defined as absent (n = 20), mild (n = 66), moderate (n = 95), and severe (n = 57) neuropathy, respectively. The F-Scan mat system was used to measure dynamic plantar pressures. The peak pressures under the forefoot and the rearfoot were selectively measured for each foot, and the forefoot-to-rearfoot ratio (F/R ratio) was calculated.Foot ulcers developed in 73 (19%) feet. The peak pressures were increased in the forefoot of the severe and moderate neuropathic groups compared with the mild neuropathic and non-neuropathic groups (6.2 +/- 4.5 and 3.8 +/- 2.7 vs. 3.0 +/- 2.1 and 3.3 +/- 2.1 kg/cm(2) [mean +/- SD], respectively; P < 0.0001). The rearfoot pressures were also higher in the severe and moderate neuropathic groups compared with the mild neuropathic and non-neuropathic groups (3.2 +/- 2.0 and 3.2 +/- 1.9 vs. 2.5 +/- 1.3 and 2.3 +/- 1.0, respectively; P < 0.0001). The F/R ratio was increased only in the severe group compared with the moderate and mild neuropathic and non-neuropathic groups (2.3 +/- 2.4 vs. 1.5 +/- 1.2, 1.3 +/- 0.9, and 1.6 +/- 1.0, respectively; P < 0.0001). In a logistic regression analysis, both forefoot pressure (odds ratio 1.19 [95% CI 1.11-1.28], P < 0.0001) and the F/R ratio (1.37 [1.16-1.61], P < 0.0001) were related to risk of foot ulceration, whereas rearfoot pressure was not.Both the rearfoot and forefoot pressures are increased in the diabetic neuropathic foot, whereas the F/R ratio is increased only in severe diabetic neuropathy, indicating an imbalance in pressure distribution with increasing degrees of neuropathy. This may lend further evidence toward the concept that equinus develops in the latest stages of peripheral neuropathy and may play an important role in the etiology of diabetic foot ulceration.
Effective Intravenous Therapy for Neurodegenerative Disease With a Therapeutic Enzyme and a Peptide That Mediates Delivery to the Brain
Authors: Yu Meng, Istvan Sohar, David E Sleat, Jason R Richardson, Kenneth R Reuhl, Robert B Jenkins, Gobinda Sarkar, Peter Lobel
Journal: Molecular Therapy (2013)

The blood–brain barrier (BBB) presents a major challenge to effective treatment of neurological disorders, including lysosomal storage diseases (LSDs), which frequently present with life-shortening and untreatable neurodegeneration. There is considerable interest in methods for intravenous delivery of lysosomal proteins across the BBB but for the most part, levels achievable in the brain of mouse models are modest and increased lifespan remains to be demonstrated. In this study, we have investigated delivery across the BBB using a mouse model of late-infantile neuronal ceroid lipofuscinosis (LINCL), a neurodegenerative LSD caused by loss of tripeptidyl peptidase I (TPP1). We have achieved supraphysiological levels of TPP1 throughout the brain of LINCL mice by intravenous (IV) coadministration of recombinant TPP1 with a 36-residue peptide that contains polylysine and a low-density lipoprotein receptor binding sequence from apolipoprotein E. Importantly, IV administration of TPP1 with the peptide significantly reduces brain lysosomal storage, increases lifespan and improves neurological function. This simple "mix and inject" method is immediately applicable towards evaluation of enzyme replacement therapy to the brain in preclinical models and further exploration of its clinical potential is warranted. The blood–brain barrier (BBB) presents a major challenge to effective treatment of neurological disorders, including lysosomal storage diseases (LSDs), which frequently present with life-shortening and untreatable neurodegeneration. There is considerable interest in methods for intravenous delivery of lysosomal proteins across the BBB but for the most part, levels achievable in the brain of mouse models are modest and increased lifespan remains to be demonstrated. In this study, we have investigated delivery across the BBB using a mouse model of late-infantile neuronal ceroid lipofuscinosis (LINCL), a neurodegenerative LSD caused by loss of tripeptidyl peptidase I (TPP1). We have achieved supraphysiological levels of TPP1 throughout the brain of LINCL mice by intravenous (IV) coadministration of recombinant TPP1 with a 36-residue peptide that contains polylysine and a low-density lipoprotein receptor binding sequence from apolipoprotein E. Importantly, IV administration of TPP1 with the peptide significantly reduces brain lysosomal storage, increases lifespan and improves neurological function. This simple "mix and inject" method is immediately applicable towards evaluation of enzyme replacement therapy to the brain in preclinical models and further exploration of its clinical potential is warranted.
The American Medical Association's Diagnostic and Therapeutic Technology Assessment Program
Authors: Richard J. Jones
Journal: JAMA (1983)

Since its founding, the American Medical Association has been actively engaged in the assessment and dissemination of new medical knowledge and new technologies. About two years ago, the Council on Scientific Affairs of the AMA recommended to its Board of Trustees that a plan be developed for establishing a mechanism within the AMA to briefly and promptly answer questions that might arise on the safety and effectiveness of medical technologies. The Board of Trustees of the AMA approved that idea. A plan was then developed and has now finally been implemented. It is important to put the new effort in context. The Council on Scientific Affairs of the AMA has for years been preparing reports for the profession on many areas of medical technology that have been of substantive interest to the public and the medical profession because of their unique popularity or their controversial nature. In the past four
LEFT VENTRICULAR LONGITUDINAL STRAIN BY SPECKLE-TRACKING ECHOCARDIOGRAPHY FOR THE DETECTION OF TREATMENT-REQUIRING REJECTION IN CLINICALLY ASYMPTOMATIC HEART TRANSPLANT RECIPIENTS
Authors: Fusako Sera, Tomoko S. Kato, Mary Jane Farr, Shuichi Kitada, Cesare Russo, Marco Di Tullio, Donna Mancini, Shunichi Homma
Journal: Journal of the American College of Cardiology (2013)
INJURY OF THE CAVUM PHARYNGEUM; REPORT OF A CASE.
Authors: EMIL ARONSON
Journal: JAMA (1898)

Several years ago, while practicing in Europe I received a call to Mr. D., a gamekeeper, who had sustained an injury from the explosion of a gun In the morning Mr. D. had tried his first experiment with his new gun. While the members of his family were looking on they saw him fall to the ground with blood oozing from nose and ear. He was carried unconscious into the house. After some time he regained consciousness but did not complain of the presence of a foreign body in his throat, yet his family thought it necessary to send for their family physician. This gentleman arrived, examined the throat and stated that except a piece of a tooth which was lodged in the posterior wall of the pharynx, nothing could be found. Promising to return in a day or two to remove that remnant of the tooth he left the
Commentary: Achieving savings will not be straightforward
Authors: D. Phizackerley
Journal: BMJ (2010)

Medicines represent one of the largest non-salary areas of NHS expenditure and have been under close scrutiny for many years. In 1994 “inappropriate spending” on medicines prescribed by general practitioners was estimated to cost around £300m (€360m; $470m) a year, and 13 years later a National Audit Office report found “over £200 million of potential efficiency savings” by looking at just 19% of the primary care drugs bill.1 2 Financial efficiency of prescribing in secondary care has been questioned in a national review.3 As a result the past 20 years has seen the evolution of management systems and support processes across primary and secondary care to improve efficiency; these include …
Calcium Density of Coronary Artery Plaque and Risk of Incident Cardiovascular Events
Authors: Michael H. Criqui, Julie O. Denenberg, Joachim H. Ix, Robyn L. McClelland, Christina L. Wassel, Dena E. Rifkin, Jeffrey J. Carr, Matthew J. Budoff, Matthew A. Allison
Journal: JAMA (2013)

Coronary artery calcium (CAC), measured by computed tomography (CT), has strong predictive value for incident cardiovascular disease (CVD) events. The standard CAC score is the Agatston, which is weighted upward for greater calcium density. However, some data suggest increased plaque calcium density may be protective for CVD.To determine the independent associations of CAC volume and CAC density with incident CVD events.Multicenter, prospective observational MESA study (Multi-Ethnic Study of Atherosclerosis), conducted at 6 US field centers of 3398 men and women from 4 race/ethnicity groups; non-Hispanic white, African American, Hispanic, and Chinese. Participants were aged 45-84 years, free of known CVD at baseline, had CAC greater than 0 on their baseline CT, and were followed up through October 2010.Incident coronary heart disease (CHD) and all CVD eventsDuring a median of 7.6 years of follow-up, there were 175 CHD events and an additional 90 other CVD events for a total of 265 CVD events. With both lnCAC volume and CAC density scores in the same multivariable model, the lnCAC volume score showed an independent association with incident CHD, with a hazard ratio (HR) of 1.81 (95% CI, 1.47-2.23) per standard deviation (SD = 1.6) increase, absolute risk increase 6.1 per 1000 person-years, and for CVD an HR of 1.68 (95% CI, 1.42-1.98) per SD increase, absolute risk increase 7.9 per 1000 person-years. Conversely, the CAC density score showed an independent inverse association, with an HR of 0.73 (95% CI, 0.58-0.91) per SD (SD = 0.7) increase for CHD, absolute risk decrease 5.5 per 1000 person-years, and an HR of 0.71 (95% CI, 0.60-0.85) per SD increase for CVD, absolute risk decrease 8.2 per 1000 person years. Area under the receiver operating characteristic curve analyses showed significantly improved risk prediction with the addition of the density score to a model containing the volume score for both CHD and CVD. In the intermediate CVD risk group, the area under the curve for CVD increased from 0.53 (95% CI, 0.48-0.59) to 0.59 (95% CI, 0.54-0.64), P = .02.CAC volume was positively and independently associated with CHD and CVD risk. At any level of CAC volume, CAC density was inversely and significantly associated with CHD and CVD risk. The role of CAC density should be considered when evaluating current CAC scoring systems.
The new ayatollahs
Authors: I. Robertson
Journal: BMJ (1996)

Are you an atheist? If so, then the chances are that you are less happy than the average believer—especially if you are no longer a spring chicken, so research by Michael Argyle of Wolfson College, Oxford, indicates. This confirms what many assert—namely, that religion and ritual give a sense of meaning and social cohesion that materialism never can.

Richard Dawkins is currently the chief ayatollah of scientific materialism and he has no time for religion, calling for theology to be banned as a subject of study at university and describing religious faith as a “mental virus.” This latter …
Abstract 1276: UV radiation interacts with Endothelin 3 and loss of nucleotide excision repair pathway to promote melanomagenesis.
Authors: Ana Paula Benaduce, Deannys Batista, Gabriel Grilo, Karen Jorge, Lidia Kos
Journal: Cancer Research (2013)

Abstract Melanomagenesis is influenced by the interaction of environmental (such as UV radiation) and genetic factors. The Xpa gene is important in the Nucleotide Excision Repair (NER) pathway. Similar to humans afflicted with Xeroderma Pigmentosum, which results from mutations in genes that play a role in NER, Xpa deficient mice show high sensitivity to UV light, leading to skin cancer development. However, Xpa deficient mice do not develop melanoma even upon UV exposure. The Endothelin 3 (Edn3) signaling pathway is essential for proliferation, survival and migration of melanocyte precursor cells. In humans, this pathway has also been implicated in melanoma progression and its metastatic potential. The purpose of this study is to develop a UV induced melanoma mouse model that combines Xpa deficiency with the over-activation of the Edn3 pathway. To this end, transgenic mice over-expressing Edn3 under the control of the keratin 5 promoter (K5-Edn3) and carrying a targeted mutation in Xpa were exposed to a single suberythemal neonatal dose of UV radiation. A subgroup of mice was also exposed to a second dose of UV radiation at 6 weeks of age. Histomorphology and immunostaining were used to confirm the melanocytic origin of primary skin tumors and metastases. Melanoma was only found in animals with the K5-Edn3 transgene. High penetrance was observed in animals exposed to one dose of UV radiation that were Xpa null (100%, n=3) when compared to Xpa heterozygous (73%, n=11) or Xpa wild type (43%, n=7). Enlarged and hyperpigmented lymph nodes were present in animals with melanoma skin lesions and these were diagnosed as local metastases. These results indicate that UV radiation exposure, in conjunction with over-activation of the Edn3 pathway is sufficient to lead to melanomagenesis in mice. Citation Format: Ana Paula Benaduce, Deannys Batista, Gabriel Grilo, Karen Jorge, Lidia Kos. UV radiation interacts with Endothelin 3 and loss of nucleotide excision repair pathway to promote melanomagenesis. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1276. doi:10.1158/1538-7445.AM2013-1276