tbuckley/cabot-search huggingface dataset:
Health Reforms Called a “Graduation Gift” for Young Adults Who Lack Insurance
Authors: Rebecca Voelker
Journal: JAMA (2010)

SEVERAL PROVISIONS IN THE HEALTH care reform legislation that Congress passed in March are likely to improve uninsured young adults’ access to health care while helping them launch careers and independent lives with fewer fears of medical debt. A recent report by the Commonwealth Fund, a private foundation that supports health policy and health system reform research, shows that 13.7 million young adults aged 19 to 29 years are uninsured, comprising about 30% of the estimated 46 million individuals without coverage. Sara Collins, PhD, a vice president at the Fund and lead author of the report, said the number of uninsured young adults has increased every year since 2003, when the Fund published its first report on young adults’ health insurance status. In 2009, Collins said, 76% of uninsured young adults did not get the health care they needed because of cost. Also, 46% of uninsured young adults with a chronic health problem reported that their condition had worsened in the previous 12 months as a result of not getting timely care. An estimated 11.3 million young adults, both insured and uninsured, were paying medical debts over time; of those, half had asked family members for financial help. About one-third delayed education or career plans and 39% could not meet other obligations, such as paying off school loans, because of medical debt (http://www .commonwealthfund.org/Content /Publications/Issue-Briefs/2010/May /Rite-of-Passage-Young-Adults-and-the -Affordable-Care-Act-of-2010.aspx). Young adults go through life transitions that make them particularly vulnerable to being uninsured. Many have jobs without health insurance or are unemployed. Individual insurance likely is unaffordable. Eligibility for Medicaid and the State Children’s Health Insurance Program ends at age 19 years, and high school or college graduation discontinues coverage on parents’ health plans. Health reform legislation, Collins said, “is in many ways a graduation gift to many young adults.”
P06.10 * MAST CELL CONTENT IN ANGIOMATOUS MENINGIOMA IN COMPARISON WITH OTHER MENINGIOMA SUBTYPES
Authors: H. D. Mennel
Journal: Neuro-Oncology (2014)

We report here that angiomatous meningioma exhibit elevated numbers of mast cells within their tissue architecture compared to most other meningioma subgroups, but similar to the so-called secretory variety of this tumour type. This finding might help to understand the development of the vascular component of this neoplasm and might equally be helpful in diagnosing such tumours, since diagnostic criteria are by no means clear: The (WHO-) definition of the entity states, that angiomatous meningioma is a tumour that exhibits numerous blood vessels on the background of a typical meningioma. But the quantitative aspect i.e. the percentage of vasculature required for this diagnosis is not specified. Our analysis of 27 angiomatous meningiomas revealed a mast cell density of 0.32 % of all tumour cells. This is a significant increase (α = 0.05, U-test) compared to an unselected sample of meningiomas of various, mostly endotheliomatous specimens (0.13 %). This finding relates angiomatous meningiomas to the similarly highly vascular secretory variant, that presents with an even higher percentage of mast cells (1.11 %). This latter subgroup, however, is well defined by the occurrence of secretory products, whereas angiomatous meningioma in other and our samples present with at least two morphological types, microvascular and macrovascular. Single cases of angiomatous as well as secretory meningiomas may therefore produce abundant intracranial edema. The microvascular subtype of angiomatous meningioma is very similar to the so-called mircrocystic variety of meningeal tumors. Thus, the similarity between both on one side (general morphology) as well as the common occurrence of mast cells, prominent vasculature and increased edema formation in angiomatous and secretory meningiomas raises the question of the rationale of meningioma subtyping. In this respect, descriptive morphological analysis may yield significant results.
Relationship of radiological change to clinical outcome in rheumatoid arthritis.
Authors: A Brook, A Fleming, M Corbett
Journal: Annals of the Rheumatic Diseases (1977)

Ninety-four patients with rheumatoid arthritis, seen within the first year after onset, have been followed prospectively with annual radiographs for a mean 63-1 months. An erosive arthropathy occurred in 72. The severity of the erosive changes showed a significant correlation with eventual clinical outcome. It is possible to predict a favourable outcome in those patients whose erosive changes become static at an early stage in the disease.
Erythrocyte Fragmentation in Defibrination Syndromes
Authors: Robert J. Jacobson, Dudley P. Jackson
Journal: Annals of Internal Medicine (1974)

The morphologic features of microangiopathic hemolytic anemia were assessed retrospectively in the peripheral blood of 40 patients with defibrination syndromes associated with various clinical conditions. All patients had hypofibrinogenemia, and all but six had thrombocytopenia. Seventeen of the 40 patients had fragmented erythrocytes in their peripheral blood in association with the episode of defibrination. The presence or absence of erythrocyte fragmentation did not correlate with the degree of hypofibrinogenemia or thrombocytopenia, nor with the duration of the coagulopathy. The microangiopathic changes in the peripheral blood, especially the more severe changes, were associated with fibrin occlusion to small blood vessels and significant organ damage.
Present Status of Electroversion in the Management of Cardiac Dysrhythmias
Authors: LEON RESNEKOV
Journal: Circulation (1973)

The theoretical and practical considerations of electrical reversion of cardiac dysrhythmias are reviewed and a comparison made between AC and DC defibrillation, indicating the superiority of DC under all circumstances. The indications for, immediate and late results of DC shock for atrial and ventricular dysrhythmias are presented, the complication of such treatment reviewed, and the need for anticoagulant cover, anesthesia, and drug therapy preceding and following the electrical treatment discussed. Each patient requires individual assessment, particularly those with chronic rhythm disturbances, especially atrial fibrillation, in whom electrical energy settings in excess of 300 joules are rarely indicated for the risk of complications becomes progressively higher as the energy setting is increased and the length of time sinus rhythm persists in this group of patients may be short. Patients with acute rhythm disturbances, however, with potentially serious hemodynamic consequences should be treated with maximum electric energies if needed. Caution is also advised in patients with coronary heart disease, atrial fibrillation, and a slow ventricular rate, even in the absence of digoxin, patients with rapidly changing rhythm disturbances, those who cannot maintain sinus rhythm for a significant period of time despite drug therapy, patients with the "sick sinus syndrome," those with atrial fibrillation of more than 5 years standing with a cardiothoracic ratio exceeding 55%, and patients in lone atrial fibrillation. Heavily digitalized patients in general should have their electroversion postponed if possible, but if not, they should be protected against serious ventricular rhythm disturbances immediately after the shock by an intravenous dose of lidocaine, phenylhydantoin, or procaine amide immediately before and the initial energy setting should be reduced to 5 joules. Quinidine or some other antidysrhythmic drug may be needed in an attempt to maintain sinus rhythm after successful electroversion, but even when controlled with adequate blood levels, results are poor.
Therapy of Gonorrhea
Authors: Fred R. Sattler
Journal: JAMA (1978)

Eighty-nine men with gonococcal urethritis were randomly treated with trimethoprim-sulfamethoxazole, four tablets (trimethoprim, 320 mg, and sulfamethoxazole, 1,600 mg) twice daily for two days, or ampicillin, 3.5 g, plus probenecid, 1 g, in a single dose. Forty-one (95.3%) of 43 patients who received trimethoprim-sulfamethoxazole and 41 (97.6%) of 42 given ampicillin were cured. Neither drug caused major side effects. All isolates of Neisseria gonorrhoeae were susceptible in vitro to trimethoprim-sulfame-thoxazole, and all but one were inhibited by ampicillin. The ampicillin-resistant strain (minimum inhibitory concentration, 4 μg/ml) produced penicillinase and was recovered from a patient who responded to treatment with trimethoprim-sulfamethoxazole. There was no significant correlation between the minimum inhibitory concentrations of trimethoprim-sulfame-thoxazole and ampicillin. It is concluded that trimethoprim-sulfamethoxazole is as efficacious and safe as ampicillin in the therapy of gonococcal urethritis. (<i>JAMA</i>240:2267-2270, 1978)
Regulation of human eosinophil viability, density, and function by granulocyte/macrophage colony-stimulating factor in the presence of 3T3 fibroblasts.
Authors: W F Owen, M E Rothenberg, D S Silberstein, J C Gasson, R L Stevens, K F Austen, R J Soberman
Journal: The Journal of Experimental Medicine (1987)

Normodense human peripheral blood eosinophils were isolated under sterile conditions from the 22/23 and 23/24% interfaces and the cell pellet of metrizamide gradients. After culture for 7 d in RPMI media in the presence of 50 pM biosynthetic (recombinant) human granulocyte/macrophage colony-stimulating factor (rH GM-CSF), 43 +/- 7% (mean +/- SEM, n = 8) of the cells were viable; in the absence of rH GM-CSF, no eosinophils survived. The rH GM-CSF-mediated viability was concentration dependent; increased survival began at a concentration of 1 pM, a 50% maximal response was attained at approximately 3 pM, and a maximal effect was reached at concentrations of greater than or equal to 10 pM rH GM-CSF. In the presence of rH GM-CSF and mouse 3T3 fibroblasts, 67 +/- 6% (mean +/- SEM, n = 8) of the eosinophils survived for 7 d. In a comparative analysis, there was no difference in eosinophil viability after 7 and 14 d (n = 3) in the presence of 50 pM GM-CSF and fibroblasts. Culture with fibroblasts alone did not support eosinophil survival. The addition of fibroblast-conditioned media to rH GM-CSF did not further improve eosinophil viability, indicating a primary role for GM-CSF in supporting these eosinophil cell suspensions ex vivo and a supplementary role for 3T3 fibroblasts. Eosinophils cultured for 7 d localized on density gradient sedimentation at the medium/18, 18/20, and 20/21 interfaces of metrizamide gradients, indicating a change to the hypodense phenotype from their original normodense condition. In addition, the cultured eosinophils generated approximately 2.5-fold more LTC4 than freshly isolated cells when stimulated with the calcium ionophore A23187 and manifested sevenfold greater antibody-dependent killing of S. mansoni larvae than the freshly isolated, normodense cells from the same donor. Thus we demonstrate the rH GM-CSF dependent conversion in vitro of normodense human eosinophils to hypodense cells possessing the augmented biochemical and biological properties characteristic of the hypodense eosinophils associated with a variety of hypereosinophilic syndromes. In addition, these studies provide a culture model of at least 14 d suitable for the further characterization of hypodense eosinophils.
Abstract 13857: Catheter Ablation of Atrial Fibrillation Using a New Non-Fluoroscopic Sensor-Guided 3D Navigation Tool
Authors: Sascha Rolf Rolf, Silke John, Thomas Gaspar, Philipp Sommer, Arash Arya, Gerhard Hindricks, Christopher Piorkowski
Journal: Circulation (2011)

In  Introduction:  A novel sensor-based electromagnetic 3D navigation system has been introduced that allows real-time catheter tracking in the environment of pre-recorded conventional 2D X-ray loops (MediGuide (TM), St. Jude Medical).   Hypothesis:  The first clinical applications of the new technology for catheter ablation of atrial fibrillation (AF) will have positive impact on procedural parameters.   Methods:  49 patients (39 male patients, age 60 ± 10 yrs) with symptomatic AF were ablated using the new technology. Two steerable diagnostic EP catheters equipped with a sensor for non-fluoroscopic catheter navigation were used for anatomical reconstruction of the left atrium within an electro-anatomic mapping system (EAMS), for tagging of defined anatomical structures, and for their placement in the coronary sinus and right ventricular apex, respectively. Circumferential pulmonary vein isolation plus additional lines - if necessary - were performed with a conventional irrigated-tip catheter using conventional EAMS navigation. A matched cohort of 49 patients ablated conventionally with the EAMS plus fluoroscopy served as a control group.   Results:  In all 49 patients the sensor-enabled catheters could be visualized and tracked non-fluoroscopically throughout the procedure. Complete pulmonary vein isolation was documented in each patient. Adverse events did not occur. Usage of the new technology significantly reduced fluoroscopy time from 31±12 min to 16±7 min compared to the control group (p   Conclusions:  The first clinical application of new sensor-guided technology in AF ablation revealed feasibility of highly precise non-fluoroscopic 3D catheter tracking within pre-acquired 2D cine-loops. With the system, we were able to significantly reduce x-ray needs without extending work-flow, although a sensor-equipped ablation catheter was not available yet.
Literature and Medicine
Authors: Elizabeth Sewell
Journal: JAMA (1989)

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Scabies Presenting as Urticaria
Authors: Thomas A. Chapel
Journal: JAMA (1981)

Three cases of urticaria developed in patients with scabies. The hives promptly disappeared after treatment with lindane (gamma benzene hexachloride). In two of the patients, physicians initially diagnosed and treated the urticaria but overlooked the scabies infestation. The point of emphasis in these cases is the occasional association of urticaria with<i>Sarcoptes scabiei</i>infestation. (<i>JAMA</i>1981;246:1440-1441)
Changing childbirth. Antenatal care must be shared.
Authors: A A Stephen
Journal: BMJ (1993)

gram would lead to smaller myocardial infarcts in 476 patients (without cerebral haemorrhage) for every one patient with cerebral haemorrhage with- out myocardial infarction; thrombolysis would be life saving in 19 of these cases.These benefit:risk ratios are even more favourable with thrombolysis before admission to hospital.Two trade offs have to be considered to maximise benefit from thrombolytic treatment: the sensitivity versus the specificity of whatever methods are used for predicting myocardial infarction, and the increasing accuracy of the diagnosis with the time from the onset of symptoms versus the waning efficacy of thrombolysis.The problem is to find the optimal balance between causing disability or death by giving thrombolytic treatment to those without myocardial infarction and causing disability or death by withholding the treatment from those with myocardial infarction.We suggest that use of ST elevation as a precondition for giving thrombolytic treatment errs in the latter direction.
Sirolimus-based graft-versus-host disease prophylaxis protects against cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation: a cohort analysis
Authors: Francisco M. Marty, Julie Bryar, Sarah K. Browne, Talya Schwarzberg, Vincent T. Ho, Ingrid V. Bassett, John Koreth, Edwin P. Alyea, Robert J. Soiffer, Corey S. Cutler, Joseph H. Antin, Lindsey R. Baden
Journal: Blood (2007)
Abstract IA8: Discovering drivers in rare ovarian cancer subtypes
Authors: David G. Huntsman
Journal: Clinical Cancer Research (2013)

Abstract Over the past several years it has become accepted that subtypes of ovarian carcinomas (high grade serous, endometriod, clear cell, low grade serous and mucinous carcinoma) are discrete diseases. Therefore, if we are to improve ovarian cancer morbidity and mortality, cancer prevention, early detection and/or screening strategies must be developed to deal with the challenges posed by each of these diseases. Whereas high grade serous carcinoma is relatively common, the other ovarian carcinoma subtypes represent 30% of cases in total and therefore are all rare. Rare cancers are usually marked by a combination of an unusual cells of origin and unusual mutations or other genomics drivers. We have undertaken a series of genomics studies to identify key drivers in rarer ovarian cancers. Some cancers such as granulosa cell tumors of the ovary and sertoli cell mutations have been found which are either pathognomonic or highly specific for that cancer type. Those mutations have great promise as diagnostics. Since the target cancers are rare such work is not possible without broad ranging international collaborations. For more common entities such as clear cell carcinoma concentrations of mutations can be found such as mutations in ARID1a. As such mutations are nonspecific they are less likely to be used diagnostically however this increases their potential therapeutic value. However, it is likely that the mutations or mutated genes have a specific role in the cell of origin of the cancers involved and therefore cell context specific cell lines of model systems will be required for functional validation. Although rare cancers are by definition unusual and therefore represent smaller medical problems they are of course highly significant to the patients involved and provide a model through which the stratification of management for common cancers can be undertaken. Citation Format: David G. Huntsman. Discovering drivers in rare ovarian cancer subtypes. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: From Concept to Clinic; Sep 18-21, 2013; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2013;19(19 Suppl):Abstract nr IA8.
Reducing the Risk of Breast Cancer
Authors: Rowan T. Chlebowski
Journal: New England Journal of Medicine (2000)

Recent research results suggest that the risk of breast cancer can be reduced. In this review I will focus on chemoprevention, emphasizing evidence from randomized clinical trials, and in addition summarize the evidence regarding preventive strategies involving surgery and lifestyle changes (Table 1).ChemopreventionTamoxifen and Risk ReductionThe risk of breast cancer is related to levels of endogenous1,2 and exogenous35 hormones. Tamoxifen and raloxifene, which are selective estrogen-receptor modulators, can be used to test the hypothesis that the risk of breast cancer can be reduced by estrogen antagonists.6 Tamoxifen is active against advanced breast cancer7 and is . . .
Spironolactone-Induced Hyperchloremic Acidosis in Cirrhosis
Authors: PATRICIA A. GABOW
Journal: Annals of Internal Medicine (1979)

Six patients with alcoholic cirrhosis developed a reversible metabolic acidosis during treatment with the aldosterone antagonist spironolactone. Mean serum bicarbonate concentration decreased significantly with spironolactone therapy (100 to 200 mg/day) from 18.2 +/- 4.5 to 10.9 +/- 3.2 meq/litre (P less than 0.001). Upon withdrawal of spironolactone, serum bicarbonate concentration increased from 10.9 +/- 3.2 to 18.1 +/- 3.5 meq/litre (P less than 0.001). During the development of this hyperchloremic metabolic acidosis, serum potassium concentration rose from 3.7 +/- 0.5 to 5.0 +/- 0.8 meq/litre (P less than 0.005); this reversed after cessation of spironolactone therapy. These effects of spironolactone treatment were not associated with significant alterations in serum creatinine or sodium concentration. Thus, even though an aldosterone antagonist in the treatment of sodium and water retention in cirrhotic patients may prevent hypokalemia and rapid diuresis, it may also induce or worsen another complication: hyperchloremic metabolic acidosis.
Patterns of presentation of the shaken baby syndrome: Four types of inflicted brain injury predominate
Authors: Robert A Minns, Anthony Busuttil
Journal: BMJ (2004)

EDITOR—One of the controversies that has recently arisen in cases of alleged shaken baby syndrome concerns the disparity between certain neuropathological findings at necropsy and whether these findings are consistent with the entity regarded as the shaken baby syndrome.

A database was collected for more than five years of documented Scottish cases of suspected non-accidental head injury diagnosed after a multiagency assessment and including cases with uncoerced confessions of perpetrators and criminal convictions. Several patterns of presentation allow delineation of cases into four predominant types.

This hyperacute encephalopathy (6% of all cases) results from extreme “whiplashing” forces, the infant suffering the equivalent of a broken neck or, more correctly, a broken brain stem. In infants with a median survival of one day Geddes et al described localised axonal damage at the craniocervical junction, in the corticospinal tracts, and in the cervical cord roots, consistent with hyperflexion and hyperextension movements.1 These cases, which truly reflect a “whiplash” shaking injury to …
Fractures: Simple, Compound, and Complex
Authors: Otto Aufranc
Journal: JAMA (1965)

<h3>To the Editor:—</h3> In many instances, and for years, I have emphasized what misnomers the terms "simple" and "compound" fractures are, especially when one realizes that a simple fracture can be accompanied by the most complicated pathology in surrounding tissues and can be more severe in many instances than the so-called compound fracture. In my opinion, the presently-used terms should be supplanted by the following: (1) closed fracture, in many instances complex closed fracture, and (2) open fracture. "Simple" fracture does not define the injury to the soft tissues, the intramuscular hemorrhage, or the loss of sensation of the parts of the tissue close to the fracture area. Neither does it emphasize the possible marked displacement of bone fragments. Too frequently, if all these exist with no open wound, the term simple fracture is used. I believe it is important that we classify as complex closed fractures those which do