tbuckley/cabot-search huggingface dataset:
Clinical Application of Blood Gases.
Authors: Barry A. Shapiro
Journal: Annals of Internal Medicine (1983)

This text/reference provides a comprehensive treatment of the interpretation of blood gas values in the acute clinical setting. Its coverage proceeds from basic material through to the most advanced levels of blood gas analysis. It also provides a review of the basic respiratory physiology, physics, and chemistry necessary to understand blood gas data. This fifth edition brings the reader up to date with the latest coverage and advances surrounding blood gas analysis, evaluation methods, and equipment. The book also includes a workbook filled with learning aids, including multiple choice questions, true/false questions, learning objectives, and tables summarizing key points. Exercises stressing clinical applications of the material are the highlight of the workbook.
The American crisis
Authors: D. Spence
Journal: BMJ (2009)

I wandered through the museum at Scapa Flow in Orkney, meeting the gaze of servicemen and women in fading black and white photos, a generation who gave their lives defending the values of democracy and fighting totalitarianism. We have never forgotten the generosity of the United States, which helped our nation in its darkest hours. Since then, we two nations have become married together—through sickness and health. Through right and wrong, we continue to battle together to defend commonly held values of democracy and freedom. …
THE TREATMENT OF TRAUMATIC GANGRENE OF THE EXTREMITIES.
Authors: VAN BUREN KNOTT
Journal: JAMA (1903)

In this brief paper it is my aim simply to call attention to a procedure which, in my experience, has proven of great utility in the management of these very trouble-some and too often fatal cases. I shall not take up the pathology of traumatic gangrene, for with that you are all familiar, but shall confine myself to its treatment. On referring to the literature we find all authorities agree that the only treatment of this class of cases consists in early amputation above the gangrenous area. How often are we able to determine accurately the limits of the disease, particularly in those cases of rapidly spreading moist gangrene? Too often we are disappointed by the continuation of the process after amputation, and are compelled to reamputate much higher, in spite of which the patient often dies. Again, if the gangrenous process does not involve the entire limb the flaps
A commission of lunacy, mad doctors, and happy hunting.
Authors: D B Gill
Journal: BMJ (1993)

Makeshift sledges after social occasion can lead to an unhappy end to a holiday Sledging can be compared with another high risk activity, motorcycle riding.The 1268 inpatients admitted over one year included 280 motorcycle drivers, among whom there were seven spinal injuries but no cases ofparaplegia.'When high speeds are achieved sledging is intrinsic- ally dangerous.Even when compared with motor cycling it produces a disproportionately high number of cases of spinal injuries.Holidaymakers should be wary of participating in a social evening of sledging while on holiday.I thank Dr H L Frankel, Mr I Nuseibeh, and Mr B P Gardner for allowing me to quote from their cases,
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
Authors: Emilie Bequignon, Tu Anh Duong, Emilie Sbidian, Laurence Valeyrie-Allanore, Saskia Ingen-Housz-Oro, Veronique Chatelin, André Coste, Pierre Wolkenstein, Olivier Chosidow, Jean François Papon
Journal: JAMA Dermatology (2015)

Ear, nose, and throat (ENT) lesions are frequently involved in Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN), although a detailed description is lacking in the literature.To describe ENT lesions at the acute stage and follow-up in a large series of patients with SJS/TEN and identify factors associated with the severe ENT form.Retrospective study of 49 patients with SJS/TEN hospitalized in a referral care center from 2005 to 2010. Patients who underwent a full ENT workup including examination and a nasal fiberoptic endoscopy by an otorhinolaryngologist in the acute phase and during follow-up at 2 and 12 months were included in the study.Recorded variables included maximal body surface area (BSA) detachment, SCORTEN (Score of Toxic Epidermal Necrosis [a severity of illness score]), sites and type of ENT mucosal lesions, intensive care unit transfer, pulmonary infection, and mortality. "Severe ENT form" was defined by the occurrence of laryngeal lesions with the risk of airways obstruction. Clinical characteristics associated with severe ENT form were analyzed in univariate and multivariable analysis.Of the 49 patients who underwent a full ENT workup (female to male ratio, 1.1:1), ENT symptoms (eg, odynophagia, dysphagia, dysphonia, dyspnea, earache, nasal obstruction) occurred in 48 (98%). Dyspnea or dysphonia were significantly associated with severe ENT form (21% [P = .03] and 50% [P < .001], respectively). Topographic frequencies of lesions were as followed: lips and oral cavity (n = 46 [93%]) and pharynx and vestibule of the nose (n = 26 [53%]). Fourteen patients (29%) had severe ENT form. Findings for other recorded variables for those with vs without ENT examination are as follows: maximal BSA detachment (20% [0%-95%] vs 5.5% [0%-95%]; P = .004), SCORTEN (1 [0-5] vs 1 [0-5]; P = .54), intensive care unit transfer (10 [20%] vs 9 [19%]; P = .80), pulmonary infection (9 [18%] vs 6 [13%]; P = .10), and mortality (3 [6%] vs 5 [10%]; P = .70). In multivariable analysis, pulmonary infection was significantly associated with severe ENT form (odds ratio, 5.9 [95% CI, 1.1-32.8] [P = .04]). After remission of SJS/TEN, a complete ENT mucosal healing occurred in 36 patients (74%) at 2 months and in nearly all patients (n = 48 [98%]) at 1 year of follow-up.Severe ENT form is associated with pulmonary infection and is easily detected by nasal fiberoptic endoscopy. ENT evaluation should be suggested when dysphonia or dyspnea is observed at the acute stage of SJS/TEN.
Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss
Authors: Nathan A. Johnson, Toos Sachinwalla, David W. Walton, Kate Smith, Ashley Armstrong, Martin W. Thompson, Jacob George
Journal: Hepatology (2009)

Weight loss remains the most common therapy advocated for reducing hepatic lipid in obesity and nonalcoholic fatty liver disease. Yet, reduction of body weight by lifestyle intervention is often modest, and thus, therapies which effectively modulate the burden of fatty liver but are not contingent upon weight loss are of the highest practical significance. However, the effect of aerobic exercise on liver fat independent of weight loss has not been clarified. We assessed the effect of aerobic exercise training on hepatic, blood, abdominal and muscle lipids in 19 sedentary obese men and women using magnetic resonance imaging and proton magnetic resonance spectroscopy (1H-MRS). Four weeks of aerobic cycling exercise, in accordance with current physical activity guidelines, significantly reduced visceral adipose tissue volume by 12% ( P &lt; 0.01) and hepatic triglyceride concentration by 21% ( P &lt; 0.05). This was associated with a significant (14%) reduction in plasma free fatty acids ( P &lt; 0.05). Exercise training did not alter body weight, vastus lateralis intramyocellular triglyceride concentration, abdominal subcutaneous adipose tissue volume, 1H-MRS–measured hepatic lipid saturation, or HOMA-IR (homeostasis model assessment of insulin resistance; P &gt; 0.05). Conclusion: These data provide the first direct experimental evidence demonstrating that regular aerobic exercise reduces hepatic lipids in obesity even in the absence of body weight reduction. Physical activity should be strongly promoted for the management of fatty liver, the benefits of which are not exclusively contingent upon weight loss. (Hepatology 2009.)
PWE-188 Patient Selection for Peg Insertion: Are we Making the right Decisions?
Authors: R Hammond, J Cotton, J Fyall, K Turnbull, J Tait
Journal: Gut (2013)

Introduction Careful patient selection is key in the success of percutaneous endoscopic gastrostomy (PEG) procedures1. The 30 day mortality rate post insertion is an indicator of appropriate selection in those who are chosen for PEG, but reveals nothing about the patients judged unsuitable for PEG. We evaluated our decision making behind patient selection based on outcomes in those with a PEG inserted and those without. Methods The study identified all patients referred for specialist nurse-led PEG assessment between Jan 2007 – Dec 2011 within our centre. Data regarding age, sex, diagnosis, indication for PEG, date of referral, reason for non-insertion and RIG referrals were stored prospectively on a clinical database and analysed retrospectively. Patients were stratified into groups and mortality in each examined. Further information regarding cause of death and alternative feeding methods were obtained for selected patients from paper and electronic patient notes. Results A total of 555 PEG referrals were received with 38% of all referrals to the PEG team resulting in PEG non-insertion. The 30 day mortality rate following PEG insertion was on average 6.1%; this reduced from 8.6% in 2007 to 2.2% in 2011. 50% of all patients in the non-insertion group had a CVA as their diagnosis. 47% of all non-insertion patients and 83% of insertion patients were alive 120 days after referral. Reasons for non-insertion were grouped into unfit (n = 98, 46% of total), improved (n = 44, 21%), contraindicated (n = 34, 16%) and refused (n = 26, 12%). 74% of those deemed unfit died within 30 days of referral, and 93% of those judged to be improving were alive at 4 months post-referral. RIG referrals were arranged in 19 of 34 patients contraindicated against a PEG procedure. Patient or family refusal was the main reason for non-insertion in 12% of the non-insertion group. 12 notes were examined in patients who died in 60–180 days following PEG referral: 9 had evidence of NG feeding and 3 received RIGs. Extensive MDT input was evident. 4 patients were re-referred to the service for a second assessment if the best option was unclear. Conclusion Patient selection for PEG will continue to be complex. The nurse-led PEG assessment team, in conjunction with other MDT members, make well-informed and justifiable decisions, based on the low 30 day mortality rate post insertion, and that reasons against insertion correlate with how patient condition progresses. Alternative feeding methods are employed in the non-insertion group to combat ongoing nutritional needs. Lack of information on quality of life is the main limitation to the conclusion. Disclosure of Interest None Declared. Reference 1. Kurien M, McAlindon ME, Westaby D, Sanders DS. Percutaneous endoscopic gastrostomy (PEG) feeding. Bmj. 2010 May 7; 340(may07 2):c2414–c2414.
Long-term inhibition of Rho-kinase induces a regression of arteriosclerotic coronary lesions in a porcine model in vivo
Authors: H Shimokawa
Journal: Cardiovascular Research (2001)

Objective: We recently demonstrated that Rho-kinase/ROK/ROCK is functionally upregulated at the arteriosclerotic coronary lesions and plays a key role for coronary vasospastic responses in our porcine model with interleukin (IL)-1β. In the present study, we tested our hypothesis that Rho-kinase is involved in the pathogenesis of coronary arteriosclerosis per se in our porcine model. Methods: Segments of the left porcine coronary artery were chronically treated from the adventitia with IL-1β. Two weeks after the procedure, coronary stenotic lesions with constrictive remodeling and vasospastic response to serotonin were noted at the IL-1β-treated site, as previously reported. Then, animals were randomly divided into two groups; one group was treated with fasudil for 8 weeks followed by 1 or 4 weeks of washout period and another group served as a control. After oral absorption, fasudil is metabolized to hydroxyfasudil that is a specific inhibitor of Rho-kinase. Results: In the fasudil group, coronary stenosis and vasospastic response were progressively reduced in vivo, while the coronary hyperreactivity was abolished both in vivo and in vitro. Furthermore, Western blot analysis showed that in the fasudil group, the Rho-kinase activity (as evaluated by the extent of phosphorylation of myosin binding subunit of myosin phosphatase, one of the major substrates of Rho-kinase) was significantly reduced, while histological examination demonstrated a marked regression of the coronary constrictive remodeling. Conclusions: These results indicate that Rho-kinase is substantially involved in constrictive remodeling and vasospastic activity of the arteriosclerotic coronary artery, both of which could be reversed by long-term inhibition of the molecule in vivo. Thus, Rho-kinase may be regarded as a novel therapeutic target for arteriosclerotic vascular disease.
REX v. HAMILTON
Authors: F. M. Gallaher
Journal: BMJ (1913)

92CAL LouRxL 1'UB3IC HEALTTh.E. 4, Tt 3Tconditions.It must be remembered that the main inspira- tory tract is upwards into the middle and superior meatal regions, and tllat the passage of air through the inferior meatus is secondary to this upward flow.
Myocardial Scar Visualized by Cardiovascular Magnetic Resonance Imaging Predicts Major Adverse Events in Patients With Hypertrophic Cardiomyopathy
Authors: Oliver Bruder, Anja Wagner, Christoph J. Jensen, Steffen Schneider, Peter Ong, Eva-Maria Kispert, Kai Nassenstein, Thomas Schlosser, Georg V. Sabin, Udo Sechtem, Heiko Mahrholdt
Journal: Journal of the American College of Cardiology (2010)
In vivo expression of an aberrant MYB-GATA1 fusion induces leukemia in the presence of GATA1 reduced levels
Authors: E. Belloni, D. Shing, C. Tapinassi, Andrea Viale, P. Mancuso, O. Malazzi, E. Gerbino, V. Dall'Olio, I. Egurbide, M. D. Odero, F. Bertolini, P. Giuseppe Pelicci
Journal: Leukemia (2011)
THU0499 Hm71224, A Novel Oral BTK Inhibitor, Inhibits Human Immune Cell Activation: New Drug Candidate to Treat B-Cell Associated Autoimmune Diseases
Authors: J.K. Park, J.A. Park, Y.J. Lee, J. Song, J.I. Oh, Y.-M. Lee, K.H. Suh, J. Son, E.B. Lee
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Bruton tyrosine kinase (BTK), a Tec family kinase, is involved in B cell activation and osteoclast formation. As BTK plays a central role in B cell receptor (BCR) signaling and B cell development, BTK might be an attractive therapeutic target for autoimmune diseases including rheumatoid arthritis (RA) [1–3]. <h3>Objectives</h3> To investigate the effects of HM7122, a novel BTK inhibitor, on human B cell activation and osteoclast formation. <h3>Methods</h3> In vitro biochemical inhibition assay was performed using Invitrogen kinase assay. Peripheral blood mononuclear cells (PBMCs) from healthy controls were activated with anti-human IgM in increasing concentrations of HM71224. Phosphorylationof BTK and its down-stream signaling molecules PLCγ2 and ERK were examined using phospho-flow and phospho-blots. The BTK occupancy was measured in PBMCs using ELISA. The expression of B cell activation marker CD40, CD69 and CD86 were examined by flow cytometry. Osteoclasts were generated from isolated monocytes in the presence of M-CSF and RANKL and the inhibition of osteoclast generation by HM71224 was examined. <h3>Results</h3> In vitro, HM71224 effectively bound to BTK (IC<sub>50</sub> =2nM) but not to STAT5 (IC<sub>50</sub> &gt;1000 nM), STAT6 (IC<sub>50</sub> =445 nM) and EGFR (IC<sub>50</sub> =800 nM). HM71224 blocked phosphorylation of BTK, PLCγ2 and ERK (IC50 =1nM, 1nM, and 100 nM, respectively). The BTK occupancy in human PBMCs showed an effective binding of HM71224 to BTK protein (IC<sub>50</sub> =69.9±14 nM). Upregulation of the activation marker CD40, CD69 and CD86 on stimulated human B cells were inhibited by HM71224 in a dose-dependent manner (Figure A). Furthermore, osteoclast formation was suppressed in the presence of HM71224 as well (Figure B). <h3>Conclusions</h3> HM71224 is a novel BTK inhibitor that effectively inhibits B cell activation and osteoclastogenesis. HM71224 might offer a new therapeutic option to treat autoimmune diseases associated with B cell activation. <h3>References</h3> Edwards J.C.W. et al, B-cell targeting in rheumatoid arthritis and other autoimmune diseases. Nature Reviews Immunology, 2006, 6: 394-403. Rickert R.C. New insights into pre-BCR and BCR signaling with relevance to B cell malignancies. Nature Reviews Immunology, 2013, 13:578-591. Swanson D.C. et al, Tyrosine kinases as targets for the treatment of rheumatoid arthritis. Nature Reviews Rheumatology, 2009, 5: 317-324. <h3>Disclosure of Interest</h3> : J. K. Park: None declared, J. A. Park: None declared, Y. J. Lee: None declared, J. Song: None declared, J. I. Oh: None declared, Y.-M. Lee: None declared, K. H. Suh: None declared, J. Son: None declared, E. B. Lee Grant/research support: Hanmi Pharm Co Ltd <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.2783
The Value of Complete Knowledge of Acid-Base Derangement in Pulmonary Insufficiency
Authors: David E. Dines
Journal: JAMA (1965)

The Astrup technique was used in the management of the acid-base abnormalities in four cases of pulmonary disease and in 20 cases of cor pulmonale in which arterial carbon dioxide pressure was increased, indicating severe respiratory acidosis. A complete knowledge of the acid-base alterations in pulmonary insufficiency is mandatory for the overall management of patients with pulmonary disease. The Astrup technique of determining acid-base alterations is dependable, rapid, and accurate.
Russian report: priorities for the new health minister.
Authors: M. Ryan
Journal: BMJ (1992)

BMJ 1992;304:563-5 The hour brings forth  man. In mid-November 1991, at a time when acute shortages of medicines and basic medical supplies confronted an already dis? integrating health service, a doctor of high distinction accepted nomination for  now unenviable post of minister of health for Russia. The exceptionally demanding burdens of that office have been assumed by Andrei Ivanovich Vorobyov, member of  Academy of Medical Sciences. Here a brief biographical sketch is appropriate. Born in 1928, Vorobyov graduated in 1953 from  prestigious 1st Moscow Medical Institute named after IM Sechenov. Beginning his professional career on  bottom rung of  ladder, as a sector (uchastok) doctor, he had an early introduction to administrative responsibilities since his job description soon included  management of his rural district polyclinic. Subse? quently he advanced to head  clinical department of  Institute of Biophysics?a major research unit? and  Centre for Assistance in Radiation Accidents. After  nuclear disaster at Chernobyl (26 March 1986) he was in charge of diagnosis and treatment of patients suffering from radiation sickness. From 1987 he held  post of director of  All-Union Haema tological Research Centre. The details given above are taken from  first feature article about Academician Vorobyov to be published in Meditsinskay a gazela? It makes no mention of him having been a member of  Communist party and thus eligible to have his career furthered by means of  party's influence over appointments to senior posts throughout  economy. But silence on that point is unsurprising since by then, the leading and guiding force of Soviet society had been suspended in  aftermath of  August coup attempt, later to be legally banned. What  newspaper does imply is that  minister has unimpeachable political credentials for a place in a post-Communist government: speaking on Radio Russia during  coup attempt, he had courageously denounced its instigators and called for  consolidation of democratic forces.
The role of fibronectin binding in the rat model of experimental endocarditis caused by Streptococcus sanguis.
Authors: J H Lowrance, L M Baddour, W A Simpson
Journal: Journal of Clinical Investigation (1990)

Inactivation of fibronectin (Fn) binding by insertional mutagenesis of Streptococcus sanguis with Tn916 reduces virulence of this bacterium in the rat model of infective endocarditis (IE). Transconjugants were screened for Fn adherence using an ELISA adherence test. One transconjugant had a decreased adherence to immobilized Fn. Southern hybridization demonstrated that the insertion occurred only once in this mutant. The parent strain and mutant strain JL113 were used as challenge strains in a rat endocarditis model. These experiments demonstrated that the mutant had a reduced ability (P less than 0.05) to produce IE. Spontaneous excision of Tn916 from JL113 produced strains identical to both the parental and mutant phenotypes. One strain (JLR-19) that retained the mutant phenotype and one (JLR-15) that regained the parental phenotype for Fn binding were tested for their ability to produce IE. These strains demonstrated that the ability to bind Fn and to produce IE were correlated after Tn916 excision. The reduced virulence of the mutant suggested that adherence of S. sanguis to immobilized Fn plays an important role in the production of IE.
Managing osteoarthritis of the knee
Authors: Caroline A Mitchell, Ade Adebajo
Journal: BMJ (2005)

Developing primary palliative care Continuity of care is paramount but needs to be tailored individuallyEditor-Riley suggests that completion of a form detailing palliative care management should be mandatory for general practitioners. 1 I have spent a great deal of time promoting palliative medicine in primary care, with variable success.Much depends on the individual practitioner's experience and interest, which probably accounts for the variable success of handover forms to communicate with out of hours services.Making this a compulsory part of general practice might bring all practice to the same level.But the initial answer to the question, "Would I be surprised if my patient died in the next 12 months?"would then make the difference.Cynical practitioners would probably answer no for nearly all of their patients, for the longer you practise the less often you are surprised.But, in truth, for many patients in general practice the answer to this question would be no: many elderly patients who live in nursing or residential homes, nearly all patients with chronic disease, including heart disease, chronic obstructive pulmonary disease, neurological disease, and so on.The workload in handing these patients over to the out of hours service would be huge, more so for the out of hours service than the individual practice.Continuity of care for patients who most need it is paramount, including all those with chronic disease.However, more sophisticated systems are needed to meet patient needs: perhaps different systems for different diseases, possibly different systems for each stage of a disease.Whatever the system, it must meet the needs of the individual patient.This entails dialogue between primary care (including out of hours), secondary care, and tertiary care to thrash out the detail.
House Officer Responses to Impaired Physicians
Authors: David B. Reuben
Journal: JAMA (1990)

Although physician impairment may have substantial personal and clinical consequences, it is commonly held that physicians fail to act in the case of impaired colleagues. To learn about initial responses when confronted with impaired house officers and attending physicians, we administered five case scenarios to all 76 internal medicine house officers at a large, urban, teaching hospital. House officer responses to an alcohol-impaired physician differed depending on whether that physician was an attending physician or a house officer. Seventy-two percent of house officers would tell the chief resident about the alcohol-impaired attending physician, whereas 96% would confront the alcohol-impaired house officer personally. The most common response to the incompetent attending physician (67%) and the incompetent house officer (49%) was to tell the chief resident; only 25% would confront an incompetent house officer. In contrast, 71% would confront a depressed house officer.