tbuckley/cabot-search huggingface dataset:
Saving lives on the Silk Road
Authors: James Owen Drife
Journal: BMJ (2004)

Long haul flights are exciting but rarely scary nowadays. We British tend to go to countries that were once pink on the map. It is a new experience to fly to someone else's former empire, to places you had not heard of until recently.

Kyrgyzstan lies between Kazakhstan and China. Tajikistan separates it from Afghanistan—only just, but enough to reassure the wimp in me. The Kyrgyz capital, Bishkek, was not in my …
HEARTBURN IN LATE PREGNANCY. MANOMETRIC STUDIES OF ESOPHAGEAL MOTOR FUNCTION*
Authors: Richard Nagler, Howard M. Spiro
Journal: Journal of Clinical Investigation (1961)

Heartburn is a burning, often hot sensation which may localize in the throat or substernal region.It is especially common during pregnancy.Gastroesophageal reflux and neuromuscular dys- function of the esophagus have been suggested as underlying pathophysiological mechanisms, but contradictory evidence has prevented a clear definition of the cause of heartburn.A prospective clinical study of 560 pregnant women disclosed that 50 per cent developed heart- burn which invariably disappeared after delivery (1).The self-limited character of pregnancy makes it an ideal experimental period during which to study heartburn.Transducer pressure recordings of esophageal motility are well adapted to such a study.This paper reports the results of serial esophageal motility studies in pregnant women with and without heartburn and in a group of asymptomatic normal women of similar age. METHODSSubjects.Fifty-seven esophageal motility studies were performed on 20 pregnant women who complained of heartburn during pregnancy.The 8 primiparae and 12 multiparae ranged in age from 16 to 39 years, with an average age of 28.Similarly, 63 recordings were ob- tained from 19 pregnant women who never developed heartburn throughout pregnancy; in this group were 10 primiparae and 9 multiparae, 20 to 35 years old, with an average age of 26.Each women was studied at least once during and after pregnancy, but the total number of studies in each subj ect depended on the month of pregnancy when the patient was first seen.Fourteen asymptomatic normal nonpregnant women, 22 to 44 years old, with an average age of 26, served as controls; each subject was studied 6 times at monthly intervals.Technique.The technique of recording esophageal motility utilizes 3 polyethylene catheters, each with an internal diameter of 1.5 mm, which are fastened together and sealed at the tips.A single lateral opening in each * Supported in part by United States Public Health Service Grants C2578, A1785, and A3473 and the Nor- wich Chapter of the Connecticut Heart Association. 955.2Q, 0.).1.* No diffuse spasm or secondary peristalsis occurred in any of the control subjects.
Evaluation de l'influence de différentes modalités de préparation intestinale sur la visibilité et qualité d'un enregistrement par vidéocapsule Endocapsule™ de l'intestin grêle: résultats d'une étude multicentrique avec double lecture
Authors: P Pequin, PN Dhalluin, M Frederic, T Maniere, J Edery, M Gaudric, M Delvaux, S Chaussade, C Cellier, G Gay, F Riou, D Heresbach
Journal: Endoscopy (2008)

Introduction: La préparation digestive avant examen de l'intestin grêle par vidéocapsule reste discutée en 2007. Il n'existe pas de score reproductible de visibilité ou de qualité de l'enregistrement permettant de mesurer l'efficacité d'une telle préparation. L'objectif de notre étude était donc d'évaluer l'efficacité de différentes modalités de préparation intestinale utilisées habituellement par les centres participant à l'étude, pour améliorer la visibilité et la qualité de l'enregistrement, mesurées par un score et par la capacité des lecteurs à détecter les lésions intestinales.
CLINICAL NOTES ON RHEUMATISM
Authors: J. Bullar
Journal: BMJ (1853)

lan its seral strands entire.That diplomacy which, though perhaps prolonged and fluctuating, yet terminates in peace, is better far, and shows a higher skill, than that which, hot and gusty, at once takes up the sword.Let us remember that there is much truth in the quaint Hindoo apopthegm-"He that knows herbs, is a man; he who knows mercury, is a god; but he who knows the knife alone, is a demon."Let us seek to acquire the utmost dexterity and tact in all operative and other mechanical details of sur- gery; let us be ready at a moment's warning, when stern necessity demands, to undertake the most fearful and for- midable knife-work, in that calmness which sense of duty, mingled with sense of power, can alone bestow.But let there be no ground for any one pointing to surgery as some Shylock, ever whetting her weapon, and demanding " the pound of flesh" which is " written in the bond".Let Ber show rather Portia's spirit, seeking mercy, and, by some easier way, saving the victim from all claims of the stern creditor Disease.Let no one have ground to say that surgery is again to become a thing of mere handicraft in its peculiar and special phase, and that it may once more be annexed to physic as little other than a menial serving- man.Let us draw more close the bonds-not servile, but friendly-which unite the two branches of our common profession, and arm in arm, with kindred spirit and kindred aim, go forth as brethren, and dwell together in unity.
Are nutritional status indicators associated with mortality in the Hemodialysis (HEMO) Study?
Authors: Johanna T. Dwyer, Brett Larive, June Leung, Michael V. Rocco, Tom Greene, Jerrilynn Burrowes, Glenn M. Chertow, David B. Cockram, W. Cameron Chumlea, John Daugirdas, Anne Frydrych, John W. Kusek, None the Hemo Study Group
Journal: Kidney International (2005)
Radionuclide Imaging of Two Patients with Metastasis to a Distal Phalanx of the Hand
Authors: SHIGERU KOSUDA, TAKEHIKO GOKAN, KOHE TAMURA, TAKUSHI DOKIYA, ATSUSHI KUBO, SHOZO HASHIMOTO
Journal: Clinical Nuclear Medicine (1986)

Although skeletal metastases from malignant neoplasms are common, the spread of cancer to the distal phalanx of the hand is quite rare. We have presented two cases with a distal phalangeal metastasis which could be definitely detected by radionuclide imaging.
SERUM IODINE IN HYPOTHYROIDISM BEFORE AND DURING THYROID THERAPY 12
Authors: Alexander W. Winkler, Douglas S. Riggs, Evelyn B. Man
Journal: Journal of Clinical Investigation (1945)

Many investigations have established the value of serum iodine concentration as a quantitative index of thyroid activity (1 to 7).Most previous reports have been concerned primarily with the increase in serum iodine which occurs in hyper- thyroidism.The present study deals with the de- crease in serum iodine characteristic of untreated hypothyroidism, and with the effect of thyroid therapy on the level of serum iodine of hypothyroid patients. MATERIALData are presented on 29 patients with spontaneous hypothyroidism and 1 patient (84883) with hypothyroidism following total thyroidectomy.Most of the patients were ambulatory.The majority have been studied in the Metabolism Clinic of the New Haven Hospital, many of them having been followed there for a period of several years.Two patients (F.S.H. 4774 and F.S.H. 4924) were observed at the Fairfield State Hospital.The re- mainder were private patients.In order to keep the group as homogeneous as possible, no patients have been included in whom the diagnosis of hypothyroidism was questionable or who developed hypothyroidism following subtotal thyroidectomy.In most of the patients included here the diagnosis of hypothyroidism was confirmed by striking improvement in signs and symptoms after a few weeks of thyroid therapy.In the few patients who re- mained untreated, or who were inadequately treated, the diagnosis rested on the presence of the clinical manifesta- tions of hypothyroidism.Most of the patients did not present the extreme clinical picture usually described as typical of full-blown, classical myxedema.For example, generalized non-pitting edema was extremely rare.While most patients at some time during the course of their disease did exhibit some puffiness of the face, in a few even this slight degree of edema was never observed.It is reasonable to suppose, therefore, that many of the patients probably had small remnants of functional thy-
Backwash Ileitis Does Not Affect Pouch Outcome in Patients With Ulcerative Colitis With Restorative Proctocolectomy
Authors: Andrea V. Arrossi, Yehuda Kariv, Mary P. Bronner, Jeffrey Hammel, Feza H. Remzi, Victor W. Fazio, John R. Goldblum
Journal: Clinical Gastroenterology and Hepatology (2011)
Science committee calls for better research into ageing
Authors: Roger Dobson
Journal: BMJ (2005)

<h3>Background and Objectives</h3> Practicing clinical nephrologists are performing fewer diagnostic kidney biopsies. Requiring biopsy procedural competence for graduating nephrology fellows is controversial. <h3>Design, Setting, Participants, &amp; Measurements</h3> An anonymous, on-line survey of all Walter Reed training program graduates (<i>n</i>=82; 1985–2017) and all United States nephrology program directors (<i>n</i>=149; August to October of 2017), regarding kidney biopsy practice and training, was undertaken. <h3>Results</h3> Walter Reed graduates’ response and completion rates were 71% and 98%, respectively. The majority felt adequately trained in native kidney biopsy (83%), transplant biopsy (82%), and tissue interpretation (78%), with no difference for ≤10 versus &gt;10 practice years. Thirty-five percent continued to perform biopsies (13% did ≥10 native biopsies/year); 93% referred at least some biopsies. The most common barriers to performing biopsy were logistics (81%) and time (74%). Program director response and completion rates were 60% and 77%. Seventy-two percent cited ≥1 barrier to fellow competence. The most common barriers were logistics (45%), time (45%), and likelihood that biopsy would not be performed postgraduation (41%). Fifty-one percent indicated that fellows should not be required to demonstrate minimal procedural competence in biopsy, although 97% agreed that fellows should demonstrate competence in knowing/managing indications, contraindications, and complications. Program directors citing ≥1 barrier or whose fellows did &lt;50 native biopsies/year in total were more likely to think that procedural competence should not be required versus those citing no barriers (<i>P</i>=0.02), or whose fellows performed ≥50 biopsies (<i>P</i>&lt;0.01). <h3>Conclusions</h3> Almost two-thirds of graduate respondents from a single military training program no longer perform biopsy, and 51% of responding nephrology program directors indicated that biopsy procedural competence should not be required. These findings should inform discussion of kidney biopsy curriculum requirements.
Payment for first-aid in hospital?
Authors: J. Gregory
Journal: BMJ (1980)

maximum part-time contracts" he states that "'many regions regard travel, administration, and emergency duties as representing two NHDs weekly for the generality of maximum part-time consultants."This seems to indicate that in those many regions maximum part- time consultants will be contracted to work for 28 hours in order to qualify for 10/1 lths of the whole-time salary.It would be helpful if Mr Bolt could com-
Tolerance to egg proteins in egg‐sensitized infants without previous consumption
Authors: M. Álvaro, Mª. B. García‐Paba, Mª. T. Giner, M. Piquer, O. Domínguez, J. Lozano, R. Jiménez, A. Machinena, M. A. Martín‐Mateos, A. Mª. Plaza
Journal: Allergy (2014)

Abstract Background Egg‐sensitized infants who have never eaten egg may react at first ingestion. We sought to determine the association between skin prick test (SPT) and specific IgE ( sIgE ) to egg proteins (EP) and oral food challenge (OFC) outcomes to find cut‐off points which can diagnose egg allergy. Methods One hundred and fifty‐four infants up to 18 months, with cow's milk allergy (CMA) and/or atopic dermatitis (AD) without previous egg consumption, were recruited. SPT to EP were performed. If it was positive, sIgE was performed. If positive SPT and/or sIgE ( n = 94), OFC was performed between 12 and 18 months. Receiver operating characteristic (ROC) curves were plotted, and the outcome of the OFC was related to SPT and sIgE . The cut‐off points with the best diagnostic accuracy were found. Results Ninety‐four patients were sensitized to egg (69%) and 60 nonsensitized (31%). Of the sensitized, 27 tolerated cooked (CE) and raw egg (RE) (28.7%). Sixty‐seven were allergic (71.3%): 29 reacted to CE, seven to egg yolk (EY) and 22 to egg white (EW) and 38 reacted to RE. 69.2% tolerated CE. EW SPT and ovalbumin (OVA) sIgE have the best area under the curve (AUC). The higher positive predictive values (PPV) were obtained for EW SPT and EW sIgE . Conclusions In egg‐sensitized infants with EW SPT ≥8 mm and/or EW sIgE ≥8.36 KU/l, egg diagnostic OFC can be avoided as there is 94% probability of becoming positive. In the other patients, OFC should be performed safely and early to avoid unnecessary diets.
TIMP-1 in asthma: guilty by association
Authors: S R Johnson
Journal: Thorax (2005)

A novel TIMP-1 polymorphism is associated with asthma in women

Over the last few years there has been increasing interest in the matrix metalloproteinases (MMPs) in asthma. The MMPs are a family of over 20 zinc dependent endopeptidases with a range of substrate specificities. Although originally classified into gelatinases, stromolysins, collagenases, and matrilysins by their ability to cleave extracellular matrix components, it is now clear that MMPs have an increasing range of other functions. Of potential relevance to asthma is the release and activation of growth and angiogenic factors including transforming growth factor β (TGFβ)1 and vascular endothelial growth factor (VEGF),2 apoptosis by release of Fas ligand,3 and activation of cell surface receptors—collectively resulting in effects on cell differentiation, survival, proliferation, and migration.4 MMP activity is tightly regulated at several levels. Gene transcription is enhanced by growth factors, cytokines and adhesion molecules and downregulated by TGFβ and corticosteroids.5 MMPs are secreted as zymogens which require activation by proteolytic cleavage either at the cell surface or in solution by other proteases including MMPs.5 Once activated, natural inhibitors including tissue inhibitors of metalloproteinases (TIMPs) bind different MMPs with varying specificities in a 1:1 ratio to inhibit proteolytic activity.6 There are four TIMP proteins which, in …
Laubry-Soulle Syndrome
Authors: Eddy D. Palmer
Journal: JAMA (1974)

THE CLINICIAN is continually being reminded of the interrelationships between heart and gastrointestinal tract, in both their physiologic and pathologic activities. He sees the results of cardiac output changes in the patient who struggles against constipation via prolonged Valsalva effort; he encounters a type of postprandial myocardial infarction seemingly sparked by gluttony; he recognizes cardiac axis shifts during attacks of splenic flexure syndrome. Sometimes he observes dramatic interrelated catastrophes such as perforation of an esophageal or gastric fundal ulcer or cancer into the pericardial sac. Many other examples of the interrelationships can be contemplated. If one adds the problem of simply attempting to distinguish, at the bedside, between certain diseases of the two systems (angina pectoris vs a small direct hiatus hernia), he concludes readily that the relationships are not only complex, but can pose diagnostic dilemmas of a dangerous sort. A surprisingly underpublicized heart-gut association is the Laubry-Soulle syndrome.
5-Methoxypsoralen plus ultraviolet (UV) A is superior to medium-dose UVA1 in the treatment of severe atopic dermatitis: a randomized crossover trial
Authors: S. Tzaneva, H. Kittler, G. Holzer, D. Reljic, M. Weber, H. Hönigsmann, A. Tanew
Journal: British Journal of Dermatology (2009)

Ultraviolet (UV) A1 and psoralen plus UVA (PUVA) are effective treatment options for severe atopic dermatitis (AD); however, their relative efficacy has not yet been determined in a head-to-head study.To compare UVA1 and oral 5-methoxypsoralen (5-MOP) plus UVA with respect to efficacy, tolerability and duration of response in patients with severe generalized AD.Forty patients were included in this randomized observer-blinded crossover trial. The patients received either 15 exposures to medium-dose UVA1 as the first treatment and, in cases of relapse, another 15 exposures to 5-MOP plus UVA as the second treatment, or vice versa. All patients were followed until 12 months after discontinuation of the last treatment. The SCORAD score was determined by a blinded investigator at baseline, after 10 and 15 treatments each and during the follow-up period. In addition, all adverse events were recorded during the whole study period.Twenty-three patients completed the crossover treatment. Both phototherapies resulted in clinical improvement; however, PUVA reduced the baseline SCORAD score to a significantly greater extent than UVA1 (mean +/- SD 54.3 +/- 25.7% vs. 37.7 +/- 22.8%; P = 0.041). The median length of remission was 4 weeks (interquartile range 4-12) after UVA1 and 12 weeks (interquartile range 4-26) after PUVA therapy (P = 0.012).PUVA provides a better short- and long-term response than medium-dose UVA1 in patients with severe AD.
GP leader warns funding shortfalls could result in services closing
Authors: G. Iacobucci
Journal: BMJ (2014)

Embargoed until 00.01, Thursday 22 May

NHS England is failing to fulfil its commitment to support general practices facing huge funding cuts and possible closure under new contractual arrangements, the leader of the BMA’s GP committee has warned.

Chaand Nagpaul called for greater support to practices facing huge funding shortfalls following the abolition of the minimum practice income guarantee (MPIG), which NHS England has admitted will leave some practices at risk of closure.

Ahead of the BMA’s annual conference of local medical committees, which took place on 21-22 May in York, Nagpaul said he had written to the chief executive of NHS England, Simon Stevens, to warn of the “serious threat” to patient care.

The …
Mechanical loading and control of breathing in patients with severe chronic obstructive pulmonary disease.
Authors: R Duranti, G Misuri, M Gorini, P Goti, F Gigliotti, G Scano
Journal: Thorax (1995)

BACKGROUND--High neural drive to the respiratory muscles and rapid and shallow breathing are frequently observed in patients with chronic obstructive pulmonary disease (COPD), and both mechanical and chemical factors are thought to play a part. However, the interrelation between these factors and the modifications in the control of breathing are not clearly defined. The effects of an acute decrease in mechanical load by the administration of a high dose of a beta 2 agonist were studied. METHODS--Nine spontaneously breathing patients with severe COPD took part in the study. Criteria for entry were FEV1 of &lt; 40% of predicted and an improvement in FEV1 of &lt; 200 ml after inhalation of 400 micrograms fenoterol. The following parameters were measured: lung volumes, tidal volume (VT), respiratory frequency (Rf), maximal pleural pressure during a sniff manoeuvre (PPLmax), pleural pressure swings (PPLsw), lung resistance (RL), RL/PPLmax ratio, and surface electromyographic activity (EMG) of diaphragm (EDI) and parasternal (EPS) muscles. Arterial oxygen saturation (SaO2), end tidal carbon dioxide pressure (PETCO2), and the electrocardiogram were also monitored. Each variable was measured under control conditions and 20 and 40 minutes after the inhalation of 800 micrograms fenoterol. In five patients the effects of placebo were also studied. RESULTS--Fenoterol resulted in an increase in FEV1 and decrease in FRC. SaO2 did not change, while PETCO2 fell and heart rate increased. The VT increased, and Rf decreased, PPLsw fell and PPLmax increased, thus the PPLsw/PPLmax ratio fell. Both RL and RL/PPLmax also fell, and a substantial decrease in EDI and EPS was observed. Changes in PPLsw were related to changes in FEV1 and RL. Changes in VT and Rf, and EDI/TI and EPS/TI were also related to changes in PPLsw and RL/PPLmax ratio, but not to changes in FEV1. No variation was observed with placebo. CONCLUSIONS--In patients with severe COPD a decrease in inspiratory muscle loading relative to the maximal available strength, as expressed by the RL/PPLmax and PPLsw/PPLmax ratios, appears to be the major determinant of changes in breathing pattern and inspiratory muscle activity (decrease in EMG).
Soft Tissue Sarcomas
Authors: J. N. Cormier, R. E. Pollock
Journal: CA A Cancer Journal for Clinicians (2004)

Sarcomas are a heterogeneous group of rare tumors that arise predominantly from the embryonic mesoderm. They present most commonly as an asymptomatic mass originating in an extremity but can occur anywhere in the body, particularly the trunk, retroperitoneum, or the head and neck. Pretreatment radiologic imaging is critical for defining the local extent of a tumor, staging the disease, guiding biopsies, and aiding in diagnosis. Core-needle biopsy is the preferred biopsy technique for diagnosing soft tissue sarcomas. The American Joint Committee on Cancer (AJCC) staging system for soft tissue sarcomas is based on histologic grade, the tumor size and depth, and the presence of distant or nodal metastases. Despite improvements in local control rates with wide local resections and radiation therapy, metastasis and death remain a significant problem in 50% of patients who present with high-risk soft tissue sarcomas. The most common site of metastasis is the lungs, and metastasis generally occurs within two to three years after the completion of therapy. Progress in the molecular characteristics of these tumors should in the near future translate into molecularly based therapies that can be incorporated into standard treatment strategies.
TCTAP A-047 Rare Complication of Coronary Guidewire Transection During Rotational Atherectomy via Transradial Access in the Percutaneous Treatment of Chronic Coronary Total Occlusion
Authors: Zhen-Yu Liao, Shih-Chi Liu, Kou-Gi Shyu
Journal: Journal of the American College of Cardiology (2015)