tbuckley/cabot-search huggingface dataset:
Calibrating the Physician
Authors: Dennis H. Novack
Journal: JAMA (1997)

Physicians' personal characteristics, their past experiences, values, attitudes, and biases can have important effects on communication with patients; being aware of these characteristics can enhance communication. Because medical training and continuing education programs rarely undertake an organized approach to promoting personal awareness, we propose a "curriculum" of 4 core topics for reflection and discussion. The topics are physicians' beliefs and attitudes, physicians' feelings and emotional responses in patient care, challenging clinical situations, and physician self-care. We present examples of organized activities that can promote physician personal awareness such as support groups, Balint groups, and discussions of meaningful experiences in medicine. Experience with these activities suggests that through enhancing personal awareness physicians can improve their clinical care and increase satisfaction with work, relationships, and themselves.
Reimbursement of Physicians
Authors: Robert D. Gillette
Journal: JAMA (1982)

<h3>To the Editor.—</h3> Jeffrey E. Hoffman, MD, misses the point when he says that family physicians should be paid less than internists and pediatricians because they do not provide the "same services" (1982;247:462). The family physician's orientation is somewhat different from that of the internist or pediatrician, but his services are no less valuable to the patient. What he lacks in knowledge of unusual diseases is more than made up by specific education in behavioral medicine and family dynamics relevant to health care. For every "horror story" that one can tell about a family physician whose training was "too superficial," I can reply with a case where a physician in another specialty overlooked a serious patient problem because his focus was too narrow.
Abstract 2332: Oncogenic <i>MYD88</i> mutants require Toll-like receptors.
Authors: Kian-Huat Lim, Gregory M. Barton, Louis M. Staudt
Journal: Cancer Research (2013)

Abstract Oncogenic mutations affecting the signaling adapter MyD88 are present in 39% of activated B-cell-like (ABC) diffuse large B cell lymphomas (DLBCLs), with the most recurrent MyD88 mutant, L265P, present in 29% of cases. MYD88 mutations constitutively activate multiple signaling cascades that promote the survival and proliferation of ABC DLBCLs, including the NF-B, type-1 interferon, p38 and JAK/STAT pathways. It is unknown whether MyD88 mutants act autonomously or require a receptor to engage these downstream pathways. Here we show that the MyD88 L265P oncoprotein binds constitutively to two members of the Toll-like receptor family, TLR7 and TLR9, thereby amplifying signals that emanate from these receptors. Knockdown of TLR7 or TLR9 potently suppressed NF-B activity in ABC DLBCL cell lines and promoted apoptosis. Depletion of known proteins essential for TLR7 and TLR9 trafficking and signaling, including UNC93B1, PRAT4A or CD14, was lethal for ABC DLBCL lines. Similarly, pharmacologic inhibition of TLR7 and TLR9 function in lysosomal compartments using the cathepsin inhibitor zFA-fmk or hydroxychloroquine diminished MyD88 signaling and reduced survival of ABC DLBCL lines. TLR7 or TLR9 mutants that are defective in ligand binding failed to promote the survival of ABC DLBCL lines following knockdown of endogenous TLR7 or TLR9 expression in ABC DLBCL lines. Moreover, an inhibitory oligonucleotide capable of suppressing TLR9 responses in normal B cells blocked NF-B signaling and survival of ABC DLBCL lines. These new insights into the oncogenic mechanisms of MyD88 mutants provide a rationale for targeting of TLR7 and TLR9 signaling for the therapy of ABC DLBCL. Citation Format: Kian-Huat Lim, Gregory M. Barton, Louis M. Staudt. Oncogenic MYD88 mutants require Toll-like receptors. [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 2332. doi:10.1158/1538-7445.AM2013-2332
Hyperbeta-Lipoproteinemia in Acute Intermittent Porphyria
Authors: Robert S. Lees, Chull S. Song, Richard D. Levere, Attallah Kappas
Journal: New England Journal of Medicine (1970)

HYPERCHOLESTEROLEMIA occurs in some patients with inherited hepatic porphyrias1 , 2 and also in laboratory animals with chemically induced hepatic porphyria.2 To define the nature of the disturbance in lipoprotein metabolism implied by this hypercholesterolemia,3 , 4 we have measured the concentrations of the various lipoproteins in the plasma of patients with the well defined hereditary hepatic porphyria, acute intermittent porphyria (AIP). The initial results of this study are reported here.Methods and ResultsEach of the 10 patients studied had AIP well documented by personal and family history and by several chemical criteria (Table 1).5 Blood was drawn, and the lipoproteins quantitated as . . .
THE CHARACTERISTICS OF THORACIC DUCT LYMPH IN MAN
Authors: H. R. Bierman, R. L. Byron, K. H. Kelly, R. S. Gilfillan, L. P. White, N. E. Freeman, N. L. Petrakis, Grace Singer, Fauno Cordes
Journal: Journal of Clinical Investigation (1953)

The thoracic duct is generally accepted as the major pathway of lymphocytes enroute to the cir- culating blood (1, 2, 3), accounting for approxi- mately 70 per cent of all the lymphocytes in the peripheral blood.The remainder of the lympho-
The Syndrome of Minimal Brain Damage in Childhood
Authors: J. H. Pincus, G. H. Glaser
Journal: New England Journal of Medicine (1966)

THE behavioral manifestations of children with brain damage have been recognized and studied with increasing interest in the past decade. Much of the work done in this area has been accomplished in highly specialized centers, though 2 excellent general discussions of the subject are available.1 , 2 The incidence of the syndrome of "minimal brain damage" or "nonmotor brain damage" seems high, however, and affected children form a large portion of the patient population seen by pediatricians, general practitioners, neurologists, child psychiatrists, psychologists and also educators who deal with learning problems in childhood.With their hypothesis of a "continuum of reproductive casualty" . . .
Relative effects of aspirin on platelet aggregation and prostaglandin-mediated coronary vasodilatation in the dog.
Authors: N L Capurro, L C Lipson, R O Bonow, R E Goldstein, N R Shulman, S E Epstein
Journal: Circulation (1980)

Aspirin, as an inhibitor of platelet aggregation, may be of benefit in ischemic heart disease. However, aspirin blocks not only platelet aggregation but also synthesis of prostacyclin, a vasodilator and platelet deaggregator. The relative sensitivity of prostaglandin-mediated coronary vasodilatation and platelet aggregation to inhibition by aspirin remains uncertain. We therefore investigated the relative dose-response relationship of aspirin on arachidonic acid-induced increments in coronary blood flow and on ADP-induced aggregation of platelets. In 11 open-chest dogs, intracoronary arachidonic acid, 0.1-3.0 mg, produced dose-related increases in coronary blood flow that were inhibited progressively by i.v. aspirin over the dose range 0.3-3.0 mg/kg. Aspirin at 3 mg/kg almost completely obliterated the response to 3 mg of arachidonic acid. Similarly, aspirin doses of 0.3-3.0 mg/kg progressively raised the minimal concentration of ADP necessary for platelet aggregation. The threshold concentration of ADP that produced aggregation of platelets from 10 control dogs ranged from 2.3 x 10(-6) M to 1.2 x 10(-5) M. Aspirin at 3 mg/kg completely inhibited aggregation of platelets from 11 of 12 dogs, even with ADP at 2.3 x 10(-4) M concentration, the maximum tested. Aspirin at 0.1 mg/kg failed to inhibit either ADP-induced platelet aggregation or arachidonic acid-induced increments in coronary blood flow. Thus, the two test systems showed similar sensitivity to inhibition by aspirin with respect to threshold dose and maximal effect. These results show that very low doses of aspirin inhibit arachidonic acid-induced coronary vasodilatation and that aspirin at low doses does not appear to selectively inhibit platelet activity relative to coronary vasodilatation.
Cell membrane perturbation of resting T cells and thymocytes causes display of activation antigens.
Authors: R S Mittler, P E Rao, M A Talle, R Look, G Goldstein
Journal: The Journal of Experimental Medicine (1983)

Three human lymphocyte antigens recognized by monoclonal antibodies OKIa1, OKT9, and OKT10 were found to be minimally represented on resting peripheral T cells (all three) and thymocytes (OKIa1 and OKT9). These antigens, which are present on "activated" T cells, were promptly displayed on "resting" T cells or thymocytes following cross-linking of surface-bound monoclonal antibody by horse alpha-mouse IgG. These experiments suggested that membrane perturbations may induce the expression of certain antigens that are normally present in an unexpressed form in resting cells.
Effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study
Authors: Pauline A Waight, Nicholas J Andrews, Shamez N Ladhani, Carmen L Sheppard, Mary P E Slack, Elizabeth Miller
Journal: The Lancet Infectious Diseases (2015)

The 13-valent pneumococcal conjugate vaccine (PCV13) protects against key serotypes that increased after routine immunisation with the seven-valent vaccine (PCV7), but its potential for herd protection and serotype replacement is uncertain. The aim of this study was to analyse the effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction.We used a national dataset of electronically reported and serotyped invasive pneumococcal disease cases in England and Wales to estimate incidence rate ratios (IRRs) for vaccine and non-vaccine type invasive pneumococcal disease between July, 2013, and June, 2014, versus the pre-PCV13 and pre-PCV7 baseline. Incidence rates were corrected for missing serotype data and changes in surveillance sensitivity over time. An over-dispersed Poisson model was used to estimate IRRs and confidence intervals.Incidence of invasive pneumococcal disease in the epidemiological year 2013/14 decreased by 32% compared with the pre-PCV13 baseline (incidence 10·14 per 100,000 in 2008-10 vs 6·85 per 100,000 in 2013/14; IRR 0·68, 95% CI 0·64-0·72). This was due to an 86% reduction of the serotypes covered by PCV7 (1·46 vs 0·20 per 100,000; IRR 0·14, 0·10-0·18) and a 69% reduction of the additional six serotypes covered by PCV13 (4·48 vs 1·40 per 100,000; IRR 0·31, 0·28-0·35). When compared with the pre-PCV7 baseline, there was a 56% overall reduction in invasive pneumococcal disease (15·63 vs 6·85 per 100,000; IRR 0·44, 95% CI 0·43-0·47). Compared with the pre-PCV13 baseline, the incidence of non-PCV13 serotypes increased (incidence all ages 4·19 vs 5·25 per 100,000; IRR 1·25, 95% CI 1·17-1·35) due to increases across a broad range of serotypes in children younger than 5 years and in people aged 45 years or more. In children younger than 5 years, incidence of non-PCV13 serotypes in 2013/14 was higher than in 2012/13 (age <2 years: 12·03 vs 10·83 per 100,000; age 2-4 years: 4·08 vs 3·63 per 100,000).8 years of PCV use in England and Wales has reduced the overall incidence of invasive pneumococcal disease by more than 50%. The herd protection induced by PCV7 is continuing, and similar indirect protection is occurring from the additional serotypes covered by PCV13. There is, however, evidence of increasing invasive pneumococcal disease due to non-PCV13 serotypes, particularly in children younger than 5 years in 2014. If this increase continues, the maximum benefit of the PCV13 programme in children might already have been achieved.Public Health England funds national surveillance of invasive pneumococcal disease.
Use of Fibrin Glue (Beriplast) in the Management of Bleeding Gastric Varices
Authors: D Datta, P Vlavianos, A Alisa, D Westaby
Journal: Endoscopy (2003)

Gastric variceal bleeding is a serious complication of portal hypertension. The optimum endoscopic treatment of bleeding gastric varices is yet to be defined. We evaluated the use of Beriplast, which is a solution of fibrinogen and thrombin, in controlling gastric variceal bleeding.Fifteen patients presenting with gastric variceal bleeding were entered into an open trial of endoscopic gastric intravariceal injection treatment with Beriplast (fibrin sealant) and followed for up to 1 month after endoscopic treatment.There was failure to control bleeding in one patient. Four patients had rebleeding after the index bleed. All four were reinjected with Beriplast, and the bleeding was controlled in three. All patients were followed for 30 days, and the 30-day mortality following injection treatment was one. Fourteen patients were discharged from the hospital after the first episode of gastric variceal bleeding. None of the patients had injection-induced complications.These results show that Beriplast is a safe and simple endoscopic treatment option and is very effective in controlling gastric variceal bleeding.
Targeting AIDS Prevention and Treatment Toward HIV-1—Infected Persons
Authors: Donald P. Francis
Journal: JAMA (1989)

We propose establishing private and public outpatient facilities where persons with human immunodeficiency virus, type 1 (HIV-1), infection can receive state-of-the-art clinical and behavioral follow-up, treatment, and assistance. The possible advantages of enrolling HIV-1—positive persons into long-term follow-up are early treatment of clinical conditions and resulting gains in life quality and life expectancy, decreased transmission of HIV-1 to uninfected persons, more efficient use of scarce patient-care resources, and improved estimates of the total number of HIV-infected persons. The possible disadvantages of such a program are adverse psychological reactions to knowledge of HIV-1 infection, adverse societal actions against infected persons, and, finally, the economic cost of the program. These facilities, with the proper expertise and safeguards of confidentiality and trust, could prolong and improve the lives of infected persons while preventing infection of others. (<i>JAMA</i>. 1989;262:2572-2576)
TGF-β in the pathogenesis and prevention of disease: a matter of aneurysmic proportions
Authors: Harry C. Dietz
Journal: Journal of Clinical Investigation (2010)

TGF-beta regulates many aspects of cellular performance relevant to tissue morphogenesis and homeostasis. Postnatal perturbation of TGF-beta signaling contributes to the pathogenesis of many disease states, as recently exemplified through the study of Marfan syndrome (MFS), including aortic aneurysm and skeletal muscle myopathy. Heterogeneity in the regulation and consequences of TGF-beta signaling, amplified in the context of disease, has engendered confusion and controversy regarding its utility as a therapeutic target. Three studies recently published in the JCI, including one in this issue, underscore the complexity of this subject. Heydemann and colleagues implicate dimorphic variation in latent TGF-beta-binding protein 4 (LTBP4), a regulator of TGF-beta bioavailability and activation, as a modifier of muscular dystrophy in gamma-sarcoglycan-deficient mice. In contrast to experience with ascending aortic aneurysm in MFS, Wang and colleagues show that systemic abrogation of TGF-beta signaling worsens (rather than attenuates) Ang II-induced abdominal aortic aneurysm progression in mice. Tieu and colleagues define alterations in the regulation of vascular inflammation in the pathogenesis of Ang II-induced aneurysm and dissection in mice, which may help shed some light on this apparent paradox.
Detection of a Dissecting Aortic Aneurysm by Renal Transplant Imaging
Authors: JÖRG ANDREAS, DAGMAR EISSNER
Journal: Clinical Nuclear Medicine (1997)

After 2 years with a normal post-transplant course a 45-year-old man showed an elevated creatinine level (4.5 mg/dL). Transplantation had been neccessary because of progressive glomerulonephritis. Renal transplant imaging was obtained with 150 Mbq Tc-99m MAG3. The perfusion images showed radionuclide accumulation in the area of the upper abdominal aorta and delayed perfusion of the right iliac artery. Accumulation of Tc-99m MAG3 in the transplant was slow and no filling of the bladder could be observed. Immediately after imaging, the patient developed acute hemorrhagic shock. At emergency surgery, a long dissecting and ruptured aneurysm of the abdominal aorta was seen causing delayed and reduced blood flow in the right iliac artery and the transplant.
Challenge to research on heart disease patterns in India sparks controversy
Authors: G. Mudur
Journal: BMJ (2013)

A research review has sought a fresh assessment of cardiovascular disease patterns in India, claiming that doctors have argued that coronary heart disease and its risk factors disproportionately affect poor people in India without sufficient evidence.

The review has claimed that many studies looking at the distribution of cardiovascular disease and its risk factors across different socioeconomic sections of the population have drawn inferences that are “often discordant with their own results.”1

The evidence suggests that deaths from coronary heart disease occur disproportionately among economically advantaged groups, according to the review, which examined 53 studies, including 49 conducted since 1989. The review said that except for high rates of smoking and poor intake of fruits, the other risk factors such as obesity, elevated lipids, and hypertension are …
Widespread and selective induction of major histocompatibility complex-determined antigens in vivo by gamma interferon.
Authors: M J Skoskiewicz, R B Colvin, E E Schneeberger, P S Russell
Journal: The Journal of Experimental Medicine (1985)

gamma Interferon (IFN-gamma) caused remarkable increases in class I (H-2Kk) and class II (I-Ak) antigens throughout the body by 6-9 d. Heart, kidney, and adrenals showed increases of 4-8 times their previous levels of class I antigen content, while the pancreas and small intestine increased 13-17-fold. Lesser increases were found in spleen, liver, and lung, which showed higher resting antigenic potency. Increases of class II antigenicity of 6-10-fold were found in heart, kidney, pancreas, lung, liver, adrenal, and small intestine, with lesser increases in thymus and spleen, and none in lymph node. Topographical analysis revealed that IFN-gamma induced class I and II antigens on most tissues in a highly selective fashion. For example, the renal proximal tubules expressed large amounts of both class I and II antigens, whereas the distal tubules and collecting ducts did not. In some epithelial cells class I and II determinants were induced only on the basal aspects of the cell membrane. IFN-gamma caused a remarkable increase in class II-positive dendritic cells in the liver, pancreas, salivary glands, and thyroid. Whether these cells were of local or systemic origin is uncertain, but the finding of a simultaneous depletion of dendritic cells from lymph nodes and spleen raises the possibility that they may have been derived, at least in part, from these sites. The dynamic and selective induction of class I and II antigen expression by IFN-gamma is likely to be important in regulation of the immune response in tissues.
Traumatic Rupture of the Aorta
Authors: G. Forbes
Journal: BMJ (1944)

nervous system may have a bearing on the production of " functional hyperinsulinism."Cori (1931) in an extensive review concluded that vagal impulses play a part in the finer regulation of the insulin production, and Cannon et al. (1924) have shown that nervous control of the adrenal medulla via the splanchnic nerves ensures a rapid adrenaline response.It can well be appreciated how the continuance of abnormal stress in a susceptible individual may give rise to abnormality or instability in the control of these opposing impulses by the hypothalamic region.The terminal stages of the glucose- tolerance test is illustrative of this. SummaryA case of " reactive hyperinsulinism," manifest by an excessive post-prandial fall of the blood-sugar level, is described.Points in the differential diagnosis from hyperinsulinism' due to tumour of the pancreatic islets are discussed.My thanks are due to Dr. H. Gardiner-Hill for his interest and permission to publish this case, and to Dr. C.
THE FUNCTION OF THE "ADMINISTRATIVE GROUP" IN A MENTAL HOSPITAL GROUP THERAPY PROGRAM
Authors: BERNARD A. CRUVANT
Journal: American Journal of Psychiatry (1953)

When a group therapy program is instituted on a psychiatric service with patients who have in the past predominantly translated their emotional conflicts into antisocial behavior, the occasions may become "gripe" meetings rather than "group" meetings. This is particularly true when the administrative physician serves as the group therapist. Institution of administrative group meetings, led by the physician-in-charge, serves several purposes. 1. It exposes as diversionary maneuvers by various group members irrational distortions of the administrative physician as a surrogate authority. 2. The sessions uncover transference and resistance phenomena previously cloaked as reasonable "gripes," thus preventing stasis of therapeutic progress. 3. Jockeying for status with the group leader as an antithetical factor in the therapeutic group sessions is reduced. 4. Reality-determined conscious reluctance about revealing emotion-charged material for fear of provoking a restrictive reaction if the group therapist is also the administrator is attenuated. 5. The meetings furnish the administrator with valid information about what is really wrong with the conditions under which his patients are living and this enables him to correct many untoward environmental influences immediately, to plan for long-term correction of others, and to interpret to the group administrative difficulties and limitations. As often as necessary I take a copy of the hospital budget to the administrative meeting to explain exactly how the annual appropriation is spent in each category. 6. The administrative group experience can promote professional growth (and may also provoke acute anxiety) in the administrative psychiatrist. 7. The administrative group serves a valuable function in therapy by providing a contribution to increasing individual ego strength in the patients participating.