tbuckley/cabot-search huggingface dataset:
Communicating risk: We as doctors are not alone
Authors: T. W V Daniels
Journal: BMJ (2003)

Editor—Risk is a crucial part of current medical practice, as clarified in the editorials by Edwards, Godolphin, and Thornton.1-3 It is a subject that we all have to deal with day to day, and knowing that others are grappling with these difficult ideas is refreshing. The debate, however, needs to be widened further.

As medical practitioners we are not alone in facing uncertainty and risk. Everyone involved in decision making faces the same problem. Whether it is the risk posed by an Iraqi regime headed by Saddam Hussein, the likelihood of a large meteorite striking the earth, or the chances of an Intercity 125 crashing, everyone is confronted with uncertainty and risk.​risk.




Figure 1




The debate on risk needs to be taken beyond the confines of medical journals and into the general media, the House of Commons, and school classrooms. Only when the concepts of risk and uncertainty become familiar to the public at large can we as doctors hope to have an informed discussion with people who come to us asking for advice.
Human B lymphoma cell line producing B cell growth factor.
Authors: J L Ambrus, A S Fauci
Journal: Journal of Clinical Investigation (1985)

Namalva, a human B cell lymphoma line, produced a factor with a molecular weight of approximately 60,000 which enhanced the proliferation of normal activated human B lymphocytes. The factor also enhanced the proliferation of certain B cell lines. It can be distinguished physiologically and biochemically from other lymphokines known to enhance B cell proliferation, namely, interleukin (IL) 1, IL 2, and interferon. The production of B cell growth factor by B cell tumor lines may contribute to their ability to grow autonomously and may reflect an important component of the neoplastic potential of the cell. B cell growth factor produced by tumors may also affect normal cells in vivo.
Relative contributions of large and small airways to flow limitation in normal subjects before and after atropine and isoproterenol.
Authors: R H Ingram, J J Wellman, E R McFadden, J Mead
Journal: Journal of Clinical Investigation (1977)

Bronchodilatation was produced in normal subjects by the inhalation of atropine, a parasympatholytic agent, and isoproterenol, a beta adrenergic stimulator. Density dependence of maximal expiratory flow (Vmax), expressed as a ratio of Vmax with an 80% helium-20% oxygen gas mixture to Vmax with air at isolung volumes, indicated that the predominant flow regimes across upstream airways changed differently after each agent was given separately. After atropine Vmax increased, elastic recoil pressure did not change, and density dependence decreased. Utilizing the equal pressure points analysis which defines upstream and downstream segments of the intrathoracic airways at flow limitation, these results suggest a greater relative dilatation of the larger upstream airways such that more of the driving pressure is dissipated across the smaller airways in which flow is less dependent upon gas density. After isoproterenol Vmax increased, elastic recoil pressure did not change, and density dependence increased. This suggests a preferential dilatation of the smaller and more peripheral airways with less density-dependent flow regimes such that more of the driving pressure would be dissipated in the larger airways in which flow is more dependent upon gas density. Systematic decreases after isoproterenol lead independently to the same conclusion. After both agents together, Vmax increased and density dependence and critical alveolar pressures did not change from control, suggesting a relatively uniform dilatation of all the airways comprising the upstream segment.
Glomerular localization of circulating antiglobulin activity in essential mixed cryoglobulinemia with glomerulonephritis
Authors: Q. Maggiore, F. Bartolomeo, A. L'Abbate, V. Misefari, C. Martorano, A. Caccamo, G. Barbiano di Belgiojoso, A. Tarantino, G. Colasanti
Journal: Kidney International (1982)
A Case of Acute Septicaemia Treated by Antistreptococcus Serum: Recovery
Authors: P. Coleman, T. G. Wakeling
Journal: BMJ (1896)

The processing of interoceptive signals in the insular cortex is thought to underlie self-awareness. However, the influence of interoception on visual awareness and the role of the insular cortex in this process remain unclear. Here, we show in a series of experiments that the relative timing of visual stimuli with respect to the heartbeat modulates visual awareness. We used two masking techniques and show that conscious access for visual stimuli synchronous to participants9 heartbeat is suppressed compared with the same stimuli presented asynchronously to their heartbeat. Two independent brain imaging experiments using high-resolution fMRI revealed that the insular cortex was sensitive to both visible and invisible cardio–visual stimulation, showing reduced activation for visual stimuli presented synchronously to the heartbeat. Our results show that interoceptive insular processing affects visual awareness, demonstrating the role of the insula in integrating interoceptive and exteroceptive signals and in the processing of conscious signals beyond self-awareness. <b>SIGNIFICANCE STATEMENT</b> There is growing evidence that interoceptive signals conveying information regarding the internal state of the body influence perception and self-awareness. The insular cortex, which receives sensory inputs from both interoceptive and exteroceptive sources, is thought to integrate these multimodal signals. This study shows that cardiac interoceptive signals modulate awareness for visual stimuli such that visual stimuli occurring at the cardiac frequency take longer to access visual awareness and are more difficult to discriminate. Two fMRI experiments show that the insular region is sensitive to this cardio–visual synchrony even when the visual stimuli are rendered invisible through interocular masking. The results indicate a perceptual and neural suppression for visual events coinciding with cardiac interoceptive signals.
Teaching Geriatrics-Reply
Authors: Knight Steel
Journal: JAMA (1981)

In Reply.—  Dr Portnoi's letter raises many interesting issues and presents viewpoints on many diverse subjects. We agree with some of the stances offered (the need for an organized system of health care for the elderly) and question others (that the solution to the ills of British geriatrics is to be found in shifting its emphasis to the community). We make this last point despite our interest in out-of-institution care; Boston University has a home medical service that dates to the 19th century and that is an integral part of geriatric medicine. Furthermore, we applaud many of Dr Portnoi's well-known efforts in geriatrics at George Washington University.  Nonetheless, the contents of his letter seem to bear little relevance to our description of a university  consultative service that was designed to provide a comprehensive consultation for the geriatric patient at a short-term care university hospital where 45% of the general
"Helping Your Doctor"
Authors: D. J. Davies
Journal: BMJ (1966)

<h3>Objective</h3> Pregnant women are advised to avoid heat stress (eg, excessive exercise and/or heat exposure) due to the risk of teratogenicity associated with maternal hyperthermia; defined as a core temperature (T<sub>core</sub>) ≥39.0°C. However, guidelines are ambiguous in terms of critical combinations of climate and activity to avoid and may therefore unnecessarily discourage physical activity during pregnancy. Thus, the primary aim was to assess T<sub>core</sub> elevations with different characteristics defining exercise and passive heat stress (intensity, mode, ambient conditions, duration) during pregnancy relative to the critical maternal T<sub>core</sub> of ≥39.0°C. <h3>Design</h3> Systematic review with best evidence synthesis. <h3>Data sources</h3> EMBASE, MEDLINE, SCOPUS, CINAHL and Web of Science were searched from inception to 12 July 2017. <h3>Study eligibility criteria</h3> Studies reporting the T<sub>core</sub> response of pregnant women, at any period of gestation, to exercise or passive heat stress, were included. <h3>Results</h3> 12 studies satisfied our inclusion criteria (n=347). No woman exceeded a T<sub>core</sub> of 39.0°C. The highest T<sub>core</sub> was 38.9°C, reported during land-based exercise. The highest mean end-trial T<sub>core</sub> was 38.3°C (95% CI 37.7°C to 38.9°C) for land-based exercise, 37.5°C (95% CI 37.3°C to 37.7°C) for water immersion exercise, 36.9°C (95% CI 36.8°C to 37.0°C) for hot water bathing and 37.6°C (95% CI 37.5°C to 37.7°C) for sauna exposure. <h3>Conclusion</h3> The highest individual core temperature reported was 38.9°C. Immediately after exercise (either land based or water immersion), the highest mean core temperature was 38.3°C; 0.7°C below the proposed teratogenic threshold. Pregnant women can safely engage in: (1) exercise for up to 35 min at 80%–90% of their maximum heart rate in 25°C and 45% relative humidity (RH); (2) water immersion (≤33.4°C) exercise for up to 45 min; and (3) sitting in hot baths (40°C) or hot/dry saunas (70°C; 15% RH) for up to 20 min, irrespective of pregnancy stage, without reaching a core temperature exceeding the teratogenic threshold.
The Usefulness of Urban Paramedics
Authors: Michael B. Heller
Journal: JAMA (1986)

To the Editor.—  We are quite concerned that the recent article by Smith and Bodai 1 might be ministerpreted by readers who are not familiar with the current status of prehospital care. Specifically, I fear that JAMA readers might erroneously consider this lively and timely article, appearing under the rubric Concepts in Emergency and Critical Care, as a consensus statement or review of what is generally agreed upon within the specialty field of prehospital care. In fact, it is much more like a review of controversies in prehospital care, with the authors offering highly controversial and minority opinions.  We concur with the authors' opinion concerning the importance of minimizing time on the scene in the care of the seriously traumatized patient. Carefully conducted studies must be done to determine the time necessary to begin preprepared intravenous (IV) setups during extrication or shortly after placing the patient in the ambulance.  Smith
Expression of APO2.7, bcl-2 and bax apoptosis-associated proteins in CD34− bone marrow cell compartments from patients with myelodysplastic syndromes
Authors: L Suárez, M B Vidriales, G Sanz, A López, M C López-Berges, M de Santiago, L Palomera, T Bernal, M E Pérez de Equiza, J F San Miguel, A Orfao
Journal: Leukemia (2004)
Leonard Alexander Ogilvie
Authors: A. Ogilvie
Journal: BMJ (2002)

Former consultant obstetrician and gynaecologist St James's Hospital, Tredegar, and Nevill Hall Hospital, Abergavenny, 1965-79 (b Dundee 1914; q Glasgow 1937; FRCP Glas), died from Alzheimer's disease on 21 October 2001.
Quantitative Studies of Febrile Tolerance and Levels of Specific Antibody Evoked by Bacterial Endotoxin*
Authors: John H. Mulholland, Sheldon M. Wolff, Anne L. Jackson, Maurice Landy
Journal: Journal of Clinical Investigation (1965)

A series of endotoxin injections, either in con- stant or progressively increasing increments, will induce a state of refractoriness termed endotoxin tolerance.Resistance to the febrile effect of endo- toxin is believed to be of short duration, disap- pearing within 3 weeks (2).Inasmuch as bac- terial endotoxins are potent 0 antigens and give rise to the production of specific antibody, early workers considered the possibility of a correlation between increased antibody levels and diminished febrile response (3).However, Morgan was un- able to discern a relationship between the mag- nitude of febrile reactivity and the levels of 0 ag- glutinins attained in rabbits given typhoid endo- toxin (4).Subsequently, Beeson sought, without success, to transfer tolerance passively with serum of rab- bits that had been rendered refractory (5).He also reported that the tolerant state was accom- panied by increased activity of the reticuloendothelial system (RES).His finding that febrile tolerance was abolished by "blockade" of the RES with thorium dioxide (Thorotrast) attested to the major role of the RES in this situation (6).These findings constituted the major evidence in support of the concept that humoral mechanisms play no role in tolerance.Nonetheless, compelling data to the contrary had been obtained by Creech,
Abstract 4999: FK506 binding protein 51 (FKBP51) sustains stemness and the metastatic potential of malignant melanoma
Authors: Simona Romano, Antonio Sorrentino, AnnaLaura Di Pace, Stefania Staibano, Massimo Mascolo, Rita Bisogni, Gennaro Ilardi, Maria Fiammetta Romano
Journal: Cancer Research (2011)

Abstract Background. FKBP51 is a cochaperone with peptidyl-prolyl isomerase activity that regulates several biological processes in the cell, through protein-protein interaction. There is increasing evidence that FKBP51 hyperexpression is associated with cancer and this protein has a relevant role in sustaining cell growth, malignancy, and resistance to therapy. Very recently, we have found that FKBP51 is a protein associated with malignant melanoma. Its expression correlates with tumor aggressiveness and is maximal in metastatic lesions. Moreover, we have found that melanoma cancer stem cells express FKBP51 at levels higher than the other tumor cells and observed a 4 to 40 fold increase in the number of cancer stem cells, in cultures of melanoma cells stably transfected with FKBP51. Mitotic index, stemness features and angiogenesis are the main signs of aggressive melanoma. To better understand the role of FKBP51 in the biology and progression of melanoma, we attempted to investigate if this protein regulated the expression of molecules associated with tumor progression, namely the Chromatin Assembly Factor-1 (CAF-1) p60; the ATP-Binding Cassette family members ABCG2 and ABCB5; and the pro-angiogenic factor, endoglin or TβRIII. Methods. The melanoma cell line SAN was used for these experiments. FKBP51 knock down was obtained with siRNA, FKBP51 hyperexpression was obtained by stably transfecting SAN with a vector containing the FKBP51 human gene under a CMV promoter. Protein expression was measured by western blot and flow cytometry; mRNA was quantified by Realtime PCR. Results. We found that ABCG2 and CAF1 p60 mRNA levels were reduced by 5 and 2.5 folds, respectively, in FKBP51-silenced cells, in comparison with non-silenced cells. Reduced ABCB5 and CAF-1 p60 protein levels were detected by Western blot. By contrast, a clear increase of ABCB5 and CAF-1 p60 protein levels was observed in FKBP51 hyperexpressing cells. Flow cytometry showed that 39% of melanoma cells expressed endoglin. Such percentage was decreased to 5% by FKBP51 silencing, whereas it increased up to 78% in FKBP51 hyperexpressing cells. Finally, we found that CAF-1 and endoglin were co-expressed in more than 80% of ABCG2+ cells, whereas their expression was &amp;lt;40% in ABCG2- cells. Conclusions. FKBP51 regulates molecules involved in chromatin rearrangement, stemness and metastatization of malignant melanoma suggesting that this cochaperone may act as a transcriptional coactivator of oncogenes in melanoma. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 4999. doi:10.1158/1538-7445.AM2011-4999
Improved survival with bisoprolol in patients with heart failure and renal impairment: an analysis of the cardiac insufficiency bisoprolol study II (CIBIS‐II) trial
Authors: Davide Castagno, Pardeep S. Jhund, John J.V. McMurray, James D. Lewsey, Erland Erdmann, Faiez Zannad, Willem J. Remme, José L. Lopez‐Sendon, Philippe Lechat, Ferenc Follath, Christer Höglund, Viacheslav Mareev, Zygmunt Sadowski, Ricardo J. Seabra‐Gomes, Henry J. Dargie
Journal: European Journal of Heart Failure (2010)
On Operating for Strangulated Hernia
Authors: G. Oliver
Journal: BMJ (1868)

why that lesion is unikely to happen frequenty.Be it noted, that the dsplacement o wsedw pnry, tag place t once in the original inury and of such a kinas coud Sm ly bprdced after lodgment Of the head of the humerus in the upper part of the axila, without in.jury to the thorcic walls or the shoulder-girdle.While the patient vas walking on cmtches, his right crutch sfIpped; he lost his footing; and, the whole weight of his body being thus thrown on the left crutch the head of that crutch gLided outwards from the axilla, and raised his elbow as he fell to the ground.This is the patient's story.The head of the crutch was the fulcrum on which the dislocation took place;
Prognostic significance of progression of coronary atherosclerosis.
Authors: D Waters, T E Craven, J Lespérance
Journal: Circulation (1993)

Angiographic progression of coronary atherosclerosis is frequently observed in clinical practice and is used as an end point in clinical trials; however, its prognostic significance is unclear.Progression defined as an increase in diameter stenosis by > or = 15% of at least one coronary lesion was seen in 141 (42%) of 335 patients who underwent repeat coronary arteriography after a 2-year interval as part of clinical trial. Coronary lesions were measured quantitatively from comparable end-diastolic frames selected by a radiologist viewing each pair of films together. During a mean follow-up of 44 +/- 10 months after the second arteriogram, cardiac death occurred in 19 patients (5.7%), cardiac death or nonfatal infarction was seen in 40 cases (11.9%), and 90 patients (26.9%) underwent coronary revascularization. At least one end point event occurred in 112 of the 335 patients. Sixteen of the 19 cardiac deaths were in progressors, a relative risk of 7.3 (95% CI, 2.2-24.7; p < 0.001). The relative risk of cardiac death or nonfatal infarction for progressors was 2.3 (1.3-4.2, p = 0.009) and of any cardiac event was 1.7 (1.3-2.3, p < 0.001). A stepwise multivariable Cox regression model of time to event was used to assess the relative contribution of progression as a predictor of coronary events. Low ejection fraction (p = 0.001), progression (p = 0.001), and hypertension (p = 0.011) were retained as predictors of cardiac death. Angina and the number of diseased vessels were the strongest predictors of revascularization.Coronary progression is a strong, independent predictor of future coronary events, particularly cardiac death, and its use as a surrogate end point in clinical trials is justified.
Complex Umbilical-Cord Knot
Authors: Norman A. Spencer
Journal: New England Journal of Medicine (2003)

ing of antiretroviral drugs in addition to low-dose immunosuppressive therapy.Unlike the patient described by Calabrese et al., our patient has not had any clinically significant episodes of rejection.Improvements in the management of HIV infection have resulted in delayed progression and extended survival, with an increasing number of patients presenting with end-organ dysfunction. [2]3][4] We agree with the authors' supposition that it is important to report individual cases of transplantation into HIV-positive recipients, although longer follow-up is needed in a greater number of patients before definitive statements can be made regarding the outcomes and the allocation of scarce resources.
Skin permeability of anthralin
Authors: W. SCHALLA, E. BAUER, H. SCHAEFER
Journal: British Journal of Dermatology (1981)

Journal Article Skin permeability of anthralin Get access W. SCHALLA, W. SCHALLA Centre International de Recherches Dermatologiques Sophia, Antipolis, F‐06565 Valbonne Cédex, France Search for other works by this author on: Oxford Academic Google Scholar E. BAUER, E. BAUER Department of Dermatology, Freie Universitat Berlin Augustenburger Pl. 1, D‐1000 Berlin 65, F.R.G. Search for other works by this author on: Oxford Academic Google Scholar H. SCHAEFER H. SCHAEFER Centre International de Recherches Dermatologiques Sophia, Antipolis, F‐06565 Valbonne Cédex, France Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 105, Issue s20, 1 August 1981, Pages 104–108, https://doi.org/10.1111/j.1365-2133.1981.tb01022.x Published: 01 August 1981
Health checks for adults.
Authors: G Fowler, D Mant
Journal: BMJ (1990)

Smoking habit * Hypertension * Cervical cancer * Breast cancer (mammography) * Alcohol consumption Possible mass screening programmes * Hyperlipidaemia (? adequate resources for management are available) * Obesity (? effective intervention is possible) * Faecal occult blood (if results of randomised trials are favourable) Unnecessary mass screening programmes * Proteinuria * Haematuria 1 (but selective urine analysis in
Needle Aspiration Biopsy of the Breast
Authors: Peter B. Marcus
Journal: JAMA (1987)

To the Editor.—  I am surprised to find myself, in 1987, having to defend fine needle aspiration biopsy  the breast, an established procedure labeled unnecessary by Dr Flamm in his letter to the editor published in your Jan 16,1987, issue. 1   Dr Flamm states that there is considerable debate as to the accuracy  this  Debate among whom? Provided that rigid and tested cyto-pathologic criteria for diagnosing cancer 2 are adhered to, this test is no less reliable than any other cytological sampling procedure. Of course, it goes without saying that a negative or inconclusive aspiration biopsy result in the face  suspicious mammographic findings or a palpable mass should always be followed by further investigation, including open biopsy.  In response to Dr Flamm's question, of what value is this procedure?, I wish to point out the following advantages  a positive diagnosis on fine needle aspiration biopsy:
CD36 deficiency impairs intestinal lipid secretion and clearance of chylomicrons from the blood
Authors: Victor A. Drover, Mohammad Ajmal, Fatiha Nassir, Nicholas O. Davidson, Andromeda M. Nauli, Daisy Sahoo, Patrick Tso, Nada A. Abumrad
Journal: Journal of Clinical Investigation (2005)

CD36 mediates the transfer of fatty acids (FAs) across the plasma membranes of muscle and adipose cells, thus playing an important role in regulating peripheral FA metabolism in vivo. In the proximal intestine, CD36 is localized in abundant quantities on the apical surface of epithelial cells, a pattern similar to that of other proteins implicated in the uptake of dietary FAs. To define the role of CD36 in the intestine, we examined FA utilization and lipoprotein secretion by WT and CD36-null mice in response to acute and chronic fat feeding. CD36-null mice given a fat bolus by gavage or fed a high-fat diet accumulated neutral lipid in the proximal intestine, which indicated abnormal lipid processing. Using a model in which mice were equipped with lymph fistulae, we obtained evidence of defective lipoprotein secretion by directly measuring lipid output. The secretion defect appeared to reflect an impaired ability of CD36-null enterocytes to efficiently synthesize triacylglycerols from dietary FAs in the endoplasmic reticulum. In the plasma of intact mice, the reduced intestinal lipid secretion was masked by slow clearance of intestine-derived lipoproteins. The impaired clearance occurred despite normal lipoprotein lipase activity and likely reflected feedback inhibition of the lipase by FAs due to their defective removal from the plasma. We conclude that CD36 is important for both secretion and clearance of intestinal lipoproteins. CD36 deficiency results in hypertriglyceridemia both in the postprandial and fasting states and in humans may constitute a risk factor for diet-induced type 2 diabetes and cardiovascular disease.