tbuckley/cabot-search huggingface dataset:
Localized cutaneous mucinosis as a presentation of secondary extramedullary cutaneous plasmacytoma
Authors: J. Rodriguez-Lozano, J. Del Pozo, M. Almagro, J. Garcia Silva, M.T. Yebra-Pimentel, E. Fonseca
Journal: British Journal of Dermatology (2004)

Sir, Extramedullary cutaneous plasmacytoma is an uncommon disease. Primary cutaneous plasmacytoma is extremely rare, with only about 30 cases documented in the literature.1 Secondary cutaneous plasmacytoma accounts for only 5–10% of secondary plasmacytomas.2 It usually appears at an advanced stage of myeloma, accompanying the infiltration of other organs by plasma cells.3 Rongioletti and Rebora,4 in an update of their classification of cutaneous mucinoses, described, within distinctive (primary) mucinoses, a group of mucinoses associated with plasma cell dyscrasia, including lichen myxoedematosus (papular mucinosis, scleromyxoedema), scleroedema, diffuse myxoedema, follicular mucinosis and reticular erythematous mucinosis. We report a case of simultaneous presentation of cutaneous mucinosis and plasma cell dyscrasia where a single infiltrated oedematous facial lesion with histopathological features of cutaneous mucinosis led to the diagnosis of secondary extramedullary plasmacytoma. A 74‐year‐old man, with a history of penicillin allergy, ischaemic cardiopathy, arterial hypertension, prostatism and chronic obstructive pulmonary disease, presented with a nonpainful, erythematous cutaneous lesion on the left zygomatic area. Examination revealed a 7‐cm nodular infiltrated lesion, with an erythematous surface and an oedematous appearance (Fig. 1A). Skin biopsy showed, subjacent to a normal epidermis, an expanded papillary dermis with sparing of collagen bundles, accompanied by a perivascular lymphocytic infiltrate. An Alcian blue stain revealed the presence of abundant mucin in the papillary and reticular dermis, mainly around follicular units (Fig. 1B). Direct immunofluorescence was negative. Routine laboratory studies showed haemoglobin 12 g dL−1, haematocrit 36, white cell count 7·78 × 109 L−1 with normal differential, and platelets 330 × 109 L−1. Blood biochemistry and coagulation were normal. Chest X‐ray, radiology of the paranasal sinus and orthopanthomography were normal.
Prevention of Schistosomiasis
Authors: Anita Karstorp
Journal: JAMA (1984)

<h3>To the Editor.—</h3> Istre et al<sup>1</sup>describe in<i>JAMA</i>a small outbreak of acute schistosomiasis among a group of adventurers rafting in Ethiopia. Being one of the "adventurers" (I like that expression!) and experienced in tropical medicine, I have a few comments. As the authors say, we were aware that the Omo and Mui rivers were infected with schistosomiasis. We therefore planned a "schistosoma checkup" three months after returning from the trip to reveal even very light infections. This time the symptoms appeared very quickly, however. The problem with white water rafting is that you get all wet every time you pass a rapid (which we did every 15 to 20 minutes) and partially wet every time you land the raft and carry it ashore. Under these conditions, normal precautions such as brisk towel drying are not realistic. It might be better to use an oily body lotion frequently
Low prevalence of hepatitis C virus (HCV) viraemia in patients with post-transfusional NANG hepatitis in France
Authors: V. Thiers, F. Lunel, L. Frangeuil, C. Fretz, J.J. Fournel, P. Opolon, J.M. Hureau, D. Valla, C. Bréchot
Journal: Journal of Hepatology (1991)
Editorial independence at the <i>BMJ</i> : … <i>JAMA</i> editor expresses disappointment at letter's smear…
Authors: Catherine DeAngelis
Journal: BMJ (2004)

EDITOR—I am deeply disappointed to read Sackett's smear of JAMA ,1 especially in contrast with his invaluable support during and after a difficult, but ultimately invigorating, episode of JAMA 's long and proud …
PREVALENCE, CORRELATES AND INTER-HOSPITAL VARIATION OF EARLY OUTPATIENT FOLLOW-UP AFTER ACUTE MYOCARDIAL INFARCTION
Authors: Adam C. Salisbury, Kevin F. Kennedy, John A. Spertus, Stacie L. Daugherty, Frederick A. Masoudi, Joseph S. Ross, Karen P. Alexander, Harlan M. Krumholz
Journal: Journal of the American College of Cardiology (2010)
Deep Inspiration-induced Bronchoprotection Is Stronger than Bronchodilation
Authors: NICOLA SCICHILONE, TRISEVGENI KAPSALI, SOLBERT PERMUTT, ALKIS TOGIAS
Journal: American Journal of Respiratory and Critical Care Medicine (2000)

We have previously shown that in healthy subjects, deep inspiration (DI) has not only a bronchodilatory but also a bronchoprotective effect that is absent in asthmatic subjects. We conducted the study reported here to test the hypothesis that the bronchoprotective effect is stronger than the bronchodilatory effect, and to determine the extent to which these two effects are related. Ten healthy subjects underwent provocations in which single doses of methacholine, previously shown to reduce FEV1 by 10% to 20% (Dose 1) and by 20% to 40% (Dose 2) were administered after a 20-min period devoid of DI. To measure the bronchodilator effect, DIs were performed immediately after the first spirometry after methacholine, and were followed by another lung function test. To measure their bronchoprotective effect, DIs were performed before administration of a single dose of methacholine, and the FEV1 after methacholine was compared with that of another single-dose challenge in which DIs were not included. From these outcomes, bronchodilation and bronchoprotection indices were constructed and compared with each other. At Dose 1 (mild obstruction), the ability of DIs to reverse methacholine-induced obstruction was equal to their ability to prevent it (bronchodilation index [BDI] versus bronchoprotection index [BPI]: 1.62 ± 0.21 versus 2.02 ± 0.40 [mean ± SEM], p = 0.26). At Dose 2, the relative potency of both the bronchodilating and bronchoprotective effects of DIs increased, but bronchoprotection was significantly stronger (BDI versus BPI: 3.40 ± 0.43 versus 6.98 ± 1.42, p = 0.02). Correlation analysis of the two indices indicated that as the BPI increased, the BDI reached a plateau. We conclude that in healthy humans, the bronchoprotective effect of lung inflation is stronger than the bronchodilatory effect.
Natural history of chronic hepatitis C
Authors: Leonard B. Seeff
Journal: Hepatology (2002)

Much controversy surrounds the issue of the natural history of hepatitis C virus (HCV) infection. Many authorities view the disease as inexorably progressive with a high probability of advancing over time to cirrhosis and occasionally hepatocellular carcinoma (HCC) and, therefore, likely to be responsible for causing death. Others regard chronic hepatitis C as having a variable outcome, the majority of infected persons not dying from the disease, but more likely from the comorbid conditions that so often accompany infection by this agent, or from more common medical conditions. Disagreements probably derive from the manner of conduct of the study and the populations studied. Efforts to determine natural history are handicapped by the primary characteristics of the disease, namely that its onset rarely is recognized and its course is prolonged exceedingly. Thus, different outcomes have come from retrospective rather than from prospective studies, but both have concluded that at least 20% of chronically infected adults develop cirrhosis within 20 years. More recent studies that used a retrospective/prospective approach, focusing largely on young infected individuals, have produced different results. Among these young people, particularly young women, spontaneous resolution of the viral infection is more common than previously thought and cirrhosis has been identified in 5% or fewer of them. The major failing for all groups studied, young and old, is that natural history studies have rarely exceeded the first 2 decades, so that outcome beyond this time is not known, other than through modeling. Several host-related and extraneous factors probably affect the natural history.
French doctors are told to restrict use of third and fourth generation oral contraceptives
Authors: S. Arie
Journal: BMJ (2013)

<h3>Background</h3> There has been rapid growth in the demand for transcatheter aortic valve replacement (TAVR), which has the potential to overwhelm current capacity. This imbalance between demand and capacity may lead to prolonged wait times, and subsequent adverse outcomes while patients are on the waitlist. We sought to understand the relationship between regional differences in capacity, TAVR wait times and morbidity/mortality on the waitlist. <h3>Methods and results</h3> We modelled the effect of TAVR capacity, defined as the number of TAVR procedures per million residents/region, on the hazard of having a TAVR in Ontario from April 2012 to March 2017. Our primary outcome was the time from referral to a TAVR procedure or other off-list reasons on the waitlist/end of the observation period as measured in days. Clinical outcomes of interest were all-cause mortality, all-cause hospitalisations or heart failure-related hospitalisations while on the waitlist for TAVR. There was an almost fourfold difference in TAVR capacity across the 14 regions in Ontario, ranging from 31.5 to 119.5 TAVR procedures per million residents. The relationship between TAVR capacity and wait times was complex and non-linear. In general, increased capacity was associated with shorter wait times (p&lt;0.001), reduced mortality (HR 0.94; p=0.08) and all-cause hospitalisations (p=0.009). <h3>Conclusions</h3> The results of the present study have important policy implications, suggesting that there is a need to improve TAVR capacity, as well as develop wait-time strategies to triage patients, in order to decrease wait times and mitigate the hazard of adverse patient outcomes while on the waitlist.
Malnutrition in the Hospital
Authors: Stephen N. Martyak
Journal: JAMA (1975)

<h3>To the Editor.—</h3> The observation of Bistrian et al (230:858, 1974) would be more accurately stated as a significant correlation of arm muscle circumference and serum albumin levels in determining protein calorie malnutrition rather than as the conclusion drawn, that the health care system is at fault for allowing 50% of its hospitalized patients to have significant malnutrition. The former observation is valid from the data presented, but to arrive at the final conclusion as intimated by Bistrian and co-workers, and as more openly expressed in the editorial by Butterworth (230:879, 1974), would require considerably more data than are presented. The knowledge of each patient's associated problems as well as the goals of hospitalization would be mandatory before any conclusions regarding failure of the medical system or physician deficiencies in identifying and treating protein malnutrition could be made. Though the 131 patients were broken down into major disease categories, this
Improving surveillance for Barrett's oesophagus
Authors: Peter A Bampton, Anne Schloithe, Jeff Bull, Robert J Fraser, Rob T A Padbury, David I Watson
Journal: BMJ (2006)

<h3>Abstract</h3> <b>Problem</b> A retrospective audit of surveillance for Barrett9s oesophagus 1996-2001 identified the need to improve adherence to guidelines for the endoscopic surveillance of patients with Barrett9s oesophagus. <b>Design</b> Prospective audit of the effect of disseminating guidelines in 2002. Prospective audit of the effect of introducing local guidelines and Barrett9s oesophagus surveillance officers, 2003-2005. <b>Setting</b> Two general hospitals in Australia, 2002-5. All adult patients diagnosed with Barrett9s oesophagus were included. <b>Key measures for improvement</b> Proportions of patients in a Barrett9s oesophagus surveillance programme who had appropriate time intervals between follow-up endoscopies and who had appropriate numbers of biopsies collected at endoscopy. <b>Strategies for change</b> Local guidelines were laid down. Surveillance coordinators for Barrett9s oesophagus were introduced to manage the process according to a clinical protocol designed for each patient. <b>Effects of change</b> Disseminating guidelines had little effect on practice. Six months after surveillance coordinators were introduced, adherence to the planned surveillance interval increased from 17% to 92% and the number of endoscopies at which sufficient biopsies were collected increased from 45% to 83%. These changes have been maintained. <b>Lessons learnt</b> Disseminating guidelines and results of an audit on endoscopic surveillance in Barrett9s oesophagus had no effect on practice. Introducing coordinators who proactively managed the process greatly improved adherence to guidelines.
Surgical Debridement for Resistant Bacterial Endocarditis
Authors: Raymond Alexander
Journal: JAMA (1969)

Endocarditis caused by<i>Serratia</i>rarely responds well to antibiotics, and is usually fatal. Such infection occurred on the tricuspid valve in a patient with a history of drug abuse. After a prolonged course of antimicrobial therapy, the patient underwent exploratory cardiac surgery without cardiac failure. Surgical debridement of the tricuspid valve effected an apparent cure. Cardiac surgery during active bacterial endocarditis has proved to be a reasonable procedure. Medically resistant infection should be added to the traditional indications for cardiac surgery.
Bone Densitometry and Treatment for Osteoporosis in Older Men—Reply
Authors: John T. Schousboe, Brent C. Taylor, Howard A. Fink, Douglas C. Bauer, Robert L. Kane, Kristine E. Ensrud
Journal: JAMA (2007)

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Compensation for non-negligent harm in trials remains shaky
Authors: Desmond R Laurence
Journal: BMJ (2006)

EDITOR—Last year in the BMJ I showed that a patient's agreement to take part in a clinical trial is a legal contract which consumer law requires to be expressed in plain language.1 2 In a letter to me on behalf of the chief medical officer (for which I am grateful), the Department of Health has now agreed that where there are contracts between patients and trials sponsors, consumer law is applicable.

I …
Osmond Nicholas Roussel
Authors: P. Roussel
Journal: BMJ (2003)

Former consultant anaesthetist Epsom District Hospital, Surrey (b 1912; q Cambridge/St Thomas's Hospital, London, 1936; FFARCS), d 7 December 2002.

He worked in the Emergency Medical Service for the first three years of the second world war, and then in the Royal Army Medical Corps, where he saw service in Europe and the Far East. On demobilisation he was appointed consultant anaesthetist at Epsom Hospital, a position he held until his retirement 30 years later. He was chairman of the hospital medical committee and the medical representative on the district management team. His wife, Beryl, died 15 weeks after he did. He leaves two children and two grandchildren.
The T-box transcription factor Brachyury promotes epithelial-mesenchymal transition in human tumor cells
Authors: Romaine I. Fernando, Mary Litzinger, Paola Trono, Duane H. Hamilton, Jeffrey Schlom, Claudia Palena
Journal: Journal of Clinical Investigation (2010)

Metastatic disease is responsible for the majority of human cancer deaths. Understanding the molecular mechanisms of metastasis is a major step in designing effective cancer therapeutics. Here we show that the T-box transcription factor Brachyury induces in tumor cells epithelial-mesenchymal transition (EMT), an important step in the progression of primary tumors toward metastasis. Overexpression of Brachyury in human carcinoma cells induced changes characteristic of EMT, including upregulation of mesenchymal markers, downregulation of epithelial markers, and an increase in cell migration and invasion. Brachyury overexpression also repressed E-cadherin transcription, an effect partially mediated by Slug. Conversely, inhibition of Brachyury resulted in downregulation of mesenchymal markers and loss of cell migration and invasion and diminished the ability of human tumor cells to form lung metastases in a xenograft model. Furthermore, we found Brachyury to be overexpressed in various human tumor tissues and tumor cell lines compared with normal tissues. We also determined that the percentage of human lung tumor tissues positive for Brachyury expression increased with the stage of the tumor, indicating a potential association between Brachyury and tumor progression. The selective expression of Brachyury in tumor cells and its role in EMT and cancer progression suggest that Brachyury may be an attractive target for antitumor therapies.
Release of beta endorphin and met-enkephalin during exercise in normal women: response to training.
Authors: T A Howlett, S Tomlin, L Ngahfoong, L H Rees, B A Bullen, G S Skrinar, J W McArthur
Journal: BMJ (1984)

Plasma beta endorphin and met-enkephalin concentrations were measured in response to treadmill exercises in 15 normal women before, during, and after an intensive programme of exercise training. Significant release of beta endorphin occurred in all three test runs, and the pattern and amount of release were not altered by training. Before training dramatic release of met-enkephalin was observed in seven subjects and smaller rises observed in a further four, and this response was almost abolished by training. This represents the first observed "physiological" stimulus to met-enkephalin release. Endogenous opioid peptides play a part in adaptive changes to exercise training and probably contribute to the menstrual disturbances of women athletes.
On-line assessment of left atrial area and function by echocardiographic automatic boundary detection.
Authors: A D Waggoner, B Barzilai, J G Miller, J E Pérez
Journal: Circulation (1993)

BACKGROUND Direct assessment of left atrial (LA) function has not been previously performed by noninvasive techniques; rather, LA function has been evaluated only indirectly via the analysis of transmitral flow velocity by Doppler. The recent development of real-time two-dimensional echocardiographic automatic boundary detection suggests that LA dimensions can be measured instantaneously to provide on-line assessment of its systolic and diastolic functions. METHODS AND RESULTS We performed echocardiographic assessment of LA dimensions and function with automatic boundary detection in 45 patients by using the apical four-chamber view. Thirty-seven patients had structural or functional cardiac abnormalities, 35 patients were in sinus rhythm, and 10 patients had atrial fibrillation. Moderate to severe mitral regurgitation (MR) was noted in 16 patients. We also studied 10 control subjects to assess normal values of LA cavity area and indexes of function. From the instantaneously derived LA area, we derived indexes of systolic atrial expansion and diastolic atrial emptying. There were excellent correlations between the on-line-derived LA areas and those measured off line from videotaped images of conventional echocardiography (r = .91 for end-diastolic and .93 for end-systolic areas; SEE, 4.0 and 3.8 cm2, respectively). Patients in atrial fibrillation had depressed diastolic emptying index (0.17 +/- 0.05) compared with those in sinus rhythm (0.28 +/- 0.12; P &lt; .02). Furthermore, patients with chronic MR exhibited larger LA cavity areas and depressed systolic and diastolic LA function as compared with those without MR. In addition, the Doppler-determined mitral E/A ratio was related to the ratio of early diastolic-to-late diastolic change in LA cavity area (r = .79; SEE 0.6; n = 35). CONCLUSIONS Instantaneous LA cavity area measurement by echocardiographic automatic boundary detection is accurate and feasible in patients with diverse cardiac disorders. Patients with atrial fibrillation had a depressed diastolic emptying index and those with significant mitral regurgitation had depressed systolic expansion index as well. LA functional indexes in both systole and diastole can be derived providing an approach for quantitative evaluations of left atrial-left ventricular interactions based on geometric assessment noninvasively.
Architecture of a K+ Channel Inner Pore Revealed by Stoichiometric Covalent Modification
Authors: Tao Lu, Bao Nguyen, Xinmin Zhang, Jian Yang
Journal: Neuron (1999)

Inwardly rectifying K+ channels bind intracellular magnesium and polyamines to generate inward rectification. We have examined the architecture of the inner pore of Kir2.1 channels by covalently attaching a constrained number (from one to four) of positively charged moieties of different sizes to the channel. Our results indicate that the inner pore is formed solely by the second transmembrane segment and is unprecedentedly wide. At a position critical for inward rectification (D172), the pore is sufficiently wide to bind three Mg2+ ions or polyamine molecules simultaneously. Single-channel recordings directly demonstrate that partially modified channels exhibit distinct subconductance levels. Such a wide inner pore may greatly facilitate ion permeation and high-affinity binding of multiple pore blockers to generate strong inward rectification.
Feeding the Phenylketonuric Infant
Authors: K. S. Holt
Journal: BMJ (1965)

factory tracings.The diagnostic accuracy of this method appears to compare quite favour- ably with that described by Miles and Surveyor.I agree with these authors that the timed ankle jerk is an observation which can be made both simply and rapidly, and as a " clinical test " is as valuable as any other single physical sign in the diagnosis of thyroid disorders.As a method of assessing response to treat- ment in either thyrotoxicosis or myxoedema, at a time when therapy may make other methods of investigation unreliable, it is, as they state, of great value.During the " follow-up " of patients treated with radio- iodine a persistently fast ankle jerk may be the earliest indication of inadequate dosage, and on the other hand excessive slowing has been shown to indicate early hypothyroidism before this has become apparent either on clinical examination or by conventional laboratory investigation.Ankle jerks were unobtainable on initial examination of two elderly and severely thyrotoxic patients, but were recordable in normal range after successful treatment.In the absence of complicating neurological disease I have wondered if this could be accepted as evidence of a thyrotoxic myo- pathy, and would be interested to know if Drs.Miles and Surveyor observed this effect in their series.-Iam, etc.,