tbuckley/cabot-search huggingface dataset:
Endoscopic removal of an impacted acupuncture needle in the duodenum
Authors: J. Yun, W. Moon, J. Roh
Journal: Endoscopy (2012)

A 49-year-old Korean woman was admitted to our hospital for treatment of hemorrhoids with intermittent blood-tinged stool since 5 months. She had had cerebral infarction 10 months ago, for which she was treated with traditional Chinese medicine including acupuncture therapy in the facial region. A detailed history could not be taken because of confusion of orientation and aphrasia. Her vital signs were stable, with normal abdominal and chest examination and laboratory tests. However, a hyperdense, linear, pin-like foreign body was incidentally found in the right upper abdominal area in a simple abdominal X-ray performed as part of the preoperative investigation ([Fig. 1]). An abdominal computed tomography (CT) scan showed the foreign body was located in the second portion of the duodenum ([Fig. 2]). Subsequently, a transparent cap-fitted upper gastrointestinal endoscopy revealed a needle-like foreign body embedding into the mucosa of the second portion of the duodenum ([Fig. 3]). The proximal part of the foreign body was firmly grasped with biopsy forceps and slow traction applied into the cap of the endoscope as it was carefully withdrawn ([Fig. 4]). The foreign body was a 6-cm long acupuncture needle consisting of two parts: a 40 × 0.25 mm thin, acupuncture part proximally located at the duodenum and a distally located 20 × 1 mm thick, strap part ([Fig. 5]). There was no significant complication associated with either the presence of the foreign body or the endoscopic procedure. Such cases are extremely rare in the published literature [1] [2] [3].
Cigarette Smoking in HIV Infection Induces a Suppressive Inflammatory Environment in the Lung
Authors: MARK D. WEWERS, PHILIP T. DIAZ, MARY ELLEN WEWERS, MELISSA P. LOWE, HAIKADY N. NAGARAJA, THOMAS L. CLANTON
Journal: American Journal of Respiratory and Critical Care Medicine (1998)

Lung lymphocyte numbers are frequently increased in human immunodeficiency virus (HIV)-infected individuals in the absence of lung infection, and may play a critical role in viral surveillance and protection against new infections. In this context, cigarette smoking by HIV-infected individuals has been associated with a relative increase in the peripheral blood CD4+ T-lymphocyte count as compared with that of nonsmokers. Because lung defense is local, the aim of the present study was to determine whether cigarette smoking had a significant impact on local lung defenses in HIV-infected individuals. The numbers and subtypes of bronchoalveolar lymphocytes and the ability of lung lavage cells to produce proinflammatory cytokines were compared in 58 smokers and 34 nonsmokers. In contrast to a trend toward an increase in peripheral blood CD4+ cell counts among nonsmokers, smokers had significant depressions in both the percentage and absolute numbers of CD4+ and CD8+ cells in their bronchoalveolar lavage fluid (BALF). A decrease in CD4+/CD8+ cell ratios was also seen with smoking. In addition, production of both interleukin-1 β (IL-1 β ) and tumor necrosis factor- α (TNF- α ) was suppressed with cigarette smoking. These observations show that cigarette smoking is associated with suppression in localized lung defenses, and suggest that smoking cessation may have a positive impact on lung defenses in HIV-infected smokers.
The Office of Fair Trading report: a prescription for value-based drug pricing
Authors: Rubin Minnas, James C Moon
Journal: Journal of the Royal Society of Medicine (2007)

According to the recent independent report from the Office of Fair Trading (OFT), the government's financial watch-dog, the UK system for regulating drug prices has failed to deliver cost effective medicines for the National Health Service. Although the UK market only accounts for 3.45% of global pharmaceutical sales, it is thought that it can affect 25% of global demand as there are many countries that set their prices by reference to the UK. UK prescription drug expenditure amounts to approximately £11 billion per annum, of which approximately £8 billion is spent on branded, on-patent medications. The potential for reform of the UK pricing mechanism to produce much larger gains through driving investment in areas of clinical need is considerable.
Methods of Smoking Cessation—Finally, Some Answers
Authors: Thomas J. Glynn
Journal: JAMA (1990)

Forty million living Americans have quit smoking.<sup>1</sup>While not as catchy, perhaps, as "Fifty million Frenchmen can't be wrong" or "Millions have read the book, now see the movie," the principle is the same—this is a massive number of people focused on one activity. Unfortunately, until now we have known very little, or have had to surmise,<i>how</i>so many smokers have achieved their goal of quitting. The article by Fiore et al<sup>2</sup>in this issue ofThe Journal, however, finally provides some answers and, even more important, guidance on this issue. Among the important findings presented by Fiore et al are the following: More than 90% of successful quitters do so on their own, without participation in an organized cessation program. Quit rates (defined as smoking abstinence for ≥1 year) are twice as high for those who quit on their own compared with those who participate in
Use of early-TIPS for high-risk variceal bleeding: Results of a post-RCT surveillance study
Authors: Juan Carlos Garcia-Pagán, Marco Di Pascoli, Karel Caca, Wim Laleman, Cristophe Bureau, Beate Appenrodt, Angelo Luca, Alexander Zipprich, Juan G. Abraldes, Frederik Nevens, Jean Pierre Vinel, Tilman Sauerbruch, Jaime Bosch
Journal: Journal of Hepatology (2012)
Opening the black box of clinical judgment an overview
Authors: L. L Weed, L. Weed
Journal: BMJ (1999)

In all advanced healthcare systems, medical decision making depends on cognitive inputs from highly trained doctors. Yet those cognitive inputs fall short of what the practice of medicine requires. The reason is that doctors are expected to do the impossible—firstly, to recall and process complex information reliably under severe time constraints, and then to identify the decisions that patients would make for themselves were they fully informed. The inevitable outcome is that doctors' decisions too often cannot be justified in light of available knowledge, medical risk, cost, benefit, or patients' desires. 

The impossible is expected of doctors because we are socialised to rely on their acquired knowledge and cognitive abilities. But cognitive psychology has shown that the human mind normally functions by oversimplifying and filtering complex information. In contrast, modern electronic tools, if properly designed, can empower the mind to systematically consider all available details and their possible combinations. A new division of intellectual labour in medicine is therefore possible—a division between electronic tools that retrieve and process information, and users who apply judgment and values to arrive at medical decisions.

#### Summary points

Medical decision making requires combinatorial analysis to comprehend patients' uniqueness and avoid harmful, unnecessary trial and error

Combinatorial analysis combines numerous, simple, inexpensive observations, tests, and procedures on a patient with medical knowledge to identify all individually relevant options, and the pros and cons of each for the patient

The apparent difficulties of a combinatorial approach—gathering comprehensive data and linking it with the medical knowledge base—are avoidable when properly designed software tools are habitually used

The actions of caregivers and the medical knowledge they use must be subject to effective feedback, which requires medical records with a problem oriented structure

New systems are needed not only to improve cognitive inputs to medical decision making but also to improve manual …
Familial Precocious Puberty Associated with Isolated Elevation of Luteinizing Hormone
Authors: Ron G. Rosenfeld, Richard E. Reitz, Allen B. King, Raymond L. Hintz
Journal: New England Journal of Medicine (1980)

THE great majority of cases of central precocious puberty, with premature activation of the hypothalamic-pituitary-gonadal axis, are sporadic and idiopathic, with a female-to-male ratio of between 4:1 and 8:1.1 Familial central precocious puberty, however, is generally inherited as a male-limited autosomal dominant trait.2 In the 11 reported kindreds, transmission has usually been from affected male to affected male or through unaffected female subjects. There has been only one documented occurrence of central precocious puberty involving siblings of opposite sexes.3 We recently observed a unique familial abnormality in pubertal development, which resulted in isosexual precocious development in a boy and heterosexual . . .
A NOTE ON DISCONNECTION OF THE COLON IN POEPHYRIA VAEIEGATA
Authors: G. H. FINDLAY
Journal: British Journal of Dermatology (1971)

One patient with porphyria variegata was treated by disconnecting the colon, and another by alkaline bowel washouts and neomycin; the enhanced bowel drainage so achieved relieved the abdominal signs altogether, and improved to some extent the skin and mental changes.
ACUTE DELIRIUM PREDICTS SHORT-TERM RE-HOSPITALIZATION AMONG ELDERLY PATIENTS ADMITTED WITH ACUTELY DECOMPENSATED HEART FAILURE.
Authors: Shanmugam Uthamalingam, Jagdesh Kandala, Marilyn Daley, Robert Capodilupo, James L. Januzzi
Journal: Journal of the American College of Cardiology (2010)
Using iPSC-derived neurons to uncover cellular phenotypes associated with Timothy syndrome
Authors: Sergiu P Paşca, Thomas Portmann, Irina Voineagu, Masayuki Yazawa, Aleksandr Shcheglovitov, Anca M Paşca, Branden Cord, Theo D Palmer, Sachiko Chikahisa, Seiji Nishino, Jonathan A Bernstein, Joachim Hallmayer, Daniel H Geschwind, Ricardo E Dolmetsch
Journal: Nature Medicine (2011)
Interventional Procedures in Peripheral Atherosclerotic Disease
Authors: Jeffrey L. Kaufman
Journal: JAMA (1989)

<h3>To the Editor.—</h3> I find two substantial problems with the review of percutaneous transluminal angioplasty and other interventional procedures for peripheral atherosclerosis by Widlus and Osterman.<sup>1</sup>First, the indications for these procedures seem imprecise. At a time when there is increasing scrutiny by private insurers, by the Medicare PRO, and by the major vascular surgery societies of the indications for peripheral vascular surgery, it is remarkable that these interventions by radiologists could seem to be offered at a lesser standard of patient selection. For example, I do not consider failure of a walking program of 1 to 3 miles a day to be truly disabling claudication, neither is the chronicity of symptoms a reason for suggesting an angiographic study or intervention. Likewise, the fact that a patient has suffered an acute occlusive event with resultant claudication, such as thrombosis of a superficial femoral artery, is not of necessity grounds
Labeled WBC Cardiac Imaging and Two-Dimensional Echocardiography to Evaluate High-Dose Gamma Globulin Treatment in Kawasaki Disease
Authors: CHIA-HUNG KAO, KAI-SHENG HSIEH, YONG-CHUNG CHEN, YEN-LIANG WANG, SHYH-JEN WANG, SHIN-HWA YEH
Journal: Clinical Nuclear Medicine (1995)

Twenty-eight children (5 girls, 23 boys; age, 20.3 +/- 16.2 months) with Kawasaki disease (KD) were included in this study. The children were treated with aspirin plus intravenous injection of gamma globulin (IVGG). Both Tc-99m HMPAO labeled WBC heart imaging (Tc-WBC) and two-dimensional echocardiograms (2D-Echo) were used to evaluate the effects of IVGG on the most common cardiac presentations--carditis and dilated coronary arteries--in KD. After IVGG therapy, the results showed that 32.1% (9/28) carditis patients had improved; 39.3% (11/28) of patients had no significant change; 28.6% (8/28) of patients had severe changes, and there was no significant difference among the three groups by the evidences of Tc-WBC. Dilated coronary arteries (CA) became smaller in 32.1% (9/28) of patients; 53.6% (15/28) of patients had no definite change; 14.3% (4/28) of patients had dilated LCA that became larger; and borderline difference existed among the three groups, proved by 2D-Echo. Between the Tc-WBC and 2D-Echo, 35.7% (10/28) of patients had similar changes, and 64% (18/28) of patients showed incongruous changes; and there was little difference. In conclusion, Tc-WBC and 2D-Echo provide strong evidence of the existence of carditis and dilated coronary arteries in certain patients, even after IVGG treatment. The improvements of carditis and dilated coronary arteries were not correlated with each other after IVGG therapy.
Insulin Status and Vascular Responses to Weight Loss in Obesity
Authors: Sherman J. Bigornia, Melissa G. Farb, Stephanie Tiwari, Shakun Karki, Naomi M. Hamburg, Joseph A. Vita, Donald T. Hess, Michael P. LaValley, Caroline M. Apovian, Noyan Gokce
Journal: Journal of the American College of Cardiology (2013)
Patterns of extensive genetic differentiation and variation among European harbor seals (Phoca vitulina vitulina) revealed using microsatellite DNA polymorphisms
Authors: S. J. Goodman
Journal: Molecular Biology and Evolution (1998)

The harbor seal (Phoca vitulina) has the most extensive distribution of any phocid seal species. An analysis of population structure in this species across its European range was made using 7 phocid derived microsatellites in a sample of 1,029 individuals from 12 separate geographic areas. Despite the species potential for long-distance movement, significant genetic differentiation between areas was observed using an unbiased estimator of RST. Six distinct population units were identified: Ireland-Scotland, English east coast, Waddensea, western Scandinavia (Norway-Kattegat-Skagerrak-west Baltic), east Baltic, and Iceland. Little local substructuring is present along coastlines with a continuous distribution of breeding animals, but differentiation does increase with geographic distance. The degree of differentiation is greater over equivalent distances where the distribution is discontinuous, such as along coasts where breeding colonies are separated by large distances or by stretches of open sea. Patterns of population differentiation derived from microsatellites are very similar to those obtained from previous mitochondrial DNA analysis and suggest that philopatry in harbor seals operates over 300-500 km. In Europe, harbor seals have experienced a complex demographic history and patterns of population structure are likely to have been affected by natural environmental influences such as Pleistocene glaciations and epizootics. Comparison of Nm values from an unbiased estimator of RST, GST, and theta are consistent and, in some cases, may indicate populations where conditions deviate from the expectations of the RST model.
Compression of Pancreatic Tumor Blood Vessels by Hyaluronan Is Caused by Solid Stress and Not Interstitial Fluid Pressure
Authors: Vikash P. Chauhan, Yves Boucher, Cristina R. Ferrone, Sylvie Roberge, John D. Martin, Triantafyllos Stylianopoulos, Nabeel Bardeesy, Ronald A. DePinho, Timothy P. Padera, Lance L. Munn, Rakesh K. Jain
Journal: Cancer Cell (2014)
Points from Letters: Anxiety and the G.P
Authors: C. W. D. Phillips
Journal: BMJ (1971)

dialysate,l is recommended routinely for all chronically dialysed patients.It is suggested that the patient under this treatment can not only substitute iron, folate, and amino-acid losses from the remaining blood into the dialyser, blood sampling for analysis, and to the dialysate, but also effectively utilize these elements incorporated in the diet, according to his real needs.-Weare, etc.,
PTU-073 Hepatic sinusoidal injury is associated with shortened long-term survival in patients undergoing right trisectionectomy for colorectal liver metastases
Authors: C P Neal, C D Mann, G Garcea, E Pointen, A McGregor, M S Metcalfe, D P Berry, A R Dennison
Journal: Gut (2012)

<h3>Introduction</h3> Recent data have suggested that oxaliplatin-associated sinusoidal injury (SI) in the non-tumour bearing liver (NTBL) may be associated with adverse long-term outcome following hepatectomy for colorectal liver metastases (CRLM), though this observation may be an epiphenomenon of associations with unfavourable tumour biology. This study aimed to assess the impact of NTBL histology upon long-term outcome in a series of consecutive patients undergoing right hepatic trisectionectomy for CRLM. <h3>Methods</h3> Clinicopathological data for patients undergoing right trisectionectomy at a UK tertiary referral hepatobiliary centre between January 2002 and December 2008 were obtained from a prospectively maintained database. Blinded NTBL pathological review was conducted by two pathologists using established criteria for SI, steatosis, non-alcoholic steatohepatitis, fibrosis and cholestasis. Univariate and multivariable Cox regression analyses were performed to correlate perioperative and pathological variables with long-term overall and disease-free survival. Postoperative deaths (90-day) were excluded from long-term survival analyses. <h3>Results</h3> A total of 66 consecutive patients underwent right trisectionectomy for CRLM over the study period. Preoperative oxaliplatin-based chemotherapy was used in 24 cases (36.4%, median 6 cycles, range 2–8 cycles). SI was noted in 21 cases (31.8%) and was independently associated with oxaliplatin use. 5-Year overall survival rate was 28.8%. On multivariable analysis, number of metastases resected and SI were independently associated with shortened overall survival following trisectionectomy. Number of metastases resected, perioperative blood transfusion and SI were independently associated with shortened disease-free survival following trisectionectomy. Steatosis, non-alcoholic steatohepatitis, fibrosis and cholestasis showed no association with long-term survival. <h3>Conclusion</h3> Short-course oxaliplatin-associated SI is associated with adverse prognosis following right trisectionectomy for CRLM. The inclusion of traditional clinicopathological variables as covariates suggests that this finding is unlikely to simply be an epiphenomenon of associations with unfavourable tumour biology. Further studies are necessary to confirm these findings and to explore the underlying mechanism(s). <h3>Competing interests</h3> None declared.
Somatization: The Experience and Communication of Psychological Distress as Somatic Symptoms
Authors: Zbigniew J. Lipowski
Journal: Psychotherapy and Psychosomatics (1987)

Somatization implies a tendency to experience and communicate psychological distress in the form of somatic symptoms and to seek medical help for them. So defined, it is neither a disorder nor a diagnostic category but a generic term for a set of experiential, cognitive, and behavioral characteristics of patients who complain of physical symptoms in the absence of relevant medical findings. Such patients are ubiquitous in all medical care settings, pose difficult diagnostic and management problems, and overutilize health care thus contributing to its cost. Somatization may be transient or persistent, and may or may not be associated with a diagnosable medical or psychiatric disorder. The most common concurrence of somatization is with affective and anxiety disorders, and, to a lesser degree, the somatoform disorders. Persistent somatization poses a serious clinical, social, and economic problem and hence early identification of potential chronic somatizers should be attempted to avoid its development. Pain, fatigue, dizziness, and dyspnea are the commonest symptoms. Etiology of somatization is multifactorial and so should be its management.
826. Transduction of Human Hematopoietic Stem Cells by RD114-TR-Pseudotyped Lentiviral Vectors
Authors: Anna A. Stornaiuolo, Francesca F. Di Nunzio, Bianca B. Piovani, Francois F.-L. Cosset, Fulvio F. Mavilio
Journal: Molecular Therapy (2006)

The promoters expressed transgenes at high
Altered fates--counseling families with inherited breast cancer
Authors: D. L. Breo
Journal: JAMA (1993)

Breo profiles Barbara Weber, M.D., and Francis Collins, M.D., of the University of Michigan School of Medicine's breast cancer clinic, and their work isolating and identifying genetic markers for the gene that means an 85% lifetime risk of developing breast cancer, as well as a significantly higher risk of ovarian cancer. Their discovery is expected to revolutionize women's health care and to present society with daunting economic, ethical, and counseling issues. [Collins discovered the genes that cause cystic fibrosis, neurofibromatosis, and Huntington's disease. He was named director of the National Center for Human Genome Research at the National Institutes of Health in April 1993].
Expression of the chemokine CCL21 during chronic hepatitis C: potential role in inflammation and fibrosis
Authors: Andrea Bonacchi, Ilaria Petrai, Paola Romagnani, Elena Lazzeri, Francesco Annunziato, Raffaella DeFranco, Eva Efsen, Stefano Milani, Massimo Pinzani, Paolo Gentilini, Fabio Marra
Journal: Journal of Hepatology (2002)
Randomised controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost
Authors: J. Wellwood, M. J Sculpher, D. Stoker, G. J Nicholls, C. Geddes, A. Whitehead, R. Singh, D. Spiegelhalter
Journal: BMJ (1998)

<h3>Abstract</h3> <b>Objective:</b> To compare tension-free open mesh hernioplasty under local anaesthetic with transabdominal preperitoneal laparoscopic hernia repair under general anaesthetic. <b>Design:</b> A randomised controlled trial of 403 patients with inguinal hernias. <b>Setting:</b> Two acute general hospitals in London between May 1995 and December 1996. <b>Subjects:</b> 400 patients with a diagnosis of groin hernia, 200 in each group. <b>Main outcome measures:</b> Time until discharge, postoperative pain, and complications; patients9 perceived health (SF-36), duration of convalescence, and patients9 satisfaction with surgery; and health service costs. <b>Results:</b> More patients in the open group (96%) than in the laparoscopic group (89%) were discharged on the same day as the operation (χ<sup>2</sup>=6.7; 1 df; P=0.01). Although pain scores were lower in the open group while the effect of the local anaesthetic persisted (proportional odds ratio at 2 hours 3.5 (2.3 to 5.1)), scores after open repair were significantly higher for each day of the first week (0.5 (0.3 to 0.7) on day 7) and during the second week (0.7 (0.5 to 0.9)). At 1 month there was a greater improvement (or less deterioration) in mean SF-36 scores over baseline in the laparoscopic group compared with the open group on seven of eight dimensions, reaching significance on five. For every activity considered the median time until return to normal was significantly shorter for the laparoscopic group. Patients randomised to laparoscopic repair were more satisfied with surgery at 1 month and 3 months after surgery. The mean cost per patient of laparoscopic repair was £335 (95% confidence interval £228 to £441) more than the cost of open repair. <b>Conclusion:</b> This study confirms that laparoscopic hernia repair has considerable short term clinical advantages after discharge compared with open mesh hernioplasty, although it was more expensive. <h3>Key messages</h3> In the 4 hours after surgery laparoscopic hernia repair with general anaesthesia causes more pain than open repair with local anaesthesia (mainly because of the anaesthesia used) and necessitates longer stay in hospital. Laparoscopic hernia repair, however, causes less pain than open hernia repair during the first 2 weeks after discharge Laparoscopic hernia repair results in fewer episodes of wound infection, persistent local pain, genital swelling, numbness, and constipation than open repair. Urinary disturbances are more common after laparoscopic than after open repair Patients9 perception of health 1 month after the operation (assessed with the SF-36) and satisfaction with treatment is superior for laparoscopic patients who also have a shorter period of convalescence after surgery The health service cost of day case laparoscopic repair is £335 more than the cost of open mesh hernioplasty performed on a day case basis