tbuckley/cabot-search huggingface dataset:
Prediction rules in cervical spine injury
Authors: V. K Podichetty, H. Morisue
Journal: BMJ (2009)

Can reduce unnecessary imaging, without missing fractures or increasing adverse events

“Clinical prediction rules” or “decision rules” are designed to suggest a pathway of probability of a pathological condition and help the clinician choose a diagnostic or therapeutic course of action. The rules reduce the uncertainty inherent in medical practice—for example, in emergency medicine and trauma—by appraising clinical findings to make predictions. Because these rules affect patient care and health costs, they must be carefully evaluated before implementation. For this purpose, guidance and methodological standards exist for users and developers of clinical prediction rules.1 2 In the linked cluster randomised controlled study (doi:10.1136/bmj.b4146),3 Steill and colleagues assess the effectiveness of a knowledge translation strategy to implement the validated Canadian c-spine rule in 12 emergency departments in Canada. 

Specific algorithms and prediction rules for the initial assessment of patients with cervical spine injury have been proposed in the literature. Since the early 1990s, the National Emergency X-Radiography Utilization Study’s low risk criteria (NEXUS)4 and the …
NHS patients are choosing to have PIP implants removed whether or not they have burst
Authors: I. Torjesen
Journal: BMJ (2012)

The options offered to women who had breast augmentation surgery with implants made by the discredited French manufacturer Poly Implant Prosthese (PIP), which differ according to whether the operation was carried out on the NHS or privately, are affecting how keen they are to have the implants removed, new figures from the Department of Health indicate.

PIP closed last year after it emerged that the company had used non-medical grade silicone in its breast implants. The NHS in England has advised women with the implants not to have them removed automatically but to seek clinical advice. Women who had surgery done on the NHS are entitled to have PIP implants removed and replaced with new implants, but the NHS will only remove and not replace implants from …
Blunt Force Violence in America— Shades of Gray or Red
Authors: George D. Lundberg
Journal: JAMA (1996)

The action of one human striking another with the fists must date to about the time humans began to walk on two feet. Aggressive behavior is certainly a normal human trait. Defending oneself using any method available is at the top of Maslov's hierarchy, namely, survival. The use of a violent act to entertain others vicariously is also thousands of years old. Gladiatorial events, Christians being fed to lions, gunfights in the old American West, and other such events have been legendary. From time to time, however, society looks at its behavior in terms of both the effects on individual participants and the moral and ethical aspects of the events affecting society as a whole. Thus, Christians are no longer fed to lions, and gladiatorial combat, sword duels to the death, cockfights, dogfights, and gunfights have been outlawed and, to some extent, do not occur. Over many decades, boxing has
Percutaneous closure of the small patent ductus arteriosus using occluding spring coils
Authors: John W. Moore, Lily George, Stanley E. Kirkpatrick, James W. Mathewson, Robert L. Spicer, Karen Uzark, Abraham Rothman, Patrick A. Cambier, Michael C. Slack, William C. Kirby
Journal: Journal of the American College of Cardiology (1994)
Case Report: Three Farmworkers Who Gave Birth to Infants with Birth Defects Closely Grouped in Time and Place—Florida and North Carolina, 2004–2005
Authors: Geoffrey M. Calvert, Walter A. Alarcon, Ann Chelminski, Mark S. Crowley, Rosanna Barrett, Adolfo Correa, Sheila Higgins, Hugo L. Leon, Jane Correia, Alan Becker, Ruth H. Allen, Elizabeth Evans
Journal: Environmental Health Perspectives (2007)

There is little evidence linking adverse reproductive effects to exposure to specific pesticides during pregnancy.In February 2005, three infants with congenital anomalies were identified in Collier County, Florida, who were born within 8 weeks of one another and whose mothers worked for the same tomato grower. The mothers worked on the grower's Florida farms in 2004 before transferring to its North Carolina farms. All three worked during the period of organogenesis in fields recently treated with several pesticides. The Florida and North Carolina farms were inspected by regulatory agencies, and in each state a large number of violations were identified and record fines were levied.Despite the suggestive evidence, a causal link could not be established between pesticide exposures and the birth defects in the three infants. Nonetheless, the prenatal pesticide exposures experienced by the mothers of the three infants is cause for concern. Farmworkers need greater protections against pesticides. These include increased efforts to publicize and comply with both the U.S. Environmental Protections Agency's Worker Protection Standard and pesticide label requirements, enhanced procedures to ensure pesticide applicator competency, and recommendations to growers to adopt work practices to reduce pesticide exposures. RELEVANCE TO PROFESSIONAL PRACTICE: The findings from this report reinforce the need to reduce pesticide exposures among farmworkers. In addition, they support the need for epidemiologic studies to examine the role of pesticide exposure in the etiology of congenital anomalies.
SOME POINTS IN THE SURGICAL TREATMENT FOR THE RADICAL CURE OF HERNIA.Read in the Section on Surgery and Anatomy, at the Forty-second Annual Meeting of the American Medical Association, held at Washington, D. C., May, 1891.
Authors: AUGUSTUS P. CLARKE
Journal: JAMA (1891)

One of the most important features in the surgical treatment for the radical cure of hernia is the selection of the proper material for sutures. The sutures in all cases should be aseptic. The wound made by the incision should also be keptaseptic. The operator should have knowledge of the manner in which the sutures have been made, and in order to have such knowledge he should superintend their final preparation. Sutures which have been prepared and are sold in shops should in no event be trusted, notwithstanding the careful manner in which they may seem to have been prepared. No one, except the surgeon, or his immediate assistants who are to use them, and who have taken occasion to make most careful observation, is at all likely to appreciate this necessity, and to carry out in every detail measures necessary for assuring their preparation in such a manner that
The price of independence
Authors: Joe Collier
Journal: BMJ (2006)

Career pressure and a focus on payment by results are making the critical and impartial thinker an endangered species. Society must take steps to protect this invaluable resource 

My professional life has been dominated by a drive to ensure that every opinion or piece of advice I give is independent and seen as such. Independence first became an issue for me in 1969 when I edited my first article for Drug and Therapeutics Bulletin .1 The then editor, Andrew Herxheimer, made my responsibilities clear: I was to scrutinise all the relevant published data, read and note all of the comments made by article reviewers, and use all this information to prepare the article for publication, ensuring clarity, reliability, and impartiality. The published article must reflect the scientific knowledge available and distinguish what was known about the product from what was derived from conjecture, bias, or the uncritical position of the establishment. Moreover, there would be no place for my own (preconceived) biases. Readers were to be given information they could trust and be confident that the advice given had no hidden agenda no ulterior motive.

Four decades on, and I am still discovering the full implications of these ideals. Their meaning became more pertinent when I was appointed the bulletin's deputy editor in 1972, then its editor in 1992, and a year later when it coined the strapline, “The independent review for doctors.” Perhaps, more importantly, the ideals have taken on new dimensions as they have shaped my career as teacher, researcher, physician, administrator, writer, broadcaster, and adviser.

In the context of this article, independence relates to intellectual function, the way our minds process information to make decisions; ultimately, it is the way we make up our minds and, as advisers, give our opinions.

What has emerged over the …
Apolipoprotein E Alleles, Dyslipidemia, and Coronary Heart Disease
Authors: Peter W. F. Wilson
Journal: JAMA (1994)

To describe the association between apolipoprotein E alleles (epsilon 2, epsilon 3, and epsilon 4), dyslipidemias, and coronary heart disease (CHD).Cross-sectional prevalence study.Community-based sample of men (n = 1034) and women (n = 916) aged 40 to 77 years who are participating in a long-term study of cardiovascular disease. Study participants underwent fasting lipid measurements, coronary risk factor determinations, and a comprehensive evaluation for the presence of current or previous CHD.Compared with the epsilon 3 allele, the epsilon 4 allele was associated with elevated low-density lipoprotein cholesterol values (> or = 4.14 mmol/L [160 mg/dL]) in women, the epsilon 2 and epsilon 4 alleles were associated with moderately elevated triglyceride values (> or = 2.82 mmol/L [250 mg/dL]) in men, and the epsilon 2 allele was associated with severely elevated triglyceride values (> or = 5.64 mmol/L [500 mg/dL]) in men. The apolipoprotein E alleles were not associated with hypertension, obesity, smoking, or diabetes, but the epsilon 4 allele frequency was reduced in women after 60 years of age. The age-adjusted prevalence of CHD was associated with the epsilon 4 allele in both men (relative odds = 1.53, P = .04) and women (relative odds = 1.99, P = .05). In analyses for women and for both sexes combined, this relation persisted after adjustment by hypertension, smoking, obesity, diabetes, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol.Apolipoprotein E alleles are important genetic markers for dyslipidemia and CHD. The estimated CHD odds associated with the epsilon 4 allele appears to be greater than that for any other known genetic lipid abnormality, and the association of the epsilon 4 allele with CHD remains significant in women and both sexes combined after adjustment by traditional coronary risk factors and lipids.
Delayed and Unsuccessful Endoscopic Retrograde Cholangiopancreatography Are Associated With Worse Outcomes in Patients With Acute Cholangitis
Authors: Mouen A. Khashab, Ali Tariq, Usman Tariq, Katherine Kim, Lucia Ponor, Anne Marie Lennon, Marcia I. Canto, Ahmet Gurakar, Qilu Yu, Kerry Dunbar, Susan Hutfless, Anthony N. Kalloo, Vikesh K. Singh
Journal: Clinical Gastroenterology and Hepatology (2012)
Pargyline Hydrochloride Poisoning in a Child
Authors: D. Lipkin, T. Kushnick
Journal: JAMA (1967)

PARGYLINE HYDROCHLORIDE (Eutonyl) is a nonhydrazine monamine oxidase inhibitor (MAOI) with a pharmacological property of lowering blood pressures. While exerting its antihypertensive activity, it has been noted to have a moodelevating effect, without any depressant qualities. The full activity develops slowly and is maintained for some time after the drug is discontinued. Troublesome side effects have included postural hypotension, constipation, insomnia, nervousness, sweating, dryness of the mouth, nightmares, headaches, nausea and vomiting. Unusual side effects have been impotence, an increase in appetite, pedal edema, and arthralgia.<sup>1</sup>As with other MAOIs, sevveral patients have had hypertensive reactions following ingestion of ripe or aged cheeses.<sup>2</sup>Reports of serious overdosages were nonexistent until recently.<sup>3</sup>The following is a description of intoxication with this agent in a 21/2-year-old child. <h3>Report of a Case</h3> A 21/2-year-old Negro girl was admitted to the Jersey City Medical Center approximately 15 hours after ingesting six
Influence of inhaled steroids on recovery from occupational asthma after cessation of exposure: an 18-month double-blind crossover study.
Authors: J L Malo, A Cartier, J Côté, J Milot, C Leblanc, L Paquette, H Ghezzo, L P Boulet
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

Occupational asthma (OA) is a useful model for the study of asthma in humans. The possibility that inhaled corticosteroids, in addition to withdrawal from the workplace, could improve clinical and functional recovery from OA can be hypothesized. We assessed clinical, functional, and behavioral characteristics of 32 subjects (22 male, 10 female), in all but one of whom OA was confirmed by specific inhalation challenges induced by either high- (n=13) or low-molecular-weight (n=19) agents within 3 mo after cessation of exposure. In this randomized, crossover, double-blind study, subjects (paired for baseline PC20 and duration of symptoms after exposure) received either placebo or 1,000 micrograms of inhaled beclomethasone daily for 1 yr, followed by the alternate medication for 6 mo. Various clinical, functional, and behavioral parameters were examined at each 3-mo visit. Significant improvement in clinical (nocturnal symptoms, cough), functional (morning and evening peak expiratory flow rates), and behavioral (quality of life) parameters were detected in the active-treatment period, although the magnitude of the improvement was relatively small. Side effects (oropharyngeal, reduced cortisol) were similar in the placebo and treatment groups. Distinguishing subjects who started with the active preparation from those who were given placebo first showed that most clinical and behavioral parameters improved in the former instance, whereas there was no significant difference in the latter. We conclude that inhaled corticosteroids induce a small but significant overall improvement of the asthmatic condition in subjects with occupational asthma caused by high- and low-molecular-weight agents after withdrawal from exposure. The beneficial effect is, however, more pronounced if inhaled steroids are given early after diagnosis.
HIV-Infected Patients Participating in Autologous Blood Programs
Authors: Lawrence D. Petz
Journal: JAMA (1993)

<h3>To the Editor.</h3> —In the analysis<sup>1</sup>of the controversy surrounding the participation of HIV-infected patients in autologous blood programs, Mintz does not appropriately compare the risks incurred by an HIV-positive patient who receives a unit of blood from the volunteer blood supply with the risk of HIV transmission as a result of an erroneous administration of a unit of HIV-positive blood that had been donated for autologous transfusion. He cites data to indicate that the rate of infusing allogeneic blood into the wrong patient is one per 12000 units, and if the unit is HIV-infected, more than 90% of the recipients will become infected, each with a fatal disease. In contrast, the risk of morbidity and mortality incurred as a result of receiving a unit of blood from a volunteer donor is much less. The greatest risk of death following transfusion is caused by non-A, non-B hepatitis (hepatitis C).
Cor Triatriatum
Authors: CHARLES R. JORGENSEN, RANDOLPH M. FERLIC, RICHARD L. VARCO, C. WALTON LILLEHEI, ROBERT S. ELIOT
Journal: Circulation (1967)

A follow-up report on the first patient with cor triatriatum to undergo successful surgical treatment is presented. A second procedure was necessary 9½ years later because of stenosis of the initial surgically created orifice in the anomalous diaphragm. A review and ananalysis have been made of 17 cases from the literature reporting successful operations for this lesion. Total excision of the accessory septum utilizing cardiopulmonary bypass is presently the appropriate surgical treatment of this entity. Preoperative and postoperative hemodynamic data are discussed. Recognition and correction of this defect are emphasized in order to avoid permanent pulmonary vascular changes attended by a relatively fixed cardiac output.
MACROGLOBULINEMIA
Authors: Leonhard Korngold, Gerda van Leeuwen
Journal: The Journal of Experimental Medicine (1959)

The monomers obtained by treating gamma(1)-macroglobulins with mercaptoethanol have proved to be antigenically different from normal 7S 7gamma-globulin. The depolymerization of the macroglobulins resulted in the loss of several antigenic determinants, although the monomers still cross-reacted with antisera against macroglobulins. Reaggregation of the monomers occasionally resulted in the reconstitution of some or all of the antigenic determinants that were lost during depolymerization. Repeated freezing and thawing of pathological macroglobulins in iodoacetate resulted in their complete antigenic destruction. Repeated freezing and thawing of one of the monomers in excess iodoacetate resulted in the degradation to a protein antigenically indistinguishable from Bence Jones protein. The other two monomers studied were stable under these conditions.
The natural course of atopic dermatitis from birth to age 7 years and the association with asthma☆
Authors: Sabina Illi, Erika von Mutius, Susanne Lau, Renate Nickel, Christoph Grüber, Bodo Niggemann, Ulrich Wahn, None the Multicenter Allergy Study Gro
Journal: Journal of Allergy and Clinical Immunology (2004)
Metadherin Promotes Hepatocellular Carcinoma Metastasis through Induction of Epithelial–Mesenchymal Transition
Authors: Kai Zhu, Zhi Dai, Qi Pan, Zheng Wang, Guo-Huan Yang, Lei Yu, Zhen-Bin Ding, Guo-Ming Shi, Ai-Wu Ke, Xin-Rong Yang, Zhong-Hua Tao, Yi-Ming Zhao, Yi Qin, Hai-Ying Zeng, Zhao-You Tang, Jia Fan, Jian Zhou
Journal: Clinical Cancer Research (2011)

To investigate the expression of metadherin (MTDH) for its prognostic value in hepatocellular carcinoma (HCC) and its role in promoting HCC metastasis.This study employed a tissue microarray containing samples from 323 HCC patients to examine the expression of MTDH and its correlation with other clinicopathologic characteristics. The role of MTDH in the regulation of HCC metastasis was investigated both in vitro and in vivo using short hairpin RNA (shRNA)-mediated downregulation of MTDH in HCC cell lines with various metastatic potentials.The expression of MTDH was markedly higher in HCC tumors than in normal liver tissue. Particularly high MTDH expression was observed in tumors with microvascular invasion, pathologic satellites, poor differentiation, or tumor-node-metastasis stages II to III. Furthermore, the clinical outcome was consistently poorer for the MTDH(high) group than for the MTDH(low) group in the 1-, 3-, and 5-year overall survival (OS) rates and in the 1-, 3-, 5-year cumulative recurrence rates. In a nude mice model, the shRNA-mediated downregulation of MTDH resulted in a reduced migratory capacity in HCC cell lines, as well as a reduction in pulmonary and abdominal metastasis. Furthermore, we found that the expression level of MTDH correlated with four epithelial-mesenchymal transition (EMT) markers. Knockdown of MTDH expression in HCC cell lines resulted in downregulation of N-cadherin and snail, upregulation of E-cadherin, and translocation of β-catenin.MTDH may promote HCC metastasis through the induction of EMT process and may be a candidate biomarker for prognosis as well as a target for therapy.
Foley Catheter Perforation of the Urinary Bladder
Authors: Ardon Rubinstein
Journal: JAMA (1976)

To the Editor.—  The following case is a remainder of an uncommon complication of long-term catheterization of the urinary bladder.  Report of a Case.—  A 71-year-old woman was admitted to the hospital because of an obtunded abdomen and shock. Her medical history included diabetes mellitus and atherosclerotic vascular disease. Urinary incontinence after a stroke necessitated the insertion of a permanent Foley catheter one year before hospitalization.  On admission, the patient's temperature was 38.7 C, her blood pressure was unobtainable, and her abdomen was tense and tender. An abdominal roentgenogram showed gastric dilatation and free air in the retroperitoneal space. The urine present in the catheter lumen contained numerous erythrocytes and leukocytes, but it soon became apparent—despite vigorous treatment that included fluids, antibiotics, and steroids—that the patient was anuric.  Abdominal puncture did not disclose any fluids. Because of the patient's poor condition and failure to respond to supportive measures, surgery was
Localization, Macromolecular Associations, and Function of the Small Heat Shock–Related Protein HSP20 in Rat Heart
Authors: Walter Pipkin, John A. Johnson, Tony L. Creazzo, Jarrett Burch, Padmini Komalavilas, Colleen Brophy
Journal: Circulation (2003)

Background— The small heat shock proteins HSP20, HSP25, αB-crystallin, and myotonic dystrophy kinase binding protein (MKBP) may regulate dynamic changes in the cytoskeleton. For example, the phosphorylation of HSP20 has been associated with relaxation of vascular smooth muscle. This study examined the function of HSP20 in heart muscle. Methods and Results— Western blotting identified immunoreactive HSP20, αB-crystallin, and MKBP in rat heart homogenates. Subcellular fractionation demonstrated that HSP20, αB-crystallin, and MKBP were predominantly in cytosolic fractions. Chromatography with molecular sieving columns revealed that HSP20 and αB-crystallin were associated in an aggregate of ≈200 kDa, and αB-crystallin coimmunoprecipitated with HSP20. Immunofluorescence microscopy demonstrated that the pattern of HSP20, αB-crystallin, and actin staining was predominantly in transverse bands. Treatment with sodium nitroprusside led to increases in the phosphorylation of HSP20, as determined with 2-dimensional immunoblots. Incubation of transiently permeabilized myocytes with phosphopeptide analogues of HSP20 led to an increase in the rate of shortening. The increased shortening rate was associated with an increase in the rate of lengthening and a more rapid decay of the calcium transient. Conclusions— HSP20 is associated with αB-crystallin, possibly at the level of the actin sarcomere. Phosphorylated HSP20 increases myocyte shortening rate through increases in calcium uptake and more rapid lengthening.
Reply: Characterization of Lymphangioleiomyomatosis as a Neoplastic Disease
Authors: Francis X. McCormack, William D. Travis, Thomas V. Colby, Elizabeth P. Henske, Joel Moss
Journal: American Journal of Respiratory and Critical Care Medicine (2013)

approaches and novel therapeutic avenues.Most importantly, I believe the designation will not help patients with LAM cope any better with their disease or improve survival or quality of life.The verdict on LAM as a neoplasm is undecided, the scientific evidence at present not substantial enough to support this designation, and the benefits of this labeling and its implications remain controversial.
Abnormalities in Platelet Behaviour in Acute Illnesses
Authors: J. R. Hampton, J. R. A. Mitchell
Journal: BMJ (1966)

Abnormalities in platelet behaviour have been described in a variety of pathological conditions. Increased platelet-to-glass adhesiveness has been found after surgical operations (Payling Wright, 1942), in ischaemic heart disease (McDonald and Edgill, 1957), pulmonary embolus (Hirsh and McBride, 1965), disseminated sclerosis (Field and Caspary, 1964), and homo cystinuria (McDonald et al., 1964), while Emmons and Mitchell (1965) showed that aggregating agents caused increased platelet to-platelet adhesion in the post-operative period. We have shown (Hampton and Mitchell, 1966a) that agents which cause platelet aggregation induce changes in platelet surface charge as estimated by measurement of the platelet electrophoretic mobility. Low concentrations of these agents cause an increase in mobility, and concentrations of the order which cause aggregation in a stirred system cause a decrease in mobility. During these investigations we found that platelets from patients with a wide variety of acute illnesses behaved abnormally, and these abnormalities are described in this paper.