tbuckley/cabot-search huggingface dataset:
Risk of tuberculosis in close contacts of patients with multidrug resistant tuberculosis: a nationwide cohort
Authors: A Attamna, D Chemtob, S Attamna, A Fraser, E Rorman, M Paul, L Leibovici
Journal: Thorax (2009)

Data on the efficacy of drugs for preventing multiple drug resistant tuberculosis (MDR-TB) in people at risk after close contact with patients is lacking. In a systematic review, we found only two small cohort studies that addressed this question.1 The aim of the present study was to describe the incidence of MDR-TB disease in people who were in close contact with patients with pulmonary MDR-TB, and to compare the incidence in people that were offered prophylaxis to those that were not (see online appendix).

Patients with MDR-TB were identified by inspecting the records of patients that were referred to the nine designated TB centres in Israel; records of the national referral laboratory and the central registry held by the Ministry …
Billions of dollars needed to close global spending gap on cancer care
Authors: K. McColl
Journal: BMJ (2009)

An annual investment of $217bn (£134bn; €152bn) is needed to meet the shortfall in global spending on cancer care and treatment, says a report from the Economist Intelligence Unit. 

The report, which was commissioned by the Lance Armstrong Foundation, calculates that of the estimated 12.9 million new cancer cases in 2009, almost two thirds (61%) will occur in low or middle income countries. Yet only 5% of the resources currently allocated to fighting cancer globally are spent in the developing world.

New cases of cancer will cost $305bn this year …
Complement activation and complement control proteins in acute pancreatitis.
Authors: J T Whicher, M P Barnes, A Brown, M J Cooper, R Read, G Walters, R C Williamson
Journal: Gut (1982)

Serum levels of the complement proteins C3, C4, C1 inhibitor (C1 INH), factor I (C3b inactivator) and factor H (BIH) and plasma levels of cleavage products of C3 (C3c) and factor B were measured in 26 patients with acute pancreatitis. Breakdown of C3 occurred in 19 patients, as shown by a reduction in C3 level and the presence of C3c. C4 levels, however, did not fall and factor B breakdown products were not detected, thus suggesting that enzymatic cleavage of C3 occurred without significant involvement of either the early classical pathway or the alternative pathway. C1 INH and factor H both showed increases, presumably reflecting an acute phase response. Factor I showed an initial fall followed by a rise. There was no correlation between the presence or extent of C3 breakdown and the clinical condition of the patients. It is concluded that C3 cleavage in pancreatitis probably results from tryptic activity and that the measurement of complement components has no part to play in the management of the disease.
Audits of antibiotic prescribing in a Bristol hospital.
Authors: P J Swindell, D S Reeves, D W Bullock, A J Davies, C E Spence
Journal: BMJ (1983)

Audits of antibiotic prescribing were done for periods of up to eight weeks in two successive years on medical, surgical, orthopaedic, gynaecology, obstetric, and urology wards and in an accident and emergency department. Clinical details were matched with antibiotic prescribing, and the appropriateness of the latter was judged independently by two medical microbiologists. Only when they agreed was an individual prescription included in the analysis. Overall, 28% of prescriptions in 1979 and 35% in 1980 were judged as unnecessary, with 17% and 16%, respectively, being for inappropriate choices of antibiotic. An educational programme about antibiotic prescribing carried out between the audits had no beneficial effect overall. Though the results compared favourably with those of audits published, prescribing could still be much improved. To judge by the failure of education, however, this might be difficult to achieve. Most prescriptions were written by junior staff, who in the absence of guidance from their seniors and because of their frequent moves would require a widespread and continual education programme. Published concern about the quality of antibiotic prescribing appears to be justified.
Preselection Based on Clinical Characteristics in German Non–Small-Cell Lung Cancer Patients Screened for EML4-ALK Translocation
Authors: Amanda Laura Helen Tufman, Martin Edelmann, Fernando Gamarra, Simone Reu, Astrid Borgmeier, Kathrin Schrödl, Regine Zauber, Ullrich Müller-Lisse, Rudolf Maria Huber
Journal: Journal of Thoracic Oncology (2013)
US report warns that lack of health insurance affects overall service provision
Authors: C. Marwick
Journal: BMJ (2003)

The lack of available health insurance for some people affects the provision of health services to everyone, not just to those who are not insured, warns a report published by the US Institute of Medicine last week.

The fourth report from an Institute of Medicine's committee on the impact of the lack of health insurance in the US argued that the lack of such insurance for some people affected health services as a whole. Dr Arthur Kellerman, chairman of the department of medicine at Emory University School of Medicine in Atlanta, Georgia, and joint chairman of the Institute of Medicine's committee, said: “It's mistaken and dangerous to assume that this affects only those who are uninsured. Since the …
The Cyanotic Infant — Heart Disease or Lung Disease
Authors: Daniel C. Shannon, Martha Lusser, Allan Goldblatt, J. Bert Bunnell
Journal: New England Journal of Medicine (1972)

Abstract To determine whether differential diagnosis in infants with cyanosis of uncertain etiology may be facilitated without requiring cardiac catheterization, the Pao2, Paco2, pH and bicarbonate of aortic blood were measured in 28 cyanotic infants. Measurements were made 10 to 15 minutes after the infant has breathed oxygen at a concentration of 0.9 to 1.0 at atmospheric pressure, and again 10 to 15 minutes after breathing the same concentration of oxygen under a positive end-expiratory pressure of 8 to 10 cm of water. In seven with subsequently proved cardiac disease, Pao2 fell 33 mm Hg on the average, whereas Paco2 rose 9 mm Hg. In 21 infants with subsequently proved lung disease, Pao2 rose an average of 141 mm Hg, whereas Paco2 did not change. Thus, a simple procedure is available to help differentiate cyanosis of cardiac from that of pulmonary causation; it permits earlier diagnosis of the former and avoids the risks of cardiac catheterization in the latter.
Florida governor orders reinsertion of feeding tube
Authors: F. Charatan
Journal: BMJ (2003)

A special session of the Florida Legislature has authorised the state's governor to order a feeding tube to be reinserted in Mrs Terri Schiavo, who has been in a persistent vegetative state since a cardiac arrest in 1990 (25 October,(p 949).

The governor, Jeb Bush, last week overruled the appeals court judge, who in November 2002, at the husband's request, ordered the removal of the feeding tube.

After the governor's order reinstating the feeding tube, another judge agreed to appoint a special legal guardian for Mrs Schiavo. …
Costs and Benefits of Cesarean Sections-Reply
Authors: Benjamin P. Sachs
Journal: JAMA (1984)

<h3>In Reply.—</h3> Dr Nabors' kind words are appreciated. We were unable to assess either the cost of long-term care for infants that do not die or the decreased cost for those infants less traumatized because of a cesarean delivery. We therefore emphasized that our study was not meant to be a cost-benefit analysis but an opening shot in a discussion that needs to take place.
Immunoglobulins Against Tyrosine-Nitrated Epitopes in Coronary Artery Disease
Authors: Leonor Thomson, Margarita Tenopoulou, Richard Lightfoot, Epida Tsika, Ioannis Parastatidis, Marissa Martinez, Todd M. Greco, Paschalis-Thomas Doulias, Yuping Wu, W.H. Wilson Tang, Stanley L. Hazen, Harry Ischiropoulos
Journal: Circulation (2012)

Several lines of evidence support a pathophysiological role of immunity in atherosclerosis. Tyrosine-nitrated proteins, a footprint of oxygen- and nitrogen-derived oxidants generated by cells of the immune system, are enriched in atheromatous lesions and in circulation of patients with coronary artery disease (CAD). However, the consequences of possible immune reactions triggered by the presence of nitrated proteins in subjects with clinically documented atherosclerosis have not been explored.Specific immunoglobulins that recognize 3-nitrotyrosine epitopes were identified in human lesions, as well as in circulation of patients with CAD. The levels of circulating immunoglobulins against 3-nitrotyrosine epitopes were quantified in patients with CAD (n=374) and subjects without CAD (non-CAD controls, n=313). A 10-fold increase in the mean level of circulating immunoglobulins against protein-bound 3-nitrotyrosine was documented in patients with CAD (3.75±1.8 μg antibody Eq/mL plasma versus 0.36±0.8 μg antibody Eq/mL plasma), and was strongly associated with angiographic evidence of significant CAD.The results of this cross-sectional study suggest that posttranslational modification of proteins via nitration within atherosclerotic plaque-laden arteries and in circulation serve as neo-epitopes for the elaboration of immunoglobulins, thereby providing an association between oxidant production and the activation of the immune system in CAD.
Modem radiology in historical perspective.
Authors: John H. Raach
Journal: JAMA (1963)

The field of radiology has developed during the lifetime of many physicians still living. When Röntgen made his momentous discovery, it was not fully appreciated by the medical profession. Early workers in the field included physicists, engineers, electricians, photographers, side-show operators, and, of course, charlatans as well as physicians. The author of the present book has performed a great service by his compilation of biographical comments on the outstanding contributors to this field. What is more, he has presented a thoughtful narration in connection with the sequence of events which have culminated in the specialty that we know. This monograph reveals considerable research into the background of radiology and is definitive in the presentation of the historical development. One minor criticism of the book is that it reads like a series of lectures, which it is. This in no way really detracts from the information that the book contains. There
Abstract PR4: Incomplete inhibition of phosphorylation of 4EBP1 is a mechanism for KRAS driven resistance to the ATP-competitive mTOR inhibitor PP242 in colorectal cancer
Authors: Gregory S. Ducker, Chloe E. Atreya, Kevan M. Shokat, Robert S. Warren
Journal: Clinical Cancer Research (2012)

Abstract The mammalian target of rapamycin (mTOR) regulates cell growth by integrating nutrient and growth factor signaling and has been strongly implicated in cancer. But mTOR is not an oncogene, and which tumors will be resistant and sensitive to new ATP-competitive mTOR inhibitors now in clinical trials remains unknown. We screened a panel of 357 human cancer cell lines to identify common markers of resistance and sensitivity to the mTOR inhibitor PP242. Analysis by tissue of origin and genetic mutation revealed colorectal origin as the most statistically significant marker for resistance to therapy, while KRAS and PI3K mutations were the most significant genetic markers for resistance and sensitivity respectively. Notably, KRAS mutations are overrepresented in colorectal cancer (CRC) cell lines. Within CRC cell lines, those with KRAS mutations were most resistant to PP242 while those with other mutations were more sensitive; cell lines with co-mutation of PI3K and KRAS had intermediate sensitivity. Immunoblot analysis of the signaling networks downstream of mTOR revealed that the degree of cellular growth inhibition induced by PP242 was directly correlated with inhibition of phosphorylation of the translational repressor eIF4E binding protein 1 (4EBP1), but not ribosomal protein S6. We were able to recapitulate these observations using a pair of KRAS mutant isogenic cell lines differing only by a PI3K mutation. PP242 treatment of the PI3K mutant cell line increased the observed inhibition of 4EBP1 phosphorylation and improved the drug response. In an efficacy trial of PP242 in primary CRC xenograft tumors, resistance to inhibition of 4EBP1 phosphorylation was again observed in KRAS mutant tumors and these tumors responded poorly compared to KRAS WT controls. We show that, in the absence of PI3K co-mutation, KRAS mutations are associated with resistance to PP242 and that this is specifically linked to changes in the 4EBP1 phosphorylation state in both CRC cell lines and primary patient xenografts. This proffered talk is also presented as Poster A35.
Specific IgM Antibody in Serum of Patients with Herpes Zoster Infections
Authors: C. A. C. Ross, R. McDaid
Journal: BMJ (1972)

Specific IgM varicella-zoster antibody was detected in "convalescent" sera from 20 out of 40 patients (50%) with herpes zoster infections. Since these were not primary infections with varicella-zoster virus, it seems that detection of IgM antibody specific for a particular virus may not differentiate a primary infection from secondary infections with that virus.
Response: Re: Residual Treatment Disparities After Oncology Referral for Rectal Cancer
Authors: Arden M. Morris, Kevin G. Billingsley, Barbara Matthews, Laura-Mae Baldwin, Awori J. Hayanga, John D. Birkmeyer
Journal: JNCI Journal of the National Cancer Institute (2008)

We appreciate the interest of Dr Field and colleagues in our recent article (1). The main objective of our study was to better understand mechanisms that underlie racial disparity in the receipt of adjuvant therapy for rectal cancer, including access to care. Using Surveillance, Epidemiology, and End Results–Medicare data, we found no statistically significant difference between black and white patients in the rates of consultation with an oncologist but a persistent and statistically significant difference in the rates of receipt of adjuvant therapy after consultation. A secondary finding was that racial disparities in receipt of care were greatest among patients with fewer comorbid diseases and those who tended to be younger.

Field and colleagues were concerned about our exclusion criteria and assumed that they limited the statistical power of our study. Overall, 54% of black patients were excluded and 41% of white patients were excluded. The difference in proportions was primarily due to racial differences in complete enrollment in Medicare parts A and B during the study and in the rates of resection. A limitation of such claims data is that little can be said about those who were not enrolled. The statistical power of the study is a nonissue, because our results were statistically significant. For example, analysis of the difference between white and blacks in the receipt of both chemotherapy and radiation therapy had a statistical power of 91.4%, which precludes the existence of a type II error.

Field and colleagues also assumed that our examination of incident cases for 1992–1999 may have limited relevance of the findings, noting that preoperative chemoradiation is now standard practice for advanced rectal cancer. Although such practice is no doubt desirable, we examined time trends in the use of radiation (2) and found that more than 30% of patients with stage III rectal cancer diagnosed in 2000 still did not receive pre- or postoperative radiation. Unlike Field and colleagues, we maintain that the year 2000 must be considered within the era of modern practice.

Finally, we congratulate Field and colleagues on their audit of their patients' receipt of adjuvant therapy for rectal cancer. They demonstrate that as patients age they are less likely to receive chemotherapy. Although this finding has nothing to do with racial disparities in receipt of chemotherapy, we concur. The majority of patients in our study were less likely to receive chemotherapy with increasing age. We look forward to a more comprehensive analysis of the data from Dr Field and colleagues in the future.
Severe Burns From Butane Lighter Explosions
Authors: Richard G. Lanzara
Journal: JAMA (1977)

<h3>To the Editor.—</h3> In the span of one month, the University of Michigan Burn Unit has admitted two patients suffering from severe third-degree burns from butane lighter explosions. Both patients are women, aged 40 and 51 years, respectively, and both have 40%, full-thickness burns to the neck, chest, abdomen, arms, and thighs. Family witnesses stated that the patients were using the lighters to light cigarettes when the lighters exploded. These incidences seem unusual in the nature of occurrence and in the short period of incidence (Feb 15, 1977, to March 16, 1977) within the metropolitan Detroit area. Currently, we are trying to ascertain the extent of these occurrences, and we would appreciate it if physicians who know of cases involving butane lighter explosions would send such information to us at the following address: Department of Respiratory Therapy E-2250 University Hospital 1405 E Ann St Ann Arbor, MI 48109
Regression of established hepatocellular carcinoma is induced by chemoimmunotherapy in an orthotopic murine model
Authors: Diego M. Avella, Guangfu Li, Todd D. Schell, Dai Liu, Samuel Shao–Min Zhang, Xi Lou, Arthur Berg, Eric T. Kimchi, Hephzibah Rani S. Tagaram, Qing Yang, Serene Shereef, Luis S. Garcia, Mark Kester, Harriet C. Isom, Bart C. Rountree, Kevin F. Staveley–O'Carroll
Journal: Hepatology (2011)

The high rate of mortality and frequent incidence of recurrence associated with hepatocellular carcinoma (HCC) reveal the need for new therapeutic approaches. In this study we evaluated the efficacy of a novel chemoimmunotherapeutic strategy to control HCC and investigated the underlying mechanism that increased the antitumor immune response. We developed a novel orthotopic mouse model of HCC through seeding of tumorigenic hepatocytes from SV40 T antigen (Tag) transgenic MTD2 mice into the livers of syngeneic C57BL/6 mice. These MTD2–derived hepatocytes form Tag–expressing HCC tumors specifically within the liver. This approach provides a platform to test therapeutic strategies and antigen–specific immune–directed therapy in an immunocompetent murine model. Using this model we tested the efficacy of a combination of oral sunitinib, a small molecule multitargeted receptor tyrosine kinase (RTK) inhibitor, and adoptive transfer of tumor antigen–specific CD8+ T cells to eliminate HCC. Sunitinib treatment alone promoted a transient reduction in tumor size. Sunitinib treatment combined with adoptive transfer of tumor antigen–specific CD8+ T cells led to elimination of established tumors without recurrence. In vitro studies revealed that HCC growth was inhibited through suppression of STAT3 signaling. In addition, sunitinib treatment of tumor–bearing mice was associated with suppression of STAT3 and a block in T–cell tolerance. Conclusion : These findings indicate that sunitinib inhibits HCC tumor growth directly through the STAT3 pathway and prevents tumor antigen–specific CD8+ T–cell tolerance, thus defining a synergistic chemoimmunotherapeutic approach for HCC. (Hepatology 2012;55:141–152)
Conference calls for urgent action on food security in Pacific
Authors: J. Parry
Journal: BMJ (2010)

A summit aimed at tackling the growing burden of poor food security in Pacific island countries has resulted in an ambitious framework for action to tackle diet related health problems in the region.

Rapid changes in diet and lifestyle in these countries have led to rising rates of obesity, malnutrition, and micronutrient deficiencies and greater prevalence of foodborne diseases and diet related non-communicable diseases. The Pacific Food Summit, held in Port Vila, Vanuatu, from 21 to 23 April, brought together more than 170 delegates from Pacific island countries and territories, as well as Australia and New Zealand, to agree on a framework for action …
Reply from Authors re: Michael W. Kattan. Classification and Regression Trees Versus Nomograms: A Bone Scan Positivity Example. Eur Urol 2010;57:559–60
Authors: Alberto Briganti, Umberto Capitanio, Nazareno Suardi, Andrea Gallina, Patrizio Rigatti, Francesco Montorsi
Journal: European Urology (2010)
Normal Variants of a Photon-Deficient Area in the Lower Sternum Demonstrated by Bone SPECT
Authors: JIAN-KUI HAN, WEI-JEN SHIH, V. STIPP, S. MAGOUN
Journal: Clinical Nuclear Medicine (1999)

A highly variable normal appearance of the sternal area makes interpretation difficult on planar bone imaging. These normal variants occur especially in the area above the xiphoid process of the sternum in which an oval photopenic area on anterior planar images may be seen. This finding is most likely caused by localized incomplete fusion.Of a group of 188 patients, 35 patients (33 men, 2 women; age range, 30 to 85 years; mean age, 57 years) were examined with sternal SPECT and planar bone imaging. These patients, who had no history of sternal trauma, surgery, radiation, or infection, were referred for bone scan for metastatic work-up (n = 20), back pain (n = 6), and other conditions (n = 9). Thus 11 of 35 (31%) patients had a SPECT study that showed a photopenic area in the lower sternum.The incidence of this normal variant was higher than the 2% to 7.7% previously reported, indicating improved detection by SPECT. The normal variant appears to be less apparent on planar bone images and is seen more clearly on SPECT images.Differentiation from malignancy appears to be related to lesion symmetry, location, midline, and evenly distributed radioactivity surrounding the edge of the photopenic area.
Annulus Instead of LVOT Diameter Improves Agreement Between Echocardiography Effective Orifice Area and Invasive Aortic Valve Area
Authors: Troy M. LaBounty, Rhonda Miyasaka, Stanley Chetcuti, Paul M. Grossman, George Michael Deeb, Himanshu J. Patel, Anna Booher, Smita Patel, David S. Bach
Journal: JACC. Cardiovascular imaging (2014)
Bad medicine: pain
Authors: D. Spence
Journal: BMJ (2010)

I knew the course of the lingual nerve but not the basics of pain management. I am still haunted by the yells of patients in pain in wards through the night. Pain management was barely taught, and doctors were fearful of powerful opioids. Rightly we have striven to improve training in pain management, especially in palliative care and after operations. The establishment of hospital pain clinics has played a key role, and patients have an absolute right to be free of pain. Opioids, however, are now prescribed widely …
COMBINED METFORMIN AND VILDAGLIPTIN THERAPY PROVIDES CARDIOPROTECTION AGAINST ISCHEMIA-REPERFUSION INJURY IN OBESE-INSULIN RESISTANT RATS BY ATTENUATING CARDIAC MITOCHONDRIAL DYSFUNCTION
Authors: Nattayaporn Apaijai, Jantira Sanit, Kroekkiat Chinda, Siripong Palee, Siriporn Chattipakorn, Nipon Chattipakorn
Journal: Journal of the American College of Cardiology (2014)
Genetic Screening by Insurance Carriers
Authors: Marvin A. Dewar
Journal: JAMA (1992)

<h3>To the Editor.</h3> —The article by the American Medical Association's Council on Ethical and Judicial Affairs regarding genetic testing by employers<sup>1</sup>is timely and welcome. For many Americans, the workplace is the major source of insurance; therefore, employment-related genetic testing is likely to impact not only on employment, but on the availability and affordability of life, health, and disability insurance. Insurers quantify the risk characteristics of individuals and small groups to establish the price and availability of insurance. New screening and diagnostic technologies will expand the genetic information available to insurers for stratifying the risk in the insurance pool. Individuals at increased risk for genetic diseases (including those whose risk of disease is clinically apparent, subclinical, or merely probabilistic) may find insurance increasingly unaffordable or altogether unavailable. Insurers may apply genetic information inappropriately. Individual risk will be overestimated if the concepts of penetrance and variable expressivity are not considered.