tbuckley/cabot-search huggingface dataset:
P42 Comparison of Ventilation Heterogeneity Indices Derived from Multiple Breath Inert Gas Washout
Authors: S Gonem, S Natarajan, S Corkill, A Singapuri, D Desai, P Gustafsson, CE Brightling, S Siddiqui
Journal: Thorax (2012)

<h3>Introduction and objectives</h3> Multiple breath inert gas washout (MBW) is a technique for quantifying ventilation heterogeneity (VH). Commonly-used indices of VH such as lung clearance index (LCI) may be biased by alterations in functional residual capacity, tidal volume and anatomical dead space. We hypothesised that a novel marker of VH, exponential decay index (EDI) would exhibit more favourable measurement properties than established indices. <h3>Methods</h3> Seventy-four patients with asthma and eighteen healthy control subjects were recruited. MBW was performed in triplicate in each subject using a modified Innocor gas analyser (Innovision A/S, Odense, Denmark). Analysis of the washout curve yielded a number of VH parameters including LCI, mixing ratio (MiR), moment ratio (MoR) and the novel parameter EDI. EDI was calculated by fitting the washout data to both one-phase and two-phase exponential decay models and deriving the difference in goodness of fit (R2) between the two models. Phase III slope analysis yielded values for Scond, Sacin and first breath SnIII (FB SnIII). Repeatability was assessed using intraclass correlation coefficient (ICC), and ability to discriminate between health and disease was determined using receiver operating characteristic (ROC) curves. Robustness to variations in FRC, Vt and Vd was determined by calculating the ratio of signal (absolute difference between healthy and asthma groups) to noise (standard deviation of calculated ‘ideal’ values for each subject, assuming perfect gas mixing). <h3>Results</h3> The most repeatable parameters were LCI (ICC = 0.905), MoR (ICC = 0.869), FB SnIII (ICC = 0.867) and Sacin (ICC = 0.846). The most discriminatory parameters were FB SnIII, Sacin and EDI, with areas under the ROC curve of 0.728, 0.707 and 0.691 respectively. Signal-to-noise ratios for LCI, MiR and MoR were 1.726, 3.911 and 0.679 respectively, thus accounting for the poor discriminatory ability of these markers. <h3>Conclusion</h3> FB SnIII and Sacin appear to be the most favourable markers of VH. EDI is the most discriminatory parameter that does not rely on phase III slope analysis. Since FB SnIII may be derived from a single-breath manoeuvre, this parameter warrants further investigation in other disease groups, and normative values should be derived in large healthy populations.
The Appropriateness of Carotid Endarterectomy
Authors: Fred A. Weaver
Journal: JAMA (1987)

<h3>To the Editor.—</h3> The recent article entitled "Use of Carotid Endarterectomy in Five California Veterans Administration Medical Centers" by Merrick et al<sup>1</sup>concluded that carotid endarterectomy is overutilized within some segments of the Veterans Administration patient population. This conclusion was obtained following a retrospective review of the records of 95 patients in five Veterans Administration hospitals who underwent 107 carotid endarterectomies for a variety of indications in 1981. The appropriateness or inappropriateness of such intervention was determined by the application of the Rand/ UCLA Health Services Utilization Study (HSUS) on indications for carotid endarterectomy. The authors' intent was to determine whether this high-cost procedure was being utilized appropriately or overutilized. In this context, indications for carotid endarterectomies performed were found to be appropriate in 55% of patients, equivocal in 32%, and inappropriate in 13%. Although the authors' intention was worthwhile, the conclusions reached by Merrick and colleagues are suspect
Hodgkin's Disease Diagnosed After Salmonella Infection
Authors: Malin R. Dollinger
Journal: JAMA (1965)

<h3>To the Editor:—</h3> I read with interest the report of Heineman and associates on "Hodgkin's Disease and<i>Salmonella typhimurium</i>Infection" (<i>JAMA</i><b>188</b>:632-634 [May 18] 1964). The importance of the association between infection with this strain of<i>Salmonella</i>and Hodgkin's disease was emphasized in a patient seen in 1960 at this center. A 40-year-old Chinese male had a three-month illness characterized by chills, fever, and weight loss, without other significant symptoms or findings.<i>S typhimurium</i>was grown from blood, bone marrow, and urine cultures and he was treated with chloramphenicol. Since extensive diagnostic studies were unrevealing, it was assumed that the<i>Salmonella</i>sepsis accounted for the entire clinical picture. When he died three months after the onset of his illness, Hodgkin's disease confined to the retroperitoneal area was found. This had not been suspected clinically. At the time of this patient's hospitalization, the relationship between infection with this strain of
NO EVIDENCE FOR GENERAL THALLIUM POISONING IN GUYANA
Authors: G De Groot, T.J.F Savelkoul, H.P Remmert, K.L Wubs, B.Lopez Cardozo, D.Van Alphen, Noel Blackman, RuthA Etzel, EricJ Sampson, RichardA Keenlyside, Peter Diggory, Suzanne Binder, RichardL Ehrenberg
Journal: The Lancet (1987)
Lithium and suicide
Authors: A. Berghofer
Journal: BMJ (2013)

With its unequivocal antisuicidal effects lithium is still a useful drug 

Losing a family member or friend to suicide leaves survivors feeling helpless, bewildered, and guilty for the rest of their lives. The loss of a patient to suicide is one of a doctor’s worst nightmares. For patients with affective disorders, the lifetime risk of committing suicide is substantial, and this has serious social and economic implications. The prevention of suicide and treatment of suicidal behaviour in those with major psychiatric disorders has therefore become the focus of therapeutic activities at the individual and social level. In a linked paper (doi:10.1136/bmj.f3646), Cipriani and colleagues present an update of their earlier meta-analysis on the effectiveness of lithium in preventing suicide in patients with mood disorders.1 

Although lithium first proved its usefulness in the acute and long term treatment of affective disorders more than 60 years ago, its …
"Ethics Man" misses mark: most bioethicists are not thugs
Authors: J. S. Crites, R. L. Volpe
Journal: BMJ (2012)

Although Sokol never explicitly says that bioethicists (clinical ethics consultants) are bullies, his anthropomorphism of bioethics insinuates this.1 It would be a tragedy for readers to believe that Sokol accurately portrays the entire field.

Clinical ethics straddles theoretical inquiry and practical application, but theoretical inquiry is not responsible …
Association of Chronic Nasal Carriage of Staphylococcus aureus and Higher Relapse Rates in Wegener Granulomatosis
Authors: Coen A. Stegeman
Journal: Annals of Internal Medicine (1994)

Objective: To examine possible risk factors for relapse, including chronic nasal carriage of Staphylococcus aureus and serial antineutrophil cytoplasmic antibody (ANCA) determinations in patients with Wegener granulomatosis. Design: Observational cohort study. Setting: Outpatient clinic at a university-affiliated hospital. Patients: Consecutive patients (n = 71) with biopsy-proven Wegener granulomatosis who were seen during follow-up at the outpatient clinic from January 1988 to July 1991. Fourteen patients were ineligible or dropped out; 57 patients were analyzed. Measurements: Serial ANCA determinations and swab cultures of both anterior nares for S. aureus taken at each visit every 4 to 6 weeks. Occurrence of infections and relapses of Wegener granulomatosis were identified according to strict, predefined criteria. Results: Thirty-six of the 57 patients (63%; 95% CI, 49% to 76%) were found to be chronic nasal carriers of S. aureus (≥ 75% of nasal cultures positive for S. aureus). Proportional-hazards regression analysis identified chronic nasal carriage of S. aureus (adjusted relative risk, 7.16; CI, 1.63 to 31.50), creatinine clearance above 60 mL x min−1 (adjusted relative risk, 2.94; CI, 1.27 to 6.67), and a history of previous relapses of Wegener granulomatosis (adjusted relative risk, 1.33; CI, 0.98 to 1.78) as independent risk factors for relapse. Twenty-two of 33 patients persistently or intermittently positive for ANCA had a relapse as opposed to only 1 of 21 persistently negative patients. Relapses of Wegener granulomatosis were not related to diagnosed infections. Conclusion: Chronic nasal carriage of S. aureus identifies a subgroup of patients with Wegener granulomatosis who are more prone to relapses of the disease, suggesting a role for S. aureus in its pathophysiology and a possible clue for treatment.
US drug company executives could face criminal charges for off-label promotion
Authors: J. Lenzer
Journal: BMJ (2010)

Executives of drug companies may face charges in a criminal court if their companies promote the off-label use of drugs, an attorney for the US Food and Drug Administration has said.

The agency’s deputy chief for litigation, Eric Blumberg, speaking at a conference in Washington, DC, said, “It’s clear we’re not getting the job done with large, monetary settlements. Unless the government shows more resolve to criminally charge individuals at all levels in the company, we cannot expect to make progress in deterring off-label promotion.”

Blumberg cited Pfizer, the world’s largest drug manufacturer, for violating regulations forbidding the promotion of drugs for conditions other than those approved by the FDA.

Monetary settlements have reached record highs …
Lawyers poised to sue US junk food manufacturers
Authors: F. Charatan
Journal: BMJ (2002)

The first lawyer to sue the tobacco industry is predicting a series of similar suits against the fast food industry for its role in the obesity epidemic.

Professor John Banzhaf of George Washington University, Washington, DC, said that successful lawsuits mounted against tobacco companies have set a precedent for suing the fast food chains and snack food companies for their part in the increasing obesity epidemic in the United States.

“As we're getting more and more figures saying just how dangerous …
P611 GAS6/AXL AXIS AS PROGNOSTIC AND THERAPEUTIC TARGET IN LIVER DISEASE
Authors: C. Barcena, M. Stefanovic, A. Tutusaus, L. Joannas, J. Caballeria, M. Mari, J.C. Fernandez-Checa, C.V. Rothlin, P. Garcia de Frutos, A. Morales
Journal: Journal of Hepatology (2014)
Associations between Polycyclic Aromatic Hydrocarbon–Related Exposures and <i>p53</i> Mutations in Breast Tumors
Authors: Irina Mordukhovich, Pavel Rossner, Mary Beth Terry, Regina Santella, Yu-Jing Zhang, Hanina Hibshoosh, Lorenzo Memeo, Mahesh Mansukhani, Chang-Min Long, Gail Garbowski, Meenakshi Agrawal, Mia M. Gaudet, Susan E. Steck, Sharon K. Sagiv, Sybil M. Eng, Susan L. Teitelbaum, Alfred I. Neugut, Kathleen Conway-Dorsey, Marilie D. Gammon
Journal: Environmental Health Perspectives (2009)

Previous studies have suggested that polycyclic aromatic hydrocarbons (PAHs) may be associated with breast cancer. However, the carcinogenicity of PAHs on the human breast remains unclear. Certain carcinogens may be associated with specific mutation patterns in the p53 tumor suppressor gene, thereby contributing information about disease etiology.We hypothesized that associations of PAH-related exposures with breast cancer would differ according to tumor p53 mutation status, effect, type, and number.We examined this possibility in a population-based case-control study using polytomous logistic regression. As previously reported, 151 p53 mutations among 859 tumors were identified using Surveyor nuclease and confirmed by sequencing.We found that participants with p53 mutations were less likely to be exposed to PAHs (assessed by smoking status in 859 cases and 1,556 controls, grilled/smoked meat intake in 822 cases and 1,475 controls, and PAH-DNA adducts in peripheral mononuclear cells in 487 cases and 941 controls) than participants without p53 mutations. For example, active and passive smoking was associated with p53 mutation-negative [odds ratio (OR) = 1.55; 95% confidence interval (CI), 1.11-2.15] but not p53 mutation-positive (OR = 0.77; 95% CI, 0.43-1.38) cancer (ratio of the ORs = 0.50, p < 0.05). However, frameshift mutations, mutation number, G:C-->A:T transitions at CpG sites, and insertions/deletions were consistently elevated among exposed subjects.These findings suggest that PAHs may be associated with specific breast tumor p53 mutation subgroups rather than with overall p53 mutations and may also be related to breast cancer through mechanisms other than p53 mutation.
A 67-Year-Old Man Who e-Mails His Physician
Authors: Warner V. Slack
Journal: JAMA (2004)

DRSHIP:Mr S is a 67-year-old retired public service worker who lives in the Boston area with his wife. He has Medicare and indemnity insurance. Approximately 4 months ago, Mr S started to communicate by e-mail with his hospital-based primary care physician Dr G, using the hospital’s secure Internet site for patients. Previously, Mr S would call his physician with questionsandleaveamessage.Henowfindselectroniccommunication both easier and faster. He has not encountered problemswiththisformofcommunicationandhasfewconcerns about privacy. Mr S tries to keep his e-mails brief because he feels that his physician’s time is valuable. Mr S understands that it takes time for his physician to respond to e-mail questions and says he would be willing to pay additionally for this. However, he is not sure how much such service is worth.
SPINAL HYDATID CYSTS CAUSING SEVERE "COMPRESSION MYELITIS.": OPERATION, WITH SUCCESSFUL RESULTS
Authors: P. Tytler, R. T. Williamson
Journal: BMJ (1903)

Torticollis dealt with, and at satne time brachial plexus exposed.Cicatricial mass at junction of lifth and sixth cervlcal nerves.Mass excised and suture of fifth and sixth nerves to the three distal ends.On November x3th (five months after operation) dis- tinctly improved contractions in deltoid by faradic stimulation.Faradic irritability also present distinctly in biceps.No improvement ini move- ments.CASE III.-M.T., female, born February, I902, fifth child.Transverse pre- sentation, version.Arms slipped above head, and in bringing them down, left arm fractured at middle of humerus.Arm placed in splints on account of fracture.After splints removed arm hung useless by side.Defect attributed to the fracture involving nerves in the arm.Sent to me in June.Typical Duclienne's paralysis; extreme inward rotation, no abduction, no flexion of, forearm, no supination, no loss of cutan- eous sensation.Involvement of nerves at seat of fracture there- fore excluded.Operation delayed till child six months old, by which me there was still no sign of faradic irritability in the affected muscles.Operation In Western Inflrmary on August 14th.Junction of fifth and sixth cervical nerves found cic4tricial and-excised together with' affected por- tions of the nerves centrally and peripherally to the junction.Wound healed in fourteen days.Examined November ioth (twelve and a-half weeks after operation).Arm no longer rotated inwards, but no apparent improvement in the vQluntary movements.Electrical reactions showed distinctfaradic irritability in deltoid and biceps.Fig. 3 (p. 300)shows the child previous to operation.
Newly identified c-KIT receptor tyrosine kinase ITD in childhood AML induces ligand-independent growth and is responsive to a synergistic effect of imatinib and rapamycin
Authors: Selim Corbacioglu, Mehtap Kilic, Mike-Andrew Westhoff, Dirk Reinhardt, Simone Fulda, Klaus-Michael Debatin
Journal: Blood (2006)
NHS should ban use of starch based intravenous fluids, say researchers
Authors: J. Wise
Journal: BMJ (2013)

Starch based colloid intravenous fluids may be causing around 250 unnecessary deaths in the United Kingdom every year, a new Cochrane systematic review concludes.1 The study’s authors call on the NHS to ban the use of starch based colloid fluids and instead use safer and cheaper crystalloid fluids.

Starch based colloid fluids are used widely in the NHS in the fluid resuscitation of critically ill patients after trauma, burns, or surgery. However, they are more expensive than …
Commentary: Denmark's health reforms are part of a wider trend
Authors: R. B. Saltman, K. Vrangbaek, J. Lehto, U. Winblad
Journal: BMJ (2012)

Rudkjobing and colleagues’ article on Danish efforts to improve integrated care provides valuable insight into the current health reform process in publicly funded health systems.1 National policymakers—facing performance, outcome, and efficiency challenges in the care of chronically ill elderly patients—have implemented a series of mechanisms to better coordinate locally organised care. The new Danish approaches include mandatory agreements between regions (and their hospitals) and municipalities (which administer long term and social care services); targeted financial incentives to encourage general practitioners to better manage debilitating conditions like diabetes and to make more home visits; placing GPs inside designated hospital departments to advise in coordination with primary health services; and establishing patient pathways for the treatment of cancers, heart disease, and other complex conditions. Forthcoming measures that will impose a de facto national veto on municipal budgets (regional budgets are already …
PREDETERMINATION BY INFECTION AND BY VACCINATION OF ANTIBODY RESPONSE TO INFLUENZA VIRUS VACCINES
Authors: Fred M. Davenport, Albert V. Hennessy
Journal: The Journal of Experimental Medicine (1957)

The antibody orienting effects of prior infections with antigenic variants of influenza viruses were confirmed by studies with monovalent adjuvant vaccines and with polyvalent aqueous and adjuvant preparations. In either case, the predominant antibody response was of a "booster" type, directed against the major antigens of strains of original infection. It was shown that vaccination with appropriate strains, selected as antigenic prototypes, could orient or predetermine subsequent antibody response upon revaccination. Moreover, the effects of exposure by vaccination were found to be durable and to constitute a foundation upon which future antibody dividends could be accumulated. As a result, it seems feasible to induce by vaccination a more lasting broad composite antibody protection against influenza if appropriate preparations and schedules are used.
Ileocolic Lesions in Woman With Abdominal Pain
Authors: Harold B. Zimmerman
Journal: JAMA (1979)

<h3>History</h3> A 64-year-old woman reported intermittent increasingly severe midabdominal crampy pain for two months. Gastrointestinal inquiry otherwise was unrevealing. The patient had been treated for pulmonary tuberculosis 35 years earlier. A firm mass was palpated to the right of the umbilicus. Several stool specimens were positive for occult blood. The hematocrit reading was normal. The roentgenogram in Fig 1 was obtained toward the conclusion of an antegrade small-bowel examination. Figure 2 shows a fluoroscopic spot film thereupon made of the ileocecal region. <h3>Diagnosis</h3> Carcinoid of the terminal ileum plus carcinoma of the cecum. <h3>Comment</h3> The small-bowel films (Fig 1 and 2) suggest, and a barium enema examination (Fig 3) subsequently verified, an abrupt irregular annular constriction of the cecum. In addition, as best observed on the ileocecal spot roentgenogram (Fig 2 and 4), the terminal ileum exhibits rigidity and narrowing, with medial angulation. Immediately proximal to this, the lumen, adjacent
Radionuclide Imaging of Splenic Laceration and Trauma
Authors: KAARE SOLHEIM, HANS J. NERDRUM
Journal: Clinical Nuclear Medicine (1979)

Tc-99m colloids are the pharmaceuticals preferred in the radionuclide diagnosis of splenic rupture. Spleen scintigraphy is also the preferred diagnostic method. It is rapid, safe, and reliable and should be recommended in all clinical situation where diagnosis is in doubt. A most important point is its value in following the healing of a splenic rupture managed nonoperatively or by suturing or resection, treatment modalities which are increasingly used at the present time.
834-3 Impaired hyperaemic myocardial blood flow is related to systolic function in idiopathic dilated cardiomyopathy
Authors: Paul Knaapen, M.W.J Götte, J.J.M Zwanenburg, J.T Marcus, P.A Dijkmans, W.G van Dockum, C.A Visser, A.C van Rossum, A.A Lammertsma, F.C Visser
Journal: Journal of the American College of Cardiology (2004)
The two faces of Eve
Authors: M. Plant
Journal: BMJ (1995)

One of the things that especially appeals to me about general practice is the way that people continue to present me with angles on their problems that I have not met before. Sometimes this causes me to re-evaluate my own assumptions and preconceptions in a way which can be challenging.

Not long ago a young woman came to see me. “I think,” she said, “I could be suffering from premenstrual tension.” I have learnt over the years to be suspicious of the conditional when used in this way. Women seem on the whole to be decided on this issue, only rarely do they want my opinion as to the nature of the diagnosis. So I asked her what made her think so, expecting to receive the usual catalogue of unhappy and uncomfortable symptoms loosely related to the days before her period. But such was not the case. Her boss, she explained, was a …
Sex Differences and Sex Steroids in Lung Health and Disease
Authors: Elizabeth A. Townsend, Virginia M. Miller, Y. S. Prakash
Journal: Endocrine Reviews (2012)

Sex differences in the biology of different organ systems and the influence of sex hormones in modulating health and disease are increasingly relevant in clinical and research areas. Although work has focused on sex differences and sex hormones in cardiovascular, musculoskeletal, and neuronal systems, there is now increasing clinical evidence for sex differences in incidence, morbidity, and mortality of lung diseases including allergic diseases (such as asthma), chronic obstructive pulmonary disease, pulmonary fibrosis, lung cancer, as well as pulmonary hypertension. Whether such differences are inherent and/or whether sex steroids play a role in modulating these differences is currently under investigation. The purpose of this review is to define sex differences in lung structure/function under normal and specific disease states, with exploration of whether and how sex hormone signaling mechanisms may explain these clinical observations. Focusing on adult age groups, the review addresses the following: 1) inherent sex differences in lung anatomy and physiology; 2) the importance of certain time points in life such as puberty, pregnancy, menopause, and aging; 3) expression and signaling of sex steroid receptors under normal vs. disease states; 4) potential interplay between different sex steroids; 5) the question of whether sex steroids are beneficial or detrimental to the lung; and 6) the potential use of sex steroid signaling as biomarkers and therapeutic avenues in lung diseases. The importance of focusing on sex differences and sex steroids in the lung lies in the increasing incidence of lung diseases in women and the need to address lung diseases across the life span.