tbuckley/cabot-search huggingface dataset:
Safety, Immunogenicity, and Induction of Immunologic Memory by a Serogroup C Meningococcal Conjugate Vaccine in Infants
Authors: Jenny M. MacLennan, Fiona Shackley, Paul T. Heath, Jonathan J. Deeks, Caroline Flamank, Mark Herbert, Helen Griffiths, Eva Hatzmann, Christian Goilav, E. Richard Moxon
Journal: JAMA (2000)

Neisseria meningitidis is a common cause of meningitis and septicemia in infants worldwide. Whether a meningococcal C conjugate vaccine protects infants against the serogroup C strain is unknown.To determine whether a meningococcal C conjugate vaccine is safe and immunogenic and induces immunologic memory in infants.Single-center, double-blind, randomized controlled trial in 1995 and 1996.Community, Oxfordshire, England.One hundred eighty-two healthy infants.Participants were randomly assigned to receive vaccination with 0. 5-mL doses of 1 of 2 lots of meningococcal C conjugate vaccine (groups 1 and 2; n=60 in each group) or a hepatitis B control vaccine (group 3; n=62), administered with routine immunizations at 2, 3, and 4 months of age. Approximately half of each group received meningococcal C conjugate vaccine and half received plain meningococcal polysaccharide vaccine (MPS) at 12 months of age.Serum antibodies to meningococcal C polysaccharide, assayed by enzyme-linked immunosorbent assay, and serum bactericidal activity (SBA), at 2, 3, 4, 5, 12, and 13 months of age; local and systemic reactions, recorded for 6 days after each vaccination, compared by intervention group.Meningococcal C conjugate vaccine was well tolerated. After 3 doses, children in groups 1 and 2 achieved significantly higher meningococcal C IgG geometric mean concentrations (21 and 17 U/mL, respectively, vs 0.20 U/mL; P<.001) and SBA titers (629 and 420, respectively, vs 4.1; P<. 001) than controls. At 12 months, antibody concentrations had decreased in all groups but remained significantly higher in children vaccinated with meningococcal C conjugate vaccine (SBA, 24 and 16 in groups 1 and 2, respectively, vs 4.2 in group 3; P<.001). Following vaccination with MPS at 12 months of age, SBA in the meningococcal C conjugate vaccine group was significantly higher than in controls (SBA, 789 vs 4.5; P<.001).Our data indicate that meningococcal C conjugate vaccine is safe and immunogenic and results in immunologic memory when given with other routinely administered vaccines to infants at 2, 3, and 4 months of age. JAMA. 2000;283:2795-2801
Early Vascular Risk Factor Modification in Type 1 Diabetes
Authors: Bruce A. Perkins, Vera Bril
Journal: New England Journal of Medicine (2005)

The discovery of insulin some 80 years ago changed type 1 diabetes from an imminently lethal disease to a chronic condition, and clinical care evolved from preventing death to preventing disability. Large-scale studies defined the natural history of the development of early retinal lesions and their progression to loss of vision, leading to interventions such as laser-photocoagulation therapy to help prevent vision loss.1 Similar work identified the fundamental importance of microalbuminuria as a sign of incipient kidney disease and defined some of the necessary interventions to prevent progression of diabetic nephropathy to impairment of renal function and end-stage renal disease. . . .
Proposed Increase in Dental Charges
Authors: A. J. Walters
Journal: BMJ (1971)

advancement in the administrative field, but to accept it in its totality seems rash in the extreme.As doctors we must state this very firmly, and I believe in doing so we voice the opinion of many of our nursing colleagues.-Iam, etc., JOHN SHEPHERD Liverpool 1 SIR,-The self-inflation of the managemnent side of nursing and medicine "as a deep training in skills . . .as complex . . .as medical training" (Dr.H. P. Ferrer's letter, 26 December, p. 806) is surely a Parkinsonian step.Bureaucracy expands in a geometric fashion.Nurses and doctors who do the work will have to carry on their backs anincrea-inq load of nmanavers and their staffs collecting in the main useless statistics and "expanding" their time collating them.What the service requires urgently is not finance for more managers and their assis- tants but money for hospital buildings, research facilities, radiographers, physiotherapists, etc.
Oesophageal motor response to reflux is not impaired in reflux oesophagitis.
Authors: R Timmer, R Breumelhof, J H Nadorp, A J Smout
Journal: Gut (1993)

Whether the oesophageal motor response to reflux, as recorded over 24 hours, is impaired in patients with reflux oesophagitis was investigated. Twenty three patients with oesophagitis (Savary-Miller grades I-IV) and 23 control subjects matched for age and sex underwent 24 hour ambulatory pH and pressure monitoring. All contractions occurring in the 2 minute period after the onset of each reflux episode were analysed automatically using dedicated computer algorithms. A total of 2085 reflux episodes occurred--1513 in patients and 572 in controls. Oesophageal acid exposure was greater (p < 0.01) in patients than in controls (mean (SEM) % time pH < 4 13.3 (1.7) and 5.3 (0.9)%, respectively). The mean duration of the supine reflux episodes was longer (p < 0.01) in patients (11.2 (2.8) minutes) than in controls (5.1 (1.8) minutes). In the upright period, no significant differences in the motor response to reflux were found. In the supine period, the patients showed a higher number of reflux induced contractions (4.40 (0.61) v 1.62 (0.31), p < 0.01), a higher contraction amplitude (4.55 (0.42) v 2.99 (0.71) kPa, p < 0.02) and longer contractions (1.86 (0.19) v 1.32 (0.29) seconds, p < 0.05). The percentages of peristaltic and simultaneous contractions that occurred in response to supine reflux did not differ between the two groups. In patients with reflux oesophagitis the motor response of the oesophagus to reflux is not impaired. During the supine period the response is even stronger than in healthy controls.
Funding will make you free
Authors: John C Alcolado
Journal: BMJ (2004)

Academic freedom does not exist and has probably always been a myth. Wright and Wedge raise several important issues regarding the autonomy of clinical academics but, perhaps wisely, are careful not to provide a clear definition of “freedom.”1 Freedom is not just an absence of physical restraint but also the lack of psychological compulsion. The central issue is the extent to which institutions and society are willing to tolerate some degree of freedom (or self indulgence) by academic physicians.

In the United Kingdom, we are already reigned in by the General Medical Council; its booklet on standards in medical research sets boundaries to what we may or may not do. …
OCCULT CAUSES OF DISEASE.
Authors: W. L. SCHENCK
Journal: JAMA (1884)

[Read in the Section of Practice of Medicine and Materia Medica of the American Medical Association, May, 1884.] The world moves in Cycles—the earth on her own axis, around the sun, her path about the sun recording the mighty cycles of the glacial eras. Periodicity marks all nature. Theories and fashions in art and science come and go, to go and come again. "The thing that hath been it is that which shall be." To this rule medicine forms no exception. Its theories come and go with such regularity, they are hardly worth combating. The next cycle will set them aside, but again and again they will return until we build upon absolute truth. It is useless to disturb them, except as they stand in the way of enduring progress. The causes of disease are oft-times hidden, and we may fail to discern them, but we should avoid building upon
REACTION TO PANTOPON (PANTOPIUM HYDROCHLORICUM) SIMULATING PROTEIN SENSITIZATION
Authors: H. M. Winans
Journal: JAMA (1930)

In the course of hypodermic injection of various drugs, it is not unusual to encounter a local reaction at the site of injection. In the case reported here, however, there was not only a local reaction but a severe constitutional one which has apparently not been reported previously from the use of this drug.  REPORT OF CASE  Mrs. E., aged 34, a housewife, had an attack of dysentery which resembled in every way similar cases that had been epidemic in this locality at the time. After two days she was somewhat improved, but she had lost considerable sleep and it was decided to give her a hypodermic to secure rest. Previous treatment had been dietary, with the use of milk of bismuth. She stated that morphine disagreed with her but described its effect as being only exciting and nauseating. She was therefore given one-sixth grain (11 mg.) of pantopon (pantopium
Medical Error
Authors: Gordon D. Schiff
Journal: JAMA (2011)

Mr B, a 60-year-old man with back pain, was not informed of an incidental finding of a renal mass suggestive of cancer on a magnetic resonance imaging scan. Failure and delays in test follow-up are a frequent problem in medicine, occurring in more than 5% of significantly abnormal ambulatory test results. Rather than simply blaming involved clinicians, systems for managing tests need to be reengineered using methods from reliability sciences. These begin with investigations into the systemic causes of the failures, then application of approaches such as heightened situational awareness, closed-loop systems, improved handoffs, just-in-time work, culture and practices of stopping to fix problems, forcing functions and simplification, enhanced visual cues, and cautious use of information technology and redundancy, all while avoiding suboptimization. Emerging test management systems and critical test follow-up recommendations illustrate how applying these principles can enhance this important aspect of patient safety.
Redistribution of Health Care Costs after the Adoption of Positron Emission Tomography among Medicare Beneficiaries with Non–Small-Cell Lung Cancer, 1998–2005
Authors: Michaela A. Dinan, Lesley H. Curtis, William R. Carpenter, Andrea K. Biddle, Amy P. Abernethy, Edward F. Patz, Kevin A. Schulman, Morris Weinberger
Journal: Journal of Thoracic Oncology (2014)
Renal Function and Blood Pressure in Patients Receiving Long-Term, Low-Dose Cyclosporine Therapy for Idiopathic Autoimmune Uveitis
Authors: Gilbert Deray, Mohamed Benhmida, Phuc Le Hoang, Philippe Maksud, Brigitte Aupetit, Alain Baumelou, Claude Jacobs
Journal: Annals of Internal Medicine (1992)

Objective: To determine the renal side effects of long-term, low-dose cyclosporine therapy (initial dose, 5 mg/kg body weight per day) in patients with autoimmune idiopathic uveitis. Design: Cohort study with at least 2 years of follow-up. Setting: A teaching hospital in Paris, France (Hôpital Pitié-Salpétrière). Patients: Sixteen patients with idiopathic autoimmune uveitis who were normotensive and had normal renal function before treatment. Cyclosporine was administered orally for at least 2 years at an initial dosage of 5 mg/kg body weight per day. Results: After 2 years of treatment, the serum creatinine level increased by 35 ± 5 µmol/L (0.40 ± 0.06 mg/dL) (95% CI, 25 to 46 µmol/L, [73 ± 4 to 108 ± 4 µmol/L]). Creatinine clearance decreased significantly from 120 ± 5 mL/min to 75 ± 4 mL/min. Glomerular filtration rate decreased from 116 ± 8 mL/min to 75 ± 3 mL/min, and effective renal plasma flow decreased from 455 ± 24 mL/min to 338 ± 30 mL/min (P < 0.05). Cyclosporine induced a significant increase in serum uric acid, total cholesterol, and serum potassium levels. Blood pressure was normal in all patients before treatment; 81% (95% CI, 64% to 98%) of these patients developed hypertension after 24 months of treatment. Blood pressure was controlled with a single drug in all but two patients. Conclusions: In patients with healthy native kidneys, long-term cyclosporine therapy, even at a low dose (5 mg/kg per day), is nephrotoxic and is associated with a high incidence of hypertension.
Regional myocardial wall thickening response to nitroglycerin. A predictor of myocardial response to aortocoronary bypass surgery.
Authors: J H Chesebro, E L Ritman, R L Frye, H C Smith, B D Rutherford, R E Fulton, J R Pluth, D A Barnhorst
Journal: Circulation (1978)

The peak rate of systolic wall thickening (p +/- dTw/dt) in regions of the left ventricle (LV) was determined preoperatively by biplane roentgen videometry in 18 patients before and after sublingual administration of nitroglycerin (NTG) and 3-23 months (median 12) after aortocoronary bypass surgery. The regional LV response to NTG was a reliable predictor for postoperative improvement in regional wall dynamics after successful aortocoronary bypass grafting. The ejection fraction response to NTG or surgery will not predict the regional myocardial response to NTG or surgery, nor will the regional response predict the global response. Subendocardial myocardial infarction is another cause of unimproved regional myocardial function after NTG and aortocoronary bypass surgery.
Congenital Heart Disease in Taiwan, Republic of China
Authors: MARY K. M. SHANN
Journal: Circulation (1969)

A review of 5 years' experience with congenital heart disease in National Taiwan University Hospital, Taipei, Taiwan, Republic of China, shows that congenital aortic valvar and supravalvar stenosis are not seen and the incidence of coarctation is very low. Statistics on congenital heart disease as reported in studies on all groups of patients from several other Asian countries were collected and compared with those from European and North American countries. The low incidence for the two mentioned congenital cardiac defects in the reports from Asian countries is probably not due to chance, but may represent a true difference in incidence. In the discussion of etiological factors possibly responsible for the low incidence of coarctation and aortic stenosis, it is postulated that dietary factors may be responsible for the observed differences in incidence.
Simultaneous occurrence of a t(9;22) (Ph) with a t(2;11) in a patient with CML and emergence of a new clone with the t(2;11) alone after imatinib mesylate treatment
Authors: B Royer-Pokora, B Hildebrandt, A Redmann, C Herold, R Kronenwett, R Haas, M Drechsler, C Wieland
Journal: Leukemia (2003)
TCTAP A-206 Three-year Cumulative Incidence of New-onset Diabetes; Are There Differences Between Atorvastatin and Simvastatin?
Authors: Sung gyu Yoon, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Cheol Ung Choi, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
Journal: Journal of the American College of Cardiology (2014)
CIRSOID ANEURISM OF THE BRANCHES OF THE INTERNAL CAROTID AND BASILAR ARTERIES.
Authors: GEORGE H. HEITMULLER
Journal: JAMA (1904)

I am indebted to Dr. Charles Montgomery for the privilege of reporting this case. The patient, M. M., aged 13, has a negative family history. She presents a tumor over the right orbit which is said to have appeared a short time after birth as a growth the size of a hazel nut, whereas it now extends midway to the occiput. The tumor is pale in color, of a doughy consistency, and is composed of dilated terminal branches of the ophthalmic artery. There is absence of hair over the tumor. The eye projects forward, downward and outward. The conjunctiva of the upper lid and of the inner and outer angles of the eye is thickened by distended blood vessels. The cheeks show dilated capillaries near the nose. Dilated vessels are not seen elsewhere. There does not appear to be any weakness in the walls of the arteries, as was shown
Does This Dizzy Patient Have a Serious Form of Vertigo? Comment and Correction
Authors: Thomas E. Lindow
Journal: JAMA (1994)

<h3>To the Editor.</h3> —The Rational Clinical Examination article on the dizzy patient by Dr Froehling and colleagues<sup>1</sup>puts forth at least two ideas that were not rational. First, they recommended that we inquire from our patients at what time of day their dizziness occurs because "matutinal vertigo... is usually due to a peripheral vestibular disorder." They later directly contradicted that advice by stating that matutinal vertigo cannot distinguish very well peripheral from central causes. They cite references (their number 20<sup>2</sup>and number 40<sup>3</sup>) for both arguments. Second, their Table 3 tries to segregate patients into either of two groups, serious or nonserious, on the basis of three criteria (vertigo, age of 69 years or less, and absence of neurological deficits). A patient would qualify for one group if he or she manifested one or more of the three criteria, and he or she would qualify for the
Are advance directives legally binding or simply the starting point for discussion on patients' best interests? Legal advice
Authors: M. Davies
Journal: BMJ (2009)

Following advance directives in emergencies throws up some complicated problems, as <b>Stephen Bonner and colleagues</b> found (doi:10.1136/bmj.b4667). We asked an emergency doctor (doi:10.1136/bmj.b4697), a medical defence adviser, and an ethicist (doi:10.1136/bmj.b4695) what they would do in the circumstances
RAC2 loss-of-function mutation in 2 siblings with characteristics of common variable immunodeficiency
Authors: Omar K Alkhairy, Nima Rezaei, Robert R Graham, Hassan Abolhassani, Stephan Borte, Kjell Hultenby, Chenglin Wu, Asghar Aghamohammadi, David A Williams, Timothy W Behrens, Lennart Hammarström, Qiang Pan-Hammarström
Journal: Journal of Allergy and Clinical Immunology (2014)

We report the first patients with a homozygous loss of function mutation in the RAC2 gene, presenting with clinical features of common variable immunodeficiency. In addition, the patients suffered from glomerulonephritis, coagulopathy, multiple hormone deficiencies potentially on the autoimmune basis and abnormalities of neutrophil granules.
A novel human R25C-phospholamban mutation is associated with super-inhibition of calcium cycling and ventricular arrhythmia
Authors: Guan-Sheng Liu, Ana Morales, Elizabeth Vafiadaki, Chi Keung Lam, Wen-Feng Cai, Kobra Haghighi, George Adly, Ray E. Hershberger, Evangelia G. Kranias
Journal: Cardiovascular Research (2015)

Depressed sarcoplasmic reticulum (SR) Ca2+ cycling, a universal characteristic of human and experimental heart failure, may be associated with genetic alterations in key Ca2+-handling proteins. In this study, we identified a novel PLN mutation (R25C) in dilated cardiomyopathy (DCM) and investigated its functional significance in cardiomyocyte Ca2+-handling and contractility. Exome sequencing identified a C73T substitution in the coding region of PLN in a family with DCM. The four heterozygous family members had implantable cardiac defibrillators, and three developed prominent ventricular arrhythmias. Overexpression of R25C-PLN in adult rat cardiomyocytes significantly suppressed the Ca2+ affinity of SR Ca2+-ATPase (SERCA2a), resulting in decreased SR Ca2+ content, Ca2+ transients, and impaired contractile function, compared with WT-PLN. These inhibitory effects were associated with enhanced interaction of R25C-PLN with SERCA2, which was prevented by PKA phosphorylation. Accordingly, isoproterenol stimulation relieved the depressive effects of R25C-PLN in cardiomyocytes. However, R25C-PLN also elicited increases in the frequency of Ca2+ sparks and waves as well as stress-induced aftercontractions. This was accompanied by increased Ca2+/calmodulin-dependent protein kinase II activity and hyper-phosphorylation of RyR2 at serine 2814. The findings demonstrate that human R25C-PLN is associated with super-inhibition of SERCA2a and Ca2+ transport as well as increased SR Ca2+ leak, promoting arrhythmogenesis under stress conditions. This is the first mechanistic evidence that increased PLN inhibition may impact both SR Ca2+ uptake and Ca2+ release activities and suggests that the human R25C-PLN may be a prognostic factor for increased ventricular arrhythmia risk in DCM carriers.
Recognising excellence, innovation, and integrity
Authors: F. Godlee, S. Dutton
Journal: BMJ (2008)

Renal infarction is a rare occurrence accounting for 0.007% of patients seen in the emergency department for renal insufficiency or hypertension. Dysfibrinogenemia is also rare, and the combination of renal artery infarct in the setting of congenital dysfibrinogenemia has not been described in the literature. Our patient, with a remote history of congenital dysfibrinogenemia with no known haemorrhagic or thrombotic complications, presented with acute flank pain and was subsequently diagnosed with an acute renal arterial infarction. He was treated with subcutaneous enoxaparin and then transitioned to lifelong anticoagulation with rivaroxaban therapy.
Mechanisms and consequences of cell activation in the microcirculation
Authors: M. C. Mazzoni, G. W. Schmid-Schonbein
Journal: Cardiovascular Research (1996)

Cells undergo activation in response to a wide range of stimuli. In vascular cells (leukocytes, endothelial cells, and platelets), the different forms of activation include degranulation, oxygen free radical formation, expression of membrane adhesion proteins, and biophysical changes such as pseudopod formation and increased cytoplasmic viscosity. Cell activation and low flow are common features of many cardiovascular diseases. There is evidence that plasma from patients contains an activating factor for neutrophils as well as other vascular cells. Activated neutrophils have the ability to impair microcirculatory transit by elevation of endothelial permeability, leukocyte adhesion to the endothelium, leukocyte capillary plugging, release of vasoactive products, and capillary deformation and compression due to oxygen-radical-mediated interstitial edema and cell dysfunction. In addition to reduced organ perfusion, cell activation can also cause cell dysfunction via release of cytotoxic mediators. A lower degree of neutrophil activation prior to acute circulatory challenge (i.e., low preactivation) correlates with improved survival rates after challenge and suggests that elevated levels of in vivo cell preactivation is a risk factor for cell injury and organ failure. Under conditions of low in-vivo cell preactivation (e.g., as is the case in endotoxin-tolerant animals), there is reduced tissue injury and lower mortality after challenge. We hypothesize that in-vivo cell preactivation due to everyday activity (infection, diet, smoking) may be a mechanism for microvascular low blood flow with leukocyte accumulation and may represent a risk factor for various cardiovascular diseases.