tbuckley/cabot-search huggingface dataset:
STUDIES ON GANGRENE FOLLOWING COLD INJURY. II. GENERAL COURSE OF EVENTS IN RABBIT FEET AND EARS FOLLOWING UNTREATED COLD INJURY 1
Authors: Frederick A. Fuhrman, J. M. Crismon
Journal: Journal of Clinical Investigation (1947)

In part I of this series (1) a method for the production of controlled cold injury (frostbite) of the ears and feet of rabbits was described, and data were given illustrating the incidence of gan- grene and extent of tissue loss following injury.The general course of events, including gross changes, skin color, and temperature measure- ments of injured ears and feet will be given here. EXPERIMENTAL RESULTSA. Gross changes following injury Following immersion of the ear of rabbits for periods ranging from 60 seconds to 10 minutes, at temperatures from -320 C. to -700 C., the entire frostbitten portion of the ear becomes gan- grenous and is eventually lost (1).Loss of the entire injured part of hind feet occurs after ex- posure for 3 minutes at temperatures of -450 C. or lower and after 60 minute exposure at -150 C. The gross changes following injury of vari- ous degrees in which actual freezing of the tissues occurs are at first similar enough so that a general
ABC of learning and teaching in medicine: Applying educational theory in practice
Authors: D. M Kaufman
Journal: BMJ (2003)

How many times have we as teachers been confronted with situations in which we really were not sure what to do? We “flew by the seat of our pants,” usually doing with our learners what had been done with us. It would be useful to be able to turn to a set of guiding principles based on evidence, or at least on long term successful experience.

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Fortunately, a body of theory exists that can inform practice. An unfortunate gap between academics and practitioners, however, has led to a perception of theory as belonging to an “ivory tower” and not relevant to practice. Yet the old adage that “there is nothing more practical than a good theory” still rings true today. This chapter describes several educational theories and guiding principles and then shows how these could be applied to three case studies realting to the “real world.”

Malcolm Knowles introduced the term “andragogy” to North America, defining it as “the art and science of helping adults learn.” Andragogy is based on five assumptions—about how adults learn and their attitude towards and motivation for learning.

#### Andragogy—five assumptions about adult learning

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Learners need to feel safe and comfortable expressing themselves

Knowles later derived seven principles of andragogy. Most theorists agree that andragogy is not really a theory of adult learning, but they regard Knowles' principles as guidelines on how to teach learners who tend to be at least somewhat independent and self directed. His principles can be summarised …

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Attitudes of Primary Care Providers Toward Diabetes: Barriers to guideline implementation
Authors: Anne C Larme, Jacqueline A Pugh
Journal: Diabetes Care (1998)

OBJECTIVE Primary care providers have been slow to adopt standards of care for diabetes, and continuing medical education (CME) programs have been minimally effective in changing provider behavior. The objective of this study was to explore the previously reported finding that attitudes, rather than knowledge, may impede primary care provider adherence to standards of care. RESEARCH DESIGN AND METHODS Study participants included 31 primary care providers attending an eight-session CME program on diabetes. Providers rated on a 10-point scale how the treatment of diabetes compared with that of five other chronic conditions (hypertension, hyperlipidemia, angina, arthritis, and heart failure; 1 = easier to 10 = harder; midpoint 5.5). In a subsequent open-ended qualitative interview, providers explained their scale ratings. RESULTS Diabetes was rated as significantly harder to treat than hypertension (24 of 30 &amp;gt;5.5; P &amp;lt; 0.001) and angina (20 of 30 &amp;gt;5.5; P = 0.03). A majority also rated hyperlipidemia (18 of 30) and arthritis (18 of 30) as easier to treat than diabetes. Explanatory themes underlying provider frustrations with diabetes include characteristics of the disease itself and the complexity of its management, and a perceived lack of support from society and the health care system for their efforts to control diabetes. CONCLUSIONS CME that addresses provider attitudes toward diabetes in addition to updating knowledge may be more effective than traditional CME in promoting adherence to standards of care. Additional changes are needed in our health care system to shift from an acute to a chronic disease model to effectively support diabetes care efforts.
Renal Failure and Multiple Myeloma
Authors: GERALDINE P. SCHECHTER
Journal: Annals of Internal Medicine (1980)

Letters and Corrections1 October 1980Renal Failure and Multiple MyelomaGERALDINE P. SCHECHTER, M.D.GERALDINE P. SCHECHTER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-93-4-643_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Border and Cohen (1) recently reported four cases of renal insufficiency in which renal biopsy was used to make the "clinically silent" diagnosis of multiple myeloma. Although the point was not clearly stated in the paper, the diagnosis was apparently "silent" because of the common failure to appreciate that screening tests for monoclonal immunoglobulin production should include electrophoresis of concentrated urine as well as of serum (2). A paraprotein is usually not detectable by serum electrophoresis in the 15% to 20% of patients with myeloma who have light chain disease. All the patients reported by Border and...References1. BORDER W and COHEN A. Renal biopsy diagnosis of clinically silent multiple myeloma. Ann Intern Med. 1980;93:43-6. LinkGoogle Scholar2. PERRY M and KYLE R. The clinical significance of Bence Jones proteinuria. Mayo Clin Proc. 1975;50:234-8. MedlineGoogle Scholar1. BORDER W and COHEN A. Renal biopsy diagnosis of clinically silent multiple myeloma. Ann Intern Med. 1980;93:43-6. LinkGoogle Scholar2. KOSS M, PIRANI C, and OSSERMAN E. Experimental Bence Jones cast nephropathy. Lab Invest. 1976;34:579-91. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: GERALDINE P. SCHECHTER, M.D.Affiliations: Veterans Administration Hospital Washington, DC 20422 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCarbohydrates 1 October 1980Volume 93, Issue 4Page: 643-644KeywordsBiopsyMultiple myelomaMyelomaRenal failureUrine ePublished: 1 December 2008 Issue Published: 1 October 1980 PDF downloadLoading ...
Shuttle walking test
Authors: S DOFFMAN
Journal: Thorax (2001)

Booth and Adams' report on the use of the shuttle walking test (SWT) in breathless patients with advanced cancer1addresses the important role of assessing exercise limitation in disease. Although they were primarily investigating breathlessness, it was surprising that only one of the 32 patients (completing at least one SWT) complained of leg pain at the end of the test. In patients with cardiorespiratory disease peripheral muscle strength correlates with maximal exercise capacity,2 and in one large series up to one third of patients referred for exercise testing because of breathlessness stopped because of discomfort in the exercising muscle.3 Given that …
Hospital doctors will get below inflation pay increase, while GPs get nothing
Authors: Michael Day
Journal: BMJ (2007)

Lester Crawford, former commissioner of the US Food and Drug Administration, was last week fined $89 377 (£45 800; €67 000), sentenced to three years of supervised probation, and required to do 50 hours of community service by Judge Deborah Robinson of the US District Court for the District of Columbia.Last October Dr Crawford (below) pleaded (below) pleaded pleaded guilty to two charges: failing to report that he and his wife owned shares in companies regulated by the agency and filing false
B7-05: Epidermal Growth Factor Receptor Mutation Analysis by Endobronchial Ultrasound Guided Transbronchial Needle Aspiration
Authors: Takahiro Nakajima, Kazuhiro Yasufuku, Makoto Suzuki, Kenzo Hiroshima, Sherif Mohamed, Yohei Miyagi, Shoichi Matsukuma, Yasuo Sekine, Kiyoshi Shibuya, Takehiko Fujisawa
Journal: Journal of Thoracic Oncology (2007)
Abstract 1253: Dual PI3K/mTOR inhibitor NVP-BEZ235 in combination with AKT inhibitor MK2206 in esophageal carcinoma cells
Authors: Hao Yu, Ni Shi, Zui Pan, Tong Chen
Journal: Cancer Research (2014)

Abstract The long-term goal of our research is to investigate the molecular carcinogenesis of esophageal squamous cell carcinoma and to develop strategies for esophageal cancer prevention. Previous studies in our laboratory demonstrated an association between activation of PI3K/AKT/mTOR pathways and the development of N-nitrosomethylbenzylamine (NMBA)-induced tumors in the rat esophagus. The objective of current study is to evaluate the effects of NVP-BEZ235, a dual PI3K/mTOR inhibitor, and MK2206, an AKT inhibitor, alone or in combination in esophageal cancer cell lines, KYSE-70, -150, -270 and -410. The cancer cell lines were treated with different doses of NVP-BEZ235 (1, 10, 50, 100, 1000 nMol/L) and MK2206 (0.5, 1, 3, 10, 20 uMol/L), or NVP-BEZ235 100 nMol/L plus MK2206 3 uMol/L. Western blot was performed to assess the activation of PI3K/AKT/mTOR pathways. Cell proliferation, apoptosis and cell cycle were analyzed by WST1 and flow cytometry. We found that the combination of NVP-BEZ235 and MK2206 significantly reduced the phosphorylation of p-AKTT308, p-AKTS473, p-mTORS2448, p-S6S235/236 and p-4EBP1T37/46, when compared to NVP-BEZ235 (1000 nMol/L) and MK2206 (20 uMol/L) alone (p&amp;lt;0.05). The cell proliferation rate was reduced by NVP-BEZ235 1000 nMol/L, MK2206 20 uMol/L, or NVP-BEZ235 plus MK2206 to 20% (p&amp;lt;0.01), 24% (p&amp;lt;0.01) and 17% (p&amp;lt;0.01), respectively. The NVP-BEZ235 1000 nMol/L and MK2206 10 uMol/L induced apoptosis in esophageal cancer cells to 30% and 20% (p&amp;lt;0.01), respectively. NVP-BEZ235 plus MK2206 induced apoptosis in esophageal cancer cells to 45% (p&amp;lt;0.01). The combination treatment increased the proportion of cells at G0/G1 phase compared to cells treated with NVP-BEZ235 or MK2206 alone. Our results indicate that co-targeting the PI3K/mTOR and AKT signaling pathways produces synergistic activity against esophageal carcinoma cell growth. This in-vitro study provides evidence to test the efficacy of NVP-BEZ235 in combination with MK2206 in inhibition of esophageal tumor development in vivo. (Supported by NIH/NCI R01 CA131073-01A1). Citation Format: Hao Yu, Ni Shi, Zui Pan, Tong Chen. Dual PI3K/mTOR inhibitor NVP-BEZ235 in combination with AKT inhibitor MK2206 in esophageal carcinoma cells. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1253. doi:10.1158/1538-7445.AM2014-1253
The Biological Imperatives: Health, Politics, and Human Survival
Authors: Gert H. Brieger
Journal: JAMA (1972)

At last, here is a book devoted to the broad problems of health care that does not merely fling indictments at the medical profession. As a medical reader, though convinced that numerous changes are required and that our profession no longer warrants the great autonomy we so jealously guard, I have wearied of the books with their many charges against us. Some, of course, are only too true, but we should seriously look for answers. Allan Chase, a veteran science writer, while appropriately critical, has written an immensely challenging book that should be read by physicians and patients alike. He looks at the problems of health and disease in the broad context of our social and biological existence. Various chapters explore the stages of health care, prevention, early detection, treatment, and rehabilitation, as well as the changing patterns of disease, life expectancy, and medical care. It should concern us that
THE PRODUCTION OF BLOOD PLATELETS IN THE LUNGS
Authors: W. H. Howell, D. D. Donahue
Journal: The Journal of Experimental Medicine (1937)

1. A new fixing solution is described, which preserves the platelets and prevents contact hemolysis of the erythrocytes, so that counts of both corpuscles may be made in the same preparation. 2. Comparative counts of platelets in arteries and veins show that arterial blood contains a larger number of platelets than venous blood. This difference is accentuated under experimental conditions that cause a reduction in the number of platelets. It is concluded that new platelets are added to the blood in the capillary areas of the lungs, and that there is a corresponding destruction of platelets as the blood passes through the capillary areas of the systemic circulation. 3. Perfusion of the lungs with a platelet-preserving solution, compared with that of other organs, gives evidence of the existence of a source of platelet material in the lungs. 4. Histological examination of the lungs with a technique adequate to give a differential staining of platelet material demonstrates the presence of giant cells in the lungs, and supports the view that they are active in the production of platelets. 5. In extrauterine life giant cells are concentrated in the marrow and the lungs, with the maximum of their activity in platelet production in the lungs.
Is combining or alternating antipyretic therapy more beneficial than monotherapy for febrile children?
Authors: M. Nabulsi
Journal: BMJ (2009)

Although fever is a beneficial host response, it is an important cause of anxiety for parents and doctors. The quest for effective treatment has led to new combination regimens of antipyretic drugs for febrile children. These are popular among caregivers and healthcare providers,1 2 3 4 but they have been tested in clinical trials only recently.4 5 6 7 8 The new regimens consist of combinations of ibuprofen and paracetamol (acetaminophen) given at variable time schedules. The main concern about these treatments is safety, because they may increase the risk of renal toxicity, as a result of reduced glutathione in the kidney and tubular necrosis,9 10 or the risk of infection with invasive group A streptococci.11 We therefore need to know whether these combinations are more effective than, and as safe as, monotherapy in children with fever.

A systematic search of PubMed, Medline, CINAHL, Cochrane, and Embase databases for systematic reviews and randomised clinical trials, published in any language, using the MeSH terms or keywords “fever” and “ibuprofen” and …
Treating acute hepatitis B
Authors: Javid Fazili, Teddy F. Bader, William Tierney
Journal: Hepatology (2007)

We read with interest the article by Kumar et al.1 on a randomized controlled trial of lamivudine to treat acute hepatitis B. The trial of lamivudine versus placebo revealed a greater decrease in HBV DNA levels in the lamivudine-treated group, but this did not translate into a biochemical or clinical improvement in the lamivudine-treated group. This is the first sound evidence to support the prevailing practice of not treating acute hepatitis B patients. However, the development of antibodies to hepatitis B e antigen (anti-Hbe) and hepatitis B s antigen (anti-HBs) was lower in the lamivudine-treated group relative to placebo (87.5% versus 71 % for anti-HBe and 85% versus 67% for anti-HBs), although this did not reach statistical significance. It is an important observation and its long-term significance in terms of potential flaring of hepatitis B in these patients remains to be determined. It seems plausible that interruption of the protective immune response may be a consequence of pharmacologic therapy. How this translates into future risk of reactivation needs examination. We hope they will follow the groups in the long term to see if any differences evolve. The second noteworthy outcome from this study is that there was no difference in the 2 groups regarding outcome of severe or fulminant hepatitis B. This suggests that lamivudine treatment of patients with acute hepatitis B may not be harmful in this setting. Clearly, the number of patients is too small to make definitive conclusions. The results may encourage use of lamivudine in a small subset of patients with acute hepatitis B who have a more severe presentation with potential need for liver transplantation. The use of lamivudine in this subset may rescue such patients by increasing chances of spontaneous recovery without liver transplantation. A 2002 German study of fulminant hepatitis B showed that 7 of 8 patients treated with lamivudine (after 2000) avoided death or transplantation compared to a historical group (before 2000) where only 5 of 21 patients not treated with lamivudine avoided death or transplantation.2 Larger prospective studies of lamivudine and other antiviral therapies in liver transplantation would help answer these questions. Javid Fazili M.D.*, Teddy F. Bader M.D.*, William Tierney M.D.*, * Section of Gastroenterology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
Delayed diagnosis of Kawasaki disease in the gamma globulin era: how often and why? Are the criteria too strict?
Authors: Umakumaran Ponniah, Frank C. Smith, Nader H. Atallah-Yunes, Rae-Ellen W. Kavey, Craig J. Byrum, Daniel A. Kvesells, Winston E. Gaum
Journal: Journal of the American College of Cardiology (2002)
Growth Inhibition and Induction of Apoptosis by Fenretinide in Small-Cell Lung Cancer Cell Lines
Authors: G. P. Kalemkerian, R. Slusher, S. Ramalingam, S. Gadgeel, M. Mabry
Journal: JNCI Journal of the National Cancer Institute (1995)

Lung cancer is the major cause of cancer-related death in the United States, with small-cell lung cancer (SCLC) constituting approximately 20% of all cases of lung cancer. Numerous epidemiologic and molecular studies have suggested that alterations in retinoid-signaling pathways play a role in the pathogenesis of lung cancer. Fenretinide [N-(4-hydroxyphenyl)retinamide; HPR] is a synthetic retinoid with minimal toxicity and favorable pharmacokinetics during long-term administration to patients in clinical trials.The aim of this investigation was to study the effect of HPR on the growth of SCLC cells in vitro.Seven SCLC cell lines (NCI-H69, NCI-H82, NCI-H146, NCI-H209, NCI-H345, NCI-H446, and NCI-H510A) were exposed continuously to a broad range of concentrations of HPR or all-trans-retinoic acid (RA), and cell viability was determined on day 3 and day 7 by the trypan blue dye exclusion assay. The growth of these cells was compared with that of control vehicle-treated cells to determine survival fraction and the dose resulting in a 50% inhibition of growth when compared with growth of control cells (IC50). The induction of apoptosis was evaluated by fluorescent microscopy, DNA content analysis, and a terminal deoxyribonucleotidyl transferase-based assay that labels 3'-hydroxyl ends of DNA fragments (TUNEL assay) combined with flow cytometric analysis.HPR inhibited growth of a panel of SCLC cell lines at IC50 values that ranged from 0.1 to 3.0 microM (concentrations that are clinically achievable). In all cell lines tested, HPR was a more potent growth inhibitor than RA. By use of fluorescent microscopy, HPR was found to induce morphologic changes consistent with apoptosis in NCI-H82 SCLC cells, including cellular shrinkage, chromatin condensation, and nuclear fragmentation. Flow cytometric analysis revealed decreased DNA content, and TUNEL assay showed increased digoxigenin-uridine triphosphate incorporation in HPR-treated NCI-H82 SCLC cells; these findings are consistent with the induction of apoptosis.HPR inhibited the in vitro growth of SCLC cells. In NCI-H82 cells, HPR inhibited growth via the induction of apoptosis.
SARCOMA OF AN UNDESCENDED (ABDOMINAL) TESTICLE
Authors: G. H. Edington
Journal: BMJ (1922)

THE specimen exhibited was an example of malignant disease of an undescended testicle.The patientwas a -labourer, aged 49, sent to -see me at the W estern Infirmary in July, 1920, with a complaint.of.pain, of several months' duration, in the 7leftside of the abdomen.Tthe pain, dragging in clharacter and coming on after streniuous work,
Detection and Dynamic Changes of <i>EGFR</i> Mutations from Circulating Tumor DNA as a Predictor of Survival Outcomes in NSCLC Patients Treated with First-line Intercalated Erlotinib and Chemotherapy
Authors: Tony Mok, Yi-Long Wu, Jin Soo Lee, Chong-Jen Yu, Virote Sriuranpong, Jennifer Sandoval-Tan, Guia Ladrera, Sumitra Thongprasert, Vichien Srimuninnimit, Meilin Liao, Yunzhong Zhu, Caicun Zhou, Fatima Fuerte, Benjamin Margono, Wei Wen, Julie Tsai, Matt Truman, Barbara Klughammer, David S. Shames, Lin Wu
Journal: Clinical Cancer Research (2015)

Blood-based circulating-free (cf) tumor DNA may be an alternative to tissue-based EGFR mutation testing in NSCLC. This exploratory analysis compares matched tumor and blood samples from the FASTACT-2 study.Patients were randomized to receive six cycles of gemcitabine/platinum plus sequential erlotinib or placebo. EGFR mutation testing was performed using the cobas tissue test and the cobas blood test (in development). Blood samples at baseline, cycle 3, and progression were assessed for blood test detection rate, sensitivity, and specificity; concordance with matched tumor analysis (n = 238), and correlation with progression-free survival (PFS) and overall survival (OS).Concordance between tissue and blood tests was 88%, with blood test sensitivity of 75% and a specificity of 96%. Median PFS was 13.1 versus 6.0 months for erlotinib and placebo, respectively, for those with baseline EGFR mut(+) cfDNA [HR, 0.22; 95% confidence intervals (CI), 0.14-0.33, P < 0.0001] and 6.2 versus 6.1 months, respectively, for the EGFR mut(-) cfDNA subgroup (HR, 0.83; 95% CI, 0.65-1.04, P = 0.1076). For patients with EGFR mut(+) cfDNA at baseline, median PFS was 7.2 versus 12.0 months for cycle 3 EGFR mut(+) cfDNA versus cycle 3 EGFR mut(-) patients, respectively (HR, 0.32; 95% CI, 0.21-0.48, P < 0.0001); median OS by cycle 3 status was 18.2 and 31.9 months, respectively (HR, 0.51; 95% CI, 0.31-0.84, P = 0.0066).Blood-based EGFR mutation analysis is relatively sensitive and highly specific. Dynamic changes in cfDNA EGFR mutation status relative to baseline may predict clinical outcomes.
Book: The Blood Doctor
Authors: J. Aronson
Journal: BMJ (2002)

Barbara Vine Viking, £16.99, pp 389 ISBN 0 670 91274 3 Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img>![Graphic][4]</img> Authors use pseudonyms for many reasons. Some doctors prefer to keep their medical and literary identities distinct—consider James Bridie (O H Mavor) and Richard Gordon (Gordon Ostlere). But some authors just use different names for different genres. Ruth Rendell writes detective stories about Inspector Wexford; her alter ego Barbara Vine writes … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif [4]: /embed/inline-graphic-4.gif