tbuckley/cabot-search huggingface dataset:
The Hunterian Oration on Surgery in its Relation to Science
Authors: W. S. Savory
Journal: BMJ (1887)

No word of defence can be needful for the form in 'which English surgeons have chosen to celebrate the memory of Hunter; but an apology may be offered by one who now attemps the task of speaking of him.The duty of reviewing in this place the life and work of Hunter has been so often and so ably performed, that it seems to me I can do little else than incur failure by any effort to tread in such familiar footsteps.But although tempted, as I may have been, by this and other reasons, to turn aside into some less known path, yet'a natural sense of loyalty to the great surgeon and of responsi- bility to the trust I have accepted has constrained me, and so Hunter in his work must be again the subject of what is called with oppressive grandeur, the Hunterian Oration.Surgeons with one voice have proclaimed the supremacy of Hunter above all who have ever studied surgery.Students of science have acknowledged him to be among the chief of those who have in any age advanced human knowledge.Yet, although his claims have been often examined, and many students and surgeons have been en- gaged'in the task, his greatest title to the high place he holds is not always recognised, perhaps not even always understood.May I stand excused then for asking once more and attempting to answer the question-What has Hunter done?It has been well said that when we attempt to estimate the achieve- ments of the foremost men of past ages, too often we see them only in eclipse.A large part-it may be much the larger part-of what they did is too often hidden from us.The proportion of sudden, or what may now appear as sudden discoveries, may be seen though from afar; they may still strike us even from a distance.But we can now no longer adequately appreciate the conditions under which the pioneers of knowledg,e laboured.In the light of the present day'it is difficult to realise the darkness of past times, or to measure fairly the part they played in dispelling it.We may diligently trace the course they took, and become familiar with every step of it, and yet fail to understand that they not only trod, but actually made the way.But was Hunter a great discoverer-I mean in the ordinary sense of the word?For we speak of discoveries in science, sometimes forgetting that all real progress involves discovery.What are the particular discoveries then or improvements in the art of surgery, which are now recalled by the mention of his name ?We quote at once, as an instance, the operation for aneurysm, known to all as the Hunterian, and then-we pause.lVhat else shall be declared upon which his fame particularly rests ?Any one, indeed, who has but a passing acquaintance with the works of Hunter can speedily furnish a long list of important papers in which many new and valuable facts are revealed, and knowledge largely increased, not only in anatomy and physiology, but in pathology and surgery.
A CASE OF RAYNAUD'S DISEASE INVOLVING THE FEET, THE LEFT RETINA AND THE HEART WALL
Authors: Clyde E. Shinkle
Journal: JAMA (1924)

This case is reported because of the distribution of the involved parts and the opportunity of direct observation of the process during life. <h3>REPORT OF CASE</h3> Mrs. J. E. Q., white, aged 44, referred to me, Aug. 21, 1923, by Dr. Clarence J. Broeman, complained of extreme pain in the feet and ankles. The family history was irrelevant. She had had ordinary childhood ailments. At 16 she was married, and at 18 was left a widow with two children, by the murder of her husband. At this time, she had attacks of pain in the left chest, radiating down the left arm. This could be relieved only by morphin, which she took occasionally for a year. She lived well on inherited money. At 24, she had malaria, at which time what may have been a cellulitis of the right lower leg occurred. At 40, she married a man who had
PATHOGENESIS OF THE OCULAR LESIONS PRODUCED BY A DEFICIENCY OF VITAMINE A
Authors: Arthur M. Yudkin, Robert A. Lambert
Journal: The Journal of Experimental Medicine (1923)

The earliest lesions in ophthalmia of rats resulting from a deficiency of vitamine A consist in focal inflammatory lesions in the conjunctivae of the lids and nictitating membrane. The involvement of the cornea, which constitutes the most conspicuous feature of the well developed ophthalmia, is a secondary phenomenon. The characteristic corneal plaque consists of keratinized epithelium beneath which the deeper layers of epithelium are generally found intact. Pathologically, the ocular manifestations of a deficiency of vitamine A are referable to a low grade inflammatory process, originating in the palpebral conjunctiva and spreading to the cornea. The rapidity of development and the degree of destruction probably depend in large part on the type of bacterial infection. The specific changes which lead to the establishment of such an infection have not been determined. It is conceivable that they may be either physiological or anatomical. There is some evidence in favor of a general disturbance of antibody formation in animals on deficient diets. The possibility of a disturbed function in the paraocular glands must be considered.
Dilated and Hypertrophic Cardiomyopathy Mutations in Troponin and α-Tropomyosin Have Opposing Effects on the Calcium Affinity of Cardiac Thin Filaments
Authors: Paul Robinson, Peter J. Griffiths, Hugh Watkins, Charles S. Redwood
Journal: Circulation Research (2007)

Dilated cardiomyopathy and hypertrophic cardiomyopathy (HCM) can be caused by mutations in thin filament regulatory proteins of the contractile apparatus. In vitro functional assays show that, in general, the presence of dilated cardiomyopathy mutations decreases the Ca 2+ sensitivity of contractility, whereas HCM mutations increase it. To assess whether this functional phenomenon was a direct result of altered Ca 2+ affinity or was caused by altered troponin–tropomyosin switching, we assessed Ca 2+ binding of the regulatory site of cardiac troponin C in wild-type or mutant troponin complex and thin filaments using a fluorescent probe (2-[4′-{iodoacetamido}aniline]-naphthalene-6-sulfonate) attached to Cys35 of cardiac troponin C. The Ca 2+ -binding affinity (pCa 50 =6.57±0.03) of reconstituted troponin complex was unaffected by all of the HCM and dilated cardiomyopathy troponin mutants tested, with the exception of the troponin I Arg145Gly HCM mutation, which caused an increase (ΔpCa 50 =+0.31±0.05). However, when incorporated into regulated thin filaments, all but 1 of the 10 troponin and α-tropomyosin mutants altered Ca 2+ -binding affinity. Both HCM mutations increased Ca 2+ affinity (ΔpCa 50 =+0.41±0.02 and +0.51±0.01), whereas the dilated cardiomyopathy mutations decreased affinity (ΔpCa 50 =−0.12±0.04 to −0.54±0.04), which correlates with our previous functional in vitro assays. The exception was the troponin T Asp270Asn mutant, which caused a significant decrease in cooperativity. Because troponin is the major Ca 2+ buffer in the cardiomyocyte sarcoplasm, we suggest that Ca 2+ affinity changes caused by cardiomyopathy mutant proteins may directly affect the Ca 2+ transient and hence Ca 2+ -sensitive disease state remodeling pathways in vivo. This represents a novel mechanism for this class of mutation.
Activated partial thromboplastin time after heparin removal (aPTT/HR) in a new scheme of anticoagulant monitoring
Authors: Herman E. Branson, Naveen Gupta, Lewis M. Slater, Awilda Fagin, Steven A. Armentrout
Journal: American Journal of Hematology (1982)

Abstract Activated partial thromboplastin time after heparin removal (aPTT/HR), a test employing anion exchange chromatography, was devised as an alternative to the prothrombin time after heparin removal (PT/HR) to monitor simultaneous anticoagulation with heparin and coumarins. The potential utility of the aPTT/HR was assessed by performing parallel PTs and aPTTs on 62 consecutive plasmas from coumarin‐treated outpatients. All samples had 0.2 units/ml of heparin added and then removed to see if the maneuver influenced therapeutic group assignment. In no instance did reassignment occur. A conditional Irwin‐Fisher test (P = 0.000604) and a special multinomial trial analysis (P = 0.002) indicated that the aPTT would be at least comparable to the PT for following coumarin antithrombotic prophylaxis. Since the heparin removal procedure had no influence on therapeutic categorization, the same statistical proof could be applied to the relationship between aPTT/HR and PT/HR. This study indicates that the aPTT can be used to monitor all stages of heparin and/or coumarin anticoagulation.
The acute splanchnic and peripheral tissue metabolic response to endotoxin in humans.
Authors: Y M Fong, M A Marano, L L Moldawer, H Wei, S E Calvano, J S Kenney, A C Allison, A Cerami, G T Shires, S F Lowry
Journal: Journal of Clinical Investigation (1990)

The in vivo alterations in organ-specific substrate processing and endogenous mediator production induced by endotoxin were investigated in healthy volunteers. An endotoxin bolus (20 U/kg) produced increased energy expenditure, hyperglycemia, hypoaminoacidemia, and an increase in circulating free fatty acids. These changes included increased peripheral lactate and free fatty acid output, along with increased peripheral uptake of glucose. Coordinately, there were increased splanchnic uptake of oxygen, lactate, amino acids, and free fatty acids, and increased splanchnic glucose output. There were no changes in circulating glucagon, or insulin and transient changes in epinephrine and cortisol were insufficient to explain the metabolic changes. Plasma cachectin levels peaked 90 min after the endotoxin infusion, and hepatic venous (HV) cachectin levels (peak 250 +/- 50 pg/ml) were consistently higher than arterial levels (peak 130 +/- 30 pg/ml, P less than 0.05 vs. HV). No interleukin 1 alpha or 1 beta was detected in the circulation. Circulating interleukin 6, measured by B.9 hybridoma proliferation, peaked 2 h after the endotoxin challenge (arterial, 16 +/- 2 U/ml; HV, 21 +/- 3 U/ml). The net cachectin efflux (approximately 7 micrograms) from the splanchnic organs demonstrates that these tissues are a major site for production of this cytokine. Hence, splanchnic tissues are likely influenced in a paracrine fashion by regional cachectin production and may also serve as a significant source for systemic appearance of this cytokine.
TCT-532 Impact of below the knee lesions to outcome in patients implanted stent for superficial femoral artery chronic total occlusion lesion.
Authors: Maoto Habara, Yoshihisa Kinoshita, Tetsuo Matsubara, Kenya Nasu, Takahiko Suzuki, Mitsuyasu Terashima
Journal: Journal of the American College of Cardiology (2013)
Half of Americans without insurance will be able to get cover for $100 a month, government says
Authors: M. McCarthy
Journal: BMJ (2013)

Premiums on plans offered on the new health insurance exchanges, a key element of the Affordable Care Act, will be around 16% lower than expected, a report from the US Department of Health and Human Services has said.

The exchanges are designed to serve as online marketplaces where individuals and families can compare prices for private health plans. The exchanges open for business on 1 October for consumers looking for 2014 coverage.

The department’s report found that the average premium for the second lowest “silver” plan will be $328 (£204; €243) a month, 16% less than the $392 predicted from estimates by the Congressional Budget Office.1 But some plans were available for just $129 a month for some people.

The findings echo those reported in a study of 18 exchanges by the non-partisan Kaiser Family Foundation published at the beginning of September.2

President Barack Obama touted the cost of insurance on the new exchanges at a healthcare forum he held with former president Bill Clinton in New York on 24 September.

“In many states across the country, …
Segmentation of pulmonary nodules in computed tomography using a regression neural network approach and its application to the Lung Image Database Consortium and Image Database Resource Initiative dataset
Authors: Temesguen Messay, Russell C. Hardie, Timothy R. Tuinstra
Journal: Medical Image Analysis (2015)

We present new pulmonary nodule segmentation algorithms for computed tomography (CT). These include a fully-automated (FA) system, a semi-automated (SA) system, and a hybrid system. Like most traditional systems, the new FA system requires only a single user-supplied cue point. On the other hand, the SA system represents a new algorithm class requiring 8 user-supplied control points. This does increase the burden on the user, but we show that the resulting system is highly robust and can handle a variety of challenging cases. The proposed hybrid system starts with the FA system. If improved segmentation results are needed, the SA system is then deployed. The FA segmentation engine has 2 free parameters, and the SA system has 3. These parameters are adaptively determined for each nodule in a search process guided by a regression neural network (RNN). The RNN uses a number of features computed for each candidate segmentation. We train and test our systems using the new Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) data. To the best of our knowledge, this is one of the first nodule-specific performance benchmarks using the new LIDC-IDRI dataset. We also compare the performance of the proposed methods with several previously reported results on the same data used by those other methods. Our results suggest that the proposed FA system improves upon the state-of-the-art, and the SA system offers a considerable boost over the FA system.
Double-balloon enteroscopy-assisted virtual chromoendoscopy for small-bowel disorders – a case series
Authors: H. Neumann, L. Fry, M. Bellutti, P. Malfertheiner, K. Mönkemüller
Journal: Endoscopy (2009)

The Fujinon intelligent color enhancement (FICE) system is a new, virtual chromoendoscopy technique that enhances mucosal visibility. The aim of this study was to assess the utility of double-balloon enteroscopy (DBE) with FICE technology (EPX-4400 processor, Japan) for the characterization of various small-bowel diseases. Overall, a total of 574 endoscopic pictures were obtained and analyzed. FICE was found to be a helpful method for the evaluation of adenomatous small-bowel polyps and angiodysplasias. Its use for the characterization of celiac and Crohn's disease appears to be limited. Overall, FICE may become a useful method that aids in characterization and provides new insights to small-bowel pathologies.
Current Trends in Botulism in the United States
Authors: Michael H. Merson
Journal: JAMA (1974)

Between 1970 and 1973, thirty outbreaks of food-borne botulism involving 91 cases and 21 deaths (23%) were reported to the Center for Disease Control (CDC). Three of the 30 outbreaks were attributed to commercial foods. Six cases of wound botulism were also reported. Electromyography and a recently developed test for detection of botulinal toxin in human feces have facilitated the laboratory diagnosis of botulism. Intensive respiratory care and elimination of toxin from the gastrointestinal tract remain the most important aspects of therapy. The efficacy of botulinal antitoxin is unclear, and the rate of untoward reactions to its administration appears to be about 20%. Education of the home canner and enforcement of federal regulations established for the canning of low-acid foods by the food industry are vital to the prevention and control of botulism. (<i>JAMA</i>229:1305-1308, 1974)
In Vivo Assessment of Pulmonary Vascular Integrity in Experimental Pulmonary Edema
Authors: Kenneth L. Brigham, James D. Snell
Journal: Journal of Clinical Investigation (1973)

During single pass indicator studies across the lungs [(14)C]urea remains in the vascular compartment, but its molecular size and solubility suggest it might escape abnormally permeable vessels. To test the hypothesis that [(14)C]urea might be used to distinguish pulmonary edema due to acutely increased intravascular pressure from that due to vascular damage by alloxan, we studied [(51)Cr]erythrocytes (r), [(125)I]albumin (a), [(14)C]urea (u), and tritiated water as dilution indicators in the pulmonary circulation of anesthetized dogs. In addition, the adequacy of albumin as an intravascular indicator was evaluated. Indicator curves, blood gases, hematocrit, and vascular pressures were determined during a base-line period and repeated 30 and 60 min after treatment in five groups of dogs: (a) saline control. (b) alloxan edema. (c) epinephrine infusion, (d) volume overload, and (e) left atrial (LA) balloon obstruction.Groups b, d, and e developed a similar degree of edema judging by wet/dry lung weights and histology. Groups a and c did not develop edema. In alloxan edema, differences between the mean transit time volume of u and r (V(v-r)) increased over base line at 30 (P < 0.001) and 60 min (P < 0.02); the differences between the mean transit time volume of a and r (V(e-r)) increased slightly at 30 (P < 0.03) and 60 min (P < 0.02); and V(u-r) significantly exceeded V(a-r) at 30 (mean difference = 9 ml, P < 0.02) and 60 min (mean difference = 11, P < 0.04). In none of the other groups did V(u-r) significantly exceed V(a-r). Thus, comparison of V(u-r) with V(a-r) may permit distinction between "high pressure" and "increased permeability" pulmonary edema. Albumin was not a consistently reliable indicator of intravascular volume as compared with composite red cell and albumin curve.
Phosphoinositide 3-kinase/protein kinase B signaling pathway is involved in estradiol 17β-d-glucuronide-induced cholestasis: Complementarity with classical protein kinase c
Authors: Andrea C. Boaglio, Andrés E. Zucchetti, Enrique J. Sánchez Pozzi, José M. Pellegrino, Justina Elena Ochoa, Aldo D. Mottino, Mary Vore, Fernando A. Crocenzi, Marcelo G. Roma
Journal: Hepatology (2010)

Estradiol 17β-D-glucuronide (E217G) is an endogenous, cholestatic metabolite that induces endocytic internalization of the canalicular transporters relevant to bile secretion: bile salt export pump (Bsep) and multidrug resistance–associated protein 2 (Mrp2). We assessed whether phosphoinositide 3-kinase (PI3K) is involved in E217G-induced cholestasis. E217G activated PI3K according to an assessment of the phosphorylation of the final PI3K effector, protein kinase B (Akt). When the PI3K inhibitor wortmannin (WM) was preadministered to isolated rat hepatocyte couplets (IRHCs), it partially prevented the reduction induced by E217G in the proportion of IRHCs secreting fluorescent Bsep and Mrp2 substrates (cholyl lysyl fluorescein and glutathione methylfluorescein, respectively). 2-Morpholin-4-yl-8-phenylchromen-4-one, another PI3K inhibitor, and an Akt inhibitor (Calbiochem 124005) showed similar protective effects. IRHC immunostaining and confocal microscopy analysis revealed that endocytic internalization of Bsep and Mrp2 induced by E217G was extensively prevented by WM; this effect was fully blocked by the microtubule-disrupting agent colchicine. The protection of WM was additive to that afforded by the classical protein kinase C (cPKC) inhibitor 5,6,7,13-tetrahydro-13-methyl-5-oxo-12 H -indolo[2,3 - a ]pyrrolo[3,4 - c ]carbazole-12-propanenitrile (Gö6976); this suggested differential and complementary involvement of the PI3K and cPKC signaling pathways in E217G-induced cholestasis. In isolated perfused rat liver, an intraportal injection of E217G triggered endocytosis of Bsep and Mrp2, and this was accompanied by a sustained decrease in the bile flow and the biliary excretion of the Bsep and Mrp2 substrates [3H]taurocholate and glutathione until the end of the perfusion period. Unlike Gö6976, WM did not prevent the initial decay, but it greatly accelerated the recovery to normality of these parameters and the reinsertion of Bsep and Mrp2 into the canalicular membrane in a microtubule-dependent manner. Conclusion: The PI3K/Akt signaling pathway is involved in the biliary secretory failure induced by E217G through sustained internalization of canalicular transporters endocytosed via cPKC. (Hepatology 2010)
A Role for Fas in Negative Selection of Thymocytes In Vivo
Authors: Hidehiro Kishimoto, Charles D. Surh, Jonathan Sprent
Journal: The Journal of Experimental Medicine (1998)

To seek information on the role of Fas in negative selection, we examined subsets of thymocytes from normal neonatal mice versus Fas-deficient lpr/lpr mice injected with graded doses of antigen. In normal mice, injection of 1–100 μg of staphylococcal enterotoxin B (SEB) induced clonal elimination of SEB-reactive Vβ8+ cells at the level of the semi-mature population of HSAhi CD4+ 8− cells found in the thymic medulla; deletion of CD4+ 8+ cells was minimal. SEB injection also caused marked elimination of Vβ8+ HSAhi CD4+ 8− thymocytes in lpr/lpr mice. Paradoxically, however, elimination of these cells in lpr/lpr mice was induced by low-to-moderate doses of SEB (≤1 μg) but not by high doses (100 μg). Similar findings applied when T cell receptor transgenic mice were injected with specific peptide. These findings suggest that clonal elimination of semi-mature medullary T cells is Fas independent at low doses of antigen but Fas dependent at high doses. Previous reports documenting that negative selection is not obviously impaired in lpr/lpr mice could thus reflect that the antigens studied were expressed at only a low level.
Providing Care for Critically Ill Surgical Patients
Authors: Samuel A. Tisherman
Journal: JAMA Surgery (2013)

Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.