tbuckley/cabot-search huggingface dataset:
Does routine oxygen supplementation in patients with acute stroke improve outcome?
Authors: S. J. Pountain, C. Roffe
Journal: BMJ (2012)

Stroke is the third most common cause of death and the leading cause of long term disability in developed countries. Specialist care in stroke units is well established as being effective in preventing death and disability after stroke.1 However, which aspects of stroke care are crucial for improving outcome remains unclear. Patients in a stroke unit are more likely than those on a non-specialised general ward to receive oxygen.2 Bravata and colleagues found that treating all episodes of hypoxia with supplemental oxygen was one of three key processes associated with better outcome in acute stroke care.3 Mild hypoxia is common in patients with stroke and may have substantial adverse effects on an ischaemic brain after stroke. Whereas healthy adults with normal cerebral circulation can compensate for mild hypoxia by an increase in cerebral blood flow, this is not possible in patients whose brain is already ischaemic after stroke.4 Hypoxaemia in the first few hours after hospital admission is associated with an increased risk of death.5

Oxygen treatment is not without problems.6 The tubing that connects the patient to the oxygen source impedes early mobilisation and could pose an infection risk. Physiological changes associated with oxygen treatment can include absorption atelectasis; worsening of ventilation-perfusion mismatch; coronary, cerebral, and systemic vasoconstriction; and a reduction in cardiac output.7 Animal models and in vitro studies show that oxygen encourages the formation of toxic free radicals, leading to further damage to the ischaemic brain, especially during reperfusion. Oxidative stress has also been implicated in the activation of cell signalling pathways, which lead to apoptosis and neuronal cell death. Although some research points towards adverse effects of hyperoxia in the ischaemic brain, some evidence supports the notion that eubaric hyperoxia (hyperoxia induced by oxygen treatment at normal atmospheric pressure) …
Asthma and gastroesophageal reflux
Authors: B. Chernow
Journal: JAMA (1977)

It is quite clear that Drs Chernow and Castell agree with the concepts set forth in my article: that adults with severe asthma have hiatal hernia and reflux more frequently than age-matched controls and that it appears quite likely that a cause and effect relationship between the two conditions exists. The advantages of widespread recognition of this concept are obvious, if one considers the prevalence of intrinsic asthma in the population. What, then, does their letter question or add to our knowledge on the point? In my report, no claim is made of having demonstrated aspiration in any patient. In fact, the commentary mentions the extreme difficulty that may be experienced in establishing definitive prospective proof of a cause and effect relationship between reflux and pulmonary symptoms. Similarly, although the UGI series was used as a screening test for reflux, I wrote that "more generally acceptable methods to
Peanut Allergic Subjects are at Increased Risk of Other Food Allergies when Compared with Peanut Tolerant Siblings with Similar Levels of IgE
Authors: A AYARS, D SCHLICHTING, H LEO, B SONG, H TALWAR, K MORGAN, R HARBECK, D FLEISCHER, F ATKINS, S DRESKIN
Journal: Journal of Allergy and Clinical Immunology (2008)
Sixty minutes of what? A developing brain perspective for activating children with an integrative exercise approach
Authors: Gregory D Myer, Avery D Faigenbaum, Nicholas M Edwards, Joseph F Clark, Thomas M Best, Robert E Sallis
Journal: British Journal of Sports Medicine (2015)

Current recommendations for physical activity in children overlook the critical importance of motor skill acquisition early in life. Instead, they focus on the quantitative aspects of physical activity (eg, accumulate 60 min of daily moderate to vigorous physical activity) and selected health-related components of physical fitness (eg, aerobic fitness, muscular strength, muscular endurance, flexibility and body composition). This focus on exercise quantity in youth may limit considerations of qualitative aspects of programme design which include (1) skill development, (2) socialisation and (3) enjoyment of exercise. The timing of brain development and associated neuroplasticity for motor skill learning makes the preadolescence period a critical time to develop and reinforce fundamental movement skills in boys and girls. Children who do not participate regularly in structured motor skill-enriched activities during physical education classes or diverse youth sports programmes may never reach their genetic potential for motor skill control which underlies sustainable physical fitness later in life. The goals of this review are twofold: (1) challenge current dogma that is currently focused on the quantitative rather than qualitative aspects of physical activity recommendations for youth and (2) synthesise the latest evidence regarding the brain and motor control that will provide the foundation for integrative exercise programming that provide a framework sustainable activity for life.
Flow-cytometric DNA analysis as a means for early detection of malignancy in patients with chronic ulcerative colitis.
Authors: C Hammarberg, C Rubio, P Slezak, B Tribukait, U Ohman
Journal: Gut (1984)

A new approach to the problem of monitoring patients with chronic ulcerative colitis is presented and discussed in connection with a case report. When annual colonoscopies are performed, biopsies are taken for histopathological examination and DNA measurements are made using flow-cytometric techniques (FCM). Using the latter approach, gross chromosomal aberrations indicating malignant transformation in a cell population may be detected. In a 46 year old man with a long history of ulcerative colitis, an area with slight mucosal dysplasia at light microscopy was accompanied by two aneuploid cells lines - that is, colonic mucosa cells with an abnormal amount of DNA in the nuclei. An operation one year later revealed a 5 X 2 mm large adenocarcinoma in the corresponding area of the colon. We suggest that flow-cytometric techniques can be used as a complement to already practised methods for monitoring the colorectal mucosa in colitic patients for the early detection of malignancy.
Evidence of functional lymphocytes in some (leaky) scid mice.
Authors: G C Bosma, M Fried, R P Custer, A Carroll, D M Gibson, M J Bosma
Journal: The Journal of Experimental Medicine (1988)

Although the majority of severe combined immune deficiency (scid) mice lack functional lymphocytes, some (2-23%) appear to develop a limited number of B and T cells between 3 and 9 mo old. Most of these leaky scid mice were shown to contain very few clones (less than or equal to 3) of Ig-producing plasmacytes. Clonal progeny were distributed unevenly in the lymphatic tissues and appeared as discrete plasmacytic foci. In many cases, individual clones persisted for several months and produced abnormally high concentrations of Ig that included multiple isotypes. Functional T cells were inferred from the ability of leaky mice to reject allogeneic skin grafts, a T cell-dependent reaction. Interestingly, approximately 40% of leaky mice developed thymic lymphomas. In other respects, leaky mice resembled regular scid mice; e.g., their splenic cells failed to express common lymphocyte antigens (Ly-5[B220], Ly-1) and to proliferate in response to lymphocyte mitogens. Histologically, their lymphoid tissues retained the same general pattern of severe lymphocytic deficiency as scid mice.
Impact of a Large-Scale Immunization Initiative in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Authors: Edward J. Hoekstra
Journal: JAMA (1998)

Inner-city immunization rates have lagged behind those in other areas of the country.To evaluate the impact of an initiative linking immunization with distribution of food vouchers in the inner city.Retrospective analysis of immunization data gathered in 1996 and 1997.Nineteen Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites serving 30% of the Chicago, III, birth cohort.A total of 16581 children 24 months old or younger.Voucher incentives (varying frequency of food voucher issuance based on immunization status) and assessment of immunization status and referral to immunization provider.Age-appropriate immunization rates and WIC enrollment rates.During the 15-month period of evaluation, immunization rates increased from 56% to 89% at sites performing voucher incentives. The proportion of children needing voucher incentives declined from 51% to 12%. Sites performing assessment and referral, but not providing voucher incentives, showed no evidence of improvement in immunization coverage. No difference was observed in enrollment rates between sites performing voucher incentives and those that did not.Applied in a large-scale, programmatic fashion, voucher incentives in WIC can rapidly increase and sustain high childhood immunization rates in an inner-city population.
Core‐binding factor acute myeloid leukemia: Heterogeneity, monitoring, and therapy
Authors: Melhem Solh, Sophia Yohe, Daniel Weisdorf, Celalettin Ustun
Journal: American Journal of Hematology (2014)

Core binding factor acute myelogenous leukemia (CBF AML) constitutes 15% of adult AML and carries an overall good prognosis. CBF AML encodes two recurrent cytogentic abnormalities referred to as t(8;21) and inv (16). The two CBF AML entities are usually grouped together but there is a considerable clinical, pathologic and molecular heterogeneity within this group of diseases. Recent and ongoing studies are addressing the molecular heterogeneity, minimal residual disease and targeted therapies to improve the outcome of CBF AML. In this article, we present a comprehensive review about CBF AML with emphasis on molecular heterogeneity and new therapeutic options.
London medical education boss quits amid plans to break up deanery
Authors: H. Jaques
Journal: BMJ (2012)

The director of medical and dental education commissioning at London Deanery is to step down in April next year amid plans to split the deanery into three.

Fiona Moss, who is responsible for commissioning, managing, and quality controlling training of around 12 500 doctors in foundation, core, and higher specialty training programmes in the capital, has announced that she will leave the deanery when the government’s changes to medical education and the medical workforce come into place in April 2013.

At this point London Deanery will divide into three local education and training boards (LETBs): South London; North West London; and North Central and East London. Each will have its own director of education quality and postgraduate dean.

Moss would not comment on her reasons for leaving but said that she hoped the new structure would be effective. “LETBs are well placed to make strong connections between service and training and thus to use education and training to improve the quality of care for today’s and tomorrow’s patients,” she said.

“My …
Treatment of Staphylococcal Endocarditis-Reply
Authors: William Hewitt
Journal: JAMA (1978)

Our intent in writing the LETTER TO THE EDITOR was to criticize Bryant and Alford's extrapolation from one patient with<i>S aureus</i>endocarditis who clearly relapsed after cefazolin therapy and one who was a very questionable failure to a general prohibition about use of this agent in<i>S aureus</i>endocarditis. We also questioned the validity of their second case and asked for studies of antibacterial activity in serum (usually considered standard procedure in managing endocarditis) to better evaluate their cases. These are not forthcoming in their answer to our letter. We also pointed out that<i>S aureus</i>endocarditis is a difficult disease to treat and that failures have been reported with every antistaphylococcal agent that has been evaluated. We certainly did not question the need to report both favorable and unfavorable results but only their interpretations. In the preceding letter, Bryant and Alford point out that there is
OUR TENDENCY TO FADS
Authors: JOSEPH ZEISLER
Journal: JAMA (1913)

This is neither the place nor the time to enlarge on the fact that the American people have a distinct tendency toward indulgence in fads of all kinds. That the medical profession in its own field of activities has shown the same inclination can easily be proved by a retrospect into recent medical history. I do not mean to suggest that Americans in general, and American physicians in particular, are possessed of that peculiar tendency to a very much larger degree than people abroad; but with us the tendency I refer to manifests itself in a somewhat different manner. Our fads show a very short life and a continuous change. Also, we are strongly inclined to cultivate certain fads just about when they begin to be discarded by Europeans. A fad is not necessarily a thing without any value as is evident from a definition taken from the dictionary: "A
ESTIMATING THE LIFETIME CLINICAL BENEFITS OF APIXABAN VERSUS CURRENT STANDARD OF CARE REGIMEN IN A UNITED STATES NON-VALVULAR ATRIAL FIBRILLATION POPULATION SIMILAR TO THAT ENROLLED IN ARISTOTLE AND AVERROES
Authors: Hemant Phatak, Paul Dorian, Thitima Kongnakorn, Tereza Lanitis, Andreas Kuznik, Jack Mardekian, Xianchen Liu, Jack Lawrence, Gregory Lip
Journal: Journal of the American College of Cardiology (2014)
Lens Vault, Thickness, and Position in Chinese Subjects with Angle Closure
Authors: Monisha E. Nongpiur, Mingguang He, Nishani Amerasinghe, David S. Friedman, Wan-Ting Tay, Mani Baskaran, Scott D. Smith, Tien Yin Wong, Tin Aung
Journal: Ophthalmology (2010)
Outcome of the acute glomerular injury in proliferative lupus nephritis.
Authors: A Chagnac, B A Kiberd, M C Fariñas, S Strober, R K Sibley, R Hoppe, B D Myers
Journal: Journal of Clinical Investigation (1989)

Treatment with total lymphoid irradiation (TLI) and corticosteroids markedly reduced activity of systemic lupus erythematosis in 10 patients with diffuse proliferative lupus nephritis (DPLN) complicated by a nephrotic syndrome. Physiologic and morphometric techniques were used serially before, and 12 and 36 mo post-TLI to characterize the course of glomerular injury. Judged by a progressive reduction in the density of glomerular cells and immune deposits, glomerular inflammation subsided. A sustained reduction in the fractional clearance of albumin, IgG and uncharged dextrans of radius greater than 50 A, pointed to a parallel improvement in glomerular barrier size-selectivity. Corresponding changes in GFR were modest, however. A trend towards higher GFR at 12 mo was associated with a marked increase in the fraction of glomerular tuft area occupied by patent capillary loops as inflammatory changes receded. A late trend toward declining GFR beyond 12 mo was associated with progressive glomerulosclerosis, which affected 57% of all glomeruli globally by 36 mo post-TLI. Judged by a parallel increase in volume by 59%, remaining, patent glomeruli had undergone a process of adaptive enlargement. We propose that an increasing fraction of glomeruli continues to undergo progressive sclerosis after DPLN has become quiescent, and that the prevailing GFR depends on the extent to which hypertrophied remnant glomeruli can compensate for the ensuing loss of filtration surface area.
Well informed uncertainties about the effects of treatment
Authors: John R Kemm
Journal: BMJ (2004)

Editor—“Evidence based medicine” and “evidence based policy” have done much to improve decision making. However, it is refreshing to see Chalmers reject the abuse that suggests these can simply be used to identify a “best practice” that should always be followed.1

The typical “evidence based” review identifies a large number of articles and then discards many as irrelevant and many more as methodologically unsound. The review is then based on the remaining handful and by implication all the other articles have nothing to contribute. However, detailed knowledge of the subject is often needed to judge the worth of a paper, and even methodologically flawed articles often contribute some information to the evidence base.

Typically an evidence base shows that fewer patients will benefit if given treatment A than if given treatment B. In the absence of any other information the best bet must be to choose treatment B, but nearly always other information and judgment are required as to whether the general conclusion that treatment B is better than A applies to an individual patient.

Wise doctors and policy makers will always use the evidence base to inform their decisions. But they also exercise judgment in considering all the information, formalised and informal, available to them before reaching a decision. In an uncertain world judgment free medicine (or policy making) is as bad as or worse than evidence free.
Clinical conference: De subitaneis mortibus. XIII. Multifocal Purkinije cell tumors of the heart.
Authors: T N James, C W Beeson, E B Sherman, R W Mowry
Journal: Circulation (1975)

Multifocal Purkinje cell tumors were found in the heart of a nine-month-old black female infant who died with arrhythmias which had become progressively more frequent and severe until they were completely intractable. The Purkinje cell tumors were composed of exactly the same type of cells found in the left bundle branch and the right bundle branch, and they were also located in the expected region of the His bundle. In none of these locations were these Purkinje cells forming normal longitudinally oriented Purkinje fibers, however, and no such fibers were found anywhere in this heart. The cells of the tumors contained glycogen but not in excess of that normally expected to be present in Purkinje cells. No evidence for a generalized abnormality of glycogen metabolism or storage was present. Except for the Purkinje cells, the remaining myocardial cells of the heart were all normal. The fundamental fault appeared to be failure of the Purkinje cells to organize into the normal histological pattern which is characterized by longitudinally oriented Purkinje fibers. Instead, all the Purkinje cells were rounded or polygonal and generally aggregated together into small discrete nodules of varying size. Future cases of this nature deserve careful attention to the nature of their cardiac rhythm and conduction, and in fatal cases there should be special studies of the histological appearance of their cardiac centers of impulse formation and conduction.
Value of the Autopsy
Authors: L. G. Dickson
Journal: JAMA (1984)

To the Editor.—  The Sept 2, 1983, issue ofThe Journalprovides valuable perspectives of the information gained from performance of autopsies. Additional persuasive arguments for the use of the autopsy in such medical staff affairs as quality assurance and risk management are provided by Clark. 1 His study is of particular value because it analyzed more than 1,000 autopsies in a hospital with an 84% autopsy rate. In this study we can see the value of the general application of the autopsy rather than its use restricted to medicolegal cases or cases in which there has been significant antemortem uncertainty.  The types of patients are typical of a large general hospital with an emergency department. Nine percent of cases provided valuable information not obtainable by means other than the autopsy.  The author also provides tabulation of the work involved in an autopsy as well as the costs. A brief
Transient blockade of CD40 ligand dissociates pathogenic from protective mucosal immunity
Authors: Arno Hänninen, Nathan R. Martinez, Gayle M. Davey, William R. Heath, Leonard C. Harrison
Journal: Journal of Clinical Investigation (2002)

Antigen administration via oral and other mucosal routes can suppress systemic immunity to the antigen and has been used to prevent experimental autoimmune disease. This approach may prove ineffective or even harmful if it leads to a concomitant induction of cytotoxic T lymphocytes (CTLs), and indeed, mucosal administration of the model antigen ovalbumin (OVA) has been shown to elicit CTL activation while simultaneously inducing oral tolerance. Here we show that induction by oral OVA of CTLs in wild-type mice, and of diabetes in mice expressing OVA transgenically in pancreatic β cells, can be prevented by transiently blocking the CD40 ligand (CD40L). However, CD40L blockade did not diminish oral tolerance, as measured by suppression of systemic OVA-primed T cell proliferation, IFN-γ secretion, and Ab production. Consistent with these findings, mice lacking CD40 expression could be orally tolerized to OVA. Transient CD40L blockade therefore dissociates pathogenic from protective immunity and should enhance the efficacy and safety of oral tolerance for preventing autoimmune disease.
Shepard's pie: The other half
Authors: Karl H. Pribram
Journal: Behavioral and Brain Sciences (2001)

Having seen the development of Shepard's program at close hand, I have been inspired by the sophistication of his results. However, his program deals with only half of what is needed: Shepard's research tells what the perception/cognitive process is about, it does not tell how that process is implemented. True, Shepard has recourse to the “how” of process in evolution, but that is not the “how” of everyday implementation. For that we need to know the brain processes with which we can implement Shepard's insights. [Shepard]
Back pain--what can we offer?
Authors: I H Bourne
Journal: BMJ (1979)

a remission of her psychosis, which reappeared when the drug was stopped.From this followed a trial in 13 cases of acute psychoses of varying aetiology, from which he and his team concluded that the symptoms of psychoses are attributable to hyperactivity of the beta- adrenergic system in the brain.There have been attempts at treatment with beta-blockers by other research teams, which have produced spectacular results in some hands2 and dubiety so far as schizophrenic illness is concerned in others.'Here one cannot rule out, in using such high doses, the possibility of a membrane- stabilising effect; but the doses used by Steinhert and Pugh4 were much lower.
VARIATIONS IN A CHICKEN SARCOMA CAUSED BY A FILTERABLE AGENT
Authors: Peyton Rous, James B. Murphy
Journal: The Journal of Experimental Medicine (1913)

Variations are described which have from time to time occurred in the structure and behavior of a transplantable, spindle-celled sarcoma of the fowl, a growth caused, as elsewhere shown, by a filterable agent. Of late the growth has frequently given rise to fatal hemorrhages from its substance. In some of the recent, rapidly growing tumors the cells have tended to be spherical, showing only a very tardy and imperfect differentiation to the spindle form. A giant-celled form of the growth is sometimes met with. Despite their diversity the tumors grade into one another and in the final analysis are all to be considered as spindle-celled sarcomata. Attempts to obtain an action of the etiological agent upon cells other than those it usually affects have failed, as have attempts to bring about changes in the histology of the sarcomata by attenuating the agent. Some of the lesser morphological variations in the sarcoma are undoubtedly due to local conditions in the host, and of the more important changes some have been associated with an increase in the growth's malignancy. For others the determining conditions have yet to be discovered. On the whole the variations described are not more marked than those occasionally manifested by the transplantable mammalian tumors, and traceable to the changes in a single strain of tumor cells during their propagation in successive hosts. In mammals the ultimate reason for these changes is not known. In the case of the chicken tumor some of them are undoubtedly the expression of changes in the growth's causative agent.