tbuckley/cabot-search huggingface dataset:
An adolescent with an altered state of mind
Authors: S. Naviglio, D. Papanti, V. Moressa, A. Ventura
Journal: BMJ (2015)

A 17 year old previously healthy adolescent presented to the emergency department with severe headache, vomiting, and an altered state of mind.His mother reported that he had returned home one hour before, looking confused and agitated; afterwards he mentioned a worsening headache and had vomited twice.On arrival at the emergency department he was conscious but drowsy and slow in answering simple questions.He reported frontal headache (8/10 on a visual analogue scale) and photophobia, and he was unable to stand unassisted.He was afebrile, his heart rate was 170 beats/min, and his blood pressure was 132/80 mm Hg.His pupils were mydriatic and poorly reactive to light.The remainder of the physical examination was unremarkable.He denied taking any drugs or medication, and a urine screen test was negative for cannabinoids, opioids, amphetamines, benzodiazepines, ethanol, and cocaine.Computed tomography of the brain and a basic set of blood tests were performed, and all results were normal.On further questioning by his parents he admitted having smoked "herbal incense" with friends in the afternoon, after which he reported having experienced visual and auditory hallucinations.Questions 1. Which diagnosis does this story suggest? 2. What potentially serious complications should be considered?3. How could you confirm the diagnosis?4. How should this patient be managed?Answers 1. Which diagnosis does this story suggest?Short answer Acute intoxication by an emerging drug of misuse, probably a synthetic cannabinoid.Clues to the diagnosis include acute onset, otherwise unexplained, central nervous system and autonomic disturbances in a healthy young person with negative drug screening tests and a history of smoking herbal incense.
Systemic Induction of the Angiogenesis Switch by the Tetraspanin D6.1A/CO-029
Authors: Sabine Gesierich, Igor Berezovskiy, Eduard Ryschich, Margot Zöller
Journal: Cancer Research (2006)

Abstract Expression of the tetraspanin CO-029 is associated with poor prognosis in patients with gastrointestinal cancer. In a pancreatic tumor line, overexpression of the rat homologue, D6.1A, induces lethally disseminated intravascular coagulation, suggesting D6.1A engagement in angiogenesis. D6.1A-overexpressing tumor cells induce the greatest amount of angiogenesis in vivo, and tumor cells as well as exosomes derived thereof strikingly increase endothelial cell branching in vitro. Tumor cell–derived D6.1A stimulates angiogenic factor transcription, which includes increased matrix metalloproteinase and urokinase-type plasminogen activator secretion, pronounced vascular endothelial growth factor expression in fibroblasts, vascular endothelial growth factor receptor expression, and strong D6.1A up-regulation in sprouting endothelium. Thus, D6.1A initiates an angiogenic loop that, probably due to the abundance of D6.1A in tumor-derived exosomes, reaches organs distant from the tumor. Most importantly, because of the strong D6.1A up-regulation on sprouting capillaries, angiogenesis could be completely inhibited by a D6.1A-specific antibody, irrespective of whether or not the tumor expresses D6.1A. Tetraspanins have been suggested to be involved in morphogenesis. This is the first report that a tetraspanin, CO-029/D6.1A, promotes tumor growth by its capacity to induce systemic angiogenesis that can effectively, and with high selectivity for sprouting endothelium, be blocked by a D6.1A-specific antibody. (Cancer Res 2006; 66(14): 7083-94)
Relationship Between Voltage Map “Channels” and the Location of Critical Isthmus Sites in Patients With Post-Infarction Cardiomyopathy and Ventricular Tachycardia
Authors: Stavros E. Mountantonakis, Robert E. Park, David S. Frankel, Mathew D. Hutchinson, Sanjay Dixit, Joshua Cooper, David Callans, Francis E. Marchlinski, Edward P. Gerstenfeld
Journal: Journal of the American College of Cardiology (2013)
An exploration of the hydration strategies of the runners of the 2010 london marathon by questionnaire
Authors: Jonathan Williams, Courtney Kipps, Victoria Tzorgiou
Journal: British Journal of Sports Medicine (2011)

Background There have been several recorded fatalities due to Exercise-associated hyponatraemia (EAH) attributed to excess fluid intake by marathon runners. A significant proportion of runners finishing marathons have been found to be hyponatraemic, mainly due to inappropriate fluid intake. Objective To explore the hydration strategies of marathon runners, their sources of information and knowledge about fluid intake on marathon day and their understanding of hyponatraemia. Design Anonymised questionnaire. Setting The London Marathon Registration. Participants A random sample of 217 runners registering for the marathon. Results 93% of the runners had read or been told about drinking fluids on marathon day. The majority of competitors had a plan regarding fluid intake prior to, during and after the marathon. 83.9% said that they knew enough about what and how much to drink on marathon day. However, 34% planned to drink a volume large enough to put themselves at higher risk of EAH. Only 21% knew the volumes of water and sports drink bottles from which they planned to drink during the marathon. 20.7% were planning to take a drink from all 24 water stations. Only 25% planned to drink according to their thirst as recommended by the international EAH conference consensus statement. 68% of runners had heard of hyponatraemia or low sodium levels, but only 35% had a basic understanding of its cause and effects. Conclusions Runners of the 2010 London Marathon lack knowledge about appropriate fluid intake on race day. A significant proportion of participants have drinking strategies that put them at risk of EAH. Runners need to be more effectively educated about safe fluid intake prior to future London Marathons.
Letter by Khan and Moukarbel Regarding Article, “Risk for Myocardial Infarction and Stroke After Community-Acquired Bacteremia: A 20-Year Population-Based Cohort Study”
Authors: Abdur Rahman Khan, George V. Moukarbel
Journal: Circulation (2015)

We read with interest the article by Dalager-Pedersen and colleagues 1 on the risk of myocardial infarction and stroke in community-acquired bacteremia.In this population-based cohort study, the authors found higher incident events of myocardial infarction and stroke within a year of admission for community-acquired bacteremia compared with hospitalized nonbacteremic or general population control subjects.This study adds to the already accumulated evidence that suggests increased cardiovascular events with infection and sepsis. 2 However, although the authors excluded patients with hospitalization within the previous 30 days, they did not provide any information about recent (within 6 months) cardiovascular events in these patients before the index admission that would have placed them at a higher risk for recurrent events. 3Patients with recent myocardial infarction and stroke are at increased risk for acquiring infections 4,5 ; therefore, the index bacteremia could be a confounder and not a cause of the cardiovascular event.The evidence is based on observational design and use of administrative databases, which may be influenced by confounders.The authors need to be commended for an attempt to adjust both known and unknown confounders in their study.However, no analysis short of a randomized, controlled trial can potentially adjust for all confounders and establish causation.
Immunovirologic Control 24 Months After Interruption of Antiretroviral Therapy Initiated Close to HIV Seroconversion
Authors: Laurent Hocqueloux, Asier Saez-Cirion, Christine Rouzioux
Journal: JAMA Internal Medicine (2013)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
A Treatise of the Rickets: Being a Disease Common to Children
Authors: John Black
Journal: BMJ (2008)

When Glisson, Bate and Regemorter studied rickets it was thought to be a new disease. Their joint work—a very early example of collaborative research—was published in 1650 under the title De Rachitide, sive Morbo Puerili qui vulgo The Rickets dicitur ( Concerning Rickets, or a disease of children which is commonly called the Rickets ) and was translated into English by Philip Armin the year after.

It described the clinical features of rickets: 

> The head bigger than ordinary, and the face fat and in good constitution …
Art and the Uncertainty of Medicine
Authors: Jeffrey I. Campbell
Journal: JAMA (2014)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Is this clinical trial fully registered? A statement from the International Committee of Medical Journal Editors
Authors: Catherine D De Angelis, Jeffrey M Drazen, Frank A Frizelle, Charlotte Haug, John Hoey, Richard Horton, Sheldon Kotzin, Christine Laine, Ana Marusic, A John PM Overbeke, Torben V Schroeder, Harold C Sox, Martin B Van Der Weyden
Journal: The Lancet (2005)
WHAT SHOULD BE THE PHYSICIAN'S POSITION IN THE BODY POLITIC?
Authors: H. BERT ELLIS
Journal: JAMA (1904)

Each man, in his time, plays many parts, and the parts which should be played by our profession may well occupy us for a little while. The logical relation of medicine to sociology has very naturally created some peculiar types of fame for physicians. Oliver Wolcott, a signer of the Declaration of Independence, who led in the foundation of medical societies and journals, is better known as a financier. Benjamin Rush, an alienist, clinician, hygienist and hospital reformer, incurred more enmity by his political conduct than he won fame by his medical science and patriotism; he was a signer of the Declaration of Independence, yet, through criticisms of the "little great" Colonial nobodies of New England, Virginia and Pennsylvania, he created so much offense that the animosity of their descendants still pursues him, so that as yet the National Capitol has not his monument. The quaintest instances of
Policies on drugs in the new Europe.
Authors: T Smith
Journal: BMJ (1990)

The recent successful molecular cloning of the viral genome of hepatitis E virus by Reyes et al represents a giant leap forward.2Briefly, a rich source of virus was required for cloning; but as virus particles in faeces were frequently degraded and the concentration of particles by sucrose gradient centrifugation may have been complicated by the lability of the virus it was argued that intact virus might be present in gall bladder bile before its discharge into the duodenum.Indeed, aspiration of bile from the gall bladders of several infected cynomolgus macaques during the early acute phase of infection yielded a sample with a very high virus particle count on electron microscopy.Bile was used for the construction of recombinant complementary DNA (cDNA) libraries.Libraries in bacteriophage lambda gt 10 were screened by differential hybridisation with cDNA probes prepared from RNA extracted from infected and unin- fected bile preparations.Several clones were identified that hybridised only to the infected bile cDNA probe.One molecular clone hybridised to a roughly 7-6 kilobase RNA species present only in the livers of infected cynomolgus macaques but not to any of the appropriate control prepara- tions of DNA and RNA extracts.The translated nucleic acid sequence of a portion of the clone had a consensus amino acid motif consistent with an RNA directed RNA polymerase, an enzyme that is present in all positive strand RNA viruses.No other similarity to any known viral or non-viral sequence was detected.Furthermore, this clone identified specifically similar sequences collected from patients with enterically transmitted non-A, non-B hepatitis in Somalia, Borneo, Pakistan, and the Soviet Union.These findings suggest that a single virus, hepatitis E virus, is responsible for this infection in geographically diverse regions of the world -observations that are also supported by the results of immune electron microscopy..The way is now open, therefore, for developing specific diagnostic tests for this important form of hepatitis, which accounts for over half of the cases of acute viral hepatitis in adults in many areas of the developing world and is responsible for very high mortality in pregnant women.The development of vaccines against hepatitis E is now feasible.
CDK 4/6 Inhibitor Palbociclib (PD0332991) in Rb+ Advanced Breast Cancer: Phase II Activity, Safety, and Predictive Biomarker Assessment
Authors: Angela DeMichele, Amy S. Clark, Kay See Tan, Daniel F. Heitjan, Kristi Gramlich, Maryann Gallagher, Priti Lal, Michael Feldman, Paul Zhang, Christopher Colameco, David Lewis, Melissa Langer, Noah Goodman, Susan Domchek, Keerthi Gogineni, Mark Rosen, Kevin Fox, Peter O'Dwyer
Journal: Clinical Cancer Research (2014)

Abstract Purpose: The G1–S checkpoint of the cell cycle is frequently dysregulated in breast cancer. Palbociclib (PD0332991) is an oral inhibitor of CDK4/6. Based upon preclinical/phase I activity, we performed a phase II, single-arm trial of palbociclib in advanced breast cancer. Experimental Design: Eligible patients had histologically confirmed, metastatic breast cancer positive for retinoblastoma (Rb) protein and measureable disease. Palbociclib was given at 125 mg orally on days 1 to 21 of a 28-day cycle. Primary objectives were tumor response and tolerability. Secondary objectives included progression-free survival (PFS) and assessment of Rb expression/localization, KI-67, p16 loss, and CCND1 amplification. Results: Thirty-seven patients were enrolled; 84% hormone-receptor (HR)+/Her2−, 5% HR+/Her2+, and 11% HR−/Her2−, with a median of 2 prior cytotoxic regimens. Two patients had partial response (PR) and 5 had stable disease ≥ 6 months for a clinical benefit rate (CBR = PR + 6moSD) of 19% overall, 21% in HR+, and 29% in HR+/Her2− who had progressed through ≥2 prior lines of hormonal therapy. Median PFS overall was 3.7 months [95% confidence interval (CI), 1.9–5.1], but significantly longer for those with HR+ versus HR− disease (P = 0.03) and those who had previously progressed through endocrine therapy for advanced disease (P = 0.02). Grade 3/4 toxicities included neutropenia (51%), anemia (5%), and thrombocytopenia (22%). Twenty-four percent had treatment interruption and 51% had dose reduction, all for cytopenias. No biomarker identified a sensitive tumor population. Conclusions: Single-agent palbociclib is well tolerated and active in patients with endocrine-resistant, HR+, Rb-positive breast cancer. Cytopenias were uncomplicated and easily managed with dose reduction. Clin Cancer Res; 21(5); 995–1001. ©2014 AACR.
Differential Regulation of Matrix Metalloproteinase-9 by Monocytes Adherent to Collagen and Platelets
Authors: Spencer W. Galt, Stephan Lindemann, Don Medd, Loren L. Allen, Larry W. Kraiss, Estelle S. Harris, Stephen M. Prescott, Thomas M. McIntyre, Andrew S. Weyrich, Guy A. Zimmerman
Journal: Circulation Research (2001)

Circulating monocytes adhere to platelets and matrix proteins at sites of vascular injury, where engagement of specific surface tethering molecules mediates outside-in signaling and synthesis of gene products by the leukocytes. Here we demonstrate that interaction of isolated human monocytes with collagen induces matrix metalloproteinase-9 (MMP-9; gelatinase B) synthesis by monocytes, a process that is greatly enhanced in the presence of platelets. MMP-9 is a potent matrix degrading enzyme implicated in atherosclerotic plaque rupture, aneurysm formation, and other vascular syndromes. Synthesis of MMP-9 by monocytes is tightly regulated and synergistically increased following adhesion to collagen and platelets. Adhesion to control matrix proteins alone did not result in MMP-9 protein production and, similarly, adhesion of monocytes to platelets activated with thrombin in suspension was not sufficient to induce MMP-9 synthesis in the absence of monocyte adhesion to collagen. Interruption of intercellular contact between platelets and monocytes dramatically inhibited MMP-9 synthesis. These observations demonstrate that discrete adhesion-dependent signaling pathways govern MMP-9 synthesis by monocytes. The synthesis of MMP-9 by monocytes may be critical in vascular syndromes and other pathological processes that are dependent on dysregulated cell-cell and cell-matrix interactions.
Parietal Lesion and "Enavid."
Authors: I. T. Lorentz
Journal: BMJ (1962)

This letter reports the case of a 41-year-old woman who had taken 4 tablets daily of 5-mg norethynodrel (Enavid) for menstrual pain over a 3-month period; she was admitted to an English hospital because of difficulty in finding words and  headache.  General examination showed that x-rays blood count and heart and lung sounds were normal; she had a nominal aphasia dysgraphia and dyslexia and there was some right-left disorientation and finger agnosia.  The diagnosis was left parietal lesion probably due to cortical venous thrombosis.  Enavid was stopped and the dysmenorrhoea returned.  She improved considerably in terms of speech writing and reading but considerable residual disability remained and some may be permanent.
Toxicity of endogenous and environmental estrogens: what is the role of elemental interactions?
Authors: G M Stancel, H L Boettger-Tong, C Chiappetta, S M Hyder, J L Kirkland, L Murthy, D S Loose-Mitchell
Journal: Environmental Health Perspectives (1995)

Many naturally occurring and man-made chemicals present in the environment possess estrogenic activity. Examples include plant and fungal products, pesticides, plasticizers, and other agricultural and industrial chemicals. These environmental estrogens as well as endogenous ovarian estrogens are thought to initiate their physiological actions in target tissues largely via interactions with a nuclear receptor system. The resultant estrogen-receptor complex in turn affects transcription via its interactions with nucleotide sequences known as estrogen response elements (EREs) present in the regulatory regions of hormone responsive genes. A "consensus" ERE sequence GGTCAnnnTGACC was originally identified in the vitellogenin genes of birds and amphibians, but it is now clear that most naturally occurring EREs differ from this sequence in one or more bases. We and others have obtained both in vivo and in vitro data suggesting a differential interaction of receptor complexes containing different ligands with the multiple EREs present in mammalian systems. This raises the possibility that the toxicity of environmental estrogens may arise in part from a differential pattern of ERE activation by environmental compounds relative to endogenous ovarian estrogens. The experimental basis for such a paradigm and its toxicological implications are discussed in this paper.
More on anticardiolipin and anti-beta2 glycoprotein I in systemic sclerosis
Authors: C M Antonioli
Journal: Annals of the Rheumatic Diseases (2003)

Patients with systemic sclerosis (SSc) may have arterial and venous thrombosis and, according to the limited and controversial data available, may have an increased incidence of pregnancy losses.1 These observations preceded the definition of antiphospholipid syndrome (APS) as the association of thrombosis and pregnancy loss with antiphospholipid antibodies (aPL), and did not focus on patients with SSc. However, the association of thrombosis and aPL, detected as lupus anticoagulant (LAC) and/or anticardiolipin antibodies (aCL), although rare, was described in SSc,2 supporting the possible existence of a “secondary” APS in SSc.3

In view of the fact that most aCL are directed to β2 glycoprotein I (aβ2GPI),4 the possibility that patients with APS may be negative for aCL, but positive for aβ2GPI,5 and considering the scarcity …
Throat Culture Processing In the Office
Authors: Harry A. Tubbs
Journal: JAMA (1967)

<h3>To the Editor:—</h3> The high rate of error in detecting beta hemolytic streptococcal infections by physicians in private offices reported by Dr. Allen M. Mondzac (<b>200</b>:1132, 1967) should surprise no one who reads his letter attentively. The appalling fact is that very few physicians know enough about the subject to realise that the conditions imposed were calculated to produce failure. The inference from context is that, among the conditions, no trained technician assistance was permitted; no quality controls were permitted; the physicians were untrained in culture technique and organism identification; apparently visual identification of difference between beta hemolysis differentiated streptococci from staphylococci; and a technique known to be deficient was required of the physicians, who were not permitted to use commercially available aids to the isolation of beta streptococci. What constructive purpose is served by such a study? Is the statement, "It is not the purpose of the study