tbuckley/cabot-search huggingface dataset:
Fibro-Sarcoma of Left Clavicle at Sternal End: Excision: Death from Suppuration Spreading down the Anterior Mediastinum
Authors: G. Barling
Journal: BMJ (1890)

<h3>Objectives</h3> Metabolic syndrome (MetS) is recognised as a reliable long-term predictor of adverse health outcomes. Elevated prevalence rates of MetS and chronic lifestyle diseases have been documented in different indigenous groups. We aimed to evaluate the prevalence of MetS and diabetes mellitus in relation to ethnicity in Northern Norway. In addition, we discussed different cut-off values for waist circumference (WC) and what impact this has on the prevalence of MetS. <h3>Materials and methods</h3> SAMINOR is a population-based study of health and living conditions in areas home to Sami and non-Sami populations. The survey was carried out in 2003–2004. All eligible residents in specific age groups were invited. In total, 16 538 males and females aged 36–79 years participated and gave informed consent for medical research. <h3>Results</h3> This study involved a total of 7822 female and 7290 male participants. Sami affiliation was reported by 5141 participants (34%). The prevalence of MetS was high in both ethnic groups independent of which WC cut-off value was used. No ethnic differences in prevalence of diabetes mellitus were demonstrated. However, ethnicity appeared to affect diabetes treatment, which was more prevalent among Sami than non-Sami women. <h3>Conclusions</h3> In this study, there was no ethnic difference in diabetes prevalence, but ethnicity appeared to affect diabetes treatment. Tablet treatment was more commonly in use among Sami women than among non-Sami women. We demonstrated a high share of negative metabolic components. These metabolic components have important health implications. Therefore, determining preventive initiatives is important in the primary and specialist healthcare system. These initiatives must be made culture and linguistic specific, in order to reduce differences and improve health status in the whole population.
Circumsporozoite proteins of malaria parasites contain a single immunodominant region with two or more identical epitopes.
Authors: F Zavala, A H Cochrane, E H Nardin, R S Nussenzweig, V Nussenzweig
Journal: The Journal of Experimental Medicine (1983)

We have used panels of monoclonal antibodies to circumsporozoite (CS) proteins of Plasmodium falciparium, P. vivax, and P. knowlesi to determine the number of topographically independent epitopes of these antigens. The results of competition binding assays indicated that single regions of the CS molecules were recognized by the homologous monoclonal antibodies. Competition binding assays were also used to study the specificity of antibodies contained in the sera of humans and monkeys that had developed sterile immunity after immunization with irradiated, intact sporozoites. We found that single monoclonal antibodies inhibited 70-95% of the specific binding of the polyclonal antibodies to crude extracts of sporozoites. It appears, therefore, that CS proteins are among the most immunogenic constituents of sporozoites, and that a single region of these molecules contains most of the immunogenic activity. An additional finding was that the immunodominant region of CS molecules is multivalent with regard to the expression of a single epitope. This was demonstrated by the ability of monomers of CS proteins to bind simultaneously two or more molecules of the same monoclonal antibody.
Postsurgical Ulnar Neuropathy
Authors: Joseph S. Barr
Journal: JAMA (1974)

<h3>To the Editor.—</h3> Drs. Murphy and Devers (227:1123, 1974) are correct in emphasizing that one must be alert to avoid the problem of ulnar neuropathy during the time a patient is anesthetized and defenseless. However, in my experience, it is much more common to see this complication occur several days or more postoperatively. The seriously ill patient or the orthopedic patient in traction cannot move much in bed, and often lies with the hands on the abdomen and the elbows flexed. This puts direct pressure on the ulnar groove and the ulnar nerve. Many hospital mattresses are covered with a firm layer of plastic; this adds to the pressure on the ulnar nerve. The condition is diagnosed easily by the location of the symptoms (fourth and fifth fingers) and by tenderness over the ulnar nerve behind the medial epicondyle. It is helpful to place a pillow at the patient's side
Quality improvement programme to achieve acceptable colonoscopy completion rates: prospective before and after study
Authors: Jennifer E Ball, Jane Osbourne, Sarah Jowett, Mike Pellen, Mark R Welfare
Journal: BMJ (2004)

<h3>Abstract</h3> <b>Problem</b> A large audit of colonoscopy in the United Kingdom showed that the unadjusted completion rate was 57% when stringent criteria for identifying the caecum were applied. The caecum should be reached 90% of the time. Little information is available on what units or operators need to do to improve to acceptable levels. <b>Design</b> Quality improvement programme using two completed cycles of audit. <b>Setting</b> Endoscopy department in a university linked general hospital in northeast England. <b>Key measures for improvement</b> Colonoscopy completion rate. <b>Strategy for change</b> Two audit cycles were completed between 1999 and 2002. Changes to practice were based on results of audit and took into account the opinions of relevant staff. Lack of time for each colonoscopy, poor bowel preparation, especially in frail patients, and a mismatch between number of colonoscopies done and completion rate for individual operators were responsible for failed colonoscopies. Appropriate changes were made. <b>Effects of change</b> The initial crude colonoscopy completion rate was 60%, improving to 71% after the first round of audit and 88% after the second round, which approximates to the agreed audit standard of 90%. The final adjusted completion rate was 94%. <b>Lessons learnt</b> Achievement of the national targets in a UK general hospital is possible by lengthening appointments, admitting frail patients for bowel preparation to one ward, and allocating colonoscopies to the most successful operators.
“Are there any doctors here?”
Authors: Graham Easton
Journal: BMJ (2005)

A s soon as I heard the bang, I knew it was a bomb. Thunder doesn't sound that brutal or shake the building like that. At the time I was in a meeting room in BMA House with a visitor to the BMJ . “That's a bomb,” I said, as my visitor and I leapt from our seats and ran out into the main editorial office. Everyone was rushing to the balcony to see what had happened. Even before I got close to the edge I knew from the contorted expressions etched into the faces of my friends and colleagues looking down on to the street two floors below that it was something horrific. Some of them were wailing. I peered over the edge for an aerial view of a most sickening scene. The roof of the crippled bus—the number 30 that was destroyed in a terrorist attack in Tavistock Square last week, right outside BMA House—had …
Using Evidence to Combat Overdiagnosis and Overtreatment: Evaluating Treatments, Tests, and Disease Definitions in the Time of Too Much
Authors: Ray Moynihan, David Henry, Karel G. M. Moons
Journal: PLoS Medicine (2014)

Ray Moynihan and colleagues outline suggestions for improving the way that medical evidence is produced, analysed, and interpreted to avoid problems of overdiagnosis and overtreatment. Please see later in the article for the Editors' Summary
Decline in mortality in children with HIV in the UK and Ireland
Authors: K P Prime, E A Jungmann, S G Edwards
Journal: BMJ (2004)

Editor—Gibb et al describe the dramatic impact of antiretroviral therapy in HIV-1 infected children.1 Improved survival means that increasing numbers of HIV infected adolescents will confront issues common to this age group, such as poor outpatient attendance,2 problems with adherence to treatment,3 and transition to an adult environment.

The Intercollegiate Working Party on Adolescent Health supports the development of dedicated adolescent clinics.4 In 2001 we established the first adolescent only HIV outpatient service in the United Kingdom. Young people were closely involved in the multidisciplinary clinic design, and a transition policy was developed together with the family unit at Great Ormond Street Hospital.5 Our aim was to create an environment where adolescents felt able to discuss complex issues including antiretroviral therapy, sexual debut, social isolation, and familial bereavement.

Over the past two years 15 adolescents have transferred to the clinic. Most (13) are Black African. At the time of transition eight had an AIDS defining illness, and 13 required antiretroviral therapy, eight with a viral load < 50 copies/ml. Seven of the 14 adolescents who have ever taken antiretrovirals have documented resistance to the drugs, and four of the 15 report being sexually active. No patients have been lost to follow up.

Increasing numbers of HIV infected children who have been treated with many drugs are reaching adolescence and becoming sexually active. We need dedicated adolescent services to minimise loss to follow up, encourage adherence to treatment with antiretrovirals and prevent transmission of drug resistant virus. As individual HIV units see only small numbers of adolescents, we should establish service networks with comprehensive guidelines to ensure best practice.
Laparoscopic distal gastrectomy reduced surgical site infection as compared with open distal gastrectomy for gastric cancer in a meta-analysis of both randomized controlled and case-controlled studies
Authors: Mikito Inokuchi, Hirofumi Sugita, Sho Otsuki, Yuya Sato, Masatoshi Nakagawa, Kazuyuki Kojima
Journal: International Journal of Surgery (2015)
Treatment of myocardial infarction should be audited before heart failure clinics are set up
Authors: A. D Timmis
Journal: BMJ (1999)

EDITOR—Cleland at al draw attention to the body of evidence favouring use of βblockers in patients with heart failure.1 In discussing implications for clinical practice they recommend that greater emphasis be given to using these drugs as part of a preventive strategy in patients with milder symptoms. To achieve this they call for a reorganisation of services, including …
The promise of cognitive behavior therapy for treatment of severe mental disorders: a review of recent developments
Authors: Michael E. Thase, David Kingdon, Douglas Turkington
Journal: World Psychiatry (2014)

Cognitive behavior therapy (CBT), as exemplified by the model of psychotherapy developed and refined over the past 40 years by A.T. Beck and colleagues, is one of the treatments of first choice for ambulatory depressive and anxiety disorders. Over the past several decades, there have been vigorous efforts to adapt CBT for treatment of more severe mental disorders, including schizophrenia and the more chronic and/or treatment refractory mood disorders. These efforts have primarily studied CBT as an adjunctive therapy, i.e., in combination with pharmacotherapy. Given the several limitations of state-of-the-art pharmacotherapies for these severe mental disorders, demonstration of clinically meaningful additive effects for CBT would have important implications for improving public health. This paper reviews the key developments in this important area of therapeutics, providing a summary of the current state of the art and suggesting directions for future research.
Clickable, Photodegradable Hydrogels to Dynamically Modulate Valvular Interstitial Cell Phenotype
Authors: Chelsea M. Magin, Daniel L. Alge, Sarah T. Gould, Kristi S. Anseth
Journal: Advanced Healthcare Materials (2014)

Biophysical cues are widely recognized to influence cell phenotype. While this evidence was established using static substrates, there is growing interest in creating stimulus‐responsive biomaterials that better recapitulate the dynamic extracellular matrix. Here, a clickable, photodegradable hydrogel substrate that allows the user to precisely control substrate elasticity and topography in situ is presented. The hydrogels are synthesized by reacting an 8‐arm poly(ethylene glycol) alkyne with an azide‐functionalized photodegradable crosslinker. The utility of this platform by exploiting its photoresponsive properties to modulate the phenotype of porcine aortic valvular interstitial cells (VICs) is demonstrated. First, VIC phenotype is monitored, in response to initial substratum modulus and static topographic cues. Higher modulus ( E ≈ 15 kPa) substrates induce higher levels of activation (≈70% myofibroblasts) versus soft ( E ≈ 3 kPa) substrates (≈20% myofibroblasts). Microtopographies that induce VIC alignment and elongation on low modulus substrates also stimulate activation. Finally, VIC phenotype is monitored in response to sequential in situ manipulations. The results illustrate that VIC activation on stiff surfaces (≈70% myofibroblasts) can be partially reversed by reducing surface modulus (≈30% myofibroblats) and subsequently re‐activatedby anisotropic topographies (≈60% myofibroblasts). Such dynamic substrates afford unique opportunities to decipher the complex role of matrix cues on the plasticity of VIC activation.
Upregulation of Interleukin 6 and Granulocyte Colony-Stimulating Factor Receptors by Transcription Factor CCAAT Enhancer Binding Protein α (C/EBPα) Is Critical for Granulopoiesis
Authors: Pu Zhang, Atsushi Iwama, Milton W. Datta, Gretchen J. Darlington, Daniel C. Link, Daniel G. Tenen
Journal: The Journal of Experimental Medicine (1998)

Cytokines stimulate granulopoiesis through signaling via receptors whose expression is controlled by lineage-specific transcription factors. Previously, we demonstrated that granulocyte colony-stimulating factor (G-CSF) receptor mRNA was undetectable and granulocyte maturation blocked in CCAAT enhancer binding protein α (C/EBPα)-deficient mice. This phenotype is distinct from that of G-CSF receptor−/− mice, suggesting that other genes are likely to be adversely affected by loss of C/EBPα. Here we demonstrate loss of interleukin 6 (IL-6) receptor and IL-6–responsive colony-forming units (CFU-IL6) in C/EBPα−/− mice. The observed failure of granulopoiesis could be rescued by the addition of soluble IL-6 receptor and IL-6 or by retroviral transduction of G-CSF receptors, demonstrating that loss of both of these receptors contributes to the absolute block in granulocyte maturation observed in C/EBPα-deficient hematopoietic cells. The results of these and other studies suggest that additional C/EBPα target genes, possibly other cytokine receptors, are also important for the block in granulocyte differentiation observed in vivo in C/EBPα-deficient mice.
Ductal Carcinoma in Situ of the Breast
Authors: Harold J. Burstein, Kornelia Polyak, Julia S. Wong, Susan C. Lester, Carolyn M. Kaelin
Journal: New England Journal of Medicine (2004)

Ductal carcinoma in situ of the breast (also called intraductal carcinoma), a clonal proliferation of malignant-appearing cells within the mammary duct lumens without evidence of invasion beyond the epithelial basement membrane, is the precursor lesion of invasive breast cancer. In the past 20 years, concomitant with the wide use of screening mammography, its detected incidence has risen dramatically. Data from large cohort studies and randomized trials have emerged to guide treatment. This review summarizes progress in the understanding, pathogenesis, and treatment of ductal carcinoma in situ.
Case of relapsed CD20(+) mixed‐cellularity Hodgkin disease treated with sequential rituximab and radiotherapy
Authors: Michalis V. Karamouzis, Nikiforos Apostolikas, Chara Georganta, Giorgos Lainakis, Kostas Kandylis, Gerasimos Rigatos
Journal: American Journal of Hematology (2004)

To the Editor: Neurotoxicity is a well-recognized complication following high-dose cytosine arabinoside (HIDAC).The pathophysiology of this toxicity is unknown, although an immune-mediated mechanism is hypothesized.We describe a patient with AML who suffered both cerebellar toxicity and peripheral neuropathy following high-dose cytarabine and showed excellent response to methylprednisolone.A 40-year-old married woman was diagnosed with acute myeloid leukemia, FAB-M2, in August 2002.She received standard induction chemotherapy with cytarabine and daunorubicin in 7-day and 3-day regimens, respectively.Her bone marrow on day 21 showed marrow to be in remission.She was given consolidation chemotherapy in the form of HIDAC in the dose of 3 g/m 2 twice daily.She developed high-grade fever on day 3, and the last dose of HIDAC was withheld.She received a total of 22.5 g of cytarabine.On day 7, she developed slurring of speech followed by gait ataxia, diplopia, dysmetria, and dysdiadochokinesia.Brain MRI on day 10 showed early cerebellar atrophy.On day 35, she noted increased weakness and paresthesias of upper and lower limbs but without an increase in uncoordination.She had proximal muscle weakness of both upper and lower limbs, absent deep tendon reflexes along with impaired joint position, and light touch sensation in a glove-and-stocking pattern.Her nerve conduction study was suggestive of distal symmetrical sensorimotor largefiber polyneuropathy.A sural nerve biopsy was nondiagnostic.Cerebrospinal fluid analysis showed no cells, proteins 45 mg (40-75 mg), sugar 54 mg (corresponding blood sugar 78 mg).She was administered methyl prednisolone 1 g IV each day for 3 days followed by oral steroids (1 mg/kg).After about 6 days, she started showing improvement in her power.She continued to improve gradually.Her power in the lower and upper limbs along with cerebellar functions improved by more than 90% over next 3-4 weeks.She was able to walk independently with no uncoordination.She refused any further chemotherapy, relapsed 3 months later, and died.The present case describes a patient with AML who had both cerebellar toxicity and peripheral neuropathy, thus implicating HIDAC as the causative agent [1][2][3].The cause of peripheral neuropathy has been attributed to
SOME INFECTIONS OF THE TONSILS: Abstract of the Hunterian Lecture delivered before the Royal College of Surgeons of England on February 19th, 1915
Authors: F. C. Pybus
Journal: BMJ (1915)

THE, fauicial tonsil, -which lies betweeln tlle pillars of the fauces, is the m-lost comuplex part of the lymplhoid tisstue at tlle entranice of 'the alimentary canial.Lymiiplhatic vessels pass frolml the tonisil to a gland in the deep cerviical cliains.Altlhouighl afferent lymtiplhatics lhave not been demonstrateJ, pigmiielnt injected iInto thle niasal mucous membrane has been foun1d after a shiort in1tervaliii the stubstance of the tonsil.Certain autlhorities ascribe some particular internial secretioni to the tonssil, btit oni evidence by nio means conclusive.The tonsils may serve as lymplhatic glands for certain regions of th1e nasal cavities.They act also as a protection against tlhe constant presence of organisms in tllis part of the pharynx either in tlhe mouth,-lacunae, or tonsil sub- stance should they reaclh it through sonme breaclh in the surface.It is also probable tllat in tlle exercise of this plhagocytosis they confer some immunity against tlle organisms inhabiting tllis region. Bacteriology.Botlh tlle sturface alnd the lacuLnae of the tonsils are subject to organismnss tlhrougllout life.No active in-N-asion is apparent tindler normiial conditions, but infection with very varied effects talkes place under the influienice of local injury or lowered resistance.Dwyer, in the exai-iiination' of perfectly healtlhy subjects, foutnd the pnelnlococcus, staplhylococcus, Micrococc us catarrhalis, the diplhtheria bacillus, tlle influenza bacillus, the spi- rillulm, and otlher patlhogenic forms on cultural examiiina- tioIn of the contents of tlie lacunmae, while the streptococcus seemed almost constant.In pathological conditions tlle balance is mlore or less upset, and additional organisms such as Bacilluts tuberculosis, the B. coli, anid actinomilycosis, are present.Tile lecturer explained at length tlle differellt ways by which tlhe-organismiis reaclhed-the tonisil so as to set up iiifective clhaniges.Actinoimycosis lhas
Paclitaxel Plus Bevacizumab in Patients with Chemosensitive Relapsed Small Cell Lung Cancer: A Safety, Feasibility, and Efficacy Study from the Hoosier Oncology Group
Authors: Shadia Jalal, Pablo Bedano, Lawrence Einhorn, Sumeet Bhatia, Rafat Ansari, Naftali Bechar, Karuna Koneru, Ramaswamy Govindan, Jingwei Wu, Menggang Yu, Bryan Schneider, Nasser Hanna
Journal: Journal of Thoracic Oncology (2010)
Greek drug price cuts will have knock on effects across Europe, industry warns
Authors: R. Watson
Journal: BMJ (2010)

The European drug industry has warned that the Greek government’s decision to reduce what it is prepared to pay for certain medicines by up to 27% will have a detrimental impact not only in Greece but elsewhere in Europe.

The warning by the European Federation of Pharmaceutical Industries and Associations (EFPIA), which represents the research based drug industry in Europe, follows the decision by two Danish companies to withdraw some of their products from the Greek market.

The federation notes that the reduction in prices “will inevitably raise the likelihood of increased parallel exports of medicinal products from Greece, diverting supplies needed …
Stress and Bronchodilator Response in Children with Asthma
Authors: John M. Brehm, Sima K. Ramratnam, Sze Man Tse, Damien C. Croteau-Chonka, Maria Pino-Yanes, Christian Rosas-Salazar, Augusto A. Litonjua, Benjamin A. Raby, Nadia Boutaoui, Yueh-Ying Han, Wei Chen, Erick Forno, Anna L. Marsland, Nicole R. Nugent, Celeste Eng, Angel Colón-Semidey, María Alvarez, Edna Acosta-Pérez, Melissa L. Spear, Fernando D. Martinez, Lydiana Avila, Scott T. Weiss, Manuel Soto-Quiros, Carole Ober, Dan L. Nicolae, Kathleen C. Barnes, Robert F. Lemanske, Robert C. Strunk, Andrew Liu, Stephanie J. London, Frank Gilliland, Patrick Sleiman, Michael March, Hakon Hakonarson, Qing Ling Duan, Jay K. Kolls, Gregory K. Fritz, Donglei Hu, Negar Fani, Jennifer S. Stevens, Lynn M. Almli, Esteban G. Burchard, Jaemin Shin, Elizabeth L. McQuaid, Kerry Ressler, Glorisa Canino, Juan C. Celedón
Journal: American Journal of Respiratory and Critical Care Medicine (2015)

Rationale: Stress is associated with asthma morbidity in Puerto Ricans (PRs), who have reduced bronchodilator response (BDR).Objectives: To examine whether stress and/or a gene regulating anxiety (ADCYAP1R1) is associated with BDR in PR and non-PR children with asthma.Methods: This was a cross-sectional study of stress and BDR (percent change in FEV1 after BD) in 234 PRs ages 9–14 years with asthma. We assessed child stress using the Checklist of Children’s Distress Symptoms, and maternal stress using the Perceived Stress Scale. Replication analyses were conducted in two cohorts. Polymorphisms in ADCYAP1R1 were genotyped in our study and six replication studies. Multivariable models of stress and BDR were adjusted for age, sex, income, environmental tobacco smoke, and use of inhaled corticosteroids.Measurements and Main Results: High child stress was associated with reduced BDR in three cohorts. PR children who were highly stressed (upper quartile, Checklist of Children’s Distress Symptoms) and whose mothers had high stress (upper quartile, Perceived Stress Scale) had a BDR that was 10.2% (95% confidence interval, 6.1–14.2%) lower than children who had neither high stress nor a highly stressed mother. A polymorphism in ADCYAP1R1 (rs34548976) was associated with reduced BDR. This single-nucleotide polymorphism is associated with reduced expression of the gene for the β2-adrenergic receptor (ADRB2) in CD4+ lymphocytes of subjects with asthma, and it affects brain connectivity of the amygdala and the insula (a biomarker of anxiety).Conclusions: High child stress and an ADCYAP1R1 single-nucleotide polymorphism are associated with reduced BDR in children with asthma. This is likely caused by down-regulation of ADRB2 in highly stressed children.