tbuckley/cabot-search huggingface dataset:
If the Doctors Owned the Hospitals
Authors: Morton C. Creditor
Journal: New England Journal of Medicine (1971)

Abstract Large voluntary hospitals function at an unacceptable level of efficiency in this age of technologic and management capability. Many of the problems are the result of a system of governance that precludes the application of rational management principles. Hospital trusteeship must become more representative of the public served and develop competencies and characteristics inherent in the corporate model. The using physician, who initiates all hospital activity, must share in accountability for the cost of those activities. In the absence of the accountability imposed by the employer-employee relation, his share of responsibility should be identified by financial investment.
Endothelial Progenitor Cells
Authors: Anthony Rosenzweig
Journal: New England Journal of Medicine (2003)

Vascular endothelial cells form a lining — one cell thick — for all the blood vessels in the body, providing a critical interface between the vessel itself and blood-borne elements. From this location, the endothelium regulates a host of essential processes on both sides, by means of molecular signals expressed on its surface or released into the environment. In the normal state, vascular endothelium presents a nonadhesive surface to circulating leukocytes and platelets while helping to prevent the clotting of blood. In response to specific stimuli, however, the endothelium changes rapidly, providing signals that effectively orchestrate the recruitment of these . . .
Bayesian probability analysis: a prospective demonstration of its clinical utility in diagnosing coronary disease.
Authors: R Detrano, J Yiannikas, E E Salcedo, G Rincon, R T Go, G Williams, J Leatherman
Journal: Circulation (1984)

One hundred fifty-four patients referred for coronary arteriography were prospectively studied with stress electrocardiography, stress thallium scintigraphy, cine fluoroscopy (for coronary calcifications), and coronary angiography. Pretest probabilities of coronary disease were determined based on age, sex, and type of chest pain. These and pooled literature values for the conditional probabilities of test results based on disease state were used in Bayes' theorem to calculate posttest probabilities of disease. The results of the three noninvasive tests were compared for statistical independence, a necessary condition for their simultaneous use in Bayes' theorem. The test results were found to demonstrate pairwise independence in patients with and those without disease. Some dependencies that were observed between the test results and the clinical variables of age and sex were not sufficient to invalidate application of the theorem. Sixty-eight of the study patients had at least one major coronary artery obstruction of greater than 50%. When these patients were divided into low-, intermediate-, and high-probability subgroups according to their pretest probabilities, noninvasive test results analyzed by Bayesian probability analysis appropriately advanced 17 of them by at least one probability subgroup while only seven were moved backward. Of the 76 patients without disease, 34 were appropriately moved into a lower probability subgroup while 10 were incorrectly moved up. We conclude that posttest probabilities calculated from Bayes' theorem more accurately classified patients with and without disease than did pretest probabilities, thus demonstrating the utility of the theorem in this application.
A Comparison of the Segmental Analysis of Sodium Reabsorption during Ringer's and Hyperoncotic Albumin Infusion in the Rat
Authors: Jay H. Stein, Richard W. Osgood, Sampanta Boonjarern, Thomas F. Ferris
Journal: Journal of Clinical Investigation (1973)

Studies were designed to compare the segmental analysis of sodium reabsorption along the nephron during volume expansion with either 10% body weight Ringer's or 0.6% body weight hyperoncotic albumin. Total kidney and nephron glomerular filtration rate increased similarly with both, but urinary sodium excretion (12.7 vs. 4.0 mueq/min, P < 0.001) and fractional sodium excretion (5.0 vs. 1.6%, P < 0.001) increased to a greater extent with Ringer's. Fractional reabsorption of sodium in the proximal tubule was diminished in both groups but to a significantly greater extent during Ringer's (P < 0.005). Absolute reabsorption was inhibited only in the Ringer's group. Delivery of filtrate out of the proximal tubule was greater in the Ringer's studies, 45 vs. 37 nl/min (P < 0.001). However, both fractional and absolute sodium delivery to the early and late distal tubule were not significantly different in the two groups. Fractional reabsorption in the collecting duct decreased from 96% in hydropenia to 31% during Ringer's but fell only slightly to 80% in the albumin studies. Absolute collecting duct reabsorption was also greater in the albumin studies, 0.55 vs. 0.21 neq/min (P < 0.001), which could totally account for the difference in urinary sodium excretion between the two groups. (22)Na recovery in the final urine after end distal microinjections was 71% during Ringer's infusion and 34% during albumin (P < 0.001). From these data we conclude that: (a) Ringer's solution has a greater inhibitory effect on proximal tubular sodium reabsorption, and (b) in spite of this effect, differences in mucosal to serosal collecting duct sodium transport are primarily responsible for the greater natriuresis during Ringer's infusion.
Progesterone-induced urticaria: response to buserelin
Authors: K.C. YEE, W.J. CUNLIFFE
Journal: British Journal of Dermatology (1994)

Summary We report a 41-year-old Caucasian woman with polycystic liver and kidney disease, and a 9-year history of severe cyclical urticaria related to her menses. The urticaria was not adequately controlled by antihistamines or Prempak-C® (conjugated oestrogens and norgestrel). Intradermal testing with progesterone was strongly positive at 30 min and 18 h. Buserelin, administered intranasally at doses of up to 800 μg daily, controlled the urticaria within 4 weeks, and she was completely symptom-free thereafter. She had therapy-induced amenorrhoea and occasional hot flushes. Unfortunately, her liver cysts progressively enlarged, and a right hepatectomy was performed in June 1992, but she died after complications 3 weeks later. Prior to this she had been free of urticaria for 6 months after starting buserelin. Buserelin, a gonadotrophin-releasing hormone analogue, may he useful in the management of progesterone-induced urticaria, in patients in whom conjugated oestrogens are contraindicated or unhelpful.
Leukokinetic Studies. IX. Experimental Evaluation of a Model of Granulopoiesis*
Authors: D. R. Boggs, J. W. Athens, G. E. Cartwright, M. M. Wintrobe
Journal: Journal of Clinical Investigation (1965)

MethodsAnimals.Dogs of either sex and weighing from 9 to 32 kg were given antihelminthic therapy and distemper vac- cine and observed for 10 days before use.All studies were done in unanesthetized animals.Labeling procedures.Tritiated DFP (HW-DFP) and DFP`were obtained commercially.'The specific ac- tivity of DFP3`was approximately 200 ,uc per ml, and the concentration of DFP`2 in propylene glycol diluent was approximately 1 mg per ml.Each batch of material was assayed in our laboratory (6).DFP`was injected rapidly into a foreleg vein.To evaluate the effect of * Figures in parentheses refer to range.
Description of Chyluria
Authors: S. J. Caserta
Journal: New England Journal of Medicine (1956)

CHYLURIA (chyle in the urine) occurs so infrequently that an adequate description is not readily obtained in a standard textbook. Aside from a recent article by Johnston,1 reports in the literature have indeed been relatively rare.Surprisingly enough the entity has been known for over three hundred years. Two varieties are described: tropical, or parasitic; and nontropical, or nonparasitic. Tropical chyluria is caused by Filaria sanguinis-hominis (Wuchereria bancrofti). They were first found by Demarquay in 1863. Wucherer, in 1866, noted their presence in chylous urine, and Bancroft, in 1877, recovered the adult female worm from a lymphatic abscess. The . . .
TGF-β-miR-34a-CCL22 Signaling-Induced Treg Cell Recruitment Promotes Venous Metastases of HBV-Positive Hepatocellular Carcinoma
Authors: Pengyuan Yang, Qi-Jing Li, Yuxiong Feng, Yun Zhang, Geoffrey J. Markowitz, Shanglei Ning, Yuezhen Deng, Jiangsha Zhao, Shan Jiang, Yunfei Yuan, Hong-Yang Wang, Shu-Qun Cheng, Dong Xie, Xiao-Fan Wang
Journal: Cancer Cell (2012)
The Hospital's Library
Authors: Harold Bloomquist
Journal: New England Journal of Medicine (1969)

THE Medical Library Assistance Act of 1965 provided federal funds for the general upgrading of the nation's medical libraries as a response to the recognized inadequacy of these facilities. One of the important goals of this legislation has been to equalize the availability of library service between the health scientist practicing at a distance from a large medical center and the health scientist who, by accident of geography, practices within a few blocks or a few miles of a strong resource like the Francis A. Countway Library of Medicine in Boston. A most promising step toward making this goal a . . .
Polymorphisms of the IL-4, TNF- α , and Fc α RI β Genes and the Risk of Allergic Disorders in At-risk Infants
Authors: SHOUKANG ZHU, MOIRA CHAN-YEUNG, ALLAN B. BECKER, HELEN DIMICH-WARD, ALEXANDER C. FERGUSON, JURE MANFREDA, WADE T. A. WATSON, PETER D. PARÉ, ANDREW J. SANDFORD
Journal: American Journal of Respiratory and Critical Care Medicine (2000)

Polymorphisms in the TNF- α (A–308G), IL-4 (C–589T), and Fc α RI β (E237G) genes have been associated with asthma and related phenotypes. To determine the predictive value of these polymorphisms we have assessed their relative risk (RR) for the development of atopy, asthma, and rhinitis in a high-risk infant population that is being followed longitudinally from birth. DNA was extracted and genotyped for 373 infants and 572 parents for each polymorphism. Phenotypic data were collected for atopy and allergic diseases in the infants at 12 mo of age. The prevalence of these phenotypes in the 281 white infants was compared in each genotypic group. There were no differences in the prevalence of any phenotype between genotypes of the TNF- α and Fc α RI β polymorphisms. However, we found that the IL4-589*T allele was associated with "probable" asthma (RR = 4.1) and that homozygotes for the IL4-589*T allele had an increased risk for the development of rhinitis (RR = 2.4). Using the transmission disequilibrium test, an association of IL4-589*T with atopy was found. We conclude that IL-4-589*T, but not TNF- α -308*2 or Fc α RI β *G, is a risk factor for the development of atopy, asthma, and rhinitis by 12 mo of age.
DIPSS Plus: A Refined Dynamic International Prognostic Scoring System for Primary Myelofibrosis That Incorporates Prognostic Information From Karyotype, Platelet Count, and Transfusion Status
Authors: Naseema Gangat, Domenica Caramazza, Rakhee Vaidya, Geeta George, Kebede Begna, Susan Schwager, Daniel Van Dyke, Curtis Hanson, Wenting Wu, Animesh Pardanani, Francisco Cervantes, Francesco Passamonti, Ayalew Tefferi
Journal: Journal of Clinical Oncology (2010)

Purpose The Dynamic International Prognostic Scoring System (DIPSS) for primary myelofibrosis (PMF) uses five risk factors to predict survival: age older than 65 years, hemoglobin lower than 10 g/dL, leukocytes higher than 25 × 10 9 /L, circulating blasts ≥ 1%, and constitutional symptoms. The main objective of this study was to refine DIPSS by incorporating prognostic information from karyotype, platelet count, and transfusion status. Patients and Methods Mayo Clinic databases for PMF were used to identify patients with available bone marrow histologic and cytogenetic information. Results Seven hundred ninety-three consecutive patients were selected and divided into two groups based on whether or not their referral occurred within (n = 428; training set) or after (n = 365; test set) 1 year of diagnosis. Multivariable analysis identified DIPSS, unfavorable karyotype, platelets lower than 100 × 10 9 /L, and transfusion need as independent predictors of inferior survival. Hazard ratio (HR) –weighted adverse points were assigned to these variables to develop a composite prognostic model using the training set. The model was subsequently validated in the test set, and its application to all 793 patients resulted in median survivals of 185, 78, 35, and 16 months for low, intermediate-1 (HR, 2.2; 95% CI, 1.4 to 3.6), intermediate-2 (HR, 4.9; 95% CI, 3.2 to 7.7), and high-risk groups (HR, 10.7; 95% CI, 6.8 to 16.9), respectively (P &lt; .001). Leukemia-free survival was predicted by the presence of thrombocytopenia or unfavorable karyotype (10-year risk of 31% v 12%; HR, 3.3; 95% CI, 1.9 to 5.6). Conclusion DIPSS plus effectively combines prognostic information from DIPSS, karyotype, platelet count, and transfusion status to predict overall survival in PMF. In addition, unfavorable karyotype or thrombocytopenia predicts inferior leukemia-free survival.
Diet-induced insulin resistance in mice lacking adiponectin/ACRP30
Authors: Norikazu Maeda, Iichiro Shimomura, Ken Kishida, Hitoshi Nishizawa, Morihiro Matsuda, Hiroyuki Nagaretani, Naoki Furuyama, Hidehiko Kondo, Masahiko Takahashi, Yukio Arita, Ryutaro Komuro, Noriyuki Ouchi, Shinji Kihara, Yoshihiro Tochino, Keiichi Okutomi, Masato Horie, Satoshi Takeda, Toshifumi Aoyama, Tohru Funahashi, Yuji Matsuzawa
Journal: Nature Medicine (2002)
Novel drugs and drug combinations for treating tuberculosis
Authors: M. L. Munang, M. K. O'Shea, M. Dedicoat
Journal: BMJ (2014)

A 56 year old man presented with pain and numbness in his lower legs. He had been treated for pulmonary tuberculosis for the previous six weeks. He thought that his symptoms had started a fortnight previously, after the tuberculosis clinic changed his treatment from a fixed dose combination preparation to multiple, separate drugs. He thought that the new tablets may be causing his symptoms. His partner was also being treated for tuberculosis but with even fewer tablets taken once weekly, and he wondered whether he could take the same treatment as she had. He had a history of excess alcohol intake and admitted to binge drinking at the weekends.

Successful tuberculosis treatment requires a prolonged (six months or more) multidrug regimen consisting of agents active against different mycobacterial targets, as populations of bacilli with variable intrinsic resistance exist in several different states of replication and persistence within an infected host. Achieving high treatment completion rates is a key component of tuberculosis control. Globally, of the 6.1 million cases of tuberculosis notified in 2012, 0.4 million were patients who had not completed a previous course of first line treatment.1 These patients have a higher prevalence of multidrug resistant tuberculosis (table 1⇓),1 2 which is more challenging to treat because second line drugs for tuberculosis are less effective and more toxic. Thus, simpler and shorter treatment regimens for drug sensitive tuberculosis and more efficacious and safer regimens for multidrug resistant tuberculosis are needed.

View this table:

Table 1 
Terms and definitions used to denote drug susceptibility and resistance in tuberculosis



In this article, we will review fixed dose combinations of the first line antituberculosis drugs; fluoroquinolones as second line drugs with potential for shortening treatment of drug sensitive tuberculosis; and bedaquiline and delamanid, the first new drugs for multidrug resistant tuberculosis with novel …
Air pollution and human health: a review and reanalysis.
Authors: L A Thibodeau, R B Reed, Y M Bishop, L A Kammerman
Journal: Environmental Health Perspectives (1980)

Since 1970, Lave and Seskin have published a series of articles dealing with the question, "Does air pollution shorten lives?" Their recent book reports revised and extended analyses of their previous studies emphasizing policy implications. We have undertaken a review of Lave and Seskin's book to evaluate the methodology used and hence gain some insight into the strength of the conclusions reached. This review concentrates on methodology and its application to establishing and quantifying the association between air quality and health. Beyond simply reviewing the analyses reported in Lave and Seskin's book, we have duplicated and expanded two of the reported analyses. Our detailed reanalysis is presented both to verify reported results, and to illustrate the difficulties encountered in such an analysis. Our overall conclusion is that Lave and Seskin have done a thorouth job of reporting and interpreting the various analyses that they performed. Lave and Seskin have made a pioneering effort in showing an association between mortality rates and air pollution. We do not disagree with the conclusion of the existence of an association but have some reservations about their methods of estimating its magnitude. We were particularly concerned that Lave and Seskin did not fully investigate how well their models fit these data. Our reanalysis results in estimated effects which differ considerably from the values reported by Lave and Seskin. Thus, we conclude that the regression coefficients are quite unstable and so must be used with care. Assessing the relative costs and benefits of reducing air pollution without extensive sensitivity analysis could, therefore, be misleading.
Wide QRS Complex Tachycardia
Authors: Akhtar Masood
Journal: Annals of Internal Medicine (1988)

Background and Purpose: Despite available criteria, diagnosis of the mechanisms of wide complex tachycardia is often incorrect. We aimed in this study to identify reasons for misdiagnoses and the value and limitations of clinical and surface electrocardiographic criteria. Data Identification: The analyzed data of 150 consecutive patients with wide QRS tachycardia from this study and a literature search of key papers in English since 1960 on clinical and surface electrocardiographic criteria form the basis of this report. The final correct diagnosis was made with intracardiac electrograms. Data Extraction and Analysis: Among the 150 patients, 122 had ventricular tachycardia, 21 had supraventricular tachycardia with aberrant conduction, and 7 had accessory pathway conduction. Only 39 of 122 patients with ventricular tachycardia were correctly diagnosed initially. In others, the diagnoses were supraventricular tachycardia with aberrant conduction (43 of 122) or simply a wide QRS tachycardia (40 of 122). Misdiagnosis in patients with aberrant or accessory pathway conduction was also common. Standard electrocardiographic criteria for ventricular tachycardia had unacceptable sensitivity, poor specificity, or both. Collectively such criteria allowed a correct diagnosis of ventricular tachycardia in 92% of cases. Diagnosis of ventricular tachycardia was also suggested by its association with structural heart disease. Criteria suggestive of ventricular tachycardia included atrioventricular dissociation, positive QRS concordance, axis less than -90 deg to ± 180 deg, combination of left bundle branch block and right axis, QRS duration of greater than 140 ms with right bundle branch block and greater than 160 ms with left bundle branch block and, a different QRS during tachycardia compared to baseline preexisting bundle branch block. Conclusions: Ventricular tachycardia is the commonest underlying mechanism for wide QRS tachycardia. A correct diagnosis can usually be made from clinical and surface electrocardiographic criteria.
Renal-Cell Carcinoma Extending into the Vena Cava and Right Side of the Heart
Authors: R P Hunsaker, J R Stone
Journal: New England Journal of Medicine (2001)

Figure 1. An obese 82-year-old woman with a history of hypertension and type 2 diabetes mellitus had had dyspnea on exertion and swelling of her legs for three to four months. Transthoracic echocardiography revealed a right atrial mass with extension into the inferior vena cava. Computed tomography of the chest and abdomen showed that the mass originated in the left kidney. The results of coronary angiography, ventilation–perfusion scanning, and bone scanning were normal. A radical left nephrectomy and excision of the right atrial mass were performed with the use of cardiopulmonary bypass. Intraoperative two-dimensional transesophageal echocardiography with an omniplane probe . . .
Consensus emerges on need for US agency similar to NICE
Authors: B. Roehr
Journal: BMJ (2008)

Speakers at a conference on integrity in science in the United States have urged the creation of a national agency to provide data on the effectiveness of treatments. 

Comparing the effectiveness of various types of therapeutic procedures and not just different drugs was “an elemental building block” and “one of the key ways to learn how to spend smarter and get better clinical outcomes,” said Gail Wilensky, an economist and senior fellow at Project Hope, an international charity that aims to achieve sustainable advances in health care around the world. 

Such an approach will be an important part of any reform of US health care, she told the fourth US conference on national integrity in science in Washington, DC, on 11 July.

“It is critical that we focus on conditions rather than specific interventions and therapeutics.” Although head to head comparisons of …
Initial Experience with a New Yamakawa-Type Prosthesis for Long-Term Percutaneous Transhepatic Drainage
Authors: None Born, None Rösch, None Willkomm, None Sandschin, None Fitz, None Weigert, None Ott, None Frimberger, None Allescher, None Classen
Journal: Endoscopy (1999)

In a previous study evaluating the problems of long-term percutaneous transhepatic biliary drainage (PTBD) using Yamakawa-type prostheses in patients with benign and malignant stenoses, breakage of the tube proved to be a serious problem, occurring in 19.7 % of PTBD exchanges. As a consequence of these results, a new PTBD tube made of Tecothane has been developed.From September 1997 to September 1998, this new PTBD tube was applied in 64 patients (39 men, 25 women; median age: 70, range 29-89) in the treatment of benign (n = 30) or malignant stenoses (n=31; three stenoses remained indeterminate), and the course was followed.A total of 134 stent exchanges were performed, 52 of these being ahead of schedule (39 %). Not a single case of breakage occurred. However, other PTBD-related problems remained unchanged. Patients accepted the new prosthesis very well; among 19 patients who had experience of both the new one and the conventional one, 11 had preferences-eight for the new one and three for the old one.This new Tecothane prosthesis has solved the problem of PTBD breakage, which was often accompanied by serious problems. As was to be expected, other PTBD-related problems were not substantially affected. Nevertheless, this new tube represents progress in the percutaneous treatment of biliary stenoses.