tbuckley/cabot-search huggingface dataset:
An XXXYY Sex-Chromosome Anomaly
Authors: Patrick Bray
Journal: JAMA (1963)

A 26-yr-old phenotypic male with moderately severe mental retardation and clinical evidence of Klinefelter's syndrome has been found to have an XXXYY sex-chromosome complex. This chromosomal constitution has not previously been reported in patients with seminiferous tubule dysgenesis. The positive nuclear chromatin on buccal smear and the appearance of occasional double chromatin masses are compatible with the triple X portion of the sex-chromosome constitution. The severity of the mental defect and the testicular changes may be proportional to the number of supernumerary X chromosomes, as suggested by others, but a review of literature shows that statistical proof for this theory is lacking. The clinical significance of an extra Y chromosome remains unknown, but the acromegalic features in this and another patient reported merit contemplation and further study.
A Chronologic Account of the Meeting Places of the Massachusetts Medical Society and Its Council
Authors: Frank R. Ober
Journal: New England Journal of Medicine (1953)

THE meetings of the Massachusetts Medical Society were held in many places for a hundred and seventy years before the present building was acquired as a permanent headquarters. The following chronologic account is an attempt to record the story of these meeting places since the Society was incorporated. Many of the sites have historical interest.During the early years the Society occupied in harmony the same quarters as the American Academy of Arts and Sciences. As time went on, however, sporadic attempts were made to obtain a more permanent home. These efforts always failed from lack either of funds or . . .
Total skin electron beam irradiation for cutaneous T-cell lymphoma (mycosis fungoides)
Authors: W.A. VLOTEN, H. VROOME, E.M. NOORDIJK
Journal: British Journal of Dermatology (1985)

Forty patients with the cutaneous T-cell lymphoma (mycosis fungoides) were treated with total skin electron beam irradiation. The total follow-up period was up to 116 months (median 57.5 months). The patients were irradiated with a total dose of 35 Gy over 10 weeks, using the six-field technique. Ten of these patients had lymph node involvement and were subsequently treated with chemotherapy. After the initial electron irradiation complete remission of the skin lesions was obtained in 87.5% of the patients. Relapse of skin lesions occurred in 52% of the patients after 2-72 months (median 4 months). Second line therapy consisted primarily of topical nitrogen mustard. The overall survival rate at 5 years was 70%. Despite the side-effects this treatment was tolerated well by all patients.
Outer Retinal Hyperreflective Spots on Spectral-Domain Optical Coherence Tomography in Macular Telangiectasia Type 2
Authors: Sönke Baumüller, Peter Charbel Issa, Hendrik P.N. Scholl, Steffen Schmitz-Valckenberg, Frank G. Holz
Journal: Ophthalmology (2010)
Study suggests hepatitis B vaccine increases risk of multiple sclerosis
Authors: Owen Dyer
Journal: BMJ (2004)

People vaccinated against hepatitis B triple their risk of developing multiple sclerosis over the following three years, a study in the current issue of the journal Neurology says ( Neurology 2004;63:838-42).

Researchers led by Dr Miguel Hernan of Harvard School of Public Health analysed the United Kingdom's general practice research database, which follows a representative sample of over three million British patients.

They found 163 cases of multiple sclerosis that had first been diagnosed in the period 1993-2001 and which met the study's criteria on record keeping. Also analysed were 1604 matched controls who did not have multiple sclerosis.

The report's key finding …
Mediastinoscopy as an Aid in the Diagnosis of Lung Diseases
Authors: G. Lukomsky, M. Shulutko
Journal: Endoscopy (1970)

Mediastinoscopy is a conventional method for exploration and biopsy in superior mediastinum. This method can be used in cases with proven pulmonary carcinoma in order to assess operability. Moreover the mediastinoscopy can be employed for differential diagnostic purpose in a variety of diseases. Our experience proved that mediastinoscopy is a safe and relatively simple method.
A New Source of Resistance to HIV Drugs
Authors: Mark A. Wainberg
Journal: JAMA (1999)

While many point mutations in the HIV-1 reverse
transcriptase (RT) confer resistance to antiretroviral drugs, inserts
or deletions in this gene have not been previously characterized. In
this report, 14 RT inhibitor–treated patients were found to have HIV-1
strains possessing a 6-basepair insert between codons 69 and 70 of the
RT gene. Known drug resistance mutations were also observed in these
strains, with T215Y appearing in all strains. Genotypic analysis
indicated that the inserts had substantial nucleotide variability that
resulted in relatively restricted sets of amino acid sequences. Linkage
of patients' treatment histories with longitudinal sequencing data
showed that insert strains appeared during drug regimens containing ddI
or ddC, with prior or concurrent AZT treatment. Drug susceptibility
tests of recombinant patient isolates showed reduced susceptibility to
nearly all nucleoside RT inhibitors. Site-directed mutagenesis studies
confirmed the role of the inserts alone in conferring reduced
susceptibility to most RT inhibitors. The addition of AZT-associated
drug resistance mutations further increased the range and magnitude of
resistance. These results establish that inserts, like point mutations,
are selected in vivo during antiretroviral therapy and provide
resistance to multiple nucleoside
analogs.
Normalization of plasma factor X levels in amyloidosis after plasma exchange
Authors: Frank V. Beardell, Mala Varma, Jose Martinez
Journal: American Journal of Hematology (1997)

Some patients with systemic light chain amyloidosis develop bleeding complications that can be caused by vascular infiltration with amyloid or by alterations of the coagulation or fibrinolytic systems.Factor X deficiency is the most common cause of bleeding manifestations, although deficiencies of other clotting factors, a disruption in the conversion of fibrinogen to fibrin, and circulating heparin-like anticoagulants have also been reported.Deficiency of factor X is a well-recognized cause of bleeding manifestations in patients with light chain amyloidosis.This acquired disorder appears to be secondary to adsorption of factor X to the amyloid fibrils.Previous studies have shown that infusion of plasma into patients with acquired factor X deficiency and amyloidosis induces a transitory improvement of the coagulation tests.However, there is a rapid return to pretransfusion levels.In this manuscript we report the clinical application of plasma exchange in the management of a patient with systemic light chain amyloidosis with acquired factor X deficiency.Am.
Vascular and adrenal receptors for atrial natriuretic factor in the rat.
Authors: E L Schiffrin, L Chartier, G Thibault, J St-Louis, M Cantin, J Genest
Journal: Circulation Research (1985)

Previous studies have shown that atrial natriuretic factor, a powerful vasorelaxant of precontracted vessels, inhibits the secretion of aldosterone stimulated by angiotensin II, adrenocorticotropic hormone, and potassium. We now report the presence of specific binding sites for atrial natriuretic factor in rat blood vessels (mesenteric and renal arteries) and adrenal capsules. Radioiodinated synthetic atrial natriuretic factor bound to a single class of high-affinity (KD = 0.1 nM) low-capacity receptors in a particulate fraction from blood vessels and adrenals. Unrelated peptides did not displace atrial natriuretic factor. Fragments of atrial natriuretic factor displaced the labeled ligand with decreasing potency after cleavage at the N-terminal. The cleavage of the C-terminal tyrosine did not decrease the potency of atrial natriuretic factor, but further cleavage at the C-terminal dramatically reduced the affinity of the resulting peptides. The potency of the atrial natriuretic factor fragments in the radioligand assay was in proportion to their potency to inhibit aldosterone secretion by isolated rat glomerulosa cells. Our results suggest that these binding sites mediate the biological actions of atrial natriuretic factor in blood vessels and the adrenal, and that both receptors have similar specificities.
A Phase I Study of Topotecan Plus Carboplatin for Relapsed SCLC: WJTOG Trial
Authors: Takayasu Kurata, Tatsuhiko Kashii, Koji Takeda, Nobuhiko Seki, Masahiro Tsuboi, Masashi Kobayashi, Taroh Satoh, Kazuhiko Nakagawa, Masahiro Fukuoka
Journal: Journal of Thoracic Oncology (2009)
Endothelium and inelastic arteries: an early marker of vascular dysfunction in non-insulin dependent diabetes
Authors: J. Goodfellow, M. W Ramsey, L. A Luddington, C. J H Jones, P. A Coates, F. Dunstan, M. J Lewis, D. R Owens, A. H Henderson
Journal: BMJ (1996)

Atheroma is the main cause of mortality and morbidity in patients with non-insulin dependent diabetes mellitus. Endothelial dysfunction underlies atheroma formation. Flow mediated vasodilatation is a measure of endothelial function as well as a determinant of arterial distensibility,1 measurements of which have not previously been reported in patients with non-insulin dependent diabetes.

We studied 12 symptom free, non-smoking, healthy patients (six men) with well controlled non-insulin dependent diabetes diabnosed 1-7 (mean 3.8) years previously (mean age 50 (SD 9) years, body mass index 26.9 (4.8) kg/m2, serum cholesterol concentration 5.8 (0.5) mmol/l). Patients with known causes of endothelial dysfunction were excluded. All patients had insulin resistance with basal hyperinsulinaemia,2 no biochemical evidence of renal impairment, and no microalbuminuria. A group of 12 normal non-smoking subjects was matched for sex, age, body mass index, blood …
P95 Oxygen delivery in an acute hospital setting
Authors: J. Maycock, K. Ellis, P. Mullholland, L. Bate, V. Sadananda, D. Nazareth, S. Agarwal, P. Stockton
Journal: Thorax (2010)

<h3>Background</h3> Oxygen is one of the most widely used drugs in secondary care. The National Patient Safety Agency (NPSA), UK issued guidance1 ensuring safer management of oxygen delivery. Many individuals do not see oxygen as a drug and hence prescribing oxygen within most Trusts has been poor. This study assesses Health Care Professionals (HCPs) knowledge of the basic principles of oxygen delivery in an acute medical setting, to ensure the safe use of oxygen and to inform a Trust Oxygen Steering Group in order to target educational sessions appropriately. <h3>Method</h3> A questionnaire listing 10 common scenarios, based on the BTS guidelines2 was administered to a random selection of doctors and nurses (Abstract P95 Table 1). Responses were evaluated by a panel of Respiratory Physicians. For each scenario respondents indicated whether they would give oxygen, appropriate target saturations, delivery device to be used and the flow rate. <h3>Results</h3> 139 HCPs completed the questionnaire (41% junior doctors, 59% nurses). The results are summarised below. Common mistakes included The use of non-rebreather mask instead of bag and mask in cardiac arrest situations Failing to identify the use of high flow oxygen in the conservative management of patients with a pneumothorax and Failing to recognize the use of Venturi masks in COPD patients. <h3>Conclusions</h3> Most healthcare professionals understand the indication for the use of oxygen. However, knowledge of the appropriate use of delivery devices and target saturations was noted to be poor. Targeted educational sessions have been developed to address the above issues. We are currently in the process of trialling a new Kardex to ensure that all oxygen used on the ward within our Trust is prescribed. A Hospital Oxygen Steering Group is being set up with the function of overseeing the management and prescription of oxygen.
Possible role of tyrosine kinase activity in interleukin 4–induced expression of germ-line Cϵ transcripts in a human Burkitt lymphoma B-cell line, DND39
Authors: Koichi Ikizawa, Keiichi Kajiwara, Takehiro Koshio, Yukiyoshi Yanagihara
Journal: Journal of Allergy and Clinical Immunology (1994)
Reduction of Old-standing Dislocation of Knee
Authors: F. P. Fitzgerald
Journal: BMJ (1942)

The population at ages 0-15 has fallen by almost one-fifth during the past 20 years, and this must be taken into account when estimating the change in mortality.If the deaths are related to the average population aged 0-15 in 1922-5 and this factor is applied to the estimated population at 0-15 in 1940-1 (obtained by extrapolating a straight line fitted to the population at 0-15 of 1935-9) the resulting expected deaths for 1940-1 would be 8,722-i.e., 6,593 in excess of those observed.We may conclude that the sum of the various factors operating towards a decline has resulted in a reduction of childhood mortality from measles of about three-quarters of what it was 20 years ago.
Sodium and the heart: a hidden key factor in cardiac regulation
Authors: Burkert Pieske, Steven R Houser, Gerd Hasenfuss, Donald M Bers
Journal: Cardiovascular Research (2003)

Myocyte Na homeostasis is crucially involved in aThere was general agreement on some central issues 1 number of vital cell functions, such as excitability, excita-(e.g., that [Na ] is elevated in hypertrophy, heart failure, i tion-contraction coupling, energy metabolism, pH regula-during ischemia / reperfusion and the slow force response tion, as well as cardiac development and growth.However, to mechanical stretch).However, there remains substantial
Glycation of Apolipoprotein C1 Impairs Its CETP Inhibitory Property: Pathophysiological Relevance in Patients With Type 1 and Type 2 Diabetes
Authors: Benjamin Bouillet, Thomas Gautier, Denis Blache, Jean-Paul Pais de Barros, Laurence Duvillard, Jean-Michel Petit, Laurent Lagrost, Bruno Vergès
Journal: Diabetes Care (2014)

OBJECTIVE Apolipoprotein (apo)C1 is a potent physiological inhibitor of cholesteryl ester transfer protein (CETP). ApoC1 operates through its ability to modify the electrostatic charge at the lipoprotein surface. We aimed to determine whether the inhibitory ability of apoC1 is still effective in vivo in patients with diabetes and whether in vitro glycation of apoC1 influences its electrostatic charge and its CETP inhibitory effect. RESEARCH DESIGN AND METHODS ApoC1 concentrations and CETP activity were measured in 70 type 1 diabetic (T1D) patients, 113 patients with type 2 diabetes, and 83 control subjects. The consequences of in vitro glycation by methylglyoxal on the electrostatic properties of apoC1 and on its inhibitory effect on CETP activity were studied. An isoelectric analysis of apoC1 was performed in patients with T1D and in normolipidemic-normoglycemic subjects. RESULTS An independent negative correlation was found between CETP activity and apoC1 in control subjects but not in patients with diabetes. HbA1c was independently associated with CETP activity in T1D patients. In vitro glycation of apoC1 modified its electrostatic charge and abrogated its ability to inhibit CETP activity in a concentration-dependent manner. The isoelectric point of apoC1 in T1D patients was significantly lower than that in control subjects. CONCLUSIONS The ability of apoC1 to inhibit CETP activity is impaired in patients with diabetes. Glycation of apoC1 leads to a change in its electrostatic properties that might account, at least in part, for a loss of constitutive CETP inhibition and an increase in plasma CETP activity in patients with diabetes.
Legal system distorts reality by focusing on a single error in untoward incidents, conference hears
Authors: C. Dyer
Journal: BMJ (2015)

“You’re only ever one error away from a manslaughter prosecution,” the consultant surgeon Kenneth Woodburn told doctors at a meeting on medical manslaughter last week. “So often, adverse events in the NHS occur when people are trying to go a little bit further.”

Woodburn, a consultant vascular surgeon with Royal Cornwall Hospitals NHS Trust, was speaking about the “surreal experience” of his own prosecution for gross negligence manslaughter in 2001, which ended when the jury at Exeter Crown Court took less than an hour to acquit him.

“I was working with a team I’d never worked with before. It was an extra list to achieve waiting list targets forced on me by managers, and it was an extra case added to that list.”

The meeting in central London …
Influence of Calcium on the Inotropic Actions of Hyperosmotic Agents, Norepinephrine, Paired Electrical Stimulation, and Treppe
Authors: James T. Willerson, J. Stanley Crie, Robert C. Adcock, Gordon H. Templeton, Kern Wildenthal
Journal: Journal of Clinical Investigation (1974)

To analyze the interaction of calcium ion concentration with hypertonic agents and with other inotropic interventions, isolated right ventricular cat papillary muscles were studied under isometric conditions in Krebs-Ringer bicarbonate solution. Extracellular calcium concentrations were varied between 2.5 and 11.0 mM. Maximal inotropic effects occurred between 5 and 8.0 mM calcium and further elevation to 11.0 mM was without additional influence. The effect of hyperosmotic sucrose and mannitol on papillary muscle performance was compared with that of 10(-6) M norepinephrine at calcium concentrations of 2.5 and 10.0 mM and with paired electrical stimulation in 10.0 mM calcium. Both norepinephrine and the hyperosmotic agents produced significant increases in developed tension and in the maximal rate of tension rise (dT/dt) in Krebs-Ringer in 2.5 and 4.0 mM calcium. In 10 mM calcium norepinephrine increased developed tension and dT/dt, but sucrose and mannitol caused no change or small reductions in both. Paired electrical stimulation, like hyperosmolality, caused no increase in dT/dt in 10 mM calcium. The presence of a potent pharmacological inhibitor of systolic calcium transfer across the cell membrane (D600, 10(-6) M) reduced developed tension and dT/dt by 76+/-2.7 and 74+/-2.0%, respectively, and prevented and in fact reversed the expected increase in dT/dt associated with an increase in rate of stimulation (treppe). However, hypertonic mannitol and paired pacing persisted in causing marked increases in developed tension and dT/dt even in the presence of D600, suggesting that their inotropic effects are not dependent on increased intracellular transfer of calcium during systole through cell membrane channels in which D600 acts as a competitive inhibitor. The results of these studies suggest that apparent functional saturation of intracellular calcium receptor sites eliminates any additional inotropic effect of hyperosmolality or paired pacing. The data are compatible with the hypothesis that the inotropic effects of hyperosmolality and of paired pacing result from an increase in calcium concentration at the myofilaments during contraction. The increase induced by hyperosmolality might occur because of an increase in the total amount of calcium released into the cytosol with each action potential and/or as a passive consequence of cellular dehydration. Norepinephrine has the capacity to increase contractility even when intracellular calcium receptor sites appear to be functionally saturated, suggesting that it may act at least in part by a mechanism that is independent of changes in net intracellular calcium concentration.
Interviewing and Patient Care
Authors: Barry Liskow
Journal: JAMA (1986)

Interviewing has always been considered an essential part of the physician's art. The ability of some doctors to elicit previously unobtainable information from patients has been greatly admired. However, this ability has often been approached as if it were an inborn trait dependent more on the personality of the physician than his training. Hence, most medical texts provide extensive lists of items to be covered in an interview but little guidance on how to obtain this information. Books that do discuss interview methods frequently come from the psychological or psychiatric fields and are so specialized or laden with jargon that they are of little value to most physicians. This book, written for students of the health professions, but aimed mainly at medical students, begins from the premise that interviewing is a skill and, like any skill, can be mastered through acquisition of a body of knowledge and continuous practice. The
The role of magnetic resonance imaging in the breast cancer patient.
Authors: M Morrow
Journal: Cancer Research (2009)

Abstract Abstract #P3-1 Breast conserving therapy (BCT) is well established. Using standard guidelines, most patients are eligible, and those who are not can be identified with a high degree of accuracy with clinical evaluation and mammography. Local recurrence rates have decreased since the initial trials of BCT. Magnetic resonance imaging (MRI) identifies cancer not found by clinical exam or mammography. Improved definition of the extent of carcinoma in the breast has the potential to improve patient outcomes in the short term by decreasing the number of patients requiring conversion from BCT to mastectomy, or decreasing the number of excisions needed to obtain negative margins. Elimination of patients with extensive disease would be expected to decrease the rate of local recurrence of BCT in the long term.&amp;#x2028; We examined the effect of MRI on short term outcomes in 577 patients seen between 2004-2006. MRI did not decrease positive margins at initial lumpectomy (21.6% MRI vs 14% no MRI) or conversion from BCT to mastectomy (9.8%MRI vs 5.9% no MRI). MRI was associated with a 19-day delay in surgery, and after controlling for stage, the odds ratio of mastectomy was 1.8 in the MRI group (p= .024). Solin et al (JCO, 2008) examined the effect of MRI on local recurrence in 756 patients. After adjustment for patient and tumor features, 8-year local recurrence rates were 3% and 4% in the MRI and no-MRI groups, and contralateral cancer rates did not differ. A meta-analysis of 2763 breast cancers found that MRI detected additional disease in 16% of cases, a rate significantly higher than the 5-8% 10-year rates of local recurrence observed in most modern studies of BCT. These observations raise important questions regarding unnecessarily radical surgery performed for MRI findings which may not result in improved outcomes.&amp;#x2028; MRI is of benefit in selected, relatively uncommon circumstances including:&amp;#x2028; a) Axillary adenopathy with occult primary tumor&amp;#x2028; b) Paget's disease without evidence of tumor&amp;#x2028; c) Assessing response to neoadjuvant therapy in patients desiring BCT&amp;#x2028; d) Major discrepancy among clinical and conventional imaging findings&amp;#x2028; Conclusion: Breast cancer is well documented by pathologic studies to be a multifocal /centric disease. This occult disease has been successfully treated with RT. MRI is a technology capable of finding some of this disease, but how this benefits patients is unclear. In the absence of this information, MRI should not be a part of routine pre-surgical evaluation. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr P3-1.
Conditioned Adaptation-Relaxation Reflex in Migraine Therapy
Authors: Donald J. Dalessio
Journal: JAMA (1979)

A new conditioned reflex, the adaptation-relaxation reflex, characterized by dilation of the peripheral blood vessels of the hand and arm, is associated with reduced blood flow in the area of the supraorbital and superficial temporal arteries. This reflex, learned through biofeedback training, is a central requirement for successful autonomic conditioning for migraine. In migraine patients whose conditions improve clinically, the finger-temperature feedback training is not associated with the conditioning of a single autonomic response, ie, digital vasodilation, but is associated with a general decrease of sympathetic tonic outflow.