tbuckley/cabot-search huggingface dataset:
Confirmation of the Mantle-Cell Lymphoma International Prognostic Index in Randomized Trials of the European Mantle-Cell Lymphoma Network
Authors: Eva Hoster, Wolfram Klapper, Olivier Hermine, Hanneke C. Kluin-Nelemans, Jan Walewski, Achiel van Hoof, Marek Trneny, Christian H. Geisler, Francesco Di Raimondo, Michal Szymczyk, Stephan Stilgenbauer, Catherine Thieblemont, Michael Hallek, Roswitha Forstpointner, Christiane Pott, Vincent Ribrag, Jeanette Doorduijn, Wolfgang Hiddemann, Martin H. Dreyling, Michael Unterhalt
Journal: Journal of Clinical Oncology (2014)

Mantle-cell lymphoma (MCL) is a distinct B-cell lymphoma associated with poor outcome. In 2008, the MCL International Prognostic Index (MIPI) was developed as the first prognostic stratification tool specifically directed to patients with MCL. External validation was planned to be performed on the cohort of the two recently completed randomized trials of the European MCL Network.Data of 958 patients with MCL (median age, 65 years; range, 32 to 87 years) treated upfront in the trials MCL Younger or MCL Elderly were pooled to assess the prognostic value of MIPI with respect to overall survival (OS) and time to treatment failure (TTF).Five-year OS rates in MIPI low, intermediate, and high-risk groups were 83%, 63%, and 34%, respectively. The hazard ratios for OS of intermediate versus low and high versus intermediate risk patients were 2.1 (95% CI, 1.5 to 2.9) and 2.6 (2.0 to 3.3), respectively. MIPI was similarly prognostic for TTF. All four clinical baseline characteristics constituting the MIPI, age, performance status, lactate dehydrogenase level, and WBC count, were confirmed as independent prognostic factors for OS and TTF. The validity of MIPI was independent of trial cohort and treatment strategy.MIPI was prospectively validated in a large MCL patient cohort homogenously treated according to recognized standards. As reflected in current guidelines, MIPI represents a generally applicable prognostic tool to be used in research as well as in clinical routine, and it can help to develop risk-adapted treatment strategies to further improve clinical outcome in MCL.
DISTRIBUTION AND BURDEN OF CORONARY ARTERY CALCIUM AS PREDICTORS OF SURGICAL AND PERCUTANEOUS REVASCULARIZATION: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS
Authors: James Harkness, Michael Blaha, Ron Blankstein, Joao Lima, Matthew Budoff, Juan Rivera, Arthur Agatston, Roger Blumenthal, Khurram Nasir
Journal: Journal of the American College of Cardiology (2012)
History of Medicine
Authors: Rahul Rajkumar
Journal: JAMA (2003)

METHOD ALONE," REMARKED WILLIAM OSLER IN 1901, "can many problems in medicine be approached profitably." 1 By the time I started medical school, my program had abandoned its history of medicine course for a monthly lecture series.This made sense.Faced with the explosion in knowledge of molecular and clinical science, there was not enough time in the day to study the past.After all, history is not essential to the day-to-day practice of medicine.And, given that physicians used to treat fever with leeches and hysteria with surgery, our history is often embarrassing.Yet I wonder if I would have been better served had I studied history in my preclinical years.Like most physicians, I have used the phrase "the patient is a poor historian."I wonder if we should more accurately admit that we "took a poor history." 2 According to one poet, "One might say, though we are told not to, that the patient is a poor historian/We are told instead that we are the historian, and that if/A poor historian is present, he is often wearing scrubs or a stethoscope." 3ne could argue that patients are never poor historians, only more or less reliable sources of information.It is the role of the physician to be a historian-to collect evidence and weigh competing sources of information against one another.The historical method is part of the craft of medicine.As Sapira 4 puts it, "Simply to write down or to recite a gaggle of true statements is not to compose a history.The facts must be placed in a form that makes them informative.Many medical schools 'teach' by having the students memorize a large number of facts.But these schools do not teach the students how to decide what a fact is, or how to collect facts in a useful and informative manner."The purpose of this issue is to demonstrate the importance of the historical method in understanding current clinical problems.In this issue of MSJAMA, David Schuster reviews the history of the diagnosis of neurasthenia-an illness that reminds us that medical diagnoses are shaped by cultural factors as well as by science.In an account that resonates with our current dilemma over vaccination against bioterrorism threats, Elise Lipkowitz describes the smallpox vaccination debate in 18th-century France.Continuing this discussion on the balance between public health and individual choice, George Joseph tells us about the legacy of the 1905 US Supreme Court case Jacobson v Massachusetts, which upheld the right of the government to order compulsory vaccination.All of these authors teach us something about how to interpret and narrate history.
Evaluation of Operative Left Ventricular Outflow Tract Lesions with a Fluid Impedance Plot
Authors: MERRILL P. SPENCER, L. HENRY EDMUNDS
Journal: Circulation (1968)

A hydraulic fluid impedance plot is produced by plotting instantaneous differential pressure against phasic blood flow across a vascular segment. This simple plot quantitatively and compactly describes the changes in flow resistance (impedance) throughout the entire cardiac cycle. Impedance plots were obtained before and after corrective surgery in patients with a variety of left ventricular outflow tract and aortic valve lesions. Although present techniques are still limited, impedance plots now provide quantitative measurement of flow resistance throughout the cardiac cycle in a variety of cardiac and great vessel lesions.
Hyperuricemia and Neurologic Deficits
Authors: Alan L. Rosenberg, LaVonne Bergstrom, B. Todd Troost, Bruce A. Bartholomew
Journal: New England Journal of Medicine (1970)

Of 22 members of a kindred who manifested varying degrees of a previously undescribed syndrome, five had the complete syndrome of hyperuricemia, renal insufficiency, ataxia and deafness. Serum urate levels were elevated in other members of the kindred who did not have renal insufficiency, indicating the hyperuricemia was not secondary to renal disease. Neurologic abnormalities, including ataxia, weakness and deafness, varied in severity from minimal to disabling involvement. Red-cell hypoxanthine-guanine phosphoribosyltransferase levels were normal in the kindred. The biochemical defect and the cause of the neurologic dysfunction are not known.
Adjuvanticity of Plasmid DNA Encoding Cytokines Fused to Immunoglobulin Fc Domains
Authors: Cristina R. Ferrone, Miguel-Angel Perales, Stacie M. Goldberg, C. Joy Somberg, Daniel Hirschhorn-Cymerman, Polly D. Gregor, Mary Jo Turk, Teresa Ramirez-Montagut, Jason S. Gold, Alan N. Houghton, Jedd D. Wolchok
Journal: Clinical Cancer Research (2006)

Abstract Purpose: Plasmid DNAs encoding cytokines enhance immune responses to vaccination in models of infectious diseases and cancer. We compared DNA adjuvants for their ability to enhance immunity against a poorly immunogenic self-antigen expressed by cancer. Experimental Design: DNAs encoding cytokines that affect T cells [interleukin (IL)-2, IL-12, IL-15, IL-18, IL-21, and the chemokine CCL21] and antigen-presenting cells [granulocyte macrophage colony-stimulating factor (GM-CSF)] were compared in mouse models as adjuvants to enhance CD8+ T-cell responses and tumor immunity. A DNA vaccine against a self-antigen, gp100, expressed by melanoma was used in combination with DNA encoding cytokines and cytokines fused to the Fc domain of mouse IgG1 (Ig). Results: We found that (a) cytokine DNAs generally increased CD8+ T-cell responses against gp100; (b) ligation to Fc domains further enhanced T-cell responses; (c) adjuvant effects were sensitive to timing of DNA injection; (d) the most efficacious individual adjuvants for improving tumor-free survival were IL-12/Ig, IL-15/Ig, IL-21/Ig, GM-CSF/Ig, and CCL21; and (e) combinations of IL-2/Ig + IL-12/Ig, IL-2/Ig + IL-15/Ig, IL-12/Ig + IL-15/Ig, and IL-12/Ig + IL-21/Ig were most active; and (f) increased adjuvanticity of cytokine/Ig fusion DNAs was not related to higher tissue levels or greater stability. Conclusions: These observations support the potential of cytokine DNA adjuvants for immunization against self-antigens expressed by cancer, the importance of timing, and the enhancement of immune responses by Fc domains through mechanisms unrelated to increased half-life.
A mass originating from chronic pyothorax in the pleural cavity
Authors: Hiroto Kishi, Koichiro Fukuda, Nobuyuki Arima, Hiroyuki Tsuda
Journal: American Journal of Hematology (2011)

A 71-year-old male with a past history of tuberculous pleuritis was referred to our hospital in 2008 because of right chest pain. Chest computed tomography (CT) demonstrated a huge mass originated from chronic pyothorax in the right pleural cavity, invading the chest wall. 2- [18F]fluoro- 2- deoxy- D- glucose Positron Emission Tomography (FDG-PET) imaging showed strong uptake only in the tumor of the right chest wall (Image 1A). Immunohistochemical staining and Southern blot hybridization of biopsied specimens revealed that the diagnosis was CD20 negative pyothorax-associated diffuse large B cell lymphoma. In situ hybridization for Epstein-Barr virus (EBV) disclosed EBV-encoded small RNA expression in the lymphoma cells. Clinical stage was IE, and international prognostic index was low intermediate. First, three courses of pirarubicin-cyclophosphamide, vincristine, prednisolone (COP) were administered. Then confirming that FDG-PET became negative (Image 1B), involved-field radiotherapy of 50 Gy was added. No sign of relapse has been found for more than 2 years. Pre- and post-chemotherapy fused PET/CT images. A: Pretherapy coronal image showed FDG avid disease only at the back of the right thorax. B: Posttherapy PET/CT performed 3 weeks following completion of 3 cycles of CHOP-like therapy showed a residual mass that was FDG-PET negative. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] Pyothorax-associated lymphoma (PAL) is defined as non-Hodgkin's lymphoma of exclusively B-cell phenotype developing in the pleural cavity of patients with chronic pyothorax [ 1, 2]. Most of PAL cases express CD20; however, there are a small proportion of cases which do not express B cell antigens such as CD20 and CD79a [3, 4]. It is suggested that PAL is strongly associated with EBV [5, 6]. A mass in the pleural cavity with a history of tuberculosis should cause one to consider PAL in the differential diagnosis.
Help for the child who is sexually abused
Authors: C N Barry
Journal: BMJ (1984)

The reduced costs for metronidazole accounted for only 15%, of this saving.It is more difficult to tell how the quality of care has been affected, but there has been no detectable reduction.There has been an increased workload both in outpatient prescribing and in inpatient admissions in the past year, the increase in admissions being associated with a change in the emergency admissions policy.An increase in drug costs might well have been expected.It could be claimed that overall quality of care has improved in certain aspects, in that at a time of financial stringency our saving on standard drugs has allowed us to introduce new valuable but expensive treatments such as acyclovir, cisretinoic acid, and atracurium with only minimal overspending on the drug budget.We trust these trends will continue.
Chlamydial Pneumonia: Not for Babies Only?
Authors: Margaret R. Hammerschlag
Journal: JAMA (1981)

Chlamydia trachomatis was first described as a possible cause of pneumonia in an infant by Schachter et al 1 in 1975. Subsequently, Beem and Saxon 2 confirmed its role as a respiratory pathogen. It would be fair to say that C trachomatis is accepted as a common cause of pneumonia in infants younger than 6 months. Cases have been reported from Europe, 3,4 Israel, 5 and Canada, 6 as well as from the United States.  The next logical question is whether C trachomatis can cause pneumonia in adults. There have been individual reports of the isolation of C trachomatis from the oropharynges of adults, usually in the context of experimental or natural-inclusion conjunctivitis or related to sexual practices. 7,8,9 Recently, Tack and colleagues 10 reported isolating C trachomatis from the lower respiratory tract of six adults, five of whom had pneumonia. In this issue ofThe Journal(p 1319), Komaroff
A Bump in the Neck
Authors: Michael S Golinko
Journal: JAMA (2006)

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Postural characteristics of diabetic neuropathy.
Authors: U Oppenheim, R Kohen-Raz, D Alex, A Kohen-Raz, M Azarya
Journal: Diabetes Care (1999)

To explore the posturographic correlates of diabetic neuropathy by comparing the performances of three groups of diabetic patients (severe, moderate, and absent neuropathy) with those of normal subjects and four clinical control groups.Using the Interactive Balance System (Tetrax, Ramat Gan, Israel), based on the assessment of the interaction of vertical pressure fluctuations on four independent platforms, one for each heel and toe part, respectively, posturographic examinations were given to 28 diabetic patients (8 with severe, 12 with moderate, and 8 with no peripheral neuropathy), 30 normal control subjects, and a clinical control group of 52 patients (14 with stage II Parkinson's disease, 13 with brain damage, 7 with whiplash, and 19 with peripheral vestibular pathology). The following posturographic parameters were evaluated; 1) general stability; 2) Fourier analysis showing patterns of sway intensity within eight frequency bands between 0.1 and 3 Hz; 3) weight distribution; 4) synchronization of sway; and 5) performance patterns for eight positions, requiring closure of eyes and standing on an elastic surface, as well as left, right, back, and downward head turns.For positions with closed eyes, diabetic patients with severe and moderate neuropathy were significantly less stable than normal subjects and diabetic patients without neuropathy, but diabetic patients with severe and moderate neuropathy turned out to be as equally unstable as clinical control subjects. However, for sway intensity within the band of 0.5 to 1.00 Hz on positions with lateral head turn with occluded vision, neuropathic diabetic patients performed significantly worse than did both normal and clinical control subjects. The same posturographic parameter also differed significantly between normal subjects and diabetic patients without neuropathy.As reported in previous studies, general instability in diabetic neuropathy is not a sufficiently characteristic correlate of the syndrome. On the other hand, spectral analysis of sway on stressful positions involving head turning appears to differentiate diabetic neuropathy from other disorders involving postural disturbances.
Physical Activity and Risk for Cardiovascular Events in Diabetic Women
Authors: Frank B. Hu, Meir J. Stampfer, Caren Solomon, Simin Liu, Graham A. Colditz, Frank E. Speizer, Walter C. Willett, JoAnn E. Manson
Journal: Annals of Internal Medicine (2001)

Background: Increased physical activity has been associated with reduced risk for cardiovascular disease in the general population, but data are limited on its role among persons with type 2 diabetes mellitus. Objective: To determine whether physical activity decreases risk for cardiovascular disease among diabetic women. Design: Prospective cohort study. Setting: The Nurses' Health Study. Patients: 5125 female nurses with diabetes. Measurements: Physical activity was first assessed in 1980 and was updated in 1982, 1986, 1988, and 1992 through validated questionnaires. Average hours of moderate or vigorous exercise and a metabolic equivalent of task (MET) score were computed. Results: During 14 years of follow-up (31 432 person-years), 323 new cases of cardiovascular disease were documented (225 cases of coronary heart disease and 98 cases of stroke). The age-adjusted relative risks according to average hours of moderate or vigorous activity per week (<1, 1 to 1.9, 2 to 3.9, 4 to 6.9, ≥ 7) were 1.0, 0.93 (95% CI, 0.69 to 1.26), 0.82 (CI, 0.61 to 1.10), 0.54 (CI, 0.39 to 0.76), and 0.52 (CI, 0.25 to 1.09) (P < 0.001 for trend). These figures did not change materially after adjustment for smoking, body mass index, and other cardiovascular risk factors (1.0, 1.02, 0.87, 0.61, and 0.55, respectively; P = 0.001 for trend). In separate analyses, levels of physical activity were inversely associated with coronary heart disease and ischemic stroke. Among women who did not exercise vigorously, the multivariate relative risks for cardiovascular disease across quartiles of MET score for walking were 1.0, 0.85, 0.63, and 0.56 (P = 0.03 for trend). Faster usual walking pace was independently associated with lower risk. Conclusion: Among diabetic women, increased physical activity, including regular walking, is associated with substantially reduced risk for cardiovascular events.
Female reproductive function in areas affected by radiation after the Chernobyl power station accident
Authors: V. I. Kulakov, T. N. Sokur, A. I. Volobuev, I. S. Tzibulskaya, V. A. Malisheva, B. I. Zikin, L. C. Ezova, L. A. Belyaeva, P. D. Bonartzev, N. V. Speranskaya, J. M. Tchesnokova, N. K. Matveeva, E. S. Kaliznuk, L. B. Miturova, N. S. Orlova
Journal: Environmental Health Perspectives (1993)

This paper reports the results of a comprehensive survey of the effects of the accidental release of radiation caused by the accident at the Chernobyl nuclear power station in April 1986. The accident and the resulting release of radiation and radioactive products into the atmosphere produced the most serious environmental contamination so far recorded. We have concentrated on evaluating the outcomes and health risks to women, their reproductive situation, and consequences for their progeny. We have concentrated on two well-defined areas: the Chechersky district of the Gomel region in Belorussia and the Polessky district of the Kiev region in the Ukraine. A number of investigations were carried out on 688 pregnant women and their babies, and data were obtained from 7000 labor histories of the development of newborns for a period of 8 years (3 years before the accident and 5 years after it). Parameters examined included birth rate, thyroid pathology, extragenital pathology such as anemias, renal disorders, hypertension, and abnormalities in the metabolism of fats, complications of gestation, spontaneous abortions, premature deliveries, perinatal morbidity and mortality, stillbirths and early neonatal mortality, infections and inflammatory diseases, neurological symptoms and hemic disturbances in both mothers and infants, trophic anomalies, and biochemical and structural changes in the placenta. Several exogenous, complicating influences were also considered such as psycho-emotional factors, stress, lifestyle changes, and others caused directly by the hazardous situation and by its consequences such as treatment, removal from affected areas, etc. The results allow us to conclude that health of mothers, fetuses, and children were significantly influenced by the radiation, with adaptational and pathological abnormalities of various organs and body systems of pregnant women and children. Although the female reproductive system itself remains relatively intact, the decrease in compensatory-adaptive mechanisms of mothers and fetoplacental disorders cause long-term or chronic diseases in the newborns. It is suggested that special attention is paid to possible prophylaxis and to treatment of groups at risk in order to reduce hazardous consequences of such accidents and to preserve the health of future generations.
Medicare Begins Prospective Payment of Hospitals
Authors: John K. Iglehart
Journal: New England Journal of Medicine (1983)

The federal government, moving with unusual speed and unanimity, has enacted sweeping Medicare legislation that reverses key economic incentives that have driven the behavior of hospitals since the federal program for the elderly began 18 years ago. The government replaced "reasonable" cost reimbursement with a policy that requires Medicare to establish and fix prices in advance on a cost-per-case basis, using as a measure 467 categories called "diagnosis-related groups" (DRGs). The Department of Health and Human Services (DHHS) Secretary Margaret M. Heckler hailed the new law as "the first major element in the President's health care reform plan.... It's the . . .
A Conceptual Model of the Effects of Health Care Organizations on the Quality of Medical Care
Authors: Bruce E. Landon
Journal: JAMA (1998)

There has been a great deal of interest in recent years in developing measures of health care quality that can be used to characterize and study the effects of health plans. However, because of the recent emergence of diverse types of health care organizations, it is often difficult to know which parts of a plan should be combined for analysis purposes. Also, simple taxonomies of health maintenance organizations (eg, staff, independent practice associations, group, and network) no longer adequately describe the diverse types of organizations that have become common. In this article we describe these trends, explain why older taxonomies of health care plans are not adequate, and present a new framework for characterizing and studying the effects of diverse types of plans.