tbuckley/cabot-search huggingface dataset:
Dynamic Changes in Three-Dimensional Architecture and Vascular Volume of Transmural Coronary Microvasculature Between Diastolic- and Systolic-Arrested Rat Hearts
Authors: Eiji Toyota, Katsukuni Fujimoto, Yasuo Ogasawara, Tatsuya Kajita, Fumiyuki Shigeto, Takeshi Matsumoto, Masami Goto, Fumihiko Kajiya
Journal: Circulation (2002)

Background — The phase difference of coronary arterial and venous flows indicates the importance of intramyocardial capacitance vessels in storing diastolic flow and in discharging volume in systole. However, the anatomic and functional characteristics of the capacitance vessels are unclear. We aimed to clarify those characteristics with their transmural difference by 3D visualization of transmural microvessels under diastole and systole. Methods and Results — We performed complete intracoronary filling of a contrast medium into Langendorff’s Wistar rat hearts under (1) St Thomas–perfused diastolic arrest (D-mode) and (2) BaCl 2 -induced systolic arrest (S-mode). Precise transmural 3D architectures of capillaries and of pre- and post-capillary microvessels (ie, microvessels larger than capillaries) were visualized clearly with a confocal laser scanning microscope and x-ray microcomputed tomography (microCT), respectively. Vascular volume fraction (VF) and systolic-induced VF reduction rate from D- to S-mode were analyzed. The net capillary VF in D-mode (20.4±0.9%) was 10 times that of larger microvessels and was reduced in S-mode by 32% without capillary collapse. Systolic-induced VF reduction rate was smaller in capillaries than in larger microvessels (48%; P &lt;0.05). The larger microvessel VF in D-mode (2.2±0.2%) was reduced in S-mode, accompanied by complicated 3D deformation. Conclusions — Capillaries were relatively resistant to the systolic extravascular compression compared with pre- and post-capillary microvessels, conveniently beneficial for the myocardial oxygen delivery throughout a cardiac cycle. Nevertheless, a larger change in the absolute volume of capillaries may function as effective capacitance. On one hand, the pre- and post-capillary microvessels showed a larger phasic change in resistance, which may function to maintain the capillary patency during systole.
Group to review babies' deaths
Authors: C. Dyer
Journal: BMJ (2003)

England's attorney general, Lord Goldsmith, last week announced that he would be setting up a high level group to review the deaths of babies that involved Dr Alan Williams, a forensic pathologist who gave evidence for the prosecution in the case of Sally Clark, who was convicted but cleared after a second appeal of killing her two baby sons. (8 February, p 304)

Dr Williams failed to disclose important results from microbiology tests on Mrs Clark's second son, Harry. The group, which will include representatives …
Incidence of lymphoproliferative disorders in patients with celiac disease
Authors: Lori A. Leslie, Benjamin Lebwohl, Alfred I. Neugut, John Gregory Mears, Govind Bhagat, Peter H.R. Green
Journal: American Journal of Hematology (2012)

Prior studies describe an increased incidence of lymphoma in celiac disease. However, few studies differentiate among lymphoproliferative disorders (LPDs). Our aim was to determine incidences of LPD subtypes in celiac disease patients, describe patterns of celiac disease presentation in patients who develop LPD, and compare survival in patients with various LPD subtypes. We conducted a retrospective cohort study of adults with biopsy-proven celiac disease seen at a US referral center from 1981 to 2010, identified patients with comorbid LPD, and calculated standardized incidence ratios (SIR) for each LPD subtype. In our cohort of 1,285 patients with celiac disease, there were 40 patients with LPD [SIR = 6.48, 95% confidence interval (CI) = 4.62-8.64] including 33 with non-Hodgkin lymphoma (NHL, SIR = 6.91, 95% CI = 4.26-8.28). The incidences of NHL subtypes including enteropathy-associated T-cell (EATL, n = 12), non-EATL T-cell (SIR = 22.43, 95% CI = 7.08-46.41), diffuse large B-cell (SIR = 5.37, 95% CI = 1.93-10.52), mantle cell (SIR = 32.21, 95% CI = 6.07-78.97), and marginal zone (SIR = 37.17, 11.73-76.89) lymphoma remained significantly elevated when only those diagnosed with celiac before LPD were considered (n = 24, NHL SIR = 4.47, 95% CI = 2.86-6.44). Patients who developed LPD were older at time of celiac disease diagnosis (57.9 ± 15.5 versus 42.5 ± 17.4 years, P < 0.0001) and more likely to present with diarrhea (60.0% versus 39.8% P = 0.016), abdominal pain (17.5% versus 5.5% P = 0.0046), and/or weight loss (12.5% versus 4.0%, P = 0.028). EATL patients had a shorter average survival than non-EATL NHL patients (3.2 versus 15.0 years, P = 0.016). The incidence of LPD is increased in celiac disease patients. Those diagnosed later in life who present with symptoms of malabsorption are more likely to be diagnosed with LPD.
The Changing Face of Chronic Bronchitis with Airways Obstruction
Authors: P. Howard
Journal: BMJ (1974)

A total of 178 patients with obstructive airways disease were studied between 1966 and 1972, a period which followed a substantial fall in atmospheric pollution in Sheffield. Compared with patients from an earlier study of the same age and smoking habits they had less productive cough, fewer winter illnesses, less severe breathlessness, and only one-third of the rate of decline of forced expiratory volume (FEV). The analysis of the change in the annual loss of FEV was complicated. There were virtually no sudden steep falls of respiratory function, and patients with very low values of FEV survived for long periods. The predominant cause of death was cor pulmonale. Chronic hypoxia may be more of a problem in the next few years than bronchial infection. I believe that the clean air policy has effected an improvement and that the nature of chronic bronchitis with severe obstructive airways disease is changing, but further studies will be needed to confirm this.
Behcet's disease and thrombophilia
Authors: M Leiba
Journal: Annals of the Rheumatic Diseases (2001)

Behcet's disease (BD), first described in 1973, is characterised by recurrent oral and genital ulcers as well as eye inflammation. Other features of this chronic multisystem inflammatory disease include neurological, cardiovascular, pulmonary, gastrointestinal, musculoskeletal, and dermatological involvement.1 

Venous or arterial thrombosis occurs in 25% (10–37%) of patients.2 Venous thrombosis is more common than arterial thrombosis (88% v 12%).3 Deep and superficial venous thrombosis of the legs predominates.4-7 

Arteritis is treated with a combination of corticosteroids and cytotoxic agents. Anticoagulants and antiplatelet agents are used for deep venous thrombosis, though there has never been a properly controlled study to justify this treatment in BD.8 

The thrombin-antithrombin complex (TAT) is a marker of intravascular thrombin formation. Prothrombin fragments 1+2 (PF1.2) are peptide fragments generated when prothrombin is activated to thrombin. TAT and PF1.2 are both biological markers of thrombin generation and thus correlate with thrombotic risk.9 10 

Several studies have shown increased levels of PF1.2 and TAT in patients with BD.11 12 These alterations probably reflect the activation of the coagulation cascade in these patients and are not the cause of the thrombosis.

Vasculitis, the main pathological process in BD, can partially explain the thrombotic phenomena.13 Why such thrombosis is not so common in other vasculitides, and why it occurs in only about 25% of patients with BD, is still unclear.

As knowledge about the cause of venous and arterial thrombosis is growing, it is now clear, that thrombosis may result from a combination of hereditary and acquired abnormalities. It is speculated that a combination of abnormalities of procoagulants, anticoagulants, and fibrinolytic factors, together with the vasculitis and the endothelial injury, accounts for the clinical thrombosis in this subgroup of patients with BD.

The present review is a critical summary of the published data …
Early Hepatitis C virus-RNA responses predict interferon treatment outcomes in chronic hepatitis C
Authors: William M. Lee, K. Rajender Reddy, Myron J. Tong, Martin Black, Dirk J. van Leeuwen, F. Blaine Hollinger, Kevin D. Mullen, Neville Pimstone, Donald Albert, Sheila Gardner
Journal: Hepatology (1998)

In previous studies employing interferons (IFNs) in the treatment of chronic hepatitis C, there have been few reliable predictors of sustained responses. We retrospectively evaluated the predictive value of hepatitis C virus (HCV)-RNA measurements in the first few months during consensus interferon (CIFN) treatment using a sensitive reverse-transcriptase polymerase chain reaction assay to determine sustained responses. Data from two large treatment trials, one of IFN-naive patients and one of retreated relapsers and nonresponders, were used, including serum samples at 2-week intervals in the naive study and 8-week intervals in the retreatment study. Patients received initial CIFN (9 μg) treatment for 6 months and were assessed 6 months after treatment. There were 28 sustained viral responders of 232 CIFN-treated patients. Of the sustained responders, 48% had already cleared HCV RNA from serum (<100 copies/mL) by week 2, 78% by week 4, 81% by week 6, and 96% by week 12. Patients with early HCV-RNA clearance were more likely to have sustained responses than those who responded later. Early clearance of HCV from serum was also associated with greater likelihood of a sustained response to 48 weeks of retreatment with 15 μg CIFN. Ninety-five percent of the sustained responders were HCV-RNA–negative by week 8 of retreatment. Early assessment of HCV RNA may help in the prediction of sustained responses to IFN and allow the value of continued treatment to be determined early in the course of IFN therapy.
Undiagnosed Tuberculosis in a Community with High HIV Prevalence
Authors: Robin Wood, Keren Middelkoop, Landon Myer, Alison D. Grant, Andrew Whitelaw, Stephen D. Lawn, Gilla Kaplan, Robin Huebner, James McIntyre, Linda-Gail Bekker
Journal: American Journal of Respiratory and Critical Care Medicine (2006)

Although failure of tuberculosis (TB) control in sub-Saharan Africa is attributed to the HIV epidemic, it is unclear why the directly observed therapy short-course (DOTS) strategy is insufficient in this setting. We conducted a cross-sectional survey of pulmonary TB (PTB) and HIV infection in a community of 13,000 with high HIV prevalence and high TB notification rate and a well-functioning DOTS TB control program.Active case finding for PTB was performed in 762 adults using sputum microscopy and Mycobacterium tuberculosis culture, testing for HIV, and a symptom and risk factor questionnaire. Survey findings were correlated with notification data extracted from the TB treatment register.Of those surveyed, 174 (23%) tested HIV positive, 11 (7 HIV positive) were receiving TB therapy, 6 (5 HIV positive) had previously undiagnosed smear-positive PTB, and 6 (4 HIV positive) had smear-negative/culture-positive PTB. Symptoms were not a useful screen for PTB. Among HIV-positive and -negative individuals, prevalence of notified smear-positive PTB was 1,563/100,000 and 352/100,000, undiagnosed smear-positive PTB prevalence was 2,837/100,000 and 175/100,000, and case-finding proportions were 37 and 67%, respectively. Estimated duration of infectiousness was similar for HIV-positive and HIV-negative individuals. However, 87% of total person-years of undiagnosed smear-positive TB in the community were among HIV-infected individuals.PTB was identified in 9% of HIV-infected individuals, with 5% being previously undiagnosed. Lack of symptoms suggestive of PTB may contribute to low case-finding rates. DOTS strategy based on passive case finding should be supplemented by active case finding targeting HIV-infected individuals.
Incidence of Spontaneous Abortion among Normal Women and Insulin-Dependent Diabetic Women Whose Pregnancies Were Identified within 21 Days of Conception
Authors: J L Mills, J L Simpson, S G Driscoll, L Jovanovic-Peterson, M Van Allen, J H Aarons, B Metzger, F R Bieber, R H Knopp, L B Holmes
Journal: New England Journal of Medicine (1988)

Whether pregnant women with insulin-dependent diabetes mellitus have an increased risk of spontaneous abortion is controversial. To address this question, we enrolled 386 women with insulin-dependent diabetes and 432 women without diabetes before or within 21 days after conception and followed both groups prospectively. Sixty-two diabetic women (16.1 percent) and 70 control women (16.2 percent) had pregnancy losses (odds ratio, 0.99; 95 percent confidence interval, 0.67 to 1.46). After adjustment for known risk factors for spontaneous abortion, the rate was still not significantly higher in the diabetic group (odds ratio, 0.91; 95 percent confidence interval, 0.59 to 1.40). Nonetheless, among the diabetic women, most of whom had good metabolic control, those who had spontaneous abortions had higher fasting and postprandial glucose levels in the first trimester than those whose pregnancies continued to delivery (P = 0.01 for fasting glucose levels and P = 0.005 for postprandial levels). In the small subgroup of diabetic women with poor control, who had elevated values for glycosylated hemoglobin in the first trimester, each increase of 1 SD above the normal range was associated with an increase of 3.1 percent in the rate of pregnancy loss (95 percent confidence interval, 0.6 to 5.6). We conclude that diabetic women with good metabolic control are no more likely than nondiabetic women to lose a pregnancy, but that diabetic women with elevated blood glucose and glycosylated hemoglobin levels in the first trimester have a significantly increased risk of having a spontaneous abortion. (N Engl J Med 1988; 319:1617–23.)
Substance Use Disorder Among Anesthesiology Residents, 1975-2009
Authors: David O. Warner, Keith Berge, Huaping Sun, Ann Harman, Andrew Hanson, Darrell R. Schroeder
Journal: JAMA (2013)

Substance use disorder (SUD) among anesthesiologists and other physicians poses serious risks to both physicians and patients. Formulation of policy and individual treatment plans is hampered by lack of data regarding the epidemiology and outcomes of physician SUD.To describe the incidence and outcomes of SUD among anesthesiology residents.Retrospective cohort study of physicians who began training in United States anesthesiology residency programs from July 1, 1975, to July 1, 2009, including 44,612 residents contributing 177,848 resident-years to analysis. Follow-up for incidence and relapse was to the end of training and December 31, 2010, respectively.Cases of SUD (including initial SUD episode and any relapse, vital status and cause of death, and professional consequences of SUD) ascertained through training records of the American Board of Anesthesiology, including information from the Disciplinary Action Notification Service of the Federation of State Medical Boards and cause of death information from the National Death Index.Of the residents, 384 had evidence of SUD during training, with an overall incidence of 2.16 (95% CI, 1.95-2.39) per 1000 resident-years (2.68 [95% CI, 2.41-2.98] men and 0.65 [95% CI, 0.44-0.93] women per 1000 resident-years). During the study period, an initial rate increase was followed by a period of lower rates in 1996-2002, but the highest incidence has occurred since 2003 (2.87 [95% CI, 2.42-3.39] per 1000 resident-years). The most common substance category was intravenous opioids, followed by alcohol, marijuana or cocaine, anesthetics/hypnotics, and oral opioids. Twenty-eight individuals (7.3%; 95% CI, 4.9%-10.4%) died during the training period; all deaths were related to SUD. The Kaplan-Meier estimate of the cumulative proportion of survivors experiencing at least 1 relapse by 30 years after the initial episode (based on a median follow-up of 8.9 years [interquartile range, 5.0-18.8 years]) was 43% (95% CI, 34%-51%). Rates of relapse and death did not depend on the category of substance used. Relapse rates did not change over the study period.Among anesthesiology residents entering primary training from 1975 to 2009, 0.86% had evidence of SUD during training. Risk of relapse over the follow-up period was high, indicating persistence of risk after training.
A NEW METHOD OF SHORTENING THE ROUND LIGAMENTS
Authors: SIEGFRIED FIGUEROA
Journal: JAMA (1913)

The problem of retroversion and uterine prolapse has been covered so thoroughly at various times by the leading gynecologists, that the subject is not to be taken up in this article. After careful study I found that all of the several methods employed in the shortening of the round ligaments, either to correct retroversion or as an aid in the treatment of uterine prolapse, were deficient, presenting several disadvantages which made me seek for a better operative procedure. It is well known by all who practice gynecology that the so-called Alquié-Adams-Alexander operation as well as its modifications, Edebohls', Newman's, Goldspohn's, Martin's, Duret's, Kellogg's, Doleris', Cassati's and others, utilize merely the distal half of the ligament, leaving the resisting and more powerful proximal half to support the uterus; all have the disadvantage, however, of leaving unaltered the point of emergence of the ligament through the anterior
Multidetector CT was noninferior to multidetector CT plus venous ultrasonography of the leg for excluding PE
Authors: Scott M. Stevens
Journal: Annals of Internal Medicine (2008)

Source Citation Righini M, Le Gal G, Aujesky D, et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet. 2008;371:1343-52. 18424324
ACC/AHA 2008 Guideline Update on Valvular Heart Disease: Focused Update on Infective Endocarditis
Authors: Rick A. Nishimura, Blase A. Carabello, David P. Faxon, Michael D. Freed, Bruce W. Lytle, Patrick T. O'Gara, Robert A. O'Rourke, Pravin M. Shah
Journal: Circulation (2008)
P182 Utility of PET/CT reporting in lung cancer
Authors: S. M. Kazmi, S. Sureshkumar, A. Nazir, D. Nazareth, J. Greenwood, M. Ledson, M. Walshaw
Journal: Thorax (2011)

<h3>Introduction</h3> PET scans are useful in lung cancer by facilitating accurate staging to ensure that optimal treatment can be offered. Although the European Association of Nuclear Medicine (EANM) has produced reporting guidelines, the utility of the test depends upon the interpretation of the obtained images by the reporting radiologist. Since most UK PET services are provided by the independent sector (IS) remote from cancer units, we were interested to assess the value of PET/CT reporting in the MDT management of lung cancer. <h3>Methods</h3> We looked at the quality of reports of all 97 PET/CT scans performed in our busy lung cancer unit between December 2010 and April 2011, measuring the reports (from 6 IS radiologists) against the EANM standards. In addition, we analysed the length of the report and documentation of PET staging. <h3>Results</h3> FDG accumulation was documented in standard guideline format (mild, moderate or intense) in 39 cases (40%), all with SUVs noted, but in 37 cases (38%) FDG accumulation was described as significant, increased or highgrade (36 with SUVs). However, 21scans (22%) had no report of FDG accumulation but 20 (90%) still described SUVs. Corresponding CT findings were reported in 93 (96%), and a summary report was issued in 94 (97%), but 33 reports (34%) were &gt;1 page in length. Seven scans showed benign disease and 8 had no excess FDG activity: of the remaining 82 with malignancy, only 39 (48%) were staged. Reasons for not staging included “inflammatory changes” (2), “uncertain findings” (18), “further investigation required” (15), and “clinical correlation required” (8). Although all radiologists failed to stage some scans, three were responsible for the majority (30 scans, 70%). <h3>Conclusions</h3> Our results show that a significant proportion of scan reports fell below the recommended EANM standards either in the description of FDG accumulation or matching those patterns to SUV. Furthermore, many scans were unstaged, diminishing their value to the commissioning MDT. Closer liaison between IS radiologists and MDT members may assist the reporting process to ensure the maximum value is obtained from this expensive test for the benefit of this unfortunate patient group.
The Utility of Bone Scans in Rheumatology
Authors: IAIN DUNCAN, ANNA DORAI-RAJ, KENNETH KHOO, KATHLEEN TYMMS, ANDREW BROOK
Journal: Clinical Nuclear Medicine (1999)

Purpose: Bone scanning is the most common diagnostic imaging service requested by Australian rheumatologists, who order $50,000 (Australian) worth of bone scans annually. Methods: To determine why rheumatologists request bone scans and how they affect their patient management, the authors administered a two-part prospective survey before and after every bone scan ordered by four rheumatologists during a 6-month period in 1996. Results: A total of 136 bone scans were requested. The primary indications for scanning were to confirm a clinical diagnosis (38%), to exclude a diagnosis (34%), and to localize the site of pain (17%). The common diseases that rheumatologists were attempting to confirm or exclude with bone scanning were inflammatory arthritis, malignancy, and fracture. However, the most common provisional and final diagnosis was soft tissue rheumatism (18%), followed by inflammatory arthritis (15%) and osteoarthritis (11%). Bone scans were successful in excluding a diagnosis in 87% and confirming a diagnosis in 80%. In 32%, bone scans altered the clinical diagnosis, and in 43% they changed the course of disease management. Bone scan results prevented further investigations in 60%.
Amateur Etymologists Beware: Even During Carnival, Dirckx Lurckx-Reply
Authors: John H. Dirckx
Journal: JAMA (1994)

In Reply.  —The chief purpose of my letter wasn't  endorse any particular etymology of the word  but  challenge the erroneous derivation of it from a phrase meaning naval carriages.  The Oxford English Dictionary(second edition),1The Oxford Dictionary of English Etymology,2Webster's Third New International Dictionary,3The American Heritage Dictionary of the English Language(third edition),4and Eric Partridge'sOrigins: A Short Etymological Dictionary of Modern English5concur in tracing carnival  medieval Latincarnilevariaor one of its variants (carnilevamen, carnilevare, carnilevarium), all from Latin caro meaning flesh, meat andlevaremeaning to take away.  The Oxford English Dictionary, Origins, and Albert Dauzat in hisDictionnaire Etymologique6explicitly reject the derivation fromCarne, vale! Meat, farewell! which is Italian, not Latin. Like most instances of folk etymology (admiral from admire, belfry from bell, cutlet from cut, and so on), it
Bleeding Manifestations in Patients With Amyloidosis
Authors: Ronald Kim
Journal: JAMA (1983)

To the Editor.—  Yood and colleagues, in a recent article inThe Journal(1983;249:1322), suggest that bleeding problems in patients with amyloidosis are probably more closely related to increased fragility of amyloid-infiltrated blood vessels than to abnormal coagulation. We would like to add, in support of their suggestion, that a localized form of amyloidosis within the CNS, cerebral amyloid angiopathy (CAA), is also associated with a bleeding tendency, apparently as a result of structural alterations in vessel walls. Cerebral amyloid angiopathy typically occurs in localized fashion within the brains of nonhypertensive elderly subjects and is characterized clinically by dementia and recurrent episodes of intracerebral hemorrhage. 1-3 The distribution of lesions correlates closely with sites of amyloid deposition within the brain, namely, small leptomeningeal and superficial cortical arteries and veins. The sharp localization of microscopic hemorrhages of varying age that we and others 2 have observed around vessels heavily infiltrated by