tbuckley/cabot-search huggingface dataset:
Adding clopidogrel to aspirin after TIA or minor ischemic stroke reduced stroke without increasing bleeding
Authors: Michael D. Hill
Journal: Annals of Internal Medicine (2013)

ACP Journal ClubOctober 15, 2013Adding clopidogrel to aspirin after TIA or minor ischemic stroke reduced stroke without increasing bleedingMichael D. Hill, MDMichael D. Hill, MDUniversity of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada (M.D.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-8-201310150-02005 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationWang Y, Wang Y, Zhao X, et al; CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369:11-9. https://pubmed.ncbi.nlm.nih.gov/23803136Clinical Impact RatingsGIM/FP/GP: Emergency Med: Hospitalists: Neurology: References1 Wu CM, McLaughlin K, Lorenzetti DL, et al. Early risk of stroke after transient ischemic attack: a systematic review and meta-analysis. Arch Intern Med. 2007;167:2417-22. [PMID: 18071162] Google Scholar2 Kennedy J, Hill MD, Ryckborst KJ, et al; FASTER Investigators. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol. 2007;6:961-9. [PMID: 17931979] Google Scholar3 Diener HC, Bogousslavsky J, Brass LM, et al; MATCH investigators. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364:331-7. [PMID: 15276392] Google Scholar4 SPS3 Investigators, Benavente OR, Hart RG, et al. Effects of clopidogrel added to aspirin in patients with recent lacunar stroke. N Engl J Med. 2012;367:817-25. [PMID: 22931315] Google Scholar5 Chimowitz MI, Lynn MJ, Derdeyn CP, et al; SAMMPRIS Trial Investigators. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365:993-1003. [PMID: 218994096]. Google Scholar6 Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial. clinicaltrials.gov/ct2/show/NCT00991029 (accessed 6 Aug 2013). Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada (M.D.H.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics October 15, 2013Volume 159, Issue 8Page: JC5KeywordsAntiplatelet therapyBrain diseasesDrugsHemorrhageHemorrhagic strokeHeparinHospitalistsIschemic strokeMyocardial infarctionNeurologyOral healthPilot studiesSafetyStrokeSurgeryTransient ischemic attacksVertigo Issue Published: October 15, 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Transcriptome analysis reveals specific changes in osteoarthritis synovial fibroblasts
Authors: Manuel J Del Rey, Alicia Usategui, Elena Izquierdo, Juan D Cañete, Francisco J Blanco, Gabriel Criado, José L Pablos
Journal: Annals of the Rheumatic Diseases (2011)

<h3>Introduction/Background*</h3> Choriocarcinoma is a highly malignant epithelial tumor originating from the trophoblast. It primarily occurs during the reproductive years <h3>Methodology</h3> We are reporting three different cases with choriocarcinoma with different presentations whether postmenopausal presentation, isthmic lesions, and later presentation after hysterectomy with vaginal metastasis. <h3>Result(s)*</h3> All cases were managed surgically with reporting of their management in detail. <h3>Conclusion*</h3> The majority of choriocarcinoma cases are intra-uterine and of gestational origin. postmenopausal and cervical choriocarcinoma are rare presentations of this pathology. It is important to include cervical choriocarcinoma in the differential diagnosis of cervical lesions during the reproductive age despite the extremely low incidence as an ectopic entity. Choriocarcinoma is completely curable by chemotherapy even in the presence of metastasis. If massive life-threatening vaginal bleeding occurs, surgery is needed. We should consider vaginal metastasis in any vaginal mass after hysterectomy for a suspected tumor as a vesicular mole or endometrial cancer.
Effect of brief myocardial ischemia on sympathetic coronary vasoconstriction.
Authors: D D Gutterman, D A Morgan, F J Miller
Journal: Circulation Research (1992)

The purpose of the present study was to determine whether sympathetic coronary vasoconstrictor responses are altered after brief ischemia and reperfusion. Adult mongrel dogs were anesthetized and instrumented for measurements of heart rate, arterial pressure, left ventricular pressure, left ventricular dP/dt, anterior myocardial wall thickening, and left circumflex coronary artery (LCX) and left anterior descending coronary artery (LAD) blood flow velocities. Changes in coronary vascular resistance were recorded during intravenous bolus doses of norepinephrine and bilateral electrical stimulation of the stellate ganglia. After beta-adrenergic blockade and bilateral vagotomy, electrical stimulation of the stellate ganglia increased coronary vascular resistance in the LAD and LCX beds by 38 +/- 5% and 39 +/- 5%, respectively. After a 15-minute LAD occlusion, repeat electrical stimulation produced increases in coronary resistance of 16 +/- 3% and 45 +/- 8%, respectively (p less than 0.05 for the LAD before versus after the occlusion). The peak increase in coronary vascular resistance to two doses of norepinephrine was unchanged. After a shorter period of myocardial ischemia (7 minutes), similar increase in coronary resistance to stellate stimulation were observed before (27 +/- 4%) and after (26 +/- 6%) myocardial ischemia. The mechanism of this impaired sympathetic coronary vasoconstriction was further tested by examining the responses to bretylium and tyramine. Brief ischemia did not alter the coronary constrictor responses to either bretylium or tyramine, suggesting that mechanisms governing prejunctional release of norepinephrine are intact in the postischemic coronary arterial bed.(ABSTRACT TRUNCATED AT 250 WORDS)
Strategies to advance translational research into brain barriers
Authors: Edward Neuwelt, N Joan Abbott, Lauren Abrey, William A Banks, Brian Blakley, Thomas Davis, Britta Engelhardt, Paula Grammas, Maiken Nedergaard, John Nutt, William Pardridge, Gary A Rosenberg, Quentin Smith, Lester R Drewes
Journal: The Lancet Neurology (2008)
Multiple Oral Corticosteroid Courses for Wheezing Illnesses in Infancy are Associated with Reduced Subsequent Lung Function
Authors: D.J. Jackson, S.R. Durrani, M.D. Evans, E.L. Anderson, C.J. Tisler, R.E. Gangnon, J.E. Gern, R.F. Lemanske Jr.
Journal: Journal of Allergy and Clinical Immunology (2011)
Frame Shift Mutation, Exon Skipping, and a Two-Codon Deletion Caused by Splice Site Mutations Account for Pyruvate Kinase Deficiency
Authors: Hitoshi Kanno, Hisaichi Fujii, David C. Wei, L.C. Chan, Akira Hirono, Ichiro Tsukimoto, Shiro Miwa
Journal: Blood (1997)
Shelley's 77 Skins
Authors: S M Cooper
Journal: Journal of the Royal Society of Medicine (2003)

This set of flashcards with illustrations of common dermatological disorders is marketed as a ‘refresher course for doctors, nurses and students’. The stated claim is that ‘when you know these, you know 95% of all you need to know’. Each card has an illustration and, on the reverse, some key features of the disease plus a catchy slogan such as for acne: ‘from zits to pits’. I tried out the cards on a handful of dermatology consultants and specialist registrars, a new dermatology SHO, medical students, and a dermatology-phobic general practitioner (my husband). The consultants and specialist registrars did not do particularly well, finding that the skin appearance of some rashes suggested a wide differential. Without a history, a red patch on a back could be due to any number of conditions, but with a typical history a fixed drug eruption is easier to diagnose. In addition, some of the illustrations were atypical—for example, granuloma annulare is shown in its unusual widespread form rather than the typical ring on the back of a hand or dorsum of a foot. The SHO thought the cards were interesting and might be useful to flick through on starting dermatology. The medical students were a little bemused, finding the cards very difficult and the GP was exasperated with the chickenpox illustrations of two vesicles that could have been insect bites.

The concept is laudable and the quality of most of the illustrations is good. Some of the photos are excellent examples, such as the cutaneous larva migrans, psoriasis and the urticarial wheals. One glaring omission is melanoma (apart from the metastatic disease). Melanoma surely must rank in the need-to-know category. Disappointingly, the leg ulcer is out of focus and the aetiology is undefined. A good example of a venous ulcer and a punched out arterial ulcer would be useful additions.

The most likely users of these cards would be new dermatology SHOs or GP clinical assistants. If the target is to be doctors just starting out in dermatology, the illustrations need to be typical in appearance. Just a few changes and these cards could be really useful, and probably even more useful on a CD Rom.
Organic Basis of Confusional States in the Elderly
Authors: F. J. Flint, S. M. Richards
Journal: BMJ (1956)

Mental confusion is a relatively common feature of ill ness in old people. The consequent domestic upheaval and the ensuing medical, nursing, and social problems are well known. This review of the aetiological factors of confusion in 242 elderly confused patients is designed to call attention to the high incidence of organic disease both in the brain and elsewhere in the body. It will be shown that  senile dementia  is not necessarily synonymous with either cerebral arteriosclerosis or  senility.
461 ACUTE HEPATITIS C IN SPAIN. RETROSPECTIVE STUDY OF 131 PATIENTS
Authors: R. Pérez Alvarez, R. Solá, R. Bárcena, R. Perez López, N. Cañete, R. Planas, M. Manzano, M.L. Gutiérrez, L. Morano, J. de la Vega, M. Castro, J.A. Pons, J. Torras, G. San Miguel, I. Mendez, J.G. Samaniego, G. López, I. García, C. Muñoz, P. Civeira, M. Torre, L. Rodrigo
Journal: Journal of Hepatology (2011)
Cough and weight loss in a young man
Authors: S. J. Chavda, A. Shepherd, C. Hasford
Journal: BMJ (2013)

A 28 year old man was referred to the emergency department by his general practitioner after presenting with a two day history of haemoptysis. He described coughing up a teaspoon of fresh blood in the morning after a month of coughing up rusty coloured sputum. This was on a background of eight months of persistent cough associated with progressive lethargy and weight loss, with isolated episodes of night sweats. His travel history showed no exposure to high risk areas for tuberculosis or HIV, and he denied any high risk behaviours for contracting HIV. He had never smoked. On chest examination, he was found to have an area that was dull to percussion over the right parasternal region and normal breath sounds throughout his lung fields. The rest of the examination was normal. His observations were heart rate of 90 beats/min, blood pressure 110/85 mm Hg, respiratory rate 20 breaths/min, oxygen saturations 100% on room air, and temperature 36.9°C. Blood results showed a haemoglobin of 136 g/L (reference range 133-167), white blood cell count 10×109 cells/L (3.5-11), and C reactive protein 55 mg/L (0-5 mg/L; 1 mg/L=9.52 nmol/L). Urea, electrolytes, and liver function tests were normal. Routine chest radiography was performed in the emergency department. This showed an anterior mediastinal mass. Biopsies were then taken from the mass. These showed Reed-Sternberg cells.
Altered Heart Rate Variability in Spontaneously Hypertensive Rats Is Associated with Specific Particulate Matter Components in Detroit, Michigan
Authors: Annette C. Rohr, Ali Kamal, Masako Morishita, Bhramar Mukherjee, Gerald J. Keeler, Jack R. Harkema, James G. Wagner
Journal: Environmental Health Perspectives (2010)

Exposure to fine particulate matter [aerodynamic diameter ≤ 2.5 μm (PM2.5)] is linked to adverse cardiopulmonary health effects; however, the responsible constituents are not well defined.We used a rat model to investigate linkages between cardiac effects of concentrated ambient particle (CAP) constituents and source factors using a unique, highly time-resolved data set.Spontaneously hypertensive rats inhaled Detroit Michigan, CAPs during summer or winter (2005-2006) for 13 consecutive days. Electrocardiogram data were recorded continuously, and heart rate (HR) and heart rate variability (HRV) metrics were derived. Extensive CAP characterization, including use of a Semicontinuous Elements in Aerosol Sampler (SEAS), was performed, and positive matrix factorization was applied to investigate source factors.Mean CAP exposure concentrations were 518 μg/m(3) and 357 μg/m(3) in the summer and winter, respectively. Significant reductions in the standard deviation of the normal-to-normal intervals (SDNN) in the summer were strongly associated with cement/lime, iron/steel, and gasoline/diesel factors, whereas associations with the sludge factor and components were less consistent. In winter, increases in HR were associated with a refinery factor and its components. CAP-associated HR decreases in winter were linked to sludge incineration, cement/lime, and coal/secondary sulfate factors and most of their associated components. Specific relationships for increased root mean square of the standard deviation of successive normal-to-normal intervals (RMSSD) in winter were difficult to determine because of lack of consistency between factors and associated constituents.Our results indicate that specific modulation of cardiac function in Detroit was most strongly linked to local industrial sources. Findings also highlight the need to consider both factor analytical results and component-specific results when interpreting findings.
Arthrocentesis of the Knee
Authors: Todd W. Thomsen, Sam Shen, Robert W. Shaffer, Gary S. Setnik
Journal: New England Journal of Medicine (2006)

Diagnostically, arthrocentesis is indicated to rule out septic arthritis in individuals presenting with a single or several inflamed joints. Arthrocentesis can also be used to differentiate between crystal arthropathies, such as gout and pseudogout, inflammatory and noninflammatory effusions, and hemarthroses. It should be emphasized that a single inflamed joint should almost always undergo at least one diagnostic aspiration. Therapeutically, arthrocentesis may be performed to drain large effusions, hemarthroses, or to inject steroids or local anesthetic. Arthrocentesis should be avoided in patients with cellulitis overlying the site of needle entry, out of concern of seeding the joint cavity with bacteria. Known . . . .
Influence of Frequency, Time Interval From Initial Instruction, and Method of Instruction on Performance Competency for Blood Glucose Monitoring
Authors: Marcia A Kucler, Marlene Goormastic, Byron J Hoogwerf
Journal: Diabetes Care (1990)

In a sample of 178 nurses who had been instructed in the performance of fingerstick monitoring of blood glucose (MBG), we investigated variables that may predict their proficiency at subsequent MBG performance. All nurses were given initial instruction in a classroom-type setting or via a self-instructional packet, and initial proficiency was documented by initial testing. All nurses were retested 1-8 mo later. To address whether actual frequency of performing MBG at work affected proficiency, the nurses were categorized based on the frequency of performing MBG groups: greater than 1 test/day (n = 53), greater than 1 test/wk (n = 51), greater than 1 test/mo (n = 52), and less than 1 test/mo (n = 22). No differences in test and retest scores were detected. To address whether the time interval from the original instruction and test to the retest affected proficiency, the nurses were divided into groups who had initial test less than 6 mo (n = 108) and greater than 6 mo (n = 70) before the retest. Mean change in test scores was less in the greater than 6-mo group than in the less than 6-mo group (P less than 0.01), and they had a lower retest fail rate (3 vs. 12%, P = 0.03). To explain this unexpected finding, test scores were analyzed by groups based on the type of original instruction. Nurses who attended class (n = 79) were compared with those who had self-instruction (n = 99). The classroom-trained group had less change in test-to-retest score (P = 0.0002) and a lower retest failure rate (3 vs. 12%, P less than 0.05).
Constructive surgery of the hip.
Authors: Frank E. Stinchfield
Journal: JAMA (1963)

Certainly no person today is more qualified to write about vitallium mold arthroplasty than Dr. Aufranc. He and Dr. Carroll Larson, who wrote the foreword to this book, assisted Dr. Smith-Petersen during early experimental work, when the mold arthroplasty was a two-stage procedure. Everyone treating a patient who has hip disease is impressed by the over-all dimensions of the problem. Dr. Aufranc devotes a rather large section to the preparation of the patient and his family for the reasonable expectations of surgery. He also includes indications for mold arthroplasty, surgical techniques, anatomy of the hip joint, surgical approaches, and postoperative care and management of infections. While several surgical approaches are discussed, Dr. Aufranc cannot help showing his enthusiasm for the anterior approach— an enthusiasm which many of us share. The postoperative management of hip arthroplasties has always been an area in which healthy disagreement exists. The program of exercises outlined
The biopsychosocial and “complex” systems approach as a unified framework for addiction
Authors: Mark D. Griffiths
Journal: Behavioral and Brain Sciences (2008)

Abstract The “unified framework” for addiction proposed by Redish and colleagues is only unified at a reductionist level of analysis, the biological one relating to decision-making. Theories of addiction may be complementary rather than mutually exclusive, suggesting that limitations of individual theories might be unified through the combination of ideas from different biopsychosocial “complex” systems perspectives.
Influence of specific CD4+ T cells and antibodies on evolution of hypervariable region 1 during acute HCV infection
Authors: Cristiano Scottà, Anna Rosa Garbuglia, Lionello Ruggeri, Enea Spada, Luca Laurenti, Maria Paola Perrone, Gabriella Girelli, Alfonso Mele, Maria Rosaria Capobianchi, Antonella Folgori, Alfredo Nicosia, Paola Del Porto, Enza Piccolella
Journal: Journal of Hepatology (2007)
SUDDEN DEATH AFTER INTRAVENOUS USE OF BISMUTH TARTRATE
Authors: O. L. Suggett
Journal: JAMA (1931)

To the Editor:  —The report of the sudden death following the intravenous injection of bismuth tartrate by Dr. Stephen H. Curtis, Troy, N. Y., inThe Journal, should serve as a timely warning against the all too free and indiscriminate practice of intravenous medication.  I have on hand a generous supply of ampules of bismuth tartrate sent me gratuitously by a well known firm specializing in intravenous preparations—attesting its chemical purity so far as that feature is concerned—that I have hesitated using on a few charity patients, awaiting further proof of its entire safety, although a brother urologist stated that he would have no hesitancy whatever, at the same time cheerfully offering to give me sodium iodide intravenously for a recalcitrant sciatica, with no therapeutic or empiric reason, as it is not specific in any sense.  Although I have given thousands of intravenous injections since 1911, I gave the last
Human leucocyte antigen in a Chinese family with thyrotoxic periodic paralysis in Singapore.
Authors: C. F. Sum, A. C. Fok, K. T. Tan, S. H. Chan, J. S. Cheah
Journal: BMJ (1988)

showed necrosis of the pancreatic body and tail.On the eighth day of the attack he became hypertensive, unconscious, and unresponsive, with increasing fever despite antibiotics.A 1-8 litre plasma exchange was performed as in case 1. Confusion cleared rapidly, vital signs and oxygenation improved, fever decreased (figure), and the APACHE II score fell from 17 to 9. Next day the necrotic pancreatic tail and body were debrided at laparotomy and irrigating drains inserted.He made a complete recovery and was discharged 38 days later. CommentMany patients with fulminant acute pancreatitis have pancreatic necrosis, and survival depends on debridement of necrotic or infected tissue.Ifoperation is undertaken during the initial week survival is unlikely,4 and the outlook is similarly bleak if multi- organ failure becomes established.'There is a logical role for treatments that allow debridement to be undertaken at a stage when recovery can be expected.Plasmapheresis scavenges various circulating toxins, including protease-U2 macroglobulin complexes.Our findings are preliminary, but the similarity of response was impressive, and in both cases there was a large reduction in the APACHE II score with the expecta- tion of an increased probability of survival.Plasma- pheresis appeared to induce more pronounced changes in the course of acute pancreatitis than other treat- ments that we have employed.Further evaluation is needed, preferably in patients who have not developed the manifestations of overt multiorgan failure and in the setting of a protocol which includes surgical debridement, when appropriate, on the basis of objective criteria including CT angiography and precise physio- logical monitoring.
AIDS and the lung. 1--AIDS, aprons, and elbow grease: preventing the nosocomial spread of human immunodeficiency virus and associated organisms.
Authors: P J Hanson, J V Collins
Journal: Thorax (1989)

Epidemiological evidence indicates that transmission of human immunodeficiency virus (HIV) other than by direct inoculation or sexual contact is extremely rare. HIV has, however, been found on fibreoptic bronchoscopes used on patients with AIDS and there is a clear theoretical risk of transmission by bronchoscopy. Applied experiments have underlined the importance of cleaning equipment thoroughly and have shown the limitations of disinfection. Infection control policies should be revised to meet the following four basic requirements: (1) all precautions should apply to all patients alike--that is, whether infectious or not; (2) equipment should be cleaned thoroughly in detergent immediately after use to remove body secretions and reduce contamination; (3) staff who may be exposed to body secretions should wear simple barrier clothing routinely; and (4) contaminated bronchoscopes should be disinfected for 20 minutes in 2% alkaline glutaraldehyde after cleaning.
Cerebellar Hemorrhage after Angioplasty
Authors: Axel Riecker, Ulrike Ernemann, Andreas Kastrup
Journal: New England Journal of Medicine (2005)

To the Editor: A 57-year-old woman without hypertension or hypercholesterolemia who was receiving therapy with 75 mg of clopidogrel per day was admitted with transient dysarthria and diplopia. Init...