tbuckley/cabot-search huggingface dataset:
‘Acopia’ and ‘social admission’ are not diagnoses: why older people deserve better
Authors: David Oliver
Journal: Journal of the Royal Society of Medicine (2008)

In any NHS general hospital, a quick trawl through the clinical notes of older patients would identify several with labels, such as ‘acopia’, ‘social admission’, ‘bed-blocker’ or ‘atypical presentation’. None of these are recognized diagnoses and their presence on discharge summaries would cause consternation to clinical coders. Moving from what staff write to what they sometimes casually say – sometimes even within earshot of a geriatrician or (worse) patients or visitors – we hear more value-laden terms (e.g. ‘crumble’, ‘bed-blocker’ or ‘GOMER’).1 One consultant colleague from another hospital recently opined to me that even internal – rather than geriatric – medicine house jobs had ‘far too much social work medicine to be of any use in training’. In another instance, a physician clinical director stated at a directorate meeting, without self-consciousness, that he was spending too much time ‘market gardening’ (i.e. caring for old patients who were ‘cabbages’). In a third, a surgeon arrived on my ward with his usual entourage, and laughingly announced (in front of our own ward team) that he ‘didn't understand how anyone could stand to work in a ward looking after all these “crumblies”.’ In my experience and that of fellow geriatricians, such incidents are depressingly commonplace. If even senior practitioners seem to have so little interest in performing what is actually much of the job of acute medicine in the 21st century, what price adequate mentorship for their juniors?

My contention is that the use of such terminology is inappropriate, unprofessional and singularly unhelpful to patient care. It would certainly not be used if the patients were children or younger adults. Similarly prejudicial remarks have long been recognized as inappropriate when applied to, for example, gender or ethnicity. Are older people the last frontier?

It isn't just about politically correct language, however. These attitudes affect diagnosis and treatment. The customary diagnostic rigour, which we have been trained to apply as standard, can be mysteriously replaced in older patients by ageist therapeutic nihilism. Education, training and received values in medicine need to change to reflect the reality of modern medical practice. The core business of hospitals in the NHS and throughout the developed world is in patients with illnesses which are long-term and common and in treatments which are low-tech and palliative or disease-modifying. Yet professional values and training still overly prioritize the acute, the rare, the high-tech and the curative. If we are providing a public service based on need, we must give adequate assessments to the patients who actually turn up in the system, rather than those whom we would find more personally engaging, or those ‘consumers’ who shout loudest.
SOME REACTIONS SEEN AFTER ELECTRIC SHOCK TREATMENT
Authors: JOHN FROSCH, DAVID IMPASTATO, LILLY OTTENHEIMER, S. BERNARD WORTIS
Journal: American Journal of Psychiatry (1945)

We have presented some evidence to illustrate an interesting by-product of electric shock treatment. A few days after shock treatment was terminated, a psychotic reaction appeared, differing in its gross clinical manifestations from the clinical picture which was present when shock treatment was started. It differs from the state of confusion that one usually meets in the course of shock treatment. Such late post-treatment psychotic episodes last anywhere from a few days to a few weeks and then subside. With its evanescence the original clinical complaints of the patient usually subsided. It was felt that the picture could not be entirely explained alone by organic brain damage and to a large extent was dependent upon the personality structure of the patient. The technical suggestion is made that when such a reaction develops, treatment should not be immediately reinstituted. One should wait, a few weeks if necessary, in view of the fact that in all our patients the psychotic episode subsided.
Amb a 1–immunostimulatory oligodeoxynucleotide conjugate immunotherapy decreases the nasal inflammatory response☆
Authors: Meri K Tulic, Pierre-Olivier Fiset, Pota Christodoulopoulos, Patrice Vaillancourt, Martin Desrosiers, François Lavigne, Joseph Eiden, Qutayba Hamid
Journal: Journal of Allergy and Clinical Immunology (2004)
Cutaneous lupus erythematosus and cancer risk
Authors: M. Sticherling
Journal: British Journal of Dermatology (2012)

Conflicts of interest None declared. Although well known since the late 19th century, cutaneous lupus erythematosus (CLE) and its various subsets are still an underestimated group of skin diseases. Associations with systemic disease and internal organ involvement have variably been described by several authors in the past. Although one‐third of patients with systemic lupus erythematosus (SLE) show primary manifestations on the skin and two‐thirds will show skin manifestations at any time during their disease course, characteristic dermal symptoms may be missing in many cases. On the other side, distinct disease entities as known in dermatology may lack any or severe internal involvement. While at least three different subsets of CLE (acute CLE, subacute CLE, chronic CLE) are dermatologically well defined, these are only partly appreciated among rheumatologists and may give rise to misunderstanding in the clinical routine as well as within therapeutic studies. However, increasing scientific work has been invested in pathogenic as well as clinical studies. With regard to the rarity of some disease subsets and with new diagnostic and activity scores at hand, registries have been established over Europe and the U.S.A. Eventually, epidemiological and clinical data of CLE will be clarified which will help in caring for the patients and in stopping mutilation and the ensuing distinct decrease of life quality.
In-Vitro Studies of Interactions Between Tampons and Staphylococcus aureus
Authors: CLAIRE V. BROOME
Journal: Annals of Internal Medicine (1982)

In-vitro studies were done to investigate the role of tampons and Staphylococcus aureus in toxic shock syndrome. Tampons did not enhance the growth of S. aureus in nutrient broth or human blood. Intrinsic contamination of tampons with S. aureus was not found among the 504 tampons cultured (95% confidence limits of fraction contaminated: 0 to 0.007). Toxin-producing S. aureus persisted significantly longer on artificially contaminated Rely tampons (Procter & Gamble) than on the other brands tested. The proportion of clinical isolates of S. aureus capable of producing toxin increased from two of 36 in 1960 to eight of 20 in 1979 (p = 0.002, Fisher's exact test). This general increase in the proportion of toxin-producing strains may partially explain the increase in cases of toxic shock syndrome in recent years.
Prediction of Intravesical Recurrence After Radical Nephroureterectomy: Development of a Clinical Decision-making Tool
Authors: Evanguelos Xylinas, Luis Kluth, Niccolo Passoni, Quoc-Dien Trinh, Malte Rieken, Richard K. Lee, Harun Fajkovic, Giacomo Novara, Vitaly Margulis, Jay D. Raman, Yair Lotan, Morgan Rouprêt, Atiqullah Aziz, Hans-Martin Fritsche, Alon Weizer, Juan I. Martinez-Salamanca, Kazumasa Matsumoto, Christian Seitz, Mesut Remzi, Thomas Walton, Pierre I. Karakiewicz, Francesco Montorsi, Marc Zerbib, Douglas S. Scherr, Shahrokh F. Shariat
Journal: European Urology (2013)
Vignette-Based Study of Ovarian Cancer Screening: Do U.S. Physicians Report Adhering to Evidence-Based Recommendations?
Authors: Laura-Mae Baldwin, Katrina F. Trivers, Barbara Matthews, C. Holly A. Andrilla, Jacqueline W. Miller, Donna L. Berry, Denise M. Lishner, Barbara A. Goff
Journal: Annals of Internal Medicine (2012)

This article has been corrected. The original version (PDF) is appended to this article as a supplement. Background: No professional society or group recommends routine ovarian cancer screening, yet physicians' enthusiasm for several cancer screening tests before benefit has been proven suggests that some women may be exposed to potential harms. Objective: To provide nationally representative estimates of physicians' reported nonadherence to recommendations against ovarian cancer screening. Design: Cross-sectional survey of physicians offering women's primary care. The 12-page questionnaire contained a woman's annual examination vignette and questions about offers or orders for transvaginal ultrasonography (TVU) and cancer antigen 125 (CA-125). Setting: United States. Participants: 3200 physicians randomly sampled equally from the 2008 American Medical Association Physician Masterfile lists of family physicians, general internists, and obstetrician-gynecologists; 61.7% responded. After exclusions, 1088 respondents were included; their responses were weighted to represent the specialty distribution of practicing U.S. physicians nationally. Measurements: Reported nonadherence to screening recommendations (defined as sometimes or almost always ordering screening TVU or CA-125 or both). Results: Twenty-eight percent (95% CI, 24.5% to 32.9%) of physicians reported nonadherence to screening recommendations for women at low risk for ovarian cancer; 65.4% (CI, 61.1% to 69.4%) did so for women at medium risk for ovarian cancer. Six percent (CI, 4.4% to 8.9%) reported routinely ordering or offering ovarian cancer screening for low-risk women, as did 24.0% (CI, 20.5% to 28.0%) for medium-risk women (P ≤ 0.001). Thirty-three percent believed TVU or CA-125 was an effective screening test. In adjusted analysis, actual and physician-perceived patient risk, patient request for ovarian cancer screening, and physician belief that TVU or CA-125 was an effective screening test were the strongest predictors of physician-reported nonadherence to published recommendations. Limitation: The results are limited by their reliance on survey methods; there may be respondent–nonrespondent bias. Conclusion: One in 3 physicians believed that ovarian cancer screening was effective, despite evidence to the contrary. Substantial proportions of physicians reported routinely offering or ordering ovarian cancer screening, thereby exposing women to the documented risks of these tests. Primary Funding Source: Centers for Disease Control and Prevention and the National Cancer Institute.
Five versus six fractions of radiotherapy per week for squamous-cell carcinoma of the head and neck (IAEA-ACC study): a randomised, multicentre trial
Authors: Jens Overgaard, Bidhu Kaylan Mohanti, Naseem Begum, Rubina Ali, Jai Prakash Agarwal, Maire Kuddu, Suman Bhasker, Hideo Tatsuzaki, Cai Grau
Journal: The Lancet Oncology (2010)
Radical Prostatectomy versus Observation for Localized Prostate Cancer
Authors: Timothy J. Wilt, Michael K. Brawer, Karen M. Jones, Michael J. Barry, William J. Aronson, Steven Fox, Jeffrey R. Gingrich, John T. Wei, Patricia Gilhooly, B. Mayer Grob, Imad Nsouli, Padmini Iyer, Ruben Cartagena, Glenn Snider, Claus Roehrborn, Roohollah Sharifi, William Blank, Parikshit Pandya, Gerald L. Andriole, Daniel Culkin, Thomas Wheeler
Journal: New England Journal of Medicine (2012)

The effectiveness of surgery versus observation for men with localized prostate cancer detected by means of prostate-specific antigen (PSA) testing is not known.
Association of Anticholinergic Load With Impairment of Complex Attention and Memory in Schizophrenia
Authors: Michael J. Minzenberg, John H. Poole, Cynthia Benton, Sophia Vinogradov
Journal: American Journal of Psychiatry (2004)

The authors' goals were 1) to establish a clinically useful standard index of the relative anticholinergic potency of psychiatric medications; 2) to determine which cognitive functions are most affected by the administration of anticholinergic medications to patients with schizophrenia; and 3) to compare in vitro and clinically derived indexes of anticholinergic load in predicting these cognitive impairments.One hundred six clinically stable patients with schizophrenia were given a brief neuropsychological battery and evaluated on a standard symptom rating scale. The anticholinergic load associated with their psychiatric medications was estimated by using 1) a pharmacological index, calculated from a compilation of published studies reporting in vitro brain muscarinic receptor antagonism, and 2) a clinical index, based on clinician ratings of the anticholinergic side effects of medications. The authors analyzed the correlations of both indexes with the neuropsychological measures and with summary neuropsychological factor scores.The clinical and pharmacological anticholinergic indexes were highly correlated with each other and showed virtually identical associations with neuropsychological measures. Anticholinergic load was associated with lower scores on measures of attention and declarative memory, including several measures of auditory and visual memory and two tests of complex attention, but was unrelated to intelligence, simple attention, working memory, executive functions, conceptual fluency, or motor speed.This pattern of cognitive impairment with central cholinergic antagonism is consistent with emerging models of the functional anatomy of ascending forebrain cholinergic subsystems. Both pharmacological and clinical indexes show utility in predicting the effects of anticholinergic load on cognition in schizophrenia. Doses of psychiatric medication within the range of routine pharmacotherapy practice may have clinically significant effects on memory and complex attention in patients with schizophrenia; these effects may contribute as much as one-third to two-thirds of the memory deficit typically seen in patients with schizophrenia.
Potassium supplementation attenuates experimental hypertensive renal injury.
Authors: D Ellis, B Banner, J E Janosky, P U Feig
Journal: Journal of the American Society of Nephrology (1992)

The long-term roles of dietary sodium and potassium on the renal end-organ damage of hypertension were investigated in Wistar-Kyoto (WKY) and in spontaneously hypertensive (SHR) rats. Eight rats from each strain were maintained since 1 month of age on one of four dietary combinations of either low (0.4%) or high (6.0%) NaCl and low (0.51%) or high (7.6%) KCl providing sodium/potassium molar ratios of 1:1, 1:15, 15:1, and 15:15, respectively. Urinary sodium/potassium excretion ratios confirmed the proportion of salts consumed. Systolic blood pressures (SBP) were similar at 5 months of age and at the completion of the study at 9.5 months; SBP was significantly higher in SHR than in WKY rats and was not attenuated by dietary potassium supplementation of a magnitude that raised plasma potassium concentrations. Albumin excretion rate (AER) was also higher in SHR than in WKY rats (P less than 0.0001). In SHR, AER rose further with high sodium intake (P less than 0.035) but, contrary to SBP, was ameliorated by an equimolar addition of potassium (P less than 0.01). Morphologic lesions were generally absent in WKY rats and were more common in SHR as a group (P less than 0.001). In all four SHR groups, the graded histopathologic injury correlated well with measured AER but a major improvement in hypertensive renal lesions occurred largely in the KCl-supplemented, salt-loaded SHR group. These results show a disassociation between the effects of dietary monovalent cations on the level of SBP and their effect on renal injury. Sodium aggravates renal injury and potassium protects against this renal effect of sodium independent of SBP effect.(ABSTRACT TRUNCATED AT 250 WORDS)
Monocyte chemotactic protein 4 (MCP-4), a novel structural and functional analogue of MCP-3 and eotaxin.
Authors: M Uguccioni, P Loetscher, U Forssmann, B Dewald, H Li, S H Lima, Y Li, B Kreider, G Garotta, M Thelen, M Baggiolini
Journal: The Journal of Experimental Medicine (1996)

A novel human CC chemokine complementary DNA was identified in a library constructed from human fetal RNA, cloned into a baculovirus vector, and expressed in Sf9 insect cells. The mature recombinant protein that was released had the NH2-terminal sequence pyro-QPDALNVPSTC...and consisted of 75 amino acids. Minor amounts of two variants of 77 and 82 residues (NH2 termini: LAQPDA...and FNPQGLAQPDA...) were released as well. The novel chemokine was designated monocyte chemotactic protein 4 (MCP-4) and the variants were designated (LA)MCP-4 and (FNPQGLA)MCP-4. MCP-4 shares the pyroglutamic acidproline NH2-terminal motif and 56-61% sequence identity with the three known monocyte chemotactic proteins and is 60% identical to eotaxin. It has marked functional similarities to MCP-3 and eotaxin. Like MCP-3, MCP-4 is a chemoattractant of high efficacy for monocytes and T lymphocytes. On these cells, it binds to receptors that recognize MCP-1, MCP-3, and RANTES. On eosinophils, MCP-4 has similar efficacy and potency as MCP-3, RANTES, and cotaxin. It shares receptors with eotaxin and shows full cross-desensitization with this cosinophil-selective chemokine. Of the two variants, only (LA)MCP-4 could be purified in sufficient quantities for testing and was found to be at least 30-fold less potent than MCP-4 itself. This suggests that the 75-residue form with the characteristic NH2 terminus of an MCP is the biologically relevant species.
SIMULTANEOUS RENAL AND HEPATIC EXCRETION OF WATER, CYANOL, AND AZOFUCHSIN I IN RABBITS
Authors: William E. Ehrich
Journal: The Journal of Experimental Medicine (1942)

1. The renal and hepatic excretion of water, cyanol, and azofuchsin I was studied in rabbits under various conditions. It was observed that under the conditions of our experiments the urine rate was independent of the bile rate, and vice versa. The renal excretion of these dyes also was independent of their hepatic excretion except in cases in which the liver was severely damaged. On the other hand, the hepatic excretion of these dyes depended also on their renal elimination. 2. The relationship between the renal and hepatic excretion of cyanol and azofuchsin I could be expressed in the form of hyperbolas. 3. In the use of dyes as a measure of renal function, no noteworthy error is introduced by their hepatic excretion except in cases in which the liver is severely damaged.
Meta-Analysis of Survival in African American and White American Patients With Breast Cancer: Ethnicity Compared With Socioeconomic Status
Authors: Lisa A. Newman, Kent A. Griffith, Ismail Jatoi, Michael S. Simon, Joseph P. Crowe, Graham A. Colditz
Journal: Journal of Clinical Oncology (2006)

The extent to which socioeconomic disadvantages and inadequate health care access account for the disproportionately elevated mortality hazard observed in African American compared with white American patients with breast cancer is poorly defined.
Recombination Yet Inefficient Selection along the Drosophila melanogaster Subgroup's Fourth Chromosome
Authors: J. Roman Arguello, Yue Zhang, Tomoyuki Kado, Chuanzhu Fan, Ruoping Zhao, Hideki Innan, Wen Wang, Manyuan Long
Journal: Molecular Biology and Evolution (2009)

A central goal of evolutionary genetics is an understanding of the forces responsible for the observed variation, both within and between species. Theoretical and empirical work have demonstrated that genetic recombination contributes to this variation by breaking down linkage between nucleotide sites, thus allowing them to behave independently and for selective forces to act efficiently on them. The Drosophila fourth chromosome, which is believed to experience no—or very low—rates of recombination has been an important model for investigating these effects. Despite previous efforts, central questions regarding the extent of recombination and the predominant modes of selection acting on it remain open. In order to more comprehensively test hypotheses regarding recombination and its potential influence on selection along the fourth chromosome, we have resequenced regions from most of its genes from Drosophila melanogaster, D. simulans, and D. yakuba. These data, along with available outgroup sequence, demonstrate that recombination is low but significantly greater than zero for the three species. Despite there being recombination, there is strong evidence that its frequency is low enough to have rendered selection relatively inefficient. The signatures of relaxed constraint can be detected at both the level of polymorphism and divergence.
Safety and tolerability of bosentan in idiopathic pulmonary fibrosis: an open label study
Authors: A. Günther, B. Enke, P. Markart, P. Hammerl, H. Morr, J. Behr, G. Stähler, W. Seeger, F. Grimminger, I. Leconte, S. Roux, H-A. Ghofrani
Journal: European Respiratory Journal (2007)

Idiopathic pulmonary fibrosis (IPF) is a fatal disease for which no effective treatment exists. In the present study, 12 IPF patients underwent analysis of gas exchange properties using the multiple inert gas elimination technique on day 1 before and after the administration of 125 mg bosentan, a dual endothelin antagonist. Following this, patients received chronic administration for 12 weeks (62.5 mg b.i.d. in week 1, 125 mg b.i.d. thereafter). The primary objective was to determine the effect of bosentan on gas exchange (day 1) and on oxygen saturation and minute ventilation (week 2). With one exception, where redistribution of total pulmonary blood flow from normal ventilation/perfusion ( V ′/ Q ′) areas (93% before, 72% after bosentan) to low V ′/ Q ′ areas (0% before, 22.2% after) was encountered, no patient showed any change in gas exchange (mean± sd shunt flow (% of cardiac output) 8.5±3.4% before, 6.1±2.3% after bosentan; day 1) or oxygen saturation and minute ventilation (week 2). Similarly, none of the secondary parameters was significantly changed either at week 2 or at the end of the study period (week 12). Five patients developed respiratory infections and two died because of pneumonia; this was judged as being unrelated to bosentan intake. In conclusion, bosentan administration does not seem to induce clinically relevant gas exchange abnormalities in idiopathic pulmonary fibrosis patients.
B Cell–dependent T Cell Responses
Authors: Ryohei F. Tsuji, Marian Szczepanik, Ivana Kawikova, Vipin Paliwal, Regis A. Campos, Atsuko Itakura, Moe Akahira-Azuma, Nicole Baumgarth, Leonore A. Herzenberg, Philip W. Askenase
Journal: The Journal of Experimental Medicine (2002)

Contact sensitivity (CS) is a classic example of in vivo T cell immunity in which skin sensitization with reactive hapten leads to immunized T cells, which are then recruited locally to mediate antigen-specific inflammation after subsequent skin challenge. We have previously shown that T cell recruitment in CS is triggered by local activation of complement, which generates C5a that triggers C5a receptors most likely on mast cells. Here, we show that B-1 cell–derived antihapten IgM antibodies generated within 1 day (d) of immunization combine with local challenge antigen to activate complement to recruit the T cells. These findings overturn three widely accepted immune response paradigms by showing that (a) specific IgM antibodies are required to initiate CS, which is a classical model of T cell immunity thought exclusively due to T cells, (b) CS priming induces production of specific IgM antibodies within 1 d, although primary antibody responses typically begin by day 4, and (c) B-1 cells produce the 1-d IgM response to CS priming, although these cells generally are thought to be nonresponsive to antigenic stimulation. Coupled with previous evidence, our findings indicate that the elicitation of CS is initiated by rapidly formed IgM antibodies. The IgM and challenge antigen likely form local complexes that activate complement, generating C5a, leading to local vascular activation to recruit the antigen-primed effector T cells that mediate the CS response.