tbuckley/cabot-search huggingface dataset:
Spinal injury in ankylosing spondylitis
Authors: G Stenhouse, C Ulbricht, M Khanna
Journal: BMJ (2014)

A 51 year old man attended the emergency department because of a painful neck after falling from standing height while climbing out of the bath. He slipped backwards in the bath and landed heavily on his back. He didn’t remember hitting his head. He lived alone and was previously independent, although his activities had become increasingly difficult in recent years owing to ankylosing spondylitis. The neck pain worsened during the day and he attended hospital. On initial clinical examination, he was alert and communicative. He had paravertebral soft tissue discomfort at the level of the mid-cervical spine but no midline bony tenderness. His range of neck movement was limited, although this was not unusual for him. No neurological deficits were noted and he was discharged with analgesia. 

He came back to the hospital five days later because of ongoing neck pain. Despite the seemingly innocuous injury at the time, the attending doctor recognised the greater risk of spinal injury in patients with ankylosing spondylitis and urgently requested cervical spine imaging (fig 1⇓).



Fig 1 Lateral radiograph of the cervical spine





### 1. What acute abnormality does the radiograph show?

#### Short answer

Unstable fracture dislocation at the level of C5/6 with fracture extension into the posterior elements.

#### Long answer

When reviewing a cervical spine radiograph, the C7-T1 junction should always be analysed. Alignment on a lateral film should be assessed using four anatomical lines—the anterior and posterior spinal lines, the spinolaminar and the spinous process lines (fig 2⇓). In this case they are …
Application Considered for Immunotoxin in Treatment of Graft-vs-Host Disease
Authors: Andrew Skolnick
Journal: JAMA (1991)

THE Food and Drug Administration (FDA) is considering the product license application for a monoclonal antibody—toxin conjugate for use in preventing and treating graft-vs-host disease (GvHD) in bone marrow transplant patients. This and other new agents for treating T cell mediated diseases recently were discussed at the Hoag Cancer Center's Biotherapy of Cancer Symposium in Newport Beach, Calif, and at an American Cancer Society seminar in Phoenix, Ariz. If the FDA approves the antibody— toxin conjugate (called Orthozyme CD5plus by its developer, XOMA Corp, Berkeley, Calif), it would be the first immunotoxin to be licensed for the treatment of any disease. Although the license application proposes its use for treating bone marrow transplant patients with steroid-resistant GvHD, the antibody—toxin conjugate also shows promise for treating autoimmune diseases such as rheumatoid arthritis and type I diabetes, as well as certain hematologic malignancies, says Vera S. Byers, MD, PhD, who is director
Presentation, management, and outcomes of ischaemic heart disease in women
Authors: Viola Vaccarino, Lina Badimon, Roberto Corti, Cor de Wit, Maria Dorobantu, Olivia Manfrini, Akos Koller, Axel Pries, Edina Cenko, Raffaele Bugiardini
Journal: Nature Reviews Cardiology (2013)
Primary pleural liposarcoma.
Authors: A R Evans, R J Wolstenholme, S P Shettar, H Yogish
Journal: Thorax (1985)

Primary intrathoracic liposarcoma is uncommon.Razzak et al in 1971' indicated that 44 cases had been recorded, of which 43 originated in the mediastinum and one in the pulmonary hilum.Sawamura et al in 19822 reported seven cases of primary pulmonary liposarcoma.We report a further case, which displays features suggesting that it was of pleural rather than mediastinal or pulmonary origin.Case report
S8 Rituximab Therapy For Refractory Myositis Related Interstitial Lung Disease Unresponsive To Conventional Immunosuppression: The Bristol Interstitial Lung Disease Service Experience
Authors: C. Sharp, N. Dodds, A. Edey, H. Adamali, H. Gunawardena, A. Millar
Journal: Thorax (2014)

<h3>Introduction</h3> Rituximab is a chimeric monoclonal antibody against CD20 that depletes B-lymphocytes. There is increasing evidence for its use in Scleroderma ILD.<sup>1</sup> Recently it has been reported as rescue therapy in patients with connective tissue disease related severe fibrotic lung disease who have failed conventional immunosuppression.<sup>2</sup> It remains unclear which patients are most likely to benefit from this potent immunosuppressive treatment. We review here the experience of the Bristol Interstitial Lung Disease service in use of Rituximab in a subset of patients with myositis (Anti-synthetase syndrome and Dermatomyositis). <h3>Methods</h3> We retrospectively reviewed the case notes of 10 patients with severe and progressive ILD despite immunosuppression with Cyclophosphamide and Mycophenolate Mofetil, who had received salvage treatment with Rituximab. Serial pulmonary function tests, 6 min walk distances and HRCT appearances (as assessed by a Thoracic radiologist) were compared in the year before and after Rixtuximab therapy. Changes in physiological variables compared to nadir at treatment were compared with paired-samples T-Test. <h3>Results</h3> The average age of the patients was 49.8 (range 26.9–72.99), with 7/10 female. 4 patients had dermatomyositis, while 6 had Anti-Synthetase Syndrome (2 Anti-Jo1, 2 Anti-PL12, 1 Anti-PL7, 1 Anti-PM-Scl). There were complete lung function data available for 9 patients and 6MWD data for 6 patients. CT appearances stabilised in all 9 patients with follow-up scans available, with significant improvement in 2 (1 after a second pulse of Rituximab). FVC improved after treatment by an average of 9.2% (p = 0.023, 95% CI 1.67–16.76), with TLCO improving by an average of 6.1% (NS). Figure shows% change in FVC and TLCO leading to and after therapy. 6MWD remained stable. There were no adverse events reported. <h3>Summary</h3> Our experience adds to the growing evidence to support the use of Rituximab in severe CTD-ILD, and suggests that a subset of patients with myositis may show good therapeutic response. <h3>References</h3> Daoussis <i>et al</i>.<i> Rheumatology</i>.2010;49;271–80 Keir <i>et al</i>.<i> Respirology</i> 2013;19;353–9
Hospital Discharge Algorithm Based on Admission HbA1c for the Management of Patients With Type 2 Diabetes
Authors: Guillermo E. Umpierrez, David Reyes, Dawn Smiley, Kathie Hermayer, Amna Khan, Darin E. Olson, Francisco Pasquel, Sol Jacobs, Christopher Newton, Limin Peng, Vivian Fonseca
Journal: Diabetes Care (2014)

Effective treatment algorithms are needed to guide diabetes care at hospital discharge in general medicine and surgery patients with type 2 diabetes.This was a prospective, multicenter open-label study aimed to determine the safety and efficacy of a hospital discharge algorithm based on admission HbA1c. Patients with HbA1c <7% (53.0 mmol/mol) were discharged on their preadmission diabetes therapy, HbA1c between 7 and 9% (53.0-74.9 mmol/mol) were discharged on a preadmission regimen plus glargine at 50% of hospital daily dose, and HbA1c >9% were discharged on oral antidiabetes agents (OADs) plus glargine or basal bolus regimen at 80% of inpatient dose. The primary outcome was HbA1c concentration at 12 weeks after hospital discharge.A total of 224 patients were discharged on OAD (36%), combination of OAD and glargine (27%), basal bolus (24%), glargine alone (9%), and diet (4%). The admission HbA1c was 8.7 ± 2.5% (71.6 mmol/mol) and decreased to 7.3 ± 1.5% (56 mmol/mol) at 12 weeks of follow-up (P < 0.001). The change of HbA1c from baseline at 12 weeks after discharge was -0.1 ± 0.6, -0.8 ± 1.0, and -3.2 ± 2.4 in patients with HbA1c <7%, 7-9%, and >9%, respectively (P < 0.001). Hypoglycemia (<70 mg/dL) was reported in 22% of patients discharged on OAD only, 30% on OAD plus glargine, 44% on basal bolus, and 25% on glargine alone and was similar in patients with admission HbA1c ≤7% (26%) compared with those with HbA1c >7% (31%, P = 0.54).Measurement of HbA1c on admission is beneficial in tailoring treatment regimens at discharge in general medicine and surgery patients with type 2 diabetes.
The prognostic value of cytogenetics is reinforced by the kind of induction/consolidation therapy in influencing the outcome of acute myeloid leukemia – analysis of 848 patients
Authors: G Visani, P Bernasconi, M Boni, GL Castoldi, S Ciolli, M Clavio, MC Cox, A Cuneo, G Del Poeta, D Dini, D Falzetti, R Fanin, M Gobbi, A Isidori, F Leoni, V Liso, M Malagola, G Martinelli, C Mecucci, PP Piccaluga, MC Petti, R Rondelli, D Russo, M Sessarego, G Specchia, N Testoni, G Torelli, F Mandelli, S Tura
Journal: Leukemia (2001)
Actually, making a diagnosis is quite important
Authors: K. Barraclough
Journal: BMJ (2002)

When I started in general practice it was clear that I was entering a new paradigm of medicine. It was one that required more holistic skills than the exclusively problem solving approach that I had learnt as a junior in hospital. I saw patients in their homes and came to view their illnesses in the context of their damp, inadequate housing, unhappy marriages, or lonely bereavement. I realised that there is, of course, a lot more to general practice than making a diagnosis.

Diagnostic accuracy is the Achilles' heel of general practice 

But making a diagnosis is still a pretty important first step. All the skills that are rightly revered by the Royal College of General Practitioners—listening, communication, empathy—are seriously devalued if major diagnoses are missed. And are they missed?

I have little doubt that they are. My own vicarious experiences, observing the outcome from a distance with family, friends, and colleagues who attend their GPs, have been very mixed. …
NON-ADHERENCE TO THE APPROPRIATE USE CRITERIA IMPAIRS THE PROGNOSTIC VALUE OF SPECT MYOCARDIAL PERFUSION IMAGING
Authors: Rami Doukky, Nathan Frogge, Gautam Balakrishnan, Maria Rangel, Venkata Satish Dontaraju, Kathleen Hayes-Brown
Journal: Journal of the American College of Cardiology (2013)
Enhanced type III collagen gene expression during bleomycin induced lung fibrosis.
Authors: S Shahzeidi, B Mulier, B de Crombrugghe, P K Jeffery, R J McAnulty, G J Laurent
Journal: Thorax (1993)

BACKGROUND--Intratracheal instillation of bleomycin into mice leads to deposition of collagen in the lung and fibrosis, but the mechanism for this is poorly understood. Enhanced collagen gene expression, increased collagen synthesis, decreased collagen degradation, and proliferation of fibroblasts have all been proposed as possible contributors. To obtain information on the activity of collagen producing cells at an early stage in the development of pulmonary fibrosis in situ hybridisation was used to detect and localise products of the type III procollagen gene. In addition, assay of type III procollagen gene expression was performed using dot-blot analysis of lung RNA extracts. METHODS--Lung fibrosis was induced in mice by intratracheal instillation of bleomycin sulphate (6 mg/kg body weight) and tissues were examined after three, 10, 21 and 35 days. RNA-RNA hybridisation was accomplished with riboprobes labelled with sulphur-35 which were generated from a 1.7 kb mouse procollagen a1(III) cDNA. In situ hybridisation was performed on sections fixed in paraformaldehyde and embedded in paraffin wax and steady state values of type III procollagen mRNA were assayed by dot-blot analysis of total lung RNA extracted by guanidium isothiocyanate. RESULTS--Data obtained using both techniques suggest that type III procollagen gene expression was enhanced in bleomycin induced fibrosis and that expression was maximal between 10 and 35 days after a single dose of bleomycin. The most active cells were located in interstitial areas around the conducting airways, although these cells were usually seen in areas with no histological evidence of fibrosis. Regions with the most advanced fibrosis, as assessed by histological methods, rarely contained cells with activity above the threshold detectable by this technique. CONCLUSIONS--These results suggest that activation of interstitial fibroblasts, with enhanced type III collagen gene expression, forms at least part of the mechanism leading to increased collagen deposition in bleomycin induced fibrosis and that this occurs before fibrosis is detected by conventional histological staining.
Cardiovascular Responses to Hypoxic Stimulation of the Carotid Bodies
Authors: S. Evans Downing, John P. Remensnyder, Jere H. Mitchell
Journal: Circulation Research (1962)

The hemodynamic responses to hypoxic stimulation of the carotid bodies were investigated in the dog with controlled respiration. A dual, rotating disc oxygenator system was utilized to perfuse the vascularly isolated carotid region alternately with blood of high or low pO 2 . Perfusion of the carotid bodies with hypoxic blood caused a large reduction of heart rate. The bradycardia response was reduced, but not abolished, by vagotomy. However, the subsequent administration of hexamethonium completely abolished the response. The contractility of the atrium was reduced by carotid body hypoxia, and varying degrees of heart block were frequently observed. These responses were abolished by vagotomy and considered to be due to efferent vagal activity. Ventricular function curves showed that carotid body hypoxia usually caused a reduction, never an increase, of ventricular contractility. This indicates a reduction of sympathetic discharge to the heart. The reduction in heart rate after vagotomy and the reduction in ventricular contractility were associated with a concomitant increase of total peripheral resistance. These findings indicate that hypoxic stimulation of the carotid bodies causes a dichotomous sympathetic response, that is, a reduction of sympathetic discharge to the heart and a simultaneous increase of sympathetic discharge to the peripheral vasculature. Systemic hypoxia caused an increase of both ventricular contractility and total peripheral resistance. Consequently, the hemodynamic responses to systemic hypoxia cannot be entirely ascribed to a primary chemoreceptor reflex from the carotid bodies. It is suggested that the cardiac sympathetic responses seen in systemic hypoxia are due, at least in part, to direct hypoxic stimulation of the central nervous system.
The Normal P-R Interval in Infants and Children
Authors: MARIANO M. ALIMURUNG, BENEDICT F. MASSELL
Journal: Circulation (1956)

The value of the P-R interval in the study and evaluation of treatment of rheumatic carditis, a disease predominantly of the younger ages, has prompted a re-examination of the normal P-R standards for infants and children. This study reports these data as obtained from 506 normal infants and children. The data reveal that both age and heart rate exert a significant influence on the P-R interval. The minimum, average, and maximum values are given as related to different ages and different heart rates.
Thromboembolism in Pulmonary Artery Sarcoma
Authors: Mohsen Farsad, Patrizia Pernter, Antonio Triani, Luzian Osele, Christian J. Wiedermann
Journal: Clinical Nuclear Medicine (2009)

Pulmonary artery sarcoma, although rare, must be considered in the differential diagnosis of pulmonary thromboembolism. Clinically and radiologically, it may imitate pulmonary embolism, making diagnosis difficult and delaying treatment. Patients often have no symptom resolution despite therapeutic anticoagulation. Visualization of filling defects within a pulmonary artery on contrast-enhanced CT cannot reliably differentiate between pulmonary thromboembolism and malignant lesions like leiomyosarcoma. FDG PET-CT offers the potential for identification of malignant lesions. The authors report a case with pulmonary artery thromboembolism due to thrombi formed on a pulmonary artery leiomyosarcoma. Integrated FDG PET-CT showed no FDG-uptake along the major part of the filling defect within the right main pulmonary artery suggesting blood clot and increased uptake along the posterior wall of the right main pulmonary artery and the left lower lobar artery suggesting malignancy.
SPECIFIC TREATMENT OF TYPHOID FEVER.Read in the Section of Practice of Medicine, Materia Medica and Physiology at the Forty-first Annual Meeting of the American Medical Association, held in Nashville, Tenn., May 22, 1890.
Authors: J. H. VAN EMAN
Journal: JAMA (1890)

While it might seem the subject of the treatment of typhoid fever is well worn, and that but little progress has been made in its treatment during the last decade, it is yet true that much diversity yet obtains as to its therapeutics, and its rational and specific treatment is far in the rear of both its etiology and pathology. Long before the microscopic discoveries of Koch and other investigators, the thinking members of the profession recognized the fact that there was a specific cause for typhoid fever, and many other diseases, and attempts were made at various times to make such application of drugs that the disease-producing ferment of poison might be either neutralized or destroyed in the blood, and thus cut short a disease which, under other conditions, either lasted until death ended the scene or the fire ceased to burn for want of fuel. Without any
Do TNF Inhibitors Reduce the Risk of Myocardial Infarction in Psoriasis Patients?
Authors: April W. Armstrong
Journal: JAMA (2013)

To assess whether patients with psoriasis treated with tumor necrosis factor (TNF) inhibitors have a decreased risk of myocardial infarction (MI) compared with those not treated with TNF inhibitors.Retrospective cohort study.Kaiser Permanente Southern California health plan.Patients with at least 3 International Classification of Diseases, Ninth Revision, Clinical Modification, codes for psoriasis (696.1) or psoriatic arthritis (696.0) (without antecedent MI) between January 1, 2004, and November 30, 2010.Incident MI.Of 8845 patients included, 1673 received a TNF inhibitor for at least 2 months (TNF inhibitor cohort), 2097 were TNF inhibitor naive and received other systemic agents or phototherapy (oral/phototherapy cohort), and 5075 were not treated with TNF inhibitors, other systemic therapies, or phototherapy (topical cohort). The median duration of follow-up was 4.3 years (interquartile range, 2.9, 5.5 years), and the median duration of TNF inhibitor therapy was 685 days (interquartile range, 215, 1312 days). After adjusting for MI risk factors, the TNF inhibitor cohort had a significantly lower hazard of MI compared with the topical cohort (adjusted hazard ratio, 0.50; 95% CI, 0.32-0.79). The incidence of MI in the TNF inhibitor, oral/phototherapy, and topical cohorts were 3.05, 3.85, and 6.73 per 1000 patient-years, respectively.Use of TNF inhibitors for psoriasis was associated with a significant reduction in MI risk and incident rate compared with treatment with topical agents. Use of TNF inhibitors for psoriasis was associated with a non-statistically significant lower MI incident rate compared with treatment with oral agents/phototherapy.
TETANUS FROM BLANK CARTRIDGE WOUND IN A BOY'S RIGHT HAND.
Authors: J. NOER
Journal: JAMA (1906)

<h3>History of the Case.</h3> —E. A., aged 12, was shot in the palm of the right hand by a blank cartridge June 26, 1905, and came at once to my office. I found a small wound in the palm of the right hand between the second and third metacarpal bones. The immediate area about the wound, was infiltrated with a 2 per cent. cocain solution, a free opening made in the skin, the interior thoroughly curetted, washed out freely, and saturated with tincture of iodin compound. A gauze drain was introduced and a light gauze dressing applied. June 27: Wound dressed and drain saturated with iodoform introduced. June 28: Some tumefaction on back of hand. Patient put under chloroform and a free counter opening made on back of hand and an attempt made to follow up and to clean out more thoroughly the track of injury made by the cartridge.
Exosomes – nanovesicles with possible roles in allergic inflammation
Authors: C. Admyre, E. Telemo, N. Almqvist, J. Lötvall, R. Lahesmaa, A. Scheynius, S. Gabrielsson
Journal: Allergy (2008)

Exosomes are nano‐sized membrane vesicles which are released extracellularly after fusion of multivesicular endosomes with the cell membrane. Despite their characteristic composition of proteins compared to the cell membrane, no exosome‐specific molecule has so far been characterized. Exosomes are found in bronchoalveolar lavage (BAL), urine, serum and breast milk, and are released from several cells implicated in allergy including mast cells, dendritic cells (DC), T cells and epithelial cells. Antigen‐loaded exosomes have been shown to be highly immunogenic and we propose that exosomes could be a modulating factor in allergic responses. Allergen‐presenting exosomes could transport allergen and stimulate allergen‐specific T cells, and possibly also biasing T cell responses depending on the molecules present on the exosome surface. Furthermore, exosomes from mast cells, highly active in allergic reactions, have been found to induce DC maturation and also to be able to transport functional RNA to recipient cells, suggesting a new pathway for cell communication. Reversely, tolerizing exosomes e.g. tolerosomes, from gut or breast milk, could block an allergic response or prevent allergy development. A better understanding of the role of exosomes in allergies could make us understand how allergy can be prevented or lead to the development of more efficient treatments.
Book Review When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families Edited by Marilyn J. Field and Richard E. Behrman. 690 pp. Washington, D.C., National Academies Press, 2003. $44.95. 0-309-08437-7
Authors: Kate W. Faulkner
Journal: New England Journal of Medicine (2003)
The Drugs Don't Work
Authors: L. Gleeson
Journal: BMJ (2011)

Death is a terrifying part of medicine, particularly for the junior trainee. Despite armfuls of medical terminology and the greater emphasis on emotional intelligence in modern training, nothing is more difficult to say to a patient than that the treatment isn’t working.

The indie rock band The Verve had been coasting along nicely in the alternative charts since the early 1990s. But in 1997 their single The Drugs Don’t Work crashed into the top position in the mainstream UK pop charts, bringing the band …
We could all learn from Brazil's Family Health Program
Authors: M. J. Harris
Journal: BMJ (2014)

<h3>Abstract</h3> Steroid hormones coordinate multiple aspects of behavior and physiology. The same hormone often regulates different aspects of a single behavior and its underlying neuroplasticity. This pleiotropic regulation of behavior and physiology is not well understood. Here, we investigated the orchestration by testosterone (T) of birdsong and its neural substrate, the song control system. Male canaries were castrated and received stereotaxic implants filled with T in select brain areas. Implanting T solely in the medial preoptic nucleus (POM) increased the motivation to sing, but did not enhance aspects of song quality such as acoustic structure and stereotypy. In birds implanted with T solely in HVC (proper name), a key sensorimotor region of the song control system, little or no song was observed, similar to castrates that received no T implants of any sort. However, implanting T in HVC and POM simultaneously rescued all measures of song quality. Song amplitude, though, was still lower than what was observed in birds receiving peripheral T treatment. T in POM enhanced HVC volume bilaterally, likely due to activity-dependent changes resulting from an enhanced song rate. T directly in HVC, without increasing song rate, enhanced HVC volume on the ipsilateral side only. T in HVC enhanced the incorporation and recruitment of new neurons into this nucleus, while singing activity can independently influence the incorporation of new neurons into HVC. These results have broad implications for how steroid hormones integrate across different brain regions to coordinate complex social behaviors.