tbuckley/cabot-search huggingface dataset:
Prescription fraud costs Wales 15m a year
Authors: R. Dobson
Journal: BMJ (2000)

The yield and safety of ultrasound (US)-assisted transthoracic fine needle aspirations (TTFNA) and cutting needle biopsies (CNB) in the setting of superior vena cava (SVC) syndrome are unknown. The aims of the present prospective study were to asses the diagnostic yield and safety of US-assisted TTFNA and CNB in SVC syndrome with an associated mass lesion abutting the chest wall. Over a 3-yr period, the present authors screened 59 patients with SVC syndrome, and enrolled 25 patients who had an associated mass lesion that extended to the chest wall. US-assisted TTFNA with rapid on-site evaluation (ROSE) was performed in all cases. CNBs were performed where a provisional diagnosis of bronchogenic carcinoma could not be established, and in 57.1% of patients with bronchogenic carcinoma (limited due to safety constraints). ROSE of US-assisted TTFNA confirmed diagnostically useful material in 24 patients, and cytological diagnoses were ultimately made in all of these cases (diagnostic yield 96%). US-assisted CNB had a diagnostic yield of 87.5%. Minor haemorrhage occurred in one out of 25 TTFNA and three out of 16 CNB. Neither procedure resulted in major haemorrhage nor pneumothoraces. US-assisted TTFNA and CNB have a high diagnostic yield and are safe in the setting of SVC syndrome with an associated mass lesion abutting the chest wall.
POINTS FROM LETTERS: "O for a Beaker Full"
Authors: J. A. McCluskie
Journal: BMJ (1960)

Fascia iliaca block or femoral nerve block is used frequently in hip fracture patients because of their opioid-sparing effects and reduction in opioid-related adverse effects. A recent anatomical study on hip innervation led to the identification of relevant landmarks to target the hip articular branches of femoral nerve and accessory obturator nerve. Using this information, we developed a novel ultrasound-guided approach for blockade of these articular branches to the hip, the PENG (PEricapsular Nerve Group) block. In this report, we describe the technique and its application in 5 consecutive patients.
Fulminant Respiratory Failure
Authors: Thomas P. Howard
Journal: JAMA (1979)

THE CAUSE of the adult respiratory distress syndrome (ARDS) remains unknown, but a variety of clinical entities are associated with it. Usually, only supportive treatment is recommended, with prevention of tissue hypoxia the primary goal, but it is important to be aware of all specific diseases that may lead to ARDS so that therapy can be individualized rather than just supportive. <h3>Report of a Case</h3> A 34-year-old woman was admitted to Tampa (Fla) General Hospital in August 1978 with a five-day history of nausea, intermittent fever, and vaginal bleeding. She was taking no medications and her only previous hospitalizations were for uncomplicated childbirth. Physical examination revealed an obese, afebrile woman with a respiratory rate of 14/min. She was confused and uncooperative. Her fundi were normal, and her conjunctiva were pale and icteric. The neck was supple. Examination of the heart and lungs showed normal findings. Vaginal wall petechiae were seen,
LIGHT Delivery to Tumors by Mesenchymal Stem Cells Mobilizes an Effective Antitumor Immune Response
Authors: Weibin Zou, Huilin Zheng, Tong-Chuan He, Jinjia Chang, Yang-Xin Fu, Weimin Fan
Journal: Cancer Research (2012)

Bone marrow-derived mesenchymal stem cells (MSC) have been shown to home into tumor tissues, where they promote tumor growth and suppress immune rejection. In this study, we tested whether MSCs engineered to express the immune stimulating factor LIGHT, a member of the TNF superfamily, could induce tumor regression. Using in vitro and in vivo migration assays, we found that LIGHT-expressing MSCs (MSC-L) displayed a strong tropism for tumor tissues. MSC-L treatment activated the LIGHT-signaling pathway, effectively organizing a potent antitumor immune response that stimulated an influx of T cells and inhibited tumor growth in vivo. CD4 T cells were found to play a role in the induction phase of the immune response, and CD8 T cells were shown to be essential for the effector phase. Together, our findings indicate that MSCs can effectively home into and deliver immune stimulating molecules to tumor tissues, thereby reversing the immune-suppressive environment, promoting antitumor immunity, and inhibiting tumor growth.
Tumor necrosis factor α promoter polymorphisms influence the phenotypic expression of hereditary hemochromatosis
Authors: Silvia Fargion, Luca Valenti, Paola Dongiovanni, Anna Scaccabarozzi, Anna Ludovica Fracanzani, Emanuela Taioli, Michela Mattioli, Maurizio Sampietro, Gemino Fiorelli
Journal: Blood (2001)
National service framework for coronary heart disease: audit of English hospitals
Authors: M. Rhodes
Journal: BMJ (2002)

The national service framework for coronary heart disease gives priority to reducing delays in the delivery of thrombolysis for acute myocardial infarction, aiming to achieve a "call to needle time" (from the initial call for help to treatment) of 60 minutes and a "door to needle time" (from arrival at the hospital to treatment) of 20 minutes or less by April 2003. 1 We audited the delivery of thrombolysis in all acute hospitals in England.
Command invariants and the frame of reference for human movement
Authors: David J. Ostry, Rafael Laboissière, Paul L. Gribble
Journal: Behavioral and Brain Sciences (1995)

Abstract We describe a solution to the redundancy problem related to that proposed in Feldman &amp; Levin's target article. We suggest that the system may use a fixed mapping between commands organized at the level of degrees of freedom and commands to individual muscles. This proposal eliminates the need to maintain an explicit representation of musculoskeletalgeometry in planning movements.
Effect of hydrogen peroxide exposure on normal human erythrocyte deformability, morphology, surface characteristics, and spectrin-hemoglobin cross-linking.
Authors: L M Snyder, N L Fortier, J Trainor, J Jacobs, L Leb, B Lubin, D Chiu, S Shohet, N Mohandas
Journal: Journal of Clinical Investigation (1985)

To further define the conditions for forming spectrin-hemoglobin cross-linking in human erythrocyte membranes and to examine its possible effects on membrane function, we incubated normal human erythrocytes for up to 3 h in concentrations of H2O2, varying from 45 to 180 microM, in an azide phosphate buffer, pH 7.4. The chemical changes observed indicated that methemoglobin formation occurred early and at a low concentration (45 microM). Morphologic changes characterized by increased echinocyte formation occurred in a dose-dependent fashion. In addition, decreased cell deformability commensurate with increased membrane rigidity was found. Finally, an increase in cell recognition as determined by monocyte phagocytosis and adherence in vitro, as well as decreased phosphatidylcholine accessibility to bee venom phospholipase A2, was found in H2O2-treated erythrocytes compared with controls. Both of these latter changes were closely correlated with the extent of spectrin-hemoglobin cross-linking. In addition to these protein-mediated interactions, lipid peroxidation also occurred after H2O2 exposure, as shown by generation of fluorescent amino propene derivatives. The addition of the antioxidant, butylated hydroxytoluene, decreased the fluorescent derivatives, but did not prevent the effects on membrane function. This suggests that lipid peroxidation, though present, was not necessary for the membrane changes found. In contrast, spectrin-hemoglobin aggregation and the alterations in membrane function were completely prevented by prior exposure of the erythrocytes to carbon monoxide.
Slowing the Deterioration of Asthma and Chronic Obstructive Pulmonary Disease Observed during Bronchodilator Therapy by Adding Inhaled Corticosteroids: A 4-Year Prospective Study
Authors: Edward Dompeling
Journal: Annals of Internal Medicine (1993)

To determine if deterioration in patients with asthma or chronic obstructive pulmonary disease (COPD) during bronchodilator therapy could be slowed by additional treatment with an inhaled corticosteroid.A 4-year prospective study.Twenty-nine general practices in the catchment area of the University of Nijmegen, Nijmegen, the Netherlands.The study included 56 patients (28 with asthma and 28 with COPD) who showed an annual decrease in the forced expiratory volume in 1 second (FEV1) of at least 80 mL in combination with at least two exacerbations per year during bronchodilator therapy alone. Forty-eight patients completed the study.During the first 2 years of treatment, patients received only bronchodilator therapy (salbutamol, 400 micrograms, or ipratropium bromide, 40 micrograms). During years 3 and 4, they received additional treatment with beclomethasone dipropionate, 400 micrograms two times daily.Prebronchodilator FEV1 increased 458 mL/y (95% CI, 233 to 683 mL/y) during the first 6 months of beclomethasone treatment; FEV1 then decreased 102 mL/y (CI, 57 to 147 mL/y) during months 7 to 24. The annual decline in FEV1 during beclomethasone treatment was less than the decline of 160 mL/y seen before beclomethasone therapy (difference, 58 mL/y; 95% CI, 2 to 87 mL/y). Only in patients with asthma did beclomethasone treatment improve bronchial hyperresponsiveness (assessed by determining the concentration of histamine that provoked a 20% decrease in FEV1 [PC20]) by 3.0 doubling doses per year (95% CI, 0.8 to 5.2 doses per year). Beclomethasone treatment was associated with improvement in peak expiratory flow rate, alleviation of symptoms, and a decrease in the number of exacerbations in both patient groups.Adding beclomethasone, 800 micrograms daily, slowed the unfavorable course of asthma or COPD seen with bronchodilator therapy alone. This effect was most evident in asthmatic patients.
Analysis of Abnormal Intra-QRS Potentials
Authors: Paul Lander, Pedro Gomis, Rajiva Goyal, Edward J. Berbari, Pere Caminal, Ralph Lazzara, Jonathan S. Steinberg
Journal: Circulation (1997)

Background Using the signal-averaged ECG (SAECG), this study developed a new electrical index for predicting arrhythmic events: abnormal intra-QRS potentials (AIQP). Methods and Results We studied 173 patients followed after myocardial infarction for a mean duration of 14±7 months. Sixteen arrhythmic events occurred, defined as sudden cardiac death, documented sustained ventricular tachycardia, or nonfatal cardiac arrest. Noninvasive indices of arrhythmia risk were measured, including AIQP, conventional SAECG, Holter, and left ventricular ejection fraction (LVEF). Abnormal intra-QRS potentials were defined as abnormal signals occurring anywhere within the QRS period. They were estimated with a lead-specific, parametric modeling method that removed the smooth, predictable part of the QRS. AIQPs are characterized by the remaining transient, unpredictable component of the QRS and manifest as low-amplitude notches and slurs. A combined XYZ-lead AIQP index exhibited higher specificity (95%) and predictive value (PV) (+PV, 47%; −PV, 94%) than the conventional SAECG in combination with Holter and LVEF (specificity, 89%; +PV, 25%; −PV, 93%). Conclusions AIQP improved specificity and predictive value, compared with conventional tests, for prediction of arrhythmic events. AIQP emerged as the best noninvasive univariate predictor of arrhythmic events after myocardial infarction in this study. A review of several other reports shows that AIQP in the present study outperformed the conventional predictive indices reported in those other data sets.
Recurrent hyperinfestation with Strongyloides stercoralis in a renal allograft recipient.
Authors: C G Fowler, I Lindsay, J Levin, P Sweny, O N Fernando, J F Moorhead
Journal: BMJ (1982)

germination of dormant spores.Radiation may possibly have damaged the microvasculature in the area of the plate by electron scatter.Postmortem studies showed radiation-induced pneumonitis.Sufficient reduction in the oxygen tension may have occurred to prejudice oxygenation of the tissues around the plate before clinical hypoxia was recognised.Prolonged immunosuppression is seen after bone-marrow transplantation, and cyclosporin A may have prevented an immune response by donor lymphocytes.With the increasing use of highly immunosuppressive regimens for allogeneic and autologous marrow transplantation we suggest that such complications may be seen more frequently.In retrospect, careful attention to the patient's history and the use of prophylactic penicillin and passive immunisation might have been beneficial.
Job sharing as a preregistration house officer
Authors: Eleanor Draeger, Daphne Hazell, Adrian Steger
Journal: BMJ (2002)

Feeling daunted at the thought of working in a demanding PRHO post? Eleanor Draeger and Daphne Hazell share their experiences of a job share and give some advice about how you can do the same. Their consultant, Adrian Steger, gives his views and encourages other consultants to consider the benefits of having two house officers instead of one

Flexible training has come a long way and is no longer set up only for women with children. There are now some well recognised schemes for flexible trainees at senior house officer (SHO) and specialist registrar (SpR) level, but still not many opportunities for preregistration house officers (PRHOs). We have nearly got to the end of our preregistration year, which we have carried out entirely as a job share, and firmly believe that it is an excellent way to start junior doctor training. Throughout our time as house officers, our colleagues have been fascinated by the idea of part time training. A large proportion of them have expressed an interest in training flexibly at some point and wanted to know how to go about it. While at medical school, neither of us realised that we could job share as PRHOs. We were fortunate to have the help of our undergraduate dean in organising our jobs. We hope that this article will help others who may want to do the same.

### Flexible training as a PRHO

Approximately 30 junior doctors have trained flexibly (part time) in the London deanery during the past five years. The procedure for setting up a flexible PRHO post is as follows:

1.  Obtain approval from the relevant associate dean for flexible training that you are eligible--that is, have a good reason. Reasons include childcare requirements, personal illness, or caring for a sick relative which means that you cannot train full time. A small number …
Gene expression profiling in the leukemic stem cell-enriched CD34+ fraction identifies target genes that predict prognosis in normal karyotype AML
Authors: H J M de Jonge, C M Woolthuis, A Z Vos, A Mulder, E van den Berg, P M Kluin, K van der Weide, E S J M de Bont, G Huls, E Vellenga, J J Schuringa
Journal: Leukemia (2011)
Transient Paraplegia From Hematoma After Lumbar Puncture
Authors: Henry D. Messer
Journal: JAMA (1976)

EXCEPT for some danger of uncal herniation in patients with increased intracranial pressure and of deterioration in patients with paraparesis, little risk is generally ascribed to lumbar puncture. Lumbar puncture From the Neurosurgery Service, Department of Surgery (Drs Messer, Forshan, and Hughes), and the Department of Neurology (Dr Brust), Harlem Hospital Center, and the departments of neurosurgery (Drs Messer and Hughes) and neurology (Dr Brust), Columbia University College of Physicians and Surgeons, New York. Reprint requests to 22 Charles St, New York, NY 10014 (Dr Messer). can initiate a train of serious events in a patient receiving anticoagulants, as illustrated in this report. <h3>Report of a Case</h3> A 51-year-old woman with rheumatic heart disease had had a presumed cerebral embolus with right hemiparesis in March 1973. Two months later, she underwent mitral comissurotomy. In September 1973, she had an episode of dysarthria and confusion lasting several
Long‐term effect of splenectomy on transfusion requirements in thalassemia major
Authors: Alan Cohen, Robin Gayer, Jeannie Mizanin
Journal: American Journal of Hematology (1989)

Abstract Splenectomy reduces transfusion requirements in the first year after surgery in patients with thalassemia major and hypersplenism. To determine whether this response is maintained, we have studied transfusion requirements in 16 patients with thalassemia major for 2–17 years after splenectomy. Transfusion requirements remained stable (mean yearly change ‐0.1%) after the predictable fall in the first year after surgery. The mean change between the first postoperative year and the most recent year was ‐7 ml/kg. Transfusion requirements and the magnitude of change from year to year were unrelated to the time since splenectomy. These studies indicate that the effect of splenectomy on transfusion requirements is long‐lasting and that large variations in annual transfusion requirements after splenectomy should prompt a search for accessory spleens or other causes of red cell destruction.
116 Serum phosphate as a predictor of clinical outcome in acetaminophen-induced acute liver failure
Authors: T DAVERNII, R BROWNJR, A SHAKIL, R STRAVITZ, J POLSON, E LALANI, W LEE
Journal: Hepatology (2003)

Simvastatin (SIM), a HMG-CoA reductase inhibitor, has therapeutic effects that are not limited to cholesterol reduction. In this study, we investigated the change in the cell surface area and protein content of cultured rat cardiomyocytes on exposure to cardiotrophin-1 (CT-1), a cytokine involved in the growth and survival of cardiac cells, plus SIM, and thus confirmed that SIM ameliorated cardiomyocyte hypertrophy induced by CT-1. We also showed that SIM attenuated cardiac hypertrophy in rats with pressure overload due to abdominal aortic constriction by measuring such parameters as systolic blood pressure, ratio of heart weight to body weight and ratio of left ventricular weight to body weight in rats as well as cross-sectional area of cardiomyocytes. Western blot analysis indicated that the Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway was involved in the mechanisms underlying the in vitro and in vivo inhibitory effects of SIM on cardiac hypertrophy. Moreover, the effect of SIM amelioration on CT-1-induced cultured cardiomyocyte hypertrophy might be related to the change in angiotensinogen (AGT) mRNA expression, as evidenced by RT-PCR analysis, and the subsequent alteration in angiotensin II (Ang II) levels. The results of our study provide further evidence that SIM, like other HMG-CoA reductase inhibitors, is a promising drug for prevention and treatment of cardiac hypertrophy.
Essential role of NKT cells producing IL-4 and IL-13 in the development of allergen-induced airway hyperreactivity
Authors: Omid Akbari, Philippe Stock, Everett Meyer, Mitchell Kronenberg, Stephane Sidobre, Toshinori Nakayama, Masaru Taniguchi, Michael J. Grusby, Rosemarie H. DeKruyff, Dale T. Umetsu
Journal: Nature Medicine (2003)
Quantitation of tumour development correlates with prognosis in tumour stage (stage IIB) mycosis fungoides
Authors: S.E. Boonk, H. Putter, L. Koolhof, R. Willemze, M.H. Vermeer
Journal: British Journal of Dermatology (2013)

Patients with mycosis fungoides (MF) tumour stage IIB disease show considerable variation in the number of tumours and time interval between each tumour occasion. To quantify the extent of tumour formation in patients with stage IIB MF and correlation with survival. The variability in tumour development of 46 patients with stage IIB MF was quantified by calculating a frailty score with the use of a statistical frailty model, based on both the number of tumours developed during follow‐up and the time interval between each tumour occasion. The prognostic value of the frailty scores and the number of tumours at 6 and 12 months after first tumour development were studied. Frailty scores varied between 0·05 and 6·94. Patients with high frailties (> 1·0, n =14) had the worst disease‐specific survival (DSS) and overall survival (OS), compared with patients in the low frailty group (0–0·35, n =17) and medium frailty group (0·35–1·0, n =15). Differences in DSS and OS between the three frailty groups were highly significant (both P <0·001). The number of tumours that developed within 6 months after the diagnosis of MF stage IIB was prognostic for subsequent DSS and OS (P <0·001 and P =0·021, respectively). The number of tumours and time interval between tumour formation differs greatly among patients with stage IIB MF and these differences correlate with survival. Patients with an adverse prognosis can be identified by quantifying the number of tumours that develop within 6 months after diagnosis of MF stage IIB.
A Question Well Put
Authors: Brendan M. Reilly, Peter D. Hart, Susana Mascarell, Hemant Chatrath
Journal: New England Journal of Medicine (2009)

A 51-year-old woman with a history of hypertension and depression reported progressively worsening pain in the left thigh over a period of several months, which had made her unable to walk for the past week. She also described generalized weakness and pains in her lower back, arms, and chest. She reported no weight loss, anorexia, trauma, or fever.
Private Practice by Residents in Training
Authors: David A. Boyd
Journal: JAMA (1967)

Private practice for fee by residents, in either general or specialty areas, has been called colloquially "moonlighting." My attention was drawn to this by observation that it appeared to be quite extensive in some localities. Some residency training programs were on a 40-hour week, and the trainee used much of the remaining time in private practice. To my knowledge, one enterprising resident established a flourishing clinic and employed ancillary personnel. To ascertain the extent of such practices, a survey of all specialty boards was undertaken. A large majority of the boards reported that this was not a problem in their field as far as they knew. Only four of those responding stated that they had a definite policy prohibiting such practice. The remainder indicated that they had no policy regarding this, many stating that although it had never been discussed, it was a personal opinion of the writer that such
Advance advance directives
Authors: D. Spence
Journal: BMJ (2011)

“Fight, fight, fight!” The children thronged around the two kids wrestling each other. It was a school spectacle, before children spent their lives on Facebook. It was generally the same people—“trouble makers”—crazed guys that you never made eye contact with. But sometimes you have to fight, to save your honour, to protect your friends, to do the right thing. And so it is with the BMJ : fighting generally breaks out in the rapid responses; everyone enjoys the spectacle; it’s what people pay their subscriptions for. I don’t mind fighting, especially among polite, …
Screening tests and indices of performance: effects of prevalence
Authors: P. Sedgwick
Journal: BMJ (2011)

The accuracy of a screening test for depression was evaluated in primary care. The screening test involved asking patients two questions about depression and pleasure in the previous month. In total, 421 consecutive general practice patients who weren’t taking psychotropic drugs agreed to participate. The two questions were asked at any time during the patient’s consultation. If the patient responded positively to either question, the screening test result was deemed “positive” and the patient at “high risk” of depression—otherwise, screening was considered “negative” and the patient at “low risk” of depression. A self completed, computerised international diagnostic interview was used to diagnose depression. The table⇓ shows the results of the depression screening test in relation to the clinical diagnostic interview. 1

View this table:

Comparison of results of screening test for depression with clinical diagnosis



As a screening test for depression, the two questions showed a sensitivity of 96.6%, a specificity of 67.1%, a positive predictive value of 17.8%, and a negative predictive value of 99.6%. The sample estimate of the population prevalence of depression was 6.9%.

If the screening test …