tbuckley/cabot-search huggingface dataset:
Treating head injuries
Authors: J. Wasserberg
Journal: BMJ (2002)

Up to 1 million people a year in the United Kingdom attend an accident and emergency department because of a head injury. Of these 90% are classified as minor (with a Glasgow coma score of 15) or mild (13 or 14), 5% as moderate (9-12), and 5% as severe (3-8).1 Road traffic accidents cause most of the severe head injuries and are likely to become the third most common cause of death and disability worldwide over the next 20 years.2 Even patients with “mild” injury (13 or 14) can suffer long term disability, with up to 47% being classed as moderately or severely disabled one year after injury.3 Magnetic resonance imaging of the brain of patients who have an initial Glasgow coma score of 13 or 14 shows a high incidence of parenchymal lesions, suggesting that even “mild” cases may sustain a significant brain injury.4 For such a major health problem, guidelines for management based on the best available evidence are essential. Although the literature on head injury might be criticised for lacking large randomised trials,5 notable improvements have been made in our management of this complex and heterogeneous condition over the past decade.

Initial assessment and triage of patients is now based …
Acquisition of carbapenemase-producing Enterobacteriaceae by healthy travellers to India, France, February 2012 to March 2013
Authors: E Ruppé, L Armand-Lefèvre, C Estellat, A El-Mniai, Y Boussadia, P H Consigny, P M Girard, D Vittecoq, O Bouchaud, G Pialoux, M Esposito-Farèse, B Coignard, J C Lucet, A Andremont, S Matheron
Journal: Eurosurveillance (2014)

Healthy travellers to countries where carbapenemases-producing Enterobacteriaceae (CPE) are endemic might be at risk for their acquisition, even without contact with the local healthcare system. Here, we report the acquisition of CPE (two OXA-181, one New Delhi metallo-beta-lactamase 1 (NDM-1)) in three healthy travellers returning from India. The duration of CPE intestinal carriage was less than one month. The results indicate that healthy travellers recently returning from India might be considered as at risk for CPE carriage.
EU waters down its plan to restrict tobacco advertising
Authors: R. Watson
Journal: BMJ (2002)

Plans to restrict tobacco advertising throughout the European Union have been severely watered down after running into fierce opposition from a small but influential group of members of the European parliament (MEPs).

After blocking the proposed legislation for 16 months, the European parliament's legal affairs committee approved a series of amendments earlier this month that remove much of the substance from the draft legislation.

It is insisting that the new rules should not cover indirect advertising (the …
Points: Urinary frequency and urgency
Authors: P J O'Boyle, G N Lumb, S Vesey, R. Maskell, R. Hole
Journal: BMJ (1987)

<b>Objective.</b> To evaluate pharmacy students9 self-assessment skills with an electronic portfolio program using mentor evaluators. <b>Design.</b> First-year (P1) and second-year (P2) pharmacy students used online portfolios that required self-assessments of specific graded class assignments. Using a rubric, faculty and alumni mentors evaluated students9 self-assessments and provided feedback. <b>Assessment.</b> Eighty-four P1 students, 74 P2 students, and 59 mentors participated in the portfolio program during 2010-2011. Both student groups performed well overall, with only a small number of resubmissions required. P1 students showed significant improvements across semesters for 2 of the self-assessment questions; P2 students9 scores did not differ significantly. The P1 scores were significantly higher than P2 scores for 3 questions during spring 2011. Mentors and students had similar levels of agreement with the extent to which students put forth their best effort on the self-assessments. <b>Conclusion.</b> An electronic portfolio using mentors based inside and outside the school provided students with many opportunities to practice their self-assessment skills. This system represents a useful method of incorporating self-assessments into the curriculum that allows for feedback to be provided to the students.
Valve function abnormalities after radiofrequency catheter ablation of left atrioventricular accessory pathway: long-term follow-up
Authors: F.E.S. Cruz, F.L. Belem, S.H. Boghossian, M. Fagundes, A. Rabischoffsky, J.C. Ribeiro, L. Vanheusden, C. Perez, R. Sa, A.I. Costa, I.G. Maia
Journal: Journal of the American College of Cardiology (1998)
CHRONIC INFLAMMATION OF THE TEAR PASSAGES.
Authors: WILLIS O. NANCE
Journal: JAMA (1900)

Lachrymal disease constitutes from 2 to 3 per cent. of all eye cases. Of 95,596 patients treated in the eye department of the Illinois Charitable Eye and Ear Infirmary between the years 1859 and 1898, 2147, or about 2.25 per cent., suffered from disturbance of the tear-conducting apparatus. Females seem more liable to be affected than do males, in the proportion of at least 2 to 1. This statement seems somewhat strange from the fact that the latter suffer much more from atmospheric exposure, undoubtedly an indirect etiological factor of considerable importance. Fuchs explains this predisposition on the part of women to the "zealous use which the female makes of the lachrymal apparatus." We find the disease occurring in all ages. C. W. Hawley<sup>1</sup>has recently reported five cases of mucocele in the new-born, and clinical experience demonstrates that infants are frequently sufferers from lachrymal disease. Any obstacle to
PUERPERAL ARTERIAL OBSTRUCTION
Authors: J. R. Bennett
Journal: BMJ (1854)

THz subject of arterial obstruction is one of such im- portance, and has of late acquired so much additional in- terest from the light which has been thrown on at least certain varieties, by Buhle, Dr. Kkes, and others, that the readers of the AssoCIATION JOURNAL must, I am sure, have perused with great interest the account given in a recent number of the very valuable communications on this sub- ject made to the Edinburgh Medico-Chirurgical Society by Professor Simpson.Any additional facts calculated to -throw further light on a subject still so obscure, ought to be recorded, and must be acceptable to the profession.I venture, therefore, briefly to detail a case which appears to fall within the category designated by Dr. Simpson as "puerperal arterial obstruction'.CASE.Eliz.Mayers, a married woman, aged 33, was ad- mitted into St.Thomas's Hospital, under my care, on the 2nd Aug. 1853.She was of small delicate frame, had had two children, and, until her last pregnancy, had enjoyed good health.For several weeks previous to her confine- ment, she had suffered from debility, dyspncea on exertion, and edema of the legs; so that she had kept her bed for a fortnight before her accouchement.She had, at this period, some pain of left side, and occasional palpitations.She had never suffered from rheumatism.Her labour took place nine weeks previous to her admis- sion, and she had " a very bad time".She did not recover 'well, and for some weeks continued very weak and ill; but, similar case which have fallen under my observation, in which the non-interfering plat was adopted.
The Debate over Physician Ownership of Health Care Facilities
Authors: John K. Iglehart
Journal: New England Journal of Medicine (1989)

America's social contract with its physicians, historically based on a binding trust reflected in the self-regulated nature of the profession, is being subjected to new questions that stem from the rapidly changing nature of medical care delivery and finance. This examination, currently focusing on the growing trend of physicians referring patients to free-standing facilities in which they hold a financial interest, is evolving on several fronts. It is raising questions that many policy makers feel uncomfortable addressing, but it is proceeding nevertheless because some consider current law and the privately crafted policies of the profession inadequate as safeguards to the . . .
Sex-related differences in callosal morphology and specific callosal connectivity: How far can we go?
Authors: Stephanie Clarke
Journal: Behavioral and Brain Sciences (1998)

The precise relationship between callosal morphology and specific connectivity is not yet known. Callosal axons are often presumed to be arranged according to their origin. In humans, this is true for the genu and the splenium, which convey axons from the prefrontal and occipital cortices, respectively, but not for the body, where axons from wide parts of the cortex are intermingled.
Impact of Progression of Diastolic Dysfunction on Mortality in Patients With Normal Ejection Fraction
Authors: Wael AlJaroudi, M. Chadi Alraies, Carmel Halley, Leonardo Rodriguez, Richard A. Grimm, James D. Thomas, Wael A. Jaber
Journal: Circulation (2012)

Diastolic dysfunction is an independent predictor of mortality in patients with normal left ventricular ejection fraction. There are limited data, however, on whether worsening of diastolic function is associated with worse prognosis.We reviewed clinical records and echocardiograms of consecutive patients who had baseline echocardiograms between January 1, 2005, and December 31, 2009, that showed left ventricular ejection fraction ≥55% and who subsequently had a follow-up echocardiogram within 6 to 24 months. Diastolic function was labeled as normal, mild, moderate, or severe dysfunction. All-cause mortality was determined by use of the Social Security Death Index. Kaplan-Meier survival analysis and Cox regression analysis with a proportional hazard model were performed to assess outcomes. A total of 1065 outpatients were identified (mean±SD age, 67.9±13.9 years; 58% male). Baseline diastolic dysfunction was present in 770 patients (72.3%), with mild being the most prevalent. On follow-up testing (mean±SD, 1.1±0.4 years), 783 patients (73%) had stable, 168 (16%) had worsening, and 114 (11%) had improved baseline diastolic function. Eighty-eight patients (8.3%) had a decrease in left ventricular ejection fraction to <55% and were more likely to have advanced diastolic dysfunction (P=0.002). After a mean±SD follow-up (from the second study) of 1.6±0.8 years, 142 patients (13%) died. On multivariate analysis, a decrease in left ventricular ejection fraction to <55% and any worsening of diastolic function were independently associated with increased risk of mortality (hazard ratio, 1.78; 95% confidence interval, 1.10-2.85; P=0.02; and hazard ratio, 1.78; 95% confidence interval, 1.21-2.59; P=0.003, respectively).In patients with normal baseline left ventricular ejection fraction, worsening of diastolic function is an independent predictor of mortality.
Evidence that TRPM8 Is an Androgen-Dependent Ca2+ Channel Required for the Survival of Prostate Cancer Cells
Authors: Lei Zhang, Gregory John Barritt
Journal: Cancer Research (2004)

The Ca(2+)-permeable channel TRPM8 is thought to play an important role in the pathophysiology of prostate cancer. We have investigated the intracellular location of TRPM8 and its role as a Ca(2+)-permeable channel in an androgen-responsive and an androgen-insensitive prostate cancer cell line. We report evidence from immunofluorescence experiments that in the androgen-responsive LNCaP cell line, the TRPM8 protein is expressed in the endoplasmic reticulum and plasma membrane, acts as a Ca(2+)-permeable channel (assessed using Fura-2 to measure increases in the cytoplasmic Ca(2+) concentration) in each of these membranes, and is regulated by androgen. Although TRPM8 was detected in the androgen-insensitive PC-3 cell line, no evidence was obtained for regulation of its expression by androgen. The results of experiments using LNCaP cells, the TRPM8 antagonist capsazepine, and small interference RNA targeted to TRPM8 indicate that TRPM8 is required for cell survival. These results indicate that TRPM8 is an important determinator of Ca(2+) homeostasis in prostate epithelial cells and may be a potential target for the action of drugs in the management of prostate cancer.
Minister rules out use of Avastin over Lucentis for wet AMD
Authors: Z. Kmietowicz
Journal: BMJ (2015)

A UK government minister has ruled that it is illegal and against the wider public interest to use the cheaper drug bevacizumab (Avastin) to treat wet age related macular degeneration (AMD) instead of the more expensive ranibizumab (Lucentis).

However, a barrister with expertise in healthcare law has criticised the ruling as “confused and illogical” and that the minister is acting outside his remit.

In February 120 clinical commissioning groups (CCGs) wrote to the General Medical Council, the Department of Health, and NHS England calling for a resolution over the impasse about whether doctors could or could not use the cheaper drug.1 The clinical leaders described the current situation as “untenable” and said that using bevacizumab instead of ranibizumab could release £102m (€140m; $150m) a …
Influence of Unrecognized Molecular Heterogeneity on Randomized Clinical Trials
Authors: Rebecca A. Betensky, David N. Louis, J. Gregory Cairncross
Journal: Journal of Clinical Oncology (2002)

PURPOSE: In solid tumor oncology, decisions regarding treatment and eligibility for trials are governed by histologic diagnosis. Despite this reliance on histology and the assumption that histology defines the disease, underlying molecular heterogeneity likely differentiates among patients’ outcomes. PATIENTS AND METHODS: To illustrate how unrecognized molecular heterogeneity might obscure a truly effective new therapy for cancer, we analyzed the planning assumptions and results of a hypothetical randomized controlled trial of chemoradiotherapy for a cancer found to be drug sensitive in preliminary phase II studies. RESULTS: Randomized controlled trials of effective cancer therapies can be falsely negative if therapeutic benefit is overestimated during study design because of enrichment of phase II trials for treatment-sensitive subtypes, a beneficial effect in responding patients is diluted by large numbers of nonresponding patients, or a beneficial effect in responders is reversed by a negative effect in nonresponders. CONCLUSION: Molecular heterogeneity, if it confers different risks to patients and is unaccounted for in the design of a randomized study, can result in a clinical trial that is underpowered and fails to detect a truly effective new therapy for cancer.
Tissue Persistence of Gentamicin in Man
Authors: Jerome J. Schentag
Journal: JAMA (1977)

A two-compartment pharmcokinetic model was used to caracterize serum concentrations and to predict tissue accumulation of gentamicin in 47 treated patients. Postmortem tissues were obtained in six cases; in each instance, tissues yielded the predicted amount of drug. Slow release of tissue-bound gentamicin accounts for its prolonged retention in the body. The two-compartment model adequately predicts gentamicin accumulation from serum concentrations and explains why this antibiotic persists in serum and urine.
What is it about the number of stitches?
Authors: R. Vijayan, G. Scott, F. Ahmed
Journal: BMJ (2015)

It is a particular peculiarity of medicine that the interrupted suture count of a wound should serve as a lay index of injury severity. Many will recognise the invariable inquiry, “How many stitches will I have, doc?” as though this irrelevancy is the ultimate determinant of injury severity and not the damage that lies beneath the gaping wound. Why are patients fixated on an issue that is so arbitrary?

A seemingly rational lay assumption is that suture count must …
Lawn Mower Injuries
Authors: William H. Salot
Journal: JAMA (1976)

<h3>To the Editor.—</h3> I noted the recent report of Ross et al (236:480, 1976) describing mutilating lawn mower injuries in children. The Fracture Service of the Children's Hospital of Michigan recently admitted two children with separate but quite similar injuries of this type. In both cases, the blades of the rotary mower seemed to skip from the groin to the medial aspect of the knee to the foot, with extensive damage at each level. In one case, the medial femoral condyle was sheared off and the patella was shattered. Both patients had partial foot amputations and extensive skin damage. Review of the skeletal injuries sustained by patients in Wilmington suggests that this pattern of injury may have been seen in several of their patients as well. The exact mechanism of the event is difficult for most patients to recall, but this pattern of injury suggests that investigation by physicians and
BCL-2 family proteins as 5-Azacytidine-sensitizing targets and determinants of response in myeloid malignancies
Authors: J M Bogenberger, S M Kornblau, W E Pierceall, R Lena, D Chow, C-X Shi, J Mantei, G Ahmann, I M Gonzales, A Choudhary, R Valdez, J Camoriano, V Fauble, R E Tiedemann, Y H Qiu, K R Coombes, M Cardone, E Braggio, H Yin, D O Azorsa, R A Mesa, A K Stewart, R Tibes
Journal: Leukemia (2014)

Synergistic molecular vulnerabilities enhancing hypomethylating agents in myeloid malignancies have remained elusive. RNA-interference drug modifier screens identified antiapoptotic BCL-2 family members as potent 5-Azacytidine-sensitizing targets. In further dissecting BCL-XL, BCL-2 and MCL-1 contribution to 5-Azacytidine activity, siRNA silencing of BCL-XL and MCL-1, but not BCL-2, exhibited variable synergy with 5-Azacytidine in vitro. The BCL-XL, BCL-2 and BCL-w inhibitor ABT-737 sensitized most cell lines more potently compared with the selective BCL-2 inhibitor ABT-199, which synergized with 5-Azacytidine mostly at higher doses. Ex vivo, ABT-737 enhanced 5-Azacytidine activity across primary AML, MDS and MPN specimens. Protein levels of BCL-XL, BCL-2 and MCL-1 in 577 AML patient samples showed overlapping expression across AML FAB subtypes and heterogeneous expression within subtypes, further supporting a concept of dual/multiple BCL-2 family member targeting consistent with RNAi and pharmacologic results. Consequently, silencing of MCL-1 and BCL-XL increased the activity of ABT-199. Functional interrogation of BCL-2 family proteins by BH3 profiling performed on patient samples significantly discriminated clinical response versus resistance to 5-Azacytidine-based therapies. On the basis of these results, we propose a clinical trial of navitoclax (clinical-grade ABT-737) combined with 5-Azacytidine in myeloid malignancies, as well as to prospectively validate BH3 profiling in predicting 5-Azacytidine response.
Risk Factors in Thyroid Replacement Treatment
Authors: Harry W. Daniell
Journal: JAMA (1974)

<h3>To the Editor.—</h3> Within the past two years I have recognized, in a general medical practice not weighted to cardiology, ten women with recurrent supraventricular tachycardia apparently due to conventional doses of replacement or supplemental thyroid hormone. This pattern of illness is of particular interest because it not only seems common and easily curable but also suggests once more that conventional doses of supplemental thyroid hormone (120 to 240 mg of desiccated thyroid hormone daily or the equivalent in liothyronine sodium or levothyroxine sodium) are hazardous, usually creating an iatrogenic hyperthyroid state that is mild enough to maintain "within normal limits" the laboratory tests most frequently used to judge the adequacy of supplemental thyroid, but intense enough to almost universally weaken bone in postmenopausal women<sup>1</sup>as well as to affect heart rhythm. Thyrotoxicosis is recognized as a cause of recurrent tachycardia. The ten women reported here were all consuming
Effect of Intensity of Oral Anticoagulation on Stroke Severity and Mortality in Atrial Fibrillation
Authors: Elaine M. Hylek, Alan S. Go, Yuchiao Chang, Nancy G. Jensvold, Lori E. Henault, Joe V. Selby, Daniel E. Singer
Journal: New England Journal of Medicine (2003)

The incidence of stroke in patients with atrial fibrillation is greatly reduced by oral anticoagulation, with the full effect seen at international normalized ratio (INR) values of 2.0 or greater. The effect of the intensity of oral anticoagulation on the severity of atrial fibrillation-related stroke is not known but is central to the choice of the target INR.We studied incident ischemic strokes in a cohort of 13,559 patients with nonvalvular atrial fibrillation. Strokes were identified through hospitalization data bases and validated on the basis of medical records, which also provided information on the use of warfarin or aspirin, the INR at admission, and coexisting illnesses. The severity of stroke was graded according to a modified Rankin scale. Thirty-day mortality was ascertained from hospitalization and mortality files.Of 596 ischemic strokes, 32 percent occurred during warfarin therapy, 27 percent during aspirin therapy, and 42 percent during neither type of therapy. Among patients who were taking warfarin, an INR of less than 2.0 at admission, as compared with an INR of 2.0 or greater, independently increased the odds of a severe stroke in a proportional-odds logistic-regression model (odds ratio, 1.9; 95 percent confidence interval, 1.1 to 3.4) across three severity categories and the risk of death within 30 days (hazard ratio, 3.4; 95 percent confidence interval, 1.1 to 10.1). An INR of 1.5 to 1.9 at admission was associated with a mortality rate similar to that for an INR of less than 1.5 (18 percent and 15 percent, respectively). The 30-day mortality rate among patients who were taking aspirin at the time of the stroke was similar to that among patients who were taking warfarin and who had an INR of less than 2.0.Among patients with nonvalvular atrial fibrillation, anticoagulation that results in an INR of 2.0 or greater reduces not only the frequency of ischemic stroke but also its severity and the risk of death from stroke. Our findings provide further evidence against the use of lower INR target levels in patients with atrial fibrillation.