tbuckley/cabot-search huggingface dataset:
Science, Statistics, and Deception
Authors: PATRICK A. HESSEL
Journal: Annals of Internal Medicine (1986)

Letters and Corrections1 December 1986Science, Statistics, and DeceptionPATRICK A. HESSEL, Ph.D.PATRICK A. HESSEL, Ph.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-105-6-974_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Dr. Bailar (1) makes an important distinction between a priori and post hoc tests of hypotheses, stating that probability statements are only valid when hypotheses are "fully developed before the data are examined in any way." Although this distinction is extremely important, there is another kind of test that is very commonly done but does not easily fit into one of these two categories.In many instances during the analysis of a study, a significant or nonsignificant result appears, whether expected or unexpected, whether suggested by the data or not. During deliberations about the real significance of...Reference1. BAILAR J. Science, statistics, and deception. Ann Intern Med. 1986;104:259-60. LinkGoogle Scholar1. BAILARMOSTELLER JF. Medical Uses of Statistics. Boston: NEJM Books; 1986:269. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: PATRICK A. HESSEL, Ph.D.Affiliations: Office of the Medical Bureau for Occupational Diseases Republic of South Africa; Johannesburg 2000 South Africa PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 1986Volume 105, Issue 6Page: 974-974KeywordsDeceptionStatistical data ePublished: 1 December 2008 Issue Published: 1 December 1986 PDF downloadLoading ...
Erroneous Reporting of Errors
Authors: William D. Clark
Journal: JAMA (1984)

<h3>To the Editor.—</h3> In a recent letter,<sup>1</sup>the roles of the physicians attending Frederick III were presented in a maneuver that seems not entirely supported by sources closest to the issues and events themselves. In discussing Virchow's role in the treatment of Frederick III, emperor of the German Republic, Dr deR Kolisch states that "British surgeons" diagnosed the Crown Prince's laryngeal lesion as cancer, while Virchow "booted the diagnosis." In point of fact, it was the German surgeons who made this diagnosis and proposed surgical treatment for the lesion. The German royal family, no doubt influenced by their relatives among the British royalty, obtained an independent opinion from Morell Mackenzie, a British laryngologist. It was Mackenzie, not the Germans, who suggested that the disease was more likely benign. Mackenzie nevertheless performed a biopsy of the lesion, and, according to Virchow, these tissue specimens did not support a diagnosis of
Endogenous adenosine mediates coronary vasodilation during exercise after K(ATP)+ channel blockade.
Authors: D J Duncker, N S van Zon, T J Pavek, S K Herrlinger, R J Bache
Journal: Journal of Clinical Investigation (1995)

The mechanism of coronary vasodilation produced by exercise is not understood completely. Recently, we reported that blockade of vascular smooth muscle K(ATP)+ channels decreased coronary blood flow at rest, but did not attenuate the increments in coronary flow produced by exercise. Adenosine is not mandatory for maintaining basal coronary flow, or the increase in flow produced by exercise during normal arterial inflow, but does contribute to coronary vasodilation in hypoperfused myocardium. Therefore, we investigated whether adenosine opposed the hypoperfusion produced by K(ATP)+ channel blockade, thereby contributing to coronary vasodilation during exercise. 11 dogs were studied at rest and during exercise under control conditions, during intracoronary infusion of the K(ATP)+ channel blocker glibenclamide (50 micrograms/kg per min), and during intracoronary glibenclamide in the presence of adenosine receptor blockade. Glibenclamide decreased resting coronary blood flow from 45 +/- 5 to 35 +/- 4 ml/min (P < 0.05), but did not prevent exercise-induced increases of coronary flow. Glibenclamide caused an increase in myocardial oxygen extraction at the highest level of exercise with a decrease in coronary venous oxygen tension from 15.5 +/- 0.7 to 13.6 +/- 0.8 mmHg (P < 0.05). The addition of the adenosine receptor antagonist 8-phenyltheophylline (5 mg/kg intravenous) to K(ATP)+ channel blockade did not further decrease resting coronary blood flow but did attenuate the increase in coronary flow produced by exercise. This was accompanied by a further decrease of coronary venous oxygen tension to 10.1 +/- 0.7 mmHg (P < 0.05), indicating aggravation of the mismatch between oxygen demand and supply. These findings are compatible with the hypothesis that K+ATP channels modulate coronary vasomotor tone both under resting conditions and during exercise. However, when K(ATP)+ channels are blocked, adenosine released from the hypoperfused myocardium provides an alternate mechanism to mediate coronary vasodilation in response to increases in oxygen demand produced by exercise.
Notes towards the History of the Medical Staff of the English Army Prior to the Accession of the Tudors
Authors: W. R. E. Smart
Journal: BMJ (1873)

taminated it.Local causes, principally congestive inflammation, deter- mined these deposits in the lungs; but they might take place anywhere in the body, especially in glandular structures.They tended to excite inflammatory changes in the tissues round about them, which became ulcerated, and so allowed their elimination.According to more modern theories, true tubercle-the tiny adenoid lymphatic gland-like growth which spreads and multiplies in its peri- phery-is most often, if not quite always, a secondary feature in the lungs ; it springs up only where connective tissue extends, and is found, therefore, most frequently and most easily, upon the pleura and in the interlobar and interlobular tissues.Any product of inflammation, pent-up pus, or tissue undergoing necrobiosis-death in a living coffin -may excite the formation of tubercle in persons constitutionally predisposed towards it.But most modern pathologists affirm that the solidification of the lungs which constitutes ordinary phthisis is not the tubercle-growth at all, or only secondarily so, but an infarction of the air-cells individually, or to the sum of lobules or lobes with cellular products of inflammation.These pneumonic solidifications differ very little, if at all, in micro- scopical features, from those of ordinary catarrhal pneumonia, but ex- hibit less capacity for being reabsorbed after an uncertain and doubtless varying lapse of time, during which they act detrimentally, partly by the pressure upon the tissues about them, and partly as plugs excluding air and so obstructing the capillary circulation.They degenerate, soften, and break down, in consequence of inflammatory or softening changes which they have excited round about them.
Health promotion in general practice. Room for improvement in data collection.
Authors: A Wilson, T Dowell, C Pollock, T Weekes
Journal: BMJ (1993)

statistical theory5 and the possibility of neatly partitioning attitudes and behaviours.The (predictable) conclusion that we need to "educate the people" on the dangers of a high fat diet plainly conflicts with a more striking feature of the results-namely, that the degree to which people thought that their behaviours were risky seems to reflect the degree of certainty among experts that change in that behaviour is beneficial.Why should the authors emphasise the need for education when experts disagreee?This paper, like others, suggests that the public may often be more sophisticated in their understanding than those who would pretend to educate them.
Adrenal Function Ablation Utilizing the Angiographic Catheter
Authors: James W. Lecky
Journal: JAMA (1971)

<h3>To the Editor.—</h3> Surgical adrenalectomy is an established procedure for arresting metastatic carcinoma of the breast and, to a lesser extent, metastatic carcinoma of the prostate. The surgical mortality varies from 1% to 5%, and there is a significant operative morbidity as well. In addition to these published series, there are patients who are unable to undergo adrenalectomy because of some other adverse physical condition which may or may not be related to the extensiveness of their carcinoma. At present, adrenal venography has an intraglandular complication rate of 1% to 5%. Most of these instances of intraglandular hemorrhage are not clinically significant, but there are some reported cases of adrenal hypofunction or complete destruction or both following adrenal venography. An extension of this occurrence would be the purposeful extravasation of iodized contrast material or other liquid into the parenchyma of the gland using the transvenous route, with the idea that,
Induction Therapy Does Not Improve Survival for Clinical Stage T2N0 Esophageal Cancer
Authors: Paul J. Speicher, Asvin M. Ganapathi, Brian R. Englum, Matthew G. Hartwig, Mark W. Onaitis, Thomas A. D’Amico, Mark F. Berry
Journal: Journal of Thoracic Oncology (2014)

This study compared survival after initial treatment with esophagectomy as primary therapy to induction therapy followed by esophagectomy for patients with clinical T2N0 (cT2N0) esophageal cancer in the National Cancer Database (NCDB).Predictors of therapy selection for patients with cT2N0 esophageal cancer in the NCDB from 1998 to 2011 were identified with multivariable logistic regression. Survival was evaluated using Kaplan-Meier and Cox proportional hazards methods.Surgery was used in 42.9% (2057 of 4799) of cT2N0 patients. Of 1599 esophagectomy patients for whom treatment timing was recorded, induction therapy was used in 44.1% (688). Pretreatment staging was proven accurate in only 26.7% of patients (210 of 786) who underwent initial surgery without induction treatment and had complete pathologic data available: 41.6% (n = 327) were upstaged and 31.7% (n = 249) were downstaged. Adjuvant therapy (chemotherapy or radiation therapy) was given to 50.2% of patients treated initially with surgery who were found after resection to have nodal disease. There was no significant difference in long-term survival between strategies of primary surgery and induction therapy followed by surgery (median 41.1 versus 41.9 months, p = 0.51). In multivariable analysis, induction therapy was not independently associated with risk of death (hazard ratio [HR], 1.16, p = 0.32).Current clinical staging for early-stage esophageal cancer is highly inaccurate, with only a quarter of surgically resected cT2N0 patients found to have had accurate pretreatment staging. Induction therapy for patients with cT2N0 esophageal cancer in the NCDB is not associated with improved survival.
A man with hypophosphataemia
Authors: J. K. Y. Lam, C. W. Lam, A. W. C. Kung, K. C. B. Tan, K. S. Lau, K. S. L. Lam
Journal: BMJ (2011)

A 76 year old man was referred with hypophosphataemia. He had a history of hypertension and gout. He presented with a six month history of generalised bone pain and lower limb weakness. Examination showed weak hip flexion and extension (power 4/5). Complete blood count, serum glucose, and kidney function tests were normal. Serum calcium was 2.33 mmol/L (normal 2.10-2.60), serum phosphate was 0.49 mmol/L (0.8-1.4), and alkaline phosphatase was 204 U/L (47-124). He had no family history of hypophosphataemia or bone disorders.

Parathyroid hormone (PTH) was within the normal range (53 ng/L; normal 11-54). Serum calcidiol was low at 38 nmol/L (50-250), and serum calcitriol was also low at 26.8 pmol/L (65.3-171.9). Maximal tubular reabsorption of phosphate was 0.44-0.49 mmol/L (0.9-1.35). A skeletal survey (radiographs including posteroanterior view of the chest; anteroposterior and lateral views of the whole spine, humeruses, and femora; anteroposterior and lateral views of the skull; and anteroposterior view of the pelvis) showed no evidence of fracture or lytic lesion. Technetium-99m-methylene diphosphonate bone scintigraphy showed multiple hot spots over rib cage, involving the costochondral and costovertebral junctions. He was treated with phosphate 500 mg twice daily and calcitriol 0.25 µg daily.



### 1 What is the most likely diagnosis?

#### Short answer

The patient has tumour induced osteomalacia, with coexisting vitamin D insufficiency.

#### Long answer

### 1 Tumour induced osteomalacia

Tumour induced osteomalacia, or oncogenic osteomalacia, is a rare acquired metabolic disorder of renal phosphate wasting and hypophosphataemia. Mesenchymal tumours in osteomalacia were first recognised to cause osteomalacia in 1959,1 and more than 120 cases of tumour induced osteomalacia have been reported since then. It is the only paraneoplastic syndrome that affects mineral metabolism and the skeleton.

Patients with tumour induced osteomalacia …
Detection of Antilymphocyte Antibody with Two-Color Method in Systemic Lupus Erythematosus and Its Heterogeneous Specificities against Human T-Cell Subsets
Authors: Kunio Okudaira, Hidenori Nakai, Tetsuo Hayakawa, Takamichi Kashiwado, Kiyoaki Tanimoto, Yoshihiko Horiuchi, Takeo Juji
Journal: Journal of Clinical Investigation (1979)

The two-color method originally described by Van Rood et al. (Van Rood, J. J., A. Van Leeuwen, and J. S. Ploen. 1976. Simultaneous detection of two cell populations by two-color fluorescence and application to the recognition of B-cell determinants. Nature (Lond.). 262: 795-797) for the typing of homologous leukocytic antibodies, D-region was used for the detection of antilymphocyte antibody (ALA) in systemic lupus erythematosus. In this method, surface immunoglobulin-bearing cells were identified with fluorescein isothiocyanate-labeled anti-immunoglobulin and nuclei of killed cells were stained with ethidium bromide. Therefore, cell type (T or B) of the target cells can be identified without fractionating them. ALA was detected in 87% of lupus sera and had a preferential reactivity with T cells. Its major immunoglobulin class was shown to be immunoglobulin (Ig)M. The subspecificity of ALA was further analyzed using fractionated T-cell subsets as target cells. When T lymphocytes were separated into Fc receptor-bearing (Tgamma) and lacking (Tgamma[-]) cells, 64% of ALA showed preferential reactivity with Tgamma cells and 14% with Tgamma(-) cells. The remainder had no selective reactivity against Tgamma or Tgamma(-) cells. Tgamma cells were shown to have suppressor activity, whereas Tgamma(-) cells were indicated to contain helper cells. The above finding was in agreement with the observation that treatment of T cells with ALA that preferentially react with Tgamma cells considerably enhanced immunoglobulin synthesis in vitro, whereas treatment of T cells with ALA reactive with Tgamma(-) cells clearly suppressed the formation of immunoglobulins. Treatment of ALA with no selective reactivity showed variable effects on in vitro immunoglobulin synthesis. These results indicate that ALA in lupus have heterogeneous specificities against human T-cell subsets.
Woman with bipolar disorder can abort her baby, judge rules
Authors: C. Dyer
Journal: BMJ (2013)

An 80-year-old Caucasian man presented with an incidental and asymptomatic lesion in his right ear thought to be secondary to his use of hearing aids for presbycusis. He used Lyric hearing aids, designed for 24 hours-a-day use for 4 months at a time and had no other previous otological problems. He underwent a bony meatoplasty and vascular flap reconstruction via a retroauricular approach to remove the lesion for histological analysis and regrafting of the area. The lesion was confirmed on histopathology as an ear canal cholesteatoma.
Comparison of Diets of Diabetic and Nondiabetic Women
Authors: Tomoko Shimakawa, MG Herrera-Acena, Graham A Colditz, JoAnn E Manson, Meir J Stamper, Walter C Willett
Journal: Diabetes Care (1993)

OBJECTIVE To assess the dietary habits of diabetic women. RESEARCH DESIGN AND METHODS Participants in the Nurses Health Study, a cohort of 121,700 registered female nurses, were followed since 1976. We compared the usual dietary intakes of women who had been diagnosed with diabetes mellitus by 1980 and age-matched nondiabetic control women; diets of these women were assessed in 1980 and 1984 by a semiquantitative food frequency questionnaire. The study examined 162 IDDM women and 738 NIDDM women. Similar comparisons were made for 429 women who developed NIDDM between 1980 and 1984. RESULTS Although differences were small, women with IDDM in 1984 and women with NIDDM in 1980 and 1984 consumed less energy from carbohydrates, especially from sucrose, and more energy from protein and fat than did control women. Similar results were also found in 1984 for the 429 women who developed NIDDM between 1980 and 1984. In 1980, energy from nonsucrose carbohydrate was slightly higher in both IDDM and NIDDM women than in the control women. However, in 1984, using a dietary questionnaire designed to assess more complete dietary intake, less consistent results were obtained. Diabetic women tended to avoid desserts and sweets, sugar-containing beverages, and alcoholic beverages but consumed more meat and meat products. Intakes of foods high in complex carbohydrates (e.g., bread, rice, pasta, and potatoes) were similar between diabetic and control women. CONCLUSIONS The results suggest that these diabetic women did not consume the high-carbohydrate, low-fat diets that the American Diabetes Association has been recommending over the past decade.
Rectal and colonic studies after resection of the sigmoid for diverticular disease
Authors: T. G. Parks
Journal: Gut (1970)

Spontaneous basal rectal activity, recorded after resection of the sigmoid colon for diverticular disease, was more than twice the normal. The rectum of post-resection cases yielded a markedly exaggerated overall response to prostigmine, in addition to producing abundant fast wave patterns. The response to stretch of the apparently normal colonic muscle remaining after resection of the sigmoid for diverticular disease resembled unresected diverticular segments, though less in degree, suggesting that a fundamental disorder of colonic muscle may be involved in the aetiology of colonic diverticula.
IMPACT OF PACLITAXEL-ELUTING STENTS IN PATIENTS WITH ANTERIOR MYOCARDIAL INFARCTION UNDERGOING PRIMARY ANGIOPLASTY COMPARED WITH BARE METAL STENTS: ANALYSIS FROM THE HORIZONS AMI TRIAL
Authors: Jochen Wö;hrle, Bernhard Witzenbichler, Giulio Gualiumi, Bruce R. Brodie, Dariusz Dudek, Ran Kornowski, Franz Hartmann, Helen Paris, Alexandra J. Lansky, Carol Moore, Roxana Mehran, Gregg W. Stone
Journal: Journal of the American College of Cardiology (2010)
A simple biological imaging system for detecting viable human circulating tumor cells
Authors: Toru Kojima, Yuuri Hashimoto, Yuichi Watanabe, Shunsuke Kagawa, Futoshi Uno, Shinji Kuroda, Hiroshi Tazawa, Satoru Kyo, Hiroyuki Mizuguchi, Yasuo Urata, Noriaki Tanaka, Toshiyoshi Fujiwara
Journal: Journal of Clinical Investigation (2009)

The presence of circulating tumor cells (CTCs) in the peripheral blood is associated with short survival, making the detection of CTCs clinically useful as a prognostic factor of disease outcome and/or a surrogate marker of treatment response. Recent technical advances in immunocytometric analysis and quantitative real-time PCR have made it possible to detect a few CTCs in the blood; however, there is no sensitive assay to specifically detect viable CTCs. Here, we report what we believe to be a new approach to visually detect live human CTCs among millions of peripheral blood leukocytes, using a telomerase-specific replication-selective adenovirus expressing GFP. First, we constructed a GFP-expressing attenuated adenovirus, in which the telomerase promoter regulates viral replication (OBP-401; TelomeScan). We then used OBP-401 to establish a simple ex vivo method that was able to detect viable human CTCs in the peripheral blood. The detection method involved a 3-step procedure, including the lysis of rbc, the subsequent addition of OBP-401 to the cell pellets, and an automated scan using fluorescence microscopy. OBP-401 infection increased the signal-to-background ratio as a tumor-specific probe, because the fluorescent signal was amplified only in viable, infected human tumor cells, by viral replication. This GFP-expressing virus-based method is remarkably simple and allows precise enumeration of CTCs.
Renal function studies after nephrectomy in renal donors.
Authors: J M Davison, P R Uldall, J Walls
Journal: BMJ (1976)

Two to six years after they had donated a kidney the 24-hour creatinine clearances of five women and four men had recovered to 85% and 87% respectively of prenephrectomy performance. The male donors had a lower 24-hour creatinine clearance than age-matched controls, but during dextrose and inulin infusion they had similar values for inulin clearance, creatinine clearance, and glucose reabsorption. By contrast, the female donors had significantly reduced clearances both over 24 hours and during infusion, as well as impaired ability to reabsorb glucose. This suggests that potential female donors should be more vigorously investigated before nephrectomy.
Fixed- vs Adjusted-Dose Heparin in the Prophylaxis of Thromboembolism in Spinal Cord Injury
Authors: David Green
Journal: JAMA (1988)

Thromboembolism is a common and occasionally catastrophic complication in patients with spinal cord injury and complete motor paralysis. We, therefore, evaluated the efficacy and safety of two prophylactic regimens, using heparin in either fixed doses of 5000 U given subcutaneously twice daily or in doses adjusted to prolong the activated partial thromboplastin time (APTT) to approximately 1 1/2 times control. Patients were monitored with daily clinical examinations, serial impedance plethysmography, and Doppler flow studies. All events suspected to be thromboembolic were confirmed by venography, ventilation-perfusion scans, or pulmonary angiography. Seventy-five patients were randomized, and 58 (29 in each group) either remained in the study for more than seven weeks or experienced a thrombotic or hemorrhagic event. Patients on the adjusted-dose regimen received a mean (±SD) of 13 200 ±2200 U of heparin per dose and had an APTT 1 1/2 times higher than those on the fixed-dose regimen. Thromboembolism was detected in nine (31%) of 29 patients randomized to the fixed-dose regimen and two (7%) of 29 on the adjusted-dose regimen. While no patient who received the adjusted dose and whose APTT reached the target level had a thrombosis, bleeding occurred in seven patients. No patient on the fixed-dose regimen bled. We conclude that patients with spinal cord injury who can be maintained on doses of heparin sufficient to prolong their APTT to 1 1/2 times control values will be spared thromboembolic complications, but these patients are at high risk of bleeding, especially if they have trauma to other tissues in addition to their spinal cord injury. (<i>JAMA</i>1988;260:1255-1258)