tbuckley/cabot-search huggingface dataset:
THU0177 The Influence of Initial Glucocorticoid Therapy on the Progression of Early RA. Results from the Swiss Prospective Observational Registry
Authors: R. Mueller, N. Reshiti, A. Finckh, S.R. Haile, T. Kaegi, H. Schulze-Koops, M. Schiff, J. von Kempis
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Anti-inflammatory and disease-modifying properties of glucocorticoids (GCs) have been demonstrated in patients with rheumatoid arthritis (RA). Better outcomes in trials by combinations of synthetic DMARDs plus GCs versus DMARD monotherapy might be due GC. Since GCs are associated with adverse events, tapering of GCs is recommended in guidelines. There is almost no information on the benefits of GC in early arthritis outside the limitations of a clinical study. <h3>Objectives</h3> To analyse whether initial GC therapy influences the long-term course of the disease in early arthritis patients. <h3>Methods</h3> We included all patients from the Swiss RA registry SCQM with recent onset arthritis (disease duration ≤1 year). The exposure of interest was initial GC use. The primary outcome was clinical and radiographic disease progression, as assessed by the disease activity (DAS28), function (HAQ-DI) and structural joint damage (Ratingen erosion score). The baseline disease characteristics were compared using standard descriptive statistics. The effects of initial GC use on disease progression during follow up was estimated using linear mixed models with random slope and random intercept and adjusted for potential confounders. In a sensitivity analysis, we adjusted for differences in baseline parameters between the two groups using propensity score. <h3>Results</h3> In total, 592 patients (pts) with early disease and 4.3 years of follow-up (average) were available. Of these, 363 pts were initially treated with glucocorticoids (GC patients) and 228 pts without (no-GC patients). DAS 28 (4.6 vs. 4.3, p=0.01) and the HAQ-DI (0.94 vs. 0.82, p=0.01) were higher at baseline in GC patients, while other prognostic factors were balanced at disease onset. Neither the evolution of DAS 28, nor HAQ-DI, or the development of joint erosions differed between the two groups during follow up. Even after adjusting for this propensity score, patients with and without use of GCs did not show statistically significantly different disease activity (DAS 28) at one year. Escalation of treatment employing biologics was documented in 18.0% of the no-GC patients and 27.3% of the GC patients (p&lt;0.01). <h3>Conclusions</h3> These results suggest that the long-term evolution of disease activity and radiographic damage are not significantly modified by initial GC use <h3>Disclosure of Interest</h3> None declared
Incidence of Left-Ventricular Thrombosis after Acute Transmural Myocardial Infarction
Authors: Richard W. Asinger, Frank L. Mikell, Joseph Elsperger, Morrison Hodges
Journal: New England Journal of Medicine (1981)

To study the incidence of left-ventricular thrombosis after transmural myocardial infarction, we performed serial two-dimensional echocardiography in 70 consecutive patients. Thirty-five patients had inferior-wall infarction: none had a left-ventricular thrombus. The other 35 had anterior-wall infarction: 12 had left-ventricular thrombi. Thrombi were diagnosed an average of five days after the infarction (range, one to 11 days). All patients with left-ventricular thrombi had severe apical-wall-motion abnormalities (akinesis or dyskinesis). Twenty-six of the 35 patients with anterior infarctions had apical akinesis or dyskinesis on echocardiography; left-ventricular thrombi developed in 12 of these 26 (46 per cent). We conclude that patients with severe apical-wall-motion abnormalities during acute transmural anterior myocardial infarction are at high risk for left-ventricular thrombosis. This high-risk group can be identified before the development of left-ventricular thrombi. Patients with inferior infarction or anterior infarction without a severe apical-wall-motion abnormality are at low risk.
Occurrence of Thyroid Cancer
Authors: Joseph E. Sokal
Journal: New England Journal of Medicine (1953)

FOR many years there has been disagreement over the incidence of carcinoma of the thyroid gland. Some authorities have claimed that it is a relatively common disease, and others have maintained that it is extremely rare. Such differences of opinion about a basic fact have led to irreconcilable differences in matters of judgment. Much of the controversy over the management of nodular goiter, for example, stems from conflicting opinions about the incidence of thyroid cancer. This has been a subject of discussion since the beginning of this century. Müller and Speese,1 in one of the first reviews of thyroid cancer . . .
Cord-Blood Total Protein Level as a Screening Aid for the Idiopathic Respiratory-Distress Syndrome
Authors: Richard D. Bland
Journal: New England Journal of Medicine (1972)

Umbilical-cord blood total protein determinations were performed on specimens from 2200 infants delivered over an eight-month period with the use of a rapid, convenient, and reproducible TS-meter protein measurement. In 34 infants the idiopathic respiratory-distress syndrome developed; 33 of the 34 had a cord-blood total protein concentration of 4.6 g per 100 ml or less. One third of the neonates with protein values at or below this level were affected by the syndrome, as were 1/2 of the immature or low-birth-weight infants with low protein levels. Independent of birth weight or maturity, infants with cord protein determinations above 4.6 g per 100 ml demonstrated a favorable prognosis, with an incidence of respiratory-distress syndrome of less than 0.5 per cent.
Common mental health problems
Authors: Pierre-André Michaud, Eric Fombonne
Journal: BMJ (2005)

The World Health Organization defines mental health as a “state of well-being whereby individuals recognize their abilities, are able to cope with the normal stresses of life, work productively and fruitfully, and make a contribution to their communities.” Applying such adult based definitions to adolescents and identifying mental health problems in young people can be difficult, given the substantial changes in behaviour, thinking capacities, and identity that occur during the teenage years. The impact of changing youth subcultures on behaviour and priorities can also make it difficult to define mental health and mental health problems in adolescents. Although mental disorders reflect psychiatric disturbance, adolescents may be affected more broadly by mental health problems. These include various difficulties and burdens that interfere with adolescent development and adversely affect quality of life emotionally, socially, and vocationally.

View this table:

Table 1 
Symptoms needing assessment



Mental disorders and mental health problems seem to have increased considerably among adolescents in the past 20-30 years. The rise has been driven by social change, including disruption of family structure, growing youth unemployment, and increasing educational and vocational pressures. The prevalence of mental health disorders among 11 to 15 year olds in Great Britain is estimated to be 11%, with conduct problems more common among boys and depression and anxiety more common among girls.

View this table:

Table 2 
Definition of a mental disorder*



The identification, treatment, and follow up of mental health problems in young people can be complicated. Parents and teachers may dismiss problems as merely reflecting adolescent turmoil. Young people are often very reluctant to seek help, owing to developmental needs about being “normal” at the time when they are exploring identity issues and trying to engage with a peer group.

View this table:

Table 3 
Mental health problems and disorders in adolescents*



Variations of mood and temporary deviant behaviours …
Human Cancers Express a Mutator Phenotype: Hypothesis, Origin, and Consequences
Authors: Lawrence A. Loeb
Journal: Cancer Research (2016)

The mutator phenotype hypothesis was postulated more than 40 years ago. It was based on the multiple enzymatic steps required to precisely replicate the 6 billion bases in the human genome each time a normal cell divides. A reduction in this accuracy during tumor progression could be responsible for the striking heterogeneity of malignant cells within a tumor and for the rapidity by which cancers become resistant to therapy. Cancer Res; 76(8); 2057-9. ©2016 AACRSee related article by Loeb et al. Cancer Res. 1974;34:2311-21.
Do Physicians Have an Obligation to Treat Patients with AIDS?
Authors: E J Emanuel
Journal: New England Journal of Medicine (1988)

Are physicians obligated to treat patients with the acquired immunodeficiency syndrome (AIDS)? This is clearly an important question for practicing physicians, but its scope extends beyond AIDS and matters of clinical care. It raises fundamental questions about the medical profession itself, about the social and professional understanding of the purpose of medicine. In analyzing the physician's obligation to patients with AIDS, two issues must be considered — the nature of the obligation, and what factors, if any, serve to limit it.The Obligation to Treat Patients with AIDSOur investigation of physicians' obligation should begin with the acknowledgment that unless . . .
Case 4-1998
Authors: Michael B. Raizman, Jacqueline J. Haas
Journal: New England Journal of Medicine (1998)

Presentation of CaseA 32-year-old man was admitted to the hospital because of unilateral vitreous hemorrhage and mediastinal lymphadenopathy.The patient had been well until 7 1/2 weeks earlier, when he experienced the gradual onset of blurred vision in the left eye, accompanied by numerous floaters, but without flashes, quadratic visual-field loss, or pain. An evaluation elsewhere showed vitreous hemorrhage with proliferative disease. A fluorescein angiographic examination showed vitreous hemorrhage, an elevated, intensely hyperfluorescent fibrovascular frond, and smaller areas of neovascularization that did not involve the optic disk. Panretinal photocoagulation was administered twice during a six-day period, and the patient's . . .
Common Pitfalls in the X-Ray Diagnosis of Tuberculosis
Authors: Joseph D. Wassersug
Journal: New England Journal of Medicine (1951)

WITH the increased emphasis on the x-ray film as a means of diagnosing pulmonary tuberculosis, less and less has appeared in current literature about possible diagnostic errors. In spite of the fact that by x-ray examination of the lungs alone it is possible to identify only 75 to 80 per cent of the lesions,1 x-ray examination of the chest has become mandatory for food handlers and schoolteachers, and efforts are being made by public-health officers3 to have premarital chest x-ray films taken as a routine procedure in much the same way as a premarital blood examination for syphilis is made. . . .
Moderate Alcohol Consumption and the Risk of Breast Cancer
Authors: W.C. Willett, M.J. Stampfer, G.A. Colditz, B.A. Rosner, C.H. Hennekens, F.E. Speizer
Journal: New England Journal of Medicine (1987)

In 1980, 89,538 U.S. women 34 to 59 years of age, with no history of cancer, completed an independently validated dietary questionnaire that included the use of beer, wine, and liquor. During the ensuring four years, 601 cases of breast cancer were diagnosed among cohort members. Among the women consuming 5 to 14 g of alcohol daily (about three to nine drinks per week), the age-adjusted relative risk of breast cancer was 1.3 (95 percent confidence limits, 1.1 and 1.7). Consumption of 15 g of alcohol or more per day was associated with a relative risk of 1.6 (95 percent confidence limits, 1.3 and 2.0; Mantel extension chi for linear trend = +4.2; P less than 0.0001). Adjustment for known breast cancer risk factors and a variety of nutritional variables did not materially alter this relation. Significant associations were observed for beer and liquor when considered separately. Among women without risk factors for breast cancer who were under 55 years of age, the relative risk associated with consumption of 15 g of alcohol or more per day was 2.5 (95 percent confidence limits, 1.5 and 4.2). These prospective data derived from measurements of alcohol intake recorded before the diagnosis of breast cancer confirm the findings of several previous case-control studies. Viewed collectively, they suggest that alcohol intake may contribute to the risk of breast cancer.
Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR)
Authors: J. Hernández, L. Molins, J.J. Fibla, F. Heras, R. Embún, J.J. Rivas, JuanJ. Rivas, Laureano Molins, Raúl Embún, Francisco Rivas, Jorge Hernández, JoséManuel Mier, Félix Heras, Javier de la Cruz, Matilde Rubio, Esther Fernández, Miguel Carbajo, Rafael Peñalver, JoséRamón Jarabo, Diego González-Rivas, Sergio Bolufer, Carlos Pagás, Sergi Call, David Smith, Richard Wins, Antonio Arnau, Andrés Arroyo, M.Carmen Marrón, Akiko Tamura, Montse Blanco, Beatriz de Olaiz, Gemma Muñoz, José M. García Prim, Carlos Rombolá, Santiago García Barajas, Alberto Rodríguez, Jorge Freixinet, Javier Ruiz, Guillermo Carriquiry, Moisés Rosenberg, Emilio Canalís
Journal: Annals of Oncology (2016)
Correlation of Gross Gastroscopic Findings with Gastroscopic Biopsy in Gastritis
Authors: Leonard Atkins, Edward B. Benedict
Journal: New England Journal of Medicine (1956)

THE development of the Wolf-Schindler flexible gastroscope in 19321 followed by the Benedict flexible operating gastroscope in 19482 and the flexible gastric-biopsy tube invented in 1949 by Wood et al.3 has stimulated a great deal of interest in gastritis. Although a previous attempt at correlation of gastroscopic and pathological findings in gastritis was made by Benedict and Mallory4 in 1943, the study was based not on biopsy but on surgical specimens resected for ulcer or carcinoma. As soon as gastroscopic biopsy became available it was evident that the concept of gastritis had to be revised. In 1949 Benedi-t5 6 7 stated that . . .
Gonadotropin, estradiol, and testosterone profiles in homosexual men
Authors: S R Newmark, L I Rose, R Todd, L Birk, F Naftolin
Journal: American Journal of Psychiatry (1979)

The authors evaluated the gonadotropin-testosterone-estradiol profiles of four homosexual men and four heterosexual men by a multiple-sampling technique. Although there was extensive overlap between the two groups, the homosexual subjects had higher estradiol levels than the heterosexuals (70.3 +/- 19.8 versus 56.8 +/- 10.7 pg/ml) and lower FSH values (5.1 +/- 1.0 versus 13.2 +/- 3.4 mIU/ml). Testosterone and luteinizing hormone levels were comparable in the two groups. These observations suggest that there may be subtle differences in gonadotropin and estradiol secretion in homosexual subjects that can be detected only by repeated sampling.
P70 Blood eosinophil counts in normal controls with no history of allergic disease
Authors: A Anand, O Ahmed, ID Pavord, M McClure, B Ferry, SR Pavord
Journal: Thorax (2015)

<h3>Background</h3> The beneficial effect of corticosteroids and anti-interleukin (IL)-5 on exacerbations of airway disease becomes apparent at blood eosinophil counts above 0.15 × 10<sup>9</sup>/L, well within the normal range. One potential explanation is that the upper limit of the normal range is artificially high because studies have included patients with allergic disease and eosinophilic inflammation. We have assessed the normal range for blood eosinophil counts in volunteers with no self-reported history of allergic disease and compared this with the findings from a more traditional control population. <h3>Methods</h3> We recruited 78 volunteers (15 male) with a mean age of 38.8 years. Volunteers with a self-reported history of asthma, allergic rhinitis and/or eczema were excluded. The differential cell count was carried out using sysmex XN analyser and serum IgE measured using automated enzyme immunoassay by Phadia Immunocap equipment. Result were compared with an unscreened population (n = 120) used to calculate our local normal ranges. <h3>Results</h3> One outlier value of 0.79 × 10<sup>9</sup>/L, (&gt;5 SD above the mean) was excluded from further analysis. In the remainder the mean blood eosinophil count was 0.15 × 10<sup>9</sup>/L with an upper limit of normal range of 0.27 × 10<sup>9</sup>/L. Volunteers with no self-reported history of allergic disease but an IgE &gt;120 iu/L and/or positive specific IgE to house dust mites or grass were not statistically different. The mean blood eosinophil count in the laboratory population was 0.19 × 10<sup>9</sup>/L (p 0.018 vs our population) and the upper limit of normal range 0.42 × 10<sup>9</sup>/L. <h3>Conclusions</h3> The upper limit of the normal range for blood eosinophil count is lower in a population who have no clinical history of allergic disease.
Risk Factors and Response to Antibiotic Therapy in Adults with Bacteremic Pneumonia Caused by Penicillin-Resistant Pneumococci
Authors: Roman Pallares, Francisco Gudiol, Josefina Liñares, Javier Ariza, Gabriel Rufi, Luis Murgui, Jordi Dorca, Pedro F. Viladrich
Journal: New England Journal of Medicine (1987)

We retrospectively studied 24 adults with bacteremic pneumonia (25 episodes) due to penicillin-resistant pneumococci, for which the minimal inhibitory concentrations (MICs) of penicillin G were 0.12 to 8.0 micrograms per milliliter; 79 percent of the strains showed multiple antibiotic resistance. As compared with 48 control patients with bacteremic pneumonia caused by penicillin-sensitive pneumococci, the 24 patients with penicillin-resistant pneumococci had a significantly higher incidence of use of beta-lactam antibiotics during the previous three months (65 vs. 17 percent, P = 0.0008), hospitalization during the previous three months (58 vs. 21 percent, P = 0.0038), nosocomial pneumonia (37 vs. 6 percent, P = 0.0032), episodes of pneumonia during the previous year (29 vs. 4 percent, P = 0.010), and factors on initial presentation that were associated with a poor prognosis (an initially critical condition) (67 vs. 27 percent, P = 0.0030). Their overall mortality rate was significantly higher (54 vs. 25 percent, P = 0.0298). Eleven of 19 episodes of pneumonia due to organisms for which MICs were 0.12 to 2.0 micrograms per milliliter, which were treated with penicillin G (10 episodes) or another beta-lactam agent (9 episodes), resulted in recovery (2 of 10 patients in an initially critical condition recovered, as compared with all of 9 not initially in a critical condition, P = 0.0012). Two patients who had penicillin-resistant pneumococci for which MICs were 4.0 and 8.0 micrograms per milliliter did not respond to ampicillin and ticarcillin therapy, respectively. Our study suggests that pneumonia due to penicillin-resistant pneumococci may occur more often in a population with some identifiable risk factors, and may respond to intravenous high-dose penicillin therapy if MICs are less than or equal to 2 micrograms per milliliter. Cases involving higher resistance may require an alternative antibiotic.
Predominance of Atopic Asthma in Patients with Severe or Difficult-to-Treat Asthma in the Tenor II Cohort
Authors: Larry Borish, Stanley J. Szefler, Robert S. Zeiger, Aimee Foreman, Steve Greenberg, Tmirah Haselkorn, Farid Kianifard, Meryl Mendelson, Brandee Paknis, Scott T. Weiss, Bradley E. Chipps
Journal: Journal of Allergy and Clinical Immunology (2016)
OC-077 Field effect identification via spectroscopic rectal microvasculature enables accurate proximal neoplasia detection by flexible sigmoidoscopy
Authors: H K Roy, A Gomes, M J Goldberg, S Ruderman, L K Bianchi, J Rogers, E Yen, V Backman
Journal: Gut (2010)

<h3>Introduction</h3> Flexible sigmoidoscopy (flex sig) remains a cornerstone for colorectal cancer (CRC) screening in the UK although concerns have been raised about about isolated proximal neoplasia which is especially common in women.1 Our group has demonstrated using novel polarisation-gated spectroscopy (4D-ELF) that peri-cryptal microvascular blood supply is elevated in the histologically normal mucosa of patients harboring neoplasia elsewhere in their colon (marker of field effect).2–4 We, therefore, wanted to investigate whether this could serve as an adjunct to flex sig. <h3>Methods</h3> Subjects undergoing colonoscopy were recruited. Microvascular readings were taken from the endoscopically normal rectum with a fibreoptic probe and analysed by an investigator blinded to colonoscopic findings. Specifically, superficially (within 100 micron of tissue surface) oxygenated hemoglobin (SupOxyHb) was calculated. Proximal lesions were defined at the level of the spenic flexure. The performance of distal adenoma and microvascular blood content was calculated. Advanced adenomas (AAs) were defined as size ≥1.0 cm or presence of high-grade dysplasia. <h3>Results</h3> Our initial data set consisted of 366 patients (age 58±10, 50% female, 28 with AA). Distal adenoma performed poorly at identifying risk proximal AA (sensitivity 11%). Rectal SupOxyHb was elevated by approximately 50% in patients harboring proximal AA (when compared to neoplasia free patients) with an area under receiver operator characteric curve (AUROC) of 0.83. On a separate data set (n=172), the results were validated with an AUROC of 0.84. With regards to gender, the performance in females was excellent. (AUROC=0.88). SupOxyHb was not confounded by demographic factors or benign colonic disease (including hyperplastic polyps) and was insensitive to non-advanced adenomas. <h3>Conclusion</h3> We demonstrate, for the first time, that evaluation of rectal microvascular hemoglobin was able to sense proximal advanced adenomas with excellent accuracy, markedly outperforming the sentinel adenoma (a conventional marker of field effect). We replicated these results with an independent data set. Furthermore, SupOxyHb worked well in women, a group in which flex sig performs relatively poorly. Our data suggest that rectal EIBS measurement may provide an accurate and inexpensive means of improving performance of flex sig for CRC screening.
Controlled Study Comparing Ethacrynic Acid to Mercaptomerin in the Treatment of Acute Pulmonary Edema
Authors: Michael Lesch, George J. Caranasos, John H. Mulholland
Journal: New England Journal of Medicine (1968)

In a controlled study comparing the therapeutic effectiveness of intravenous ethacrynic acid to intramuscular mercaptomerin in patients with acute pulmonary edema, all 39 patients were treated by the usual methods except that 19 received ethacrynic acid and 20 mercaptomerin. Although ethacrynic acid induced a noticeably greater diuresis and natriuresis in the first three hours, differences in this respect were not significant at the end of six hours. The diuretic response to mercaptomerin was evenly distributed around a mean of 1239 ml per six hours, whereas the response to ethacrynic acid was biphasic, with six patients failing to respond (mean diuresis of 287 ml per six hours), and the remaining 13 voiding an average of 2506 ml per six hours. The rate of clinical improvement was independent of the rapidity of diuresis, thus casting doubt on the necessity for the use of the most rapidly acting diuretics in the treatment of acute pulmonary edema.