tbuckley/cabot-search huggingface dataset:
Soundings: I saw Satan fall like lightning
Authors: Liam Farrell
Journal: BMJ (2000)

I was called recently to a patient who had collapsed in the carpark after church. This is a good place to collapse, implying a previous life of probity and devotion.

The bystanders are likely to be helpful. Collapsing outside a bar late at night, by contrast, you are unlikely to get a lift home from a friendly drug dealer; a better class of people attend church, although they may be more fastidious about mouth to mouth—perhaps not a bad thing. The doctor also feels more obliged to attend; there is something deserving about a church carpark. This collapse, we infer, is unrelated to debauchery.

I drove out at once, but some dogooder had already taken the patient to the surgery. And, returning to the surgery, I found, with a certain fatal satisfaction, that the entourage had inevitably returned to the church.

Eventually, a few laps later, I hounded the patient to earth. Invigorated by the chase, she was at first unwilling to accept cardiac pulmonary resuscitation, but a crowd had gathered and, as Pierre said in War and Peace, the common good is the only kind there is. Pleasing the mob always comes first, and saying all was fine would have been inconsiderately detumescent; doing nothing was too hard a proposition, the power was intoxicating, put a beggar on horseback and he'll ride to hell.

So, instead a symphony; excited oohs as I whip out the shock blanket like a magician's rabbit; somebody shouting, “Don't move her!” (because the conventions must be observed); the triumphant clash of the defib paddles as I flourish them theatrically on high; the patient's futile protests, “I'm fine, no really I am, really”; the crowd moaning and crooning and swaying with pleasure until the ambulance arrives, rabbits transfixed by the weasel's dance.

I accepted the plaudits modestly, mindful of La Rochefoucauld's maxim, “To refuse praise is to be praised twice.” And as I led her up the steps into the ambulance, its interior lambent like a little piece of heaven, a ghostly Roman slave appeared at my elbow, whispering, “Remember thou art mortal, remember . . .” And I said, “Who the hell are you?”

The patient infarcted and died in the ambulance.

[Any resemblance to patients living or dead is entirely coincidental]
Pancreatic Isoamylases
Authors: MICHAEL E. ROSS
Journal: Annals of Internal Medicine (1974)

Comments and Correction1 October 1974Pancreatic IsoamylasesMICHAEL E. ROSS, M.D., ROBERT O. WOLF, D.D.S.MICHAEL E. ROSS, M.D.Search for more papers by this author, ROBERT O. WOLF, D.D.S.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-81-4-566 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The problems in the clinical interpretation of hyperamylasemia are well summarized in a recent editorial (1); however, this editorial does not give an adequate picture of the situations in which the serum amylase may be clinically valuable.Polyacrylamide gel electrophoresis can reliably separate serum or urine samples into their constituent isoamylases, and when this is done the pancreatic isoamylases are separated from the isoamylases of salivary gland origin (2). The isoamylases can then be analyzed either qualitatively, by examination of zymograms (3), or quantitatively, by fractionating the gel and assaying the amylase content of each slice (4)....References1. BERK J: Hyperamylasemia: beacon or siren? Ann Intern Med 80:665, 1974 LinkGoogle Scholar2. WOLFTAYLORBRACE RLK: Effects of irradiation of the parotid gland and pancreas on human isoamylases. Am J Clin Pathol 54:214-218, 1970 CrossrefMedlineGoogle Scholar3. WOLFTAYLOR RL: Isozyme demonstration technique. Am J Clin Pathol 49:871-876, 1968 CrossrefGoogle Scholar4. ROSSWOLFNOTKINS MRA: Amylase isoenzymes during viral infections of the pancreas and salivary glands. J Lab Clin Med 83:750-756, 1974 MedlineGoogle Scholar5. TAUSSIGWOLFWOOD LRR: Use of serum amylase isoenzymes in evaluation of pancreatic function. Pediatrics 54:229-235, 1974 MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: National Institutes of Health Bethesda, Maryland 20014 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 October 1974Volume 81, Issue 4Page: 566-566KeywordsGel electrophoresisSalivary glandsUrine Issue Published: 1 October 1974 PDF DownloadLoading ...
THU0282 Macrophage-Colony Stimulating Factor Elevation as a Marker of Active Nephritis in ANCA-Associated Vasculitides
Authors: G.A. Ramirez, M. Blasi, C. Sciorati, M.G. Sabbadini, P. Rovere-Querini, A.A. Manfredi
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Anti Neutrophil Cytoplasmic Antibodies (ANCA) – associated vasculitides (AAV) are characterized by small vessel injury and in some cases granulomatous lesions and glomerular inflammation. The pathogenic bases of clinical phenotypes are incompletely understood, but monocyte/macrophages are possibly involved in the perpetuation of tissue injury. Macrophage colony stimulating factor (M-CSF) is a promoter of monocyte recruitment and macrophage proliferation, involved in mesangial cell proliferation and in the establishment of experimental nephritis. Elevated serum concentrations of M-CSF mark and herald the onset of lupus nephritis. <h3>Objectives</h3> To investigate M-CSF expression in patients with AAV with and without renal involvement. <h3>Methods</h3> Upon informed consent, plasma samples from 29 patients with AAV (18 granulomatosis with polyangiitis, GPA, 6 eosinophilic granulomatosis with polyangiitis, EGPA, and 5 microscopic polyangiitis, MPA) and 10 healthy controls were collected, together with data regarding clinical history, disease activity (as estimated by the Birmingham Vasculitis Activity Score, BVAS) at the time of venepuncture and routine laboratory parameters. M-CSF plasma concentration was assessed by using a commercial ELISA assay. Data are expressed as mean ± standard error of mean. <h3>Results</h3> Higher levels of M-CSF were detected in patients with AAV in comparison to controls (453.45±78.14 vs 117.58±14.24 pg/ml; p=0.017). Differences between AAV types were not significant. M-CSF levels correlated positively with the BVAS (p=0.010). Positive correlations were also identified among M-CSF, serum C-reactive protein (p&lt;0.001) and erythrocyte sedimentation rate (p=0.022), while haemoglobin correlated inversely with M-CSF (p=0.012). Patients with active renal disease had significantly higher levels of M-CSF when compared to patients with active disease and no kidney involvement, with patients in remission with or without a history of renal involvement and with healthy controls (p=0.001; p=0.019; p=0.016; p&lt;0.001 respectively). M-CSF levels did not differ between ANCA-positive/negative patients and were not associated with the involvement of other organs. <h3>Conclusions</h3> M-CSF is higher in patients with AAV and active nephritis and could contribute to the pathogenesis of these diseases. In addition, M-CSF could represent a marker of renal involvement in AAV. <h3>References</h3> Luqmani RA. Frontiers Immunol. 2014 Hamilton TA et al. Front Immunol. 2014 Menke J et al. J Am Soc Nephrol. 2014 <h3>Disclosure of Interest</h3> None declared
Liver uptake and increased renal uptake of Tc-99m HMDP in a patient with iron overload.
Authors: HITOYA OHTA
Journal: Clinical Nuclear Medicine (2001)

From the Department of Radiology, Osaka Red Cross Hospital, Osaka, Japan Received for publication March 8, 2000. Accepted May 29, 2000. Reprint requests: Hitoya Ohta, M.D., Department of Radiology, Osaka Red Cross Hospital, Osaka, 543-8555 Japan
FRI0196 CCR2 Expression was Increased in Patients with Ankylosing Spondylitis Independent from Disease Activity: Table 1
Authors: D. Solmaz, A. Tekinalp, O. Avci, B. Turgut
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Ankylosing Spondylitis (AS), with poorly understood pathogenesis, is a chronic inflammatory rheumatic disease, and as a result of inflammation, morbidity and mortality may occur. Many cell types are involved in inflammatory process, and particularly antigen presentation is important. Monocytes are also one of the most important sources of antigen presenting cells, activated by inflammation and chemotactic stimulation, reach the inflammatory focus through the vessel wall and become macrophage, a cell type which has more highly phagocytic ability. There are two main monocyte populations in peripheral blood. First, forming a smaller population, less mature, has a lower volume and higher tumoricidal activity cells (CD14<sup>+/</sup>CD16<sup>+</sup>), second and higher population, consist of more mature monocytes; this monocytes have a higher volume, and they get more actively involved in antibody dependent cellular cytotoxicity (CD14<sup>+</sup>/CD16<sup>-</sup>). CCR2 is a chemokine expressed on monocytes, and in inflammatory condition they play an important role on extravasation and transmigration of monocytes. <h3>Objectives</h3> The aim of this study is to evaluate phenotypes and determine the distribution according to disease activity of monocytes, important source of antigen presenting cells, in patients with AS. <h3>Methods</h3> Patients classified as AS according to modified New York criteria and healthy controls were included. Patients on biologic treatment have an active infection, or known chronic diseases were excluded. Besides routine clinic laboratory evaluation, to determine subtypes and activation status of monocytes, flow cytometry analyzes were performed on peripheral blood. In multi- colored analyze CD14-FITC, CD16-PE and CCR2-PerCP were used. Monocyte percentages and monocyte subtype were determined. CCR2 expression on monocytes and on monocyte subtypes was studied. <h3>Results</h3> The demographic characteristics of AS patients and controls were summarized on table. Inflammatory markers were found to be significantly higher in patients with AS. Apart from percentages of CD14<sup>+</sup>/CD16<sup>+</sup> and CD14<sup>+/</sup>CD16<sup>-</sup> subtypes which were similar between two groups, CCR2 expression was detected significantly higher in AS patients in both subgroups. There was no difference between monocyte subgroups and CCR2 expressions when classified according to disease activity in patients with AS. <h3>Conclusions</h3> In our study, compared to control group, CCR2 expression on monocyte subgroups was significantly higher independent from disease activity in patients with AS. We believe, this may contribute to the understanding of inflammatory process in AS patients. <h3>Disclosure of Interest</h3> None declared
The Biopsychosocial Model and Medical Education
Authors: George L. Engel
Journal: New England Journal of Medicine (1982)

Elsewhere I have discussed the need for medicine to adopt a more inclusive scientific model if physicians in the future are to apply the same scientific rigor to the approach and understanding of patients and their care as they customarily apply to the diagnosis and treatment of disease.1 2 3 In this essay I address the question of who are to be the teachers of such a new scientific model. Because psychiatry has in the past had the main responsibility for education in, broadly speaking, the psychological and social aspects of medicine, it is widely assumed, especially by psychiatrists, that to psychiatry . . .
BME staff are more likely to be bullied in most acute trusts, report finds
Authors: Abi Rimmer
Journal: BMJ (2016)

Black and ethnic minority (BME) staff were more likely to be bullied, harassed, or abused than their white colleagues in most acute trusts, a report by NHS England has found.1

On Thursday 2 June the NHS Equality and Diversity Council published the first national report on the NHS Workforce Race Equality Standard (WRES).

The report gathered together the experiences of BME and white staff in every NHS …
AB0533 Recommendations of Brazilian Society of Rheumatology for the Treatment of SjÖGren's Syndrome
Authors: V. Valim, V.F.M. Trevisani, S.G. Pasoto, E.V. Serrano, S.L.E. Ribeiro, T.S.D.A. Fidelix, V.S. Vilela, L.L. Prado, T.N. Libόrio-Kimura, O.H. de Brito Filho, L.A.P.D. Barros, S.T. Miyamoto, S. Lourenço, M.C.S. Santos, L.A. Vieira, C.B.D. Adán
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Objectives</h3> Recommendations of Brazilian Society of Rheumatology for the treatment of Sjögren9s syndrome (SS) were developed to guide management of SS considering the Brazilian social and economic context. <h3>Methods</h3> It was based on specialist9s opinion and systematic review on MEDLINE (PubMed) and Cochrane database until October 2014, including 127 articles classified according Oxford &amp; Grade. <h3>Results</h3> Forty-four recommendations were organized in 3 main topics: <i>Part 1. General recommendations and patient education:</i> The management of SS should be conducted by multidisciplinary team. Systemic treatment should be according disease severity measured by EULAR Sjögren9s Syndrome Disease Activity (ESSDAI). Patients should avoid caffeine, tobacco, alcohol, toothpaste with abrasive, and mouthrinses with alcohol. Patient should be educated about preventive measures for oral health and hydration. Aerobic exercise improves fatigue and quality of life. Immunization to influenza and pneumococo are indicated. Serum levels of vitamin D should be evaluated and supplemented if it is necessary. <i>Part 2. Symptomatic treatment of dryness:</i> Topical treatment for dry mouth includes saliva substitutes, sugar-free candies and gums. Topical treatments for dry eye are lubricants (glucanes or carboximethylcelulose), cyclosporine 0.05%, and punctual occlusion. Topical glucocorticoids may be used for severe dry eye for short time avoiding complications. Pilocarpine and cevimeline should be used for dry mouth and for severe dry eye. N-acetylcysteine may be used for dryness symptoms, including patients showing intolerance for muscarinic agonists. Omega-3 supplementation may be used to dry eye. <i>Part 3. Systemic treatment:</i> Immunosupressant and/or biological therapy are not indicated to dryness treatment. Hydroxichloroquine, glucocorticoid, and immunossupressants (azathioprine, mycophenolate mofetil, cyclophosphamide, cyclosporine) should be indicated according severity of systemic involvement. Rituximab is indicated to treat systemic manifestations without improvement with immunosuppressive therapy. Abatacept and belimumab may be considered in patients not responding to rituximab and with high level of disease activity. <h3>Acknowledgements</h3> Sociedade Brasileira de Reumatologia (SBR) <h3>Disclosure of Interest</h3> None declared
SP0068 What Current Strategies Do We Employ for Stratifying Treatments in Rheumatoid Arthritis?
Authors: B. Combe
Journal: Annals of the Rheumatic Diseases (2015)

Personalized medicine including patients stratification for the best outcome is a major grail in medicine. Rheumatoid arthritis (RA) outcome has dramaticaly improved with the efficacy of synthetic and biologic DMARDs combined with early effective management and tight control targeting remission or low disease activity. However unmet needs are still there and with numerous therapeutic options available making treatment decisions in clinical practice remains challenging. To date no predictive factors of therapeutic response have been identified to guide the choice of a specific treatment in RA patients. The first recommended treatment is similar for every patients including methotrexate frequently combined with low dose steroids. Anyway, EULAR recommends to guide second line treatment decisions based on the use of prognostic factors of outcome (eg, early erosion, high disease activity, rheumatoid factor positivity, and/or anti-cyclic citrullinated peptide antibodies). In case of bad prognostic features it is suggested the addition of biologic therapy rather than other synthetic DMARDs. The choice of the biological DMARD is also challenging since all biological drugs currently available show similar response rates, similar safety profile and same frequency of good outcome regardless of their mechanisms of action. One of the major unmet needs in RA is the group of patients for whom anti-TNF agents, usually the first line biologic therapy, have failed. Such patients may be more likely to have less TNF-dependent disease and could benefit from subsequent treatment with a targeted therapy of different class. However, this attractive hypothesis has still not been confirmed by clinical data and the choice of the new therapeutic option may be based on the primary or secondary inefficacy to this first line therapy. In addition, factors apart from disease activity, and disease severity such as co-morbidities and safety issues, could also influence the treatment options for an individual patient. Finally, since achieving remission is the major objective in the management of RA patients in daily life, predictive factors of remission, such as early therapeutic response, have been identified and may also guide the therapeutic strategy. In summary, stratifying treatment in RA patients is a difficult task in daily practice and is still mainly based on clinical evaluation. <h3>Disclosure of Interest</h3> None declared
Cellular Immunity in Mice With Simian Virus 40-Induced mKSA Tumors: Comparison of Three Assays of Tumor Immunity
Authors: S. B. Howell, E. C. Esber, L. W. Law
Journal: JNCI Journal of the National Cancer Institute (1974)

BALB/c mice with syngeneic simian virus-40-derived tumors for 0–4 weeks were tested for their cellular immune capacity by a combination of in vivo and in vitro assays. Early tumor growth was associated with detectable cellular immunity, as measured by direct tumor challenge, the Winn test, and a modified microcytotoxicity assay. Animals with advanced tumors lost immunity detected by direct tumor challenge and the Winn test, whereas specific immunity detected by the microcytotoxicity assay persisted. These studies support previous concepts that the immune status of tumor-bearing mice is altered with increasing total tumor load. Additionally, the discrepancy between these assays performed in parallel may reflect functionally different components of the immune response to tumor-associated transplantation antigens.
Serum inflammatory parameters as prognostic factors in patients with gastic cancer: Is serum albumin the best inflammotory biomarker predicting prognosis?
Authors: Fatma Sen, Ethem Zobaci, Haci Kemal Erdemli, Ramazan Kocabas, Leyla Kilic, Ibrahim Yildiz
Journal: Journal of Clinical Oncology (2014)

e15002 Background: Our aim was to evaluate the significance of serum inflammatory markers including serum C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), neutrophil lymphocyte ratio (NLR) and serum albumin level in predicting prognosis in patients with gastric cancer and to evaluate relationship between inflammatory markers and clinicopathologic characteristics. Methods: The study population consisted of 53 advanced gastric cancer patients. The systemic inflammatory markers including CRP, ESR, albumin and NLR in addition to clinical and tumor-releated factors were recorded. Patients were classified into 2 groups based on median levels of each marker (group 1: patients with serum marker ≤ median level, group 2: patients with serum marker > median level). The relationship between inflammatory markers and the clinicopathologic parameters were assessed via chi square test. The association of each marker with survival was analyzed using the log-rank test. Multivariate analyses were carried out using the Cox proportional hazard model. Results: Twenty one percent of patients was female and 81% was male with a median age of 65 years (min-max: 37-87). Twenty two patients had stage IV disease and 28 patients had tumor load. All analysed inflammatory parameters were statistically significantly higher in patients with tumor load than those without (p<0.05). ESR did not correlate with distant metastasis in contrast to CRP, serum albumin and NLR. In univariate analysis, serum albumin, CRP, and NLR levels were useful prognostic biomarker for predicting progression free survival (PFS) and overall survival (OS). In multivariate analysis, only serum albumin was found to be prognostic for PFS (p =0.05; HR: 4.735; 95% CI: 0.966-23.202), but none of the studied inflammatory markers were found to be significant for OS. Conclusions: This study demonstrates that gastric cancer patients with low serum albumin level, high CRP, high ESR and high NLR may have tumor load. In addition, patients with high CRP levels should be evaluated for distant metastasis. Serum albumin level may be the most useful inflammatory biomarker predicting prognosis of gastric cancer.
Reply
Authors: Ling Li, Florin M. Selaru
Journal: Hepatology (2014)

Patients with the deadly cancer, cholangiocarcinoma (CCA), are in dire need of improved diagnostics.1 Our recent endeavors in this field yielded a microRNA marker panel developed based on extracellular vesicles (EVs) present in human bile.2 Our declared goal was to identify a CCA marker panel that is reproducible and accurate. With reproducibility in mind, we purposely sought a bile processing protocol that can easily be performed in a clinical laboratory. In addition, while ultimately pursuing accuracy, we did not seek to be all-inclusive regarding sources of microRNA in human bile. Through direct experimentation, we found that utilization of whole bile for microRNA extraction, as previously described,3 yields a higher quantity of microRNA per volume unit of bile. However, in our hands, when whole bile was used, microRNA species extracted demonstrated a much higher variation as a function of the bile processing protocol, storage at room temperature, and freeze-thaw cycles. Therefore, we deliberately moved away from whole bile and explored biliary EVs as a sole source of microRNA. We found that, although the quantity of microRNA extracted per volume unit of bile was less, the stability of microRNA expression was greatly improved.2 Specimen collection in clinics and hospitals is subject to variability; moreover, the more stringent the requirements for strict collection and storage protocols, the higher the cost and the likelihood of poor-quality specimens. As correctly noted in the Letter to the Editor by our colleagues (Roest et al., this issue), we did not use the full spectrum of microRNAs present in human bile, but restricted our analyses to EV-sourced microRNAs. While further studies may demonstrate that the use of soluble microRNA fraction will yield further improved accuracy, such experiments were not the aim of the current study. We sought accuracy, simplicity, and reproducibility. We deem this tradeoff acceptable, as our marker panel displays high reproducibility and minimal requirements with regard to sample collection, storage, and processing, while providing an additional diagnostic tool to increase diagnostic accuracy in CCA patients. Ling Li, M.D., Ph.D.Florin M. Selaru, M.D. Johns Hopkins University Johns Hopkins Hospital Baltimore, MD
Historical comment on DSM-III schizoid and avoidant personality disorders
Authors: W J Livesley, M West, A Tanney
Journal: American Journal of Psychiatry (1985)

The authors examine the DSM-III distinction between schizoid and avoidant personality disorders. This distinction is based on Millon's biosocial learning theory and his interpretation of Kretschmer's personality types. The authors argue that this separation of a continuous distribution is historically misconceived and serves to obscure the significant features of schizoid personality. They examine Kretschmer's conceptualization of schizoid personality for the implications it carries for the development of a classification of personality disorder, suggesting that Kretschmer's approach implies a "polythetic" model of personality disorder that conceptualizes disorders as categories of dimensions.