tbuckley/cabot-search huggingface dataset:
Plasma Renin Activity and Blood Pressure in Terminal Renal Failure
Authors: Peter Weidmann, Morton H. Maxwell, Andrei N. Lupu, Andrew J. Lewin, Shaul G. Massry
Journal: New England Journal of Medicine (1971)

The predictive value of renin determinations in selection of patients with terminal renal failure and hypertension for bilateral nephrectomy was evaluated in 51 patients maintained on chronic hemodialysis. Nine patients were normotensive before dialysis (Group 1); of the 42 hypertensive subjects, blood pressure was controlled by sodium restriction and Ultrafiltration in 24 (Group 2), but was resistant to these modalities and antihypertensive drugs in 18 (Group 3). Moderately to markedly increased plasma renin activity (PRA) levels clearly distinguished the 17 patients of Group 3 whose hypertension was improved by nephrectomy from patients with sodium-volume-dependent hypertension treatable by dietary restrictions and hemodialysis (Group 2). One patient of Group 3 had a normal PRA and did not benefit from nephrectomy. alpha-methyldopa consistently decreased PRA and should be withdrawn before diagnostic studies. In 16 of our 17 cases of hypertensive hyper-reninemic terminal renal failure the underlying renal disease was nephrosclerosis or glomerulonephritis.
Breast Self-Examination Practices and Breast-Cancer Stage
Authors: Roger S. Foster, Sandra P. Lang, Michael C. Costanza, John K. Worden, Carleton R. Haines, Jerome W. Yates
Journal: New England Journal of Medicine (1978)

To determine the relation between breast self-examination performance and the clinical and pathological stage of breast cancer at first diagnosis, we studied 335 patients with breast cancer. Approximately one fourth of the patients reported that they had been practicing monthly breast self-examination, and half that they had never practiced breast self-examination. More frequent performance of breast self-examination was associated with more favorable clinical stage and fewer axillary-lymph-node metastases on histologic examination. On pathological examination, the age-adjusted maximum tumor diameter of patients practicing monthly breast self-examination was 1.97 +/- 0.22 cm (mean +/- S.E.M.) as compared to 2.47 +/- 0.20 for those performing self-examination less often than monthly and 3.59 +/- 0.15 for patients never performing breast self-examination. These data associating more favorable clinical and pathological stages of breast cancer with more frequent breast self-examination need to be extended by determination of the survival rates of the various self-examination groups.
P164 Smoking at the time of curative-intent lung cancer surgery increases perioperative complications: is there a role for electronic cigarettes?
Authors: ST Lugg, T Tikka, PJ Agostini, A Kerr, J Webb, K Adamas, E Bishay, RS Steyn, MS Kalkat, PB Rajesh, DR Thickett, B Naidu
Journal: Thorax (2015)

<h3>Introduction</h3> Smoking is a risk factor for postoperative pulmonary complications (PPCs) following curative-intent surgery for lung cancer. Risk modification is via smoking cessation; the role that electronic cigarettes (e-cigarettes) have in preoperative tobacco replacement is a debated topic. <h3>Aims</h3> Investigate the impact of smoking on postoperative outcome including long-term survival. Assess current smoking habits and attitudes towards preoperative smoking cessation, with emphasis on e-cigarette use. <h3>Methods</h3> A prospective observational study was carried out on all patients following curative-intent lung cancer resection in a regional thoracic centre over 4 years. Preoperative smoking status was self-reported by all patients. PPCs were assessed daily in hospital using the Melbourne group scale.<sup>1</sup> Other data included patient demographics, hospital length of stay (LOS), intensive treatment unit (ITU) admission and mortality data. To assess smoking habits, a questionnaire was given to 105 patients attending the preoperative assessment unit. <h3>Results</h3> Of 460 patients, 24% were current smokers, 12% ex-smokers 6 weeks duration, and 11% never smoked Compared to never smokers, current smokers had significantly longer hospital LOS in days (9, CI 7–11 vs. 6, CI 4–8; p &lt; 0.001), higher frequency of PPCs (22% vs 2%, p = 0.001) and ITU admissions (14% vs. 0%; p &lt; 0.005). Compared to never smokers, the trend was for reduced survival in current smokers from 1–3 years, but the survival lines converged after this (median follow-up 30 vs. 31 months; p = 0.31). The questionnaire found 24/105 patients were smokers, of these 80% patients had previously tried to quit but only 38% had been specifically approached by health-care professionals about smoking cessation. When asked if they would consider stopping smoking immediately if supplied an e-cigarette, 54% said yes. <h3>Conclusions</h3> Preoperatively, 1 in 4 patients continue to smoke; the majority have attempted to quit and failed. Current smokers have higher postoperative morbidity with no significant survival difference within our follow-up period. Current methods of preoperative smoking cessation in this population are ineffective; patients appear willing to use e-cigarettes. Further research in this field is urgently needed. <h3>Reference</h3> 1 Agostini P, <i>et al</i>.<i> Thorax</i> 2010;<b>65</b>:815–18
HCP-08PROGNOSTIC AWARENESS AND PROGNOSTIC COMMUNICATION IN MALIGNANT GLIOMA
Authors: Eli Diamond, Holly Prigerson, Katherine Panageas, Denise Correa, Maria Kryza-Lacombe, Elizabeth Neil, Anne Reiner, Justin Buthorn, William Breitbart, Lisa DeAngelis, Allison Applebaum
Journal: Neuro-Oncology (2015)

BACKGROUND: For patients with incurable cancer, prognostic awareness (PA) is associated with favorable psychological states and end-of-life outcomes. Malignant glioma (MG) is a devastating cancer with uniformly poor prognosis, however prospective and systematic measurement of (1) patients' and caregivers' PA and (2) evaluation of prognostic communication (PC) has not been attempted. METHODS: Cross-sectional study of fully-oriented (Glasgow Coma Scale 15/15) MG patients and a subset of caregivers. Participants underwent a semi-structured assessment of their awareness of incurability and life expectancy and evaluated PC with Likert-scale responses. Interviews were audio-recorded and consensus-scored by two independent raters. Patients underwent multi-domain neurocognitive testing and screening for anxiety and depression. RESULTS: 34 patients with 20 matched caregivers have participated. No patients withdrew consent or refused to discuss PA. Fifteen (44%) had zero or one recurrence of disease and 19(56%) were multiply-recurrent. Fourteen (41%) patients demonstrated full PA (awareness of incurability and estimated life expectancy). Of the 20 (59%) patients with limited or no PA, 10 (50%) had multiply-recurrent MG; 8 (40%) indicated that they desired more PC and 9(45%) rated the quality of PC as satisfactory, fair, or poor. Full PA was not associated with anxiety or depression as compared to limited/no awareness (36% versus 32% and 43% versus 42%, respectively). There was no significant difference in cognitive performance between those with full versus limited/no awareness. Fourteen (70%) of caregivers had full PA. CONCLUSIONS: Candid discussion of prognostic information is feasible in MG. A significant proportion of MG patients are unaware of their life expectancy, even in the setting of multiply-recurrent disease. Absence of awareness does not appear related to lower importance attributed to PC, or to worse cognitive function, as compared to full awareness. Full awareness is not associated with psychological distress. Further study of PA and associated outcomes in MG is necessary.
Sixty seconds on . . . striking junior doctors
Authors: Adrian O’Dowd
Journal: BMJ (2016)

Quite a few, it seems . NHS England estimated that around 52.6% of the 26 000 junior doctors due to be working that 24 hour period from 8 am on Tuesday 12 January to 8 am on Wednesday 13 January didn’t go to work, so around 13 670 juniors were on strike.

Yes, suspiciously so, some …
Unified Airway Theory: Association of Bronchiectasis and Chronic Rhinosinusitis
Authors: Sumit Bose, Whitney W. Stevens, Newton Li, Mariel G. Rosati, Leslie C. Grammer, Kathryn E. Hulse, Atsushi Kato, Robert C. Kern, Bruce K. Tan, Stephanie S. Smith, Kevin C. Welch, David B. Conley, Pedro C. Avila, Robert P. Schleimer, Anju T. Peters
Journal: Journal of Allergy and Clinical Immunology (2016)
Observations on the Antibody Content of the Blood in Patients with Multiple Myeloma
Authors: Herman A. Lawson, C. A. Stuart, Alton M. Paull, Arthur M. Phillips, Roswell W. Phillips
Journal: New England Journal of Medicine (1955)

GREAT advances have been made in knowledge and understanding of the complex factors concerned in resistance or susceptibility to infection, but much remains that is controversial or incompletely understood.The current widespread interest in and demonstrated value of gamma-globulin administration in the prophylaxis of certain infectious diseases, such as viral hepatitis, has served to call attention to this constituent of the plasma proteins and its role in protection against infection. The recognition in recent years of that rare disorder, agammaglobulinemia, and the greatly increased susceptibility to infections in such patients, has also stimulated interest in gamma globulin and its ability . . .
Making Better Chimeric Antigen Receptors for Adoptive T-cell Therapy
Authors: Marcela V. Maus, Carl H. June
Journal: Clinical Cancer Research (2016)

Chimeric antigen receptors (CAR) are engineered fusion proteins constructed from antigen recognition, signaling, and costimulatory domains that can be expressed in cytotoxic T cells with the purpose of reprograming the T cells to specifically target tumor cells. CAR T-cell therapy uses gene transfer technology to reprogram a patient's own T cells to stably express CARs, thereby combining the specificity of an antibody with the potent cytotoxic and memory functions of a T cell. In early-phase clinical trials, CAR T cells targeting CD19 have resulted in sustained complete responses within a population of otherwise refractory patients with B-cell malignancies and, more specifically, have shown complete response rates of approximately 90% in patients with relapsed or refractory acute lymphoblastic leukemia. Given this clinical efficacy, preclinical development of CAR T-cell therapy for a number of cancer indications has been actively investigated, and the future of the CAR T-cell field is extensive and dynamic. Several approaches to increase the feasibility and safety of CAR T cells are currently being explored, including investigation into the mechanisms regulating the persistence of CAR T cells. In addition, numerous early-phase clinical trials are now investigating CAR T-cell therapy beyond targeting CD19, especially in solid tumors. Trials investigating combinations of CAR T cells with immune checkpoint blockade therapies are now beginning and results are eagerly awaited. This review evaluates several of the ongoing and future directions of CAR T-cell therapy.
Terminal Deoxynucleotidyl Transferase Activity in Malignant Lymphomas
Authors: Jerome A. Donlon, Elaine S. Jaffe, Raul C. Braylan
Journal: New England Journal of Medicine (1977)

To determine the usefulness of terminal deoxynucleotidyl transferase enzyme activity as a biochemical marker in the study of lymphoma, we assayed 50 various malignant lymphomas as well as normal lymphoid tissue for this activity. Neoplastic cells from patients with Hodgkin's disease, Burkitt's tumor, Sézary's syndrome, chronic lymphocytic leukemia, leukemic reticuloendotheliosis and lymphocytic lymphomas (poorly differentiated and intermediate) were all without notable enzyme activity. Large-cell tumors of B-cell type were also negative. One of three large-cell tumors without B-cell or T-cell-surface specificity was positive (1.40 nmol per hour per milligram of DNA). Enzyme activity was consistently present only in lymphoblastic lymphomas (all six cases studied), with a mean activity of 7.80 nmol per hour per milligram of DNA. These six cases had heterogeneous surface immunomarkers. We conclude that terminal deoxynucleotidyl transferase is a biochemical marker that will be useful in the study of lymphoma.
Case 11-2009
Authors: Sigall K. Bell, Eric S. Rosenberg
Journal: New England Journal of Medicine (2009)

A 47-year-old man was admitted to the hospital because of fever, headache, rash, and vomiting. The patient had been well until 8 days earlier, when pleuritic chest pain developed, along with a maculopapular rash that spared the palms and soles. Examination of the cerebrospinal fluid disclosed an elevated white-cell count (70% lymphocytes), elevated protein levels, and a normal glucose level. Vancomycin, ceftriaxone, and acyclovir were administered. Additional diagnostic tests were performed.
Gingival Hypertrophy in Myelomonocytic Leukemia
Authors: S H van Uum, J J Keuning
Journal: New England Journal of Medicine (1994)

Figure 1. Gingival Hypertrophy in Myelomonocytic Leukemia. A 36-year-old woman with chronic myelomonocytic leukemia had marked gingival hypertrophy, thought to be due to infiltration of the gingiva by leukemic cells. The patient presented with a white-cell count of 28,800 per cubic millimeter, with 23 percent monocytes and 2 percent monoblasts, a hematocrit of 20 percent, and a platelet count of 156,000 per cubic millimeter. Treatment with etoposide, idarubicin, and cytarabine resulted in a clinical remission, with resolution of the gingival lesions.
MMPI diagnosis of black psychiatric patients
Authors: V R Adebimpe, J Gigandet, E Harris
Journal: American Journal of Psychiatry (1979)

Black-white differences in MMPI norms may lead to significant misclassification of black psychiatric patients, which can compound diagnostic errors from other sources. The authors suggest that clinicians who use MMPI results in evaluations of black patients interpret test reports carefully, keeping in mind the possibility of spuriously elevated scores and paying careful attention to areas of potential "false positives."
Mild cough and decreased breath sounds in an 82 year old woman
Authors: David C Howlett, Joseph Dalby Sinnott
Journal: BMJ (2016)

An 82 year old woman presented to her general practitioner with a tickling cough and symptoms of an upper respiratory tract infection. Her blood gas saturations were normal and she was otherwise well. However, she had a history of tuberculosis and had undergone an unknown operation many years ago. The GP thought that she had decreased breath sounds at …
Appropriate Use of Nomograms to Guide Prostate Cancer Treatment Selection
Authors: Andrew K. Lee, Christopher L. Amling
Journal: Journal of the National Comprehensive Cancer Network (2010)

For decades physicians have attempted to accurately predict post-treatment outcomes before performing prostate cancer interventions. Use of basic clinical factors, such as clinical T-stage, biopsy Gleason sum, and pretreatment prostate specific antigen, has allowed some level of prediction of pathologic and clinical outcomes. However, these basic tables and risk stratification schema provide a broad range of potential outcomes. The rapid growth of retrospective research in prostate cancer has yielded an abundance of additional potential prognostic factors that may influence outcomes of interest; however, incorporating and understanding the significance of these ever-expanding factors is difficult for even the most experienced physicians. Nomograms incorporate these factors (including treatment-specific) and assign them relative weights to provide a probability of the outcome of interest on a graphical scale. They distill large numbers of data into a manageable format and provide the probability of outcomes on a continuous scale rather than in categoric groups. However, because they require a computation to generate a probability, they are not amenable to memorization, which decreases ease of use. Furthermore, these numbers still have associated confidence intervals and the models are largely derived from retrospective data, which have inherent drawbacks. Clinicians and patients should still exercise due diligence when interpreting the results of these nomograms, and these prediction tools should not serve as a stand-alone substitute for clinical decision-making.
The Use of Aspirin to Prevent Ppregnancy-Induced Hypertension and Lower the Ratio of Thromboxane A<sub>2</sub>to Prostcyclin in Relatively High Risk Pregnancies
Authors: Eyal Schiff, Edna Peleg, Mordechai Goldenberg, Talma Rosenthal, Eytan Ruppin, Mordechai Tamarkin, Gad Barkai, Gilad Ben-Baruch, Iris Yahal, Joseph Blankstein, Boleslav Goldman, Shlomo Mashiach
Journal: New England Journal of Medicine (1989)

We carried out a prospective, randomized, double-blind, placebo-controlled study to investigate the capacity of aspirin to prevent pppregnancy-induced hypertension and to alter prostaglandin metabolism. A total of 791 pregnant women with various risk factors for preeclamptic toxemia were screened with use of the rollover test (a comparison of blood pressure before and after the woman rolls from her left side to her back) during week 28 or 29 of gestation. Of 69 women with abnormal results (an increase in blood pressure during the rollover test), 65 entered the study and were treated with a daily dose of either aspirin (100 mg; 34 women) or placebo (31 women) during the third trimester of pregnancy. The number of women in whom pppregnancy-induced hypertension developed was significantly lower among the aspirin-treated than among the placebo-treated women (4 [11.8 percent] vs. 11 [35.5 percent]; P = 0.024); the same was true for the incidence of preeclamptic toxemia (1 [2.9 percent] vs. 7 [22.6 percent]; P = 0.019). The mean ratio of serum levels of thromboxane A2 to serum levels of prostacyclin metabolites after three weeks of treatment decreased by 34.7 percent in the aspirin-treated group but increased by 51.2 percent in the placebo-treated group. No serious maternal or neonatal side effects of treatment occurred in either group. We conclude that low daily doses of aspirin taken during the third trimester of pregnancy significantly reduce the incidence of pppregnancy-induced hypertension and preeclamptic toxemia in women at high risk for these disorders, possibly through the correction of an imbalance between levels of thromboxane and prostacyclin. (N Engl J Med 1989;321:351–6.)
Case 38-1963
Authors: William H. Harris, Walter G. J. Putschar
Journal: New England Journal of Medicine (1963)

Presentation of CaseA six-year-old Negro girl was admitted to the hospital because of a swelling on the right leg.Three years before entry the child struck the right leg in a fall from a seesaw, and x-ray films taken at another hospital revealed a fracture through a cystic lesion in the mid-shaft of the right tibia (Fig. 1). A cast was applied for six weeks, and thereafter the mother noticed persistent swelling over the fracture site, with no change during the interval before the present admission. The child was well and active until three weeks before entry, when she . . .
P243 Assessing the Effect of pH on Citric Acid Cough Challenges in Chronic Cough Patients and Healthy Volunteers
Authors: Z Rai, H Fowles, J Howard, A Morice
Journal: Thorax (2015)

<h3>Introduction</h3> Citric acid has been used for over 6 decades in cough challenge studies, however despite this, the mechanism of its tussive effect is still not fully understood. We assessed the cough response to citric acid solutions, at different levels of acidity (pH) to determine what role this plays in the induction of cough. Healthy volunteers and chronic cough patients were compared. <h3>Methods</h3> 20 chronic cough patients and 20 healthy volunteers were recruited and underwent three cough challenges at 48 h apart. Each visit involved 5 repeated inhalations of a 300 mM citric acid solution. Whilst the concentration of the citrate cation was kept constant, the pH was varied by titration with sodium hydroxide, to achieve pH 3, 5 and 6. These represent the Pka values of the individual acid moieties within citric acid. The total number of coughs elicited per study day was recorded. <h3>Results</h3> Participants were gender matched, each group consisting 12 females Two participants withdrew and were not included in the analysis. In healthy volunteers, 60% of people coughed at pH3 (average coughs 9), 30% of people coughed at pH5 (average coughs 3), and 10% of people coughed at pH6 (average coughs 0). In contrast, 74% of chronic coughers coughed at pH 3 (average coughs 16), 89% coughed at pH 5 (average coughs 18) and 63% coughed at pH 6 (average coughs 7). Thus there was a clear dose response to decreasing pH in healthy volunteers but not in chronic cough patients. The standard deviation of cough challenge on an individual day was determined to explore the variability of response to inhalation challenge. At pH 3 CC vs HV was x vs y, at pH 5 × 1 vs y1 and at pH 6 × 2 vs y2 (p &gt; 0.01). <h3>Discussion</h3> As we have previously reported, chronic cough patients are hypersensitive to citric acid challenge. However the response to individual challenge is much more variable than in HV, suggesting the cough reflex circuitry in these patients is ‘unstable’. This was particularly shown at higher pH where cough was virtually abolished in healthy volunteers but not chronic cough patients. It has been widely suggested that cough hypersensitivity resides in up regulation and interplay of different peripheral receptors. That a single stimulus increases the variability of response in a pathological state suggests that hypersensitivity to citric acid resides in a complex central rather than peripheral mechanism.
Longer Follow-Up Of The Combination Of Clofarabine, Idarubicin, and Cytarabine (CIA) As Frontline Therapy For Patients Younger Than 61 Years With Newly Diagnosed Acute Myeloid Leukemia (AML)
Authors: Aziz Nazha, Hagop M. Kantarjian, Farhad Ravandi, Huang Xuelin, Sangbum Choi, Guillermo Garcia-Manero, Elias Jabbour, Gautam Borthakur, Tapan M. Kadia, Marina Konopleva, Jorge E. Cortes, Alessandra Ferrajoli, Steven M. Kornblau, Michael Andreeff, Min Du, Mark Brandt, Stefan H. Faderl
Journal: Blood (2013)
A Leading Question
Authors: Yitzhak Beigel, Iris Ostfeld, Nili Schoenfeld
Journal: New England Journal of Medicine (1998)

A 43-year-old man was hospitalized because of a three-day history of epigastric pain, pain in the right upper quadrant, and constipation. The pain was intermittent and not associated with nausea, vomiting, fever, or eating.The patient had been born in Israel to parents of Libyan origin. His job as a merchant often took him abroad, especially to Spain and Egypt. He had had type 2 diabetes mellitus for six years, for which he took 5 mg of glyburide per day. Approximately 13 months before the present admission, he had been hospitalized at another facility for several days for . . .