tbuckley/cabot-search huggingface dataset:
Birth “Out-of-Hours”: An Evaluation of Obstetric Practice and Outcome According to the Presence of Senior Obstetricians on the Labour Ward
Authors: Hannah E. Knight, Jan H. van der Meulen, Ipek Gurol-Urganci, Gordon C. Smith, Amit Kiran, Steve Thornton, David Richmond, Alan Cameron, David A. Cromwell
Journal: PLoS Medicine (2016)

Background Concerns have been raised that a lack of senior obstetricians ("consultants") on the labour ward outside normal hours may lead to worse outcomes among babies born during periods of reduced cover. Methods and Findings We carried out a multicentre cohort study using data from 19 obstetric units in the United Kingdom between 1 April 2012 and 31 March 2013 to examine whether rates of obstetric intervention and outcome change "out-of-hours," i.e., when consultants are not providing dedicated, on-site labour ward cover. At the 19 hospitals, obstetric rotas ranged from 51 to 106 h of on-site labour ward cover per week. There were 87,501 singleton live births during the year, and 55.8% occurred out-of-hours. Women who delivered out-of-hours had slightly lower rates of intrapartum caesarean section (CS) (12.7% versus 13.4%, adjusted odds ratio [OR] 0.94; 95% confidence interval [CI] 0.90 to 0.98) and instrumental delivery (15.6% versus 17.0%, adj. OR 0.92; 95% CI 0.89 to 0.96) than women who delivered at times of on-site labour ward cover. There was some evidence that the severe perineal tear rate was reduced in out-of-hours vaginal deliveries (3.3% versus 3.6%, adj. OR 0.92; 95% CI 0.85 to 1.00). There was no evidence of a statistically significant difference between out-of-hours and "in-hours" deliveries in the rate of babies with a low Apgar score at 5 min (1.33% versus 1.25%, adjusted OR 1.07; 95% CI 0.95 to 1.21) or low cord pH (0.94% versus 0.82%; adjusted OR 1.12; 95% CI 0.96 to 1.31). Key study limitations include the potential for bias by indication, the reliance upon an organisational measure of consultant presence, and a non-random sample of maternity units. Conclusions There was no difference in the rate of maternal and neonatal morbidity according to the presence of consultants on the labour ward, with the possible exception of a reduced rate of severe perineal tears in out-of-hours vaginal deliveries. Fewer women had operative deliveries out-of-hours. Taken together, the available evidence provides some reassurance that the current organisation of maternity care in the UK allows for good planning and risk management. However there is a need for more robust evidence on the quality of care afforded by different models of labour ward staffing.
Case 13-2013
Authors: Michael J. Kelly, Pallavi Sagar, Veronica E. Klepeis
Journal: New England Journal of Medicine (2013)

A 6-year-old girl was admitted to this hospital because of bone and joint pain for 1 year and recent onset of fever and abdominal distention. Imaging revealed a mass in the abdominal and pelvic region and lesions in the liver, kidneys, and multiple bones.
Case 10-2008
Authors: Kenan E. Haver, Christopher J. Hartnick, Daniel P. Ryan, Randheer Shailam, Eugene J. Mark
Journal: New England Journal of Medicine (2008)

A 10-year-old girl was seen because of dyspnea and noisy respirations. Three weeks earlier, sharp pain in the chest and shortness of breath had developed abruptly, followed by dyspnea and noisy respirations with exertion. Symptoms did not improve with the use of bronchodilators. A diagnostic procedure was performed.
Case 15-2007
Authors: Michael E. Wechsler, Jo-Anne O. Shepard, Eugene J. Mark
Journal: New England Journal of Medicine (2007)

A 20-year-old woman with a history of severe asthma was found at home in an unresponsive state and was taken to the emergency room. Asthma had been diagnosed at 4 years of age, with multiple exacerbations thereafter that required hospitalization. The patient and her mother had not followed environmental and medication regimens. In the weeks before admission, the patient had visited many emergency rooms and clinics because of exacerbations. She was pronounced dead shortly after arrival. An autopsy was performed.
A Study of Antibiotic Prophylaxis in Patients with Acute Heart Failure
Authors: Robert G. Petersdorf, Richard K. Merchant
Journal: New England Journal of Medicine (1959)

PATIENTS in congestive heart failure have a tendency to contract pulmonary infections. Conversely, pulmonary infections often precipitate bouts of cardiac decompensation in patients with heart disease. Since it may be exceedingly difficult to differentiate pulmonary congestion from pulmonary infection by physical examination or roentgenography, it has been suggested that antibiotics be administered routinely to all patients with acute episodes of decompensation, either to prevent the occurrence of pneumonia in a particularly susceptible subject or to treat an infection already present.1 , 2 This practice has never been subjected to critical analysis. The observation that antibiotic prophylaxis was unsuccessful in preventing pulmonary infections . . .
Congenital Deaf-Mutism, Prolonged QT Interval, Syncopal Attacks and Sudden Death
Authors: Samuel A. Levine, Clyde R. Woodworth
Journal: New England Journal of Medicine (1958)

THE case reported below represents a new and very distinct clinical entity. The young patient was observed by us for some years. It was hoped that a similar combination of clinical findings might be met with before these extraordinary features were regarded as more than coincidental. Now that a family in which 4 members manifested these same unusual features has recently been reported,1 it seems appropriate to record this experience.This boy showed the essential peculiarities that identify the condition — that is, congenital deaf-mutism, attacks of unconsciousness, peculiar electrocardiograms consisting of marked prolongation of the QT interval, with large . . .
Re: Hashim U. Ahmed, Louise Dickinson, Susan Charman, et al. Focal Ablation Targeted to the Index Lesion in Multifocal Localised Prostate Cancer: a Prospective Development Study. Eur Urol 2015;68:927–36
Authors: Hanzhong Li, Weigang Yan, Zhigang Ji
Journal: European Urology (2016)
Acid Débridement of Burns with Phosphoric-Acid Gel
Authors: Robert J. Schweitzer, Jacob T. Bradsher
Journal: New England Journal of Medicine (1951)

THE introduction of a satisfactory chemical method for the early débridement of burns would simplify a perplexing problem. For many years attempts have been made to find some agent that would selectively digest or remove the necrotic slough that follows severe burning. Since Connor and Harvey1 in 1944 first reported the use of pyruvic-acid starch paste as a suitable agent, few clinical reports have been published on the use of this method of débridement.With a severe burn the open wound is largely responsible for serious electrolytic and protein aberrations resulting from the tremendous loss of serum. The persistence of . . .
Eczema Is an Independent Risk Factor for Incident Mouse Skin Test Sensitivity Among Employees at a Mouse Production and Research Facility
Authors: Torie Grant, Jennifer Dantzer, Corinne Keet, Roger Peng, Mary Krevans, Karol Hagberg, Jean Curtin-Brosnan, Wayne Shreffler, Elizabeth Matsui
Journal: Journal of Allergy and Clinical Immunology (2016)
159P: Early radiological response (ERR) as predictor of overall survival in non small cell lung cancer (NSCLC) patients with EGFR mutations
Authors: C. Salvador Coloma, O.M. Niño, J. Gomez Codina, C. Escoin Pérez, S. Palanca, D. Akhoundova Sanoyan, M. Melián, J. Montalar, O. Juan
Journal: Journal of Thoracic Oncology (2016)
Comparison of Standard and Low Serum Levels of Lithium for Maintenance Treatment of Bipolar Disorder
Authors: Alan J. Gelenberg, John M. Kane, Martin B. Keller, Philip Lavori, Jerrold F. Rosenbaum, Karyl Cole, Janet Lavelle
Journal: New England Journal of Medicine (1989)

In recent years, lower serum levels have been recommended for maintenance therapy with lithium. We studied 94 patients with bipolar disorder in a randomized, double-blind, prospective trial of two different doses of lithium for maintenance therapy: the "standard" dose, adjusted to achieve a serum lithium concentration of 0.8 to 1.0 mmol per liter, and a "low" dose, resulting in a serum concentration of 0.4 to 0.6 mmol per liter. The group medians of the patients' average serum lithium levels were 0.83 mmol per liter for the patients in the standard-range group and 0.54 mmol per liter for those in the low-range group. Six of 47 patients (13 percent) assigned to receive lithium doses that would produce serum levels in the standard range had relapses while on protocol, as compared with 18 of 47 (38 percent) assigned to the low-dose range. The risk of relapse was 2.6 times higher (95 percent confidence interval, 1.3 to 5.2) among patients in the low-range group than among those in the standard-range group. Side effects, including tremor, diarrhea, urinary frequency, weight gain, and a metallic taste in the mouth, were more frequent in the standard-range group. We conclude that doses resulting in serum lithium levels from 0.8 to 1.0 mmol per liter are more effective in treating bipolar disorder than those that result in lower serum lithium concentrations, although the higher doses are associated with a higher incidence of side effects. Recent findings about the limited nephrotoxicity of lithium, along with our observations, suggest that physicians should attempt to maintain serum lithium levels between 0.8 and 1.0 mmol per liter in most patients with bipolar disorder and that they should attempt to enhance patients' understanding of and compliance with this regimen. (N Engl J Med 1989; 321:1489–93.)
Hospital trusts will adapt junior doctor contract if they have to
Authors: Ingrid Torjesen
Journal: BMJ (2016)

England’s health secretary, Jeremy Hunt, has reiterated that hospital trusts will be expected to implement the new junior doctor contract for all new trainees from August and move existing junior doctors onto it as they change training posts—or else face losing funding for training posts.

But some trusts have told The BMJ that they may be prepared to set their own terms and conditions if faced with unworkable rotas and morale at rock bottom among junior doctors.

Responding to an urgent request by Labour’s shadow health secretary, Heidi Alexander, on what Hunt meant by “imposition” of the contract, the health secretary told the House of Commons on 18 April, “It has never been the government’s plan to insist on changes to existing contracts.” He explained, “It will start with those in foundation year 1 from this August and proceed with a phased implementation for other …
FRI0426 Sjögren Syndrome &amp; Systemic Lupus Erythematosus: Performance of the New Slicc Criteria in the Detection of True Overlap
Authors: S. Colafrancesco, A. Minniti, G. Picarelli, A. Gattamelata, D. Bonfiglio, F. Brancatisano, R. Priori, G. Valesini
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Primary Sjogren Syndrome (pSS) and Systemic Lupus Erythematosus (SLE) express a significant overlap in their clinical and immunological aspects. Moreover, SS often presents clinical and immunological manifestations included in the SLE classification criteria. A secondary SS (diagnosis according to AECG criteria) has been described in about 9-19% of SLE cases. Few data is available regarding the prevalence of a true overlap of the two disorders. <h3>Objectives</h3> To investigate the prevalence of patients with pSS who can be classified as having an overlap syndrome with SLE considering both the 1997-revised ACR criteria and the new criteria proposed in 2012 by the Systemic Lupus International Collaborating Clinics (SLICC). <h3>Methods</h3> Charts from patients with pSS (diagnosis according to AECG criteria) were retrospectively evaluated in order to collect clinical and laboratory data. <h3>Results</h3> Two-hundred seventy patients with pSS [8M, 262 F, mean age 57.8±12,5 years, mean age at diagnosis 52.6 years ±12.5, mean follow-up 5.6 years (range 0–42 years)] were considered. Taking into account the 1997-ACR criteria, 11 patients (4.1%) could be classified as having an overlap with SLE (SS-SLE). Considering the new SLICC criteria, the number of patients raise to 18 (6.7%). Both considering the old and the new criteria, the most frequent items satisfied by the SS-SLE group were: ANA, leukopenia, oral ulcer and arthritis (Table). The items responsible for the increasing number of patients fulfilling the new criteria were low complement and the presence of leukopenia, thrombocytopenia or hemolytic anemia since these are considered separately in the new criteria. Compared to the remaining patients with pSS (246 F, 8M, mean age at diagnosis 53.3±12.4 years), the SS-SLE group (18 F, mean age at pSS diagnosis 47.9±13.1 years) showed a significantly higher frequency of leukopenia (77.7% in SS-SLE vs 14.2% in pSS; p&lt;0.001), arthritis (44.4% in SS-SLE vs 10.3% in pSS; p&lt;0.001) and low complement (38.8% in SS-SLE vs 7.14% pSS; p&lt;0.001). <h3>Conclusions</h3> The occurrence of a true overlap between SS and SLE is relatively infrequent and the new SLICC criteria may allow a higher sensitivity to detect such condition. The items responsible for the increased sensitivity are both the introduction of hyopocomplementemia and the separate consideration of different hematological disorders in the new classification criteria. In patients with SS-SLE, hypocomplementemia, leukopenia and arthritis appear to be the most frequent manifestations. <h3>Disclosure of Interest</h3> None declared
PTU-200 Why do crohn’s and idiopathic anal fistulae persist?
Authors: NA Yassin, H Al-Hassi, T Ansari, S Knight, P Sibbons, A Hart, R Phillips
Journal: Gut (2015)

<h3>Introduction</h3> An interaction between genetic, microbiological and immunological factors drives Crohn’s disease. Bacterial infection probably initiates idiopathic anal fistulae but does not maintain them. Dendritic cells (DC) express Toll-Like receptors (TLR), which are pattern recognition receptors that are activated by bacterial ligands. We compared the expression of TLRs and microbiota profiles of CD and idiopathic fistulae. <h3>Method</h3> Biopsies were taken from 35 Crohn’s and 25 idiopathic fistulae at surgery. DC were identified as HLA-DR-positive and lineage-negative, and characterised by flow cytometry using fresh samples. The expression of TLR2 and 4 was determined. Immunohistochemical techniques determined the expression of TLR2, TLR4 and TLR9 on paraffin-imbedded biopsies. DNA was extracted from frozen samples and bacterial 16S rRNA genes were sequenced using a MiSeq sequencer. <h3>Results</h3> TLR2 and 4 were expressed on DC from both Crohn’s and idiopathic perianal fistulae using flow cytomtery. There was no significant difference in TLR2 (p = 0.27) or TLR4 (p = 0.45) expression on CD and idiopathic fistulae. Immunohistochemistry showed equal expression of TLR2 (p = 0.42) and TLR4 (p = 0.11) on lymphocytes. TLR9 expression was significantly higher in CD fistulae (p = 0.01). Microbiota were classified as common and abundant, infrequent, and rare. The total number of operational taxonomic units (OTUs) observed and the number of species identified in Crohn’s fistulae was significantly higher than idiopathic (p = 0.02). The most abundant species in the Crohn’s group were Bradyrhizobium pachyrhizi followed by Pseudomonas azotoformans and Prevotella oris. <h3>Conclusion</h3> Bacterial products and the local immune response to them are present in perianal fistula tracts. Fistula persistence may be driven by bacterial products rather than live bacteria. This could provide therapeutic treatment targets for Crohn’s anal fistulae. <h3>Disclosure of interest</h3> None Declared.
A National Agenda for Research on Aging
Authors: Edmund T. Lonergan, Julius R. Krevans
Journal: New England Journal of Medicine (1991)

ON June 12, 1991, the Institute of Medicine of the National Academy of Sciences released a report delineating a national agenda for research on aging.* In this report, a committee of 18 national leaders in health care identified national priorities for research on aging for the next 20 years and estimated the resources required to implement the research agenda. The committee also listed areas of research that would improve knowledge of the basic processes of aging and maximize the ability to function and the quality of life of older persons. The committee was aided by documents created by 63 outstanding . . .
Autoantibodies against Erythropoietin in a Patient with Pure Red-Cell Aplasia
Authors: Nicole Casadevall, Evelyne Dupuy, Pascale Molho-Sabatier, Gérard Tobelem, Bruno Varet, Patrick Mayeux
Journal: New England Journal of Medicine (1996)

Autoimmunity is often implicated in pure red-cell aplasia. Approximately 10 to 15 percent of patients with pure red-cell aplasia have thymomas,1 and remission of the anemia occurs in 25 to 30 percent of these patients after the thymoma is removed.2 In other patients there are immunologic abnormalities, such as hypogammaglobulinemia,3 monoclonal immunoglobulins,4 antithyroid antibodies,5 antinuclear antibodies,6,7 and autoimmune hemolytic anemia.3,8 Immunosuppressive therapy is successful in many patients,2,9–12 and a good response to plasmapheresis has been reported in two patients.13,14 In 1967 Krantz and Kao reported that plasma from a patient with pure red-cell aplasia inhibited . . .
Clinical Applications of Thyroid Echography
Authors: Manfred Blum, Amy Beth Goldman, Arnold Herskovic, Joseph Hernberg
Journal: New England Journal of Medicine (1972)

Thyroid echography was carried out in 800 patients with thyroid abnormalities, including 122 with operative correlation. Echography was most useful in determining if solitary "cold" nodules 1 to 3 cm in diameter were cystic or solid. All 13 cysts and 54 solid tumors over 1 cm in diameter were correctly diagnosed. Ultrasound also allows the measurement of the depth dimension of thyroid goiters and nodules. It enables the clinician to follow the course of thyroid masses even while the patient is on suppressive therapy, and to ascertain hemorrhage or tumor as the cause of changes in thyroid size. Improved estimation of thyroid volume is helpful for 131I dose calculation. The method is safe and without contraindications. Lesions less than 1 cm in diameter escape detection, and those over 4 cm in diameter frequently contain areas of cystic or hemorrhagic degeneration and give a "mixed" echogram pattern. Various types of solid abnormalities are not reliably differentiated. Correlation with the isotope scan, history and physical examination is imperative for accurate interpretation of echograms.
Umbilical Cord Blood Transplant Patients At High Risk Of Graft Rejection Achieve Early Full Donor Chimerism When 300cGy Is Used In The Reduced Intensity Conditioning Regimen
Authors: Rachel B Salit, Filippo Milano, Jonathan A Gutman, Michael B Maris, Thomas Chauncey, Finn Petersen, Colleen Delaney
Journal: Blood (2013)
Monoclonality of Lymphoproliferative Lesions in Cardiac-Transplant Recipients
Authors: Michael L. Cleary, Roger Warnke, Jeffrey Sklar
Journal: New England Journal of Medicine (1984)

Whether lymphoproliferative disorders arising in immunosuppressed recipients of organ transplants are primarily neoplastic or hyperplastic in nature is a matter of controversy. Reports of polyclonal B-cell proliferations in these lesions suggest the presence of hyperplasia, but these disorders resemble lymphoma histologically and are clinically aggressive and often rapidly fatal, as expected of a malignant neoplastic disease. We examined tissue specimens from 10 cases of lymphoproliferative disease that occurred in immunosuppressed recipients of cardiac transplants. Specimens from nine of these patients lacked cellular immunoglobulin; however, analysis of DNA extracted from these tissues revealed that each lesion contained large numbers of cells possessing uniform, clonal rearrangements of immunoglobulin-gene DNA. Therefore, when first seen clinically these proliferations contained a notable monoclonal-cell population typical of conventional B-cell lymphomas that are not associated with immunosuppression. We therefore suggest that lymphoproliferative disorders in recipients of cardiac transplants are neoplastic at the earliest stages of detectable disease. (N Engl J Med 1984;310:477–82.)
Antithyroid Drug Therapy for Graves' Disease during Pregnancy
Authors: Naoko Momotani, Jaeduk Noh, Hiroshi Oyanagi, Naofumi Ishikawa, Kunihiko Ito
Journal: New England Journal of Medicine (1986)

We compared fetal and maternal serum indexes of thyroid status at delivery in 70 patients with Graves' disease who required therapy with thionamides (such as propylthiouracil) during pregnancy. Forty-three mothers required thionamides until delivery (Group 1), whereas the drugs were discontinued during pregnancy after remission in 27 mothers (Group 2). Maternal free thyroxine levels were closely correlated with cord levels in both groups, being essentially identical in Group 2 but slightly lower in fetuses than in mothers in Group 1. Normal maternal free thyroxine levels did not preclude fetal hypothyroidism. The mothers and fetuses in Group 1 had a significantly higher incidence of antibodies that inhibit thyrotropin binding than did those of Group 2. However, a significant correlation between maternal levels of these antibodies and cord levels of free thyroxine or triiodothyronine was found only in Group 2, in which some maternal and cord thyroxine levels were in the thyrotoxic range at delivery, presumably because therapy was discontinued. These findings indicate that high free thyroxine levels and the presence of antibodies that inhibit binding of thyrotropin are useful indexes of the fetal need for antithyroid treatment, and that the thionamide dosage that maintains maternal free thyroxine levels in a mildly thyrotoxic range seems appropriate for maintaining euthyroid status in the fetus. (N Engl J Med 1986; 315:24–8.)