tbuckley/cabot-search huggingface dataset:
Diagnosis and Surgical Treatment of Mitral Regurgitation Secondary to Ruptured Chordae Tendineae
Authors: Charles A. Sanders, W. Gerald Austen, J. Warren Harthorne, Robert E. Dinsmore, J. Gordon Scannell
Journal: New England Journal of Medicine (1967)

THE chordae tendineae serve an essential anchoring function in the mechanics of mitral-valve closure during ventricular systole. Rupture of one or more of these fibrous structures usually leads to mitral regurgitation, the severity of which is related to the location and number of chordae tendineae involved1 as well as the presence of prior disease of the mitral valve itself. Although active bacterial endocarditis was probably the major cause of ruptured chordae tendineae in the preantibiotic era,2 rheumatic mitral valvulitis, often with healed bacterial endocarditis, appears to be the most common etiology at present.3 4 5 However, a significant number of cases have . . .
Clinical Course of Acute Gastric Mucosal Lesions Caused by Acute Infection with<i>Helicobacter pylori</i>
Authors: Tetsuya Moriai, Nobustune Hirahara
Journal: New England Journal of Medicine (1999)

To the Editor: The clinical course of acute Helicobacter pylori infection in adults is not well known. Information on the clinical features and natural course of acute H. pylori infection is available from only a few voluntary-ingestion studies and scattered reports of postendoscopic acute gastric mucosal lesions caused by cross-infection. We report on the clinical course of postendoscopic acute gastric mucosal lesions caused by acute infection with H. pylori. Five adults (ranging in age from 27 to 61 years) without previous gastroduodenal disease underwent endoscopic screening for gastric disease at another hospital and were found to be endoscopically normal. After . . .
Preserved Endothelium-Dependent Vasodilatation in Patients with Essential Hypertension
Authors: John R. Cockcroft, Philip J. Chowienczyk, Nigel Benjamin, James M. Ritter
Journal: New England Journal of Medicine (1994)

Previous studies suggest that vascular endothelial function may be impaired in essential hypertension. Although muscarinic agonists dilate blood vessels by releasing an endothelium-derived relaxing factor closely related to nitric oxide, nitroprusside dilates vessels by a mechanism that is independent of the endothelium. The finding of an impaired response to muscarinic agonists but a normal response to nitroprusside in patients with hypertension has suggested that endothelial function is abnormal in hypertension.
MPTH-04LOMUSTINE AS SALVAGE THERAPY IN PATIENTS WITH RECURRENT HIGH GRADE GLIOMA
Authors: Zhijian Chen, Ming Chi, Nehaw Sarmey, Lauren Gotterer, Glen Stevens, David Peereboom, Paul Elson, Manmeet Ahluwalia
Journal: Neuro-Oncology (2015)

BACKGROUND: Nitrosoureas are frequently used in treatment of patients with high grade gliomas (HGG). We reviewed our institutional experience with HGG patients treated with lomustine. METHODS: After IRB approval, Cleveland Clinic's database was used to identify HGG patients treated at our institution between 2007 and 2014. Multivariable analysis was conducted with use of a COX proportional hazards model and a stepwise selection algorithm that used p = .10 and p = .05 for the entry and retention criteria. RESULTS: 98 HGG patients treated with lomustine were included for this analysis. 53 patients received lomustine alone, 28 received lomustine and bevacizumab, and 17 received lomustine with other agents with or without bevacizumab. The median PFS of lomustine with bevacizumab (n = 8) versus lomustine alone (n = 11) was 13 months versus 3.5 months(p = .003); while those with EGFR amplified tumors in lomustine with bevacizumab (n = 6) versus lomustine alone (n = 8) had a median PFS of 7 months versus 5.5 months, respectively (p = 0.98). CONCLUSION: Lomustine and bevacizumab improved PFS in recurrent EGFR wild type HGG in this series. EGFR amplification status may serve as a molecular marker that predicts benefit with lomustine and bevacizumab combination.
Common-Bile-Duct Stones
Authors: Bentley P. Colcock, Harold V. Liddle
Journal: New England Journal of Medicine (1958)

IN recent years, cholecystectomy has been performed in an increasing number of patients. As a result, two serious complications of biliary-tract surgery have occurred with increasing frequency. The first and most serious is operative injury to the common bile duct. The other complication is the frequent need for a second operation because of inadequate surgery at the time of cholecystectomy. Only part of the gall bladder may have been removed. Cystic-duct stumps 2 or 3 cm. long and containing stones may remain. Recurrent attacks of severe right-upper-quadrant pain may be due to unrelieved stenosis of the sphincter of Oddi.1 The . . .
Julia Alleyne
Authors: Johann Windt
Journal: British Journal of Sports Medicine (2016)

I served Canada on five Olympic teams but being the Chief Medical Officer for the 2015 Pan American Games in Toronto was my most challenging games. It was the biggest project I have ever undertaken and really the only one where I felt that I was part of creating a sustainable legacy—12 Physical Activity Facilities, 2000 interprofessional Medical/Anti-doping volunteers and the first ever integrated Pan and Parapan Sport Medicine Conference…to name the top three!⇓



Julia Alleyne



Making musculoskeletal medicine ‘simple’ by translating it into teachable moments and key messages. I have built many course curricula—classroom, online and blended—all interactive and many in the experiential model. Learners tell me that ‘it finally makes sense’. The true value is that our patients have better outcomes!

Flexibility! That is, flexible thinking, negotiations, time management and work–life balance. Being flexible just lets you shift gears and makes you a better team player.

I had been teaching for many years already, but I went …
Endoscopic Evaluation of the Effects of Aspirin, Buffered Aspirin, and Enteric-Coated Aspirin on Gastric and Duodenal Mucosa
Authors: Frank L. Lanza, George L. Royer, Robert S. Nelson
Journal: New England Journal of Medicine (1980)

THE damaging effect of aspirin on the gastric mucosa has been well documented by endoscopy1 2 3 4 5 6 and by studies of fecal blood loss.7 , 8 Because of the unquestioned value of aspirin in the therapy of rheumatoid diseases and other painful musculoskeletal disorders, various buffered and enteric-coated aspirin compounds have been developed in an attempt to circumvent this serious problem. Our study had two purposes: to determine by an endoscopic technique in a controlled prospective manner whether buffering or enteric coating was effective in ameliorating this major side effect of aspirin therapy; and to observe concurrently whether the changes seen in the gastric . . .
A7.5 A whole blood micro-RNA signature for primary SjÖgren’s syndrome-related lymphoma
Authors: J Tarn, S Cockell, C Gillespie, S Al-Ali, K James, J Locke, S Bowman, B Griffiths, D Young, WF Ng
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background/Purpose</h3> Micro RNAs (miRNAs) are 18–25 nt non-coding RNAs that bind target/complementary sequences within the 3'UTR of RNA molecules steering them towards degradation or translational repression, and play a key role in the regulation of gene expression. Better understanding of the expression pattern of miRNAs in diseases may improve our understanding of the biological basis of the disease and identify potential biomarkers. The role of miRNAs in primary Sjögren's syndrome (PSS) and PSS-related lymphoma remains poorly understood. The aim of this project is to identify a miRNA signature for PSS-related lymphoma. <h3>Methods</h3> We profiled the expression of miRNAs in whole blood (PaxGene) total RNA preparations using the Exiqon miRCURY LNA array which encompasses &gt;1400 miRNAs and other small non-coding RNAs. A discovery cohort comprised of 36 samples from the United Kingdom Primary Sjögren's Syndrome Registry (UKPSSR) (12 PSS patients with lymphoma, 12 PSS patients without lymphoma, 12 healthy controls) were used in the initial analysis. We also explored different normalisation strategies and developed an approach, which we considered most appropriate for analysing these data. Real-Time PCR was used to validate the most highly differentially expressed miRNAs between groups. A miRNA signature for PSS-related lymphoma was identified using cluster analysis followed by validation with a second independent cohort of 36 patients and controls. <h3>Results</h3> The initial miRNA array profiling revealed a clear clustering of the 3 subject groups. Between patient groups with and without lymphoma association, 44 miRNAs were differentially expressed. RT-PCR was used to validate 3 out of 9 of the most highly differentially expressed miRNAs. A 5-miRNA signature for pSS-associated lymphoma was identified using clustering analysis followed by validation with a second independent cohort of 36 patients and controls. The sensitivity and specificity of the signature is excellent with an area under the ROC curve of 0.92. <h3>Conclusion</h3> We have identified 5 miRNAs that are differentially expressed in peripheral blood between PSS patients with lymphoma and those without lymphoma. Identifying the mRNA targets of these miRNAs in PSS may improve our understanding of the pathogenesis of PSS-related lymphoma. Furthermore, miRNAs may be useful biomarkers for PSS-related lymphoma.
The Use of Deferoxamine in the Management of Aluminum Accumulation in Bone in Patients with Renal Failure
Authors: Hartmut H. Malluche, Albert J. Smith, Kenneth Abreo, Marie-Claude Faugere
Journal: New England Journal of Medicine (1984)

Aluminum frequently accumulates in patients with end-stage renal failure. We investigated the value of long-term, intermittent infusions of deferoxamine for the removal of aluminum from bone in seven patients undergoing long-term maintenance dialysis. Transient rises in serum aluminum levels occurred initially after treatment. Three patients who were studied by bone biopsy had absent or reduced levels of bone aluminum. Histologic studies of bone before and after therapy showed differences similar to those observed between patients with uremia who had an accumulation of aluminum in bone and those who did not. The diagnostic value of rises in the serum aluminum level after a single infusion of deferoxamine was studied in 12 patients with and 10 patients without aluminum accumulation in bone. All patients with bone aluminum had rises in serum aluminum levels, but rises were also observed in some patients without bone aluminum. Thus, the test cannot be used to diagnose aluminum accumulation in bone. Urinary aluminum levels increased significantly after a single infusion of deferoxamine in three patients with kidney transplants and accumulation of aluminum in bone. These findings indicate that deferoxamine is beneficial for the therapy of aluminum accumulation in the bone of patients with renal failure. (N Engl J Med 1984; 311: 140–4.)
A Comparison of Electrophysiologic Testing with Holter Monitoring to Predict Antiarrhythmic-Drug Efficacy for Ventricular Tachyarrhythmias
Authors: Jay W. Mason
Journal: New England Journal of Medicine (1993)

Invasive electrophysiologic study and noninvasive Holter monitoring (in conjunction with exercise testing) have both been used to evaluate the efficacy of antiarrhythmic drugs in patients with sustained ventricular tachycardia and in survivors of cardiac arrest. We directly compared these two approaches to the prediction of drug efficacy.A total of 486 patients who had documented ventricular tachyarrhythmias that were inducible during electrophysiologic study and 10 or more premature ventricular complexes per hour during Holter monitoring were randomly assigned to undergo serial testing of antiarrhythmic-drug efficacy by electrophysiologic study or Holter monitoring. The patients received up to six drugs in random order until one was predicted to be effective either in suppressing inducible arrhythmia (in the electrophysiologic-study group) or in suppressing premature ventricular complexes (in the Holter-monitoring group). The patients were then followed for recurrences of arrhythmia or death.In the electrophysiologic-study group, 108 of 242 patients (45 percent) received a prediction of efficacy, as compared with 188 of 244 patients (77 percent) in the Holter-monitoring group (P < 0.001). Over a six-year follow-up period, there were 150 recurrences of arrhythmia and 46 deaths among the 296 patients receiving drugs predicted to be effective. Thirty-four of the deaths were from arrhythmic causes, and eight were from cardiac causes. There was no significant difference between the two study groups in the actuarial probabilities of these events. The risk of a recurrence of arrhythmia was significantly lower in patients who received sotalol than in those who received other antiarrhythmic drugs, and the risk was lower in those who had not previously failed to respond to antiarrhythmic drugs than in those who had.Although Holter monitoring led to predictions of antiarrhythmic-drug efficacy more often than did electrophysiologic study in patients with sustained ventricular tachyarrhythmias, there was no significant difference in the success of drug therapy as selected by the two methods.
50 years of oral lipid-based formulations: Provenance, progress and future perspectives
Authors: Orlagh M. Feeney, Matthew F. Crum, Claire L. McEvoy, Natalie L. Trevaskis, Hywel D. Williams, Colin W. Pouton, William N. Charman, Christel A.S. Bergström, Christopher J.H. Porter
Journal: Advanced Drug Delivery Reviews (2016)
Risk of Connective-Tissue Diseases and Other Disorders after Breast Implantation
Authors: Sherine E. Gabriel, W. Michael O'Fallon, Leonard T. Kurland, C. Mary Beard, John E. Woods, L. Joseph Melton
Journal: New England Journal of Medicine (1994)

We conducted a population-based, retrospective study to examine the risk of a variety of connective-tissue diseases and other disorders after breast implantation.All women in Olmsted County, Minnesota, who received a breast implant between January 1, 1964, and December 31, 1991 (the case subjects), were studied. For each case subject, two women of the same age (within three years) from the same population who had not received a breast implant and who underwent a medical evaluation within two years of the date of the implantation in the case subject were selected as control subjects. Each woman's inpatient and outpatient medical record was reviewed for the occurrence of various connective-tissue diseases, certain other disorders thought to have an autoimmune pathogenesis (e.g., Hashimoto's thyroiditis), and cancer other than breast cancer, as well as related symptoms and abnormal results of laboratory tests. The case subjects were categorized according to whether they received implants for cosmetic reasons, for reconstruction after mastectomy for breast cancer, or for reconstruction after subcutaneous mastectomy for cancer prophylaxis. Additional control subjects (women treated for breast cancer who did not have breast reconstruction) were studied for comparison with the case subjects.A total of 749 women who had received a breast implant were followed for a mean of 7.8 years, and 1498 community controls were followed for a mean of 8.3 years. In 5 case subjects, as compared with 10 subjects in the control group, one of the specified connective-tissue diseases was diagnosed (relative risk, 1.06; 95 percent confidence interval, 0.34 to 2.97). Twenty-five case subjects had signs or symptoms of arthritis, as compared with 39 control subjects (relative risk, 1.35; 95 percent confidence interval, 0.81 to 2.23). Among the various signs or symptoms examined, only morning stiffness was significantly increased among the women who had received a breast implant (relative risk, 1.81; 95 percent confidence interval, 1.11 to 2.95).We found no association between breast implants and the connective-tissue diseases and other disorders that were studied.
Virologic Characteristics of Subclinical and Symptomatic Genital Herpes Infections
Authors: Anna Wald, Judith Zeh, Stacy Selke, Rhoda L. Ashley, Lawrence Corey
Journal: New England Journal of Medicine (1995)

The frequency, pattern, and anatomical sites of subclinical shedding of herpes simplex virus (HSV) in the genital tract, along with factors that predict such shedding, have not been well characterized.
The Significance and Treatment of Polyps of the Colon and Rectum
Authors: Neil W. Swinton, Wilton A. Doane
Journal: New England Journal of Medicine (1953)

IN a review of records of patients studied at the Lahey Clinic twenty or more years ago, it is not unusual to see a diagnosis noted "polyp of rectum or colon; patient to have periodic checkups." Since that time the true significance of rectal and colon polyps has been quite generally appreciated, and at present not only are increasing numbers of patients of all ages and both sexes being found to have polyps but also these polyps are being removed or destroyed without delay.On the basis of current knowledge of this subject, the association of polyps with cancer of . . .
Exposure to Greenness and Mortality in a Nationwide Prospective Cohort Study of Women
Authors: Peter James, Jaime E. Hart, Rachel F. Banay, Francine Laden
Journal: Environmental Health Perspectives (2016)

Green, natural environments may ameliorate adverse environmental exposures (e.g., air pollution, noise, and extreme heat), increase physical activity and social engagement, and lower stress.We aimed to examine the prospective association between residential greenness and mortality.Using data from the U.S.-based Nurses' Health Study prospective cohort, we defined cumulative average time-varying seasonal greenness surrounding each participant's address using satellite imagery [Normalized Difference Vegetation Index (NDVI)]. We followed 108,630 women and observed 8,604 deaths between 2000 and 2008.In models adjusted for mortality risk factors (age, race/ethnicity, smoking, and individual- and area-level socioeconomic status), women living in the highest quintile of cumulative average greenness (accounting for changes in residence during follow-up) in the 250-m area around their home had a 12% lower rate of all-cause nonaccidental mortality [95% confidence interval (CI); 0.82, 0.94] than those in the lowest quintile. The results were consistent for the 1,250-m area, although the relationship was slightly attenuated. These associations were strongest for respiratory and cancer mortality. The findings from a mediation analysis suggested that the association between greenness and mortality may be at least partly mediated by physical activity, particulate matter < 2.5 μm, social engagement, and depression.Higher levels of green vegetation were associated with decreased mortality. Policies to increase vegetation may provide opportunities for physical activity, reduce harmful exposures, increase social engagement, and improve mental health. Planting vegetation may mitigate the effects of climate change; in addition, evidence of an association between vegetation and lower mortality rates suggests it also might be used to improve health.James P, Hart JE, Banay RF, Laden F. 2016. Exposure to greenness and mortality in a nationwide prospective cohort study of women. Environ Health Perspect 124:1344-1352; http://dx.doi.org/10.1289/ehp.1510363.
Patient Profile and Therapeutic Management in Glioblastoma (Gbm): a Subgroup Analysis of a Large Prospective Observational Study of the Neuro-Oncology Investigation Spanish Group (Geino)
Authors: J.M. Sepúlveda, J.M. Vieitez, S. Vazquez, A. Rodriguez Sanchez, O. Gallego, L.M. Rodríguez, J. Andrade, F. González, E. Pujol, M. Gil Gil
Journal: Annals of Oncology (2014)
Dickkopf-related protein 1 (Dkk1) regulates the accumulation and function of myeloid derived suppressor cells in cancer
Authors: Lucia D’Amico, Sahil Mahajan, Aude-Hélène Capietto, Zhengfeng Yang, Ali Zamani, Biancamaria Ricci, David B. Bumpass, Melissa Meyer, Xinming Su, Andrea Wang-Gillam, Katherine Weilbaecher, Sheila A. Stewart, David G. DeNardo, Roberta Faccio
Journal: The Journal of Experimental Medicine (2016)

Tumor–stroma interactions contribute to tumorigenesis. Tumor cells can educate the stroma at primary and distant sites to facilitate the recruitment of heterogeneous populations of immature myeloid cells, known as myeloid-derived suppressor cells (MDSCs). MDSCs suppress T cell responses and promote tumor proliferation. One outstanding question is how the local and distant stroma modulate MDSCs during tumor progression. Down-regulation of β-catenin is critical for MDSC accumulation and immune suppressive functions in mice and humans. Here, we demonstrate that stroma-derived Dickkopf-1 (Dkk1) targets β-catenin in MDSCs, thus exerting immune suppressive effects during tumor progression. Mice bearing extraskeletal tumors show significantly elevated levels of Dkk1 in bone microenvironment relative to tumor site. Strikingly, Dkk1 neutralization decreases tumor growth and MDSC numbers by rescuing β-catenin in these cells and restores T cell recruitment at the tumor site. Recombinant Dkk1 suppresses β-catenin target genes in MDSCs from mice and humans and anti-Dkk1 loses its antitumor effects in mice lacking β-catenin in myeloid cells or after depletion of MDSCs, demonstrating that Dkk1 directly targets MDSCs. Furthermore, we find a correlation between CD15+ myeloid cells and Dkk1 in pancreatic cancer patients. We establish a novel immunomodulatory role for Dkk1 in regulating tumor-induced immune suppression via targeting β-catenin in MDSCs.
Quitter's Nail
Authors: A Verghese
Journal: New England Journal of Medicine (1994)

Figure 1. Quitter's Nail. The tip of the fingernail is discolored in a 68-year-old former cigarette smoker who was unable to smoke after sustaining a head injury. Given the rate of nail growth (0.5 to 1.2 mm per week), the tar-stained portion took approximately 9 to 21 weeks to reach its current position.
Catechol-O-methyltransferase association with hemoglobin A1c
Authors: Kathryn T. Hall, Kathleen A. Jablonski, Ling Chen, Maegan Harden, Benjamin R. Tolkin, Ted J. Kaptchuk, George A. Bray, Paul M. Ridker, Jose C. Florez, Kenneth J. Mukamal, Daniel I. Chasman
Journal: Metabolism (2016)
C-Type Virus Expression in Systemic Lupus Erythematosus
Authors: Sandra Panem, Nelson G. Ordóñez, Werner H. Kirstein, Adrian I. Katz, Benjamin H. Spargo
Journal: New England Journal of Medicine (1976)

Kidneys from patients with lupus nephropathy, non-lupus immune-complex glomerulonephritis and other renal diseases were examined by indirect immunofluorescence for antigens related to a C-type virus from human cells (HEL-12 virus). All 11 specimens of lupus nephropathy contained HEL-12 virus antigens deposited in the same pattern as the immune complexes. The intensity of immunofluorescence with anti-HEL-12 virus serum correlated with the extent of immune-complex deposition. In contrast, nine renal lesions other than lupus nephropathy and seven normal tissues did not react with anti-HEL-12 virus serum. Antibody eluted from one kidney with lupus nephropathy reacted by indirect immunofluorescence with human and dog cells infected with HEL-12 virus but not with uninfected control cells. These findings demonstrate a specific association of lupus nephropathy with a C-type viral antigen that is deposited as antigen-antiviral antibody complex. (N Engl J Med 295:470–475, 1976)