tbuckley/cabot-search huggingface dataset:
A pregnant woman with anaemia and thrombocytopenia
Authors: Muhajir Mohamed, Arsalan Mahmud
Journal: BMJ (2016)

A 28 year old woman who was 31 weeks pregnant attended the emergency department of our hospital with acute onset of abdominal pain in her right upper quadrant. She had undergone regular antenatal check-ups in the midwifery clinic, with no problems reported. She had no medical history of note and was not taking any drugs. She was a non-smoker and before she was pregnant she rarely drank alcohol. Her cardiovascular, respiratory, and neurological examinations were unremarkable and she had no peripheral oedema. The fetal heart sounds were normal. Her blood pressure was high (136/104 mm Hg) and her pulse was 88 beats/min. The urine protein to creatinine ratio showed no evidence of proteinuria.

A full blood screen showed a low platelet count (25×109/L; reference range 150-400), high neutrophil count (14×109/L; 2.0-8.0), low haemoglobin (94 g/L; 130-170), and raised absolute reticulocyte count (204×109/L; 50-100). Red blood cells with morphological abnormalities were seen on the blood film (fig 1⇓). Liver function tests showed moderately raised alanine transferase (356 U/L; 0-33) and aspartate transferase (304 U/L; 0-32), mildly deranged alkaline phosphatase and γ-glutamyl transferase values, and normal bilirubin levels. Serum lactate dehydrogenase (LDH) was high (951 U/L; 125-243) and serum haptoglobin was undetectable. A direct antiglobulin test was negative. Coagulation parameters—prothrombin time, activated partial thromboplastin time, and fibrinogen concentration—were within normal limits and D-dimer was raised. Blood glucose, serum creatinine, iron studies, vitamin B12, and folate values were within the normal ranges.



Fig 1 

1.  What does the blood film show?

2.  What is the most likely diagnosis?

3.  What are the differential diagnoses in this patient?

4.  How do you diagnose this condition?

5.  How should the patient be managed and what is the prognosis?

### 1. What does the blood film show?

#### Short answer

Polychromasia, fragmented red blood cells (schistocytes), and thrombocytopenia. These features are suggestive of microangiopathic haemolytic …
Response and survival in clinical trials.
Authors: G A Omura
Journal: Journal of Clinical Oncology (1986)

Article Tools Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1986.4.6.1013 Journal of Clinical Oncology - published online before print September 22, 2016 PMID: 3711954 Response and survival in clinical trials. G A OmuraxG A OmuraSearch for articles by this author https://doi.org/10.1200/JCO.1986.4.6.1013 First Page PDF © 1986 by American Society of Clinical Oncology
Tritiated Thymidine Labeling Index and Response in Human Breast Cancer
Authors: Aaron Sulkes, Robert B. Livingston, William K. Murphy
Journal: JNCI Journal of the National Cancer Institute (1979)

Tumor cell uptake of tritiated thymidine, expressed as the labeling index (Ll), was determined prior to treatment of 25 patients with disseminated breast carcinoma. All patients subsequently received combination chemotherapy with adriamycin, cyclophosphamide, and an antimetabolite (usually 5-fluorouracil), with or without vincristine. The Ll was significantly higher in responders to chemotherapy than in nonresponders (mean, 15 vs. 7.1; P less than 0.01). Other pretreatment variables examined did not show a significant association with likelihood of response. Measurements of the tumor cell Ll in patients with accessible tumor may be of benefit in selection of treatment; 0 of 9 patients with an Ll less than 9 had a response in our series in contrast to 11 of 16 patients with an Ll greater than 9 who had a response (P = 0.001).
PTH-012 The sensitivity and specificity of brush cytology at ERCP and the impact on the number of further investigations for patients
Authors: RK Sethi, K Singh, BD Warner, M Wilkinson
Journal: Gut (2015)

<h3>Introduction</h3> Patients with suspected pancreatico-biliary (PB) cancers frequently undergo ERCPs to obtain brush cytology for confirmatory pathological diagnosis. The outcome of this often leads the management of the patient and avoids unnecessary invasive investigations. <h3>Aims</h3> – To determine the diagnostic yield and accuracy of the brush cytology obtained at ERCP by performing a retrospective audit looking at all patients admitted to Guy’s and St. Thomas’ Hospital for ERCP during 2008–2013.​ – To evaluate the impact of cytology results on patient management following ERCP, specifically the number of further investigations the patient requires. <h3>Method</h3> Data was collected between January 2008 and December 2013. This involved analysing EndoSoft – the in-house software for endoscopic data entry, PathNet – the pathology database and Electronic Patient Records (EPR). The frequency of tests performed following cytology results (biopsies and imaging only) was retrospectively analysed to determine the impact of positive cytology on the diagnosis and the need for further investigations. <h3>Results</h3> 162 patients in total had brush cytology performed at ERCP. 58 patients had positive cytology with a 72.6% diagnostic yield. With intention to treat analysis, sensitivity is 54.7%, specificity is 100.0% and negative predictive value is 53.9% with positive predictive value of 100%. In patients with a positive brush cytology result fewer investigations were required in comparison with patients with a negative cytology result (see chart) <h3>Conclusion</h3> Our results compare favourably with previous studies in the field. Brush cytology has been ignored in recent times due to perceived poor results and efficacy. In fact it serves as a valuable tool in the diagnosis of PB malignancies and saves on further investigations suggesting that we should strive to improve sensitivity and specificity of cytology brushings through new brush designs or improvements in pathology processing. <h3>Disclosure of interest</h3> None Declared.
Patients' perceptions of the therapeutic relationship and group therapy outcome
Authors: A L Gurman, J P Gustafson
Journal: American Journal of Psychiatry (1976)

The authors review the empirical literature examining the hypothesized relationship between the patient's perception of the therapeutic relationship and treatment outcome in group therapy and describe studies of both inpatient and outpatient group therapy. Their review indicates that, in contrast to the overwhelming evidence in support of the perceived relationship-outcome hypothesis in individual psychotherapy, there is no persuasive evidence in favor of the proposed relationship between the therapist-patient relationship and the efficacy of group treatment. The authors discuss the clinical and theoretical differences between individual and group therapy that would contribute to this result.
High fat Mediterranean diet is not linked to greater weight gain than low fat diet
Authors: Ingrid Torjesen
Journal: BMJ (2016)

Low fat diet not better than Mediterranean

An unrestricted calorie Mediterranean diet enriched with healthy vegetable fats does not increase weight gain or waist circumference more than a low fat diet, a five year study published in The Lancet Diabetes and Endocrinology has suggested, bolstering the argument that total fat content is not a useful measure of harms or benefits of food.1

The authors said that current health guidelines that recommend a low fat, low calorie diet created an unnecessary fear of the healthy fats present in a Mediterranean diet, which have known health benefits.

The study, which was funded by the Spanish government, the Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBER OBN), and Instituto de Salud Carlos III, included 7447 men and women aged 55 to 80 years who had type 2 diabetes or three or more cardiovascular risk factors. …
Types of psychopathology displayed by heroin addicts
Authors: R A Steer, J Schut
Journal: American Journal of Psychiatry (1979)

Symptom profiles of 157 male and 54 female heroin addicts based on Brief Psychiatric Rating Scale scores were compared with normative data for 6,000 psychiatric patients by using previously described schizo-depressive and coping-resignation contrast functions. Diagnostic types found among the addicts were as follows: anxious-depressive features, 35.1%; undifferentiated syndromes, 26.5%; hostile-depressive features, 16.6%; retarded depressive features, 9.5%; hostile suspicious traits, 6.6%; and blunted affect without significant depressive features, 5.7%. None of the addicts showed levels of thought disturbance comparable to those found in the psychiatric patients.
ANALGESIC ABUSE AND THE KIDNEY— A COMMENTARY
Authors: M GILBERT, J ROTSTEIN, C CUNNINGHAM, I ESTRIN, A DAVIDSON, G PINCUS
Journal: JAMA (1964)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Variations in teaching bring variations in learning
Authors: Melissa Koenig
Journal: Behavioral and Brain Sciences (2015)

Abstract A unified account of teaching such as Kline's can and should accommodate facts about teaching in nonhuman animals and culturally diverse populations. But to benefit from Kline's insights, we need to understand how her taxonomy of teaching maps onto a taxonomy of learning. The crux of the problem for scientists studying humans and nonhumans is to determine not only how different models teach, but how individuals select models, and how they learn differently from different models.
Endoscopic ultrasound-guided antegrade bile duct stone treatment followed by direct peroral transhepatic cholangioscopy in a patient with Roux-en-Y reconstruction
Authors: Hiroshi Kawakami, Masaki Kuwatani, Yoshimasa Kubota, Shuhei Kawahata, Kimitoshi Kubo, Kazumichi Kawakubo, Naoya Sakamoto
Journal: Endoscopy (2015)

Endoscopic ultrasound (EUS)-guided antegrade treatment for biliary disorders was developed for patients with an altered anatomy [1] [2] [3] [4] [5]. This report describes a case of successful EUS-guided bile duct stone (BDS) treatment followed by direct peroral transjejunal-hepatic cholangioscopy in a patient with Roux-en-Y reconstruction.
SAT0631 Similar Enthesopathy Scores by Us in Psoriatic Arthritis and Osteoarthritis: Table 1.
Authors: Y. Yumusakhuylu, E. Kasapoglu, S. Murat, E. Kurum, H. Keskin, A. Icagasioglu, D. McGonagle, S.Z. Aydın
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Enthesitis is a frequent feature of psoriatic arthritis (PsA). Osteoarthritis (OA) shares many features with PsA including DIP, PIP, neck and spinal involvement, lower limb large joint arthropathy and enthesopathies including trochanteric bursitis and lateral epicondylitis. <h3>Objectives</h3> In this study we tested the hypothesis that a similar ultrasound (US) determined enthesopathy load existed in PsA and OA. <h3>Methods</h3> Twenty-four patients with PsA, 25 with OA and 28 healthy controls (HC) were recruited. The clinical assessments were performed by the same clinician unaware of the US assessments. Patients with PsA were chosen consecutively if they did not have any psoriatic lesions at the lower limbs to provide blindness for the ultrasonographer and with no suspicion of OA clinically. OA patients and healthy controls did not have any history of psoriasis and HC did not have any knee pain. The major enthesis of the lower limbs (Quadriceps, patellar tendon origin and insertion, Achilles and plantar fascia, bilaterally) were scanned by US for abnormalities related to inflammation (hypoechogenicity, thicknening, Doppler, bursal effusion) and chronicity (calcifications, enthesophytes and erosions) semiquantitavely on a scale between 0-3. The overall US scores were calculated by adding each finding. The US was performed blinded to diagnosis. <h3>Results</h3> All three groups were matched for body mass index (BMI) (mean (SD) values in HC, OA and PsA respectively: 28.7 (5.4), 30.3 (3.9), 29.3 (5.4)). Patients with PsA (53.5 (6.1)) and OA (52.8 (1.1) were older than HC (41.3 (9.8)). PsA patients had higher US scores than HC (p&lt;0.001 for inflammation, chronicity and overall scores) (table 1). OA patients also had higher US scores than HC (p value for inflammation: 0.003; chronicity: 0.017; overall: 0.001). The difference between PsA and OA did not reach significance. ANCOVA was performed to control for age, gender and BMI, which showed that only PsA group had higher US scores then HC (p value for inflammation: 0.03; chronicity: 0.05; overall: 0.017) which could not be shown in OA vs PsA and HC. The BMI was significantly correlated to US scores of enthesopathies in OA (R=0.451; p=0.03) but not in PsA or HC. On the other hand, age was correlated to US scores only in PsA (R=0.609; p=0.002), but not in OA or HC. <h3>Conclusions</h3> This study shows that enthesopathies are also frequent in OA, similar to PsA. BMI was more important in OA and age in PsA. These findings are important for the assessment of the relevance of sonographic determined enthesopathy in a patient with psoriasis and OA. <h3>Disclosure of Interest</h3> None declared
Alveolar macrophage-derived microvesicles mediate acute lung injury
Authors: Sanooj Soni, Michael R Wilson, Kieran P O'Dea, Mariko Yoshida, Umar Katbeh, Samantha J Woods, Masao Takata
Journal: Thorax (2016)

Microvesicles (MVs) are important mediators of intercellular communication, packaging a variety of molecular cargo. They have been implicated in the pathophysiology of various inflammatory diseases; yet, their role in acute lung injury (ALI) remains unknown.We aimed to identify the biological activity and functional role of intra-alveolar MVs in ALI.Lipopolysaccharide (LPS) was instilled intratracheally into C57BL/6 mice, and MV populations in bronchoalveolar lavage fluid (BALF) were evaluated. BALF MVs were isolated 1 hour post LPS, assessed for cytokine content and incubated with murine lung epithelial (MLE-12) cells. In separate experiments, primary alveolar macrophage-derived MVs were incubated with MLE-12 cells or instilled intratracheally into mice.Alveolar macrophages and epithelial cells rapidly released MVs into the alveoli following LPS. At 1 hour, the dominant population was alveolar macrophage-derived, and these MVs carried substantive amounts of tumour necrosis factor (TNF) but minimal amounts of IL-1β/IL-6. Incubation of these mixed MVs with MLE-12 cells induced epithelial intercellular adhesion molecule-1 (ICAM-1) expression and keratinocyte-derived cytokine release compared with MVs from untreated mice (p<0.001). MVs released in vitro from LPS-primed alveolar macrophages caused similar increases in MLE-12 ICAM-1 expression, which was mediated by TNF. When instilled intratracheally into mice, these MVs induced increases in BALF neutrophils, protein and epithelial cell ICAM-1 expression (p<0.05).We demonstrate, for the first time, the sequential production of MVs from different intra-alveolar precursor cells during the early phase of ALI. Our findings suggest that alveolar macrophage-derived MVs, which carry biologically active TNF, may play an important role in initiating ALI.
FRI0028 Gazing into the Crystal Ball? Prospective MRI Score to Predict Negative Eular-Response in Patients with Rheumatoid Arthritis (RA) Before Therapy-Escalation to a Biological Therapy
Authors: P. Sewerin, R. Brinks, C. Schleich, F. Miese, S. Vordenbäumen, S. Klein, G. Antoch, M. Schneider, B. Ostendorf
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Objectives</h3> To define and validate a new MRI score for the prediction of negative response in patients with rheumatoid arthritis (RA) before therapy-escalation to a biological therapy. <h3>Methods</h3> Remission plus was a multicentre (n=11) German "real-life" MRI study with the aim to implement MRI in diagnostic and therapy-control in patients with RA. MRI was performed before therapy-escalation (T0) and after 12 month (T1) and were analysed by using the OMERACT rheumatoid arthritis MRI score (RAMRIS). In addition clinical and laboratory parameters (DAS-28 and CRP) were collected for each visit. The new MRI score was developed using a logistic regression and is a combination of the patients9 age and the RAMRIS-T0 score. In the logistic regression we adjusted for possible confounders. Performance of the score is assessed in terms of area-under-the-curve (AUC). To validate the new score, a bootstrap analysis is performed with 5000 resamplings. <h3>Results</h3> Overall 257 patients were investigated with MRI, while 29 (20 female, median age 57 (IQR 46 – 65) years, 95% anti-TNF-alpha therapy) of them were escalated to a biological therapy. Poor responders (n=5) and non-poor responders (n=24) had a mean RAMRIS-T0 score of 14.4 and 52.0, respectively (Wilcoxon test p&lt;0.01). High RAMRIS-score seemed protective against non-response. The odds ratio for an increase of RAMRIS by one point was 0.90 (95% confidence interval 0.79-1.03, p=12%). The strength of the association was stable after adjusting for age, CCP, CRP, rheumatoid-factor (RF) and DAS28 at baseline. The median AUC in the bootstrap analysis is 88.9% with IQR 84.0-92.8%. <h3>Conclusions</h3> RAMRIS-T0 possibly has the potential to predict poor EULAR-response in patients with RA before initiation of a biological therapy. By using the new score the predictive value was (AUC up to 95%) surprisingly high. Due to its high predictive value this score could be a possible tool in personalized medicine concepts after performing follow-up studies in clinical trials. <h3>Disclosure of Interest</h3> None declared
Mental health services for Medicaid enrollees in a prepaid group practice plan
Authors: S S Goldensohn, R Fink
Journal: American Journal of Psychiatry (1979)

The authors present the patterns of utilization of mental health services of a low-income population in a prepaid group practice setting, the Health Insurance Plan of Greater New York (HIP). Over a 6-year period, utilization rates for psychiatric consultations and mental health services by Medicaid enrollees rose to equal or exceed utilization by employed groups. The authors also provide evidence that psychiatric treatment reduces the use of other physician services, especially X-ray and laboratory services.
AB1037 Multiplex Biomarker Analysis of Synovial Fluid and Serum in Rheumatoid Arthritis
Authors: A. Novikov, E. Aleksandrova, D. Karateev, E. Lutchihina, T. Popkova, M. Cherkasova, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Analysis of synovial fluid (SF) in rheumatoid arthritis (RA) provides an opportunity to discover the complex of biomarkers involved in the inflammatory process. <h3>Objectives</h3> To characterize synovial fluid biomarker profile in RA. <h3>Methods</h3> We studied 53 pts with RA (&gt;6 months disease duration, median and interquartile range (25th–75th percentile) of age 51 (43-61) years, 72% female). Cytokine analyses were performed with multiplex technology (Human Grp I Cytokine 27-plex panel for BioPlex 200), anti-CCP2, anti-MCV was measured by ELISA, IgM RF and CRP - by immunonephelometry. <h3>Results</h3> SF levels of inflammation marker (CRP), pro- (IL-1β,-6,-15), anti- inflammatory (IL-1ra,-10,-13) and Th17 cytokines (IL-17), angiogenic factor (VEGF), chemokines (IL-8, IP-10, MCP-1) were significantly higher than in serum. CRP, IgM RF, anti-CCP2, anti-MCV, IL-1β, -1ra, -2, -4, -5, -7, -9, -10, -12, -15, eotaxin, G-CSF, GM-CSF, IFN-γ, MCP-1 showed a positive correlation their SF and serum concentration. <h3>Conclusions</h3> Multiplex biomarker analysis of SF is powerful instrument to investigation immunopathogenic mechanism of RA. Serum levels of autoantibodies, inflammation markers, cytokines, chemokines and growth factors is able to reflect such in the microenvironment within the inflamed joints. <h3>Disclosure of Interest</h3> None declared
OC-082 The results of a multi-centre study of surgery for full thickness rectal prolapse: Abstract OC-082 Table 1
Authors: V Brown, P Bearn
Journal: Gut (2015)

<h3>Introduction</h3> Rectal prolapse is a disabling condition which is under-reported and affects the quality of life of our ageing population. Despite this there is ‘no accepted standard procedure’<sup>1</sup>a given patient should receive. The perceived risk of surgery has meant that elderly patients often undergo a perineal operation with an abdominal operation being reserved for younger patients or those with recurrence. Randomised controlled trials have found it challenging to recruit patients making comparison between outcomes difficult for abdominal and perineal operations. <h3>Method</h3> The Surrey and South West London Pelvic floor group was founded in 2014 and includes the following hospitals – Ashford and St Peters Hospital, Croydon University Hospital, East Surrey Hospital, Epsom and St Heliers Hospital, Frimley Park Hospital, Kingston Hospital, Royal Berkshire Hospital, St Georges Hospital and Wexham Park Hospital. All patients who underwent surgery for full thickness rectal prolapse between April 2011 and March 2013 were included. Data was collected retrospectively from the notes using a standardised proforma. <h3>Results</h3> 244 patients underwent surgery for full thickness rectal prolapse in the study period. Seven patients were excluded due to incomplete data leaving 237 patients. All but four patients were female. Median age at time of operation was 78.4 years with an average ASA of 2.1. The recorded overall recurrence for all surgery was 17.7%. Median length of stay (LOS) was 2 days. <h3>Conclusion</h3> In this retrospective multicentre study abdominal operations for full thickness rectal prolapse had a significantly lower rate of recurrence than the perineal approach. This was despite there being a higher proportion of patients in the abdominal group who had had previous surgery for rectal prolapse. Although patients in the abdominal group were younger and fitter there was no difference in length of stay and complication rates. The rates of recurrence for perineal operations were similar<sup>1</sup>but the recurrence rate after abdominal operations was higher than previousy reported in the literature.<sup>1</sup>This may be a reflection of the individual learning curves for laparoscopic rectal prolapse surgery during the study period (2011–2013). <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Senapati A, Gray RG, Middleton LJ, <i>et al</i>.; PROSPER Collaborative Group. PROSPER: a randomised comparison of surgical treatments for rectal prolapse. Colorectal Dis. 2013;15(7):858–68