tbuckley/cabot-search huggingface dataset:
Purpura in a 5 year old girl
Authors: Chi-Hone Lien, Ming-Dar Lee, Chien-Yu Lin
Journal: BMJ (2017)

A 5 year old girl presented with a one day history of fever, coryzal symptoms, and multiple skin lesions. She also reported abdominal pain and had vomited once. Physical examination revealed hypotension and multiple petechial bruises and purpura-like lesions over the four limbs and the face (fig 1⇓). Over 12 hours, the skin lesions evolved into irregular gangrenous purpura with a central dusky necrosis surrounded by fading redness (fig 2⇓). Blood tests revealed anaemia, thrombocytopenia, high C reactive protein, acute renal failure, and coagulopathy.



Fig 1  Multiple petechial and purpuric lesions





Fig 2  Irregular gangrenous purpura with a central dusky necrosis surrounded by fading redness



1.  What is the most likely diagnosis?

2.  How would you manage the most likely diagnosis?

3.  What are the preventive measures?

### 1. What is the most likely diagnosis?

#### Short answer

Purpura fulminans caused by Neisseria meningitidis .

#### Discussion

Purpura fulminans refers to a rapidly progressive thrombotic disorder that manifests with disseminated intravascular coagulation, intravascular thrombosis, and haemorrhagic infarction of the skin.1 It can herald multiple organ failure and has a high mortality rate (10%~ >50%).2 The disease course is fulminant, and early recognition of purpura fulminans is crucial for successful treatment.2 The initial skin lesions can …
Comprehensive Analysis of Activation and Proliferation Kinetics and Effector Functions of Human Lymphocyte Subsets in Xenogeneic GvHD Model
Authors: Yasufumi Kawasaki, Kazuya Sato, Norihito Takayama, Hiroko Hayakawa, Kiyomi Mashima, Takashi Ikeda, Yumiko Toda, Shoko Ito, Kento Umino, Daisuke Minakata, Hirofumi Nakano, Ryoko Yamasaki, Miyuki Sugimoto, Chihiro Yamamoto, Masahiro Ashizawa, Kaoru Hatano, Kiyoshi Okazuka, Iekuni Oh, Shin-ichiro Fujiwara, Ken Ohmine, Takahiro Suzuki, Kazuo Muroi, Yoshinobu Kanda
Journal: Blood (2016)
Prognostic Value of the Parameters of Myeloma Bone Disease Signaling in Patients with Newly Diagnosed Multiple Myeloma Treated with Proteasome Inhibitors
Authors: Jiri Minarik, Zuzana Hermanova, Jan Hrbek, Pavla Petrova, Patrik Flodr, Petra Krhovska, Tomas Pika, Jaroslav Bacovsky, Miroslav Herman, Vlastimil Scudla
Journal: Blood (2016)
Smoking prevalence falls among adults in England
Authors: Susan Mayor
Journal: BMJ (2017)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following Smoking prevalence falls among adults in England Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Comparison Betwen 15 and 30 Minute Sampling Interval for C-Urea Breath Testing
Authors: R Cooney, L Ellis, G Cox, M Healy, C Goulding, NPW Keeling
Journal: Endoscopy (2004)

13C Urea breath testing is a non-invasive and accurate method for diagnosing active H. pylori infection. Sensitivities and specificities of 90–95% are found when the δ 13CO2 levels at baseline and 30 minutes post ingestion of 13C urea are measured.
Whole body diffusion-weighted MRI to predict treatment outcome after one cycle of immunochemotherapy in aggressive non-Hodgkin lymphoma.
Authors: Katja De Paepe, Frederik De Keyzer, Oliver Bechter, Ciska-Anne Van Keerberghen, Olivier Gheysens, Pascal Wolter, Daan Dierickx, Ann Janssens, Gregor Verhoef, Raymond Oyen, Vincent Vandecaveye
Journal: Journal of Clinical Oncology (2017)

7534 Background: Treatment adaptation based on early identification of non-Hodgkin lymphoma (NHL) patients not responding to therapy might improve survival. The role of interim fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) after 2-4 cycles of immunochemotherapy (ICT) herein is experimental as it renders false positive results, due to a rituximab-induced inflammatory response. Whole body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) was evaluated as a radiation-free imaging technique to predict treatment outcome in NHL after one cycle ICT (2-3 weeks). Methods: 47 patients with aggressive NHL (35 DLBCL,2 primary mediastinal BCL,3 unclassifiable BCL, 2 Burkitt,2 MCL, 2 peripheral TCL and 1 extranodal NK-TCL) were enrolled. All had baseline and interim WB-DWI/MRI, and end-of-treatment PET/CT; 39/47 had interim PET/CT. International prognostic index (IPI), immunohistochemical (IHC) markers Ki-67, Bcl-6 and Bcl-2 were evaluated for their predictive value. WB-DWI/MRI was assessed quantitatively with histogram analysis (high b-value signal intensity (SI) and apparent diffusion coefficient (ADC)). Patients were categorized as non-responder when lesions had decreased ADC or insufficient SI decrease between scans. Kaplan-Meier survival analysis was performed with log rank, Cox hazard ratio calculation and multivariate analysis. Outcome measure was disease-free-survival (DFS). Results: Median follow-up time was 43 months (4-70 months). 33 patients had complete remission (CR), 5 progression and 9 recurrent disease. WB-DWI/MRI predicted DFS correctly in 45/47 (96%) [log rank p&lt;0.001; hazard ratio (HR) 52, (CI 95% 6-401)]; end-of-treatment PET/CT was correct in 37/47 (79%) [p=0.003;HR 4.3, (1.5-12.4)], and interim PET/CT in 28/39 (72%) [p=0.016;HR 3.9, (1.2-12.5)]. IPI score and IHC parameters were not significantly predictive. Multivariate analysis showed WB-DWI/MRI as the only independent prognostic factor (p&lt;0.001). Conclusions: WB-DWI/MRI can accurately predict treatment outcome in aggressive NHL after only one cycle of immunochemotherapy without the burden of radiation exposure. Clinical trial information: NCT01231269.
Leptin is a vasocillator in human saphenous vein: evidence for divergence of resistance to leptin's vascular and metabolic actions
Authors: A U Momin, Ajay Shah, D Grieve, C Driver, A El-Gamel, J Desai, L John, M Marrinan, R Sherwood, Mark Kearney
Journal: Journal of the American College of Cardiology (2005)
Unicef report calls for children to move to the top of the health agenda
Authors: Susan Mayor
Journal: BMJ (2000)

The poverty and neglect still suffered by millions of children in the world is a “waste of human potential,” warned an assessment of the wellbeing of children published this week by Unicef (the United National Children's Fund).

Unicef's latest assessment of the wellbeing of children, The State of the World's Children 2001 —reported a lack of investment in child health in many countries around the world, despite growing realisation of the importance of sustainable development in other areas.

The executive director of Unicef, Carol Bellamy, argued: “Investment in the development and care of our youngest children is the most fundamental form of good leadership. The world is squandering human potential on a massive scale as hundreds of millions of the world's youngest citizens flounder in poverty and neglect in their first years of life.”

The report focused particularly on the health of children aged 3 years and under, arguing that these early years are critical to how the …
Revalidation and assessment: giving marks might help
Authors: R. Lehman
Journal: BMJ (2001)

EDITOR—Once again the BMJ ‘s letters pages are full of correspondence about professional revalidation and assessment.1 Fortunately, with a change of leadership in the General Medical Council and greater realism within government, the tide is turning from complex systems of assessment that assume that every doctor is a potential rotten apple until proved otherwise, towards systems that assume that all the apples are sound except for …
Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial
Authors: R I Lindley, C S Anderson, L Billot, A Forster, M L Hackett, L A Harvey, S Jan, Q Li, H Liu, P Langhorne, P K Maulik, G V S Murthy, M F Walker, J D Pandian, M Alim, C Felix, A Syrigapu, D K Tugnawat, S J Verma, B R Shamanna, G Hankey, A Thrift, J Bernhardt, M M Mehndiratta, L Jeyaseelan, P Donnelly, D Byrne, S Steley, V Santhosh, S Chilappagari, J Mysore, J Roy, M V Padma, L John, S Aaron, N C Borah, P Vijaya, S Kaul, D Khurana, P N Sylaja, D S Halprashanth, B K Madhusudhan, V Nambiar, S Sureshbabu, M C Khanna, G S Narang, D Chakraborty, S S Chakraborty, B Biswas, S Kaura, H Koundal, P Singh, A Andrias, D S Thambu, I Ramya, J George, A T Prabhakar, P Kirubakaran, P Anbalagan, M Ghose, K Bordoloi, P Gohain, N M Reddy, K V Reddy, T N M Rao, S Alladi, V R R Jalapu, K Manchireddy, A Rajan, S Mehta, C Katoch, B Das, A Jangir, T Kaur, S Sreedharan, S Sivasambath, S Dinesh, B S Shibi, A Thangaraj, A Karunanithi, S M S Sulaiman, K Dehingia, K Das, C Nandini, N J Thomas, T S Dhanya, N Thomas, R Krishna, V Aneesh, R Krishna, S Khullar, S Thouman, I Sebastian
Journal: The Lancet (2017)
Detection of Driver and Resistance Mutations in Leptomeningeal Metastases of NSCLC by Next-Generation Sequencing of Cerebrospinal Fluid Circulating Tumor Cells
Authors: Ben-Yuan Jiang, Yang-Si Li, Wei-Bang Guo, Xu-Chao Zhang, Zhi-Hong Chen, Jian Su, Wen-Zhao Zhong, Xue-Ning Yang, Jin-Ji Yang, Yang Shao, Biao Huang, Yan-Hui Liu, Qing Zhou, Hai-Yan Tu, Hua-Jun Chen, Zhen Wang, Chong-Rui Xu, Bin-Chao Wang, Shu-Yu Wu, Cun-Yi Gao, Xian Zhang, Yi-Long Wu
Journal: Clinical Cancer Research (2017)

Purpose: Leptomeningeal metastases are more common in non-small cell lung cancer (NSCLC) with EGFR mutations. The diagnosis is difficult by traditional imaging only, and leads to poor understanding of resistance mechanisms of leptomeningeal metastases.Experimental Design: We compared the CellSearch Assay, the Thinprep cytologic test (TCT), and brain magnetic resonance imaging (MRI) in 21 NSCLC patients with suspected leptomeningeal metastases. Next-generation sequencing that included 416 cancer-associated genes was also performed on cerebrospinal fluid circulating tumor cells (CSFCTC) of 19 patients.Results: Twenty-one patients were diagnosed with leptomeningeal metastases, and CSFCTCs were captured by CellSearch in 20 patients (median, 969 CSFCTCs/7.5 mL; range, 27-14,888). CellSearch had a sensitivity of 95.2% for leptomeningeal metastases diagnosis, which was higher than that of TCT (12/21, 57.1%), MRI (10/21, 47.6%), and MRI plus TCT (19/21, 90.5%), respectively. CTCs were found only in 5 of 14 patients (median, 2 CTCs/7.5 mL; range, 2-4), which was a much lower ratio than CSFCTCs. Genetic profiles of CSFCTCs were highly concordant with molecular mutations identified in the primary tumor (17/19, 89.5%). The resistance gene EGFR T790M was detected in 7 of 9 patients with extracranial lesions, but was detected in only 1 of 14 CSFCTC samples. Other potential resistant mutations, such as MET amplification and ERBB2 mutation, were also identified in CSFCTCs.Conclusions: CSFCTCs captured by CellSearch may be a more sensitive and effective way to diagnose leptomeningeal metastases, and may serve as a liquid biopsy medium for gene profiles in NSCLC patients with leptomeningeal metastases. Clin Cancer Res; 23(18); 5480-8. ©2017 AACR.
Abstract 2580: Potential Role of Circulating Progenitor Cells in Coronary Microvascular Dysfunction of Heart Transplant Patients with Normal Coronary Angiograms
Authors: Francesco Tona, Gianpaolo Fadini, Alida Caforio, Ilenia Baesso, Carlo Agostini, Annalisa Angelini, Massimo Napodano, Gino Gerosa, Angelo Avogaro, Sabino Iliceto
Journal: Circulation (2007)

Peripheral blood progenitor cells (PCs) may play a role in the early stages of cardiac allograft vasculopathy (CAV). We assessed the relationship between PCs and coronary microvascular function in heart transplant (HT) patients (pts) with normal coronary angiograms. Methods : We studied 41 pts with (36 M, aged 50 ± 12 years) at 6 ± 3 years from HT and 40 age and sex matched healthy subjects. Six subpopulations of PCs were determined by flow cytometry as follows: uncommitted (CD34 + , CD133 + , CD34 + CD133 + ) and endothelial PCs (EPCs, CD34 + KDR + , CD133 + KDR + , CD34 + CD133 + KDR + ). Coronary flow velocity in the LAD was detected at rest and during i.v. adenosine by transthoracic echocardiography. Coronary flow reserve (CFR) was the ratio of hyperemic diastolic mean velocity (DMV) to resting DMV. CFR &lt;2.5 was considered abnormal. CFR was measured in 10 pts (8 M, aged 50 ± 12 years) and was abnormal in 3 (group A) and normal in 7 (group B). Results : EPCs were lower in pts than in controls (p&lt;0.05). CD34 + cell count was higher in group A than in group B (583 ± 100 vs 282 ± 185 cells/10 ^ 6 cytometric events, p=0.01). CD34 + cell count was also inversely correlated with CFR as shown in the figure . At multivariable analysis, adjusted for time from HT, diabetes, hypertension and hypertrophy, CD34 + cell count was the only independent predictor of CFR (β=-0.773, p=0.006). Conclusion : EPCs were reduced in HT pts with normal angiograms, in keeping with their immunosuppressed status. Levels of CD34 + cells were inversely related with CFR. Mobilization of uncommitted PCs may be involved in the pathogenesis of CAV, possibly by PCs capacity of differentiation into neointimal and medial cells.
Von Hippel–Lindau and Hereditary Pheochromocytoma/Paraganglioma Syndromes: Clinical Features, Genetics, and Surveillance Recommendations in Childhood
Authors: Surya P. Rednam, Ayelet Erez, Harriet Druker, Katherine A. Janeway, Junne Kamihara, Wendy K. Kohlmann, Katherine L. Nathanson, Lisa J. States, Gail E. Tomlinson, Anita Villani, Stephan D. Voss, Joshua D. Schiffman, Jonathan D. Wasserman
Journal: Clinical Cancer Research (2017)

Abstract Von Hippel–Lindau disease (vHL) is a hereditary tumor predisposition syndrome that places affected individuals at risk for multiple tumors, which are predominantly benign and generally occur in the central nervous system or abdomen. Although the majority of tumors occur in adults, children and adolescents with the condition develop a significant proportion of vHL manifestations and are vulnerable to delayed tumor detection and their sequelae. Although multiple tumor screening paradigms are currently being utilized for patients with vHL, surveillance should be reassessed as the available relevant clinical information continues to expand. We propose a new vHL screening paradigm similar to existing approaches, with important modifications for some tumor types, placing an emphasis on risks in childhood. This includes advancement in the timing of surveillance initiation and increased frequency of screening evaluations. Another neuroendocrine-related familial condition is the rapidly expanding hereditary paraganglioma and pheochromocytoma syndrome (HPP). The tumor spectrum for patients with HPP syndrome includes paragangliomas, pheochromocytomas, renal cancer, and gastrointestinal stromal tumors. The majority of patients with HPP syndrome harbor an underlying variant in one of the SHDx genes (SDHA, SDHB, SDHC, SDHD, SDHA, and SDHAF2), although other genes also have been described (MAX and TMEM127). Annual screening for elevated plasma or urine markers along with complete blood count and biennial whole-body MRI accompanied by focal neck MRI is recommended for older children and adults with HPP syndrome to detect tumors early and to decrease morbidity and mortality from HPP-related tumors. Clin Cancer Res; 23(12); e68–e75. ©2017 AACR. See all articles in the online-only CCR Pediatric Oncology Series.
Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Chronic Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction
Authors: Alaa Alashi, Amgad Mentias, Amjad Abdallah, Ke Feng, A. Marc Gillinov, L. Leonardo Rodriguez, Douglas R. Johnston, Lars G. Svensson, Zoran B. Popovic, Brian P. Griffin, Milind Y. Desai
Journal: JACC. Cardiovascular imaging (2017)
Pulmonary artery to aorta ratio and risk of all-cause mortality in the general population: the Rotterdam Study
Authors: Natalie Terzikhan, Daniel Bos, Lies Lahousse, Lennard Wolff, Katia M.C. Verhamme, Maarten J.G. Leening, Janine F. Felix, Henning Gall, Hossein A. Ghofrani, Oscar H. Franco, M. Arfan Ikram, Bruno H. Stricker, Aad van der Lugt, Guy Brusselle
Journal: European Respiratory Journal (2017)

A pulmonary artery to aorta ratio (PA:A) &gt;1 is a proxy of pulmonary hypertension. It is not known whether this measure carries prognostic information in the general population and in individuals with chronic obstructive pulmonary disease (COPD). Between 2003 and 2006, 2197 participants from the population-based Rotterdam Study (mean± sd age 69.7±6.7 years; 51.3% female), underwent cardiac computed tomography (CT) scanning with PA:A quantification, defined as the ratio between the diameters of the pulmonary artery and the aorta. COPD was diagnosed based on spirometry or clinical presentation and obstructive lung function measured by a treating physician. Cox regression was used to investigate the risk of mortality. We observed no association between 1- sd increase of PA:A and mortality in the general population. Larger PA:A was associated with an increased risk of mortality in individuals with COPD, particularly in moderate-to-severe COPD (hazard ratio 1.36, 95% CI 1.03–1.79). We demonstrated that the risk of mortality in COPD was driven by severe COPD, and that this risk increased with decreasing diffusing capacity. Larger PA:A is not associated with mortality in an older general population, but is an independent determinant of mortality in moderate-to-severe COPD. Measuring PA:A in CT scans obtained for other indications may yield important prognostic information in individuals with COPD.
Abstract P386: Design of a Tailored Text-message Intervention for Weight Loss
Authors: Julia Kolodziejczyk, Anglica Barrera, Kevin Patrick, Lindsay Dillon, Simon Marshall, Elva Arredondo, Cheryl Rock, Fred Raab, William Griswold, Mark Sullivan, Gregory Norman
Journal: Circulation (2012)

Introduction: Tailoring information is a commonly used health communication technique to individualize behavior change programs. However, few studies have applied individualized tailoring to a text-message intervention. Using tailoring with text-messages may be a powerful behavior change tool as this technology is inexpensive, asynchronous, and is ubiquitous across socio-economic segments. We developed a tailored, “push/pull,” text-message intervention for overweight/obese English and Spanish-speaking participants that targets weight management behaviors. The development of the theory-driven logic rules for individualized text-messages is described. Methods: A robust web-based participant intake system was developed to gather and store the data needed to individualize the messages by personalization, feedback, and content matching. Feedback and content matching was based on both a baseline weight management behavior survey and continual text message-based assessments related to individual behaviors and perceived barriers. The system is designed so that participants who show rapid and sustained progress can advance through the content, while those having difficulties can receive additional tips and suggestions. Participants will be scheduled to receive 3-4 interactive messages per day from our library of over 6,000 text messages. We categorized the messages into five groups: 1) Subject matter: Content related to nutrition and physical activity behaviors; 2) Behavioral core strategies based on Self-Regulation Theory (e.g. self-monitoring, goal setting); 3) Message type (e.g. reminder, feedback); 4) Personalization (e.g. favorite restaurants, friends’ names); and 5) Location related messages. We also developed a “like/ don’t like” feature so that the system can continuously learn user preferences for message types and adjust the type of future messages sent accordingly. Conclusion: A large-scale randomized controlled trial is underway to evaluate the efficacy of this text-message intervention. While this intervention is aimed at weight loss, our tailoring technique will likely apply to other health behaviors as well.
Contribution of microRNA-137 to CDDP resistance in lung adenocarcinoma.
Authors: Te-Jen Su, Sung-Liang Yu, Jian-Wei Chen
Journal: Journal of Clinical Oncology (2016)

e23262 Background: Although targeted therapy can prolong the survival of non-small cell lung cancer (NSCLC) patients with EGFR mutations, chemotherapy still is the choice for patients with wild-type EGFR or failure in targeted therapy. However, most of the patients will develop chemoresistance eventually. Our previous study showed that microRNA-137 is risky and associated with poor prognosis of NSCLC patients. Here we investigated the role of microRNA-137 in cisplatin resistance of lung adenocarcinoma. Methods: We use microarray and web-based microRNA target prediction to find possible targets of microRNA-137. Real-time quantitative polymerase chain reaction and immunohistochemistry were futher applied for confirm the relatioship between microRNA-137 and its target using clinical samples. Kaplan-Meier survival analysis then were subjected to analyse the effects of microRNA-137 and its target on lung adenocarcinoma patients' survival. Results: Through computational prediction and microarray, we identified caspase-3 (CASP3) as a potential target of microRNA-137. Luciferase reporter and site-directed mutagenesis assays demonstrated that microRNA-137 downregulates CASP3 through binding to its 3’-UTR. Moreover, the endogenous CASP3 can be modulated by overexpressing or silencing microRNA-137 in lung adenocarcinoma cell lines regardless of EGFR status. Suppression of CASP3 by microRNA-137 provides cancer cells with the ability of anti-apoptosis, leading to cisplatin resistance. Immunohistochemistry results revealed an inverse correlation between microRNA-137 and CASP3 expressions in lung adenocarcinoma patients. Conclusions: Our data provide a new mechanism of chemoresistance in lung adenocarcinoma, and a possible target to control chemo-resistance in lung adenocarcinoma patients.