tbuckley/cabot-search huggingface dataset:
Pleural procedures - Are junior doctors struggling to gain experience?
Authors: Manish Gautam, Diana Lees, Josheel Naveed, Chris Warburton, Lisa Davies
Journal: European Respiratory Journal (2012)

Introduction:

BTS guidelines and UK training curricula highlight the importance of gaining experience in pleural procedures. By the end of core medical training (CMT), trainees are required to demonstrate competency in pleural aspiration and Seldinger chest drain insertion.

Aim:

To investigate the self-reported competency of junior doctors in performing pleural procedures

Method:

'On the spot' questionnaires were randomly distributed to 64 doctors training in a large university teaching hospital. Participants graded their level of competence in performing a variety of pleural procedures and possible reasons for lack of experience.

Results:

Response rate was 91%; 7 Speciality trainees (ST3-7), 17CMTs, 12 Foundation Year 2 (FY2) and 22 FY1 trainees. 36% reported independent ability to perform pleural tap, 31% aspiration, 21% chest drain insertion, 22% pleurodesis, 45% removal and 34% flushing of chest drains. All STs reported competence, but, 76% of trainees felt they were struggling to gain sufficient practical experience. Those with respiratory experience were more likely to report competence (p=0.001) although only 1/3 could insert a chest drain independently. Top reasons for 'struggling' were increasing use of ultrasound (US) (33%), followed by perceived lack of senior encouragement (17%).

Conclusion:

Our data suggest that the majority of trainee physicians do not feel competent to undertake pleural procedures independently. With increasing use of US for pleural procedures, trainees are having difficulty gaining experience. For CMTs, UK curricula now state mandatory competency in chest drain insertion for pneumothorax only, but training programmes must ensure adequate exposure to important pleural procedures.
Karyologic Studies of Normal Cells and of Adenovirus-Type-12-Induced Tumor Cells of the Syrian Hamster&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;&lt;xref ref-type="fn" rid="FN3"&gt;3&lt;/xref&gt;
Authors: Kazuhiko R. Utsumi, Isamu Kitamura, John J. Trentin
Journal: JNCI Journal of the National Cancer Institute (1965)

Journal Article Karyologic Studies of Normal Cells and of Adenovirus-Type-12-Induced Tumor Cells of the Syrian Hamster Get access Kazuhiko R. Utsumi, Kazuhiko R. Utsumi Division of Experimental Biology, Baylor University College of Medicine, Houston, Texas Search for other works by this author on: Oxford Academic PubMed Google Scholar Isamu Kitamura, Isamu Kitamura Division of Experimental Biology, Baylor University College of Medicine, Houston, Texas Search for other works by this author on: Oxford Academic PubMed Google Scholar John J. Trentin John J. Trentin Division of Experimental Biology, Baylor University College of Medicine, Houston, Texas Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 35, Issue 5, November 1965, Pages 759–769, https://doi.org/10.1093/jnci/35.5.759 Published: 01 November 1965 Article history Received: 31 July 1964 Published: 01 November 1965
the relationship between surface immunoglobulin isotype and immune function of murine B lymphocytes. III. Expression of a single predominant isotype on primed and unprimed B cells
Authors: I Zan-Bar, ES Vitetta, F Assisi, S Strober
Journal: The Journal of Experimental Medicine (1978)

We determined whether primed and unprimed B cells in the spleen of (BALB/c × C57BL/Ka)F(1) mice contain subpopulations that express a predominant surface Ig isotype. Spleen cells were stained for surface isotypes and sorted on the fluorescence-activated cell sorter (FACS) in order to obtain B cells bearing predominantly IgM (μp cells), IgD (δp cells), or IgG (γp cells). Each population was assayed for its capacity to restore the adoptive primary and secondary anti-bovine serum albumin (BSA) antibody response in irradiated syngeneic recipients. In addition, the adoptive response restored by isotype-predominant cells was compared to that restored by isotype- positive cells (B cells bearing a given surface isotype alone or in combination with others). The experimental results show that μp cells restore the adoptive primary and secondary IgM and IgG responses to BSA, and γP cells restore only the primary and secondary IgG response. Δp Cells restored the adoptive secondary IgG response, but failed to restore the adoptive primary response at the cell doses tested. ΓP Cells but not δp cells suppressed the IgM response of the μ(+) and δ(+) cells. The contribution of isotype-predominant cells to both the adoptive primary and secondary anti-BSA response was smaller than that of B cells bearing a combination of surface isotypes. Differences in the Ig isotype pattern expressed on the surface of primed and unprimed B cells are discussed.
Molecular Pathways: Sensitivity and Resistance to Anti-EGFR Antibodies
Authors: Andrea Bertotti, Francesco Sassi
Journal: Clinical Cancer Research (2015)

Monoclonal antibodies targeting the EGF receptor (EGFR) tyrosine kinase, such as cetuximab and panitumumab, achieve clinically meaningful responses in patients affected by head and neck and colorectal cancers. Despite this evidence of efficacy, no genomic abnormalities that robustly predict sensitivity to EGFR blockade have been yet identified. This suggests that, in some tumor contexts, EGFR dependency is not acquired during neoplastic transformation and rather reflects an aberrant declination of physiologic traits typical of normal tissue counterparts. Indeed, EGFR signals are crucial for the reconstitution of damaged mucosa in the context of acute inflammation, and their sustained activation is likely to turn into a pro-oncogenic cue during chronic inflammation. Although positive predictors of response to anti-EGFR antibodies remain unknown, multiple determinants of resistance have been described, including alterations interfering with antibody-receptor interaction, deregulation of parallel signaling pathways, and mutations in downstream transducers. These findings provide new opportunities for the optimization of therapeutic strategies based on drug combinations. However, the emerging notion that genetic interactions and compensatory mechanisms may affect-both positively and negatively-the efficacy of targeted therapies complicates the rational design of combinatorial approaches and implies a rethinking of the criteria required to prioritize laboratory findings for clinical validation in investigational trials.
Incidence of chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism
Authors: Su-Qiao Yang, Yuan-Hua Yang, Zhen-Guo Zhai, Tu-Guang Kuang, Juan-Ni Gong, Jian-Guo Zhu, Yi-Dan Li, Ya-Feng Wu, Chen Wang
Journal: European Respiratory Journal (2011)

Background:  Recent studies suggest that chronic thromboembolic pulmonary hypertension (CTEPH) following acute pulmonary embolism (PE) may be more common than previously thought.   Objective:  To investigate the incidence of CTEPH and associated risk factors through a systematic screening in patients after acute PE in China.   Methods:  A cohort study of consecutive patients with acute PE in a national referral institute was retro and prospectively approached by a questionnaire for the presence of new or increased complaints of dyspnea after acute PE episode. Subsequently, these patients were evaluated for the presence of pulmonary hypertension with echocardiography, perfusion lung scanning and right heart catheterization (RHC) in follow-up period. Pulmonary hypertension was defined as a systolic pulmonary artery pressure ≥50 mmHg at rest in the presence of residual perfusion defects at perfusion lung scanning.   Results:  From 2006 to 2010, 488 patients with acute PE were screened, and 475 patients were included. Overall mortality after a median follow-up period of 21 months was 12.9%; 74 patients were lost to follow-up. In the remaining patients, nine were diagnosed with pulmonary hypertension by echocardiography, and two of the nine patients underwent right heart catheterization (RHC). The incidence of CTEPH after acute PE was 2.24%. In Cox regression, 173 cases which had no missing data of biomarkers were involved. The analysis showed that protein C deficiency (hazard ratio, 10.40, 95% confidence interval, 1.06 to 102.25) increased the risk of CTEPH after acute PE.   Conclusions:  The incidence of CTEPH after acute PE was 2.24%. Protein C deficiency may increase the risk of CTEPH.
Bax and Bcl-2 Polymorphisms Modulating Aggressiveness and Prognosis in Diffuse Large B-Cell Lymphoma
Authors: A.B.C. Brito, C. Oliveira, M.T. Delamain, C.A. De Souza, J. Vassallo, C.S.P. Lima
Journal: Annals of Oncology (2014)
Indoleamine‐2,3‐dioxygenase as an effector and an indicator of protective immune responses in patients with acute hepatitis B
Authors: Sachiyo Yoshio, Masaya Sugiyama, Hirotaka Shoji, Yohei Mano, Eiji Mita, Toru Okamoto, Yoshiharu Matsuura, Alato Okuno, Osamu Takikawa, Masashi Mizokami, Tatsuya Kanto
Journal: Hepatology (2015)

Indoleamine‐2, 3‐dioxygenase (IDO), an interferon‐γ‐inducible enzyme catalyzing tryptophan into kynurenine, exerts dual functions in infectious diseases, acting as a suppressor of intracellular pathogens and as an immune regulator. We explored the roles of IDO in hepatitis B virus (HBV) clearance from infected patients. We examined IDO activity, serum chemokines, and cytokines in 53 HBV‐positive patients (25 acute hepatitis, 14 chronic hepatitis, and 14 hepatic flare) and 14 healthy volunteers. In order to clarify the mechanisms of IDO induction and its impact on HBV replication, we used a culture model consisting of human natural killer cells, plasmacytoid dendritic cells, and HBV‐transfected Huh7 cells in which IDO expression is controlled. A robust activation of IDO with an inverse correlation of alanine aminotransferase at the peak was observed in patients with acute hepatitis B but not in patients with hepatic flare. In acute hepatitis patients who eventually cleared HBV, IDO activity, chemokine (C‐X‐C motif) ligand 9 (CXCL9), CXCL10, and CXCL11 increased at the peak of alanine aminotransferase. In contrast, in patients with hepatic flare, IDO activity remained at lower levels during the observation period, regardless of the surge of CXCL9, CXCL10, and CXCL11 at the alanine aminotransferase peak. Natural killer cells and plasmacytoid dendritic cells synergistically produced interferon‐γ and interferon‐α, thereby enhancing IDO activity and HBV suppression in Huh7 cells. Such suppressor capacity of IDO on HBV was abrogated in IDO‐knockout cells and recovered by the reinduction of IDO in the cells. Conclusion: IDO is an anti‐HBV effector and an indicator of subsequent immune responses operative during the early phase of infection; its activity is boosted by coexisting natural killer cells and plasmacytoid dendritic cells. (H epatology 2016;63:83–94)
Is long-term treatment with inhaled steroids in adults hazardous?
Authors: J Boe, BE Skoogh
Journal: European Respiratory Journal (1992)

<i>INTRODUCTION:</i> This report demonstrates the spectrum of central nervous system (CNS) abnormalities observed on MR imaging and CT studies in 6 patients with clinical or pathologic diagnoses of acute retinal necrosis (ARN) and retrobulbar optic neuritis (RBON-H) resulting from Herpes Zoster Virus and Cytomegalovirus. We discuss the etiologic and pathophysiologic implications regarding these findings. <i>METHODS:</i> Standard MR imaging sequences of the whole brain and selected high-resolution images of the orbits and globes, from 6 patients, were reviewed by three neuroradiologists for consensus interpretation of the findings. Special sequences augmenting disease were obtained in individual cases. Axial CT images were obtained from two patients using 5mm sequential slices. <i>RESULTS:</i> MR imaging findings showed both T2 signal brightening and contrast enhancement in one or both optic nerves, optic tracts and lateral geniculate bodies, as well as the postsynaptic optic radiations and optic cortex. Similar findings were observed in the superior colliculus, lateral midbrain and cerebellum, with multiple potential etiologic possibilities regarding pathways of dissemination. Low T2* signal (indicating magnetic field susceptibility effects) and CT hyperdensity, consistent with prior hemorrhage, were also observed in the optic tracts, optic radiations and lateral geniculate bodies. Post-contrast enhancement was observed in the meninges and Meckle’s cave in one HIV negative patient. <i>CONCLUSION:</i> These cases demonstrate CNS imaging findings associated with RBON that are temporally-related to ARN. They support the hypothesis that RBON can either precede or follow ARN and implicate transneuronal, transsynaptic and/or transcerebrospinal fluid viral spread by the herpetic family.
Uncertainty in sample estimates: standard error
Authors: P. Sedgwick
Journal: BMJ (2015)

The efficacy of nicotine patches among pregnant smokers was investigated using a randomised placebo controlled trial. The intervention was the administration of 16 hour nicotine patches after recruitment until the time of delivery. Participants were pregnant women over 18 years who smoked at least five cigarettes a day and whose babies were between 12 and 20 weeks’ gestation. In total, 402 women were recruited from 23 maternity wards throughout France and randomly allocated to the intervention (n=203) or placebo patches (n=199).1 The outcome measures included achievement of complete abstinence until delivery and birth weight. The proportion of women who achieved complete abstinence was higher in the nicotine patch group than in the placebo group, although the difference was not significant (11 (5.5%) v 10 (5.1%); odds ratio 1.08, 95% confidence interval 0.45 to 2.60; P=0.87). The mean birth weight was higher in the nicotine patch group, although the difference was not significant (3065 g (standard error 44 g) v 3015 g (44 g); difference 50 g, −71.1 to 172.3; P=0.41). It was concluded that the nicotine patch did not increase smoking cessation rates or birth weights when compared with placebo. Which of the following statements, if any, are true?
Cell Surface &lt;italic&gt;α&lt;/italic&gt;-&lt;sc&gt;D&lt;/sc&gt;-Galactopyranosyl End Groups: Use as Markers in the Isolation of Murine Tumor Cell Lines With Different Cancer-Causing Potentials&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;&lt;xref ref-type="fn" rid="FN3"&gt;3&lt;/xref&gt;
Authors: James Varani, Edmund J. Lovett, Max Wicha, Herb Malinoff, J. Philip McCoy
Journal: JNCI Journal of the National Cancer Institute (1983)

Cell lines from 2 3-methylcholanthrene-induced murine tumors were established in culture and examined for reactivity with Griffonia simplicifolia isolectin B4 (GS I-B4), a lectin that has strict specificity for terminal alpha-D-galactopyranosyl residues. Virtually all of the cells in both populations were strongly reactive, indicating the presence of this carbohydrate on the cell surface. Both tumor lines were exposed to human serum with antibodies to the blood group B antigen. More than 99.99% of the exposed cells were killed by this treatment. This is not surprising, because terminal alpha-D-galactopyranosyl residues comprise the blood group B antigen. From the few surviving cells, it was possible to establish cell lines resistant to the cytotoxic effects of the anti-blood group B antibodies. A total of 4 cell lines were independently obtained in this way. The human serum-resistant lines showed no detectable reactivity with GS I-B4, indicating that alpha-D-galactopyranosyl-deficient cell lines had been obtained. The parent and variant cells were compared for reactivity with anti-laminin antibodies. Both parent lines showed strong reactivity by immunofluorescence in the viable state, whereas the alpha-D-galactopyranosyl-deficient lines showed no reactivity. The parent and variant lines were also compared with regard to in vitro and in vivo growth. The alpha-D-galactopyranosyl-deficient lines had reduced in vitro growth capacity relative to the parent lines. More importantly, in contrast to the parent lines, these lines were significantly less tumorigenic than the parent lines when injected into syngeneic mice and did not metastasize spontaneously.
Matrix metalloproteinase-7 activates heparin-binding epidermal growth factor-like growth factor in cutaneous squamous cell carcinoma
Authors: A.K. Kivisaari, M. Kallajoki, R. Ala-aho, J.A. McGrath, J.W. Bauer, R. Königová, M. Medvecz, W. Beckert, R. Grénman, V.-M. Kähäri
Journal: British Journal of Dermatology (2010)

Journal Article Matrix metalloproteinase‐7 activates heparin‐binding epidermal growth factor‐like growth factor in cutaneous squamous cell carcinoma Get access A.K. Kivisaari, A.K. Kivisaari Department of Dermatology, University of Turku and Turku University Hospital, PO Box 52, 20521 Turku, FinlandMedicity Research Laboratory, University of Turku, Turku, Finland Search for other works by this author on: Oxford Academic Google Scholar M. Kallajoki, M. Kallajoki Department of Pathology, Turku University Hospital, Turku, Finland Search for other works by this author on: Oxford Academic Google Scholar R. Ala‐aho, R. Ala‐aho Department of Dermatology, University of Turku and Turku University Hospital, PO Box 52, 20521 Turku, FinlandMedicity Research Laboratory, University of Turku, Turku, Finland Search for other works by this author on: Oxford Academic Google Scholar J.A. McGrath, J.A. McGrath St John's Institute of Dermatology, King's College London (Guy's Campus), London, U.K. Search for other works by this author on: Oxford Academic Google Scholar J.W. Bauer, J.W. Bauer Department of Dermatology, General Hospital, Salzburg, Austria Search for other works by this author on: Oxford Academic Google Scholar R. Königová, R. Königová Burn Centre, Charles University, Prague, Czech Republic Search for other works by this author on: Oxford Academic Google Scholar M. Medvecz, M. Medvecz Department of Dermatology, Venereology and Dermato‐oncology, Semmelweis University Budapest, Budapest, Hungary Search for other works by this author on: Oxford Academic Google Scholar W. Beckert, W. Beckert Laboratory for Histology and Cytology, Nürtingen, Germany Search for other works by this author on: Oxford Academic Google Scholar R. Grénman, R. Grénman Department of Otorhinolaryngology – Head and Neck Surgery, University of Turku, Turku, Finland Search for other works by this author on: Oxford Academic Google Scholar V.‐M. Kähäri V.‐M. Kähäri Department of Dermatology, University of Turku and Turku University Hospital, PO Box 52, 20521 Turku, FinlandMedicity Research Laboratory, University of Turku, Turku, Finland Correspondence: Veli‐Matti Kähäri. E‐mail: veli‐matti.kahari@utu.fi Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 163, Issue 4, 1 October 2010, Pages 726–735, https://doi.org/10.1111/j.1365-2133.2010.09924.x Published: 01 October 2010
A phase I trial of intravenously-administered recombinant tumor necrosis factor-alpha in cancer patients.
Authors: B Feinberg, R Kurzrock, M Talpaz, M Blick, S Saks, J U Gutterman
Journal: Journal of Clinical Oncology (1988)

We report a phase I clinical investigation of 30-minute and four-hour intravenous (IV) infusions of recombinant tumor necrosis factor (rTNF)-alpha. Thirty-nine patients with disseminated cancer received escalating doses of rTNF-alpha for five consecutive days every 2 weeks for a total duration of 8 weeks. Dose escalations followed a modified Fibonacci scale with a minimum of four patients entered at each dose level: 5, 10, 25, 50, 75, 100, 150, 200, and 250 micrograms/m2/d. Toxicities consisted mainly of constitutional symptoms including fever, chills, headache, and fatigue, increasing in severity with dose escalation. No significant differences in dose-limiting toxicities were seen between the two rates of IV infusion. The maximum tolerated dose (MTD) was 200 micrograms/m2 with dose limiting toxicity being constitutional symptoms and hypotension. Hematologic changes included median decrease in both granulocyte and platelet counts of 38% and 41%, respectively (range, 16% to 85%), although clinically significant granulocytopenia and thrombocytopenia were not observed. Hematological parameters returned to baseline within 72 hours after rTNF-alpha was stopped. rTNF-alpha induced changes in lipid metabolism were manifested by median fasting triglyceride elevations above baseline (median, 103 micrograms/dL) of 157% (range, 16% to 389%) after five days of therapy with doses greater than 75 micrograms/m2, associated with a median increase in very-low-density lipoprotein (VLDL) of 80%. Serum rTNF peak levels exceeding 10 ng/mL were observed 30 minutes following rTNF-alpha infusions at MTD dose. Twelve of 34 patients had no change in their evaluable disease for a median duration of 18 weeks (range, 8 to 30 weeks), and 22 patients showed progressive disease. This study forms the framework for phase II trials of IV administered rTNF-alpha.
Letters from the Clinic: Letter Writing in Clinical Practice for Mental Health Professionals
Authors: Rosalind Ramsay
Journal: Journal of the Royal Society of Medicine (2001)

Whatever their sphere of therapeutic practice, clinicians spend a substantial amount of time writing letters to and about patients. In mental health work, where physical tests play a small part, proportionately more time goes in to exploring a patient's problems, their background, attempts to manage them so far and so on. A key task for the clinician is to distil this information into a formulation that will allow better understanding of how the problem has developed, and what to do now. So it is surprising how little training health professionals get in the art of writing letters to and about their patients. Derek Steinberg is a consultant in child and adolescent psychiatry, but his views go beyond the realms of his specialty. In Letters from the Clinic he takes us through a series of 42 situations—engaging in work, work in progress, and endings, with a fascinating collection of letters and accompanying notes to illustrate different points.

The beginning and end of the book include more theoretical discussion on the role of the letter. ‘Why write?’ Steinberg asks. He gives good reasons—‘first, because finding the right words is a good exercise, and committing them to paper adds to the responsibility to get it right...’ and also because of the importance of words in therapy, and as a reminder of the agreed treatment plan. Steinberg points to the magic in words too, telling us, for example, that Rx is shorthand for ‘Under the good auspices of Jove, the patron of medicines, take the following drug in the prescription laid down’.

Steinberg advocates keeping letters short (but not brusque) and free of jargon. Almost all of his letters are to the patient and family members, with a copy to relevant professionals, and they are refreshing in their clarity. In some cases he reflects in the notes at the end on an alternative approach that he could have taken, as a reminder that there is not always just one correct way of communicating. Several letters appropriately imply, or declare, uncertainty; for example, ‘I don't know whether you want another appointment’ puts the decision into the recipient's court.

A recurring theme in the book is confidentiality. Working in child and adolescent psychiatry, doctors are likely to deal with a particularly wide range of other agencies—for example, social services, education, and possibly probation—as well as colleagues in the Health Service. Against the right of ‘needing to know’ Steinberg reminds us of the ‘bald fact of confidentiality’ that, until permission has been given to do otherwise, a doctor ‘can only talk about a patient's history and clinical state to another doctor’.

Letters from the Clinic is not a collection of ‘how to say it’ letters but a helpful reminder to health professionals of the power of the written word.