tbuckley/cabot-search huggingface dataset:
Preregistration house officers in eight English regions: survey of quality of training.
Authors: J H Gillard, T H Dent, E J Aarons, P J Smyth-Pigott, M W Nicholls
Journal: BMJ (1993)

OBJECTIVE--To assess the quality of preregistration house officer training in eight English regions. DESIGN--Postal questionnaire. SETTING--Thames, East Anglian, Mersey, Northern, and Wessex regions. PARTICIPANTS--1670 preregistration house officers. MAIN OUTCOME MEASURES--Education, hours of work, workload, conditions of work, and attitudes to job and medicine as a career. RESULTS--Response rate was 69% (1146 replies). Most house officers had attended induction courses (1036/1129 (92%)); 74% (757/1024) found them satisfactory. The proportions who had never received adequate guidance on how to break bad news and how to control pain were 59% (670/1135) and 56% (634/1136) respectively. There was much variation between regions. Overall, 65% (736/1138) reported confidence in performing cardiopulmonary resuscitation. Most respondents (95% (1089/1142)) worked an on call rota, 3% (36) a partial shift, and 0.6% (seven) a full shift; 19% (202) were on duty for average weekly hours that exceeded the targets for 1 April 1993. House officers had a median of 20 patients under their care and clerked a median of 10 emergency cases, six routine cases, and two day cases a week. Over half (690/1128 (61%)) could not obtain hot food after 8 pm, 20% (223/1095) did not always have clean sheets available in their on call room, and 45% (462/1036) did not consider the protection of staff against violence to be adequate at their hospital. The most important problems with the preregistration year were inappropriate or non-medical tasks (ranked first by 360 respondents), hours of work (359), and pay for out of hours work (167). Overall 57% (646/1125) would encourage a friend to apply for their post, but only 24% (266/1112) would encourage a friend to take up medicine and 44% (494/1112) would discourage the idea. CONCLUSIONS--House officers9 training is deficient in important respects, with inappropriate tasks and heavy clinical workloads impeding the provision of proper education.
Pediatric CVAs linked to lipid abnormalities
Authors: Phil Gunby
Journal: JAMA (1982)

The child was scarcely more than a baby. Yet, at the age of 17 months, she had suffered a stroke that left residual weakness on her right side. However, for University of Cincinnati physicians, the real surprise involved the child's mother.  This 28-year old woman also had suffered a stroke while a child. Hers had occurred when she was 7 years old, and apparently she had recovered completely.  Cerebrovascular accidents in children are among the most tragic and puzzling problems in pediatrics, so this familial occurrence sent Charles J. Glueck, MD, and colleagues to the medical records in the hope of piecing together at least part of the puzzle.  Their conclusion, as reported at the American Heart Association meeting in Dallas, is that familial lipoprotein abnormalities appear to be involved. These abnormalities, they suggest, may be related to hundreds of the childhood strokes that occur in this country every year.
Hypothyroidism and hepatocellular carcinoma: More questions than answers
Authors: Tugrul Purnak, Ersan Ozaslan
Journal: Hepatology (2009)

We read with great interest the article by Hassan et al.1 The authors have comprehensively evaluated the risk factors for hepatocellular carcinoma (HCC) and found that the length of hypothyroidism positively correlated with the development of HCC. They reported that this association is more prominent among women compared to men. The authors also postulated that hypothyroidism-induced obesity may cause the acceleration of nonalcoholic fatty liver disease (NAFLD) leading to cirrhosis, which creates a vulnerability to the development of HCC. We have some questions about the patients included in the study. First of all, we are curious about the liver histology of the HCC group. We would like to know more details about the liver histology to understand whether HCC is developed on the basis of NAFLD-induced cirrhosis, as proposed by the authors. Secondly, when the patients in HCC group were diagnosed with hypothyroidism, we assume that they all received the appropriate treatment for hypothyroidism. In this situation, the hypothyroid patients included in this study must have become euthyroid as a result in this time period (from the diagnosis of hypothyroidism to the diagnosis of HCC). The proposed mechanisms of the development of HCC such as hypothyroidism-induced obesity and hyperinsulinemia will probably be invalid if this assumption is correct. Thirdly, we do not agree with the authors regarding why hypothyroidism and HCC association are more common in female patients. The authors mentioned the role of hepatic growth hormone receptors and growth hormone binding protein messenger RNA elevation in female patients compared to male patients, and claimed that this elevation may cause susceptibility to the development of HCC, particularly in female patients. When we take into account the nature of autoimmune thyroid diseases, which frequently occur in hypothyroid states and are encountered predominantly in females, we could understand why the association of HCC and hypothyroidism is more prevalent in the female group. This could be a more logical explanation rather than other factors. Moreover, any chronic medical condition may alter thyroid hormone levels frequently in favor of hypothyroidism. This entity is known as "euthyroid sick syndrome". In the article, the authors declared that patients were carefully evaluated via questionnaire to reveal any chronic disease in their medical history. We wonder how many patients have any chronic illness which may alter thyroid hormone levels in the HCC group. By knowing this, we could appreciate whether hypothyroidism is a true cause of the development of HCC or just a result. Finally, we would like to ask the authors whether they can reveal some new data about the patients, particularly in the HCC group included in the study, and we hope to find a chance to discuss our concerns with the authors. Tugrul Purnak M.D.*, Ersan Ozaslan M.D.*, * Ankara Numune Education and Research Hospital, Department of Gastroenterology, Talatpasa Bulvari, Samanpazari, Sihhiye/Ankara, Turkey.
Surveillance Colonoscopy in Elderly Patients
Authors: An Hong Tran, Eunis Wai Man Ngor, Bechien U. Wu
Journal: JAMA Internal Medicine (2014)

The risks and benefits of surveillance colonoscopy in elderly patients have not been well characterized.To investigate the relative impact of surveillance colonoscopy in elderly patients compared with a reference cohort.Retrospective cohort study from 2001 through 2010 of patients 50 years and older undergoing surveillance colonoscopy for a history of colorectal cancer (CRC) or adenomatous polyps at an integrated health care system in southern California. Patients were followed up from the surveillance examination until CRC diagnosis, death, disenrollment, IBD diagnosis, or study end date (December 31, 2010).The primary outcome measure was incidence of CRC detected following surveillance colonoscopy. The secondary outcome was risk of procedure defined as postprocedure hospitalization within 30 days. Cox regression and multivariable logistic regression analyses were used to determine the impact of age on CRC incidence on surveillance examination as well as postprocedure hospitalization, respectively.The study cohort included 4834 elderly patients (age ≥75 years; 55.8% male) (median surveillance age, 79 years) and 22 929 individuals in the reference group (age 50-74 years; 57.7% male) (median surveillance age, 63 years). A total of 373 cancers were detected following surveillance colonoscopy (368 in the reference group and 5 among the elderly patients). There were a total of 711 postprocedure hospitalizations (184 in the reference group and 527 among the elderly patients). The CRC incidence among elderly patients undergoing surveillance was 0.24 per 1000 person-years vs 3.61 per 1000 person-years in the reference population (P < .001). In Cox regression analysis, the hazard ratio for CRC in the elderly patients compared with the reference group was 0.06 (95% CI, 0.02-0.13) (P < .001) after adjusting for comorbid illness, sex, and race/ethnicity. In logistic regression analysis, age 75 years and older was independently associated with increased risk of postprocedure hospitalization (adjusted odds ratio, 1.28 [95% CI, 1.07-1.53]; P = .006). Charlson score of 2 was also independently associated with increased risk of postprocedure hospitalization (adjusted odds ratio, 2.54 [95% CI, 2.06-3.14]; P < .001).A low incidence of CRC and relatively high rate of postprocedure hospitalization were found among elderly patients undergoing surveillance colonoscopy. Recommendations for ongoing surveillance in the elderly population should take into consideration the impact of comorbid illness and increasing age on the anticipated risks and benefits of colonoscopy.
Estimating the Independent Effects of Multiple Pollutants in the Presence of Measurement Error: An Application of a Measurement-Error–Resistant Technique
Authors: Ariana Zeka, Joel Schwartz
Journal: Environmental Health Perspectives (2004)

Misclassification of exposure usually leads to biased estimates of exposure-response associations. This is particularly an issue in cases with multiple correlated exposures, where the direction of bias is uncertain. It is necessary to address this problem when considering associations with important public health implications such as the one between mortality and air pollution, because biased exposure effects can result in biased risk assessments. The National Morbidity and Mortality Air Pollution Study (NMMAPS) recently reported results from an assessment of multiple pollutants and daily mortality in 90 U.S. cities. That study assessed the independent associations of the selected pollutants with daily mortality in two-pollutant models. Excess mortality was associated with particulate matter of aerodynamic diameter less than or equal to 10 microm/m3 (PM10), but not with other pollutants, in these two pollutant models. The extent of bias due to measurement error in these reported results is unclear. Schwartz and Coull recently proposed a method that deals with multiple exposures and, under certain conditions, is resistant to measurement error. We applied this method to reanalyze the data from NMMAPS. For PM10, we found results similar to those reported previously from NMMAPS (0.24% increase in deaths per 10-microg/m3) increase in PM10). In addition, we report an important effect of carbon monoxide that had not been observed previously.
More extensive analysis is needed when assessing facial structure in SIDS
Authors: P Mossey, G D Singh, M E Smith
Journal: BMJ (1999)

EDITOR—In their short report on facial structure in infants who died of the sudden infant death syndrome Rees et al evaluated the role of retroposition of maxillae and mandibles in predisposing to narrowing and occlusion of the upper airway in the sudden infant death syndrome.1

Their hypothesis assumes that maxillary, mandibular, or bimaxillary retroposition reduces the nasopharyngeal airway. This may seem logical, but a range of congenital syndromes exhibit maxillary hypoplasia, such as Binder's syndrome (maxillonasal dysplasia), in which a reduced nasopharyngeal airway …
AN ARTICLE CONTRIBUTED TO AN ANNIVERSARY VOLUME IN HONOR OF DOCTOR JOSEPH HERSEY PRATT
Authors: J. H. MUSSER
Journal: Annals of Internal Medicine (1937)

Article1 November 1937AN ARTICLE CONTRIBUTED TO AN ANNIVERSARY VOLUME IN HONOR OF DOCTOR JOSEPH HERSEY PRATTNUTRITIONAL DISTURBANCES OF THE EXTREME SOUTH*J. H. MUSSER, M.D., F.A.C.P.J. H. MUSSER, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-11-5-827 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptKnowing the life long interest that Dr. Pratt has had in dietetics, the keen enthusiasm he has shown on the subject of nutrition, and appreciating the magnificent dietetic facilities that he has organized in his clinic, it seems appropriate to present some observations on the nutritional disturbances that are observed in the far South.There is considerable variation in the type of patients seen in the wards of a large general hospital in the South as contrasted with the wards of a Northern metropolis. In the North it is customary to see many cases of rheumatic heart disease, for example,... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: J. H. MUSSER, M.D., F.A.C.P.Affiliations: New Orleans, Louisiana*Received for publication August 3, 1932. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1937Volume 11, Issue 5Page: 827-832KeywordsCardiovascular therapyNutrition ePublished: 1 December 2008 Issue Published: 1 November 1937 PDF downloadLoading ...
'The Shrinking Man'-Reply
Authors: Joseph B. Rosenfeld
Journal: JAMA (1981)

<h3>In Reply.—</h3> Dr Lindsey is correct in his statement that "a second exploration for recurrent hyperparathyroidism should never be undertaken without venous sampling for parathyroid hormone assays." However, when our patient underwent his second exploration in 1975, the technique of venous sampling was not available to us. Since that time the severe kyphoscoliosis with severe pulmonary dysfunction have prevented further intervention. This patient is an extreme example of renal osteodystrophy, which, because of the length of time he has been receiving hemodialysis, has produced this picture.
Dynamic systems theory places the scientist in the system
Authors: Alan Fogel, Ilse de Koeyer, Cory Secrist, Ryan Nagy
Journal: Behavioral and Brain Sciences (2002)

Dynamic systems theory is a way of describing the patterns that emerge from relationships in the universe. In the study of interpersonal relationships, within and between species, the scientist is an active and engaged participant in those relationships. Separation between self and other, scientist and subject, runs counter to systems thinking and creates an unnecessary divide between humans and animals.
A fibreoptic colonoscope.
Authors: J. A. Fox
Journal: BMJ (1969)

A 47-year-old woman presented with a history of vague abdominal pain for several years, which worsened over the past 2 months, with pain more prominent in the right upper quadrant. She also had a history of peptic ulcer disease. The ultrasound scan of right upper quadrant revealed normal gallbladder and oesophagogastroduodenoscopy was unremarkable. A <sup>99m</sup>technetium labelled hepato iminodiacetic acid (HIDA) scan with cholecystokinin provocation demonstrated a decreased gallbladder ejection fraction (EF) of 32%. On this basis, the patient was diagnosed with biliary dyskinesia and underwent an elective laparoscopic cholecystectomy. Histopathological analysis revealed chronic cholecystitis with <i>Cystoisospora belli</i> identified in the gallbladder wall. <i>Cystoisospora</i> has been identified to cause an opportunistic acalculous cholecystitis among immunocompromised hosts, especially those with AIDS. This is the first case report of chronic cholecystitis due to <i>C. belli</i> in an immunocompetent patient.
Carotid endarterectomy's value still uncertain
Authors: William A. Check
Journal: JAMA (1982)

A six-year follow-up of patients undergoing carotid endarterectomy at the Mayo Clinic in Rochester, Minn, has revealed a reduction in stroke incidence that is "better than the natural history and better than alternative treatments." Neurologists Jack P. Whisnant, MD, and Burton Sandok, MD, caution, however, that this good outcome was obtained under "ideal circumstances," adding: "You certainly can't extrapolate these results to all situations." Furthermore, even though morbidity from stroke appeared to be reduced, Whisnant concedes that "I'm not sure that we've improved the overall mortality, although the presumption is that we've decreased deaths from stroke." Whisnant gave the report at the recent Joint International Conference on Stroke and Cerebral Circulation in New Orleans. Several other neurologists at the meeting underlined his caveats that these results could not be extrapolated to endarterectomy done at all hospitals and that the study does not prove that surgery alters the natural history of
Tests for Blood in Feces
Authors: J. G. dos Santos
Journal: JAMA (1962)

ABSTRACT To the Editor:— In regard to the answer of Dr. J. H. Lewis to the question Blood in Feces (JAMA178:534 [Nov. 4] 1961), I would like to make 2 statements. One concerns the sensitivity of the benzidine test: A long time has elapsed since O. and R. Adler's original article and the Schlesinger-Holst modification about using benzidine to determine occult blood in the stool. The very sensitive method was modified in 1919 by J. P. Gregersen to reduce its sensitivity. Today, methods of reduced sensitivity using benzidine di-hydrochloride exist. I have found equal sensitivity between this improved benzidine di-hydrochloride and the guaiac methods. Meat-free diet is not a must with the benzidine method mentioned. The second statement concerns the so-called better specificity of guaiac. I do not know in what way this word is used. If used literally, it would be the same as stating that the V.D.R.L.
Geoffrey Merton Berlyne
Authors: Neville Berlyne
Journal: BMJ (2007)

<b>Backgound:</b> The pattern of bacterial colonization in the lower airways of patients with PCD changes over time. Studies show that younger patients are predominantly colonized with <i>H. influenzae</i> and <i>M. catarrhalis</i> whereas adults show <i>P. aeruginosa</i> significantly more often. The number of different pathogens increases with the patients’ age. <i>P. aeruginosa</i> is associated with a lower FEV1 and a young age of diagnosis reduces the risk of colonization with this pathogen. Studies evaluating the long-time effect of the colonization pattern on lung function in PCD are rare. <b>Aims:</b> The aim of our study is to evaluate whether a chronic or intermittent bacterial colonization in PCD with different pathogens leads to a decrease in lung function and more frequent exacerbations. <b>Methods:</b> We performed a retrospective analysis of microbiological results, clinical data and lung function parameters from 03/2010 - 12/2020. <b>Results:</b> We included 44 patients (22 female, 22 male) who regularly attended the Paediatric Pneumology Outpatient Department. Medium follow up period was 7.7 years and the medium number of visits 38. Medium age of patients at appointments was 13.6 years. The most frequent pathogen found in the 1398 available microbiological samples was <i>H. influenzae</i> (262x, 18.74%), followed by <i>S. aureus</i> (148x, 10.59%), <i>M. catarrhalis</i> (65x, 4.65%) and <i>P. aeruginosa</i> (51x, 3.65%). In the following analysis, we evaluate the lung function parameters and correlate them with colonization patterns. A preliminary evaluation suggests that the impact of bacterial colonization on the course of lung function in patients with PCD is more individual than in CF.
European researchers are urged to do more trials in children, conference hears
Authors: E. Sukkar
Journal: BMJ (2012)

<h3>Abstract</h3> Small ubiquitin-like modifier (SUMO) is a widespread regulatory mechanism of post-translational modification (PTM) that induces rapid and reversible changes in protein function and stability. Using SUMO conjugase Ubc9-overexpressing or knock-down cells in Parkinson’s disease (PD) models, we demonstrate that SUMOylation protects dopaminergic cells against MPP+ or preformed fibrils (PFFs) of α-synuclein (α-syn)-induced toxicities in cell viability and cytotoxicity assays. In the mechanism of protection, Ubc9 overexpression significantly suppressed the MPP+ or PFF-induced reactive oxygen species (ROS) generation, while Ubc9-RNAi enhanced the toxicity-induced ROS production. Further, PFF-mediated protein aggregation was exacerbated by Ubc9-RNAi in thioflavin T staining, compared with NC1 controls. In cycloheximide (Chx)-based protein stability assays, higher protein level of α-syn was identified in Ubc9-enhanced green fluorescent protein (EGFP) than in EGFP cells. Since there was no difference in endogenous mRNA levels of α-syn between Ubc9 and EGFP cells in quantitative real-time PCR (qRT-PCR), we assessed the mechanisms of SUMO-mediated delayed α-syn degradation via MG132, proteasomal inhibitor, and PMA, lysosomal degradation inducer. Ubc9-mediated SUMOylated α-syn avoided PMA-induced lysosomal degradation because of its high solubility. Our results suggest that Ubc9 enhances the levels of SUMO1 and ubiquitin on α-syn and interrupts SUMO1 removal from α-syn. In immunohistochemistry, dopaminergic axon tips in the striatum and cell bodies in the substantia nigra from Ubc9-overexpressing transgenic mice were protected from MPTP toxicities compared with wild-type (WT) siblings. Our results support that SUMOylation can be a regulatory target to protect dopaminergic neurons from oxidative stress and protein aggregation, with the implication that high levels of SUMOylation in dopaminergic neurons can prevent the pathologic progression of PD.
Sequential Treatment with Epirubicin/Cyclophosphamide, Followed by Docetaxel Is Equieffective, but Less Toxic Than FEC120 in the Adjuvant Treatment of Breast Cancer Patients with Extensive Lymph Node Involvement: The German ADEBAR Phase III Study.
Authors: W. Janni, N. Harbeck, H. Sommer, B. Rack, D. Augustin, W. Simon, J. Jueckstock, A. Wischnik, K. Annecke, P. Hepp, K. Friese, M. Kiechle
Journal: Cancer Research (2009)

Abstract Background: Based on meta-analytic evidence, taxane containing adjuvant chemotherapy has been established as standard treatment in node-positive breast cancer. However, in the MA-21 study, adriamycin-cyclophosphamide, followed by paclitaxel (AC-P) was significantly inferior to the gold standard of anthracycline treatment, FEC120 (Burnell, SABCS 2006). We prospectively compared a sequential epirubicin-docetaxel chemotherapy regimen to FEC120.Patients and Methods:The ADEBAR study was a multicenter phase III trial (n=1502) to evaluate whether breast cancer (BC) pts with &amp;gt; 3 axillary lymph node metastases benefit from a sequential anthracycline-docetaxel regimen (E90C–D: 4 cycles epirubicin [E] 90 mg/m2 plus cyclophosphamide [C] 600 mg/m2 q21 days followed by 4 cycles docetaxel [D] 100mg/m2 q21 days) compared to dose-intensive anthracycline-containing polychemotherapy (FE120C: 6 cycles E 60 mg/m² d 1+8, 5-FU 500mg/m² d 1+8 and C 75 mg/m² d 1-14, q4 weeks). The median follow-up time was 47 mts.(range 2-83 mts).Results:Treatment was stopped prematurely in 3.7% of the pts in the E90C–D arm and in 8.0% in the FE120C arm due to toxicity (p=0.0009). Antibiotic treatment was given in 10.4% (E90C–D) vs. 19.7% (FE120C), G-CSF support in 39.2% vs 61.4 % and erythropoietin stimulation in 8.7% vs. 20.0%, respectively (p&amp;lt;0.0001). Haematological toxicity (leucopenia, neutropenic fever, thrombocytopenia, anemia) was significantly higher in the FE120C-arm.At the time of the current analysis, 281 events of recurrence of breast cancer, were observed: 128 events in the FE120C group and 153 in the E90C–D group. The unadjusted hazard ratio (HR) was 0.88 (95 percent confidence interval, 0.694 to 1.115; p=0.2197, log-rank test). Overall survival in the two groups was not significantly different: (84 deaths with FE120C vs. 88 with E90C–D (HR 0.999, 0.738-1.352, p=0.99). Subgroup analyses, stratifying for tumor size, lymph node involvement, hormone receptor and HER2-neu status showed no significant difference between the two treatment arms.Conclusion:Different toxicity profiles given, hematological toxicity in the FE120C group was more severe than in the E90C–D.In contrast to AC-P in earlier studies, EC-Doc provides a feasible and effective alternative option to dose-intensified FEC with different saftey profile in this high risk breast cancer cohort. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 604.