tbuckley/cabot-search huggingface dataset:
P86 Chest Drain insertion training; is Simulation training the answer?
Authors: T. R. Naicker, D. T. McLeod
Journal: Thorax (2010)

<h3>Background</h3> The West Midlands Deanery is running a training module in Chest Drain insertion for all CMT trainees using Simulation training in a Porcine–Resin Model. Between Feb 2009 and Feb 2010, 176 trainees have completed the training module. Universal feedback (95%) was good. Our concerns were that analogous to driving, experience on the road is necessary to produce a competent trainee. We present this study evaluating two cohorts of trainees derived from the original pool after 6 months of their simulation training. <h3>Methods</h3> One cohort consisted of 12 CMT Trainees who were paired with a trainer who is a Consultant or SpR in Respiratory Medicine. The trainees were selected depending on the availability of trainer rather than their enthusiasm to participate. The other cohort of 18 trainees was randomly selected from the general pool, which was originally advised to seek experience in their trust during routine work. Both cohorts were asked about their confidence in chest drain insertion as well as number of procedures they have done in the last 6 months. In the supervised cohort, we have analysed the DOPS score and plotted the learning curve for chest drain insertion. <h3>Results</h3> On average the trainees in the mentored group have done 10.5 procedures in the last 6 months while trainees from the general cohort have done only 2.2 procedures. Disappointingly universal feed back from the general cohort was that they quickly lost the confidence and skill. They have pointed out number of reasons; the prominent ones are lack of opportunity, radiologists taking the routine work, lack of supervision. It took about five procedures for trainees in the mentored group to get up to satisfactory level in the DOPS score and after seven procedures there was a definite plateau in the learning curve. <h3>Conclusion</h3> Simulation training imparts confidence and familiarisation with the seldinger chest drain insertion but at least five to seven further supervised insertions on patients is required to do the procedure with out direct supervision. This needs further work on a larger group which is on going. What is clear is that close mentoring is essential to master the skill and Consultant time must be set aside formally to sustain the training programmes.
Outbreak of systemic Candida albicans in intensive care unit caused by cross infection.
Authors: J P Burnie, F C Odds, W Lee, C Webster, J D Williams
Journal: BMJ (1985)

The first documented outbreak of systemic candidosis shown to be due to cross infection with a particular strain of Candida albicans is reported. Over nine months in an intensive care unit 13 patients developed definite and one probable systemic candidosis. Twenty five further patients had superficial candidal infections. The strain that caused the outbreak (serotype A, morphotype A1, biotype 0/(1)5 5/7) was responsible for all the cases of systemic candidosis acquired in the intensive care unit, 11 (44%) of the superficial candidal infections in the unit, and 17% of candidal infections outside the unit but in the same hospital. The strain was also isolated from oral swabs taken from four nurses working in the unit and the hands of one of these nurses. Two out of 17 nurses were shown to have acquired the strain on their hands when examined immediately after nursing systemically infected patients. No environmental source could be identified. The strain also showed enhanced survival in handwashing experiments and was relatively resistant to Hibiscrub. Management of patients with systemic candidosis might include measures to prevent cross infection and handwashing with disinfectants that are active against candida.
Continuous Arteriovenous Hemofiltration
Authors: Andre A. Kaplan, Robert E. Longnecker, Vaughn W. Folkert
Journal: Annals of Internal Medicine (1984)

Continuous arteriovenous hemofiltration using small hollow-fiber hemofilters, without pumps, was used as an alternative to conventional methods of acute dialytic therapy. During a 6-month period, 15 patients had 17 treatments. Mean treatment duration was 98.5 ± 101.1 (SD) hours (range, 4 to 300 hours), for a total of 1673 hours. Mean output per treatment was 9.5 ± 4.4 mL/min, which was found to be adequate to control uremia despite a considerable protein intake. Six patients had a significant hemorrhage; however, all 6 had active bleeding and existing coagulopathies before beginning treatment. Overall, continuous arteriovenous hemofiltration was found to be a convenient and safe method for providing continuous fluid, electrolyte, and acid-base balance in patients with inadequate renal function. The treatment was particularly useful in patients with vascular instability or severe fluid overload.
Persistent Elevation of Plasma Insulin Levels Is Associated With Increased Cardiovascular Risk in Children and Young Adults
Authors: Weihang Bao, Sathanur R. Srinivasan, Gerald S. Berenson
Journal: Circulation (1996)

Background Hyperinsulinemia has been considered to be a potent cardiovascular risk factor. The present investigation examines persistently elevated fasting insulin levels from childhood to young adulthood and its influence on cardiovascular risk factors. Methods and Results A longitudinal cohort was constructed from two cross-sectional surveys in a community-based population over an 8-year period: 1606 individuals (39% were black) aged 5 to 23 years participated in the first survey. Stability in rankings (persistence) of insulin levels was shown by the presence of significant correlations between year 1 and year 8 values ( r =.23 to .36, P &lt;.0001), with a greater magnitude in older subjects. Compared with subjects with levels of insulin consistently in the lowest quartile, those with levels always in the highest quartile showed higher ( P &lt;.001) levels of body mass index (+9 kg/m 2 ), triglycerides (+58 mg/dL), LDL cholesterol (+11 mg/dL), VLDL cholesterol (+8 mg/dL), glucose (+9 mg/dL), systolic blood pressure (+7 mm Hg), and diastolic blood pressure (+3 mm Hg); lower ( P &lt;.001) levels of HDL cholesterol (−4 mg/dL); and higher ( P &lt;.05) prevalence of parental history of diabetes (3.3-fold) and hypertension (1.2-fold). There were 739 young adults aged 20 to 31 years at follow-up. As adults, individuals with consistently elevated insulin versus those with consistently decreased insulin had increased ( P &lt;.05) prevalence of obesity (36-fold), hypertension (2.5-fold), and dyslipidemia (3-fold), which was attributed to both baseline insulin and change of insulin from baseline to follow-up. In addition, clustering of these risk factors was stronger ( P &lt;.05) in adults with persistent insulin elevation. Conclusions Elevated insulin levels persist from childhood through young adulthood, resulting in a clinically relevant adverse cardiovascular risk profile in young adults.
Myocardial Uptake of 99mTc-Phosphate Tracer in Amyloidosis
Authors: SIMON D. BRAUN, ROBERT LISBONA, JAVIER A. NOVALES-DIAZ, A SNIDERMAN
Journal: Clinical Nuclear Medicine (1979)

BRAUN, SIMON D. M.D.; LISBONA, ROBERT M.D.; NOVALES-DIAZ, JAVIER A. M.D.; SNIDERMAN, A M.D. Author Information
Clinical Remarks on a Case of Strangulated Hernia
Authors: T. H. Bartleet
Journal: BMJ (1875)

THE BRITISH MEDICAL _70VRNAL.5 and by and bye ulceration-occurs and perforation, with, it may be, a general peritoniitis.In certain cases, however, and this seems to be one, the coats becomic tlhicker as the dilatation proceeds, and the secretion is retained while the cyst attains very large dimensions.The thick colloid contents represent the mucous secretion of the glands of the appendage.
v-rasH induces non-small cell phenotype, with associated growth factors and receptors, in a small cell lung cancer cell line.
Authors: J P Falco, S B Baylin, R Lupu, M Borges, B D Nelkin, R K Jasti, N E Davidson, M Mabry
Journal: Journal of Clinical Investigation (1990)

Small cell lung cancer (SCLC) tumor progression can involve partial or complete conversion to a more treatment-resistant non-small cell (NSCLC) phenotype. In a cell culture model of this phenomenon, we have previously demonstrated that insertion of the viral Harvey ras gene (v-Ha-ras) into SCLC cell lines with amplification and overexpression of the c-myc gene induced many NSCLC phenotypic features. We now report that the v-Ha-ras gene can also induce morphologic, biochemical, and growth characteristics consistent with the NSCLC phenotype in an N-myc amplified SCLC cell line, NCI-H249. We show that v-Ha-ras has novel effects on these cells, abrogating an SCLC-specific growth requirement for gastrin-releasing peptide, and inducing mRNA expression of three NSCLC-associated growth factors and receptors, platelet-derived growth factor B chain, transforming growth factor-alpha (TGF-alpha), and epidermal growth factor receptor (EGF-R). TGF-alpha secretion and EGF-R also appear, consistent with the induction of an autocrine loop previously shown to be growth stimulatory for NSCLC in culture. These data suggest that N-myc and v-Ha-ras represent functional classes of genes that may complement each other in bringing about the phenotypic alterations seen during SCLC tumor progression, and suggest that such alterations might include the appearance of growth factors and receptors of potential importance for the growth of the tumor and its surrounding stroma.
Report shows wide variation in cancer survival across England
Authors: S. Mayor
Journal: BMJ (2009)

Survival rates for different cancers show stark variation depending on where patients live. The findings from a report on the latest cancer statistics show, for example, a threefold difference across England in the proportion of people with lung cancer living for at least a year.

The second annual report on the Department of Health’s cancer reform strategy—the five year plan published in 2007 setting out how to implement improvements in cancer services—looked for the first time at local information on cancer services and outcomes.

The findings show a continuing reduction in overall cancer mortality but major differences in survival rates for a range of cancers in different primary care trusts. The greatest variation was for lung cancer: the best survival rate at one year was 44% among patients in the Kensington and Chelsea primary care trust, the only trust to achieve the international “good practice” level of at least 37%; the lowest one year survival was 15% in Herefordshire.

The report focused on one year survival data as a proxy for …
Assignment of the receptor for ecotropic murine leukemia virus to mouse chromosome 5.
Authors: N H Ruddle, B S Conta, L Leinwand, C Kozak, F Ruddle, P Besmer, D Baltimore
Journal: The Journal of Experimental Medicine (1978)

The gene for the receptor for ecotropic murine leukemia virus (Rev) has been assigned to mouse chromosome 5. This determination was made possible by an analysis of somatic cell hybrids between mouse and Chinese hamster cells. The parents of these hybrids were A/HeJ or Mus poschiavinus peritoneal exudate cells or BALB/c primary embryo fibroblasts and E36, a Chinese hamster lung fibroblast deficient in hypoxanthine guanine phosphoribosyltransferase. Segregation of mouse chromosomes in these hybrids was analyzed by chromosome banding and isozyme expression. Cells were tested for their ability to absorb and replicate vesicular stomatitis virus (murine leukemia virus [MuLV]) pseudotype particles and ecotropic MuLV as measured by the XC test. The presence of chromosome 5 was essential for receptor expression as determined by three statistical procedures. Segregation of the receptor for ecotropic murine leukemia virus was also followed in two series of subclones. In both, receptor expression was syntenic with phosphoglucomutase-1, an isozyme which has been mapped to mouse chromosome 5.
Impotence in Medical Clinic Outpatients
Authors: M. F. Slag, J. E. Morley, M. K. Elson, D. L. Trence, C. J. Nelson, A. E. Nelson, W. B. Kinlaw, H. S. Beyer, frank q Nuttall, R. B. Shafer
Journal: JAMA (1983)

One thousand one hundred eighty men in a medical outpatient clinic were screened as to the presence of impotence. Four hundred one men (34%) were impotent, and of those, 188 (47%) chose to be examined for their problem. After a comprehensive evaluation the following diagnoses were obtained: medication effect, 25%; psychogenic, 14%; neurological, 7%; urologic, 6%; primary hypogonadism, 10%; secondary hypogonadism, 9%; diabetes mellitus, 9%; hypothyroidism, 5%; hyperthyroidism, 1%; hyperprolactinemia, 4%; miscellaneous, 4%; and unknown causes, 7%. The mean age of the impotent patients was 59.4 years, and the prevalence of alcoholism was 7%. Luteinizing hormone, follicle-stimulating hormone, testosterone, thyroxine, triiodothyronine (T3), T3 resin uptake, and prolactin studies were necessary to diagnose individual cases. We conclude that erectile dysfunction is a common and often overlooked problem in middle-aged men followed in a medical clinic.
The role of hepatitis B surface antigen quantification in predicting HBsAg loss and HBV relapse after discontinuation of lamivudine treatment
Authors: Chien-Hung Chen, Sheng-Nan Lu, Chao-Hung Hung, Jing-Houng Wang, Tsung-Hui Hu, Chi-Sin Changchien, Chuan-Mo Lee
Journal: Journal of Hepatology (2014)
High prevalence of MAP2K1 mutations in variant and IGHV4-34–expressing hairy-cell leukemias
Authors: Joshua J Waterfall, Evgeny Arons, Robert L Walker, Marbin Pineda, Laura Roth, J Keith Killian, Ogan D Abaan, Sean R Davis, Robert J Kreitman, Paul S Meltzer
Journal: Nature Genetics (2013)
Cytomegalovirus Acute Necrotizing Esophagitis
Authors: E. Barjas, S. Pires, J. Lopes, A. Valente, E. Oliveira, R. Palma, M. Raimundo, P. Alexandrino, M. C. Moura
Journal: Endoscopy (2001)

Figure 1A 50-year-old man was admitted with obstructive acute renal failure. In the second week after admission he suffered an episode of upper gastrointestinal bleeding. Emergency upper endoscopy revealed black diffuse mucosa and mucosal bridges resulting from laceration of the submucosal layer in the lower esophagus. Biopsies showed unspecified esophagitis with necrosis. The patient's condition deteriorated and he died with multiple organ failure.
Exercise Tolerance and Hemodynamic Studies After Replacement of Canine Mitral Valve With and Without Preservation of Chordae Tendineae
Authors: G. C. RASTELLI, ANASTASIOS G. TSAKIRIS, ROBERT L. FRYE, JOHN W. KIRKLIN
Journal: Circulation (1967)

The effect of the mitral Starr-Edwards ball-valve prosthesis on cardiac function was investigated in the dog. Fifteen dogs were studied for the first 48 hours after replacement of the mitral valve (the chordae tendineae [see Figure in the PDF file] had been totally resected, partially resected, or preserved). The cardiac output and left atrial pressure were similar in these three groups of animals and in two animals subjected to sham operation. Ten dogs (five with intact chordae and five with excised chordae) were studied two months after the insertion of a Starr-Edwards prosthesis. In these animals normal hemodynamic values were obtained at rest and during infusion of acetylcholine, except for a marked (liastolic gradient across the prosthesis, which developed at high cardiac output and heart rate. Six dogs were able to complete a standard test of substantial, unrestrained, graded exercise and gave a normal heart rate response. Heart rate increased and was maintained during maximal efforts, to levels of about 300 beats/min, demonstrating that heart rate need not be a limit of cardiac performance. No evidence of left ventricular dysfunction or of a decrement in cardiac performance could be demonstrated in dogs early or late after replacement of the mitral valve with a Starr-Edwards prosthesis. The presence or absence of chordae tendineae was irrelevant to cardiac performance.
Inequality in funding for AIDS across England threatens regional services
Authors: M. A Bellis, J. McCullagh, R. Thomson, D. Regan, Q. Syed, T. Kelly
Journal: BMJ (1997)

Editor—Recent developments in antiretroviral treatment offer the potential for substantial progress in the management of patients infected with HIV.1 A series of trials have now shown that combination treatments with antiretroviral drugs offer significantly better prospects to patients than the use of monotreatment with nucleoside analogues such as zidovudine.2 In addition, limited evidence suggests that triple treatments, incorporating protease inhibitors, produce further substantial reductions in viral loads and may almost entirely eliminate the virus.3 Monotreatments have proved too costly …
ON THE CAUSES OF INSANITY: SOME PRE-FREUDIAN VIEWS
Authors: Ilza Veith
Journal: JAMA (1961)

The early 19th century witnessed the birth of psychiatry as a special discipline within the field of medicine. It was the time when Pinel's reforms in the treatment of the insane were discussed and emulated by other physicians and when the new British concept of a "retreat" began to supplant that of the age-old lunatic asylum. It became fashionable to talk about "moral treatment," occupational therapy, and nonrestraint and about the humoring of the patient instead of his coercion. The beneficial results of these permissive therapeutic attitudes were obvious. Less obvious, however, were the reasons for these good results, since the etiology of insanity was shrouded in mystery and open to numerous different interpretations. One of the best summaries of contemporary thoughts on causes of insanity appeared in a work by an Englishman, John Gideon Millingen, entitled<i>Curiosities of Medical Experience</i>(London, 1839). The author, who admitted having patterned his
Mammalian Target of Rapamycin Activation Impairs Hepatocytic Differentiation and Targets Genes Moderating Lipid Homeostasis and Hepatocellular Growth
Authors: Romain Parent, Deepak Kolippakkam, Garrett Booth, Laura Beretta
Journal: Cancer Research (2007)

Abstract The mammalian target of rapamycin (mTOR) pathway, a major regulator of translation, is frequently activated in hepatocellular carcinomas. We investigated the effects of mTOR activation in the human HepaRG cells, which possess potent hepatocytic differentiation capability. Differentiation of HepaRG cells into functional and polarized hepatocyte-like cells correlated with a decrease in mTOR and Akt activities. Stable cell lines expressing an activated mutant of mTOR were generated. Sustained activation of mTOR impaired the hepatocytic differentiation capability of these cells as shown by impaired formation of bile canaliculi, absence of polarity, and reduced secretion of α1-antitrypsin. An inhibitor of mTOR, rapamycin, was able to revert this phenotype. Furthermore, increased mTOR activity in HepaRG cells resulted in their resistance to the antiproliferative effects of transforming growth factor-β1. Profiling of polysome-bound transcripts indicated that activated mTOR specifically targeted genes posttranscriptionally regulated on hepatocytic differentiation. Three major biological networks targeted by activated mTOR were identified: (a) cell death associated with tumor necrosis factor superfamily members, IFNs and caspases; (b) lipid homeostasis associated with the transcription factors PPARα, PPARδ, and retinoid X receptor β; and (c) liver development associated with CCAAT/enhancer binding protein α and hepatic mitogens. In conclusion, increased mTOR activity conferred a preneoplastic phenotype to the HepaRG cells by altering the translation of genes vital for establishing normal hepatic energy homeostasis and moderating hepatocellular growth. [Cancer Res 2007;67(9):4337–45]
PERSISTENT COUGH DUE TO HAIR IMPINGING ON EARDRUM
Authors: Alex M. Burgess
Journal: JAMA (1952)

To the Editor:—  Every practitioner who deals with children is familiar with what has been called an ear cough. This is produced by mechanical irritation of the membrana tympani during manipulation incident to clearing out the external auditory canal. Dried cerumen or foreign bodies introduced in the canal by children may be the cause of such reflex coughing, which is usually relieved by removal of the irritating substance whatever it may be. This communication is for the purpose of calling attention to a cause of such coughing that may easily escape notice if it is not suspected.  This cough reflex is mediated through the auricular branch of the vagus, which is distributed to the outer surface of the eardrum and through one or both of the laryngeal nerves. It is probably not produced by simple contact of a hair against the eardrum, unless the end of the hairdefinitely impinges
Any pregnant woman who wants a caesarean section should not be denied it, says NICE
Authors: I. Torjesen
Journal: BMJ (2011)

All pregnant women who ask for an elective caesarean section should be allowed one if they still want the procedure after being made aware of its risks and benefits, the UK National Institute for Health and Clinical Excellence (NICE) says.

NICE’s updated clinical guideline on caesarean sections, published this week, recognises for the first time mental health problems as well as physical conditions as possible indicators for a caesarean section. It says that most women who ask for a caesarean section do so because they are anxious about childbirth (have tokophobia) and should be offered mental health support if they need it. If their fears are not allayed by this support, they should be offered an elective caesarean.

But it also …
Some Further Considerations in Relation to Life-Insurance
Authors: A. S. Underhill
Journal: BMJ (1876)

THE BRITISH MEDICAL YOURNAL.placenta was removed, and there was no haemorrhage nor any pro- minent symptom, save a severe gastric pain which lasted several days, and added greatly to the discomfort and exhaustion already present.Under the administration of suitable tonics and light nourishing food, the patient made a good recovery.She is still in the Institution and enjoys excellent health.
Effect of percutaneous coronary interventions for in-stent restenosis in degenerated saphenous vein grafts without distal embolic protection
Authors: Dale T Ashby, George Dangas, Eve A Aymong, Ioannis Iakovou, Frank Kuepper, Roxana Mehran, Gregg W Stone, Martin B Leon, Jeffery W Moses
Journal: Journal of the American College of Cardiology (2003)