tbuckley/cabot-search huggingface dataset:
Book: Five Past Midnight in Bhopal
Authors: B. Twisselmann
Journal: BMJ (2002)

Dominique Lapierre, Javier Moro Scribner, £17.99, pp 352 ISBN 0 743 22034 X Rating: ![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img>![Graphic][4]</img> This account of one of the worst public health disasters of the past 20 years makes for uncomfortable, even scary, reading, but it is simultaneously unputdownable. Journalist Dominique Lapierre and scriptwriter Javier Moro spent three years in Bhopal in the Indian state of Madhya Pradesh in the late 1990s, where in 1984 a cloud of toxic gas had escaped from a pesticide plant owned by US firm Union Carbide, killing and injuring thousands. In an investigative tour de force, Lapierre and Moro interviewed witnesses and participants from India and the United States and spliced together the causes and aftereffects of the catastrophic poison cloud. The result reads like a thriller, albeit one whose terrifying outcome is known from the outset. Sometimes the story is incredible enough to seem entirely fictional—it seems impossible that negligence and … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif [4]: /embed/inline-graphic-4.gif
Four years of experience with cyclosporin A for psoriasis
Authors: A.V. POWLES, B.S. BAKER, H. VALDIMARSSON, B. HULME, L. FRY
Journal: British Journal of Dermatology (1990)

Forty-four patients with severe psoriasis have been treated with cyclosporin A (CyA) for 2-50 months (mean 17 months). During the study, 31 (70%) of these patients achieved a greater than 70% reduction in PASI score, 39 (88%) achieved a greater than 60% reduction and 42 (95%) a greater than 50% reduction. The mean initial dose of CyA was 3 mg/kg/day and the mean dose was 3.3 mg/kg/day throughout the study. Twenty-five (57%) patients were maintained on less than or equal to 3 mg and six (14%) required greater than 5 mg/kg/day for limited periods to obtain significant improvement. In three of these patients, this was achieved with 6 mg/kg/day but, of the remainder, one required 7 mg and two required 10 mg/kg/day. Of the 44 patients, 32 (73%) are still taking CyA. Patients were discontinued because of: side-effects directly attributable to treatment (n = 4); remission of psoriasis (n = 4); death (n = I); defaulting (n = I); infrequent attendance (n = I); high doses of NSAID were necessary for arthritis (n = I). Before starting CyA, 39 patients were normotensive; 21 (54%) developed mild hypertension. In 28 patients where the GFRs were estimated before and during treatment, there was a 16% reduction (P less than 0.0001) during a mean period of 8 months. Two patients developed malignancies. The incidence of hypertension and percentage decrease in GFR were strongly correlated with the dose required to control the psoriasis.
Gynecological Care of Elderly Women
Authors: Jeanne Mandelblatt
Journal: JAMA (1986)

Mortality from cervical cancer is decreasing in countries where aggressive Papanicolaou smear screening programs are in place. However, elderly women are likely to be lifelong nonusers or underusers of Papanicolaou screening, and mortality has not declined for older women. Many studies have noted that nonparticipants in Papanicolaou screening have a 2.7 to four times greater incidence of cervical cancer when they are screened compared with women who have been screened at least once. Gynecological screening was offered to 1542 elderly women in a primary care setting; 75% of the women had not had regular prior screening and 25% had never been screened. Half of these women chose to participate in our screening program. An overall prevalence rate of 13.5 per 1000 abnormal Papanicolaou smears (95% confidence interval, 5.6 to 21.4) was noted in the group. Age, race, prior screening history, and abnormal gynecological symptoms failed to predict the women who would have abnormal Papanicolaou smears. Our results suggest that cervical cancer screening should continue beyond 65 years of age if women have not received regular prior screening.
Plastic surgeon is struck off for surgical errors and risk to patients
Authors: C. Dyer
Journal: BMJ (2014)

A plastic surgeon who worked at a private clinic in Liverpool has been struck off for a catalogue of surgical errors that left patients disfigured or in need of repair by other surgeons.

Olufemi Adeyinka Adeogba also repeatedly failed to record adequate medical histories, to obtain proper informed consent, to take before and after photographs, and to deal with patients’ concerns over poor outcomes.

Adeogba, who qualified in Germany in 1979, was found to have provided deficient care in four breast procedures and two rhinoplasties between March 2008 and August 2010.

One rhinoplasty resulted in a “major and catastrophic” complication, and the patient told the General Medical Council that …
PAF-induced RANTES Production by Human Airway Smooth Muscle Cells Requires Both p38 MAP Kinase and Erk
Authors: SHUICHIRO MARUOKA, SHU HASHIMOTO, YASUHIRO GON, IKUKO TAKESHITA, TAKASHI HORIE
Journal: American Journal of Respiratory and Critical Care Medicine (2000)

Airway smooth muscle (ASM) cells, which have been regarded as having contractile properties in response to contractile inflammatory mediators, may also participate in airway inflammatory response by expressing various cytokines, including RANTES. However, the intracellular signal that regulates cytokine expression in ASM cells has not been determined. In the present study, we examined the role of p38 mitogen-activated protein (MAP) kinase and extracellular signal-regulated kinase (Erk) in RANTES production by ASM cells stimulated by platelet-activating factor (PAF) and tumor necrosis factor (TNF)- α . The results showed that PAF induced the threonine and tyrosine phosphorylation of p38 MAP kinase and Erk, and p38 MAP kinase and Erk activity. SB 203580 and PD 98059 almost completely inhibited p38 MAP kinase and Erk activity, respectively. SB 203580 and PD 98059 partially inhibited and acted additively to inhibit PAF-induced RANTES production. PAF also induced c-Jun-NH2-terminal kinase ( JNK) phosphorylation. TNF- α induced p38 MAP kinase and Erk phosphorylation, but neither SB 203580 nor PD 98059 inhibited RANTES production. These results indicate that both p38 MAP kinase and Erk involve RANTES production by ASM cells stimulated with PAF, but not TNF- α , and that the role of p38 MAP kinase and Erk in RANTES production by ASM cells appears to be stimulus-dependent. Maruoka S, Hashimoto S, Gon Y, Takeshita I, Horie T. PAF-induced RANTES production by human airway smooth muscle cells requires both p38 MAP kinase and Erk.
Fibreoptic injection of oesophageal varices.
Authors: K G Williams, J L Dawson
Journal: BMJ (1979)

A new technique for injecting sclerosant into oesophageal varices uses a flexible gastroscope. Once the gastroscope has been inserted a flexible tube with a window cut into its distal end is pushed down over the gastroscope until a varix protrudes through the window. The varix can then be injected with a needle passed down the biopsy channel of the gastroscope. Once the varices have all been injected in this way the tube is advanced to compress the injection sites and so help control bleeding. This method, using a flexible gastroscope, has proved easier and safer than the traditional method using a rigid gastroscope.
Academic medicine: who is it for?
Authors: Hamish S Fraser
Journal: BMJ (2005)

Editor—Dobson in his news article on continental doctors taking up top posts in UK heart medicine and surgery describes an important but not surprising situation.1,2 The refusal of the postgraduate training system to train more than a few cardiologists in the 90s has had serious repercussions for the provision of cardiac care in the United Kingdom. Nine years ago when I moved to the United States, one of seven or eight major teaching hospitals in Boston had more consultant cardiologists than in the whole of Scotland. It could be argued that the greatest need just now is to get clinical cardiologists and surgeons into post as soon as possible. This will obviously reduce the flow into the academia, compounded by the incentive of gold.

In addition the UK specialist training system remains rigid and perverse. New specialties such as my own, medical informatics, struggle to take hold in hospitals as it is very hard to take the risk of stepping off the career ladder to complete novel research training (which ideally needs to be done when young).

In the United States and some European countries, medical training is modular, and a three or four year residency leads to a registerable qualification to practise. Academic physicians can “bolt on” fellowships in research or clinical work relatively interchangeably. Often research training is also done as an undergraduate in the United States.

In the United Kingdom, seven or eight years of clinical work and membership of the Royal College of Physicians or fellowship of the Royal College of Surgeons count for virtually nothing. Exciting research requires risk taking and a new vision, but the nine to 10 year monolithic training system sets up such individuals to fail. It is no coincidence that with short modular training in general practice the United Kingdom leads the world in primary care informatics, but its hospitals require massive and risky investment to catch up.
Clinical Trial of Epsilon-aminocaproic Acid in Severe Haemophilia
Authors: A. M. Gordon, G. P. McNicol, A. H.C. Dubber, G. A. McDonald, A. S. Douglas
Journal: BMJ (1965)

The main components of the fibrinolytic enzyme system are plasminogen, plasmin, activators, and inhibitors. Plasminogen, a naturally occurring plasma globulin, is converted by activators to plasmin, an enzyme which can digest many proteins, including fibrinogen and fibrin, prothrombin, factor V, and antihaemophilic globulin. Under physiological circumstances it is thought that natural inhibitors in the plasma restrict plasmin to digestion of fibrin, but in pathological fibrinolytic (hyperplasminaemic) states plasma proteins, including fibrinogen and antihaemophilic globulin, are digested. Activators of plasminogen include a plasma activator, trace quantities of which are probably responsible for physiological fibrinolytic activity, a urinary activator named urokinase, and activators of bacterial origin?for example, streptokinase. E.A.C.A., a potent competitive inhibitor of plasminogen activa tion (Alkjaersig et al., 1959), was first used in man by Sherry et al. (1959), who found it effective in inhibiting plasma fibrino lytic activity induced by a variety of plasminogen activators. The value of E.A.C.A. in the treatment of pathological fibrinolytic states has recently been reviewed by McNicol and Douglas (1964), who also discuss the pharmacology and toxicity of E.A.C.A. E.A.C.A., a synthetic amino-acid which closely resembles lysine in structure, is rapidly absorbed when taken by mouth. Peak plasma levels are found about two hours after a single oral dose. Urinary excretion is also rapid, the greater part of a single dose being recovered unchanged in the urine in 12 hours. The action of E.A.C.A. as an inhibitor of plasminogen activation is seen with plasma concentrations above 1 mg./100 ml. The first report of the use of E.A.C.A. in haemophilia was from McNicol et al. (1961a) who, during a study of the bene ficial effect on post-operative haemostasis of E.A.C.A. given to produce local inhibition of urokinase activity in the urinary tract, gave E.A.C.A. to a high-grade haemophiliac with haematuria. The haematuria ceased with E.A.C.A. administra tion, but at the same time the patient developed renal colic and was found subsequently to have permanent loss of function in one kidney, presumably because of ureteric blockage with unlysable clot. Steiger et al. (1962) and Barkhan (1964) have also reported successful control of haematuria in three patients and one patient respectively with haemophilia, without any adverse effects on renal function. Abe et al. (1962) and Reid et al. (1964) report favourably on the use of E.A.C.A. for other haemorrhagic complications in small numbers of haemophiliacs. On theoretical grounds there are reasons for considering that E.A.C.A. might have a beneficial systemic effect in the treatment of high-grade haemophilia, in addition to control of local
Determinants of car travel on daily journeys to school: cross sectional survey of primary school children
Authors: C. DiGuiseppi, I. Roberts, L. Li, D. Allen
Journal: BMJ (1998)

The annual distance walked by children has fallen 28% since 1972, partly because car travel has replaced walking on many school journeys.1 Increasing car use has been linked with obesity, adverse health effects in later life, limitations on children's independence, traffic congestion, and pollution. 2 3 To inform the development of strategies to reduce school related car travel, we surveyed the travel patterns of urban primary school children.

The survey was conducted in the inner London boroughs of Camden and Islington. The questionnaire—based partly on published surveys 4 5 and prepared in English, Bengali, Turkish, Greek, and Cantonese (first languages of 85% of eligible pupils)—asked about that day's school journey, children's independent travel, and parental concerns. From the sampling frame of all primary schools (excluding pilot, boarding, and special schools), 31 of the 100 eligible schools were randomly selected. We weighted sampling probability by combined class sizes in year 2 (ages 6-7 years) and year …
Bact. coli Meningitis in Adults
Authors: E. W. Hughes, G. C. Manning
Journal: BMJ (1955)

Bact. Coil Meningitis in AdultsBact. coli is a rare cause of meningitis.Most of the recorded cases of meningitis due to this organism have occurred in newborn infants and young children.There have been few reports of adult cases.The rarity of the disease is confirmed by Neal (1924), Barrett et al. (1942), MacGregor (1943), and Fraser (1952).Ravid (1935) points out that Bact. coli agglutinins are absent from neonatal blood though present in the blood of adults, thus suggesting s possible explanation of the age incidence of this condition.Previous reports of Bact. coli meningitis in adults and older children show that the condition has generally been associated with a septic focus, not infrequently in the genitourinary tract, or has been a sequel of compound fractures of the skull or vertebral column.
IL-8 and its CXCR1 and CXCR2 receptors participate in the control of megakaryocytic proliferation, differentiation, and ploidy in myeloid metaplasia with myelofibrosis
Authors: Sharareh Emadi, Denis Clay, Christophe Desterke, Bernadette Guerton, Eliane Maquarre, Agnès Charpentier, Claude Jasmin, Marie-Caroline Le Bousse-Kerdilès
Journal: Blood (2004)
Lark-and-Elephant Pie Meets Humble Pie
Authors: David L. Sackett
Journal: Annals of Internal Medicine (1993)

Letters15 February 1993Lark-and-Elephant Pie Meets Humble PieDavid L. Sackett, MDDavid L. Sackett, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-118-4-199302150-00035 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Drummond who? Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 February 1993Volume 118, Issue 4Page: 320 ePublished: 15 August 2000 Issue Published: 15 February 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Mutations in the CLCN5 gene in Japanese patients with familial idiopathic low-molecular-weight proteinuria
Authors: Hitoshi Nakazato, Shinzaburo Hattori, Akio Furuse, Tomoyasu Kawano, Shinnyo Karashima, Motoko Tsuruta, Junichiro Yoshimuta, Fumio Endo, Ichiro Matsuda
Journal: Kidney International (1997)
Interleukin 2 mediates stimulation of complement C3 biosynthesis in human proximal tubular epithelial cells.
Authors: R A Brooimans, A P Stegmann, W T van Dorp, A A van der Ark, F J van der Woude, L A van Es, M R Daha
Journal: Journal of Clinical Investigation (1991)

Previous reports have suggested the production of complement components C4, C2, and factor B by renal tissue. However, the cells involved in production of complement have not been identified. In this study metabolic labeling experiments demonstrated that human proximal tubular epithelial cells (PTEC) synthesize a 180-kD precursor of C3 that is secreted after proteolytic cleavage into a disulphide linked two-chain molecule as found in plasma. C3 present in culture supernatants of PTEC was functionally active, however, during the culture period there was a partial inactivation of the C3 molecule as assessed by hemolytic titration. Recombinant IL-2 enhances the rate of C3 synthesis in a dose-dependent manner reaching maximal stimulation at doses of 200-400 U/ml IL-2. Northern blot analysis demonstrated a 5.2-kb C3 mRNA species present in PTEC that was increased within 24 h of IL-2 treatment. IL-2-induced enhancement of C3 production by PTEC could be neutralized with specific antibodies to IL-2. This study demonstrates that C3 synthesis in PTEC is upregulated by IL-2, the major cytokine produced by activated T cells.
Ipilimumab-Induced Immunomediated Adverse Events
Authors: Laura Gilardi, Marzia Colandrea, Stefano Vassallo, Laura Lavinia Travaini, Giovanni Paganelli
Journal: Clinical Nuclear Medicine (2013)

A 42-year-old woman underwent resection of a high-risk melanoma of the right thigh. Adjuvant treatment with ipilimumab was then started within a phase III randomised, double-blind clinical trial. F-FDG PET/CT scan showed intense uptake in mediastinal hilar lymph nodes, bilaterally, and in rectus abdominis muscle. Biopsy at the abdominal wall revealed a chronic granulomatous inflammation. After oral steroid treatment, all the areas of abnormal tracer uptake disappeared. Ipilimumab can induce inflammatory immunomediated reactions that should be taken into account to avoid misinterpretation.
Subjective and Objective Assessments of Medical Comorbidity in Chronic Depression
Authors: G.D. Schrader
Journal: Psychotherapy and Psychosomatics (1997)

<i>Background:</i> While the extent of medical comorbidity in depressive illness is widely recognised, there have been few studies where objective and subjective assessment of comorbidity in chronic depression have been made. The aim of this study was to determine the extent and nature of medical comorbidity, in terms of both physician and patient assessments, in a group of outpatients with chronic depressive symptoms. <i>Methods:</i> Eighty-seven outpatients with a history of depressed mood for at least 2 years were assessed using the SCID and the Hamilton Depression scale. Physician and patient assessment of any medical comorbidity were completed. <i>Results:</i> Sixty percent of patients, and significantly more public general hospital outpatients than private outpatients, viewed themselves as suffering from a serious medical illness in addition to their depression. Only 8% were viewed objectively as having a serious medical condition. <i>Conclusions:</i> The discrepancy between patient and physician assessments of medical comorbidity in chronic depression is of note and may relate to depressed mood. Careful evaluation of chronically depressed patients' perceptions of physical illness may help achieve a positive treatment outcome.
Assembly and budding of a hepatitis B virus is mediated by a novel type of intracellular vesicles
Authors: Mouna Mhamdi, Anneke Funk, Heinz Hohenberg, Hans Will, Hüseyin Sirma
Journal: Hepatology (2007)

Formation of enveloped viruses involves assembly and budding at cellular membranes. In this study, we elucidated the morphogenesis of hepadnaviruses on the ultrastructural and biochemical level using duck hepatitis B virus (DHBV) as a model system. Formation of virus progeny initiates at the endoplasmic reticulum (ER) and is conserved both in vitro and in vivo. The morphogenesis proceeds via membrane-surrounded vesicles containing both virions and subviral particles, indicating a common morphogenetic pathway. The virus particle-containing vesicles (VCVs) are generated and maintained by reorganization of endomembranes accompanied by a striking disorganization of the rough ER (rER). VCVs are novel organelles with unique identity and properties of ER, intermediate compartment, endosomes, and multivesicular bodies. VCVs are dynamic structures whose size and shape are regulated by both membrane fusion and fission.Our data indicate a strong reorganization of endomembranes during DHBV infection, resulting in the biogenesis of novel organelles serving as multifunctional platforms for assembly and budding of virus progeny.
Relevance of p53 Gene Alterations for Tumor Recurrence in Patients with Superficial Transitional Cell Carcinoma of the Bladder
Authors: Martin G. Friedrich, Sabine Riethdorf, Andreas Erbersdobler, Christian Tiemer, Hartwig Schwaibold, Jan K. S&ouml;lter, Edith Huland, Lutz Riethdorf, Stefan Conrad, Peter G. Hammerer, Hartwig Huland
Journal: European Urology (2001)
Anaplastic Lymphoma Kinase Translocation: A Predictive Biomarker of Pemetrexed in Patients with Non-small Cell Lung Cancer
Authors: Jeong-Ok Lee, Tae Min Kim, Se-Hoon Lee, Dong-Wan Kim, Soyeon Kim, Yoon-Kyung Jeon, Doo Hyun Chung, Woo-Ho Kim, Young Tae Kim, Seok-Chul Yang, Young Whan Kim, Dae Seog Heo, Yung-Jue Bang
Journal: Journal of Thoracic Oncology (2011)
Strategies to prevent burnout
Authors: C. Johnstone
Journal: BMJ (1999)

Ten years ago, I crashed into a rock-face. I'd fallen asleep at the wheel of my car while on holiday in Scotland. My car was a write off, but I escaped with a grazed knee. At that time, I'd been working for several years as a junior hospital doctor, most recently in a busy obstetrics unit. For some time, I'd had the feeling that my life had gone sour: I felt empty inside, I was losing my ability to care, and I hated what my job was doing to me. The car accident seemed like a message: if you keep driving on and on when you need to stop, you're likely to crash. I was severely burnt out, and it took a crisis to prompt necessary change. When I got back from my holiday I handed in my resignation. While many doctors do leave the profession well before retirement age, we may not have to reach the point of choosing between medicine and having a life. Instead, we can practise strategies to prevent burnout and protect our quality of life at work.

### Awareness of the problem 

Burnout is “a state of physical, emotional and mental exhaustion caused by long term involvement in situations that are emotionally demanding.”(1)

While we may all feel worn out by work at times, burnout is when we feel so chronically ground down that our life and work suffer. Doctors are a high risk group: a recent study of general practitioners showed that nearly 60% felt that their physical health had suffered as a result of overwork.(2) In its more severe forms burnout leads to a lack of interest in work, complete disillusionment, hostility to patients, and feelings of hopelessness. Both the sufferer and the …