tbuckley/cabot-search huggingface dataset:
Supporting clinicians after medical error
Authors: H. Edrees, F. Federico
Journal: BMJ (2015)

The needs of these “second victims” are often ignored 

Clinicians who are unable to cope with their emotions after a medical error or adverse event are suffering in silence. These healthcare providers are often told to take care of the next patient without an opportunity to discuss the details of the event or share how this has affected them personally and professionally. While patients and families are the first victims of such events, we refer to the healthcare providers who are involved as the second victims.1

Second victims may feel guilt, fear, anxiety, or anger and experience social withdrawal, disturbing and troubling memories, depression, and insomnia.1 They tend to doubt their clinical skills, feel as though they have failed the patient, and worry about what their colleagues think. They are embarrassed to request emotional support and feel that the organisation has abandoned them. Often, these symptoms are experienced by not only one healthcare provider but a few members of the healthcare team who have either taken care of the patient or were …
Suppression of p53 by Notch in Lymphomagenesis: Implications for Initiation and Regression
Authors: Levi J. Beverly, Dean W. Felsher, Anthony J. Capobianco
Journal: Cancer Research (2005)

Abstract Aberrant Notch signaling contributes to more than half of all human T-cell leukemias, and accumulating evidence indicates Notch involvement in other human neoplasms. We developed a tetracycline-inducible mouse model (Top-Notchic) to examine the genetic interactions underlying the development of Notch-induced neoplastic disease. Using this model, we show that Notch suppresses p53 in lymphomagenesis through repression of the ARF-mdm2-p53 tumor surveillance network. Attenuation of Notch expression resulted in a dramatic increase in p53 levels that led to tumor regression by an apoptotic program. This shows that continued Notch activity is required to maintain the disease state. However, all tumors relapsed with rapid kinetics, most of which, by reactivation of Notch expression. Furthermore, by directly inhibiting the mdm2-p53 interaction by using either ionizing radiation or the novel small molecule therapeutic Nutlin, p53 can be activated and cause tumor cell death, even in the presence of sustained Notch activity. Therefore, it is the suppression of p53 that provides the Achilles heel for Notch-induced tumors, as activation of p53 in the presence of Notch signaling drives tumor regression. Our study provides proof-of-principle for the rational targeting of therapeutics against the mdm2-p53 pathway in Notch-induced neoplasms. Furthermore, we propose that suppression of p53 by Notch is a key mechanism underlying the initiation of T-cell lymphoma.
Recent developments in the understanding of paediatric musculoskeletal pain syndromes.
Authors: T R Southwood
Journal: Annals of the Rheumatic Diseases (1993)

Recent developments in the understanding of paediatric musculoskeletal pain syndromes Chronic idiopathic musculoskeletal pain syndromes in children are regarded as very rare by most rheumatologists and paediatricians.This is somewhat surprising as similar syndromes are among the most commonly diagnosed conditions in adult rheumatology clinics.In addition, over 15% of apparently normal school children report musculo- skeletal pain in health questionnaires.'The proportion of children in whom the pain becomes chronic (in the absence of a known cause) is unclear, but it may be much greater than previously realised.Of the 2959 children entered into the British Paediatric Rheumatology Group's diagnostic index to date, about 10% had a chronic idiopathic musculoskeletal pain syndrome2 (Symmons D P M, personal communication).It has been suggested that failure to recognise the characteristic clinical features of these conditions may contribute to their chronicity.3Recently, there have been several advances in the understanding of chronic idiopathic musculoskeletal pain syndromes in children, which may clarify some of the issues surrounding their diagnosis, epidemiology, and treatment.Pain in the absence of an organic cause is a difficult symptom to label.None of the traditional names, including hysterical disorder, pain amplification, psychogenic disease, abnormal illness behaviour, and supratentorial dysfunction, are universally appropriate.They appear judgmental and even perjorative, implying perhaps that the problems are psychological, when in fact their cause is unknown.In addition, terms coined in reports of adults, such as reflex sympathetic dystrophy (RSD) and fibro- myalgia, are not entirely satisfactory as their diagnosis requires the presence of several clinical features which in children may be subtle, variable, intermittent, and even absent.Can RSD be diagnosed if the child's painful limb looks and feels normal on examination, or fibromyalgia be considered if no hyperalgesic trigger points are found?The answer is probably no, but recently Malleson and colleagues proposed that these specific conditions are only the more severe manifestations of a broader spectrum of disease in children.4They put forward criteria for the diagnosis of localised and diffuse idiopathic pain syndromes in children (table 1), and also noted that both disorders share a number of clinical features, raising the possibility that they have a similar pathogenesis.
Website to report corruption in medicine launches in India
Authors: S. Bagcchi
Journal: BMJ (2014)

A new website (www.medileaks.in) for medical professionals and the public to report unethical medical practices across India was launched on 19 November. 

Founded by Sunil Nandraj and Alam Singh, who both have substantial experience in the Indian health sector, the website has already started to gain attention among patients, doctors, activists, and the general public.

The non-profit platform aims to record the trends and patterns of unethical activities and irregularities in the Indian …
Histochemical and fatigue characteristics of conditioned canine latissimus dorsi muscle.
Authors: J D Mannion, T Bitto, R L Hammond, N A Rubinstein, L W Stephenson
Journal: Circulation Research (1986)

To induce fatigue resistance in the latissimus dorsi muscle of the dog in preparation for possible myocardial assistance, eight adult male beagles underwent unilateral electrical stimulation of the thoracodorsal nerve at a frequency of 2 Hz (120 stimuli/min) and 10 Hz (600 stimuli/min) for a 6-week period. The conditioned muscles were compared with their unconditioned contralateral controls by fiber typing, pyrophosphate gel electrophoresis, isometric characteristics, and fatigue rates. At the end of the period of stimulation, the conditioned muscles had a greater percentage of slow-twitch, fatigue-resistant fibers on acid and alkaline stains (100 +/- 0.7% and 83 +/- 15.3%), respectively, than did their contralateral controls (45 +/- 7.6% and 43 +/- 7.0). Pyrophosphate gel electrophoresis revealed an increase in the slow myosin and a decrease in the fast myosin content in the conditioned muscles; the stimulated muscles also demonstrated a slower contraction time (87 +/- 20 msec vs. 57 +/- 17.9 msec), a lower initial tension (4.4 +/- 1.45 kg vs. 7.2 +/- 2.11 kg), and a slower fatigue rate during a 30-minute fatigue test than did their contralateral controls. The muscles stimulated at 2 Hz had fatigue rates similar to those stimulated at 10 Hz, but generally had less diminution in muscle fiber diameters and less interfiber connective tissue. Thus, it is possible to make canine latissimus dorsi muscles more fatigue resistant, and, theoretically, more capable of myocardial assistance by electrical stimulation of the thoracodorsal nerve at a frequency as low as 2 Hz--the natural canine heart rate.
Pneumococcal vaccination for welders: Table 1
Authors: David Coggon, E Clare Harris, Vanessa Cox, Keith T Palmer
Journal: Thorax (2014)

Over the past 20 years, evidence has accumulated that occupations entailing exposure to metal fume (principally welders) are at increased risk of developing and dying from pneumococcal and unspecified lobar pneumonia.1–9 The hazard is apparent in people working with ferrous metal,2 ,4 may extend to other metals4 and is reversible following cessation of exposure.1 ,4 ,5 There are indications that the ultrafine particles in welding fume promote adherence of pneumococci to bronchial epithelium,10 but the underlying mechanisms are not yet well established. Nevertheless, in 2011, the independent Joint Committee on Vaccination at the English Department of Health (DH) judged that the evidence of increased risk was sufficient to recommend that employers offer welders vaccination against pneumococcus.11 This was a new measure that had not previously been applied in other countries.

Subsequently, on the advice of the UK Health and Safety Executive (HSE), the DH weakened its recommendation, stating only that vaccination ‘should be considered for those at risk of frequent or continuous occupational exposure to metal fume (e.g. welders), taking into account the exposure control measures in place’.12 Then after some delay, HSE published guidance for employers in which they were advised to …
Unsuccessful rescue therapy with adefovir dipivoxil for lamivudine resistant HBV in a patient with liver failure
Authors: D Thabut
Journal: Gut (2003)

Adefovir dipivoxil is a new nucleoside analogue which is active against lamivudine resistant hepatitis B virus (HBV). A 48 week course of adefovir in human immunodeficiency virus type 1 infected patients with lamivudine resistant HBV induces a rapid and major decrease in serum HBV DNA levels with improvement in liver inflammation.1 Although reassuring, this efficacy of adefovir may be influenced by the timing of its initiation after the emergence of lamivudine resistant HBV. We report here the case of a cirrhotic patient treated with lamivudine for four years who died of liver failure due to the emergence of lamivudine resistant HBV, despite the introduction of …
Characterisation of the beta adrenergic response cascade in fetal guinea pig lung.
Authors: M E Lyon, C A Lefebvre, D J Davis
Journal: Thorax (1994)

BACKGROUND--Suitable models for the study of lung development are needed. The suitability of the guinea pig for studying the role of the beta adrenergic response cascade in fetal lung development has been evaluated. METHODS--Radioligand binding assays with iodine-125 labelled iodopindolol were performed to identify and characterise the beta adrenergic receptors. To demonstrate that these receptors were functional, isoprenaline and forskolin stimulated generation of cyclic AMP (cAMP) in the lung tissue was quantitated by radioimmunoassay. RESULTS--The concentration of beta receptors increased with gestational age from 23 fmol/mg at 35 days to 140 fmol/mg at 64 days. Competition binding studies were consistent with a predominance of beta 2 receptors. The ability of isoprenaline to stimulate cAMP generation was greater during the saccular phase than during the canalicular phase of lung development. Incorporation of tritium labelled choline into phosphatidylcholine increased significantly between the canalicular and saccular phases. CONCLUSIONS--The beta adrenergic response cascade in fetal guinea pig lung exhibits similar characteristics to those previously described in fetal human lung and is therefore a good model in which to study the effects of beta agonists on fetal lung development.
Diet and Coronary Artery Disease
Authors: ROBERT E. OLSON
Journal: Circulation (1960)

ATHEROSCLEROSIS of the coronary artery is currently the leading cause of death in the United States and in many west- ern countries.It is remarkable that a disease that was not recognized clinically before 19121 could have in half a century come from this relative obscurity to the commonest cause of death in middle-aged and elderly persons.Al- though its exact etiology is far from settled, intensive study over the past three decades has pointed increasingly to nutritional factors as playing a prominent role.The concept of any disease arising from a single cause is obsolete and misleading.On the contrary, as Gordon pointed out, "To recognize a disease as the resultant of ecologic forces within the dynamic system made up of agent, host, and environment may often clar- ify our concepts of that disease." 2 Athero- sclerosis is undoubtedly a disease of multiple causation, which appears to have so many de- terminants that they tend to defy orderly classification under titles of agent, host, and environment.It is certain that atheroma arises within the host as the result of a com- plex interaction between host and environment.Instead of arising in the environment and constituting an independent variable such as the agents of infection, allergy, poison- ing, addiction, or vitamin deficiency disease, the agent of atherosclerosis is an endogenous and dependent variable.Since this agent arises within the host, it obscures the usual
Inhaled sodium cromoglycate
Authors: M SILVERMAN
Journal: Thorax (2001)

The systematic review and meta-analysis performed by Tasche and colleagues1 appears to have been carried out with commendable thoroughness. The results seem clear cut: sodium cromoglycate is ineffective as maintenance therapy in children with asthma. However, their conclusions are not objective but depend in the final analysis on their multivariate regression model. Perhaps this is where the most important bias has crept into the analysis.

As in the case of many new drugs, clinical trials are first carried out in adults, later in schoolchildren, and finally (if ever) in infants and pre-schoolchildren. This appears to have been the …
Combination Immunotherapy with Clinical-Scale Enriched Human γδ T cells, hu14.18 Antibody, and the Immunocytokine Fc-IL7 in Disseminated Neuroblastoma
Authors: Mario Otto, Raymond C. Barfield, William J. Martin, Rekha Iyengar, Wing Leung, Thasia Leimig, Stanley Chaleff, Stephen D. Gillies, Rupert Handgretinger
Journal: Clinical Cancer Research (2005)

Abstract Purpose: To evaluate a combined cellular and humoral immunotherapy regimen in a mouse model of disseminated human neuroblastoma. We tested combinations of clinical-grade, isolated human γδ T cells with the humanized anti-GD2 antibody hu14.18 and a novel fusion cytokine, Fc-IL7. Experimental Design: γδ T cells were large-scale enriched from leukapheresis product obtained from granulocyte colony-stimulating factor–mobilized donors. γδ T cell cytotoxicity was tested in a europium-TDA release assay. The effect of Fc-IL7 on γδ T-cell survival in vitro was assessed by flow cytometry. NOD.CB17-Prkdcscid/J mice received 1 × 106 NB-1691 neuroblastoma cells via the tail vein 5 to 6 days before therapy began. Treatment, for five consecutive weeks, consisted of injections of 1 × 106 γδ T cells weekly, 1 × 106 γδ T cells weekly, and 20 μg hu14.18 antibody four times per week, or 1 × 106 γδ T cells weekly with 20 μg hu14.18 antibody four times per week, and 20 μg Fc-IL7 once weekly. Results: The natural cytotoxicity of γδ T cells to NB-1691 cells in vitro was dramatically enhanced by hu14.18 antibody. Fc-IL7 effectively kept cultured γδ T cells viable. Combination therapy with γδ T cells and hu14.18 antibody significantly enhanced survival (P = 0.001), as did treatment with γδ T cells, hu14.18 antibody, and Fc-IL7 (P = 0.005). Inclusion of Fc-IL7 offered an additional survival benefit (P = 0.04). Conclusions: We have shown a new and promising immunotherapy regimen for neuroblastoma that requires clinical evaluation. Our approach might also serve as a therapeutic model for other malignancies.
Qualitative study of views of health professionals and patients on guided self management plans for asthma
Authors: Alan Jones, Roisin Pill, Stephanie Adams
Journal: BMJ (2000)

<h3>Abstract</h3> <b>Objectives:</b> To explore the views held by general practitioners, practice nurses, and patients about the role of guided self management plans in asthma care. <b>Design:</b> Qualitative study using nine focus groups that each met on two occasions. <b>Setting:</b> South Wales. <b>Subjects:</b> 13 asthma nurses, 11 general practitioners (six with an interest in asthma), and 32 patients (13 adults compliant with treatment, 12 non-compliant adults, and seven teenagers). <b>Results:</b> Neither health professionals nor patients were enthusiastic about guided self management plans, and, although for different reasons, almost all participants were ambivalent about their usefulness or relevance. Most professionals opposed their use. Few patients reported sustained use, and most felt that plans were largely irrelevant to them. The attitudes associated with these views reflect the gulf between the professionals9 concept of the "responsible asthma patient" and the patients9 view. <b>Conclusions:</b> Attempts to introduce self guided management plans in primary care are unlikely to be successful. A more patient centred, patient negotiated plan is needed for asthma care in the community.
Cannabis use and mental health in young people: cohort study
Authors: George C Patton, Carolyn Coffey, John B Carlin, Louisa Degenhardt, Michael Lynskey, Wayne Hall
Journal: BMJ (2002)

To determine whether cannabis use in adolescence predisposes to higher rates of depression and anxiety in young adulthood.Seven wave cohort study over six years.44 schools in the Australian state of Victoria.A statewide secondary school sample of 1601 students aged 14-15 followed for seven years.Interview measure of depression and anxiety (revised clinical interview schedule) at wave 7.Some 60% of participants had used cannabis by the age of 20; 7% were daily users at that point. Daily use in young women was associated with an over fivefold increase in the odds of reporting a state of depression and anxiety after adjustment for intercurrent use of other substances (odds ratio 5.6, 95% confidence interval 2.6 to 12). Weekly or more frequent cannabis use in teenagers predicted an approximately twofold increase in risk for later depression and anxiety (1.9, 1.1 to 3.3) after adjustment for potential baseline confounders. In contrast, depression and anxiety in teenagers predicted neither later weekly nor daily cannabis use.Frequent cannabis use in teenage girls predicts later depression and anxiety, with daily users carrying the highest risk. Given recent increasing levels of cannabis use, measures to reduce frequent and heavy recreational use seem warranted.
Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser
Authors: T.S. Alster, C.M. Williams
Journal: The Lancet (1995)

Despite increasing knowledge of wound healing and collagen metabolism, hypertrophic scars and keloid scars are difficult to eradicate. Median sternotomy scars are often hypertrophic or keloidal. We treated them with a 585 nm flashlamp-pumped pulsed-dye laser, which selectively injures cutaneous microvessels without inducing scars. 16 adult patients with hypertrophic or keloidal median sternotomy scars after heart surgery received two treatments to one half of their previously untreated scars every 6-8 weeks and were reviewed at 6 months. Symptoms and clinical, histological, photographic, and surface texture assessments were obtained for treated and untreated areas of scar and evaluated independently by two observers blind to the treatment and by digital image analysis of skin surface casts. There was a significant improvement in erythema, scar height, skin surface texture, and pruritis in laser-treated scar areas; this improvement persisted for at least 6 months.
Early detection of premalignant conditions in the colon by fluorescence endoscopy using local sensitization with hexaminolevulinate
Authors: B. Mayinger, F. Neumann, C. Kastner, K. Degitz, E. Hahn, D. Schwab
Journal: Endoscopy (2008)

See also: Commentaire de travail de B. Mayinger et al., pp. 106Endoscopy 2008; 40(02): 233-233DOI: 10.1055/s-0032-1306807
Language as shaped by the brain
Authors: Morten H. Christiansen, Nick Chater
Journal: Behavioral and Brain Sciences (2008)

Abstract It is widely assumed that human learning and the structure of human languages are intimately related. This relationship is frequently suggested to derive from a language-specific biological endowment, which encodes universal, but communicatively arbitrary, principles of language structure (a Universal Grammar or UG). How might such a UG have evolved? We argue that UG could not have arisen either by biological adaptation or non-adaptationist genetic processes, resulting in a logical problem of language evolution . Specifically, as the processes of language change are much more rapid than processes of genetic change, language constitutes a “moving target” both over time and across different human populations, and, hence, cannot provide a stable environment to which language genes could have adapted. We conclude that a biologically determined UG is not evolutionarily viable. Instead, the original motivation for UG – the mesh between learners and languages – arises because language has been shaped to fit the human brain, rather than vice versa. Following Darwin, we view language itself as a complex and interdependent “organism,” which evolves under selectional pressures from human learning and processing mechanisms. That is, languages themselves are shaped by severe selectional pressure from each generation of language users and learners. This suggests that apparently arbitrary aspects of linguistic structure may result from general learning and processing biases deriving from the structure of thought processes, perceptuo-motor factors, cognitive limitations, and pragmatics.
Demonstration that the atria, ventricles, and lungs each are responsible for a tonic inhibition of the vasomotorcenter in the dog.
Authors: G Mancia, D E Donald
Journal: Circulation Research (1975)

To localize the areas of the cardiopulmonary region involved in tonic inhibition of the vasomotor center, anesthetized dogs were subjected to sinoaortic denervation and diaphragmatic vagotomy. Afferent vagal nerve traffic was interrupted in the neck by cooling. With the venous return taken from the venae cavae, oxygenated extracorporeally, and returned to the aorta, the heart was removed, leaving the ventilated lungs (condition 1), and the lungs and the ventricles were removed, leaving the beating atria (condition 3). With the venous return taken from the pulmonary arteries, oxygenated extracorporeally, and returned to the left atrium, the lungs were removed, leaving the intact working heart (condition 2), and the lungs were removed and the atria were denervated, leaving the working innervated ventricles (condition 4). Vagal cooling increased aortic pressure by 25 plus or minus 2 (SE) mm Hg in condition 1, by 36 plus or minus 2 mm Hg in condition 2, by 29 plus or minus 2 mm Hg in condition 3, and by 29 plus or minus 7 mm Hg in condition 4. Removing the atria in condition 3 or denervating the ventricles in condition 4 abolished the reflex response. Thus, afferent vagal nerves from the lungs and the heart tonically inhibit the vasomotor center. The inhibition exerted by the heart is caused by receptors in the atria and the ventricles.