tbuckley/cabot-search huggingface dataset:
British surgeons’ experiences of mandatory online workplace-based assessment – reply to authors
Authors: Chris Munsch
Journal: Journal of the Royal Society of Medicine (2009)

It is perhaps not surprising that an innovative project such as ISCP should face challenges in its early phase. The paper by Pereira and Dean1 reiterates many of the already well-described issues that currently surround the ISCP, but contributes little by way of constructive comment. In particular they appear to have misunderstood the purpose of the on-line assessments, which are essentially feedback tools to guide and direct training, rather than summative competency-based assessments, although they may not be alone in this regard. Having said that, a line-by-line disassembling of their paper, including its many factual inaccuracies, however tempting, would be equally unconstructive, and we would prefer to look forward to how the problems with ISCP are currently being addressed.

In the two years since the launch, the ISCP team has continually been utilizing user feedback, obtained through a wide range of sources, to modify and improve both user interface and the programme utility. Modifications to on-line assessments have been made on the basis of constructive feedback and an active programme of faculty development is helping surgical trainers become familiar with the assessments and other aspects of the ISCP.

In recognition of the need to continue with the programme of improvements, the ISCP has organized a trainees feedback day, to take place on 11 September. A wide and inclusive range of trainees has been invited to join the ISCP team, and work collaboratively towards developing the next version (version 6) of the ISCP which will be launched by the end of 2009. We can look forward to further developments and improvements in the near future as the ISCP goes into partnership with OCAP, and good practice will be shared between the two programmes.

Pereira and Dean are, however, quite right to draw our attention to the Eraut Report2 into the implementation phase of the ISCP, but should ensure that they draw the right conclusions from it and report them accurately. The report actually concluded that the potential benefits of an improved system for surgical training were in danger of being negated by the many other changes taking place in the training environment and the NHS. The JCST is currently undertaking a wide-ranging consultation in order to identify practical methods to restore high quality surgical training. During these challenging times, it is important to resist the temptation to ‘throw out the baby with the bathwater’. Instead we would like to reassure the authors as well as all users of ISCP that ‘constructive [our italics] criticism by trainees and trainers alike will be heeded by the developers’ and that the ‘versatility and usability of the ISCP will continue to improve’.
WHOLE BODY PERIODIC ACCELERATION IMPROVES CORONARY MICROCIRCULATION IN HEALTHY SUBJECTS AND PATIENTS WITH CORONARY ARTERY DISEASE
Authors: Kono Yasushi, Shota Fukuda, Kenei Shimada, Toshihiro Kawasaki, Satoshi Jissho, Haruyuki Taguchi, Kumiko Maeda, Minoru Yoshiyama, Masatoshi Fujita, Junichi Yoshikawa
Journal: Journal of the American College of Cardiology (2010)
* Host iron metabolism gene expression in ins-gas mouse model of helicobacter infection
Authors: M. J. Thomson, D. M. Pritchard, S. A. Boxall, A. Varro, J. E. Crabtree
Journal: Gut (2011)

<h3>Introduction</h3> Iron deficiency is the most common nutritional disorder globally. There is increasing evidence from clinical and population studies for a role of H pylori infection in the aetiology of iron deficiency. Rodent models of <i>Helicobacter</i> infection are needed to investigate causal links to iron deficiency in the host. The aim of this study was to investigate the effects of gastric <i>Helicobacter</i> infection on host iron metabolism gene expression in hypergastrinaemic INS-GAS mice. <h3>Methods</h3> Male transgenic INS-GAS mice were inoculated with <i>H felis</i> or broth only by oral gavage. Uninfected genetic background FVB/N mice were used as controls. Infected mice and uninfected controls were sacrificed at 9 months post-inoculation. Gastric corpus mucosa was stored for total RNA extraction and analysis by quantitative real time PCR. The level of expression of target genes was assessed as relative abundance compared to <i>Gapdh</i> control gene by the ΔΔCt method. Serum ferritin protein levels were measured by ELISA. <h3>Results</h3> H felis-infected INS-GAS mice had a significant reduction in hepcidin transcript levels in the gastric mucosa compared to uninfected INS-GAS mice and FVB/N controls (p &lt; 0.03). The reduction in hepcidin hormone expression in H felis infected mice is likely to result in increased expressions of genes which control the influx and efflux of iron in gastrointestinal cells. Divalent metal transporter 1 (DMT1) which is negatively controlled by hepcidin is expressed on the apical membrane of gastrointestinal cells and absorbs reduced ferrous iron (Fe<sup>2+</sup>) from the lumen. There was a significant increase (p &lt; 0.02) in <i>Dmt1</i> gastric transcript levels in H felis-infected INS-GAS compared to uninfected INS-GAS mice or FVB/N controls. Other iron metabolism gene expression levels were also significantly increased with gastric H felis infection, such as Ferroportin 1 (p &lt; 0.05), Transferrin receptor 1 (p &lt; 0.003) and Lipocalin 2 (p &lt; 0.001). Serum ferritin levels were significantly reduced (p &lt; 0.001) in H felis-infected INS-GAS mice compared to uninfected controls at 9 months. <h3>Conclusion</h3> This study demonstrates the interplay between hepcidin transcript levels and the expression of host iron metabolism genes. Previous studies have shown that chronic gastric H felis<i></i> infection in INS-GAS mice results in decreased serum transferrin saturation. This study investigates the molecular basis for previous observations and finds that chronic gastric <i>Helicobacter</i> infection results in a significant reduction in gastric hepcidin gene expression levels which coincides with significant increases in gene expression of several proteins implicated in host iron metabolism.
Validation of urban trails for COPD patients
Authors: Ane Arbillaga-Etxarri, Jaume Torrent-Pallicer, Elena Gimeno-Santos, Jordi Vilaró-Casamitjana, Alfredo Irurtia-Amigó, David Donaire-González, Eva Balcells, Pere Vall-Casas, Judith Garcia-Aymerich
Journal: European Respiratory Journal (2014)

We designed urban trails to train COPD patients in public areas of different nature (promenade, beach or park). Trails had 3 intensities (low, medium and high) according to the combination of urban elements (ramps, sand and stairs). Aims (1) To assess physiological response in trails of different intensities. (2) To compare physiological response in trails of the same intensity of different areas. Methods : Experimental study, 2 phases: (Aim 1) 10 COPD patients (age 67(9) y, FEV1 49(21)%) were randomized on different days under standardized conditions to perform 3 intensity trails in a promenade. Oxygen consumption (VO2) and metabolic equivalents (METs) were collected by indirect calorimetry (Metamax 3B CORTEX). We defined the %time accumulated in light-to-moderate (≤3.3 METs) and hard-to-very hard intensity (≥3.4 METs). We used mixed models. (Aim 2) 10 healthy volunteers (age 31(4) y) performed in different days under standardized conditions the 3 intensity trails designed in 3 different zones. Heart rate (HR) and total time were collected. We used repeated ANOVA measures to compare mean HR in trails of the same intensity across areas. Results : (Aim 1) Mean VO2peak: 16(4), 17(5) and 17(4) ml·kg-1 in low, medium and high intensity trails respectively. The %time acumulated in hard-to-very hard intensity was 18%, 28% and 39%, p-trend=0.03. (Aim 2) There were no differences in mean HR across areas for low intensity trails: 97(9), 96(10) and 95(8) bpm in promenade, beach and park (p=0.41). Similar results were found for moderate and high intensity trails. Conclusion : Physiological response increases with intensity of the trails. Characteristics of areas do not affect the physiological response between trails of the same intensity.
Treatment of spondylolysis with external electrical stimulation in young athletes: a critical literature review
Authors: D Stasinopoulos
Journal: British Journal of Sports Medicine (2004)

Lumbar spondylolysis is a common cause of low back pain in adolescent athletes. It is a unilateral or bilateral defect of the pars interarticularis. The cause is still a matter of debate. A wide range of conservative treatments has been used. The purpose of this critical literature review is to investigate the efficacy of external electrical stimulation in the healing of this disorder.
Epoprostenol use in a National Pulmonary Hypertension Centre from 1997 to 2007
Authors: A C Church, D Sanabria, A Peacock, M Johnson
Journal: Thorax (2009)

The cost-effectiveness of prostanoids in pulmonary arterial hypertension (PAH) has recently been called into question by the National Institute for Health and Clinical Excellence (NICE),1 and the possibility exists that this treatment would not be recommended by this body. This would be the first time that a treatment already in routine clinical practice would be withdrawn as a result of NICE recommendations. Guidelines published by the UK, European and US authorities still advocate prostanoid use in certain patient groups.2–4 Of the disease-targeted therapy available for PAH, only epoprostenol has been shown to improve patient survival in the context of a randomised controlled trial.5

To assess the impact that withdrawal of intravenous epoprostenol in 1997 would …
Early immunophenotypical evaluation of minimal residual disease in acute myeloid leukemia identifies different patient risk groups and may contribute to postinduction treatment stratification
Authors: Jesús F. San Miguel, Marı́a B. Vidriales, Consuelo López-Berges, Joaquı́n Dı́az-Mediavilla, Norma Gutiérrez, Consuelo Cañizo, Fernando Ramos, Marı́a J. Calmuntia, José J. Pérez, Marcos González, Alberto Orfao
Journal: Blood (2001)
In vitro fragmentation of gallstones: Comparison of electrohydraulic, electromagnetic and piezoelectric shockwave lithotripters
Authors: Thomas H. Schneider, Martin Fromm, Roland Ott, Paul Janowitz, Werner Swobodnik, Horst Neuhaus, Christian Ell
Journal: Hepatology (1991)

To compare the fragmentation efficiency of three different shockwave systems, 63 human gallstone triplets were disintegrated in vitro using an electrohydraulic (MPL 9000, Dornier), an electromagnetic (Lithostar Plus, Siemens) and a piezoelectric (Piezolith 2300, R. Wolf) lithotripter. Since each stone triplet was obtained from the same gallbladder, the concrements of one such set were identical in physicochemical parameters. According to the maximal diameter, the calculi were divided into group A (6 to 15 mm) and group B (16 to 30 mm). Shockwave application was terminated when residual fragments measured 4 mm or less. Forty-five triplets were fragmented at energy settings mainly used in clinical treatment of patients with gallbladder stones (MPL 9000: 20 kV; Lithostar Plus: setting 9 (maximal); Piezolith 2300: setting 3). The fragmentation endpoint was achieved in group A (n = 3 × 36) with the Piezolith 2300 after median 150 (range = 50 to 500) pulses and with the Lithostar Plus after 150 (50 to 750) pulses compared with 500 (50 to 1,500) pulses using the MPL 9000 (p &lt; 0.01). In group B (n = 3 × 9) the Lithostar Plus (median = 750, range = 250 to 1,250 pulses) required fewer discharges than the Piezolith 2300 (1,250,250 to 2,500 pulses; p &lt; 0.05) and the MPL (1,500,500 to 1,600 [upper limit] pulses; p &lt; 0.01). At maximal intensities (MPL 9000: 26 kV; Lithostar Plus: setting 9; Piezolith 2300: setting 4), no statistically significant differences between the three tested shockwave systems were observed (Piezolith 2300: 100, 50 to 250 pulses; MPL 9000: 100, 50 to 500 pulses; Lithostar Plus: 100, 50 to 1000 pulses) for group A stones (n = 3 × 12) and group B stones (n = 3 × 6; Piezolith 2300 [500, 250 to 750 pulses], MPL 9000 [625,250 to 750 pulses] and Lithostar Plus [750, 250 to 1,000 pulses]). An adequate degree of fragmentation independent of the physical shockwave system can be achieved in vitro at maximal intensities for each tested stone size. At submaximal energy settings, better results were obtamed in stones up to 15 mm in diameter with the piezoelectric generator than with the electrohydraulic device, whereas in larger stones disintegration efficiency did not differ significantly between these two lithotripters. (HEPATOLOGY 1991;14:301-305.)
Effects of coronary venous pressure on left ventricular diastolic distensibility.
Authors: J Watanabe, M J Levine, F Bellotto, R G Johnson, W Grossman
Journal: Circulation Research (1990)

Coronary arterial pressure and flow are known to influence left ventricular (LV) diastolic distensibility, but the influence of coronary venous pressure is unknown. To test the hypothesis that increased coronary venous pressure leads to an increase in LV wall volume and a decrease in LV diastolic distensibility, we studied excised, blood-perfused LV isovolumic dog hearts without the pericardium. In protocol I (n = 8), to raise coronary venous pressure the pressure of right atrium (RA) and right ventricle (RV) was increased by the height of a blood reservoir connected with a cannula that opened in both the RA and RV. In protocol II (n = 7), to isolate the effect of RV enlargement on LV diastolic distensibility (direct ventricular interaction), an isovolumic RV balloon was used with coronary venous pressure held constant at 0 mm Hg. Changes in LV diastolic distensibility were assessed by shifts of the LV end-diastolic pressure-volume relation. Changes in LV wall volume were detected by subepicardial segment length at end-diastole. The mean pressures of RA and RV (protocol I) and RV balloon only (protocol II) were increased from 0 to 15 and 30 mm Hg over a range of LV volume. In protocol I, when RA.RV pressure was increased from 0 to 30 mm Hg at three levels of LV volume (22 +/- 2, 31 +/- 3, and 40 +/- 3 ml), LV end-diastolic pressures increased significantly from 5.2 +/- 0.3 to 11.2 +/- 1.5, from 10.4 +/- 0.3 to 18.2 +/- 1.2, and from 20.2 +/- 1.0 to 28.8 +/- 1.2 mm Hg, respectively. In protocol II, when RV balloon pressure was increased from 0 to 30 mm Hg at the three LV volumes (21 +/- 3, 31 +/- 3, and 41 +/- 4 ml), LV end-diastolic pressures showed smaller increases from 5.2 +/- 0.2 to 6.6 +/- 0.2, from 9.8 +/- 0.3 to 11.6 +/- 0.6, and from 19.0 +/- 0.5 to 21.4 +/- 0.8 mm Hg, respectively. In both protocols, the LV end-diastolic pressure-volume relation shifted upward in a nearly parallel fashion, but the shift was much greater in protocol I than in protocol II. Despite constant LV volume, an increase in LV wall dimension in protocol I was significant and much greater than that in protocol II. From these results, we conclude that increased coronary venous pressure decreases LV diastolic distensibility with increasing LV wall volume, and this mechanism appears to act independently of diastolic ventricular interaction caused by RV enlargement.
Polycaprolactone electrospun mesh conjugated with an MSC affinity peptide for MSC homing in vivo
Authors: Zhenxing Shao, Xin Zhang, Yanbin Pi, Xiaokun Wang, Zhuqing Jia, Jingxian Zhu, Linghui Dai, Wenqing Chen, Ling Yin, Haifeng Chen, Chunyan Zhou, Yingfang Ao
Journal: Biomaterials (2012)
Cardiac Nerves Affect Myocardial Stunning Through Reactive Oxygen and Nitric Oxide Mechanisms
Authors: Cheng-Hsiung Huang, Stephen F. Vatner, Athanasios P. Peppas, Guiping Yang, Raymond K. Kudej
Journal: Circulation Research (2003)

The goal of this study was to investigate the role of cardiac nerves on the response to 90-minute coronary artery stenosis (CAS), which reduced coronary blood flow by 40% for 90 minutes, and subsequent myocardial stunning after reperfusion in chronically instrumented conscious pigs. In pigs with regional cardiac denervation (CD), myocardial stunning was intensified, ie, at 12 hours reperfusion wall thickening (WT) was depressed more, P<0.05, in CD (-46+/-5%) as compared with intact pigs (-31+/-3%) and remained depressed in CD at 24 hours reperfusion (-45+/-6%). Although the TTC technique was negative for infarct, histopathological analysis revealed patchy necrosis present in 11+/-2% of the area at risk. In intact pigs, WT had essentially recovered at 24 hours without infarct. In CD pigs treated with either an antioxidant, N-2-mercaptopropionyl glycine (MPG, 100 mg/kg per hour) or systemic nitric oxide synthase inhibition using N(omega)-nitro-L-arginine (L-NA, 30 mg/kg for 3 days), recovery of wall thickening was similar to that in pigs with intact nerves and without evidence of infarct. Immunohistochemistry analysis for 3-nitrotyrosine in tissue after CAS and 1 hour reperfusion demonstrated enhanced peroxynitrite-related protein nitration in pigs with regional CD compared with pigs with intact cardiac nerves, and pigs with regional CD and MPG or L-NA. Thus, reperfusion after myocardial ischemia in the setting of CD results in enhanced stunning and development of infarct. The underlying mechanism appears to involve nitric oxide and reactive oxygen species.
Bovine colostrum is a health food supplement which prevents NSAID induced gut damage
Authors: R J Playford, D N Floyd, C E Macdonald, D P Calnan, R O Adenekan, W Johnson, R A Goodlad, T Marchbank
Journal: Gut (1999)

BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are effective for arthritis but cause gastrointestinal injury. Bovine colostrum is a rich source of growth factors and is marketed as a health food supplement. AIMS To examine whether spray dried, defatted colostrum or milk preparations could reduce gastrointestinal injury caused by indomethacin. METHODS Effects of test solutions, administered orally, were examined using an indomethacin restraint rat model of gastric damage and an indomethacin mouse model of small intestinal injury. Effects on migration of the human colonic carcinoma cell line HT-29 and rat small intestinal cell line RIE-1 were assessed using a wounded monolayer assay system (used as an in vitro model of wound repair) and effects on proliferation determined using [ 3 H]thymidine incorporation. RESULTS Pretreatment with 0.5 or 1 ml colostral preparation reduced gastric injury by 30% and 60% respectively in rats. A milk preparation was much less efficacious. Recombinant transforming growth factor β added at a dose similar to that found in the colostrum preparation (12.5 ng/rat), reduced injury by about 60%. Addition of colostrum to drinking water (10% vol/vol) prevented villus shortening in the mouse model of small intestinal injury. Addition of milk preparation was ineffective. Colostrum increased proliferation and cell migration of RIE-1 and HT-29 cells. These effects were mainly due to constituents of the colostrum with molecular weights greater than 30 kDa. CONCLUSIONS Bovine colostrum could provide a novel, inexpensive approach for the prevention and treatment of the injurious effects of NSAIDs on the gut and may also be of value for the treatment of other ulcerative conditions of the bowel.
Influence of Income, Hours Worked, and Loan Repayment on Medical Students' Decision to Pursue a Primary Care Career
Authors: Michael P. Rosenthal, James J. Diamond, Howard K. Rabinowitz, Laurence C. Bauer, Robert L. Jones, Gary W. Kearl, Robert B. Kelly, Kent J. Sheets, Arnold Jaffe, A. Patrick, Mack T. Ruffin
Journal: JAMA (1994)

To assess the specialty plans of current fourth-year medical students and, for those not choosing primary care specialties, to investigate the potential effect that changes in key economic or lifestyle factors could have in attracting such students to primary care.A survey study was sent to 901 fourth-year medical students in the 1993 graduating classes of six US medical schools.Comparisons were made between students choosing and not choosing primary care specialties. For the non-primary care students, we also evaluated whether alteration of income, hours worked, or loan repayment could attract them to primary care careers.Of the 688 responses (76% response rate), primary care specialties were chosen by 27% of the students and non-primary care specialties by 73%. One quarter (25%) of the non-primary care students indicated they would change to primary care for one of the following factors: income (10%), hours worked (11%), or loan repayment (4%). For students whose debt was $50,000 or greater, the loan repayment option became much more important than for students with lesser debt. In all, a total of 45% (n = 313) of the students indicated either they were planning to enter primary care (n = 188) or they would change to a primary care specialty (n = 125) with appropriate adjustments in income, hours worked, or loan repayment.Significant changes in economic and lifestyle factors could have a direct effect on the ability to attract students to primary care. Including such changes as part of health system reform, especially within the context of a supportive medical school environment, could enable the United States to approach a goal of graduating 50% generalist physicians.
Hydrogen Peroxide– and Peroxynitrite-Induced Mitochondrial DNA Damage and Dysfunction in Vascular Endothelial and Smooth Muscle Cells
Authors: Scott W. Ballinger, Cam Patterson, Chang-Ning Yan, Richard Doan, David L. Burow, Christal G. Young, F. Michael Yakes, Bennett Van Houten, Carol A. Ballinger, Bruce A. Freeman, Marschall S. Runge
Journal: Circulation Research (2000)

Abstract —The mechanisms by which reactive species (RS) participate in the development of atherosclerosis remain incompletely understood. The present study was designed to test the hypothesis that RS produced in the vascular environment cause mitochondrial damage and dysfunction in vitro and, thus, may contribute to the initiating events of atherogenesis. DNA damage was assessed in vascular cells exposed to superoxide, hydrogen peroxide, nitric oxide, and peroxynitrite. In both vascular endothelial and smooth muscle cells, the mitochondrial DNA (mtDNA) was preferentially damaged relative to the transcriptionally inactive nuclear β -globin gene. Similarly, a dose-dependent decrease in mtDNA-encoded mRNA transcripts was associated with RS treatment. Mitochondrial protein synthesis was also inhibited in a dose-dependent manner by ONOO − , resulting in decreased cellular ATP levels and mitochondrial redox function. Overall, endothelial cells were more sensitive to RS-mediated damage than were smooth muscle cells. Together, these data link RS-mediated mtDNA damage, altered gene expression, and mitochondrial dysfunction in cell culture and reveal how RS may mediate vascular cell dysfunction in the setting of atherogenesis.