tbuckley/cabot-search huggingface dataset:
Planning your elective - Western Samoa
Authors: Jo Bramall, Khalika Hasrat
Journal: BMJ (2001)

The article was very helpful in discussing the type of medicine practiced in Samoa and the purpose of this response is not to rewrite the article, but merely to add to it an important health and safety issue. The article correctly highlights the number of stray dogs that wonder the streets, particularly at night, and more worryingly on route to the main hospital in Apia, however it makes no suggestion on how to avoid being bitten in the first place.

Whilst on my elective there recently a student was badly bitten by one of these stray dogs and according to the doctor who treated him, it could have easily been avoided through performing a few simple actions. Samoans are rarely bitten; if a dog were to approach them, as if to bite, they would simply bend down as if picking up a stone (although not actually doing so) and shout “Alu!” forcefully, (meaning ‘go’) and frighten the dogs away.

The experience of being run at by a drooling dog is indeed a terrifying one, as it happened to me on one occasion, and I was grateful for the advice above because following it saved my leg from having a dog bite permanently imprinted on it.

Western Samoa is a young developing nation, which gained its independence from Britain …
Re: Jürgen E. Gschwend, Matthias M. Heck, Jan Lehmann, et al. Extended Versus Limited Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Survival Results from a Prospective, Randomized Trial. Eur Urol 2019;75:604–11
Authors: Satoru Taguchi, Tohru Nakagawa, Hiroshi Fukuhara
Journal: European Urology (2019)
Sports medicine education: Socrates, Science and South Africa
Authors: Jon Patricios
Journal: British Journal of Sports Medicine (2019)

> ‘Wonder is the beginning of wisdom. I cannot teach anybody anything. I can only make them think’ Socrates (469–399 BC).1 

Greek philosopher Socrates used cross-examination and interrogation of claims to test for potential contradictions or inconsistencies. This is called ‘the dialectic (discussion-based) method’ of inquiry. Although most clinicians are not aware of this, his ideas form the basis of the critical thinking and medical reasoning we employ in reflecting on our own clinical practices, in reviewing research and in reading the papers in this journal.

Medical education has recently undergone substantial critical review in many parts of the world. Invaluable for me was a report by the American Medical Association2 on Medical Education Trends (https://edhub.ama-assn.org/module/2706435). The changes being aptly described by Dr Timothy Smith of the AMA as ‘Not your grandfather’s med school…’3 

Not only has medical education changed significantly since our grandparents’ generation (eg, the very science-focused, lecture-based teaching evolved into a more clinically oriented approach) but the concept of Sport and Exercise Medicine (SEM) as a distinct specialty and a core part of the medical curriculum would not even have been entertained. To those of us in the SEM trenches this seems bizarre. The benefits of cardiorespiratory fitness (in no way a new discovery!) succinctly summarised in the infographic by Smirmaul and Arena ( see page 614 ) in this edition seem so …
A Christmas Story
Authors: James Eugene Dalen
Journal: JAMA Cardiology (2019)

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Abstract 19544: Prognostic Value of QRS Duration in High Risk Patients for Ventricular Tachyarrhythmia With LVEF>35%; A Prospective Comparison With Early Repolarization Pattern and Fragmented QRS
Authors: Masato Kawasaki, Takahisa Yamada, Takashi Morita, Yoshio Furukawa, Shunsuke Tamaki, Yusuke Iwasaki, Atsushi Kikuchi, Tsutomu Kawai, Masahiro Seo, Iyo Ikeda, Eiji Fukuhara, Makoto Abe, Jun Nakamura, Masatake Fukunami
Journal: Circulation (2017)

Background: It is important to predict ventricular tachyarrhythmias in patients (pts) with cardiac disease and left ventricular ejection fraction (LVEF) >35%. QRS duration, early repolarization pat...
Abstract 18996: Impact of Infarct Size on Left Ventricular Diastolic Function Following Acute Myocardial Infarction
Authors: Andrew Lin, Christopher Kwan, Kristyan Guppy-Coles, Joanne Sippel, John Atherton, Sandhir Prasad
Journal: Circulation (2015)

Introduction: Severe left ventricular diastolic dysfunction is associated with worse prognosis after acute myocardial infarction (MI). Twenty percent of patients have a restrictive filling pattern (RFP) following MI, and this is associated with a fourfold increase in mortality. The determinants of diastolic function in this setting are not well defined. Aim: We sought to determine the correlation between enzymatic infarct size and RFP in patients with a first ever MI. We hypothesized that a larger infarct size would result in greater impairment of left ventricular diastolic function. Methods: Data analysis was performed on consecutive patients admitted with first ever non-ST elevation MI (NSTEMI) or ST-elevation MI (STEMI) to a single large tertiary referral hospital from January 2013 to December 2014. All patients underwent coronary angiography during the index admission. Infarct size was determined by peak troponin I. Doppler transmitral flow pattern was obtained from the initial transthoracic echocardiogram performed within 48 hours of admission. RFP was defined as: E/A ratio &gt;2.0 and/or E-wave deceleration time &lt;160ms (American Society of Echocardiography Guidelines 2009). Results: Data were available on 645 consecutive patients who underwent coronary angiography for MI. We excluded 160 patients with a previous MI. Of the remaining 485 patients (mean age 62±13 years; mean left ventricular ejection fraction (LVEF) 53±12%), there were 338 NSTEMIs (70%) and 147 STEMIs (30%). PCI was performed in 360 (74%) patients (single vessel (82%), ≥2 vessels (18%)); coronary artery bypass surgery in 58 (13%); and medical management in 67 (13%). Sixty-nine patients (14.4%) had RFP; 52% of these had a LVEF ≥45%. Peak troponin I levels were higher in the RFP group (31.8±30.9μg/L vs 16.8±25.2μg/L, p=&lt;0.001). On multivariate analysis, infarct size by peak troponin I (OR 1.02, 95%CI 1.00-1.03, p=0.026) and low LVEF (OR 0.95, 95%CI 0.91-0.99, p=0.015) were the only independent predictors of RFP. Conclusion: Infarct size was a major determinant of diastolic dysfunction following first ever MI. Whilst LV systolic dysfunction was strongly associated with impaired diastolic function, 52% of patients with severe diastolic dysfunction had relatively preserved LVEF.
Targeting the High-Mobility Group Box 3 Protein Sensitizes Chemoresistant Ovarian Cancer Cells to Cisplatin
Authors: Anirban Mukherjee, Van Huynh, Kailee Gaines, Wade Alan Reh, Karen M. Vasquez
Journal: Cancer Research (2019)

Abstract Chemotherapeutic regimens for ovarian cancer often include the use of DNA interstrand crosslink–inducing agents (e.g., platinum drugs) or DNA double-strand break–inducing agents. Unfortunately, the majority of patients fail to maintain a durable response to treatment, in part, due to drug resistance, contributing to a poor survival rate. In this study, we report that cisplatin sensitivity can be restored in cisplatin-resistant ovarian cancer cells by targeting the chromatin-associated high-mobility group box 3 (HMGB3) protein. HMGB proteins have been implicated in the pathogenesis and prognosis of ovarian cancer, and HMGB3 is often upregulated in cancer cells, making it a potential selective target for therapeutic intervention. Depletion of HMGB3 in cisplatin-sensitive and cisplatin-resistant cells resulted in transcriptional downregulation of the kinases ATR and CHK1, which attenuated the ATR/CHK1/p-CHK1 DNA damage signaling pathway. HMGB3 was associated with the promoter regions of ATR and CHK1, suggesting a new role for HMGB3 in transcriptional regulation. Furthermore, HMGB3 depletion significantly increased apoptosis in cisplatin-resistant A2780/CP70 cells after cisplatin treatment. Taken together, our results indicate that targeted depletion of HMGB3 attenuates cisplatin resistance in human ovarian cancer cells, increasing tumor cell sensitivity to platinum drugs. Significance: This study shows that targeting HMGB3 is a potential therapeutic strategy to overcome chemoresistance in ovarian cancer.
Minerva: August 2003
Authors: Sarita Jain, Catherine Stephens, Vanita Pathak-Ray, H A Ahluwalia
Journal: BMJ (2003)

The consumption of junk food arguably places a greater burden on healthcare systems than healthy food. A spokesman for the Centre for Science in the Public Interest (Canada) says that Canadians should be ready to pay additional taxes on these items, as they already do on tobacco and alcohol, “to pay for the increased financial toll.” The association wants such “sin taxes” to apply at both restaurants and grocery shops ( Canadian Medical Association Journal 2003;168:1697).



A 41 year old man with multiple tattoos on his arm presented to the dermatology department with an itchy eczematous rash in all the red areas of the tattoos. He had tattoos for 15 years but had had some of the red areas refilled a year earlier. The rash appeared after the refilling, and it affected red areas that had not been touched up with red dye. This second exposure to …
Standing on the shoulders of giants: two centuries of struggle against meningococcal disease
Authors: Pere Domingo, Virginia Pomar, Albert Mauri, Nicolau Barquet
Journal: The Lancet Infectious Diseases (2019)

Meningococcal disease was first clinically characterised by Gaspard Vieusseux in 1805, and its causative agent was identified by Anton Weichselbaum in 1887, who named it Diplococcus intracellularis menigitidis. From the beginning, the disease was dreaded because of its epidemic nature, predilection for previously healthy children and adolescents, and high mortality. In the last decade of the 19th century, the concept of serum therapy for toxin-related bacterial diseases was identified. This concept was applied to meningococcal disease therapy, in an independent way, by Wilhelm Kolle, August von Wasserman, and Georg Jochmann in Germany, and Simon Flexner in the USA, resulting in the first successful approach for the treatment of meningococcal disease. During the first three decades of the 20th century, serum therapy was the standard treatment for meningococcal disease. With the advent of sulphamides first and then antibiotics, serum therapy was abandoned. The great challenges that infectious diseases medicine is facing and the awaiting menaces in the future in terms of increasing antibiotic resistance, emergence of new pathogens, and re-emergence of old ones without effective therapy, make passive immunotherapy a promising tool. Acknowledging the achievements of our predecessors might teach us some lessons to bring light to our future.
Contact-Dependent Killing by Cytotoxic T Lymphocytes Is Insufficient for EL4 Tumor Regression <i>In Vivo</i>
Authors: Richard J. Beck, Maarten Slagter, Joost B. Beltman
Journal: Cancer Research (2019)

Immunotherapies are an emerging strategy for treatment of solid tumors. Improved understanding of the mechanisms employed by cytotoxic T lymphocytes (CTL) to control tumors will aid in the development of immunotherapies. CTLs can directly kill tumor cells in a contact-dependent manner or may exert indirect effects on tumor cells via secretion of cytokines. Here, we aim to quantify the importance of these mechanisms in murine thymoma EL4/EG7 cells. We developed an agent-based model (ABM) and an ordinary differential equation model of tumor regression after adoptive transfer of a population of CTLs. Models were parameterized based on in vivo measurements of CTL infiltration and killing rates applied to EL4/EG7 tumors and OTI T cells. We quantified whether infiltrating CTLs are capable of controlling tumors through only direct, contact-dependent killing. Both models agreed that the low measured killing rate of CTLs in vivo was insufficient to cause tumor regression. In our ABM, we also simulated CTL production of the cytokine IFNγ in order to explore how an antiproliferative effect of IFNγ might aid CTLs in tumor control. In this model, IFNγ substantially reduced tumor growth compared with direct killing alone. Collectively, these data demonstrate that contact-dependent killing is insufficient for EL4 regression in vivo and highlight the potential importance of cytokine-induced antiproliferative effects in T-cell-mediated tumor control. SIGNIFICANCE: Computational modeling highlights the importance of cytokine-induced antiproliferative effects in T-cell-mediated control of tumor progression.
An odd kind of fame: Stories of Phineas Gage
Authors: Sally–Ann S Price
Journal: BMJ (2001)

Over 150 years ago, in an industrial accident, a tamping iron was blown through Phineas Gage's head. The resulting personality change - he was “no longer Gage” - has featured widely in neuroscience and psychology courses.

Take a moment to marvel at the unlikely occurrence: an iron bar, thicker than a broomhandle, crashes through a man's head. He “is able to walk off, talking with composure and equanimity of the hole in his head. …
Thrombin Signaling Promotes Pancreatic Adenocarcinoma through PAR-1–Dependent Immune Evasion
Authors: Yi Yang, Amanda Stang, Patrick G. Schweickert, Nadia A. Lanman, Erin N. Paul, Brett P. Monia, Alexey S. Revenko, Joseph S. Palumbo, Eric S. Mullins, Bennett D. Elzey, Edith M. Janssen, Stephen F. Konieczny, Matthew J. Flick
Journal: Cancer Research (2019)

Pancreatic ductal adenocarcinoma (PDAC) is associated with robust activity of the coagulation system. To determine mechanisms by which clotting factors influence PDAC tumor progression, we generated and characterized C57Bl/6-derived KPC (KRasG12D, TRP53R172H ) cell lines. Tissue factor (TF) and protease-activated receptor-1 (PAR-1) were highly expressed in primary KPC pancreatic lesions and KPC cell lines similar to expression profiles observed in biopsies of patients with PDAC. In allograft studies, tumor growth and metastatic potential were significantly diminished by depletion of TF or Par-1 in cancer cells or by genetic or pharmacologic reduction of the coagulation zymogen prothrombin in mice. Notably, PAR-1-deleted KPC cells (KPC-Par-1KO) failed to generate sizable tumors, a phenotype completely rescued by restoration of Par-1 expression. Expression profiling of KPC and KPC-Par-1KO cells indicated that thrombin-PAR-1 signaling significantly altered immune regulation pathways. Accordingly, KPC-Par-1KO cells failed to form tumors in immune-competent mice but displayed robust tumor growth comparable to that observed with control KPC cells in immune-compromised NSG mice. Immune cell depletion studies indicated that CD8 T cells, but not CD4 cells or natural killer cells, mediated elimination of KPC-Par-1KO tumor cells in C57Bl/6 mice. These results demonstrate that PDAC is driven by activation of the coagulation system through tumor cell-derived TF, circulating prothrombin, and tumor cell-derived PAR-1 and further indicate that one key mechanism of thrombin/PAR-1-mediated tumor growth is suppression of antitumor immunity in the tumor microenvironment. SIGNIFICANCE: The tissue factor-thrombin-PAR-1 signaling axis in tumor cells promotes PDAC growth and disease progression with one key mechanism being suppression of antitumor immunity in the microenvironment.
Our new writers: results of the column competition
Authors: James Thomas, Sally Morrison-Griffiths, Jean Adams, Ian Bickle
Journal: BMJ (2000)

Our new writers: results of The competition for two new soundings columnists attracted many entries - thank you to all those who submitted a column. The winners were <b>James Thomas</b> and <b>Sally Morrison-Griffiths</b>. You can read their columns, along with those of the two runners up, who will receive £75 each.
Association of Blood and Cerebrospinal Fluid Tau Level and Other Biomarkers With Survival Time in Sporadic Creutzfeldt-Jakob Disease
Authors: Adam M. Staffaroni, Abigail O. Kramer, Megan Casey, Huicong Kang, Julio C. Rojas, Christina D. Orrú, Byron Caughey, I. Elaine Allen, Joel H. Kramer, Howard J. Rosen, Kaj Blennow, Henrik Zetterberg, Michael D. Geschwind
Journal: JAMA Neurology (2019)

Fluid biomarkers that can predict survival time in sporadic Creutzfeldt-Jakob disease (sCJD) will be critical for clinical care and for treatment trials.
Learning in English makes sense
Authors: Ahmed Magdy Kassem
Journal: BMJ (2004)

Some Egyptian critics are sceptical about the dominance of English in the medical world. They say that teaching in a foreign language is a remnant of imperial times which should be removed. We are independent and our language should be too. I have also heard people argue that studying in a foreign language prevents a proper understanding and hinders learning.

I do not think that the use of a foreign language is evidence of a country's dependence, unless using this language is humiliating or it destroys …
Promoting Neutrophil Apoptosis to Treat Acute Lung Injury
Authors: Anna K. Kurdowska, Jon M. Florence
Journal: American Journal of Respiratory and Critical Care Medicine (2019)

bicarbonate in acute illness and comparing different formulations of balanced crystalloids could delineate the respective contributions of each cation and anion to organ function and clinical outcomes.Someday the evidence may allow a verdict on whether the chloride anion is individually guilty of worsening patient outcomes, a contributing accomplice, or an innocent bystander.Mechanism aside, for the 30 million patients treated with intravenous fluid each year, we believe the weight of the current evidence favors balanced crystalloids over saline.Saline's innocence can no longer be presumed.The burden of proof now lies with those who would defend saline's safety.
Minerva: May 2001
Authors: G A Johnston, T O Bleiker, RAC Graham Brown
Journal: BMJ (2001)

John Travolta, Leonardo DiCaprio, and Sharon Stone have all played a string of characters whose on.screen charisma depends on smoking. US tobacco researchers single them out as the most likely stars out of a group of 43 to encourage smoking among school children (Tobacco Control 2001;10:16.22). Children who nominated any of them as a favourite star were more at risk of becoming smokers than others who chose the image of non.smoking idols such as Tom Cruise, Mel Gibson, or Sandra Bullock.

Medical graduates in Australasia can train to be ophthalmologists in about four years. Medical graduates in the United Kingdom usually take about eight years-why? Are they overtrained? An ophthalmologist from Britain's flagship eye hospital stops short of admitting it, but suggests that if specialty leaders want Britain to fall in line with the rest of the world, basic surgical training could be the first victim (British Journal of Ophthalmology 2001;85:383.4). Most trainees spend three years as a senior house officer in unrelated surgical specialties before their ophthalmology training gets under way.

Another paper on trainees in the United Kingdom, this time in cardiothoracic surgery, looks at the effect of training on …
Association of Modifiable Risk Factors With Dental Caries Among Indigenous and Nonindigenous Children in Australia
Authors: Xiangqun Ju, Loc Do, Diep Ha, Lisa Jamieson
Journal: JAMA Network Open (2019)

Although the prevalence of untreated dental caries among Indigenous Australian children greatly exceeds the prevalence observed among non-Indigenous children, the associations of dental caries with risk factors is considered to be the same.To estimate the association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children using decomposition analysis.Cross-sectional study using data from Australia's National Child Oral Health Study 2012-2014, a nationally representative sample of both Indigenous and non-Indigenous children aged 5 to 14 years. Data analyses were completed in November 2018.Outcomes were the mean number of decayed tooth surfaces in the primary dentition for children aged 5 to 10 years and mean number of decayed tooth surfaces in the permanent dentition for children aged 8 to 14 years. The area-based measure was the school-based Index of Community Socio-Educational Advantage, with individual-level variables including sex, equivalized household income, tooth-brushing frequency, sugar-sweetened beverage (SSB) consumption, time from last dental visit, and residing in an area with water fluoridation.There were 720 Indigenous children aged 5 to 10 years, 14 769 non-Indigenous children aged 5 to 10 years, 738 Indigenous children aged 8 to 14 years, and 15 631 non-Indigenous children aged 8 to 14 years. For area-based inequalities in primary dentition among Indigenous children, two-thirds of the contribution was associated with SSB consumption (65.9%; 95% CI, 65.5%-66.3%), followed by irregular tooth brushing (15.0%; 95% CI, 14.6%-15.5%) and low household income (14.5%; 95% CI, 14.1%-14.8%). Among non-Indigenous children, almost half the contribution was associated with low household income (47.6%; 95% CI, 47.6%-47.7%), followed by SSB consumption (31.0%; 95% CI, 30.9%-31.0%) and residing in an area with nonfluoridated water (9.5%; 95% CI, 9.5%-9.6%). For area-based inequalities in permanent dentition among Indigenous children, 40.0% (95% CI, 39.9%-40.1%) of the contribution was associated with residing in an area with nonfluoridated water, followed by low household income (20.0%; 95% CI, 19.7%-20.0%) and consumption of SSBs (20.0%; 95% CI, 19.9%-20.1%). Among non-Indigenous children, the contribution associated with low household income, SSB consumption, and last dental visit more than a year ago were each 28.6%.The association of modifiable risk factors with area-based inequalities in untreated dental caries among Indigenous and non-Indigenous Australian children differed substantially. Targets to reduce SSB consumption may reduce oral health inequalities for both groups; however, Indigenous children require additional focus on oral hygiene.
What's on the web? Health news
Authors: Karen Hebert
Journal: BMJ (2003)

Websites can be invaluable sources of health news, and many are reliable and well researched. We are all expected to keep up to date with medical developments for personal interest, when writing essays, or to keep abreast of patients- concerns'health news websites are a good addition to any medic-s favourites list.

The best place to start is definitely www.yahoo.com. Choose News & Media from the website directory and then click on Health@. Although Yahoo is not the best direct access site to health news it has a list of links to all of the health news …