tbuckley/cabot-search huggingface dataset:
Comparative Safety of Phosphate Binders Without Proven Efficacy—How Did We Get Here?
Authors: Bryan R. Kestenbaum, Ian H. de Boer
Journal: JAMA Internal Medicine (2019)

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What a belly ache
Authors: Steven Kennish, Shireen McKenzie
Journal: BMJ (2006)

You are a medical student attached to a general surgery firm. While you are shadowing the senior house officer he is contacted for a trauma case; you accompany him to the resuscitation bay of the emergency department.

The trauma team awaits the arrival of a patient with an abdominal stab wound. You stand clear and observe the ordered and calm way in which the patient is dealt with on arrival. After a short period of initial assessment and resuscitation, consent is given for surgery and the patient is transferred to the acute theatre, where he is anaesthetised and prepared for an operation (fig 1).



Fig 1 
Patient prepared for laparotomy



1.  What is the ordered approach for the assessment and resuscitation of trauma patients?

2.  Why was this patient taken to theatre withoutpreoperative imaging?

3.  The patient's head is towards the top left of the picture under the drape. The umbilicus is pooled with betadine preparation solution. Describe the location of the injury and list the organs and structures the surgeons are most worried about?

1.  The advanced trauma life support method.1

2.  The knife required removal under surgical control and the patient was haemodynamically stable and adequately …
What do I do now?
Authors: Griffin Trotter, Kate Christensen
Journal: BMJ (2001)

> The aim of “What do I do now?” is not to provide answers but to offer readers a range of reasonable and defensible options with which to inform their own thinking and conduct. We invite readers to submit their own dilemmas for possible presentation and discussion. In all cases, scenarios are presented anonymously to prevent identification of individuals and institutions involved. Cases may be submitted to the Student BMJ directly or to hrc@globetrotter.berkeley.edu. The subject line should read: What do I do now?
> 
> Thomasine Kushner, University of California, Berkeley, and David C Thomasma, Loyola University Chicago Stritch School of Medicine, are coeditors of the book, Ward Ethics, published by Cambridge University Press, from which some of the cases and commentaries in this column will be drawn.

As medical students we are given no instructions on the proper way to identify ourselves. Sometimes on ward rounds the doctors introduce us to patients as “Dr So and So,” and students are not discouraged from describing themselves the same way. I even overheard a doctor instructing a student to take a history from a patient, But, don't tell her you are a medical student because she won't talk to you. I am uneasy about this dishonest self description. But the practice is common, and when I introduce myself as a medical student, I get the feeling people think that it is silly or unnecessary.

Every medical student faces this issue at some point in his or her training. I faced it in my first month as a medical student. One of my fellow students passed round his new business cards, which said “Doctor Bloggs” and …
Abstract 21308: Mesenchymal Stem Cells Driven by Exosomal Mir-125b Protect Myocardial Infarction via P53-Mediated Autophagy Signalling
Authors: Xinyang Hu, Changchen Xiao, Yinchuang Xu, Wei Zhu, Jian’an Wang
Journal: Circulation (2017)

Background and Objectives: Bone marrow derived mesenchymal stem cells (MSCs) transplantation confers protection against adverse cardiac remodeling mainly through paracrine effects, however, it remains largely unknow whether autophagy is involved in the protection offered by MSCs therapy. In the present study, we used the mice myocardial infarction(MI)model to investigate whether and how MSCs modulates autophagy activity to protect the injured myocardium. Methods and Results: Using a well established methodology of MSCs therapy for treating myocardial infarction, we reproduced the data that MSCs can reduce myocardial apoptosis to improve cardiac function post-MI, which was closely associated with attenuated autophagy flux in cardiac tissue. To further investigate how MSCs modulate autophagic activity, we co-cultured MSCs with neonatal mice cardiomyocytes (NMCMs) to test whether NMCMs co-cultured with MSCs exhibited enhanced tolerance to hypoxia. We showed that NMCMs exposed to hypoxia had increased autophagic flux, co-culture with MSCs resulted in a decrease in autophagic flux which was associated with improved apoptosis. Interestingly, NMCMs exposed to hypoxia exhibited up-regulated levels of p53 and its downward target Bnip3 at both mRNA and protein levels. Importantly, NMCMs co-cultured with MSCs had decreased p53 and bnip3 expression levels, suggesting that MSCs protected hypoxic cardiomyocytes via modulating autophagic flux through suppressing p53/bnip3 pathways. Exosome has been considered as the major paracrine components of MSCs, therefore, we extracted the exosomes from MSCs and it displayed the similar effects with MSCs on the autophagy modulation. We found miR-125b was an important component of exosome, inhibition of miR-125b in exosome abolished the effect of autophagy modulation via p53/Bnip3 signal pathway. Conclusion: MSCs, can exert the paracrine effects via miR-125b containing exosomes to block p53/Bnip3 pathway and decrease the autophagic related cell death, thus conferring protection for the cardiomyocytes.
The eminent scientist
Authors: Tiago Villanueva
Journal: BMJ (2005)

<b>Paula Ravasco</b> won the Eminent Scientist of the Year and Millennium Golden International Award in 2005, awarded by the International Research Promotion Council and the World Scientists Forum, thanks to her research work on nutrition in patients with cancer. <b>Tiago Villanueva</b> talked to her to find out what drives this Portuguese qualified nutritionist, who is on the verge of finishing her PhD while studying simultaneously for her medical degree
Abstract 16961: Evaluation of microRNAs as Novel Markers of Cardiotoxicity in Patients Treated With Anthracycline Therapy for Childhood Cancer
Authors: Kasey J Leger, David Leonard, James A de Lemos, Danelle Nielson, Naomi J Winick, Pradeep P Mammen
Journal: Circulation (2013)

Background: Early detection of anthracycline cardiotoxicity may allow cardioprotective intervention(s) prior to irreversible damage. microRNA (miR) modulation in anthracycline carditoxicity has been identified in animal models, however there are no data regarding circulating miR expression following anthracycline-induced cardiac injury in humans. Methods: We measured candidate plasma miR expression in thirteen children immediately prior to and six hours following a cycle of anthracycline chemotherapy, and in five control children before and after non-cardiotoxic chemotherapy. Candidate miRs, including miRs-1, -133a, -195, -208a, -29b, -423-5p, and -499a, were selected based on their established roles in regulating stress-induced cardiomyocyte hypertrophy and fibrosis or as circulating biomarkers of cardiac injury. Additionally, miR-146a was selected based on its known upregulation in cardiac tissue following anthracycline-induced cardiac injury. Results: Children treated with anthracycline had a 2.4-fold ...
Synthetic indicator of the impact of colorectal cancer screening programmes on incidence rates
Authors: Manuel Zorzi, Marco Zappa
Journal: Gut (2019)

The impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists' sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence.We defined the 'rate of advanced adenoma on the target population' (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50-69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50-74 year old subjects and the cumulative AA-TAP.In 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013-2014 and those in 2003-2004 (p=0.009).The AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.
Conference agrees on wider range of candidates for medical school
Authors: Muhunthan Thillai
Journal: BMJ (2000)

UK medical students who leave the course early should be allowed an “honourable exit” by being awarded a “half way degree.” This was one of the many recommendations made by the British Medical Association's board of medical education after a conference on selection for medical school.

The recently published report from the conference suggests that a half way degree would be given to students who have completed part of the course but feel that medicine is not for them. The only system currently available is to complete two years of a preclinical medical course and study for a one year BSc degree.

The main …
Networking as a junior doctor
Authors: Tiago Villanueva
Journal: BMJ (2006)

Professional networking is an art. It is also fun and is an important tool in the repertoire of the 21st century medic. Networking not only leads to new contacts, opportunities, and projects, but can also lead to new friendships and a strong sense of personal and professional fulfilment. Here are some tips on how to be a successful networker.
A guide to medical etiquette: applying for a job
Authors: David McAllister
Journal: BMJ (2000)

Barring criminality, a well paid job with excellent prospects and public regard is pretty much guaranteed for a doctor in Britain. Given this, it is no wonder that the application for jobs in the final year is a calm, relaxed affair where everyone behaves courteously to their colleagues and would not consider any unethical or underhand behaviour.

Does this sound familiar or is your medical school different? Let's be honest, if a little …
Effects of Arteriovenous Fistula Ligation on Cardiac Structure and Function in Kidney Transplant Recipients
Authors: Nitesh N. Rao, Michael B. Stokes, Adil Rajwani, Shahid Ullah, Kerry Williams, David King, Ewan Macaulay, Christine H. Russell, Santosh Olakkengil, Robert P. Carroll, Randall J. Faull, Karen S.L. Teo, Stephen P. McDonald, Matthew I. Worthley, P. Toby Coates
Journal: Circulation (2019)

Cardiovascular morbidity and mortality remain high in recipients of a kidney transplant. The persistence of a patent arteriovenous fistula (AVF) after transplantation may contribute to ongoing maladaptive cardiovascular remodeling. The ability to reverse this maladaptive remodeling by ligation of this AVF is unknown. We conducted the first randomized controlled trial to evaluate the effect of AVF ligation on cardiac structure and function in stable kidney transplant recipients.In this randomized controlled trial, kidney transplant recipients (>12 months after transplantation with stable graft function) were randomized to AVF ligation or no intervention. All participants underwent cardiac magnetic resonance imaging at baseline and at 6 months. The primary outcome was the change in left ventricular (LV) mass. Secondary outcomes included changes in LV volumes, left and right atrial areas, LV ejection fraction, NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, cardiac output/index, brachial flows (ipsilateral to AVF), and pulmonary artery velocity.A total of 93 patients were screened, of whom 64 met the inclusion criteria and were randomized to the AVF ligation (n=33) or control (n=31) group. Fifty-four participants completed the study: 27 in the AVF ligation group and 27 in the control group. On the second cardiac magnetic resonance scan, a mean decrease of 22.1 g (95% CI, 15.0-29.1) was observed in LV mass in the AVF ligation group compared with a small increase of 1.2 g (95% CI, -4.8 to 7.2) in the control group ( P<0.001). Significant decreases in LV end-diastolic volumes, LV end-systolic volumes, cardiac output, cardiac index, atrial volumes, and NT-proBNP were also seen in the AVF closure group ( P<0.01). No significant changes were observed in LV ejection fraction ( P=0.93) and pulmonary artery velocity ( P=0.07). No significant complications were noted after AVF ligation. No changes in estimated glomerular filtration rate or systolic and diastolic blood pressures were observed between cardiac magnetic resonance scans.Elective ligation of patent AVF in adults with stable kidney transplant function resulted in clinically significant reduction of LV myocardial mass.Australian and New Zealand Clinical Trials Registry URL: https://www.anzctr.org.au . Unique Identifier: ACTRN12613001302741.
Going from acute to chronic kidney injury with FoxO3
Authors: Xiangchen Gu, Archana Raman, Katalin Susztak
Journal: Journal of Clinical Investigation (2019)

Acute kidney injury (AKI) is one of the most important risk factors for chronic and progressive kidney disease, leading to end-stage kidney failure. Tubule epithelial regeneration leads to the resolution of renal failure in AKI. Failure of tubule epithelial regeneration leads to concomitant hypoxia from loss of microcirculation, which serves as a critical factor leading to chronic kidney disease. In this issue of the JCI, Li et al. show that hypoxia activates the stress-responsive transcription factor FoxO3. Increased FoxO3 protein abundance leads to alterations in tubular epithelial autophagy and metabolism, highlighting an important mechanism causing permanent renal damage even after an acute injury.
Scottish Executive refuses to pay for graduate students
Authors: Helen Barratt
Journal: BMJ (2001)

The Scottish Executive is refusing to pay NHS bursaries for Scottish graduate students studying on the new fast track medical degree programmes in England. English and Welsh students studying on the four year courses at Cambridge, Oxford, Leicester Warwick, and St George's Hospital in London will be entitled to receive the bursaries in their final three years.

The situation arose after the introduction of the new programme at Leicester Warwick Medical School, one of several new medical faculties in the UK. Of the 64 students in the first year, two are from Wales …
Risk Factors and Predictive Scoring System for Post-Transplant Lymphoproliferative Disorder after Hematopoietic Stem Cell Transplantation
Authors: Ayumi Fujimoto, Nobuhiro Hiramoto, Satoshi Yamasaki, Yoshihiro Inamoto, Naoyuki Uchida, Tetsuo Maeda, Takehiko Mori, Yoshinobu Kanda, Tadakazu Kondo, Junji Tanaka, Tatsuo Ichinohe, Yoshiko Atsuta, Masao Ogata, Ritsuro Suzuki
Journal: Blood (2018)
Abstract 357: Resuscitative Balloon Occlusion of the Aorta in Non-Traumatic out of Hospital Cardiac Arrest - Evaluation of an Educational Program
Authors: Jostein Rødseth Brede, Thomas Lafrenz, Andreas Jørstad Kruger, Edmund Søvik, Torjus Steffensen, Carlo Kriesi, Martin Steinert, Pål Klepstad
Journal: Circulation (2018)

Background: Out of hospital cardiac arrest (OHCA) is a critical incident with a high mortality rate. Augmentation of the circulation and hence oxygen delivery to vital organs such as the brain and heart during cardio-pulmonal resuscitation (CPR) might be beneficial. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) redistribute cardiac output to the organs proximal to the occlusion. Preclinical data supports that patients in non-traumatic CA might benefit from REBOA placed in the thoracic level during CPR. Methods: We developed a REBOA team-based training program involving the physicians and prehospital emergency medical service (P-EMS) operators working on the National Air Ambulance helicopter base in Trondheim, Norway. The program consists of a four-step approach to educate, train and implement the REBOA procedure in a simulated prehospital setting. An objective structured assessment of prehospital REBOA application (OSAPRA) scoring chart and a special designed training dummy was made for this study. Results: 7 physicians and 3 P-EMS operators participated. The time needed to perform the REBOA procedure was 8,5 min (range; 6,3 - 12,7). The corresponding time from arrival at scene to balloon inflation was 12,0 min (range; 8,8 - 15). The total objective assessment scores of the candidates’ competency was 41,8 points out of 48 (range; 39 - 43,5). The advanced cardiovascular life support (ACLS) remained at standard quality, regardless of the simultaneous REBOA procedure. Conclusions: This four-step approach to educate, train and implement the REBOA technique to a prehospital working team is feasible and provides adequate competence. In a simulated setting the procedure does not add significant time to the prehospital resuscitation time nor does the procedure interfere with the quality of the ACLS.
RESCUE OF NEUROPHYSIOLOGICAL PHENOTYPE SEEN IN PRP NULL MICE BY TRANSGENE ENCODING HUMAN PRION PROTEIN, (VOL 9, PG 197, 1995)
Authors: M A Whittington, Sidle Kcl., I Gowland, J Meads, A F Hill, M S Palmer, Jefferys Jgr., J Collinge
Journal: Nature Genetics (1995)
Intravenous administration of cardiac progenitor cell-derived exosomes protects against doxorubicin/trastuzumab-induced cardiac toxicity
Authors: Giuseppina Milano, Vanessa Biemmi, Edoardo Lazzarini, Carolina Balbi, Alessandra Ciullo, Sara Bolis, Pietro Ameri, Dario Di Silvestre, Pierluigi Mauri, Lucio Barile, Giuseppe Vassalli
Journal: Cardiovascular Research (2019)

Combined administration of anthracyclines (e.g. doxorubicin; Dox) and trastuzumab (Trz), a humanized anti-human epidermal growth factor receptor 2 (HER2; ErbB2), is an effective treatment for HER2-positive breast cancer. However, both agents are associated with cardiac toxicity. Human cardiac-resident mesenchymal progenitor cells (CPCs) secrete extracellular vesicles including nanosized exosomes which protect against myocardial ischaemia. Here, we investigated the effects of these exosomes using a novel model of Dox/Trz-mediated cardiotoxicity.CPCs were derived from cardiac atrial appendage specimens from patients who underwent heart surgery for heart valve disease and/or ischaemic heart disease, and exosomes were purified from CPC conditioned media. Proteomics analyses revealed that CPC exosomes contained multiple proteins involved in redox processes. Dox/Trz induced a significant increase in reactive oxygen species (ROS) in rat cardiomyocytes, which was prevented by CPC exosomes. In vivo, rats received six doses of Dox (Days 1-11), followed by six doses of Trz (Days 19-28). Three doses of either exosomes or exosome suspension vehicle were injected intravenously on Days 5, 11, and 19 in the treatment and control groups, respectively. Dox/Trz induced myocardial fibrosis, CD68+ inflammatory cell infiltrates, inducible nitric oxide synthase expression, and left ventricular dysfunction. CPC exosomes prevented these effects. These vesicles were highly enriched in miR-146a-5p compared with human dermal fibroblast exosomes. Dox upregulated Traf6 and Mpo, two known miR-146a-5p target genes (which encode signalling mediators of inflammatory and cell death axes) in myocytes. CPC exosomes suppressed miR-146a-5p target genes Traf6, Smad4, Irak1, Nox4, and Mpo in Dox-treated cells. Specific silencing of miR-146a-5p abrogated exosome-mediated suppression of those genes leading to an increase in Dox-induced cell death.Human CPC exosomes attenuate Dox-/Trz-induced oxidative stress in cardiomyocytes. Systemic administration of these vesicles prevents Dox/Trz cardiotoxicity in vivo. miR-146a-5p mediates some of the benefits of exosomes in this setting.
A selection of rapid responses to this article after it was published in the BMJ
Authors: Melissa Sayer
Journal: BMJ (2002)

Protecting the public is of key importance; I would hope that people entering the medical profession are doing so, at least in part. It certainly seems to be what potential medical students believe when they apply to study medicine, and are told not to say at interview. It would be naive not to expect that a small proportion of entrants to medical school may not be suited to medicine. Let's not side step the difficult issue here; we are talking about trying to prevent people like Harold Shipman becoming doctors, but I'm not sure how this would be achieved. Let's not confuse this issue with people who have ill health or a disability. Let's not, for that matter, stigmatise people with problems of substance abuse either.

Rubin states that there should be an environment conducive to students seeking help, which is a laudable aim that I wholeheartedly agree with. The same paragraph, however, demonstrates that this environment does not exist, and never will while the General Medical Council asks doctors to breach confidentiality …
The Evolution Deceit
Authors: Amina Rahman
Journal: BMJ (2001)

Everyone takes the theory of evolution for granted. How many people even know where the ideas for the theory came from, apart from spontaneously saying “Darwin”? Have you ever thought that it might all sound a bit vague and far fetched?

The Evolution Deceit completely explodes the myths surrounding the theory, with nothing but evidence based scientific research and knowledge. At the end of the day, that's all it is, a theory, that was never proved. Darwin himself admitted …
Parts of brain responsible for love identified
Authors: Siân Knight
Journal: BMJ (2000)

Scientists from University College London believe they have identified the parts of the brain responsible for true love. Using a functional magnetic resonance scanner, Andreas Bartels and Semir Zeki monitored the brain activity of 17 volunteers who described themselves as “madly and truly in love.” The volunteers, recruited from posters placed around the university, were shown pictures of the partners with whom they claimed to be “head over heels in love” while a scan took place. They were then shown pictures of a friend who was the same …