tbuckley/cabot-search huggingface dataset:
Environmental risk factors and exposure to the zoonotic malaria parasite Plasmodium knowlesi across northern Sabah, Malaysia: a population-based cross-sectional survey
Authors: Kimberly M Fornace, Paddy M Brock, Tommy R Abidin, Lynn Grignard, Lou S Herman, Tock H Chua, Sylvia Daim, Timothy William, Catriona L E B Patterson, Tom Hall, Matthew J Grigg, Nicholas M Anstey, Kevin K A Tetteh, Jonathan Cox, Chris J Drakeley
Journal: The Lancet Planetary Health (2019)

BackgroundLand use changes disrupt ecosystems, altering the transmission of vector-borne diseases. These changes have been associated with increasing incidence of zoonotic malaria caused by Plasmodium knowlesi; however, the population-level distributions of infection and exposure remain unknown. We aimed to measure prevalence of serological exposure to P knowlesi and assess associated risk factors.MethodsWe did an environmentally stratified, population-based, cross-sectional survey across households in the Kudat, Kota Marudu, Pitas, and Ranau districts in northern Sabah, Malaysia, encompassing a range of ecologies. Using blood samples, the transmission intensity of P knowlesi and other malaria species was measured by specific antibody prevalence and infection detected using molecular methods. Proportions and configurations of land types were extracted from maps derived from satellite images; a data-mining approach was used to select variables. A Bayesian hierarchical model for P knowlesi seropositivity was developed, incorporating questionnaire data about individual and household-level risk factors with selected landscape factors.FindingsBetween Sept 17, 2015, and Dec 12, 2015, 10 100 individuals with a median age of 25 years (range 3 months to 105 years) were sampled from 2849 households in 180 villages. 5·1% (95% CI 4·8–5·4) were seropositive for P knowlesi, and marked historical decreases were observed in the transmission of Plasmodium falciparum and Plasmodium vivax. Nine Plasmodium spp infections were detected. Age, male sex, contact with macaques, forest use, and raised house construction were positively associated with P knowlesi exposure, whereas residing at higher geographical elevations and use of insecticide were protective. Agricultural and forest variables, such as proportions and fragmentation of land cover types, predicted exposure at different spatial scales from households.InterpretationAlthough few infections were detected, P knowlesi exposure was observed in all demographic groups and was associated with occupational factors. Results suggest that agricultural expansion and forest fragmentation affect P knowlesi exposure, supporting linkages between land use change and P knowlesi transmission.FundingUK Medical Research Council, Natural Environment Research Council, Economic and Social Research Council, and Biotechnology and Biosciences Research Council.
The American Health Security Act
Authors: H M Goldin
Journal: New England Journal of Medicine (1993)

The American Health Security Act (S 491, HR 1200) was introduced in the U.S. Senate by Paul Wellstone (D-MN) and in the House of Representatives by John Conyers (D-MI) and Jim McDermott (D-WA), along with 54 co-sponsors. The legislation, which replaces and strengthens the 1992 bill proposed by former Rep. Marty Russo and Sen. Wellstone, presents a single-payer alternative to managed competition proposals. This summary is excerpted from material provided by Sen. Wellstone's office.
Pure cystic groove pancreatitis: endosonographic appearance
Authors: Dario Ligresti, Matteo Tacelli, Michele Amata, Luca Barresi, Settimo Caruso, Ilaria Tarantino, Mario Traina
Journal: Endoscopy (2019)

Corrected by: Correction: Pure cystic groove pancreatitis: endosonographic appearanceEndoscopy 2019; 51(08): C7-C7DOI: 10.1055/a-1126-5092
RCGP urges health secretary to “get the basics right first” on NHS IT
Authors: Gareth Iacobucci
Journal: BMJ (2019)

The government should focus on creating a “robust and joined up” IT system across general practice and the NHS before embarking on a full scale technological revolution, the Royal College of General Practitioners (RCGP) has said.

The RCGP’s new manifesto1 stresses the importance of “getting the basics right first.”

The college said it recognised the potential of genomics, artificial intelligence, digital medicine, and robotics to “potentially revolutionise patient care and improve safety.”

But it argues that such ambitious improvements will only be possible if all GP practices have robust, secure IT …
The genome sequence of segmental allotetraploid peanut Arachis hypogaea
Authors: David J. Bertioli, Jerry Jenkins, Josh Clevenger, Olga Dudchenko, Dongying Gao, Guillermo Seijo, Soraya C. M. Leal-Bertioli, Longhui Ren, Andrew D. Farmer, Manish K. Pandey, Sergio S. Samoluk, Brian Abernathy, Gaurav Agarwal, Carolina Ballén-Taborda, Connor Cameron, Jacqueline Campbell, Carolina Chavarro, Annapurna Chitikineni, Ye Chu, Sudhansu Dash, Moaine El Baidouri, Baozhu Guo, Wei Huang, Kyung Do Kim, Walid Korani, Sophie Lanciano, Christopher G. Lui, Marie Mirouze, Márcio C. Moretzsohn, Melanie Pham, Jin Hee Shin, Kenta Shirasawa, Senjuti Sinharoy, Avinash Sreedasyam, Nathan T. Weeks, Xinyou Zhang, Zheng Zheng, Ziqi Sun, Lutz Froenicke, Erez L. Aiden, Richard Michelmore, Rajeev K. Varshney, C. Corley Holbrook, Ethalinda K. S. Cannon, Brian E. Scheffler, Jane Grimwood, Peggy Ozias-Akins, Steven B. Cannon, Scott A. Jackson, Jeremy Schmutz
Journal: Nature Genetics (2019)

Like many other crops, the cultivated peanut (Arachis hypogaea L.) is of hybrid origin and has a polyploid genome that contains essentially complete sets of chromosomes from two ancestral species. Here we report the genome sequence of peanut and show that after its polyploid origin, the genome has evolved through mobile-element activity, deletions and by the flow of genetic information between corresponding ancestral chromosomes (that is, homeologous recombination). Uniformity of patterns of homeologous recombination at the ends of chromosomes favors a single origin for cultivated peanut and its wild counterpart A. monticola. However, through much of the genome, homeologous recombination has created diversity. Using new polyploid hybrids made from the ancestral species, we show how this can generate phenotypic changes such as spontaneous changes in the color of the flowers. We suggest that diversity generated by these genetic mechanisms helped to favor the domestication of the polyploid A. hypogaea over other diploid Arachis species cultivated by humans. The genome sequence of segmental allotetraploid peanut suggests that diversity generated by genetic deletions and homeologous recombination helped to favor the domestication of Arachis hypogaea over its diploid relatives.
Advice freely given
Authors: Sally Morrison-Griffiths
Journal: BMJ (2000)

It's classic isn't it? You tell someone you're a medical student and, “Ooh, what do you know about ankylosing spondylitis. My auntie's got it.” As students we can often be forgiven for our ignorance, and phrases like, “Sorry, we haven't covered rare tropical diseases of the eye yet,” come in quite useful.

A friend of mine phoned me up the other day. “Hi, our Sandra's here with our Kylie.”

“Oh, how is the little poppet?” I …
Prospective, Multicenter, Randomized Phase III Trial Evaluating the Impact of Lymphoscintigraphy as Part of Sentinel Node Biopsy in Early Breast Cancer: SenSzi (GBG80) Trial
Authors: Sherko Kuemmel, Johannes Holtschmidt, Bernd Gerber, Albert Von der Assen, Joerg Heil, Marc Thill, David Krug, Christian Schem, Carsten Denkert, Juliane Lubitz, Jens Uwe Blohmer, Mattea Reinisch, Michael Hötzeldt, Fenja Seither, Valentina Nekljudova, Ilka Schwidde, Klara Uhrhan, Gunter Von Minckwitz, Mahdi Rezai, Jana Mulowski, Sibylle Loibl, Thorsten Kuehn
Journal: Journal of Clinical Oncology (2019)

PURPOSE The aim of the current work was to clarify whether a preoperative lymphoscintigraphy (LSG) enhances staging accuracy of sentinel lymph node biopsy (SLNB). PATIENTS AND METHODS In a prospective, multicenter, randomized phase III trial, patients with cN0 early breast cancer or extensive/high-grade ductal carcinoma in situ planned for standard radioactive-labeled colloid LSG with subsequent SLNB were randomly assigned 1:1 to receive SLNB either with knowledge of the LSG findings or without. As the false-negative rate of SLNB correlates with the number of resected sentinel lymph nodes (SLNs), our primary end point was the mean number of histologically detected SLNs per patient. One thousand one hundred two evaluable patients were necessary to demonstrate noninferiority of SLNB without LSG. Stratified one-sided 95% CI for the difference (without LSG − with LSG) in the mean number of histologically detected SLNs had to be greater than −0.27 (10% noninferiority margin). Stratification was performed according to tumor focality and trial site. Additional predefined secondary end points (rates of node-positive patients and of completion axillary lymph node dissection) were analyzed to rule out differences in the reliable detection of nodal metastases. RESULTS Between May 2014 and October 2015, 1,198 patients were randomly assigned in 23 German and Swiss breast centers. Modified intention-to-treat analysis (n = 1,163) showed a mean number of histologically detected SLNs of 2.21 with LSG and 2.26 without LSG (difference 0.05; stratified 95% CI, −0.18 to infinity), thus establishing noninferiority of omitting preoperative LSG. Secondary end points displayed no statistically significant differences. CONCLUSION We show that SLNB is equally effective irrespective of the surgeon’s knowledge of preoperative LSG results. SLNB without LSG will speed up the preoperative workflow and reduce cost.
Heat-moulded versus custom-made mandibular advancement devices for obstructive sleep apnoea: a randomised non-inferiority trial
Authors: Jean Louis Pépin, Nathalie Raymond, Olivier Lacaze, Nathalie Aisenberg, Jérôme Forcioli, Eric Bonte, Arnaud Bourdin, Sandrine Launois, Renaud Tamisier, Nicolas Molinari
Journal: Thorax (2019)

Rationale Custom-made mandibular advancement devices (MADs) are reported as providing higher efficacy rates compared with thermoplastic heat-moulded MADs but at the price of higher costs and treatment delays. Objective To determine whether a thermoplastic heat-moulded titratable MAD (ONIRIS; ONIRIS SAS, Rueil Malmaison, France) is non-inferior to a custom-made acrylic titratable MAD (TALI; ONIRIS SAS, Rueil Malmaison, France) for obstructive sleep apnoea (OSA). Methods We conducted a multicentre, open, randomised controlled trial of patients with OSA refusing or not tolerating continuous positive airway pressure (CPAP). Participants were randomly assigned to a thermoplastic heat-moulded titratable device or a custom-made acrylic device for 2 months with stratification by centre and OSA severity. The non-inferiority primary outcome was a ≥50% reduction in apnoea–hypopnoea index (AHI) or achieving AHI &lt;10 events/hour at 2 months. The non-inferiority margin was preset as a difference between groups of 20% for the primary outcome in the per-protocol analysis. Main results Of 198 patients (mean age 51 [SD, 12] years; 138 [72.6%] men; mean body mass index 26 [SD, 2.7] kg/m 2 ; mean AHI 26.6/hour [SD, 10.4]), 100 received TALI and 98 ONIRIS. In per-protocol analysis, the response rate was 51.7% in the TALI group versus 53.6% in the ONIRIS group (absolute difference 1.9%; 90% CI: 11% to 15%, within the non-inferiority margin). Effectiveness was the same for severity, symptoms, quality of life and blood pressure reduction. Patients in ONIRIS group reported more side effects and adherence was slightly better with TALI. Conclusion In patients with OSA refusing or not tolerating CPAP, the thermoplastic heat-moulded titratable MAD was non-inferior in the short-term to the custom-made acrylic MAD. Trial registration number NCT02348970 .
Medical schools hypocrisy
Authors: Clare Hughes
Journal: BMJ (2003)

when I entered the world of medicine, I expected to experience a whole range of emotions, but an emotion I never expected to feel quite so strongly is anger. Anger at the hypocrisy shown by medical establishments.

Why are poor facilities in medical schools forcing young mums to avoid one of the best things they can do to give their infant a healthy start in life—breast feeding? My idealistic outlook tells me that doctors should improve peoples health, the health service should promote healthy lifestyles, and medical schools should train students to make people healthier.

Breast milk is the cheapest and healthiest option. It provides everything that babies need for the first six months of life in just the right quantities. Breast fed babies have a lower incidence of …
Dual histamine blockade for the treatment of adult functional dyspepsia: a single centre experience
Authors: Michael D E Potter, Thomas M Goodsall, Marjorie M Walker, Nicholas J Talley
Journal: Gut (2019)

We read with interest the paper by Camilleri and Boeckxstaens1 which summarises the role of mast cells and their mediators in the pathogenesis of functional gastrointestinal disorders, and describes the particular role of histamine action on H1 receptors in submucosal neurons in rectal biopsies, as well as the clinical response to H1 blockade observed in some patients with the IBS.

Mast cells are implicated in both IBS and to a lesser extent in functional dyspepsia.2 These cells release, among other mediators, histamine, which acts on histamine receptors on submucosal neurons, as well as on epithelial cells causing secretion of chloride and bicarbonate.2 Histamine-2 receptor blockade …
Abstract 13984: Extracorporeal Cardiopulmonary Resuscitation for Unwitnessed Cardiac Arrest
Authors: Eisuke Kagawa, Keigo Dote, Masaya Kato, Shota Sasaki, Noboru Oda, Yoshinori Nakano, Michiaki Nagai, Yasuki Kihara
Journal: Circulation (2016)

Extracorporeal Cardiopulmonary Resuscitation for Unwitnessed Cardiac Arrest Introduction: An unwitnessed cardiac arrest has worse prognosis compared to a witnessed cardiac arrest. Extracorporeal cardiopulmonary resuscitation (ECPR) using venoarterial extracorporeal membrane oxygenation (ECMO) may improve outcomes for patients after cardiac arrest. Hypothesis: We assessed the hypothesis that ECPR will improve patient outcomes following an unwitnessed and refractory cardiac arrest. Methods: Patients who were treated with ECPR were enrolled in this study. We divided the patients into two groups based on whether their cardiac arrest was witnessed or unwitnessed. We assessed baseline patient characteristics, 30-day survival, and neurological outcomes. Results: The patients age in years (median 65 [interquartile range 56 - 72] vs. 60 [50 - 74], P = 0.74) and the rate of initially recorded shockable rhythms (39% vs. 33%, P = 0.70) were similar between the patients in the witnessed group (N = 172) and those in the unwitnessed group (N = 15). The duration of cardiopulmonary resuscitation was longer for patients in the unwitnessed group than for those in the witnessed group (66 [44 - 77] min vs. 45 [24 - 62] min, P = 0.004). The rates of performing immediate coronary angiography (75% vs. 87%, P = 0.53), coronary revascularization (44% vs. 33%, P = 0.44), and targeted temperature management (55% vs. 47%, P = 0.55) were similar between the two groups. The rate of return of spontaneous heart beat (91% vs. 60%, P = 0.003) was lower in the unwitnessed group. The rates of weaning from ECMO (44% vs. 27%, P = 0.19) were similar between the two groups. The 30-day survival curves are shown in Figure. There were no favorable neurological outcomes (Cerebral Performance Category scale of 1 or 2) in the unwitnessed group. Conclusions: ECPR may not improve patient outcome following unwitnessed arrest even in patients who were initially found to have a shockable rhythm.
There must be a better way
Authors: Eleanor Barkell
Journal: BMJ (2001)

Since leaving medical school I have had little practical experience in dealing with patients who are terminally ill. I have, however, been involved with a case that has changed my view of my chosen profession as I watched powerlessly as a 61 year old widow slowly succumbed to metastatic oesophageal carcinoma.

I shuddered when she first described to me her symptoms of progressive dysphagia, and envisaging the nightmare that would follow I tried to be positive, while waiting for the inevitable diagnosis. Over the next eight months I watched in horror as she was treated not as an intelligent woman who was dying of a cruel incurable cancer but as a disease.

From the moment of diagnosis to her death her prognosis was not mentioned to her. I listened incredulously as she agreed to her radiotherapy and chemotherapy - hastily explained and certainly not with real “informed consent.” Meanwhile her stunned family was told that there was no hope. She was given warfarin for multiple pulmonary emboli and began the relentless round …
Dead Reckoning: The New Science of Catching Killers
Authors: Sally-Ann S Price
Journal: BMJ (2002)

As with sex and psychology, we all know something about death. Michael Baden and Marion Roach are expert forensic pathologists. In this enthralling book, they share their expertise and fascination with the cause and mode of death. Used to being an expert witness, Baden has mastered the art of expressing his science passionately and in easy to understand terms, without patronising the reader.

The authors revel in the gruesome and grotesque subspecialties of …
Activation of Pregnane X Receptor Sensitizes Mice to Hemorrhagic Shock–Induced Liver Injury
Authors: Yang Xie, Meishu Xu, Meihong Deng, Zhigang Li, Pengcheng Wang, Songrong Ren, Yan Guo, Xiaochao Ma, Jie Fan, Timothy R. Billiar, Wen Xie
Journal: Hepatology (2019)

Hemorrhagic shock (HS) is a life‐threatening condition associated with tissue hypoperfusion and often leads to injury of multiple organs including the liver. Pregnane X receptor (PXR) is a species‐specific xenobiotic receptor that regulates the expression of drug‐metabolizing enzymes (DMEs) such as the cytochrome P450 (CYP) 3A. Many clinical drugs, including those often prescribed to trauma patients, are known to activate PXR and induce CYP3A. The goal of this study is to determine whether PXR plays a role in the regulation of DMEs in the setting of HS and whether activation of PXR is beneficial or detrimental to HS‐induced hepatic injury. PXR transgenic, knockout, and humanized mice were subject to HS, and the liver injury was assessed histologically and biochemically. The expression and/or activity of PXR and CYP3A were manipulated genetically or pharmacologically in order to determine their effects on HS‐induced liver injury. Our results showed that genetic or pharmacological activation of PXR sensitized wild‐type and hPXR/CYP3A4 humanized mice to HS‐induced hepatic injury, whereas knockout of PXR protected mice from HS‐induced liver injury. Mechanistically, the sensitizing effect of PXR activation was accounted for by PXR‐responsive induction of CYP3A and increased oxidative stress in the liver. The sensitizing effect of PXR was attenuated by ablation or pharmacological inhibition of CYP3A, treatment with the antioxidant N ‐acetylcysteine amide, or treatment with a PXR antagonist. Conclusion: We have uncovered a function of PXR in HS‐induced hepatic injury. Our results suggest that the unavoidable use of PXR‐activating drugs in trauma patients has the potential to exacerbate HS‐induced hepatic injury, which can be mitigated by the coadministration of antioxidative agents, CYP3A inhibitors, or PXR antagonists.
Misconceptions and stereotypes
Authors: Manuela Moraru
Journal: BMJ (2006)

Do you sometimes imagine yourself as an old person? I guess you do, because ageing is part of our natural evolution. Have you also considered that at a certain age you might become dependent on other people for your basic needs? This is a useful exercise that you can apply to your medical training. No matter the specialty you choose, most of your future patients will be more than 60 years old, and you will be unable to avoid dealing with old patients who are disabled.

Try to see life …
Up and running
Authors: Asela Dharmadasa
Journal: BMJ (2004)

Going into schools to educate schoolchildren may be a small step in changing their habits and attitudes towards health. Asela Dharmadasa and Laura Wilkins explain what you can do GETTY IMAGES From sex education to basic life support, medical students are becoming increasingly involved in educating schoolchildren about health. These are two of the more well established initiatives around the country, but as medical schools expand, there may be scope for other student led initiatives, perhaps relating to drugs and alcohol, bullying, and nutrition. We explore the steps required to convert a good idea into a viable project and look at different approaches to teaching children of all ages. Although in recent years the national curriculum has been honed down, to relieve some of the pressure on teachers, health education still forms a compulsory part; most is taught within dedicated personal, social, and health education sessions and the rest within the remit of other subject areas. A well thought out project, with a realistic view of the needs of a school, has the potential to benefit everyone involved, including the pupils, teachers, and medical student volunteers. So you have an idea for a project that you want to set up in a local school. This could be related to existing projects around the country or something altogether new. What are the steps needed to convert this idea into reality (box 1)? ### Box 1: Setting up a project in a schoolRETURN TO TEXT