tbuckley/cabot-search huggingface dataset:
Mum's the Word
Authors: Helen Lodge
Journal: BMJ (2002)

Although childbirth and all that it entails is fundamental to human existence, it is still regarded as taboo and not something to be discussed in polite company. In 1993, six women who had once been glamorous actresses but were now frazzled mothers, with ten children between them, came together to write a show about their experiences.



Mid-supermarket tantrums even got to Bev Callards character Deborah



Mums the Word breaks all the taboos and has been a smash hit worldwide. Originally premiered in Vancouver, Canada, the play had its European premiere in Dundee earlier this year—it sold out weeks in advance and broke all the theatres box office records—and is touring the United Kingdom this autumn. Several other teams of mums have been bringing the show to audiences across the globe.

Mums the Word is made up of a series of short monologues with the cast sat around the stage, and is based on the authors Saturday morning sessions when they should have been preparing the script but instead spent …
Why bother with medical ethics?
Authors: Liam P Scott
Journal: BMJ (2008)

The so called soft subjects at medical school can get a lot of hassle. Psychology, communication skills, epidemiology, and behavioural science are often seen by older members of the medical profession as distractions from the real sciences of pathology, anatomy, pharmacology, or physiology. Although we can appreciate the value of communication skills when we're speaking to patients, or the value of epidemiology skills when we're trying to decipher a complex medical paper, the one subject that still seems remote and needless to many students is medical ethics. It seems …
Muscle Alterations Are Associated With Minimal and Overt Hepatic Encephalopathy in Patients With Liver Cirrhosis
Authors: Silvia Nardelli, Barbara Lattanzi, Manuela Merli, Alessio Farcomeni, Stefania Gioia, Lorenzo Ridola, Oliviero Riggio
Journal: Hepatology (2019)

Muscle alterations (myosteatosis and sarcopenia) are frequent in cirrhosis and related to some complications including overt hepatic encephalopathy (HE). The aim of our study was to investigate the relationship between muscle alterations and minimal HE (MHE) and their role in the risk of overt HE. Sixty-four patients with cirrhosis were administered the Psychometric Hepatic Encephalopathy Score and animal naming test to detect MHE. Computed tomography was used to analyze the skeletal muscle index and attenuation. The incidence of the first episode of HE, taking into account the competing risk nature of the data, was estimated. Myosteatosis was observed in 24 patients (37.5%), sarcopenia in 37 (58%), and MHE in 32 (50%). Both myosteatosis (62.5% versus 12.5%, P < 0.001) and sarcopenia (84% versus 31%, P < 0.001) were more frequent in patients with MHE. The variables independently associated with the presence of MHE were sarcopenia, previous overt HE, and myosteatosis. Thirty-one (48%) patients developed overt HE over 16.1 ± 13 months; myosteatosis was detected in 68% and sarcopenia in 84% of them. Sarcopenia and myosteatosis were also independently associated with the development of overt HE. Venous ammonia was significantly higher in patients with sarcopenia (62.6 ± 17.7 versus 41.4 ± 16.1 μg/dL, P < 0.001) and in patients with myosteatosis (65.2 ± 19.2 versus 46.7 ± 17.1 μg/dL, P < 0.001) and inversely correlated to both parameters. Survival was significantly lower in malnourished patients compared to patients without myosteatosis or sarcopenia (P < 0.001). Conclusion: Myosteatosis and sarcopenia, probably by reducing the handling of ammonia in the muscle, are independently associated with MHE and the risk of overt HE in patients with cirrhosis; in malnourished patients, the amelioration of nutritional status may be a goal to decrease both the prevalence of MHE and the incidence of overt HE.
A swollen eye
Authors: Caroline Blaine, Nneka Eze
Journal: BMJ (2008)

A 58 year old man presented with a two week history of swelling of his left eye after symptoms of an upper respiratory tract infection. His vision had not changed but on examination his left eye was erythematous and slightly proptosed. There was no chemosis. The range of eye movements was normal despite limited eye opening (fig 1). Clinical photograph of patient's left eye
Interstitial lung disease and weight loss
Authors: Sadat Edroos, Laura Samuel, P D J Handslip
Journal: BMJ (2005)

A 52 year old man presented to the outpatients' department with dyspnoea, dry cough, and weight loss. The breathlessness had progressed over two years. Also 41 kg of weight loss in 12 months was concerning.

In seeking a cause for this, he underwent bronchoscopy two weeks before his outpatients' appointment, and since then his breathlessness had rapidly worsened. At the consultation he was unable to complete a sentence and was in a wheelchair.

1.  What is the main abnormality shown in the figure? Suggest some causes.

2.  What would you expect to find on examination? What is the immediate management?

3.  What are the differentials for the chronic aspect of this presentation?

4.  What risk factors should be identified in the patient's social history?

5.  What would you do next? (6) What was the outcome?



Chest radiograph on admission



1.  There is an absence of lung markings in the left upper zone of the chest radiograph. The …
Oxford offers places for cash
Authors: Helen Barratt
Journal: BMJ (2002)

Oxford University is once again at the centre of controversy after a report in the Sunday Times which claimed that one of its colleges was prepared to offer a place to a student in return for a cash donation.1 An undercover reporter, posing as a wealthy banker, was allegedly told by senior staff at Pembroke College that they could create an extra place for his son in return for a donation …
Upfront chemotherapy and accelerated radiotherapy with EGFR inhibition for locally advanced inoperable head and neck cancer
Authors: C. Mercke, G. Wickart-Johansson, H. Sjödin, G. Adell, J. Nyman, H. Haugen
Journal: Journal of Clinical Oncology (2009)

6040 Background: Concomitant chemoradiotherapy (CT/RT) is the standard treatment for locally advanced head and neck squamous cell carcinoma. However, late toxicity is substantial.This phase II trial explores the feasibility and efficacy of combining neoadjuvant TPF and accelerated RT where the concomitant cytostatic component is replaced with cetuximab (E), a chimeric IgG1 mAb against EGFR. Methods: Patients (pts) had previously untreated stage III/IV M0,WHO 0–1, unresectable squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx and were scheduled for 2 cycles of TPF (docetaxel 75 mg/m2 and cisplatin 75 mg/m2 day 1 and 5-FU 1,000 mg/m2 96 hours CI) every 3 weeks followed by RT (68 Gy/4.5 weeks) with E given one week before (400 mg/m2) and weekly during RT (250 mg/m2). A brachytherapy boost of 8 Gy was given to pts with oral cavity or oropharyngeal tumours. Neck dissection was planned for pts with N2–3 and complete response (CR) at the primary tumour. Tumour response was evaluated according to RECIST with CT, MRI or PET/CT after CT and at 6 weeks follow up. Toxicity (CTC 3.0) and quality of life (EORTC QLQ 30) was registered during and after treatment. Results: From 070401 to 081115 68 pts were enrolled, 56 had stage IV disease (T4, n = 14, N3, n = 9). Median age 57, 60 males, 3 oral cavity, 44 oropharynx, 10 larynx, and 11 hypopharynx. 30 pts were followed beyond 6 weeks and evaluated for response and early toxicity: stage IV disease 24 (T4, n = 6, N3, n = 3), median age 60, 25 males, 18 oropharynx, 5 larynx, and 7 hypopharynx. Remissions after TPF/after RT: CR 1/10, PR 15/18, SD 14/1, and PD 1. TPF as prescribed: 28/30 (pat refusal 1, renal insuff 1, dose reduction 0/28); E as prescribed: 22/30 (dermatitis 4, hypersensitivity 3, liver tox 1). Vital tumour in resected specimen 0/13. Alive at follow-up 29/30 (1 local failure). Conclusions: TPF followed by RT concomitant with E is feasible with manageable toxicities. Dermatitis in the irradiated neck, at least with the present accelerated fractionation, is troublesome to some patients but does not interrupt treatment and heals rapidly. To dispose of feeding tubes after disappearance of acute mucosal reactions has not been a problem. Early survival results are promising. Toxicity and survival results will be updated. [Table: see text]
Abstract 397: Chronic Infusion of Growth Hormone Releasing Hormone Prevents Heart Failure with Preserved Ejection Fraction Phenotype Development in Murine Cardiomyocytes by Reducing Myofilament Sensitivity to Calcium
Authors: Raul A Dulce, Rosemeire M Kanashiro-Takeuchi, Lauro M Takeuchi, Alessandro G Salerno, Wayne Balkan, Renzhi Cai, Andrew V Schally, Joshua M Hare
Journal: Circulation Research (2017)

Introduction: Heart failure with preserved ejection fraction (HFpEF) represents ~50% of heart failure cases and is characterized by impaired relaxation, ventricular stiffening and fibrosis. Growth hormone releasing hormone agonists (GHRH-A) reduce fibrosis in rat and swine models of ischemic myocardial injury. However, their effect on failing cardiomyocytes (CMs) is unknown. We hypothesized that activation of GHRH receptor signaling targets proteins associated with excitation-contraction coupling, reduces affinity of myofilaments for Ca 2+ and prevents the development of HFpEF. Methods: CD1 mice, implanted with mini-osmotic pump (Alzet) to deliver angiotensin-II (Ang-II) for 4 weeks, received daily injections of GHRH-A (MR-356; n=8) or vehicle (n=8). CMs were isolated and Ca 2+ and sarcomere length recorded. Expression and phosphorylation of Ca 2+ handling and sarcomeric proteins were assessed. Unmanipulated CD1 mice (n=7) acted as normal controls. Results: Ang-II-treated CMs exhibited reduced sarcomere length consistent with shorter cell length, indicating an inability to completely relax. These CMs also exhibited impaired contractility that correlated with reduced myosin binding protein C (cMyBPC) expression with no changes in phosphorylation. Response of [Ca 2+ ] transient amplitude to increasing pacing rate was depressed and Ca 2+ decay was delayed and associated with lower expression of SERCA2 and NCX1, increased SR Ca 2+ leak but no change in phospholamban phosphorylation (p-PLB) at Ser16. Slower sarcomere re-lengthening and reduced phospho-cTnI (p-cTnI) at Ser 23/24 were observed in HFpEF CMs. MR-356 treatment maintained resting sarcomere length as well as sarcomere shortening at control values, and completely abrogated Ang-II-induced delay in Ca 2+ decay and sarcomere relaxation. SR Ca 2+ leak was reduced. p-PLB was further enhanced by MR-356, and cMyBPC and p-cTnI were maintained at control levels. Conclusion: Our findings demonstrate that chronic administration of Ang-II mediates functional changes in CMs consistent with HFpEF and suggest that activation of the GHRH receptor signaling pathways desensitizes myofilaments and prevents HFpEF-associated alterations in Ca 2+ handling and dysfunctional CM relaxation.
Patients don't mind inexperienced students
Authors: Karen Hebert
Journal: BMJ (2005)

Medical students' inexperience in performing minor procedures does not put patients off giving their consent to undergoing the procedure, a study has found (Medical Education 2005;39:365-9). Sally Santen and colleagues from Vanderbilt University Medical Center in Nashville found that 90% of patients gave their consent to a medical student performing a minor procedure on them, even when informed that it was the student's first time.

The researchers recruited 114 patients needing minor procedures, such as intravenous access, splinting, suturing, and six first year clinical medical students to carry them out. They first surveyed the patients about their …
Insoles help prevent sports injuries
Authors: Samena Chaudhry
Journal: BMJ (2003)

Knobbly rubber insoles worn inside sports shoes should reduce knee and ankle injuries, according to research published in the British Journal of Sports Medicine (2003;37:170). The insoles radically improve athletes' awareness of the orientation of their feet.

The research involved working with the Australian women's soccer squad to examine the players' sensitivity to …
A case of recurrent miscarriage
Authors: Marie-Claire Wilson, Nishanthan Rajakumaraswamy, Wai Yoong
Journal: BMJ (2005)

A 30 year old woman booked for antenatal care of a much wanted pregnancy at nine weeks' gestation. She had previously undergone three surgical terminations of pregnancy at 15, 12, and 10 weeks. She was otherwise fit and healthy and the pregnancy was progressing normally. A routine ultrasound scan was done at 19 weeks (figure).

1.  What does the ultrasound scan show and what are the implications for the pregnancy?

2.  What are the causes of this condition?

3.  How should this woman be managed? What are the risks?

1.  The scan shows “beaking” or “funnelling” of the internal cervical os, which could be a sign of cervical incompetence. Cervical incompetence can lead to a midtrimester miscarriage.

2.  Cervical surgery, such as cone biopsy (where a small piece of the cervix is removed for testing), forceful dilatation of the cervix (especially in late surgical terminations), trauma during labour, congenital malformations (for example, hypoplastic cervix), and connective tissue disorders (for example, Marfan's syndrome) can all cause cervical …
Improving Cancer Diagnosis and Care: Patient Access to Oncologic Imaging Expertise
Authors: Sharyl J. Nass, Christopher R. Cogle, James A. Brink, Curtis P. Langlotz, Erin P. Balogh, Ada Muellner, Dana Siegal, Richard L. Schilsky, Hedvig Hricak
Journal: Journal of Clinical Oncology (2019)
Reply
Authors: David Hagerty, Guadalupe Garcia‐Tsao, Jaime Bosch
Journal: Hepatology (2019)

Potential conflict of interest: Dr. Hagerty is employed by Conatus. Dr. Garcia‐Tsao consults for Conatus. Dr. Bosch consults and received grants from Conatus. We are grateful for the opportunity to respond to Drs. Khurana and Khara’s comments. This exploratory study examined whether emricasan might ameliorate portal hypertension in patients with cirrhosis and whether “responder” subgroups could be identified.1 Emricasan had been shown to ameliorate portal hypertension in a murine cirrhosis model.2 Overall, there was not a significant trend for the hepatic venous pressure gradient (HVPG) to decrease (−1.1 mmHg), but HVPG significantly decreased (−3.7 mmHg) in patients with baseline HVPG ≥ 12 mmHg. When defining a significant change in HVPG as a change ≥ 1 mmHg,3 clinically meaningful changes occurred in 10 of 12 patients in the HVPG ≥ 12 mmHg group and in only 1 of 10 patients in the HVPG < 12 mmHg group (data not shown in paper). Therefore, the strength of the study was in identifying a subgroup of patients with cirrhosis in whom emricasan had the potential of causing a beneficial effect. The mechanism of action of emricasan is undetermined, although the significant reduction in aspartate aminotransferase/alanine aminotransferase suggests an intrahepatic effect. This is supported by experimental studies showing decreased hepatic vascular resistance with emricasan due to amelioration of liver endothelial sinusoidal cell phenotype and deactivation of hepatic stellate cells, mediated by the release of small extracellular vesicles from the hepatocytes during emricasan treatment.4 Whether the effect is intrahepatic (resistance) or extrahepatic (flow) cannot be elucidated by changes in free or wedged hepatic venous pressure. Pressure is always expressed as a gradient, the wedged hepatic vein pressure measures sinusoidal pressure, and the free pressure measures systemic venous pressure, which corrects for increases in intra‐abdominal pressure (e.g., ascites) and/or the position of the transducer, but is not indicative of changes in flow or resistance. Notably, pressures were recorded in triplicate and read blindly by a world expert, to reduce any potential bias. We agree that our results are preliminary. We reiterate the closing sentence of the manuscript: “Future randomized, placebo‐controlled studies will elucidate the potential for additional long‐term effects of the drug, clarify its mechanism of action and disclose whether continued emricasan administration may represent an effective treatment for cirrhotic portal hypertension.”
Reduced Hepatocellular Carcinoma Risk vs Bleeding Risk Associated With Aspirin
Authors: Nicholas Chien, Yee Hui Yeo, Mindie H. Nguyen
Journal: JAMA Oncology (2019)

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US doctors are granted the right to form unions
Authors: Scott Gottlieb
Journal: BMJ (2000)

For the first time, doctors in training in the United States have been granted the legal right to form workers' unions to negotiate salary and working conditions.

The US National Labor Relations Board opened the door to the unionisation of medical residents at American teaching hospitals by giving house staff the right to bargain collectively. By ruling that residents at private hospitals have the right to unionise under federal labor protections, the National Labor Relations Board strengthened the hand of doctors in training, potentially shifting the economic underpinnings of the nation's teaching hospitals.

The ruling by the US National Labor Relations Board changes a precedent of 23 years that has held that medical residents, interns, …
What rheumatologist should know about Fabry disease
Authors: Sergey Moiseev, Ekaterina Karovaikina, Pavel I Novikov, Dilyara Ismailova, Alexey Moiseev, Nikolai Bulanov
Journal: Annals of the Rheumatic Diseases (2019)

Fabry disease (FD) is a rare X-linked lysosomal storage disease resulting from the deficient activity of the α-galactosidase A enzyme and leading to a progressive accumulation of glycosphingolipids in a wide range of cells throughout the body. Early symptoms of FD, that is, neuropathic pain (pain in hands and/or feet characterised by exacerbations that are provoked by fever, exercise or heat), angiokeratoma (clustered angiomas in characteristic areas including bathing trunk area, lips and umbilicus) (figure 1), hypohidrosis/anhidrosis and gastrointestinal disorders, are usually present from childhood or adolescence, while progressive nephropathy, left ventricular hypertrophy (figure 2) and stroke/transient ischaemic attacks develop by the second to fourth decades of life (earlier in males than in females).1 Undiagnosed patients with FD can be detected by screening in at-risk populations, such as patients with end-stage renal disease, unexplained myocardial hypertrophy or early stroke (at the age of 18 to 55 years).2 



Figure 1 
Multiple angiokeratomas in male patient with Fabry disease.





Figure 2 
Significant left ventricular hypertrophy on ECG in the same patient.



Acroparesthesias in FD can be confused with joint pain. …
Lhasa to Kathmandu—a cycle ride
Authors: Richard Lyon
Journal: BMJ (2002)

In September 2000 my dad and I set off to cycle across the main spine of the Himalayas—a 1000 km trip from Lhasa, the capital of Chinese occupied Tibet, via Everest Base Camp, to Kathmandu in Nepal. Landing in Lhasa, at 3650 m above sea level, was the first shock. I was breathless after climbing a single flight of stairs. We spent three days there acclimatising. With the Chinese occupation great care was needed. Mentioning the Dalai Lama, the exiled Buddhist leader, could land you in prison. Every publicly accessible room in The Potala—the palace of the Dalai Lama— has walls that both see and hear. The Tibetans leave money on the shrines in every room they enter in the belief that they will be rewarded in the afterlife, seemingly indifferent that the money actually goes to the Chinese government.



After three days of the bustling city it was a …
Future of London Ambulance Service under debate
Authors: Jason Neale-Roach
Journal: BMJ (2000)

Three Court of Appeal judges ruled this month that ambulance services can be liable to pay compensation for injuries resulting from failure to respond to 999 calls within a reasonable time. This test case ruling could leave ambulance services open to a huge increase in costly litigation. Tracey Kent, a 35 year old asthma sufferer, was awarded more than £360 000 when she claimed that she had suffered …
www.therightbrain.co.uk
Authors: Bella Dave
Journal: BMJ (2003)

Being able to ‘see the whole picture’ is a crucial part of being a good doctor, which is why finding a balance between medicine and other activities is important. The left hemisphere of the brain is thought to be responsible for language and logic; the right side is concerned with the more creative aspects of human nature—exactly what this website is all about—the more imaginative side of healthcare professionals.

The site was created by two final year …
The advice zone
Authors: Idris Baker, Sam Flynn, Nick Banatvala
Journal: BMJ (2003)

You can use BMJ Careers' advice zone (www.bmjcareers.com/advicezone) to submit a career question or browse existing questions and answers on many different topics. A panel of more than 200 experienced advisers are ready to respond to your queries. Here is a selection of what has been published on the advice zone site so far



There are two ways to look at this. One is to say that if you consider the death of a patient to be a failure then palliative medicine will be depressing and you should choose another career. The other more positive perspective is shared by most palliative medicine doctors: sadly, patients are inevitably going to die, and good palliative care can turn bad deaths into good deaths. You would prefer it if people were not ill at all but, given that they are going to die, you can do them the biggest favour by making it as comfortable as possible. And you can achieve at least some success in this direction with most patients.

Discrimination is against the law, and there are steps …
Flank pain radiating to the suprapubic region
Authors: Iona Meryon, Paul Cockwell, K Subu Subramonian
Journal: BMJ (2008)

A 33 year old woman presented at the urology department with a two year history of intermittent flank pain radiating to the suprapubic region. She had no medical or family history of note. Examination showed that she had microscopic haematuria and proteinuria. Radiological investigations were carried out (figs 1 and 2). Fig 1 Plain abdominal x ray, including kidneys, ureters, and bladder Fig 2