tbuckley/cabot-search huggingface dataset:
Abstract 17208: Trends in Hospitalizations Due to Cocaine-Induced Acute Myocardial Infarction: Results From National Inpatient Sample, 2005-2014
Authors: Anshul Saxena, Muni Rubens, Sankalp Das, Venkataraghavan Ramamoorthy, Peter McGranaghan, Emir Veledar
Journal: Circulation (2018)

Introduction: According to the National Institute on Drug Abuse, lifetime cocaine use has remained stable since 2009. An estimated 1.5 million individuals aged ≥12 years reported cocaine use in 2014. Cocaine use is a significant risk factor for acute myocardial infarction (AMI), especially in the age group 18-45 years. Hence, we examined trends in hospitalizations due to cocaine-induced AMI in the United States. Methods: The current study was a retrospective analysis of the National Inpatient Sample, collected during the period 2005-2014. Participants between 18 and 45 years were included in the analysis. Cocaine-induced AMI hospitalizations were identified using ICD-9-CM codes 304.2X and 305.6X for cocaine dependence or abuse, and 410.XX for AMI diagnosis. We used Cochran Armitage test for categorical variables and Cuzick nonparametric test for trends for continuous variables. Results: A total of 49,715 weighted cocaine-induced AMI hospitalizations were reported during the study period. Cocaine-induced AMI hospitalizations increased from 4,619 in 2005 to 5,065 in 2014 (relative increase, 9.7%, P trend =0.124). Majority of the patients were non-White (55.3%), men (79.3%), in the age group 41-45 years (83.1%), and with Medicare/Medicaid coverage (51.2%). Highest change in trend was observed for non-White population and Medicare/Medicaid payers. Conclusion: Our study showed that cocaine-induced AMI hospitalizations remained stable during the years 2005-2014. Initial results point towards structural and racial disparities in such hospitalizations, especially among non-White men and population with Medicare/Medicaid coverage. Effective interventions to reduce cocaine use are needed, and treatment must be based on 2008 AHA guidelines for cocaine-associated chest pain and myocardial infarction.
Personalised reimbursement: a risk-sharing model for biomarker-driven treatment of rare subgroups of cancer patients
Authors: S.B. van Waalwijk van Doorn-Khosrovani, A. Pisters-van Roy, L. van Saase, M. van der Graaff, J. Gijzen, S. Sleijfer, L.R. Hoes, J.M. van Berge Henegouwen, H. van der Wijngaart, D.L. van der Velden, E. van Werkhoven, V.P. Retel, W.H. van Harten, A.D.R. Huitema, L. Timmers, H. Gelderblom, H.M.W. Verheul, E.E. Voest
Journal: Annals of Oncology (2019)
Information for students with disabilities
Authors: Nigel Gray, Rhona MacDonald
Journal: BMJ (2004)

Eleven UK medical schools still do not provide adequate disability related information on their websites despite being made aware of this a year ago, according to a new report the Sequel to Pushing the Boat Out .1 The study, which also included dental and veterinary schools, is the follow up study to Pushing the Boat Out ,2 which was published a year ago. Both studies are part of the DIVERSE project (funded by the Higher Education Funding Council for England), which aims to improve the provision for disabled students in veterinary medicine, medicine, and dentistry.

The focus of Pushing the Boat Out was how UK medical, dental, and veterinary schools differ in the information offered on their websites to potential applicants with disabilities. At that time, only 13 schools had information that could be considered anywhere near adequate for an applicant seeking disability related information. (Having information on a website can be considered a proxy for taking disability seriously.) This led the author, Anne Tynan, to undertake the follow up study, the Sequel .

Pushing the Boat Out was widely distributed. A copy was sent to every dean of all the UK medical, dental, and veterinary schools; professional bodies for medicine, dentistry, and veterinary medicine; disability organisations; and a wide range of other related organisations and individuals in the United Kingdom and abroad. It is therefore disappointing that although some improvements had been made, …
Response to ‘What rheumatologist should know about Fabry disease’ by Moiseev<i>et al</i>
Authors: Stefan Vordenbäumen, Ralph Brinks, Jutta G Richter, Katinka Albrecht, Matthias Schneider
Journal: Annals of the Rheumatic Diseases (2019)

Response to 'What rheumatologist should know about Fabry disease' by Moiseev et al In their correspondence 1 to our study on the prevalence of Fabry disease (FD) within a national cohort of early undifferentiated arthritis patients in Germany, 2 Moiseev et al raise additional issues of importance for clinical rheumatologists pertaining to the change of symptoms in FD over time.Retrospective studies analysing the medical history of patients with confirmed FD raised concerns that FD may be overlooked in rheumatological practice.In particular, Lidove et al reported that 9 of 40 patients were mistakenly diagnosed with a rheumatic condition in adulthood prior to the diagnosis of FD. 3 This is well in line with the data reported by Moiseev et al in their correspondence.They observed erroneous rheumatological diagnoses in 28 of 107 confirmed FD cases across all age groups.4][5] For instance, Lidove et al report a mean age at diagnosis of 37.2 years with a range up to 71 years in their study focusing on musculoskeletal complaints of FD patients. 3Moreover, a cross-sectional study from the Fabry Outcome Survey comparing older (>50 years) to younger patients with confirmed FD showed that the mean age at first diagnosis was >50 years in the older FD patients, representing 34% of the 1934 patients included. 6Additionally, patients diagnosed at an older age or with a presumably late clinical onset may differ phenotypically from patients diagnosed at a younger age. 6Although acroparesthesias or Fabry crises tend to be a more prominent feature at a younger age and to diminish over time, 5 7 joint complaints remain a significant burden for patients with 40%-50% of patients>50 years of age reporting joint pain or swelling in a survey by Ivleva et al. 7 In summary, FD patients often display musculoskeletal complaints and the correct diagnosis is typically delayed by years.In our opinion, these data provided a strong rationale for our study in which we intended to explore the prevalence of FD patients in a national cohort of early undifferentiated arthritis in adult patients (n=798, aged 56.5±14.3years, range 18-87).We did not find a mutation considered pathogenic under the inclusion criterion of at least one swollen joint.Hence, our study reassures us that we do not systematically miss the diagnoses of FD in our adult early arthritis patients employing current standard of practice procedures.However, rheumatologists and even paediatricians may not generally be familiar with signs and symptoms of FD. 8 We are therefore delighted that our study raised the interest of Moiseev et al who comprehensively summarised clinical features of FD and shared data on the musculoskeletal complaints of their FD cohort in their comment.
Computer game to raise awareness of prostate cancer
Authors: Helen Barratt
Journal: BMJ (2002)

A cartoon sperm called Sammy is the star of a new computer game aimed at raising public awareness about prostate cancer. The game, “Planet Prostate,” is the first part of the Prostate Cancer Charity's “Secret Sex Gland” campaign.

Although cancer of the prostate is the most common malignancy affecting men in Britain, a MORI poll commissioned by the charity showed that seven out of eight people had no idea where the gland is located or what its role is. The charity hopes to …
HIV and AIDS: clinical perspectives
Authors: Teresa Pun
Journal: BMJ (2005)

Enter “AIDS” into Google and you find an impressive49 500 000 links. A nice beginners' site is www.aids.org. The site has a user friendly interface and a comprehensive knowledge base, including 123 fact sheets about HIV and AIDS, often asked questions, and updates on AIDS related global happenings. It is a great resource for hard facts on a particular aspect of AIDS. There is a noteworthy list of drugs, with each fact sheet outlining the type of drug, …
A guide to medical etiquette: effective daytime sleeping
Authors: David McAllister
Journal: BMJ (2000)

Most medical students lead busy lives. Sometimes working in the ward all day and studying during the night can mean you don't get all the sleep you need. If, like me, you also delay handing in assessments in order to allow time for all possible research to be published, you can be up all night writing.

Sleep, however, is very important. So, if you can't get it at night, you have to …
Head On: Art with the Brain in Mind
Authors: Kay Seong Ngoo
Journal: BMJ (2002)

The human brain is regarded by many as one the most intriguing human organs. In London, at least two groups have tried to unravel this mysterious anatomical structure. Artists and medical scientists have collaborated in Head On: Art with the Brain in Mind, offering the artists interpretation of the brains structure and functions, aided by the works and historical collections of scientists.



Superior aspect of a human brain manipulated to represent the brain falling to pieces. HEAD ONScience Museum, 14 March to 28 July 2002An exhibition organised by the Wellcome Trust Photo credit: Courtesy Heidi Cartwright/Wellcome Photo Library



Head On is based on three broad themes: the anatomy of the brain, models of the brain, …
Walnut antigens can trigger autoantibody development in patients with pemphigus vulgaris through a “hit-and-run” mechanism
Authors: Lan Lin, Timothy P. Moran, Bin Peng, Jinsheng Yang, Donna A. Culton, Huilian Che, Songsong Jiang, Zhi Liu, Songmei Geng, Yuzhu Zhang, Luis A. Diaz, Ye Qian
Journal: Journal of Allergy and Clinical Immunology (2019)
CB1 agonism prolongs therapeutic window for hormone replacement in ovariectomized mice
Authors: Kun Zhang, Qi Yang, Le Yang, Yan-jiao Li, Xin-shang Wang, Yu-jiao Li, Rui-li Dang, Shao-yu Guan, Yan-yan Guo, Ting Sun, Yu-mei Wu, An Liu, Yan Zhang, Shui-bing Liu, Ming-gao Zhao
Journal: Journal of Clinical Investigation (2019)

Hormone therapy (HT) is reported to be deficient in improving learning and memory in older postmenopausal women according to recent clinical studies; however, the reason for failure is unknown. A "window of opportunity" for estrogen treatment is proposed to explain this deficiency. Here, we found that facilitation of memory extinction and long-term depression by 17β-estradiol (E2) was normal in mice 1 week after ovariectomy (OVXST), but it was impaired in mice 3 months after ovariectomy (OVXLT). High-throughput sequencing revealed a decrease of miR-221-5p, which promoted cannabinoid receptor 1 (CB1) ubiquitination by upregulation of Neurl1a/b in E2-treated OVXLT mice. Blood samples from postmenopausal women aged 56–65 indicated decreases of miR-221-5p and 2-arachidonoylglycerol compared with samples from perimenopausal women aged 46–55. Replenishing of miR-221-5p or treatment with a CB1 agonist rescued the impairment of fear extinction in E2-treated OVXLT mice. The present study demonstrates that an HT time window in mice can be prolonged by cotreatment with a CB1 agonist, implying a potential strategy for HT in long-term menopausal women.
Renal Perfusion during Hemodialysis: Intradialytic Blood Flow Decline and Effects of Dialysate Cooling
Authors: Raanan Marants, Elena Qirjazi, Claire J. Grant, Ting-Yim Lee, Christopher W. McIntyre
Journal: Journal of the American Society of Nephrology (2019)

Significance Statement Residual renal function (RRF) characteristically declines after patients with ESRD initiate dialysis. Although RRF preservation correlates with improved outcomes, poor understanding of the pathophysiology underlying RRF decline limits protection strategies. Previous research found that dialysate cooling reduces hemodialysis-induced circulatory stress and protects the brain and heart from ischemic injury. To examine renal perfusion decline during hemodialysis and the effects of cooling, the authors used computed tomography perfusion imaging to scan patients undergoing continuous dialysis with or without dialysate cooling. They found an acute decrease in renal perfusion during hemodialysis, a first step toward characterizing hemodialysis-mediated RRF loss. Dialysate cooling ameliorated this decline but this effect did not reach statistical significance. Further study is needed to explore the potential of dialysis-based interventions to slow RRF decline. Background Residual renal function (RRF) confers survival in patients with ESRD but declines after initiating hemodialysis. Previous research shows that dialysate cooling reduces hemodialysis-induced circulatory stress and protects the brain and heart from ischemic injury. Whether hemodialysis-induced circulatory stress affects renal perfusion, and if it can be ameliorated with dialysate cooling to potentially reduce RRF loss, is unknown. Methods We used renal computed tomography perfusion imaging to scan 29 patients undergoing continuous dialysis under standard (36.5°C dialysate temperature) conditions; we also scanned another 15 patients under both standard and cooled (35.0°C) conditions. Imaging was performed immediately before, 3 hours into, and 15 minutes after hemodialysis sessions. We used perfusion maps to quantify renal perfusion. To provide a reference to another organ vulnerable to hemodialysis-induced ischemic injury, we also used echocardiography to assess intradialytic myocardial stunning. Results During standard hemodialysis, renal perfusion decreased 18.4% ( P &lt;0.005) and correlated with myocardial injury ( r =−0.33; P &lt;0.05). During sessions with dialysis cooling, patients experienced a 10.6% decrease in perfusion (not significantly different from the decline with standard hemodialysis), and ten of the 15 patients showed improved or no effect on myocardial stunning. Conclusions This study shows an acute decrease in renal perfusion during hemodialysis, a first step toward pathophysiologic characterization of hemodialysis-mediated RRF decline. Dialysate cooling ameliorated this decline but this effect did not reach statistical significance. Further study is needed to explore the potential of dialysate cooling as a therapeutic approach to slow RRF decline.
Healthcare professionals should not smoke
Authors: Teresa Pun
Journal: BMJ (2004)

Last summer, I was happily stationed at a Toronto hospital, doing research for a neurosurgeon. I loved the work and I loved the hospital—the doctors were fabulous. Then, one of these prestigious individuals lit a cigarette. Wait a minute; was I the only one who found this odd? No one else seemed to care, certainly not the patients who were huffing and puffing alongside, or the colleague that came to join his friend a minute later.

To add a little spice, everyone entering a hospital is encouraged to wash their hands with antiseptic alcohol rinse. Healthcare professionals tend to re-wash when they exit as well. One such individual, a doctor, squeezed a healthy amount of alcohol gel into his palm, scrubbed briskly and decided that he wanted a smoke on his five minute break. He set his hands on fire.

In response to this sad display, I propose that healthcare professionals, especially doctors, be prohibited from smoking, or if they must smoke, they do so away from the hospital vicinity. How can …
Minerva: October 2000
Authors: J P M Charon, J T Murchison, M Young
Journal: BMJ (2000)

Researchers looking for a way to make night shifts more bearable for residents in emergency medicine, did a randomized crossover trial of melatonin as an aid to daytime sleeping ( Academic Emergency Medicine 2000;7:955.8). It didn't work. Melatonin had no more effect than placebo on sleep duration, sleep efficiency, mood disturbance, and night time sleepiness. This is the fourth trial of melatonin for people working shifts in emergency departments. All had negative or equivocal results.

Medical students and junior doctors rate their mentors differently, according to a study in Academic Medicine (2000;75:843.5). Students from Baylor College of Medicine in Texas ranked teaching skills highest. Residents in family medicine were more impressed by good supervisors who allowed them to practise their skills and gave feedback. Both groups rated commitment to teaching highly, but only residents ranked teachers by the depth of their knowledge.

It's hard to imagine anything more ironic than British American Tobacco criticising the World Health Organization for its record on tobacco control, except perhaps the suggestion, made in a press release last week, that the tobacco giant could do it better. This display of brass neck is made all the more breathtaking by the fact that covert operations inside the WHO by moles …
Regulation and function of α2-chimaerin, a diacylglycerol-responsive GAP for the small G-protein Rac
Authors: Francheska Colon-Gonzalez, Ying Liu, Garret Brodeur, Marcelo Kazanietz
Journal: Cancer Research (2007)

2801  The small GTPase Rac plays critical roles in the progression of cancer by modulating the actin cytoskeleton, cell cycle progression, migration, and metastasis. Rac inactivation is controlled by GTPase Activating Proteins (GAPs), which accelerate GTP hydrolysis. Chimaerins are a family of Rac-GAP proteins that have a high affinity binding site (C1 domain) for the phorbol ester tumor promoters and the lipid second messenger diacylglycerol (DAG). The β2-chimaerin isoform is down-regulated in breast cancer and gliomas and modulates proliferative and metastatic responses; however, very little is known about the role of other chimaerin isozymes in carcinogenesis. We have determined that α2-chimaerin, a member of the family that is highly expressed in human brain, is subject to translocation to the plasma membrane in response to phorbol 12-myristate 13-acetate (PMA) with an EC50 of 3.1 ± 0.2 μM, suggesting a lipid-mediated association with Rac in response to stimulation of receptors coupled to DAG generation. Based on the established model for protein kinase C (PKC) activation by phorbol esters and DAG, we speculated that the activation of α2-chimaerin requires a conformational change that exposes the C1 and the GAP domains. To address this issue we designed α2-chimaerin point mutants based on structural predictions that may disrupt the inactive (“closed”) conformation (W16A, L20A, Q24A, I122A, and I352A mutants). Subcellular fractionation and microscopy studies in COS-1 cells revealed that these mutants were constitutively localized to the plasma membrane. Rac-GTP pull-down assays revealed that these mutants have elevated Rac-GAP activity, suggesting that they may be locked in an “open” conformation in which lipid- and Rac-binding sites are exposed. Introducing an additional mutation in the α2-chimaerin C1 domain that confers reduced DAG/phorbol ester responsiveness (P216A) retains high Rac-GAP activity. To study the relevance of this Rac-GAP in nervous system tumor signaling we assessed its activity in human SH-SY5Y neuroblastoma cells expressing the TrkA or TrkB receptors. Activation of these receptors with nerve growth factor (NGF) or brain-derived neurotrophic factor (BDNF), respectively, cause a 3-fold elevation in Rac-GTP levels, with maximum activation at 3 min. Adenoviral delivery of α2-chimaerin into these cells greatly impaired Rac activation in response to the neurotrophins. Our results identified the Rac-GAP α2-chimaerin as a potential downstream modulator of neurotrophin responses that involve Rac activation and suggest that, like other DAG/phorbol ester-regulated proteins (PKC isozymes), it may require a significant conformational change to access and subsequently inactivate its target Rac.
Disability training reduces students' negativity
Authors: Karen Hebert
Journal: BMJ (2005)

Three quarters of the words used by medical students to describe disability were negative, a study has shown, but a training course caused a significant change in attitude ( Medical Education 2005;39: 176-83).

Margaret Byron and colleagues asked a cohort of 381 medical students at Bristol University to anonymously write down words that they associated with disability. They repeated the exercise after a four day course about disability.

Words visually describing disability and loss were prominent initially, accounting for 85% of the words, and 74% of the words were negative. Commonly used words were “wheelchair,” “handicap,” “impairment,” and “disadvantage.”



VOISIN/PHANIE/REX

Students associate disability with disadvantage



Focus groups showed that students were nervous about meeting disabled people and although well intentioned were patronising in their attitude. One student was quoted as saying, “Make special arrangements for them so that they …
Association of Time Between Left Ventricular and Aortic Systolic Pressure Peaks With Severity of Aortic Stenosis and Calcification of Aortic Valve
Authors: Kimi Sato, Arnav Kumar, Yash Jobanputra, Jorge Betancor, Mohamed Halane, Robin George, Vivek Menon, Amar Krishnaswamy, E. Murat Tuzcu, Serge Harb, Wael A. Jaber, Stephanie Mick, Lars G. Svensson, Samir R. Kapadia
Journal: JAMA Cardiology (2019)

Diagnosis of low-gradient severe aortic stenosis (AS) is challenging. We hypothesized that the time between left ventricular (LV) and aortic systolic pressure peaks (TLV-Ao) is associated with aortic stenosis (AS) severity and may have additive value in diagnosing severe AS, especially in patients with low-gradient AS.To investigate the diagnostic utility of measuring catheter-based TLV-Ao in patients with severe AS.We studied 123 patients with severe AS at the Cleveland Clinic Foundation, a tertiary referral center, who underwent transcatheter aortic valve replacement (TAVR) via femoral access and had pre-TAVR cardiac computed tomography assessment and hemodynamic measurements recorded during a TAVR procedure. All patients received hemodynamic evaluation, echocardiographic assessment, and quantification of aortic valve calcification (AVC) by multidetector computed tomography. Hemodynamic data were collected via left heart catheterization done just before TAVR, and TLV-Ao was calculated offline. Data were analyzed between October 5, 2015, and July 20, 2016.The association between TLV-Ao and AVC or other conventional imaging parameters was analyzed.Of the included patients, the mean (SD) age was 81 (9) years, and 65 (54%) were men (54%). Among 123 patients, 48 patients (39%) had low-gradient AS (<40 mm Hg) and mean (SD) TLV-Ao was 69 (39) milliseconds. In multivariable logistic regression analyses, higher TLV-Ao (odds ratio [OR], 1.02; 95% CI, 1.01-1.04; P = .002) and higher peak aortic valve (AV) velocity (OR, 1.01; 95% CI, 1.00-1.02; P = .008) were independently associated with severe AVC (AVC >1000 AU). Adding TLV-Ao to the peak AV velocity and AV area showed significant incremental value to be associated with AVC, with a net reclassification improvement of 0.61 (95% CI, 0.23-0.99; P = .002) and integrated discriminatory improvement of 0.09 (95% CI, 0.03-0.16; P = .003). In a subgroup of patients with low-grade AS, higher TLV-Ao was the only parameter associated with severe AVC (OR, 1.02; 95% CI, 1.001-1.04; P = .03).Prolonged TLV-Ao was associated with severe AVC. This catheter-based hemodynamic index may be an additional surrogate to differentiate low-gradient true severe AS. Larger, prospective studies investigating the role of TLV-Ao as a marker of clinical outcomes in patients undergoing TAVR are required.
Medicine for the whole person: A Critique of Scientific Medicine
Authors: Patrick Harris
Journal: BMJ (2000)

E K Ledermann Shaftesbury: Element 1997; £8.99 ISBN 1862040567

I wanted this book to offer some insight into “alternative” styles of medical practice, to present its arguments clearly, and to offer something illuminating. Instead I found myself frustrated and annoyed by its failure to deliver much beyond glib assertion and pious moralising.

In fairness, however, the author's intentions in writing this book are admirable. As a psychiatrist and practitioner of homoeopathy who is clearly disillusioned with …