tbuckley/cabot-search huggingface dataset:
Cultural “Deafness”: about more than language
Authors: Emma Joanne Wilding
Journal: BMJ (2006)

Even before we arrive at medical school it is obvious that good communication skills are vital for a successful and hassle-free medical career. Nodding your head while a patient talks and you pretend to write, when you are in fact completing a sudoku (which, for those who don't know, is a numerical puzzle), is nobody's idea of good communication. But are we really doing our best to communicate?

One of the attractions of a medical career is that you can expose yourself to not only a wonderful array of pathogens but also a wide range of people. The opportunity to meet people from different backgrounds and cultures is for some one of the great allures of medicine (and also backpacking). But this is also one of the profession's greatest challenges.

A recent topic of discussion in the media is the refusal of Deaf parents to allow their deaf children to have cochlear implants, which could provide some form of audible stimulation. So what am I trying to say? Am I implying that all health professionals should run out and …
Behind the list
Authors: Caroline Ward
Journal: BMJ (2002)

There I was, in consulting rooms in London, trying to remember what I had done with my elective. I could manage “Stanford,” “western blots for p40” and that was it. I'd only been back eight months but my brain was too addled to extract this simple information. I had had various ailments over the past two years and was having to restructure my self image. I thought that I was a fit 23 year old who had never been ill, so adjusting to months of illness with no energy for anything was a hefty task. When I finally took sick leave in my fifth year, I was overcome by a seemingly inescapable tiredness.

Eventually, my dad convinced me to see a specialist in fatigue. After half an hour of respiration questionnaires, I was told that I had a chronic disruption of my breathing pattern and I was …
Junior doctors pressured to lie about working hours
Authors: Elspeth Isbister
Journal: BMJ (2002)

Preregistration house officers (PRHOs) are pressured to lie about their hours of work during periods of monitoring by management. This is one of the issues being taken up by the BMA Junior Doctors Committee in its “fair treatment” campaign for junior doctors, which was launched this month.

Dr Trevor Pickersgill, chairman of the committee, said, “Junior doctors are still working too many hours despite tougher measures to regulate their hours of work. No junior doctor should have to tolerate coercion or unfair treatment in the workplace. Junior doctors do not find it easy to seek help. They risk putting their careers on the line if they are seen to rock the boat.”

Under the …
An unusual cause of breathlessness: part 1
Authors: James S Dawson, Jonathan Corne
Journal: BMJ (2005)

A71 year old man with breathlessness and a non-productive cough was referred by his general practitioner to the respiratory team. He gave a two year history of breathlessness, and at presentation had an exercise tolerance of about 180 metres. He denied wheeze, slept with four pillows, and occasionally woke with shortness of breath. He was not taking any regular medication, and was unaware of any drug allergies. He had no relevant family history. Thirty years previously, benign asbestos related disease had been diagnosed. The patient had worked in the postal industry all his life, had never smoked, and consumed 10 units of alcohol a week.

Examination showed the man was of normal build and comfortable at rest. Basic observations were within normal limits. Physical examination was unremarkable with no evidence of cardiovascular or respiratory disease. Results of spirometry were within normal limits. A chest radiograph revealed subtle pleural thickening (characterised by smooth denser white areas at the edges of …
G-CSF partially mediates effects of sleeve gastrectomy on the bone marrow niche
Authors: Ziru Li, Julie Hardij, Simon S. Evers, Chelsea R. Hutch, Sarah M. Choi, Yikai Shao, Brian S. Learman, Kenneth T. Lewis, Rebecca L. Schill, Hiroyuki Mori, Devika P. Bagchi, Steven M. Romanelli, Ki-Suk Kim, Emily Bowers, Cameron Griffin, Randy J. Seeley, Kanakadurga Singer, Darleen A. Sandoval, Clifford J. Rosen, Ormond A. MacDougald
Journal: Journal of Clinical Investigation (2019)

Bariatric surgeries are integral to the management of obesity and its metabolic complications. However, these surgeries cause bone loss and increase fracture risk through poorly understood mechanisms. In a mouse model, vertical sleeve gastrectomy (VSG) caused trabecular and cortical bone loss that was independent of sex, body weight, and diet, and this loss was characterized by impaired osteoid mineralization and bone formation. VSG had a profound effect on the bone marrow niche, with rapid loss of marrow adipose tissue, and expansion of myeloid cellularity, leading to increased circulating neutrophils. Following VSG, circulating granulocyte-colony stimulating factor (G-CSF) was increased in mice, and was transiently elevated in a longitudinal study of humans. Elevation of G-CSF was found to recapitulate many effects of VSG on bone and the marrow niche. In addition to stimulatory effects of G-CSF on myelopoiesis, endogenous G-CSF suppressed development of marrow adipocytes and hindered accrual of peak cortical and trabecular bone. Effects of VSG on induction of neutrophils and depletion of marrow adiposity were reduced in mice deficient for G-CSF; however, bone mass was not influenced. Although not a primary mechanism for bone loss with VSG, G-CSF plays an intermediary role for effects of VSG on the bone marrow niche.
Spare a thought for the secretaries
Authors: Kerry Maxwell
Journal: BMJ (2009)

Poorly paid and often overworked, you’ll find them, most likely, in the crumbling recesses of the hospital, struggling with ageing computers in offices piled high with patients’ charts. I have spent two summers working as a temporary medical secretary to help finance my medical degree. There are different types of medical secretary, but my job mostly involved typing up letters that had been dictated on tapes, filing letters and results in patients’ charts, storing radiographs, and sometimes answering the phone to anxious relatives or concerned general practitioners.

It can seem a strangely dislocated experience, bereft of much contact with the many patients whose intimate clinical examinations most …
Insights From the International Registry of Acute Aortic Dissection
Authors: Arturo Evangelista, Eric M. Isselbacher, Eduardo Bossone, Thomas G. Gleason, Marco Di Eusanio, Udo Sechtem, Marek P. Ehrlich, Santi Trimarchi, Alan C. Braverman, Truls Myrmel, Kevin M. Harris, Stuart Hutchinson, Patrick O’Gara, Toru Suzuki, Christoph A. Nienaber, Kim A. Eagle
Journal: Circulation (2018)

Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality rates, and it remains a challenge to diagnose and treat. The International Registry of Acute Aortic Dissection was established in 1996 with the mission to raise awareness of this condition and provide insights to guide diagnosis and treatment. Since then, &gt;7300 cases have been included from &gt;51 sites in 12 countries. Although presenting symptoms and physical findings have not changed significantly over this period, the use of computed tomography in the diagnosis has increased, and more patients are managed with interventional procedures: surgery in type A AAD and endovascular therapy in type B AAD; with these changes in care, there has been a significant decrease in overall in-hospital mortality in type A AAD but not in type B AAD. Herein, we summarized the key lessons learned from this international registry of patients with AAD over the past 20 years.
Rate of undergraduates pregnancies is worryingly high
Authors: Siân Knight
Journal: BMJ (1999)

One in 10 female graduates become pregnant before they graduate, according to new research commissioned by the National Union of Students (NUS) which surveyed 970 female higher and further education students in England and Wales. Students who were married or in steady relationships and mature student were, unsurprisingly, three times more likely to have been pregnant than comparative subgroups - 36% and 35% respectively, compared …
Fears for safety of students in Liberia
Authors: Deborah Cohen
Journal: BMJ (2001)

Amnnesty International has voiced concern about the safety of student protesters detained by security officers after a raid on the University of Liberia in Monrovia in March.

Dozens of students were reportedly whipped and beaten and women students were stripped naked after the special operation division, a unit of the security forces, brought to a halt a peaceful demonstration in support of four imprisoned journalists. The journalists, who worked for the Liberian newspaper The News, were detained and charged with espionage after publishing an article criticising the government's spending on spare …
Picture Quiz: Know your enemy
Authors: Stephen Goldie, Vincent Smith
Journal: BMJ (2003)

A 22 year old man visits his general practitioner for advice on an “itchy rash” which has developed overnight. The young man had just returned from a fishing trip on a loch near the village of Fort Augustus in the Highlands of Scotland, famed for its position at the bottom end of Loch Ness. He and a friend had camped on the shore of the fishing loch. On closer examination the doctor noted an urticarial rash spread all over the man's face, neck, hands, and forearms (figures 1 and 2)--that is, the exposed areas of the body that were not covered by clothing while fishing.



Fig 1 



Fig 2 

1.  What is the cause of the rash?

2.  What advice should the doctor give on current management of symptoms?

3.  Are there any suggestions the doctor can give on prevention for the future?

1.  The rash has been caused primarily by midge bites …
Bill Gates gives $100m for AIDS vaccine trials
Authors: Benjamin Hope
Journal: BMJ (2001)

The software tycoon, Bill Gates, has announced that his charitable foundation will donate $100m (£71.5m) as a five year grant to the International AIDS Vaccine Initiative. The initiative is a New York based non-profit making body, which wants to see three of its most promising AIDS vaccines in clinical trials by 2007. It has already enabled a joint team from Oxford and Nairobi universities …
From the front line
Authors: Jabar Hameed Al Khirbit
Journal: BMJ (2005)

During November 2004, in my final year at medical school, my college closed because of the deteriorating security situation in Iraq. Instead I decided to go to Ramadi city's general hospital, along with two of my friends and colleagues, Omar and Ahmed. We decided to help out at the hospital to gain experience. It never crossed our minds that we would be responsible for peoples' lives in such a short time.

The city of Ramadi is the largest city in the Anbar province, with a population of about 400 000 people. This province also includes the city of Fallujah, where the insurgency is occurring. When the coalition forces decided to …
Extrarenal Signs of Proximal Renal Tubular Acidosis Persist in Nonacidemic Nbce1b/c-Null Mice
Authors: Emily E. Salerno, Sangita P. Patel, Aniko Marshall, Jordan Marshall, Thamer Alsufayan, Cheikh S. Alassane Mballo, Bianca N. Quade, Mark D. Parker
Journal: Journal of the American Society of Nephrology (2019)

Significance Statement Recessive SLC4A4 mutations are a cause of proximal renal tubular acidosis (pRTA), a rare but devastating disorder associated with loss of electrogenic sodium bicarbonate cotransporter 1 (NBCe1) function in kidney and other organs. Alkali therapy is the preferred treatment for pRTA, which is characterized by acidemia, developmental impairment, and vision loss, and often enamel hypomineralization. However, which nonrenal findings are secondary to acidemia is poorly understood. The authors describe the phenotype of a line of transgenic mice in which NBCe1 expression is blocked in all tissues except the proximal tubule. These mice are not acidemic but still exhibit many of the extrarenal signs associated with pRTA, revealing the potential limitations of pH correction by alkali therapy in pRTA and the need to develop novel therapies. Background The SLC4A4 gene encodes electrogenic sodium bicarbonate cotransporter 1 (NBCe1). Inheritance of recessive mutations in SLC4A4 causes proximal renal tubular acidosis (pRTA), a disease characterized by metabolic acidosis, growth retardation, ocular abnormalities, and often dental abnormalities. Mouse models of pRTA exhibit acidemia, corneal edema, weak dental enamel, impacted colons, nutritional defects, and a general failure to thrive, rarely surviving beyond weaning. Alkali therapy remains the preferred treatment for pRTA, but it is unclear which nonrenal signs are secondary to acidemia and which are a direct consequence of NBCe1 loss from nonrenal sites (such as the eye and enamel organ) and therefore require separate therapy. SLC4A4 encodes three major NBCe1 variants: NBCe1-A, NBCe1-B, and NBCe1-C. NBCe1-A is expressed in proximal tubule epithelia; its dysfunction causes the plasma bicarbonate insufficiency that underlies acidemia. NBCe1-B and NBCe1-C exhibit a broad extra-proximal-tubular distribution. Methods To explore the consequences of Nbce1b/c loss in the absence of acidemia, we engineered a novel strain of Nbce1b/c-null mice and assessed them for signs of pRTA. Results Nbce1b/c-null mice have normal blood pH, but exhibit increased mortality, growth retardation, corneal edema, and tooth enamel defects. Conclusions The correction of pRTA-related acidemia should not be considered a panacea for all signs of pRTA. The phenotype of Nbce1b/c-null mice highlights the physiologic importance of NBCe1 variants expressed beyond the proximal tubular epithelia and potential limitations of pH correction by alkali therapy in pRTA. It also suggests a novel genetic locus for corneal dystrophy and enamel hypomineralization without acidemia.
Abstract 14918: Concomitant Long QT Syndrome and Arrhythmogenic Bileaflet Mitral Valve Prolapse: Sentinel Description of a Rare and Malignant Clinical Entity
Authors: John R Giudicessi, Ram K Rohatgi, Martijn J Bos, Michael J Ackerman
Journal: Circulation (2017)

Introduction: Arrhythmogenic bileaflet mitral valve prolapse syndrome (aBiMVPS) is a recently recognized sudden death-predisposing disorder characterized by bileaflet mitral valve prolapse (MVP) wi...
Distinct immunocyte-promoting and adipocyte-generating stromal components coordinate adipose tissue immune and metabolic tenors
Authors: Raul German Spallanzani, David Zemmour, Tianli Xiao, Teshika Jayewickreme, Chaoran Li, Paul J. Bryce, Christophe Benoist, Diane Mathis
Journal: Science Immunology (2019)

Adipose tissue T regs dynamically dialogue with stromal cells via the ST2:IL-33 axis in homeostasis and disease.
Film review: American Psycho
Authors: Alisdair McNeill
Journal: BMJ (2000)

American Pscyho is a dark comedy focusing on the life of mass murdering yuppie Patrick Bateman. The film's central theme is the conflict between individuality and the demands of society. Bateman's yuppie lifestyle requires absolute conformity. Appearance is all important; the right suit and shoes make or break an individual. To ensure acceptance Bateman's social group all dress alike. Thus clothes become uniform, preventing expressions of individuality and denying Bateman …
Long-Term Exposure to Ozone and Cause-Specific Mortality Risk in the United States
Authors: Chris C. Lim, Richard B. Hayes, Jiyoung Ahn, Yongzhao Shao, Debra T. Silverman, Rena R. Jones, Cynthia Garcia, Michelle L. Bell, George D. Thurston
Journal: American Journal of Respiratory and Critical Care Medicine (2019)

Rationale: Many studies have linked short-term exposure to ozone (O3) with morbidity and mortality, but epidemiologic evidence of associations between long-term O3 exposure and mortality is more limited.Objectives: To investigate associations of long-term (annual or warm season average of daily 8-h maximum concentrations) O3 exposure with all-cause and cause-specific mortality in the NIH-AARP Diet and Health Study, a large prospective cohort of U.S. adults with 17 years of follow-up from 1995 to 2011.Methods: The cohort (n = 548,780) was linked to census tract–level estimates for O3. Associations between long-term O3 exposure (averaged values from 2002 to 2010) and multiple causes of death were evaluated using multivariate Cox proportional hazards models, adjusted for individual- and census tract–level covariates, and potentially confounding copollutants and temperature.Measurements and Main Results: Long-term annual average exposure to O3 was significantly associated with deaths caused by cardiovascular disease (per 10 ppb; hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.01–1.06), ischemic heart disease (HR, 1.06; 95% CI, 1.02–1.09), respiratory disease (HR, 1.04; 95% CI, 1.00–1.09), and chronic obstructive pulmonary disease (HR, 1.09; 95% CI, 1.03–1.15) in single-pollutant models. The results were robust to alternative models and adjustment for copollutants (fine particulate matter and nitrogen dioxide), although some evidence of confounding by temperature was observed. Significantly elevated respiratory disease mortality risk associated with long-term O3 exposure was found among those living in locations with high temperature (Pinteraction < 0.05).Conclusions: This study found that long-term exposure to O3 is associated with increased risk for multiple causes of mortality, suggesting that establishment of annual and/or seasonal federal O3 standards is needed to more adequately protect public health from ambient O3 exposures.
Clinical surgery guides
Authors: Ayesha Jameel
Journal: BMJ (2008)

Medical student friendly guides

The Pocket Essentials of Clinical Surgery belongs to the Kumar and Clarke family, and it shows. It is colourful and vibrant, with a logical approach to surgical learning. Practical guidance on emergencies, trauma, and the care of the critically ill patient is covered in section 2, “The general surgical take,” which precedes the system based chapters. The book concludes with a fascinating insight into surgical techniques and a quiz for self assessment. Throughout the book, …
Non-traditional entry to medical school may increase dropout rate
Authors: Roger Dobson
Journal: BMJ (2004)

Medical students who have a parent who is a doctor, who live on rather than off campus, or who did well in science subjects at A level were less likely to drop out during their first year at university, a new study shows.

The study's authors, from the University of Warwick, looked at data on 51 810 first year students at 21 medical schools between 1980 and 1992 ( Medical Education 2004;38:492-503).

Students who scored high grades in biology, chemistry, or physics were less likely to drop out of medical school than other students, while those who scored well in other subjects were more likely to transfer out of medicine.

Men were more likely to quit than women, with men 8% more likely to drop out than women, but social class and school background had little effect on the dropout rate. The authors also found significant differences between medical schools in the probability of dropping out in the first year.



ULRIKE PREUSS

Science students do it better



Across …
My accident and emergency attachment
Authors: Jonny Martin
Journal: BMJ (1999)

Jonny Martin splits his attachment between John Radcliffe Hospital, Oxford, and Craigavon Area Hospital, Portadown, and appreciates their differences It is often said that time is one of the greatest resources a medical student has. Only s/he can spare enough to tease out the finer points of a patient's history. Their neighbour's cat's social activity may not be directly relevant to their renal failure, but it can allow the humble student to set up a rapport with the patient that would put a Macmillan nurse to shame. In the fast paced arena of acute medicine, however, the medical student must learn, perhaps for the first time, to ration what becomes a most precious commodity.

In the John Radcliffe Hospital, as a new medical student on the “front door”, when you see a patient, time is everything. You have 10 minutes. After this, the curtain is pulled back so a face can peer in to see what rare disease is taking so long to identify. Your fledgling diagnosis directed history and exam skills have been tested to the limit with this sprained knee, and as you attempt some non-specific test you find yourself presenting. Gone are the days of the confident, well drilled medical student slickly delivering the negative findings of his or her exam. Now you need to get to the point. The cubicle is needed, your time is up. The senior house officer repeats the exam to the tune of your potted history, and before you've voiced your dubious exam findings it's a “double tubigrip, ibuprofen, and next patient …
Modernising medical careers
Authors: Rhona MacDonald
Journal: BMJ (2003)

It is over six months since <i>Modernising Medical Careers</i> exploded onto the scene--a radical, wide ranging set of proposals that will change medical training as we currently know it. Now that the dust has settled and everyone seems to agree that it is a good idea, where do we go from here? Rhona MacDonald went to see Aidan Halligan, deputy chief medical officer for England, to find out what is happening to make the proposed foundation programmes for newly qualified doctors a reality
Gene duplication and evolution in recurring polyploidization–diploidization cycles in plants
Authors: Xin Qiao, Qionghou Li, Hao Yin, Kaijie Qi, Leiting Li, Runze Wang, Shaoling Zhang, Andrew H. Paterson
Journal: Genome biology (2019)

Abstract Background The sharp increase of plant genome and transcriptome data provide valuable resources to investigate evolutionary consequences of gene duplication in a range of taxa, and unravel common principles underlying duplicate gene retention. Results We survey 141 sequenced plant genomes to elucidate consequences of gene and genome duplication, processes central to the evolution of biodiversity. We develop a pipeline named DupGen_finder to identify different modes of gene duplication in plants. Genes derived from whole-genome, tandem, proximal, transposed, or dispersed duplication differ in abundance, selection pressure, expression divergence, and gene conversion rate among genomes. The number of WGD-derived duplicate genes decreases exponentially with increasing age of duplication events—transposed duplication- and dispersed duplication-derived genes declined in parallel. In contrast, the frequency of tandem and proximal duplications showed no significant decrease over time, providing a continuous supply of variants available for adaptation to continuously changing environments. Moreover, tandem and proximal duplicates experienced stronger selective pressure than genes formed by other modes and evolved toward biased functional roles involved in plant self-defense. The rate of gene conversion among WGD-derived gene pairs declined over time, peaking shortly after polyploidization. To provide a platform for accessing duplicated gene pairs in different plants, we constructed the Plant Duplicate Gene Database. Conclusions We identify a comprehensive landscape of different modes of gene duplication across the plant kingdom by comparing 141 genomes, which provides a solid foundation for further investigation of the dynamic evolution of duplicate genes.
Abstract 19893: Depression Screening in Pediatric Patients With Cardiomyopathy
Authors: Sairah Khan, Seth Gray, Constance Mara, Masatoshi Ashiki, James Brown, John L Jefferies
Journal: Circulation (2016)

Introduction: Advances in pediatric heart failure (HF) therapies have resulted in improved survival and a resultant shift toward improving long-term quality of life. Aim of this study was to determ...