tbuckley/cabot-search huggingface dataset:
Picture quiz When vomiting relieves severe abdominal pain
Authors: S S Jaunoo, T Tang, A Brown, B V Praveen
Journal: BMJ (2007)

A 72 year old woman presented with sudden onset of severe epigastric and left upper quadrant pain. The pain was sharp and constant, relieved only by vomiting. The vomitus was projectile and streaked with blood. Medical history included a hiatus hernia, for which the patient was taking a proton pump inhibitor.
Endoscopic ultrasound-guided hepaticoduodenostomy for an obstructed anterior hepatic branch in a patient with Billroth-II reconstruction
Authors: Yujiro Kawakami, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toji Murabayashi, Kei Ito
Journal: Endoscopy (2019)

A 70-year-old man who had previously undergone distal gastrectomy with Billroth-II reconstruction visited our hospital complaining of a repetitive fever. Contrast-enhanced computed tomography (CT) revealed a 25-mm liver abscess in the right anterior segment, communicating with the anterior hepatic duct, which was dilated due to stenosis at the anomalous confluence with the middle of the cystic duct; this obstruction was believed to be the cause of the fever ([Fig. 1]). Conservative treatment with antimicrobial agents was not sufficiently effective. After obtaining written informed consent from the patient, endoscopic ultrasound (EUS)-guided biliary drainage was performed to resolve the structural problem ([Fig. 2], [Video 1]) after considering other interventions, including transpapillary stenting through the narrow, winding cystic duct and highly stenotic confluence.
Potential Adverse Effects of Marijuana Use in Pregnancy
Authors: Russell Kamer
Journal: Annals of Internal Medicine (2019)

Letters7 May 2019Potential Adverse Effects of Marijuana Use in PregnancyRussell Kamer, MDRussell Kamer, MDWhite Plains, New York (R.K.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0073 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Goler and colleagues (1) state that more data are needed on the adverse effects of prenatal marijuana use because the effects "remain unclear." However, the report by the Committee on the Health Effects of Marijuana (2) that the authors cited concluded that there is "substantial evidence of a statistical association between maternal cannabis smoking and lower birth weight of the offspring" and "limited evidence of a statistical association between maternal cannabis smoking and pregnancy complications for the mother [and] admission of the infant to the neonatal intensive care unit." Although confounding variables limit the conclusions of studies ...References1. Goler N, Conway A, Young-Wolff KC. Data are needed on the potential adverse effects of marijuana use in pregnancy. Ann Intern Med. 2018;169:492-3. [PMID: 30140934]. doi:10.7326/M18-1141 LinkGoogle Scholar2. Committee on the Health Effects of Marijuana. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Report Committee's Conclusions. Washington, DC: National Academies Pr; 2017. Accessed at http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2017/Cannabis-Health-Effects/Cannabis-conclusions.pdf on 28 October 2018. Google Scholar3. Dickson B, Mansfield C, Guiahi M, Allshouse AA, Borgelt L, Sheeder J, et al. Recommendations from cannabis dispensaries on first trimester marijuana use. Am J Obst Gynecol. 2018;218:S551. doi:org/10.1016/j.ajog.2017.11.518 CrossrefGoogle Scholar4. Keyhani S, Steigerwald S, Ishida J, Vali M, Cerdá M, Hasin D, et al. Risks and benefits of marijuana use: a national survey of U.S. adults. Ann Intern Med. 2018;169:282-90. [PMID: 30039154]. doi:10.7326/M18-0810 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: White Plains, New York (R.K.)Disclosures: The authors has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0073. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoData Are Needed on the Potential Adverse Effects of Marijuana Use in Pregnancy Nancy Goler , Amy Conway , and Kelly C. Young-Wolff Potential Adverse Effects of Marijuana Use in Pregnancy Kelly C. Young-Wolff , Amy Conway , and Nancy Goler Metrics 7 May 2019Volume 170, Issue 9Page: 666-667KeywordsAddictionCannabisMarijuanaMaternal healthNeonatal intensive care unitsPregnancyPregnancy complicationsPrevention, policy, and public healthSafetySubstance abuse ePublished: 7 May 2019 Issue Published: 7 May 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Beginners guide to genetics: Past, present, and future
Authors: Osvaldo Mutchinick, Heidy Arrieta, Juan Morales, Jazmin Arteaga, Rodrigo Macias, Regina Gomez-Palacio, Leonora Luna, Nancy Monroy, Adrian Gonzalez
Journal: BMJ (2005)

In the last article of our series, the Genetics Group, coordinated by Osvaldo Mutchinick, deals with the history of genetics and how future research will impact diagnosis and treatment of diseases
Paradigms of Dynamic Control of Thyroid Hormone Signaling
Authors: Antonio C Bianco, Alexandra Dumitrescu, Balázs Gereben, Miriam O Ribeiro, Tatiana L Fonseca, Gustavo W Fernandes, Barbara M L C Bocco
Journal: Endocrine Reviews (2019)

Thyroid hormone (TH) molecules enter cells via membrane transporters and, depending on the cell type, can be activated (i.e., T4 to T3 conversion) or inactivated (i.e., T3 to 3,3′-diiodo-l-thyronine or T4 to reverse T3 conversion). These reactions are catalyzed by the deiodinases. The biologically active hormone, T3, eventually binds to intracellular TH receptors (TRs), TRα and TRβ, and initiate TH signaling, that is, regulation of target genes and other metabolic pathways. At least three families of transmembrane transporters, MCT, OATP, and LAT, facilitate the entry of TH into cells, which follow the gradient of free hormone between the extracellular fluid and the cytoplasm. Inactivation or marked downregulation of TH transporters can dampen TH signaling. At the same time, dynamic modifications in the expression or activity of TRs and transcriptional coregulators can affect positively or negatively the intensity of TH signaling. However, the deiodinases are the element that provides greatest amplitude in dynamic control of TH signaling. Cells that express the activating deiodinase DIO2 can rapidly enhance TH signaling due to intracellular buildup of T3. In contrast, TH signaling is dampened in cells that express the inactivating deiodinase DIO3. This explains how THs can regulate pathways in development, metabolism, and growth, despite rather stable levels in the circulation. As a consequence, TH signaling is unique for each cell (tissue or organ), depending on circulating TH levels and on the exclusive blend of transporters, deiodinases, and TRs present in each cell. In this review we explore the key mechanisms underlying customization of TH signaling during development, in health and in disease states.
Association of Economic Status and Educational Attainment With Posttraumatic Stress Disorder
Authors: Renato Polimanti, Andrew Ratanatharathorn, Adam X. Maihofer, Karmel W. Choi, Murray B. Stein, Rajendra A. Morey, Mark W. Logue, Caroline M. Nievergelt, Dan J. Stein, Karestan C. Koenen, Joel Gelernter
Journal: JAMA Network Open (2019)

<h3>Importance</h3> There is a well-established negative association of educational attainment (EA) and other traits related to cognitive ability with posttraumatic stress disorder (PTSD), but the underlying mechanisms are poorly understood. <h3>Objectives</h3> To investigate the association of PTSD with traits related to EA. <h3>Design, Setting, and Participants</h3> Genetic correlation, polygenic risk scoring, and mendelian randomization (MR) were conducted including 23 185 individuals with PTSD and 151 309 control participants from the Psychiatric Genomics Consortium for PTSD and up to 1 131 881 individuals assessed for EA and related traits from UK Biobank, 23andMe, and the Social Science Genetic Association Consortium. Data were analyzed from July 3 through November 19, 2018. <h3>Main Outcomes and Measures</h3> Genetic correlation obtained from linkage disequilibrium score regression, phenotypic variance explained by polygenic risk scores, and association estimates from MR. <h3>Results</h3> Summary association data from multiple genome-wide association studies were available for a total of 1 180 352 participants (634 391 [53.7%] women). Posttraumatic stress disorder showed negative genetic correlations with EA (<i>r</i><sub>g</sub> = −0.26; SE = 0.05;<i>P</i> = 4.60 × 10<sup>−8</sup>). Mendelian randomization analysis, conducting considering a random-effects inverse-variance weighted method, indicated that EA has a negative association with PTSD (β = −0.23; 95% CI, −0.07 to −0.39;<i>P</i> = .004). Investigating potential mediators of the EA-PTSD association, propensity for trauma exposure and risk-taking behaviors were observed as risk factors for PTSD independent of EA (trauma exposure: β = 0.37; 95% CI, 0.19 to 0.52;<i>P</i> = 2.57 × 10<sup>−5</sup>; risk-taking: β = 0.76; 95% CI, 0.38 to 1.13;<i>P</i> = 1.13 × 10<sup>−4</sup>), while income may mediate the association of EA with PSTD (MR income: β = −0.18; 95% CI, −0.29 to −0.07;<i>P</i> = .001; MR EA: β = −0.23; 95% CI, −0.39 to −0.07;<i>P</i> = .004; multivariable MR income: β = −0.32; 95% CI, −0.57 to 0.07;<i>P</i> = .02; multivariable MR EA: β = −0.04; 95% CI, −0.29 to 0.21; SE, 0.13;<i>P</i> = .79). <h3>Conclusions and Relevance</h3> Large-scale genomic data sets add further evidence to the negative association of EA with PTSD, also supporting the role of economic status as a mediator in the association observed.
Tapering without relapse in rheumatoid arthritis patients with high TNF blocker concentrations: data from STRASS study
Authors: Hubert Marotte, Mélanie Rinaudo-Gaujous, Cécile Petiet, Bruno Fautrel, Stéphane Paul
Journal: Annals of the Rheumatic Diseases (2019)

Correspondenceclinical remission and high TNF blocker blood concentration.Furthermore, since the initial concentration of STRASS study will be predictive of RA relapse in case of TNF blocker injection spacing, we propose to assess trough TNF blocker concentration before each tapering step in order to maintain remission and avoid a relapse in RA patients with clinical remission.Finally, we proposed an algorithm to manage step-down strategy (figure 2), which should be confirmed in a prospective study.
Moving From Poly (ADP-Ribose) Polymerase Inhibition to Targeting DNA Repair and DNA Damage Response in Cancer Therapy
Authors: Charlie Gourley, Judith Balmaña, Jonathan A. Ledermann, Violeta Serra, Rebecca Dent, Sibylle Loibl, Eric Pujade-Lauraine, Simon J. Boulton
Journal: Journal of Clinical Oncology (2019)

The DNA damage response (DDR) pathway coordinates the identification, signaling, and repair of DNA damage caused by endogenous or exogenous factors and regulates cell-cycle progression with DNA repair to minimize DNA damage being permanently passed through cell division. Severe DNA damage that cannot be repaired may trigger apoptosis; as such, the DDR pathway is of crucial importance as a cancer target. Poly (ADP-ribose) polymerase (PARP) is the best-known element of the DDR, and several PARP inhibitors have been licensed. However, there are approximately 450 proteins involved in DDR, and a number of these other targets are being investigated in the laboratory and clinic. We review the most recent evidence for the clinical effect of PARP inhibition in breast and ovarian cancer and explore expansion into the first-line setting and into other tumor types. We critique the evidence for patient selection techniques and summarize what is known about mechanisms of PARP inhibitor resistance. We then discuss what is known about the preclinical rationale for targeting other members of the DDR pathway and the associated tumor cell genetics that may confer sensitivity to these agents. Examples include DNA damage sensors (MLH1), damage signaling molecules (ataxia-telangiectasia mutated; ataxia-telangiectasia mutated-related and Rad3-related; CHK1/2; DNA-dependent protein kinase, catalytic subunit; WEE1; CDC7), or effector proteins for repair (POLQ [also referred to as POLθ], RAD51, poly [ADP-ribose] glycohydrolase). Early-phase clinical trials targeting some of these molecules, either as a single agent or in combination, are discussed. Finally, we outline the challenges that must be addressed to maximize the therapeutic opportunity that targeting DDR provides.
Expression of factor V by resident macrophages boosts host defense in the peritoneal cavity
Authors: Nan Zhang, Rafael S. Czepielewski, Nicholas N. Jarjour, Emma C. Erlich, Ekaterina Esaulova, Brian T. Saunders, Steven P. Grover, Audrey C. Cleuren, George J. Broze, Brian T. Edelson, Nigel Mackman, Bernd H. Zinselmeyer, Gwendalyn J. Randolph
Journal: The Journal of Experimental Medicine (2019)

Macrophages resident in different organs express distinct genes, but understanding how this diversity fits into tissue-specific features is limited. Here, we show that selective expression of coagulation factor V (FV) by resident peritoneal macrophages in mice promotes bacterial clearance in the peritoneal cavity and serves to facilitate the well-known but poorly understood "macrophage disappearance reaction." Intravital imaging revealed that resident macrophages were nonadherent in peritoneal fluid during homeostasis. Bacterial entry into the peritoneum acutely induced macrophage adherence and associated bacterial phagocytosis. However, optimal control of bacterial expansion in the peritoneum also required expression of FV by the macrophages to form local clots that effectively brought macrophages and bacteria in proximity and out of the fluid phase. Thus, acute cellular adhesion and resident macrophage-induced coagulation operate independently and cooperatively to meet the challenges of a unique, open tissue environment. These events collectively account for the macrophage disappearance reaction in the peritoneal cavity.
Abstract 2228: Schoolchildren As Ambassadors Of CPR - A Model For Mass Training Of Lay Rescuers?
Authors: Tonje Lorem, Aud Palm, Lars Wik
Journal: Circulation (2007)

Background: Norwegian 7th graders were trained in CPR by using a 30 minutes DVD and an inflatable resuscitation manikin (MiniAnne, Laerdal Medical, Norway). Afterwards they were instructed to take ...
Trauma endoscopy: endoscopic closure of an esophageal perforation caused by knife stabbing
Authors: Roeland Zoutendijk, Philippe P. de Rooij, Arjun D. Koch
Journal: Endoscopy (2019)

A young woman was admitted to the emergency room after being assaulted with a knife, resulting in a deep cervical wound. On examination, she had subcutaneous emphysema in the neck and air leakage from her trachea. Because of a compromised airway, she underwent endotracheal intubation. Computed tomography angiography (CTA) revealed a tracheal perforation, but no clear esophageal defect ([Fig. 1]).
Abstract 11665: Oral Triiodothyronine Supplementation Decreases Time to Extubation After Pediatric Open Heart Surgery in Indonesia
Authors: Eva M Marwali, Novik Budiwardhana, Radityo Prakoso, Dicky Fakhri, Cindy E Boom, Mulyadi M Djer, Sudigdo Sastroasmoro, Michael A Portman
Journal: Circulation (2015)

Background: In Indonesia, children with congenital heart disease (CHD) usually present later for corrective surgery than in developed countries. These children show chronic malnutrition associated with low thyroid hormone levels, which decline further immediately after open-heart surgery. Objectives: To test the hypothesis that oral triiodothyronine (T3) supplementation improves clinical outcome indexed by time to extubation (TTE) after aortic cross-clamp release. Methods: The study was a single center, randomized, double blind, and placebo controlled trial in children with CHD younger than 2 years of age undergoing open-heart surgery. Oral T3 or placebo was administered every 6 hours for 60 hours. TTE served as the primary endpoint. Hemodynamics, echocardiography parameters, inotropic score, fluid balance, diuresis, and sepsis complication were serially recorded and evaluated as secondary endpoints Results: A total of 78 patients were allocated to T3 group and 74 patients to the control group. Oral T3 prevented the declination in serum T3 noted in control group. The T3 group had a shorter time to extubation than placebo with a mean (SD) 25.99(24.30) and 40.71(56.29) hours, respectively and a hazard ratio for chance of extubation (95% CI) 1.49 (1.06-2.11), p=0.02. The median (IQ) cardiac index increased significantly after surgery in T3 (day 1 vs. day 2, 3.28 (2.46 - 4.46) to. 3.65 (2.65 - 4.77) L/min/m2, p=0.01), but not in the placebo group. More diuresis and a significantly more negative fluid balance (p=0.03) were found in T3 group during the first 72 hours post surgery. No difference in the use of inotropic agents or loop diuretics. Sepsis was significantly lower in T3 group with incidence (%) of sepsis in T3 and placebo group 1(1) vs. 10(13) patients, (p=0.004), respectively. Otherwise there was no difference in adverse events including arrhythmia. Conclusion: Oral T3 supplementation is safe and provides multiple clinical benefits in an extremely vulnerable population of children in a developing country. Any reduction in TTE could improve sparse resources by increasing ventilator and ICU availability.
Country students outshine city slackers
Authors: Saffy Rushworth
Journal: BMJ (2004)

Medical students who have their clinical training in the community get higher exam results than those who train in tertiary hospitals, says a new BMJ study ( BMJ 2004;328:207-9).

A five year study carried out by Flinders University, Adelaide, Australia, found that nearly a third of students, who were placed at rural general …
The night before finals
Authors: Thomas Hanna
Journal: BMJ (2003)

> I just did my written medical finals. How were they I hear you ask? Fine, I say in retrospect; a very different answer to the one I would have given you the night before they started. What should have been a night of productive study turned out to be something different.



10 pm. Begin to panic. Realise I have forgotten a few important topics. Amazed at my lack of legible revision notes and the sheer …
That's funny
Authors: Vijay Aswani
Journal: BMJ (2003)

Laughter is good medicine. By now, this seems to be an accepted fact. As medical students, we can look back over the times in our recent past when we have laughed with fellow students, professors, and friends over this, that, or the other. Interestingly though, while laughter seems to be universal, humour is affected by race, age, sex, and even profession. Have you had the experience of going home over break and trying to narrate to a loved one something funny that happened at university that really made you laugh, only to be met with a quizzical “I …
Abstract P343: E-Epidemiology to study the Associations of Socioeconomic Status with Risk of Cardiovascular Disease Hospitalization Among Patients with Chronic Kidney Disease
Authors: Nrupen A Bhavsar, Benjamin A Goldstein, Matthew Phelan, Leigh E Boulware
Journal: Circulation (2017)

Introduction: There has been a paradigm shift in epidemiology to integrate large, disparate sources of information, including electronic health record (EHR) data, to identify, prevent and treat individuals at risk for cardiovascular disease (CVD). This developing field, termed “e-epidemiology,” has the potential to enhance our ability to utilize these resources more efficiently, however limited data exists on how results from EHR based studies compare to traditional cohort studies. Objective: Quantify the association between socioeconomic status (SES) and CVD hospitalization among patients with chronic kidney disease (CKD) using EHR clinical and public SES data. Methods: We quantified the odds of incident or recurrent CVD hospitalization for a fatal/nonfatal heart disease or stroke event (defined by ICD-9 codes) among patients with lower vs. higher SES. We included patients ≥40 years old with prevalent CKD receiving care in 2 Durham NC health systems from 2007-13. Annual cross sectional cohorts of patients (new and returning) were created to calculate the probability of a CVD hospitalization in the following year. We measured SES using the AHRQ SES score (based on income, education, occupation, wealth and housing data). In logistic regression models, we estimated the odds of CVD hospitalization in the next year per quartile of SES score, adjusting for demographic and clinical covariates. Results: Of 60463 patients, 61% were female, 45% were Black, 89% had hypertension, and 41% had diabetes. Examined continuously, the probability of a CVD hospitalization was inversely associated with SES score (Figure 1). Patients in the lowest quartile of SES had a 32% greater odds of CVD hospitalization in the next year as compared to patients in the highest quartile of SES (OR = 1.32, 95% CI=1.08-1.61). Conclusions: Our results support published data from traditional cohort studies that lower SES is associated with CVD hospitalizations. The EHR is a feasible, efficient and robust data source that may have great potential to advance CVD research.
It's all about attitude
Authors: Katherine McGinn
Journal: BMJ (2006)

We've all seen the telltale signs of medical students who would rather be anywhere but here; chatting in lectures, muttered complaints about travelling miles to come to the ward round, the sigh of reluctance when faced with the prospect of sticking a needle into anyone despite having endlessly rehearsed it on the fake arm-pincushion. So why do some students often seem reluctant to learn when given the opportunity?

Whether graduates fare better than high school applicants at medical school has sparked off much debate. Many reasons supporting the view that graduates make better medical students have been proffered: the …
Should job applications be meritocratic?
Authors: Susannah Daniel
Journal: BMJ (2005)

In four months time, when I apply for my first postregistration house officer job, my overall worth as a doctor will be represented by a number between one and 400-the number of people in my year. The new application process in the United Kingdom gives a numerical value to everything on my CV, from exam results to voluntary work, and the sum total is added up to give me a personal score. This then determines my rank in the year.

The concept of being ranked according to exam results is not new to me. At least it acts as a useful guide about the amount of revision I did before an exam. But the notion that a ranking can somehow reflect the infinite number …
SARS epidemic continues
Authors: Adrián González Aguirre
Journal: BMJ (2003)

Two strains of the virus responsible for severe acute respiratory syndrome (SARS) have been sequenced. As health authorities work to halt the epidemic, researchers from Canada and the United States have discovered the sequences of TOR2 and Urbani.

The TOR2 strain is made up of 29 751 bases and, apart from 8 bases, is identical to Urbani's sequence. The two teams disagree as to which is correct. No conclusive clues have been found concerning the potential animal origin of the pathogen. This coronavirus cannot be classified in the three known groups of the …