tbuckley/cabot-search huggingface dataset:
Sexual discrimination and harassment affects career choices
Authors: Irina Haivas
Journal: BMJ (2005)

Exposure to sexual discrimination and sexual harassment in medical school influences students' choice of specialty and later their residency programme ranking, especially for women (Academic Medicine 2005;80:400-8). Terry Stratton and colleagues analysed responses from 1314 students in US medical schools and found that 93% of women and 83% of men experienced, observed, or heard about such incidents during medical school. For a high percentage of women (45%) compared with men (16%), exposure to discrimination and harassment influenced choice of specialty.

“Gender discrimination and …
NOD‐like receptor C4 Inflammasome Regulates the Growth of Colon Cancer Liver Metastasis in NAFLD
Authors: Koichiro Ohashi, Zhijun Wang, Yoon Mee Yang, Sandrine Billet, Wei Tu, Michael Pimienta, Suzanne L. Cassel, Stephen J. Pandol, Shelly C. Lu, Fayyaz S. Sutterwala, Neil Bhowmick, Ekihiro Seki
Journal: Hepatology (2019)

Nonalcoholic fatty liver disease (NAFLD) enhances the growth and recurrence of colorectal cancer (CRC) liver metastasis. With the rising prevalence of NAFLD, a better understanding of the molecular mechanism underlying NAFLD‐associated liver metastasis is crucial. Tumor‐associated macrophages (TAMs) constitute a large portion of the tumor microenvironment that promotes tumor growth. NOD‐like receptor C4 (NLRC4), a component of an inflammasome complex, plays a role in macrophage activation and interleukin (IL)‐1β processing. We aimed to investigate whether NLRC4‐mediated TAM polarization contributes to metastatic liver tumor growth in NAFLD. Wild‐type and NLRC4 ‐/‐ mice were fed low‐fat or high‐fat diet for 6 weeks followed by splenic injection of mouse CRC MC38 cells. The tumors were analyzed 2 weeks after CRC cell injection. High‐fat diet–induced NAFLD significantly increased the number and size of CRC liver metastasis. TAMs and CD206‐expressing M2 macrophages accumulated markedly in tumors in the presence of NAFLD. NAFLD up‐regulated the expression of IL‐1β, NLRC4, and M2 markers in tumors. In NAFLD, but not normal livers, deletion of NLRC4 decreased liver tumor growth accompanied by decreased M2 TAMs and IL‐1β expression in tumors. Wild‐type mice showed increased vascularity and vascular endothelial growth factor (VEGF) expression in tumors with NAFLD, but these were reduced in NLRC4 ‐/‐ mice. When IL‐1 signaling was blocked by recombinant IL‐1 receptor antagonist, liver tumor formation and M2‐type macrophages were reduced, suggesting that IL‐1 signaling contributes to M2 polarization and tumor growth in NAFLD. Finally, we found that TAMs, but not liver macrophages, produced more IL‐1β and VEGF following palmitate challenge. Conclusion: In NAFLD, NLRC4 contributes to M2 polarization, IL‐1β, and VEGF production in TAMs, which promote metastatic liver tumor growth.
Expression Analysis and Significance of PD-1, LAG-3, and TIM-3 in Human Non–Small Cell Lung Cancer Using Spatially Resolved and Multiparametric Single-Cell Analysis
Authors: Ila Datar, Miguel F. Sanmamed, Jun Wang, Brian S. Henick, Jungmin Choi, Ti Badri, Weilai Dong, Nikita Mani, Maria Toki, Luis D. Mejías, Maria D. Lozano, Jose Luis Perez-Gracia, Vamsidhar Velcheti, Matthew D. Hellmann, Justin F. Gainor, Kristen McEachern, David Jenkins, Konstantinos Syrigos, Katerina Politi, Scott Gettinger, David L. Rimm, Roy S. Herbst, Ignacio Melero, Lieping Chen, Kurt A. Schalper
Journal: Clinical Cancer Research (2019)

Abstract Purpose: To determine the tumor tissue/cell distribution, functional associations, and clinical significance of PD-1, LAG-3, and TIM-3 protein expression in human non–small cell lung cancer (NSCLC). Experimental Design: Using multiplexed quantitative immunofluorescence, we performed localized measurements of CD3, PD-1, LAG-3, and TIM-3 protein in &amp;gt;800 clinically annotated NSCLCs from three independent cohorts represented in tissue microarrays. Associations between the marker's expression and major genomic alterations were studied in The Cancer Genome Atlas NSCLC dataset. Using mass cytometry (CyTOF) analysis of leukocytes collected from 20 resected NSCLCs, we determined the levels, coexpression, and functional profile of PD-1, LAG-3, and TIM-3 expressing immune cells. Finally, we measured the markers in baseline samples from 90 patients with advanced NSCLC treated with PD-1 axis blockers and known response to treatment. Results: PD-1, LAG-3, and TIM-3 were detected in tumor-infiltrating lymphocytes (TIL) from 55%, 41.5%, and 25.3% of NSCLC cases, respectively. These markers showed a prominent association with each other and limited association with major clinicopathologic variables and survival in patients not receiving immunotherapy. Expression of the markers was lower in EGFR-mutated adenocarcinomas and displayed limited association with tumor mutational burden. In single-cell CyTOF analysis, PD-1 and LAG-3 were predominantly localized on T-cell subsets/NKT cells, whereas TIM-3 expression was higher in NK cells and macrophages. Coexpression of PD-1, LAG-3, and TIM-3 was associated with prominent T-cell activation (CD69/CD137), effector function (Granzyme-B), and proliferation (Ki-67), but also with elevated levels of proapoptotic markers (FAS/BIM). LAG-3 and TIM-3 were present in TIL subsets lacking PD-1 expression and showed a distinct functional profile. In baseline samples from 90 patients with advanced NSCLC treated with PD-1 axis blockers, elevated LAG-3 was significantly associated with shorter progression-free survival. Conclusions: PD-1, LAG-3, and TIM-3 have distinct tissue/cell distribution, functional implications, and genomic correlates in human NSCLC. Expression of these immune inhibitory receptors in TILs is associated with prominent activation, but also with a proapoptotic T-cell phenotype. Elevated LAG-3 expression is associated with insensitivity to PD-1 axis blockade, suggesting independence of these immune evasion pathways.
BMI, Mortality, and Cardiovascular Outcomes in Type 1 Diabetes: Findings Against an Obesity Paradox
Authors: Jon Edqvist, Araz Rawshani, Martin Adiels, Lena Björck, Marcus Lind, Ann-Marie Svensson, Sofia Gudbjörnsdottir, Naveed Sattar, Annika Rosengren
Journal: Diabetes Care (2019)

Low weight has been associated with increased mortality risks in type 1 diabetes. We aimed to investigate the importance of weight and weight gain/loss in the Swedish population diagnosed with type 1 diabetes.Patients with type 1 diabetes (n = 26,125; mean age 33.3 years; 45% women) registered in the Swedish National Diabetes Registry from 1998 to 2012 were followed from the first day of study entry. Cox regression was used to calculate risk of death from cardiovascular disease (CVD), major CVD events, hospitalizations for heart failure (HF), and total deaths.Population mean BMI in patients with type 1 diabetes increased from 24.7 to 25.7 kg/m2 from 1998 to 2012. Over a median follow-up of 10.9 years, there were 1,031 deaths (33.2% from CVD), 1,460 major CVD events, and 580 hospitalizations for HF. After exclusion of smokers, patients with poor metabolic control, and patients with a short follow-up time, there was no increased risk for mortality in those with BMI <25 kg/m2, while BMI >25 kg/m2 was associated with a minor increase in risk of mortality, major CVD, and HF. In women, associations with BMI were largely absent. Weight gain implied an increased risk of mortality and HF, while weight loss was not associated with higher risk.Risk of major CVD, HF, CVD death, and mortality increased with increasing BMI, with associations more apparent in men than in women. After exclusion of factors associated with reverse causality, there was no evidence of an obesity paradox.
Improving your language skills
Authors: Tiago Villanueva
Journal: BMJ (2003)

Going on an elective often drives medical students to learn a foreign language. Classroom based teaching or self study books are effective ways to learn, and resources on the internet have evolved as credible learning tools. They have unique assets of their own; they are almost always free, and they allow an unprecedented degree of interactivity—for example, being able to listen to an audio sample as many times as you need until you get the pronunciation right. You also choose to spend as little or as much …
Dealing with dying
Authors: Paul Grant
Journal: BMJ (2003)

One of the many things that medical school fails to prepare you for is how to deal with death. At some point, every doctor experiences the death of a patient. But when we are fresh faced and newly qualified, death can be difficult to come to terms with.

Appreciating the context in which a death occurs is always important. Not every death is a failure; in fact, the concept of dying well can be of utmost importance. Death is the natural end of things and we cannot turn the tide indefinitely. Often people are ready to die and it should be our job to help smooth that passage.

Many junior doctors will do a rotation in medicine for the elderly and here thoughtfulness and care are required for patients who are often terminally ill, frail, and in a great deal of pain. For such patients, aggressive interventions and the fruitless search for a cure can …
Whither the recognition?
Authors: David S Y Chan, Aaron S Z Chan
Journal: BMJ (2006)

Kids put on their best behaviour when their parents are home. Students go wild when the teacher is not in class. And we pick up litter only when someone is watching. So, do doctors only teach when they get sufficient recognition for it?

The General Medical Council states that doctors should be willing to contribute to the education of students or colleagues.1 The spectrum of attitudes that doctors harbour to teaching is by no means narrow. Some bubble with enthusiasm and are keen to use every opportunity to impart bits …
Minerva: April 2003
Authors: J Mountney
Journal: BMJ (2003)

Rabbit sperm will always swim towards the heat in a laboratory mock up of a fallopian tube. The Israeli scientists who discovered this think that human sperm might do the same, guided to their target like small, heat seeking missiles ( Nature Medicine 2003;9:149-50). Thermotaxis, they say, has the potential to guide sperm over longer distances than chemotaxis, which probably only works for the last few millimetres.

The next stage of reproduction—implantation of an embryo in the uterine wall—has always been something of a mystery. Laboratory research on human endometrium now suggests that embryos stick to endometrium in the same way as leukocytes sometimes stick to vascular endothelium, by covering themselves in proteins called selectins. When receptive, endometrial cells express oligosaccharide receptors that interlock with selectins, capturing the embryo as it floats by ( Science 2003;299:405-8).

A survey of primary school children in England and Sweden confirms what many parents already know—that school toilets are dirty, smelly, and dangerous. A quarter of the boys and half the girls surveyed say they dont go to the toilet at school because, among other things, they are afraid of bullies kicking the door in or pushing their heads down the toilet ( Child: Care, Health and Development 2003;29:47-51). Swedish children call …
Informed Shared Decisions for Patients with Aortic Stenosis
Authors: Catherine M. Otto
Journal: New England Journal of Medicine (2019)

Valve replacement is the only effective treatment for adults with severe, symptomatic aortic stenosis. The ideal prosthetic valve would be associated with minimal risk and discomfort at implantation, would have hemodynamics similar to those of a normal valve, would not require anticoagulation, and would be durable for the patient's lifetime. We are moving closer to this goal, as evidenced by sequential randomized clinical trials of transcatheter aortic-valve replacement (TAVR), initially in patients at prohibitive or high estimated risk for death with surgical aortic-valve replacement, then in patients at intermediate risk, and now — in the trials by Mack et al.1 . . .
Nanoscale Mobility of the Apo State and TARP Stoichiometry Dictate the Gating Behavior of Alternatively Spliced AMPA Receptors
Authors: G. Brent Dawe, Md. Fahim Kadir, Raminta Venskutonytė, Amanda M. Perozzo, Yuhao Yan, Ryan P.D. Alexander, Camilo Navarrete, Eduardo A. Santander, Marika Arsenault, Christian Fuentes, Mark R.P. Aurousseau, Karla Frydenvang, Nelson P. Barrera, Jette S. Kastrup, J. Michael Edwardson, Derek Bowie
Journal: Neuron (2019)
Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study
Authors: Casey Crump, Jan Sundquist, Marilyn A Winkleby, Kristina Sundquist
Journal: BMJ (2019)

Abstract Objective To investigate the relation between preterm birth (gestational age &lt;37 weeks) and risk of CKD from childhood into mid-adulthood. Design National cohort study. Setting Sweden. Participants 4 186 615 singleton live births in Sweden during 1973-2014. Exposures Gestational age at birth, identified from nationwide birth records in the Swedish birth registry. Main outcome measures CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors. Results 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (&lt;28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P&lt;0.001; 3.01, 1.67 to 5.45; P&lt;0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P&lt;0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P&lt;0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P&lt;0.001) and 20-43 years (1.34, 1.15 to 1.57; P&lt;0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families. Conclusions Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.
Modern grave robbers
Authors: Subhash Chandir Ochani, Ahsan M Ahmad, Farrukh Raza Malik
Journal: BMJ (2004)

What would you do if human bones were an essential part of your medical course but your university could not afford them? Three medics from Pakistan present some ways out of the dilemma

The practice of robbing graves to facilitate scientific study of bones and cadavers is nothing new in medicine. In the early 18th century, Britain witnessed a booming trade of exhumed human bodies controlled by grave robbers when anatomy and dissection of the human body became an integral part in study of modern medicine. Because exhuming bodies was considered to be a sacrilege, grave diggers--also known as body snatchers, resurrectionists, or sack ''em up men--became associated with anatomy and surgery departments of medical schools. The practice still persists in many countries across the world, especially developing countries.1–5 In countries such as Pakistan, medical institutions may not be able to afford scientific tools, including bones required for anatomical studies.

In Pakistan, anatomy and osteology form a major part of exams and carry a large percentage of marks. There's a widespread belief among students that if you don't have important learning resources your academic career may be jeopardised and without proper anatomical knowledge you are an “incomplete” doctor. However, bones in medical schools are in short supply, and there aren't enough for students to study.6 Medical faculties allow students to study bones only during routine hours and forbid students from taking bones out of the college building.

Students therefore feel the necessity to obtain skeletons themselves, as they aren't able to understand osteology in such short spans of time to get a clear picture of human anatomy. As a result, students …
Cardiologist is struck off for inappropriate touching of female colleagues
Authors: Clare Dyer
Journal: BMJ (2019)

A consultant cardiologist who routinely and inappropriately touched the female junior doctors he was supervising has been struck off the UK medical register.

Five women doctors told the General Medical Council that Palaniappan Saravanan made them uncomfortable by unnecessarily placing his hands on them, putting his arm around them, or pressing himself against them, sometimes in front of patients while doing ward rounds.

The incidents took place at Arrowe Park Hospital, part of Wirral University Teaching Hospital NHS Foundation Trust. They happened between 2014 and 2017, when Saravanan was reported to his employer, who investigated and then notified the GMC.

“The tribunal considered there was an element …
Career focus: Surviving (and even enjoying) medicine
Authors: Abi Berger
Journal: BMJ (2000)

Being attracted to medicine and having a propensity for burnout are two sides of the same coin. Abi Berger has some tips to help doctors revitalise their lives Hands up if you recognise any of the following psychological traits: perfectionist, overly conscientious, tendency to seek approval (“people pleasing”) and need to control others, great sense of responsibility, chronic self doubt, uncomfortable with praise, and ability to delay gratification. It's a given that most people who enter medicine will hold many of these characteristics. It's not something that happens to us at medical school--although a lot of what happens there does account for later problems--it's what we medics tend to bring with us. It's what attracts us to medicine in the first place. Acknowledging this helps. Acknowledging it early enough, and adopting self caring practices, will help to ensure that we do not burn out and that we remain safe and competent at our jobs, and we may even reverse the trend of seeking early retirement. Most doctors suffer from an episode of depression at some point in their career, and every medical school should include lectures on “burnout prevention” alongside those on anatomy and physiology. According to a recent US conference on physicians' health in South Carolina, organised by the American and the Canadian Medical Associations, we doctors are sitting ducks for becoming burnt out. With thanks to some of the conference speakers, here are five practical tips on how to survive, succeed, and sustain interest in a career in medicine. ### Burnout beating behaviours
The crown jewel of medical school
Authors: Earim Chaudry, Aeisha Aslam
Journal: BMJ (2006)

Your elective could be the most exciting part of your time at medical school. Earim Chaudry and Aeisha Aslam explain why and how to organise one One of the highlights of your medical degree is the opportunity to spend time abroad. Ask almost any doctor about their elective and you're almost certain to induce a kind of nostalgic daydream. “Ah yes my elective,” (glazed eyes and smile). “I had a really amazing time. So where are you going?” (typical blank look from medical student). “I don't know, I haven't given it much thought yet.” Here is a guide to help you to plan your elective, wherever it is you decide to go. It is important to remember that the elective is your chance to sample whatever type of medicine you would like; you have complete autonomy to travel anywhere and do anything you want (well almost). There are opportunities to work in almost any country in the world, from remote medical outposts deep in tropical jungles through to working at the forefront of medicine and surgery in state of the art hospitals. You are unlikely to have the opportunity to travel abroad for two months when you are working, and your next chance may well be in retirement. As with most things in life, what you put in is what you get out. A bit of time and organisation can make the difference between just completing a compulsory part of your course and enjoying the experience of a lifetime. Although organising an elective can be a baffling and stressful task, it doesn't need to be. Here are some pointers to give you a helping hand. ### Box 1: Useful grants to apply for
Abstract 9207: Distinct Prognostic Factors in Patients with Chronic Heart Failure and Chronic Kidney Disease
Authors: Takamasa Sato, Tomofumi Misaka, Takashi Ohwada, Hiroyuki Yamauchi, Akiomi Yoshihisa, Hitoshi Suzuki, Shu-ichi Saitoh, Yasuchika Takeishi
Journal: Circulation (2011)

Background: In chronic heart failure (CHF), impaired renal function is a strong predictor of mortality. However, the impact of chronic kidney disease (CKD) on prognostic factors in CHF has not been rigorously examined. Purpose: The purpose of this study was to compare prognostic factors between CHF patients with and without CKD. Methods: Consecutive 505 patients with CHF (226 males, age 60±14 years) who performed cardiopulmonary exercise testing before discharge were enrolled. Patients were divided into two groups: CKD group (estimated GFR&lt;60 mL/min/1.73m 2 , n=213) and non-CKD group (estimated GFR&gt;60 mL/min/1.73m 2 , n=292). Patients were followed up to register cardiac events including cardiac deaths and re-hospitalization due to worsening heart failure. Results: Patients with CKD had lower hemoglobin concentration, higher uric acid concentration, higher plasma brain natriuretic peptide levels, lower left ventricular ejection fraction, larger left atrium volumes, higher E/E’ rario, lower peak heart rate, lower peak VO 2 , and higher VE/VCO 2 slope than those without CKD (P&lt;0.01, for each). There were 115 events during follow-up period (746±238days), and cardiac event rate was higher in CKD group than in non-CKD group (34% vs. 14%, P&lt;0.001). In non-CKD group, multivariate Cox hazard analysis demonstrated that body mass index (hazard ratio (HR): 0.532, 95% confidence interval (CI): 0.322-0.879, P&lt;0.001), log BNP (HR: 3.300, CI: 1.634-6.661, P&lt;0.001), left atrial dimension (HR: 1.318, CI: 1.105-1.573, P&lt;0.05) and peak VO 2 (HR: 0.743, CI: 0.557-0.956, P&lt;0.05) were independent parameters to predict cardiac events after discharge. In contrast, serum concentration of sodium (HR: 0.876, CI: 0.767-0.999, P&lt;0.05), uric acid (HR: 1.345, CI: 1.062-1.705, P&lt;0.05), log BNP (HR 2.364, CI: 1.404-3.980, P&lt;0.001) and peak VO 2 (HR: 0.742, CI: 0.631-0.874, P&lt;0.001) were independent prognostic factors in CKD group. Conclusions: Prognostic factors were different between CHF patients with and without CKD, and this should be considered to manage CHF patients with CKD.
Night shifts are bad for you, says report
Authors: Kay Brennan
Journal: BMJ (2000)

Working during the day, enjoying nights out, and lying in at the weekend to catch up on sleep may result in more than just grumpiness on a Monday morning. Burning the candle at both ends could be as unhealthy as smoking, warn scientists.

A report in New Scientist looks at the problems of Britain's emerging 24-hour society. It claims that shopping at midnight, selling shares at 4 am, and working night shifts can damage health, intelligence, and relationships as our …