tbuckley/cabot-search huggingface dataset:
Editor’s Choice: Edging ahead of the pack
Authors: Tom Moberly
Journal: BMJ (2015)

Two articles this week look at the continuing importance to doctors’ careers of maintaining a demonstrable edge over their peers. Annie Swanepoel provides practical advice on how specialty trainees can use the time they spend in training to make sure they are in the best possible position when it comes to applications and interviews for consultant posts (http://careers.bmj.com/careers/advice/view-article.html?id=20020923). She discusses the importance …
FRAGMENTED QRS AND MORTALITY IN PATIENTS UNDERGOING PERCUTANEOUS INTERVENTION FOR ST ELEVATION MYOCARDIAL INFARCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Pattara Rattanawong, Wasawat Vutthikraivit, Nath Limpruttidham, Narut Prasitlumkum, Tanawan Riangwiwat, Pakawat Chongsathidkiet
Journal: Journal of the American College of Cardiology (2018)
Systemic immune inflammation index and treatment response in patients with metastatic renal cell cancer.
Authors: Kadriye Bir YÃ¼cel, Arzu Yasar, Gokhan Ucar, Gungor Utkan, Nuriye Yildirim, Yuksel Urun
Journal: Journal of Clinical Oncology (2018)

591 Background: To investigate the prognostic value of the pretreatment inflammatory characteristics on treatment response and survival. Methods: We included 151 patients with metastatic renal cell carcinoma (mRCC) Patients’ charts were retrospectively analyzed for their clinical, pathological and demographic features. Systemic immune inflammation index (SII) cut off is estimated with median value. Overall survival (OS) was estimated by Kaplan-Meier method for univariate analysis and Cox-regression for multivariate analysis. Results: In high SII group (SII &gt; 844) overall survival is 11 months and in low SII group (SII &lt; 844) overall survival is 22 months (p = 0,008). Median OS is lower in the hypercalcemic group (7 months vs.18 months, P = 0,013). In patients with anemia and thrombocytosis, OS is lower (41 months vs. 13 months p = 0,001 and 6 months vs. 18 months p = 0,01). In multivariate analysis, anemia, SII, and ECOG performance status were able to predict OS (HR = 2,69, HR = 2,04, HR = 2,57) Conclusions: In patients with mRCC, SII may have a prognostic value and higher score may related with decreased overall survival.
Should doctors recommend acupuncture for pain?
Authors: Mike Cummings, Asbjørn Hróbjartsson, Edzard Ernst
Journal: BMJ (2018)

It's a safe alternative to drugs that is under-researched because it lacks commercial interest, writes <b>Mike Cummings,</b> but <b>Asbjørn Hróbjartsson</b> and <b>Edzard Ernst</b> argue there is no convincing evidence of clinical benefit and that the potential risks and health service costs are unjustified
Abstract P4-13-16: Impact of immediate breast reconstruction after mastectomy on the outcome of patients receiving neoadjuvant chemotherapy
Authors: H Nogi, S Tomita, M Kamio, H Shioya, Y Toriumi, H Takeyama
Journal: Cancer Research (2018)

Abstract Background and purpose In breast cancer patients receiving neoadjuvant chemotherapy (NAC), immediate breast reconstruction (IBR) is controversial. IBR might favor recurrences and metastases due to delayed adjuvant radiation therapy. We retrospectively investigated whether IBR after mastectomy influenced the outcome of patients receiving neoadjuvant chemotherapy. Patients and methods Between 2006 and 2016, 243 breast cancer patients received total mastectomy after NAC, 48 of whom underwent IBR. Patients receiving IBR (IBR group) were compared to patients who did not receive IBR (no-IBR group) over a prolonged median follow-up time (72.3 moths). The regimen was 4 cycles of epirubicin (100 or 75 mg/m2), 5-fluorouracil (500 mg/m2), and cyclophosphamide (500 mg/m2) followed by 4 cycles of docetaxel (75 mg/m2). Post-mastectomy radiation was applied in cases treated by IBR following the same selection criteria as for standard mastectomy regardless of the reconstruction approach. Results Patients in the IBR group were on average younger than patients in no-IBR group (p&amp;lt;0.001). The percentage of patients with clinical T1/2 tumor was 81.2% in the IBR group and 58.4% in no-IBR group (p=0.0042). 2 patients (4.2%) in the IBR group and 9 patients (4.6%) in no-IBR group showed the locoregional recurrences. 2 patients (4.2%) in the IBR group and 20 patients (10.3%) showed distant metastases. There were no significant differences. Conclusions IBR after total mastectomy was not associated with worse rate of locoregional recurrences in patients receiving NAC. Citation Format: Nogi H, Tomita S, Kamio M, Shioya H, Toriumi Y, Takeyama H. Impact of immediate breast reconstruction after mastectomy on the outcome of patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-16.
European Computer Driving Licence (ECDL)
Authors: Mark Taubert
Journal: BMJ (2006)

The European Computer Driving Licence (ECDL) is a computer proficiency course available to all NHS medics and is particularly handy for doctors wanting to enhance their computing skills. The name is a little misleading, as it does not test your motoring skills, but rather teaches you how to use a computer, from switching it on to more complex processes like programming databases.

May to August 2005, although you have a year to do it if you prefer.

A friend who works in finance …
AGREEMENT OF FRACTIONAL FLOW RESERVE AND INSTANTANEOUS WAVE-FREE RATIO WITH CORONARY FLOW CAPACITY: A SUB-ANALYSIS OF THE IBERIAN-DUTCH-ENGLISH (IDEAL) STUDY
Authors: Yuetsu Kikuta, Tim van de Hoef, Ricardo Petraco Da Cunha, Mauro Echavarria-Pinto, Gilbert Wijntjens, Yasutsugu Shiono, Sukhjinder Nijjer, Rasha Al-Lamee, Sayan Sen, Martijn Meuwissen, Hernan Mejia-Renteria, Ibrahim Danad, Paul Knaapen, Niels Van Royen, Javier Escaned, Justin Davies, Jan J. Piek
Journal: Journal of the American College of Cardiology (2018)
NATURAL HISTORY OF DIABETIC CORONARY ATHEROSCLEROSIS BY QUANTITATIVE MEASUREMENT OF SERIAL CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY
Authors: Michael Shao, Jonathon Leipsic, Ung Kim, Stephanie L. Sellers, Philipp Blanke, Jeroen J. Bax, Daniel Berman, Leslee Shaw, Renu Virmani, Jagat Narula, James K. Min, Hyuk-Jae Chang
Journal: Journal of the American College of Cardiology (2018)
Interleukin‐25 Axis Is Involved in the Pathogenesis of Human Primary and Experimental Murine Sjögren's Syndrome
Authors: Giuliana Guggino, Xiang Lin, Aroldo Rizzo, Fan Xiao, Laura Saieva, Stefania Raimondo, Diana Di Liberto, Giuseppina Candore, Piero Ruscitti, Paola Cipriani, Roberto Giacomelli, Francesco Dieli, Riccardo Alessandro, Giovanni Triolo, Liwei Lu, Francesco Ciccia
Journal: Arthritis & Rheumatology (2018)

Objective To investigate the role of the interleukin‐25 ( IL ‐25)/ IL ‐17 receptor B ( IL ‐17 RB ) axis in experimental Sjögren's syndrome ( SS ) and in patients with primary SS and primary SS –associated lymphoma. Methods Expression of IL ‐25, IL ‐17 RB , IL ‐17B, and tumor necrosis factor receptor–associated factor 6 ( TRAF 6) was analyzed on minor salivary gland ( SG ) samples from patients with primary SS and on parotid gland samples from patients with primary SS –associated B cell non‐Hodgkin's lymphoma ( NHL ). IL ‐17 RB expression and the frequencies of natural group 2 innate lymphoid cells ( ILC 2s), inflammatory ILC 2s, and M2‐polarized macrophages were assessed by flow cytometry in SG mononuclear cells and peripheral blood mononuclear cells ( PBMC s). Tissue distribution of ILC 2s was studied by confocal microscopy. The role of recombinant IL ‐25 and of rituximab in modulating IL ‐25 expression was investigated in in vitro studies. IL ‐25/ IL ‐17 RB and TRAF 6 expression and the role of IL ‐25 inhibition were also studied in the experimental murine model of SS . Results Activation of the IL ‐25/ IL ‐17 RB / TRAF 6 axis correlated with the focus score and was observed in patients with primary SS and in patients with primary SS –associated NHL . A significant increase in the frequency of inflammatory ILC 2s was observed both in SG mononuclear cells and in PBMC s. IL ‐25 stimulation of isolated SG mononuclear cells and PBMC s from patients and controls resulted both in inflammatory ILC 2 expansion and in increased autoantibody production. Rituximab modulated expression of inflammatory ILC 2s and IL ‐25 in primary SS . SG protein–immunized mice developed overt SS symptoms with increased IL ‐25 expression and increased frequency of CD 4+ IL ‐17 RB + TRAF 6+ cells. IL ‐25 neutralization attenuated disease progression and tissue pathology in mice with experimental SS . Conclusion IL ‐25 may promote the inflammatory state in primary SS and may be a potential target for novel disease‐modifying therapeutic strategies in patients with primary SS .
How do I apply for an observer post in a UK hospital before taking the PLAB test part 2?
Authors: Elitham Turya
Journal: BMJ (2004)

Have a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone (www.bmjcareers.com/advicezone) for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site.
Welsh government is urged to tackle junior doctor shortage
Authors: Caroline White
Journal: BMJ (2012)

Orthopaedic operations at the Royal Glamorgan Hospital in Llantrisant have been cancelled because of a shortage of junior doctors, leading to renewed calls for the Welsh government to do more than mount “a marketing campaign” to tackle the lack of doctors in the country.

In February the Welsh government launched a campaign, “Work for Wales,” which included a glossy website extolling the virtues of life in Wales, to attract more young doctors to the country.1

But the BMA in Wales has said that this isn’t enough and that the time has come …
Checkpoint inhibitors and arthritis
Authors: Nicholas Manolios, Leslie Schrieber
Journal: Annals of the Rheumatic Diseases (2018)

It was with interest that we read the article by Belkhir et al 1 in the recent Annals of Rheumatic Disease . The article described the first report of rheumatoid arthritis (RA) and polymyalgia rheumatica developing after the use of immune checkpoint inhibitors to treat a variety of cancers. We found the article interesting and informative but noted that in all of their 10 reported cases, the patients seroconverted from rheumatoid factor (RF) or cyclic citrullinated peptide antibody (CCP) negative to positive, supporting their claim that ‘rheumatoid arthritis’ may develop after immune checkpoint inhibitor treatment.

The report by Belkhir et al  is in contrast to our experience managing …
Opportunities to Understand Unique Cancer Risks in Global HIV-Infected Populations
Authors: Marie-Josèphe Horner, Satish Gopal
Journal: JNCI Journal of the National Cancer Institute (2018)

In this issue, Coghill and colleagues (1) describe reduced incidence of three common screen-detectable cancers among people living with HIV relative to the general population of the United States.Findings from the population-based HIV/AIDS Cancer Match Study show a 37% reduced incidence of breast cancer, 52% reduced incidence of prostate cancer, and 31% to 49% reduced incidence of rectal cancer, proximal colon, and distal colon cancer, respectively, among people living with HIV.Coghill et al. further investigate whether observed deficits in the incidence of breast, prostate, and colorectal cancers are consistent across tumor stage and size, as stage and size distribution may be impacted by differential application of cancer screening in HIV-infected and HIV-uninfected populations.For example, if reduced incidence of these cancers in HIV-positive populations is due to lower uptake of cancer screening, an excess of advanced stage disease and larger tumors would be observed in people with HIV.Conversely, a stage shift toward earlier-stage disease and smaller tumor size could result from higher screening rates among HIV-infected populations engaged in regular care than the general population.With the exception of late-stage breast cancer, which did not show a statistically significant association, the observed reduced incidence of breast, prostate, and colorectal cancers was consistent across local, regional, and distant tumor stages, as well as small, medium, and large tumors, suggesting that reduced risk for these cancers in people with HIV cannot be explained solely by population-level screening effects.Furthermore, the study addressed whether inverse risk associations could be artifacts of the study design itself or confounded by unmeasured risk factors (1).Advanced analytic approaches examined several scenarios and conditions that would need to occur to replicate the magnitude of inverse risk associations observed in this study.Under different scenarios, the level of measurement error and confounding required to generate such strong inverse associations are essentially implausible.These findings taken together suggest a putative direct effect of HIV infection and its sequelae on reduced risk for these three common cancers without known oncogenic virus
Nearly half of trainees chose not to progress straight to specialty training in 2015
Authors: Abi Rimmer
Journal: BMJ (2015)

Nearly half of junior doctors chose not to enter specialty training immediately after completing their second year of foundation training (F2) in 2015.

The UK Foundation Programme Office’s 2015 F2 Career Destination survey shows that, in 2015, 48% of successful F2 doctors did not progress directly into specialty training.1 This equates to over 3400 trainees of the 7168 trainees who provided information on their career destinations.

The proportion of doctors going straight from F2 into specialty training …
Abstract 12947: Clarithromycin Prevents Progression & Rupture of Aortic Aneurysm
Authors: Wataru Uchida, Aika Yamawaki-Ogata, Hideki Oshima, Akihiko Usui, Yuji Narita
Journal: Circulation (2016)

Introduction:  The pathogenesis of aortic aneurysm (AA) is mainly characterized by chronic inflammation in the aortic wall with accumulation of macrophages and degradation of extracellular matrix (ECM) with increased matrix metalloproteinases (MMP), particularly MMP-2 & -9, resulting in the degradation of collagen, elastin fragmentation and smooth muscle cell apoptosis. Meanwhile, clarithromycin (CAM) is well-known potent antibiotic, otherwise, CAM has been reported to have multiple biologic effects, such as alteration of inflammatory factors including MMP-2 & -9. In this study, we investigated the effects of clarithromycin on induced AA in mice.   Methods:  Male aged apolipoprotein E deficient (ApoE-/-) mice were infused 1000 ng/kg/min Angiotensin II for 28 days to induce AA. In the CAM-treated group (CAM group: n=13), the mice were dosed with CAM (100 mg/kg/day) by the gastric tube every day. In the control group (CONT; n=13), saline was administrated. Echo-aortography was performed every week to measure aortic diameters. The aneurysm induced aorta was removed and evaluated. Elastica van-Gieson stain was performed for evaluation of ECM in the aortic wall. The elastin content of the aorta were measured. Infiltrations of inflammatory macrophages were evaluated by immunofluorescence staining against CD 206 & F4/80. Gelatin zymography was performed to evaluate MMP-2 & -9 activities in aortic tissues.   Results:  Echo-aortography showed the aortic diameters were significantly attenuated in CAM group. The incidence of AA in CONT was 100%, which was significantly decreased to 23% in CAM group. No ruptured death was observed in CAM group in contrast to 5 ruptured deaths in CONT (Log Rank test, p=0.01). CAM significantly suppressed degradation of aortic elastin (56.3% & 16.5%, p   Conclusions:  CAM prevented the development of AA & rupture through suppression of inflammatory macrophages infiltration, decreased MMP-2 & -9, & preserved elastin content.
The role of inflammation in temporal shifts in the inflammatory bowel disease mucosal microbiome
Authors: Christopher John Kiely, Paul Pavli, Claire Louise O'Brien
Journal: Gut Microbes (2018)

Studies of the human intestinal microbiome in patients with inflammatory bowel disease (IBD) consistently show that there are differences (an abnormal or unbalanced microbiome, "dysbiosis") when compared to healthy subjects. We sought to describe changes in the microbiome in individual patients over time, and determine the clinical factors that are associated with significant alteration. Forty-two mucosal biopsies were collected from 20 patients that were spaced an average of 2.4 years apart. These were analysed using bacterial 16S rRNA gene high-throughput sequencing methods. Presence of active inflammation was determined endoscopically and histologically. Inferred metagenomics analysis was conducted using the PICRUSt package. We found that the differences in the microbiome over time in individual patients were greatest in the presence of ongoing intestinal inflammation, as determined by the Yue and Clayton theta distance between sample pairs (adjusted p = 0.00031). Samples from patients with previous abdominal surgery had lower alpha (within sample) diversity compared with those with no prior operations (mean Shannon index 2.083, 2.510 respectively, p = 0.017). There were no changes in the inferred bacterial metagenomic profile. The microbiome in IBD undergoes considerable fluctuation over time. These changes are greatest when there is histologically confirmed inflammation at both time-points.
What are the options open to medical graduates who do not wish to progress to the preregistration house officer year?
Authors: Adam Poole
Journal: BMJ (2004)

<i>Got a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone (www.bmjcareers.com/advicezone) for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site.</i>
Novel compound heterozygous mutations in <i>KREMEN1</i> confirm it as a disease gene for ectodermal dysplasia
Authors: N. Intarak, T. Theerapanon, A. Srijunbarl, K. Suphapeetiporn, T. Porntaveetus, V. Shotelersuk
Journal: British Journal of Dermatology (2018)

Ectodermal dysplasia (ED) is a heterogeneous group of disorders caused by mutations in at least thirteen genes. Recently, a study reported Palestinian patients with ED from consanguineous families with a homozygous mutation in KREMEN1 (Kringle-containing transmembrane protein 1) and proposed it to be a causative gene for the autosomal recessive ED 13, hair/tooth type (ECTD13; OMIM #617392). A Thai family, parents and two children affected with ED, was recruited. The study was exempted from review by the Institutional Review Board, Faculty of Medicine, Chulalongkorn University (IRB584/60). Written informed consents of each participant were obtained according to the Declaration of Helsinki. Mutation analyses were performed as described previously.

This article is protected by copyright. All rights reserved.
NHS staff must be given time to develop new care models, King’s Fund says
Authors: Matthew Limb
Journal: BMJ (2015)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following NHS staff must be given time to develop new care models, King’s Fund says Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Necroptotic cancer cells-mimicry nanovaccine boosts anti-tumor immunity with tailored immune-stimulatory modality
Authors: Ting Kang, Yukun Huang, Qianqian Zhu, Hao Cheng, Yuanyuan Pei, Jingxian Feng, Minjun Xu, Gan Jiang, Qingxiang Song, Tianze Jiang, Hongzhuan Chen, Xiaoling Gao, Jun Chen
Journal: Biomaterials (2018)
Comparative study of transhiatal and transthoracic thoracoscopic esophagectomy results in adenocarcinoma of the esophagogastric junction.
Authors: Flavio Roberto Takeda, Ivan Cecconello, Ulysses Ribeiro, Rubens Antonio Aissar Sallum
Journal: Journal of Clinical Oncology (2018)

185 Background: The surgical treatment of adenocarcinoma of the esophagogastric junction surgical treatment (AGEJ) is still controversial, particularly concerning to survival and postoperative complications. To compare thoracoscopic esophagectomy (group A) with transhiatal esophagectomy (group B) in patients with AGEJ in relation to the occurrence of complications and mortality; number of ressected lymph nodes, the positive and the ratio between the ressected and positive; overall and disease free survival; and survival after relapse. Methods: There was a selection of 147 patients from 2000 to 2017. Epidemiological data were analyzed and compared between the groups. Postoperative complications were evaluated. The anatomopathological staging was evaluated, analyzing the resected lymph nodes. Analysis of overall survival, disease free survival and survival after relapse were made, besides multivariate analysis of survival related factors. Results: In relation to the complications, group A presented greater occurrence of hoarseness and surgical infections. In relation to mortality, group A presented 2 cases (3.7%) and group B presented 4 (4.3%), without statistical difference. In group A, the average number of ressected lymph nodes was 31.88 and in group B was 20.73 (p &lt; 0.001), however the average number of affected lymph nodes was 3.96 in group A and 4.25 in group B. The general overall survival was 42.3%, in group A was 38.9% and in group B was 47.6% (p = 0.298). In the multivariate analysis of overall survival only lymphatic invasion (p = 0.005), diabetes mellitus (p = 0.038) and surgical infection (p-0.001) were significant. However, in tumors with stage until 2B, group A overall survival was 80.4% and group B was 38.5% (p = 0.001). Conclusions: Both methods are safe with similar morbidity and mortality rates. Transthoracic thoracoscopic esophagectomy allows a larger ressection in the number of lymph nodes. Overall survival and disease free survival are similar, however until stage 2B thoracoscopic esophagectomy improves overall survival. Diabetes and lymphatic invasion interfere in overall and disease free survival.
CARDIOVASCULAR SIGNALING PROTEINS AS PREDICTORS OF DOXORUBICIN-RELATED CARDIAC EFFECTS IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA
Authors: Steven Lipshultz, Traci M. Blonquist, Tracie L. Miller, Donna S. Neuberg, Holly M. Smith, Brent Anderson, Vivian I. Franco, Neha Bansal, Emma R. Lipshultz, Rebecca E. Scully, Lewis B. Silverman, Steven D. Colan, Barbara L. Asselin, Uma Athale, Luis A. Clavell, Caroline Laverdiere, Bruno Michon, Marshall A. Schorin, Stephen E. Sallan, Douglas Sawyer
Journal: Journal of the American College of Cardiology (2018)