tbuckley/cabot-search huggingface dataset:
Discovery and validation of a quantitative, stromal-associated imaging biomarker of pancreatic ductal adenocarcinoma (PDAC).
Authors: Mohamed Zaid, Baishali Chaudhury, Gauri R. Varadhachary, Matthew H. G. Katz, Joseph M. Herman, Eric P. Tamm, Eugene Jon Koay
Journal: Journal of Clinical Oncology (2018)

228 Background: As pancreatic ductal adenocarcinoma (PDAC) remains highly lethal, biomarkers are needed to identify patients who may benefit from specific therapeutic strategies. We previously described a qualitative computed tomography (CT) based biomarker - delta classification, whereby high delta tumors showed lower stromal content, more aggressive biology and poorer outcomes, than their counterparts. Here, we describe a quantitative method to differentiate these patients and predict outcomes. Methods: We retrospectively identified 101 treatment naïve patients who underwent pancreatectomy as a discovery cohort and 90 patients who underwent preoperative gemcitabine-based chemoradiation for validation. All patients underwent a pre-therapy pancreatic protocol CT and were classified as high or low delta, as described before. We semi-automatically segmented the tumors, chose normal pancreatic (NP) tissue and abdominal fat as references, then measured relative enhancement values using Philips IntelliSpace8 multimodality tumor tracking. We then analyzed the arterial and portal-venous phases separately using ROC and cox proportional hazards. Results: Delta class significantly associated with normalized enhancement values (NEV) in the arterial phase referenced to NP (P&lt;0.0001, AUC =90%). A cutoff of 0.72 was identified that also distinguished high and low delta groups in the validation cohort (P&lt;0.0001). As a continuous variable, the NEV was associated with distant metastasis free survival (DMFS) and overall survival (OS) on uni and multivariate analyses, accounting for traditional survival covariates. Using cutoff of 0.72, patients with high NEV had longer median OS (39 and 35.9 months) compared to those with low NEV (17.5 and 17.6 months, P=&lt;0.0001) in discovery and validation cohorts, respectively. Similarly, patients with high NEV had longer median DMFS (46.6 and 62.2 months) compared to those with low NEV (15.6 and 13.1 months, P=0.005) in discovery and validation cohorts, respectively. Conclusions: The NEV measurement on baseline CT scans may serve as a quantitative imaging biomarker that can objectively reflect tumor biology and provide prognostic insight.
THE IMPACT OF ANNULUS ECCENTRICITY AND OVER-SIZING VALVE DEPLOYMENT FOR LESS PARAVALVULAR LEAKAGE AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT
Authors: Mana Nakao, Kazuki Mizutani, Tsukasa Okai, Keiko Yoshida, Shinsuke Nishimura, Asahiro Ito, Shinichi Iwata, Yosuke Takahashi, Takashi Murakami, Toshihiko Shibata, Minoru Yoshiyama
Journal: Journal of the American College of Cardiology (2018)
<i>Can I do ophthalmology if I am colour blind?</i>
Authors: Emma Jain
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>
miR-451a abrogates treatment resistance in FLT3-ITD-positive acute myeloid leukemia
Authors: Rosanna H. E. Krakowsky, Alexander A. Wurm, Dennis Gerloff, Christiane Katzerke, Daniela Bräuer-Hartmann, Jens-Uwe Hartmann, Franziska Wilke, Christian Thiede, Carsten Müller-Tidow, Dietger Niederwieser, Gerhard Behre
Journal: Blood Cancer Journal (2018)
Risk of Prostate Cancer in Men Treated With 5α-Reductase Inhibitors—A Large Population-Based Prospective Study
Authors: Anna Wallerstedt, Peter Strom, Henrik Gronberg, Tobias Nordstrom, Martin Eklund
Journal: JNCI Journal of the National Cancer Institute (2018)

Studies have shown that 5α-reductase inhibitors (5-ARIs) decrease the risk for low-grade prostate cancer (PC), but results are conflicting concerning high-grade PCs. The objective of the present study is to evaluate the association between 5-ARI treatment for lower urinary tract symptoms and the risk for PC. This is a population-based prospective study on all men age 40 years and older with at least one prostate-specific antigen (PSA) test in Stockholm County from January 2007 until December 2015. Data are derived from the Stockholm PSA and Biopsy Register and Prescribed Drug Register in Sweden, containing data on 5-ARI-use before diagnosis of PC. Cox proportional hazards models were used to estimate the cause-specific hazard ratios of PC for each exposure level relative to men not taking the medication. Of the 333 820 men in the cohort, 23 442 (7.0%) were exposed to 5-ARI at some time during the study period of eight years. Treatment with 5-ARI decreased the risk for overall PC, and the effect was larger with longer time of exposure (0.1 to 2 years: hazard ratio [HR] = 0.81, 95% confidence interval [CI] = 0.71 to 0.93; 2 to 4 years: HR = 0.39, 95% CI = 0.32 to 0.47; 4 to 6 years: HR = 0.40, 95% CI = 0.31 to 0.52; and 6 to 8 years: HR = 0.31, 95% CI = 0.16 to 0.60). Specifically, 5-ARI decreased the risk for PC with Gleason Scores 6 and 7 but did not statistically significantly affect the long-term risk of being diagnosed with a PC with a Gleason Score of 8 to 10 with up to eight years of treatment. Treatment with 5-ARI for lower urinary tract symptoms is safe with respect to prostate cancer risk.
I am currently approaching my third year of specialist training in endocrinology/diabetes. I now feel that I have made the wrong choice and would like to change specialty to gastroenterology. How easy or feasible would this be? Would the year of high intensity medicine at SpR level be counted at all for another number?
Authors: Rebecca Fitzgerald
Journal: BMJ (2006)

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 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. <b>www.bmjcareers.com/advicezone</b>
Abstract 15583: Incidence, Risk Factors and Clinical Impact of Atrial Arrhythmias After Lung Transplantation
Authors: Byung Gyu Kim, Dong Geum Shin, Young Ah Park, Yeong Min Lim, Pil Sung Yang, Hee Tae Yu, Tae Hoon Kim, Bo Young Joung, Hui Nam Pak, Moon Hyoung Lee, Song Yee Kim, Moo Suk Park, Hyo Chae Paik, Jae Sun Uhm
Journal: Circulation (2016)

Introduction:  Atrial arrhythmias (AAs) after lung transplantation (LT) are common but, clinical implications of postoperative AA are not fully determined. We aimed to investigate the incidence, risk factors and clinical outcomes of AAs after LT in adults.   Methods:  Total 90 consecutive patients who underwent LT from 2012 to 2015 were evaluated retrospectively. An arrhythmia episode is defined as documented atrial fibrillation (AF), atrial flutter (AFL) or atrial tachycardia (AT) lasting > 30 minutes on 12-lead ECG or telemetry monitoring.   Results:  Postoperative AAs occurred in 30 of 90 patients, of whom 21 patients had AF, 16 had AFL, and 9 had AT. The mean time to onset after LT was 8.8 ± 8.1 days for AF, 12.4 ± 8.2 days for AFL and 27.3 ± 27.2 days for AT, respectively. AAs were more likely to occur in patients with older age (56.7 ± 11.4 AAs vs. no AAs group 49.1 ± 14.6; p=0.008), combined coronary artery disease (16.7% vs. 3.3%; p=0.039), history of AF before LT (13.3% vs. 1.7%; p=0.041) and postoperative tracheostomy (73.3% vs. 40%; p=0.003) which means longer period of mechanical ventilation. Advanced age (hazard ratio [HR] 1.04, p=0.048) and postoperative tracheostomy (HR 4.02, p=0.007) were found to be independent factors for AAs after surgery. Although most of AAs were paroxysmal, and well controlled with rate control strategy, in-hospital mortality (43.3% vs. 15%; p=0.003) and 1 year overall mortality (60% vs. 26.7%; p=0.002) were higher in patients with postoperative AAs.   Conclusions:  Incidence of AAs after LT was 33.3% in this study. Advanced age and postoperative tracheostomy, which indicates longer duration of mechanical ventilation increase the risk of AAs after LT. AAs were relatively transient after LT, but significantly related with increased mortality.  Figure 1. Kaplan-Meier curve showing 1 year survival in lung transplant patients
Medicine in Chechnya
Authors: Richard A Sturge
Journal: BMJ (2004)

EDITOR —I was interested in Iona Vlad's interview with Khassan Baiev as I had just finished reading The Oath , his harrowing account of the two recent wars in Chechnya.1 I am currently working in the North Caucasus for Medecins Sans Frontieres, supporting medical services in Chechnya and nearby Ingushetia, which still …
The association between physician trust and prostate specific antigen screening: Implications for shared decision making.
Authors: Zachary William Abraham Klaassen, Christopher J.D. Wallis, Hanan Goldberg, Thenappan Chandrasekar, Neil Eric Fleshner, Antonio Finelli, Girish S. Kulkarni, Raj Satkunasivam
Journal: Journal of Clinical Oncology (2018)

13 Background: Most cancer organizations recommend shared decision making for PSA screening, a process relying on a trusting relationship between patient and physician. The objective of this study was to assess the degree to which an individual’s trust in cancer information from their physician compared to internet-based information impacts the likelihood of receiving PSA-screening. Methods: This was a cross-sectional study (2011-2014) of the Health Information National Trends Survey (HINTS), a survey of people living in the US. The primary exposure was degree of trust in cancer information from participant’s physician (CIP). The secondary exposure was degree of trust in cancer information from the internet (CII). The primary outcome was patient-reported receipt of PSA-screening. The Cochran-Armitage test was used to identify significant trends in the primary outcome, across levels of trust. A multivariable logistic regression model assessed the association between CIP and CII with PSA-screening, adjusted for a priori covariates. Results: Among 5069 eligible respondents, 3,606 (71.1%) reported trusting CIP ‘a lot’, 1,186 (23.4%) ‘some’, 219 (4.3%) ‘a little’, and 58 (1.1%) ‘not at all’. 2,655 (52.4%) men received PSA-screening. The degree of trust in CIP was strongly associated with the likelihood of receiving PSA-screening: among men who reported ‘a lot’ of trust, 54.9% underwent screening, 48.6% ‘some’ trust, 38.4% ‘a little’ trust, and 27.6% among men ‘not at all’ trusting their physician (trend p &lt; 0.0001). The degree to which men trusted CII was also associated with having received PSA-screening (p = 0.005), albeit with an insignificant trend (p = 0.07). After multivariable adjustment, these significant results persisted for degree of CIP trust (vs ‘a lot’: ‘some’ OR 0.80, 95%CI 0.66-0.97; ‘a little’ OR 0.61, 95%CI 0.41-0.90; ‘not at all’ OR 0.33, 95%CI 0.15-0.73), but not for trust in CII. Conclusions: The level of trust an individual has in their physician is strongly associated with undergoing PSA-screening. As rationale implementation of PSA screening requires shared decision-making, the level of physician trust has implications for dissemination of PSA-screening guidelines.
Proefferocytic Therapy Promotes Transforming Growth Factor-β Signaling and Prevents Aneurysm Formation
Authors: Yoko Kojima, Norna Werner, Jianqin Ye, Vivek Nanda, Noah Tsao, Ying Wang, Alyssa M. Flores, Clint L. Miller, Irving Weissman, Hongping Deng, Baohui Xu, Ronald L. Dalman, Suzanne M. Eken, Jaroslav Pelisek, Yuhuang Li, Lars Maegdefessel, Nicholas J. Leeper
Journal: Circulation (2018)
Association of Albuminuria With Outcomes in Adults With Congenital Heart Disease
Authors: Roger Andrew de Freitas
Journal: JAMA Cardiology (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Cardiology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Cardiology journal
Real-world evidence in patient-related outcomes (PROs) of metastatic castrate-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate plus prednisone (AA+P).
Authors: Geoffrey Gotto, Vincent Fradet, Darrel Drachenberg, Robert Sabbagh, Ricardo A. Rendon, Bobby Shayegan, Brita Lavender Danielson, Richard Casey, Katherine Chan, Fernando Camacho, Anousheh Zardan, Huong Hew, Andrew Feifer
Journal: Journal of Clinical Oncology (2018)

196 Background: Oral androgen biosynthesis inhibitor, abiraterone acetate plus prednisone (AA+P), has shown to improve survival and patient-related outcomes (PROs) in clinical trials. The COSMiC study (Canadian Observational Study in Metastatic Cancer of the Prostate; ClinicalTrials.gov: NCT02364531) set out to prospectively amass real-world data on mCRPC patients (pts) managed with AA+P in communities within Canada. Here, we report the interim analysis of their PROs. Methods: At planned data cutoff in Sept 2017 after a median follow-up of 33.8 months, 264 pts were enrolled in 39 sites across Canada. Their FACT-P (Functional Assessment of Cancer Therapy – Prostate) and MoCA (Montreal Cognitive Assessment) were evaluated at baseline as well as at weeks 12, 24, 48 and 72 after AA+P initiation. A 10-point decrease denotes clinically significant degradation in FACT-P and a total MoCA score of &gt; = 26 is considered normal. Descriptive analysis was utilized with continuous variables. Changes from baseline were summarized using mean (SD). Results: At a median age of 77 among 264 pts, 230, 185, 110 and 63 pts were available for analysis at their week 12, 24, 48, and 72 assessments respectively. The mean baseline FACT-P total score was 111.2 (19.44) with a &lt; 3-point absolute change from baseline at subsequent assessments, denoting no clinically significant change in functional status over time. The mean baseline MoCA score was 25.2 (4.50), yet all subsequent assessments scored above 26 and a mean absolute change from baseline of &lt; 1, showing an absence of cognitive decline over time. PSA value was available for 221 pts, 64.3% (142/221) and 34.4% (76/221) achieved a PSA decline of &gt; 50% and 90% respectively. All-grade treatment-related adverse events were reported in 63 pts, with 11% who have had AA+P discontinuation or interruption. Conclusions: COSMiC represents the largest Canadian mCRPC cohort treated with AA+P with real world prospective evaluation of PROs. This data demonstrated the maintenance in quality of life and cognitive status over the course of the study, and underscores the importance of PRO utilization in this complex patient population. Clinical trial information: NCT02364531.
Health-related quality-of-life (HRQoL) results from the FAST study: A phase II trial of epirubicin, oxaliplatin, and capecitabine with or without IMAB362 in patients with advanced CLDN18.2+ gastric and gastroesophageal junction adenocarcinoma.
Authors: Robert Morlock, James Turnbull, Steven Blahut, Michelle R Krukas-Hampel, Emily Hawryluk, Özlem Tureci
Journal: Journal of Clinical Oncology (2018)

54 Background: In the FAST study, IMAB362 (loading dose 800 mg/m 2 then 600 mg/m 2 d1 qd21) plus EOX (epirubicin 50 mg/m 2 and oxaliplatin 130 mg/m 2 d1, and capecitabine 625 mg/m 2 bid) was compared with EOX alone in patients with advanced/metastatic gastric (GA), gastroesophageal (GE), and gastroesophageal junction (GEJ) adenocarcinoma. The FAST study exhibited a clinically relevant benefit in PFS and OS with a manageable safety profile in patients treated with IMAB362. Here we present the HRQoL results from the FAST study. Methods: CLDN18.2-positive patients (intermediate/strong membrane staining in ≥40% of cells) with advanced/metastatic GA/GE/GEJ adenocarcinoma were randomized 1:1 to first-line EOX for a maximum of 8 cycles with or without 600 mg/m 2 q3w IMAB362, which after 8 cycles could be continued as monotherapy until disease progression (DP). The EORTC QLQC30 and a gastric cancer specific measure EORTC STO22 were collected at baseline (BL), Cycle 5, end of EOX therapy (EOT) and post-EOT every 12 weeks until DP. Change from BL in EORTC scores over 8 cycles of EOX treatment were analyzed using mixed model repeated measures. Time to deterioration in HRQoL was defined as time from randomization to first minimally clinically important difference (MCID) decline in each HRQoL domain. Results: The HRQoL analysis included 74 EOX and 68 IMAB362 + EOX per protocol patients. There were no significant differences in mean changes from BL in EORTC QLQC30 Global Health Status/QoL Score and STO22 Total Score across the 8 cycles of treatment with EOX. The QLQC30 Nausea and Vomiting domain showed a statistical difference (p = 0.0108) in favor of EOX-only. The median time to first HRQoL MCID deterioration for the QLQC30 Global Health Status was 8.6 mo for EOX + IMAB362 and 6.0 mo for EOX alone (p = 0.008). For patients who remained on IMAB362 post EOT, HRQoL improved from BL. Conclusions: HRQoL was maintained for a longer duration in pts with advanced/metastatic GA/GE/GEJ adenocarcinoma who received EOX + IMAB362 therapy vs EOX alone. HRQoL post EOT was improved for EOX + IMAB362 therapy vs EOX alone. Clinical trial information: NCT01630083.
Patients with cerebral palsy are being failed on multiple levels
Authors: Jacqui Thornton
Journal: BMJ (2018)

The care of young people with a cerebral palsy is being hampered by inconsistent coding, poor transition from paediatric to adult services, and “inadequate” multidisciplinary teamworking, a report has found.1

The report, by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), paints a picture of children and young people receiving treatment in a number of different healthcare settings, including emergency departments, acute wards, critical care units, and outpatient clinics, often across a mix of different organisations that can be difficult to coordinate and manage.

It found inconsistent codes used in documents that record a cerebral palsy, and failure to log the cerebral palsy each time the patient attended the NHS for treatment.

Multidisciplinary team working, which is key for this patient group with complex needs, was viewed as inadequate for 137 out of 285 …
I would like to find out about doing general practice in California as I have family there. I'm finding it difficult to get any information—can you help?
Authors: James Sherifi
Journal: BMJ (2005)

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 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. <b>www.bmjcareers.com/advicezone</b>
ABSENCE OF VISUAL CORONARY ARTERY CALCIUM ON LOW DOSE ATTENUATION CT DURING PET/CT PREDICTS VERY LOW INCIDENCE OF REVASCULARIZATION AND MACE
Authors: Viet T. Le, Stacey Knight, David Min, Kurt Jensen, Donald Lappe, Ritesh Dhar, Kent G. Meredith, Steve Mason, Jeffrey Anderson, J. Muhlestein, Kirk Knowlton
Journal: Journal of the American College of Cardiology (2018)
Myeloid-deprived suppressor cell mediated the prognostic value of platelet-to-lymphocyte ratio for advanced hepatocellular carcinoma patients.
Authors: Xing Li, Xiang-yuan Wu, Nan Jiang, Yan-Fang Xing, Dong-hao Wu, Min Dong
Journal: Journal of Clinical Oncology (2018)

331 Background: Myeloid Deprived Suppressor Cell (MDSC) has been recoganized as a promising target for hepatocellular carcinoma (HCC). However, targeted therapy on MDSC failed to display convincing efficacy. Optimization of patient selection to find the most potential beneficiaries might be a solution to this issue. In the present study, we aimed to identify clinical parameters relevant to MDSC level in HCC patients for future MDSC targeted therapy. Methods: In the present study, a series of 55 HCC patients (prospective group) and 20 healthy donors were analyzed investigating frequencies of MDSC in peripheral blood mononuclear cells (PBMC). Results: As a result, we found that MDSC level was increased in HCC patients compared to healthy donors (10.33% vs 1.54%, p&lt; 0.0001). The monocytes (r 2 = 0.2875, p&lt; 0.0001), neutrophils (r 2 = 0.3630, p&lt; 0.0001) and platelet counts (r 2 = 0.0828, p= 0.0331) in circulation was positively associated with MDSC level. Then, the prognostic value of the above predictors was determined in a retrospective database of 243 HCC patients (retrospective group). The baseline characteristics of prospective and retrospective group were similar. Platelet-to-lymphocyte ratio (PLR) were confirmed to be an independent predictor for OS ( p= 0.003) with the rest parameters presented negative results. Then, advanced HCC patients were divided into two groups based on PLR value ≤111.23 or &gt; 111.23 according to ROC analysis. Patients with low PLR presented higher 3-month survival rate (57.6% vs 37.6%) compared with patients with high PLR. PLR was associated with aggressive behavior of malignancies, such as distant metastasis and portal vein thrombosis. Conclusions: In summary, the present study firstly indentified blood platelet counts was a predictor of MDSC level in PBMC for HCC patients. And, patients with higher PLR might be the optimal patient subgroup for MDSC targeted therapy.
DOES RENAL FUNCTION INFLUENCE THE BENEFIT OF DUAL ANTITHROMBOTIC THERAPY WITH DABIGATRAN IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION? RESULTS FROM RE-DUAL PCI
Authors: Stefan Hohnloser, Philippe Steg, Jonas Oldgren, Georg Nickenig, Robert Gabor Kiss, Zeki Ongen, Jose Navarro Estrada, Ton Oude Ophuis, Gregory Lip, Matias Nordaby, Eva Kleine, Jurrien Ten Berg, Deepak Bhatt, Christopher Cannon
Journal: Journal of the American College of Cardiology (2018)
The cost of child and adolescent mental health services
Authors: Norbert Skokauskas, Tara A Lavelle, Kerim Munir, Filipa Sampaio, Camilla Nystrand, Paul McCrone, David McDaid, Dan Chisholm, Sarah Byford, Poushali Ganguli, Inna Feldman, Myron Belfer
Journal: The Lancet Psychiatry (2018)
Contrary to popular belief, ventilator-associated lower respiratory tract infections are less common in immunocompromised patients
Authors: Lieuwe D. Bos
Journal: European Respiratory Journal (2018)

<b>Ventilator-associated lower respiratory tract infections (VA-LRTIs) are less common in immunocompromised patients than in general ICU patients, so host response might be less important than anticipated in the pathophysiology of VA-LRTIs</b>http://ow.ly/1V6Y30ih8yS