tbuckley/cabot-search huggingface dataset:
The impact of C-reactive protein to albumin ratio on survivals in patients with esophageal cancer.
Authors: Masato Hayashi, Hirofumi Kawakubo, Shuhei Mayanagi, Rieko Nakamura, Kazumasa Fukuda, Koichi Suda, Norihito Wada, Yuko Kitagawa
Journal: Journal of Clinical Oncology (2018)

22 Background: C-reactive protein to albumin (CRP/Alb) ratio is a novel inflammation-based prognostic score. It was originally reported as a prognostic score in septic patients, however, recent reports show CRP/Alb can be a prognostic score in some cancer patients. There are a few reports about CRP/Alb in patients with esophageal cancer. The usefulness of CRP/Alb in patients with esophageal cancer is still unclear. Methods: The aim of this study is to ensure the evidence of CRP/Alb in patients with esophageal cancer as a prognostic score. One hundred and sixty patients with esophageal cancer were reviewed in the current study. CRP/Alb was calculated before the treatment: In neoadjuvant chemotherapy (NAC) patients, CRP/Alb was calculated before NAC, in non-NAC patients, CRP/Alb was calculated before surgery. CRP/Alb was divided into high group and low group, using cut off value 0.035. The number of 0.035 was determined, referred from other reports of CRP/Alb. Results: The distributions of postoperative pathologic stages 0, 1, 2, 3, and 4 were respectively 4, 51, 33, 56, and 16. The number of high CRP/Alb group was 58 (36.3%). That of low CRP/Alb group was 102 (63.7%). In the survival analysis, the patients with high CRP/Alb showed a significantly shorter overall survival. In the multivariate analysis with pathological stage, neoadjuvant treatment, field of lymph node dissection, and CRP/Alb as covariates, CRP/Alb was detected as a significantly independent prognostic score (hazard ratio 2.602; P &lt; 0.001). Conclusions: In this study, CRP/Alb was thought to be a prognostic score with statistical significance in esophageal cancer. Therefore, further investigation of reducing preoperative inflammation and increasing preoperative nutrition in esophageal cancer is needed.
Female doctors are increasingly seeking help for eating disorders, Gerada says
Authors: Abi Rimmer
Journal: BMJ (2014)

More female doctors are seeking help for eating disorders, Clare Gerada, former chair of the Royal College of General Practitioners, has said.

Gerada is medical director of the Practitioner Health Programme, a confidential London based health service for doctors and dentists.1 Speaking at the International Conference on Physician Health in London on Monday 15 September, …
Abstract 11011: Long-Term Outcomes of Definitive Surgical Repair for Congenitally Corrected Transposition of the Great Arteries
Authors: Yuki Nakamoto, In-Sam Park, Yukihiro Takahashi
Journal: Circulation (2015)

Background: Congenitally corrected transposition of the great arteries (ccTGA) is characterized by atrioventricular and ventriculoarterial discordance. The indications, timing, and type of repair vary according to the morphology of the heart, the clinical status of the patient, and the patient’s age. Optimal surgical management of patients with ccTGA remains controversial. Methods: The medical records of all patients with ccTGA who underwent definitive repairs between 1977 and 2013 were retrospectively reviewed. The surgical procedures comprised a physiologic repair in 45 patients, anatomic repair (double switch operation) in 14 patients, and a Fontan-type repair in 12 patients. Results: The Kaplan-Meier survival at 20 years was similar (75.7% in physiologic repair vs. 83.3% in anatomic repair). However, patients with significant TR showed a worse survival rate than those of the other groups (20 year survival without TVR 96.3%, but only 58.6% with TVR). The freedom from reoperation at 10 years was 78.3% in physiologic repair vs. 66.7% in anatomic repair. The freedom from pacemaker implantation at 10 years was 93.0% in physiologic repair vs. 64.3% in anatomic repair. 14 patients underwent a Fontan-type repair without mortality or heart block. Conclusions: No differences were observed between long-term survival rates of patients who underwent physiologic versus anatomic repair. The poorest outcome was seen in patients who required tricuspid valve replacement. Performing an anatomic repair should be considered for patients with significant TR. The best outcome was seen in the patients undergoing the Fontan procedure. However, various complications late after Fontan procedure remain a concern.
Association of DNA repair gene-mutation, mutation burden and, neoantigen load in breast cancer.
Authors: Po-Han Lin
Journal: Journal of Clinical Oncology (2018)

9 Background: Anti-cancer therapy with immune checkpoint inhibitors demonstrated high efficacy in hypermutated tumors; Food and Drug Administration recently proved PD1/PDL-1 blockade therapy in solid tumors characterized with deficiency of mismatch repair (MMR). However, several malignancies contain less feature of MMR deficiency. Except MMR, it remains uncertain whether mutations of other DNA repair genes are associated with hypermutated status. We aim to analyze the relationship between DNA repair gene-mutation statuses, mutation burden and neoantigen load in breast cancer. Methods: Whole exome sequencing was performed on germline and tumor DNA in 82 patients with early-onset breast cancer (≤ 40 year-old). Calculation of mutation burden includes tumor-specific insertion/deletion (Indel) and single nucleotide variants. Missense mutations, frameshift mutations and uncorrected splicing were considered to generate new peptides (neopeptides). Binding affinity of neopeptide-major histocompatibility complex class I and their immunogenicity were predicted by NetMHC 4.0 and POPI 2.0. Results: A total of 18 pathogenic mutations were found, 4 in ATM (2 germline and 2 somatic), 3 in BRCA1 (germline), 4 in BRCA2 (germline), 1 in BRIP1 (germline), 1 in CHK2 (germline), 1 in ERCC8 (germline), 2 in MSH2 (1 germline and 1 somatic), 1 in RAD51C (somatic) and 1 in OGG1 (germline). The median number of exomic mutations (missense mutations and Indels) were 744 (min. 355; max. 3587) variants per sample. Tumors with mutations of homologous recombination (HR) and MMR genes contained a higher trend of exomic mutations than those without mutation. However, tumors with mutations of HR and MMR genes contained significantly higher numbers of neopeptides with high binding affinity and immunogenicity than those without mutation (p = 0.04). Conclusions: Tumors with mutations of HR and MMR genes contained higher numbers of neoantigens. This study showed that HR and MMR mutation may be a biomarker predicted clinical benefit of immune checkpoint blockade therapy in breast cancer.
Occurrence of pathologic stage T3 disease at radical prostatectomy with isup grade group 1 (Gleason 3+3=6) prostate cancer.
Authors: David Theodore Greenwald, Alice Y. Wang, Jason Huang, Harpreet Wadhwa, Tony Nimeh, Justin J. Cohen, Paul Yonover
Journal: Journal of Clinical Oncology (2018)

21 Background: Treatment of ISUP Grade Group 1 (Gleason 3+3 = 6) disease continues to evolve in the modern era. We examined our surgical database to investigate patterns of behavior in this pathologic subset. Methods: We reviewed the results of 1127 consecutive radical prostatectomies performed by our surgeons from 2012−2015 at various community and academic medical centers in Chicagoland. Specifically, we examined the ISUP Grade Group 1 (Gleason 3+3 = 6) patients in our database, 314 patients overall. Results: A review of our database revealed that of ISUP Grade Group 1 (Gleason 3+3 = 6) patients (n = 314), only 3.82% had pT3 disease (11 patients stage pT3a and 1 stage pT3b). The only patient of these 12 to have lymphovascular invasion (LVI) was the singular pT3b patient. Overall, ISUP Grade Group 1 (Gleason 3+3 = 6) pT3 disease represents only 1.06% of all prostatectomies in our database. Conclusions: In our large prostatectomy cohort, ISUP Grade Group 1 (Gleason 3+3 = 6) prostate cancer was rarely associated with extra−prostatic extension (pT3) or lymphovascular invasion (LVI), suggesting that it has very low metastatic potential. These findings give further support to the trend of increased utilization of active surveillance for low risk prostate cancer.
Cover Image: Blisters owing to dermal capillary occlusion by sickle cells
Authors: C. Bachmeyer, P. Moguelet, S. Mattioni, P. Senet, F. Lionnet
Journal: British Journal of Dermatology (2018)

Funding sources: none. Conflicts of interest: none declared. Dear Editor, A 20‐year‐old man with sickle cell anaemia was admitted for vaso‐occlusive crisis and asymptomatic flaccid bullae on the limbs and back (Fig. 1a). Skin biopsy showed a subepidermal bullae with few neutrophils in the lumen, rare basal cell necrosis in the epidermis, capillary occlusion in the upper dermis (Fig. 1b) by sickle cells (Fig. 1c) and negative immunochemistry with antifibrin antibodies (Fig. 1d). The blisters healed within 5 days. Only one case of cutaneous sickle cell crisis with erythematous papules and purpura has been reported.1 In our case, the subepidermal bullae with alterations restricted to the epidermal basal cells could be related to upper dermal localization of capillary occlusion by sickle cells with transient ischaemia.
Southwest trusts look to pursue NHS pay cuts within national framework
Authors: Tom Moberly
Journal: BMJ (2013)

Cuts to pay and conditions for doctors and other NHS staff should be pursued within current national agreements, a group of NHS trusts in the southwest of England has decided.

Since June 2012 a group of 20 NHS trusts and foundation trusts has been looking at the potential to change pay, terms, and conditions of its employees outside national agreements.1 The South West Pay, Terms and Conditions Consortium has been considering how …
Mutation patterns identify adult patients with de novo acute myeloid leukemia aged 60 years or older who respond favorably to standard chemotherapy: an analysis of Alliance studies
Authors: Ann-Kathrin Eisfeld, Jessica Kohlschmidt, Krzysztof Mrózek, James S. Blachly, Christopher J. Walker, Deedra Nicolet, Shelley Orwick, Sophia E. Maharry, Andrew J. Carroll, Richard M. Stone, Albert de la Chapelle, Eunice S. Wang, Jonathan E. Kolitz, Bayard L. Powell, John C. Byrd, Clara D. Bloomfield
Journal: Leukemia (2018)
Response by Merghani et al to Letters Regarding Article, “Prevalence of Subclinical Coronary Artery Disease in Masters Endurance Athletes With a Low Atherosclerotic Risk Profile”
Authors: Ahmed Merghani, Viviana Maestrini, Stefania Rosmini, Andrew T. Cox, Harshil Dhutia, Rachel Bastiaenan, Sarojini David, Tee Joo Yeo, Rajay Narain, Aneil Malhotra, Michael Papadakis, Mathew G. Wilson, Maite Tome, Khaled AlFakih, James C. Moon, Sanjay Sharma
Journal: Circulation (2018)
Relationship between growth, maturation and musculoskeletal conditions in adolescents: a systematic review
Authors: Michael Swain, Steven J Kamper, Christopher G Maher, Carolyn Broderick, Damien McKay, Nicholas Henschke
Journal: British Journal of Sports Medicine (2018)

Objective To determine whether there is a relationship between physical growth and development, as determined by markers of biological maturation, and musculoskeletal conditions in adolescents. Design Systematic review. Data sources Electronic databases (PubMed, EMBASE and the Cumulative Index to Nursing and Allied Health Literature) were searched up to 6 September 2017. Eligibility criteria for selecting studies Studies that evaluated the association between biological maturation or growth and musculoskeletal conditions in adolescents (chronological age 10–19 years). Results From 20 361 titles identified by the searches, 511 full-text articles were retrieved and assessed for eligibility; 56 studies, all at high risk of bias, evaluating the relationship between maturation and/or growth and musculoskeletal conditions were included. A total of 208 estimates of association were identified across the included studies, which generally indicated no association or an unclear association between maturation, growth and musculoskeletal conditions. Summary/Conclusions While the relationship between maturation, growth and musculoskeletal conditions remains plausible, the available evidence is not supportive. The current body of knowledge is at high risk of bias, which impedes our ability to establish whether biological maturity and growth are independent risk factors for musculoskeletal conditions.
Immortal Time Bias in Assessing Evidence-Based Care Processes for <i>Staphylococcus aureus</i> Bacteremia
Authors: Steven Y. C. Tong, Allen C. Cheng, Justin T. Denholm
Journal: JAMA Internal Medicine (2018)

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THE USE OF RIGHT VENTRICULAR IMPELLA IN A PATIENT WITH RIGHT VENTRICULAR FAILURE SECONDARY TO MASSIVE PULMONARY EMBOLISM: A NOVEL ALTERNATIVE TO SURGICAL THROMBECTOMY
Authors: Abdelrahman Ahmed, Sajid Ali, Lamin Bangura, Ahmad Abu-Heija, Jasleen Kaur, Said Ashraf, Mohit Pahuja
Journal: Journal of the American College of Cardiology (2018)
Aluminum hydroxide colloid vaccine encapsulated in yeast shells with enhanced humoral and cellular immune responses
Authors: Hui Liu, Zhenghu Jia, Chengmao Yang, Mei Song, Zhe Jing, Yapu Zhao, Zhenzhou Wu, Liqing Zhao, Dongsheng Wei, Zhinan Yin, Zhangyong Hong
Journal: Biomaterials (2018)
David Oliver: A manifesto for multimorbidity
Authors: David Oliver
Journal: BMJ (2018)

In 2012 a Scottish study of over three million people showed that living with three or more long term medical conditions was the norm for people over 65.1 In 2016 a study that used data from more than 200 000 people in England aged over 75 showed that 7% had severe frailty and 21% moderate frailty.2 This year, researchers predicted that the proportion of people in the UK with four or more long term conditions would nearly double between 2015 and 2035, from 9.8% to 17%.3 Two thirds of these would also have dementia, depression, or cognitive impairment.

The need for a greater focus on prevention of ill health is something I have argued for …
EFFECT OF PREPROCEDURAL HEPARIN ADMINISTRATION ON BIVALIRUDIN-BASED ANTICOAGULATION STRATEGY DURING PRIMARY PERCUTANEOUS CORONARY INTERVENTION: A NETWORK META-ANALYSIS
Authors: Rahman Shah, Mannu Nayyar, Beatrix Ramos Bondy, Amina Chaudhry, Arsa K. Butt, Abigail Shell, Kelly Rogers
Journal: Journal of the American College of Cardiology (2018)
Diffusion radiomics as a diagnostic model for atypical manifestation of primary central nervous system lymphoma: development and multicenter external validation
Authors: Daesung Kang, Ji Eun Park, Young-Hoon Kim, Jeong Hoon Kim, Joo Young Oh, Jungyoun Kim, Yikyung Kim, Sung Tae Kim, Ho Sung Kim
Journal: Neuro-Oncology (2018)

Radiomics is a rapidly growing field in neuro-oncology, but studies have been limited to conventional MRI, and external validation is critically lacking. We evaluated technical feasibility, diagnostic performance, and generalizability of a diffusion radiomics model for identifying atypical primary central nervous system lymphoma (PCNSL) mimicking glioblastoma.
The trainee perspective
Authors: Kate Wiles, Michelle Downie
Journal: BMJ (2005)

We have found these assessment tools to be both trainee centred and training centred. The trainee initiates assessment with a choice of both patient and assessor. The use of a variety of clinical skills, patients, and pathologies on multiple occasions allows for broad based, fair assessment.

In particular, the case based discussion focuses on a trainee's understanding and thought process. This allows an opportunity to discuss and analyse a trainee's clinical thinking and decision making. It provides …
Surgical trainees report poor training owing to working time restrictions
Authors: Caroline White
Journal: BMJ (2012)

Many surgical trainees don’t rate their training highly and primarily blame European working time regulations, finds research published in the Annals of the Royal College of England (suppl 2012; 94: 268-73).

The study is based on the responses of 310 surgical trainees, representing all training grades and every UK postgraduate deanery, in two online surveys conducted in 2009 and 2010.

The surveys aimed to gather information on working arrangements, the impact of the European working time regulations on work-life balance, and quality of training. …
Identification of a novel molecule target for the diagnosis, prediction, and treatment of hepatic metastasis of gastric cancer.
Authors: Mitsuro Kanda, Haruyoshi Tanaka, Takashi Miwa, Daisuke Kobayashi, Chie Tanaka, Hideki Takami, Masamichi Hayashi, Naoki Iwata, Yukiko Niwa, Suguru Yamada, Goro Nakayama, Hiroyuki Sugimoto, Masahiko Koike, Michitaka Fujiwara, Yasuhiro Kodera
Journal: Journal of Clinical Oncology (2018)

53 Background: Hepatic metastasis of gastric cancer has become a growing issue, because effective treatment and specific biomarkers are not available. The aim of this study was to identify a molecule mediating hepatic metastasis, which serves as a diagnostic marker, and to determine its potential as a therapeutic target. Methods: Stable knockdown gastric cancer cells were established using genome editing technique and cell activities were compared to control cells in vitro and in vivo. Tissue expression levels of the candidate molecule were evaluated in 300 patients with gastric cancer and correlated to clinicopathological parameters including patterns of metastasis and recurrences. Results: Global expression analysis revealed that synaptotagmin VII (SYT7) was overexpressed in gastric cancer tissues with hepatic metastasis. Gastric cancer cell lines differentially expressed high levels of SYT7 that positively correlated with those of SNAI1 and TGFB3, and inversely with RGS2. Stable knockout of SYT7 inhibited the proliferation of gastric cancer cells, indicated by increased apoptosis, and decreased cell migration, invasion, and adhesion abilities. The tumorigenicity of SYT7 knockout cells was moderately reduced in a mouse subcutaneous model and more strikingly decreased in a hepatic metastasis model. The protein expression levels of BCL2 and HIF1A were decreased in tumors formed by SYT7 knockout cells, and SYT7 levels in primary gastric cancer tissues were significantly associated with hepatic recurrence, metastasis, and adverse prognosis. Conclusions: SYT7 serves as a target for treating hepatic metastasis of gastric cancer as well as a diagnostic tool.
Shadowing by foundation doctors halves errors, pilot shows
Authors: Helen Jaques
Journal: BMJ (2012)

The four day shadowing period being introduced for medical graduates starting foundation year 1 this summer could halve the number of mistakes made by new doctors, a pilot of the scheme in Bristol has indicated.

In March the Department of Health announced that all new foundation year 1 doctors will spend a minimum of four paid working days shadowing the job that they will be taking up in August.1

The pilot conducted at University Hospitals Bristol NHS Foundation Trust, the results of which have just been published by the health department, found that …
Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial
Authors: Yoanna Skrobik, Matthew S. Duprey, Nicholas S. Hill, John W. Devlin
Journal: American Journal of Respiratory and Critical Care Medicine (2018)

Dexmedetomidine is associated with less delirium than benzodiazepines and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring sedation remains unclear.To determine if nocturnal dexmedetomidine prevents delirium and improves sleep in critically ill adults.This two-center, double-blind, placebo-controlled trial randomized 100 delirium-free critically ill adults receiving sedatives to receive nocturnal (9:30 p.m. to 6:15 a.m.) intravenous dexmedetomidine (0.2 μg/kg/h, titrated by 0.1 μg /kg/h every 15 min until a goal Richmond Agitation and Sedation Scale score of -1 or maximum rate of 0.7 μg/kg/h was reached) or placebo until ICU discharge. During study infusions, all sedatives were halved; opioids were unchanged. Delirium was assessed using the Intensive Care Delirium Screening Checklist every 12 hours throughout the ICU admission. Sleep was evaluated each morning by the Leeds Sleep Evaluation Questionnaire.Nocturnal dexmedetomidine (vs. placebo) was associated with a greater proportion of patients who remained delirium-free during the ICU stay (dexmedetomidine [40 (80%) of 50 patients] vs. placebo [27 (54%) of 50 patients]; relative risk, 0.44; 95% confidence interval, 0.23-0.82; P = 0.006). The average Leeds Sleep Evaluation Questionnaire score was similar (mean difference, 0.02; 95% confidence interval, 0.42-1.92) between the 34 dexmedetomidine (average seven assessments per patient) and 30 placebo (six per patient) group patients able to provide one or more assessments. Incidence of hypotension, bradycardia, or both did not differ significantly between groups.Nocturnal administration of low-dose dexmedetomidine in critically ill adults reduces the incidence of delirium during the ICU stay; patient-reported sleep quality appears unchanged. Clinical trial registered with www.clinicaltrials.gov (NCT01791296).