tbuckley/cabot-search huggingface dataset:
Short-term and long-term outcomes of laparoscopic pylorus-preserving gastrectomy.
Authors: Haruna Onoyama, Haruhiko Cho, Ryouki Oohinata,
Journal: Journal of Clinical Oncology (2018)

181 Background: Distal gastrectomy is still a standard surgical procedure for early gastric cancer locating in the middle third of the stomach. Laparoscopic pylorus-preserving gastrectomy (LPPG) is promising method which can achieve both minimally invasive and function-preserving outcomes; however, the advantage of PPG against laparoscopic distal gastrectomy (LDG) has not been clarified. Methods: This study examined the clinical outcomes of 71 patients who underwent LPPG for cT1 N0 GC located in the middle part of the stomach and 168 patients who underwent LDG with BillrothI reconstruction for cT1 N0 GC located in the middle or lower part of the stomach between September 2006 and December 2014. Surgical outcomes of LPPG were retrospectively compared with those of LDG. Results: The pathological T- and N-stage of the two groups were similar. There was no significant difference in the mean number of resected lymph nodes (37 in LPPG and 33 in LDG). Operation time was longer in LPPG than LDG (248min:LPPG, 228min:LDG) and blood loss were higher in LPPG than LDG (72ml:LPPG, 54ml:LDG). Postoperative hospital stay was longer in LPPG than LDG (13days:LPPG, 11days:LDG). There was no difference in the surgical complications (12.7%:LPPG, 9.5%:LDG) and no mortality occurred(no in-hospital deaths). Only one case of LDG was died of postoperative recurrence. The mean weight loss rate in 3 years after gastrectomy was lower in LPPG than in LDG (7.7% and 10.4%, respectively). Conclusions: LPPG is an acceptable and favorable operative method with possible prevention of weight loss for clinically diagnosed early stage GC.
MACRA: Big Fix or Big Problem?
Authors: J. Eugene Huffstutter
Journal: Annals of Internal Medicine (2018)

Letters6 February 2018MACRA: Big Fix or Big Problem?J. Eugene Huffstutter, MDJ. Eugene Huffstutter, MDArthritis Associates, Hixson, Tennessee (J.E.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0627 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read McWilliams' commentary on the potential risks and benefits of the Merit-based Incentive Payment System with interest (1). Although I agree that this system may exacerbate health care disparities without improving quality or lowering costs, I disagree with 2 of his views.The author suggests that physicians will game the system for profit. He correctly identifies the increased costs of reporting under this system and simultaneously criticizes the incentives for being weak and easily achieved. However, I believe that these views are mutually exclusive: The system is either cheap and easy or expensive and difficult.The ...References1. McWilliams JM. MACRA: big fix or big problem? Ann Intern Med. 2017;167:122-4. [PMID: 28505630]. doi:10.7326/M17-0230 LinkGoogle Scholar2. Geruso M, Layton T. Upcoding: evidence from Medicare on squishy risk adjustment. National Bureau of Economic Research. Working paper no. 21222. Updated 2015. Accessed at www.nber.org/papers/w21222.pdf on 27 December 2017. Google Scholar3. Castellucci M. Two insurers pay $31 million in Medicare Advantage fraud settlement. 30 May 2017. Accessed at www.modernhealthcare.com/article/20170530/NEWS/170539989 on 27 December 2017. Google Scholar4. Livingston S. Justice Department joins Medicare Advantage fraud lawsuit against United Health. 16 February 2017. Accessed at http://modernhealthcare.com/article/20170216/NEWS/170219911 on 27 December 2017. Google Scholar5. Schulte F. Audits of some Medicare Advantage plans reveal pervasive overcharging. 29 August 2016. Accessed at www.npr.org/sections/health-shots/2016/08/29/491543167/audits-of-some-medicare-advantage-plans-reveal-pervasive-overcharging on 27 December 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: Arthritis Associates, Hixson, Tennessee (J.E.H.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0627. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMACRA: Big Fix or Big Problem? J. Michael McWilliams MACRA: Big Fix or Big Problem? J. Michael McWilliams Metrics 6 February 2018Volume 168, Issue 3Page: 235KeywordsConflicts of interestDisclosureGamesHealth careMedicareMotivationPatients ePublished: 6 February 2018 Issue Published: 6 February 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
A COMPARATIVE ANALYSIS OF CLINICAL PREDICTION MODELS VERSUS A CLINICIAN'S ASSESSMENT FOR THE PREDICTION OF OBSTRUCTIVE CORONARY ARTERY DISEASE IN PATIENTS WITH CHEST PAIN
Authors: Jean Ho, Alexander Ivanov, Pavan Patel, Natalia Crenesse-Cozien, Saadat Khan, Krishnanjali Jonnalagadda, Michelle Sayad, Sorin Brener, Terrence Sacchi, John Heitner
Journal: Journal of the American College of Cardiology (2018)
Hazards of Hazard Ratios — Deviations from Model Assumptions in Immunotherapy
Authors: Brian M Alexander, Jonathan D Schoenfeld, Lorenzo Trippa
Journal: New England Journal of Medicine (2018)

Look Beyond Hazard Ratios Many trials are based on the proportional-hazards assumption that an event is equally likely in different treatment groups over time and deviations are related to the intervention. Full Kaplan–Meier estimates from earlier trials may be more informative than summary statistics.
The Canadian Cancer Trials Group PA.7 trial: Results from the safety run in of a randomized phase II study of gemcitabine (GEM) and nab-paclitaxel (Nab-P) versus GEM, nab-P, durvalumab (D), and tremelimumab (T) as first-line therapy in metastatic pancreatic ductal adenocarcinoma (mPDAC).
Authors: Daniel John Renouf, Neesha C. Dhani, Petr Kavan, Derek J. Jonker, Alice Chia-chi Wei, Tina Hsu, Patricia A. Tang, Barbara Graham, Lisa Gallinaro, Tasnia Hasan, Weiwei Li, Kate Hart, Dongsheng Tu, Christopher J. O'Callaghan
Journal: Journal of Clinical Oncology (2018)

349 Background: GEM and Nab-P is a standard first line therapy for mPDAC based on the MPACT Trial. D is a human monoclonal antibody (mAb) that inhibits binding of programmed cell death ligand 1 (PD-L1) to its receptor. T is a mAb directed against the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). PA.7 is designed to evaluate whether combining PD-L1 and CTLA-4 inhibition with GEM and Nab-P increases treatment efficacy. Methods: This randomized phase II study (ClinicalTrials.gov NCT02879318) is assessing the efficacy and safety of GEM and Nab-P vs. GEM, Nab-P, D, and T in patients (pts) with mPDAC (n = 190). Pts with untreated mPDAC and good performance status (ECOG PS 0-1) are eligible. A safety run in was planned for 10 pts receiving GEM, Nab-P, D and T. The study is then planned to randomize pts in a 2:1 ratio to receive GEM (1000mg/m2 D1, 8, 15); Nab-P (125mg/m2 D1, 8, 15); D (1500 mg) D1 q 28 days and T (75 mg) D1 for first 4 cycles vs. GEM and Nab-P alone. The primary endpoint is overall survival (OS); secondary endpoints include progression free survival (PFS), safety, overall response rate and quality of life. Results: 11 pts were enrolled in the safety run in (2 final pts enrolled on the same day). Median (Med) age = 59; 9 male/ 2 female; 2 ECOG 0/ 9 ECOG 1; no pts had prior adjuvant therapy. Med follow-up was 8.3 months at the time of data lock. Med number of treatment cycles was 6 (3-10). The most common Grade 3 or greater adverse events included fatigue (27%), anemia (36%), abnormal WBC (27%), hyponatremia (27%), hypoalbuminemia (45%), and abnormal lipase (45%). 1 pt (9.1%) experienced grade 3 colitis. 8/11 pts (73%) had a partial response, with the med duration of 7.4 months. Disease control rate was 100%. Med PFS was 7.9 months (95% C.I. 3.5-9.2 months). 6-month survival rate was 80% (95% C.I 40.9%-94.6%). Med OS has not been reached. Conclusions: The combination of GEM, Nab-P, D and T was well tolerated and promising efficacy signals were noted. The originally designed randomized phase II study is ongoing, and an international randomized phase III trial is planned. Clinical trial information: NCT02879318.
EXERCISE HEART RATE DURING TREADMILL TEST IS RELATED TO RENAL FUNCTIONAL RESERVE IN ESSENTIAL HYPERTENSIVE PATIENTS: A NOVEL LINK BETWEEN THE HEART AND THE KIDNEYS
Authors: Konstantinos P. Tsioufis, Kyriakos Dimitriadis, Katerina Damianaki, Dimitris Konstantinidis, Theodoros Kalos, Spyros Galanakos, Eirini Andrikou, Rania Katsarou, Konstantinos Konstantinou, Dimitrios Petras, Dimitris Tousoulis
Journal: Journal of the American College of Cardiology (2018)
A preregistration house officer and reigning world karate champion
Authors: Katariina Jarvi
Journal: BMJ (2005)

Zoe Campbell was born and raised in Nottingham. She took up karate at the age of eight. She is the current ladies world karate champion, having won numerous medals along the way. She obtained a first class biochemistry degree at Birmingham University before becoming a postgraduate student at Leicester-Warwick Medical School. She works as a house officer at Walsgrave Hospital, Coventry.
Doctors’ pension contributions to double under reforms
Authors: Helen Jaques
Journal: BMJ (2013)

Doctors’ pension contributions will have doubled once all the changes to contribution rates included in reforms of public sector pensions come into place, the BMA says. 

The government has proposed increasing pension contributions for members of the NHS pension scheme by up to 2.4 percentage points in 2013-14,1 and rates will rise again in 2014-15. NHS staff have already seen their pension contributions rise by a maximum of 2.4 percentage points in April 2012, as part of the government’s plans to implement an overall increase of 3.2 …
Enhancing fatty acid utilization ameliorates mitochondrial fragmentation and cardiac dysfunction via rebalancing optic atrophy 1 processing in the failing heart
Authors: Yongzheng Guo, Zhen Wang, Xinghua Qin, Jie Xu, Zuoxu Hou, Hongyan Yang, Xuechao Mao, Wenjuan Xing, Xiaoliang Li, Xing Zhang, Feng Gao
Journal: Cardiovascular Research (2018)

Heart failure (HF) is characterized by reduced fatty acid (FA) utilization associated with mitochondrial dysfunction. Recent evidence has shown that enhancing FA utilization may provide cardioprotection against HF. Our aim was to investigate the effects and the underlying mechanisms of cardiac FA utilization on cardiac function in response to pressure overload. Transverse aortic constriction (TAC) was used in C57 mice to establish pressure overload-induced HF. TAC mice fed on a high fat diet (HFD) exhibited increased cardiac FA utilization and improved cardiac function and survival compared with those on control diet. Such cardioprotection could also be provided by cardiac-specific overexpression of CD36. Notably, both HFD and CD36 overexpression attenuated mitochondrial fragmentation and improved mitochondrial function in the failing heart. Pressure overload decreased ATP-dependent metalloprotease (YME1L) expression and induced the proteolytic cleavage of the dynamin-like guanosine triphosphatase OPA1 as a result of suppressed FA utilization. Enhancing FA utilization upregulated YME1L expression and subsequently rebalanced OPA1 processing, resulting in restoration of mitochondrial morphology in the failing heart. In addition, cardiac-specific overexpression of YME1L exerted similar cardioprotective effects against HF to those provided by HFD or CD36 overexpression. These findings demonstrate that enhancing FA utilization ameliorates mitochondrial fragmentation and cardiac dysfunction via rebalancing OPA1 processing in pressure overload-induced HF, suggesting a unique metabolic intervention approach to improving cardiac functions in HF.
Doctors most complained about profession in hospitals
Authors: Caroline White
Journal: BMJ (2012)

Doctors continue to be the most complained about groups of healthcare professionals in hospital and community services and are around twice as likely to be complained about as nurses, show the latest figures on written complaints made about the NHS in England.

A report on written complaints in the NHS for 2011-12, published by the Health and Social Care Information Centre, shows that the “medical profession” attracted the largest proportion of complaints about NHS staff in hospital and community …
I have two medical conditions that are usually well controlled on medication. However, if I were to stop the medication, I would develop difficulty in coping with everyday life. Does this mean they qualify under the Disability Discrimination Act, even though they are normally well controlled? Do I have to declare them to employers or only to occupational health?
Authors: Carl Gray
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>
Afatinib is active in osteosarcoma in vitro models
Authors: M. Cruz Ramos, Y. Zamudio-Cuevas, K. Martínez-Flores, D. Medina-Luna, G. Martínez-Nava, J. Fernández-Torres, A. López Reyes, F. Solca
Journal: Annals of Oncology (2018)
Inducing hair follicle neogenesis with secreted proteins enriched in embryonic skin
Authors: Sabrina Mai-Yi Fan, Chia-Feng Tsai, Chien-Mei Yen, Miao-Hsia Lin, Wei-Hung Wang, Chih-Chieh Chan, Chih-Lung Chen, Kyle K.L. Phua, Szu-Hua Pan, Maksim V. Plikus, Sung-Liang Yu, Yu-Ju Chen, Sung-Jan Lin
Journal: Biomaterials (2018)
Sensitization and Exposure to Other Indoor Allergens May Attenuate the Clinical Benefit of Mouse Allergen Reduction Among Mouse-Sensitized Urban Children with Asthma
Authors: Sara C. Sadreameli, Jean Curtin-Brosnan, Ammara G. Ahmed, Matthew Perzanowski, Wanda Phipatanakul, Susan L. Balcer-Whaley, Adnan Divjan, Elizabeth C. Matsui
Journal: Journal of Allergy and Clinical Immunology (2018)
ASSESSMENT OF RIGHT VENTRICULAR PERFORMANCE: COMPARISON BETWEEN 2D-ECHO AND CARDIAC MAGNETIC RESONANCE
Authors: Wai Ling Jessica Poon, Xiaowan Tong, Kenji Shiino, Jonathan Chan, Ying Wah Andrew Li, Kit Chan, Ming-Yen Ng, Yuk Kong Lau
Journal: Journal of the American College of Cardiology (2018)
The FACT inhibitor CBL0137 Synergizes with Cisplatin in Small-Cell Lung Cancer by Increasing <i>NOTCH1</i> Expression and Targeting Tumor-Initiating Cells
Authors: Sarmishtha De, Daniel J. Lindner, Claire J. Coleman, Gary Wildey, Afshin Dowlati, George R. Stark
Journal: Cancer Research (2018)

Abstract Traditional treatments of small-cell lung cancer (SCLC) with cisplatin, a standard-of-care therapy, spare the tumor-initiating cells (TIC) that mediate drug resistance. Here we report a novel therapeutic strategy that preferentially targets TICs in SCLC, in which cisplatin is combined with CBL0137, an inhibitor of the histone chaperone facilitates chromatin transcription (FACT), which is highly expressed in TICs. Combination of cisplatin and CBL0137 killed patient-derived and murine SCLC cell lines synergistically. In response to CBL0137 alone, TICs were more sensitive than non-TICs, in part, because CBL0137 increased expression of the tumor suppressor NOTCH1 by abrogating the binding of negative regulator SP3 to the NOTCH1 promoter, and in part because treatment decreased the high expression of stem cell transcription factors. The combination of cisplatin and CBL0137 greatly reduced the growth of a patient-derived xenograft in mice and also the growth of a syngeneic mouse SCLC tumor. Thus, CBL0137 can be a highly effective drug against SCLC, especially in combination with cisplatin. Significance: These findings reveal a novel therapeutic regimen for SCLC, combining cisplatin with an inhibitor that preferentially targets tumor-initiating cells. Cancer Res; 78(9); 2396–406. ©2018 AACR.
Response to Comment on Novodvorsky et al. Diurnal Differences in Risk of Cardiac Arrhythmias During Spontaneous Hypoglycemia in Young People With Type 1 Diabetes. Diabetes Care 2017;40:655–662
Authors: Michael Campbell, Simon R. Heller, Richard M. Jacques
Journal: Diabetes Care (2018)

We welcome the opportunity to respond to the comments from Home and Lachin (1) on our article (2). One of us (M.C.) has independently reexamined the nighttime bradycardia data using the negative binomial generalized estimated equations approach (SPSS version 22; IBM, Chicago, IL) described in our article. With autocorrelated error terms, he could approximately replicate our results (incident rate ratio [IRR] 5.7 [95% CI 5.0, 6.5], P < 0.001 vs. IRR 6.4 [95% CI 6.3, 6.6], P < 0.001) as previously reported. The minor differences are probably because in the article, autocorrelation within subjects between days was accounted for, as was autocorrelation within subjects between hours. He agreed that the model that we used is a reasonable approach as it models over dispersed count data and allows both for the correlation within subjects and that the data are ordered as a time series within each person. He did however identify an unusual distribution of the data. We have therefore conducted additional analyses.

Table 1 shows the number and percentage of hours where subjects have no bradycardia counts and at …
Current Concepts in Meniscus Tissue Engineering and Repair
Authors: Bahar Bilgen, Chathuraka T. Jayasuriya, Brett D. Owens
Journal: Advanced Healthcare Materials (2018)

Abstract The meniscus is the most commonly injured structure in the human knee. Meniscus deficiency has been shown to lead to advanced osteoarthritis (OA) due to abnormal mechanical forces, and replacement strategies for this structure have lagged behind other tissue engineering endeavors. The challenges include the complex 3D structure with individualized size parameters, the significant compressive, tensile and shear loads encountered, and the poor blood supply. In this progress report, a review of the current clinical treatments for different types of meniscal injury is provided. The state‐of‐the‐art research in cellular therapies and novel cell sources for these therapies is discussed. The clinically available cell‐free biomaterial implants and the current progress on cell‐free biomaterial implants are reviewed. Cell‐based tissue engineering strategies for the repair and replacement of meniscus are presented, and the current challenges are identified. Tissue‐engineered meniscal biocomposite implants may provide an alternative solution for the treatment of meniscal injury to prevent OA in the long run, because of the limitations of the existing therapies.
Long-term sexual functioning in germ-cell tumor survivors.
Authors: Michal Chovanec, Lucia Vasilkova, Lucia Setteyova, Jana Obertova, Patrik Palacka, Katarina Rejlekova, Zuzana Sycova-Mila, Katarina Kalavska, Daniela Svetlovska, Beata Mladosievicova, Jozef Mardiak, Michal Mego
Journal: Journal of Clinical Oncology (2018)

549 Background: Treatment for germ-cell tumors (GCT) may lead to long-term consequences in GCT survivors. This study aimed to evaluate a long-term sexual functioning after curative treatment for GCT. Methods: GCT survivors (N = 155) from a national cancer centre completed a Sexual Function Questionnaire that was modified from PROMIS Sexual Function and Satisfaction Questionnaire at a median 10 years of follow up (range 5-32) as a primary exploratory aim. Seventeen survivors (11%) had orchiectomy alone (controls), while 138 (89%) survivors received treatment beyond orchiectomy. The study group consisted of survivors receiving a cisplatin-based chemotherapy, radiotherapy to the retroperitoneal lymph nodes or both, while the control group included survivors treated with orchiectomy only. Results: Survivors treated with both chemotherapy and radiotherapy or any treatment had difficulty maintaining erection during the intercourse compared to the controls (both P = 0.04). Moreover, patients who received chemotherapy and radiotherapy reported difficulty in achieving orgasm during the intercourse ( P = 0.04) and they were disappointed with their overall quality of sex life ( P = 0.002). No difference in education, employment, marital status and parity was observed between the study groups (all P &gt; 0.05). GCT survivors reported no differences in their sexual desire and in the number of attempts to initiate sexual intercourse in the last month. Survivors from all treatment groups reported none or mild anxiety resulting from sexual relationships and the desire to be sexually active was moderate among all subgroups, with no significant difference. Conclusions: Our prospective study shows that an impairment insexual function is a significant issue for long-term GCT survivors. Treatment with chemotherapy plus radiotherapy had the highest impact on the quality of sex life.
How can I train to become a careers counsellor/coach?
Authors: Susan Kersley
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 (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.
Abstract P4-10-19: Disparities in use of adjuvant radiotherapy following lumpectomy among California regions
Authors: RJ Huang, RA Mukhtar, M Alvarado
Journal: Cancer Research (2018)

Abstract Background Women undergoing lumpectomy for invasive breast cancer typically receive radiotherapy (RT) to reduce risk of recurrence. Previous studies have reported disparities in the utilization of RT by race, socioeconomic status (SES), and age. In this study, we evaluate whether various sociodemographic factors are associated with use of RT in the different regions of California. Methods Utilizing data from the California Cancer Registry, the authors identified cases of women whose first primary invasive breast cancer was diagnosed between January 1, 2007 and December 31, 2012, whose primary surgery was breast conserving surgery, and for whom information was complete (n = 71,767). Multivariate logistic regression was used to determine whether demographic factors (SES, race, payer status, age) were significantly associated with use of RT following lumpectomy (p &amp;lt; .05), adjusting for tumor characteristics (size, stage, grade, hormone receptor status, and nodal status). Results In three out of eight regions in California, black race was associated with decreased odds of RT use (San Francisco, OR = 0.79, 95% CI = 0.68-0.92; Desert Sierra, OR = 0.72, 95% CI = 0.58-0.90; Los Angeles, OR = 0.78, 95% CI = 0.70-0.87). In Sacramento and Los Angeles regions, lower socioeconomic status was associated with declined odds of RT use. Age (70 years or older) was also associated with lower likelihood of RT use across all regions. Conclusions Even after accounting for payer status, racial and socioeconomic disparities persist in the use of RT. These disparities, previously documented in the time period of 2000-2007, have not disappeared. Hispanic race was not shown to be associated with decreased odds of RT use in Los Angeles, contrary to the results of a previous study. Women aged 70 years or older are less likely to receive RT. Citation Format: Huang RJ, Mukhtar RA, Alvarado M. Disparities in use of adjuvant radiotherapy following lumpectomy among California regions [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 P4-10-19.
USE OF ELECTRONIC PATIENT REPORTED OUTCOMES AND AUTOMATED DEVICES FOR HEART FAILURE DISEASE MANAGEMENT
Authors: Emamuzo Otobo, Ashish Atreja, Robert Freeman, Jason Rogers, Farah Fasihuddin, Allyssa Deorocki, Rivelle Zlatopolsky, Marni Goldstein, Jennifer Ullman, Sean Pinney
Journal: Journal of the American College of Cardiology (2018)