tbuckley/cabot-search huggingface dataset:
A systematic review and meta-analysis on the role of exercise or rest in patients with concussion and mild traumatic brain injury
Authors: Avtar Lal, Stephanie Kolakowsky-Hayner, Jamshid Ghajar, Oscar Vazquez, Maya Balamane
Journal: British Journal of Sports Medicine (2017)

Objective To conduct a systematic review and meta-analysis evaluating the role of exercise or rest in patients with concussion or mild traumatic brain injury. Design Systematic review and meta-analysis. Data sources Medline, PsychInfo, Scopus, Cochrane Controlled Trials Registers and Sport Discus, till March 2016 and hand search of some articles. Study selection Randomised controlled trials (RCTS) and observational studies (OBS) comparing the effect of exercise or rest in patients with concussion, on different outcomes. Participants Children and adults with concussion or mild traumatic brain injury. Intervention Exercise or Rest. Outcomes Post concussive symptoms (PCCS), balance error scoring system (BESS), immediate post concussion assessment and cognitive testing (ImPACT). Main results Our search generated 921 studies. Of these, 5 RCTs and 12 OBS met our inclusion criteria. Methodological quality of most of the studies was poor. Meta-analysis of 6 studies involving more than 556 patients showed statistical significant decrease in PCCS with exercise compared to control, Mean Difference (MD) [95% Confidence Interval (CI)], −14.6 [−17.8, −11.3], p&lt;0.001. There was some clinical, but no statistical heterogeneity among the studies (I2=32%). Exercise did not affect BESS, neuropsychological scale and ImPACT score. There was not effect of rest on total symptoms in patients with concussion and number of patients with symptoms. Conclusion Our systematic review and meta-analysis showed clear benefits of exercise in PCCS. However, the evidence was based on poor quality studies that vary in duration, frequency and intensity of exercise. A good quality RCT needs to be conducted to evaluate a clear effect of exercise and rest in patients with concussion. Competing interests None.
David Oliver: Let’s streamline NHS bureaucracy and then leave it well alone
Authors: David Oliver
Journal: BMJ (2017)

BerkshireThe House of Lords' recent report, The Long-Term Sustainability of the NHS and Adult Social Care, is a considered document, full of prescient evidence. 1Its recommendations include increasing NHS and social care funding, ringfencing public health budgets, and establishing an independent Office for Health and Care Sustainability.Overall, the report is a fairly sound and depoliticised template for the future.
Safe return to play after protocol-based concussion management by a team therapist: a prospective study
Authors: Pierre Frémont, Édith Castonguay, Francesco Pepe-Esposito, Vincent Beaudoin-Hamel, Catherine Desloges, Monika Dionne, Marie-Christine Gourde, Benoit Hogue, Jérémie Lanthier-Plante, Maxime Provencher, Mikael Quirion
Journal: British Journal of Sports Medicine (2017)

Objective To analyse the safety of a multidisciplinary concussion management protocol where a team therapist is involved in return-to-play (RTP) decisions. Design Prospective, pre- post-intervention cohort study over 4 seasons of competition Setting School-based American football program (4 teams; grades 8–12) Participants: 672 players x year (11–17 year old) for a total of 27741 athlete-exposure. Intervention A protocol based on the Concussion In Sport Group recommendations was implemented. A computerised neuropsychological (CNP) test was used at baseline and prior to clearance for unrestricted training. For seasons 1–2, the protocol required the team physician to make all RTP decision while defined criteria allowed the team physiotherapist to make the vast majority of the RTP decisions over seasons 3–4. Outcome measures The primary outcome was the early recurrence (ER) of concussion symptoms following RTP (defined as during the same season). Results A total of 119 concussions were identified (55 and 64 for the first and last 2 seasons, respectively; incidence rate 4, 3: 1000 athlete-exposures). At the time of the first clearance decision, the CNP test contributed to a negative RTP decision in 67% of cases. During seasons 1–2 no ER was observed. During season 3 one injury unrelated to football resulted in one case of ER prior to clearance and, during season 4, one case of ER occurred during the second game, 11 days after clearance. Conclusions Safe management of concussions was achieved whether the team physician or the team therapist was responsible for the application of the terms of the protocol. Competing interests Pierre Frémont chair of the Canadian Concussion Collaborative. Édith Castonguay is the physiotherapist for the football program described in this study. Francesco Pepe-Esposito is Head coach of the football program described in this study. None.
The association between moderate and vigorous physical activity and time to medical clearance to return to play following sport-related concussion in youth ice-hockey players
Authors: Justin Lishchynsky, Luz Palacios-Derflinger, Clodagh Toomey, Carolyn Emery, Keith Yeates, Willem Meeuwisse, Kathryn Schneider
Journal: British Journal of Sports Medicine (2017)

Objective The objective of this study was to determine if youth ice-hockey players who perform more moderate and vigorous physical activity (MVPA) during recovery take longer to achieve medical clearance to return to play (RTP). Design Cohort study. Setting Sport Medicine Centre, Alberta, Canada. Participants Thirty youth ice-hockey players [25 males, 5 females, median age 14 years (range 12–17)] presenting to a sport medicine clinic within 4 days (range 2–20 days) of sustaining a sport-related concussion diagnosed by a sport medicine physician. Exposure Participants MVPA during the first three days following their initial appointment was measured using a waist worn Actigraph accelerometer. MVPA was dichotomized into high (≥45 minutes) and low (&lt;45 minutes) activity based on the median daily MVPA. Outcome The primary outcome was time (days) to medical clearance to RTP. Results All thirty participants performed at least some MVPA over the first three days, despite physician instruction to initially rest following the concussion. Players performing low levels of MVPA reached medical clearance in a median of 15 days (range: 10–30 days). Players performing high levels of MVPA reached medical clearance in a median of 19 days (range: 12–55 days). The low level MVPA group reached medical clearance significantly sooner than the high activity group (log-rank chi 2 =5.27, p=0.02). Conclusions More time in MVPA during the first three days after initial assessment is significantly associated with greater time to medical clearance to RTP. Future research is needed to better understand the optimal amount and timing of MVPA for concussion recovery. Competing interests None.
The technique of thyroidectomy
Authors: Malcolm H Wheeler
Journal: Journal of the Royal Society of Medicine (1998)

The earliest account of thyroidectomy is probably that given by Roger Frugardi of Salerno in 11701. Thyroidectomy remained a rarely performed procedure, William Halsted2 finding accounts of only eight operations in which the scalpel had been used on the thyroid between 1596 and 1800, and of only 69 more cases between 1800 and 1848. The morbidity and mortality, usually from uncontrolled bleeding and sepsis, were prohibitive but advances in general anaesthesia, antisepsis and haemostasis paved the way for surgeons at the turn of the century to make thyroidectomy a safe and acceptable operation. At the forefront of these developments was Theodor Kocher of Berne3 who performed thousands of thyroidectomies bringing the mortality down to under 1%. Today, thyroidectomy should be an extremely safe and uneventful procedure when performed by a trained endocrine surgeon. The term 'thyroidectomy' embraces a variety of surgical procedures on the thyroid, the precise operation being tailored according to the existing pathology (Table 1). Thyroid nodules are a common disorder occurring in 4% of the population and many of these patients, especially when the lesion is solitary or fine needle aspiration (FNA) has raised the possibility of malignancy, are treated by surgery. Unilateral total lobectomy including the isthmus and pyramidal lobe is the minimum procedure necessary to treat such disease and obtain an adequate histological diagnosis. This operation will therefore be described in detail.
The Changing Paradigm for Assessment of Ischemic Coronary Artery Disease
Authors: Ajay J. Kirtane
Journal: JAMA Cardiology (2017)

Christopher M. Cook, MBBS; Ricardo Petraco, MD, PhD; Matthew J. Shun-Shin, MBBS; Yousif Ahmad, MBBS; Sukhjinder Nijjer, MBChB; Rasha Al-Lamee, MBBS; Yuetsu Kikuta, MD; Yasutsugu Shiono, MD; Jamil Mayet, MBChB, MD, MBA; Darrel P. Francis, MB, BChir, MA, MD; Sayan Sen, MBBS, PhD; Justin E. Davies, MBBS, PhD
Relationship of early participation in physical activities to persistent post-concussive symptoms following acute paediatricpediatric concussion
Authors: Roger Zemek, Anne M Grool, Mary Aglipay, Franco Momoli, William P Meehan, Stephen B Freedman, Keith Owen Yeates, Jocelyn Gravel, Isabelle Gagnon, Kathy Boutis, Willem Meeuwisse, Nick Barrowman, Martin H Osmondon
Journal: British Journal of Sports Medicine (2017)

Trial Registration Clinicaltrials.gov Indentifier: NCT01873287 . Objective To investigate if early physical activity (7-days post-injury) was associated with lower risk of persistent post-concussive symptoms (PPCS) compared to guideline-recommended conservative rest. Design Prospective, multicenter, cohort study. Setting Nine tertiary Canadian Paediatric EDs. Participants 2413 children (61% male) aged 5-18 years with acute concussion (&lt;48 hours) with inclusion/exclusion criteria per Predicting Persistent Post-concussive Problems in Paediatrics (5P) study. Assessment of risk factors Participation in physical activities, post-concussive symptoms, and concussion modifiers were assessed using standardised questionnaires at baseline, 7- and 28-days post-injury. Outcome measures PPCS (primary outcome) was defined as ≥3 new or worsening symptoms on Post-Concussion Symptom Inventory at 28-days post-enrolment. The relationship between early physical activity and PPCS was examined using regression, 1:1 propensity-matched, and inverse probability of treatment weighting (IPTW) analyses. Results PPCS occurred in 678/2413 (30.1%) participants. Most children (n=1677, 70%) participated in physical activity at one-week of which only n=528 (31%) were symptom-free. Early physical activity was associated with reduced likelihood of PPCS [regression: OR=0.42, (95% CI: 0.35–0.51)]. Early activity remained associated with reduced PPCS risk when matched 1:1 for propensity score [n=1290, OR=0.56, (95% CI: 0.44–0.71)], and using IPTW [n=2235, OR=0.62, (95% CI: 0.51–0.76)]. Sensitivity analyses (replacement of baseline symptoms with one-week symptoms) maintained significant associations [regression: OR=0.42, (95% CI: 0.35–0.51); propensity matching: OR=0.75, (95% CI: 0.60–0.94); and IPTW: OR=0.69, (95% CI: 0.57–0.85)]. Conclusions Physical activity within 7-days post-injury was associated with lower risk for PPCS in youth recovering from acute concussion. RCTs are urgently needed to confirm these findings and to determine the optimal timing of the initiation of physical activity. Competing interests No competing interests to disclose. This study was supported by Canadian Institutes of Health Research (CIHR) Operating Grant MOP:#126197; CIHR-Ontario Neurotrauma Foundation Mild Traumatic Brain Injury Team Grant TM1:#127047; and CIHR planning grant MRP: #119829. None.
TRTH-24. DEVELOPMENT OF A PRE-OPERATIVE SCORING SYSTEM FOR PREDICTING RISK OF PAEDIATRIC POST-OPERATIVE CEREBELLAR MUTISM
Authors: Robert A Dineen, Shivram Avula, Jo-Fen Liu, Tom Chambers, Manali Dutta, Tim Jaspan, Daniele Soria, Philip Quinlan, Donald C MacArthur, Simon Howarth, Chan Chang Ong, Conor Mallucci, Ram Kumar, Barry Pizer, David A Walker
Journal: Neuro-Oncology (2017)

BACKGROUND: Cerebellar mutism syndrome (CMS) is the commonest and most serious complication of posterior fossa tumour surgery with life-long consequences on speech and motor function. Despite previous identification of pre-operative clinical and radiological predictors of CMS, a unifying pre-operative risk stratification model for use during surgical consent is currently lacking. The aims of the project are to develop a simple pre-operative risk scoring scheme to stratify patients in terms of post-operative CMS risk. METHODS: Pre-operative radiological features were recorded for a retrospectively assembled cohort of 89 posterior fossa tumor patients from two major UK treatment centers (age 2-23yrs; gender 28M,61F; diagnosis: 38 pilocytic astrocytoma, 32 medulloblastoma, 12 ependymoma, 1 high grade glioma, 1 pilomyxoid astrocytoma, 1 atypical teratoid rhabdoid tumor, 1 hemangioma, 1 neurilemmoma, 2 oligodendroglioma). Twenty-six (29%) developed post-operative CMS. Based upon results from univariate analysis and C4.5 decision tree, stepwise logistic regression was used to develop the optimal model and generate risk scores. RESULTS: Univariate analysis identified five significant risks and C4.5 decision tree identified six predictors. The final model has an accuracy of 88.8% (79/89). Using risk score cut-off of 203 and 238 allowed discrimination into low (38/89, predicted CMS probability < 3%), intermediate (17/89, predicted CMS probability 3–52%) and high-risk (34/89, predicted CMS probability ≥ 52%). CONCLUSIONS: We will continue to work with leading neurosurgical centres in Europe and North America to expand the cohort and organise an international workshop in Nottingham to (1) validate and/or modify the preliminary model; (2) compare surgical techniques through detailed discussion; and (3) use the information exchange to establish a stratified approach to cerebellar mutism risk reduction. Following further multi-centre validation, this tool could be of value in providing CMS risk during the consent procedure and for stratifying patients in terms of CMS risk in trials of therapeutic strategies.
Previous radiotherapy and the clinical activity and toxicity of pembrolizumab in the treatment of non-small-cell lung cancer: a secondary analysis of the KEYNOTE-001 phase 1 trial
Authors: Narek Shaverdian, Aaron E Lisberg, Krikor Bornazyan, Darlene Veruttipong, Jonathan W Goldman, Silvia C Formenti, Edward B Garon, Percy Lee
Journal: The Lancet Oncology (2017)
EPND-11. P16 LOSS AND E2F/CELL CYCLE DEREGULATION IN INFANT EPENDYMOMA
Authors: Andrew Donson, Seth Lummus, Rajeev Vibhakar, Nicholas Foreman, BK Kleinshmidt-DeMasters
Journal: Neuro-Oncology (2017)

BACKGROUND: Ependymomas in infants less than 1 year of age (iEPN) have a poorer clinical outcome than EPNs in older children. While radiation therapy is the standard of care for the latter, it is withheld in iEPN to avoid neurotoxicity to immature brain. It is unknown whether the adverse outcome in iEPNs is due to treatment differences or aggressive biology. We examined this question using molecular profiling. METHODS: Six anaplastic posterior fossa (PF) iEPNs had transcriptomic analysis and fluorescence in situ hybridization for loss of p16 and gains of 1q sequences. Results were compared with anaplastic PF EPNs from older children and findings validated by immunohistochemistry. RESULTS: All 6 iEPNs grouped within EPN PF subgroup A (PFA). Further transcriptomic analyses identified E2F targets and G2M checkpoint as the most enriched gene sets in iEPN, which was validated in a larger independent cohort. Accordingly, MIB-1 immunohistochemistry demonstrated a higher mitotic rate in iEPNs than non-infant anaplastic EPN PFA. Genetic analyses demonstrated that loss of p16 was almost exclusive to iEPN, and that none harbored 1q gains. Kaplan-Maier analysis confirmed the poorer clinical outcome of the iEPN cohort. CONCLUSIONS: Biological differences, characterized by genetic loss of p16 without gains of 1q in iEPNs, as well as deregulated E2F target gene transcription, are indicative of deregulated p16-CDK4/6-pRB-E2F pathway activity. This may underlie the poor clinical outcome seen in this group of iEPNs, rather than the withholding of radiation therapy. Results suggest a potential actionable targeted therapy for iEPN, namely CDK4/6 inhibitors such as palbociclib, which has shown favorable safety profiles in children.
Good things come in threes: Communicative acts comprise linguistic, imagistic, and modifying components
Authors: Lena Kästner, Albert Newen
Journal: Behavioral and Brain Sciences (2017)

Gesture and sign form an integrated communication system, as do gesture and speech. Communicative acts in both systems combine categorical linguistic (words or signs) with imagistic (gestures) components. Additionally, both sign and speech can employ modifying components that convey iconic information tied to a linguistic base morpheme. An accurate analysis of communicative acts must take this third category into account.
APOL1 genetic variants are not associated with longitudinal blood pressure in young black adults
Authors: Teresa K. Chen, Michelle M. Estrella, Eric Vittinghoff, Feng Lin, Orlando M. Gutierrez, Holly Kramer, Cora E. Lewis, Jeffrey B. Kopp, Norrina B. Allen, Cheryl A. Winkler, Kirsten B. Bibbins-Domingo, Carmen A. Peralta
Journal: Kidney International (2017)
Bronchoalveolar lavage triacetylfusarinine C (TAFC) determination for diagnosis of invasive pulmonary aspergillosis in patients with hematological malignancies
Authors: Thomas Orasch, Juergen Prattes, Klaus Faserl, Susanne Eigl, Wiebke Düttmann, Herbert Lindner, Hubertus Haas, Martin Hoenigl
Journal: Journal of Infection (2017)
Gemcitabine and Oxaliplatinum (GemOx): An Effective Regimen in Patients with Refractory and Relapsing Hodgkin Lymphoma
Authors: Antonio Gutierrez, Jose Rodriguez, Andres Lopez, Jordi Martinez-serra, Jorge Gines, María Pilar Paredes, Florencia Garcia, Javier Vercher, Josep Balanzat, Raquel Del campo, Pilar Galan, Miguel Morey, Joan Bargay, Juan Besalduch
Journal: Blood (2012)
Long-Term Risk of Subsequent Malignant Neoplasms After Treatment of Childhood Cancer in the DCOG LATER Study Cohort: Role of Chemotherapy
Authors: Jop C. Teepen, Flora E. van Leeuwen, Wim J. Tissing, Eline van Dulmen-den Broeder, Marry M. van den Heuvel-Eibrink, Helena J. van der Pal, Jacqueline J. Loonen, Dorine Bresters, Birgitta Versluys, Sebastian J.C.M.M. Neggers, Monique W.M. Jaspers, Michael Hauptmann, Margriet van der Heiden-van der Loo, Otto Visser, Leontien C.M. Kremer, Cécile M. Ronckers
Journal: Journal of Clinical Oncology (2017)

Purpose Childhood cancer survivors (CCSs) are at increased risk for subsequent malignant neoplasms (SMNs). We evaluated the long-term risk of SMNs in a well-characterized cohort of 5-year CCSs, with a particular focus on individual chemotherapeutic agents and solid cancer risk. Methods The Dutch Childhood Cancer Oncology Group-Long-Term Effects After Childhood Cancer cohort includes 6,165 5-year CCSs diagnosed between 1963 and 2001 in the Netherlands. SMNs were identified by linkages with the Netherlands Cancer Registry, the Dutch Pathology Registry, and medical chart review. We calculated standardized incidence ratios, excess absolute risks, and cumulative incidences. Multivariable Cox proportional hazard regression analyses were used to evaluate treatment-associated risks for breast cancer, sarcoma, and all solid cancers. Results After a median follow-up of 20.7 years (range, 5.0 to 49.8 years) since first diagnosis, 291 SMNs were ascertained in 261 CCSs (standardized incidence ratio, 5.2; 95% CI, 4.6 to 5.8; excess absolute risk, 20.3/10,000 person-years). Cumulative SMN incidence at 25 years after first diagnosis was 3.9% (95% CI, 3.4% to 4.6%) and did not change noticeably among CCSs treated in the 1990s compared with those treated earlier. We found dose-dependent doxorubicin-related increased risks of all solid cancers ( Ptrend < .001) and breast cancer ( Ptrend < .001). The doxorubicin-breast cancer dose response was stronger in survivors of Li-Fraumeni syndrome-associated childhood cancers (leukemia, CNS, and non-Ewing sarcoma) versus survivors of other cancers ( Pdifference = .008). In addition, cyclophosphamide was found to increase sarcoma risk in a dose-dependent manner ( Ptrend = .01). Conclusion The results strongly suggest that doxorubicin exposure in CCSs increases the risk of subsequent solid cancers and breast cancer, whereas cyclophosphamide exposure increases the risk of subsequent sarcomas. These results may inform future childhood cancer treatment protocols and SMN surveillance guidelines for CCSs.
Case 24-1997
Authors: Neil R. Feins, Carolyn C. Compton
Journal: New England Journal of Medicine (1997)

Presentation of CaseA six-year-old boy was admitted to the hospital because of recurrent abdominal pain with vomiting and weight loss.The boy had been well until 3 1/2 months earlier, when he began to experience recurrent periumbilical pain once or twice a week, with vomiting two or three times daily for 1 to 3 days, accompanied by anorexia, reduced energy, and decreased stool frequency. There was no diarrhea, and the vomitus was free of blood and bile. The pain improved after emesis or a bowel movement and worsened after a meal. Three weeks before admission, abdominal and rectal examinations . . .
Erratum: Idiopathic nonspecific interstitial pneumonia: Report of an American Thoracic Society project (American Journal of Respiratory and Critical Care Medicine (2008) 177, (1338-1347))
Authors: W. D. Travis, G. Hunninghake, T. E. King, D. A. Lynch, T. V. Colby, J. R. Galvin, K. K. Brown, M. P. Chung, J. F. Cordier, R. M. Du Bois
Journal: American Journal of Respiratory and Critical Care Medicine (2008)
More Treatments on Deck for Alcohol Use Disorder
Authors: Jeff Lyon
Journal: JAMA (2017)

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