tbuckley/cabot-search huggingface dataset:
Variation in incidence trends of malignant pleural mesothelioma in Europe
Authors: Mohammed Ahmed, Antoinette Flannery, Irfan Mujammil, David Breen
Journal: European Respiratory Journal (2018)

We read with interest the article by Ji et al. [1] regarding the epidemiology of malignant pleural mesothelioma (MPM) in Sweden and familial clustering. The data in the study show the incidence of MPM in Sweden peaked in 2000 and has sharply declined since 2005. Data from other countries suggest a more delayed peak [2–4]. The highest annual incidence of MPM in the world has been reported to occur in the UK and Australia [5]. The incidence of MPM was predicted to peak in UK between 2011 and 2015; this was based on the known associated high latency period and the ban in using asbestos-containing products [6]. This variability in incidence trends across Europe can be explained by the different dates of asbestos bans in Europe, but Ireland migration trends also potentially play a role. Data from our institute indicates that the incidence of malignant mesothelioma has been increasing over the last decade (20 new cases diagnosed in 2002–2008 versus 26 cases in 2009–2013, an increase of 30% (95% CI 11.9–54.2%)). These findings are consistent with the statistics from the National Cancer Registry Ireland (figure 1) [7]. The incidence of malignant pleural mesothelioma is rising in some European countries; migration trends play a role <http://ow.ly/YPRr30hAd3T>
Thrombus-Related Coronary High-Intensity Signal on T1-Weighted Magnetic Resonance Imaging Is a Potential Predictor of Adverse Cardiovascular Events After Stent Implantation
Authors: Kenji Matsumoto, Shoichi Ehara, Takao Hasegawa, Satoshi Nishimura, Kenei Shimada
Journal: JACC. Cardiovascular imaging (2018)
Practical Introduction to Intensive Care
Authors: Camille Gajria
Journal: BMJ (2008)

Practical Introduction to Intensive Care is a one day introductory course covering hands-on aspects of critical care. It is designed to give junior doctors an overview of modern intensive care practice, making it easier to manage patients on the unit.

The course is aimed at doctors who have minimal experience of working in intensive care or high dependency units. This may include doctors who are about to rotate to an intensive care job, as well as medics and surgeons who are likely to visit patients on the unit. Delegates range from house officers to medical registrars. Attendance on this course can help show …
Abstract 12761: The Association of Resting and Exercise Ventricular-Vascular Coupling With Heart Failure Hospitalization in Patients With Stable Coronary Heart Disease and Preserved Systolic Function: The Heart and Soul Study
Authors: Jesse K Fitzpatrick, Nelson B Schiller, Mary A Whooley, Rakesh K Mishra
Journal: Circulation (2016)

Introduction: The ventricular-vascular coupling ratio ( E A /E ES ) is defined as the ratio of arterial (E A ) to left ventricular elastance (E ES ) and is a key determinant of cardiac performance. Contractile reserve with exercise is inversely related to changes in the E A /E ES in healthy patients. However, the prognostic value of the E A /E ES at rest and its change with exercise has not been evaluated in patients with stable coronary heart disease (CHD) and preserved systolic function. Methods: Among 647 patients with stable CHD and left ventricular ejection fraction ≥50%, we evaluated the association of baseline echocardiographically-determined E A , E ES , and E A /E ES , at rest and at peak exercise, with subsequent heart failure hospitalization (HF) during 7.5±2.8 years of follow-up. Results: Both E A (2.1±0.7 to 3.0±1.6 mmHg/mL, p&lt;0.001) and E ES (4.0±1.63 to 7.0±4.5 mmHg/mL, p&lt;0.001) increased significantly with exercise compared to rest. E A / E ES decreased from 0.67±0.40 at rest to 0.63±0.52 at peak exercise (p=0.001). Overall, 75 (12%) patients were hospitalized for HF. In multivariable adjusted models, participants with higher resting E ES (HR 0.75 per mmHg/mL increase, 95% CI 0.61 - 0.89, p = 0.004) were at lower risk for HF hospitalization while those with higher resting E A /E ES (HR 5.0 per unit increase, 95% CI 1.19 - 12.85, p&lt;0.001) were at increased risk for HF hospitalization. With exercise, each doubling of E A /E ES was associated with a 25% increased risk of incident HF in the fully adjusted model (H.R. 1.25 per doubling, 95% C.I. 1.08-1.45, p&lt;0.002). Neither resting E A nor its change with exercise predicted HF hospitalization. Conclusions: In patients with stable CHD and preserved systolic function, E A /E ES decreases with exercise while both its components, arterial and ventricular elastance, increase. A higher resting E A /E ES and its increase with exercise are independently associated with an increased risk of HF hospitalization.
Doctors from some medical schools are more likely to pass specialist exam
Authors: Ingrid Torjesen
Journal: BMJ (2012)

Doctors who attended particular medical schools, such as Oxford, Cambridge, and Edinburgh, are more likely to pass their specialist training exams, says research published online in the Postgraduate Medical Journal (doi:10.1136/postgradmedj-2011-130479).

The researchers looked at the first time pass rate for both parts of the Royal College of Obstetricians and Gynaecologists membership (MRCOG) examinations, a prerequisite for doctors who want to complete specialist training in obstetrics and gynaecology, and assessed the potential effects on pass rates of the medical school attended, sex, and overall academic performance at A level.

Between 1998 and 2008 …
Abstract P5-09-02: Tβ4 expression in cancer-associated endothelial cells enhances progression of invasive breast cancer
Authors: J Cai, W Jiang
Journal: Cancer Research (2018)

Abstract Background: Invasive breast cancer is a highly aggressive primary breast tumour with poor prognosis. As tumour angiogenesis is exhibited by invasive breast cancer, anti-angiogenic therapy has been intensively evaluated over the past decade. However, clinical studies were disappointing. Thymosin β4 (Tβ4), a multi-functional peptide, is associated with induction of angiogenesis, but the role of Tβ4 in tumorigenesis of invasive breast cancer is unknown. We tested whether Tβ4 inhibition could be a new target involved in tumour development and tumour angiogenesis for treatment of invasive breast cancer. Methods: We have adapted a 3D co-culture system to acquire invasive breast cancer cells-associated endothelial cells (ECs), which is followed by characterising the differential gene expressions by PCR-based subtraction analysis. We performed Western blot analysis on the protein samples obtained from ECs-stimulated by invasive breast cancer cells. Expression of Tβ4 in invasive breast cancer was assessed by qPCR in the breast tissues (tumour, n=119; background, n=55), and protein expression confirmed by immunohistochemical examination in an invasive breast cancer tissue microarray. Finally, mice breast cancer xenografts plus non-invasively photoacoustic microscopy were used to analyse the effect of Tβ4 knockdown on the tumorigenesis of invasive breast cancer. Results: We found that invasive breast cancer cells could stimulate an increase in Tβ4 expression in microvascular ECs. High Tβ4 levels were strongly associated with high malignant invasive breast cancer and poor clinical outcome. In vivo study showed that siRNA targeting Tβ4 blocked growth of invasive breast cancer in mice. Photoacoustic imaging revealed that knockdown of Tβ4 elicited anti-breast cancer growth, in part, through disruption of tumour vasculature. Our results demonstrate that endothelial cell-derived Tβ4 enhances the progression of breast cancer by up-regulating tumour angiogenesis and it indicates that a high level of tumour stromal Tβ4 is an independent predictor of poor outcome. Conclusions: Inhibiting endothelial Tβ4 could be a new therapeutic target in anti-angiogenic strategy for treatment of invasive breast cancer. Citation Format: Cai J, Jiang W. Tβ4 expression in cancer-associated endothelial cells enhances progression of invasive breast cancer [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 P5-09-02.
I am a second year medical student. I am interested in pursuing a career in obstetrics. Please tell me what I should choose at each level during medical school and after graduation.
Authors: Dharani Hapangama
Journal: BMJ (2007)

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>
18-month efficacy and safety update from JAVELIN Merkel 200 part A: A phase II study of avelumab in metastatic Merkel cell carcinoma progressed on chemotherapy.
Authors: Sandra P. D'Angelo, Jeffery Scott Russell, Shailender Bhatia, Omid Hamid, Janice M. Mehnert, Patrick Terheyden, Kent C. Shih, Isaac Brownell, Celeste Lebbé, Karl D. Lewis, Gerald P. Linette, Michele Milella, Meliessa Hennessy, Marcis Bajars, Isabella Zwiener, Paul Nghiem
Journal: Journal of Clinical Oncology (2018)

192 Background: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer. Avelumab, a human anti–PD-L1 monoclonal antibody, is FDA and EMA approved for the treatment of metastatic MCC (mMCC). Here, we report efficacy and safety data for avelumab in patients (pts) with mMCC at ≥18-mo of follow-up. Methods: Pts with mMCC and progression on prior chemotherapy received avelumab 10 mg/kg IV Q2W. Objective response rate (ORR), duration of response (DOR), and progression-free survival (PFS) were evaluated by independent review committee (RECIST v1.1) with tumor assessment every 6 wks; overall survival (OS) and adverse events (AEs; NCI CTCAE v4.0) were also evaluated. Results: As of Mar 24, 2017, 88 pts were treated and followed for a median of 23.0 mo (range 18.7–32.0). Median treatment duration was 17 wks (range 2–132; mean 35 wks ±37). Treatment was ongoing in 15 pts (17%); 7 pts (8%) voluntarily discontinued with continuing responses (5 complete responses [CR] and 2 partial responses). Other reasons for discontinuation were disease progression (n = 42; 48%), death (n = 10; 11%), AE (n = 8; 9%), or consent withdrawal/other (n = 6; 7%). Confirmed ORR of 33% (95% CI 23.3–43.8; CR in 11.4%) remained unchanged from previous analysis and median DOR has not been reached (range 2.8–24.9 mo; 95% CI 18.0–not estimable). Responses were ongoing in 20/29 pts (69%), including 5 pts with &gt; 2 y of follow-up. PFS curve showed a plateau with identical 12- and 18-mo rates of 29% (95% CI 19–39). Median OS was 12.6 mo (95% CI 7.5-19.0) and the 12- and 18-mo OS rates were 51% (95% CI 40–61) and 40% (95% CI 29–50), respectively. 66 pts (75%) had a treatment-related (TR)AE, most commonly ( &gt; 10%) fatigue (25%), infusion-related reaction (15%; all grade 1/2), nausea (11%), and diarrhea (11%); 8 (9%) had a grade ≥3 TRAE. 17 pts (19%) had an immune-related AE, which was grade ≥3 in 4 pts (4.5%). No treatment-related deaths occurred. Conclusions: Updated results demonstrate continued durable antitumor activity of avelumab in pts with mMCC, beyond that expected with cytotoxic chemotherapy. The median OS exceeding 1 y and manageable safety profile of avelumab signify a clinically meaningful benefit in pts with mMCC. Clinical trial information: NCT02155647.
What is the next step for current F2 trainees with interest in general medicine? Application process is not very clear to us. Where should we be looking for job advertisements apart from <i>BMJ Careers</i> ?
Authors: Howard Clark
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>
Body mass index and mortality in patients with gastric cancer: A large cohort study.
Authors: Jung Hwan Lee, Boram Park, Jungnam Joo, Young-Il Kim, Chan Gyoo Kim, Jong Yeul Lee, Il Ju Choi, Hong Man Yoon, Bang Wool Eom, Keun Won Ryu, Young Woo Kim, Soo-Jeong Cho
Journal: Journal of Clinical Oncology (2018)

16 Background: Although excess body weight has been known to be an important risk factor for mortality from many cancers including colorectal, endometrial and breast cancers, the prognosis of gastric cancer (GC) in obese patients seems controversial. Methods: We aimed to evaluate the association between body mass index (BMI) and mortality in GC in a large cohort. A single institute cohort of 7,765 GC patients undergoing curative gastrectomy between October 2000 and June 2016 were categorized into 6 groups; underweight (&lt; 18.5 kg/m2), normal (18.5 to &lt; 23 kg/m2), overweight (23 to &lt; 25 kg/m2), obese I (25 to &lt; 28 kg/m2), obese II (28 to &lt; 30 kg/m2), and severely obese (≥30 kg/m2). The hazard ratios (HRs) for overall survival and disease-specific survival were calculated using Cox proportional hazard model. Results: We identified 1,279 all-cause and 763 disease-specific deaths among 7,765 patients, and the median follow-up period was 83.05 months (range, 1.02-186.97 months). In multivariable analyses adjusted by age, sex, tumor stage, comorbidity and operation methods, preoperative BMI was associated with all-cause mortality in a nonlinear pattern. As compared with patients who were normal weight, underweight BMI showed increasing mortality risk (hazard ratio (HR), 1.42, 95% confidence interval (CI), 1.15-1.77). In contrast, patients who were overweight (HR, 0.84; 95% CI, 0.73-0.97), obese I (HR, 0.77; 95% CI, 0.66-0.90) and obese II (HR, 0.77; 95% CI, 0.59-1.01) had lower risk of mortality. disease-specific mortality also had a similar pattern to overall survival showing the lowest mortality in obese II group (HR, 0.59; 95% CI, 0.40-0.88). There was no significant difference in severely obese patients in both all-cause and disease-specific mortalities. In spline analyses illustrated by a bell-shaped curve, risk for all-cause mortality was the lowest in patients with 26.67 kg/m 2 . Conclusions: Preoperative overweight and obese patients (23 to &lt; 30 kg/m2) had lower all-cause and disease-specific mortalities compared to those with normal weight in GC patients who underwent curative surgical resection.
Redundant military medical staff should work for NHS in Wales, Plaid Cymru says
Authors: Abi Rimmer
Journal: BMJ (2015)

Armed forces medical staff members who have been made redundant should be recruited to work in the NHS in Wales, Plaid Cymru has said.

Elin Jones, the party’s shadow health minister, said that it would be a wasted opportunity not to employ trained military medical staff in the NHS. The party’s call followed an announcement by the British army that it was launching a new army …
Detailed analysis of clonal evolution and cytogenetic evolution patterns in patients with myelodysplastic syndromes (MDS) and related myeloid disorders
Authors: Julie Schanz, Naciye Cevik, Christa Fonatsch, Friederike Braulke, Katayoon Shirneshan, Ulrike Bacher, Detlef Haase
Journal: Blood Cancer Journal (2018)

Abstract Clonal cytogenetic evolution (CE) (i.e., acquisition of new chromosomal aberrations over time) is relevant for the progression of myelodysplastic syndromes (MDS). We performed detailed analysis of CE in 729 patients with MDS and related disorders. Patients with CE showed shorter survival (median OS 18.0 versus 53.9 months; P &lt; 0.01), higher leukemic transformation rate (48.0% versus 21.4%; P &lt; 0.01) and shorter intervals to leukemic transformation ( P &lt; 0.01). Two main CE patterns were detected: early versus late CE (median onset 5.3 versus 21.9 months; P &lt; 0.01) with worse survival outcomes for early CE. In the case of CE, del (7q)/−7 ( P = 0.020) and del (17p) ( P = 0.002) were especially unfavorable. Extending the evolution patterns from Tricot et al. (1985) forming five subgroups, prognosis was best (median OS not reached) in patients with “transient clones/changing clone size”, whereas those with “CE at diagnosis” showed very poor outcomes ( P &lt; 0.01 for comparison of all). Detailed sequential cytogenetic analysis during follow-up improves prognostication in MDS patients and acknowledges the dynamic biology of the disease. Evidence, time-point, and patterns of cytogenetic clonal evolution should be included into future prognostic scoring systems for MDS.
LONG-TERM OUTCOMES OF CARDIAC RESYNCHRONIZATION THERAPY IN ASYMPTOMATIC HEART FAILURE PATIENTS
Authors: Valentina Kutyifa, Blanca Quesada, Helmut Klein, Yitschak Biton, Scott McNitt, Bronislava Polonsky, Wojciech Zareba, Arthur Moss, Aurelio Quesada
Journal: Journal of the American College of Cardiology (2018)
Planning work overseas
Authors: Mark Wilson
Journal: BMJ (2004)

Medicine is your passport—you can use it to travel the world and get involved in many different cultures. Here are a few tips to get you started.

1.  Have a plan—and plan early. Think “when?” (in your career), “where?” (developed or developing world), and “how?” (are you going to organise it yourself or let an agency or non-governmental organisation (NGO) do it …
Molecular Data Support an Early Shift to an Intermediate-Light Niche in the Evolution of Mammals
Authors: Yang Liu, Hai Chi, Longfei Li, Stephen J Rossiter, Shuyi Zhang
Journal: Molecular Biology and Evolution (2018)

The visual ability and associated photic niche of early mammals is debated. The theory that ancestral mammals were nocturnal is supported by diverse adaptations. However, others argue that photopigment repertoires of early mammals are more consistent with a crepuscular niche, and support for this also comes from inferred spectral tuning of middle/long wavelength-sensitive (M/LWS) opsin sequences. Functional studies have suggested that the M/LWS pigment in the ancestor of Mammalia was either red- or green-sensitive; however, these were based on outdated phylogenies with key lineages omitted. By performing the most detailed study to date of middle/long-wave mammalian color vision, we provide the first experimental evidence that the M/LWS pigment of amniotes underwent a 9-nm spectral shift towards shorter wavelengths in the Mammalia ancestor, exceeding predictions from known critical sites. Our results suggest early mammals were yellow-sensitive, possibly representing an adaptive trade-off for both crepuscular (twilight) and nocturnal (moonlight) niches.
Junior doctors need guidance on how to use smartphones in practice
Authors: Sophie Hives-Wood
Journal: BMJ (2013)

Junior doctors need guidance on how to use their smartphones at work, says research published in the Postgraduate Medical Journal .1

The researchers surveyed 108 junior doctors in their first year of clinical practice in the Republic of Ireland and found that 102 (94%) owned a smartphone. Eighty per cent of those who owned a device said that they made or received work related calls and texts, and 40% …
Association of Human Immunodeficiency Virus Infection and Risk of Peripheral Artery Disease
Authors: Joshua A. Beckman, Meredith S. Duncan, Charles W. Alcorn, Kaku So-Armah, Adeel A. Butt, Matthew Bidwell Goetz, Hilary A. Tindle, Jason J. Sico, Russel P. Tracy, Amy C. Justice, Matthew S. Freiberg
Journal: Circulation (2018)

The effect of human immunodeficiency virus (HIV) on the development of peripheral artery disease (PAD) remains unclear. We investigated whether HIV infection is associated with an increased risk of PAD after adjustment for traditional atherosclerotic risk factors in a large cohort of HIV-infected (HIV+) and demographically similar HIV-uninfected veterans.We studied participants in the Veterans Aging Cohort Study from April 1, 2003 through December 31, 2014. We excluded participants with known prior PAD or prevalent cardiovascular disease (myocardial infarction, stroke, coronary heart disease, and congestive heart failure) and analyzed the effect of HIV status on the risk of incident PAD events after adjusting for demographics, PAD risk factors, substance use, CD4 cell count, HIV-1 ribonucleic acid, and antiretroviral therapy. The primary outcome is incident peripheral artery disease events. Secondary outcomes include mortality and amputation in subjects with incident PAD events by HIV infection status, viral load, and CD4 count.Among 91 953 participants, over a median follow up of 9.0 years, there were 7708 incident PAD events. Rates of incident PAD events per 1000 person-years were higher among HIV+ (11.9; 95% confidence interval [CI], 11.5-12.4) than uninfected veterans (9.9; 95% CI, 9.6-10.1). After adjustment for demographics, PAD risk factors, and other covariates, HIV+ veterans had an increased risk of incident PAD events compared with uninfected veterans (hazard ratio [HR], 1.19; 95% CI, 1.13-1.25). This risk was highest among those with time-updated HIV viral load >500 copies/mL (HR, 1.51; 95% CI, 1.38-1.65) and CD4 cell counts <200 cells/mm3 (HR, 1.91; 95% CI, 1.71-2.13). In contrast, HIV+ veterans with time updated CD4 cell count ≥500 cells/mm3 had no increased risk of PAD (HR, 1.03; 95% CI, 0.96-1.11). Mortality rates after incident PAD events are high regardless of HIV status. HIV infection did not affect rates of amputation after incident PAD events.Infection with HIV is associated with a 19% increased risk of PAD beyond that explained by traditional atherosclerotic risk factors. However, for those with sustained CD4 cell counts <200 cells/mm3, the risk of incident PAD events is nearly 2-fold higher whereas for those with sustained CD4 cell counts ≥500 cells/mm3 there is no excess risk of incident PAD events compared with uninfected people.