tbuckley/cabot-search huggingface dataset:
I am a postgraduate in surgery. I am from India, working in New Delhi, and have passed the membership exam for the Royal College of Surgeons (MRCS). Kindly tell me how to enter the FRCS (general surgery) programme in the UK?
Authors: Sunder R Gopaul
Journal: BMJ (2007)

Have a career related problem that needs answering? Can9t find the 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>
Effect of AdipoR agonist in cholangiocarcinoma.
Authors: Khac Cuong Bui, Mai Ly Thi Nguyen, Samarpita Barat, Xi Chen, Vikas Bhuria, Jun Xing, Linh Toan Nguyen, Huu Song Le, Thirumalaisamy P. Velavan, Ludwig Wilkens, Nisar P Malek, Przemyslaw Bozko, Ruben R Plentz
Journal: Journal of Clinical Oncology (2018)

323 Background: Adiponectin is the key adipokine, which plays an important role in health and disease such as obesity, diabetes, and cancer. Adiponectin is reduced in different tumor types, especially in obesity-related cancer, and recent studies showed that Adiponectin had a potential anti-cancer effect. Obesity is a risk factor for various tumor diseases including cholangiocarcinoma (CC), the second most common primary hepatic cancer. The aim of this study is to investigate for the first time the anti-cancer effect of AdipoR agonist in CC cell lines and a CC engineered mouse model. Methods: Human CC cell lines (TFK-1 and SZ-1) and CC engineered mice (Alb-Cre/KRAS G12D /p53 L/L ) were used to investigate the anti-cancer effects of an AdipoR agonist (2-(4-Benzoylphenoxy)-N-[1-(phenylmethyl)-4-piperidinyl]-acetamide). Cell proliferation, migration, invasion, colony formation, apoptosis assay were applied to evaluate the effect of AdipoR agonist in vitro. In addition, important cancer signalling pathways and targets were analysed by Western Blot. Mice (n = 12) were treated with AdipoR or verhicle and tumor burden and survival were monitored. Results: AdipoR agonist suppressed proliferation, migration, invasion, colony formation and apoptosis in CC cells. AdipoR agonist regulated the expression of different proteins such as EMT markers, pAMPK, pSTAT3, and PARP, which have pivotal functions in cholangiocarcinogenesis. AdipoR agonist also prolonged survival time in a CC engineered mouse model. Conclusions: Our data revealed that AdipoR agonist inhibited successfully cell proliferation, migration, invasion, colony formation and apoptosis in vitro, and prolonged mice survival in vivo through regulation of crucial signaling pathways in cholangiocarcinogenesis. These results suggested that AdipoR agonist might become a new potential candidate for CC treatment in the future.
Prognostic Factors for Complete Response to Ibrutinib in Patients With Chronic Lymphocytic Leukemia
Authors: Susan M. O’Brien, Samantha Jaglowski, John C. Byrd, Rajat Bannerji, Kristie A. Blum, Christopher P. Fox, Richard R. Furman, Peter Hillmen, Thomas J. Kipps, Marco Montillo, Jeff Sharman, Sam Suzuki, Danelle F. James, Alvina D. Chu, Steven E. Coutre
Journal: JAMA Oncology (2018)

Ibrutinib, a first-in-class Bruton tyrosine kinase inhibitor taken once daily, is approved in the United States for patients with chronic lymphocytic leukemia/small lymphocytic lymphoma and allows for treatment without chemotherapy. Extended treatment with ibrutinib has demonstrated increased complete response (CR) rates over time.
Association Between Estimated Cumulative Vaccine Antigen Exposure Through the First 23 Months of Life and Non–Vaccine-Targeted Infections From 24 Through 47 Months of Age
Authors: Jason M. Glanz, Sophia R. Newcomer, Matthew F. Daley, Frank DeStefano, Holly C. Groom, Michael L. Jackson, Bruno J. Lewin, Natalie L. McCarthy, David L. McClure, Komal J. Narwaney, James D. Nordin, Ousseny Zerbo
Journal: JAMA (2018)

Some parents are concerned that multiple vaccines in early childhood could weaken their child's immune system. Biological data suggest that increased vaccine antigen exposure could increase the risk for infections not targeted by vaccines.To examine estimated cumulative vaccine antigen exposure through the first 23 months of life in children with and without non-vaccine-targeted infections from 24 through 47 months of age.A nested case-control study was conducted in 6 US health care organizations participating in the Vaccine Safety Datalink. Cases were identified by International Classification of Diseases codes for infectious diseases in the emergency department and inpatient medical settings and then validated by medical record review. Cases of non-vaccine-targeted infection were matched to controls by age, sex, health care organization site, and chronic disease status. Participants were children ages 24 through 47 months, born between January 1, 2003, and September 31, 2013, followed up until December 31, 2015.Cumulative vaccine antigen exposure, estimated by summing the number of antigens in each vaccine dose received from birth through age 23 months.Non-vaccine-targeted infections, including upper and lower respiratory infections and gastrointestinal infections, from 24 through 47 months of age, and the association between these infections and estimated cumulative vaccine exposure from birth through 23 months. Conditional logistic regression was used to estimate matched odds ratios representing the odds of non-vaccine-targeted infections for every 30-unit increase in estimated cumulative number of antigens received.Among the 944 patients (193 cases and 751 controls), the mean (SD) age was 32.5 (6.3) months, 422 (45%) were female, and 61 (7%) had a complex chronic condition. Through the first 23 months, the estimated mean (SD) cumulative vaccine antigen exposure was 240.6 (48.3) for cases and 242.9 (51.1) for controls. The between-group difference for estimated cumulative antigen exposure was -2.3 (95% CI, -10.1 to 5.4; P = .55). Among children with vs without non-vaccine-targeted infections from 24 through 47 months of age, the matched odds ratio for estimated cumulative antigen exposure through age 23 months was not significant (matched odds ratio, 0.94; 95% CI, 0.84 to 1.07).Among children from 24 through 47 months of age with emergency department and inpatient visits for infectious diseases not targeted by vaccines, compared with children without such visits, there was no significant difference in estimated cumulative vaccine antigen exposure through the first 23 months of life.
CLINICAL IMPACT OF NUTRITION STATUS AND CLINICAL FRAILTY SCORE AFTER TAVR
Authors: Yohsuke Honda, Motoharu Araki, Shirai Shigemitsu, Kenji Makino, Takahiro Tokuda, Masakazu Tsutumi, Shinsuke Mori, Yasunari Sakamoto, Norihiro Kobayashi, Masahiro Yamawaki, Keisuke Hirano, Yoshiaki Ito
Journal: Journal of the American College of Cardiology (2018)
A practical introduction to cardiac catheterisation and percutaneous coronary intervention
Authors: Claire Brough
Journal: BMJ (2010)

This two day course encompasses the fundamentals of catheterisation and percutaneous coronary intervention (PCI). Candidates are guided through equipment and patient preparation, radiation safety, and catheter selection, before finally integrating catheter manipulation, angiogram interpretation, and teamwork on angiography simulators. When they have grasped basic catheterisation, candidates explore PCI from inception to contemporary evidence based procedures, with observation of intra-aortic balloon pump and pressure wire device demonstrations.

Cardiac catheterisation is team oriented, which is appropriately reflected in the course by a multidisciplinary enthusiastic faculty (consultant cardiologists, experienced specialist registrars, radiographers, and device company representatives).

This course is for medical trainees embarking upon cardiology higher specialist training and individuals who want to show their commitment to the specialty. Cardiology career grade doctors with some catheterisation experience are also accommodated.

All adult learning styles …
Prevalence, risk factors and clinical correlates of COPD in a rural setting in Tanzania
Authors: Ng'weina Francis Magitta, Richard William Walker, Komalkirti Keshavkiran Apte, Meshack Denson Shimwela, Julius David Mwaiselage, Anna Alphonce Sanga, Anil Kumar Namdeo, Sapna Jitendra Madas, Sundeep Santosh Salvi
Journal: European Respiratory Journal (2018)

Chronic obstructive pulmonary disease (COPD) causes substantial burden of disease in developed countries, but there are limited data from Africa. We aimed to estimate the prevalence of COPD in Tanzania and identify the risk factors associated with it.This was a cross-sectional descriptive survey involving adults aged ≥35 years. We collected data on symptoms and risk factors using the Burden of Obstructive Lung Diseases questionnaire. Spirometry was performed and COPD diagnosed based on post-bronchodilator forced expiratory volume in 1 s/forced vital capacity <70%. We also measured indoor and outdoor carbon monoxide (CO) levels.A total of 869 participants (49.1% females) completed the questionnaires. Of these, 57.1% completed post-bronchodilator spirometry. Of the 25.2% ever-smokers, only 5.4% were current smokers. COPD prevalence was estimated at 17.5% (21.7% in males and 12.9% in females). COPD was associated with a history of cough, phlegm production and wheezing. 51.7% of COPD patients reported cough and 85% had mild to moderate airway limitation. Females had a higher rate of exacerbation. Pulmonary tuberculosis (TB) was reported in 10% of patients. Only 1.7% of patients who were diagnosed as COPD had ever received any medication, with only one female COPD patient having received an inhaler. 99.5% of the population used biomass fuels for cooking. The majority of households had CO levels up to 20 ppm.The prevalence of COPD in Tanzania is high, with a peak at a relatively young age and a preponderance in males. A history of TB, cigarette smoking and male sex are important risk factors. Indoor air pollution coupled with use of biomass fuel for cooking and heating may be an important risk factor for developing COPD in rural Tanzania. However, these factors need to be studied further.
Forward to the past: ultrasound might be necessary in some patients with rheumatoid arthritis
Authors: Ottar Gadeholt
Journal: Annals of the Rheumatic Diseases (2018)

In the January issue of ARD , Caporali and Smolen1 argue against the use of ultrasound in the management of rheumatoid arthritis (RA), citing the negative findings of the TaSER2 and ARCTIC3 studies and a lack of standardisation. Even disregarding that the results were not unequivocal, showing a slight, but not statistically significant difference between the ultrasound and control groups after a longer time span, I strongly disagree with the overall conclusion.

There is no doubt that modern disease management has led to excellent outcomes for most patients with RA, with the mutilating disease courses of the prebiological era largely a thing of the past.4 However, there are still patients, …
A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis
Authors: Donna Franklin, Franz E. Babl, Luregn J. Schlapbach, Ed Oakley, Simon Craig, Jocelyn Neutze, Jeremy Furyk, John F. Fraser, Mark Jones, Jennifer A. Whitty, Stuart R. Dalziel, Andreas Schibler
Journal: New England Journal of Medicine (2018)

High-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear.In this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high-flow oxygen therapy (high-flow group) or standard oxygen therapy (standard-therapy group). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting ≥3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events.The analyses included 1472 patients. The percentage of infants receiving escalation of care was 12% (87 of 739 infants) in the high-flow group, as compared with 23% (167 of 733) in the standard-therapy group (risk difference, -11 percentage points; 95% confidence interval, -15 to -7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1% of infants) occurred. Among the 167 infants in the standard-therapy group who had treatment failure, 102 (61%) had a response to high-flow rescue therapy.Among infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy. (Funded by the National Health and Medical Research Council and others; Australian and New Zealand Clinical Trials Registry number, ACTRN12613000388718 .).
David John Dickson
Authors: Christine Dickson
Journal: BMJ (2018)

David John Dickson (“John”) was born in Nunthorpe on the outskirts of Middlesbrough, Teesside, the second of four children. His father was a surgeon born in Fife and his mother was from a steel manufacturing family in Sheffield. Sadly, both his parents died before he started his medical training at St Andrews. He did various hospital jobs, then was awarded an American Heart Association scholarship for a year in Ohio, US, doing physical cardiology. On …
Most doctors think patient care has deteriorated and won’t be improved by reforms
Authors: Helen Jaques
Journal: BMJ (2012)

Hospital doctors and GPs believe that the quality of care provided by their local NHS has got worse and will not be improved by new initiatives such as clinical commissioning and opening up service delivery to the private sector, research commissioned by the Department of Health has found.

The NHS staff tracking survey, carried out among 1130 NHS staff in winter 2011, found that GPs and hospital doctors had among the lowest levels of staff satisfaction with local service delivery (66% for GPs and 71% for hospital doctors versus 76% for NHS staff overall).

Almost half …
Circulating Tumor Cells: Diagnostic and Therapeutic Applications
Authors: Eric Lin, Thong Cao, Sunitha Nagrath, Michael R. King
Journal: Annual Review of Biomedical Engineering (2018)

Metastasis contributes to poor prognosis in many types of cancer and is the leading cause of cancer-related deaths. Tumor cells metastasize to distant sites via the circulatory and lymphatic systems. In this review, we discuss the potential of circulating tumor cells for diagnosis and describe the experimental therapeutics that aim to target these disseminating cancer cells. We discuss the advantages and limitations of such strategies and how they may lead to the development of the next generation of antimetastasis treatments.
Surgical trainer roles should be reserved for the best consultants, college says
Authors: Abi Rimmer
Journal: BMJ (2014)

Only the best consultants should take up surgical trainer roles, the Royal College of Surgeons of Edinburgh has said, as it launched a set of standards for consultant surgical trainers across the UK, developed by its Faculty of Surgical Training. 

Many aspects of the current surgical training system were outdated and must be changed to safeguard standards and ensure the safety of patients, the college said.

Speaking to The BMJ , Craig McIlhenny, the faculty’s surgical director, said, “Training at the moment by surgeons and for surgeons is really a default position. When you become …
<i>HER2</i> Deregulation in Lung Cancer: Right Time to Adopt an Orphan?
Authors: Federico Cappuzzo, Lorenza Landi
Journal: Clinical Cancer Research (2018)

Abstract HER2-deregulated non–small cell lung cancer is an orphan of any specific therapy, probably because of lack of both accurate patient selection and effective drugs. Recent evidence suggests that osimertinib could be effective in HER2-amplified or mutated lung cancer as a single agent or in combination. Clin Cancer Res; 24(11); 2470–2. ©2018 AACR. See related article by Liu et al., p. 2594
Genomic analysis of same-patient metachronous upper-tract and bladder urothelial carcinoma.
Authors: Firas G. Petros, Yuan Qi, Woonyoung Choi, Roger Li, Xiaoping Su, Charles Guo, Colin P.N. Dinney, David McConkey, Surena F. Matin
Journal: Journal of Clinical Oncology (2018)

449 Background: Despite similarities between upper-tract (UTUC) and bladder urothelial carcinoma (BUC), distinctive clinicopathologic and genomic differences are being described. We further investigate the genomic landscape of these two interrelated malignancies in same-patient metachronous (m) UTUC and BUC using next generation sequencing (NGS). Methods: Following institutional board approval, UTUC and BUC samples were obtained from patients via surgical resection or endoscopic biopsy. Tumors were macrodissected from unstained formalin-fixed, paraffin-embedded slides. Study inclusion was untreated patient samples of UTUC and/or BUC divided into 4 groups: 1) UTUC with mBUC, 2) BUC with mUTUC, 3) Synchronous BUC and UTUC, 4) UTUC with no bladder history. Exclusions were for inadequate clinical data or histological tumor purity &lt; 30%. Whole transcriptome RNA sequencing was performed and analyzed using BASE47 panel (includes basal, luminal, p53-like and cell cycle genes). Results: A total of 95 (UTUC = 61, BUC = 34) samples from 40 patients were analyzed. UTUC samples were 33 primary ureter and 28 renal pelvis cancer. Median age was 72 years, 68% male, 76% Caucasian, 60% former smokers. Groups samples were: 1) UTUC (n = 19), mBUC (n = 12); 2) BUC (n = 12), mUTUC (n = 9); 3) Synchronous UTUC/BUC (n = 10); and 4) UTUC (n = 23). Unsupervised hierarchical clustering segregated tumors into basal-like and luminal subtypes, with 87.5% of metachronous tumors displaying conserved subtype membership. For the groups with UTUC and BUC, only 3/24 (12.5%) clusters (2 patients in Group 2, and 1 patient in Group 3) had unmatched basal/luminal subtypes. Conclusions: NGS analysis of same-patient metachronous UTUC and BUC shows that the majority stay within the same molecular subtype regardless of chronologic development or anatomic origin. Additional studies are necessary to explore differences that may occur within the subtypes, the role of methylation, and clinical correlates.
Ingestible Electronic Capsule Measures Gases in the Gut
Authors: Jennifer Abbasi
Journal: JAMA (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 HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Prediction of hepatic encephalopathy: Why disregard well‐known risk factors?
Authors: Lorenzo Ridola, Oliviero Riggio
Journal: Hepatology (2018)

Potential conflict of interest: Nothing to report. TO THE EDITOR: We read with interest the paper by Tapper et al.,1 who performed a retrospective cohort study of all patients with cirrhosis without baseline hepatic encephalopathy (HE) by extracting information from the Veterans Administration database. The authors used two readily available laboratory tests and a brief inventory of the medication list to develop a simple scoring system to identify patients at risk for HE. In our opinion, some criticisms should be applied to this study. The authors included several parameters in their analysis; however, they did not consider some very well‐known risk factors for HE development—namely, previous HE episodes, minimal HE,2 and the presence of porto‐systemic shunts (spontaneous or iatrogenic)—likely because of the lack of data in a database that was not designed to meet the study's specific goal. This probably explains the low performance of the model in terms of sensitivity and specificity. Moreover, albumin levels may vary because of the need for plasma expansion, and this unknown variable is difficult to control in retrospective studies. Finally, the statistical approach raises some concerns, because the standard armamentarium of Kaplan‐Meier survival estimates and Cox regression was used to evaluate the proportion of patients who developed HE and the associated risk factors without acknowledging that HE incidence should be considered as an event competing with other outcomes (e.g., liver transplantation and death).3 Moreover, no validation of the model (either internal or external) was provided, making its performance more uncertain regarding the identification of patients at risk for HE. In future studies, the lack of data both on previous HE and covert HE will be unjustified, as the first parameter may be objectively definite4 and the diagnostic difficulties for covert HE assessment can be overcome using a simple diagnostic tool, such as the recently described Animal Naming Test.5 Because HE is prognostically relevant, associated with low quality of life and representing a significant socioeconomic burden, the identification of patients who are at risk for this condition is an important goal. Models with a better performance are therefore critical to avoid this challenging complication of liver disease, and a specifically designed database and a correct statistical approach will be essential if this goal is to be met.
<i>EML4-ALK</i> Variant Affects <i>ALK</i> Resistance Mutations
Authors: Martin Früh, Solange Peters
Journal: Journal of Clinical Oncology (2018)

Article Tools UNDERSTANDING THE PATHWAY Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES Impact of EML4-ALK Variant on Resistance Mechanisms and Clinical Outcomes in ALK-Positive Lung Cancer. January 26, 2018 ARTICLE CITATION DOI: 10.1200/JCO.2017.77.2764 Journal of Clinical Oncology - published online before print March 1, 2018 PMID: 29494260 EML4-ALK Variant Affects ALK Resistance Mutations Martin FrühxMartin FrühSearch for articles by this author and Solange PetersxSolange PetersSearch for articles by this author Show More Martin Früh, Cantonal Hospital of St Gallen, St Gallen, Switzerland; and Solange Peters, University Hospital of Lausanne, Lausanne, Switzerland https://doi.org/10.1200/JCO.2017.77.2764 First Page Full Text PDF Figures and Tables © 2018 by American Society of Clinical Oncology Companion Impact of EML4-ALK Variant on Resistance Mechanisms and Clinical Outcomes in ALK-Positive Lung Cancer