tbuckley/cabot-search huggingface dataset:
An unusual localised pigmented skin lesion on the nipple-areola complex
Authors: Hao Guo, Xing-Hua Gao, Chang Liu, Jiu-Hong Li
Journal: BMJ (2018)

A 62 year old Chinese woman presented with a painless pigmented lesion on the right nipple-areola complex (NAC). The lesion began as a small asymptomatic black spot on the base of nipple five years ago and had gradually increased in size. Physical examination revealed an irregular pigmented macular lesion, about 4×3 cm, on the right NAC (fig 1). The borders of the lesion were darkly pigmented, with scales on the surface. The lesion was painless and moveable from the underlying structures. The woman denied any discharge, pruritus, or history of carcinogen exposure; and her family history was unremarkable.



Fig 1 
Skin lesion on the right nipple-areola complex



On palpation, no breast masses or lymphadenopathy were found.



### 1. What are the differential diagnoses for a pigmented skin lesion with colour variegation on the NAC?

Differential diagnoses include: eczematous breast conditions, seborrheic keratosis, pigmented Bowen’s disease, pigmented mammary Paget’s disease, and superficial spreading melanoma. In contact dermatitis and eczema, hyperpigmentation appears in the chronic phase.1 In seborrheic keratosis, hyperkeratosis and horn cysts are present. In pigmented mammary Paget’s disease, the lesion occurs on the surrounding skin …
COLONIC ESD WITH SIMILAR RESULTS TO JAPANESE TEAMS IS POSSIBLE IN EUROPE USING THE DOUBLE-CLIP COUNTER-TRACTION STRATEGY
Authors: J Jacques, R Legros, J Rivory, T Ponchon, D Sautereau, M Pioche
Journal: Endoscopy (2018)

Colonic ESD is the most technically challenging location for large superficial precancerous and cancerous lesion. Appropriate exposure of the submucosal space could be very difficult even for Japanese experts due to its thinness in this location, inconstant help by the gravity, colonic loops, bowel and respiratory movements.
ENDOSCOPIC MANAGEMENT OF A PATIENT WITH A DUODENAL BULB FISTULA AFTER LAPAROSCOPIC CHOLECYSTECTOMY: A VIDEO-CASE
Authors: M Fragaki, I Dimas, A Mpitouli, M Velegraki, G Paspatis
Journal: Endoscopy (2018)

A 74-year-old woman was referred to our hospital for ERCP due to bile leakage after laparoscopic cholecystectomy. In the gastroscopy there was a fistula at the anterior upper wall of the duodenal bulb, possibly due to prior perforation. An OTSC clip was applied after evaluating the quality of the surrounding tissue. The OTSC closure was successful. The patient was discharged without any other intervention. The patient was reassessed 5 months later.
Effects of Heavy High Energy Charged Particles: III. In Vivo Activation in Mice of C12, N14, and O16 by Bombardment with 2 bev Protons
Authors: S W LIPPINCOTT, J E JESSEPH, W H MOORE, R F STRAUB
Journal: JAMA (1963)

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Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer
Authors: Dawn L. Hershman, Joseph M. Unger, Heather Greenlee, Jillian L. Capodice, Danika L. Lew, Amy K. Darke, Alice T. Kengla, Marianne K. Melnik, Carla W. Jorgensen, William H. Kreisle, Lori M. Minasian, Michael J. Fisch, N. Lynn Henry, Katherine D. Crew
Journal: JAMA (2018)

<h3>Importance</h3> Musculoskeletal symptoms are the most common adverse effects of aromatase inhibitors and often result in therapy discontinuation. Small studies suggest that acupuncture may decrease aromatase inhibitor–related joint symptoms. <h3>Objective</h3> To determine the effect of acupuncture in reducing aromatase inhibitor–related joint pain. <h3>Design, Setting, and Patients</h3> Randomized clinical trial conducted at 11 academic centers and clinical sites in the United States from March 2012 to February 2017 (final date of follow-up, September 5, 2017). Eligible patients were postmenopausal women with early-stage breast cancer who were taking an aromatase inhibitor and scored at least 3 on the Brief Pain Inventory Worst Pain (BPI-WP) item (score range, 0-10; higher scores indicate greater pain). <h3>Interventions</h3> Patients were randomized 2:1:1 to the true acupuncture (n = 110), sham acupuncture (n = 59), or waitlist control (n = 57) group. True acupuncture and sham acupuncture protocols consisted of 12 acupuncture sessions over 6 weeks (2 sessions per week), followed by 1 session per week for 6 weeks. The waitlist control group did not receive any intervention. All participants were offered 10 acupuncture sessions to be used between weeks 24 and 52. <h3>Main Outcomes and Measures</h3> The primary end point was the 6-week BPI-WP score. Mean 6-week BPI-WP scores were compared by study group using linear regression, adjusted for baseline pain and stratification factors (clinically meaningful difference specified as 2 points). <h3>Results</h3> Among 226 randomized patients (mean [SD] age, 60.7 [8.6] years; 88% white; mean [SD] baseline BPI-WP score, 6.6 [1.5]), 206 (91.1%) completed the trial. From baseline to 6 weeks, the mean observed BPI-WP score decreased by 2.05 points (reduced pain) in the true acupuncture group, by 1.07 points in the sham acupuncture group, and by 0.99 points in the waitlist control group. The adjusted difference for true acupuncture vs sham acupuncture was 0.92 points (95% CI, 0.20-1.65;<i>P</i> = .01) and for true acupuncture vs waitlist control was 0.96 points (95% CI, 0.24-1.67;<i>P</i> = .01). Patients in the true acupuncture group experienced more grade 1 bruising compared with patients in the sham acupuncture group (47% vs 25%;<i>P</i> = .01). <h3>Conclusions and Relevance</h3> Among postmenopausal women with early-stage breast cancer and aromatase inhibitor–related arthralgias, true acupuncture compared with sham acupuncture or with waitlist control resulted in a statistically significant reduction in joint pain at 6 weeks, although the observed improvement was of uncertain clinical importance. <h3>Trial Registration</h3> ClinicalTrials.gov Identifier:NCT01535066
Nuestros hallazgos en las colonoscopias de revisión al año tras una colonoscopia de cribado
Authors: R Irisarri Garde, EL Borobio Aguilar, A Cebrián García, C Echeverria Perez, A Esparza Nieva, C Alonso Ganuza, R Rojas Zuasti, MP Ortiz Lana
Journal: Endoscopy (2017)

Los pacientes con CCR, adenomas o pólipos hiperplásicos de alto riesgo deben realizarse una colonoscopia de control al año.
<i>Gua Sha,</i> or Coining Therapy
Authors: Tyler Marion, Kevin Cao, Jorge Roman
Journal: JAMA Dermatology (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 Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast 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 Dermatology journal
Tumor-suppressing miR-141 gene complex-loaded tissue-adhesive glue for the locoregional treatment of hepatocellular carcinoma
Authors: Min-Kyoung Kim, Young-Ah Moon, Chung Kil Song, Rengarajan Baskaran, Sijeong Bae, Su-Geun Yang
Journal: Theranostics (2018)

microRNAs (miRNAs) regulate gene expression post-transcriptionally and have been extensively tested as therapeutic molecules against several human diseases. In vivo delivery of miRNAs needs to satisfy the following conditions: safety, efficiency, and long-term therapeutic effectiveness. To satisfy these conditions, we developed a tissue-adhesive nucleotide-polymer complex (NPX-glue) for in vivo delivery of miRNAs to treat hepatocellular carcinoma (HCC). Methods: Polyallylamine (PAA), a cationic polymer, was mixed with tumor-suppressing miR-141 to form NPX and then mixed with partially oxidized alginate (OA) to form NPX-glue. Delivery efficiency of miR-141:NPX-glue was determined in cultured HCC cells and in an implanted HCC tumor model. In vivo tumor-suppressive effects of miR-141 on HCC were examined in mice upon intratumoral injection of miR-141:NPX-glue. Result: NPX-glue was generated by mixing of NPX with OA, which eliminated the inherent cytotoxic effect of NPX. NPX-glue led to the efficient delivery of miR-141 and plasmid to cultured cells and solid tumors in mice, where their expression was maintained for up to 30 days. Upon intratumoral injection of miR-141:NPX-glue, the growth of the tumors was dramatically retarded in comparison with the negative control, NCmiR:NPX-glue, (p < 0.05). Molecular examination proved miR-141:NPX-glue efficiently regulated the target genes including MAP4K4, TM4SF1, KEAP1, HDGF, and TIAM1 and finally induced apoptosis of cancer tissues. Conclusion: Here, we show that NPX-glue delivers therapeutic miR-141 to solid tumors in a safe, stable, and long-term manner and prove that locoregional treatment of HCC is possible using the NPX-glue system.
ENDOSCOPIC VACUUM THERAPY FOR PROXIMAL ANASTOMOTIC LEAKS
Authors: K Shishin, I Nedoluzhko, N Kurushkina, L Shumkina, A Pyatakova
Journal: Endoscopy (2018)

The anastomosis failure after esophageal or gastric surgery is a serious life-threatening complication, which can be the cause of the patient's death. This paper presents our clinical experience of endoscopic vacuum therapy (EVT).
Maternal pregestational or gestational diabetes and childhood wheezing: A population‐based cohort study
Authors: Xiaoqin Liu, Esben Agerbo, Jiong Li, Shyamali C. Dharmage, Reimar W. Thomsen, Jørn Olsen, Trine Munk‐Olsen
Journal: Allergy (2018)

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Cannabis based drugs should be rescheduled to make research and prescribing easier, says chief medical officer
Authors: Nigel Hawkes
Journal: BMJ (2018)

Cannabis based drugs should be rescheduled under the UK’s misuse of drugs legislation so that they can be prescribed and more easily researched, the chief medical officer has advised.1

Sally Davies’s report says that the current classification of cannabis and cannabis-like products in schedule 1 of the legislation, which means that they cannot be prescribed, “Only makes medical sense if there is no or very little evidence of potential therapeutic benefit in a treatment setting.”

Her review, heavily reliant on similar recent reviews in Australia, Ireland, and the US, concludes that evidence of benefit now exists in a range of medical conditions, so she recommends moving such drugs out of schedule 1. It will be up to the Home Office to make this change, if it agrees.

The process was triggered by high profile cases such as that of Billy Caldwell, 12, who has an intractable form of epilepsy that seems …
Pathologic findings at risk-reducing salpingo-oophorectomy among women at increased ovarian cancer risk: Results from GOG-199.
Authors: Phuong L. Mai, Mark E Sherman, Marion Piedmonte, Olga B. Ioffe, Brigitte M. Ronnett, Linda Van Le, David Gardner Mutch, David E. Cohn, J. Tate Thigpen, Krishnansu Sujata Tewari, Paul Disilvestro, Noah D. Kauff, Karen H. Lu, Mark H. Greene
Journal: Journal of Clinical Oncology (2012)

1519 Background: Although risk-reducing salpingo-oophorectomy (RRSO) is a standard management option for women with BRCA1/2 mutations, the lack of large, prospective cohort studies makes estimating the prevalence of cancer at RRSO problematic. Methods: GOG-199 is a large, non-randomized multi-center trial which enrolled women at high-risk (due to BRCA mutations or strong family history) of ovarian cancer, comparing surgery at enrollment with serial transvaginal ultrasound and CA-125 screening. RRSO specimens were processed according to a standardized tissue processing protocol including 2-3mm sectioning of both ovaries and tubes. Results: 2,605 participants were accrued to GOG-199. Of the 1 030 enrolled in the baseline RRSO cohort, 28 were ineligible and 36 declined surgery after enrollment, resulting in 966 baseline RRSO. Pathology review demonstrated 4 tubal intraepithelial carcinoma and 20 serous pelvic cancers, of which 12 were identified only microscopically. Among the 20 serous cancers, the predominant or exclusive site of involvement was ovary in 10, fallopian tube in 5, and peritoneum in 5 cases. In addition, 6 endometrial cancers (among the 515 undergoing concomitant hysterectomy) and 3 adenocarcinomas suggestive of metastasis were identified. The serous pelvic cancer prevalence was: entire cohort=2.1% (20/966), all BRCA mutation carriers=3.2 (18/558), BRCA1 mutation carriers=3.7% (12/325), BRCA2 mutation carriers=2.6% (6/231), and mutation-negative=0.5% (2/402). Compared to those without cancer, women with serous pelvic cancer were older at surgery (p&lt; .001), and more often menopausal (vs pre-menopausal, p= .002), nulliparous (vs parous, p=.04) and never users of tamoxifen (vs ever users, p= .04). Serous pelvic cancers were more frequent in BRCA mutation carriers (vs no mutation, p= .004), and among carriers, more common in those with BRCA1 mutations (vs BRCA2 mutation, p= .02). Conclusions: The prevalence of serous pelvic cancers in this cohort was 3.2% among carriers vs 0.5% among the mutation-negative but with a strong family history. Our data will be useful when counseling women at increased ovarian cancer risk who are contemplating risk-reducing surgery.
Abstract 13111: The Registry to Evaluate Anticoagulation in Atrial Fibrillation (REAL-AF)
Authors: David Matchar, David Garcia, Gregory Samsa, Stephen Sander, Camiel P VanderMaelen, Zhaohui Su, Michael Ezekowitz
Journal: Circulation (2010)

Background:  Warfarin reduces the risk of stroke in patients (pts) with atrial fibrillation (AF) by approximately 40% compared to antiplatelet therapy, but is underutilized and its management can present challenges.   Methods:  REAL-AF is a registry enrolling retrospective and prospective warfarin-naive (   Results:  Of 1490 retrospective pts from 156 sites, 67.4% (1004) were prescribed warfarin. Pts on warfarin were slightly older than those not on warfarin (72.3 vs. 69.2, p=0.0002). Pts were 51.9% (743/1431) male and 94.1% (1055/1121) white. Among the 1004 pts who received warfarin, within the first 6 months of therapy there were a total of 1065 physician office visits, 207 hospital visits, 105 ER visits, and 143 other healthcare utilization visits. Mean TTR (INR = 2.0–3.0) was 47.7% (N=770 pts). Median time to reach stable therapeutic range (3 consecutive INRs between 2.0 and 3.0) was 19.0 weeks (N=763 pts). Physician-perceived “low stroke risk” (46.1%; 224/486) and “high bleed risk” (25.5%; 124/486) were the most common reasons cited for not prescribing warfarin. Additional analyses indicated that pts with excessive fall risk were less likely to be prescribed warfarin (OR 0.145, 95% CI 0.094–0.225), while pts with conditions such as left ventricular dysfunction, hypertension, CAD, or CHF were more likely to be prescribed warfarin [Odds Ratios and (CIs) = 2.32 (1.65–3.26); 2.04 (1.57–2.64); 1.85 (1.43–2.40); 1.71 (1.25–2.34)].   Conclusion:  A long period of time to reach therapeutic range and low TTR are common among newly diagnosed non-valvular AF pts with little or no previous exposure to warfarin. From this analysis it appears that these pts may not be deriving the full therapeutic benefit of anticoagulation therapy.
Direct Primary Care
Authors: Eli Y. Adashi, Ryan P. Clodfelter, Paul George
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
Role of C1q-binding anti-HLA antibodies as a predictor of lung allograft outcome
Authors: Olivier Brugière, Antoine Roux, Jerome Le Pavec, Deborah Sroussi, François Parquin, Pauline Pradère, Clairelyne Dupin, Vincent Bunel, Gisele Mourin, Gilles Jebrak, Gaëlle Dauriat, Yves Castier, Pierre Mordant, Brice Lortat-Jacob, Sylvain Jean-Baptiste, Herve Mal, Caroline Suberbielle, Chantal Gautreau, Sophie Caillat-Zucman, Aurélie Cazes, Gabriel Thabut, Jean-Luc Taupin
Journal: European Respiratory Journal (2018)

Presence of anti-human leukocyte antigen donor-specific antibodies (DSAs) is associated with poor outcome after lung transplantation. Currently, DSAs are detected using the Luminex technique, which may be overly sensitive. The new C1q assay allows for the exclusive detection of complement (C1q)-binding antibodies, involved in antibody-mediated rejection. We investigated whether early detection of complement-binding DSAs is associated with chronic lung allograft dysfunction (CLAD) and survival.From 2009 to 2012, lung transplant recipients from three transplantation centres were screened for the presence of DSA and their complement-binding capacity during the 6-12 months post-transplantation in a stable condition.The analysis included 168 patients. The 3-year rates of freedom from CLAD and graft survival were lower for patients with complement-binding DSAs (33.6% and 53.7%, respectively), as compared with patients with non-complement-binding DSAs (61.9% and 77.4%, respectively) and patients without DSA (70% and 84.9%, respectively) (p<0.001 and p=0.001, respectively). Detection of complement-binding DSA was associated with a risk of graft loss that was nearly tripled after adjustment for clinical, functional, histological and immunological factors (hazard ratio 2.98, 95% CI 1.33-6.66; p=0.008).Assessment of the C1q-binding capacity of DSA appears to be useful in identifying stable lung transplant recipients at high risk of lung allograft loss.
Revisión multicéntrica sobre seguridad y aspectos legales de la endoscopia bariátrica española (GETTEMO)
Authors: E Espinet Coll, J Nebreda Durán, G López-Nava Breviere, AJ Del Pozo-García, J Ducóns García, C Silva González, R Abad Belando, M Rodríguez-Téllez, J Espinel Díez, J Crespo García
Journal: Endoscopy (2017)

La endoscopia bariátrica, entendida como medicina asistencial o curativa, debe exigir una moderada eficacia y una elevada seguridad. Cuando estos requisitos no se cumplen, o cuando se entiende como medicina satisfactiva, pueden aparecer consecuencias legales. Hasta la fecha, estas consecuencias legales no han sido adecuadamente reportadas.
A double-blind, randomized, placebo-controlled trial of l-glutamine for the severe oral mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer.
Authors: Takae Tsujimoto, Yoshifumi Yamamoto, Masafumi Wasa, Yukinori Takenaka, Wataru Nakahara, Tatsuya Takagi, Mamiko Tsugane, Noriyuki Hayashi, Kazuhisa Maeda, Hidenori Inohara, Etsuko Uejima, Toshinori Ito
Journal: Journal of Clinical Oncology (2014)

6059 Background: The incidence ofseveremucositis is high among patients with head and neck cancer receiving chemoradiotherapy, resulting in significant pain and impairment of quality of life. This study aimed to investigate whether L-glutamine (glutamine) decreases the severity of oral mucositis (OM) including an area of the pharynx and larynx induced by chemoradiotherapy. Methods: This double-blind, randomized, placebo-controlled trial included 40 untreated patients with squamous cell carcinoma of the nasopharynx, oropharynx, hypopharynx, or larynx between May 2010 and August 2013. The inclusion criteria of this study were that patients must be more than 20 years old, suitable for chemoradiotherapy with cisplatin and docetaxel. The exclusion criteria were the presence of serious liver and/or renal dysfunction, uncontrolled diabetes mellitus, and oral and/or throat soreness before study. Patients received 66 or 70 Gy of total radiation at the rate of 2 Gy per fraction daily and 5 fractions per week. Cisplatin (20 mg/m2) and docetaxel (10 mg/m2) were intravenously coadministered once a week for 6 weeks. Patients were randomized to orally receive either glutamine (group G: 20 patients) or placebo (group P: 20 patients) at a dose of 10 g 3 times a day throughout the chemoradiotherapy course. OM was assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. The primary end point was oral mucositis severity. NCI CTCAE grade was analyzed using the Mann–Whitney U test, and Fisher’s exact test. The p values were 2-sided, and a value of <0.05 was considered statistically significant. Results: OM developed in all patients. A maximal OM grade of G4 was observed in 0% and 25% group G and group P patients, respectively, while that of G2 was observed in 10% and 0% group G and group P patients, respectively(p = .023).Glutamine significantly decreased the maximal OM grade (group G: 2.9 ± 0.3, group P: 3.3 ± 0.4; p = .005). Conclusions: Glutamine significantly decreased oral mucositis severity induced by chemoradiotherapy in patients with head and neck cancer. Clinical trial information: UMIN000003991.
Computer software that can calculate confidence intervals is now available
Authors: I. E Buchan
Journal: BMJ (1995)

by 25% to 33% overall.Of more importance is that the proportion of children with extended illness- that is, those who do not experience signs of improvement until after the fourth day of illness- was reduced from 20% to 3% in placebo controlled clinical trials.`"In other words, those who need it most benefit most.What price tag can we attach to that?D J Paynton's family probably did not experience the usual situation of secondary cases in the family being more severe than the index case.My family was less fortunate.One winter before oral acyclovir was available my three children had chickenpox one after the other in painfully slow succession.My son, the tertiary case, was nearly admitted to hospital because of central nervous system complications that were, in retrospect, due to a concomitant infection with influenza A virus.The service implication of an additional treat- ment option is a valid concern.My suggestion would be to set up a triage system so that only questionable cases need be seen by a practitioner.In my experience, the parents or guardians are reliable at recognising chickenpox, epecially after they have suffered through the index case.