tbuckley/cabot-search huggingface dataset:
Correlation of neutrophil lymphocyte ratio, platelet lymphocyte ratio and rate of change of CA 19.9 in predicting outcome for metastatic pancreatic cancer.
Authors: Andrew Peter Dean, Dom Higgs, Adarsh Das, Madeline Rogers-Seeley, Sean Fennessy, Caoimhe McGarvey
Journal: Journal of Clinical Oncology (2018)

326 Background: CA19.9, NLR and PLR have all been proposed as prognostic in pancreatic cancer. We analysed correlation between NLR, PLR and rate of change of CA19.9. Methods: A total of 63 metastatic pancreatic cancer patients were identified from our database and evaluated retrospectively for blood count, NLR, PLR and serial CA19.9 levels during treatment. Daily Rate of Change of CA19.9 levels were calculated for the first 90 days (DRC90) of the patient’s treatment. Kaplan-Meir curves, univariate and multivariate Cox-regression analyses were calculated to assess the effects of these 3 markers on overall survival. Results: In a univariate analysis, PLR &gt; 240, NLR &gt; 5 and DRC90 &gt; 0.4% were all significantly associated with deceased overall survival. The Cox proportional hazards model showed that NLR &lt; 5 (HR 0.475, 95% CI 0.259 to 0.873, P = 0.017), PLR &lt; 240 (HR 0.444, 95% CI 0.229 to 0.861, P = 0.016), and a DRC90 &lt; 0.4% (HR 0.294, 95% CI 0.102 to 0.851, P = 0.024) were independent predictors of good prognosis (22.6 months vs. 9.6 months, 22.3 months vs 12.4 months and 23.9 months vs. 9.3 months respectively). In multivariate analysis, only a DRC90 &lt; 0.4% was independently associated with a longer survival (HR 0.239, 95% CI 0.076 to 0.752, P = 0.014). The formula (F) {PLR + (NLRxNLR) + (DRC90 x 100)} was predictive for survival, as patients with F &gt; 190 (HR 3.295, 95% CI 1.232 to 8.807, P = 0.017), having a significantly lower survival rate than patients with F &lt; 190 (25.1 months vs. 10.6 months, log-rank P = 0.009). Conclusions: These findings indicate the prognostic utility of the rate of CA 19.9 decline - measured as a standardised daily percentage change in value over 90 days. Our data validates daily rate of change of CA 19.9 over 90 days as an independent variable that correlates with prognosis, independent of PLR and NLR. We also identified a novel formula - PLR + (NLRxNLR) + (DRC90 x 100) - as being predictive for survival. We would like to increase the sample size to further validate our initial findings and investigate possible relationships in combining these variables for better prognostication in metastatic pancreatic cancer.
GP workforce problems may force ministers to renegotiate contract, BMA says
Authors: Tom Moberly
Journal: BMJ (2013)

Recruitment and retention problems among GPs in England may force ministers to renegotiate the general medical services (GMS) contract, the BMA believes.

Laurence Buckman, chairman of the BMA’s General Practitioners Committee, raised the prospect at the BMA’s annual conference of representatives of local medical committees in London on 23 May.

But Buckman said that, despite GPs’ frustrations with the GMS contract, it was currently “a very bad time to enter new contract negotiations for general …
Childhood BMI and Adult Type 2 Diabetes, Coronary Artery Diseases, Chronic Kidney Disease, and Cardiometabolic Traits: A Mendelian Randomization Analysis
Authors: Tingting Geng, Caren E. Smith, Changwei Li, Tao Huang
Journal: Diabetes Care (2018)

To test the causal effect of childhood BMI on adult cardiometabolic diseases using a Mendelian randomization analysis.We used 15 single nucleotide polymorphisms as instrumental variables for childhood BMI to test the causal effect of childhood BMI on cardiometabolic diseases using summary-level data from consortia.We found that a 1-SD increase in childhood BMI (kg/m2) was associated with an 83% increase in risk of type 2 diabetes (odds ratio [OR] 1.83 [95% CI 1.46, 2.30]; P = 2.5 × 10-7) and a 28% increase in risk of coronary artery disease (CAD) (OR 1.28 [95% CI 1.17, 1.39]; P = 2.1 × 10-8) at the Bonferroni-adjusted level of significance (P < 0.017) in adults. In addition, a 1-SD increase in childhood BMI was associated with a 0.587-SD increase in adulthood BMI (kg/m2), a 0.062-SD increase in hip circumference (cm), a 0.602-SD increase in waist circumference (cm), a 0.111 pmol/L increase in log fasting insulin, a 0.068 increase in log-transformed HOMA of ß-cell function (%), a 0.126 increase in log-transformed HOMA of insulin resistance (%), and a 0.109-SD increase in triglyceride (mg/dL) but a 0.138-SD decrease in HDL (mg/dL) in adults at the Bonferroni-adjusted level of significance (P < 0.0026).A genetic predisposition to higher childhood BMI was associated with increased risk of type 2 diabetes and CAD in adult life. These results provide evidence supportive of a causal association between childhood BMI and these outcomes.
Ontario outlines how law on doctors’ industry ties will work
Authors: Barbara Kermode-Scott
Journal: BMJ (2018)

Canada’s most populous province, Ontario, is using new legislation to tackle the conflicts of interest that can result from undisclosed financial relations between the drug and medical device industries and individuals or groups in the health sector.

In 2017 Ontario became the first Canadian province or territory to legislate that drug and device companies must disclose the funding they provide to any of a long list of recipients in the province’s health sector. This includes hospitals, laboratories and universities, professional medical societies and colleges, health charities and non-profits, and individual doctors and health professionals in 26 regulated health professions.

Ontario’s bill 160, the Strengthening Quality and Accountability for Patients Act 2017, became law last …
Bioengineered microRNA-1291 effects on pancreatic cancer cell proliferation and xenograft tumor growth.
Authors: Mei-Juan Tu, Zhijian Duan, Qianyu Zhang, Jing-Xin Qiu, Frank J Gonzalez, Edward Jae-hoon Kim, Aiming Yu
Journal: Journal of Clinical Oncology (2018)

307 Background: MicroRNAs (miR) have proved to be vital regulators in the control of tumor progression. Our recent studies have revealed miR-1291 is downregulated in patient pancreatic cancer (PC) specimens and re-introduction of miR-1291 suppresses tumorigenesis of PC cells. We have developed a novel ncRNA bioengineering technology to produce a miR-1291 prodrug. In this study, we aimed to assess the effectiveness of this miR-1291 prodrug as a monotherapy, as well as in combination with chemotherapy, for treatment of PC. Methods: Sensitivity of PC cells to miR-1291 prodrug alone, gemcitabine plus nab-paclitaxel (Gem-nP) alone, and their combination was evaluated by CellTiter-Glo assay. Mature miR-1291 and ARID3B mRNA levels were determined by quantitative real-time PCR (q-PCR) assay. A luciferase reporter gene assay was used to validate interaction between miR-1291 and ARID3B 3’UTR. Target protein expression was examined by Western blot and immunofluorescence analyses. PANC-1 and PC patient-derived xenograft (PDX) mouse models were established and used to assess anti-tumor effects of miR-1291 monotherapy and combination therapy with Gem-nP. Results: Cytotoxicity assays showed that miR-1291 prodrug enhanced the sensitivity of PANC-1 and AsPC-1 cells to Gem-nP. Luciferase assays confirmed ARID3B as a target for miR-1291 as predicted by computational analysis. qPCR analysis demonstrated that miR-1291 prodrug was readily processed to mature miR-1291 and subsequently upregulated ARID3B mRNA levels. miR-1291 prodrug also elevated the protein levels of ARID3B. Co-administration of miR-1291 prodrug and Gem-nP increased caspase-3/7 and γH2AX levels in PC cells, compared to miR-1291 or Gem-nP treatment alone. In addition, systemic administration of in vivo-jet PEI formulated miR-1291 prodrug suppressed tumor growth in both a PANC-1 xenograft model and three PDX models, and largely enhanced the efficacy of Gem-nP. All treatments were well tolerated in mice in vivo. Conclusions: Our bioengineered miR-1291 prodrug has therapeutic potential as a monotherapy but also can act as a sensitizing agent to chemotherapy. This novel treatment approach should be further explored for PC.
I am undecided between a career in obstetrics and gynaecology and one in genitourinary medicine. I have a clinical attachment in obstetrics and gynaecology and also a clinical assistant post in genitourinary medicine. What should I do?
Authors: Alexander McMillan
Journal: BMJ (2005)

Have a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone 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>
Small-Cell Neuroendocrine Tumors: Cell State Trumps the Oncogenic Driver
Authors: Matthew G. Oser, Pasi A. Jänne
Journal: Clinical Cancer Research (2018)

Small-cell neuroendocrine cancers often originate in the lung but can also arise in the bladder or prostate. Phenotypically, small-cell carcinoma of the bladder (SCCB) shares many similarities with small-cell lung cancer (SCLC). It is unknown whether SCCB and SCLC share common genetic driver mutations. Clin Cancer Res; 24(8); 1775-6. ©2018 AACRSee related article by Chang et al., p. 1965.
The role of medical manslaughter must be reconsidered, says leading lawyer
Authors: Abi Rimmer
Journal: BMJ (2018)

The role of criminal law and medical manslaughter in cases where doctors make mistakes must be rethought, a leading professor of health law and ethics has said.

Queens Council barrister Ian Kennedy led a review into the breast surgeon Ian Paterson who was sentenced to 15 years in prison last year for carrying out “extensive, life changing operations for no medically justifiable reason.”1

Speaking at the Royal College of Surgeons of Edinburgh’s triennial conference in Edinburgh on 22 March, Kennedy said that the law caused …
What is the status of a medical student who is a British graduate who qualifies from outside the European Union regarding the new rules for foundation year 1 and year 2 jobs?
Authors: Manoj Kumar
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>
How do I prepare for an interview for an SHO post in medical microbiology? What questions can I expect?
Authors: Andrew Wilson
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>
IMPACT OF MAJOR PRICE REDUCTION BY GOVERNMENT OF INDIA FOR DRUG ELUTING STENTS ON STENT TYPE IMPLANTATION AND ASSOCIATED OUTCOMES
Authors: Parloop Bhatt, Parth Parikh, Anish Chandarana, Milan Chag, Vipul Kapoor, Aditi Nanavati, Tejas Patel, Satya Gupta, Hemang Baxi, Urmil Shah, Vineet Sankhla, Neil Jain, Keyur Parikh
Journal: Journal of the American College of Cardiology (2018)
Biodegradable near-infrared-photoresponsive shape memory implants based on black phosphorus nanofillers
Authors: Hanhan Xie, Jundong Shao, Yufei Ma, Jiahong Wang, Hao Huang, Na Yang, Huaiyu Wang, Changshun Ruan, Yanfeng Luo, Qu-Quan Wang, Paul K. Chu, Xue-Feng Yu
Journal: Biomaterials (2018)
South Korea expands investigation into child author scandal
Authors: Owen Dyer
Journal: BMJ (2018)

At least 82 published scientific papers written by South Korean researchers list co-authors who are children or relatives of the researchers, most of them still in school, a South Korean government investigation has found.

The practice of naming children as co-authors is aimed at improving their chances of securing a good university place in the country’s competitive education system.

The education ministry …
Circulating Tumor Cells with Stem-Like Phenotypes for Diagnosis, Prognosis, and Therapeutic Response Evaluation in Hepatocellular Carcinoma
Authors: Wei Guo, Yun-Fan Sun, Min-Na Shen, Xiao-Lu Ma, Jiong Wu, Chun-Yan Zhang, Yan Zhou, Yang Xu, Bo Hu, Min Zhang, Gang Wang, Wei-Qin Chen, Lin Guo, Ren-Quan Lu, Chao-Hui Zhou, Xin Zhang, Ying-Hong Shi, Shuang-jian Qiu, Bai-shen Pan, Ya Cao, Jian Zhou, Xin-Rong Yang, Jia Fan
Journal: Clinical Cancer Research (2018)

Abstract Background: In the present study, we assessed the clinical value of circulating tumor cells (CTC) with stem-like phenotypes for diagnosis, prognosis, and surveillance in hepatitis B virus (HBV)–related hepatocellular carcinoma (HCC) by an optimized qPCR-based detection platform. Methods: Differing subsets of CTCs were investigated, and a multimarker diagnostic CTC panel was constructed in a multicenter patient study with independent validation (total n = 1,006), including healthy individuals and patients with chronic hepatitis B infection (CHB), liver cirrhosis (LC), benign hepatic lesion (BHL), and HBV-related HCC, with area under the receiver operating characteristic curve (AUC-ROC) reflecting diagnostic accuracy. The role of the CTC panel in treatment response surveillance and its prognostic significance were further investigated. Results: The AUC of the CTC panel was 0.88 in the training set [sensitivity = 72.5%, specificity = 95.0%, positive predictive value (PPV) = 92.4, negative predictive value (NPV) = 77.8] and 0.93 in the validation set (sensitivity = 82.1%, specificity = 94.2%, PPV = 89.9, NPV = 89.3). This panel performed equally well in detecting early-stage and α-fetoprotein–negative HCC, as well as differentiating HCC from CHB, LC, and BHL. The CTC load was decreased significantly after tumor resection, and patients with persistently high CTC load showed a propensity of tumor recurrence after surgery. The prognostic significance of the CTC panel in predicting tumor recurrence was further confirmed [training: HR = 2.692; 95% confidence interval (CI), 1.617–4.483; P &amp;lt; 0.001; and validation: HR = 3.127; 95% CI, 1.360–7.190; P = 0.007]. Conclusions: Our CTC panel showed high sensitivity and specificity in HCC diagnosis and could be a real-time parameter for risk prediction and treatment monitoring, enabling early decision-making to tailor effective antitumor strategies. Clin Cancer Res; 24(9); 2203–13. ©2018 AACR.
IMPACT OF SLEEP DEPRIVATION ON PERCUTANEOUS CORONARY INTERVENTION
Authors: Ann Iverson, Larissa Stanberry, Ross Garberich, Amber Antos, Yader Sandoval, Peter Tajti, M. Nicholas Burke, Ivan Chavez, Mario Goessl, Timothy Henry, Daniel Lips, Michael Mooney, Anil Poulose, Paul Sorajja, Jay Traverse, Yale Wang, Steven Bradley, Emmanouil Brilakis
Journal: Journal of the American College of Cardiology (2018)
Consultant contract must contain safeguards for doctors working out of hours, says BMA
Authors: Abi Rimmer
Journal: BMJ (2014)

The consultant contract must include safeguards for doctors working out of hours to provide seven day services, the BMA has said.

Rob Harwood, a BMA consultant negotiator, said that the association would “insist that there are safeguards in place to ensure that any increase in out of hours working is achievable and doesn’t impose unreasonable burdens on those people that are doing it.”

Contract negotiations between the BMA and NHS Employers began last October.1 An agreement has not yet been reached on whether discussions will result in amendments to the current consultant contract or a new …
The Danger of Applying the ProtecT Trial to Minority Populations
Authors: Shearwood McClelland, Timur Mitin
Journal: JAMA Oncology (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 Oncology 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 Oncology journal
Shaping careers around patients’ needs
Authors: Tom Moberly
Journal: BMJ (2014)

The drive to improve the integration of services across different sectors of the NHS and across healthcare and social care will lead to some big changes for healthcare staff. These developments are likely to involve major shifts in doctors’ training and day to day work. They will also change the roles that doctors take on and the way they plan and manage their careers.

In BMJ Careers this …
The impact of the chemoradiation to surgery interval on pathological complete response: Short and long-term overall survival in esophageal cancer patients.
Authors: Basem Azab, Omar Picado, Caroline Ripat, Francisco Igor Macedo, Alan S Livingstone, Dido Franceschi, Danny Yakoub
Journal: Journal of Clinical Oncology (2018)

2 Background: The association of the interval between neoadjuvant chemo-radiation and surgery (CRT-S), and cancer outcomes in patients with esophageal cancer is not clear. We aimed to determine the relationship between CRT-S interval and pathological complete response rate (pCR), short and long overall survival (OS). Methods: Patients listed on the National Cancer Data Base from 2004 to 2013 were studied. We included patients with CRT followed by surgery in 15-90 days. All patients had reported pT, pN cancer stages and survival status. CRT-S interval was studied as continuous (weeks) and categorical variables (quintiles). Results: A total of 5181 patients were included; 81% were adenocarcinomas, 84% were males and mean age was 62 years. They were divided into CRT-S interval quintiles (15 to 37, 38 to 45, 46 to 53, 54 to 64 and 65 to 90 days) (n = 1016, 1063, 1081, 1083 and 938 patients), respectively. There was a significant increase of pCR rate across the CRT-S quintiles (18%, 21%, 24%, 25% and 29%, p &lt; 0.001). This advantage persisted when CRT-S was measured as continuous variable in weeks (OR: 1.11, 95% CI = 1.078-1.143, p &lt; 0.001). However, 90-day mortality significantly increased as CRT-S increased across quintiles (5.7%, 6.2%, 6.8%, 8.5% and 8.2%, p = 0.02) and through weeks (OR = 1.05, 95%CI = 1.005-1.106, p = 0.03). Mean OS across CRT-S quintiles was 59.2, 58.8, 55.4, 56.6 and 51.5 months, respectively. Multivariate Cox regression showed significantly worse OS per week increase in CRT-S interval (HR 1.02, 95% 1.003-1.037, p = 0.02), especially among the last quintile (CRT-S = 65-90 days: HR 1.2, 95% CI 1.04-1.32, p = 0.009). Those with no-pCR had worse OS as time to surgery increased (p &lt; 0.001), while pCR group had similar OS across CTR-S intervals. Conclusions: Despite higher pCR rate as CRT-S interval increasing, surgery is preferred to be done in less than 65 days after CRT to avoid worse 90-day mortality and achieve better OS. Further randomized studies are needed to consolidate our findings.
Considerations for Cost-effectiveness Analysis of Curative Pediatric Therapies
Authors: Melanie D. Whittington, R. Brett McQueen, Jonathan D. Campbell
Journal: JAMA Pediatrics (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 Pediatrics 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 Pediatrics journal
Outcomes of Early Dermatology Consultation for Inpatients Diagnosed With Cellulitis
Authors: David G. Li, Fan Di Xia, Hasan Khosravi, Anna K. Dewan, Daniel J. Pallin, Christopher W. Baugh, Karl Laskowski, Cara Joyce, Arash Mostaghimi
Journal: JAMA Dermatology (2018)

<h3>Importance</h3> Many inflammatory skin dermatoses mimic cellulitis (pseudocellulitis) and are treated with antibiotics and/or hospitalization, leading to unnecessary patient morbidity and substantial health care spending. <h3>Objective</h3> To evaluate the impact of early dermatology consultation on clinical and economic outcomes associated with misdiagnosed cellulitis. <h3>Design, Setting, and Participants</h3> This prospective cohort study enrolled patients with presumed diagnosis of cellulitis in the emergency department, in the emergency department observation unit, or within 24 hours of admission to an inpatient unit of a large urban teaching hospital between February and September 2017. Patients were provided with telephone and clinic follow-up during the 30-day postdischarge period. We screened 165 patients with the primary concern of cellulitis. Of these, we excluded 44 who required antibiotics for cutaneous, soft-tissue, and deeper-tissue and/or bone infections irrespective of cellulitis status, and 5 who were scheduled to be discharged by the emergency department. <h3>Interventions</h3> Early dermatology consultation for presumed cellulitis. <h3>Main Outcomes and Measures</h3> Primary outcomes were patient disposition and rates of antibiotic use. <h3>Results</h3> Of 116 patients (63 [54.3%] women; 91 [78.4%] non-Hispanic white; mean [SD] age, 58.4 [19.1] years), 39 (33.6%) were diagnosed with pseudocellulitis by dermatologists. Of these, 34 (87.2%) had started using antibiotics for presumed cellulitis as prescribed by the primary team at the time of enrollment. The dermatology team recommended antibiotic discontinuation in 28 of 34 patients (82.4%), and antibiotics were stopped in 26 of 28 cases (92.9%). The dermatologists also recommended discharge from planned observation or inpatient admission in 20 of 39 patients with pseudocellulitis (51.3%), and the primary team acted on this recommendation in 17 of 20 cases (85.0%). No patients diagnosed with pseudocellulitis experienced worsening condition after discharge based on phone and clinic follow-up (30 of 39 [76.9%] follow-up rate). Extrapolating the impact of dermatology consultation for presumed cellulitis nationally, we estimate 97 000 to 256 000 avoided hospitalization days, 34 000 to 91 000 patients avoiding unnecessary antibiotic exposure, and $80 million to $210 million in net cost savings annually. <h3>Conclusions and Relevance</h3> Early consultation by dermatologists for patients with presumed cellulitis represents a cost-effective intervention to improve health-related outcomes through the reduction of inappropriate antibiotic use and hospitalization.