tbuckley/cabot-search huggingface dataset:
Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience
Authors: Olaya Brewer Gutierrez, Shayan Irani, Saowanee Ngamruengphong, Hanaa Aridi, Rastislav Kunda, Ali Siddiqui, Markus Dollhopf, Jose Nieto, Yen-I Chen, Nadav Sahar, Majidah Bukhari, Omid Sanaei, Marcia Canto, Vikesh Singh, Richard Kozarek, Mouen Khashab
Journal: Endoscopy (2018)

Abstract Background Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE. Methods This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected. Results 18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6 % vs. 76.5 %; P &lt; 0.001). Conclusion EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.
MPs raise alarm over “crisis” in emergency medicine staffing
Authors: Helen Jaques
Journal: BMJ (2013)

Emergency medicine is facing a “crisis” in the recruitment and retention of trainees and consultants that could make hospitals’ emergency departments unsustainable if not dealt with quickly, MPs have said.

Only 17% of emergency departments can guarantee consultant coverage for a minimum of 16 hours a day during the working week, the House of Commons Health Committee has reported, a situation it has described as “extraordinary.” 

The committee’s inquiry into urgent and emergency services pinpointed medical staffing as one …
P030 Serum levels of immunoglobulin d and factors influencing the levels in rheumatoid arthritis
Authors: G Gravina, MC Erlandsson, A Bossios, L Ekerljung, C Malmhäll, B Lundbäck, B Mikael, MI Bokarewa
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Introduction</h3> Immunoglobulin D (IgD) remains an enigmatic molecule due to the limited understanding of its function both in healthy and in patients with autoimmune diseases. <h3>Objectives</h3> In this study we analysed serum IgD (sIgD) levels in patients with rheumatoid arthritis (RA) and healthy controls, paying special attention to differences related to age, gender, smoking and presence of autoantibodies Methods sIgD levels were measured in 416 individuals: 248 (184 female, 65 male) RA patients randomly selected at Sahlgrenska and Uddevalla Hospitals, and 169 (95 female, 73 male) healthy controls selected from the OLIN epidemiological study. Sandwich ELISA was developed by using mouse monoclonal antibodies for capture and goat polyclonal for detection (both SouthernBiotech). Serum samples were tested in dilution 1:5000 and sIgD was quantified after serial dilution of human serum with known IgD levels (Siemens, OTRD). The detection limit was 0.08 µg/ml. Smoking information was collected from all RA patients and controls by self-reported questionnaires. ACPA and RF were measured by automatic multiplex method (anti-CCP2) and rate nephelometry technology. Statistical analysis was performed using the Mann-Whitney test. <h3>Results</h3> Median sIgD was 38 µg/ml (IQR 14–97) in RA and 43 µg/ml (IQR 19–108) in healthy controls. sIgD was lower in RA females than RA males (p=0.039) whereas healthy controls had no gender differences in sIgD. Among the females, healthy controls&lt;50 y had high sIgD compared to healthy &gt;50 y (p=0.009), and to RA patients&lt;50 y (p=0.014) and RA &gt;50 y (p=0.046). sIgD was not related to the disease activity, however, RA females producing RF alone (p=0.009) and in combination with ACPA (p=0.028) had low sIgD compared to non-producers. In RA, female smokers had high sIgD compared to never (p=0.022) and former smokers (p=0.003). Smoking was not affecting sIgD in healthy controls. No consistent difference in sIgD was found in males. <h3>Conclusions</h3> The present study indicates that sIgD is influenced by age, gender, smoking and presence of autoantibodies. Low sIgD levels seem to be pathological due to their association with RA and the presence of RF and indicate a potential link between serum IgD and disease severity. <h3>Disclosure of interest</h3> None declared
GMC sees sharp rise in doctors coming to UK from southern Europe
Authors: Abi Rimmer
Journal: BMJ (2014)

The number of doctors coming to work in the United Kingdom from southern Europe has risen sharply, the General Medical Council has said.

The regulator’s 2014 report, The State of Medical Education and Practice in the UK , noted a shift in the pattern of doctors from overseas coming to work in the UK.1 The GMC said that, in the past, the largest source of overseas trained doctors was southern Asia, but recently it has recorded a sharp rise in doctors from southern Europe. 

In 2013, more graduates from the European Economic Area (EEA) joined the medical register than other international medical graduates, the report said. A third (1840) of non-UK graduates who joined the register were from southern Europe, and a fifth were from Italy (616) or Greece (483). 

The GMC said, “We do not know all the reasons …
A paclitaxel prodrug with bifunctional folate and albumin binding moieties for both passive and active targeted cancer therapy
Authors: Lingling Shan, Xin Zhuo, Fuwu Zhang, Yunlu Dai, Guizhi Zhu, Bryant C. Yung, Wenpei Fan, Kefeng Zhai, Orit Jacobson, Dale O. Kiesewetter, Ying Ma, Guizhen Gao, Xiaoyuan Chen
Journal: Theranostics (2018)

Folate receptor (FR) has proven to be a valuable target for chemotherapy using folic acid (FA) conjugates.However, FA-conjugated chemotherapeutics still have low therapeutic efficacy accompanied with side effects, resulting from complications such as short circulation half-life, limited tumor delivery, as well as high kidney accumulation.Herein, we present a novel FA-conjugated paclitaxel (PTX) prodrug which was additionally conjugated with an Evans blue (EB) derivative for albumin binding.The resulting bifunctional prodrug prolonged blood circulation, enhanced tumor accumulation, and consequently improved tumor therapeutic efficacy.Methods: Fmoc-Cys(Trt)-OH was coupled onto PTX at the 7'-OH position for further synthesis of ester prodrug FA-PTX-EB.The targeting ability was investigated using confocal microscopy and flow cytometry.The pharmacokinetics of this bifunctional compound was also studied.Meanwhile, cell viability was evaluated in normal cells and three cancer cell lines by MTT assay.In vivo therapeutic effect was tested on FR-α overexpressing MDA-MB-231 tumor model.Results: Compared with free PTX, the FA-PTX, PTX-EB and FA-PTX-EB prodrugs increased circulation half-life in mice from 2.19 to 3.82, 4.41, and 7.51 h, respectively.Pharmacokinetics studies showed that the FA-PTX-EB delivered more PTX to tumors than FA-PTX and free PTX.In vitro and in vivo studies demonstrated that FA-EB-conjugated PTX induced potent antitumor activity.Conclusion: FA-PTX-EB showed prolonged blood circulation, enhanced drug accumulation in tumors, higher therapeutic index, and lower side effects than either free PTX or monofunctional FA-PTX and EB-PTX.The results support the potential of using EB for the development of long-acting therapeutics.
Pan‐pseudothrombocytopenia: An unusual case of platelet clumping
Authors: Hany Elmariah, Satish Shanbhag
Journal: American Journal of Hematology (2018)

A 39-year-old, healthy Asian female was admitted to the labor and delivery service for twin–twin transfusion syndrome. She was incidentally noted to have thrombocytopenia with a platelet count of 42 k/mm3 checked in an ethylenediaminetetraacetate (EDTA) vial. She was asymptomatic, without history of unexpected bleeding or bruising and normal platelet counts earlier in pregnancy. Both citrated and heparinized platelet counts were similarly suggestive of true thrombocytopenia. However, review of blood smears showed platelet clumping in all three tubes: EDTA (Image 1A), citrated (Image 1B), and heparinized (Image 1C). The patient's true platelet count was approximately 250 k/mm3 by manual count, well within the normal range. We concluded that this patient's thrombocytopenia was an in vitro artifact, commonly termed pseudothrombocytopenia. Blood smears showing platelet clumping in all three tubes: A, EDTA, B, citrated, and C, heparinized Pseudothrombocytopenia is mediated by anti-glycoprotein IIb/IIIa autoantibodies that result in platelet clumping when exposed to EDTA in vitro.1, 2 The effect is a lab artifact that results in a falsely decreased platelet count, but no clinical manifestations.3 The diagnosis is suspected when review of a peripheral blood smear from the EDTA tube confirms platelet clumping with a normal quantity of platelets by manual evaluation. The diagnosis may be confirmed if a repeat blood smear from a citrated tube resolves the clumping. However, in up to 17% of cases, the platelet clumping may persist in the citrated tube.4 In these instances, collection in a heparinized tube uniformly corrects the artifactual effects. We report the first case of pseudothrombocytopenia that persisted in both the citrated and heparinized tubes. The blood smear review remains important in the workup of thrombocytopenia despite the advent and use of automated blood cell counters. This diagnosis would have been missed without review of the blood smear, resulting in further unnecessary workup and inappropriate treatment. Nothing to report.
Recurrence in Resected Gastroenteropancreatic Neuroendocrine Tumors
Authors: Simron Singh, David L. Chan, Lesley Moody, Ning Liu, Hadas D. Fischer, Peter C. Austin, Eva Segelov
Journal: JAMA Oncology (2018)

strength, a proportional reporting ratio (PRR) was calculated and compared with drug-ADR pairs with no known associations to calibrate the threshold at which the PRR represents true ADR signal. 3 To establish time-to-detection comparisons against literature, we reviewed extractions, excluding noncausal drug-ADR mentions, and compared the frequency and timing of these detections against published clinical reports.
Comparisons between intestinal and diffuse gastric cancer in response to apatinib: Data from post-marketing phase IV study.
Authors: Guifang Zhang, Shukui Qin, Jin Li, Wenying Deng, Lu Wen, Junsheng Wang, Haijun Zhong, Tongfu Jia, Jianwei Yang, Yi Ba, Xiaoyan Lin, Mei Wang, Lin Wang, Likun Liu, Yifu He, Min Tao, Congying Xie, Feng Ye, Xiang-yuan Wu, Yuxian Bai
Journal: Journal of Clinical Oncology (2018)

36 Background: Intestinal and diffuse gastric cancer are main histological types of gastric cancer, based on Lauren’s classification, which account for 34–47% and 46–57%, respectively. Patients (pts) with intestinal gastric cancer have better prognosis. The present study aimed to compare the safety and efficacy of apatinib between the two intestinal gastric cancer, based on data from post-marketing Phase IV study (Ahead-G201). Methods: The single-arm, open-label, multi-center, Phase IV trial enrolled advanced or metastatic adenocarcinoma of stomach or gastroesophageal junction after failure of ≥2 lines of chemotherapy. Data of pts with intestinal and diffuse gastric cancer were collected and compared. Results: As of 2017/7/10, 96 intestinal and 104 diffuse pts were recruited. Differences in age (64 vs. 55 yrs), gender (male: 77.1% vs. 57.7%) and disease duration ( &gt; 12 months: 71.3% vs. 56.7%) were detected. Between intestinal and diffuse gastric cancer, there was no discrepancy in incidences of adverse events (AEs) (78.1% vs. 73.1%) and Grade ≥3 AEs (41.7% vs. 38.5%). The incidences of typical AEs associated anti-angiogenesis drugs were also comparable (hypertension 26.0% vs. 16.4%; proteinuria 14.6% vs. 20.2%; hand-foot-skin reaction 16.7% vs. 9.6%). No statistical difference was observed in best overall response rate (12.8% vs. 14.3%) and disease control rate (76.0% vs. 64.3%). Survival benefit in pts with intestinal gastric cancer was detected (progression free survival: 5.52 vs. 2.76 months, p = 0.036; overall survival: 8.11 vs. 4.70 months, p = 0.047). However, the multivariable Cox regression model analysis showed that histological type was not independently prognostic factors for survival, indicating that clinical benefit of pts with intestinal gastric cancer was influenced by other factors. Conclusions: Compared with diffuse gastric cancer, pts intestinal gastric cancer have more clinical benefit after treated by apatinib. However, histological type based on the Lauren’s classification was not independently prognostic factors for survival, which needs to be further analyzed, considering the small sample size. Clinical trial information: NCT02426034.
Evaluating the Long-term Safety of Hysteroscopic Sterilization
Authors: Eve Espey, Lisa G. Hofler
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
Vascular and tumor cell expression of VEGFR2 and molecular subtyping: An innovative biomarker approach in bladder cancer.
Authors: Aejaz Nasir, Beverly L Falcon, Dan Wang, Timothy R. Holzer, Elizabeth M Nonte, Mia Yang Chen, Angie D Fulford, Julia H Carter, Larry E Douglass, Bronislaw Pytowski, Katherine M Bell-McGuinn, Richard A. Walgren, Andrew E Schade, Aafia Chaudhry
Journal: Journal of Clinical Oncology (2018)

497 Background: Treatment approaches combining anti-angiogenic therapy with chemotherapy have shown promising clinical results in metastatic bladder cancer (BC). In order to interrogate the potential clinico-pathologic and molecular basis of these findings, we evaluated VEGFR2, vascular density and molecular subtyping in a series of BC patients. Methods: A custom-TMA with primary BC tissues from 117 patients (mean age 71 yrs; range 38-99 yrs; M:F = 83:34) treated at a single institution, was stained and scored (0-3) for CD34 (vascular density) and for VEGFR2 on tumor vessels and cells. CK5/6 and GATA3 IHC was scored by a pathologist to identify main molecular classes of BC. The association between clinico-pathologic variables, VEGFR2, CD34 and molecular subtypes was analyzed by Fisher’s exact test and ANOVA. Univariate and multivariate Cox proportional models were used for survival analysis. Results: Of 112 analyzable BC tissues, 41% were muscle-invasive (MIBC) vs. 56% non-muscle invasive (NMIBC) and 3% undetermined. Compared to NMIBC patients those with MIBC had shorter overall survival (p &lt; 0.001). The main molecular subtypes included basal (11%), mixed baso-luminal (28%) and luminal (61%). Compared to luminal and baso-luminal subtypes, the majority of basal BCs were muscle invasive (p = 0.036). VEGFR2 expression was higher in tumor vessels but variable in tumor cells. 74% of BCs showed high-medium levels of VEGFR2 (scores 3-2) in tumor vessels and 88% had high-medium levels of tumor vascular density. Within basal, luminal and baso-luminal subtypes, 58%, 78% and 71% had high-medium levels of vascular VEGFR2 (p = 0.52), while 83%, 91% and 82% had high-medium levels of tumor vascular density (p = 0.08). Survival analyses showed increasing patient age, higher stage and lower VEGFR2 levels as independent predictors of shorter survival. Conclusions: Given the observed complexity of BC regarding VEGFR2 expression and vascular density across molecular subtypes, further investigation is warranted to understand how the frequent expression of VEGFR2 on tumor vasculature and variable expression in tumor cells relates to the efficacy of anti-angiogenic agents across these subtypes in bladder cancer.
Abstract P3-01-18: Determining the need for axillar lymph node dissection based on pre-neoadjuvant chemotherapy sentinel lymph node biopsy results
Authors: VF Semiglazov, PV Krivorotko, EK Zhiltsova, GA Dashayan, KU Zernov, AA Bessonov, ES Trufanova, TT Tabagua, OA Ivanova, SV Kanaev, SN Novikov, PI Krzivickiyi, ZV Brayanceva, AV Komayachov, KS Nikolaev, LP Gigolaeva
Journal: Cancer Research (2018)

Abstract An open-label single institution study of sentinel lymph node biopsy prior to neoadjuvant chemotherapy is conducted in the N.N. Petrov research institute of oncology. So far 30 patients with locally advanced breast carcinoma (T2-4N0) were included. Mammography, breast US and SPECT are performed prior to hospitalization so as core biopsy with subsequent IHC staining to determine the levels of ER, PR, KI67 and HER2. Sentinel lymph node biopsy with the use of radiocompound is performed prior to the first cycle of neoadjuvant chemotherapy. Patients receive 4 to 6 cycles with response evaluation after cycles 2, 4 and 6 (same evaluations as at the baseline). Axillary lymph node dissection is later performed along with the definitive surgery of the primary. Interim analysis showed: 3 of 30 patients with cN0 were node positive after sentinel lymph node biopsy, 27 were node-negative (sn)pN0. All patients with (sn)pN0 completed neoadjuvant chemotherapy with clinical response. No cases of upfront progression were detected. All patients (sn)pN0 underwent axillary dissection upon completion of the neoadjuvant therapy. No cases of nodal involvement were detected (ypN0). All of the patients considered node-positive after sentinel biopsy also underwent lymph node dissection after completion of the neoadjuvant therapy. 2 of them were pN1 and one was pN2. Conclusion: sentinel lymph node biopsy in cN0 patients prior to neoadjuvant chemotherapy allows to determine a category of patients ((sn)pN0) in whom axillary dissection can be avoided, provided they remain clinically node-negative at the time of definitive surgery. Citation Format: Semiglazov VF, Krivorotko PV, Zhiltsova EK, Dashayan GA, Zernov KU, Bessonov AA, Trufanova ES, Tabagua TT, Ivanova OA, Kanaev SV, Novikov SN, Krzivickiyi PI, Brayanceva ZV, Komayachov AV, Nikolaev KS, Gigolaeva LP. Determining the need for axillar lymph node dissection based on pre-neoadjuvant chemotherapy sentinel lymph node biopsy results [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 P3-01-18.
Trainee groups decline offer to meet Hunt
Authors: Abi Rimmer
Journal: BMJ (2015)

Groups representing trainee doctors have turned down the opportunity to meet the health secretary for England, Jeremy Hunt, to discuss issues concerning their members.

Trainee representative groups said that it would be inappropriate to meet Hunt, given the ongoing dispute over juniors doctors’ contracts.

The health secretary has held discussions with royal colleges to prepare the NHS for any industrial action.1 The BMA’s ballot of junior doctors closes on 18 November, and in the event of a positive result the association said that industrial action could take place on 1 December.2

Mustafa Rashid, president of the British Orthopaedic Trainees Association, said that …
OUTCOMES OF DIABETIC PATIENTS UNDERGOING PCI WITH CONTEMPORARY DRUG-ELUTING STENTS: ANALYSIS FROM THE BIONICS STUDY
Authors: Maayan Konigstein, Ori Ben-Yehuda, Gidon Perlman, Melek Ozgu Ozan, Michael Love, Pieter Smits, Shmuel Banai, Martin B. Leon, Gregg Stone, David Kandzari
Journal: Journal of the American College of Cardiology (2018)
Safety and efficacy of checkpoint inhibition (CI) in cancer patients (pts) with concurrent human immunodeficiency virus (HIV) infection.
Authors: Soo Park, Assuntina Gesualda Sacco, Ezra E.W. Cohen, Gregory A. Daniels
Journal: Journal of Clinical Oncology (2018)

136 Background: There is limited knowledge about the use of CI in cancer pts with HIV. Here we report the safety and efficacy of these agents in this pt population. Methods: We identified cancer pts with HIV at UCSD who received ≥1 dose of ipilimumab, pembrolizumab or nivolumab (anti-PD1), or the combination of ipi+nivo and had ≥1 follow-up visit. Data regarding clinical history, treatment response, and toxicity were collected. Results: Three pts had head and neck squamous cell carcinoma (HNSCC), 2 pts had advanced melanoma, 1 pt had cutaneous SCC, and 1 pt had SCC of unknown primary (suspected lung). Age ranged from 51-73 years. All pts had ECOG PS 0-1 at time of treatment. Six pts received anti-PD1 for a median of 8 cycles (range 2-35); one pt received 4 cycles of ipi+nivo q3wk followed by 4 cycles of anti-PD1. All 7 pts were on anti-retroviral therapy (ART) and had well-controlled HIV (viral load &lt; 400 copies/mL) with varying degrees of immune dysfunction: 4 pts with moderate immune dysfunction (100-199), 1 pt with mild immune dysfunction (200-350), and 2 pts with normal immune function ( &gt; 350). 3/7 pts (43%) had ≥1 clinically significant irAE of grade ≤2 (fatigue and rash); one pt who received ipi+nivo developed grade 3 hepatitis and required systemic steroids though progressive disease likely contributed. No atypical toxicities were seen. Objective responses were seen in 4/7 pts (57%) with 1 complete response and 3 partial responses; two pts had progressive disease and response was not yet evaluable in 1 pt. Four patients died from clinical deterioration unrelated to CI or immunodeficiency. Conclusions: CI demonstrated significant anti-tumor activity in cancer pts with well-controlled HIV. The toxicity profile is consistent with known irAEs. Further study of these agents in this pt population is warranted.
One in five obstetrics and gynaecology trainees would leave if contract were imposed, survey finds
Authors: Abi Rimmer
Journal: BMJ (2015)

A fifth (21%) of trainees in obstetrics and gynaecology would leave medicine if the proposed changes to the junior doctors’ contract in England were imposed, a survey has found.

The survey of trainees carried out by the Royal College of Obstetricians and Gynaecologists’ National Trainees Committee received 521 responses from a total of 1600 trainees. Responses came from junior doctors at all levels of specialty training. 

Of those who responded, …