tbuckley/cabot-search huggingface dataset:
Benefits and Harms of Cranial Electrical Stimulation for Chronic Painful Conditions, Depression, Anxiety, and Insomnia
Authors: Paul G. Shekelle, Ian A. Cook, Isomi M. Miake-Lye, Marika Suttorp Booth, Jessica M. Beroes, Selene Mak
Journal: Annals of Internal Medicine (2018)

Cranial electrical stimulation (CES) is increasingly popular as a treatment, yet its clinical benefit is unclear.To review evidence about the benefits and harms of CES for adult patients with chronic painful conditions, depression, anxiety, and insomnia.Several databases from inception to 10 October 2017 without language restrictions and references from experts, prior reviews, and manufacturers.Randomized controlled trials of CES versus usual care or sham CES that reported pain, depression, anxiety, or sleep outcomes in any language.Single-reviewer extraction checked by another; dual independent quality assessment; strength-of-evidence grading by the first author with subsequent group discussion.Twenty-eight articles from 26 randomized trials met eligibility criteria. The 2 trials that compared CES with usual care were small, and neither reported a statistically significant benefit in pain or anxiety outcomes for patients with fibromyalgia or anxiety, respectively. Fourteen trials with sham or placebo controls involving patients with painful conditions, such as headache, neuromuscular pain, or musculoskeletal pain, had conflicting results. Four trials done more than 40 years ago and 1 from 2014 provided low-strength evidence of a possible modest benefit compared with sham treatments in patients with anxiety and depression. Trials in patients with insomnia (n = 2), insomnia and anxiety (n = 1), or depression (n = 3) had inconclusive or conflicting results. Low-strength evidence suggested that CES does not cause serious side effects.Most trials had small sample sizes and short durations; all had high risk of bias due to inadequate blinding.Evidence is insufficient that CES has clinically important effects on fibromyalgia, headache, neuromusculoskeletal pain, degenerative joint pain, depression, or insomnia; low-strength evidence suggests modest benefit in patients with anxiety and depression.Veterans Affairs Quality Enhancement Research Initiative. (PROSPERO: CRD42016023951).
Doctors must learn to cede leadership positions but retain responsibility, says Monitor’s medical director
Authors: Abi Rimmer
Journal: BMJ (2015)

Doctors must learn to relinquish leadership roles while at the same time remaining responsible for decisions and patient safety, the medical director of Monitor has said.

Speaking at an NHS Employers Workforce Summit in London on Tuesday, Hugo Mascie-Taylor, who is also executive director of patient and clinical engagement for Monitor, said that the NHS was asking doctors to take on a more sophisticated role than in the past.

“There is a great stress placed on individual decision making in medical school,” he said. “I think appropriately that remains; we wouldn’t want to get to a situation where doctors are not …
Response to: ’A20 haploinsufficiency (HA20): clinical phenotypes and disease course of patients with a newly recognised NF-kB-mediated autoinflammatory disease' by Aeschlimann<i>et al</i>
Authors: Florence A Aeschlimann, Ronald M Laxer
Journal: Annals of the Rheumatic Diseases (2018)

Response to: 'A20 haploinsufficiency
Deep vein thrombosis
Authors: M J Stubbs, Maria Mouyis, Mari Thomas
Journal: BMJ (2018)

### What you need to know

Deep vein thrombosis (DVT) commonly affects the lower limb, with clot formation beginning in a deep calf vein and propagating proximally.1 It is a common venous thromboembolic (VTE) disorder with an incidence of nearly 1.6 per 1000 inhabitants a year.234 The rate of involvement of particular sites varies: distal veins 40%, popliteal 16%, femoral 20%, common femoral 20%, and iliac veins 4%.1 Certain medical conditions listed in box 1 increase the likelihood of clot formation in the deep veins. Upper limb DVT represents less than 10% of all DVT, and central venous catheters are the main risk factor.7 Venocaval thromboses are rare and are associated with malignancy, compression, and vascular abnormalities.8 This article provides an overview for non-specialists on initial approach to patients with suspected DVT.

Box 1 
### DVT risk factors56

#### Transient risk factors

#### Persistent risk factors

#### Unprovoked VTERETURN TO TEXT

### Sources and selection criteria

We searched Medline and Cochrane databases for clinical trials, systematic reviews, and meta-analyses relevant to the diagnosis and management of DVT. Search terms included “deep vein thrombosis,” …
Cardiopulmonary rehabilitation for obese sleep-disordered breathing: a new treatment frontier?
Authors: Craig L Phillips, Elizabeth A Cayanan, Camilla M Hoyos
Journal: Thorax (2018)

The health benefits of routine exercise in otherwise healthy people, including in those who are obese, are well proven.1 Exercise improves cardiorespiratory fitness and improves blood supply to the musculature to enhance oxidative metabolism and overall efficiency of energy expenditure. There is also evidence showing the benefits of exercise might extend to people with debilitating conditions including congestive heart failure (CHF),2 COPD3 and more recently, obesity hypoventilation syndrome (OHS).4 In these populations, exercise training as part of a rehabilitation programme has been shown to improve exercise and functional capacity as well as overall quality of life. However, there are inherent (disease-specific) physiological limitations that pose significant barriers to full engagement in exercise training in people with chronic illness. For example, in the setting of pulmonary rehabilitation in COPD, exercise-induced dynamic hyperinflation increases the work of breathing, resulting in severe dyspnoea and a reduction in exercise tolerance, making it difficult for patients to adhere to exercise programmes.5 As a solution to this, rehabilitation programmes, particularly in COPD, are increasingly using supportive methods in an attempt to reduce the physiological burden of exercise and improve exercise tolerance and capacity with anticipated positive effects on health outcomes.

For example, non-invasive ventilation (NIV) that is deployed during exercise in patients with COPD undergoing pulmonary rehabilitation is thought to unload respiratory muscles and reduce the work of breathing, reducing diaphragm fatigue and dyspnoea. While this is supported by a number of studies showing an increase in training intensity, the effect on subsequent exercise capacity seems variable and currently the benefits remain unclear.6 Another technique used to improve exercise tolerance involves respiratory muscle training (RMT), incorporating both respiratory muscle strength (resistive/threshold) and respiratory endurance (isocapnic hyperpnoea) training. In healthy individuals, …
Young Bone Marrow Sca-1 Cells Rejuvenate the Aged Heart by Promoting Epithelial-to-Mesenchymal Transition
Authors: Jiao Li, Shu-Hong Li, Jun Wu, Richard D Weisel, Alina Yao, William L Stanford, Shi-Ming Liu, Ren-Ke Li
Journal: Theranostics (2018)

Background: To improve the regenerative capacity of aged individuals, we reconstituted bone marrow (BM) of aged mice with young Sca-1 cells, which repopulated cardiac progenitors and prevented cardiac dysfunction after a myocardial infarction (MI). However, the mechanisms involved were incompletely elucidated. This study aimed to investigate whether young, highly regenerative BM Sca-1 cells exert their cardio-protective effects on the aged heart through reactivation of the epithelial-to-mesenchymal transition (EMT) process. Methods:In vitro, BM Sca-1 cells were co-cultured with epicardial-derived cells (EPDCs) under hypoxia condition; mRNA and protein levels of EMT genes were measured along with cellular proliferation and migration. In vivo, BM Sca-1+ or Sca-1- cells from young mice (2-3 months) were transplanted into lethally-irradiated old mice (20-22 months) to generate chimeras. In addition, Sca-1 knockout (KO) mice were reconstituted with wild type (WT) BM Sca-1+ cells. The effects of BM Sca-1 cell on EMT reactivation and improvement of cardiac function after MI were evaluated. Results:In vitro, BM Sca-1+ cells increased EPDC proliferation, migration, and EMT relative to Sca-1- cells and these effects were inhibited by a TGF-β blocker. In vivo, more young BM Sca-1+ than Sca-1- cells homed to the epicardium and induced greater host EPDC proliferation, migration, and EMT after MI. Furthermore, reconstitution of Sca-1 KO mice with WT Sca-1+ cells was associated with the reactivation of EMT and improved cardiac function after MI. Conclusions: Young BM Sca-1+ cells improved cardiac regeneration through promoting EPDC proliferation, migration and reactivation of EMT via the TGF-β signaling pathway.
The estrogenic hormone effect in gastric cancer.
Authors: Youjin Jang, Youjae Mok
Journal: Journal of Clinical Oncology (2018)

85 Background: Estrogen receptors (ERs) are steroid hormone receptors that regulate cellular activities in many physiological and pathological processes in different tissues. A few of studies have examined the expression of ER in gastric cancer. However, considerable controversy is raised as to the expression level of ER and its prognostic value in gastric cancer. In the present study, the expression profile of ERα, ERβ was determined in gastric cancer cell lines according Lauren classification and evaluate that the treatment effect of selective estrogen receptor modulator. Methods: Using four cell lines established from human gastric carcinomas according Lauren classification, check endogenous ERα, ERβ expression levels with RT-PCR. The SERM treatment effect were detected MTT test. Using immunohistochemical detection, the present study analyzed the clinical relevance of ERα, ERβ expression in tumor cells in 197 patients who underwent curative radical surgery and who were observed on long-term follow-up. Results: Endogenous ERα was high expression not intestinal cancer cell lines but in diffuse cancer cell line. Endogenous ERβ was high expression both type cancer cell line than normal gastrointestinal cell lines. According MTT assay, only raloxifene among SERM was significant treatment effect. In immonohistochemial study of gastric tissue, ERα negative and ERβ positive was associated with good prognosis. Conclusions: ERβ may be partly involved in gastric carcinogenesis and ERβ antagonist might be new therapeutic drug for gastric cancer.
GP funding set to fall by nearly £200m by 2015, warns royal college
Authors: Helen Jaques
Journal: BMJ (2013)

NHS funding allocated to general practitioners (GPs) in England could fall by up to £200m over the next three years, the Royal College of General Practitioners has warned.

General practice funding is already being “stretched to the limits,” and any fall in resources could seriously affect GPs’ ability to provide high quality patient care, it said.

Analysis by the college suggests that, if the 1.2% decrease in spending on GP services recorded in 2011-12 continues, investment …
Effect of germline DNA repair gene mutations on outcomes in men with metastatic castration-resistant prostate cancer receiving first-line abiraterone and enzalutamide.
Authors: Emmanuel S. Antonarakis, Changxue Lu, Brandon Luber, Hao Wang, Yan Chen, John Silberstein, Danilo Piana, Zhao Lai, Yidong Chen, William B. Isaacs, Jun Luo
Journal: Journal of Clinical Oncology (2018)

221 Background: Inherited DNA repair gene mutations are more prevalent in men with advanced prostate cancer than previously thought, but their clinical implications are not fully understood. Here we investigated the clinical significance of germline DNA repair gene alterations in men with metastatic castration-resistant prostate cancer (mCRPC) receiving first-line novel hormonal therapy (NHT), with a particular emphasis on BRCA1/2 and ATM mutations. Methods: We interrogated 50 DNA repair genes for pathogenic or likely pathogenic germline mutations using leukocyte DNA from 172 mCRPC patients beginning treatment with first-line NHT: abiraterone or enzalutamide. We assessed the impact of germline DNA repair gene mutation status on ≥50% and ≥90% PSA response rates, PSA progression-free survival (PSA-PFS), clinical/radiologic progression-free survival (PFS), and overall survival (OS). Outcomes were adjusted using propensity score-weighted multivariable Cox regression analyses. Results: Among 172 mCRPC patients, germline mutations (in any DNA repair gene) were found in 12.8% (22/172) of men, and germline BRCA/ATM mutations were found in 5.2% (9/172) of men. In unadjusted analyses, outcomes to first-line NHT were better in men with germline BRCA/ATM mutations (vs. no mutations) with respect to ≥90% PSA responses (78% vs. 28%, P = 0.004), PSA-PFS (HR 0.47, P = 0.061), PFS (HR 0.50, P = 0.090) and OS (HR 0.28, P = 0.059). In propensity score-weighted multivariable analyses, outcomes remained superior in men with germline BRCA/ATM mutations with respect to PSA-PFS (HR 0.48, 95%CI 0.25–0.92, P = 0.027), PFS (HR 0.52, 95%CI 0.28–0.98, P = 0.044) and OS (HR 0.34, 95%CI 0.12–0.99, P = 0.048), but this was not true for men with non- BRCA/ATM germline mutations (all endpoints, P &gt; 0.10). Conclusions: Outcomes to first line NHT appeared better in mCRPC patients harboring germline BRCA/ATM mutations (vs. no mutations), but not for patients with other non- BRCA/ATM germline mutations. These results support the hypothesis that AR may promote DNA repair, and that inhibiting AR in the context of homologous recombination deficiency may lead to synthetic lethality.
Five ways ministers have defined a “seven day NHS”
Authors: Gareth Iacobucci
Journal: BMJ (2016)

In March 2015 David Cameron said, “With a future Conservative government we would have a truly seven day NHS.” He added, “Already millions more people can see a GP seven days a week, but by 2020 I want this for everyone, with hospitals properly staffed especially for urgent and emergency care, so that everyone will have access to the NHS services they need seven days a week by 2020.”1

Referring in May …
Is it possible to defer a GPVTS post after accepting it? I am going through a difficult pregnancy and would like to delay the start of my post
Authors: Kay Mohanna
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>
Spatial and temporal clonal evolution of intrahepatic cholangiocarcinoma
Authors: Liang-Qing Dong, Yang Shi, Li-Jie Ma, Liu-Xiao Yang, Xiao-Ying Wang, Shu Zhang, Zhi-Chao Wang, Meng Duan, Zhao Zhang, Long-Zi Liu, Bo-Hao Zheng, Zhen-Bin Ding, Ai-Wu Ke, Da-Ming Gao, Ke Yuan, Jian Zhou, Jia Fan, Ruibin Xi, Qiang Gao
Journal: Journal of Hepatology (2018)
USE OF INTRAVASCULAR ULTRASOUND AND OPTIMAL COHERENCE TOMOGRAPHY FOR ETIOLOGICAL DIAGNOSIS IN A WOMAN PRESENTING WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION, APICAL WALL MOTION ABNORMALITY AND NON-OBSTRUCTIVE CORONARY ARTERY DISEASE
Authors: Odayme Quesada, Ameera Ahmed, Stephanie Cantu, Janet Wei, Babak Azarbal, C. Noel Bairey Merz
Journal: Journal of the American College of Cardiology (2018)
I am a consultant in medicine in the United States. I have General Medical Council and Irish Medical Council registration, have passed the PLAB tests, and have worked in the United Kingdom. How do I apply for consultant posts in the United Kingdom or Ireland?
Authors: Jo Constable
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 (www.bmjcareers.com/advicezone) 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.
SERUM UROMODULIN PREDICTS A DECLINE IN KIDNEY FUNCTION INDEPENDENTLY FROM THE PRESENCE OF TYPE 2 DIABETES
Authors: Andreas Leiherer, Axel Muendlein, Christoph Saely, Eva-Maria Brandtner, Kathrin Geiger, Peter Fraunberger, Heinz Drexel
Journal: Journal of the American College of Cardiology (2018)
The neurosurgeon shadowed by Ian McEwan for his latest book
Authors: Zosia Kmietowicz
Journal: BMJ (2005)

N eil Kitchen is a consultant neurosurgeon and associate clinical director at the National Hospital for Neurology and Neurosurgery in London. He studied medicine at Bart's and University College Hospitals in London and at Addenbrooke's Hospital in Cambridge. (He opted to do his clinical training at Addenbrooke's because it was six months shorter than in London and he says he was impatient.) Before heading up to Cambridge he squeezed in a BSc in the history of medicine at the Wellcome Institute. He briefly flirted with ophthalmology and spent a month at the St John Eye Hospital in Jerusalem before taking up a surgical house post at Addenbrooke's. Mr Kitchen has also worked at Bart's, Charing Cross Hospital, the Royal Free, Atkinson Morley's, Southend Hospital, and the National Hospital for Neurology and Neurosurgery.⇓



He was introduced to me by a mutual friend, …
Diabetes in Youth—Looking Backwards to Inform the Future: Kelly West Award Lecture 2017
Authors: Dana Dabelea
Journal: Diabetes Care (2018)

The Kelly West Award for Outstanding Achievement in Epidemiology is presented in honor of the memory of Kelly M. West, widely regarded as the "father of diabetes epidemiology." Harry Keen described West as characterized by "generosity of spirit, deeply human and humorous, deliberate of address, modest, conciliatory and untiringly persevering. Few people have done so much to change the landscape of diabetes" (1). The award and lecture recognize a leading epidemiologist in the field of diabetes. Dana Dabelea, MD, PhD, received this award at the American Diabetes Association's 77th Scientific Sessions, 9-13 June 2017, in San Diego, CA. She presented the Kelly West Award Lecture, "Diabetes in Youth-Looking Backwards to Inform the Future," on Sunday, 11 June 2017.
Organ Dysfunction After Surgery in Patients Treated With Individualized or Standard Blood Pressure Management
Authors: Luke J. Laffin, Michael R. Laffin
Journal: JAMA (2018)

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Retinal imaging interpretation course
Authors: Umiya Agraval
Journal: BMJ (2011)

The retinal imaging interpretation course is ideal for all junior trainees in ophthalmology, including foundation doctors, who are preparing for examinations for fellowship of the Royal College of Ophthalmologists (FRCOphth) and those interested in learning about current trends in ophthalmic diagnostic imaging.

During foundation year 2.

I have a very keen interest in ophthalmology, and while I was preparing for the FRCOphth part 1 exam I believed that this course would help me to build on my basic knowledge of imaging techniques of the retina. The course aimed to cover the basic concepts of the main imaging techniques and gave the opportunity to test my knowledge with cases and quizzes, which was exactly what I wanted. I had heard that the course …
MITRAL REGURGITATION IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE IMPLANTATION FOR DEGENERATED SURGICAL AORTIC BIOPROSTHESIS: INSIGHTS FROM PARTNER 2 VALVE-IN-VALVE REGISTRY
Authors: Dale Murdoch, Janarthanan Sathananthan, S. Chris Malaisrie, Wael Jaber, Rebecca T. Hahn, Ted Feldman, Aaron Crowley, Anson Cheung, Jian Ye, David Wood, Martin B. Leon, Michael J. Mack, John Webb
Journal: Journal of the American College of Cardiology (2018)
RIGHT INFERIOR PULMONARY VEIN STENOSIS BY PECTUS EXCAVATUM IN A 35 YEAR OLD FEMALE WHO UNDERWENT CORONARY ARTERY BYPASS GRAFT PROCEDURE DUE TO KAWASAKI DISEASE: DIFFERENTIATION OF THE OCCURRENCE OF PARTIAL PULMONARY VEIN CONGESTION
Authors: Nobusada Funabashi, Gentaro Koyama, Hideyuki Miyauchi, Yoshihide Fujimoto, Hiroyuki Takaoka, Takuro Horikoshi, Goro Matsumiya, Yoshio Kobayashi
Journal: Journal of the American College of Cardiology (2018)
Editor’s Choice: Four decades of adventure
Authors: Tom Moberly
Journal: BMJ (2015)

Over 7000 UK medical graduates will start their first day as doctors next week, and many will have kept an eye on the advice offered on social media by using the #tipsfornewdocs hashtag (http://bit.ly/1LSPAKR). There they will find practical advice on everything from how to cope with sleep deprivation to how you should treat colleagues with due respect. 

Psychiatrist Alex Langford (‏@PsychiatrySHO) says, “Be nice to everyone. Especially …