tbuckley/cabot-search huggingface dataset:
Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events
Authors: Nils Lehmann, Raimund Erbel, Amir A. Mahabadi, Michael Rauwolf, Stefan Möhlenkamp, Susanne Moebus, Hagen Kälsch, Thomas Budde, Axel Schmermund, Andreas Stang, Dagmar Führer-Sakel, Christian Weimar, Ulla Roggenbuck, Nico Dragano, Karl-Heinz Jöckel, T. Meinertz, C. Bode, P.J. de Feyter, B. Güntert, F. Gutzwiller, H. Heinen, O. Hess, B. Klein, H. Löwel, M. Reiser, G. Schmidt, M. Schwaiger, C. Steinmüller, T. Theorell, S.N. Willich, C. Bode, K. Berger, H.R. Figulla, C. Hamm, P. Hanrath, W. Köpcke, B. Ringelstein, M. Dichgans, A. Zeiher
Journal: Circulation (2017)

Computed tomography (CT) allows estimation of coronary artery calcium (CAC) progression. We evaluated several progression algorithms in our unselected, population-based cohort for risk prediction of coronary and cardiovascular events.In 3281 participants (45-74 years of age), free from cardiovascular disease until the second visit, risk factors, and CTs at baseline (b) and after a mean of 5.1 years (5y) were measured. Hard coronary and cardiovascular events, and total cardiovascular events including revascularization, as well, were recorded during a follow-up time of 7.8±2.2 years after the second CT. The added predictive value of 10 CAC progression algorithms on top of risk factors including baseline CAC was evaluated by using survival analysis, C-statistics, net reclassification improvement, and integrated discrimination index. A subgroup analysis of risk in CAC categories was performed.We observed 85 (2.6%) hard coronary, 161 (4.9%) hard cardiovascular, and 241 (7.3%) total cardiovascular events. Absolute CAC progression was higher with versus without subsequent coronary events (median, 115 [Q1-Q3, 23-360] versus 8 [0-83], P<0.0001; similar for hard/total cardiovascular events). Some progression algorithms added to the predictive value of baseline CT and risk assessment in terms of C-statistic or integrated discrimination index, especially for total cardiovascular events. However, CAC progression did not improve models including CAC5y and 5-year risk factors. An excellent prognosis was found for 921 participants with double-zero CACb=CAC5y=0 (10-year coronary and hard/total cardiovascular risk: 1.4%, 2.0%, and 2.8%), which was for participants with incident CAC 1.8%, 3.8%, and 6.6%, respectively. When CACb progressed from 1 to 399 to CAC5y≥400, coronary and total cardiovascular risk were nearly 2-fold in comparison with subjects who remained below CAC5y=400. Participants with CACb≥400 had high rates of hard coronary and hard/total cardiovascular events (10-year risk: 12.0%, 13.5%, and 30.9%, respectively).CAC progression is associated with coronary and cardiovascular event rates, but adds only weakly to risk prediction. What counts is the most recent CAC value and risk factor assessment. Therefore, a repeat scan >5 years after the first scan may be of additional value, except when a double-zero CT scan is present or when the subjects are already at high risk.
Identification of High-Risk Plaques Destined to Cause Acute Coronary Syndrome Using Coronary Computed Tomographic Angiography and Computational Fluid Dynamics
Authors: Joo Myung Lee, Gilwoo Choi, Bon-Kwon Koo, Doyeon Hwang, Jonghanne Park, Jinlong Zhang, Kyung-Jin Kim, Yaliang Tong, Hyun Jin Kim, Leo Grady, Joon-Hyung Doh, Chang-Wook Nam, Eun-Seok Shin, Young-Seok Cho, Su-Yeon Choi, Eun Ju Chun, Jin-Ho Choi, Bjarne L. Nørgaard, Evald H. Christiansen, Koen Niemen, Hiromasa Otake, Martin Penicka, Bernard de Bruyne, Takashi Kubo, Takashi Akasaka, Jagat Narula, Pamela S. Douglas, Charles A. Taylor, Hyo-Soo Kim
Journal: JACC. Cardiovascular imaging (2018)
Antiviral therapy in hepatitis B virus-infected children with immune-tolerant characteristics: A pilot open-label randomized study
Authors: Shishu Zhu, Hongfei Zhang, Yi Dong, Limin Wang, Zhiqiang Xu, Weiwei Liu, Yu Gan, Hongmei Tang, Dawei Chen, Fuchuan Wang, Pan Zhao
Journal: Journal of Hepatology (2018)
Associations of Distance to Trauma Care, Community Income, and Neighborhood Median Age With Rates of Injury Mortality
Authors: Molly P. Jarman, Frank C. Curriero, Elliott R. Haut, Keshia Pollack Porter, Renan C. Castillo
Journal: JAMA Surgery (2018)

<h3>Importance</h3> Rural, low-income, and historically underrepresented minority communities face substantial barriers to trauma care and experience high injury incidence and mortality rates. Characteristics of injury incident locations may contribute to poor injury outcomes. <h3>Objective</h3> To examine the association of injury scene characteristics with injury mortality. <h3>Design, Setting, and Participants</h3> In this cross-sectional study, data from trauma center and emergency medical services provided by emergency medical services companies and designated trauma centers in the state of Maryland from January 1, 2015, to December 31, 2015, were geocoded by injury incident locations and linked with injury scene characteristics. Participants included adults who experienced traumatic injury in Maryland and were transported to a designated trauma center or died while in emergency medical services care at the incident scene or in transit. <h3>Exposures</h3> The primary exposures of interest were geographic characteristics of injury incident locations, including distance to the nearest trauma center, designation level and ownership status of the nearest trauma center, and land use, as well as community-level characteristics such as median age and per capita income. <h3>Main Outcomes and Measures</h3> Odds of death were estimated with multilevel logistic regression, controlling for individual demographic measures and measures of injury and health. <h3>Results</h3> Of the 16 082 patients included in this study, 8716 (52.4%) were white, and 5838 (36.3%) were African American. Most patients were male (10 582; 65.8%) and younger than 65 years (12 383; 77.0%). Odds of death increased by 8.0% for every 5-mile increase in distance to the nearest trauma center (OR, 1.08; 95% CI, 1.01-1.15;<i>P</i> = .03). Compared with privately owned level 1 or 2 centers, odds of death increased by 49.9% when the nearest trauma center was level 3 (OR, 1.50; 95% CI, 1.06-2.11;<i>P</i> = .02), and by 80.7% when the nearest trauma center was publicly owned (OR, 1.81; 95% CI, 1.39-2.34;<i>P</i> &lt; .001). At the zip code tabulation area level, odds of death increased by 16.0% for every 5-year increase in median age (OR, 1.16; 95% CI, 1.03-1.30;<i>P</i> = .02), and decreased by 26.6% when the per capita income was greater than $25 000 (OR, 0.73; 95% CI, 0.54-0.99;<i>P</i> = .05). <h3>Conclusions and Relevance</h3> Injury scene characteristics are associated with injury mortality. Odds of death are highest for patients injured in communities with higher median age or lower per capita income and at locations farthest from level 1 or 2 trauma centers.
Prevalence of carriage of extended-spectrum β-lactamase-producing enterobacteria and associated factors in a French hospital
Authors: S. Jolivet, L. Vaillant, T. Poncin, I. Lolom, Y. Gaudonnet, E. Rondinaud, G. Bendjelloul, A. Lomont, J.-C. Lucet, L. Armand-Lefèvre
Journal: Clinical Microbiology and Infection (2018)
Male-GBG54 : a prospective, randomised multi-centre phase II study evaluating endocrine treatment with either tamoxifen plus /- gonadotropin releasing hormone analogue (GnRHa) or an aromatase inhibitor plus GnRHa in male breast cancer patients
Authors: M. Reinisch, Hj. Strittmatter, D. Strik, S. Loibl, S. Seiler, J. Furlanetto, D. M. Zahm, S. Schmatloch, A. Kamischke, C. Rudlowski, F. Marme, T. Hauzenberger, V. Nekljudova, W. Janni, C. Jackisch, C. Thode, M. Schmidt, G. von Minckwitz, Elmar Stickeler
Journal: Cancer Research (2018)
Antibiotics after incision and drainage for uncomplicated skin abscesses: a clinical practice guideline
Authors: Mieke Vermandere, Bert Aertgeerts, Thomas Agoritsas, Catherine Liu, Jako Burgers, Arnaud Merglen, Patrick Mbah Okwen, Lyubov Lytvyn, Shunjie Chua, Per O Vandvik, Gordon H Guyatt, Claudia Beltran-Arroyave, Valéry Lavergne, Reinhart Speeckaert, Finn E Steen, Victoria Arteaga, Rachelle Sender, Shelley McLeod, Xin Sun, Wen Wang, Reed A C Siemieniuk
Journal: BMJ (2018)

What role do antibiotics have in the treatment of uncomplicated skin abscesses after incision and drainage? A recent study suggested that, for small uncomplicated skin abscesses, antibiotics after incision and drainage improve the chance of short term cure compared with placebo. Triggered by this trial, the Rapid Recommendation team produced a new systematic review. Relying on this review and using the GRADE framework according to the BMJ Rapid Recommendation process, an expert panel makes a weak recommendation in favour of trimethoprim-sulfamethoxazole (TMP-SMX, co-trimoxazole) or clindamycin in addition to incision and drainage over incision and drainage alone. For patients who have chosen to initiate antibiotics, the panel issues a strong recommendation for TMP-SMX or clindamycin rather than a cephalosporin and a weak recommendation for TMP-SMX rather than clindamycin. Box 1 shows the articles and evidence linked to this Rapid Recommendation. The infographic presents the recommendations together with other pertinent information, including an overview of the absolute benefits and harms of candidate antibiotics in the standard GRADE format. The panel emphasises shared decision making in the choice of whether to initiate antibiotics and in which antibiotic to use, because the desirable and undesirable consequences are closely balanced: clinicians using MAGICapp ( http://magicapp.org/goto/guideline/jlRvQn/section/ER5RAn ) will find decision aids to support the discussion with patients. Table 2 below shows any evidence that has emerged since the publication of this article. ### What you need to know
Are there any courses or exams I should consider to enhance my application for GP training at specialty training year 1 level?
Authors: Rodger Charlton
Journal: BMJ (2007)

This is a good question because general practice is becoming an increasingly popular option. I think you are right in considering what you can do to make your application stand out. A number of courses are available, and you can show your competence in a particular field by successfully completing an exam. Many certificate and diploma courses are …
Cardiac Magnetic Resonance Myocardial Feature Tracking for Optimized Prediction of Cardiovascular Events Following Myocardial Infarction
Authors: Ingo Eitel, Thomas Stiermaier, Torben Lange, Karl-Philipp Rommel, Alexander Koschalka, Johannes T. Kowallick, Joachim Lotz, Shelby Kutty, Matthias Gutberlet, Gerd Hasenfuß, Holger Thiele, Andreas Schuster
Journal: JACC. Cardiovascular imaging (2018)
Treatments for metastatic hormone-sensitive prostate cancer: A systematic review.
Authors: Belal Firwana, Mohamad Bassam Sonbol, Fade A. Mahmoud, Konstantinos Arnaoutakis
Journal: Journal of Clinical Oncology (2018)

346 Background: Over the past few years, the treatment of metastatic hormone sensitive prostate cancer (mHSPC) was revolutionized with the addition of docetaxel (DOC) or abiraterone (ABI) to the previous standard of care androgen deprivation treatment (ADT). Here, we sought to compare the effectiveness of docetaxel and abiraterone directly against ADT and indirectly to each other. Methods: We included randomized controlled trials (RCT) evaluating the efficacy of treatments in adults with newly diagnosed mHSPC. First-line treatments with DOC and ABI were considered. Efficacy outcome measures are overall survival (OS) and failure-free survival as (FFS) as defined by individual trial. If FFS was not reported, biochemical progression-free survival was considered FFS due to its specificity. The overall effect was pooled using the DerSimonian random effects model. Testing for subgroup difference was conducted using meta-regression method. Results: A total of five RCTs were included; three RCTs compared DOC+ADT versus ADT involving 2,992 participants, and two RCT compared ABI+ADT versus ADT involving 2,201 participants. The addition of DOC to ADT showed a significant improvement in OS compared to ADT monotherapy (HR 0.77, 95% CI 0.66 to 0.89) as well did the addition of ABI to ADT (HR 0.62, 95% CI 0.53 to 0.71). p-value for subgroup interaction was &lt;0.05, suggesting a significant difference between pooled DOC and ABI effects, favoring the addition of ABI vs. DOC to ADT. Similar effects were found in significantly improving FFS when adding DOC (HR 0.64, 95% CI 0.58 to 0.70) or ABI (HR 0.30, 95% CI 0.27 to 0.34) to ADT compared to ADT monotherapy. p-value for interaction subgroup interaction was again significant &lt;0.05 favoring the addition of ABI vs. DOC to ADT. Conclusions: The addition of either DOC or ABI to ADT showed significant improvement in OS and FFS when compared to ADT monotherapy in patients with mHSPC. Test for interaction suggests better outcome of ABI in comparison against DOC. Discussion with patients is encouraged to choose the appropriate treatment considering the adverse event profile for each. Further head-to-head comparison is needed to determine the effect.
OBESITY PARADOX IN ATRIAL FIBRILLATION: OBESITY IS ASSOCIATED WITH LOWER MORTALITY IN PATIENTS WITH ATRIAL FIBRILLATION WHO UNDERGO ABLATION
Authors: Seyed Hamed Hosseini Dehkordi, Farid Gholitabar, Shawn Lee, Syed Ahsan, May Bakir, Alejandro Lemor, Davendra Mehta
Journal: Journal of the American College of Cardiology (2018)
A novel frailty index improves risk prediction of waitlist mortality over the model for end‐stage liver disease score alone
Authors: Heng Fan, Jian‐hua Zhu
Journal: Hepatology (2018)

Potential conflict of interest: Nothing to report. We read with great interest the article by Lai et al.,1 in which the authors aimed to develop a frailty index to capture the extrahepatic complications of cirrhosis and enhance mortality prediction in patients who have cirrhosis. The authors indicated that comparing with the Model for End‐Stage Liver Disease (MELDNa) score alone, MELDNa + frailty index correctly reclassified 16% of deaths/delistings and 3% of nondeaths/delistings with a total net reclassification index of 19%. Compared with patients who had robust frailty index scores, patients with cirrhosis who had poor frailty index scores were more impaired by gait speed, difficulty with instrumental activities of daily living, exhaustion, and low physical activity. We thank the authors for their comprehensive contribution. Cirrhosis is the terminal complication of a multitude of chronic liver conditions that lead to progressive liver failure and even death. The most commonly used metric to determine prognosis for patients with cirrhosis is the MELDNa score.2 However, at a given MELDNa score, the clinical manifestations of patients with end‐stage liver disease are highly heterogeneous.3 As such, a novel tool is needed to objectively capture this risk. Lai et al. present a novel liver‐specific frailty index that objectively captures this frail phenotype in patients with end‐stage liver disease in the outpatient setting. Their analyses demonstrate that a frailty index can enhance risk prediction for waitlist mortality in patients who have cirrhosis and are awaiting liver transplantation over MELDNa alone. We support the information provided by Lai et al.; however, we have two questions about this article. First, the authors did not internally validate the results using a split‐sample cohort, but rather utilized a combination of stepwise selection, Aikaike Information Criterion reduction, and best subset selection on the entire cohort to derive the frailty index. Because external validation remains the gold standard to assess the true validity of this index when applied to other patient samples,4 future reports should take this into account. Second, this study did not include patients in the inpatient setting, overlooking the fact that not all hospitalized patients are not eligible for liver transplantation.
Abstract P5-23-05: Prognostic value of PD-L1 expression in male breast cancer
Authors: S Abdeljaoued, I Bettaieb, O Adouni, A Goucha, D Chiba, H Bouzaiene, J Ben Hassouna, H Boussen, K Rahal, A Gamoudi
Journal: Cancer Research (2018)

Abstract Background Growing evidence have shown promise for targeting programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) signaling in several tumors. In female breast cancer, PD-L1 expression has been correlated with poor clinical outcome. However, whether PD-L1 has any indication for prognosis in male breast cancer (MBC) patients remains unknown. The purpose of this study was to examine the expression levels of PD-L1 in MBC and to identify the relationship between PD-L1 expression and patient survival. Methods We retrospectively identified 110 male breast cancer patients diagnosed between 2000 and 2013 at Salah Azaïz Cancer Institute. PD-L1 expression was evaluated by immunohistochemistry (IHC) using CD274 antibody. Specimens were scored as IHC low or high, when &amp;lt; 5% or ≥ 5% of cells were PD-L1 positive, respectively. The association between expression of PD-L1 and survival was investigated using Kaplan-Meier survival and COX proportional hazard regression analyses. Results Median follow up was 12.5 months [range 1-132 months]. High expression of PD-L1 was observed in 64.5% of MBC samples (71/110). PD-L1 expression was significantly associated with advanced clinical stage (p=0.012), higher histological grade (p=0.014), higher Ki67 expression (p=0.023) and hormone-receptor negative status (p=0.024). Patients with high PD-L1 expression had significantly shorter overall survival (OS) than patients with low expression (p=0.002, hazard ratio (HR) =5 [2.624–10.642]). Multivariate analysis identified PD-L1 as an independent prognostic factor for OS (p&amp;lt;0.001, HR = 0.775 [0.680–0.870]). Conclusion Our results indicate that high PD-L1 expression may be a prognostic indicator for reduced OS. Thus, PD-L1 expression is a promising novel biomarker with prognostic significance in MBC and may suggest a potential therapeutic target of anti-PD-L1 antibody therapy in MBC patients. Citation Format: Abdeljaoued S, Bettaieb I, Adouni O, Goucha A, Chiba D, Bouzaiene H, Ben Hassouna J, Boussen H, Rahal K, Gamoudi A. Prognostic value of PD-L1 expression in male breast cancer [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 P5-23-05.
GMC is to pilot face to face meetings rather than fitness to practise panels in some cases
Authors: Caroline White
Journal: BMJ (2012)

The General Medical Council (GMC) is considering scrapping referral to fitness to practise panel hearings in certain cases and instead having a system of face to face meetings to agree a course of action with doctors who breach professional standards.

The GMC’s chief executive, Niall Dickson, told a cross party panel of MPs on the health select committee earlier this week that the intention was to streamline the regulatory process and make it more effective and that the GMC intended to start testing the effectiveness of this approach, in less serious cases, later in the year.

The Health Committee had been convened to scrutinise the regulator’s performance over the past year and gauge its readiness to implement revalidation, which is expected to be given the go …
A tsunami relief doctor
Authors: Zosia Kmietowicz
Journal: BMJ (2005)

Dr Andrew Cavey graduated in medicine from Oxford University in 2002 and gained a masters degree in public health from Harvard in 2004. After house jobs in Bath and Oxford he worked in Liberia with Médecins du Monde (MDM) and as a consultant to Physicians for Human Rights on a fact finding mission in Uganda. On his return to the United Kingdom he took up a position at Charing Cross Hospital in London as a senior house officer in accident and emergency. He is now following a medical rotation at St Mary9s Hospital, London.
‘A20 haploinsufficiency (HA20): clinical phenotypes and disease course of patients with a newly recognised NF-kB-mediated autoinflammatory disease’
Authors: Florian Berteau, Bénédicte Rouvière, Alice Nau, Rozenn Le Berre, Guillaume Sarrabay, Isabelle Touitou, Claire de Moreuil
Journal: Annals of the Rheumatic Diseases (2018)

We have read with interest the article by Aeschlimann1 and colleagues about clinical phenotypes and disease course of 16 American patients with A20 haploinsufficiency (HA20).

We would like to share our experience of a French family of three new related patients with juvenile onset Behcet’s disease associated with HA20 (figure 1).



Figure 1 
Pedigree of a French family diagnosed with HA20. The arrow indicates the proband. Filled in blue symbols indicate subjects carrying a p.Glu332* mutation in TNFAIP3 . Men are indicated by squares, and women are indicated by circles.



P1, a 48-year-old woman, was the first patient to be diagnosed with HA20 in July 2017 in our unit. She carries the heterozygous loss of function c.[994G>T] p.Glu332* truncating mutation, …
Episodic memory and the witness trump card
Authors: Jeremy Henry, Carl Craver
Journal: Behavioral and Brain Sciences (2018)

Abstract We accept Mahr &amp; Csibra's (M&amp;C's) causal claim that episodic memory provides humans with the means for evaluating the veracity of reports about non-occurrent events. We reject their evolutionary argument that this is the proper function of episodic memory. We explore three intriguing implications of the causal claim, for cognitive neuropsychology, comparative psychology, and philosophy.
BrUOG 324: Adjuvant nivolumab and low-dose ipilimumab for stage IIC, III, and resected stage IV melanoma: A phase II Brown University Oncology Research Group trial.
Authors: Maria Constantinou, Michael P. Vezeridis, Martin A. Weinstock, Joanna Walker, Thomas J. Miner, Peter Barth, Kayla Rosati, Kristen Mitchell, Sopha Dionson, Wendy Turchetti, John Vatkevich, William Matthew Rafelson, Kalyan C. Mantripragada, Howard Safran
Journal: Journal of Clinical Oncology (2018)

TPS202 Background: Adjuvant ipilimumab improves survival in stage III melanoma. Adjuvant nivolumab improves progression-free survival as compared to ipilimumab with reduced toxicity. Checkpoint 067 showed that the combination of ipilimumab and nivolumab is more active in advanced melanoma than either agent alone. The Brown University Oncology Research Group sought to evaluate dual checkpoint inhibition in the adjuvant setting. This may be particularly beneficial to patients with melanoma with low PD-L1 expression. To balance safety and efficacy, the combination of low dose ipilimumab and standard dose nivolumab was investigated. Methods: Patients with stage IIc, III and resected stage IV disease are eligible. No prior treatment for melanoma other than surgery or radiation was allowed. All patients received nivolumab 3mg/kg (maximum 240 mg) every 2 weeks and ipilimumab 1mg/kg every 6 weeks for 6 months. The primary goal is to determine the toxicity of adjuvant ipilimumab and nivolumab in patients with melanoma. Unacceptable toxicity has been defined as the development of grade 4 hematologic toxicity (neutropenia or thrombocytopenia), any transient grade ≥3 or persistent grade 2 treatment-related non-hematologic toxicity that prevents completion of the planned 6 month course of treatment in more than 35% of the enrolled patients; thus, if such events occur in 10 or more patients out of 25 evaluable patients, the study will have exceeded the limit for unacceptable adverse events. Secondary objectives are to determine the recurrence-free and overall survival. Results: Between August 2016 and August 2017, 17 patients have been enrolled, 11 male and 6 female. Median age is 59 (range 25-84). Twelve patients were Stage III disease, 2 patients were stage IIC and 3 were stage IV. Conclusions: BrUOG 324 represents one of the first trials investigating adjuvant dual checkpoint inhibition in melanoma. Preliminary safety and efficacy are being assessed. Acknowledgements: This study was supported in part by the Washington Trust Company and LIFEcycle Clinical trial information: NCT02656.