tbuckley/cabot-search huggingface dataset:
Contribution of alcohol use disorders to the burden of dementia in France 2008–13: a nationwide retrospective cohort study
Authors: Michaël Schwarzinger, Bruce G Pollock, Omer S M Hasan, Carole Dufouil, Jürgen Rehm, S Baillot, Q Guibert, F Planchet, S Luchini
Journal: The Lancet Public Health (2018)

Dementia is a prevalent condition, affecting 5-7% of people aged 60 years and older, and a leading cause of disability in people aged 60 years and older globally. We aimed to examine the association between alcohol use disorders and dementia risk, with an emphasis on early-onset dementia (<65 years).We analysed a nationwide retrospective cohort of all adult (≥20 years) patients admitted to hospital in metropolitan France between 2008 and 2013. The primary exposure was alcohol use disorders and the main outcome was dementia, both defined by International Classification of Diseases, tenth revision discharge diagnosis codes. Characteristics of early-onset dementia were studied among prevalent cases in 2008-13. Associations of alcohol use disorders and other risk factors with dementia onset were analysed in multivariate Cox models among patients admitted to hospital in 2011-13 with no record of dementia in 2008-10.Of 31 624 156 adults discharged from French hospitals between 2008 and 2013, 1 109 343 were diagnosed with dementia and were included in the analyses. Of the 57 353 (5·2%) cases of early-onset dementia, most were either alcohol-related by definition (22 338 [38·9%]) or had an additional diagnosis of alcohol use disorders (10 115 [17·6%]). Alcohol use disorders were the strongest modifiable risk factor for dementia onset, with an adjusted hazard ratio of 3·34 (95% CI 3·28-3·41) for women and 3·36 (3·31-3·41) for men. Alcohol use disorders remained associated with dementia onset for both sexes (adjusted hazard ratios >1·7) in sensitivity analyses on dementia case definition (including Alzheimer's disease) or older study populations. Also, alcohol use disorders were significantly associated with all other risk factors for dementia onset (all p<0·0001).Alcohol use disorders were a major risk factor for onset of all types of dementia, and especially early-onset dementia. Thus, screening for heavy drinking should be part of regular medical care, with intervention or treatment being offered when necessary. Additionally, other alcohol policies should be considered to reduce heavy drinking in the general population.None.
Cryptogenic Stroke and High-Risk Patent Foramen Ovale
Authors: Pil Hyung Lee, Jae-Kwan Song, Jong S. Kim, Ran Heo, Sahmin Lee, Dae-Hee Kim, Jong-Min Song, Duk-Hyun Kang, Sun U. Kwon, Dong-Wha Kang, Dongwhane Lee, Hyuk Sung Kwon, Sung-Cheol Yun, Byung Joo Sun, Jae-Hyeong Park, Jae-Hwan Lee, Hye Seon Jeong, Hee-Jung Song, Jei Kim, Seung-Jung Park
Journal: Journal of the American College of Cardiology (2018)
Diploma in occupational medicine (DOccMed)
Authors: Aloke Sen, Donald Menzies
Journal: BMJ (2008)

Anyone wishing to develop an interest in the interface between health and work (for example, general practitioners).The multiple choice section equates to membership of the Faculty of Occupational Medicine part 1 for specialty registrars in occupational medicine.

I sat the full diploma exam nine months into my first year of training as a specialty registrar in occupational medicine (2007-8).

The multiple choice section (membership of the Faculty of Occupational Medicine part 1) is an exit examination for the first year of specialty training in occupational medicine. I decided to also sit the viva section in order to obtain an extra qualification (DOccMed) and to gain experience in writing up …
Core skills in orthopaedic surgery
Authors: Sara Dorman
Journal: BMJ (2012)

Core skills in orthopaedic surgery is a three day course run by the Royal College of Surgeons of Edinburgh. The course emphasises development of competency in basic emergency department, outpatient, and operative procedures in trauma and orthopaedics.

The course is aimed at foundation year 2 doctors who wish to pursue a career in trauma and orthopaedics and year 1 and 2 specialty trainees currently working in a surgical post. Most participants are required to have at least some practical experience in trauma and orthopaedics. The candidates on my course were from foundation year 1 and 2 to specialty trainee 1 level from all over the United Kingdom and overseas, and all participants had worked in trauma and orthopaedics at some point.

Having done four months as a foundation doctor in trauma and orthopaedics, I had a good understanding of the principles of orthopaedic management but wanted to gain more …
Ethnic minority women think racism rather than sexism limits career progression
Authors: Abi Rimmer
Journal: BMJ (2014)

Women from ethnic minority groups think that racism, rather than sexism, limits their career progression, delegates to the Medical Women’s Federation autumn conference have heard.

Speaking at the conference in London on 7 November, Abeyna Jones, an occupational medicine registrar, discussed barriers that ethnic minority women face in medical leadership roles. She said …
Choroid plexus tumors in infants and young children - Lessons learnt from an institutional review
Authors: Ribhav Pasricha, Chinmaya Dash, Pankaj Singh, Bhawani S Sharma, Ashok K Mahapatra
Journal: Neuro-Oncology (2018)

Choroid plexus tumors (CPT) are rare tumors characterized by papillary and intraventricular growth. The young age of presentation of such tumors as well as the lack of consensus on adjuvant therapy in cases of atypical choroid plexus papillomas (aCPP) and choroid plexus carcinomas (CPC) create a dilemma in their management. We retrospectively analyzed the case records of all patients in the age group 0 to 5 years with CPTs who were operated at our institute from January 2010 to July 2015. The variables analyzed included age, sex, presentation, location, surgical approach, extent of resection, intraoperative blood loss, percentage of blood loss, blood transfused, histopathology, postoperative complications and outcome. Images were obtained from PACS, patient details and follow up were obtained from discharge summaries, operative notes and hospital records. 11 children were included in our study. 7 patients had choroid plexus papillomas (CPP), two patients had aCPP and two patients had CPC. The median age was 8 months (range 40 days - 4 years). The mean blood loss was 285.7 ml whereas the median blood loss was 130 ml. Out of 3 deaths, 2 deaths occurred on post operative day 1 (POD1) (one patient with aCPP and one patient with CPC) where as one patient (CPC) died four months after surgery. CPT’s are challenging tumors in infants and very young children because of potential for massive blood loss in such patients. CPP are associated with lesser blood loss and favorable outcome as compared to aCPP and CPC, where massive blood loss can be life threatening. CPC have a rapid proliferation potential as shown in one of our cases. Attempts at decreasing vascularisation of such tumors should be made by various methods which includes preoperative embolization and neo-adjuvant chemotherapy, although a consensus on this is lacking.
Supervision of London trainees and students varies in quality, GMC finds
Authors: Helen Jaques
Journal: BMJ (2013)

Hospitals and medical schools in London are providing clinical placements and supervision of variable quality to junior doctors and medical students, a report by the General Medical Council (GMC) has concluded.

The GMC’s review of undergraduate and postgraduate medical training in London has reported a “positive overall impression” of medical education. But the review found that clinical placements in hospitals varied around the capital for both students and junior doctors. The quality of placements largely depended on the time and enthusiasm …
NOVEL USE OF DIGITALLY INTEGRATED MAP SOFTWARE AND TRAFFIC CONGESTION DATA TO IMPROVE FIRST MEDICAL CONTACT TO DEVICE TIME FOR STEMI
Authors: Justin Cole, Richard Beare, Thanh Phan, Velandai Srikanth, Andrew MacIsaac, David Tong, Christianne Tan, Padeepa Perera, Susan Yee, Jesslyn Ho, Jamie Layland
Journal: Journal of the American College of Cardiology (2018)
SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR COMPARED TO CORONARY ARTERY CALCIUM SCORE AND HIGH SENSITIVITY C REACTIVE PROTEIN IN PREDICTING DEATH IN AFRICAN AMERICANS WITH DIABETES
Authors: Mohamad Raad, Salim Hayek, Jianzhao Xu, Donald Bowden, Jochen Reiser, Barry Freedman
Journal: Journal of the American College of Cardiology (2018)
Selection of Tissue Factor-Deficient Cell Transplants as a Novel Strategy for Improving Hemocompatibility of Human Bone Marrow Stromal Cells
Authors: Michaela Oeller, Sandra Laner-Plamberger, Sarah Hochmann, Nina Ketterl, Martina Feichtner, Gabriele Brachtl, Anna Hochreiter, Cornelia Scharler, Lara Bieler, Pasquale Romanelli, Sebastien Couillard-Despres, Elisabeth Russe, Katharina Schallmoser, Dirk Strunk
Journal: Theranostics (2018)

Intravascular transplantation of tissue factor (TF)-bearing cells elicits an instant blood-mediated inflammatory reaction (IBMIR) resulting in thrombotic complications and reduced engraftment.Here we studied the hemocompatibility of commonly used human white adipose tissue (WAT), umbilical cord (UC) and bone marrow stromal cells (BMSC) and devised a possible strategy for safe and efficient stromal cell transplantation.Methods: Stromal cell identity, purity, and TF expression was tested by RTQ-PCR, flow cytometry and immunohistochemistry. Pro-coagulant activity and fibrin clot formation/stabilization was measured In Vitro by viscoelastic rotational plasma-thromboelastometry and in vivo by injecting sorted human stromal cells intravenously into rats.The impact of TF was verified in factor VII-deficient plasma and by sort-depleting TF/CD142 + BMSC.Results: We found significantly less TF expression by a subpopulation of BMSC corresponding to reduced pro-coagulant activity.UC and WAT stroma showed broad TF expression and durable clotting.Higher cell numbers significantly increased clot formation partially dependent on coagulation factor VII. Depleting the TF/CD142 + subpopulation significantly ameliorated BMSC's hemocompatibility without affecting immunomodulation.TF-deficient BMSC did not produce thromboembolism in vivo, comparing favorably to massive intravascular thrombosis induction by TF-expressing stromal cells. Conclusion:We demonstrate that plasma-based thromboelastometry provides a reliable tool to detect pro-coagulant activity of therapeutic cells.Selecting TF-deficient BMSC is a novel strategy for improving cell therapy applicability by reducing cell dose-dependent IBMIR risk.The particularly strong pro-coagulant activity of UC and WAT preparations sounds an additional note of caution regarding uncritical systemic application of stromal cells, particularly from non-hematopoietic extravascular sources.
I am a qualified gynaecologist from India and I suffered a stroke recently, which has affected my left arm (I am right handed) and am now incapable of working as a gynaecologist. What are my chances of getting a training post in radiology after I clear part 1 of the FRCR exam? Also will my disability come in the way of my career as a radiologist?
Authors: Alan Denison
Journal: BMJ (2004)

<i>Got 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.</i>
Incidence and mortality of renal cell carcinoma in the U.S.: A SEER-based study investigating trends over the last four decades.
Authors: Mohamed M Gad, Anas M Saad, Muneer J Al-Huseini, Inas A. Ruhban, Mohamad B. Sonbol
Journal: Journal of Clinical Oncology (2018)

604 Background: Renal cell carcinoma (RCC) is the third most common urologic malignancy worldwide, with clear cell subtype being the most common. In this study, we sought to investigate RCC incidence and mortality trends by demographic and tumor characteristics using data from the surveillance, epidemiology and end results (SEER) database. Methods: We used SEER database to study RCC cases between 1973 and 2014. Incidence and mortality rates were calculated by sex, age, race, state, stage, size, and histological subtype of RCC. Annual percent change (APC) was calculated using joinpoint regression software. Results: A total of 96,058 RCC cases were identified, with 54,000 RCC deaths between 1973 and 2014. Overall incidence was 9.712 per 100,000 persons-years, being highest among males (13.698), blacks (11.886), and people older than 65 years (38.693). Incidence rates of localized cases (5.845) and tumors smaller than 7 cm (6.550) were higher than other tumor subgroups with distant disease incidence of 1.773 per 100,000 persons-years. Overall incidence rates increased by 2.709% (95% CI, 2.544-2.875, p &lt; .001) per year over the study period, but rates became stable since 2007 with only an increase in the incidence of clear-cell subtype (2.538%; 95% CI, 1.300-3.791, p &lt; .001). Overall RCC mortality rates have been declining since 2000, and distant disease mortality have been decreasing since 2008 with most profound decline in the period between 2012 and 2014 with APC of -22.635% (-37.419- -4.359, P = .019) Conclusions: Despite overall increase in rates over the last 40 years, recent years have shown stable incidence and decrease in mortality rates of RCC. The significant decline in mortality over the last 10 years since the approval of the first Vascular Endothelial Growth Factor ‘VEGF’ inhibitor highlights the impact of this class of medications along with other subsequent agents such as mTOR inhibitors and checkpoint inhibitors on the prognosis of renal cell carcinoma.
Phase 1b/2 study of margetuximab (M) plus pembrolizumab (P) in advanced HER2+ gastroesophageal junction (GEJ) or gastric (G) adenocarcinoma (GEA).
Authors: Daniel V.T. Catenacci, Haeseong Park, A. Craig Lockhart, Philip Jordan Gold, Peter C. Enzinger, Jeffrey L. Nordstrom, Sam Hong, Howard S. Hochster, Ronan Joseph Kelly, Hope Elizabeth Uronis, Johanna C. Bendell, Sang Cheul Oh, Se Hoon Park, Yeul Hong Kim, Yoon-Koo Kang, Keun-Wook Lee, Matthew CH Ng, Jon M. Wigginton, Jan Kenneth Davidson-Moncada, Yung-Jue Bang
Journal: Journal of Clinical Oncology (2018)

140 Background: Trastuzumab (T) + chemotherapy (ctx) is standard for 1st line advanced HER2+ GEA, yet subsequent targeted options are lacking. M is an anti-Her 2 monoclonal antibody with an optimized Fc domain to increase affinity for activating CD16A Fc-receptors (FcR) on NK cells. Outcomes for T-treated patients (pts) carrying the low-affinity CD16A-F allele are generally worse than pts homozygous for the high-affinity V allele. M is designed to be FcR genotype independent. Evidence of clinical activity of M alone has been seen in HER2+ GEA pts post T, while P has demonstrated durable activity. Loss of HER2 amplification may occur after T failure in a subset of initially HER2+ GEA pts. Preclinical studies suggest that engagement of innate and adaptive immunity with the combination of anti-HER-2 antibodies and T-cell checkpoint inhibition could achieve greater antitumor activity than either agent alone. Methods: Advanced HER2+, PD-L1-unselected GEA pts post T failure were eligible. Dose escalation evaluated 10 and 15 mg/kg M and 200 mg P for 2 nd line or higher pts. Cohort expansion evaluates safety and objective response rate (ORR) by RECIST v1.1 in 2 nd line pts. M + P is given every 21 days; response assessed every 6 weeks. HER2 amplification status was assessed in a subset of pts by plasma circulating tumor (ct) DNA analysis prior to Cycle 1 of M+P. Results: Dose escalation enrolled 9 pts; cohort expansion 48 pts at 15 mg/kg M: 30 in North America (NA) and 18 in Asia (A). Treatment was well tolerated, with 1 drug-related serious adverse event. Of 38 evaluable pts to date in expansion (24 NA and 14 A), the best overall responses include 7 pts (18.4%) with PR (4 confirmed and 3 unconfirmed) and 11 (28.9%) with SD. Higher ORR trends were observed in A vs NA (35.7% vs 8.3%) and G vs GEJ (31.6% vs 5.3%). Of 25 pts with ctDNA results, HER2 amplification detection was higher in GC than GEJ (80% vs 53%). Responses were independent of FcR genotype; CD16A genotype for evaluable pts with PR: 1 V/V, 2 V/F, 2 F/F with similar allelic distribution among non-responders. Conclusions: M+P is a well-tolerated ctx-free regimen that has shown preliminary antitumor activity in 2 nd line pts with advanced/metastatic GEA. Clinical trial information: NCT02689284.
Association of Reperfusion With Brain Edema in Patients With Acute Ischemic Stroke
Authors: W. Taylor Kimberly, Bruna Garbugio Dutra, Anna M. M. Boers, Heitor C. B. R. Alves, Olvert A. Berkhemer, Lucie van den Berg, Kevin N. Sheth, Yvo B. W. E. M. Roos, Aad van der Lugt, Ludo F. M. Beenen, Diederik W. J. Dippel, Wim H. van Zwam, Robert J. van Oostenbrugge, Hester F. Lingsma, Henk Marquering, Charles B. L. M. Majoie
Journal: JAMA Neurology (2018)

It is uncertain whether therapeutic reperfusion with endovascular treatment yields more or less brain edema.To elucidate the association between reperfusion and brain edema. The secondary objectives were to evaluate whether brain edema could partially be responsible for worse outcomes in patients with later reperfusion or lower Alberta Stroke Program Early Computed Tomography Score.This was a post hoc analysis of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), which was a prospective, randomized, multicenter clinical trial of endovascular treatment compared with conventional care of patients with acute anterior circulation ischemic stroke. Of 502 patients enrolled from December 2010 to June 2014, 2 patients declined to participate. Additionally, exclusion criteria were absence of follow-up imaging or presence of parenchymal hematoma, resulting in 462 patients included in this study. Brain edema was assessed retrospectively, from December 10, 2016, to July 24, 2017, by measuring midline shift (MLS) in all available follow-up scans. Observers were blinded to clinical data.Midline shift was assessed as present or absent and as a continuous variable. Reperfusion status was assessed by the modified thrombolysis in cerebral infarction score in the endovascular treatment arm. The modified arterial occlusive lesion score was used to evaluate the recanalization status in both arms. The modified Rankin scale score at 90 days was used for functional outcome.Of 462 patients, the mean (SD) age was 65 (11) years, and 41.8% (n = 193) were women. Successful reperfusion and recanalization were associated with a reduced likelihood of having MLS (adjusted common odds ratio, 0.25; 95% CI, 0.12-0.53; P < .001 and adjusted common odds ratio, 0.34; 95% CI, 0.21-0.55; P < .001, respectively). Midline shift was partially responsible for worse modified Rankin scale scores in patients without reperfusion or recanalization (MLS changed the logistic regression coefficients by 30.3% and 12.6%, respectively). In patients with delayed reperfusion or lower Alberta Stroke Program Early Computed Tomography Score, MLS mediated part of the worse modified Rankin scale scores, corresponding to a change in the regression coefficient of 33.3% and 64.2%, respectively.Successful reperfusion was associated with reduced MLS. This study identifies an additional benefit of reperfusion in relation to edema, as well as rescuing ischemic brain tissue at risk for infarction.Netherlands Trial Registry number: NTR1804 and Current Controlled Trials number: ISRCTN10888758.
BMA should convince<i>The BMJ</i>not to advertise non-standard posts, say SAS doctors
Authors: Abi Rimmer
Journal: BMJ (2014)

The BMA should convince The BMJ not to advertise non-standard grade posts, said delegates at the BMA’s staff, associate specialist, and specialty (SAS) grade doctors’ conference this week.

Representatives voted in favour of a motion that “deplored” the creation of non-standard grade posts and “urged” the BMA to “help convince The BMJ not to advertise these …
Perspective on Circulating Tumor Cell Clusters: Why It Takes a Village to Metastasize
Authors: Mario Giuliano, Anum Shaikh, Hin Ching Lo, Grazia Arpino, Sabino De Placido, Xiang H. Zhang, Massimo Cristofanilli, Rachel Schiff, Meghana V. Trivedi
Journal: Cancer Research (2018)

Circulating tumor cell (CTC) clusters may represent one of the key mechanisms initiating the metastasis process. However, the series of pathophysiologic events by which CTC clusters originate, enter the circulation, and reach the distant sites remain to be identified. The cellular and molecular mechanisms that provide survival advantage for CTC clusters during the transit in the blood stream are also still largely unknown. Understanding the biology of CTC clusters is critical to assess this unified scheme employed by cancer and to device strategies to overcome key pathways responsible for their improved metastatic potential. CTC clusters remain an underdeveloped area of research begging the attention of multidisciplinary cancer research teams. Here, we provide insight on existing preclinical evidence on the potential mechanisms leading to CTC cluster formation and dissemination and on processes that may offer survival advantage. We also offer our perspective on future directions to delineate the role of CTC clusters in metastatic cascade and discuss their clinical significance. Cancer Res; 78(4); 845-52. ©2018 AACR.
How is the role of clinical fellow different from that of senior house officer?
Authors: Justin Stebbing
Journal: BMJ (2004)

<i>Got 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.</i>
Senior trainees who strike for three weeks will undergo competence review, says HEE
Authors: Abi Rimmer
Journal: BMJ (2016)

Senior trainee doctors who miss more than 14 days of training by taking strike action will be subject to a review of their competence, Health Education England has said.

The BMA announced last week that junior doctors in England will stage four rounds of industrial action from September until December. Each round will comprise full withdrawal of labour between …
Practical management of toxicities associated with bosutinib in patients with Philadelphia chromosome-positive chronic myeloid leukemia
Authors: H.J. Khoury, C. Gambacorti-Passerini, T.H. Brümmendorf
Journal: Annals of Oncology (2018)

Bosutinib (SKI-606) is an oral, dual Src/Abl tyrosine kinase inhibitor (TKI) approved for treatment of patients with Philadelphia chromosome-positive (Ph+) chronic myeloid leukemia (CML) that is resistant or intolerant to prior TKI therapy or for whom other TKIs are not appropriate choices. The objective of this review is to provide a longitudinal summary of toxicities that may arise during treatment with second-line or later bosutinib in patients with Ph+ chronic phase CML and to provide strategies for managing these toxicities. As bosutinib is not currently indicated for newly diagnosed CML, toxicities associated with first-line treatment are not reviewed. Recognition and optimal management of these toxicities can facilitate patient compliance and affect treatment outcomes.
External confirmation and exploration of the Kigali modification for diagnosing moderate or severe ARDS
Authors: Veronica Vercesi, Luigi Pisani, Patricia S. I. van Tongeren, Wim K. Lagrand, Stije J. Leopold, Mischa M. A. Huson, Patricia C. Henwood, Andrew Walden, Marry Smit, Elisabeth D. Riviello, Paolo Pelosi, Arjen M. Dondorp, Marcus J. Schultz
Journal: Intensive Care Medicine (2018)