tbuckley/cabot-search huggingface dataset:
TRANSCATHETER PATENT DUCTUS ARTERIOSUS (PDA) CLOSURE IN LOWER WEIGHT INFANTS (&lt;6KG): MID- AND LONG-TERM FOLLOW-UP
Authors: Erin Nealon, Corey Stiver, Clifford Cua, Claire Mitchell, Brian Boe, Aimee Armstrong, Darren Berman, Charles Smith, Joanne Chisolm, Brian Rivera, Carl Backes
Journal: Journal of the American College of Cardiology (2018)
An anaesthetist's nightmare in North America
Authors: Damon Kamming
Journal: BMJ (2004)

After my exam for fellowship of the Royal College of Anaesthetists (FRCA) I decided to do a 12 month clinical research fellowship in Toronto, Canada. I left for the frozen north with an interest in ambulatory anaesthesia, a need to spice up the back page of my curriculum vitae, and a longing for off piste skiing. As it turned out, my year included the hottest Canadian summer and the coldest winter in living memory, two operations to rebuild a broken leg, a new cold war, the largest outbreak of severe acute respiratory syndrome (SARS) in the Western world, West Nile virus, and no skiing whatsoever.

Toronto means “the meeting place” in native North American Indian, and it's certainly a buzzing cosmopolitan city. I worked with other research fellows from every corner of the globe. The Toronto Western Hospital is the largest combined neurosurgical and spinal surgical centre in North America. It has …
Pancreatic Malignancy or Not?
Authors: Ashwin Singh Parihar, Harmandeep Singh, Rajender Kumar, Vikas Gupta, Harpreet Singh, Bhagwant Rai Mittal
Journal: Clinical Nuclear Medicine (2018)

Immunoglobulin G4-related disease is an autoimmune entity with multisystem involvement. F-FDG PET/CT can provide important information about disease extent and severity and also aid in treatment response evaluation. We report a case of a 57-year-old woman presenting with abdominal discomfort, belching, and loss of weight in whom F-FDG PET/CT provided valuable information in diagnosis and monitoring treatment response.
PHARMACOLOGICAL INHIBITION OF ADENYLYL CYCLASE TYPE 5: A NOVEL THERAPEUTIC MODALITY TO REDUCE INFARCT SIZE EVEN WHEN DELIVERED AFTER CORONARY ARTERY REPERFUSION
Authors: Jie Zhang, Daniel Levy, Thomas Richardson, Christopher Meenan, Seonghun Yoon, Dorothy E. Vatner, Stephen F. Vatner
Journal: Journal of the American College of Cardiology (2018)
Activity of HSP90 Inhibiton in a Metastatic Lung Cancer Patient With a Germline BRCA1 Mutation
Authors: Susana Cedrés, Enriqueta Felip, Cristina Cruz, Ana Martinez de Castro, Nuria Pardo, Alejandro Navarro, Alex Martinez-Marti, Jordin Remon, Jorge Zeron-Medina, Judith Balmaña, Alba Llop-Guevara, Josep M Miquel, Irene Sansano, Paolo Nuciforo, Francesco Mancuso, Violeta Serra, Ana Vivancos
Journal: JNCI Journal of the National Cancer Institute (2018)

Heat shock proteins (HSPs) are molecular chaperones that maintain proteins in their correct conformation to ensure stability and protect carcinoma cells from apoptosis. HSP90 inhibitors (HSP90i) block multiple targets simultaneously, and despite responses in a selected population, no HSP90i have yet been approved. We present a patient with a lung tumor with an exceptional response to cisplatin/gemcitabine in combination with HSP90i, which nowadays continues with HSP90i maintenance after three years. Whole-exome sequencing of the lung tumor unveiled a BRCA1/2 deficiency mutational signature, and mutation analysis confirmed a germline BRCA1 mutation. The striking efficacy of HSP90i plus chemotherapy vs chemotherapy alone was reproduced in a patient-derived xenograft (PDX) model from a breast cancer patient with a BRCA1 mutation (mean tumor volume [SD], No. of tumors: vehicle 8.38 [7.07] mm3, n = 3; HSP90i 4.18 [1.93] mm3, n = 5; cisplatin plus gemcitabine 3.31 [1.95] mm3, n = 5; cisplatin plus gemcitabine plus HSP90i 0.065 [0.076] mm3, n = 6). This case and the PDX demonstrate the efficacy for therapeutic inhibition of HSP90 in a BRCA-mutated patient, opening a new potential avenue for better identifying patients who might benefit most from HSP90i.
“Stop moaning. In my day we did a one in two and enjoyed it”
Authors: Zhaleh Khaleeli Anwar
Journal: BMJ (2004)

Did these “good old days” of the NHS ever really exist? If so, it seems there is a chasm between the experience of juniors today and that of older consultants. While juniors fill in their duty diaries, dread their on-calls, and are cosseted endlessly to maximise their training and minimise their discomfort, they encounter consultants who have not only poured their entire lives into the NHS but apparently thrived on it. In my opinion, today's juniors are no less dedicated, but they are more cynical.

NHS doctors have always worked long hours under adverse conditions. So why are there now so many reports of low morale within the service and of large numbers leaving? The working environment seems to have altered so much that it has deeply affected doctors' satisfaction with their work. To find out some answers, I asked two old time consultants about their different experience at the beginning of their careers. Although not rigorous scientific evidence, their thoughts and memories give some useful insights.

The …
The 2016 WHO classification and diagnostic criteria for myeloproliferative neoplasms: document summary and in-depth discussion
Authors: Tiziano Barbui, Jürgen Thiele, Heinz Gisslinger, Hans Michael Kvasnicka, Alessandro M. Vannucchi, Paola Guglielmelli, Attilio Orazi, Ayalew Tefferi
Journal: Blood Cancer Journal (2018)

Abstract The new edition of the 2016 World Health Organization (WHO) classification system for tumors of the hematopoietic and lymphoid tissues was published in September 2017. Under the category of myeloproliferative neoplasms (MPNs), the revised document includes seven subcategories: chronic myeloid leukemia, chronic neutrophilic leukemia, polycythemia vera (PV), primary myelofibrosis (PMF), essential thrombocythemia (ET), chronic eosinophilic leukemia-not otherwise specified and MPN, unclassifiable (MPN-U); of note, mastocytosis is no longer classified under the MPN category. In the current review, we focus on the diagnostic criteria for JAK2 / CALR / MPL mutation-related MPNs: PV, ET, and PMF. In this regard, the 2016 changes were aimed at facilitating the distinction between masked PV and JAK2 -mutated ET and between prefibrotic/early and overtly fibrotic PMF. In the current communication, we (i) provide practically useful resource tables and graphs on the new diagnostic criteria including outcome, (ii) elaborate on the rationale for the 2016 changes, (iii) discuss the complementary role of mutation screening, (iv) address ongoing controversies and propose solutions, (v) attend to the challenges of applying WHO criteria in routine clinical practice, and (vi) outline future directions from the perspectives of the clinical pathologist.
Antibiotic resistance and One Health: a mapping project
Authors: Sabiha Essack
Journal: The Lancet Global Health (2018)

BackgroundThe One Health approach is a global strategy that encourages interdisciplinary collaboration on health at the human–animal–environmental interface. Antibiotic resistance is a direct consequence of the selection pressure from antibiotic use in humans, animals, and the environment, requiring a One Health approach towards its containment. The high HIV/AIDS burden and other risk factors for communicable diseases in South Africa results in a high incidence of infectious diseases, engendering extensive antibiotic use and subsequent resistance. Two-thirds of the antimicrobials sold for animal use are used in growth promotion. Although the burden of antibiotic resistance has not been quantified, available evidence indicates that it is escalating in humans, animals, and the environment. There is thus a need to quantify the burden of antibiotic resistance with a view to implementing measures for its containment on biomedical, clinical, sociobehavioural, drug discovery/diagnostics, and policy grounds.MethodsThis project delineates the molecular epidemiology, nature, and extent of antibiotic resistance in the One Health context in the uMgungundlovu District in KwaZulu-Natal, South Africa. The aim is to map the fluidity of antibiotic-resistant bacterial clones, antibiotic resistance genes, and their associated mobile genetic elements within and between the human, animal, and environmental health sectors by (1) instituting surveillance programmes on antibiotic use and resistance in human, animal, and environmental health; (2) demonstrating the phenotypic and genotypic mechanisms of antibiotic resistance by sensitivity testing and appropriate screening tests and whole-genome sequencing; and (3) establishing the clonality and genetic determinants of resistance by multi-locus sequence typing and whole-genome sequencing.FindingsThis project began in 2017. Isolates have been collected from patients, chicken, water, and soil. The molecular epidemiology of their antibiotic resistance profiles will be determined. The project will (1) provide a proxy surveillance system for antibiotic resistance in humans and food animals and (2) unambiguously give credence to the One Health approach for the containment of antibiotic resistance mooted in the UN General Assembly Political Declaration on Antimicrobial Resistance and by the tripartite alliance of the WHO, the Food and Agriculture Organization, and the World Organisation for Animal Health using a specific conceptual framework.InterpretationSuccessful proof of concept will require validation of the conceptual framework in different countries and health systems with different levels of antibiotic resistance and will thus be tested in high-income, middle-income, and low-income countries with different antibiotic resistance burdens.FundingSouth African National Research Foundation, South African Medical Research Council.
Plastic and reconstructive surgery: upper limb dissection workshop
Authors: Christopher R Davis, Jeremy Rodrigues
Journal: BMJ (2011)

Reconstructive surgery of the upper limb is a technically challenging and exciting subspecialty. This course blends lecture and cadaveric teaching and provides participants with fresh frozen cadaveric specimens, surgical instrumentation, and high quality supervision to learn, improve, or perfect many of the reconstructive possibilities in surgery to the upper limb.

Day one of this intensive two day course covers surgically applied anatomy and technical considerations in raising flaps in upper limb reconstructive surgery and covering soft tissue defects. Day two concentrates on nerve and tendon anatomy, repair, and reconstruction. The course aims to provide the opportunity to carry out many surgical procedures on fresh frozen human cadavers. Run by Paul McArthur, consultant plastic surgeon, and Jane McPhail, consultant prosthetist, teaching is delivered by an array of consultant plastic surgeons offering unique, …
GMC must publish its report on suicide in doctors facing investigations, says BMA
Authors: Abi Rimmer
Journal: BMJ (2014)

The General Medical Council must publish the results of its internal review of suicide in doctors who are facing investigation, the BMA has said.

Delegates at the BMA’s Annual Representative Meeting voted in favour of a motion on the issue. The motion also called for the outcomes of a GMC and BMA pilot of support for doctors facing investigation to be published. BMA members said …
CARDIAC TROPONIN T CONCENTRATIONS MEASURED WITH A HIGH-SENSITIVITY ASSAY AND REVERSIBLE MYOCARDIAL ISCHEMIA IN PATIENTS WITH SUSPECTED STABLE ANGINA: A DOPPLER-CIP SUBSTUDY
Authors: Peder Myhre, Helge Rosjo, Sebastian Sarvari, Jan D’hooge, Jan Engvall, Rosa Sicari, Jose Zamorano, Thor Edvardsen, Torbjorn Omland
Journal: Journal of the American College of Cardiology (2018)
Training and assessment in practice (TAIP)
Authors: Muhammad E A Khan
Journal: BMJ (2011)

The training and assessment in practice (TAIP) course has been developed by the Royal College of Surgeons of England for trainers, including programme directors, assigned educational supervisors, and clinical supervisors, to understand the current training and assessment of trainee specialty registrars (such as core surgical trainees and foundation year doctors). The course is designed to integrate the changes in the training and assessment system into everyday practice.

Surgical specialty registrars level 5 to 8 and consultant surgeons.

It was a unique opportunity for me to learn about the training and assessment tools used to assess surgical specialty trainees in my daily practice, at the same time as fulfilling my daily duties. In addition it taught me how to use these tools for my own benefit.

The faculty consisted of Stella Vig (consultant vascular surgeon and foundation programme director at Mayday University Hospital NHS Trust) and Hayley Allan (course convenor …
Recommendations on the use of magnetic resonance imaging in PSC‐A position statement from the International PSC Study Group
Authors: Christoph Schramm, John Eaton, Kristina I. Ringe, Sudhakar Venkatesh, Jin Yamamura
Journal: Hepatology (2017)

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disorder characterized by inflammation and fibrosis of the intra‐ and/or extrahepatic bile ducts. Magnetic resonance imaging (MRI) is a noninvasive imaging modality that can be used to diagnose PSC and detect disease related complications. Quantitative MRI technologies also have the potential to provide valuable prognostic information. Despite the potential of this imaging technology, the clinical application of MRI in the care of PSC patients and imaging standards vary across institutions. Moreover, a unified position statement about the role of MRI in the care of PSC patients, quality imaging standards, and its potential as a research tool is lacking. Conclusion : Members of the International PSC Study Group and radiologists from North America and Europe have compiled the following position statement to provide guidance regarding the application of MRI in the care of PSC patients, minimum imaging standards, and future areas of research. (H epatology 2017;66:1675–1688).
The Role of Aging, Drug Dependence, and Hepatitis C Comorbidity in Alcoholism Cortical Compromise
Authors: Edith V. Sullivan, Natalie M. Zahr, Stephanie A. Sassoon, Wesley K. Thompson, Dongjin Kwon, Kilian M. Pohl, Adolf Pfefferbaum
Journal: JAMA Psychiatry (2018)

The prevalence of alcohol misuse increased substantially over a decade in adults, particularly in those aged 65 years or older. Ramifications for brain structural integrity are significant, especially in older adults.
Comparative assessment of abiraterone or enzalutamide activity in the PROREPAIR-B study.
Authors: Rebeca Lozano, Nuria Romero-Laorden, Angela del Pozo, Ana Medina, Maria Jose Mendez, Rafael Morales Barrera, Aranzazu Aranzazu Gonzalez del Alba, Alejo Rodriguez-Vida, Amaia Hernandez, Juan Carlos Silla-Castro, Sergio Vazquez, Belen Gonzalez, Alvaro Pinto, Jose Luis Perez Gracia, Rosa Querol, Vanessa Cañadilla, Montserrat Domenech, Colin Pritchard, Elena Castro, David Olmos
Journal: Journal of Clinical Oncology (2018)

164 Background: Germline mutations in DNA repair genes have been associated with poor prostate cancer outcomes in retrospectives studies. Such defects have been identified in 12% of mCRPC patients. Several studies are ongoing to assess the benefit of these patients from platinum-based chemotherapy and PARP inhibitors, but no conclusive data are available with regards to currently approved therapies for mCRPC, as Abiraterone or Enzalutamide. Methods: PROREPAIR-B (NCT03075735) is a prospective multicentre observational cohort study. Patients diagnosed with mCRPC, with unknown mutational status at study entry and who were going to start a first-line treatment for mCRPC were eligible. For this sub-analysis patients who received Abiraterone or Enzalutamide as first androgen receptor targeted therapy (ART) were selected. The endpoints of this sub-analysis included to assess the impact of BRCA1, BRCA2, ATM, PALB2 and other germline mutations in DNA repair genes on cause-specific survival (CSS), progression-free survival (PFS), time to PSA progression (bPFS) and response to the first ART received as 1 st or 2 nd line therapy. Results: 337 patients were eligible for this analysis. CSS from mCRPC was not significantly different between gDDR carriers and non-carriers. However, CSS from mCRPC in BRCA2 carriers was significantly shorter than in non-carriers (23.3 Vs 34.6 months, p = 0.02). CSS from first ART, PFS and response-rates were not significantly different between both groups. However, the bPFS was significantly shorter in patients harbouring gDDR mutations (7.3 Vs 3.8 months, p = 0.04), especially in BRCA2 carriers (7.3 Vs 3.0 months, p = 0.03). Conclusions: This is the first study to prospectively follow-up DNA repair germline mutations to determine the outcome on standard treatment for mCRPC. The results suggest that different gDDR defects may have different impact on mCRPC outcomes. Clinical trial information: NCT03075735.
Changes in the use of commercial and lab-developed IVD assays in the clinical setting for PD-L1 expression testing in NSCLC in the United States.
Authors: Ayse Levent, Pieter De Richter, William H Angel, Ciny Edathanal, Christophe Homer
Journal: Journal of Clinical Oncology (2018)

154 Background: In 2016 we observed a lack of standardization in the use of cut-off points to define positivity when testing for PD-L1 expression in NSCLC, despite these being specified by assay manufacturers or recommended based on trial data. One year on we look at how clinical practice has changed in light of new approvals for PD-(L)1 inhibitors, availability of new IVD assays and changes in clinical practice guidelines recommending the use of immunotherapy for stage IV NSCLC. Here we explore how the variety of test brands and cut-off points used in the US has changed since 2016 by examining real-world clinical usage data. Methods: Between June and August 2016 and June and August 2017, a panel of pathologists in the US (n = 21 in 2016 and n = 28 in 2017) was asked to report on their practices relating to PD-L1 expression testing in NSCLC, through the submission of online de-identified record forms (n = 167 and n = 224 PD-L1-tested samples in 2016 and 2017 respectively). Results: Of the 224 samples gathered in 2017, 187 (84%) were tested with the Dako 22C3 pharmDx assay (vs 67% in 2016), 16 (7%) with the Dako 28-8 pharmDx assay (vs 22% in 2016) and 11 (5%) with a lab-developed test (LDT). An increase in the use of 1% staining as the cut-off was observed for both 22C3 and 28-8 pharmDx. The full distribution of cut-offs used is shown in the table below. Conclusions: Following initial fragmentation of clinical practices in 2016, PD-L1 expression testing has seen consolidation towards greater use of the Dako 22C3 assay and higher conformity in testing at the recommended cut-off points. While greater standardization simplifies testing, the choice of assay has potential implications on subsequent treatment: current PD-L1 assays allow physicians to confirm whether a specific PD-(L)1 inhibitor is appropriate for a patient, but there is no single PD-L1 expression test that supports oncologists in making treatment decisions for the PD-(L)1 inhibitor class as a whole.[Table: see text]
<i>Malassezia</i> species retrieved from skin with pityriasis versicolor, seborrhoeic dermatitis and skin free of lesions: a comparison of two sampling methods
Authors: A.F. Pedrosa, C. Lisboa, I. Faria-Ramos, R.M. Silva, I.M. Miranda, A.G. Rodrigues
Journal: British Journal of Dermatology (2018)
Extra 1500 medical students should be given leadership training, royal colleges say
Authors: Abi Rimmer
Journal: BMJ (2016)

Health Education England should consider only allowing medical schools that teach leadership to train the 1500 new medical students promised by government, leaders of medical royal colleges have said.

In October Jeremy Hunt, England’s health secretary, announced that “from September 2018 we will train up to 1500 more doctors every year” in England.1

During a discussion at the Leaders in Healthcare 2016 conference in Liverpool on Tuesday 1 November, Clare Marx, president of the Royal …
Correction to: The Intensive Care Global Study on Severe Acute Respiratory Infection (IC-GLOSSARI): a multicenter, multinational, 14-day inception cohort study
Authors: Yasser Sakr, Ricard Ferrer, Konrad Reinhart, Richard Beale, Andrew Rhodes, Rui Moreno, Jean Francois Timsit, Laurent Brochard, B Taylor Thompson, Ederlon Rezende, Jean Daniel Chiche
Journal: Intensive Care Medicine (2017)
Identification of miR-9-5p as direct regulator of ABCA1 and HDL-driven reverse cholesterol transport in circulating CD14+ cells of patients with metabolic syndrome
Authors: Simona D’Amore, Jennifer Härdfeldt, Marica Cariello, Giusi Graziano, Massimiliano Copetti, Giuseppe Di Tullio, Marilidia Piglionica, Natasha Scialpi, Carlo Sabbà, Giuseppe Palasciano, Michele Vacca, Antonio Moschetta
Journal: Cardiovascular Research (2018)

Abstract Aims Metabolic syndrome (MS) is a cluster of cardio-metabolic risk factors associated with atherosclerosis and low-grade inflammation. Using unbiased expression screenings in peripheral blood mononuclear cells, we depict here a novel expression chart of 678 genes and 84 microRNAs (miRNAs) controlling inflammatory, immune and metabolic responses. In order to further elucidate the link between inflammation and the HDL cholesterol pathway in MS, we focussed on the regulation of the ATP-binding cassette transporter A1 (ABCA1), a key player in cholesterol efflux (CE). Methods and results ABCA1 mRNA levels are suppressed in CD14+ cells of MS patients and are negatively correlated to body mass index (BMI), insulin-resistance (HOMA-IR) and cardiovascular risk, and positively to HDL cholesterol and CE. miRNA target in silico prediction identified a putative modulatory role of ABCA1 for the nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB) target miR-9-5p, whose expression pattern was up-regulated in CD14+ cells of MS patients, positively correlated to BMI, HOMA-IR, and triglycerides, and negatively to ABCA1 mRNA levels, HDL cholesterol and CE. Ectopic gain and loss of miR-9-5p function in macrophages modulated ABCA1 mRNA and protein levels, ABCA1 miRNA 3’-untranslated region target sequence reporter assay, and CE into HDL, thus confirming ABCA1 as a target of miR-9-5p. Conclusions We identified the NF-κB target miR-9-5p as a negative regulator of ABCA1 adding a novel target pathway in the relationship between inflammation and HDL-driven reverse cholesterol transport for prevention or treatment of atherosclerosis in MS.
I am a year 4 trainee and wish to complete subspecialty training in sexual and reproductive health on a modular basis. I have completed a significant proportion of the logbook in my current post in outpatient gynaecology. Are there any precedents for this? I would be happy to complete the outstanding modules unpaid
Authors: Alan Mathers
Journal: BMJ (2007)

Have a career related problem that needs answering? Can9t find the 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>
According to the new consultant contract, do we get paid a supplement for on-call duties according to the intensity and frequency of the on call if the on call would be part of programmed activity (PA)?
Authors: Rachel L Hooke
Journal: BMJ (2007)

Have a career related problem that needs answering? Can9t find the 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>