tbuckley/cabot-search huggingface dataset:
WHERE THERE IS SMOKE THERE IS FIRE: ‘SMOKE’ ON TRANSESOPHAGEAL ECHOCARDIOGRAPHY PREDICTS NON-PULMONARY VEIN TRIGGERS IN PATIENTS WITH ATRIAL FIBRILLATION
Authors: Sanghamitra Mohanty, Chintan Trivedi, Carola Gianni, Domenico Giovanni Della Rocca, Vivek Bhupathi, John Burkhardt, Javier Sanchez, Patrick Hranitzky, Gerald Gallinghouse, Amin Al-Ahmad, Rodney Horton, Luigi Di Biase, Andrea Natale
Journal: Journal of the American College of Cardiology (2018)
What is meant by standalone posts, and what are the criteria for getting them?
Authors: Simon Eccles
Journal: BMJ (2005)

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NOVEL PROGNOSTIC BIOMARKERS FOR ISCHEMIC STROKE IN PATIENTS WITH ATRIAL FIBRILLATION USING MULTIMARKER SCREENING: INSIGHTS FROM THE ARISTOTLE TRIAL
Authors: Ziad Hijazi, Tymon Pol, Jonas Oldgren, Johan Lindbáck, John Alexander, Christopher Granger, Renato Lopes, Lars Wallentin, Agneta Siegbahn
Journal: Journal of the American College of Cardiology (2018)
QUALITY OF INR CONTROL IN A CENTRALIZED PHARMACIST-LED PEDIATRIC CARDIOLOGY WARFARIN MANAGEMENT PROGRAM
Authors: Joanne Lee, Jenna Murray, Sarah Wilkens, Yulin Zhang, Fred Nishioka, David Rosenthal, Stephen Roth, Daniel Murphy, Doff McElhinney, Christopher Almond
Journal: Journal of the American College of Cardiology (2018)
Evaluation of topical Dexmedetomidine administration in postlaminectomy epidural fibrosis rat model
Authors: M.E. Yaman, G. Ergül, Y. Güvenç, Y. Öztürk, F.K. Erbay, T. Tolunay, S. Şentürk, C. Kırçıl, G. Bozkurt
Journal: International Journal of Surgery (2018)
Intraperitoneal immunotherapy with the bispecific anti-EpCAM x anti-CD3 directed antibody catumaxomab for patients with peritoneal carcinomatosis from gastric cancer: Final results of a randomized phase II AIO trial.
Authors: Florian Lordick, Volker Kunzmann, Jorg Trojan, Severin Daum, Michael Schenk, Frank Kullmann, Sebastian Schroll, Dirk M. Behringer, Michael Stahl, Salah-Eddin Al-Batran, Stefan Ibach, Justus Koerfer, Maren Kristina Knoedler
Journal: Journal of Clinical Oncology (2018)

4 Background: The peritoneal surface is a common location for metastases in gastric cancer (GC). Intraperitoneal (i.p.) application of the bispecific (anti-EpCAM/CD3) monoclonal antibody catumaxomab (CATU) in addition to i.v. chemotherapy may improve elimination of peritoneal carcinomatosis (PC). Methods: This randomized open-label phase II study aimed to investigate the efficacy of i.p. CATU following i.v. chemotherapy in patients (pts) with GC and PC (Gilly stages P1-4). Pts were randomly allocated to receive four cycles of FLOT (5FU, LV, Oxaliplatin, Docetaxel) followed by i.p. CATU at escalating doses (10, 20, 50, 150µg) on days 0, 3, 7, 10 or FLOT alone. Secondary gastrectomy and peritonectomy were allowed to achieve complete resection of all malignant lesions. The primary endpoint was to show an increased rate of macroscopic complete remission of PC at second-look surgery. Secondary endpoints included toxicity, progression-free and overall survival (PFS/OS). Results: Of 35 pts screened, 31 were enrolled. Median follow-up time is 52 months. 15 pts were allocated to FLOT-CATU (arm A) and 16 to FLOT alone (arm B). Complete remission rate of PC was 27% in arm A and 19% in arm B (p = 0.69). Severe side effects with i.p. CATU were nausea (15%), fever (23%), abdominal pain (31%), and elevated liver enzymes (gGT 31%, bilirubin 23%). Adverse events tended to be more common during FLOT-CATU compared to FLOT alone. Median PFS was not significantly different in both arms with 6.7 months in arm A compared to 5.4 months in arm B (p = 0.71). Median OS was 13.2 and 13.0 months. Conclusions: Addition of i.p. CATU as part of a multimodal treatment approach revealed feasible and tolerable in pts with GC and PC. Although the primary endpoint was not met, the results are promising for future trials investigating i.p. immunotherapy in this patient population. Clinical trial information: NCT01504256.
COMPARISON BETWEEN QUANTITATIVE FLOW RATIO AND FRACTIONAL FLOW RESERVE IN INTERMEDIATE CORONARY STENOSIS
Authors: Yu Sato, Tetsu Tanaka, Keita Koseki, Taishi Okuno, Hideki Koike, Kei Sato, Kazuyuki Yahagi, Jiro Aoki, Kengo Tanabe, Kota Komiyama
Journal: Journal of the American College of Cardiology (2018)
Abstract P165: Associations of Coronary Artery Calcium Volume and Density With Incident Heart Failure in the Multi-Ethnic Study of Atherosclerosis
Authors: Nketi I Forbang, Erin Michos, Sonia Ponce, Isac Thomas, Matthew Allison, David Bluemke, Michael Criqui
Journal: Circulation (2018)

Background: Coronary artery calcium (CAC) predicts incident heart failure (HF) independent of cardiovascular disease (CVD) risk factors. In MESA, Components of CAC, volume and density, have opposite associations with incident CVD, such that for a given volume of CAC, higher CAC density is inversely associated with events. The relationship between CAC volume and density with HF is unknown. Methods: We studied 6814 participants in a multi-ethnic, community-based cohort, free from clinical CVD at recruitment. CAC volume and density were measured by non-contrast cardiac CT at the baseline exam (2000-2002). Adjudicated HF events were assessed through 2014, and analysis limited to those with imaging confirmation and estimated ejection fraction (EF). Cox proportional hazard was used to estimate independent associations of baseline CAC volume and density with incident HF: HF with reduced (&lt; 50%), and preserved EF (HFrEF &amp; HFpEF respectively). Results: The mean age was 62 + 10 years, 47% were men, 38% identified as European-, 28% as African-, 22% as Hispanic-, and 12% as Chinese-ethnicity. Average time to 189 HF events (119 HFrEF &amp; 70 HFpEF) was 6.6 years. In unadjusted models, higher CAC volume (HR 1.27 [1.02-1.59], p=0.03), but not CAC density (HR 0.87 [0.67-1.13], p=0.29) was significantly associated with incident HF, non-significant associations were observed with HFrEF, or HFpEF, and no significant associations were observed for all three outcomes after adjustments for demographics and CVD risk factors (Table). Also, in unadjusted analyses, stratified by sex (p-value for interaction = 0.13), higher CAC volume was associated with increased risk for HF (HR 1.37 [1.03-1.81], p=0.03) and HFpEF (HR 1.76 [0.99-3.16], p=0.06), in males only. No significant associations were observed after adjustments. Conclusion: In a multi-ethnic cohort, CAC volume and density were not independently associated with HF, the trend for volume was positive while density was inverse. Low frequency of incident HF in our cohort was an important limitation.
Bleeding and Blood Disorders in Clients of Voluntary Medical Male Circumcision for HIV Prevention — Eastern and Southern Africa, 2015–2016
Authors: Lawrence E. Hinkle, Carlos Toledo, Jonathan M. Grund, Vanessa R. Byams, Naomi Bock, Renee Ridzon, Caroline Cooney, Emmanuel Njeuhmeli, Anne G. Thomas, Jacob Odhiambo, Elijah Odoyo-June, Norah Talam, Faustin Matchere, Wezi Msungama, Rose Nyirenda, James Odek, Jotamo Come, Marcos Canda, Stanley Wei, Alfred Bere, Collen Bonnecwe, Isaac Ang’Ang’A Choge, Enilda Martin, Dayanund Loykissoonlal, Gissenge J.I. Lija, Erick Mlanga, Daimon Simbeye, Stella Alamo, Geoffrey Kabuye, Joseph Lubwama, Nafuna Wamai, Omega Chituwo, George Sinyangwe, James Exnobert Zulu, Charles A. Ajayi, Shirish Balachandra, John Mandisarisa, Sinokuthemba Xaba, Stephanie M. Davis
Journal: MMWR Morbidity and Mortality Weekly Report (2018)

A new CDC analysis of data from eight African countries shows the importance of screening for bleeding disorders before voluntary medical male circumcision (VMMC), promptly detecting and managing bleeding complications, and maintaining surveillance systems to monitor adverse events.
The Bristol Bladder trial: A single-arm phase II trial of cisplatin and cabazitaxel for muscle invasive transitional cell carcinoma of the urinary bladder prior to radical cystectomy.
Authors: Amit Bahl, Susan Masson, Amarnath Challapalli, Alicia Bravo, Sylvia Pearson, Serena Hilman, Raj Persad, Anthony Koupparis, Edward Rowe, Emily Foulstone, Heidi Evans, Jon Oxley, Rosemary Greenwood, Hannah Kirk, Rebecca Huckett, Julian Kabala, Janice Ash-Miles, Narges Dailami, Claire Perks, Jeff Holly
Journal: Journal of Clinical Oncology (2018)

468 Background: Neoadjuvant cisplatin-based combination chemotherapy improves survival in muscle invasive transitional cell carcinoma (MI-TCC). However response rates and survival remain suboptimal. We sought to evaluate the efficacy of cabazitaxel (CBZ) with cisplatin (CIS) in this setting. Methods: A single arm phase 2 study was designed with 80% power to detect an objective response rate (ORR) of &gt;35%. Patients with MI-TCC were included if fit to receive neoadjuvant chemotherapy and to undergo radical cystectomy. Treatment was with CIS 70mg/m 2 and CBZ 15mg/m 2 on day 1 of a 21 day cycle, for 4 cycles prior to surgery. Primary prophylaxis was with pegylated GCSF. Toxicity was recorded using CTCAE v.4.03. Objective response was defined as a reduction in Tumour (T) stage from T2 or greater at diagnosis, to T1 or less at radical cystectomy. QoL data was assessed during and after chemotherapy using EQ-5D and EORTC-BLM30 questionnaires. Results: 28 patients were enrolled with median age 68.6 years (range 47-79). Response outcome (first 23 cases) and toxicity data (first 24 cases) are in this abstract; the remaining cases, currently scheduled for surgery, will be added to the final presentation. Pathological complete response (pCR) was observed in 7/23 patients (30.4%) and ORR was 56.5% (13/23). 18/24 (75%) completed 4 cycles; reasons for stopping were disease progression (2/24, 8.3%), adverse events (2/24, 8.3%) and patient choice (2/24, 8.3%). 7/24 patients (29%) experienced treatment related grade 3 and 4 adverse events. Conclusions: These results demonstrate that CIS and CBZ chemotherapy has an acceptable safety profile and is well tolerated in this setting. This combination shows promising efficacy (pCR 30.4%, ORR 56.5%) prior to definitive treatment for MI-TCC. Response outcomes for all patients and QoL data will be reported in the final presentation. Grade 3/4 adverse events. Clinical trial information: NCT01616875. [Table: see text]
Combinations of Bevacizumab and Erlotinib Show Activity in Colorectal Cancer Independent of <i>RAS</i> Status
Authors: Paul Mésange, Anaïs Bouygues, Nathalie Ferrand, Michèle Sabbah, Alexandre E. Escargueil, Ariel Savina, Benoist Chibaudel, Christophe Tournigand, Thierry André, Aimery de Gramont, Annette K. Larsen
Journal: Clinical Cancer Research (2018)

Purpose: There is extensive cross-talk between VEGF- and EGFR-pathway signaling in colorectal cancer. However, combinations of VEGF- and EGFR-targeted monoclonal antibodies (mAb) show disappointing activity, in particular for patients with mutant RAS Previous results show that tyrosine kinase inhibitors (TKI) can be active in colorectal cancer models resistant to mAbs. This prompted us to examine whether the activity of bevacizumab can be increased by combination with erlotinib.Experimental Design: The antitumor activity of bevacizumab, erlotinib, and their combination was determined in colorectal cancer models with different RAS status and bevacizumab sensitivity. EGFR/VEGF pathway activation was characterized by immunohistochemistry, Western blot, and ELISA assays. The influence of cetuximab and erlotinib on EGF-mediated migration and the EGFR-EGF ligand feedback loop was established in colorectal cancer cell lines with different RAS status.Results: The addition of erlotinib increased bevacizumab activity in all models independent of RAS status. Bevacizumab exposure was accompanied by marked EGFR activation in tumor cells as well as in tumor-associated endothelial cells (TECs) and resulted in strong accumulation of intracellular EGFR, which could be attenuated by erlotinib. In cellular models, erlotinib was able to attenuate EGF-mediated functions in all cell lines independent of RAS status while cetuximab only showed activity in RAS wild-type cells.Conclusions: These results should provide a molecular framework to better understand the increased activity of the bevacizumab-erlotinib combination, compared with bevacizumab alone, in the GERCOR DREAM phase III clinical trial. Differential activity of mAbs and TKIs targeting the same signaling pathway is likely applicable for other tumor types. Clin Cancer Res; 24(11); 2548-58. ©2018 AACR.
Effectiveness of Early Psychosis Intervention: Comparison of Service Users and Nonusers in Population-Based Health Administrative Data
Authors: Kelly K. Anderson, Ross Norman, Arlene MacDougall, Jordan Edwards, Lena Palaniyappan, Cindy Lau, Paul Kurdyak
Journal: American Journal of Psychiatry (2018)

Objective: Early psychosis intervention (EPI) programs improve clinical and functional outcomes for people with first-episode psychosis. Less is known about the impact of these programs on the larger health care system. The authors sought to compare indicators of health service use, self-harm, suicide, and mortality between people with first-episode psychosis who were using EPI services and a propensity-matched group of concurrent control subjects who were not accessing EPI services. Method: A retrospective cohort of incident cases of nonaffective psychosis in the catchment area of the Prevention and Early Intervention Program for Psychoses in London, Ontario, between 1997 and 2013 was constructed using health administrative data. This cohort was linked to primary data from the same program to identify people who used EPI services. Outcomes for people who used EPI services and those who did not were compared using Cox proportional hazards models. Results: People who used EPI services had substantially lower rates of all-cause mortality in the 2-year period after EPI program admission (hazard ratio=0.24, 95% CI=0.11–0.53), although a significant difference in self-harm (hazard ratio=0.86, 95% CI=0.18–4.24) and suicide (hazard ratio=0.73, 95% CI=0.29–1.80) between the two groups was not observed. Those who used EPI services also had lower rates of emergency department presentation (hazard ratio=0.71, 95% CI=0.60–0.83) but higher rates of hospitalization (hazard ratio=1.42, 95% CI=1.18–1.71). These benefits were not observed after 2 years, when EPI care is typically stepped down to medical management. Conclusions: People with first-episode psychosis who used EPI services had mortality rates that were four times lower than those with first-episode psychosis who did not use these services, as well as better outcomes across several health care system indicators. These findings support the effectiveness of EPI services for the treatment of first-episode psychosis in the larger context of the overall health care system.
D-alanyl-D-alanine-Modified Gold Nanoparticles Form a Broad-Spectrum Sensor for Bacteria
Authors: Xinglong Yang, Yan Dang, Jinli Lou, Huawu Shao, Xingyu Jiang
Journal: Theranostics (2018)

Rationale: Rapid and facile detection of pathogenic bacteria is challenging due to the requirement of large-scale instruments and equipment in conventional methods. We utilize D-amino acid as molecules to selectively target bacteria because bacteria can incorporate DADA in its cell wall while mammalian cells or fungi cannot. Methods: We show a broad-spectrum bacterial detection system based on D-amino acid-capped gold nanoparticles (AuNPs). AuNPs serve as the signal output that we can monitor without relying on any complex instruments. Results: In the presence of bacteria, the AuNPs aggregate and the color of AuNPs changes from red to blue. This convenient color change can distinguish between Staphylococcus aureus (S. aureus) and methicillin-resistant Staphylococcus aureus (MRSA). This system can be applied for detection of ascites samples from patients. Conclusion: These D-amino acid-modified AuNPs serve as a promising platform for rapid visual identification of pathogens in the clinic.
Use of Uncrossmatched Cold-Stored Whole Blood in Injured Children With Hemorrhagic Shock
Authors: Christine M. Leeper, Mark H. Yazer, Franklyn P. Cladis, Richard Saladino, Darrell J. Triulzi, Barbara A. Gaines
Journal: JAMA Pediatrics (2018)

No transfusion reactions were reported.The median (IQR) time from ED admission to the start of the WB transfusion was 15 (14-77) minutes, compared with 303 (129-741) minutes (P < .001)for administration of at least 1 unit of RBCs, plasma, and platelets in the historical cohort (Figure).Discussion | To our knowledge, this is the first cohort of pediatric civilian trauma patients to receive WB during resuscitation.These preliminary data suggest that WB transfusion of up to 20 mL/kg is safe in children with severe injuries; there was no evidence of hemolysis in non-group O recipients, and no transfusion reactions were reported.Based on these data, the transfusion committee of Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center approved an increase in maximum volume of WB transfusion to 30 mL/kg.Larger cohorts are necessary for further study to determine if WB administration will affect outcomes, including number of donor exposures, cost, total volume transfused, and mortality.
<i>I'm coming to the end of my registrar training. Should I do some locum work before I look for a practice?</i>
Authors: Judith Harvey
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>
Nurse perceptions of facilitators and barriers to effective delivery room neonatal resuscitations: a comparison between Zimbabwean and US settings
Authors: Valerie Clary-Muronda
Journal: The Lancet Global Health (2018)

BackgroundMost babies transition to life outside the uterus with little intervention at the time of birth; however, 4–10% will require some assistance with establishing respirations. Delivery room neonatal resuscitations require prompt, well-coordinated interventions for optimal outcomes. While the importance of timeliness is well documented in the literature, evidence suggests that most delivery room resuscitations do not occur in accordance with the recommended timeline. The purpose of this research was to examine the facilitators for, and barriers to, neonatal resuscitation from the contexts of nurses working in a rural clinic in Zimbabwe and in a hospital in the USA to identify potential areas for improvement that may be similar across resource settings.MethodsBetween March 1, 2015, and Feb 1, 2016, nurses working in the Kutama Clinic in the Zvimba District in Zimbabwe and the Virtua Health hospital in Voorhees, NJ, USA were interviewed to explore perceptions of facilitators for, and barriers to, effective neonatal resuscitations in delivery settings. Individual semi-structured interviews using an interview guide were conducted. Interviews were audiotaped and transcribed verbatim for analysis. Data were analysed using qualitative description with a direct content analysis approach.FindingsWe interviewed three nurses from Zimbabwe and 12 nurses from the USA. Contextual barriers specific to each setting seemed to affect delivery room neonatal resuscitations. Resources in the Zimbabwe setting were the most prominent barrier, while resuscitation skills for delivery room nurses were identified as the most prominent barrier for nurses working in the USA. Additionally, similarities were identified across settings such as a need for improved competency in neonatal resuscitation, ongoing continuing education, and frequent skills review. Nurses in the Zimbabwean setting use simulation to reinforce neonatal resuscitation skills on a regular basis—a practice that may be useful for skill reinforcement for nurses in the US setting.InterpretationTargeted bag-mask ventilation training with frequent practice outside of routine training may improve nurse comfort with the crucial skill of positive pressure ventilation and may improve neonatal outcomes across settings.FundingNone.
Abstract 12235: A Randomized Control Hands-on Defibrillation Study - Barrier Use Evaluation
Authors: David Wampler, Chetan Kharod, Scotty Bolleter, Alison Burkett, Caitlin Gabehart, Craig Manifold
Journal: Circulation (2015)

Introduction: Chest compressions and defibrillation are the only therapies proven to increase survival in cardiac arrest. Historically, rescuers must remove hands to shock, thereby interrupting chest compressions. This hands-off time (pre-shock pause) results in a zero blood flow state. Pre-shock pause has been associated with poorer neurological recovery from cardiac arrest. Methods: This was a blinded randomized control cadaver study evaluating a rescuer’s ability to detect defibrillation during manual chest compressions. We used two defibrillators, with identical auditory signals during charging, and shock delivery. The active defibrillator was connected to the cadaver in the sternum-apex configuration with self-adhesive defibrillation pads. The sham defibrillator was connected to a device designed to safely and silently receive current. After informed consent, paramedic subjects performed chest compressions on the cadaver using 6 types of hand barriers: no-barrier, single and double layer nitrile gloves, firefighter gloves, neoprene pad, and a manual chest compression/decompression device. Randomized defibrillations (10 per barrier type) were delivered at 30 joules (J) for bare hand and 360J for all other barriers. After each shock, the subject indicated degree of sensation on a Likert scale. Results: Ten subjects participated and utilized six barrier methods. Half of the shocks were randomized to sham. All subjects detected 30j shocks during barehand compressions, with only 1 undetected real shock, and no reports of feeling a bare-handed sham shock. All barriers combined totaled 500 shocks delivered. Five (1%) active shocks were detected with any barrier, 1 (0.2%) with single layer of Nitrile gloves, 3 (0.6%) with double layer nitrile-gloves and 1 (0.2%) with the neoprene barrier. One sham shock was reported detected with the single layer nitrile glove. No shocks were detected with fire gloves or compression decompression device. Subjects reported all shocks detected as barely perceptible (0.25 (±.05) cm on 10 cm Likert scale). Conclusions: Nitrile gloves or a neoprene pad essentially prevent (99%) responder’s detection of a 360J defibrillation on a cadaver. Fire gloves and compression decompression device prevented detection.
More than 7500 doctors revalidated in first six months
Authors: Helen Jaques
Journal: BMJ (2013)

More than 7500 doctors in the UK have been revalidated since the process was introduced at the end of last year, the General Medical Council has announced.

A total of 7663 (3%) of the 235 000 licensed doctors in the UK were revalidated successfully between 3 December 2012, when revalidation was first implemented, and 3 June 2013 (table⇓).

View this table:

No of UK doctors who have revalidated since process began in December 2013



Medical leaders—such as Peter Rubin, chairman of the GMC, and Clare Gerada, chairwoman of the Royal College of …
REAL WORLD CLINICAL OUTCOMES OF SIROLIMUS COATED BALLOON IN CORONARY ARTERY LESIONS: RESULTS FROM SINGLE CENTRE STUDY
Authors: Keyur H. Parikh, Parth Parikh, Parloop Bhatt, Aenasha Chag, Hemang Baxi, Milan Chag, Urmil Shah, Satya Gupta, Anish Chandarana, Manish Doshi
Journal: Journal of the American College of Cardiology (2018)