tbuckley/cabot-search huggingface dataset:
Returning to clinical training after maternity leave
Authors: Alexandra Brightwell, Susie Minson, Allison Ward, Caroline Fertleman
Journal: BMJ (2013)

Doctors increasingly take maternity leave during training, but little is known about the challenges they face in doing so. <b>Alexandra Brightwell and colleagues</b> held focus groups to try to fill that gap in evidence and to learn about the issues faced by trainees taking maternity leave
Unusual Case of Diffuse Penile Metastasis of Prostate Cancer on 68Ga PSMA PET/CT Imaging and 177Lu PSMA Posttherapy Scintigraphy
Authors: Shelvin Kumar Vadi, Rajender Kumar, Bhagwant Rai Mittal, Ashwin Singh Parihar, Shrawan Kumar Singh
Journal: Clinical Nuclear Medicine (2018)

Abstract An 85-year-old man with prostate cancer for metastatic workup underwent 68 Gallium Prostate-Specific Membrane Antigen ( 68 Ga-PSMA) PET/CT ( 68 Ga-PSMA PET/CT), which revealed unusual tracer uptake in the shaft and glans of penis as well as multiple systemic metastases in liver, skeletal, and lymph nodes. The penile lesion was proved to be metastatic adenocarcinoma from prostate on fine needle aspiration cytology. The patient underwent 177 Lutetium ( 177 Lu)-labeled PSMA radioligand therapy, which also revealed diffuse tracer uptake in the penile shaft as well as other metastatic sites.
TRANSCATHETER VALVE-IN-VALVE REPLACEMENT VERSUS REDO AORTIC VALVE SURGERY FOR BIOPROSTHETIC AORTIC VALVE DYSFUNCTION: A META-ANALYSIS
Authors: Saroj Neupane, Hemindermeet Singh, Johannes Lämmer, Hussein Othman, Hiroshi Yamasaki, Howard Rosman, Eduardo Bossone, Rajendra Mehta, Holger Eggebrecht
Journal: Journal of the American College of Cardiology (2018)
Asbestos-related lung cancers are rarely associated with <i>ALK</i>, <i>ROS1</i> and <i>RET</i> rearrangements
Authors: Marie Uguen, Jean-Dominique Dewitte, Brice Loddé, Pascale Marcorelles, Arnaud Uguen
Journal: European Respiratory Journal (2018)

Lung cancer remains the main cause of cancer death. In addition to smoking, exposure to occupational carcinogens constitutes a major risk for lung cancer. Among occupational cancers, asbestos-related ones are the most frequent, accounting for about 5–7% of lung cancers. A better understanding of the molecular pathways implicated in the progression of cancer has greatly improved the therapeutic management of patients with advanced lung cancers, especially nonsmall cell lung cancer (NSCLC) of the adenocarcinoma subtype. Indeed, several therapies targeting the epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK)/ROS1 pathways are now approved to treat patients with advanced EGFR -mutated or ALK/ROS1 -rearranged NSCLC, respectively. While EGFR and ALK alterations are mainly encountered in NSCLC of nonsmokers, other biomarkers are more frequent in smoking patients, such as KRAS mutations, and are of prognostic interest. Nevertheless, the frequencies of the different biomarkers analysed daily for the therapeutic management of patients with NSCLC are rarely reported in occupational lung cancers, including asbestos-related ones. ALK , ROS1 and RET rearrangements can also be diagnosed in asbestos-related lung cancers <http://ow.ly/rFpb30hV5Wt> We would like to also acknowledge the pathologists of Brest and the Local tumor tissue biobank BB-0033-00037 ("CRB Santé/Tumorothèque de Brest") for their collaboration in this study and Miss Sandrine Duigou, Mrs Le Prunennec Annette and Mr Eric Gobin for technical assistance.
Abstract MP77: Patient, Provider, and Insurance Predictors of Oral Anticoagulation Initiation and Dosing in Atrial Fibrillation
Authors: Inmaculada Hernandez, Yuting Zhang, Samir Saba
Journal: Circulation (2018)

Background: Recent research has shown strong provider-level variation in oral anticoagulation (OAC) use in atrial fibrillation (AF). The objective of the present study was to examine predictors of prescribing OAC to newly diagnosed AF patients, with special attention to prescribing low-dose direct oral anticoagulant agents (DOACs) to patients with no diagnosis of chronic kidney disease (CKD). Methods: Using 2013-2014 Medicare claims data, we identified patients newly diagnosed with AF who had CHA2DS2-VASc score≥2. Our sample included 19,390 patients who did not initiate OAC, and 22,299 OAC initiators, among whom 12,786 initiated warfarin, 5,984 high-dose DOACs and 3,529 low-dose DOACs. We constructed logistic regression models to estimate the effect of patient demographics, clinical characteristics, provider specialty, and insurance factors on OAC initiation and likelihood of prescribing low dose DOAC in patients with no CKD. Results: As shown in the table, age, gender, heart failure, and a history of bleeding affected the initiation of OAC as well as DOAC dosing. White patients were more likely to initiate OAC, but race did not affect DOAC dosing. Use of antiplatelet agents decreased the odds of OAC initiation by 27% (95%CI, 23%-31%), but did not impact DOAC dosing. The odds of OAC initiation decreased by 10% (95%CI, 6%-15%) for each point increase in the Geographic Practice Cost Index for malpractice. The odds of initiating low-dose DOACs were 30% (95%CI, 11%-38%) lower for patients seen by cardiologists than for those seen by internists or family practitioners. Conclusions: In addition to demographics and clinical characteristics, provider and insurance factors have a strong impact on initiation and dosing of OAC.
Cyclophosphamide versus etoposide in combination with total body irradiation as conditioning regimen for adult patients with Ph‐negative acute lymphoblastic leukemia undergoing allogeneic stem cell transplant: On behalf of the ALWP of the European Society for Blood and Marrow Transplantation
Authors: Anna Czyz, Myriam Labopin, Sebastian Giebel, Gerard Socié, Jane Apperley, Liisa Volin, Péter Reményi, Ibrahim Yakoub‐Agha, Kim Orchard, Mauricette Michallet, Gernot Stuhler, Sridhar Chaganti, Martin Murray, Mahmoud Aljurf, Adrian Bloor, Jacob Passweg, Jürgen Finke, Mohamad Mohty, Arnon Nagler
Journal: American Journal of Hematology (2018)

Allogeneic hematopoietic cell transplantation (alloHCT) with myeloablative conditioning based on total body irradiation (TBI) is widely used for the treatment of adults with acute lymphoblastic leukemia (ALL). TBI is most frequently administered in combination with either cyclophosphamide (Cy/TBI) or etoposide (Vp/TBI). The goal of this study was to retrospectively compare these two regimens. Adult patients with Ph-negative ALL treated with alloHCT in first or second complete remission who received Cy/TBI (n = 1346) or Vp/TBI (n = 152) conditioning were included in the analysis. In a univariate analysis, as compared to Cy/TBI, the use of Vp/TBI was associated with reduced incidence of relapse (17% vs. 30% at 5 years, P = .007), increased rate of leukemia-free survival (60% vs. 50%, P = .04), and improved "graft versus host disease (GVHD) and relapse-free survival" (GRFS, 43% vs. 33%, P = .04). No significant effect could be observed in terms of the incidence of nonrelapse mortality or acute or chronic GVHD. In a multivariate model, the use of Vp/TBI was associated with reduced risk of relapse (HR = 0.62, P = .04) while the effect on other study end-points was not significant. In conclusion, conditioning regimen based on Vp combined with TBI appears more effective for disease control than the combination of Cy with TBI for adult patients with Ph-negative ALL treated with alloHCT.
External validation of the Gustave Roussy immune score (GRIm score) in an unselected cohort of patients treated at the Clinica Universidad de Navarra
Authors: L. Ceniceros, I. Gardeazabal, M. Rodriguez, J.L. Perez Gracia, I. Melero, M. Ponz-Sarvisé, E. Castanon Alvarez
Journal: Annals of Oncology (2018)
Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints—an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force
Authors: Georgios Filippou, Carlo Alberto Scirè, Antonella Adinolfi, Nemanja S Damjanov, Greta Carrara, George A W Bruyn, Tomas Cazenave, Maria Antonietta D’Agostino, Andrea Delle Sedie, Valentina Di Sabatino, Mario Enrique Diaz Cortes, Emilio Filippucci, Frederique Gandjbakhch, Marwin Gutierrez, Daryl K Maccarter, Mihaela Micu, Ingrid Möller Parera, Gaël Mouterde, Mohamed Atia Mortada, Esperanza Naredo, Carlos Pineda, Francesco Porta, Anthony M Reginato, Iulia Satulu, Wolfgang A Schmidt, Teodora Serban, Lene Terslev, Violeta Vlad, Florentin Ananu Vreju, Pascal Zufferey, Panagiotis Bozios, Carmela Toscano, Valentina Picerno, Annamaria Iagnocco
Journal: Annals of the Rheumatic Diseases (2018)

To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints.A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises.The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached high interobserver and intraobserver k values in both exercises, ranging from 0.75 to 0.87 (good to excellent agreement). AC reached moderate kappa values, from 0.51 to 0.85 (moderate to excellent agreement) and can readily be used for US CPPD identification.Based on the results of our exercise, the OMERACT US definitions for the identification of CPPD demonstrated to be reliable when applied to the TFC and AC. Other sites reached good kappa values in the web-based exercise but failed to achieve good reproducibility at the patient-based exercise, meaning the scanning method must be further refined.
Death of baby from hyperinsulinaemic hypoglycaemia prompts safety upgrade at Barts trust
Authors: Clare Dyer
Journal: BMJ (2018)

A coroner has sent a report intended to prevent future deaths to the chief medical officer for Barts Health NHS Trust after a newborn baby boy died from undiagnosed low blood sugar levels.

Caliel Smith-Kwami was born in July 2017 and had a hypoglycaemic attack 28 hours later. He was admitted to the Royal London Hospital in east London, part of Barts Health, and tests were taken to determine the cause of the hypoglycaemia. But he was discharged from hospital before the results came back.

Insulin test results had not come back because a laboratory machine …
How Should Surgeons Interpret Operating Room Costs?
Authors: Peter A. Najjar, Stanley W. Ashley
Journal: JAMA Surgery (2018)

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Cardiac Genetic Predisposition in Sudden Infant Death Syndrome
Authors: David J. Tester, Leonie C.H. Wong, Pritha Chanana, Amie Jaye, Jared M. Evans, David R. FitzPatrick, Margaret J. Evans, Peter Fleming, Iona Jeffrey, Marta C. Cohen, Jacob Tfelt-Hansen, Michael A. Simpson, Elijah R. Behr, Michael J. Ackerman
Journal: Journal of the American College of Cardiology (2018)
Taskforce calls for more routes into emergency medicine
Authors: Caroline White
Journal: BMJ (2012)

Routes into emergency medicine training must be widened to boost the pool of eligible trainees in the specialty and achieve the expansion of consultant numbers needed for a safe and effective service, an interim report from the Emergency Medicine Taskforce has said.

All emergency departments need to have a consultant present for at least 16 hours a day, seven days a week, the report says. Larger departments and major trauma centres need 24/7 consultant presence or 10 whole time equivalents for each department, it …
Abstract 14346: Combined Cornell Voltage and Quantitative Assessment of Absolute Area Under ST Segment Predicts Cardiovascular Events in Japanese General Practice Population: J-HOP Study
Authors: Satoshi Hoshide, Tomoyuki Kabutoya, Yasushi Imai, Kazuo Eguchi, Natsuko Jimba, Tatsuya Yoneyama, Tsuyoshi Yamauchi, Takumi Sawada, Kazuomi Kario
Journal: Circulation (2016)

Introduction:  Both ECG-left ventricular hypertrophy diagnosed by Cornell voltage (CV-LVH) and the classic strain pattern or depression of ST segment have been accepted to be associated with adverse prognosis in clinical population. However, there are a few studies about the quantitative assessment of ST segment.   Hypothesis:  We assessed the hypothesis whether the area under of ST segment (AUST) using computerized measurements as the degree of AUST is associated with cardiovascular events.   Methods:  We analyzed 834 patients (mean age 63±11years, male 52%) performing ECG of 4310 patients recruited for the J-HOP study. The absolute AUST above or below isoelectric baseline was measured by computer in lead V 5 .   Results:  After a mean follow up of 6.2 years, there were 58 cardiovascular events. The patients with CV-LVH were suffered more cardiovascular events than those without (Figure A). When we divided patients into quintiles based on AUST, cardiovascular events were significantly increased at the lowest quintile (≤0.084msec•mV) compared with any other groups (Figure B). The group with both CV-LVH and the lowest quintile of AUST had a highest risk of cardiovascular events among 3 groups (Figure C). Multivariate Cox analysis demonstrated that after adjustment for other potential predictors, the combination of CV-LVH and the lowest quintile of AUST had a significant predictor of cardiovascular events compared with those without both CV-LVH and the lowest quintile of AUST (Hazard ratio, 3.25; 95% confidence interval 1.41-7.51, P=0.006) .   Conclusions:  The combination CV-LVH and absolute area of ST segment was a predictor of cardiovascular events in Japanese general practice population.
Evaluation of liquid from the Papanicolaou test and other liquid biopsies for the detection of endometrial and ovarian cancers
Authors: Yuxuan Wang, Lu Li, Christopher Douville, Joshua D. Cohen, Ting-Tai Yen, Isaac Kinde, Karin Sundfelt, Susanne K. Kjær, Ralph H. Hruban, Ie-Ming Shih, Tian-Li Wang, Robert J. Kurman, Simeon Springer, Janine Ptak, Maria Popoli, Joy Schaefer, Natalie Silliman, Lisa Dobbyn, Edward J. Tanner, Ana Angarita, Maria Lycke, Kirsten Jochumsen, Bahman Afsari, Ludmila Danilova, Douglas A. Levine, Kris Jardon, Xing Zeng, Jocelyne Arseneau, Lili Fu, Luis A. Diaz, Rachel Karchin, Cristian Tomasetti, Kenneth W. Kinzler, Bert Vogelstein, Amanda N. Fader, Lucy Gilbert, Nickolas Papadopoulos
Journal: Science Translational Medicine (2018)

Endometrial and ovarian cancers can be detected through the analysis of DNA from Pap test fluids, intrauterine samples, and plasma.
The presence of glutamate residues on the PAS sequence of the stimuli-sensitive nano-ferritin improves in vivo biodistribution and mitoxantrone encapsulation homogeneity
Authors: Elisabetta Falvo, Francesca Malagrinò, Alessandro Arcovito, Francesco Fazi, Gianni Colotti, Elisa Tremante, Patrizio Di Micco, Aldo Braca, Roberta Opri, Alessandro Giuffrè, Giulio Fracasso, Pierpaolo Ceci
Journal: Journal of Controlled Release (2018)
The IFN-lambda-IFN-lambda R1-IL-10R beta Complex Reveals Structural Features Underlying Type III IFN Functional Plasticity.
Authors: J.L Mendoza, W.M Schneider, H.H Hoffmann, K Vercauteren, K.M Jude, A Xiong, I Moraga, T.M Horton, J.S Glenn, Y.P de Jong, C.M Rice, K.C. Garcia
Journal: Immunity (2017)
Natural killer cell activity: A test for immune reactivity with clinical perspectives.
Authors: Line Nederby, Torben Hansen, Louise Raunkilde, Lars Henrik Jensen, Anders Kristian Moeller Jakobsen
Journal: Journal of Clinical Oncology (2018)

87 Background: Natural Killer (NK) cells are essential in the biological fight against cancer and the activity of these cells has been suggested as a biomarker for immunological reaction in cancer patients. An assay has been introduced to measure NK cell activity (NKA) in a simple and standardized manner. Following stimulation of NK cells in whole blood with a recombinant protein, it utilizes the concentration of interferon-gamma (IFNγ) in plasma as a surrogate marker for NKA. This study aimed to verify that the test was indeed measuring NKA and whether it could predict the response to cytostatic treatment in metastatic colorectal cancer (mCRC). Methods: Blood was collected in dedicated tubes (NK Vue Promoca) and placed at 37°C. After 24 hours the plasma was analyzed for IFNγ by ELISA (NK Vue ELISA). Blood from patients with mCRC (n = 22) were sampled at baseline and prior to each treatment cycle, and IFNγ levels were compared to response data from first evaluation. The protocol is ongoing hence the results are preliminary. In healthy controls (n = 8), IFNγ was measured intracellularly using flow cytometry at baseline and after 5-, 10-, 15-, 20-, 24-, and 28 hours of incubation. Results: When analyzing the distribution of cells among the IFNγ expressing subset, the proportion of NK cells was significantly different than that of monocytes, T-, and NKT cells at all time points of incubation (p &lt; 0.0001), thus suggesting that the readout of the test was indicative of the NK cells´ ability to mount a response. Using the NKA test, plasma levels of IFNγ in healthy controls were all above 200pg/mL after 24 hours of incubation. The mCRC patients were divided into three NKA groups: 1) IFNγ dropped below 200pg/mL or remained below that level throughout treatment (n = 9), 2) IFNγ remained above 200pg/mL throughout treatment (n = 5), and 3) IFNγ changed from being below 200pg/mL to above that level during treatment (n = 8). The response rates were 11%, 40%, and 100%, respectively, and the difference was significant (p &lt; 0.001). The positive and negative predictive values of increasing IFNγ were 100% and 79%. Conclusions: These data suggest that increasing NK cell activity during treatment has predictive potential in mCRC. The NKA test performs reliably in this setting. Clinical trial information: NCT02705300.
Abstract P146: Public Health Surveillance Reveals an Increase in Health Care Utilization for Generic versus Brand-name Warfarin Users
Authors: Jacinthe Leclerc, Claudia Blais, Louis Rochette, Denis Hamel, Line Guénette, Paul Poirier
Journal: Circulation (2018)

Background: Even with many direct oral anticoagulant options, brand-name or generic warfarin is still widely used to prevent atherothrombotic events in cardiology. Federal standards regulate bioequivalence of generic vs. brand-name drugs through comparative bioavailability studies but does not regulate clinical equivalence nor tolerability in a “real-life” settings. Through public health surveillance, we have evaluated the impact of the generic warfarin commercialization on health care utilization: emergency room (ER) consultations or hospitalizations. Methods: We used an interrupted time series analysis using the Quebec Integrated Chronic Disease Surveillance System, a surveillance system from the second populous province in Canada (~8.3 million in 2017). Rates of health care utilization for warfarin users (n=280,158) aged ≥ 66 years were calculated for 6-month periods, 5 years before up to 15 years after warfarin commercialization (from January 1996 to January 2016). Periods before and after generic warfarin commercialization were compared by negative binomial segmented regression models for all users with a specific variable for generic or brand-name users. Sensitivity analyses were also conducted. Results: Generic warfarin analogs (n=5) were commercialized from January 2001. There was an approximated mean rate of 1134 ER or hospitalizations for 1000 brand-name and generic users per 6-month period, similar before and after generics commercialization. After generics commercialization, there was an immediate increase in rates of health care utilization for generic (9.9%) vs. brand-name users (0%), a statistically significant difference (9.9% [95% confidence interval: 4.4% to 15.5%], p = 0.0001). Rates of health care utilization remained stable and higher for generic vs. brand-name users throughout the period after generics commercialization. Conclusion: Among generic warfarin users, we observed an increased rates of health care utilization soon after generics commercialization. Risk and survival analysis studies controlling for potential confounders are required to deepen this pharmacovigilance signal as stricter licensing process may be required.
Using an interpreting service
Authors: Satnam Chahal
Journal: BMJ (2006)

A key component of a successful and meaningful consultation is mutual understanding. A language barrier should no longer be an unassailable obstacle. One must resist the temptation to soldier on in pidgin English or raise one's voice, ensuring as brief a ward round as possible. There may well be occasions where a “functional history” is necessary in acute settings, but the task to “come back later and find out …