tbuckley/cabot-search huggingface dataset:
Impact of adjuvant hepatic arterial infusion chemotherapy using high-dose 5-fluorouracil with systemic gemcitabine for resectable pancreatic cancer.
Authors: Kota Nakamura, Takahiro Akahori, Minako Nagai, Satoshi Nishiwada, Kenji Nakagawa, Toshihiro Tanaka, Hideyuki Nishiofuku, Kimihiko Kichikawa, Tetsuro Tamamoto, Masatoshi Hasegawa, Naoya Ikeda, Masayuki Sho
Journal: Journal of Clinical Oncology (2018)

360 Background: Despite recent advances in cancer treatment, postoperative recurrence remains an unsolved issue for resectable pancreatic cancer. To prevent hepatic recurrence and prolong postoperative survival, we introduced postoperative adjuvant chemotherapy of high-dose 5-fluorouracil (5-FU) hepatic arterial infusion (HAI) with systemic chemotherapy using gemcitabine in 2006. We retrospectively evaluated the clinical impact of HAI. Methods: A total of 251 patients who underwent pancreatic resection for PC were analyzed. Patients received weekly high-dose 5-FU through the hepatic artery using a port-catheter system (1000 mg/m2 for 5 h) plus concurrent systemic gemcitabine (1000 mg/m2) followed by systemic 3 cycles of gemcitabine or 4 cycles of S-1. Patients were divided into two groups. The patients who completed planned adjuvant chemotherapy of HAI were classified as the completion group (HAI), and the patients who failed to complete HAI or received systemic adjuvant chemotherapy other than HAI were classified as the control group. Results: One hundred thirty-eight patients (55%) completed planned adjuvant chemotherapy of HAI. On the other hand, 28 patients (11%) failed to complete HAI and 85 patients (34%) received systemic adjuvant chemotherapy alone. The reasons for incompletion of HAI were as follows: any recurrence during HAI treatment in 8, poor general condition of patients in 4, hepatic arterial stenosis in 4 and catheter trouble in 3. Initial hepatic metastasis rate was significantly lower in the HAI group than the control group (15.2 vs. 26.3%, p=0.029), and liver metastasis free survival was significantly better in the HAI group than the control group (p=0.001). The HAI group had a better prognosis than the control group (58.1 vs. 26.9M, p &lt; 0.001). Prognostic factor analysis indicated that failure to complete HAI (p &lt; 0.001, HR 1.95), borderline resectable tumor (p = 0.028, HR 1.63), and lymph node metastasis (p = 0.018, HR 1.59) were the independent adverse prognostic factors. Conclusions: Our data demonstrate that HAI can significantly prevent hepatic recurrence and also improve the postoperative prognosis in pancreatic cancer.
NON INFARCT RELATED ARTERY MICROVASCULAR OBSTRUCTION IS A PREDICTOR OF PERSISTENT DIASTOLIC DYSFUNCTION IN PATIENTS PRESENTING WITH ST ELEVATION MYOCARDIAL INFARCTION
Authors: Amir Lerman, Reza Khorramirouz, Michel Corban, Shi-Wei Yang, John Bois, Lilach Lerman, Jae K. Oh
Journal: Journal of the American College of Cardiology (2018)
Surveillance of antimicrobial consumption in animal production sectors of low- and middle-income countries: Optimizing use and addressing antimicrobial resistance
Authors: Daniel Schar, Angkana Sommanustweechai, Ramanan Laxminarayan, Viroj Tangcharoensathien
Journal: PLoS Medicine (2018)

In a policy forum, Daniel Schar and colleagues discuss the need for surveillance of antimicrobial consumption in animals in low- and middle-income countries and propose the establishment of antimicrobial consumption monitoring systems.
Guidelines for Patient-Reported Outcomes in Clinical Trial Protocols
Authors: Roxana Mehran, Usman Baber, George Dangas
Journal: JAMA (2018)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Abstract P272: Dietary Intake of Vitamin K and the Risk of Incident Pulmonary Embolism in the Nurses’ Health Study
Authors: Laura B Harrington, Kenneth J Mukamal, Kaitlin A Hagan, Jae H Kang, Jihye Kim, Eric B Rimm, Christopher Kabrhel, Majken K Jensen
Journal: Circulation (2018)

Introduction: Vitamin K, which is consumed as phylloquinone (K 1 ) and menaquinone (K 2 ), impacts some vitamin-K dependent proteins involved in hemostasis. It is unknown whether dietary intake of phylloquinone and menaquinone are associated with incident pulmonary embolism (PE) risk. Hypotheses: Dietary intake of phylloquinone and menaquinone will be positively associated with the risk of incident PE and, in secondary analyses, idiopathic PE. Methods: Eligible women were Nurses’ Health Study participants free of venous thromboembolism (VTE) at 1984 baseline (n=74,821). Participants completed a food frequency questionnaire every four years (1984-2010) and we calculated intake of phylloquinone and menaquinone. Eligible PE cases were confirmed via medical record review or participant reconfirmation, or self-reported among persons with prior cancer. Cases were defined as idiopathic in the absence of cancer, recent surgery, and trauma. Cox Proportional Hazards models estimated hazard ratios and 95% confidence intervals for PE associated with time-varying energy-adjusted quintiles of phylloquinone, and separately, menaquinone. Two models adjusted for time-varying covariates, first including lifestyle and medical factors and next adding energy-adjusted nutrients. Secondary analyses estimated idiopathic PE risk. Results: We identified 568 incident PE events during 1,328,669 person-years. In analyses adjusted for lifestyle and medical factors, there was no evidence of a linear association between incident PE risk and energy-adjusted quintiles of phylloquinone intake (linear p-trend across quintile medians = 0.37) or menaquinone intake (linear p-trend = 0.57). Results for idiopathic PE risk were similarly null, as were results after further adjustment for nutrients (Table). Conclusions: In this study of U.S. women, there was no evidence of a linear association between energy-adjusted quintiles of phylloquinone or menaquinone intake and incident PE risk, before or after adjustment for other nutrients.
Doctors and disciplinary action
Authors: Hemant J Vadeyar
Journal: BMJ (2006)

I read with interest the article from Dr Umesh Prabhu on doctors and disciplinary action.1 I fully agree with all the issues raised by the author. Most doctors within the NHS are very conscientious and are keen to do a very good job. Whenever there is an adverse event, the doctor is almost always as distressed as the patient. But the system does not always support the doctor or offer him or her help.

I …
Junior contract talks will resume on Thursday
Authors: Abi Rimmer
Journal: BMJ (2016)

Talks on the junior doctors’ contract are set to resume between the government and the BMA on Thursday 14 January.

The Advisory, Conciliation and Arbitration Service (Acas), which previously facilitated talks between the two parties, said that both sides had agreed to take part in talks on 14 and 15 January.

On 12 …
What is my entitlement to paternity leave during a one year GP registrar post; is it paid leave, and should it be counted as sick leave?
Authors: Sarah Burnett
Journal: BMJ (2006)

Have 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 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>
Editor’s Choice: Working together
Authors: Tom Moberly
Journal: BMJ (2016)

Some unconventional thinking may be needed to tackle the pressures facing general practice in the UK, Richard Fieldhouse argues in BMJ Careers this week http://careers.bmj.com/careers/advice/GP\_chambers\_can\_help\_practices\_to\_stem\_the\_flow\_of\_demand. He describes the potential of GP chambers—a new way for GPs to work modelled on the shared support structures used by other professional …
Time-responsive osteogenic niche of stem cells: A sequentially triggered, dual-peptide loaded, alginate hybrid system for promoting cell activity and osteo-differentiation
Authors: Zuyuan Luo, Siqi Zhang, Jijia Pan, Rui Shi, Hao Liu, Yalin Lyu, Xiao Han, Yan Li, Yue Yang, Zhixiu Xu, Yi Sui, En Luo, Yuanyuan Zhang, Shicheng Wei
Journal: Biomaterials (2018)
Image Gallery: Acquired zinc deficiency of prematurity
Authors: Z.R. Csoma, L. Kemény
Journal: British Journal of Dermatology (2018)

DEAR EDITOR, An extremely premature male infant was discharged home after 11 weeks of intensive care.After 1 week, brownish-red, eroded macules and papules developed on the face, and also brown macules, plaques and bullae appeared on his fingers, hands, wrists, ankles, feet and toes.Despite multiple antibacterial and anti-inflammatory treatments administered to the patient as the diagnosis was thought to be impetigo, a significant worsening of the symptoms was observed.Laboratory testing demonstrated an unusually low serum zinc level, which supported the diagnosis of acquired zinc deficiency of prematurity.The introduction of supplementation therapy resulted in a rapid improvement of the clinical symptoms within days.Classic acrodermatitis enteropathica was excluded by testing the SLC39A4 gene.
The anti-caspase inhibitor Q-VD-OPH prevents AIDS disease progression in SIV-infected rhesus macaques
Authors: Mireille Laforge, Ricardo Silvestre, Vasco Rodrigues, Julie Garibal, Laure Campillo-Gimenez, Shahul Mouhamad, Valérie Monceaux, Marie-Christine Cumont, Henintsoa Rabezanahary, Alain Pruvost, Anabela Cordeiro-da-Silva, Bruno Hurtrel, Guido Silvestri, Anna Senik, Jérôme Estaquier
Journal: Journal of Clinical Investigation (2018)

Apoptosis has been proposed as a key mechanism responsible for CD4+ T cell depletion and immune dysfunction during HIV infection. We demonstrated that Q-VD-OPH, a caspase inhibitor, inhibits spontaneous and activation-induced death of T cells from SIV-infected rhesus macaques (RMs). When administered during the acute phase of infection, Q-VD-OPH was associated with (a) reduced levels of T cell death, (b) preservation of CD4+/CD8+ T cell ratio in lymphoid organs and in the gut, (c) maintenance of memory CD4+ T cells, and (d) increased specific CD4+ T cell response associated with the expression of cytotoxic molecules. Although therapy was limited to the acute phase of infection, Q-VD-OPH–treated RMs showed lower levels of both viral load and cell-associated SIV DNA as compared with control SIV-infected RMs throughout the chronic phase of infection, and prevented the development of AIDS. Overall, our data demonstrate that Q-VD-OPH injection in SIV-infected RMs may represent an adjunctive therapeutic agent to control HIV infection and delaying disease progression to AIDS.
I am interested in working in the Middle East on a long term basis. Could someone please advise me on how to find jobs and on the working conditions?
Authors: Nick Banatvala
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>
Coronary Serum Exosomes Derived from Patients with Myocardial Ischemia Regulate Angiogenesis through the miR-939-mediated Nitric Oxide Signaling Pathway
Authors: Hao Li, Yiteng Liao, Lei Gao, Tao Zhuang, Zheyong Huang, Hongming Zhu, Junbo Ge
Journal: Theranostics (2018)

Rationale: Angiogenesis is a crucial step towards tissue repair and regeneration after ischemia.The role of circulating exosomes in angiogenic signal transduction has not been well elucidated.Thus, this study aims to investigate the effects of coronary serum exosomes from patients with myocardial ischemia on angiogenesis and to elucidate the underlying mechanisms.Methods and Results: The patients were enrolled according to the inclusion and exclusion criteria.Coronary blood was obtained from the angiography catheter.Serum exosomes were purified and characterized by their specific morphology and surface markers.In vitro analysis showed that compared to exosomes from healthy controls (con-Exo), exosomes from patients with myocardial ischemia (isc-Exo) enhanced endothelial cell proliferation, migration and tube formation.In a mouse hind-limb ischemia model, blood perfusion and histological staining demonstrated that isc-Exo significantly promoted blood flow recovery and enhanced neovascularization compared to con-Exo.Further, we revealed that cardiomyocytes, but not cardiac fibroblasts or endothelial cells, were initiated to release exosomes under ischemic stress; cardiomyocytes might be the source of bioactive exosomes in coronary serum.In addition, microarray analysis indicated that miR-939-5p was significantly down-regulated in isc-Exo.By knockdown and overexpression analyses, we found that miR-939-5p regulated angiogenesis by targeting iNOS.miR-939-5p inhibited both iNOS's expression and its activity, attenuated endothelial NO production, and eventually impaired angiogenesis.Conclusions: Exosomes derived from patients with myocardial ischemia promote angiogenesis via the miR-939-iNOS-NO pathway.Our study highlights that coronary serum exosomes serve as an important angiogenic messenger in patients suffering from myocardial ischemia.
Validation of a testosterone-deficiency symptoms rating-scale in prostate cancer patients treated with androgen deprivation therapy and radiotherapy.
Authors: Micheal O'Cathail, Jessica Little, Shaymaa Hosni, Santhanam Sundar
Journal: Journal of Clinical Oncology (2018)

63 Background: Androgen deprivation therapy (ADT) plays an important role in the management of non-metastatic prostate cancer (NMPC). We prospectively assessed the performance of a symptom rating scale, the aging men’s symptoms score (AMS) in relation to other validated QOL tools. Methods: Following ethics approval, 145 patients with a diagnosis of NMPC receiving ADT as part of radical treatment were enrolled after informed consent. Data was collected using the EORTC QLQ-C30, the AMS and the International Index of Erectile Function score (IIEF-5) questionnaires at baseline, 3 months (post ADT) and after ADT was stopped. Results: Eighty six (58.1%) patients had ADT for &lt;9 months, 7 (4.7%) had 9 -18 months and 55 (37.2%) had 27-36 months. A third (32.3%) of patients had moderate/severe symptoms of testosterone deficiency (TD) at baseline vs 62% and 44.4% at time points 2 &amp; 3 (p&lt;0.0001). Severe erectile dysfunction was common and worsened with ADT (45.3% &amp; 74.1% respectively) and did not recover post ADT (p&lt;0.0001). Few (1.6%) patients retained normal erectile function at the end of the study vs 15.6% at baseline. Self-reported QoL using EORTC QLQ C30 (Q.30) remained high at all time points (80.8%, 76.2%,75.8% respectively for a score of 5-7, 7 =very good, 1=very poor). Conclusions: TD due to ADT resulted in significant symptoms only in a subset of patients and not all symptoms resolved post ADT. However, self-reported QoL remained unaffected indicating that andropause symptoms may not affect QoL in radically treated prostate patients. This prospective data validates AMS scale and it could be used in routine clinical practice to assess TD symptoms in this group. [Table: see text]
Randomized, open-label, phase II study comparing five-weekly S-1 plus cisplatin (SP) with tri-weekly capecitabine plus cisplatin (XP) in chemotherapy-naïve patients with HER2 negative advanced gastric cancer (AGC): OGSG 1105 HERBIS-4A trial.
Authors: Atsushi Takeno, Youichi Makari, Shunji Endo, Jin Matsuyama, Ryohei Kawabata, Naotoshi Sugimoto, Hirokazu Taniguchi, Kenichi Nagai, Shigeyuki Tamura, Junichi Nishijima, Shugo Ueda, Yutaka Kimura, Takao Tamura, Kenji Kobayashi, HIsato Kawakami, Kazumasa Fujitani, Daisuke Sakai, Toshio Shimokawa, Yukinori Kurokawa, Taroh Satoh
Journal: Journal of Clinical Oncology (2018)

102 Background: This phase II study aimed to investigate the safety and efficacy of XP compared to SP in the first-line treatment of HER2 negative AGC. Methods: Patients were randomly assigned to receive either SP (S-1 at 40–60 mg twice daily for 21 days plus cisplatin at 60 mg/ m 2 on day 8, every 5 weeks) or XP (capecitabine 1,000 mg/m 2 twice daily for 14 days plus cisplatin 80 mg/m 2 on day 1, every 3 weeks). Primary endpoint was response rate (RR), and secondary endpoints were progression-free survival (PFS), overall survival (OS), time to treatment failure (TTF), and adverse events. Results: 84 eligible patients were randomly assigned to receive SP ( N = 41) or XP ( N = 43). No statistical difference was observed in overall RR between the SP and XP groups [51.2% (95% CI, 35.1% to 67.1%) vs. 53.5% (95% CI, 37.7% to 68.8%), P = 1.000]. Despite not significant, however, SP vs. XP showed a trend toward better PFS [median, 5.9 months vs. 4.1 months; hazard ratio (HR), 0.763; 95% CI, 0.462 to 1.259; P = .284] and OS (median, 13.5 months vs. 10.0 months; HR, 0.776; 95% CI, 0.485 to 1.244; P = .290). This trend in the SP vs. XP comparison was more pronounced in TTF (median, 4.5 months vs. 3.1 months; HR, 0.651; 95% CI, 0.421 to 1.006; P = .052). Common grade 3 to 4 hematological toxicities were neutropenia and anemia (SP group, 23% and 23%; XP group, 35% and 28%). Grade 3-4 anorexia and hyponatremia were more frequently seen in the XP group (31% and 16%) compared to the SP group (13% and 5%). Treatment-related deaths occurred in one patient (2.3%) in the XP group. Conclusions: XP failed to demonstrate the superior efficacy over SP. Higher incidence of severe toxicities by XP suggests SP as the standard 1 st line chemotherapy for HER2 negative AGC in Japan. Clinical trial information: UMIN000006755.
Does radiosurgery have a role for patients with colorectal brain metastases?
Authors: Charles Fong, Geoff Heyes, Rosemary Simmons, Ruth Stange, Timothy Jackson, Helen Benghiat, Garth Cruickshank, Paul Sanghera, Andrew Hartley
Journal: Neuro-Oncology (2018)

Patients with colorectal brain metastases (CRC-BM) are under-represented in radiosurgery (SRS) series. This paper explores SRS outcomes for this specific group. Patients with CRC-BM undergoing SRS between June 2013 and August 2016 were identified. Patient selection criteria reflected NHS-England guidelines. Target volumes were all approved by a neuroradiologist and no margin was used. All patients were treated with Cyberknife. Sixteen patients with 26 CRC-BM were identified. Median age was 64 years. Median follow-up was 6.3 months. Ten patients had 1 BM, five had 2 BM, one had 6 BM treated with SRS. Four BM were treated with 3 fractions. Mean volume was 4.06cc (range 0.05 – 13.06cc). Median surface dose was 20.5 Gy. Twenty-three BM (13 patients) were evaluable for local control (LC) and distant brain control (DBC). LC rate at 3 and 6 months were 95% and 55%. All 4 BM with LC failure underwent salvage excision, two also underwent partial brain RT, one also had repeat SRS. DBC rate at 6 and 12 months were both 78%. Median overall survival (OS) was 8.0 months. OS at 6 and 12 months were 55% and 32%. Twelve patients had died: 5 from extracranial disease, 5 from neurological deterioration, and mode of death was unclear for 2 patients. Four patients died within 90 days including 2 with neurological deterioration. Four patients lived beyond 1 year: all had single BM and PS 0, and 3 were younger than 55 years with prior BM excision. Consistent with the limited available data, outcomes for CRC-BM were poor. Although favourable DBC supported focal treatment, only patients with a single BM survived beyond 1 year.
The world of patient safety through the eyes of a junior doctor
Authors: Andrew Heighton
Journal: BMJ (2010)

Patient safety has been a relatively recent consideration in medicine but has rapidly become a mainstay of the clinical governance structure of NHS organisations. Lord Darzi’s 2008 report High quality care for all has again brought the issue to the forefront of healthcare provision.1 As a trainee in psychiatry, I have been aware of the importance of overt safety considerations in day to day practice but also the somewhat different barriers to safe care experienced, particularly by psychiatric patients. In this essay I aim to draw attention to aspects of patient safety that I have recognised as important as a result of my training experience so far and that have helped to develop my professional practice. In particular, the context is with regard to mental health, and my intention is to address overt issues of risk assessment but also less obvious ethical and conceptual aspects of patient safety. I will set out my concerns initially before considering where I have seen positive changes in psychiatric care.

Throughout my training, I have repeatedly been made aware of the importance of personal safety. Unlike in most other specialties, all psychiatric trainees are trained in safe interviewing and practical “breakaway” techniques for managing violent situations. I have also been expected to record an assessment of risk in all patients’ notes following an interview. This should cover all aspects of concern: the risk of self harm or suicide, violence or homicide, absconding (if inpatient), substance misuse, non-concordance with the treatment plan, self neglect, child safeguarding, and so on. In addition, we are taught to speculate on the probability of these things occurring, interventions that may reduce this risk, and whether these are static or dynamic risk factors. These things are extremely important and go some way to preventing avoidable disasters. This is an …
CORONARY ANGIOGRAPHY AND PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH TRANSCATHETER AORTIC VALVE PROSTHESIS: A SYSTEMATIC REVIEW AND PRACTICAL ALGORITHM
Authors: Matias Yudi, Gilbert Hin-Lung Tang, Asaad Khan, Farhan Majeed, Samin K. Sharma, Annapoorna Subhash Kini
Journal: Journal of the American College of Cardiology (2018)
THE CLINICAL OUTCOMES OF DRUG-ELUTING STENT VERSUS BARE METAL STENT IN THE TREATMENT OF SAPHENOUS VEIN GRAFT LESION: AN UPDATED META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS
Authors: Babikir Kheiri, Mohammed Osman, Ahmed Abdalla, Sahar Ahmed, Mustafa Hassan, Ghassan Bachuwa
Journal: Journal of the American College of Cardiology (2018)