tbuckley/cabot-search huggingface dataset:
Abstract P4-13-11: A complication analysis between complete and partial tissue expander coverage using autologous flaps in cases of immediate breast reconstruction
Authors: K Kubo, A Hamahata, K Tozuka, M Tsuboi, Y Hayashi, K Takai, T Saito, H Sakurai, H Matsumoto
Journal: Cancer Research (2018)

Abstract Background: To avoid tissue expander exposure following mastectomy flap necrosis, several methods for covering expander by autologous flap in cases of immediate breast reconstruction have been reported. These methods are classified into two groups, complete or partial expander coverage. Two methods have potential risks of postoperative complications following: insufficient lower pole expansion and cranial migration in complete coverage methods, and lateral migration in partial coverage methods. However, the comparisons of complication rates between these two methods have not been reported. This study aims to compare the incidence of expander exposure following mastectomy flap necrosis and expander migration between two methods. Methods: A retrospective review of 93 patients (99 breasts) who underwent immediate expander-based breast reconstruction was performed. Patients were divided into two groups, complete or partial expander coverage by autologous flaps. In both groups, expanders were placed into subpectral position. In partial coverage group, the lateral borders of pectralis major muscles were sutured to the mastectomy skin flaps. If the skin flap was too thin to be sutured, the serratus anterior muscro-fascial flap was dissected and sutured to the lateral border of pectralis major muscle to cover the expander completely. Allograft products were not used in both groups. Demographics, intraoperative findings, and postoperative complications were compared between two groups. Results: Of the 99 breasts, 56 underwent complete expander coverage and 43 underwent partial coverage. Mastectomy flap necrosis rate was higher in the complete coverage group (Complete 14.3% versus Partial 0%; p=0.0091), however, there was no incidence of expander exposure in both groups. Lateral migration rate was higher in the partial coverage group (Complete 0% versus Partial 9.3%; p=0.033). There was no difference in cranial migration rate between two groups (Complete 12.5% versus Partial 2.3%; p=0.133). Conclusions: The thinness of the mastectomy flaps was considered to provide the higher incidence of mastectomy flap necrosis in the complete coverage group. The complete expander coverage reduced lateral migration rate and prevented expander exposure in cases of mastectomy flap necrosis. Citation Format: Kubo K, Hamahata A, Tozuka K, Tsuboi M, Hayashi Y, Takai K, Saito T, Sakurai H, Matsumoto H. A complication analysis between complete and partial tissue expander coverage using autologous flaps in cases of immediate breast reconstruction [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-13-11.
Lung Recruitment and Positive End-Expiratory Pressure Titration in Patients With Acute Respiratory Distress Syndrome
Authors: Idunn S. Morris, Andrew S. Lane, Ian Seppelt
Journal: JAMA (2018)

To the Editor The ART investigators performed a multicenter randomized clinical trial comparing a high-PEEP strategy using lung recruitment with titrated PEEP vs a low-PEEP strategy in patients with ARDS.1 The trial, however, still leaves unanswered questions.
The performance of human papillomavirus DNA detection with type 16/18 genotyping by hybrid capture in primary test of cervical cancer screening: a cross-sectional study in 10,669 Chinese women
Authors: X. Zhao, Q. Wu, X. Wang, Y. Fu, X. Zhang, X. Tian, B. Cheng, B. Lu, X. Yu, S. Lan, W. Lu, D. Ma, X. Cheng, X. Xie
Journal: Clinical Microbiology and Infection (2018)

We aimed to assess the performance of DH3 human papillomavirus (HPV) assay, a newly developed hybrid capture technique that detects 14 high-risk HPVs with type 16/18 genotyping, as a primary test in cervical cancer screening.In total 11,356 Chinese women aged 21-65 years participated in a cervical cancer screening programme using cytology (Thinprep, Hologic) and HPV testing (Cobas 4800 Test, Roche). Residual samples were used to detect HPV by DH3 HPV.In total 10,669 women with valid results were included in the study. Of those, 135 were diagnosed as CIN2+, and 83 were diagnosed as CIN3+; 1056 women (9.9%) were DH3 HPV-positive and 255 (2.4%) of those were 16/18-positive, while 990 (9.3%) women were Cobas HPV-positive and 243 (2.3%) of those were 16/18-positive. DH3 HPV was non-inferior to Cobas HPV in identifying CIN1- and CIN2+ using predetermined thresholds (both p < 0.001). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DH3 HPV were 93.3% (95% confidence interval [CI] = 87.7-96.9), 91.2% (95%CI = 90.6-91.7), 12.0% (95%CI = 10.1-14.1) and 99.9% (95%CI = 99.8-100), respectively, similar to those of Cobas HPV (91.1%, 95%CI = 85.0-5.3; 91.8%, 95%CI = 91.2-92.3; 12.5%, 95%CI = 10.5-14.7; and 99.9%, 95%CI = 99.8-99.9, respectively), in identifying CIN2+ (all p > 0.05). When DH3 HPV and Cobas HPV were respectively used as primary testing in screening strategy, the performance of two strategies were similar in identifying CIN2+. The results were similar in identifying CIN3+.Our data suggest that DH3 HPV performs similarly to Cobas HPV in identifying high-grade CIN in cervical cancer screening.
Is it best to join a scheme or do stand alone posts for senior house officer jobs in London?
Authors: Adam Poole
Journal: BMJ (2004)

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 (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.
Perioperative outcomes of aspirin use in partial nephrectomy.
Authors: Matthew D. Ingham, Ross Erik Krasnow, Matthew Mossanen, Ye Wang, Adam B. Althaus, Steven Lee Chang
Journal: Journal of Clinical Oncology (2018)

698 Background: Increasing cardiovascular disease has led to increases in the patient population on anti-platelet therapy who require urologic surgery. We sought to study perioperative outcomes for those undergoing partial nephrectomy (PN) while taking or not taking perioperative aspirin (pASA). Methods: A retrospective review of those undergoing PN was performed on the Premier Hospital Database from 2003 to 2015, with survey projection weighting resulting in a cohort of 10,807 patients. Two groups were formed – those continued on pASA (group 1, n = 774) and those with no pASA (group 2, n = 10,033). In-hospital complication rates were studied: major bleeding, overall transfusion, day-of-surgery transfusion, prolonged ( &gt; 4 days) length of stay (LOS), and prolonged ( &gt; 285 minutes) operative time. We also assessed 90-day rates of: cardiovascular catastrophe, readmission, major complication, and DVT/PE. Unadjusted rates were calculated for all PN patients and further subdivided into open and minimally invasive PN. Adjusted odds ratios (OR) were then calculated between groups 1 and 2. Results: Group 1 was older (58% vs 38% ≥65 years, p &lt; 0.0001), largely male (73.1% vs 58.7%, p = 0.001), and less healthy (34.8% vs 18.4% with a CCI score ≥2, p = 0.003) than to group 2. For in-hospital outcomes, no significant differences were noted. Stratifying by surgical approach, those in group 1 undergoing minimally invasive PN were slightly less likely to require a day-of-surgery transfusion (OR 0.29, CI [0.05-0.99], p &lt; 0.05). For 90-day outcomes, group 1 were far more likely to suffer a cardiovascular catastrophe (OR 7.56, CI [3.38-16.92], p &lt; 0.001) regardless of surgical approach. Conversely, group 1 was slightly less likely to experience readmission (OR 0.48, CI [0.24-0.94], p &lt; 0.05) and was likely driven by those undergoing minimally invasive PN. Conclusions: This large review of academic and community hospitals provides insight into the impact perioperative ASA has on PN outcomes. As noted, in-hospital outcomes were largely equivalent between groups while 90-day cardiovascular catastrophe rates were much higher in the ASA group. Despite this, this study lends support to the belief that pASA should not be considered an absolute contraindication to PN.
Improving risk-stratification of localized prostate cancer in a prospective active surveillance cohort.
Authors: Justin Gregg, Chad A. Reichard, Xuemei Wang, Brian Francis Chapin, Louis L. Pisters, Curtis Alvin Pettaway, John Francis Ward, Mary F. Achim, Seungtaek Choi, Deborah A. Kuban, John W. Davis, Jeri Kim
Journal: Journal of Clinical Oncology (2018)

104 Background: Prospective active surveillance (AS) studies in men with low- and intermediate-risk prostate cancer (PCa) have demonstrated feasibility, but no consensus supports an optimal monitoring scheme. To expand our findings on AS disease reclassification, we examined predictors of disease reclassification in a prospective single-institution AS study. Methods: Men with localized PCa diagnosed within 6 months (mos) of AS enrollment were stratified into four groups: group 1 (Gr 1) was defined by a Gleason score (GS) ≤6 (3+3), one positive (pos) core ( &lt; 3 mm), and a prostate-specific antigen (PSA) level &lt; 4 ng/mL (adjusted by prostate size); Gr IIa by GS 6, one pos core, and either tumor length ≥3 mm or PSA ≥4 ng/mL; Gr IIb by GS6, &gt; one pos core, and any PSA level or tumor length; Gr IIc by GS7, &gt; one pos core or any PSA. Monitoring included PSA and digital rectal exam every 6 mo. Biopsy (BX) was repeated at 1 year and then on a predetermined BX scheme. Patients with reclassified disease (upgrading, increase in pos cores and/or tumor length) were offered treatment. Cox proportional hazards modeling was used to determine the association of baseline clinicopathologic parameters with time to reclassification. Results: Between 2006 and 2015, 803 patients met criteria for inclusion: Gr I, 242; Gr IIa, 67; Gr IIb, 376; Gr IIc, 118. Median age was 64 years (range, 36–83), 662 (82.4%) were white, 703 (87.5%) had cT1c disease, 687 (85.6%) had GS 6, and median PSA level was 4.2 ng/mL (range 0.2–34). At a median follow-up of 2.9 years, 249 (31.0%) men had disease reclassification and 258 (32.1%) left AS to pursue curative treatment. Overall, 82% of reclassifications occurred within 3 years of study enrollment. Stratification to group IIb/IIc was significantly associated with time to reclassification compared to Gr I/IIa (HR 2.13, 95 CI 1.63-2.80, p &lt; 0.001) while CAPRA score did not show a significant difference (p = 0.27). Conclusions: Grouping patients on characteristics including tumor length and pos core number may improve risk stratification in localized PCa. Risk-based surveillance protocols merit further evaluation. Clinical trial information: NCT00490763.
Heme Regulates the Expression in Erythroblasts of Placenta Growth Factor, a Contributor to Pulmonary Hypertension in Sickle Cell Disease, through the Oxidant Response Transcription Factor NRF2
Authors: Maria G Kapetanaki, Oluwabukola Gbotosho, Deva Sharma, Schrott Valerie, Frances Weidert, Solomon Fiifi Ofori-Acquah, Grant C. Bullock, Gregory J. Kato
Journal: Blood (2017)
Treating Sleep Problems: A Transdiagnostic Approachby Allison G. Harvey, Ph.D., and Daniel J. Buysse, M.D. New York, Guilford, 2017, 192 pp., $25.50 (paperback).
Authors: Thomas Mellman
Journal: American Journal of Psychiatry (2018)

Huang (unpublished 2007 paper) reported on an innovative intensive brief partial hospital for combat stress that enabled most soldiers to return to their units in a few days.These and comparable interventions are not represented in this volume.The strength of this book lies in the window it offers into the mental life of military medical officers deployed to a war zone.May we look forward to another volume that details how clinical psychiatry-and psychology-is practiced in that very different world of military operations?
Dyspnoea modifies the recognition of fearful expressions by healthy humans
Authors: Fabien Vinckier, Capucine Morélot-Panzini, Thomas Similowski
Journal: European Respiratory Journal (2018)

Brainstem neural oscillators normally generate resting breathing. Yet cortical premotor and motor respiratory-related networks can operate voluntary breathing and compensate for defective automatic respiratory drive [1, 2]. These networks are engaged when the respiratory system load-capacity balance is compromised, typically during experimental inspiratory loading [3] that is associated with dyspnoea of the "excessive inspiratory effort" type. An emerging body of evidence suggests that respiratory-related cortical activation (and by extension the corresponding dyspnoea) can have a cognitive cost [4–6], thought to derive from competition for resources (dual-tasking) or attentional distraction. Of note, dyspnoea can also occur in response to carbon dioxide (CO2) stimulation; in this instance, the dyspnoea is not associated with motor respiratory-related cortical activation [3] but with intense activation of limbic regions of the brain, including the insular cortex [7]. This provokes air hunger and strong emotional reactions that could interfere with the capacity to process concurrent emotions. Here we tested the hypothesis that inspiratory loading and hypercapnic stimulation affect executive and emotional processing tasks and do so in different ways. Do respiratory diseases alter emotional interactions? Becoming dyspnoeic distorts our identification of others' fear <http://ow.ly/JkxF30hJGFH>
Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis
Authors: Karoliina Tainio, Antonios Athanasiou, Kari A O Tikkinen, Riikka Aaltonen, Jovita Cárdenas, None Hernándes, Sivan Glazer-Livson, Maija Jakobsson, Kirsi Joronen, Mari Kiviharju, Karolina Louvanto, Sanna Oksjoki, Riikka Tähtinen, Seppo Virtanen, Pekka Nieminen, Maria Kyrgiou, Ilkka Kalliala
Journal: BMJ (2018)

To estimate the regression, persistence, and progression of untreated cervical intraepithelial neoplasia grade 2 (CIN2) lesions managed conservatively as well as compliance with follow-up protocols.Systematic review and meta-analysis.Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1 January 1973 to 20 August 2016.Studies reporting on outcomes of histologically confirmed CIN2 in non-pregnant women, managed conservatively for three or more months.Two reviewers extracted data and assessed risk of bias. Random effects model was used to calculate pooled proportions for each outcome, and heterogeneity was assessed using I2 statistics.Rates of regression, persistence, or progression of CIN2 and default rates at different follow-up time points (3, 6, 12, 24, 36, and 60 months).36 studies that included 3160 women were identified (seven randomised trials, 16 prospective cohorts, and 13 retrospective cohorts; 50% of the studies were at low risk of bias). At 24 months, the pooled rates were 50% (11 studies, 819/1470 women, 95% confidence interval 43% to 57%; I2=77%) for regression, 32% (eight studies, 334/1257 women, 23% to 42%; I2=82%) for persistence, and 18% (nine studies, 282/1445 women, 11% to 27%; I2=90%) for progression. In a subgroup analysis including 1069 women aged less than 30 years, the rates were 60% (four studies, 638/1069 women, 57% to 63%; I2=0%), 23% (two studies, 226/938 women, 20% to 26%; I2=97%), and 11% (three studies, 163/1033 women, 5% to 19%; I2=67%), respectively. The rate of non-compliance (at six to 24 months of follow-up) in prospective studies was around 10%.Most CIN2 lesions, particularly in young women (<30 years), regress spontaneously. Active surveillance, rather than immediate intervention, is therefore justified, especially among young women who are likely to adhere to monitoring.PROSPERO 2014: CRD42014014406.
LOW VO2 PEAK IS INDEPENDENTLY ASSOCIATED WITH IMPROVEMENT IN FUNCTIONAL CAPACITY AFTER CARDIAC REHABILITATION: RESULTS FROM A NATIONAL AND MULTICENTER STUDY
Authors: Luiz Eduardo, Fonteles Ritt, Eneas Rocco, Pedro G.M. Barros, Gustavo Feitosa, Alexandre Galvão, Priscila F. da Silva, Gabriel A. de Bastos, Thais Pellegrino, Jessica S. Porto, Gabriela Bastos, Queila Borges, Eduardo Darze, Renato Lopes
Journal: Journal of the American College of Cardiology (2018)
ELECTROCARDIOGRAPHIC VARIABLES ASSOCIATED WITH ATRIAL ARRHYTHMIAS IN PATIENTS WITH LEFT VENTRICULAR NONCOMPACTION
Authors: Vaibhav Vaidya, Melissa Lyle, Abhinav Nadipalli, Hector Michelena, Samuel Asirvatham, Heidi Connolly, Rowlens Melduni, Suraj Kapa
Journal: Journal of the American College of Cardiology (2018)
Government agrees to fund remediation of GPs
Authors: Caroline White
Journal: BMJ (2012)

GPs whose revalidation identifies them as in need of remedial training away from their place of work will no longer have to cover the costs themselves, as originally intended, the BMA has announced.

Instead, remediation in England will be funded by the NHS Commissioning Board, and responsibility for funding remedial placements and assessments for GPs will rest with commissioners.

The announcement comes after intense discussions over the past few days between the board and the Department of Health, during which “significant progress” was made on what the BMA’s chairman of council, Mark Porter, described as “one …
THE PRECISE DAPT SCORE CAN BE USED TO REFINE RISK STRATIFICATION AND PREDICT SHORT AND LONG-TERM MORTALITY IN ACUTE MI PATIENTS
Authors: Francois Schiele, Etienne Puymirat, Marion Chatot, Francois-Xavier Soto, Fabien De Poli, Jean-Michel Tartière, Pierre Chevallereau, Guillaule Taldir, Karim Moussa, Jean Ferrières, Tabassome Simon, Nicolas Meneveau, Nicolas Danchin
Journal: Journal of the American College of Cardiology (2018)
Emerging Clinical Concepts for Personalized Therapy in Multiple Myeloma; Systemtic Review
Authors: Faiza Hassan Warraich, Sami Ullah Warraich, Azka Latif, Vikas Kapoor, Faisal Akbar, Ali McBride, Ahmad Iftikhar, Pavan Tenneti, Adeela Mushtaq, Raahem Nayab Zafar, Hafiz Muhammad Fazeel, Syeda Sabeeka Batool, Zabih Warraich, Faiz Anwer
Journal: Blood (2017)
Efficacy and Safety of Transarterial Chemoembolization Plus External Beam Radiotherapy vs Sorafenib in Hepatocellular Carcinoma With Macroscopic Vascular Invasion
Authors: Sang Min Yoon, Baek-Yeol Ryoo, So Jung Lee, Jong Hoon Kim, Ji Hoon Shin, Ji Hyun An, Han Chu Lee, Young-Suk Lim
Journal: JAMA Oncology (2018)

Patients with hepatocellular carcinoma showing macroscopic vascular invasion have a poor prognosis. Sorafenib is the sole treatment option for these patients, with unsatisfactory response and survival benefit. Combined treatment with transarterial chemoembolization (TACE) plus external beam radiotherapy (RT) has shown promising results for these patients in observational studies.To evaluate the efficacy and safety of TACE plus RT compared with sorafenib for patients with hepatocellular carcinoma and macroscopic vascular invasion.In this randomized, open-label clinical trial conducted at an academic tertiary care center between July 1, 2013, and October 31, 2016, 90 treatment-naive patients with liver-confined hepatocellular carcinoma showing macroscopic vascular invasion were randomly assigned to receive sorafenib (400 mg twice daily; 45 participants [the sorafenib group]) or TACE (every 6 weeks) plus RT (within 3 weeks after the first TACE, maximum 45 Gy with the fraction size of 2.5 to 3 Gy; 45 participants [the TACE-RT group]).The primary end point was the 12-week progression-free survival rate by intention-to-treat analysis. Radiologic response was assessed by independent review according to the Response Evaluation Criteria in Solid Tumors (RECIST; version 1.1). Treatment crossover was permitted after confirming disease progression.Of the 90 patients (median age, 55 years; range, 33-82 years), 77 were men and 13 were women. All patients had portal vein invasion of hepatocellular carcinoma and Child-Pugh class A liver function. The median maximal tumor diameter was 9.7 cm. Most patients (71 [78.9%]) had multiple lesions. At week 12, the progression-free survival rate was significantly higher in the TACE-RT group than the sorafenib group (86.7% vs 34.3%; P < .001). The TACE-RT group showed a significantly higher radiologic response rate than the sorafenib group at 24 weeks (15 [33.3%] vs 1 [2.2%]; P < .001), a significantly longer median time to progression (31.0 vs 11.7 weeks; P < .001), and significantly longer overall survival (55.0 vs 43.0 weeks; P = .04). Curative surgical resection was conducted for 5 patients (11.1%) in the TACE-RT group owing to downstaging. No patients in the TACE-RT group discontinued treatment owing to hepatic decompensation.For patients with advanced hepatocellular carcinoma showing macroscopic vascular invasion, first-line treatment with TACE plus RT was well tolerated and provided an improved progression-free survival, objective response rate, time to progression, and overall survival compared with sorafenib treatment.clinicaltrials.gov Identifier: NCT01901692.
Itch in dermatomyositis: the role of increased skin interleukin-31
Authors: H.J. Kim, M. Zeidi, D. Bonciani, S.M. Pena, J. Tiao, S. Sahu, V.P. Werth
Journal: British Journal of Dermatology (2018)

Interleukin (IL)-31 is implicated in pruritus associated with pruritic skin diseases like atopic dermatitis. Although pruritus is a prominent feature in dermatomyositis (DM), few studies have evaluated the pathogenesis of DM-associated itch.To establish the prevalence of itch in DM, and to investigate the role of IL-31 in DM-related itch.Pruritus and disease activity of DM were evaluated by a visual analogue scale (VAS) and the Cutaneous Disease and Activity Severity Index (CDASI), respectively. Expression of IL-31 and IL-31 receptor alpha (IL-31RA) in lesional DM, nonlesional DM and healthy control skin was evaluated by quantitative reverse-transcriptase polymerase chain reaction and immunofluorescence. Flow cytometry was performed on skin cells isolated from lesional DM skin to identify cellular sources of IL-31 in DM.Among 191 patients with DM, 50·8% had moderate-to-severe itch, and itch was correlated with increased cutaneous severity (r = 0·34). In patients with itchy DM, gene expression of IL31 and IL31RA in lesional skin was upregulated compared with nonlesional skin and healthy control skin. IL31 mRNA expression positively correlated with VAS itch score (r = 0·67). On immunofluorescence, immunoreactivity for IL-31 and IL-31RA was stronger in lesional skin. Flow cytometry showed that lesional DM skin contained significantly more IL-31-producing cells, and CD4+ cells were the most common cell type. Lenabasum, an emerging treatment for DM, significantly downregulated IL-31 from CpG-stimulated peripheral blood mononuclear cells.Increased skin IL-31 may play a role in DM-associated itch, and ongoing trials will evaluate the effects of systemic treatment on IL-31 and itch in DM.