tbuckley/cabot-search huggingface dataset:
Relaxation of the one child policy and trends in caesarean section rates and birth outcomes in China between 2012 and 2016: observational study of nearly seven million health facility births
Authors: Juan Liang, Yi Mu, Xiaohong Li, Wen Tang, Yanping Wang, Zheng Liu, Xiaona Huang, Robert W Scherpbier, Sufang Guo, Mingrong Li, Li Dai, Kui Deng, Changfei Deng, Qi Li, Leni Kang, Jun Zhu, Carine Ronsmans
Journal: BMJ (2018)

<h3>Abstract</h3> <h3>Objective</h3> To examine how the relaxation of the one child policy and policies to reduce caesarean section rates might have affected trends over time in caesarean section rates and perinatal and pregnancy related mortality in China. <h3>Design</h3> Observational study. <h3>Setting</h3> China’s National Maternal Near Miss Surveillance System (NMNMSS). <h3>Participants</h3> 6 838 582 births at 28 completed weeks or more of gestation or birth weight ≥1000 g in 438 hospitals in the NMNMSS between 2012 and 2016. <h3>Main outcome measures</h3> Obstetric risk was defined using a modified Robson classification. The main outcome measures were changes in parity and age distributions and relative frequency of each Robson group, crude and adjusted trends over time in caesarean section rates within each risk category (using Poisson regression with a robust variance estimator), and trends in perinatal and pregnancy related mortality over time. <h3>Results</h3> Caesarean section rates declined steadily between 2012 and 2016 (crude relative risk 0.91, 95% confidence interval 0.89 to 0.93), reaching an overall hospital based rate of 41.1% in 2016. The relaxation of the one child policy was associated with an increase in the proportion of multiparous births (from 34.1% in 2012 to 46.7% in 2016), and births in women with a uterine scar nearly doubled (from 9.8% to 17.7% of all births). Taking account of these changes, the decline in caesarean sections was amplified over time (adjusted relative risk 0.82, 95% confidence interval 0.81 to 0.84). Caesarean sections declined noticeably in nulliparous women (0.75, 0.73 to 0.77) but also declined in multiparous women without a uterine scar (0.65, 0.62 to 0.77). The decrease in caesarean section rates was most pronounced in hospitals with the highest rates in 2012, consistent with the government’s policy of targeting hospitals with the highest rates. Perinatal mortality declined from 10.1 to 7.2 per 1000 births over the same period (0.87, 0.83 to 0.91), and there was no change in pregnancy related mortality over time. <h3>Conclusions</h3> China is the only country that has succeeded in reverting the rising trends in caesarean sections. China’s success is remarkable given that the changes in obstetric risk associated with the relaxation of the one child policy would have led to an increase in the need for caesarean sections. China’s experience suggests that change is possible when strategies are comprehensive and deal with the system level factors that underpin overuse as well as the various incentives at work during a clinical encounter.
Rare Variant of Intravascular Large B-Cell Lymphoma With Hemophagocytic Syndrome
Authors: Joseph S. Donald, Nick Barnthouse, Delphine L. Chen
Journal: Clinical Nuclear Medicine (2018)

Abstract Intravascular lymphoma (IVL) is a rare subtype of diffuse large B-cell lymphoma characterized by a clonal proliferation of lymphocytes restricted to the intravascular space. We present the case of a 60-year-old man with hemophagocytic syndrome secondary to IVL. 18 F-FDG PET/CT demonstrated hepatosplenomegaly with marked diffuse hepatic, splenic, and bone marrow hypermetabolism. The case report illustrates the imaging findings of this uncommon variant of IVL.
The EVERPRO study: Final results of a non-interventional study (NIS) evaluating the quality of life (QoL) in second-line treatment of metastatic renal cell carcinoma (mRCC) with everolimus.
Authors: Peter-Juergen Goebell, Edwin Herrmann, Ulrich Kube, Christian Doehn, Norbert Walter Marschner, Anja Dietel, Klaus Blumenstengel, Marc-Oliver Grimm, Michael Thomas Scheffler, Anja Rogler, Lothar Bergmann
Journal: Journal of Clinical Oncology (2018)

631 The EVERPRO study: Final results of a non-interventional study evaluating QoL in second-line treatment of mRCC with everolimus Background: Although the prognosis of mRCC patients remains poor, median overall survival has improved since 2006, probably due to the introduction of TKIs. Everolimus treatment following first-line VEGFR-TKI was demonstrated to be efficacious and safe and is recommended by current guidelines. Assuring an adequate QoL has become a major therapy goal, especially in the 2 nd line. Hence, QoL and the implication of time effort of everolimus treatment were the major objectives assessed in this study. Methods: Adult patients scheduled for in-label everolimus treatment after 1 st line VEGFR-TKI or bevacizumab were eligible. QoL was assessed by means of the NCCN-FACT FKSI-19 questionnaire. Additionally, time needed for therapy and limitations thereof were evaluated based on a particularly developed questionnaire (including total treatment duration and treatment type). Results: 202 patients were evaluable for analyses. Median treatment duration was 19.1 weeks [95% CI: 16.4 – 23.0] and median time to progression was 26.0 weeks [95% CI: 23.3 – 32.6]. The FKSI-19 median total score remained stable during treatment. The median time effort spent on total therapy was 20 hours per patient. Most of the patients stated to have ‘no’, ‘a little’ or ‘moderate’ limitations in their daily, social and professional life. Two months after treatment start, 65 patients reported none or a little time burden due to therapy. 167 patients experienced 804 adverse events (AEs) in total. The most commonly reported AEs related to everolimus were dyspnoea, fatigue and anaemia (all grade). Conclusions: QoL was maintained during everolimus therapy and limitations as well as time effort were acceptable for most patients. The observed safety profile is consistent with previous data and does not implicate changes on the benefit-risk balance of everolimus. This study supports previously published data demonstrating that everolimus is an effective and safe treatment option following a VEGF(R)-targeted drug. Clinical trial information: 2284.
Conditional survival and landmark analysis for patients with small renal masses undergoing active surveillance at a tertiary care center.
Authors: Firas G. Petros, Aradhana M. Venkatesan, Diana Kaya, Chaan S. Ng, Bryan M. Fellman, Jose A. Karam, Christopher G. Wood, Surena F. Matin
Journal: Journal of Clinical Oncology (2018)

609 Background: Conditional survival can provide guidance for patients once they have survived a period of time after diagnosis of their disease. We determine conditional survival for patients with small renal masses (SRM) undergoing active surveillance (AS). Methods: Patients were enrolled in a prospective AS registry at our institution between May 2005 and January 2016. Patients with localized SRM ≤4cm were included, with serial radiologic imaging available in-house for re-review. Overall survival (OS) was estimated using the Kaplan-Meier method and modeled via Cox proportional hazards models. The primary end points analyzed were the conditional probability of survival and tumor growth over time. Landmark analysis was used to evaluate survival outcomes. Results: A total of 272 patients were included in this analysis. Mean initial tumor size was 1.74 ± 0.77 cm and mean tumor size closest to the 2-year mark was 1.97 ± 0.83 cm. The likelihood of continued survival to 5 years improved after the 2-year landmark was reached. Patients with tumors &lt; 3cm who survived the first 2-years on AS had a 0.84-0.85 chance of surviving to 5 years, and if they survived 3 years, the probability of surviving to 5 years improved to 0.91. Multivariable Cox proportional hazards analysis of survival revealed eGFR, Charlson comorbidity index (CCI), and tumor size of 3-4cm were significantly predictive of OS both at baseline and at 2-year mark (all p &lt; 0.05). Patients with a tumor size 3-4 cm were at a greater risk of non-RCC death (HR &gt; 3.5; p ≤ 0.001). A linear mixed effects model revealed slow tumor growth (beta: 0.12; p &lt; 0.001) for tumors &lt; 3cm. Adjusted tumor size predictions disclosed parallel growth rates for SRM of &lt; 2cm and 2-2.99cm with insignificant difference (p = 0.969). Conclusions: Our study provides insight into the survival of patients with SRM on AS who have already survived a certain period of time. The conditional survival probability of patients with SRM &lt; 3cm on AS improved after the initial 2 years, suggesting a role for re-counseling for those who survive to the 2-year landmark. Patient factors (renal function and CCI) were significantly associated with survival at baseline and at the 2-year landmark.
Interview practice for foundation doctors
Authors: Shan Shan Jing
Journal: BMJ (2010)

Interview preparation is an anxious and stressful period for all foundation doctors who are about to move on to higher surgical training. This one day course provides an overview of the interview process for core surgical training and a practical approach to gaining interview skills. In addition, it provides individual feedback.

This course is recommended for foundation doctors, mainly year 2 trainees about to go through the specialty recruitment process.

There is a lack of information and understanding about the recruitment process. Changes are brought in every year. Competition is fierce, particularly for popular deaneries such as London. For all these reasons I wanted to learn more about the system, understand what the interviewers are looking for, and gain interview skills from the …
GMC cuts or freezes its fees for 2013
Authors: Helen Jaques
Journal: BMJ (2012)

The General Medical Council’s annual registration and retention fees for 2013-14 will be cut or frozen, the council has announced.

Next year the provisional registration fee for foundation year 1 doctors will drop from £95 to £90 and the fee for new registrants from £195 to £185. The annual retention fee will be frozen at …
Role of a prolonged inpatient admission when evaluating children with problematic severe asthma
Authors: Prasad Nagakumar, Nikki Gambir, Nina Sanghani, Pippa Hall, Angela Jamalzadeh, Frances Beresford, Sejal Saglani, Andrew Bush, Louise Fleming
Journal: European Respiratory Journal (2018)

Severe asthma continues to be a significant cause of morbidity in children. Despite optimised standard therapy, many children remain symptomatic with subsequent impact on their quality of life and increased healthcare utilisation [1]. Children with ongoing poorly controlled asthma despite maximally prescribed treatment are identified as having problematic severe asthma [2]. Those whose poor control is due to modifiable factors including poor adherence to medications, continued exposure to allergens, social issues and psychological factors have difficult asthma. Severe therapy-resistant asthma is the term used for those with persistent symptoms despite attention to the basics of asthma management [3]. Valuable information can be obtained during inpatient assessment of children with problematic severe asthma <http://ow.ly/RiKc30hzNXz>
DOES EX VIVO PERFUSION LEAD TO MORE OR LESS INTIMAL THICKENING IN THE FIRST-YEAR POST-HEART TRANSPLANTATION?
Authors: Takuma Sato, Richard Cheng, Babak Azarbal, Ryan Levine, Sadia Dimbil, Maria Thottam, Fardad Esmailian, Lawrence Czer, Jon Kobashigawa
Journal: Journal of the American College of Cardiology (2018)
Diploma in palliative medicine
Authors: Simon Auty
Journal: BMJ (2006)

The diploma is aimed at developing a sound understanding of palliative medicine. It is useful for anyone who is interested in palliative care, such as GPs, hospice doctors, and palliative care professionals. We even had a few consultants on the course who wanted to develop further their knowledge and skills in this area.

I initially began the diploma from Cardiff University in 2003. As I was in the process of moving office, however, my coursework had not been forwarded and once it had been received I was already a month behind. Because it is essential to keep on top of the coursework I deferred my start to 2004. The course can be taken over one or two years.

I work …
Moving From Big Data to Deep Learning—The Case of Atrial Fibrillation
Authors: Mintu P. Turakhia
Journal: JAMA Cardiology (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 Cardiology HomeNew OnlineCurrent IssueFor Authors Podcast 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 Cardiology journal
Female Sex Is a Risk Modifier Rather Than a Risk Factor for Stroke in Atrial Fibrillation
Authors: Peter Brønnum Nielsen, Flemming Skjøth, Thure Filskov Overvad, Torben Bjerregaard Larsen, Gregory Y. H. Lip
Journal: Circulation (2018)

Background: Stroke risk in atrial fibrillation is assessed by using the CHA 2 DS 2 -VASc score. Sex category (Sc, ie, female sex) confers 1 point on CHA 2 DS 2 -VASc. We hypothesized that female sex is a stroke risk modifier, rather than an overall risk factor, when added to a CHA 2 DS 2 -VA (sex-independent thromboembolism risk) score scale. Methods: Using 3 nationwide registries, we identified patients with incident nonvalvular atrial fibrillation from January 1, 1997, through December 31, 2015. Patients receiving oral anticoagulant treatment at baseline were excluded, and person-time was censored at the time of treatment initiation (if any). CHA 2 DS 2 -VA scores were calculated for men and women, and were followed for up to 1 year in the Danish National Patient Registry. The primary outcome was a primary hospital code for ischemic stroke or systemic embolism (thromboembolism). We calculated crude event rates for risk strata as events per 100 person-years. For quantifying absolute risk of stroke, we calculated risks based on the pseudovalue method. Female sex as a prognostic factor was investigated by inclusion as an interaction term on the CHA 2 DS 2 -VA score to calculate the thromboembolic risk ratio for different score points. Results: A total of 239 671 patients with atrial fibrillation (48.7% women) contributed to the analyses. The mean ages for women and men were 76.6 years and 70.3 years, respectively; the mean CHA 2 DS 2 -VA scores were 2.7 for women and 2.3 for men. The overall 1-year thromboembolic rate per 100 person-years for women was 7.3 and 5.7 for men. The 1-year absolute risk of thromboembolism was 0.5% among men and women with a CHA 2 DS 2 -VA score of 0 and increased up to &gt;7% among very comorbid patients (score &gt;5). The risk ratio (male as reference) across points &gt;1 indicated that women exhibit a higher stroke risk. The interaction was statistically significant ( P &lt;0.001). Conclusions: Female sex is a risk modifier for stroke in patients with atrial fibrillation. Initial decisions on oral anticoagulant treatment could be guided by a CHA 2 DS 2 -VA score (ie, excluding the sex category criterion), but the Sc risk component modifies and accentuates stroke risk in women who would have been eligible for oral anticoagulant treatment on the basis of ≥2 additional stroke risk factors.
ACUTE DETRIMENTAL EFFECTS OF E-CIGARETTE AND TOBACCO CIGARETTE SMOKING ON BLOOD PRESSURE AND SYMPATHETIC NERVE ACTIVITY IN HEALTHY SUBJECTS
Authors: Konstantinos P. Tsioufis, Kyriakos Dimitriadis, Alexandros Kasiakogias, Dimitris Konstantinidis, Theodoros Kalos, Manos Mantzouranis, Dimitrios Aragiannis, George Annousis, Christos Fragoulis, Konstantinos Konstantinou, Dimitris Tousoulis
Journal: Journal of the American College of Cardiology (2018)
RELATIONSHIP BETWEEN GLOBAL MYOCARDIAL BLOOD FLOW EVALUATED BY PHASE CONTRAST CINE-MAGNETIC RESONANCE IMAGING AND REGIONAL PRESSURE WIRE-DERIVED PHYSIOLOGICAL INDICES
Authors: Tadashi Fukuda, Yoshinori Kanno, Rikuta Hamaya, Hiroaki Ohya, Yohei Sumino, Masahiro Hada, Masahiro Hoshino, Eisuke Usui, Yoshihisa Kanaji, Taishi Yonetsu, Tsunekazu Kakuta
Journal: Journal of the American College of Cardiology (2018)
Delta24-RIVER oncolytic adenovirus:targeting mutant EGFR glioma cells
Authors: Yuji piao, Hong jiang, Jing xu, Marta Alonso, Ok-hee lee, Charles conrad, Alfred yung, Candelaria Gomez-Manzano, Juan fueyo
Journal: Cancer Research (2007)

3297   Malignant gliomas are characterized by infiltrative growth that causes progressive neurologic dysfunction and, almost invariably, death. Currently there is no effective treatment for glioblastoma, however, recent advances in our understanding of brain tumor biology have suggested that treatment strategies that target the fundamental molecular defects of brain tumors may provide effective and selective therapies. Oncolytic adenoviruses are promising therapies for the treatment of gliomas. Previously we have studied the antiglioma activity of the tumor-selective Delta-24 adenovirus, which encompasses an early 1A adenoviral deletion in the retinoblastoma protein-binding region. However, the paucity of coxsackie-adenovirus receptor on tumor cells is major stumbling blocks for adenovirus-based treatment. Because the mutant variant III of EGFR constitutes the prototype of cancer specific receptor, we constructed an adenovirus with Retargeted Infectivity Via EGFR, Delta-24-RIVER, by inserting the PEPCH1 coding sequence in the HI loop of a Delta-24 detargeted (unable to bind CAR ) adenovirus. We hypothesize that redirection of Delta-24 infectivity to mutant EGFR should result in the targeting of the cancer cells responsible for the advanced neoplastic phenotype of gliomas. To prove the EGFRVIII-dependent infectivity and cytolysis of Delta-24-RIVER, we examined the effect of Delta-24-RIVER in the U87MG isogenic cell lines and U251-E18 cell (in which EGFRVIII expression is tetracycline dependent ). Delta-24-RIVER induced potent cytolysis in the U87MG.ΔEGFR and tetracycline treated U251-E18 cells, but not in the U87MG and U251-E18 cells without tetracycline treatment. We found that Delta-24-RIVER showed selective cytotoxicity in high EGFR-expression A549 non small cell lung cancer cell, but not in low EGFR -expressing U-2OS and Saos-2 sarcoma cells and normal human astrocytes. We construced the replication-deficient adenovirus AdGFP-Delta-24-RIVER and tested its infectivity, AdGFP-Delta-24-RIVER showed more significant infectivity in U87MG.ΔEGFR and tetracycline treated U251-E18 cells than in U87MG and U251-E18 cells without tetracycline treatment. In vivo experiments using U87MG and U87MG.ΔEGFR xenografts implanted in nude mice and treated intratumorally with a dose of 10 8  pfu/animal of Delta-24-RIVER are in progress. Taking together these data constitute proof of principle for the direct target of a cancer specific receptor using replication competent tumor-selective adenoviruses.
Bone morphogenetic protein 2 (BMP-2) induces in vitro invasion and in vivo hormone independent growth of breast carcinoma cells
Authors: Joachim H. Clement, Martin Raida, Jörg Sänger, Roy Bicknell, Jinwen Liu, Anke Naumann, Annette Geyer, Anja Waldau, Peter Hortschansky, Andreas Schmidt, Klaus Höffken, Stefan Wölfl, Adrian L. Harris
Journal: Cancer Research (2004)

2740    Introduction:  Bone morphogenetic proteins (BMPs) are expressed in various normal tissues as well as in tumor cells. There is growing evidence that these secreted proteins, especially bone morphogenetic protein 2 (BMP-2), are involved in the regulation of intracellular processes that support cell survival such as cell cycle control. Therefore, we analysed how BMP-2 modulates the behaviour of tumor cells.  Materials and methods:  The breast cancer cell lines BT-20, BT-474, MCF-7 and T-47D were cultivated with DMEM and RPMI1640. An BMP-2 overexpressing cell line (MCF7/BMP2) was created by transfecting MCF-7 with a pcDNA3.1(-) vector containing full-length BMP-2. Recombinant human BMP-2 was supplied by one of us (P.H.). The  in vitro  migratory and invasive properties of the cells were analysed with the transwell setting and the Boyden chamber assay. Western blots and immunohistochemistry were performed as previously described (Schwalbe et al., 2003). Tumorigenicity assays were performed with MCF7/BMP2 and MCF7/3.1 (for control) using athymic NuNu mice.  Results:  We could show that breast cancer cell lines were able to move towards a BMP-2 source depending on BMP-2 concentration. Also, after a short exposure to a single dose of BMP-2, the cells were able to migrate through matrigel. Overexpression of BMP-2 resulting in a continuous high level of BMP-2 in the breast cancer cell line MCF-7 (MCF7/BMP2) enhances migratory properties, too. The altered phenotype of MCF7/BMP2 is characterised by lamellipodia and a very high expression level of the metastasis-related gene BCSG1. In a xenograft model without estrogen supplementation MCF7/BMP2 cells formed tumors, whereas no tumors were found with MCF7/3.1 cells. MCF7/BMP2 tumors were characterised by an enhanced vasculature and an accumulation of myogenic cells from the host, which resulted in chondroid and osseous structures formed within several weeks.  Conclusion:  We could demonstrate that elevated levels of BMP-2 enhance the tumorigenic properties of breast carcinoma cells and drive the cells towards a more aggressive phenotype with estrogen independent growth. This work was supported in part by the Dr. Rainald-Stromeyer-Foundation and the Deutsche Krebshilfe e.V. Schwalbe et al. (2003) Int J Oncol 23: 89-95
Two thirds of emergency medicine consultants plan to retire early
Authors: Abi Rimmer
Journal: BMJ (2014)

Two thirds of consultants in emergency medicine in the UK plan to retire early, despite most reporting average to high levels of satisfaction at work, researchers have found.

A team of researchers led by Sunil Dasan, from St George’s Hospital, London, said there needed to be a review of consultant on-call rota systems and more varied job plans to help reduce the intensity and repetitiveness of work in emergency medicine. They …