tbuckley/cabot-search huggingface dataset:
Atypical chest pain in an older woman
Authors: Omed Amin, David C Howlett
Journal: BMJ (2018)

A 73 year old woman with no cardiac history presented with a three week history of atypical chest pain. She had no associated signs or symptoms. She was referred for a computed tomography coronary angiogram (fig 1) at the rapid access chest pain clinic, as part of routine investigations for atypical chest pain.



Fig 1 
Arterial phase computed tomography coronary angiogram



What is the diagnosis?

The computed tomography coronary angiogram shows extensive bilateral pulmonary emboli (fig 2).



Fig 2 
Arterial phase computed tomography coronary angiogram reveals extensive pulmonary emboli within the distal main right …
THE DNA-BASED THERAPEUTIC AGENT BC 007 COMPLETELY NEUTRALIZES AGONISTIC AUTOANTIBODIES DIRECTED AGAINST β1-ADRENOCEPTORS: RESULTS OF A PHASE 1 TRIAL
Authors: Johannes Mueller, Annekathrin Haberland, Niels-Peter Becker, Katrin Wenzel, Gerd Wallukat, Peter Goettel, Sarah Schulze-Rothe, Ingolf Schimke, Georg Golor, Matthias Grossmann, Angela Sinn, Martina Steiper, Tuba Yilmaz, Anne Wallukat, Hanna Davideit
Journal: Journal of the American College of Cardiology (2018)
SAKK 08/15-promet: Multicenter, randomized phase II trial of salvage radiotherapy +/- metformin for patients with prostate cancer after prostatectomy.
Authors: Alan Dal Pra, Pirus Ghadjar, Stephane Supiot, Aurelius Gabriel Omlin, Stefanie Hayoz, Daniel Rudolf Zwahlen, Michael N. Pollak, Silke Gillessen, Daniel M. Aebersold
Journal: Journal of Clinical Oncology (2018)

TPS157 Background: Salvage radiotherapy (SRT) is as a potentially curative treatment for prostate cancer (CaP) patients presenting biochemical relapse after radical prostatectomy (RP). Metformin is a well-known antidiabetic drug that has demonstrated anti-cancer and radio-sensitizing effects. We aim to study whether metformin combined with SRT will improve cancer control by prolonging time to progression (TTP). Methods: This is a multicenter, randomized (1:1) phase II trial of SRT (70Gy/35fr to the prostate bed) with or without metformin (850mg BID for 52 wks) (NCT02945813). Metformin 850mg q.d. is started 4 wks prior to SRT. Stratification variables include Gleason score, PSA at randomization, surgical margin status and ADT use (allowed if PSA &gt; 0.5, R0, post-RP PSA-DT &lt; 6 mos or pT3b). Major eligibility criteria include: histologically proven CaP adenocarcinoma pT2a-3b, pN0 or cN0, M0; RP &gt; 12 wks before registration; PSA progression after RP defined as 2 consecutive rises with final PSA &gt; 0.1 ng/mL or 3 consecutive rises; and PSA ≤ 2 ng/mL within 14 days prior to registration. A sample size of 170 patients (85 per arm) is planned based on the primary endpoint TTP. Using a type I error of 5% and a power of 80%, 62 events are needed to show superiority of the treatment arm under the alternative hypothesis that the hazard ratio (HR) is 0.65 (TTP at 18 mos of 80% in the control arm vs. 86.5% in the treatment arm). All efficacy endpoints will be analyzed based on the full analysis population. The treatment effect will be assessed using Cox regression with the treatment arm as independent variable and the stratification factors as strata. Correlative studies including prostate tissue, blood (metabolic parameters), saliva and feces (microbiota) will be performed. Conclusion: Centers in Switzerland, Germany and France (GETUG) will recruit patients for this study. If positive, these results could help elucidate the role of metformin in CaP and determine the design of a subsequent phase III trial. Clinical trial information: NCT02945813.
Mobile Phone Detection of Atrial Fibrillation With Mechanocardiography
Authors: Jussi Jaakkola, Samuli Jaakkola, Olli Lahdenoja, Tero Hurnanen, Tero Koivisto, Mikko Pänkäälä, Timo Knuutila, Tuomas O. Kiviniemi, Tuija Vasankari, K.E. Juhani Airaksinen
Journal: Circulation (2018)
Patterns of recurrence and outcomes after curative resection of locally advanced HER2-positive gastroesophageal cancer (HPGEC).
Authors: Di Maria Jiang, Charles Henry Lim, Lucy Xiaolu Ma, Peiran Sun, Hao-Wen Sim, Akina Natori, Bryan Anthony Chan, Daniel Yokom, Stephanie Moignard, Eric Xueyu Chen, Geoffrey Liu, Jennifer J. Knox, Carol Jane Swallow, Gail Elizabeth Darling, Savtaj Singh Brar, Sara Hafezi-Bakhtiari, James Conner, Raymond Woo-Jun Jang, Elena Elimova
Journal: Journal of Clinical Oncology (2018)

147 Background: Literature on recurrence and outcomes of HPGEC is scarce. The aim of this study was to determine pattern of recurrence and outcomes after curative intent surgery for locally advanced HPGEC. Methods: A retrospective database was used to identify consecutive patients with gastroesophageal adenocarcinomas undergoing curative intent resection between 2011 and 2016 at the Princess Margaret Cancer Centre. Clinico-demographic data were extracted from the electronic health record. Patterns of relapse are classified as nonvisceral (defined as recurrences in the bone, peritoneal or both), visceral (not nonvisceral, including the brain), or both. Time to relapse (TTR) and overall survival (OS) were calculated from date of histologic diagnosis. Results: Of 45 patients with HPGEC, 78% were male, and 91% were non-Asian. Median age was 64.4 years (interquartile range [IQR] 53, 70); 60% were gastroesophageal junction, 24% were gastric, and 16% were esophageal adenocarcinomas; 31% were poorly differentiated tumors while 68% had clinical or pathological node positive disease. Complete R0 resection occurred in 93%, and 84% had received perioperative therapy (31% with perioperative chemotherapy; 40% with pre-operative chemoradiation; 9% with post-operative chemoradiation). With a median follow-up time of 26.0 months. relapse rate of HPGEC at last follow-up was 78%. Among first relapses, 94% were distant, while 6% were local recurrences. Among distant relapses, visceral recurrences occurred in 85%, nonvisceral in 3%, and 12% patients had both visceral and nonvisceral recurrences. None had peritoneal only recurrence. Median TTR was 12.2 months (IQR 8.8, 23.5), while median post-recurrence survival was 9.7 months (IQR 4.7, 16.3). Of the entire cohort, 2-year OS was 53% and 3-year OS was 26%. Conclusions: More than three-quarters of patients with HPGEC experienced recurrence after curative intent multimodality therapy. Our results suggest that HPGEC rarely relapse with peritoneal only disease or local recurrence, thereby calling into question the utility for aggressive surveillance, pending verification from larger cohorts.
MARKERS OF OXIDATIVE STRESS AND PERIPHERAL ARTERY DISEASE
Authors: Jamal Hajjari, Ayman S. Tahhan, Ayman Alkhoder, Belal Kaseer, Abdelhadi Naser, Zakaria Almuwaqqat, Mohamad M. Gafeer, Fahad Choudhary, Keyur Patel, Arti Patel, Murtuza Jafri, Muaaz Choudhary, Laila Hasnain, Saqib Qadir, Arianna Sidoti, Anjali Lankford, Ravila Bhimani, Yi-An Ko, Viola Vaccarino, Laurence Sperling, Dean Jones, Arshed Quyyumi
Journal: Journal of the American College of Cardiology (2018)
Shortage of doctors across Europe may be caused by migration to UK
Authors: Abi Rimmer
Journal: BMJ (2014)

Shortages of doctors across Europe may be a result of doctors moving to the United Kingdom and other countries in search of better salaries and working conditions, the European Commission has said.

The commission has published a study of occupations where employers typically have problems finding and hiring staff to fill vacancies,1 sometimes known as “bottleneck” occupations. The study found that labour mobility was a major contributory factor in creating shortages of health workers in newer EU member states, such as Poland. Workers often moved to the UK, Germany, …
A <scp>CD</scp>8α− Subset of <scp>CD</scp>4+<scp>SLAMF</scp>7+ Cytotoxic T Cells Is Expanded in Patients With IgG4‐Related Disease and Decreases Following Glucocorticoid Treatment
Authors: Emanuel Della‐Torre, Emanuele Bozzalla‐Cassione, Clara Sciorati, Eliana Ruggiero, Marco Lanzillotta, Silvia Bonfiglio, Hamid Mattoo, Cory A. Perugino, Enrica Bozzolo, Lucrezia Rovati, Paolo Giorgio Arcidiacono, Gianpaolo Balzano, Dejan Lazarevic, Chiara Bonini, Massimo Falconi, John H. Stone, Lorenzo Dagna, Shiv Pillai, Angelo A. Manfredi
Journal: Arthritis & Rheumatology (2018)

An unconventional population of CD4+ signaling lymphocytic activation molecule family member 7-positive (SLAMF7+) cytotoxic effector memory T (TEM ) cells (CD4+ cytotoxic T lymphocytes [CTLs]) has been linked causally to IgG4-related disease (IgG4-RD). Glucocorticoids represent the first-line therapeutic approach in patients with IgG4-RD, but their mechanism of action in this specific condition remains unknown. We undertook this study to determine the impact of glucocorticoids on CD4+ CTLs in IgG4-RD.Expression of CD8α, granzyme A, perforin, and SLAMF7 within the effector memory compartment of CD45RO+ (TEM ) and CD45RA+ effector memory T (TEMRA ) CD4+ cells was quantified by flow cytometry in 18 patients with active IgG4-RD, both at baseline and after 6 months of glucocorticoid treatment. Eighteen healthy subjects were studied as controls. Next-generation sequencing of the T cell receptor α- and β-chain gene was performed on circulating CD4+ CTLs from patients with IgG4-RD before and after treatment and in affected tissues.Circulating CD4+ TEM and TEMRA cells were not expanded in IgG4-RD patients compared to healthy controls. CD4+SLAMF7+ TEM cells (but not TEMRA cells) were significantly increased among IgG4-RD patients. Within CD4+SLAMF7+ TEM cells, CD8α- cells but not CD8αlow cells were elevated in IgG4-RD patients. The same dominant clones of CD8α-CD4+SLAMF7+ TEM cells found in peripheral blood were also identified in affected tissue. CD8α- and CD8αlow CD4+SLAMF7+ TEM cells both expressed cytolytic molecules. Clonally expanded CD8α- but not CD8αlow CD4+SLAMF7+ TEM cells decreased following glucocorticoid-induced disease remission.A subset of CD8α-CD4+SLAMF7+ cytotoxic TEM cells is oligoclonally expanded in patients with active IgG4-RD. This TEM cell population contracts following glucocorticoid-induced remission. Further characterization of this cell population may provide prognostic information and targets for therapeutic intervention.
Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. What We Know and Can Do for Our Patients
Authors: Ariel Jaitovich, Esther Barreiro
Journal: American Journal of Respiratory and Critical Care Medicine (2018)

Skeletal muscle dysfunction occurs in patients with chronic obstructive pulmonary disease (COPD) and affects both ventilatory and nonventilatory muscle groups. It represents a very important comorbidity that is associated with poor quality of life and reduced survival. It results from a complex combination of functional, metabolic, and anatomical alterations leading to suboptimal muscle work. Muscle atrophy, altered fiber type and metabolism, and chest wall remodeling, in the case of the respiratory muscles, are relevant etiological contributors to this process. Muscle dysfunction worsens during COPD exacerbations, rendering patients progressively less able to perform activities of daily living, and it is also associated with poor outcomes. Muscle recovery measures consisting of a combination of pulmonary rehabilitation, optimized nutrition, and other strategies are associated with better prognosis when administered in stable patients as well as after exacerbations. A deeper understanding of this process' pathophysiology and clinical relevance will facilitate the use of measures to alleviate its effects and potentially improve patients' outcomes. In this review, a general overview of skeletal muscle dysfunction in COPD is offered to highlight its relevance and magnitude to expert practitioners and scientists as well as to the average clinician dealing with patients with chronic respiratory diseases.
The Value of Behavioral Counseling for Skin Cancer Prevention
Authors: Laura K. Ferris
Journal: JAMA Oncology (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 Oncology 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 Oncology journal
GPs trainees should be able to attend 70% of formal teaching, updated guidance says
Authors: Abi Rimmer
Journal: BMJ (2014)

GPs trainees must have protected training time to allow them to attend at least 70% of the formal GP teaching programme, updated guidance says.1

Guidance on standards for GP specialty training has recently been published by the Royal College of General Practitioners and Committee of General Practice Education Directors (COGPED). The guidance makes specific …
SEVERITY OF BIOPSY-PROVEN NAFLD NOT PREDICTIVE OF PRESENCE OR SEVERITY OF CORONARY ATHEROSCLEROSIS IN ASYMPTOMATIC PATIENTS: RESULTS FROM THE PROSPECTIVE PREVALENCE STUDY
Authors: Dustin Thomas, Kelvin Bush, Ryan Prentice, Bryan Ramsey, Angelo Paredes, James K. Aden, Stephen A. Harrison
Journal: Journal of the American College of Cardiology (2018)
MYNXGRIP VASCULAR CLOSURE DEVICE IS SAFE AND EFFECTIVE FOR HEMOSTASIS OF PERCUTANEOUS TRANSFEMORAL VENOUS ACCESS CLOSURE
Authors: Ron Waksman, Itsik Ben-Dor, Toby Rogers, Rebecca Torguson, Kyle Buchanan, M. Chadi Alraies, Micaela Iantorno, Deepakraj Gajanana, Mun Hong, Lowell Satler, Petros Okubagzi, William Suddath
Journal: Journal of the American College of Cardiology (2018)
Concurrent Chemoradiotherapy for Stage IIIB Cervical Cancer—Global Impact Through Power
Authors: Chika R. Nwachukwu, Jyoti Mayadev, Akila N. Viswanathan
Journal: JAMA Oncology (2018)

Shyamkishore Shrivastava, MD; Umesh Mahantshetty, MD; Reena Engineer, DNB; Supriya Chopra, MD; Rohini Hawaldar, MSc; Vinod Hande, BHMS; Rajendra A. Kerkar, MD; Amita Maheshwari, MD; T. S. Shylasree, MD; Jaya Ghosh, DM; Jyoti Bajpai, DM; Lavanya Gurram, MD; Seema Gulia, DM; Sudeep Gupta, DM; for the Gynecologic Disease Management Group
Endocuff-assisted underwater snare polypectomy in complex ascending colon neoplasia
Authors: Taku Sakamoto, Seiichiro Abe, Marina Yoshida, Yusaku Tanaka, Yutaka Saito
Journal: Endoscopy (2018)

Endoscopic mucosal resection (EMR) is a simple, universal treatment for intramucosal colorectal neoplasms. The technical difficulties associated with the process increase depending on the location of lesion, particularly for lesions at the hepatic or splenic flexures. Such lesions are easily missed and are considered to be a cause of interval cancer. The Endocuff was developed to improve detection of lesions located in these difficult locations [1] [2]. Here, we report a case showing the efficacy of Endocuff assistance when performing endoscopic resection.
Medical schools exceed permitted overseas student quota to boost income, claims BMA
Authors: Caroline White
Journal: BMJ (2012)

UK medical schools have been contributing to the oversubscription of foundation year 1 (F1) placements for newly qualified doctors by getting round their maximum quota of overseas students, the chairman of the BMA’s Junior Doctors Committee, Ben Molyneux, has claimed.

The body that represents medical schools in the UK, the Medical Schools Council, has denied the claim.

Molyneux told BMJ Careers that the permitted proportion of medical students from overseas was 7.5% of the annual intake but that most medical schools exceeded that figure to boost their income.

“Overseas students are very lucrative, and most [medical schools] take more than the [permitted] maximum by changing the calculations, so inflating numbers to over 10%,” he explained.

“That happens to be the amount of oversubscription we are looking at,” he said. However, he acknowledged that graduates …
Any tips on starting in a new place of work?
Authors: Zoe Goodman
Journal: BMJ (2005)

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>
Pulmonary Artery Banding for Functional Regeneration of End-Stage Dilated Cardiomyopathy in Young Children
Authors: Dietmar Schranz, Hakan Akintuerk, Leonard Bailey, Oliver Miera, Friederike Danne, Minoo N. Kavarana, Mac Felmly, Joseph Panzer, Thierry Bove, Daniël De Wolf, Sabine Recla, Iki Adachi, Jeffrery W. Dreyer, Martin A. Chacon, Cansaran Tanidir, Alper Guzeltas, Sertac Haydin, Rene Pretre, Stefano Di Bernado, Marc Gewillig, Bjorn Cools, Brent Gordon, Dexter Cheng, Norma Balderrábano Saucedo, Julio Erdmenger Orellana, Alejandro Bolio Cerdán, Peter Ewert, Gunter Balling, Massimo Padalino, Giovanni Stellin, Biagio Castaldi, Karel Koubský, Roman Gebauer, Jan Janousek, Bohdan Maruszewski, Andrzej Kansy, Michal Kozlowski
Journal: Circulation (2018)
Cardiovascular Risk Prediction Functions Underestimate Risk in HIV Infection
Authors: Virginia A. Triant, Jeremiah Perez, Susan Regan, Joseph M. Massaro, James B. Meigs, Steven K. Grinspoon, Ralph B. D’Agostino
Journal: Circulation (2018)

Background: Cardiovascular disease (CVD) risk is elevated in HIV-infected individuals, with contributions from both traditional and nontraditional risk factors. The accuracy of established CVD risk prediction functions in HIV is uncertain. We sought to assess the performance of 3 established CVD risk prediction functions in a longitudinal cohort of HIV-infected men. Methods: The FHS (Framingham Heart Study) functions for hard coronary heart disease (FHS CHD) and atherosclerotic CVD (FHS ASCVD) and the American College of Cardiology/American Heart Association ASCVD function were applied to the Partners HIV cohort. Risk scores were calculated between January 1, 2006, and December 31, 2008. Outcomes included CHD (myocardial infarction or coronary death) for the FHS CHD function and ASCVD (myocardial infarction, stroke, or coronary death) for the FHS ASCVD and American College of Cardiology/American Heart Association ASCVD functions. We investigated the accuracy of CVD risk prediction for each function when applied to the HIV cohort using comparison of Cox regression coefficients, discrimination, and calibration. Results: The HIV cohort was comprised of 1272 men followed for a median of 4.4 years. There were 78 (6.1%) ASCVD events; the 5-year incidence rate was 16.4 per 1000 person-years. Discrimination was moderate to poor as indicated by the low c statistic (0.68 for FHS CHD, 0.65 for American College of Cardiology/American Heart Association ASCVD, and 0.67 for FHS ASCVD). Observed CVD risk exceeded the predicted risk for each of the functions in most deciles of predicted risk. Calibration, or goodness of fit of the models, was consistently poor, with significant χ 2 P values for all functions. Recalibration did not significantly improve model fit. Conclusions: Cardiovascular risk prediction functions developed for use in the general population are inaccurate in HIV infection and systematically underestimate risk in a cohort of HIV-infected men. Development of tailored CVD risk prediction functions incorporating traditional CVD risk factors and HIV-specific factors is likely to result in more accurate risk estimation to guide preventative CVD care.
Senior emergency medicine doctors warn of unsustainable workload
Authors: Caroline White
Journal: BMJ (2013)

Most senior doctors in emergency medicine believe that their current workload is unsustainable, and most regularly work in excess of their programmed activities, a survey by the College of Emergency Medicine has found.1

The survey drew responses from 1077 consultants, locum consultants, and associate specialists, of 1536 working in the NHS in England and the devolved nations. More than half of the respondents questioned the long term sustainability of their workload: 62% said that their job was not sustainable in its current form. Nearly all (94%) of the respondents said that they regularly worked in excess of their planned programmed activities, with 57% saying that …
THE EFFECT OF IVABRADINE ADMINISTRATION ON THE NIGHT DROP OF HEART RATE IN PATIENTS WITH INAPPROPRIATE SINUS TACHYCARDIA
Authors: Pawel Ptaszynski, Krzysztof Kaczmarek, Iwona Cygankiewicz, Thomas Klingenheben, Jan Ruta, Irmina Urbanek, Michal Kalowski, Jerzy K. Wranicz
Journal: Journal of the American College of Cardiology (2018)
NHS should reject online GP schemes that “cherry pick” patients, say LMCs
Authors: Gareth Iacobucci
Journal: BMJ (2018)

Services that allow patients to consult online with their GP should not be established in the NHS unless they are willing to provide comprehensive care to all patients, general practice leaders have said.

At their annual conference in Liverpool on 9 March, UK Local Medical Committees (LMCs) passed a motion which expressed concern that new online GP services such as GP at Hand are “cherry picking” healthy, less complex patients, to the detriment of …
Dermatologists criticise Facebook and Instagram for removing psoriasis images
Authors: Ned Stafford
Journal: BMJ (2018)

German and British dermatologists have accused Facebook and Instagram of discrimination and censorship for removing photographs of skin affected by psoriasis and blocking hashtags relating to psoriasis from their platforms.1

The accusations come as patients are increasingly posting photos of their skin on social media in an attempt to generate support, raise awareness, and destigmatise skin problems, according to support groups.

In response to the social media bans, the UK Psoriasis Association launched an online petition to “stop the censorship of psoriasis on social media.”2 (www.change.org/p/instagram-and-facebook-stop-the-censorship-of-psoriasis-on-social-media)

A spokesperson for Facebook, which owns Instagram, issued a statement saying that the bans were only temporary and are no longer in effect.

“People use Instagram and Facebook to connect around the things that …
RITONAVIR-BASED ANTI-RETROVIRAL THERAPY IS ASSOCIATED WITH A LOWER EJECTION FRACTION AND AN INCREASED RISK FOR DECOMPENSATED HEART FAILURE AND CARDIOVASCULAR MORTALITY AMONG PERSONS LIVING WITH HIV
Authors: Raza M. Alvi, Anne M. Neilan, Noor Tariq, Magid Awadalla, Dahlia Banerji, Adam Rokicki, Virginia Triant, Markella V. Zanni, Tomas Neilan
Journal: Journal of the American College of Cardiology (2018)