tbuckley/cabot-search huggingface dataset:
Dog ownership at three months of age is associated with protection against food allergy
Authors: Tom Marrs, Kirsty Logan, Joanna Craven, Suzana Radulovic, W.H.A. Irwin McLean, Gideon Lack, Carsten Flohr, Michael R. Perkin
Journal: Allergy (2019)

The prevention of food allergy is a key priority for reducing the burden of allergic disease. Environmental exposures modulate the risk of developing food allergy and some of this may be mediated by the infants' developing microbiome. However, the role of potentially protective environmental exposures, such as pet ownership, is largely uninvestigated with respect to food allergy.We performed a secondary cohort analysis in the Enquiring About Tolerance (EAT) study, which enrolled 1303 three-month infants onto a randomized trial to prevent food allergy. A survey elicited domestic animal ownership and participants were examined for atopic dermatitis (AD) at enrolment. Sensitization to foods and aeroallergens were elicited by skin and serum testing at 3, 12 and 36 months. Food allergy status was determined by double-blind placebo-controlled food challenges between 1 and 3 years.Food allergy was diagnosed amongst 6.1% (68/1124) of participants with complete data. No significant relationships were demonstrated between food allergy and caesarean delivery, infections or antibiotic exposure in early life. After adjusting for familial atopic disease, maternal dog/cat sensitization and participant AD, living with dogs was associated with a 90% reduction in the odds of infants developing food allergy (adjusted odds ratio (aOR) 0.10 (confidence interval (CI) 0.01-0.71), P = 0.02). None of the 49 infants living with at least two dogs developed food allergy, suggesting a dose-response relationship (each dog owned aOR 0.12 (CI 0.02-0.81), P = 0.03). No relationship was demonstrated between owning dogs or cats and the development of AD.Dog ownership in infancy may prevent food allergy.
Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study
Authors: Kirsten Patrick
Journal: BMJ (2012)

The paper

Pain over speed bumps in diagnosis of acute appendicitis: diagnostic accuracy study by Helen F Ashdown and colleagues ( BMJ 2012;345:e8012)

Abstract

Objective —To assess the diagnostic accuracy of pain on travelling over speed bumps for the diagnosis of acute appendicitis.

Design —Prospective questionnaire based diagnostic accuracy study.

Setting —Secondary care surgical assessment unit at a district general hospital in the UK.

Participants —101 patients aged 17-76 years referred to the on-call surgical team for assessment of possible appendicitis.

Main outcome measures —Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for pain over speed bumps in diagnosing appendicitis, with histological diagnosis of appendicitis as the reference standard.

Results —The analysis included 64 participants who had travelled over speed bumps on their journey to hospital. Of these, 34 had a confirmed histological diagnosis of appendicitis, 33 of whom reported increased pain over speed bumps. The sensitivity was 97% (95% confidence interval 85% to 100%), and the specificity was 30% (15% to 49%). The positive predictive value was 61% (47% to 74%), and the negative predictive value was 90% (56% to 100%). The likelihood ratios were 1.4 (1.1 to 1.8) for a positive test result and 0.1 (0.0 to 0.7) for a negative result. Speed bumps had a better sensitivity and negative likelihood ratio than did other clinical features assessed, including migration of pain and rebound tenderness.

Conclusions —Presence of pain while travelling over speed bumps was associated with an increased likelihood of acute appendicitis. As a diagnostic variable, it compared favourably with other features commonly used in clinical assessment. Asking about speed bumps might contribute to clinical assessment and could be useful in telephone assessment of patients.

As noted in a BMJ Easily Missed article published in 2011, acute appendicitis can be difficult to diagnose, …
Ambulatory Advanced Heart Failure in Women
Authors: Garrick C. Stewart, Thomas Cascino, Blair Richards, Shokoufeh Khalatbari, Douglas L. Mann, Wendy C. Taddei-Peters, J. Timothy Baldwin, Neal O. Jeffries, Catherine Spino, Lynne W. Stevenson, Keith D. Aaronson
Journal: JACC Heart Failure (2019)
Gabriel Weston: Keeping an open mind
Authors: Gabriel Weston
Journal: BMJ (2019)

This month marks the 500th anniversary of the death of Leonardo da Vinci. Despite very little formal education he was surely the greatest polymath who ever lived, displaying genius in areas as diverse as art, medicine, engineering, and invention.

Given the huge influence of Leonardo’s imagination, it’s disappointing how arts and sciences have become siloed over the years—a steady divorce that gained real traction in the 19th century. This is still evident today, in ways ranging from how museums are organised to our ludicrous tradition of choosing just three A level subjects, which often results in …
St George’s cuts graduate entry places
Authors: Elizabeth Dunningham
Journal: BMJ (2013)

St George’s University of London (SGUL) medical school is cutting student numbers on its graduate entry programme, from the 120 places offered in 2012 to a target of 50 in 2014.

SGUL gives several reasons for the action, including the national reduction in the numbers of medical students, the impact of £9000 (€10 700; $14 500) fees, and uncertainty over government funding. A spokesperson for SGUL said external factors have driven the university “to carefully review the balance of student numbers between the five year entry and the graduate entry programme to ensure that we have a strong and sustainable basis for student recruitment.”

The university is making more places available on its five year course—35 more in 2014 than were available in 2013. The spokesperson said the five year course is a more accessible …
Optimal sunscreen use, during a sun holiday with a very high ultraviolet index, allows vitamin D synthesis without sunburn
Authors: A.R. Young, J. Narbutt, G.I. Harrison, K.P. Lawrence, M. Bell, C. O'Connor, P. Olsen, K. Grys, K.A. Baczynska, M. Rogowski‐Tylman, H.C. Wulf, A. Lesiak, P.A. Philipsen
Journal: British Journal of Dermatology (2019)

Sunlight contains ultraviolet (UV)A and UVB radiation. UVB is essential for vitamin D synthesis but is the main cause of sunburn and skin cancer. Sunscreen use is advocated to reduce the sun's adverse effects but may compromise vitamin D status. To assess the ability of two intervention sunscreens to inhibit vitamin D synthesis during a week‐long sun holiday. The impact of sunscreens on vitamin D status was studied during a 1‐week sun holiday in Tenerife (28° N). Comparisons were made between two formulations, each with a sun protection factor (SPF) of 15. The UVA‐protection factor (PF) was low in one case and high in the other. Healthy Polish volunteers (n = 20 per group) were given the sunscreens and advised on the correct application. Comparisons were also made with discretionary sunscreen use (n = 22) and nonholiday groups (51·8° N, n = 17). Sunscreen use in the intervention groups was measured. Behaviour, UV radiation exposure, clothing cover and sunburn were monitored. Serum 25‐hydroxyvitamin D3 [25(OH)D3] was assessed by high‐performance liquid chromatography–tandem mass spectrometry. Use of intervention sunscreens was the same (P = 0·60), and both equally inhibited sunburn, which was present in the discretionary use group. There was an increase (P < 0·001) in mean ± SD 25(OH)D3 (28·0 ± 16·5 nmol L−1) in the discretionary use group. The high and low UVA‐PF sunscreen groups showed statistically significant increases (P < 0·001) of 19·0 ± 14·2 and 13·0 ± 11·4 nmol L−1 25(OH)D3, respectively with P = 0·022 for difference between the intervention sunscreens. The nonholiday group showed a fall (P = 0·08) of 2·5 ± 5·6 nmol L−1 25(OH)D3. Sunscreens may be used to prevent sunburn yet allow vitamin D synthesis. A high UVA‐PF sunscreen enables significantly higher vitamin D synthesis than a low UVA‐PF sunscreen because the former, by default, transmits more UVB than the latter. What's already known about this topic? Action spectra (wavelength dependence) for erythema and the cutaneous formation of vitamin D overlap considerably in the ultraviolet (UV)B region. Theoretically, sunscreens that inhibit erythema should also inhibit vitamin D synthesis. To date, studies on the inhibitory effects of sunscreens on vitamin D synthesis have given conflicting results, possibly, in part, because people typically apply sunscreen suboptimally. Many studies have design flaws. What does this study add? Sunscreens (sun protection factor, SPF 15) applied at sufficient thickness to inhibit sunburn during a week‐long holiday with a very high UV index still allow a highly significant improvement of serum 25‐hydroxyvitamin D3 concentration. An SPF 15 formulation with high UVA protection enables better vitamin D synthesis than a low UVA protection product. The former allows more UVB transmission.
Risk and Risk Factors Associated With Recurrent Venous Thromboembolism Following Surgery in Patients With History of Venous Thromboembolism
Authors: Banne Nemeth, Willem M. Lijfering, Rob G. H. H. Nelissen, Inger B. Schipper, Frits R. Rosendaal, Saskia le Cessie, Suzanne C. Cannegieter
Journal: JAMA Network Open (2019)

<h3>Importance</h3> The size of the risk of recurrent venous thromboembolism (VTE) after surgery in patients with a history of VTE is not well known. <h3>Objectives</h3> To estimate the risk of and to identify the factors associated with recurrent VTE in patients undergoing surgery who have a history of VTE. <h3>Design, Setting, and Participants</h3> This population-based, follow-up cohort study includes patients with VTE who participated in the Multiple Environment and Genetic Assessment (MEGA) study. Original data were collected from March 1999 to April 2010. Data analysis began in June 1999 and ended in April 2010. <h3>Exposures</h3> Surgery following a first VTE. <h3>Main Outcomes and Measurements</h3> Kaplan-Meier analyses were used to estimate cumulative incidences of recurrent VTE. Cox regression with a time-dependent covariate (surgery) was used to calculate the hazard ratio (HR) for developing recurrent VTE after surgery compared with no surgery. <h3>Results</h3> Overall, 3741 patients (mean [SD] age, 48.4 [12.8] years; 2020 [54.0%] women) with a history of VTE were included in the analysis, amounting to 18 899 person-years, with a median (interquartile range) follow-up of 5.7 (3.0-7.2) years. Of the 3741 patients, 580 (15.5%) underwent surgery and 601 (16.1%) developed a recurrent thrombotic event. The 1-month cumulative incidence of recurrent VTE for all surgery types was 2.1% (95% CI, 1.2%-3.6%), which increased to 3.3% (95% CI, 2.1%-5.1%) at 3 months and 4.6% (95% CI, 3.1%-6.6%) at 6 months. At 6 months, risk of recurrent VTE ranged from 2.3% to 9.3%, depending on surgery type. In addition to surgery type, factor V Leiden mutation (HR, 3.4; 95% CI, 1.6-7.4) and male sex (HR, 2.7; 95% CI, 1.3-5.8) were associated with increased risk of recurrent VTE. <h3>Conclusions and Relevance</h3> Surgery was associated with an increased risk of recurrent VTE in patients with a history of VTE; risk remained high for up to 6 months after the procedure. This study suggests that high-risk individuals may be identified based on surgery type, sex, and the presence of factor V Leiden mutation. These findings stress the need for revision of the current thromboprophylactic approach to prevent recurrence in these patients.
Abstract 1645: DNA-damaging compound 0404 effectively inhibits hepatocellular carcinoma by upregulation of miR-34a and miR-200c expression
Authors: Caixia Xia, Yanning Liu, Guohua Lou, Xiao Xu, Long Mao, Min Zheng
Journal: Cancer Research (2015)

Abstract Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the third most common cause of cancer deaths worldwide. DNA-damaging agents have a long history of use in cancer chemotherapy. Unfortunately, chemotherapeutic treatment strategies against HCC are very ineffective. We have screened of a novel DNA-damaging compounds, 0404, by using time-dependent cellular response (TCRP) based on unique TCRP DNA-damage signature. This new compound could induce apoptosis effectively in hepatocellular carcinoma at nM-degree concentration. Since microRNAs (miRNAs) have been show play critical roles in pathogenesis of HCC, the present study was aimed to investigate the role of miRNAs in the anticancer effects of 0404. We found that, HepG2 cells, which retain wild-type p53, were more sensitive to 0404 treatment than Huh7 cells, which with mutant p53. At IC50 and IC99 concentration, 0404 upregulated the expression of miR-34a and miR-200c, two major miRNA regulated by p53, in a dose- and time-dependent manner in HepG2 cells. Western blot analysis further show that up-regulation of miR-34a decreased SIRT1 expression, leading to an increase in acetylated p53 levels and also an increase in p53 targets such as p21 and PUMA. In addition, up-regulation of miR-200c decreased the expression of EMT-inducing transcription factors ZEB1 and ZEB2, which play key role in tumor invasion and metastasis. Furthermore, miR-34a or miR-200c inhibitors impaired the down-regulation of miR-34a or miR-200c target genes, respectively, by 0404 treatment, and partially impaired the tumor suppression effect of 0404. These results suggest that 0404 may be an attractive agent in chemotherapy for HCC, especially in HCC with wt p53, by regulation of miR-34a and miR-200c. Financial support: This study was supported by the National Natural Science Fund (81272679) and the Major national S&amp;T Projects (2013ZX09041003). Citation Format: Caixia Xia, Yanning Liu, Guohua Lou, Xiao Xu, Long Mao, Min Zheng. DNA-damaging compound 0404 effectively inhibits hepatocellular carcinoma by upregulation of miR-34a and miR-200c expression. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1645. doi:10.1158/1538-7445.AM2015-1645
Reply
Authors: None Shalimar, Mohammed Faisal Sheikh, Rajeshwar P. Mookerjee, Banwari Agarwal, Subrat Kumar Acharya, Rajiv Jalan
Journal: Hepatology (2019)

Potential conflict of interest: RJ consults for and owns stock in Yaqrit. He consults for Takeda and has research collaborations with Mallickrodt, and has received speaking fees from Grifols. We appreciate Choudhary et al. for their interest in our study published in Hepatology.1 They have raised an important issue that the inclusion of patients with renal failure could have influenced the effect of ammonia on 28‐day mortality. We have reanalyzed the data after exclusion of patients with renal failure (n = 119). In the cohort of 379 patients without renal failure, ammonia was independently associated with mortality (Table 1). The exclusion of patients with renal failure made no change in the association of ammonia with mortality. We do not have baseline data of ammonia‐lowering therapies received by the patients in the cohort; hence, no comment can be made regarding the effect of ammonia‐lowering therapies on the current cohort. Choudhary et al. recommend a cohort free of ammonia‐lowering therapy and without acute kidney injury to study the role of ammonia. The established management of hepatic encephalopathy (HE) includes ammonia‐lowering drugs, such as lactulose and rifaximin,2 which would be unethical to withhold or discontinue for the purposes of investigating ammonia kinetics. Table 1 - Uni‐ and Multivariate Analysis of Predictors of 28‐Day Mortality After Exclusion of Patients With Renal Failure Unadjusted HR (95% CI) P Value Adjusted HR (95% CI) P Value HE NI None, minimal 1 Moderate 1.292 (0.862‐1.936) 0.216 Advanced 2.820 (1.819‐4.373) <0.001 Age 0.980 (0.968‐0.992) 0.001 1.010 (0.995‐1.024) 0.189 Sex Male 1 Female 0.799 (0.547‐1.167) 0.245 MAP 0.985 (0.971‐0.999) 0.031 0.985 (0.971‐1.000) 0.055 TLC 1.070 (1.052‐1.089) <0.001 1.034 (1.012‐1.057) 0.002 Creatinine 2.214 (1.487‐3.296) <0.001 1.364 (0.889‐2.093) 0.156 Total bilirubin 1.031 (1.017‐1.044) <0.001 NI Ammonia 1.011 (1.009‐1.014) <0.001 1.006 (1.003‐1.010) <0.001 INR 1.785 (1.536‐2.073) <0.001 NI Organ failures Liver 2.207 (1.563‐3.115) <0.001 1.340 (0.922‐1.947) 0.125 Cerebral 2.609 (1.719‐3.962) <0.001 1.179 (0.736‐1.889) 0.493 Coagulation 2.824 (1.980‐4.026) <0.001 1.960 (1.324‐2.901) 0.001 Circulation 1.686 (0.885‐3.211) 0.112 Respiratory 2.207 (1.555‐3.134) <0.001 1.280 (0.870‐1.883) 0.210 Abbreviations: CI, confidence interval; HR, hazard ratio; INR, international normalized ratio; MAP, mean arterial pressure; NI, not included; TLC, total leucocyte count.
In a land of death and diamonds
Authors: Emma Missen
Journal: BMJ (2014)

The Lassa Ward is a real account of a US medical student’s time in a country ravaged by war and poverty. Ross Donaldson, a 20 something medical student leaves behind the comfort and relative safety of the United States and travels to Sierra Leone. While working in a remote hospital he comes face to face with the deadly viral haemorrhagic disease Lassa fever. The Lassa Ward offers a glimpse of the struggles faced by the people of this war stricken country.

In the summer of 2003 …
Human herpesvirus 6 infection after autologous stem cell transplantation: A multicenter prospective study in adult patients
Authors: Marie Balsat, Sylvie Pillet, Emmanuelle Tavernier, Victoria Cacheux, Vanessa Escuret, Cécile Moluçon-Chabrot, Karine Augeul-Meunier, Audrey Mirand, Christel Regagnon, Fabien Tinquaut, Véronique Bousser, Mathieu Oriol, Denis Guyotat, Gilles Salles, Jacques-Olivier Bay, Bruno Pozzetto, Jérôme Cornillon
Journal: Journal of Infection (2019)
An introduction to safeguarding
Authors: Marina Soltan, Anthony Choules
Journal: BMJ (2018)

How to identify signs of child maltreatment and raise concerns As a doctor, it is your duty to safeguard children and vulnerable adults by protecting them from abuse and neglect.1 Safeguarding is defined as protecting children from maltreatment, preventing impairment of children’s health or development, ensuring that children grow up in circumstances consistent with the provision of safe and effective care, and taking action that enables all children to have the best outcomes.2 Children can present with features of maltreatment to primary and secondary care centres, and to community services.3 In your role as a medical student or junior doctor, when you clerk patients, you are responsible for identifying when a child may have been maltreated and escalating your concerns to a senior member of staff or a designated safeguarding colleague in your area. Different professionals who deal with children, including healthcare professionals, each hold part of the picture of a child who is being maltreated; therefore, as a medical student or junior doctor, you can play an important part in contributing to the understanding of what might be going on. The National Institute for Health and Care Excellence (NICE) defines child maltreatment in three ways4: ### Physical abuse Suspected cases of maltreatment or neglect should be reported when there is no explanation for an injury or the child’s history does not correlate with examination findings. Keep a lookout for the following:
Should medical students be required to study the arts? No
Authors: Jane Macnaughton
Journal: BMJ (2013)

The way medicine is taught and the contents of curriculums are always under scrutiny. Giskin Day and Matthew Rinaldi (doi:10.1136/sbmj.f5055) say students are missing a valuable lesson by not studying the arts, but Jane Macnaughton says including the arts in medical education has failed to meet its objectives
Shaking the foundations
Authors: Matthew Billingsley
Journal: BMJ (2014)

At the beginning of 2015 the United Kingdom’s first private medical school will open at the University of Buckingham, and this potentially represents a tectonic shift in medical education.

The 66 students set to embark on this course will have to independently fund the £35 000 (€43 700; $54 800) a year tuition fees, and they will not receive any subsidy from the government for their studies. Similar courses at the University of Central Lancashire and Aston University are set to follow in 2015 and 2017. An immediate concern from some quarters is that these unprecedented fees will only attract students with …
Abstract P4-08-22: Impact of application of AJCC 8th edition on survival rate of the breast cancer
Authors: S Kwon, DS Yoon, IE Bae, WJ Choi, IS Choi, SE Lee, JI Moon, NS Sung, SM Park
Journal: Cancer Research (2019)

Abstract Background The AJCC 8 edition has changed much in comparison with the 7 edition. In addition to TNM stage, biologic marker (ER, PR, HER2), Histologic grade and multigene assays (oncotype Dx.) should be considered for staging. and it has been applied since January 1, 2018. patients were recategorized and analyzed in order to know if this more complex classification helps to predict the real prognosis of the patients, Method We review patients who were diagnosed and treated as breast cancer at Konyang Universty Hospital. we studied retrospectively 582 patients who were followed up and were able to review. Stage was classified according to AJCC 7th edition and AJCC 8th edition. survival rate of each stage were analyzed in both editions. Result Mean follow up period was 68.6 months. Total 582 patients were included. There was no change in the stage in 257 patients. In 195 patients, the stage was elevated and in 130 patients, the stage was changed down. When classified as AJCC 7th edition, the 5year-survival rate was 95.9% in stage I, 97.9% in stage II, 93.1% in stage III and 89.9% in stage IV. The survival rate of patients in stage I was lower than that of stage II. However, when the AJCC 8th edition was applied, the 5- year survival rate was 97.9% in stage I, 96.9% in stage II, 92.2% in stage III, and 89.9% in stage IV. In 8th edition, the patients in lower stage has higher survival rate. Conclusion The prediction of survival rate by stage was more accurate and the difference in survival rate of each stages was more clearly distinguished when The AJCC 8th edition was applied than AJCC 7th edition. AJCC 8th edition was reliable and useful for prediction of prognosis of breast cancer patient. Citation Format: Kwon S, Yoon DS, Bae IE, Choi WJ, Choi IS, Lee SE, Moon JI, Sung NS, Park SM. Impact of application of AJCC 8th edition on survival rate of the breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-22.