tbuckley/cabot-search huggingface dataset:
Risk Factors for Lymphatic and Hematogenous Dissemination in Patients With Stages I to II Cutaneous Melanoma
Authors: Laura Calomarde-Rees, Rosario García-Calatayud, Celia Requena Caballero, Esperanza Manrique-Silva, Víctor Traves, Zaida García-Casado, Virtudes Soriano, Rajiv Kumar, Eduardo Nagore
Journal: JAMA Dermatology (2019)

<h3>Importance</h3> The lymphatic and the hematogenous pathways have been proposed for disease progression in cutaneous melanoma, but association with recurrence has not been studied separately to date. <h3>Objective</h3> To identify the risk factors associated with lymphatic and hematogenous metastasis. <h3>Design, Setting, and Participants</h3> This retrospective cohort study included 1177 patients with malignant melanoma treated at Instituto Valenciano de Oncología, València, Spain. Data were retrieved from the melanoma database from January 1, 2000, through December 31, 2015, and analyzed from June 1 to 30, 2018. <h3>Exposure</h3> Malignant melanoma at stages I to II. <h3>Main Outcomes and Measures</h3> Analyses of survival free of lymphatic and hematogenous metastasis were performed using Kaplan-Meier curves and Cox proportional hazards regression. <h3>Results</h3> For the 1177 patients included in the study analysis (51.1% women; median age at diagnosis, 55 years [interquartile range, 42-68 years), median follow-up was 75 months (interquartile range, 33-121 months); 108 (9.2%) developed lymphatic metastasis, and 108 (9.2%) developed hematogenous metastasis. In the multivariate analysis, being older than 55 years (hazard ratio [HR], 1.9; 95% CI, 1.2-3.1), tumor in the head/neck (HR, 1.7; 95% CI, 1.0-2.9) and acral locations (HR, 2.4; 95% CI, 1.3-4.5), greater Breslow thickness (HR for &gt;4.00 mm, 5.4; 95% CI, 2.4-12.4), and presence of vascular invasion (HR, 3.2; 95% CI, 0.9-10.6) were associated with lymphatic spreading. Hematogenous metastasis was associated with greater Breslow thickness (HR for &gt;4.00 mm, 10.4; 95% CI, 3.6-29.7), the absence of regression (HR, 0.1; 95% CI, 0.0-1.0),<i>TERT</i>promoter mutations (HR, 2.9; 95% CI, 1.5-5.7), and<i>BRAF</i>mutations (HR, 1.9; 95% CI, 1.1-3.6). <h3>Conclusions and Relevance</h3> Risk factors associated with lymphatic and hematogenous metastasis differ. Follow-up and adjuvant treatment strategies may therefore need to be adapted to individual clinical, histopathologic, and molecular characteristics.
Two fifths of women have no interest in sex
Authors: Upasana Tayal
Journal: BMJ (2003)

Up to two fifths of women and almost one fifth of men lack interest in sex, according to the results of a study published in the BMJ (2003;327:426-7). Catherine Mercer's group at the Royal Free and University College Medical School, London, interviewed 11 161 men and women aged 16-44 using a computer assisted self interview.

In total, 34.8% of men …
The Performance of Dying
Authors: Monica Desai
Journal: BMJ (2003)

Those who have seen the Vagina Monologues will appreciate the poignancy of a collation of monologues or dialogues about an emotive and sometimes taboo subject. In a similar fashion, Nell Dunns Cancer Tales uses the stories of seven women and one man whose lives have been affected by cancer. They relate their stories, the way in which cancer affected their lives and relationships, and the interactions they had with doctors.



FRANK BARON/GUARDIAN

Nell Dunn, author of Cancer Tales 



An excerpt from Cancer Tales was one of the four pieces of theatre used in The Performance of Dying , a session run jointly by Kings College London and the Royal Academy of Dramatic Arts as part of their “Art of Dying” series. Each of the four plays ( Cancer Tales, Spoonface Steinberg, Tis Pity Shes a Whore , and Tomorrows News ) illuminated the variety of different emotions involved …
Medical ethics online
Authors: Laura James
Journal: BMJ (2009)

Good Medical Practice in Action (www.gmc-uk.org/guidance/case_studies/index.asp) is a lively interactive ethics section of the UK General Medical Council’s website. The website was launched a year ago for medical students, doctors, and patients. Its aim is to communicate messages from the revised 2006 Good Medical Practice , a guide for professionalism among doctors in the United Kingdom, in a unique and engaging manner.

It sets the scene in a virtual patients’ waiting room, with a receptionist and four patients. By clicking on the receptionist you can watch any of the patient’s consultations and listen to the dialogue between them and their general practitioner. You can find out how ethically sound you are by deciding …
The Med School Survival Guide
Authors: Hennah Bashir
Journal: BMJ (2001)

The Med School Survival Guide is a deeply delicious book. This is the kind of book that you will read again and again, thinking, “Now why didn't I start doing that the first time I was told to?” Imagine confronting your lecturers with a smile and a thank you from the bottom of your heart after they have illuminated the darkness of your misunderstandings and everybody else in your year pelting stale doughnuts at you when you attempted to enter the coffee lounge afterwards.

That's right, …
Doctors angry at limited smoking ban
Authors: Zosia Kmietowicz
Journal: BMJ (2004)

Plans to ban smoking in only some public places and to delay the introduction of the policy until the end of 2008 have been greeted with frustration and condemnation by health campaigners.

The announcement by the health secretary, John Reid, to restrict the smoking ban to restaurants and pubs which serve food, but to allow other pubs and private members' clubs to choose to ban smoking will be confusing and difficult to enforce, said the BMA.

“I recognise that John Reid has certainly gone …
Abstract 14479: Association Between Chest Compressions and Ventricular Fibrillation Recurrences in Successfully Shocked Out-Of-Hospital Cardiac Arrests
Authors: Alessandro Capucci, Daniela Aschieri, Federico Guerra, Valentina Pelizzoni, Enrico Paolini, Giovanni Q Villani, Stefano Nani, Gust H Bardy
Journal: Circulation (2016)

Introduction: Chest compressions (CC) are unquestioned as appropriate and beneficial during rescuing attempts of out-of-hospital cardiac arrest (OOHCA). However, adverse consequences from CC are well documented and CC share many aspects with commotio cordis, a well-known cause of VF induction. Hypothesis: To test the association between CC and VF recurrences (VFr) after a successful shock in OOHCA. Methods: The Progetto Vita database, prospectively collecting data on all resuscitation efforts in the Piacenza province (Italy), was used for the present analysis. All data concerning the resuscitation were prospectively collected according to the Utstein recommendations. From the 461 OOHCA found in a shockable rhythm, only those with both good ECG tracings and good quality audio recordings (160) were included in the analysis. VFr was defined as related to CC when the onset of VFr occurred during the actual CC artifact or immediately after. Otherwise, it was defined as spontaneous. The conduct of CC was confir...
Abstract 17900: Analysis of Left Atrial Flow Velocity Distribution by 4D Flow MRI in Patients With Atrial Fibrillation
Authors: Daniel C Lee, Jeffrey J Goldberger, Jacob Fluckiger, Jason Ng, James C Carr, Jeremy D Collins, Michael Markl
Journal: Circulation (2013)

Background: To identify atrial fibrillation (AF) patients with high stroke risk, clinicians use risk scores with mediocre predictive values (C statistic 0.55-0.64). Because blood stasis is a key factor responsible for thrombus formation in the left atrium (LA), evaluating LA 3D flow patterns may improve understanding of stroke risk in AF patients. Objective: To assess differences in LA flow velocity distribution in AF patients and controls by 4D flow MRI Methods: We performed 4D flow MRI in 21 AF patients in sinus rhythm during imaging (AF-sinus), 10 AF patients in AF (AF-afib), and 9 controls. Manual segmentation of LA volume enabled analysis of all LA voxel velocities over all phases of the cardiac cycle. LA flow was quantified by mean LA velocity and the percentage of LA velocities > 0.2 m/s (incidence). To evaluate the highest velocities in each voxel, varying proportions of the velocity profiles (top 5%, 25%, 50%, 65%, 100%) were analyzed. Results: Patient ages (years) in the groups were control (59±...
Dealing with an unexpected loss
Authors: Michael A Grasso
Journal: BMJ (2005)

Dealing with the unexpected loss of a patient can be a difficult and emotional experience. You may feel sadness over the patient's death, helplessness over the inability to effect a positive outcome, or fear over mistakes that might have been made. It may help to take some active steps to deal with these feelings.

Here are some of the steps I took to deal with my feelings in a constructive way when a relatively young patient died …
Book review: White Teeth
Authors: Debashis Singh
Journal: BMJ (2000)

“Where are you from originally?” I don't know how many times I have been asked that question, usually by the elderly and confused, unable to comprehend that my little brown face could possibly emanate from these shores. Now, when asked, I lie and explain that I was born in the jungle, brought up by wolves and came over here to sit my GCSEs. To these people being “English” is equated with being white. Times …
A single-cell atlas of mouse brain macrophages reveals unique transcriptional identities shaped by ontogeny and tissue environment
Authors: Hannah Van Hove, Liesbet Martens, Isabelle Scheyltjens, Karen De Vlaminck, Ana Rita Pombo Antunes, Sofie De Prijck, Niels Vandamme, Sebastiaan De Schepper, Gert Van Isterdael, Charlotte L. Scott, Jeroen Aerts, Geert Berx, Guy E. Boeckxstaens, Roosmarijn E. Vandenbroucke, Lars Vereecke, Diederik Moechars, Martin Guilliams, Jo A. Van Ginderachter, Yvan Saeys, Kiavash Movahedi
Journal: Nature Neuroscience (2019)
Hip pain after trivial trauma
Authors: Vibhore Gupta, Rishi Singhal
Journal: BMJ (2006)

A 48 year old woman attended the emergency department with a two day history of pain in the left hip. No bruising, tenderness, restriction of movement, or deformity was found on examination. She was able to bear weight on her left leg. A diagnosis of musculoskeletal pain was made, and she was discharged home with analgesia and advice.

She came back the next day with increasing pain in the left hip. Clinical examination revealed no new findings, and she was discharged with the same diagnosis and management plan.

The patient presented again four days later, unable to walk or stand because of pain. X ray examination of her left hip and pelvis was arranged (fig 1).



Fig 1 
Radiograph of the pelvis



1.  What are the radiological findings?

2.  What is a stress fracture …
Abstract 17883: Electromechanical Papillary Muscle Robotic Archetype Can Improve Diagnosis and Treatment Options in Patients With Mitral Valve Regurgitation
Authors: Zeynep Tuzun, Jiheum Park, Pramod Bonde
Journal: Circulation (2017)

Introduction: Ischemic mitral regurgitation (IMR) predominantly suggests pathology with ventriculo-papillary-mitral complex and has disappointing surgical outcomes and survival rates with conventional repair techniques. Current computational fluid dynamics modeling systems lack the accuracy needed to elucidate fundamental displacement of papillary muscles that can impact leaflet coaptation. We have designed a reciprocative robot with twelve planes of motion to address the kinematics of papillary muscles through the cardiac cycle. Methods: The three-dimensional modeling of the left ventricular components is provided by two parallel robots that mimic the papillary muscle motion as a combination of translational and rotational motion that model twelve degrees of freedom, as shown in Figure 1. Twelve stepper motors are controlled by a microcontroller on a source code written in C++. The heart rate of the patient is mimicked by adjusting the angular velocity of each motor shaft. Results: The twin robots succes...
Tell No One
Authors: Helen Barratt
Journal: BMJ (2002)

David Beck and his wife Elizabeth return to Lake Charmaine to celebrate the 13th anniversary of their first kiss. Elizabeth is snatched and later murdered; David is beaten up and left for dead. Three days after Elizabeths body is found in a ditch, the police conclude that she is the latest victim of the serial killer known as KillRoy.

Eight years on, David is working as a paediatrician, still struggling to come to terms with his wifes death. On …
Danger hidden underneath: a rare esophageal subepithelial lesion
Authors: Yan Jin, Liang Chengbo, Wen Qiuyuan, Tan Yuyong, Liu Deliang
Journal: Endoscopy (2019)

A 54-year-old woman was admitted because regular gastroendoscopy incidentally revealed an 8-mm subepithelial lesion 30 cm from the incisors ([Fig. 1]). Magnifying narrow-band imaging (NBI) showed regular intrapapillary capillary loops, several of which showed slight dilatation (type A) ([Fig. 2]). Lugol's iodine staining and ultrasound gastroscopy yielded negative findings. Endoscopic biopsy revealed several scattered heterocyst clusters. Positron emission tomography-computed tomography did not indicate metastasis.
UK universities to train physicians assistants
Authors: Vittal Katikireddi
Journal: BMJ (2004)

Birmingham University and Wolverhampton University have announced plans to start courses to train the first British physician assistants, in a bid to relieve pressure on doctors working in the NHS.

Physician assistants have existed for the last 40 years in the United States and have been employed to take histories, examine patients, diagnose conditions, and initiate treatments, under doctors' supervision.

Hilary Paniagua, a senior lecturer, is developing the course at Wolverhampton …
Nociceptin Receptors Upregulated in Cocaine Use Disorder: A Positron Emission Tomography Imaging Study Using [<sup>11</sup>C]NOP-1A
Authors: Rajesh Narendran, Savannah Tollefson, Michael L. Himes, Jennifer Paris, Brian Lopresti, Roberto Ciccocioppo, N. Scott Mason
Journal: American Journal of Psychiatry (2019)

Nociceptin/orphanin FQ (N/OFQ) is an antistress neuropeptide transmitter in the brain that counteracts corticotropin-releasing factor (CRF)-mediated stress and anxiety symptoms during drug and alcohol withdrawal. It also inhibits the release of a wide array of neurotransmitters, including dopamine and glutamate, which allows for it to block the rewarding properties of cocaine. Chronic cocaine administration in rodents has been shown to decrease N/OFQ and increase nociceptive opioid peptide (NOP) receptors in the nucleus accumbens. No previous studies have reported on the in vivo status of NOP in chronic cocaine-abusing humans.[11C]NOP-1A and positron emission tomography (PET) were used to measure in vivo NOP binding in 24 individuals with cocaine use disorder and 26 healthy control subjects matched for age, sex, and smoking status. Participants with cocaine use disorder with no comorbid psychiatric or medical disorders were scanned after 2 weeks of outpatient-monitored abstinence. [11C]NOP-1A distribution volume (VT) was measured with kinetic analysis using the arterial input function in brain regions that mediate reward and stress behaviors. Participants with cocaine use disorder were followed up for 12 weeks after PET scanning to document relapse and relate it to VT.A significant increase in [11C]NOP-1A VT was observed in the cocaine use disorder group compared with the healthy control group. This increase, which was generalized across all regions of interest (approximately 10%), was most prominent in the midbrain, ventral striatum, and cerebellum. However, increased VT in these regions did not predict relapse.Increased NOP in cocaine use disorder suggests an adaptive response to decreased N/OFQ, or increased CRF transmission, or both. Future studies should examine the interactions between CRF and NOP to elucidate their role in negative reinforcement and relapse. NOP agonist medications to enhance N/OFQ should be explored as a therapeutic to treat cocaine use disorder.
Abstract 16479: Ankle-Brachial Index and Subsequent Clinical Ischemic Leg Outcomes in the General Population: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Kunihiro Matsushita, Chao Yang, Shoshana Ballew, Corey Kalbaugh, Elizabeth Selvin, Maya Salameh, Gerardo Heiss, Josef Coresh
Journal: Circulation (2017)

Background: Ankle-brachial index (ABI) has high validity in detecting lower extremity artery stenosis and is predictive of cardiovascular mortality and outcomes. Although ABI is an established tool...
Physician, heal thyself
Authors: Thomas C McAnea
Journal: BMJ (2001)

It's happening again. My mind is exercising its power, making me more neurotic.

The process of training to be a doctor offers privileges and opportunities. We are given access to people's lives, and are allowed to take part in ward rounds, clinics, and surgeries. We are encouraged to become caring, skilled professionals.

But being a medical student does bring with it certain demands and drawbacks. We are pressured physically, emotionally, and intellectually over a five year course. Illness, distress, and death are difficult to deal with when they occasionally occur in our own lives, but …
Minerva: April 2002
Authors: Roger Holden, Amar Alwitry
Journal: BMJ (2002)

Magnetic resonance scans showed a number of structural brain abnormalities in 17 children with school problems who had been exposed to alcohol in utero. Deviations in the development of the vermis were the most sensitive indicator of prenatal alcohol exposure, although no specific structural abnormality correlated with a particular cognitive deficit ( Developmental Medicine and Child Neurology 2002;44:98-106).

Liver metastases associated with gastrointestinal malignancies tend to present late, and radiological investigations can give false negative results in the early stages. Looking for a simple laboratory technique to detect liver metastases, researchers hit on high molecular weight alkaline phosphatase (determined by electrophoresis). In a comparison of levels in 50 patients with gastrointestinal cancers with 20 healthy volunteers, this test offered 54% sensitivity and 88.5% specificity ( Turkish Journal of Gastroenterology 2001;12:253-7). The authors say this makes it a useful marker. Others may disagree.

Antinuclear antibodies, commonly associated with autoimmune diseases, may in future join other tests for coronary atherosclerosis. Unaware of the artery status of 70 people, two observers scored positively for the antibodies. Of those with known angiographically proven coronary disease, 70% were positive for antinuclear antibodies, compared with 17% of the group with no evidence of …
Medical students should not be forced to study all subjects
Authors: Kallur Suresh
Journal: BMJ (2002)

I was a medical student between 1986 and 1991. It took me six long years to qualify as a doctor. During those years, I was forced to study many subjects—anatomy, physiology, biochemistry, pharmacology, pathology, microbiology, forensic medicine, ENT, ophthalmology, public health medicine, internal medicine, neurology, paediatrics, dentistry, anaesthetics, psychiatry, general surgery, orthopaedics, urology, dermatology and venereology, obstetrics and gynaecology … the list goes on.

We were expected to know about each specialty in some detail. We read elaborate textbooks about the common (and uncommon) diseases in each, their clinical presentations, and their treatments and prognoses. It didnt seem so strange at the time, probably because everyone was doing it. There was an air of inevitability about it. Yet we forgot most of the intricate details a few days after the exams.

Now, more than a decade down the line and having chosen psychiatry as my career, it seems like …
Dirty water creates an education drain
Authors: Vittal Katikireddi
Journal: BMJ (2004)

A lack of clean water and sanitation is a leading cause of 104 million children worldwide being unable to attend school, says a new report, The Education Drain , published by the charity WaterAid.

The report shows that many children in Africa and Asia are too sick to attend school after using dirty water and do not have time to attend school because they have …
Raft of ideas
Authors: Séamus Phillipsm
Journal: BMJ (2000)

It is said that in Nepal there is a metaphor for everything. Some aspect of the country can represent whatever issues loom large in your life. The search for one's true self is mirrored in the quest for the elusive snow leopard in the high west. The fickle power of fortune is seen in the sudden storms on the high Himalayan ridges. And the danger of too much rash experimentation finds expression in the acquisition of apocalyptic diarrhoea.

So now here I was, in Nepal, after my finals. I thought about my own life issues. The gaining of a medical degree had been my goal for years. Now that I had it, I saw how little it meant. Like a Buddhist acolyte, I was one step closer to Nirvana and the …
Contrast-enhanced endoscopic ultrasound-guided access to nondilated bile duct
Authors: Takeshi Ogura, Tadahiro Yamada, Masanori Yamada, Nobu Nishioka, Kazuhide Higuchi
Journal: Endoscopy (2019)

Endoscopic ultrasound (EUS)-guided biliary access has recently been indicated not only for malignant biliary obstruction but also for benign biliary stricture [1] [2] [3] [4]. Among EUS-guided biliary drainage routes, EUS-guided hepaticogastrostomy (HGS) may be the most challenging procedure because the diameter of the intrahepatic bile duct is smaller than the extrahepatic bile duct. In addition, if the intrahepatic bile duct is not dilated, such as in benign biliary disease, EUS-guided access may be challenging. Recently, EUS-HGS under contrast-enhanced EUS has been reported as a novel technique [5]. The concept of this technique is to obtain a clear image of the bile duct. We herein describe technical tips for contrast-enhanced EUS-guided access to a nondilated bile duct.