tbuckley/cabot-search huggingface dataset:
Risk of Melanoma Recurrence After Diagnosis of a High-Risk Primary Tumor
Authors: Lena A. von Schuckmann, Maria Celia B. Hughes, Reza Ghiasvand, Maryrose Malt, Jolieke C. van der Pols, Vanessa L. Beesley, Kiarash Khosrotehrani, B. Mark Smithers, Adele C. Green
Journal: JAMA Dermatology (2019)

With emerging new systemic treatments for metastatic melanoma, early detection of disease recurrence is increasingly important.To investigate the risk of melanoma recurrence in patients with a localized melanoma at a high risk of metastasis.A total of 1254 patients with newly diagnosed, histologically confirmed tumor category T1b to T4b melanoma in Queensland, Australia, were recruited prospectively between October 1, 2010, and October 1, 2014, for participation in a cohort study. Data analysis was conducted from February 8, 2018, to February 20, 2019. We used Cox proportional hazards regression analysis to examine associations between patient and tumor factors and melanoma recurrence.Disease-free survival (DFS) by melanoma tumor category defined by the 7th vs 8th editions of the AJCC Cancer Staging Manual (AJCC 7 vs AJCC 8).Melanoma recurrences were self-reported through follow-up questionnaires administered every 6 months and confirmed by histologic or imaging findings.Of 1254 patients recruited, 825 individuals (65.8%) agreed to participate. Thirty-six were found to be ineligible after providing consent and a further 89 patients were excluded after reclassifying tumors using AJCC 8, leaving 700 participants with high-risk primary melanoma (mean [SD] age, 62.2 [13.5] years; 410 [58.6%] men). Independent predictors of recurrence were head or neck site of primary tumor, ulceration, thickness, and mitotic rate greater than 3/mm2 (hazard ratio, 2.36; 95% CI, 1.19-4.71). Ninety-four patients (13.4%) developed a recurrence within 2 years of diagnosis: 66 tumors (70.2%) were locoregional, and 28 tumors (29.8%) developed at distant sites. After surgery for locoregional disease, 37 of 64 patients (57.8%) remained disease free at 2 years, 7 patients (10.9%) developed new locoregional recurrence, and 20 patients (31.3%), developed distant disease. Two-year DFS was similar when comparing AJCC 7 and AJCC 8, for T1b (AJCC 7, 253 [93.3% DFS]; AJCC 8, 242 [93.0% DFS]) and T4b (AJCC 7 and AJCC 8, 50 [68.0% DFS] category tumors in both editions. Patients with T2a to T4a tumors who did not have a sentinel lymph node biopsy (SLNB) at diagnosis had lower DFS than patients with the same tumor category and a negative SLNB (T2a: 136 [91.1%; 95% CI, 86.4-95.9] vs 96 [96.9%; 95 % CI, 93.4-100.0]; T4a: 33 [78.8%; 95% CI, 64.8-92.7] vs 6 [83.3; 95% CI, 53.5-100.0]).These findings suggest that 13.4% of patients with a high-risk primary melanoma will experience disease recurrence within 2 years. Head or neck location of initial tumor, SLNB positivity, and signs of rapid tumor growth may be associated with primary melanoma recurrence.
Lend your idle computer to research
Authors: Balaji Ravichandran
Journal: BMJ (2008)

Ever dreamt of being part of the next biomedical revolution? Well, if you have a computer and an internet connection, here is your chance. The concept, called “distributed computing infrastructure,” is simple. For a given project, massive amounts of data are collected by central servers, split up into small units, and sent to your computer through the internet. A piece of software called BOINC (Berkeley Open Infrastructure for Network Computing; http://boinc.berkeley.edu) analyses these bits of data in the background as you continue working normally on a …
Molecular Characterization of Acute Myeloid Leukemia Patients with Normal Karyotype
Authors: Aziz Nazha, Manja Meggendorfer, Sudipto Mukherjee, Wencke Walter, Stephan Hutter, Ahed Makhoul, Cassandra M. Hirsch, Bartlomiej P. Przychodzen, Hetty E. Carraway, Yasunobu Nagata, Yihong Guan, Teodora Kuzmanovic, Metis Hasipek, Babal K. Jha, Jaroslaw P. Maciejewski, Claudia Haferlach, Mikkael A. Sekeres, Torsten Haferlach
Journal: Blood (2018)
Viewpoint: On the front line
Authors: Sam Ley
Journal: BMJ (2007)

I am a member of 144 Parachute Medical Squadron, UK Royal Army Medical Corps. People often ask if I would be happy to serve in a conflict. What if it was to fight in a war for political motives with which I do not agree? How about treating an enemy soldier? People also occasionally voice the opinions such as “being a medic in the army means you condone war and human suffering.”



Whether members of the Defence Medical Services agree with war or not, it is their military and moral duty to provide health care to …
Renal failure after cardiac surgery
Authors: Vanash Mahendra Patel, Nikesh Chandarana
Journal: BMJ (2007)

A 52 year old non-smoking black man presented with a two week history of dysuria, malaise, fever, and rigors. In the past he had had recurrent urinary tract infections requiring antibiotic treatment.

On clinical examination he had a temperature of 38.9°C, his pulse rate was 70 beats/min, and blood pressure was 125/70 mm Hg. A pansystolic murmur was auscultated, which was loudest at the apex beat and radiated to the left axilla. Urine dipstick was positive for protein and blood. Laboratory investigations showed a haemoglobin concentration of 9.7 g/dl (normocytic), white cell count of 12.2 ¥ 109/l (neutrophil count 8.8 ¥ 109/l), C reactive protein of 106 mg/l, erythrocyte sedimentation rate of 130 mm in the first hour, raised corrected calcium (2.73 mmol/l), and a total protein count of 113 g/l. Renal …
Book review: Saunders' Pocket Essentials of Clinical Medicine
Authors: Stephen Ford
Journal: BMJ (2000)

Think of situations when a dinky medical textbook is useful: panic revision on the bus; outpatient clinics, when fathoming your consultant's inscrutable diagnoses; nocturnal on.calls with exhausted senior house officers; romantic dinners when the conversation runs dry.

The gastroenterology specialists Ballinger and Patchett offer salvation from such plights by way of an attractive rival to the Oxford Handbooks and companion to the Kumar and Clark texts. At £11.99 it represents …
What kind of doctor do you want to be?
Authors: Rhona MacDonald
Journal: BMJ (2001)

There are plenty of choices

If you are reading this you have probably already answered the question, “What do you want to do when you grow up?” The multimillion dollar question you need to answer now is, “What kind of doctor do you want to be?”

There is usually no formal career advice during undergraduate training so future choices might be based solely on undergraduate experiences. However, judging potential career options by experience alone is not a balanced approach as it is not very objective. If a certain specialty was not as well taught as others and experiences were mostly negative - such as hanging around wards waiting for someone to teach you - then that option will probably be low down your list of potential possibilities.

Ideally, all specialties should be taught well so that you get a non.prejudiced view of them all which would make your decision less biased. However, back in the real world, what …
15 minute interview: The neurosurgeon who separates Siamese twins
Authors: Sadat Edroos
Journal: BMJ (2004)

Professor Keith Goh qualified from the National University of Singapore Medical School in 1985. After completing his basic surgical training, he moved to Prince of Wales Hospital in Hong Kong in 1992 to specialise in neurosurgery. He later took up a clinical training fellowship at the Beth Israel Institute of Neurology and Neurosurgery in New York, where he specialised in paediatric neurosurgery. Keith Goh and his wife returned home to Singapore in 1999, and two years later headed the first of three operations to separate conjoined twins. The second of these was unprecedented in that it involved an adult pair. Laleh and Ladan Bijani were 29 at the time, and their story captured the imagination not just of Singaporeans but of the whole world.1 Unfortunately, they died during the operation. Professor Goh is currently working in Hong Kong.

I began my surgical career late, compared with most people. I ad a lot of fun in medical school. I got by my exams but didn't really excel. I began searching for which path to take as a doctor, and that's when …
Abstract 20514: Cardiac-Specific Overexpression of Histone Deacetylase 4 Promotes Cardiac Dysfunction and Enhances Cardiac Remodeling
Authors: Ling Zhang, Jianfeng Du, Yu T Zhao, Jianguo Wang, Hao Wang, Megan Denicola, Ting C Zhao
Journal: Circulation (2017)

Introduction: Histone deacetylases are recently identified as key regulators for cardiac development and pathological disorders. However, the function of this specific HDAC isoform in the heart in controlling cardiac development and cardiac function remains unknown. Hypothesis: This study sought to determine whether cardiac-specific overexpression of HDAC4 (HDAC4-Tg) could modulate cardiac dysfunction during the course of development. Methods: Adult wild type mice and HDAC4-Tg mice were assessed for myocyte proliferation, vascular growth, and cardiac hypertrophy from post-natal day 3 (P3), one month, and six-month old age. Histological analyses were performed to assess for cardiomyocyte size and cardiac remodeling. TUNEL was used to assess for cardiac apoptosis. qPCR was employed to detect transcription of fetal gene expression. Cardiac function was monitored by using echocardiography. Results: As compared to wild type mice, HDAC4-Tg mice attenuated myocyte proliferation, as indicated by the decrease in K...
Why memories should be noted
Authors: Seye Abimbola
Journal: BMJ (2008)

Bullying. The dominance, the arrogance, the vanity of it all. Think of the medical students who must keep their heads low. They are always on the line. They have to make the right impressions—or at least avoid making the wrong ones.



What baffles me is that most if not all consultants must have been irked, piqued, offended, disgusted, even exasperated while they were bullied as medical students. So why is it that some still end up bullies? What fuels this vicious circle?

Do memories of these wrongs merely dissolve into a fast receding past? Memories, of course, decay. Does the mind simply …
Abdominal x rays made easy: bones and soft tissues
Authors: Ian Bickle, Barry Kelly
Journal: BMJ (2002)

In the fifth article in their series on how to read plain abdominal x ray films, Ian Bickle and Barry Kelly discuss inspecting bones and soft tissues and interpreting the findings

Often, little attention is paid to bones and soft tissues when reviewing an abdominal x ray film. However, careful inspection may find new, associated, or longstanding concomitant pathology. With concomitant pathology two abnormalities are identified but have no direct association--for example, an abdominal aortic aneurysm and a fracture of the femoral neck. So including bone and soft tissues as part of a systematic review ensures that no significant findings are overlooked (box 1).

### Box 1: Interpreting an abdominal x ray film (a reminder)RETURN TO TEXT

Let's begin by reminding ourselves of the bones and soft tissues shown on an abdominal x ray film.

Bones include the lower ribs and their articulations, the lower thoracic and the lumbar spine, the bony pelvis, and the proximal femora. Soft tissues include the abdominal viscera and the surrounding muscle and soft tissues that envelop the lower trunk.

Pathology of the bone and soft tissues can be identified on abdominal x …
A single-institution experience with the hyper-CVAD regimen in aggressive NHL.
Authors: Mariam Younas, Stephanie A. Gregory, Ahmad Jajeh, Melissa L. Larson, Taha Al-Rifai
Journal: Journal of Clinical Oncology (2012)

e18510 Background: Hyper-CVAD (± rituximab) is a chemotherapy regimen designed as a treatment for aggressive hematological malignancies. It consists of 8 cycles. Cycle 1, 3, 5, 7 (3-4 weeks/cycle) includes cyclophosphamide 300mg/m 2 IV over 2 hours (hrs) every 12 hrs for 6 doses on day 1-3 + Mesna 600mg/m 2 per day continuous IV on days 1-3 to start 1 hr before cyclophosphamide till 12 hrs after completion of cyclophosphamide + vincristine 2mg IV on days 4 and 11 + doxorubicin 50mg/m 2 IV over 24 hrs on Day 4 + dexamethasone 40mg daily orally on days 1-4 and days 11-14. Cycle 2, 4, 6, 8 (3-4 weeks/cycle) consist of high dose methotrexate (MTX) (200mg/m 2 ) IV over 2 hrs followed by 800mg/m 2 continuous IV infusion over 22 hrs on day 1 + cytarabine 3gm/m 2 (1gm/m 2 for patient age over 60 years old) IV over 2 hrs every 12 hrs for doses on days 2 and 3 + leucovorin 50mg IV every 6 hrs starting 12 hrs after completion of MTX till MTX level &lt; 0.05µM. Hyper-CVAD is a short intensified regimen given over eight months compared to known therapy for ALL and Burkitt lymphoma. Methods: Retrospective review of all cases of acute lymphoblastic leukemia/lymphoma and Burkitt’s lymphoma between 2000 and 2012 was done. It included all patients and evaluated response to therapy including Hyper-CVAD. Results: A total of 79 patients with aggressive acute lymphoblastic leukemia/lymphoma and Burkitt’s NHL were analyzed. Mean age 39 years (range 15-75 years). All patients were admitted at least twice with febrile neutropenia. Prolonged cytopenias were observed in more than 50% of patients. Conclusions: Hyper-CVAD is an intense regimen that produces high rates of clinical remission in less than 8 months of therapy compared to established regimen for aggressive hematological malignancies. [Table: see text]
Minerva: March 2000
Authors: Elizabeth Bruce
Journal: BMJ (2000)

New objects tend to stand out in a familiar environment, and neurologists have now begun to understand why. Humans have frontal lobes that direct their attention to new visual stimuli ( Journal of Neurology, Neurosurgery and Psychiatry 2000;68:18.24). In visual experiments, people with infarctions in the dorsolateral prefrontal cortex paid substantially less attention to new targets than did normal controls. This might explain the apathy characteristic of this kind of stroke, say the researchers.

Newborn babies love skin to skin contact. It's warm, comforting, even analgesic, according to a study in Pediatrics (www.pediatrics.org/cgi/content/full/105/1/14). Neonates laid naked but for a nappy on their mothers' chests during a heel prick cried 82% less than control infants laid in a cot. Other studies will have to examine whether skin to skin contact is any better than straightforward cuddling.

Patients often disagree with doctors over what is good for them, even when given the evidence from trials ( Medical Journal of Australia 2000;171:9.12). Surveys of Australian patients show that they are much less likely to want treatment, even lifesaving treatment such as coronary artery bypass surgery, than their doctors think. This is …
Abstract 14767: Delayed R-Wave Peak Time on the 12-lead ECG is Associated With Increased Risk of Sudden Death
Authors: Navid Darouian, Kumar Narayanan, Audrey Uy-Evanado, Carmen Teodorescu, Kyndaron Reinier, Harpriya Chugh, Karen Gunson, Jonathan Jui, Sumeet S Chugh
Journal: Circulation (2015)

Background: Left ventricular hypertrophy (LVH) is associated with sudden cardiac death (SCD), and there is emerging evidence for unique electrical vs. ventricular myocardial mass related mechanisms. We investigated the correlation between delayed R-Wave Peak Time (DRWPT), or intrinsicoid deflection, in the lateral precordial leads and LV mass in patients who suffered SCD. Methods: In an ongoing prospective, population based study of SCD in a Northwestern US metro region (approx. 1 million population), SCD cases were compared to geographic controls with coronary artery disease (CAD) and no SCD. Archived ECGs (closest and unrelated to SCD event for cases) were evaluated for the presence of DRWPT defined as an intrinsicoid deflection of ≥ 0.05 seconds in V5 or V6. LV mass from echocardiograms and detailed clinical information was obtained for all subjects. Patients with wide QRS (&gt;100 ms) were excluded. Results: Cases (n=146, Age: 67.7 ± 14.6 yrs, Male: 55.5%) as compared to controls (n=227, Age: 66.3 ± 11.5 yrs, Male: 59.0%) were significantly more likely to have DRWPT on ECG (17.1% vs 9.2%, p=0.02). DRPWT correlated poorly with echo determined LVH (Kappa statistic 0.03) with no significant difference in mean adjusted LV Mass between those with DRWPT versus those without (104.3 ± 34.9 vs. 100.9 ± 33.5 g/m 2 , p =0.55). Multivariable analysis adjusting for diabetes, renal failure, LV dysfunction and angiotensin receptor blocker use demonstrated a significant association of DRWPT with SCD risk (OR: 2.2, 95% CI: 1.1-4.3, p=0.020). With the addition of echo LVH to the model, this risk was not significantly attenuated (OR: 2.6, 95% CI: 1.3-5.4, p=0.008). Conclusion: DRWPT was independently associated with SCD risk, and not correlated with increased LV mass. These findings suggest that abnormalities of myocardial conduction velocity should be explored as mechanisms of electrical risk in LVH and SCD.
Körperwelten: the fascination of authenticity
Authors: Dora Vertes
Journal: BMJ (2002)

As the now notorious Professor Gunther von Hagenss controversial “Body Worlds” exhibition finally reaches London, Dora Vertes remains outraged after seeing it in Brussels …

he human body is the most fascinating machine I have ever seen. I am now finishing my third year of medical school, and I chose to study medicine so that I might understand the body better.

I have studied the anatomy of the human body and done dissection: I learnt to respect death. I have met patients, listened to their problems, and tried to understand them: I have learnt to respect life.



Gunther von Hagens thinks that everyone has to learn about the body. He uncovers it to let people see whats inside—the machine, without soul. He invented a technique called plastination—the fixation of an organic object, in this case the human body—which prevents putrefaction. After dissection, the body is dehydrated and then impregnated with a resin that polymerises and hardens in the tissues.

The technique itself is interesting: the dissected part of the body …
The Man Who Got Lost In Duty Free - Video Casebook: Medicine
Authors: Kay Seong Ngoo
Journal: BMJ (2001)

The title is bewildering and this will certainly encourage the reader to explore beyond the covers. This is not a mystery novelette; it is a compilation of 50 real medical cases. It is packed with photographs of the patients involved and accompanied by a CD Rom filled with video clips that effectively illustrate the diseases.

Professor Levy introduces the readers to a man lost in an airport who subsequently became irritable and confused …
A patient with confusing symptoms
Authors: Victoria Matheson, James A O Ahlquist
Journal: BMJ (2006)

A 48 year old woman presented to her general practitioner with a 16 month history of her mouth and fingers going numb and tingly. She also complained of feeling vacant and mentally detached. She reported numerous episodes of wandering, confusion, repeating words inappropriately, looking vacant, and not responding. All these events were witnessed by her children, but she had no recollection of them. All her symptoms were improved on eating.

She was otherwise well, with no clinical features of Addison's disease, no past medical history of note, and was on no regular medication other than oestrogen implants.

Home capillary glucose readings were 3.2 mmol/l, 2.7 mmol/l, 2.7 mmol/l, and 1.2 mmol/l (reference range 4-8 mmol/l).

She was admitted for an overnight fast and was found to be completely unrousable by nursing staff in the morning.



1.  What are the causes of hypoglycaemia?

2.  What structure is seen on the computed tomography scan (line), and what is the abnormality (arrow)?

3.  What does the histology image (figure 2) show?

4.  What is the most likely diagnosis?

5.  What is c peptide and what is its role in the diagnosis of hypoglycaemia?

1.  A. Exogenous drugs—for example, insulin, oral hypoglycaemics, alcohol. B. Adrenal insufficiency or hypopituitarism. C. Liver failure. D. Islet cell tumour. E. Non-pancreatic neoplasm. F. Reactive …
Abstract P172: Associations of Body Mass Index From Early-, Mid-, and Older- Adulthood With Incident Heart Failure and Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis
Authors: Michael J Fliotsos, Di Zhao, Chiadi Ndumele, Eliseo Guallar, Gregory L Burke, Dhananjay Vaidya, Vishal Rao, Joseph (Chris) A Delaney, Erin D Michos
Journal: Circulation (2018)

Background: Obesity contributes significantly to increased risk of cardiovascular disease (CVD) and particularly heart failure (HF). However, an elevated body mass index (BMI) in older adults might not fully reflect the additional risk associated with excess weight at a younger age. We determined the prognostic value of self-reported weights from early- and mid-adulthood, after accounting for current weight, with incident HF and CVD. Methods: We studied 6,437 MESA participants (aged 45-84 years) with self-reported weights at ages 20 and 40 (by questionnaire) and measured weight at the baseline exam (2000-2002). BMI was calculated using measured height at baseline. Cox hazard models assessed relationships between BMI at each age with HF and CVD. Results: Participant mean age was 62±10 years and 53% were women. Over a median follow-up of 13 years, 290 HF and 828 CVD events occurred. Elevated BMI at each age point (age 20, age 40, and MESA baseline) was independently associated with HF, and to lesser extent with CVD ( Figure ). After adjustment for demographics, CVD risk factors, and baseline BMI, higher self-reported BMIs at ages 20 and 40 years were independently associated with increased risk of incident HF with hazard ratios (HR) 1.18 (95% CI 1.05-1.32) and 1.30 (1.15-1.46), respectively, per 1 SD higher BMI. Participants with self-reported obesity (BMI≥30) at age 20 [HR 3.20 (1.93-5.32)] and age 40 [HR 1.92 (1.31-2.83)] had greater HF risk, even after accounting for current BMI. For incident CVD, only higher self-reported BMI at age 20 (per 1 SD) was associated after accounting for current BMI [HR 1.09 (1.01-1.17)]. Conclusions: Assessment of self-reported lifetime weights is a simple tool utilized in any clinical encounter. Although subject to recall bias, self-reported weights provide prognostic information about future HF risk, incremental to current BMI, in a multi-ethnic cohort of middle-aged to older adults.
Increased risk of melanoma in airline pilots
Authors: Negin Shamsian
Journal: BMJ (2000)

Commercial airline pilots have a substantially increased risk of developing malignant melanoma, according to new research from Iceland. Dr Rafnsson and his team from the University of Reykjavik found that the rate of malignant melanoma was 10 times higher in a group of 458 commercial airline pilots than in Iceland's general population. Their findings were published in the …