tbuckley/cabot-search huggingface dataset:
Fragmentation of Gallstones by Extracorporeal Shock Waves
Authors: Tilman Sauerbruch, Michael Delius, Gustav Paumgartner, Joseph Holl, Othmar Wess, Werner Weber, Wolfgang Hepp, Walter Brendel
Journal: New England Journal of Medicine (1986)

We treated nine patients with functioning gallbladders containing one to three symptomatic radiolucent stones not larger than 25 mm in diameter, as well as five patients with stones in the common bile duct that were not removable by endoscopic procedures, by means of extracorporeally generated shock waves during general anesthesia. The patients with gallbladder stones received adjuvant treatment with a combination of ursodeoxycholic acid and chenodeoxycholic acid. All gallbladder stones were disintegrated into sludge or fragments with diameters of no more than 8 mm. In six of the nine patients the fragments disappeared completely within 1 to 25 weeks. No adverse effects were detected during a follow-up period of 10 to 34 weeks, except transient biliary pain in two patients, with mild pancreatitis in one. In four of the five patients with common-bile-duct stones, shock-wave treatment permitted stone disintegration and successful endoscopic extraction or spontaneous passage of fragments. We conclude that gallstone disease may be treated successfully and without serious adverse effects by extracorporeally generated shock waves in selected patients. (N Engl J Med 1986; 314:818–22.)
Learning to Talk
Authors: Alison Landrey
Journal: JAMA (2012)

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 HomeNew OnlineCurrent IssueFor Authors 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) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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 journal
Covid-19: how to use your time when clinical placements are postponed
Authors: John A Henry, Susannah Black, Matthew Gowell, Elizabeth Morris
Journal: BMJ (2020)

Most UK medical schools have postponed clinical teaching because of the covid-19 pandemic, leaving students, who would usually be busy with exam preparations and clinical commitments, with time off. Some students might find a long period of unstructured study daunting. In this article, we share our thoughts and experiences on how you might use this time positively by continuing learning and professional development and helping the national efforts in dealing with covid-19 (box 1).

Box 1 
### Tips for using time positively during the covid-19 pandemic

#### Exam preparation

#### Preparing for practice

#### Career development

#### Look out for others

#### Look after yourselfRETURN TO TEXT

### Improve your learning strategies and prepare educational resources

Medicine involves lifelong learning, so find effective study strategies that work for you. With the pressures of upcoming exams and a seemingly endless amount to learn, it is tempting to rote learn topics, but this will give you only a superficial grasp of them.1 Use this time to develop more effective learning strategies that support long term knowledge retention. Strategies might include:

Following your medical school’s curriculum will ensure you cover the right topics.

You can commit …
Identification and Characterization of Trajectories of Cardiac Allograft Vasculopathy After Heart Transplantation
Authors: Alexandre Loupy, Guillaume Coutance, Guillaume Bonnet, Jan Van Keer, Marc Raynaud, Olivier Aubert, Marie-Cécile Bories, Maud Racapé, Daniel Yoo, Jean-Paul Duong Van Huyen, Patrick Bruneval, Jean-Luc Taupin, Carmen Lefaucheur, Shaida Varnous, Pascal Leprince, Romain Guillemain, Jean-Philippe Empana, Ryan Levine, Maarten Naesens, Jigneh K. Patel, Xavier Jouven, Jon Kobashigawa
Journal: Circulation (2020)

Cardiac allograft vasculopathy (CAV) is a major contributor of heart transplant recipient mortality. Little is known about the prototypes of CAV trajectories at the population level. We aimed to identify the different evolutionary profiles of CAV and to determine the respective contribution of immune and nonimmune factors in CAV development.Heart transplant recipients were from 4 academic centers (Pitié-Salpêtrière and Georges Pompidou Hospital, Paris, Katholieke Universiteit Leuven, and Cedars-Sinai, Los Angeles; 2004-2016). Patients underwent prospective, protocol-based monitoring consisting of repeated coronary angiographies together with systematic assessments of clinical, histological, and immunologic parameters. The main outcome was a prediction for CAV trajectory. We identified CAV trajectories by using unsupervised latent class mixed models. We then identified the independent predictive variables of the CAV trajectories and their association with mortality.A total of 1301 patients were included (815 and 486 in the European and US cohorts, respectively). The median follow-up after transplantation was 6.6 (interquartile range, 4-9.1) years with 4710 coronary angiographies analyzed. We identified 4 distinct profiles of CAV trajectories over 10 years. The 4 trajectories were characterized by (1) patients without CAV at 1 year and nonprogression over time (56.3%), (2) patients without CAV at 1 year and late-onset slow CAV progression (7.6%), (3) patients with mild CAV at 1 year and mild progression over time (23.1%), and (4) patients with mild CAV at 1 year and accelerated progression (13.0%). This model showed good discrimination (0.92). Among candidate predictors assessed, 6 early independent predictors of these trajectories were identified: donor age (P<0.001), donor male sex (P<0.001), donor tobacco consumption (P=0.001), recipient dyslipidemia (P=0.009), class II anti-human leukocyte antigen donor-specific antibodies (P=0.004), and acute cellular rejection ≥2R (P=0.028). The 4 CAV trajectories manifested consistently in the US independent cohort with similar discrimination (0.97) and in different clinical scenarios, and showed gradients for overall-cause mortality (P<0.001).In a large multicenter and highly phenotyped prospective cohort of heart transplant recipients, we identified 4 CAV trajectories and their respective independent predictive variables. Our results provide the basis for a trajectory-based assessment of patients undergoing heart transplantation for early risk stratification, patient monitoring, and clinical trials. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04117152.
TCT-566 Impact of Type-II Endoleak on Aneurysm Sac Growth and Predictors of Type-II Endoleak after Endovascular Aneurysm Repair
Authors: Ren Kawaguchi, Yusuke Miyaishi, Hakuken Kan, Masahiko Ezure, Tatsuo Kaneko, Shigeru Oshima
Journal: Journal of the American College of Cardiology (2014)
Nuclear Medicine Imaging Techniques of the Neuroendocrine System
Authors: Alexander Haug
Journal: Clinical Nuclear Medicine (2020)

Nuclear medicine plays a major role in well-differentiated neuroendocrine tumors (NETs). Due to the unique characteristics of NETs, such as very high expression of somatostatin receptors, somatostatin receptor positron emission tomography (SSTR PET) is considered the gold standard in imaging. SSTR PET has proven its unsurpassed diagnostic accuracy in prospective trials and has a major influence on the choice of the right treatment. Its use is well established, and it is recommended for initial staging, treatment monitoring, and the follow-up of patients with NET. In other tumors of the neuroendocrine system, such as pheochromocytoma and paraganglioma, nuclear medicine offers several diagnostic approaches for enhanced diagnosis. [123I]-MIBG scintigraphy, including single-photon emission computed tomography (SPECT), is of great value, especially in hormone-active tumors. PET tracers such as fluorodeoxyglucose (FDG), [18F]-DOPA, and SSTR analogs have been introduced recently and offer similar diagnostic accuracy. In neuroblastoma, [123I]-MIBG scintigraphy is the imaging of choice for staging and treatment monitoring. In medullary thyroid cancer, FDG, SSTR, and [18F]-DOPA PET/CT can be considered as modalities with equal diagnostic accuracy.
Association Between State Policies Using Medicaid Exclusions to Sanction Noncompliance With Welfare Work Requirements and Medicaid Participation Among Low-Income Adults
Authors: Atheendar S. Venkataramani, Elizabeth F. Bair, Erica Dixon, Kristin A. Linn, William J. Ferrell, Kevin G. Volpp, Kristen Underhill
Journal: JAMA Network Open (2020)

This cohort study examines the association of implementation of Medicaid sanctions in the Temporary Assistance for Needy Families program with Medicaid coverage rates among low-income adults.
Correction: Complement-activating donor-specific anti-HLA antibodies and solid organ transplant survival: A systematic review and meta-analysis
Authors: Antoine Bouquegneau, Charlotte Loheac, Olivier Aubert, Yassine Bouatou, Denis Viglietti, Jean–Philippe Empana, Camilo Ulloa, Mohammad Hassan Murad, Christophe Legendre, Denis Glotz, Annette M. Jackson, Adriana Zeevi, Stephan Schaub, Jean–Luc Taupin, Elaine F. Reed, John J. Friedewald, Dolly B. Tyan, Caner Süsal, Ron Shapiro, E. Steve Woodle, Luis G. Hidalgo, Jacqueline O’Leary, Robert A. Montgomery, Jon Kobashigawa, Xavier Jouven, Patricia Jabre, Carmen Lefaucheur, Alexandre Loupy
Journal: PLoS Medicine (2018)

[This corrects the article DOI: 10.1371/journal.pmed.1002572.].
Rifabutin-Based Triple Therapy (RHB-105) for <i>Helicobacter pylori</i> Eradication
Authors: David Y. Graham, Yamil Canaan, James Maher, Gregory Wiener, Kristina G. Hulten, Ira N. Kalfus
Journal: Annals of Internal Medicine (2020)

Although consensus supports eradication of Helicobacter pylori infections, antimicrobial resistance has substantially reduced eradication rates with most current therapies.To assess the effectiveness of a novel rifabutin-based therapy (RHB-105) for H pylori eradication.Phase 3, double-blind trial (ERADICATE Hp2). (ClinicalTrials.gov: NCT03198507).55 clinical research sites in the United States.455 treatment-naive adults with epigastric discomfort and confirmed H pylori infection.RHB-105 (amoxicillin, 3 g; omeprazole, 120 mg; and rifabutin, 150 mg) versus active comparator (amoxicillin, 3 g, and omeprazole, 120 mg), given as 4 capsules every 8 hours for 14 days.Between-group difference for H pylori eradication rate, demonstrated by 13C urea breath test 4 weeks after treatment, analyzed by using the χ2 test.In the intention-to-treat population, the eradication rate was higher with RHB-105 than with the active comparator (228 vs. 227 patients, respectively; 83.8% [95% CI, 78.4% to 88.0%] vs. 57.7% [95% CI, 51.2% to 64.0%]; P < 0.001). Eradication rates were unaffected by resistance to clarithromycin or metronidazole. No rifabutin resistance was detected. The most commonly reported adverse events (incidence ≥5%) were diarrhea (10.1% with RHB-105 vs. 7.9% with active comparator), headache (7.5% vs. 7.0%), and nausea (4.8% vs. 5.3%).Persons of Asian descent were excluded because of their higher prevalence of poor cytochrome P450 2C19 metabolizers.These findings suggest potential for RHB-105 as first-line empirical H pylori therapy, addressing an unmet need in the current environment of increasing antibiotic resistance.RedHill Biopharma Ltd.
Metrics of salbutamol use as predictors of future adverse outcomes in asthma
Authors: Mark Weatherall, Mitesh Patel, Janine Pilcher, Helen Reddel, Dominick Shaw, Richard Beasley
Journal: European Respiratory Journal (2013)

Background Beta-agonist overuse is associated with adverse outcomes in asthma, however the relationships between different metrics of salbutamol use and future risk are uncertain. Aim To explore the relationship between metrics of salbutamol use and future severe exacerbations, poor asthma control and salbutamol overuse. Methods A 24-week randomised controlled trial in adult asthma included treatment with fixed-dose maintenance budesonide/formoterol and salbutamol as reliever, with actual medication use measured electronically. A nested cohort study explored the relationship between metrics of baseline salbutamol use over two weeks and future severe asthma exacerbations, poor asthma control [ACQ-5 score ≥1.5] or 'extreme' salbutamol overuse [>32 salbutamol actuations/24-hour period]. Results Higher mean daily salbutamol use (per two actuations/day) [Odds Ratio (OR) (95% CI) 1.24 (1.06-1.46)], higher days of salbutamol use (per two days in two weeks) [OR 1.15 (1.00-1.31)] and higher maximal 24-hours use (per two actuations/day) [OR 1.09 (1.02-1.16)] were all significantly associated with future severe exacerbations. Higher mean daily salbutamol use was associated with future poor control [OR 1.13 (1.02-1.26)]. Higher mean daily salbutamol use [OR 2.73 (1.84-4.07)], number of days of use [OR 1.46 (1.24-1.71)], and maximal daily salbutamol use [OR 1.57 (1.31-1.89)] were associated with an increased risk of future extreme salbutamol overuse. Conclusion Electronically-recorded frequency of current salbutamol use is a strong predictor of risk of future adverse outcomes in asthma, with average daily salbutamol use performing the best in predicting future risk. Funding Health Research Council of New Zealand.
OTU-01 The B-ADENOMA trial: a multicentre, randomised controlled trial of adenoma detection with endocuff vision
Authors: Martin Walls, Andrew Brand, Wee Sing Ngu, Clive Stokes, Linda Sharp, Zoe Hoare, Nikki Totton, Alexandra Bastable, Pradeep Bhandari, Colin Rees
Journal: Endoscopy (2019)

<h3>Introduction</h3> Adenoma detection rate (ADR) is the most important measure of mucosal visualisation at lower gastrointestinal endoscopy. Higher ADRs are associated with lower post-colonoscopy colorectal cancer (PCCRC) rates with a 3% reduction in PCCRCs with every 1% increase in ADR. In the English flexible sigmoidoscopy screening programme (Bowel scope) there is also significant variation in ADRs across screening centres. Large studies have demonstrated improved detection rates during screening procedures utilising Endocuff Vision™ (EV). The aim of this study is to determine the effect of Endocuff Vision on ADR in a flexible sigmoidoscopy bowel cancer screening population. <h3>Methods</h3> B-ADENOMA was a multicentre, randomised controlled trial involving 16 English Bowel scope screening centres, performed between February 2017 and April 2018. Patients attending for Bowel scope screening were randomised to Endocuff™-assisted Bowel scope (EAB) or Standard Bowel scope (SB). Adenoma Detection Rate (ADR) was compared between trial arms on an intention-to-treat basis. Secondary analyses compared Mean number of Adenomas per Procedure (MAP), Polyp Detection Rate (PDR), characteristics and location of polyps, procedural characteristics between arms and made comparisons with national Bowel scope data. Patient experience, procedure extent and complication rates were assessed for non-inferiority. <h3>Results</h3> 3222 patients were randomised (53% male) to receive EAB (n=1610) or SB (n=1612). Baseline demographics were comparable between the two arms. ADR in the EAB arm was 13.3% and in the SB arm was 12.2% (p=0.353). Also, no statistically significant differences between arms were found in MAP, PDR, polyp morphology or location. Patient experience and complication rates were similar in both arms. The cuff exchange rate in the EAB arm was 4.2%. ADR in the SB arm was 3.1% higher than the national ADR (9.1%). <h3>Conclusions</h3> EV did not improve Bowel scope ADR when compared with standard Bowel scope. ADR in both arms was higher than the national ADR. This suggests that, where detection rates are already high, use of EV does not improve detection further. Reasons for the high ADR in the SB arm require further exploration but may include selection effects at centre level and contamination effects at endoscopist level.
Renal, Cardiovascular, and Safety Outcomes of Canagliflozin by Baseline Kidney Function: A Secondary Analysis of the CREDENCE Randomized Trial
Authors: Meg J. Jardine, Zien Zhou, Kenneth W. Mahaffey, Megumi Oshima, Rajiv Agarwal, George Bakris, Harpreet S. Bajaj, Scott Bull, Christopher P. Cannon, David M. Charytan, Dick de Zeeuw, Gian Luca Di Tanna, Tom Greene, Hiddo J.L. Heerspink, Adeera Levin, Bruce Neal, Carol Pollock, Rose Qiu, Tao Sun, David C. Wheeler, Hong Zhang, Bernard Zinman, Norman Rosenthal, Vlado Perkovic
Journal: Journal of the American Society of Nephrology (2020)

Canagliflozin reduced renal and cardiovascular events in people with type 2 diabetes in the CREDENCE trial. We assessed efficacy and safety of canagliflozin by initial estimated glomerular filtration rate (eGFR).CREDENCE randomly assigned 4401 participants with an eGFR of 30 to <90 ml/min per 1.73 m2 and substantial albuminuria to canagliflozin 100 mg or placebo. We used Cox proportional hazards regression to analyze effects on renal and cardiovascular efficacy and safety outcomes within screening eGFR subgroups (30 to <45, 45 to <60, and 60 to <90 ml/min per 1.73 m2) and linear mixed effects models to analyze the effects on eGFR slope.At screening, 1313 (30%), 1279 (29%), and 1809 (41%) participants had an eGFR of 30 to <45, 45 to <60, and 60 to <90 ml/min per 1.73 m2, respectively. The relative benefits of canagliflozin for renal and cardiovascular outcomes appeared consistent among eGFR subgroups (all P interaction >0.11). Subgroups with lower eGFRs, who were at greater risk, exhibited larger absolute benefits for renal outcomes. Canagliflozin's lack of effect on serious adverse events, amputations, and fractures appeared consistent among eGFR subgroups. In all subgroups, canagliflozin use led to an acute eGFR drop followed by relative stabilization of eGFR loss. Among those with an eGFR of 30 to <45 ml/min per 1.73 m2, canagliflozin led to an initial drop of 2.03 ml/min per 1.73 m2. Thereafter, decline in eGFR was slower in the canagliflozin versus placebo group (-1.72 versus -4.33 ml/min per 1.73 m2; between-group difference 2.61 ml/min per 1.73 m2).Canagliflozin safely reduced the risk of renal and cardiovascular events, with consistent results across eGFR subgroups, including the subgroup initiating treatment with an eGFR of 30 to <45 ml/min per 1.73 m2. Absolute benefits for renal outcomes were greatest in subgroups with lower eGFR.Evaluation of the Effects of Canagliflozin on Renal and Cardiovascular Outcomes in Participants With Diabetic Nephropathy (CREDENCE), NCT02065791.
Panel provides new recommendations and advice for doctors on rosacea
Authors: M. Schaller, L.M.C. Almeida, A. Bewley, B. Cribier, J. Del Rosso, N.C. Dlova, R.L. Gallo, R.D. Granstein, G. Kautz, M.J. Mannis, G. Micali, H.H. Oon, M. Rajagopalan, M. Steinhoff, E. Tanghetti, D. Thiboutot, P. Troielli, G. Webster, M. Zierhut, E.J. Zuuren, J. Tan
Journal: British Journal of Dermatology (2020)

Rosacea is a skin disease that mainly affects facial skin and eyes. It has a number of different visible signs and symptoms, or ‘features’. Doctors are currently switching from a subtype approach, which specifies groups of disease features, to a phenotype approach that treats each patient as an individual with their own particular set of features. The 2019 ROSCO panel (a panel of experts) aimed to make recommendations and produce methods that help doctors use the phenotype approach with their rosacea patients. The panel was formed of 19 skin specialists and two eye specialists from around the world. They used a process to vote how far they agreed with statements on rosacea diagnosis and management. Statements with 75% agreement were recorded as recommendations. The panel recommended that doctors should discuss disease burden with patients during appointments and offered questions to help them do this. The main treatment goal should be clear skin, because it can improve many aspects of patients’ lives. New descriptions of how rosacea affects the skin and eyes are provided, to help recognition of this disease. Recent research has been used to update recommendations for treating rosacea, including ways to combine treatments. The panel also developed the Rosacea Tracker tool, which doctors can use with patients to keep an ongoing record of their rosacea and its treatment, and a patient case study library to help doctors recognise common rosacea features. Altogether, these recommendations should continue supporting improvements in the care of patients with rosacea. This is a summary of the study: Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel.
The Urgency of Care during the Covid-19 Pandemic — Learning as We Go
Authors: Eric J. Rubin, David P. Harrington, Joseph W. Hogan, Constantine Gatsonis, Lindsey R. Baden, Mary Beth Hamel
Journal: New England Journal of Medicine (2020)

Chloroquine and hydroxychloroquine, alone or in combination with azithromycin, have been highly touted as potential therapies for Covid-19. The claims of efficacy are based largely on anecdotes and...
Contribution of Serum and Cellular Factors in Host Defense Reactions
Authors: K. Frank Austen, Zanvil A. Cohn
Journal: New England Journal of Medicine (1963)

THE principal noncellular factors definitely involved in host resistance are complement and antibody. Although a specific immune antibody response may be too delayed to protect the immunologically inexperienced host against an overwhelming infection the so-called natural antibodies can contribute to innate or nonspecific resistance. Whether complement and these natural antibodies, which in all likelihood arise as a result of specific or crossreacting subclinical antigenic stimulation, account for all the actions attributed to the properdin system is a matter of much concern and is discussed below.The role of antibody (natural or immune) and complement in mediating serum bactericidal activity against . . .
Frequently asked questions regarding SARS-CoV-2 in cancer patients—recommendations for clinicians caring for patients with malignant diseases
Authors: Marie von Lilienfeld-Toal, Jörg Janne Vehreschild, Oliver Cornely, Livio Pagano, Francesca Compagno, Hans H. Hirsch
Journal: Leukemia (2020)

Since early 2020, the SARS-CoV-2 pandemic has a massive impact on health care systems worldwide. Patients with malignant diseases are assumed to be at increased risk for a worse outcome of SARS-CoV-2 infection, and therefore, guidance regarding prevention and management of the infection as well as safe administration of cancer-therapy is required. Here, we provide recommendations for the management of patients with malignant disease in the times of COVID-19. These recommendations were prepared by an international panel of experts and then consented by the EHA Scientific Working Group on Infection in Hematology. The primary aim is to enable clinicians to provide optimal cancer care as safely as possible, since the most important protection for patients with malignant disease is the best-possible control of the underlying disease.
Covid-19: skin damage with prolonged wear of FFP3 masks
Authors: Anna Payne
Journal: BMJ (2020)

Sayburn refers to Public Health England guidance recommending the use of FFP3 masks when performing aerosol generating procedures and in high risk units where such procedures are performed. 1Thus healthcare workers should wear FFP3 masks in intensive care units housing patients with covid-19, which means several hours of continuous wear.