tbuckley/cabot-search huggingface dataset:
Collateral damage of the covid-19 pandemic: a Dutch perinatal perspective
Authors: E Joanne Verweij, H Ismaili M’hamdi, E A P Steegers, I K M Reiss, S Schoenmakers
Journal: BMJ (2020)

<h3>Objective</h3> We report a case of shoulder dislocation after a brachial plexus block with a double-injection technique using the infraclavicular coracoid approach. <h3>Case Report</h3> An obese woman with no previous episodes of joint dislocation developed an anterior dislocation of the head of the humerus after an infraclavicular coracoid block performed for hand surgery. Dislocation was probably because of a combination of unrecognized glenohumeral instability, paralysis of some muscles of the shoulder, and positioning of her arm on a board below her torso. Shoulder dislocation was recognized after surgical positioning of her arm, and painless reduction was achieved. There were no sequelae after 10-day follow-up. <h3>Conclusions</h3> When motor block of the muscles of the shoulder occurs after brachial plexus anesthesia, special care must be taken in patient positioning to avoid shoulder dislocation.
Pernicious anaemia: self-administration of hydroxocobalamin in the covid-19 crisis
Authors: John Warren
Journal: BMJ (2020)

Mohamed and colleagues explain well the varied presentation and diagnostic difficulties of pernicious anaemia.1 I write as a retired physician, who has had pernicious anaemia for 28 years. The authors repeat the standard guidance that maintenance treatment for patients without neurological symptoms should be 1000 μg hydroxocobalamin every three months; every two months for those with neurological symptoms. Some patients, however, myself included, …
Efficient Coding by Midget and Parasol Ganglion Cells in the Human Retina
Authors: Florentina Soto, Jen-Chun Hsiang, Rithwick Rajagopal, Kisha Piggott, George J. Harocopos, Steven M. Couch, Philip Custer, Josh L. Morgan, Daniel Kerschensteiner
Journal: Neuron (2020)
Tackling UK’s mortality problem: covid-19 and other causes
Authors: Veena S Raleigh
Journal: BMJ (2020)

Tackling UK's mortality problem: covid-19 and other causesWe cannot reduce excess deaths unless we know what's causing them Veena S Raleigh senior fellowThe number of deaths from covid-19 in the UK is among the highest reported internationally, second only to the US. 1 This covid-19 related mortality surge comes on the heels of the historical legacy of stalling improvements in life expectancy in UK. 2 The development of evidence based policies and interventions for tackling both covid-19 and other causes of death is imperative if the UK's mortality problem is to improve.This requires a clear understanding of what's driving mortality.In under three months, SARS-CoV-2 has claimed at least 46 000 lives in England and Wales, 3 overtaking the annual death toll from major conditions such as lung cancer and stroke to become the third leading cause of death in 2020. 4 The death toll from covid-19 is still rising, and even these grim statistics don't fully capture the effect of covid-19 since deaths from other causes also increased (by over 12 000) during the same period.
Advances in the diagnosis and management of IgG4 related disease
Authors: Marco Lanzillotta, Gaia Mancuso, Emanuel Della-Torre
Journal: BMJ (2020)

IgG4 related disease was recognized as a unified disease entity only 15 years ago. Awareness of IgG4 related disease has increased worldwide since then, and specialists are now familiar with most of its clinical manifestations. Involvement of the pancreato-biliary tract, retroperitoneum/aorta, head and neck, and salivary glands are the most frequently observed disease phenotypes, differing in epidemiological features, serological findings, and prognostic outcomes. In view of this multifaceted presentation, IgG4 related disease represents a great mimicker of many neoplastic, inflammatory, and infectious conditions. Histopathology remains key to diagnosis because reliable biomarkers are lacking. Recently released classification criteria will be invaluable in improving early recognition of the disease. IgG4 related disease is highly treatable and responds promptly to glucocorticoids, but it can lead to end stage organ failure and even death if unrecognized. Prolonged courses of corticosteroids are often needed to maintain remission because the disease relapses in most patients. Rapid advancement in our understanding of the pathophysiology of IgG4 related disease is leading to the identification of novel therapeutic targets and possible personalized approaches to treatment.
Response to: ‘Bowman's capsule rupture on renal biopsy improves the outcome prediction of ANCA-associated glomerulonephritis classifications’ by L'Imperio<i>et al</i>
Authors: Dilek Solmaz, Servet Akar
Journal: Annals of the Rheumatic Diseases (2020)

Selection of appropriate outcome measure in ANCA-associated vasculitis.Response to: 'Bowman's capsule rupture on renal biopsy improves the outcome prediction of ANCAassociated glomerulonephritis classifications' by L'Imperio et alWe have read delicately the report by L'Imperio et al. 1 We thank them for their interest in our work.Previously, we evaluated the performance of both Berden's histopathological classification and anti-neutrophil cytoplasmic antibody (ANCA) renal risk score (ARRS) in the prediction of end-stage renal disease in patients with ANCA-associated vasculitis (AAV) with baseline renal involvement and showed that ARRS might be more advantageous, possibly due to the incorporation of baseline glomerular filtration rate as a clinical parameter to the histopathological findings. 2However, L'Imperio et al investigated the prognostic role of the additional glomerular, tubulointerstitial and vascular lesions to the Berden's scheme and ARRS in 52 ANCA-positive patients with AAV all had available renal biopsy, complete clinical data.In their multivariable model, the authors revealed that inclusion of Bowman's capsule rupture improved the prognostic performance of both Berden's classification and ARRS.In their analysis, the selected outcome of interest was the time to need for renal replacement therapy or death (whichever occurred first) and during a median 31 months of follow-up, 13 events developed (that eight out of them were death).However, one should keep in mind that originally both classification schemes were developed to predict the renal outcome in patients with AAV.Although baseline renal involvement is a well-known predictor of mortality in patients with AAV, cardiovascular events and infections are responsible for the vast majority of deaths 3 in those patients.Therefore, the selection of a more appropriate outcome measure might ensure more precise results.
Epigenomes of Human Hearts Reveal New Genetic Variants Relevant for Cardiac Disease and Phenotype
Authors: Wilson Lek Wen Tan, Chukwuemeka George Anene-Nzelu, Eleanor Wong, Chang Jie Mick Lee, Hui San Tan, Sze Jing Tang, Arnaud Perrin, Kan Xing Wu, Wenhao Zheng, Robert John Ashburn, Bangfen Pan, May Yin Lee, Matias Ilmari Autio, Michael P. Morley, Wai Leong Tam, Christine Cheung, Kenneth B. Margulies, Leilei Chen, Thomas P. Cappola, Marie Loh, John Chambers, Shyam Prabhakar, Roger S.Y. Foo, Solmaz Assa, Patrick Ellinor, Janine Felix, Pim van der Harst, Benjamin Meder, Gustav J. Smith, Rewati Tappu
Journal: Circulation Research (2020)

Identifying genetic markers for heterogeneous complex diseases such as heart failure is challenging and requires prohibitively large cohort sizes in genome-wide association studies to meet the stringent threshold of genome-wide statistical significance. On the other hand, chromatin quantitative trait loci, elucidated by direct epigenetic profiling of specific human tissues, may contribute toward prioritizing subthreshold variants for disease association.
Abstract 18348: Exercise Training Mitigates Oxidative Stress and Restores Nitric Oxide Production in the Diabetic Heart
Authors: Ilkka Heinonen, Oana Sorop, Bas van Dalen, Vincent de Beer, Yanti Octavia, Richard van Duin, Lau Blonden, Daphne Merkus, Dirk Duncker
Journal: Circulation (2016)

Introduction: Diabetic metabolic derangement (DMD) is associated with increased myocardial oxidative stress (OS) and left ventricular (LV) dysfunction. Here we tested the hypothesis that exercise t...
Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes
Authors: Lori M. Laffel, Lauren G. Kanapka, Roy W. Beck, Katherine Bergamo, Mark A. Clements, Amy Criego, Daniel J. DeSalvo, Robin Goland, Korey Hood, David Liljenquist, Laurel H. Messer, Roshanak Monzavi, Thomas J. Mouse, Priya Prahalad, Jennifer Sherr, Jill H. Simmons, R. Paul Wadwa, Ruth S. Weinstock, Steven M. Willi, Kellee M. Miller
Journal: JAMA (2020)

Adolescents and young adults with type 1 diabetes exhibit the worst glycemic control among individuals with type 1 diabetes across the lifespan. Although continuous glucose monitoring (CGM) has been shown to improve glycemic control in adults, its benefit in adolescents and young adults has not been demonstrated.To determine the effect of CGM on glycemic control in adolescents and young adults with type 1 diabetes.Randomized clinical trial conducted between January 2018 and May 2019 at 14 endocrinology practices in the US including 153 individuals aged 14 to 24 years with type 1 diabetes and screening hemoglobin A1c (HbA1c) of 7.5% to 10.9%.Participants were randomized 1:1 to undergo CGM (CGM group; n = 74) or usual care using a blood glucose meter for glucose monitoring (blood glucose monitoring [BGM] group; n = 79).The primary outcome was change in HbA1c from baseline to 26 weeks. There were 20 secondary outcomes, including additional HbA1c outcomes, CGM glucose metrics, and patient-reported outcomes with adjustment for multiple comparisons to control for the false discovery rate.Among the 153 participants (mean [SD] age, 17 [3] years; 76 [50%] were female; mean [SD] diabetes duration, 9 [5] years), 142 (93%) completed the study. In the CGM group, 68% of participants used CGM at least 5 days per week in month 6. Mean HbA1c was 8.9% at baseline and 8.5% at 26 weeks in the CGM group and 8.9% at both baseline and 26 weeks in the BGM group (adjusted between-group difference, -0.37% [95% CI, -0.66% to -0.08%]; P = .01). Of 20 prespecified secondary outcomes, there were statistically significant differences in 3 of 7 binary HbA1c outcomes, 8 of 9 CGM metrics, and 1 of 4 patient-reported outcomes. The most commonly reported adverse events in the CGM and BGM groups were severe hypoglycemia (3 participants with an event in the CGM group and 2 in the BGM group), hyperglycemia/ketosis (1 participant with an event in CGM group and 4 in the BGM group), and diabetic ketoacidosis (3 participants with an event in the CGM group and 1 in the BGM group).Among adolescents and young adults with type 1 diabetes, continuous glucose monitoring compared with standard blood glucose monitoring resulted in a small but statistically significant improvement in glycemic control over 26 weeks. Further research is needed to understand the clinical importance of the findings.ClinicalTrials.gov Identifier: NCT03263494.
Repeat-induced point mutation in Neurospora crassa causes the highest known mutation rate and mutational burden of any cellular life
Authors: Long Wang, Yingying Sun, Xiaoguang Sun, Luyao Yu, Lan Xue, Zhen He, Ju Huang, Dacheng Tian, Laurence D. Hurst, Sihai Yang
Journal: Genome biology (2020)

Abstract Background Repeat-induced point (RIP) mutation in Neurospora crassa degrades transposable elements by targeting repeats with C→T mutations. Whether RIP affects core genomic sequence in important ways is unknown. Results By parent-offspring whole genome sequencing, we estimate a mutation rate (3.38 × 10 −6 per bp per generation) that is two orders of magnitude higher than reported for any non-viral organism, with 93–98% of mutations being RIP-associated. RIP mutations are, however, relatively rare in coding sequence, in part because RIP preferentially attacks GC-poor long duplicates that interact in three dimensional space, while coding sequence duplicates are rare, GC-rich, short, and tend not to interact. Despite this, with over 5 coding sequence mutations per genome per generation, the mutational burden is an order of magnitude higher than the previously highest observed. Unexpectedly, the majority of these coding sequence mutations appear not to be the direct product of RIP being mostly in non-duplicate sequence and predominantly not C→T mutations. Nonetheless, RIP-deficient strains have over an order of magnitude fewer coding sequence mutations outside of duplicated domains than RIP-proficient strains. Conclusions Neurospora crassa has the highest mutation rate and mutational burden of any non-viral life. While the high rate is largely due to the action of RIP, the mutational burden appears to be RIP-associated but not directly caused by RIP.
Comparison of Multiple Cut Points for Time in Range in Relation to Risk of Abnormal Carotid Intima-Media Thickness and Diabetic Retinopathy
Authors: Jingyi Lu, Philip D. Home, Jian Zhou
Journal: Diabetes Care (2020)

Compared with conventional glucose metrics including HbA1c, continuous glucose monitoring (CGM) can provide more information on diabetes management. Of the multiple metrics generated by CGM, time in range (TIR) is becoming popular for assessing glycemic control in practice and research (1–3). Various target ranges for TIR have been adopted and published, with 3.9–10.0 mmol/L (70–180 mg/dL) often headlined. Since hypoglycemia accounts for a small part of time during a day, TIR is largely a metric of hyperglycemia, thus correlating with vascular complications. Logically, ideal TIR would be matched to minimal complication risk, although pragmatic considerations, namely, what is achievable, may also influence choice of level. For CGM there is a lack of information on the relationship between derived metrics and complications, but normal glucose profiles suggest very tight physiological control, with only brief postprandial excursions >140 mg/dL (7.8 mmol/L) (4,5). To begin to address the issue of the threshold of range above which vascular risk can be detected, we have investigated the associations of multiple prespecified TIR levels with carotid intima-media thickness (CIMT) and diabetic retinopathy (DR) in a large sample of people with type 2 diabetes.

Individuals with type 2 diabetes and using a stable glucose-lowering regimen for the previous 3 months were consecutively enrolled from hospitalized patients at …
New-Onset Diabetes in Covid-19
Authors: Francesco Rubino, Stephanie Amiel, Paul Zimmet, George Alberti, Stefan Bornstein, Robert Eckel, Geltrude Mingrone, Bernhard Boehm, Mark Cooper, Zhonglin Chai, Stefano del Prato, Linong Ji, David Hopkins, William Herman, Kamlesh Khunti, Jean-Claude Mbanya, Eric Renard
Journal: New England Journal of Medicine (2020)

Diabetes and Covid-19 Diabetes is associated with an increased risk of severe Covid-19. New-onset diabetes and metabolic complications of preexisting diabetes, including diabetic ketoacidosis and h...
The Association Between Age of Onset of Type 2 Diabetes and the Long-term Risk of End-Stage Kidney Disease: A National Registry Study
Authors: Jedidiah I. Morton, Danny Liew, Stephen P. McDonald, Jonathan E. Shaw, Dianna J. Magliano
Journal: Diabetes Care (2020)

OBJECTIVE The long-term risk of end-stage kidney disease (ESKD) in type 2 diabetes is poorly described, as is the effect that younger age of diabetes onset has on this risk. Therefore, we aimed to estimate the effect of age of onset on the cumulative incidence of ESKD from onset of type 2 diabetes. RESEARCH DESIGN AND METHODS This study included 1,113,201 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2002 until 2013. The NDSS was linked to the Australia and New Zealand Dialysis and Transplant Registry and the Australian National Death Index. RESULTS Between 2002 and 2013, there were 7,592 incident cases of ESKD during 7,839,075 person-years of follow-up. In the first 10–15 years following the onset of diabetes, the incidence of ESKD was highest in those with an older age of onset of diabetes, whereas over longer durations of diabetes, the incidence of ESKD became higher in those with younger-onset diabetes. After 40 years of diabetes, the cumulative incidence of ESKD was 11.8% and 9.3% in those diagnosed with diabetes at ages 10–29 and 30–39 years, respectively. When death from ESKD without renal replacement therapy was included, the incidence of ESKD remained higher in older-onset diabetes for the initial 20 years, with no clear effect of age thereafter. CONCLUSIONS The long-term risk of ESKD in type 2 diabetes is high, which disproportionately affects those with younger onset of diabetes because they are more likely to survive to longer diabetes durations.
Rechallenge patients with immune checkpoint inhibitors following severe immune-related adverse events: review of the literature and suggested prophylactic strategy
Authors: John Haanen, Marc Ernstoff, Yinghong Wang, Alexander Menzies, Igor Puzanov, Petros Grivas, James Larkin, Solange Peters, John Thompson, Michel Obeid
Journal: Journal for ImmunoTherapy of Cancer (2020)

Patients with cancer who developed severe, grade 3 or 4 immune-related adverse events (irAEs) during therapy with immune checkpoint inhibitors are at risk for developing severe toxicities again on rechallenge with checkpoint inhibitors. Consequently, medical oncologists and multidisciplinary teams are hesitant to retreat in this scenario, despite the fact that a number of patients may derive clinical benefit from this approach. Balancing such clinical benefit and treatment-related toxicities for each patient is becoming increasingly challenging as more and more patients with cancer are being treated with checkpoint inhibitors. In this manuscript, we provide an extensive overview of the relevant literature on retreatment after toxicity, and suggest prophylactic approaches to minimize the risk of severe irAE following rechallenge with immune checkpoint blockade, since treatment may be lifesaving in a number of occasions.
Deep learning algorithm helps to standardise ATS/ERS spirometric acceptability and usability criteria
Authors: Nilakash Das, Kenneth Verstraete, Sanja Stanojevic, Marko Topalovic, Jean-Marie Aerts, Wim Janssens
Journal: European Respiratory Journal (2020)

Rationale While ATS/ERS quality control criteria for spirometry include several quantitative limits, it also requires manual visual inspection. The current approach is time consuming and leads to high inter-technician variability. We propose a deep learning approach called convolutional neural network (CNN), to standardise spirometric manoeuvre acceptability and usability. Methods and methods In 36 873 curves from the national health and nutritional examination survey (NHANES) USA 2011–12, technicians labelled 54% of curves as meeting ATS/ERS 2005 acceptability criteria with satisfactory start and end of test but identified 93% of curves with a usable FEV1. We processed raw data into images of maximal expiratory flow-volume curve (MEFVC), calculated ATS/ERS quantifiable criteria, and developed CNNs to determine manoeuvre acceptability and usability on 90% of the curves. The models were tested on the remaining 10% of curves. We calculated Shapley values to interpret the models. Results In the test set (N=3738), CNN showed an accuracy of 87% for acceptability and 92% for usability, with the latter demonstrating a high sensitivity (92%) and specificity (96%). They were significantly superior (p&lt;0.0001) to ATS/ERS quantifiable rule-based models. Shapley interpretation revealed MEFVC&lt;1 s (MEFVC pattern within first second of exhalation) and plateau in volume-time were most important in determining acceptability, while MEFVC&lt;1 s entirely determined usability. Conclusion The CNNs identified relevant attributes in spirometric curves to standardise ATS/ERS manoeuvre acceptability and usability recommendations, and further provides individual manoeuvre feedback. Our algorithm combines the visual experience of skilled technicians and ATS/ERS quantitative rules in automating the critical phase of spirometry quality control.
Diagnostic Applications of Ultrasmall Superparamagnetic Particles of Iron Oxide for Imaging Myocardial and Vascular Inflammation
Authors: Ioannis Merinopoulos, Tharusha Gunawardena, Colin Stirrat, Donnie Cameron, Simon C. Eccleshall, Marc R. Dweck, David E. Newby, Vassilios S. Vassiliou
Journal: JACC. Cardiovascular imaging (2020)
Long Term Follow up of Patients with Relapsed/Refractory Systemic Light Chain (AL) Amyloidosis Treated with Bendamustine and Dexamethasone in a Phase 2 Study
Authors: Galina G. Lagos, Suzanne Lentzsch, Raymond L. Comenzo, Jeffrey A Zonder, Keren Osman, Julia Gould, Wei-Yann Tsai, Silva Pregja, Mariamne Reyna, Shahzad Raza, Vaishali Sanchorawala, Heather Landau
Journal: Blood (2017)
Endoscopic retrograde pancreatography-guided versus endoscopic ultrasound-guided technique for pancreatic duct cannulation in patients with pancreaticojejunostomy stenosis: a systematic literature review
Authors: Kirill Basiliya, Govert Veldhuijzen, Christian Gerges, Johannes Maubach, Uwe Will, B. Joseph Elmunzer, Martijn W. J. Stommel, Reinier Akkermans, Peter D. Siersema, Erwin-Jan M. van Geenen
Journal: Endoscopy (2020)

Background Stenosis of the pancreaticojejunostomy is a well-known long-term complication of pancreaticoduodenectomy. Traditionally, the endoscopic approach consisted of endoscopic retrograde pancreatography (ERP). Endoscopic ultrasound (EUS)-guided intervention has emerged as an alternative, but the success rate and adverse event rate of both treatment modalities are poorly known. We aimed to compare the outcome data of both interventions. Methods We performed a systematic literature search using the Pubmed/Medline and Embase databases in order to summarize the available data regarding efficacy and complications of ERP- and EUS-guided pancreatic duct (PD) drainage and compare these outcome data using uniform outcome measures in a multilevel logistic model. Results 13 studies were included, involving 77 patients who underwent ERP-guided drainage, 145 who underwent EUS-guided drainage, and 12 patients who underwent both modalities. An EUS-guided approach was significantly superior to an ERP-guided approach with regard to pancreatic duct opacification (87 % vs. 30 %; P &lt; 0.001), cannulation success (79 % vs. 26 %; P &lt; 0.001), and stent placement (72 % vs. 20 %; P &lt; 0.001). An EUS-guided approach also appeared superior with regard to clinical outcomes such a pain resolution. The adverse event rate between the two treatment modalities could not be compared due to insufficient data. All included studies were found to be of low quality. Conclusion Based on limited available data, EUS-guided PD intervention appears superior to ERP-guided PD intervention.