tbuckley/cabot-search huggingface dataset:
Women who experience domestic abuse are three times as likely to develop mental illness
Authors: Elisabeth Mahase
Journal: BMJ (2019)

Women who have experienced domestic abuse have three times the risk of developing a mental illness, including severe conditions such as schizophrenia and bipolar disorder, compared with those who have not, according to new research.1

The retrospective study, the first UK cohort study looking at the associations between domestic abuse and mental illness, reported a “strong association” between exposure to intimate partner violence (IPV) and the incidence of mental illness.

The researchers, from the University of Birmingham, said that although they could not show a causal relationship—because of the study …
The role of CPAP treatment in elderly patients with moderate obstructive sleep apnoea: a multicentre randomised controlled trial
Authors: Silvia Ponce, Esther Pastor, Belen Orosa, Grace Oscullo, Pablo Catalán, Alfonso Martinez, Luis Hernández, Alfonso Muriel, Eusebi Chiner, Miguel Ángel Martínez-García
Journal: European Respiratory Journal (2019)

The efficacy of continuous positive airway pressure (CPAP) treatment in elderly patients with nonsevere obstructive sleep apnoea (OSA) is controversial. The objective of this study was to assess the effect of CPAP treatment in elderly patients with moderate OSA in terms of clinical, quality-of-life and neurocognitive measures. This was an open-label, randomised, multicentre clinical trial in 145 elderly patients (≥70 years old) with confirmed moderate OSA (apnoea–hypopnoea index 15–29.9 events·h −1 ) randomised to receive CPAP (n=73) or no CPAP (n=72) for 3 months. The primary end-point was the Epworth Sleepiness Scale (ESS) score, and the secondary end-points included quality of life (Quebec Sleep Questionnaire (QSQ) domain scores), sleep-related symptoms, presence of anxiety/depression, office-based blood pressure measurements and some neurocognitive tests. The analysis was performed according to the intention-to-treat principle. Mean± sd age was 74.9±4.6 years. The CPAP group achieved a greater improvement in the ESS score (adjusted difference of 2.6 (95% CI 3.6–1.6) points; effect size 1) in some sleep-related symptoms and in some dimensions of the QSQ questionnaire (nocturnal symptoms: −0.7 (95% CI −0.3–−1.0) points; p&lt;0.0001 and emotions: −0.4 (95% CI −0.1–−0.7) points; p=0.023). However, CPAP did not demonstrate any effect on either neurocognitive tests (including anxiety and depression) or blood pressure levels. There was a positive correlation between the effect of CPAP and the improvement in ESS scores and quality of life domains. CPAP treatment resulted in a significant improvement in diurnal hypersomnia and some sleep-related symptoms and quality of life domains in elderly patients with moderate OSA.
Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation
Authors: David A. Nardone
Journal: Annals of Internal Medicine (2019)

Letters4 June 2019Stroke Rate Variation and Anticoagulation Benefit in Atrial FibrillationDavid A. Nardone, MDDavid A. Nardone, MDHillsboro, Oregon (D.A.N.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0127 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read Shah and colleagues' article (1) with great interest. Does the old adage still ring true: Is the risk for stroke the same whether one has paroxysmal, persistent, or permanent AF? I would like to see data on strokes and bleeding among patients who received anticoagulation; were documented over time to have paroxysmal, persistent, or permanent AF; and have CHA2DS2-VASc scores greater than 1.Reference1. Shah SJ, Eckman MH, Aspberg S, Go AS, Singer DE. Effect of variation in published stroke rates on the net clinical benefit of anticoagulation for atrial fibrillation. Ann Intern Med. 2018;169:517-27. [PMID: 30264130]. doi:10.7326/M17-2762 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Hillsboro, Oregon (D.A.N.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0127. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation Sachin J. Shah , Mark H. Eckman , Sara Aspberg , Alan S. Go , and Daniel E. Singer Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation Linda P.T. Joosten , Sander van Doorn , Frans H. Rutten , and Geert-Jan Geersing Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation Sachin J. Shah and Daniel E. Singer Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation Martin Mayer , Brian S. Alper , and Louis Leff Stroke Rate Variation and Anticoagulation Benefit in Atrial Fibrillation James A. Reiffel Metrics 4 June 2019Volume 170, Issue 11Page: 818KeywordsAtrial fibrillationConflicts of interestDisclosureHemorrhageStroke ePublished: 4 June 2019 Issue Published: 4 June 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
US states that expanded Medicaid to include people with lower incomes saw fewer cardiovascular deaths
Authors: Elisabeth Mahase
Journal: BMJ (2019)

States in the US that expanded their Medicaid programmes to cover people with lower incomes did not see a rise in rates of cardiovascular deaths, whereas rates continued to rise in those that did not expand their coverage, according to a new study.1

Researchers analysed whether the expansion of Medicaid eligibility—under the 2014 Affordable Care Act—has been associated with any differences in cardiovascular mortality rates.

They found that …
Quantitative Assessment of the Retina Using OCT and Associations with Cognitive Function
Authors: Yoshikazu Ito, Mariko Sasaki, Hiroki Takahashi, Shoko Nozaki, Shinichiro Matsuguma, Kaoru Motomura, Rihito Ui, Ryo Shikimoto, Ryo Kawasaki, Kenya Yuki, Norie Sawada, Masaru Mimura, Kazuo Tsubota, Shoichiro Tsugane
Journal: Ophthalmology (2019)
Gender equality: countries are failing to deliver changes by 2030
Authors: Zosia Kmietowicz
Journal: BMJ (2019)

Denmark has the best gender equality of 129 countries and is closely followed by Finland, Sweden, Norway, and the Netherlands, a new index shows.1

But even those countries have more to do if they are to meet gender equality targets set out in a number of sustainable development goals (SDGs), said Equal Measures 2030, an independent partnership that promotes action on equality by collecting data and evidence. The index was launched at the Women Deliver conference in Vancouver, Canada.

Alison Holder, director of Equal Measures 2030, said, “With just …
The lumen-apposing metal stent (LAMS)-in-LAMS technique as an intraprocedural rescue treatment during endoscopic ultrasound-guided gastroenterostomy
Authors: Dario Ligresti, Michele Amata, Luca Barresi, Antonino Granata, Mario Traina, Ilaria Tarantino
Journal: Endoscopy (2019)

Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a new effective mini-invasive treatment for gastric outlet obstruction (GOO) [1] [2] [3]. An anastomosis is created between the stomach and a duodenal (or jejunal) loop by placement of a lumen-apposing metal stent (LAMS). Stent displacement can be a serious complication, often requiring surgery.
FRI0124 Does mixed connective tissue disease have a less favourable prognosis than systemic lupus erythematosus?
Authors: FJ López-Longo, CM González, AI Turrión, M Moreno-Zazo, R Del Castillo, N Caro, L Cebrián, C González-Montagut, E Carmona, S Gómez, I Monteagudo, L Carreño
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Mixed connective tissue disease (MCTD) has been considered to have a good prognosis, although some patients present severe clinical manifestations like pulmonary hypertension. <h3>Objectives</h3> To compare the cumulative tissue damage occurring in patients with MCTD and systemic lupus erythematosus (SLE). <h3>Methods</h3> We compared the cumulative tissue damage index scores of patients with MCTD and SLE studied between 1988 and 2000. The consequences of MCTD and SLE and their treatment were evaluated using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR) obtained at the last follow-up visit; scleroderma lesions were not taken into account in patients with MCTD. <h3>Results</h3> We studied 37 patients with MCTD and 236 patients with SLE. There was no difference in the relative proportion of women in with MCTD and SLE (32 of 37; 86.5% vs 211 of 236; 89.4%). Mean age (40 years; SD 17.6 vs 39; SD 15.8), mean age at onset of disease (29 years; SD 17.6 vs 29; SD 14.7), and mean duration of disease (11 years; SD 7.9 vs 9.7; SD 6.9) were similar in both groups. There were no differences in mortality (1 of 37; 2.9% vs 8 of 236; 3.4%) or SLICC score (1.43; SD 1.11 vs 1.49; SD 1.88). Patients with MCTD had more musculoskeletal sequelae (20 of 37; 54.1% vs 36 of 236; 15.3%) (OR: 6.5) (p &lt; 0.005) and pulmonary fibrosis (5 of 37; 13.5% vs 9 of 236; 3.8%) (OR: 3.9) (p &lt; 0.05) than patients with SLE. Patients with SLE had more kidney disease as defined by the SLICC (66 of 236; 28% vs 3 of 37; 8.1%) (p &lt; 0.01). <h3>Conclusion</h3> In spite of the differences observed, the cumulative tissue damage and mortality were similar in MCTD and SLE, after excluding from consideration scleroderma lesions in patients with MCTD.
Surgeon’s suspension shortened by just a month after new hearing demanded by High Court
Authors: Clare Dyer
Journal: BMJ (2019)

A consultant orthopaedic surgeon who won a High Court appeal against a three month suspension from the UK medical register has now been suspended for two months instead at a new medical practitioners tribunal hearing.

The result means that, after a trip to the High Court and a new tribunal hearing, Mohammed Sait’s suspension from the register has been shortened by just one month.

A previous hearing found in April 2018 that Sait had acted with sexual motivation in meeting a woman who had recently stopped being his patient. But at the High Court last November Mr Justice Mostyn quashed that tribunal’s three month suspension, ruling that a “remarkable failure” to cross examine the doctor about his alleged sexual motivation constituted “procedural unfairness.” Mostyn sent the case back …
How to facilitate cannulation of an intradiverticular papilla: a technique with two devices in one channel using pediatric forceps
Authors: Jean-Michel Gonzalez, Antoine Debourdeau, Marc Barthet
Journal: Endoscopy (2019)

The proportion of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with a periampullary duodenal diverticulum ranges in the literature from 9 % to 32 % [1]. The prevalence of periampullary diverticula increases with age, and they are associated with a higher risk of choledocholithiasis [2]. In a few series, they have been identified as a risk factor for difficulty in and failure of biliary catheterization [3]. Several techniques have been proposed to facilitate cannulation, such as clips, or in one case forceps [4] [5]. [Video 1] shows three patients who benefited from our technique involving double instrumentation in one channel for the treatment of biliary obstruction with peridiverticular papillae.
Phase 2 Study of Carfilzomib and Bone Metabolism in Patients with Relapsed Multiple Myeloma
Authors: Attaya Suvannasankha, Rafat Abonour, Sherif Farag, Rebecca W. Silbermann, Sariya Wongsaengsak, Mary Helen Cangany, Anita Rush-Taylor, Mark Tann, Sandra K Althouse, Susan M Perkins, G David Roodman
Journal: Blood (2017)
Dapagliflozin Plus Saxagliptin Add-on Therapy Compared With Insulin in Patients With Type 2 Diabetes Poorly Controlled by Metformin With or Without Sulfonylurea Therapy: A Randomized Clinical Trial
Authors: Tina Vilsbøll, Ella Ekholm, Eva Johnsson, Nalina Dronamraju, Serge Jabbour, Marcus Lind
Journal: Diabetes Care (2019)

This study evaluated whether an oral combination of a sodium-glucose cotransporter 2 inhibitor and a dipeptidyl peptidase 4 inhibitor achieved glycemic control similar to basal insulin in patients with type 2 diabetes, poorly controlled with metformin, without increasing hypoglycemia or body weight.In a multinational, open-label, randomized, phase 3 trial (ClinicalTrials.gov reg. no. NCT02551874), adults with type 2 diabetes inadequately controlled on metformin, with or without sulfonylurea, were randomized (1:1) to receive dapagliflozin (DAPA) plus saxagliptin (SAXA) or titrated insulin glargine (INS). The primary end point was change in glycated hemoglobin A1c (HbA1c) from baseline to week 24. DAPA + SAXA treatment was tested for noninferiority versus INS.The efficacy data set included 643 patients (mean ± SD HbA1c, 9.1 ± 1.0% [75 ± 11 mmol/mol]). At week 24, DAPA + SAXA treatment versus INS resulted in noninferior reductions in HbA1c (adjusted mean ± SE change, -1.7 ± 0.1% vs. -1.5 ± 0.1% [18.3 ± 0.7 mmol/mol vs. 16.8 ± 0.7 mmol/mol]; P = 0.118), significantly different body weight change (between-group difference, -3.64 kg [95% CI -4.20 to -3.09]; P < 0.001), fewer patients with confirmed hypoglycemia (21.3% vs. 38.4%, P < 0.001), more patients achieving HbA1c <7.0% (53 mmol/mol) without hypoglycemia (20.9% vs. 13.1%, P = 0.008), and a similar proportion of patients achieving HbA1c <7.0% (33.2% vs. 33.5%, P = 0.924). Mean reductions in 24-h glucose measurements from baseline to week 2 were greater with DAPA + SAXA than with INS (P < 0.0001). No patients in the DAPA + SAXA group and three patients (0.9%) in the INS group experienced severe hypoglycemia.Adding DAPA + SAXA to insulin-naive patients with poorly controlled type 2 diabetes achieved similar glycemic control, a lower risk of hypoglycemia, and a clinically relevant body weight difference compared with basal INS.
Quizartinib versus salvage chemotherapy in relapsed or refractory FLT3-ITD acute myeloid leukaemia (QuANTUM-R): a multicentre, randomised, controlled, open-label, phase 3 trial
Authors: Jorge E Cortes, Samer Khaled, Giovanni Martinelli, Alexander E Perl, Siddhartha Ganguly, Nigel Russell, Alwin Krämer, Hervé Dombret, Donna Hogge, Brian A Jonas, Anskar Yu-Hung Leung, Priyanka Mehta, Pau Montesinos, Markus Radsak, Simona Sica, Meena Arunachalam, Melissa Holmes, Ken Kobayashi, Ruth Namuyinga, Nanxiang Ge, Antoine Yver, Yufen Zhang, Mark J Levis
Journal: The Lancet Oncology (2019)
Association of Medicaid Expansion With Cardiovascular Mortality
Authors: Sameed Ahmed M. Khatana, Anjali Bhatla, Ashwin S. Nathan, Jay Giri, Changyu Shen, Dhruv S. Kazi, Robert W. Yeh, Peter W. Groeneveld
Journal: JAMA Cardiology (2019)

<h3>Importance</h3> Medicaid expansion under the Patient Protection and Affordable Care Act led to one of the largest gains in health insurance coverage for nonelderly adults in the United States. However, its association with cardiovascular mortality is unclear. <h3>Objective</h3> To investigate the association of Medicaid expansion with cardiovascular mortality rates in middle-aged adults. <h3>Design, Setting, and Participants</h3> This study used a longitudinal, observational design, using a difference-in-differences approach with county-level data from counties in 48 states (excluding Massachusetts and Wisconsin) and Washington, DC, from 2010 to 2016. Adults aged 45 to 64 years were included. Data were analyzed from November 2018 to January 2019. <h3>Exposures</h3> Residence in a Medicaid expansion state. <h3>Main Outcomes and Measures</h3> Difference-in-differences of annual, age-adjusted cardiovascular mortality rates from before Medicaid expansion to after expansion. <h3>Results</h3> As of 2016, 29 states and Washington, DC, had expanded Medicaid eligibility, while 19 states had not. Compared with counties in Medicaid nonexpansion states, counties in expansion states had a greater decrease in the percentage of uninsured residents at all income levels (mean [SD], 7.3% [3.2%] vs 5.6% [2.7%];<i>P</i> &lt; .001) and in low income strata (19.8% [5.5%] vs 13.5% [3.9%];<i>P</i> &lt; .001) between 2010 and 2016. Counties in expansion states had a smaller change in cardiovascular mortality rates after expansion (146.5 [95% CI, 132.4-160.7] to 146.4 [95% CI, 131.9-161.0] deaths per 100 000 residents per year) than counties in nonexpansion states did (176.3 [95% CI, 154.2-198.5] to 180.9 [95% CI, 158.0-203.8] deaths per 100 000 residents per year). After accounting for demographic, clinical, and economic differences, counties in expansion states had 4.3 (95% CI, 1.8-6.9) fewer deaths per 100 000 residents per year from cardiovascular causes after Medicaid expansion than if they had followed the same trends as counties in nonexpansion states. <h3>Conclusions and Relevance</h3> Counties in states that expanded Medicaid had a significantly smaller increase in cardiovascular mortality rates among middle-aged adults after expansion compared with counties in states that did not expand Medicaid. These findings suggest that recent Medicaid expansion was associated with lower cardiovascular mortality in middle-aged adults and may be of consideration as further expansion of Medicaid is debated.
Abstract 14997: Subclinical Device-Detected Atrial Fibrillation is Associated With a Higher Risk of Adverse Cardiovascular Outcomes to the Same Extent as Clinical Atrial Fibrillation
Authors: James R Verner, Erin Austin, Ian C Chang, Yusuf Agamawi, Wayne O Adkisson, Henri Roukoz, Scott Sakaguchi, David Benditt, Lin Y Chen
Journal: Circulation (2015)

Introduction: Atrial fibrillation (AF) is a known risk factor for adverse cardiovascular (CV) outcomes in patients with implantable cardioverter-defibrillators (ICDs). As the use of ICDs becomes more common, subclinical device-detected atrial fibrillation (SAF) is increasingly being identified. Studies have shown an association between SAF and increased risk of thromboembolic events. However, no study has compared the risk of adverse CV outcomes of SAF vs. clinical AF (CAF). Hypothesis: In patients with ICDs, SAF is associated with adverse CV outcomes to the same extent as CAF. Methods: We identified patients who had ICD implantation at the University of Minnesota Medical Center between Jan 1, 2003 and Dec 31, 2009. Baseline data on demographics, CV risk factors, diagnoses, and medications were collected. Follow-up was through Dec 31, 2012. Our primary outcome was a composite CV outcome (see table). CAF episodes were identified from clinical documents confirmed by ECGs. SAF episodes of any duration were identified from ICD interrogation reports. We fit a multivariable Cox proportional hazards model and used backwards stepwise selection to identify the most parsimonious model to predict the outcome (0.05 threshold). Results: We included 371 patients; 37 had incident or recurrent CAF; 88 had SAF. Median follow up was 490 days. The full model included age, sex, coronary artery disease, diabetes, ejection fraction, hypertension, and use of beta-blockers, anticoagulants, and ACE inhibitors. The table shows the most parsimonious model for prediction of the composite outcome. Conclusions: SAF and CAF were significantly associated with a greater than 11-fold and 9-fold increased risk of adverse CV outcomes, respectively. This study indicates that SAF is associated with increased risk of CV outcomes to the same extent as CAF. More research is needed to determine whether treatment of SAF (e.g., anticoagulation) will lead to improved outcomes in patients with ICDs.
A cullin-RING ubiquitin ligase targets exogenous α-synuclein and inhibits Lewy body–like pathology
Authors: Juan A. Gerez, Natalia C. Prymaczok, Edward Rockenstein, Uli S. Herrmann, Petra Schwarz, Anthony Adame, Radoslav I. Enchev, Thibault Courtheoux, Paul J. Boersema, Roland Riek, Matthias Peter, Adriano Aguzzi, Eliezer Masliah, Paola Picotti
Journal: Science Translational Medicine (2019)

Parkinson's disease (PD) is a neurological disorder characterized by the progressive accumulation of neuronal α-synuclein (αSyn) inclusions called Lewy bodies. It is believed that Lewy bodies spread throughout the nervous system due to the cell-to-cell propagation of αSyn via cycles of secretion and uptake. Here, we investigated the internalization and intracellular accumulation of exogenous αSyn, two key steps of Lewy body pathogenesis, amplification and spreading. We found that stable αSyn fibrils substantially accumulate in different cell lines upon internalization, whereas αSyn monomers, oligomers, and dissociable fibrils do not. Our data indicate that the uptake-mediated accumulation of αSyn in a human-derived neuroblastoma cell line triggered an adaptive response that involved proteins linked to ubiquitin ligases of the S-phase kinase-associated protein 1 (SKP1), cullin-1 (Cul1), and F-box domain-containing protein (SCF) family. We found that SKP1, Cul1, and the F-box/LRR repeat protein 5 (FBXL5) colocalized and physically interacted with internalized αSyn in cultured cells. Moreover, the SCF containing the F-box protein FBXL5 (SCFFBXL5) catalyzed αSyn ubiquitination in reconstitution experiments in vitro using recombinant proteins and in cultured cells. In the human brain, SKP1 and Cul1 were recruited into Lewy bodies from brainstem and neocortex of patients with PD and related neurological disorders. In both transgenic and nontransgenic mice, intracerebral administration of exogenous αSyn fibrils triggered a Lewy body-like pathology, which was amplified by SKP1 or FBXL5 loss of function. Our data thus indicate that SCFFXBL5 regulates αSyn in vivo and that SCF ligases may constitute targets for the treatment of PD and other α-synucleinopathies.