tbuckley/cabot-search huggingface dataset:
Co-production of knowledge: the future
Authors: S Redman, T Greenhalgh, L Adedokun, S Staniszewska, S Denegri
Journal: BMJ (2021)

on behalf of the Co-production of Knowledge Collection Steering Committee Co-production is a collaborative model of research that includes stakeholders such as patients, the public, donors, clinicians, service providers, and policy makers.It is a sharing of power, with stakeholders and researchers working together to develop the agenda, design and implement the research, and interpret, disseminate, and implement the findings.Co-production has been embraced because of its potential to improve the quality and relevance of research and its effect on policy and practice. 1 -3 This is nicely captured in the Thai concept of the "triangle that moves the mountain," whereby researchers, citizens, and policy makers work together to achieve change.
LPS-enriched small extracellular vesicles from metabolic syndrome patients trigger endothelial dysfunction by activation of TLR4
Authors: Sakina Ali, Marine Malloci, Zainab Safiedeen, Raffaella Soleti, Luisa Vergori, Xavier Vidal-Gómez, Charlène Besnard, Séverine Dubois, Soazig Le Lay, Jérôme Boursier, Arnaud Chevrollier, Frédéric Gagnadoux, Gilles Simard, Ramaroson Andriantsitohaina, M. Carmen Martinez
Journal: Metabolism (2021)
Abstract SP054: Obesity and Breast Cancer: Body Composition, Metabolic Mediators and Inflammation
Authors: P Goodwin
Journal: Cancer Research (2021)

Abstract Obesity has been associated with an increased risk of postmenopausal breast cancer (predominantly ER+), as well as triple negative premenopausal breast cancer. It has also been associated with an increased risk of breast cancer distant recurrence and death, regardless or menopausal status or IHC defined breast cancer subtype. Obesity effects on recurrence and death are modest, with HRs for either outcome approximating 1.3. Obesity is linked to metabolic alterations that include insulin resistance (with associated high insulin and reduced glucose tolerance), altered lipids and adipokines, hypertension, central obesity, inflammation and increased risks of type 2 diabetes (T2DM) and cardiovascular disease - this constellation of attributes comprises the insulin resistance or metabolic syndrome. There is growing appreciation that BMI [weight (kg)/height (m)2] ≥ 30 kg/m2 is an imperfect measure of both body composition and underlying metabolic status. Recent research has focused on body composition (e.g. central obesity/sarcopenic obesity) and metabolic health (“healthy” obese, “unhealthy” normal weight) as predictors of breast cancer outcomes. Many of the inter-related physiologic changes associated with obesity (including higher levels of insulin, glucose, altered adipokines and, less consistently, circulating inflammatory factors) have individually been associated with increased breast cancer risk and/or poor breast cancer outcomes. These circulating factors, and obesity per se, have, in turn, been associated with changes in breast tissue and tumor micro-environment, including crown-like structures (dying adipocytes surrounded by inflammatory cells) as well as increased infiltration of inflammatory cells, cytokines and chemokines - all of which have been linked to cancer risk and progression in preclinical and/or clinical research. Evidence linking obesity/body composition, circulating obesity-associated physiologic and inflammatory factors to breast cancer outcomes will be discussed as will interventions (notably weight loss, metformin) targeting these factors in breast cancer patients. Recent findings linking breast inflammation to obesity/obesity-associated physiology and breast cancer outcomes will be reviewed. The inter-relatedness of these factors and the likelihood that the breast cancer-obesity link is complex and multifactorial will be highlighted. Citation Format: P Goodwin. Obesity and Breast Cancer: Body Composition, Metabolic Mediators and Inflammation [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SP054.
Multiple itchy lesions after recent travel
Authors: Carole Eldin, Philippe Gautret
Journal: BMJ (2021)

A woman in her late teens presented with cutaneous lesions on both feet after a seven day trip to a beach destination in Brazil, where she walked barefoot most of the time. On examination, she had multiple serpiginous erythematous tracks that were intensely itchy and had been slowly migrating for the past few days (fig 1).



Fig 1 
Multiple serpiginous lesions on …
The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study
Authors: Andrew Street, Laia Maynou, Thomas Gilbert, Tony Stone, Suzanne Mason, Simon Conroy
Journal: The Lancet Healthy Longevity (2021)

BackgroundThe Hospital Frailty Risk Score (HFRS) has been widely but inconsistently applied in published studies, particularly in how diagnostic information recorded in previous hospital admissions is used in its construction. We aimed to assess how many previous admissions should be considered when constructing the HFRS and the influence of frailty risk on long length of stay, in-hospital mortality, and 30-day readmission.MethodsThis is a retrospective observational cohort study of patients aged 75 years or older who had at least one emergency admission to any of 49 hospital sites in the Yorkshire and Humber region of England, UK. We constructed multiple versions of the HFRS for each patient, each form incorporating diagnostic data from progressively more previous admissions in its construction within a 1-year or 2-year window. We assessed the ability of each form of the HFRS to predict long length of stay (>10 days), in-hospital death, and 30-day readmission.FindingsBetween April 1, 2013, and March 31, 2017, 282 091 patients had 675 155 hospital admissions. Regression analyses assessing the different constructions of HFRS showed that the form constructed with diagnostic information recorded in the current and previous two admissions within the preceding 2 years performed best for predicting all three outcomes. Under this construction, 263 432 (39·0%) of 674 615 patient admissions were classified as having low frailty risk, for whom 33 333 (12·7%) had a long length of stay, 10 145 (3·9%) died in hospital, and 45 226 (17·2%) were readmitted within 30 days. By contrast with those patients with low frailty risk, for those with intermediate frailty risk, the probability was 2·5-times higher (95% CI 2·4 to 2·6) for long length of stay, 2·17-times higher (2·1 to 2·2) for in-hospital death, and 0·7% higher (0·5 to 1) for readmission. For patients with high frailty risk, the probability was 4·3-times higher (4·2 to 4·5) for long length of stay, 2·48-times higher (2·4 to 2·6) for in-hospital death, and −1% (−1·2 to −0·5) lower for readmission than those with low frailty risk. The intermediate and high frailty risk categories were more important predictors of long length of stay than any of the other rich set of control variables included in our analysis. These categories also proved to be important predictors of in-hospital mortality, with only the Charlson Comorbidity Index offering greater predictive power.InterpretationWe recommend constructing the HFRS with diagnostic information from the current admission and from the previous two admissions in the preceding 2 years. This HFRS form was a powerful predictor of long length of stay and in-hospital mortality, but less so of emergency readmissions.FundingNational Institute of Health Research.
Underwater endoscopic mucosal resection for complete R0 removal of colorectal polyp in a patient with ulcerative colitis
Authors: Kazuya Hosotani, Satoko Inoue, Kana Takahashi, Shigeo Hara, Tetsuro Inokuma
Journal: Endoscopy (2021)

Current guidelines recommend endoscopic resection for superficial colorectal neoplasia in patients with ulcerative colitis, particularly for a clearly visible lesion with distinct margins [1]. However, endoscopic removal of colorectal polyps is technically challenging in patients with ulcerative colitis. Endoscopic submucosal dissection (ESD) enables complete removal of such polyps but presents some technical difficulties and is time consuming [2].
Real-life use of talimogene laherparepvec (T-VEC) in melanoma patients in centers in Austria, Switzerland and Germany
Authors: Julia Maria Ressler, Matthias Karasek, Lukas Koch, Rita Silmbrod, Joanna Mangana, Sofiya Latifyan, Veronica Aedo-Lopez, Helmut Kehrer, Felix Weihsengruber, Peter Koelblinger, Christian Posch, Julian Kofler, Olivier Michielin, Erika Richtig, Christine Hafner, Christoph Hoeller
Journal: Journal for ImmunoTherapy of Cancer (2021)

Background Talimogene laherparepvec (T-VEC) is a licensed therapy for use in melanoma patients of stage IIIB-IVM1a with injectable, unresectable metastatic lesions in Europe. Approval was based on the Oncovex Pivotal Trial in Melanoma study, which also included patients with distant metastases and demonstrated an overall response rate (ORR) of 40.5% and a complete response (CR) rate of 16.6%. Objectives The aim of this study was to assess the outcome of melanoma patients treated with T-VEC in a real-life clinical setting. Methods Based on data from 10 melanoma centers in Austria, Switzerland and southern Germany, we conducted a retrospective chart review, which included 88 patients (44 male, 44 female) with a median age of 72 years (range 36–95 years) treated with T-VEC during the period from May 2016 to January 2020. Results 88 patients fulfilled the inclusion criteria for analysis. The ORR was 63.7%. 38 patients (43.2%) showed a CR, 18 (20.5%) had a partial response, 8 (9.1%) had stable disease and 24 (27.3%) patients had a progressive disease. The median treatment period was 19 weeks (range: 1–65), an average of 11 doses (range: 1–36) were applied. 39 (45.3%) patients developed adverse events, mostly mild, grade I (64.1%). Conclusion This real-life cohort treatment with T-VEC showed a high ORR and a large number of durable CRs.
David Edward Sargent
Authors: R Marriott, J McLachlan
Journal: BMJ (2021)

David Edward Sargent was born in Wimbledon, son of a GP. He was not academic at school and always refuted the saying that your schooldays are the best days of your life. However, it was at Dauntsey’s School in Wiltshire that, alongside his academic education, he developed his interest in the countryside and many of the animal husbandry skills that he used in his spare time and especially in his retirement. At various times during his long life he kept donkeys, goats, pigs, sheep, chickens, turkeys, ducks, geese, and guinea fowl. He always said that if he hadn’t been able to be …
Long-term microstructure and cerebral blood flow changes in patients recovered from COVID-19 without neurological manifestations
Authors: Yuanyuan Qin, Jinfeng Wu, Tao Chen, Jia Li, Guiling Zhang, Di Wu, Yiran Zhou, Ning Zheng, Aoling Cai, Qin Ning, Anne Manyande, Fuqiang Xu, Jie Wang, Wenzhen Zhu
Journal: Journal of Clinical Investigation (2021)

BACKGROUNDThe coronavirus disease 2019 (COVID-19) rapidly progressed to a global pandemic. Although some patients totally recover from COVID-19 pneumonia, the disease's long-term effects on the brain still need to be explored.METHODSWe recruited 51 patients with 2 subtypes of COVID-19 (19 mild and 32 severe) with no specific neurological manifestations at the acute stage and no obvious lesions on the conventional MRI 3 months after discharge. Changes in gray matter morphometry, cerebral blood flow (CBF), and white matter (WM) microstructure were investigated using MRI. The relationship between brain imaging measurements and inflammation markers was further analyzed.RESULTSCompared with healthy controls, the decrease in cortical thickness/CBF and the changes in WM microstructure were more severe in patients with severe disease than in those with mild disease, especially in the frontal and limbic systems. Furthermore, changes in brain microstructure, CBF, and tract parameters were significantly correlated (P < 0.05) with the inflammatory markers C-reactive protein, procalcitonin, and interleukin 6.CONCLUSIONIndirect injury related to inflammatory storm may damage the brain, altering cerebral volume, CBF, and WM tracts. COVID-19-related hypoxemia and dysfunction of vascular endothelium may also contribute to neurological changes. The abnormalities in these brain areas need to be monitored during recovery, which could help clinicians understand the potential neurological sequelae of COVID-19.FUNDINGNatural Science Foundation of China.
Rethinking research processes to strengthen co-production in low and middle income countries
Authors: David Beran, Maria Amalia Pesantes, Maria Claudia Berghusen, Branwen J Hennig, Johanna Jacobi, Maria Lazo-Porras, Aymara Llanque, Enrichetta Placella, Carmenza Robledo-Abad, Marta Tufet Bayona, J Jaime Miranda
Journal: BMJ (2021)

Rethinking research processes to strengthen co-production in low and middle income countriesCo-production needs to become an integral part of the training and funding of researchers to ensure research meets everyone's needs, argue David Beran and colleagues
Abstract SP111: Interpreting reports
Authors: B Park
Journal: Cancer Research (2021)

Abstract Although next generation sequencing (NGS) has become commonplace for breast and other cancers, interpretation of reports remains a challenging unmet need. This is further confounded by the therapeutic importance of understanding and interpreting whether pathogenic variants/mutations are germline versus somatic. Here we will discuss and provide examples of how molecular tumor boards can aid clinicians in providing interpretation of NGS results for optimal patient benefit. Citation Format: B Park. Interpreting reports [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SP111.
Art in Endoscopy: “The smiling diverticulum”
Authors: Cameron Schauer
Journal: Endoscopy (2021)

Diverticular disease is among the most common conditions encountered in medical practice, associated with medical morbidity such as inflammation, pain, bleeding, strictures, and perforation. Despite diverticula often making colonoscopy more challenging, particularly in the sigmoid colon as in this instance, it is uncommon to see them look back with a friendly face.
Screening for Fabry Disease in Male Patients With Arrhythmia Requiring a Pacemaker or an Implantable Cardioverter–Defibrillator
Authors: Dimitri Hemelsoet, Jan De Keyser, Frederic Van Heuverswyn, Rik Willems, Hans Vandekerckhove, Antoine Bondue, Carlo de Asmundis, Johan Saenen, Stefaan Van de Walle, Pascal Godart, Christoph Kampmann, Hedwig Stepman, Bruce Poppe, Wim Terryn
Journal: Circulation (2021)
Abstract PS3-24: Using big data to gauge effectiveness of breast cancer awareness month
Authors: Diamone A. Gathers, Vernon S. Pankratz, Bernard Tawfik
Journal: Cancer Research (2021)

Abstract Introduction: Breast Cancer Awareness Month (BCAM) has been used for decades to increase awareness and screening for breast cancer but it’s reach and effectiveness is difficult to judge. Using Internet Search Interest (ISI) could allow better evaluation of BCAM effects.Methods: Using Google Trends, we evaluated the ISI of a given term(s) as compared to that cancer’s awareness month. The ISI represents population level Google internet searches relative to the highest number of searches for the United States from 2004-2019 with a max number of 100. The ISI for breast cancer and mammogram in October, which is BCAM, was compared against all other months during this period. Results: The BCAM of October was associated with statistically significant more ISI for breast cancer 77.0 vs. 34.6 (95% CI 69.5-84.5, CI 32.9-35.3, p &amp;lt; 0.0005) as compared to the rest of the year. ISI for mammogram was similar (41.6 vs. 60.2, 95% CI 39.4-43.7, 48.5-71.9, p = 0.007). There was significant differences between the top half of states with Mississippi (100), Delaware (97) and West Virginia (95) having the highest ISI while Nevada (60), Oregon (60) and Utah (57) the lowest (87.6 vs 71.8, 95% CI, 85.5-89.7, 69.0-74.6, p &amp;lt; 0.0005). There was significant differences between the top half of 208 United States metro areas with Rochester MN (100), Greenwood MS (85) and Jackson MS (80) having the highest ISI while Salt Lake City UT (43), Idaho Falls UT (41) and Roanoke VA (40) the lowest (67.5 vs 54.4, 95% CI, 66.4-68.6, 53.4-55.4, p &amp;lt; 0.0005). Conclusion: ISI suggests that BCAM is effective at increasing breast cancer awareness with significant heterogeneity across states and metro areas. This publicly available free tool can be used to assess penetrance of awareness campaigns in a time sensitive manor for future targeting of populations with low breast cancer awareness. Future research is needed to correlate outcomes and ISI. Citation Format: Diamone A. Gathers, Vernon S. Pankratz, Bernard Tawfik. Using big data to gauge effectiveness of breast cancer awareness month [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-24.
Five-Year Outcomes for Refractory B-Cell Lymphomas with CAR T-Cell Therapy
Authors: Elise A Chong, Marco Ruella, Stephen J Schuster
Journal: New England Journal of Medicine (2021)

Long-Term Follow-up of CAR T-Cell–Treated Lymphoma Progression-free survival at 5 years was 31% in patients with diffuse large B-cell lymphoma and 43% in patients with follicular lymphoma. A total ...
An epidermal patch for the simultaneous monitoring of haemodynamic and metabolic biomarkers
Authors: Juliane R. Sempionatto, Muyang Lin, Lu Yin, Ernesto De la paz, Kexin Pei, Thitaporn Sonsa-ard, Andre N. de Loyola Silva, Ahmed A. Khorshed, Fangyu Zhang, Nicholas Tostado, Sheng Xu, Joseph Wang
Journal: Nature Biomedical Engineering (2021)
Partha Kar: Losing one’s faith in leaders
Authors: Partha Kar
Journal: BMJ (2021)

It’s awkward—really awkward—to look back at something you’ve written and realise it hasn’t aged well. I’ve reached the point where I need to reassess an issue I wrote about for The BMJ in March 2020, where I argued that “we must keep faith in our experts.”1

Spending time on wards full of patients with covid-19 in recent weeks has made things hit home. I’ve worked with teams who are tired, gritting their teeth, and battling exhaustion, looking after so many when the spirit of the first wave has long passed.

Among all the suffering, some patients stand out. Walking into side rooms or closed bays, I’ve seen sheer fright in the eyes of those who teetered on the edge—those patients’ imploring looks as oxygen saturations were held just high …
Sexual and Gender Minority Health in Neurology
Authors: Nicole Rosendale, Jeffrey O. Wong, Jason D. Flatt, Evans Whitaker
Journal: JAMA Neurology (2021)

Little is known about the neurologic health needs of sexual and gender minority (SGM) individuals, and existing research indicates health care disparities for this group.To describe the current state of science in SGM neurology and highlight areas of knowledge and gaps to guide future research.All articles published before April 12, 2020, in PubMed, Embase, Web of Science, PsycInfo, CINAHL, and BIOSIS Previews were searched using a search string encompassing SGM descriptors and neurologic disorders. A total of 8359 items were found and entered into EndNote, and 2921 duplicates were removed. A blind title and abstract review was performed followed by full-text review in duplicate, with conflicts settled through consensus, to identify 348 articles eligible for data abstraction. Articles presenting primary data about an identified adult SGM population addressing a clinical neurology topic were included. Descriptive statistics were used for abstracted variables.Of 348 studies, 205 (58.9%) were case reports or series, 252 (72.4%) included sexual minority cisgender men, and 247 (70.9%) focused on HIV. An association was found between autism spectrum disorder and gender dysphoria in 9 of 16 studies (56.3%), and a higher risk of ischemic stroke in transgender women was shown in other studies. Literature in neuroinfectious disease, the most common topic, largely focused on HIV (173 of 200 studies [86.5%]). Findings in other neurologic topics were limited by lack of data.In this rigorous compendium of SGM neurology literature, several deficiencies were found: most studies focused on a limited breadth of neurologic pathology, included only a portion of the overall SGM community, and did not assess other aspects of sociodemographic diversity that may contribute to disparities in health care access and outcomes among SGM individuals. Expanding neurologic research to include broader representation of SGM individuals and incorporating sociodemographic factors, like race/ethnicity and socioeconomic status, are essential steps toward providing equitable neurologic care for this community.
David Oliver: Lack of PPE betrays NHS clinical staff
Authors: David Oliver
Journal: BMJ (2021)

The failure to provide adequate personal protective equipment (PPE) to health and social care workers during the pandemic has highlighted the disintegration of any culture of integrity, transparency, honesty, and support for healthcare staff from the government and NHS employers.

I have reported in The BMJ this week on NHS trusts’ behaviour around supply of PPE to their clinical staff and the trusts’ responses when staff complained.1 Of 66 NHS trusts (of 130 approached) that replied to my freedom of information request, only two confirmed that they had explicitly restricted PPE use, warned staff about its overuse, or warned them over complaining about shortages. Only one NHS trust admitted being subject to investigation from the Health and Safety Executive for covid related deaths among staff, even though the HSE confirmed a number of investigations.

In response, the Department of Health and Social Care (DHSC) pointed me to sections of a National Audit Office report on PPE supply suggesting that supply lines had always been adequate and that no staff members had been put at risk.2 NHS England told …
Atopic dermatitis in children: when topical steroid treatment “does not work”
Authors: Jin Ho Chong
Journal: BMJ (2021)

### What you need to know

A 1 year old boy visits your clinic. He received a diagnosis of atopic dermatitis six months ago. On return visit today, his rash and pruritus have worsened despite intermittent application of a small quantity of hydrocortisone 1% cream. His sleep has been constantly interrupted by scratching. On examination, his skin is dry with excoriated, erythematous plaques on his limbs and trunk. His parents want to stop using topical corticosteroids (TCS) out of concern for side effects and because the cream is not working. 

Atopic dermatitis, a type of eczema, is the most commonly diagnosed paediatric dermatosis (box 1), affecting about 20% of children.2

Box 1 
### Diagnosis of atopic dermatitis

#### Essential features

#### Other featuresRETURN TO TEXT

Emollients are essential treatment for acute flare and for maintenance, and TCS continue to be the first-line drug treatment.23 Sub-optimal management results in poor control of symptoms, which negatively affects quality …