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3 ["Investigating the possible causal association of smoking with depression and anxiety using Mendelian randomisation meta-analysis: the CARTA consortium"] 10.1136/bmjopen-2014-006141 http://dx.doi.org/10.1136/bmjopen-2014-006141 2014-10-08T06:07:47Z [] 0 53 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To investigate whether associations of smoking with depression and anxiety are likely to be causal, using a Mendelian randomisation approach.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Mendelian randomisation meta-analyses using a genetic variant (rs16969968/rs1051730) as a proxy for smoking heaviness, and observational meta-analyses of the associations of smoking status and smoking heaviness with depression, anxiety and psychological distress.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>Current, former and never smokers of European ancestry aged ≥16 years from 25 studies in the Consortium for Causal Analysis Research in Tobacco and Alcohol (CARTA).</jats:p></jats:sec><jats:sec><jats:title>Primary outcome measures</jats:title><jats:p>Binary definitions of depression, anxiety and psychological distress assessed by clinical interview, symptom scales or self-reported recall of clinician diagnosis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The analytic sample included up to 58 176 never smokers, 37 428 former smokers and 32 028 current smokers (total N=127 632). In observational analyses, current smokers had 1.85 times greater odds of depression (95% CI 1.65 to 2.07), 1.71 times greater odds of anxiety (95% CI 1.54 to 1.90) and 1.69 times greater odds of psychological distress (95% CI 1.56 to 1.83) than never smokers. Former smokers also had greater odds of depression, anxiety and psychological distress than never smokers. There was evidence for positive associations of smoking heaviness with depression, anxiety and psychological distress (ORs per cigarette per day: 1.03 (95% CI 1.02 to 1.04), 1.03 (95% CI 1.02 to 1.04) and 1.02 (95% CI 1.02 to 1.03) respectively). In Mendelian randomisation analyses, there was no strong evidence that the minor allele of rs16969968/rs1051730 was associated with depression (OR=1.00, 95% CI 0.95 to 1.05), anxiety (OR=1.02, 95% CI 0.97 to 1.07) or psycho… 62 [] ["Amy E Taylor", "Meg E Fluharty", "Johan H Bj\u00f8rngaard", "Maiken Elvestad Gabrielsen", "Frank Skorpen", "Riccardo E Marioni", "Archie Campbell", "Jorgen Engmann", "Saira Saeed Mirza", "Anu Loukola", "Tiina Laatikainen", "Timo Partonen", "Marika Kaakinen", "Francesca Ducci", "Alana Cavadino", "Lise Lotte N Husemoen", "Tarunveer Singh Ahluwalia", "Rikke Kart Jacobsen", "Tea Skaaby", "Jeanette Frost Ebstrup", "Erik Lykke Mortensen", "Camelia C Minica", "Jacqueline M Vink", "Gonneke Willemsen", "Pedro Marques-Vidal", "Caroline E Dale", "Antoinette Amuzu", "Lucy T Lennon", "Jari Lahti", "Aarno Palotie", "Katri R\u00e4ikk\u00f6nen", "Andrew Wong", "Lavinia Paternoster", "Angelita Pui-Yee Wong", "L John Horwood", "Michael Murphy", "Elaine C Johnstone", "Martin A Kennedy", "Zdenka Pausova", "Tom\u00e1\u0161 Paus", "Yoav Ben-Shlomo", "Ellen A Nohr", "Diana Kuh", "Mika Kivimaki", "Johan G Eriksson", "Richard W Morris", "Juan P Casas", "Martin Preisig", "Dorret I Boomsma", "Allan Linneberg", "Chris Power", "Elina Hypp\u00f6nen", "Juha Veijola", "Marjo-Riitta Jarvelin", "Tellervo Korhonen", "Henning Tiemeier", "Meena Kumari", "David J Porteous", "Caroline Hayward", "P\u00e5l R Romundstad", "George Davey Smith", "Marcus R Munaf\u00f2"] [""] [""] [""]
6 ["What\u2019s up doc? A national cross-sectional study of psychological wellbeing of hospital doctors in Ireland"] 10.1136/bmjopen-2017-018023 http://dx.doi.org/10.1136/bmjopen-2017-018023 2017-10-16T22:16:03Z [] 0 19 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>To measure levels of psychological distress, psychological wellbeing and self-stigma in hospital doctors in Ireland.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>National cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex, marital status), work grade (consultant, higher/basic specialist trainee), specialty and work hours and completed well-being questionnaires (the Depression Anxiety Stress Scale, WHO Well-being Index, General Health Questionnaire) and single-item scales on self-rated health and self-stigma.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Irish publicly funded hospitals and residential institutions.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>1749 doctors (response rate of 55%). All hospital specialties were represented except radiology.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Half of participants were men (50.5%). Mean hours worked per week were 57 hours. Over half (52%) rated their health as very good/excellent, while 50.5% reported positive subjective well-being (WHO-5). Over a third (35%) experienced psychological distress (General Health Questionnaire 12). Severe/extremely severe symptoms of depression, anxiety and stress were evident in 7.2%, 6.1% and 9.5% of participants (Depression, Anxiety, Stress Scale 21). Symptoms of distress, depression, anxiety and stress were significantly higher and levels of well-being were significantly lower in trainees compared with consultants, and this was not accounted for by differences in sociodemographic variables. Self-stigma was present in 68.4%.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The work hours of doctors working in Irish hospitals were in excess of European Working Time Directive’s requirements. Just over half of hospital doctors in Ireland had positive well-being. Compared with international e… 5 [] ["Bl\u00e1naid Hayes", "Lucia Prihodova", "Gillian Walsh", "Frank Doyle", "Sally Doherty"] [""] [""] [""]
14 ["Study protocol for a randomised controlled trial evaluating the effect of prenatal omega-3 LCPUFA supplementation to reduce the incidence of preterm birth: the ORIP trial"] 10.1136/bmjopen-2017-018360 http://dx.doi.org/10.1136/bmjopen-2017-018360 2017-09-26T00:10:18Z [] 0 10 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Introduction</jats:title><jats:p>Preterm birth accounts for more than 85% of all perinatal complications and deaths. Seventy-five per cent of early preterm births (EPTBs) occur spontaneously and without identifiable risk factors. The need for a broadly applicable, effective strategy for primary prevention is paramount. Secondary outcomes from the docosahexaenoic acid (DHA) to Optimise Mother Infant Outcome trial showed that maternal supplementation until delivery with omega-3 (ω-3) long chain polyunsaturated fatty acid (LCPUFA), predominantly as DHA, resulted in a 50% reduction in the incidence of EPTB and an increase in the incidence of post-term induction or post-term prelabour caesarean section due to extended gestation. We aim to determine the effectiveness of supplementing the maternal diet with ω-3 LCPUFA until 34 weeks’ gestation on the incidence of EPTB.</jats:p></jats:sec><jats:sec><jats:title>Methods and analysis</jats:title><jats:p>This is a multicentre, parallel group, randomised, blinded and controlled trial. Women less than 20 weeks’ gestation with a singleton or multiple pregnancy and able to give informed consent are eligible to participate. Women will be randomised to receive high DHA fish oil capsules or control capsules without DHA. Capsules will be taken from enrolment until 34 weeks’ gestation. The primary outcome is the incidence of EPTB, defined as delivery before 34 completed weeks’ gestation. Key secondary outcomes include length of gestation, incidence of post-term induction or prelabour caesarean section and spontaneous EPTB. The target sample size is 5540 women (2770 per group), which will provide 85% power to detect an absolute reduction in the incidence of preterm birth of 1.16% (from 2.45% to 1.29%) between the DHA and control group (two sided α=0.05). The primary analysis will be based on the intention-to-treat principle.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p>Australia and New Zealand Clinical Trial Registry Num… 7 [] ["Shao J Zhou", "Karen Best", "Robert Gibson", "Andrew McPhee", "Lisa Yelland", "Julie Quinlivan", "Maria Makrides"] [] ["National Health and Medical Research Council"] ["10.13039/501100000925"]
18 ["Post-traumatic growth and its relationship to quality of life up to 9 years after liver transplantation: a cross-sectional study in Spain"] 10.1136/bmjopen-2017-017455 http://dx.doi.org/10.1136/bmjopen-2017-017455 2017-09-17T00:10:22Z [] 0 7 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objective</jats:title><jats:p>Little is known concerning post-traumatic growth (PTG) after liver transplantation. Against this backdrop the current study analysed the relationship between PTG and time since transplantation on quality of life. Furthermore, it compared PTG between liver transplant recipients and their caregivers.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Cross-sectional case–control study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>University Hospital in Spain.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>240 adult liver transplant recipients who had undergone only one transplantation, with no severe mental disease, were the participants of the study. Specific additional analyses were conducted on the subset of 216 participants for whom caregiver data were available. Moreover, results were compared with a previously recruited general population sample.</jats:p></jats:sec><jats:sec><jats:title>Outcome measures</jats:title><jats:p>All participants completed the Posttraumatic Growth Inventory, and recipients also filled in the 12-Item Short-Form Health Survey. Relevant sociodemographic and clinical parameters were also assessed.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the sample of 240 recipients, longer time since transplantation (&gt;9 years) was associated with more pain symptoms (p=0.026). Regardless of duration, recipients showed lower scores on most quality of life dimensions than the general population. However, high PTG was associated with a significantly higher score on the vitality quality of life dimension (p=0.021). In recipients with high PTG, specific quality of life dimensions, such as bodily pain (p=0.307), vitality (p=0.890) and mental health (p=0.353), even equalled scores in the general population, whereas scores on general health surpassed them (p=0.006). Furthermore, liver transplant recipients (n=216) compared with their caregivers showed higher t… 7 [] ["Mar\u00eda \u00c1ngeles P\u00e9rez-San-Gregorio", "Agust\u00edn Mart\u00edn-Rodr\u00edguez", "Mercedes Borda-Mas", "Mar\u00eda Luisa Avargues-Navarro", "Jos\u00e9 P\u00e9rez-Bernal", "Rupert Conrad", "Miguel \u00c1ngel G\u00f3mez-Bravo"] [] ["Spanish Ministry of Economy and Competitiveness"] [[""]]
26 ["Relationship between estimated cardiovascular disease risk and insulin resistance in a black African population living with HIV: a cross-sectional study from Cameroon"] 10.1136/bmjopen-2017-016835 http://dx.doi.org/10.1136/bmjopen-2017-016835 2017-08-11T20:25:24Z [] 0 4 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Objectives</jats:title><jats:p>Cardiovascular disease (CVD) and metabolic diseases are growing concerns among patients with HIV infection as a consequence of the improving survival of this population. We aimed to assess the relationship between CVD risk and insulin resistance in a group of black African individuals with HIV infection.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This cross-sectional study involved patients with HIV infection aged 30–74 years and followed up at the Yaoundé Central Hospital, Cameroon. Absolute CVD risk was calculated using the Framingham and the DAD CVD risk equations while the HOMA-IR index was used to assess insulin resistance (index ≥2.1).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 452 patients (361 women; 80%) were screened. The mean age was 44.4 years and most of the respondents were on antiretroviral therapy (88.5%). The median 5-year cardiovascular risk was 0.7% (25th−75th percentiles: 0.2–2.0) and 0.6% (0.3–1.3) according to the Framingham and DAD equations respectively. Of all participants, 47.3% were insulin resistant. The Framingham equation derived absolute CVD risk was significantly associated with insulin resistance; while no linear association was found using the DAD equation.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The relationship between cardiovascular risk and insulin resistance in black African patients with HIV infection seems to depend on the cardiovascular risk equation used.</jats:p></jats:sec> 13 ["http://orcid.org/0000-0001-8018-6279", "http://orcid.org/0000-0001-6155-235X"] ["Steve Raoul Noumegni", "Jean Joel Bigna", "Vicky Jocelyne Ama Moor epse Nkegoum", "Jobert Richie Nansseu", "Felix K Assah", "Ahmadou Musa Jingi", "Magellan Guewo-Fokeng", "Steve Leumi", "Jean-Claude Katte", "Mesmin Y Dehayem", "Liliane Mfeukeu Kuate", "Andre Pascal Kengne", "Eugene Sobngwi"] [""] [""] [""]
28 ["GCAT|Genomes for life: a prospective cohort study of the genomes of Catalonia"] 10.1136/bmjopen-2017-018324 http://dx.doi.org/10.1136/bmjopen-2017-018324 2018-03-28T06:10:36Z [] 0 4 ["2044-6055", "2044-6055"] BMJ Open <jats:sec><jats:title>Purpose</jats:title><jats:p>The prevalence of chronic non-communicable diseases (NCDs) is increasing worldwide. NCDs are the leading cause of both morbidity and mortality, and it is estimated that by 2030, they will be responsible for 80% of deaths across the world. The Genomes for Life (GCAT) project is a long-term prospective cohort study that was designed to integrate and assess the role of epidemiological, genomic and epigenomic factors in the development of major chronic diseases in Catalonia, a north-east region of Spain.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>At the end of 2017, the GCAT Study will have recruited 20 000 participants aged 40–65 years. Participants who agreed to take part in the study completed a self-administered computer-driven questionnaire, and underwent blood pressure, cardiac frequency and anthropometry measurements. For each participant, blood plasma, blood serum and white blood cells are collected at baseline. The GCAT Study has access to the electronic health records of the Catalan Public Healthcare System. Participants will be followed biannually at least 20 years after recruitment.</jats:p></jats:sec><jats:sec><jats:title>Findings to date</jats:title><jats:p>Among all GCAT participants, 59.2% are women and 83.3% of the cohort identified themselves as Caucasian/white. More than half of the participants have higher education levels, 72.2% are current workers and 42.1% are classified as overweight (body mass index ≥25 and &lt;30 kg/m<jats:sup>2</jats:sup>). We have genotyped 5459 participants, of which 5000 have metabolome data. Further, the whole genome of 808 participants will be sequenced by the end of 2017.</jats:p></jats:sec><jats:sec><jats:title>Future plans</jats:title><jats:p>The first follow-up study started in December 2017 and will end by March 2018. Residences of all subjects will be geocoded during the following year. Several genomic analyses are ongoing, and metabolomic and genomic integrations will be performed t… 13 ["http://orcid.org/0000-0003-4646-3513"] ["Mireia Ob\u00f3n-Santacana", "Mireia Vilardell", "Anna Carreras", "Xavier Duran", "Juan Velasco", "Iv\u00e1n Galv\u00e1n-Femen\u00eda", "Teresa Alonso", "Llu\u00eds Puig", "Lauro Sumoy", "Eric J Duell", "Manuel Perucho", "Victor Moreno", "Rafael de Cid"] [] ["\u2019Ram\u00f3n y Cajal' action from the Spanish Ministry of Economy and Competitiveness", "Ag\u00e8ncia de Gesti\u00f3 d\u2019Ajuts Universitaris i de Recerca (AGAUR)", "Acci\u00f3n de Dinamizaci\u00f3n del ISCIII-MINECO", "Ministry of Health of the Generalitat of Catalunya", "the Catalan Government DURSI"] [[""], [""], [""], [""], [""]]
36 ["THE TOS2 STUDY: AN INTERNATIONAL MULTI-CENTRE AUDIT ASSESSING THE STANDARD OF NEUROLOGICAL EXAMINATION"] 10.1136/jnnp-2015-312379.1 http://dx.doi.org/10.1136/jnnp-2015-312379.1 2015-10-14T18:12:15Z [] 0 2 ["0022-3050", "1468-330X"] Journal of Neurology, Neurosurgery & Psychiatry <jats:p>Having previously demonstrated that in-patients referred to neurology at two UK hospitals were not fully examined prior to referral, we designed an audit with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention.</jats:p><jats:p>In-patients referred to neurology over a 4 month period in the UK, Jordan, Sweden and the United Arab Emirates were asked whether they recalled examination with a Tendon hammer, Ophthalmoscope and Stethoscope since admission. Results were disseminated to local medical teams and data were collected for a further 4 months. Pre and post-intervention data were available for 11 centres with 407 and 391 patients in each arm. 264 patients (64.86%) recalled examination with a tendon hammer pre-intervention, which significantly improved to 298 (76.21%) (p&lt;0.001). 119 (29.24%) recollected ophthalmoscopy pre-intervention, which significantly improved to 149 (38.11%) (p=0.009). 321 (78.87%) recalled examination with a stethoscope pre-intervention, which significantly improved to 330 (84.4%) (p=0.045). Most patients were not fully examined prior to neurology referral, yet a simple assessment score and educational intervention can improve the standard of neurological examination. This is the largest and – to our knowledge – only study to assess the standard of neurological examination internationally. This has implications for national neurological educators.</jats:p> 10 [] ["JP Appleton", "A Ilinca", "AG Lindgren", "A Puschmann", "M Habahbeh", "K Siddiqui", "R DeSilva", "M Jones", "R Butterworth", "DJ Nicholl"] [""] [""] [""]
54 ["PO 8417\u2005RISING TRENDS IN TB MORTALITY AMID DECLINE IN CASES NOTIFIED IN A RURAL COUNTY IN KENYA: COHORT STUDY"] 10.1136/bmjgh-2019-edc.89 http://dx.doi.org/10.1136/bmjgh-2019-edc.89 2019-04-24T15:32:16Z [] 0 0 ["2059-7908"] BMJ Global Health <jats:sec><jats:title>Background</jats:title><jats:p>Despite introduction of rapid and accurate diagnostic tools and aggressive treatment for tuberculosis (TB), it is still a global health problem. In 2016, globally, 1.7 million people died of TB, 95% from resource-poor countries. This study aimed to estimate changing trends in all-cause mortality rate and identify features associated with mortality among suspected TB patients on treatment.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A cohort study of patients registered in a TB surveillance system from 2012 to 2016 and followed up for six months during TB treatment. The outcome was all-cause mortality within six months of TB treatment. The exposures examined were demographic and clinical features at the time of starting TB treatment.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 10,717 participants, median (IQR) age 33 (24–45) years, of which 3163 (30%) were HIV-infected were included in the analyses. During follow-up of 5175.5 person-years (PY), 585/10,717 (5.5%) participants died; mortality rate was 12.2 (95% CI 11.3,13.3) deaths per 100PY. The yearly mortality rate increased from 7.79 (95% CI 6.35, 9.54) in 2012 to 17.73 (95% CI 14.93, 21.06) in 2016 per 100PY (P<jats:sub>trend</jats:sub> &lt;0.001) but the number of suspected-TB notifications declined from 2610 (24%) in 2012 to 1689 (16%) in 2016 (P<jats:sub>trend</jats:sub>=0.02). 77% of all deaths occurred by month three. Mortality among HIV-infected participants was higher (325/3163; 10.3%) than among HIV-non-infected participants (251/7413; 3.4%; p&lt;0.001). Old age, being a female, type of TB diagnosis used, body mass index (BMI) &lt;18.5, HIV status and year of diagnosis were associated with mortality in the multivariate regression model.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>This large population level TB study identifies an alarming trend of patients dying within months of starting treatment. These early dea… 5 [] ["Moses Ngari", "Osman Abdullahi", "Deche Sanga", "Geoffrey Katana", "Annie Willetts"] [""] [""] [""]
58 ["Mining treatment patterns of glucose-lowering medications for type 2 diabetes in the Netherlands"] 10.1136/bmjdrc-2019-000767 http://dx.doi.org/10.1136/bmjdrc-2019-000767 2020-01-08T10:45:11Z [] 0 0 ["2052-4897"] BMJ Open Diabetes Research & Care <jats:sec><jats:title>Rationale and objectives</jats:title><jats:p>Different classes of glucose-lowering medications are used for patients with type 2 diabetes mellitus (T2DM) management. It is unclear how often these medications are prescribed in clinical practice. In this study, we aimed to describe treatment patterns of glucose-lowering medications in patients with T2DM in the Netherlands.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We studied a cohort of 73 819 patients with T2DM, aged ≥45 years with a first prescription for oral glucose-lowering medication between 2011 and 2017. We used the NControl database with dispensing data from 800 pharmacies in the Netherlands. Prevalence of each glucose-lowering medication class during 6 years after the index date was calculated. Using SQL Server, we identified stepwise patterns of medication prescription in this population.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>During the study period, prevalence of biguanides (BIGU) decreased from 95.6% to 80.8% and use of sulfonylureas (SU) increased from 27.3% to 42.3%. 55.2% of all patients only received BIGUs, 19.1% of all patients started on BIGUs but switched to BIGU +SU. 13.5% of patients with T2DM initiated insulins, on average 532 days (almost 18 months) after the index date.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our findings showed that in the Netherlands, medication treatment in patients with T2DM is mainly consistent with the clinical guidelines in the Netherlands during the study period.</jats:p></jats:sec> 5 ["http://orcid.org/0000-0003-2775-7276", "http://orcid.org/0000-0002-2957-5436"] ["Jan Maurik van den Heuvel", "Niloufar Farzan", "Mandy van Hoek", "Anke-Hilse Maitland-van der Zee", "Fariba Ahmadizar"] [""] [""] [""]
81 ["British Veterinary Association Annual General Meeting Belfast, September 21, 2017"] 10.1136/vr.j3847 http://dx.doi.org/10.1136/vr.j3847 2017-08-18T17:40:35Z [] 0 0 ["0042-4900", "2042-7670"] Veterinary Record <jats:p>The 2017 Annual General Meeting of the British Veterinary Association will be held at W5 at Odyssey, 2 Queen’s Quay, Belfast, Antrim, on Thursday, September 21, 2017, at 15.50.</jats:p> 1 [] ["D. Thorpe"] [""] [""] [""]
85 ["ID: 129: PARTICULATE MATTER DISRUPTS ENDOTHELIAL CELL PERMEABILITY VIA GAP JUNCTION PROTEIN"] 10.1136/jim-2016-000120.124 http://dx.doi.org/10.1136/jim-2016-000120.124 2016-05-10T23:43:02Z [] 0 0 ["1081-5589", "1708-8267"] Journal of Investigative Medicine <jats:sec><jats:title>Introduction</jats:title><jats:p>Particulate matter (PM) is significantly associated with cardiopulmonary morbidity and mortality. We previously demonstrated that PM induces endothelial barrier disruption via reactive oxygen species (ROS)-dependent mechanisms. This study is focused on characterization of PM-regulated endothelial dysfunction via connexin43 (Cx43), a Gap junction protein. Gap junction is designated as intercellular channel which allows cells to communicate with each other, share nutrients, and transfer chemical or electrical signals, in turn, enables cells in a tissue to function in a coordinated manner.</jats:p></jats:sec><jats:sec><jats:title>Methods and Results</jats:title><jats:p>Cx43 protein levels were evaluated by western blotting, and band density quantified using MyImageAnalysis. Real-time PCR was conducted to determine Cx43 mRNA levels. Human pulmonary artery endothelial cell (EC) barrier function was measured using the electrical cell-substrate impedance sensing (ECIS) system (Applied Biophysics) that provides a readout of transendothelial electrical resistance (TER). PM sample (0.1–0.3 µm of aerodynamic diameter) was collected (April of 2005) from the Ft. McHenry Tunnel, Baltimore, MD using a high-volume cyclone collector. PM (100 µg/ml) induced time-dependent increases in EC Cx43 mRNA levels (∼5 fold increase at 4 hr) and protein expression which was attenuated by N-acetyl-cysteine (NAC, 5 mM, 1 hr pretreatment), an ROS scavenger. Unlike Cx43, Cx37, another connexin expressed in ECs, remained unaltered by PM challenge. In addition, EC pretreatment with a Cx43 inhibitor, connexin-mimetic peptide Gap27 (500 µM, 2 hr pretreatment), significantly attenuated PM-reduced TER reduction by 45%, suggesting a central role of Cx43 in PM-induced lung EC barrier integrity disruption and signal transduction.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our results suggest Cx43 as a key and novel participant in PM-mediated signal transduction that resu… 4 [] ["X Wu", "X Xu", "JG Garcia", "T Wang"] [""] [""] [""]
97 ["Sex, gender or occupational psychology: what matters most to preventing heat-related illnesses and improving outcomes for women in ground close combat?"] 10.1136/bmjmilitary-2020-001480 http://dx.doi.org/10.1136/bmjmilitary-2020-001480 2020-04-28T07:44:52Z [] 0 0 ["2633-3767", "2633-3775"] BMJ Military Health <jats:p>Since the advent of women in ground close combat (WGCC) roles, the impact on women of the attendant risk of heat stress and heat illness has been considered. Much emphasis has been placed on sex differences in thermal physiology. This article considers the application of evidence of sex-associated thermoregulatory variation to the occupational and environmental setting of WGCC, and weighs the relative importance of physiological differences arising from biological sex, and behaviour associated with gender normatives. Quantifying the risk of heat illness to WGCC should draw on data from their real-world occupational context.</jats:p> 4 ["http://orcid.org/0000-0002-6248-6400"] ["Robert M Gifford", "N Taylor", "M Stacey", "D R Woods"] [""] [""] [""]
27 ["Guideline review: British Society of Gastroenterology/UK-PBC Primary Biliary Cholangitis treatment and management guidelines"] 10.1136/flgastro-2018-101109 http://dx.doi.org/10.1136/flgastro-2018-101109 2019-01-09T22:19:25Z [] 11 4 ["2041-4137", "2041-4145"] Frontline Gastroenterology <jats:p>New guidelines have been produced for the management of primary biliary cholangitis, an infrequent but nonetheless important autoimmune liver disease. We provide a succient commentary and overview of the key features of disease management that arise from these recent guideline recommendations, with a focus on therapy with licensed agents (ursodeoxycholic acid and obeticholic acid) as well as personalised management of disease complications and associated symptoms.</jats:p> 2 ["http://orcid.org/0000-0002-6054-569X"] ["Jorn C Goet", "Gideon M Hirschfield"] [""] [""] [""]
51 ["A challenging presentation of invasive nasopharyngeal sarcomatoid carcinoma"] 10.1136/bcr-2018-226168 http://dx.doi.org/10.1136/bcr-2018-226168 2019-07-09T10:09:12Z [] 13 0 ["1757-790X"] BMJ Case Reports <jats:p>Sarcomatoid carcinoma is a rare clinical entity, especially when presenting in the nasopharynx. We describe the first documented case of nasopharyngeal sarcomatoid carcinoma with intracranial extension in a 59-year-old Caucasian man presenting with severe bifrontal headache and diplopia, secondary to left abducens nerve palsy. We highlight some of the major diagnostic challenges and describe its unusual histological appearance. We outline the importance of a multidisciplinary approach to his management, which includes input from the medicine, neurosurgery, Ear, Nose and Throat (ENT), pathology, radiology, oncology and respiratory teams. In the context of limited evidence, we then describe the rationale to proceed with induction chemotherapy followed by concurrent chemoradiotherapy. Although there was a partial response to treatment, it was not sufficient enough to allow subsequent surgical clearance. The plan going forward is to palliate with chemotherapy as and when the disease progresses.</jats:p> 5 ["http://orcid.org/0000-0002-9143-8942"] ["Alexander Yao", "Haroon Saeed", "Gavin Udall", "Vivek Kaushik", "Lip Wai Lee"] [""] [""] [""]
80 ["Odontogenic myxomas: what is the ideal treatment?"] 10.1136/bcr-2018-228540 http://dx.doi.org/10.1136/bcr-2018-228540 2019-05-22T11:16:59Z [] 13 0 ["1757-790X"] BMJ Case Reports <jats:p>There is no consensus regarding the ideal treatment for odontogenic myxomas, an odontogenic mesenchymal neoplasm. Various authors have suggested en bloc resection due to a concern regarding inadequate clearance while others have suggested more conservative treatment. We present a case managed by buccal cortical resection and an iliac crest bone graft. The patient had no recurrence for over 7 years.</jats:p> 2 [] ["Milad Tavakoli", "Raymond Williamson"] [""] [""] [""]
93 ["Analysis of the risk of ovarian torsion in 49 consecutive pediatric patients treated at a single institution"] 10.1136/wjps-2018-000009 http://dx.doi.org/10.1136/wjps-2018-000009 2019-06-05T21:11:19Z [] 15 0 ["2516-5410"] World Journal of Pediatric Surgery <jats:sec><jats:title>Purpose</jats:title><jats:p>An early diagnosis of ovarian torsion is sometimes difficult due to variable clinical symptoms and non-specific imaging findings. We retrospectively reviewed patients with pediatric ovarian masses manifesting torsion.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Fifty-eight ovarian masses (55 episodes) in 49 non-neonatal patients treated from April 1984 to March 2017 were retrospectively analyzed. The Mann-Whitney U test and Fisher’s exact test were used for the statistical analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The median age of these 55 episodes was 10.5 years old (range 1.0–23.0). Thirty-three patients presented with abdominal pain. Forty-five tumors and 13 cystic masses were resected and diagnosed pathologically (50 benign and 8 malignant). Torsion was identified in 15 cases (25.9%) at operation. The torsion masses were all benign, and 8 ovaries (53.3%) were successfully preserved. Comparing the torsion cases with the non-torsion cases, only the white cell count was significantly higher in the torsion cases (p=0.0133) and in the patients presented with abdominal pain (p=0.0068). The duration of abdominal pain was significantly shorter in ovary preserved cases than in oophorectomy cases.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The white blood cell may be a helpful indicator of the presence of torsion as well as the need for surgery.</jats:p></jats:sec> 13 [] ["Koshiro Sugita", "Takafumi Kawano", "Mukai Motoi", "Toshihiro Muraji", "Shun Onishi", "Tomoe Moriguchi", "Koji Yamada", "Waka Yamada", "Ryuta Masuya", "Seiro Machigashira", "Kazuhiko Nakame", "Tatsuru Kaji", "Satoshi Ieiri"] [""] [""] [""]
34 ["Pneumothorax after acupuncture"] 10.1136/bcr-2018-228770 http://dx.doi.org/10.1136/bcr-2018-228770 2019-06-12T11:35:13Z [] 16 2 ["1757-790X"] BMJ Case Reports <jats:p>Acupuncture is a well-known form of complementary medicine that is increasingly being used worldwide. Despite being rare, pneumothorax is the most common serious complication described in acupuncture. A 79-year-old woman was admitted to the emergency department with a pneumothorax. Two days before, she had undergone an acupuncture treatment for chronic back pain. She felt a sharp right shoulder pain as needles were inserted in the interscapular area. As the pain did not resolve, she consulted her general practitioner and had a chest radiography done, revealing a right-sided pneumothorax. At the hospital, a right chest tube was inserted with relief of the symptoms and lung expansion. The chest tube was removed on the second day of admission, and she was discharged on the third day. Both acupuncturists and clinicians need to be aware of the possibility of adverse events following acupuncture, especially in those who develop symptoms.</jats:p> 4 ["http://orcid.org/0000-0003-3408-0515"] ["Sofia Costa Corado", "Margarida Gra\u00e7a Santos", "Lu\u00edsa Quaresma", "Jos\u00e9 Rodrigues Baltazar"] [""] [""] [""]
89 ["Contralateral effect of systemic absorption of low dose bevacizumab (Avastin) after unilateral intravitreal injection in severe retinopathy of prematurity (ROP)"] 10.1136/bcr-2019-232359 http://dx.doi.org/10.1136/bcr-2019-232359 2020-03-13T09:15:12Z [] 18 0 ["1757-790X"] BMJ Case Reports <jats:p>An extremely premature baby boy born at 23 weeks’ gestational age was treated with unilateral low dose of 0.16 mg/0.025 mL intravitreal bevacizumab in the left eye for aggressive retinopathy of prematurity (ROP). He developed photographically documented changes in his contralateral right eye on imaging 5 days later. Second eye treatment was at 12 days. He has development assessment and ophthalmic review beyond age 2, which is normal. Systemic absorption of the drug caused an end organ effect to slow down and reverse ROP in his untreated right eye. Both eyes vascularised fully. His normal Bayley III developmental score at age 2 is uncommon for a 23-week gestation baby. Even at a low dose, bevacizumab has the potential for end organ effect on the second eye, and therefore other organs. In this case, there are no medium-term measurable neurodevelopmental side-effects. We suggest longer term follow-up is required before excluding unwanted side-effects.</jats:p> 3 [] ["Ayad Shafiq", "Roxane Hillier", "Richard Hearn"] [""] [""] [""]
19 ["Clinical significance of the circle of Willis in intracranial atherosclerotic stenosis"] 10.1136/neurintsurg-2014-011439 http://dx.doi.org/10.1136/neurintsurg-2014-011439 2014-12-10T04:09:30Z [] 19 6 ["1759-8478", "1759-8486"] Journal of NeuroInterventional Surgery <jats:sec><jats:title>Introduction</jats:title><jats:p>The effectiveness of a scoring system based on the circle of Willis for evaluations of collateral circulation was studied in patients with intracranial atherosclerotic stenosis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Eighty-three patients who underwent medical or endovascular treatment for symptomatic and severe intracranial atherosclerotic stenosis were enrolled in the study. Clinical profiles, status of the circle of Willis (poor and good integrity group), and clinical outcomes were analyzed. Primary endpoints were: (1) symptomatic ischemic or hemorrhagic stroke within 30 days; and (2) recurrent transient ischemic attack or ischemic stroke beyond 30 days.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The estimated rates of the primary endpoint at 1 and 2 years after treatment were 8.5% and 11.4% in the medical group and 7.0% and 9.7% in the endovascular group, respectively. A primary endpoint event after medical treatment was only identified in patients with poor integrity of the circle of Willis (p=0.059). In patients with poor integrity of the circle of Willis, previous antiplatelet medication before initial presentation (p=0.026) and hypertension (p=0.006) were more prevalent. During the follow-up period, complete arterial occlusion was identified in 9 patients. The circle of Willis score of the patients with complete arterial occlusion was 1.33±1.52 in the fatal stroke group (n=3) and 3.20±1.64 in the asymptomatic group (n=6, p=0.099).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>If patients have poor integrity of the circle of Willis, the risk of recurrent stroke may be increased. Such patients appear to be good candidates for endovascular treatment.</jats:p></jats:sec> 6 [] ["Kang Min Kim", "Hyun-Seung Kang", "Woong Jae Lee", "Young Dae Cho", "Jeong Eun Kim", "Moon Hee Han"] [""] [""] [""]
73 ["Synchronous recurrence of concurrent colon adenocarcinoma and dedifferentiated liposarcoma"] 10.1136/bcr-2018-228868 http://dx.doi.org/10.1136/bcr-2018-228868 2019-05-14T11:54:19Z [] 19 0 ["1757-790X"] BMJ Case Reports <jats:p>A 62-year-old man presented with concurrent sigmoid colon adenocarcinoma and small bowel mesenteric dedifferentiated liposarcoma. Following surgical resection of the colon cancer, complete excision of the mesenteric sarcoma and adjuvant folinic acid, fluorouracil and oxaliplatin (FOLFOX) chemotherapy, the patient demonstrated no radiological evidence of disease for more than 2 years. The patient then developed synchronous recurrence of both cancers: the colon cancer metastasised to the liver and a pelvic lymph node, and the liposarcoma recurred in the original location. The patient underwent additional chemotherapy with complete response of the metastatic colon cancer and stable disease for the liposarcoma. The recurrent mesenteric tumour was subsequently resected. Although concurrent cancers have been reported, this unique case of synchronous recurrence raises interesting hypotheses regarding host–tumour interaction and immune surveillance.</jats:p> 7 ["http://orcid.org/0000-0001-8440-1271"] ["Eric E Jung", "F Scott Heinemann", "Colt A Egelston", "Jennifer Wang", "Raphael E Pollock", "Peter P Lee", "William W Tseng"] [""] [""] [""]
25 ["Using Q-methodology to guide the implementation of new healthcare policies"] 10.1136/bmjqs-2017-007380 http://dx.doi.org/10.1136/bmjqs-2017-007380 2018-04-12T16:20:06Z [] 25 5 ["2044-5415", "2044-5423"] BMJ Quality & Safety <jats:p>There are many challenges in the development, implementation and evaluation of healthcare policy. One challenge is understanding how different stakeholders view a particular policy and what impact these views may have during implementation. Q-methodology is one approach that can be used to help policy makers and researchers actively engage with those who are important in policy implementation, and anticipate their responses. Q-methodology combines qualitative and quantitative research methods to systematically explore and describe the range of viewpoints about a topic. Participants are required to rank a set of predefined statements relating to the topic, according to their own viewpoint. Factor analytic techniques then identify people who are like-minded in the way they view the topic and enable areas of consensus and divergence in viewpoint to be clearly defined. This mapping of viewpoints allows those working in policy implementation to anticipate likely barriers and levers in implementing new policies.</jats:p> 5 ["http://orcid.org/0000-0002-5418-0495", "http://orcid.org/0000-0001-8721-8026"] ["Sarah Alderson", "Robbie Foy", "Louise Bryant", "Shenaz Ahmed", "Allan House"] [""] [""] [""]
46 ["Impact of self-administration of misoprostol for early medical abortion: a prospective observational cohort study"] 10.1136/bmjsrh-2018-200278 http://dx.doi.org/10.1136/bmjsrh-2018-200278 2019-08-17T21:25:18Z [] 25 1 ["2515-1991", "2515-2009"] BMJ Sexual & Reproductive Health <jats:sec><jats:title>Introduction</jats:title><jats:p>In October 2017, Scotland legalised the home use of misoprostol for the purpose of early medical abortion (EMA). Women up to 9+6 weeks’ gestation can now self-administer the drug at home, 24–48 hours after receiving mifepristone in the clinic.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the impact of this change on the uptake and success rate of EMA, and on the provision of effective contraception on discharge.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A prospective observational study was conducted to compare the outcomes of two cohorts of women in the 6 months before and 6 months after the introduction of home administration of misoprostol. The main outcome measures were uptake of EMA, success of EMA and provision of long-acting reversible contraception (LARC) to women undergoing EMA.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There was a statistically significant increase in the uptake of EMA from 698/1075 (64.9%) women in the first study period to 823/1146 (71.8%) in the second study period. There was no statistically significant difference in the success rate of EMA: 99.3% and 98.9% in clinic and home misoprostol cohorts, respectively. There was also no statistically significant difference in the proportion of women provided with LARC: 37.7% and 33.7% in clinic and home misoprostol cohorts, respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Self-administration of misoprostol at home increased uptake of EMA, with no effect on the high success rate that was previously seen with clinic administration of misoprostol. In addition, the reduced number of visits associated with home use of misoprostol has not affected the provision of effective contraception to women.</jats:p></jats:sec> 4 ["http://orcid.org/0000-0003-0044-5635"] ["Rebecca Elizabeth Finch", "Kevin McGeechan", "Anne Johnstone", "Sharon Cameron"] [""] [""] [""]
11 ["Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index"] 10.1097/igc.0000000000001097 http://dx.doi.org/10.1097/igc.0000000000001097 2017-08-01T21:01:48Z [] 28 10 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Objective</jats:title><jats:p>The present study assessed the predictive value of age and Modified Frailty Index (mFI) on the management of primary epithelial ovarian cancer (EOC) patients aged 70 years or older (elderly).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A retrospective multicenter study selected elderly EOC patients treated between 2006 and 2014. Treatments were analyzed according to the following age group categories: (1) 70 to 75 years versus (2) older than 75 years, and mFI of less than 4 (low frailty) versus greater than or equal to 4 (high frailty).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Seventy-eight patients were identified (40 in age group 1 and 38 in age group 2). The mFI was greater than or equal to 4 in 23 women. Median age of low frailty and high frailty was not significantly different (75.6 vs 75.3). Comorbidities were equally distributed according to age, whereas diabetes, hypertension, obesity, and chronic renal failure were more frequent in the high-frailty group. Performance status was different only according to mFI. Twenty percent of age group 1 versus 55.3% of age group 2 underwent none or only explorative surgical approach (<jats:italic>P</jats:italic> = 0.003), whereas surgical approaches were similar in the 2 frailty groups. The rate of postoperative complications was higher in high-frailty patients compared with low-frailty patients (23.5% vs 4.3%; <jats:italic>P</jats:italic> = 0.03). Chemotherapy was administered to all the patients, a monotherapy regimen to 50% of them. No differences in toxicity were registered, except more hospital recovery in the high-frailty cohort. Median survival time was in favor of younger patients (98 versus 30 months) and less-frailty patients (56 vs 27 months).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Elderly EOC patients can receive an adequate treatment, but patients who are older than 75 years can be undertreated, if not adequately selec… 8 [] ["Annamaria Ferrero", "Luca Fuso", "Elisa Tripodi", "Roberta Tana", "Alberto Daniele", "Valentina Zanfagnin", "Stefania Perotto", "Angiolo Gadducci"] [""] [""] [""]
83 ["Reliability of administrative data to identify sexually transmitted infections for population health: a systematic review"] 10.1136/bmjhci-2019-100074 http://dx.doi.org/10.1136/bmjhci-2019-100074 2020-04-22T00:34:06Z [] 29 0 ["2632-1009"] BMJ Health & Care Informatics <jats:sec><jats:title>Introduction</jats:title><jats:p>International Classification of Diseases (ICD) codes in administrative health data are used to identify cases of disease, including sexually transmitted infections (STIs), for population health research. The purpose of this review is to examine the extant literature on the reliability of ICD codes to correctly identify STIs.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a systematic review of empirical articles in which ICD codes were validated with respect to their ability to identify cases of chlamydia, gonorrhoea, syphilis or pelvic inflammatory disease (PID). Articles that included sensitivity, specificity and positive predictive value of ICD codes were the target. In addition to keyword searches in PubMed and Scopus databases, we further examined bibliographies of articles selected for full review to maximise yield.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>From a total of 1779 articles identified, only two studies measured the reliability of ICD codes to identify cases of STIs. Both articles targeted PID, a serious complication of chlamydia and gonorrhoea. Neither article directly assessed the validity of ICD codes to identify cases of chlamydia, gonorrhoea or syphilis independent of PID. Using ICD codes alone, the positive predictive value for PID was mixed (range: 18%–79%).</jats:p></jats:sec><jats:sec><jats:title>Discussion and conclusion</jats:title><jats:p>While existing studies have used ICD codes to identify STI cases, their reliability is unclear. Further, available evidence from studies of PID suggests potentially large variation in the accuracy of ICD codes indicating the need for primary studies to evaluate ICD codes for use in STI-related public health research.</jats:p></jats:sec> 4 ["http://orcid.org/0000-0002-1121-0607"] ["Brian E Dixon", "Saurabh Rahurkar", "Yenling Ho", "Janet N Arno"] ["T15LM012502"] ["U.S. National Library of Medicine", "National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention"] ["10.13039/100000092", "10.13039/100005258"]
12 ["Exploring the potential chemopreventative effect of aspirin and rofecoxib on hereditary nonpolyposis colorectal cancer\u2013like endometrial cancer cells in vitro through mechanisms involving apoptosis, the cell cycle, and mismatch repair gene expression"] 10.1111/j.1525-1438.2007.00867.x http://dx.doi.org/10.1111/j.1525-1438.2007.00867.x 2007-02-21T17:45:30Z [] 34 10 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:p>Women in hereditary nonpolyposis colorectal cancer (HNPCC) families have up to a 71% lifetime risk for developing endometrial cancer (EC). This compares to the female lifetime risk for colorectal cancer (CRC) in HNPCC of 60%. The basis of HNPCC is an inherited mutation in a mismatch repair gene (MMR). Aspirin and COX2 inhibitors seem to have a chemoprotective effect on CRC in the general population and are the subject of prospective clinical studies in patients at high risk for CRC including HNPCC. There is no evidence that these agents have any protective effect against EC in the general population. This study investigated the effect of aspirin and a COX2 inhibitor (rofecoxib) on an HNPCC EC cell line model (Ishikawa) by assessing the effect on proliferation, apoptosis, the cell cycle, and MMR gene expression. Aspirin inhibits EC cell proliferation by inducing apoptosis and changes in the cell cycle. This effect is not mediated by changes in MMR gene (hMSH2) expression as assessed by quantitative reverse transcription–polymerase chain reaction. Rofecoxib inhibits EC cell proliferation; this did not appear to be mediated by induction of apoptosis, by alterations of the cell cycle, or by changes in MMR gene expression</jats:p> 5 [] ["N. J. Wood", "N. A. Quinton", "S. Burdall", "E. Sheridan", "S. R. Duffy"] [""] [""] [""]
8 ["Increased Incidence of Severe Gastrointestinal Events With First-Line Paclitaxel, Carboplatin, and Vorinostat Chemotherapy for Advanced-Stage Epithelial Ovarian, Primary Peritoneal, and Fallopian Tube Cancer"] 10.1097/igc.0b013e31828566f1 http://dx.doi.org/10.1097/igc.0b013e31828566f1 2013-02-02T09:45:07Z [] 37 13 ["1048-891X", "1525-1438"] International Journal of Gynecologic Cancer <jats:sec><jats:title>Objectives</jats:title><jats:p>We sought to assess the response rate and toxicity of paclitaxel, carboplatin, andvorinostat primary induction therapy for the treatment of advanced-stage ovarian carcinoma.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients were treated with 6 cycles of weekly paclitaxel (80 mg/m<jats:sup>2</jats:sup>), carboplatin (6 times area under the curve), and vorinostat (200 mg) every 28 days according to an institutional review board–approved protocol. The subjects were eligible for response evaluation; in patients who achieved stable disease or better following the conclusion of primary induction chemotherapy, they were subsequently treated with a planned 12 cycles of paclitaxel (135 mg/m<jats:sup>2</jats:sup>) and vorinostat (400 mg) maintenance chemotherapy every 28 days.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Eighteen patients received a combined 90 cycles (median, 6 cycles; range, 1–6 cycles) of primary induction chemotherapy. Of the 18 subjects, 7 demonstrated a complete response, and 2 subjects exhibited a partial response (a total response rate of 50.0%). Eight patients also received a combined total of 50 cycles (median, 5 cycles; range, 1–12 cycles) of consolidation therapy. Grade 3/4 neutropenia and thrombocytopenia were observed in 9 (56.3%) and 2 (12.5%) patients. One patient (6.3%) developed grade 3 anemia, and another (6.3%) manifested a grade 3 neuropathy. Remarkably, we observed a significant gastrointestinal event (eg, bowel anastomotic perforation) in 3 patients, which effectuated the study’s closure.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Because the current study was prematurely terminated, we cannot derive a conclusive assessment regarding the efficacy of this treatment. Nevertheless, the high incidence of severe gastrointestinal toxicity warrants further consideration when using vorinostat in the adjuvant setting for patients who have undergone a bowel res… 7 [] ["Alberto A. Mendivil", "John P. Micha", "John V. Brown", "Mark A. Rettenmaier", "Lisa N. Abaid", "Katrina L. Lopez", "Bram H. Goldstein"] [""] [""] [""]
22 ["EGFR gene copy number as a predictive/biomarker for patients with non-small-cell lung cancer receiving tyrosine kinase inhibitor treatment: a systematic review and meta-analysis"] 10.1136/jim-2016-000252 http://dx.doi.org/10.1136/jim-2016-000252 2016-09-24T02:48:22Z [] 41 6 ["1081-5589", "1708-8267"] Journal of Investigative Medicine <jats:p>Epidermal growth factor receptor (<jats:italic>EGFR</jats:italic>) gene copy number has been proposed as a candidate biomarker for predicting treatment response to EGFR tyrosine kinase inhibitors (EGFR-TKIs) in patients with advanced non-small-cell lung cancer (NSCLC). MEDLINE, PubMed, Cochrane, and Google Scholar databases were searched until October 21, 2015 using the following search terms: lung neoplasms/lung cancer/non-small cell lung cancer/NSCLC, EGFR, gene amplification, copy number, erlotinib, gefitinib, tyrosine-kinase inhibitor/TKI, predictor. 17 studies were included in the analysis with a total of 2047 patients. The overall analysis found that increased <jats:italic>EGFR</jats:italic> gene copy number was associated with higher overall response rate (ORR), overall survival (OS) and progression-free survival (PFS; p values ≤0.008) compared with patients without a high <jats:italic>EGFR</jats:italic> gene copy number. Subgroup analysis found that in a population of patients who were primarily Caucasian, a higher <jats:italic>EGFR</jats:italic> gene copy number was also associated with increased ORR, OS, and PFS (p values ≤0.018). The results were similar in a population of Asian patients, except that a higher <jats:italic>EGFR</jats:italic> gene copy number was not associated with improved OS (p=0.248). Sensitivity analysis indicated that no one study overly influenced the results and that the findings are robust. The result of the analysis found that <jats:italic>EGFR</jats:italic> gene copy number was associated with increased OS and PFS, supporting the idea that <jats:italic>EGFR</jats:italic> gene copy number is a biomarker for response to EGFR-TKI therapy in patients with advanced NSCLC.</jats:p> 4 [] ["Xin Zhang", "Yiwen Zhang", "Hailing Tang", "Jianxing He"] [""] [""] [""]
21 ["Association between frontal plane knee control and lower extremity injuries: a prospective study on young team sport athletes"] 10.1136/bmjsem-2017-000311 http://dx.doi.org/10.1136/bmjsem-2017-000311 2018-01-14T01:10:19Z [] 47 6 ["2055-7647"] BMJ Open Sport & Exercise Medicine <jats:sec><jats:title>Background/aim</jats:title><jats:p>Poor frontal plane knee control can manifest as increased dynamic knee valgus during athletic tasks. The purpose of this study was to investigate the association between frontal plane knee control and the risk of acute lower extremity injuries. In addition, we wanted to study if the single-leg squat (SLS) test can be used as a screening tool to identify athletes with an increased injury risk.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A total of 306 basketball and floorball players participated in the baseline SLS test and a 12-month injury registration follow-up. Acute lower extremity time-loss injuries were registered. Frontal plane knee projection angles (FPKPA) during the SLS were calculated using a two-dimensional video analysis.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Athletes displaying a high FPKPA were 2.7 times more likely to sustain a lower extremity injury (adjusted OR 2.67, 95% CI 1.23 to 5.83) and 2.4 times more likely to sustain an ankle injury (OR 2.37, 95% CI 1.13 to 4.98). There was no statistically significant association between FPKPA and knee injury (OR 1.49, 95% CI 0.56 to 3.98). The receiver operating characteristic curve analyses indicated poor combined sensitivity and specificity when FPKPA was used as a screening test for lower extremity injuries (area under the curve of 0.59) and ankle injuries (area under the curve of 0.58).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Athletes displaying a large FPKPA in the SLS test had an elevated risk of acute lower extremity and ankle injuries. However, the SLS test is not sensitive and specific enough to be used as a screening tool for future injury risk.</jats:p></jats:sec> 10 ["http://orcid.org/0000-0003-3056-8169"] ["Anu M R\u00e4is\u00e4nen", "Kati Pasanen", "Tron Krosshaug", "Tommi Vasankari", "Pekka Kannus", "Ari Heinonen", "Urho M Kujala", "Janne Avela", "Jarmo Perttunen", "Jari Parkkari"] [] ["The Foundation of Sports Institute", "the Competitive State Research Financing of The Expert Responsibility Area of Tampere University Hospital", "The Finnish Ministry of Education and Culture"] [[""], [""], [""]]
50 ["Mediastinal cystic teratoma masquerading as a hydatid cyst"] 10.1136/bcr-2020-234755 http://dx.doi.org/10.1136/bcr-2020-234755 2020-06-30T06:17:26Z [] 8 0 ["1757-790X"] BMJ Case Reports <jats:p>A case is presented in which a preoperatively diagnosed hydatid cyst was found to be a mature cystic teratoma on pathological examination. Diagnostic dilemmas surrounding each disease are discussed.</jats:p> 4 [] ["David Williams", "Fang Zhou", "Max Grovenburg", "Mikhail Vaynblat"] [""] [""] [""]
44 ["Adult intussusception secondary to diverticular disease"] 10.1136/bcr-2018-226678 http://dx.doi.org/10.1136/bcr-2018-226678 2018-11-09T07:25:40Z [] 9 1 ["1757-790X"] BMJ Case Reports <jats:p>Intussusception is the invagination of a proximal segment of bowel into the lumen of an adjacent distal segment. It is a common condition in the paediatric age group although it rarely occurs in adults. Organic lesions in the bowel wall are the primary cause of adult intussusceptions with malignant neoplasms being the most common. However, we present a rare case of a 92-year-old man diagnosed with an intussusception of the sigmoid-rectal colon secondary to a diverticular stricture.</jats:p> 4 ["http://orcid.org/0000-0003-0461-0861"] ["Habib Syed", "Labib Syed", "Umesh Parampalli", "Mokhtar Uheba"] [""] [""] [""]
90 ["Junctional bradycardia caused by ciguatera intoxication"] 10.1136/bcr-2019-229354 http://dx.doi.org/10.1136/bcr-2019-229354 2019-05-31T12:15:32Z [] 9 0 ["1757-790X"] BMJ Case Reports <jats:p>Ciguatera is a common but underreported tropical disease caused by the consumption of coral reef fish contaminated by ciguatoxins. Gastrointestinal and neurological symptoms predominate, but may be accompanied by cardiovascular features such as hypotension and sinus bradycardia. Here, we report an unusual case of junctional bradycardia caused by ciguatera in the Caribbean; to our knowledge, the first such report from the region. An increase in global sea temperatures is predicted to lead to the spread of ciguatera beyond traditional endemic areas, and the globalisation of trade in coral reef fish has resulted in sporadic cases occurring in developed countries far away from endemic areas. This case serves as a reminder to consider environmental intoxications such as ciguatera within the differential diagnosis of bradycardias.</jats:p> 4 ["http://orcid.org/0000-0001-6099-0948"] ["Rajendra Raman", "Sarah Coppes", "Tessa Hellingman", "Casper Lacl\u00e9"] [""] [""] [""]
32 ["Medication-related harm in older adults following hospital discharge: development and validation of a prediction tool"] 10.1136/bmjqs-2019-009587 http://dx.doi.org/10.1136/bmjqs-2019-009587 2019-09-16T21:15:37Z [] 94 2 ["2044-5415", "2044-5423"] BMJ Quality & Safety <jats:sec><jats:title>Objectives</jats:title><jats:p>To develop and validate a tool to predict the risk of an older adult experiencing medication-related harm (MRH) requiring healthcare use following hospital discharge.</jats:p></jats:sec><jats:sec><jats:title>Design, setting, participants</jats:title><jats:p>Multicentre, prospective cohort study recruiting older adults (≥65 years) discharged from five UK teaching hospitals between 2013 and 2015.</jats:p></jats:sec><jats:sec><jats:title>Primary outcome measure</jats:title><jats:p>Participants were followed up for 8 weeks in the community by senior pharmacists to identify MRH (adverse drug reactions, harm from non-adherence, harm from medication error). Three data sources provided MRH and healthcare use information: hospital readmissions, primary care use, participant telephone interview. Candidate variables for prognostic modelling were selected using two systematic reviews, the views of patients with MRH and an expert panel of clinicians. Multivariable logistic regression with backward elimination, based on the Akaike Information Criterion, was used to develop the PRIME tool. The tool was internally validated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>1116 out of 1280 recruited participants completed follow-up (87%). Uncertain MRH cases (‘possible’ and ‘probable’) were excluded, leaving a tool derivation cohort of 818. 119 (15%) participants experienced ‘definite’ MRH requiring healthcare use and 699 participants did not. Modelling resulted in a prediction tool with eight variables measured at hospital discharge: age, gender, antiplatelet drug, sodium level, antidiabetic drug, past adverse drug reaction, number of medicines, living alone. The tool’s discrimination C-statistic was 0.69 (0.66 after validation) and showed good calibration. Decision curve analysis demonstrated the potential value of the tool to guide clinical decision making compared with alternative approaches.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:ti… 10 ["http://orcid.org/0000-0002-9988-3717"] ["Nikesh Parekh", "Khalid Ali", "John Graham Davies", "Jennifer M Stevenson", "Winston Banya", "Stephen Nyangoma", "Rebekah Schiff", "Tischa van der Cammen", "Jatinder Harchowal", "Chakravarthi Rajkumar"] ["PB-PG-0711-25094"] ["National Institute for Health Research"] ["10.13039/501100000272"]

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