tbuckley/cabot-search huggingface dataset:
OC-138 Quality of colonoscopic procedures among independently practising gastroenterology trainees in a NW London cohort: are they reaching national standards?
Authors: S Nayagam, N Selvapatt, J Louis Auguste, H R T Williams, T R Orchard, H J W Thomas, J P Teare, J Hoare
Journal: Gut (2012)

<h3>Introduction</h3> The Global Rating Scale (GRS) and Joint Advisory Group on GI Endoscopy (JAG) auditable outcome standards have been used to improve quality and define minimum standards for colonoscopy across the UK.<sup>1</sup> JAG also provides a clear competency based framework to assess trainee performance; however, there is reluctance in some units to allow independent senior registrars, who have passed JAG assessment, to practise independently. At our teaching centre we encourage appropriately trained registrars to perform their own lists. Supervision is available if needed and departmental protocols define limits of therapy to be undertaken independently (eg, large polypectomies). Attendance at training lists to continue development is also actively encouraged. Our aim was to evaluate whether this provided a quality of service comparable to national standards. <h3>Methods</h3> We used data collected retrospectively from endoscopy reporting software (Ascribe-Scorpio) on the caecal intubation rate, polyp detection rate, sedation usage and complication rate, to evaluate the performance of senior gastroenterology trainees between 2007 and 2011, against the JAG auditable outcomes for colonoscopy. <h3>Results</h3> Over a 4-year period, 17 senior gastroenterology registrars performed a total of 2917 colonoscopies. 2221 (76.1%) procedures were unsupervised and 696 (23.9%) were supervised. An uncorrected caecal intubation rate of 94.9% was achieved during unsupervised procedures, 96.6% with supervision (p=0.93, X<sup>2</sup>). Polyp (all type) detection rate was 30%. Average sedation dose for patients aged &gt;70 years, was pethidine 30 mg and midazolam 1.96 mg; aged &lt;70 years, pethidine 35.5 mg and midazolam 2.54 mg. Flumazenil was used on four occasions and naloxone on one occasion. There were two major complications. One perforation, following argon therapy to an angiodysplasia, treated conservatively and one major post polypectomy bleed, treated endoscopically but admitted for observation. None of the registrars were outliers on the comfort score data. <h3>Conclusion</h3> Our findings show that given appropriate training and support, independently practising senior UK gastroenterology registrars contribute significantly to service delivery, providing high quality colonoscopy, meeting JAG auditable outcome standards. <h3>Competing interests</h3> None declared. <h3>Reference</h3> 1. <b>Roland V</b>. <i>BSG Quality and Safety Indicators for Endoscopy (JAG)</i>. 2007.
A MODIFICATION OF BOSWORTH'S NASAL AND AURAL SNARE.
Authors: P. L. ANDERSON
Journal: JAMA (1897)

Long experience with the various snares on the market has demonstrated that while they all have their individual points of excellence, no one snare combines all of the good qualities without some of the bad ones. The accompanying cuts show by comparison, the simplicity and advantages of the Bosworth snare as modified by the author. Instead of the long wire loop, there is substituted a flexible steel stilette, with one end flattened and having a round eye large enough to receive a double thread of No. 5 piano wire; the other end terminates in a circular hook, the central point of which is in line with the long axis of the stilette. The stilette is inserted into the canula of Bosworth's snare with the eye projecting just beyond the distal end, in position for threading with the short loop of wire. The other end is hooked around a screw-post set
Desmoid Tumour of the Chest
Authors: W. K. Nickell, C. F. Kittle, J. O. Boley
Journal: Thorax (1958)

Desmoid tumours are uncommon fibrous neo- plasms usually originating from fascia of the anterior rectus muscle in multiparous women.Extra-abdominal desmoids are rare and present certain problems in their diagnosis and operative management.We should like to describe a patient with a desmoid tumour of the chest wall recently treated at the University of Kansas Medical Center.CASE HISTORY B. H., a 21-year-old housewife, was first seen on February 27, 1956, complaining of a gradually en- larging painless nodule in the left chest wall of six months' duration.No history of trauma, inflammation, or rapid growth could be elicited.The patient had experienced a normal pregnancy and delivery two years previously.When first seen she had had amenorrhoea and morning nausea for two months.
NI-20 * ADC HISTOGRAM ANALYSIS FOLLOWING RADIOTHERAPY PREDICTS RESPONSE TO ADJUVANT TEMOZOLOMIDE IN NEWLY DIAGNOSED GBM
Authors: B. Ellingson, W. Chang, R. Harris, R. Mody, A. Lai, P. Nghiemphu, T. Cloughesy, W. Pope
Journal: Neuro-Oncology (2014)

INTRODUCTION: The current standard of care for newly diagnosed GBM consists of concurrent radiotherapy and temozolomide (TMZ) plus adjuvant TMZ. We hypothesize there is a subset of patients that will have a significant benefit from this adjuvant therapy. Therefore, the purpose of the current study was to identify a diffusion imaging phenotype for patients with newly diagnosed GBM that will benefit from adjuvant TMZ following concurrent radiotherapy and TMZ. METHODS: A total of 120 patients with: 1) histologically confirmed glioblastoma, 2) treated with concurrent radiotherapy and TMZ followed by adjuvant TMZ; and 3) high quality diffusion MR data were included in the current study. Diffusion and standard structural MRI were performed approximately 10 weeks after the start of radiotherapy and concurrent TMZ. ADC histogram analysis was performed by fitting a double Gaussian mixed model to ADC data extracted from contrast enhancement tumor. ADCL was defined as the mean ADC of the lower Gaussian distribution. We hypothesize that patients with a high ADCL have a lower tumor burden and thus favorable response to adjuvant TMZ in terms of TTP and OS. RESULTS: Results demonstrate that patients with an ADCL lower than 1 um2/ms has a significantly shorter PFS compared with patients having a higher ADCL (Log-rank, P < 0.0001), showing almost twice the median PFS (297 days vs. 156 days). Additionally, patients with a high ADCL had a significantly longer OS (Log-rank, P = 0.0049). Patients with a high ADCL had a median OS of 648 days while patients with a low ADCL had a median OS of only 407 days from the start of adjuvant TMZ. CONCLUSION: Newly diagnosed GBM patients with elevated tumor diffusivity after completion of radiotherapy and concurrent TMZ have a favorable prognosis.
Inferring Evolutionary Rates Using Serially Sampled Sequences from Several Populations
Authors: A. G. Rodrigo
Journal: Molecular Biology and Evolution (2003)

The estimation of evolutionary rates from serially sampled sequences has recently been the focus of several studies. In this paper, we extend these analyzes to allow the estimation of a joint rate of substitution, ω, from several evolving populations from which serial samples are drawn. In the case of viruses evolving in different hosts, therapy may halt replication and therefore the accumulation of substitutions in the population. In such cases, it may be that only a proportion, p, of subjects are nonresponders who have viral populations that continue to evolve. We develop two likelihood-based procedures to jointly estimate p and ω, and empirical Bayes' tests of whether an individual should be classified as a responder or nonresponder. An example data set comprising HIV-1 partial envelope sequences from six patients on highly active antiretroviral therapy is analyzed.
MCP‐1 gene regulatory region polymorphism in Chinese children with mild, moderate and near‐fatal asthma
Authors: T.‐C. Yao, K.‐C. Wu, H.‐T. Chung, C.‐K. Shaw, M.‐L. Kuo, C.‐J. Wu, J.‐L. Huang
Journal: Allergy (2004)

Background: A polymorphism in the monocyte chemoattractant protein 1 (MCP‐1) gene regulatory region has been associated with asthma in Caucasians. This polymorphism is possibly endemic to the Asian region, but its impact on Asian populations is unclear. In addition, the relationship of this marker with life‐threatening asthma has not been clarified. The aim of this study was to test the genetic association between the MCP‐1 –2518A/G polymorphism and asthma/atopy in a cohort of Chinese children, with particular emphasis on those patients who had experienced life‐threatening asthma attacks. Methods: Forty‐eight children with near‐fatal asthma, 134 mild‐to‐moderate asthmatics, 69 allergic‐disorder cases without asthma, and 107 nonasthmatic, nonatopic control children were genotyped by a polymerase chain reaction‐based assay. Results: Comparison of the four groups of children ( n = 358) revealed no detectable differences in genotype or allele frequencies of the MCP‐1 –2518A/G polymorphism. There was no evidence of association between the polymorphism and any of the outcomes of interest including clinical severity, blood eosinophil count, atopy, total serum IgE levels, and degree of bronchial hyper‐responsiveness. Conclusion: These results suggest that the MCP‐1 –2518A/G polymorphism is not a risk factor for near‐fatal asthma. Furthermore, this polymorphism seems to play no role in the development of asthma or atopy in Chinese subjects, possibly as a result of the genetic heterogeneity between Asian and Caucasian populations with respect to regulation of MCP‐1 expression. Our results underscore the necessity of accounting for ethnic background in the investigation of asthma‐predisposition genes.
Fasting plasma glucose variability predicts 10-year survival of type 2 diabetic patients: the Verona Diabetes Study.
Authors: M Muggeo, G Zoppini, E Bonora, E Brun, R C Bonadonna, P Moghetti, G Verlato
Journal: Diabetes Care (2000)

OBJECTIVE: In the present study, we evaluated whether the coefficient of variation (CV) of fasting plasma glucose (FPG) over a 3-year period was a significant predictor of mortality in type 2 diabetic patients aged 56-74 years. RESEARCH DESIGN AND METHODS: All type 2 diabetic patients (n = 1,409) aged 56-74 years attending the Verona Diabetes Clinic and having at least two FPG determinations in each of the years 1984-1986 were followed for 10 years (1987-1996) to assess total and cause-specific mortality Patients were grouped into tertiles of mean and CV of FPG during 1984-1986. These parameters as well as sex, age, diabetes duration, insulin treatment, smoking, hypertension, and hypercholesterolemia were included in multivariate survival analyses. RESULTS: During the follow-up, 468 patients died. The CV of FPG was an independent predictor of total, cardiovascular, and cancer mortality. Mean FPG was a predictor of total mortality only when the CV of FPG was not included in the analyses. CONCLUSIONS: Long-term variability of fasting glucose is an independent predictor of mortality in patients with type 2 diabetes. The CV of FPG might be considered a useful additional parameter in the management of these patients.
Cytogenetic findings in reactive lymphoid hyperplasia: Significance of non‐clonal t(3;14) and t(3;22)
Authors: Wing Y. Au, Douglas E. Horsman, Joseph M. Connors, Richard J. Klasa, Randy D. Gascoyne
Journal: American Journal of Hematology (2002)

Despite several reports of the molecular detection of recurrent lymphoma translocations in reactive lymph nodes (LN), cytogenetic analysis is seldom performed on such cases. We report the clinical and cytogenetic analysis results on 30 reactive LN. Of these, 17 cases yielded either no growth (n = 9) or normal metaphases only (n = 8), and seven of the 17 patients subsequently developed lymphoma. Lymphoma developed in all 10 patients with a clonal karyotype (median of 2.6 months). Three patients (1 HIV-positive) had non-clonal t(3;14) or t(3;22). Their lymphadenopathy resolved spontaneously, and none progressed to lymphoma at 4-6 years of follow-up. Molecular methods detected a small B-cell clone in one case and an oligoclonal B-cell population in the other. Cytogenetic analysis may be useful for interpreting cases of lymphoid hyperplasia. A clonal abnormality is highly predictive of concurrent and/or subsequent lymphoma. A lymphoma-specific but non-clonal abnormality does not necessarily herald the development of subsequent lymphoma.
The Cri1 locus is the common genetic cause of susceptibility to<i>Citrobacter rodentium</i>infection in C3H and FVB mouse strains.
Authors: Sarah Ann Teatero, Jenny-Lee Thomassin, Lei Zhu, Eduardo Diez, Danielle Malo, Samantha Gruenheid
Journal: Gut Microbes (2011)

Citrobacter rodentium is a natural pathogen of mice that causes intestinal hyperplasia and colitis. Resistant strains such as C57BL/6J (B6) experience a self-limiting disease that peaks between one and two weeks post infection, followed by a clearing of the infection and complete recovery. However, the inbred mouse strains C3H/HeJ (C3), C3H/HeOuJ (C3Ou) and FVB/N (FVB) are highly susceptible to C. rodentium infection and develop more severe symptoms of disease leading to high rates of mortality during infection. We have recently demonstrated through a systematic genetics approach that a single locus on proximal chromosome 15 is responsible for the susceptibility of both C3 and C3Ou mice to C. rodentium infection. We have named the locus Citrobacter rodentium infection 1 (Cri1). Here we show that Cri1 also controls susceptibility to C. rodentium in FVB mice, using a targeted method of genotyping to stratify (B6 x FVB)F2 mice according to their genotype at Cri1. Mice that inherit two copies of the resistant B6 allele have 97% cumulative survival at day 30 post-infection, whereas those that inherit one or two copies of Cri1 from the FVB parent have significantly lower rates of survival (35% and 42%, respectively). These results provide evidence for a common genetic cause of fatal infectious colitis in C3, C3Ou and FVB mice following infection with Citrobacter rodentium.
Interleukin-10 expression is autoregulated at the transcriptional level in human and murine kupffer cells
Authors: Percy A. Knolle, Anja Uhrig, Ulrike Protzer, Martin Trippler, Rainer Duchmann, Karl-Hermann Meyer zum Büschenfelde, Guido Gerken
Journal: Hepatology (1998)

Interleukin 10 (IL-10) is known to downregulate immune responses. The regulation of IL-10 gene expression therefore determines the outcome of local immune reactions. We investigated time course and downregulation of IL-10 production in primary Kupffer’s cells (KC), which are known to secrete IL-10 in response to endotoxin challenge. Human and murine KC were isolated by centrifugal elutriation and investigated for IL-10 gene expression by a two-step amplification procedure (reverse transcriptase-polymerase chain reaction [PCR] followed by T7-polymerase chain reaction). We show that IL-10 messenger ribonucleic acid (mRNA) showed a &gt;450 fold increase in KC 2 hours after endotoxin challenge. IL-10 protein release from KC strictly depended on de novo protein synthesis. Endotoxin mediated increase in IL-10 gene expression was downregulated by exogenous (&gt;350-fold reduction of IL-10 mRNA level), as well as endogenous IL-10 protein, showing a negative autoregulatory feedback loop. IL-10 receptor expression was found to be constitutive and functional in KC. Early expression of IL-10 in KC may be of functional relevance to the outcome of immune and inflammatory reactions in the liver sinusoid. The negative autoregulation of IL-10 expression may represent a mechanism to regain a state of functional responsiveness in the microenvironment towards new proinflammatory stimuli. In conclusion, autoregulatory downregulation of IL-10 expression in KC may account for important regulatory steps of local immune response in the liver sinusoid.
Abstract 2427: Risk Stratification for Primary Implantation of an ICD in the Multicenter Automatic Defibrillator Implantation Trial - II (MADIT-II)
Authors: Anant Vyas, Ilan Goldenberg, W. Jackson Hall, Hongyue Wang, Hua He, Wojciech Zareba, Scott McNitt, Mark L Andrews, Arthur J Moss, Madit-Ii Investigators
Journal: Circulation (2007)

Background: ICD therapy reduced mortality in the MADIT-II trial (post MI patients with an EF≤30%). We hypothesized that certain low-risk patients may not benefit by virtue of being low-risk for sud...
Review of Medical Histology
Authors: Nelson R. Niles
Journal: JAMA (1977)

The problem of relevance continues to bedevil the presentation of medical histology courses. Students are not likely to understand the value of the subject until its applications become visible, and this may occur in divided and irregular doses at odd times, and even long after the course is completed. Curricula, as they expand in content and get compressed in time, may produce some unforeseen and undesirable gaps in knowledge. The introduction to this small but useful volume states its authors' intent to present in concise from (227 easy-to-read pages) the fundamentals of histology necessary for a modern medical curriculum. They have succeeded admirably. Students need more histology than this, but it should come by means of observation, discussion, and application, not through reading textbooks. The text may seem too brief, but the expressed and fulfilled objective is to make drawings and diagrams complement, not duplicate, information. Obviously, great care and
Prediction of Hepatocellular Carcinoma Recurrence in Patients With Low Hepatitis B Virus DNA Levels and High Preoperative Hepatitis B Surface Antigen Levels
Authors: Gang Huang, Wan Yee Lau, Wei-ping Zhou, Feng Shen, Ze-ya Pan, Sheng-xian Yuan, Meng-chao Wu
Journal: JAMA Surgery (2014)

In patients with low viral loads, high levels of hepatitis B surface antigen (HBsAg) have been shown to predict development of hepatocellular carcinoma (HCC). Whether high levels of HBsAg increase the risk for HCC recurrence after hepatic resection remains unknown.To investigate the association between levels of HBsAg and the risk for tumor recurrence after curative resection in HCC patients with low levels of hepatitis B virus (HBV) DNA.We performed a retrospective analysis of the clinical data of 1062 patients with low HBV DNA levels (<200 IU/mL) who underwent partial hepatectomy for HCC. In particular, we investigated the association between levels of HBsAg and recurrence of HCC.Partial hepatectomy for HCC.The risk for first tumor recurrence between patients with high and low HBsAg levels. We calculated cumulative incidences and hazard ratios after adjusting for competing mortality.The risk for tumor recurrence increased with HBsAg levels of 1000 IU/mL or greater. When we compared the groups with low (<1000 IU/mL) and high (≥1000 IU/mL) HBsAg levels, the 5-year disease-free survival rate (46.1% vs 34.1% [P = .002]) and the overall survival rate (57.5% vs 48.8% [P = .004]) were better in the group with low HBsAg levels. On multivariate analysis, hepatitis B e antigen seropositivity, HBsAg level of 1000 IU/mL or greater, tumor size of greater than 5 cm, blood transfusion, surgical margin of less than 1.0 cm, the presence of satellite nodules, and the presence of portal vein tumor thrombus were independent risk factors for HCC recurrence. When compared with hepatitis B e antigen status, HBsAg level better predicted recurrence of HCC.A preoperative HBsAg level of 1000 IU/mL or greater is an independent risk factor for HCC recurrence in patients with low HBV DNA levels.
Alterations in circulating activin A, GDF‐15, TGF‐β3 and MMP‐2, ‐3, and ‐9 during one year of left ventricular reverse remodelling in patients operated for severe aortic stenosis
Authors: Johannes L. Bjørnstad, Nils O. Neverdal, Øystein A. Vengen, Cathrine Wold Knudsen, Trygve Husebye, John Pepper, Mons Lie, Geir Christensen, Theis Tønnessen
Journal: European Journal of Heart Failure (2008)
Physicians Called Upon to Help Chart Future Space Effort
Authors: Charles Marwick
Journal: JAMA (1986)

CONGRESS, THE PRESIDENT, and a task force of NASA's Advisory Council are studying a report that looks beyond the present gloom and offers a glowing forecast—with implications for medicine—for the next 50 years of space exploration.  The nation's space program has received more scrutiny in a shorter time this year than perhaps any federal activity in history. This latest report was prepared by members of the National Commission on Space.  In effect, their report (the commission itself ceased to exist this summer, 60 days after the report was transmitted to the President and Congress) supports NASA's humans-in-space policy, including what medicine can learn about prolonged exposure to that environment. And, in turn, NASA officials support the commission's report, saying they intend to carry out its recommendations.  Although humans have been taking journeys into space for a quartercentury with the declared goal of eventually living and working there for protracted periods
Will Cell Reprogramming Resolve the Embryonic Stem Cell Controversy? A Narrative Review
Authors: Carl Power, John E.J. Rasko
Journal: Annals of Internal Medicine (2011)

In the past few years, relatively straightforward laboratory techniques have been developed to reprogram normal body cells to enter an embryonic stem cell–like state. Not only do these induced pluripotent stem cells hold great medical promise—perhaps greater than that of embryonic stem cells—but they also have escaped the ethical controversy in which the latter is mired. This article examines how cell reprogramming is likely to transform regenerative and reproductive medicine and highlights some of the medical, moral, and political hurdles that it faces. It also argues that induced pluripotent stem cells are more ethically problematic than most people believe and that cell reprogramming will not solve the stem cell controversy but complicate it further.
Adverse Reactions to Trimethoprim-Sulfamethoxazole in Patients with the Acquired Immunodeficiency Syndrome
Authors: FRED M. GORDIN
Journal: Annals of Internal Medicine (1984)

We reviewed the charts of 38 patients with the acquired immunodeficiency syndrome who were treated for Pneumocystis carinii pneumonia. Only 5 of 37 patients started on trimethoprim-sulfamethoxazole were able to complete treatment; in 29 patients drug toxicity occurred and in 19 treatment was changed due to adverse reactions that included rash, fever, neutropenia, thrombocytopenia, and transaminase elevation. Pentamidine was given to 30 patients (1 as initial treatment); toxicity occurred in 13 but only 4 required a change in drug. Adverse reactions from pentamidine included fever, rash, neutropenia, transaminase elevation, azotema, and hypoglycemia. Patients received trimethoprim-sulfamethoxazole a median of 9.5 days, and pentamidine, a median of 12.5 days. Toxicity from trimethoprim-sulfamethoxazole appeared earlier than toxicity associated with pentamidine (7.5 versus 9.5 days of treatment). In patients with the acquired immunodeficiency syndrome, trimethoprim-sulfamethoxazole has a higher incidence of adverse reactions than pentamidine (p < 0.005).
The Mystery of General Practice
Authors: W. R Phillips
Journal: BMJ (1996)

Iona Heath Nuffield Provincial Hospitals Trust, pounds sterling8, pp 53 ISBN 0 900574 93 3

The role of the general practitioner is changing rapidly on both sides of the Atlantic. In the United Kingdom general practitioners enter into fund holding arrangements with the National Health Service. In the United States family physicians accept capitated contracts with managed care organisations. Both arrangements require doctors to balance the competing needs of the patient, the practice, and the larger system. The opportunity is to provide services to …