tbuckley/cabot-search huggingface dataset:
PTU-144 Can we Predict Patients with Barrett’S Dysplasia who will Progress to Malignancy Despite Endotherapy; Results of a Prospective, Single Centre Experience
Authors: H C Mcewan, J Going, G Fullarton, A J Morris
Journal: Gut (2013)

<h3>Introduction</h3> In the treatment of Barrett’s patients with intramucosal cancer (IMC) and high grade dysplasia (HGD), there is mounting evidence to support a combined endoscopic approach of endoscopic mucosal resection (EMR) and radiofrequency ablation (RFA). Despite the efficacy and safety of endotherapy in the treatment of IMC and HGD, some patients fail to respond to treatment or progress to oesophageal adenocarcinoma (EAC). We sought to examine the factors associated with the failure to respond or the progression to EAC from a tertiary referral practise. <h3>Methods</h3> 105 patients with a mean age of 70 (range 43 – 90) years with HGD or IMC were treated between July 2008 and December 2012. The treatment protocol involved EMR of all nodular areas with subsequent RFA of all remaining Barretts epithelium. The RFA technique involved a combination of circumferential (HALO 360) followed by subsequent focal ablation (HALO 90) of residual areas of Barrett’s tongues or islands. Patients were deemed to have completed endotherapy on eradication of dysplasia. A maximum of 2 HALO 360’s and 3 HALO 90’s were allowed. Patients who failed to respond to endotherapy or developed EAC were withdrawn from endotherapy. Median follow up was 9 (3 – 41) months. <h3>Results</h3> 105 patients were treated (29 IMC and 76 HGD). Eighty patients have completed the treatment protocol to date (median of 1 HALO 360 and 1 HALO 90) and 42 (52%) of these had initial EMR. Eleven patients died during follow up, 2 from oesophageal cancer and the remaining 9 from non-oesophageal related causes. Eradication of Barrett’s dysplasia was achieved in 80/91 (87%) and eradication of metaplasia in 61/91 (67%). Five (4.7%) patients progressed to EAC and 3 (2.8%) patients failed treatment as their IMC or HGD was refractory to RFA and required surgery. The demographics for those that progressed to EAC compared to those that did not (Non-EAC) are as follows. EAC; males 5 (100%), mean initial Barrett’s length 7cm, those having pre-halo EMR 4 (80%) and initial pathology of 2 IMC (40%) and 3 HGD (60%). Non-EAC group; males 71 (73%), females 26 (27%), mean initial Barrett’s length 7 cm, those having pre-halo EMR 42 (43%) and initial pathology of 28 IMC (28%) and 69 HGD (71%). Finally the time from first RFA to developing malignancy was a mean of 182 (42 – 733) days. <h3>Conclusion</h3> In this cohort, there is a 4.7% chance of developing EAC, 2.8% of patients could not complete planned endotherapy and an 8.5% chance of death from non-oesophageal diseases. These outcomes are independent of the demographic, pathologic and endoscopic variables studied. <h3>Disclosure of Interest</h3> None Declared
Recommended Dietary Allowances and the Health of the Elderly
Authors: Edward L. Schneider, Eugenia M. Vining, Evan C. Hadley, Stacy A. Farnham
Journal: New England Journal of Medicine (1986)

THE sale of vitamin, mineral, and food supplements constitutes a billion-dollar business in the United States, and older persons consume a disproportionate amount of these expensive items.1 Nevertheless, information on the specific needs of older people is scarce. Since 1943, the National Academy of Sciences' Food and Nutrition Board has published recommended dietary allowances (RDAs) for infants, children, and adults.2 The ninth edition of these recommendations was published in 1980. The 10th edition was scheduled for publication in 1985, but because of a lack of consensus among those formulating the RDAs, publication will be delayed. The National Research Council has . . .
Quantitative cancer risk assessment for dioxins using an occupational cohort.
Authors: H Becher, K Steindorf, D Flesch-Janys
Journal: Environmental Health Perspectives (1998)

We consider a cohort of 1189 male German factory workers (production period 1952-1984) who produced phenoxy herbicides and were exposed to dioxins. Follow-up until the end of 1992 yielded a significantly increased standardized mortality ratio (SMR) for total cancer (SMR 141; 95% confidence interval 117-168). 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) concentrations up to 2252 ng/kg body fat were measured in 275 cohort members. Other higher chlorinated dioxins and furans also occurred in high concentrations. For quantitative analysis, the integrated TCDD concentration over time was used as an exposure variable, which was calculated using results from half-life estimation for TCDD and workplace history data. The other congeners were expressed as toxic equivalency (TEQ) and compared to TCDD using international toxic equivalency factors. Poisson and Cox regressions were used to investigate dose-response relationships. Various covariables (e.g., exposure to beta-hexachlorocyclohexane, employment characteristics) were considered. In all analyses, TCDD and TEQ exposures were related to total cancer mortality. The power model yielded a relative risk (RR) function RR(x) = (1 + 0.17x)0.326 for TCDD (in microgram/kilogram blood fat x years)--only a slightly better fit than a linear RR function--and RR(x) = (1 + 0.023x)0.795 for TEQ. Investigations on latency did not show strong effects. Different methods were applied to investigate the robustness of the results and yielded almost identical results. The results were used for unit risk estimation. Taking into account different sources of variation, an interval of 10(-3) to 10(-2) for the additional lifetime cancer risk under a daily intake of 1 pg TCDD/kg body weight/day was estimated from the dose-response models considered. Uncertainties regarding the dose-response function remain. These data did not indicate the existence of a threshold value; however, such a value cannot be excluded with any certainty.
AAV2 Delivery of Flt23k Intraceptors Inhibits Murine Choroidal Neovascularization
Authors: Xiaohui Zhang, Subrata K Das, Samuel F Passi, Hironori Uehara, Austin Bohner, Marcus Chen, Michelle Tiem, Bonnie Archer, Balamurali K Ambati
Journal: Molecular Therapy (2014)

Long-term inhibition of extracellular vascular endothelial growth factor (VEGF) in the treatment of age-related macular degeneration (AMD) may induce retinal neuronal toxicity and risk other side effects. We developed a novel strategy which inhibits retinal pigment epithelium (RPE)-derived VEGF, sparing other highly sensitive retinal tissues. Flt23k, an intraceptor inhibitor of VEGF, was able to inhibit VEGF in vitro. Adeno-associated virus type 2 (AAV2)-mediated expression of Flt23k was maintained for up to 6 months postsubretinal injection in mice. Flt23k was able to effectively inhibit laser-induced murine choroidal neovascularization (CNV). VEGF levels in the RPE/choroid complex decreased significantly in AAV2.Flt23k treated eyes. Neither retinal structure detected by Heidelberg Spectralis nor function measured by electroretinography (ERG) was adversely affected by treatment with AAV2.Flt23k. Hence AAV2.Flt23k can effectively maintain long-term expression and inhibit laser-induced CNV in mice through downregulation of VEGF while maintaining a sound retinal safety profile. These findings suggest a promising novel approach for the treatment of CNV.
Surgical Wound Infection and Closure Technique-Reply
Authors: Harvey R. Bernard
Journal: JAMA (1963)

<h3>To the Editor:—</h3> We agree with Dr. Caswell that a 42% infection rate following gastrectomy, appendectomy, biliary-tract surgery, colon-tract surgery, etc, using primary closure, is undesirable. This was precisely why the study was undertaken. With regard to the data, we have made every effort to insure their accuracy and to include every infection. It may be of some interest to note that in only five patients did the infection influence significantly the patient's hospital course. It is our opinion that direct contamination at the time of operation is the most likely cause of the infections, and undoubtedly improvements in technique are possible and highly desirable. However, it is unlikely that defects in sterilizing procedures, autoclaves, etc, are at fault, since the incidence of wound infection following inguinal hernia during the period studied was less than 1%. No attempt was made to alter the technique in use by the surgeons who
Novel hepatic progenitor cell surface markers in the adult rat liver
Authors: Mladen I. Yovchev, Petar N. Grozdanov, Brigid Joseph, Sanjeev Gupta, Mariana D. Dabeva
Journal: Hepatology (2006)

Hepatic progenitor/oval cells appear in injured livers when hepatocyte proliferation is impaired. These cells can differentiate into hepatocytes and cholangiocytes and could be useful for cell and gene therapy applications. In this work, we studied progenitor/oval cell surface markers in the liver of rats subjected to 2-acetylaminofluorene treatment followed by partial hepatectomy (2-AAF/PH) by using rat genome 230 2.0 Array chips and subsequent RT-PCR, immunofluorescent (IF), immunohistochemical (IHC) and in situ hybridization (ISH) analyses. We also studied expression of the identified novel cell surface markers in fetal rat liver progenitor cells and FAO-1 hepatoma cells. Novel cell surface markers in adult progenitor cells included tight junction proteins, integrins, cadherins, cell adhesion molecules, receptors, membrane channels and other transmembrane proteins. From the panel of 21 cell surface markers, 9 were overexpressed in fetal progenitor cells, 6 in FAO-1 cells and 6 are unique for the adult progenitors (CD133, claudin-7, cadherin 22, mucin-1, ros-1, Gabrp). The specificity of progenitor/oval cell surface markers was confirmed by ISH and double IF analyses. Moreover, study of progenitor cells purified with Ep-CAM antibodies from D-galactosamine injured rat liver, a noncarcinogenic model of progenitor cell activation, verified that progenitor cells expressed these markers. Conclusion : We identified novel cell surface markers specific for hepatic progenitor/oval cells, which offers powerful tool for their identification, isolation and studies of their physiology and pathophysiology. Our studies also reveal the mesenchymal/epithelial phenotype of these cells and the existence of species diversity in the hepatic progenitor cell identity. (Hepatology 2007;45:139–149.)
Improved Outcomes With Early Collaborative Care of Ambulatory Heart Failure Patients Discharged From the Emergency Department
Authors: Douglas S. Lee, Thérèse A. Stukel, Peter C. Austin, David A. Alter, Michael J. Schull, John J. You, Alice Chong, David Henry, Jack V. Tu
Journal: Circulation (2010)

The type of outpatient physician care after an emergency department visit for heart failure may affect patients' outcomes.Using the National Ambulatory Care Reporting System, we examined the care and outcomes of heart failure patients who visited and were discharged from the emergency department in Ontario, Canada (April 2004 to March 2007). Early collaborative care by a cardiologist and primary care (PC) physician within 30 days after discharge was compared with PC alone. Care for 10 599 patients (age, 74.9±11.9 years; 50.2% male) was provided by PC alone (n=6596), cardiologist alone (n=535), or concurrently by both cardiologist and PC (n=1478); 1990 did not visit a physician. Collaborative care patients were more likely to undergo assessment of left ventricular function (57.4% versus 28.7%), noninvasive stress testing (20.1% versus 7.8%), and cardiac catheterization (11.6% versus 2.7%) compared with PC. Drug prescriptions (patients ≥65 years of age) demonstrated higher use of angiotensin-converting enzyme inhibitors (58.8% versus 54.6%), angiotensin receptor blockers (22.7% versus 18.1%), β-adrenoceptor antagonists (63.4% versus 48.0%), loop diuretics (84.2% versus 79.6%), metolazone (4.8% versus 3.4%), and spironolactone (19.8% versus 12.7%) within 100 days after emergency department discharge for collaborative care compared with PC. In a propensity-matched model, mortality was lower with PC compared with no physician visit (hazard ratio, 0.75; 95% confidence interval, 0.64 to 0.87; P<0.001). Collaborative care reduced mortality compared with PC (hazard ratio, 0.79; 95% confidence interval, 0.63 to 1.00; P=0.045). Sole cardiology care conferred a trend to increased mortality (hazard ratio, 1.41 versus collaborative care; 95% confidence interval, 0.98 to 2.03; P=0.067).Early collaborative heart failure care was associated with increased use of drug therapies and cardiovascular diagnostic tests and better outcomes compared with PC alone.
975 IRON LOAD IN HFE MUTATED PATIENTS IS DECREASED DURING MORBID OBESITY
Authors: R. Anty, Y. Deugnier, A. Iannelli, E. Mariné-Barjoan, M. Dahman, S. Bekri, Y. Le Marchand-Brustel, P. Gual, J. Gugenheim, A. Tran
Journal: Journal of Hepatology (2009)
Prolongation of RV-PA Conduit Life Span by Percutaneous Stent Implantation
Authors: Andrew J. Powell, James E. Lock, John F. Keane, Stanton B. Perry
Journal: Circulation (1995)

Background Right ventricle–to–pulmonary artery (RV-PA) homografts and bioprosthetic conduits are commonly used to palliate various types of complex congenital heart disease. These conduits frequently develop progressive obstruction and require surgical replacement. This report reviews our experience implanting balloon-expandable stents to relieve conduit obstruction and delay reoperation. Methods and Results A retrospective review identified 44 patients who underwent placement of 48 stents in obstructed RV-PA conduits. Median patient age was 6.9 years (range, 7 months to 30 years), and median follow-up time was 14.2 months (range, 0 to 48 months). Stent implantation initially decreased the RV-PA pressure gradient from 61.0±16.9 to 29.7±11.9 mm Hg ( P ≤.001) and the right ventricular–to–systemic arterial pressure ratio from 0.92±0.17 to 0.63±0.20 ( P ≤.001). The diameter of the stenotic region expanded from 9.3±3.5 to 12.3±3.3 mm in the anteroposterior view ( P ≤.001) and from 6.6±2.9 to 10.9±2.5 mm in the lateral view ( P ≤.001). During the follow-up period, 2 patients had their stents redilated, 7 had additional conduit stents deployed, and 14 underwent surgical replacement of their conduits. Actuarial freedom from conduit reoperation was 65% at 30 months postprocedure. Seven patients were found to have fractured stents on follow-up, suggesting an important role for external compressive forces in conduit failure. Recatheterization in 16 patients a median of 11.8 months (3 to 48 months) postprocedure demonstrated hemodynamic evidence of recurrent obstruction despite sustained enlargement at the previously stented sites. Complications included stent displacement (n=1), bacterial endocarditis (n=1), and false aneurysm formation (n=1). One patient died awaiting conduit replacement surgery. Conclusions Stent implantation in obstructed RV-PA conduits results in significant immediate hemodynamic and angiographic improvement. In a subgroup of patients, the procedure prolongs conduit life span by several years and increases the interval between conduit reoperations. Recurrent obstruction is caused by external compression and progressive stenosis outside the stented region.
Inhaled Hypertonic Saline in Infants and Children Younger Than 6 Years With Cystic Fibrosis
Authors: Margaret Rosenfeld, Felix Ratjen, Lyndia Brumback, Stephen Daniel, Ron Rowbotham, Sharon McNamara, Robin Johnson, Richard Kronmal, Stephanie D. Davis, for the ISIS Study Group
Journal: JAMA (2012)

Inhaled hypertonic saline is recommended as therapy for patients 6 years or older with cystic fibrosis (CF), but its efficacy has never been evaluated in patients younger than 6 years with CF.To determine if hypertonic saline reduces the rate of protocol-defined pulmonary exacerbations in patients younger than 6 years with CF.The Infant Study of Inhaled Saline in Cystic Fibrosis (ISIS), a multicenter, randomized, double-blind, placebo-controlled trial conducted from April 2009 to October 2011 at 30 CF care centers in the United States and Canada. Participants were aged 4 to 60 months and had an established diagnosis of CF. A total of 344 patients were assessed for eligibility; 321 participants were randomized; 29 (9%) withdrew prematurely.The active treatment group (n = 158) received 7% hypertonic saline and the control group (n = 163) received 0.9% isotonic saline, nebulized twice daily for 48 weeks. Both groups received albuterol or levalbuterol prior to each study drug dose.Rate during the 48-week treatment period of protocol-defined pulmonary exacerbations treated with oral, inhaled, or intravenous antibiotics.The mean pulmonary exacerbation rate (events per person-year) was 2.3 (95% CI, 2.0-2.5) in the active treatment group and 2.3 (95% CI, 2.1-2.6) in the control group; the adjusted rate ratio was 0.98 (95% CI, 0.84-1.15). Among participants with pulmonary exacerbations, the mean number of total antibiotic treatment days for a pulmonary exacerbation was 60 (95% CI, 49-70) in the active treatment group and 52 (95% CI, 43-61) in the control group. There was no significant difference in secondary end points including height, weight, respiratory rate, oxygen saturation, cough, or respiratory symptom scores. Infant pulmonary function testing performed as an exploratory outcome in a subgroup (n = 73, with acceptable measurements at 2 visits in 45 participants) did not demonstrate significant differences between groups except for the mean change in forced expiratory volume in 0.5 seconds, which was 38 mL (95% CI, 1-76) greater in the active treatment group. Adherence determined by returned study drug ampoules was at least 75% in each group. Adverse event profiles were also similar, with the most common adverse event of moderate or severe severity in each group being cough (39% of active treatment group, 38% of control group).Among infants and children younger than 6 years with cystic fibrosis, the use of inhaled hypertonic saline compared with isotonic saline did not reduce the rate of pulmonary exacerbations over the course of 48 weeks of treatment.clinicaltrials.gov Identifier: NCT00709280.
Endoscopic hemostasis with hemoclips for active gastric variceal bleeding
Authors: T. Morimoto, K. Fu, H. Konuma, Y. Izumi, A. Asano, S. Kokubu, A. Miyazaki, S. Watanabe
Journal: Endoscopy (2010)

A 53-year-old woman was transferred by ambulance to our institution because of hematemesis. Her medical history included alcoholic cirrhosis with no regular medical follow-up or treatment. Emergency esophagogastroduodenoscopy (EGD) identified a “bleeding jet” from isolated gastric varices in the fundus ([Fig. 1]).
Halothane Hepatitis Revisited
Authors: Burnell R. Brown
Journal: New England Journal of Medicine (1985)

Absolute documentation of the entity labeled halothane hepatitis remains impossible at best, and delineation of its pathogenesis is as will-o'-the-wispish as ever. A variety of causative mechanisms have been suggested over the years on the basis of studies in human beings and animals, including straightforward hypersensitivity,1 liver hypoxia,2 metabolic activation of halothane to destructive, reactive intermediates via a specific reductive pathway,3 metabolic activation with consequent metabolite—protein haptene formation possessing immunologic properties,4 and recrudescence of viral hepatitis; some workers have denied any association of liver damage with the anesthetic. Uncertainty about this issue has led to a great deal of anguish . . .
A BEDSIDE METHOD FOR DETERMINING BLOOD SUGAR
Authors: Everett D. Kiefer
Journal: JAMA (1925)

Insulin treatment of diabetes, more than anything else, has demonstrated the clinical value of a knowledge of blood sugar levels. The increased frequency of hypoglycemia with its attendant dangers makes information concerning the concentration of glucose in the blood essential, and second to it is the importance of the determination of the degree of hyperglycemia. The urine often fails to indicate correctly the degree of hyperglycemia, since the percentage of sugar in the urine may remain the same through a wide variation of the concentration of the glucose in the blood. Particularly in cases of diabetic coma, blood sugar determinations are of high therapeutic value. The patient with an extremely high blood sugar receives more insulin than one with a moderate hyperglycemia. The effect of the first injection of insulin can be learned by a second blood analysis made an hour later, and this is the guide for further treatment.
Girning as a cause of respiratory obstruction.
Authors: S Dogra, J F Nunn
Journal: BMJ (1987)

Our patient gave a clear history of contact sensitivity to Elastoplast.Patch testing confirmed her sensitivity to colophony and the unfortunate cross reaction to her Christmas tree.She declined to consider any ofthe other 249 species in the Pinaceae family this year and opted for an artificial tree.She was advised not to get too close to other people's trees-and not to get plastered.I thank Dr C M King for performing patch testing.
Esophagitis and anticonvulsant hypersensitivity syndrome
Authors: C. Balatsinou, A. Milano, F. Laterza, M. Caldarella, D. Angelucci, J. Vecchiet, P. Zingariello, K. Falasca, D. Lapenna, M. Neri
Journal: Endoscopy (2006)

Figure 1 Anticonvulsant hypersensitivity syndrome (AHS) is a rare syndrome caused by a severe idiosyncratic reaction to antiepileptic agents. A 61-year-old man developed cutaneous rash, fever, and dysphagia after 1 month of carbamazepine treatment for neuralgia. At endoscopy, starting from the upper esophagus, the mucosa was found to be fragile and covered with longitudinal, whitish, removable membranes with minimal oozing.
The link between IFN-γ and allograft arteriopathy: is the answer NO?
Authors: Richard N. Mitchell, Andrew H. Lichtman
Journal: Journal of Clinical Investigation (2004)

Vascularized organ transplants often fail because of smooth muscle cell migration and proliferation in the intima of graft arteries, leading to progressive lumenal narrowing and resultant ischemic damage. Graft arterial disease is caused by IFN-γ secreted by alloreactive T cells. New evidence indicates that IFN-γ dysregulates expression of the enzymes eNOS and iNOS in graft-infiltrating leukocytes. Dysregulated NO synthase expression occurs prior to and is causally linked to intimal smooth muscle cell accumulation.
Six-Year Slowing Noted in Previously Growing Rate of US Blood Collections, Transfusions
Authors: Charles Marwick
Journal: JAMA (1989)

A SLOWING of the previously growing rate of blood collections and transfusions has occurred since 1982, according to a new national survey. This reverses a 30-year trend. In the 10 years from 1971 to 1980 alone, transfusions of blood and blood components doubled. But Douglas M. Surgenor, MD, Center for Blood Research, Boston, Mass, says there is every indication that the present slowdown will continue. <h3>No Serious Shortages So Far</h3> "In all of the sectors we measured, growth has slowed precipitously," Surgenor said at a National Heart, Lung, and Blood Institute (Bethesda, Md) committee meeting. Despite these changes, Surgenor pointed out that the nation's blood banking system is functioning well and serious shortages of blood nationally so far have been avoided. The survey used data obtained from the three large national organizations that collect blood. These are the American National Red Cross, the American Association of Blood Banks (AABB), and