tbuckley/cabot-search huggingface dataset:
Abstract S2-01: The PRIME II trial: Wide local excision and adjuvant hormonal therapy ± postoperative whole breast irradiation in women ≥ 65 years with early breast cancer managed by breast conservation
Authors: IH Kunkler, LW Williams, W Jack, P Canney, RJ Prescott, MJ Dixon
Journal: Cancer Research (2013)

Abstract Background. Local Recurrence rates after breast conserving surgery (BCS) are falling because of increasing use of effective systemic therapy. The question of whether whole breast radiotherapy (WBRT) can be omitted in carefully defined groups of older patients receiving appropriate systemic therapy has not been addressed. PRIME II is an International phase III RCT addressing this question. Methods. Between April 2003 and December 2009, 1326 patients were randomised to receive (n = 658) or nor receive (n = 668) radiotherapy (RT). Eligiblity criteria were ≥65 years, T1-2 (up to 3cm), N0, M0, hormone receptor positive, clear excision margins (≥ 1mm), axillary node negative women in receipt of adjuvant hormone therapy. Patients could have Grade 3 tumours or lympho-vascular invasion but not both. An accrual of 1300 was planned to detect a difference based on estimates of local recurrence of 2% in RT group and 5% in no RT arm at 5 years, with 80% power and 5% significance. The primary endpoint was ipsilateral breast tumour recurrence (IBTR). Secondary endpoints were regional recurrence, contralateral breast cancer, distant metastases and overall survival (OS). Median follow up is 5.0 years. Results IBTR at 5 years was 4.1% (95% CI 2.4, 5.7%) without RT, 1.3% (95% CI 0.2, 2.3%) with RT. The hazard ratio for IBTR in those IBTR receiving radiotherapy was 4.34 (1.79, 10.55) (p = 0.001). Overall actuarial survival at 5 years was 93.8% (95% CI 91.6, 95.9%) without RT and 94.2% (95% CI 92.2, 96.3%) with RT, (p = 0.24). No significant differences in regional recurrence (1.4% no RT vs 0.5% RT), contralateral breast cancer (0.9% no RT vs 1.5% RT), nor distant metastases (1.0% vs 0.3%) were seen. Breast cancer-free survival was 94.6% (95% CI 92.7, 96.5%)for no RT and 97.3% (95% CI 95.9, 98.8%) for those receiving RT (p = 0.003): this difference was due to the greater IBTR in no RT group. The majority of deaths were not linked to breast cancer (35 no RT vs 29 RT from a total of 87 deaths), with no influence of omission of RT (p = 0.27). Conclusions The randomised International Trial has shown that • Omission of RT in women ≥65 year of age with N0, ER positive breast cancer receiving endocrine therapy results in only a 4.1% 5 year IBTR • Although RT reduces IBTR significantly, the absolute reduction in this study is very small. • RT does not reduce the rate of regional recurrence, distant metastases or affect overall survival. • Omission of postoperative WBRT in this population based on the 5 year rate of IBTR appears safe, especially in the presence of comorbidities. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S2-01.
Familial Carboxypeptidase N Deficiency
Authors: KENNETH P. MATHEWS
Journal: Annals of Internal Medicine (1980)

Carboxypeptidase N is a serum metalloenzyme that inactivates C3a, C4a, C5a, bradykinin, kalladin, and fibrinopeptides. Of 172 sera from patients with chronic urticaria or angioedema, one had a remarkably depressed carboxypeptidase N level (21% of normal). Of sera from 103 patients with other diseases, elevated levels were observed in cases of neoplasms, and one abnormally low value was detected in a patient with cirrhosis. The patient with a remarkably low carboxypeptidase N level was a 65-year-old man with an 11-year history of episodic angioedema occurring about 40 times per year. Inactivation of C3a and lysyl-bradykinin by his serum was markedly prolonged. Plasma histamine was elevated during attacks, but serotonin and kinin activity were not. The proband's sister had an equally depressed serum carboxypeptidase N level, and studies of other family members suggested an autosomal recessive inheritance of the enzyme deficiency.
Doctor of Pharmacy
Authors: Joel Covinsky
Journal: JAMA (1983)

<h3>To the Editor.—</h3> We read with much interest the recent COMMENTARY concerning the doctor of pharmacy by John Biles, PhD. One innovation at the University of Missouri-Kansas City School of Medicine and its primary teaching hospital, Harry S Truman Medical Center, is the addition of clinical pharmacists as full-time members of the patient care and education teams. These practitioner-educators share responsibilities for patient drug therapy and for the provision of instruction in basic and clinical pharmacology.<sup>1</sup> Examination of the impact of these practitioners in separate studies indicates that they substantially increase cost-effectiveness in drug therapy. In a study concerning the impact of the clinical pharmacist in the treatment of pneumococcal pneumonia, it was found that physicians exposed to these persons treated all cases of pneumococcal pneumonia with standard antibiotic therapy—penicillin— as compared with physicians who did not have clinical pharmacists on their team.<sup>2</sup>The total cost of antibiotic
No passion against limited list
Authors: W. Russell
Journal: BMJ (1984)

The Commons order paper is quite a good barometer of backbench opinion.There has, for instance, been an overwhelming response to one early day motion attacking the government's plans for student grants and a major rebellion threatens.But the motion tabled by Mrs Ann Winterton, Conservative MP for Congleton, which says that doctors should be allowed to prescribe whatever preparation they deem most appropriate, and asserts that the implications for the professional freedom of doctors of the limited list are such that the proposal should not be implemented, has attracted only six signatures.On that basis it looks as if the issue is not going to arouse passions in the Commons.
Abstract 4741: Inhibition of TNBC cell growth by CSPG4-specific mAb 225.28 with a Sonic Hedgehog pathway inhibitor.
Authors: Yangyang Wang, Francesco Sabbatino, Soldano Ferrone, Xinhui Wang
Journal: Cancer Research (2013)

Abstract In the US, about 10-20% of breast cancers are found to be triple-negative breast cancer(TNBC). Because of the lack of estrogen receptor (ER) and progesterone receptor (PR) expression, and human epidermal growth factor receptor 2 (HER2) amplification, TNBC does not benefit from the currently available targeted therapies. Furthermore, recent molecular analysis of TNBC cell lines and lesions has suggested that these tumors might be enriched with cancer initiating cells (CICs). This possibility is consistent with the failure of conventional therapies to control disease progression, because according to the cancer stem cell theory, CICs play a major role in disease recurrence and metastatic spread, the two major causes of patient mortality. These findings and the lack of curative therapy for any TNBC patient with metastatic disease emphasize the need to develop effective novel therapies for this type of breast cancer. To address this need, we have developed a combinatorial immunotherapy, which eliminates both differentiated TNBC cells and TNBC CICs. The tumor antigen we have selected as a target is chondroitin sulfate proteoglycan (CSPG)4, since this membrane bound tumor antigen is expressed at high levels on both differentiated TNBC cells and TNBC CICs. CSPG4 plays a crucial role in the biology of TNBC cells, since it is involved in ERK and FAK signaling pathways which are associated with TNBC cell proliferation and migration. Furthermore, it is upregulated on activated pericytes in the tumor microenvironment. CSPG4-specific mAb 225.28 inhibits TNBC cell growth and migration. Moreover, it inhibits signaling pathways associated with TNBC cell growth and survival. It also can selectively inhibit neoangiogenesis in the tumor microenvironment, contributing to the elimination of TNBC cells, even those that do not express CSPG4. To enhance the targeting of TNBC CICs, immunotherapy is combined with the administration of an inhibitor (cyclopamine/ LDE225) of the Sonic Hedgehog Homolog (SHH) pathway which is activated in TNBC cells and, especially in TNBC CICs. Inhibition of TNBC CIC growth by mAb 225.28 is around 10%, but is enhanced up to about 70% when mAb 225.28 is combined with a SHH pathway inhibitor. Our in vitro findings strongly suggest that targeting CSPG4 with mAb 225.28 in combination with a SHH inhibitor may represent an effective strategy to eliminate differentiated TNBC cells and TNBC CICs. Citation Format: Yangyang Wang, Francesco Sabbatino, Soldano Ferrone, Xinhui Wang. Inhibition of TNBC cell growth by CSPG4-specific mAb 225.28 with a Sonic Hedgehog pathway inhibitor. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4741. doi:10.1158/1538-7445.AM2013-4741
Endoscopic Management of Obstructive Jaundice due to Portal Cavernoma
Authors: L. Thervet, B. Faulques, A. Pissas, A. Bremondy, B. Monges, J. Salducci, J. C. Grimaud
Journal: Endoscopy (1993)

See also: Endoscopic Management of Obstructive Jaundice due to Portal CavernomaEndoscopy 1995; 27(06): 462-463DOI: 10.1055/s-2007-1005745 See also: Endoscopic Managment of Obstructive Jaundice due to Portal CavernomaEndoscopy 1996; 28(06): 521-521DOI: 10.1055/s-2007-1005535
Detection of anti-DNA antibody using synthetic antigens. Characterization and clinical significance of binding of poly (deoxyadenylate-deoxythymidylate) by serum.
Authors: C R Steinman, U Deesomchok, H Spiera
Journal: Journal of Clinical Investigation (1976)

Virtually all preparations of DNA used to detect antibody to native DNA (nDNA) by binding assays have been found to be subtly contaminated by single stranded DNA. Because recent DNA binding data have directly challenged the unique role previously attributed to these antibodies in systemic lupus erythematosus (SLE), resolution of the consequent ambiguity is of theoretical and practical importance. It is proposed that a synthetic nDNA molecule (dAT) might circumvent this difficulty by being antigenically equivalent to nDNA while, on theoretical grounds, lacking significant contamination with single stranded DNA or other cellular antigens. These expectations were generally confirmed by biochemical and immunological analyses. In clinical studies, sera from 124 pateints with SLE and from controls were examined for their ability to bind dAT. In contrast to results with KB binding, patients with non-SLE rheumatologic disorders were indistinguishable from normals by dAT binding. dAT binding was elevated in 85% of sera from SLE patients with clinically-judged active nephritis but in only 9% of those with inactive renal disease. Active non-renal disease, including cerebritis, was not associated with increased dAT binding. Individual non-lupus sera which bound increased amounts of KB DNA, failed to bind dAT. It is suggested that such binding resulted from contaminating non-nDNA antigens. When elevated, dAT binding, like KB binding, varied with disease activity and might thus be useful as a parameter thereof. In several patients elevated dAT binding led to the finding, on biopsy, of clinically silent, active, diffuse proliferative nephritis. It is concluded that use of synthetic nDNA antigens such as dAT may offer theoretical and practical advantages over naturally-derived preparations in detecting anti-nDNA, both clinically and for investigational purposes. Also, caution is urged in interpreting DNA binding data derived from incompletely characterized systems, particularly with regard to the occurrence of anti-nDNA antibodies in serum.
Advantages and Limitations of Teleneurology
Authors: Lawrence R. Wechsler
Journal: JAMA Neurology (2015)

The growing disparity between the demand for neurological services and the need for neurologists requires new and innovative strategies for delivering care. Teleneurology allows neurological expertise to be delivered to remote locations to supplement or replace in-person neurological care.To summarize the current status of teleneurology. Applications of teleneurology include acute care, outpatient teleneurology, and teleconsultations. Existing barriers to further expansion of teleneurology are also discussed.Published studies pertaining to teleneurology were reviewed. Practical experience with telemedicine in neurological practice contributed to the conclusions.Outcomes after intravenous tissue plasminogen activator treatment via telemedicine (telestroke) are similar to those achieved with in-person evaluations. Other aspects of teleneurology are less established but have demonstrated feasibility, high patient satisfaction, and, in some cases, cost savings.Teleneurology provides neurological expertise to rural areas with limited availability of neurologists and improves care for patients with difficulty traveling owing to neurological disease. It is likely that use of teleneurology will continue to grow and become incorporated into many aspects of neurological practice. Understanding the advantages and limitations of teleneurology is vital to delivering optimal clinical care for patients with neurological disease regardless of the setting.
Ectopic Polypeptide Hormone Production By Tumors
Authors: MAVLIGIT GIORA
Journal: Annals of Internal Medicine (1970)

Letters and Comments1 April 1970Ectopic Polypeptide Hormone Production By TumorsMAVLIGIT GIORA, M.D.MAVLIGIT GIORA, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-72-4-604 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Dr. Omenn (January 1970 issue of the ANNALS) outlined the various polypeptide hormones known to be ectopically produced, with the associated paraneoplastic syndromes. It seems as if one hormone was inadvertently left out, namely, growth hormone. I would like to draw attention to a case reported by Steiner, Dahlbäck, and Waldenström (1) in which adenocarcinoma of the left lung was associated with acromegaloid traits and typical hypertrophic osteoarthropathy. The fasting plasma growth hormone level was very high (38 ng/ml), and it came back to normal (3.5 ng/ml) after resection of the tumor. Although tumor tissue was not...Reference1. STEINERDAHLBÄCKWALDENSTRÖM HOJ: Ectopic growth-hormone production and osteoarthropathy in carcinoma of the bronchus. Lancet 1:783-785, 1968 MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Tufts University Medical Oncology Unit Lemuel Shattuck Hospital Boston, Mass. 02130 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1970Volume 72, Issue 4Page: 604-604KeywordsAdenocarcinomaBlood plasmaGrowth hormoneLungsPeptide hormonesTumor resection ePublished: 1 December 2008 Issue Published: 1 April 1970 PDF downloadLoading ...
Down syndrome childhood acute lymphoblastic leukemia has a unique spectrum of sentinel cytogenetic lesions that influences treatment outcome: a report from the Children's Oncology Group
Authors: Kelly W. Maloney, William L. Carroll, Andrew J. Carroll, Meenakshi Devidas, Michael J. Borowitz, Paul L. Martin, Jeanette Pullen, James A. Whitlock, Cheryl L. Willman, Naomi J. Winick, Bruce M. Camitta, Stephen P. Hunger
Journal: Blood (2010)
The Kidney in Progressive Systemic Sclerosis
Authors: MICHAEL T. KOVALCHIK
Journal: Annals of Internal Medicine (1978)

Nine normotensive progressive systemic sclerosis patients with normal renal function underwent renal biopsy. Four specimens had prominent vascular abnormalities, two mild vascular abnormalities, and three were normal. Vascular deposits of C3 were present in all specimens. Plasma renin activity was elevated in three of four patients with prominent vascular abnormalities, one of two patients with mild vascular lesions, and none of two patients with normal biopsies. Plasma renin activity elevation in response to cold pressor testing in the four patients with prominent vascular lesions was 5.6 ng/ml · h compared to 0.55 ng/ml · h in those with mild or no lesions and 0.26 ng/ml · h in six control subjects. These data indicate that renal vascular lesions may be present in normotensive patients. Elevation or a substantial rise in plasma renin activity (1.8 ng/ml · h or greater) in response to cold pressor testing suggests preclinical renal involvement.
Effect of energy restriction, weight loss, and diet composition on plasma lipids and glucose in patients with type 2 diabetes.
Authors: L K Heilbronn, M Noakes, P M Clifton
Journal: Diabetes Care (1999)

OBJECTIVE: To determine the optimal diet for improving glucose and lipid profiles in obese patients with type 2 diabetes during moderate energy restriction. RESEARCH DESIGN AND METHODS: A total of 35 free-living obese patients with type 2 diabetes were assigned to one of three 1,600 kcal/day diets for 12 weeks. The diets were high carbohydrate (10% fat, 4% saturated), high monounsaturated fat (MUFA) (32% fat, 7% saturated), or high saturated fat (SFA) (32% fat, 17% saturated). RESULTS: Diet composition did not affect the magnitude of weight loss, with subjects losing an average of 6.6 +/- 0.9 kg. Energy restriction and weight loss resulted in reductions in fasting plasma glucose (-14%), insulin (-27%), GHb (-14%), and systolic (-7%) and diastolic blood pressure (-10%) levels and the glucose response area (-17%) independent of diet composition. Diet composition did affect the lipoprotein profile. LDL was 10% and 17% lower with the high-carbohydrate and high-MUFA diets, respectively, whereas no change was observed with the high-SFA diet (P &amp;lt; 0.001 for effect of diet). HDL was transiently reduced on the high-carbohydrate diet at weeks 1, 4, and 8, whereas higher fat consumption maintained these levels. The total cholesterol:HDL ratio, although significantly reduced on the high-MUFA diet (P &amp;lt; 0.01), was not different from the other two diets after adjustment for baseline differences. CONCLUSIONS: Energy restriction, independent of diet composition, improves glycemic control; however, reducing SFA intake by replacing SFA with carbohydrate or MUFA reduces LDL maximally during weight loss and to a greater degree than has been shown in weight-stable studies.
Asymptomatic splenic infarction in Wegener's granulomatosis
Authors: D Papaioannides
Journal: Annals of the Rheumatic Diseases (2002)

In an article on Rubens' painting "The Three Graces" Dequeker suggests that hypermobility is a medical explanation of the seeming scoliosis and Trendelenburg sign in the middle figure . 1 But the posture of this middle figure should probably be interpreted as an artistic phenomenon without medical reference.Sculptors in classical Greek and Roman periods often used the contrapposto posture.In this, by putting most weight on one leg, the other leg can be shown in a relaxed and semiflexed position.This undulating between tension and relaxation will animate the figure.A person with normal muscular function and a normal back can perfectly well pose in this way with relaxed hip abductors on the weightbearing side, a descending hip on the opposite side, and a compensating scoliotic posture.This posture is facilitated by support from the arm as in Rubens' painting.If the person tries to take a forward step, relaxation of the muscles of the weightbearing hip can no longer be maintained, and the positive Trendelenburg sign will disappear.In the Renaissance period the use of this contrapposto posture was revived.During his stay in Rome Rubens eagerly studied the then recently excavated Laokoön sculpture with its three distorted figures. 2 He often used such distorted postures in his paintings to give the impression of vigorous muscular characters capable of performing great tasks.The best example is probably "The Debarkation at Marseilles" in the Maria de Medici cycle from 1622 to 1625 for the Luxembourg Palace in Paris. 3 Here, three young women, nereides, with curved muscular backs at the bottom of the picture nearly seem to carry the ship of Maria de Medici.
Pachyonychia congenita Jackson-Lawler type: a distinct malformation syndrome
Authors: M. CLEMENTI, E.CARDIN STEFANI, C.DEI ROSSI, V. AVVENTI, R. TENCONI
Journal: British Journal of Dermatology (1986)

Journal Article Pachyonychia congenita Jackson‐Lawler type: a distinct malformation syndrome Get access M. CLEMENTI, M. CLEMENTI Servizio di Genetica Medica, Dipartimento di Pediatria, Treviso, Italy Search for other works by this author on: Oxford Academic Google Scholar E.CARDIN DE STEFANI, E.CARDIN DE STEFANI Clinica Dermosifilopatica, Università di Padova, Treviso, Italy Search for other works by this author on: Oxford Academic Google Scholar C.DEI ROSSI, C.DEI ROSSI Ospedale Civile, Treviso, Italy Search for other works by this author on: Oxford Academic Google Scholar V. AVVENTI, V. AVVENTI Clinica Dermosifilopatica, Università di Padova, Treviso, Italy Search for other works by this author on: Oxford Academic Google Scholar R. TENCONI R. TENCONI Servizio di Genetica Medica, Dipartimento di Pediatria, Treviso, Italy R. Tenconi, M.D., Servizio di Genetica Medica, Dipartimento di Pediatria, via Giustiniani 3, 35128 Padova, Italy. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 114, Issue 3, 1 March 1986, Pages 367–370, https://doi.org/10.1111/j.1365-2133.1986.tb02829.x Published: 01 March 1986 Article history Accepted: 13 August 1985 Published: 01 March 1986
Sonography of hepatic hemangioma accompanied by arterioportal shunt
Authors: Sang Hyun Choi, Kyoung Won Kim, Gil Sun Hong, So Jung Lee, So Yeon Kim, Jong Seok Lee, Hyoung Jung Kim
Journal: Clinical and Molecular Hepatology (2014)

Arterioportal shunt accompanying hepatic hemangioma can be diagnosed on Doppler sonography, by demonstrating the hepatofugal flow at the peritumoural portal branch parallel to the feeder. In the presence of hepatic steatosis, an arterioportal shunt associated with high-flow hemangiomas may result in peritumoral sparing of steatosis so that the tumor appear as hypoechoic masses surrounded by geographic peritumoral less hypoechoic area. A precise sonographic appreciation of such findings may ensure an accurate sonographic diagnosis of these tumors.