tbuckley/cabot-search huggingface dataset:
Hospital and Surgeon Volume in Relation to Survival After Esophageal Cancer Surgery in a Population-Based Study
Authors: Maryam Derogar, Omid Sadr-Azodi, Asif Johar, Pernilla Lagergren, Jesper Lagergren
Journal: Journal of Clinical Oncology (2013)

Purpose The influence of hospital and surgeon volume on survival after esophageal cancer surgery deserves clarification, particularly the prognosis after the early postoperative period. The interaction between hospital and surgeon volume, and the influence of known prognostic factors need to be taken into account. Methods A nationwide Swedish population-based cohort study of 1,335 patients with esophageal cancer who underwent esophageal resection in 1987 to 2005, with follow-up for survival until February 2011, was conducted. The associations between annual hospital volume, annual surgeon volume, and cumulative surgeon volume and risk of mortality were calculated with multivariable parametric survival analysis, providing hazard ratios (HRs) with 95% CIs. HRs were mutually adjusted for the surgery volume variables and further adjusted for the prognostic factors age, sex, comorbidity, calendar period, tumor stage, tumor histology, and neoadjuvant therapy. Results There was no independent association between annual hospital volume and overall survival, and hospital volume was not associated with short-term mortality after adjustment for hospital clustering effects. A combination of higher annual and cumulative surgeon volume reduced the mortality occurring at least 3 months after surgery (P trend &lt; .01); the HR was 0.78 (95% CI, 0.65 to 0.92) comparing surgeons with both annual and cumulative volume above the median with those below the median. These results remained when hospital and surgeon clustering were taken into account. Conclusion Because surgeon volume rather than hospital volume independently influences the prognosis after esophageal cancer surgery, centralization of this surgery to fewer surgeons seems warranted.
Tumor Development by Transgenic Expression of a Constitutively Active Insulin-Like Growth Factor I Receptor
Authors: Joan M. Carboni, Adrian V. Lee, Darryl L. Hadsell, Bruce R. Rowley, Francis Y. Lee, David K. Bol, Amy E. Camuso, Marco Gottardis, Ann F. Greer, Ching Ping Ho, Warren Hurlburt, Aixin Li, Mark Saulnier, Upender Velaparthi, Cindy Wang, Mei-Li Wen, Richard A. Westhouse, Mark Wittman, Kurt Zimmermann, Brent A. Rupnow, Tai W. Wong
Journal: Cancer Research (2005)

The insulin-like growth factor I receptor (IGF-IR) is a transmembrane tyrosine kinase that is essential to growth and development and also thought to provide a survival signal for the maintenance of the transformed phenotype. There has been increasing interest in further understanding the role of IGF-I signaling in cancer and in developing receptor antagonists for therapeutic application. We describe herein a novel animal model that involves transgenic expression of a fusion receptor that is constitutively activated by homodimerization. Transgenic mice that expressed the activated receptor showed aberrant development of the mammary glands and developed salivary and mammary adenocarcinomas as early as 8 weeks of age. Xenograft tumors and a cell line were derived from the transgenic animals and are sensitive to inhibition by a novel small-molecule inhibitor of the IGF-IR kinase. This new model should provide new opportunities for further understanding how aberrant IGF-IR signaling leads to tumorigenesis and for optimizing novel antagonists of the receptor kinase.
Upregulation of Endothelial Receptor for Oxidized Low-Density Lipoprotein (LOX-1) in Cultured Human Coronary Artery Endothelial Cells by Angiotensin II Type 1 Receptor Activation
Authors: D. Y. Li, Y. C. Zhang, M. I. Philips, T. Sawamura, J. L. Mehta
Journal: Circulation Research (1999)

Abstract —Cross talk between oxidized LDL (ox-LDL) and angiotensin II (Ang II) may be relevant in atherosclerosis. In this study, we examined the presence of a specific endothelial receptor for ox-LDL (LOX-1) and Ang II receptors in human coronary artery endothelial cells (HCAECs). In addition, we studied the effect of Ang II on LOX-1 gene and protein expression. LOX-1 was consistently identified in HCAECs by reverse transcriptase–polymerase chain reaction (RT-PCR), cDNA sequence, Western blot, and 125 I-labeled ox-LDL binding assay (B max , 29.7 ng/mg protein). The HCAECs also exhibited Ang II receptors (AT 1 &gt;AT 2 ), as determined by RT-PCR and 125 I-labeled Ang II binding assay (B max , 2.21 and 1.19 fmol/mg protein, respectively). Incubation of HCAECs with Ang II markedly increased LOX-1 mRNA (RT-PCR) and protein (Western blot) expression. The increase in LOX-1 expression was dependent on Ang II concentration (10 –12 to 10 –6 mol/L). Ang II caused a concentration-dependent increase in 125 I-labeled ox-LDL uptake by HCAECs and enhanced ox-LDL–mediated cell injury, as evident from an increase in LDH release and a decrease in cell viability. These effects of Ang II were completely blocked by pretreatment of HCAECs with losartan, a specific AT 1 blocker, but not by PD123319 , a specific AT 2 blocker. These observations indicate the following: (1) HCAECs possess abundant LOX-1 as well as Ang II (AT 1 &gt;AT 2 ) receptors, (2) Ang II upregulates LOX-1 receptor and ox-LDL uptake, (3) the effects of Ang II are mediated by AT 1 activation, and (4) Ang II enhances ox-LDL–mediated injury to HCAECs.
Exposure to Indoor Tanning Without Burning and Melanoma Risk by Sunburn History
Authors: Rachel Isaksson Vogel, Rehana L. Ahmed, Heather H. Nelson, Marianne Berwick, Martin A. Weinstock, DeAnn Lazovich
Journal: JNCI Journal of the National Cancer Institute (2014)

Indoor tanning is carcinogenic to humans. Individuals report that they tan indoors before planning to be in the sun to prevent sunburns, but whether skin cancer is subsequently reduced is unknown. Using a population-based case–control study, we calculated the association between melanoma and indoor tanning after excluding exposed participants reporting indoor tanning–related burns, stratified by their number of lifetime sunburns (0, 1–2, 3–5, >5). Confounding was addressed using propensity score analysis methods. All statistical tests were two-sided. We observed increased risk of melanoma across all sunburn categories for participants who had tanned indoors without burning compared with those who never tanned indoors, including those who reported zero lifetime sunburns (odds ratio = 3.87; 95% confidence interval = 1.68 to 8.91; P = .002). These data provide evidence that indoor tanning is a risk factor for melanoma even among persons who reported never experiencing burns from indoor tanning or outdoor sun exposure.
Practising sports and exercise medicine in an environment of rising medical costs
Authors: Chris Milne
Journal: British Journal of Sports Medicine (2010)

One of the major challenges facing today's clinicians is the rising cost of healthcare. Sports and exercise medicine clinicians can address these challenges by making a working diagnosis on clinical grounds and using investigations only selectively. They should also educate their patient about the limits to funding and be prepared to use time as a diagnostic aid.

As clinicians we face many challenges. Hippocrates challenged us to ‘primum non nocere’—first do no harm. Second, the challenge is to practise medicine in a scientific manner. This has evolved from anecdote and case studies to evidence-based medicine, where such evidence exists. The third and potentially most difficult challenge is to practise affordable medicine.

In the 1950s, when I was born, the limits to medicine were largely around what we could do. Now the limits are increasingly around what we can afford. This is a major challenge facing health systems in many countries and is fuelled by several factors: demand for health services will always exceed society's ability to pay. This is compounded by physicians feeling duty-bound to advocate for their own patients. Additionally, politicians realise that health is an emotionally sensitive issue and funding decisions are often made in response to pressure from special interest groups—this has been termed ‘planning by decibels’. The Herceptin (Roche Basle, Switzerland) debate in New Zealand is a good example of this.1 Herceptin is a high cost drug used in the treatment of breast cancer. Funding for this drug was granted to New Zealand women after a high-profile campaign by women's health advocates.

Health administration is a science which is in its relative youth. Secondary and tertiary care services chew up the majority of the health budget. These are hospital based and several decades ago hospitals were usually run by a triumvirate of a medical superintendent …
Obstructive sleep apnea syndrome in non-arteritic anterior ischemic optic neuropathy
Authors: Jorge Vale, Vitor Melo, Eloísa Silva, Cláudia Sousa, Isabel Gil, Ricardo Faria, Amparo Sánchez Serrano, José Arêde, Antόnio Simões Torres
Journal: European Respiratory Journal (2011)

Introduction:  The acute vision loss associated with non-arteritic anterior ischemic optic neuropathy (NAION) frequently occurs upon awakening, suggesting that a pathological event during sleep may trigger NAION. Several recent studies have reported links between NAION and obstructive sleep apnea syndrome (OSAS).   Objective:  To evaluate newly diagnosed NAION patients for the existence of an associated OSAS.   Methods:  Newly identified NAION patients, from the department of Ophthalmology, underwent overnight laboratory polysomnography. The prevalence of sleep apnea in NAION patients was compared to the prevalence previously found in the general population. The classic risk factors associated with NAION were also identified.   Results:  A total of 23 patients were recruited (16 men and 7 women), mean age 63,6±8,6 years, body mass index 30,2±5,6 kg/m 2 . 13 of these 23 NAION patients (56,5%) had OSAS and 20,8% had severe OSAS (RDI > 30/h). In this study, 69,2% of the patients had hypertension, 61,5% had dyslipidemia, 38,5% had past history of transient ischemic attack and 30,8% had diabetes. The mean cumulative time with oxygen saturation less than 90% (CT90) was 13,7±24,3%. Treatment with autoadjusting positive airway pressure (APAP) was started in 76, 9% of the OSAS patients. The relative risk for a NOIAN patient to have sleep apnea was 3.1 compared to the general population.   Conclusions:  Our results suggest an association between OSAS and NOIAN. The prevalence of OSAS was lower than in other studies. The explanation for these results is probably due to the size of our sample. However, more than 50% patients with NOIAN had associated OSAS, reinforcing the need for screening these patients.
P195 Case Series: How Useful Are Fleischner Guidelines For Nodule Surveillance in a District General Hospital?
Authors: RW Lee, KE Millward, FE Ossai, D Ellis, M Townsend
Journal: Thorax (2012)

<h3>Background</h3> Surveillance of pulmonary nodules aims to identify early-stage lung cancers where radical therapy can offer cure. Interval CT scans track nodule characteristics with Fleischner criteria commonly used in an attempt to standardise care. There remains debate regarding the applicability of Fleischner guidance in populations of UK patients that can differ substantially from those included in existing studies that define the Fleischner recommendations. <h3>Objectives</h3> Audit compliance of pulmonary nodule follow up with Fleischner Guidelines. Compare local outcomes with those used to create Fleischner guidelines. Compare local compliance with published compliance. <h3>Methods</h3> Patients referred to a specialist respiratory nurse service for pulmonary nodule surveillance since 2008 (including patients already under surveillance) with opportunity for 2 years of completed follow-up were included with retrospective review of the nodule database/electronic records and imaging. Patients were risk stratified according to nodule size and Fleischner risk category (e.g. smoking). <h3>Results</h3> 111 patients under surveillance were identified of whom 56 were Male and 55 Female with median age 67 (34–91) years. 67 were solitary and 44 were multiple. Patients were stratified to Low- and High-risk groups according to main nodule size: (L1–4 or H1–4 respectively). Each group included; High-risk: H1 (&lt;=4mm)10, H2 (&gt;4–6mm) 25, H3 (&gt;6–8mm) 19 and H4 (&gt;8mm) 36 cases and Low-risk: L1 (&lt;=4mm) 0, L2 (&gt;4–6mm) 5, L3 (&gt;6–8mm) 4 and L4 (&gt;8mm) 3 cases. 89 patients completed standard follow-up and were discharged. Positive scans included Lung tumours (3) - (two underwent lobectomy); Aspergilloma (1); Rectal carcinoma (1)- discovered by non-Fleischner abdominal CT. Surveillance was discontinued for: Patient choice/co-morbidity (8); Nodule resolution (3); Not documented/lost (6). <h3>Conclusion</h3> Fleischner guidelines were well adhered to and were also utilised where their application is less well defined e.g. development of a new nodule during follow-up prompted either re-initiation or more commonly continued/modified trajectory of Fleischner - an area notably not well covered in current guidance. Furthermore principals of Fleischner recommendations were applied to multiple nodules but management of such patients is often not as easily followed as solitary nodules. <i>MacMahon et al, University of Chicago, Radiology 2005; 237:295–400.</i>
Does the type of hormone replacement therapy affect lipoprotein (a), homocysteine, and C-reactive protein levels in postmenopausal women?
Authors: Hanna Bukowska, Stanisław Stanosz, Ewa Żochowska, Barbara Millo, Krzysztof Sieja, Kornel Chełstowski, Marek Naruszewicz
Journal: Metabolism (2004)
Development of a novel rapid non-invasive screening test for coeliac disease
Authors: V Baldas
Journal: Gut (2000)

<h3>BACKGROUND</h3> Coeliac disease is one of the commonest underdiagnosed diseases in general practice. The autoantigen recognised by the sera of patients with coeliac disease has recently been identified as tissue transglutaminase. <h3>AIMS</h3> We evaluated a simple non-invasive immunological dot blot assay for coeliac disease, suitable for use by the general physician in the ambulatory setting. The sensitivity and specificity of this dot blot assay based on recognition of recombinant human transglutaminase were compared with those of antiendomysial antibodies and an enzyme linked immunosorbent assay. <h3>METHODS</h3> Serum samples were analysed from 64 healthy controls, 58 first degree relatives of coeliacs, 74 diseased controls, and 70 biopsy confirmed untreated patients with coeliac disease. Dot blot assay and enzyme linked immunosorbent assay were performed using recombinant human transglutaminase as antigen. <h3>RESULTS</h3> The dot blot assay, which can be performed in 20 minutes, was positive in all 70 untreated coeliacs (sensitivity 100%). Among the three control groups, there were three false positive tests by dot blot (specificity 98%), all belonging to the group of healthy subjects. The antiendomysial antibodies test missed five untreated coeliac patients (sensitivity 93%) and was negative in all three control groups (specificity 100%). The specificity of the immunosorbent assay was 99% for IgA and 98% for IgG, while sensitivity was 93% for IgA, 47% for IgG, and 100% for IgA and IgG combined. <h3>CONCLUSIONS</h3> The dot blot assay is highly accurate in detecting untreated subjects with coeliac disease and can be performed in the general physician9s medical office during the course of a routine examination. This innovative test is a practical, reliable alternative to both the immunofluorescent based antiendomysial test and immunosorbent assay for detection of transglutaminase antibodies for the diagnosis of coeliac disease.
The adequacy of oxygenation in COPD patients undergoing long-term oxygen therapy assessed by pulse oximetry at home
Authors: P Sliwinski, M Lagosz, D Gorecka, J Zielinski
Journal: European Respiratory Journal (1994)

It is probable that some daily activities may cause marked falls in arterial oxygen saturation (SaO2) in patients undergoing long-term oxygen therapy (LTOT), despite good oxygenation at rest. We estimated the adequacy of LTOT in 34 randomly selected chronic obstructive pulmonary disease (COPD) patients at home by monitoring SaO2 continuously over 24 h. The subjects were also asked to complete a questionnaire listing frequent daily activities. Despite almost normal mean SaO2 (94%) at the beginning of recording (O2 2 l.min-1, at rest) the subjects studied spent 6.9 h below an SaO2 of 90%, with minimum SaO2 of 61%. On average we observed 10 episodes of desaturation in each patient over 24 h, both while breathing air and oxygen. The comparison of SaO2 recordings and questionnaires revealed the highest number of desaturations during sleep, followed by naps, watching the television, eating, washing and talking. The oxygen flow rate prescribed, based on blood gas measurements at rest, did not protect 85% of the patients studied from deep falls in SaO2 during daily life. An increase oxygen flow during some activities and during sleep is suggested.
Tumour necrosis factor blockers do not increase overall tumour risk in patients with rheumatoid arthritis, but may be associated with an increased risk of lymphomas
Authors: P Geborek
Journal: Annals of the Rheumatic Diseases (2005)

<b>Objective:</b> To determine whether TNF blockers increase tumour risk in patients with RA. <b>Material and methods:</b> The South Swedish Arthritis Treatment Group register (SSATG) comprises over 90% of anti-TNF treated patients with RA in the area. 757 patients treated with etanercept or infliximab included between 1 February 1999 and 31 December 2002 were identified. 800 patients with conventional antirheumatic treatment in a community based cohort served as a comparison cohort. Tumours and deaths were identified in the cancer registry and population census registers. Patients were followed up from initiation of anti-TNF treatment or 1 July 1997 for the comparison group, until death or 31 December 2002. <b>Results:</b> In the anti-TNF group, 16 tumours (5 lymphomas) were identified in 1603 person-years at risk, and in the comparison group 69 tumours (2 lymphomas) in 3948 person-years. Standardised incidence ratios (SIRs) for total tumour relative risk for the anti-TNF group and the comparison group were 1.1 (95% confidence interval (CI) 0.6 to 1.8) and 1.4 (95% CI 1.1 to 1.8), respectively. The lymphoma relative risk (RR) was 11.5 (95% CI 3.7 to 26.9) and 1.3 (95% CI 0.2 to 4.5), respectively The total tumour RR excluding lymphoma was 0.79 (95% CI 0.4 to 1.42) and 1.39 (95% CI 1.08 to 1.76), respectively. Proportional hazard analysis for lymphomas yielded RR 4.9 (95% CI 0.9 to 26.2) in anti-TNF treated versus untreated patients. <b>Conclusion:</b> Community based patients with RA treated conventionally had an increased overall tumour risk compared with the background population. A possible additional increased risk for lymphoma associated with TNF blockers was based on few cases and needs confirmation.
Late Mortality After Dexrazoxane Treatment: A Report From the Children's Oncology Group
Authors: Eric J. Chow, Barbara L. Asselin, Cindy L. Schwartz, David R. Doody, Wendy M. Leisenring, Sanjeev Aggarwal, K. Scott Baker, Smita Bhatia, Louis S. Constine, David R. Freyer, Steven E. Lipshultz, Saro H. Armenian
Journal: Journal of Clinical Oncology (2015)

Given concerns that dexrazoxane may reduce treatment efficacy, induce second cancers, and thus compromise overall survival among children, we examined long-term overall and cause-specific mortality and disease relapse rates from three randomized clinical trials.
Histocompatibility antigens in asthma: population and family studies.
Authors: C W Turton, L Morris, J A Buckingham, S D Lawler, M Turner-Warwick
Journal: Thorax (1979)

One hundred and twenty-two patients with intrinsic asthma, extrinsic atopic asthma, or asthma with allergic bronchopulmonary aspergillosis were tissue typed for the HLA A, B, and C loci. No associations were found with any of the clinical groups, or with serum total IgE concentrations. Sixty-eight members of 10 families where more than one member was affected by asthma were studied. The segregation of haplotypes in siblings of the propositi who were or were not affected by asthma did not differ from the predicted segregation, and there were no differences when atopy or serum total IgE were considered. No biologically important association between HLA and asthma has been shown.
Cognitive dysfunction, falls and helicobacter pylori in cirrhosis
Authors: German Soriano, Eva Román, Joan Córdoba
Journal: Hepatology (2012)

We appreciate the comments of Kountouras et al. regarding our article showing that cognitive dysfunction evaluated by the Psychometric Hepatic Encephalopathy Score (PHES) is associated with falls during follow-up in patients with cirrhosis.1 We agree with these authors that subclinical cognitive dysfunction in cirrhosis is a multifactorial issue. Although minimal hepatic encephalopathy plays a key role in such dysfunction, other factors, such as etiology of cirrhosis, comorbidities, or psychoactive treatments, can also be implicated.1-3 Multiple factors are also involved in the risk of falling.4 Helicobacter pylori infection has been suggested as a factor predisposing patients with cirrhosis to overt hepatic encephalopathy and minimal hepatic encephalopathy through the increase in ammonemia5, 5 or, as proposed by Kountouras et al., through the proinflammatory state. However, this association has not been clearly demonstrated.5 The relationship between H. pylori and dementia in patients without cirrhosis is also controversial.7, 8 To our knowledge, there are no studies evaluating the potential link between falls or fractures and H. pylori infection. In any case, we cannot study the relationship between H. pylori and cognitive dysfunction or falls in our study group because H. pylori infection was not systematically evaluated in all the patients. As recently pointed out by Butterworth,9 the main contribution of our article is that it shows that psychometric testing can predict the risk of falling in patients with cirrhosis, in addition to its already known ability to detect the risk of overt hepatic encephalopathy, mortality, and traffic accidents.2, 10 This finding could help to establish measures to prevent falls and fractures and their consequences in this population.1, 9 When considering the mechanisms involved in the risk of falling, we found no correlation between the severity of PHES impairment and predisposition to falling. This suggests that the main cause of falling is not cognitive dysfunction per se but a coincident neuromuscular disturbance, such as parkinsonism, cerebellar degeneration, or sarcopenia.1, 9 The precise mechanisms by which patients with cirrhosis and impaired PHES have a higher tendency to fall remain to be determined. German Soriano M.D., Ph.D.* , Eva Román R.N.* §, Joan Córdoba M.D., Ph.D. ¶, * Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain, § Escola Universitària d'Infermeria Sant Pau, Barcelona, Spain, ¶ Internal Medicine Department, Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain.
Workgroup IV: public education. UICC International Workshop on Facilitating Screening for Colorectal Cancer, Oslo, Norway (29 and 30 June 2002)
Authors: R. Hiatt, J. Wardle, S. Vernon, J. Austoker, L. Bistanti, S. Fox, R. Gnauck, D. Iverson, M. Mandelson, D. Reading, R. Smith
Journal: Annals of Oncology (2004)
Potentiation between Urecholine and gastrin extract and between Urecholine and histamine in the stimulations of Heidenhain pouches
Authors: I. E. Gillespie, M. I. Grossman
Journal: Gut (1964)

EDITORIAL SYNOPSIS These studies clearly establish the existence of true potentiation between Urecholine and gastrin and between Urecholine and histamine in stimulating secretion both of acid and of pepsin.