tbuckley/cabot-search huggingface dataset:
Gastroenterology training in 2010: results from the TiG/BSG national training survey
Authors: A. Haycock, A. Ignjatovic, C. Lamb, J. Neale, P. Flanagan, J. Hender, M. Mottershead, T. Valliani, V. Patel, J. Russell
Journal: Gut (2011)

<h3>Introduction</h3> The last national survey of gastroenterology trainees in 2008 revealed that although the majority of trainees felt that their training was satisfactory, there was significant variation across the country. Overall, lack of adequate training in nutrition was considered the most concerning area. Educational supervision and personal development plans were not being widely utilised. <h3>Methods</h3> An invitation to complete a web-based questionnaire was emailed to all trainees and data was collected in Febuary 2010. For comparison, results from the 2008 survey are given in square brackets where applicable. <h3>Results</h3> <b>Training positions</b> 10.1% of trainees were in specialist hepatology posts. 24.2% were in OOPE, with 19.6% having already done OOPE (85.5% for research). <b>General gastroenterology</b> Nutrition is still the area the majority of trainees do not think they will attain competence in, and it was worse than in 2008. 25% felt that they had not had and were unlikely to get a period of formal nutrition training as a registrar. 64% did not feel that they would be confident to run a nutrition team after attaining CCST. <b>Specialisation</b> 73% SpRs want to subspecialise but many were not certain if there were adequate training opportunities in their region to attain specialist competence. 74% (81%) would be prepared to commute and 47% (50%) to move permanently to another area to obtain better training in a sub-speciality. <b>Endoscopy</b> 54% (40%) now get formative DOPS filled in regularly. 21.4% (16.9%) are not very or very unsatisfied with their endoscopy training. Most comments were due to lack of training lists, particularly for colonoscopy and therapeutic techniques. <b>Study leave</b> 68% (59%) never or only occasionally are able to take half day study leave per week. <b>Training/Education</b> 65.8% (58.2%) of training programmes are now on a rolling schedule. 97.1% (95.4%) now have an educational supervisor. 24.8% (22.8%) of SpRs intend to sit the SCE. 29.5% (50.8%) do not have a PDP (Personal Development Plan) <b>General</b> 11.8% (18%) posts non-EWTD compliant. 72.3% (78.8%) believe training affected by EWTD with 100% (95.3%) saying it has been impaired (38.7% greatly impaired). <b>Workforce planning</b> Given the choice, 44.6% (48.9%) would choose to practice gen med. 75.3% (67.7%) would not consider a job in acute medicine with gastroenterology. 19.6% wish to work part time as a consultant. <h3>Conclusion</h3> More trainees have formal educational support and are using assessment tools regularly than 2 years ago. However, the issues that were of concern in the last survey remain problems, and trainees feel that in some cases, in particular the provision of nutrition training, things may actually have become worse.
Osteopontin Expression and Prognostic Significance in Non–Small Cell Lung Cancer
Authors: Valentina Donati, Laura Boldrini, Matteo Dell'Omodarme, Maria C. Prati, Pinuccia Faviana, Tiziano Camacci, Marco Lucchi, Alfredo Mussi, Massimo Santoro, Fulvio Basolo, Gabriella Fontanini
Journal: Clinical Cancer Research (2005)

Abstract Purpose: The survival rate of non–small cell lung cancer patients is very low, and knowledge of predictors of outcome is inadequate. To improve the curability of lung cancer, we need to identify new specific molecules involved in tumorigenesis and progression. The purpose of this study was to better define the role of osteopontin in non–small cell lung cancer biology by determining its prognostic significance. Experimental Design: Osteopontin expression was evaluated by immunohistochemistry, as percentage of neoplastic cells with cytoplasmic immunoreactivity, in a wide series of patients with stage I-IIIA non–small cell lung cancer (207 cases). The median value of this series (20% of positive cells) was used as the cutoff value to distinguish tumors with low (&amp;lt;20%) from tumors with high (≥20%) osteopontin expression. Results: Taking the series of patients as a whole (207 cases), osteopontin expression was associated with neither overall survival (P = 0.14) nor disease-free survival (P = 0.074). However, among patients with at least 6 years of follow-up (163 cases), 6-year overall survival and disease-free survival were significantly reduced if osteopontin expression was high (P = 0.0085 for overall survival, P = 0.0023 for disease-free survival). Moreover, a statistically significant correlation between high levels of osteopontin and shorter overall survival (P = 0.034) and disease-free survival (P = 0.011) in patients with stage I tumors (136 cases) was shown. Conclusions: Our results support the hypothesis of an association between high osteopontin expression and poor survival of patients with stage I non–small cell lung cancer, suggesting that osteopontin could be a candidate target for cancer therapy.
31P magnetic resonance spectroscopy of the liver: Correlation with standardized serum, clinical, and histological changes in diffuse liver disease
Authors: H VANWASSENAERVANHALL
Journal: Hepatology (1995)

The goal of this study was to analyze the possibilities of 31P MR spectroscopy to detect abnormal hepatic histological changes in patients with diffuse liver disease. 31P MR spectroscopy was performed, on a 1.5 T whole-body spectrometer using an image guided localization technique (ISIS), on 38 patients with various diffuse liver diseases, who all underwent histological and serum analysis, and 22 healthy volunteers. Phosphomonoester expressed as a fraction of total phosphorus (PME/P) showed a correlation with abnormal serum aspartate transaminase (AST), histological intralobular degeneration/focal necrosis, portal inflammation, and piecemeal necrosis. We found a lower correlation for PME/P with fibrosis. It was not possible to differentiate between fibrosis and cirrhosis. In summary, 31P MR spectroscopy is a technique to detect intralobular degeneration, inflammation and necrosis and to a less extent fibrosis. No diagnostic value was found with respect to steatosis and cholangitis. Furthermore, 31P MR spectroscopy is a poor method for classifying patients into diagnostic categories.
Syndromes of Ketosis-Prone Diabetes Mellitus
Authors: Ashok Balasubramanyam, Ramaswami Nalini, Christiane S. Hampe, Mario Maldonado
Journal: Endocrine Reviews (2008)

Ketosis-prone diabetes (KPD) is a widespread, emerging, heterogeneous syndrome characterized by patients who present with diabetic ketoacidosis or unprovoked ketosis but do not necessarily have the typical phenotype of autoimmune type 1 diabetes. Multiple, severe forms of β-cell dysfunction appear to underlie the pathophysiology of KPD. Until recently, the syndrome has lacked an accurate, clinically relevant and etiologically useful classification scheme. We have utilized a large, longitudinally followed, heterogeneous, multiethnic cohort of KPD patients to identify four clinically and pathophysiologically distinct subgroups that are separable by the presence or absence of β-cell autoimmunity and the presence or absence of β-cell functional reserve. The resulting "Aβ" classification system of KPD has proven to be highly accurate and predictive of such clinically important outcomes as glycemic control and insulin dependence, as well as an aid to biochemical and molecular investigations into novel causes of β-cell dysfunction. In this review, we describe the current state of knowledge in regard to the natural history, pathophysiology, and treatment of the subgroups of KPD, with an emphasis on recent advances in understanding their immunological and genetic bases.
Maintenance of Glucose Control in Patients With Type 1 Diabetes During Acute Mental Stress by Riding High-Speed Rollercoasters
Authors: Peter Wiesli, Pierre-Alexandre Krayenbühl, Oranna Kerwer, Burkhardt Seifert, Christoph Schmid
Journal: Diabetes Care (2007)

Patients with diabetes and health care providers are often confronted with questions concerning psychological stress as a possible reason for glucose excursions; chronic psychosocial stress has been associated with higher levels of A1C and poor adherence to treatment (1,2). Few studies have addressed the effect of acute psychological stress on glucose concentrations in patients with type 1 diabetes, showing no or only minor effects, such as an increase in insulin resistance and slightly delayed decreases in glucose concentrations following moderate stress in the postprandial period (3–5). Since many patients and caregivers have challenged this view, we asked patients with type 1 diabetes to monitor glucose concentrations during a strongly stressing experiment.

A total of 20 patients with type 1 diabetes (all on intensified insulin treatment) were recruited from a recent study investigating the effect of acute moderate psychosocial stress on glucose concentrations (5). Patients were exposed to acute mental stress by riding on two different rollercoasters within 15 min. The first rollercoaster was a steel coaster starting from a height of 240 feet and reaching a speed of 79 mph with four positive Gs and the second an indoor coaster in absolute darkness. Blood pressure (by an ambulatory blood pressure monitoring device), heart rate (by 24-h electrocardiogram), and salivary cortisol were monitored during a preceding control day without stress application and on the stress testing day. Glucose concentrations were monitored in 5-min intervals by the Medtronic MiniMed continuous glucose monitoring system (CGMS). Capillary blood glucose concentrations were determined in 15- to 30-min …
Burch Colposuspension versus Fascial Sling to Reduce Urinary Stress Incontinence
Authors: Michael E. Albo, Holly E. Richter, Linda Brubaker, Peggy Norton, Stephen R. Kraus, Philippe E. Zimmern, Toby C. Chai, Halina Zyczynski, Ananias C. Diokno, Sharon Tennstedt, Charles Nager, L. Keith Lloyd, MaryPat FitzGerald, Gary E. Lemack, Harry W. Johnson, Wendy Leng, Veronica Mallett, Anne M. Stoddard, Shawn Menefee, R. Edward Varner, Kimberly Kenton, Pam Moalli, Larry Sirls, Kimberly J. Dandreo, John W. Kusek, Leroy M. Nyberg, William Steers
Journal: New England Journal of Medicine (2007)

Many surgical procedures are available for women with urinary stress incontinence, yet few randomized clinical trials have been conducted to provide a basis for treatment recommendations.We performed a multicenter, randomized clinical trial comparing two procedures--the pubovaginal sling, using autologous rectus fascia, and the Burch colposuspension--among women with stress incontinence. Women were eligible for the study if they had predominant symptoms associated with the condition, a positive stress test, and urethral hypermobility. The primary outcomes were success in terms of overall urinary-incontinence measures, which required a negative pad test, no urinary incontinence (as recorded in a 3-day diary), a negative cough and Valsalva stress test, no self-reported symptoms, and no retreatment for the condition, and success in terms of measures of stress incontinence specifically, which required only the latter three criteria. We also assessed postoperative urge incontinence, voiding dysfunction, and adverse events.A total of 655 women were randomly assigned to study groups: 326 to undergo the sling procedure and 329 to undergo the Burch procedure; 520 women (79%) completed the outcome assessment. At 24 months, success rates were higher for women who underwent the sling procedure than for those who underwent the Burch procedure, for both the overall category of success (47% vs. 38%, P=0.01) and the category specific to stress incontinence (66% vs. 49%, P<0.001). However, more women who underwent the sling procedure had urinary tract infections, difficulty voiding, and postoperative urge incontinence.The autologous fascial sling results in a higher rate of successful treatment of stress incontinence but also greater morbidity than the Burch colposuspension. (ClinicalTrials.gov number, NCT00064662 [ClinicalTrials.gov] .).
Trusts warn that NHS reforms could cause patient care failures and financial chaos
Authors: A. O'Dowd
Journal: BMJ (2010)

NHS trusts in England are concerned at the “significant risks and worrying uncertainties” of the proposed reforms to the health service, mirroring concerns raised by the medical professional bodies.

The NHS Confederation, which represents 95% of NHS organisations, warns that the government’s plan to make major structural changes to the NHS when money is being trimmed could lead to a reduction in the quality of patient care and loss of financial control.

The confederation, which published its response to the government’s white paper, Equity and Excellence: Liberating the NHS , on 11 October, said its members had major concerns that GPs did not yet have enough capacity …
Growth and infectious exposure during infancy and the risk of rheumatoid factor in adult life
Authors: C J Edwards
Journal: Annals of the Rheumatic Diseases (2005)

The contribution of the environment to rheumatoid arthritis (RA) remains uncertain. Intrauterine and early postnatal life may be important. Rheumatoid factor (RF) found in around 10% of the normal population confers a risk of developing RA and may be present years before onset of clinical disease. The immune pathology leading to RA and RF may have similar genetic and environmental influences.To measure RF in people for whom data on birth weight, infant growth, and markers of infectious exposure during infancy and childhood, had been previously recorded.675 men and 668 women aged 59-67 years, born and still resident in Hertfordshire, UK, were studied. RF was measured with an ELISA. Associations between presence of RF, early growth, and markers of hygiene in infancy, were investigated.RF was detected in 112/675 (16.6%) men and 79/668 (11.8%) women. No significant relationships existed between early growth and presence of RF in men or women. Among women, sharing a bedroom during childhood was associated with a lower risk of RF positivity (OR = 0.48, 95% CI 0.30 to 0.78, p = 0.003).A developing immune system exposed to increased infectious exposure is less likely to produce RF in adult life; this may reduce the pathological process which leads to RA.
A Phase II Study of the Panitumumab+ Irinotecan Therapy for Advanced / Recurrence Colorectal Cancer (Topic Study)
Authors: T. Denda, T. Nishi, K. Yamaguchi, A. Kenji, Y. Miyata, Y. Yamanaka, K. Yanai, Y. Hamamoto, M. Nagase, H. Fujii
Journal: Annals of Oncology (2013)
A[H1N1] flu and refractory hypoxaemia: Is extracorporeal lung support the holy grail?
Authors: T. V. Veenith, M. Rana, A. Ercole, K. Gunning, R. Mahroof
Journal: Thorax (2011)

There is a call for methodologically robust randomised clinical trials in adult extracorporeal membrane oxygenation for its routine implementation for patients with "failing" conventional ventilation. Adherence to lung protective ventilation strategies, along with fluid balance [if required early renal replacement therapy] and inotropes to support the circulation to minimise ventilator-induced lung injury, may mitigate deterioration requiring extracorporeal lung support. Currently there is no convincing evidence to routinely advocate extracorporeal lung support in failed conventional ventilation, and a prospective trial is needed to define standard best practice and to tailor extracorporeal lung support referral criteria in young patient cohort with severe refractory respiratory failure.
Prognosis of Women With Primary Breast Cancer Diagnosed During Pregnancy: Results From an International Collaborative Study
Authors: Frédéric Amant, Gunter von Minckwitz, Sileny N. Han, Marijke Bontenbal, Alistair E. Ring, Jerzy Giermek, Hans Wildiers, Tanja Fehm, Sabine C. Linn, Bettina Schlehe, Patrick Neven, Pieter J. Westenend, Volkmar Müller, Kristel Van Calsteren, Brigitte Rack, Valentina Nekljudova, Nadia Harbeck, Michael Untch, Petronella O. Witteveen, Kathrin Schwedler, Christoph Thomssen, Ben Van Calster, Sibylle Loibl
Journal: Journal of Clinical Oncology (2013)

We aimed to determine the prognosis of patients with breast cancer diagnosed during pregnancy (BCP).In this cohort study, a multicentric registry of patients with BCP (from Cancer in Pregnancy, Leuven, Belgium, and GBG 29/BIG 02-03) compiled pro- and retrospectively between 2003 and 2011 was compared with patients who did not have associated pregnancies, using an age limit of 45 years. Patients with a diagnosis postpartum were excluded. The main analysis was performed using Cox proportional hazards regression of disease-free survival (DFS) and overall survival (OS) on exposure (pregnant or not), adjusting for age, stage, grade, hormone receptor status, human epidermal growth factor 2 status, histology, type of chemotherapy, use of trastuzumab, radiotherapy, and hormone therapy.The registry contained 447 women with BCP, mainly originating from Germany and Belgium, of whom 311 (69.6%) were eligible for analysis. The nonpregnant group consisted of 865 women. Median age was 33 years for the pregnant and 41 years for the nonpregnant patients. Median follow-up was 61 months. The hazard ratio of pregnancy was 1.34 (95% CI, 0.93 to 1.91; P = .14) for DFS and 1.19 (95% CI, 0.73 to 1.93; P = .51) for OS. Cox regression estimated that the 5-year DFS rate for pregnant patients would have increased from 65% to 71% if these patients had not been pregnant. Likewise, the 5-year OS rate would have increased from 78% to 81%.The results show similar OS for patients diagnosed with BCP compared with nonpregnant patients. This information is important when patients are counseled and supports the option to start treatment with continuation of pregnancy.
Progressive familial intrahepatic cholestasis type 1 and extrahepatic features: no catch-up of stature growth, exacerbation of diarrhea, and appearance of liver steatosis after liver transplantation
Authors: Panayotis Lykavieris, Saskia van Mil, Danièle Cresteil, Monique Fabre, Michelle Hadchouel, Leo Klomp, Olivier Bernard, Emmanuel Jacquemin
Journal: Journal of Hepatology (2003)
REPORT OF A CASE OF SEVERE TETANUS SUCCESSFULLY TREATED BY ANTITOXIN
Authors: T. P. Kilner
Journal: BMJ (1916)

exanmined thle blood. of four of tlhe inoculated persons.I lave collected tlle results in the following table ; Teta araecii/e.Limits of Agglutination., dividuals Blood tested against I_Weeks after First Injection.Inoculated.-3 4 ~~~~~~~~1l 2 3 4 5 B. Ivp,os,zi ... . .. 1/40 11'1T200 1I500 -1J20oNo.
Genome-wide association study to identify genetic determinants of severe asthma
Authors: Y I Wan, N R G Shrine, M Soler Artigas, L V Wain, J D Blakey, M F Moffatt, A Bush, K F Chung, W O C M Cookson, D P Strachan, L Heaney, B A H Al-Momani, A H Mansur, S Manney, N C Thomson, R Chaudhuri, C E Brightling, M Bafadhel, A Singapuri, R Niven, A Simpson, J W Holloway, P H Howarth, J Hui, A W Musk, A L James, M A Brown, S Baltic, M A R Ferreira, P J Thompson, M D Tobin, I Sayers, I P Hall
Journal: Thorax (2012)

<h3>Background</h3> The genetic basis for developing asthma has been extensively studied. However, association studies to date have mostly focused on mild to moderate disease and genetic risk factors for severe asthma remain unclear. <h3>Objective</h3> To identify common genetic variants affecting susceptibility to severe asthma. <h3>Methods</h3> A genome-wide association study was undertaken in 933 European ancestry individuals with severe asthma based on Global Initiative for Asthma (GINA) criteria 3 or above and 3346 clean controls. After standard quality control measures, the association of 480 889 genotyped single nucleotide polymorphisms (SNPs) was tested. To improve the resolution of the association signals identified, non-genotyped SNPs were imputed in these regions using a dense reference panel of SNP genotypes from the 1000 Genomes Project. Then replication of SNPs of interest was undertaken in a further 231 cases and 1345 controls and a meta-analysis was performed to combine the results across studies. <h3>Results</h3> An association was confirmed in subjects with severe asthma of loci previously identified for association with mild to moderate asthma. The strongest evidence was seen for the <i>ORMDL3</i>/<i>GSDMB</i> locus on chromosome 17q12-21 (rs4794820, p=1.03×10<sup>(−8)</sup> following meta-analysis) meeting genome-wide significance. Strong evidence was also found for the <i>IL1RL1</i>/<i>IL18R1</i> locus on 2q12 (rs9807989, p=5.59×10<sup>(−8)</sup> following meta-analysis) just below this threshold. No novel loci for susceptibility to severe asthma met strict criteria for genome-wide significance. <h3>Conclusions</h3> The largest genome-wide association study of severe asthma to date was carried out and strong evidence found for the association of two previously identified asthma susceptibility loci in patients with severe disease. A number of novel regions with suggestive evidence were also identified warranting further study.
Argentine randomized study: coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple-vessel disease (ERACI II): 30-day and one-year follow-up results
Authors: Alfredo Rodriguez, Victor Bernardi, Jose Navia, Julio Baldi, Liliana Grinfeld, Jorge Martinez, Daniel Vogel, Roberto Grinfeld, Alejandro Delacasa, Marcelo Garrido, Raul Oliveri, Eduardo Mele, Igor Palacios, William O’Neill
Journal: Journal of the American College of Cardiology (2001)
Thoracoscopic fluorescence diagnosis (TFD) of pleural malignancies: experimental studies
Authors: R L Prosst
Journal: Thorax (2002)

Fluorescence diagnosis (FD) using the photosensitiser 5-aminolaevulinic acid (ALA) was experimentally combined with conventional video assisted thoracic surgery (VATS) to improve tumour staging in advanced lung cancer with pleural tumour spread.A disseminated pleural carcinosis affecting the entire pleural cavity was induced by inoculation of human adenocarcinoma cells in nude rats. After 5-7 weeks of tumour growth the animals were randomised into six groups with different photosensitisation parameters. Pleural lavage was performed either with 1.5% or 3.0% ALA solution. Photosensitisation times varied were 2, 4, or 6 hours. Conventional white light VATS was first performed to evaluate tumour growth in the pleural cavity. Fluorescence illumination of the light source, the D-light, was then used to examine the site for additional tumours which were previously invisible. The tumour fluorescence intensity was measured spectrometrically and compared with normal tissue.Compared with conventional white light VATS alone, thoracoscopic fluorescence diagnosis (TFD) detected up to 30% additional pleural malignant lesions. The highest diagnostic sensitivity was reached 6 hours after 3.0% ALA pleural lavage. Photosensitiser accumulation in the tumour, measured indirectly by spectrometry, was up to 11 times higher than in normal tissue.TFD increases sensitivity of VATS for tumour staging. It may prevent unnecessary thoracotomies in cancer patients and facilitate surgical planning.
Induction of polyclonal antibody synthesis by human allogeneic and autologous helper factors.
Authors: N Chiorazzi, S M Fu, H G Kunkel
Journal: The Journal of Experimental Medicine (1979)

Human helper factors were obtained from supernates of 48 h unidirectional allogeneic and autologous mixed lymphocyte reactions. These supernates were shown to induce the production of large amounts of immunoglobulin by tonsillar and peripheral blood mononuclear cells. Abundant polyclonal activation to antibody production occurred in these cultures in the absence of antigenic challenge which was similar in degree to that produced by pokeweed mitogen. This was documented by quantitating plasma cells, specific plaque-forming cells, and secreted immunoglobulin. In addition, the supplementation of companion cultures with sheep erythrocytes resulted in a significant enhancement of the specific plaque-forming cell response without an appreciable change in plasma cell number of secreted Ig.