tbuckley/cabot-search huggingface dataset:
Infrared endoscopic system for detection of bleeding points during endoscopic resection
Authors: R. Ishihara, H. Iishi, M. Kato, S. Yamamoto, S. Yamamoto, E. Masuda, K. Tatsumi, Y. Takeuchi, K. Higashino, N. Uedo, M. Tatsuta
Journal: Endoscopy (2007)

Endoscopic resection is a widely used treatment for gastrointestinal tumors. The major complications of endoscopic resection are bleeding and perforation. Bleeding during the procedure can cause technical difficulties.
Case 15-2009
Authors: Camille N. Kotton, Nahel Elias, Francis L. Delmonico, Richard L. Kradin
Journal: New England Journal of Medicine (2009)

A 25-year-old man was admitted to this hospital because of coma after cardiac arrest. Cardiopulmonary resuscitation was performed, and a junctional rhythm was established. On admission, the patient remained unconscious. Despite aggressive measures, the patient met criteria for brain death, and his family agreed to organ donation. During the procurement procedure, a thickened region of the colon was seen. A diagnostic procedure was performed.
Submucosal endoscopic tumor resection for subepithelial tumors in the esophagus and cardia
Authors: H. Inoue, H. Ikeda, T. Hosoya, M. Onimaru, A. Yoshida, N. Eleftheriadis, R. Maselli, S. Kudo
Journal: Endoscopy (2012)

<b>Background and study aims:</b> Resection of submucosal tumors by means of endoscopy has been reported using a variety of techniques, but cannot be performed safely in tumors originating from the muscularis propria. Using the submucosal tunnel created by the technique of peroral endoscopic myotomy (POEM), we report the first series describing the new technique of submucosal endoscopic tumor resection (SET) for tumors of the esophagus and cardia. <b>Patients and methods:</b> SET was attempted in nine consecutive patients with tumors (size > 2 cm) of either the esophagus or cardia with clinical indications for lesion removal. Following creation of a submucosal tunnel from 5 cm above the tumor, as described previously, the tumor was dissected from the overlying mucosa/submucosa and then carefully removed from the muscular layer using triangle-tip and insulated-tip knives. Following specimen retrieval through the tunnel, the orifice was closed by clips. <b>Results:</b> Of the nine patients, two had tumors that were too large (60 mm and 75 mm, respectively) to allow safe removal due to loss of endoscopic overview. All remaining tumors (maximal tumor extension 12 – 30 mm) could be resected safely using this method. No complications occurred and follow-up was unremarkable. On histology, all tumors were resected completely (one gastrointestinal stromal tumor, five leiomyomas). The technique had to be modified in one patient with an aberrant pancreas. <b>Conclusions:</b> SET is a promising new technique for selected submucosal tumors in the esophagus and cardia up to a size of 4 cm and should be studied further.
Abstract P1-01-18: The results of 55 consecutive cases of intra-operative sentinel node analysis using real time polymerase chain reaction detection of cytokeratin 19 and mammoglobin expression (Metasin) to direct immediate axillary clearance.
Authors: K Nadi, Y Sharaiha, P Sai-Girdhar, A Huws, S Khawaja, S Holt
Journal: Cancer Research (2012)

Abstract The standard management of early beast cancer is complete excision of the primary from the breast by either wide local excision or mastectomy and sentinel node biopsy to stage the axilla. The standard of care in the UK remains clearance of the axilla in node positive patients. Unless immediate multiple frozen section histology is available, positive patients require a second operation between 3 and 6 weeks later, with the associated increased cost, inconvenience and risk. By using the real time polymerase chain reaction (PCR) to detect mammary derived cells in the sentinel lymph nodes (SLN), we aim to provide the surgeon with a reliable indicator of the presence or absence of nodal macro-metastases within a timeframe that will allow axillary clearance to be performed under the same anaesthetic as the initial surgery. We detect cytokeratin 19 (CK19) or mammoglobin within the lymph node using reagents developed by the UK National Health Service under the name Metasin. Method: 55 consecutive patients undergoing SLN biopsy as part of their initial treatment for early breast cancer were tested using the Metasin. The nodes were divided into 2mm slices and alternate sections submitted to PCR and the remainder to conventional histology. The results were compared and an assessment of the costs made. The time taken report the Metasin result to the surgeon was recorded. Results: Five patients had positive results by Metasin and proceeded to immediate axillary clearance. When compared to histology there were no false positive results (0%). Two patients were negative on Metasin testing with the threshold set at 2 mm but positive on histology (3.6%). The average time for the test was 43.2 minutes and the mean number of lymph nodes was 2.3. The average cost is £40 to test 2 nodes. Discussion: The test is accurate. The two false negative cases were found to be due to the sampling, the metastases being only present by chance in the histologically examined specimens and not due to assay failure. The total cost to run the test for 55 patients was £2,520. The cost for completion axillary clearance as a separate procedure is estimated at £2,227. The total saving for 5 cases is about £11,000, making the test cost saving as well as safer, more acceptable to the patients and limiting delay in starting adjuvant therapies. The additional time of surgery caused by using Metasin was minimal. Conclusion: Metasin has become our standard of care in patients requiring SLN biopsy and generally avoids second surgeries to clear the axilla in positive cases. We are considering analyzing the complete node using this technique and this would eliminate false negatives caused by sampling and offer further cost savings in the histology department. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-18.
Secretion of Pancreatic Polypeptide in Patients with Pancreatic Endocrine Tumors
Authors: Thomas E. Adrian, Lars O. Uttenthal, Susan J. Williams, Stephen R. Bloom
Journal: New England Journal of Medicine (1986)

Pancreatic polypeptide is often secreted by pancreatic endocrine tumors and is considered a marker for such tumors. To investigate the diagnostic value of this marker, we studied 323 patients with proved pancreatic endocrine tumors. We found plasma concentrations of pancreatic polypeptide to be elevated (more than 300 pmol per liter) in 144 patients (diagnostic sensitivity, 45 percent). However, plasma levels of pancreatic polypeptide can also be elevated in the absence of a pancreatic tumor. To ascertain whether the administration of atropine could distinguish between normal and tumor-associated polypeptide secretion, we studied 30 patients with pancreatic tumors and high plasma levels of pancreatic polypeptide, 18 patients without tumors who had elevated levels of pancreatic polypeptide, and eight normal controls. Polypeptide levels In the 18 patients without tumors were substantially lower than in the 30 patients with tumors. Atropine (1 mg intramuscularly) did not suppress polypeptide levels in patients with tumors, but did suppress plasma levels by more than 50 percent in all subjects without tumors. Thus, although its diagnostic sensitivity is low, pancreatic polypeptide appears to be a useful adjunctive marker of many pancreatic endocrine tumors, and the atropine suppression test can be used to distinguish normal from tumor-related secretion of the polypeptide. Identification of the type of pancreatic endocrine tumor still requires measurement of the hormone that is specific for the tumor. (N Engl J Med 1986; 315:287–91.)
ANOMALOUS ORIGIN OF THE CORONARY ARTERIES: INCIDENCE AND OUTCOMES AMONG PATIENTS UNDERGOING CORONARY CTA
Authors: Michael Cheezum, Brian Ghoshhajra, Marcio Bittencourt, Edward Hulten, Negareh Mousavi, Michael Steigner, Frank Rybicki, Nishant Shah, Thomas MacGillivray, Ami Bhatt, Anne Marie Valente, Suhny Abbara, Udo Hoffmann, Marcelo Di Carli, Doreen Yeh, Michael Landzberg, Richard Liberthson, Ron Blankstein
Journal: Journal of the American College of Cardiology (2015)
THU0215 Incidence of wegener’s granulomatosis in finland in 1981-2000 — different age group proportions in four 5-year periods
Authors: J.H. Takala, H. Kautiainen, M. Leirisalo-Repo
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Patients with Wegener's granulomatosis (WG) used to be ca. 40 years old at diagnosis in the 1950s and 1960s. Since then, WG-patients have been diagnosed at a more advanced age, nowadays around 50-60 years. This trend has been thought be due to changes in population and proportions of age groups. <h3>Objectives</h3> To compare the incidence of WG in different age groups in four 5-year periods in 1981-2000. <h3>Methods</h3> Information on patient characteristics and data on disease characteristics and treatment details were collected in hospital files. All 492 patients diagnosed with in Finland in 1981-2000 were divided into eight age groups and the 20-year time divided into four 5-year periods. The incidence of WG was calculated for each age group in each 5-year period. <h3>Results</h3> The overall incidence of WG increased throughout the study period. The increase was very mild in age groups under 35 years, but increased markedly in older groups, particularly in the age group 65-74 years. It's incidence increased from 2.18/million/year up to 24.75/million/year. <h3>Conclusions</h3> Altered age distribution in population does not explain the altered age of WG patients at diagnosis. There must be environmental factors that alter immunologic reactions e.g. better management of infections, vaccinations, better general condition of people which postpones disease admission, etc. <h3>Disclosure of Interest</h3> None Declared
Case 18-2013
Authors: Andrew J. Cole, Emad Eskandar, Theofanie Mela, Jeffrey L. Noebels, R. Gilberto Gonzalez, Declan McGuone
Journal: New England Journal of Medicine (2013)

A 32-year-old woman was seen in the neurology clinic because of episodes of altered consciousness — staring, aphasia, and occasional sudden loss of postural tone and collapse. EEG revealed left-temporal-lobe seizures; brain imaging revealed a left-temporal-lobe mass.
Abstract 949: miR-634 restores drug sensitivity in tumor cells derived from patients with terminal drug-resistant ovarian cancer.
Authors: Marijn TM van Jaarsveld, Patricia F. van Kuijk, Antonius WM Boersma, Jozien Helleman, Wilfred F. van Ijcken, Ron HJ Mathijssen, Joris Pothof, Els MJJ Berns, Jaap Verweij, Erik AC Wiemer
Journal: Cancer Research (2013)

Abstract The development of drug resistance is still a major impediment for the successful treatment of cancer. This is particularly pressing in the case of advanced ovarian cancer, which has a 5-year survival rate of 30%. Ovarian cancer is treated with paclitaxel and platinum (e.g cisplatin or carboplatin) combination chemotherapy. Despite an initial high chemo-responsiveness, most ovarian cancer patients will relapse and ultimately die of drug-resistant disease. The molecular processes that contribute to resistance have been extensively studied, however, not much is known about the role of microRNAs (miRNAs), small non-coding RNAs that regulate gene expression. We compared miRNA expression profiles of isogenic cisplatin sensitive and resistant cell line pairs. The only miRNA that was consistently downregulated in all three resistant cell lines was miR-634 (FDR&amp;lt;1%). Overexpression of miR-634 in ovarian cancer cell lines gave rise to a minor, but reproducible, cell cycle block and reduced cellular viability by 20-50%. In addition, miR-634 transfection resensitized cisplatin-resistant ovarian cancer cell lines. We next investigated whether miR-634 overexpression could enhance therapy response in a more clinical setting. We isolated and cultured tumor cells from 7 patients that had become refractory to carboplatin-paclitaxel combination chemotherapy. We show that miR-634 overexpression causes a ∼two-fold decrease in IC50 for cisplatin and carboplatin treatment. In addition, a ∼1.3-fold decrease in doxorubicin sensitivity was observed upon miR-634 overexpression. Finally, overexpression of miR-634 resulted in downregulation of its predicted targets Cyclin D1 and GRB2, ERK2, RSK1 and RSK2, components of the Ras-MAPK pathway. The combined effect on these miR-634 targets may explain the effects on the cell cycle, cellular viability and response to chemotherapy. Altogether, our findings suggest that miR-634 modulates important cancer relevant targets and that raising miR-634 levels can be a means to resensitize chemotherapy resistant ovarian tumors. Citation Format: Marijn TM van Jaarsveld, Patricia F. van Kuijk, Antonius WM Boersma, Jozien Helleman, Wilfred F. van Ijcken, Ron HJ Mathijssen, Joris Pothof, Els MJJ Berns, Jaap Verweij, Erik AC Wiemer. miR-634 restores drug sensitivity in tumor cells derived from patients with terminal drug-resistant ovarian cancer. [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 949. doi:10.1158/1538-7445.AM2013-949
Abstract 1269: Activation of the NKG2D receptor differentially activates mTOR and NFκB signaling pathways in CD8+ T cells.
Authors: Amorette E. Barber, Taylor Bedsworth, Jasmine Spence, Emily Whitman
Journal: Cancer Research (2013)

Abstract To induce strong anti-tumor immune responses, CD8+ T cells require stimulation through the TCR and costimulatory receptors. Each costimulatory molecule can have a unique effect on the function of T cells due to differential activation of downstream signaling pathways and gene expression. One costimulation molecule that is likely to be engaged in the tumor microenvironment is NKG2D since the ligands for this receptor are expressed in over 80% of tumors. In order to determine how activation of costimulatory receptors in the tumor microenvironment affects CD8+ T cell functions, previous studies have compared the activation of CD8+ T cells through CD3 in combination with either CD28 or NKG2D and showed that CD3 and NKG2D stimulated cells secreted less anti-inflammatory cytokines. Both costimulatory receptors activated AKT, however the altered cytokine secretion was due to the unique activation of β-catenin in NKG2D stimulated cells. This study aimed to further investigate the differences in the signaling pathways downstream of AKT that are activated by CD3 /CD28 and CD3/NKG2D. Specifically, this study focused on the activation of mammalian target of rapamycin complex 1 and 2 (mTORC1 and mTORC2) along with nuclear factor kappa B (NFκB), all of which have been shown to have important roles in the CD8+ T cell anti-tumor functions. Activation of the mTORC1, mTORC2 and NFκB pathways were compared in murine CD8+ effector T cells stimulated through CD3 alone, CD3 and CD28 or CD3 and NKG2D. The activation of mTORC1was measured through phosphorylation of its downstream effectors including 4-EBP1, P70SK6 and HIF-1, while mTORC2 measured activation of AKT, SGK1 and NFkβ. Activation of CD8+ T cells through CD3 and NKG2D decreased activation of mTORC1 while increasing activation of mTORC2. Together this shows that activation through NKG2D leads to the differential activation of signaling pathways, thus likely altering the anti-tumor effector functions of the CD8+ T cells. Citation Format: Amorette E. Barber, Taylor Bedsworth, Jasmine Spence, Emily Whitman. Activation of the NKG2D receptor differentially activates mTOR and NFκB signaling pathways in CD8+ T cells. [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 1269. doi:10.1158/1538-7445.AM2013-1269
FRI0494 Determinants of erythrocyte methotrexate polyglutamates levels in rheumatoid arthritis
Authors: E. Den Boer, M. de Rotte, S. Pluijm, M. Hazes, R. de Jonge
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Methotrexate (MTX) is the gold standard in the management of rheumatoid arthritis (RA) and other arthritic diseases. Stable plasma MTX levels are not reached in RA but in the cell MTX polyglutamates (MTX-PGs) accumulate and can be measured. MTX-PGs occur with polyglutamate chains of up to five glutamate groups and longer chains correlate with clinical response. However, there is large inter-patient variability between intracellular MTX-PG concentrations and it is not yet known which factors influence this. <h3>Objectives</h3> The aim of this study was to examine determinants for the red blood cell MTX-PG concentrations in patients treated with low-dose oral MTX. <h3>Methods</h3> This study included data of RA patients treated with MTX from two combined longitudinal cohorts: 285 from the tREACH study and 102 from the MTX-R study. MTX-PG<sub>1-5</sub> concentrations were separately measured at 3 months of treatment using an LC-MS/MS assay. MTX-PG<sub>1-2</sub> are considered short chain, MTX-PG<sub>3</sub> as medium chain and MTX-PG<sub>4-5</sub> as long chain. The separate MTX-PGs and the sum of MTX-PG<sub>2-5</sub>(MTXPG<sub>total</sub>)were used as outcome measure. Various socio-demographic, clinical, biochemical determinants were assessed at baseline. Multiple regression analysis was used to examine the associations between these potential determinants and the different MTX-PG concentrations. <h3>Results</h3> After 3 months of MTX treatment, median [IQR] MTX-PG concentrations were 17.8 [8.5-19.6], 9.4 [6.5-11.1], 18.6 [13.3-23.3], 7.9 [3.4-11.1] and 2.2 [0.-2.7] nmol/l for MTX-PG<sub>1-5</sub> respectively, and 55.8 nmol/l [37.9-67.5] for total MTX-PG. The MTX-PG<sub>total</sub> concentration, was associated with higher age (ß=0.28; p&lt;0.001), male sex (ß=-0.12; p=0.021), higher MTX dose (ß=0.11; p=0.008), glucocorticoid use (ß=0.13; p=0.047), baseline CRP (ß=0.13; p=0.031) and baseline erythrocyte folate (ß=0.15; p=0.031). Apart from age, no significant associations were found for MTX-PG<sub>1</sub>. Higher age, male sex and MTX dose were the strongest determinants for the MTX-PG<sub>2</sub> till MTX-PG<sub>5</sub>. Furthermore, the longer chain MTX-PG<sub>3</sub> till MTX-PG<sub>5</sub> were also associated with disease activity, glucocorticoid use, intracellular erythrocyte folate and creatinine, at start of treatment. <h3>Conclusions</h3> This prospective study shows that age, sex and MTX dose are the most important determinants of MTX-PG concentrations. In addition, we showed that long chain MTX-PG concentrations are dependent on disease activity, glucocorticoid use and creatinine, at start of treatment. As response is thought to be mediated by the longer chain MTX-PGs, the identification of these determinants is a first step towards personalized treatment of RA. <h3>Acknowledgements</h3> RDJ: Dutch Arthritis Association (06-02-402 and 09-1-402) <h3>Disclosure of Interest</h3> None Declared
CLASSIFYING PLAQUES ACCORDING TO LIPID CONTENT AS ASSESSED BY NEAR INFRARED SPECTROSCOPY: IMPLICATIONS FOR PLAQUE VULNERABILITY
Authors: Annapoorna Subhash Kini, Yuliya Vengrenyuk, Sadako Motoyama, Jacobo Pena, Jonathan Feig, Usman Baber, Anitha Rajamanickam, Javed Suleman, Joseph Sweeny, Jagat Narula, Samin Sharma, Pedro Moreno
Journal: Journal of the American College of Cardiology (2015)
The caring doctor is an oxymoron
Authors: A. D Short, C. Blow, J. Rawlinson, H Tooby, T. Pitcairn
Journal: BMJ (1998)

Editor—Mackenzie’s hypothesis that the term “the caring doctor” is an oxymoron struck a chord with many doctors I speak to.1 I have long thought that general practice will develop best if we replace the sham of caring with better professionalism. This does not stop us practising good medicine in a compassionate and considerate manner. We spend a lot of time teaching consulting skills to registrars. Good consulting is not the same as “niceness,” and the term “the caring professions” is patronising and arrogant. 

There is still a place for the registered list of patients, but in a computerised world it is a tool for targeting and delivering good medicine—for example, in secondary prevention. The modern world is demanding of us. If general practice is to remain vibrant and attract high quality recruits we have to develop practice beyond the personal attributes of individual doctors. We need to think imaginatively, to continue the drive for better organisation, to use information technology to the full, to recognise the strengths of other members of the team, to delegate and give up some of our traditional perceived duties to those who often do them better. Surely routine visiting is a thing of the past. 

Practitioners as team leaders need to have the time and energy to step back and look critically at what the practice does as a whole and not to be afraid to initiate change. Too much of what we do still depends on tradition rather than planning. This opens the doors to external influences, as we have seen in the past few years to our disadvantage. 

Clinical audit should no longer be a threat to most of us, and perhaps we need to open the debate about clinical outcomes in practice. This debate should include the limitations that patients should expect of our services, and their responsibilities towards their own health. It should be aimed at reducing the dependency on doctors that seems to be ingrained in some quarters—for example, for numerous prescriptions for minor illness. 

I suspect that patients in general would support attempts to improve services at the expense of personal doctoring, which is probably more important to some doctors than to most patients. Inevitably this may touch on the question of standards, but if the debate is open and the standards explicit then most of us have nothing to fear.
Effects of Alcohol Ingestion on the Production of and Response to Experimental Hemorrhagic Stress
Authors: David H. Knott, George Barlow, James D. Beard
Journal: New England Journal of Medicine (1963)

ACUTE blood loss in patients intoxicated with ethyl alcohol is a common medical emergency problem. However, little work has been done to elucidate the effect, if any, of alcohol on the prognosis of such patients. Battey et al.1 reported that severe acute alcohol intoxication resulted in an increased cerebral blood flow, decreased cerebrovascular resistance, decreased cerebral oxygen consumption and a decreased systemic mean arterial pressure in many of their patients. Cournand2 noted that intoxicated victims of accidents were less tolerant to blood loss than nondrinking injured patients. Moss, Chenault and Gaston,3 in an attempt to delineate this problem experimentally, observed . . .