tbuckley/cabot-search huggingface dataset:
Insulin like growth factor in breast cancer subtypes.
Authors: R Yerushalmi, B Gilks, T Nielsen, S Leang, M Cheang, R Woods, K Gelmon, H Kennecke
Journal: Cancer Research (2009)

Abstract Abstract #3048 Background: Insulin Like Growth Factor -1 Receptor (IGF-1R) is an important new therapeutic target expressed in all cancer types. IGF-1R supports cell survival pathways implicated in resistance to cancer therapy. Knowledge of the pattern of IGF-R1 expression among breast cancer subtypes and its impact on prognosis may enhance development of therapeutics targeting this pathway.&amp;#x2028; Methods: Patients with early breast cancer cases, stage I-III, referred to the BC Cancer Agency from 1986 to 1992 were included. Archival paraffin tissue blocks were used to construct a tissue microarray. Among 4,046 patients with early stage on the TMA, 1,238 patients (30.6 %) were excluded due to missing subtype biomarkers, IGFR staining or both. Breast cancer subtypes were defined as Luminal A (ER/PR+, HER2- and Ki67 &amp;lt;19%), Luminal B (ER/PR+,and HER2- and Ki67 &amp;gt;19%), Luminal HER2+ (HER2+ and ER/PR+), HER2 (HER2+ and ER-and PR-), and Basal {HER2-,ER-PR- and (CK 5/6+ and/or EGFR+)}. IGF-1R staining was done with Santa Cruz antibody and was scored negative if there was no or weak staining and positive if staining was moderate or strong. Chi-square and Kaplan-Meier Survival analysis were done to compare IGF-1R expression among subtypes and determine impact on Breast Cancer Specific (BCSS) and Overall Survival (OS).&amp;#x2028; Results: A total of 2,808 evaluable cases were included with a median follow-up of 12.5 years. IGF-1R staining was scored positive in 86.4%, and negative in 13.6%. Cases with Luminal A (1,676), Luminal B (426), Luminal HER2+ (199), HER2 (206 ) and Basal (301 ) had an IGF-1R+ rate of 89.9%, 94.4 %, 83.4%, 59.2% and 76.1%, respectively (p&amp;lt;0.0001). 10 year BCSS was 68% (95% CI 66.0%-70.0%) in IGF-R1+ and 63% (95% CI 59.1%-66.9%) in IGF-R1 - group. Among subtypes, IGF-1R positivity was associated with improved BCSS only in Luminal A patients (p=0.015 ) and was not prognostic in other subtypes.&amp;#x2028; Conclusion: Luminal breast cancer subtypes are associated with high rates of IGF1-R expression, while non-luminal groups have lower rates of expression. The prognostic impact of IGF-R1 expression supports the role of this pathway as a therapeutic target particularly among hormone receptor positive breast cancer. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3048.
A10.03 B cell depletion with rituximab in patients with rheumatoid arthritis: Multiplex bead array reveals kinetics ofigg and iga autoantibodies to citrullinated antigens
Authors: G Cambridge, LL Lahey, MJ Leandro, T Fairhead, WH Robinson, J Sokolove
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background&nbsp;and&nbsp;purpose</h3> Seropositivity for Rheumatoid factors and for antibodies to citrullinated (Cit) protein antigens (ACPA) is the strongest predictor for clinical response to Rituximab (rituximab) in rheumatoid arthritis (RA). The aim of this study was to follow fluctuations of IgG- and IgA-ACPA to multiple individual citrullinated protein epitopes in relation to clinical improvement and resumption of symptoms after rituximab. <h3>Methods</h3> 16 patients with severe, active RA (DAS28&nbsp;≥&nbsp;5.1) undergoing initial cycles of rituximab were included. All achieved peripheral B-cell depletion (&lt;5 CD19<sup>+</sup>cells/μl) and clinically responded (ΔDAS28&nbsp;≥&nbsp;1.2) within 5 months. Follow-up to disease flare (Relapse) was available in 11/16 patients. IgG- and IgA-ACPAbinding to a custom, bead-based, antigen array comprising 30 Cit-antigens and 22 corresponding native antigenswas assessed using mean fluorescence intensity (MFI). Data was Z-normalised to compensate for variability in number of autoantibody binding sites per antigen. <h3>Results</h3> At Baseline, MFI of IgG- and of IgA-Cit antibodies were strongly correlated (R<sup>2&nbsp;</sup>=&nbsp;0.75; p &lt; 0.0001). Between Baseline and Depletion phase (median 3 months), IgG- and IgA-ACPA showed mean% decreases of -21.4% and -30.2% respectively. In 11 patients followed up to Relapse, ACPA fluctuated with different patterns. Of ACPAinitially decreasing following rituximab, 30/52 IgG- and 31/48 IgA-ACPA then rose before Relapse with reactivity largelyshared by IgA- and IgG-ACPA. 24% (16/68) of IgG-Cit and 6% (3/51) IgA-Cit, unexpectedly showed a transient increase following rituximab, subsequently decreasing to pre-treatment levels at Relapse. ACPA in different sera recognising the same epitopes were not linked to particular patterns of response. Putative 'new' specificities (Z-scores: Baseline &lt;1 and Relapse ≥1)were rare, with most detectable at low levels pre-rituximab. <h3>Conclusion</h3> Dissection of the ACPA response after rituximab using multiplex bead array revealed diverse kinetics of autoantibody production and followed several distinct patterns, largely un-related to Cit-epitope specificity. At Relapse, rising levels of ACPA with the same specificities as those at baseline suggested re-expansion of residual Cit-specific memory B cells. As B cell return is mandatory for relapse, and with no marked presence of new autoantibody specificities, potential interactions between newly generated and residual B cells could be exploited for more efficient B cell directed therapies.
DOES WARFARIN TIME-IN-THERAPEUTIC RANGE AFFECT HEALTHCARE RESOURCE UTILIZATION AND COSTS AMONG NONVALVULAR ATRIAL FIBRILLATION PATIENTS IN THE U.S.?
Authors: Steven Deitelzweig, Michael Evans, Eric Hillson, Jeffrey Trocio, Amanda Bruno, Wilson Tan, Melissa Lingohr-Smith, Jay Lin
Journal: Journal of the American College of Cardiology (2015)
Endoscopic submucosal dissection for Barrett-associated neoplasia: is it ready for the endoscopist’s toolbox?
Authors: Gary Falk
Journal: Endoscopy (2015)

Esophageal adenocarcinoma continues to be a vexing problem for the Western world, where its incidence has increased at an alarming rate and is projected to continue to increase in the coming decades as well [1]. Compounding this problem is the fact that most patients who have esophageal adenocarcinoma present with late-stage symptomatic disease and accompanying poor survival; in only a small minority has the precursor lesion of Barrett’s esophagus been diagnosed. That said, the treatment of early neoplasia in Barrett’s esophagus has advanced dramatically in recent years. Whereas surgical esophagectomy, with its well-documented limitations, was once viewed as the treatment of choice, endoscopic therapy consisting of endoscopic mucosal resection (EMR) of visible lesions followed by ablation of the residual Barrett’s segment, typically with radiofrequency ablation, has become the standard of care and is endorsed by both professional society guidelines and an international consensus panel [2] [3].
Vertebral Hemangioma Presenting as a Cold Defect on Bone Scintigraphy
Authors: DOUGLAS W. READER, RODNEY V. POZDERAC
Journal: Clinical Nuclear Medicine (2001)

From the Department of Radiology, Ohio State University, Columbus, Ohio Received for publication January 10, 2001. Accepted February 19, 2001. Request reprints: Rodney V. Pozderac, Ohio State University Medical Center, 203 B Doan Hall, 410 W. 10th Avenue, Columbus, Ohio 43210.
FRI0308 Effectiveness of combining tuberculin skin test and interferon gamma release assays as a screening strategy for detecting latent tuberculosis infection in high risk patients with systemic lupus erythematosus
Authors: S. Kadavath, E. Zapantis, W. Henriquez, B. Mehta, P. Efthimiou
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Latent TB reactivation is a cause of concern in patients with SLE, since the underlying immune dysregulation and concurrent immunosuppressive use may influence the sensitivity of both the Tuberculin Skin Test (TST) and the newer interferon-Y release assays (IGRAs), such as the QuantiFERON-TB Gold (QFT-G) test. Screening for latent tuberculosis infection (LTBI) with TST has shown low sensitivity when used in SLE, with increased false negative results. The applicability of IGRAs in SLE patients has also not been fully explored. <h3>Objectives</h3> Our study aims at comparing the performance of TST and QFT-G testing as a screening strategy for the detection of LTBI in a high-risk, inner city, SLE patient population. <h3>Methods</h3> A retrospective chart review study was conducted in SLE patients at an outpatient rheumatology clinic of an urban teaching hospital serving a large immigrant population. 174 SLE patients were identified who satisfied the 2012 SLICC SLE diagnostic criteria. The patients had been screened for LTBI at initial evaluation using TST (positive if &gt;/ 5mm), QFT-G, or both tests. QFT-G was interpreted as positive, negative, or indeterminate. Patients were diagnosed as having LTBI if TST and/or QFT-G were positive and were treated with 9 months of Isoniazid/B6, after ruling out active pulmonary tuberculosis (TB) by chest radiography. Findings from this study were compared to a previously presented study in RA where similar methodology had been used. <h3>Results</h3> Of the 174 SLE patients who were studied, 73(42.0%) had documented LTBI screening. 45(25.9%) had been screened with TST, 28(16.1%) with QFT-G, and 15(8.62%) with both tests. Out of the 45 screened with TST, 8(17.7%) were positive, while of the 28 patients screened with QFT-G, 7(25%) had positive, 4(14.28%) indeterminate, and 17(60.7%) negative results. 2/7 QFT-G positive patients had a concurrent TST test done which was negative. When comparing patients who had both tests done, 1/15 tested positive and 10/15 tested negative for both tests, while 2/15 patient tested positive for TST but negative for QFT-G. The agreement between TST and QFT-G was 73.33% with a kappa value of 0.167(CI-95% -0.401 to 0.734) versus a kappa of 0.306(CI-95% 0.136-0.477) in the RA study. LTBI was diagnosed in 8% of the SLE patients in comparison to 38% in RA. <h3>Conclusions</h3> TST and QFT-G tests have poor correlation with each other and LTBI diagnosis can be missed in SLE patients when using each test alone. A safer, comprehensive approach for LTBI detection may be the combined use of TST and IGRAs, especially since potent biologic agents are being added in the SLE therapeutic armamentarium. *equal contribution <b>Disclosure of Interest</b>: None Declared
Haemoglobin "Singapore--Bristol"
Authors: A. B. Raper, J. A. M. Ager, H. Lehmann
Journal: BMJ (1960)

BArouI 1537 MECLJOURNAL SumaqR Two cases of recurrent exsanguinating menorrhagia following childbirth and miscarriage, which finally had to be subjected to hysterectomy, are described.On pathological examination the cause for the severe uterine haemorrhages was found to be a surviving largecalibre vessel of the placental bed, possibly an arterial branch, which had failed to undergo involution in the normal way during the puerperium.To the authors' knowledge this syndrome has not been described previously.We would like to express our gratitude to Dr. R. Pollok for allowing us to include his case as Case 2 in this paper, and to Professor R. A. Willis for reading the manuscript.
PTU-024 Non-radical, Stepwise Endoscopic Ablation Of Barrett’s Epithelium In Short Segment Barrett’s Oesophagus Has Low Stricture Rate
Authors: A Koutsoumpas, LM Wang, AA Bailey, R Marshall, B Sgromo, N Maynard, B Braden
Journal: Gut (2014)

<h3>Introduction</h3> Radical endoscopic ablation of Barrett’s epithelium performing 4–6 endoscopic resections during the same endoscopic session has been shown to result in complete Barrett’s ablation but has a high stricture rate (48–88%).<sup>1–3</sup> Therefore radiofrequency ablation is preferred for the ablation of Barrett’s epithelium after endoscopic mucosal resection (EMR) of visible nodules. We investigated whether non-radical, stepwise endoscopic mucosal resection with maximal 2 endoscopic resections per endoscopic session also resulted in complete remission of Barrett’s epithelium. <h3>Methods</h3> We analysed our database of patients undergoing oesophageal EMR for early neoplasia in Barrett’s oesophagus from 2008 to 2013. Patients undergoing surgery or palliative therapy after staging EMR showing poorly differentiated cancer or advanced cancer (&gt;T1sm) were excluded. In patients suitable for further endoscopic therapy, EMR was performed using maximal two band ligation mucosectomies per endoscopic session. Patients were endoscopically followed up 3 monthly and EMR was repeated as required for Barrett’s ablation. If no dysplasia was detected after a year, the follow up interval was increased to 6 months. Only patients with circumferential Barrett’s length of more than 5 cm underwent radiofrequency ablation. <h3>Results</h3> 83 patients underwent staging EMR for early Barrett’s neoplasia. Subsequently, 25 patients underwent surgery/chemotherapy due to submucosal or more advanced tumour stages or were managed conservatively depending on patient’s fitness, comorbidities and choice. 58 patients with HGD (21), intramucosal (22) or submucosal cancer (5) in the resected nodule underwent further endoscopic therapy with a mean follow-up of 24 months (8–36 months IQR). Remission of dysplasia/neoplasia was achieved in 96.5%. Stepwise endoscopic Barrett’s resection resulted in complete Barrett’s ablation in 28 patients (48.3%) in a median of 4 sessions (IQR 2–5). 31 patients (53.4%) had a short Barrett’s segment (&lt;3 cm). In this group, repeated EMR achieved complete Barrett’s ablation in 87%. Only two patients developed a stricture (3.4%), there were no perforations. <h3>Conclusion</h3> Stepwise, non-radical endoscopic Barrett’s resection at the time of scheduled endoscopy follow up allows complete Barrett’s ablation with very low stricture rate in patients with short Barrett’s segment. <h3>References</h3> van Vilsteren FG, Pouw RE, Seewald S <i>et al</i>. <i>Gut</i> 2011;60:765–73 Alvarez Herrero L, Pouw RE, van Vilsteren FG <i>et al</i>. <i>Endoscopy</i> 2011;43:177–83 Pouw RE, Seewald S, Gondrie JJ <i>et al</i>.<i> Gut</i> 2010;59:1169–77 <h3>Disclosure of Interest</h3> None Declared.
OP0056 The PTPN22/CSK Signalling Pathway is Involved in Susceptibility to Develop Giant Cell Arteritis
Authors: A. Serrano, D. Carmona, A. Marquez, R. Solans, J. Hernández-Rodríguez, M. C. Cid, S. Castañeda, I. C. Morado, J. Narvaez, B. Sopeña, M. J. Garcia-Villanueva, L. Tío-Barrera, N. Ortego-Centeno, A. Unzurrunzaga, B. Marí-Alfonso, J. Sanchez-Martin, E. de Miguel, C. Magro, E. Raya, A. Hidalgo-Conde, L. Martinez, P. Fanlo-Mateo, M. A. Gonzalez-Gay, J. Martin
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> The <i>PTPN22</i>/<i>CSK</i> signalling represents one of the most relevant pathways in the innate immunity, and it has been implicated in the susceptibility to develop a wide number of autoimmune diseases. <h3>Objectives</h3> To analyse the possible role of different single-nucleotide polymorphisms of the <i>PTPN22</i> and <i>CSK</i> genes in the predisposition and clinical phenotypes of giant cell arteritis (GCA) in a large Caucasian population. <h3>Methods</h3> Our study population consisted of 623 patients diagnosed with biopsy-proven GCA and 1,729 healthy controls of Spanish Caucasian origin. Two functional <i>PTPN22</i> polymorphisms (rs24746601, R620W and rs33996649, R263Q) and two variants of the <i>CSK</i> gene (rs1378942 and rs34933034), previously associated with autoimmunity, were genotyped using specifically designed TaqMan® assays. <h3>Results</h3> A significant association of the <i>PTPN22</i> non-synonymous change rs2476601 with GCA susceptibility was yielded after the analysis of the allele frequencies (<i>P</i>=1.06E-04, OR= 1.62, CI 95% 1.29-2.04). No statistically significant differences between cases and controls of the rest of SNPs analysed were observed. Similarly, when patients were stratified according to specific clinical features of GCA, such as polymyalgia rheumatica (PMR), visual ischemic manifestations (VIM) or irreversible occlusive disease (IOD), only significant differences were found between the case subgroups and the control set for <i>PTPN22</i> rs2476601 (<i>P</i>=2.26E-04, OR=1.77 CI 95% 1.30-2.40; <i>P</i>=1.03E-03, OR=1.82 CI 95% 1.27-2.62; <i>P</i>=5.47E-04, OR=2.14 CI 95% 1.38-3.33, respectively). <h3>Conclusions</h3> Our results clearly suggest that the <i>PTPN22</i> polymorphism rs2476601 is associated with susceptibility to GCA. <h3>Disclosure of Interest</h3> None Declared
The human face of improbabilities
Authors: J. Baru
Journal: BMJ (2012)

I was recently an attending physician on the general medicine inpatient service for two weeks. During that fortnight I admitted 56 patients, among whom I diagnosed four cases of tuberculosis—pulmonary reactivation, disseminated, peritoneal, and spinal osteomyelitis. Three of them were immigrants (from Mexico and Ecuador), and the other was a native of Chicago. None of them had HIV, and none had other risk factors for tuberculosis.

“What are the odds?” I wondered, so I grabbed an envelope lying on my desk and started scribbling on the back. There were 12 000 cases …
There's an App for That: A Pilot and Feasibility Study of Mobile-Based Asthma Action Plans
Authors: A.J. Burbank, J. Hall-Barrow, R.R. Denman, S.D. Lewis, M. Hewes, D.E. Schellhase, M. Rettiganti, C. Luo, L.A. Bylander, R.H. Brown, T.T. Perry
Journal: Journal of Allergy and Clinical Immunology (2013)
T150 Treatment of pulmonary embolism in active malignancy - prescribing practices amongst physicians
Authors: MR Kavu, M Coates, NM Cummings
Journal: Thorax (2013)

<h3>Introduction</h3> Pulmonary embolism (PE) is a common complication of malignancy. NICE guidance for the treatment of venous thromboembolism (VTE) issued in June 2012 recommended that those with active cancer and confirmed PE be treated with low molecular weight heparin (LMWH) rather than alternative anticoagulants.<sup>1</sup> We assessed whether this guidance is being adhered to in our Trust. <h3>Methods</h3> A retrospective review of electronic discharge summaries was undertaken on those who were discharged from the two acute hospitals in our Trust (population 600,000) with a diagnosis of PE between July 2012 and June 2013, the 12 months following the publication of the NICE guidance. In addition, an anonymised, internet-based survey was undertaken of the 62 consultant physicians within the Trust, to determine which anticoagulant they would routinely prescribe for PE in active malignancy. <h3>Results</h3> Within the 12 month period of this study, 298 patients (173 women, 125 men) survived to discharge, having had PE confirmed on imaging. Forty six of these were known to have malignancy and a further 13 were found to have cancer at the time of diagnosis or very shortly afterwards. Two thirds of these (69.5%) were discharged on LMWH but the remainder (30.5%) were discharged on warfarin. Perhaps unsurprisingly, a similar percentage of the consultant physicians who completed the internet-based survey said they would prescribe LMWH, although a sizeable proportion continue to prescribe warfarin. <h3>Conclusion</h3> NICE guidance is largely being adhered to but a proportion of clinicians continue to prescribe warfarin despite there being good evidence that LMWH is associated with a reduced risk of VTE recurrence in this group.<sup>2</sup> Further investigation is needed to determine whether this pattern of prescribing is prevalent throughout the UK, and why the guidance is being ignored in our Trust. <h3>References</h3> National Institute for Health and Care Excellence (2012). Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing [CG144]. London: National Institute for Health and Care Excellence. Lee AY <i>et al</i>. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. <i>N Engl J Med</i> 2003;349:146–153.
A memorable patient: Miss Stepney till the end
Authors: S. Ahmed
Journal: BMJ (1998)

When I was a GP trainee in the east end of London I was asked to see a patient.

“My sister doesn't seem very well doctor, I can't really explain why but I think she needs a visit. She has cancer you know.” It was late, about 10 pm, and I went along not knowing quite what to expect. I felt slightly guilty about being irritated at having to visit someone who was dying so late at night, but knew that she definitely warranted a visit.

When I got there I saw a 65 year old semiconscious …
Jejunal diverticular bleeding treated using cap-assisted enteroscopy: pulling the plug
Authors: Christophe Snauwaert, Martine De Vos, Danny De Looze
Journal: Endoscopy (2014)

A 66-year-old man was admitted because of massive hematochezia and hemorrhagic shock. Esophagogastroduodenoscopy (EGD) showed no stigmata of recent hemorrhage. Colonoscopy after a rapid purge revealed a fixed diverticular sigmoid colon and old blood clots throughout the colon and ileum. The following day, the patient developed a new episode of hematochezia and shock. Computed tomographic angiography (CTA) could not detect any bleeding sites. However, a suspicious lesion was observed in the sigmoid colon ([Fig. 1]). Because of the diagnostic uncertainty and inadequate endoscopic visualization, surgical resection was recommended, and a Hartmann's procedure was performed. Analysis of the pathological specimen revealed chronic diverticulitis without any signs of malignancy.
THE EFFECT OF SMOKING ON ANASTOMOTIC STRICTURE RATES FOLLOWING OESOPHAGECTOMY
Authors: N Burnside, R Beattie, I Gambardella, K G McManus
Journal: Gut (2013)

<h3>Introduction</h3> Anastomotic stricture following oesophagectomy causes a significant morbidity and often necessitates repeated dilation or even revision surgery. Smoking has been identified as a cause of microvascular disease associated with ischaemia. <h3>Aims/Background</h3> Previously identified as an independent cause of anastomotic stricture following colorectal surgery, this study assessed the effects of smoking on stricture rates following all stomach-to-neck type oesophagectomies in oesophageal cancer patients. <h3>Method</h3> 66 sequential patients had oesophagectomy for oesophageal cancers by a single surgeon. Multiple cancer types were included in the analysis. All medical records were reviewed and a multivariate analysis was carried out to identify risk factors. Patients were divided into current smokers, smoking within six weeks of the surgery, ex-smokers, those with a significant smoking history, and non-smokers. <h3>Results</h3> The rate of anastomotic strictures in current smokers was 52% (11 of 21 patients), in ex-smokers was 9% (4 of 44 patients), and in patients who had never smoked was 0% (0 of 1 patients). The data was analysed and the difference stricture rates in current smokers and ex-smokers was found to be statistically significant (p-value 0.0002). <h3>Conclusion</h3> Active smoking within six weeks of surgery is an independent extremely significant risk factor for anastomotic strictures following stomach to neck oesophagectomy.
DECLINING IMPACT OF ISCHEMIC MITRAL REGURGITATION ON LONG TERM MORTALITY FOLLOWING PRIMARY PERCUTANEOUS CORONARY INTERVENTION
Authors: Amgad G. Mentias, Mohammad Q. Raza, Amr F. Barakat, Elizabeth Hill, Brian Griffin, Stephen Ellis, Venu Menon, E. Murat Tuzcu, Samir Kapadia
Journal: Journal of the American College of Cardiology (2016)