tbuckley/cabot-search huggingface dataset:
Acute otalgia and otorrhoea in primary care
Authors: Leigh N Sanyaolu, Sarah E J Farmer
Journal: BMJ (2016)

A 26 year old otherwise well man with no medical history of note attended his general practice with a five day history of severe right ear pain and scanty ear discharge. He had returned from holiday one week earlier, where he had been swimming. He had no headache, fever, or systemic upset.

Clinical examination identified oedema and discharge at the right external auditory meatus but an otherwise normal pinna. Palpation of the right tragus caused sudden onset intense pain, and otoscopy showed oedema of the external auditory canal, with a small amount of discharge obstructing visualisation of the tympanic membrane. He had no post-auricular swelling, erythema, tenderness suggestive of mastoiditis, or signs of meningism. His observations were within normal limits.

1.  What is the most likely diagnosis?

2.  How would you manage this patient?

3.  When would you refer him to secondary care?

4.  What advice would you give him?

### 1. What is the most likely diagnosis?

#### Short answer

Acute otitis externa.

#### Discussion

The diagnosis is acute right otitis externa, an acute inflammatory condition of the skin of the external auditory canal, generally secondary to bacterial infection.1 This condition is often seen in primary care, with a reported prevalence of 1% within a 12 month period.1 2 Common symptoms associated with this condition include otalgia, otorrhoea, pruritus, and hearing loss.1-3 In uncomplicated disease, clinical examination often shows oedema of the external auditory canal, with or without erythema and discharge, and a normal and intact tympanic membrane.1 3 A key clinical sign is tenderness over the …
A conservative's social psychology
Authors: Clark McCauley
Journal: Behavioral and Brain Sciences (2015)

Abstract I suggest that social psychologists should stick to studying positive and negative attitudes and give up stigmatizing some attitudes as “prejudice.” I recommend that we avoid assuming that race and ethnicity have no biological foundations, in order to avoid a collision course with modern biology. And I wonder how much difference the target article recommendations can make in the context of hiring a social psychologist for an academic position.
An assessment of the collective efforts of clinical trials to provide evidence-based practice guidelines in cancer care.
Authors: Shane Lloyd, Daniela L. Buscariollo, Cary P. Gross, Danil V. Makarov, James B. Yu
Journal: Journal of Clinical Oncology (2012)

6019 Background: It is unclear how many of the recommendations in the National Comprehensive Cancer Network (NCCN) guidelines are based Category 1 (C1: “high level evidence”), or whether current cancer research efforts are focusing on the knowledge gap between guidelines and supporting evidence. We defined the knowledge gap as the percent of NCCN recommendations based on lower levels of evidence, and assessed the relation between the knowledge gap and cancer research efforts in terms of clinical trial enrollment. Methods: We examined the active, phase 3 randomized controlled trials (RCTs) listed on clinicaltrials.gov for the 17 most prevalent solid tumors. We used the NCCN guidelines to tally the percentage of C1 recommendations. We used the Pearson coefficient and linear regression to examine whether enrollment in active phase 3 RCTs is associated with 1) the knowledge gap and 2) measures of burden to society including prevalence, incidence, person years life lost (PYLL) and disability adjusted life years (DALY). Results: We identified 834 treatment recommendations for the 17 included cancer types. Overall, 15% of the NCCN recommendations were rated as C1, varying from 40% for hepatobiliary to 0% for endometrial cancer. There was no association between RCT enrollment and the proportion of C1 recommendations in univariate or multivariate analyses. RCT enrollment positively correlated with measures of burden to society including prevalence (p-value &lt; 0.001), incidence (p-value 0.001), and DALY (p-value 0.038). Breast and prostate cancers have a large amount of RCT enrollment per PYLL and a relatively small knowledge gap. Melanoma, ovarian, and endometrial cancers have a moderate amount of RCT enrollment per PYLL and a relatively large knowledge gap. Lung, esophagus, bladder and CNS cancers have a low amount of RCT enrollment per PYLL and a moderate to large knowledge gap. Conclusions: RCT enrollment is not correlated to the knowledge gap. Current planned enrollment in RCTs is partially predicted by burden to society, with the strongest correlation to incidence and prevalence. Most recommendations in the NCCN guidelines are not based on C1 evidence.
Carcinogenicity of &lt;italic&gt;Fusarium moniliforme&lt;/italic&gt; Culture Material in Rats
Authors: Kasimir Jaskiewicz, Schalk J. van Rensburg, Walter F. Marasas, Wentzel C. Gelderblom
Journal: JNCI Journal of the National Cancer Institute (1987)

Two isolates of Fusarium moniliforme from corn were used in a chronic study with groups of 30 inbred male BD IX rats fed a semipurified diet that was marginally adequate nutritionally. Group 1 served as the controls and received the semipurified diet containing 5% cornmeal, group 2 received 5% of strain MRC 1069 culture material that was nontoxic to rats, and group 3 received 0.5% of strain MRC 826 culture material that was highly toxic to rats. The amount of the mutagen fusarin C detected in the culture material of strains MRC 826 and MRC 1069 was 104 and 364 mg/kg, respectively. Survival up to 2 years was good in all groups. Pathologic examination showed that many rats in group 2 had mild ductular cell hyperplasia. Almost all rats in group 3 had neoplastic nodules, γ-glutamyltransferase-positive foci, adenofibrosis, and esophageal basal cell hyperplasia. Whereas no tumors were induced in groups 1 and 2, the 21 long-term survivors in group 3 developed 8 cholangiocarcinomas, 2 hepatocellular carcinomas, 4 carcinomas of the forestomach epithelium, and 1 esophageal papilloma. Since neoplastic lesions were confined to rats in group 3 and the diet of these rats contained much less fusarin C than that of group 2, it is highly unlikely that fusarin C was responsible for the carcinogenicity of the MRC 826 culture material. It appears that the toxicity of F. moniliforme strains may be related to their carcinogenicity, but the chemical nature of the toxic and carcinogenic metabolite(s) produced by F. moniliforme MRC 826 remains unknown.
Topoisomerase I expression in locally advanced rectal cancer as predictive marker for response to preoperative chemoradiation
Authors: K. E. Horisberger, R. D. Hofheinz, B. Muessle, P. Findeisen, A. Hochhaus, S. Post, F. Willeke
Journal: Journal of Clinical Oncology (2007)

14566 Background: In locally advanced rectal cancer combined modality treatment has become the standard therapeutical intervention. Preoperative downstaging is known as a predictor concerning lower local recurrence rate and probably better overall-survival. However, efficacy of neoadjuvant chemoradiation is compromised in some patients by so far unknown factors. The aim of the present study was to investigate topoisomerase I expression as a potential parameter for predicting response to irinotecan-based chemoradiation. Methods: 15 patients with rectal cancer clinical stages T3/4 Nx or N+ were recruited to receive weekly neoadjuvant irinotecan (1 hour before radiation) and capecitabine as well as cetuximab with a concurrent RT dose of 50.4 Gy (45+5.4 Gy). Surgery was scheduled 4–6 weeks after the completion of chemoradiation. Samples of normal and tumor tissues of all patients were collected before neoadjuvant treatment. Initially, RNA-oligonucleotid-array of three patients (one good responder and two non-responders) was accomplished to show qualitatively different gene expression. To quantify the differences, real-time PCR of topoisomerase I was performed. Results: The differences of gene expression in the RNA-oligonucletoidarray were correlated to the clinical response to neoadjuvant chemoradiation as topoisomerase I showed a significant higher expression in the tumor tissue of the good responder before treatment (p&lt;0.0001). PCR-analysis showed a relatively higher median expression of topoisomerase I in normal tissue (1.7 vs. 0.9; p=0.85) and in tumor tissue (1.5 vs. 1.3; p=0.36) of the subsequent good responding patients (n=10). Conclusion: Patients respond differentially to chemoradiation in terms of clinical response and gene expression shifts. The oligonucleotidarray results leads us to assume that response may be predictable. The preliminary results of PCR demonstrate that TopoI expression describes a valuable parameter for prediction of efficiency of irinotecan in advanced rectal cancer. The small number of patients may have caused the missing of the statistical significance. We are intending an extension of the PCR analysis to more powerful series based on the achievements of the current investigation results. No significant financial relationships to disclose.
May the istotype influence the response to pemetrexed in patients with non small cell lung cancer? Preliminary data of our clinical experience
Authors: T. Franchina, A. Scimone, B. Adamo, N. Denaro, P. Gambadauro, M. Iorfida, N. Caristi, M. Zanghì, V. Adamo
Journal: Journal of Clinical Oncology (2008)

19115 Background: Patients with relapsed or refractory NSCLC can benefit from pemetrexed, a new-generation antifolate, approved for the treatment of mesothelioma and non-small cell lung cancer (NSCLC).The aim of this retrospective analysis was to evaluate activity and tolerability of pemetrexed in pre-treated patients with relapsed or refractory NSCLC, focusing on potential correlations between antitumor activity of pemetrexed and the different histological subtypes. Methods: Between November 2005 and December 2006, 19 patients received pemetrexed at a dose of 500 mg/m2 on day 1, every 3 weeks, with folic acid and vitamin B12 supplementation. The patients (14 M and 5 F) had a median age of 64.4 years (range 43 to 79), ECOG PS/pts: 0/7 1/8 2/4. Four patients had stage III B, 15 stage IV. Median number of metastatic sites was 2 (range 1–3). Distribution of tumors by histology was: squamous carcinoma 5/19, adenosquamous carcinoma 1/19, adenocarcinoma 7/19, bronchiolar-alveolar adenocarcinoma (BAC) 2/19, large cell carcinoma 1/19, undifferentiated 3/19. Pemetrexed was employed as second-line treatment in 10 patients and as further lines in 9 patients. Results: Rapid disease precluded treatment in one patient, 18 patients were evaluable. Objective response rate (RR) was 45%, including 1 CR and 7 PR, all obtained in patients with adenocarcinoma (RR, adenocarcinoma 45% vs. non-adenocarcinoma 0%, p=0.004, Fisher exact test). The median time to disease progression was 4.3 months (range 2–10) and overall survival was 9.2 months (range 2–17). Pemetrexed was well tolerated and the main side effects were grade 1–2 anemia, asthenia and vomiting, observed in 8 patients. Conclusions: The results of our small experience may suggest an increased sensibility of adenocarcinomas to pemetrexed, including BAC. A plausible hypothesis that may explain these findings may be related to a peculiar genetic expression or to the presence of polymorphisms in target genes. Further studies will be conducted to identify genetic markers of sensitivity to this drug and the possible correlations with the different adenocarcinoma subtypes. No significant financial relationships to disclose.
<i>Notes from the Field</i>: Verona Integron-Encoded Metallo-Beta-Lactamase–Producing Carbapenem-Resistant Enterobacteriaceae in a Neonatal and Adult Intensive Care Unit — Kentucky, 2015
Authors: Anna Q. Yaffee, Lynn Roser, Kimberly Daniels, Kraig Humbaugh, Robert Brawley, Douglas Thoroughman, Andrea Flinchum
Journal: MMWR Morbidity and Mortality Weekly Report (2016)

During August 4-September 1, 2015, eight cases of Verona integron-encoded metallo-beta-lactamase (VIM)-producing Carbapenem-resistant Enterobacteriaceae (CRE) colonization were identified in six patients, using weekly active surveillance perirectal cultures in a Kentucky tertiary care hospital. No cases of clinical infection or complications attributable to colonization were reported. Four of the eight isolates were identified as Enterobacter cloacae; other organisms included Raoultella species (one), Escherichia coli (one), and Klebsiella pneumoniae (two). Six isolates were reported in a neonatal intensive care unit (ICU), and two isolates in an adult trauma and surgical ICU. Patient ages at isolate culture date ranged from 21 days to 68 years. Fifty percent of the patients were male. Previously, only one VIM-producing CRE-colonized patient (an adult, in 2013) had been reported by the same hospital. The six cases are the largest occurrence of VIM-producing CRE colonization reported in the United States and the only recognized cluster of VIM-producing CRE colonization in the United States reported to include a neonatal population. Despite environmental sampling over the same period, surveying patients for exposure to health care outside the United States, surveying health care providers for risk factors, and surveillance culturing of health care provider nares and axillae, a source of VIM-producing CRE has not been identified for this cluster. Prevention measures throughout the ICUs have been enhanced in response to this cluster, as detailed in CDC's 2015 CRE toolkit update.
Segmental volume reduction using thermal vapour ablation in patients with severe emphysema: 6-month results of the multicentre, parallel-group, open-label, randomised controlled STEP-UP trial
Authors: Felix J F Herth, Arschang Valipour, Pallav L Shah, Ralf Eberhardt, Christian Grah, Jim Egan, Joachim H Ficker, Manfred Wagner, Christian Witt, Uta Liebers, Peter Hopkins, Wolfgang Gesierich, Martin Phillips, Franz Stanzel, William H McNulty, Christoph Petermann, Greg Snell, Daniela Gompelmann
Journal: The Lancet Respiratory Medicine (2016)
A Phase 2, Non-Comparative, Open-Label, Multicenter, International Study of Medi4736 in Patients with Locally Advanced or Metastatic Pd-L1-Positive Nsclc (Stage Iiib-Iv) Who Have Received ≥ 2 Prior Systemic Treatment Regimens, Including a Platinum-Based Chemotherapy (Atlantic)
Authors: N. Rizvi, J. Gray, M. Ballas, D. Jayawardene, P. Stockman, J.D. Powderly
Journal: Annals of Oncology (2014)
<i>Notes from the Field</i>: Nosocomial Outbreak of Middle East Respiratory Syndrome in a Large Tertiary Care Hospital — Riyadh, Saudi Arabia, 2015
Authors: Hanan H. Balkhy, Thamer H. Alenazi, Majid M. Alshamrani, Henry Baffoe-Bonnie, Hail M. Al-Abdely, Aiman El-Saed, Hussain A. Al Arbash, Zayid K. Al Mayahi, Abdullah M. Assiri, Abdulaziz bin Saeed
Journal: MMWR Morbidity and Mortality Weekly Report (2016)

Since the first diagnosis of Middle East respiratory syndrome (MERS) caused by the MERS coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia in 2012, sporadic cases and clusters have occurred throughout the country (1). During June-August, 2015, a large MERS outbreak occurred at King Abulaziz Medical City, a 1,200-bed tertiary-care hospital that includes a 150-bed emergency department that registers 250,000 visits per year.
Clinical profile of patients with metastatic colorectal adenocarcinoma treated with bevacizumab in first-line: AVATRAN study
Authors: C. Castañón, V. Alonso, J. Vieitez, G. Esquerdo, R. Pérez-Carrión, C. Belda-Iniesta, M. Rubio, J. Roca, G. García, A. Salut
Journal: Journal of Clinical Oncology (2008)

15119 Background: Since the approval of Bevacizumab (Bev) for its use in the first line setting of metastatic colorectal cancer (mCRC) treatment, it has become one of the standard drugs used in first line combinations. To date there are no markers to identify patients (pts) that can most benefit from this drug, moreover, data from clinical trials indicate that almost every patient can benefit from this drug so, the decision whether to use it or not in a particular patient, is taken on an individual basis, patient by patient. We have analysed the clinical profile of pts treated with Bev all over Spain to identify the more common clinical profiles of pts selected by the physicians as the more suitable to receive Bev. Methods: This is an observational study carried out in 88 spanish centers. 280 patients have been included. Eligibility criteria: pts with mCRC that were being treated with a combination including Bev in first line in the common clinical practice. Primary end point was to describe the clinical profile of patients selected to receive Bev. Results: Data from 250 out of 280 pts included are available. Median number of cycles received before data collection was 4.6. Baseline characteristics of the pts were: median age 60.9 yrs (range 29–80); male 60%; PS 0/1/2 56/39/5%; 72% of the pts had liver metastasis. 22.8% of pts were diagnosed of HTA and 3.6% had suffered a tromboembolic event before starting Bev treatment. 3.2% of the pts had a history of other GI diseases (including 2 pts with GI perforations before Bev treatment). 67.6% of the pts received Bev associated to biweekly chemotherapy regimens. Conclusions: This analyses shows that pts treated with Bev in the common clinical practice do not differ from the general population of pts diagnosed with mCRC. This confirms that physicians feel confident of the benefits provided by Bev regardless of pt characteristics. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Roche Roche
A phase II study of preoperative figitumumab (F) in patients (pts) with localized prostate cancer (PCa).
Authors: K. N. Chi, M. E. Gleave, L. Fazli, S. L. Goldenberg, A. So, C. K. Kollmannsberger, N. Murray, A. Tinker, A. Gualberto, M. N. Pollak
Journal: Journal of Clinical Oncology (2010)

4662 Background: F is a fully human IgG2 monoclonal antibody against insulin- like growth factor-1 receptor (IGF1R). Activation of the IGF1R pathway is implicated in PCa progression. This study evaluated biologic and clinical effects of F in pts with treatment-naive localized PCa. Methods: Pts received F 20 mg/kg IV q3 weeks for 3 cycles. Radical prostatectomy was performed within 1 week of last dose. Single center, 1-stage design with primary endpoint of IGF1R expression inhibition by immunohistochemistry (IHC) (H0<5%, H1>30%, α=0.05, β=0.1). Additional studies included: serial PSA, serum IGF1 by ELISA, granulocyte IGF1R expression by flow cytometry, IHC of IGF1R downstream effectors and androgen receptor, and F tissue level. Results: Accrual completed 10/2009 with 16 pts. Baseline characteristics: median age 63 years (range 50-71), cT1:cT2 = 4:14 pts, Gleason score 6:7:9 = 1:14:1 pts, median PSA 7.2 (range 2.5-35). Post-op stage was pT2:pT3:pN1 in 5:9:1 pts and Gleason score 7:8:9 in 9:3:2 pts. 14 pts received 3 cycles, 2 pts received 1 cycle (1 pt choice, 1 grade 3 hyperglycemia in a pt with diabetes) with no F-related post-op adverse events. For all 16 pts a pre-op PSA decline from baseline by ≥25%, ≥30% and ≥50% occurred in 15 (94%), 14 (88%) and 5 (31%) pts respectively. Serum IGF1 increased by a mean 4.8 fold (P<0.001). Granulocyte IGF1R expression decreased in 13 of 14 pts with a mean change of -34% (range -54% to +17%, P<0.001). Preliminary IGF1R IHC results for 6 matched biopsy/prostatectomy specimens currently analyzed show that all had decreased IGF1R expression by visual score (based on % of cells with staining intensity 0-3): in pre-F and post-F PCa the mean IGF1R IHC score was 1.9 and 0.8 respectively (P=0.006), and the mean % of cells with IHC intensity score of 0-1 increased from 25% Pre-F to 92% post-F (P=0.003). Analyses will be completed on all tissues by 04/2010. Conclusions: F prior to prostatectomy was well tolerated. Single agent biologic and clinical activity was observed with compensatory serum IGF1 increase, decreased IGF1R expression on granulocytes and PCa tissues, and a high rate of PSA declines. These results support the clinical relevance of IGF1R signaling in PCa and justify further clinical trials. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Pfizer Pfizer Pfizer Pfizer
Further Observations on Paget's Disease of the Nipple&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: Cyril Toker, M.D.
Journal: JNCI Journal of the National Cancer Institute (1967)

It was previously suggested that the clear and dark cells of Paget's disease might represent neoplastic counterparts of the basal clear cells and superficial eosinophilic cells, normally found within the mammary epithelium. Both the Paget cells and normal ductular epithelium have now been investigated by electron microscopy. The Paget clear and dark cells differed considerably in cytoplasmic ultrastructure. Comparison with the components of the normal ductule revealed that, whereas the Paget dark cells closely resembled the superficial dark cells of the ductular lining, the Paget clear cells differed morphologically from the basal clear cells of the mammary epithelium. They resembled, however, a clear cell component of the superficial layer of the ductular lining, the existence of which had not been previously appreciated on light microscopy. The significance and interrelationships of the clear and dark cell variants, both normal and neoplastic, are, however, not understood.
Inhibitory Synapses Are Repeatedly Assembled and Removed at Persistent Sites In Vivo
Authors: Katherine L. Villa, Kalen P. Berry, Jaichandar Subramanian, Jae Won Cha, Won Chan Oh, Hyung-Bae Kwon, Yoshiyuki Kubota, Peter T.C. So, Elly Nedivi
Journal: Neuron (2016)