tbuckley/cabot-search huggingface dataset:
Differences in mortality after fracture of hip
Authors: J Calder, E C Ashby
Journal: BMJ (1995)

Doubt remains over anticoagulant prophylaxis for deep venous thrombosis

EDITOR,--Anticoagulant prophylaxis may reduce the incidence of venous thromboembolism in hospital, but C J Todd and colleagues' study does not dispel doubts about its overall effect on mortality.1 There was no significant difference between the survival rate at 90 days (82.2% at the four hospitals that routinely gave such prophylaxis (to 79.5% of patients)) and 82.0% at the other four hospitals (prophylaxis given to only 16.1%) despite the fact that 62.3% of patients in the former hospitals had surgery within 24 hours (favourable …
In Vitro and In Vivo Studies of a 2,4,6-Trinitrophenyl {TNP)-Binding Immunoglobulin A (IgA) Lymphoma Isolated From MOPC-315, a TNP-Binding IgA Plasmacytoma of BALB/c Mice&lt;xref ref-type="fn" rid="FN1"&gt;2&lt;/xref&gt;&lt;xref ref-type="fn" rid="FN2"&gt;3&lt;/xref&gt;
Authors: H M Gebel, J R Autry, J W Rohrer, R G Lynch
Journal: JNCI Journal of the National Cancer Institute (1979)

The cells of 315/P, a long-passaged in vitro line established from the BALB/c plasmacytoma MOPC-315, appeared to be arrested at a preplasmacytic level of development in vitro. Studies were conducted to determine if differentiation of 315/P cells might be influenced by in vivo conditions. Differentiation of immunoglobulin expression was monitored by detection of the anti-2,4,6-trinitrophenyl antibody activity of M315, the immunoglobulin produced by MOPC-315. Tumors that developed after sc injection of 1-2×107 315/P cells were compared to 315/+ tumors (MOPC-315 passaged continuously in vivo) for M315 expression and a number of growth properties. In contrast to wild-type (315/+) tumors, none of the 315/P tumors contained cells that formed indirect hemolytic plaques with 2,4,6-trinitrophenylated sheep erythrocytes; however, 315/P cells continued to express cytoplasmic and cell-surface membrane M315. Immunoglobulin expression by 315/P cells in vitro and through eight transplantation generations in vivo was therefore more typical of an IgA lymphoma than a plasmacytoma. Furthermore, when 315/+ and 315/P tumors were compared, striking differences were also observed in: a) cytologic and ultrastructural features, b) growth potential in different anatomic sites, c) tumorigenicity, and d) the occurrence of M315-bearing lymphocytes in the circulation. These studies demonstrated that a clonal murine B-cell neoplasm may express strikingly dissimilar morphologic, immunologic, and clinical phenotypes, and it was concluded that 315/P cells may provide unique advantages in: 1) studies on the mechanisms regulating the differentiation of normal and neoplastic B-cells and 2) structural studies of a cell-surface membrane immunoglobulin whose secreted form has already been extensively characterized.
DNA methylation profile to predict clinical outcome of anti-EGFR treatment in metastatic colorectal cancer.
Authors: Kota Ouchi, SHIN Takahashi, Yasuhide Yamada, Shingo Tsuji, Kenji Tatsuno, Hidekazu Takahashi, Naoki Takahashi, Masanobu Takahashi, Hideki Shimodaira, Hiroyuki Aburatani, Chikashi Ishioka
Journal: Journal of Clinical Oncology (2015)

e14574 Background: For metastatic colorectal cancer (mCRC) treatment, anti-epidermal growth factor receptor (EGFR) treatment is one of the major options. However, there are few reliable biomarkers to predict the clinical response to anti-EGFR treatment. We investigated the genome-wide DNA methylation status in metastatic colorectal cancer to identify associations between the methylation status and clinical response to anti-EGFR antibody. Methods: We retrospectively corrected the medical records of 45 patients who received anti-EGFR treatment for mCRC as 1st cohort, and of 52 patients as 2nd cohort. All cases were verified that they had no mutations at KRAS codon 12 or 13. We investigated the associations between the genome-wide DNA methylation status in the primary tumors and clinical response to anti-EGFR treatment, and evaluated the predictive power and value of the methylation status in mCRC statistically. Results: Unsupervised clustering analysis classified cases contained in each cohorts were classified into highly-methylated colorectal cancer (HMCC) and low-methylated colorectal cancer (LMCC) subgroups. In the 1st cohort, all examined clinical outcomes were significantly better in the LMCC subgroup than in the HMCC subgroup (response rate: 35.7% vs. 6.3%; P = 0.03, disease control rate: 75% vs. 31.3%; P = 0.005, hazard ratios for progression-free survival: 0.27; 95% CI, 0.13–0.57; P < 0.001 and overall survival: 0.19; 95% CI, 0.06–0.54; P < 0.001). These results were reproduced in the 2nd cohort. The genome-wide DNA methylation status was a strong predictive factor of progression-free survival and overall survival, and it was independent of RAS mutation status in both univariate and multivariate Cox regression analyses. Conclusions: The genome-wide DNA methylation status is a powerful epigenetic predictor of the anti-EGFR treatment in patients with KRAS wild-type metastatic colorectal cancer (UMIN000005490).
Abstract 16520: Association Between Blush Grade and Wound Healing or Amputation in Critical Limb Ischemia
Authors: Won Yu Kang, Umberto Campia, Nelson L Bernardo, Romain Didier, Smita Negi, Sarkis Kiramijyan, Edward Koifman, Nevin Baker, Michael Lipinski, Ricardo Escarcega, Rebecca Torguson, Ron Waksman
Journal: Circulation (2015)

Background: Percutaneous endovascular intervention (PEI) of below-the-knee arteries is the first-line approach for treatment in critical limb ischemia (CLI). However, intraprocedural predictors of outcomes in CLI have not been established. We aimed to investigate the role of blush grade in predicting wound healing and amputation in patients undergoing PEI for CLI. Methods: This study is a retrospective analysis of data of consecutive patients who underwent PEI for CLI and had follow-up for outcomes between January 2011 and December 2014 at the MedStar Washington Hospital Center in Washington, DC. Blush grade was defined as the percent value of blush on the wound area compared to the blush on an area supplied by normal blood flow. The patients were classified into two groups (Group I: blush grade ≥50% [n=26] vs. Group II: &lt;50% [n=28]) and examined wound healing at 6 month and amputation. Results: A total of 54 patients were included in the present study. Blush grade was ≥50% in 26 patients and &lt;50% in 28. Participants had a high prevalence of male sex (72%), diabetes (74%), hypertension (98%), hyperlipidemia (94%), hemodialysis (24%), and previous diagnosis of peripheral arterial disease (74%). No significant differences in the prevalence of these variables were shown between groups. Angiosome-based treatment was performed for the majority of patients, without significant difference between groups (88.5% in Group I vs. 85.7% in Group II, p=1.0). Direct flow to wound could be obtained more frequently in Group I (76.9% vs. 21.4%, p&lt;0.001). Wound healing within 6 month was observed in 65.4% in Group I compared with 10.7% in Group II (p&lt;0.001). Rates of amputation were 15.4% and 57.1%, respectively (p=0.001), with longer time-to-amputation in Group I compared with Group II (403.52±337.55 vs. 233.16±267.89, respectively; p=0.044). On multivariable analysis, a blush grade ≥50% was an independent predictor of wound healing (RR 0.051, 95% CI: 0.008-0.319, p=0.001) and amputation free survival (RR 4.12, 95% CI: 1.206-14.755, p=0.024). Conclusion: Our single-center data indicate that blush grade is an independent intraprocedural predictor of wound healing and amputation in patients with CLI.
Margaret McCartney: Troubling leadership
Authors: Margaret McCartney
Journal: BMJ (2016)

Keith McNeil resigned as chief executive of Addenbrooke’s Hospital in 2015 shortly before the Care Quality Commission rated it inadequate.1 He was popular and highly regarded. But, like many other chief executives before him, he resigned after a short tenure, having found nurse recruitment expensive and difficult and in “challenging” financial circumstances.2 3 His colleagues wanted him to stay. If the NHS is so toxic that the leaders who are wanted can’t stay, we have a problem.

Calls to be a “leader” are endemic in the service. …
Kuru, AIDS and Unfamiliar Social Behaviour—Biocultural Considerations in the Current Epidemic: Discussion Paper
Authors: E D Cominos, S K Gottschang, S C M Scrimshaw
Journal: Journal of the Royal Society of Medicine (1989)

This paper focuses on biocultural considerations regarding kuru and AIDS epidemic.  The report explores cultural relativism in the study of the disease legal remedies and medical misdirections and learnings from the experience of the Fore community who was greatly devastated by kuru. Analyzing the social antecedents of a disease such as kuru and AIDS requires both perversion and observation of the longstanding practices of the community.  To reduce the transmission of infectious diseases such as AIDS and kuru both the biomedical and cultural aspects as well as an anthropological perspective regarding infection control should be considered.  It was argued that efforts to terminate kuru epidemic did not involve rigorous state control of deviant behavior in a particular Melanian society.  The experience of the Fore community and the medical misdirections regarding kuru reflects the need for a more anthropologically sound approach to disease prevention and control.  Many people are dying from preventable tragedies including AIDS and aberrant social behaviors towards AIDS patients are common.  The ultimate virological nightmare has clearly been paralleled by a sociological nightmare which can only be curtailed through a commitment to an interdisciplinary approach and recognition by medical scientists of anthropological imperatives.  A clinician or epidemiologist should adopt the example of a medical anthropologist and retain a sense of cultural relativism whenever possible.
Physician spending and risk of malpractice claims: what about the effects of socioeconomic status?
Authors: John S Barbieri, Carrie L Kovarik
Journal: BMJ (2015)

Jena and colleagues’ evaluation of the association between physician spending and malpractice claims found that higher spending is associated with fewer claims.1 However, although they examined several potential confounders, including age, sex, race, diagnosis related group, and comorbid conditions, they did not include socioeconomic status (SES). Previous work has shown that, although there is a perception among physicians that patients of lower SES are more likely …
Density, Distribution, and Composition of Immune Infiltrates Correlate with Survival in Merkel Cell Carcinoma
Authors: Laurence Feldmeyer, Courtney W. Hudgens, Genevieve Ray-Lyons, Priyadharsini Nagarajan, Phyu P. Aung, Jonathan L. Curry, Carlos A. Torres-Cabala, Barbara Mino, Jaime Rodriguez-Canales, Alexandre Reuben, Pei-Ling Chen, Jennifer S. Ko, Steven D. Billings, Roland L. Bassett, Ignacio I. Wistuba, Zachary A. Cooper, Victor G. Prieto, Jennifer A. Wargo, Michael T. Tetzlaff
Journal: Clinical Cancer Research (2016)

Abstract Purpose: Merkel cell carcinoma (MCC) is an aggressive cancer with frequent metastasis and death with few effective therapies. Because programmed death ligand-1 (PD-L1) is frequently expressed in MCC, immune checkpoint blockade has been leveraged as treatment for metastatic disease. There is therefore a critical need to understand the relationships between MCPyV status, immune profiles, and patient outcomes. Experimental Design: IHC for CD3, CD8, PD-1, PD-L1, and MCPyV T-antigen (to determine MCPyV status) was performed on 62 primary MCCs with annotated clinical outcomes. Automated image analysis quantified immune cell density (positive cells/mm2) at discrete geographic locations (tumor periphery, center, and hotspot). T-cell receptor sequencing (TCRseq) was performed in a subset of MCCs. Results: No histopathologic variable associated with overall survival (OS) or disease-specific survival (DSS), whereas higher CD3+ (P = 0.004) and CD8+ (P = 0.037) T-cell density at the tumor periphery associated with improved OS. Higher CD8+ T-cell density at the tumor periphery associated with improved DSS (P = 0.049). Stratifying MCCs according to MCPyV status, higher CD3+ (P = 0.026) and CD8+ (P = 0.015) T-cell density at the tumor periphery associated with improved OS for MCPyV+ but not MCPyV− MCC. TCRseq revealed clonal overlap among MCPyV+ samples, suggesting an antigen-specific response against a unifying antigen. Conclusions: These findings establish the tumor-associated immune infiltrate at the tumor periphery as a robust prognostic indicator in MCC and provide a mechanistic rationale to further examine whether the immune infiltrate at the tumor periphery is relevant as a biomarker for response in ongoing and future checkpoint inhibitor trials in MCC. Clin Cancer Res; 22(22); 5553–63. ©2016 AACR.
The NHS's new information strategy
Authors: J. Wyatt, J. Keen
Journal: BMJ (1998)

News p  901

How often are you forced to phone a colleague to get an endoscopy report or ask your patient which drugs she takes, even though all are documented somewhere? With our crumbling cardboard records and circuitous communications, assembling patient data takes time and effort and often involves interrupting colleagues. Small wonder we spend a quarter of our time managing information,1 eroding time needed for the carefully balanced judgments required in most consultations. Now, however, these impediments have been confronted by the government's Information for Health strategy,2 and proposals, together with a £1bn subsidy, have been made for eliminating them.

This strategy, published last week, maps the routes towards helping patients receive the best care, explores some in detail, signposts others, and defines implementation milestones over the next seven years (see p 901). For doctors and patients implementation of this strategy should end the communication compromises we assume are inevitable: repeated duplication …
HCP-09BENEFITS OF A NEURO-ONCOLOGY NURSE PROGRAM
Authors: Emma Daly, Gabrielle O'Connor, Lauren Todorovic, Ron Freilich
Journal: Neuro-Oncology (2015)

BACKGROUND: The position of a neuro-oncology support coordinator within brain tumour units is becoming more widespread. There is no standard model of care for this position. Although it is clear that these positions are beneficial, there is little hard data to demonstrate this benefit to hospital administrations, who ultimately decide on funding for this role. METHODS: A Neuro-Oncology Nurse role was established at Monash Medical Centre in 1997, with a Palliative Care nurse taking that position. In many ways palliative care for these patients begins at diagnosis, and the palliative care background has been of great benefit with the changing needs of our patients towards the later stages of their illness. This model was reproduced at Cabrini Hospital, an acute private hospital in Melbourne, in early 2012. The Cabrini health service includes a palliative care hospital and a rehabilitation hospital, which has helped us coordinate services for our patients. RESULTS: We have compared the admission profile of patients in the 2 years before and the 2 years after the establishment of the Neuro-Oncology Nurse position at Cabrini. Although there were a similar number of patients treated in the 2 study periods, there was a 24% reduction in the total bed days in the acute private hospital (393 less bed days over 2 years), more admissions to palliative care and rehabilitation, increased outpatient rehabilitation visits and increased palliative care home visits. There was a 46% reduction of the average length of stay and a 17% reduction in the 30-day readmission rate in the acute hospital. CONCLUSIONS: This data demonstrates the benefits of the Neuro-Oncology Nurse position to the health service. It also indicates some of the benefits to our patients, with a reduction in time spent in the acute hospital setting and improved access to continuing care services.
Reflux and Barrett’s disease
Authors: R. Bisschops, I. Demedts
Journal: Endoscopy (2008)

Several pilot studies have been published over the past 2 years with regard to the use of newly available imaging techniques, in particular narrow band imaging (NBI). In this prospective study in 109 patients with Barrett’s esophagus, Singh et al. describe a simplified NBI classification to predict final histology. In contrast to the previously reported Kara classification [2], the vascular and mucosal assessment are combined into four patterns: Type A, round pits and regular microvasculature; Type B, villous/ridge pits with regular microvasculature; Type C, absent pits and regular microvasculature; and Type D, distorted pit with irregular microvasculature. The diagnostic accuracy of the NBI-zoom images in predicting the final histology was high (87.9 %). Type A, Type B or C, and type D were predictive of columnar epithelium without intestinal metaplasia, intestinal metaplasia, and high-grade intraepithelial neoplasia (HGIN), respectively. Moreover, the inter- and intraobserver agreement was very good.
The Innate Lymphoid Cell Precursor
Authors: Isabel E. Ishizuka, Michael G. Constantinides, Herman Gudjonson, Albert Bendelac
Journal: Annual Review of Immunology (2016)

The discovery of tissue-resident innate lymphoid cell populations effecting different forms of type 1, 2, and 3 immunity; tissue repair; and immune regulation has transformed our understanding of mucosal immunity and allergy. The emerging complexity of these populations along with compounding issues of redundancy and plasticity raise intriguing questions about their precise lineage relationship. Here we review advances in mapping the emergence of these lineages from early lymphoid precursors. We discuss the identification of a common innate lymphoid cell precursor characterized by transient expression of the transcription factor PLZF, and the lineage relationships of innate lymphoid cells with conventional natural killer cells and lymphoid tissue inducer cells. We also review the rapidly growing understanding of the network of transcription factors that direct the development of these lineages.
Mechanical Regulation of Cardiac Aging in Model Systems
Authors: Ayla O. Sessions, Adam J. Engler
Journal: Circulation Research (2016)

Unlike diet and exercise, which individuals can modulate according to their lifestyle, aging is unavoidable. With normal or healthy aging, the heart undergoes extensive vascular, cellular, and interstitial molecular changes that result in stiffer less compliant hearts that experience a general decline in organ function. Although these molecular changes deemed cardiac remodeling were once thought to be concomitant with advanced cardiovascular disease, they can be found in patients without manifestation of clinical disease. It is now mostly acknowledged that these age-related mechanical changes confer vulnerability of the heart to cardiovascular stresses associated with disease, such as hypertension and atherosclerosis. However, recent studies have aimed at differentiating the initial compensatory changes that occur within the heart with age to maintain contractile function from the maladaptive responses associated with disease. This work has identified new targets to improve cardiac function during aging. Spanning invertebrate to vertebrate models, we use this review to delineate some hallmarks of physiological versus pathological remodeling that occur in the cardiomyocyte and its microenvironment, focusing especially on the mechanical changes that occur within the sarcomere, intercalated disc, costamere, and extracellular matrix.
Treatment of a patient with genotype 7 hepatitis C virus infection with sofosbuvir and velpatasvir
Authors: Jonas Schreiber, John McNally, Krishna Chodavarapu, Evguenia Svarovskaia, Christophe Moreno
Journal: Hepatology (2016)

During a phase 3 study evaluating the combination of sofosbuvir‐velpatasvir for 12 weeks in patients with genotype 1, 2, 4, 5, and 6 hepatitis C virus (HCV) infection, we enrolled a patient who was subsequently found to be infected with genotype 7 HCV. This patient tolerated the study regimen well and achieved sustained virological response 12 weeks after treatment (SVR12). (H epatology 2016;64:983‐985)
PTU-287 Abdominal paracentesis – improving practice with a multi-disciplinary proforma
Authors: A Boyd, J Dallimore, E Turner-Moss, G Carnaby, J Kennedy, E Brown, U Chelvaratnam
Journal: Gut (2015)

<h3>Introduction</h3> Abdominal paracentesis is a common procedure performed both on Gastroenterology wards and as a day procedure. Although Foundation Doctors and Core Medical Trainees do not have to be independent at this procedure for satisfactory progression of training,<sup>1,2</sup>it is an important part of any Gastroenterology rotation. Furthermore it is an essential sign-off for CCT in General Internal Medicine. Within the Core Medical Training curriculum it is identified as a “potentially life-threatening” procedure.<sup>2</sup>We sought to assess trainees’ attitudes to the procedure and implement a proforma to help improve both confidence in performing the procedure and documentation. <h3>Method</h3> Foundation doctors and Core Medical Trainees were surveyed about their attitudes towards abdominal paracentesis both before and after the implementation of a multi-disciplinary proforma. The survey consisted of four questions with free text responses: trainees’ confidence in performing the procedure, common worries about the procedure, what has previously gone wrong and whether a proforma would be useful. Documentation of important steps in the procedure and results were audited both before and after implementation of the proforma. <h3>Results</h3> Only 25 percent of respondents were confident in performing abdominal paracentesis independently and 67 percent of respondents felt a proforma would be useful. Common areas of uncertainty were surrounding bleeding risk and regimes of albumin replacement. Documentation of many key steps in the process of abdominal paracentesis was poor; following the introduction of the proforma documentation rates hit 100% for steps including informed written consent, number of passes to insert the drain and assessment of bleeding risk. The proforma was well received with 100% of respondents, both medical and nursing colleagues, agreeing it was a useful addition. <h3>Conclusion</h3> Introduction of a simple, multi-disciplinary proforma has improved documentation in abdominal paracentesis. In addition, it clearly sets out best practice and addresses many of the concerns identified by junior doctors. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> UK Foundation Programme Training Curriculum file:///home/chronos/u9d51564d35947b93f52a5afa31247c656f09b206/Downloads/Fp_Curriculum_2012_updated_for_2014_WEB_FINAL.pdf Specialty Training Curriculum for Core Medical Training, JRCPTB http://www.mrcpuk.org/sites/default/files/documents/2009-CMT-Curriculum