tbuckley/cabot-search huggingface dataset:
Surgeons' Decisions and the Financial and Human Costs of Medical Care
Authors: Mark D Neuman
Journal: New England Journal of Medicine (2010)

A popular animated Web video is circulating among members of my anesthesia department. It depicts a fictional exchange between an orthopedic surgeon and an anesthesiologist. The surgeon wants to book a case for the operating room: “There is a fracture; I need to fix it.”1 The anesthesiologist pushes him for more details, but the surgeon simply repeats his line: “There is a fracture; I need to fix it.” Finally, the surgeon is asked whom the fracture belongs to, and he responds: “The fracture belongs to . . . a femur.” The dialogue eventually reveals that the patient is a 97-year-old woman who . . .
Endoscopic ultrasound (EUS)-guided transluminal endoscopic removal of gallstones
Authors: K. Kamata, M. Kitano, M. Kudo, H. Imai, H. Sakamoto, T. Komaki
Journal: Endoscopy (2010)

Although laparoscopic cholecystectomy is the standard treatment for cholecystitis, including cholecystolithiasis [1] [2], endoscopic ultrasound (EUS)-guided cholecystenterostomy is an alternative treatment for patients at high surgical risk [3] [4] [5]. Here we report on using the fistula created by the EUS-guided cholecystenterostomy to remove gallstones for successful radical treatment of cholecystolithiasis without cholecystectomy.
PWE-002 The Positive Predictive Value Of A Colonoscopist Labelling A Lesion As Cancer – What Should We Tell The Patient?
Authors: AM Verma, RE Smith, A Dixon, AP Chilton
Journal: Gut (2014)

<h3>Introduction</h3> Colonoscopy is the modality of choice for bowel cancer screening and investigation of iron deficiency anaemia. Hence colonoscopists are most likely to diagnose colorectal cancer (CRC). It is desirable to inform a patient post endoscopy they have CRC but a colonoscopist may fear giving an incorrect diagnosis. All patients with CRC are discussed at the weekly multi-disciplinary team meeting. A delay in treatment is often caused by the patient not being aware of a CRC diagnosis. This may require an additional appointment to inform the patient before the appointment with a Surgeon or Oncologist to discuss treatment. This delay can increase the risk of progression of CRC and reduces the time the patient and family have to adjust to a CRC diagnosis and its consequences. We aim to test the positive predictive value (PPV) of colonoscopists diagnosing CRC and audit if patients were informed. <h3>Methods</h3> 8561 colonoscopies undertaken at Kettering General Hospital (KGH), if “tumour/cancer” was recorded this was correlated to outcome. The reporting software gives an option to record if patient “informed of cancer” or “informed of lesion”. <h3>Results</h3> “Tumour/cancer” recorded 350 times (4.09% of colonoscopies) Confirmed CRC = 333, <b>PPV = 95.14%</b> Adenomas = 12 (3.43%): 7 required surgery, 1 EMR Benign lesions = 5 (1.43%): 2 required surgery 223 of 350 (<b>63.71%</b>) informed of CRC: 219 had CRC, 4 had adenomas 102 (29.14%) informed of “lesion”: 90 had CRC, 12 had benign disease 25 (7.14%) no record (of discussion with patient): 24 had CRC, 1 had adenoma Consultant colonoscopists (241 records) PPV 95.44% 166 out of 241 (68.18%) informed of CRC: 163 had CRC, 3 had adenoma 58 (24.07%) informed of “lesion”: 50 had CRC, 3 had adenoma, 5 had benign disease 17 (7.05%) no record: 17 had CRC Trainee colonoscopists (81 records) PPV 92.59% 47 out of 81 (58.02%) informed of CRC: 46 had CRC, 1 had adenoma 26 (32.10%) informed of “lesion”: 22 had cancer, 4 had adenoma 8 (9.88%) no record: 7 had CRC, 1 had adenoma Nurse colonoscopists (28 records) PPV 100% 10 out of 28 (35.71%) informed of CRC, 18 out of 28 (64.29%) informed of “lesion” <h3>Conclusion</h3> This data shows that colonoscopists are proficient at diagnosing CRC (PPV 95.14%). Those cases not confirmed with CRC usually have serious pathology which often requires surgery (9 out of 17). Yet only 63.71% of patients were informed of CRC. Consultants informed 68.18%, trainees informed 58.02% and nurses informed only 35.71%. To reduce delay in CRC treatment and to give patients more time to deal with CRC diagnosis, colonoscopists should inform patients of a suspicion of CRC (and not a “lesion”) and record this on reports. <h3>Disclosure of Interest</h3> None Declared.
ASSESSMENT OF CARDIAC FUNCTION FOLLOWING PROTON RADIATION IN A COHORT OF POST MASTECTOMY PATIENTS WITH LOCALLY ADVANCED BREAST CANCER
Authors: Timothy Tan, Joanna Chin, Hsiao-Ming Lu, Nicholas Depauw, Hanne Booy, Alphonse Taghian, Roger Bauer, Marielle Scherrer-Crosbie, James Januzzi, Jonathan Passeri, Shannon M. Macdonald
Journal: Journal of the American College of Cardiology (2015)
Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma
Authors: K. Matsuo, Y. Takazawa, M.S. Ross, E. Elishaev, I. Podzielinski, M. Yunokawa, T.B. Sheridan, S.H. Bush, M.M. Klobocista, E.A. Blake, T. Takano, S. Matsuzaki, T. Baba, S. Satoh, M. Shida, T. Nishikawa, Y. Ikeda, S. Adachi, T. Yokoyama, M. Takekuma, K. Fujiwara, Y. Hazama, D. Kadogami, M.N. Moffitt, S. Takeuchi, M. Nishimura, K. Iwasaki, N. Ushioda, M.S. Johnson, M. Yoshida, A. Hakam, S.W. Li, A.M. Richmond, H. Machida, P. Mhawech-Fauceglia, Y. Ueda, K. Yoshino, K. Yamaguchi, T. Oishi, H. Kajiwara, K. Hasegawa, M. Yasuda, K. Kawana, K. Suda, T.M. Miyake, T. Moriya, Y. Yuba, T. Morgan, T. Fukagawa, A. Wakatsuki, T. Sugiyama, T. Pejovic, T. Nagano, K. Shimoya, M. Andoh, Y. Shiki, T. Enomoto, T. Sasaki, K. Fujiwara, M. Mikami, M. Shimada, I. Konishi, T. Kimura, M.D. Post, M.M. Shahzad, D.D. Im, H. Yoshida, K. Omatsu, F.R. Ueland, J.L. Kelley, R.G. Karabakhtsian, L.D. Roman
Journal: Annals of Oncology (2016)
THU0528 Decrease in Circulating Visfatin Levels is Associated with Disease Activity Improvement in Early Rheumatoid Arthritis
Authors: H. Hulejová, O. Sglunda, H. Mann, M. Kuklová, O. Pecha, L. Pleštilová, M. Filková, K. Pavelka, J. Vencovský, L. Šenolt
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Identification of novel molecules contributes to better understanding of rheumatoid arthritis (RA) pathogenesis and offers promise for comprehensive identification of novel biomarkers that would allow monitoring of disease activity and individualize prognosis of RA patients. Visfatin may represent a novel biomarker of disease severity. Serum visfatin levels are elevated in RA, may be associated with the degree of inflammation, clinical disease activity and radiographic joint damage. <h3>Objectives</h3> To assess circulating visfatin and its relationship with disease activity and serum lipids in patients with early treatment-naïve RA and to evaluate the effect of treatment with conventional synthetic DMARDs on visfatin levels. <h3>Methods</h3> Serum levels of visfatin were analysed in 40 patients with early RA before and after three months of treatment and in 30 age- and sex-matched healthy individuals. Disease activity was assessed by the Disease Activity Score for 28 joints (DAS28) at baseline and at months 3 and 12. Multivariate linear regression analysis was performed to evaluate whether disease activity improvement can be related to serum circulating visfatin or to a change of visfatin levels. <h3>Results</h3> Visfatin serum levels were significantly elevated in early RA patients compared with healthy controls (1.92±1.17 vs. 1.36±0.93 ng/ml; p=0.034) and significantly decreased after three months of treatment (to 0.99±0.67 ng/ml; p&lt;0.001). Circulating visfatin and change in visfatin levels correlated with disease activity and disease activity improvement over time, respectively. Visfatin decrease after three months predicted DAS28 improvement after 12 months (p=0.031, adjusted R<sup>2</sup>=10.1%). In addition, decrease of serum visfatin levels was not associated with improved atherogenic index, but was negatively associated with the increase of total cholesterol levels. <h3>Conclusions</h3> Short-term decrease in circulating visfatin levels may represent independent predictor of long-term disease activity improvement in patients with early RA. <h3>Acknowledgements</h3> This study was supported by Internal Grant Agency of Ministry of Health of the Czech Republic NT/13696-4 and Research Project No. 00023728. <h3>Disclosure of Interest</h3> : None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.4092
In-111 DTPA to Evaluate the Patency of an Implanted Intrathecal Infusion Pump
Authors: EIKE SCHMIDT, ELIZABETH OATES
Journal: Clinical Nuclear Medicine (1997)

In-111 DTPA cisternography confirmed placement and patency of a slow flow, implanted, programmable, intrathecal morphine infusion pump system. Other radiologic methods failed and were impractical.
OP0262 A Physically Demanding Job May Amplify the Effect of Disease Activity on the Development of Syndesmophytes in Patients with As: Table 1.
Authors: S. Ramiro, A. van Tubergen, R. Landewé, A. Boonen, C. Stolwijk, M. Dougados, F. van den Bosch, D. van der Heijde
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> We have shown that disease activity in AS leads to radiographic progression, which is accelerated in males, in those with a short disease duration, and also in smokers [1]. A plausible biological explanation for the last relationship, however, is lacking. We hypothesize that smoking is associated with occupations that require physically demanding activities, as these were associated with more radiographic damage [2], and that smoking is a confounder of this relationship. Alternatively, smoking can be associated with a lower socio-economic status, which in turn could be associated with radiographic progression. <h3>Objectives</h3> To investigate whether and how occupational physical activities and socio-economic status influence the longitudinal relationship between disease activity and radiographic damage. <h3>Methods</h3> Patients from OASIS were followed-up for 12 years, with biannual assessments. Two readers independently scored the x-rays according to the mSASSS. Disease activity was assessed by the ASDAS-CRP. The relationship between ASDAS and radiographic progression was investigated using GEE, with a focus on subgroups, according to occupational physical activities (“white vs blue collar” jobs, i.e. manual vs “intellectual” labor), education, baseline gross monthly personal income, and baseline gross monthly family income (Table). Smoking was investigated as a covariate. <h3>Results</h3> A total of 154 patients were included (77% males, mean (SD) age 41 (12) years, mean symptom duration 18 (11) years, 81% HLA-B27+). There was a (non-statistically significant) difference in the proportion of smokers per type of occupation (51% blue collar vs 34% white collar, p=0.077). The relationship between disease activity and radiographic progression was significantly different dependent on occupational activity (p=0.014) and on personal income (Table). In blue-collar workers, every additional unit of ASDAS resulted in a 2-year 1.19 mSASSS-units increase, compared to 0.20 mSASSS-units in white collar workers (6-fold amplification). Adjustment for smoking only partly diminished this contrast. <h3>Conclusions</h3> Physically demanding occupational activities seem to amplify the deleterious effects of disease activity on radiographic damage in AS patients. This effect, which is partly explained by differences in socio-economic status, may be a consequence of forces acting on the spine [3], but may in part also be due to smoking habits. If confirmed, these findings may have implications for our commonly given advice to patients with SpA to strenuously exercise. <h3>References</h3> Ramiro 2013 ACR. Ward 2008 A&amp;R. Benjamin 2009 ARD. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.2677
Abstract 1674: Significant reduction of primary growth and metastases through combined CXCR4 and HER-2 inhibition in an esophageal carcinoma orthotopic model
Authors: Stephanie J. Gros, Nina Kurschat, Thorsten Dohrmann, Astrid Drenckhan, Uta Reichelt, Alexander Schultze, Katharina Effenberger-Harms, Tamina Rawnaq, Kersten Peldschus, Ute Eicke-Kohlmorgen, Robert M. Hoffman, Gerhard Adam, Jakob R. Izbicki, Jussuf T. Kaifi
Journal: Cancer Research (2011)

Abstract Metastatic disease is the main cause of morbidity and mortality in esophageal carcinoma and the leading cause of death. While in the early stages surgical resection is the best therapeutic option, in late stages the conventional therapies surgery, chemotherapy, and radiation are limited. The expression of the chemokine receptor CXCR4 is known to be involved in metastatic homing and is associated with a poor prognosis in esophageal cancer patients. Trastuzumab treatment leads to significant tumor growth reduction in a model of HER-2 positive esophageal carcinoma. In the present report, we show the effects of the humanized monoclonal antibody trastuzumab, the CXCR4 inhibitor AMD3100 and their combined use in a metastastic orthotopic nude mouse model of esophageal cancer. Although both single therapies lead to tumor growth reduction the effect is further enhanced by their combination and leads to significant reduction of metastases. Tumor progression was monitored by non invasive MR imaging. High correlation between HER-2 and CXCR4 expression in primary tumor and metastatic organs was observed and might suggest a link between the chemokine receptor CXCR4 and receptor tyrosine kinase HER-2 in tumor progression and metastases. The results of this study suggest an effective treatment of metastatic prostate cancer by the combined use of drugs that target HER-2 and CXCR4. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1674. doi:10.1158/1538-7445.AM2011-1674
Abstract B28: Trisomy suppress tumorgenesis in the NP-cis tumor model
Authors: Annan Yang, Roger Reeves
Journal: Cancer Research (2009)

Abstract Down syndrome results from trisomy for human chromosome 21 (chr21). People with DS have an increased risk of getting leukemia, but the likelihood of solid tumors might be reduced by contribution of several genes. We showed that trisomy in Ts65Dn “Down syndrome” mice reduces tumor number in the ApcMin model of intestinal cancer and that tumor number is inversely proportional to copy number of the Ets2 gene [Sussan TE, Nature 451, 73–75]. The current study provides evidence for additional dosage sensitive tumor repressor gene(s) in the cancer model, NP-cis. These mice carry a single copy of both the tightly linked Nf1 and p53 genes in cis. Tumors form by LOH. When NP-cis mice were crossed with Ts65Dn, trisomic offspring survived significantly longer than euploid. In contrast to the intestinal adenoma finding, introduction of a null allele of Ets2 in either trisomic or euploid mice (resulting in 2 or one copies of Ets2, respectively) had no effect on survival. This result demonstrates further dosage effects of genes trisomic in these mice and in Down syndrome. The lack of Ets2 effect in the NP-cis model is consistent with a protective mechanism that involves up-regulation of p53 by Ets2, thereby sensitizing trisomic cells to p53-mediated apoptosis. This mechanism would not work in NP-cis since tumors form due to loss of p53. In this regard, in vitro analysis of fibroblast cell lines from several genotypes showed that trisomic cells expressing more Ets2 than euploid were more sensitive to induction of apoptosis by camptothecin and showed a higher frequency of senescence. Other genes, like Endostatin, a cleavage product of Col18a1, and Rcan1 have been shown to inhibit angiogenesis in adosage dependent manner in xenograft models of tumor growth [Zorick TS, EJHG 9, 811-4, Baek KH, Nature 459, 1126-30]. In contrast to results from xenografted tumors, endogenous tumors formed in trisomic, NP-cis mice showed no reduction in angiogenesis. Our findings indicate that multiple mechanisms involving other genes trisomic in Ts65Dn mice likely contribute to reduced tumor incidence in Down syndrome. Citation Information: Cancer Res 2009;69(23 Suppl):B28.
A3.7 Anti-fibrotic and anti-inflammatory effect of mesenchymal stem cells in murine hypochlorite-induced systemic sclerosis
Authors: A Maria, C Bony, K Toupet, C Jorgensen, P Guilpain, D Noël
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background and objectives</h3> Systemic sclerosis (SSc) is a rare disease with unmet medical need and fibrosis-related mortality. Absence of efficient treatments has prompted to develop novel therapeutic strategies among which mesenchymal stem cells (MSCs) appear one of the most attractive options. Herein we provide the first preclinical study using MSCs in the relevant hypochlorite (HOCl)-induced murine model of diffuse SSc, recapitulating the main features of the disease: multivisceral fibrosis, vasculopathy, and autoimmunity. <h3>Materials and methods</h3> Balb/c mice underwent six weeks of daily intradermal injections of HOCl leading to SSc-HOCl phenotype. Different doses of syngenic bone marrow-derived MSCs were infused in the tail vein of the mice, either the day before disease induction, or at day 21. Skin thickness was measured weekly, and samples of skin and lung were taken at euthanasia (d42) to assess by RT-qPCR the expression of collagens I and III, TGFβ1, alpha-smooth actin muscle (α-SMA), MMP-1 and -9, Tissue Inhibitor of MMP (TIMP1), Hepatocyte Growth Factor (HGF), VEGFA, IL-1β, TNF-α, IL-6, IL-10, Superoxide Dismutase (SOD2), and Heme Oxygenase (HMOX1). Anti-scl70 antibodies levels were measured in sera by ELISA. <h3>Results</h3> We first compared the effects of different doses of MSCs (2.5 × 10<sup>5</sup>; 5 × 10<sup>5</sup> and 10<sup>6</sup>) infused the day before disease induction, on clinical and biological parameters. When considering skin thickness in time, we observed a slower progression in MSC-treated mice, with the best results obtained with the lowest dose of 2.5 × 10<sup>5</sup>MSCs. At euthanasia, a lower expression of fibrotic markers (collagens I and III, TGF-β1, α-SMA) was observed in both skin and lung of treated mice, consistent with histological improvement and inversely proportional to the injected dose. Importantly, sera from treated mice exhibited lower levels of anti-scl70 autoantibodies and enhanced antioxidant capacity, confirming the systemic effect of MSCs. Of interest, MSC administration was also efficient when infused at d21 while disease is known to be established. We further provide evidence at a molecular level that in skin and lung tissues, MSCs exerted an anti-fibrotic role by normalising extracellular matrix remodelling parameters (MMP-1 and -9, TIMP-1, HGF, VEGFA), as well as reducing pro-inflammatory cytokines (IL1β, TNF-α, IL-6, IL-10) and increasing antioxidant defenses (SOD2, HMOX1). <h3>Conclusion</h3> This preclinical study is the first to demonstrate the therapeutic efficacy of MSCs in a model of diffuse SSc, acting through the modulation of inflammation, tissue remodelling and antioxidant defenses. The benefits observed are particularly promising in sight of clinical perspectives.
SAT0270 The Outcomes of Surgical and Percutaneous Vascular Intervention for Takayasu Arteritis in South Korea
Authors: J. Moon, J.K. Park, I.A. Choi, E.Y. Lee, Y.W. Song, E.B. Lee
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Takayasu arteritis (TA) affects the aorta and its major branches. The damage to arterial wall by the chronic inflammation often results in vascular complications including aneurysm formation or luminal stenosis which can be benefited from vascular interventions. <h3>Objectives</h3> The aim of this study was to investigate outcomes of surgical and percutaneous intervention and to identify factors associated with vascular restenosis requiring a reintervention. <h3>Methods</h3> In this retrospective study, patients with TA receiving care between 1979 and 2009 at Seoul National University Hospital were enrolled. Data on choice and outcome of vascular intervention were ascertained by medical chart review. Kaplan-Meier analysis and log-rank test were performed to compare the failure rate of surgical vs. percutaneous vascular interventions. Risk factors associated with a restenosis were investigated using cox proportional hazard regression analysis. <h3>Results</h3> A total of 184 patients with TA were identified. The mean age at diagnosis was 35.3±16.4 years and 160 (87.2%) were female. Forty-four (23.9%) patients underwent open surgery and 25 (13.6%) patients underwent a percutaneous endovascular intervention. After median follow-up of 20.1±1.4 years, 17 (38.6%) patients in the open surgery group and 11 (44%) patients in the percutaneous intervention group developed significant restenosis requiring a second intervention (Fig. 1). The use of corticosteroid, azathioprine or cyclophosphamide did not affect restenosis rate (HR=0.77, 95% CI: 0.3–2.0). Nor did disease activity or traditional cardiovascular risk factors such as diabetes and hypertension (P&gt;0.05). However, use of methotrexate was associated with a higher risk of significant restenosis (HR=2.48, 95% CI 1.074–5.747). <h3>Conclusions</h3> Open surgical and percutaneous endovascular interventions for vascular complications in patients with TA did not differ in regard to the restenosis rate. Since treatment with methotrexate is associated with a higher restenosis rate, its use should be re-evaluated in a further study. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.3983
Abstract P4-14-06: Contralateral Prophylactic Mastectomy and Survival: Selection Bias or True Survival Benefit?
Authors: Katharine Yao, Hongyan Du, Czechura Tomasz, David P Winchester, David J Winchester, Ningi Hou, Dezheng Huo
Journal: Cancer Research (2012)

Abstract Withdrawn by Author Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-14-06.
18F-FDG PET/CT in Detecting Metastatic Infection in Children
Authors: Ilse J.E. Kouijzer, Gijsbert J. Blokhuis, Jos M.T. Draaisma, Wim J.G. Oyen, Lioe-Fee de Geus-Oei, Chantal P. Bleeker-Rovers
Journal: Clinical Nuclear Medicine (2016)

Purpose of the Report Metastatic infection is a severe complication of bacteremia with high morbidity and mortality. The aim of this study was to investigate the diagnostic value of 18F-FDG PET combined with CT (FDG PET/CT) in children suspected of having metastatic infection. Methods The results of FDG PET/CT scans performed in children because of suspected metastatic infection from September 2003 to June 2013 were analyzed retrospectively. The results were compared with the final clinical diagnosis. Results FDG PET/CT was performed in 13 children with suspected metastatic infection. Of the total number of FDG PET/CT scans, 38% were clinically helpful. Positive predictive value of FDG PET/CT was 71%, and negative predictive value was 100%. Conclusions FDG PET/CT appears to be a valuable diagnostic technique in children with suspected metastatic infection. Prospective studies of FDG PET/CT as part of a structured diagnostic protocol are needed to assess the exact additional diagnostic value.