tbuckley/cabot-search huggingface dataset:
Medicine and books: Life in the Balance: Emergency Medicine and the Quest for Survival
Authors: Tim Ashworth
Journal: BMJ (1998)

Mickey S Eisenberg 

Oxford University Press, £19.99, pp 304 

ISBN 0 19 510179 0 

Death, and particularly sudden death, was an accepted fact of life for most of recorded history. With the renaissance, attitudes changed to one of abhorrence—death was a sign of the wrath of God or that peace had not been made with one’s Maker. Now the loss of a relationship with a beloved has been compounded by loss of faith, decreased exposure to the event of death itself, and a misguided belief in the power of modern medicine to render us immortal. 

When drowning was the main cause of sudden death, it is not surprising that all attention was centred on the lungs. Meaningful resuscitation can be said to have had its origins with the formation of the Amsterdam Rescue Society in 1767. What is surprising is that rescue attempts were dominated for so long by largely useless methods of resuscitation, mainly dictated by objections to that “vulgar act” of mouth to mouth resuscitation. Equally surprising is that so little attention was paid to the circulation. In 1891 the importance of external cardiac massage had been documented, but it was not “rediscovered” for a further 68 years. 

Although the “spark of life” had been known from the time of experimentation on guillotined corpses 200 years ago, it needed the 20th century epidemic of coronary heart disease and changed attitudes to death to address the issues of cardiac arrest and ventricular fibrillation. The breakthrough, despite constant opposition from a variety of sources, occurred in Baltimore in the late 1950s. When the head of the local ambulance service became the catalyst for an association between two engineers, a cardiac surgeon, and two anaesthetists, modern cardiopulmonary resuscitation had been born. 

As a former pathologist whose daily fare was sudden death, I cannot help being a little cynical. Cardiopulmonary resuscitation would not have made the slightest difference to the outcome in the vast majority of my clientele of cardiac arrests: the circumstances in which death is witnessed is all a matter of luck, reinforcing Dawkins’ “blind, indifferent nature.” 

Nevertheless, what Eisenberg has described in this chequered history, for the general public and doctors alike, is a wonderfully constructed and absorbing account of these issues and many more: the economic cost, clinical versus biological death, the safety of using non-medically trained staff, and the problems of those hearts “too young to die” and those “too sick to live.” The subject impinges on every field of medical endeavour. Perhaps cardiopulmonary resuscitation is too recent a development for us to give a balanced view? 

With such a fund of information, the extensive bibliography, chronological table, glossary, and index are added bonuses. It is also a source of lively anecdotes: Elisha, John Wesley, Benjamin Franklin, and Tsar Alexander among others.
PWE-421 Knowledge of refeeding syndrome amongst foundation year doctors
Authors: W On, R Harrison, A Haddick
Journal: Gut (2015)

<h3>Introduction</h3> Refeeding syndrome (RS) is a potentially fatal condition and our trust has local guidelines in place to monitor for RS. Junior doctors on the wards are often the ones who are most responsible for the day-to-day care of patients and thus, they should be aware of the risk factors, monitoring and treatment of RS. We aimed to assess the knowledge of RS amongst Foundation Year 1 (F1) and Year 2 (F2) doctors in our trust. <h3>Method</h3> We conducted a paper questionnaire survey which was distributed to F1s and F2s over a time period from October 2014 to December 2014. The contents of the survey were based off the 2006 NICE guidelines ‘Nutrition support in adults’<sup>1</sup>and our trust’s local guidelines. <h3>Results</h3> The response rate was 56% (55/99). All respondents were aware of RS. 49% were able to list 2 risk factors for RS. 69% were aware of which electrolytes that were of importance in the monitoring of RS and 91% would monitor the electrolytes daily until stable. Only 40% were aware of the importance of supplementary vitamins such as thiamine, vitamin B co-strong and multivitamin in patients at risk of RS. 7% were able to list 3 clinical complications of RS. Only 26% were aware of our trust’s guidelines on RS. <h3>Conclusion</h3> Our survey showed that whilst junior doctors were aware of RS, the knowledge of management of RS in clinical practice has to be improved upon. Further education is needed and junior doctors should be aware of the availability of national and local trust guidelines which are valuable resources. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> NICE CG32 Guidelines: Nutrition support in adults. (http://www.nice.org.uk/guidance/cg32/)
AB0644 B Cell Characterization in ADA2 Deficiency Patients
Authors: F. Schena, S. Volpi, C. Pastorino, R. Caorsi, A. Omenetti, F. Penco, S. Chiesa, A. Bertoni, P. Picco, I. Aksentijevich, A. Martini, E. Traggiai, M. Gattorno
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> ADA2 deficiency, a recently described disease, is characterized by systemic vasculopathy and episodes of strokes. The defect is due to a loss of function mutation of <i>CECR1</i> gene, codifying for Adenosine Deaminase 2 protein. This protein regulates the catabolism of extracellular adenosine, which we have recently shown is an important regulator of Class Switch Recombination in B lymphocytes. Accordingly DADA2 patients can present hypogammaglobulinemia. <h3>Objectives</h3> The aim of the project is to characterize peripheral B-cell compartment of two patients to directly address if ADA2 mutation affects B-cell function. <h3>Methods</h3> Two brothers (15 and 7 years old) carrying mutations in <i>CECR1</i> were followed up from the age of two. They showed similar clinical history with livedo reticularis, fever, vasculitis and neurological symptoms caused by haemorragic strokes. Both presented early hypogammaglobulinemia requiring intravenous immunoglobulin replacement therapy. Remarkably after etanercept treatment serum Igs slowly increased to a normal level. We analyzed peripheral B-cell phenotype by flow cytometry, <i>in vitro</i> B-cell proliferation and differentiation to plasmacells in response to CpG, BCR and T cell help. <h3>Results</h3> Flow cytometer analysis showed a significative reduction of total B cells compared with age matched controls. Intriguingly a defect in the memory B-cell compartment (CD19<sup>+</sup>CD27<sup>+</sup>) was observed. We found that the rate of proliferation and differentiation to Igs secreting cells is lower as compared to normal controls and it is not supported by autologous T cells. <h3>Conclusions</h3> Our findings suggest that ADA2 defect could lead to a reduced formation of T cell dependent memory B cells. <h3>References</h3> Zhou Q. et al., N Engl J Med. 2014 Mar 6;370(10):911-20 Navon Elkan et al. P. N Engl J Med. 2014 Mar 6;370(10):921-31 Garg N. et al. Eur J Pediatr. 2014 Jun;173(6):827-30 Schena F. et al. Cell Rep. 2013 Jun 27;3(6):1824-31 Hasko G. et al. Trends Mol Med. 2013 Jun;19(6):355-67 Antonioli L. et al. Nat Rev Cancer. 2013 Dec;13(12):842-57 Eltzschig HK et al. N Engl J Med. 2012 Dec 13;367(24):2322-33. <h3>Disclosure of Interest</h3> None declared
Certain Metabolic and Pharmacologic Effects in Cancer Patients Given Infusions of 2-Deoxy-D-Glucose
Authors: Bernard R. Landau, John Laszlo, James Stengle, Dean Burk
Journal: JNCI Journal of the National Cancer Institute (1958)

2-Deoxy-D-glucose (2-DG) was administered to 1 patient with islet-cell carcinoma, 5 patients with leukemia, 1 patient with bronchogenic carcinoma, and 1 with renal-cell carcinoma. After a single intravenous infusion of 2-DG, the following effects were noted: 1) Blood-glucose levels rose. 2) Symptoms were diaphoresis, generalized warmth, flushing, headache, drowsiness, and tachycardia. No symptoms were severe and all of them were transient. 3) In the leukemic patients, white-blood-cell counts either fell directly, or rose and then fell during the 24-hour period following administration. 4) Glycolytic inhibition of leukemic cells occurred in some of the patients. 5) Approximately 30 percent of the administered dose was excreted in the urine; the fate of the remainder of the compound was unknown. The significance of these observations was discussed.
Pedigrees, functioning, and psychopathology in families of school phobic children
Authors: G A Bernstein, B D Garfinkel
Journal: American Journal of Psychiatry (1988)

Family pedigrees of six children with severe school phobia compared with those of a matched group of families of five children with psychiatric disorders showed a clustering of affective and anxiety disorders. Blind and independent family histories and structured interviews of parents and siblings demonstrated higher rates of depressive and anxiety disorders in first-degree relatives of children with school phobia. Parents of children with school phobia described more disturbance in family functioning on the Family Assessment Measure than did parents in the comparison group in the areas of role performance, communication, affective expression, and control.
AB0856 Quantitative Proteomics (Itraq) Reveals Putative Biomarkers in Pre-Radiological Osteoarthritis
Authors: J. Mateos, P. Fernández-Puente, S. Relaño, I. Rego-Pérez, N. Oreiro, C. Fernández-Lόpez, C. Ruiz-Romero, F. Blanco-García
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Osteoarthritis (OA) is the most common rheumatic disease and the major cause of pain and disability along the aging population globally (1, 2, 3). Recently, a panel of experts of the EULAR outlined the priority research needs for the near future, including the search for predictors of OA progression [4, 5]. <h3>Objectives</h3> The identification in serum of a panel of early indicators or biomarkers to predict the pathology in pre-radiological stages but also for its handling and the developing of trials of treatment in radiological stages. <h3>Methods</h3> 15 individual samples for each condition (OA Grade 0, pre-radiological stage Grade I, and radiological stage grades II-III and IV) were pooled in three groups with the aim of reducing the individual extreme values. After enrichment in the low-abundant protein fraction, the pooled samples were subjected to iTRAQ labelling and relative quantitative analysis was done using a 4800 MALDI-TOF/TOF platform (ABSciex). <h3>Results</h3> We have detected two big sets of serum proteins modulated in the early pre-radiological OA process. Levels of apolipoproteins (apoE: ratio GI/G0=2.25; apoB-100: ratio GI/G0=2.01; apoA-IV: ratio GI/G0=1.99) are altered when comparing Grade I vs. Grade 0. Furthermore, up to six components of the complement, a group of proteins involved in immune response and inflammation are decreased in serum in early OA grades. Among them, complement component 5 -C5-, that have been recently identified as key player of the OA process (6), is much less abundant in any OA grade in comparison to Grade 0 (ratio GI/G0=0.35). <h3>Conclusions</h3> Our results indicate that early pathological grades of the OA process are linked to an imbalance in the metabolism and, specifically, in the lipid metabolism. Altered serum levels of apo-lipoproteins and C5 could be used, in combination with other “dry” biomarkers, as an indicator for early OA process and to detect the pathology in pre-radiological stages. <h3>References</h3> Tonge DP, Pearson MJ, Jones SW (2014). Osteoarthritis Cartilage. Mobasheri A (2013) Curr Rheumatol Rep 15: 385. Jotanovic Z, Mihelic R, Sestan B, Dembic Z (2014) Curr Drug Targets. Conaghan PG, Kloppenburg M, Schett G, Bijlsma JW, committee oboaEoah (2014) Ann Rheum Dis. Lotz M, Martel-Pelletier J, Christiansen C, Brandi ML, Bruyère O, et al. (2013) Ann Rheum Dis 72: 1756-1763. Wang Q et al. (2011) Nat Med. Nov 6;17(12):1674-9. <h3>Acknowledgements</h3> We would like to thank to all the members of the Proteored network for scientific discussion and helpful suggestions and to the patients for the donation of the serum samples. <h3>Disclosure of Interest</h3> None declared
PTU-046 Prospective comparison of emr vs esd in barrett’s neoplasia: are we too afraid of knives in the oesophagus?: Abstract PTU-046 Table 1
Authors: FJQ Chedgy, R Bhattacharyya, K Kandiah, P Basford, P Bhandari
Journal: Gut (2015)

<h3>Introduction</h3> Use of ESD in the Western setting is limited to a few centres with limited numbers of cases, due to concerns regarding complication rates and no established training pathway. The risks of ESD in the oesophagus are perceived to be high and the consequences disastrous. For this reason, endoscopic mucosal resection (EMR) is the most common technique used to resect early Barrett's cancer. The drawback of EMR is piecemeal resection and poor interpretation of histology. <h3>Method</h3> We report our experience of oesophageal ESD in 51 cases and compare our data for EMR (140 cases) over the same period. <h3>Results</h3> 51 ESD resections for Barrett's neoplasia were performed between 2006 and 2014. 140 EMR's were performed in the same period. Mean age 71 years for ESD group and 75 for EMR group. All procedures were undertaken by a single expert endoscopist (PB). Table 1shows patient characteristics and lesion characteristics. The endoscopic cure rate in the ESD group was 83% and the EMR group was 82%. It took a mean of 1.2 procedures in the ESD group and 1.4 procedures in the EMR group. In the ESD group there was a recurrence rate of 3%, in the EMR group 16%. Additional radiofrequency ablation was required in 17% of patients in the ESD group and 34% of patients in the EMR group. There was one perforation in the ESD group which was successfully managed conservatively with endoclips, not requiring surgery. There were 4 cases of bleeding and 3 cases of stricturing managed endoscopically in the EMR group. <h3>Conclusion</h3> ESD for Barrett's neoplasia is feasible, safe and effective in Western hands. Our lesion selection data shows that ESD is being used mainly for nodular lesions and cancerous lesions as compared to EMR for flat and non-cancerous lesions. Neoplasia recurrence is higher in EMR vs ESD. This calls for a randomised controlled trial comparing EMR vs ESD for the resection of nodular lesions in Barrett's neoplasia. <h3>Disclosure of interest</h3> None Declared.
Panic disorder in patients attending a clinic for vestibular disorders
Authors: M B Stein, G J Asmundson, D Ireland, J R Walker
Journal: American Journal of Psychiatry (1994)

In a study of the prevalence of panic and other anxiety disorders in persons with complaints of dizziness, 87 patients referred to a clinic for vestibular disorders completed self-rating measures of anxiety and depression; 32 also underwent a structured diagnostic interview. Thirteen (14.9%) of the patients met the DSM-III-R criteria for panic disorder, agoraphobia, or both. They rated themselves as much more disabled by their dizziness than the patients with no psychiatric disorder. Panic disorder was equally prevalent among patients with and without vestibular disease. In some cases panic disorder may provide an explanation for the dizziness, whereas in others it may be a comorbid condition compounding the disability attributable to the vestibular disorder.
PTH-130 An audit of primary prophylaxis against variceal bleeding in the liver transplant population
Authors: N Sagar, D Tripathi
Journal: Gut (2015)

<h3>Introduction</h3> Mortality at six weeks for patients with variceal bleeding approaches 10–20%. International and local guidelines state all liver cirrhotic patients should be screened for varices at diagnosis. For primary prophylaxis, non-selective beta-blockers (NSBB) are recommended in patients with small oesophageal varices (OV) with red wale signs or Child C class as well as for patients with gastric varices (GV). Either NSBB or endoscopic band ligation (EBL) is advised for medium sized OVs.<sup>1</sup>We aim to audit primary prophylaxis in patients on the transplant waiting list. <h3>Method</h3> 77 consecutive cirrhotic patients on the liver transplant waiting list from January 2013 to January 2014 were evaluated. Of these 77 patients, 36 (47%) did not live locally therefore had missing data and were excluded from the study. The remaining 41 (53%) patients local to the area were studied. <h3>Results</h3> 64% of patients were male, 36% female. The most common aetiologies of liver disease were alcoholic liver disease (30%), Hepatitis C (17%) and PSC (17%). 28 (68%) patients had OVs at screening of which 5 (18%) had at least grade 2 OVs and all patients received either NSBB (40%) or EBL (60%). 8 (29%) patients had OVs which were less than grade 2. Grading of OVs was not specified in 15 (54%) patients, with 8 (53%) of these patients receiving NSBB, 4 (27%) EBL, 2 (13%) both NSBB and EBL and 1 (7%) untreated. GVs were evident in 3 (7%) patients, 1 of whom had a TIPPS, 1 NSBB and 1 was untreated. Both OVs and GVs were present in 1 (2%) patient who received a TIPPS. There were no varices demonstrated in 9 (22%) patients however 2 (22%) received NSBB and 7 (78%) were left untreated. Out of the 77 patients on the transplant waiting list, there were 12 (16%) deaths, 2 of which were secondary to variceal bleeding. One of these patients had received a TIPSS for GVs and another had EBL for OVs of an unknown grade. <h3>Conclusion</h3> Our data demonstrates that reporting of the size of varices could be improved (grading of OVs not specified in 54% of patients). This would have implications of primary prophylaxis being offered to the appropriate patients. Secondly, there was some evidence of lack of adherence with regards to primary prophylaxis but good adherence to current guidelines was demonstrated in patients with grade 2 or larger OVs, which bears the greatest clinical relevance. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> de Franchis R; Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. <i>J Hepatol</i>. 2010 Oct;53(4):762–8
PTU-128 Novel insights into metastatic spread of oesophageal adenocarcinoma from whole genome sequencing data
Authors: A Noorani, D Wedge, P Lao-Sirieix, J Weaver, N Grehan, I Debiram, D Gilligan, A Hindmarsh, M Goddard, R Hardwick, R Fitzgerald
Journal: Gut (2015)

<h3>Introduction</h3> The evolution of metastatic oesophageal adenocarcinoma (OAC) is poorly understood. Whole genome sequencing (WGS) across multiple metastatic sites provides the unique opportunity to study clonal evolution of OAC. <h3>Method</h3> 2 cases of junctional OAC were extensively sampled at autopsy within 4 h of death. At presentation case 1 was palliative, case 2 had potentially curative disease but progressed during treatment. 20 fresh frozen tumour samples from primary tumour and multiple metastases (adrenal, liver, pancreas, station 102, left gastric and para-aortic lymph nodes) underwent WGS. Clonal analysis involved estimating copy number status and tumour purity, followed by point mutation clustering based on allele frequency (proportion of tumour cells harbouring a mutation); clusters were referred to as clones and were annotated with driver events of clonal progression (single nucleotide variants (SNVs) and copy number events). <h3>Results</h3> 11 clones spanned all samples in case 1 compared to 5 in case 2. Median SNVs per clone were 5885 in case 1 (range 1091–29883) and 2149 (range 424–27031) in case 2. The founding clone in both cases contained the bulk of the SNVs and key potential drivers of carcinogenesis (case 1:KRAS and GATA4 amplification, case 2:TP53 mutation). Metastases in case 1 had a branching pattern of evolution; 6 clones were unique to individual metastases and only 1 was shared across sites. Clones were on average 9363 (+/-5827) SNVs distant from the founder clone demonstrating continuing evolution in metastases. Para-aortic nodal metastasis preceded local lymph node metastasis. In contrast case 2 demonstrated linear evolution with just 2 metastatic clones that were on average 1286 (+/-1219) SNVs distinct from the primary tumour; 1 was only in the adrenal, the second was shared across multiple sites suggestive of an embolic pattern of tumour seeding. The liver metastasis was identical to the primary founder clone demonstrating that metastasis to the liver was the initial event, even prior to local lymph node metastasis. <h3>Conclusion</h3> Metastases can result from contrasting patterns of clonal evolution. Both cases demonstrate the striking phenomenon of early distant metastases, prior to the development of local lymph node metastases thus challenging our traditional algorithms of tumour staging and prognostication. Additional cases are being analysed to support our findings. <h3>Disclosure of interest</h3> None Declared.
Electrophoresis of Proteins of Irradiated Mouse Chimeras
Authors: Raymond A. Popp, L. H. Smith
Journal: JNCI Journal of the National Cancer Institute (1959)

A comparative study was made of the proteins in various tissues of Sprague-Dawley rats and (101 × C3H)F1 mice. The results were used as a basis for studying changes in the protein patterns in tissues of rat-mouse chimeras: i.e., (101 × C3H)F1 mice were given 950 r of X rays and then received an injection of bone marrow from Sprague-Dawley rats. Electrophoretic mobilities of rat proteins extracted from the bone marrow, spleen, lymph node, and thymus of chimeras and rats were similar. The quantity of rat proteins and the rate and time at which they appeared in different hematopoietic organs were quite different. Some mouse-type proteins not found in chimera tissues examined 30 days after treatment were frequently present on the 50th day or later, which suggests regression of the graft. The results are consistent with the idea that rat-type proteins synthesized in the cytoplasm of transplanted rat cells are controlled by the genotype of these cells, even in a mouse environment. They also indicate that there are organ-specific differences, in the rate and degree of replacement of transplanted cells, that require further investigation.
Dyspepsia
Authors: Janet M. Torpy, Cassio Lynm, Richard M. Glass
Journal: JAMA (2006)

Dyspepsia Dyspepsia, also called indigestion, is a problem that most adults experience at least once in their lifetime.Upper abdominal discomfort, nausea, vomiting, and belching are all symptoms of dyspepsia.Indigestion is often related to consumption of too much food, especially heavy or greasy foods, eating late at night, smoking, alcohol consumption, or life stress.For some individuals, dyspepsia occurs regularly and becomes a health and quality-of-life issue.The April 5, 2006, issue of JAMA includes an article about dyspepsia.
Androgen Deprivation Therapy for Advanced Prostate Cancer: Can Evolution Be Accelerated?
Authors: James L. Mohler
Journal: Journal of the National Comprehensive Cancer Network (2016)

Dr. Mohler's clinical practice focuses on prostate cancer and robot-assisted laparoscopic surgery.His laboratory focuses on the role of the androgen receptor in racial differences in prostate cancer aggressiveness and prostate cancer recurrence during androgen deprivation therapy.
Skeletal “Superscan” on 18F-Choline PET/CT
Authors: André H. Dias, Kirsten Bouchelouche
Journal: Clinical Nuclear Medicine (2015)

We describe 2 cases of skeletal “superscan” with 18F-choline PET/CT in prostate cancer (PCa) patients. Both cases demonstrated diffuse skeletal involvement besides their primary prostate tumor. The first impression was that this presentation would be related to diffuse tumoral skeletal invasion by PCa as often seen in 99mTc-MDP bone scintigraphy. In both cases, the bone involvement was shown to be caused by hematological disease (polycythemia vera and chronic myelomonocytic leukemia), demonstrating the importance of also considering the presence of myeloproliferative syndromes when presented with diffuse bone disease on choline PET/CT performed in PCa patients.