tbuckley/cabot-search huggingface dataset:
ERCP (Ensuring Really Competent Practitioners)
Authors: Peter Cotton, Gregory Coté
Journal: Endoscopy (2014)

Endoscopic retrograde cholangiopancreatography (ERCP) can provide great clinical benefits, but can also cause serious complications. We should all be interested in maximizing the benefits and minimizing the risks [1]. In this issue of Endoscopy, Ekkelenkamp and colleagues from the Rotterdam group extend their earlier work [2] on measuring the performance of their trainees [3], adding to the literature showing that the procedure is difficult to learn. Using a basic quality metric (deep biliary cannulation with a virgin papilla), they showed that their trainees achieved only around 60 % success after 150 procedures. Based largely on the earlier seminal study by Jowell and colleagues [4], the American Society for Gastrointestinal Endoscopy (ASGE) and other societies have suggested that 80 % – 85 % should be the target, but it is still far from clear how many procedures are required to achieve this degree of proficiency. The Rotterdam data on 15 trainees shows substantial variability. The average cannulation rate was 85 % after 200 ERCPs, but the 95 % confidence interval spanned 70 % and 90 %. Some individuals may be ready for “prime time” sooner than others, but to assure competency in nearly all trainees the volume threshold may have to exceed 300. It is worth remembering that the number of cases required will depend also on the quality of the teaching, and how much a trainee has to be involved in a procedure before he or she can count it as a “case.”
Downregulation of the Novel Candidate Tumor Suppressor Gene NCOR2/SMRT in Human Breast Cancer Progression.
Authors: J. Geradts, R. Saxena, J. Groth, M. Desouki, J. Burchette, S. Liao
Journal: Cancer Research (2009)

Abstract Background: We recently described a number of DNA copy number changes that differentiated low grade ductal carcinoma in situ (DCIS) lesions with and without associated invasive carcinoma. One of the invasion-associated candidate genes was Nuclear Corepressor 2/Silencing Mediator of Retinoid and Thyroid Receptors (NCOR2/SMRT). This gene is a component of a repressing nuclear receptor complex and a mediator of ER activity. It facilitates recovery from DNA double strand breaks. Previous studies showed that downregulation of the gene was associated with transformation of non-Hodgkin lymphomas.Materials and Methods: Genomic DNA was extracted from microdissected paraffin sections of formalin fixed low grade DCIS lesions with an invasive component (n=42), as well as morphologically similar DCIS lesions without associated invasion within at least 5 years (n=38). Comparative PCR was performed with GAPDH as the reference gene. In addition, we assayed tissue microarrays (TMAs) by immunohistochemistry using two anti-Smrt antibodies. Three TMAs included 162 interpretable cases of invasive breast carcinoma from Roswell Park Cancer Institute (RPCI). One additional TMA included 73 interpretable breast cancers from a previously described cohort from Vienna, Austria. Nuclear staining in neoplastic cells was scored as positive, reduced (significantly weaker compared to admixed benign cells), and negative. Ncor2/Smrt expression was correlated with various patho-biologic variables.Results: Allelic loss of NCOR2/SMRT was observed in 79% (33/42) of DCIS lesions with associated invasion, but in only 26% (10/38) of pure DCIS cases (p&amp;lt;0.01). In the RPCI breast cancer cohort, nuclear Ncor2/Smrt protein was absent or downregulated in 73% (119/162) of tumors. In the Vienna cohort, there was no or markedly reduced nuclear staining in 48% (35/73) of cases. In both cohorts, loss of nuclear reactivity was more common in ER-negative breast cancers. In the Vienna series, Ncor2/Smrt loss was more frequent in PR-negative tumors as well. In the RPCI cohort, Ncor2/Smrt downregulation was more common in ductal (81%, 109/135) than in lobular (37%, 10/27) carcinomas. Neither series showed a significant association between Ncor2/Smrt expression and tumor grade or HER2/neu status.Discussion: Allelic loss of NCOR2/SMRT was significantly more common in DCIS lesions associated with stromal invasion. In invasive tumors, the protein downregulation rate was between 48% and 73%. The gene was more commonly downregulated in ER-negative carcinomas, consistent with its role as a modulator of ER function. Our data provide new evidence that NCOR2/SMRT may play an important part in early breast cancer progression. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3150.
Stat Bite Trends in Breast Cancer Surgery
Authors: A. Coleman, A. Baker
Journal: JNCI Journal of the National Cancer Institute (1991)

Journal Article Stat Bite Trends in Breast Cancer Surgery Get access Ann Coleman, Ph.D, Ann Coleman, Ph.D Search for other works by this author on: Oxford Academic PubMed Google Scholar Anita Baker, Ph.D Anita Baker, Ph.D Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 83, Issue 22, 20 November 1991, Page 1607, https://doi.org/10.1093/jnci/83.22.1607 Published: 20 November 1991
Neuronal Correlates of Clinical Asymmetry in Progressive Supranuclear Palsy
Authors: Florian Amtage, Sabine Hellwig, Annabelle Kreft, Timo Spehl, Volkmar Glauche, Christian Winkler, Michel Rijntjes, Bernhard Hellwig, Cornelius Weiller, Wolfgang A Weber, Oliver Tüscher, Philipp Tobias Meyer
Journal: Clinical Nuclear Medicine (2014)

Progressive supranuclear palsy (PSP) is characterized by a symmetric hypokinetic syndrome with early falls and vertical supranuclear gaze palsy. However, clinically asymmetric manifestations occur, resembling idiopathic Parkinson disease or corticobasal degeneration. The aim of this study was to determine the neuronal correlates of patients suffering from PSP with a lateralized disease manifestation (hemi-PSP) in comparison to patients with symmetric clinical presentation (symPSP) and corticobasal degeneration.Twenty-three patients with PSP and 8 patients with corticobasal degeneration according to standard diagnostic criteria underwent F-fluorodeoxyglucose (FDG) PET scans to assess disease-specific patterns of regional cerebral glucose metabolism reflecting neuronal activity. Group differences were analyzed by statistical parametric mapping and region-of-interest analyses.Clinically, 14 patients presented with symPSP while 9 patients were considered as hemi-PSP. Patients with symPSP or hemi-PSP showed similar bilateral medial frontal hypometabolism compared to corticobasal degeneration patients. In contrast, corticobasal degeneration patients exhibited a prominent parietal hypometabolism compared to both symPSP and hemi-PSP patients. SymPSP patients showed no significant hypometabolism compared to hemi-PSP, whereas hemi-PSP patients presented with significant hypometabolism of the motor thalamus, middle cingulate gyrus, and sensorimotor cortex contralateral to the most affected body side compared to symPSP patients.The present study demonstrates that a more pronounced and asymmetric involvement of cortical and subcortical motor areas is associated with a lateralized disease manifestation of PSP. Furthermore, these findings strongly suggest that FDG PET imaging may assist the challenging clinical differentiation between hemi-PSP and corticobasal degeneration by depicting disease-specific patterns of regional cerebral glucose metabolism.
PTH-132 Gastrostomy Insertions: Is It All About Choosing The Right Patients? A Comparison Between Percutaneous Endoscopic Gastrostomy (peg) And Radiologically Inserted Gastrostomy (rig) Indications, Complications And Mortality Rates
Authors: T Abd Rahim, C Sharratt, M Tinker, T Buchanan, T Bowling
Journal: Gut (2014)

<h3>Introduction</h3> Nottingham University Hospitals (NUH) NHS Trust serves as a tertiary centre for Gastroenterology, Stroke, Neurosurgery and Oncology. Our current practice for vetting referrals differs for PEG and RIG. PEG requests are forwarded to the Nutrition Team for vetting. RIG referrals are sent directly to Radiology for vetting. Our Specialist Nutrition nurses provide a robust assessment including clinical assessment, dietician and speech and language therapy review. Complex cases are discussed with a Gastroenterologist. Pre-procedure review of RIG patients may be undertaken by any physician. <h3>Methods</h3> We retrospectively reviewed all PEG and RIG referrals from 2012. The nutrition records, case notes and electronic records were reviewed. We collected data on referring specialty, indication and 30-day complication and mortality rates. Data was collated onto a database for analysis. <h3>Results</h3> 329 referrals were received; 148 for PEG and 181 for RIG. Of these, 76 (51.4%) were deemed appropriate for PEG and 168 (92.8%) for RIG. Reasons for refusal included patient fitness, meeting nutritional needs, suitable for alternative method of feeding or unsuitable for anatomical/technical reasons. Main service users were Stroke and Neurology, other medical specialties, Clinical Oncology, Neurosurgery and Ear, Nose and Throat. Indications included intracranial events, head and neck cancers and dysphagia secondary to gastroenterological, neuromuscular or neurodegenerative conditions. 30-day complications: Stoma site infections; (15.8% for PEG and 19.6% for RIG), chest infections; (6.58% for PEG and 6.55% for RIG) and minor complications (including blocked or dislodged tube); (5.26% for PEG and 11.9% for RIG). Major complications were low (0% for PEG and 2.97% RIG - including perforation (0.60%), respiratory arrest (0.60%), desaturation (0.60%) and pneumoperitoneum (1.19%)). 30-day all-cause mortality was 6.58% (PEG) and 8.33% (RIG). <h3>Conclusion</h3> Pre-screening PEG referrals identified more inappropriate cases than those referred for RIG. With the exception of chest infections, 30 day minor and major complications were lower in the PEG group, as was 30-day all-cause mortality. We hypothesise that the less rigorous screening process may be contributing to excess complication and mortality rates of RIG insertion. This may, or may not be unique to our Trust. RIG is usually the second line method of insertion, and we recognise that this patient group may have a poorer premorbid state. We recommend formal assessment of all gastrostomy referrals regardless of insertion technique. The Nutrition Team is currently looking towards pre-screening all gastrostomy referrals. <h3>Disclosure of Interest</h3> None Declared.
Abstract 52: Overexpression of uridine phosphorylase 2 (UPP2) in tissues of uridine phosphorylase (UPP1) knock-out mice
Authors: Yang Gao, Amy Ziemba, Jennifer Turner, Giuseppe Pizzorno
Journal: Cancer Research (2010)

Abstract Uridine phosphorylase (UPase) and thymidine phosphorylase (TPase) play critical roles in the metabolism of pyrimidines and their analogs used in cancer chemotherapy. These enzymes catalyze the reversible conversion of uridine, deoxyuridine and thymidine to the corresponding free bases and ribose or deoxyribose-1-phosphate. Uridine phosphorylase activity, in particular, has been reported to be elevated in breast cancers, colorectal cancer, oral squamous carcinomas, melanoma tissue, and lung adenocarcinomas when compared with adjacent normal tissues. Recently, a novel pyrimidine phosphorylase has been identified, called UPase-2. In human tissues, UPase-2 is predominantly expressed in kidney tissue, while in mouse tissue it is predominately expressed in the liver. Our recent studies have indicated that the UPase-2 isoform is overexpressed in UPase-1 knockout mice we have recently developed. A 37kDa (predicted MW of UPase-2) protein is overrepresented in liver lysate of UPase-/- mice after western blot analysis using a uridine phosphorylase polyclonal antibody. Real time RT-PCR analysis using UPase-2 specific primers shows a 4-fold increase in liver UPase-2 expression in UPase-/- mice compared to wild type mice. We also observed an increase in the expression of this enzyme in kidney and brain tissues; however, the enzymatic activity was below the limit of detection. No detectable mRNA levels were observed in spleen, lung or heart tissues. Interestingly, UPase-2 mRNA expression in wild-type and UPase-/- liver tissue decreased to 32% and 8% respectively after mice were fed diets containing 0.5% fenofibrate for 15 hours, however, UPase-1 mRNA expression increased 3.8-fold in the livers of wild-type mice. Fenofibrate, a ligand for peroxisome proliferator-activated receptor alpha, is used to treat high cholesterol and triglyceride levels, calling into question the role of UPase in lipid metabolism. Both the physiological role of UPase-2 in nucleoside metabolism and the homeostatic regulation of UPase-1 and UPase-2 in liver are presently unclear. To address this question, we plan to study this newly developed animal model to characterize UPase-2 contribution to pyrimidine and fluoropyrimidine metabolism, and the regulatory mechanisms affecting its expression and function. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 52.
Abstract 5535: Delivery of siRNA via functionalized lipopolyamine systems
Authors: Kevin J. Polach, Jeff Sparks, Richard Congo, Gregory Slobodkin, Angela Rea-Ramsey, Casey Pence, Majed Matar, Diane McClure, Jennifer Rice, Elaine Brunhoeber, Leslie Wilkinson, Khursheed Anwer, Jason G. Fewell
Journal: Cancer Research (2010)

Abstract The efficient delivery of siRNA molecules to target cells is critical for the application of RNAi to the treatment of human cancers. To this end, we have developed novel cationic lipopolyamime structures that can be used to complex or encapsulate siRNA into nanoparticles for efficient in vitro or in vivo delivery. Unlike conventional cationic delivery systems, these lipopolyamines are chemically flexible which allow for covalent attachment of functional moieties which can modulate their biological activity. For example, modification of these systems with serum stabilizing agents allows for modulation of physical parameters important for biological properties such as toxicity and biodistribution. Intravenous (iv) injection of these functionalized nanoparticles showed preferential distribution to the lungs and corresponding depletion of targeted mRNA transcripts from lung tissue. We have investigated these systems for use in delivering siRNA targeting VEGF in mice with advanced disseminated ovarian cancer through intraperitoneal (ip) injection of siRNA-lipopolyamine nanoparticles. This model was established by injecting animals (ip) with 2.5×106 ID8 cells (malignant transformed ovarian surface epithelial cells that have been further modified to overexpress VEGF protein). Delivery of serum stabilized complexes to the peritoneal cavity of mice with disseminated ovarian cancer resulted in significant target gene knockdown in cells obtained from the malignant ascites fluid of these animals with modest knockdown in the peritoneal tumors themselves. A further modification of the core lipopolyamine structure incorporated attachment of a targeting peptide ligand through a linker molecule. Physico-chemical characterization of this targeted system and in vitro assays with ID8 cancer cells demonstrated specific delivery of siRNAs dependent on the presence of the targeting ligand on the liposome and the targeted receptor on the cell surface. These results have prompted in vivo testing using the targeted delivery systems to assess siRNA distribution as a function of delivered dose. Additional studies are underway that will establish the optimized delivery conditions for use in tumor bearing animals. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5535.
Albumin versus dextran-70 IN cirrhotics with tense ascites treated with total paracentesis. Final results of a multicenter randomized comparative study
Authors: R. Planas, J Llach, P Ginès, J Panés, V Vargas, JM Salmeeron, E Cabré, A Ginès, J Panés, V Toledo, R Morillas, A Rimola, W Jiménez, F Rivera, V Arroyo, J Rodés
Journal: Journal of Hepatology (1990)
Reduced Rate of Energy Expenditure as a Risk Factor for Body-Weight Gain
Authors: Eric Ravussin, Stephen Lillioja, William C. Knowler, Laurent Christin, Daniel Freymond, William G.H. Abbott, Vicky Boyce, Barbara V. Howard, Clifton Bogardus
Journal: New England Journal of Medicine (1988)

The contribution of reduced energy expenditure to the development of obesity has been a point of controversy. We measured 24-hour energy expenditure (adjusted for body composition, age, and sex), in a respiratory chamber, in 95 southwestern American Indians. Energy expenditure correlated with the rate of change in body weight over a two-year follow-up period (r = -0.39, P<0.001). The estimated risk of gaining more than 7.5 kg in body weight was increased fourfold in persons with a low adjusted 24-hour energy expenditure (200 kcal per day below predicted values) as compared with persons with a high 24-hour energy expenditure (200 kcal per day above predicted values; P<0.01). In another 126 subjects, the adjusted metabolic rate at rest at the initial visit was also found to predict the gain in body weight over a four-year follow-up period. When the 15 subjects who gained more than 10 kg were compared with the remaining 111 subjects, the initial mean (±SD) adjusted metabolic rate at rest was lower in those who gained weight (1694±103 vs. 1764±109 kcal per day; P<0.02) and increased to 1813±134 kcal per day (P<0.01) after a mean weight gain of 15.7±5.7 kg. In a group of 94 siblings from 36 families, values for adjusted 24-hour energy expenditure aggregated in families (intraclass correlation = 0.48). We conclude that a low rate of energy expenditure may contribute to the aggregation of obesity in families. (N Engl J Med 1988; 318:467–72.)
PTU-169 Giant hiatus hernia repair: a single-centre experience of the Crurasoft® (BARD) composite mesh
Authors: A C Katz-Summercorn, A C Hindmarsh, R H Hardwick, P M Safranek
Journal: Gut (2012)

<h3>Introduction</h3> Use of prosthetic mesh is advocated in giant hiatus hernia repair to reduce the chance of recurrence. However, complications related to the use of mesh at the oesophageal hiatus have been reported. Composite meshes have been developed which have a lower adhesive potential and may reduce complication rates. We report the outcome of a large case series of patients undergoing hiatus hernia repair using the composite Crurasoft® (BARD) mesh. <h3>Methods</h3> A retrospective study was performed of all patients who had undergone primary or recurrent hiatus hernia repair using Crurasoft® (BARD) mesh in a single tertiary referral centre. Patient demographics, pre-operative investigations, operation and follow-up details were recorded. <h3>Results</h3> Over a 6-year period 53 patients underwent laparoscopic hiatus hernia repair using Crurasoft® (BARD) mesh, of which 36 patients had a primary giant hiatus hernia repair. A concurrent anti-reflux procedure was performed in 44 patients. There were three conversions to open operation, two in patients undergoing primary repair due to difficulties reducing the stomach, and one in a patient undergoing surgery for recurrence due to adhesions. The median time for follow-up was 45 months (range 8–94). Significant complications included dysphagia in 12 (22.6%) patients, which was due to an oesophageal stricture in 2 (3.8%) patients. Mesh erosion into the oesophagus occurred in 2 (3.8%) patients, and 12 (22.6%) patients developed a symptomatic recurrence. Reoperation within 30 days of initial surgery was required in 5 (9.4%) patients and was due to an early recurrence in 3 (5.7%) patients. There were no mortalities. <h3>Conclusion</h3> The composite Crurasoft® (BARD) mesh can successfully be used in giant hiatus hernia repair. However, this mesh does not prevent significant mesh related oesophageal complications and is associated with a high recurrence rate. <h3>Competing interests</h3> None declared.
Clinical Profile of Patients with Congenital Corrected Transposition of the Great Arteries
Authors: David Z. Friedberg, Alexander S. Nadas
Journal: New England Journal of Medicine (1970)

Of 60 patients with congenital corrected transposition of the great arteries, 44 (73 per cent) are still alive. The oldest has lived for 41 years and five months, and seven (16 per cent) are over 20 years of age. Twenty-five patients (42 per cent) had a single ventricle, 31 an associated ventricular septal defect, and four an intact ventricular septum. Twenty-seven (45 per cent) had pulmonary stenosis and 23 per cent left-atrioventricular-valve regurgitation. Associated lesions included subaortic stenosis (four) and left-atrioventricular-valve atresia or stenosis (six). The usual ausculatory, roentgenographic and electrocardiographic criteria were found to be inaccurate. Short of autopsy or surgery, catheterization offers the only reliable evidence for the diagnosis. Surgical procedures included Brock valvulotomies, systemic-pulmonary-artery anastomoses, atrial-septal-defect creations, pulmonary-artery bandings and pacemaker insertions. Forty-seven per cent of the original 60 patients are reasonably well without surgical intervention.
Professor who criticized prostate screening seminar did not suffer retaliation, says university
Authors: J. Lenzer
Journal: BMJ (2013)

A medical school professor was not subjected to retaliation after he raised concerns about a university seminar promoting routine prostate cancer screening, an internal review has found.

Michael Wilkes, a former vice dean for medical education and now director of Global Health, a research and policy institute, and professor of medicine at the University of California, Davis, wrote about his concerns in an editorial published online in the San Francisco Chronicle on 30 September 2010, with Jerome R Hoffman, emeritus professor of medicine at the University of California, Los Angeles.1

The editorial criticized a seminar at Davis promoting prostate cancer screening that was supported by Intuitive Surgical, manufacturer of the da Vinci robot used to perform prostatectomies.

After Wilkes raised his concerns he received an email from the executive associate dean at the medical school stating that Wilkes would …
Coronary Insufficiency Associated with Oral Administration of Gall-Bladder Dye
Authors: David Littmann, Frank I. Marcus
Journal: New England Journal of Medicine (1958)

IN January, 1949, a patient who was known to have arteriosclerotic heart disease was admitted to the Veterans Administration Hospital in West Roxbury, Massachusetts, for determination of the cause of blood-streaked stools. During investigation of the gastrointestinal system a gall-bladder series was scheduled, and the dye administered. He died suddenly twelve hours later of what appeared to be acute coronary insufficiency. Interest in this patient was revived when a second fatal case occurred in a like manner some three months later. In the succeeding eight years 2 more cases of coronary inadequacy have been observed after ingestion of gall-bladder dye; . . .
Rating the Appropriateness of Coronary Angiography — Do Practicing Physicians Agree with an Expert Panel and with Each Other?
Authors: John Z. Ayanian, Mary Beth Landrum, Sharon-Lise T. Normand, Edward Guadagnoli, Barbara J. McNeil
Journal: New England Journal of Medicine (1998)

Evaluations of the appropriateness of medical care are important to monitor the quality of care and to contain costs and enhance safety by reducing inappropriate care. Experts' views are usually incorporated into evaluations of appropriateness. However, practicing physicians may not concur with these views, and physicians' clinical backgrounds may influence their beliefs.