tbuckley/cabot-search huggingface dataset:
PWE-274 Robotic rectal cancer surgery offers significant benefits over the laparoscopic technique
Authors: A Day, H Tilney, M Gudgeon
Journal: Gut (2015)

<h3>Introduction</h3> Robotic surgery provides unique potential benefits when performing rectal surgery such as a stable 3D view and precision dissection with wristed instruments and improved access to the pelvis. Previous studies have reported equivalent outcomes to laparoscopic surgery but no benefit has yet been identified. We aimed to review our unselected cohort of rectal cancer resections. <h3>Method</h3> Analysis of a prospectively collected database was conducted covering a consecutive five-year period from 2009 to 2014. All patients were treated by one of two robotic surgeons and had a tumour within 15 cm of the anal verge and underwent either robotic or laparoscopic resection. The decision to offer robotic surgery was based on surgeon preference for the individual case and influenced by availability of the robot and in some cases the results of randomization in an international trial. For robotic resections a hybrid technique was employed with laparoscopic abdominal surgery followed by 4-arm robotic rectal mobilisation. <h3>Results</h3> 156 cases were analysed, 88 robotic and 68 laparoscopic, with a median follow up of 20 months. There was no significant difference between the groups in terms of gender, BMI, ASA classification, pathological staging or the use of pre-operative long-course chemo-radiotherapy. Robotic patients were significantly younger (65.7 yrs (SD 10.8) vs 69.7 yrs (SD 11.3); p = 0.029). Distance of the tumour from the anal verge was significantly shorter in the robotic group (height (7.7 cm (SD 3.7) vs. 9.2cm (SD 3.6); p = 0.01) and this was reflected in a greater number of abdomino-perineal resections in the robotic versus laparoscopic group (17.0% vs. 7.4% respectively). The rate of conversion to open surgery (defined as any part of the procedure performed open apart from specimen extraction and stapler anvil insertion) was significantly lower in the robotic (11.4%) versus laparoscopic group (39%), p = 0.004, and there was a non-significant trend towards a shorter length of stay in the robotic group (median (IQR): robotic 6(5–9.75) days vs. laparoscopic 7(4.25–11), p = 0.60). There were no significant differences in other short-term outcomes including operative mortality, readmission and circumferential resection margin involvement rates. <h3>Conclusion</h3> In this unselected group, robotic surgery for rectal cancer provided equivalent oncological outcomes to laparoscopic surgery and a significantly lower rate of conversion to open surgery, despite lower tumours being treated. There was no difference in short-term adverse events. There may be a benefit in terms of shorter hospital stay and the results of a major international trial are awaited to determine whether there are any potential quality of life benefits. <h3>Disclosure of interest</h3> None Declared.
Case 49-1979
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, Sherwood L. Gorbach, Karl H. Proppe
Journal: New England Journal of Medicine (1979)

Presentation of CaseA 53-year-old truck driver was admitted to the hospital because of pain in the shoulder.The patient had diabetes of unknown duration, controlled by diet. He was well until the day of admission, when he went to another hospital because of shoulder pain. An x-ray film of the shoulder was normal, and a diagnosis of bursitis was made. He was sent home on Percodan and indomethacin. The pain became more severe, and 10 hours later he returned to the hospital; subcutaneous crepitance was found in the region of the left shoulder, and he was transferred to this . . .
Costimulation Blockade with Belatacept in Renal Transplantation
Authors: Vikas R Dharnidharka
Journal: New England Journal of Medicine (2005)

Renal transplantation is the standard of care for patients with end-stage renal disease.Although maintenance immunosuppression with calcineurin inhibitors yields excellent one-year survival, it is associated over the long term with high rates of death and graft loss, owing in part to the adverse renal, cardiovascular, and metabolic effects of these agents.The use of potentially less toxic agents, such as belatacept, a selective blocker of T-cell activation, may improve outcomes. methodsWe randomly assigned renal-transplant recipients to receive an intensive or a lessintensive regimen of belatacept or cyclosporine.All patients received induction therapy with basiliximab, mycophenolate mofetil, and corticosteroids.The primary objective was to demonstrate the noninferiority of belatacept over cyclosporine in the incidence of acute rejection at six months (with an upper bound of the 95 percent confidence interval around the treatment difference of less than 20 percent). resultsAt six months, the incidence of acute rejection was similar among the groups: 7 percent for intensive belatacept, 6 percent for less-intensive belatacept, and 8 percent for cyclosporine.At 12 months, the glomerular filtration rate was significantly higher with both intensive and less-intensive belatacept than it was with cyclosporine (66.3, 62.1, and 53.5 ml per minute per 1.73 m 2 , respectively), and chronic allograft nephropathy was less common with both regimens of belatacept than with cyclosporine (29 percent, 20 percent, and 44 percent, respectively).Lipid levels and blood-pressure values were similar or slightly lower in the belatacept groups, despite the greater use of lipidlowering and antihypertensive medications in the cyclosporine group.conclusions Belatacept, an investigational selective costimulation blocker, did not appear to be inferior to cyclosporine as a means of preventing acute rejection after renal transplantation.Belatacept may preserve the glomerular filtration rate and reduce the rate of chronic allograft nephropathy.
Pharmacogenetic determinants of sunitinib-induced toxicity in Korean patients with metastatic renal cell carcinoma.
Authors: H. R. Kim, W. S. Kwon, L. Gui Youn, J. R. Ahn, H. J. Park, H. S. Kim, S. J. Shin, J. B. Ahn, S. Y. Rha
Journal: Journal of Clinical Oncology (2011)

e15087 Background: There have been reports about the ethnic difference of toxicity profile to sunitinib. In Asian population, thrombocytopenia, neutropenia, and hand-foot syndrome (HFS) were more frequently reported. We aim to assess the pharmacogenetic determinants of these toxicities, which were developed after treatment with sunitinib in Korean patients with metastatic renal cell carcinoma (mRCC). Methods: A pharmacogenetic study was performed in 51 patients with mRCC treated with sunitinib 50mg orally, once daily (4 weeks on-2 weeks off). This study included 41 male and 10 female. Clear cell type in 48 patients (94.1%) and papillary type in three patients (5.9%) were observed. Detailed toxicities of sunitinib, including thrombocytopenia, neutropenia, and HFS during treatment with sunitinib were prospectively collected. A total of 10 single nucleotide polymorphisms (SNPs) in 7 candidate genes (CYP1A1, ABCG2, ABCB1, PDGFRa, VEGFR2, RET, and FLT3) were genotyped and their relationship with toxicities were assessed. Results: The most frequently reported treatment related AEs of all grades were thrombocytopenia (72.5%, 37/51), neutropenia (72.5%, 37/51), and hand-foot syndrome (64.7%, 33/51). Among them, grade 3/4 AEs were 43.1% in thrombocytopenia, 31.4% in neutropenia, and 7.8% in HFS. The risk for neutropenia was increased when the AA type in CYP1A1 2455A/G (odds ratio [OR], 4.38; P=0.032), the GG type in PDGFRα -537G/T (OR, 5.52; P=0.026) or the TT type in PDGFRα 1580T/C (OR, 5.26; P= 0.031) was presented. The risk for HFS was increased when the CC type in ABCG2 421C/A (OR, 1.915; P=0.048) was. Whereas, AA type in CYP1A1 2455A/G (OR, 2.95; P=0.07), TT type in PDGFRα 1580T/C (OR, 2.82; P=0.09) or the GG type in PDGFRα -537G/T (OR, 3.00; P=0.085) showed the trend towards conferring thrombocytopenia. Conclusions: This study suggested that polymorphisms in specific gene related with pharmacokinetics or pharmacodynamics pathway might have an association with sunitinib toxicity of Asian mRCC patients. A better understanding of genetic determinants of sunitinib toxicity will help to optimize personalized drug treatment and keep off the severe complication induced by toxicity.
PTH-139 The effect of neo-adjuvant chemotherapy on the discrepancy between the eus and pathological staging of oesophageal cancer
Authors: MS Dorrington, JH Saunders, K Ragunath, SL Parsons
Journal: Gut (2015)

<h3>Introduction</h3> EUS plays an important role in the preoperative staging of oesophageal cancer with high sensitivity and specificity when determining TN stage. However, discrepancy remains between EUS and the pathological TN staging. The majority of patients now undergo neoadjuvant chemotherapy prior to resection which may result in downstaging the tumour if they respond to chemotherapy but may also lead to disease progression if the patient has no response during their 3 months of chemotherapy. We sought to determine whether the patient’s response to chemotherapy correlated with a difference in staging between EUS and pathology. <h3>Method</h3> A cohort of 107 patients that underwent staging EUS, neoadjuvant chemotherapy, surgical resection and histopathological examination were evaluated. EUS examinations took place at a high volume centre, by 4 different consultants, between July 2011 and July 2014. The patients were grouped according to their tumour regression grade (TRG), with a TRG of 1–3 considered a response to chemotherapy and a TRG of 4–5 considered resistance to chemotherapy. If the difference between EUS and pathology TN stage was greater than 1, the patient was considered to have been over or under-staged. <h3>Results</h3> Of the 107 EUS examinations, 26 were over-staged and 12 under-staged. Patients with a TRG 1–3 (n = 39), were never under-staged by 2, by either T or N. Eighteen T grades were over-staged: by 2 (n = 9), and by greater than 2 (n = 9). Three N grades were over-staged: this was by 2 (n = 3). Patients with a TRG 4–5 (n = 68) were more frequently under-staged than over-staged. One patient’s T grade was under-staged, by an under-estimation of 2. Eleven N grades were under-staged, this was by 2 (n = 6), and by greater than 2 (n = 5). Two T grades were over-staged, by 2 (n = 2). Four N grades were over-staged: by 2 (n = 3), and by greater than 2 (n = 1). There were 4 incomplete EUS examinations, all within TRG 4–5 group. There was no association between endoscopist and staging accuracy. <h3>Conclusion</h3> Patients with a TRG 1–3 were never distinctly under-staged, but were over-staged in 50% of cases. This is likely a reflection of the down staging of disease following response to neo-adjuvant chemotherapy. Those patients with a TRG 4–5 had a distinctly different EUS from pathological staging in 25% of cases, and this was twice as frequently under-staging than over staging, potentially reflecting disease progression. In conclusion, response to chemotherapy dramatically affects the perceived accuracy of EUS staging. <h3>Disclosure of interest</h3> None Declared.
Number of general practice comparison websites should be cut to one, recommends Health Foundation
Authors: Jacqui Wise
Journal: BMJ (2015)

The multitude of NHS and other public sector websites carrying information on the quality of care in general practices in England should be consolidated into a single site, an independent review by the Health Foundation recommends.1

The review was commissioned by the health secretary, Jeremy Hunt, in June. Alongside the announcement of the review, Hunt sent a message to NHS staff on the new deal for GPs referring to the concept of a publicly available general practice “scorecard.” He said that this “would help support quality improvement by providing unprecedented transparency …
The Effects of Compounds Related to Choline on Azo-Dye Carcinogenesis&lt;xref ref-type="fn" rid="fn1"&gt;1&lt;/xref&gt;
Authors: C. J. Kensler, E. Bierman, G. Condouris
Journal: JNCI Journal of the National Cancer Institute (1955)

The Effects of Compounds Related to Choline on Azo-Dye Carcinogenesis C. J. Kensler, C. J. Kensler Department of Pharmacology, Cornell University Medical College, New York, N. Y., and Arthur D. Little, Inc., Cambridge, Mass Search for other works by this author on: Oxford Academic PubMed Google Scholar E. Bierman, E. Bierman Department of Pharmacology, Cornell University Medical College, New York, N. Y., and Arthur D. Little, Inc., Cambridge, Mass Search for other works by this author on: Oxford Academic PubMed Google Scholar G. Condouris G. Condouris Department of Pharmacology, Cornell University Medical College, New York, N. Y., and Arthur D. Little, Inc., Cambridge, Mass Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 15, Issue Supplement_5, April 1955, Pages 1569–1570, https://doi.org/10.1093/jnci/15.Supplement_5.1569 Published: 01 April 1955
Should physician training centers offer formal psychiatric assistance to house officers? A report on the major findings of a prototype program
Authors: D B Borenstein
Journal: American Journal of Psychiatry (1985)

The literature suggests that the emotional needs of interns, residents, and fellows have received inadequate attention. Comprehensive psychiatric services are provided by a model program at UCLA. During the 1981-1983 academic years, 89 house officers were seen. Between 16% and 19% of certain groups sought help each year; depression was the most frequent diagnosis (63%, N = 56), followed by anxiety disorders (24%, N = 21). Over two-thirds of the evaluated residents entered free or low-fee treatment, and these therapies were generally considered quite beneficial. This report reemphasizes the desirability of providing carefully structured, confidential psychiatric assistance to house staff and documents medical trainees' acceptance and use of such programs.
Brief Report: Trends in Hospitalizations Due to Acute Coronary Syndromes and Stroke in Patients With Systemic Lupus Erythematosus, 1996 to 2012
Authors: Maria G. Tektonidou, Zhong Wang, Michael M. Ward
Journal: Arthritis & Rheumatology (2016)

Objective Cardiovascular disease (CVD) has been recognized as a major cause of morbidity in patients with systemic lupus erythematosus (SLE), but it is not clear whether increased awareness of these risks has translated into improvements in CVD morbidity at the population level. The aim of this study was to examine trends in hospitalization rates for CVD events in a representative sample of adult patients with SLE in the US from 1996 to 2012. Methods We used the Nationwide Inpatient Sample to estimate the rates of hospitalization for acute myocardial infarction (MI), unstable angina, and ischemic stroke from 1996 to 2012 in patients with SLE. We compared these trends with those in the general population. Results During the study years, there were an estimated 31,012 hospitalizations for acute MI, 4,160 hospitalizations for unstable angina, and 26,144 hospitalizations for ischemic stroke among patients with SLE. The rates of hospitalization for acute MI and ischemic stroke increased over time in patients with SLE, while the rates for unstable angina decreased. The rates for all 3 conditions decreased in the general population over these years, with hospitalization rates for unstable angina decreasing faster in the general population than in patients with SLE. Conclusion Increased awareness of the burden of CVD in patients with SLE has not yet translated into decreased rates of hospitalization for acute MI or stroke. This may be due to barriers in implementation of CVD risk factor modification or to SLE‐specific risks that have not yet been identified or effectively targeted.
Case 25-1989
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Cecil H. Coggins, John L. Niles, Robert Fienberg
Journal: New England Journal of Medicine (1989)

Presentation of CaseA 56-year-old man was admitted to the hospital because of hemoptysis.He was well until about three weeks earlier, when there was the onset of weakness, malaise, anorexia, and chilliness. A physician made a diagnosis of a "viral syndrome" and advised aspirin, without improvement. Six days before admission the patient went to another hospital, where a single posteroanterior x-ray film of the chest showed air-space disease in the right mid-lung zone. Erythromycin was begun, but he was again unimproved.One day before entry hemoptysis developed, and the patient was admitted to a second hospital. On examination the . . .
PWE-214 The management of incidentally diagnosed pancreatic neuroendocrine lesions: a new tool to evaluate risk of malignancy
Authors: L Mills, J Ramage, A Prachalias, P Srinivasan, K Menon, A Quaglia, N Heaton, D Sarker, P Ross, R Basuroy, R Srirajaskanthan
Journal: Gut (2015)

<h3>Introduction</h3> The regular use of CT scanning has increased the number of incidentally diagnosed, small, asymptomatic pancreatic neuroendocrine tumours (PNETs). Given their uncertain natural history, they pose a management dilemma. Whilst resection offers curative outcomes, the risks of surgery such as with a Whipple–s procedure have led many to adopt surveillance strategies. Patient selection criteria for surveillance lack definitive evidence. Diameter &lt;2cm is often used, but recent work suggests this may not be effective. In order to safely select patients for surveillance, a clearer understanding of the predictors of malignancy is needed. <h3>Method</h3> The notes of 233 patients with PNETs of all stages were reviewed for pathology reports. Tumours were defined as malignant if displaying local invasion, nodal involvement or distant metastasis (metachronous or synchronous). Predictors of malignancy were considered using logistic regression. <h3>Results</h3> Malignant characteristics were shown to correlate with tumour diameter (r<sup>2</sup>&gt;0.8). However, of 68 tumours &lt;2cm, 21 (31%) developed local or vascular invasion, 18 (28%) nodal metastasis and 16 (24%) distant metastasis. 164 tumours displayed malignant characteristics, 64 had no evidence of malignancy and data was unavailable for 5. Significant univariate predictors of malignancy included diameter (mean 21mm vs. 47mm, p &lt; 0.001), symptomatic presentation vs. asymptomatic (p &lt; 0.001), familial syndromes (p &lt; 0.022) and elevated serum CgA (p &lt; 0.001). Multivariate analysis showed that diameter, symptomatic presentation and elevated CgA were independent predictors of malignancy (p &lt; 0.001, p = 0.001, p = 0.019). The odds ratios were used to construct a model predicting malignancy, shown in Figure 1. <h3>Conclusion</h3> PNETs &lt;2cm often display malignant characteristics. A model incorporating diameter, CgA and symptoms can be used to predict malignancy, and this probability compared to the known risks of surgery in order to help patients and clinicians choose between surgery and surveillance. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Cherenfant, J. <i>et al</i>. Predicting aggressive behavior in nonfunctioning pancreatic neuroendocrine tumors. Surgery 2013;<b>154</b>:785–91; discussion 791–793
Mouse Poliomyelitis or Theiler's Mouse Encephalomyelitis&lt;xref ref-type="fn" rid="FN1"&gt;1&lt;/xref&gt;
Authors: Fred D. Maurer, Lt. Col., VC
Journal: JNCI Journal of the National Cancer Institute (1958)

Mouse Poliomyelitis or Theiler's Mouse Encephalomyelitis Get access Fred D. Maurer, Lt. Col., VC Fred D. Maurer, Lt. Col., VC Armed Forces Institute of Pathology, Washington, D. C. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 20, Issue 5, May 1958, Pages 871–874, https://doi.org/10.1093/jnci/20.5.871 Published: 01 May 1958
Cylindroid Lamella-Particle Complexes in Lymphoma Cells of Northern Pike (Esox lucius)
Authors: William G. Banfield, Clyde J. Dawe, Cecil E. Lee, Ron Sonstegard
Journal: JNCI Journal of the National Cancer Institute (1976)

Cells of the malignant lymphoma of northern pike of Canada contained cylindrical structures with central cores of cytoplasmic elements and walls composed of lamellae in a spiral arrangement, separated by ribosome-like particles or by membranes. These cylindroids were similar, if not identical, to structures in the cells of certain human lymphomas and leukemias. In cross and longitudinal sections, the lamellae showed a pattern of light and dark bands resulting in an approximately 95 A-period that has not been described in the human cylindroids.
Genomic Classification and Prognosis in Acute Myeloid Leukemia
Authors: Elli Papaemmanuil, Moritz Gerstung, Lars Bullinger, Verena I. Gaidzik, Peter Paschka, Nicola D. Roberts, Nicola E. Potter, Michael Heuser, Felicitas Thol, Niccolo Bolli, Gunes Gundem, Peter Van Loo, Inigo Martincorena, Peter Ganly, Laura Mudie, Stuart McLaren, Sarah O’Meara, Keiran Raine, David R. Jones, Jon W. Teague, Adam P. Butler, Mel F. Greaves, Arnold Ganser, Konstanze Döhner, Richard F. Schlenk, Hartmut Döhner, Peter J. Campbell
Journal: New England Journal of Medicine (2016)

Recent studies have provided a detailed census of genes that are mutated in acute myeloid leukemia (AML). Our next challenge is to understand how this genetic diversity defines the pathophysiology of AML and informs clinical practice.