tbuckley/cabot-search huggingface dataset:
PTH-056 Productive Endoscopy Project
Authors: N Taggart, J Lucking, C Eccles, C Cooper, K Kennedy, D Daw, L Williams, W Hymer, D Mcguinness, L Flavell, J Dahill, S Sarkar
Journal: Gut (2014)

<h3>Introduction</h3> In June 2012 the Royal Liverpool endoscopy department was chosen by NHS Improving Quality to be a pilot site for the development and implementation of a productive endoscopy toolkit. The outcome was improved efficiency, safety, patient experience and team-working. <h3>Methods</h3> The aim was to apply processes and cultures of lean thinking to endoscopy and complete a series of modules that increase safety, reliability of care, improve team performance and improve efficiency. A six month “diagnostic phase” involved collecting data on all aspects of the service to identify areas for improvement. A number of modules were completed that tackled the inefficiencies identified and involved the engagement of all staff groups. <h3>Results</h3> Stock: The “well organised unit” module identified £7,500 of redundant stock. Clearing the extra space meant equipment could be re-allocated, releasing two bed spaces in recovery. Enemas: 44% of patients were not compliant with their enemas. Of the 56% who were complaint 14% was ineffective. This impacted on the daily running of the department due to un-prepped patients. This has led to a different type of enema now being used along with the development of more detailed patient information. Department efficiency: Start/ Stop audit identified that 15% of the time, rooms were not utilised and 85% of time the list started late, due to staff or the room not being ready for the start of the morning session. Sharing this information with the teams led to more motivation and demonstrable leadership by senior Clinicians and Nursing staff to improve workforce compliance. 50% of lists finished late, 43% was due to complex procedures over-running this has led to stricter vetting and more points allocated for these procedures. Further data analysis has shown that Thursday and Friday run late 65% of the time due to endoscopists arriving late for the start of the afternoon session because of over-run clinics. This has led to a review of the scheduling template. Patient experience: Long waits were problematic for patients particularly, time after admission, prior to procedure, patients waited 12 to 90 mins and time spent post procedure, waiting for discharge, up to 210 mins. Discharges were also slower in the afternoon than in the evening. Review of skill mix and assigning specific roles to discharge will help to expedite effective and timely discharge. <h3>Conclusion</h3> Working through the innovative tools and processes of each module has allowed us to use an evidence based methodology for quality improvement. The use of advanced data collection has highlighted clearly what improvements are needed based upon facts and not assumptions. <h3>Disclosure of Interest</h3> None Declared.
TPA and CK-BB: New Tumor Markers in Leptomeningeal Carcinomatosis Secondary to Breast Cancer
Authors: F. BACH, G. SOLETORMOS, F. W. BACH, A. G. PEDERSEN
Journal: JNCI Journal of the National Cancer Institute (1990)

A recent Journal article (7) by Kenneth Bogen provides a useful review of cellkinetic multistage (CKM) models of carcinogenesis.Such models account for clonal proliferation of precancerous cell populations during tumorigenesis.However, Bogen incorrectly states on page 268 that we (2) gave "an erroneous treatment of CKM models" of carcinogenesis.Our treatment is not erroneous; rather, Bogen's paper is in error, as we shall now explain.We considered the case in which the volume of a clone of precancerous cells in stage / is w,{t) = af when the clone is of age t.Here a t and n are constants.Bogen observes correctly on page 269 that "If H^O = 1 for; = 1,. . .,k-1 (i.e., if no net intermediate cell growth is assumed), then the £-stage CKM model reduces to the &-stage multistage model."But then he asserts on page 270 that "cancer incidence rates approach zero as cell proliferation (i.e., as a or a,-) approaches zero."However, letting a, approach zero makes w^t) = a t f tend to zero, not to 1 as should be the case when there is no intermediate cell growth.In order to make w/ft) = 1, one must set a, -1 and n = 0. Bogen cites the expression (ab • • • a*-/ )/ ( " +l)( *~l ) on page 270 as the appropriate cancer incidence rate.He notes that this rate should be proportional to r*~' when there is no cell proliferation, and this is exactly true when we set n = 0 and a 0 . . .a k _, = 1.However, by mistakenly setting a 0 . . .a k _, = 0, Bogen did not obtain this agreement, and he falsely concluded that "all of the geometric CKM models must be erroneous."
P254 Identifying MMP-12 Substrates as Therapeutic Targets in COPD
Authors: B Mallia-Milanes, D Clements, A Sheehan, C Bolton, SR Johnson
Journal: Thorax (2012)

<h3>Background</h3> Matrix metalloprotease (MMP)-12 is a key protease in COPD which cleaves pulmonary extracellular matrix and non-matrix substrates. Variation in MMP-12 activity affects severity of COPD, yet the mechanism of this, including MMP-12’s non-matrix substrates in COPD lungs are unknown. Targeting MMP-12 substrates may lead to the development of drugs for COPD with reduced side effects compared to the broader spectrum MMP inhibitors. <h3>Aims</h3> To identify MMP-12 substrates of relevance to COPD and determine how their activity affects disease progression <i>in vitro</i> and <i>in vivo</i>. <h3>Methods</h3> <i>In vitro</i> cleavage assays: After literature review the pro-inflammatory mediators osteopontin and tumour necrosis factor (TNF)-α were selected as potential MMP-12 substrates in COPD. Both were incubated with MMP-12 and reaction products analysed by silver stain and western blot. EDTA was used as a metalloprotease inhibitor and thrombin as positive control. COPD cohort: Patients with COPD were recruited during exacerbations at the Nottingham University Hospitals NHS Trust. Sputum, lung function and other data were collected on Day 0 and 1 and 4 weeks later. Sputum was analysed by western blot for proteins of interest. The study was approved by the local research ethics committee and all patients gave informed consent. <h3>Results</h3> MMP-12 cleaved osteopontin and pro-TNF-α in a dose and time-dependent manner when visualised by silver staining. Cleavage was dependent on MMP-12 activity as it was inhibited by EDTA. Western blot of cleaved protein fragments gave a characteristic band signature. MMP-12 was present in sputum of patients with COPD as demonstrated by western blotting, ELISA and casein zymography. Western blot analysis of sputum with anti-osteopontin antibodies showed a similar band signature to the <i>in vitro</i> cleavage suggesting osteopontin is cleaved in the airways of patients with COPD. <h3>Discussion</h3> MMP-12 possesses proteolytic activity against osteopontin and pro-TNF-α <i>in vitro</i>. MMP-12, osteopontin and TNFα are present in COPD sputum and our data suggest that MMP-12 may target osteopontin in COPD. Further work is needed to determine the precise mechanisms of such MMP-12 substrate activity in COPD.
Neonatal Group B Streptococcal Disease — Screening and Prevention
Authors: Anne Schuchat
Journal: New England Journal of Medicine (2000)

During the 1990s, the incidence of disease caused by mother-to-child transmission of group B streptococcus fell by 65 percent, from 1.7 to 0.6 case per 1000 live births.1 The decline stemmed from the increased use of penicillin during labor in women at high risk for transmitting the infection to their newborns. Given this striking reduction in incidence, where do we go from here?Group B streptococcus became the leading cause of life-threatening infections in newborns during the 1970s. One woman in five is colonized with group B streptococcus in the gastrointestinal or genital tract. Infants become ill through aspiration of . . .
Abstract 4347: Anaplastic lymphoma kinase (ALK) expression is an independent prognostic factor in neuroblastoma patients and correlates well with ALK inhibitor response in vitro
Authors: Floor A.M. Duijkers, Jose Gaal, Jules P.P. Meijerink, Pieter Admiraal, Rob Pieters, Ronald R. de Krijger, Max M. van Noesel
Journal: Cancer Research (2011)

Abstract Introduction: ALK mutations are one of the most common genetic aberrations occurring in 3-11% of the neuroblastoma (NBL) patients and are considered oncogenic. We determined the role of ALK protein levels on survival of NBL patients. Secondly, we tested in vitro responsiveness to ALK inhibitors in NBL cell lines with and without ALK mutation. Results: Formalin-Fixed, Paraffin-Embedded material of 71 NBL, 12 ganglioneuroblastoma (GNBL) and 20 ganglioneuroma (GN) patients was stained for total ALK protein by immunohistochemistry (IHC). The percentage of ALK positive cells in IHC was stratified in 4 Ccategories; Category 1 (n=40): &amp;lt; 20% ALK-positive cells, category 2 (n=25): 20-50% ALK positive cells, category 3 (n=25): 50-75% ALK positive cells, and category 4 (n=13): 75-100% ALK positive cells. These categories correlate significantly with overall survival in the spectrum of NBL, GNBL and GN (p=0.002, Logrank test). ALK mutations were identified in 2/63 NBL (3.2%) and 2/11 GNBL (18.2%) patients by sequencing. Importantly, in NBL and GNBL patients, ALK protein expression remains a significant factor in a multivariate model (Cox Proportional Hazard model) including the COG risk stratification (p&amp;lt;0.000), which encompasses stage and NMYC status (see table). Further, we studied the role of ALK levels in the response to ALK inhibitors in vitro in NBL cell lines. ALK inhibitor response (TAE684) correlates well with ALK protein levels (r=−0.813, p=0.001). ALK point mutated cell lines show higher ALK levels and a better ALK inhibitor response (LC50 values 14.9 fold lower, p=0.004) than WT and amplified cell lines. In conclusion: ALK protein expression is an independent predictor of overall survival in NBL patients and ALK inhibitor response in vitro. ICH staining with ALK antibody is reliable and correlates well with prognosis. 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 4347. doi:10.1158/1538-7445.AM2011-4347
Screening for Breast Cancer
Authors: SUZANNE W. FLETCHER, WILLIAM BLACK, RUSSELL HARRIS, BARBARA K. RIMER, SAM SHAPIRO
Journal: JNCI Journal of the National Cancer Institute (1994)

Journal Article Screening for Breast Cancer Get access SUZANNE W. FLETCHER, SUZANNE W. FLETCHER Search for other works by this author on: Oxford Academic PubMed Google Scholar WILLIAM BLACK, WILLIAM BLACK Search for other works by this author on: Oxford Academic PubMed Google Scholar RUSSELL HARRIS, RUSSELL HARRIS Search for other works by this author on: Oxford Academic PubMed Google Scholar BARBARA K. RIMER, BARBARA K. RIMER Search for other works by this author on: Oxford Academic PubMed Google Scholar SAM SHAPIRO SAM SHAPIRO Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 86, Issue 7, 6 April 1994, Pages 558–559, https://doi.org/10.1093/jnci/86.7.558-a Published: 06 April 1994
Abstract 3784: Caloric restriction inhibits 1, 2-dimethylhydrazine-induced aberrant crypt foci formation and induces differential expression of sirtuins in colonic mucosa of F344 rats
Authors: Mariko Tomita, Sayuri Kanemoto, Mayumi Nakano, Yuri Matsui, Takamitsu Morioka, Changxu Cui, Naoki Yoshimi
Journal: Cancer Research (2010)

Abstract Caloric restriction (CR), a 20-40% lowering of caloric intake, is associated with longevity, and decreased incidences of age-related diseases including cancer. The sirtuins are a highly conserved family of nicotinamide adenine dinucleotide (NAD+)-dependent enzymes and have been implicated as a key mediator for the beneficial effects of CR on aging and longevity. However, the underlying mechanisms by which CR decreases cancer risk have not yet been elucidated. The present study was conducted to determine whether CR would modify the growth of preneoplastic colonic aberrant crypt foci (ACF), and whether sirtuin expression levels would be correlated with ACF formation. Five-week-old male F344 rats were randomly divided into four experimental groups. Groups 1 and 2 were given subcutaneous injection of 1, 2-dimethylhydrazine (DMH, 40 mg/Kg body weight), once a week for 2 weeks to induce ACF. Rats in groups 2 and 4 were fed a CR diet (60% of the ad libitum intake), and those in groups 1 and 3 were fed CE-2 diet (CLEA, Tokyo, Japan) ad libitum. All animals were sacrificed at 4 weeks after the first DMH injection. Rat colons were removed and fixed in 10% formalin. ACF were counted after 2% methylene blue staining. The expressions of sirt1 and sirt4 in the colonic mucosa were evaluated by RT-PCR. The number of ACF in colonic mucosa was significantly decreased in DMH-treated rats with CR (group 2) as compared to in DMH-treated rats without CR (group 1). No ACF was found in DMH-untreated animals with or without CR (groups 3 and 4). The expression levels of sirt1 and sirt4 in colonic mucosa were increased by CR (group 1 vs. group 2 and group 3 vs. group 4). Interestingly, DMH treatment also increased the expression of sirt1 and sirt4 (group 1 vs. group 3), and DMH-treated rats with CR (group 2) showed the highest expression levels of these genes. These results suggest that sirt1 and sirt4 induced by CR might inhibit colonic mucosa from formation and development of ACF. Our observations warranted further investigation of association between expression of sirtuins and prevention of colon carcinogenesis. We are currently analyzing the expression of other sirtuins and will compare the expression of all sirtuin family and ACF formation in colonic mucosa of the rats with or without CR. 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 3784.
The Combination Of Skin Prick Testing And Atopy Patch Testing Can Successfully Guide A Food Elimination/reintroduction Diet In EE
Authors: S.M. Maggadottir, J.M. Spergel, A. Cianferoni, T. Brown-Whitehorn, M.M. Shuker, C. Liacouras
Journal: Journal of Allergy and Clinical Immunology (2012)
AB0900 Kawasaki Diseasein Infants: Clinical Data of Kawasaki Patients in Tyrol from 2003-2012
Authors: E. Binder, J. Brunner, E. Griesmaier, T. Giner, M. Sailer-Hoeck
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Kawasaki disease (KD) is a rare vasculitis seen predominantly in children. In developing countries, it is the leading cause of childhood-acquired heart disease. Besides a case report from 1981 there have beenno data published dealing with the epidemiology and clinical aspects of KD in Austria. <h3>Objectives</h3> The purpose of the present study was to investigate the clinical spectrum of KDin an entire geographically determined cohort of infants that were diagnosed and treated at the University Hospital of Innsbruck from 2003-2012. <h3>Methods</h3> 32 patients were included in the study with a median age of 32.96 months (2-192). 59.4% of the patients were aged between six months and four years. The male-to-female ratio was 1:1.13. <h3>Results</h3> Clinical examination revealed non-purulent conjunctivitis and exanthema as the most common symptoms (84.4%). 75% showed oropharyngeal changes, 21.9% had gastrointestinal complaints such as diarrhoe, stomach ache or vomiting prior to diagnosis. One third of the patients were admitted with a preliminary diagnosis, whereas 78.1% were pre-treated with antibiotics.The median fever duration at the time of presentation was estimated with 4.96 days (1-14), at time of diagnosis 6.76 days (3-15).75% were diagnosed with complete, 25% with incomplete KD. There was no significant difference in the duration of fever neither between complete and incomplete KD nor between the different age groups.Typical laboratory findings included increased C-reactive protein (CRP) (80.6%) and erythrocyte sedimentation rate (ESR) (96%),leukocytosis (48.4%) and thrombocytosis (40.6%) without any significant quantitative difference between complete and incomplete KD.Coronary complications could be observed in six patients, one with a coronary aneurysm and five with tubular dilatation of the coronary arteries.Our patient cohort represents the age distribution as described in literature and emphasizes that KD could affect persons of any age. The frequency of occurrence of the clinical symptoms differs from previous reports – whilst peripheral desquamation is reported as one of the most common symptom, in our study, we predominantly observed non-purulent conjunctivitis and exanthema. <h3>Conclusions</h3> KD should always be considered as a differential diagnosis in a child or adult with fever of unknown origin, as treatment can significantly decrease the frequency of coronary complications. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.4872
Heparin-Associated Thrombocytopenia
Authors: Douglas B. Cines, Paul Kaywin, Mahin Bina, Ann Tomaski, Alan D. Schreiber
Journal: New England Journal of Medicine (1980)

We studied the mechanism of platelet injury in 20 patients receiving heparin, three of whom became thrombocytopenic. Platelets from these three patients had increased levels of IgG and C3, which correlated with the presence of thrombocytopenia; their plasma caused the release of serotonin from normal platelets at concentrations of heparin within the usual therapeutic range. This reaction required IgG and an intact classic complement pathway. The 17 patients receiving heparin in whom thrombocytopenia did not develop had normal levels of platelet-associated IgG and C3. Plasma from 14 of these patients caused the release of serotonin, but only at heparin concentrations above the therapeutic range, in a reaction that also required IgG and complement. The addition of heparin to 15 normal plasma samples did not cause platelet injury in vitro. These studies indicate that heparin administration can be associated with complement-mediated platelet injury. The dose-dependent nature of this process may account for the occurrence of thrombocytopenia in some of these patients. (N Engl J Med. 1980; 303:788–95.)
Hypertension with Inappropriate Aldosterone Stimulation
Authors: A. Richard Christlieb, Roger B. Hickler, David P. Lauler, Gordon H. Williams
Journal: New England Journal of Medicine (1969)

Two Negro patients with hypertension failed to achieve sodium balance after six to nine days on a diet containing 10 mEq of sodium and 100 mEq of potassium. Whereas plasma renin activity and plasma angiotensin II showed a normal response to sodium depletion, the aldosterone secretion rate (ASR) was inappropriately low. After ACTH stimulation, a normal increase in both the ASR and glucocorticoid excretion was observed. Each patient was able to conserve sodium when given desoxycorticosterone acetate or when endogenous aldosterone was stimulated by ACTH. The data suggest that in these patients, hypoaldosteronism is secondary to defective stimulation of aldosterone by angiotensin II. It is proposed that the elevated blood pressure is causally related to this defect.
Autoantibodies to GABA-ergic Neurons and Pancreatic Beta Cells in Stiff-Man Syndrome
Authors: Michele Solimena, Franco Folli, Roxanne Aparisi, Guido Pozza, Pietro De Camilli
Journal: New England Journal of Medicine (1990)

Stiff-man syndrome is a rare disorder of the central nervous system of unknown pathogenesis. We have previously reported the presence of autoantibodies against glutamic acid decarboxylase (GAD) in a patient with stiff-man syndrome, epilepsy, and insulin-dependent diabetes mellitus. GAD is an enzyme selectively concentrated in neurons secreting the neurotransmitter gamma-aminobutyric acid (GABA) and in pancreatic beta cells.
TWO-YEAR CLINICAL OUTCOME OF BIODEGRADABLE POLYMER BIOLIMUS-ELUTING STENTS FOLLOWING ROTATIONAL ATHERECTOMY FOR SEVERE CALCIFIED LESIONS COMPARED WITH DURABLE POLYMER EVEROLIMUS-ELUTING STENTS
Authors: Hiroyuki Jinnouchi, Shoichi Kuramitsu, Takashi Morinaga, Takashi Hiromasa, Yohei Kobayashi
Journal: Journal of the American College of Cardiology (2015)
Case 12-1993
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, David S. Lazarus, Eugene J. Mark
Journal: New England Journal of Medicine (1993)

Presentation of CaseA 44-year-old man was admitted to the hospital because of a nonproductive cough and dyspnea.The patient had been well until 25 months earlier, when hematochezia, diarrhea, and urgency of stool passage developed. Sigmoidoscopic examination showed erythema, edema, and friability of the rectum, and microscopical examination of a biopsy specimen revealed active chronic proctitis, with ulceration, cryptitis, and crypt-abscess formation; examination of specimens stained for fungi, amebae, and acid-fast bacilli was negative. The patient disliked topical therapy, and prednisone (30 mg daily) was begun four months before admission. His symptoms resolved, and prednisone was tapered and discontinued . . .
S17 Pleural Irrigation Trial (PIT): Standard Care Versus Pleural Irrigation, a Randomised Controlled Trial in Patients with Pleural Infection
Authors: CE Hooper, AJ Edey, AJ Wallis, AO Clive, AJ Morley, M Darby, N Zahan, JE Harvey, AR Medford, NA Maskell
Journal: Thorax (2012)

<h3>Background</h3> Pleural infection remains common with an increasing incidence. It is associated with a high morbidity and mortality. Despite chest tube drainage and antibiotic therapy up to 30% of patients will die or require surgery. Case reports suggest that irrigation of the pleural space with saline may be beneficial but this has never been the tested in the form of a randomised controlled trial. <h3>Method</h3> Randomised controlled pilot study comparing saline irrigation (250ml normal saline intra-pleurally over one hour, 3 times a day for 3 days) plus best standard care, with best standard care alone, in patients with pleural infection (microbiology positive or pH&lt;7.2 or purulent pleural fluid and clinical infection) requiring chest tube drainage, who had a residual pleural collection on baseline CT thorax. Primary outcome was percentage change in CT pleural volume from day 0 to day 3. Secondary outcomes included referral for surgery, hospital stay and adverse events. <h3>Results</h3> 47 patients approached, 38 randomised, 3 excluded (drain fell out/no residual fluid on CT/removal of consent). Saline irrigation results in significant reduction in CT pleural collection volume compared to standard care – Irrigation group 29.15% reduction (95% CI 16.2–62) vs Standard care 13.9% (95% CI –4.1–26.3) p&lt;0.04. There was also a significant reduction in the need for thoracic surgery in the irrigation group 9/17 vs 2/18 p=0.01 (OR 9.0, 95% CI 1.56–51.9). No differences were seen in length of hospital stay or fall in inflammatory markers (CPR, WCC and procalcitinin). The safety profile of saline irrigation was good with no serious complications and adverse events did not differ between groups. <h3>Conclusion</h3> Saline irrigation improves fluid drainage in pleural infection (as measured by volumetric CT), leading to reduction in referral for surgery. No change in hospital stay was noted. This study now needs to be repeated as a large multicentre RCT powered to look at mortality and length of hospital stay.