tbuckley/cabot-search huggingface dataset:
PTU-312 Patients referred straight to test for suspected upper gastro intestinal malignancy and normal endoscopy need further investigation: Abstract PTU-312 Table 1
Authors: M Cheryala, A Sainsbury, S Everett
Journal: Gut (2015)

<h3>Introduction</h3> Straight to Test (STT) Oesophagogastroduodenoscopy (OGD) is a referral pathway for General Practitioners (GP) for suspected cancer (red flag) symptoms of the Upper Gastrointestinal (UGI) tract. Pathways vary between organisations, many of which discharge patients following a normal OGD. Here we report the outcome of further investigation of patients with a normal upper endoscopy. <h3>Method</h3> Data were gathered retrospectively from STT referrals over a 3 month period (January – March 2012) at Leeds Teaching Hospitals NHS Trust, UK. Patients with simple dyspepsia and a normal OGD were discharged; those with weight loss underwent CT scan and clinic review. Electronic records were reviewed for further investigations and outcomes. Data were compared to a similar audit in 2009 in the same hospital. <h3>Results</h3> Of 298 STT endoscopy referrals 16 were excluded, due to failure to attend for OGD (8) or incomplete or inappropriate procedure (8). 282 patients underwent STT OGD; age range: 20 to 91 yrs, mean: 66 yrs, 44% males. In comparison, in the previous audit 200 patients were referred over a 6 month period. Presenting symptoms included: dysphagia 114 (40%), dyspepsia 98 (34%) and unintentional weight loss 91 (32%). UGI and non-UGI cancer was identified in 17 (6.02%) and 16 (5.67%) of patients, respectively; the corresponding figures from the 2009 audit were 13 (6.5%) and 7 (4.0%). Of the 17 identified UGI cancers, 9 (52.9%) were oesophageal, 7 (41.2%) gastric and 1 (5.9%) gastro-oesophageal junction. Other findings included peptic ulcer 20 (7.1%) and oesophagitis 10 (3.5%). Patients with a normal OGD and alarm symptoms (84) underwent further investigation, usually CT (65). The 16 cancers identified outside the UGI tract were pancreatic (3), lung (3), lymphoma (2), CLL (1), renal (2), ampullary (1), liver- HCC (1), parathyroid (1), colorectal (1) and ovarian (1). The positive predictive value (PPV) of individual symptoms is shown in the table; the PPV of dysphagia plus weight loss for UGI cancer was 23.07%. <h3>Conclusion</h3> Since 2009, suspected UGI cancer referrals have tripled, yet detection of UGI and non-UGI malignancy combined remains over 10%. UGI malignancy was identified in 1 in 4 patients presenting with the combination of dysphagia and weight loss. For patients referred with suspected UGI cancer and no significant finding on endoscopy, further targeted investigation is recommended. <h3>Disclosure of interest</h3> None Declared.
Collagenases
Authors: Edward D. Harris, Stephen M. Krane
Journal: New England Journal of Medicine (1974)

Specific Involvement of Collagenase in Normal Physiology and PathologyRheumatoid Arthritis — Synovial CollagenaseIn chronic active rheumatoid arthritis two principal mechanisms for joint destruction have been postulated: one is mechanical, and the other enzymatic. In the former, it has been proposed, without direct demonstration, that fragmentation and mechanical breakdown can occur after depletion of proteoglycans from cartilage matrix and other connective-tissue components. Articular cartilage in arthritis remote from granulations is frequently depleted of proteoglycans.137 Cartilage in this state has a diminished capacity to resist deformation156 and could be more easily fragmented by stress such as weight-bearing. However, it is . . .
BMJ Awards South Asia 2016: Nominate a healthcare champion today
Authors: Jeetha D’Silva
Journal: BMJ (2016)

Help The BMJ celebrate all the best in South Asian healthcare, with winners to be announced at a ceremony in New Delhi on 19 November, writes <b>Jeetha D’Silva</b>. Submit your nominations now at southasiaawards.bmj.com—and good luck!
Deferiprone‐induced agranulocytosis: 20 years of clinical observations
Authors: Fernando Tricta, Jack Uetrecht, Renzo Galanello, John Connelly, Anna Rozova, Michael Spino, Jan Palmblad
Journal: American Journal of Hematology (2016)

Use of the iron chelator deferiprone for treatment of iron overload in thalassemia patients is associated with concerns over agranulocytosis, which requires weekly absolute neutrophil counts (ANC). Here, we analyze all episodes of agranulocytosis ( n = 161) and neutropenia ( n = 250) during deferiprone use in clinical trials (CT) and postmarketing surveillance programs (PMSP). Rates of agranulocytosis and neutropenia in CT were 1.5% and 5.5%, respectively. Of the agranulocytosis cases, 61% occurred during the first 6 months of therapy and 78% during the first year. These events appeared to be independent of dose, and occurred three times more often in females than males. Their duration was not significantly shortened by use of G‐CSF. No patient with baseline neutropenia ( n = 12) developed agranulocytosis during treatment, which raises questions about the validity of prior neutropenia as a contraindication to use. Only 1/7 novel neutropenia cases in CT progressed to agranulocytosis with continued treatment, indicating that neutropenia does not necessarily lead to agranulocytosis. The agranulocytosis fatality rate was 0% in CT and 15/143 (11%) in PMSP. Rechallenge with deferiprone produced agranulocytosis in 75% of patients in whom the event had already occurred, and in 10% with previous neutropenia. Weekly ANC monitoring allows early detection and interruption of therapy, but does not prevent agranulocytosis from occurring. Its relevance appears to decrease after the first year of therapy, when agranulocytosis occurs less often. Based upon analysis of data collected over the past 20 years, it appears that patient education may be the key to minimizing agranulocytosis‐associated risks during deferiprone therapy. Am. J. Hematol. 91:1026–1031, 2016. © 2016 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc.
Case 26-1975
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, Bennett M. Stein, Edward P. Richardson
Journal: New England Journal of Medicine (1975)

Presentation of CaseA 19-year-old male high-school student from Taiwan was admitted to the hospital because of a question of a spinal-cord tumor.He was well until 13 months previously, when pain developed in the left anterior aspect of the chest above the nipple and spread to the upper portion of the sternum. The pain was increased on coughing or straining. Numbness occurred in the same area and spread caudally to involve the right and then the left lower extremity; there was progressive weakness of both legs, especially the right. Urinary frequency and constipation developed, and he had occasional penile . . .
Colonic perforation following endoscopic mucosal resection in a patient on bevacizumab treatment
Authors: Evangelos Kalaitzakis, Roald Havre, Gro Willemoe, Søren Meisner
Journal: Endoscopy (2016)

An 81-year-old woman who had previously undergone left hemicolectomy for an adenocarcinoma (pT3 N1) of the descending colon was diagnosed with a 2-cm flat polyp in the transverse colon during surveillance colonoscopy ([Fig. 1 a]). Subsequently, she also developed liver metastases and underwent three cycles of neoadjuvant chemotherapy with leucovorin, 5-fluorouracil, irinotecan, and bevacizumab (325 mg per cycle).
Case 35-1964
Authors: Arnold S. Relman, Edward M. Darmady
Journal: New England Journal of Medicine (1964)

Presentation of CaseA thirty-one-year-old woman entered the hospital because of hypertension.She had been in good health until five months previously, when she began to experience urinary frequency and urgency with occasional urinary incontinence, accompanied by loss of weight, sweating and morning headaches. Hypertension and proteinuria were found on examination by a physician. An intravenous pyelographic study (Fig. 1) performed at another hospital five weeks before admission disclosed kidneys of normal size without obstruction, although contrast material was excreted in poor concentration bilaterally.The patient's first pregnancy three and a half years earlier had been uneventful; during her second . . .
P1047 : Controlled attenuation parameter (CAP): Combination of M and XL probe improves feasibility and accuracy for discriminating advanced grades of steatosis
Authors: T. Karlas, N. Garnov, F. Lindner, H. Busse, N. Linder, A. Schaudinn, B. Relke, R. Chakaroun, M. Tröltzsch, V. Keim, J. Wiegand
Journal: Journal of Hepatology (2015)
Daily Dilemmas
Authors: Julie R Rosenbaum
Journal: Annals of Internal Medicine (2011)

On Being a Doctor20 December 2011Daily DilemmasJulie R. Rosenbaum, MDJulie R. Rosenbaum, MDFrom Yale University, New Haven, CT 06520.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-12-201112200-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail As a primary care physician, sometimes the smallest requests can create the biggest challenges.Between patients, I peeked at my electronic inbox. Among the usual prescription refills, there was a request for a callback from Mrs. Talbot, a spry elderly patient of mine with well-controlled high blood pressure, osteoarthritis, and a remote history of cancer. She was an active participant at the local senior center, had lunch regularly with friends on her fixed income, and loved to talk about her grandchildren. Speaking with her would probably brighten my day.“Every year, I receive a subsidy from the state to help ... Author, Article, and Disclosure InformationAffiliations: From Yale University, New Haven, CT 06520.Corresponding Author: Julie R. Rosenbaum, MD, Yale University, Primary Care Internal Medicine Residency, Waterbury Hospital Health Center, PO Box 208030, New Haven, CT 06250; e-mail, julie.[email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 20 December 2011Volume 155, Issue 12Page: 855-856KeywordsElderlyHospital medicineOsteoarthritisPatient advocacyPatientsPrimary hypertensionResidencySleep apneaType 1 diabetes ePublished: 20 December 2011 Issue Published: 20 December 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Prophylaxis of hereditary angioedema attacks: A randomized trial of oral plasma kallikrein inhibition with avoralstat
Authors: Emel Aygören-Pürsün, Markus Magerl, Jochen Graff, Inmaculada Martinez-Saguer, Wolfhart Kreuz, Hilary Longhurst, Iman Nasr, Murat Bas, Ulrich Straßen, Lei Fang, Melanie Cornpropst, Sylvia Dobo, Phil Collis, William P. Sheridan, Marcus Maurer
Journal: Journal of Allergy and Clinical Immunology (2016)
Principles and uses of HIV incidence estimation from recent infection testing - a review
Authors: S Le Vu, J Pillonel, C Semaille, P Bernillon, Y Le Strat, L Meyer, J  C Desenclos
Journal: Eurosurveillance (2008)

Since the 1990s, the development of laboratory-based methods has allowed to estimate incidence of human immunodeficiency virus (HIV) infections on single samples. The tests aim to differentiate recent from established HIV infection. Incidence estimates are obtained by using the relationship between prevalence, incidence and duration of recent infection. We describe the principle of the methods and typical uses of these tests to characterise recent infection and derive incidence. We discuss the challenges in interpreting estimates and we consider the implications for surveillance systems. Overall, these methods can add remarkable value to surveillance systems based on prevalence surveys as well as HIV case reporting.The assumptions that must be fulfilled to correctly interpret the estimates are mostly similar to those required in prevalence measurement. However, further research on the specific aspect of window period estimation is needed in order to generalise these methods in various population settings.
Acquired nonmalignant esophagotracheobronchial fistula. Report of 36 cases
Authors: A. R. Wychulis
Journal: JAMA (1966)

Acquired nonmalignant esophagotracheobronchial fistulas are rare. The chief causes are infection and trauma. The pathognomonic complaint is a strangulating sensation occurring several seconds after the ingestion of liquids or solids. Nine of the fistulas in our study were esophagotracheal and 27 were esophagobronchial. The fistula was delineated roentgenographically in every case in which radiopaque material was introduced into the esophagus. Bronchography should be used to exclude the presence of pulmonary complications which often develop during the course of this disease. These fistulas are best treated by direct surgical repair through a cervical or transpleural approach, depending on their location. The result was successful in 13 of the 14 patients treated by this method.
Risks and Population Burden of Cardiovascular Diseases Associated with Diabetes in China: A Prospective Study of 0.5 Million Adults
Authors: Fiona Bragg, Liming Li, Ling Yang, Yu Guo, Yiping Chen, Zheng Bian, Junshi Chen, Rory Collins, Richard Peto, Chunmei Wang, Caixia Dong, Rong Pan, Jinyi Zhou, Xin Xu, Zhengming Chen
Journal: PLoS Medicine (2016)

Background In China, diabetes prevalence is rising rapidly, but little is known about the associated risks and population burden of cardiovascular diseases. We assess associations of diabetes with major cardiovascular diseases and the relevance of diabetes duration and other modifiable risk factors to these associations. Methods and Findings A nationwide prospective study recruited 512,891 men and women aged 30–79 y between 25 June 2004 and 15 July 2008 from ten diverse localities across China. During ~7 y of follow-up, 7,353 cardiovascular deaths and 25,451 non-fatal major cardiovascular events were recorded among 488,760 participants without prior cardiovascular disease at baseline. Cox regression yielded adjusted hazard ratios (HRs) comparing disease risks in individuals with diabetes to those without. Overall, 5.4% (n = 26,335) of participants had self-reported (2.7%) or screen-detected (2.7%) diabetes. Individuals with self-reported diabetes had an adjusted HR of 2.07 (95% CI 1.90–2.26) for cardiovascular mortality. There were significant excess risks of major coronary event (2.44, 95% CI 2.18–2.73), ischaemic stroke (1.68, 95% CI 1.60–1.77), and intracerebral haemorrhage (1.24, 95% CI 1.07–1.44). Screen-detected diabetes was also associated with significant, though more modest, excess cardiovascular risks, with corresponding HRs of 1.66 (95% CI 1.51–1.83), 1.62 (95% CI 1.40–1.86), 1.48 (95% CI 1.40–1.57), and 1.17 (95% CI 1.01–1.36), respectively. Misclassification of screen-detected diabetes may have caused these risk estimates to be underestimated, whilst lack of data on lipids may have resulted in residual confounding of diabetes-associated cardiovascular disease risks. Among individuals with diabetes, cardiovascular risk increased progressively with duration of diabetes and number of other presenting modifiable cardiovascular risk factors. Assuming a causal association, diabetes now accounts for ~0.5 million (489,676, 95% CI 335,777–681,202) cardiovascular deaths annually in China. Conclusions Among Chinese adults, diabetes is associated with significantly increased risks of major cardiovascular diseases. The increasing prevalence and younger age of onset of diabetes foreshadow greater diabetes-attributable disease burden in China.
PD-025 RECOURSE trial: impact of adverse events on quality of life and duration of TAS-102 (trifluridine and tipiracil) treatment
Authors: J. Tabernero, J. Mayer Robert, A. Ohtsu, T. Yoshino, R. Garcia-Carbonero, A. Pastorino, M. Peeters, R. Winkler, L. Makris, M. Wahba, A. Zaniboni, Y. Shimada, K. Yamazaki, Y. Komatsu, H. Hochster, H.-J. Lenz, A. Falcone, B. Tran, E. Van Cutsem
Journal: Annals of Oncology (2016)
Abstract 36: Diet Soda Consumption and Risk of Incident End-stage Renal Disease
Authors: Casey M Rebholz, Morgan E Grams, Lyn M Steffen, Deidra C Crews, Cheryl A Anderson, Lawrence J Appel, Josef Coresh
Journal: Circulation (2016)

Introduction: Diet soda consumption may be associated with kidney disease, as shown in Caucasian women, due to phosphorus content, by increasing dietary acid load, or as a proxy for poor diet quality. However, less is known about the relationship between diet soda consumption and end-stage renal disease (ESRD) risk in the general population. Methods: We conducted a prospective analysis of time-varying diet soda consumption and incident ESRD in the population-based Atherosclerosis Risk in Communities study (N=15,369) using Cox regression. Usual dietary intake was assessed by a food frequency questionnaire in 1987-89 (baseline) and 1993-95. Incident ESRD was defined as initiation of renal replacement therapy (transplant, dialysis) through 2011. Results: Baseline mean age was 54 years, 55% were female, 27% were African-American, 12% had diabetes, and 35% had hypertension. Approximately a third of participants consumed &lt;1 glass of diet soda per month; 42% of participants consumed up to 6 glasses/week; and 22% consumed more than 6 glasses/week. Over a median follow-up of 23 years, 357 incident ESRD cases were observed. Consuming up to 6 glasses of diet soda per week and more than 6 glasses of diet soda per week, respectively, was associated with 1.28-times (95% CI: 0.96, 1.70; p=0.10) and 1.95-times (95% CI: 1.43, 2.64; p&lt;0.001) greater risk of ESRD relative to &lt;1 glass/month after adjusting for total caloric intake, sugar-sweetened beverages, diet quality, age, sex, race-center, estimated glomerular filtration rate, diabetes, hypertension, overweight/obesity status, education level, smoking status, and physical activity (p-value for trend &lt;0.001; Figure ). For each additional glass of diet soda consumed per day, there was a 26% higher risk of ESRD (HR: 1.26; 95% CI: 1.14, 1.40; p&lt;0.001). Sugar-sweetened beverage consumption was not association with ESRD. Conclusion: Diet soda consumption was associated with ESRD risk and may be an important target for dietary interventions aimed at slowing kidney disease progression.
The host STING pathway at the interface of cancer and immunity
Authors: Leticia Corrales, Sarah M. McWhirter, Thomas W. Dubensky, Thomas F. Gajewski
Journal: Journal of Clinical Investigation (2016)

A major subset of human cancers shows evidence for spontaneous adaptive immunity, which is reflected by the presence of infiltrating CD8+ T cells specific for tumor antigens within the tumor microenvironment. This observation has raised the question of which innate immune sensing pathway might detect the presence of cancer and lead to a natural adaptive antitumor immune response in the absence of exogenous infectious pathogens. Evidence for a critical functional role for type I IFNs led to interrogation of candidate innate immune sensing pathways that might be triggered by tumor presence and induce type I IFN production. Such analyses have revealed a major role for the stimulator of IFN genes pathway (STING pathway), which senses cytosolic tumor–derived DNA within the cytosol of tumor-infiltrating DCs. Activation of this pathway is correlated with IFN-β production and induction of antitumor T cells. Based on the biology of this natural immune response, pharmacologic agonists of the STING pathway are being developed to augment and optimize STING activation as a cancer therapy. Intratumoral administration of STING agonists results in remarkable therapeutic activity in mouse models, and STING agonists are being carried forward into phase I clinical testing.
Physician-level variation in the diagnosis of myocardial infarction and the use of angiography among Veterans with elevated troponin
Authors: David E. Winchester, Nayan Agarwal, Lucas Burke, Steven Bradley, Tatiana Schember, Carsten Schmalfuss
Journal: Military Medical Research (2016)

Cardiac troponin assays have improved the ability to detect myocardial damage. However, ascertaining whether troponin elevation is due to myocardial infarction (MI) or secondary to another process can be challenging. Our aim is to evaluate provider-level variation in the diagnosis of MI and the use of invasive coronary angiography (ICA) among patients with undifferentiated elevations in cardiac troponin.We analyzed data from all patients with elevated troponin levels in a single Veterans Affairs (VA) Medical Center between 2006 and 2007. One of several cardiologists prospectively evaluated each patient's presentation and course of care. We compared the frequency of MI diagnosis and ICA use between physicians using univariate odds ratios (OR).Among 761 patients, 34.0 % were diagnosed with MI and 25.9 % underwent ICA. The unadjusted rates of MI (23.9 to 56.7 %, P = 0.02) and ICA (17.3 to 73.3 %, P < 0.001) differed between physicians. Comparing the patient cohorts for each physician, baseline characteristics were similar except for chest pain. In multivariate regression, factors associated with the use of cardiac ICA included an abnormal electrocardiograph (ECG) (OR = 1.89, P = 0.014), level of troponin (OR = 1.71, P = 0.004), chest pain (OR = 8.60, P < 0.001), and care by non-VA physicians (OR = 4.45, P = 0.006). One physician had a lower ICA use (OR = 0.56, P = 0.017). In multivariate regression of MI, no physician-level variation was observed.Among patients with elevated troponin, the likelihood of being diagnosed with MI and undergoing ICA is dependent on their clinical presentation. After adjustment, physician-level variation in care was observed for the use of ICA, but not for the diagnosis of MI.
Case 24-1971
Authors: Richard C. Cabot, Benjamin Castleman, Betty U. McNeely, Anne P. Forbes, Robert E. Scully
Journal: New England Journal of Medicine (1971)

Presentation of CaseA 32-year-old woman was admitted to the hospital because of amenorrhea of four years' duration.The menses had been irregular since the menarche. She had often had no menstrual periods for two or three months, but occasionally more that one episode of bleeding occurred per month. Ten years before entry the patient began to notice the gradual development of hirsutism on the face, chest, back, legs and abdomen, associated with temporal recession of the hairline. She had to shave daily. She had been obese since childhood and remembered having weighed 75 kg in the sixth grade. The . . .
Spontaneous CD4 and CD8 Memory T Cell Responses Against MUC1 and Carcinoembryonic Antigen in Bone Marrow of Multiple Myeloma Patients.
Authors: Mathias Witzens-Harig, Dirk Hose, Michael Hundemer, Simone Juenger, Anthony D. Ho, Hartmut Goldschmidt, Philipp Beckhove
Journal: Blood (2007)
Psychosurgery — Justifiable?
Authors: Lawrence C. Kolb
Journal: New England Journal of Medicine (1973)

Today, in spite of the public agitation and rhetorical violence — as well as the amount of attention and time given to the subject of psychosurgery — the protedure is uncommon in this country. Not a single psychosurgical procedure was carried out last year for patients with severe mental illness in the hospitals under the direction of the New York State Department of Mental Hygiene, the largest mental-hospital system in the country, if not the world. Yet some procedures are done —usually in the university medical centers — for those referred for presumably intractable psychiatric disorders, for recurrent episodes of . . .