tbuckley/cabot-search huggingface dataset:
PWE-087 Colonoscopy demand and adherance to polyp surveillance guidelines
Authors: J Butterworth, S Hafiz
Journal: Gut (2012)

<h3>Introduction</h3> Demand for colonoscopy is projected to increase by 5–10% per annum. Many units are struggling to match the demand to existing capacity. A significant proportion of endoscopy unit workload is related to follow-up colonoscopy in patients with a previous history of colorectal adenomas. Non-adherence to the BSG polyp surveillance guidelines could result in either excess demand for colonoscopy or inappropriate delays in diagnosing advanced colorectal neoplasia. <h3>Methods</h3> We retrospectively searched the Trust9s endoscopy database (catchment population 520 000) to assess our compliance to the BSG Polyp Surveillance guidelines (originally published in 2002). We chose different time periods to study including 2002, 2005–2006, 2009 (50 patients each) and 2011 (100 patients). We had previously conducted an audit in 2010 (unpublished) and following this embarked on a programme of endoscopist education to improve compliance data. <h3>Results</h3> Compliance with the BSG Polyp Surveillance guidelines was 33% in 2002, 65% in 2005/2006, 57% in 2009 and 98% in 2011. Based on our unit9s activity 3832 colonoscopies were performed in 2011 with an overall polyp detection rate of 34.6% (1325.9 colonoscopies). 98% compliance with BSG guidelines would have resulted in inappropriate advice being given in 26.5 of those colonoscopies. For every 10% reduction in compliance against the BSG standard (and for our unit based on 2011 figures) an additional 123.5 polyp positive colonoscopies would receice inappropriate guidance on polyp follow-up. In our experience (unpublished), inappropriate advice results in an increase in frequency of follow-up colonoscopies as endoscopists overestimate the patient9s future risk of advanced colorectal neoplasia. This potentially has huge resource and organisation implications. <h3>Conclusion</h3> We demonstrate a big improvement in compliance with the BSG polyp surveillance guidelines at our unit following a period of endoscopist education in 2010. With demand for colonoscopy projected to rise 5%–10% year on year and with limited ability to increase capacity under current financial constraints, appropriate patient selection for colonoscopy is essential. Failure to comply with the BSG guidelines has significant financial, organisational and patient implications. We recommend all units validate waiting lists for patients on a polyp surveillance programme. <h3>Competing interests</h3> None declared.
P209 Standardisation Of Lung Clearance Index In A Multicentre Clinical Trial
Authors: D. Armstrong, K. Bayfield, E. Alton, A. Boyd, S. Cunningham, H. Elgmati, D. Gill, U. Griesenbach, T. Higgins, S. Hyde, J. Innes, C. Saunders, E. Spearing, J. Davies
Journal: Thorax (2014)

<h3>Introduction</h3> Lung clearance index (LCI) is a sensitive and repeatable non-invasive measure of ventilation inhomogeneity derived from the multiple breath washout (MBW) technique. It is more sensitive to early lung disease than traditional lung function measurements. Before it can be adopted as a primary endpoint in multicentre trials, it must be demonstrated that it can be applied with minimal inter-operator variability. LCI is a major secondary outcome in our gene therapy multidose trial. <h3>Aim</h3> To assess LCI achievability and intra- and inter-site agreement. <h3>Method</h3> 136 CF patients at two sites with FEV<sub>1 </sub>50–90% predicted were randomly allocated on a 1:1 basis to receive 12 monthly nebulised doses of active gene therapy product or placebo. LCI was performed in triplicate on seven occasions for each subject using a MBW technique completed on an Innocor<sup>TM</sup> device using 0.2% SF<sub>6</sub>. Stringent quality control criteria have been developed, including offset calculations and minimal acceptable differences between tests. LCI was calculated using customised offline analysis software (SimpleWashout, Igor Pro) by a single operator at each site. To test inter-operator agreement, every seventh MBW from each timepoint was randomly selected, without subject duplication, and used to calculate LCI values by both operators separately. <h3>Results</h3> A total of 854 LCIs were performed during the trial, and technically acceptable measurements were achieved in 95.9% and 94.2% of tests at the two sites (mean 94.8%). 118 (13.8%) of LCIs were analysed independently by two operators, with a full range LCI values represented (range 7.24–19.21). The 95% limits of agreement (LoA) for LCI values were -0.04 to 0.04 (mean difference 0.00) and for FRC values were -0.01 to 0.01 (mean difference 0.00). <h3>Conclusions</h3> Our results demonstrate that LCI is an achievable outcome measure in a multicentre trial in 94.8% of attempts. Separate offline analysis completed by two operators, with appropriate training and knowledge of the test, produces mean LCI and FRC inter-site differences of 0.00. LCI is feasible and appropriate for use as a surrogate endpoint in multicentre clinical trials using stringent methodology.
Retraction: Darsee JR, Heymsfield SB. Decreased myocardial taurine levels and hypertaurinuria in a kindred with mitral-valve prolapse and congestive cardiomyopathy. N Engl J Med 1981; 304:129-35.
Authors: Steven B. Heymsfield, James F. Glenn
Journal: New England Journal of Medicine (1983)

Editorial from The New England Journal of Medicine — Retraction: Darsee JR, Heymsfield SB. Decreased myocardial taurine levels and hypertaurinuria in a kindred with mitral-valve prolapse and congestive cardiomyopathy. N Engl J Med 1981; 304:129-35.
“Tomatophagia” and Iron-Deficiency Anemia
Authors: Mark A. Marinella
Journal: New England Journal of Medicine (1999)

The Risks of Lowering the Cesarean-Delivery RateTo the Editor: Sachs et al. (Jan.7 issue) 1 are incorrect in their assumption that programs designed to reduce the rate of cesarean delivery center on increasing the number of operative vaginal deliveries (the use of forceps and vacuum extractors).Quite to the contrary, we have found that physicians who perform fewer cesarean sections tend to perform fewer operative vaginal deliveries (14.9 percent, as compared with a rate of 20.7 percent among those who perform more cesarean sections). 2These same physicians also have lower rates of use of epidural analgesia and induction of labor, but they more often monitor the fetal heart rate and encourage ambulation during labor.The goal of recent programs, such as the "breakthrough series" collaborative, 3 has been to help all clinicians involved in perinatal care to learn the techniques of providers who are able to deliver obstetrical care safely without resorting to unnecessary interventions.The ultimate intervention is cesarean delivery.Thus, learning to improve obstetrical care leads to lower rates of cesarean delivery as a secondary effect.
SAT0192 Post-hoc analysis to assess effect of belimumab in patients on mycophenolate mofetil with renal manifestations at baseline:
Authors: F. Houssiau, M.A. Dooley, C. Aranow, D. D’Cruz, A. Askanase, D.A. Roth, S. Cooper, Z.J. Zhong, W. Freimuth, E.M. Ginzler
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Mycophenolate mofetil (MMF) is an accepted induction and maintenance therapy in lupus nephritis. In the phase 3 BLISS-52 (NCT00424476) and BLISS-76 (NCT00410384) SLE trials, patients on MMF at baseline (BL) treated with belimumab + standard therapy demonstrated an enhanced treatment differential in the composite SLE Responder Index endpoint: 24.6%. 36.1% and 52.2% with placebo (standard therapy alone), and belimumab 1 and 10 mg/kg, respectively. <h3>Objectives</h3> To determine whether there was additional benefit from belimumab in patients with renal involvement receiving MMF in the BLISS trials. <h3>Methods</h3> Patients with BL renal manifestations treated with MMF ± belimumab were assessed for improvement in renal parameters (by reduction in BILAG A/B/C scores and SELENA-SLEDAI). <h3>Results</h3> 189 patients were on MMF at BL. 29.6% had ≥1 renal SELENA-SLEDAI item; 15.3% had BILAG renal A/B and 40.2% had renal C scores; 40.2% had proteinuria &gt;0.5 g/24 h. Renal SELENA-SLEDAI improvement was seen by wk 52 in 27.8%, 52.6%, and 63.2% of patients with placebo, and belimumab 1 and 10 mg/kg, respectively (table). Assessment of BILAG renal improvement (requiring BL A/B scores) was difficult due to the small numbers of patients: 3/8 (37.5%), 4/9 (44.4%), and 7/12 (58.3%) improved with placebo, and belimumab 1 and 10 mg/kg, respectively; of patients with BL BILAG A/B/C, the corresponding numbers were 7/35 (20.0%),11/34 (32.4%), and 11/36 (30.6%). <h3>Conclusions</h3> The BLISS trials excluded patients with severe active lupus nephritis. The sample size for this analysis was reduced by restricting analysis to patients taking MMF at BL. The data, however, suggest that belimumab may provide additional benefit in patients with SLE with continued renal activity despite treatment with MMF. <h3>Disclosure of Interest</h3> F. Houssiau Consultant for: GlaxoSmithKline/Human Genome Sciences, M. Dooley Grant/Research support from: GlaxoSmithKline/Human Genome Sciences, Consultant for: GlaxoSmithKline/Human Genome Sciences, C. Aranow Grant/Research support from: GlaxoSmithKline/Human Genome Sciences, Consultant for: GlaxoSmithKline/Human Genome Sciences, D. D'Cruz Consultant for: GlaxoSmithKline/Human Genome Sciences, A. Askanase: None Declared, D. Roth Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline, S. Cooper Shareholder of: Human Genome Sciences, Employee of: Human Genome Sciences, Z. Zhong Shareholder of: Human Genome Sciences, Employee of: Human Genome Sciences, W. Freimuth Shareholder of: Human Genome Sciences, Employee of: Human Genome Sciences, E. Ginzler Grant/Research support from: GlaxoSmithKline/Human Genome Sciences, Consultant for: GlaxoSmithKline/Human Genome Sciences
Speech as a breakthrough signaling resource in the cognitive evolution of biological complex adaptive systems
Authors: Tobias A Mattei
Journal: Behavioral and Brain Sciences (2014)

Abstract In self-adapting dynamical systems, a significant improvement in the signaling flow among agents constitutes one of the most powerful triggering events for the emergence of new complex behaviors. Ackermann and colleagues' comprehensive phylogenetic analysis of the brain structures involved in acoustic communication provides further evidence of the essential role which speech, as a breakthrough signaling resource, has played in the evolutionary development of human cognition viewed from the standpoint of complex adaptive system analysis.
AB1246 Reproducible metacarpal joint space thickness measurements using 3D analysis of images acquired with high-resolution peripheral quantitative computed tomography (HR-PQCT)
Authors: C. Barnabe, H. Buie, M. Kan, S.G. Barr, L. Martin, S.K. Boyd
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Joint space narrowing from cartilage loss in RA is associated with irreversible physical disability (1). HR-pQCT, a novel instrument capable ofaccurately and reproducibly imaging bone microstructure at a nominal isotropic voxel dimension of 82 micrometres, shows promise in the longitudinal monitoring of erosion development and repair (2), and may also be the ideal technology for detecting small changes in joint space width over time. <h3>Objectives</h3> To assess the reproducibility of a 3D metacarpal joint space thickness measurement with repositioning. <h3>Methods</h3> The 2nd and 3rd MCPs of the dominant hand of early rheumatoid arthritis and control subjects were imaged using HR-pQCT (Scanco Medical AG, Brüttisellen, Switzerland). Grayscale data was binarized using the standard patient analysis method to extract bone from the surrounding soft tissue. The periosteal contours are smoothed, and the masks of the smoothed bones are subtracted from the final image to yield a mask of the joint space. The joint space is measured in 3D using the method of "fitting maximal spheres" which provides a distribution of joint space thickness. <h3>Results</h3> Seventeen joints were imaged twice, with repositioning between series. The mean joint space width of the 2nd MCP was 1.82 mm (SD 0.20) and of the 3rd MCP was 1.84 mm (SD 0.23). Reproducibility with repositioning was excellent, with overlapping filtered histograms and a root square mean coefficient of variance of 4.8%. <h3>Conclusions</h3> We have devised an analytical method to provide precise measurements of metacarpal joint space width, robust to changes in joint position. This method shows excellent potential for analyzing joint space width measurements in longitudinal studies, where repositioning error is of concern. <h3>References</h3> Aletaha D, et al. Ann Rheum Dis. 2011 May;70(5):733-9. Finzel S, et al. Ann Rheum Dis. 2011 Sep;70(9):1587-93. <h3>Disclosure of Interest</h3> None Declared
What is your diagnosis in this iTest?
Authors: G Ansede, J C Lee, J C Healy, A W Mitchell
Journal: British Journal of Sports Medicine (2011)

Acute anterior glenohumeral dislocation (figure 1).

The plain radiographs show an anterior glenohumeral dislocation (figure 1).

The MR arthrographic image (figure 2) taken 2 years after dislocation of the glenohumeral joint shows a displaced thickened antero-inferior glenoid labrum or Bankart lesion. The presence of the subscapularis tendon anteriorly helps to locate this image below the level of the glenoid equator.

Imaging features indicative of a Bankart lesion following traumatic anterior glenohumeral dislocation were confirmed on arthroscopy and the patient underwent arthroscopic Bankart repair with a speedy uneventful recovery.

Glenohumeral instability refers to subluxation or dislocation of the humeral head and this may have a traumatic or atraumatic aetiology. In the absence of an acute episode of anterior glenohumeral dislocation, it can be a challenging diagnosis to make.

The glenohumeral joint relies on the interplay of multiple soft tissue components for stability and control as the bony restraint, mainly the relatively small shallow glenoid concavity, is minimal. The advantage of little bony restraint is a wide range of motion. The disadvantage is an inherent unstable relationship between the large humeral head and the shallow smaller glenoid, analogous to a golf ball on a tee. Therefore the glenohumeral joint offers the widest range of motion in the body but it …
Is Steroid-Induced Osteoporosis Preventable?
Authors: Pierre J. Meunier
Journal: New England Journal of Medicine (1993)

Osteoporosis is the most serious side effect of long-term corticosteroid therapy. The bone mass in corticosteroid-treated patients is reduced in the forearm, spine, and proximal femur, with more loss in trabecular than in cortical bone. The bone mass lost varies from 10 to 40 percent, depending on the site examined, the dose and duration of corticosteroid therapy, the particular corticosteroid used, and the disease treated. The tendency of corticosteroids to damage trabecular bone more than cortical bone is reflected in the greater loss of lumbar mineral density assessed in the lateral projection than in the anteroposterior projection1. More important, . . .
SAT0022 In Rheumatoid Arthritis, Younger Age at Onset is Associated with a Higher Rate of Remission at 1 Year: Results from a French Cohort of Early Arthritis Patients (Espoir Cohort)
Authors: T. Krams, A. Ruyssen-Wtrand, D. Nigon, B. Fautrel, F. Berenbaum, A. Cantagrel, A. Constantin
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Rheumatoid arthritis (RA) is a chronic disease characterized by a peak incidence in the fourth and fifth decades of age. Despite several cross-sectional and a few prospective studies, it has not been clearly established whether there are important clinical differences between early-onset and late-onset RA. <h3>Objectives</h3> To investigate whether age at disease onset determines clinical, radiographic or functional outcomes in a cohort of early RA. <h3>Methods</h3> The ESPOIR cohort is a longitudinal, prospective, multicenter, observational study that included adult patients with early arthritis. Patients fulfilling the 2010 ACR/EULAR criteria for RA over the first 3 years of follow-up were selected for the present study (n=698). Patients were pooled into 3 groups according to their age at RA onset: &lt;45 years (early-onset [EORA], n=266), 45 to 60 years (intermediate-onset [IORA], n=314) and &gt;60 years (late-onset [LORA], n=118). The following outcomes were compared at baseline and over the first 3 years of follow-up according to the age at disease onset: SDAI remission rate, total Sharp score and HAQ-DI score. <h3>Results</h3> The main baseline characteristics of RA patients were as follows: median (IQR) age = 50.3 (39.8-57.2) years, female = 78.2%, median (IQR) SDAI = 28.5 (20.6-38.6), median (IQR) HAQ-DI score = 1 (0.5-1.5), RF+ = 53%, ACPA+ = 45%. Outcomes of interest are shown at baseline and over the first 3 years of follow-up according to the age at disease onset (Table). <h3>Conclusions</h3> In a cohort of early RA patients, a younger age at disease onset is associated with a higher rate of remission at 1 year, a lower radiographic score at baseline and thereafter over the 3-year follow-up period and a lower functional score at 1 year and thereafter over the 3-year follow-up period. The analysis of the potential impact of treatment modalities on these age-related differences is under process. <h3>Disclosure of Interest</h3> None Declared
Visual and Quantitative Analysis of Ictal Cerebral Perfusion SPECT in Comparison to High Resolution MRI and EEG in Partial Epilepsy
Authors: D H Lewis, D Rosenbaum, J Overbeck, S Ferency, J Donat, M D Holmes
Journal: Clinical Nuclear Medicine (1998)

s Presented At The 22Nd Annual Western Regional Meeting Of The Society Of Nuclear Medicine October 1997
Abstract 78: Epigenetic regulation of the metastatic progression of non-small cell lung cancer by the histone H3K9 methyltransferase SETDB1
Authors: Tsai-Yu Tzeng
Journal: Cancer Research (2011)

Abstract Aberrant histone methylation is contributes to tumor development and progression by histone methyltransferase. SETDB1 is an authentic H3K9 methyltransferase that contributes to the epigenetic silencing of target genes in cancer cells, but the role of SETDB1 function in mediating tumor metastasis has not been reported. We show here that H3K9Me2 and SETDB1 are down-regulated in metastatic lung cancer cell lines. Ectopic expression of SETDB1 in highly invasive lung cancer cells suppressed cancer cell migration, invasion and filopodia formation. In contrast, knockdown of endogenous SETDB1 in non-invasive lung cancer cells by RNA interference increases cell migration and invasion in vitro. Mechanistic investigations suggested that SETDB1 is specifically down-regulated by miR-29b in metastatic lung cancer cells. Ectopic miR-29b expression in non-invasion lung cancer cells increases cell invasion ability. These results indicate that SETDB1 contributes to the repressive role and concomitant dysregulation of epigenetic pathways in lung cancer progression. 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 78. doi:10.1158/1538-7445.AM2011-78
Effect of Histamine on Gastric Peptic Secretion in Man
Authors: Emanuel Friedman, Irving Poliner, Howard M. Spiro
Journal: New England Journal of Medicine (1957)

PARENTERAL administration of histamine leads to a marked outpouring of acid and a transient rise in pepsin concentration in the gastric juice. Whether this rise in pepsin concentration is the result of stimulation of pepsin production or whether it represents the "washout" of preformed pepsinogen has been a matter of dispute. Most recorded opinion favors the concept that the parietal cells pour acid out into a canaliculus from which pepsinogen, previously secreted by the chief cells, is passively carried. Previous conclusions about the meaning of blood pepsin levels in relation to gastric secretion have been based in part on this . . .
AB0904 Anti-Mullerian Hormone in A Cohort of Young Adult Women with Juvenile Idiopathic Arthritis
Authors: M.C. Miceli, L. Messuti, A. Barini, S. Canestri, M.R. Gigante, A. Barini, B. Tolusso, E. Gremese, G. Ferraccioli
Journal: Annals of the Rheumatic Diseases (2014)

Tamoxifen is an antiestrogen drug commonly used to treat breast cancer and has been shown to cause prolongation of the electrocardiographic QT interval in humans. Because QT prolongation could influence cardiac arrhythmias, we sought to determine the electrophysiologic mechanism(s) underlying the tamoxifen action. The whole-cell patch-clamp technique was used to study the effect of tamoxifen on the delayed rectifier (I<sub>Kr</sub>), the inward rectifier (I<sub>K1</sub>), the transient outward current (I<sub>to</sub>), and the inward L-type calcium current (I<sub>Ca</sub>) in rabbit ventricular myocytes. By switching to the current-clamp mode, the effect of tamoxifen on action potential duration (APD) was also studied. Tamoxifen blocked I<sub>Kr</sub> in a time-, concentration- and voltage-dependent fashion. I<sub>Kr</sub> tail currents were completely blocked by 10 μmol/l tamoxifen with no recovery after 15 min of washout. At +50 mV, tamoxifen 1 and 3.3 μmol/l blocked I<sub>Kr</sub> by 39.5 ± 1.7% (P &lt; .01) and 84.8 ± 1.3% (P &lt; .01) respectively, while no significant block of I<sub>K1</sub> or I<sub>to</sub> was observed. Significant block of I<sub>Ca</sub> by tamoxifen was also observed at concentrations greater than 1 μmol/l, with almost complete inhibition at 10 μmol/l. Tamoxifen showed no significant effect on APD at concentrations up to 3.3 μmol/l. We conclude that tamoxifen potently blocks both I<sub>Kr</sub> and I<sub>Ca</sub> at clinically relevant concentrations. The observed QT prolongation by tamoxifen in humans may be a result of its predominant effect on I<sub>Kr</sub>. Inhibition of I<sub>Kr</sub>, in conjunction with other QT-prolonging factors in patients could increase their risk of developing torsades de pointes-type cardiac arrhythmias.
Prognosis Model for Overall Survival in Locally Advanced Pancreatic Cancer (LAPC): An Ancillary Study of the Lap 07 Trial
Authors: D. Vernerey, P. Hammel, S. Paget-Bailly, F. Huguet, J.L. Van Laethem, D. Goldstein, B. Glimelius, P. Artru, M. Moore, T. André, L. Mineur, B. Chibaudel, C. Louvet, F. Bonnetain
Journal: Annals of Oncology (2014)
Bizarre Clinical Manifestations of Hyperthyroidism
Authors: Earle M. Chapman, Farahe Maloof
Journal: New England Journal of Medicine (1956)

THE diagnosis of hyperthyroidism is usually easy A for the physician. The classic manifestations of the disease are quickly recognized even by those with little clinical experience. Although textbooks refer to masked hyperthyroidism, clinical descriptions of occult forms of the disease are singularly meager. Sattler,1 an ophthalmologist, recognized and carefully described many of these bizarre forms late in the nineteenth century. We are presenting case histories in some detail for the physician who is interested in following the deceptive preludes, the confirmation of the diagnosis and the response to treatment of patients whose hyperthyroidism was masked or bizarre in its . . .
Should we discard the needle stylet during EUS-FNA?
Authors: J.-M. Dumonceau
Journal: Endoscopy (2011)

I read with interest a recent article comparing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of identical lesions with vs. without the needle stylet [1]. The authors’ conclusion ”Use of the stylet with EUS-FNA does not increase the yield for malignancy” is unconvincing due to methodological flaws.