tbuckley/cabot-search huggingface dataset:
Intact removal of seven metal stents from the bile duct in a single endoscopic session
Authors: S. Iqbal, T. Pitea, S. Stavropoulos
Journal: Endoscopy (2011)

An 89-year-old woman who had undergone placement of multiple uncovered biliary metal stents (Wallstent; Boston Scientific, Natick, Massachusetts, USA) over the previous 10 years for an indeterminate distal common bile duct (CBD) stricture was referred to us for an attempt at removal of the stents. She had recently been undergoing monthly sessions of endoscopic retrograde cholangiopancreatography (ERCP) to clean the stents as treatment of recurrent cholangitis.
P96 A New Interactive Game Device May Improve Compliance With Spacer Devices In Very Young Children
Authors: C. Murray, S. Shakir, T. Aslam
Journal: Thorax (2014)

<h3>Background</h3> The use of spacers in young children is not always easy and can result in distressed children and parents. We aimed to develop and assess an interactive electronic game to improve ease of use and potentially compliance with inhalers in young children. <h3>Methods</h3> The Respiratory Aid For Inhalers (RAFIhaler) consists of an electronic sensor adjacent to the outflow valve of a spacer mask, providing input every 0.1 seconds to a custom designed android application on a smartphone that is mounted, in full view of the child, on top of the spacer. The application displays on-screen characters designed to respond to correct breathing as part of a game storyline, for example by blowing away characters unfriendly to the hero (RAFI) or blowing his boat across a river. The RAFIhaler was developed through iterative testing and multiple redesigns of hardware and software until a satisfactory final module was completed. This module was tested on 14 children admitted to hospital with acute wheeze by an independent researcher, along with a survey to assess the child’s reaction and the parent and child’s perceived benefit from RAFIhaler. Open-ended questions allowed further feedback. <h3>Results</h3> Fourteen children (2–7 yrs, 7M:7F) participated; 13 children and 14 parents completed the survey. All children stated they enjoyed the activity. Eleven children responded further; 10(91%) felt the RAFIhaler helped them taking medication. All but one parent felt that RAFIhaler helped their child use the spacer. Of the thirteen parents who felt the RAFIhaler helped, three felt their child previously really struggled with the inhaler. Some benefits of RAFIhaler voiced by parents were: enjoyable (3); good distraction (3); made child calmer (2); helped in breathing/inhalation technique (3); would be useful at home (1). One parent felt RAFIhaler was not of benefit as they felt their child already took their inhaler well. <h3>Conclusions</h3> Children universally found using the RAFIhaler with their spacer enjoyable. The majority of parents felt the RAFIhaler helped their child take their medicine. The RAFIhaler may be of use both in encouraging young children to use their inhaler/spacer, and in combatting anxiety and stress associated with their use.
Induction of Menstrual Disorders by Strenuous Exercise in Untrained Women
Authors: Beverly A. Bullen, Gary S. Skrinar, Inese Z. Beitins, Gretchen von Mering, Barry A. Turnbull, Janet W. McArthur
Journal: New England Journal of Medicine (1985)

We performed a prospective study of 28 initially untrained college women with documented ovulation and luteal adequacy to determine whether strenuous exercise spanning two menstrual cycles would induce menstrual disorders. To ascertain the influence, if any, that weight loss might exert, we randomly assigned the subjects to weight-loss and weight-maintenance groups. Subjects were expected to run 4 miles (6.4 km) per day, progressing to 10 miles (16.1 km) per day by the fifth week, and to engage daily in 3 1/2 hours of moderate-intensity sports. The normalcy of the menstrual cycles during the period of exercise was judged independently according to clinical and hormonal criteria, the latter comprising serial measurements of gonadotropin and sex-steroid excretion. A higher percentage of abnormalities proved to be detectable by hormonal means (P<0.02). Only four subjects (three in the weight-maintenance group) had a normal menstrual cycle during training. In the weight-loss group, the number of women who had luteal abnormalities as compared with those who lost the surge in luteinizing hormone altered significantly over time, the latter occurring more frequently (P<0.01) as training progressed. Within six months of termination of the study, all subjects were again experiencing normal menstrual cycles. We conclude that vigorous exercise, particularly if compounded by weight loss, can reversibly disturb reproductive function in women. (N Engl J Med 1985; 312:1349–53.)
SAT0135 Modified antitnf dose patterns in clinical practice: Achieving clinical control with minimum effective dosages:
Authors: J.C. Nieto González, L. Martínez-Estupiñan, D. Hernández, N. Bello, M. Hinojosa, L. Valor, M. Montoro, A. García-Monforte, J. Lόpez-Longo, C. González, I. Monteagudo, L. Carreno, I. de la Torre
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> In the management of rheumatoid arthritis (RA) patients, the election of the drug and dosage needs to be personalized considering each particular subject conditions. <h3>Objectives</h3> Assessclinical characteristics, disease activity and concomitant treatment in patients with RA treated with diverse anti-TNF dosage strategies. Estimate annual associated costs (2011). <h3>Methods</h3> Cross-sectional study (2011) conducted at the Hospital Universitario Gregorio Marañόn Rheumatology Department. Inclusion criteria: patients diagnosed of RA (ACR 1987 revised criteria); attending routine follow-up visit; treated with anti-TNF: etanercept (ETN), adalimumab (ADA) or infliximab (IFX). Main variables were drug administered, dosage regimen, disease activity (DAS28) and concomitant treatment (DMARD). Anova test was using to compare groups. Doses where calculated based on percentage of dose, considering 100% the stardard dose in RA (ETN 50mg once weekly; ADA 40mg every other week; IFX 3 mg/kg/8 weeks). Escalated and reduced doses were defined as those higher and lower than standard doses respectively. Associated annual costs were estimated based on national pricing including tax. <h3>Results</h3> The study evaluated 195 patients (79% women, mean age 58.1). The distribution by anti-TNF used was n: 81 ETN, N: 56 ADA and n: 58 IFX. There were significant differences between years to first biologic from diagnosis (IFX:7.5, ETAN: 5.7 and ADA: 5.9, p:0.03) and % of patients with previous biologic drugs (IFX:,12.7, ETN: 36.7, ADA: 29.7, p:0.04) Dose regimens and estimated costs are shown in the Table. Regarding disease activity, 61.73% and 64.29% of patients were good responders (DAS 28&lt;3.2) in the ETN and ADA groups, versus 48.28% in the IFX but cross-sectional DAS28 value was similar between groups (ETN: 2.7±1.5, ADA: 2.6±1.5), IFX: 3.2±1.5, p=0.6). ETN patients were less likely to use concomitant DMARD (58.02% vs 66.07% in ADA vs 79.31% in IFX), <h3>Conclusions</h3> Choosing a minimum effective dose is important to achieve the goal of effectiveness while reducing adverse events and costs. ETN seems to be associated with lower doses and less concomitant DMARDs while maintaining clinical control in RA patients. <h3>Disclosure of Interest</h3> None Declared
AB0341 Experience of tocilizumab usage in chronic renal insufficiency stipulated by aa-amyloidosis due to rheumatoid arthritis complication
Authors: A. Alexeeva, Y. Mouraviev, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Uremia stipulated by AA-amyloidosis is one of basic lethal causes in rheumatoid arthritis (RA) pts in Russia. <h3>Methods</h3> RA pts resistant to earlier therapy with chronic renal insufficiency, stipulated by morphologically confirmed AA-amyloidosis. Tocilizumab in dosage of 8mg/kg of body weight was administrated iv every 4 weeks for the period of observation, with regular control of integral index DAS28, creatinin clearance (ml/min), amyloid A (mg/l), proteinuria (g/24Hr). <h3>Results</h3> The study included 5 RA pts – women with medial age of 56.6±1.8 years, medial arthritis duration 18.8±5.5 with morphologically confirmed AA-amyloidosis (bioptates: kidneys -1 pt, duodenal mucous – 4 pts), with moderate renal function insufficiency: creatinin clearance (CrCl) – 36.0±3.7 ml/min, active inflammatory process – averagely DAS28was equal to 5.8±0.8, median amyloid A 61.3±19.2. Disease modifying anti-rheumatic drugs (DMARD) applied earlier to all pts – Metotrexate, Leflunomide and three of them –FNO-a - Infliximab, Humira, were withdrawn due to inefficacy or unfavorable reactions. Average period of Tocilizumab therapy was 7 months (10 months – 1, 7 months – 3, 4 months – 1 pt). At the end of observation the following indices were seen: CrCl increase to 49.2±6.7, SAA decrease 18.8±10.2 and DAS28 index – 3.2±0.8 (p&lt;0.005). Proteinuria was considerably diminished in 2 and disappeared in 1 pts. There were no adverse effects, requiring withdrawal of Tocilizumab. <h3>Conclusions</h3> Our experience allows us to discuss the expedience of Tocilizumab usage in chronic renal insufficiency, stipulated by AA-amyloidosis, complicating RA and resistant to traditional DMARD and FNO-a inhibitors. <h3>Disclosure of Interest</h3> None Declared
Cancer Program Becomes Case Study in Public Policy Formation
Authors: L. Fintor
Journal: JNCI Journal of the National Cancer Institute (1991)

Journal Article Cancer Program Becomes Case Study in Public Policy Formation Get access Lou Fintor Lou Fintor Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 83, Issue 24, 18 December 1991, Pages 1785–1789, https://doi.org/10.1093/jnci/83.24.1785 Published: 18 December 1991
Abstract 2014: An estrogen receptor - centered network for probing anti-estrogen drug resistance with siRNA screening technology
Authors: Rochelle E. Nasto, Ilya Serebriiskii, Sandra A. Jablonski, Michael D. Johnson, Robert Clarke, Louis M. Weiner, Erica A. Golemis
Journal: Cancer Research (2010)

Abstract De novo and acquired drug resistance pose significant problems for the effective treatment of estrogen-receptor (ER) positive breast cancers. We hypothesized that changes in the action of proteins interacting with core components of the estrogen response machinery may be responsible for such resistance, and that inhibition of these proteins may modulate response to hormonal therapies. To test this idea, we created a 631 gene network using ERα (ESR1), ERβ (ESR2), estrogen related receptors α (ESRRA) and γ (ESRRG), and aromatase as seed genes. The addition of genes to the network was selectively based on connectedness to the 5 seed genes. We used a set of bioinformatic resources including protein-protein interactions (PPIs), protein complexes, canonical pathways and estrogen responsive genes, to generate candidates for insertion into this network. An siRNA library has been developed from these 631 genes, for use in screening of breast cancer cell lines. Our primary goal is to identify networks of candidate genes involved in resistance to estrogen pathway-targeted drugs, corresponding to genes that reduce cell viability specifically in the presence of the hormonal therapies fulvestrant and tamoxifen. We have used MCF7/LCC1 cells (tamoxifen sensitive/fulvestrant sensitive), MCF7/LCC2 (tamoxifen resistant/fulvestrant sensitive) and MCF7/LCC9 (tamoxifen resistant/ fulvestrant resistant) cell lines as syngeneic models with varying drug resistance profiles for these experiments. In addition, we are identifying genes that differentially affect the intrinsic viability of these cell lines, and thus should illuminate the mechanism of their resistance to hormonal therapies. Our goal is to elucidate a network of regulators of anti-estrogen resistance. 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 2014.
PWE-108 Toxin A-specific antigen-activated and memory B cells in the circulation of patients with<i>Clostridium difficile</i>infection
Authors: T M Monaghan, A Robins, H F Sewell, Y R Mahida
Journal: Gut (2012)

<h3>Introduction</h3> In <i>Clostridium difficile</i> infection, antibody-mediated immune response to secreted toxins A and B (which are also the main virulence factors) appears to be important in determining the nature of clinical disease. During a bacterial infection, activation of B cells leads to loss of immunoglobulin (Ig) D and expression of antigen-specific Ig on the cell surface. Following resolution of infection, antigen-specific memory B cells may be detectable in the circulation. Our aim was to identify circulating toxin A-activated B cells during clinical disease and toxin A-specific memory B cells following resolution of <i>C difficile</i> infection. <h3>Methods</h3> Purified <i>C difficile</i> toxin A was labelled with Alexa Fluor 488 (toxin A<sup>488</sup>) and its biological activity and specificity of fluorescence were confirmed using Vero cells and anti-toxin A antibody, respectively. Peripheral blood mononuclear cells (PBMNCs) were obtained from 20 patients [13 female, 7 male; median age 67 yrs (range 32–96 yrs)] with <i>C difficile</i> infection, within 10 days of diarrhoeal onset. For flow cytometry, PBMNCs were incubated on ice in the dark for 1 h in the absence or presence of toxin A<sup>488</sup>. After washing, cells were labelled with anti-CD19-ECD (B cell marker) and anti-IgD-PE (to identify antigen-activated IgD-negativecells). PBMNCs were also polyclonally stimulated in vitro for 6 days to induce differentiation of memory B cells to antibody secreting cells (ASCs). Enzyme-linked immunospot (ELISPOT) assays were used to quantify toxin A-specific IgG ASCs and expressed as percentage of total IgG ASCs. Toxin A-specific IgG antibody levels in sera were studied by ELISA. Data are expressed as median (range). <h3>Results</h3> Compared to control buffer, a significantly greater proportion of events (flow cytometry) were seen in the CD19-positive, IgD-negative gate in PBMNCs exposed to toxin A<sup>488</sup> [0.09% (0%–0.54%) vs 0.92% (0.09%–1.78%); p&lt;0.001]. In four patients studied at the same time as flow cytometry, toxin A-specific ASCs were detected by ELISPOT assays (0.04%–2%). In studies over 4 (1–10) months after infection, toxin A-specific ASCs were observed [0.33 (0.07–2.12)%]. Serum anti-toxin A antibodies were detectable in eight patients at the time of clinical disease and in four patients, the antibody levels increased over the following 6 (2–10) months. <h3>Conclusion</h3> (1) A small population of toxin A-specific, antigen-activated B cells can be detected in the circulation soon after <i>C difficile</i> infection. (2) In addition to circulating antibody, toxin A-specific memory B cells can be detected over many months after <i>C difficile</i> infection. (3) Future studies can investigate the relationship between the development of B cell responses to <i>C difficile</i> toxins and the nature of clinical disease. <h3>Competing interests</h3> None declared.
Abstract 3630: Fat intake interacts with cigarette smoking to alter lung cancer risk.
Authors: Jianjun Zhang, Hideo Tanaka, Hidemi Ito, Keitaro Matsuo
Journal: Cancer Research (2013)

Abstract Although cigarette smoking is the primary cause of lung cancer, it alone cannot explain large difference in risk of this malignancy worldwide. During the last three decades, age-adjusted male lung cancer mortality rates have been remarkably higher in Hungary than in Japan, but per capita cigarette consumption has remained lower in Hungary than in Japan. A similar pattern of difference has been observed between other Asian and western countries, (e.g., China, South Korea, Poland, and the US). It remains unclear why this lung cancer paradox occurs. Lung cancer incidence is generally high in countries with high intake of saturated fat. In addition, animal studies revealed a synergistic effect of fat and tobacco carcinogens on the development of lung tumors. Therefore, it is possible that different types of fat interact with cigarette smoking to modulate lung cancer risk. We sought to investigate this hypothesis in a hospital-based case-control study conducted from 2000 to 2005 in Nagoya, Japan. Cases (n=500), ages 20-79, were patients pathologically diagnosed with lung cancer at the Aichi Cancer Center. Controls (n=500) were recruited from visitors to the outpatient department of the same institution, and matched to cases by age (within 5 years) and sex. Fat intake was assessed with a validated food frequency questionnaire, and cigarette smoking was evaluated with a pre-tested risk factor questionnaire. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using unconditional logistic regression. After adjustment for age, sex, BMI, energy intake, and alcohol drinking, lung cancer risk among heavy smokers (≥40 pack-years) decreased with increasing intake of monounsaturated fat (MUFA). Compared with never or light smokers (≤20 pack-years), ORs (95% CI) were 8.44 (4.53, 15.7), 4.34 (2.32, 8.13), and 3.63 (1.84, 7.04) for heavy smokers who were in the 1st(lowest), 2nd, and 3rd tertiles of MUFA intake, respectively. A similar pattern of interaction was present for intake of polyunsaturated fat (PUFA) and for moderate smokers (20-39 pack-years). To our knowledge, the present study is among the first to show that intake of unsaturated fat modifies the association between cigarette smoking and lung cancer risk, and thereby sheds new light on the etiology and prevention of this malignancy. Citation Format: Jianjun Zhang, Hideo Tanaka, Hidemi Ito, Keitaro Matsuo. Fat intake interacts with cigarette smoking to alter lung cancer risk. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3630. doi:10.1158/1538-7445.AM2013-3630
The internship year: a negative view
Authors: S L Halleck
Journal: American Journal of Psychiatry (1978)

The decision to add a fourth year of training with emphasis on a primary care internship experience has created serious problems for most psychiatric residency training programs. The logistic problems involved in having a department of psychiatry develop an internship program are formidable. The experiences being provided are less than optimum. Conceivably, the logistic and quality uncertainties that now characterize some PGY-I programs may be a factor in discouraging medical graduates from entering psychiatry. The reasons for moving to an internship experience are also questionable. There are no data which suggest that the new training will produce better psychiatrists. Nor can the case for the internship be supported by past experience or an analysis of the educational needs of today's psychiatrist. Dr. John Romano comments on the author's presentation.
BM-27 * ESTIMATING THE ADDITIONAL BENEFIT OF SURGICAL EXCISION TO STEREOTACTIC RADIOSURGERY IN THE MANAGEMENT OF METASTATIC BRAIN DISEASE
Authors: M. Quigley, N. Bello, D. Jho, R. Fuhrer, S. Karlovits, F. Buchinsky
Journal: Neuro-Oncology (2014)

There are limited data on the benefits of surgical tumor excision plus stereotactic radiosurgery (SRS) in comparison to SRS alone for patients with oligometastatic brain disease. We conducted a retrospective cohort study of 162 consecutive patients, who were whole brain radiation therapy (WBXRT) naïve, undergoing tumor excision + SRS boost (n = 49) or SRS alone (n = 113). Factors related to patient survival were determined by Cox regression; time-to-recurrence (TTR) was analyzed similarly but with robust residuals to account for clustering. The effect of complete resection + SRS boost on survival was further explored by 2:1 propensity score matching. The average age of the cohort was 65.3 years, 49.4% female, and included 260 brain tumors of which 119 tumors were solitary. Surgical patients were younger, had better performance status and less burden of disease compared to SRS alone. None of these differences were statistically significant; RPA class was significantly better in the SRS + boost group (p = .003, Mann-Whitney). Seventy three tumors recurred (28%). Factors related to TTR were radiation sensitive pathology (non renal or melanoma) (hazard ratio (HR) =.345, p = .0014), treatment volume (HR = 1.078, p = .0022) and complete tumor resection (HR = .371, p = .015). Factors related to survival were age (HR = 1.02, p = .037), ECOG performance score (HR= 1.9, p = .0001) and complete surgical excision (HR = .55, p = .01). Propensity score matched analysis of complete resection + SRS boost (n = 40) versus SRS alone (n = 80) yielded nearly identical results of improved survival with complete resection (HR = .52, p = .03). Incomplete tumor resection had both median survival and TTR equivalent to SRS alone. Complete surgical excision + SRS boost is associated with improved survival and reduced likelihood of tumor recurrence in comparison to SRS alone. These results were replicated in the propensity score analysis which matched surgical and non-surgical patients on factors known to influence outcome. Incomplete resection did not improve survival or TTR compared to SRS alone.