tbuckley/cabot-search huggingface dataset:
Neostigmine for the Treatment of Acute Colonic Pseudo-Obstruction
Authors: Robert J. Ponec, Michael D. Saunders, Michael B. Kimmey
Journal: New England Journal of Medicine (1999)

Acute colonic pseudo-obstruction -- that is, massive dilation of the colon without mechanical obstruction -- may develop after surgery or severe illness. Although it may resolve with conservative therapy, colonoscopic decompression is sometimes needed to prevent ischemia and perforation of the bowel. Uncontrolled studies have suggested that neostigmine, may be an effective treatment.We studied 21 patients with acute colonic pseudo-obstruction. All had abdominal distention and radiographic evidence of colonic dilation, with a cecal diameter of at least 10 cm, and had had no response to at least 24 hours of conservative treatment. We randomly assigned 11 to receive 2.0 mg of neostigmine intravenously and 10 to receive intravenous saline. A physician who was unaware of the patients' treatment assignments recorded clinical response (defined as prompt evacuation of flatus or stool and a reduction in abdominal distention), abdominal circumference, and measurements of the colon on radiographs. Patients who had no response to the initial injection were eligible to receive open-label neostigmine three hours later.Ten of the 11 patients who received neostigmine had prompt colonic decompression, as compared with none of the 10 patients who received placebo (P<0.001). The median time to response was 4 minutes (range, 3 to 30). Seven patients in the placebo group and the one patient in the neostigmine group without an initial response received open-label neostigmine; all had colonic decompression. Two patients who had an initial response to neostigmine required colonoscopic decompression for recurrence of colonic distention; one eventually underwent subtotal colectomy. Side effects of neostigmine included abdominal pain, excess salivation, and vomiting. Symptomatic bradycardia developed in two patients and was treated with atropine.In patients with acute colonic pseudo-obstruction who have not had a response to conservative therapy, treatment with neostigmine rapidly decompresses the colon.
Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis
Authors: Annemarie B Docherty, Rob O’Donnell, Susan Brunskill, Marialena Trivella, Carolyn Doree, Lars B Holst, Martyn Parker, Merete Gregersen, Juliano Pinheiro de Almeida, Timothy S Walsh, Simon J Stanworth
Journal: BMJ (2016)

<b>Objective</b>&nbsp;To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery. <b>Design</b>&nbsp;Systematic review and meta-analysis. <b>Data sources</b>&nbsp;Randomised controlled trials involving a threshold for red blood cell transfusion in hospital. We searched (to 2 November 2015) CENTRAL, Medline, Embase, CINAHL, PubMed, LILACS, NHSBT Transfusion Evidence Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ISRCTN Register, and EU Clinical Trials Register. Authors were contacted for data whenever possible. <b>Trial selection</b>&nbsp;Published and unpublished randomised controlled trials comparing a restrictive with liberal transfusion threshold and that included patients with cardiovascular disease. <b>Data extraction and synthesis</b>&nbsp;Data extraction was completed in duplicate. Risk of bias was assessed using Cochrane methods. Relative risk ratios with 95% confidence intervals were presented in all meta-analyses. Mantel-Haenszel random effects models were used to pool risk ratios. <b>Main outcome measures</b>&nbsp;30 day mortality, and cardiovascular events. <b>Results</b>&nbsp;41 trials were identified; of these, seven included data on patients with cardiovascular disease. Data from a further four trials enrolling patients with cardiovascular disease were obtained from the authors. In total, 11 trials enrolling patients with cardiovascular disease (n=3033) were included for meta-analysis (restrictive transfusion, n=1514 patients; liberal transfusion, n=1519). The pooled risk ratio for the association between transfusion thresholds and 30 day mortality was 1.15 (95% confidence interval 0.88 to 1.50, P=0.50), with little heterogeneity (I<sup>2</sup>=14%). The risk of acute coronary syndrome in patients managed with restrictive compared with liberal transfusion was increased (nine trials; risk ratio 1.78, 95% confidence interval 1.18 to 2.70, P=0.01, I<sup>2</sup>=0%). <b>Conclusions</b>&nbsp;The results show that it may not be safe to use a restrictive transfusion threshold of less than 80 g/L in patients with ongoing acute coronary syndrome or chronic cardiovascular disease. Effects on mortality and other outcomes are uncertain. These data support the use of a more liberal transfusion threshold (&gt;80 g/L) for patients with both acute and chronic cardiovascular disease until adequately powered high quality randomised trials have been undertaken in patients with cardiovascular disease. <b>Registration</b>&nbsp;PROSPERO CRD42014014251.
Case 30-1995
Authors: M.V. Seiden, M.R. Pins
Journal: New England Journal of Medicine (1995)

Presentation of CaseA 69-year-old woman was admitted to the clinic because of systemic lupus erythematosus and painful lesions on the feet.The patient had been well until eight years earlier, when she began to lose her scalp hair and a rash developed. Evaluation showed periungual erythema of the fingers and mild anemia; a test for antinuclear antibodies was positive in a titer of 1:256, with a speckled pattern, and a test for anti–native DNA antibodies was negative. A diagnosis of systemic lupus erythematosus was made. Prednisone was administered in low doses for an uncertain interval. Four years before admission . . .
NORMALIZATION OF LEFT VENTRICULAR EJECTION FRACTION FOLLOWING CARDIAC RESYNCHRONIZATION THERAPY IS ASSOCIATED WITH A REDUCTION IN APPROPRIATE ICD THERAPY
Authors: Ammar M. Killu, Avishay Grupper, Anya Mazo, Tracy Webster, Kelly Brooke, Paul Friedman, David Hodge, Samuel Asirvatham, Michael Glikson, Yong-Mei Cha
Journal: Journal of the American College of Cardiology (2015)
Abstract P6-06-02: Characterization of an exosome-associated apoptosis-inducing activity produced by triple negative breast cancer cells.
Authors: NE Georgoulia, D Iliopoulos, TJ Mitchison
Journal: Cancer Research (2012)

Abstract Purpose: We sought to investigate whether breast cancer cells can suppress the proliferation of other breast cancer cells in order to understand the biological significance of cell heterogeneity in breast cancer. Materials and Methods: 20 breast cancer cell lines, corresponding to all molecular profiles of breast cancer, were cultured in a 20×20 conditioned medium protocol. Cell proliferation and apoptosis were evaluated by EdU (5-ethynyl-2′-deoxyuridine) and PARP (Poly ADP ribose) cleaved labeling respectively, and documented by fluorescence microscopy. Serum free conditioned media (CM) were prepared from all the cell lines, 24hrs of incubation, and screened for their anti-proliferative effect against the different breast cancer tumor cells. Active media were ultra-centrifuged and both the supernatants as well as the pellets were assessed for the anti-proliferative activity. Results: Using this 20×20 matrix, CM obtained from two out of six triple negative breast cancer cells displayed anti-proliferative activity against the majority of cell lines, irrespectively of their molecular phenotype including triple negative cells. No significant anti-proliferative activity was observed in CMs from luminal or HER2(+) cell lines. However the two triple negative CMs induced a significant decrease in the cell lines' proliferation index, which was associated with a concomitant increase in cells' apoptotic index. Ultracentrifugation revealed that the apoptosis-inducing activity was retained in the pellet but not the supernatant of the CM. Negative staining electron microscopy (EM) revealed the presence of exosomes in the CM's ultra-centrifuged pellet, which stained positive for cd63 surface protein marker using an immunogold assay. Conclusions: These data strongly suggest that some triple negative breast cancer cell lines posses exosome-mediated apoptosis-inducing activity. This activity may have biological and clinical relevance since it could be a factor participating in the selection of tumor cell subpopulations of different degrees of aggressiveness. Further proteomic and microRNA profiling of the exosomes is ongoing in order to characterize this exosome-mediated apoptosis-inducing activity. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-06-02.
The leaders of quality improvement are the ones who are doing the improvement work
Authors: Rob M Bethune
Journal: Journal of the Royal Society of Medicine (2013)

Martin Marshall and James Mountford make many important points relating to the development of quality improvement in healthcare.1 They rightly say that whereas academic clinical research is well developed the ability to improve how we deliver healthcare is only just beginning to enter clinical practice. However, I think their definitions of ‘visitors’ and ‘residents’ of the emerging business of quality improvement should be reversed and perhaps amended.

Quality improvement is different to academic medicine. It is an iterative approach delivered by those working on the frontline of healthcare using their system knowledge to discover the areas that need attention and then improving the care. The Keystone central line infection project they describe developed in this way.2 These frontline clinicians with their sleeves rolled up and with a bead of sweat on their foreheads are the ‘residents’ of quality improvement. The improvement scientists who evaluate and attempt to understand these improvements are the ‘visitors’ or perhaps ‘supporters’ would be a better word. This is a very important part of the quality improvement world, but as we take this forward we must recognize that the leaders are the frontline clinicians who are both doing their job and seeking to improve their job.3
Restoring Apc Gene Function Enables New Avenues of Research
Authors: Marilyn Fenichel
Journal: JNCI Journal of the National Cancer Institute (2015)

NEWS | 5 of 7 news growth.For instance, metastatic cells remodel collagen and other matrix proteins that adjacent cells deposit.That activity produces nanoscale alterations that Backman could detect and measure to infer how many metastatic cells were present in the scaffold while it was still in the mouse's body.Cancer cells invaded the scaffold but not the fat pads of control mice, indicating that it had performed as predicted."The research needs to replicated, but the results so far point to an intriguing tool for isolating metastatic subclones for further analysis," said Lisa Carey, M.D., a professor in breast cancer research at the University of North Carolina at Chapel Hill, who was not involved in the study."At the moment, we still rely on biopsies, which is challenging."Carey was also intrigued by the scaffold's ability to reduce tumor burdens in the lung.She suggested that it might have clinical uses in slowing or delaying metastatic progression.Jeruss had already shown in research dating back to 2008 that if women present with highstage disease, their long-term prognosis is poor regardless of how well they do in primary treatment."Our hope," Jeruss said, "is that early intervention when the metastatic disease burden is still low would translate to longer progression-free survival time."According to Shea, women would be implanted with the scaffold upon completing therapy for breast cancer, and the implant would be checked noninvasively every 3-6 months.
IN VIVO ASSESSMENT OF VASA VASORUM NEOVASCULARIZATION USING OPTICAL COHERENCE TOMOGRAPHY: A COMPARISON BETWEEN UNSTABLE AND STABLE ANGINA PECTORIS
Authors: Teruyoshi Kume, Ryotaro Yamada, Terumasa Koyama, Kenzo Fukuhara, Yutaka Goryo, Hiroshi Okamoto, Yusuke Kobayashi, Yoji Neishi, Shiro Uemura
Journal: Journal of the American College of Cardiology (2016)
Apport de l'échografie abdominale dans le diagnostic et le suivi de la tuberculose péritonéale: étude prospective à propos de 445 cas
Authors: G Kharrasse, H Krami, I Errabih, G Drissi, N Benzzoubeir, L Ouazzani, H Ouazzani
Journal: Endoscopy (2011)

Introduction: La tuberculose péritonéale demeure un sujet de préoccupation de santé publique au Maroc. Son diagnostic positif repose essentiellement sur l'étude histologique des prélèvements biopsiques péritonéaux effectués au cours de la cœlioscopie. L'échotomografie de plus en plus utilisée de première intention s'avère d'un grand apport pour le diagnostic et la surveillance de cette affection.
SERUM LEPTIN IS ASSOCIATED WITH LESS ADVERSE FUTURE LEFT VENTRICULAR STRUCTURE AND FUNCTION: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS(MESA)
Authors: Shishir Sharma, Laura Colangelo, Matthew Allison, Joao Lima, Bharath Ambale Venkatesh, Satoru Kishi, Kiang Liu, Philip Greenland
Journal: Journal of the American College of Cardiology (2015)
RT-10 * DO WE NEED IMAGE-GUIDANCE OF GTV DEFINED BY FET-PET IN RADIOTHERAPY OF HIGH GRADE GLIOMA?
Authors: S. Engelholm, J. Costa, M. Lundemann, I. Law, P. M. a. Rosenschold, S. Engelholm
Journal: Neuro-Oncology (2014)

METHODS: The study population comprised of 54 pts with high grade glioma treated with RT and Temozolomide. CT and MRI images were fused in a radiation therapy treatment planning software. GTV was delineated as a contrast-enhancing tumor plus the operation cavity, defined by a radiologist blinded to the results of FET/PET. The CTV was generated by the geometric expansion of GTV plus 20 mm and the PTV was achieved by an additional margin to the CTV by 2 mm. The FET-PET volume was determined by SUV of 1.6. On corresponding axial slices, FET uptake was compared to contrast enhancement in T1-weighted MR. Intensity modulated arc therapy (IMAT) with steep dose-gradients was delivered using daily image-guidance and 6D patient positioning. Pts received 60 Gy in 30 fractions. RESULTS: Five pts had no postoperative FET-PET uptake. Of 49 pts, 5 pts were diagnosed with PET positive areas outside the GTV plus 20 mm. In 40% of the cases there was a similarity between GTV defined by MRI and FET/PET, respectively. CONCLUSION: In this retrospective study of 54 pts, pretreatment FET-PET appears to identify areas of tumor activity outside the MRI-GTV, with the majority placed in the CTV. With stereotactic radiotherapy and a steeper gradient it is important with better imaging technique to define the tumor. With an unchanged CTV margin and by including FET PET for GTV definition, the irradiated volume will tend to increase moderately for most patients, and quite substantially for a minority of patients. Prospective radiation therapy trials could determine if the GTV-to-CTV margin can be adjusted with FET-PET.
Pour quelle raison la coloscopie ne diminuerait-elle pas l'incidence, ni la mortalité par cancer du côlon proximal?
Authors: JF Bretagne, S Hamonic, C Piette, S Manfredi, G Mallard, G Durand, F Riou
Journal: Endoscopy (2011)

Introduction: Plusieurs travaux épidémiologiques récents ont mis en exergue les insuffisances de la coloscopie en termes de diminution de l'incidence et de la mortalité par cancer du côlon proximal. Ceci pourrait être le fait de lésions plus souvent manquées par l'endoscopiste au niveau du côlon proximal que distal, ou d'une carcinogenèse différente selon la localisation. Le but de ce travail a été de rechercher si les variations de performance entre les endoscopistes diffèrent selon le siège proximal ou distal des lésions coliques.
Abstract 1735: Expression of circadian genes correlate with liver metastasis and prognosis in colorectal cancer
Authors: Takashi Oshima, Chikara Kunisaki, Tsutomu Sato, Roppei Yamada, Shoich Fujii, Naoto Yamamoto, Manabu Shiozawa, Makoto Akaike, Yasushi Rino, Munetaka Masuda, Toshio Imada
Journal: Cancer Research (2010)

Abstract The circadian rhythms are daily oscillations in various biological processes, and generated by the feedback loops of eight core circadian genes. These eight genes are, Clock, casein kinase I ε (CKI ε), cryptochrome1 (Cry1) and cryptochrome2 (Cry2), Period1 (Per1), Period2 (Per2) and Period3 (Per3), Bmal1. Recent studies have suggested that the circadian genes participate in the growth and development of various cancers. This study examined the relations of the circadian genes expression to clinicopathological factors and prognosis in patients with colorectal cancer. We studied surgical specimens of cancer tissue and adjacent normal mucosa obtained from 202 patients with untreated colorectal cancer. The relative expression levels of the circadian genes in the specimens were measured by quantitative real-time, reverse-transcription polymerase chain reaction. Expressions of Clock and CKI ε in cancer tissue were significantly higher than those in adjacent normal mucosa. Expressions of Per1 and Per3 in cancer tissue were significantly lower than those in adjacent normal mucosa. Analysis of the relations between clinicopathological features and expressions of the eight circadian genes showed that high expression of the Bmal1 and low expression of the Per1 correlated with liver metastasis. In the analysis of the relations between prognosis and expressions of the eight circadian genes, the prognosis of high expression of the Per2 was significantly better than that of low expression of the Per2. Our results suggest that over-expression of the Bmal1 and reduced expression of the Per1 might promote liver metastasis, and reduced expression of Per2 might shorten prognosis in colorectal cancer. Thus over-expression of the Bmal1 gene and reduced expression of the Per1 gene may be a useful predictor of liver metastasis. And reduced expression of Per2 may be useful as prognostic factor in patients with colorectal cancer. 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 1735.
Abstract 2012: Changes in gene expression and global histone marks in a human population exposed to nickel compounds
Authors: Adriana G. Arita, Fen Wu, Hong Sun, Kathrin Kiok, Thomas Kluz, Qingshan Qu, Najuan Zhao, Ye Ruan, Jingping Niu, Richard Hayes, Max Costa
Journal: Cancer Research (2011)

Abstract All of the studies on the global and selective gene promoter changes in epigenetic marks induced by carcinogenic Nickel compounds have been mostly done in tissue culture model systems. Here we report the results of the first study to evaluate the global changes in epigenetic marks and changes in gene expression that occur in the peripheral blood lymphocytes of a human population occupationally exposed to Nickel compounds. Nickel (II) is a toxic nonessential transition metal used in modern industry with other metals to form alloys to produce coins, jewelry, stainless steel, Ni-Cd batteries, and carbon nanoparticles. Nickel is of great environmental concern because occupational exposure to Ni compounds has been associated with an increased risk for lung and nasal cancers. Using an ELISA method, a decrease in both H3K4me3 and H3K9me2 histone marks were found with increasing levels of Nickel in the urine of subjects recruited to the study from a nickel refinery in Jinchang, China. Changes in global levels of other epigenetic marks are also being measured in the samples of subjects recruited to the study. Inter- and intra-individual variability of H3K4me3 and H3K9me2 and other epigenetic marks will also be evaluated in primary lymphocytes of this particular Chinese population. Additionally, changes in gene expression patterns between individuals with low exposure to Ni and those with higher exposure will be compared in order to identify a possible biomarker of Ni exposure. Studies on the effect of Ni compounds to human health are very important since Nickel is a classified human carcinogen. Here we are studying for the first time the mechanisms of nickel-associated changes in gene regulation and global histone epigenetic marks found in the primary lymphocytes of a human population occupationally exposed to Nickel compounds. 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 2012. doi:10.1158/1538-7445.AM2011-2012
P301 A Large Retrospective Evaluation Of Domiciliary And Outpatient Initiation Of Home Mechanical Ventilation
Authors: J. Palmer, N. Ward, J. Robinson, B. Kathiresan, P. Hughes
Journal: Thorax (2014)

<h3>Introduction and objectives</h3> Home Mechanical Ventilation (HMV) for patients with chronic ventilatory failure (CVF) often requires hospital admission for initiation of treatment. There are limited data evaluating the efficacy, efficiency and safety of initiating HMV in the domiciliary setting. Our centre has undertaken over 200 ‘home set-ups’ and we have evaluated outcomes in these patients. <h3>Methods</h3> Patients with CVF who had HMV initiated in the domiciliary or outpatient setting were identified from our hospital database and data were retrospectively collected from their hospital records. <h3>Results</h3> 214 patients with CVF were set-up at home between 2004 to 2013. Notes were available for 193 (90%) patients, mean (SD) age 59 (14) years, 63% male. The majority of patients had Motor Neuron Disease (MND)(30%) or obesity related respiratory failure (23%). Baseline lung function and arterial blood gas parameters are shown in Table 1. 178 (92%) patients had HMV initiated in their home; 15 attended the outpatient clinic for set-up. Three patients subsequently required hospital admission to support adaptation to HMV. Following initiation, 135 (70%) patients were assessed as compliant with HMV, defined as &gt;4 h self-reported use each night. Patients with MND had the lowest compliance rate with only 30 (52%) achieving this usage. If those with MND are excluded, overall compliance was 77% which is similar to our inpatient initiated HMV compliance rate of 83% (n = 224) and to case series reported by other centres. Patients with few symptoms of nocturnal hypoventilation had a lower compliance rate (55%) than more symptomatic patients (71%). In patients who were compliant with HMV, mean (SD) time until &gt;4 h use per night was 27 (60) days, but 33 (17%) patients achieved this usage after the first night. Those who became compliant with HMV had a mean of 2.9 (3.2) home visits and 1.4 (1.8) phone calls each. <h3>Conclusion</h3> Establishing HMV in the domiciliary and outpatient setting can be effectively and safely achieved, even in patients with marked nocturnal hypoventilation. Apart from patients with MND or those who are minimally symptomatic, ‘home set-up’ of HMV does not appear to affect compliance significantly.
A NOVEL ECHOCARDIOGRAPHIC RISK STRATIFICATION SCHEME FOR PREDICTING HEART FAILURE HOSPITALIZATION AND CARDIOVASCULAR MORTALITY AFTER ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION
Authors: Flemming Javier Olsen, Jan Jensen, Sune Pedersen, Kotaro Nochioka, Tor Biering-Sorensen
Journal: Journal of the American College of Cardiology (2016)