tbuckley/cabot-search huggingface dataset:
Intractable nausea and vomiting associated with poor glycaemic control in a patient with type 1 diabetes
Authors: S Gururaj Setty,, Marie-France Kong,
Journal: BMJ (2016)

A 54 year old woman with type 1 diabetes was referred to the diabetes clinic with a four year history of nausea, early satiety, abdominal pain, and intermittent vomiting. In recent months she had experienced intractable nausea and vomiting, requiring frequent admission to hospital. Her glycaemic control was poor, with blood glucose readings in the high teens and frequent severe hypoglycaemic episodes after meals, when she needed help.

She has had diabetes for 45 years, complicated by diabetic retinopathy, peripheral neuropathy, and nephropathy. She has had chronic back pain and depression. She was taking insulin glulisine (quick acting insulin) 15 units with meals and insulin glargine (long acting insulin) 26 units at bedtime. Her other drugs included lansoprazole, atorvastatin, zopiclone, gabapentin, metoclopramide (short term), zomorph, and lactulose. She weighed 68.6 kg and her body mass index was 28 kg/m2. Her blood pressure was 129/78 mm Hg, with no postural drop. Her injection sites were normal and systemic examination unremarkable.

Her glycated haemoglobin (HbA1c) was 11.6% (103 mmol/mol), sodium 133 mmol/L (reference range 133-146), potassium 4.9 mmol/L (3.5-5.3), urea 12.3 mmol/L (2.5-7.8), creatinine 113 µmol/L (60-120), estimated glomerular filtration rate 65 mL/min/1.73 m2 (90-120), and blood glucose 19.3 mmol/L (3.3-6.0). Haemoglobin was 145 g/L (115-165), white cell count 12.1×109/L (4.0-11.0), and platelets 251×109/L (140-400). An upper gastrointestinal endoscopy six months ago found no obstruction or ulceration but showed residual food in the stomach after an eight hour fast (fig 1⇓). An ultrasound scan of the abdomen was normal.



Fig 1  Gastric emptying curves



1.  What is the most likely diagnosis and how would you confirm this?

2.  How would you treat an acute presentation?

3.  How would you control symptoms in the long term?

### 1. What is the most likely diagnosis and how would you confirm this?

#### Short answer

Diabetic gastroparesis. Request fasting upper gastrointestinal endoscopy, coeliac screen, thyroid function …
Relapse from Complete Remission More Than 5 Years after Therapy for Diffuse Large B-Cell Lymphoma (DLBCL): Relapse Histology Most Commonly DLBCL with a Germinal Center B-Cell (GCB) Phenotype.
Authors: Julie M. Vose, John C. Chan, Philip J. Bierman, Alejandro Arevalo, Fausto Loberiza, Kai Fu, Dennis Weisenburger, Robert G. Bociek, Martin Bast, James O. Armitage
Journal: Blood (2007)
Weekly topotecan as first-line treatment for recurrent or persistent epithelial ovarian cancer (EOC)
Authors: T. Safra, J. Menczer, M. Inbar, E. En-Shem, M. Glezerman, D. Grisaro, I. Ron, T. Levy
Journal: Journal of Clinical Oncology (2005)

5111 Background: Treatment of recurrent or persistent epithelial ovarian cancer (EOC) is mainly palliative and therefore quality of life is of high priority. This study purpose is to evaluate the safety as well as response rate, time to progression and survival of Topotecan in the weekly schedule for recurrent and persistent epithelial ovarian cancer and primary peritoneal cancer. Methods: Seventeen EOC patients with recurrent or persistent disease, previously exposed to not more than one platinum-based regimen (mostly carboplatin and paclitaxel) were treated with weekly Topotecan. Topotecan at a dose of 4 mg/m2 was administered on days 1,8 and 15 every 28-days cycle. Results: The median age of the study group was 59 years (42–75). A median ECOG performance status of 1 (0–2). Six (35%) patients had a persistent disease on carboplatin and paclitaxel. Nine women had a platinum sensitive disease and 8 platinum resistant. Patients were exposed to a median of 5(2–6) cycles of weekly Topotecan. With a median follow up of 12(1.2–18.93) months. Five (29.4%) complete responses (CR) were observed, 2(11.8%) partial responses (PR) and 7(41.1%) stable disease (SD) with an overall response rate of 41.2%. Of the CR’s patients, 2 are still in remission after 12 and 4 months, three recur after 2,3 and 6 months. Median time to progression (TTP) is 6.87 months (1.2–16), 3 of the CR’s had persistent disease, one CR was Ic and one IIc. The median overall survival time is 12+ months (1.2–18.93) with all but one patient alive. Bone marrow toxicity consisted of 1(5.8%) patient with grade III thrombocytopenia followed by treatment cessation, 2(11.8%) patients with grade II anemia and 1(5.8%) grade II neutropenia. Non-hematologic toxicity consisted of mild alopecia, nausea and fatigue. Grade I fatigue was noted in 4 (23.5%) patients and grade III in 1(5.8%) and 2 (11.8%) patients had grade I nausea. Grade II-III toxicities were rare and no treatment delays was needed. Conclusions: Topotecan given, as a weekly bolus is an active and well-tolerated first-line regimen for persistent and relapsed ovarian cancer. It seems to be less toxic compared to the 5-day schedule and warrants further investigation. No significant financial relationships to disclose.
Земський лікар і драматург
Authors: M. Chaban, Z. Shevtsova, V. Haponov
Journal: GASTROENTEROLOGY (2016)

Проведено вивчення життєвої долі та професійної діяльності земського лікаря, доктора медицини, судового експерта, громадського діяча, письменника, неординарної особистості Григорія Максимовича Бораковського (1846–?). Він зробив вагомий внесок у розвиток земської медицини на Катеринославщині (сучасна Дніпропетровщина). Григорій Бораковський завідував дільницею та земською лікарнею в Новомосковську протягом 27 років, виконав значну кількість оперативних втручань. Його як експерта залучали до складних судових справ. Пізнавальне значення мають його звіти про відрядження до клінік Москви, Одеси, Палестини, Праги. Лікар Г.М. Бораковський займає також почесне місце в українській драматургії. Він є автором багатьох водевілів, комедій і драм (найвизначніша з них — «Маруся Чурай»).
LBA-03 Efficacy and safety of regorafenib versus placebo in patients with hepatocellular carcinoma (HCC) progressing on sorafenib: results of the international, randomized phase 3 RESORCE trial
Authors: J. Bruix, P. Merle, A. Granito, Y.-H. Huang, G. Bodoky, O. Yokosuka, O. Rosmorduc, V. Breder, R. Gerolami, G. Masi, J. Ross Paul, S. Qin, T. Song, J.-P. Bronowicki, I. Ollivier-Hourmand, M. Kudo, M.-A. LeBerre, A. Baumhauer, G. Meinhardt, G. Han
Journal: Annals of Oncology (2016)
NHS trusts cut overall deficit but remain at “breaking point,” leaders warn
Authors: Gareth Iacobucci
Journal: BMJ (2016)

NHS trusts in England improved their financial position at the end of the first quarter of this year but remain under huge pressure from unprecedented demand, new figures have shown.

The figures, published on 25 August by the regulator NHS Improvement,1 showed that the NHS provider sector recorded a combined deficit of £461m (€540m; $610m) in the first three months of 2016-17, £5m ahead of plan. This compared with a £930m deficit in the same quarter of last year.

But the figures also showed a further sharp increase in demand, particularly at hospital emergency departments, which saw a 6.3% year on year rise in attendances and a 6.4% year on year rise in admissions in the first three months of 2016-17.

The improvement in trusts’ financial position came after …
Progress in respiratory management of bulbar complications of motor neuron disease/amyotrophic lateral sclerosis?
Authors: Anita K Simonds
Journal: Thorax (2016)

Loss of motor neurons in the cortex, brainstem and spinal cord is the hallmark of motor neuron disease/amyotrophic lateral sclerosis (MND/ALS), resulting in weakness of limbs, respiratory and bulbar muscles and eventually death from respiratory failure in the majority of patients. Around 20%–30% have bulbar symptoms at onset—this is less common in younger patients, but affects more than 40% of those over 70 years.1 Virtually all patients will develop bulbar symptoms with disease progression. Symptoms consist of dysarthria, dysphagia, difficulties clearing oropharyngeal secretions, impaired cough, choking, laryngospasm and aspiration. Each symptom is attributable to lower motor neuron weakness (true bulbar palsy), upper motor neuron weakness (pseudobulbar palsy) or a combination of both.

Safe swallowing requires adequate strength and coordination of orofacial and lingual muscles. With increasing weakness, difficulties in mastication, bolus preparation and oral food transport develop resulting in oral, pharyngeal and laryngeal residues of food. Lip closure and problems swallowing saliva lead to drooling. Failure of the larynx to move superiorly and anteriorly on swallowing and incomplete closure leads to laryngeal penetration or overt aspiration into the lungs.

The clearance of aspirated food, saliva or bronchial secretions depends on a forceful cough. An effective cough requires the inspiratory muscles to generate a deep inspiration of around 2–4 L, followed by closure of the glottis and the generation of a peak cough flow (PCF) of 360 to 1000 L/min in adults—depending on age, size and gender. This level of expiratory flow after glottal opening is required to shear secretions and debris from the airway and lift these to the upper airway/mouth. It is assumed that a minimum PCF of 160 L/min is required in adults and is estimated that those with values of 270 L/min or less may be prone to secretion retention at the time of chest infections, as these are associated with …
Development of an Anti-HTLV-1 Vaccine for the Treatment of Adult T-Cell Leukemia/Lymphoma
Authors: Déborah Revaud, Ana Bejanariu, Lamya Loussaief, Emeline Sarry, Abdel Zemmar, Guillaume Deplaine, Téreza Coman, Julien Rossignol, Olivier Hermine, Cecile Bauche
Journal: Blood (2015)
Extramedullary sudden blast crisis in chronic-phase chronic myeloid leukemia during first-line treatment with nilotinib
Authors: M K Angelopoulou, J V Asimakopoulos, Z Galani, G Levidou, M Roumelioti, T P Vassilakopoulos, P Korkolopoulou, P Panayiotidis
Journal: Blood Cancer Journal (2016)

Extramedullary sudden blast crisis in chronic-phase chronic myeloid leukemia during first-line treatment with nilotinib
Nondisclosure
Authors: Abby R. Rosenberg
Journal: JAMA (2016)

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Comprehensive mutation analysis in NRG Oncology/RTOG 9813: A phase III trial of RT + TMZ vs RT + nu for anaplastic astrocytoma and mixed anaplastic oligoastrocytoma (Astrocytoma Dominant).
Authors: Erica Hlavin Bell, Joseph P McElroy, Jessica Fleming, Cynthia Dawn Timmers, Arup R Chakraborty, Andrea L Salavaggione, Susan Marina Chang, Kenneth D. Aldape, David Brachman, Helen Alice Shih, Peixin Zhang, Minesh P. Mehta, Arnab Chakravarti
Journal: Journal of Clinical Oncology (2016)

2016 Background: This study sought to examine the prognostic value of mutations within IDH1/2, ATRX, CIC, FUBP1, and the TERT promoter in a phase III study of grade III astrocytomas using multivariate analyses (MVAs). Methods: IDH mutations were determined by immunohistochemistry and/or next-generation sequencing. A custom Ion AmpliSeq DNA panel was used for mutation analysis; TERT promoter mutations were detected by Sanger sequencing. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated and tested using the Cox proportional hazard model and the log-rank test. MVAs were performed including age, treatment, surgery, and performance status as covariates. Results: Mutations within IDH1/2 were found in 55% (57/104), ATRX in 46% (28/61), the TERT promoter in 20% (11/55), CIC in 10% (6/61), and FUBP1 in 2% (1/61) of analyzed cases. In the univariate analyses on OS, IDH1/2 (HR=0.41; p<0.001) and ATRX mutations (HR=0.45; p=0.02) significantly correlated with improved OS, and TERT promoter mutations (HR=1.76; p=0.16) trended toward worse OS; on PFS, IDH1/2 (HR=0.50; p=0.004) and ATRX mutations (HR= 0.41; p=0.009) were significantly associated with improved PFS, and TERT promoter mutations (HR=2.0; p=0.08) trended toward worse PFS. Upon MVA, ATRX mutations were significantly associated with OS (HR=0.48; p=0.04) and PFS (HR=0.42; p=0.02), as were IDH1/2 mutations (OS: HR=0.49, p=0.01; PFS: HR=0.53, p=0.02). Conclusions: This study underscores the prognostic significance of IDH and ATRX. Importantly, this is the first study to examine the prognostic value of these mutations using rigorous MVA in a grade III astrocytoma cohort with prospectively-collected, well-annotated clinical data. Efforts to increase sample size and to perform predictive analyses are ongoing. Funding:U10CA21661, U10CA180868, U10CA180822, U10CA37422 (NCI), Bristol Myers Squibb and Merck &Co. Also, R01CA108633, R01CA169368, RC2CA148190, U10CA180850-01 (NCI), Brain Tumor Funders Collaborative Grant, and The Ohio State University CCC (all to AC). Clinical trial information: NCT00004259.
A mutation-specific peptide vaccine targeting <i>IDH1R132H</i> in patients with newly diagnosed malignant astrocytomas: A first-in-man multicenter phase I clinical trial of the German Neurooncology Working Group (NOA-16).
Authors: Michael Platten, Daniela Schilling, Theresa Bunse, Felix Sahm, Angela Hueckelhoven, Irini Schenkel, Stefan Stevanovic, Anita Schmitt, Marion Laumann, Joachim Peter Steinbach, Martin Misch, Ghazaleh Tabatabai, Astrid Weyerbrock, Oliver Schnell, Dietmar Krex, Joerg Hense, Martin Bendszus, Andreas von Deimling, Michael Schmitt, Wolfgang Wick
Journal: Journal of Clinical Oncology (2016)

TPS2082 Background: Mutations in the gene for isocitrate dehydrogenase type 1 frequently occur in diffuse gliomas resulting in a point mutation (IDH1R132H) in most of the cases. Preclinical studies have shown that mutation-specific T helper (Th) cell responses spontaneously occur in patients with IDH1-mutated gliomas and that a peptide vaccine encoding IDH1R132H is therapeutic in a humanized mouse tumor model. Methods: NOA-16 (ClinicalTrials.gov Identifier: NCT02454634) is a multicenter, first-in-man, phase I clinical trial, which is planned to enroll 39 patients with newly diagnosed malignant astrocytomas with IDH1R132H mutations at eight German sites. The target population is molecularly enriched for an unfavorable prognosis within the IDH1-mutated subgroup by mandating (i) absence of co-deletion of 1p/19q and (ii) loss of alpha-thalassemia/mental retardation syndrome X-linked (ATRX) expression. Patients aged ≥ 18 years with a Karnofsky performance score of ≥ 70 will receive radiotherapy only (cohort 1), combined radiochemotherapy with temozolomide (TMZ, cohort 2) or TMZ only (cohort 3) as the primary treatment based on the decision of the local investigator. Over a period of 32 weeks a total of eight vaccinations with an IDH1R132H peptide emulsified in incomplete Freund's adjuvant produced at a central good manufacturing practice (GMP) site will be administered subcutaneously with topical imiquimod starting three months after the initiation of primary treatment. The primary end points are safety and immunogenicity as measured by IDH1R132H-specific antibody and T cell responses. Secondary outcome measures include progression-free survival (PFS) and overall response rate (ORR). Enrollment started in June 2015. The DMC reviewed the trial in December 2015 and suggested that the trial continues as planned after the first three patients had completed the first vaccinations without a regime-limiting toxicity (RLT). Eight patients have been enrolled at three sites (as of January 2016). Clinical trial information: NCT02454634.
Cancer biomarker discovery is improved by accounting for variability in general levels of drug sensitivity in pre-clinical models
Authors: Paul Geeleher, Nancy J. Cox, R. Stephanie Huang
Journal: Genome biology (2016)

We show that variability in general levels of drug sensitivity in pre-clinical cancer models confounds biomarker discovery. However, using a very large panel of cell lines, each treated with many drugs, we could estimate a general level of sensitivity to all drugs in each cell line. By conditioning on this variable, biomarkers were identified that were more likely to be effective in clinical trials than those identified using a conventional uncorrected approach. We find that differences in general levels of drug sensitivity are driven by biologically relevant processes. We developed a gene expression based method that can be used to correct for this confounder in future studies.
Survival advantage in patients treated with high-dose interleukin-2 (HDIL2) for metastatic renal cell carcinoma (mRCC)
Authors: S. Lee, M. Baig, V. Rusciano, Y. Gao, S. Malik, P. H. Wiernik, J. P. Dutcher
Journal: Journal of Clinical Oncology (2009)

e16039 Background: A prognostic index developed at MSKCC(Memorial-Sloan-Kettering Cancer Center) relates to survival in mRCC patients (pts) treated with interferon. We evaluated 79 pts treated first line with HDIL2 to see if this prognostic index is applicable. Eligibility for HDIL2 was based on cardiopulmonary screening and performance status (PS). Method: Medical records were analyzed retrospectively from 2000–2008. Pts were categorized into favorable, intermediate &amp; poor risk category according to MSKCC prognostic index, which includes time from diagnosis to treatment, serum calcium &amp; LDH, hemoglobin and PS. Median survival (OS) &amp; median progression free survival (PFS) were compared between risk categories. Results were evaluated taking into consideration potential confounders such as subsequent treatment with tyrosine kinase inhibitors (TKI) &amp; time from nephrectomy to metastasis interval of more than 1 year. Statistical analysis utilized SPSS. Results: 29 pts (36.7%) were treated with TKIs subsequently and this had no impact on median OS compared to those not receiving TKIs. 19 pts (24%) had nephrectomy to metastasis interval of more than 1 year and this also did not impact on OS analysis compared to those with shorter time to metastasis. Poor risk group was not analyzed due to small sample size. Conclusions: Median OS for mRCC pts eligible for and treated with HDIL2 as first line therapy exceeds reports of other first line treatment, either cytokines or TKIs. The survival advantage occurs regardless of being in either favorable or intermediate risk category and this benefit is not confounded by subsequent treatment with TKIs or nephrectomy to treatment interval more than 1 year. HDIL2 pts requires good PS and organ function, but 72% were intermediate risk pts. Thus, MSKCC risk categories do not predict for HDIL2 treatment outcome. HDIL2 should still be considered as a first line agent for mRCC, in the era of TKIs, as long as patients meet the eligibility criteria, as it infers survival advantage. [Table: see text] [Table: see text]
Noninvasive Approach to Assess Coronary Artery Stenoses and Ischemia
Authors: Nils P. Johnson, Richard L. Kirkeeide, K. Lance Gould
Journal: JAMA (2013)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Depression After Stroke—Frequency, Risk Factors, and Mortality Outcomes
Authors: Craig S. Anderson
Journal: JAMA Psychiatry (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Psychiatry HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Psychiatry journal
3D Cell Printing of Functional Skeletal Muscle Constructs Using Skeletal Muscle‐Derived Bioink
Authors: Yeong‐Jin Choi, Taek Gyoung Kim, Jonghyeon Jeong, Hee‐Gyeong Yi, Ji Won Park, Woonbong Hwang, Dong‐Woo Cho
Journal: Advanced Healthcare Materials (2016)

Engineered skeletal muscle tissues that mimic the structure and function of native muscle have been considered as an alternative strategy for the treatment of various muscular diseases and injuries. Here, it is demonstrated that 3D cell-printing of decellularized skeletal muscle extracellular matrix (mdECM)-based bioink facilitates the fabrication of functional skeletal muscle constructs. The cellular alignment and the shape of the tissue constructs are controlled by 3D cell-printing technology. mdECM bioink provides the 3D cell-printed muscle constructs with a myogenic environment that supports high viability and contractility as well as myotube formation, differentiation, and maturation. More interestingly, the preservation of agrin is confirmed in the mdECM, and significant increases in the formation of acetylcholine receptor clusters are exhibited in the 3D cell-printed muscle constructs. In conclusion, mdECM bioink and 3D cell-printing technology facilitate the mimicking of both the structural and functional properties of native muscle and hold great promise for producing clinically relevant engineered muscle for the treatment of muscular injuries.