tbuckley/cabot-search huggingface dataset:
PTU-274 Comparison of outcomes of screen detected and symptomatic colorectal cancers
Authors: J Sagar, D Edwards, H Tilney, M Gudgeon
Journal: Gut (2015)

<h3>Introduction</h3> National bowel cancer screening programme was started in April 2006 across England. Our institution became one of the centres for screening colonoscopy in September 2008. The aim of this study is to compare the clinical and oncological outcomes of symptomatic vs. screen detected colorectal cancers. <h3>Method</h3> This is a single centre retrospective study of prospectively collected data of patients diagnosed with colorectal cancer following screening colonoscopy or symptomatic presentation from September 2008 to December 2013 using PMAS database. Data were analysed using Microsoft Excel 2010. <h3>Results</h3> Over a period of 5 years, 199 patients were diagnosed through screening colonoscopy while 791 cancers were symptomatic. The mean age was 67.5 and 72.85 years in screen detected and symptomatic cancers respectively. 59.8% patients were male in screening group compared to 54.7% in symptomatic group. Incidence of colon cancer was slightly higher in screening group (70% vs. 67.8%) but more so in sigmoid colon. Colonoscopy was successful in 95% of screening cases but only 55.2% in symptomatic group. Only 3% of patients in screening group did not have any surgical procedure compared to 12.8% in symptomatic group. The laparoscopic resection was achieved in 74% patients in screening group compared to 61% in symptomatic group. There was significant difference in permanent stoma rate (2% in screening group compared 9% in symptomatic group) but there was no difference in defunctioning stoma rates. Curative resection was achieved in significantly higher number of patients in screening group (96.9%) compared to symptomatic group (63.8%). Median hospital stay was 4 and 6 days in screening and symptomatic groups respectively. There was no difference in major complications between two groups including postoperative death, anastomotic leaks and DVT. Duke’s distribution revealed 45% vs. 15% of A, 28% vs. 31% of B, 25% vs. 35% of C and 2% vs. 19% of D stage tumours in screen vs symptomatic group. The overall recurrence rate was significantly lower in screening group (8.5%) compared to symptomatic group (18.6%). The overall recurrence free survival was 28 and 24 months respectively in screening group and symptomatic group. <h3>Conclusion</h3> Colonoscopy as a part of national bowel cancer screening programme has improved the detection rate of colorectal cancer at an earlier stage. It has also demonstrated decreased recurrence rate and permanent stoma rate with encouraging recurrence free survival rates compared to symptomatic cancers. <h3>Disclosure of interest</h3> None Declared.
Tenacity of attachment to a cult leader: a psychiatric perspective
Authors: A Deutsch
Journal: American Journal of Psychiatry (1980)

This follow-up study describes a cult whose leader became cruel and increasingly bizarre. Six of 14 members who were investigated at the time of the cult's formation remained loyal to the leader until the dissolution of the group almost four years later. The author describes the attitudes of these and other devotees who submitted to the irrational guru. The leader's radical teachings, his purported closeness to God, and his embodiment of a countercultural ideal of freedom appeared to be factors that bolstered his overwhelming authority in his followers' lives. The devotees used denial, rationalization, and other defensive operations to maintain the fantasy that the leader was acting for their benefit.
Plasma <i>ESR1</i> Mutations and the Treatment of Estrogen Receptor–Positive Advanced Breast Cancer
Authors: Charlotte Fribbens, Ben O’Leary, Lucy Kilburn, Sarah Hrebien, Isaac Garcia-Murillas, Matthew Beaney, Massimo Cristofanilli, Fabrice Andre, Sherene Loi, Sibylle Loibl, John Jiang, Cynthia Huang Bartlett, Maria Koehler, Mitch Dowsett, Judith M. Bliss, Stephen R.D. Johnston, Nicholas C. Turner
Journal: Journal of Clinical Oncology (2016)

ESR1 mutations are selected by prior aromatase inhibitor (AI) therapy in advanced breast cancer. We assessed the impact of ESR1 mutations on sensitivity to standard therapies in two phase III randomized trials that represent the development of the current standard therapy for estrogen receptor-positive advanced breast cancer.In a prospective-retrospective analysis, we assessed ESR1 mutations in available archived baseline plasma from the SoFEA (Study of Faslodex Versus Exemestane With or Without Arimidex) trial, which compared exemestane with fulvestrant-containing regimens in patients with prior sensitivity to nonsteroidal AI and in baseline plasma from the PALOMA3 (Palbociclib Combined With Fulvestrant in Hormone Receptor-Positive HER2-Negative Metastatic Breast Cancer After Endocrine Failure) trial, which compared fulvestrant plus placebo with fulvestrant plus palbociclib in patients with progression after receiving prior endocrine therapy. ESR1 mutations were analyzed by multiplex digital polymerase chain reaction.In SoFEA, ESR1 mutations were found in 39.1% of patients (63 of 161), of whom 49.1% (27 of 55) were polyclonal, with rates of mutation detection unaffected by delays in processing of archival plasma. Patients with ESR1 mutations had improved progression-free survival (PFS) after taking fulvestrant (n = 45) compared with exemestane (n = 18; hazard ratio [HR], 0.52; 95% CI, 0.30 to 0.92; P = .02), whereas patients with wild-type ESR1 had similar PFS after receiving either treatment (HR, 1.07; 95% CI, 0.68 to 1.67; P = .77). In PALOMA3, ESR1 mutations were found in the plasma of 25.3% of patients (91 of 360), of whom 28.6% (26 of 91) were polyclonal, with mutations associated with acquired resistance to prior AI. Fulvestrant plus palbociclib improved PFS compared with fulvestrant plus placebo in both ESR1 mutant (HR, 0.43; 95% CI, 0.25 to 0.74; P = .002) and ESR1 wild-type patients (HR, 0.49; 95% CI, 0.35 to 0.70; P < .001).ESR1 mutation analysis in plasma after progression after prior AI therapy may help direct choice of further endocrine-based therapy. Additional confirmatory studies are required.
Shattered All
Authors: Bruce Leff
Journal: Annals of Internal Medicine (2000)

On Being a Doctor16 May 2000Shattered AllBruce Leff, MDBruce Leff, MDJohns Hopkins Bayview Medical Center; Baltimore, MD 21224 (Leff)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-10-200005160-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I had known Mr. G. for about 4 years. Though quite demented, he exuded utter serenity and projected an aura of tranquility that would have been enviable except for its underlying cause. With his heft and large round face and placid countenance, were he to have donned a saffron robe, he could have passed easily for a Buddhist holy man. He always made me feel better about things, and I looked forward to seeing him on my nursing home rounds. However, when I saw him on my monthly visit looking unmistakably yellow, it was very disturbing. Still more disturbing were ... Author, Article, and Disclosure InformationAffiliations: Johns Hopkins Bayview Medical Center; Baltimore, MD 21224 (Leff)Corresponding Author: Bruce Leff, MD, Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, 5505 Hopkins Bayview Circle, Baltimore, MD 21224; e-mail, [email protected]welch.jhu.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 16 May 2000Volume 132, Issue 10Page: 837-838KeywordsAnxietyGeriatricsMorphineNursing homesPancreatic cancerQuality indicatorsRacial and ethnic issuesRapid eye movementSleepSweat ePublished: 15 August 2000 Issue Published: 16 May 2000 Copyright & PermissionsCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Air pollution is a leading risk factor for stroke, global study shows
Authors: Susan Mayor
Journal: BMJ (2016)

Air pollution, including environmental and household pollution, is a leading risk factor for stroke and is associated with nearly one in three strokes worldwide, a large study has shown.1

Researchers analysed data on stroke related disability adjusted life years (DALYs) and 17 potentially modifiable risk factors, including air pollution, to estimate how various risk factors contribute to the burden of stroke in 188 countries worldwide.

Results …
Warfarin Therapy
Authors: Daniel Deykin
Journal: New England Journal of Medicine (1970)

THE coumarin anticoagulants are widely used in the management of thromboembolic vascular disease. Of the coumarin agents, sodium warfarin is the most frequently employed in the United States. Recent studies have advanced our understanding of the pharmacology of warfarin and allow a reassessment of current practice in the initiation and maintenance of warfarin therapy.Warfarin is a water-soluble derivative of coumaric acid. When given by mouth, it is absorbed completely from the small intestine. It is transported in the blood, loosely bound to albumin. Its distribution in the body and in body fluids, therefore, is essentially the "albumin space." However, . . .
AB0559 Associations Between Systemic Lupus Erythematosus and Chronic Periodontitis – a Single-Centre Case-Control Study
Authors: D. Calderaro, G.A. Ferreira, S. Mendonça, J.D. Corrêa, T.A. Silva, A. Teixeira
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Immunological pathways and predisposing genetic factors common to chronic periodontitis (CP) and systemic lupus erythematosus (SLE) have been described. Studies evaluating clinical, laboratory and therapeutics associations between CP and SLE yielded conflicting results<sup>1</sup>. <h3>Objectives</h3> To compare the frequency and severity of CP in SLE patients with subjects without rheumatic diseases and to evaluate the clinical, laboratory and therapeutic associations between SLE and CP. <h3>Methods</h3> Seventy-five SLE adult patients were compared to 75 subjects without rheumatic diseases (control group), matched for age, educational level and income. <i>Systemic Lupus Erythematosus Disease Activity Index</i> 2000 (SLEDAI 2K) measured SLE activity. <i>Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus</i> (SDI) evaluated SLE associated damage. Periodontal evaluation included measurement of probing depth, clinical attachment level and bleeding on probing. CP was diagnosed and classified according to Eke e Page<sup>2</sup>. <h3>Results</h3> Fifth-one (68%) SLE patients and 42 (56%) subjects in the control group had CP (p=0.13). Considering the 93 subjects with CP, SLE patients were younger than control group individuals (40.7±9.8 <i>versus</i> 46.14±12.5 years, p=0.02). Periodontal parameters and the severity of CP were similar in both groups. SLE patients with CP were older, had a lower educational level, longer SLE duration and greater prednisone cumulative dosage than SLE patients without CP. Probing depth and clinical attachment loss correlated to age, educational level, SLE duration and prednisone cumulative dosage. Clinical attachment loss also associated to SDI. CP was not associated to disease activity or therapeutics in SLE patients. <h3>Conclusions</h3> The frequency and severity of CP in SLE patients were similar to control group, however CP occurred earlier in SLE patients. The DP was associated with variables related to risk of damage in SLE patients. <h3>References</h3> Gonzales TS, Coleman GC. Periodontal manifestations of collagen vascular disorders. Periodontol 2000 1999; 21: 94-105. Eke PI, Page RC, Wei L, Thornton-Evans G, Genco RJ. Update of the case definitions for population-based surveillance of periodontitis.J Periodontol 2012:83(12):1449-54. <h3>Disclosure of Interest</h3> None declared
SP0246 Rheumatology Education - The U.S. Experience
Authors: B. Siaton
Journal: Annals of the Rheumatic Diseases (2015)

The American College of Rheumatology has demonstrated a strong commitment to rheumatology education in the United States through the creation of the Rheumatology Research Foundation9s Clinician Scholar Educator Award (CSE). The CSE provides grant support for clinician educators in their mission to educate, mentor, and inspire trainees. Since 1999, the Rheumatology Research Foundation has funded more than 60 educators and created a community of educational scholars who are dedicated to advancing education in rheumatology and the musculoskeletal diseases. Awardees have developed educational products for trainees of all levels, ranging from medical student to fellow. This lecture will briefly discuss the impact of the CSE on rheumatology education in the United States and highlight the scholarly work of three CSE awardees whose projects demonstrate educational innovation. Topics discussed in this lecture include the state of undergraduate musculoskeletal education in the United States, the use of novel assessment methods in web-based rheumatology modules for residents, and collaborative efforts between fellowship programs to develop a rheumatology objective standardized clinical examination (ROSCE). <h3>Disclosure of Interest</h3> None declared
OP0042 Sacroiliac Inflammation on MRI is Related to Disease Activity Only in Male Patients With Axial Spondyloarthritis: A Longitudinal Analysis in the Desir Cohort: Table 1.
Authors: V. Navarro-Compán, S. Ramiro, R. Landewé, M. Dougados, C. Miceli, D. van der Heijde
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> In patients with axial spondyloarthritis (axSpA), the relationship between inflammatory lesions on MRI and clinical disease activity (DA) measures is still unclear, especially at the early stages of the disease. <h3>Objectives</h3> To investigate the relationship between inflammatory lesions in sacroiliac joints on magnetic resonance imaging (MRI-SI) and clinical disease activity measures in patients with axSpA. <h3>Methods</h3> Patients with inflammatory back pain of maximum 3 years and suspicion of SpA by the rheumatologist were included in the DESIR cohort. Two-year follow-up data from 474 patients fulfilling ASAS axSpA criteria with MRI-SI at baseline, 1- and 2-years were analysed. The relationship between MRI-SI (SPARCC) and ASDAS, BASDAI, patient9s global DA, night pain, CRP and ESR was investigated using cross sectional (correlation-coefficients at baseline) and longitudinal (GEE using 2-year follow-up data) analyses. Model fit was assessed with the QIC. <h3>Results</h3> The relationship between clinical DA measures and MRI-SI was shown to be different for males and females and analyses are therefore presented stratified for gender. <i>Cross-sectional analysis:</i> In males, a significant positive correlation with MRI-SI was found for ASDAS (r =0.19), ESR (r=0.31) and CRP (r=0.36) but not for BASDAI or pain. In females, a positive correlation was found for ESR and CRP at baseline while negative correlations were found for the remaining measures. <i>Longitudinal analysis:</i> In males, a statistically significant relationship with MRI-SI was found for all clinical DA measures except BASDAI (Table); ASDAS (beta parameter estimate (95%CI): 2.41 (1.13-3.69), pain at night: 0.50 (0.04-0.95) and global DA assessment: 0.45 (0.06-0.84), ESR: 0.18 (0.01-0.35) and CRP: 0.15 (0.03-0.28)]. In females, there was no significant relationship. <h3>Conclusions</h3> In patients with axSpA, inflammation on MRI-SI is related to clinical disease activity measures only in males. Moreover, the measures that best relate to MRI are acute phase reactants and ASDAS. <h3>Disclosure of Interest</h3> None declared
The epidemiology of murine typhus in Texas, 1969
Authors: J. J. Older
Journal: JAMA (1970)

During 1969, 28 cases of murine typhus were reported in Texas. This number was consistent with the number of cases reported in previous years. The majority occurred in south Texas in the spring of the year. Patients presented with an illness resembling influenza, but the correct diagnosis was established by the complement-fixation test. Epidemiologic investigations implicated fleas from cats as vectors in the transmission of this illness to several patients.
AB0675 Correlation Between Microvascular Abnormalities in Videocapillaroscopy and Angiogenesis Modulators in Patients with Raynaud's Phenomenon Before and After Multiwave Locked System (MLS) Laser Therapy
Authors: A. Kuryliszyn-Moskal, J. Kita, S. Chwieśko-Minarowska, A. Dakowicz, P.A. Klimiuk
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Raynaud9s phenomenon (RP) is a vascular disorder characterised by reversible vasospastic response of the fingers and toes to cold or emotional stimuli. Microvascular abnormalities, manifested as RP, may be due to a severe underlying disease with reduced life expectancy. The unsuccessful effects and limitations of the pharmacological treatment are the reason of searching for new therapeutical methods, such as non-pharmacologic therapy. <h3>Objectives</h3> The aim of this study was to investigate the correlation between the Multiwave Locked System (MLS) laser therapy, clinical features, microvascular changes in nailfold videocapillaroscopy (NVC) and circulating modulators releasing as a consequence of vascular endothelium injury such as vascular endothelial growth factor (VEGF), angiopoietin 2 (Ang-2) and nitrogen oxide (NO) in patients with RP. <h3>Methods</h3> Seventy-eight RP patients and 30 healthy subjects were recruited into the study. All patients with RP received MLS laser irradiation for 3 weeks. Clinical, NVC and laboratory investigations were performed before and after the MLS laser therapy. The serum concentration of VEGF and Ang-2 were determined by an enzyme-linked immunosorbent assay (ELISA). Total NO concentration was determined using an indirect method based on assessment of nitrite concentration according to Griess9s reaction. <h3>Results</h3> After three weeks of MLS laser therapy the clinical improvement manifested by decreasing of the number of RP attacks, duration of single attack and pain intensity in RP patients was observed. In RP patients before MLS laser therapy the strong positive correlations between the severity of microvascular abnormalities and Ang-2 (r =0.535, p&lt;0.001), NO (r =0.443, p&lt;0.001) and VEGF (r =0.0382, p&lt;0.05) were observed. After MLS laser therapy such correlations were still observed, however there were not so strong as before therapy and in case of NO the correlation was not significant. <h3>Conclusions</h3> Our results suggest that NVC may reflect microvascular changes associated with clinical improvement after MLS laser therapy in patients with primary and secondary RP. Ang-2, VEGF and NO serum levels may be the useful markers of microvascular changes in patients with RP before and after MLS laser therapy. <h3>Disclosure of Interest</h3> None declared
Image of the Month—Quiz Case
Authors: Harvey L. Bumpers, Sheryl Gabram-Mendola, Joel Okoli, Monica Rizzo
Journal: JAMA Surgery (2013)

AMERICAN FEMALE patient presented to the emergency department with a complaint of severe shortness of breath and a swollen right hand.On admission, she was unable to walk.She gave no past medical history of diabetes mellitus or of treatments for other pathologies.A physical examination was significant for severe edema in the right upper extremity accompanied by excoriation and necrosis of the skin and soft tissue of the limb and the right chest wall.A chest radiograph showed a massive pleural effusion with near complete collapse of the right lung.A photograph of the patient (Figure 1) and a computed tomographic scan of the chest (Figure 2) are shown.What Is the Diagnosis?A. Caustic burn injury B.
The Effectiveness of Total Worker Health Interventions: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop
Authors: Cynthia Feltner, Kristina Peterson, Rachel Palmieri Weber, Laurie Cluff, Emmanuel Coker-Schwimmer, Meera Viswanathan, Kathleen N. Lohr
Journal: Annals of Internal Medicine (2016)

Background: The Total Worker Health (TWH) program of the National Institute for Occupational Safety and Health aims to advance worker well-being by integrating injury and illness prevention efforts with work-related safety and health hazard efforts. Purpose: To evaluate evidence on the benefits and harms of integrated TWH interventions. Data Sources: MEDLINE, Cochrane Library, and PsycINFO (January 1990 through September 2015); clinical trial registries; and reference lists. Study Selection: English-language studies that enrolled employed adults and compared integrated interventions with usual work practice, no intervention, or another intervention. Data Extraction: Dual abstraction and risk-of-bias (ROB) assessment. Data Synthesis: Ten of the 15 included studies had high ROB, primarily because of selection and attrition bias. Findings graded as having low strength of evidence (SOE) supported the effectiveness of TWH interventions for improving smoking cessation, as measured by self-reported 7-day abstinence over 22 to 26 weeks (2 randomized, controlled trials [RCTs]; n = 737), and increasing consumption of fruits and vegetables over 26 to 104 weeks (3 RCTs; n = 6056); results apply to populations of blue-collar manufacturing and construction workers. Findings graded as having low SOE supported the effectiveness of TWH interventions for reducing sedentary work behavior in office workers over 16 to 52 weeks (2 RCTs; n = 262). Evidence was insufficient or lacking for other outcomes of interest, such as rates of work injuries, quality of life, and harms. Limitation: Small, diverse body of evidence with many methodological limitations; possible publication bias. Conclusion: Integrated TWH interventions might improve health behaviors (for example, reduce tobacco use and sedentary behavior and improve diet) of workers, but effects of these interventions on injuries and overall quality of life are not known. Primary Funding Source: Agency for Healthcare Research and Quality.
Carbon monoxide poisoning
Authors: R. J Howard
Journal: BMJ (1988)

the Chinese."But despite the low local background risk table I of their report supports my case: a significant 10 5% of leg scans were positive after major surgery for benign conditions in those taking the pill (excluding the minilap sterilisations), not 4-6% as quoted.Among those not taking the pill there was not a single postoperative positive 125I fibrinogen scan for deep vein thrombosis in that study or in the London study, which showed a 20% rate in those taking the pill.Sagar et al concluded, "Women on oral contraceptives con- stitute a high risk group for postoperative throm- boembolism.""Mr Sue-Ling and Professor Hughes rightly emphasise the other side of the risk-benefit equa- tion-unwanted pregnancy.But given a United Kingdom maternal mortality of less than 1 in 1000012 it is far from obvious that more women would die.Moreover, the choice implied is not correct: it is not "the pill" or "unwanted pregnancy."There are other effective methods, including injectable contraceptives, such as medroxyprogesterone.' At the Margaret Pyke Centre we now routinely offer this (with coun- selling).One or more injections each lasting three months will cover the time on any waiting list.The oral contraceptive may be resumed two or more weeks after surgery without regard to the time of the last injection.Progestogen only pills also do not increase the risk of deep vein thrombosis and pulmonary embolism and have a failure rate above age 35 of less than 1 per 100 woman years.13JOHN GUILLEBAUD