tbuckley/cabot-search huggingface dataset:
PTH-174 Non-endoscopic screening for barrett’s oesophagus: identifying neoplasia with infrared spectroscopy
Authors: OJ Old, G Lloyd, M Almond, C Kendall, H Barr, A Shore, N Stone
Journal: Gut (2015)

<h3>Introduction</h3> Non-endoscopic detection of Barrett’s oesophagus (BO) and associated neoplasia would allow population screening and could potentially replace endoscopic surveillance. A swallowed cytology brush has been developed (‘Cytosponge’) for oesophageal cell collection. A recent study (BEST2) assessing the Cytosponge used immunostaining with Trefoil Factor 3 (TFF3) as a means of BO detection. Accurate identification of neoplasia could enable risk stratification to determine who requires endoscopy. Infrared spectroscopy (IR) of biological samples analyses sample biochemistry: subtle spectral differences can be used to classify samples into pathological subtypes. This study aimed to evaluate IR as a diagnostic tool for automated detection of neoplasia in oesophageal cytology. <h3>Method</h3> Brush cytology was collected from patients undergoing endoscopy for BO, with contemporaneous biopsy from the same region. Cells were fixed in formalin, centrifuged and plated onto calcium fluoride slides. IR spectra were measured across the entire sample area. Data pre-processing steps selected spectra from individual cells and removed confounding effects from water vapour and non-cellular debris. Contemporaneous endoscopy and biopsy results provided a reference for developing a predictive model. Prinicipal component analysis (PCA), linear discriminant analysis (LDA), and leave-one-out cross-validation (LOOCV) were used to develop and test classification models. <h3>Results</h3> Samples were measured from 20 patients (7 BO, 13 dysplasia or adenocarcinoma). LOOCV testing showed a sensitivity for detecting neoplastic change (dysplasia or adenocarcinoma) of 79.9%, with specificity 75.8%. <h3>Conclusion</h3> These results show feasibility of using IR to detect neoplasia in Barrett’s screening. Further work is required to expand our preliminary results and refine pre-processing steps to improve sensitivity, and develop trials using the Cytosponge. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Ross-Innes, <i>et al</i>. Evaluation of a minimally invasive cell sampling device, coupled with assessment of Trefoil Factor 3 expression for diagnosiing Barrett’s esophagus: a multi-centre case-controlled study. PLoS Med. 2015;12(1):e1001780 Kadri, <i>et al</i>. Acceptability and accuracy of a non-endoscopic screening test for Barrett’s oesophagus in primary care: cohort study. BMJ 2010;<b>341</b>:c4372 Townsend, <i>et al</i>. Infrared microspectroscopy for cyto-pathological classification of esophageal cells. Analyst 2015 doi: 10.1039/C4AN01884B
Staphylococcal Epidemiology on a Surgical Ward
Authors: John F. Burke, E. A. Corrigan
Journal: New England Journal of Medicine (1961)

CONSIDERABLE effort is being expended to control postoperative complications secondary to the staphylococcus, as the large number of articles in the current medical literature indicates. These articles deal with a number of problems, many indicating the presence of an epidemic or endemic strain of staphylococci. However, the literature contains little evidence of the exact reservoir of endemic or epidemic strains. The question arises, Is it the ward physical plant (walls, floors, drapes, treatment rooms, clean-up rooms and so forth) or is it the patient already infected with or carrying the epidemic or endemic strain that is the exact reservoir? It . . .
Arteriography of Cerebrovascular Occlusive Disease
Authors: Thomas H. Newton, John E. Adams, Edwin J. Wylie
Journal: New England Journal of Medicine (1964)

WITH advances in reconstructive vascular surgery and the increase in life expectancy accurate angiographic demonstration of cerebrovascular occlusive disease has become increasingly important. Extracranial arterial occlusive disease, which may be well localized and segmental, is now well recognized as a precursor and common cause of cerebrovascular insufficiency. Although the clinical findings usually indicate the locus of brain involvement, the site and extent of vascular disease often cannot be accurately determined clinically.1 , 2 Palpation of pulsatile arteries, ophthalmodynamometry and auscultation of the neck and mediastinum are helpful adjuncts in determining the site of the occlusive lesions.3 The interpretation of these findings, however, . . .
A Second Outbreak of Boston Exanthem Disease in Pittsburgh during 1954
Authors: Franklin A. Neva
Journal: New England Journal of Medicine (1956)

A PREVIOUS report1 described an unusual epidemic exanthem that occurred during the late summer of 1951 in Boston. Evidence then available indicated that the illness represented a clinical entity different from the more commonly known exanthems. In addition, the isolation of a new group of transferable agents from feces of several of the patients, as well as their neutralizing-antibody responses, suggested a possible etiologic relation of these agents to the disease.These initial observations have now been corroborated and extended by studies of a second outbreak of a similar clinical entity observed in Pittsburgh during June to September, 1954. Filterable . . .
Renal Tubular Acidosis with Recurrent Nephrolithiasis and Nephrocalcinosis
Authors: D. L. Wilansky, C. Schneiderman
Journal: New England Journal of Medicine (1957)

THE syndrome of renal tubular acidosis is a clinical disorder resulting from impaired renal tubular control of acid–base metabolism. Since first described by Lightwood1 in 1936, cases have been recognized in increasing numbers. Frequently resulting from an inborn error of metabolism, the congenital form of this syndrome may become clinically apparent in infancy, early childhood or adolescence. Occurrence in the adult is rare; 22 cases had been recorded up to 1956.2 Whether the adult form may be of congenital origin is unknown. Furthermore, the adult syndrome may result from chronic pyelonephritis, and is frequently seen after bilateral ureteral transplantation into . . .
Sickle Cell Anemia and HSCT: Relation Between ATG, Chimerism, Gvhd and Outcome In Myeloablative Genoidentical Transplants For The SFGM-TC
Authors: Francoise Bernaudin, Dominique Bories, Jean-Hugues Dalle, Marie Robin, Regis Peffault de Latour, Benedicte Neven, Yves Bertrand, Corinne Pondarre, Jean-Pierre Vannier, Karima Yakouben, Mathieu Kuentz, Catherine Cordonnier, Nathalie Dhedin, Isabelle Thuret, Patrick Lutz, Eliane Gluckman, Gérard Socié
Journal: Blood (2013)
Fingerprints and Palm Prints (Dermatoglyphics) and Palmar-Flexion Creases in Gonadal Dysgenesis, Pseudohypoparathyroidism and Klinefelter's Syndrome
Authors: Anne P. Forbes
Journal: New England Journal of Medicine (1964)

ALTHOUGH the heritability of the patterns on fingers and palms was pointed out by Sir Francis Galton1 in 1892 and soon put to wide use in physical anthropology, little agreement has been reached to date on the mode of inheritance of individual patterns and characteristics.2 3 4 5 6 7 Cummins and Midlo8 have summarized a substantial body of literature on this controversy in their comprehensive monograph, in which they review the comparative anatomy of fingerprints and palm prints and the incidence of individual dermatoglyphic traits in large numbers of people of different races.Palmar-flexion creases, which came to medical attention before fingerprints, have been . . .
PTPS-14THE NEED FOR MULTI-TARGETED THERAPY IN PEDIATRIC BRAIN TUMORS WITH BRAF MUTATION
Authors: Soumen Khatua, Wafik Zaky, Michael Rytting, Jeffrey Weinberg, David Sandberg, Anita Mahajan, Leena Ketonen, Jason Johnson, Vivek Subbiah
Journal: Neuro-Oncology (2015)

Emerging evidence confirms dysregulation of BRAF gene inducing oncogenesis of pediatric brain tumors. To-date few reports show short-lived efficacy using BRAF inhibitors in these tumors. This indicates the need to target diverse pathways to have sustained clinical efficacy. We present two cases where a combination of vemurafenib (BRAF inhibitor) with everolimus (mTOR inhibitor) as a part of an IRB approved protocol was used. A 10-year-boy diagnosed with a left parietal pleomorphic xanthoastrocytoma (PXA) demonstrated tumor progression despite radiotherapy and three surgical interventions over two years. The tumor showed BRAF mutation for which he received a combinatorial therapeutic approach using the above two drugs given orally every day on a 28 day cycle. He experienced a partial response after two cycles and continued response after 13 cycles. This therapy has been well-tolerated with only minor (Grade I) skin rash. The child remains clinically stable with a Lansky score of 100. The second case is a 13-year-old female diagnosed at 1 year of age with a right-sided optic pathway glioma. The biopsy was consistent with pilocytic astrocytoma. The tumor progressed through multiple chemotherapeutic regimens, including carboplatin, vincristine, vinblastine, celexocib. Molecular analysis performed at our institution demonstrated the tumor to harbor a BRAF mutation for which she is currently receiving the above therapeutic regimen. She is tolerating the therapy well, with mild mouth sores. Her tumor after four cycles shows ongoing response and stable vision. It is now known that these tumors can induce escape mechanisms conferring therapeutic resistance and short-lived efficacy, undermining single drug BRAF targeted approach. This is the first ongoing study targeting these pathways (RAF/MAPK/ERK) and PI3K/mTOR pathway in pediatric brain tumors with BRAF mutation. Larger prospective larger studies are warranted to overcome therapeutic limitations through optimal combination therapy targeting multiple signaling pathways.
Comparison of the Carcinogenicity of Methylazoxymethanol-β-&lt;sc&gt;d&lt;/sc&gt;-glucosiduronic Acid in Conventional and Germfree Sprague-Dawley Rats&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;&lt;xref ref-type="fn" rid="FN3"&gt;3&lt;/xref&gt;&lt;xref ref-type="fn" rid="FN4"&gt;4&lt;/xref&gt;&lt;xref ref-type="fn" rid="FN5"&gt;5&lt;/xref&gt;
Authors: G L Laqueur, H Matsumoto, R S Yamamoto
Journal: JNCI Journal of the National Cancer Institute (1981)

Methylazoxymethanol-beta-D-glucosiduronic acid (MAM-GlcUA) was administered to young adult male Sprague-Dawley rats by oral and ip routes. Most neoplasms developed in rats that had received the compound orally. The most prevalent site for the neoplasms was the intestinal tract, predominantly the colon. Comparatively fewer tumors occurred in the liver and kidneys. Germfree rats did not develop tumors when MAM-GlcUA was administered either orally or ip.
Inhibition of Serotonin Synthesis by Para-Chlorophenylalanine in Patients with the Carcinoid Syndrome
Authors: Karl Engelman, Walter Lovenberg, Albert Sjoerdsma
Journal: New England Journal of Medicine (1967)

ALTHOUGH the role of 5-hydroxytryptamine (serotonin, 5HT) in the pathophysiology of the carcinoid syndrome, and especially in flush production, has been seriously questioned,2 the fact remains that increased production of serotonin is a hallmark of the condition. If it were possible effectively to inhibit the formation of this pharmacologically potent amine in patients with carcinoid tumors, a likely result would be a better understanding of the clinical significance of serotonin. A possibility of achieving this goal appeared with the studies of Koe and Weissman3 showing that para-chlorophenylalanine (PCP) is a potent and selective depletor of tissue serotonin in animals. It . . .
P-101 Tumor differentiation is a risk factor for lymph node metastasis in patients with gastric cancer
Authors: A. Baušys, D. Klimas, A. Kilius, K. Pauža, G. Rudinskaite˙, N. Samalavičius, Ž. Sinkevičius, E. Sangaila, R. Baušys
Journal: Annals of Oncology (2015)
Images in Clinical Medicine: Acupuncture-Needle Fragments
Authors: Perry S. Gerard, Eric Wilck, Thomas Schiano
Journal: New England Journal of Medicine (1995)

To the Editor: Chiu and Austin (Feb. 2 issue)1 provide radiographic evidence of multiple, fine, metallic densities in the soft tissue of the back of a Japanese man, representing permanently placed acupuncture needles. We disagree, however, with the statement that the needles remain in the subcutaneous tissue permanently. This form of acupuncture, known as Hari acupuncture, is undertaken to improve one's general health and specifically to treat pain, paralysis, and skin diseases. The skin is initially prepared with alcohol, and a spring-loaded syringe is used to inject the 1-cm needles along predefined meridians. In a typical session lasting one to . . .
P51 Advancing Quality (AQ) Reducing Variation and Improving Quality and Outcomes for patients with Chronic Obstructive Pulmonary Disease (COPD) in the North West of England
Authors: J Roberts, D Szwandt, S Hammond
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> COPD patients in the North West of England die 15 years earlier than expected. Advancing Quality is a programme of work where a common approach supports quality improvement that focuses on clinical pathways. <h3>Methods</h3> A regional clinical expert group agreed the AQ COPD evidence based measures (clinical interventions) in February 2013. <b>The AQ COPD clinical interventions are:</b> <b>Within 4 Hours Hospital Arrival:</b> Oxygen - Bronchodilator - Corticosteroid - Antibiotic Therapy. <b>During Hospital Admission:</b> Smoking Cessation - Pulmonary Rehab - Inhaler Technique - Written Self-Management Plan - Spirometry – Home Oxygen - Appropriate End of Life Care – follow up. Following an initial pilot, AQ COPD went live in September 2014. AQ is a proven approach to improve quality, providing standardisation and transparency for providers and commissioners. <h3>Results</h3> Trusts aim to deliver all the interventions that the patient is eligible for, this is known as the Appropriate Care score (ACS). More patients are receiving “perfect care” with AQ, (see Figure 1). Trusts participating in AQ had a mean LOS of 4.7 days compared to 5.7 days for non-participating trusts and average bed days for patients re-admitted in participating trust was 5.5 days compared to 11.8 days in non- participating trusts. Trusts participating saw their readmission rate fall to 20.1% over the period (a reduction of 9%). <h3>Conclusion</h3> A regional standardised approach, focused on a small but significant set of clinical interventions, can have a significant impact on improving patient care and outcomes. In 2015/16 North West CCGs have commissioned AQ COPD across 15 of the 21 Acute Trusts. An AQ incentive framework was also developed for providers and commissioners that supports “doing the right thing” collaborative events ensure that ongoing sharing of best practise happens and we have future plans to expand into Primary and Community Care.
Surveillance Scanning of Children with Medulloblastoma
Authors: Carlos F. Torres, Susan Rebsamen, Jeffrey H. Silber, Leslie N. Sutton, Larissa T. Bilaniuk, Robert A. Zimmerman, Joel W. Goldwein, Peter C. Phillips, Beverly J. Lange
Journal: New England Journal of Medicine (1994)

The standard follow-up care for children with medulloblastoma includes regular clinical evaluations and surveillance scanning of the central nervous system with computed tomography or magnetic resonance imaging. The evaluations and scanning assess the response of the tumor to treatment, detect any recurrence of disease, and monitor any complications of treatment. We compared the effectiveness of a periodic history taking and physical examination with that of surveillance scanning in detecting recurrent tumors.
P238 A randomised, double-blind (sponsor-unblind), placebo controlled, cross-over study to investigate the efficacy, effect on cough reflex sensitivity, safety, tolerability and pharmacokinetics of inhaled GSK2339345 in patients with chronic idiopathic cough using an aqueous droplet inhaler: Abstract P238 Table 1
Authors: H Badri, I Satia, R Dockry, L McGarvey, J Marks-Konczalik, RD Murdoch, A Cheesbrough, F Warren, S Siederer, JA Smith
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> Voltage gated sodium channels (VGSC) are important in the initiation and propagation of action potentials in the afferent sensory nerve fibres innervating the airways responsible for evoking cough. Therefore a VGSC inhibitor may be an effective anti-tussive agent, inhibiting cough irrespective of the type of stimuli. We aimed to investigate the efficacy of a novel use-and frequency-dependent VGSC inhibitor (GSK2339345) in patients with chronic idiopathic cough. <h3>Methods</h3> We performed a two-part randomised, double-blind, placebo-controlled, cross-over study recruiting patients with chronic idiopathic cough from two specialist clinics. In the first part of the study, patients were randomly assigned to receive two inhaled doses of either GSK2339345 or placebo, 4 h apart during three study periods. The primary endpoint was the objective cough frequency (VitaloJAK, Vitalograph Ltd) during the 8 h post-treatment (4 hrs following each dose). The difference between GSK2339345 and placebo in log-transformed cough counts was investigated using a mixed effects model with fixed effects terms for treatment and period, and subject fitted as a random effect. In the second part, subjects attended on four study days, and underwent full dose-response cough challenges with capsaicin and citric acid following single doses of GSK2339345 or placebo. This was analysed using dose response modelling. <h3>Results</h3> Of 16 patients enrolled (56.7 ± 9.6 yrs; 13 female), 11 completed the study. Eight hour cough counts showed a 26% increase in cough counts with GSK2339345 vs placebo. However, on exclusion of the coughs occurring within 2 min of inhalation of the study drug, there was only a 1.6% increase in coughs; see Table 1 for ratio of adjusted geometric means. There appeared to be no impact of GSK2339345 on either of the cough challenges however, the dataset was too small to draw definitive conclusions. <h3>Conclusion</h3> There was no evidence of an anti-tussive effect of GSK2339345 over the 8 h analysis for any subject, despite cough frequency being highly reproducible within patients. Inhalation of GSK2339345 had a pro-tussive effect in all subjects following actuation of the device, not seen with placebo. The novel cough challenge methodology warrants further investigation as a development tool.
Alterations in Circulating Estradiol-17β in Male Patients with Graves's Disease
Authors: Inder J. Chopra, Guy E. Abraham, Usha Chopra, David H. Solomon, William D. Odell.
Journal: New England Journal of Medicine (1972)

Abstract Serum concentrations of estradiol-17β (E2), gonadotropins and long acting thyroid stimulator were studied in 10 consecutive male patients with active Graves's disease. Serum E2 was elevated in all patients before therapy. In two men with gynecomastia the concentrations were as high as those observed in normal women. The per cent dialyzable E2 was significantly reduced in hyperthyroid males as compared to normal males and was similar to that seen in eugonadal women; but the absolute concentration of unbound E2, evaluated in one prepubertal and five adult patients without gynecomastia, was elevated in four of the five adults. The mean serum concentrations of luteinizing and follicle-stimulating hormones were also higher in the hyperthyroid men than in normal men. Serum E2 fell gradually and consistently during effective treatment of hyperthyroidism with propylthiouracil. Neither the occurrence of gynecomastia nor the serum concentration of E2 correlated with serum concentration of long acting thyro...
Birth Weight in Relation to Morbidity and Mortality among Newborn Infants
Authors: Donald D. McIntire, Steven L. Bloom, Brian M. Casey, Kenneth J. Leveno
Journal: New England Journal of Medicine (1999)

At any given gestational age, infants with low birth weight have relatively high morbidity and mortality. It is not known, however, whether there is a threshold weight below which morbidity and mortality are significantly greater, or whether that threshold varies with gestational age.We analyzed the neonatal outcomes of death, five-minute Apgar score, umbilical-artery blood pH, and morbidity due to prematurity for all singleton infants delivered at Parkland Hospital, Dallas, between January 1, 1988, and August 31, 1996. A distribution of birth weights according to week of gestation at birth was created. Infants in the 26th through 75th percentiles for weight served as the reference group. Data on preterm infants (those born at 24 to 36 weeks of gestation) were analyzed separately from data on infants delivered at term (37 or more weeks of gestation).A total of 122,754 women and adolescents delivered singleton live infants without malformations between 24 and 43 weeks of gestation. Among the 12,317 preterm infants who were analyzed, there was no specific birth-weight percentile at which morbidity and mortality increased. Among 82,361 infants who were born at term and whose birth weights were at or below the 75th percentile, however, the rate of neonatal death increased from 0.03 percent in the reference group (26th through 75th percentile for weight) to 0.3 percent for those with birth weights at or below the 3rd percentile (P<0.001). The incidence of five-minute Apgar scores of 3 or less and umbilical-artery blood pH values of 7.0 or less was approximately doubled for infants at or below the 3rd birth-weight percentile (P=0.003 and P<0.001, respectively). The incidence of intubation at birth, seizures during the first day of life, and sepsis was also significantly increased among term infants with birth weights at or below the 3rd percentile. These differences persisted after adjustment for the mother's race and parity and the infant's sex.Mortality and morbidity are increased among infants born at term whose birth weights are at or below the 3rd percentile for their gestational age.
Vacuolar Myelopathy Pathologically Resembling Subacute Combined Degeneration in Patients with the Acquired Immunodeficiency Syndrome
Authors: Carol K. Petito, Bradford A. Navia, Eun-Sook Cho, Barry D. Jordan, Daniel C. George, Richard W. Price
Journal: New England Journal of Medicine (1985)

Twenty of 89 consecutive patients with the acquired immunodeficiency syndrome (AIDS) in whom autopsies were performed over a 3 1/2-year period had a vacuolar myelopathy that was most severe in the lateral and posterior columns of the thoracic cord. Light and electron microscopy showed that vacuoles were surrounded by a thin myelin sheath and appeared to arise from swelling within myelin sheaths. Signs and symptoms referable to the spinal-cord lesions, including paraparesis, often accompanied by spasticity or ataxia (or both), were present in all five patients with marked pathological changes, in five of seven patients with moderate changes, and in two of eight patients with mild changes. Fourteen patients were demented. The clinical presentation was sufficiently distinctive to provide a guide for antemortem diagnosis. Possible causes of the vacuolar changes include uncharacterized viral infection or a metabolic derangement related to selective nutritional deficiency.