tbuckley/cabot-search huggingface dataset:
Soundings: Saving lives on the Silk Road
Authors: James Owen Drife
Journal: BMJ (2004)

Long haul flights are exciting but rarely scary nowadays. We British tend to go to countries that were once pink on the map. It is a new experience to fly to someone else's former empire, to places you had not heard of until recently.

Kyrgyzstan lies between Kazakhstan and China. Tajikistan separates it from Afghanistan—only just, but enough to reassure the wimp in me. The Kyrgyz capital, Bishkek, was not in my atlas but according to the web it did exist. Until the Soviet Union broke up it was called Frunze.

At Bishkek airport you cannot help noticing the United States Air Force planes. Then, as your taxi turns east along the Silk Road, you see an endless range of snow capped mountains. When the sun begins to set, they turn pink. Gee whiz, this is a beautiful country.

The central Asian republics have convoluted borders said to have been drawn by Stalin to prevent their peoples uniting. Now their leading doctors and midwives were being brought together by the World Health Organization (WHO) to discuss how to reduce maternal mortality.

Their rates are good compared with some nearby countries. In Afghanistan mothers are dying in huge numbers. In Iraq, sanctions multiplied the maternal mortality rate more than tenfold, even before last year's invasion. Central Asia's rates—at least officially—are only four or five times those in Western Europe. One way to reduce them, we hope, is UK-style confidential inquiries.

Each delegation sat at a long table with a little flag. Everyone except the WHO visitors spoke Russian. You had to remember to remove your earpiece when answering questions, otherwise you heard yourself in Cyrillic.

I was prepared for disappointment. International meetings often generate only hot air. Soon, however, we were making delayed-action jokes through our interpreters and by the end there was an unmistakable air of resolve. We were all professionals who had seen women bleed. We got quite emotional.

The farewell party beside a moonlit lake involved toasts, a bonfire, a sheep's head (delicious), Moldovan brandy, communal Kazakh dancing, and a not entirely successful Scottish reel. I felt surprisingly at home, but then I come from a long line of shepherds.
Cell-Free DNA for Minimal Residual Disease Monitoring in Multiple Myeloma Patients
Authors: Lenka Kubiczkova-Besse, Daniela Drandi, Lenka Sedlarikova, Stefania Oliva, Manuela Gambella, Paola Omedè, Zdenek Adam, Ludek Pour, Sabina Sevcikova, Mario Boccadoro, Antonio Palumbo, Roman Hajek
Journal: Blood (2014)
Abnormal diurnal variation in circulating natural killer cell phenotypes and cytotoxic activity in major depression
Authors: J M Petitto, J D Folds, H Ozer, D Quade, D L Evans
Journal: American Journal of Psychiatry (1992)

This investigation tested the hypothesis that depressed patients have abnormal diurnal variation of natural killer (NK) cell measures. The diurnal variation of levels of Leu-11 NK cells and NK cytotoxic activity was significantly less in 24 patients with major depression than in 24 normal comparison subjects. These findings provide evidence that aspects of immune, as well as neural and endocrine, chronobiology are abnormal in depression.
The Pineal Organ
Authors: Richard J. Wurtman, Michael A. Moskowitz
Journal: New England Journal of Medicine (1977)

Probably no organ in the body was less understood two decades ago than the pineal. Textbooks of physiology and endocrinology published during that "Dark Age" characteristically dismissed the pineal as Descartes' "Seat of the Soul," as the rudimentary "third eye" of lower vertebrates (but not mammals) or, most commonly, as a calcified vestige, which provided a useful landmark for neuroradiologists. They might have added that, at one time, the pineal has mistakenly been thought to secrete a gonad-inhibiting hormone, because its tumors were sometimes associated with precocious puberty in boys.Between 1959 and 1964, research on the pineal attained what . . .
Cognitive impairment and dementia in older cancer patients.
Authors: Beatrice Jara-Almonte Edwards, Peter Khalil, Holly Michelle Holmes, Ming Sun, Juhee Song, Heather Valladarez
Journal: Journal of Clinical Oncology (2016)

e269 Background: Chemotherapy effect on cognitive function has also been described in women with breast cancer. Our objective was to define the prevalence of cognitive impairment and dementia in older patients with cancer. Methods: This is a retrospective study at the Program for Healthy Aging at MD Anderson Cancer Center between January 1, 2013 and March 31, 2015. Patients with cancer, 65 years of age and older underwent functional and cognitive testing through personal interview, using IADLs, ADLs, and the Montreal cognitive assessment (MOCA). Screening for depression used PHQ-9. Risk factors for dementia assessed, included depression, concussions, alcohol abuse, and family history of dementia. Level of education was determined. Cognitive impairment was diagnosed with an abnormal MOCA ( &lt; 26) without functional impairment, dementia was diagnosed with an abnormal MOCA with functional impairment. Imaging and assessment for reversible factors of memory loss was conducted. SAS 9.4 (SAS Institute INC, Cary, NC) was used for data analysis. Results: 192 patients were evaluated, male gender (n = 93, 48.4%), female (n = 99, 51.6%), mean age 78 years old (SD, 7) range 65 to 94 years. Sixty-two patients (32.3%) with a hematological malignancy; 26 (13.5%) with breast cancer; 22 (11.5%) with GI cancer; 19 (9.9%) with prostate malignancy; 16 (8.3%) with lung cancer; 14 (7.3%) with bladder cancer; and 33 (17.2%) with other malignancies. Cognitive impairment and/or dementia was identified in 118 (61.5%) patients. Mild cognitive impairment was evidenced in 27 cases (18.2%). Types of dementia included Alzheimer’s disease (n = 11, 7.4%), vascular dementia (n = 21, 14.2%), and mixed dementia (n = 59, 39.9%). The majority of cases of dementia were early stage dementia (n = 45, 56.3%), moderate stage dementia (n = 29, 36.3%), and advanced or severe dementia (n = 6, 7.5%). No significant thyroid abnormalities, B12 deficiency or other reversible causes were identified. Conclusions: Cognitive impairment and/or dementia are commonly seen in patients with cancer in a comprehensive cancer center. Further research in this area is necessary.
Quantitative Histologic Analysis of the Effect of X-Radiation on the Interstitial Tissue of the Testes of Laf&lt;sub&gt;1&lt;/sub&gt; Mice
Authors: Allen B. Eschenbrenner, Eliza Miller
Journal: JNCI Journal of the National Cancer Institute (1946)

Journal Article Quantitative Histologic Analysis of the Effect of X-Radiation on the Interstitial Tissue of the Testes of Laf1 Mice Get access Allen B. Eschenbrenner, Allen B. Eschenbrenner surgeon National Cancer Institute, National Institute of Health, United States Public Health Service Search for other works by this author on: Oxford Academic PubMed Google Scholar Eliza Miller Eliza Miller assistant biologist National Cancer Institute, National Institute of Health, United States Public Health Service Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 6, Issue 6, June 1946, Pages 343–348, https://doi.org/10.1093/jnci/6.6.343 Published: 01 June 1946
Ulcerative Proctitis
Authors: Jarrett H. Folley
Journal: New England Journal of Medicine (1970)

THE purpose of this review is to call further attention to "ulcerative proctitis" as a clinical entity, as opposed to involvement of the rectal segment in diffuse ulcerative colitis.Physicians are generally familiar with the clinical picture, course and difficult treatment of diffuse chronic ulcerative colitis, which has been extensively studied and reported in the literature over many years. It is known as a severe, disabling and progressive disease, frequently requiring total colectomy as the ultimate therapy to control multiple complications in its life-threatening course.Less well known is that ulcerative proctitis may be a limited and relatively benign disease . . .
Prostate-Specific Antigen as a Unique Routine Test in Monitoring Therapy for Inoperable Prostate Cancer: Comparison with Radionuclide Bone Scan and Prostatic Acid Phosphatase
Authors: M. Barichello, M. Gion, A. Bonazza, U. Santucci Delli Ponti, A. Bolgan, G.P. Contemori, P. Barioli, G. Capitanio, B. Pecori, S. Omacini, L. Benvegnù, S. Petracco
Journal: European Urology (1995)
Cetuximab plus Irinotecan as third line chemotherapy for metastatic colorectal cancer
Authors: M. Moe, R. A. Micallef, T. Pwint, T. Maughan, D. Mort, J. Wagstaff
Journal: Journal of Clinical Oncology (2008)

14623 Background: Cetuximab combined with irinotecan has shown progression free and overall survival benefits in metastatic colorectal cancer as third line chemotherapy. We evaluate the outcome of this treatment given to patients in South Wales, UK. Methods: Metastatic colorectal cancer patients who received cetuximab and irinotecan were identified. Data was collected from patient records. Cetuximab was given 400 mg/m2 first dose followed by 250 mg/m2 weekly thereafter. Irinotecan was given 350 mg/m2 every 3 weeks or 180 mg/m2 fortnightly. The response status was evaluated with CT scan according to RECIST after 6 weeks of treatment. Time to progression (TTP) was defined as time from treatment start date to documented disease progression or death whichever is earlier. Overall survival (OS) is defined as time from treatment start date to death from any cause. Results: Total of 42 patients were treated between October 2004 and January 2007. Male =23; median age =63 (range = 42–84); PFS 0–1 =42; previous oxaliplatin =38; liver metastases =37; >3 metastatic sites = 9; EGFR status Positive = 13, Negative =3, unknown =27. Median treatment duration: 12 weeks (range: 1 - 71). PR = 9 (21.4%), SD = 10 (23.8%), PD =23 (54.7%). Two patients with negative EGFR expression showed PR. At analysis all patients had disease progression and 37 patients had died. Median TTP =16 weeks (1–74 weeks), median OS =30 weeks (1 - 130 weeks). Reasons for stopping treatment are: radiological disease progression = 28, poor PFS = 4, break from treatment = 7, side effects = 2 (rash and tiredness each) and CVA = 1. Patients who achieved PR or SD on CT scan after 6 weeks treatment had significantly longer median survival compared to those who did not achieve this (17 vs. 51 weeks; p = 0.001). Median OS after stopping cetuximab was longer for those patients with PR/SD compared to those with PD. Conclusions: Our median TTP and OS are comparable to those of BOND trial (4.1 and 8.6 months). Response to cetuximab and irinotecan could be seen in tumours with negative EGFR expression by current IHC method. Novel treatment options are needed for those whose disease progressed on cetuximab and irinotecan treatment as they have significantly shorter survival compared to those who achieve PR or SD. The PD status after 6 weeks treatment is predictive of shorter survival. No significant financial relationships to disclose.
Abstract P206: Dog Ownership and the Risk of Cardiovascular Disease: A Nation-wide Cohort Study
Authors: Mwenya Mubanga, Liisa Byberg, Erik Ingelsson, Tove Fall
Journal: Circulation (2016)

Introduction: Conflicting results surround the relationship between dog ownership and the risk of developing cardiovascular disease. Registration of dog ownership has been mandatory in Sweden since 2001 and it is estimated that 83% of dogs are registered. The aim of this study was to use the Swedish national dog registers to assess the association of dog ownership and incident cardiovascular disease. Methods: The study cohort was defined from the Register of the Total Population including all Swedish residents aged 40-75 years in 2001. The personal identity number was used to link records to the Longitudinal Integration Database for Health Insurance and Labor Market Studies, the National Patient Register and the Cause of Death Register for socioeconomic variables and health outcomes. Dog exposure was defined as being registered or having a partner registered as a dog owner in either the Swedish Board of Agriculture and/or the Swedish Kennel Club dog registers. Study participants with cardiovascular events before baseline or immigrating to Sweden after 1987 were excluded. Outcomes were examined independently and included coronary heart disease, heart failure, ischemic stroke and hemorrhagic stroke. Cox proportional hazards regression using age as time-scale was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Study subjects were censored at death, emigration or 31st December 2012. Models were adjusted for sex, marital status, presence of children &lt;18 years in the household, country of birth, province of residence, education level and income. Results: The study population included 3 113 864 individuals, of whom 169 395 (5.4%) were dog owners. At baseline, the median age was 55 years in non-owners (interquartile range, IQR, 48 -62) and 52 years in dog owners (IQR 46-58). Dog ownership was inversely associated with hemorrhagic stroke (30 513 events, HR 0.93 [95% CI 0.88-0.98]), ischemic stroke (91 160 events, HR 0.94 [0.91-0.98]) and heart failure (67 740 events, HR 0.95 [0.91-0.99]). There was no association with coronary heart disease (165 275 events, HR 0.99 [0.97-1.01]). Conclusion: Our study provides evidence that dog owners are at a lower risk for ischemic stroke, hemorrhagic stroke and heart failure. This relationship could be explained by a positive effect of dog ownership on daily exercise and psychosocial health or be due to unmeasured confounding. Although the cohort was free from cardiovascular disease at baseline, we cannot exclude the possibility that those individuals that buy a dog have better overall health than those that do not.
Platelet MAO activity and long-term outcome in schizophrenia and schizoaffective disorder
Authors: K L Malas, D P van Kammen
Journal: American Journal of Psychiatry (1983)

Several years after MAO activity determination, 36 patients with schizophrenia or schizoaffective disorder were contacted for assessment of their outcome. Patients who had had low platelet MAO activity had significantly better social adjustment and fewer schizophrenic symptoms at follow-up.
Acute toxicity of alternating schedule of chemotherapy and irradiation in limited small-cell lung cancer in a pilot study (08877) of the EORTC Lung Cancer Cooperative Group
Authors: A. Gregor, P. Drings, M. Rinaldi, L. Schuster, J. Burghouts, P.E. Postmus, O. Dalesio, A. Kirkpatrick, G. Hoctin Boes, N. Van Zandwijk
Journal: Annals of Oncology (1995)
Massachusetts Department of Public Health
Authors: Jonathan E. Fielding, Stephen Weiner
Journal: New England Journal of Medicine (1978)

Despite widespread concern about the cost of health care in the United States, little has been done to change the general picture of soaring inflation. Nationwide, costs rose from $95 billion in fiscal-year 1973 to $163 billion in 1977, 1 an increase of 69 per cent as compared to an overall rise in the Consumer Price Index of 37 per cent. Many government officials and others have expressed grave concerns over the rate of growth in hospital costs, the largest single component of health-care expenditures, accounting for 40 per cent of the total. Both the President and the Secretary of Health, . . .
Influenza-related deaths - available methods for estimating numbers and detecting patterns for seasonal and pandemic influenza in Europe
Authors: A Nicoll, B  C Ciancio, V Lopez Chavarrias, K Mølbak, R Pebody, B Pedzinski, P Penttinen, M van der Sande, R Snacken, M D Van Kerkhove
Journal: Eurosurveillance (2012)

Two methodologies are used for describing and estimating influenza-related mortality: Individual-based methods, which use death certification and laboratory diagnosis and predominately determine patterns and risk factors for mortality, and population-based methods, which use statistical and modelling techniques to estimate numbers of premature deaths. The total numbers of deaths generated from the two methods cannot be compared. The former are prone to underestimation, especially when identifying influenza-related deaths in older people. The latter are cruder and have to allow for confounding factors, notably other seasonal infections and climate effects. There is no routine system estimating overall European influenza-related premature mortality, apart from a pilot system EuroMOMO. It is not possible at present to estimate the overall influenza mortality due to the 2009 influenza pandemic in Europe, and the totals based on individual deaths are a minimum estimate. However, the pattern of mortality differed considerably between the 2009 pandemic in Europe and the interpandemic period 1970 to 2008, with pandemic deaths in 2009 occurring in younger and healthier persons. Common methods should be agreed to estimate influenza-related mortality at national level in Europe, and individual surveillance should be instituted for influenza-related deaths in key groups such as pregnant women and children.
SP0196 Impact of Co-Morbidities on Disease Severity and Treatment Strategy in Patients With Inflammatory Arthritis
Authors: D. Symmons
Journal: Annals of the Rheumatic Diseases (2015)

Patients with inflammatory arthritis (IA) frequently also have other chronic medical conditions. These may preceed or follow after the diagnosis of IA. From the patient9s perspective their IA may not be the most important of these medical conditions and, acknowledging this, it is better to refer to multimorbidity rather than co-morbidity. Some chronic medical conditions occur more frequently in IA than the general population. This may reflect the genetic and environmental risk factors for IA which, by definition, occur more frequently in IA patients than in the general population. Examples include smoking related illnesses such as chronic obstructive pulmonary disease and lung cancer; and other auto-immune conditions. After IA onset, the inflammatory disease process may predispose to other medical conditions such as coronary heart disease (CHD) and peripheral vascular disease. Immunosuppressant treatment may lead to patients being more susceptible to infection and certain types of cancer. Steroid therapy is associated with a wide range of co-morbid conditions including diabetes, hypertension and obesity. Treatment of IA is inevitably more difficult in the presence of other medical conditions. The treatment of IA may exacerbate a co-morbid condition. For example some of the drugs used (NSAIDs, leflunomide, ciclosporin, steroids) may make hypertension more difficult to control. Many anti-rheumatic drugs are associated with an increased risk of infection which may be particularly problematic in patients with chronic lung disease. Thus patients with multi-morbidity tend to have more severe IA because it is more challenging to control disease activity and also for the patients to maintain their physical activity and general fitness. Nevertheless the imperative to achieve disease remission is often greater in patients with multimorbidity. There is evidence that the increased prevalence of CHD in IA is related to cumulative disease activity - and so complete suppression of disease activity will reduce the patient9s risk of CHD as well as benefitting the joints. Stopping smoking will not only help the patient9s chest and heart, but also increase their likelihood of responding to certain anti-rheumatic drugs. The patient needs to receive consistent advice and not to attend multiple clinics for their conditions if this is possible; hence the importance of multidisciplinary clinics and a holistic approach to management. <h3>Disclosure of Interest</h3> None declared
PTU-301 Suspected upper gi cancer referrals in secondary care centre: are they always appropriate?
Authors: E Paulon, F Jaboli, O Epstein
Journal: Gut (2015)

<h3>Introduction</h3> According to NICE guidelines all patients with suspected cancer should be seen within 2 weeks of referral. Our Gastroenterology Department is experiencing an increasing workload burden due to a high number of suspected upper GI cancer referrals. We therefore decide to perform an audit to evaluate the nature, appropriateness and diagnostic findings of these referrals. <h3>Method</h3> We reviewed 90 consecutive referrals from 26<sup>th</sup>September 2013 to 4<sup>th</sup>November 2013. We focused our attention on duration of symptoms, type of symptoms and diagnosis. <h3>Results</h3> 36 patients were male (40%) and 54 patients were female (60%) with a mean age of 64 years (range 32–89). The most common reason for the referral was weight loss, present in 42 patients (47%), followed by dysphagia, in 34 patients (38%) and iron deficiency anaemia (21 patients-23%). Other symptoms that prompted the referral were abdominal pain in 20 patients (22%), dyspepsia in 19 (21%), altered bowel habits in 12 (13%) nausea and vomiting in 11 (12%) and abnormal imaging in 7 (8%). The majority of patients presented with a duration of symptoms of &lt;6 months (65 patients-72%) and 43 (47%) had a symptom duration of &lt;2 months. Twenty-one patients (23%) had symptoms for &gt;6 months and 7 had symptoms of &gt;2 years duration (7%). Looking at appropriateness of referrals we took into account the duration of symptoms and evidence of recent investigations which had already excluded a malignant cause, and considered 17 (19%) of target referrals not appropriate. Investigations didn’t reveal any pathology in 19% of the cases (17 patients). The most common finding was hiatus hernia, seen in 21 patients (23%), followed by gastritis, seen in 17 patients (19%). The cancer detection rate in our series was 10% (9 patients), 2 of the cancers were not gastrointestinal (1 renal, 1 lung). In few cases a diagnosis could not be reached because patients didn’t attend their appointments (6%). <h3>Conclusion</h3> The cancer detection rate (10%) hasn’t improved over the last few years and is very similar to other GI cancers yields in literature.<sup>1</sup>The symptoms most predictive of upper GI malignancy were dysphagia, weight loss and iron deficiency anaemia (IDA). Weight loss and IDA were not seen as isolated symptoms in patients diagnosed with a malignancy. These results would suggest that our upper GI cancer referral guidelines should be reviewed in order to make a better use of our resources, perhaps focusing on a symptom spectrum more predictive of upper GI malignancy. We have also to point out that there is a high rate (19%) of referrals that could be made without using the target referral proforma. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Patel K, <i>et al</i>. Are upper gastrointestinal cancer two week referrals an appropriate use of National Health Service resources? Clin Med. 2011;11(4):412