tbuckley/cabot-search huggingface dataset:
PTU-061 Vitamin D Deficiency is Widely Prevalent in South Asian Patients with Inflammatory Bowel Disease
Authors: C Boyd, J K Limdi
Journal: Gut (2013)

<h3>Introduction</h3> There has been resurgent interest in recent years in the pro-hormone vitamin D in its role and plausible effects on immune regulation and inflammatory bowel disease (IBD). We postulated a wide prevalence of vitamin D deficiency in South Asian patients with implications for the control of their IBD. The aim of our study was to review vitamin D assessment in a South Asian IBD cohort. <h3>Methods</h3> We conducted a retrospective review of 102 South Asian patients attending IBD clinics in our institution. Clinical data including demographics, disease characteristics (Montreal classification) and therapy were obtained from electronic record review. Serum 25-hydroxyvitamin D (25-OHD) concentrations were recorded in all patients tested and in all having serial measurements. <h3>Results</h3> Of 106 patients reviewed, 55 were male. The median age was 38 years (range 16–80) and mean disease duration was 9.5 years. Seventy-six patients had ulcerative colitis (UC) and 30 had Crohn’s disease (CD). Five patients were current or ex smokers (4.7%). Vitamin D status was assessed in 52 patients (49%), 26 had serial measurements. Median 25-OHD was 10.25 (range 3.3–44.4). Fifty one patients had levels &lt; 25 ng/ml consistent with deficiency and all 52 had insufficient levels &lt; 50 ng/ml. Of the patients with deficiency 35 had UC and 16 had CD. Of the UC patients, 18 had pancolitis, 13 had left sided disease and 4 proctitis. Of the CD patients 5 had penetrating disease and 4 had stricturing disease. Forty-three of the deficient patients had received steroids and 29 received immunomodulatory therapy (27 azathioprine, 3 methotrexate, 1 cyclosporin, 2 6MP, 10 infliximab, 6 adalimumab). Seven deficient patients (4 CD, 3 UC) required a colectomy and the mean 25-OHD level in this group was 10.7 (range 4.0–20.1 ng/ml). Mean time to surgery was 3.6 years (range 0–8 years). Of the CD patients 1 had a subtotal colectomy, 3 had hemicolectomy and of the UC patients 2 had subtotal colectomy and 1 had total colectomy. <h3>Conclusion</h3> There was a high prevalence of Vitamin D deficiency although assessment was suboptimal and probably reflective of a wider experience. Patients with vitamin D deficiency appeared to have a more aggressive disease course. The role of vitamin D in IBD is a science in evolution underpinning exciting implications for research. Meanwhile vitamin D deficiency is under-recognised and consequently undertreated with likely implications for adequate disease control in this potentially vulnerable group. <h3>Disclosure of Interest</h3> None Declared
EFFECTS OF ATORVASTATIN TREATMENT ON ENDOTHELIAL FUNCTION AND INFLAMMATORY STATUS IN ISCHEMIC HEART FAILURE PATIENTS: THE IMPACT OF RENAL FUNCTION
Authors: Evangelos Oikonomou, Gerasimos Siasos, Savvas Mazaris, Georgios Chatzis, Eleni Kokkou, Marina Zaromitidou, Sotirios Tsalamandris, Manolis Vavuranakis, Konstantinos Zisimos, Konstantinos Mourouzis, Theodoros Zografos, Konstantinos Maniatis, Stavroula Michalea, Christodoulos I Stefanadis, Dimitris Tousoulis
Journal: Journal of the American College of Cardiology (2015)
Abstract P2-09-05: Risk Group Selection in Primary Breast Cancer According to ASCO Recommended Biomarkers Onkotype DX and uPA/PAI-1: First Experience from Prospective Multicenter WSG Plan B Trial
Authors: T Degenhardt, O Gluz, C Thomssen, M Vetter, R Kates, M Warm, S Shak, D Augustin, M Kusche, M Untch, S Paepke, C Uleer, J Dünnebacke, U Nitz, N Harbeck
Journal: Cancer Research (2010)

Abstract Background: Both the Oncotype DX multi-gene assay and invasion factors uPA/PAI-1 are guideline-recommended (ASCO, AGO) biomarkers for decision support regarding adjuvant chemotherapy in primary breast cancer (BC). Material and Methods: The West German Study Group (WSG) Plan B trial (planned n=2,448) is evaluating anthracyline-free adjuvant chemotherapy (6x TC) vs. standard 4xEC-4xDOC in HER2- negative BC with 0-3 positive lymph nodes, Oncotype DX is used as selection criterion where pts with RS&amp;gt; 11 are randomized to one of the two chemotherapy arms and pts with RS ≥11 treated with hormonal therapy alone. uPA/PAI-1 (both low vs. either/both high), measured by ELISA, is obtained as an optional risk factor. Results: By June 2010, 1064 patients had been randomized in Plan B (96 recruiting centers). In 153 patients (27 centers), uPA and PAI-1 had been measured; for 131 (84 N0, 47 N+) of these, Oncotype DX Recurrence Score® (RS) results were also available. When considered as continuous variables, RS was weakly positively correlated (Spearman's coefficient) with uPA (rs=0.18, p=0.04) and with PAI-1 (rs=0.23, p=0.01). When considered as risk categories/(Table 1), there was a weak concordance between RS and uPA/PAI-1, using either the standard RS cutoff points (18 and 30) or the TAILORx trial cutoff points (11 and 25). Table T: Association between RS and uPA/PAI-1 categories Assignment of high risk was most strongly concordant between uPA/PAI-1 and RS (RS &amp;gt; 25: 22/25 patients had high uPA/PAI-1; RS &amp;gt;30: 14/15 patients had high uPA/PAI-1). This high-risk concordance extends to N0 patients (RS&amp;gt;25: 17/19 N0 pts had high uPA/PAI-1; RS&amp;gt;30: 11/12 pts had high uPA/PAI-1). Discussion: For the first time, risk groups in primary breast cancer according to both Oncotype DX and uPA/PAI-1 have been compared. These preliminary data show that the high RS group seems highly concordant with the prospectively assessed invasion markers uPA/PAI-1. However, within low and intermediate RS, uPA/PAI-1 could still identify a substantial collective at risk; low uPA/PAI-1 could define a clinically relevant low-risk collective within risk groups that would be classified as “intermediate” according to the multigene assay Oncotype DX. Additional recruitment and outcome assessment of the ongoing multicenter WSG Plan B trial will address the clinical significance of these findings. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-09-05.
Now or later? Strategy for removing small colorectal polyps
Authors: M. Kaminski, J. Regula
Journal: Endoscopy (2012)

Effective colonoscopic polypectomy requires a balance between the efficacy and safety of polyp removal. Despite widespread use, the technique of colonoscopic polypectomy has not been adequately studied, optimized, and standardized. The more basic the issue, the harder it is to find an answer as to what the best approach is and the larger the observed variability among endoscopists. A survey of American College of Gastroenterology members revealed considerable inconsistency in the types of accessories, current settings, and submucosal injection policy used for polypectomy [1]. One of the unanswered questions is whether polyps should be removed during both endoscope insertion and withdrawal, or during withdrawal only. The concept of performing polypectomy on withdrawal is driven only by a theoretical fear of causing hemorrhage or perforation at the polypectomy site because of tearing forces associated with endoscope insertion. On the other hand, doing polypectomy both on insertion and withdrawal could theoretically avoid difficulties in finding polyps again on withdrawal and reduce polyp miss rates. This could further translate into reduced variation in polyp and adenoma detection rates and have immediate consequences for patients [2]. Although most endoscopists agree that large polyps need to be removed on withdrawal only, the approach to smaller polyps remains unclear.
P752Sex-associated differences in oxidative stress and renin-angiotensin system contribute to a differential regulation of vascular aging
Authors: M Garabito, G Costa, F Jimenez-Altayo, E Vila, AP Dantas
Journal: Cardiovascular Research (2014)

Aging is a cardiovascular risk factor associated to an increase of reactive oxygen species (ROS) and Renin-Angiotensin System (RAS) activation, which in turn contributes to vascular dysfunction and remodelling. Both systems are known to be influenced by sex. In this regard, our study aims to determine whether sex-associated differences in ROS and RAS contribute to a differential regulation of vascular aging and associated dysfunction. Male and female outbreed CD-1 mouse were studied at 3, 7 and 12 months of age (mo). To determine the contribution of RAS, mice were treated from 3 to 12 months with Losartan (0.6 mg/L in the drinking water). Contraction to KCl and Angiotensin II (AngII) were determined in aortic rings by wire-myography. Morphometric analysis was performed by Haematoxylin-eosin staining. Oxidative stress was determined in aortic cross sections by dihydroethidiem (DHE). Sections were treated with AngII (10-6M), apocynin (10-4M), L-NMMA (3x10-4M) to determine signalling pathways involved in ROS production. At 12 mo, contractions to 60mM KCl were higher in males (15.4±0.4 mN) than in females (12.6±0.5 mN); P<0.001. Aging also increases AngII contractions at higher levels in 12mo males (AUC: 84.3±19.1) compared to 12mo females (AUC: 34.5±9.8); P<0.05. Losartan treatment prevented age-related increase in KCl contractions, with higher effect in females (P<0.01) than in males (P<0.05). Aging also triggers an outward hypertrophy of aorta [Wall Thickness (μm): 3mo (Male: 54.5±4.9 vs Female 47.0±7.3); 12mo (Male 101.4±4.3 vs Female 100.3±3.4); P<0.001], which appears at earlier age (7mo) in males (93.1±2.5) than in females (78.6±3.1), P<0.05. Losartan treatment prevented hypertrophy in both males and females (P<0,001). Aging-associated increase of ROS follows same chronology as vascular hypertrophy [DHE Fluorescence (%): 3mo (Male 35.3±8.7 vs Female 30.5±5.0); 7 mo (Male 58.7±3.3 vs Female 31.6±5.5); 12mo (Male 72.69±2.6 vs Female 69.1±4.3); P<0.001], although losartan did not modify ROS generation in 12mo mice. Neither we found changes in ROS generation in sections treated with AngII, suggesting a lack of crosstalk between RAS and ROS in vascular aging. On the other hand, apocynin treatment diminished ROS generation in 12 mo female (P<0.01) and in 7mo and 12mo males (P<0.01). Aging increases vascular contraction and induces outward hypertrophy in a different time-course in males and females. Sex-associated differences in RAS activity with aging are also observed. Although RAS plays a critical role in the aging-associated hypertrophy, it does not contribute to the increased ROS generation observed.
PTH-037 Adherence To 2013 Bsg Barrett’s Oesophagus Surveillance Guidelines Could Facilitate Safe Discharge Of Patients
Authors: G Walker, N Moini, F Mayall, S Pugh
Journal: Gut (2014)

<h3>Introduction</h3> The prevalence of Barrett’s oesophagus (BO) is increasing and surveillance of this population is a growing burden for endoscopy units.<sup>1</sup> Guidelines exist to facilitate quality surveillance but are poorly adhered to.<sup>2 </sup>We evaluated previous endoscopy (OGD) and histology reports of patients due to undergo BO surveillance in 2014 at a UK district general hospital. By using the 2013 BSG guidelines we decided if sufficient data were available to discharge patients or increase their surveillance interval.<sup>3</sup> <h3>Methods</h3> The endoscopy department provided a list of all adult patients booked for BO surveillance in 2014. Electronic reports were used to find the length of BO, presence/absence of intestinal metaplasia (IM), adherence to the Prague CandM criteria and compliance with the Seattle biopsy protocol (4 biopsies every 2 cm). A Consultant pathologist clarified any uncertain histology reports. Outcomes after reviewing the cases were: ‘discharged from surveillance’, ‘delayed OGD’ or ‘no change to date of OGD’. No patients with long segment BO(&gt;3 cm) had their endoscopies delayed. Finally hypothetical outcomes were calculated assuming all previous OGD’s were compliant with BSG standards. Data were entered into an Excel spreadsheet and simple statistics used to analyse findings. <h3>Results</h3> 125 patients were due BO surveillance in 2014. 96 male (77%), average age 64 years (range 34–84). 76 (61%) endoscopy reports were compliant with Prague CandM criteria. 33 (26%) reports were compliant with the Seattle biopsy protocol, whilst 92 (74%) were not. In 110 (88%) cases no change was made to the planned surveillance date, either due to inadequate biopsies being taken to delay/discharge or appropriate date of surveillance already booked. 15/125 (12%) patients were either discharged or had their OGD delayed. If all procedures had been compliant with BSG standards this might have led to more than three times as many patients having their surveillance discontinued or delayed (48/125:38%). <h3>Conclusion</h3> Using the 2013 BSG guidelines enables departments to safely discharge patients with Barrett’s oesophagus or increase surveillance intervals. This will save money and reduce the risk and discomfort inherent with this program. Endoscopists adherence to the Seattle biopsy protocol is poor, and this is the main barrier preventing more patients from being discharged. <h3>References</h3> 1 Coleman HG, <i>et al</i>. Increasing incidence of Barrett’s oesophagus: a population-based study. <i>Eur J Epidemiol</i> 2011;26(9):739–45 2 Abrams JA, <i>et al</i>. Adherence to biopsy guidelines for Barrett’s esophagus surveillance in community setting in the USA.<i> Clin Gastroenterol Hepatol </i>2009;7(7):736–42 3 Fitzgerald RC, <i>et al</i>. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. <i>Gut </i>2014;63:7-42 <h3>Disclosure of Interest</h3> None Declared.
S106 A randomised double blind 13 week crossover trial of hypertonic saline (HTS) (6%) vs isotonic saline (ITS) (0.9%) in patients with bronchiectasis
Authors: J. M. Bradley, K. Treacy, B. O'Neill, F. McCourt, L. Green, E. Gardner, J. S. Elborn
Journal: Thorax (2011)

<h3>Background</h3> Hypertonic saline is a hyperosmolar agent which increases mucociliary clearance in CF but there is little data available on its effectiveness in bronchiectasis. <h3>Aim</h3> To determine the effectiveness of nebulised HTS (6%) in comparison to ITS (0.9%) on 24 h sputum production, lung function and patient related outcome measures in patients with stable bronchiectasis. <h3>Design</h3> Proof of concept double blind cross-over study. <h3>Methods</h3> Patients with clinical and CT diagnosis of bronchiectasis were randomised (double—blinded) to receive two consecutive 4-week treatments of twice daily nebulised HTS (6%) or ITS (0.9%) each masked with quinine sulphate; with a 2-week washout period between treatment cycles. The order of treatment was determined using concealed computerised randomised allocation performed by a statistician not involved in study conduct (EG). <h3>Outcomes</h3> 24 h sputum volume/weight, lung function (FEV<sub>1</sub>), cough (Leicester Cough Questionnaire, LCQ) and quality of life (Quality of Life Questionnaire-Bronchiectasis, QOL-B), and adverse events. <h3>Results</h3> 19 patients (9M: 10F; Mean (SD): 61 (11) yrs; FEV<sub>1</sub>, 57 (23) % predicted; daily sputum weight 17 (17) grams) were recruited into this study. 13 patients completed both arms of the study. A patient and co-ordinator questionnaire indicated that the study design and the use of quinine sulphate was successful in achieving double blinding and masking HTS/ITS. HTS had a small to large effect (effect sizes 0.01–0.14) on sputum and FEV<sub>1</sub>, LCQ, and QOL-B. The overall trend was a benefit from HTS compared to ITS. There was a significant improvement in the physical domain of the LCQ (−0.8 (0.9), p=0.01) and the respiratory symptoms domain of the QOL-B (−11.6 (17.7), p=0.03) in the HTS cycle compared to the ITS. There was no differences in adverse events between the cycles. <h3>Conclusion</h3> This study suggests that HTS may be effective in bronchiectasis. It provides data on study feasibility (study design and sample size) to justify a Phase 3 multicentre clinical trial to investigate the effectiveness of HTS in bronchiectasis.
Untying the knot: technique of unraveling a guidewire knot created during EUS-guided biliary drainage
Authors: Payal Saxena, Gerard Aguila, Vivek Kumbhari, Mouen Khashab
Journal: Endoscopy (2014)

Inadvertent knotting of guidewires and catheters has been reported in several procedures, including cardiac catheterization [1], central venous access [2], and urologic procedures [3]. However, there are no reports of guidewire knotting during endoscopic procedures. We describe successful untangling of a knot created in a guidewire during endoscopic ultrasound (EUS)-guided rendezvous biliary drainage.
Adjuvant Methotrexate and Citrovorum-Factor Treatment of Osteogenic Sarcoma
Authors: Norman Jaffe, Emil Frei, Demetrius Traggis, Yvonne Bishop
Journal: New England Journal of Medicine (1974)

Twenty consecutive patients with osteogenic sarcoma without visible metastases received adjuvant chemotherapy starting three weeks after local treatment of the primary tumor with operation or radiation. Adjuvant chemotherapy consisted of intravenous vincristine followed in 30 minutes by a six-hour infusion of methotrexate. Two hours later citrovorum factor was administered every six hours for 12 doses. Such treatment courses were given at three-week intervals. Ninety-eight patients referred to this center between 1950 and June, 1972, served as controls. The incidence of pulmonary metastases was significantly reduced by adjuvant chemotherapy to two as opposed to the expected 12.2 cases. Nineteen of the 20 patients treated with the adjuvant chemotherapy are surviving with follow-up periods of two to 23 months. Only six of 212 courses of treatment were associated with myelosuppression or stomatitis. These observations indicate that systemic (adjuvant) chemotherapy delays relapse and may provide definitive treatment in some patients with osteogenic sarcoma. (N Engl J Med 291:994–997, 1974)
Extrarenal Adult Nephroblastoma
Authors: NAOTO WATANABE, MASASHI SHIMIZU, KYO NOGUCHI, SHINYA KAJIURA, GAKUTO TOMIZAWA, HIKARU SETO
Journal: Clinical Nuclear Medicine (2003)

WATANABE, NAOTO M.D.; SHIMIZU, MASASHI M.D.; NOGUCHI, KYO M.D.; KAJIURA, SHINYA M.D.; TOMIZAWA, GAKUTO M.D.; SETO, HIKARU M.D. Author Information
Hypoglycemia Associated with Massive Intra-Abdominal Mesothelial-Cell Sarcoma
Authors: J. C. Sellman, G. T. Perkoff, F. C. Null, J. R. Kimmel, F. H. Tyler
Journal: New England Journal of Medicine (1959)

THE occurrence of hypoglycemia in patients with massive fibrous1 2 3 4 5 6 7 8 9 10 11 or nonfibrous12 13 14 15 tumors is well known. Several mechanisms have been proposed to account for the hypoglycemia seen in such patients, but an explanation applicable to all cases has not been established.These patients have had certain features in common irrespective of the histologic type of their tumor: all the tumors were of very large size; all but 3 of the patients were male; and none of the tumors originated in or involved the pancreas. Recently, we have had the opportunity to observe a patient with a massive intra-abdominal mesothelial-cell sarcoma in . . .
Wrong biochemistry results
Authors: A. A. Ismail, J. H Barth
Journal: BMJ (2001)

The success of analytical methods in clinical chemistry has led to a sense of security in the value of laboratory results. This is largely justified, as evidenced by the quality of laboratory performance assessed by external assurance schemes. Nevertheless, it is not widely recognised among clinicians that some biochemical tests are more prone to interference from unusual serum constituents than others—and that quality assurance schemes can do little about this.

An important example of this is tests carried out by immunoassays based on the recognition of molecules by antibodies. The antibodies are largely derived from animal sources and are typically used for measuring hormones, tumour markers, cardiac troponins, and therapeutic drugs and for viral serology.

The design of assays has evolved enormously since the discovery of immunoassay by Berson et al in 1956,1 and it is now a major analytical tool in clinical laboratories worldwide, allowing relatively minute (picomole (10−12)) amounts of analytes to be measured with unrivalled precision.

Interference …
Deconstructing a Lethal Foodborne Epidemic
Authors: Martin J. Blaser
Journal: New England Journal of Medicine (2011)

Beginning in early May 2011, northern Germany was the principal site of a massive epidemic of bloody diarrhea and the hemolytic–uremic syndrome caused by Shiga-toxin–producing Escherichia coli. By the time the outbreak ended in early July, there were reports of more than 4000 illnesses, 800 cases of the hemolytic–uremic syndrome, and 50 deaths in Germany and in 15 other countries. As a result of remarkable efforts by public health officials, clinicians, and microbiologists who raced to control the outbreak and to treat its victims, much was learned. As reported in this issue of the Journal by Frank et al. . . .
The Use of Technegas in the Detection of a Bronchopleural Fistula
Authors: DAVID C. WONG, WALTER HAINDL
Journal: Clinical Nuclear Medicine (2000)

A case report of a bronchopleural fistula after lower lobectomy detected using Technegas ventilation scintigraphy is presented. Most of the published literature on the diagnosis and localization of bronchopleural fistulas using nuclear medicine techniques is based on the use of Tc-99m DTPA, Xe-133, Kr-81m, and Tc-99m albumin. No published literature exists on the use of Technegas to detect a bronchopleural fistula.
Esophageal hematoma caused by foreign body ingestion
Authors: Na Li, Xiao-jun Zhao, Dong-liang Yu, Xin Wang, Jian-qiu Sheng
Journal: Endoscopy (2014)

A 51-year-old man was admitted to our hospital with hematemesis after swallowing a chicken bone. An endoscopy was performed, which showed a large submucosal hematoma in the esophagus, which extended from 15 cm down to the esophagogastric junction. The esophageal lumen was occupied by the hematoma. No active bleeding or foreign body was seen ([Fig. 1]; [Video 1]).
THE COMPARATIVE SAFETY OF BIVALIRUDIN VERSUS HEPARIN MONOTHERAPY IN PATIENTS ON DIALYSIS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE BLUE CROSS BLUE SHIELD OF MICHIGAN CARDIOVASCULAR CONSORTIUM
Authors: Devraj Sukul, Milan Seth, Theodore Schreiber, George Hanzel, Akshay Khandelwal, Louis Cannon, Thomas LaLonde, Ronald Miller, Hitinder Gurm
Journal: Journal of the American College of Cardiology (2016)