tbuckley/cabot-search huggingface dataset:
P184 Modified WHO safety checklist for Pleural Interventions – preventing system errors
Authors: N Hutchinson, K Marshall, H Espley, AA Ionescu
Journal: Thorax (2015)

<h3>Introduction</h3> Pleural interventions (PI) are generally safe, however adverse events occur due to human error or system failure. The World Health Organisation (WHO) safety checklists are widely used in surgery and reduce complications.<sup>1</sup> The Royal College of Physicians has recently advocated their use for invasive medical procedures.<sup>2</sup> <h3>Aims</h3> To develop and implement a modified WHO surgical checklist for use in PI; specifically thoracoscopy (TS) and chest drain (ICD) insertion. <h3>Methods</h3> Adverse events for TS were identified using a locally developed TS database (previous 3 years data) and ICD events were identified using our unit’s BTS National audit data. Following a MDT discussion we developed and implemented a modified WHO checklist for the specific risks of TS and ICD. The checklists follow the three-part structure recommended by the WHO; 1. Sign in (before arrival to procedural area), 2. Time out (before starting), 3. Sign out (before leaving). Checklist effectiveness was reviewed 6 months following implementation. <h3>Results</h3> <b><i>Pre-implementation</i></b> For TS there were a small number of adverse events (mistaken identity of an abnormal ECG in patients with similar names, delay in pre-procedure blood results, ECG not performed, intravenous fluids not readily available, kinked ICD, thromboprophylaxis not prescribed); most events led to delayed procedure only. For ICD insertion, several avoidable patient safety issues were identified: 5.6% no support nurse available; insufficient documentation of observations pre (13.7%) and post (5.6%) ICD insertion. <b><i>Post-implementation</i></b> No adverse events recorded in TS and an improvement in ICD patient safety issues (procedure not done without support present, observations documented in 42% of cases). Team-working and communication reported to have improved. However, ICD checklist completion rate was poor (53%), with form retrieval rates in TS low compared to reported completion rates (66.7% v 100%). Forms were generally incomplete. <h3>Conclusion</h3> Most adverse events identified were due to system errors despite previously available safeguards. Well-designed procedural checklists can improve patient safety. Paper versions were not fully completed therefore we have incorporated an electronic version of the checklist into the procedural database, which has to be completed before the procedure starts. <h3>References</h3> 1 <i>N Engl J Med</i>. 2009;<b>360</b>:491 2 <i>Clin Med</i>. 2014;<b>14</b>:468–474
Complete Remission of Metastatic Cervical Cancer with the Angiogenesis Inhibitor TNP-470
Authors: Andrzej P. Kudelka, Claire F. Verschraegen, Evelyn Loyer
Journal: New England Journal of Medicine (1998)

To the Editor: Hunter et al. (Oct.30 issue) 1 report that there is no significant correlation between breast cancer and plasma levels of 1,1 Ј -dichloro-2,2-bis( p -chlorophenyl)ethylene (p,p Ј -DDE) and polychlorinated biphenyls (PCBs) two to three years before diagnosis, but estrogenic chemicals in pesticides, plastics, and other products that could contribute significantly to the burden of environmental estrogens in the body were not examined.Hunter et al. state, "The blood levels of DDE and PCBs we measured reflect exposure that occurred over a period of many years."Although parent 2,2-bis( p -chlorophenyl)-1,1,1-trichloroethane (DDT) and PCB mixtures show estrogenic activity, persistent residues in plasma measured years after exposure to parent mixtures do not show a similar net estrogenic activity.Although p,p Ј -DDE is the highly persistent in vivo metabolite of DDT, it acts primarily as an antiandrogen. 2 The most active estrogenic contaminant in commercial DDT is o,p Ј -DDT, but neither o,p Ј -DDT nor its in vivo metabolite is detected years after exposure.Only a small proportion of the 209 PCB congeners have been tested.Many of the estrogenic PCBs (and their more active in vivo metabolites) are not persistent and would also not be present in plasma years after exposure.Some persistent PCB metabolites typically found in plasma actually antagonize estrogenic actions. 3,4 The interaction of these chemicals with components of the endocrine system was thus not accurately described.Persistent PCB residues and p,p Ј -DDE are often measured, because the analysis is relatively inexpensive, and they are always detected in human plasma.The analogy is looking under the nearest lamppost for lost keys because that is where there is light.The approach taken here does not test the hypothesis that exposure to estrogenic chemicals during critical periods in development, from conception through adolescence, may predispose organs to disease much later in life. 5,6There are now dozens of chemicals that should be measured during early life for subsequent correlation with diseases and other outcomes.
Bortezomib’s effect on NFkB nuclear localization is not sufficient information for predicting its modulation of chemotherapy-induced cytotoxicity
Authors: R. L. Dubowy, N. Schiff, B. Toms
Journal: Journal of Clinical Oncology (2005)

2081 Background: The observation that bortezomib (B) can diminish nuclear localization of NFkB via inhibition of proteasomal degradation of ubiquitinated IkB forms a basis for investigating combination chemotherapy using B. Given B’s potential to affect levels of other proteins, we studied whether its effect on nuclear NFkB correlated with modulation of drug-induced cytotoxicity. Methods: For each cell line, the B concentration that produced ∼50% inhibition of chymotryptic activity after 1 h incubation was determined using the substrate LLVY-AMC. Proliferative assays were performed by incubating cells in B (∼50% inhibitory dose for each cell line) for 1 h, followed by the addition of doxorubicin (D), cisplatin (CP), carboplatin (CA) or etoposide (E) for 2 h. The cells were then washed twice and incubated in 96-well plates for 48 h. Cell numbers were estimated at h 0 and 48 using the Dojindo tetrazolium dye reduction assay, and doubling times (DT) were calculated. Nuclear NFkB p65 was measured in cells similarly treated, except for an additional 2 h post-wash incubation, using the TransAM TM p65 Transcription Factor Assay Kit. Concentrations of D, CP, CA, and E used for the NFkB experiments were those that increased the DT to 125–260% of controls, and are shown in the table. Results: The use of D with SKNSH was the only condition in which a cytotoxicity treatment effect (synergy) of B was seen. The table below shows NFkB results. The data show variation among drugs and cell lines with respect to modulation of NFkB by B. Conclusions: The exposure times and agent sequencing in our proliferation experiments did not show synergy or antagonism except for the combination of D and B in SKNSH, yet the NFkB results showed effects of B (both up and down) in most cell-drug combinations. It is unlikely that an observed effect on NFkB nuclear localization is sufficient for predicting an interaction of B with other chemotherapeutic agents. No significant financial relationships to disclose.
Surgical Treatment of Achalasia of the Esophagus
Authors: Richard H. Sweet
Journal: New England Journal of Medicine (1956)

ALTHOUGH its etiology remains obscure, an experience of ten years' surgical treatment of achalasia of the esophagus has brought about a better understanding of the nature of the disease as it exists among patients who do not respond favorably to more conservative measures. It has become apparent that two distinct types can be differentiated on the basis of the clinical history, the x-ray examination and the anatomic appearance at operation.Type 1 AchalasiaThe more frequent type, comprising about 75 per cent of the cases, is that characterized by an enormous dilatation of the esophagus above the distal segment. The . . .
Phenotypic, transcriptomic, and genomic features of clonal plasma cells in light-chain amyloidosis
Authors: Bruno Paiva, Joaquin Martinez-Lopez, Luis A. Corchete, Beatriz Sanchez-Vega, Inmaculada Rapado, Noemi Puig, Santiago Barrio, Maria-Luz Sanchez, Diego Alignani, Marta Lasa, Alfonso García de Coca, Emilia Pardal, Alberto Oriol, Maria-Esther Gonzalez Garcia, Fernando Escalante, Tomás J. González-López, Luis Palomera, José Alonso, Felipe Prosper, Alberto Orfao, Maria-Belen Vidriales, María-Victoria Mateos, Juan-Jose Lahuerta, Norma C. Gutierrez, Jesús F. San Miguel
Journal: Blood (2016)
PTH-086 Surgery for perianal crohn’s disease: uk national population based cohort study
Authors: V Chhaya, S Saxena, E Cecil, V Curcin, V Subramanian, A Majeed, R Pollok
Journal: Gut (2015)

<h3>Introduction</h3> Recent falls in surgical intervention in Crohn’s disease (CD) are associated with improvements in drug therapy. However, little is known about the changing incidence of perianal manifestations, which can be debilitating and may lead to perianal surgery including proctectomy. Our aim was to determine trends in perianal surgery rates using the Clinical Practice Research Datalink (CPRD) and their relation to the diagnosis of CD. <h3>Method</h3> Incident cases of CD were identified between 1989–2009 from the nationally representative CPRD which contains clinical records and prescribing data for 13 million people in the UK and is a validated research database. Patients were included if they had been registered with a practice for greater than 12 months. The primary outcome was first perianal surgery defined by READ/OXMIS coding. We used Kaplan-Meier survival analysis to demonstrate the rate of first perianal surgery at 1, 5, 10 and 20 years after diagnosis. We also determined the time to first perianal surgery relative to the date of diagnosis. <h3>Results</h3> The CPRD contained 9391 incident cases of CD between 1989–2009. 405 patients underwent perianal surgery of whom 75% (305) had a single surgery, 16% (63) required 2 surgeries, 6% (26) required 3 surgeries and 3% (11) required 4 or more surgeries during follow up. The commonest forms of perianal surgery were abscess drainage (51%), laying open of fistula (20%) and proctectomy (11%). The overall rate of perianal surgery was 2.6% (95% CI: 2.3–2.9%), 4.0% (95% CI: 3.6–4.4%), 5.5% (95% CI: 4.9–6.2%) and 8.4% (95% CI: 7.0–9.9%) at 1, 5, 10 and 20 years after diagnosis. The median time to perianal surgery was 4 months (IQR: –1.3–2.7 years) after diagnosis. Of all the patients undergoing perianal surgery, 13% (n = 53), 17% (n = 69) and 34% (n = 137) had surgery within 6 months, 1 year and 5 years, respectively before receiving a formal CD diagnosis. 59% (n = 238) of all patients undergoing perianal surgery had this performed before the first anniversary of their CD diagnosis. <h3>Conclusion</h3> This is the first study to evaluate a nationally representative population and shows that the majority of patients undergoing perianal surgery are operated on within the first year of CD diagnosis. A third of patients who had perianal surgery underwent the procedure in the 5 years preceding the diagnosis of CD. Surgical treatment for perianal disease should alert clinicians to the possible underlying diagnosis of CD. <h3>Disclosure of interest</h3> None Declared.
CT-diagnosed emphysema and lung cancer mortality: novel association or old news?
Authors: Jennifer K Quint
Journal: Thorax (2016)

Hippocrates may well have appreciated the significance of the presence of emphysema, but it was not until the 17th century that Bonet1 described the larger lungs of those with emphysema, to which he attributed their breathlessness. In 1821, Laennec connected emphysema to ageing, when he ascribed a subtly different definition to emphysema, describing it as “a breakdown of tissue in the parenchyma of the lungs as opposed to air trapped in the alveoli due to obstruction as occurs in asthma and chronic bronchitis” essentially considering emphysema to be an ‘independent finding’ to obstructive lung disease, although at postmortem.2 Fast forward 200 years, and one could argue that even in 2016 the significance of emphysema on a CT scan in someone who does not have airflow obstruction or clinical symptoms of breathlessness is unclear.

Even the significance of emphysema among people with COPD and the association between emphysema and smoking are obscure. Around half of patients with COPD do not have significant emphysema,3 and up to 10% of never smokers have evidence of emphysema at postmortem.4 On the …
NIMG-36COMPREHENSIVE EVALUATION OF GLIOMA RECURRENCE WITH SIMULTANEOUS O-(2-18F-FLUOROETHYL)-L-TYROSINE (18F-FET) POSITRON EMISSION TOMOGRAPHY MAGNETIC RESONANCE IMAGING (PET MRI)
Authors: Amarnath Jena, Sangeeta Taneja, Aashish Gambhir, Anil Kumar Mishra, Sapna Manocha Verma, Puja Panwar Hazari, Pradeep Negi, Ganesh Krishna Rao Jadhav, Shanti Kumar Sogani
Journal: Neuro-Oncology (2015)

BACKGROUND: Simultaneous PET MRI offers opportunity to combine attributes of 18F-FET PET and MRI together during a single examination in the evaluation of post treatment glioma recurrence. The purpose of this study was to examine its potential in distinguishing glioma recurrence vs. radiation necrosis. METHODS: 27 patients with 36 suspicious brain lesions were evaluated with contrast enhanced 18F FET PET MRI using Biograph mMR acquired over 25 min immediately following tracer administration. Dynamic (20/27 patients: 5 data points), and static PET data ( 0 to 25 min) & MR images were analyzed using manually drawn ROI over the area of maximal contrast enhancement and/or FET uptake and migrating the same over corresponding other images to obtain various PET and MR parametric values for analysis. Statistical analysis was done for each parameter individually and in various combinations using Sigma Plot 13.0 and PASW 18. Positive histopathology and long term imaging/clinical follow up served as gold standard. RESULTS: 21 patients were classified as recurrence and 6 patients as radiation necrosis Individually, TBRmax, TBRmean, ADCmean, Cho: Cr ratios and normalized rCBVmean were significant in differentiating recurrence from radiation necrosis with an accuracy of 94.4% for TBRmax, 91% for TBRmean, 83.3% for ADCmean, 94.4% for Cho: Cr ratio and 86.1% for N rCBVmean respectively. TBRmax with Cho: Cr ratio yielded the highest accuracy of 97.2 % (AUC, 0.979± 0.03; sensitivity, 93.1%; specificity, 100%; P< 0.001). TTP & SUVmax of the lesion were found to be most significant parameters in distinguishing between recurrence & radiation necrosis with a p value of <0.05. SUVmax (p < 0.05) & slope to peak (p < 0.05) were most useful in differentiating low grade recurrence from radiation necrosis. CONCLUSION: Simultaneous FET PET MRI offers a quick and comprehensive method in differentiating glioma recurrence and treatment effect with high accuracy.
Doctors slam junior contract for discrimination against women
Authors: Abi Rimmer
Journal: BMJ (2016)

Doctors have expressed outrage after the government’s own analysis of the new junior doctor contract found that it discriminated against women.

After a breakdown of negotiations with the BMA the health secretary, Jeremy Hunt, announced in February that the government would impose a new contract on junior doctors in England from August this year.1

On Thursday 31 March, NHS Employers published the new contract for junior doctors in England.2 At the same time, the Department of Health published an equality analysis of the draft contract.3

The equality analysis said that, “while there are features of the new contract that impact disproportionately on women, of which some we expect to be advantageous and others disadvantageous, we do not consider that this would amount to indirect discrimination as the impacts can be comfortably justified.”

Responding to this statement Jane …
Percutaneous orchiectomy: A noninvasive method of castration beyond percutaneous testicular sclerosis
Authors: E. C. Nepomuceno, F. Quintiliano, F. S. Lima, E. Café, P. Boente
Journal: Journal of Clinical Oncology (2009)

e16153 Background: Surgical castration is the gold standard for hormonal deprivation in metastatic prostate cancer, nevertheless this simple procedure may involve on psychological consequences. According to many studies, it's possible to achieve ischemic lesion in liver tissue beyond sclerosants agents (like alcohol or glycerol), however there are very few reports about the effects of such agents in testicles. These study objectives evaluating histological and morphological characteristics of rat testicles submitted to percutaneous administration of sclerosants agents and also, to compare serum testosterone levels between rats submitted to a surgical orchiectomy or percutaneous injection. Methods: Twenty four rats have been shared in four groups with eight animals each. In group O, rats were submitted to bilateral orchiectomy. In the other groups, rats were submitted to percutaneous administration of a sclerosant agent and orquiectomy after thirty days as follows: Group A, Alcohol injection; Group G - Glycerol; Group S - Saline solution (control group). Serum testosterone level was measured after 15 and 30 days in each animal. Results: There is no complication or death in this series. Rats of groups A and G comparing to control group (group S) had smaller testicular weight (0,8±0,1g; 1±0,2g versus 3,15±0,1g p&lt;0,0000001) and smaller testicular volume (0,16±0,05mL; 0,23±0,11mL versus 2,38±0,05mL p&lt;0,0000001). Testosterone serum levels were as similar in groups A and G (sclerosis) as in group O (orchiectomy). After 15 days testosterone levels were A=2,9±0,74 ng\dL; G=2,8±0,39 ng\dL versus O=2,91±1,46ng\dL p=0,99; and after 30 days were A=2,58±0,4ng\mL, G=2,78±0,3ng\mL versus O=2,7±0,95ng\mL p=0,895). Histological findings show extensive necrosis beyond macrophagic infiltration and no Leydig cells visualized.There is no significantly statistical difference between Alcohol and Glycerol groups. Conclusions: Percutaneous administration of alcohol or glycerol in rats testicles causes atrophy and reduces testosterone serum levels like it occurs after surgical castration. More studies are necessary to evaluate if this minimally invasive procedure may be an alternative to surgical orchiectomy in advanced prostate cancer. No significant financial relationships to disclose.
Network Meta-analysis for Clinical Practice Guidelines: A Case Study on First-Line Medical Therapies for Primary Open-Angle Glaucoma
Authors: Benjamin Rouse, Andrea Cipriani, Qiyuan Shi, Anne L. Coleman, Kay Dickersin, Tianjing Li
Journal: Annals of Internal Medicine (2016)

Network meta-analysis compares multiple treatment options for the same condition and may be useful for developing clinical practice guidelines.
Management of the Late Failure of Arterial Reconstruction of the Lower Extremities
Authors: R. Clement Darling, Robert R. Linton
Journal: New England Journal of Medicine (1964)

RECONSTRUCTIVE arterial surgery has now progressed to a time when the majority of patients with ischemic disease of the lower extremities, associated with either complete or partial large-vessel occlusion and manifest either by intermittent claudication alone or by threatened loss of the extremity, can be successfully treated. To a certain extent, early success may be unrelated to the method used, whether it is homograft artery, synthetic fabric cloth, thrombendarterectomy or saphenous-vein bypass autograft, but is due rather to the technical excellence with which the reconstruction is initially performed. On the other hand, the late behavior of these reconstructive procedures, in . . .
Lapatinib Versus Lapatinib Plus Capecitabine As Second-Line Treatment in Her2-Overexpressing Metastatic Gastro-Esophageal Cancer (Gc): a Randomized Phase Ii Trial of the Arbeitsgemeinschaft Internistische Onkologie (Aio)
Authors: S. Lorenzen, U. Helbig, J. Riera-Knorrenschild, G.M. Haag, M. Pohl, P.C. Thuss-Patience, F. Bassermann, F. Weißinger, E. Schnoy, K. Becker, J. Rüschoff, A. Eisenmenger, I. Karapanagiotou-Schenkel, F. Lordick
Journal: Annals of Oncology (2014)
Epidemiology of cancer in Afghanistan
Authors: D. Pendharkar, H. Salim-Ul-Zaman
Journal: Journal of Clinical Oncology (2009)

e22200 Background:Cancer statistics from Afghanistan is not available. Aim of the exercise was to see pattern of cancer in the region. The analysis was done by inviting existing patients in a cancer assistance camp organized in Kabul Afghanistan. There are no existing cancer registries or treatment facilities in the country. Patients travel to neighboring states for treatment. Methods: Cancer assistance camps are one of the unique way to offer some medical as well as social and educational support to the patients and their families. National cancer Society an NGO from Delhi, India, organized two such camps at Kabul. Media advertisement was used to invite cancer patients and relatives. Overall about 350 patients were examined. Data from these patients were analysed. Results: Overall the commonest malignancy was found to be esophageal cancer. Nearly 25 % of the patients presented with signs and symptoms of esophageal cancer. GE junction tumors were common as well. Second commonest problem was lung cancer. Cases of head and neck cancer were not as common. Amongst females breast cancer was found to be commonest and about 15 % of ladies had female cancer. Evaluation of the probable causes of very high incidence of esophageal cancer was carried out by analyzing food habits. The population had unique habit of using large quantity of red barbeque meat. Large quantity means beyond A kilogram per day. The food is barbecued on wood and eaten without any spices.Similar analysis from similar altitude in Kashmir region of India, had shown very high incidence of GE junction and stomach cancer. The food pattern is similar except that the barbecued food is added with spices. Conclusions: The incidence of upper gastrointestinal (GI) cancer is unexpectedly high. There is a definite need to study causative mechanisms in the Himalayan part. These areas could serve as good models for preventive strategies as well as clinical trials for upper GI cancer. No significant financial relationships to disclose.