tbuckley/cabot-search huggingface dataset:
OC-004 Lorec registry – interim analysis of operative technique, pathology and oncological outcomes after abdomino-perineal excision
Authors: H Jones, S Crane, B Moran, C Cunningham
Journal: Gut (2015)

<h3>Introduction</h3> The LOREC perineal wound healing registry was developed to record data on abdomino-perineal excision (APE) for rectal cancer in colorectal units across the UK between 2012 and 2014 to understand current practice. Initial interim results are reported. <h3>Method</h3> Surgeons wishing to participate received secure web-based access to the registry. Collected data included pre-operative staging, neo-adjuvant treatment, operative details, pathology, early outcome and follow-up at 12 months. <h3>Results</h3> Overall 43 units entered a total of 259 patients undergoing APE. These included 168 extralevator APE (ELAPE) procedures (65%) and 91 non-ELAPEs, comprising 73 ‘standard’ APE, 9 intersphincteric, 2 ischioanal and 7 unspecified procedures. The ELAPE and non-ELAPE groups are compared. This indication for APE was oncological in 98% with only 5 cases having APE for functional reasons, eg weak sphincters. On pre-op MRI the ELAPE group had higher grade tumours, with 112 (67%) staged on MRI as T3/4 compared with 47 (54%) for non-ELAPEs. ELAPEs also had a higher incidence of predicted positive lymph nodes, with 97 (58%) N1/2 compared with 38 (43%) for non-ELAPEs. The circumferential resection margin was predicted as less likely to be clear in the ELAPE group, 68 (45%), versus 38 (53%) in the non-ELAPE group. Metastatic disease was reported in 6% of the ELAPE group and 3% of the non-ELAPEs. The majority of patients received pre-operative treatment, most commonly chemoradiotherapy. Overall, the response to treatment was graded on MRI as mixed fibrosis and tumour in 32%, while 38% showed mainly or only tumour and 29% showed small or no residual tumour. Multivisceral resection was undertaken in 19 (11%) of ELAPEs and 7 (8%) of non-ELAPEs, the vast majority involving the vagina. Operative complications were recorded in 8%. These included rectal perforation (7 cases), urethral injury (6 cases), ureteric injury (2 cases) and 9 cases of ‘other’ complications. On pathology similar proportions had higher grade tumours: 81 (52%) T3/4 in the ELAPE group compared with the 41 (47%) in the non-ELAPE group. The ELAPEs were more likely to be node-positive, 55 (35%), versus 23 (27%) in the non-ELAPEs. A positive resection margin was reported in 21 (14%) of ELAPEs and 2 (2%) of non-ELAPEs. Perforation was noted in 3 patients in each group. The quality of TME was graded as mesorectal plane intact in 112 (67%) of ELAPEs and 46 (51%) of non-ELAPEs. The quality of the levator plane was graded as complete levator wrap in 110 (65%) of ELAPEs. <h3>Conclusion</h3> It appears that surgeons are using ELAPE in more advanced cases but R1 rates of 14% suggest these are challenging and further means of improving outcomes should be explored. <h3>Disclosure of interest</h3> None Declared.
FRI0488 Prevalence and Clinical Significance of Cognitive Impairment in Systemic Sclerosis
Authors: T.N. Amaral, F.A. Peres, A.T. Lapa, R.B. Fritolli, A.P. del Rio, J.F. Marques-Neto, S. Appenzeller
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> There is an increased appreciation of the burden of cognitive impairment in people with autoimmune diseases. Autoantibodies, cytokines and cardiovascular disease (CVD) risk factors have been shown to contribute in different levels. Furthermore, recent studies have demonstrated diffuse white matter involvement and cerebral hypoperfusion in Systemic Sclerosis (SSc) patients. <h3>Objectives</h3> To evaluate the prevalence of cognitive impairment in SSc and to determine the role of disease related features and CVD risk factors in its occurrence. <h3>Methods</h3> Consecutive SSc patients [42 (68.85%) limited SSc (lSSc) and 19 (31.15%) with diffuse SSc (dSSc)] from the State University of Campinas were enrolled. Controls were age and sex matched and had the same educational level and sociodemographic background as SSc patients. Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction and scores ≤26 were considered abnormal. Mood disorders were determined through Becks Depression and Anxiety Inventory in all participants. CVD risk factors (hypertension, diabetes mellitus, insulin resistance, obesity, dyslipidemia) were screened in all individuals according to 2009 Joint Interim Statement on Metabolic Syndrome. SSc patients were further clinically and laboratory assessed to determine organ involvement, autoantibody profile (anti-topoisomerase I, anticentromere, and anti-RNA polymerase III), disease activity (Valentine Activity Index) and disease severity (Medsger Severity Index). Data were compared by non-parametric tests. <h3>Results</h3> A total of 61 SSc (55 female; mean age =50.9; SD ±11.6) and 40 health subjects (38 female; mean age=53.1; SD ±13.1) (p=0.7) were included in the study. Active disease was observed in 15 (24.59%) SSc patients. Cognitive impairment was identified in 53 (86.89%) SSc patients (38 lSSc and 15 dSSc) and in 5 (12.5%) health controls (p&lt;0.001). Cognitive impaired SSc patients were significantly younger than controls (p=0.01). Cognitive impaired SSc patients were significantly older [mean age of 52.30 (SD=11.58); vs 41.95 (SD=9.17); p=0.016] and had higher insulin resistance evaluated by homeostatic model assessment (HOMA) (p=0.01) when compared to SSc without cognitive impairment. No association with other metabolic or disease related variables, disease9s activity or severity was identified. <h3>Conclusions</h3> An increased prevalence of cognitive impairment was observed in SSc and associated with age and insulin resistance. Nonetheless, cognitive impairment seems to be an early age-related process in SSc when compared to healthy controls. <h3>Disclosure of Interest</h3> None declared
Refusing treatment for mental illness: historical and ethical dimensions
Authors: S J Reiser
Journal: American Journal of Psychiatry (1980)

The author summarizes the historical bases for overzealous intervention by physicians, noting the tensions among medical technology, nature as a healing force, and the physician's warrant to treat. He discusses John Mill's On Liberty and Gerald Dworkin's "Paternalism" and suggests that there are times when the intervention should be withheld, but never the care.
Neuropsychology in alcoholic men in their late thirties: one-year follow-up
Authors: K M Adams, I Grant, R Reed
Journal: American Journal of Psychiatry (1980)

In a previous article the authors reported on two groups of alcoholic men in their late 30s who were remarkably free of neuropsychological impairment. In this article they present the results of a 1-year follow-up of many of these subjects. They found similarities in performance between alcoholic subjects who in the original study had been abstinent for 18 months and nonalcoholic control subjects who drank moderately. However, the group of alcoholic men who in the original study had been recently detoxified (about 3 weeks) failed to show practice-effect learning on follow-up. The authors interpret this failure as possibly indicative of a preclinical phase of what might ultimately become organic impairment.
Psychiatric decision making in the emergency room: a research overview
Authors: D C Marson, M P McGovern, H C Pomp
Journal: American Journal of Psychiatry (1988)

In an overview of the research on psychiatric decision making in the emergency room, the authors discuss studies done between 1963 and 1977, which suffered from an overreliance on univariate statistical techniques, problems with the reliability and validity of the instruments used for data collection, and the lack of alternatives to hospitalization for emergency room patients. More recent studies of emergency room decision making are then reviewed, with particular attention to those that had multivariate statistical designs. The article concludes with a synthesis of the research findings to date and recommends multivariate approaches and choices of variables for future studies.
Hypothalamic-pituitary-adrenal axis hyperactivity and psychosis: recovery during an 8-year follow-up
Authors: W Coryell, D Tsuang
Journal: American Journal of Psychiatry (1992)

An earlier study showed that the results of dexamethasone suppression test (DST) predicted outcome among patients with a functional psychosis followed to 1 year. The present study was undertaken to replicate these findings with a different patient group and a longer follow-up.Ninety-two inpatients with nonorganic, nonmanic psychoses had DSTs during their hospitalizations. Raters who were blind to DST results, and to baseline chart or research diagnoses, conducted personal interviews with 71 of the patients 8 years later.Patients who had been nonsuppressors on the DST were five times more likely than those who had been suppressors to be free of psychotic features and to exhibit insight at the follow-up interview (42% versus 8%). Prognostic differences between these groups were clear within the first year of follow-up. Baseline diagnoses also strongly predicted outcome, even among DST nonsuppressors, and DST results had no prognostic significance among patients with a baseline diagnosis of schizophrenia. Later ages at onset and short episode durations at intake also predicted recovery, but baseline DST suppressor status remained important after control for these factors.The findings of this study and those of the earlier follow-up suggest that among patients with a functional psychosis, nonsuppression on the DST is prognostically important, particularly after the exclusion of those who meet narrow criteria for schizophrenia.
Soundings: Music of the mountains
Authors: James Owen Drife
Journal: BMJ (2005)

Armenia once stretched from the Black Sea to the Caspian, but these days it is small, high, and landlocked. Its capital, Yerevan, looks wistfully across a valley to Mount Ararat, last resting place of Noah's Ark and now part of Turkey. “But only temporarily,” they say in Yerevan's marketplace.

The country's population is three million, but with its troubled history there are more Armenians in the diaspora. Many of them are musical. Charles Aznavour was born Charles Aznavourian in Paris. Cher, famed for her minimalist gowns, began life as Cherilyn Sarkisian in California. Aram Khachaturian, best known for his “Sabre Dance,” lived in Moscow but Yerevan Opera House has an auditorium named after him.

Its favourite opera, Tigranyan's Anoush, is a story of doomed love in a mountain village. The male chorus wear shaggy coats and hats, and the heroine throws herself off a cliff in the last act. Just the thing, we thought, for pre-conference relaxation.

Opera-going in former Soviet countries is a family affair. We found ourselves sitting in front of middle aged mums who exchanged observations during most of the performance. They fell silent in the tenor's final scene—not when the poor man was fatally shot by the bass but when the crowd parted to reveal his mother. Behind us there was dead silence, then sniffles.

In front of us was a group from the diaspora, just flown in from the West and checking out their heritage.

After the conference, there was time for a short trip to a mountain monastery. Armenia adopted Christianity in 301 ad, and church building has been a national preoccupation ever since. This one nestled against a cliff and merged with a series of chambers hewn from the rock, complete with pillars that had survived several centuries and one major earthquake.

As we marvelled, the sound of a choir echoed around us. We lowered our digital cameras respectfully. The singing seemed to come from another world. Back at the altar we saw in the candlelight a young woman—head bowed, lips barely moving—murmuring a psalm. The mountain was supplying the harmonies. Nice to know that the diaspora does not have all the best tunes.
THU0582 Readability of Online Ankylosing Spondylitis Patient Education Material
Authors: A. Omar, I. Sari, R. Inman, N. Haroon
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> The internet has become a valuable source for patient education material. Patients are increasingly seeking health information on the web. Within all specialties, including rheumatology, health care providers are increasingly referring patients to reputable websites to obtain further knowledge with regards to their rheumatolgical conditions. Available evidence suggests many patients find internet educational material difficult to understand. Expert opinion recommends that patient educational material readability levels should be at grade six equivalent or less, ideally not exceeding the grade 8 level. Analysis of online Rheumatological patient related material is lacking and to the best of our knowledge, no previous studies have been published on the readability of online Ankylosing Spondylitis (AS) patient education material. <h3>Objectives</h3> The aim of our study is to assess the readability of Ankylosing Spondylitis patient education material available online and to compare it to the recommended readability standards. <h3>Methods</h3> Ten reputable and publically accessible websites were chosen for this study. The material was accessed in October 2014. The readability of their AS text was then individually assessed using Microsoft Word® 2010 version to calculate their reading grades and reading ease using the validated Flesch-Kincaid grade level formula (FKGL) and the Flesch-reading ease scores (FRES). To measure reliability of our results, two independent researchers scored the chosen websites using two different computers and the intraclass correlation coefficient (ICC) was calculated. A comparison of the mean FKGL with the recommended readability level was done using unpaired t-test was used. <h3>Results</h3> The Mean ± SD grade level readability of the selected AS text of all the ten websites was 10.1±2.1 (Table 1). All but two of the articles had a readability score above the sixth-grade level. No articles were below grade 6, with only 20% articles just reaching grade 6 level (6.7 and 6.9), also the only two articles with readability below grade 8 level (Figure 1). The remaining 80% exceeded the recommended readability. Readability of the articles exceeded the maximum recommended level by a mean ± SD of 4.1±2.12 grade levels (95% Cl, 2.8-5.42, P&lt;0.0001). The FRES mean ± SD for all the articles was 51.74±11.19 (95% CI, 44.8 to 58.68). The FRES is scored from 0 to 100, the higher the score, the easier to read. The ICC was 1 indicating the website scores obtained were in perfect agreement. <h3>Conclusions</h3> The majority of the assessed online Ankylosing Spondylitis patient educational material exceeded the recommended reading levels. This has the potential for making comprehension difficult for a substantial number of patients referred to these websites. Our study suggests that more effort needs to be applied to make online AS educational material easier to read. <h3>Disclosure of Interest</h3> None declared
Effects of Acidity and of Heating on the Capacity of Rat Liver Extracts to Desamidate Glutamine and Asparagine
Authors: Errera, Maurice, Greeinstein, Jesse P.
Journal: JNCI Journal of the National Cancer Institute (1947)

Journal Article Effects of Acidity and of Heating on the Capacity of Rat Liver Extracts to Desamidate Glutamine and Asparagine Get access Maurice Errera, Maurice Errera research fellow Search for other works by this author on: Oxford Academic PubMed Google Scholar Jesse P. Greeinstein Jesse P. Greeinstein chief biochemist 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 7, Issue 6, June 1947, Pages 437–442, https://doi.org/10.1093/jnci/7.6.437 Published: 01 June 1947 Article history Received: 11 March 1947 Published: 01 June 1947
Treatment of Colovaginal Fistula with Coaxial Placement of Covered and Uncovered Stents
Authors: H.-U. Laasch, L. Wilbraham, A. Marriott, D. Martin
Journal: Endoscopy (2003)

In the colon self-expanding stents may be used for palliation of malignant obstruction as well as being employed as a temporary measure prior to definitive surgery [1]. Difficulties include a high rate of migration and stent occlusion. Successful treatment of enteric fistulas has been described [2] [3] [4] [5]. We present a case of a large colovaginal fistula that was successfully sealed at the second attempt by coaxial placement of an uncovered and a covered stent. A 78-year-old lady was admitted with a history of altered bowel habit, abdominal pain and increasing vaginal discharge. Computed tomography showed a sigmoid carcinoma arising within diverticular disease, confirmed on sigmoidoscopy. She was unfit for surgery and was referred for colonic stenting. By this time she had free faeculent vaginal discharge and was completely bed-bound. A large sigmoido-vaginal fistula within a sigmoid stricture was demonstrated on fluoroscopy (Figure [1]). The stricture was traversed with a 7-Fr angiographic catheter and hydrophilic wire. After exchange for a stiff wire, a 17-cm, 18-mm covered oesophageal nitinol stent (Choo; DiagMed, UK) was deployed (Figure [2]). Injection of contrast showed no residual leak. From the following day the patient passed stools normally and the vaginal discharge stopped completely. At 7 days later the patient passed the stent into the toilet and developed recurrent intestinal obstruction and vaginal discharge. A second attempt was made at stenting. An uncovered 9-cm, 22-mm Enteral Wallstent (Boston Scientific UK) was deployed as an anchor, through which a further Choo stent was placed coaxially (Figure [3]). The patient made an uneventful recovery, with bowel motions returning to normal and complete resolution of vaginal discharge. The stents were still in situ and functioning 6 months later and the fistula was sealed. Relieving colonic obstruction with an uncovered stent and reducing the pressure proximal to this may be sufficient to allow a fistula to close. In difficult cases a combination with a covered stent should be considered.
I Remember
Authors: R J McIvor
Journal: JAMA (2001)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Autosomal dominant polycystic kidney disease in children
Authors: Satyamaanasa Polubothu, Amanda Richardson, Larissa Kerecuk, Manish D Sinha
Journal: BMJ (2016)

Screen now to save later?

Autosomal dominant polycystic kidney disease (ADPKD) was previously known as “adult PKD” because most cases come to medical attention during adulthood. However, clinically important morbidity such as hypertension and cardiovascular disease occurs much earlier. Screening children could detect those affected, and randomised controlled trials show that early intervention reduces disease progression. Despite this, very few children from families with the condition are currently assessed in the United Kingdom.

ADPKD is the most common inherited kidney disease and accounts for 10% of people under 65 years on renal replacement therapy in the UK.1 Often asymptomatic during the first three decades of life, the condition typically presents with abdominal pain or an incidental finding of hypertension. Renal disease is characterised by gradual bilateral cystic dilation of the renal tubules, with eventual compression of normal renal parenchyma and kidney enlargement. After patients develop hypertension, the disease has an accelerated trajectory, with a …
Evaluating new drugs: a three-step approach.
Authors: Z A Arlin
Journal: Journal of Clinical Oncology (1986)

Article Tools Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1986.4.9.1418 Journal of Clinical Oncology - published online before print September 22, 2016 PMID: 3746378 Evaluating new drugs: a three-step approach. Z A ArlinxZ A ArlinSearch for articles by this author https://doi.org/10.1200/JCO.1986.4.9.1418 PDF "Evaluating new drugs: a three-step approach.." Journal of Clinical Oncology, 4(9), pp. 1418–1419© 1986 by American Society of Clinical Oncology
Immunohistochemical screening of ALK lung cancer with biopsy specimens of advanced lung cancer.
Authors: K. Kudo, K. Takeuchi, H. Tanaka, N. Yanagitani, A. Horiike, F. Ohyanagi, N. Motoi, Y. Ishikawa, T. Horai, M. Nishio
Journal: Journal of Clinical Oncology (2010)

10532 Background: The EML4-ALK fusion oncogene represents a novel molecular target in a small subset of lung cancers. Low expression of EML4-ALK fusion protein complicates detection by conventional immunohistochemistry. We recently developed intercalated antibody-enhanced polymer (iAEP) immunohistochemistry, which sensitively and specifically detects ALK fusion proteins including EML4-ALK. Here, we aimed to identify and characterize ALK-positive individuals among patients with advanced lung cancer. Methods: We immunohistochemically screened for ALK fusion proteins using biopsy specimens from 492 non-selected patients with advanced lung cancer. The expression of ALK was examined by iAEP and medical records were reviewed. Results: Of the 492 patients, 331 were male and 160 were female. Stages were IIIA (n = 126), IIIB (n = 117), IV (n = 212) and recurrence (n = 36). Histology revealed adenocarcinoma (n = 253; BAC, n = 5), squamous carcinoma (n = 71), large cell carcinoma (n = 36), LCNEC (n = 13), NSCLC (n = 46) and SCLC (n = 72). Of the 492 tumors screened, 10 (2%) were positively stained for ALK and all ALK-positive tumors were adenocarcinoma. The characteristics of the patients with ALK-positive lung cancer were as follows, male:female (3:7), median age: 53 (26-75) years, stage IIIA (n = 3), IIIB (n = 5) and IV (n = 2). Eight patients were light smokers or had never smoked and two were heavy smokers. Patients with ALK-positive lung cancer were significantly younger (p < 0.05), and more likely to be female (70% vs 47%, p < 0.05) than those with ALK-negative lung adenocarcinoma. Among the ALK-positive patients, nine received platinum-based chemotherapy and five (71%) of seven evaluable patients were responders. None of the five patients who received EGFR TKIs were responders. Conclusions: The frequency of ALK-positive lung cancer among patients with advanced lung cancer is similar at the early stage of lung cancer as reported and EGFR TKIs are ineffective whereas platinum doublets might be favorable for these patients. No significant financial relationships to disclose.