tbuckley/cabot-search huggingface dataset:
OC-037 The Increasing Role Of Enhanced Sedation Assisted Ercp: Important Lessons For Service Provision
Authors: D Joshi, B Paranandi, G El Sayed, G Johnson, MH Chapman, SP Pereira, GJ Webster
Journal: Gut (2014)

<h3>Introduction</h3> ERCP in the UK has historically been performed under conscious sedation (SED). However, given the increasing complexity of cases the role of enhanced sedation assisted ERCP (ENS ERCP) is increasing. A previous audit iat UCLH showed that intolerance of SED was a major factor in ERCP failure. BSG guidance was issued in 2011 regarding the use of propofol sedation for ERCP in the UK<sup>.1</sup> We describe our experience of ENS ERCP and highlight the importance of the regular availability of this service. <h3>Methods</h3> Our prospective ERCP database was interrogated to include cases between Jan-Nov 2013. Two dedicated ENS ERCP lists run weekly at UCLH. Data collection included procedural information, patient demographics, ASA status, Cotton grade of difficulty (1–4), and endoscopic/anaesthetic complications. ENS ERCP was defined as the use of propofol +/- fentanyl without the need for intubation. ENS was administered by consultant anaesthetists. Data presented as median with range. Comparison was made between SED and ENS ERCP patients. <h3>Results</h3> During the 10 month study period 629 ERCPs were performed in 532 patients (52% male). 423 procedures were performed under SED and 139 under ENS. ENS patients were younger compared to SED patients (54, 9–88 years vs. 66, 20–96 years, p &lt; 0.0001) but ASA grade 1–2 status was similar between the two groups (84 vs. 78%, p=NS). An increased number of Cotton grade 3–4 ERCPs were perfomed in the ENS group (64 vs. 34%, p &lt; 0.0001). Common indications for ENS included previously uncomfortable/failed procedure (30%), biliary/pancreatic sphincter of Oddi manometry (24%) and single operator cholangioscopy (20%). Patient choice accounted for only 4% of cases. 59% of cases were tertiary referrals, 12% of which had failed previously. 77% of referrals were elective cases, 12% urgent day-case referrals and 11% urgent in-patients. ERCP was completed successfully in 95% of cases. Anaesthetic complications occurred in 3 cases all relating to over sedation requiring intubation. ERCP-related complications occurred in 5% of cases. Where previous SED ERCP was unsuccessful due to patient intolerance, the procedure was completed in all cases using ENS. <h3>Conclusion</h3> To date ENS ERCP has predominately been used for previously failed/poorly tolerated procedures and Cotton Grade 3–4 ERCPs. ENS ERCP improves outcomes and is safe when delivered with anaesthetic support. It is likely to be increasingly requested by patients and referrers. Regular ENS provision should be offered by all endoscopy units offering ERCP, and the anaesthetic resource and funding implications will need to be pursued. <h3>Reference</h3> 1 Guidance for the use of propofol sedation for adult patients undergoing ERCP and other complex upper GI endoscopy procedures, April 2011. RCoA and BSG guidance <h3>Disclosure of Interest</h3> None Declared.
Myocardial Perfusion Scintigraphy After Cardiac Arrest
Authors: Hamid Javadi, Majid Assadi
Journal: Clinical Nuclear Medicine (2012)

To the Editor Lima et al1 presented a 74-year-old man who showed extensive ischemia associated with cardiac arrest during exercise stress myocardial perfusion scintigraphy (MPI). The authors concluded that MPI after cardiac arrest is able to illustrate the pathophysiology of cardiac death. To expand further on this point, we would like to add a rare experience in which MPI was able to show the consequence of cardiac death during cardiac arrest. This is a 48-year-old woman who was referred to our department to be assessed for coronary artery disease. She had been hospitalized because of diabetic foot. She also had a history of hypertension. The patient underwent dipyridamole 99mTc followed by gated myocardial perfusion imaging (MPI) 90 minutes later. During image acquisition (at frame 59 of 64), she showed cardiac arrest with asystolic cardiac rhythm. Cardiopulmonary resuscitation was started immediately, and it was successful. The MPI showed decreased perfusion of most left ventricle segments and just preserved septal and anteroseptal walls (Fig. 1).FIGURE 1: A and B, Dipyridamole 99mTc-MIBI MPI SPECT images of a 48-year-old patient showing severe perfusion defects in the most left ventricle segments. Just the septal and anteroseptal walls were preserved.This is a rare report of cardiac arrest 1.5 hours after dipyridamole stress, which was recorded by a gamma camera. This report emphasized the unique role of MPI in showing real-time cardiac arrest. In addition, it depicted the value of patient monitoring during the recovery period even after dipyridamole stress. Hamid Javadi, MD Golestan Research Center of Gastroenterology and Hepatology Golestan University of Medical Sciences Gorgan, Iran Majid Assadi, MD The Persian Gulf Nuclear Medicine Research Center Bushehr University of Medical Sciences Bushehr, Iran [email protected], [email protected]
Management and survival of frail elderly cancer patients within a Geriatric Oncology Program
Authors: U. Basso, L. Vamvakas, C. Falci, E. Lamberti, L. M. Pasetto, A. Brunello, S. Tonti, S. Lonardi, S. Vigorelli, S. Monfardini
Journal: Journal of Clinical Oncology (2006)

8547 Background: Abstention from administration of either chemo- or endocrine therapy to elderly cancer patients deemed frail at the Multidimensional Geriatric Assessment is still controversial, and few data are available concerning the actual survival of such patients. Methods: To evaluate the management and survival of all consecutive frail cancer patients older than 70 years, seen from October 2004 to December 2005 within our Geriatric Oncology Program. Frailty was defined by one or more of the following: age ≥ 85 years, dependence in one or more Activity of Daily Living (ADL), presence of at least three comorbidity of grade 3 or one of grade 4 according to CIRS-G, one or more geriatric syndromes [Balducci L, Cancer Control 2001]. Results: A total of 364 elderly patients were divided into three categories: fit (26.4%), vulnerable (49.5%) and frail patients (24.2%). These 88 frail patients had a median age of 79 years (range, 70–93), 43.2% males. Motives for being considered frail were age alone (13.6% of patients), ADL dependence (25%), comorbidity (14.8%), geriatric syndromes (6.8%) or, more frequently, the co-existence of two or more of these factors (39.8%). Thirty patients (34.1%) underwent chemotherapy: 8 for gastro-intestinal tumors, 7 lung, 7 hematological and 8 other sites. Patients received standard regimens at standard doses (27.6%) or with ≥ 25% dose reduction (24.1%), age-adapted regimens at standard doses (44.8%) or with reduced doses (6.9%). Six patients (20%) derived some clinical benefit but only two (6.7%) showed radiological response. Twenty-two patients interrupted chemotherapy prematurely due to toxicity/death (23.3%) or refusal/drop out (26.7%). All twenty-eight women with estrogen receptor positive breast cancer (31.9% of all frail patients) were prescribed endocrine therapy either adjuvantly, neo-adjuvantly or for metastatic disease, with a predominance of aromatase inhibitors (82.1%) compared to tamoxifen. Thirty out of 88 patients have died, with a 2-year overall survival of 35%. Conclusions: Frailty was observed in one fourth of all our elderly patients, but it did not prevent treatment of tumor with either chemo- or endocrine therapy in 66% of cases. Overall survival of frail elderly patients with cancer appears worse than in geriatric series. No significant financial relationships to disclose.
Commensal microbiota affects ischemic stroke outcome by regulating intestinal γδ T cells
Authors: Corinne Benakis, David Brea, Silvia Caballero, Giuseppe Faraco, Jamie Moore, Michelle Murphy, Giulia Sita, Gianfranco Racchumi, Lilan Ling, Eric G Pamer, Costantino Iadecola, Josef Anrather
Journal: Nature Medicine (2016)
1315 THE EFFECT OF VITAMIN D AND SITAGLIBTIN/METFORMIN COMBINATION ON HEPATIC FAT AND TRIGLYCERIDE CONTENT IN MO-1 MICE WITH FATTY LIVER DISEASE
Authors: A. Shalata, Y. Vintfield, L. Krichevsky, S. Svzalb, M. Grosovski, A. Djibre, N. Assy
Journal: Journal of Hepatology (2013)
Abstract 577: DNA replication origin of human alphoid centromere regions .
Authors: Indri Erliandri, Haiqing Fu, Jung-Hyun Kim, Mirit Aladjem, William Earnshaw, Ramaiah Nagaraja, David Schlessinger, Vladimir Larionov
Journal: Cancer Research (2013)

Abstract The human centromere DNA consist of 171 bp AT-rich-alpha satellite DNA that tandemly arranged into higher order repeat units that is diverged at each centromere, extend from 200kb to 4MB. As the chromosomal site that regulates accurate chromosome segregation, maintaining the correct and coordinated DNA replication prior to cell division is critical. This process should ensure that whole genetic information transferred to daughter cell faithfully. Irregularities on replication process are leading to the mitosis defect and apoptosis. Flanking regions of alpha-satellite DNA arrays are organized in heterochromatin domains that are co-localized with other types of centromeric repeats, i.e. satellite II and gamma-satellite DNA. Previous studies indicate that centromeric DNA replicates in the middle to late S-phase. However little is known what determines activities and positions of replicators on chromatin domains. In this work, we addressed the mechanism of replication on the centromere and other repeat sequences on pericentromeric regions using two different approaches: i) origin mapping using nascent-strand DNA and ii) DNA-protein interaction using chromatin-immunoprecipitation (ChIP) assay. Our results detect active origin of replication within alpha-satellite DNA monomers of centromere, as well as on gamma-satellite repeats. In contrast, satellite II repeats representing centromere-adjacent heterochromatin do not exhibit a significant activity as origin of replication. The accumulation of modified-Histone proteins indicated dynamic activity of DNA arrays. Moreover, DNA replication proteins are formed complex with centromere proteins, presented direct evident on DNA replication activity on centromere. In summary, data indicated position of replicator within alphoid centromere and other large tandem repeat arrays on pericentromeric region with condense chromatin structure, thus suggested role of epigenetic modifications on DNA arrays propagation. Citation Format: Indri Erliandri, Haiqing Fu, Jung-Hyun Kim, Mirit Aladjem, William Earnshaw, Ramaiah Nagaraja, David Schlessinger, Vladimir Larionov. DNA replication origin of human alphoid centromere regions . [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 577. doi:10.1158/1538-7445.AM2013-577
SP0041 Hopes and real life experiences of communication between specialist health care and primary health
Authors: C.R. Ziegler
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> From the patients perspective it is obvious that specialist health care and primary health care have to communicate well, relevant and to full extend. The patient doesn’t change body or diseases when moving between primary and secondary care. Co-morbidity is an increasing problem with the chronic patients and this means new and bigger challenges for everybody: patients as well as the health care system. Good communication between sectors is a necessity for low risks and high quality of life. <h3>Objectives</h3> Unfortunately the patient’s experience often is, that the health care system is all to busy – or to unwilling? - to share information with anyone outside their own department. Or is it just lack of easy-to-use tools, which can help us all to systematic solutions? The speak will be based on the patient’s experience of crossing boundaries between primary and secondary care giving examples – the nice ones and the scary ones. Furthermore I will present a small study initiated by the Danish Rheumatism Association. The study was conducted between a group of persons with RA asking them about their experience with communication and coordination between secondary and primary care. The results show increasing problems with exchange of information which leaves the patient with still more responsibility for their own treatment. Let’s discuss: Who is actually taking responsibility for the rheumatic patient today? Finally I will perspect on my hopes for the future – all seen from the patient’s perspective. <h3>Disclosure of Interest</h3> None Declared
Abstract 1914: Consumption of Lake Ontario sport fish and prostate cancer incidence in the New York State Angler Cohort Study (NYSACS)
Authors: Joseph W. Green, Lina Mu, Mya Swanson, Jacqueline Mix, Matthew R. Bonner
Journal: Cancer Research (2011)

Abstract Fish from the Great Lakes are an important source of exposure to persistent organic pollutants, including polychlorinated biphenyls (PCBs) and organochlorine pesticides (e.g., Mirex and DDT). Some of these pollutants are hypothesized to be hormonally active and therefore may increase the risk of prostate cancer. Conversely, fish are also a source of micro- and macro-nutrients hypothesized to have chemopreventive properties. We investigated the consumption of sport-caught fish from Lake Ontario and the incidence of prostate cancer in the NYSACS, a prospective cohort of 17,110 anglers and their spouses aged 18 to 40 years old at enrollment. Participants completed a mailed self-administered questionnaire upon enrollment in 1991. Demographic factors, smoking history and selected potential confounders were ascertained. The questionnaire also queried for the number of years that fish from Lakes Ontario and Erie were consumed as well as the preparation and cooking practices for sport caught fish. As of December 31, 2008 fifty-eight first primary incident prostate cancers were identified via the New York State Cancer Registry. Vital status was determined by linkage with the Social Security Administration Death file. Of the 10,436 males enrolled at baseline, 10% (n=1,075) were lost to follow-up. Fish consumption was dichotomized into never vs. ever. Duration of consumption was categorized into tertiles based on the distribution among the cases who reported eating L Ontario sport caught fish. Poisson regression was used to calculate rate ratios (RR) and 95% confidence intervals, adjusting for age, education and pack-years of smoking. Ever eating Lake Ontario fish was inversely associated with prostate cancer incidence (RRadjusted=0.5 (95% CI=0.3-0.9)) compared with never consumers. In addition, we found a suggestion of an inverse association with increasing duration of L. Ontario fish consumption (non-eaters RR = 1.0 (ref); 1st tertile RR = 0.6 (95% CI = 0.3-1.3); 2nd tertile RR = 0.4 (95% CI = 0.2-1.0); 3rd tertile RR = 0.5 (95% CI = 0.2-1.0); although the exposure-response gradient was neither monotonic nor significant (ptrend = 0.157). The exposure-response gradients were similar when consumption was lagged 5- and 10-years (5-year lag ptrend = 0.289; 10-year ptrend = 0.269). While interpretation is complicated by a lack of information on family history of prostate cancer, and a small number of cases, these preliminary results are suggestive of an inverse association between Lake Ontario fish consumption and prostate cancer risk. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1914. doi:10.1158/1538-7445.AM2011-1914
Case 37-2009
Authors: Daniela Kroshinsky, Jonathan Kay, Rosalynn M. Nazarian
Journal: New England Journal of Medicine (2009)

A 46-year-old woman with chronic kidney disease and a history of deep venous thrombosis presented with swelling of the leg and skin changes. Thickening and erythema of the skin of both legs developed, leading to difficulty walking, sitting, and bending.
Surface functionalized nanoparticles for proximity-activated detection and imaging of breast cancer.
Authors: SL Sewell, TD Giorgio
Journal: Cancer Research (2009)

Abstract Abstract #6002 Site directed therapy of metastatic and primary breast cancer promises to minimize systemic toxicity associated with chemotherapy agents that have no specificity for pathologic tissues. We have developed a multifunctionalized nanoparticle specifically designed to target breast cancer, including metastases.&amp;#x2028; Quantum dots (QDs) were functionalized with a matrilysin (MMP-7) cleavable, proximity activated substrate, PEG-peptide-PEG (PA construct), where cleavage occurs at the peptide bridge. The QDs were further functionalized with folic acid, a strong breast cancer cell targeting ligand with well-known binding to some normal tissues. The construct initially conceals the folate ligand and reduces binding to non-target tissues. MMP-7 activated cleavage of the PA construct and subsequent unmasking of the folate ligand occurs only at the site of the breast tumor, resulting in a proximity activated targeting (PAT) system. The activity of QDs functionalized with both the PA construct and folic acid (FA-QD-PA) was compared to QDs functionalized with only folic acid (QD-FA).&amp;#x2028; Cellular association of QD-FA nanoparticles with the human breast cancer cell line MDA-MB-231 revealed that 61.9 ± 6.5% of the cells were fluorescently labeled. Addition of the PA construct reduced QD-FA recognition by MDA-MB-231 cells to 2.1 ± 0.4%. MMP-7 cleavage of the protected FA-QD-PA construct restored MDA-MB-231 recognition to 21.9 ± 5.4 %, a significant increase compare to the uncleaved multifunctional nanoparticle construct (one-way ANOVA, p*&amp;lt;0.001, n=3). This in vitro data suggests that the PAT nanoparticle model could function effectively in vivo for specific targeting of breast cancer and metastasis. In the next phase of research, the ability of the FA-QD-PA and FA-QD nanoparticles to detect breast cancer in vivo will be tested using murine models of human breast cancer.&amp;#x2028; This work was funded by the US Army Medical Research and Material Command CDMRP under award BC043908. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6002.
Maternal Polybrominated Diphenyl Ether (PBDE) Exposure and Thyroid Hormones in Maternal and Cord Sera: The HOME Study, Cincinnati, USA
Authors: Ann M. Vuong, Glenys M. Webster, Megan E. Romano, Joseph M. Braun, R. Thomas Zoeller, Andrew N. Hoofnagle, Andreas Sjödin, Kimberly Yolton, Bruce P. Lanphear, Aimin Chen
Journal: Environmental Health Perspectives (2015)

Polybrominated diphenyl ethers (PBDEs) reduce blood concentrations of thyroid hormones in laboratory animals, but it is unclear whether PBDEs disrupt thyroid hormones in pregnant women or newborn infants. We investigated the relationship between maternal PBDE levels and thyroid hormone concentrations in maternal and cord sera. We used data from the Health Outcomes and Measures of the Environment (HOME)Study, a prospective birth cohort of 389 pregnant women in Cincinnati, Ohio, who were enrolled from 2003 through 2006 and delivered singleton infants. Maternal serum PBDE concentrations were measured at enrollment (16 ± 3 weeks of gestation). Thyroid hormone concentrations were measured in maternal serum at enrollment (n = 187) and in cord serum samples (n = 256). Median maternal serum concentrations of BDEs 28 and 47 were 1.0 and 19.1 ng/g lipid, respectively. A 10-fold increase in BDEs 28 and 47 concentrations was associated with a 0.85-μg/dL [95% confidence interval (CI): 0.05, 1.64] and 0.82-μg/dL (95% CI: 0.12, 1.51) increase in maternal total thyroxine concentrations (TT4), respectively. Both congeners were also positively associated with maternal free thyroxine (FT4). We also observed positive associations between BDE-47 and maternal total and free triiodothyronine (TT3 and FT3). A 10-fold increase in BDE-28 was associated with elevated FT3 concentrations (β = 0.14 pg/mL; 95% CI: 0.02, 0.26). In contrast, maternal PBDE levels were not associated with thyroid hormone concentrations in cord serum. These findings suggest that maternal PBDE exposure, particularly BDEs 28 and 47, are associated with maternal concentrations of T4 and T3 during pregnancy.
Efficacité du traitement endoscopique des fistules biliaires après hépatectomie complexe
Authors: A Bourrier, A Chryssostalis, M Gaudric, O Soubrane, O Scatton, B Dousset, P Massault, S Chaussade, F Prat
Journal: Endoscopy (2007)

L'intérêt et l'efficacité du traitement endoscopique des fistules de la voie biliaire principale sont connus. En revanche, les résultats du traitement endoscopique pour fistule biliaire après hépatectomie restent très peu étudiés alors que les hépatectomies complexes se multiplient notamment dans le domaine de la cancérologie. Nous avons analysé rétrospectivement les résultats de ce traitement afin de déterminer d'éventuels caractères spécifiques dans la présentation et la prise en charge.
OP0093 Income and Patient-Reported Outcomes (PROS) after Primary Total Knee Arthroplasty
Authors: J. A. Singh, D. Lewallen
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Few studies have examined the association of lower income with arthroplasty outcomes. To our knowledge, there is only one study in TKA cohort. This study found no differences in pain and function outcomes 2-years after TKA by income level, but higher gains in lower income group. Thus, knowledge gap exists in this area. <h3>Objectives</h3> To assess whether income is associated with patient-reported outcomes (PROs) after primary total knee arthroplasty (TKA). <h3>Methods</h3> We used the prospectively collected data from the Mayo Clinic Total Joint Registry to assess the association of income with index knee functional improvement, moderate-severe pain and moderate-severe activity limitation at 2- and 5-year follow-up after primary TKA using multivariable-adjusted logistic regression analyses. <h3>Results</h3> There were 7,139 primary TKAs at 2-years and 4,234 at 5-years. In multivariable-adjusted analyses, at 2-year follow-up, compared to income &gt;$45K, lower income of ≤$35K and &gt;$35-45K were associated: (1) significantly with moderate-severe pain with odds ratio (OR) 0.61 [95% confidence interval (95% CI): 0.40, 0.94] (p=0.02) and 0.68 [95% CI: 0.49, 0.94] (p=0.02); and (2) trend towards significance for moderate-severe activity limitation with OR 0.78 [95% CI: 0.60, 1.02] (p=0.07) and no significant association with OR, 0.96 [95% CI: 0.78, 1.20] (p=0.75), respectively. At 5-years, odds were not statistically significantly different by income, although numerically favored lowering income. In multivariable-adjusted analyses, overall improvement in knee function was rated as 'better' slightly more often at 2-years by patients with income in the ≤$35K compared to patients with income &gt;$45K, with an OR 1.9 [95% CI: 1.0, 3.6] (p=0.06). <h3>Conclusions</h3> We found that patients with lower income had better pain outcomes compared to patients with higher income. There was more improvement in knee function, and trend towards less overall activity limitation after primary TKA in lower income patients, compared to higher income. Insights into mediators of these relationships need to be investigated to understand how income influences outcomes after TKA. <h3>Disclosure of Interest</h3> None Declared