tbuckley/cabot-search huggingface dataset:
OC-105 Experience in polypectomy training and assessment: an international survey
Authors: K Patel, A Rajendran, O Faiz, M Rutter, C Rutter, R Jover, I Koutroubakis, W Januszewicz, M Ferlitsch, E Dekker, D MacIntosh, SC Ng, T Kitiyakara, H Pohl, S Thomas-Gibson
Journal: Gut (2015)

<h3>Introduction</h3> Colonoscopy is widely practised to reduce rates of colorectal cancer, although it does not confer absolute protection. The most hazardous part of colonoscopy is polypectomy, accounting for the majority of serious complications. It is unclear whether countries around the world have highlighted polypectomy as a specific skill that needs to be taught. The objective of the study was to assess both trainees' and trainers' experience of polypectomy training in countries around the world. <h3>Method</h3> Colonoscopy trainers from 19 countries worldwide (Figure 1)were asked to provide access to local trainers and trainees who would be invited to participate in a survey. An online survey was created asking about trainees' experience of instruction and trainers' experience of teaching polypectomy skills. <h3>Results</h3> Data were obtained from 610 colonoscopists- 348 (57.0%) trainers and 262 (43.0%) trainees. Most (79.6%) of the trainers surveyed were involved in polypectomy assessment weekly. 51.4% of those surveyed said that they used a specific framework when assessing polypectomy. 90.5% of trainees had a primary specialty of medical gastroenterology. The trainees had a breadth of colonoscopic experience, 31.7% having completed more than 500 colonoscopies and 38.2% fewer than 200 procedures. 51.1% stated that the principles of polypectomy had only been taught intermittently. Most (64.1%, 168 respondents) trainees had never been taught the principles of EMR. Only 53.1% of trainees had ever had their polypectomy technique formally assessed by any trainer. Of the 177 trainees who stated that they were competent at polypectomy, 70 (39.5%) had never had a formal evaluation of their polypectomy technique. <h3>Conclusion</h3> This study, the only in the literature, shows that polypectomy training is variable worldwide with low prevalence of formal competency assessment. There is a need to a) understand the learning curve for polypectomy, b) develop an international consensus defining optimal training methods and c) develop a framework of competency assessment. This should improve the safety of polypectomy and the effectiveness of colonoscopy in preventing colorectal cancer. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> The authors would like to acknowledge the contribution of all 610 respondents and in particular the local training faculty who facilitated this study
Successful Treatment of<i>Pneumocystis carinii</i>Pneumonitis in a Patient with Congenital Hypogammaglobulinemia
Authors: John B. Robbins, Robert H. Miller, Victor M. Arean, Howard A. Pearson
Journal: New England Journal of Medicine (1965)

PNEUMOCYSTIS CARINII is established as a pathogen for the susceptible human host1 and in the laboratory animal2 and is the etiologic agent of the clinical entity known as pneumocystis or "plasma-cell" pneumonia. Definitive diagnosis of this infectious disease is rarely made ante mortem. The inability to cultivate the organism in vitro and the difficulty in demonstrating its presence ante mortem in body fluids have contributed to this diagnostic problem. Until recently, no treatment of the infection had been successful,3 , 4 and the disease has been uniformly fatal. Introduction of pentamidine isothionate as a chemotherapeutic agent that may permit successful treatment for . . .
Symmetric Peripheral Gangrene
Authors: M M Berrey, J A van Burik
Journal: New England Journal of Medicine (2001)

Figure 1. Fevers, chills, hypotension, and a generalized seizure occurred in a 57-year-old man who had undergone splenectomy for stage IV non-Hodgkin's lymphoma three years earlier. He was treated initially with ceftriaxone, vancomycin, and rifampin. A Gram's stain of the cerebrospinal fluid showed gram-positive organisms in pairs and short chains, but cultures of cerebrospinal fluid were negative. A latex-agglutination test was positive for Streptococcus pneumoniae. During the next several days, disseminated intravascular coagulation and symmetric areas of pallor developed on the back of both hands and the soles of the feet, with overlying bullae. Cultures of the bullous fluid . . .
Protection against Cholera in Breast-Fed Children by Antibodies in Breast Milk
Authors: Roger I. Glass, Ann-Mari Svennerholm, Barbara J. Stoll, M. R. Khan, K. M. Belayet Hossain, M. Imdadui Hug, Jan Holmgren
Journal: New England Journal of Medicine (1983)

We performed a prospective study to examine whether the IgA antibodies against cholera that are present in breast milk protect breast-fed infants and children against colonization with Vibrio cholerae 01 and disease. Among families of patients with cholera, we collected breast milk from mothers who had not had diarrhea in the previous week and monitored them and their breast-fed children for cholera colonization and diarrhea for 10 days. Breast milk was assayed for IgA antibodies to cholera toxin and lipopolysaccharide. Ninety-three mother--child pairs were studied; 30 infants became colonized with V. cholerae 01 and disease developed in 19. There were no differences between the antibody levels in milk fed to children who became colonized and in milk fed to children who did not. However, among the children who became colonized, those who had diarrhea drank breast milk containing significantly lower levels of both kinds of cholera antibodies than were present in the milk consumed by children who had no symptoms. We conclude that breast-milk antibodies against cholera do not appear to protect children from colonization with V. cholerae 01 but do protect against disease in those who are colonized.
P22 Distribution and Prediction of 10-years Risk for Coronary Heart Disease in COPD
Authors: A Albarrati, NS Gale, M Munnery, JR Cockcroft, DJ Shale
Journal: Thorax (2015)

<h3>Introduction</h3> Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in COPD in excess of the effect of smoking. Clarification of cardiovascular risk factors could clarify the extra risk and lead to appropriate clinical management. We hypothesise that COPD increases the 10 year risk for CVD in patients free of clinically overt CVD. <h3>Methods</h3> Using data from ARCADE study, 382 stable patients with COPD free from CVD and 143 controls were assessed for; lung function (forced expiratory volume (FEV<sub>1</sub>), forced vital capacity (FVC) and their ratio), blood pressure (BP), BMI, aortic pulse wave velocity (PWV) and number of exacerbations. In addition, medical and smoking history were recorded and used to calculate the Framingham risk score (FRS).<sup>1</sup> <h3>Results</h3> Patients with COPD had greater FRC, 24 (8) than controls, 19 (9), p &lt; 0.001. The majority of patients were at high risk, 72%, while only 7% were at low risk. There was no difference between genders. Post hoc analysis showed patients at high risk of CVD had greater aortic stiffness, 10.2 (2.4) m/s compared to patients at low, 8.3 (2) m/s and moderate risk, 9.1 (2) m/s, p &lt; 0.001. The FRS was related to age, r = 0.39, p &lt; 0.001, waist circumference, r = 0.11, p = 0.026, and number of exacerbations, r = 0.10, r = 0.039, but was not related to FEV<sub>1</sub>. <h3>Conclusion</h3> The majority of our patients were at high risk of developing fatal and non-fatal cardiovascular events. Early identification of cardiovascular risk factors and aggressive management would contribute to lowering the incidence of CVD in COPD. <h3>Reference</h3> 1 D’Agostino RB, Grundy S, Sullivan LM, <i>et al</i>. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. <i>JAMA</i> 2001;<b>286</b>:180–187
Net‐like superficial vascular malformation: clinical description and evidence for lymphatic origin
Authors: L. Noguera‐Morel, S.L. Stein, G. Xirotagaros, A. Hernández‐Martín, I. Prada, I.J. Frieden, L. Requena, A. Torrelo
Journal: British Journal of Dermatology (2016)
Subcutaneous Low-Molecular-Weight Heparin Compared with Continuous Intravenous Heparin in the Treatment of Proximal-Vein Thrombosis
Authors: Russell D. Hull, Gary E. Raskob, Graham F. Pineo, David Green, Arthur A. Trowbridge, C. Gregory Elliott, Robert G. Lerner, Jack Hall, Terence Sparling, Herbert R. Brettell, John Norton, Cedric J. Carter, Ralph George, Geno Merli, John Ward, Warren Mayo, David Rosenbloom, Rollin Brant
Journal: New England Journal of Medicine (1992)

Low-molecular-weight heparin has a high bioavailability and a prolonged half-life in comparison with conventional unfractionated heparin. Limited data are available for low-molecular-weight heparin as compared with unfractionated heparin for the treatment of deep-vein thrombosis.
Removal Of Alpha/Beta+ T Cells and Of CD19+ B Cells From The Graft Translates Into Rapid Engraftment, Absence Of Visceral Graft-Versus-Host Disease and Low Transplant-Related Mortality In Children With Acute Leukemia Given HLA-Haploidentical Hematopoietic Stem Cell Transplantation
Authors: Alice Bertaina, Daria Pagliara, Daniela Pende, Sergio Rutella, Michela Falco, Aurelie Bauquet, Benedetta Contoli, Barbarella Lucarelli, Letizia P. Brescia, Pietro Merli, Marco Andreani, Giuseppina Li Pira, Stefano Ceccarelli, Lavinia Grapulin, Giuseppe Palumbo, Maria Ester Bernardo, Simone Biagini, Francesca Moretta, Giuseppe M Milano, Irma Airoldi, Annemarie Moseley, Alessandro Moretta, Lorenzo Moretta, Franco Locatelli
Journal: Blood (2013)
Case 48-1992
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, J.S. Berman, E.J. Mark
Journal: New England Journal of Medicine (1992)

Presentation of CaseAn 82-year-old man was admitted to the hospital because of abdominal pain, nausea, and vomiting.There was a history of a right pulmonary parahilar radiologic density interpreted as atelectasis in the superior segment of the right lower lobe and discovered 3 1/2 years earlier (Fig. 1), when the patient was admitted for treatment of pneumonia. A test for human immunodeficiency virus antibodies was negative. One year before admission the patient was readmitted to the hospital because of pneumonia and recovered.Seven months before entry the patient returned to the hospital because of a dry cough and dyspnea . . .
Syncope in Blood Donors
Authors: William C. Moloney, Lelias R. Lonnergan, James K. McClintock
Journal: New England Journal of Medicine (1946)

THE present emergency has provided an unusually abundant opportunity for the study of syncope, or fainting, in blood donors. Although not in itself serious, fainting results in loss of time to the donor, it is detrimental to the efficiency of the donor center, and, as pointed out by Taylor,1 an occasional donor has fallen and suffered injury. The present investigation of some of the clinical and etiologic aspects of syncope was undertaken to aid in reducing the incidence of fainting in blood donors. Aside from practical considerations, it is hoped that the observations and data recorded in this paper will . . .
First human dose study evaluating safety and pharmacokinetics of LY2181308, an antisense oligonucleotide designed to inhibit survivin
Authors: D. C. Talbot, J. Davies, S. Callies, V. Andre, M. Lahn, J. Ang, J. S. De Bono, M. Ranson
Journal: Journal of Clinical Oncology (2008)

3518 Background: Survivin is a member of the inhibitors of apoptosis proteins (IAP) family, which are generally expressed in tumor but not in normal differentiated cells. LY2181308, a novel 2'-O-methoxymethyl modified anti-sense oligonucleotide (2-MOE-ASO), is a specific inhibitor of survivin mRNA. Methods: Patients who had exhausted all effective anti-tumor therapies were enrolled in this study consisting of 3 parts. Part A consisted of 1-patient cohorts and a dose escalation of 100% to the anticipated biological effective dose range; Part B enrolled 3-patient cohorts with pre- and post-dosing tumor biopsies to determine PD effects including intra-tumoral ASO and survivin using immunocytochemistry and branched chain DNA analysis for survivin mRNA; Part C consisted of an expansion cohort with pre- and post-dosing biopsies. The treatment schedule consisted of 3 consecutive daily 3-hour intravenous (iv) loading doses followed by weekly iv maintenance doses. Results: 24 patients were enrolled in the study all of whom were evaluable for safety and PK up to the 1000 mg dose. The maximum tolerated dose was 750 mg. The PK was consistent with other 2-MOE-ASOs. LY2181308 was rapidly distributed into tissues with 90% of the plasma exposure cleared through tissue distribution within 24 hours. Plasma profiles were adequately described by the pre-clinical three-exponential disposition PK model. The half-lives of these disposition phases were 30 to 60 minutes, 2 to 3 hours and 15 to 25 days, respectively. LY2181308 plasma clearance was approximately 2.66 L/h (geomean with coefficient of variation <30%) corresponding to a mean exposure of about 280–300 μg.h/mL and a mean Cmax of about 61 μg/mL (CV 23 %) following a 750 mg dose. The most frequent adverse events were a transient prolongation of aPTT (not associated with bleeding) and flu-like symptoms. The vast majority of the events observed up to 750 mg were mild to moderate according to the CTCAE severity grading. No drug-related CTCAE grade 3 and 4 was observed at the 750 mg dose. Conclusions: LY2181308 showed a safety and PK profile consistent with previously described 2- MOE-ASOs. Based on the favourable toxicity profile of LY2181308, further single agent and combination studies are warranted. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Eli Lilly Eli Lilly
Multicycle Efficacy and Safety of Nepa, a Fixed-Dose Antiemetic Combination of Netupitant and Palonosetron, in Patients Receiving Chemotherapy of Varying Emetogenicity
Authors: M.S. Aapro, R. Gralla, M. Karthaus, L. Schwartzberg, G. Rossi, G. Rizzi, M.E. Borroni, M. Palmas, H.S. Rugo, K. Jordan
Journal: Annals of Oncology (2014)
Personal views: BMJ should stop confusing its readers over national differences
Authors: Arthur Morris
Journal: BMJ (1999)

Almost every week the BMJ makes mistakes about which elements of the health service apply in England only and which are true for the rest of the United Kingdom. It is not alone in this. Most of the London based media confuse their readers and viewers about the differences between the four countries of the United Kingdom, and it is time for them to do better. Devolution makes this essential.
US officials threaten to sanction firm that promised to revolutionize blood testing
Authors: Michael McCarthy
Journal: BMJ (2016)

US regulators have proposed revoking the federal license of the California laboratory of the biotechnology firm Theranos and banning the company’s top officials from owning or running a laboratory for at least two years.

The privately held company had promised to revolutionize the blood testing industry with a technology that the company said made it possible to run various tests for a wide variety of conditions from only few drops of blood collected with a simple finger prick. With the claim that its technology would make blood testing faster, cheaper, less painful, and more …
Simulation of Cardiac Disease by Adrenocortical Failure in Infants
Authors: Laurence H. Kyle, Catharine Q. Knop
Journal: New England Journal of Medicine (1950)

ADRENAL insufficiency, although uncommon in infants, appears to be a definite clinical entity when associated with congenital adrenal hyperplasia. Recent reports in the pediatric literature attest to the probability that this syndrome occurs more frequently than has been previously supposed and indicate that the diagnosis is often overlooked.1 , 2 It is significant that even in the cases that have been recognized the primary diagnosis was invariably pyloric stenosis or some other type of gastrointestinal disorder.3 , 4 In none of the reported cases were the cardiac abnormalities incident to hyperpotassemia a striking feature. This paper deals with 3 children born to a healthy . . .
Metabolomics in Prediabetes and Diabetes: A Systematic Review and Meta-analysis
Authors: Marta Guasch-Ferré, Adela Hruby, Estefanía Toledo, Clary B. Clish, Miguel A. Martínez-González, Jordi Salas-Salvadó, Frank B. Hu
Journal: Diabetes Care (2016)

To conduct a systematic review of cross-sectional and prospective human studies evaluating metabolite markers identified using high-throughput metabolomics techniques on prediabetes and type 2 diabetes.We searched MEDLINE and EMBASE databases through August 2015. We conducted a qualitative review of cross-sectional and prospective studies. Additionally, meta-analyses of metabolite markers, with data estimates from at least three prospective studies, and type 2 diabetes risk were conducted, and multivariable-adjusted relative risks of type 2 diabetes were calculated per study-specific SD difference in a given metabolite.We identified 27 cross-sectional and 19 prospective publications reporting associations of metabolites and prediabetes and/or type 2 diabetes. Carbohydrate (glucose and fructose), lipid (phospholipids, sphingomyelins, and triglycerides), and amino acid (branched-chain amino acids, aromatic amino acids, glycine, and glutamine) metabolites were higher in individuals with type 2 diabetes compared with control subjects. Prospective studies provided evidence that blood concentrations of several metabolites, including hexoses, branched-chain amino acids, aromatic amino acids, phospholipids, and triglycerides, were associated with the incidence of prediabetes and type 2 diabetes. We meta-analyzed results from eight prospective studies that reported risk estimates for metabolites and type 2 diabetes, including 8,000 individuals of whom 1,940 had type 2 diabetes. We found 36% higher risk of type 2 diabetes per study-specific SD difference for isoleucine (pooled relative risk 1.36 [1.24-1.48]; I(2) = 9.5%), 36% for leucine (1.36 [1.17-1.58]; I(2) = 37.4%), 35% for valine (1.35 [1.19-1.53]; I(2) = 45.8%), 36% for tyrosine (1.36 [1.19-1.55]; I(2) = 51.6%), and 26% for phenylalanine (1.26 [1.10-1.44]; I(2) = 56%). Glycine and glutamine were inversely associated with type 2 diabetes risk (0.89 [0.81-0.96] and 0.85 [0.82-0.89], respectively; both I(2) = 0.0%).In studies using high-throughput metabolomics, several blood amino acids appear to be consistently associated with the risk of developing type 2 diabetes.
Geographic Variation in Expenditures for Physicians' Services in the United States
Authors: W. Pete Welch, Mark E. Miller, H. Gilbert Welch, Elliott S. Fisher, John E. Wennberg
Journal: New England Journal of Medicine (1993)

The national volume-performance standard recently implemented by Medicare does not account for geographic variation in expenditures for physicians' services. To study this variation, we examined expenditures for physicians' services in all metropolitan areas in the United States.
Case 29-1996
Authors: R. Bruce Donoff, Gerard F. Domanowski
Journal: New England Journal of Medicine (1996)

Presentation of CaseA 59-year-old man was admitted to the hospital because of a painful preauricular mass.He had been well until five months earlier, when he noticed a mild hearing impairment in the right ear. Several weeks later, the hearing loss worsened. Evaluation by an otologist showed no evidence of an acoustic neuroma. A cranial magnetic resonance imaging (MRI) scan (Figure 1) showed that the articular disk was absent; there was gross expansion of the joint capsule, with heterogeneous signal characteristics on T1-weighted and T2-weighted images, as well as heterogeneous enhancement. Low-signal regions were interpreted . . .
Vasomotor Disturbances in Poliomyelitis, with Special Reference to Treatment with Paravertebral Sympathetic Block
Authors: Vincent J. Collins, William L. Foster, William J. West
Journal: New England Journal of Medicine (1947)

POLIOMYELITIS in adults can no longer be considered unusual. Lewin1 states that the incidence is definitely increasing in the older age groups. At the Army and Navy General Hospital, Hot Springs, Arkansas, a center for poliomyelitis patients, 131 cases in military personnel were studied. Practically all the cases were convalescent — that is, the acute symptoms had subsided and the patients were observed prior to the end of the two-year interval arbitrarily set as the convalescent period.In a review of these cases vasomotor and sudomotor disturbances frequently appeared in the extremities. These changes formed an important part of the . . .
The myth of the alliance with borderline patients
Authors: G Adler
Journal: American Journal of Psychiatry (1979)

The author questions the concept of a therapeutic alliance in the psychotherapy of patients with borderline and narcissistic personality disorders. The motivating elements in their treatment are the emerging, sustaining transferences, which also allow the patients to appreciate the real qualities of their therapist. As they internalize aspects of their interactions with the therapist, including the therapist's real characteristics that are lacking in themselves, the patients gradually develop the capacity to work collaboratively with him or her. When a solid therapeutic alliance is established, the patients have reached a neurotic level of functioning.
Randomized phase III study comparing etoposide and cisplatin (EP) with irinotecan and cisplatin (IP) following EP plus concurrent accelerated hyperfractionated thoracic radiotherapy (EP/AHTRT) for the treatment of limited-stage small-cell lung cancer (LD-SCLC): JCOG0202.
Authors: Kaoru Kubota, Toyoaki Hida, Satoshi Ishikura, Junki Mizusawa, Makoto Nishio, Masaaki Kawahara, Akira Yokoyama, Fumio Imamura, Koji Takeda, Shunichi Negoro, Masao Harada, Hiroaki Okamoto, Nobuyuki Yamamoto, Tetsu Shinkai, Hiroshi Sakai, Kaoru Matsui, Kazuhiko Nakagawa, Taro Shibata, Nagahiro Saijo, Tomohide Tamura
Journal: Journal of Clinical Oncology (2012)

7028 Background: Four cycles of EP plus AHTRT is the standard treatment for LD-SCLC. IP demonstrated statistically significant overall survival (OS) improvement compared to EP for extensive-stage SCLC (JCOG9511; Noda, et al.NEJM, 2002). EP plus AHTRT followed by 3 cycles of IP is feasible with acceptable toxicities for LD-SCLC (Kubota, et al. CCR,2005). Methods: Eligibility criteria included patients with previously untreated LD-SCLC with measurable lesion, ECOG PS of 0-1, age: 20=&lt;, =&lt;70 years old. Eligible patients received one cycle of EP (etoposide 100 mg/m 2 on days 1-3 and cisplatin 80mg/m 2 on day 1) plus AHTRT (1.5 Gy b.i.d. total 45 Gy/3 weeks). Patients who achieved CR, good PR, PR or SD with induction EP/AHTRT were randomized to receive either 3 cycles of consolidation EP or IP (irinotecan 60 mg/m 2 and cisplatin 60 mg/m 2 on days 1, 8, 15). Patients with CR or good PR after consolidation chemotherapy received prophylactic cranial irradiation. The primary endpoint is OS after the randomization. The planned sample size for randomization is 250 with a one-sided alpha of 2.5% and at least 70% power to detect a difference between gruops, 30% in EP versus 42.5% in IP group in 3-year survival. Results: From Sep 2002 to Sep 2006, 281 patients from 36 institutions were registered. After the induction EP/AHTRT, 258 patients were randomized to consolidation EP (n=129) or IP (n=129). Patient demographics were well balanced between the two groups. At the final analysis, the superiority of IP in OS was not demonstrated (hazard ratio of IP to EP, 1.085 [95%CI: 0.80-1.46]; one sided p=0.70, stratifield log-rank test). Grade 3/4 neutropenia (95%/78%), anemia (35%/39%), thrombocytopenia (21%/5%), neutropenic fever (17%/14%), diarrhea (2%/10%) were observed in EP and IP groups, respectively. Conclusions: EP plus AHTRT followed by 3 cycles of IP failed to demonstrate survival advantage over 4 cycles of EP plus AHTRT which still is the standard treatment for LD-SCLC. [Table: see text]