tbuckley/cabot-search huggingface dataset:
A teenage girl with lower abdominal pain
Authors: Chiara Zanchi, Giorgio Cozzi, Caterina Businelli, Egidio Barbi
Journal: BMJ (2017)

A 14 year old girl arrived with her mother at the emergency department complaining of a 6 day history of lower abdominal pain, associated with dysuria and mild fever.She reported no other symptoms.On examination, the girl was tender across the lower abdomen, particularly in the right lower quadrant, where mild guarding and rebound tenderness were present.She was given intravenous paracetamol.During a brief private talk, she said she was sexually active with her boyfriend and was not using any form of contraception.Laboratory tests showed increased white blood count (13.6×10 9 /L, neutrophils 8.7×10 9 /L), C reactive protein of 5.4 mg/dL, and erythrocyte sedimentation rate of 47 mm/h.Beta-human chorionic gonadotropin levels were negative.Urine analysis showed mild leucocyturia.An abdominal ultrasound showed normal appendix and ovaries, with a small amount of free pelvic fluid.Gynaecological physical examination showed cervical and uterine motion tenderness and vaginal discharge.A transvaginal ultrasound with colour Doppler analysis showed thickened, fluid filled fallopian tubes with hypervascularity ().Ultrasound image shows tubes with thick walls and intraluminal fluid Colour Doppler shows increased vascularity of the tube Questions 1.What is the most likely diagnosis?2. How should this patient be managed?3. What specific issues relate to managing this condition in adolescence?
New test for asthma will save NHS millions, says NICE
Authors: Jacqui Wise
Journal: BMJ (2017)

GPs should diagnose asthma using objective tests including fractional exhaled nitric oxide (FeNO) and spirometry, the National Institute for Health and Care Excellence (NICE) recommends.1 However, NICE says this change to current practice will take the NHS some time to implement, with additional infrastructure and training needed in primary care.

NICE says that the current practice of relying on signs and symptoms of asthma without objective testing can lead to overdiagnosis. It estimates that using objective tests could save the NHS between £10m and £15m (€11.2m and €16.7m; $13.2m and $19.9m) over a five year period, mainly through reducing unnecessary prescriptions.

FeNO tests measure the concentrations of nitric oxide in a …
Modulation of the gut microbiota by metformin improves metabolic profiles in aged obese mice
Authors: Heetae Lee, Youngjoo Lee, Jiyeon Kim, Jinho An, Sungwon Lee, Hyunseok Kong, Youngcheon Song, Chong-Kil Lee, Kyungjae Kim
Journal: Gut Microbes (2017)

The gut microbiota is a contributing factor in obesity-related metabolic disorders. The effect of metformin on the gut microbiota has been reported; however, the relationship between the gut microbiota and the mechanism of action of metformin in elderly individuals is unclear. In this study, the effect of metformin on the gut microbiota was investigated in aged obese mice. The abundance of the genera Akkermansia, Bacteroides, Butyricimonas, and Parabacteroides was significantly increased by metformin in mice fed a high-fat diet. Metformin treatment decreased the expression of IL-1β and IL-6 in epididymal fat, which was correlated with the abundance of various bacterial genera. In addition, both fecal microbiota transplantation from metformin-treated mice and extracellular vesicles of Akkermansia muciniphila improved the body weight and lipid profiles of the mice. Our findings suggest that modulation of the gut microbiota by metformin results in metabolic improvements in aged mice, and that these effects are associated with inflammatory immune responses.
P2.02-024 Phase I and II Trial of Intrapleural Paclitaxel Injection for Non-Small-Cell Lung Cancer Patients with Malignant Pleural Effusions
Authors: Masato Sasaki, Akitoshi Okada, Kayo Sakon, Masaki Anzai, Miwa Morikawa, Yukihiro Umeda, Shingo Ameshima, Tamotsu Ishizuka, Takaaki Koshiji
Journal: Journal of Thoracic Oncology (2017)
Practice Standards for Electrocardiographic Monitoring in Hospital Settings
Authors: Barbara J. Drew, Robert M. Califf, Marjorie Funk, Elizabeth S. Kaufman, Mitchell W. Krucoff, Michael M. Laks, Peter W. Macfarlane, Claire Sommargren, Steven Swiryn, George F. Van Hare
Journal: Circulation (2004)

The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, computerized ST-segment ischemia analysis is available only in newer-generation monitors, and computerized QT-interval monitoring is currently unavailable. Even in hospitals with ST-monitoring capability, ischemia monitoring is vastly underutilized by healthcare professionals. Moreover, because no computerized analysis is available for QT monitoring, healthcare professionals must determine when it is appropriate to manually measure QT intervals (eg, when a patient is started on a potentially proarrhythmic drug). The purpose of the present review is to provide 'best practices' for hospital ECG monitoring. Randomized clinical trials in this area are almost nonexistent; therefore, expert opinions are based upon clinical experience and related research in the field of electrocardiography. This consensus document encompasses all areas of hospital cardiac monitoring in both children and adults. The emphasis is on information clinicians need to know to monitor patients safely and effectively. Recommendations are made with regard to indications, timeframes, and strategies to improve the diagnostic accuracy of cardiac arrhythmia, ischemia, and QT-interval monitoring. Currently available ECG lead systems are described, and recommendations related to staffing, training, and methods to improve quality are provided.
Arsenic trioxide inhibited the growth of human breast cancer cells via cell cycle arrest and apoptosis
Authors: Lin Li Zhou, Kwok Pui Fung
Journal: Cancer Research (2007)

4850   Abstract:  Breast cancer is a common cancer among women in Hong Kong and world wide. Tamoxifen is the most common drug used to treat breast cancer, which antagonist the effects of estrogen on breast cancer cells, called an “anti-estrogen.” But tamoxifen is low in potency in late stage breast cancer, which is Estrogen Receptor-alpha (ER α) negative.  Arsenic trioxide (As 2 O 3 ) has been explored for medical application in both Western and Chinese societies. Derived from Pishi by sublimation, it constitutes a major ingredient of arsenic compounds in Traditional Chinese Medicine (TCM). In 1990s, As 2 O 3  was reported to be effective for treatment of acute promyelocytic leukemia (APL). The arsenic therapy was focused on APL and other leukemia until recently when researchers begin to study its effect on other solid tumor cells.  In present study, we investigate the anti-tumor effects of As 2 O 3  on breast cancer, using MDA-MB-231, an ER α negative human breast cancer cell line. The methylthiazoletetrazolium (MTT) assay showed that As 2 O 3  inhibited cell proliferation of MDA-MB-231 cells  in a time and dose dependent manner. The IC50 of cells treated with As 2 O 3  for 72h was 12.5 µM.  A  typical ladder pattern was observed in DNA fragmentation assay. Quantification of apoptosis using flow cytometry with Annexin V-PI staining revealed a shift of cell population to the right bottom quadrate in cells treated with As 2 O 3 . Moreover, the result of cell cycle analysis showed an increase in G2/M phase further indicated that the As 2 O 3  inhibited the proliferation of MDA-MB-231 cells via cell cycle arrest or apoptosis. And the involvements of apoptosis and cell cycle arrest were confirmed by the western bolt analysis that: (1) As 2 O 3 -induced apoptosis was dependent on the extrinsic pathway, as shown by caspase 8 and caspase 3 activation. (2) As 2 O 3 -induced apoptosis was dependent on the mitochondria intrinsic pathway, as shown by activation of caspase 9, what’s more, decrease of bcl-2 expression, the increase ratio of Bax/bcl-2. (3) As 2 O 3  induced cell cycle arrest at G2/M phase, as shown by decrease of cyclin B.  We therefore concluded that arsenic trioxide inhibited the growth of MDA-MB-231 cells via cell cycle arrest and apoptosis
Sudden Cardiac Arrest during Participation in Competitive Sports
Authors: Cameron H. Landry, Katherine S. Allan, Kim A. Connelly, Kris Cunningham, Laurie J. Morrison, Paul Dorian
Journal: New England Journal of Medicine (2017)

The incidence of sudden cardiac arrest during participation in sports activities remains unknown. Preparticipation screening programs aimed at preventing sudden cardiac arrest during sports activities are thought to be able to identify at-risk athletes; however, the efficacy of these programs remains controversial. We sought to identify all sudden cardiac arrests that occurred during participation in sports activities within a specific region of Canada and to determine their causes.In this retrospective study, we used the Rescu Epistry cardiac arrest database (which contains records of every cardiac arrest attended by paramedics in the network region) to identify all out-of-hospital cardiac arrests that occurred from 2009 through 2014 in persons 12 to 45 years of age during participation in a sport. Cases were adjudicated as sudden cardiac arrest (i.e., having a cardiac cause) or as an event resulting from a noncardiac cause, on the basis of records from multiple sources, including ambulance call reports, autopsy reports, in-hospital data, and records of direct interviews with patients or family members.Over the course of 18.5 million person-years of observation, 74 sudden cardiac arrests occurred during participation in a sport; of these, 16 occurred during competitive sports and 58 occurred during noncompetitive sports. The incidence of sudden cardiac arrest during competitive sports was 0.76 cases per 100,000 athlete-years, with 43.8% of the athletes surviving until they were discharged from the hospital. Among the competitive athletes, two deaths were attributed to hypertrophic cardiomyopathy and none to arrhythmogenic right ventricular cardiomyopathy. Three cases of sudden cardiac arrest that occurred during participation in competitive sports were determined to have been potentially identifiable if the athletes had undergone preparticipation screening.In our study involving persons who had out-of-hospital cardiac arrest, the incidence of sudden cardiac arrest during participation in competitive sports was 0.76 cases per 100,000 athlete-years. The occurrence of sudden cardiac arrest due to structural heart disease was uncommon during participation in competitive sports. (Funded by the National Heart, Lung, and Blood Institute and others.).
Role of palliative radiotherapy (PRT) in patients with malignant airway obstruction (MAO) in the intensive care unit (ICU).
Authors: Alireza Fotouhi Ghiam, Yash Singh, Sriram Venigalla, Jaclyn Bassett, Joshua Adam Jones
Journal: Journal of Clinical Oncology (2017)

143 Background: MAO is a challenging sequela of advanced cancer, leading to significant morbidity and mortality. A number of patients with MAO present with significant airway compromise necessitating intubation and mechanical ventilation. PRT for MAO patients in the ICU is complex, requiring high levels of coordination and support. The role and efficacy of PRT in intubated patients is not well defined. We performed a retrospective review of intubated patients with MAO receiving PRT to understand efficacy of treatment and patient outcomes. Methods: After obtaining IRB approval, a retrospective query was performed to identify all patients who received PRT and required mechanical ventilation at some point during the course of RT at the Hospital of the University of Pennsylvania from 2008 to 2016. Data was analyzed looking at demographics, reason for intubation, PRT dose and fractionation, length of intubation, extubation success and overall survival. Data was subsequently entered into a database using the secure online application, REDCap. Results: 22 (M:13; F:9) patients with different histologies (most common: lung (11) and lymphoma (3)) were studied. 14 patients had stage IV and 8 had stage II-III disease. All patients had KPS ≤ 50 (ECOG ≤3) at the time PRT initiation. Two patients received PRT and then completed definitive course when became medically stable. The median RT dose was 2000cGy (300 - 7000cGy) given over 1 – 35 (median: 6) fractions. 13 (59%) patients received a full course of initially planned RT. Successful extubation was achieved in 13 (59%) cases but only 11 (50%) patients were survived to hospital discharge. 11 (50%) patients died despite PRT. The average ICU stay was 41.4 days (1 – 75 days). The median overall survival measured from the time of intubation to death or the last follow-up was 23.5 days (1 day - 5.3 year). Favorable histology and lower stage were associated with better outcome following PRT. Conclusions: We found that, in carefully selected patients, PRT can yield successful extubation and potentially improve survival in patients with MAO intubated in ICU. PRT should be considered early in the management of these patients, particularly when it is the treatment of last resort.
Molecular characterisation of human Shiga toxin-producing Escherichia coli O26 strains: results of an outbreak investigation, Romania, February to August 2016
Authors: Codruţa-Romaniţa Usein, Adriana Simona Ciontea, Cornelia Mãdãlina Militaru, Maria Condei, Sorin Dinu, Mihaela Oprea, Daniela Cristea, Valeria Michelacci, Gaia Scavia, Lavinia Cipriana Zota, Alina Zaharia, Stefano Morabito
Journal: Eurosurveillance (2017)

IntroductionAt the beginning of 2016, an increase in paediatric haemolytic uremic syndrome (HUS) cases was observed in Romania. The microbiological investigations allowed isolation of Shiga toxin-producing Escherichia coli (STEC) O26 as the causative agent from most cases. Methods: An enhanced national surveillance of HUS and severe diarrhoea was established across the country following the identification of the first cases and was carried out until August 2016. A total of 15 strains were isolated from 10 HUS and five diarrhoea cases. Strains were characterised by virulence markers (i.e. stx type/subtype, eae, ehxA genes), phylogroup, genetic relatedness and clonality using PCR-based assays, PFGE and multilocus sequence typing (MLST). The first six strains were further characterised by whole genome sequencing (WGS). Results: Five PCR-defined genotypes were distinguished. All strains from HUS cases harboured stx2a and eae, with or without stx1a, while strains from diarrhoea cases carried exclusively stx1a and eae genes. PFGE resolved strains into multiple pulsotypes, compatible with a certain geographic segregation of the cases, and strains were assigned to phylogroup B1 and sequence type (ST) 21. WGS confirmed the results of conventional molecular methods, brought evidence of O26:H11 serotype, and complemented the virulence profiles. Discussion/conclusion: This first description of STEC O26 strains from cases in Romania showed that the isolates belonged to a diverse population. The virulence content of most strains highlighted a high risk for severe outcome in infected patients. Improving the national surveillance strategy for STEC infections in Romania needs to be further considered.
RHCG Suppresses Tumorigenicity and Metastasis in Esophageal Squamous Cell Carcinoma via Inhibiting NF-κB Signaling and MMP1 Expression
Authors: Xiao-Yan Ming, Xu Zhang, Ting-Ting Cao, Li-Yi Zhang, Jia-Li Qi, Ngar-Woon Kam, Xu-Ming Tang, Yu-Zhu Cui, Bao-Zhu Zhang, Yan Li, Yan-Ru Qin, Xin-Yuan Guan
Journal: Theranostics (2017)

Background and Aims: Esophageal squamous cell carcinoma (ESCC), a major histologic subtype of esophageal cancer, is increasing in incidence, but the genetic underpinnings of this disease remain unexplored. The aim of this study is to identify the recurrent genetic changes, elucidate their roles and discover new biomarkers for improving clinical management of ESCC. Methods: Western blotting and immunohistochemistry were performed to detect the expression level of RHCG. Bisulfite genomic sequencing (BGS) and methylation-specific PCR (MSP) were used to study the methylation status in the promoter region of RHCG. The tumor-suppressive effect of RHCG was determined by both in-vitro and in-vivo assays. Affymetrix cDNA microarray was used to identify the underlying molecular mechanism. Results:RHCG was frequently downregulated in ESCCs, which was significantly correlated with poor differentiation (P = 0.001), invasion (P = 0.003), lymph node metastasis (P = 0.038) and poorer prognosis (P < 0.001). Demethylation treatment and bisulfite genomic sequencing analyses revealed that the downregulation of RHCG in both ESCC cell lines and clinical samples was associated with its promoter hypermethylation. Functional assays demonstrated that RHCG could inhibit clonogenicity, cell motility, tumor formation and metastasis in mice. Further study revealed that RHCG could stabilize IκB by decreasing its phosphorylation, and subsequently inhibit NF-κB/p65 activation by blocking the nuclear translocation of p65, where it acted as a transcription regulator for the upregulation of MMP1 expression. Conclusions: Our results support the notion that RHCG is a novel tumor suppressor gene that plays an important role in the development and progression of ESCC.
A necessidade de harmonizar o controlo da exposição ao VIH na Europa
Authors: R Tubiana
Journal: Eurosurveillance (2004)

Ha algum tempo que sao necessarias recomendacoes europeias harmonizadas para o controlo da exposicao ao VIH. Dois grupos de peritos de um total de 14 paises obtiveram trabalhos importantes e impressionantes, constando as suas conclusoes e recomendacoes de dois documentos da autoria de Jesus Almeda e col e Vincenzo Puro e col [1,2]. 
Sao especificados dois contextos caracteristicos, embora a diferenca entre cada um seja discutivel se a questao passar por evitar ou prevenir uma infeccao estabelecida depois da exposicao ao VIH (ou, efectivamente, ao VHC ou VHB). Conforme salientam os autores, a profilaxia pos-exposicao (PEP) constitui o padrao de cuidados para os trabalhadores de cuidados de saude (HCW) em quase todos os paises, inlcuindo os Estados Unidos, mas nao para o controlo da exposicao ao VIH por via sexual, consumo de substâncias injectaveis ou outras exposicoes nao profissionais.
No caso da exposicao profissional de HCW, a tarefa dos autores passou por padronizar varias recomendacoes e estrategias nacionais. Para a exposicao nao profissional, o objectivo consistiu em estabelecer normas europeias, dado que existem muito poucas recomendacoes nacionais. 
Conforme demonstram estes artigos, os fundamentos, gestao e escolha do tratamento para a PEP sao bastante semelhantes nas duas situacoes.
Specific immunotherapy in local allergic rhinitis: A randomized, double‐blind placebo‐controlled trial with <i>Phleum pratense</i> subcutaneous allergen immunotherapy
Authors: C. Rondón, N. Blanca‐López, P. Campo, C. Mayorga, R. Jurado‐Escobar, M. J. Torres, G. Canto, M. Blanca
Journal: Allergy (2017)

Abstract Background Allergen immunotherapy has been shown to be an effective treatment for local allergic rhinitis ( LAR ) to house dust mites. Studies with pollen allergen immunotherapy are limited to observational studies. The aim of this study was to evaluate the clinical efficacy and safety of Phleum pratense subcutaneous immunotherapy (Phl‐ SCIT ) in LAR . Methods In a randomized double‐blind placebo‐controlled study, 56 patients with moderate‐severe LAR to grass pollen received Phl‐ SCIT with a depigmented polymerized pollen vaccine or placebo for the first year, and Phl‐ SCIT the second one. The blind was maintained throughout the study. Primary outcome was combined symptom medication score ( CSMS ) during grass pollen season ( GPS ). Secondary clinical outcomes included organ‐specific symptoms, medication‐free days, rhinitis severity and asthma control. Rhinoconjunctivitis Quality of Life Questionnaire ( RQLQ ), nasal allergen provocation test ( NAPT ), skin testing, serum levels of specific IgG4 and specific IgE and safety were also evaluated. Results Subcutaneous immunotherapy ( SCIT ) had a short‐term and sustained effect with significant improvements of all primary and secondary clinical outcomes and RQLQ score. SCIT significantly increased serum sIgG 4 levels and allergen tolerance, from the 6th to 24th months of treatment. At the end of the study, 83% of patients treated with ≥6 months of SCIT tolerated a concentration of P. pratense over 50 times higher than baseline, and 56% gave a negative NAPT . SCIT was well tolerated; six mild local reactions occurred, and there were no serious adverse events related to the study medication. Conclusions Subcutaneous immunotherapy with depigmented polymerized allergen extracts is a safe and clinically effective treatment for LAR to P. pratense .
Primary ciliary dyskinesia: keep it on your radar
Authors: Margaret Rosenfeld, Lawrence E Ostrowski, Maimoona A Zariwala
Journal: Thorax (2017)

Primary ciliary dyskinesia (PCD) is a rare disorder of mucociliary clearance resulting in chronic oto-sinopulmonary disease. While the prevalence worldwide is estimated to be 1:10 000–1:15 000, it may be much higher in certain communities, especially where consanguinity is more prevalent. In the British South Asian community, for example, the prevalence has been estimated at 1:2450, similar to that of cystic fibrosis among caucasians.1

In Thorax , Shoemark and colleagues2 describe PCD in a highly consanguineous UK South Asian community, due to homozygous missense variants in CCDC103, usually resulting in the loss of both outer and inner dynein arms. The investigators identified 86 patients of South Asian (primarily Pakistani) descent with clinical signs and symptoms of PCD from the UK National PCD Diagnostic and Management Services. These individuals had a compatible clinical phenotype, but diagnosis was complicated by the fact that many of the standard diagnostic tests for PCD had yielded variable and frequently normal results, including nasal nitric oxide, ciliary beat frequency and ciliary ultrastructure by transmission electron microscopy. Ultimately, next-generation sequencing confirmed a homozygous pathogenic variant, p.His154Pro, in CCDC103 in 16 (19%) of these 86 cases, from 12 independent families.

From a clinical perspective, this report by Shoemark and colleagues2 highlights two important issues in the diagnosis of PCD. The first is that the prevalence of PCD may be higher than previously appreciated in certain populations, particularly in highly consanguineous communities. Indeed, in this report, all 16 patients with homozygous CCDC103 p.His154Pro mutations were children of consanguineous parents. While this UK South Asian PCD cohort was enriched for the CCDC103 p.His154Pro mutation, a number of other PCD-causing mutations were also present, including CCDC40 , DNAAF1 , HEATR2 , LRRC6 , ZMYND10 and RSPH4A . A high prevalence of PCD with genetic heterogeneity has similarly been …
Building on prior knowledge without building it in
Authors: Steven S Hansen, Andrew K Lampinen, Gaurav Suri, James L McClelland
Journal: Behavioral and Brain Sciences (2017)

Abstract Lake et al. propose that people rely on “start-up software,” “causal models,” and “intuitive theories” built using compositional representations to learn new tasks more efficiently than some deep neural network models. We highlight the many drawbacks of a commitment to compositional representations and describe our continuing effort to explore how the ability to build on prior knowledge and to learn new tasks efficiently could arise through learning in deep neural networks.
Ramucirumab in East Asian patients with stage IV non-small cell lung cancer after disease progression on platinum-based therapy: A pooled analysis of two randomized double-blind studies
Authors: J-Y Shih, K. Yoh, Y. Hosomi, G-C Chang, T-C Hsia, T. Tamura, R. Varea, T. Nakamura, J. Gallo, R. Cheng, S. Enatsu, K. Nakagawa
Journal: Annals of Oncology (2017)