tbuckley/cabot-search huggingface dataset:
Early diagnosis and aberrant methylation of NPTX2 gene in pancreatic cancer
Authors: Joo Kyung Park, Ji Kon Ryu, Yong-Tae Kim, Yong Bum Yoon
Journal: Cancer Research (2008)

5514  Background & Aims: The majority of pancreatic cancers are found out to be unresectable and there is only chance to cure in early detection and complete resection. The serum of cancer patients often harbors increased free DNA levels, which can potentially be used for cancer detection. Recently, several genes (including NPTX2) have been discovered to be aberrantly methylated in primary pancreatic cancer tissue. The aim of study was to develop a novel molecular diagnostic approach based on epigenetic characteristics of pancreatic cancer, and to investigate possibility of differential diagnostic method in high risk group of pancreatic cancer such as chronic pancreatitis.  Methods: We enrolled 37 pancreatic cancer patients and 22 benign pancreaticobiliary disease patients as a pilot study to confirm NPTX2 hypermethylation in cancer tissue. Therefore, ERCP guided pancreatic duct brush cytology samples were obtained. After that, we enrolled 106 pancreatic cancers, 60 chronic pancreatitis and 7 benign biliary tract stone disease patients. We collected blood samples before surgery or any kinds of treatment modalities. From each cytology and blood sample, genomic DNA was extracted and NPTX2 CpG island hypermethylation was examined quantitatively by real-time PCR amplification after chemical modification.  Results: There were 106 pancreatic cancers and their AJCC stages were as followed; 5 in stage I, 21in II, 43 in III, 37 in IV. We could see statistically significant higher levels of NPTX2 hypermethylation compared to chronic pancreatitis (p=0.016). From ROC curve, we could get 79% sensitivity and 75% specificity (cut off=0.015). NPTX2 methylation appeared in all stages of pancreatic cancer, but it got significantly higher as AJCC stages progress. This was in contrast to the fact that there were statistically significant higher levels of NPTX2 hypermethylation compared to chronic pancreatitis but there were no significant difference among the stages in cytology samples of pancreatic cancer.Conclusions: The quantitative analysis of NPTX2 hypermethylation revealed that aberrantly hypermethylated NPTX2 gene could be detected from the plasma and cytology samples of pancreatic cancer patients and it was significantly higher levels compared to chronic pancreatitis. Therefore, aberrantly methylated NPTX2 gene may help differentiate from chronic pancreatitis with conventional diagnostic tools and we carefully suggest that it may become a valuable diagnostic marker in the routine workup of suspected pancreatic cancer.
Abstract 19111: XANTHIPPE: Examining the Effect of Ticagrelor on Platelet Activation, Platelet-Leukocyte Aggregates, and Acute Lung Injury in Pneumonia
Authors: Travis R Sexton, Tracy Macaulay, Leigh Ann Callahan, Richard Charnigo, Susan S Smyth
Journal: Circulation (2016)

Introduction: Despite advances in supportive treatment and antibiotic therapy for pneumonia, significant improvement in the early and late mortality have yet to be realized and increased rates of a...
Detecting false-positive disease references in veterinary clinical notes without manual annotations
Authors: Noel Kennedy, Dave C. Brodbelt, David B. Church, Dan G. O’Neill
Journal: npj Digital Medicine (2019)

Clinicians often include references to diseases in clinical notes, which have not been diagnosed in their patients. For some diseases terms, the majority of disease references written in the patient notes may not refer to true disease diagnosis. These references occur because clinicians often use their clinical notes to speculate about disease existence (differential diagnosis) or to state that the disease has been ruled out. To train classifiers for disambiguating disease references, previous researchers built training sets by manually annotating sentences. We show how to create very large training sets without the need for manual annotation. We obtain state-of- the-art classification performance with a bidirectional long short-term memory model trained to distinguish disease references between patients with or without the disease diagnosis in veterinary clinical notes.
The medics guide to work and Electives Around the World
Authors: Ian C Bickle
Journal: BMJ (2001)

The Medic's Guide to Work and Electives Around the World has been put together by an experienced traveller and qualified doctor who is well placed to enlighten us on all the vagaries of a medical elective or work abroad. Mark Wilson has tried to put together a Lonely Planet of medical electives and to a large degree has succeeded.

This plump, yet cheap, book gives a sound grasp of what is …
Blood - An Epic History of Medicine and Commerce
Authors: Alex Brooks
Journal: BMJ (2000)

Blood in its myriad of preparations has become a mainstay of modern medical practice. It is easy to forget that transfusion has been common medical practice only since 1915, when the anticlotting properties of sodium citrate were discovered.

This book traces the history of blood use, from using “gentle calf” blood in France in the 17th century to tame madmen up …
Discomfort of patient power
Authors: D. McQueen
Journal: BMJ (2002)

Editor—Smith in his editorial on the discomfort of patient power says that there is no “truth” defined by experts.1 Coulter reports that doctors and patients are equals with different expertise.2 The government's working group on chronic fatigue syndrome and myalgic encephalomyelitis wove patients' assertions into the scientific research in its report.3

It is absurd to say that there is no truth defined by experts, that patients are equals, or allow patients to define conditions and treatment. Although criticism of medical hubris is important, this is a denial of the nature of medicine. Clinical effectiveness depends on understanding the patient's beliefs and expectations. Patients are, however, not equals, and their beliefs do not have the ontological status of medical knowledge.

Denial of the status of doctors and of medicine's tradition of research is false democracy. It is an attempt to avoid destructive envy. Destructive envy denigrates and spoils that which is needed, biting the hand that feeds us or cutting off one's nose to spite one's face. More than other professional groups, doctors are envied. Partly this derives from the inequality of the relationship between doctors and patients. It can be difficult to tolerate powerlessness, ignorance, dependence, needing help, and being helped. For doctors it is difficult having their attempts to help spoiled by the patient. It is easier to feign uncertainty or powerlessness and comply with patients' demands. But this attempt to avoid envy leads talented doctors to deny their skills, knowledge, and authority. Placatory goodwill abounds but addressing the painful problems of the patient is hindered.4

Often patients come demanding investigations, referrals, or treatments. Acquiescence leads to further demands and feelings of desperation in the doctor. Attendant is the risk of unnecessary, harmful interventions, just to do something.5 One can endlessly improve one's consulting skills or be more patient centred, but the envy doesn't go away. These patients strive to undermine their doctor's skill, knowledge, and concern. This is not restricted to just a minority of manifestly antisocial patients.

Understanding the destructive forces in the doctor-patient relationship is essential. The bland pseudodemocratic niceties in the BMJ are no substitute for understanding the dynamics of the consultation or the legal and social changes affecting the health service, neither do they enable us to work in the best interests of our patients.
Workflow Requirements for Cost-of-Care Conversations in Outpatient Settings Providing Oncology or Primary Care
Authors: Nora B. Henrikson, Matthew P. Banegas, Leah Tuzzio, Catherine Lim, Jennifer L. Schneider, Callie Walsh-Bailey, Aaron Scrol, Stephanie M. Hodge
Journal: Annals of Internal Medicine (2019)

Background: Patients prefer to discuss costs in the clinical setting, but physicians and teams may be unprepared to incorporate cost discussions into existing workflows. Objective: To understand and improve clinical workflows related to cost-of-care conversations. Design: Qualitative human-centered design study. Setting: 2 integrated health systems in the U.S. Pacific Northwest: a system-wide oncology service line and a system-wide primary care service line. Participants: Clinicians, clinical team members, operations staff, and patients. Measurements: Ethnographic observations were made at the integrated health systems, assessing barriers to and facilitators of discussing costs with patients. Three unique patient experiences of having financial concerns addressed in the clinic were designed. These experiences were refined after in-person interviews with patients (n = 20). Data were synthesized into a set of clinical workflow requirements. Results: Most patient cost concerns take 1 of 3 pathways: informing clinical care decision making, planning and budgeting concerns, and addressing immediate financial hardship. Workflow requirements include organizational recognition of the need for clinic-based cost-of-care conversations; access to cost and health plan benefit data to support each conversation pathway; clear team member roles and responsibilities for addressing cost-of-care concerns; a patient experience where cost questions are normal and each patient's preferences and privacy are respected; patients know who to go to with cost questions; patients' concerns are documented to minimize repetition to multiple team members; and patients learn their expected out-of-pocket costs before treatment begins. Limitation: Results may have limited generalizability to other health care settings, and the study did not test the effectiveness of the workflows developed. Conclusion: Clinic-based workflows for cost-of-care conversations that optimize patients' care experience require organizational commitment to addressing cost concerns, clear roles and responsibilities, appropriate and complete data access, and a team-based approach. Primary Funding Source: Robert Wood Johnson Foundation.
Detection of familial hypercholesterolaemia: external validation of the FAMCAT clinical case-finding algorithm to identify patients in primary care
Authors: Stephen Weng, Joe Kai, Ralph Akyea, Nadeem Qureshi
Journal: The Lancet Public Health (2019)

BackgroundThe vast majority of individuals with familial hypercholesterolaemia in the general population remain unidentified worldwide. Recognising patients most likely to have the condition, to enable targeted specialist assessment and treatment, could prevent major coronary morbidity and mortality. We aimed to evaluate a clinical case-finding algorithm, the familial hypercholesterolaemia case ascertainment tool (FAMCAT), and compare it with currently recommended methods for detection of familial hypercholesterolaemia in primary care.MethodsIn this external validation study, FAMCAT regression equations were applied to a retrospective cohort of patients aged 16 years or older with cholesterol assessed, who were randomly selected from 1500 primary care practices across the UK contributing to the QResearch database. In the main analysis, we assessed the ability of FAMCAT to detect familial hypercholesterolaemia (ie, its discrimination) and compared it with that of other established clinical case-finding approaches recommended internationally (Simon Broome, Dutch Lipid Clinic Network, Make Early Diagnosis to Prevent Early Deaths [MEDPED] and cholesterol concentrations higher than the 99th percentile of the general population in the UK). We assessed discrimination by area under the receiver operating curve (AUROC; ranging from 0·5, indicating pure chance, to 1, indicating perfect discrimination). Using a probability threshold of more than 1 in 500 (prevalence of familial hypercholesterolaemia), we also assessed sensitivity, specificity, positive predictive values, and negative predictive values in the main analysis.FindingsA sample of 750 000 patients who registered in 1500 UK primary care practices that contribute anonymised data to the QResearch database between Jan 1, 1999, and Sept 1, 2017, was randomly selected, of which 747 000 patients were assessed. FAMCAT showed a high degree of discrimination (AUROC 0·832, 95% CI 0·820–0·845), which was higher than that of Simon Broome criteria (0·694, 0·681–0·703), Dutch Lipid Clinic Network criteria (0·724, 0·710–0·738), MEDPED criteria (0·624, 0·609–0·638), and screening cholesterol concentrations higher than the 99th percentile (0·581, 0·570–0·591). Using a 1 in 500 probability threshold, FAMCAT achieved a sensitivity of 84% (1028 predicted vs 1219 observed cases) and specificity of 60% (443 949 predicted vs 745 781 observed non-cases), with a corresponding positive predictive value of 0·84% and a negative predictive value of 99·2%.InterpretationFAMCAT identifies familial hypercholesterolaemia with greater accuracy than currently recommended approaches and could be considered for clinical case finding of patients with the highest likelihood of having hypercholesterolaemia in primary care.FundingUK National Institute for Health Research School for Primary Care Research.
Achievement of Normal Circulating Factor VIII Activity Following Bmn 270 AAV5-FVIII Gene Transfer: Interim, Long-Term Efficacy and Safety Results from a Phase 1/2 Study in Patients with Severe Hemophilia a
Authors: K. John Pasi, Savita Rangarajan, Benjamin Kim, Will Lester, David Perry, Bella Madan, Fatemeh Tavakkoli, Ke Yang, Glenn F. Pierce, Wing Yen Wong
Journal: Blood (2017)
MAN 120000 BC to Present Day
Authors: Clare Hughes
Journal: BMJ (2003)

Question: how do you get a man to take his health seriously? Answer: liken his body to a car and get him to read the Haynes Owners Workshop Manual .

For 40 years the Haynes Publishing Group has produced manuals about car and motorcycle repair. The step by step instructions and jargon-free information in Haynes manuals has made them iconic to British men. The Mens Health Forum, which helped to produce the book, …
St Thomas's battle over land earmarked for teaching
Authors: Helen Barratt
Journal: BMJ (2002)

Plans by the United Kingdom's largest teaching hospital to expand its central London site have been threatened by a controversial rival bid. The Aga Khan has offered £24m ($35m; €39m) for the land adjacent to St Thomas's Hospital—twice the previously valued cost—to develop an Islamic cultural centre.



Prince Aga Khan with his wife, Princess Gabriele zu Leiningen



The billionaire spiritual leader of around 20 million Ismaili Muslims wants to build the biggest Islamic museum and cultural centre in …
Pancoast's apical bronchial carcinoma
Authors: Ian C Bickle, Barry Kelly
Journal: BMJ (2002)

This 72 year old retired engineer, a former smoker, presented to his GP complaining of a recent onset cough, productive of sputum and containing “spots” of fresh blood. He also said that he had recently been more breathless than normal on walking to collect his morning newspaper.

On examination the left apex was dull to percussion and there were increased breath sounds over this area. There was also a reduction in chest expansion on the left side. His left eyelid was slightly droopy and the pupil seemed smaller on that side.



Lateral chest radiograph



1.  What preliminary investigations would you request given the above clinical features?
        The posterod …
Association Between Microscopic Lesions at Ileal Resection Margin and Recurrence After Surgery in Patients With Crohn’s Disease
Authors: Nassim Hammoudi, Dominique Cazals-Hatem, Claire Auzolle, Charlotte Gardair, Marjolaine Ngollo, Hugo Bottois, Stéphane Nancey, Benjamin Pariente, Anthony Buisson, Xavier Treton, Mathurin Fumery, Madeleine Bezault, Philippe Seksik, Lionel Le Bourhis, Jean-François Flejou, Matthieu Allez, Pierre Cattan, Mircea Chirica, Nicolas Munoz-Bongrand, Hélène Corte, Nathan Beaupel, Jonathan Catry, Jean-Marc Gornet, Clotilde Baudry, Nelson Lourenco, Mariane Maillet, My-Linh Tran-Minh, Victor Chardiny, Céline Grand, Brice Gergaud, Joelle Bonnet, Leila Chedouba, Andrée Nisard, Laurent Beaugerie, Harry Sokol, Anne Bourrier, Isabelle Nion-Larmurier, Julien Kirchgesner, Elodie Quevrain, Loic Brot, Najim Chafai, Jeremie H. Lefevre, Emmanuel Tiret, Magali Svrcek, Nathalie Guedj, Yves Panis, Leon Magiorri, Marianne Ferron, Yoram Bouhnik, Olivier Corcos, Carmen Stefanescu, Philippe Marteau, Xavier Dray, Ulrika Chaput, Rachid Kaci, Anne Dubois, Gilles Bommelaer, Marion Goutte, Nicolas Barnich, Dilek Coban, Catherine Godfraind, Juliette Joubert Zakeyh, Pierre Desreumaux, Maria Nachury, Coralie Sommeville, Florence Renaud, Jean-Louis Dupas, Julien Loreau, Franck Brazier, Denis Chatelain, Christophe Attencourt, Charles Sabbagh, Martine Leconte, Gilles Boschetti, Bernard Flourié, Yves François, Eddy Cotte, Anne-Laure Charlois, Peggy Falgon, Helena Hadjisavvas, Driffa Moussata, Marion Chauvenet, Sarah Boyer, Alexandra Traverse-Glehen, Xavier Hebuterne, Jérome Filippi, Paul Hofmann, Amine Rahili, Stéphanie Patouraux, Xavier Jouven
Journal: Clinical Gastroenterology and Hepatology (2019)
The Role of Upfront Hematopoietic Stem Cell Transplantation (HSCT) in Peripheral T-Cell Lymphoma (PTCL) Patients in Complete Remission (CR) with a Special Focus on Nodal PTCL: Report from the Comprehensive Oncology Measures for Peripheral T-Cell Lymphoma Treatment (COMPLETE), a Prospective Multicenter Cohort Study
Authors: Steven I Park, Steven M. Horwitz, Francine M Foss, Lauren C. Pinter-Brown, Kenneth R. Carson, Steven T. Rosen, Barbara Pro, Eric D. Hsi, Massimo Federico, Christian Gisselbrecht, Marc Schwartz, Lisa A Bellm, Mark Acosta, Ranjana H. Advani, Tatyana A Feldman, Mary Jo Lechowicz, Sonali M. Smith, Frederick Lansigan, Anil Tulpule, Michael Craig, John P. Greer, Brad S Kahl, Joseph W Leach, Neil Morganstein, Carla Casulo, Andrei R. Shustov
Journal: Blood (2017)
The Prognostic Significance of Minimal Residual Disease Detection after Induction and ASCT to the Patients with Multiple Myeloma
Authors: Weiqin Yao, Zhu Mingqing, Yao Feirong, Lingzhi Yan, Song Jin, Jingjing Shang, Ying Yao, Shuang Yan, Depei Wu, ChengCheng Fu
Journal: Blood (2018)
Periportal SRY (Sex Determining Region Y)‐Box 9‐Positive Hepatocytes: Progenitors With a Biliary Leaning
Authors: Malcolm R. Alison, Wey‐Ran Lin
Journal: Hepatology (2019)

Alison, Malcolm R. Ph.D., D.Sc., F.R.C.Path.; Lin, Wey‐Ran M.D., Ph.D.Editor(s): Corey, Kathleen E.3; Malhi, Harmeet4 Author Information
Abstract 14827: Nitric Oxide During Cardiopulmonary Bypass Improves Clinical Outcome: A Blinded, Randomized Controlled Trial
Authors: Christopher S James, Stephen Horton, Christian Brizard, Charlotte Molesworth, Johnny Millar, Warwick Butt
Journal: Circulation (2015)

Background: Children requiring cardiac surgery with cardiopulmonary bypass (CPB) frequently develop Low Cardiac Output Syndrome (LCOS), particularly when very young, A pilot study of 16 children by Checchia et al. (2013) showed that the delivery of nitric oxide (NO) to the CPB circuit shortened duration of mechanical ventilation and ICU stay. We hypothesized that administering NO to oxygenator gas flow during CPB would decrease the incidence of LCOS and effect subsequent clinical outcomes. Methods: We conducted a prospective, blinded, randomized controlled trial in children with congenital heart disease having surgery with CPB. Randomization was stratified by age and ‘blocked’ at six in each group. Children received oxygen alone or 20 ppm gaseous NO and oxygen to the CPB gas administration line. Only the study perfusionist was aware of the allocation and all equipment and devices were otherwise identical in each group; in particular the cardiac surgeon and anesthetist remained blinded to patient allocation. Results: 198 children were enrolled following written consent. There were no differences in patient characteristics, diagnoses or surgeries between groups. 101 children received NO and had a significant reduction in LCOS (14% vs 31%, p=0.004), use of ECMO (1% vs 8%, p=0.014) and a non-significant reduction in ICU length of stay (48hrs vs 72hrs, p=0.111), compared to the 97 children who did not receive NO. The reduction in LCOS was most pronounced in children less than 6 weeks of age (20% vs 52%, p=0.012) and in those aged 6 weeks to 2 years (6% vs 24%, p=0.026), who also had significantly reduced ICU length of stay (43hrs vs 84hrs, p=0.031). LCOS occurred equally between groups in children greater than 2 years of age (17% vs 21%, p=0.678). There was no difference in the amount of post-operative bleeding in any age group. Children greater than 2 years of age who received NO required fewer blood transfusions (8.3% vs 24.1%, p=0.096). Conclusions: Delivery of NO to the CPB circuit for children undergoing cardiac surgery significantly reduces the incidence of LCOS, use of ECMO and ICU length of stay by varying degrees, according to age group.
Video Review: The Idiots
Authors: Andrew Papanikitas
Journal: BMJ (2000)

Lars von Trier is the enigmatic director who previously created The Kingdom (parts 1 and 2), a ghost story cum soap opera set in a bleak Scandinavian hospital. His latest offering, now out to rent, is in a slightly different vein. It still pokes fun at last century's ideas of health and disease, but rather than satirise the ER genre, The Idiots focuses on the …
Career focus: Generic careers for graduates
Authors: Wai-Ching Leung
Journal: BMJ (2000)

Generic careers for graduates Half of all careers for graduates are for graduates from any discipline, which includes medicine. Wai-Ching Leung considers the place of medical graduates in the wider world of work The nature of work has changed considerably and will continue to do so, but not all of these changes are reflect- ed in conventional medical careers. Employers outside the NHS now perceive the value of a medical degree and doctors' experience differently than they did previously. Doctors contemplating careers outside medicine need to take into account these factors that shape the future of work as they decide whether to embark on alternative careers and as they market themselves to prospective employers.

The main driving force is “economic globalisation.” Globalisation is defined as the accelerated flow of labour, capital, goods, and services between countries because of improvements in transport and communication and deregulation policies adopted in many countries.1 Countries compete for capital investment from the major world corporations.2 In order to attract that investment, it is necessary to have a flexible work- force with high levels of skill and a commitment to “lifelong learning” and training.3

To create a highly skilled workforce, higher education has expanded considerably in the past few decades and further expansion has been planned.4 The proportion of school leavers entering higher education has increased from a 10th in 1962 to a third currently. Since 1997, there have been over 250 000 graduates of first degrees and over 110 000 students completing postgraduate courses each year5 Of all first degrees conferred, 8% were first class honours and 42% were upper seconds, and 54% of first degree graduates were women. To create a flexible workforce to enable business to compete internationally, the government has gradually …
VIP Interneurons Contribute to Avoidance Behavior by Regulating Information Flow across Hippocampal-Prefrontal Networks
Authors: Anthony T. Lee, Margaret M. Cunniff, Jermyn Z. See, Scott A. Wilke, Francisco J. Luongo, Ian T. Ellwood, Srimadh Ponnavolu, Vikaas S. Sohal
Journal: Neuron (2019)