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Non-Compliance with endoscopy appointments places a major burden on the healthcare system and can lead to delay in the diagnosis and treatment of potentially life-threatening conditions. Although several studies have investigated causes, trends, and interventions to improve compliance with endoscopy appointments, we present a comprehensive, high-quality, and focused literature review on this important topic. A search of the PubMed database revealed 72 papers that were screened for eligibility according to their title and text; among these 72, a total of 42 papers are focused on non-compliance with endoscopy, and 12 investigated ways to improve compliance. The average non-compliance rate for endoscopy was found 22.25%. Patients’ age (younger than 60-year-old), low socioeconomic status, history of healthcare visits non-adherence, medical history, and season/month of the appointment all contribute to non-compliance with endoscopy appointments. On the other hand, decreasing scheduling lead time and some specific modes of appointment confirmations could improve appointment-keeping behavior.

The date traditionally accepted for the death of the Younger Pliny is far from being sufficiently proven and answers to deductions done from the form of the imperial titulature of the inscription that contains a part of the testament of the writer. There adds the fact of the apparent silence of his correspondence during the last part of his government in Bithynia. These facts that seem to be coherent between them cannot be, in our opinion, considered as an irrefutable test, since they can have be caused by other factors, and Pliny’s death probably should be placed in a slightly later moment., La fecha tradicionalmente aceptada para la muerte de Plinio el Joven dista mucho de estar suficientemente probada y responde a deducciones hechas a partir del formulario de la titulación imperial de la inscripción que contiene una parte del testamento del escritor. Se suma a ello el aparente silencio de su correspondencia durante la última parte de su gobierno en Bithynia. Estos hechos, que pueden parecer coherentes entre sí, no pueden ser, en nuestra opinión, considerados como una prueba irrefutable, ya que pueden haber sido causados por otros factores, y dicha muerte quizás debería de situarse en un momento algo posterior.

Thanks to a new reading of the text, the passage from Pliny the Elder (Nat. XXIX 7-8) confirms some data about the physician of the emperor Claudius Stertinius Xenophon which so far has been only object of conjectures.

edited by Gerard P. Luttikhuizen. Leiden: Brill, 2000. 214 pp. $76.00. This book is a collection of twelve fascinating articles related to the biblical accounts of the creation of humankind in Gen. 1-3, all expanded from papers originally presented at the June 1999 conference of the "Jewish and Christian Traditions" research group of the Faculty of Theology and Religious Studies at the University of Groningen in the Netherlands. The first chapter, "The Creation of Man and Woman in Biblical and Ancient Near Eastern Traditions," by Ed Noort, attempts to determine the original and abiding messages of Gen. 1:27 and Gen. 2:7, 18-24 concerning the relative place of the two human sexes in the divine economy. Noort's exegesis rests upon two of the pillars of the modern academic study of Hebrew Scripture. These are 1) the documentary hypothesis, which treats Gen. 1:1-2:4a and Gen. 2:4b-3:24, respectively, as two separate narratives produced by distinct authors at different times; and 2) the utilization of ancient Near Eastern texts to shed light upon the Bible. Noort shows that the documentary hypothesis provides cogent answers to many of the exegetical questions raised by Philo Judaeus in first-century C.E. Alexandria and by the Talmudic sages of the early centuries C.E. Taking for granted that the Priestly narrative contained in Gen. 1:1-2:4a was composed in an Achaemenid period urban society, Noort argues that Gen. 1:27 teaches that "the separation [of humankind] in male and female belongs to creation from the beginning. There is no priority. Neither male nor female have a dominant position." Noort accepts the dominant view in contemporary biblical research that the second biblical creation story contained in Gen. 2:4b-3:24 originates in the agricultural society of Ancient Israel [i.e., Iron Age II; 9th to 6th centuries B.C.E.] (cf. p. 11). This "Yahwist Account" teaches that "Woman belongs to the same `material' as man does; from their very origins they are an unseparable union" (p. 12). Moreover, Gen. 2:18 teaches that man is "the perfect counterpart to" man "and vice versa" (p. 13). Like Noort's article, the second chapter, "Pandora or the Creation of a Greek Eve," written by Jay N. Bremmer, proves indispensable for reading the subsequent articles. Bremmer introduces the reader to the legacy of Hellenic speculation, which, alongside of Hebrew Scripture, formed the common cultural legacy of ancient Christians, Jews, and Gnostics, whose exegeses of Gen. 1:27 and Gen. 2:7, 18-24 are the agenda of Chapters Three through Nine. The third article, "The Creation of Man and Woman in Early Jewish Literature," by J. T. A. G. M. van Rutten, discusses the exegeses of Gen. 1-3 reflected in several corpora of Second Temple period Jewish sacred literature. Van Rutten employs tables to clarify comparisons and contrasts between various Second Temple writings and Hebrew Scripture. The fourth chapter, "Endowed with Reason or Glued to the Senses: Philo's Thoughts on Adam and Eve," by Annewies van den Hoek, analyzes both the sources of Philo's theories and the influences of Philo upon Patristic thought. Because Philo's corpus is not canonical for either Judaism or Christianity as is Gen. 1-3 for both Judaism and Christianity and as are 1 Cor. 11:2-16 and 1 Tim. 2:8-15 for Christianity, van den Hoek can be completely objective in delineating both egalitarian and misogynist tendencies within the Philonic corpus. L. J. Lietaert Peerbolte, on the other hand, in "Man, Woman and the Angels in 1 Cor. 11:2-16," the fifth chapter of the volume, seeks to reconcile the latter texts' apparent justification of the subordination of women to men with Gal. 3:28 in which Paul asserts, "There is no longer Jew or Greek, there is no longer slave or free, there is no longer male and female in Christ Jesus." Peerbolte explains, therefore, that the real reason why women must cover their heads in church is to prevent angels from lusting after them. After all, it was the lusting of the angels after mortal women, described in Gen. …

Read in the light of the best selling books by John Gray and Deborah Tannen concerning communication between the sexes, three ancient tests—two from Hebrew Scripture and one from ancient Iraq—teach primarily by illustration how not to dialogue with one's spouse, one's friend, or one's boss. Rereading these ancient texts in the light of what John Gray Men are From Mars, Women are From Venus [New York: Harper Collins, 1992] calls “advanced relationship skills” reveals vital lessons, which can be applied to improve the quality of life at home, in the workplace, and God help us, in the house of mourning.

Judaism and Disability: Portrayals in Ancient Texts from the Tanach through the BavliIn this book Judith K. Abrams presents scholar and layperson alike with a masterful study of the treatment of the physically and cognitively challenged in the authoritative sacred texts of Israel from the Iron Age through the Babylonian Talmud circa 500 C.E. (her date, which follows the traditional date given by Sherira, head of the academy of Pumbeditha [c. 970-1000 C.E.]). She exhibits total mastery of the relevant passages in Hebrew Scripture, the Dead Sea Scrolls, Mishnah, Tosefta, the Talmuds and Rabbinic midrash. She makes creative use of the work of the important pathfinders in 1) twentieth century Jewish biblical studies (Haran, Kaufman, Knohl, Milgrom, Weinfeld); 2) the contemporary scientific study of rabbinic literature (Halivni, Jaffee, Kraemer, Neusner); and 3) the post-modern study of the body in Judaism (Boyarin, Eillberg-Schwartz). Abrams is equally at home in the history of medicine and in anthropology and sociology. The depth and breadth of Rabbi Dr. Abrams' knowledge is a tribute not only to the author of Judaism and Disability but also to her mentors at Hebrew Union College, where she earned her rabbinic ordination and at Baltimore Hebrew University where she earned her Ph.D.A generation ago Rabbi Douglas Goldhamer, spiritual leader of the Jewish congregation for the deaf in Greater Chicago (Bene Sholom), reported to the Chicago Board of Rabbis the grave difficulty that deaf Jews had in receiving a fair hearing within the Jewish community. Wrongly assuming that every deaf person should be defined as cheresh (deaf and dumb; consequently in a subcategory of shoteh [imbecile]), rabbis and congregations refused to provide prayer groups of deaf Jews with Torah scrolls and other necessary appurtenances of public worship. Finding that the Jewish community turned a deaf ear to their pleadings, hearing-impaired Jews often fled to the welcoming arms of Christian churches.In a feature article concerning the treatment of the handicapped in the State of Israel in the Hebrew daily newspaper Ma'ariv (February 10, 2000) Tall Barzilai Sonenfeld writes: "Israel is insensitive to the physically handicapped; it does not see the blind, nor does it hear the deaf." Consequently, she explains, elevators in public buildings lack buttons with captions in Braille for the blind; many government buildings provide no wheelchair access, and few ATMs are situated low enough to be operated from a wheelchair. Moreover, she reports, the head of one supermarket chain asked Ms. Sonenfeld please not to report that the chain would, if asked, help handicapped customers carry their purchases to their vehicles: "We do not want the handicapped taking advantage of us."Rabbi Dr. Judith Z. Abrams shows that the basic sacred texts of Judaism -- Hebrew Scripture, Mishnah, Tosefta, the two Talmuds, and the vast midrashic literature produced in Byzantine-age Palestine -- constitute a treasure-trove of insights as to how the physically and cognitively unchallenged can learn to treat as peers the blind, the lame, the deaf, as well as the cognitively challenged.The author explains that the priestly heritage of Judaism exemplified by Lev. …

By bringing to bear upon the discussion of two ancient Semitic verbs meaning "to fear"-Hebrew yr' and Akkadian paldbuthe findings of the modern study of the emotions, it is possible to propose a plausible answer to the theological dilemma as to why the Hebrew Bible should employ as a term for religiosity a term which "regularly describes emotions of dread and fright". Moreover, the light shed on Hebrew yr' and Akkadian palahu will, in turn, elucidate the nuances of the verb stc (ttc) in Ugaritic, Phoenician, Ammonite, and Biblical Hebrew (see below). The Hebrew verb yr', which is commonly rendered "to fear", may refer either to virtuous feelings and behavior,2 which are prescribed,3 or to non-virtuous feelings and behavior, which are pro

Four patients with proven ovarian cancer were found to have single lesions in the liver parenchyma after completing chemotherapy. They otherwise appeared to be in complete clinical remission. Percutaneous needle biopsy was sometimes misleading and dangerous. Laparoscopy and laparotomy were required for optimum safe diagnosis, staging, and treatment. Definitive resection appeared to be beneficial but usually only as a palliative form of debulking. Subsequent adjuvant combination chemotherapy may sometimes improve the duration of useful remissions. Unusual sites of metastatic ovarian cancer appear to be increasing in frequency. Successful management of late recurrences in the liver is possible, provided the diagnosis is immediately suspected and one utilizes both definitive surgery and chemotherapy.

Hexamethylmelamine, mitomycin C and 5-fluorouracil infusion (HexMF) achieved a median survival of 9 months for the 45 patients with either metastatic stage III or unresectable stage II carcinoma of the pancreas. Fifteen percent survived 2 years. Of 32 patients with measurable tumors, 7 had partial and 3 had minor responses (31%); an additional 44% has stable disease for 3 months or more. Response was associated with a 17-month median survival. These findings are indications for further evaluation of both dosage-intensive 5-fluorouracil infusions alone and HexMF as an alternative to streptozotocin- or adriamycin-containing regimens. Patients with nonmeasurable disease are candidates for survival-oriented phase III studies.

We assessed the structure–function relationship of the human cholinergic system and hypothesized that structural measures are associated with short-latency sensory afferent inhibition (SAI), an electrophysiological measure of central cholinergic signal transmission. Healthy volunteers (n = 36) and patients with mild cognitive impairment (MCI, n = 20) underwent median nerve SAI and 3T structural MRI to determine the volume of the basal forebrain and the thalamus. Patients with MCI had smaller basal forebrain (p p 10% SAI) had more basal forebrain volume than non-responders (p = 0.004) or patients with MCI (p r = 0.33, p

BACKGROUND: HER2-positive (+) breast cancers, defined by HER2 overexpression and/or amplification, are often addicted to HER2 to maintain their malignant phenotype. Yet, some HER2+ tumors do not benefit from anti-HER2 therapy. We hypothesize that HER2 amplification levels and PI3K pathway activation are key determinants of response to HER2-targeted treatments without chemotherapy. PATIENTS AND METHODS: Baseline HER2+ tumors from patients treated with neoadjuvant lapatinib plus trastuzumab [with endocrine therapy for estrogen receptor (ER)+ tumors] in TBCRC006 (NCT00548184) were evaluated in a central laboratory for HER2 amplification by fluorescence in situ hybridization (FISH) (n = 56). HER2 copy number (CN) and FISH ratios, and PI3K pathway status, defined by PIK3CA mutations or PTEN levels by immunohistochemistry were available for 41 tumors. Results were correlated with pathologic complete response (pCR; no residual invasive tumor in breast). RESULTS: Thirteen of the 56 patients (23%) achieved pCR. None of the 11 patients with HER2 ratio

Aberrant activation of the PI3K pathway has been implicated in resistance to HER2-targeted therapy, but results of clinical trials are confounded by the co-administration of chemotherapy. We investigated the effect of perturbations of this pathway in breast cancers from patients treated with neoadjuvant anti-HER2-targeted therapy without chemotherapy. Baseline tumor samples from patients with HER2-positive breast cancer enrolled in TBCRC006 (NCT00548184), a 12-week neoadjuvant clinical trial with lapatinib plus trastuzumab [plus endocrine therapy for estrogen receptor (ER)-positive tumors], were assessed for PTEN status by immunohistochemistry and PIK3CA mutations by sequencing. Results were correlated with pathologic complete response (pCR). Of 64 evaluable patients, PTEN immunohistochemistry and PIK3CA mutation analysis were performed for 59 and 46 patients, respectively. PTEN status (dichotomized by H-score median) was correlated with pCR (32% in high PTEN vs. 9% in low PTEN, p = 0.04). PIK3CA mutations were identified in 14/46 tumors at baseline (30%) and did not correlate with ER or PTEN status. One patient whose tumor harbored a PIK3CA mutation achieved pCR (p = 0.14). When considered together (43 cases), 1/25 cases (4%) with a PIK3CA mutation and/or low PTEN expression levels had a pCR compared to 7/18 cases (39%) with wild-type PI3KCA and high PTEN expression levels (p = 0.006). PI3K pathway activation is associated with resistance to lapatinib and trastuzumab in breast cancers, without chemotherapy. Further studies are warranted to investigate how to use these biomarkers to identify upfront patients who may respond to anti-HER2 alone, without chemotherapy.

Clinical trials have demonstrated the efficacy of combining phosphoinositide 3-kinase (PI3K) inhibitors with endocrine therapies in hormone therapy-refractory breast cancer. However, biomarkers of PI3K pathway dependence in ER+ breast cancer have not been fully established. Hotspot mutations in the alpha isoform of PI3K (PIK3CA) are frequent in ER+ disease and may identify tumors that respond to PI3K inhibitors. It is unclear whether PIK3CA mutations are the only biomarker to suggest pathway dependence and response to therapy. We performed correlative molecular characterization of primary and metastatic tissue from patients enrolled in a phase Ib study combining buparlisib (NVP-BKM-120), a pan-PI3K inhibitor, with letrozole in ER+, human epidermal growth factor-2 (HER2)-negative, metastatic breast cancer. Activating mutations in PIK3CA and inactivating MAP3K1 mutations marked tumors from patients with clinical benefit (≥6 months of stable disease). Patients harboring mutations in both genes exhibited the greatest likelihood of clinical benefit. In ER+ breast cancer cell lines, siRNA-mediated knockdown of MAP3K1 did not affect the response to buparlisib. In a subset of patients treated with buparlisib or the PI3Kα inhibitor alpelisib each with letrozole where PAM50 analysis was performed, nearly all tumors from patients with clinical benefit had a luminal A subtype. Mutations in MAP3K1 in ER+ breast cancer may be associated with clinical benefit from combined inhibition of PI3K and ER, but we could not ascribe direct biological function therein, suggesting they may be a surrogate for luminal A status. We posit that luminal A tumors may be a target population for this therapeutic combination.