tbuckley/cabot-search huggingface dataset:
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Authors: Jamuna Karkhanis, Elizabeth C. Verna, Matthew S. Chang, Todd R. Stravitz, Michael L. Schilsky, William M. Lee, Robert S. Brown
Journal: Hepatology (2014)

We thank Fujiwara et al. for their comments on our study "Steroid use in acute liver failure."1 They note that corticosteroids (CS) may be helpful when used early in acute liver failure (ALF) while the transaminases are high and bilirubin level is low. This is usually preceding the development of encephalopathy and thus does not represent true ALF. In their study,2 only a small number of patients (13 of the 31) met standard criteria for ALF (international normalized ratio >1.5 and encephalopathy). Additionally, their study focused entirely on viral hepatitis, many of whom may have derived benefit from antiviral therapy, rather than CS, whereas our study looked solely at autoimmune, drug-induced, and indeterminate ALF with no patients with viral hepatitis being included. Our study had 361 patients, which allowed for more statistically significant results. In the study referred to by Fujiwara et al., there was no survival benefit, only a lowering of transaminase values. We did show a benefit in spontaneous survival with steroid use in patients with higher levels of alanine aminotransferase (ALT), which does parallel their experience. Unfortunately, with a large, multicenter cohort study designed to investigate ALF, we could not control for the timing, dose, or duration of steroids nor could we systematically study early steroid administration. Our findings across all subgroups suggest that there is no survival benefit with steroid use, once patients have progressed to encephalopathy and liver failure. Whether earlier steroid use provides benefit in those with high ALT levels deserves further study. Overall, the risks and benefits of CS administration should be carefully weighed and early discontinuation considered, as Dr. Fujiwara also notes, in the absence of a clear beneficial effect, particularly in high Model for End-Stage Liver Disease patients. Jamuna Karkhanis, M.D.1 Elizabeth C. Verna, M.D., M.S.1 Matthew S. Chang, M.D.1 R. Todd Stravitz, M.D.2 Michael L. Schilsky, M.D.3 William M. Lee, M.D.4 Robert S. Brown, Jr., M.D., M.P.H.1 1Department of Medicine Columbia University College of Physicians & Surgeons New York, NY 2Section of Hepatology Virginia Commonwealth University Richmond, VA 3Division of Digestive Diseases and Section of Immunology and Transplantation Department of Medicine and Surgery Yale University School of Medicine New Haven, CT 4Division of Digestive and Liver Diseases Department of Internal Medicine University of Texas Southwestern Medical Center Dallas, TX
Food Allergies
Authors: Huan J. Chang
Journal: JAMA (2010)

Food AllergiesA food allergy is an adverse immune response to a food.Your immune system makes antibodies to protect you from germs and disease, but it may also sometimes make antibodies to certain food proteins.Some of these antibodies (called IgE) are known to be associated with allergic reactions.When that happens, your immune system treats the food as if it were a harmful substance, resulting in an allergic reaction.The proportion of people with food allergies is not known with precision because of differing definitions, but it is between 2% and 10% and is more common in children than adults.The May 12, 2010, issue of JAMA includes a review article about food allergies.
T-cell receptor tau delta +/CD3+4-8-T- cell acute lymphoblastic leukemias: a distinct subgroup of leukemias in children. A report of five cases
Authors: GC Alfsen, K Beiske, H Holte, E Hovig, A Deggerdal, I Sandlie, E Widing, S Slordahl, LK Klepper, W Sizoo
Journal: Blood (1991)
CK- and small nuclear size circulating tumor cell (CTCs) phenotypes in metastatic castration-resistant prostate cancer (mCRPC).
Authors: Roberta Ferraldeschi, Andrew McDaniel, Rachel Krupa, Jessica Louw, Eric Tucker, Natalee Bales, Dena Marrinucci, Ruth Riisnaes, Joaquin Mateo, Ryan Dittamore, Johann Sebastian De Bono, Scott A. Tomlins, Gerhardt Attard
Journal: Journal of Clinical Oncology (2014)

209 Background: Circulating tumor cell (CTCs) are traditionally defined as EpCAM/CK+ cells, CD45-, and morphologically distinct. However, recent evidence suggests that other populations of CTC candidates exist including cells that are EpCAM/CK- or smaller in size than traditional CTCs. CTC positive selection techniques that isolate CTCs based on size, density, or EpCam positivity may miss subpopulations. We aimed to molecularly characterize novel CTC candidates utilizing the Epic Sciences platform, which performs no physical selection. Methods: Blood from 10 healthy volunteers (HV) and 39 patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) were collected and shipped to Epic Sciences, where all nucleated cells were plated onto glass slides and subjected to immunofluorescence (IF) staining and CTC identification by fluorescent scanners and algorithms. Traditional CTCs were identified as CK+CD45- cells with intact DAPI nuclei and after pathologist review of their morphology. Candidate CK- CTC populations were identified as CK-CD45- that were morphologically malignant. Small nuclear size candidate CTCs were identified as CK+CD45- cells with diameters similar to or smaller than that of a typical white blood cells (WBCs). All candidate CTC were evaluated with prostate cancer relevant biomarkers, including androgen receptor (AR) by IF and PTEN loss and ERG rearrangements by FISH. Results: Thrity eight out of 39 pts had one or more traditional CTCs/mL and 36 out of 39 pts had one or more CK- CTCs/mL of blood. Eight out of 39 samples had more than 10 CK- CTCs/mL. Fifteen out of 39 samples had evidence of small nuclear size CTCs at varying incidences and sizes of cells. We observed PCa biomarkers including high AR expression, PTEN deletion, and ERG rearrangements in both CK- and small nuclear size CTCs. These features were not observed in over 1,000 WBCs evaluated and HV. Conclusions: Candidate CTC that are CK-CD45- and/or with a small nucleus are identified on the Epic Sciences platform in blood from mCRPC pts. Studies are ongoing to determine their clinical relevance.
THU0591 Comparative Efficacy of Two Exercises Programs in Patients with Early Rheumatoid Arthritis: 6-Month Randomized Controlled Trial: Table 1
Authors: E. Orlova, D. Karateev, L. Denisov, A. Kochetkov, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> The patients with rheumatoid arthritis (RA) are less physically active than the general population [1]. Physical exercises improve muscle strength, range of movements, aerobic capacity and bone density in patients with RA [2–4]. However, some physicians fear to recommend the intensive exercises. <h3>Objectives</h3> To compare the efficacy of two exercise programs in patients with early RA during 6 months. <h3>Methods</h3> 51 patients with early RA (92,2% females, age of 18 to 53 years, disease duration of 2 to 17 months) were randomized into 3 groups. At hospital stage 15 patients underwent 10 high-intensity dynamic exercises using gym apparatus Enraf-Nonius for 45–60 min, including aerobic part (En-Cardio) and 18–20 muscle-strengthening exercises (En-Dynamic Track), 18 patients – 10 therapeutic exercises for joints for 45 min under the supervision of a trainer. At outpatient stage the exercises lasted for 6 months 3 times a week. 18 patients received only drug therapy (control). Tender and swollen joint count, pain on 100-mm VAS, erythrocyte sedimentation rate (ESR), DAS28, HAQ, RAPID3, the average powers of knee extension and ankle flexion by EN-TreeM movement analysis were evaluated at baseline and at 6 months. <h3>Results</h3> After 6 months in the both exercise groups there were statistically significant differences from the control group in most parameters (p&lt;0,05). Efficacy of the intensive gym exercises was higher than the therapeutic exercises by tender joint count, HAQ, RAPID3 (p&lt;0,05). Adherence to the regular therapeutic exercises for 6 months was better (77,8%) then to the gym exercises (60,0%). Predictors of the regular high-intensity gym exercises were the young age (under 40 years) and the very early stage of RA. Most patients, who regularly did exercises, had DAS28 low disease activity (66,7% in the gym group and 57,1% in the therapeutic exercises group vs 36,7% in the control group, p&lt;0,05). <h3>Conclusions</h3> The both 6-month exercise programs reduce pain, increase functional status, quality of life and power of motion without detrimental effect on disease activity. <h3>References</h3> van den Berg M.H. et al. J Clin Rheumatol 2007;13(4):181–6. Hurkmans E. et al. Cochrane Database Syst Rev 2009;4:CD006853. De Jong Z. et al. Clin Rheumatol 2009;28(6):663–71. Baillet A. et al. Arthritis Care Res 2010;62:984–92. <h3>Disclosure of Interest</h3> None declared
AB0498 A True to Life Study on Effects of Switching from Oral to Subcutaneous Methotrexate
Authors: L. Dolan, A. Joshi
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Subcutaneous methotrexate has been shown to be more efficacious than oral methotrexate in the treatment of rheumatoid arthritis. However, there has been no reported difference in tolerability<sup>1</sup>. <h3>Objectives</h3> Our study aimed to determine whether subcutaneous methotrexate had a better side effect profile and what effect it had upon disease control. <h3>Methods</h3> We performed a retrospective observational study in our district general hospital. Thirty two patients with rheumatoid arthritis (21 seropositive and 11 seronegative) had switched from oral to subcutaneous Methotrexate between January 2013 and June 2014. <h3>Results</h3> Of the 32 patients, 11 switched from oral to subcutaneous methotrexate due to intolerable side effects (mainly nausea, diarrhoea and mouth ulcers). Of these 11 patients, 7 patients (63.6%) had complete resolution of side effects but 4 patients (36.4%) suffered persistent nausea requiring a change in treatment. Disease control was assessed by DAS28-CRP recorded before and during treatment with subcutaneous methotrexate. Prior to commencing subcutaneous methotrexate the average DAS28-CRP was 4.60 and following treatment commencement this reduced to an average of 4.13. According to EULAR criteria 5 patients (20.8%) obtained a "good response" and 8 (33.3%) a "moderate response" to therapy. Eleven patients were classified as having "no response" to subcutaneous methotrexate and treatment was escalated to biologics in 8 patients. Two out of three patients classified as "no response" met either disease remission criteria or low disease activity criteria as per DAS28-CRP. At present 16 patients (50%) are still maintained on subcutaneous methotrexate and other disease modifying drugs without biologic agents, the mean DAS28-CRP for these patients is 3.29 indicating low disease activity. <h3>Conclusions</h3> In summary, this study has shown that switching from oral to subcutaneous methotrexate can improve disease control and reduce incidence of side effects making medication more tolerable for patients. As a result of this study we propose that an early switch to subcutaneous methotrexate be considered for all patients with suboptimal disease control or intolerable side effects. <h3>References</h3> Braun et al. Comparison of the clinical efficacy and safety of subcutaneous versus oral administration of methotrexate in patients with active rheumatoid arthritis: results of a six-month, multicentre, randomized, double-blind, controlled, phase IV trial. Arthritis Rheumatology 2008; 58(1):73-81. <h3>Disclosure of Interest</h3> None declared
AB1092 Assessing Forefoot Calluses in Rheumatoid Arthritis Using 3D Volume Rendering
Authors: T. Kashiwagura, Y. Kimura, I. Wakabayashi, Y. Ono, S. Miyamoto, K. Nozaka, N. Miyakoshi, Y. Shimada
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Multi-slice computed tomography (CT) is frequently used to assess bone morphology and bone arrangement, among other items. 3D volume rendering (3D-VR) enables three-dimensional rendering of soft tissue such as skin, tendons, and ligaments by arbitrarily changing CT values. <h3>Objectives</h3> Painful calluses often require surgery in cases of forefoot deformation associated with rheumatoid arthritis (RA). Therefore, the relationship between calluses and the bones and joints was investigated in RA patients using 3D-VR. <h3>Methods</h3> A total of 14 feet (2 right and 10 left) was examined in 13 patients (3 men and 10 women). The patients9 mean age at the time of CT scans was 58.0 (36–71) years, and preoperative scans were taken without loading. Volume Analyzer SYNAPSE VINCENT (Fujifilm Holdings Corporation, Tokyo, Japan) was used for 3D-VR reconstructions. CT values were adjusted, and calluses were detected from rendered soft tissue. CT values were then gradually changed, and the relationships between flexor tendons and the bone and joints were examined. <h3>Results</h3> All subjects had plantar calluses on the second and third metatarsophalangeal (MTP) joints. A total of 26 calluses was rendered: on the third MTP joint for 13 feet, on the second MTP joint for 5 feet, on the fifth MTP joint for 3 feet, on the first MTP joint for 2 feet, on the first interphalangeal (IP) joint for 2 feet, and on the fourth MTP joint for 1 foot. All were plantar calluses. Only seven subjects had a fallen horizontal arch at the metatarsal head level, and six subjects had callus formation despite no fallen arch. The path of the flexor tendon ran more to the hallux side of each bone head in 11 cases where the callus was on the third MTP joint and three cases where the callus was on the second MTP joint. In those subjects whose postoperative CT scans could be compared, the path of the flexor tendon had been normalized. <h3>Conclusions</h3> Calluses are thought to form as a result of MTP joint arthritis, which loosens the joint capsules and ligaments, thereby leading to gradual dislocation and pushing down of the metatarsal head toward the plantar side by the proximal phalanx. While the present results were obtained without loading, some subjects had calluses despite having no fallen horizontal arch at the metatarsal head level. These findings suggest that a dynamic element is involved in callus formation. On examining calluses and the path of the flexor tendon, the flexor tendon followed a path that avoided the callus, although this was improved with surgery. 3D-VR is useful in assessing calluses and bone, joints, and tendons. <h3>Acknowledgements</h3> The authors thank Miss Sasaki, for her assistance with this project. <h3>Disclosure of Interest</h3> None declared
The Results of an Internal Pilot for the European Study of Therapeutic Hypothermia (32-35°C) for Intracranical Pressure Reduction After Traumatic Brain Injury (Eurotherma3235trial), ISRCTN 34555414
Authors: P Andrews, H Sinclair, C Battison, K Poldeman, G Citerio, L Mascia
Journal: Intensive Care Medicine (2012)
OC-030 Investigation of faecal volatile organic compounds as biomarkers for the diagnosis of necrotising entercolitis
Authors: A Mayor, N Ellaby, S Reade, R Aggio, R Greenwood, R Jackson, E Simcox, CS Probert, AK Ewer
Journal: Gut (2015)

<h3>Introduction</h3> Necrotising enterocolitis (NEC) is the most common serious gastrointestinal complication of preterm birth. Clinical signs and symptoms are often non-specific and may only become apparent once disease is established. A biomarker to indicate early disease would allow earlier treatment and may improve outcome. We have reported a pilot study showing changes in faecal volatile organic compounds (VOCs) profile in the prodromal period of NEC. Here, we report a much larger series with more comprehensive clinical and laboratory data. <h3>Method</h3> Daily faecal samples were collected prospectively from 1375 apparently healthy preterm babies, born between 23 and 34 weeks gestation, in 8 NICUs over a 2-year period. Over 13,000 samples were catalogued. Samples from 70 healthy preterm babies and 34 preterm babies who developed NEC (Bell’s stage II and III) were analysed. In short, 50–100 mg of faeces underwent headspace gas extraction using solid phase micro-extraction followed by gas chromatography–mass spectrometry using our optimised method. Each NEC patient was matched with 1 to 3 healthy control patients. Samples from NEC patients between 1 to 6 days prior to diagnosis and matched samples from controls were selected. Compounds were identified using an in-house developed pipeline involving the AMDIS software, the NIST database and the R packages Metab and XCMS. Univariate and multivariate analysis were performed on the clinical and VOC data. The features best describing the differences between NEC and control samples were used to build a classifier for the diagnosis of NEC. <h3>Results</h3> Six VOCs and birthweight were significant in multivariable analysis. Birthweight was the strongest predictor. Of the VOCs, 3 were positively associated with NEC and 3 negatively associated. A logistic regression model was developed to diagnose NEC overall, then for each of the 6 days that preceded the clinical diagnosis. Overall the model had an area under the ROC (AUROC) curve of 0.83. When estimated for each day, the AUROC ranged from 0.78 to 0.9. <h3>Conclusion</h3> To the best of our knowledge, this is the first large scale metabolomics study of faecal VOCs aiming at classifying NEC patients. The data indicate the VOCs may be used to predict NEC up to 6 days before the condition is diagnosed using current methods. This may have an important impact on reducing the mortality of this devastating condition. Further investigation of VOCs may also elucidate the pathogenesis of NEC. <h3>Disclosure of interest</h3> None Declared.
Soundings: Symphonic praise
Authors: George Dunea
Journal: BMJ (2006)

Why should any modern doctor still want to read Sir Thomas Browne? He has been dead for over 300 years. He made no medical discoveries. He practised no evidence based medicine, and actually believed in witches, a species now uncommon except in certain households.

His precept (in the book Christian Morals) not to look for whales in the Black Sea—because there are none—could be taken as a warning against making fanciful rare diagnoses because common diseases occur most commonly. “Look not for profundity where there is none,” he writes, “nor place great expectations of happiness here below,” reflecting that “there are many canonized on earth, that shall never be saints in heaven.”

He would also rather “go off at one blow than be sawed in pieces by the grating torture of a disease,” as he has examined the parts of man and knows “on what tender filament that fabrick hangs.” Rather than take good health for granted and complain about being sick, he wonders that “we are not always so; and considering the thousand doors that lead to death, do thank my God that we can die but once.”

As a young medical practitioner in Norwich he seems to have been averse to sexual intimacy, wishing (in Religio Medici) that we could procreate like trees, without conjunction, and “without this trivial and vulgar way of union”—“the foolishest act a wise man commits all his life.” Later he had second thoughts and fathered 10 children.

He was the favourite of Sir William Osler, who kept his book at his bedside and ranked him among “the great saints of humanity,” with whom one should spend the last few minutes of the day. I like best the last chapter of Urn Burial (Hydrothapia), in which he writes that “there is nothing strictly immortal but immortality,” that “there is no antidote against the opium of time,” that most of us must be content to be as though we had not been, “to be found in the Register of God, not in the record of man.” One of his editors compared “the magnificent discourse of the Hydrothapia” with a symphony of Beethoven, “with its vast undulations of rhythmic sound, its triumphal processions, its funeral pageants, its abysmal plunges into unfathomable depths, its ecstatic soarings to the heights of heaven.”
Referrals from a psychiatric emergency room: relationship of compliance to demographic and interview variables
Authors: M Jellinek
Journal: American Journal of Psychiatry (1978)

In a sample of 89 patients referred from a psychiatric service emergency room, the author investigated variables related to completion and noncompletion of the physician's recommendation. The completers (58%) tended to be older and more educated, to be diagnosed as depressed, and to demonstrate congruence in terms of their request and their perception of the physician's goal. Implications for referral include ensuring that the interview with the patient includes a communication, empathy, and mutual influence. Using the negotiated approach and criteria derived during the clinical interview, certain patients can be identified as being "at risk" for noncompletion and as requiring special efforts.
Norepinephrine and 3-methoxy-4-hydroxyphenyl glycol gradients in human cerebrospinal fluid
Authors: M G Ziegler, J H Wood, R Lake, I J Kopin
Journal: American Journal of Psychiatry (1977)

The presence of abnormal levels of 3-methoxy-4-hydroxyphenyl glycol (MHPG) in the cerebrospinal fluid (CSF) of some patients with affective disorders may indicate abnormal norepinephrine metabolism in these patients. The authors evaluated the relationship between norepinephrine and MHPG in CSF and found that both are present in increasing levels as more CSF is removed from the lumbar puncture needle. Norepinephrine and MHPG are closely related, although norepinephrine levels are more variable within and between subjects. Both norepinephrine and MHPG levels in CSF should provide important information about norepinephrine metabolism in affective disorders.
PTH-290 Determining the indeterminate: one third of indeterminate pulmonary nodules are metastatic cancer on follow up scans
Authors: M Oliveira Cunha, MI Aslam, WM Thomas
Journal: Gut (2015)

<h3>Introduction</h3> Initial radiological staging imaging frequently detects indeterminate pulmonary nodules (IPNs) in patients presenting with colorectal cancer (CRC). The discovery of such nodules creates a clinical dilemma for multidisciplinary team. We aimed to assess the outcome of initial IPNs during follow up for patients with CRC. <h3>Method</h3> A prospectively maintained CRC database (2008–2010) at University Hospitals of Leicester NHS Trust was analysed. Clinical, pathological and radiological characteristics were studied for outcome of IPNs during CRC follow up. Nodules were characterised as malignant, benign or indeterminate). Data is expressed as number (n) and percentage (%). <h3>Results</h3> 2008 patients were studied for IPNs. Median Follow up was 44 months. 180 (8.9%) patients were identified with pulmonary nodules on initial staging scan. In 69 (3.4%) patients, pulmonary nodules were characterised as IPNs. Follow up imaging for IPNs modality was CT chest in 65.2% (24 patients did not have follow up scans) and CT-PET in 13% patients. After follow up scans, 20 cases (30.4%) were found to have metastasis in lung and one case had primary lung cancer. <h3>Conclusion</h3> This study shows that one third of the indeterminate lung nodule on initial staging scan were characterised as malignant in follow up radiological imaging. <h3>Disclosure of interest</h3> None Declared.
Blunted growth hormone responses to growth hormone-releasing factor and to clonidine in panic disorder
Authors: M E Tancer, M B Stein, B Black, T W Uhde
Journal: American Journal of Psychiatry (1993)

Blunted growth hormone (GH) responses to growth hormone-releasing factor (GH-RF) and clonidine have been reported in patients with panic disorder. In this study GH-RF and clonidine were administered to 13 patients with panic disorder and 20 healthy volunteers. Compared to the normal subjects, the patients with panic disorder had significantly blunted GH responses after both GH-RF and clonidine.