tbuckley/cabot-search huggingface dataset:
AB1112 Does the Specialized Rheumatology Assessment Produce a Pull Effect in an Accident &amp; Emergency Department?
Authors: C.A. Guillen Astete, J. Bachiller-Corral, A.L. Boteanu
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Our A&amp;E department counts with a specialized rheumatology unit in order to assess all rheumatology urgencies since October 2013. The Urgency clinic for Rheumatologic and Musculoskeletal conditions (URMES) is operative three days per week during business hours and. Although those urgencies do not include any complaint related to a traumatic process, they account for around 14% of all consultations. No other hospital in Madrid neither Spain counts with a unit of this kind. It is a concern that URMES activity could cause a pull effect into patients who are awaiting a scheduled specialized consultation and want to be attended sooner. <h3>Objectives</h3> To determine if the URMES activity has generated a pull effect into the quantity of patients who claims for urgency assessment in our A&amp;E department. <h3>Methods</h3> We performed a systematic randomization of clinical records of patients who claimed for urgent healthcare in our A&amp;E department and whose main complaint was related to a rheumatologic or musculoskeletal condition not related with a traumatic process. This randomization process selected 60 days per year equally distributed across the four seasons from 2009 to 2014. Main complains and volume of affluence was registered. Variables studied were demographic features, healthcare area (ours or other), origin of consultation (primary care physician or self initiative) and the volume of consultations generated by a single patient. <h3>Results</h3> In the 300 days randomized, there were assessed 143192 patients. From them, 24507 consulted by a rheumatologic or musculoskeletal condition (16.8%). There were no significative differences into the volume of patients assessed from 2009 to 2014. Table 1 shows detailed information. <h3>Conclusions</h3> The specialized rheumatology activity in our A&amp;E environment does not seem to modify the gross amount of patient affluence to our department, however, it has been detected a significant increase of affluence of patients from other geographical healthcare areas and a higher proportion of patients who consults by self initiative in the very last two years. By the other hand, it seems that this increase is compensated by a reduction of the number of consultation per patient, maybe due to the high capacity to solve accurately this kind of pathology. It could be interpreted that both events together can have an impact in the long term, increasing the demand of the A&amp;E department, however, we believe that URMES activity also reduces the demand of specialized scheduled consultation by performing –when is needed- and accurate derivation. This effect should the focus of further research to obtain a global acknowledge of the benefits of its implementation in terms of global hospital functioning rather than just A&amp;E department. <h3>Disclosure of Interest</h3> None declared
PTH-218 The effects of home parenteral nutrition on occupation
Authors: JW Duffus
Journal: Gut (2015)

<h3>Introduction</h3> Home parenteral nutrition (HPN) has been shown in previous studies to reduce the quality of life<sup>1</sup>of those receiving it. An essential part of life that provides meaning, financial security and community is occupation. The effect of HPN on a recipient’s occupation has not been looked at in detail before. This study sets out to ascertain the effect of HPN on occupation and the factors that influence a patient’s occupational status on HPN. <h3>Method</h3> We developed a questionnaire with questions about occupational status before and after starting HPN, type of work, motivation for returning to work and if HPN had impacted on their ability to work. This was completed at the outpatient clinic and also sent to patients to complete as a web-based questionnaire. The information was then compiled onto a database. The questionnaire has, so far, been carried out among patients from St Marks Hospital in London and Glasgow Royal Infirmary. <h3>Results</h3> There were 70 respondents in total (M:F 32:38, mean age 55 [20–80] years). Before starting HPN 73% patients were working, 11% were unemployed and 16% were retired; however, on HPN only 34% remained in work. The type of work was also different among those who did work with 79% in full time employment prior to HPN as well as 18% part time and 3% volunteering. Post HPN there was 42% in full time, 33% part time and 25% volunteering. The most common reason given for HPN treatment to impinge on the ability to work was ‘time needed to be on it’ (36%), ‘restricts how far from apparatus they can go’ (19%), ‘tiring’ (14%), ‘risk of complications’ (10%) and 12% stated it had ‘no impact’. For patients over 45, 91% worked prior to HPN and 49% afterwards (excluding those already retired). In patients under45, 71% worked before (bearing in mind some were under 18 before HPN) and 57% worked afterwards. In regard to gender, 43% of men (excluding those already retired) worked after HPN and only 39% of women. <h3>Conclusion</h3> Whilst HPN is an exceptionally successful treatment it does undoubtedly limit a person’s ability to work. The extent to which HPN restricts the ability to work is more pronounced in some groups such as the over 45s. How it limits the ability to work differs greatly in patients and is very subjective to the individual patient. However, identifying more common areas of difficulty opens up the opportunity to discuss these with patients and endeavour to take measures that counteract these difficulties. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Winkler MF. Quality of life in adult home parenteral nutrition patients. <i>J Parent Enteral Nutr. </i>2005;29(3):162–70. http://www.ncbi.nlm.nih.gov/pubmed/15837775(accessed 23rd April 2014)
Chronic Gastritis of the Glandular Stomach, Adenomatous Polyps of the Duodenum, and Calcareous Pericarditis in Strain DBA Mice
Authors: William V. Hare, Harold L. Stewart
Journal: JNCI Journal of the National Cancer Institute (1956)

Journal Article Chronic Gastritis of the Glandular Stomach, Adenomatous Polyps of the Duodenum, and Calcareous Pericarditis in Strain DBA Mice Get access William V. Hare, William V. Hare Laboratory of Pathology, National Cancer Institute,3Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar Harold L. Stewart Harold L. Stewart Laboratory of Pathology, National Cancer Institute,3Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 16, Issue 4, February 1956, Pages 889–911, https://doi.org/10.1093/jnci/16.4.889 Published: 01 February 1956 Article history Received: 16 August 1955 Published: 01 February 1956
SP0069 Synovial Phenotypes in RA and Prediction of Response – Ready For Application?
Authors: M. Townsend
Journal: Annals of the Rheumatic Diseases (2015)

Rheumatoid arthritis (RA) is a heterogeneous autoimmune disease both clinically and biologically. Currently, the relationship between molecular drivers of disease in RA and therapeutic outcome is poorly understood, and advances are needed if improved drugs targeted to subsets of disease are to be developed. Using a combination of gene expression, histologic, and cellular analysis of RA synovial samples, different pathological phenotypes within the rheumatoid synovium have been defined with distinct underlying gene expression profiles and histological features. A myeloid biology-dominated synovial subset had a more robust response to anti-TNFα therapy. Further, using differential gene expression in synovium to nominate systemic biomarker candidates, pre-treatment assessment of serum biomarkers indicated that different RA patient populations optimally respond to anti-TNFα therapy as compared with anti-IL6R therapy. Of note, patients with a low inflammatory synovial subset showed poor clinical response to therapy. These data underscore the importance of disease heterogeneity in RA, and provide a path forward for the identification and validation of systemic biomarkers that predict response to targeted therapies. <h3>Disclosure of Interest</h3> M. Townsend Shareholder of: Roche, Employee of: Genentech/Roche
Abstract 17392: Gastrointestinal Bleeding With Edoxaban versus Warfarin: Results From the ENGAGE AF-TIMI 48 Trial
Authors: James Aisenberg, Kathryn Friedman, Jay Desai, Jeffrey I Weitz, Robert Giugliano, Christian T Ruff, Francesco Nordio, Michele Mercuri, Youngsook Choi, Laura Bower, Elliot Antman, Eugene Braunwald
Journal: Circulation (2015)

Background: There is more major gastrointestinal bleeding (M-GIB) with most NOACs than with warfarin. The clinical impact of this finding is poorly understood. Methods: The ENGAGE AF-TIMI 48 trial compared the efficacy and safety of higher-dose (HD-E: 60 mg/ 30mg) or lower-dose (LD-E: 30 mg/15 mg) edoxaban regimens with dose-adjusted warfarin for prevention of stroke and systemic embolism in non-valvular atrial fibrillation. ISTH definitions for major and life-threatening (LT) bleeding events were utilized. In this pre-specified analysis, we investigated the adjudicated M-GIB events utilizing pre-defined severity and outcome endpoints. Results: Although the risk of M-GIB was higher with HD-E than with warfarin, the risk of LT or fatal GIB was similar (figure), and surgery for GIB was required less frequently with HD-E than warfarin (HR 0.37; 95%CI, 0.16-0.88; p=0.03). The risk for M-GIB-related permanent drug discontinuation was similar with HD-E and warfarin (HR 0.96; 95% CI, 0.67-1.37, p=0.8), as were the risks of hospitalization (HR 1.14; 95%CI, 0.92-1.40, p=0.2) and Hgb decrease &gt; 5 g/dL (HR 1.01; 95%CI, 0.74-1.38; p=0.9). The risks of M-GIB and of LT or fatal GIB were lower with LD-E than with warfarin (Figure), as were the risks of M-GIB-related permanent drug discontinuation (HR 0.51; 95% CI, 0.33-0.78, p=0.002), hospitalization (HR 0.67; 95%CI, 0.53-0.85; p=0.001), Hgb decrease &gt; 5 g/dL (HR 0.58; 95%CI, 0.40-0.84; p=0.003), and M-GIB requiring transfusion of &gt; 2 units of red cells (HR 0.66; 95%CI, 0.50-0.89; p=0.006). Fatal GIB occurred in 2, 3 and 7 patients treated with HD-E, LD-E and warfarin, respectively. Conclusions: M-GIB and LT-GIB with edoxaban are dose-dependent. Although the risk of M-GIB is higher with HD-E than warfarin, the risk of LT-GIB or fatal GIB is similar and the severity and outcomes are no worse than with warfarin. The risks of M-GIB, and of LT-GIB or fatal GIB, are lower with LD-E than warfarin.
PTH-070 Patients receiving anti-tnf agents for inflammatory bowel disease: exposure to diagnostic ionising radiation and trends in imaging modalities
Authors: S Meredith, M Dibb, T Ellis, M Gordon, C Probert, S Subramanian, P Collins
Journal: Gut (2015)

<h3>Introduction</h3> Concern has been raised as to the risk of malignancy in patients with inflammatory bowel disease related to their exposure to ionising radiation from diagnostic tests. A meta-analysis has reported that 8.8% of patients with inflammatory bowel disease were exposed to potentially harmful levels of diagnostic medical radiation (DMR) (defined as greater than 50 milli-sieverts (mSv)).<sup>1</sup>Patients requiring anti-TNF treatment for management of their disease may be at greatest risk of exposure to diagnostic medical radiation by virtue of their disease activity. <h3>AIM</h3> To determine the prevalence of exposure to a potentially harmful dose of DMR in patients receiving anti-TNF treatment and to determine predictors of high exposure. <h3>Method</h3> A retrospective review of patients receiving anti-TNF agents for IBD in a tertiary referral centre between 2005 and 2012 was undertaken. Logistic regression was used to identify predictors of exposure to a potentially harmful cumulative effective dose (CED) of &gt;50 mSv in patients with Crohn’s disease. Variables considered as potential predictors of a harmful CED included elements of the Montreal classification of disease (site and behaviour of disease and presence of perianal disease), age and sex. <h3>Results</h3> A cohort of 149 patients was identified. The median age was 36 (range 18 to 72 years). 135 patients had Crohn’s disease. 1137 diagnostic procedures associated with exposure to ionising radiation were performed. The median CED was 10.72mSv (Range 0 to 146). 12% of all IBD patients received a potentially harmful CED of &gt;50 mSv. In patients with Crohn’s disease, 9.6% received a CED of &gt; 50mSv. Logistic regression failed to demonstrate a significant association between a CED of &gt; 50mSv and the variables assessed. Abdominal CT scans accounted for 69% of the CED. During the study period the ratio of abdominal MR scans to abdominal CT scans was 1:24 and 2:3 in the first and last quartile of the study period, respectively. <h3>Conclusion</h3> 12% of IBD patients receiving anti-TNF agents for IBD in a tertiary setting received a potentially harmful dose of ionising radiation from diagnostic imaging. This was largely related to abdominal CT scans. The temporal trend towards a greater use of non-ionising radiation for diagnostic imaging in this group is therefore reassuring. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Chatu <i>et al</i>. Aliment Pharmacol Ther. 2012;35:529
SP0219 The Heart of the Matter. A Critical Evaluation of Health Economics from A Patient Perspective
Authors: M. De Wit
Journal: Annals of the Rheumatic Diseases (2015)

In times of economic constraints, cost effectiveness studies on health interventions become more important for health authorities and payers. For this reason EULAR included in 2014 the collection of data on cost effectiveness in the new standardized operational procedures when developing disease management recommendations. Since then recommendation task forces are expected to make cost effectiveness an integral part of the SLR. This new requirement put patients and their organizations for an ethical dilemma: Till recently treatments and interventions were assessed by patients for safety and effectiveness reasons. They raise the question to what extent cost effectiveness arguments belong to the decision making process in the consultation room. Do individual patients and individual physicians have a responsibility to include these arguments in the discussion of pro9s and cons when considering a treatment change? In addition, patient organizations do accept the importance of cost effectiveness data in the process of health technology assessment but argue whether they are appropriate in the process of developing management recommendations. Here, the common goal should be to determine, based on the best available efficacy evidence, the most optimal pathway to manage the disease. In this presentation the challenges of incorporating the patient voice in health economics as well as the use of economic arguments in the consultation between patients and health care professionals will be discussed from a patient perspective. <h3>Disclosure of Interest</h3> None declared
PTU-036 Endoscopic sphincteroplasty in combination with sphincterotomy; is it worth it?
Authors: C Manning, A deSilva, B Brett, K Sheikh
Journal: Gut (2015)

<h3>Introduction</h3> Endoscopic balloon sphincteroplasty (EBS) is an adjunct and possible alternative to sphincterotomy to remove biliary stones. EBS alone can be associated with complications like pancreatitis but can be safe and effective when combined with sphincterotomy. Reduced pancreatitis rates with a combined technique may relate to the force of dilatation being directed away from the pancreatic orifice. NSAIDs reduce the risk of post-procedure pancreatitis but there is insufficient data on its use specifically with combined technique. <h3>Method</h3> A retrospective review of patients undergoing EBS in addition to sphincterotomy for management of stones. Objectives were to assess CBD clearance and complication rates, and review the outcome of rectal NSAID use. We identified 93 eligible cases – 10 were excluded due to insufficient data. <h3>Results</h3> 30 of 41 index cases had successful clearance with EBS. 8 failed cases underwent further ERCP, 5 had upstaged balloon sphincteroplasty with successful clearance. For 32 of 42 repeat cases, this was the first EBS procedure. 22 of these were successful. Reasons for failed clearance were mainly poor tolerance/prolonged procedure/duodenoscope malfunction. Of a total of 22 failed cases, only 4 were due to large stones/difficult anatomy. The addition of EBS achieved higher clearance rates for stones &lt;2 cm at both index and repeat ERCP. Immediate complications increased with balloon size. Stones &gt;2 cm led to more complications and reduced clearance rates. No complications were seen when ‘interval’ sphincteroplasty was performed with balloon &gt;15 mm. 15 cases developed complications, 11 were minor bleeds resolved at ERCP. 1 elderly patient had a significant delayed bleed requiring endoscopic haemostasis but developed fatal re-bleeding triggered by anticoagulation. There were 3 cases of post-ERCP biliary sepsis. A total of 39 of 83 cases received rectal diclofenac based on perceived risk of post procedure pancreatitis and risk of NSAID use. No cases of post-ERCP pancreatitis were seen. <h3>Conclusion</h3> EBS with sphincterotomy appears safe and potentially prevents additional procedures. Complication rates are greater with balloons &gt;15 mm or stones &gt;2 cm at index procedure and suggests alternative modalities should be considered in such cases. ‘Interval’ sphincteroplasty &gt;15 mm appears safer than use at index. Immediate complications encountered were largely minor except 1 patient who required repeat endoscopic haemostasis but had fatal re-bleed due to anticoagulation. The use of adrenaline to control haemostasis and prevent delayed bleeding appears effective. No cases of pancreatitis were seen in our cohort; this may signify a benefit in using NSAIDs post-ERCP where suitable but requires analysis with a larger patient cohort. <h3>Disclosure of interest</h3> None Declared.
Case 48-1971
Authors: Richard C. Cabot, Benjamin Castleman, Betty U. McNeely, Eugene Braunwald, Robert E. Scully
Journal: New England Journal of Medicine (1971)

Presentation of CaseA 22-year-old woman entered the hospital because of loss of consciousness.There was a long history of sociopathic behavior, and the patient's guardians characterized her as a "pathologic liar." Her menses had always been irregular, occurring every three or four months; five years before admission she was taken to a physician for evaluation but refused to return. Four years before admission edema developed. Another physician determined the basal metabolic rate, which was normal, and prescribed a diuretic agent, with improvement; she refused to return for further treatment. Three years before entry edema recurred, with abdominal swelling. She . . .
SAT0038 Osteoclasts Activate Chondrocyte Catabolism Through S1P Production
Authors: C. Cherifi, H.-K. Ea, T. Funck-Brentano, E. Hay, M. Cohen-Solal
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Subchondral bone features accompanied all stages development of osteoarthritis (OA). We have previously demonstrated that high osteoclastogenesis and bone remodeling is observed at the initiation of OA, while inhibition of osteoclast function prevents bone and cartilage catabolism in murine OA models. <h3>Objectives</h3> Our purpose was to evaluate how osteoclast-derived factors affect the chondrocyte metabolism and to further investigated the role of S1P, an osteoclast-secreted molecule in chondrocyte metabolism and osteoarthritis. <h3>Methods</h3> Primary murine chondrocytes were cultured with conditioned medium of osteoclasts (Oc-M) or RAW cells (Raw-CM) to analyze the expression of catabolism and anabolism genes (RT-qPCR). Femoral head explants were cultured in the presence of Oc-CM for 48h to quantify matrix protein expression and proteoglycan content and further investigated the role of S1P released in Oc-CM in the presence of JTE-013, a S1P receptor S1PR2 antagonist. <h3>Results</h3> Oc-CM reduced the proteoglycan release in primary chondrocytes and activated p38MAPkinase pathway. Increased expression of catabolic enzymes (MMP-3, -13, Adamts-4,-5) was observed only with Oc-CM while reduction of expression of anabolic markers (Col2, ACAN, Sox9) was induced with both Oc-CM and Raw-CM. Oc-CM increased the chondrocytic expression of S1P receptors 1 to 4 and the inhibition of S1PR2 protected chondrocytes from degradation enzymes induced by Oc-CM. In joint explants, JTE-013 reversed proteoglycan loss and NITEGE expression induced by Oc-CM, and reduced proteoglycan release and expression of MMP-3/MMP-13 by the chondrocytes. Our results indicate that S1P produced in Oc-CM promotes chondrocyte catabolism. <h3>Conclusions</h3> These data demonstrated that osteoclast-secreted factors disrupt the balance of chondrocyte metabolism through the production of S1P. Therefore, subchondral bone manipulation may affect chondrocyte function and OA. <h3>Disclosure of Interest</h3> None declared
ESGE NewsletterESGE/ESDO Quality in Endoscopy: Colonoscopy and colonic neoplasms symposium reports
Authors: T. Ponchon
Journal: Endoscopy (2012)

The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Digestive Oncology (ESDO) joined forces for this second symposium in the Quality in Endoscopy series and invited leaders in the field of colonoscopy and colonic neoplasms, alongside young rising stars. Sixty-seven abstracts were submitted and 30 were finally accepted. Over 200 endoscopists attended the symposium. The meeting took place in a modern and very convenient location with high-quality video facilities, which allowed excellent illustration of the case presentations and stimulated the debates. All participants and the survey responses indicated that the meeting fulfilled its aim of providing state-of-the-art knowledge of quality in colonoscopy through lectures, case discussion, and interactive participation. The different aspects of quality in colonoscopy were covered from A (bowel cleansing) to Z (stenting), and the social networking was also very fruitful. Indeed, the meeting was so active and productive that it is hard to summarize. One particularly striking feature was the number of young women working as experts in this field and contributing excellent presentations.