tbuckley/cabot-search huggingface dataset:
OC-078 Evaluating innovative surgery: a nested ideal phase 2 study within an external randomised pilot (the romio trial)
Authors: P Barham, R Berrisford, D Titcomb, A Hollowood, G Sanders, C Streets, T Wheatley, K Avery, G Hanna, C Metcalfe, JM Blazeby
Journal: Gut (2015)

<h3>Introduction</h3> There is a need for well designed and conducted pragmatic randomised controlled trials (RCTs) of open and minimally invasive approaches for oesophageal cancer, but totally minimally invasive techniques are still evolving. The NIHR ROMIO pilot RCT was designed to inform a definitive trial. This paper describes how the ROMIO Study informed the main trial design and incorporated a nested IDEAL (Idea, Development, Evaluation, Assessment and Long-term evaluation of innovative surgery) Phase 2a evaluation of totally minimally invasive oesophagectomy (TMIO). <h3>Method</h3> The pilot ROMIO trial was conducted in two centres. In one centre (with a team of 3 surgeons) patients were randomised to open gastric mobilisation and right thoracotomy (open surgery) or laparoscopic gastric mobilisation and right thoractomy (hybrid surgery) and in the other centre (team of 6 surgeons) patients were randomised into three groups, also including totally TMIO. The surgical protocol for open and hybrid surgery was agreed and monitored during the trial, where as the protocol for TMIO was deliberately flexible to monitor development of the technique and to document changes in the procedure and collect prospective data. <h3>Results</h3> During 20 months of recruitment, 256 patients were assessed for eligibility, 132 (52%) were found to be eligible and 101 (76.5%) agreed to participate. A high proportion of patients received their randomised allocation (87%). Dressing patients with large bandages, covering all possible incisions, was successful in keeping patients blind whilst pain was assessed during the first week post-surgery (patients were unable to guess the type of surgery they had received). In the TMIO group three-phase surgery was undertaken by three of the six surgeons in one centre. This evolved to two-phase TMIO surgery with continuing modifications to the anastomotic technique. During the study period the national audit data showed that only 14% of oesophagectomies are TMIO. <h3>Conclusion</h3> Rapid recruitment to the pilot ROMIO trial and the successful refinement of methodology indicated that a definitive two group trial comparing open and hybrid surgery is feasible. Techniques for TMIO are however still evolving and the procedure is not widely undertaken. The main ROMIO trial, therefore, is designed within a continuing IDEAL Phase 2b study to monitor when this complex technique has stabilised and ready for full evaluation within a pragmatic trial design. <h3>Disclosure of interest</h3> None Declared.
Pancreatic Intraductal Ultrasonography (IDUS) Allows Early Diagnosis of Pancreatic Carcinoma in Situ: A Case Report
Authors: Q.  Ly, M.  Rünzi, J.  Menzel, K.  U.  Rehbehn, A.  Zimmermann, M.  W.  Büchler, H.  Friess
Journal: Endoscopy (2003)

A 66-year-old woman was admitted with diarrhea, weight loss, slight recurrent abdominal pain, and raised serum amylase and lipase. Lactose intolerance was diagnosed, and treatment was begun. The symptoms diminished. However, slight back pain and elevated serum amylase and lipase levels persisted. A pancreatic tumor was then suspected. Ultrasound, spiral computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) examinations were inconclusive. Endoscopic retrograde cholangiopancreatography (ERCP) showed a slight narrowing of the pancreatic duct within the pancreatic body, and endoscopic ultrasound (EUS) revealed a 10 mm intrapancreatic lesion. Finally, intraductal ultrasonography (IDUS) reliably identified a small pancreatic tumor. The tumor was resected, and histology confirmed a well-differentiated adenocarcinoma in situ (UICC stage 0, TisN0M0). This case shows that using high-resolution imaging techniques such as EUS plus IDUS, small malignant pancreatic lesions can be detected at an early stage, when curative action is possible.
A case of pancreatic cancer in a patient who suffered CPA during TC therapy and was diagnosed at autopsy with AMI
Authors: Hiroki Yamashita, Shunsuke Okazaki, Hiroki Moriyoshi, Yasuhiro Hamatani, Hiroyuki Tanaka, Bunji Endo, Hisateru Yasui
Journal: Annals of Oncology (2015)
Liver-Directed Therapies for Hepatocellular Carcinoma
Authors: Cletus A. Arciero, Elin R. Sigurdson
Journal: Journal of the National Comprehensive Cancer Network (2006)

Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. This disease can be treated through several surgical and nonsurgical approaches. Although the only curative options for patients with HCC are surgical (resection or transplantation), most patients unfortunately present with advanced neoplastic disease or experience the effects of chronic liver disease, making surgical resection implausible. Several additional options are available for treating this population. Ablative therapies such as percutaneous ethanol injection, cryotherapy, radiofrequency ablation, laser ablation, and microwave hyperthermic ablation can be used with varying degrees of success. Transarterial chemoembolization can be used in patients with advanced disease or advanced chronic liver disease that cannot be treated with resection or ablation. This article explores the various liver-directed therapies, including surgical resection, and defines morbidity, mortality, and survival for each.
Tick-borne encephalitis transmitted by unpasteurised cow milk in western Hungary, September to October 2011
Authors: S Caini, K Szomor, E Ferenczi, Á Székelyné Gáspár, Á Csohán, K Krisztalovics, Z Molnár, J K Horváth
Journal: Eurosurveillance (2012)

In October 2011, a cluster of four tick-borne encephalitis (TBE) cases was identified in Hungary. Initial investigations revealed a possible link with consumption of unpasteurised cow milk sold by a farmer without authorisation. We performed a cohort study including all regular customers of the farmer. Overall, eleven cases (seven confirmed and four suspected) were identified. Customers who had consumed the farmer’s unpasteurised cow milk had more than a two-fold increased risk for being a TBE case, although not at statistically significant level.
AB1234-HPR Effect of Acupuncture and Electroacupuncture in Pain, Disability and Depression in Patients with Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial
Authors: J. Comachio, M. Oliveira Magalhães, C. Coelho Oliveira, I.F. Rodrigues Silva, A.P. de Moura Carvalho e Silva, A. Pasqual Marques
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Chronic nonspecific low back pain (CNLBP) is a serious health and socioeconomic problem responsible for a high rate of work absenteeism and reduced functional performance. Acupuncture and electroacupuncture has shown positive results reducing pain and disability. However, we still have inconclusive results. <h3>Objectives</h3> To compare the effect of the techniques of acupuncture and electroacupuncture in the treatment of Pain, Functional Disability and Depression in patients with CNLPB. <h3>Methods</h3> This study examined 55 patients with low back pain randomized into two groups: Electroacupuncture group (GE) (n=28: 14 women and 14 men; mean age = 47.2 (10.5) years) and Acupuncture group (GA) (n=27: 19 women and 8 men; mean age = 49.4 (9.9) years). The interventions were individualized, forty minutes per session, for six weeks and often twice a week. The following questionnaires were used: the Pain Numeric Scale (NRS) for pain intensity, Roland Morris Disability Questionnaire for Disability and Beck Depression Inventory (BDI) for depression. Intergroup statistical analysis was performed using the t-test for data sets with normal distribution and the same variance and Mann-Whitney Rank Sum Test for data sets without normal distribution or equal variance. The significance level was α=0.05. <h3>Results</h3> The groups are homogeneous in age, weight, height and body mass index. Both groups showed improvement in pain, disability and depression. Acupuncture group had 48% improvement in pain [7.7±1.7; 4.0±2.6; &lt;0.001], functional disability 53.4% [12.9±4.9; 6.5±4.4; &lt;0.001] and depression 38% [10.9±8.5; 4.2±5.0; &lt;.001]. The Electroacupuncture group also showed improvement in pain 42% [7.6±1.3; 4.4±2.2; &lt;0.001], functional disability 43.3% [12.9±4.9; 6.5±4.4; &lt;0.001] and depression 47% [12.3±8.2; 5.8±4.2; &lt;0.001]. <h3>Conclusions</h3> Our results suggest that Acupuncture and Electroacupuncture has similar effects for pain, functional disability and depression. <h3>References</h3> Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, et al. Low back pain. J Orthop Sports Phys Ther 2012;42(4):A1-57. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006;15 Suppl 2:S192-300. Witt CM, Schutzler L, Ludtke R, Wegscheider K, Willich SN: Patient Characteristics and Variation in Treatment Outcomes Which Patients Benefit Most From Acupuncture for Chronic Pain? Clin J Pain 2011, 27:550-555. <h3>Disclosure of Interest</h3> None declared
PTH-197 Significant reduction in catheter-related bloodstream infections in high risk adult patients on home pn or iv fluids after introduction of secondary prophylaxis with taurolidine-citrate line lock: Abstract PTH-197 Table 1
Authors: I Barnova, KC Fragkos, S Morgan, L Smith, H Saravanapavan, M Samaan, PS Patel, N Keane, M Babington, S Di Caro, F Rahman
Journal: Gut (2015)

<h3>Introduction</h3> Patients on home parenteral nutrition (HPN) or IV fluids are at risk of complications especially of catheter-related bloodstream infection (CRBI). The primary aim of this study was to compare the CRBI rate before and after introduction of secondary prophylaxis with Taurolidine-citrate line lock (TLL). <h3>Method</h3> Data from 28 patients using TLL from one centre were collected retrospectively. The data collection was from patients’ medical records at our centre and patients’ interviews. CRBI rate was calculated per 1,000 catheter days (CD) and p-value (Z-test) was used to assess significance. <h3>Results</h3> Number of patients included into the study was 28. F:M ratio was 19:9 and the ratio of patients with short bowel syndrome to patients with dysmotility disorders was 9:5. Self/nursing administration ratio was 1:1. TLL was introduced on first patient in Sept 2007 and the last in May 2014. Results showed the CRBI rate of 6.8/1,000 CD prior to introduction of TLL (142 CRBI in 20,881 days) and 0.92/1,000 CD post introduction of TLL (18 CBSI in 19,642 days) with p-value of &lt;0.001. 71.4% of patients were CRBI free after introduction of TLL (0 infections per 1,000 CD), 21.4% TLL significantly improved CRBI rate by at least 50%. Self/nursing administration post TLL introduction did not show any significant difference (1.14: 0.98 CRBI/1,000 CD with p-value 0.74). Patients with single lumen catheters had CRBI rate of 0.58 per 1,000 CD after TLL use and patients with double lumen catheters had CRBI rate of 1.2 per 1,000 CD with p-value of 0.176. There was no significance in CRBI rate of patients with stoma/fistula compared to patients without stoma/fistula pre and post introduction of TLL. The p value for CRBI pre TLL introduction was 0.58. The p value post TLL introduction was 0.67. The highest rate of CRBI after introduction of TLL was recorded in patients using HPN for 7/7 + IV fluids and meds which (2.1 per 1,000 CD) and the lowest rate was recorded for patients using PN less than 7 days or using only IV fluids 0 per 1,000 CD (Table 1). <h3>Conclusion</h3> The data suggest that secondary prophylaxis with TLL significantly decreases the CRBI rate in selected high-risk patients. <h3>Disclosure of interest</h3> None Declared.
PTU-069 The fate of epithelial keratins in active ulcerative colitis
Authors: A Assad-Sangabi, C Evans, D Majumdar, SS Cross, BM Corfe, AJ Lobo
Journal: Gut (2015)

<h3>Introduction</h3> Intermediate filaments (IF), which mainly consist of keratins (K), are one of the main components of the human cell cytoskeleton. K8, K18 and K19 constitute the main keratins in the intestinal epithelial cells. Keratin alterations may play a role in the pathophysiology of ulcerative colitis (UC). We have previously shown reduced expression of Keratins in IF fraction from distal active UC relative to proximal inactive mucosa as well as controls using proteomic iTRAQ-based analysis.<sup>1</sup>Whether this reduced expression is due to change in solubilisation, reduced total expression and/or degradation, is unknown. We aimed to clarify the fate of epithelial keratins during UC disease activity. <h3>Method</h3> Soluble proteome fractions were extracted from rectal biopsies in patients (n = 10) with active distal colitis (ACT) as well as endoscopically and histologically uninflamed proximal colonic mucosa (INACT) in the same patients. Median histological activity index in ACT and INACT were 2 (range 1–3) and 0 (range 0). Control colonic biopsies (n = 7) from normal individuals were fractionated similarly. An iTRAQ-compatible extraction protocol for soluble proteins was developed and applied. Labelled peptides from pooled patients in each group were analysed by SCX-LC-MS/MS and data reconstituted in GeneBio Phenyx. Inter-group comparisons were made using in-house algorithms based on t-testing with multiple test correction. Validation of iTRAQ results was carried out with immunoblotting on pooled and individual samples using monoclonal antibody against K8. These outcomes were then compared with our previous insoluble proteome analyses.<sup>1</sup> <h3>Results</h3> Comparative iTRAQ analysis of the soluble fraction showed significantly lower log fold changes in K8, K18 and K19 levels in ACT relative to INACT (0.42, 0.53, 0.42) and normal controls (0.61, 0.76, 0.41), respectively. The results were similar to our recent iTRAQ analysis of the IF fraction.<sup>1</sup>Immunoblotting further confirmed these findings: median relative K8 concentration in IF/soluble proteome fractions in individual ACT and INACT samples was 0.18/1 (p = 0.02) and 1.21/1.02 (p = 0.02), respectively. <h3>Conclusion</h3> This study suggests relative total reduction in expression of epithelial keratins in actively inflamed colonic mucosa of UC patients compared to un-inflamed proximal mucosa and normal controls. Keratins may have utility as a tissue biomarker of UC disease activity. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Corfe BM, Majumdar D, Assadsangabi A, Marsh AMR, Cross SS, Connolly JB, Evans CA, Lobo AJ. Inflammation decreases keratin level in ulcerative colitis; inadequate restoration associates with increased risk of colitis-associated-cancer. <i>BMJ Open Gastroenterol.</i>, In press
Cardiopulmonary Resuscitation
Authors: Janet M. Torpy, Cassio Lynm, Richard M. Glass
Journal: JAMA (2010)

Cardiopulmonary ResuscitationW hen the heart stops beating (cardiac arrest), only a few minutes remain before that person dies, unless circulation (blood flow) returns or is restored.Providing cardiopulmonary resuscitation (CPR) is a way to keep some circulation going until expert help arrives.Compressing-pushing down on the patient' s chest and then allowing the chest to recoil-helps push some blood through the heart, into the lungs, and into the major arteries of the body (including to the brain).These chest compressions, possibly combined with artificial respiration (breathing) that is usually performed in a "mouth-to-mouth" manner, are termed basic CPR.Automated external defibrillators (AEDs) have become part of out-of-hospital resuscitation efforts.Using an AED can be lifesaving in certain types of cardiac arrest.AEDs are increasingly available in schools, athletic venues, airports, and other public places.The October 6, 2010, issue of JAMA contains an article about performing CPR using chest compressions only, without mouth-to-mouth breathing, during out-of-hospital cardiac arrest.
Endoscopic Placement of a Biliary Expandable Metal Stent Through the Mesh Wall of a Duodenal Stent
Authors: G Novacek, R Pötzi, G Kornek, M Häfner, R Schöfl, A Gangl, A Püspök
Journal: Endoscopy (2003)

Endoscopic palliation of advanced pancreatic carcinomas with biliary and gastric outlet obstruction involves the placement of self-expanding metal stents (SEMS) within the biliary tree and the duodenum [1] [2] [3] [4] [5]. Biliary stenting following duodenal stenting across the papilla usually requires a percutaneous transhepatic approach [1] [4] [5]. We report a case in which a biliary SEMS was placed endoscopically through the mesh wall of a previously inserted duodenal SEMS.
PTH-226 Prevalence of malnutrition in medical and surgical gastrointestinal outpatient clinics
Authors: N Kamperidis, K Katechia, L Tesser, D Robinson, J Nightingale
Journal: Gut (2015)

<h3>Introduction</h3> UK NICE guidelines, state that patients attending an outpatient clinic for the first time, should be screened for malnutrition.<sup>1</sup>30% of inpatients are malnourished or at risk of malnutrition,<sup>2</sup>however the prevalence of malnutrition in outpatients, especially those with gastro-intestinal (GI) illnesses has not been assessed. Therefore, we aimed to determine the prevalence of malnutrition in the outpatient department (OPD) using body mass index (BMI) and% weight loss (%WL) and to assess the physicians’/surgeons’ response malnutrition being detected. <h3>Method</h3> The BMI and the WL were determined for every patient for a 2 week period and the results put in the notes immediately before the clinician’s entry. The BMI and WL were scored as in the Malnutrition Universal Screening Tool (MUST). The demographic data, underlying disease and action taken were recorded. Data were statistically analysed using the chi-square test. <h3>Results</h3> 605 patients (316 females) of mean age 54 years were included. 150 (25%) were new patients, 223 (37%) had previous abdominal surgery, 208 (34%) had inflammatory bowel disease, 73 (12%) had anorectal issues, 54 (9%) upper GI symptoms or conditions, 44 (7%) cancer and 33 (6%) had liver disease. 214 patients (35%) had co-morbidities: 107 (18%) cardiovascular, 91 (15%) endocrine, 45 (7%) musculoskeletal or connective tissue disorders, 38 (6%) respiratory, 21 (4%) non GI malignancies,19 (3%) neurological and 10 (2%) psychiatric co-morbidities. 519 participants (86%) had a normal BMI and%WL. 86 (14%) had a BMI &lt;20 kg/m² or had 5% WL. 61 (10%) were in MUST “medium risk” and 25 (4%) were in MUST “high risk” of malnutrition. 15 (60%) of the “high risk” patients were under the care or referred to a dietitian compared to 19 (28%) of “medium risk” patients. The prevalence of malnutrition was independent of sex, age, history of previous surgery and co-morbidity. There was no difference in the prevalence of malnutrition between new and follow up patients. Malnourished patients with IBD (38, 18%) vs. non-IBD (48, 12%) and patients with cancer (11, 25%) vs. non cancer (75, 13%) were more likely to be malmourished (p &lt; 0.05). <h3>Conclusion</h3> The risk of malnutrition in our outpatient department is 14%. IBD and cancer patients have a higher prevalence. Most patients with malnutrition (52, 61%) are not being seen by a dietitian. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> NICE, <i>Quality standard for nutrition support in adults.</i>2012 Vera Todorovic CR, Marinos Elia, <i>The MUST explanatory booklet. A guide to the Malnutrition Universal Screening Tool (MUST) for adults</i>
AB0187 Increased Serum TIE-2 Level in Systemic Lupus Erythematosus Patients and Related Factors
Authors: O.N. Pamuk, G.E. Pamuk, M. Gedik
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Systemic lupus erythematosus (SLE) is a multisystem, chronic inflammatory disease. The activation of endothelial cells determines the initiation, localisation and spread of inflammatory disease. Central nervous system (CNS) involvement in SLE is a life-threating manifestation of disease and it might be related to endothelial injury or thrombosis. Neurofilament (NF) proteins have been shown to be promising biomarkers for monitoring and predicting disease progression for different neurologic disorders. <h3>Objectives</h3> In this study, we evaluated biomarkers related to endothelial injury, angiogenesis (tyrosine-kinase with Ig-like and epidermal growth factor-like domain 2, Tie-2) and NF level. In addition, we investigated the association between this parameters and clinical findings in our SLE patients. <h3>Methods</h3> Age-and-sex matched 60 SLE patients (56 females, 4 males, mean age: 39.5±11.5 years) and 34 apparently healthy subjects (29 females, 5 males, mean age: 38.2±10.9 years) were included into the study. The demographic, clinical features, major organ involvements - including that of the CNS- and laboratory data of SLE patients were recorded from medical charts. Plasma Tie-2 and neurofilament level were evaluated by ELISA method. SLE disease activity index (SLEDAI) score was calculated at the time of study. NF level was converted to its log level, because the distribution of its level was not normal. <h3>Results</h3> Tie-2 level was significantly lower in SLE patients than in healthy controls (19.03±11.9 pg/ml vs. 31.3±15.1 pg/ml, p=0.001). Neurofilamentin level was similar in SLE patients and controls (median: 5.08 (range: 3.09-6.35) pg/ml vs. 5.12 (3.08-5.7) pg/ml, p&gt;0.05). Serum Tie-2 level in SLE patients with major organ involvement was significantly lower than in patients without major organ involvement (13.6±7.8 vs. 20.5±12.4 pg/ml, p=0.05). In the healthy control group, serum Tie-2 level correlated significantly with NF level (r=-0.66, p=0.003). In the SLE group, these parameters did not seem to correlate with each other. <h3>Conclusions</h3> Serum Tie-2 level in SLE patients was significantly lower. Decreased Tie-2 level may be related to major organ involvement in SLE. <h3>Disclosure of Interest</h3> None declared