tbuckley/cabot-search huggingface dataset:
PTH-134 Setting Up An Endoscopy Unit in Northern Malawi
Authors: R Nyahoda, S Uledi, W Kibrete, R Nyirenda, P O’Toole, MA Gordon, AJ Stanley
Journal: Gut (2016)

<h3>Introduction</h3> There is a major need for endoscopic services in Malawi due to the very high incidence of both variceal bleeding related to schistosomiasis and gastro-oesophageal cancer. The availability of facilities and trained staff to perform variceal band ligation (VBL) and endoscopic stent insertion would benefit local patients. The aim of this project was to set-up an endoscopy unit at Mzuzu Central hospital (MCH), the regional hospital in Northern Malawi, which serves a population of approximately 2 million. <h3>Methods</h3> After an initial assessment visit, four on-site training visits (two accompanied by endoscopy nurse trainers) were undertaken by a UK endoscopy trainer between 2012–2015. Endoscopy equipment was donated and shipped out from Glasgow. The local endoscopists and endoscopy nurses also attended formal endoscopy training courses at the recognised regional training centre in Blantyre. Malawi-adapted DOPS and unit GRS were undertaken and numbers of procedures audited. <h3>Results</h3> During this period, six donated endoscopes and many accessories were delivered to MCH. Local clinicians and nurses had four weeks of on-site intensive training and attended five formal training courses. Skills in diagnostic endoscopy and VBL were taught and there was an introduction to stent insertion. A total of 20 DOPS were undertaken showing a gradual improvement in endoscopic skills. The unit GRS assessment improved with regard to patient consent, clinical monitoring, reporting and audit. A nine-month audit of consecutive endoscopic procedures at MCH revealed either varices or upper GI cancer in 28% cases. Over the total study period, the annual number of endoscopies undertaken at MCH increased from 108 to 376, with VBL cases increasing from 17 to 51. <h3>Conclusion</h3> A functioning endoscopy unit has been set up at MCH with introductory skills provided to local endoscopists and nurses, by both on-site training and attendance at formal training courses. Advanced training of more endoscopists in therapeutic endoscopy and ongoing equipment support is required to ensure the unit becomes sustainable. <h3>Disclosure of Interest</h3> None Declared
Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI
Authors: C. Michael Gibson, Roxana Mehran, Christoph Bode, Jonathan Halperin, Freek W. Verheugt, Peter Wildgoose, Mary Birmingham, Juliana Ianus, Paul Burton, Martin van Eickels, Serge Korjian, Yazan Daaboul, Gregory Y.H. Lip, Marc Cohen, Steen Husted, Eric D. Peterson, Keith A. Fox
Journal: New England Journal of Medicine (2016)

In patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) with placement of stents, standard anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and aspirin reduces the risk of thrombosis and stroke but increases the risk of bleeding. The effectiveness and safety of anticoagulation with rivaroxaban plus either one or two antiplatelet agents are uncertain.We randomly assigned 2124 participants with nonvalvular atrial fibrillation who had undergone PCI with stenting to receive, in a 1:1:1 ratio, low-dose rivaroxaban (15 mg once daily) plus a P2Y12 inhibitor for 12 months (group 1), very-low-dose rivaroxaban (2.5 mg twice daily) plus DAPT for 1, 6, or 12 months (group 2), or standard therapy with a dose-adjusted vitamin K antagonist (once daily) plus DAPT for 1, 6, or 12 months (group 3). The primary safety outcome was clinically significant bleeding (a composite of major bleeding or minor bleeding according to Thrombolysis in Myocardial Infarction [TIMI] criteria or bleeding requiring medical attention).The rates of clinically significant bleeding were lower in the two groups receiving rivaroxaban than in the group receiving standard therapy (16.8% in group 1, 18.0% in group 2, and 26.7% in group 3; hazard ratio for group 1 vs. group 3, 0.59; 95% confidence interval [CI], 0.47 to 0.76; P<0.001; hazard ratio for group 2 vs. group 3, 0.63; 95% CI, 0.50 to 0.80; P<0.001). The rates of death from cardiovascular causes, myocardial infarction, or stroke were similar in the three groups (Kaplan-Meier estimates, 6.5% in group 1, 5.6% in group 2, and 6.0% in group 3; P values for all comparisons were nonsignificant).In participants with atrial fibrillation undergoing PCI with placement of stents, the administration of either low-dose rivaroxaban plus a P2Y12 inhibitor for 12 months or very-low-dose rivaroxaban plus DAPT for 1, 6, or 12 months was associated with a lower rate of clinically significant bleeding than was standard therapy with a vitamin K antagonist plus DAPT for 1, 6, or 12 months. The three groups had similar efficacy rates, although the observed broad confidence intervals diminish the surety of any conclusions regarding efficacy. (Funded by Janssen Scientific Affairs and Bayer Pharmaceuticals; PIONEER AF-PCI ClinicalTrials.gov number, NCT01830543 .).
P6 Significance of minimal pleural effusion in non-small cell lung cancer
Authors: GA Martin, S Tsim, J MacLay, C Stewart, KG Blyth
Journal: Thorax (2016)

<h3>Introduction and objectives</h3> Recent publications report a significant survival disadvantage associated with minimal pleural effusion (MiniPE) at presentation of non-small cell lung cancer (NSCLC). MiniPE is defined when an effusion is too small for thoracentesis or where aspiration cytology is negative. Occult pleural metastases (OPM), indirect pathophysiology or comorbidity may cause MiniPE, but staging beyond thoracentesis is rarely performed. Assumption of OPM and therapeutic nihilism may contribute to poor outcomes. We assessed the prognostic impact of MiniPE in potentially radically-treatable NSCLC (Stage I-IIIA), oncologists' attitudes to treatment planning and the final treatment delivered. <h3>Methods</h3> Electronic records and baseline imaging were reviewed retrospectively in 441 consecutive diagnoses of NSCLC made over 6 months in 2009. Stage I-IIIA patients were dichotomized into: No effusion and MiniPE. Malignant effusion (Stage IV) cases were recorded for comparison. The impact of effusion status on overall survival (OS) was estimated using Kaplan-Meier methodology. The probable cause of MiniPE was assessed indirectly using follow-up imaging/records. 3 Clinical Oncologists were surveyed for theoretical treatment plans in 8 randomly-selected MiniPE Stage I-IIIA cases based on anonymised imaging and history. These 24 plans were compared to the treatment delivered in MiniPE patients. <h3>Results</h3> 103/441 (23%) patients had MiniPE. 167/441 (38%) were Stage I-IIIA; 26/167 (16%) of these had MiniPE. OS based on effusion status (Stage I-IIIA) is shown in Figure 1. 28/103 (17%) MiniPE patients survived &lt;30 days and had limited post-diagnosis imaging. These were excluded from probable cause analyses. Of the remaining 75/103, 20 (27%) had radiological evidence of progressive pleural malignancy. Radical treatment was delivered in 4/26 (15%) Stage I-IIIA MiniPE cases but advocated in 17/24 (71%) theoretical plans, which showed significant inconsistencies. <h3>Conclusions</h3> These retrospective data confirm the negative prognostic impact of MiniPE and suggest the prevalence of OPM is at least 27% in Stage I-IIIA NSCLC. This is likely an underestimate given our limited data in poor prognosis patients. Radical treatment was rarely delivered despite aggressive treatment plans. A prospective study utilising thoracoscopic staging could define the true prevalence of OPM in MiniPE. Objective staging might improve decision-making, radical treatment rates and OS in this context.
Study of Pegylated Liposomal Doxorubicin in First Line Therapy of Aggressive Lymphomas.
Authors: Eudokia Mandala, Christos Lafaras, George Ilonidis, Ioannis Venizelos, George Grollios, Constantina Tsioni, Theodoros Bischiniotis, Constantinos Arvanitakis
Journal: Blood (2005)
SP0153 Emerging Therapies in Large Vessel Vasculitis
Authors: K. Warrington
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Giant Cell Arteritis (GCA) and Takayasu arteritis (TAK) are the two main forms of large vessel vasculitis. Because of parallels in clinical, radiographic and histologic features, the therapeutic approach to GCA and TAK has generally been similar. In both conditions, glucocorticoids (GC) are effective for remission induction. However relapses frequently occur during tapering of GC, and adverse effects commonly occur. The use of conventional immunosuppressive agents has not shown consistent benefit in maintaining disease remission or reducing GC-associated adverse events. <h3>Emerging therapies</h3> Several biologic agents have been studied in observational and randomized trials for both GCA and TAK. Tumor necrosis factor-alpha inhibitors appear to be effective in the treatment of TAK based on observational study data. In clinical trials of patients with GCA, TNF inhibitors have failed to show significant therapeutic efficacy and their use is not recommended. Interleukin-6 inhibition has gained particular focus in the treatment of GCA and TAK. Observational evidence supports the use of interleukin-6 inhibitors in TAK. Several retrospective studies and a recent randomized placebo-controlled trial has demonstrated efficacy of tocilizumab in GCA. Preliminary clinical trial data also suggests that abatacept may reduce the risk of relapse in GCA. Based on a small open-label study, ustekinumab appears safe and potentially effective for refractory GCA. A possible role of B cell dysregulation may contribute to pathogenic mechanisms in large vessel vasculitis, and B cell depleting therapy may also be an emerging treatment option. Ongoing clinical trials will yield vital information on the efficacy of biologic agents for GCA and TAK within the next year. <h3>Summary</h3> Interleukin-6 inhibitors appear efficacious in the treatment of refractory cases of large vessel vasculitis. Abatacept and ustekinumab are promising targets for therapy in large vessel vasculitis but further investigation is needed before routine use is considered. <h3>Disclosure of Interest</h3> None declared
No Association Was Found Between MTHFR and MTHFD1 SNPs and Vitamin Levels in People with Increased and Normal Erythropoiesis, after Compulsory Flour Fortification with Folic Acid
Authors: Maylla Rodrigues Lucena, Clovis Paniz, Juliano Felix Bertinato, Patricia Mendonça da Silva Amorim, Tamara Ramos Jorge, Maria Stella Figueiredo, Rodolfo Cancado, Maria de Fatima Sonati, Magnun N N Santos, Vera Bláia-D'Avila, Elvira M Guerra-Shinohara
Journal: Blood (2014)
Epilepsy Among Iraq and Afghanistan War Veterans — United States, 2002–2015
Authors: Mary Jo Pugh, Anne C. Van Cott, Megan Amuan, Christine Baca, Paul Rutecki, Matthew M. Zack, Rosemarie Kobau
Journal: MMWR Morbidity and Mortality Weekly Report (2016)

The age-adjusted prevalence of seizure disorder in United States veterans deployed in Iraq and Afghanistan conflicts (IAV) is 6.1 per 1,000 persons (1), compared with 7.1 to 10 per 1,000 persons in the general population (2,3). Persons with epilepsy are at risk of excess mortality in part because of comorbidity (4). Although patterns of comorbidity have been associated with mortality in IAV (5), the unique contribution of epilepsy to excess mortality in IAV is unknown. A cohort study was developed using inpatient, outpatient, and pharmacy data from the U.S. Department of Veterans Affairs, Veterans Health Administration (VA) to identify epilepsy, demographic characteristics, and baseline comorbidity for IAV who received VA care in 2010 and 2011. The VA's vital status records were used to identify 5-year mortality (2011-2015). The unadjusted Kaplan-Meier estimator and adjusted proportional hazards regression models tested the hypothesis that excess mortality is associated with epilepsy. IAV with epilepsy were more likely than those without epilepsy to have mental and physical comorbidity, and significantly higher mortality, even after controlling for demographic characteristics and other comorbid conditions (adjusted hazard ratio = 2.6; 95% confidence interval [CI] 2.1-3.2). IAV with epilepsy could benefit from evidence-based chronic disease self-management programs to reduce physical and psychiatric comorbidity, and linkages to VA clinical and other community health and social service providers.
Reduced Expression of CXCR4 on Circulating CD34+ Cells Is Associated with Hematopoietic Progenitor Cells (HPC) Mobilization in Patients with Myelofibrosis with Myeloid Metaplasia (MMM).
Authors: Margherita Massa, Vittorio Rosti, Alessandro M. Vannuccchi, Rita Campanelli, Alessandro Pecci, Gianluca Viarengo, Valentina Meli, Monia Marchetti, Paola Guglielmelli, Edward Bruno, Ming Xu, Ronald Hoffman, Giovanni Barosi
Journal: Blood (2005)
CHOP Chemotherapy for Unfavorable or Advanced Hodgkin’s Lymphoma. A Pilot Study.
Authors: Jan Walewski, Elzbieta Lampka, Ewa Kraszewska, Wlodzimierz Osiadacz, Joanna Tajer, Robert Konecki, Joanna Romejko-Jarosinska, Jacek Zwolinski, Janusz Meder
Journal: Blood (2004)
P0240 : Proteomic analysis of tissue interstitial fluid for identification of novel serum candidate diagnostic marker for hepatocellular carcinoma
Authors: W. Sun, Z. Liu, L. Guo, B. Xing, J. Mu, L. Sun, H. Wei, X. Zhao, X. Qian, Y. Jiang, F. He
Journal: Journal of Hepatology (2015)
PTH-100 Nice Guidance on The Treatment of Hepatitis C (HCV) Genotype 3 (G3) – Have We Forgotten The Past? Single Centre Experience of Biopsy Proven Fibrosis in HCV G3 Suggests Slower Progression than Previously Suggested
Authors: K Fairbrass, K Forrester, L Fenton, R Simpson, S Moreea
Journal: Gut (2016)

<h3>Introduction</h3> NICE guidance in 2000 (TA14) only recommended treatment of patients with moderate/severe HCV. NICE now advises that patients with G3 early disease should not be given DAAs but be treated with pegylated interferon/ribavirin, which is a longer treatment with lower SVR and more side effects. <h3>Methods</h3> Our databases were used to obtain: demographics, age at point of liver biopsy, stage of fibrosis and SVR in relation to all genotypes. We aim to plot the rate of progression of fibrosis in HCV G3 patients to ensure NICE guidance isn’t disadvantageous to this group. <h3>Results</h3> Between 1998–2015 we biopsied 477 patients: G1 112(81 males average 40 years, 31 females average 42 years) SVR 48%; G2 16(10 males; average 39 years, 6 females average 43 years) SVR75%; <b>G3 337</b>(194 males average 39 years, 143 females average 40 years) SVR 68%; G4 12(10 males average 38 years, 2 females average 45 years) SVR 42%. The point prevalence of fibrosis in <b>HCV G3 </b>at the time of liver biopsy is shown on the graph along with the SVR in relation to the stage of fibrosis. This confirms that fibrosis progresses with age but not in an exponential way and also recognises the well described fall in SVR with increasing fibrosis. <h3>Conclusion</h3> We confirm HCV G3 progresses in both males and females from the mid-40s. Our SVR data strongly suggests that we should provide all of our HCV G3 patients with the new potent DAAs to prevent progression of disease and subsequent consequences. We urge for a change in the current guidance. <h3>Disclosure of Interest</h3> None Declared
Monoclonal Gammopathy (MG) Associated with Gaucher Disease (GD). Report of 16 Cases from the French Observatoire on Gaucher Disease (FROG Study).
Authors: Bernard Grosbois, Jean Leone, Fabrice Camou, Florence Dalbies, Jean Robert Harle, Thierry Lamy, Luminita Luca, Christophe Plane, Jean Pierre Robin, Christian Rose, Christine deRoux-Serratrice, Eric Solary, Jean Marie Steiger
Journal: Blood (2006)
SAT0490 Poor Long-Term Adherence To Secondary Penicillin Prophylaxis among Pediatric Patients with Rheumatic Fever
Authors: G. Amarilyo, G. Chodick, I. Somekh, J. Zalcman, L. Harel
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Recurrent episodes of acute rheumatic fever (RF) may contribute to the development or worsening of rheumatic heart disease (RHD) and was estimated to occur in 50–70% of RF patients prior to the introduction of penicillin. Meta-analyses from the United States showed that secondary penicillin prophylaxis (SPP) may reduce the incidence of RHD. Moreover, SPP using monthly Intra muscular (IM) Benzathine Penicillin was more effective in prevention of RF recurrences than daily oral SPP. <h3>Objectives</h3> We aimed to evaluate the long-term adherence to SPP in RF patients using real-life data. <h3>Methods</h3> The study population included children up to 18 years old in Maccabi Healthcare Services (MHS), a 2-million member health organization in Israel, who were diagnosed with acute RF between 1/1996 to 5/2015 and were dispensed at least one monthly pack of penicillin (either in oral or IM form). Treatment persistence was defined as continuation of drug use for the entire duration of therapy or until age 18, whichever occurred first. Adherence to treatment refers to the extent of drug use during the period of persistence, expressed as mean proportion of days covered (PDC). This was calculated by dividing the quantity of penicillin dispensed by the total time span between index date and age 18, leaving MHS, or 31 April 2015, whichever occurred first. <h3>Results</h3> A total of 842 RF patients were identified. Mean (SD) ages at diagnosis among patients on oral (n=734) and IM (n=108) initial therapy were 8.6y (3.7y) and 10.9y (3.2y), respectively. The median PDC for the treatment regimens were oral: 8% [interquartile range (IQR) 2–33%] and IM: 10% (IQR 3–28%). Overall, days covered with SPP (figure 1) decreased exponentially from 103 days in the first year of therapy to 20 days in the 10th year. <h3>Conclusions</h3> Adherence and persistence to secondary penicillin prophylaxis among Israeli children diagnosed with RF is poor. Although less effective, oral SPP was the preferred regimen. Intervention plans to increase adherence and persistence to SPP must be implemented in countries where RF still exists. <h3>Disclosure of Interest</h3> None declared
SAT0065 Effects of Dmard Tapering on Treatment Costs in Rheumatoid Arthritis Patients- An Analysis from The Prospective Randomized Controlled Retro- Study
Authors: M. Hagen, C. Figueiredo, J.F. Cobra, M. Reiser, J. Haschka, M. Englbrecht, A. Hueber, B. Manger, A. Kleyer, S. Finzel, H.-P. Tony, J. Wendler, S. Kleinert, F. Schuch, M. Ronneberger, M. Feuchtenberger, M. Fleck, K. Manger, W. Ochs, M. Schmitt-Haendle, H.-M. Lorenz, H. Nuesslein, R. Alten, J.C. Henes, K. Krueger, G. Schett, J. Rech
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Achieving remission is the most important treatment goal in patients with rheumatoid arthritis (RA). With the development and wider use of highly effective disease modifying anti-rheumatic drugs (DMARD) about half of RA patients reach a state of disease remission, raising the question about tapering or stopping anti-rheumatic treatment. <h3>Objectives</h3> To assess the effect of a controlled DMARD tapering regimen on treatment costs and work productivity in RA patients in remission <h3>Methods</h3> 101 RA patients in sustained remission (DAS28 &lt;2.6 for more than 6 months) enrolled in the multicenter randomized controlled RETRO Study were analyzed (1). Patients either continued DMARDs (arm1), tapered dose by 50% (arm 2) or entire stopped DMARDs after tapering (arm 3) for one year. Assessment of DMARD costs and work productivity was done every three months in all 101 patients including those remaining in remission and those relapsing a re-starting their original DMARD regimen. <h3>Results</h3> In RA patients treated with conventional DMARDs, baseline quarterly treatment costs of 154€ remained stable in arm 1 (156€), while decreasing to 81€ in arm 2 and 75€ in arm 3. In patients treated with biologic DMARDs quarterly treatment costs were 5708€ at baseline. They remained stable in arm1 (5533€) and decreased to 2855€ in arm 2 and 2668€ in arm 3. Overall DMARD costs were reduced by 327.292€ within one year, while outcome was very good with patients either remaining in remission or immediately regaining remission when exposed to original DMARD regimen after relapse. <h3>Conclusions</h3> Controlled tapering of DMARD treatment leads to effective reduction of treatment costs in RA patients in sustained remission. <h3>References</h3> ) Relapse rates in patients with rheumatoid arthritis in stable remission tapering or stopping antirheumatic therapy: interim results from the prospective randomised controlled RETRO study.Haschka J, Englbrecht M, Hueber AJ, Manger B, Kleyer A, Reiser M, Finzel S, Tony HP, Kleinert S, Feuchtenberger M, Fleck M, Manger K, Ochs W, Schmitt-Haendle M, Wendler J, Schuch F, Ronneberger M, Lorenz HM, Nuesslein H, Alten R, Demary W, Henes J, Schett G, Rech J. Ann Rheum Dis. 2016 Jan;75(1):45–51. doi: 10.1136/annrheumdis-2014-206439. Epub 2015 Feb 6. <h3>Disclosure of Interest</h3> None declared
Impact of Pre-Transplantation, Mobilization and Graft Variables on Transplant Outcome after Autologus Hematopoietic Stem Cell Transplantation in Multiple Myeloma in Patients
Authors: Mauricette Michallet, Quoc Hung Le, Mohamad Sobh, Nicole Raus, Melissa Clarck, Jean Vial, Gilles Clapisson, Carole Paillet, Franck E Nicolini, Jacques Troncy, Xavier Thomas, Youcef Chelghoum, Emmanuelle Nicolas-Vierlizier, Giovanna Cannas, Claudiu Plesa, Fiorenza Baracco
Journal: Blood (2008)
Functional variants in the sucrase–isomaltase gene associate with increased risk of irritable bowel syndrome
Authors: Maria Henström, Lena Diekmann, Ferdinando Bonfiglio, Fatemeh Hadizadeh, Eva-Maria Kuech, Maren von Köckritz-Blickwede, Louise B Thingholm, Tenghao Zheng, Ghazaleh Assadi, Claudia Dierks, Martin Heine, Ute Philipp, Ottmar Distl, Mary E Money, Meriem Belheouane, Femke-Anouska Heinsen, Joseph Rafter, Gerardo Nardone, Rosario Cuomo, Paolo Usai-Satta, Francesca Galeazzi, Matteo Neri, Susanna Walter, Magnus Simrén, Pontus Karling, Bodil Ohlsson, Peter T Schmidt, Greger Lindberg, Aldona Dlugosz, Lars Agreus, Anna Andreasson, Emeran Mayer, John F Baines, Lars Engstrand, Piero Portincasa, Massimo Bellini, Vincenzo Stanghellini, Giovanni Barbara, Lin Chang, Michael Camilleri, Andre Franke, Hassan Y Naim, Mauro D'Amato
Journal: Gut (2016)

IBS is a common gut disorder of uncertain pathogenesis. Among other factors, genetics and certain foods are proposed to contribute. Congenital sucrase-isomaltase deficiency (CSID) is a rare genetic form of disaccharide malabsorption characterised by diarrhoea, abdominal pain and bloating, which are features common to IBS. We tested sucrase-isomaltase (SI) gene variants for their potential relevance in IBS.We sequenced SI exons in seven familial cases, and screened four CSID mutations (p.Val557Gly, p.Gly1073Asp, p.Arg1124Ter and p.Phe1745Cys) and a common SI coding polymorphism (p.Val15Phe) in a multicentre cohort of 1887 cases and controls. We studied the effect of the 15Val to 15Phe substitution on SI function in vitro. We analysed p.Val15Phe genotype in relation to IBS status, stool frequency and faecal microbiota composition in 250 individuals from the general population.CSID mutations were more common in patients than asymptomatic controls (p=0.074; OR=1.84) and Exome Aggregation Consortium reference sequenced individuals (p=0.020; OR=1.57). 15Phe was detected in 6/7 sequenced familial cases, and increased IBS risk in case-control and population-based cohorts, with best evidence for diarrhoea phenotypes (combined p=0.00012; OR=1.36). In the population-based sample, 15Phe allele dosage correlated with stool frequency (p=0.026) and Parabacteroides faecal microbiota abundance (p=0.0024). The SI protein with 15Phe exhibited 35% reduced enzymatic activity in vitro compared with 15Val (p<0.05).SI gene variants coding for disaccharidases with defective or reduced enzymatic activity predispose to IBS. This may help the identification of individuals at risk, and contribute to personalising treatment options in a subset of patients.