tbuckley/cabot-search huggingface dataset:
PWE-031 How many Colorectal Cancers (CRC) Have Been Missed in the 36 Months after ‘Normal’ Lower Gi Endoscopy (Colonoscopy/Flexible Sigmoidscopy)
Authors: K Keshk, J T Green, G Swift
Journal: Gut (2013)

<h3>Introduction</h3> Colonoscopy and flexible sigmoidscopy are the primary tools for diagnosis of CRC, although they have false negative rates of 2–6%.¹ The aim of this study was to estimate how frequently lower GI endoscopy might have failed to detect cancer within 36 months preceding a confirmed diagnosis of CRC. <h3>Methods</h3> We identified 253 patients diagnosed with CRC between Sep 2010 – Aug 2012 from the database of cellular pathology in Cardiff and Vale University Health Board. Medical records were reviewed for the results of colonoscopy, flexible sigmoidscopy, histology and CT imaging. Patients with missed cancer were those who had had a ‘normal’ (if no cancer discovered) lower GI endoscopy procedure 1–36 months before diagnosis. We examined the characteristics that might be risk factors for missed CRC. <h3>Results</h3> Among the 253 patients included in the study, cancer was located in the rectosigmoid colon (78.5%), descending colon (2.7%), splenic flexure (1.9%), transverse colon (4.3%), hepatic flexure (1.1%) and right colon (9.4%). We identified 10 (5 females, 5 males, mean age 80 years, range 42–92) patients (3.9%) who had had colonoscopy and/or flexible sigmoidscopy that had not shown CRC 1–36 months prior to the final diagnosis. In the missed cancer group only one flexible sigmoidscopy was incomplete due to suboptimal bowel preparation and difficult sigmoid bend. Nine patients had false negative lower GI endoscopy. The median diagnostic delay was 13.6 months (1–36). Two of the missed cancers were diagnosed with Dukes’ C colon cancer, one with Dukes’ D colon cancer and one presented with emergency complications due perforation. Of the ten missed cancers, eight were in rectosigmoid colon, one in the transverse colon and one in the ascending colon. <h3>Conclusion</h3> Bressler <i>et al</i> reported 2–6% missed CRC at colonoscopy performed 6–36 months prior to a final diagnosis of cancer.¹ Our miss rates are in line with previous studies. However, the available literature suggests that lesion miss rate is higher for proximal colonic tumours. In our study, the missed cancers were predominantly in the rectosigmoid colon (3.1%) and were minimal in the right colon (0.4%). The reasons for missed cancers in our study are likely related to incomplete procedure, suboptimal bowel preparation, inadequate technique, failure to recognise flat lesions and diverticulosis. Optimal withdrawal technique, good luminal view, frequent position change, high quality bowel prep and adequate time for inspection are of utmost importance to minimise the rate of missed CRC. <h3>Disclosure of Interest</h3> None Declared. <h3>Reference</h3> Bressler B,<i></i><i>et al.</i> Rates of new or missed colorectal cancer after colonoscopy and their risk factors: a population–based study. Gastroenterology 2007; 132(1):96–102
Mutations in the Precore Region of Hepatitis B Virus DNA in Patients with Fulminant and Severe Hepatitis
Authors: M Omata, T Ehata, O Yokosuka, K Hosoda, M Ohto
Journal: New England Journal of Medicine (1991)

The presence of the hepatitis B e antigen (HBeAg) in serum is known to be a marker of a high degree of viral infectivity. However, fulminant hepatitis may occur in persons who are negative for HBeAg. A single point mutation has been reported to produce a stop codon in the precore region of hepatitis B virus DNA and prevent the formation of the precore protein required to make HBeAg. To determine whether a precore-mutant virus is causally related to severe liver injury, we analyzed the entire precore region in viral strains isolated from patients with fatal cases and uncomplicated cases of hepatitis B.Serum was obtained from 9 patients with fatal hepatitis B (5 with fulminant and 4 with severe exacerbations of chronic hepatitis) and 10 patients with acute, self-limited hepatitis B. Serum samples from a sex partner implicated as the source of the virus in one case of fulminant hepatitis were also studied. The 87 nucleotides in the precore region of the hepatitis B virus were amplified by the polymerase chain reaction and then directly sequenced.Of the nine patients with fatal hepatitis, seven had retrievable hepatitis B DNA: In all seven there was a point mutation from G to A at nucleotide 1896 of the precore region, converting tryptophan (TGG) to a stop codon (TAG). In contrast, this mutation was not found in the 10 patients with acute, self-limited hepatitis B. The hepatitis B DNA from the implicated source contained a sequence with the stop-codon mutation that was identical to the sequence in her partner, who had fulminant hepatitis.The presence of a mutant viral strain is associated with and may be involved in the pathogenesis of fulminant hepatitis B and severe exacerbations of chronic hepatitis B.
COMPARATIVE EFFECTIVENESS OF CARDIAC RESYNCHRONIZATION THERAPY WITH DEFIBRILLATOR VERSUS DEFIBRILLATOR ALONE IN HEART FAILURE PATIENTS WITH MODERATE TO SEVERE CHRONIC KIDNEY DISEASE
Authors: Daniel Friedman, Jagmeet Singh, Jeptha Curtis, Wai Hong Tang, Haikun Bao, Erica Spatz, Adrian Hernandez, Uptal Patel, Sana Al-Khatib
Journal: Journal of the American College of Cardiology (2015)
ET-31 * RADIOSENSITIZATION BY OMX-4.80P, A PEGylated H-NOX OXYGEN CARRIER THAT PENETRATES AND OXYGENATES HYPOXIC TUMORS, IN PRECLINICAL MODELS OF GLIOBLASTOMA AND OTHER HYPOXIC CANCERS
Authors: A. Krtolica, N. Le Moan, J. Getz, T. Davis, S. Ng, C. Bedard, A. Davis, P. Leung, L. Serwer, K. Tanaka, T. Keating, F. Yan, J. Winger, S. Cary
Journal: Neuro-Oncology (2014)

BACKGROUND: Omniox has engineered OMX-4.80P, a PEGylated H-NOX oxygen carrier, as a long-acting therapeutic candidate to enhance radiotherapy (RT) in the treatment of glioblastoma (GB) and other solid tumors. We have previously described the un-PEGylated OMX-4.80 variant, which can penetrate intracranial mouse GB tumors, release oxygen exclusively into hypoxic tumor tissue, and enhance tumor growth delay and survival when combined with RT. However, OMX-4.80 has a short circulation half-life that limits its clinical potential. Here, we describe the pre-clinical profile of PEGylated OMX-4.80 (OMX-4.80P), demonstrating it is well tolerated, long-lasting in circulation and tumors, and is significantly more efficacious than OMX-4.80. METHODS: We PEGylated OMX-4.80 to increase its circulation half-life while retaining its ability to preferentially accumulate in tumors and selectively release oxygen to hypoxic microenvironments. We characterized the efficacy of OMX-4.80P in large, hypoxic, radioresistant tumors, and its activity in intracranial GB models in nude mice and immunocompetent rats. We also conducted toxicology and pharmacokinetic studies in multiple animal models including naïve dogs. RESULTS: In xenograft studies of large, hypoxic, radioresistant tumors, single doses of OMX-4.80P in combination with RT result in apparent tumor cures in ∼30-50% of tumors compared to 0% cures in RT-only groups. Interestingly, the larger molecular size of OMX-4.80P (∼120kDa) did not prevent its passing the blood-tumor barrier in mouse and rat intracranial tumors and resulted in hypoxia reduction. Pharmacokinetic and toxicology studies using single or multiple supratherapeutic and therapeutic doses of OMX-4.80P in rodents and dogs demonstrated that it has a circulation half-life of ∼24h in rats and ∼52h in dogs, compared to 1-2h for OMX-4.80, and that it is well tolerated. Finally, OMX-4.80P has no detectable immunogenic response. CONCLUSIONS: The preclinical efficacy data, and promising pharmacokinetic and toxicology profile, of OMX-4.80P support its clinical development for the enhancement of radiotherapy in GB patients.
SAT0363 Evaluation of the Use of Colchicine in the Management of Chronic Gout
Authors: D. Chandrasekaran, S. Cioffi, J. Waterman
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> The rising cost of colchicine in the United States for the treatment of gout resulted in our evaluation of the use of colchicine in the management of gout. <h3>Objectives</h3> The purpose of this analysis was to ascertain whether colchicine is used appropriately and if we could reduce the cost of colchicine use at the VA Connecticut Healthcare System (VACHCS) by establishing criteria for its use. <h3>Methods</h3> All VACHCS primary care patients who were currently taking colchicine in July 2011 were identified using the pharmacy prescription processing system (VISTA). A total of 515 patients were identified from VISTA as being on colchicine. Patients who were on short courses of colchicine (prescriptions given for less than 30 days) or for whom it was prescribed on a PRN basis were excluded. We identified situations in which we felt the use of chronic colchicine was inappropriate: 1. colchicine use for &gt; 6 months with control of clinical gout; 2. chronic colchicine alone without hypouricemic therapy; 3. serum uric acid levels &gt; 6 mg/dl without control of gout and no attempt to titrate hypouricemic agent; 4. serum uric acid level not checked in the past 6 months <h3>Results</h3> Of the 515 patients identified as taking colchicine, 41 patients were prescribed colchicine for less than 30 days and 263 patients were on colchicine on a PRN basis. The remaining 211 patients charts were reviewed and they formed the study group. All these patients were on colchicine inappropriately fulfilling one or more of the above criteria. A total of 168 (79%) had serum uric acid levels checked within a year. Of these patients only 56(26%) were below the recommended serum uric acid target level of 6 mg/dl or less. 113(54%) patients were on hypouricemic drugs (allopurinol/febuxastat or probenecid). The average dose of allopurinol was only 225mg. Those patients on hypouricemic drugs, only 45 had serum uric acid levels at or below target. <h3>Conclusions</h3> Our study demonstrates that a significant percentage of gout patients are inappropriately on long-term colchicine with only 26% having serum uric acid levels at or below the target level of 6 mg/dl. In addition, a number of patients were either on sub-therapeutic doses or on no hypouricemic agents at all. Following guidelines for appropriate colchicine use will not only reduce the cost of colchicine use but also decrease the risk of adverse events. <h3>References</h3> Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis Borstad GC, Alloway A randomised controlled trial on the efficacy and tolerability with dose escalation of allopurinol 300-600mg/day versus benzbromarone 100-200mg/day in patients with gout. Reinders MK, Brouwers JR. A critical reappraisal of allopurinol dosing, safety and efficacy for hypouricemia in gout. Chao J, Terkeltaub R.Oral colchicine (Colcrys): in the treatment and prophylaxis of gout. Yang LP <h3>Disclosure of Interest</h3> None Declared
FRI0453 Gait assessment in patients with plantar fasciitis using the modular electronic baropodometer:
Authors: H.A.V. Oliveira, A. Jones, E. Moreira, F. Jenings, J. Natour
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Plantar fasciitis (PF) is an inflammation of the plantar fascia characterized by pain and stiffness in the medial arch of the foot and ankle, especially during initial steps, and can have a significant effect on activities of daily living. There are no previous studies assessing the gait of individuals with PF. <h3>Objectives</h3> Assess gait variables in patients with PF and foot pain using the Modular Electronic Baropodometer. <h3>Methods</h3> Seventy-four patients over 18 years of age with a diagnosis of PF and foot pain while walking ranging from 3 to 8 points on a 10-point pain scale were analyzed. Patients with other musculoskeletal conditions in symptomatic lower limbs, inflammatory conditions of the central or peripheral nervous systems, diabetes mellitus or an inability to walk were excluded. Evaluations were performed using a visual analogue scale (VAS) for pain, the SF-36 quality of life questionnaire, foot function index (FFI) and six-minute walk test (6MWT). Gait analysis was performed using AM Cube - FootWork Pro Walk analysis system. The correlations between pain/function and baropodometer parameters were analysed. <h3>Results</h3> Mean age was 49.3 (10.41) years. Mean duration of symptoms was 111.57 (157.18) weeks and mean body mass index was 29.34 (5.49) kg/m<sup>2</sup>. Table 1 displays the clinical and baropodometer parameters. <h3>Conclusions</h3> Pain and function were correlated with cadence and step time. Showing that the worsening of pain and function has direct correlation with the decrease of these parameters in PF patients. <h3>References</h3> Lynch DM et al. Conservative treatment of plantar fasciitis: a prospective study. J Am Pod Med Assoc 1998; 88(8):375-380. Ribeiro, A.P., et al., The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners, Clin. Biomech. (2010), doi: 10.1016/j.clinbiomech.2010.08.004 <h3>Disclosure of Interest</h3> None Declared
Massive Ascites Due to Myxedema
Authors: Franklin K. Paddock
Journal: New England Journal of Medicine (1950)

OF THE many causes of ascites, myxedema is rarely considered and rarely encountered, particularly at present, when an estimation of the basal metabolic rate is a frequent part of routine medical examinations. The following case of this condition is presented because of its comparative rarity and because of the associated massive ascites.Case ReportMrs. G., a 48-year-old housewife, was admitted to the Pittsfield General Hospital on February 28, 1949, because of abdominal swelling. Little or no history was obtained from the patient herself because of deafness (which had become increasingly severe for many years) and obvious mental dullness. This . . .
Immersion Day — Transforming Governance and Policy by Putting on Scrubs
Authors: Richard W. Bock, Ronald A. Paulus
Journal: New England Journal of Medicine (2016)

Interview with Dr. Ronald Paulus on a program at his health system for educating board members about care delivery. (06:52)Download The disconnect between real-world health care and the information delivered in boardrooms or policy discussions is a barrier to responsive governance and policymaking. So Mission Health immerses board members, journalists, legislators, and regulators in its daily work.
Role of platelets, neutrophils, and factor XII in spontaneous venous thrombosis in mice
Authors: Marco Heestermans, Salam Salloum-Asfar, Daniela Salvatori, El Houari Laghmani, Brenda M. Luken, Sacha S. Zeerleder, Henri M. H. Spronk, Suzanne J. Korporaal, Gerry T. M. Wagenaar, Pieter H. Reitsma, Bart J. M. van Vlijmen
Journal: Blood (2016)
P165Magnesium orotate in high concentration elicits cardioprotection via modulation of mitochondrial functions
Authors: O M Duicu, A Gorbe, A Privistirescu, N S Mirica, T Csont, P Ferdinandy, D M Muntean
Journal: Cardiovascular Research (2014)

Modulation of mitochondrial function in the settings of ischemia/reperfusion (I/R) injury represents a major therapeutic target of pharmacological agents able to reduce the cell death at reperfusion. The aim of this study was to compare the effects of acute administration of magnesium orotate (MO), MgCl2, orotic acid (OA) with those elicited by the classic mitochondrial permeability transition pore (mPTP) desensitizer, cyclosporine A (CsA) in two experimental settings. The pharmacological agents were administered: i) at reoxygenation in neonatal cardiomyocytes subjected to 4 hours simulated ischemia followed by 2 hours reoxygenation with the assessment of cell viability and reactive oxygen species (ROS) generation, and ii) at reperfusion in isolated rat hearts subjected to 30 min of global ischemia and 120 min of reperfusion. In the latter model myocardial functional recovery (at 30 min of reperfusion) and infarct size (at 120 min of reperfusion) were assessed. In a separate group of animals, mitochondria were isolated at 15 min of reperfusion after global ischemia, and mitochondrial respiration, ROS production (Amplex Red) and calcium retention capacity were assessed. Acute administration of 5 mM MO, MgCl2, OA or 1 μM CsA in neonatal cardiomyocytes subjected to simulated ischemia/reoxygenation enhanced cell survival; these protective effects were not associated with changes in ROS production during reoxygenation. During the postischemic reperfusion in rat hearts and isolated mitochondria, respectively, MO, MgCl2 (5 mM both) and CsA (0.2 μmol/L), but not OA: (i) induced an important recovery of left ventricular end-diastolic pressure (LVDP), and decreased infarct size vs. controls, and (ii) protected against loss of outer mitochondrial membrane integrity and subsequent deficits in electron transport and also inhibited the calcium triggered-mPTP opening. In particular, the effects of MO were comparable to the ones elicited by CsA. In conclusion, acute administration of magnesium orotate in high concentration during the postischemic reperfusion is associated with cardioprotective effects via modulation of mitochondria functions.
FRI0183 Adherence to Methotrexate in Rheumatoid Arthritis Treated by Practice Vs. Hospital Based Rheumatologists: A Danish Nationwide Cohort Study: Table 1.
Authors: H. Bliddal, S.A. Eriksen, R. Christensen, T. Lorenzen, M.S. Hansen, M. Østergaard, L. Dreyer, P. Vestergaard
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Adherence to Methotrexate has been reported to be weak in patients with rheumatoid arthritis. <h3>Objectives</h3> To study adherence to methotrexate (MTX) and factors of importance thereof. in rheumatoid arthritis (RA). <h3>Methods</h3> Danish Nationwide cohort study. All patients with a hospital diagnosis of RA (ICD10 codes M05.X, M06.X) after January 1, 1997 and aged ≥18 years at the date of first diagnosis/contact, with at least one prescription of MTX (L04AX03) were included. To avoid prevalent cases only those with a first time diagnosis after January 1, 1998 were included. <h3>Results</h3> A total of 18,703 patients had ever used MTX among 39,286 with a diagnosis of RA, and among these, 16,503 had filed more than one MTX prescription. Among MTX users, 48% had been exposed to systemic corticosteroids within the last year prior to first MTX prescription. Time from diagnosis to first MTX prescription was 1.6±2.4years with no indication of decrease during the period. In those who filed more than one MTX prescription, the mean persistence time for ≥7.5 mg MTX per week was 4,766 days. The main determinants of non-persistence were female gender, younger age, and time from diagnosis to initiation of MTX (those with more than 1 year of lag time being less compliant). The MTX adherence was the same in patients treated in hospital outpatient clinics or by private practising specialist. <h3>Conclusions</h3> Treatment at hospital or in private practice did not influence the adherence to MTX. Non-modifiable factors of importance were gender and age, while adherence to MTX therapy decreased with a longer time lapse between diagnosis and prescription. The present study could not document a quick and consistent use of MTX early after diagnosis, as the recommended aggressive treat-to-target strategy with MTX as anchor drug would suggest. <h3>Acknowledgements</h3> We thank the personal and scientific support of Statistics Denmark. <h3>Disclosure of Interest</h3> H. Bliddal Grant/research support: Roche, Pfizer, Abbvie, Novo, S. Eriksen: None declared, R. Christensen Grant/research support: Roche, Pfizer, MSD, UCB, T. Lorenzen Grant/research support: Roche, M. Hansen Grant/research support: Roche, M. Østergaard Grant/research support: Abbott, Bristol-Myers Squibb, Centocor, GlaxoSmithKline, Janssen, Merck, Mundipharma, Novo Nordisk, Pfizer, Schering-Plough, Roche UCB, L. Dreyer: None declared, P. Vestergaard: None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.5585
European Parliament rejects high sugar content in baby foods
Authors: Rory Watson
Journal: BMJ (2016)

Members of the European Parliament are placing pressure on the European Commission to follow World Health Organization recommendations limiting the amount of sugar in baby foods. They voted by a majority of 393 votes to 305 to reject the commission’s proposal to maintain the current European Union permitted level. This is three times the WHO guidelines.

The British Green MEP Keith Taylor, who led the parliamentary opposition, said that the vote showed a determination to place the health of babies and children first. “The health …
Discrimination against Negroes in Hospitals
Authors: Max Seham
Journal: New England Journal of Medicine (1964)

GUNNAR Myrdahl, in The American Dilemma, wrote, "A genuine and irreconcilable conflict exists between two sets of irreconcilable ideas: on the one hand, the principle of equal rights and fundamental equality of all Americans: and on the other hand race prejudice and discrimination which deny equal opportunity to members of certain racial and ethnic groups."Although more subtle and less publicized than discrimination in other social and economic areas, this moral conflict has spread to all areas of medicine, including hospitals.In the days of slavery, there was no discrimination against Negroes in hospitals for the simple reason that there . . .
Stability of diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area study
Authors: E Nelson, J Rice
Journal: American Journal of Psychiatry (1997)

This study examined the 1-year temporal stability of a National Institute of Mental Health Diagnostic Interview Schedule (DIS) lifetime diagnosis of obsessive-compulsive disorder in the Epidemiologic Catchment Area (ECA) study.In that study, 20,862 individuals, aged 18 years and over, at five sites were evaluated by lay interviewers using the DIS (wave 1). All of those who were available 12 months later were reinterviewed (wave 2). In the present study, the temporal stability of wave 1 obsessive-compulsive disorder diagnoses at wave 2 was examined, as well as relationships with comorbid diagnoses. The consistency of reports of "new-onset" illness was also examined. Factors contributing to these measures were evaluated.The temporal stability of the diagnosis of obsessive-compulsive disorder was very low. Subjects with a stable diagnosis of obsessive-compulsive disorder had a higher rate of both obsessions and compulsions, an earlier age at onset, and more comorbid anxiety, affective, and alcohol abuse/dependence disorders at initial assessment. The originally reported 1-year incidence estimates for obsessive-compulsive disorder primarily reflect data from subjects at wave 2 who reported the onset of symptoms as preceding the wave 1 interview. Older and less-educated subjects had significantly higher error rates in reporting onset.The DIS diagnosis of obsessive-compulsive disorder has poor validity, leaving the true incidence and prevalence of the disorder unknown. Older and less-educated subjects require special attention in the design of instruments for use with community samples.