tbuckley/cabot-search huggingface dataset:
PTU-037 Predicting inflammatory pathology at capsule enteroscopy: what is the utility of a raised faecal calprotectin?
Authors: C Parker, CA Lamb, M Robinson, JC Mansfield, M Gunn
Journal: Gut (2015)

<h3>Introduction</h3> Faecal Calprotectin (FCP) is a widely used biomarker of gastrointestinal (GI) mucosal inflammation. Many capsule enteroscopy (CE) services are receiving increased referrals of patients with abdominal symptoms combined with an elevated FCP (&gt;50 µg/g) but normal gastroscopy, colonoscopy or radiology. There is little data on using FCP levels as a screening tool for selecting patients in whom CE will lead to a definitive diagnosis. Elevated FCP levels may indiscriminately drive investigations in endoscopy and imaging-negative patients who subsequently have normal findings at CE. We aimed to determine the incidence of inflammatory pathology on CE in patients with a raised FCP, and if a suitable concentration of the biomarker could be identified as a screening tool to avoid unnecessary CE. <h3>Method</h3> A single centre retrospective review of The Newcastle upon Tyne Hospitals CE database was conducted (Feb 2012–Feb 2015). Patients with GI symptoms (abdominal pain, diarrhoea, bloating, vomiting, weight loss) and a raised FCP (&gt;50 µg/g) were identified. Findings at CE considered to be inflammatory were: erythema, ulceration, erosions and fissuring. <h3>Results</h3> 35 patients were identified with elevated FCP and GI symptoms. 45.7% (n = 16) had inflammation identified by CE and in 54.3% (n = 19) no inflammatory pathology was identified. The mean (+/-SE) FCP was higher in patients with evidence of inflammation at CE in comparison to those with no inflammation: 452.1 (95.8) µg/g vs. 206 (20.8) µg/g; p = 0.01. Stratifying patients according to FCP revealed that only 8.3% of patients (n = 1/12) with a FCP of 50–200 µg/g had inflammatory findings at CE. This rose to 58.3% of patients (n = 7/12) with a FCP of 201–300 µg/g, and 72.7% of patients (n = 8/11) with a FCP &gt;300 µg/g. A threshold of 200 µg/g FCP revealed a sensitivity of 94.1% to predict inflammation at CE, with a specificity of 55.6%. This FCP threshold had a negative predictive value of 90.9%, and positive predictive value of 66.7% for CE inflammation. <h3>Conclusion</h3> In this small retrospective analysis of a sub-group of patients referred for CE with a FCP of &gt;50 μg/g the likelihood of identifying inflammatory pathology at CE increased with rising FCP concentrations above 200 μg/g. A threshold of 200 μg/g provided a high negative predictive value for CE inflammation and may be a useful screening tool to reduce the requirement for CE in select patient groups. This retrospective analysis should be confirmed in a larger prospective cohort. <h3>Disclosure of interest</h3> None Declared.
FRI0146 Effectiveness of Retreatment After Relapse of Rheumatoid Arthritis Patients Under Down-Titrated Biological Therapy
Authors: J.P. Vinicki, M. Arredondo, E. Ramírez-Herráiz, A. Ortiz, S. Castañeda Sanz, A. Morell, R. García-Vicuña, J. Alvaro-Gracia
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Down-titration of biological therapy (BT) in rheumatoid arthritis (RA) patients with a good clinical response is frequently applied in daily clinical practice. An important factor in order to know if this can be safely applied is the response to retreatment in flaring patients. We present an analysis of relapses and responses to retreatment in RA patients who had previously undergone down-titration of BT. <h3>Objectives</h3> To evaluate the effectiveness (in daily clinical practice) of retreatment in RA patients receiving BT who had been previously down-titrated and relapsed. <h3>Methods</h3> Retrospective observational study in a single center. RA patients receiving BT (infliximab, adalimumab, etanercept, certolizumab pegol, abatacept and tocilizumab) previously down-titrated (quarterly dose of BT less than or equal to 83% of the approved dose) were included. Retreatment consisted of increasing the dose to previous or standard (EMA approved) dose, at the discretion of the attending physician. Relapse was defined as an increase greater than or equal to 0.6 points from baseline DAS28 or according to the attending physician criteria. Response to retreatment was defined according to EULAR response criteria. Numerical data are expressed as mean and standard deviation for continuous variables and percentages for qualitative variables. <h3>Results</h3> Two hundred and fifty-six RA patients were under BT and 91 patients were down-titrated of whom 52% were in remission, 24% with low disease activity and 24% with moderate disease activity according to DAS28. Most patients (78.6%) were receiving first line BT. Twenty eight patients relapsed and received retreatment at full dose (61%) or previous dose (39%). The average time between down-titration and retreatment was 17.2±13.7 months. Mean DAS28 at the time of retreatment was 4.01±0.99. Most patients (75%) achieved EULAR good or moderate response before 6 months of retreatment, regardless of standard or previous dose. Mean DAS28 in these patients was 2.87±0.78. There was no significant difference in the response achieved at 6 months depending upon baseline disease activity status or BT line. <h3>Conclusions</h3> Although down-titration carries a risk of relapse in RA, most patients achieve a good response after retreatment. <h3>Disclosure of Interest</h3> None declared
Surgeon criticised for transplant operation
Authors: Annette Tuffs
Journal: BMJ (2002)

A senior surgeon in Germany has come under fire for going ahead with a kidney transplant operation using an organ from a living donor—despite the proposed operation being opposed by colleagues in psychological medicine and the ethics committee of the regional medical council.

The surgical university hospital in Essen, where surgeon Christoph Broelsch is director, was approached by a dialysis patient from Israel who said his cousin from Moldavia, who was 30 years younger, wanted to donate his kidney.

In 15 out of Germany's 16 states, transplant law requires, in the case of living donors, that an independent committee ensures that there is no commercial basis to the donation and that there are emotional and personal ties between donor and recipient. None were found in this case, so the patient's request was refused. He decided to resort to a hospital in the one state without such a rule, Thuringia. He went to the surgical university hospital in Jena, where he was accepted and where Professor Broelsh carried out the operation.

The medical director of Essen University Hospital, Werner Havers, rejected any suspicion that the operation had involved any commercial trade in organs but said that Professor Broelsch should have abided by the vote of his Essen colleagues and the transplant operation should not have gone ahead.
The hypothalamic-pituitary-thyroid axis in social phobia
Authors: M E Tancer, M B Stein, C S Gelernter, T W Uhde
Journal: American Journal of Psychiatry (1990)

The authors investigated indices of hypothalamic-pituitary-thyroid (HPT) axis function in patients with social phobia. They found no differences between patients with social phobia and age- and sex-matched control subjects in plasma T3, T4, free T4, or TSH levels or in the proportion of subjects with positive antithyroid antibodies. Patients with social phobia and control subjects also did not differ in three of the four measures used to assess TSH response to TRH. These data suggest that abnormalities in thyroid function are not requisite neuroendocrine correlates of social phobia.
Generation of Functional Human Dendritic Cells From Adherent Peripheral Blood Monocytes by CD40 Ligation in the Absence of Granulocyte-Macrophage Colony-Stimulating Factor
Authors: Peter Brossart, Frank Grünebach, Gernot Stuhler, Volker L. Reichardt, Robert Möhle, Lothar Kanz, Wolfram Brugger
Journal: Blood (1998)
Enzyme Changes Induced in Normal and Malignant Tissues with Chemical Agents. VII. Effect on Hydrolytic and Synthetic Enzymes of Diphosphopyridine Nucleotide in Sarcoma 37
Authors: V. S. Waravdekar, O. H. Powers, J. Leiter
Journal: JNCI Journal of the National Cancer Institute (1956)

Enzyme Changes Induced in Normal and Malignant Tissues with Chemical Agents. VII. Effect on Hydrolytic and Synthetic Enzymes of Diphosphopyridine Nucleotide in Sarcoma 37 V. S. Waravdekar, V. S. Waravdekar Laboratory of Chemical Pharmacology, National Cancer Institute,3Bethesda, Maryland Search for other works by this author on: Oxford Academic PubMed Google Scholar O. H. Powers, O. H. Powers Laboratory of Chemical Pharmacology, National Cancer Institute,3Bethesda, Maryland Search for other works by this author on: Oxford Academic PubMed Google Scholar J. Leiter J. Leiter Laboratory of Chemical Pharmacology, National Cancer Institute,3Bethesda, Maryland Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 17, Issue 2, August 1956, Pages 145–154, https://doi.org/10.1093/jnci/17.2.145 Published: 01 August 1956 Article history Received: 23 March 1956 Published: 01 August 1956
Monoamine oxidase inhibitors as treatment for depressed patients with primary degenerative dementia (Alzheimer's disease)
Authors: M A Jenike
Journal: American Journal of Psychiatry (1985)

Two Alzheimer's patients with disabling depression failed to respond to standard antidepressants but improved with a monoamine oxidase inhibitor. The author points out that the cholinergic system is involved in Alzheimer's symptoms and that demented patients have high monoamine oxidase levels.
PTH-232 Retention of the ileocolic sphincter in a modified brooke ileostomy decreases the loss of key electrolytes in ileostomy fluid of patients who have undergone colectomy for ulcerative colitis
Authors: L Magill, M Quinn, I Robertson, P Sharma, A Macdonald
Journal: Gut (2015)

<h3>Introduction</h3> Previous published work has shown that modifying the traditional Brooke ileostomy (MBI) by retaining the ileocolic sphincter (ICS) preserves a functional high pressure zone which may improve the clinical function of the stoma. The effect of this modification (MBI) on ileal fluid biochemistry has not been reported previously by this group. This study reports the results of this modification on the electrolyte concentration in ileal fluid and also its influence on the reabsorption of urinary electrolytes by way of renal compensation. <h3>Method</h3> Ileostomy fluid specimens were collected from stoma bags in two groups of patients. Group 1 – ileocolic sphincter retained (MBI); controls – patients undergoing formation of a loop ileostomy (10 cm from the ileocolic junction) as part of an operation for rectal cancer. These samples were collected from patients and controls from stoma bags after an overnight fast. Additionally, 24hr urine collections were made from MBI patients and controls to measure the concentration of routine urinary electrolyes and, in addition, urinary magnesium and calcium. In order to compensate for the changes in urinary volume, which can be accounted for by varied water intake and different kidney efficiency, the urine results for each analyte measured were adjusted against the change in creatinine using a standard formula: adjusted concentration = mmol of analyte/mmol of urinary creatinine. Contemporaneously, routine serum electolytes were collected from patients and controls. This study was approved by the regional ethics committee and statistical analysis was performed using the Wilcoxon paired test where appropriate with p &lt; 0.05 considered significant. <h3>Results</h3> 13 MBI patients (mean (SD) age - 52.5(17.8)yrs) were compared with 11 controls age −58.4 (10.9) yrs). Routine serum and urinary biochemistry (except sodium) in both groups was the same. Urinary sodium, calcium and magnesium were raised in patients with a modified Brooke Ileostomy (MBI), when compared to controls: urinary sodium, 8.2 ± 4.5 vs. 4.43 ± 2.19 mmols/mmol creatinine, p &lt; 0.05, urinary calcium, 0.28 ± 0.15 vs. 0.15 ± 0.13 mmols/mmol creatinine, p &lt; 0.03 and urinary magnesium, 0.21 ± 0.09 vs. 0.08 ± 0.04 mmols/mmol creatinine, p &lt; 0.01. Electrolyte concentrations in ileal fluid in both patients (MBI and controls) was the same. <h3>Conclusion</h3> These results suggest that retention of the ICS in an ileostomy (MBI) has beneficial effects on the retention of ileal sodium, calcium and magnesium by virtue of the reduced reabsorption of these electrolytes from the MBI patients’ urine. Further work is required to confirm this initial finding. <h3>Disclosure of interest</h3> None Declared.
The reporting of trials of adjuvant therapy for breast cancer.
Authors: I F Tannock
Journal: Journal of Clinical Oncology (1990)

Article Tools Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1990.8.11.1923 Journal of Clinical Oncology - published online before print September 22, 2016 PMID: 2230881 The reporting of trials of adjuvant therapy for breast cancer. I F TannockxI F TannockSearch for articles by this author https://doi.org/10.1200/JCO.1990.8.11.1923 First Page PDF © 1990 by American Society of Clinical Oncology
Waterborne outbreak of acute gastroenteritis in a costal area in Slovenia in June and July 2008
Authors: B Kopilović, V Ucakar, N Koren, M Krek, A Kraigher
Journal: Eurosurveillance (2008)

In June and July 2008, an outbreak of acute gastroenteritis with a total of at least 408 cases occurred in the municipality of Piran, Slovenia. The town has 17,400 inhabitants and is located in touristic area on the Slovenian Adriatic coast. The first 20 cases were reported on 26 June to regional Institute of Public Health Koper (IPH Koper). Preliminary interviews indicated that the only common source of exposure was the local water distribution system in Piran which supplies all inhabitants of the town. IPH Koper informed the local water distribution company on the same day, and control measures for containing the outbreak were implemented immediately.
Legal and Ethical Aspects of Behavior Control
Authors: Seymour L. Halleck
Journal: American Journal of Psychiatry (1974)

There is a new climate of concern over the power of psychiatrists to shape behavior—a question made more critical by the increasing effectiveness of psychiatric treatment, including the use of drugs and the new behavior therapy techniques. The author focuses his discussion on the need for truly informed consent and the safeguards (including the use of a monitoring agency) that should be applied in those instances where the patient does not consent to the treatment but where the three criteria of dangerousness, treatability, and incompetence are obviously present. If psychiatrists are to respond to the new pressures, they must develop a system of internal regulation that will satisfy not only their own needs but the needs of patients and the general public.
PTH-084 Bullous cutaneous vasculitis-a rare side effect to adalimumab therapy
Authors: UN Shivaji, A Awasthi, R Kasturi, K Desai
Journal: Gut (2015)

<h3>Introduction</h3> Anti-TNF(tumour necrosis factor) therapy is an effective treatment for Crohn’s disease. As the usage of anti-TNF drugs increase worldwide, the proportion of reported serious side effects are expected to rise. We present a serious adverse reaction to Adalimumab. <h3>Method</h3> Case A 20 year old gentleman with background of Crohn’s disease with previous terminal ileal resection and Juvenile Idiopathic arthritis (JIA) had been on Adalimumab (Humira, Abbvie, USA), for dual indication, on a dose of 40mg per week since 2010 and was in remission. He presented to hospital in September 2014 with an erythematous maculo-papular rash distributed over his lower limbs, trunk and upper limbs. Initial blood tests showed raised inflammatory markers with no other abnormality and a vasculitis screen was negative. He had dramatic worsening of the rash while in hospital with rapid development of new lesions and bullous transformation of some of the existing lesions with necrotic areas. A skin biopsy showed severe cutaneous leucocytoclastic vasculitis. <h3>Results</h3> He was treated with high-dose intravenous Methyl-Prednisolone and was later switched to oral therapy. He improved over the next 8 weeks with reducing dose of Prednisolone. Anti-TNF drug therapy was the likely cause of the cutaneous vasculitis in absence of another specific trigger and based on existing literature, cutaneous vasculitis secondary to anti-TNF therapy is one of the side effects which may require drug withdrawal, and can be potentially serious and debilitating. There have been very few case reports worldwide of cutaneous vasculitis secondary to anti-TNF therapy, with fewer cases reported secondary to Adalimumab. According to current literature, the average duration of treatment before patients developed a major cutaneous reaction was noted to be 36 months, with all responding to drug withdrawal. <h3>Conclusion</h3> We believe this is the first reported case of bullous vasculitis of this degree of severity, secondary to Adalimumab, involving nearly 63% of body surface area (Rule of 9s) with full thickness involvement. (Picture) As the use of anti-TNF drugs increases worldwide, it is worth considering them as a possible cause of cutaneous lesions. Our experience suggests that withdrawal of the drug and high dose corticosteroids is an effective treatment strategy. <h3>Disclosure of interest</h3> None Declared.
PWE-015 Radiofrequency ablation for management of malignant biliary obstruction
Authors: AK Dutta, U Basavaraju, L Sales, JS Leeds
Journal: Gut (2015)

<h3>Introduction</h3> Malignant biliary obstruction is usually treated using metal stents at ERCP but some patients can develop stent dysfunction. Radiofrequency ablation (RFA) causes coagulative necrosis of tissue using thermal energy which may reduce tumour volume prior to biliary stenting or can be used to ablate ingrowth of tumour in previously placed stents. Improving stent patency has the potential to reduce morbidity, reduce reintervention rate and possibly improve survival. We report our experience in the use of RFA for malignant biliary obstruction. <h3>Method</h3> Retrospectively analysis of clinical and procedure related data of all patients undergoing RFA for malignant biliary obstruction over the last two years at Aberdeen Royal Infirmary. Age, sex and procedure/disease stage matched controls were selected from patients undergoing ERCP prior to the commencement of this service. Each RFA application delivers 10 watts of energy for 90 s via a specific probe passed through the lesion over a wire during ERCP. Technical success rates, complications, time to reintervention and date of death were recorded following the initial ERCP with RFA and Kaplan-Meier survival analysis performed. <h3>Results</h3> 12 patients underwent biliary 13 RFA applications during the study period (median age 78 years, 7 females). 5 patients had cholangiocarcinoma, 5 had pancreatic cancer, 1 had ampullary carcinoma and 1 had metastatic colorectal cancer. In 8 patients RFA was applied prior to biliary metallic stenting and good drainage was achieved. RFA was given in 1 – 3 applications with a median of 1 application. 4 patients underwent RFA for a blocked metal stent resulting in adequate biliary drainage in all cases. Post procedure complications included acute pancreatitis in 2 (mild) and Klebsiella bacteraemia and 30 day mortality rate was 0/12 (0%). 2 controls required reintervention within 30 days compared to none who received RFA. Median time to death or reintervention was 220 days in those receiving RFA compared o 131 in controls (Hazard ratio 0.59, 95% CI 0.25–1.4, p = 0.23). <h3>Conclusion</h3> Biliary RFA is a safe, useful adjunct in the management of malignant biliary obstruction or blocked metal stents. Time to death or reintervention was longer in those receiving RFA but a larger, prospective study is required to show a significant survival benefit. <h3>Disclosure of interest</h3> None Declared.
SP0172 How to Treat/ Manage Osteoarthritis
Authors: M. Kloppenburg
Journal: Annals of the Rheumatic Diseases (2015)

Osteoarthritis is a heterogeneous disease affecting predominantly knees, hands and hips. The burden of disease for patients with osteoarthritis is considerable. Currently, the treatment for osteoarthritis is focused on alleviation of symptoms, such as pain, stiffness and disability. Both non-pharmacological interventions, such as education strategies, exercise therapy, assistive technology and weight loss, and pharmacological interventions, such as paracetamol and topical and oral NSAIDs, have been investigated for that purpose and evidence for their efficacy is available. For many years treatment to modify the disease course of osteoarthritis have been sought and investigated. New developments have elucidated that not only cartilage loss could be a target for treatment, but also processes going on in other compartments of the joint: the subchondral bone and synovium. Especially subchondral bone activity and synovitis open new possibilities for treatment. Promising treatments to modify the disease are currently investigated. <h3>Disclosure of Interest</h3> None declared
Landscape and climatic characteristics associated with human alveolar echinococcosis in France, 1982 to 2007
Authors: M Piarroux, J Gaudart, S Bresson-Hadni, K Bardonnet, B Faucher, F Grenouillet, J Knapp, J Dumortier, J Watelet, A Gerard, J Beytout, A Abergel, M Wallon, D A Vuitton, R Piarroux, collective the FrancEchino network
Journal: Eurosurveillance (2015)

Human alveolar echinococcosis (AE) is a severe hepatic disease caused by Echinococcus multilocularis. In France, the definitive and intermediate hosts of E. multilocularis (foxes and rodents, respectively) have a broader geographical distribution than that of human AE. In this two-part study, we describe the link between AE incidence in France between 1982 and 2007 and climatic and landscape characteristics. National-level analysis demonstrated a dramatic increase in AE risk in areas with very cold winters and high annual rainfall levels. Notably, 52% (207/401) of cases resided in French communes (smallest French administrative level) with a mountain climate. The mountain climate communes displayed a 133-fold (95% CI: 95-191) increase in AE risk compared with communes in which the majority of the population resides. A case-control study performed in the most affected areas confirmed the link between AE risk and climatic factors. This arm of the study also revealed that populations residing in forest or pasture areas were at high risk of developing AE. We therefore hypothesised that snow-covered ground may facilitate predators to track their prey, thus increasing E. multilocularis biomass in foxes. Such climatic and landscape conditions could lead to an increased risk of developing AE among humans residing in nearby areas.