tbuckley/cabot-search huggingface dataset:
PTU-330 A pragmatic business case for fibroscan service
Authors: A Ramakrishnan, S Chandrapalan, S Thomas
Journal: Gut (2015)

<h3>Introduction</h3> Liver disease is the only disease with increasing mortality of the chronic diseases in UK. Lancet commission recommended early identification of cirrhosis and addressing of risk factors as ways to decrease mortality. Fibroscan helps to identify fibrosis at an early stage in a non-invasive manner with clinical incremental effectiveness of at least 17% to existing methods but is expensive. <h3>Method</h3> We loaned an old Fibroscan machine from Echosens to prove the cost effectiveness to put forward a successful business case using the NHS technology adoption centre (NTAC) model. 4 operators trained in Fibroscan used the machine (1<sup>st</sup>generation machine - M probe only) over 4 months (February to June 2013) using validated definitions for fibrosis and success. <h3>Results</h3> 108 Fibroscan were done during 4 month period with 60 scans (56%) being valid. M: F 44: 16, Median age 47 (Range 21–78). Diagnoses were Hep C 27% (16), Hep B 25% (15), NAFLD/Crypto 18% (11), ALD 17% (10), Hemochromatosis 5% (3), PBC 3% (2), others 5%. 50% (30/60) had no significant fibrosis, 38% (23/60) had significant fibrosis and 12% (7/60) had ≥ F2 ≤ F3 fibrosis. Gross money saved using the NTAC model was £102,817. Since the increment would have been only 17% with Fibroscan, net money saved over 4 months was £17478.89, amounting to £52436.67/year <h3>Conclusion</h3> Fibrosis and success was comparable to published data. Our pragmatic approach enabled us to successfully prove the NTAC model for business case using a loaned 1<sup>st</sup>generation Fibroscan machine and set up Fibroscan services. <h3>Disclosure of interest</h3> None Declared.
Further Studies on the Proliferation &lt;italic&gt;in Vitro&lt;/italic&gt; of Single Isolated Tissue Cells
Authors: Gwendolyn D. Likely, Katherine K. Sanford, Wilton R. Earle
Journal: JNCI Journal of the National Cancer Institute (1952)

Journal Article Further Studies on the Proliferation in Vitro of Single Isolated Tissue Cells Get access Gwendolyn D. Likely, Gwendolyn D. Likely Laboratory of Biology, National Cancer Institute2Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar Katherine K. Sanford, Katherine K. Sanford Laboratory of Biology, National Cancer Institute2Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar Wilton R. Earle Wilton R. Earle Laboratory of Biology, National Cancer Institute2Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 13, Issue 1, August 1952, Pages 177–184, https://doi.org/10.1093/jnci/13.1.177 Published: 01 August 1952 Article history Received: 25 April 1952 Published: 01 August 1952
Case 24-1979
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, John T. Harrington, Robert T. Mccluskey
Journal: New England Journal of Medicine (1979)

Presentation of CaseA 51-year-old man was admitted to the hospital because of rapidly progressive renal failure.Eight years earlier a diagnosis of tuberculosis of the right lung was made, and he was treated elsewhere with isoniazid and para-aminosalicylic acid for two years; subsequent x-ray films of the chest showed resolution of the process. He was otherwise well until 22 months before admission, when he became fatigued. One month later a sore throat developed, with radiation of pain to the left ear. Eighteen months before entry he became dyspneic, with laryngeal stridor, and entered another hospital. Laryngoscopic examination disclosed subglottic . . .
Retroperitoneal fibrosis associated with metoprolol.
Authors: D W Bullimore
Journal: BMJ (1982)

Elderly implies that the answers which may be produced by this large multinational, hospital-based trial will be no more clearcut than the ones we reported from our small single-centre trial.If so, we share the hopes of Professor W S Peart and his colleagues (p 1397) that a further "trial of antihypertensive treat- ment in people aged 65-74 may be mounted attempting to determine the balance between the benefits of pressure reduction and any adverse effects."
Briquet's syndrome in association with depression and panic: a reconceptualization of Briquet's syndrome
Authors: H Orenstein
Journal: American Journal of Psychiatry (1989)

In a sample of 188 consecutive female psychiatric patients, Briquet's syndrome was found to be associated more closely with the aggregation of both major depression and either panic disorder or agoraphobia than with major depression or panic disorder-agoraphobia alone. These results are consistent with the hypothesis of a shared diathesis underlying some cases of major depression, panic disorder, agoraphobia, and Briquet's syndrome. The author proposes that Briquet's syndrome may represent the most extreme expression of a tendency for a number of physical and psychological syndromes to aggregate.
SP0138 Anti-TNF Therapy in Systemic Lupus Erythematosus
Authors: J. Cortes Hernandez
Journal: Annals of the Rheumatic Diseases (2015)

The development of anti-tumor necrosis factor a (TNF-a) therapy has been a milestone in the treatment of rheumatoid arthritis and other inflammatory-mediated conditions, but their use has also been accompanied by new or aggravated forms of autoimmunity, making its use in SLE controversial. SLE is characterized by heterogeneity of clinical manifestations and a relapsing-remitting course. Despite a significant improvement in its prognosis and management, there are still significant unmet therapeutic needs. Therapeutic agents targeting pro-inflammatory cytokines are an interesting option. Several studies support a role for TNFa in the pathogenesis of the disease and therefore a potential benefit from inhibition. Serum TNFa levels and expression in renal and cutaneous biopsies are highly elevated in SLE patients and correlate with disease activity. Several open-label studies suggest that TNF blockade is effective in SLE patients with arthritis, nephritis and skin disease. Our long-term study of etanercept in refractory arthritis supports its efficacy in arthritis and also suggests a possible benefit in refractory pleuropericarditis. To sufficiently address the potential value of TNFa-blocking therapy in SLE, larger and controlled clinical trials are necessary in a near future. <h3>Disclosure of Interest</h3> None declared
Incidence Of VTE Following Genitourinary Surgery In Korea and Evidence-Based Korean Guidelines For Preventing VTE In Patients Undergoing Genitourinary Surgery
Authors: Yeo-Kyeoung Kim, Soo-Mee Bang, Moon Ju Jang, Ho-Young Yhim, Won-Il Choi, Kyoung Ha Kim, Sung Hwa Bae, Yang-Ki Kim, Seung-Hyun Nam, Sung-Hyun Kim, Yeung-Chul Mun, Inho Kim, Chul Won Jung, Doyeun Oh
Journal: Blood (2013)
Book: George and Sam
Authors: Michael Fitzpatrick
Journal: BMJ (2004)

Having seen a newspaper excerpt from Charlotte Moore's account of her autistic sons, some parents wrote to complain that she had neglected the “grittier realities” of life as a single parent caring for children with autism. In fact, the book reveals a household smeared with excrement, olive oil, and ketchup, and details all manner of bizarre behaviours. What seems to have rankled is that Moore describes her family in a positive and often humorous way, and that she does not seem to feel sorry for herself.​herself.




Figure 1



Charlotte Moore

Viking/Penguin, £16.99, pp 252 ISBN 0 670 91441 X

Rating: ★★★★




The truly distinctive feature of George and Sam is its author's lack of self pity. This outlook stands in marked contrast to that of the parents engaged in the campaign to blame their children's autism on the MMR (measles, mumps, and rubella) vaccine, who have received such widespread publicity. This campaign has nurtured parental self pity, expressed in an enduring rage against the drug companies, the medical establishment, indeed anybody who defends the vaccine. The quest for somebody to blame, for somebody to suffer as they have suffered, has driven the protracted—and now doomed—litigation against the MMR manufacturers.

While Moore deftly sidesteps the MMR controversy (though she does not believe that the vaccine was a factor in her sons' cases), she categorically rejects the notion that autism can be “cured.” This does not mean that she recommends an attitude of resignation; far from it. She reports on the wide range of interventions she has tried on her boys, including diets and drugs, psychotherapy, and behaviour therapy, with varying degrees of success in alleviating some of the clinical features of their condition.

Finely observed, well researched, and elegantly written, George and Sam is full of insights into the mysteries of autism. Moore's appreciation of the physical beauty and “incorruptible innocence” of her sons will strike a chord with many parents. So too will her observation that “the people who get on best with autists are those who can put their own ego to one side.” My wife often says that our autistic son “brings out the best in people.”

Moore includes a brilliant survey of autistic tastes in videos and books, and fascinating reflections on the challenge of autism to theologians and on the problems posed by Christmas for families of autistic children. She also offers useful practical suggestions for doctors and teachers, for families, and—a generally neglected category—their friends.

“Acceptance is all,” wrote Charlotte Moore in one of the newspaper columns from which this book originated. This simple, yet profound, message is what makes George and Sam such a valuable contribution to families affected by autism.
THU0226 ASAS Partial Remission Ratio of as and Axial Spondyloarthritis Patients During Anti-TNF Treatments: HUR-BIO Real Life Results
Authors: U. Kalyoncu, L. Kilic, A. Erden, E. Seyhoglu, S. Kilickap, Y.Z. Sener, B.Y. Aktas, D. Guven, O. Karadag, A. Akdogan, S.A. Bilgen, I. Ertenli, S. Kiraz
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> ASAS partial remission is relevant treatment target for ankylosing spondylitis (AS) and axial spondyloarthritis (AxSpA) patients. <h3>Objectives</h3> Objective of this study was to assess ASAS partial remission ratio during anti-TNF treatment in real life experience. Second objective was to assess related factors of ASAS partial remission at both AS and AxSpA. <h3>Methods</h3> HUR-BIO (Hacettepe University Rheumatology Biologic Registry) is a single center biological registry since 2005. HUR-BIO includes patients with AS and AxSpA under anti-TNF drugs. HUR-BIO biological dataset included demographic data, education level, co-morbidities, smoking status. After september 2012, outcome measures of ASAS were recorded regularly every six months or during switched of anti-TNF. Outcome measures of HUR-BIO include BASDAI, BASDAI 2, 5 and 6. questions, BASFI, VAS global, VAS pain, VAS fatique, ESR and CRP. ASAS partial remission was defined as less than 20/100 mm of BASFI, back pain, morning stiffness and VAS global. ASAS partial remission was calculated according to last control visit of patients. <h3>Results</h3> There were 874 patients (747 AS and 127 AxSpA) in HUR-BIO dataset. Among 716 of 874 (81.9%) patients [602 (84.1%) and AxSPA 115 (15.9%)] had at least one control visit during last 2 years. Overall, 452 of those 716 (63.1%) patients were male. Mean age (41.3±11.3 vs 35.5±9.7, p&lt;0.001), mean disease duration (9.8±7.3 vs 4.3±2.9, p&lt;0.001), and mean symptom duration (14.3±8.8 vs 7.8±6.6, p&lt;0.001) were higher at AS than AxSpA patients. Initial anti-TNF drugs were etanercept 249 (34.8%), adalimumab 197 (27.5%), infliximab 208 (29.1%) and golimumab 62 (8.6%). Anti-TNF switch was found 207 (28.9%) of patients. ASAS partial remission was found at 205 (28.6%) patients (29.7% vs 22.8%, p=0.13, for AS and AxSpA, respectively). Results of univariate analysis related with ASAS remission was shown at table 1. In logistic regression analysis, positive HLA-B27 OR 3.76 (CI 95% 1.34-10.56, p=0.012), baseline CRP upper than normal limit OR 4.65 (CI 95%, 1.67-12.95, p=0.003) and disease duration less than 5 years OR 0.32 (95%CI 0.14-0.77, P=0.01) were related with ASAS partial remission. <h3>Conclusions</h3> At real life experience, ASAS partial remission was reached only almost 29% of AS and 23% of AxSpA patients. We should keep in mind that, almost 20% of patients were not followed in HUR-BIO and analysis was performed only patients with continue anti-TNF treatments. Patients with HLA B27 positive, high baseline CRP and disease duration less than 5 years were candidate for remission. <h3>Disclosure of Interest</h3> None declared
PTU-045 Matters of the heart: double-balloon enteroscopy in patients with cardiovascular comorbidities – is it worth the ‘coronary’?
Authors: F Branchi, DS Sanders, R Sidhu
Journal: Gut (2015)

<h3>Introduction</h3> Double balloon enteroscopy (DBE) is an advanced endoscopic technique for the diagnosis and treatment of small bowel diseases. It is a relatively invasive and long procedure therefore its use in patients with comorbidity can be risky. Our aim was to assess the safety and feasibility of DBE in patients with cardiovascular (CV) comorbidities. <h3>Method</h3> All consecutive patients referred for DBE in our Trust were prospectively reviewed. Patients with CV comorbidities were divided into elderly (Group 1: age &gt;70 years) and young (Group 2: &lt;70 years). Diagnostic and therapeutic yields and complications rates were collected. <h3>Results</h3> Out of 404 DBE procedures, 97 were performed in patients with one or more CV comorbidities (Group 1 = 52, group 2 = 45), including ischaemic heart disease (61), valvular replacement (24), atrial fibrillation (AF, 19), chronic cardiac failure (CCF, 16), arrhythmias (5), previous cerebrovascular event (8). AF and CCF were commoner in the elderly compared to the young (p = 0.035 and 0.026 respectively). The indications for DBE were obscure gastrointestinal bleeding (occult, 59% and overt, 27%), suspected Crohn’s disease (7%), stricture at radiology (4%) and suspected celiac complication (3%). Transfusion was required in 67% patients in the elderly group and 60% in the younger (p = ns). There were no differences in terms of procedure time between the groups (median time 70 min, range 35–125, vs 65, range 25–140, p = ns). Elderly patients were administered lower doses of midazolam (median 4 mg, range 1.5–10 vs 6, range 2–10, p &lt; 0.0001) and fentanyl (median 50 mcg, range 12.5–100 vs 75, range 12.5–200, p &lt; 0.0001). DBE had high diagnostic (65% and 58%, p = ns) and therapeutic yield (54% vs 33%, p = ns) in both groups. The most common finding was angiodysplasia (48% vs 29%, p = 0,06), followd by ulcers (6% vs 9%), polyps (0% vs 7%) or tumours (0% vs 4%), diverticula (4% vs 0%), changes of celiac disease (0% vs 6%). The complication rate was 3% overall (one nSTEMI in the elderly group and one cardiac failure and a respiratory arrest in the younger group). We also made comparisons between patients with CV comorbidity compared to all others without CV comorbidity undergoing DBE in the same period. The overall diagnostic yield was higher in patients with CV, irrespective of age (62% vs 46%, p = 0.005). The therapeutic yield was also higher (44% vs 18%, p &lt; 0.0001) in relation to the high number of vascular lesions treated in patients with CV comorbidity. The difference in complication rate between patients with and without CV comorbidity did not reach statistical significance (3% vs 1%, p = 0.15). <h3>Conclusion</h3> In patients with CV comorbidity, DBE is safe and with a good diagnostic and therapeutic yield. Careful patient selection is imperative to prevent serious complications. <h3>Disclosure of interest</h3> None Declared.
PWE-433 A qualitative assessment of cognitive framework development in novice endoscopists: implications for programmed lesion recognition training
Authors: K Axe, E Hawkes, J Turner, J Hurley, P Neville, N Warren, N Hawkes
Journal: Gut (2015)

<h3>Introduction</h3> UK training pathways in upper GI endoscopy (UGIE) constitute a mandatory JAG Hands-on Course and supervised endoscopy experience. Trainee surveys have highlighted a deficit in formal endoscopic lesion recognition (ELR) training. We aimed to evaluate a range of teaching formats for ELR for novice UGIE trainees, determining key elements in development of their cognitive framework (CF). <h3>Method</h3> As part of a Structured Programme of Induction and Training in UGIE (SPRINT) we delivered ELR teaching sessions at months 0, 1, 2 and 4 in different formats – small group discussion (still image); small group (video); online Standardised Lesion Assessment Tests in Endoscopy (SLATE); and one-to-one training at hands-on sessions. All 7 trainees evaluated sessions at time of delivery. A semi-structured interview was conducted at month 4 (40 mins) exploring the relationship of training to development of ELR skills. A deductive approach to data analysis using a modified grounded theory approach<sup>1</sup>was followed. <h3>Results</h3> ELR sessions were highly valued, both for content and relevance to training. Formative assessment established baseline declarative knowledge, but learners expressed anxieties related to exposing lack of knowledge. At baseline, small group sessions (supportive, non-threatening) involving all trainees, using common pathologies, correcting misconceptions and exploring differential diagnoses, were highly valued and supported learning. Online testing of this subject matter in the first 3 months provided useful reinforcement, if allied to detailed feedback. Teaching classification systems aids higher level CF development, if illustrated with numerous examples in various contexts. After 3 months, management plans and report writing (meta-cognitive skills) need emphasis, with testing of procedural knowledge recall. Video cases, rare presentations of common disease and rare pathologies are only usefully integrated into mental frameworks at or after 4 months. Interactive Q&amp;A group formats remained highly valued at this stage. SLATE assessment charted progress, but lacked immediate, targeted feedback and created performance-related focus on marks. <h3>Conclusion</h3> Delivery and format of ELR training must be matched to CF development. Initial exposure should focus on common pathologies, to develop confidence and observation skills. Once handling skills are secure, structured observation and classification structures link knowledge at a deeper level. Formative assessment, feedback and discussion drive learning. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Burnard P, <i>et al</i>. Br Dental J. 2008;204:429–432
The prognostic role of metastatic lymph node immunological status in clinical stage III melanoma patients.
Authors: Piotr Rutkowski, Aleksandra Gos, Joost van den Oord, Monika Jurkowska, Katarzyna Szamotulska, Anna Szumera-Cieckiewicz, Hanna Melania Kosela, Janusz A. Siedlecki, Maria Debiec-Rychter, Iwona Lugowska
Journal: Journal of Clinical Oncology (2015)

e20103 Background: A large proportion of stage III melanoma patients will develop recurrent and metastatic disease. For these patients, treatment options are still limited. Significant progress has been made in the use of immunotherapy for the treatment of metastatic/unresectable melanoma. Therefore, there is a strong rationale for analyzes of immunological status in stage III melanoma, and to assess its impact on patients’ survival. Methods: We included 201 patients with resected clinical stage III melanoma (after lymphadenectomy 1995-2010); F:M –1:1, median age 54 years; nodal status: N1 -26%, N2 -29% and N3 -45%; mutational status: 60% of cases BRAF(+) and 19% - NRAS(+). None of patients received immunotherapy and/or BRAF inhibitors. Median follow up was 24 months, 131 patients deceased. The expressions of CD8, programmed death-ligand 1 (PD-L1), phosphohistone H3(Ph-H3), T-cell intracellular antigen-1 (TIA1), and p53 were assessed by immunohistochemistry with automated image analysis on TMA composed from FFPE metastatic node tissues. For statistical analysis Classification and Regression Tree (CART), Kaplan-Meier survival analysis with log-rank test and Cox proportional-hazards regression model were performed. Results: CART has classified patients into four prognostic groups: (1) with CD8 > 23.9% - 100% of patients died; (2) with CD8 < 23.9% and TIA1 above 165.5% - 61.1% of patients alive; (3) with CD8 < 23.9%, TIA1 below 165.5% and N1/2 stage - 35% of patients alive, and (4) with CD8 < 23.9%, TIA1 below 165.5% and N3 – 18% alive; log rank p = 0.019. The Cox regression model adjusted for nodal status, age and nodal extracapsular infiltration confirmed that CD8 and TIA1 were independent prognostic factors (CD8 > 23.9% - HR 0.344 (95% CI: 0.181 – 0.653), and TIA1 > 165.5% - HR 2.061 (95% CI: 1.036- 4.101). Conclusions: The immunological status in melanomas and its influence on prognosis should be analyzed as interaction between different factors. Our results show that the specific relation between expression of CD8, TIA-1 and the number of melanoma metastatic nodes appears to be a marker of tumor progression in patients with resectable stage III disease
The Diagnostic Approach to Acute Venous Thromboembolism
Authors: V F Tapson, B A Carroll, B L Davidson, C G Elliott, P F Fedullo, C A Hales, R D Hull, T M Hyers, K V Leeper, T A Morris, K M Moser, G E Raskob, D Shure, H D Sostman, B Taylor Thompson
Journal: American Journal of Respiratory and Critical Care Medicine (1999)
FRI0255 Patients Treated for Behcet's Syndrome in the US Have Higher Disease Activity Scores at Presentation if they Fulfill Diagnostic Criteria and if they are Females
Authors: Y. Yazici, H. Bernstein, C. Swearingen
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Diagnosis of Behcet9s syndrome (BS) is based on clinical signs and symptoms, without the use laboratory or imaging tests and the most commonly used diagnostic criteria are the International Study Group (ISG) criteria. Patients have also been diagnosed with BS not meeting ISG criteria based on the clinical impression of the treating physicians. <h3>Objectives</h3> To determine differences in disease activity among BS patients meeting and not meeting the ISG criteria. <h3>Methods</h3> Behcet9s patients seen at the NYU Behcet9s Center had their demographic, clinical features and outcomes data abstracted. Confirmed BS diagnosis was determined if ISG criteria were met at any time during the course of observation. Multiple linear regression estimated any association between meeting ISG criteria and gender with the patient-reported outcomes Behcet9s Syndrome Activity Scale (BSAS), Pain Visual Analog Scale (VAS), Fatigue VAS, Patient Global Assessment VAS, and RAPID3 as well as Physician Global Assessment VAS. <h3>Results</h3> First observation data on 832 subjects were abstracted for this analysis. 504 (63%) met ISG criteria for Behcet9s, 616 (74%) were female with an average age of 35 years (±13.8). Mean scores for BSAS, pain, fatigue, patient global, RAPID3 and physician global were uniformly higher in those meeting criteria vs not meeting criteria. Meeting ISG criteria was significantly associated with increases in all clinical outcomes independently of gender, ranging from 5 points on the Physician Global VAS to 13 points on the Fatigue VAS (Table). Conversely, gender was only associated with significant increases in BSAS, Fatigue and RAPID3 independent of meeting ISG criteria. <h3>Conclusions</h3> Behcet9s patients who fulfill ISG criteria have more active disease, based on all measures of disease activity, including patient and physician based outcomes. Interestingly, females were also at risk for more active disease as measured by composite patient reported outcome measures, reflecting possibly the different character of Behcet9s in non-endemic areas, such as the US. <h3>Disclosure of Interest</h3> Y. Yazici Grant/research support from: BMS, Celgene, Genentech, Consultant for: BMS, Celgene, H. Bernstein: None declared, C. Swearingen: None declared