tbuckley/cabot-search huggingface dataset:
PWE-282 Implications of a ‘false negative’ faecal occult blood test (FOBT) – results from a multicentre study
Authors: AT George, S Aggarwal, M Dube, A Menon, M Vogler, R Logan, A Field
Journal: Gut (2015)

<h3>Introduction</h3> We aimed to identify the implications of a false negative FOBT in the population tested. <h3>Method</h3> Data from the National Bowel Cancer Audit Programme from three centres in the FOBT age group (60–74 years) over 2 years (August 2011–2013) were linked for their FOBT screening status to the Eastern FOB hub. Comparisons were done primarily between two groups: the interval cancer group (cancers diagnosed between 2 yearly FOBT screening rounds) and the non-uptake group (patients who were offered but declined FOBT screening). Demographics, presentation, tumour characteristics and survival were compared. Tumours from and distal to the splenic flexure were classed as left sided tumours. Dukes C and D tumours were classed as advanced tumours. <h3>Results</h3> 521 colorectal cancers were diagnosed in the above population. Of these 231 cancers were diagnosed in the non-uptake group and 128 were diagnosed in the interval cancer group. Both the non-uptake group and the interval cancer groups were comparable in age ranges (mean age in years (+/− 1SD); 68(4.2) and 67(3.8)); gender distribution (Males (%); 133(58) and 84(66)) and location of tumour (left sided (%); 165(71) and 79 (62))as well as for ethnicity and deprivation indices. The interval cancer group were more likely to present with an advanced tumour (Dukes C/D) compared to the non-uptake group (89(70%) vs. 125(54%);<i>X</i><sup>2</sup>=8.1; <i>p = 0.004</i>). The median time between diagnosis and death in the interval cancer group was 10 months (0–34 months) compared to 13 months (0–34 months) in the non-uptake group. The 1 year mortality in the interval cancer group was also higher (n = 20; 16%) compared to the non-uptake group (n = 27; 12%). All except 2 patients in the interval cancer group had underlying ongoing ‘red flag’ symptoms with anaemia being present in 36 patients (28.1%; (mean) Hb 10.3 gm; MCV 82.4;MCH 26.3). <h3>Conclusion</h3> We report a poorer outcome in patients who had a false negative FOBT compared to those patients who had declined the test. Though this may in part be explained by duration bias, we highlight the possibility that the ‘false negative’ result may have had a detrimental effect of falsely reassuring the patients who undertook the test in-spite of their underlying symptoms leading on to a subsequent delay in their seeking medical advice coupled with a natural progression of the disease. We flag up the caution that should be exercised in patients who have a negative FOBT. <h3>Disclosure of interest</h3> None Declared.
Systematic characterization of basophil anergy
Authors: Kia Joo Puan, Anand Kumar Andiappan, Bernett Lee, Dilip Kumar, Tuck Siong Lai, Giminna Yeo, Derya Bercin, Mireille Starke, Doreen Haase, Josephine Lum, Fook Tim Chew, John Connolly, Siew Cheng Wong, Francesca Zolezzi, Michael Poidinger, De Yun Wang, Olaf Rötzschke
Journal: Allergy (2016)

Cohort studies indicated that in certain individuals the basophils do not respond toward allergens due to a desensitization of their Fc epsilon receptor pathway. Cause and functional role as well as the implications on allergic reactions, however, are not clear yet.A cross-sectional study was carried out in the tropical urban environment of Singapore, where the allergic response is dominated by a single allergen (house dust mite; HDM). Blood samples were collected from 476 individuals and analyzed comprehensively to correlate the functional state of their basophils with the clinical state as well as the composition of the cellular and soluble plasma components.Inactivation of basophils ('basophil anergy') was observed in about 10% of the cohort. It was associated with a downregulation of basophil Syk and an apparent reduction in the incidence of allergic rhinitis. Correlations on the cohort level suggest that it represents a transitional state to be passed through during the interconversion of responder and nonresponder state.Basophil anergy thus seems to function as activation barrier to prevent unwanted reactions against minor allergens. It may therefore be relevant for diagnostic purposes or therapeutic interventions of allergic diseases.
AB0972 Rheumatological Signs and Symptoms as the Presenting Manifestations of Childhood Hematological Malignancies
Authors: E. Ağırgöl, N. Aktay Ayaz, G. Keskindemirci, M. Çakan, G. Aydoğan
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Objectives</h3> The earliest manifestations of malignant diseases such as leukemia and lymphoma are diverse. The aim of this study is to determine the characteristics and frequency of rheumatic features as initial symptoms among children diagnosed as acute leukemia and lymphoma. <h3>Methods</h3> The study is a prospective analysis of 93 children diagnosed as leukemia and lymphoma between 2013-2015. They were diagnosed and treated at pediatric hematology and oncology clinic of Kanuni Sultan Suleyman Research and Training Hospital. Each patient was reviewed for rheumatological symptoms and signs. The evaluation sheet consisted of twelve clinical features and eight signs. <h3>Results</h3> There were 58 males (62,3%) and 35 females (37,7%) with a total of 93 patients. Acute lymphocytic leukemi (ALL) was diagnosed in 76 (81,8%) patients, acute myeloid leukemia (AML) in 13 (13,9%) patients, and lymphoma (hodgkin and nonhodgkin lymphoma) in 4 (4,3%) patients. Mean age was 78 months (range: 10-204 months). The most common symptoms were fatigue and pallor (51%), fever (25%), bone and leg tenderness (17%). Other symptoms were abdominal pain (9,6%), back pain (7,5%), weight loss (6,4%), arthritis (5,3%), arthralgia without arthritis (5,3%), and chest pain (4,3%). Five patients presenting only with arthritis had the diagnosis of acute lymphocytic leukemia. Four of them were monoarticular and one of them was oligoarticular arthritis. The large joints chiefly knees (2 patients), ankles (2 patients) and elbow (1 patient) were affected. Two patients had been diagnosed as familial mediterranean fever and were under colchicine treatment while they were diagnosed as malignancy. The physical findings included hepatosplenomegaly (36,5%), lymphadenopathy (20%), and petechia, ecchymoses or spontaneous bruising (13,9%). Abnormal laboratory findings in the leukemia group included anemia (65%), thrombocytopenia (76%), leukopenia (25%), leukocytosis (26%), and elevated LDH and ESR levels. The laboratory findings were normal with the exception of one patient in the lymphoma group who only had leukopenia. <h3>Conclusions</h3> Rheumatological signs and symptoms are not uncommon findings that were faced at hematology-oncology outpatient clinics. Children diagnosed with malignant diseases may present with rheumatological symptoms as initial manifestations. In the differential diagnosis of juvenile rheumatological diseases, malignancies should be kept in mind. Pediatricians facing with atypical symptoms should be aware of these features in malignant diseases. <h3>Disclosure of Interest</h3> None declared
Finding psychiatric diagnosis-related groups that work: a call for research
Authors: D W Light, E J Phipps, G E Piper, D J Rissmiller, J N Mobilio, W F Ranieri
Journal: American Journal of Psychiatry (1986)

Diagnosis-related groups (DRGs) are under consideration as a way to pay hospitals for psychiatric care. Yet psychiatric DRGs account for only 3% of the variation in how long patients stay in the hospital. This nearly random variation means that psychiatrists may be working under a payment system that will have little relation to clinical reality. The authors identify important flaws in the current psychiatric DRGs and describe an alternative approach that promises to reflect clinical reality much more accurately.
SAT0449 The Spanish Scleroderma Study Group: Focusing on Interstitial Lung Disease
Authors: D. Sánchez Cano, J.L. Callejas Rubio, R. Ríos Fernández, N. Ortego Centeno, V. Fonollosa, C. Tolosa, M. Rodríguez Carballeira, C.P. Simeόn
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Systemic sclerosis (SSc) can virtually affect any organ system, but it is the pulmonary manifestations that account for the majority of deaths, especially interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) (60% of SSc-related deaths)<sup>1</sup> <h3>Objectives</h3> Our aim was to ascertain ILD in patients with SSc <h3>Methods</h3> A descriptive study was conducted, using the available data from the Registro Español de ESCLErodermia or Spanish Scleroderma Study Group (RESCLE or SSSG). Patients were classified attending the modified classification criteria proposed by LeRoy and Megdsger<sup>2</sup> <h3>Results</h3> Fourteen referral centers for SSc participated in the registry. By April 2014, 1374 patients with SSc had been enrolled, 595 of whom (43%) had ILD: 316 (53%) with limited cutaneous SSc (lcSSc), 240 (40%) with diffuse cutaneous SSc (dcSSc) and 39 (7%) with SSc sine scleroderma (ssSSc). Pulmonary functional testing (PFT) results along with high-resolution computed tomography (HRCT) findings and PAH assessment, are displayed on tables 1 and2, respectively. As to causes of death, SSc-associated mortality data were as follows: 37 (50%) for lcSSc, 39 (59%) for dcSSc and 5 (42%) for ssSSc; while those for other causes of death were: 37 (50%), 27 (41%) y 7 (58%), respectively (no statistical significance was achieved). <h3>Conclusions</h3> ILD is more common in dcSSc and ssSSc, though its occurrence in lcSSc is far from negligible. Furthermore, even if mean systolic pulmonary arterial pressure (PAP) was higher in lcSSc, no significant differences could be found regarding PAH diagnosis among subsets. Therefore, our data suggests that ILD is not exclusive of dcSSc, nor is PAH of lcSSc. <h3>References</h3> Steen VD, Medsger TA. Changes in causes of death in systemic sclerosis, 1972-2002. Ann Rheum Dis 2007;66(7):940-4. LeRoy EC, Medsger TA, Jr. Criteria for the classification of early systemic sclerosis. J Rheumatol 2001;28(7):1573-6. <h3>Disclosure of Interest</h3> None declared
Cabozantinib versus everolimus in advanced renal cell carcinoma (METEOR): final results from a randomised, open-label, phase 3 trial
Authors: Toni K Choueiri, Bernard Escudier, Thomas Powles, Nizar M Tannir, Paul N Mainwaring, Brian I Rini, Hans J Hammers, Frede Donskov, Bruce J Roth, Katriina Peltola, Jae Lyun Lee, Daniel Y C Heng, Manuela Schmidinger, Neeraj Agarwal, Cora N Sternberg, David F McDermott, Dana T Aftab, Colin Hessel, Christian Scheffold, Gisela Schwab, Thomas E Hutson, Sumanta Pal, Robert J Motzer
Journal: The Lancet Oncology (2016)
Role and Determinants of Adherence to Off-loading in Diabetic Foot Ulcer Healing: A Prospective Investigation
Authors: Ryan T. Crews, Biing-Jiun Shen, Laura Campbell, Peter J. Lamont, Andrew J.M. Boulton, Mark Peyrot, Robert S. Kirsner, Loretta Vileikyte
Journal: Diabetes Care (2016)

OBJECTIVE Studies indicate that off-loading adherence is low in patients with diabetic foot ulcers (DFUs), which may subsequently delay healing. However, there is little empirical evidence for this relationship or the factors that influence adherence. RESEARCH DESIGN AND METHODS This prospective, multicenter, international study of 79 (46 from the U.K. and 33 the U.S.) persons with type 2 diabetes and plantar DFUs assessed the association between off-loading adherence and DFU healing over a 6-week period. Additionally, potential demographic, disease, and psychological determinants of adherence were examined. DFUs were off-loaded with a removable device (77% a removable cast walker). Off-loading adherence was assessed objectively by activity monitors. Patient-reported measures included Hospital Anxiety and Depression Scale (HADS), Neuropathy and Foot Ulcer Quality of Life (NeuroQoL) instrument, and Revised Illness Perception Questionnaire (IPQ-R). RESULTS Off-loading adherence was monitored for 35 ± 10 days, and devices were used during 59 ± 22% of subjects' activity. In multivariate analyses, smaller baseline DFU size, U.K. study site, and better off-loading adherence predicted smaller DFU size at 6 weeks (P &amp;lt; 0.05). Better off-loading adherence was, in turn, predicted by larger and more severe baseline DFUs, more severe neuropathy, and NeuroQoL foot pain (P &amp;lt; 0.05). In contrast, greater NeuroQoL postural instability predicted worse off-loading adherence (P &amp;lt; 0.001). HADS and IPQ-R measures were not significantly associated with off-loading adherence. CONCLUSIONS Off-loading adherence is associated with the amount of DFU healing that occurs, while postural instability is a powerful predictor of nonadherence. Clinicians should take this neuropathic symptom into consideration when selecting an off-loading device, as off-loading–induced postural instability may further contribute to nonadherence.
Enzymatic Activity in Primary and Transplanted Rat Hepatomas
Authors: Jesse P. Greenstein, Florence M. Leuthardt
Journal: JNCI Journal of the National Cancer Institute (1946)

Journal Article Enzymatic Activity in Primary and Transplanted Rat Hepatomas Get access Jesse P. Greenstein, Jesse P. Greenstein principal biochemist National Cancer Institute, National Institute of Health, United States Public Health Service Search for other works by this author on: Oxford Academic PubMed Google Scholar Florence M. Leuthardt Florence M. Leuthardt junior biochemist National Cancer Institute, National Institute of Health, United States Public Health Service Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 6, Issue 4, February 1946, Pages 211–217, https://doi.org/10.1093/jnci/6.4.211 Published: 01 February 1946
Treatment of depression associated with Briquet's syndrome
Authors: I Maany
Journal: American Journal of Psychiatry (1981)

Although depression appears to be common in patients with Briquet's syndrome, there is a paucity of literature dealing with the efficacy of treatment of this depression and the effect of treatment on the overall course of the illness. The author presents two case histories demonstrating the effectiveness of treatment of depression secondary to Briquet's syndrome with antidepressant medications, which resulted in an improvement of the various aspects of the primary illness.
SP0090 Ultrasound Findings in Patients with Asymptomatic Hyperuricemia
Authors: A.R. Valea
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Asymptomatic hyperuricaemia is the most important risk factor in the development of gout, as the risk of acute arthritis rises exponentially with the serum levels of uric acid. It is a common condition, estimated at 15-20% in the general population and even though asymptomatic, approximately 20% of patients with untreated high uric acid levels develop gout over the following 5 years. Unfortunately there is not enough data available about subclinical urate crystal deposition and the joint damage that it causes. <h3>Objectives</h3> This study aimed to demonstrate that high levels of serum uric acid can induce changes suggestive of gout in the hyaline cartilage, joints and tendons of patients with asymptomatic hyperuricaemia. <h3>Method</h3> The study was a cross-sectional study on 30 patients with hyperuricaemia with no history of gout. An ultrasound examination on the knees and first methatarsophalangeal joints was performed. <h3>Results</h3> Synovitis was found in 7 patients (23%), 6 patients had erosions (20%), 9 patients had tophaceous material (30%) and 2 patients had DCS (6.6%). There was a slightly higher rate of findings in men than in women (8 men vs 5 women). <h3>Conclusion</h3> The study confirms that sustained high levels of serum uric acid can induce subclinical articular and periarticular urate deposits, synovitis and joint erosions that are detectable on ultrasound. These ultrasound findings may allow early diagnosis and treatment of gout in patients with hyperuricaemia. <h3>References</h3> Find all the books, read about the author, and more. See search results for this author. Are you an author? Learn about Author Central. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH. Rheumatology, 5th ed. 2011. Doherty M. New insights into the epidemiology of gout, Rheumatology (2009) 48 (suppl 2) ii2-ii8. doi 10.1093/rheumatology/kep086. Neogi T. Asymptomatic hyperuricemia: perhaps not so benign? J Rheumatol 2008;35:734-737. Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez-Henríquez P, Hernández-Díaz C, Vargas A, Hofmann F, Gutiérrez M. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther 2011 Jan 17;13(1):R4. doi: 10.1186/ar3223. De Miguel E, Puig JG, Castillo C, Peiteado D, Torres RJ, Martín-Mola E. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann Rheum Dis 2012;71:157-158. doi:10.1136/ard.2011.154997. Puig JG, De Miguel E, Castillo MC, Rocha AL, Martinez MA, Torres RJ: Asymptomatic hyperuricemia impact of ultrasonography. [abstract] Nucleosides Nucleotides Nucleic Acids 2008;27:592-595. Chowalloor PV, Keen HI. A systematic review of ultrasonography in gout and asymptomatic hyperuricaemia [abstract] Ann Rheum Dis 2013;72:5 638-645. <h3>Disclosure of Interest</h3> None declared
OC-075 Management and outcomes of oesophageal perforation: a national study of 2564 patients in england
Authors: SR Markar, H Mackenzie, T Wiggins, A Askari, O Faiz, G Zaninotto, GB Hanna
Journal: Gut (2015)

<h3>Introduction</h3> Traditionally oesophageal perforation is a rare clinical emergency that confers a high rate of mortality and major morbidity. The aim of the present study was to determine patient and hospital-related factors associated with mortality from oesophageal perforation. <h3>Method</h3> Patients admitted with a diagnosis of oesophageal perforation between 2001–2012 were identified. Comparative analysis was performed for the effect of hospital volume on clinical outcomes. Quartile thresholds used to divide hospitals were 1–14 (Lowest Volume (LV)), 15–20 (Low Middle Volume (LMV)), 21–35 (High Middle Volume (HMV)), and ≥36 cases (High Volume (HV)). <h3>Results</h3> Over the twelve-year study period 2,564 patients with oesophageal perforation were treated at 158 hospitals. The 30-day and 90-day mortality rates were 30.0% and 38.8% respectively. There was a significant increase in the percentage of patients managed supportively and a reduction in surgical management over time. Furthermore there were significant reductions in 30-day (36.6% to 24.9%; P &lt; 0.001) and 90-day mortality (44.1% to 35.4%; P = 0.006) over the 12-year study period. Important patient demographics associated with 30-day and 90-day mortality included age ≥70, preoperative congestive cardiac failure, ischaemic heart, liver, and renal disease. High hospital volume was associated with significant reductions in 30-day (OR = 0.68; P = 0.001) and 90-day mortality (OR = 0.69; P = 0.001). Subset analysis of patients undergoing endoscopic intervention, identified hospital volume as an important factor associated with mortality. <h3>Conclusion</h3> This study provides evidence for the centralization of management of oesophageal perforation to high volume centres with appropriate multi-disciplinary infrastructure to treat these complex patients. <h3>Disclosure of interest</h3> None Declared.
Substance abuse and family relationships of persons with severe mental illness
Authors: L Dixon, S McNary, A Lehman
Journal: American Journal of Psychiatry (1995)

The authors sought to determine how substance abuse affects family relationships of persons with severe mental illness.Patient reports of family relationships were compared between 101 psychiatric inpatients with a concurrent substance use disorder and 78 subjects with severe mental illness only.Patients with comorbid substance abuse reported significantly lower family satisfaction and a greater desire for family treatment. Objective indicators of frequency of family contact did not differ.Substance abuse is associated with low levels of satisfaction with family relationships among persons with severe mental illness. Family interventions would meet the stated needs of persons with mental illness and a comorbid substance use disorder and might help to engage them in treatment.
Clindamycin resistant emm33 Streptococcus pyogenes emerged among invasive infections in Helsinki metropolitan area, Finland, 2012 to 2013
Authors: A K Pesola, R Sihvonen, L Lindholm, A Pätäri-Sampo
Journal: Eurosurveillance (2015)

In 2012, blood, skin and soft tissue infections caused by clindamycin resistant Streptococcus pyogenes (group A streptococcus; GAS) appeared to be increasing in the Helsinki metropolitan area. We compared monthly percentages of clindamycin resistant isolates in the area between 2012 and 2013, with those in 2010 and 2011. Resistance frequency in terms of patient age was also studied. We reviewed the medical records of bacteraemic cases in 2012 and 2013 and linked the data to emm types. To inform on the emm distribution among GAS isolated from skin and soft tissue infections during the epidemic, GAS isolates of one month (March 2013) were emm typed. For GAS blood, skin, and soft tissue isolates taken together, the proportions of clindamycin resistant isolates were significantly higher in 2012 and 2013 (23% and 17%, respectively) compared with the two previous years (3%, p<0,001). The erythromycin resistance percentages were almost equal to clindamycin (22% and 17%) in 2012 and 2013, respectively. Clindamycin resistance was most frequent in GAS isolates of 40 to 60 year-old patients (148/417; 36%). Among clindamycin resistant isolates, 12 of 14 blood isolates from 2012 to 2013, and 11 of 13 skin and soft tissue isolates from March 2013, were emm33. Emm33 GAS bacteraemia was associated with clindamycin and erythromycin resistance (odds ratio (OR): 7.0; 95% confidence interval (CI): 1.9-25.3). Infection focus was mainly the skin; either cellulitis (7/12) or necrotising fasciitis (3/12). All emm33 GAS isolates harboured the ermTR resistance gene with constitutive macrolides, lincosamides and streptogramines B (MLS(B)) phenotype. Emm33 GAS was responsible for the higher proportion of clindamycin resistance in skin, soft tissue, and blood isolates locally in 2012 and 2013.
Perforation of the uterus with Lippes loop. Epidemiologic analysis
Authors: F. D. Scutchfield
Journal: JAMA (1969)

Eight uterine perforations with the Lippes loop were seen by the members of the Emory University Family Planning Program at Grady Memorial hospital. This program has been responsible for 6,839 insertions of the Lippes loop. We feel that uterine perforation frequently involves one physician. The use of a uterine sound prior to insertion can help prevent uterine perforations. The most common complaints are pregnancy without a known expulsion and inability to see the strings of the intrauterine contraceptive device during pelvic examination or both.
Hyperprolactinemia, distress, and hostility
Authors: R Kellner, M T Buckman, G A Fava, D Pathak
Journal: American Journal of Psychiatry (1984)

The scores of 14 women with hyperprolactinemia on the Symptom Rating Test and the Symptom Questionnaire were compared with those of nonpsychotic women attending a psychiatric clinic, women attending a family practice clinic, and female nonpatient employees. The scores of the hyperprolactinemic women were similar to those of the psychiatric patients. Hyperprolactinemic patients were significantly more hostile, depressed, and anxious and had more feelings of inadequacy than family practice patients and nonpatient employees. The authors recommend measuring the serum prolactin levels of women with depression, hostility, anxiety, and symptoms or signs suggestive of hyperprolactinemia.