tbuckley/cabot-search huggingface dataset:
PTH-001 Use Of Pancreatic Stents In Endoscopic Retrograde Cholangio-pancreatography
Authors: A Malik, G Thomas, A Roberts
Journal: Gut (2014)

<h3>Introduction</h3> The indications for placing pancreatic stents (PS) during endoscopic retrograde cholangio-pancreatography (ERCP) include pancreatic duct stones and strictures, prevention of post-ERCP pancreatitis and as an aid to biliary cannulation, where there is persistent preferential pancreatic cannulation. The flange at the proximal end of the stent used in our practice (Cook UK) is designed to prevent spontaneous migration. As a minimum, abdominal x-ray (AXR) should be performed at 4 weeks to confirm spontaneous stent passage. The aims of this study were to assess a) indications for PS b) compliance with AXR recommendation c) whether flange removal aids spontaneous stent passage. <h3>Methods</h3> Retrospective review of ERCP reports and case notes in 1250 ERCPs performed at our institution between August 2011 and December 2013. <h3>Results</h3> In 82 of 1250 ERCPs, PS were placed (6.5%). 31 male, 51 female, mean age 63 years (range 20–92). The indication for PS placement in all 82 was to aid biliary cannulation, and in all 82, the PS was left <i>in situ</i> to reduce the pancreatitis risk. In 72/82, biliary cannulation was successful (pre-cut in 55). 42/82 had AXR, and in 36/42 the stent had passed. 21/82 had repeat ERCP and in 15/21 the stent had passed. 19/82 (23%) had no record of AXR or repeat ERCP. Based on operator preference, the flange was removed in 38 and left <i>in situ</i> in 44. Of the 12 PS that failed to pass spontaneously the flange was removed in 4 and left <i>in situ</i> in 8. <h3>Conclusion</h3> Pancreatic stents are a useful aid to biliary cannulation, and pass spontaneously in the majority of patients, although flange removal may facilitate this. Compliance with the minimum recommendation of post-ERCP AXR to confirm stent passage in only 77% is poor, and requires further investigation. <h3>Disclosure of Interest</h3> None Declared.
Case 18-1989
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, J.J. Skillman, J.F. Southern
Journal: New England Journal of Medicine (1989)

Presentation of CaseA 52-year-old woman was admitted to the hospital because of pain in the left lower abdominal quadrant and a question of peritonitis.The patient was well until two weeks earlier, when she fell and injured her left foot. At about the same time she experienced the onset of increasing pain in the left lower quadrant of the abdomen, accompanied by constipation, anorexia, progressive weakness, polydipsia, and polyuria. During the five days before entry she passed no stool. Two or three days before admission nausea and vomiting developed. On the day of entry she went to another hospital, . . .
Press: Mixed messages on breast cancer
Authors: J. Hopkins Tanne
Journal: BMJ (2002)

Green light on mammography, amber on tamoxifen

In covering controversies about breast cancer, the US media show bias in favour of screening, but are less enthusiastic about chemoprevention, a study has shown.

Researchers looked at how US newspapers and television covered two stories—one about the detection of breast cancer by mammography and the other about chemoprevention by tamoxifen—and found striking differences.

In January 1997 a National Institutes of Health consensus panel said that evidence did not support screening for women in their 40s and told women to decide for themselves whether or not to have the test. In March 1997, under political pressure, the National Cancer Institute changed course and recommended screening. …
P988 SERUM INSULIN-LIKE GROWTH FACTOR-1 PREDICTS DISEASE PROGRESSION AND SURVIVAL IN PATIENTS WITH HEPATOCELLULAR CARCINOMA WHO UNDERGO TRANSARTERIAL CHEMOEMBOLIZATION
Authors: E.J. Cho, H.-C. Kim, J.-H. Lee, J.-J. Yoo, Y. Cho, D.H. Lee, Y.B. Lee, S.J. Yu, Y.J. Kim, J.-H. Yoon, J.W. Chung, H.-S. Lee
Journal: Journal of Hepatology (2014)
SP0161 Functional Consequences of Anti-Pad-Antibodies in RA
Authors: E. Darrah
Journal: Annals of the Rheumatic Diseases (2014)

<h3></h3> Peptidylarginine deiminase (PAD) enzymes have emerged as key participants in the pathogenesis of rheumatoid arthritis (RA) due to their expression in inflamed RA synovium and generation of citrullinated autoantigens, hallmark targets of the immune response in RA. Autoantibodies to PAD4, a nuclear member of this enzyme family, are present in 35% of RA patients and are associated with more erosive joint disease. Interestingly, soluble PAD4 has been detected in the synovial fluid of inflamed joints, and has been postulated to possess extracellular citrullination activity. However, the calcium availability in the joint is estimated to be 0.5-1.0mM, far less than the 5-10mM calcium required for PAD4 activity <i>in vitro</i>. Functional studies of PAD4 enzymatic activity have revealed heterogeneous effects of autoantibody binding on the citrullination of small molecule and protein substrates at supraphysiologic calcium concentrations. <h3>Results</h3> We have recently described a subset of PAD4 autoantibodies, present in 12-18% of RA patients, that cross-react with the related enzyme PAD3, and have unique biochemical and clinical properties. In functional assays measuring citrullination of the PAD4 substrate, histone H3, cross-reactive antibodies had the striking ability to enhance PAD4 enzymatic activity up to 400-fold at physiologic calcium concentrations (0.2-1.0mM). Cross-reactive antibodies lowered the amount of calcium required for half maximal PAD4 activity from 3.3 to 0.5mM, well into the physiologic range. This effect was mediated by autoantibody binding to a region of PAD4 which normally undergoes calcium-induced structural changes necessary for citrullination of target proteins. A pathogenic role for these PAD4-activating antibodies was suggested by the finding that RA patients with cross-reactive antibodies had the most severe and progressive joint disease compared to patients who lacked this subset. In addition, cross-reactive antibody positive patients were at the highest risk for the development of RA-associated interstitial lung disease, an effect augmented by cigarette smoking. <h3>Conclusions</h3> Taken together, this work describes a potentially pathogenic subset of PAD4 autoantibodies with the capacity to drive the production of autoantigens in RA and identifies patients who may benefit from the addition of novel PAD-inhibitor therapies. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.6169
Management and prevention of gingival recession
Authors: George K. Merijohn
Journal: Periodontology 2000 (2016)

Abstract Gingival recession is highly prevalent worldwide. It increases the risk for root caries and can interfere with patient comfort, function and esthetics. Progressive gingival recession also increases the risk of tooth loss secondary to clinical attachment loss. Although mitigating the causes of gingival recession decreases its incidence and severity, implementing practical management and prevention strategies in the clinical setting can be challenging. Identification of susceptible patients and evaluating them for the presence of modifiable risk exposures are essential first steps in developing action plans for appropriate interventions. This article reviews these steps and introduces chairside tools that can help in the selection of interventions designed to reduce the risk of future gingival recession and may also facilitate patient communication. Practical decision‐making criteria are proposed for when and how to monitor gingival recession, for deciding when a patient is a candidate for surgical evaluation or referral to a periodontist, and, if surgery is the treatment of choice, what should be considered as key surgical outcome objectives.
AB0142 Mycophenolate mofetil and sirolimus inhibit proliferation of primary human osteoblasts in vitro
Authors: S. Stracke, L. Ramudo, C. Aymanns, F. Ernst, B. Fiene, M. Fiene
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Maintenance of bone homeostasis depends on the coupling between the activity of osteoblasts and osteoclasts that is locally regulated by B cells and T cells. Thus, both autoimmune diseases and immunosuppressive therapy can influence bone metabolism and bone turnover. Calcineurin inhibitors can induce high turnover osteopathy, with and without bone loss. There are only limited data on the influence of other immunosuppressants such as mycophenolate mofetil (MMF) and mTOR inhibitors (sirolimus) on bone turnover and osteoblast proliferation. <h3>Objectives</h3> We analyzed the antiproliferative capacity of cyclosporine (CsA), MMF and sirolimus (sir) on primary human osteoblasts (hOB) and human osteosarcoma cells (TE85 cell line) <i>in vitro</i>. <h3>Methods</h3> hOB ad TE8-cells were cultured under standardized conditions with serum stimulation. Sirolimus and MMF were added in ascending concentrations of 1 – 100 μg/L and cyclosporine was given at 100 – 1000 μg/L for 24 hours. The antiproliferative capacity was measured by MTT-assay and compared to serum-stimulated controls. <h3>Results</h3> MMF dose-dependently inhibited the proliferation of primary hOB. We saw a growth inhibition to 92% [at 1 μg/L MMF], 84% [at 10 μg/L MMF] and 69% respectively [at 100 μg/L MMF]. Sirolimus already inhibited hOB growth at the lowest concentration used. Cell growth was reduced to 69% compared to control cells [at 1 μg/L sir], 74% [at 10 μg/L sir] and 70% respectively [at 100 μg/L sir]. Also cyclosporine showed an inhibitory effect on hOB proliferation, however, only at higher doses: 93% [at 100 μg/L CsA], 84% [at 500 μg/L CsA], 77% [at 1000 μg/L CsA]. In the osteosarcoma cell line TE85, cyclosporine and sirolimus were without effect while MMF showed an inhibition of proliferation at the highest dose used: reduction to 83% cell growth [at 100 μg/L MMF]. <h3>Conclusions</h3> At doses used in clinical routine, sirolimus [1 μg/L] and MMF [10 μg/L] inhibited the proliferative capacity of primary human osteoblasts <i>in vitro</i>. Sirolimus and MMF may contribute to bone loss in autoimmune diseases via inhibition of osteoblast growth. <h3>Disclosure of Interest</h3> None Declared
Extrarenal Retroperitoneal Angiomyolipoma Mimicking Metastatic Melanoma
Authors: Rodney D. Welling, Matthew P. Lungren, R. Edward Coleman
Journal: Clinical Nuclear Medicine (2012)

A 38-year-old man with melanoma of the right flank underwent a staging 18F-fluoro-2-deoxyglucose (FDG) PET/CT scan, which demonstrated a hypermetabolic extrarenal mass in the left retroperitoneal space, concerning for metastatic melanoma. However, surgical pathology demonstrated an angiomyolipoma (AML). Although AMLs can rarely occur in an extrarenal location, extrarenal retroperitoneal AMLs are exceptional. AMLs have variable imaging appearances on multiple imaging modalities, including FDG PET, and can confound accurate diagnosis when in an extrarenal location. This case demonstrates the only known FDG PET description of an extrarenal retroperitoneal AML and highlights the challenge in accurate diagnosis based on FDG PET findings.
Chronic Idiopathic Thrombocytopenic Purpura
Authors: James N. George, Mayez A. El-Harake, Gary E. Raskob
Journal: New England Journal of Medicine (1994)

Idiopathic thrombocytopenic purpura (ITP), also referred to as primary immune thrombocytopenic purpura, is defined by a low platelet count, normal bone marrow, and the absence of other causes of thrombocytopenia. This review focuses on ITP and its management in adults. Typically, adult ITP is a chronic disease.Clinical FeaturesPresentationAmong adults, ITP is most common in young women: 72 percent of patients over 10 years old are women, and 70 percent of these women are less than 40 years old1. The onset is often insidious. History and physical examination are normal except for symptoms and signs of the . . .
Estrogen Profiles of Oriental and Caucasian Women in Hawaii
Authors: Louis E. Dickinson, Brian MacMahon, Philip Cole, James B. Brown
Journal: New England Journal of Medicine (1974)

Abstract It has previously been suggested that young women who excrete a low proportion of urinary estrogen as estriol are at high risk for breast cancer. Breast-cancer rates of Oriental women in Hawaii are lower than those of Caucasians but substantially higher than those of Oriental women in Asia. In this study three estrogens were measured in urine of women 15 to 39 years old in Honolulu; 101 study subjects were of Chinese, 132 of Japanese and 129 of Caucasian descent. Caucasians in Hawaii, whose breast cancer rate is high and similar to that of Caucasians on the North American mainland, had estriol ratios similar to those of mainland women. Japanese and Chinese of Hawaii showed estrogen profiles different from those seen in Japan and China and approaching those of Caucasians. The observations support the idea that the urinary estriol ratio of young women is associated inversely with breast-cancer risk. (N Engl J Med 291:1211–1213, 1974)
Abstract 5007: Nuclear targeted Deleted in liver cancer 1 exhibited reduced tumor suppressive function both in vitro and in vivo
Authors: Lo Kong Chan, Frankie Chi Fat Ko, Irene Oi Lin Ng, Judy Wai Ping Yam
Journal: Cancer Research (2010)

Abstract The tumor suppressor Deleted in liver cancer 1 (DLC1) protects cell from transformation by catalyzing the GTP hydrolysis of active RhoA. Besides the RhoGAP activity, accumulating evidences have supported that localization at focal adhesions and interaction with tensin protein are key factors guiding the tumor suppressive activity of DLC1. In this study, we provided new evidence that DLC1 was a dynamic protein which shuttles between cytoplasm and nucleus instead of statically staying in the cytoplasm. Subcellular fractionation assay showed that DLC1 protein can be detected in cytoplasmic and nuclear fractions. Treatment of Leptomycin B (LMB), a nuclear export blocker, could lead to the nuclear retention of exogenous and endogenous DLC1 in different human cancer cell lines. Detail examination of relevant DLC1 mutants had shown that the center region of DLC1 was necessary and sufficient for its nuclear localization. We transiently expressed a NLS fusion DLC1 (NLS-DLC1) with preferential nuclear localization in SMMC HCC cells and found that NLS-DLC1 was less potent in suppressing colony formation and actin stress fiber formation. To study the tumor suppressive function of nuclear DLC1 both in vitro and in vivo, we employed retroviral transduction to stably express NLS-DLC1 in a p53−/− RasV12 hepatoblast model. We found that NLS-DLC1 expressing cells proliferated faster in vitro and exhibited increased tumorigenicity upon nude mice injection when compared with the non-nuclear targeted DLC1. Although the function of nuclear DLC1 remains to be answered, our results clearly demonstrated that nuclear localization of DLC1 may serve as a potential mechanism in negatively regulating its tumor suppressive activity. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5007.
S43 Real World Experience Of The Use Of Pet-ct For Distinguishing Between Benign Pleural Disease And Malignant Mesothelioma
Authors: K. Prior, J. Fingleton, T. Howell
Journal: Thorax (2014)

<h3></h3> Patients presenting with pleural disease on a background of asbestos exposure pose a diagnostic dilemma. Malignant mesothelioma and benign pleural disease have similar radiological appearances but markedly different prognoses. Definitive histological diagnosis is gold standard, however, there are small case series where PET-CT has been compared to pleural biopsy. These have suggested cut-off standardised uptake values (SUV) of 2.0–3.0, with reported sensitivity of 94.1–100% and specificity of 94–100% for excluding pleural malignancy. It has been suggested that where the CT appearances are more in keeping with a benign aetiology, pleural avidity on PET-CT may be able to adequately distinguish between benign and malignant disease, identifying a low-risk population that can be observed in preference to proceeding to thoracoscopy. We are a cardiothoracic centre which utilises PET-CT in this way. We aimed to review our single-centre experience to see if our outcomes were consistent with the reported data. All PET-CT reports carried out since 2007 with the mention of pleura/pleural within the request or report were reviewed. Radiological reports and patient records were examined, scans requested primarily for assessment of the pleura were included. Indication, radiological diagnosis, final diagnosis, presence of histological confirmation and duration of follow-up were determined. All patients with at least 6 months follow-up were analysed. 185 PET CT scan reports were reviewed, of which 28 were carried out primarily for assessment of pleural disease. 9 were found to have high SUVs suggestive of malignancy. 7 of which were demonstrated to be mesothelioma, 1 pleural tumour, 1 recurrence of non-small cell lung cancer. The remaining 19 were reported to have low SUVs, consistent with benign pleural disease. For those with PET findings consistent with benign pleural disease, follow up data was available for a median of 12 months (Min 6- Max 66). One patient underwent pleural biopsy, which was consistent with benign disease. None of those designated as benign pleural disease based on PET-CT appearances were subsequently found to have pleural malignancy. Our findings are consistent with previously published data and support the utility of PET-CT scanning in differentiating benign from malignant pleural disease in a clinical setting.
SAT0390 Axial Involvement in Early Psoriatic Arthritis: Magnetic Resonance Imaging and X-RAY of Sacroiliac Joints, Inflammation Back Pain and Hla-B27
Authors: E. Loginova, T. Korotaeva, A. Smirnov, L. Denisov, D. Karateev, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Early psoriatic arthritis (EPsA) is predominantly peripheral spondyloarthritis (SpA), but certain patients (pts) may have axial involvement with inflammatory back pain (IBP) and sacroiliitis (SI). Active inflammation of sacroiliac joints detected by magnetic resonance imaging (MRI) has been proposed as an important symptom of early axial SpA. Axial involvement and frequency of SI by MRI in EPsA insufficiently studied. <h3>Objectives</h3> to investigate frequency of involvement of sacroiliac joints by MRI and x-ray, IBP and HLA B27 in peripheral EPsA. <h3>Methods</h3> 40 (M/F – 17/23) pts with EPsA, according to the CASPAR criteria, the mean age 36.5 [28.5;49.5] yrs, mean PsA duration 13.5 [5;24] mo., mean psoriasis duration 3 [1;6] yrs. were included. All pts underwent clinical examination to determine IBP by ASAS criteria, HLA B27, x-ray of sacroiliac joints to determine definite radiographic SI (II-III grade) according to the New-York criteria. MRI of sacroiliac joints was performed in 37 pts by the apparatus "Signa Ovation" (0,35T `GE Medical Systems"). Bone marrow oedema/osteitis on STIR images by MRI are believed to be a sign of active SI (MRI-ASI). All MRI scans were checked by blinded readers. Median and quartiles [Me (Q25; Q75)], χ<sup>2</sup>, Yule9s coefficient of association (Q level from-1 to 1) were performed. All p&lt;0.05 were considered to indicate statistical significance. <h3>Results</h3> Pts with EPsA had an high level of activity by DAS=3.99 [2.99;4.92], moderate by DAS28=4.22 [3.37;4.8]. MRI-ASI was found in 40.5% pts, definite radiographic SI – in 28.9%. IBP was found in 22 pts (55%), 12 out of them (30% out of all) had long-term (≥3 months) IBP and 10 out of them (25% out of all) had short-term IBP. HLA B27 was found in 42.5% pts. No correlations were found between MRI-ASI and DAS/DAS28 in EPsA pts. A high level of association was found between MRA-ASI and IBP in EPsA pts (Q=0.91, χ<sup>2</sup> p&lt;0,002) (Table 1). A modest association was found between MRA-ASI and HLA B27 in EPsA pts, differences are not significant (Q=0.53, χ<sup>2</sup> p&lt;0.08) (Table 2). <h3>Conclusions</h3> Although PsA refers to SpA, axial involvement had less than half of EPsA pts. MRI-ASI was found in EPsA only in 40.5% pts, x-ray definite SI - in less of cases (28.9%), IBP – in 55% of pts and less than one third of them had long-term IBP by ASAS criteria. MRI-ASI and x-ray definite SI was strongly associated with IBP and moderately with HLAB27. The degree of activity of peripheral arthritis doesn9t have an effect on frequency of involvement of sacroiliac joints by MRI and x-ray. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.3198
SAT0119 Asymtptomatic Carotid Plaques in RA Patients is Associated with Increased HDL Function
Authors: S. Rollefstad, B. Halvorsen, T. Skarpengland, T.K. Kvien, S.A. Provan, A.G.P. Semb
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Reverse cholesterol transport (RCT) is a major anti atherogenic function of high density lipoprotein cholesterol (HDL-c) and has been shown to be related to disease activity in patients with rheumatoid arthritis (RA). <h3>Objectives</h3> To evaluated if atherosclerosis affects the HDL-c function differently in RA patients compared to healthy controls. <h3>Methods</h3> RA patients from the Oslo RA register and the European Research on Incapacitating Disease and Social Support cohorts without cardiovascular disease (CV) and not using lipid lowering agents or biologic DMARDS were included. Healthy community controls were selected by Statistics Norway. RCT was measured as plasma induced 14C-cholesterol efflux from 14C-cholesterol loaded human THP1 macrophages as previously described.<sup>1</sup> Apolipoprotein A1 (ApoA1) and paraoxgenase-1 (PON-1) activity was measured in serum using commercial kits. <h3>Results</h3> Twenty RA patients, 10 with and 10 without asymptomatic carotid plaques (CP), and 10 controls were age and gender matched (p=0.09 and p=0.35, respectively). The traditional CV risk factors were comparable in RA patients with and without CP and controls; smoking: p=0.55, systolic blood pressure: p=0.77, total cholesterol: p=0.48, LDL-c p=0.31, HDL-c: p=0.89, triglycerides: p=0.85. None had diabetes. Untraditional biomarkers of CV disease as CRP, ESR and proBNP were also comparable across the 3 groups; p=0.53, p=0.86 and p=0.45, respectively. RA disease factors as disease duration, rheumatoid factor, anti-CCP and DAS-28 were comparable between RA patients with and without CP (p=0.81, p=0.34, p=0.34 and p=0.94). Efflux capacity was significantly increased in RA patients with CP compared both to controls without CP (p=0.03) and controls with CP (p=0.01). Likewise, both ApoA1 and PON-1 activity was increased in RA patients with CP compared to controls (p=0.02 and p=0.05, respectively). Further, APOA1 and PON-1 activity were comparable between RA patients without CP and controls (p=0.58 and p=0.69, respectively). <h3>Conclusions</h3> The cholesterol efflux capacity was increased in RA patients with early atherosclerosis compared to controls, independent of HDL-c level and CRP. Our findings indicates an association between atherosclerosis and upgraded HDL-c function in patients with RA when disease activity is low, possibly as a compensatory mechanism to the atherosclerotic process. This study is hypothesis generating and larger studies are warranted to verify these findings. <h3>References</h3> Ottestad IO, Halvorsen B, Balstad TR, Otterdal K, Borge GI, Brosstad F et al. Triglyceride-rich HDL3 from patients with familial hypercholesterolemia are less able to inhibit cytokine release or to promote cholesterol efflux. J Nutr 2006; 136(4):877-881. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.5221