tbuckley/cabot-search huggingface dataset:
PWE-325 Do we practice what we preach with complete responders in rectal cancer?
Authors: HM Joshi, N Ormsby, R Rajaganeshan
Journal: Gut (2015)

<h3>Introduction</h3> There is a lack of conclusive long-term studies evaluating risk and benefit in the surgical management of complete pathological response to rectal cancer. The trend in practice is becoming increasingly conservative, especially with an ageing population with increasing comorbidity, with recent data supporting a ‘watch and wait’ approach to complete responders. A recently published article utlilsing decision-analytical modelling predicted no difference in survival in 60 year old male patients between those managed conservatively and operatively. More interestingly they predicted a significant improvement in absolute survival in 80 year olds managed conservatively. Given the trend of the current evidence we aimed to determine the regional practice in Merseyside. We questioned whether increased age and/or comorbidity influenced surgeon decision when complete pathological response was detected. <h3>Method</h3> A questionnaire was submitted to all the colorectal cancer surgeons within the greater Merseyside region, in the north west of England, United Kingdom. The participants were asked for their practice in managing 3 patient cohorts (60, 70, 80 years of age) with complete pathological response and of varying comorbid status. They were then asked for their preference should they be faced with the same clinical scenario personally. <h3>Results</h3> 10 colorectal cancer units with 33 colorectal surgeons were surveyed. The response rate was 23/33 (70%). 5% of surgeons would offer surgery to 70–80 year old patients with multiple comorbidities, whereas 22% would if the patient was 60 years of age. 27% of surgeons would offer surgery to patients who were 80 years of age who had no medical comorbidities, and 55% would if they were 60 years of age with no comorbidities. 66% of surgeons would not want any surgery if they personally had a completely responding rectal cancer. 44% would want different treatment from what they would offer their patients. One surgeon would not routinely offer surgery but would personally want one. <h3>Conclusion</h3> Patients with complete pathological response get different treatment according to surgeon preference in Merseyside. 44% of surgeons would advise their patients something they would not choose should they be faced with the same scenario. More study into the long-term risk and benefit of surgical vs. conservative management of complete responders is required, in order that surgeons can offer a more evidence based treatment for the patient, a treatment they would wish upon themselves. <h3>Disclosure of interest</h3> None Declared.
PTU-140 Neoadjuvant therapy toxicity and efficacy in oesophago-gastric cancer
Authors: D Bunting, T Wheatley, P Peyser, R Berrisford, T Bracey, J Rahamim, G Sanders
Journal: Gut (2015)

<h3>Introduction</h3> The advantages of neoadjuvant therapy (NAT) in oesophago-gastric (OG) cancer have been proven in randomised trials. Benefits are modest and likely to be restricted to patients who respond well to therapy. The risks may outweigh benefits in earlier stages of disease. This study explores the risks associated with NAT, analyses which patients benefit and investigates whether there is a need for a change in NAT treatment strategy. <h3>Method</h3> All patients planned for surgical resection of OG cancer in this unit between 01/2010 and 12/2014 were identified. Part a) patients were divided according to pre-operative stage. Within each stage, survival was compared in patients undergoing NAT and those undergoing surgery alone. Similar comparisons were made with the NAT group further divided into histological responders and non-responders. Part b) from the cohort, patients undergoing NAT were identified. Adverse effects (AE) were recorded and graded according to the Common Terminology Criteria for Adverse Events v3.0. The relationships between the presence of AE and a range of variables were investigated along with survival. Survival analyses were undertaken by plotting Kaplan-Meier curves. Groups were compared using the Log Rank (Mantel-Cox) test. <h3>Results</h3> 587 patients were identified from the database. Part a) only stage III patients had improved survival with NAT vs. surgery alone (P = 0.02). Those in stage II with a histological response to treatment showed a trend towards better survival vs. surgery alone (P = 0.058). In all patients above the threshold for offering NAT (≥stage II), survival was no different in non-responders vs. those having surgery alone. Age and performance status were lower in the NAT group vs. the surgery only group and were both associated inversely with survival. This could mean NAT effects are overestimated and true survival in non-responders to NAT may be poorer than in patients having surgery alone. Part b) 376 patients received NAT and 88 (23.4%) suffered AE. 69% of these were severe, life-threatening or fatal. NAT course completion rate was lower in patients suffering AE vs. those not (P = 0.003). 20.5% patients with AE did not proceed to resection vs. 6.4% without AE (P = 0.001). Survival was better in patients without AE vs. with AE (P = 0.02) and was better in those undergoing resection (P &lt; 0.001) but was no different in patients completing the course vs. not completing (P = 0.861). <h3>Conclusion</h3> Efficacy of NAT is dependent on cancer stage and histological response to NAT. AE are common, often severe and associated with a reduced resection rate and survival. Identifying a means of predicting response to NAT is of great importance and should be used to guide treatment alongside/instead of disease stage. <h3>Disclosure of interest</h3> None Declared.
Fortnightly Review: Irritable bowel, irritable body, or irritable brain?
Authors: M. J G Farthing
Journal: BMJ (1995)

<h3>Summary points</h3> The irritable bowel syndrome affects about 20% of adults in the industrialised world The condition is a disturbance of gastrointestinal function of unknown cause, but abnormalities of intestinal motility and visceral sensation are found in some patients Symptoms of the irritable bowel syndrome are often associated with extraintestinal manifestations, including urinary symptoms, dyspareunia, and fatigue Overall, 40–60% of patients with the irritable bowel syndrome who seek medical advice have psychological symptoms of depression or anxiety, or both Diagnosis of the irritable bowel syndrome can usually be made on the basis of clinical history and examination, but exclusion of organic disease is advisable in patients aged &gt;45 years who present with new bowel symptoms No uniformly successful treatment exists for the irritable bowel syndrome. End organ treatment aimed at relieving abdominal pain (antispasmodic drugs) or disturbed bowel habit (antidiarrhoeal and bulking agents) can produce symptomatic relief, and "central" treatment (for example, anti-depressants, hypnotherapy, psychotherapy) should be considered in patients with associated affective disorders
Exposure to ambient light in patients with winter seasonal affective disorder
Authors: D A Oren, D E Moul, P J Schwartz, C Brown, E M Yamada, N E Rosenthal
Journal: American Journal of Psychiatry (1994)

In a study of the quantitative relationship between ambient light and depression in winter seasonal affective disorder, 13 outpatients and 13 normal comparison subjects each wore a light monitor for 1 week. The patients and normal subjects showed similar light exposure profiles; among the patients, severity of depression was inversely related to photoperiod, and there was a trend toward a correlation between greater severity of depression and later time of onset of morning light exposure. These findings suggest that vulnerability to short photoperiods may be related to depression in winter seasonal affective disorder.
Clinical Pharmacokinetics
Authors: David J. Greenblatt, Jan Koch-Weser
Journal: New England Journal of Medicine (1975)

THE intensity of the therapeutic and toxic effects of most pharmacologic agents depends on their concentration at the sites of action. The time course of this concentration is determined by the drug dosage schedule and by the metabolic fate of the drug in the body. Pharmacokinetics is the quantitative study of the metabolic processes of drug absorption, distribution, biotransformation and elimination. The use of mathematical models to describe these processes allows predictions about drug concentrations in various parts of the body as a function of dosage, route of administration, and time. In view of the complexity . . .
Training psychiatrists to work with community support systems for chronically mentally ill persons
Authors: D L Cutler, J D Bloom, J H Shore
Journal: American Journal of Psychiatry (1981)

Community support programs are becoming a major priority in community mental health centers throughout the country. The authors present a training design that integrates principles and skills associated with this model into a 4-year residency training program. The aim of such programs is to keep young psychiatrists involved and in the forefront of the newer approaches to the treatment of chronically mentally ill persons.
Acute Mountain Sickness
Authors: T. Scott Johnson, Paul B. Rock
Journal: New England Journal of Medicine (1988)

THE majority of persons who ascend rapidly to terrestrial elevations higher than approximately 2500 m (8200 ft) undergo an unpleasant period of acclimatization. During this time, they have a variety of symptoms, the most prominent of which are headache, nausea, vomiting, and insomnia, that are collectively referred to as acute mountain sickness.1 2 3 This paper reviews current concepts of the pathogenesis and treatment of this disorder. Factors that influence susceptibility to this condition will be discussed. Acute mountain sickness is part of a continuum of diseases related to ascension to high altitudes4 that includes the infrequent life-threatening conditions high-altitude pulmonary edema . . .
Banning Electrical Shock Devices
Authors: Rebecca Voelker
Journal: JAMA (2016)

The FDA wants to ban devices that apply electrical shocks to the skin to stop aggressive behavior and self-inflicted injuries such as head-banging, hand-biting, or eye gouging.

Only on rare occasions does the agency seek to ban devices. “These devices are dangerous and a risk to public health—and we believe they should not be used,” William Maisel, MD, MPH, of the FDA’s Center for Devices and Radiological Health, said in a statement (http://1.usa.gov/1VGHKus).
Early parental absence as an indicator of course and outcome in chronic schizophrenia
Authors: P Stastny, D Perlick, L Zeavin, M Empfield, M Mayer
Journal: American Journal of Psychiatry (1984)

In two studies of chronic schizophrenic patients, long-term inpatients were found to have a significantly higher rate of histories of early parental absence than outpatients. Early parental absence may be an indicator of course and outcome in chronic schizophrenia.
Production of Malignancy &lt;italic&gt;in vitro&lt;/italic&gt;. X. Continued Description of Cells at the Glass Interface of the Cultures
Authors: Wilton R. Earle, Edward L. Schilling, Emma Shelton
Journal: JNCI Journal of the National Cancer Institute (1950)

Production of Malignancy in vitro. X. Continued Description of Cells at the Glass Interface of the Cultures Get access Wilton R. Earle, Wilton R. Earle Search for other works by this author on: Oxford Academic PubMed Google Scholar Edward L. Schilling, Edward L. Schilling Search for other works by this author on: Oxford Academic PubMed Google Scholar Emma Shelton Emma Shelton National Cancer Institute, National Institutes of Health, Public Health Service, Bethesda, Md. Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 10, Issue 5, April 1950, Pages 1067–1103, https://doi.org/10.1093/jnci/10.5.1067 Published: 01 April 1950 Article history Received: 30 November 1949 Published: 01 April 1950
Thirteen Questions: Some Historical Outlines for Cancer Research
Authors: Michael B. Shimkin, M.D.
Journal: JNCI Journal of the National Cancer Institute (1957)

Journal Article Thirteen Questions: Some Historical Outlines for Cancer Research Get access Michael B. Shimkin, M.D. Michael B. Shimkin, M.D. National Cancer Institute, Bethesda, Maryland Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 19, Issue 2, August 1957, Pages 295–328, https://doi.org/10.1093/jnci/19.2.295 Published: 01 August 1957
Psychiatrists' familiarity with legal statutes governing emergency involuntary hospitalization
Authors: G G Affleck, M A Peszke, R M Wintrob
Journal: American Journal of Psychiatry (1978)

The authors sent out questionnaires regarding knowledge of statutes governing emergency involuntary hospitalization to psychiatrists in Connecticut and in the District of Columbia. Fifty-five percent (N=207) of the sample in Connecticut and 25% (N=87) of the sample in the District of Columbia responded. The responses showed that few of these psychiatrists had a thorough familiarity with the legal statutes governing emergency involuntary hospitalization in their jurisdictions. The most frequently cited criterion was the dangerousness standard, especially in the District of Columbia sample, and many psychiatrists were not sure of the nature of their statutory authority when their patients met the criteria for emergency hospitalization.
HOME CARE FOR THE NEEDY AND MEDICALLY NEEDY
Authors: F GOLDMANN
Journal: JAMA (1952)

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FRI0600 Quantification of Cortical Breaks Using High-Resolution Peripheral Quantitative Computed Tomography Imaging; A Case Control Study
Authors: M. Peters, A. Scharmga, A. van Tubergen, J. van den Bergh, R. Weijers, D. Loeffen, B. van Rietbergen, C. Arts, P. Geusens
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Radiography is considered the gold standard for the detection of bone erosions in Rheumatoid arthritis (RA). Early detection of small erosions may potentially promote timely initiation of treatment and improve outcome. Small cortical breaks cannot be seen on radiographs, but can be detected with High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT). Small cortical breaks can be seen in healthy controls (HCs) and can be the first stages of erosions in RA. <h3>Objectives</h3> To compare the number of cortical breaks in hand joints of RA patients and HCs according to their size. <h3>Methods</h3> Nineteen subjects (mean age ± SD; 53.9±8.0) from 3 different groups were evaluated: 1) 6 late RA, (diagnosis ≥10 years ago); 2) 6 early RA, (diagnosis ≤2 years ago); and 3) 7 HCs. From these subjects the 2nd MCP and PIP joints were imaged and evaluated with HR-pQCT (isotropic voxel size of 82 μm). In the RA groups, both hands were evaluated (24 joints per RA group), in the HC group only the dominant hand (total of 14 joints). A semi-automated algorithm was applied to the HR-pQCT images for the detection of cortical breaks. First, the outer margin of the bone structure was contoured. Second, the bone within 0.25 mm from this contour was defined as the cortical region. Last, different sizes for defining a cortical beak (&gt;0.50mm, &gt;0.66mm and &gt;0.82mm) were applied and the number of breaks using each cut off was evaluated. Descriptive statistics were calculated and non-parametric tests for comparisons were performed. <h3>Results</h3> In the HC group, one joint was excluded due to movement artifacts; therefore, in total 61 joints could be evaluated (Late RA 24 joints, early RA 24 joints, HCs 13 joints). Table 1 shows the total number of breaks of each group stratified per cortical break size. Significant differences were found for break sizes &gt;0.50mm and &gt;0.82mm across the three different groups (p&lt;0.05). These significant differences were found between the HC and late RA group (p&lt;0.05), a trend towards a significant difference was also found between HC and early RA groups with breaks of &gt;0.50mm and &gt;0.66mm (both p=0.07), and between early RA and late RA with breaks of &gt;0.82mm (p=0.06). Most breaks were located close to the rim of the joint (Fig. 1). <h3>Conclusions</h3> The number and size of cortical breaks increases over the course of the disease in RA, with a significantly higher number of breaks in late RA compared to HCs. Therefore, the use of HR-pQCT in combination with our semi-automatic algorithm is a promising tool for early detection and monitoring of the number of small cortical breaks. <h3>Disclosure of Interest</h3> None declared
THU0479 The Sex Ratios of Knee and Hip Osteoarthritis are Different in Korea: Data from the Korean National Health and Nutrition Examination Survey 2013
Authors: K.W. Moon
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Osteoarthritis (OA) is one of the most common arthritis in the world, but little data are available in Asian populations. We sought to assess the prevalence and sex difference of knee and hip OA in Korean population. <h3>Objectives</h3> This study aimed to evaluate the prevalence and sex difference of knee and hip OA in Korea. <h3>Methods</h3> This cross-sectional study involved the data of 8018 participants of the Korean National Health and Nutrition Surveys at 2013. Symptomatic OA was defined as the presence of joint pain and Kellgren-Lawrence (KL) grade ≥2. Radiographic OA was defined as KL grade ≥2. The prevalence of knee and hip OA was evaluated in people aged ≥50 years. <h3>Results</h3> The prevalence of symptomatic knee OA was 11.8%, with women having higher rate than men (16.8% vs 6.1%). Women were more prevalent than men in radiographic knee OA (45.8% vs 33.6%). The prevalence of symptomatic hip OA was 0.3%, with men having higher rate than women (0.5% vs 0.1%). Men were more prevalent than women in radiographic hip OA (2.9% vs 1.3%). <h3>Conclusions</h3> Knee OA was more prevalent in women, but hip OA was more prevalent in men in Korea. <h3>References</h3> Ho-Pham LT, Lai TQ, Mai LD, et al. Prevalence of radiographic osteoarthritis of the knee and its relationship to self-reported pain. PloS one 2014;9(4):e94563. Lee KM, Chung CY, Sung KH, et al. Risk factors for osteoarthritis and contributing factors to current arthritic pain in South korean older adults. Yonsei medical journal 2015;56(1):124-31. Maillefert JF, Gueguen A, Monreal M, et al. Sex differences in hip osteoarthritis: results of a longitudinal study in 508 patients. Annals of the rheumatic diseases 2003;62(10):931-4. Muraki S, Akune T, Oka H, et al. Incidence and risk factors for radiographic knee osteoarthritis and knee pain in Japanese men and women: a longitudinal population-based cohort study. Arthritis and rheumatism 2012;64(5):1447-56. Srikanth VK, Fryer JL, Zhai G, et al. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthritis and cartilage/OARS, Osteoarthritis Research Society 2005;13(9):769-81. <h3>Disclosure of Interest</h3> None declared
Granulocyte-macrophage colony-stimulating factor is an endogenous regulator of cell proliferation in juvenile chronic myelogenous leukemia
Authors: RJ Gualtieri, PD Emanuel, KS Zuckerman, G Martin, SC Clark, RK Shadduck, RA Dracker, J Akabutu, R Nitschke, ML Hetherington
Journal: Blood (1989)
PWE-023 Should patients with ida have routine ileo-colonoscopy? data from capsule endoscopy
Authors: LJ Neilson, S Dunn, S Panter
Journal: Gut (2015)

<h3>Introduction</h3> Video capsule endoscopy (VCE) is appropriate for patients with iron deficiency anaemia (IDA) who do not respond to oral iron replacement following normal upper and lower gastrointestinal endoscopy.<sup>1</sup>Terminal ileal (TI) intubation at the time of colonoscopy has a significant diagnostic yield in patients with IDA.<sup>2 </sup>Bidirectional endoscopy without ileoscopy may miss significant lesions later noted by VCE. <h3>Method</h3> This study aimed to identify what proportion of patients had TI pathology within the reach of the colonoscope and to assess whether ileo-colonoscopy would have prevented the need for VCE. Patients with VCEs for IDA at a single site between Jan 2009 – Dec 2014 were identified. Data were collected retrospectively, including previous colonoscopy findings and extent, VCE findings and subsequent colonoscopy findings. <h3>Results</h3> 120 patients were identified, of which only 28 (23.3%) had TI intubation at colonoscopy. 5/28 (17.9%) demonstrated TI pathology at colonoscopy (4 ulceration, 1 inflammation). 23/28 (82.1%) had normal TI at initial colonoscopy, but 3 of these patients had ulceration in TI on VCE. 11 (9%) patients had TI pathology on VCE (6 normal TI, 4 TI ulceration, 1 TI inflammation), possibly within reach of ileo-colonoscopy. All 11 patients had undergone colonoscopy prior to VCE- 8/11 to TI, 5 of which were abnormal. Of those who had positive ileo-colonoscopy findings, VCE changed management in 2 additional cases (40%). 3 patients with TI pathology on VCE had not undergone ileo-colonoscopy. 1/3 (33.3%) of these patients was found to have a definite TI abnormality at subsequent ileo-colonoscopy and was treated for Crohn’s. A cause for IDA was found at VCE in 37/120 patients overall (30.8%). 29/109 (26.6%) VCEs with no TI pathology revealed a cause for IDA, compared with 8/11 (72.7%) where TI pathology was found. <h3>Conclusion</h3> In this cohort, only 5/37 (13.5%) of cases of IDA would have been diagnosed by ileo-colonoscopy and only one capsule endoscopy avoided by ileoscopy being performed. These data suggest that ileo-colonoscopy should be performed in cases of IDA but should not alter plans for VCE. A further prospective study is planned. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Goddard AF, James MW, McIntyre AS, <i>et al</i>. Guidelines for the management of iron deficiency anaemia. Gut. 2011;60:1309-16 Neilson LJ, Bevan R, Panter S, <i>et al</i>. Terminal ileal intubation and biopsy in routine colonoscopy practice. <i>Expert Rev Gastroenterol Hepatol</i>. 2015 Jan 12:1-8. (accessed online 18/02/2015)