tbuckley/cabot-search huggingface dataset:
PTU-060 Enteral or parenteral feeding in intestinal graft dysfunction: any clues from serum citrulline?
Authors: M O'Connor, A Vaidya, L Smith, P Friend
Journal: Gut (2012)

<h3>Introduction</h3> Citrulline has been successfully used as a marker for intestinal graft dysfunction after intestinal transplantation.<sup>1</sup> We have extended its use to direct enteral vs parenteral feeding in the early post operative period as well as during graft dysfunction presenting as high volume stoma effluent. <h3>Methods</h3> Weekly serum citrulline concentrations were used in directing nutrition in all recipients of intestinal grafts. A cut off of 13 μmol/l was used. Patients with citrulline levels &lt;13 mmol/l in the post operative period were kept on low volume enteral feed and maintained on TPN. Once the levels were above 13 mmol/l, enteral feeds were advanced to meet target rate and TPN independence was achieved. A similar pattern was followed with patients presenting with high output stomal effluent. These citrulline levels were then matched with histopathological diagnosis. <h3>Results</h3> From October 2008, nine patients underwent a small bowel transplant at the Oxford transplant centre. Mean citrulline levels week one after transplantation were 15 mmol/l (range 12–17). Endoscopic biopsies in the first week showed signs of ischaemia reperfusion with significant oedema in the submucosa of the transplanted ileum. All these patients were maintained on TPN and had enteral feed (Peptisorb) at 30 ml/h. As mean citrulline levels increased patients progressed to full feed and TPN discontinued. Four patients presented with intestinal dysfunction after discharge from the hospital. These were all commenced on TPN if the citrulline level fell below 13 mmol/l. The first, had a citrulline of 19 mmol/l on presentation and. Biopsy demonstrated acute rejection. The second, presented with a high stoma output with a citrulline level of 9 mmol/l. Biopsy results revealed increase in mitotic figures as well as apoptosis and loss of tips of villi architecture. The third patient presented with a high stomal output and a citrulline of 18 mmol/l. Citrulline fell further to 9 mmol/l. The fourth patient presented with a high output and citrulline level of 13 mmol/l, dropping further to 6 mmol/l. His biopsy revealed dense mitotic activity in the face of increased apoptosis. He recovered in a span of 30 days with subsequent citrulline showing a rise. He was then weaned off TPN and commenced on diet. Mean time to graft dysfunction from transplantation was 240 days (range 46–450). <h3>Conclusion</h3> Firstly serum citrulline is a good marker to direct nutritional therapy in the early post transplant period as well as during graft dysfunction. <h3>Competing interests</h3> None declared. <h3>Reference</h3> 1. <b>Crenn P</b>, <i>et al.</i> Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans. <i>Gastroenterology</i> 2000;<b>119</b>:1496.
FRI0190 CDAI is a predictor of physical function and bone destruction at week 52 in RA patients
Authors: K. Hanami, K. Saito, H. Tasaka, Y. Tanaka
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Although American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) developed a new definition of remission in rheumatoid arthritis (RA) in 2010, it was based on data in RA patients treated with methotrexate (MTX) and TNF inhibitors. <h3>Objectives</h3> We attempted to evaluate the predictive validity of the new remission criteria from tocilizumab (TCZ) data obtained in a daily clinical practice. <h3>Methods</h3> One-hundred fifty-five RA patients who inadequately responded to prior MTX and anti-TNF inhibitor were treated with 8mg/kg of TCZ every 4 weeks in our institute. Data were analyzed from 61 patients whose physical function and progression of joint damage were evaluated at week 52 after introduction of TCZ. 28-joint Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI), Health Assessment Questionnaire (HAQ), modified total Sharp score (mTSS) were assessed by the LOCF method at 0, 24 and 52 weeks after TCZ treatment. <h3>Results</h3> Among 61 RA patients, the mean age of the enrolled patients was 61.4 (20-84) years, disease duration was 12.8 years (0.3-40), 34 patients (55.7%) had received TNF-inhibitors, and during the study 59.0% of the patients received concomitant MTX. At baseline, almost all patients had high disease activity, mean DAS28 was 6.2±1.2 and mean CDAI was 29.7±14.0. DAS28 and CDAI were improved to 3.1±1.5 and 12.0±9.8, respectively, at week 52. 42.6% and 14.8% achieved DAS28&lt;2.6 (DAS remission) and CDAI remission (≤2.8), respectively. The mean estimated yearly progression of mTSS was reduced from 19.7 to 0.2 after treatment with TCZ at week 52. HAQ also improved 1.55 at week 52 from 1.71 at baseline. HAQ and radiological remission rates were 16.3% and 79.0%, respectively.When a good outcome was defined as patients showing stability on both X-rays (delta mTSS [0-52weeks] ≤0) and the functional remission (HAQ ≤0.5), CDAI remission at week 24 increased the likelihood ratio (5.6, patients achieved CDAI remission vs. those did not) of the good outcome at week 52, whereas remission defined by DAS28-ESR, DAS28-CRP, SDAI and Boolean definition did not increased the likelihood ratio. <h3>Conclusions</h3> Among remission definition, CDAI at week 24 is an important predictor of good outcome of physical function and bone destruction at week 52 in the patients with RA treated by TCZ. <h3>Disclosure of Interest</h3> K. Hanami: None Declared, K. Saito: None Declared, H. Tasaka Employee of: Chugai Pharma, Y. Tanaka Consultant for: Mitsubishi-Tanabe Pharma, Pfizer Inc., Speakers Bureau: Mitsubishi-Tanabe Pharma, Takeda Pharmaceutical Co Ltd, Abbott, Eisai Pharma, Chugai Pharma
Endpiece: The plague returns
Authors: D. Defoe
Journal: BMJ (1999)

It was about the beginning of September, 1664, that I, among the rest of my neighbours, heard in ordinary discourse that the plague was returned again in Holland; for it had been very violent there, and particularly at Amsterdam and Rotterdam, in the year 1663, whither, they say, it was brought, some said from Italy, others from the Levant, among some goods which were brought home by their Turkey fleet; others said it was brought from Candia; others from Cyprus. It mattered not from whence it came; but all agreed it was come into Holland again.
Right Ventricular Infarction as an Independent Predictor of Prognosis after Acute Inferior Myocardial Infarction
Authors: Manfred Zehender, Wolfgang Kasper, Elisabeth Kauder, Martin Schonthaler, Annette Geibel, Manfred Olschewski, Hanjorg Just
Journal: New England Journal of Medicine (1993)

Acute inferior myocardial infarction frequently involves the right ventricle. We hypothesized that right ventricular involvement, as diagnosed by ST-segment elevation in the right precordial lead V4R, may affect the prognosis of patients with inferior myocardial infarctions.
AB1031 Profile of a series of 196 patients treated with IV zoledronic acid
Authors: M. Gonzalez Cabanas, D. Cerdà, D. Roig, D. Reina, R. Fíguls, S. García Diaz, X. Juanola, J.M. Nolla, H. Corominas
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Zoledronic acid is a third generation intravenous (IV) drug, indicated for the treatment of Osteoporosis, among other diseases, including Paget’s disease and Reflex sympathetic dystrophy. <h3>Objectives</h3> To describe the clinical features of a series of 196 patients treated with zoledronic acid ev in the period 2008-2011 in two hospitals in Barcelona. To analyze the indications, clinical and densitometric characteristics and treatment side effects of zoledronic acid. <h3>Methods</h3> A total of 196 patients received zoledronic acid. We performed a retrospective design reviewing medical records of these patients. We collected epidemiological, clinical, densitometric parameters and side effects to treatment. <h3>Results</h3> Of the 196 patients who received zoledronic acid, 157 were women (80.1%) and 39 men (19.9%). 94% of patients (184) had Osteoporosis, 4% (8) Paget, 1 patient had SAPHO, 1 Reflex sympathetic dystrophy, 1 neuropathic arthropathy and 1 osteogenesis imperfecta Of the total of Osteoporosis treated, 84% had primary osteoporosis and 16% had secondary osteoporosis. 47% of patients had received prior treatments for Osteoporosis (66.5% bisphosphonates, 16.2% estrontium ranelate, 4.8% raloxifene, 8% PTH and 4.5% calcitonin). 51% of patients had previous fractures (62.5% vertebral fractures, 18.7% Colles’ fracture, 12.5% fracture of the femur and 6.3% in other locations). Only 4.7% presented a new fracture after starting treatment. Average patients’ densitometric values before starting the treatment were: T-score -3.3 at the lumbar spine and -2.3 at femoral neck. Only 9.5% of patients experienced adverse effects, 75% of them flu like syndrome. Among the other side effects, there was a case of hypocalcemia and another one of keratoconjunctivitis sicca. <h3>Conclusions</h3> Zoledronic acid is indicated primarily as intravenous treatment for Osteoporosis, in cases of intolerance to oral treatment and refractory Osteoporosis to previous treatments. Most cases have a history of fracture. This is an effective and safe treatment with a low rate of adverse effects. <h3>Disclosure of Interest</h3> None Declared
Catheterization of the Heart in Man with Use of a Flow-Directed Balloon-Tipped Catheter
Authors: H. J. C. Swan, William Ganz, James Forrester, Harold Marcus, George Diamond, David Chonette
Journal: New England Journal of Medicine (1970)

Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscopy. A No. 5 Fr double-lumen catheter with a balloon just proximal to the tip is inserted into the right atrium under pressure monitoring. The balloon is then inflated with 0.8 ml of air. The balloon is carried by blood flow through the right side of the heart into the smaller radicles of the pulmonary artery. In this position when the balloon is inflated wedge pressure is obtained. The average time for passage of the catheter from the right atrium to the pulmonary artery was 35 seconds in the first 100 passages. The frequency of premature beats was minimal, and no other arrhythmias occurred.
Website of the week: http://www.fgmnetwork.org/
Authors:  M llner M
Journal: BMJ (1999)

The Female Genital Mutilation Homepage www.fgmnetwork.org At this very moment about 8to 10million women and girls in the Middle East and in Africa are at risk of undergoing one form or another of genital mutilation.

Even though there is increasing awareness for this topic, we may not realise the magnitude of this problem: the number of affected women is vast; pathophysiological understanding is low, …
Diagnostic concordance of different criteria for exercise pulmonary hypertension in subjects with normal resting pulmonary artery pressure
Authors: Laurent Godinas, Edmund M. Lau, Denis Chemla, Frédéric Lador, Laurent Savale, David Montani, Xavier Jaïs, Olivier Sitbon, Gérald Simonneau, Marc Humbert, Philippe Hervé
Journal: European Respiratory Journal (2016)

Pulmonary hypertension is defined by a resting mean pulmonary artery pressure (mPAP) ≥25 mmHg [1]. Despite a better understanding of the biology of pulmonary hypertension and new therapeutic advances, pulmonary hypertension remains diagnosed late in its natural history and is largely a non-curable condition [2]. Recently, there has been renewed interest in stress-testing of the pulmonary circulation since the early stages of pulmonary vascular disease (PVD) or left heart disease (LHD) can be associated with normal resting mPAP but an abnormal haemodynamic response that is unmasked by exercise [3–5]. Methodology of pressure–flow assessment needs to be standardized for the diagnosis of exercise pulmonary hypertension <http://ow.ly/YMgZw>
PTH-064 Implementation of the low-fermentable oligo-, di-, mono-saccharides and polyols diet in the UK: how easy is it and does it work?: Abstract PTH-064
Authors: H M Staudacher, M C E Lomer, K Whelan, P Irving
Journal: Gut (2010)

<h3>Introduction</h3> Avoidance of fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) is an effective treatment for irritable bowel syndrome (IBS) and is widely used in Australasia. The complexity of this strategy requires that dietitians undergo specialist training prior to successful implementation of the diet. Differences between Australian and UK food availability, composition and intake are such that it is not clear whether this dietary approach is effective outside Australasia. We aimed to develop and implement the low FODMAP diet in the UK and evaluate its efficacy in the management of IBS. <h3>Methods</h3> An Australian dietitian with 3 years9 experience in the low FODMAP diet joined a UK Consultant Gastroenterologist, also experienced in the diet, and a UK Consultant Dietitian with a special interest in IBS. Resources were developed and tailored to the UK context. Extensive review of food availability and FODMAP composition of processed foods was undertaken via supermarket research. Dietary intake and food choice was examined by patient consultation. Input from experienced UK dietitians ensured appropriate dietary language was used in the resources. Subsequently, the diet was implemented and service evaluation on 8-week symptom response was conducted. The evaluation consisted of Likert scale questions assessing change in severity of individual and global symptoms. This was compared with data collected from patients receiving standard dietary advice. <h3>Results</h3> Marked differences in the UK and Australian diets were noted, including greater availability of pre-prepared foods, frequent addition of high FODMAP ingredients (eg, oligofructose) to packaged foods and differences in the availability and consumption of fruit and vegetables. Accordingly, implementation of the diet in the UK required marked adaptation in its application and supporting materials. Early evaluation data indicate that although standard advice is effective, a low FODMAP approach offers additional benefit for bloating and flatulence (Abstract 064). <h3>Conclusion</h3> The low FODMAP diet appears to be a promising strategy for managing IBS in the UK. The success of this complex diet requires delivery by an experienced dietitian and the use of comprehensive and relevant education material.
SP0069 Finding the Right Key for the Right Lock: Choosing the Appropriate Study Design to Answer a Research Question
Authors: D. Symmons
Journal: Annals of the Rheumatic Diseases (2013)

<h3></h3> This lecture relates to the selection of study design for clinical and epidemiological (as opposed to laboratory) questions. Epidemiological studies divide into those which are purely descriptive and those which are analytical/hypothesis testing. The first step in addressing a research question is therefore to establish whether the question can be expressed in the form of a hypothesis. Hypothesis testing studies generally require a comparison group in addition to the disease group. Epidemiological study designs include: (i) Cross sectional studies - these collect information at a single time point and may be relevant to either descriptive or hypothesis testing studies. Associations between measures can be estimated, but it is not possible to infer causality as it is impossible to tell which of any pair of variables may have come first i.e. which is cause and which is effect. (ii) Case control studies - these select subjects on the basis of the outcome of interest and then collect data retrospectively with respect to risk factors/predictors. Selection of an appropriate control group is often the most challenging step. Controls should be subjects who, if they had developed the disease in question, would have been included amongst the cases i.e. they should come from the same catchment area, primary care physician etc. Controls may be matched on an individual level with the cases or may be a random selection of subjects without the disease under study. (iii) Cohort studies - these select subjects either at random or on the basis of certain potential risk factors and then follow them forward for the development of the disease. Alternatively they may recruit subjects with a disease and then follow them forwards for the development of a particular complication or co-morbidity. Clinical trials are an example of cohort studies in which the investigator assigns the exposure status (e.g. trial drug, placebo) to the individual subject. Cohort - or longitudinal observational studies - are also the basis of drug registries and other pharmacoepidemiological studies. <h3>Disclosure of Interest</h3> None Declared
Incidental Finding of Upper Extremity Deep Venous Thrombosis on Skeletal Scintigraphy
Authors: PARTHA SINHA, GARY R. CONRAD
Journal: Clinical Nuclear Medicine (2002)

From the Department of Diagnostic Radiology, University of Kentucky College of Medicine, Lexington, Kentucky Received for publication March 7, 2001. Revision accepted October 17, 2001. Reprint requests: Dr. P. Sinha, Assistant Professor, Department of Diagnostic Radiology, University of Kentucky–Chandler Medical Center, 800 Rose Street, Lexington, Kentucky 40536–0293. E-mail: [email protected]
Fibroblasts as negative regulators of inflammation: implications for the pathogenesis of rheumatoid arthritis?
Authors: Lars-Oliver Tykocinski, Antonia Bohnen, Anna-Marie Lauffer, Stefan Krienke, Hanns-Martin Lorenz
Journal: Annals of the Rheumatic Diseases (2012)

<h3>Backgroundand objectives</h3> Fibroblasts possess immune regulatory capacities. They are able to suppress the proliferation of T lymphocytes and to modulate the differentiation of dendritic cells (DC). Being ubiquitously present at the sites of lymphocyte priming and restimulation, fibroblasts may have a fundamental role in preventing inappropriate T cell responses or in the termination of immune reactions. A malfunction of fibroblasts could result in an imbalance between immune responses and self tolerance. Such a dysregulation can be observed in rheumatoid arthritis (RA) where pathogenic alterations in the function of synovial fibroblasts result in chronic inflammation and joint destruction. In this study, the authors directly compared the influence of normal dermal and synovial fibroblasts to that of RA synovial fibroblasts (RASF) on T lymphocyte activation and proliferation and on the differentiation, maturation and T cell stimulatory capacity of dendritic cells (DC) in vitro. <h3>Materials and methods</h3> Dermal fibroblasts were isolated from the skin of healthy donors, synovial fibroblasts from synovectomy tissue of patients with osteoarthritis (OA) or RA. CD4+T cells were stimulated in the presence or absence of fibroblasts, their proliferation was measured by 3H-Thymidine incorporation and the cytokine secretion was quantified by ELISA. Differentiation of monocytes into DCs was induced in presence or absence of fibroblasts, their phenotype was analysed cytometrically. The T cell stimulatory capacity of DCs was determined in mixed lymphocyte reactions. <h3>Results</h3> All fibroblasts prevented the differentiation of monocytes into classical DCs, moreover fibroblast-modulated DCs showed a lower T cell stimulatory capacity. In addition, normal fibroblasts were highly effective in suppressing the proliferation of activated T lymphocytes and in reducing the secretion of T cell effector cytokines such as interferon (IFN)-γ or tumour necrosis factor (TNF)-α. Interestingly, RASF seem to have lost the capability to inhibit the proliferation and cytokine production of activated T cells. Remarkably, in contrast to control fibroblasts, RASF from some patients even stimulated T cells to secrete pro-inflammatory cytokines like IFNγ and Interleukin-17A. The reason and molecular background of this specific phenomenon is currently under investigation. <h3>Conclusions</h3> Fibroblasts negatively regulate T cell responses, but these tolerogenic properties are partially lost in RASF. This defect may play a central role in the pathogenesis of RA. So far, treatments with biologics, including anti-TNFα, are often unable to achieve permanent remission. In the future, a reestablishment of the immunosuppressive properties of fibroblasts might enrich the therapeutic armamentarium in the treatment of RA.
Sleep disturbance as the hallmark of posttraumatic stress disorder
Authors: R J Ross, W A Ball, K A Sullivan, S N Caroff
Journal: American Journal of Psychiatry (1989)

The reexperiencing of a traumatic event in the form of repetitive dreams, memories, or flashbacks is one of the cardinal manifestations of posttraumatic stress disorder (PTSD). The dream disturbance associated with PTSD may be relatively specific for this disorder, and dysfunctional REM sleep mechanisms may be involved in the pathogenesis of the posttraumatic anxiety dream. Furthermore, the results of neurophysiological studies in animals suggest that CNS processes generating REM sleep may participate in the control of the classical startle response, which may be akin to the startle behavior commonly described in PTSD patients. Speculating that PTSD may be fundamentally a disorder of REM sleep mechanisms, the authors suggest several strategies for future research.