tbuckley/cabot-search huggingface dataset:
PTU-157 The clinical and phenotypic assessment of ultra-short coeliac disease
Authors: PD Mooney, M Kurien, E Rosario, R Fernando, M Hadjivassiliou, S Cross, DS Sanders
Journal: Gut (2015)

<h3>Introduction</h3> Data suggests that an additional duodenal bulb (D1) biopsy may increase the diagnostic yield for coeliac disease (CD) by up to 10%. However no consensus exists on necessity of D1 biopsy. One reason may be that it is not clear if these patients with Ultra-Short Coeliac Disease (USCD) have the same phenotype or are at risk of the same consequences as conventional CD. We aimed to assess the clinical phenotypes of patients with USCD compared to those with conventional disease. <h3>Method</h3> All patients attending a specialist CD endoscopy list were invited to take part. All patients had duodenal biopsy taken as routine. Patients had standard quadrantic biopsies taken from the second part of the duodenum (D2) and at least one biopsy taken from D1. Biopsies were analysed separately according to the Marsh classification system. Marsh 3 disease was required to diagnose CD. Patients had concurrent tissue tranglutaminase (tTG) and endomysial antibodies (EMA) and total IgA. All patients with VA were followed up in the CD specialist clinic where routine haematology, biochemistry, HLA typing and DXA scans were requested. Presenting symptoms and immunology were compared for all presentations. Haematology and biochemistry results were compared to a control group of patients that had CD excluded with normal serology and histology. <h3>Results</h3> 1378 new presentations (62% female; mean age 50.3) underwent duodenal biopsy. 268 (19.4%) new diagnoses of CD were made (66% female; mean age 41.6). CD patients were significantly younger than controls (p &lt; 0.0001). 25/268 (9.3%) of new CD patients had USCD. Univariate analysis showed fewer USCD patients had diarrhoea than conventional CD (3.8 vs 24.0%, <i>P &lt; </i>0.0001). Decision tree analysis to identify USCD showed the absence of diarrhoea was the single discriminating factor (Adj <i>P = </i>0.018). Rates of osteoporosis (p = 0.78) and anaemia (p = 0.14) were equal. Ferritin deficiency (<i>P = </i>0.007) and folate deficiency (<i>P = </i>0.003) rates were higher in conventional CD than USCD and controls. On multivariate analysis, patients with USCD were younger than those with conventional CD 36.6 vs. 42.1 (AOR 0.97 (0.94–0.998) <i>P = </i>0.03), had lower tTG titres (AOR 0.89 (0.81–0.98) <i>P = </i>0.02) and had higher folate levels (AOR 1.17 (1.01–1.36) <i>P = </i>0.03) compared to conventional disease. <h3>Conclusion</h3> USCD appears to represent early disease with younger age and lower tTG titres and may represent a milder form of CD with lower rates of diarrhoea and folate deficiency. Long term follow up of patients with USCD is required to fully assess the clinical impact of diagnosis. <h3>Disclosure of interest</h3> None Declared.
PTH-043 Anastomotic leak rate after intestinal resection for crohn’s: does pathological subtype make a difference?
Authors: C Zabkiewicz, R Chatha, T Sabah, A Oliver, T Kelly, G Whiteley
Journal: Gut (2015)

<h3>Introduction</h3> Three out of four Crohn’s patients will undergo intestinal resection.<sup>1</sup>There are identified risks for post operative complications before their procedure such as malnutrition, abscess, obstruction, and pre operative therapies such as steroids and immunomodulators.<sup>2</sup> The Montreal system<sup>3</sup>of classification attempts to assess disease severity and guide treatment. It divides Crohn’s into pathological subtypes of non penetrating/non stricturing, stricturing and penetrating. Evidence is limited as to the influence of Crohn’s subtype on anastomotic leak rate following bowel resection; however, it is felt penetrating Crohn’s may have higher risk of anastomotic leak. Our aim was to determine if this is the case. <h3>Method</h3> We collected retrospective data on all Crohn’s patients undergoing elective and emergency intestinal resection and anastamosis from March 2008–2014. 64 patients were identified and clinical records analysed for pathological subtype, operation/resection performed with a primary outcome of anastomotic leak. For tests of independence in discrete data fisher’s exact test was used. A p value of &lt;0.05 was deemed statistically significant. <h3>Results</h3> We identified 33 males and 31 females with an age range of 15–86 years (mean 45 years). 27 (42%) were emergency procedures ad 37(58%) were elective. The most common procedure was right hemicolectomy (59%) followed by small bowel resection (25%). Pathology demonstrated 19 cases (30%) of penetrating and 15(23%) cases of stricturing disease. The remaining 30(47%) were non stricturing/non penetrating. There were 4 post operative anastomotic leaks, all within the penetrating disease group. This was statistically significant when compared to the stricturing and non stricturing/non penetrating groups (p = 0.006). <h3>Conclusion</h3> Our small study adds evidence to the suggestion that penetrating Crohn’s subtype is associated with anastomotic leak after intestinal resection. Surgeons operating on Crohn’s patients should be aware of this association and have a high index of suspicion for anastomotic complication in this group. Further study with larger numbers should be performed. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Gardiner <i>et al</i>. Operative management of small bowel Crohn’s disease. Surg Clin N Am 2007;87:587–610 Samimi <i>et al</i>. Outcome of medical treatment of stricturing and penetrating Crohn’s disease: a retrospective study. Inflamm Bowel Dis 2010;16:1187–1194 Silverberg <i>et al</i>. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;<b>19</b>(Suppl A):5A–36A
Early Intensified Chemotherapy with Autologous Bone Marrow Transplantation in First Line Treatment of Poor Risk Non-Seminomatous Germ Cell Tumours
Authors: C Chevreau, J P Droz, J L Pico, P Biron, P Kerbrat, H Cure, J F Héron, B Chevallier, P Fargeot, A Kramar
Journal: European Urology (1993)
Hepatic Perfusion Changes in Patients with Cirrhosis
Authors: P Koranda, M Myslivecek, J Erban, V Seidlová, V Husák
Journal: Clinical Nuclear Medicine (1999)

Purpose: This study used radionuclide angiography to evaluate semiquantitatively the hepatic arterial blood flow changes associated with cirrhosis. Methods: The parameters of net arterial hepatic perfusion were estimated by analysis of first-pass flow studies in 11 control participants and in 15 patients with cirrhosis (Child-Pugh classification B-C). Hepatic, renal, and splenic time-activity curves were generated, normalized per pixel, and corrected for background. The rate of hepatic arterial blood flow was compared with the reference kidney and spleen perfusion using the hepatorenal and hepatolienal perfusion indices, respectively. These indices were defined as: (Equation 1) Results: The values of both these perfusion indices are significantly greater in the patients with cirrhosis than in controls (hepatorenal perfusion index, P < 0.01; hepatolienal perfusion index, P < 0.05). The values of the hepatic perfusion index (the ratio of the arterial to the total liver blood flow), which were also calculated, were elevated in the patients with cirrhosis (P < 0.01). Conclusions: The results confirm that the net hepatic arterial blood flow is increased in patients with cirrhosis. Radionuclide angiography accompanied by calculation of arterial perfusion indices may provide semiquantitative parameters of net hepatic arterial blood flow.
The postdivorce clinic
Authors: D J Sheffner, J M Suarez
Journal: American Journal of Psychiatry (1975)

The authors describe a clinic that evaluates court-referred families who have child custody or visitation problems in the postdivorce period. A multidisciplinary staff uses interviews, auxiliary sources of information, and psychological testing to arrive at recommendations that often address issues not specifically mentioned in the legal proceedings, particularly regarding treatment for disturbed children. The authors suggest that the clinic is an example of an appropriate interaction between law and psychiatry.
Pharmacokinetic Determinants of the Response to Single Doses of Chlordiazepoxide
Authors: David J. Greenblatt, Richard I. Shader, Jan Koch-Weser
Journal: American Journal of Psychiatry (1974)

Blood concentrations of the minor tranquilizer chlordiazepoxide were measured in nine healthy volunteers after administration of single 25-mg. doses. Peak blood concentrations and rates of absorption and disappearance varied considerably among the subjects. Such pharmacokinetic variations have important clinical consequences and probably contribute to individual differences in the response to minor tranquilizers.
THU0139 Cardiovascular Risk Factor Profile in an Italian Cohort of Patients with Rheumatoid Arthritis: Results of a Three Year Follow-up
Authors: G. Grosso, G. Erba, C.A. Valena, M. Riva, M. Betelli, E. Allevi, F. Bonomi, S. Barbarossa, M. Ricci, R.L. Facchetti, M.R. Pozzi, G. Grassi, G. Mancia
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by an elevated cardiovascular morbidity and mortality, but detailed information on the risk score profile using different approaches, as well as on the major determinant(s) of the cardiovascular risk of these patients are scanty. <h3>Objectives</h3> The present study reports data collected in a cohort of RA patients with CV risk score calculators Framingham and SCORE uncorrected or corrected according to EULAR recommendations. Cardiovascular events were recorded during the 3 year follow-up, to determine the burden of CV morbidity and the relative impact of traditional CV risk factors and disease activity/severity. <h3>Methods</h3> We enrolled 198 pts. We use Framingham and SCORE to predict CV risk. Cardiovascular events were recorded during the 3 year follow-up. <h3>Results</h3> We enrolled 198 pts, 77% females, age 65.0±11.6 yrs (means ± SD), disease duration 13±9 yrs. 76% of pts were RF +, 68% ACPA+ and 46% with erosive disease. The mean DAS28 CRP was 2.67±1.17. 3% were smokers and 32% ex smokers. Mean BMI (24.6±44), plasma levels of cholesterol (total,HDL,LDL), triglycerides and glucose and prevalence of smokers were comparable with those detected in the local general population (GP), while the prevalence of hypertension (78 and 71% in RA M/F vs 49 and 43% in GP M/F) and diabetes (21.7 and 10.8% in RA M/F vs 4.8 and 2,58% in GP M/F) were significantly higher in both male and females. Risk scores with Framingham were lower than in GP and comparable using SCORE, but the application of 1.5x correction factor for RA, as recommended by EULAR, modified these figures. The number of hypertensive and diabetic pts increased significantly (P&lt;0.0001/0.019) during the follow-up as well as the mean values of Framingham and SCORE (p&lt;0.015/0.011). The MI and stroke prevalence were 5% and 2% respectively: the incidence rate/1000 person/year were 8.8 and 3.7 versus 2.7 and 2.6 in the general population. No relation was detectable between disease activity indices and CV events or risk scores. Half of our patients were treated with Prednisone ≤7.5 mg/day: lipid profile, glucose level and blood pressure were comparable in steroid-treated and steroid-free patients. <h3>Conclusions</h3> The present study provides evidence that 1) RA is associated with an increased CV morbidity even in the medium follow-up period, 2) risk score needs to be adjusted as by EULAR indications to obtain sensitive assessment of risk 3) that hypertension represents a major CV risk factor in this population and 4) that the achievement of low disease activity doesn9t seem sufficient to reduce the CV risk. <h3>Disclosure of Interest</h3> None declared
Soundings: Off balance
Authors: Trisha Greenhalgh
Journal: BMJ (2001)

Most days, I drop him outside the tube station. Today, I am travelling by tube too, so I park the car and queue for a ticket. My destination—the Department of Health—is eight stops south. His—school—is four stops north. I descend the steps. He crosses the footbridge.

The station is crowded. I spot him standing on the northbound platform and position myself directly opposite him. I smile, then wink, then wave. He stares straight ahead. He is in a daydream, or perhaps reading the billboards behind me. A boy in the same blazer approaches him, passes him by, and adopts the same standing stare pose a few yards on.

My son is 12. Proud and independent in his grammar school uniform, he will not acknowledge me. I am in my committee suit, carrying an umbrella and slimline briefcase. I have already been informed by my younger son that I look “stupid” and have been instructed to change before meeting him from football tonight. Normal mothers, in case anyone is in doubt, wear ski pants and are accompanied by a dog on a lead or a toddler in a buggy.

One of my children was teased when he told his friends that I had become a professor. The other was beaten up. Across from me this morning, he is pale and seems friendless. The child to his left is about his size. Why do they not chat or play? Perhaps the friend also has a working mother, who drops him perfunctorily at the tube every morning rather than hugging him properly at the school gate. Perhaps that mother too arrives home tired and distracted, and proceeds to mark assignments or prepare lectures in the living room. I take refuge in my newspaper, and read, with heavy irony, that it is Work Life Balance Week (see www.w-lb.org).

The tube approaches. A loud catcall emerges from the front carriage, where half a dozen lads in blue uniforms are bagging seats. Suddenly animated, my son punches the other boy on the shoulder and they run, satchels flying, to catch the front carriage. He jumps on as the sliding doors begin to close, roughing someone's hair as he goes. Someone is passing round a bag of sweets. As the train pulls out, he flashes a grin at me through the window. Did I like his game?

He was just being cool.
Abstract 3751: Selective Improvement of Renal Function in Renovascular Disease by Intra-Renal Infusion of Endothelial Progenitor Cells Restores Myocardial Microvascular Integrity
Authors: Xiangyang Zhu, Jing Lin, Kyle Textor, Alejandro R Chade, James D Krier, Amir Lerman, Lilach O Lerman
Journal: Circulation (2008)

Background : Renovascular disease (RVD) and impaired renal function are important risk factors for cardiac disease, but it remained unclear whether selective recovery of renal function can reverse cardiac dysfunction. Aims: This study tested the hypothesis that improvement in renal function using selective intra-renal administration of endothelial progenitor cells (EPC) in swine renovascular hypertension would improve myocardial microvascular (MV) integrity. Methods: The functions of the myocardial MV (response to IV adenosine) and the stenotic kidney of 7 pigs were assessed in-vivo using multi-detector CT after 6 weeks of RVD and hypertension. Autologous EPC expanded in culture were then infused (10x10 6 cells) intra-renally, and in vivo studies repeated 4 wks later. Six normal pigs served as controls. Results : Glomerular filtration rate was lower in RVD compared to normal (47.9±10.1 vs. 70.8±4.3 mL/min, p&lt;0.05) and improved after EPC (to 62.7±1.5 mL/min, p=NS vs. normal), as did renal blood flow. Mean arterial pressure remained elevated after EPC (120.7±11 and 129.4±6 vs. 99.9±4.7 mmHg in normal, p&lt;0.05), and plasma renin activity was unchanged. Myocardial MV permeability-surface area increased in RVD in response to adenosine (0.009±0.001 to 0.011±0.002 AU, p=0.01), while MV volume fraction decreased (4.3±0.8 to 2.7±0.6%, p=0.01), indicating impaired MV barrier function and integrity. Contrarily, both remained unchanged in response to adenosine 4 wks after EPC (0.01±0.002 to 0.01±0.002 AU, p=0.24, and 3.5±0.8 to 3.4±0.5%, p=0.46, respectively), as did normal MV. Conclusion : A single intra-renal infusion of EPC that improved renal function in experimental RVD also preserved remote myocardial MV function, despite sustained systemic hypertension. These findings underscore the cross talk between renal and cardiac function, and the potential of selective renal EPC intervention to preserve both the kidney and heart in RVD. Renal and myocardial microvascular function change in normal and RVD before and after EPC treatment
Psychosis, thought disorder, and regression
Authors: N C Adnreasen, P S Powers
Journal: American Journal of Psychiatry (1976)

Focusing on the definition, scope, and role of psychiatry today, the author discusses whether psychiatry is primarily medical, whether it is overstepping its boundaries in attempting to treat problems of living, and whether it is too involved with social questions. On the basis of an examination of the current scientific base of psychiatry, he predicts that psychiatry will continue to grow in size and diversity, that it will refocus substantially on biological issues, that it will become more humble about what it can do with regard to social problems, and that it will continue to yield new therapeutic measures and techniques.
PWE-002 How accurately are we tattooing colonic lesions prior to laparoscopic surgery? an institutional report
Authors: J Younis, J Ali, P Nisar, J Trickett
Journal: Gut (2015)

<h3>Introduction</h3> Small colonic cancers or polyps can be difficult to identify during laparoscopic surgery, hence the need to tattoo lesions when seen during endoscopic examination. The Joint Advisory Group on GI endoscopy (JAG) have minimal guidance on tattooing. The aim here was to assess the accuracy and frequency of tattooing within our trust with regards to local tattooing policy within our endoscopy unit. <h3>Method</h3> Data was retrospectively analysed over a 12 month period between January 2013 – January 2014 in patients undergoing a laparoscopic resection for a colonic lesion. Areas examined looked at frequency of tattooing, site and documentation. <h3>Results</h3> 43 patients underwent surgery during this time period. 80% of these were tattooed at the time of endoscopic investigation. Of these only 46% were tattooed according to the unit’s tattooing protocol. 25% of these had no clear documentation as to the method of tattooing. At the time of surgery, in 10% the tattoo was not deemed visible. The conversion rate was not higher in the group that were not tattooed according to local policy in comparison to the group that were (p = 0.8). <h3>Conclusion</h3> Huge variability exists in the tattooing methods of the endoscopists within our unit, which quite often does not adhere to local policy. This could potentially result in failure to identify lesions during surgery or resection of an incorrect segment altogether. <h3>Disclosure of interest</h3> None Declared.
Kidney Cancer
Authors: _ _
Journal: Journal of the National Comprehensive Cancer Network (2006)

An estimated 38,890 Americans will be diagnosed with kidney cancer and 12,840 will die of this disease in the United States in 2006. Renal cell carcinoma (RCC) constitutes approximately 2% of all malignancies, with a median age at diagnosis of 65 years. Smoking and obesity are among the risk factors for RCC development, and tumor grade, local extent of the tumor, presence of regional nodal metastases, and evidence of metastatic disease at presentation are the most important prognostic determinants of 5-year survival. These guidelines discuss evaluation, staging, treatment, and management after treatment. For the most recent version of the guidelines, please visit NCCN.org
The bottleneck may be the solution, not the problem
Authors: Arnon Lotem, Oren Kolodny, Joseph Y. Halpern, Luca Onnis, Shimon Edelman
Journal: Behavioral and Brain Sciences (2016)

Abstract As a highly consequential biological trait, a memory “bottleneck” cannot escape selection pressures. It must therefore co-evolve with other cognitive mechanisms rather than act as an independent constraint. Recent theory and an implemented model of language acquisition suggest that a limit on working memory may evolve to help learning. Furthermore, it need not hamper the use of language for communication.
Hepatocyte mitochondrial DNA released in microparticles and toll‐like receptor 9 activation: A link between lipotoxicity and inflammation during nonalcoholic steatohepatitis
Authors: Maria Eugenia Inzaugarat, Alexander Wree, Ariel E. Feldstein
Journal: Hepatology (2016)

Inzaugarat, Maria Eugenia Ph.D.; Wree, Alexander M.D.; Feldstein, Ariel E. M.D. Author Information
PWE-442 Balancing gastroenterology and general internal medicine training in the uk
Authors: S Biswas, L Alrubaiy
Journal: Gut (2015)

<h3>Introduction</h3> The majority of UK Gastroenterology trainees undertake dual accreditation with General Internal Medicine (GIM). The aim of this study is to explore trainees' views on dual accreditation training. <h3>Method</h3> Data was collected from the BSG online survey which was sent to all higher specialist gastroenterology trainees in the UK. The survey was open from July to September 2014. <h3>Results</h3> 263 out of 806 (32.6%) trainees across the UK completed the survey. 36% (95/263) of responders were female and all training grades were well represented. Almost all (97.6%) gastroenterology trainees are dual accrediting in GIM. The majority (81%) feel that GIM training is useful for their future work as a consultant. Trainees spend 20–40% of their time in GIM commitments. Only 37% agree that their GIM training is of a good quality. More than half (62%) of trainees feel GIM training has a negative impact on their gastroenterology training (Figure 1). This impact is commented upon more noticeably with seniority – 60% of junior trainees (ST3-ST5) and 70% of senior trainees (ST6 and above). Only 10.6% of trainees felt that GIM training met their educational competencies due to the role of the medical registrar being more one of service provision, due to less experienced juniors, an increased work load and difficulty in obtaining workplace-based assessments (Figure 2). Another common theme was the lack of opportunity to present patients on post-take ward rounds. 31.2% of trainees would stop their GIM training if given the opportunity. <h3>Conclusion</h3> Whilst the majority of trainees recognise the importance of dual accreditation for future consultant jobs, a large proportion of trainees feel that the quality of their GIM training does not satisfy their training needs and curriculum requirements. In addition, more than half of trainees feel that GIM training has a negative impact on their gastroenterology training and a third would give up GIM if possible. The workload in acute medicine and decreasing experience of junior doctors are clearly topical issues. A way to improve the quality of GIM training could be to encourage consultants to allow time to present patients and complete work-based assessments, either on the post-take ward round or at another agreed time. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Neale JR, Basford PJ; British Society of Gastroenterology Trainees Section. General medical training in gastroenterology: views from specialist trainees on the challenges of dual accreditation. Clin Med. 2015;15(1):35–9