tbuckley/cabot-search huggingface dataset:
Staging and managing lung tumors using F-18 FDG coincidence detection.
Authors: MARCIN ROMAN, MONICA ROSSLEIGH, SOCRATES ANGELIDES, BRENDA WALKER, JENNY DIXON
Journal: Clinical Nuclear Medicine (2001)

Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomographic (PET) imaging can be a vital tool in the evaluation and preoperative staging of pulmonary neoplasms. Imaging studies on the gamma camera using coincidence PET (co-PET) were introduced recently into clinical practice. This prospective study assessed the efficacy of co-PET for identifying primary tumors, mediastinal lymph node involvement, the presence of distant spread, the effect on disease staging, and influence on disease management.Sixty consecutive patients with 61 lung tumors were enrolled in the study (36 men, 24 women; age range, 32-87 years; mean age, 67 years). Histopathologic confirmation was obtained in 58 patients (59 tumors).In assessments of a primary lesion to establish its malignant or benign nature, the sensitivity rate of co-PET was 96% (53 of 55 lesions), the specificity rate was 83% (5 of 6 lesions), and the accuracy rate was 95% (58 of 61 lesions). In the co-PET assessment of lymph node involvement in which histopathologic confirmation was obtained (n = 32), the sensitivity rate was 89% (8 of 9 lesions), the specificity rate was 91% (21 of 23 lesions), and the accuracy rate was 91% (29 of 32 lesions). Previously unknown distant metastases were correctly identified in eight patients, but five false-positive lesions were detected in the brain. Disease staging was correctly altered in 20 patients (33%), and disease management plans were changed in 20 patients (33%) based on the co-PET findings. Unnecessary surgery was obviated in six patients (10%). One patient was given the chance for curative treatment based on the findings of the co-PET study.The evaluation of patients with lung neoplasms using F-18 FDG coincidence detection appears to be reliable.
PTU-139 Re-defining response to neoadjuvant therapy in patients with oesophago-gastric cancer
Authors: D Bunting, T Bracey, T Wheatley, P Peyser, J Rahamim, R Berrisford, G Sanders
Journal: Gut (2015)

<h3>Introduction</h3> Response to neoadjuvant therapy in oesophago-gastric (OG) cancer can be measured using a range of radiological and histological measures. However, there is no agreed definition of what constitutes a beneficial response. An accurate definition is critical for standardisation of outcome reporting and will be necessary if predicting response can be used to provide personalised treatment. This study re-defines response to neoadjuvant therapy in OG cancer. <h3>Method</h3> A literature search was performed to identify potential measures for accurately defining response the neoadjuvant therapy. All patients undergoing surgical resection for OG cancer at this Unit between January 2010 and December 2014 were identified from a database. Part a) Patients meeting the threshold for offering neoadjuvant therapy (≥T3 and/or ≥N1) were identified and divided according to whether they were TRG responders, non-responders or had surgery only. These groups were then compared with respect to the apparent T- and N-down-staging (defined as a reduction in stage between pre-operative staging and post-operative pathological staging) in order to assess the validity of down-staging for use in defining response. Part b) Patients undergoing neoadjuvant therapy were identified and potentially valid measures of response were then analysed with respect to overall survival in order to determine and validate a definition of response. <h3>Results</h3> The literature review identified methods using histopathological regression as the most promising measures of response with the Becker and Mandard scoring systems validated for use in OG cancer. T and N down-staging offer the potential to identify partial responders. 587 patients were identified from the database. Part a) In 419 patients above the neoadjuvant therapy threshold, the rate of apparent T down-staging was 62.8% in TRG responders, 15.7% in non-responders and 21.4% in the surgery only patients. The rate of apparent N down-staging was 35.9% in responders, 13.0% in non-responders and 12.9% in the surgery only patients. Part b) In 376 patients undergoing neoadjuvant therapy, patients with a Mandard TRG score of 1–3 had longer survival than those with TRG 4–5, mean survival 49.5 months vs. 35.7 months respectively (P = 0.001, Log Rank Mantel-Cox). <h3>Conclusion</h3> Histopathological regression scores correlate well with survival and represent the most accurate measure of response to neoadjuvant therapy in OG cancer. Survival in TRG1–3 patients (Mandard Score) is better than in TRG 4–5 patients. Apparent T and N down-staging were no higher in the TRG non-responder group than the surgery only group suggesting this represents clinical over-estimation of stage rather than a true therapy effect and is not valid for use in the definition of response to therapy. <h3>Disclosure of interest</h3> None Declared.
AB0419 Determination of Anti-Drug Antibodies in Long-Term Treatment of Rheumatoid Arthritis Patients with Etanercept
Authors: S. Drynda, R. Beuermann, J. Kekow
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> For about 15 years biological compounds belong to the therapeutic options for the treatment of rheumatoid arthritis. By targeting of tumor necrosis factor alpha (TNFα), one of the key cytokines in the pathogenesis of rheumatoid arthritis (RA), patients benefit in terms of disease activity as well as radiologic progression. The application of biologic substances is subject to a risk to develop antibodies against these structures causing adverse events or loss of efficacy. <h3>Objectives</h3> It was the aim of the study to analyse the occurrence of anti-drug antibodies in the course of a long term treatment of patients with rheumatoid arthritis with etanercept (ETN). <h3>Methods</h3> In this retrospective analysis sera from 100 RA patients obtained during an up to 4 years treatment period with etanercept (after 6, 12, 24, 36 and 48 months) and 43 adalimumab (ADL)-treated patients were included for determination of anti-drug antibodies. If available the first serum sample obtained at least 2 weeks after discontinuation of ETN treatment (due to side effects, non-response, remission or surgery) was included for analysis to exclude any interference with high drug levels. For the determination of anti-ETN and anti-ADL levels Promonitor® -anti-ETN and –anti-ADL assays (Proteomika, Spain) were used according to the manufacturer9s instructions. Both assays are designed as bridging assays with cut-off values of 142 AU/ml and 3.5 AU/ml for ETN and ADL, respectively. For calculation of results a data analysis software (http://www.myassays.com) was used. <h3>Results</h3> No anti-ETN antibodies were found in 100 RA patients, neither in the course of treatment nor in samples from 72 of these patients obtained after discontinuation of ETN treatment after mean 36.3 months (range 5-78 months). However, in the ADL-treated cohort anti-ADL antibodies were found in 51.2% of patients (22 out of 43) after discontinuation of therapy after mean 23.4 months (range 3-77 months). <h3>Conclusions</h3> Our study confirms the lack of anti-drug antibodies in a large cohort of RA patients in the course of a long-term treatment with ETN over up to 4 years. The absence of anti-ETN antibodies in serum samples after discontinuation of therapy confirms this result by exclusion of false negative results resulting from interference with high etanercept levels in the course of treatment. <h3>Acknowledgements</h3> Supported by Pfizer Pharma GbmH <h3>Disclosure of Interest</h3> S. Drynda Grant/research support from: Pfizer Pharma GmbH, R. Beuermann: None declared, J. Kekow: None declared
Activation Profile of <i>Mycobacterium tuberculosis</i>–Specific CD4<sup>+</sup> T Cells Reflects Disease Activity Irrespective of HIV Status
Authors: Katalin A. Wilkinson, Tolu Oni, Hannah P. Gideon, Rene Goliath, Robert J. Wilkinson, Catherine Riou
Journal: American Journal of Respiratory and Critical Care Medicine (2016)

The diagnosis of pulmonary tuberculosis in HIV-infected individuals is particularly 33 challenging, as HIV-induced alterations of the immune system lead to reduced cavitations, 34 limiting the sensitivity of sputum-based assays (1).Thus, alternate markers are needed to 35 distinguish between latent (LTBI) and active TB (aTB) in this high-risk group.Several 36 attributes of Mtb-specific CD4+ T cells have been shown to efficiently delineate LTBI and 37 aTB in HIV-uninfected individuals, including their polyfunctional or memory profiles (2-4).38Moreover, Adekambi et al. recently demonstrated that the activation profile of Mtb-specific 39 CD4+ T cells accurately discriminates between LTBI and aTB (5).As chronic HIV infection 40 is characterized by persistent systemic immune activation (6), it is plausible that these blood-41 based markers may not be relevant for HIV-infected individuals.42We therefore compared the potential of the activation and polyfunctional profiles of 43Mtb-specific CD4+T cells to distinguish between LTBI and aTB in HIV-uninfected and HIV-44 infected individuals.We analyzed 76 participants divided in four groups according to their 45 TB and HIV status (Table S1): LTBI/HIV-(n=17), aTB/HIV-(n=17), LTBI/HIV+ (n=21, 46 median CD4 count: 316 cells/mm 3 , IQR: 231-543) and aTB/HIV+ (n=21, CD4 count: 250 47 cells/mm 3 , IQR: 155-295).LTBI was defined as TST positive, IGRA positive, sputum culture 48 negative and normal CXR.aTB was diagnosed based on symptoms suggestive of tuberculosis 49 and Mtb positive smear and/or sputum culture, as previously described ( 7).All HIV-infected 50 participants were ART-naïve.UCT ethics committee approved the study and written consent 51 was obtained from participants.Cryopreserved PBMCs were stimulated for 16 hours with 52 ESAT-6/CFP-10 peptide pool and intracellular staining using a live/dead marker and 53 antibodies towards CD3, CD4, CD8, HLA-DR, Ki67, CD38, IFN-γ, TNF-α and IL-2 was 54 performed.Positive ESAT-6/CFP-10 responses (defined as twice the background) were 55 detectable in 16 subjects in the LTBI/HIV-and LTBI/HIV+ groups; and in 15 and 18
AB0704 Pulmonary Embolism in Oligosymptomatic Systemic Sclerosis Patients
Authors: I. Cordeiro, A. Cordeiro, T.J. Matos, V.S. Martins, M.J. Loureiro, S. Carmona, M.J. Santos, J. Canas da Silva
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Systemic Sclerosis (SSc) patients were recently described to have a higher risk of pulmonary embolism (PE) than healthy individuals<sup>1</sup>. Portuguese expert consensus<sup>2</sup> recommends screening for PE when respiratory distress cannot be explained by the presence of cardiovascular or pulmonary interstitial involvement (ILD). <h3>Objectives</h3> We present our 5-year experience with PE in SSc patients. <h3>Methods</h3> We included all adult SSc patients submitted to lung ventilation/perfusion scintigraphy (V/Q scan) or CT pulmonary angiography (AngioCT) due to worsening dyspnea/fatigue or isolated reduction of the carbon monoxide diffusing capacity (DLCO), from January 2010 to December 2014. We collected demographic data, functional class according to the World Health Organization (WHO-FC) classification, comorbidities, risk factors for PE and results from AngioCT and V/Q scans. A descriptive statistical analysis was performed. <h3>Results</h3> Eighteen patients were included: 15 females, with a mean age of 55±14 years and median disease duration 2 (IQR 2.5) years. Nine patients were diagnosed with PE, 8 of which by V/Q scan and 1 using AngioCT. Eight patients had bilateral peripheral multisegmental PE and 1 unisegmental PE. Five PE patients had a WHO-FC of 1-2. Three of the remaining 4 patients with WHO-FC &gt;2 had concomitant extensive ILD, and one patient had pulmonary hypertension. No patient had thrombophilia, previous surgery or cancer. The frequency of hypertension, diabetes, smoking, obesity and dyslipidemia was similar to patients without PE. Anti-topoisomerase positive SSc patients (Anti-topo+) were slightly overrepresented in the PE group (5 vs 2 Anti-topo+ patients without PE). Other disease imunophenotypes were equally distributed between subgroups. <h3>Conclusions</h3> Oligosymptomatic PE is common in SSc patients. Traditional procoagulant risk factors do not account for this increased risk. Disease-specific risk factors, such as vascular endothelial dysfunction, may be involved. The impact of PE in disease prognosis is yet unknown. <h3>References</h3> Chung WS, Lin CL, Sung FC, Hsu WH, Yang WT, Lu CC, Kao CH. Systemic sclerosis increases the risks of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study. Rheumatology (Oxford). 2014 Sep;53(9):1639-45. doi: 10.1093/rheumatology/keu133. Epub 2014 Apr 8. Grupo de Estudos de Doenças Reumáticas Sistémicas (GEDRESIS). Manual Prático de Esclerose Sistémica. Sociedade Portuguesa de Reumatologia; 2014. <h3>Disclosure of Interest</h3> None declared
Low electrooculographic ratios in patients with seasonal affective disorder
Authors: R W Lam, C W Beattie, A Buchanan, R A Remick, A P Zis
Journal: American Journal of Psychiatry (1991)

Changes in retinal sensitivity to light have been hypothesized as etiological in seasonal affective disorder. This study was undertaken to investigate sensitivity to light in seasonal affective disorder using electrooculography (EOG), an objective measure of retinal light response.In a mood disorders clinic, 19 depressed, drug-free patients with seasonal affective disorder, diagnosed by DSM-III-R criteria, were compared with 19 age- and sex-matched normal comparison subjects. All subjects had identical EOG testing performed during the winter. EOG (Arden) ratios were calculated from the EOG data. RESULTS According to multivariate analysis of variance, the EOG ratios in the patients with seasonal affective disorder were significantly lower than those of the normal comparison subjects, although there was considerable overlap in EOG ratios between patients and comparison subjects.These results suggest that seasonal affective disorder is associated with subtle retinal abnormalities at the level of the photoreceptor/retinal pigment epithelium complex, consistent with subsensitivity to light. A limitation of this study is that the retinal origins of the EOG response are nonspecific and still not completely elucidated.
Rapid Verification of Unusual Tracer Uptake Patterns by Means of SPECT/CT
Authors: Fevziye Canbaz, Tarik Basoglu, Deniz Ersoy, Nevzat Dabak
Journal: Clinical Nuclear Medicine (2010)

A 45-year-old woman with gluteal mass and a histopathological diagnosis of malign small round cell sarcoma was investigated for metastatic spread. The patient was referred to nuclear medicine for further evaluation by means of somatostatin analogues. 111Indium- pentetreotide whole body imaging revealed an intense and inverted arrow-shaped uptake in the left upper quadrant resembling cardiac activity. Although the location and posterior appearance of the tracer uptake was indicating somehow splenic activity, a SPECT/CT scan was performed for anatomic verification. The reconstructed SPECT/CT fusion images depicted clearly that the totality of the atypical activity originated from the spleen, which was defined as an anatomic variant. In this case, SPECT/CT easily clarified the unusual appearance of the spleen, suggesting a pathologic finding on conventional whole body imaging.
PTU-275 Facilitating early discharge with post-operative pudendal nerve block analgesia following ano-rectal procedures
Authors: K Siddique, K khan, T Offori
Journal: Gut (2015)

<h3>Introduction</h3> <b>Background</b>: Effective postoperative pain control following benign ano-rectal procedures is an essential component of good clinical practice and early discharge. Aim of our study was to assess if early facilitated discharge can be achieved by this technique following ano-rectal procedures. <h3>Method</h3> <b>Patients and methods</b>: A prospective study was conducted at Barnsley Hospital from Jan 14–Aug 14. All patients who underwent post-operative standard pudendal nerve block were included. Post-op stay was divided into three groups; group 1 = &lt;4 h, group 2 = 4–6 h and group 3 = more than 6 h. Demographics, procedure performed, post-operative pain score, complications and readmissions were recorded and analysed. <h3>Results</h3> Total number of patients was 36. There were 19 (54%) males while rest were female with an age of *36 (22–76) (* represents median). Procedures performed included laying open of fistula (12), complex fistula (2), Open haemorrhoidectomy (3), insertion of seton (1), excision of skin tag (2), fistulectomy (1) and lateral internal sphincterotomy (1) etc. There were no peri-operative complications. Pain scores reported as mild (27), moderate (7) and severe (2). The number of patients in group1, 2 and 3 were 14 (39%), 16 (44%) and 4 (115) respectively. Two patients stayed overnight due to social reasons. 32 (90%) patient agreed that pain relief worked and only 12 (33%) required additional pain relief. Two patients were re-admitted and 33 (92%) patients were very satisfied with this technique. <h3>Conclusion</h3> <b>Discussion and conclusions</b>: Pudendal nerve block is a simple and useful method; without any significant complications, which can provide effective post-operative analgesia following ano-rectal procedures. It is associated with a high patient satisfaction and helped early facilitated discharges. Larger studies can help to look into efficacy and cost effectiveness. <h3>Disclosure of interest</h3> None Declared.
THU0051 PPAR-GAMMA Agonist Inhibits Migration and Invasion by Down Regulating TNF Alpha-Induced CYR61 Expression in Rheumatoid Arthritis-Fibroblast Like Synoviocyte
Authors: E.-J. Kwon, M. Cho, E.-J. Park, J. Kim
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Peroxisome proliferator-activated receptor gamma (PPARγ) agonist has anti-inflammatory properties, which has known to reduce inflammatory cytokine production in RA. Cysteine-rich angiogenic inducer 61 (Cyr61) is associated with diseases related to chronic inflammation. Cyr61, pro-inflammatory factor, has been shown to be increased in the synovial tissues of patients with RA. However the action mechanisms between Cyr61 and PPARγ are unknown. <h3>Objectives</h3> The aim of this study was to investigate mechanism of PPARγ and its relation to Cyr61 in pathogenesis of RA. <h3>Methods</h3> All synovial tissue were obtained from RA patients undergoing total joint replacement. RA-FLS were cultured with TNFα, and Cyr61 in the presence or absence of PPARγ agonist. Expression of the Cyr61 was estimated by RT-PCR and western blotting. The Cell migration and invasion was assessed by wound repair assays and transwell system. <h3>Results</h3> Cyr61 protein was expressed on RA-FLS, and its expression was increased by TNFα. Moreover, Cyr61 directly promotes RA-FLS migration (p&lt;0.01) and invasion (p&lt;0.01) compared to the untreated RA-FLS. RSG significantly decreased TNFα-induced Cyr61 protein expression. Furthermore, not only did RSG inhibit TNFα induced RA-FLS migration distance (p&lt;0.01) and invasion (p=0.018), but also decreased Cyr61 treated RA-FLS invasion (p&lt;0.01). However, RSG did not affect Cyr61 gene expression in RA-FLS. <h3>Conclusions</h3> Our result show that PPARγ agonist may have beneficial effects on migration and invasion of RA-FLS via down-regulation of Cyr61. Therefore, PPARγ agonist could be a potential treatment of RA. <h3>References</h3> Jie LG, Huang RY, Sun WF, Wei S, Chu YL, Huang QC, et al. Role of cysteinerich angiogenic inducer 61 in fibroblastlike synovial cell proliferation and invasion in rheumatoid arthritis. Mol Med Rep 2015 Feb;11(2):917-923. Pang X, Wei Y, Zhang Y, Zhang M, Lu Y, Shen P. Peroxisome proliferator-activated receptor-gamma activation inhibits hepatocellular carcinoma cell invasion by upregulating plasminogen activator inhibitor-1 Cancer Sci 2013 Jun;104(6):672-680. <h3>Disclosure of Interest</h3> None declared
Rickets, American style
Authors: L. B. Berman
Journal: JAMA (1974)

RICKETS is seldom a matter of nutritional deprivation or lack of exposure to sunlight in most parts of the United States. The occasional child we see with classic rickets—by x-ray film and bone biopsy—usually represents one of a group of disorders characterized by loss of calcium or phosphorus in the urine, classified under the heading of "tubular disorders." This term indicates that the primary fault is attributed to impaired tubular reabsorption of calcium or phosphorus without abnormality in the glomeruli or the glomerular filtration of these solutes. The result, for the bones, is exactly the same as old-fashioned avitaminosis D. The prognosis lies not in the bone disease but in the associated renal disease that may lead to renal failure. It is possible to describe briefly the more common tubular syndromes leading to rickets as follows: Renal tubular acidosis: rickets, nephrocalcinosis, nephrolithiasis, metabolic acidosis with alkaline urine, hypokalemia.
PTU-254 Incidence, presentation and outcomes for patients with ischaemic colitis admitted to an open-access gi bleeding unit
Authors: A Reilly, J Leeds, P Phull
Journal: Gut (2015)

<h3>Introduction</h3> Ischaemic colitis (IC) is the most common form of gastrointestinal ischaemia; an acute impairment of perfusion of the colon leads to mucosal injury resulting in inflammation, ulceration and occasionally full-thickness necrosis. A recent meta-analysis has suggested that ∼20% of patients require surgery, and the mortality rate is almost 13%.<sup>1</sup>The aim of this study was to determine the incidence, presentation and outcomes for patients with ischaemic colitis. <h3>Method</h3> Retrospective audit of prospectively collected data for the open-access GI Bleeding Unit (GIBU) at our institution between January 1995 and December 2004. Data was extracted from the GIBU database for all patients coded as IC or ‘other colonic’ diagnoses. The diagnosis of IC was validated by cross-checking with the hospital endoscopy and pathology software systems. <h3>Results</h3> Over the 10 year period studied, there were 1885 admissions with lower GI bleeding of which 108 (5.7%) had an endoscopically and/or histologically confirmed diagnosis of IC. The number of cases of IC increased over time; the incidence of bleeding from ischaemic colitis increased from 0.24 per 100,000 in 1995 to 5.06 per 100,000 of the adult population in 2004. The mean age of the patients was 69 (range 35–91) years, with 93 (86.1%) being &gt;55 yrs; 83 (76.9%) were female. Presentation was with rectal bleeding in 103 (95.4%) cases, diarrhoea in 52 (48.1%) and vomiting in 38 (35.2%). Regular medication included aspirin in 39 (36.1%) of patients, NSAIDS in 19 (17.6%), and anti-coagulants in 12 (11.1%). Of the 108 admissions, 107 (99.1%) underwent lower GI endoscopy and 96 of these (89.7%) had biopsies taken for histology. One patient proceeded directly to surgical resection without prior endoscopic examination. Analysis of outcomes revealed rebleeding in 3 (2.8%) cases, with 5 (4.6%) patients requiring surgical resection; 30 day mortality was 3.7%. Readmission with IC was seen in 2 (1.9%) cases during the period studied. <h3>Conclusion</h3> The incidence of IC appears to be rising, with the majority of patients being female and over 55 years of age. However, the surgery and mortality rates are lower than previously reported, and recurrence is rare. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> O’Neill S, Yalamarthi S. Systematic review of the management of ischaemic colitis. Colorectal Dis. 2012;14:e751–e763