tbuckley/cabot-search huggingface dataset:
AB0141 Porphyromonas Gingivalis Enhances Citrullination in Collagen Induced Arthritis
Authors: S.M. Jung, J.H. Koh, H.K. Min, J.Y. Lee, J. Lee, J.H. Kim, S.-K. Kwok, K.-S. Park, C.-H. Yoon, S.-H. Park, J.H. Ju
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> The association of rheumatoid arthritis (RA) and periodontal disease is supported by many epidemiologic studies. <i>P. gingivalis</i>, a pathogenic organism in periodontal disease, can be a link between two diseases via citrullination. <h3>Objectives</h3> This study was conducted to investigate the pathogenic effect of <i>P. gingivalis</i> on autoimmune arthritis <i>in vivo</i>. <h3>Methods</h3> We compared the clinical and histological characteristics in collage-induced arthritis (CIA) mice infected with or without <i>P. gingivalis</i>. W83 strain of the anaerobic bacteria was intraperitoneally injected twice a week to simulate the chronic infection. Clinical evaluation and routine histological analysis were performed in the experimental groups. In addition, the joint sections of CIA mice were immunostained with anti-citrullinated peptide antibodies (ACPAs) produced by hybridoma cell lines (12G1) reactive to cyclic citrullinated peptide. The areas stained with ACPAs were measured by computerized system for quantitative image analysis. <h3>Results</h3> Infection with <i>P. gingivalis</i> exacerbated clinical arthritis in CIA mice. Histological analysis also revealed aggravation of synovial inflammation and bone destruction in CIA mice infected with <i>P. gingivalis</i>. Accordingly, TRAP positive cells were more abundant in synovial tissues of the infected CIA mice. Citrullination of tissue was prominently shown in RA synovium than osteoarthritis by 12G1 ACPA. Citrullination was detected in all of CIA mice, while ACPA-positive area was absent in wild type mice infected with <i>P. gingivalis</i>. Citrullinated area determined by staining with ACPA was more extensive in CIA mice infected with <i>P. gingivalis</i> compared to control CIA mice. <h3>Conclusions</h3> This result suggests that <i>P. gingivalis</i> might aggravate autoimmune arthritis by overproduction of citrullinated antigen. Citrullination mediated by <i>P. gingivalis</i> can be a possible mechanism bridging a gap between periodontal disease and RA. <h3>References</h3> Koziel, J., P. Mydel, and J. Potempa, The link between periodontal disease and rheumatoid arthritis: an updated review. Curr Rheumatol Rep, 2014. 16(3): p. 408. Maresz, K.J., et al., Porphyromonas gingivalis facilitates the development and progression of destructive arthritis through its unique bacterial peptidylarginine deiminase (PAD). PLoS Pathog, 2013. 9(9): p. e1003627. <h3>Acknowledgements</h3> This work was supported by a grant from the Korea Healthcare Technology R&amp;D Project, Ministry for Health, Welfare &amp; Family Affairs, Republic of Korea (A092258). <h3>Disclosure of Interest</h3> None declared
Case 32-1997
Authors: Martin A. Samuels, Kathy L. Newell
Journal: New England Journal of Medicine (1997)

Presentation of CaseA 43-year-old woman was admitted to the hospital in early June because of possible adult respiratory distress syndrome.The patient had been in excellent health until nine days earlier, when she began to have low-grade fever, chilliness, and headache. On the next day, she slept excessively. One week before admission to this hospital, she vomited and lost consciousness for 15 seconds while kneeling. Later that day, an examination at another hospital revealed tender postoccipital lymph nodes; the white-cell count was 7600 per cubic millimeter. Her husband recalled that he had removed a tick from her neck about . . .
Abstract 17912: Health-related Quality of Life Outcomes in PARADIGM-HF
Authors: Eldrin Lewis, Michael R Zile, Karl Swedberg, Jean L Rouleau, Brian Claggett, Martin P Lefkowitz, Victor C Shi, Scott D Solomon, Milton Packer, John J McMurray
Journal: Circulation (2015)

Introduction: Heart failure with reduced ejection fraction (HF) patients have impaired health-related quality of life (HRQL) with variable responses to therapies that target mortality and HF hospitalizations. In PARADIGM-HF, LCZ696 reduced morbidity and mortality compared with enalapril. Prior analysis demonstrated a significant difference in 8-month Kansas City Cardiomyopathy-Clinical Summary score (KCCQ-CSS) when imputing 0 for death (-2.99 vs. -4.63, p=0.0014). Given improvements in mortality with LCZ696, this analysis provides impact of therapy on all domains of HRQL in survivors only. Hypothesis: LCZ696 will improve HRQL Methods: Patients (after run-in phase) completed disease-specific KCCQ at randomization, 4 month, 8 month, and annual visits. Changes in KCCQ scores were calculated using repeated measures ANCOVA model adjusting for treatment, region, &amp; baseline values (primary efficacy pre-specified at 8 months), and association of KCCQ with mortality was assessed. Results: Among 8442 patients enrolled in PARADIGM-HF, 7623 (90%) completed KCCQ scores at randomization with complete data at 8 months on 7281 (86%). Baseline KCCQ scores were similar in LCZ696 and enalapril groups (73.5±20 vs. 72.3±19). Death increased with every 10 point decrement of baseline KCCQ-CSS [HR 1.11 (1.09, 1.14)]. At 8 months, LCZ696 group noted improvements in both KCCQ-CSS (+0.61 vs. -0.28, p=0.010) and KCCQ-Overall summary score (+1.10 vs. -0.15, p&lt;0.001) in comparison to enalapril group with consistent trends in most KCCQ domains (Table). Adjusted change scores demonstrated consistent improvements in LCZ696 compared with enalapril through 36 months. Conclusions: Disease-specific HRQL is associated with survival. Changes in HRQL were better in patients treated with LCZ696 compared with enalapril with consistency in most domains. These findings suggest that LCZ696 leads to better HRQL in addition to morbidity &amp; mortality in HF-reduced ejection fraction patients.
Diagnosis and Management of Neural-Tube Defects Today
Authors: John C. Hobbins
Journal: New England Journal of Medicine (1991)

About 10 of every 10,000 American babies are born with anencephaly or meningomyelocele (spina bifida), the disorders known collectively as neural-tube defects. The incidence of anencephaly has declined from 8 per 10,000 live births in 1970 to about 3 to 4 per 10,000 in the 1980s. Similarly, the incidence of meningomyelocele declined steadily from 12 per 10,000 in 1970 to 6 to 8 per 10,000 in 1980, where it has plateaued since.1 The neural tube closes between 22 and 29 days after conception; disruption of the events that are programmed to occur during this critical period of development results in . . .
Truth Is Stranger Than Factitious
Authors: Milton W. Hamolsky
Journal: New England Journal of Medicine (1982)

Virtually all physicians have learned that some of their patients sometimes deviate from their recommended therapies. Physicians also know — uneasily — that some people become patients because they surreptitiously administer pharmacologic agents to themselves or otherwise abuse their bodies. The list of factitious diseases thus produced is long and continues to grow in proportion to the availability of potent pharmacologic agents to those in our self-medicating society who seek relief or presumptive personal gain from real or imagined ills. Anecdotes and case reports abound, revealing puzzling fevers of unknown origin due to thermometer manipulation, debilitating diarrhea due to cathartics, . . .
Chemo-hormonal therapy for biochemical progression of prostate cancer
Authors: M. Taplin, W. Xie, D. Morganstern, G. Bubley, M. Ernstoff, M. Regan
Journal: Journal of Clinical Oncology (2006)

4559 Background: Androgen deprivation therapy (ADT) is effective for relapsed prostate cancer, but is rarely curative. The purpose of this trial was to determine the feasibility, toxicity and PSA response of chemotherapy and ADT for men with PSA relapse. Methods: Eligible men had a rising PSA and no metastases after prostatectomy and/or radiation for localized disease. Treatment consisted of four cycles of docetaxel (70 mg/M 2 ) every 21 days and estramustine 280 mg three times daily on days 1–5. After chemotherapy, goserelin acetate and bicalutamide 50 mg daily were prescribed for 15 months. Results: Sixty-two patients were enrolled at four institutions: median age 65 (range 49–78), median PSA 3.01 ng/mL (range 0.08–47.04), 24% Gleason 8–10. A complete PSA response (CR) was defined as PSA at or below assay-specific lower limit (0.01–0.2 ng/mL). The proportion of patients with CR after chemotherapy, after ADT and at one year off ADT was 53%, 63% and 36%. Testosterone was &gt; 100 ng/dL (median 250 ng/dL) one year off ADT in 97%. Patients with a PSA &lt; 3.0 ng/mL had a significantly longer time to progression (p-value 0.0002). At the time of last follow-up 24/56 (43%) who are at least one year off ADT have not progressed. Median TTP is 34 months from treatment initiation (maximum 74 months free from progression). Toxicity was manageable with no toxic deaths: there were 4 thromboses on chemotherapy and 38% of cycles were associated with grade III/IV neutropenia with 5 cases of documented infections. Conclusion: Chemotherapy prior to hormone therapy was feasible for early prostate cancer relapse. Forty-three percent of men who are at least one year off ADT with recovered testosterone have not progressed. This approach is being tested in a randomized trial with investigation of predictors of response. No significant financial relationships to disclose.
Punjab’s minister of medical education moves to oust medical council president
Authors: Priyanka Pulla
Journal: BMJ (2016)

A long running dispute between members of the Punjab Medical Council has ended in the state’s minister of medical education and research moving to oust the council’s president.

Anil Joshi, Punjab’s minister of medical education and research, announced on 17 January that Gurinder Singh Grewal was no longer president of the Punjab Medical Council. Joshi has reportedly constituted a panel to nominate a new president, alleging that Grewal’s presidency ended in January 2015 because his term as council member ended then.1 

Grewal has vociferously disputed Joshi’s claim, pointing to an amendment to the Punjab Medical Register Act, which says that the council’s president need not be a council member. Therefore, even though he stopped being a council member in January 2015 he will continue to be president until his five year tenure ends in December 2016, he maintains. “The minister has no right to remove me or appoint me. It is the chief minister [of Punjab] who will take the decision,” Grewal told The BMJ. 

Grewal’s brother, Maheshinder Singh Grewal, who is an adviser to the chief minister, has also previously spoken out in support of Grewal …
Madeleine McCann
Authors: Des Spence
Journal: BMJ (2007)

At the time of writing Madeleine McCann is still missing.

I became vaguely aware of the story of the 4 year old girl who went missing while on holiday in Portugal from a crackling radio bulletin. I had an odd sense of unease, but it wasn't until the phone rang—“That's Gerry's daughter”—that the penny dropped. I was at university with Madeleine's father. As the media story took off, my children bombarded me with questions, but I just didn't know what to say. The next day I pulled into a local garage. After sifting through all the banal birthday cards I eventually found a card I felt I could send. Half an hour later the card was still blank: what possible words of comfort could I offer to Gerry and his wife in such plight? I wrote four words.

Since then I have stayed silent, partly out of respect and partly through a desire not to intrude on the family's grief. Last week an old friend emailed me and asked if I would write for Madeleine, but I am a hack and do not feel worthy.

The vision of Madeleine's mother, Kate McCann, holding her daughter's soft toy is my abiding memory. Little is made of Gerry and Kate being doctors, because above all else they are simply parents. Despite all the generous offers of support, the pain etched on their faces says it all: there is nothing that they would not sacrifice to have her back.

They have been criticised for leaving their children unattended, but I too have taken my family on a Mark Warner holiday. We did exactly what Gerry and Kate did: left the kids and checked them regularly while we ate. This was a type of holiday promoted as brief respite from the constant onslaught of caring for preschoolers and, above all, considered “safe.” The McCanns merely did as countless thousands of other parents have done. Any blame or guilt is grossly misplaced and unkind, for they are victims of a random act of utter malevolence. No one has the right to question the McCanns' parental commitment.

Our profession can relate directly to Madeleine's disappearance, and many doctors have personalised the tragedy. Yellow ribbons have been widely worn; beautiful Madeleine innocently gazes from posters on every surgery waiting room in Glasgow; and church services have been overflowing. Medicine can seem a disparate profession, as we scurry along pursuing our careers, but Madeleine's abduction reminds us that the professional veneer of coping with anything is just that—a veneer. We are just ordinary people too, and this story pointedly reminds us that without family and friends life has little meaning. Importantly, religious faith has been recognised for what it is, an affirming source of hope and comfort for the McCanns and millions of others.

Kate and Gerry have been dignified and resolute. They should know that they carry the best wishes and thoughts of the whole profession. We hope they find Madeleine soon. They rightly seek to maintain Madeleine's media profile (www.findmadeleine.com).
P25 Standards of end-of-life care in patients with non-malignant respiratory disease
Authors: H Brothers, A Gleeson, J Kilbane, M Scott, J Evans, E Powell, S Margetts
Journal: Thorax (2015)

<h3>Objectives</h3> Recognising the end of life phase in chronic non-malignant lung conditions remains a challenge which has been proposed as a major barrier to ensuring effective end-of-life care in this population.<sup>1</sup> Our aims were threefold. Firstly, to establish whether patients who died of causes related to their lung condition could have been predicted to have been in the last 6–12 months of their lives. Secondly, to evaluate the standard of care they received leading up to their death. Finally, to compare end-of-life care received by patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). <h3>Methods</h3> A retrospective review of deaths due to COPD and ILD over a 26 month period in two acute hospitals in South Wales using paper and electronic health records. Gold Standards Framework (GSF) prognostic indicators of poor prognosis were identified, and ‘standards of care’ evaluated in the 12 months preceding death. <h3>Results</h3> 119 cases were analysed. 83% of patients could have been identified as ‘approaching end of life’ (AEOL) using GSF criteria. ‘Standards of care’ were variably met: do not attempt cardiopulmonary resuscitation (DNACPR) forms were completed in 93% of cases. Advanced care planning, establishing preferred place of care and use of specific end-of-life care documentation took place in &lt;1%, 7% and 14% respectively. COPD patients had more indicators of poor prognosis than patients with ILD but received fewer ‘standards of care’. <h3>Conclusions</h3> The majority of patients in our study could have been identified as AEOL and therefore ought to have been in receipt of the ‘standards of care’. There is a need to improve recognition of patients that are AEOL in order that they receive better end-of -life care. Further investigation to confirm or refute the discrepancy in care between COPD and ILD patients is necessary. Research into the best means of identifying, and subsequent provision of care, for patients with non-malignant respiratory disease is also required. <h3>Reference</h3> 1 Boland J, Martin J, Wells A, Ross J. Palliative care for people with non-malignant lung disease: summary of current evidence and future direction.<i> Palliat Med</i>. 2013;<b>27</b>(9):811–816
Human Immunodeficiency Virus Type 1 Infection in Homosexual Men Who Remain Seronegative for Prolonged Periods
Authors: David T. Imagawa, Moon H. Lee, Steven M. Wolinsky, Kouichi Sano, Fatima Morales, Shirley Kwok, John J. Sninsky, Parunag G. Nishanian, Janis Giorgi, John L. Fahey, Jan Dudley, Barbara R. Visscher, Roger Detels
Journal: New England Journal of Medicine (1989)

Infection with the human immunodeficiency virus type 1 (HIV-1), as demonstrated by viral cultures, has been described in some patients before antibodies to HIV–1 can be detected, but the duration and frequency of such latent infections are uncertain. We selected prospectively a cohort of 133 seronegative homosexual men who continued to be involved in high-risk sexual activity, and we cultured 225 samples of their peripheral-blood lymphocytes, using mitogen stimulation to activate the integrated HIV-1 genome. HIV-1 was isolated in blood samples from 31 of the 133 men (23 percent), 27 of whom have remained seronegative for up to 36 months after the positive culture. The other four men seroconverted 11 to 17 months after the isolation of HIV-1. In three of them, we studied cryopreserved lymphocytes obtained earlier, using the polymerase chain reaction to amplify small amounts of viral DNA, and we demonstrated that HIV-1 provirus had been present 23, 35, and 35 months before seroconversion. We conclude that HIV-1 infection in homosexual men at high risk may occur at least 35 months before antibodies to HIV-1 can be detected. A prolonged period of latency in such infections may be more common than previously recognized; the degree of infectiousness during such periods is unknown. (N Engl J Med 1989; 320:1458–62.)
Cerebral Microbleeds and Thrombolysis
Authors: Mark Fisher
Journal: JAMA Neurology (2016)

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Zoledronate Does not Reduce the Risk of Treatment Failure in Osteosarcoma: Results of the French Multicentre Os2006 Randomised Trial
Authors: S. Piperno-Neumann, M. Le Deley, F. Rédini, P. Marec-Bérard, H. Pacquement, C. Lervat, J. Gentet, N. Entz-Werlé, A. Italiano, N. Corradini, E. Bompas, N. Penel, M. Tabone, G. De Pinieux, P. Petit, K. Buffard, J. Blay, L. Brugières
Journal: Annals of Oncology (2014)
SP0066 Challenges to Make Work Productivity a Meaningful Outcome for Clinical Trials and For Health Care Interventions
Authors: S.M. Verstappen
Journal: Annals of the Rheumatic Diseases (2015)

Patients with rheumatological problems often experience problems at work and many patients have to stop working due to their rheumatological condition within the first couple of years after symptom onset. Remaining in work or being re-employed is important because it increases patient9s self-esteem, self-rated health, self-satisfaction, physical health and relieve financial concerns. Work productivity includes both absenteeism and presenteeism. Absenteeism is defined as absence from work (i.e. reduced working hours, sick-leave, and permanent sick leave/work disability). Presenteeism refers to reduced productivity or performance due to a rheumatological condition while at work. Since work productivity is an important outcome for patients, questions about absenteeism and presenteeism should be addressed in clinic and in clinical studies including clinical trials (RCTs). Early intervention may reduce the likelihood of work productivity loss and possible permanent work loss. However, there are more than 26 instruments available to measure absenteeism and presenteeism. These measures range from simple global measures (e.g. a visual analogue scale (VAS) to multi-item measures. Differences between measures also relate to the construct (e.g. productivity, ability to work, interference with work, instability), recall period (e.g. one day, 7 days, one month), reference (e.g. prior disease onset, colleagues) and attribution (e.g. generic, rheumatological condition). As part of the OMERACT worker productivity initiative and an EULAR-PRO study, we have been investigating the meaningfulness of the different measures with an aim to recommend measures to be used in clinical practice, observational studies and RCTs. This talk will give an overview in the interpretation of various worker productivity measures and the pros and cons of using these measures in clinical practice or in clinical studies. <h3>Disclosure of Interest</h3> None declared
ANGI-05CORRELATION BETWEEN VEGF AND YKL-40 TISSUE EXPRESSION AND PLASMA LEVELS IN GLIOBLASTOMA
Authors: Camilla Bjørnbak Holst, Julia Sidenius Johansen, Eva Løbner Lund, Kjeld Møllgård, Petra Hamerlik, Hans Skovgaard Poulsen
Journal: Neuro-Oncology (2015)

The secreted glycoprotein YKL-40 is elevated (compared to normal) both in plasma and tumor tissue in several types of cancers including glioblastoma (GBM), which is a highly vascularized aggressive malignant brain tumor with a devastating prognosis and limited treatment options. YKL-40 regulates Vascular Endothelial Growth Factor (VEGF) and long-term inhibition of VEGF induces YKL-40, thereby making these pro-angiogenic factors important for the development of GBM vascular phenotype. When evaluated independently, both plasma and tumor tissue YKL-40 levels have proven prognostic in patients with GBM. However, no direct comparison of the two parameters has been reported yet. In search of reliable biomarkers in GBM, this study aimed at exploring the putative correlation between tumor/plasma YKL-40 and VEGF levels in matched primary GBM tissue biopsies and plasma samples and their impact on GBM patient survival. Biopsies and plasma samples from 50 patients with GBM were collected from 2005 to 2015 at Rigshospitalet, Copenhagen, Denmark in relation to neurosurgery, and analyzed for YKL-40 and VEGF by immunohistochemistry and commercial enzyme-linked immunosorbent assay. Clinical data including age, sex, steroid dose, performance status, progression-free survival, overall survival etc. have been compiled in a clinical database. Preliminary results evaluating the correlation between above-mentioned markers in plasma and tumor tissue and their impact on GBM patient survival will be presented. We sincerely hope that our data will provide some insights into the regulation of the GBM angiogenic phenotype and its contribution to poor prognosis in this fatal disease.