tbuckley/cabot-search huggingface dataset:
PTH-037 Double balloon enteroscopy under conscious sedation is safe and well tolerated
Authors: D Tate, V Pattni, S Hughes, A Terlevich, P Marden
Journal: Gut (2015)

<h3>Introduction</h3> Double balloon enteroscopy (DBE) has become the test of choice for complete investigation of the small bowel.<sup>1</sup>Southmead hospital is a large centre in the Southwest of the United Kingdom serving a population of 620,000. It acts as a tertiary referral centre for DBE serving in excess of 2 million people. We report the experience of this centre with 205 patients who underwent DBE under conscious sedation. <h3>Method</h3> The endoscopy database was interrogated for all DBE procedures performed from 04/2009 to 10/2014. During this period there were two Consultant operators and an additional Consultant operator started in 05/2013. Data was collected retrospectively on multiple factors associated with the procedure; these included dose of sedative agents, endoscopist and nursing comfort scores and serious complications. The data was analysed by chi-squared, ANOVA, Fisher transformation test and unpaired t-test. <h3>Results</h3> 205 procedures were performed over the study period: 139 DBE from above and 66 DBE from below. The mean age (+- standard deviation) was 62.8 (+-2.2) years, range 17–94. All procedures were performed under conscious sedation. The agents used were midazolam alone or with the addition of pethidine or fentanyl. Midazolam was used in 181 cases and the average dose was 5.2mg (+-0.3), range 1–12 mg. The dose was higher for DBE from above (mean 5.6 mg) versus DBE from below (mean 4.36mg) (p &lt; 0.001). Lower doses of midazolam were used in older patients (p &lt; 0.001) and there was no difference between the three endoscopists (p = 0.522). Pethidine was used in 176 cases. The average dose was 44.2 mg (+-1.6) (range 25–50 mg). This did not vary significantly between the two procedure types performed (p = 0.716). Fentanyl was used in 5 cases with a mean dose of 80mcg. Comfort scores recorded by nursing staff and endoscopists were compared using the departmental comfort score which rates discomfort during endoscopic procedures from 0 (comfortable) to 3 (severe discomfort). 50% of the procedures were performed with a rating of zero. Two was the maximum pain score attributed to any procedure and this occurred in only 11% of cases. Comfort scores were well correlated between nursing and endoscopist reporting (p &lt; 0.001). DBE from above was significantly better tolerated than DBE from below (p &lt; 0.001) and older patients tolerated the procedure significantly better than younger patients (p = 0.023). There were no cases of perforation, significant bleeding, 8 day readmission nor 30-day mortality. <h3>Conclusion</h3> We have demonstrated in this large cohort of patients that DBE under conscious sedation is safe and well tolerated without the need for general anaesthesia. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Rahmi G, Samaha E, Vahedi K <i>et al</i>. Multicenter comparison of double-balloon enteroscopy and spiral enteroscopy. J Gastroenterol Hepatol. 2013;28:992–998
DSM-III, draft DSM-III-R, and the diagnosis and prevalence of bulimia in Australia
Authors: D I Ben-Tovim
Journal: American Journal of Psychiatry (1988)

A self-report questionnaire for bulimic symptoms was administered to three different groups of community residents and to patients in a hospital's weight disorders unit and its dietetics department. The prevalence of DSM-III bulimia was 12.7% among female community residents, while the prevalence of draft DSM-III-R bulimia was 1.7%. The questionnaire, scored to reflect DSM-III, categorized as bulimic large numbers of patients who were not given that diagnosis by clinicians. The draft DSM-III-R criteria seemed more closely aligned to clinical experience.
FRI0596 Impact of Spatial Resolution on Size Quantification of Erosions in the Metacarpals: A Cadaver Study Comparing Clinical Whole Body Scanners with High Resolution Xtremect
Authors: K. Engelke, D. Töpfer, S. Finzel, O. Museyko, G. Schett
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Bone erosions are a characteristic of inflammatory joint disease although they are also found in the healthy elderly population. In order to correctly discriminate pathological bone erosions from normal physiological bone changes, it is important to use a high resolution imaging techniques. Hr-pQCT offers higher spatial resolution but whole body CT scanners are more widely available and offer faster scans times, larger anatomic coverage and improved patient comfort. So far a golden standard has not been established. <h3>Objectives</h3> To compare the performance of two imaging modalities – whole body clinical CT scanners (wbCT) versus high resolution peripheral QCT (hr-pQCT) to detect bone erosions and to quantify erosion size. <h3>Methods</h3> Left and right hands of 12 human cadavers (7 females, age 65-90y, mean 89y, cause of death diseases related to internal medicine or oncology) were scanned twice (with repositioning) with wbCT (Siemens Somatom Flash) using an extremity protocol (120 kV, 120 mAs, wrist UHR, U70, 0.5 mm slice thickness, FoV 135mm) and once with hr-pQCT (XtremeCT, Scanco Medical, Switzerland, isotropic voxel size of 80μm). The 300-400 slices of the hr-pQCT scan covered the metacarpal-phalangeal joints. Erosion detection by an expert rheumatologist was performed independently for both imaging modalities. Volume of the erosions detected in the hr-pQCT data sets was measured using MIAF-Finger. In short, first periosteal bone surface and then the volume of interest (VOI) covered by an erosion was segmented in the hr-pQCT data. In a second step the periosteal bone surface was rigidly registered to the wbCT scans. Erosions at corresponding locations were segmented independently in the wbCT scans to compare erosion volume between both modalities. <h3>Results</h3> 3 hr-pQCT scans were excluded from analysis due to inadequate scan range. In 11 cadavers a total of 93 erosions were found in the HR-pQCT scans. Nine of these could not be segmented in at least one of the two wbCT scans due to small volume or small cortical break. For the remaining 85 erosions correlation of volume between the repeat wbCT scans and between wbCT and hr-pQCT is shown in the figure. <h3>Conclusions</h3> It is unknown which erosions were related to inflammation. Correlation of erosion volume between the two modalities was high, although as expected wbCT underestimated volume by about 30%. Large discrepancies in size were detected for example if two erosions close together but still separated appeared as one larger erosion in the lower resolution wbCT images. Detectability of erosions still has to be compared between the two modalities. The preliminary results however are promising that by applying high-resolution extremity protocol, wbCT may be used for erosion detection, if HR-pQCT is not available. <h3>Disclosure of Interest</h3> None declared
The "atypical" clinical picture of adolescent mania
Authors: J C Ballenger, V I Reus, R M Post
Journal: American Journal of Psychiatry (1982)

The authors examined the records of 9 manic patients under age 21 and 12 over age 30 for the incidence of "schizophrenic" and manic symptoms. The adolescent patients had a higher incidence of each of the 10 schizophreniform symptoms rated and significantly more delusions and ideas of reference. Significantly more adolescent patients had 3 or more schizophreniform symptoms; they also had symptoms typical of mania. These findings highlight the diagnostic importance of affective symptoms in psychotic adolescents with mixed symptoms and raise important clinical and theoretical questions about the atypical clinical picture of manic-depressive illness in young patients.
PTH-144 Risk adjustment for surgical short-term outcomes for oesophago-gastric cancer patients
Authors: O Groene, D Cromwell, R Hardwick, C Fischer
Journal: Gut (2015)

<h3>Introduction</h3> Health outcomes are increasingly compared between providers with the aim to benchmark quality of care. In such benchmarks adjusting for patient characteristics is of major importance to avoid unfair comparisons between providers. We developed a case-mix adjustment model for comparing 30-, 90-day mortality and anastomotic leakage rates after oesophagus gastric (O-G) cancer resections between NHS hospitals. <h3>Method</h3> We reviewed the literature for existing prediction models for 30-, 90-day mortality and anastomotic leakage after oesophago-gastric cancer resections. Based on this review we selected predictors that were consequently used to develop a case-mix adjustment model in the national audit data of 4,882 O-G cancer patients undergoing surgery in the years 2012 and 2013. Models were developed with logistic regression analysis. Discriminative ability was quantified with the Area under the ROC curve and internal validity was assessed using a bootstrap procedure. <h3>Results</h3> The risk prediction models identified in the literature were not suitable for case-mix adjustment in the NHS audit data as they required detailed laboratory data that are not available at the national level. Moreover, the majority of existing models were methodologically weak and developed based on data pooled over long periods of time during which outcomes improved considerably in the UK. In the data used for model development, 30-day mortality was 2.3%, 90-day mortality was 4.4% and 6.2% of the patients developed an anastomotic leakage. Discriminative ability in the model development dataset was 0.70, 0.69 and 0.63 for 30-day mortality, 90-day mortality and anastomotic leakage, respectively. The internally validated AUCs were well calibrated and showed moderate discriminative ability (area under ROC curve 0.65 for 30-day mortality, 0.66 for 90-day mortality, yet only 0.59 for anastomotic leakage). <h3>Conclusion</h3> Based on nationally available data, we developed three case mix adjustment models for postoperative outcomes in the largest contemporary cohort of O-G patients undergoing curative surgery. These models should be used for the risk adjustment when assessing hospital performance in the NHS. <h3>Disclosure of interest</h3> None Declared.
Lasker Awards
Authors: Mary Lasker
Journal: JAMA (2015)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
PTH-052 C-reactive protein levels in the perioperative period as a predictive marker of endoscopical recurrence
Authors: E Iaculli, GS Sica, L Biancone, G Tema, G Maggi, S Di Carlo
Journal: Gut (2015)

<h3>Introduction</h3> Objective of present study was to determine the perioperative behaviour of CRP in Crohn Disease (CD) in patients undergoing elective ileo-cecal (IC) resection and to identify association between perioperative CRP levels and endoscopic recurrence at 1 year. Our hypothesis is that perioperative CRP changes are disease-specific and therefore could detect subset of patient with more aggressive disease <h3>Method</h3> 75 patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed perioperatively: preoperative, postoperative day 1 (POD1) and 5 (POD5). CD patients’ values were compared against same interval assessments of control groups undergoing right colectomy (Group B) and appendicectomy (Group C). Receiver operating characteristic (ROC) analysis identified a threshold value for any serum CRP associated with endoscopic recurrence in a test cohort (n 25) and subsequently validated in the whole series. Logistic regression for association between clinicopathological characteristics including perioperative serum CRP thresholds and endoscopic recurrence was performed. <h3>Results</h3> In all 3 groups CRP significantly increased at POD1 vs baseline but the increase was significantly higher in CD patients than in controls (p &lt; 0.001). Comparing to control groups CRP remained remarkably high in CD at POD5. Difference between groups was statistical significant (p &lt; 0.001). The ROC analysis performed in the preliminary test group (n 25) indicated a significant association between CRP serum levels at any different times and endoscopic recurrence with optimal cut-off levels for predicting endoscopic recurrence identified. Applying these thresholds in the whole study cohort (n 75) for validation, a serum CRP &gt;39.8 mg/L at POD1 and &gt;23.2 at POD5 have shown statistically significant association to endoscopic recurrence when using bivariate correlation. Binary logistic regression used to determine association between clinico-pathological characteristics already known as clinical predictor of disease severity and CRP concentration at any perioperative determination couldn’t demonstrate statistical significance for any of these variables in this limited series. <h3>Conclusion</h3> This is the only study so far that investigates and confirms with preliminary data a disease-specific activation and up-regulation of CRP response in the postoperative period for CD patients undergoing surgery. We suggest that the degree of immunologic changes and related severity of disease might be explored immediately soon after surgery by determining peri-operative CRP modification. The postoperative CRP levels and kinetics seem to be related to the grade of mucosal inflammation and recurrence rate according to our 12 months endoscopic evaluation <h3>Disclosure of interest</h3> None Declared.
Former Tory health minister attacks new junior doctor contract
Authors: Jacqui Wise
Journal: BMJ (2015)

A former Conservative health minister has delivered a scathing attack on the government’s handling of the new contract for UK junior doctors.

Writing in the Guardian newspaper, Dan Poulter said that the junior doctor contract that the Department of Health for England now wanted to impose was very different from the one being discussed last year when he was overseeing the coalition government’s negotiations over the new contracts for doctors.1

Poulter, who is still a Conservative MP, said that there was no talk then of 90 hour weeks or of cuts to junior doctors’ pay. Instead there was recognition …
Risk factors for needle sharing among methadone-treated patients
Authors: D Metzger, G Woody, D De Philippis, A T McLellan, C P O'Brien, J J Platt
Journal: American Journal of Psychiatry (1991)

This paper examines the sociodemographic and psychiatric characteristics of patients taking methadone who continue to share needles.Three hundred twenty-three patients were recruited from four methadone programs. Data were collected by using questionnaires and interviews. Psychiatric symptoms were measured with the SCL-90, the Beck Depression Inventory, and the Addiction Severity Index.Twenty percent of these subjects reported sharing needles within the previous 6 months. Those who shared reported greater difficulty in acquiring new needles, more legal difficulties, more severe drug problems, and higher levels of psychiatric symptoms.These data suggest that patients who continue to share needles are a more disturbed subgroup of the methadone maintenance population. Efforts designed to reduce needle sharing may need to be more sharply focused on patients who are at greatest risk of infection, and these patients may require more intensive psychiatric services.
AB0177 Human Umbilical Cord Mesenchymal Stem Cells Inhibit Follicular Helper T Cell Expansion in B6.Mrl-Faslpr Lupus Mice
Authors: Z. Zhang, X. Feng, W. Deng, S. Huang, G. Yao, W. Chen, L. Sun
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Follicular helper T (Tfh) cells have been implicated in the pathogenesis of autoimmune diseases. Human umbilical cord mesenchymal stem cell (hUC-MSC). Transplantation could alleviate disease progression in both lupus mice and patients. However, the mechanism is largely unknown. <h3>Objectives</h3> The objective of this study was to explore modulatory effects of hUC-MSCs on Tfh cells in B6.MRL-Fas<sup>lpr</sup> lupus mice. <h3>Methods</h3> The percentages of spleen Tfh cells in B6.MRL-Fas<sup>lpr</sup> lupus mice and C57BL/6 (B6) mice were examined by flow cytometry. Serum IL-21 levels were measured by ELISA. The correlations between the percentage of spleen Tfh cells, serum IL-21 concentrations and lupus-related manifestations of B6.MRL-Fas<sup>lpr</sup> mice were analyzed by Pearson9s correlation test respectively. CD4+ T cells were isolated from the spleen of B6.MRL-Fas<sup>lpr</sup> mice and cocultured with hUC-MSCs for 3 days at different ratios (100:1, 20:1, 4:1), and then the frequencies of CD4+CXCR5+PD-1+T cells were determined by flow cytometry. The differentiation, proliferation and apoptosis of Tfh cells were also analyzed by flow cytometry after cocultured with hUC-MSCs. 1×10<sup>6</sup> hUC-MSCs were injected into B6.MRL-Fas<sup>lpr</sup> lupus mice via tail vein and the control groups were administered with 1×10<sup>6</sup> fibroblast-like synoviocytes (FLSs) and PBS respectively. 4 weeks later, all the mice were sacrificed. The percentages of spleen Tfh cells and plasma cells were examined by flow cytometry. CD4+CXCR5+Tfh cells were isolated from spleens of all the administered mice and cocultured with B220+cells isolated from spleens of B6 mice. 5 days later, IgG level of the coculture supernatants were measured by ELISA. <h3>Results</h3> The percentages of spleen Tfh cells and serum IL-21 concentrations in lupus mice were significantly higher than those in B6 mice. Both the frequencies of spleen Tfh cells and serum IL-21 levels were positively correlated with serum IgG, ANA and ds-DNA antibody levels in lupus mice. HUC-MSCs could suppress Tfh generation when cocultured with CD4+T cells at different ratios. The differentiation, proliferation and apoptosis of Tfh cells could all be inhibited by hUC-MSCs in vitro. 4 weeks after hUC-MSC transplantation, the percentages of spleen Tfh cells and plasma cells were significantly lower than those in control groups. Supernatants of B220+cells cocultured with CD4+CXCR5+Tfh cells isolated from spleens of hUC-MSC treated lupus mice had lower levels of IgG than control groups. <h3>Conclusions</h3> HUC-MSCs could inhibit Tfh expansion in B6.MRL-Fas<sup>lpr</sup> lupus mice, which may be a mechanism of hUC-MSC transplantation alleviating lupus. <h3>Disclosure of Interest</h3> None declared
AB0754 Persistence Rate with Subcutaneous Biologic Therapies in Patients with Ankylosing Spondylitis (AS)
Authors: R. Lyu, Q. Ding, M. Govoni, C. Makin, J. Korn, T. Fan, A. Ogbonnaya, C.M. Black, S. Kachroo
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> The treatment landscape of rheumatoid diseases has evolved in recent years, with the introduction of subcutaneous TNF-alpha blockers in the EU. These changes in the rheumatoid disease treatment landscape could affect how patients are managed with rheumatoid diseases. <h3>Objectives</h3> This study aimed to describe persistence with subcutaneous biologics among biologic naïve AS patients over 12 months, and to identify differences among patients with and without NSAID drug experience. <h3>Methods</h3> This retrospective study used IMS Disease Analyzer-Germany, an electronic medical records database. Data for adult (≥18 years of age) AS patients with a prescription for subcutaneous biologic between January 1, 2009 and June 30, 2012 were used for this analysis. The index date was the date of the first subcutaneous biologic prescription. Prescription for any biologic during the pre-index period or diagnosis for rheumatoid arthritis, psoriatic arthritis or other conditions treated with subcutaneous biologics either in pre- or post-index qualified patients for exclusion from the study. Differences between pre -index NSAID naïve and experienced patients were measured using a chi-square test. A logistic regression model was used to further assess the impact of NSAID use on persistence, controlling for baseline characteristics. <h3>Results</h3> The study cohort included a total of 108 biologic naïve AS patients, 72 with use of NSAIDs in the pre-index period. The mean age of the AS cohort was 42 years, with 70% of patients being male. Adalimumab, etanercept, and golimumab were initiated by 61%, 28%, and 11% of patients, respectively. Persistence for at least 12 months with the index subcutaneous biologic was observed in 46.3% of the overall cohort, with similar results among those with and without NSAID use (47% vs 44%, respectively). Multivariate analysis confirmed similar persistence between those with and without pre-index NSAID (OR: 0.97; 95% CI: 0.39-2.44). <h3>Conclusions</h3> Findings from this German study showed that less than half of AS patients are persistent with the index subcutaneous biologic over a 12 month period. Results were similar irrespective of prior use of NSAIDs. <h3>Disclosure of Interest</h3> R. Lyu Employee of: Merck, Q. Ding Employee of: Merck, M. Govoni Employee of: Merck, C. Makin: None declared, J. Korn: None declared, T. Fan Employee of: Merck, A. Ogbonnaya: None declared, C. Black Employee of: Merck, S. Kachroo Employee of: Merck
A Sleeping Giant
Authors: Ralph J. Blair, John J. Ross, Alanna Morris, Sarah Grudberg
Journal: New England Journal of Medicine (2011)

A 71-year-old woman presented with abdominal pain and reported that intermittent drenching night sweats, a global nonpulsatile headache, sinus pressure, and left maxillary pain radiating into her teeth had developed 4 weeks earlier. Amoxicillin was prescribed for presumed sinusitis, and her symptoms abated. However, after 1 week of therapy, dull abdominal pain developed that was . . .
Canine CD34: cloning of the cDNA and evaluation of an antiserum to recombinant protein
Authors: PA McSweeney, KA Rouleau, R Storb, L Bolles, PM Wallace, M Beauchamp, L Krizanac-Bengez, P Moore, G Sale, B Sandmaier, T de Revel, FR Appelbaum, RA Nash
Journal: Blood (1996)
WR-2721 and hypocalcemia.
Authors: N O'Rourke, E McCloskey, J Kanis
Journal: Journal of Clinical Oncology (1994)

Article Tools Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1994.12.1.232 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 8270981 WR-2721 and hypocalcemia. N O'RourkexN O'RourkeSearch for articles by this author , E McCloskeyxE McCloskeySearch for articles by this author , J KanisxJ KanisSearch for articles by this author https://doi.org/10.1200/JCO.1994.12.1.232 PDF "WR-2721 and hypocalcemia.." Journal of Clinical Oncology, 12(1), p. 232© 1994 by American Society of Clinical Oncology