tbuckley/cabot-search huggingface dataset:
AB0297 Outcomes of Systemic Juvenile Arthritis (Still's Disease) in Adults
Authors: N. Muravieva, Y. Muraviev
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Systemic juvenile arthritis (Still9s disease, ICD-10 M08.2) is a severe condition, persisting in the majority of cases into adulthood. <h3>Objectives</h3> To assess the outcomes of systemic juvenile arthritis in adult patients. <h3>Methods</h3> Analysis of personal database for the period of 12-year follow up (2003-2014 years). Therapy, disease activity (DAS28), radiographic stage (<i>Steinbrocker criteria</i>), functional class (<i>Steinbrocker criteria</i>), bone avascular necrosis status and nanism, as well as social status (education, professional activity, marital status) of the patients were analyzed. <h3>Results</h3> The data base contains data on 29 patients with Still9s disease with the onset at 6.1±4.2 years: 18 females, 11 males aged 17-29 years, with disease duration of 6-25 years. Glucocorticoids were prescribed to all patients (dose 10-70 mg/day, therapy duration 1-23 years), 18 - continue taking them. Disease-modifying anti-rheumatic drugs were also prescribed to all patients: methotrexate – 24 (dose 7.5-30 mg/week, duration 1-17 years), leflunomide – 15, cyclosporine – 10, hydroxychloroquine – 7, azathioprine – 6, sulfasalazine – 4, D-penicillamine – 3. Biological agents (BA) were administered in 14 patients (including 1 BA – to 5 patients, 2 BAs – 7, 3 BAs – 2 patients): infliximab – 10, tocilizumab – 5, rituximab – 4, etanercept – 4, abatacept – 1, adalimumab – 1. Active disease was established in 72.4% patients, medically induced remission (≥2 years) – in 5, non-medical remission (≥2 years) – in 3 patients. I radiographic stage was found in 1, II – in 11, III – in 8, IV – in 9 patients. I functional class was detected in 1 patient, II – in 24, III – in 3 patients, one patient was wheel-chaired. Avascular bone necrosis was diagnosed in 55.2% patients, nanism – in one out of 3 patients. Higher education has 10 patients, vocational secondary education – 17 patients, secondary education - 2 patients. Out of 13 graduated patients 11 have work, and 2 depend on the family. 12 have their own families, 2 patients have children. <h3>Conclusions</h3> Presented from long-term follow up data on adulthood outcomes in patients with systemic juvenile arthritis (Still9s disease) indicate, that this rare entity is of medical and social importance, requiring further studies. <h3>References</h3> Nigrovic P.A., White P.H. Care of the adult with juvenile rheumatoid arthritis. Arthritis Rheum., 2006, 55, 2, 208-216. Coulson E.J., Hanson H.J.M., Foster H.E. What does an adult rheumatologist need to know about juvenile idiopathic arthritis? Rheumatology, 2014, 53, 2155-2166. <h3>Disclosure of Interest</h3> None declared
Transurethral Microwave Thermotherapy in the Treatment of Symptomatic Benign Prostatic Hyperplasia
Authors: A. Tubaro, G. Paradiso Galatioto, A. Trucchi, A. Begani, A. Stoppacciaro, E. Trucchi, R. Begani Provinciali, A. Furbetta, C. Laurenti, R. Albanese, L. Miano
Journal: European Urology (1993)
AB1126 Changes in Das28 by Age and Ethnicity Among Patients Attending one Rheumatology Clinic in London, UK: Table 1.
Authors: J. Galloway, F. Ibrahim, A. Mian, N. Gullick, S. Steer, H. Lempp
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> There have been few published studies in the UK that examined specifically the impact of ethnicity and age on Rheumatoid Arthritis (RA) outcomes, cross-sectional or longitudinal. From the available literature it seems uncertain whether differences in the clinical phenotype may result from the discrepancy in aetio-pathogenesis, or whether it is a consequence of environmental, cultural and socioeconomic factors. <h3>Objectives</h3> To study changes in Disease Activity Score (DAS28) and its components to identify severity of disease by ethnicity among patients with RA attending an outpatient clinic in a diverse inner city population. <h3>Methods</h3> All RA patients attending a large teaching hospital outpatient clinic between 2010 and 2014 were identified via a Rheumatology clinic database. The socio-demographic and clinical (DAS28 &amp; HAQ) variables were obtained, including estimates of socioeconomic status using postcodes to obtain indices of multiple deprivation. Ethnicity data were self-reported. A mixed-effects linear model was used to examine the mean difference between ethnicity groups (White Caucasians versus Black patients) in clinical variables throughout follow up, including individual DAS28 components. Comparisons were adjusted for age, gender, disease duration and index of multiple deprivation. <h3>Results</h3> 815 RA patients were suitable for analysis: mean age was 62 years; 78% were female; a quarter of patients self-identified as Black (e.g. Afro-Caribbean, African). DAS28 was significantly higher in Black compared to White patients, even after adjustment. Analysis of the individual components revealed that this difference was driven by significantly higher ESR and patient global scores in Black patients. Tender and swollen joint counts were numerically higher, but the differences did not reach statistical significance in adjusted analyses. Disability levels were significantly higher in Black patients. Paradoxically the CRP was significantly lower in Black patients. <h3>Conclusions</h3> The disease pattern for Black patients with RA appear to be different in comparison to White Caucasians. Both subjective and objective measures were higher in Black patients. The observed differences may reflect different RA disease phenotypes or different treatment exposures. Significant disagreement was present between ESR and CRP in black patients. Ethnicity is a patient specific factor that clinicians need to take account of both when considering disease assessment and treatment pathways <h3>Disclosure of Interest</h3> J. Galloway: None declared, F. Ibrahim Employee of: King9s Collge London, A. Mian: None declared, N. Gullick: None declared, S. Steer: None declared, H. Lempp Grant/research support from: NIHR, Health Foundation, ARUK, EU, South London Membership Council, Employee of: King9s College London
Serum prolactin and tardive dyskinesia
Authors: W M Glazer, D C Moore, M D Bowers, W A Brown
Journal: American Journal of Psychiatry (1981)

The authors correlated the serum prolactin levels of 19 men with tardive dyskinesia, 29 postmenopausal women with tardive dyskinesia, and 21 men without tardive dyskinesia with the variables age, sex, antipsychotic dosage, and severity of illness. All subjects were taking antipsychotic medication. The prolactin levels of the 14 women with severe tardive dyskinesia were significantly higher than those of the 15 women with mild symptoms. The prolactin levels of the 8 men with severe tardive dyskinesia did not differ from those of the 11 men with mild symptoms. The authors discuss the sex-related association between prolactin and severity of tardive dyskinesia in the context of recent animal studies that have examined the effect of prolactin and estrogens on the striatum.
Physician-assisted suicide in Oregon
Authors: N G Hamilton, P J Edwards, R S Crawshaw, J K Boehnlein, L M Toenniessen
Journal: American Journal of Psychiatry (1997)

ing site for the outpatient and longitudinal portion of the residency: St. Vincent de Paul Village Medical Clinic for the homeless.This innovative clinic provides a comprehensive continuum of services for up to 2 years to homeless individuals in San Diego.The San Diego Regional Task Force for the Homeless estimates that over 50% of homeless men and 70% of homeless women have some mental health needs.In addition, approximately one-third of the homeless are families with children.Therefore, this training site provides a relevant, unique opportunity for residents to practice and develop their combined skills in providing comprehensive medical and psychiatric care through family medicine continuity and outpatient psychiatry clinics.Initial response of medical students to this innovative program has been enthusiastic, "striking a chord" with those who are fascinated by brain and behavior but do not want to relinquish their identity as a physician.Additionally, we expect that this collaboration between the departments of psychiatry and family medicine will reciprocally improve and strengthen the family physician's understanding of behavioral medicine and the psychiatrist's skills in basic primary care.
Current State of Value-Based Purchasing Programs
Authors: Tingyin T. Chee, Andrew M. Ryan, Jason H. Wasfy, William B. Borden
Journal: Circulation (2016)

The US healthcare system is rapidly moving toward rewarding value. Recent legislation, such as the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act, solidified the role of value-based payment in Medicare. Many private insurers are following Medicare's lead. Much of the policy attention has been on programs such as accountable care organizations and bundled payments; yet, value-based purchasing (VBP) or pay-for-performance, defined as providers being paid fee-for-service with payment adjustments up or down based on value metrics, remains a core element of value payment in Medicare Access and CHIP Reauthorization Act and will likely remain so for the foreseeable future. This review article summarizes the current state of VBP programs and provides analysis of the strengths, weaknesses, and opportunities for the future. Multiple inpatient and outpatient VBP programs have been implemented and evaluated; the impact of those programs has been marginal. Opportunities to enhance the performance of VBP programs include improving the quality measurement science, strengthening both the size and design of incentives, reducing health disparities, establishing broad outcome measurement, choosing appropriate comparison targets, and determining the optimal role of VBP relative to alternative payment models. VBP programs will play a significant role in healthcare delivery for years to come, and they serve as an opportunity for providers to build the infrastructure needed for value-oriented care.
Second malignancy tumors following Hodgkin's disease in children.
Authors: D Jenkin
Journal: Journal of Clinical Oncology (1995)

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.1995.13.8.2143 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 7636560 Second malignancy tumors following Hodgkin's disease in children. D JenkinxD JenkinSearch for articles by this author https://doi.org/10.1200/JCO.1995.13.8.2143 PDF "Second malignancy tumors following Hodgkin's disease in children.." Journal of Clinical Oncology, 13(8), p. 2143© 1995 by American Society of Clinical Oncology
How Do We Make Clinical Molecular Testing for Cancer Standard of Care for Pathology Departments?
Authors: Sanam Loghavi, Mark J. Routbort, Keyur P. Patel, Rajyalakshmi Luthra, Wei-Lien Wang, Russell R. Broaddus, Michael A. Davies, Alexander J. Lazar
Journal: Journal of the National Comprehensive Cancer Network (2016)

Understanding of the genetic basis and molecular pathogenesis of cancer has evolved substantially over the past century. The advent of high-throughput gene sequencing methods has unraveled hundreds of recurrent somatic genetic alterations in various malignancies, either causative or harboring major prognostic and/or predictive implications. Knowledge of these specific changes has dramatically altered diagnostic and therapeutic approaches to cancer, enabling personalized molecular therapies. This article shares approaches to adopting and fine-tuning the practice of molecular diagnostics as an essential component of diagnostic pathology in a tertiary care cancer hospital and proposes methods by which genetic testing in cancer can become standard of care in pathology departments across the nation.
AB0115 Phenotypic Variations of Alpha-One Anti-Trypsin Are Associated with Higher Titres of Ana
Authors: C. Orr, C. McCarthy, D.A. Bergin, T.P. Carroll, K. Creevey, E.P. Reeves, N.G. McElvaney, U. Fearon, D.J. Veale
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Recent evidence suggests a link between deficient states of the ubiquitous protease inhibitor alpha-one antitrypsin (A1AT), and autoimmunity in vitro.<sup>1</sup> The most common phenotype in Ireland is MM, however heterozygous individuals for the Z allele (i.e. MZ) have increased activation of the TNF α system, a key cytokine in the pathogenesis of inflammation in rheumatoid arthritis (RA).<sup>2</sup> Previous studies of the prevalence of allelles associated with deficient states of A1AT in RA have given conflicting results.<sup>3,4</sup> <h3>Objectives</h3> We set out to examine the A1AT phenotype of an RA cohort, and to determine if heterozygosity is associated with higher levels of auto-antibodies for ANA, RF and anti-CCP. <h3>Methods</h3> Qualitative detection and characterisation of A1AT phenotypes in 135 RA patients was performed using the Hydrasys electrophoresis platform (Sebia) and the Hydragel 18 A1AT Isofocusing kit (Sebia). A cohort of 1,100 randomly selected individuals from the voting registry in Ireland were used to determine the overall prevalence of phenotypes in Ireland.<sup>1</sup> Fisher9s exact test was used to test for a correlation between allelic status and RA. Antibody dilution factors for ANA and titres for RF and ACPA were available for all patients for RF (n=135), and for anti-CCP in 118 of the patients. The Mann Whitney U-Test was employed to determine differences in median levels of antibodies between the cohorts. <h3>Results</h3> Higher concentrations of ANA were associated with heterozygosity for A1AT when compared with homozygous states (p=0.045, see fig 1), and this was not observed for RF or anti-CCP titres. There was no difference between the prevalence of the homozygous MM phenotype and the heterozygous phenotypes i.e. MZ or MS in patients with RA and the control group. <h3>Conclusions</h3> ANA is a non-specific marker of many auto-immune conditions. A direct role has been observed for A1AT in regulating neutrophil degranulation in the innate immune system,<sup>1</sup> and the higher titres of ANA seen in those heterozygote for A1AT alleles may implicate A1AT in the adaptive immune response, for example RA. <h3>References</h3> Bergin DA, Reeves EP, et al. The Circulating Proteinase Inhibitor α-1 Antitrypsin Regulates Neutrophil Degranulation and Autoimmunity. Science Translational Medicine. 2014;6(217):217ra1 McInnes IB, Schett G. Cytokines in the pathogenesis of rheumatoid arthritis. Nature Reviews Immunology. 2007;7(6):429-42. Cox DW, Huber O. Association of severe rheumatoid arthritis with heterozygosity for alpha 1-antitrypsin deficiency. Clin Genet. 1980;17(2):153-60. Cox DW, Huber O. Rheumatoid arthritis and alpha-1-antitrypsin. Lancet. 1976;1(7971):1216 <h3>Disclosure of Interest</h3> None declared
SP0120 Cyprus National Committee for Rheumatologist Diseases: Rheumatology Training for General Practice Doctors GPS
Authors: S. Kioupi
Journal: Annals of the Rheumatic Diseases (2015)

Cyprus is under an Economic adjustment program. The Memorandum of Understanding (MOU) between Cyprus and Troika includes a number of reform measures, including structural and cost containing measures. The main reforms relate to the implementation of the NHS, as well as reforms relating to public hospitals and other health facilities. According to existing timeframes, the new National Health System (NHS) is expected to be fully in place by mid-2016, whereas various policy and implementation issues continue to be under careful study and investigation by the Ministry of Health. The needs of general practice doctors on rheumatologic education must be considered from within the context of their working environment. The population has free choice to visit either any specialist or a general practitioner. But still the GPs are usually the first port of call for most patients with symptoms of illness. Whereas the patients have free access to a general practitioner may present with illnesses which cross the boundaries of specialties such as rheumatology or orthopedic or with symptoms of problems that are best located within other health professionals (psychologist, physiotherapist etc). Consequently, there is a different set of priorities for investigation and management within general practice, which includes the early detection of the problem and the early reference to the suitable specialist. The Cyprus National Committee for Rheumatologist Diseases, having in mind the new conditions regarding the reform measures of the health system in Cyprus and the role of GPs in the environment of NHS took the initiative to prepare the general practitioner doctors in order to recognize the symptoms, to determine the diagnosis and to intervene in time for the best management and treatment of their patients. The Training courses include case studies, lectures and workshops. The main scope is GPs doctors come into contact and become familiar with the disease and promptly recognise the symptoms. <h3>Disclosure of Interest</h3> None declared
Inter-pregnancy Weight Change and Risks of Severe Birth-Asphyxia-Related Outcomes in Singleton Infants Born at Term: A Nationwide Swedish Cohort Study
Authors: Martina Persson, Stefan Johansson, Sven Cnattingius
Journal: PLoS Medicine (2016)

Maternal overweight and obesity are associated with increased risks of birth-asphyxia-related outcomes, but the mechanisms are unclear. If a change of exposure (i.e., maternal body mass index [BMI]) over time influences risks, this would be consistent with a causal relationship between maternal BMI and offspring risks. Our objective was to investigate associations between changes in maternal BMI between consecutive pregnancies and risks of birth-asphyxia-related outcomes in the second offspring born at term.This study was a prospective population-based cohort study that included 526,435 second-born term (≥37 wk) infants of mothers with two consecutive live singleton term births in Sweden between January 1992 and December 2012. We estimated associations between the difference in maternal BMI between the first and second pregnancy and risks of low Apgar score (0-6) at 5 min, neonatal seizures, and meconium aspiration in the second-born offspring. Odds ratios (ORs) were adjusted for BMI at first pregnancy, maternal height, maternal age at second delivery, smoking, education, mother´s country of birth, inter-pregnancy interval, and year of second delivery. Analyses were also stratified by BMI (<25 versus ≥25 kg/m2) in the first pregnancy. Risks of low Apgar score, neonatal seizures, and meconium aspiration increased with inter-pregnancy weight gain. Compared with offspring of mothers with stable weight (BMI change of -1 to <1 kg/m2), the adjusted OR for a low Apgar score in the offspring of mothers with a BMI change of 4 kg/m2 or more was 1.33 (95% CI 1.12-1.58). The corresponding risks for neonatal seizures and meconium aspiration were 1.42 (95% CI 1.00-2.02) and 1.78 (95% CI 1.19-2.68), respectively. The increased risk of neonatal seizures related to weight gain appeared to be restricted to mothers with BMI < 25 kg/m2 in the first pregnancy. A study limitation was the lack of data on the effects of obstetric interventions and neonatal resuscitation efforts.Risks of birth-asphyxia-related outcomes increased with maternal weight gain between pregnancies. Preventing weight gain before and in between pregnancies may improve neonatal health.
Delayed Targeting of Cytokine-Nonresponsive Human Bone Marrow CD34+ Cells With Retrovirus-Mediated Gene Transfer Enhances Transduction Efficiency and Long-Term Expression of Transduced Genes
Authors: Ponnazhagan Veena, Christie M. Traycoff, David A. Williams, Jon McMahel, Susan Rice, Ken Cornetta, Edward F. Srour
Journal: Blood (1998)
A Fatally Flawed Trial
Authors: Vance W. Berger
Journal: Annals of Internal Medicine (2009)

Editor: When the camera is sufficiently out of focus so as to preclude the possibility of identifying what or who is in the photo, one can imagine that there would be no shortage of expert consultants who, for a fee, will help you figure it out. After all, since you do not know what is really there, you can never prove them wrong. Likewise, when a clinical trial makes one methodological error after another, it is fun to pretend that we can still use it to draw conclusions. But are these conclusions justified? Are obese patients really to trust the results of a trial [1] that randomized inappropriately, allowed the study cohort to be decimated by drop outs, did not account for these myriad numbers of drop outs in the “modified” intent to treat analysis, and based the analysis on distributional and other assumptions that could not possibly be true? If you will pardon the pun, this is just a bit hard to swallow.

In an unmasked trial, such as this one, the worst form of randomization is permuted blocks, especially with a small, fixed block size [2], [3], such as the fixed block size of five that was used in this trial. With five treatments, this means that each block allocated each treatment only once; hence, five is the smallest possible block size, and leads to the most prediction of future allocations. Allocation concealment then becomes impossible. Notice the maldistribution of race among the treatment groups. A more appropriate method of randomization, perhaps the maximal procedure [2], [3], should have been used instead of permuted blocks.

The large numbers of drop outs may have been unavoidable, but failure to include them in the analysis is inexcusable. We all know the merits of the intent to treat approach, and the rationale for using it. There is a flip side to this; if using a method (such as intent to treat) is good, then surely not using it must be bad. That corollary certainly applies in this case, as the exclusion of randomized patients opens the analysis to all kinds of biases. This is especially true when the drop outs are large in number and uneven across treatment groups, as they are here. Moreover, the primary analysis was a repeated measures linear model which piles assumption upon assumption, not the least of which is normality. When the analysis drowns out the data, rather than reflecting the data, it cannot be taken seriously.

The flawed randomization (permuted blocks with a small fixed block size in an unmasked trial), the large and uneven number of drop outs, the failure to include all randomized patients in the analysis, and the use of an overly optimistic analysis that in no way reflects the limitations of the data as collected all conspire to cast intense doubt on all conclusions deriving from this study. About all that can be concluded with certainty is that we need better studies.
But are they cases? Validity of DSM-III major depression in children identified in a family study
Authors: W R Beardslee, G L Klerman, M B Keller, P W Lavori, D L Podorefsky
Journal: American Journal of Psychiatry (1985)

The authors examine the validity of the diagnosis of major depression in nine children and adolescents assessed as part of a study of offspring of parents who had affective disorders. The authors conclude that these nine children were suffering from valid cases of affective disorder because disruptions in multiple domains of functioning accompanied the major depression. The seriousness of the impairment and the finding that few of these children received any treatment at all strongly suggest the need for a heightened awareness among clinicians about the seriousness of depression in children whose parents have affective disorders.
Tumor Genomic Profiling of Nsclc From the Phase III Trial of First-Line S-1/Cbdca Versus Paclitaxel/Cbdca (Wjog6611Ltr)
Authors: Hiroyasu Kaneda, Isamu Okamoto, Kazuko Sakai, Satoshi Morita, Koichi Takayama, Keisuke Tomii, Tadashi Maeda, Kazuhiko Nakagawa, Yoichi Nakanishi, Kazuto Nishio
Journal: Annals of Oncology (2014)