tbuckley/cabot-search huggingface dataset:
Visa cap: Reactions to government’s announcement
Authors: Gareth Iacobucci
Journal: BMJ (2018)

After a campaign by The BMJ (bmj.com/scrap-the-cap), on Thursday 14 June the Home Office announced that it would remove restrictions on the number of tier 2 visas available to doctors and nurses from outside the European Economic Area who are offered jobs in the NHS.1 Delegates at this week’s conference of the NHS Confederation in Manchester gave their responses.

“We absolutely welcome this. Since December, 18 doctors have been appointed from outside the EU but had their certificates of sponsorship refused. In March all of the trust’s applications were turned down. Not only was this …
Abstract 13999: Elevated Asleep Blood Pressure is Associated With All-cause and Cardiovascular Mortality in Heart Failure With Preserved Left Ventricular Ejection Fraction (HFpEF) -From Nara-HF Study
Authors: Tomoya Ueda, Yasuki Nakada, Hiroyuki Kawata, Rika Kawakami, Hiroyuki Okura, Yoshihiko Saito
Journal: Circulation (2016)

Introduction: Abnormal circadian blood pressure (BP) rhythms are one of the risks of cardiovascular diseases and death. However, circadian BP rhythms in heart failure (HF) patients are unclear. Therefore, we examined the relationship between circadian BP rhythms for survival in HF patient. Moreover, we valued the difference of circadian BP rhythms between HF with preserved left ventricular ejection fraction (HFpEF) and HF with reduced left ventricular ejection fraction (HFrEF). Methods: Of 810 consecutive patients with acute decompensated HF emergently admitted to our hospital, we studied 228 HF patients performed ambulatory blood pressure monitoring (ABPM) at discharge. We examined the relationship between circadian BP rhythms and survival in HFpEF and HFrEF. Kaplan-Meier survival analysis and Cox proportional hazard model were performed to assess outcomes. Results: During a mean follow-up of 27.9 months, there were 80 deaths from all causes, including 36 deaths from cardiovascular causes. The pattern of circadian BP rhythms was similar between HFpEF and HFrEF. In HFpEF patients, Kaplan-Meier analysis showed that all-cause and cardiovascular death were significantly higher in patients with the pattern of elevated asleep BP (EABP), in which sleep BP exceeded awake BP (log-rank P=0.0298 and P=0.0195, respectively). In a multivariate analysis, EABP pattern was an independent predictor for all-cause and cardiovascular death (HR 2.57; 95% CI 1.09-6.13; P=0.0310 and HR 10.66; 95% CI 1.91-93.9; P=0.0063, respectively) after adjusted by age, hemoglobin and brain natriuretic peptide. However, these findings were not observed in HFrEF. Conclusions: EABP pattern was associated with increasing risk for adverse outcome in HFpEF patients, but not in HFrEF patients. Although further studies are necessary to elucidate the mechanism, we should pay attention to EABP pattern in HFpEF.
SAT0667 Implementation and role of modern musculoskeletal imaging in rheumatological practice in europe
Authors: P. Mandl, A. Ciechomska, X. Baraliakos, P.G. Conaghan, M.-A. D’Agostino, A. Iagnocco, C.J. van der Laken, M. Ostergaard, L. Terslev, E. Naredo
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Modern non-X-ray imaging methods are increasingly utilised by rheumatologists though the uptake and use of these techniques has developed very differently across Europe and there is limited data on their present impact in rheumatology for individual countries. <h3>Objectives</h3> To document the current implementation, role and training in modern musculoskeletal imaging techniques: musculoskeletal ultrasound (MSUS), magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) among rheumatologists in the member countries of the European League Against Rheumatism (EULAR). <h3>Methods</h3> A EULAR Taskforce comprised of 9 rheumatologist experts in imaging developed English-language questionnaires for each imaging modality (CT, MRI, MSUS, PET) which were sent out to: national rheumatology societies of EULAR, national societies of the European Federation of Societies for Ultrasound in Medicine and Biology, the European Society for Magnetic Resonance Ultrasound in Medicine and Biology, as well as identified experts in the given modalities involved in research and/or training. The surveys were distributed via an online survey tool (Surveymonkey). Simple descriptive and summary statistics were calculated from the responses. <h3>Results</h3> A total of 205 out of 395 experts replied to the surveys. More than 90% of MSUS experts had an MSUS unit in their department. The majority of responders reported having easy access to MRI, CT or PET (56%, 78% and 50% respectively). Suspicion of rheumatoid arthritis and peripheral spondyloarthrity were the main clinical indications for performing MSUS for diagnostic purposes. Suspicion of sacroiliitis and degenerative spine disease were the most common indications to perform MRI or CT for diagnostic purposes, while PET was mainly performed to diagnose large vessel vasculitis and investigation of fever of unknown origin. When asked about the percentage of rheumatologists performing MSUS in their country 37% of experts reported less than 20%, 33% reported values between 20%–40% and 24% reported more than 40% (6%: unknown). The overwhelming majority (99%) of experts were certified in MSUS, while only 22% and 26% of experts in MRI and CT were certified in their techniques. Seventy-seven percent of responders reported that their national rheumatology societies organise MSUS courses, while courses in MRI or CT organised by the national rheumatology societies were less commonly reported (38% and 16% respectively). <h3>Conclusions</h3> Rheumatologists in Europe utilise modern imaging techniques, however access among the techniques and training offered is varied. <h3>Disclosure of Interest</h3> None declared
AB1190 Ultrasonography in spainsh rheumatology: a cross sectional survey
Authors: J. Uson, E. Naredo, E. de Miguel, J.L. Andreu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Ultrasonography (US) is the rheumatologísts' best tool that must be taught and learnt correctly. The ultrasound school of the Spanish Society of Rheumatology has trained many rheumatologists for more than twenty years. Approximately 75% of the rheumatology departments in Spain use US. However, we lack current views of features related with competency, teaching rheumatology residents, US usage and implementation. <h3>Methods</h3> A cross sectional survey was performed using an online standardised questionnaire sent to all members of the SSR in January 2017. The questionnaire was developed by the four authors, corrected for size, style, syntaxes and was piloted on four different aged rheumatologists. Six aspects were studied; general data, US training, rheumatology residents training in US and main uses and applications of US. The questionnaire used either closed or Likert scale answers and took about 20 min to answer. Herein we describe the main results on usage and applications of US. <h3>Results</h3> 113 responses: 60% women, 45±12 years old, 73% working in public university hospital with one or more US machines. US is usually used at the time of clinical consultation or at appointment for US. 43% have a specific agenda for US diagnosis and monitoring inflammatory arthritis patients. The 3 principals for using US are: as a problem solving tool in the clinical context; as a diagnostic tool in inflammatory arthritis and; as a tool to guide injections. The table shows the percentage of the responses always and almost always for 10 clinical contexts. As diagnostic tool in rheumatoid arthritis (RA), 66% use US to confirm arthritis when clinical exam is unclear and 33% in patients with inflammatory arthralgia plus high ESR, CRP, RF or anti-CCP. 36% monitor disease activity using a reduced joint assessment; one target joint plus 2,3 MCP and 2,3, 5 MTP joints and 32% use a validated joint count. 66% use US to assess remission in RA all patients (22%), only in those treated with biologic drugs (28%) and in RA patients with poor prognostic factors (18%). Most use US to confirm clinical enthesitis when a spondyloarthropathy (SpA) is suspected and half consider that a positive entheseal Dopppler signal supports more aggressive management. 76% perform real-time guided injections for the following disorders/sites: Baker's cyst, subacromial-subdeltoid bursa, tibionavicular joint, anterior coxofemoral joint, retrocalanceal bursa and extensor wrist tenosinovitis. <h3>Conclusions</h3> Rheumatologist- ultrasonographers in Spain use ultrasonography in a wide spectrum of diseases and clinical contexts mainly to facilitate diagnosis and improve treatment of rheumatic patients. <h3>Disclosure of Interest</h3> None declared
Early Variations in White Matter Microstructure and Depression Outcome in Adolescents With Subthreshold Depression
Authors: Hélène Vulser, Marie-Laure Paillère Martinot, Eric Artiges, Ruben Miranda, Jani Penttilä, Yvonne Grimmer, Betteke M. van Noort, Argyris Stringaris, Maren Struve, Tahmine Fadai, Viola Kappel, Robert Goodman, Eleni Tzavara, Charbel Massaad, Tobias Banaschewski, Gareth J. Barker, Arun L.W. Bokde, Uli Bromberg, Rüdiger Brühl, Christian Büchel, Anna Cattrell, Patricia Conrod, Sylvane Desrivières, Herta Flor, Vincent Frouin, Juergen Gallinat, Hugh Garavan, Penny Gowland, Andreas Heinz, Frauke Nees, Dimitri Papadopoulos-Orfanos, Tomas Paus, Luise Poustka, Sarah Rodehacke, Michael N. Smolka, Henrik Walter, Robert Whelan, Gunter Schumann, Jean-Luc Martinot, Hervé Lemaitre
Journal: American Journal of Psychiatry (2018)

Objective: White matter microstructure alterations have recently been associated with depressive episodes during adolescence, but it is unknown whether they predate depression. The authors investigated whether subthreshold depression in adolescence is associated with white matter microstructure variations and whether they relate to depression outcome. Method: Adolescents with subthreshold depression (N=96) and healthy control subjects (N=336) drawn from a community-based cohort were compared using diffusion tensor imaging and whole brain tract-based spatial statistics (TBSS) at age 14 to assess white matter microstructure. They were followed up at age 16 to assess depression. Probabilistic tractography was used to reconstruct white matter streamlines spreading from the regions identified in the TBSS analysis and along bundles implicated in emotion regulation, the uncinate fasciculus and the cingulum. The authors searched for mediating effects of white matter microstructure on the relationship between baseline subthreshold depression and depression at follow-up, and then explored the specificity of the findings. Results: Lower fractional anisotropy (FA) and higher radial diffusivity were found in the anterior corpus callosum in the adolescents with subthreshold depression. Tractography analysis showed that they also had lower FA in the right cingulum streamlines, along with lower FA and higher mean diffusivity in tracts connecting the corpus callosum to the anterior cingulate cortex. The relation between subthreshold depression at baseline and depression at follow-up was mediated by FA values in the latter tracts, and lower FA values in those tracts distinctively predicted higher individual risk for depression. Conclusions: Early FA variations in tracts projecting from the corpus callosum to the anterior cingulate cortex may denote a higher risk of transition to depression in adolescents.
AB0519 Impact of higher body mass index (BMI) in patients with systemic lupus erythematosus
Authors: I. Saulescu, D. Opris Belinski, A. Borangiu, L. Groseanu, S. Daia-Iliescu, D. Mazilu, M. Negru, V. Stoian, V. Bojinca, A. Balanescu, C. Constantinescu, R. Ionescu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Systemic lupus erythematosus (SLE) patients may have nutritional changes triggered by disease itself or by treatment with possible implication for patients prognosis. <h3>Objectives</h3> The main focus of the study was to evaluate nutritional status and its impact in a SLE cohort with disease duration of at least 1 year. <h3>Methods</h3> 105 SLE patients admitted in Sf. Maria Clinical Hospital in 2017 were enrolled. Inclusion criteria were represented by disease evolution of at least 1 year. All patients agreed to participate in this observational study. Data about demographic, clinical or serological characteristics, but also activity (SLEDAI), damage accrual (SLICC damage index SDI) and treatment or complications (osteoporosis, cataract, glaucoma, etc) were collected. Nutritional status was evaluated by calculating Body Mass Index (BMI) for each patient. A descriptive and analytical statistics was performed with SPSS. <h3>Results</h3> 99 females and 6 males were enrolled. Mean age at SLE diagnosis was 34.39, SD 11.34. BMI was calculated as ratio of body weight to squared height (kg/m2). According to BMI, 5% of patients were underweight (BMI &lt;18.5), 56% had normal weight (BMI 18.5–25), 25% were overweight (BMI 25–30) and 14% were obese (BMI &gt;30). Increased BMI was correlated with longer disease duration (p 0.0001, r 0.30) and older age (p 0.0001, r 0.35), but these correlation loose the strength for patients older than 40 years (p 0.04, r 0.15), suggesting a more pronounced weight gain at the beginning of the disease. Quality of sleep was significant altered in patients with abnormal BMI (p0.005, r 0.35). As expected, overweight and obese patients had a sedentary life style (p&lt;0.01). Higher BMI was correlated also with higher SDI score (p 0.026, r 0.35) and higher number of complications related to chorticotherapy per patient (p 0.0001, r 0.45). <h3>Conclusions</h3> SLE patients have an increased risk for higher BMI, especially patients younger than 40 years, in the first years after diagnosis. Optimising weight in our SLE patients should be in our focus in order to limit number of complications, damage accrual and lifestyle patterns that negatively impact their life. <h3>References</h3> [1] Zhu LW, Zhang T, Pan HF. BMI, disease activity and health-related quality of life in systemic lupus erythematosus. Clin Rheumatol2010;29:1413. [2] Rizk A, Gheita TA, et al. The impact of obesity in SLE on disease parameters, quality of life, functional capacity and the risk of atherosclerosis. Int J Rheum Dis2012;15:261–267. <h3>Disclosure of Interest</h3> None declared
Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function
Authors: Jérémie Jacques, Lauriane Pagnon, Florent Hure, Romain Legros, Sabrina Crepin, Anne-Laure Fauchais, Sylvain Palat, Philippe Ducrotté, Benoit Marin, Sebastien Fontaine, Nour Boubaddi, Marie-Pierre Clement, Denis Sautereau, Veronique Loustaud-Ratti, Guillaume Gourcerol, Jacques Monteil
Journal: Endoscopy (2018)

Abstract Background Gastroparesis is a functional disorder with a variety of symptoms that is characterized by delayed gastric emptying in the absence of mechanical obstruction. A recent series of retrospective studies has demonstrated that peroral endoscopic pyloromyotomy (G-POEM) is a promising endoscopic procedure for treating patients with refractory gastroparesis. The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of G-POEM. Methods 20 patients with refractory gastroparesis (10 diabetic and 10 nondiabetic) were prospectively included in the trial. Patients were treated by G-POEM after evaluation of pyloric function using an endoscopic functional luminal imaging probe. Clinical responses were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using the Patient Assessment of Upper Gastrointestinal Disorders – Quality of Life scale and the Gastrointestinal Quality of Life Index scores. Gastric emptying was measured using 4-hour scintigraphy before G-POEM and at 3 months. Results Feasibility of the procedure was 100 %. Compared with baseline values, G-POEM significantly improved symptoms (GCSI: 1.3 vs. 3.5; P &lt; 0.001), quality of life, and gastric emptying (T½: 100 vs. 345 minutes, P &lt; 0.001; %H2: 56.0 % vs. 81.5 %, P &lt; 0.001; %H4: 15.0 % vs. 57.5 %, P = 0.003) at 3 months. The clinical success of G-POEM using the functional imaging probe inflated to 50 mL had specificity of 100 % and sensitivity of 72.2 % (P = 0.04; 95 % confidence interval 0.51 – 0.94; area under the curve 0.72) at a distensibility threshold of 9.2 mm2/mmHg. Conclusion G-POEM was efficacious and safe for treating refractory gastroparesis, especially in patients with low pyloric distensibility.
To a Patient
Authors: Rosalind D. Kaplan
Journal: Annals of Internal Medicine (2018)

On Being a Doctor19 June 2018To a PatientRosalind D. Kaplan, MDRosalind D. Kaplan, MDThomas Jefferson University, Bala Cynwyd, Pennsylvania (R.D.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-0626 Audio Reading - “To a Patient” Audio. Virginia L. Hood, MD, reads "To a Patient," by R.D. Kaplan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Your e-mail says the pain is even worse, more than you can tolerate. You want me to give you instructions on what to do next. But here's the thing: I have run out of ideas. I have no plans. No new potions or lotions or patches or pills, no magic—I am without my wand. I have come to the end of my repertoire. You know this but ask me anyway, and I know this but still wrack my brain, hoping for an answer to fly out of some forgotten crevice.You have been everywhere, to everyone, to pain management doctors ... Author, Article, and Disclosure InformationAffiliations: Thomas Jefferson University, Bala Cynwyd, Pennsylvania (R.D.K.)Corresponding Author: Rosalind D. Kaplan, MD, Thomas Jefferson University, 211 South 9th Street, Philadelphia, PA 19107; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “To a Patient” Audio. Virginia L. Hood, MD, reads "To a Patient," by R.D. Kaplan. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 19 June 2018Volume 168, Issue 12Page: 890KeywordsBrainMusclesMuscular dystrophiesNervesOpioidsPain managementPatient advocacyPersonality disordersPrimary hypertensionPrimary sclerosing cholangitis ePublished: 19 June 2018 Issue Published: 19 June 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
SAT0507 Implantable loop recorder can screen for incidental significant arrhythmias in scleroderma, with cardiac mri ecv and troponin biomarker, useful for risk stratification
Authors: R. Dumitru, L.-A. Bissell, G. Abignano, B. Erhayiem, G. Fent, H. Donica, A. Burska, F. Del Galdo, J. Greenwood, S. Plein, L. Graham, M.H. Buch
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Cardiac involvement and in particular conduction abnormalities represent a significant cause of morbidity and mortality in patients with systemic sclerosis (SSc). No studies assessed the value of implantable loop recorder (ILR) for early detection of arrhythmias in asymptomatic patients with SSc; or whether cardiac magnetic resonance (CMR) features associate with arrhythmias. <h3>Objectives</h3> To assess the prevalence of conduction abnormalities over a 3 year period using an ILR (REVEAL) and evaluate relationship with disease phenotype, cardiac biomarkers and CMR in SSc patients. <h3>Methods</h3> 20 patients(pts) with ACR/EULAR criteria for SSc, with no history of cardiovascular (CV) disease and ≤1 CV risk factor had 3T CMR with late gadolinium enhancement (LGE) and T1 mapping for ECV quantification. An ILR was then inserted, for 3 years follow-up. ILR data were downloaded every 3 months. Serum cardiac biomarkers were also measured at the initial visit. <h3>Results</h3> 19 pts had available ILR data; 12 (63%) females, median (SD) age 53(,<sup>12</sup> 6 (32%) diffuse SSc(dcSSc), 6 (32%) ACA+, 4 (21%) Scl70+, 8 (42%)history of interstitial lung disease (ILD) and 7 (36%) history of digital ulcers (DU). 14/19 had any ILR abnormalities, 8/14 significant arrhythmias: 1 complete heart block; 2 non-sustained ventricular tachycardia (NSVT), and 5 atrial arrhythmias (1 atrial flutter, 1 AF, 1 SVT, 1 AF and SVT and 1 AF followed by atrial flutter and SVT). Of these 8 pts, 4 had dcSSc, 2 Scl70+, 4 ACA+, 3 with ILD and 3 DU history. All 3 patients with severe arrhythmias (NSVT/CHB) were dcSSc, 2 Scl70+, 2 males. Management comprised 1 permanent pacemaker implantation, 3 antiarrhythmic treatment, 1 anticoagulation.15 pts had CMR. The 8 pts with significant arrhythmia appeared to have higher ECV, LV mass, and LVEF%(table 1). LGE was observed in 1(NSVT), of a total of 5/15 with LGE. HsTnI was considerably higher in those with significant arrhythmias[(mean diff.(95% CI)117 (-10, 245)].NTproBNP [(mean diff.(95% CI) 92 (-30, 214)] also appeared greater in those with significant arrhythmias. There was no difference in CK levels between the two groups. <h3>Conclusions</h3> This pilot study demonstrates the ability of ILR to detect life-threatening arrhythmia in asymptomatic SSc pt. The data suggest CMR ECV(but not LGE) and cardiac biomarkers, in particular hsTnI (indicating subclinical myocardial injury) may be able to identify at risk pts that would benefit from ILR screening. Future studies can inform a risk model, and provide insight into the pathogenesis of SSc associated arrhythmias. <h3>Disclosure of Interest</h3> None declared
CARM1 Is Essential for Myeloid Leukemogenesis but Dispensable for Normal Hematopoiesis
Authors: Sarah M. Greenblatt, Na Man, Pierre-Jacques Hamard, Takashi Asai, Daniel Karl, Concepcion Martinez, Daniel Bilbao, Vasileios Stathias, Anna M. Jermakowicz, Stephanie Duffort, Madhavi Tadi, Ezra Blumenthal, Samantha Newman, Ly Vu, Ye Xu, Fan Liu, Stephan C. Schurer, Michael T. McCabe, Ryan G. Kruger, Mingjiang Xu, Feng-Chun Yang, Daniel G. Tenen, Justin Watts, Francisco Vega, Stephen D. Nimer
Journal: Cancer Cell (2018)
Safety, pharmacokinetics, and immunogenicity of a co-formulated cocktail of three human monoclonal antibodies targeting Ebola virus glycoprotein in healthy adults: a randomised, first-in-human phase 1 study
Authors: Sumathi Sivapalasingam, Mohamed Kamal, Rabih Slim, Romana Hosain, Weiping Shao, Randall Stoltz, Joseph Yen, Laura G Pologe, Yuan Cao, Michael Partridge, Giane Sumner, Leah Lipsich
Journal: The Lancet Infectious Diseases (2018)