tbuckley/cabot-search huggingface dataset:
Assessing Exposure to Household Air Pollution: A Systematic Review and Pooled Analysis of Carbon Monoxide as a Surrogate Measure of Particulate Matter
Authors: Ellison Carter, Christina Norris, Kathie L. Dionisio, Kalpana Balakrishnan, William Checkley, Maggie L. Clark, Santu Ghosh, Darby W. Jack, Patrick L. Kinney, Julian D. Marshall, Luke P. Naeher, Jennifer L. Peel, Sankar Sambandam, James J. Schauer, Kirk R. Smith, Blair J. Wylie, Jill Baumgartner
Journal: Environmental Health Perspectives (2017)

Background: Household air pollution from solid fuel burning is a leading contributor to disease burden globally. Fine particulate matter (PM2.5) is thought to be responsible for many of these health impacts. A co-pollutant, carbon monoxide (CO) has been widely used as a surrogate measure of PM2.5 in studies of household air pollution. Objective: The goal was to evaluate the validity of exposure to CO as a surrogate of exposure to PM2.5 in studies of household air pollution and the consistency of the PM2.5–CO relationship across different study settings and conditions. Methods: We conducted a systematic review of studies with exposure and/or cooking area PM2.5 and CO measurements and assembled 2,048 PM2.5 and CO measurements from a subset of studies (18 cooking area studies and 9 personal exposure studies) retained in the systematic review. We conducted pooled multivariate analyses of PM2.5–CO associations, evaluating fuels, urbanicity, season, study, and CO methods as covariates and effect modifiers. Results: We retained 61 of 70 studies for review, representing 27 countries. Reported PM2.5–CO correlations (r) were lower for personal exposure (range: 0.22–0.97; median=0.57) than for cooking areas (range: 0.10–0.96; median=0.71). In the pooled analyses of personal exposure and cooking area concentrations, the variation in ln(CO) explained 13% and 48% of the variation in ln(PM2.5), respectively. Conclusions: Our results suggest that exposure to CO is not a consistently valid surrogate measure of exposure to PM2.5. Studies measuring CO exposure as a surrogate measure of PM exposure should conduct local validation studies for different stove/fuel types and seasons. https://doi.org/10.1289/EHP767
Nonoperative Treatment of Appendicitis
Authors: Peter C. Minneci, Katherine J. Deans
Journal: JAMA Pediatrics (2017)

To the Editor We appreciate the meta-analysis1 and Editorial2 evaluating nonoperative treatment of uncomplicated appendicitis in children in this issue of JAMA Pediatrics. However, we propose an alternative interpretation of the evidence and future direction of this work.1,2
FRI0551 Use of glucocorticoid is the risk factor for inadequate response to the treatment of osteoporosis by denosumab
Authors: K Orita, T Koike
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> In treating rheumatoid arthritis (RA), T2T (treat-to-Target) is the most reliable treatment strategy. Recent reports have indicated that reaching normal levels of bone mineral density (BMD) might be important for the prevention of fractures in osteoporosis treatment (reference 1 and 2).From this fact, there might be a possibility that T2T targeting BMD might be feasible also in osteoporosis treatment. In doing so, medicines with the ability to sufficiently increase BMD at a fast speed should be needed. Denosumab (DMAb) specifically inhibits the receptor activator for nuclear factor-kappa B ligand (RANKL) improves BMD rapidly at lumbar or hip. Therefore, DMAb is one of candidate drugs for T2T practice, and it is very important to know risk factors that attenuate its effect in the treatment of osteoporosis. <h3>Objectives</h3> The aim of this study was to identify risk factors for inadequate response to the treatment of osteoporosis by DMAb. <h3>Methods</h3> Sixty-six patients treated with DMAb were observed retrospectively for one year. The mean age was 74 years, women were 91% and 36 patients with RA were included.We measured BMDs at lumbar and hip by dual-energy X-ray absorptiometry (Hologic Discovery) at baseline and one year later. We evaluated the effects of age, body mass index (BMI), use of glucocorticoide (GC), previous treatment for osteoporosis, BMD at baseline, bone metabolic markers (BAP; bone alkaline phosphatase, uNTx; urinary N-telopeptide), serum Ca and P levels and the previous vertebral fractures for inadequate response to DMAb.We defined the cases who could not gain the increase of BMD over 2% at the lumbar vertebrae and 4% at the hip as inadequate responders by taking the measurement error into account. <h3>Results</h3> Dose of PSL was significantly high in non-responder at non-RA trochanter and RA lumbar BMD (p=0.028, 0.006). BAP was higher in non-responder at RA lumbar BMD (p=0.007). Urinary NTX was significantly low in non-responder at non-RA lumbar and RA trochanter BMD (p=0.026, 0.048). Previous treatment for osteoporosis was significantly high in non-responder at non-RA lumbar, total hip and trochanter BMD (p=0.026, 0.022, 0.003).Multivariate logistic analysis including age, BMI, dose of PSL, BMD at baseline, BAP, uNTX, Ca and P level as confounders revealed that dose of PSL was the significant risk factors for no-response at lumbar BMD (OR0.634, 95% CI 0.433–0.93, p=0.02). <h3>Conclusions</h3> Patients receiving GC might not gain an adequate response to the treatment by DMAb for osteoporosis. Reducing dose of GC or altanative treatment regimen might be necessary. <h3>References</h3> Kuroda T. et al. J Clin Densitom 15: 392–8, 2012. Bauer D.C. et al. JAMA 174: 1126–34, 2014. <h3>Disclosure of Interest</h3> None declared
PARE0011 Ask the users - establishing a digital user panel
Authors: CR Ziegler
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> A high level of user involvement is one way of assuring campaigns to be relevant to people with RMD9s. This is true for all projects within the PARE organisations. The Danish Rheumatism Association would like to strengthen our political campaigning and we found this goal could be reached by establishing a representative digital user panel. A representative digital user panel would give us quicker, more relevant and high quality information about the opinion of the users and their experience within many different aspects of living with RMD9s in Denmark. <h3>Objectives</h3> The Danish Rheumatism Association wanted to strengthen the impact of our political campaigning. We wanted to establish a representative user panel consisting of 1500 Danes with RMD9s. A digital user panel was found to be a quick and efficient tool to secure real life experiences and knowledge from the users. The user panel would make us interact with our users in even better ways and through that we were able to strengthen our political campaigning. <h3>Methods</h3> In 2016 we tried to recruit participants among our members to assure that the panel was representative, but that was more difficult than we expected and we had to use other channels to recruit too. We wanted to ask the user panel about different themes 6–8 times each year. We investigated the collected data and used them directly in our political campaigning and communicative work – without the time waster of making fancy reports. <h3>Results</h3> It turned out to be more difficult to establish a representative user panel than we thought. The barriers were various, but we succeeded in the end. The knowledge gained from the user panel has focused and strengthened our political work. This obtained influence would have been very difficult or even impossible to achieve without the experiences of the users. In our presentation we will go into details about the barriers of the establishing phase, share how we use the panel, give examples of how the answers are an added value and show how it helped us gain more political impact. <h3>Conclusions</h3> After overcoming several barriers it will possible to establish a digital user panel which can help organisations to improve their political campaigning. <h3>Disclosure of Interest</h3> None declared
Abstract 13163: End of Life in Adults With Congenital Heart Disease: A Call for Communication
Authors: Matthias Greutmann, Daniel Tobler, Mehtap Greutmann-Yantiri, Larry Librach, Jack M Colman, Adrienne H Kovacs
Journal: Circulation (2010)

Introduction: Many adults with congenital heart disease (CHD) die prematurely, but data regarding desire for and occurrence of end of life (EOL) communication are lacking. This is the first study to investigate the perspectives of patients and of health care providers (HCPs) regarding EOL communication with adults with CHD. Methods: Adult CHD outpatients completed a survey that assessed their preferences for and experience of EOL communication. Background medical information was obtained from chart review. In addition, all HCPs within a national adult CHD network were invited to complete a parallel online survey. Responses were compared between the groups. Results: Two-hundred patients (52% male, 35±15 years) and 48 HCPs (primarily cardiologists) completed surveys. Only 2 patients (1.0 %) indicated that they had discussed EOL planning with their medical team. In contrast, 50% of HCPs reported that they typically discuss issues including life expectancy, advance planning, and resuscitation preferences with...
Therapeutic Drug Monitoring of Carboplatin in High-Dose Protocol (TI-CE) for Advanced Germ Cell Tumors: Pharmacokinetic Results of a Phase II Multicenter Study
Authors: Sotheara Moeung, Christine Chevreau, Sophie Broutin, Jérôme Guitton, Bénédicte Lelièvre, Joseph Ciccolini, Christophe Massart, Aude Fléchon, Rémy Delva, Gwenaëlle Gravis, Jean-Pierre Lotz, Jacques-Olivier Bay, Marine Gross-Goupil, Angelo Paci, Sabrina Marsili, Laurence Malard, Etienne Chatelut, Fabienne Thomas
Journal: Clinical Cancer Research (2017)

Purpose: We aimed to evaluate the performance of therapeutic drug monitoring (TDM) approach in controlling interpatient variability of carboplatin exposure (AUC) in patients treated with TI-CE high-dose chemotherapy for advanced germ cell tumors and to assess the possibility of using a formula-based dosing method as a possible alternative.Experimental Design: Eighty-nine patients receiving carboplatin for 3 consecutive days during 3 cycles were evaluable for pharmacokinetic study. Blood samples were taken on day 1 to determine the carboplatin clearance using a Bayesian approach (NONMEM 7.2) and to adjust the dose on day 3 to reach the target AUC of 24 mg.min/mL over 3 days. On days 2 and 3, samples were taken for retrospective assessment of the actual AUC. A population pharmacokinetic analysis was also performed on 58 patients using NONMEM to develop a covariate equation for carboplatin clearance prediction adapted for future TI-CE patients, and its performance was prospectively evaluated on the other 29 patients along with different methods of carboplatin clearance prediction.Results: The mean actual AUC was 24.4 mg.min/mL per cycle (22.4 and 26.8 for 10th and 90th percentiles, respectively). The new covariate equation [CL (mL/min) = 130.7 × (Scr/83)-0.826 × (BW/76)+0.907 × (Age/36)-0.223 with Scr in μmol/L, BW in kilograms, age in years] allows unbiased and more accurate prediction of carboplatin clearance compared with other equations.Conclusions: TDM allows controlling and reaching the target AUC. Alternatively, the new equation of carboplatin clearance prediction, better adapted to these young male patients, could be used if TDM cannot be implemented. Clin Cancer Res; 23(23); 7171-9. ©2017 AACR.
Opioid prescriptions in England doubled over 12 years, study shows
Authors: Deborah Cohen
Journal: BMJ (2017)

The proportion of general practice patients in England given prescriptions of opioids and “Z drugs”—non-benzodiazepines such as zopiclone and zolpidem—doubled between 2000 and 2012, a new study has shown.1

Researchers from the Public Health Research Consortium, which is based at the London School of Hygiene and Tropical Medicine, analysed a random sample of 49 999 patients who between 2000 and 2015 were prescribed any dependence forming medicine: benzodiazepines, Z drugs, opioids, or “GABAergic” drugs (those producing an effect by interacting with the γ-amino-butyric acid receptor system). The sample was taken from the Clinical Practice Research Datalink (CPRD), a primary care database of anonymised medical records.

Excluding patients with diagnoses of cancer and epilepsy, the study found that the proportion of patients given prescriptions of dependence forming drugs increased from 6.3% of all patients …
AB1022 The recall survey: the relationship between ultrasound synovitis and bone erosion in patients with rheumatoid arthritis
Authors: E Filippucci, C Bonali, P Macchioni, A Iagnocco, A Delle Sedie, S Tropea, O Epis, M Canzoni
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Ultrasound (US) has shown to be a sensitive imaging tool for the detection of subclinical signs of synovitis in patients (pts) with rheumatoid arthritis (RA); further studies are still required to delineate the impact of US findings in the management of RA pts in daily clinical practice. <h3>Objectives</h3> To investigate the relationship between US findings indicative of joint inflammation and US bone erosions at joint level in pts with RA. <h3>Methods</h3> In 2015 an educational event focused on the added value of US in RA pts was held in 22 rheumatology centers in Italy. In every center, the local rheumatologists provided RA pts to be examined by US. Pts signed an informed consent and a brief history of them was collected by the local rheumatologists (previous and current therapy, DAS28, HAQ score). Bilateral US examinations of wrists, metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints were performed by rheumatologists expert in US, to assess synovitis (joint effusion, synovial proliferation, and power Doppler (PD) signal), and bone erosions, using a Logiq E R7, General Electrics, with a 4.2–13 MHz linear probe. All US findings were scored using a 4 degree semiquantitative scoring system. <h3>Results</h3> In 465 RA pts, a total of 10.230 joints were scanned. Of these joints, 3.969 (39%) showed joint effusion and/or synovial proliferation and 1.784 (17%) were found positive for PD signal. The most frequently involved joints were the wrists followed by the second MCP joints and first MTP joints. In 749 joints US detected at least one bone erosion. The most frequently eroded joints were the wrists, the second and fifth MCP joints and the first and fifth MTP joints. A total of 226 RA pts showed at least one bone erosions and in 181 (80%) of these pts the eroded joints were found positive for PD signal. <h3>Conclusions</h3> A high prevalence of PD signal was found in the joints found eroded by US. This is the first study providing such an evidence using a portable US equipment. <h3>Disclosure of Interest</h3> None declared
AB0846 Osteoporosis and atherosclerosis - alternative or coexistence
Authors: L Lagvilava
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> The majority of scientific research data promote the idea that OP and Atherosclerosis are inter-connected via OPG system. Scientists have speculation that OPG is the molecular bond between artery hardening and bone resorbtion. Thus the mechanism explained above makes obvious the co-existence of two: Artery hardening and Osteoporosis. <h3>Objectives</h3> There are number of ongoing Clinical trials on Denosumab therapy in patients with diagnosis of Osteoporosis and Atherosclerosis. The increase of Bone mineral density is associated with less intensive hardening of arteries. This fact inspired us to study bone mass in patients with cardiovascular events and atherosclerosis. <h3>Methods</h3> 1675 men, age range 38–78 years, mean age 59±4.3 Disease duration 6,4±1,75 with the diagnosis of Atherosclerosis (revealed on coronarography, assessed lipid profile).At the moment of research Stabile Angina Pectoris (Stable Angina) found in 20% (335); unstable angina non S-T elevation in 48% (804); - Myocardial Infarction 32% (536) Bone Mass was assessed by DXA Absorbtiometry technique (Hologic 1000) using T and Z Scores (WHO 1994). As a control group 680 healthy Georgian men 40–70 age range were assessed. <h3>Results</h3> Men having atherosclerosis are rather predisposed to Osteoporosis than health individuals.In Atherosclerosis subgroup normal bone mass was measured in 23% (385.25 patients) of patients; Osteopenia was diagnosed in 19% (315.25 patients), Osteoporosis was detected in 58% (971.5%) according to T-Score SD BMD records are shown in table 1. <h3>Conclusions</h3> 1.According to our research more than 50% of men with verified Atherosclerosis are diagnosed to have Osteoporosis 2.The lowest BMD values were observed in Lumbar Spine L1-L4, indicating that trabecular bone is more deteriorated than cortical 3.Correlation between T Score values and clinical forms of Atherosclerosis were not observed 4. The best understanding of interrelations of mechanisms could point out the right direction for the simultaneous therapy against both targets – Osteoporosis and Atherosclerosis 5. Therefore the expectation of establishing novelty direction among other subtypes of the Medical Specialties as a Preventive Gerontology can be realistic <h3>Disclosure of Interest</h3> None declared
SAT0296 Relationship between disease activity index scores and subjective assessments in early systemic lupus erythematosus
Authors: M Garabajiu, V Sadovici-Bobeica, L Mazur-Nicorici, M Cebanu, V Salaru, M Mazur
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Objectives</h3> To evaluate the disease activity in patients with early systemic lupus erythematosus (early SLE) and to compare it to patient9s and physician9s global assessment. <h3>Methods</h3> Cross-sectional study including 41 early SLE patients that fulfilled SLICC classification criteria, 2012. The early disease was defined one with the duration 2 years from the diagnosis. The disease activity was assessed by SLEDAI-2K and SLAM. Global indices were appreciated by patient and physician global assessments (PGA and MDGA), rated by 0–100 numeric score. We correlated disease activity indices with global assessments by Pearson coefficient. <h3>Results</h3> There were 41 SLE patients integrated in the study, female:male ratio 9,25:1, mean age (SD) 39 (12.35) years (range 20–67 years), disease duration (SD) was 9.92 (9.18) month (range 1–24). The mean disease activity by SLEDAI was 11.2±7.84 (range 2–34) and SLAM – 8.83±4.41 (range 3–22) points, both indices denoted high disease activity level. Mean PGA values were 48.93 (19.13) (range 10–80), and mean MDGA values 45 (19.04) (range 10–80). Also, PGA and MDGA didn9t correlate with SLEDAI (r=0,25, p&gt;0,05; r=0,27, p&gt;0,05), while a statistically significant correlation was determined with SLAM index (r=0,85, p&lt;0.001; r=0,46, p=0.002). A subclass analysis of SLAM components showed that cortical dysfunction (depression, psychosis) and the presence of headache correlated with PGA (r=0,36, p&lt;0,05; r=0,4, p&lt;0,05), so we can establish that the difference in correlation between SLAM and SLEDAI with PGA and MDGA is explained by a more accurate disease assessment by SLAM, including also subjective complaints that influences the global patient9s status. <h3>Conclusions</h3> The use of SLAM for disease activity assessment in early SLE patients is more sensible than SLEDAI and its results correlates with PGA and MDGA. <h3>Disclosure of Interest</h3> None declared
Outcomes of occult primary (OP) of the head and neck squamous cell carcinoma (HNSCC) treated with oropharynx (OPX)-targeted radiotherapy (RT) and concurrent chemotherapy (CCRT).
Authors: Kenneth Hu, Louis Benjamin Harrison, Rania Ayman Shourbaji, Bruce Culliney, Zujun Li, Waleed Fouad Mourad
Journal: Journal of Clinical Oncology (2012)

5559 Background: OP of HNSCC is commonly treated with comprehensive mucosal RT including nasopharynx, OPX, hypopharynx and larynx and bilateral neck. We are reporting the long term outcomes of a conservative mucosal sparing technique consisting of targeting only the OPX mucosa and bilateral necks. Methods: This is a single-institution retrospective study. From January 1998-2010, a total of 68 patients with OP of HNSCC were treated with CCRT (90%) or RT alone (10%), 40% with IMRT. RT fields comprehended OPX mucosa only and bilateral necks. Gross disease in the neck received 70Gy, involved neck 63 Gy, OPX 60 Gy, uninvolved neck and ipsilateral retropharyngeal nodes 54 Gy. All fractions were given at the rate of 1.8-2 Gy/fraction. The median age was 58 (21-87), 80% Caucasian, and 75% males. Stage IVa (N2) was 75% of the population, while stages III (N1), and IVb (N3) were 9, and 16% respectively. 16 patients (9N3+7 bulky N2) underwent neck dissection (ND). The median time interval from diagnosis to RT and RT duration were 60 (13-70) and 50 days (49-63) respectively. The Median number of Chemotherapy cycles was 2 (1-3). Cisplatin was given to 70% of pts, while Carboplatin and Cetuximab were 10 and 20% respectively. Results: With a median follow-up of 5.3 years (1– 13.6), the loco-regional control, (LRC) for all stages is 95.6 %. The median time to LRF is 18 months (12 - 63). Chronic CCRT toxicity was; grade (1) xerostomia (67%), dysphagia (35%), altered taste (28%), neck stiffness (15%), skin toxicity (12%), dysphonia (9%), and trismus (6%). One HIV patient developed grade 4 dysphagia. No patients experienced distant metastases. The emergence of primary was (1.5%) 1 patient developed subglottic SCC 2 years after CCRT, 2 patients failed in the neck (originally N3) all the 3 patients were salvaged successfully by surgery. Kaplan-Meier curve shows the 5-year cause-specific survival to be 100. Conclusions: Our data show that CCRT or definitive RT alone to the OPX and bilateral neck provides excellent oncologic and functional outcomes. Sparing the mucosal surfaces of the nasopharynx, hypopharynx, and larynx seems reasonable and likely reduces toxicity.
J Curve in Patients Randomly Assigned to Different Systolic Blood Pressure Targets
Authors: Deborah N. Kalkman, Tom F. Brouwer, Jim T. Vehmeijer, Wouter R. Berger, Reinoud E. Knops, Robbert J. de Winter, Ron J. Peters, Bert-Jan H. van den Born
Journal: Circulation (2017)

Background: Low systolic blood pressure (SBP) values are associated with an increased risk of cardiovascular events, giving rise to the so-called J-curve phenomenon. We assessed the association between on-treatment SBP levels, cardiovascular events, and all-cause mortality in patients randomized to different SBP targets. Methods: Data from 2 large randomized trials that randomly allocated hypertensive patients at high risk for cardiovascular disease to intensive (SBP&lt;120 mm Hg) or conventional (SBP&lt;140 mm Hg) treatment were pooled and harmonized for outcomes and follow-up duration. Using natural cubic splines, we plotted the hazard ratio for all-cause mortality and cardiovascular events against the mean on-treatment SBP per treatment group. Results: The pooled data consisted of 194 875 on-treatment SBP measurements in 13 946 patients (98.9%). During a median follow-up of 3.3 years, cardiovascular events occurred in 1014 patients (7.3%), and 502 patients died (3.7%). For both blood pressure targets, an identical shape of the J curve was present, with a nadir for cardiovascular events and all-cause mortality just below the SBP target. Patients in the lowest SBP stratum were older, had a higher body mass index, smoked more often, and had a higher frequency of diabetes mellitus and cardiovascular events. Conclusions: Low on-treatment SBP levels are associated with increased cardiovascular events and all-cause mortality. This association is independent of the attained blood pressure level because the J curve aligns with the SBP target. Our results suggest that the benefit or risk associated with intensive blood pressure–lowering treatment can be established only via randomized clinical trials. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01206062 and NCT00000620.