tbuckley/cabot-search huggingface dataset:
THU0560 Development of symptoms in very early phase in patient with adult onset still disease
Authors: H Tamai, Y Kaneko, N Nishina, J Kikuchi, T Takeuchi
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Adult onset Still Disease (AOSD) is a systemic inflammatory disease presenting various non-specific symptoms like fever, arthralgia and pharyngalgia. Those symptoms are mimicking common cold, which could lead to the delayed diagnosis. However, little is known about the profiles and development of symptoms in very early phase before diagnosis. <h3>Objectives</h3> To clarify the clinical course of AOSD symptom development in very early phase and its effect on the diagnosis delay. <h3>Methods</h3> Consecutive patients with AOSD with enough information in our hospital were enrolled. Initial symptoms before and at diagnosis were investigated in detail. The gradual course from the initial symptoms to the fulfilment of Yamaguchi criteria for AOSD was examined. <h3>Results</h3> A total of 51 patients were enrolled. The mean age at diagnosis was 45.0±18.9 years old and 41 (80%) were female. All patients were met with the Yamaguchi criteria. The mean duration from the first symptom to diagnosis was 50.4 days. The duration from the first symptom to the first visit to the medical facility including a general physician was 19.1 days, and that from the first medical facility visit to the first blood test was 8.0 days. While the first symptom was arthralgia in 29 (34.1%), fever in 20 (23.5%), and eruption in 20 (23.5%), pharyngalgia in 13 (15.3%), at diagnosis, fever was found in all patients, eruption in 47 (92.2%), arthralgia in 45 (88.2%), pharyngalgia in 34 (66.7%), lymphadenopathy and/or splenomegaly in 35 (68.6%), increased white blood cell (WBC) count in 44 (86.3%), ferritin elevation in 42 (82.4%), liver enzyme elevation in 41 (80.4%), negative rheumatoid factor (RF) and anti-nucleolar antibody (ANA) in 30 (58.8%). Arthralgia developed 41.9 days prior to the diagnosis, fever 40.9 days, eruption 29.5 days, pharyngalgia 24.5 days and lymphadenopathy and/or splenomegaly 14.8 days. WBC increase was detected 17.8 days prior to the diagnosis, negative RF and ANA 15.1 days, liver enzyme elevation 14.6 days, and ferritin elevation 10.9 days. At 14 days from the first symptom, 32 (62.7%) met 3 of Yamaguchi criteria, 23 (45.1%) met 4, and 19 (37.3%) met 5. At 28 days, 40 (78.4%) met 3 of Yamaguchi criteria, 32 (62.7%) met 4, and 27 (52.9%) met 5. The duration to diagnosis was significantly shorter in the patients with eruption developing within 7 days since the first symptoms than those without (35.2 vs 74.3 days, p=0.03) <h3>Conclusions</h3> The mean duration from the first symptom to the diagnosis of AOSD was approximately 50 days, and only a half of the patients met Yamaguchi criteria at 28 days after first symptom. The time of eruption emergence affected the early diagnosis. <h3>Disclosure of Interest</h3> None declared
Anti-EGFR-based conversion chemotherapy in RAS wildtype colorectal cancer patients: Impact on survival and resection rates.
Authors: Christine Koch, Niklas Schmidt, Ria Winkelmann, Katrin Eichler, Martin-Leo Hansmann, Wolf O. Bechstein, Ursula Pession, Stefan Zeuzem, Jorg Trojan, Oliver Waidmann
Journal: Journal of Clinical Oncology (2017)

e15029 Background: Initially unresectable colorectal liver metastases can become resectable after chemotherapy. Chemotherapy combined with EGF-receptor antibodies has shown consistent high response rates in patients with RAS wildtype tumors. However, the influence of RAS mutations other than exon 2 mutations in the context of a conversion strategy has not been systematically studied yet. Methods: Out of a cohort of 424 patients with mCRC, we identified 30 patients with initially unresectable KRAS exon 2 wildtype colorectal liver metastases who received neoadjuvant chemotherapy including cetuximab or panitumumab between January 2008 and February 2014. In all patients extended RAS analysis (KRAS and NRAS exon 3 codon 59 and 61 and exon 4 codon 117 and 146) was carried out. Resection status (R0, R1 or R2), PFS and OS were recorded in all patients and maximum tumor shrinkage was calculated. Results: RAS mutation analysis identified further KRAS mutations in 4/30 patients (13.3%). No NRAS mutations were found. In none of these four patients a R0 resection could be achieved. In contrast, 15/26 (57.7%) RAS wildtype patients could be R0 resected. Median survival of patients with a RAS wildtype tumor was 64.0 [range: 7.4-98.6] months vs. 28.0 [range: 16.4- 40.6] months in those with a RAS mutation (hazard ratio, HR, 0.53; 95% confidence interval, CI: 0.15-1.81, p = 0.3). Median PFS in patients with a RAS mutation was 8 [range: 6-28.8] months compared to 10.4 [range, 1.7-15.2] months in patients with a RAS wildtype cancer. Median overall survival was &gt; 63.3 months in R0-resected patients vs. 30.0 months in those with a R1 or R2 resection (HR 0.23; [95% CI 0.10- 0.75; p = 0.008). Conclusions: Our data suggest that a RAS wildtype status and a R0 resection are the strongest predictors for overall survival. The extended RAS analysis allows a better patient selection for anti-EGFRbased conversion chemotherapy before secondary resection of colorectal liver metastases.
Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline
Authors: Timothy Gilligan, Nessa Coyle, Richard M. Frankel, Donna L. Berry, Kari Bohlke, Ronald M. Epstein, Esme Finlay, Vicki A. Jackson, Christopher S. Lathan, Charles L. Loprinzi, Lynne H. Nguyen, Carole Seigel, Walter F. Baile
Journal: Journal of Clinical Oncology (2017)

Purpose To provide guidance to oncology clinicians on how to use effective communication to optimize the patient-clinician relationship, patient and clinician well-being, and family well-being. Methods ASCO convened a multidisciplinary panel of medical oncology, psychiatry, nursing, hospice and palliative medicine, communication skills, health disparities, and advocacy experts to produce recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. The systematic review focused on guidelines, systematic reviews and meta-analyses, and randomized controlled trials published from 2006 through October 1, 2016. Results The systematic review included 47 publications. With the exception of clinician training in communication skills, evidence for many of the clinical questions was limited. Draft recommendations underwent two rounds of consensus voting before being finalized. Recommendations In addition to providing guidance regarding core communication skills and tasks that apply across the continuum of cancer care, recommendations address specific topics, such as discussion of goals of care and prognosis, treatment selection, end-of-life care, facilitating family involvement in care, and clinician training in communication skills. Recommendations are accompanied by suggested strategies for implementation. Additional information is available at www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki .
Cortical Bone Stem Cell Therapy Preserves Cardiac Structure and Function After Myocardial Infarction
Authors: Thomas E. Sharp, Giana J. Schena, Alexander R. Hobby, Timothy Starosta, Remus M. Berretta, Markus Wallner, Giulia Borghetti, Polina Gross, Daohai Yu, Jaslyn Johnson, Eric Feldsott, Danielle M. Trappanese, Amir Toib, Joseph E. Rabinowitz, Jon C. George, Hajime Kubo, Sadia Mohsin, Steven R. Houser
Journal: Circulation Research (2017)

Rationale: Cortical bone stem cells (CBSCs) have been shown to reduce ventricular remodeling and improve cardiac function in a murine myocardial infarction (MI) model. These effects were superior to other stem cell types that have been used in recent early-stage clinical trials. However, CBSC efficacy has not been tested in a preclinical large animal model using approaches that could be applied to patients. Objective: To determine whether post-MI transendocardial injection of allogeneic CBSCs reduces pathological structural and functional remodeling and prevents the development of heart failure in a swine MI model. Methods and Results: Female Göttingen swine underwent left anterior descending coronary artery occlusion, followed by reperfusion (ischemia–reperfusion MI). Animals received, in a randomized, blinded manner, 1:1 ratio, CBSCs (n=9; 2×10 7 cells total) or placebo (vehicle; n=9) through NOGA-guided transendocardial injections. 5–ethynyl–2′deoxyuridine (EdU)—a thymidine analog—containing minipumps were inserted at the time of MI induction. At 72 hours (n=8), initial injury and cell retention were assessed. At 3 months post-MI, cardiac structure and function were evaluated by serial echocardiography and terminal invasive hemodynamics. CBSCs were present in the MI border zone and proliferating at 72 hours post-MI but had no effect on initial cardiac injury or structure. At 3 months, CBSC-treated hearts had significantly reduced scar size, smaller myocytes, and increased myocyte nuclear density. Noninvasive echocardiographic measurements showed that left ventricular volumes and ejection fraction were significantly more preserved in CBSC-treated hearts, and invasive hemodynamic measurements documented improved cardiac structure and functional reserve. The number of EdU + cardiac myocytes was increased in CBSC- versus vehicle- treated animals. Conclusions: CBSC administration into the MI border zone reduces pathological cardiac structural and functional remodeling and improves left ventricular functional reserve. These effects reduce those processes that can lead to heart failure with reduced ejection fraction.
FRI0758-HPR Co-morbidity profile in patients with rheumatoid arthritis. data from rheumatoid arthritis registry in qatar
Authors: F Alam, M Hammoudeh, S Al Emadi
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Comorbid conditions are frequently associated with rheumatoid arthritis (RA) which not only increase morbidity but also has impact on treatment and may shorten the life span of those patients. <h3>Objectives</h3> To study the prevalence of different comorbid conditions among patients with RA. <h3>Methods</h3> Data was collected from rheumatoid arthritis Registry in Qatar. Patients fulfilling 2010 ACR/EULAR criteria for RA were included in this observational study from period of June 2013 to November 2015. Data about Baseline demographics, treatment pattern, disease scores and details of comorbid conditions were recorded in this observational study <h3>Results</h3> Data of 496 patients was analyzed. Demographic and disease characteristic of our RA cohort was as follows: 75.8% were female, 74.9% were positive for rheumatoid factor, 79.8% were positive for anti CCP and 31.3% have erosion at the time of data collection. One hundred thirty patients (26.4%) were receiving biologic drugs, 71.8 were on synthetic DMARDS (either as monotherapy or different combination) and 39.7% were receiving concomitant steroid. The most commonly associated comorbid conditions were hypertension (24.2%) followed by diabetes mellitus (20.6%), dyslipidemia 10.9%, hypothyroidism 10.9%, asthma and chronic obstructive disease 1.4%. Steroid was used by 39.2% of patients with diabetes and hypertension. Cardiovascular events (Ischemic heart disease and ischemic stroke) occurred in 2.2% of patients and 45.5% of patients with cardiovascular events were receiving concomitant steroid. Infections requiring hospital visit were recorded in 1.8% of patients; 77.8% of patients with infection were on biologic DMARD and 33.3% were receiving concomitant steroid. Out of Two hundred seventy six patients who underwent DXA scanning for estimation of bone mineral density, 48.6% were having decrease bone density (37% osteopenia, 11.6% osteoporosis). Steroid use was significantly associated with decrease bone density. <h3>Conclusions</h3> Comorbid conditions are frequently associated with Rheumatoid arthritis as observed in our cohort of patients. Patient care should not be focused only on arthritis care. All RA patients should be screened for comorbidities and treated accordingly in order to avoid their deleterious effect on patient health. <h3>Disclosure of Interest</h3> None declared
AB0721 The evaluation of ultrasonographic and clinical enthesopathy in patients with inflammatory rheumatic diseases
Authors: E Suleyman, H Harman, K Nas
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Enthesitis is considered as the primary anatomical lesion in spondyloarthropathy (SpA) but it can be seen in other rheumatologic diseases. Its locations and clinical relationships have not been studied well in the literature. <h3>Objectives</h3> We aimed to investigate the frequency of ultrasonographic, clinical enthesopathy and the relationship between enthesopathy and disease activity, functional status in patients with rheumatoid arthritis (RA) and axial SpA. <h3>Methods</h3> Thirty three axial SpA, 21 RA patients and 30 healthy subjects were included in the study. The clinical and functional evaluations relied on the BASDAI, BASFI, ASQoL, DAS28, and HAQ, and on a VAS for entheseal pain, as well as on the MASEI. Knee, ankle and elbow were examined with US bilaterally in 172 joint regions. <h3>Results</h3> The physical examination scores for enthesitis were 1.97±2.68, 2.43±1.80, 0.23±0.12 in axial SpA, RA and healthy subjects, respectively. There was no statistically significant difference between axial SpA and RA about enthesitis physical examination scores (p=0.123). A statistically significant difference was not found between axial SpA and RA in quadriceps tendon enthesitis and distal patellar ligament enthesitis according to MASEI index (MASEI 3,4,5) (p=0.993, p=0.124, p=0.652). Other MASEI enthesit scores were statistically higher in axial SpA group than RA and healthy subjects (p=0.008). Positive correlations were found between BASDAI scores and enthesitis pyhsical examination scores, MASEI total scores (r=0.739, p=0.0001, r=0.516, p=0.002). There was moderately positive correlation between ASQoL total scores and MASEI total scores (r=0.466, p=0.006). HAQ total scores were not correlated with MASEI total scores (r=0.213, p=0.065). <h3>Conclusions</h3> Ultrasonographic enthesitis was associated with impaired quality of life in axial SpA. MASEI 1 and 2 was spesific entheseal regions in MASEI index for axial SpA. Different from RA, the calcaneal enthesitis region for clinical investigation and ultrasonographic enthesopathy should be focused on in axial SpA. <h3>Disclosure of Interest</h3> None declared
Annals Story Slam - Loss
Authors: Seema Marwaha
Journal: Annals of Internal Medicine (2017)

Web Exclusives19 September 2017Annals Story Slam - LossFREESeema Marwaha, MDSeema Marwaha, MDFrom University of Toronto, Toronto, Ontario, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/W17-0060 SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Video. Annals Story Slam - Loss "Loss," by Dr. Seema Marwaha (Duration 08:04)Building on the popular Annals feature “On Being a Doctor,” storytellers share stories about the experience of doctoring on video.For more videos from and information on Annals Story Slam, visit go.annals.org/StorySlam. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From University of Toronto, Toronto, Ontario, Canada.Current Author Address: Seema Marwaha, MD, University of Toronto, Toronto, Ontario, Canada; e-mail, [email protected]com. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 19 September 2017Volume 167, Issue 6Page: SS1 ePublished: 19 September 2017 Issue Published: 19 September 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.Loading ...
SAT0716 A first time hospital admission for comorbid conditions in patients with systemic lupus erythematosus is more frequently due to cardiovascular and renal complications than in controls and subsequently increases the risk for death
Authors: WD Raymond, D Preen, C Inderjeeth, H Keen, J Nossent
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that runs an unpredictable disease course. <h3>Objectives</h3> We aimed to understand the characteristics and outcomes of incident hospitalisation for conditions other than the underlying disease in SLE patients. <h3>Methods</h3> Using whole-population data linkage of hospital admissions and death records in Western Australia (WA) WA between 1980 and 2015, we performed a retrospective analysis for patients where SLE (ICD-9-CM 695.4, 710.0 and ICD-10-AM L93.0 &amp; M32) was a <i>co-existing</i> discharge diagnosis. All SLE patients were age- and gender-matched with hospital controls free of rheumatic disease. We investigated the rate and characteristics of the index hospitalisation for comorbidity and the risk of subsequent death by Kaplan-Meier survival and Cox regression. <h3>Results</h3> Hospitalisation rates for comorbidity were 13.9/million/year in SLE patients. SLE patients were similar to controls for age and gender, but more likely to be Indigenous, have renal failure, cardiovascular and thrombotic conditions (Table 1). Independent predictors of mortality risk following hospitalisation for a comorbid condition included: SLE diagnosis (OR 1.6, CI: 1.3–1.9, p&lt;0.001) (Fig. 1), cerebrovascular events (OR 2.0, CI: 1.2–3.7, p&lt;0.001), renal disease (OR 1.75, CI: 1.4–2.3 p&lt;0.001), thrombotic events (OR 1.8 CI: 1.1–2.8, p=0.001) and reliance on Medicare (OR 1.5, CI: 1.3–1.8, p&lt;0.001) (Table 2). <h3>Conclusions</h3> SLE patients were more frequently hospitalised than controls for cardiovascular or renal conditions and this increased their mortality risk. These results strengthen the need for close monitoring and interventions to prevent such comorbidity in all SLE patients. <h3>Disclosure of Interest</h3> None declared
Tumor-related interleukins: old validated targets for new anti-cancer drug development
Authors: Sarra Setrerrahmane, Hanmei Xu
Journal: Molecular Cancer (2017)

In-depth knowledge of cancer molecular and cellular mechanisms have revealed a strong regulation of cancer development and progression by the inflammation which orchestrates the tumor microenvironment. Immune cells, residents or recruited, in the inflammation milieu can have rather contrasting effects during cancer development. Accumulated clinical and experimental data support the notion that acute inflammation could exert an immunoprotective effect leading to tumor eradication. However, chronic immune response promotes tumor growth and invasion. These reactions are mediated by soluble mediators or cytokines produced by either host immune cells or tumor cells themselves. Herein, we provide an overview of the current understanding of the role of the best-validated cytokines involved in tumor progression, IL-1, IL-4 and IL-6; in addition to IL-2 cytokines family, which is known to promote tumor eradication by immune cells. Furthermore, we summarize the clinical attempts to block or bolster the effect of these tumor-related interleukins in anti-cancer therapy development.
SAT0573 Sociodemographic, clinical characteristics and joint involvement of a chikungunya epidemic in colombia
Authors: JC Rueda, J-I Angarita, AM Santos, E-L Saldarriaga, I Pelaez-Ballestas, E Couto-Luvie, J Londono
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> During 2014 and 2015 a chikungunya epidemic took place in Colombia concurrently with a COPCORD study across the country. <h3>Objectives</h3> To describe the clinical characteristics of CHIKV infection in 6 different cities in Colombia and determine the most frequently associated clinical picture with CHIKV. <h3>Methods</h3> World Health Organization criteria was used to identify CHIKV patients. A complete characterization and confirmation was established with CHIKV immunoglobulin G and IgM serology. Four possible scenarios were stablished: patients who met or not the criteria for probable case, and patients who met or not the criteria for confirmed case. <i>P</i> values were calculated between patients who met or not met the criteria. Sensibility and specificity was calculated for the WHO criteria. <h3>Results</h3> A total of 604 patients with MSK symptoms were evaluated in 6 different cities. The sociodemographic, clinical characteristics and joint involvement of the studied population is depicted in tables 1 and 2. Sensibility and specificity of the WHO criteria were 56.2% and 91.1% respectively (PPV: 83.3%, NPV: 74.4%). <h3>Conclusions</h3> Our study shows a clear clinical picture of systemic symptoms, high titters of CHIKV immunoglobulins, and a defined joint involvement, which will help clinicians to identify and differentiate CHIKV infection from other viral infections and MSK diseases. Also, the sensibility of the WHO criteria applied to our cohort of patients demonstrates the need to improve clinical criteria without the use of laboratory tests. <h3>Disclosure of Interest</h3> None declared
Utility of Combining a Simulation-Based Method With a Lecture-Based Method for Fundoscopy Training in Neurology Residency
Authors: Deepak K. Gupta, Namir Khandker, Kristin Stacy, Curtis M. Tatsuoka, David C. Preston
Journal: JAMA Neurology (2017)

<h3>Importance</h3> Fundoscopic examination is an essential component of the neurologic examination. Competence in its performance is mandated as a required clinical skill for neurology residents by the American Council of Graduate Medical Education. Government and private insurance agencies require its performance and documentation for moderate- and high-level neurologic evaluations. Traditionally, assessment and teaching of this key clinical examination technique have been difficult in neurology residency training. <h3>Objective</h3> To evaluate the utility of a simulation-based method and the traditional lecture-based method for assessment and teaching of fundoscopy to neurology residents. <h3>Design, Setting, and Participants</h3> This study was a prospective, single-blinded, education research study of 48 neurology residents recruited from July 1, 2015, through June 30, 2016, at a large neurology residency training program. Participants were equally divided into control and intervention groups after stratification by training year. Baseline and postintervention assessments were performed using questionnaire, survey, and fundoscopy simulators. <h3>Interventions</h3> After baseline assessment, both groups initially received lecture-based training, which covered fundamental knowledge on the components of fundoscopy and key neurologic findings observed on fundoscopic examination. The intervention group additionally received simulation-based training, which consisted of an instructor-led, hands-on workshop that covered practical skills of performing fundoscopic examination and identifying neurologically relevant findings on another fundoscopy simulator. <h3>Main Outcomes and Measures</h3> The primary outcome measures were the postintervention changes in fundoscopy knowledge, skills, and total scores. <h3>Results</h3> A total of 30 men and 18 women were equally distributed between the 2 groups. The intervention group had significantly higher mean (SD) increases in skills (2.5 [2.3] vs 0.8 [1.8],<i>P</i> = .01) and total (9.3 [4.3] vs 5.3 [5.8],<i>P</i> = .02) scores compared with the control group. Knowledge scores (6.8 [3.3] vs 4.5 [4.9],<i>P</i> = .11) increased nonsignificantly in both groups. <h3>Conclusions and Relevance</h3> This study supports the use of a simulation-based method as a supplementary tool to the lecture-based method in the assessment and teaching of fundoscopic examination in neurology residency.