tbuckley/cabot-search huggingface dataset:
FRI0552 The correlation between erosion and bone mineral density in patients with rheumatoid arthritis treated with denosumab and biologic dmards: a prospective cohort study
Authors: K Izumi, Y Kaneko, T Hasegawa, T Takeuchi
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> We have previously reported the efficacy of denosumab combined with biological DMARDs on radiographic progression in rheumatoid arthritis (RA). <h3>Objectives</h3> The aim of this work was to reveal the relationship between the changes in structural joint damage and in bone mineral density (BMD) in patients with RA who were started on denosumab in addition to biologic DMARDs. <h3>Methods</h3> We prospectively evaluated erosion (ERO) and joint space narrowing (JSN) scores by the van der Heijde-modified Sharp method and T-scores of the lumbar spine (LS) and total hip (TH) by dual energy X-ray absorptiometry scans at baseline and 12 months in the RA patients who were started on denosumab (60 mg every 6 months) for osteoporosis in addition to biologic DMARDs. We compared the 12-month change in ERO or JSN scores (ΔERO; ΔJSN) with the change in T-scores of the LS or TH (ΔLS; ΔTH). <h3>Results</h3> Twenty-two patients (1 man and 21 women) at the mean±SD age of 74.4±8.1 at baseline were included in this study. The T-scores of the LS and TH at baseline were -1.38±1.57 and -2.53±0.85, respectively. ΔERO, ΔJSN, ΔLS, and ΔTH were 0.16±0.49, 0.44±0.66, 0.30±0.39, and 0.20±0.42, respectively. BMD was significantly increased from baseline to 12 months. There was a significant inverse correlation between the ΔERO and the ΔTH (ρ=−0.473, P=0.03), while there was no correlation between the ΔERO and the ΔLS (P=0.98) nor correlation between the ΔJSN and the ΔLS (P=0.57) or ΔTH (P=0.25). <h3>Conclusions</h3> The change in erosive joint damage of hands and feet showed a significant relationship with the change in femoral BMD in patients with RA treated with denosumab and biologic DMARDs. BMD was ameliorated along with erosion by denosumab combined with biologic DMARDs, and may be an indicator for joint destruction. <h3>References</h3> Hasegawa T, Kaneko Y, Izumi K, Takeuchi T. Efficacy of denosumab combined withbDMARDs on radiographic progression in rheumatoid arthritis. Joint Bone Spine.2016 Jun 28. pii: S1297–319X(16)30099–9. <h3>Disclosure of Interest</h3> None declared
PTH-004 Magniview zoom endoscopy increases the detection of villous atrophy compared to high definition white light endoscopy
Authors: WL White, MS Lau, PD Mooney, MA Rees, M Burden, DS Sanders
Journal: Endoscopy (2017)

<h3>Introduction</h3> Coeliac disease (CD) is common yet under-diagnosed at endoscopy. The optical zoom technology of Pentax Magniview endoscopes can magnify images by 136 times. We aimed to assess the accuracy of Magniview in the detection of duodenal villous atrophy (VA), and the ease of interpretation of live zoomed-in images. <h3>Method</h3> Patients attending for a gastroscopy from 2014–17 were recruited. Endomysial (EMA) and tissue transglutaminase (TTG) antibodies were taken at endoscopy. Appearances of the first and second part of the duodenum (D1 and D2) observed with high definition white light endoscopy (HDWLE) and Magniview were graded on a 3-point scale validated by Cammarota et al.: normal, partial or marked villous atrophy (PVA, MVA). In all patients, quadrantic biopsies were taken from D2 and 1 biopsy from D1. Endoscopic findings of the duodenum were compared to histology as the reference standard. A short training video with 12 clips of normal duodenum and various grades of VA with Magniview was used to train medical staff to identify VA. They were assessed immediately after the training with 22 video clips for the ability to detect normal duodenum, PVA or MVA. <h3>Results</h3> A total of 250 patients were recruited (145 females, 58%; age range 16–84, median age 50.5). Ninety-six patients had VA on histology (38.4%), of which 80 were newly diagnosed CD and 16 were persistent VA in known CD patients, leaving the remaining 154 as controls. Magniview had a significantly higher sensitivity in detecting VA compared to HDWLE (p=0.0005). (Table 1) Ten individuals (5 endoscopists and 5 non-endoscopists) undertook the Magniview training, and 9/10 correctly identified all cases of VA. (Table 2) <h3>Conclusion</h3> Magniview had superior diagnostic accuracy in detecting VA compared to HDWLE. A short training on the identification of VA with Magniview demonstrated its ease of use and suitability for Magniview to be utilised by general endoscopists in their daily practice to increase the detection of CD. <h3>Disclosure of Interest</h3> W. White: None Declared, M Lau: None Declared, P Mooney: None Declared, M Rees: None Declared, M Burden: None Declared, D Sanders Conflict with: Professor Sanders has received educational research grants from Dr Schaer (a gluten-free food manufacturer) and Tillotts Pharma (producer of a point of care test for celiac disease) for investigator led studies. Dr Shaer and Tillott's Pharma did not have any input in the study design, access to study data, interpretation of the findings or drafting of the manuscript.
FRICTION OF SPORTS FLOORS IN GERMAN MEN'S PROFESSIONAL BASKETBALL AND HANDBALL COMPETITIONS
Authors: Thomas Henke, Luig Patrick
Journal: British Journal of Sports Medicine (2017)

Background With regard to sliding friction sports floor manufacturers focus on comfort and performance aspects of athletes. In relation to safety aspects standardisation bodies rather concentrate on slippery than on dull floors. Thus, sliding friction coefficients from 0.4 to 0.6 (DIN 18032) are recommended. Biomechanical analyses have shown that higher sliding friction values produce higher joint moments and thereby probably increase the risk of acute and chronic injuries to the lower extremities. Objective Evaluation of the floor conditions of sports floors used in German men's professional basketball and handball with specific regard to sliding friction. Design Pilot study. Setting Two highest professional leagues in German men's basketball and handball. Participants Overall, eight out of 53 sports floors used in regular league basketball and handball competition, two floors from first and second league respectively, were randomly picked for sample measurement of the floor conditions. Assessment of Risk Factors Determination of the friction coefficient by tribometric method (GTE, GMG 200) in four different areas of the playgrounds in each case. Main Outcome Measurements Friction coefficient in accordance to DIN 18032 (sports floors), DIN 51131, EN 13893. Results In basketball the mean sliding friction coefficient was 0.41, ranging from 0.37 to 0.43. By contrast, in handball the observed mean value was 0.95, ranging from 0.78 to 1.06. Conclusions In view of sliding friction, all sample measured basketball floors were in accordance with the DIN 18032 but neither of the evaluated handball floors met these criteria. High sliding friction values were likely to result from intense resin use in handball. With regard to players' safety sports floor manufacturers, clubs and cleaning companies should be aware of this problem and develop targeted cleaning regimes for sports floors used in professional handball competitions. In handball, especially in view of resin use, rather than to the floor type.
Recurrent Leiomyosarcoma of External Oblique Muscle Detected on 99mTc-MDP SPECT/CT
Authors: Taisong Wang, Yan Xing, Wenli Qiao, Jinhua Zhao
Journal: Clinical Nuclear Medicine (2017)

A Tc-MDP bone scintigraphy was performed in an 88-year-old man with a history of right external oblique muscle leiomyosarcoma, which was resected 8 months ago. The static images showed abnormal tracer uptake in the region of resection bed. SPECT/CT images demonstrated that the increased activity was from a partially calcified soft tissue mass in external oblique muscle. Subsequent pathological examination confirmed recurrent tumor.
PTH-041 Definitive management of a very rare cause of significant acute upper gastrointestinal bleeding: gastric lipoma resected by hybrid endoscopic submucosal dissection
Authors: N Koukias, A Murino, A Telese, G Johnson, N Power, TV Luong, CD Murray, EJ Despott
Journal: Endoscopy (2017)

<h3>Introduction</h3> Gastric lipomas are rare, benign, slow-growing subepithelial tumours. Most lipomas remain asymptomatic and are detected incidentally at endoscopy. Large lipomas however, may very rarely cause significant upper gastrointestinal (GI) bleeding and warrant removal. For the management of large gastric lipomas, laparoscopic excision may be required but endoscopic techniques such as endoscopic submucosal dissection (ESD) and unroofing are also described. This endoscopic video case highlights this rare cause of upper GI bleeding and its definitive management by hybrid ESD. <h3>Method</h3> A 66 year old man presented with melaena, pallor and fatigue. On admission, his haemoglobin level was 89 g/L. The patient underwent an upper gastrointestinal (GI) endoscopy during which a 3 cm ulcerated submucosal lesion was identified at the greater curvature. An endoscopic clip and Hemospray(R) were applied and haemostasis was achieved. Computed tomography imaging revealed an ovoid (fat density) lesion measuring 25 × 15 mm consistent with a lipoma. Endoscopic ultrasound assessment of the lesion was subsequently performed which showed the presence of an homogenous and slightly hyperechoic lesion 25 × 15 mm arising from the hyperechoic submucosal layer. A 22g needle was used to obtain core biopsies but unfortunately the sample was inadequate for diagnostic assessment. <h3>Results</h3> Endoscopic management of the lesion was agreed and the lesion was successfully resected by hybrid ESD. No immediate or delayed adverse events were encountered. Histopathology confirmed the diagnosis of submucosal gastric lipoma which was completely excised. On repeat endoscopy three months post-procedure, a well healed scar was seen at the site of excision. <h3>Conclusion</h3> Our video case highlights the role of hybrid ESD in the minimally invasive and definitive management of this rare submucosal cause of upper GI bleeding. <h3>References</h3> . Lee KJ, Kim GH, Park DY, et al. Endoscopic resection of gastrointestinal lipomas: a single-centre experience. Surgical endoscopy2014; 28: 185–192 . Matsushita M, Fukata N, Okazaki K. Endoscopic removal of large gastric lipomas: en bloc resection with submucosal dissection or partial resection with unroofing technique?Dig Endosc. 2013Mar;25(2):211–2. doi: 10.1111/den.12011. Epub 2012 Dec 17. <h3>Disclosure of Interest</h3> None Declared
18 Can a short training module improve nutritional knowledge of malnutrition by junior doctors
Authors: H Musson, P Rajasekhar, N Thompson, C Mountford, L Gemmell, B Davidson
Journal: Gut (2017)

Background  Malnutrition is a major cause and consequence of poor health. Hospitalised patients are at increased risk of malnourishment; around 30% of people aged over 65 are at risk of malnutrition on admission. Additionally, malnutrition increases costs hugely to the NHS. Despite the prevalence and cost of this problem, formal teaching to junior doctors about malnutrition is limited.  Aim  To assess whether an online training module could improve knowledge of nutritional management of hospitalised patients.  Methods  Using SurveyMonkey, a survey was distributed to Foundation Year FY1 and FY2 doctors working at both Newcastle and Northumbria NHS Foundation Trainee (FT). The doctors were asked five questions, then given information relating to malnutrition. Finally they answered the five questions again. The survey took approximately 15 min to complete. Participants could then download a certificate to show involvement with training. Statistical analysis was performed using a paired t-test to assess the doctors’ improvement in answering the questions.  Results  87 doctors participated. The results are outlined in the table below.  A paired t-test was used to measure the difference in correct answers selected between the 1st and 2nd attempts, p-value of 0.013.  Conclusions  Knowledge of malnutrition can be improved by completing a short training module. Future studies should address the technical issues of using SurveyMonkey within FTs and use larger sample sizes to prove the generalisability of the results. Improved knowledge should lead to earlier recognition and treatment of malnutrition with improved health outcomes and reduced costs.
Peut-on optimiser le temps de lecture d’un examen par vidéo-capsule sans en diminuer le rendement diagnostique: Evaluation du système Multi-view™ à vitesse de lecture maximale
Authors: E Ben Soussan, S Ramirez, S Lecleire, M Antonietti, G Savoye, P Ducrotté
Journal: Endoscopy (2004)

Objectif: Le but de cette étude était d’évaluer d’une part si la lecture à vitesse maximale était préjudiciable au rendement d’un examen par vidéo-capsule (V/C) et d’autre part si le niveau d’expertise influait sur la détection des ces lésions. Matériels et Méthodes: De juin 2002 à avril 2003, douze patients explorés par V/C pour un saignement digestif obscur extériorisé ou non ont été sélectionnés pour cette étude. Tous les examens étaient pathologiques et montraient des anomalies du grêle: angiodysplasies (n = 11), ulcérations (n = 7) et saignement actif sans lésion visible (n = 4). L’ensemble de ces examens avait été initialement lu par un médecin expert (A) à la vitesse de 15 à 20 images/sec (temps de lecture moyen = 38 min). Le médecin A n’avait jamais relu ces examens depuis au mois 5 mois (extrême: 5–15 mois). Les enregistrements étaient visionnés indépendamment une seconde fois par le même médecin A (»expert« > 50 V/C), par un médecin B (»confirmé« < 30 V/C) et par deux médecins »novices« C et D (< 5 V/C) en lecture Multiview™ et à la vitesse maximale de 40 images par secondes. La durée totale de lecture, le nombre, la nature et la localisation temporelle des lésions étaient relevés indépendamment par chaque opérateur. Le nombre de lésions observées à 40 images/sec était rapporté au nombre total de lésions et les résultats des quatre observateurs étaient comparés entre eux au moyen du test Chi². Résultats: Le médecin A retrouvait 18/22 (82%) des lésions, les médecins B et C (14/22) (64%) (NS) et le médecin D (9/22) (41%) (p < 0,02). Les lésions de type »saignement actif« ont toutes été visualisées par les 4 médecins (Tableau 1). Le temps de lecture moyen était de 14 min pour A, 16 min pour B et 20 min pour C et D (Tableau 1). Conclusion: A une vitesse de lecture maximale, le rendement de la V/C est significativement meilleur chez un médecin expérimenté que chez un médecin novice. Cependant près de 20% des lésions ne sont pas vues à cette vitesse par le médecin expérimenté, et on ne peut donc pas la recommander en pratique courante.
Abstract 274: Carvedilol Stimulated Gαi-β-Arrestin Biased β1 Adrenergic Receptor Signaling
Authors: Jialu Wang, Kunhong Xiao, Howard A Rockman
Journal: Circulation Research (2015)

The β1 and β2 adrenergic receptors (βARs) are the predominant G-protein-coupled receptors (GPCRs) subtypes expressed in the heart. It is now appreciated that ligands can induce multiple distinct “active” receptor conformations with unique downstream functional signaling profiles or efficacies. Our current understanding of GPCR signaling is that ligands can be biased toward activating either a G protein or a β-arrestin-signaling pathway, a concept known as biased ligand signaling. To identify novel biased signaling pathways mediated by β1- and β2ARs, we performed a proteomic interactome study of β1AR and β2AR using stable isotope labeling by amino acids in cell culture (SILAC). We identified several hundred proteins that distinctly bind to the β1AR or β2AR following stimulation with the unbiased full agonist, isoproterenol, or the β-arrestin-biased ligand carvedilol. We found that stimulation by the β-arrestin-biased agonist carvedilol of only β1ARs resulted in the recruitment of Gαi. No of the other ligand tested promoted Gαi recruitment, suggesting that carvedilol may be unique in its ability to activate Gαi-biased signaling. The Gαi inhibitor pertussis toxin blocked β-arrestin-dependent extracellular signal-regulated kinase (ERK) activation and epidermal growth factor receptor (EGFR) transactivation stimulated by carvedilol, suggesting the involvement of Gαi in carvedilol-induced β-arrestin biased signaling of β1ARs. Using β1AR/β2AR chimeric receptors we show that the C-terminal tail of the β1AR is required for carvedilol stimulated Gαi recruitment, but is unable to rescue the lack of Gαi recruitment by the β2AR. Since our current conceptual framework for biased signaling is based on the “bar code hypothesis”, ongoing phosphoproteomic experiments are testing whether recruitment of Gαi by carvedilol induces a distinct phosphorylation pattern on the c-tail of the β1AR. Our study shows that activation of β-arrestin-biased signaling requires G proteins for signaling and provides a new mechanistic understanding of how biased β-blockers can activate signaling.
PTH-040 Positive faecal occult blood testing and negative screening colonoscopy: four year outcomes
Authors: JA Fegredo, B Patani, AF Muller
Journal: Endoscopy (2017)

<h3>Introduction</h3> The Bowel Cancer Screening Programme (BCSP) uses the faecal occult blood test (FOBT) to identify patients who may benefit from colonoscopy to exclude serious, usually asymptomatic pathology. If no polyps are detected, the patient is returned to the screening programme without further investigation. <h3>Method</h3> A retrospective cohort study was undertaken to elucidate the final diagnosis of all patients in the East Kent Hospitals screening programme in 2012 with a positive FOBT but no polyps or tumours detected at colonoscopy. The details of all patients were reviewed to determine which further investigations had been performed over a four-year period up to 31 December 2016. Data collected included: reported findings at index colonoscopy, histology if biopsies had been taken, results of subsequent colonoscopy or gastroscopy, CT, ultrasound and MRI scans. Results were obtained via the computerised patient records (endoscopy reports, patient letters, pathology viewer and PACS system). Patients with confirmed adenomatous polyps, tumours or those with incomplete procedures at index colonoscopy were excluded. Data were collated using Microsoft Excel 2016 and analysed using SPSS v15.0. <h3>Results</h3> Of the 621 patients that underwent a colonoscopy under the BCSP in 2012, 205 fulfilled the aforementioned criteria and were included in analysis. The median age was 64 years (range 60–86). Fifty-three (25.9%) colonoscopies were normal and 123 (60%) demonstrated only diverticular disease or haemorrhoids. Ten (4.9%) had definite endoscopic and histological evidence of inflammatory bowel disease (IBD) and 11 (5.4%) had non-specific endoscopic features such as erythema or mucosal oedema but without significant histological abnormality. Seven (3.4%) patients had colonic telangiectasia and one (0.5%) had ileitis. Of those patients with diverticulosis, haemorrhoids or a normal index colonoscopy, one was subsequently diagnosed with microscopic colitis and one with proctitis; 11 (6.3%) had polyps on subsequent colonoscopy of which one demonstrated evidence of mixed low and high grade dysplasia. This individual subsequently underwent left hemicolectomy for confirmed adenocarcinoma. Twelve patients (6.8%) were found to have upper gastrointestinal (UGI) pathology including gastric polyps, oesophagitis, gastritis, duodenitis, telangiectasias or duodenal ulceration. Imaging modalities reviewed were non-contributory in establishing the final diagnosis. <h3>Conclusion</h3> This study confirms that patients with a positive FOBT but negative colonoscopy should be strongly encouraged to continue in the screening programme as serious ‘missed’ pathology may subsequently be confirmed. Many patients with a negative screening colonoscopy underwent additional investigation in the four years following their index procedure, which in a small percentage of cases identified significant UGI pathology. <h3>Disclosure of Interest</h3> None Declared
PTU-078 The “getting fit” project in nottingham: a comparison of faecal haemoglobin levels as measured by oc sensor and hm jack in primary care
Authors: C Chapman, A Banerjea, O Ng, R Rogers, A Barke, A Duffin, K Dale, RF Logan
Journal: Gut (2017)

Introduction  NICE guidance (NG12) published in 2015, on indications for urgent referral for possible colorectal cancer (CRC) included the use of faecal occult blood tests (FOB) but did not specify the type of FOB to be used.  Quantitative faecal immunochemical tests (FIT) are now available for analysis of occult blood. Recent draft recommendations from NICE propose using a FIT with a 10 µg Hb/g faeces threshold to guide referral in primary care although it is unclear if all analysers perform the same way in a clinical setting.  Method  In September 2016 FIT was incorporated into Nottingham’s straight to test (STT) pathway. GPs were also given access to FIT for eligible low risk patients (under 60 years without rectal bleeding) using a specific referral form vetted by Nottingham’s straight to test pathway team.  FIT kits from 2 different manufacturers were posted to patients with instructions for use, along with return packaging. Patients were asked to complete both kits and sample faecal material from the same bowel motion. All returned kits were analysed according to manufacturer’s protocols (EIKEN OC-Sensor and Alpha HM Jack) and results expressed in µg Hb/g faeces.  Results  So far 90% of GP requested samples have been returned (17/19). The median time to return was 8 days, with time-to-return ranging from 5 to 28 days. Hb values ranged from 0 to 112 µg Hb/g faeces for OC Sensor and 0 to 429 µg Hb/g faeces for HM Jack.  Using a cut off of 10 µg/g for OC sensor and 7 µg/g for HM Jack 4/17 (24%) of the GP requested samples would be considered ‘positive’ in either test, although only 2 of these would have been the same patient.  Complete agreement between both tests using a 10 µg/g cut off was seen for only 1 subject. Variation could be due to difference in the assays, or occult blood distribution within faecal samples.  Conclusion  Although numbers are small, FITs sent by post following GP requests appear acceptable to subjects to complete and return. Referral on the basis of a single cut off of 10 µg/g would see different patients sent for 2WW referral.  Data from these referrals, taken together with the data produced from our 2WW pathway suggests an analyser specific cut off will be needed. Differences in levels of Hb within the same individual bowel motion appear to occur highlighting the importance of repeating tests for individuals whose symptoms persist.  Disclosure of Interest  None Declared