tbuckley/cabot-search huggingface dataset:
Screening for Unhealthy Drug Use
Authors: Carrie D. Patnode, Leslie A. Perdue, Megan Rushkin, Tracy Dana, Ian Blazina, Christina Bougatsos, Sara Grusing, Elizabeth A. O’Connor, Rongwei Fu, Roger Chou
Journal: JAMA (2020)

<h3>Importance</h3> Illicit drug use is among the most common causes of preventable morbidity and mortality in the US. <h3>Objective</h3> To systematically review the literature on screening and interventions for drug use to inform the US Preventive Services Task Force. <h3>Data Sources</h3> MEDLINE, PubMed, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials through September 18, 2018; literature surveillance through September 21, 2019. <h3>Study Selection</h3> Test accuracy studies to detect drug misuse and randomized clinical trials of screening and interventions to reduce drug use. <h3>Data Extraction and Synthesis</h3> Critical appraisal and data abstraction by 2 reviewers and random-effects meta-analyses. <h3>Main Outcomes and Measures</h3> Sensitivity, specificity, drug use and other health, social, and legal outcomes. <h3>Results</h3> Ninety-nine studies (N = 84 206) were included. Twenty-eight studies (n = 65 720) addressed drug screening accuracy. Among adults, sensitivity and specificity of screening tools for detecting unhealthy drug use ranged from 0.71 to 0.94 and 0.87 to 0.97, respectively. Interventions to reduce drug use were evaluated in 52 trials (n = 15 659) of psychosocial interventions, 7 trials (n = 1109) of opioid agonist therapy, and 13 trials (n = 1718) of naltrexone. Psychosocial interventions were associated with increased likelihood of drug use abstinence (15 trials, n = 3636; relative risk [RR], 1.60 [95% CI, 1.24 to 2.13]; absolute risk difference [ARD], 9% [95% CI, 5% to 15%]) and reduced number of drug use days (19 trials, n = 5085; mean difference, –0.49 day in the last 7 days [95% CI, –0.85 to –0.13]) vs no psychosocial intervention at 3- to 4-month follow-up. In treatment-seeking populations, opioid agonist therapy and naltrexone were associated with decreased risk of drug use relapse (4 trials, n = 567; RR, 0.75 [95% CI, 0.59 to 0.82]; ARD, –35% [95% CI, –67% to –3%] and 12 trials, n = 1599; RR, 0.73 [95% CI, 0.62 to 0.85]; ARD, –18% [95% CI, –26% to –10%], respectively) vs placebo or no medication. While evidence on harms was limited, it indicated no increased risk of serious adverse events. <h3>Conclusions and Relevance</h3> Several screening instruments with acceptable sensitivity and specificity are available to screen for drug use, although there is no direct evidence on the benefits or harms of screening. Pharmacotherapy and psychosocial interventions are effective at improving drug use outcomes, but evidence of effectiveness remains primarily derived from trials conducted in treatment-seeking populations.
FRI0436 ARTICULAR AND PERIARTICULAR INFECTIOUS DISEASES: REVIEW AND ANALYSIS OF A COHORT IN A 3RD LEVEL HOSPITAL
Authors: R. Dos Santos Sobrín, N. Pérez Gómez, E. Perez-Pampín, A. Souto Vilas, A. Mera Varela
Journal: Annals of the Rheumatic Diseases (2020)

Background: Infectious diseases in Rheumatology are still a prevalent healthcare issue nowadays. Microbiological tests and early beginning of antibiotic treatment are basic supportive therapy for those patients. In some cases, surgery is needed and it can involve prognostic features. Objectives: To analyze prognostic factors related to articular and periarticular infectious diseases. Methods: Patients hospitalized between January and December 2019 in Rheumatology Service (CHUS) and diagnosed of articular or periarticular infectious disease were enrolled. Demographic, clinical and therapeutic data were collected. Stata 15.1 was used to perform statistical analysis. Results: 21 patients diagnosed of articular or periarticular infectious disease were included (138 patients hospitalized in 2019). Mean age was 57,3 years old (SD 18,2) and 76,2% were males. One cardiovascular risk factor was achieved, at least, by 71,4% (arterial hypertension the most frequent, followed by hypercholesterolemia and hyperuricemia). Gram positive cocci were identified in 76,2% of patients ( Staphylococcus aureus in 47,6%, only one case oxacillin-resistant). A concomitant rheumatic disease was present in 4 patients (2 suffer from gout). No statistical association was found between this topic and acute-phase reactants (APR), complication rates or days of hospitalization. At hospitalization time, mean values of erythrocyte sedimentation rate (ESR) were 65,6 mm (SD 30,8) and C-reactive protein (CRP) 11,7 mg/dl (SD 7,7). Both have a positive association with days of hospitalization (r ESR =0,282 r CRP =0,424) and further, ESR demonstrates a positive correlation with this topic (CI95% -0,009 to 0,723 p=0,05569). Only 3 patients needed adjuvant surgery (articular infectious diseases with higher APR values). Surgery demonstrates a relationship statistically significant with articular involvement (t=-3,72 p=0,00), higher hospitalization rates (t=-2,51 p=0,02) and complication rates (Chi2=4,67 p=0,03 as decease, recurrence, bacteriemia, aftermath or soft tissue abscess). Conclusion: Gout is the main rheumatic disease associated, in this study, to infectious diseases of musculoskeletal system. As opposed, to suffer a rheumatic disease isn’t associate to a bad prognostic (hospitalization or complication rates). Furthermore, this cohort shows us the high prevalence of cardiovascular risk factors related with these diseases (hyperuricemia as predecessor of gout). Surgery intensifies as the main bad prognostic factor regarding days of hospitalization, complication rates and higher APR. References: [1]Morbimortality in adult patients with septic arthritis: a three-year hospital-based study. Ferrand J, et al . BMC Infect Dis 2016 [2]Predictors of treatment failure and mortality in native septic arthritis. Maneiro JR, et al . Clin Rheum 2014 Disclosure of Interests: None declared
68Ga-DOTATATE PET/MRI for Neuroendocrine Tumors
Authors: Nghi C. Nguyen, Chan-Hong Moon, Ashok Muthukrishnan, Alessandro Furlan
Journal: Clinical Nuclear Medicine (2020)

Abstract Neuroendocrine tumors (NETs) constitute a variety of neoplastic entities and exhibit variable degrees of neuroendocrine differentiation and phenotypes, as well as genetic profiles. 68 Ga-DOTATATE PET is a novel imaging technique for NET. Although PET/CT is commonly utilized for oncologic imaging, PET/MRI is particularly suited for NETs, as MRI provides greater soft tissue contrast than CT, allowing for improved detection and characterization of NETs, particularly when liver metastasis is suspected or needs to be ruled out. The current pictorial review aims to illustrate the complementary advantages, as well as pitfalls of 68 Ga-DOTATATE PET/MRI in the evaluation of NETs.
AB0474 CAROTID CONTRAST ENHANCED ULTRASOUND IN CASES OF TAKAYASU ARTERITIS COMPLICATED WITH BEHCET’S DISEASE
Authors: W. Fan, J. Zhu, P. Yu, L. Yu, X. Wang, X. Wei, D. Che
Journal: Annals of the Rheumatic Diseases (2020)

Background: Carotid contrast enhanced ultrasound (CEUS) is used for diagnosis and activity determination of patients with Takayasu’s arteritis (TA). However, very little is known about the carotid CEUS features of TA complicated with Behcet’s disease (BD). Objectives: This study reports the carotid CEUS features in cases of TA complicated with BD (TBD). Methods: A total of 10 carotid CEUS examinations were performed on 4 patients of TBD. 10 TA patients complicated with no rheumatoid disease were included as control group. For each carotid artery lesion, the carotid CEUS features was graded as follows: Grade 0, artery wall shows no microbubbles, Grade 1, artery wall shows limited or moderate microbubbles, Grade 2, artery wall shows severe microbubbles. Results: 2/10 patients in TBD group has oral ulcer during the CEUS examination, while all the other patients included in our study showed no clinical symptoms related to active TA or BD. The carotid wall thickness was greater of CEUS grade 2 than grade 1 in both group(TBD: 2.62±0.74mm vs 1.66±0.22mm, p =0.001; TA:1.84±0.31mm vs 1.53±0.5mm, p =0.136). The carotid wall thickness was significantly greater in TBD group than TA group, but there was no significant differences between the two groups in clinical data and CEUS grade (table 1). Table 1. Clinical data and carotid CEUS features of both groups TBD TA p Age (year) 32.5±3.44 30.5±9.2 0.487 Male 3 2 0.605 ESR (mm/h) 4(2, 10) 7(3.5, 11) 0.406 CRP (mg/L) 6.42(0.55, 15.38) 0.58(0.44, 5.05) 0.168 Wall thickness (mm) 2.10±0.70 1.67±0.44 0.030 CEUS grade 2 9 12 0.527 Conclusion: This study first shows carotid CEUS features in cases of TA complicated with BD, which may help with the comprehensive treatments of the disease. Disclosure of Interests: : None declared
Abstract 12017: Mechanisms Underlying Control of Cardiac Automaticity by the Cohesin Protein SGOL1
Authors: Donghai Liu, Xiaoyan Qi, Jiening Xiao, Gregor Andelfinger, Stanley Nattel
Journal: Circulation (2018)

Background: We (G.A.) have described a novel genetic syndrome, manifesting in children as severe cardiac dysrhythmia (often requiring pacemaker implantation) and pseudo megacolon. This chronic atri...
Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients With Coronavirus Disease 2019
Authors: Sravanthi Parasa, Madhav Desai, Viveksandeep Thoguluva Chandrasekar, Harsh K. Patel, Kevin F. Kennedy, Thomas Roesch, Marco Spadaccini, Matteo Colombo, Roberto Gabbiadini, Everson L. A. Artifon, Alessandro Repici, Prateek Sharma
Journal: JAMA Network Open (2020)

Coronavirus disease 2019 (COVID-19) is a global pandemic and can involve the gastrointestinal (GI) tract, including symptoms like diarrhea and shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces.To provide a pooled estimate of GI symptoms, liver enzyme levels outside reference ranges, and fecal tests positive for SARS-CoV-2 among patients with COVID-19.An electronic literature search was performed for published (using MEDLINE/PubMed and Embase) and preprint (using bioRxiv and medRxiv) studies of interest conducted from November 1, 2019, to March 30, 2020. Search terms included "COVID-19," "SARS-Cov-2," and/or "novel coronavirus."Eligible studies were those including patients with SARS-CoV-2 infection who reported GI symptoms.Data on patients with GI symptoms (ie, diarrhea, nausea, or vomiting), liver enzyme level changes, and fecal shedding of virus were extracted. Quality of studies was examined using methodological index for nonrandomized studies. Pooled estimates (%) were reported with 95% CIs with level of heterogeneity (I2).Study and patient characteristics with pooled detection rates for diarrhea, nausea or vomiting, liver enzyme levels outside reference ranges, and SARS-CoV-2 positivity in feces tests were analyzed.Of 1484 records reviewed, 23 published and 6 preprint studies were included in the analysis, with a total of 4805 patients (mean [SD] age, 52.2 [14.8] years; 1598 [33.2%] women) with COVID-19. The pooled rates were 7.4% (95% CI, 4.3%-12.2%) of patients reporting diarrhea and 4.6% (95% CI, 2.6%-8.0%) of patients reporting nausea or vomiting. The pooled rate for aspartate aminotransferase levels outside reference ranges was 20% (95% CI, 15.3%-25.6%) of patients, and the pooled rate for alanine aminotransferase levels outside reference ranges was 14.6% (95% CI, 12.8%-16.6%) of patients. Fecal tests that were positive for SARS-CoV-2 were reported in 8 studies, and viral RNA shedding was detected in feces in 40.5% (95% CI, 27.4%-55.1%) of patients. There was high level of heterogeneity (I2 = 94%), but no statistically significant publication bias noted.These findings suggest that that 12% of patients with COVID-19 will manifest GI symptoms; however, SAR-CoV-2 shedding was observed in 40.5% of patients with confirmed SARS-CoV-2 infection. This highlights the need to better understand what measures are needed to prevent further spread of this highly contagious pathogen.
Active case finding with case management: the key to tackling the COVID-19 pandemic
Authors: Zhongjie Li, Qiulan Chen, Luzhao Feng, Lance Rodewald, Yinyin Xia, Hailiang Yu, Ruochen Zhang, Zhijie An, Wenwu Yin, Wei Chen, Ying Qin, Zhibin Peng, Ting Zhang, Daxin Ni, Jinzhao Cui, Qing Wang, Xiaokun Yang, Muli Zhang, Xiang Ren, Dan Wu, Xiaojin Sun, Yuanqiu Li, Lei Zhou, Xiaopeng Qi, Tie Song, George F Gao, Zijian Feng, Zhongjie Li, Qiulan Chen, Luzhao Feng, Lance Rodewald, Yinyin Xia, Hailiang Yu, Ruochen Zhang, Wenwu Yin, Daxin Ni, Ying Qin, Ting Zhang, Jinzhao Cui, Qing Wang, Xiaokun Yang, Muli Zhang, Wei Chen, Zhibin Peng, Xiang Ren, Zhijie An, Dan Wu, Xiaojin Sun, Yuanqiu Li, Lei Zhou, Xiaopeng Qi, George F Gao, Zijian Feng, Tie Song, Huiming Luo, Zundong Yin, Liping Wang, Chao Ma, Shu Li
Journal: The Lancet (2020)
AB0318 CHARACTERISTICS OF PATIENTS WITH RHEUMATOID ARTHRITIS WHO HAVE WITHDRAWN THE LAST BIOLOGICAL DRUG: REAL-LIFE RESULTS FROM A LOCAL REGISTRY
Authors: J. Rosas, A. Pons, J. M. Senabre Gallego, G. Santos Soler, J. A. Bernal, J. A. García-Gómez, C. Cano, E. Ivars, M. Lorente Betoret, X. Barber
Journal: Annals of the Rheumatic Diseases (2020)

Objectives: To assess the characteristics of patients with rheumatoid arthritis (RA), who have withdrawn the last biological drug (bDMARD), and to know the reasons for withdrawal of treatment. Methods: Retrospective and cross-sectional study on December 31, 2019, of patients with RA, treated with any of the bDMARDs, including JAK (JAKi) inhibitor drugs, commonly used, from 1/1/2000 to 12/31/2019. General data were collected from patients, and RA: time of evolution, presence of rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPA), type of bDMARD, time in bDMARD, and cause of withdrawal. Results: Of 252 patients, who have received some bDMARD, 81 (32%) patients had withdrawn on 12/31/2019. 62 (77%) patients were women, with a mean age at diagnosis of RA of 48 years (SD: 16.5 years) and 59.5 (15) years at the beginning of the first bDMARD (F1), with an average evolution of RA 10.2 (2.5) years. 68% and 74% of patients were positive for RF and ACPA, respectively. In 64 (79%) patients, bDMARD was withdrawn as second to fifth bDMARD received (F2 to F5): as F2: 37/81 (46%) patients, F3: 14 (18%), F4: 8 (10%) and as F5: (6%) patients. When comparing the last bDMARD received, before the suspension as F1 vs F2-F5, 95% vs. 61% of patients (p &lt;0.0001), the drug was an anti-TNF (TNFi); Abatacept: 1 (1%) vs 9 (14%); Tocilizumab: 0% vs 8 (12%); Rituximab: 1 (1%) vs 5 (8%) and JAKi: 4 (5%) vs 3 (5%). The mean time in treatment with some bDMARD was 2.6 (SD: 3) years in the F1 group vs 1.7 (2) years in the F2-F5 group (p = 0.034). Among the F3-F5 patients, 9 (14%) patients had failed at 2 different previous therapeutic targets and 6 (9%) at 3 targets. No differences were detected between the F1 group vs F2-F5, regarding the causes of withdrawal of bDMARD: whether it had occurred due to 1) loss of efficacy (25/31% patients vs 19/30%); 2) adverse events (31/38% vs. 29/45%): infection: 18/81 (22%) patients, malignancy: 5 (6%), malaise/pain: 11 (14%), laboratory parameters alteration: 7 (9%), death: 5 (6%), others: 14 (17%); 3) change of address/loss of follow-up (20/25% vs. 7/11%) or by 4) voluntary abandonment of treatment by the patient (5/6% vs. 9/14%). Conclusion: 1. 32% of patients with RA withdraw the bDMARD. 2. The group treated with TNFi withdraws it significantly higher among the F1 group. 3. Survival of bDMARD is significantly higher in group F1 compared to F2-F5. 4. No differences were detected between the groups regarding the cause of withdrawal of bDMARD. 25% -30% of patients withdraw it due to loss of follow-up or voluntary abandonment of bDMARD. Acknowledgments: The study was supported by a research grant from the Association for Research in Rheumatology of the Marina Baixa (AIRE-MB). Disclosure of Interests: None declared
Treatment of Stage IV Colon Cancer in the United States: A Patterns-of-Care Analysis
Authors: Xiang Gao, Amanda R. Kahl, Paolo Goffredo, Albert Y. Lin, Praveen Vikas, Imran Hassan, Mary E. Charlton
Journal: Journal of the National Comprehensive Cancer Network (2020)

Background: National guidelines recommend chemotherapy as the mainstay of treatment for stage IV colon cancer, with primary tumor resection (PTR) reserved for patients with symptomatic primary or curable disease. The aims of this study were to characterize the treatment modalities received by patients with stage IV colon cancer and to determine the patient-, tumor-, and hospital-level factors associated with those treatments. Methods: Patients diagnosed with stage IV colon cancer in 2014 were extracted from the SEER Patterns of Care initiative. Treatments were categorized into chemotherapy only, PTR only, PTR + chemotherapy, and none/unknown. Results: The total weighted number of cases was 3,336; 17% of patients received PTR only, 23% received chemotherapy only, 41% received PTR + chemotherapy, and 17% received no treatment. In multivariable analyses, compared with chemotherapy only, PTR + chemotherapy was associated with being married (odds ratio [OR], 1.9), having bowel obstruction (OR, 2.55), and having perforation (OR, 2.29), whereas older age (OR, 5.95), Medicaid coverage (OR, 2.46), higher T stage (OR, 3.51), and higher N stage (OR, 6.77) were associated with PTR only. Patients who received no treatment did not have more comorbidities or more severe disease burden but were more likely to be older (OR, 3.91) and non-Hispanic African American (OR, 2.92; all P &lt;.05). Treatment at smaller, nonacademic hospitals was associated with PTR (± chemotherapy). Conclusions: PTR was included in the treatment regimen for most patients with stage IV colon cancer and was associated with smaller, nonacademic hospitals. Efforts to improve guideline implementation may be beneficial in these hospitals and also in non-Hispanic African American and older populations.
Single-cell transcriptomic architecture and intercellular crosstalk of human intrahepatic cholangiocarcinoma
Authors: Min Zhang, Hui Yang, Lingfei Wan, Zhaohai Wang, Haiyang Wang, Chen Ge, Yunhui Liu, Yajing Hao, Dongdong Zhang, Gaona Shi, Yandong Gong, Yanli Ni, Chaojie Wang, Yuan Zhang, Jiafei Xi, Sen Wang, Lei Shi, Lina Zhang, Wen Yue, Xuetao Pei, Bing Liu, Xinlong Yan
Journal: Journal of Hepatology (2020)

Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignancy. ICC typically features remarkable cellular heterogeneity and a dense stromal reaction. Therefore, a comprehensive understanding of cellular diversity and the interplay between malignant cells and niche cells is essential to elucidate the mechanisms driving ICC progression and to develop therapeutic approaches.Herein, we performed single-cell RNA sequencing (scRNA-seq) analysis on unselected viable cells from 8 human ICCs and adjacent samples to elucidate the comprehensive transcriptomic landscape and intercellular communication network. Additionally, we applied a negative selection strategy to enrich fibroblast populations in 2 other ICC samples to investigate fibroblast diversity. The results of the analyses were validated using multiplex immunofluorescence staining, bulk transcriptomic datasets, and functional in vitro and in vivo experiments.We sequenced a total of 56,871 single cells derived from human ICC and adjacent tissues and identified diverse tumor, immune, and stromal cells. Malignant cells displayed a high degree of inter-tumor heterogeneity. Moreover, tumor-infiltrating CD4 regulatory T cells exhibited highly immunosuppressive characteristics. We identified 6 distinct fibroblast subsets, of which the majority were CD146-positive vascular cancer-associated fibroblasts (vCAFs), with highly expressed microvasculature signatures and high levels of interleukin (IL)-6. Functional assays indicated that IL-6 secreted by vCAFs induced significant epigenetic alterations in ICC cells, particularly upregulating enhancer of zeste homolog 2 (EZH2) and thereby enhancing malignancy. Furthermore, ICC cell-derived exosomal miR-9-5p elicited high expression of IL-6 in vCAFs to promote tumor progression.Our single-cell transcriptomic dataset delineates the inter-tumor heterogeneity of human ICCs, underlining the importance of intercellular crosstalk between ICC cells and vCAFs, and revealing potential therapeutic targets.Intrahepatic cholangiocarcinoma is an aggressive and chemoresistant malignancy. Better understanding the complex transcriptional architecture and intercellular crosstalk of these tumors will help in the development of more effective therapies. Herein, we have identified important interactions between cancer cells and cancer-associated fibroblasts in the tumor stroma, which could have therapeutic implications.
James Gowans: immunologist whose research revealed the crucial role of lymphocytes in the immune response
Authors: Rebecca Wallersteiner
Journal: BMJ (2020)

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Photo credit: Lucy Neal

James Learmonth Gowans (“Jim”) was born in Sheffield to parents John, a technician in a hospital pathology laboratory, and Selma (nee Ljung). He attended the Whitgift Middle School in Croydon, where he shone academically.

While at medical school he assisted in the newly liberated Bergen-Belsen concentration camp as a voluntary medical student. In 1948 he obtained a first class honours degree in physiology at Lincoln College, Oxford, and then remained at Oxford to take a DPhil on lymphocytes with Howard (later Lord) Florey at the Sir William Dunn School of Pathology.

In the summer of 1949, he was admitted to hospital with tuberculosis and spent nearly four months as an inpatient. Interviewed nearly 50 years later, Gowans recalled, “A friend brought me a brass telescope and a birdwatching book, and as my bed was wheeled outside for fresh air every day I could sit there all day long, watching the birds, and that interest has stayed with me. I also read a lot.” After his discharge, Gowans travelled to Cornwall and spent the winter convalescing at the St Christopher’s Hotel in Penzance. There he befriended the wife of the artist Terry Frost, who worked in the kitchen, and found himself in the middle of a thriving artists’ colony. He remembered sitting in the kitchen as Barbara Hepworth and Ben Nicholson and other artists dropped by for tea. Thankfully he never had a recurrence of the tuberculosis.

Gowans then spent a year as a Medical Research Council (MRC) exchange scholar at the Pasteur Institute in Paris, where he forged friendships and developed his interest in infection and immunity, before returning to Oxford. …
Nutrition Regulates Innate Immunity in Health and Disease
Authors: Samuel Philip Nobs, Niv Zmora, Eran Elinav
Journal: Annual Review of Nutrition (2020)

Nutrient content and nutrient timing are considered key regulators of human health and a variety of diseases and involve complex interactions with the mucosal immune system. In particular, the innate immune system is emerging as an important signaling hub that modulates the response to nutritional signals, in part via signaling through the gut microbiota. In this review we elucidate emerging evidence that interactions between innate immunity and diet affect human metabolic health and disease, including cardiometabolic disorders, allergic diseases, autoimmune disorders, infections, and cancers. Furthermore, we discuss the potential modulatory effects of the gut microbiota on interactions between the immune system and nutrition in health and disease, namely how it relays nutritional signals to the innate immune system under specific physiological contexts. Finally, we identify key open questions and challenges to comprehensively understanding the intersection between nutrition and innate immunity and how potential nutritional, immune, and microbial therapeutics may be developed into promising future avenues of precision treatment.