False Elevation of Volume Determined by Bladder Scanner Secondary to Bowel Obstruction

Bladder scanners allow for quick determination of bladder volumes (BV) with minimal training. BV measured by a machine is generally accurate; however, circumstances exist in which falsely elevated BVs are reported. This case details a patient with a significant small bowel obstruction (SBO) due to superior mesenteric artery syndrome causing a falsely elevated BV. We believe this is the first case report of a SBO causing an elevated BV by bladder scanner. Emergency physicians should be aware of the pitfalls of using bladder scanners, and use their point-of-care ultrasound skills when possible to expand their differential

Randomized control trial of Teaching Recovery Techniques in rural occupied Palestine:Effect on adolescent dissociation

The current study assessed the effect of a cognitive behavioral group intervention, Teaching Recovery Techniques (TRT), for adolescents with high levels of posttraumatic stress (n = 154), from villages in occupied Palestine. A randomized control trial involved standardized measures to assess war stressors, posttraumatic stress, depression, and dissociation. Program fidelity was measured by presenter and observer ratings and program delivery cost was calculated per adolescent. High levels of traumatic exposure, dissociation, and posttraumatic stress were found. In comparison to a Wait List group (n = 75), TRT adolescents reported significantly fewer posttraumatic stress symptoms post-intervention. Depression and dissociation remained stable for TRT adolescents, but worsened for Wait List. Given the high returns and low costs, this costbenefit analysis makes a clear case for TRT to be delivered throughout the West Bank. Longitudinal evaluation is needed to assess adolescent traumatization and the impact of TRT within a context of ongoing violence.<br/

Synergistic anticancer effect of combination treatment of vitamin D and pitavastatin on the HCC1937 breast cancer cells

Vitamin D (Vit D) has anticancer properties including activating cell senescence inhibiting cancer cell proliferation, inducing apoptotic cell death, and decreasing cancer cell migration. On the other hand, statins showed favorable anticancer activities including anti-survival, anti-proliferation, and anti-migration effects. The current study aimed to investigate the synergistic anticancer effect of Vit D and statins against HCC1937 triple-negative breast cancer cells. The antiproliferative effect was tested by MTT assay after 48 hours of the treatments. Trypan blue test and clonogenic assay were used to test the anti-survival activities of the treatments. The ability of the treatments to inhibit the migration ability was tested by scratch assay. Levels of the cell cycle and apoptotic markers were determined by western blotting. Results of the study revealed that all the tested compounds including Vit D, atorvastatin (Ator), simvastatin (Simv), and pitavastatin (Pita) inhibited HCC1937 breast cancer cell growth with different IC50 values ranging from 4.49-12.95 µM. Combined application of Pita and Vit D showed potent synergistic antiproliferative activities against HCC1937 breast cancer cells. The combined therapy of (1µM Vit D and 2 µM Pita) inhibited HCC1937 cell proliferation by cell cycle arrest and apoptosis as evidenced by increasing p21, p53, and cleaved PARP. Finally, the combined treatment decreased the p-STAT3 level in HCC1937 breast cancer cells. The results of the study can be concluded that the combined treatment of Pita and Vit D has a synergistic anticancer effect against HCC1937 breast cancer cells

False Elevation of Volume Determined by Bladder Scanner Secondary to Bowel Obstruction

Bladder scanners allow for quick determination of bladder volumes (BV) with minimal training. BV measured by a machine is generally accurate; however, circumstances exist in which falsely elevated BVs are reported. This case details a patient with a significant small bowel obstruction (SBO) due to superior mesenteric artery syndrome causing a falsely elevated BV. We believe this is the first case report of a SBO causing an elevated BV by bladder scanner. Emergency physicians should be aware of the pitfalls of using bladder scanners, and use their point-of-care ultrasound skills when possible to expand their differential

Synergistic anticancer effect of combination treatment of vitamin D and pitavastatin on the HCC1937 breast cancer cells

Vitamin D (Vit D) has anticancer properties including activating cell senescence inhibiting cancer cell proliferation, inducing apoptotic cell death, and decreasing cancer cell migration. On the other hand, statins showed favorable anticancer activities including anti-survival, anti-proliferation, and anti-migration effects. The current study aimed to investigate the synergistic anticancer effect of Vit D and statins against HCC1937 triple-negative breast cancer cells. The antiproliferative effect was tested by MTT assay after 48 hours of the treatments. Trypan blue test and clonogenic assay were used to test the anti-survival activities of the treatments. The ability of the treatments to inhibit the migration ability was tested by scratch assay. Levels of the cell cycle and apoptotic markers were determined by western blotting. Results of the study revealed that all the tested compounds including Vit D, atorvastatin (Ator), simvastatin (Simv), and pitavastatin (Pita) inhibited HCC1937 breast cancer cell growth with different IC50 values ranging from 4.49-12.95 µM. Combined application of Pita and Vit D showed potent synergistic antiproliferative activities against HCC1937 breast cancer cells. The combined therapy of (1µM Vit D and 2 µM Pita) inhibited HCC1937 cell proliferation by cell cycle arrest and apoptosis as evidenced by increasing p21, p53, and cleaved PARP. Finally, the combined treatment decreased the p-STAT3 level in HCC1937 breast cancer cells. The results of the study can be concluded that the combined treatment of Pita and Vit D has a synergistic anticancer effect against HCC1937 breast cancer cells.</jats:p

SAT0550 Remaining Pain in Early RA Patients Treated with Methotrexate – Results from the Eira Cohort and the Swedish Rheumatology Quality Register

Background Although treatment with methotrexate is efficient in decreasing inflammation and joint destruction in RA, several patients report remaining pain at follow-up, and the potential discrepancy between decrease in inflammation and pain needs to be explored further. Objectives We investigated the frequency and possible predictors of remaining pain after 3 months treatment with MTX as the only DMARD treatment in early RA, with special focus on the patients who had a good clinical response to MTX. Methods The study base was cases reported to the Environmental investigation of RA (EIRA) cohort 1996-2009 who had follow-up data in the Swedish Rheumatology Quality Register (1996-2010), a total of 1241 patients (69% women). Disease activity was measured with the 28-joint based disease activity score (DAS28) and the EULAR response criteria were used to evaluate clinical response to treatment. The primary endpoint was ‘remaining pain’ at the 3 months follow-up visit, defined as pain according to a 100 mm visual analog scale above 20 mm (VAS pain >20 mm), which has earlier been stated as a cutoff for patient reported significant pain (Ref Wolfe J Rheumatol 2007). The association between baseline parameters and remaining pain was evaluated by logistic regression and expressed as odds ratios (OR) with 95% confidence interval (95%CI), adjusted for age at onset/treatment start, gender and cigarette smoking status. Results Median VAS-pain was 54 mm at baseline and 25 mm at the 3 months follow-up visit. Remaining pain was observed in 57% of all patients at the 3 months follow-up. The frequency of EULAR good/moderate/no response was 40%/38%/22% respectively, and in these response groups, the frequency of remaining pain was 29%/70%/83% respectively. In the EULAR good responder group (n=421), remaining pain was associated with more disability, measured as higher baseline HAQ (adjusted OR 2.2, 95%CI=1.4-3.4 per unit increase) and less inflammation, measured as lower baseline erythrocyte sedimentation rate, ESR (adjusted OR 0.81; 95%CI=0.70-0.93 per 10 mm increase). In line with this, patients who were EULAR good responders and had a remaining pain at follow-up exhibited lower ESR (p<0.02), and higher HAQ (p<0.02) at baseline compared to patients with less pain. Moreover, increase in VAS pain during the treatment period was observed in 19% of the whole cohort and frequencies of increased pain in the response groups were 9%/15%/45% respectively Conclusions Majority of early RA patients starting methotrexate monotherapy at diagnosis have remaining pain after 3 months. Further, almost 1/5 of the patients actually exhibit increase in VAS pain during treatment. Despite good response to methotrexate, almost a third of those patients have remaining pain, and in moderate responders, more than two thirds of the patients have remaining pain. Remaining pain despite a good response to MTX is associated with more disability and less inflammation at baseline. These results are in line with the hypothesis that a subgroup of early RA patients exhibit pain that is not inflammatory mediated and where alternative treatment strategies can be discussed. References Wolfe J Rheumatol 2007 Disclosure of Interest None Declare