bluuebunny/crossref_metadata_2025 huggingface dataset:
Vital exhaustion and risk of myocardial infarction in male population aged 25- 64 years in Russia/Siberia. Epidemiological program WHO Monica-psychosocial
Authors: Gafarov V , Gromova E , Panov D , Gagulin I , Gafarova A
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose

To determine the effect of vital exhaustions (VE) on risk of myocardial infarction (MI) in male population aged 25-64 years in Russia/Siberia.

Methods

Within the framework of WHO program MONICA-psychosocial a representative sample of men 25-64 years was examined in 1994 year in Novosibirsk. Total sample of 657 males were measured for VE symptoms at baseline with the use of the MONICA - psychosocial Interview - Vital Exhaustion scale. The incidence of new-onset MI cases was revealed over 14-years of follow-up in frame budgetary issue # AAAA-A17-117112850280-2. Cox - proportional regression model was used for an estimation of hazard ratio (HR).

Results

Prevalence of VE in cohort of men with AH was 73.7%. 58% men had high level of VE and 15.7% - an average level of VE. The risk MI incidence over the first 5 years of follow-up in a group with VE was 2.7-fold higher compare o those without VE.  Within 10 years HR = 2.25, within 14 years HR = 2,1 for males with VE (p for all <0.05). In the multivariate Cox regression model after controlling for social factors (education, occupation, marital status) and age, the influence of vital exhaustion on MI risk decreased but remained statistically significant HR = 1.16 (p <0.05). Marital status as divorced and primary degree (elementary school) increased risk of MI more significantly in men with VE.

Conclusions

Vital exhaustion is a predictor of higher risk of MI in middle-age men. Level of MI risk influenced by social gradient.
Impact of dual antiplatelet non-adherence after percutaneous coronary intervention in patients with or without history of myocardial infarction
Authors: Chiarito M , Baber U , Cao D , Zhang Z , Nicholas J , Nardin M , Steg PG , Colombo A , Dangas G , Pocock S , Mehran R
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

PARIS (patterns of non-adherence to antiplatelet regimen in stented patients)

INTRODUCTION

In patients with myocardial infarction (MI) predisposition to atherothrombosis may persist for years, and prolonged DAPT could be beneficial in these high-risk group. Similarly, premature dual antiplatelet therapy (DAPT) cessation seems to increase the risk of adverse events after percutaneous coronary intervention (PCI). If DAPT non-adherence could have an enhanced impact on prognosis in patients with prior MI is still an uncharted territory.

METHODS

in this  prospective, observational, multicentre registry we enrolled all patients undergoing PCI with stent implantation in 15 clinical sites in USA and Europe and discharged with DAPT. Prespecified categories for DAPT cessation included physician recommended discontinuation, brief interruption (for surgery), or disruption (non-compliance or because of bleeding). Using Cox models with time-varying covariates, we examined the effect of DAPT cessation on major adverse cardiac events (MACE, primary endpoint, composite of cardiac death, definite or probable stent thrombosis, myocardial infarction, or target-lesion revascularization), its single components, and if patients with prior MI had different rate of DAPT cessation or MACE.

RESULTS

patients with prior MI (n = 1214; 24.2%) presented more often with cardiovascular risk factors compared to patients without prior MI (n = 3804, 75.8%). Interruption rate was similar among the two groups. Patients with prior MI had lower rate of any DAPT discontinuation and disruption compared to patients without prior MI. This notwithstanding, patients with prior MI had increased 2-year rates of MACE (adjusted hazard ratio 1.41, 95% confidence interval 1.20 - 1.67) and its single components (with the exception of definite or probable stent thrombosis), irrespective of DAPT non-adherence (p interaction= 0.983).

CONCLUSION

in this real world cohort of patients undergoing PCI with stent implantation, patients with prior MI, despite lower rate of DAPT non-adherence, had worse prognosis than patients without prior MI. New antithrombotic strategies are needed to improve the bleeding/ischemic trade-off in patients with prior MI and their outcome after PCI.
Patient-reported experiences and preferences with intraoral scanners: a systematic review
Authors: Christopoulou Isidora , Kaklamanos Eleftherios G , Makrygiannakis Miltiadis A , Bitsanis Ilias , Tsolakis Apostolos I
Published: April 2021

Background

Intraoral scanners have become an increasingly popular alternative to conventional impression methods. Although their accuracy and validity have been examined thoroughly, patient-reported information including experiences, preferences, and satisfaction has not yet been investigated in a systematic way.

Objective

The objective of this systematic review is to investigate the available data and appraise the evidence on patient-reported experiences and preferences following impression taking with intraoral scanners.

Search methods

Unrestricted search of seven databases (Pubmed, CENTRAL, Cochrane reviews, Scopus, Web of Science, Clinical Trials, and ProQuest) and grey literature were conducted until October 2020. Detailed search strategies were developed for each database.

Selection criteria

Studies involving individuals of any gender or age, subjected to full arch impression taking with conventional and intraoral scanning methods were eligible for inclusion.

Data collection and analysis

Following the retrieval and selection of the studies, data extraction was performed. Risk of bias assessment was performed using the RoB 2 and ROBINS-I tools.

Results

From the initially identified records, nine studies [eight crossover (two of them randomized) and one parallel group] were eventually included in the present systematic review. Randomized studies were shown, overall, to have some concerns regarding bias, whereas the non-randomized studies were found to be at serious risk, mainly because of bias due to confounding. All studies demonstrated some benefit in favour of intraoral scanning compared with conventional techniques. More positive feelings were generally observed with the intraoral scanners regarding smell, taste, sound, vibration, nausea, and queasiness. Overall, comfort assessment mostly favoured digital methods. No differences were found concerning the level of anxiety between the two methods. Among the included studies, time perception was a parameter leading to contradictory results.

Limitations

These emerge due to the nature and characteristics of the information retrieved from the included studies. The validation of the instruments to capture patient-reported outcomes needs to be further elaborated.

Conclusions

Intraoral scanners seem to be a promising new asset in the orthodontic office from the perspective of individuals’ experiences and preferences. Nevertheless, to investigate patient-reported outcomes correctly, further high-quality studies are required in the future.

Registration

Open Science Framework (https://osf.io/ayug2/)
The Effect of Photos and a Local-Sounding Name on Discrimination against Ethnic Minorities in Austria. A Field Experiment
Authors: Weichselbaumer Doris , Schuster Julia
Published: April 2021

A large body of research documents the existence of discrimination against migrants and ethnic minorities in the labour market. This study experimentally investigates for Austria, to what degree employment discrimination against ethnic minorities is mitigated, when they abstain from following the Austrian norm of including a photograph to their job application that would make their ethnicity salient or when they hold a local-sounding name. We apply social identity theory to explain why such mitigation may occur. In our correspondence test, using a single application design, we found that with matching ethnic names and ethnic photographs, black but not Asian job applicants suffered from discrimination. Discrimination was reduced for blacks (but not Asians) when they held a local-sounding name. Although photographs may facilitate ethnic discrimination, we did not find that their omission improved minorities’ relative employment chances. On the contrary, Asians were penalized for leaving out their photograph. Indeed, if candidates did not attach photos despite the convention to do so, we found statistically significant discrimination not only against black, but also Asian applicants.
Earnings and Income Penalties for Motherhood: Estimates for British Women Using the Individual Synthetic Control Method
Authors: Vagni Giacomo , Breen Richard
Published: April 2021

Using data from the British Household Panel Survey and focusing on women who became mothers between 1995 and 2005, we estimate the motherhood penalty for women’s own earnings and for the total income of their household: that is, we consider the extent to which motherhood carries a penalty not only for a mother but also for her family. We adopt an approach that differs from those previously employed in research on motherhood penalties: we follow Hernán and Robins, setting up our data as a ‘target trial’, and we analyse it using the Individual Synthetic Control method, based on the Synthetic Control approach of Abadie, Diamond and Hainmueller. We find considerable variation in the effect of motherhood on British women’s earnings, but the median penalty is a reduction in medium- and long-term earnings by about 45 per cent relative to what women would have earned if they had remained childless. Motherhood has no effect on average on the income of the woman’s household, but has substantial negative effects for some households. Focusing on both individual and household penalties yields a more complete picture of the distributional consequences of motherhood than hitherto.
Migration, Class Attainment and Social Mobility: An Analysis of Migrants’ Socio-Economic Integration in Italy
Authors: Panichella Nazareno , Avola Maurizio , Piccitto Giorgio
Published: April 2021

This article focuses on the socio-economic integration of ethnic minorities in Italy, combining the literature on migration with research on social stratification. We analyse the ethnic penalty on occupational attainment and career mobility, integrating the origin–education–destination theoretical framework with the migration status. Since ethnic penalty is an ‘umbrella concept’, we also quantify the extent to which it is mediated by differences in education and social origin. Furthermore, adopting a diachronic view of migrants’ class attainment, we verify whether the post-migration downgrading is followed by a recovery during the career, considering also mobility within the working class (standard and non-standard). Our analyses are based on the Multipurpose Survey on Households and Social Condition and Integration of Foreign Citizens. The results show that migrants are penalized in the Italian labour market, remaining largely ‘trapped’ in the working class. This inclusion at the bottom of the class structure reduces their heterogeneity by education and by social origin. Moreover, their penalty increases during the career, except when they move from the non-standard to the standard working class. Finally, we find that the ‘unexplained’ component of ethnic penalty, net of education and social origin, is substantial and increases from the first to the current job.
Sociodemographic features and patterns of non-participation in colorectal cancer screening in Finland
Authors: Jäntti Maija , Heinävaara Sirpa , Malila Nea , Sarkeala Tytti
Published: April 2021

Background

Colorectal cancer (CRC) screening was run as a randomized health services programme in Finland between 2004 and 2016. This study evaluates sociodemographic features and patterns of non-participation among men and women invited to be screened.

Methods

The study population in this register-based study includes 233 211 men and women invited to guaiac faecal occult blood test screening on consecutive screening rounds (n = 708 621 invitations). A generalized estimating equation (GEE) was used to estimate incidence rate ratios (IRR) between sociodemographic features and non-participation.

Results

The overall proportion of non-participation was 31.6% and was higher in men (38.8%) than in women (24.6%). Birth cohort, education, marital status and country of birth were associated with non-participation. The birth cohort of 1950–54 was less likely to participate than the birth cohort of 1940–44. Men and women with primary education were more likely non-participants (IRR 1.26, CI 1.23–1.29 and IRR 1.22, CI 1.18–1.26, respectively) than men or women with tertiary education. Further, unmarried persons and immigrants had an increased risk of non-participation. Initial non-participation predicted subsequent behaviour, since, e.g. ∼80% of first-round non-participants also remained non-participants in the second round.

Conclusion

Education, gender and marital status had a significant effect on non-participation in the CRC screening programme. As high and comprehensive participation is essential for a successful screening programme, attention should be paid in ensuring participation of all sociodemographic groups. Special efforts should be invested in those not participating in the first invitational round, since initial non-participation predicts non-participation to subsequent invitations.
Discriminative-Stimulus Effects of Synthetic Cathinones in Squirrel Monkeys
Authors: Wakeford Alison G P , Sherwood Alexander M , Prisinzano Thomas E , Bergman Jack , Kohut Stephen J , Paronis Carol A
Published: April 2021

Background

Synthetic cathinones display overlapping behavioral effects with psychostimulants (e.g., methamphetamine [MA]) and/or entactogens (e.g., 3,4-methylenedioxymethaphetamine [MDMA])—presumably reflecting their dopaminergic and/or serotonergic activity. The discriminative stimulus effects of MDMA thought to be mediated by such activity have been well characterized in rodents but have not been fully examined in nonhuman primates.

Methods

The present studies were conducted to systematically evaluate the discriminative stimulus effects of 5 abused synthetic cathinones (methylenedioxypyrovalerone [MDPV], α-pyrrolidinovalerophenone [α-PVP], methcathinone [MCAT], mephedrone, and methylone) in adult male squirrel monkeys trained to distinguish intramuscular injections of MA (0.1 mg/kg; n = 4) or MDMA (0.6 mg/kg; n = 4) from vehicle.

Results

Each training drug produced dose-dependent effects and, at the highest dose, full substitution. MDMA produced predominantly vehicle-like responding in the MA-trained group, whereas the highest dose of MA (0.56 mg/kg) produced partial substitution (approximately 90% appropriate lever responding in one-half of the subjects) in the MDMA-trained group. MDPV, α-PVP, and MCAT produced full substitution in MA-trained subjects, but, at the same or higher doses, only substituted for MDMA in one-half of the subjects, consistent with primarily dopaminergically mediated interoceptive effects. In contrast, mephedrone and methylone fully substituted in MDMA-trained subjects but failed to fully substitute for the training drug in MA-trained subjects, suggesting a primary role for serotonergic actions in their interoceptive effects.

Conclusions

These findings suggest that differences in the interoceptive effects of synthetic cathinones in nonhuman primates reflect differing compositions of monoaminergic actions that also may mediate their subjective effects in humans.
The brain–gut axis, inflammatory bowel disease and bioelectronic medicine
Authors: Eberhardson Michael , Levine Yaakov A , Tarnawski Laura , Olofsson Peder S
Published: April 2021

The hallmark of inflammatory bowel diseases (IBD) is chronic intestinal inflammation with typical onset in adolescents and young adults. An abundance of neutrophils is seen in the inflammatory lesions, but adaptive immunity is also an important player in the chronicity of the disease. There is an unmet need for new treatment options since modern medicines such as biological therapy with anti-cytokine antibodies still leave a substantial number of patients with persisting disease activity. The role of the central nervous system and its interaction with the gut in the pathophysiology of IBD have been brought to attention both in animal models and in humans after the discovery of the inflammatory reflex. The suggested control of gut immunity by the brain–gut axis represents a novel therapeutic target suitable for bioelectronic intervention. In this review, we discuss the role of the inflammatory reflex in gut inflammation and the recent advances in the treatment of IBD by intervening with the brain–gut axis through bioelectronic devices.
The Common Bed Bug (Hemiptera: Cimicidae) Does Not Commonly Use Canines and Felines as a Host in Low-Income, High-Rise Apartments
Authors: Black M K , Chandler J G , Trout Fryxell R T , Vail K M
Published: April 2021

The common bed bug (Cimex lectularius L.) is a known pest and an obligate blood-feeding ectoparasite. Bed bugs can feed on warm-blooded animals including humans, bats, poultry, and rabbits, but no research has investigated the use of companion animals (canines and/or felines) as a blood source. This study investigates how long known host DNA could be detected in a bed bug and the prevalence of bed bugs feeding on companion animals. Laboratory-reared bed bugs were fed host blood to determine how long DNA of human, feline, canine, and rabbit blood could be detected up to 21 d postfeeding. Additionally, 228 bed bugs were collected from 12 apartments with pets (6: canine, 5: feline, and 1: canine and feline), characterized as engorged or unengorged, and then screened with host-specific primers to identify the bloodmeal. Host meals of human, rabbit, feline, and canine blood were detected up to 21 d after feeding laboratory strains. All bed bugs died after feeding on the canine blood, but DNA could be detected up to 21 d post feeding/death. Of the field-collected bed bugs analyzed, human DNA was amplified in 158 (69.3%) bed bugs, canine DNA amplified in 7 bed bugs (3.1%), and feline DNA amplified in 1 bed bug (0.4%). Results of this study suggest that bed bugs predominately feed on humans and rarely feed on companion animals when they cohabitate in low-income, high-rise apartments. Additionally, results from this study warrant future investigations into host use by bed bugs in different housing structures and socioeconomic environments.
The role of amino acid metabolism in signaling and metabolic adaptation to stress-induced energy deficiency in plants
Authors: Heinemann Björn , Hildebrandt Tatjana M
Published: April 2021

The adaptation of plant metabolism to stress-induced energy deficiency involves profound changes in amino acid metabolism. Anabolic reactions are suppressed, whereas respiratory pathways that use amino acids as alternative substrates are activated. This review highlights recent progress in unraveling the stress-induced amino acid oxidation pathways, their regulation, and the role of amino acids as signaling molecules. We present an updated map of the degradation pathways for lysine and the branched-chain amino acids. The regulation of amino acid metabolism during energy deprivation, including the coordinated induction of several catabolic pathways, is mediated by the balance between TOR and SnRK signaling. Recent findings indicate that some amino acids might act as nutrient signals in TOR activation and thus promote a shift from catabolic to anabolic pathways. The metabolism of the sulfur-containing amino acid cysteine is highly interconnected with TOR and SnRK signaling. Mechanistic details have recently been elucidated for cysteine signaling during the abscisic acid-dependent drought response. Local cysteine synthesis triggers abscisic acid production and, in addition, cysteine degradation produces the gaseous messenger hydrogen sulfide, which promotes stomatal closure via protein persulfidation. Amino acid signaling in plants is still an emerging topic with potential for fundamental discoveries.
Black swans in astronomical data
Authors: Kipping David
Published: April 2021

Astronomy has always been propelled by the discovery of new phenomena lacking precedent, often followed by new theories to explain their existence and properties. In the modern era of large surveys tiling the sky at ever high precision and sampling rates, these serendipitous discoveries look set to continue, with recent examples including Boyajian’s Star, Fast Radio Bursts, and ‘Oumuamua. Accordingly, we here look ahead and aim to provide a statistical framework for interpreting such events and providing guidance to future observations, under the basic premise that the phenomenon in question stochastically repeat at some unknown, constant rate, λ. Specifically, expressions are derived for (1) the a posteriori distribution for λ, (2) the a posteriori distribution for the recurrence time, and, (3) the benefit-to-cost ratio of further observations relative to that of the inaugural event. Some rule-of-thumb results for each of these are found to be (1) $\lambda \lt \lbrace 0.7, 2.3, 4.6\rbrace \, t_1^{-1}$ to $\lbrace 50, 90, 95\rbrace {{\ \rm per\ cent}}$ confidence (where t1 = time to obtain the first detection), (2) the recurrence time is $t_2 \lt \lbrace 1, 9, 99\rbrace \, t_1$ to $\lbrace 50, 90, 95\rbrace {{\ \rm per\ cent}}$ confidence, with a lack of repetition by time t2 yielding a p-value of 1/[1 + (t2/t1)], and, (3) follow-up for $\lesssim 10\, t_1$ is expected to be scientifically worthwhile under an array of differing assumptions about the object’s intrinsic scientific value. We apply these methods to the Breakthrough Listen Candidate 1 signal and tidal disruption events observed by TESS.
Apostasy in the Baltic Provinces: Religious and National Indifference in Imperial Russia
Authors: Gibson Catherine , Paert Irina
Published: April 2021

There has been a rich body of scholarship in recent years that challenges the accepted idea of the spread of nationalist thinking in the late nineteenth and early twentieth centuries by highlighting the flexible, ambiguous, opportunistic or instrumental ways in which the inhabitants of central and eastern Europe engaged with ideas about nationhood. However, so far these discussions of ‘national indifference’ have not extensively examined the crossovers with flexible and ambivalent attitudes and actions regarding matters of religion, such as oscillating religious commitment, hybrid forms of religiosity and conversion. This article examines cases of conversion and reconversion (apostasy) between Lutheranism and Orthodoxy in the Baltic provinces of the Russian empire in the second half of the nineteenth century, in order to deepen our understanding of how institutionally determined forms of religious ascription often became blurred at the level of everyday activities as people exercised choice over matters of faith for various personal, social and economic reasons. By extending the concept of national indifference through an examination of religious indifference, the cases under consideration elucidate how confession became entangled with ideas about national and imperial belonging in the late nineteenth century.
C

YTO

K

ININ-RESPONSIVE

G

ROWTH REGULATOR regulates cell expansion and cytokinin-mediated cell cycle progression
Authors: Park Joonghyuk , Lee Seungchul , Park Geuntae , Cho Hyunwoo , Choi Daeseok , Umeda Masaaki , Choi Yeonhee , Hwang Daehee , Hwang Ildoo
Published: April 2021

The cytokinin (CK) phytohormones have long been known to activate cell proliferation in plants. However, how CKs regulate cell division and cell expansion remains unclear. Here, we reveal that a basic helix–loop–helix transcription factor, CYTOKININ-RESPONSIVE GROWTH REGULATOR (CKG), mediates CK-dependent regulation of cell expansion and cell cycle progression in Arabidopsis thaliana. The overexpression of CKG increased cell size in a ploidy-independent manner and promoted entry into the S phase of the cell cycle, especially at the seedling stage. Furthermore, CKG enhanced organ growth in a pleiotropic fashion, from embryogenesis to reproductive stages, particularly of cotyledons. In contrast, ckg loss-of-function mutants exhibited smaller cotyledons. CKG mainly regulates the expression of genes involved in the regulation of the cell cycle including WEE1. We propose that CKG provides a regulatory module that connects cell cycle progression and organ growth to CK responses.
Genomic reconfiguration in parasitic plants involves considerable gene losses alongside global genome size inflation and gene births
Authors: Lyko Peter , Wicke Susann
Published: April 2021

Parasitic plant genomes and transcriptomes reveal numerous genetic innovations, the functional-evolutionary relevance and roles of which open unprecedented research avenues.
A formative approach to the evaluation of Transformative Innovation Policies
Authors: Molas-Gallart Jordi , Boni Alejandra , Giachi Sandro , Schot Johan
Published: April 2021

Transformative Innovation Policies (TIPs) assert that addressing the key challenges currently facing our societies requires profound changes in current socio-technical systems. To leverage such ‘socio-technical transitions’ calls for a different, broad mix of research and innovation policies, with particular attention being paid to policy experiments. As TIPs diffuse and gain legitimacy they pose a substantial evaluation challenge: how can we evaluate these policy experiments with a narrow geographical and temporal scope, when the final objective is ambitiously systemic? How can we know whether a specific set of policy experiments is contributing to systemic transformation? Drawing on TIPs principles as developed by and applied in the activities of the Transformative Innovation Policy Consortium and on the concept of transformative outcomes, this article develops an approach to the evaluation of TIPs that is operational and adaptable to different contexts.
O03 Prevalence of fragility fractures and medication prescription for osteoporosis in patients with polymyalgia rheumatica: results from the PMR Cohort Study
Authors: Sokhal Balamrit Singh , Hider Samantha L , Paskins Zoe , Mallen Christian D , Muller Sara
Published: April 2021

Background/Aims 

Polymyalgia rheumatica (PMR) is one of the commonest indications for long term glucocorticoid (GC) use, leading to an increased risk of osteoporosis and fragility fractures. Clinical guidelines recommend prescribing medication including vitamin D, calcium and anti-resorptives, such as bisphosphonates. The aim of this study was to examine the association of reported falls and prescriptions of medications for osteoporosis with future fragility fractures in a cohort of people with PMR.

Methods 

652 people with an incident diagnosis of PMR responded to a baseline survey between June 2012 and June 2014. This included data on general health, sociodemographics, history of falls and medication. Data on fractures and prescriptions were collected at 12 and 24 months. Fragility fractures were defined as fractures of the hip, wrist or spine. Logistic regression models were used to assess the association between baseline characteristics and fractures at 12 and 24 months. Analysis was conducted unadjusted and adjusted for age, gender, reported medication use and falls history.

Results 

112 (17.2%) baseline respondents reported a previous fragility fracture. 60 (83.3%) of the 72 respondents who reported a fragility fracture between baseline and month 12 also reported a fragility fracture at baseline. 49 (79.1%) of the 60 respondents who reported a fragility fracture at between the month 12 and 24 also reported a fragility fracture at baseline. Falls before baseline was the most significant predictor of fragility fracture at 12 (OR 2.35 95% CI 1.35-4.12) and 24 (OR 1.91 95% CI 1.05-3.49) months. Fewer than 50% of respondents were ever prescribed treatment for osteoporosis. Being prescribed treatment for osteoporosis was associated with a reduced incidence of fragility fractures at 24 months (adjusted OR 0.28 95% CI 0.10-0.80), but an increased incidence at 12 months (adjusted OR 2.10 95% CI (1.3-3.48). Calcium and vitamin D prescription, gender and age were not significantly associated with fracture outcome.

Conclusion 

Despite guidelines, fewer than 50% of patients were prescribed medications for osteoporosis. This data highlights the risks of fractures in PMR patients who have experienced previous falls. Over a period of two years, medication for osteoporosis was significantly protective, hence more needs to be done to encourage adherence to guidelines. Further studies need to address reasons for non-adherence to guidelines and the effects of long-term treatment.

Disclosure 

B. Sokhal: None. S.L. Hider: None. Z. Paskins: None. C.D. Mallen: None. S. Muller: None.
P047 An unusual case of dermatomyositis with co-existent anti-GAD and anti-NXP2 antibody positivity
Authors: Beharry Karen , Barminski Grzegorz , De Lord Denise
Published: April 2021

Background/Aims 

Dermatomyositis (DM) is a rare disease. We present a case of DM with both anti-nuclear matrix protein 2 antibody (NXP2) as well as anti-glutamic acid decarboxylase antibody (GAD) positivity, the combination of which has yet not been documented in the current literature.

Methods 

The case is described below.

Results 

A 48 year old Caucasian male with no co-morbidities presented with a one-month history of sore throat and lethargy, followed 2 weeks later by muscular pain in his upper arms. On examination, there was erythema to the sun-exposed areas of the face and arms, hoarse voice and Gottron’s papules. He had proximal muscle weakness of 4/5 in his shoulder and hips. His creatinine kinase(CK) was elevated at 2914U/L. He was started on methylprednisolone 1 gram od for 3 days with improvement of his CK to 642U/L. His muscle biopsy showed mild chronic neurogenic changes and upregulation of C5b-9 but no evidence of inflammatory myopathy which was attributed to the steroid use prior to the biopsy. His myositis antibody screen was positive for Anti-Nuclear Matrix Protein antibody 2(NXP2). After 4 days he developed rapid onset dysphagia and a sudden drop in his spirometry readings with a fall in his FEV1from 94% to 85% and a fall in his FVC from 88% to 79%. He became acutely unwell, drowsy with difficulty completing sentences and global weakness. His CK had risen to 1567U/L despite the high dose intravenous methylprednisolone. He was diagnosed with Diabetic ketoacidosis(DKA) with a blood glucose of 32mmol/L , pH of 7.0, and transferred to ITU. Intravenous immunoglobulin (IVIG) was administered with subsequent improvement in all muscle groups. He was then commenced on a subcutaneous insulin regime and pulsed intravenous cyclophosphamide (Eurolupus) as his EMG showed a sensorimotor polyneuropathy as well as an inflammatory myopathy. His serology was negative for infectious aetiology. Malignancy screen including PET scan, oesophagogastroduodenoscopy and colonoscopy were normal however, he was found to be positive for anti-GAD antibody.

Conclusion 

GAD antibodies are known to be associated with many disorders including diabetes and stiff person syndrome and can recognise different epitopes in various diseases. This is the first documented case of GAD occurring in a DM patient, in the presence of NXP2 antibodies. IVIG is used to treat both stiff man syndrome and refractory DM. It is possible that the combination of GAD and NXP2 contributed to the pathogenesis and severity of the clinical presentation in this case.

Disclosure 

K. Beharry: None. G. Barminski: None. D. De Lord: None.
P094 Incidence of clinically diagnosed Paget’s disease of bone: evidence of a continuing decline
Authors: Cook Michael J , Pye Stephen R , Dixon William G , O'Neill Terence W
Published: April 2021

Background/Aims 

Evidence from the UK suggest that the incidence of Paget's disease of bone declined during the latter half of the last century with a decline also in the incidence of clinically apparent disease. We aimed to characterise the recent incidence of clinically diagnosed Paget’s disease of bone in the UK by age and sex among those aged >18 years and, to determine whether the incidence has changed from 1999-2015.

Methods 

Incident cases of Paget’s disease during 1999-2015 were identified from the first recorded diagnostic code for Paget’s disease in the UK Clinical Practice Research Datalink (CPRD) database. Crude incidence was calculated for each year from 1999 to 2015 and, to account for changes in the distribution of age and sex over time within the CPRD, direct age- and sex-standardised incidence rates were calculated for each year. This was done by multiplying the crude incidence in each age-sex stratum by the age-sex stratum weight of the 1999 population of those at risk of developing Paget’s disease. We looked also at the incidence of disease by quintile of index of multiple deprivation and geographic region. Using Poisson regression, we looked at the influence of deprivation and geography on occurrence of the disease after adjustment for age and sex.

Results 

In total 3,592 incident cases of Paget’s disease were identified between 1999 and 2015. Overall the incidence increased with age and at all ages was greater in men than women. In men, and women, respectively, incidence increased from 0.074 and 0.037 per 10,000 per year at the age of 45-49 years to 6.3 and 3.7 per 10,000 per year at age of 85 years and older. When stratified by year, the age- and sex-standardised incidence fell from 0.75/10,000 person years in 1999 to 0.20/10,000 person years in 2015. Crude incidence (1999-2015) was slightly higher in those living in the most deprived areas (0.53/10,000 person years) compared to those in least deprived areas (0.43/10,000 person years). After adjustment for age and sex, compared to those in the highest quintile of index of multiple deprivation, those in the lowest quintile of index of multiple deprivation had over a 30% increased risk of disease. There was evidence also of geographic variation in the occurrence of disease with the highest incidence in the North West of England.

Conclusion 

The incidence of clinically diagnosed Paget’s disease has continued to decrease since 1999. The reason for the decline remains unknown, though the rapidity of change points to an alteration in one or more environmental determinants.

Disclosure 

M.J. Cook: None. S.R. Pye: None. W.G. Dixon: None. T.W. O'Neill: None.
P097 Raised inflammatory markers with unclear cause; what do they tell us? An audit of patients presenting to rheumatology service at RNHRD, Bath
Authors: Jamal Muhammad Safwan , Peck Rachel , Sengupta Raj
Published: April 2021

Background/Aims 

Unexplained persistently raised inflammatory response in patients’ leads to concern for clinicians. Different studies have demonstrated increased risk of mortality in patients with persistently raised inflammatory response. Rheumatology input is often sought in these cases when cause of inflammatory response is unclear. We conducted this project in our department to see the progress of new patients with raised inflammatory markers presenting to the rheumatology service.

Methods 

Patients referred to the rheumatology outpatients with raised inflammatory markers (Plasma viscosity >1.85 or CRP>100) from April to November 2018 were included. Patient demographic information was gathered through patient’s records and imaging information was gathered through PACS system. Information about investigative modalities was included. Treatment recommendations were also included. Patients were followed up for 6 months and any change in their diagnosis was also incorporated into the data.

Results 

169 patients satisfied the inclusion criteria. Median age was 58 years. Majority were females (72%). Mean referral to seen time was 3.43 weeks. Mean elevation in CRP and PV was 10 and 1.93 respectively. A diagnosis of mechanical/non rheumatological cause was made in 36% patients of those 11% were Fibromyalgia. Inflammatory arthritis diagnosis made in 34% patients. Autoimmune testing and radiological tests were performed in 97% and 90% patients respectively. 67% patients had malignancy or infection work up. Diagnosis was changed in 25% patients on follow up with investigation. With PV > 2.0 (44 patients), only 20% had non inflammatory conditions. There were 6 deaths in this cohort of patients (13% mortality). 3 new cases of malignancy were diagnosed. P097 Table 1:Investigative modalitiesInflammatory disorders N=number of scansNon-inflammatory conditionsCT100MRI1812PET CT71NM scan14

Conclusion 

Patients with persistently elevated inflammatory markers had a higher mortality rate than the other group over 6 months. Three quarters of patients with raised inflammatory markers remain under follow up of Rheumatology team for surveillance. Patients were reviewed in Rheumatology clinics in reasonable time. Appropriate investigative modalities were considered while investigating for inflammatory disorders. Further large scale studies are required to find an association between raised inflammatory response with mortality in rheumatology patients.

Disclosure 

M. Jamal: None. R. Peck: None. R. Sengupta: None.
P098 Higher self-reported depression, anxiety and MSK scores in patients with non-inflammatory compared to inflammatory rheumatic diseases irrespective of age and gender
Authors: Henty Julian R , Ciurtin Coziana , Stefanova Eveta , Ellis Benjamin , Kocsis Agnes
Published: April 2021

Background/Aims 

It is recognised that chronic musculo-skeletal (MSK) conditions have a significant impact on patients’ quality of life and level of functioning, as well as mood. In order to explore holistic therapeutic approaches and multidisciplinary support for this patient group, the differential impact of a diagnosis of an inflammatory versus non-inflammatory rheumatic condition on anxiety, depression and MSK general health was assessed.

The objectives of this pilot study were to determine the level of anxiety and depression in patients with inflammatory versus non-inflammatory rheumatic conditions and explore some of their determinants.

Methods 

A questionnaire comprising the GAD-7 (anxiety), PHQ-9 (depression) and MSKHQ instruments was disseminated to 165 randomly selected patients attending outpatient clinics. Preliminary results from this questionnaire were analysed using descriptive statistics, Mann-Whitney tests and a multiple linear regression. Patients were stratified according to diagnosis classified as categorical variable, inflammatory and non-inflammatory rheumatic conditions.

Results 

Differences between patients’ age and gender, as well anxiety, depression and MSK outcomes between the inflammatory and non-inflammatory groups are presented in the table below:

Linear regression showed that the strongest determinant of anxiety and depression was the category of diagnosis, i.e. inflammatory or non-inflammatory (p = 0.002, R2 = 0.060; p = 0.001, R2 = 0.072, respectively). Anxiety, depression or MSKHQ outcomes were not affected by gender or age, and MSKHQ was not predicted by diagnosis category either, when we accounted for gender and age. P098 Table 1:InflammatoryNon-inflammatoryp-valuen11946% Female65.871.70.467Age mean (range)54.1 (24-85)53.1 (26-81)0.689Anxietymedian (IQR)5 (1-11)9.5 (5-15.3)0.001n (%) clinically significant anxiety44 (37.0)25 (54.4)0.042Depressionmedian (IQR)8 (4-13)13 (7-19.3)0.002n (%) clinically significant depression54 (45.4)30 (65.2)0.022MSKHQ median (IQR)26 (16-35)33 (22-42.5)0.004

Conclusion 

The preliminary analysis of our study showed that patient-reported anxiety, depression and MSK outcomes were significantly higher in patients with non-inflammatory compared to those with inflammatory rheumatic conditions, and that the diagnosis category was the strongest determinant for anxiety and depression.

Disclosure 

J.R. Henty: None. C. Ciurtin: None. E. Stefanova: None. B. Ellis: None. A. Kocsis: None.
P100 Acute crystal arthritis: a leading cause of hospital admission, yet poorly recognised and mistreated
Authors: Abdalla A
Published: April 2021

Background/Aims 

Crystal arthritis is the commonest inflammatory arthritis in adults. A common mimic is septic arthritis. Without appropriate synovial fluid analysis, a mis-diagnosis of sepsis can be made with resultant unnecessary hospitalization, inappropriate intravenous antibiotic therapy and excess cost. Such cases are frequently described as ‘culture-negative’ septic arthritis. We aimed to examine and analyse the cases of acute arthritis requiring acute hospital admission in a tertiary referral centre in Dublin.

Methods 

A retrospective review of database between Jan - Dec 2019 at the Mater Misericordiae University Hospital, Dublin, was carried out. All cases of acute arthritis requiring acute hospital admission were identified. Cases treated at the Emergency Department, Acute Medical Unit or Outpatients which did not require hospital admission were excluded.

Results 

30 patients were identified during this period, 16 (53%) had an ultimate diagnosis of crystal arthritis, 8 (27%) had confirmed septic arthritis and 6 (20%) had other arthritides (e.g. haemoarthrosis). The median age for crystal arthritis was significantly higher (85.5 y) compared to septic arthritis (47 y). Apart from age, the clinical profile and biomarkers for crystal and septic arthritis were comparable. The majority of crystal arthritis cases were due to pseudogout (69 %), ultimately diagnosed by rheumatology. Septic arthritis led to more days in hospital than crystal arthritis (median 14 vs 5.5 days). All 30 patients received IV antimicrobial therapy for presumed septic arthritis.

Conclusion 

This retrospective study showed crystal arthritis, especially pseudogout, was the commonest cause of hospital admission (53%) with acute arthritis particularly among elderly patients. Accurate diagnosis by synovial fluid analysis with appropriate equipment is extremely useful in the assessment of these cases. More awareness and training among orthopedic, emergency and acute clinicians is needed in order to avoid unnecessary admissions and interventions.

Disclosure 

A. Abdalla: None.
P141 How effective are high-cost drugs for rheumatoid arthritis beyond the third choice in routine care?
Authors: Walker David , Robinson Sandra , Barry Jane , Punter Phillip , Kearns Sinead , Goff Iain
Published: April 2021

Background/Aims 

It became apparent at a session at the BSR Annual Conference 2019 that some CCGs restrict the prescription of high cost drugs (HCDs) beyond three drugs for people with rheumatoid arthritis (RA). We were interested to explore the efficacy of HCDs beyond the third choice in our own service.

Methods 

All patients in our service who are being considered for HCDs, are discussed at a multi-disciplinary team meeting comprising of seven consultants and eight nurses. The HCD decision is recorded in the minutes of the meeting which were scrutinised to identify patients who had received four or more HCDs. We began at March 2017, the launch of JAK inhibitors, in the expectation that few people would have had four HCDs before that time. The medical records were reviewed for the order of HCDs given and for evidence of efficacy and toxicity. The response to each drug choice was graded as: responder; partial responder and failure (primary non-responder or toxicity).

Results 

From a database of 2,673 patients with RA, 542 patients were taking HCDs, thirty-two of those had received four or more of these drugs. Eleven of the thirty-two patients had tried four HCDs, seven had received five HCDs, ten patients had six, one patient had seven HCDs, two had tried eight and one patient had received nine HCDs. The response rates for each choice of drug are shown in table 1. Many patients responded to their fourth, fifth and sixth choice of HCD. If there was a restriction of three HCDs in our service, thirty-three prescriptions for drugs that patients have responded to, would not have been made.

Conclusion 

Many patients responded to their fourth or subsequent HCD. Thus, there is no clinical justification in restricting the use of HCDs below at least six choices. Additionally, this data suggests that only small numbers of patients are prescribed more than four HCDs. Therefore lifting this limitation would have little cost implication. P141 Table 1:HCD Response RateHCD Choice*123456>6Responder12 (38%)10 (31%)10 (31%)12 (44%)14 (58%)6 (60%)1 (14%)Partial Responder5 (16%)1 (3%)7 (22%)5 (19%)4 (17%)1 (10%)1 (14%)Failure15 (47%)21 (66%)15 (47%)10 (37%)6 (25%)3 (30%)5 (71%)n =3232322724107*Switches to biosimilars were not regarded as a change.

Disclosure 

D. Walker: Honoraria; Gilead Sciences Ltd, Ely Lilly Pharmaceuticals, Pfizer Pharmaceutical. Grants/research support; Gilead Sciences Ltd. S. Robinson: None. J. Barry: Corporate appointments; Gilead Sciences Ltd. P. Punter: Corporate appointments; Gilead Sciences Ltd. S. Kearns: Corporate appointments; Gilead Sciences Ltd. I. Goff: None.
P183 Osteitis condensans ilii or axial spondyloarthritis: a diagnostic challenge!
Authors: Saeed Sadaf , Jamal Muhammad Safwan , Ostry Dave , Robinson Graham , Sengupta Rajiv
Published: April 2021

Background/Aims 

Osteitis condensans ilii (OCI) is a rare cause of chronic non-inflammatory axial lower back pain. It has become an important differential diagnosis of axial spondyloarthritis. Bone marrow oedema can be present in 48% of patients. Although 'aunt minnie' appearance on MRI is pathognomonic, specialised imaging like SPECT/PET CT can be considered in difficult cases to confirm the diagnosis. We reviewed case notes of patients with incidental diagnosis of OCI on imaging and followed their clinical progression to see if the diagnosis was modified later.

Methods 

Retrospective radiological database analysis was performed to find imaging reported as OCI or osteitis from 2015-2020. Electronic patient records were analyzed and data was compiled through Microsoft Excel.

Results 

Data from 24 patients was reviewed. Most patients were females (91.7%), with a median age of 43 years (range 19-79 years). CT and MRI were the chief modalities of imaging (46% and 38% respectively) while 20% had plain x-rays of the pelvis. The main indications for imaging were pelvic or hip girdle pain (58.3%), cancer surveillance (25%), abdominal pain (6%), and infection (6%). 20% had an underlying rheumatological diagnosis of which 8% had spondyloarthritis. 12.5% of patients had seronegative features of spondyloarthritis and 8.3% were HLA B27 positive. Approximately 40% of patients were seen by the Rheumatology team for further assessment after imaging and 12.5% of patients were diagnosed with axial spondyloarthritis and remained under follow-up.

Conclusion 

OCI can mimic sacroiliitis on imaging. Although only a minority of patients with OCI reported on initial imaging were subsequently diagnosed with axial spondyloarthritis, thorough clinical assessment and multidisciplinary discussion can reduce the chance of a missed axial spondyloarthritis diagnosis. Further large-scale studies are required to find the exact incidence of spondyloarthritis in patients with imaging features of OCI.

Disclosure 

S. Saeed: None. M. Jamal: None. D. Ostry: None. G. Robinson: None. R. Sengupta: None.