bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatitis B and hepatitis C testing outcomes among service users of Sexual Health London: an online sexually transmitted infection testing service for London residents
Authors: Day Sara Louise , McDonald Gemma , Kellett Chris 
Published: November 2023

ObjectivesThe UK signed up to the 2016 global health strategy to eliminate viral hepatitis as a public health problem. Effective monitoring of hepatitis testing outcomes is required to track progress against targets. National reporting does not include hepatitis B and hepatitis C infections (HBV/HCV) detected by online sexually transmitted infection (STI) testing services (e-services). We identify HBV/HCV infection rates among individuals using Sexual Health London (SHL), a large e-service.MethodsSHL e-records of individuals receiving reactive HBsAg and/or HepCAb screening results between 1 January 2021 and 1 January 2022 were reviewed. Only at-risk groups are offered HBV/HCV testing, with risks captured via an online triage/consultation. Roche Cobas e801 HBV/HCV screening assay uses a cut-off index of reactivity (COI) to categorise results: low reactive (COI >1–9) and reactive (COI ≥10). SHL refers individuals with any reactive result for confirmatory testing (CT) at a sexual health clinic that provides hepatitis outpatient management. Clinic staff performing the CT access the shared SHL e-record and electronically take over the patient’s care.Results67, 718 HBV and 61 064 HCV tests were performed, representing 16% of all kit returns. HBV reactivity was 1.4% (922/67 718): 474 low-reactive, 302 reactive and 146 unconfirmed-reactive. HCV reactivity was 0.3% (163/61 064): 53 low-reactive, 99 reactive and 11 unconfirmed-reactive.Among individuals with reactive (COI ≥10) screening HBV results, 85% results confirmed, 12% negative and 3% unknown. For HCV, 79% results confirmed, 13% negative and 8% unknown. 57 out of 57 new HBV/HCV infections were electronically transferred. HBV prevalence was 299/67 718 (0.4%). The rate of previously undiagnosed cases detected was 40 out of 67 338 (0.06%) for HBV and 17 out of 61 016 (0.03%) for HCV.Conclusions16% of SHL service users received targeted testing for hepatitis in 2021. Testing volumes significantly exceeded and new HBV/HCV diagnosis rates were similar to those reported by sentinel laboratory surveillance. 100% new infections transitioned to care, demonstrating effective integration between online and local sexual health services.
Effect of sweet flavouring on the rewarding and reinforcing value of cigarillo use among young adults
Authors: Audrain-McGovern Janet , Manikandan Divya , Koita Fodie , Klapec Olivia , Pickworth Wallace B , Stone Matthew D 
Published: November 2023

IntroductionCigarillos dominate the US cigar market, and young adults largely drive use. While young adults prefer flavoured to non-flavoured cigarillos, especially those flavoured to taste like fruit or other sweets, the factors that underlie this preference have received little attention. We sought to determine if key indicators of abuse liability, the rewarding and reinforcing effects, are greater for sweet versus non-flavoured cigarillos.MethodsYoung adults (18–24 years old) completed three laboratory visits assessing the subjective rewarding value (exposure paradigm), relative reinforcing value (computerised choice task) and absolute reinforcing value (ad libitum cigarillo smoking session) of sweet-flavoured versus non-flavoured cigarillos. General linear regression models were fit with the appropriate family link for each outcome measure.ResultsYoung adults rated sweet-flavoured cigarillos as more rewarding (estimated marginal mean (EMM) =4.52, 95% CI 4.00 to 5.03) than the non-flavoured cigarillo (EMM=3.31, 95% CI 2.80 to 3.83; B=1.20, 95% CI 0.80 to 1.60, p<0.001). The reinforcing value of sweet-flavoured cigarillos, measured by break point, was higher relative to non-flavoured cigarillos (6.34 out of 10), especially among young adults with a preference for flavoured cigarillos (B=1.94, 95% CI 0.71 to 3.18, p=0.003). Young adults took 1.9 times the number of puffs (35.75 vs 19.95) from sweet-flavoured cigarillos compared with non-flavoured cigarillos (Rate Ratio =1.94, 95% CI 1.30 to 2.90, p<0.001).ConclusionsSweet flavouring increases the abuse liability of cigarillos among young adults as reflected in greater liking, motivation to use and actual use. Banning sweet flavouring in cigarillos may diminish their use in young adults.Trial registration number CT.gov (NCT05092919).
Hong Kong Guangdong Rheumatology Meeting
Authors: MO Yingqian 
Published: November 2023

Sjögren’s syndrome is a chronic autoimmune disease that is estimated to affect 35 million people worldwide. Hallmarks of the disease are a loss of salivary and lacrimal gland function as well as lymphocytic infiltration, elevated proinflammatory cytokines, and circulating autoantibodies. The effective treatments are limited. However, new therapies targeting specific immune pathways associated with Sjögren’s syndrome are being developed. Gene transfer to the salivary glands has been considered a promising approach to treating the dysfunction. The application of this treatment on salivary gland injuries has been studied for decades, yet its clinical progress is delayed. This chapter provides a coup d’oeil into gene transfer methods and various gene/vector types for salivary glands. AAV2-LAMP3-treated mice developed an SS-like phenotype with progressive salivary hypofunction and autoantibody production. To confirm the role of TLR4 in the induction of BMP6 following stimulation, AAV2-LAMP3–treated mice with established salivary hypofunction were treated i.p. with the TLR4 antagonist TAK242 for 10 days, and the effect of the drug on salivary gland protein expression and function was tested. We observed that treatment with TAK242 significantly decreased BMP6 expression and increased AQP5 expression in the salivary gland tissues. In agreement with this observation, the saliva flow rate of AAV2-LAMP3–treated mice also increased compared with that in vehicle control–treated mice. Gene therapy using recombinant viruses as gene transfer vectors to deliver a water channel (aquaporin 1, AQP1) to restore membrane water permeability in the salivary gland was shown to be safe and resulted in some patients with radiation-induced xerostomia having a sustained increase in saliva flow. A clinical trial using AAV2 to transfer AQP1 to the salivary glands of radiation-induced xerostomia patients is ongoing (NCT02446249) and results from this study may support application of this treatment in Sjögren’s syndrome. Gene therapy could also be used to deliver immunomodulators locally to the salivary gland resulting in a higher local concentration within the gland that could deliver therapeutics levels of recombinant protein, while minimizing the side effects associated with the drugs. Another study investigated whether a neurturin-expressing adenovirus could be used for gene therapy in vivo to protect parasympathetic neurons and prevent gland hypofunction after irradiation. The results suggest that in vivo neurturin gene therapy prior to irradiation protects parasympathetic function and prevents irradiation-induced hypofunction.
Lunch Symposium
Authors: ØSTERGAARD Mikkel 
Published: November 2023

The overall objectives of this session are to understand the patient burden of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) and to reflect on the role of tailored treatment strategies in the management of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). The presentation will initially, for each of the 3 diseases, describe key disease characteristics and the clinical responses to different types of therapy, with emphasis on biological and targeted synthetic disease modifying antirheumatic drugs (b/tsDMARDs). Subsequently, the focus will be the gap between patients’ and physicians’ perspectives on the most important aspects of the diseases, and on the main goals of treatment. Thereafter, current international recommendations for RA, PsA and axSpA and the treat-to-target concept will be introduced and discussed, followed by a discussion, disease by disease, of whether prevention of radiographic progression should be an important the goal of treatment. Finally, it will be discussed how the strategy for treating patients RA, PsA, and axSpA should be in the future, including the role of therapeutic strategies tailored for the individual patients.
Symposium 8
Authors: NASH Peter 
Published: November 2023

Psoriatic arthritis (PsA) is a chronic inflammatory autoimmune condition characterized by inflamed joints. PsA often, but not always, occurs along with psoriasis (PsO), an autoimmune skin condition that results in scaly, red itchy patches. Biologics therapy has been a standard of treatment for moderate to severe PsA after the use of disease-modifying antirheumatic drugs (DMARDs). Traditionally PsA biologics targeted on inhibiting the tumor necrosis factor (TNF) or interleukin-17 (IL-17) pathway to suppress the inflammatory triggering cascade. Recently biologics inhibiting the interleukin-23 (IL-23) pathway, such as guselkumab, is approved for the management of both PsA and PsO with promising efficacy in both skin and joint improvement. IL-23 inhibitors are included as recommended treatment option for peripheral and skin-involved PsA in the latest EULAR recommendations. With the availability of new mode of therapy, it is important to understand the characteristics and clinical evidence of different biologics modality and this lecture will demonstrate how to apply the various options to PsA patients presented with different disease profiles.
Abstract 14 — Comparison of the ASAS Health Index Between Radiographic Axial Spondyloarthritis and Non-Radiographic Spondyloarthritis in Singapore
Authors: Kwan Yu Heng , Woon Ting Hui , Wang Charmaine , Fong Warren 
Published: November 2023

Background Prior studies reported conflicting results regarding differences in Assessment of SpondyloArthritis (ASAS) Health Index (HI) scores between radiographic axial spondyloarthritis (r-axSpA) and non-radiographic axial spondyloarthritis (nr-axSpA). Country-level variations in disease activity were also observed. Hence, this study aimed to compare the ASAS HI scores between r-axSpA and nr-axSpA in Singapore, and determine factors associated with poorer ASAS HI scores. Methods This was a cross-sectional evaluation of baseline data from a prospective cohort study in Singapore General Hospital, from January 2018 to March 2023. Patients aged 21 years and above who were clinically diagnosed with axial spondyloarthritis (axSpA) based on the 2009 ASAS criteria were included. Sociodemographic variables, clinical variables and patient-reported outcomes were collected. Univariable and multivariable linear regression were performed to identify variables associated with ASAS HI scores. Variables with p-value of <0.10 were included in the multivariable regression. A p-value of <0.05 was considered significant. Results Of the 331 patients, 265 (80.0%) and 66 (20.0%) had r-axSpA and nr-axSpA respectively. The median (IQR) age in r-axSpA was [40.0 (30.0-53.0) years], higher than nr-axSpA [34.0 (25.0-47.0) years], p<0.01. There was a higher proportion of males in r-axSpA (80.4%) than nr-axSpA (65.2%), p=0.01. Patients with r-axSpA had a longer disease duration [6.8 (1.8-14.0) years] than nr-axSpA [1.1 (0.2-5.4) years], p<0.01. More patients with r-axSpA (90.2%) were positive for HLA-B27 than nr-axSpA (69.7%), p<0.01. Differences in ASAS HI scores were not statistically significant between r-axSpA and nr-axSpA [4.0 (2.0-6.8) vs 5.5 (1.1-8.5), p=0.12]. Post multivariable regression, nr-axSpA ([Formula: see text]: 0.70, 95% CI: 0.09, 1.32, p=0.02), BASDAI ([Formula: see text]: 0.18, 95% CI: 0.01, 0.35, p=0.04), BASFI ([Formula: see text]: 0.47, 95% CI: 0.30, 0.65, p<0.01) and HADS-Depression scores ([Formula: see text]: 0.11, 95% CI: 0.01, 0.21, p=0.04) were positively associated with ASAS HI. Higher SF36-PCS ([Formula: see text]: −0.11, 95% CI: −0.14, −0.08, p<0.01) and SF36-MCS ([Formula: see text]: −0.07, 95% CI: −0.10, −0.04, p<0.01) were negatively associated with ASAS HI (Table 1). Conclusion Patients with nr-axSpA were associated with poorer overall health and functioning as compared to r-axSpA. Higher disease activity, poorer physical function, poorer mental health status and more depressive symptoms were associated with worse health and functioning.
Abstract 15 — Lupus Low Disease Activity State: An Underutilised Clinical Target that is Attainable and Protective against Lupus Nephritis Relapse
Authors: Cheung Chak Kwan , Lau Chak Sing , Chan Shirley Chiu Wai 
Published: November 2023

Background Lupus nephritis (LN) is a significant comorbidity affecting approximately 50-60% of patients with systemic lupus erythematosus (SLE). Complete and partial renal response (CRR/PRR) have been recommended as treatment targets in LN. Lupus low disease activity state (LLDAS) is also associated with favourable clinical outcomes. This study aims to investigate the LLDAS attainment rate and outcomes in patients with LN. Methods Patients with biopsy-proven LN during 2010-2020 in Queen Mary Hospital were included. Baseline demographics, blood parameters and urinalysis results were documented. Renal response and LLDAS attainment were assessed at 12 months after LN diagnosis. CRR was defined as proteinuria [Formula: see text]0.5g/day with a normal estimated glomerular filtration rate (eGFR); PRR was defined as a reduction in proteinuria by [Formula: see text]50% with near normal eGFR. A relapse was defined as a biopsy-proven active LN on histology after an initial treatment response of proteinuria reduction of [Formula: see text]50% or to sub-nephrotic range. Time-to-relapse survival analysis was performed to compare the significance of CRR/PRR and LLDAS attainment. Results 143 LN patients were included, with a median follow-up duration of 10.4 years. At 12 months, 57 (40%), 14 (10%) and 69 (48%) patients achieved CRR, PRR and LLDAS, respectively. Although 39 (27%) patients attained both CRR/PRR and LLDAS, a significant number of 30 (21%) patients reached LLDAS without meeting CRR/PRR (Figure 1). Among 136 patients who achieved the pre-defined treatment response, 30 (22%) patients developed LN relapse after a median of 2.98 years. Patients reaching either CRR/PRR or LLDAS had a significantly lower risk of relapse (CRR/PRR: HR = 0.34, p = 0.02; LLDAS: HR = 0.28, p = 0.003). The attainment of both CRR/PRR and LLDAS was associated with the lowest risk of relapse (Figure 2). Conclusion We advocate LLDAS as a target for LN patients as attaining LLDAS reduces future LN relapse risks.
Abstract 17 — Overall Infection Risks of Tofacitinib in Patient with Rheumatoid Arthritis: A Meta-Analysis of Randomized Clinical Trials
Authors: Yusof Mohd Haidir Mohd , Jinih Marcel , Roos Nur Aishah Che , Yusof Ahmad Asmadi 
Published: November 2023

Background There is an ongoing controversy surrounding whether tofacitinib increases the risk of infections in patients with rheumatoid arthritis (RA). To address this issue, we conducted a meta-analysis using data from randomized clinical trials (RCTs) to assess the overall risk of infection in these patients. Methods We conducted a comprehensive systematic search in EMBASE, MEDLINE, and CENTRAL from their inception until December 2022 to identify relevant RCTs reporting the occurrence of infections in patients with RA who were treated with the standard clinical therapeutic dosage of tofacitinib (5mg twice daily orally). The primary outcomes of the included studies in this review focused on the incidence of total infections, serious infections, non-serious infections, and opportunistic infections (including herpes zoster and tuberculosis). Additionally, we examined secondary outcomes related to the incidence of various sites of infections, including the upper respiratory tract, lower respiratory tract, gastrointestinal tract, hepatobiliary system, urinary tract, skin and soft tissue, blood, dental and oral soft tissue, genital, reproductive tract, bone and joint, and central nervous system infections. Due to the expected anticipation of clinical and methodological heterogeneity across studies, the effect estimate was pooled with a random-effects model, to obtain the RRs and 95% CIs, using Mantel-Haenszel statistical method. Results Twelve eligible RCTs, involving a total of 6,056 patients, were included in the analysis. In comparison to the control group (placebo and other active treatments), tofacitinib exhibited a significant increase in the risk of total infections (RR, 1.21; 95% CI, 1.07-1.37; I2, 28%), serious infections (RR, 1.23; 95% CI, 1.02-1.48; I2, 0%), non-serious infections (RR, 1.20; 95% CI, 1.05-1.36; I2, 29%), and opportunistic infections (RR, 1.66; 95% CI, 1.40-1.97; I2, 0%). Secondary outcomes analyses revealed a significant increase in the risk of lower respiratory infections with tofacitinib (RR, 1.27; 95% CI, 1.10–1.47; I2, 0%). Conclusion Compared with placebo and other active treatments, tofacitinib significantly increased the overall risk of infections (total infections, serious infections, non-serious infections, and opportunistic infections). These findings can help clinicians assess the risk of infections in RA patients treated with tofacitinib.
Abstract 19 — Treat-to-Target in Spondyloarthritis (SpA): Are There Sex-Related Differential Responses?
Authors: Cheng Isaac T , So Ho , Yip Carson Chun Yin , Leung Ying Ying , Shin Kichul , Saeed Muhammad Ahmed , Chiowchanwisawakit Praveena , Hammoudeh Mohammed , Haroon Muhammad , Nallasivan Subramanian , Angkodjojo Stanley , Chung James Ho Yin , Kishimoto Mitsumasa , Wei James , Tam Lai Shan 
Published: November 2023

Background: Studies have reported that female patients with spondyloarthritis have different disease courses and treatment responses compared to male patients. Whether patients’ sex is associated with a different outcome after receiving one-year of tight control, treat-to-target (T2T) strategy remains uncertain. Thus, this study aimed to evaluate the differences in the clinical response between male and female patients from the APLAR SpA Registry. Methods: Patients who fulfilled the CASPAR 2006 classification criteria for PsA and 2009 ASAS classification for axSpA were recruited. They received 1 year of protocolized treatment aiming at 1) MDA or DAPSA-LDA for PsA patients, and 2) ASDAS-LDA for axSpA patients. Patients were assessed every 3-monthly and treatment was escalated if target was not reached. Results: Ninety-one male (age: 45.6±16.1, 43 PsA, 48 axSpA) and 52 female (age: 49.2±13.4, 36 PsA, 16 axSpA) patients were included. There was no significant difference between the 2 sexes at baseline, except a higher ESR and more severe enthesitis in female patients. During the study period, the use of csDMARDs and NSAIDs decreased slightly, whilst the use of bDMARDs significantly increased across both sexes (Fig. 1a). Considering the whole cohort, there were significant improvement in disease activity in PsA after 1-year and disease activity in axSpA remained low. Despite similar bDMARDs use at 1-year, female PsA patients had a lower MDA achievement rate (36% in female vs 51% in male). Female patients also remained to have a higher physician global assessment score (2.61±1.76 in female vs 1.98±1.57 in male, p=0.03), greater functional impairment (HAQ: 0.54±0.57 in female vs 0.32±0.46 in male, p=0.01) and more severe enthesitis (SPARCC: 0.83±1.67 in female vs 0.16±1.09 in male, p=0.005) at 1-year. There was also a trend of higher perceived disease burden and peripheral involvement in female (Fig. 1b). Conclusion: There may be differential treat-to-target responses between male and female SpA patients. The causes of such differential characteristics should be further explored to potentially implement a sex-specific treat-to-target strategy for spondyloarthritis.
Abstract 24 — Myricetin Impedes Tfh Cell Differentiation and Ameliorates the Tumorigenic Phenotype of Adjuvant-Induced Arthritis FLS in Rheumatoid Arthritis
Authors: Rasool Mahaboobkhan , Jose Ann Miriam 
Published: November 2023

Background Rheumatoid arthritis (RA) is an autoimmune disorder characterized by destructive polyarthritis and extra-articular manifestations. Myricetin, a flavonoid, possesses several pharmacological benefits, including anti-arthritic effects. However, the specific role and molecular basis of myricetin in IL-21 mediated T follicular helper (Tfh) cell differentiation and activation of fibroblast-like synoviocytes (FLS) in RA remain unknown. In the present study, we decoded the therapeutic intervention of myricetin as an anti-arthritic small-molecule drug for impeding Tfh cell differentiation and for abrogating the RA-FLS-transformed aggressive phenotype. Methods In vivo experiments were conducted using an adjuvant-induced arthritis animal model to evaluate the effects of myricetin on Tfh cell differentiation, IL-21 production, choline kinase (ChoK) activation, and the JAK/STAT signaling pathway. Results In this study, myricetin was found to significantly inhibit the interaction between IL-21 and IL-21R, and at the molecular level, it suppressed JAK/STAT signaling and the downstream transcription factor Bcl-6, which decreased Tfh cell differentiation. Additionally, myricetin suppressed the IL-21-induced hyperproliferation of AIA-FLSs by downregulating the ChoK signaling cascade (Ras, Ral-GDS, and PI3K). Myricetin treatment reduced ChoK enzymatic activity and the proliferative, migratory, and invasive properties of AIA-FLS. Conclusion Taken together, our results demonstrated that myricetin is a promising therapeutic compound that abates IL-21-induced Tfh cell differentiation and the invasive behavior of AIA-FLS.