tbuckley/cabot-search huggingface dataset:
Type 2 Myocardial Infarction—Diagnosis, Prognosis, and Treatment
Authors: Cian P. McCarthy, Muthiah Vaduganathan, James L. Januzzi
Journal: JAMA (2018)

This Viewpoint reviews what is known about myocardial infarction (MI) caused by oxygen supply-and-demand mismatch (type 2 MI) and differences from MI caused by coronary artery disease, as well as proposes areas for further investigation to identify optimal management strategies.
Cardiac Implantable Electronic Device Interrogation at Forensic Autopsy
Authors: Philipp Lacour, Claas Buschmann, Christian Storm, Jens Nee, Abdul Shokor Parwani, Martin Huemer, Philipp Attanasio, Leif-Hendrik Boldt, Geraldine Rauch, Andreas Kucher, Burkert Pieske, Wilhelm Haverkamp, Florian Blaschke
Journal: Circulation (2018)

Postmortem interrogations of cardiac implantable electronic devices (CIEDs), recommended at autopsy in suspected cases of sudden cardiac death, are rarely performed, and data on systematic postmortem CIED analysis in the forensic pathology are missing. The aim of the study was to determine whether nonselective postmortem CIED interrogations and data analysis are useful to the forensic pathologist to determine the cause, mechanism, and time of death and to detect potential CIED-related safety issues.From February 2012 to April 2017, all autopsy subjects in the department of forensic medicine at the University Hospital Charité who had a CIED underwent device removal and interrogation. Over the study period, 5368 autopsies were performed. One hundred fifty subjects had in total 151 CIEDs, including 109 pacemakers, 35 defibrillators, and 7 implantable loop recorders.In 40 cases (26.7%) time of death and in 51 cases (34.0%) cause of death could not be determined by forensic autopsy. Of these, CIED interrogation facilitated the determination of time of death in 70.0% of the cases and clarified the cause of death in 60.8%. Device concerns were identified in 9 cases (6.0%), including 3 hardware, 4 programming, and 2 algorithm issues. One CIED was submitted to the manufacturer for a detailed technical analysis.Our data demonstrate the necessity of systematic postmortem CIED interrogation in forensic medicine to determine the cause and timing of death more accurately. In addition, CIED analysis is an important tool to detect potential CIED-related safety issues.
Beatrix “Betty” Hamburg: child and adolescent psychiatrist who became a global expert on teaching children not to hate
Authors: Ned Stafford
Journal: BMJ (2018)

Credit: US National Academy of Medicine

A renowned child and adolescent psychiatrist, Beatrix “Betty” Hamburg dedicated her life to helping children. Her list of accomplishments was long and impressive, and her groundbreaking work included developing the concept of youth peer counselling, devising school based programmes for conflict resolution and violence prevention, and exploring bio-behavioural aspects of diabetes in children and adolescents.

Hamburg held professorships and leadership positions at Stanford University, Harvard Medical School, and the Mount Sinai School of Medicine in New York City. She influenced public policy as a member of US president Jimmy Carter’s Commission on Mental Health and, in the 1990s, as president of the William T Grant Foundation, a non-profit organisation that focuses on reducing inequality and helping young people. After “retiring,” she went back to work and spent 15 years, late in her life, as DeWitt Wallace distinguished scholar at Weill Cornell Medical College in New York City. She was a fellow of the Royal Society of Medicine in London, and she was widely admired around the world.

Jack Barchas, a lifelong friend and colleague who is chair of the department of psychiatry at Weill Cornell, told The BMJ : “Betty Hamburg was one of the most remarkable people I have ever known.”

But 78 years ago, in the autumn of 1940, Beatrix was a scared girl a few weeks shy of her 17th birthday. She had arrived at the elite Vassar College in Poughkeepsie, New York, for her first semester of studies. At the time, Vassar was an all women’s school, and all the women were white. Beatrix was African-American.

Beatrix Ann McCleary was born on 19 October 1923 in Jacksonville, Florida. But after her father, a doctor, died when she was still young, her mother moved …
Online opioid distributors must cease trading, US drug regulator warns
Authors: Owen Dyer
Journal: BMJ (2018)

A warning this week from the US Food and Drug Administration (FDA), threatening nine online networks with injunctions and seizures unless they stopped marketing opioids, appeared to be having the desired effect, as most of the targeted websites had shut down or switched to marketing erectile dysfunction drugs two days later. It remains unclear, however, if there is any way to stop them reopening with new names and web addresses.

The web businesses targeted—which included AnonShop, TramadolHub, Eassybuyonline, and RxCash.biz—controlled some 53 websites which, the FDA said, offered for sale opioids, including tramadol and oxycodone, that are misbranded and unapproved.

“This illegal online marketing of unapproved opioids is contributing …
AB0837 The effect of anti-tnf on renal function in patients with ankylosing spondylitis: a prospective cohort study
Authors: I.A. Swart, M. Heslinga, I.M. Visman, I.E. van der Horst-Bruinsma, C. van Denderen, M.T. Nurmohamed
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Impaired renal function is common in patients with ankylosing spondylitis (AS) and patients also have an increased risk of cardiovascular disease (CVD). Previous studies showed that biologicals, such as anti-Tumour Necrosis Factor (anti-TNF) reduce CVD in patients with inflammatory rheumatic disease. Impaired renal function is a known predictor of CVD (also elevated in AS). We postulated that the favourable cardiovascular effect of anti-TNF might be mediated by improving renal function. However, data about the effect of biologicals on renal function in patients with AS are lacking. <h3>Objectives</h3> To assess the effect of anti-TNF on renal function in patients with AS. <h3>Methods</h3> Biological-naïve consecutive AS patients treated with etanercept or adalimumab were prospectively followed from 2005 to 2014. Renal function was determined by calculation of the estimated Glomerular Filtration Rate (eGFR), which was estimated with the abbreviated Modification of Diet in Renal Disease (MDRD) formula. Patients were divided into two groups: patients with normal renal function at baseline and patients with impaired renal function at baseline, to investigate whether the effect is different for these groups. Normal renal function was defined by eGFR ≥90 mL/min/1.73 m<sup>2</sup> at baseline and impaired renal function was defined by eGFR &lt;90 mL/min/1.73 m<sup>2</sup> at baseline. The effect of anti-TNF on eGFR was analysed using mixed model analysis. <h3>Results</h3> 211 AS patients were followed for a median of 156 (36 – 286) weeks. 153 patients had normal renal function and 58 had impaired renal function at baseline. In patients with normal renal function at baseline eGFR decreased significantly over time (β=−0.041, p=0.001), although this association did not remain significant after adjustment for disease activity (β=−0.015, p=0.212). Patients with impaired renal function at baseline did not have a significant change in eGFR over time (β=0.022, p=0.087) and this association remained not significant after adjustment for alcohol consumption, BMI, disease duration and disease activity (β=0.008, p=0.593). The change in eGFR on average over time after starting anti-TNF in AS patients with normal and impaired kidney function are presented in figure 1. <h3>Conclusions</h3> This study demonstrates that anti-TNF is not associated with renal function in AS patients, which means that use of anti-TNF is safe concerning renal function in patients with AS. From our results it seems that the effect of anti-TNF on CVD in AS patients is not mediated by an effect on renal function. <h3>Disclosure of Interest</h3> None declared
Cutaneous squamous cell carcinoma progression during imiquimod treatment
Authors: Emi Dika, Pier Alessandro Fanti, Martina Lambertini, Federica Scarfì, Giulia Maria Ravaioli, Giulia Veronesi, Carlotta Baraldi, Alba Guglielmo, Annalisa Patrizi
Journal: Journal of the American Academy of Dermatology (2018)
OP0274-HPR A functional exercise program improves pain and health related quality of life in patients with fibromyalgia: a randomisedcontrolled trial
Authors: G. Fernandes, F. Jennings, M. Cabral, R. Santos, J. Natour
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Fibromyalgia (FM) is a syndrome characterised mainly by chronic generalised pain that affects the physical fitness and functional capacity of patients. There is increasing evidence of the benefits of physical exercise in improving FM symptoms, making these interventions part of therapeutic arsenal. <h3>Objectives</h3> To evaluate the effectiveness of a program of functional exercises in reducing pain, improving functional capacity, increasing muscle strength, improving flexibility, balance and quality of life of patients with FM. <h3>Methods</h3> It is a controlled and randomised study, with blind evaluator. A total of 82 female patients with FM were included, with age between 18 and 65 years, randomised into two groups, intervention and control. The intervention group (FEG) performed functional exercise training for 45 min twice a week for 14 weeks. The control group (SEG) performed stretching exercises with the same duration and frequency. Evaluation instruments were: VAS – Visual Analogue Scale for pain assessment; FIQ- Fibromyalgia Impact Questionnaire, for assessing health-related quality of life; Time-up and go test for functional performance evaluation; 1RM, for evaluation of muscle strength; Bank of Welss, for the assessment of flexibility; Berg Balance Scale, to evaluate balance; and SF-36 to evaluate general quality of life. Also, the amount of analgesics used during the intervention period was assessed. <h3>Results</h3> 41 patients were randomised to the FEG and 41 patients to the SEG. After intervention, the FEG presented a reduction in pain and an improvement in the quality of life related to the disease, which was statistically significant compared to SEG. Regarding general quality of life, functional capacity, muscle strength, flexibility and balance, there was no difference between the groups. <h3>Conclusions</h3> Functional exercise training proved to be effective in reducing pain and improving the health-related quality of life of patients with FM when compared to stretching exercises. <h3>References</h3> [1] Wolfe F, Clauw D, Fitzcharles MA, Goldenberg D, Katz RS, Mease P, et al. The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care Res2010;62:600–10. [2] Hauser W, Klose P, Langhorst J, et al. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: A systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther2010;12:R79. [3] Burchardt CS. Multidisciplinary approaches for management of fibromyalgia. Curr Pharm Des2006;12:59–66. <h3>Disclosure of Interest</h3> None declared
AB1033 Comorbidities and metabolism indexes in patients with hua comparing with normal uric acid: a data from 33319 patients between 2014 and 2015
Authors: L. Xu, H. Zhu, Y. Su
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To investigate and compare the differences in Comorbidities and metabolism indexes between peoples with high and normal uric acid. <h3>Methods</h3> All the outpatients were enrolled in this cross–sectional study from September 2014 to September 2015 in peking university people's hospital. The patients were divided into high uric acid (HUA) and normal uric acid according to the international definition of HUA. The distribution characteristics of UA level and correlations between UA level and prevalence rate of comorbidities and metabolism indexes, including glutamic-pyruvic transaminase, glutamic-oxalacetic transaminase, serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), blood glucose, creatinine (CRE), carbonyldiamide, estimated glomerular filtration rate (eGFR) were analysed. <h3>Results</h3> (<sup>1</sup> Among 33 319 outpatients, with an average age of 56.4, 44.4% were men with a higher uric acid level than women (368±113.1 umol/ vs 300±95.5 umol/L, p&lt;0.001). In all patients, 25.6% had HUA and the sex ratio was about 1:1, while 50–59 age were most common in men and women with 60–69 age were the most.<sup>2</sup> Both the levels of uric acid in males and females had a significant relationship with the metabolism indexes above-mentioned. However, the levels of uric acid in females had a positive correlation with age and blood glucose, the levels of uric acid in males were negative correlated with age and bloodglucose. And the uric acid levels in females displayed a higher relationship with carbonyldiamide and eGFR.<sup>3</sup> The prevalences of common chronic metabolic disorders, were significantly increased in HUA patients than those with normal uric acid, such as hypertension, hypertensive renal disease, hyperlipoidemia, diabetes mellitus (DM), diabetic nephropathy (DN), chronic renal failure. And male patients with HUA had higher prevalence of gout than females (10.76% VS 2.58%, p&lt;0.001). In patients with normal uric acid, the prevalence of DM and DN in males was higher than females. In contrast, the prevalence of DM and DN in males was lower than females in the patients with HUA (25.7% VS 57.1%, p&lt;0.05;6.52% VS 41.76%, p&lt;0.001). <h3>Conclusions</h3> The prevalence of HUA in females was showing a increasing trend and the uric acid level in females had more influence in blood glucose and renal function than males. <h3>Disclosure of Interest</h3> None declared
SAT0200 Long term safety of filgotinib in the treatment of rheumatoid arthritis: week 108 data from a phase 2b open-label extension study
Authors: R. Westhovens, R. Alten, K. Winthrop, M. Greenwald, L. Ponce, F. Enriquez-Sosa, M. Stanislavchuk, M. Mazur, A. Spindler, R. Cseuz, N. Nikulenkova, M. Glowacka-Kulesz, I. Szombati, A. Dudek, N. Mozaffarian, J. Greer, R. Kunder, D. An, P. Harrison, A. Van der Aa, A. Kavanaugh, M. Genovese
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> Filgotinib (FIL) is an orally administered, selective inhibitor of Janus Kinase 1 (JAK1) in Phase 3 development for the treatment of rheumatoid arthritis (RA). <h3>Objectives:</h3> Assess the long-term safety and efficacy of FIL in the DARWIN 3 open-label extension study. <h3>Methods:</h3> Two 24-week Phase 2b studies were completed in patients (pts) with moderately to severely active RA (DARWIN 1, DARWIN 2; Ref 1, 2). Following study completion, pts were offered FIL in the ongoing DARWIN 3 extension study: 100 mg QD (US males), 200 mg QD, or 100 mg BID. This report summarizes safety data from the first dose of FIL in the DARWIN program to 11 Oct 2017 and efficacy data from the DARWIN 3 baseline visit to Week 108, which all ongoing pts have completed. <h3>Results:</h3> Of 877 pts, 790 (90%) completed DARWIN 1/2, and 739 (84%) enrolled in DARWIN 3; 603 (82%) were female, mean age 53 years. At analysis, 491/739 (66%) were on study. Cumulative patient years of exposure (PYE) was 1931, median time on study drug was 1072 days. Key data are summarized in table 1. 87%, 68%, and 48% of pts achieved ACR20/50/70, respectively, and 72% achieved DAS28-CRP≤3.2 (by observed case analysis). <h3>Conclusions:</h3> Filgotinib long-term RA data demonstrates an acceptable safety and durable efficacy profile. <h3>References</h3> [1]Westhovens R, et al. Ann Rheum Dis2017;76:998–1008. [2]Kavanaugh A, et al. Ann Rheum Dis2017;76:1009–1019. <h3>Disclosure of Interest:</h3> R. Westhovens Grant/research support from: Galapagos and Celltrion, Roche and BMS, Consultant for: Galapagos and Celltrion, Roche and BMS, R. Alten Grant/research support from: Galapagos/Gilead, K. Winthrop Consultant for: Pfizer, Lilly, Galapagos, Gilead, AbbVie, M. Greenwald Grant/research support from: Gilead, L. Ponce: None declared, F. Enriquez-Sosa: None declared, M. Stanislavchuk: None declared, M. Mazur: None declared, A. Spindler: None declared, R. Cseuz: None declared, N. Nikulenkova: None declared, M. Glowacka-Kulesz: None declared, I. Szombati: None declared, A. Dudek: None declared, N. Mozaffarian Shareholder of: Gilead, Employee of: Gilead, J. Greer Shareholder of: Gilead, Employee of: Gilead, R. Kunder Shareholder of: Gilead, Employee of: Gilead, D. An Shareholder of: Gilead, Employee of: Gilead, P. Harrison Shareholder of: Galapagos, Employee of: Galapagos, A. Van der Aa Shareholder of: Galapagos, Employee of: Galapagos, A. Kavanaugh Consultant for: Galapagos, M. Genovese Consultant for: Gilead, Galapagos, Abbvie, Lilly, Pfizer
OP0068 Short term effects of ambient air pollution on osteoporotic hip fracture. an ecological study in a period of 16 years
Authors: R. Mazzucchelli, E. Pérez-Fernandez, J. Quirós, N. Crespí_Villarías, A. García-Vadillo
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To examine the short-term effects of outdoor air pollution on the incidence of osteoporotic HFx in a southern European region. <h3>Methods</h3> This is a retrospective cohort study based on data from three databases. Daily HFx incidence was calculated using discharge data from the hospital of Alcorcón for the period 2000–2015. Daily weather conditions were compiled from records of the national meteorological station (AEMET). Daily air pollutant levels (mcg/m<sup>3</sup>) were calculated from data from the Ministry of Environment for the Madrid Community: sulfur dioxide (SO<sub>2</sub>), nitrogen monoxide (NO), nitrogen dioxide (NO<sub>2</sub>), ozone (O<sub>3</sub>) and particulate matter in suspension &lt;2.5 µm (PM<sub>2.5</sub>) and &lt;10 µm (PM<sub>10</sub>), for the same period. Pollutant concentrations were categorised into quartiles (Q1 to Q4, lowest to highest). Associations between HFx incidence and air pollutant levels were examined through Ggeneralized Additive Models (GAM) at a daily level with Poisson link function. Models were adjusted for a penalised spline function of time. <h3>Main outcome measures</h3> Daily hospital admissions for hip fracture. <h3>Results</h3> HFx incidence showed a direct association with NO, NO<sub>2</sub>, PM<sub>2.5</sub> and PM<sub>10</sub> and inverse association with O<sub>3</sub> levels. Incidence rate ratios for Q1vsQ2, Q1vsQ3 and Q1vsQ4 respectively were: 1.171 (1.103–1.244), 1.245 (1.173–1.322) and 1.331 (1.253–1.414) for NO; 1.057 (0.996–1.122), 1.185 (1.116–1.259) and 1.276 (1.199–1.357) for NO2; 1.028 (0.943–1.12), 1.092 (1.006–1.185) and 1.146 (1.049–1.253) for PM<sub>2.5</sub>; 1.083 (1.016–1.155), 1.099 (1.034–1.168) and 1.213 (1.136–1.294) for PM<sub>10</sub>; and 0.975 (0.914–1.04), 0.868 (0.815–0.924) and 0.814 (0.765–0.867) for O<sub>3</sub>. These associations persisted when the models were corrected for season, day of the week and weather conditions. When participants were stratified by age and sex, associations persisted only in women older than 75 years. <h3>Conclusions</h3> A short-term effect was observed of several indicators of air pollution on hip fracture incidence. This is the first study that finds this association. <h3>Disclosure of Interest</h3> None declared
FRI0308 Corticosteroids combined with doublet or single-agent immunosuppressive therapy for active proliferative lupus nephritis
Authors: B. Liu, Y. Yu, Y. Tang, S. Fu, P. Liang, A. Xu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Current evidence exploring whether corticosteroids (C) plus doublet immunosuppressive therapy (IT) is superior to the classical combination of C with single-agent IT for active proliferative lupus nephritis (LN) is controversial. <h3>Objectives</h3> We aimed to clarify the efficacy and safety of C+doublet versus single-agent IT for active proliferative LN by a meta-analysis. <h3>Methods</h3> We searched for randomised clinical trials that evaluated the benefits and risks of C+doublet versus single-agent IT for active proliferative LN. The primary outcome was overall response rate (ORR). The second outcomes were the change from baseline in Systemic Lupus Erythematosus Disease Activity Index (SLE-DAI) score, negative conversion ratio of anti–double-stranded DNA (anti-dsDNA), and adverse events. The quality of the evidence was evaluated with the GRADE framework. The PROSPERO registry number is CRD42017068491. <h3>Results</h3> The analysis included 10 trials with 1587 unique patients. Compared with C+single agent IT, C+doublet IT was statistically significant with higher ORR (relative risk [RR], 1.22; 95% confidence interval [CI], 1.09 to 1.35; p<i>&lt;</i>0.0001; moderate certainty). In subgroup analysis, C+doublet IT without biologics resulted into significant higher ORR than C+single agent IT (RR, 1.30; 95% CI, 1.13 to 1.50; p<i>&lt;</i>0.0001; moderate certainty), while C+doublet IT including biologics improved ORR only for refractory severe LN (RR, 1.46; 95% CI, 1.09 to 1.96; p=0.012; very-low certainty). A larger change from baseline in SLE-DAI score (standardised mean difference, −0.49; 95% CI, −0.68 to −0.30; p<i>&lt;</i>0.0001; moderate certainty) and a higher negative conversion ratio of anti-dsDNA (RR, 1.34; 95% CI, 1.06 to 1.69; p=0.014; high certainty) were observed with C+doublet IT than with C+single agent IT. The rates of adverse events were similar between the two regimens (high to moderate certainty). <h3>Conclusions</h3> Compared with single-agent IT, the combination of corticosteroids with doublet IT improved clinical outcomes for active proliferative LN. C+doublet IT including biologics may be a better regimen for refractory severe LN. There is imperative that prospective biomarker-driven trials to identify patients for whom C+doublet IT is most efficacious. <h3>Disclosure of Interest</h3> None declared
Clinical characteristics of COPD patients with early-onset desaturation in the 6-minute walk test
Authors: I. García-Talavera, J.M. Figueira-Gonçalves, N. Gurbani, L. Pérez-Méndez, A. Pedrero-García
Journal: Pulmonology (2018)

Exercise-induced desaturation in chronic obstructive pulmonary disease (COPD) frequently has prognostic implications. Desaturation within the first minute of the walk 6-minute walk test will probably also occur in daily life activities and translate into hypoxaemic respiratory failure at rest in later years. This study aimed at comparing these patients with those who desaturate after the first minute and determine potential markers.We conducted a cross-sectional, retrospective study collecting data on respiratory function tests, cardiovascular comorbidity, body mass index, pack-year index, 6-minute walk test outcomes, BODE index, and Charlson comorbidity index. Patients who desaturated during the first minute of the test were referred to as early desaturators compared to the non-early ones.We observed a higher mean body mass index in early desaturating patients, and an inverse relation as to the body mass index categories <25, 25-29, and ≥30. Early desaturators had a lower FEV1/FVC index. The mean distance walked in the test was shorter in early than in non-early desaturators, and they desaturated more deeply.Overweight and obesity, as determined by body mass index, seem to behave like markers for early desaturation. This simple anthropometric measure might indicate point to potential early desaturation in COPD patients.