tbuckley/cabot-search huggingface dataset:
Complete response under sorafenib in patients with hepatocellular carcinoma: Relationship with dermatologic adverse events
Authors: Jordi Rimola, Álvaro Díaz‐González, Anna Darnell, María Varela, Fernando Pons, Manuel Hernandez‐Guerra, Manuel Delgado, Javier Castroagudin, Ana Matilla, Bruno Sangro, Carlos Rodriguez de Lope, Margarita Sala, Carmen Gonzalez, Carlos Huertas, Beatriz Minguez, Carmen Ayuso, Jordi Bruix, María Reig
Journal: Hepatology (2017)

The clinical benefit of sorafenib in patients with hepatocellular carcinoma (HCC) has been undervalued due to the absence of complete responses, even though patients who develop early dermatologic reactions have shown to have a positive outcome. In addition, sorafenib is described as an antiangiogenic drug, but it also acts on immunological cells. Thus, the goal of this study was to assess the complete response rate in a retrospective cohort of HCC patients treated with sorafenib and to describe the profile of the patients who achieve complete response for identifying factors related to this event and their connection with the immunological profile of sorafenib. Ten Spanish centers submitted cases of complete response under sorafenib. The baseline characteristics, development of early dermatologic reactions, and cause of treatment discontinuation were annotated. Radiological images taken before starting sorafenib, at first control, after starting sorafenib, at the time of complete response, and at least 1 month after treatment were centrally reviewed. Of the 1119 patients studied, 20 had been classified as complete responders by the centers, but eight of these patients were excluded after central review. Ten patients had complete disappearance of all tumor sites, and two had just a small residual fibrotic scar. Thus, 12 patients were classified as complete responders (58% HCV, median age 59.7 years, 83.4% Child‐Pugh class A, Eastern Cooperative Oncology Group performance status 0 91.7%, and Barcelona Clinic Liver Cancer stage C 83.3%). The median overall survival and treatment duration were 85.8 and 40.1 months, respectively. All but one patient developed early dermatologic reactions, and seven patients discontinued sorafenib after achieving complete response due to adverse events, patient decision, or liver decompensation. Conclusion : Complete response affects 1% of patients with HCC who are treated with sorafenib. The association of complete response with early dermatologic reactions supports the role of a specific immune/inflammatory patient profile in the improved response to sorafenib. (H epatology 2018;67:612‐622).
SAT0367 Capillaroscopy patterns among systemic sclerosis patients with gastrointestinal involvement and malnutrition evaluated by self-reported questionnaires
Authors: Y Yalçınkaya, Z Ertürk, AU ÜNal, S Kaymaz, P Atagündüz, H Direskeneli, N Inanç
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Gastrointestinal system (GI) is commonly involved in systemic sclerosis (SSc) beginning after early stages of disease. <h3>Objectives</h3> We aimed to investigate capillaroscopic findings among the SSc patients with GI involvement and malnutrition. <h3>Methods</h3> GI involvement was evaluated by UCLA SCTC GIT 2.0 questionnaire (Khanna D.) (7 multi-item; reflux, distension, soilage, diarrhea, social functioning, emotional wellbeing and constipation) in SSc patients ACR/EULAR classification criteria (2013). To report the nutrition status of the patients "malnutrition universal screening tool (MUST)" (sum of the scores of body mass index, weight loss in last 3–6 months and acute disease effect) scores were calculated. Simultaneously, nail fold video-capillaroscopy (NVC) was performed in all paatients to deterimine ealy, active late scleroderma patterns (Cutalo et al.). <h3>Results</h3> In 58 SSc patients (51 female); the mean age, duration of Raynaud9s, non-Raynaud symptom (year) and follow-up (month) were 46±13, 54±50, 10±9 and 7±7, respectively. Limited cutaneous form, positive ANA and anti-Scl70, telangiectases, dysphagia, digital ulcers, lung disease were found in 40 (71%), 48 (83%) and 21 (36%), 45 (78%), 39 (67%), 33 (57%), 23 (40%) in patients, respectively. Of the NVC patterns, early was found in 16 (28%), active was in 11 (19%), late was in 28 (48%) and normal in 3 (5%). The scores of disease activity, severity and GI were shown to be higher in patients with late NVC pattern (table-1). Of the patients with MUST score of &gt;0 (n=10), 9 had late and 1 had early NVC pattern. <h3>Conclusions</h3> This SSc cohort predominantly had limited cutanous disease and vascular manifestations. In patients with late scleroderma pattern, severity of GI was higher similar to disease activity and severity. Undernutrition was frequently seen in patients with late pattern. NVC might be useful to predict the severity of GI and malnutrition and allow to direct the patients to required procedures earlier. <h3>Disclosure of Interest</h3> None declared
SAT0433 Anti-tnf treatment in rheumatoid arthritis and ankylosing spondylitis patients is associated with a strong increase of palmoplantar pustulosis but not of psoriasis vulgaris
Authors: J Ruwaard, E van der Vlugt, M Nurmohamed, T Rispens, GJ Wolbink
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> The prevalence of paradoxical psoriasis developed with biological use is already studied. However, none of these studies discriminate between psoriasis vulgaris (PV) and palmoplantar pustulosis (PPP), while these might be different entities (1). The prevalence in general population is 2–4% for PV and 0.01–0.05% for PPP (1–3). Moreover, most reports in the literature imply only a role for anti-Tumor necrosis factors (anti-TNF), although, a few cases described paradoxical psoriasis in patients treated with biologicals other than anti-TNF. <h3>Objectives</h3> To study the prevalence and incidence density of paradoxical psoriasis and palmoplantar pustulosis in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) treated with biological therapy. Second to investigate differences between paradoxical psoriasis and palmoplantar pustulosis. <h3>Methods</h3> Data were collected from the observational cohorts of AS and RA patients. 1499 consecutive patients were included for calculating prevalence and incidence density. Incidence density is calculated per 1000 person years. For calculating differences, only biological naïve patients (n=830) were included. Kaplan Meier curve was used to show the difference in time in onset. <h3>Results</h3> In all, 13 cases of PPP and 16 cases of PV were observed in both the RA as AS cohorts. In AS patients 1.73% developed PPP and 1.38% PV. In RA patients respectively 0.66% and 0.99%. The incidence density of PPP in RA was 2.1 (95% CI 0.7–3.6), for PV 3.2 (95% CI 1.4–5.0). In AS, 4.7 (95% CI 0.6–8.8) for PPP and 3.7 (95% CI 2.3–12.7) for PV. Although not statistically significant, PPP was more prevalent in adalimumab (0.94%) compared to etanercept (0.34%). In contrast, PV occurs in 0.53% in adalimumab and 0.92% in etanercept treated patients. PPP was only observed in anti-TNF, PV was also observed in 1 patient treated with tocilizumab and 1 with abatacept. A difference was observed in the time to event, with a median of 6 months (IQR 4–16 months) for PPP and 50 months (IQR 11–67 months) for PV; p=0.003 (figure 1). Discontinuation of biological treatment was indicated in 80% of the PPP patients and 18.2% PV patients. <h3>Conclusions</h3> Our findings show that biological therapy in patients with RA or AS is associated with a 13 to 35 fold increase in prevalence of PPP. While the prevalence of biological-associated PV is lower than the prevalence of PV in the general population. In this study PV and PPP are different from each other regarding prevalence, time to onset and consequences for biological treatment, and therefore should be considered as separate entities. <h3>References</h3> J Dermatolog Treat 2011 Apr;22(2):102–5. Lancet 2015 Sep 5;386(9997):983–94. Acta Derm Venereol 1971;51(4):284–8. <h3>Disclosure of Interest</h3> None declared
Generalized Net-like Erythema and Stroke in a Young Female
Authors: Olivia Lai, Detlef Zillikens, Iakov Shimanovich
Journal: JAMA Dermatology (2017)

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FRI0432 Clinical worsening according to the patient is infrequent in axial spondyloarthritis: results of the asas-flare study in 1169 patients
Authors: A Moltό, B Meghnathi, L Gossec, R Landewé, D van der Heijde, M Dougados
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Prevalence of flares/worsening of the disease in axSpA is not well known, with prevalences ranging from 10 to 40%. <h3>Objectives</h3> To evaluate the prevalence of disease worsening according to the patient9s perception in an axSpA population with stable disease and its correlation with disease activity parameters. <h3>Methods</h3> Study: International multicentric (20 countries) longitudinal (2 visits: 1 week – 6 months) observational in 2016, under the guidance of ASAS. Patients: axSpA patients with stable disease according to the rheumatologist. Data on disease characteristics were collected at baseline, and data on disease activity were collected at both visits. Disease worsening was defined at the follow-up visit by the patient using the MCID question (“<i>Think about all the ways your spondyloarthritis has affected you during the last 48 hours. Compared to the last visit how did you feel during the last 48 hours? Improved/No change/Worse”).</i> If patients answered “worse”, they marked if they considered themselves in an acceptable symptoms state (PASS) and whether they considered treatment intensification was necessary. Analyses were descriptive and changes in disease activity were calculated according to patient-reported worsening. <h3>Results</h3> Among the 1639 patients included, 1169 patients had complete data. Patients were predominantly males (64.8%), had a mean age and disease duration of of 41.7 (SD 12.4) and 12.6 (9.9) years, respectively. History of X-ray sacroiliitis, MRI sacroiliitis and HLAB27+ were present in 944 (80.8%), 471 (40.6%) and 807 (69.0%) patients, respectively. 56% (n=655) patients were receiving a biologic treatment. At the baseline visit, mean BASDAI (0–10) was 3.1 (2.3), mean ASDAS 2.3 (1.0) and mean CRP 8.4mg/L (14.5). Mean interval between both visits was 91.2 (51.0) days. At the follow-up visit, 590 (50.5%), 388 (33.2%) and 191 (16.3%) patients considered their condition had improved, not changed and worsened, respectively. Among the 191 patients reporting a worsening, 123 (64.4%) considered their symptom status unacceptable, and 127 (66.5%) judged their state required treatment intensification. BASDAI, ASDAS and CRP significantly increased in patients considering themselves worsening (Table). <h3>Conclusions</h3> in this real-life study of stable axSpA, worsening, as defined by the patient, was not frequent, but was significantly associated with increase in disease activity measures, including objective parameters such as CRP and not only patient-reported outcomes. <h3>Acknowledgements</h3> This study was supported by ASAS (Assessment in SpondyloArthritis international Society) <h3>Disclosure of Interest</h3> None declared
SAT0632 Impact of lumbar spine morphology (scoliosis) on early spondyloarthritis pattern (the impala-desir study)
Authors: M. Voirin-Hertz, G.C. Alegria, F. Garrigues, A. Simon, A. Feydi, F. de Bruin, M. Reijnierse, D. van der Heijde, D. Loeuille, P. Claudepierre, T. Marhadour, A. Saraux, Desir
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Objectives</h3> To evaluate the impact of scoliosis on both clinical presentation and lumbar imaging of early inflammatory back pain suggestive of spondyloarthritis. <h3>Methods</h3> The DESIR cohort is a prospective longitudinal cohort study of adults aged 18–50 with inflammatory back pain (IBP) ≥3 months, ≤3 years. Baseline lumbar X-Rays of patients included in DESIR cohort were read by two central blinded fellow readers (and a rheumatologist spine specialist in case of discrepancy) for presence or not of scoliosis (defined as a Cobb angle&gt;10° and a Nash Moe grade≥1). Associations between scoliosis and baseline clinical variables, presence of X-Rays (New York) and MRI (ASAS and MORPHO proposal definition) sacroiliitis, presence of spinal signs of spondyloarthritis (mSASSS, BASRI-total, SPARCC scores), presence of spinal degenerative MRI signs on X-rays (yes or no) and MRI (presence of Modic abnormalities, Pfirrmann score, Canal stenosis, Extrusion, High intensity zone Facet osteoarthritis) according to central reading (two readers) and axSpA diagnostic confidence (according to local clinician9s confidence on a 0–10 visual analogic scale) were assessed by univariate analysis using the chi-square test (or Fisher9s exact test where appropriate) and the Mann-Whitney test. Adjustment for multiple testing was performed according to Bonferroni method. <h3>Results</h3> 675 patients (47.1% men, mean age of 33.6 years, 89.6% had lumbar pain, 65% fulfilling ASAS criteria) were studied. The mean Cobb angle was 3.2° (± 4.8) and 49/675 (7.3%) patients had lumbar scoliosis. The only significant difference was the lumbosacral sagittal balance. Indeed, scoliotic patients had greater lumbar lordosis (57.8° versus 50.9°; p&lt;0.001) than non-scoliotic. About MRI findings, spinal degenerative manifestations were very scarce in both groups. The major part of degenerative changes was in the two last lumbar discs and vertebras, without significant difference between scoliotic and non-scoliotic patients. <h3>Conclusions</h3> Scoliotic patients with inflammatory back pain suggestive of spondyloarthritis do not have more lumbar degenerative lesions than non-scoliotic patients, nor difference of clinical presentation, but they have greater lumbar lordosis. <h3>Disclosure of Interest</h3> None declared
AB1060 Measuring agreement in the ultrasonographic evaluation of disease activity in rheumatoid arthritis patients. a latin-american multicenter exercise assessing the influence of sonographer experience and expertise
Authors: T Cazenave, MV Martire, C Waimann, M Rosemffet
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Ultrasonography (US) is an important tool in rheumatology practice but it depends on sonographer9s experience. <h3>Objectives</h3> To evaluate the reliability of US assessment among observers across Latin American using a web tool. <h3>Methods</h3> Cross-sectional study. Fifty-one Latin American ultrasonographers took part in a web- based US exercise evaluating images from 20 RA patients. The 4 joints US score was calculated for each patient including bilateral radiocarpal, midcarpal and second metacarpophalangeal joints. PD and GS were graded from 0 to 3. US scores comes as the result of the addition of PD and GS score, being 36 the highest disease activity. Five patients were evaluated twice in order to address intra – rater reliability. The inter and intra-rater reliability was assessed using a two-way random, absolute, individual and average-measures intra-class correlation coefficient (ICC). We stratified sonographers according to experience (defining High experience as: at least 5 years of experience and 80 US assessments/month). <h3>Results</h3> A total of 1020 US image assessments were performed. Mean 4-joints US score was 17±8. The ICC was in the excellent range for intra [(individual ICC = 0.945 (IC95% 0.905–0.965); average ICC =0.972 (IC95% 0.950–0.982)] and inter- reader reliability [(individual ICC =0.867 (IC95% 0.786–0.934); average ICC = 0.997 (IC95% 0.995–0.999)]. When comparing high with low experience sonographers, there was no significant differences in intra-class correlation coefficient. However, there was a greater variation between the means among low experience readers (13 to 22) and higher experience sonographers (14–18) (Figure 1). <h3>Conclusions</h3> US reliability is related to sonographer expertise and experience. <h3>Acknowledgements</h3> Edith Alarcόn, Lucio Ventura, Walter J. Spindler, Christina Hernandez-Diaz, Javier Rosa, Santiago Ruta, Mara Guinsburg, Gustavo Rodriguez Gil, Cecilia Urquiola, Guillermo Py, Magalí Alva, Patricio Tate, Carmen Cerόn, Lida Santiago, Ana Laura Alvarez del Castillo Araujo, Maria Jezabel Haye Salinas, Erika Catay, Maximiliano Bravo, Johana Zacariaz, Clarisa Sandobal, Gonzalo Pacheco, Mariana Benegas, David Navarta, Verόnica Arturi, Ana Bertoli, Marcelo Audisio, Carlos Pineda, Natalia Estrella, Carla Airoldi, Paula Kohan, María Julia Santa Cruz, Lina Saldarriaga Rivera, Romulo Wong, Ignacio Carrillo, Hugo Najera, Julio García, Daniele Freitas Pereir, Fernanda Athayde Cardoso Linhares, José Alexandre Mendonça, Maritza Quintero, Anthony M. Reginato, Eliana Natalí Ayala Ledesma, Lorena Urioste, Eugenio De Miguel, María Soledad Gálvez Elkin, Carla Saucedo, Josefina Marin, Rodolfo Arape, Marwin Gutierrez. <h3>Disclosure of Interest</h3> None declared
AB0131 Platelet microparticles (PMPS) are higher in patients with SLE compared to healthy controls
Authors: C-LM Murphy, V Ripoll-Nunez, C Periculeous, T McDonnell, S Croca, I Giles, A Rahman
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Patients with SLE have an increased risk of cardiovascular disease (CVD) and reasons for this are unknown. Microparticles (MPs) are membrane-bound particles released by many cells, 70–90% are derived from platelets. MPs are a rich source of autoantigens, including DNA and have many functions including thrombosis and inflammation. PMPs can induce foam cell formation and promote adherence of platelets to endothelial lesions. MPs are potentially important in the pathogenesis of autoimmune rheumatic disease and in cardiovascular disease. <h3>Objectives</h3> To determine if EMPs and PMPs are increased in patients with SLE. Our secondary aim was to determine if there was a difference between those with/without subclinical cardiovascular disease and healthy controls. <h3>Methods</h3> Atherosclerotic plaque was previously determined in patients with SLE who had no known history of CVD by carotid and femoral ultrasound scans. Plaque and thickened intima media thickness (IMT) &gt;0.1cm were defined according to the Mannheim Carotid Consensus. Data regarding plaque area, IMT and echolucency were collected. Plasma was stored at -80° at the time of scan. Plasma from n=57; plaque (n=16), no plaque (n=23) and healthy controls (HC) (n=18) were analysed for presence of endothelial and platelet microparticles (EMPs and PMPs), as per protocol. Samples were stained with Annexin V and platelet and endothelial antibodies, CD42a, CD31, CD105 and CD144. MPs were measured using flow cytometry. Statistical analysis was carried out using PRISM. <h3>Results</h3> A total of 57 plasma samples were tested. The average age of those with SLE was 45±12 years. 96% were female. 56% were Caucasian, 18% Asian, 21% Afrocaribbean, 5% other ethnicity. 18% of the SLE patients were smokers. Of the 18 HC, the average age was 37±7 years, 83% were female. 88% were Caucasian and 12% other ethnicity. 11% of the HCs were smokers. PMPs were significantly higher in patients with SLE compared to healthy controls (p=0.025). Patients with SLE without plaque had more PMPs compared to healthy controls (p=0.037). There was no correlation between age and PMPs. There was no statistical significance between those with SLE with plaque and healthy controls or in EMP levels between the three groups. There was no correlation between EMPs or PMPs with disease activity as measured by BILAG. <h3>Conclusions</h3> PMPs were raised in patients with SLE compared to the healthy controls regardless of whether there was atherosclerotic plaque evident on imaging. Therefore, raised PMPs were associated with SLE itself and did not stratify a subset of patients with subclinical CVD. Further research is required to define whether PMP are important in the pathogenesis of SLE and to clarify the relationship of subclinical CVD in larger cohorts. <h3>Disclosure of Interest</h3> None declared
Patient safety and comparative effectiveness of anesthetic technique in lung resections: A population-based analysis.
Authors: Umut Ozbek, Jashvant Poeran, Cardinale B. Smith, Bruce Darrow, Stavros G Memtsoudis, Madhu Mazumdar
Journal: Journal of Clinical Oncology (2015)

e12612 Background: Neuraxial anesthetic techniques are shown to be beneficial on perioperative outcomes. However, the effect of regional anesthesia in lung surgeries is understudied. Therefore, we aimed to investigate the impact of combined neuraxial and general anesthesia on outcomes using a large national database of cancer patients having open lung resections. Methods: We queried the Premier Perspective claims-based database on open lung resections (2006-2013). Unlike SEER-Medicare, this database provides all-payor data without age restrictions. Patient and healthcare variables, perioperative complications, and resource use were compared between anesthesia groups: general and combined neuraxial/general anesthesia. Multivariable analyses assessed the independent impact of choice of anesthetic technique on complications. Results: Among 18,943 open lung resections, 14,912 (79%) were performed under general and 4,031 (21%) under combined neuraxial and general anesthesia. Unadjusted incidences of acute myocardial infarction (1.09% vs 0.67%, P = 0.018), pulmonary complications (20.96% vs 18.98%, P = 0.006), blood transfusion (14.15% vs 9.80%, P < 0.0001), and mechanical ventilation (11.60% vs 8.81%, P < 0.0001) were significantly lower in the latter group. Neuraxial/general anesthesia was associated with lower adjusted odds for blood transfusion (OR 0.82, CI 0.69-0.98) and mechanical ventilation (OR 0.81, CI 0.67-0.98), and higher adjusted odds for deep vein thrombosis (OR 1.50, CI 1.01-2.23) and pulmonary embolism (OR 1.56, CI 1.02-2.38). While further investigating these findings, we found that the use of anticoagulant medications was also significantly lower in patients having combined neuraxial/general anesthesia, possibly reflecting fear of neuraxial hematoma formation in these patients. Conclusions: This study shows the effects of adding neuraxial to general anesthesia in open lung resections among cancer patients such as decreasing the need for blood transfusion and increasing the risk of thromboembolism. Additional studies to examine the effects of e.g. fluid resuscitation practices and pharmacological interventions used are underway.
Chimeric antigen receptor T-cell therapy — assessment and management of toxicities
Authors: Sattva S. Neelapu, Sudhakar Tummala, Partow Kebriaei, William Wierda, Cristina Gutierrez, Frederick L. Locke, Krishna V. Komanduri, Yi Lin, Nitin Jain, Naval Daver, Jason Westin, Alison M. Gulbis, Monica E. Loghin, John F. de Groot, Sherry Adkins, Suzanne E. Davis, Katayoun Rezvani, Patrick Hwu, Elizabeth J. Shpall
Journal: Nature Reviews Clinical Oncology (2017)