tbuckley/cabot-search huggingface dataset:
Predictors of atrial fibrillation in ibrutinib-treated CLL patients: a prospective study
Authors: Gianluigi Reda, Bruno Fattizzo, Ramona Cassin, Veronica Mattiello, Tatiana Tonella, Diana Giannarelli, Ferdinando Massari, Agostino Cortelezzi
Journal: Journal of Hematology & Oncology (2018)

Ibrutinib is an oral irreversible inhibitor of Bruton's tyrosine kinase, indicated for the treatment of chronic lymphocytic leukaemia. The drug is generally well tolerated; however, not infrequent side effects are reported, with the major two being bleeding and ibrutinib-related atrial fibrillation. Atrial fibrillation pathogenesis in this setting is not completely clear, and no prospective studies have evaluated the impact of previous cardiologic history and baseline characteristics. We prospectively performed cardiologic assessment in 43 CLL patients before starting ibrutinib therapy. Cardiologic workup included comorbidity collection and electrocardiographic and echocardiographic baseline evaluation. After a median observation of 8 months, seven patients developed atrial fibrillation (16.3%). Cases developing atrial fibrillation were all elderly males (p = 0.04), and mostly with a history of previous arterial hypertension (p = 0.009). Atrial fibrillation occurrence also correlated with the presence of one or more pre-existent cardiologic comorbidities (p = 0.03), with a higher atrial fibrillation risk score (calculated with comorbidities and cardiologic risk factor evaluation p < 0.001), and with higher left atrial diameter (p = 0.02) and area (p = 0.03) by echocardiography. The occurrence of atrial fibrillation was managed after an integrated cardio-oncologic evaluation: anticoagulation was started in 4 (57.1%) patients and beta-blockers or amiodarone in 5 (71.4%). One patient underwent electric cardioversion and another patient pacemaker positioning to normalise heart rate in order to continue ibrutinib. Our data show that echocardiography is a highly informative and reproducible tool that should be included in pre-treatment workup for patients who are candidates for ibrutinib therapy.
AB0328 Cardiovascular risk evaluation in long standing rheumatoid arthritis: real clinical data
Authors: A. Babaeva, E.V. Kalinina, M.S. Zvonorenko, K.S. Solodenkova, M.A. Osadchuk
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> According to recent national and EULAR recommendation cardiovascular risk (CVR) in pts with RA should be evaluated using modified SCORE system. But a lot of investigations and real clinical data demonstrate that this system commonly down-estimates CVR in RA pts. <h3>Objectives</h3> Aim of our study was to compare standard CVR assessment and additional CVR evaluation on the basis of specific disease-associated risk factors (RF) and CV system investigations in long standing RA. <h3>Methods</h3> 118 pts (96 female, 22 male) aged from 34 to 74 years old (mean age 55.91±5.21) with long standing RA (duration &gt;5 years) were observed. In all pts CVR was stratified according to modified SCORE. We have analysed pts medical cards and standard examination data to determine clinical features of RA and associated conditions to verify severity of CVR. In term to reveal asymptomatic CV disease pts had undergone additional investigations (echocardiography, Dopplerography of carotid arteries, ECG-monitoring). <h3>Results</h3> Conventional CVRF were registered in 110 (93.22%) pts. Age&gt;45 (male),&gt;50 (female) was in 85 (72.03%) pts, BMI&gt;25 kg/m<sup>2</sup>; in 10.17%, elevated cholesterol level and/or dyslipidemia in 41.52%, AH with target organ damage was detected in 45.76%, T2DM in 11.8%, CKD 3 stage in 10.17%, history of MI was in 2 (1.69%) pts. According to modified SCORE for RA very high, high, moderate and low CVR was detected in 17.80%, 47.46%, 18.64%, 16.10% cases respectively. High activity of RA was diagnosed in 61.02%, and erosive arthritis in 84.75% pts. Inadequate disease-modifying treatment was qualified in15.26% cases. Majority of pts (59.32%) received systemic glucocorticoids (GC) in daily doses from 2 to 12 mg of methylprednizolon, among these pts 14 (11.86%) have been taken GC in moderate and high dose for a long period. On the basis of instrumental data asymptomatic atherosclerosis of aorta and/or aortic valve and/or carotid arteries was detected in 44 pts (37.29%). Silent ischemia was revealed in 3 pts (2.54%). High disease activity and long term systemic GC treatment were associated with significantly high CV events in observed pts (p&lt;0.05). Using obtained results we reassessed CVR in studied cohort. Revised data of CVR stratification suggest that 49 (41.53%) pts were in VH-CVR, 41 (34.75%) – in H-CVR, 16 (13.56%) in M-CVR and only 12 (10.17%) in L-CVR. The difference in pt ratio for CVR stratification was significant in accordance with χ<sup>2</sup>; criterion. <h3>Conclusions</h3> Obtained data suggest that modified SCORE is not absolutely reliable tool for precise CVR stratification in long standing RA. Additional investigations to define asymptomatic atherosclerosis and coronary artery disease are required in term to prevent CV complications especially in pts with high active erosive RA treated with systemic GC. <h3>Disclosure of Interest</h3> None declared
OP0078 Is the efficacy of physical therapy related to the pain in the patient’s mind?
Authors: A. Caliskan Uckun, B. Köse, F.G. Yurdakul, Y. Garip, H. Bodur
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The degree of improvement in functionality and pain after physical therapy in the patients with knee osteoarthritis (OA) may be due to various peripheral factors and used modalities. Additionally, in some patients, modifiable psychological factors such as pain catastrophizing and depression may influence the therapy outcome.<sup>1</sup> <h3>Objectives</h3> The aim of this study was to investigate the impact of pain catastrophizing and depression on pain and functionality in the patients with knee OA who were treated with physical therapy. <h3>Methods</h3> The prospective cohort study participants were 89 patients with knee OA who underwent 10 sessions of physical therapy consist of hot-pack, transcutaneous electrical nerve stimulation (TENS), and ultrasound (US). Socio-demographic and clinical data were initially recorded. At baseline, pain catastrophizing and depression were measured with the standardised questionnaires including Pain Catastrophizing Scale (PCS) and Beck Depression Inventory-II (BDI-II).The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the visual analogue scale (VAS) were performed at baseline, at the end of therapy and at first month after therapy. <h3>Results</h3> The patients' mean age was 60.38 (0.97), 82% were women, and 58.4% were not working. At baseline, the mean VAS and WOMAC scores were 7.39 (1.07) and 43.03 (19.47), respectively. 47.20% of the patients had clinically proper catastrophizing. The baseline demographic and clinical characteristics, except BDI-II score, VAS, and WOMAC were not different among the low catastrophizing and high catastrophizing groups (table 1). The patients who had high scores on pain catastrophizing had a lower improvement in VAS and WOMAC scores at the end of therapy and at first month after therapy (figure 1). <h3>Conclusions</h3> We suggest that high levels of initial PCS score may cause lower improvement on pain and functional levels in the patients who underwent physical therapy. Screening for pain catastrophizing and depression in the patients who receive physical therapy and taking necessary precautions may improve outcomes. <h3>Reference</h3> [1] Deutscher D, Horn SD, Dickstein R, Hart DL, Smout RJ, Gutvirtz M, Ariel I. Associations between treatment processes, patient characteristics, and outcomes in outpatient physical therapy practice. Arch Phys Med Rehabil2009Aug;90(8):1349–63. <h3>Disclosure of Interest</h3> None declared
SAT0611 Canakinumab use in adult familial mediterranean fever patients: a large single centre experience
Authors: H. Babaoglu, O. Varan, H. Kucuk, N. Atas, H. Satis, R.B. Salman, M.A. Ozturk, B. Goker, A. Tufan, S. Haznedaroglu
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> IL-1 blocking agents have been shown to be effective in the prevention of attacks in colchicine resistant FMF (crFMF) patients. Canakinumab is FDA approved long acting recombinant IL-1 receptor antagonist for use in crFMF patients which is available for off label use in Turkey. Herein, we aimed to share our real life single centre experience for use of canakinumab in adult crFMF patients. <h3>Methods</h3> Data was derived from Gazi FMF cohort which was established in year 2010. From that date patients with FMF who were diagnosed according to the Tel Hashomer criteria were registered. Co-morbidities, detailed attack characteristics, type, duration, severity, treatments, laboratory parameters and impact of FMF on their life in terms of quality of life and work productivity were recorded either by FMF diary or a mobile phone application (FMF AIDD free to download from AppStore and android market). A retrospective cohort analysis was made from records of patients who were treated with canakinumab. <h3>Results</h3> Eighteen adult crFMF patients (%61 female) treated with canakinumab were enrolled in this study. The median age was 31<sup>24–58</sup> years and the median disease duration was 28<sup>16–40</sup> years. All patients harbour homozygous or compound heretozygos exon 10 <i>MEFV</i> mutations. Treatment reasons for canakinumab were colchicine resistance (n=14) and amyloidosis (n=4). In three patients canakinumab was initiated directly, while in 15 it was switched from anakinra (seven was allergic to anakinra, one patient had significant leukopenia, in six fail to control attacks). The median duration of canakinumab use was 8 (min 1- max 22) months. In two patients canakinumab was used as 300 mg/monthly, and in remaining as 150 mg/monthly. Pre- and post-canakinumab periods of patients were compared (Table). Patient reported attack severity (p≤0.01), duration (p≤0.01), frequency (p≤0.01), C-reactive protein (CRP) (p≤0.01) and erythrocyte sedimentation rates (p≤0.01) were significantly improved while serum creatinine and alanine aminotransferase (ALT) levels remained same (p=0.2, p=0.35, respectively). Canakinumab achieved complete disease remission in 5 patients. Side effects requiring discontinuation of canakinumab were observed in none of patients. <h3>Conclusions</h3> Canakinumab is effective in the prevention of attacks with a favourable safety profile. <h3>Disclosure of Interest</h3> None declared
Spectrum of biliary parasites affecting the biliary tree (Fasciola hepatica, Echinococcus granulosus, and Ascaris lumbricoides)
Authors: Guido Villa-Gómez Roig, Manuel Mahler, Dante Manazzoni, Miguel Villa-Gomez, Gustavo Vidales, Mariano Marcolongo
Journal: Endoscopy (2018)

Parasites are common worldwide and may involve any part of the gastrointestinal tract. Despite the high prevalence, reports of biliary involvement and its endoscopic treatment are scarce. Hereby we present a spectrum of biliary tree parasitosis ([Video 1]).
SP0163 A case of severe osteoporosis and ischaemic heart disease; what will be the future cardiovascular risk?”
Authors: G. Weerasinghe
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Case description</h3> A 63-year-old female recently presented to metabolic bone clinic with vertebral fractures at L4 and L5. DEXA scan showed osteoporosis with T-scores at the spine −4.0 and left hip −3.8. Patient was commenced on weekly Alendronic acid 70 mg, calcium and vitamin D supplements. Patient had severe vitamin D deficiency and was commenced on treatment at primary care. She is on analgesics and physiotherapy for back pain, which was of moderate severity. She was on oral prednisolone for 5 years for polymyelgia rheumatica in the past and weaned off year ago. Other past medical history includes coronary artery disease; a myocardial infarction requiring coronary artery bypass graft 3 years back. She does not have diabetes or hypertension. She has hypercholeterolaemia; probably polygenic in origin and is on lipid lowering medications since the age of 50 years. Her alcohol intake is minimal, and is a non-smoker. There is no family history of osteoporosis or cardiovascular disease. Her milk consumption accounted for 300 mg of calcium per day. She has reached menapuase at 43 years of age and has not been on hormonal replacement therapy. Her current medications are Aspirin, Atorvastatin, Bisoprolol and Omeprazole. There is no history of indigestion or dental concerns. Except mild local tenderness at L4–5 region, rest of the clinical examination is unremarkable. Recent blood investigations showed normal calcium, inorganic phosphate, PTH and vitamin D. Alkaline phosphatase (195 IU/L) and P1NP (55 ug/L) were raised. Renal functions showed normal creatinine with eGFR of 62 mL/min. Full blood count is unremarkable. Serum and urine electrophoresis excluded multiple myeloma. <h3>Summary</h3> This is a case of severe osteoporosis involving vertebral fractures requiring osteoporosis treatment. Possible causes for osteoporosis would be previous use of oral steroids for long time and severe undiagnosed vitamin D deficiency. Hypercholesterolaemia and significant history of ischaemic heart disease are other concomitant diagnoses. <h3>Disclosure of Interest</h3> None declared
Assessment of the Utility of Ictal Magnetoencephalography in the Localization of the Epileptic Seizure Onset Zone
Authors: Rafeed Alkawadri, Richard C. Burgess, Yosuke Kakisaka, John C. Mosher, Andreas V. Alexopoulos
Journal: JAMA Neurology (2018)

<h3>Importance</h3> Literature on ictal magnetoencephalography (MEG) in clinical practice and the relationship to other modalities is limited because of the brevity of routine studies. <h3>Objective</h3> To investigate the utility and reliability of ictal MEG in the localization of the epileptogenic zone. <h3>Design, Setting, and Participants</h3> A retrospective medical record review and prospective analysis of a novel ictal rhythm analysis method was conducted at a tertiary epilepsy center with a wide base of referrals for epilepsy surgery evaluation and included consecutive cases of patients who experienced epileptic seizures during routine MEG studies from March 2008 to February 2012. A total of 377 studies screened. Data were analyzed from November 2011 to October 2015. <h3>Main Outcomes and Measures</h3> Presurgical workup and interictal and ictal MEG data were reviewed. The localizing value of using extended-source localization of a narrow band identified visually at onset was analyzed. <h3>Results</h3> Of the 44 included patients, the mean (SD) age at the time of recording was 19.3 (14.9) years, and 25 (57%) were male. The mean duration of recording was 51.2 minutes. Seizures were provoked by known triggers in 3 patients and were spontaneous otherwise. Twenty-five patients (57%) had 1 seizure, 6 (14%) had 2, and 13 (30%) had 3 or more. Magnetoencephalography single equivalent current dipole analysis was possible in 29 patients (66%), of whom 8 (28%) had no clear interictal discharges. Sublobar concordance between ictal and interictal dipoles was seen in 18 of 21 patients (86%). Three patients (7%) showed clear ictal MEG patterns without electroencephalography changes. Ictal MEG dipoles correlated with the lobe of onset in 7 of 8 patients (88%) who underwent intracranial electroencephalography evaluations. Reasons for failure to identify ictal dipoles included diffuse or poor dipolar ictal patterns, no MEG changes, and movement artifact. Resection of areas containing a minimum-norm estimate of a narrow band at onset, not single equivalent current dipole, was associated with sustained seizure freedom. <h3>Conclusions and Significance</h3> Ictal MEG data can provide reliable localization, including in cases that are difficult to localize by other modalities. These findings support the use of extended-source localization for seizures recorded during MEG.
THU0707 Analysis of antinuclear antibodies in breast cancer patients
Authors: A. Neppel, M.C.C. Machoski, T. A. F. G. Santos, R. Nisihara, T.L. Skare
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Analysis of antinuclear antibodies (ANA) may be found in malignant diseases <h3>Objectives</h3> To study the prevalence of ANA in breast cancer patients and its association with tumour characteristics. <h3>Methods</h3> Ninety one patients with breast mass detected by image studies and assigned to do diagnostic biopsy and eventual surgical treatment were studied for demographical, tumour data and presence of ANA. Serum of positive ANA patients was submitted to examination of ENA (extractable nuclear antigens) profile. As comparison 91 healthy individuals paired for age and from same geographical area had ANA determination. <h3>Results</h3> In this sample 72/91 (79.1%) had malignant lesions (83% ductal infiltrative carcinoma). Ana was positive in 44.4% of malignant tumour patients, in 15.7% of benign lesions (p=0.03) and in 5.4% of controls (p&lt;0.0001). The most common immunofluorescence pattern was fine dense speckled pattern. In the ANA positive patients with malignant lesions, 7 had positivity for ENA profile (3 for anti-RNP and anti-Sm, 1 for just anti-RNP, 2 for anti-Ro and anti-LA e 2 for just anti-La). It was not possible to associate ANA positivity with tumour histological characteristics or staging, neither with patient’s age. A negative association of ANA with hormonal receptor status was found (p=0.01). (*) OR=4.8 (95%CI=1.33–17.7) Figure 1 Prevalence of ANA in patients with breast tumours and controls <h3>Conclusions</h3> In this sample there was a high prevalence of ANA positivity in breast cancer patients with a negative association with the presence of hormone receptors. <h3>References</h3> [1] Pisetsky DS. Antinuclear antibody testing - misunderstood or misbegotten?Nat Rev Rheumatol2017;13:495–502. [2] Madrid FF, Maroun MC, Olivero OA, Long M, Stark A, Grossman L, et al. Autoantibodies in breast cancer sera are not epiphenomena and may participate in carcinogenesis. BMC Cancer2015;15:407. [3] Chapman C, Murray A, Chakrabarti J, Thorpe A, Woolston C, Sahin U, et al. Autoantibodies in breast cancer: their use as an aid to early diagnosis. Ann Oncol2007;18:868–73. [4] Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biol Res2017;50:33. [5] Ortona E, Pierdominici M, Berstein L. Autoantibodies to estrogen receptors and their involvement in autoimmune diseases and cancer. J Steroid Biochem Mol Biol2014;144 Pt B:260–7. [6] Mohammed ME, Abdelhafiz K. Autoantibodies in the sera of breast cancer patients: Antinuclear and anti-double stranded DNA antibodies as example. J Cancer Res Ther2015;11:341–4. [7] Bernatsky S, Ramsey-Goldman R, Petri M, Urowitz MB, Gladman DD, Fortin PF, et al. Breast cancer in systemic lupus. Lupus2017; 26:311–5. <h3>Disclosure of Interest</h3> None declared
SAT0648 Coxalgia in hemophilic patients. sonographic evaluation of a not target joint
Authors: D. Melchiorre, G. Castaman, S. Linari, M. Matucci-Cerinic
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> <b>Background</b>: Spontaneous bleeding in haemophilia shows a predilection for joints, and repeated hemarthrosis induce synovial inflammation, cartilage degeneration and bone damage, leading to hemophilic arthropathy. The hip is not a target joint and its involvement is not easy to be distinguished from other conditions which may provoke pain referred to the hip. <h3>Objectives</h3> <b>Objectives:</b> Aim of the study was to analyse the different sonographic findings related to different pain producing conditions. <h3>Methods</h3> <b>Methods:</b> Thirty patients with haemophilia A and monolateral coxalgia were examined. Sonographic exam (US) was performed in all patients by Esaote equipment My Lab 70 with linear probe 4–13 MHz and power Doppler. The iliopsoas muscle and its bursa, the greater trochanteric bursa, and the hip joint were analysed. Sonographic findings in the joint were scored (score ranging from 0 to 21) for effusion, bone remodelling, cartilage damage, synovial hypertrophy, hemosiderin, osteophytes, hemarthrosis, erosion and fibrotic septa. The World Federation of Haemophilia (WFH) orthopaedic joint scale score and the radiologic Pettersson score were evaluated in all patients. <h3>Results</h3> <b>Results</b>: US showed effusion in 20 hip joints (67%), bone remodelling in 18 (60%), cartilage damage in 10 (33%), synovial hypertrophy in 12 (40%), hemosiderin in 4 (13%), osteophytes in 7 (23%), hemarthrosis in 10 (33%) with power Doppler activity (&gt;3 flags). In no patient erosion or fibrotic septa were observed. Fifteen out of 30 joints showed US score ≤5, and 15 US score &gt;5. In 8 patients a hematoma of iliopsoas muscle was present, in two patients great trochanteric bursitis was detected. WFH mean score value was 39.5 (range 12–57) and the mean Pettersson score value was 10.4 (range 6–12). <h3>Conclusions</h3> <b>Conclusions</b>: Surprisingly, in most cases (67%) coxalgia was not related to trochanteric bursitis or iliopsoas muscle involvement but was due to hemophilic arthropathy of the hip which is not a target joint. Moreover, power Doppler allowed to detect hemarthrosis in 33% of patients, supporting the hypothesis that vascular changes and remodelling in haemophilia are associated with bleeding and joint damage<sup>1</sup>. <h3>Reference</h3> [1] Bhat V, et al. Vascular remodeling underlies rebleeding in hemophilic arthropathy. Am J Hematol2015;90:1027–1035. <h3>Disclosure of Interest</h3> None declared
Anatomic Characterization of the Aortic Root in Patients With Bicuspid and Tricuspid Aortic Valve Stenosis
Authors: Dimitri Arangalage, Mikael Laredo, Phalla Ou, Eric Brochet, Claire Cimadevilla, Maurice Enriquez-Sarano, Alec Vahanian, David Messika-Zeitoun
Journal: JACC. Cardiovascular imaging (2018)
Response by Patel et al to Letter Regarding Article, “Radiation Induced DNA Damage in Operators Performing Endovascular Aortic Repair”
Authors: Ashish S. Patel, Tamer El-Sayed, Jun S. Cho, James A. Kelly, Francesca E. Ludwinski, Prakash Saha, Oliver T. Lyons, Alberto Smith, Bijan Modarai
Journal: Circulation (2018)
Abstract 18363: Type 1 and Type 2 Cardiac Autonomic Neuropathy in Type 1 and Type 2 Diabetes Mellitus
Authors: Daniel J Pelchovitz, Jason Ng, Haris Subacius, Alexandru B Chicos, Daniel W Bergner, Smriti Banthia, Mark Molitch, Jeffrey J Goldberger
Journal: Circulation (2015)

Introduction: Cardiac autonomic neuropathy (CAN) is a complication of diabetes mellitus (DM) that is associated with increased mortality. The severity of CAN may be related to type and duration of DM. Methods: 16 subjects with type 1 DM (age 32.9±10.1 years), 18 subjects with type 2 DM (55.4±8.0 years) and 30 controls (44.0±11.6 years) underwent exercise-based assessment of CAN. Two 16-minute submaximal bicycle tests were performed followed by 45 minutes of recovery. Continuous 12-lead electrocardiography was performed. On the 2nd test, atropine (0.04 mg/kg) was administered at peak exercise so that all of recovery occurred under parasympathetic blockade. Plasma epinephrine and norepinephrine levels were measured at rest, during exercise, and during recovery. For each subject and at each time point in recovery, parasympathetic effect on the RR interval was defined as the difference of the RR interval at baseline without atropine and the RR interval after parasympathetic blockade with atropine. Results: There were no differences in resting or peak exercise heart rates in the 3 groups. Parasympathetic effect on RR intervals during recovery (p&lt;0.03) and heart rate recovery (p=0.02) were blunted in type 2 DM. Type 1 DM had higher baseline epinephrine and norepinephrine levels (p&lt;0.03), and exhibited persistent sympathoexcitation during recovery. Conclusions: Both type 1 and type 2 DM exhibit subtle abnormalities in autonomic function, but differentially affect the parasympathetic and sympathetic limbs of the autonomic nervous system. This is the first report of variable pathophysiology for CAN in type 1 versus type 2 DM.