tbuckley/cabot-search huggingface dataset:
AB1421-HPR Is there any change in the demographics of ra patients candidate for bdmard therapy?
Authors: M Ban, K. Bezsila, B. Rojkovich
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> There ara an increasing number of data that rheumatoid arthritis (RA) patients who are candidates for bDMARD (biologic disease modifying drug) therapy have nowadays a milder disease and lower disease duration then 10 years ago. The T2T strategy aims to achieve remission. Percentage of patients achieving the treatment goals seems to be a good quality indicator. <h3>Objectives</h3> To verify among our RA patients treated with bDMARD since 2006, whether they have lower disease activity (DAS28) and shorter disease duration and younger age nowadays then at the beginning of the biologic area. As a measure of quality: how many patients treated with bDMARD achieved remission. <h3>Methods</h3> This is a cross sectional study. Among 455 patients RA treated with 9 different bDMARD we selected those who were treated with the most widely used at the time of the study (12.01.2017). The 103 ADA treated patients' data were collected by means of a tablets with the help of study nurses. Descriptive statistics were used for analysis of data (age and disease duration at the start of bDMARD, DAS28 at start and last visit, percentage of patients on remission). <h3>Results</h3> 103 (incl. 15 men) biologic naive patients (age: 56±13,1) are treated with ADA at time of the study. In 3 years cohorts (2006–2008;2009–2011, 2012–2014, 2015–2017) we found no change of age, but a slight decrease of disease duration as well as DAS28 at bDMARD initatiaton. <h3>Conclusions</h3> In our study population on ADA treatment we did'n t find significant shift toward younger patients, but the disease duration and activity of disease at the start of the ADA treatment slightly decreased. By means of bDMARD's half of the patients achieved remission. <h3>Disclosure of Interest</h3> None declared
Treatment of atopic dermatitis with tralokinumab, an anti–IL-13 mAb
Authors: Andreas Wollenberg, Michael D. Howell, Emma Guttman-Yassky, Jonathan I. Silverberg, Christopher Kell, Koustubh Ranade, Rachel Moate, René van der Merwe
Journal: Journal of Allergy and Clinical Immunology (2018)

IL-13 has an important role in atopic dermatitis (AD) pathogenesis. Tralokinumab is a fully human mAb that potently and specifically neutralizes IL-13.We sought to evaluate the efficacy and safety of tralokinumab in adults with moderate-to-severe AD.In this phase 2b study (NCT02347176), 204 adults were randomized 1:1:1:1 to receive 45, 150, or 300 mg of subcutaneous tralokinumab, or placebo, every 2 weeks for 12 weeks with concomitant topical glucocorticoids. Coprimary end points were change from baseline in Eczema Area Severity Index score and percentage of participants with an Investigator's Global Assessment response (0/1 score and reduction of ≥2 grades from baseline) at week 12.At week 12, 300 mg of tralokinumab significantly improved change from baseline in Eczema Area Severity Index score versus placebo (adjusted mean difference, -4.94; 95% CI, -8.76 to -1.13; P = .01), and a greater percentage of participants achieved an Investigator's Global Assessment response (26.7% vs 11.8%). Greater responses were found in participants with greater concentrations of biomarkers of increased IL-13 activity. Participants treated with 300 mg of tralokinumab demonstrated improvements in SCORAD, Dermatology Life Quality Index, and pruritus numeric rating scale (7-day mean) scores versus placebo. Upper respiratory tract infection was the most frequent treatment-emergent adverse event reported as related to study drug in the placebo (3.9%) and pooled tralokinumab (3.9%) groups.Tralokinumab treatment was associated with early and sustained improvements in AD symptoms and an acceptable safety and tolerability profile, thereby providing evidence for targeting IL-13 in patients with AD.
SAT0662 Screening research of ultrasonographic peripheral arthritis and enthesitis in patients with inflammatory bowel disease
Authors: M. Uematsu, T. Okano, K. Inui, Y. Yamada, K. Mandai, Y. Sugikoka, K. Mamoto, T. Koike, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Some patients with inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD) develop spondyloarthritis (SpA). Conventionally, the assessment of affected joint count in patients with SpA was relied for the detection of swelling and tenderness in the joints and enthesis by clinical physical examination. To date, high quality ultrasonography (US) can detect in&amp;xFB02;ammatry condition in the joint and enthesis more sensitively than clinical assessment. <h3>Objectives</h3> The aim of this study was to research the utility of US screening for detection of peripheral arthritis in patients with IBD. <h3>Methods</h3> Total 42 patients including 27 patients with UC and 15 patients with CD were consecutively included. HI VISION Ascendus (Hitachi Aloka Medical, Tokyo, Japan) was used with an 18 MHz linear array transducer. US examination was performed in MCP, PIP, DIP and wrist joints in both hand. Greyscale (GS) and power Doppler (PD) US were scored on a 0–3 semi quantitative scale for each joint. Moreover, the US assessment of enthesis was performed. Lateral epicondyle, triceps enthesis, the proximal and distal patella tendon enthesis, Achilles tendon and fascia plantaris tendon enthesis was scanned in both GS and PD assessment. Abnormal findings of enthesis was defined structure, thickness, bursitis, erosion, calcification in GS and power Doppler signal. <h3>Results</h3> In the joint clinical assessment, 12 patients with UC and 7 patients with CD had joint symptoms. US active synovitis (GS Grade≥2 · PD Grade≥1) was found in 8 patients with UC and 6 patients with CD. The concordance rate between clinical findings and US findings was relatively low in UC and high in CD patients. In the enthesial clinical assessment, 9 patients with UC and 7 patients with CD had tenderness in any enthesis. Active enthesitis in US was found in 16 patients with UC and 8 patients with CD. The concordance rate between clinical findings and US findings was relatively high and subclinical enthesitis was also found in many patients. <h3>Conclusions</h3> The peripheral arthritis and enthesitis findings in patients with IBD was compared between clinical and US examination. The prevalance rate of subclinical synovitis was not high, thus US screening might not be useful in patients with IBD without arthritis symptom. However, the subclinical enthesitis was found in patients without any enthesial symptoms. US screening might be useful to detect subclinical enthesitis than clinical examination in patients with IBD. <h3>Reference</h3> [1] Eshed I, Hermann KG. Novel imaging modalities in spondyloarthritis. Curr Opin Rheumatol2015;27:333–42. <h3>Disclosure of Interest</h3> None declared
Swiss doctors object to new suicide guidance
Authors: Ned Stafford
Journal: BMJ (2018)

Leading doctors in Switzerland are objecting to new guidelines issued by the Swiss Academy of Medical Sciences (SAMS) that would make assisted suicide a normal part of doctors’ medical responsibilities.

Under the new guidelines, “assisted suicide [by physicians] is justifiable in the case of patients capable of judgement, if the symptoms of disease or functional impairments are causing them intolerable suffering, and other options have proved ineffective or been rejected as unacceptable.”

The new guidelines are part of a set entitled Management of Dying and Death that cover topics such as advance care planning and care and support for relatives. The guidelines, which are available for download in English from the SAMS website,1 replace the previous Care of Patients in the End of Life guidance …
Safety and efficacy of upadacitinib in patients with rheumatoid arthritis and inadequate response to conventional synthetic disease-modifying anti-rheumatic drugs (SELECT-NEXT): a randomised, double-blind, placebo-controlled phase 3 trial
Authors: Gerd R Burmester, Joel M Kremer, Filip Van den Bosch, Alan Kivitz, Louis Bessette, Yihan Li, Yijie Zhou, Ahmed A Othman, Aileen L Pangan, Heidi S Camp
Journal: The Lancet (2018)
Abstract 15261: Substrate Modification by Focal Exosome Injection as a Novel Strategy to Prevent Ventricular Tachyarrhythmias: Proof of Concept in a Porcine Model of Chronic Myocardial Infarction
Authors: James F Dawkins, Jackelyn Valle, Ashkan Ehdaie, Eduardo Marban, Eugenio Cingolani
Journal: Circulation (2016)

Introduction:  Myocardial infarction (MI) survivors are at increased risk of ventricular arrhythmias (VA) and sudden death. Current therapies for VA include ablation to “destroy” re-entry circuits. Isolated late potentials (ILP), which arise from viable myocardial bundles within scar, are targets for ablation in patients with recurrent VA. Cardiosphere-derived cell exosomes (CDC EXO ) have been shown to reduce scar and improve ventricular function, due to their regenerative, anti-fibrotic and anti-inflammatory properties. Here we sought to determine if substrate modification with CDC EXO  could reduce ILP and the incidence of scar-related VA in a pre-clinical model.   Methods:  A balloon catheter was inflated in the LAD for 90 minutes, then reperfused for 8 weeks in 10 minipigs. MRI, programmed electrical stimulation (PES), and electroanatomic mapping (EAM; Rhythmia, Boston Scientific) were performed to evaluate arrhythmia inducibility and define sites of ILP. At 6-9 such sites, human CDC EXO  (7.5mg/2ml, n=5) or vehicle only (2ml, n=5) was injected using a NOGA MYOSTAR catheter (Biosense Webster). Two weeks later, EAM and PES were repeated with continuous 12 lead ECG recordings. Final infarct size (scar mass divided by total LV mass) was quantified by MRI.   Results:  In CDC EXO -injected pigs vs. controls, infarct size was reduced (-3.4±1.2% vs. 0.6±0.9%, p=0.025) and ejection fraction improved (2.6±2.2% vs. -5.8±2.1% p=0.02). The CDC EXO  group exhibited fewer ILP (CDC EXO  baseline 18.6±5.9; 2 weeks 3.6±2.9 p EXO -injected pigs (-23.4±5.8 ms vs. 9.4±6.2 ms P=0.007). VA was induced in 5 of 5 CDC EXO  animals at baseline, but only 1 of 5 remained inducible 2 weeks later. All control animals had inducible VA during the 2 week follow up (p=0.04 vs CDC EXO ).   Conclusions:  CDC EXO  delivered by endocardial catheter injection can diminish ILP associated with slow conduction, and decrease the inducibility of VA. Substrate modification was evidenced by decreased infarct size and reduced ILP in CDC EXO  but not in control animals. Exosome injection may represent a viable nondestructive alternative to conventional VA ablation.
Gender difference in requesting abdominoplasty, after bariatric surgery: Based on five years of experience in two centers in Sulaimani Governorate, Kurdistan Region/Iraq
Authors: Hiwa O. Ahmed, Sarmad H. Arif, Sabah Abid Abdulhakim, Aram Kakarash, Mohammad Amin Ali Omer, Aree Majid Nuri, Hallo H. Omer, Hardi Kareem Jalal, Shahen H. Omer, Nashadin Aziz Muhammad
Journal: International Journal of Surgery (2018)

The increasing incidence of morbid obesity suggests that the quantity of bariatric surgical procedures will continue to multiply each year, many patients who have experienced massive weight loss are left with the dissatisfying consequences of loose and redundant skin, resulting in contour irregularities, an aesthetic and functional problem, and profound dissatisfaction with appearance, residual body image dissatisfaction, There is a subsequent increase in the number of patients seeking additional corrective procedures including abdominoplasty which considered as one of the most popular body-contouring procedures. Correcting skin excess, could improve all the corollaries, including body, and functional problems and gives profound satisfaction with appearance, it has shown to improve both psychological and social aspects of the patients' lives. Is there a gender difference in seeking body countering after bariatric surgery for weight loss? A longitudinal observational study includes 209 obese patients with mean age of 31 ± 8.6 years; (31 ± 9, 31 ± 7 years for female and male patients respectively). Gender ratio M/F = 1.94/1, mean BMI 40 ± 9 kg/m2sin (n = 138 female) and 45±8m2s in (n = 71 male) patients, and Waist circumference 109 ± 7 cm in female and 118 ± 4 cm in males. Some female (n = 10, 7.25%) patients were seeking abdominoplasty from the third month after the operations were they have lost (21 ± 2 kg) of their excess weight, fourteen patients (10.14%), at 6 months and 27 patients (19.56%) at 12 months, but most of male patients were requesting abdominoplasty (n = 7, 09.86%) at 12 months after the operations. Male patients have shifted their ideal from weight loss to abdominoplasty after losing (50–70) of their excess weight 12 months after the operations. The main motivation of requesting abdominoplasty in female and male patients was physical difficulty because of redundant skin, and a smaller number in both genders were motivated by a friend or by a doctor. The motivation for abdominoplasty in females is parallel to the amount of EWL or waist circumference. Female patients are looking for body countering three months after surgery, while male patients more often than not request body shaping following one year after surgery, the age groups are invert in genders; female patients asking for body contouring in younger age group while male patients in older age group.
AB0338 Clinical characteristics of patients with rheumatoid arthritis who used computer terminals for self-assessment of disease activity and quality of life
Authors: E. Pogozheva, V. Amirdzhanova
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To present the clinical features, pharmacotherapy, activity and quality of life in pts with rheumatoid arthritis (RA) who used computer terminals for self-assessment of pts with rheumatic diseases. <h3>Methods</h3> The study included 976 RA patients from the cohort of "TERMINAL" multicenter study, envisaging pts' self-assessment of disease activity and quality of life using a designated computer system ("Computer terminals for self-assessment of pts with rheumatic diseases) before the visit to the rheumatologist. Mean age 52,3±13,3 years, mean disease duration 10,2±8,5 years, 85% female. Baseline clinical parameters and pharmacotherapy were assessed, as well as disease activity (using DAS 28 and RAPID-3), and quality of life (using HAQ and EQ-5D). <h3>Results</h3> 83% of pts were RF positive, and 60% ACCP positive. Almost all (91,2%) pts received conventional DMARDs. 70,2% of them received methotrexate: 56,7% 15 mg/week and 13,5% &gt;15 mg/week (from 17,5 to 40 mg/week). 20,5% pts were treated earlier with low doses of glucocorticoids. 6,6% pts received Infliximab, 16,4% – Rituximab and 9,8% pts were treated with more than 1 biological agent in anamnesis. 46,2% of pts had high disease activity, 40,9% moderate, 4,5% low and 1,5% pts achieved clinical remission (mean DAS28 score 4,2±1,8, RAPID 13,6±3,6). Only 14,3% pts achieved general population HAQ values. The remaining showed significant reduction in the quality of life (mean HAQ 1,7±0,9, EQ-5D 0,6±0,2). 7,4% of the pts had prosthetic joints. <h3>Conclusions</h3> In the studied population almost all patients were treated with DMARDs (mostly methotrexate), and about 30% received biological agents. High to moderate disease activity and reduction in quality of life were typical for this population. Persistence of disease activity and functional insufficiency in pts who received DMARD therapy may be explained by poor monitoring in real clinical practice. The introduction of computer system for self-assessment of disease activity and quality of life in the out-patient facilities will improve the interaction between doctors, nurses and patients, providing better control of therapy efficacy in RA patients. <h3>Disclosure of Interest</h3> None declared
Effects of low-level laser therapy in the prevention and treatment of concurrent chemoradiotherapy induced oral mucositis: A triple-blind randomized controlled trial.
Authors: P.U. Prakash Saxena, Donald Jerald Fernandes, Ajay Gautam, Arun Maiya, Krishna Sharan
Journal: Journal of Clinical Oncology (2012)

5526 Background: Oral mucositis (OM) is the most cumbersome acute side effect of concurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC). OM associated pain affects oral function also may lead to CCRT break. Several modalities have been tried to prevent and treat this complication but none has been proved successful till date. We used prophylactic Low Level Laser Therapy (LLLT) for the prevention and treatment of CCRT induced OM. Methods: In this triple blind study, 221 HNC patients scheduled to undergo CCRT were randomized into laser (n=111) and placebo (n=110) group. Laser group received LLLT (Helium Neon laser, λ=632.8nm, P=24m, W=3.0J/cm 2 ) while placebo received sham treatment daily prior to radiation for 45days. Oral Mucositis (OM) (RTOG/EORTC Scale), oral pain (Visual Analog Scale - VAS), dysphagia (Functional Impairment Scale - FIS), weight loss, duration of analgesic use were assessed. Data was analyzed using frequencies and percentage, generalized estimating equations (GEE) and Odds ratio. Results: There was significant reduction in incidence of severe OM (F=16.64, degree of freedom df=8,876, p&lt;0.0001) and its associated pain (F=25.06, df=8,876, p&lt;0.0001) and dysphagia (F=20.17, df=8,876, p&lt;0.0001) and loss of weight (F=87.56, df=8,876, p&lt;0.0001) when compared between the Laser and placebo group. The duration of step III analgesia required was also significantly lower (p&lt;0.001) in laser (3.2 ±1.4days) than placebo (6.7 ±2.6days) group. Conclusions: LLLT was able to decrease the incidence of CCRT induced severe OM its associated pain, dysphagia, weight loss and the duration of analgesic use. [Table: see text]
Evaluation of the Impact of Ambient Temperatures on Occupational Injuries in Spain
Authors: Èrica Martínez-Solanas, María López-Ruiz, Gregory A. Wellenius, Antonio Gasparrini, Jordi Sunyer, Fernando G. Benavides, Xavier Basagaña
Journal: Environmental Health Perspectives (2018)

Extreme cold and heat have been linked to an increased risk of occupational injuries. However, the evidence is still limited to a small number of studies of people with relatively few injuries and with a limited geographic extent, and the corresponding economic effect has not been studied in detail. We assessed the relationship between ambient temperatures and occupational injuries in Spain along with its economic effect. The daily number of occupational injuries that caused at least one day of leave and the daily maximum temperature were obtained for each Spanish province for the years 1994-2013. We estimated temperature-injuries associations with distributed lag nonlinear models, and then pooled the results using a multivariate meta-regression model. We calculated the number of injuries attributable to cold and heat, the corresponding workdays lost, and the resulting economic effect. The study included 15,992,310 occupational injuries. Overall, 2.72% [95% confidence interval (CI): 2.44-2.97] of all occupational injuries were attributed to nonoptimal ambient temperatures, with moderate heat accounting for the highest fraction. This finding corresponds to an estimated 0.67 million (95% CI: 0.60-0.73) person-days of work lost every year in Spain due to temperature, or an annual average of 42 d per 1,000 workers. The estimated annual economic burden is €370 million, or 0.03% of Spain's GDP (€2,015). Our findings suggest that extreme ambient temperatures increased the risk of occupational injuries, with substantial estimated health and economic costs. These results call for public health interventions to protect workers in the context of climate change. https://doi.org/10.1289/EHP2590.
An Elderly Woman With Painful Buttock and Vulvar Ulcers
Authors: Saeed El Zein, Ossama Abbas, Souha S. Kanj
Journal: JAMA Dermatology (2018)

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Mitochondrial ROS Drive Sudden Cardiac Death and Chronic Proteome Remodeling in Heart Failure
Authors: Swati Dey, Deeptankar DeMazumder, Agnieszka Sidor, D. Brian Foster, Brian O’Rourke
Journal: Circulation Research (2018)

Despite increasing prevalence and incidence of heart failure (HF), therapeutic options remain limited. In early stages of HF, sudden cardiac death (SCD) from ventricular arrhythmias claims many lives. Reactive oxygen species (ROS) have been implicated in both arrhythmias and contractile dysfunction. However, little is known about how ROS in specific subcellular compartments contribute to HF or SCD pathophysiology. The role of ROS in chronic proteome remodeling has not been explored.We will test the hypothesis that elevated mitochondrial ROS (mROS) is a principal source of oxidative stress in HF and in vivo reduction of mROS mitigates SCD.Using a unique guinea pig model of nonischemic HF that recapitulates important features of human HF, including prolonged QT interval and high incidence of spontaneous arrhythmic SCD, compartment-specific ROS sensors revealed increased mROS in resting and contracting left ventricular myocytes in failing hearts. Importantly, the mitochondrially targeted antioxidant (MitoTEMPO) normalized global cellular ROS. Further, in vivo MitoTEMPO treatment of HF animals prevented and reversed HF, eliminated SCD by decreasing dispersion of repolarization and ventricular arrhythmias, suppressed chronic HF-induced remodeling of the expression proteome, and prevented specific phosphoproteome alterations. Pathway analysis of mROS-sensitive networks indicated that increased mROS in HF disrupts the normal coupling between cytosolic signals and nuclear gene programs driving mitochondrial function, antioxidant enzymes, Ca2+ handling, and action potential repolarization, suggesting new targets for therapeutic intervention.mROS drive both acute emergent events, such as electrical instability responsible for SCD, and those that mediate chronic HF remodeling, characterized by suppression or altered phosphorylation of metabolic, antioxidant, and ion transport protein networks. In vivo reduction of mROS prevents and reverses electrical instability, SCD, and HF. Our findings support the feasibility of targeting the mitochondria as a potential new therapy for HF and SCD while identifying new mROS-sensitive protein modifications.