tbuckley/cabot-search huggingface dataset:
Necessity of More Sensitivity Analyses and Interpretations From Public Health Perspectives
Authors: Vasveebye Sonoo, Jay V. Kumar, Xibei Liu, Johnson Ukken, Mary Froehlich, Ji Won Yoo
Journal: Hepatology (2017)

View this article online at wileyonlinelibrary.com. Potential conflict of interest: Nothing to report. TO THE EDITOR: We read with interest the study by Rush et al.1 identifying increased utilization of palliative care in hospitalized patients with end‐stage liver disease (ESLD) in the United States. A few considerations should be made, including additional sensitivity analyses and interpretation of these findings from a public health perspective. First, the number of hospitalizations and palliative care consultations were analyzed instead of the number of patients. Analysis of these numbers could over‐represent patients or hospitals with frequent palliative care utilization groups. This concern can be appropriately adjusted by using the hierarchical modeling analysis.2 Because Rush et al. used the SAS v9.4 statistical software, PROC GLIMMIX procedure can fit continuous, binary, or count outcomes to adjust data at multiple levels (patient and hospital).2 If the researchers used multilevel adjustment methods, it is essential that they clarify this step. Second, the researchers did not fully report the number of missing data points. Identifying the proportion of missing data might be necessary given that this study used the International Classification of Diseases, Ninth Edition code V66.7 (palliative care consultation). Rush et al.1 cited the validity of using V66.7 code from a study using a small number of patients (100) with a different diagnosis (ischemic stroke) from their analysis (ESLD).3 However, when evaluating more than 100,000 admissions and a variety of diagnostic subgroups, Hua et al.4 found that the sensitivity for the V66.7 code was 61.11% in chronic liver disease. Third, Rush et al.1 collapsed insurance covariate into yes versus no. However, patients under private insurance, when compared to those with Medicaid, are quite heterogenous in annual income and disease severity.
SAT0110 The impact of pummonary involvement to the treatment of reumatoid arthritis
Authors: K Setoguchi, FY Chen, S Kamei, M Ogawa, S Kobayashi
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Standard treatment of patients with rheumatoid arthritis (RA) complicated with pulmonary involvements has not been clarified. <h3>Objectives</h3> To evaluate the influence of pulmonary involvement on immunological background and treatment of patients with RA. <h3>Methods</h3> A cross-sectional study was conducted, in which medical records of 479 RA patients who visited our hospital during September the first to November 31th, 2016 were reviewed. Pulmonary involvements were diagnosed by imaging including plain chest radiography or chest computed tomography findings. Patients were divided into two groups, with or without pulmonary involvement, and compared with immunological background (serum level of rheumatoid factor (RF), anti-CCP antibody and recent treatment. <h3>Results</h3> Among 479 patients, pulmonary involvements were diagnosed in 158 patients (female =116), mean age was 73.4 (standard deviation (SD) 9.0) year old, and mean disease duration was 143.3 (SD 125.9) months. Pulmonary involvements included interstitial pneumonia (N=52), organizing pneumonia (N=11), airway diseases (N=36), old tuberculosis (N=18), nontuberculous mycobacteria (N=13), pleurisy (N=5). Higher anti-CCP titers were found in RA with pulmonary involvement than RA only (medians 303.9±596.5 versus 163.5±256.1 U/mL, P&lt;0.001), and the same result was found in RF (medians 322.5±437.2 versus 157.9±277.5 IU/mL, P&lt;0.001). Methotrexate (MTX) was less frequently used (N=56, 35.4% versus N=205, 63.9%, P&lt;0.001), but biological agents were more used (N=31, 19.6% versus N=49, 15.3%), especially abatacept (ABT) was highly used (N=15, 9.5% versus N=8, 2.5%). <h3>Conclusions</h3> RA patients with pulmonary involvements had high immunological response and were less prescribed MTX with may injure lungs and more used ABT. Association between pulmonary involvement and high titer of ACPA, and between positivity for RF or ACPA and good response of ABT were reported. ABT may be useful treatment for RA patients with pulmonary involvement. <h3>References</h3> Gottenberg JE et al.: Arthritis Rheumatol.68 (6):1346–1352.2016. Rocha-Munoz AD et al.: J immunol Res. Epub 2015 May 19. <h3>Disclosure of Interest</h3> None declared
Hidradenitis suppurativa is associated with myocardial infarction, but not stroke or peripheral arterial disease of the lower extremities
Authors: I.M. Miller, O. Ahlehoff, K. Zarchi, H. Rytgaard, U.B. Mogensen, C. Ellervik, G.B. Jemec
Journal: British Journal of Dermatology (2017)

We performed a comparative cross-sectional study of the potential association of HS and the three outcome events: self-reported MI, self-reported stroke, and PAD measured by ankle-brachial index (ABI) ≤ 0.9. We included a self-reported HS group (n=430) identified in the general suburban population study (GESUS) using a validated questionnaire 2(Table 1).The control group comprised participants from GESUS without HS, n=20,780.

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FRI0659 Inclusion of the assessment of cervical facet joints in the m-sasss score in patients with ankylosing spondylitis. improving sensitivity to change
Authors: MJ Moreno-Martínez, MJ Moreno-Ramos, LF Linares-Ferrando
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Ankylosing Spondylitis is characterized by axial involvement, especially of sacroiliacs and the vertebral bodies, although we also know that other such as facet joints (Fj) are affected. These joints can be seen with a simple x-ray, especially in the cervical spine. Despite their involvement, the different rates of radiographic progression do not assess their alteration. <h3>Objectives</h3> To evaluate the sensitivity to the change of the m-SASSS radiographic score by including the assessment of the cervical Fj. <h3>Methods</h3> The patients come from a Spondyloarthritis Unit (Hospital U. Virgen de la Arrixaca de Murcia, Spain). All patients are diagnosed of Ankylosing Spondylitis (New York Modified Criteria) The usual radiographic study was performed to calculate the m-SASSS and a lateral cervical radiograph at two different times to calculate the difference between the scores. The score used for Fj (only one score is given for each intervertebral segment) is: – 0: normal. – 1: pinching (narrowing of joint space). – 2: sclerosis in the joint margins. – 3: joint fusion. We will analyze the mean of the two m-SASSS radiographic score, with (m-SASSS + Fj) and without the inclusion of the Fj, and the difference between those means. We will also analyze the correlation with the rest of the radiographic scores and with the clinical patient9s parameters. <h3>Results</h3> We included 47 patients (81% male and 19% female) with a mean age of 48 (± 8) years and a mean duration of symptoms of 18 (± 8.5) years. The mean time between the two radiographic studies was 3 (± 1.5) years. In the following table we show the difference of means of the radiographic scores over time: After comparing Δ mSASSS with Δ mSASSS+Fj, we found significant differences in favor of inclusion: 2.6 (± 2) vs 4.9 (± 4.7), p=0.04. <h3>Conclusions</h3> The inclusion of the evaluation of cervical Fj improves sensitivity to change of m-SASSS. <h3>References</h3> Averns HL, Oxtoby J, Taylor HG, Jones PW, Dziedzic K, Dawes PT. Radiological outcome in ankylosing spondylitis: use of the Stoke Ankylosing Spondylitis Spine Score (SASSS). Rheumatology.1996;35(4):373–376. Bleil J, Maier R, Hempfing A, Schlichting U, Appel H, Sieper J, et al. Histomorphologic and Histomorphometric Characteristics of Zygapophyseal Joint Remodeling in Ankylosing Spondylitis: Histomorphometric Characteristics of the Joints of AS Patients. Arthritis Rheumatol.2014;66(7):1745–1754. <h3>Disclosure of Interest</h3> None declared
Neuraxis imaging in leptomeningeal metastasis: A retrospective case series.
Authors: Marc C. Chamberlain
Journal: Journal of Clinical Oncology (2012)

2046 Background: (and Objective) Leptomeningeal metastasis (LM) is a central nervous system metastatic complication of cancer that affects the entire neuraxis. Quantify imaging (brain and spine MRI and radio-isotope cerebrospinal fluid [CSF] flow study) abnormalities in a retrospective case series of patients with LM. Methods: 240 adult patients with LM (125 non-brain solid tumor patients with positive CSF cytology; 40 non-brain solid tumor patients with negative CSF cytology; 50 lymphoma and 40 leukemia patients with positive CSF flow cytometry) underwent prior to treatment brain and entire spine MRI and radio-isotope CSF flow studies (FS). Results: Neuraxis MRI in pathologically defined patients was more often normal in hematologic tumors (80-84%) compared to solid tumors (60%). Similarly, FS was more often normal in hematologic tumors (90-92%) compared to solid tumors (72-75%). However, neuraxis MRI and FS abnormalities (i.e. CSF flow obstruction; nodular subarachnoid or parenchymal disease; hydrocephalus) altered therapy by requiring CSF diversion, site specific radiotherapy, systemic chemotherapy or recommending no further therapy in one third of CSF cytology positive solid tumors and 15% of CSF flow cytometry positive hematologic tumors. Conclusions: Notwithstanding less frequent imaging abnormalities in hematologic tumors, similar to solid tumors imaging abnormalities frequently result in treatment alteration for patients with LM. Consequently, neuraxis imaging is recommended in both tumor categories in patients being considered for LM-directed and in particular intra-CSF chemotherapy treatment.
OP0065 Nurse-led vaccination program dramatically improves pneumococcal vaccination coverage among patients with chronic inflammatory rheumatic diseases: a prospective pilot study
Authors: T Goulenok, J Serre, C Francois, M-C Van der Haegen, J-F Alexandra, T Papo, K Sacre
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Patients with chronic inflammatory rheumatic diseases (IRD) receiving immunosuppressive therapy are at high risk for invasive pneumococcal disease. Despite national recommendations regarding pneumococcal vaccination, vaccination rate remains low in this population. <h3>Objectives</h3> We aimed to determine whether a nurse-led vaccination program improve pneumococcal vaccination coverage among patients with chronic IRD. <h3>Methods</h3> From April to August 2015, all consecutive adult patients with a chronic IRD admitted in our day hospital unit (Department of Internal Medicine, Bichat Hospital, Paris, France) were screened. Eligibility for pneumococcal vaccination was assessed according to French national recommendations. Patients were identified as candidate for pneumococcal vaccination, informed on the benefice and risk of vaccination and vaccinated by nurses. Pre-intervention (i.e. percentage of patients candidate for vaccination vaccinated before the intervention program) and post-intervention (i.e. percentage of patients candidate for vaccination vaccinated after the intervention program) pneumococcal vaccination rate were compared using Chi2 test. <h3>Results</h3> 126 consecutive patients (43 [24–89] years, 61.9% females) with a chronic IRD were admitted in our day hospital unit during a 4 months period. Among them, 76 (60.3%) patients were candidate for pneumococcal vaccination because receiving prednisone, immunosuppressive drugs and/or biotherapy. The pre-intervention pneumococcal vaccination rate was 17.1 (13/76) %. Among patients candidate for pneumococcal infection but not vaccinated (n=63), 56 (88.9%) were accurately identified by nurses. Ten patients refused to be vaccinated and 46 eventually received pneumococcal vaccination. The post-intervention pneumococcal vaccination was 77.6 (59/76) % (p&lt;0.001 as compared to the pre-intervention rate). <h3>Conclusions</h3> Nurse-led vaccination program dramatically improves pneumococcal vaccination coverage among patients with chronic IRD. <h3>Disclosure of Interest</h3> None declared
AB0302 Workability in patients with seropositive rheumatoid arthritis
Authors: C Berner, T Lamprecht, KH Fenzl, L Erlacher, TE Dorner
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Rheumatoid arthritis (RA) and other rheumatic conditions can lead to work disability, and temporary or permanent exit from the labour market. The indirect costs related to work disability, are higher than direct treatment costs, and pose an economic burden on patients and society. Workability in RA is influenced by many factors, including symptoms, such as pain, swelling and stiffness, muscle strength, or physical or mental exhaustion, which are components of the frailty syndrome. <h3>Objectives</h3> This study aimed to determine the association of workability with disease activity, pain, functional disability and frailty in patients with seropositive rheumatoid arthritis. <h3>Methods</h3> We conducted a monocentric cross-sectional study at a rheumatologic outpatient clinic and day hospital including 100 seropositive RA patients (according to 2010 EULAR classification) in the working age (&lt;65 years). Workability was assessed with the self-administered Work Ability Index questionnaire. For disease activity, we used the Clinical Disease Activity Index (CDAI), a Visual analogue scale for pain assessment, for functional disability the self-administered Health Assessment Questionnaire Disability Index (HAQ-DI) and for the degree of frailty the SHARE Frailty Instrument (SHARE-FI). After testing for normal distribution, bivariate correlations between workability and associated variables were calculated using Spearman9s correlation coefficients. <h3>Results</h3> Of 100 patients for 58 the workability index could be assessed. The remaining 42 were either unemployed, on disability pension, or employed but currently not working. These 58 patients, 37 women and 21 men, had an average age of 64.8 years (min-max=22–59, SD=9.3) and an average disease duration of 93.9 months (min-max=3–360, SD=86.7). 8 patients reported excellent workability, 27 good workability, 16 moderate workability and 7 poor workability. The workability was weakly correlated with age (<i>r</i><sub>s</sub>= -0.37, p&lt;0.004), and moderately correlated with pain intensity (<i>r</i><sub>s</sub>=0.42, p&lt;0.001), disease activity (<i>r</i><sub>s</sub>=0.40, p&lt;0.002), functional disability (<i>r</i><sub>s</sub>=0.64, p&lt;0.000) and frailty (<i>r</i><sub>s</sub>=0.623, p&lt;0.000). <h3>Conclusions</h3> A considerable portion of employed RA patients reported poor or moderate workability, which is significantly associated with disease activity but also with the other parameters assessed. An adequate therapy may therefore not only improve well-being and state of health in RA patients but also provide socioeconomically advantage by maintaining patients9 workability. <h3>Disclosure of Interest</h3> None declared
SP0104 Reprogramming of myeloid cells in cancer: mechanisms and significance
Authors: A Sica
Journal: Annals of the Rheumatic Diseases (2017)

Chronic inflammation mediates tumor development by promoting a constant influx of inflammatory cells capable of modulating genes involved in cancerogenesis and creating micro and macroenvironments that support cancer growth. A major side effects of cancer inflammation is the pathological expansion and recruitment of myeloid cells endowed with immunosuppressive activity, to control the unresolved inflammation. Tumors reprogram myeloid cell differentiation and functions through various mechanisms, including altered metabolism, cancer-related inflammation andalteration of the hematopoietic output. These events govern the expansion of myeloid suppressor populations, mainly myeloid-derived suppressor cells (MDSCs) and tumor associated macrophages (TAMs). MDSCs and TAMs orchestrate tumor immunosuppression in concert with regulatory T cells, inhibitory cytokines and immune check points receptors, and act to subvert anti-tumor immunity, hence causing that eventually support immune evasion establishing a bottleneck for cancer immunotherapy. I will discuss inflammatory circuits and epigenetic events sustaining the expansion and the tumor-promoting reprogramming of myeloid cells in cancer bearers. <h3>Disclosure of Interest</h3> None declared
SAT0432 Correlation between the spinal MRI findings and new bone formation factor (DKK-1)i n patients with spondyloarthritis
Authors: Z Zhao, G Wang, YY Wang, JS Yang, J Zhu, F Huang
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Recent prospective data suggest that spinal inflammatory damage in patients with ankylosing spondylitis will eventually convert into fat. In these complex inflammatory lesions, bone formation and inflammation are not synchronized. The molecular basis responsible for new bone formation in SpA patients is still unclear. Serum level of dickkopf-1 (Dkk-1), the natural inhibitor of WNT protein, is a main factor in limiting new bone formation. <h3>Objectives</h3> In this study, we aimed to assess the correlation between the secreted protein Dkk-1 and abnormal findings on spinal MRI through a prospective study of SpA. <h3>Methods</h3> Thirty patients with active axial SpA (axSpA) who fulfilled the ASAS axSpA criteria were enrolled. All patients received an injection of recombinant human TNF receptor-antibody fusion protein (YISAIPU) at a dosage of 50 mg/week for 6 months. Patient report outcome measure questionnaires and physical examination, blood tests were completed according to the study protocol. All patients were scored for bone marrow edema and fat infiltration on spinal MRI imaging. The spinal MRI imaging of the patients before and after the treatment were blindly reviewed and scored using the SPARCC scoring system by two individuals who were familiar with the system. <h3>Results</h3> There are 28 male and two female patients (mean age: 31±5.5 yrs, range: 22–41; mean duration: 93.5±75.8; HLA-B27(+): 96.7% (29/30)). In patients who finished the 6 month anti-TNF treatment, the ESR, CRP, BASDAI, BASFI, BASMI and ASDAS-CRP were significantly decreased (<i>P</i>&lt;0.01). Serum Dkk-1 concentration was also significantly decreased (<i>P</i>&lt;0.05), as were the edema measurements of spinal bone marrow (<i>P</i>&lt;0.05), but not with the before and after treatment differences in fat infiltration scores (p&gt;0.05). (Table1). Correlation analysis found that serum Dkk-1 concentration before treatment was significantly correlated with spinal bone marrow edema scores (<i>P</i>&lt;0.01). The differences in serum Dkk-1 levels significantly correlate with differences in spinal MRI bone marrow edema scores after treatment (<i>P</i>&lt;0.05).(Figure 1 and 2). <h3>Conclusions</h3> Spinal marrow edema may have a role in predicting new bone formation in the spine, since the change of serum Dkk-1 level is correlated with change of spinal marrow edema. And Dkk-1 may participate in the molecular basis of the TNF inhibitor9s blockade of new bone formation. Further research is needed on patients who have received long-term TNF antagonist treatment to find the time points when serum Dkk-1 level reaches a stabilized plateau. Increased knowledge in this area will be helpful when assessing a predictive marker for the timing of treatment withdrawal. <h3>Disclosure of Interest</h3> None declared
FRI0628 Ultrasound shows signs of inflammation in most patients with rheumatoid arthritis in longstanding clinical remission, irrespective of conventional synthetic or biologic dmard therapy
Authors: U Døhn Møller, CH Brahe, ML Hetland, V Fana, S Krabbe, M Ammitzbøll-Danielsen, M Østergaard, L Terslev
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> None of the currently accepted remission criteria in rheumatoid arthritis (RA) incorporate inflammation on imaging. Signs of inflammation on ultrasound (US) and magnetic resonance imaging are frequently seen in RA patients in clinical remission.(1–3) It is not known whether patients in longstanding clinical and radiographic remission obtained through a DAS28 driven treat to target (T2T) strategy by conventional synthetic disease modifying anti-rheumatic drugs (csDMARD) or by biologic (bDMARD) therapy differ with respect to US detected synovitis. <h3>Objectives</h3> In RA patients in longstanding clinical and radiographic remission, achieved by a DAS28-driven T2T strategy, to investigate if US signs of inflammation differs between RA patients, treated with csDMARD or bDMARD (+/- csDMARD). <h3>Methods</h3> Eighty-seven patients with RA in longstanding clinical (continuous DAS28&lt;2.6 for the preceding year) and radiographic (no progression for at least 1 year) remission, were included in the study. US of elbows, wrists, MCP2–5, knees, ankles and MTP2–5 were performed using a GE LOGIQE9 US unit. Each joint was scored for grey-scale synovitis (GSS) and synovial color Doppler activity (CDA) by a 0–3 semi-quantitative score. Ultrasound remission was defined in two ways: either no (GSS=0 and CDA=0) or minimal (GSS≤1 and CDA=0) inflammation in any of the 24 assessed joints. <h3>Results</h3> Clinical characteristics and US findings are shown in the table. All 87 patients fulfilled DAS28 remission criteria at entry and CDAI remission was fulfilled in 76% and 79% in the csDMARD and bDMARD group, respectively. Complete absence of any signs of US inflammation (GSS=0 and CDA=0) was seen in 0% and 14% in the csDMARD and bDMARD groups, respectively (p=0.01), while minimal US inflammation (GSS≤1 and CDA=0) was seen in 33% and 40% (NS). CDA in at least one joint was seen in the majority of patients in both groups, 58% and 57% respectively. <h3>Conclusions</h3> The majority of RA patients, in this cohort of patients in longstanding clinical and radiographic remission obtained through a DAS28 driven T2T strategy, had signs of inflammation as assessed by US, irrespective of receiving biologic treatment or not. For patients in clinical remission, the consequences of sustained US inflammation still have to be investigated. <h3>References</h3> Brown AK et al.: Arthritis Rheum 2006;54(12):3761–73. Saleem B et al.: Arthritis Rheum 2009;60(7):1915–22. Gandjbakhch F et al.: J Rheumatol 2011;38(9):2039–44. <h3>Disclosure of Interest</h3> None declared