tbuckley/cabot-search huggingface dataset:
ABC of hypertension: Blood pressure measurement
Authors: G. Beevers
Journal: BMJ (2001)

The measurement of blood pressure in clinical practice by the century-old technique of Riva-Rocci/Korotkoff is dependent on the accurate transmission and interpretation of a signal (Korotkoff sound or pulse wave) from a subject via a device (the sphygmomanometer) to an observer. Errors in measurement can occur at each of these interactionary points of the technique, but by far the most fallible component is the observer.

#### Rose classification of observer error

In 1964, Geoffrey Rose and his colleagues classified observer error into three categories.1

#### Observer training techniques

### Systematic error

This leads to both intraobserver and interobserver error. It may be caused by lack of concentration, poor hearing, confusion of auditory and visual cues, etc. The most important factor is failure to interpret the Korotkoff sounds accurately, especially for diastolic pressure.

### Terminal digit preference

This refers to the phenomenon whereby the observer rounds off the pressure reading to a digit of his or her choosing, most often to zero. Doctors may have a 12-fold bias in favour of the terminal digit zero; this has grave implications for decisions on diagnosis and treatment, although its greatest effect is in epidemiological and research studies in which it can distort the frequency distribution curve and reduce the power of statistical tests.2

### Observer prejudice or bias

This is the practice whereby the observer simply adjusts the pressure to meet his or her preconceived notion of what the pressure should be. It usually occurs when there has been recording of an excess of pressures below the cut-off point for hypertension and it reflects the observer's reluctance to diagnose hypertension. This is most likely to occur when an arbitrary division is applied between normal and high blood pressure, for example 140/90 mm Hg. An observer might tend to record a …
FRI0458 Assessment of bone mineral density in patients with early axial spondyloarthritis from corsar cohort: 2 years follow up
Authors: O Rumyantseva, T Dubinina, A Demina, D Rumiantceva, S Erdes, E Agafonova, S Krasnenko, E Gubar
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Bone loss in patients (pts) with early axial spondyloarthritis (axSpA) is insufficiently studied and may be associated with disease activity. <h3>Objectives</h3> To assess the bone mineral density (BMD) in pts with early axSpA base on data from 2 years follow up of CORSAR cohort. <h3>Methods</h3> The research included 65 pts with axSpA (criteria ASAS 2009) with disease duration &lt;5 years and age at onset &lt;45 years. Pts at least 2 years follow up, 32 (49,2%) male, pts mean age was 28,5 (5,8) y., average disease duration 24,1 (15,4) mo, 60 (92,3%) pts were HLA-B27 positive. At baseline all pts were NSAID-naïve, DMARD-naïve, anti-TNF-naïve. For 2 years all pts taking NSAIDs at therapeutic doses, part of the pts received sulfasalazine and anti-TNF. BMD was measured using dual energy x-ray absorptiometry (DXA) of the femoral neck (FN) and lumbar spine (LS) (L2–4) at baseline and after 1 year, and 2 years follow up. BMD reduction was defined as Z score ≤ -2 (at least one site). <h3>Results</h3> Low BMD at baseline founded in 9 (13,8%) pts, in 10 (15,3%) pts after 1 year and in 5 (7,7%) pts after 2 years follow up. There were no significantly differences between the mean values of BMD at baseline and after 2 year, data are shown in the Table. <h3>Conclusions</h3> Low BMD was quite rare (14%) in patients with early axSpA. Small frequency of BMD reduction in the Russian cohort of axSpA patients after 2 years of study is probably due to disease activity decrease on anti-inflammatory therapy. <h3>Disclosure of Interest</h3> None declared
AB0359 Assessing depression in patients with established rheumatoid arthritis-how do different approaches compare?
Authors: SL Hider, S Ryan, N Dale, N Stanyer, A Machin, CA Chew-Graham
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Depression is common in patients with rheumatoid arthritis and negatively impacts on their quality of life and disease outcomes, including disease activity and treatment response. Several case-finding tools for depression are available, including the PHQ2, which is both valid (1) and easy to use. <h3>Objectives</h3> The aim of this study was to compare the prevalence of depression using case finding tools and self-report measures in patients with established RA. <h3>Methods</h3> Patients with established RA, attending a nurse-led annual review clinic, which aimed to offer patients a holistic review, were asked to complete a short questionnaire including demographics and self-reported comorbidity. The presence of depression was assessed in 3 ways a) PHQ2 score ≥3 b) Self recorded "ever" depression using the self-administered report comorbidity questionnaire (2) and c) Self report health status using the EQ5D - which includes a statement regarding current anxiety/depression (dichotomised into no anxiety/depression vs. slight/moderate/severe/extremely anxious or depressed. Ethical approval was obtained (15-WS-0063). <h3>Results</h3> 179 RA patients provided data. Of these 119 (66%) were female and the mean (sd) age was 67.1 (11.7) years. 59 patients (33%) reported they had ever had depression using the self-report comorbidity questionnaire and 25 (14%) indicated they were currently receiving treatment. 68 (38%) indicated they were currently slightly (or more) anxious or depressed when assessed with the EQ5D. 37 (21%) scored positively on the PHQ2. There was good concordance between the PHQ2 and EQ5D at higher levels of depression, in that all those with severe or extreme anxiety or depression on EQ5D also scored positively on the PHQ2. However, of those with moderate anxiety/depression on EQ5D, 4/14 patients scored less than 3 using the PHQ2 score. <h3>Conclusions</h3> Depression is common in patients with established RA. Use of the PHQ2 case-finding questions in patients with established RA, may help clinicians identify patients who may benefit from more detailed assessment of mood and interventions to improve their outcomes. Reliance should not be placed on a single tool, and exploration of mood should be part of routine assessment of a patient with RA. <h3>References</h3> Meader N,et al. BJGP 2011:61: 733–734. Sangha O, et al.Arthritis Rheum 2003;49:156–63. <h3>Acknowledgements</h3> ND was funded by the Haywood Foundation. CCG is funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands. The views expressed are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health. <h3>Disclosure of Interest</h3> None declared
SAT0507 Oxytocine in osteoarthritis: from in vitro to in vivo
Authors: CH Roux, E Fontas, L Euller-Ziegler, V Breuil, EZ Amri
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> The relationship between oxytocine (OT) and osteoarthritis (OA) is poorly studied and remains unknown. However the subchondral bone is considered as a major player in osteoarthritis, and a protective effect of OT on bone mineralization is described in recent studies. <h3>Objectives</h3> The aim of our work was to investigate a possible link between OT and OA <h3>Methods</h3> we used three different approaches: i) In vitro using MSC (adipose and bone marrow derived stem cells) that were maintained as mono-layer (2D) or as pellets in three dimension (3D) in the absence or the presence of OT. RT-PCR, histological and immunohistochemical analysis were performed. ii) in vivo using a rat animal model developing OA upon anterior cruciate ligament transection (ACLT). Twenty female Wistar rats were divided in 2 groups: one group was sham operated whereas the second was ACL transected. Half of each group received either OT (1 mg/kg/day) injections or saline buffer. Histological analysis was performed on day 28. The severity of OA lesions was assessed on a scale adapted from Mankin9s score at medial part of the femur. iii) Clinical analysis using a <i>human cohort</i>. Samples issued from a hand OA cohort (ADEM). 63 OA women have been included; men were excluded because of their low number. At baseline, all subjects benefited of OT and leptin circulating levels measurements and hand X rays (Scoring systems including Kelgren and Lawrence and Verbruggen scores). The control group consists in subjects of the same age range without osteoporosis, OA or inflammatory disease. <h3>Results</h3> OT treatment of differentiating MSCs for 21 days induced a significant increase of agrecan, Col X and COMP mRNA levels without variation of Col 1a. Immunostaining experiments showed an improvement of Sox9 and Col II expression in the presence of OT. The histological analysis of rat knee showed no differences in the severity of lesions between the different ACLT groups. The characteristics of the women cohorts is as follow: 63 OA women age = 65 (+/-11), Body Mass Index (BMI) = 24 (+/-4), OT=1.4 (+/-2) and 19 control women age=63 (+/-10), BMI=26 (+/-5), OT=6.5 (+/-7).The multivariate analysis adjusted for age, BMI and leptin levels, showed a significant lower level of OT in hand OA women (p=0.002, β=3.4). In univariate analysis, there was no relationship between OT blood levels and the severity of OA (Verbruggen: p=0.7, KL: p=0.2), Joint Space Narrowing (p=0.2) and osteophytes (p=0.1). <h3>Conclusions</h3> Our study shows an anabolic effect of OT on chondrogenesis and that OT circulating levels was significantly lower in OA patients. OT might represents an interesting player in the pathophysiology of osteoarthritis and further studies will shed some light on its mechanism of action. <h3>Disclosure of Interest</h3> None declared
Predicting epiglottic collapse in patients with obstructive sleep apnoea
Authors: Ali Azarbarzin, Melania Marques, Scott A. Sands, Sara Op de Beeck, Pedro R. Genta, Luigi Taranto-Montemurro, Camila M. de Melo, Ludovico Messineo, Olivier M. Vanderveken, David P. White, Andrew Wellman
Journal: European Respiratory Journal (2017)

Obstructive sleep apnoea (OSA) is characterised by pharyngeal obstruction occurring at different sites. Endoscopic studies reveal that epiglottic collapse renders patients at higher risk of failed oral appliance therapy or accentuated collapse on continuous positive airway pressure. Diagnosing epiglottic collapse currently requires invasive studies (imaging and endoscopy). As an alternative, we propose that epiglottic collapse can be detected from the distinct airflow patterns it produces during&nbsp;sleep. 23 OSA patients underwent natural sleep endoscopy. 1232 breaths were scored as epiglottic/nonepiglottic collapse. Several flow characteristics were determined from the flow signal (recorded simultaneously with endoscopy) and used to build a predictive model to distinguish epiglottic from nonepiglottic collapse. Additionally, 10 OSA patients were studied to validate the pneumotachograph flow features using nasal pressure signals. Epiglottic collapse was characterised by a rapid fall(s) in the inspiratory flow, more variable inspiratory and expiratory flow and reduced tidal volume. The cross-validated accuracy was 84%. Predictive features obtained from pneumotachograph flow and nasal pressure were strongly correlated. This study demonstrates that epiglottic collapse can be identified from the airflow signal measured during a sleep study. This method may enable clinicians to use clinically collected data to characterise underlying physiology and improve treatment decisions.
AB0505 Does vitamin d deficiency contribute to cognitive dysfunction in patients with systemic lupus erythematosus?
Authors: HA Hussein, NA Fouad, L Daker, A Elamir, SR Mohamad
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Neurocognitive impairment is one of the most common SLE manifestations. However, its pathophysiology remains poorly understood [1]. Vitamin D deficiency is a potential risk factor for cognitive impairment [2,3]. <h3>Objectives</h3> Our aim is to evaluate the relationship between 25(OH)D3 level and cognitive performance in patients with SLE. <h3>Methods</h3> Thirty Egyptian patients diagnosed as systemic lupus erythematosus and their age and sex matched controls were subjected to a battery of neuropsychological evaluation by California Verbal Learning Test (CVLT-II), Controlled Oral Word Association Test (COWAT) and Trail making test and evaluation of depression by using Beck Depression Inventory (BDI). Serum level of 25(OH)D3 was measured in cases and controls. <h3>Results</h3> Patients with SLE had a worse performance than controls in verbal memory total recall, executive function and phonemic verbal fluency as there was a statistically significant difference in CVLT-II total recall, Trail making test and phonemic-COWAT respectively. There was no significant difference between the patients and controls in Beck Depression Inventory (BDI). There was a significant positive correlation between the vitamin D level and executive function assessed by trail making test (r =0.399, p=0.03). <h3>Conclusions</h3> Vitamin D deficiency in patients with SLE could have a significant impact on their cognitive performance. <h3>References</h3> Carbotte R. M., Denburg S. D. and Denburg J. A., "Cognitive Dysfunction and Systemic Lupus Erythematosus," In: R. G. Lahit, Ed., Systemic Lupus Erythematosus, Churchill Livingstone, New York, 1992, pp. 865–881. Etgen T, Sander D, Bickel H, Sander K, Forstl H. Vitamin D deficiency, cognitive impairment and dementia: a systematic review and meta-analysis. Dement Geriatr Cogn Disord. 2012; 33:297–305. Balion C, Griffith LE, Strifler L, Henderson M, Patterson C, Heckman G, et al. Vitamin D, cognition, and dementia: a systematic review and meta-analysis. Neurology. 2012; 79:1397–405. <h3>Disclosure of Interest</h3> None declared
THU0190 Dermatological guidelines for monitoring methotrexate treatment reduce drug-survival compared to rheumatological guidelines
Authors: H Bernelot Moens, F Busger op Vollenbroek, R Janssens, C Doggen
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Methotrexate (MTX) is widely used in the treatment of psoriasis and psoriatic arthritis (PsA). To prevent MTX-induced adverse events dermatological MTX guidelines advise a higher number and frequency of blood tests than rheumatological guidelines (1,2). These differences are not based on evidence indicating a higher risk for patients with psoriasis compared to PsA. <h3>Objectives</h3> Compare the effects of MTX monitoring strategies by rheumatologists and dermatologists. <h3>Methods</h3> Patients with psoriasis or PsA in a Dutch teaching hospital. Inclusion criteria: start methotrexate (MTX) between 2006 and 2012 and scheduled follow-up by dermatologist or rheumatologist. Exclusions: incomplete availability of lab data. Start and stop dates and dosing of MTX and folic acid, reasons for withdrawal of MTX, numbers and results of laboratory tests performed for MTX safety, occurrence of any serious adverse event (SAE) were retrieved from electronic records. <h3>Results</h3> PsA patients used higher initial and maximum doses of MTX and folic acid, but psoriasis patients had a higher frequency of abnormal liver function tests, resulting in a striking difference in withdrawal of MTX (Table). In PsA MTX was more often withdrawn for remission, and less frequently for ineffectiveness leading to longer drug survival in the first course of treatment. There were no differences in the occurrence of SAE or death between these groups. Hospital admissions related to infection were recorded in 6 (3.1%) PsA vs 4 (2.1%) psoriasis patients. <h3>Conclusions</h3> Monitoring by dermatologists resulted in more abnormal liver function tests and shorter drug survival of MTX. The monitoring strategy by rheumatologists was not associated with increased SAEs. This supports the safety of current rheumatological guidelines and suggests reconsideration of a higher number of liver function tests in dermatological guidelines. <h3>References</h3> Menter A, Korman NJ, Elmets C et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol. http://dx.doi.org/10.1016/j.jaad.2009.03.027. Barker J, Horn EJ, Lebwohl M et al. Assessment and management of methotrexate hepatotoxicity in psoriasis patients: Report from a consensus conference to evaluate current practice and identify key questions toward optimizing methotrexate use in the clinic. J Eur Acad Dermatol Venereol 2011;25:758–64. <h3>Disclosure of Interest</h3> None declared
AB0456 Safety and retention rate of belimumab: data from a multicentric italian study
Authors: L Iaccarino, M Larosa, L Andreoli, E Bartoloni-Bocci, A Bortoluzzi, F Ceccarelli, F Conti, R De Angelis, G De Marchi, S De Vita, A Di Matteo, G Emmi, L Emmi, R Gerli, M Gerosa, M Govoni, M Mosca, PL Meroni, G Pazzola, R Reggia, C Salvarani, C Tani, M Zen, A Tincani, A Doria
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Belimumab is used in the treatment of systemic lupus erithematosus (SLE), but few data on its safety in daily clinical practice are available to date. <h3>Objectives</h3> To investigate safety, retention rate (RR), reasons and predictors of belimumab discontinuation in a prospective multicentric Italian study. <h3>Methods</h3> A total of 188 active SLE patients refractory to standard therapy were treated with belimumab as add-on-therapy in 11 Italian centers. Adverse events (AEs) were defined as "any untoward medical occurrence in a patient treated with a pharmaceutical product which does not necessarily have a causal relationship with this treatment". AEs were subdivided in non-infectious, infectious, infusion and hypersensitivity reactions. Infusion and hypersensitivity reactions were defined as transient AEs related to belimumab occurring within 6 hours and 6–48 hours after drug administration, respectively. AEs was defined as severe (SAE) in case of hospitalization and/or death and/or life-threatening manifestations. Infections were considered severe in case of hospitalization and/or intravenous antibiotic use and/or death. Infusion and hypersensitivity reactions were considered severe when intensive care unit support was required. As baseline predictors of discontinuation the following variables were analyzed: gender, age, age at SLE onset, disease duration, disease activity pattern (relapsing remitting or chronic active), SLEDAI-2K ≥10, prednisone &gt;7.5 mg/day, concomitant immunosuppressant, antimalarial drug use, number and type of comorbidities, number of previous organ involvement, type of major involvement and number of flares in the 12 months before belimumab initiation. Data were analyzed using the SPSS (version 23.0, Chicago, IL) software. <h3>Results</h3> A total of 453 EAs were recorded in 132 patients after a mean follow-up period of 17.5±10.6 months (range 3–36): 443 (97.8%) were non severe and 10 (2.2%) SAEs (Table 1). No deaths and severe infusion/hypersensitivity reactions occurred. Belimumab discontinuation was observed in 58 patients (30.8%) after 10.4±7.5 months of follow-up (Table 2). RR was 91.5% at 6 months, 81.4% at 12 months, 72.9% at 18 months, 72.4% at 24 months, 69.7% at 30 months and 69.2% at 36 months. No associations were found between baseline variables and drug discontinuation. <h3>Conclusions</h3> Belimumab demonstrated a good safety profile with a low rate of SAEs. Discontinuation occurred in less than 1/3 of subjects with a low rate of discontinuation due to AEs. <h3>Disclosure of Interest</h3> None declared
Administration of Albumin Solution Increases Serum Levels of Albumin in Patients With Chronic Liver Failure in a Single-Arm Feasibility Trial
Authors: Louise China, Simon S. Skene, Zainib Shabir, Alexander Maini, Yvonne Sylvestre, Kate Bennett, Scott Bevan, James O’Beirne, Ewan Forrest, Jim Portal, Steve Ryder, Gavin Wright, Derek W. Gilroy, Alastair O’Brien
Journal: Clinical Gastroenterology and Hepatology (2017)

Infections are life-threatening to patients with acute decompensation and acute-on-chronic liver failure (AD/ACLF). Patients with AD/ACLF have prostaglandin E2-mediated immune suppression, which can be reversed by administration of albumin; infusion of 20% human albumin solution (HAS) might improve outcomes of infections. We performed a feasibility study to determine optimal trial design, assess safety, and validate laboratory assessments of immune function to inform design of a phase 3 trial.
Sensitive <i>in vivo</i> Visualization of Breast Cancer Using Ratiometric Protease-activatable Fluorescent Imaging Agent, AVB-620
Authors: Marcel Miampamba, Junjie Liu, Alec Harootunian, Andrew J Gale, Stephen Baird, Steven L Chen, Quyen T Nguyen, Roger Y Tsien, Jesús E González
Journal: Theranostics (2017)

With the goal of improving intraoperative cancer visualization, we have developed AVB-620, a novel intravenously administered, in vivo fluorescent peptide dye conjugate that highlights malignant tissue and is optimized for human use. Matrix metalloproteinases (MMPs) hydrolyze AVB-620 triggering tissue retention and a ratiometric fluorescence color change which is visualized using camera systems capable of imaging fluorescence and white light simultaneously. AVB-620 imaging visualizes primary tumors and demonstrated high in vivo diagnostic sensitivity and specificity (both >95%) for identifying breast cancer metastases to lymph nodes in two immunocompetent syngeneic mouse models. It is well tolerated and single-dose toxicology studies in rats determined a no-observed-adverse-effect-level (NOAEL) at >110-fold above the imaging and estimated human dose. Protease specificity and hydrolysis kinetics were characterized and compared using recombinant MMPs. To understand the human translation potential, an in vitro diagnostic study was conducted to evaluate the ability of AVB-620 to differentiate human breast cancer tumor from healthy adjacent tissue. Patient tumor tissue and healthy adjacent breast tissue were homogenized, incubated with AVB-620, and fluorogenic responses were compared. Tumor tissue had 2-3 fold faster hydrolysis than matched healthy breast tissue; generating an assay sensitivity of 96% and specificity of 88%. AVB-620 has excellent sensitivity and specificity for identifying breast cancer in mouse and human tissue. Significant changes were made in the design of AVB-620 relative to previous ratiometric protease-activated agents. AVB-620 has pharmaceutical properties, fluorescence ratio dynamic range, usable diagnostic time window, a scalable synthesis, and a safety profile that have enabled it to advance into clinical evaluation in breast cancer patients.