tbuckley/cabot-search huggingface dataset:
SP0174 The value of type i interferon signature to stratify patients
Authors: L. Rönnblom
Journal: Annals of the Rheumatic Diseases (2018)

<h3></h3> Since the first reports 2003 of an increased expression of type I interferon (IFN) regulated genes in cells from patients with SLE, a number of studies have demonstrated that many systemic inflammatory autoimmune diseases display this overexpression of type I IFN regulated genes, now known as an IFN signature. This is true for a majority of patients with SLE, but also large proportion of patients with primary Sjögrens syndrome, myositis, systemic sclerosis and rheumatoid arthritis (RA). The so called type I interferonopathies is a group of rare Mendelian diseases with a very strong IFN signature. Other autoimmune diseases, such as type I diabetes, also display an IFN signature. Type I IFN seems to be most important for inducing the IFN signature, but it's clear that type II and type III IFNs can contribute to the IFN signature. Besides the expression of type I IFN regulated genes, recent studies have shown that patients with SLE and other autoimmune disease, have epigenetic changes in IFN regulated gene, which are hypomethylated. Thus, there are strong evidences that type I IFN system activation is a key event in many autoimmune diseases. Can the IFN signature help us to stratify patients in order to predict risk for major organ manifestations, disease outcome or response to treatment? Early studies showed that patients with active disease and more severe disease manifestations usually have a more prominent IFN signature, which still is true. However, recent studies have revealed that the IFN signature needs to be combined with a broader analysis of expressed genes. For instance, a plasmablast signature seems to correlate best with SLE disease activity and a neutrophil signature associates with lupus nephritis. For treatment stratification, it's perhaps not surprising that SLE patients with a high IFN signature have a better treatment response to type I IFN inhibition, compared to IFN low patients. At least when type I IFN receptor inhibition has been used to downregulated the type I IFN response. In RA, the IFN signature at baseline predict a poor response to TNF-alpha treatment as well as nonresponse to B-cell depleting therapy. In conclusion, there are several indications that the type I IFN signature is a valuable biomarker for patient stratification. However, we are just at the brink of the understanding how to apply this signature in clinical practice. <h3>Disclosure of Interest</h3> L. Rönnblom Grant/research support from: AstraZeneca, Consultant for: UCB, AstraZeneca, Speakers bureau: Biogen
FRI0682 Exercise may decrease syncope secondary to postural change in females with rheumatoid arthritis: pilot study
Authors: D. C. Janse Van Rensburg, J. A. Ker, C. C. Grant, L. Fletcher
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background:</h3> The autonomic nervous system (ANS) regulates the heart rate via sympathetic and parasympathetic influences. Literature has shown that rheumatoid arthritis (RA) patients suffer from autonomic dysfunction. This may consequently lead to syncope with possible falls after posture change i.e. rising from supine to the standing position. Previous research has shown general improvement of the ANS after exercise, but not in specific relation with posture change. <h3>Objectives:</h3> To determine the effect of exercise on posture change (supine to standing position) in females with RA as measured by short-term heart rate variability (ANS function). <h3>Methods:</h3> Patients with confirmed RA were randomly selected to a control group (RAC) or an exercise group (RAE). The RAE group (n=19) trained two to three times per week under supervision. The RAC group (n=18) continued with their current sedentary lifestyle. The medium intensity exercise programme lasted for 12 weeks. No change in medication was allowed during this time. ANS function and balance were determined by quantification of the variability of the inter-beat interval detected with the Polar 810i heart rate monitor system. Frequency domain analyses were used for quantification, including LF (ms²) – indicating mainly sympathetic influence, HF (ms²) – indicating parasympathetic influence, and LF/HF – indicator of autonomic balance. <h3>Results:</h3> The two groups matched regarding baseline demographic data (age, sex, disease activity, disease duration). Due to small sample sizes and variables not following a normal distribution, non-parametric Mann Whitney U analyses were performed on the heart rate variability parameters. Comparing posture change (i.e. standing value minus supine value) from pre- to post intervention, all frequency domain parameters changed as anticipated (i.e. vagal withdrawal and increased sympathetic influence) for the RAE group. For the RAC group the measurements deteriorated. LF (ms²): RAE -1.03 to 22.03 (stronger sympathetic influence); RAC 43.45 to -31.21 (weaker sympathetic influence) HF (ms²): RAE -24.03 to -33.34 (better vagal withdrawal); RAC -191.7 to -114.1 (less vagal withdrawal) <h3>LF/HF:</h3> RAE 10.57 to 15.04; RAC 2.9 to 7.6 <h3>Conclusions:</h3> From these preliminary results it appear that exercise may indeed improve autonomic function in RA patients, in such a way that posture change will not be an added burden for falls in an already otherwise compromised population. <h3>Disclosure of Interest:</h3> None declared
Patient-reported outcomes of patients with advanced renal cell carcinoma treated with nivolumab plus ipilimumab versus sunitinib (CheckMate 214): a randomised, phase 3 trial
Authors: David Cella, Viktor Grünwald, Bernard Escudier, Hans J Hammers, Saby George, Paul Nathan, Marc-Oliver Grimm, Brian I Rini, Justin Doan, Cristina Ivanescu, Jean Paty, Sabeen Mekan, Robert J Motzer
Journal: The Lancet Oncology (2019)
Emergence of Extensively Drug-Resistant <i>Salmonella</i> Typhi Infections Among Travelers to or from Pakistan — United States, 2016–2018
Authors: Kevin Chatham-Stephens, Felicita Medalla, Michael Hughes, Grace D. Appiah, Rachael D. Aubert, Hayat Caidi, Kristina M. Angelo, Allison T. Walker, Noël Hatley, Sofia Masani, June Nash, John Belko, Edward T. Ryan, Eric Mintz, Cindy R. Friedman
Journal: MMWR Morbidity and Mortality Weekly Report (2019)

In February 2018, a typhoid fever outbreak caused by Salmonella enterica serotype Typhi (Typhi), resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporins, was reported in Pakistan. During November 2016-September 2017, 339 cases of this extensively drug-resistant (XDR) Typhi strain were reported in Pakistan, mostly in Karachi and Hyderabad; one travel-associated case was also reported from the United Kingdom (1). More cases have been detected in Karachi and Hyderabad as surveillance efforts have been strengthened, with recent reports increasing the number of cases to 5,372 (2). In the United States, in response to the reports from Pakistan, enhanced surveillance identified 29 patients with typhoid fever who had traveled to or from Pakistan during 2016-2018, including five with XDR Typhi. Travelers to areas with endemic disease, such as South Asia, should be vaccinated against typhoid fever before traveling and follow safe food and water practices. Clinicians should be aware that most typhoid fever infections in the United States are fluoroquinolone nonsusceptible and that the XDR Typhi outbreak strain associated with travel to Pakistan is only susceptible to azithromycin and carbapenems.
Abstract 19303: Cognitive Dysfunction and Patients’ Attitudes Toward Generator Replacement and Deactivation of Their Implantable Cardioverter Defibrillator at the End-of-life
Authors: Muna Hammash, Ingela Thylen, Martha Biddle, Alison Bailey, Jennifer Miller, Debra Moser
Journal: Circulation (2015)

Background: Despite its life saving benefits, Cardioverter Defibrillator (ICD) implantation is associated with increased risk of cognitive dysfunction. Studies examining the association between cognitive status and attitudes toward withdrawing ICD therapy [i.e., generator replacement at end-of-service and ICD deactivation at End-of-Life (EOL)] in the long term are scarce. Objective: The specific aims of this study were to: 1) describe patients’ attitudes toward withdrawal of ICD therapy at EOL; and 2) determine the association between cognitive dysfunction and recipients’ attitudes toward generator replacement and toward ICD deactivation at EOL, controlling for age, anxiety and depression. Methods: A total of 114 ICD recipients (35% female, age 67 ± 12 years) completed the Montreal Cognitive Assessment, Patient Health Questionnaire-9, and Brief Symptom Anxiety instruments. Data about participants’ attitudes toward withdrawal of therapy were collected by asking participants to answer “Yes/No” or “Not sure” for the following two statement, respectively: “I want to have the battery in my ICD replaced even if I am seriously ill suffering from another disease,” “I want to have the defibrillating shocks in my ICD even if dying of cancer or another serious disease.” The association between cognitive dysfunction and attitudes toward generator replacement and ICD deactivation were tested using logistic regression analysis. Results: The majority of participants (68%) would like to replace the generator at end-of-service even if they are seriously ill with another disease; 44% favored to keep shocks even if they are dying from cancer or other serious disease. Ten per cent and 16%, respectively, were indecisive about generator replacement and ICD deactivation at EOL. Cognitive dysfunction significantly predicted recipients’ attitude toward generator replacement (β = 4.12, p = .02), but not their attitudes toward ICD deactivation at EOL. Conclusion: Cognitive dysfunction predicted recipients’ attitude toward generator replacement at end of service. This suggests that considering patients’ cognitive function is essential to maximize ICD recipients’ ability to make treatment decisions at EOL.
THU0536 Knowledge of and expectations about functional restoration program for chronic low back pain are often false: a mirror survey of 40 patients and 59 physicians in 2017
Authors: L. Pierre, F. Bailly, M. Assadourian, V. Foltz, A. Potel, L. Morardet, S. Ascione, M. Le Ralle, A. Dupeyron, N. Ibrahim, I. Griffoul-Espitalier, B. Duplan, J. Beaudreuil, B. Fautrel, L. Gossec
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Functional restoration programs (FRP) are multi-disciplinary programs that have demonstrated their effectiveness in chronic low back pain (CLBP) but they appear to be little known by patients and/or physicians. <h3>Objectives</h3> To assess the knowledge and expectations of CLBP patients and physicians about FRP. <h3>Methods</h3> Multicenter cross-sectional study in 2017 in 6 tertiary-care hospitals in France. Consecutive patients with CLBP (more than 6 weeks) who were seen for their CLBP were included. Physicians (rheumatologists or general practitioners, GPs) who had referred at least 5 patients to the tertiary-care centres were sent a survey. Patients and physicians were asked about their knowledge and expectations of a FRP. Results were scored as 'correct' regarding health professionals involved in the FRP, if both doctors and (physiotherapists or physical activity coach) were ticked; and 'correct' for duration if 3 to 6 weeks. Expectations regarding the FRP were rated on a list of potential expectations on a scale of 0–10. Expectations were scored ' correct' if return to work was scored ≥7/10, and 'fully correct' if physical activity and pain management, but not 'healing' were also expected. Responses were then compared between patients and physicians by Chi 2 test. <h3>Results</h3> Of 172 patients, median age 48 years (IQR 38–58), median CLBP duration 5 years (IQR 2–10), 60.0% women: 110 (64.0%) had no knowledge of FRP; 22 had already participated in an FRP. The remaining 40 patients were compared to physicians (figure 1). Of 80 physicians, 42.5% GPs and 53.7% rheumatologists, 57.5% women: 21 (26.2%) had no knowledge of FRP (p value&lt;0.0001 vs patients). The remaining 59 were compared to the 40 patients. Knowledge of FRP health professionals was 'correct' for 13/40 (32.5%) patients vs 41/59 (69.5%) physicians (p=0.0003); and knowledge of duration was 'correct' for 26/40 (65.0%) vs 46/59 (78.0%) physicians (p=0.15). Expectations were 'correct' for 21/40 (52.5%) patients vs 44/59 (74.6%) for physicians (p=0.02), and 'fully correct' for 9/40 (22.5%) patients vs 16/59 (27.1%) for physicians (p=0.6). <h3>Conclusions</h3> FRP was largely unknown to patients with CLBP. Even those who were aware of the FRP did not know what to expect. While physicians' knowledge and perception of the FRP was better, there was still a lack of knowledge and therefore a likely underutilization or misuse of the FRP. Information campaigns are needed. <h3>Disclosure of Interest</h3> None declared
Abstract P103: Age Differences in Patterns of Use, Health Knowledge, Perception, and Intention to Quit Among Current E-Cigarette Users
Authors: Thanh-Huyen T Vu, Joy Hart, Kandi Walker, Robyn Landry, Allison Groom, Clara Sears, Lindsay Tompkins, Delvon Mattingly, Anshula Kesh, Aida Giachello, Thomas J Payne
Journal: Circulation (2018)

Background: Using electronic nicotine delivery systems (e.g., e-cigarette) or vaping may have negative health effects from the aerosol and product constituents. Though the products are relatively new in the US, the use of e-cigarettes has rapidly increased, especially in younger adults. In this study, we examined age differences in use patterns, reasons for use, health knowledge, e-cigarette perceptions, and quit intentions among current e-cigarette users. Methods: The sample was 1,494 current e-cigarette users ages 18-64, drawn from a national adult vaping survey conducted in 2016. Intention to quit was categorized into 3 groups: very likely, moderate, and less likely. Descriptive and multivariate analyses were used. Results: The sample included participants in the following age groups: 18-24 (17%), 25-34 (38%), 35-44 (23%), and 45-64 (25%). Main reasons for e-cigarette initiation were as a cigarette alternative, perceived as healthier, and attraction to flavors. Only 4% of the participants reported using e-cigarettes on recommendation from a healthcare professional(s); 66% did not hear/see/read about the health effects of e-cigarettes in the past 3 months. Compared to older groups, the 18-24 age group was less likely to use e-cigarettes as an alternative to cigarettes (33% vs. 40-49%) or on a healthcare professional’s recommendation (2.3% vs. 6.8%), but more likely to vape for reasons such as flavors (44% vs. 20-33%) or friends’ use (18% vs. 4%). The 18-24 age group was also more likely than the oldest age group to use flavored e-liquid other than tobacco flavor (67% vs. 53%), have heard/seen/read information about vaping health effects (41.4% vs. 27%), and believe that vaping has no health benefits (26.1% vs. 16%).(All P -values for the above comparisons &lt;.05). With adjustment for sex, race/ethnicity, and education levels, compared to the oldest group, the odds of being very likely to quit e-cigarette use versus less likely to quit in the 18-24 age group were 37% lower (95% CI: 0.41-0.98). Conclusions: There were significant age differences in use motivation, usage patterns, receipt of health information, perceived risks, and quit intentions. Public health efforts should increase the accessibility of information on e-cigarette use risks. Different health messaging and communication strategy approaches may be required for varying age groups.
Implicit Cognition and Psychopathology: Looking Back and Looking Forward
Authors: Bethany A. Teachman, Elise M. Clerkin, William A. Cunningham, Sarah Dreyer-Oren, Alexandra Werntz
Journal: Annual Review of Clinical Psychology (2019)

Implicit cognitive processing is theorized to have a central role in many forms of psychopathology. In the current review, we focus on implicit associations, by which we mean evaluative representations in memory that are difficult to control and do not require conscious reflection to influence affect, cognition, or behavior. We consider definitional and measurement challenges before examining recent empirical evidence for these associations in anxiety, obsessive-compulsive, posttraumatic stress, depressive, and alcohol use disorders. This examination is framed by a brief review of the ways that prominent models of psychopathology represent biased implicit processing of disorder-relevant information. We consider to what extent models reflect more traditional automatic/implicit versus strategic/explicit dual-process perspectives or reflect more recent dynamical systems perspectives in which mental representations are iteratively reprocessed, evolving continuously. Finally, we consider the future research needed to better understand the interactive and temporal dynamics of implicit cognition in psychopathology.
SAT0275 Vitamin d insufficiency is associated with vertebral fractures in patients with axial spondyloarthritis
Authors: C. Romera-Lopez, C. Fernández-Carballido, M.P. Martínez-Vidal, T. Pedraz
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Vitamin D insufficiency is common in general population, and it has been associated with the development and activity of several diseases, such as cardiovascular and autoinmune diseases. In patients with axial spondyloarthritis (axSpA) vitamin D (25(OH)D) insufficiency has been associated with disease activity, but studies in these patients that associate 25(ODH)D insufficiency with vertebral fractures (VF) are scarce. <h3>Objectives</h3> To evaluate the associations between 25(OH)D levels and VF, as well as the 10 year-estimated risk (FRAX) and low bone mineral density (BMD), in patients with axSpA. <h3>Methods</h3> Cross-sectional study of patients with axSpA (ASAS criteria); 25(ODH)D insufficiency when&lt;30 ng/mL and BMD measured by Lumbar spine (LS) and femoral neck (FN) Dual X-ray absorptiometry (DXA). Evaluation of VF with semiquantitative method (Genant) in thoracolumbar X-rays. Bivariate and multivariate analyses performed, and p values&lt;0.05 considered significant. <h3>Results</h3> We included 206 axSpA patients (70% male; 86% AS714% nr-axSpA); age 52±14 and disease duration 12.9±10.3 years; ASDAS-CRP 2.2±0.9, ASDAS-ESR 2.5±0.9; total mSASSS 20.5±19.1 and 25(OH)D levels 19.8±9.3 ng/mL (all values are mean ±SD); with 85.7% of the patients having insufficiency; VF were observed in 34% of the patients. The prevalence of low BMD was higher in FN 45.2% (z-score) and 28.9% (t-score) than in LS 25.7% (z-score) and 29.9% (t-score). These differences were even higher when 25(OH)D insufficiency was also present (table). In multivariate analysis, 25(OH)D was associated with FN BMD (p=0.001); without association with LS BMD. Vitamin D insufficiency was directly associated with the presence of VF [OR 0.95 (95%CI 0.86–0.98); p=0.029] and a higher 10 year-estimated risk of fracture (major FRAX [OR 0.92 (95%CI 0.81–0.96); (p=0.036)]. <h3>Conclusions</h3> In patients with axSpA, vitamin D insufficiency is even more generalised than in general population. Low 25(OH)D is associated with lower FN BMD and more vertebral fractures, as well as increased disease activity and disability. Vertebral fractures are a serious complication of axSpA, so 25(OH)D insufficiency should be taken into account in the management of the comorbidities of the patients with axial spondyloarthritis. <h3>References</h3> [1] Cai G, et al. Clin Chim Acta2015Jan 1;438:316–22. [2] Carmona L, et al. grupo ESPOGUIA. Reumatol Clin2010Mar;6(Suppl 1);1–5. [3] Davey-Ranasinghe N, et al. Curr Opini Rheumatol2013Jul;25(4):509–16. <h3>Disclosure of Interest</h3> None declared
OP0065 Osteoporosis and vertebral fracturesare associated with disease activity and radiographic damage in patients with axial spondyloarthritis
Authors: C. Romera-Lopez, C. Fernández-Carballido, M. Martínez-Vidal, T. Pedraz
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Osteoporosis (OP) and vertebral fractures (VF) are common comorbidities of axial Spondyloarthritis (axSpA) with deleterious effects for the physical function of the patients. <h3>Objectives</h3> To evaluate the relationship between disease activity and radiographic damage and bone mineral density (BMD), 25 (OH) vitamin D levels and VF in patients with axSpA (ASAS Criteria). <h3>Methods</h3> Cross-sectional study. Activity variables: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS); ESR and CRP. Vitamin D insufficiency if &lt;30 ng/mL. Lumbar Spine (LS) and femoral neck (FN) Dual X-ray absorptiometry (DXA) performed. Evaluation of VF with semiquantitative method (Genant) in thoracolumbar X-rays. Bivariate analysis to evaluate the associations with the presence of OP and/or VF, then binary and multiple logistic regression models, by using SPSS (v23); p values&lt;0.05 considered significant. <h3>Results</h3> We studied 206 patients (62 women/144 men); 86% AS/14% nr-axSpA and associated peripheral involvement in 42%. Mean ±standard deviation (SD) values: age 52±14; activity (BASDAI 3.6±2.2, ASDAS-CRP 2.2±0.95, ASDAS-ESR 2.5±0.99, CRP 4.97±8.97 mg/L, ESR 18.2±14, 8 mm); physical function (BASFI 3.3±2.7); radiographic damage: mSASSS total 20.46±19.14, lumbar 10.41±9.89 and cervical 10.05±10.78; 25 (OH)vitD 19.83±9.25 ng/mL, 85.7% of the patients had insufficiency. Low LS BMD in 25.7% (z-score) and 28.9% (t-score) and low FN BMD in 45.2% (z) and 28.9% (t) of the patients. OP prevalence in LS 3.2%(z)/6.9%(t) and in FN 9.1% (z)/13.4% (t). Morphometric VF were identified in 34% of the patients. Bivariate analysis: ESR, ASDAS-ESR, age, male sex, low 25 (OH) vitD levels and the mSASSS were associated with low FN BMD. Multivariate models confirmed the association between disease activity (ASDAS-ESR) [OR 3.32 (95% CI: 2.35 to 4.55); p=0.016], 25(OH)D [OR 0.95 (95% CI: 0.86 to 0.98); p=0.029] and low FN BMD (z score). An association was confirmed between CRP [OR 2.34 (95% CI: 1.10 to 4.98); p=0.027], radiographic damage [lumbar mSASSS OR 1.06 (95% CI: 1.03 to 1.10) p=0.001], high LS BMD [OR 296 (95% CI: 5.07 to 12258); p=0.006] and low FN BMD [OR 0.11 (95% CI: 0.03 to 0.12); p=0.000] and the presence of VF. <h3>Conclusions</h3> In patients with axSpA, low FN BMD is associated with disease activity and vitamin D insufficiency and VF are associated with CRP and low hip bone mass. Furthermore, the presence of radiographic damage, even when 'falsely' increases LS BMD, is associated with the presence of fractures. <h3>Reference</h3> [1] Van der Heide, et al. 2016update of the ASAS-EULAR management recommendations of axial SpA. Ann Rheum Dis2017 Jun;76(6):978–991. <h3>Disclosure of Interest</h3> None declared