tbuckley/cabot-search huggingface dataset:
SAT0465 VALUE OF SERUM PROCALCITONIN FOR THE DIAGNOSIS OF BACTERIAL SEPTIC ARTHRITIS IN DAILY PRACTICE IN RHEUMATOLOGY
Authors: Mickaël Chouk, Frank Verhoeven, Maxime Sondag, Xavier Guillot, Clément Prati, Daniel Wendling
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Septic arthritis is a diagnostic and therapeutic emergency because of a high morbidity and mortality. Nevertheless, the etiologic diagnosis is often difficult. <h3>Objectives</h3> The aim of our study was to determine if serum procalcitonin was a discriminatory biomarker in case of arthritis of undetermined etiology. <h3>Methods</h3> Patients were separated in 5 groups: gouty arthritis, calcium pyrophosphate deposition arthritis, osteoarthritis or post-traumatic arthritis ("mechanical" arthritis), chronic inflammatory rheumatic arthritis, and septic arthritis. Levels of serum with blood cells, C-Reactive Protein and procalcitonin were measured. <h3>Results</h3> 98 patients were included: 18 in the "gout" group, 26 in the "calcium pyrophosphate deposition arthritis" group, 16 in the "mechanical" group, 18 in the "chronic inflammatory rheumatic" group and 20 in the "sepsis" group. The area under the receiver operating characteristic curve of with blood cells, C-Reactive Protein and procalcitonin levels to diagnose a septic arthritis were 0.69 (IC95% 0.55-0.83), 0.82 (IC95% 0.73-0.91), and 0.87 (IC95% 0.76-0.98) respectively. For a cut-off of 0.5 ng/ml, procalcitonin sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 65%, 91%, 65%, 91%, 7.2 and 0.4, respectively. Serum C-Reactive Protein and procalcitonin levels were correlated, were not different in "sepsis" or "gout" groups and were higher in non-septic arthritis with poly-arthritis than with mono-arthritis (p&lt;0.05). <h3>Conclusion</h3> Serum procalcitonin is a useful biomarker in arthritis management with diagnosis performances higher than those of other biomarkers (with blood cells, C-Reactive Protein). <h3>Disclosure of Interests</h3> None declared
Use of Artificial Intelligence to Represent Emergent Systems and Augment Surgical Decision-making
Authors: Tyler J. Loftus, Gilbert R. Upchurch, Azra Bihorac
Journal: JAMA Surgery (2019)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Surgery HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal
FRI0590 UVEITIS SECONDARY TO CHECKPOINT INHIBITORS
Authors: JAVIER GARCíA, Eugenio Perez-Blazquez
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The introduction of immunotherapy (immune checkpoint inhibitors, ICI) has led to a revolution in oncological treatments. The inhibitors of CTLA4 (ipilimumab), of PD1 (pembrolizumab, nivolumab) and of the ligand of PD1 (atezolizumab, avelumab, durvalumab) regulate T activation and its effector function, being effective for the treatment of various types of cancer<sup>1</sup>. However, this effect leads to a series of immune-mediated adverse events, among which uveitis of autoimmune mechanism have been described in about 1% of treatments<sup>2</sup>. <h3>Objectives</h3> Methods: descriptive study of retrospective review of the cases of a tertiary hospital with about 1000 treatments between the beginning of 2014 and the end of 2018. <h3>Results</h3> A series of 4 cases of uveitis of autoimmune origin associated with ICI is presented (see table). The series described has characteristics similar to the information previously reported in the literature<sup>2</sup>, with an incidence of around 0.4%, according to the previously described, with frequencies of ocular toxicity around 1%, being the uveitis is the most frequent form of presentation. The time of presentation of uveitis since the beginning of treatment has been in all cases in the first 6 months. The forms of presentation described before, ranges from anterior uveitis (AU) to panuveitis and often papilledema, usually bilateral, as are all those described in our series. In addition, 50% are AU (grade 2) and the other 50% panuveitis with papilledema (grade 3). In all the cases described, treatment was interrupted, a half it could be reintroduced without recurrence of uveitis. All the patients received topical treatment, the more severe systemic corticosteroids at doses of 0.5-1 mg/kg in accordance with the recommendations. The final prognosis was good, with preservation of VA in all cases, and topical and systemic treatment could be withdrawn in all patients. A patient treated with Ipilimumab presented synechiae as a complication. <h3>Conclusion</h3> Uveitis is an infrequent, although potentially serious, immune-mediated side effect of ICI. Early recognition, discarding other causes of uveitis, particularly the masquerade syndrome, and early intervention are key to a good prognosis. The collaboration between the oncology teams and the ocular inflammation units must be close to establish the correct diagnosis and treatment, as well as to decide individually on the reintroduction or not of the oncological treatment. The implementation of registers on the adverse effects of these drugs can help to dimension the problem more accurately. <h3>References</h3> [1] Calabrese LH, Calabrese C, Capelli, LC. Rheumatic immune-related adverse events from cancer immunotherapy. Nat Rev Rheumatol. 2018Oct;14(10):569-579. [2] Dalvin LA, Shields CL, Orloff M, Sato T, Shields JA. Checkpoint inhibitor immune therapy: Systemic Indications and Ophthalmic Side Effects. Retina. 2018Jun;38(6):1063-1078. <h3>Disclosure of Interests</h3> None declared
SAT0495 PHENOTYPE OF PATIENTS WITH JUVENILE DERMATOMYOSITIS ASSOCIATED WITH ANTI-FACTOR H AUTO-ANTIBODY : A SEVERITY FACTOR?
Authors: Cécile Dumaine, Isabelle Melki, Brigitte Bader-Meunier, Cyril Gitiaux, Marie-Agnes Durey
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Juvenile Dermatomyositis (JDM) is a rare, autoimmune and highly heterogeneous paediatric-onset myopathy, characterized by skin and muscles inflammation. Development of vasculopathy is associated with the severe extra-muscular manifestations of JDM, and portends a poor prognosis. Impaired function of JDM vasculature includes immune complex and complement deposition. <h3>Objectives</h3> The aim of our study is to describe the clinical and paraclinical phenotype of patients with anti-factor H autoantibody (Ab) associated with JDM and overlap myositis. <h3>Methods</h3> Patients with a diagnosis of JDM or overlap myositis and presence of anti-FH auto-antibody, followed in two Parisian tertiary centers over the last twelve years, were retrospectively selected. Besides demographic data, clinical features (cutaneous lesions, severity of muscle involvement, extra-muscular manifestations), treatment options and their outcome were retrieved for each patient. Biological data and presence of myositis-specific autoantibodies were collected, muscle MRI were examined, and data from muscle biopsies were assessed using a validated score tool when available. <h3>Results</h3> Eleven female patients were included in the study, with a median age at diagnosis of 8.8 years [2.8 – 13.1], and a median follow-up of 3 years [1 – 11.7]. Apart typical cutaneo-muscular presentation, seven developed calcinosis, and six presented with subcutaneous oedema (of which 5 were anti-NXP2 positive). Median CMAS was 24/52 [1 – 47], and median MMT was 52/80 [2 -76]. Gastro-intestinal involvement was found in 10 patients (91%), 4 presented a pulmonary impairment, and 3 girls had psychiatric symptoms. Six patients had a severe form (54%), one of them led to death (after 2.8 years of evolution). MSA were found in 9 patients (anti-NXP2 = 1, anti-fibrillarine = 2, anti-MDA5 = 1 and anti-TIF1gamma = 1). IFN-signature was positive in 9 patients. Complement exploration was normal in all patients, and median positive rate of Anti-Factor H Ab was 260 UA/L [115 – 2800]. Muscle biopsy was performed in all patients but one with a median total score severity of 20. All patients received corticosteroids, and one to six other lines of treatment to achieve remission, obtained in 8 patients, with a median time to remission of 2 years [0.5; 4.8]. Use of plasmapheresis/immunoadsorption and/or Ruxolitinib was necessary in 3 of them (27%). <h3>Conclusion</h3> Presence of anti-factor H auto-antibodies in JDM or overlap myositis patients seems associated with more frequent gastro-intestinal involvement, and a more severe phenotype, requiring more aggressive treatment. <h3>References</h3> <h3>Disclosure of Interests</h3> None declared
AB0611 A NEW SHAPE OF THE TREATMENT OF VASCULITIDES: SINGLE CENTER BIOLOGICAL AGENTS EXPERIENCE
Authors: Fatih Albayrak, Mehmet Emin Derin, Burak Karakaş, Ali Şahin
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Vasculitides are a group of inflammatory diseases with different clinical and pathological features of vital importance in various sized and types which may lead to organ failure and inflammation of the vascular wall. The framework for the treatment of vasculitis is similar to that used for many other systemic autoimmune rheumatic disorders, while the specific therapeutic regimen depends upon the nature and severity of the particular disorder (1,2). <h3>Objectives:</h3> The aim of this study is to evaluate the efficacy of biological agents in 56 vasculitides patients with resistant/intolareted to cDMARDs. <h3>Methods:</h3> Between January 2015 and December 2018, fifty six patients who were diagnosed as vasculitis (Takayasu arteritis-TA, Granulomatosis with polyangiitis(GPA), Giant cell arteritis (GCA) and Behçet Syndrome(BS) at Sivas Cumhuriyet University Medical Faculty Rheumatology-Internal Medicine Department were included in to the study. <h3>Results:</h3> 24 (43%) male and 32 (57%) female were included in the study. The median age of the patients was 56 years (min:19-max: 77) and the median age at diagnosis was 39 years (min 17-max 73). 14 (25%) patients with TA, 22 (39%) patients with GPA, 3 (5%) patients with GCA and 17 (31%) patients with BS included in this study.Tocilizumab treatment was used 6 of 8 patients who were resistant to anti-TNF. In 22 GPA patients with pulmonary and kidney involvement, Rituximab (RTX) treatment was started in 18 patients who were unresponsive to cDMARD and cyclophosphamide therapy. Plasmaexchange were used in 4 (18%) patients with alveolar hemorrhage. Indication of anti- TNF agents in behçet's syndrome were as follows panuveitis 70%, neuro-behcet 17.5% and vessel involvement 12.5% (Table 1). 1 GPA patient was died and other GPA, TA and BS patients have clinically response. Biological treatment is continued as maintenance therapy. <h3>Conclusion:</h3> Biological treatments were used safely and effectively in vasculitis. In particular, RTX treatment is recommended for both induction and maintenance of GPA. Tosilizumab treatment is very effective in TA and GCA. However, large and long-term studies are needed in terms of long-term effects. <h3>References</h3> [1] Specks U, Merkel PA, Seo P, et al. Efficacy of remission-induction regimens for aNCA-associated vasculitis. N Engl J Med2013; 369:417. [2] Mukhtyar C, Guillevin L, Cid MC, et al. EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis2009; 68:318. <b>Key Words:</b> vasculitis, biologic agents <h3>Disclosure of interests:</h3> None declared
PB2089 THE GENETIC PROFILE OF THE PATIENTS DIAGNOSED WITH MYELODYSPLASTIC SYNDROMES IN ALBANIA (2009-2013)
Authors: A. Perolla, E. Çalliku, A. Cili, P. Pulluqi, T. Nakuci, A. Ivanaj, A. Pushi
Journal: HemaSphere (2019)

Background: Myelodysplastic Syndromes (MDS) are a heterogeneous group of malignant myeloid neoplasms affecting especially the eldest population and are characterized by cytopenia, dysplasia and a high risk of progression to acute myeloid leukemia. The accurate diagnosis and risk stratification are the hallmarks of the therapeutic strategy. Knowledge of the different cytogenetic abnormalities gives us the opportunity to improve the stratification, prognosis and providing tools for more individualized treatment of the MDS patients. Aims: Our study aims to study the genetic profile of all the patients diagnosed with MDS in our Service of Hematology, UHC “ Mother Tereza” during the interval of time from 2009 to 2013. Methods We analyzed cytogenetically 120 patients diagnosed with MDS during the period 2009-2013. All the patients were hospitalized in our Service of Hematology during this period of time and have performed bone marrow aspiration (biopsy only in cases where the diagnosis was uncertain), FBC and flow cytometry. Cytogenetic analyses were performed from peripheral blood samples from the patients at the moment of the diagnosis and were analyzed in our Department of Genetics. The data were analyzed with SPSS statistics 20.0. Results: From 120 patients diagnosed with MDS, 60% has shown a normal karyotype, 35% of patients have an abnormal karyotype and in 5% no growth has been shown. 83 patients (69,1%) has a good karyotype, patients (9,10%)a intermediate karyotype, 20 patients (16,6%) a worse karyotype. We have found the anomaly of chromosome 7 in 42,8%(18) of patients, the anomalies of chromosome 5 in 21,4% (9)of patients, del(20q) in 33,3% (14), del(11q) in 9,5% (4), anomalies on chromosome 2 in 2,3%(1), trisomy 8 in 2,3%(1),Y- in 7,1% (3) and del(17p) in 14,2%(6) of patients. The frequency of abnormal karyotype was more elevated in the patients diagnosed with RCMD and AREB-2 respectively 11 patients and 10 patients and the anomalies were more frequent in the patients more than 60 years old (28 patients) versus the patients less than 60 years old (11 cases). Summary/Conclusion: Karyotype is one of the most important constituents of the International Prognostic Scoring System (IPSS) and of the revised-IPSS. Knowing the genetic profile of the patients diagnosed with MDS allows us to perform a very accurate diagnosis and to treat them with the best-individualized treatment.
A journey to the centre of the mediastinal lymph nodes
Authors: Beatriz Amat, Sandra Sapia
Journal: European Respiratory Journal (2019)

In 1864, Jules Verne wrote his famous book, Journey to the Center of the Earth , in which the discovery of an ancient manuscript found by Professor Lidenbrock proved that it was possible to travel to the bowels of the Earth. With this in mind, it would be worthwhile discussing the article published in this issue of the European Respiratory Journal , on the subject of needle-based confocal laser endomicroscopy (nCLE) [1]. The authors would like to thank Dr García-Pachón for his disinterested help in the revision of this editorial, and also to our families for their constant support.
A Two-Antibody Pan-Ebolavirus Cocktail Confers Broad Therapeutic Protection in Ferrets and Nonhuman Primates
Authors: Zachary A. Bornholdt, Andrew S. Herbert, Chad E. Mire, Shihua He, Robert W. Cross, Anna Z. Wec, Dafna M. Abelson, Joan B. Geisbert, Rebekah M. James, Md Niaz Rahim, Wenjun Zhu, Viktoriya Borisevich, Logan Banadyga, Bronwyn M. Gunn, Krystle N. Agans, Ariel S. Wirchnianski, Eileen Goodwin, Kevin Tierney, William S. Shestowsky, Ognian Bohorov, Natasha Bohorova, Jesus Velasco, Eric Ailor, Do Kim, Michael H. Pauly, Kevin J. Whaley, Galit Alter, Laura M. Walker, Kartik Chandran, Larry Zeitlin, Xiangguo Qiu, Thomas W. Geisbert, John M. Dye
Journal: Cell Host & Microbe (2019)
PB1817 A STUDY OF SERUM ALBUMIN AND CALCIUM IN 93 PATIENTS WITH SECONDARY HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS
Authors: X. Gao, H. Qiu, J. Wang, L. Duan, T. Tian
Journal: HemaSphere (2019)

Background: Hemophagocytic lymphohistiocytosis is a fatal syndrome of overactive inflammation, which is caused by excessive cytokines released by abnormal cytotoxic T cells, NK cells and macrophages. According to the etiology, it can be divided into primary HLH and secondary HLH. Aims: To investigate the clinical significance of serum albumin levels and calcium concentrations in patients with secondary hemophagocytic lymphohistiocytosis. Methods: The clinical and laboratory data of 93 patients with newly diagnosed sHLH in 2013.4 to 2017.5, and 20 healthy controls were retrospectively analyzed. The patients were classified as the clinical remission group and the progression group according to the response criteria. To explore the changes of serum calcium concentrations and albumin levels in the patients, its correlations with other laboratory indexes and the impact on survival. Results: (1) The serum calcium concentrations and albumin levels in lymphoma‐related HLH group and non‐tumor HLH group were lower than control group (P &lt; 0.001); The serum calcium concentrations and albumin levels in the clinical remission group after treatment was higher than that before treatment (P &lt; 0.001), while in the progression group the serum calcium concentrations and albumin levels after treatment did not changed significantly (P &gt; 0.05,P = 0.101). (2) The serum calcium concentrations in newly diagnosed sHLH patients was positively correlated with ANC, PLT, HGB (P &lt; 0.05); The overall survival (OS) was significantly longer in patients with serum calcium concentration ≥1.88 mmol/L than that&lt;1.88 mmol/L (P = 0.006). (3) The serum albumin levels in newly diagnosed sHLH patients was positively correlated with ANC, HGB (P &lt; 0.05); The overall survival was longer in patients with serum albumin level ≥25.2 g/L than that&lt;25.2 g/L (P = 0.005). Summary/Conclusion: The serum calcium concentrations and albumin levels have clinical significance for disease diagnosis, decision‐making therapy and treatment outcomes in the patients with sHLH.
SP0118 FIBROMYALGIA; AN ACCEPTABLE DIAGNOSIS?
Authors: Rinie Geenen
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Neither patients nor clinicians and researchers fully embrace the fibromyalgia diagnosis. A core objection relates to the huge overlap with other polysymptomatic distress disorders such as somatic symptom disorder and chronic fatigue syndrome. Another objection has to do with the classification of fibromyalgia as a rheumatic disease, which may hamper research and treatment of psychosocial factors. <h3>Objectives:</h3> To get insight into the pros and cons of the fibromyalgia diagnosis. <h3>Methods:</h3> The scientific literature was reviewed with a focus on homogeneity and heterogeneity within the group diagnosed as fibromyalgia. <h3>Results:</h3> That fibromyalgia is not a stable diagnosis of a homogeneous group is reflected in the ongoing development of new classification and diagnostic criteria; the newest including diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms (Arnold et al., 2019). Moreover, treatment recommendations progressed from a focus on pharmacological treatment in 2008 to a focus on nonpharmacological therapies in 2017 (Macfarlane et al., 2017). Also, several studies showed that the group is quite heterogeneous with respect to type, number and severity of symptoms and comorbidities (e.g., Davis et al., 2018) as well as with respect to adaptation profiles covering a spectrum of severely maladjusted to quite well adjusted in terms of objective and subjective management (Estevez-Lopez et al., 2018). <h3>Conclusion:</h3> Although diagnostic classifications such as fibromyalgia help to examine underlying mechanisms and interventions and to define treatment recommendations, in clinical practice and research account should be taken of heterogeneity of patients in terms of symptoms and disorder-transcending biopsychosocial factors that influence the disorder. This suggests that fibromyalgia is an acceptable diagnosis to the extent that individuality is accepted as part of the diagnosis. <h3>References:</h3> [1] Arnold, et al. AAPT Diagnostic Criteria for Fibromyalgia. J Pain 2019, in press. [2] Davis, et al. Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome. J Pain Res 2018;11:2551-60. [3] Estevez-Lopez, et al. Adaptation profiles comprising objective and subjective measures in fibromyalgia: the al-Andalus project. Rheumatology (Oxford) 2017;56:2015-24 [4] Macfarlane, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017;76:318-28. <h3>Disclosure of Interests:</h3> None declared
PF332 THE EFFECT OF ANTITHROMBOTIC STEWARDSHIP ON THE EFFICACY AND SAFETY OF ANTITHROMBOTIC THERAPY DURING AND AFTER HOSPITALIZATION IN TWO DUTCH HOSPITALS
Authors: A. Dreijer, M. Kruip, J. Diepstraten, R. Brouwer, N. Croles, E. Kragten, F. Leebeek, P. van den Bemt
Journal: HemaSphere (2019)

Background: Although the benefits of antithrombotic drugs are indisputable, they carry a high risk for patient safety. Studies on the implementation and effectiveness of a hospital-based multidisciplinary antithrombotic team on bleeding and thrombotic outcomes are scarce. Aims: Main aim is to investigate the effect of implementing a hospital-based multidisciplinary antithrombotic team on the efficacy and safety of antithrombotic therapy during and after hospitalization. Secondary aims are to determine the effect of the multidisciplinary team on severity of bleeding, all-cause mortality and length of hospitalization. Methods: Design: Prospective, observational multicenter cohort study. Setting: Patients admitted to Erasmus University Medical Center and Reinier de Graaf Hospital between October 2015 and December 2017, using one or more therapeutically dosed anticoagulants. Intervention: Implementation of a hospital-based multidisciplinary antithrombotic team. Primary outcome: proportion of patients with a composite end point consisting of ≥1 bleeding or ≥1 thrombotic event from hospitalization until 3 months after hospitalization. Secondary outcomes: proportion of patients with a major and non-major bleeding event, all-cause mortality and length of hospitalization before and after implementation of the multidisciplinary antithrombotic team. Statistical analysis: For analysis of the primary outcome we used segmented regression analysis for the interrupted time series data. For the secondary outcomes logistic regression analysis was used. T-test analysis was performed for the length of hospitalization. Results: 941 patients were included in the usual care period and 945 patients in the intervention period. Introduction of the multidisciplinary antithrombotic team led to a significant reduction in the proportion of patients with the primary outcome (−1.83% (95% CI: −2.58%; −1.08%). Lower all-cause mortality (odds ratio [OR] 0.71, 95% confidence interval [95% CI] 0.53–0.95) was observed after introduction of the multidisciplinary antithrombotic team. No significant effect of the intervention was found for the severity of bleeding and mean length of hospital stay. Summary/Conclusion: Introducing a multidisciplinary antithrombotic team contributes to patient safety.