tbuckley/cabot-search huggingface dataset:
AB0252 RACIAL DISPARITIES IN OUTCOMES FOR PATIENTS WITH RHEUMATOID ARTHRITIS UNDERGOING TOTAL KNEE OR TOTAL HIP ARTHROPLASTY
Authors: Julianna Hirsch, Bella Mehta, Jackie Finik, Serene Mirza, Mark Figgie, Collin Brantner, Iris Navarro-Millan, Susan Goodman
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Race is linked to delays in healthcare. Black and Hispanic patients with osteoarthritis have worse pain and function than Whites before arthroplasty. Whether Black and Hispanic patients with RA similarly delay care is unknown. <h3>Objectives</h3> To assess whether Black and/or Hispanic (minority) RA patients have worse pain, function and disease activity at the time of arthroplasty. <h3>Methods</h3> We used prospectively acquired data on RA patients between 10/2013 and 11/2018 prior to total knee arthroplasty (TKA) or total hip arthroplasty (THA). Pain, function, and disease activity were assessed using the visual analogue scale (VAS), the Multidimensional Health Assessment Questionnaire (MD HAQ), and the Disease Activity Score (DAS28). Race, ethnicity, education, income, insurance and medications were collected via self-report questionnaire. Multivariable linear and logistic models examined whether minority status predicted pain, function and disease activity. <h3>Results</h3> 37 (23%) of the 164 patients were minorities (Table 1). MD HAQ and DAS28 were worse in minorities, only VAS was significant (p-value= 0.029). There was no significant difference in education. Unadjusted comparisons indicated no difference in pain, function, disease activity or medication use between groups. Insurance varied significantly between groups (p= &lt;0.0001). In the multivariable analyses (Table 2), minority status was not significantly associated with worse function (MD HAQ) [p=0.26], disease activity (DAS28-ESR) [p=0.658], or VAS pain [p=0.18]. Increased age was significantly associated with better function (p=0.004). <h3>Conclusion</h3> For Black and/or Hispanics with RA undergoing THA or TKA at a high-volume specialty hospital, minority status was not significantly associated with pain, disability or RA disease activity at the time of elective arthroplasty. <h3>Disclosure of Interests</h3> Julianna Hirsch: None declared, Bella Mehta: None declared, Jackie Finik: None declared, Serene Mirza: None declared, Mark Figgie: None declared, Collin Brantner: None declared, Iris Navarro-Millan: None declared, Susan Goodman Grant/research support from: Novartis: research support, Consultant for: Novartis, UCB, Pfizer: consulting
Abstract 18264: Heart Rate Variability Predicts Mental Stress Ischemia in Patients With Stable Coronary Artery Disease
Authors: Amit J Shah, Arshed A Quyyumi, Michael Kutner, James D Bremner, Ernest Garcia, Jonathon Nye, Kobina Wilmot, Ibhar Al Mheid, Ayman Alkhoder, Nino Isakadze, Malik Obideen, Naser Abdelhadi, Brad Pearce, Qi Long, Rachel Lampert, Paolo Raggi, Viola Vaccarino
Journal: Circulation (2015)

Introduction: Mental stress ischemia (MSI) is an independent risk factor for cardiovascular outcomes and death in CAD patients, but little is known about the mechanisms behind this phenomenon. We hypothesized that alterations in autonomic function before, during, or after mental stress may play a role. We examined whether MSI positive patients with CAD have reduced parasympathetic (PNS) tone, as measured by high frequency heart rate variability (HF HRV), as well as reduced baroreceptor sensitivity (BRS), as approximated by low frequency (LF) HRV at baseline, peak mental stress, and recovery. Methods: A mental stress test with a standardized speech stressor was performed in 425 CAD patients wearing an ambulatory ECG monitor. Myocardial perfusion imaging was performed with TC-99m Sestamibi. After careful editing for artifacts and ectopic beats, HF HRV and LF HRV were measured for 5-min periods during a baseline rest period, 5 min of speech, and 5 min of recovery. Logistic regression was used to adjust for potential confounders. Results: The mean (SD) age was 63 (9) years, 26% were women, and 30% were African American; 42 (10%) patients developed MSI. Compared with MSI negative, MSI positive patients had lower HF HRV and LF HRV during rest, stress, and recovery. The largest difference was observed during stress; HF HRV was 46% lower (p=0.01), and LF HRV was 44% lower (p=0.01). When examining reactivity to stress (difference between stress and rest), only LF HRV was significantly different between groups, such that MSI positive patients had an average 32% reduction in LF HRV with stress, while MSI negative patients had an average 3% increase (p=0.04). LF HRV reactivity remained an independent predictor of MSI (p=0.01) in models adjusting for sociodemographics, traditional risk factors, antidepressants, beta-blocker use, revascularization history, heart failure, depression, posttraumatic stress disorder, and heart rate/blood pressure reactivity. Conclusions: Autonomic factors, most notably reduced LF HRV reactivity, predict MSI in CAD patients. This implies reduced BRS and autonomic inflexibility as an important pathophysiological component of the ischemic response to mental stress.
PB2071 GENETIC VARIATIONS IN TUMOR NECROSIS FACTOR‐RELATED APOPTOSIS‐INDUCING LIGAND RECEPTOR‐1 (TRAIL‐R1) GENE AND THE SUSCEPTIBILITY TO B CELL NON‐HODGKIN LYMPHOMA IN EGYPT
Authors: M. Khorshied, N. Soliman, S. Bakr, O. Khorshid
Journal: HemaSphere (2019)

Background: Apoptosis is essential for normal tissue homeostasis, cellular differentiation and development. Inhibition or blockade of Tumor Necrosis Factor‐Related Apoptosis‐Inducing Ligand‐Receptor 1 (TRAIL‐R1) may alter its apoptotic function, and subsequently provide growth advantage to neoplastic cells. Genetic polymorphisms in TRAIL‐R1 gene were involved with susceptibility to many cancers, however dearth of reports about B‐non‐Hodgkin lymphomas (B‐NHLs) particularly from Arab African nations. Aims: To assess the possible association between TRAIL‐R1 ‐A1322G, ‐C626G and ‐A683 C and polymorphisms and B‐NHL risk among Egyptians. Methods Genotyping of TRAIL‐R1 ‐C626G, ‐A683 C and ‐A683 C was performed to 100 B‐NHL patients and 150 controls. Results: The frequency of polymorphic alleles of ‐A1322G and ‐C626G was higher in B‐NHL compared to controls with almost twofold increased risk of B‐NHL (OR = 2.04; 95%CI = 1.02‐4.07 and OR = 1.76; 95%CI = 1.01‐3.07 respectively), while there was no statistical difference in the distribution of ‐A683 C polymorphic allele (OR = 1; 95%CI = 0.5‐2). Combined genotypes analysis revealed that co‐existence of the three variants conferred fourfold increased risk (OR = 4.1; 95% CI = 1.01‐17.63), while co‐inheritance of ‐C626G and ‐A1322G, and co‐inheritance of ‐A683 C and ‐A1322G conferred fivefold and threefold increased the risk respectively. Summary/Conclusion: TRAIL‐R1–C626G and ‐A1322G polymorphisms could be considered as molecular risk factors for B‐NHL in Egyptian population. Furthermore, the growing interest in TRAIL‐based interventions has led to the development of recombinant human TRAIL (rhTRAIL) as a promising target therapy. Accordingly, screening for TRAIL‐R1 gene polymorphisms is mandatory for selecting patients who will gain benefit from this novel therapeutic modality
SAT0381 MINIMAL DISEASE ACTIVITY IN PSORIATIC ARTHRITIS PREDICTS LOW IMPACT OF DISEASE
Authors: Ganesh Kasavkar, Siwalik Banerjee, Nicola Gullick
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Psoriatic arthritis (PsA) is the commonest form of inflammatory spondyloarthropathy with prevalence of 0.19% in UK. Patients suffering from PsA often have significant impact on daily life due to articular, non-articular and psychological symptoms. Minimal disease activity is an increasingly used target of therapy in both clinical trials and clinical practice. <h3>Objectives:</h3> We aimed to assess relationships between physician and patient reported outcomes in routine clinical practice. <h3>Methods:</h3> We performed a retrospective analysis of routinely collected patient reported and physician reported outcomes. We obtained clinical information of patients with PsA attending clinic from March 2018 to December 2018. Data was gathered from clinical letters (swollen and tender joint count, Leeds enthesitis index, Body surface area psoriasis), laboratory results (ESR, CRP) and questionnaire responses (HAQ, global assessments and PSAID12). Data were analysed using SPSS25. Logistic regression was used to assess patient reported outcomes which were associated with achieving MDA. <h3>Results:</h3> Data were available for 205 patient visits. Presence of MDA could be evaluated at 187 patient visits (MDA n=60, Not MDA n=127). All components of PSAID12 were associated with MDA achievement on univariate logistic regression but only pain remained an independent variable on multiple logistic regression. Disease duration, age and sex were not associated with achievement of MDA. Patients in MDA had significantly lower PSAID12 then those not in MDA (mean 2.1 ± SD 1.9 vs. 5.8 ±1.9. We also looked at individual components of PSAID (Figure1, mean values for numerical rating scales). Patients in MDA continue to report pain and discomfort despite good clinical outcomes, albeit far lower than patients not in MDA. PSAID12 of less than 4 is considered a good outcome. All components of MDA assessment were associated with low PSAID12 on univariate analysis, but only pain VAS and HAQ remained independent predictors on multiple regression analysis. Patients with active but not severe arthritis (SJ or TJ 2-3) continued to have high PSAID (one way ANOVA p&lt;0.001), driven by other psoriatic disease manifestations including skin and enthesitis. <h3>Conclusion:</h3> MDA is a relevant treatment target in psoriatic arthritis, with markedly lower PSAID12 in patients in MDA Patients with even low numbers of tender or swollen joints continue to have significant impact of disease, supporting the use of a multidimensional treatment target. Pain and fatigue are dominant symptoms in patients with psoriatic arthritis, even in those in MDA <h3>References</h3> [1] Ann Rheum Dis. 2014 Jun;73(6):1012-9. doi: 10.1136/annrheumdis-2014-205207 [2] RMD Open. 2017 Jul 18;3(1):e000415. doi: 10.1136/rmdopen-2016-000415. eCollection 2017 <h3>Disclosure of Interests:</h3> None declared
Dissecting HIV Virulence: Heritability of Setpoint Viral Load, CD4+ T-Cell Decline, and Per-Parasite Pathogenicity
Authors: Frederic Bertels, Alex Marzel, Gabriel Leventhal, Venelin Mitov, Jacques Fellay, Huldrych F Günthard, Jürg Böni, Sabine Yerly, Thomas Klimkait, Vincent Aubert, Manuel Battegay, Andri Rauch, Matthias Cavassini, Alexandra Calmy, Enos Bernasconi, Patrick Schmid, Alexandra U Scherrer, Viktor Müller, Sebastian Bonhoeffer, Roger Kouyos, Roland R Regoes
Journal: Molecular Biology and Evolution (2017)

Pathogen strains may differ in virulence because they attain different loads in their hosts, or because they induce different disease-causing mechanisms independent of their load. In evolutionary ecology, the latter is referred to as “per-parasite pathogenicity”. Using viral load and CD4+ T-cell measures from 2014 HIV-1 subtype B-infected individuals enrolled in the Swiss HIV Cohort Study, we investigated if virulence—measured as the rate of decline of CD4+ T cells—and per-parasite pathogenicity are heritable from donor to recipient. We estimated heritability by donor–recipient regressions applied to 196 previously identified transmission pairs, and by phylogenetic mixed models applied to a phylogenetic tree inferred from HIV pol sequences. Regressing the CD4+ T-cell declines and per-parasite pathogenicities of the transmission pairs did not yield heritability estimates significantly different from zero. With the phylogenetic mixed model, however, our best estimate for the heritability of the CD4+ T-cell decline is 17% (5–30%), and that of the per-parasite pathogenicity is 17% (4–29%). Further, we confirm that the set-point viral load is heritable, and estimate a heritability of 29% (12–46%). Interestingly, the pattern of evolution of all these traits differs significantly from neutrality, and is most consistent with stabilizing selection for the set-point viral load, and with directional selection for the CD4+ T-cell decline and the per-parasite pathogenicity. Our analysis shows that the viral genotype affects virulence mainly by modulating the per-parasite pathogenicity, while the indirect effect via the set-point viral load is minor.
Diagnostic testing for penicillin allergy: A survey of practices and cost perceptions
Authors: Bernardo Sousa‐Pinto, Kimberly G. Blumenthal, Eric Macy, Sevim Bavbek, Mirjana Stanić Benić, Magna Alves‐Correia, Adile Berna Dursun, Elina Jerschow, Bárbara Kong‐Cardoso, Peter Kopač, Sébastien Lefèvre, Carla Lombardo, Paolo Marraccini, Luis Moral, Allison Eaddy Norton, Cristina Petrişor, Iwona Poziomkowska‐Gęsicka, Frederico S. Regateiro, Natacha Santos, Francesca Saretta, Mirjana Turkalj, Jelena Veličković, Stefan Wöhrl, Mehtap Yazicioglu, Mihaela Zidarn, Mariana Pereira, Eva Rebelo‐Gomes, Ana Margarida Pereira, Luís Delgado, João Almeida Fonseca
Journal: Allergy (2019)

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AB0288 PERSISTENTLY ACTIVE DISEASE IN PATIENTS WITH NEW-ONSET RHEUMATOID ARTHRITIS DURING THE FIRST YEAR OF TIGHT CONTROL AND AGGRESSIVE THERAPY: PREVALENCE AND CLINICAL PREDICTORS IN DIFFERENT CRITERIA SETS
Authors: Wenhui Xie, Xiaoying Sun, Zhuoli Zhang
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Early intervention and aggressive therapy of rheumatoid arthritis (RA) improves prognosis, however a substantial proportion of patients under guideline-based care remain persistently active disease (PAD) in the first year. <h3>Objectives</h3> To investigate the proportion of PAD (LDA/MDA/HDA) in real-life practice and identify its prognostic factors in early RA (≤2 years) patients receiving tight-controlled conventional synthetic disease-modifying antirheumatic drugs (csDMARD) treatment at 1 year of follow-up. <h3>Methods</h3> In our observational RA cohort, patients were usually three-monthly followup and step-up csDMARD escalation treatment at the discretion of physicians in the first year. Disease activity and remission were assessed by four commonly-used indices (DAS28-ESR, CDAI, SDAI, and Boolean criteria). Logistic regression was used to estimate odds ratios (ORs) and their 95% confidence intervals (CIs) for PAD by 12 months. <h3>Results</h3> The study included 303 DMARD-naïve early RA patients completing one year follow-up schedule, who were mostly female (72%) with a mean age of 55, and a median disease duration of 6 months. Most patients were in MDA or HDA at baseline and most of them (83.5%) received csDMARDS combination in the first year. 26.4-55.1% of participants did not reach remission by 12 months. Compared to patients experienced remission, patients in PAD were frequently in female, elder, shorter disease duration, and high baseline disease activity components, including SJC, TJC, PGA, EGA, ESR, CRP and glucocorticoids use. In multivariate logistic regression analyses, female (OR=1.34-1.58), increasing age (OR=1.03-1.10), longer disease duration (OR=1.45-1.78), higher baseline SJC (OR=1.11-1.25), EGA (OR=1.02-1.08) showed the independent association with the increased risk for PAD, across all criteria. Higher ESR (OR=1.05) was an independent risk factor for PAD, measured by DAS28-ESR. <h3>Conclusion</h3> Our results indicated around one-third of RA participants receiving guideline-based healthcare had PAD in the first year. Female, increasing age, long disease duration, higher SJC, EGA, and ESR at baseline independently increased the risk of PAD. <h3>Disclosure of Interests</h3> None declared
PF816 DEFORMABILITY OF PACKED RED BLOOD CELLS: UNIT-TO-UNIT VARIABILITY
Authors: S. Yedgar, O. Zelig, G. Barshtein
Journal: HemaSphere (2019)

Background: ENKTL account for more than 20% of the peripheral T-cell lymphoma in Asia. Patients with r/r ENKTL have a poor prognosis after failing an L-asparaginase based regimen, and the median overall survival is less than 6 months. The overexpression of PD-L1 induced by EBV infection is a potential mechanism for ENKTL to avert immune surveillance, and recent studies of PD-1 antibodies in pts with r/r ENKTL have demonstrated potential efficacy. Sintilimab, a fully human anti-PD-1 monoclonal antibody, has a safety profile consistent with other approved PD-1 antibodies and was approved for r/r classical Hodgkin lymphoma in China in 2018. Aims: This multicenter, single-arm, phase 2 study aims to validate the efficacy and safety of sintilimab monotherapy in patients with r/r ENKTL in China. Methods: Patients with pathologically confirmed r/r ENKTL were enrolled. Sintilimab was given 200 mg IV Q3W, until PD, death, unacceptable toxicity, or withdrawal from the study. Treatment beyond PD is allowed. Tumor response evaluation was performed by both PET-CT and CT/MRI with contrast. The primary endpoint was objective response rate based on LUGANO 2014 criteria. Data cut-off date for this analysis was Feb 2, 2019. Results: From Aug 31, 2017 to Feb 7, 2018, a total of 28 patients were enrolled: 60.7% male and the median age was 37 (range: 19∼65) yr. Sixty-eight percent of patients were stage IV and 89.3% were ECOG PS ≥ 1. All patients had failed an L-asparaginase based regimen, the median lines of previous therapy were 3 (range: 1∼13), 78.6% patients received prior radiotherapy and 7.1% had failed HSCT. Median duration of therapy was 14.04 (range: 1.4∼17.3) months and 19 patients are still receiving sintilimab. Sixty-eight percent (19/28, 95%CI: 47.6%∼84.1%) of patients achieved response (CR+PR), including 4 pts who experienced PD prior to having a response. DCR was 85.7%, including 5 pts who experienced PD before SD or response. The 1-year OS rate was 82.1% and the median OS has not been reached. Most TRAEs were G1∼2 (67.9%) and no patients discontinued treatment due to AEs. The most common TRAE was decreased lymphocyte count (46.4%) and 84.6% were grade 1∼2. SAEs occurred in 21.4% of patients and none were related to sintilimab. No patients died from AEs. Summary/Conclusion: Sintilimab is effective and well tolerated in r/r ENKTL and could be a promising treatment option for these patients. Early disease progression observed by PET scan in this study could be pseudo-progression as it did not correlate with poor outcome, which warrants further investigation. NCT03228836
PS1588 FIBRINOLYSIS IN PATIENTS WITH CHEMOTHERAPY INDUCED THROMBOCYTOPENIA AND THE EFFECT OF PLATELET TRANSFUSION
Authors: F. Heubel‐Moenen, Y. Henskens, P. Verhezen, R. Wetzels, H. Schouten, E. Beckers
Journal: HemaSphere (2019)

Background: Bleeding events in chemotherapy induced thrombocytopenic (CIT) patients with similar platelet counts might be influenced by changes in clot lysis potential. Aims: In this observational study we investigated thromboelastographic lysis parameters, alterations in clot strength and susceptibility to clot lysis in CIT patients and identified factors associated with fibrinolytic profiles. Furthermore, the effects of platelet transfusions were evaluated. Methods: Independent determinants of tPA‐ROTEM lysis parameters were identified with multivariable linear regression. Clot formation, strength and lysis parameters were compared with results of healthy individuals. Characteristics of CIT patients with and without hyperfibrinolytic profiles were compared. tPA‐ROTEM results before, 1 hour and 24 hours after platelet transfusion were compared. Results: A total of 72 consecutive CIT patients were included. tPA‐ROTEM lysis parameters correlated with changes in fibrinolytic proteins. Compared to healthy individuals, clot formation time was longer, maximum clot firmness was weaker and lysis times were shorter. CIT patients had low PAI‐1 and TAFI levels and forty percent exhibited hyperfibrinolytic profiles. Platelet transfusions resulted in less hyperfibrinolytic profiles in many, but not all CIT patients. Patients without hyperfibrinolytic profiles had higher fibrinogen, FVIII and a2‐AP levels. Summary/Conclusion: tPA‐ROTEM can be used as a fast and reliable assay to detect hyperfibrinolytic profiles in CIT patients. CIT patients have weaker clots which are more susceptible to clot lysis compared to healthy individuals. Besides platelets, other factors are likely to influence clot susceptibility to fibrinolysis in CIT patients. The impact of a hyperfibrinolytic tPA‐ROTEM profile on bleeding remains to be investigated.
Abstract 12433: Cardiac Sympathetic Nerve Activity Predicts Ventricular Tachyarrhythmia After Implantable Cardioverter Defibrillator Implantation
Authors: Naofumi Anjo, Isao Taguchi, Yuichi Hori, Shiro Nakahara, Ryuji Chida, Itaru Hisauchi, Ayako Nakagawa, Naoki Nishiyama, Kohta Yamada, Akihiro Higashi, Hidehiko Nakamura, Akinori Fujikake, Takanori Kuroyanagi, Akiko Hayashi, Takaaki Komatsu, Yoshihiko Sakai
Journal: Circulation (2015)

Introduction: In patients with implantable cardioverter defibrillators (ICDs), increased sympathetic tone is associated with sudden death. Hypothesis: We assumed that cardiac sympathetic nerve activity (CSNA)is associated with Ventricular arrhythmia(VT). Methods: To evaluate whether CSNA estimated by the heart to mediastinum ratio (H/M) of I-123 MIBG imaging can predict the occurrence of VT after ICD implantation, 56 consecutive patients (43 males/13 females, 61±13 y.o.) who received ICD implantation were enrolled. The endpoint was defined as the occurrence of VT that required antitachycardia pacing (ATP) and/or shock therapy by the device. Receiver-operating characteristic curve analysis was used to obtain the cut-off value of the delayed H/M ratio required to predict VT. The patients were divided into two groups based on this cut-off value: a higher H/M (≥1.92) group (H-H/M, n=31), and a lower H/M (&lt;1.92) group (L-H/M, n=25). The average follow-up was 10.7 ± 6.4 months. Results: One or more VT episodes occurred in 11 patients (ATP:4, shocks:7). The VT event rate in the L-H/M group was significant higher than that in the H-H/M group (40% (10/25) vs. 3.2% (1/31), p=0.0013). The Kaplan-Meier VT event-free curve showed a worse outcome in the L-H/M group than in the H-H/M group (p=0.00044 by the log-rank test, Fig.1). Conclusions: CSNA estimated by the H/M ratio of I-123 MIBG imaging might predict the occurrence of VT after ICD implantation.