tbuckley/cabot-search huggingface dataset:
Accuracy of Computer-Aided Diagnosis of Melanoma
Authors: Vincent Dick, Christoph Sinz, Martina Mittlböck, Harald Kittler, Philipp Tschandl
Journal: JAMA Dermatology (2019)

The recent advances in the field of machine learning have raised expectations that computer-aided diagnosis will become the standard for the diagnosis of melanoma.To critically review the current literature and compare the diagnostic accuracy of computer-aided diagnosis with that of human experts.The MEDLINE, arXiv, and PubMed Central databases were searched to identify eligible studies published between January 1, 2002, and December 31, 2018.Studies that reported on the accuracy of automated systems for melanoma were selected. Search terms included melanoma, diagnosis, detection, computer aided, and artificial intelligence.Evaluation of the risk of bias was performed using the QUADAS-2 tool, and quality assessment was based on predefined criteria. Data were analyzed from February 1 to March 10, 2019.Summary estimates of sensitivity and specificity and summary receiver operating characteristic curves were the primary outcomes.The literature search yielded 1694 potentially eligible studies, of which 132 were included and 70 offered sufficient information for a quantitative analysis. Most studies came from the field of computer science. Prospective clinical studies were rare. Combining the results for automated systems gave a melanoma sensitivity of 0.74 (95% CI, 0.66-0.80) and a specificity of 0.84 (95% CI, 0.79-0.88). Sensitivity was lower in studies that used independent test sets than in those that did not (0.51; 95% CI, 0.34-0.69 vs 0.82; 95% CI, 0.77-0.86; P < .001); however, the specificity was similar (0.83; 95% CI, 0.71-0.91 vs 0.85; 95% CI, 0.80-0.88; P = .67). In comparison with dermatologists' diagnosis, computer-aided diagnosis showed similar sensitivities and a 10 percentage points lower specificity, but the difference was not statistically significant. Studies were heterogeneous and substantial risk of bias was found in all but 4 of the 70 studies included in the quantitative analysis.Although the accuracy of computer-aided diagnosis for melanoma detection is comparable to that of experts, the real-world applicability of these systems is unknown and potentially limited owing to overfitting and the risk of bias of the studies at hand.
Risk of Major Gastrointestinal Bleeding With New vs Conventional Oral Anticoagulants: A Systematic Review and Meta-analysis
Authors: Zhi-Chun Gu, An-Hua Wei, Chi Zhang, Xin-Hua Wang, Le Zhang, Long Shen, Zheng Li, Mang-Mang Pan, Xiao-Yan Liu, Jun Pu, Hou-Wen Lin
Journal: Clinical Gastroenterology and Hepatology (2019)
AB1014 USE OF ETANERCEPT BIOSIMILAR IN JIA: PRELIMINARY EXPERIENCE USING REAL WORLD DATA
Authors: Marco Marinelli, Achille Marino, Gabriele Simonini, Rolando Cimaz, Teresa Giani
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Biosimilars are biological medical drugs that are almost an identical copy of an original drug, manufactured by a different company. Since last year regional regulations have imposed a non-medical switch from reference etanercept (ETN) originator to biosimilar (SB4). We compared treatment survival on SB4 to reference etanercept, assessing efficacy and safety data in our cohort of patients with JIA. <h3>Objectives</h3> To review clinical charts of JIA patients, including efficacy and safety of ETN biosimilars after transition from originator. Compliance was also assessed. <h3>Methods</h3> This was a retrospective observational study of patients with JIA who switched from reference etanercept to SB4 starting during 2018 in our Pediatric Reumatology Department. Clinical and demographic data were collected from charts and inserted into a dedicated database. relevant data included: age at disease onset, age at first administration and duration of treatment, if patients had remission of disease with etanercept therapy or if there were any relapses, ESR and CRP values before and after etanercept therapy, ESR and CRP values before switch to SB4 and after SB4 onset, any adverse effects or relapses of disease after biosimilar. <h3>Results</h3> A total of 14 patients (13F, 1M) were identified. Age at diagnosis ranged from 1 to 12 years. Before ETN, all had received methotrexate. ETN was added for disease activity persistence, and induced remission in all cases but one. SB4 treatment duration ranged from 1 to 11 months. After switch to SB4 no disease recurrence was observed. CRP levels, initially elevated in 8/14 cases, normalized during reference etanercept treatment and remained within normal values in all cases during SB4 treatment. ESR median value initially was 40 mm/h (elevated), normalized during reference etanercept treatment (ESR median value 7 mm/h) and remained within normal values (ESR median value 8 mm/h), in all cases during SB4 except one. No side effects were seen, and all families accepted willingly the new prescription. <h3>Conclusion</h3> Our preliminary experience shows that a switch from originator to a biosimilar did not lead to loss of efficacy or new safety signals. Our preliminary results suggest that transitioning from reference etanercept to SB4 is associated with sustained efficacy and no change in the adverse event profile. In conclusion SB4 may provide therapeutically equivalent alternative in pediatric patients with JIA. <h3>Disclosure of Interests</h3> None declared
AB1240 CAUSES AND ASSOCIATION OF DEATH IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS IN A TERTIARY REFERRAL UNIVERSITY HOSPITAL IN EGYPT
Authors: Fatma Ibrahim Abdelrahman, Mohammed A. Mortada
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with heterogeneous, multisystem involvements which can sometimes be severe and life threatening. Different causes of mortality have been described over different decades in SLE patients<sup>(1)</sup>. <h3>Objectives:</h3> To describe and analyze the causes of death in SLE patients and to identify the associated risk factors in Egypt. <h3>Methods:</h3> A retrospective study was conducted on the SLE patients who died in the period from January 2014 to November 2019 in the Zagazig University hospitals. We collected demographic and laboratory data for all patients including; age of onset of SLE, age at death, disease duration, systems affected, last reported disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), treatment received immunosuppressive regimen (dose and duration) and the cause of death. <h3>Results:</h3> 41 SLE patients (33 female and 8 males) had died during period from January 2014 to November 2019 with mean age at onset (26.1±8.1), mean age at death (37.4±13.3), mean SLE duration (11.2±6.7) and mean SLEDAI (15.4±6.8). Majority of the dyed patients had lupus nephritis (87.8%), (26.8%) had neurophsycatric lupus, (14.6%) had SLE vasculitis. (31.7%) had APS, (29.2%) had ILD, (14.6%) had pneumonitis, (19.5%) had carditis, and (14.6%) had PAH. All these patients were on a median dose of prednisolone 10 (2.5-20) mg daily with median of 10 (4-24) years of steroids. 11 of these patients (26.8%) had a family history of SLE. 21(51.2%) of them had received intravenous cyclophosphamide during their with mean cumulative dose of (6.7±4.6) gm, 16 (39%) had received MMF, 5 (12.3%) had received cyclosporine and 9 (22%) had received azathioprine. As regard causes of death, serious infection particularly pulmonary infection was the most common cause of death in 16 patients (39%), followed by stroke in 8(19.5%) patients, renal failure in 7 (17.1%), pneumonitis in 3(7.3%),cancer in 3(7.3%), Disseminated Intravascular Coagulation (DIC) in 1 (2.4%), Macrophage Activating Syndrome (MAC) in 1 (2.4%), pancytopenia in 1 (2.4%) and one (2.4%) pregnant patient died from eclampsia in her third trimester with her fetus. The risk of death from serious pulmonary infections is higher in patients with ILD and pneumonitis (p&lt;0.000). The risk of stroke is higher in SLE patients with APS (P=0.03) and neurophsycatric lupus (p= 0.002). Conclusion: pulmonary infections was the most common cause of death in SLE patients in a tertiary university hospital in Egypt. <h3>References</h3> [1] Wu, X., Yang, M., Xie, Y. et al. Clin Rheumatol (2019) 38: 107. https://doi.org/10.1007/s10067-018-4259-z. <h3>Disclosure of Interests:</h3> None declared
SP0210 IMPLEMENTATION AND ROLE OF MODERN MUSCULOSKELETAL IMAGING (US, MRI AND PET) IN RHEUMATOLOGICAL PRACTICE IN EUROPE – A EULAR SURVEY
Authors: Peter Mandl
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Objectives:</h3> To document the current training, implementation and role of modern musculoskeletal imaging techniques, i.e. ultrasound (US), magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) among rheumatologists in the member countries of the European League Against Rheumatism (EULAR). <h3>Methods:</h3> English-language questionnaires for each imaging modality developed by aEULAR Taskforce were sent out to national and international scientific societies as well as imaging experts in the given modalities involved in research and/or training. The surveys were distributed via an online survey tool (Surveymonkey). Simple descriptive and summary statistics were calculated from the responses. <h3>Results:</h3> More than 90% of US experts reported the availability of an US unit in their department. Suspicion of rheumatoid arthritis and spondyloarthritides were the main clinical indications for performing US for diagnostic purposes. Suspicion of sacroiliitis and degenerative spine disease were the most common indications to perform MRI or CT for diagnostic purposes, while PET was mainly performed to diagnose large vessel vasculitis and to investigate fever of unknown origin. The reported percentage of rheumatologists performing US was highly variable, ranging from more than 80% in 6% of countries to less than 10% in 15% of countries. The majority of experts (77%) reported that their national rheumatology societies organize US courses, while courses in MRI or CT organized by the national rheumatology societies were less commonly reported (29% and 8% respectively). <h3>Conclusions:</h3> Rheumatologists in Europe utilise modern imaging techniques, however access to the techniques and training offered is varied. <h3>Disclosure of Interests:</h3> None declared
MicroRNA-1251-5p Promotes Carcinogenesis and Autophagy via Targeting the Tumor Suppressor TBCC in Ovarian Cancer Cells
Authors: Yang Shao, Xiaomin Liu, Jiao Meng, Xiaofei Zhang, Zhongliang Ma, Gong Yang
Journal: Molecular Therapy (2019)

Accounting for more than 70% of ovarian cancer cases, epithelial ovarian malignancy has a low 5-year survival rate. MicroRNAs may be targeted in the clinical treatment of the disease. In this study, we first found that miR-1251-5p was significantly upregulated in human ovarian cancer cell lines and tissues with the cancer progression and stages. Overexpression or inhibition of miR-1251-5p promoted or impeded cell proliferation and cell cycle progression. Subsequently, TBCC, one of the tubulin-binding cofactors (TBCs), was identified as a target of miR-1251-5p to be negatively associated with cell cycle and autophagy. Exogenous overexpression of TBCC inhibited the expressions of CDK4 and LC3BII, but it promoted the expressions of α/β-tubulin and p62 to suppress cell growth and autophagy, particularly under the starving condition; whereas the introduction of miR-1251-5p in TBCC-overexpressing cells rescued the suppressive effects of TBCC on cell cycle and autophagy through the inverse regulation of the above proteins. Finally, miR-1251-5p was proven to enhance xenograft tumor growth through the downregulation of TBCC but upregulation of Ki67 and LC3B in xenograft tumor tissues. Collectively, these results suggest that miR-1251-5p functions as an oncogene to suppress TBCC and α/β-tubulin expression. Thus, the miR-1251-5p/TBCC/α/β-tubulin axis may be targeted for ovarian cancer treatment.
PB2114 NEUTROPHILIC LEUKEMOID REACTION ASSOCIATED WITH SMOLDERING MULTIPLE MYELOMA
Authors: H. Martínez‐Cordero, J. Valdes‐Cespedes, L. Enciso‐Olivera, L. Alfaro‐Acosta, D. Otero, P. Spirko, B. Patiño‐Escobar
Journal: HemaSphere (2019)

Background: Chronic neutrophilic leukemia is a rare chronic myeloproliferative neoplasm characterized by splenomegaly, sustained neutrophilia, elevated B12 levels, and negative BCR/ABL translocation. It can be confused with leukemoid reactions in the context of plasma cell neoplasms. Aims: To describe the clinical case of a female patient with neutrophilic leukemoid reaction in the context of latent IgA multiple myeloma treated at the National Cancer Institute of Colombia. Methods Clinical case report Results: We present a 67‐year‐old woman with a history of type 2 diabetes mellitus and rosacea with headache, epistaxis, fatigue, intermittent chest pain, hyperleukocytosis in the hemograma and qualitative negative PCR BCR ABL in peripheral blood. She received treatment with hydroxyurea since January 2016 extra institutionally. Upon admission to our institution a complete bone marrow study was requested confirming the BCR ABL negativity by cytogenetics and JAK2 V617F negative mutational state, however the myelogram showed infiltration by plasma cell disorder with dohle bodies and moderate megaloblastic changes in the myeloid and erythroid series. Bone marrow biopsy was hypercellular with 30% infiltration by abnormal plasma cells. The immunophenotype of the plasmacytic population in flow cytometry revealed a positive population for CD38/CD138/CD56/B2‐m and negative CD19/CD45 with lambda restriction. Protein electrophoresis showed a monoclonal peak in the beta region, immunofixation was positive for lambda IgA, high IgA levels with a value of 3874 mg/dL. No monoclonal component was detected in the urine, including immunofixation. The free light chains in serum showed a monoclonal lambda of 116.52 mg/L, Kappa 11.01 mg/L with a ratio of 10.5. No CRAB component was shown including PET CT without bone or extramedullary lesions. Despite treatment with hydroxyurea, hyperleukocytosis persisted with 47330 cels/ul with neutrophilia (44060/uL). Finally, smoldering IgA lambda high risk multiple myeloma diagnosis was made. She started treatment with lenalidomide and dexamethasone attaining partial response after two cycles and progresive resolution of leukemoid reaction. Summary/Conclusion: The neutrophilic leukemoid reaction or a similar clinical picture should alert to the existence of a plasma cell neoplasm. The associated morphological characteristics are usually the toxic granulations and Dohle bodies like in our patient. It is not clear if neutrophilia becomes a factor of poor prognosis in smoldering multiple myeloma, for this reason the risk should be stratified according to existing guidelines. There are still controversies about the need for treatment even in higk risk patients. The fact of being IgA, having a peak greater than 3 grams in SPEP, the ratio of light chains greater than 8 were the high‐risk characteristics seen in our patient that they defined in management. image
JNK activation as an in vivo marker of Aplidin® activity.
Authors: Maria Munoz, Enrique Alvarez, Teresa Martinez, Laura Gonzalez-Santiago, Halina Sasak, Doreen Lepage, Pablo Aviles, Alberto Munoz
Journal: Cancer Research (2007)

5580  Aplidin® (Plitidepsin) is an anti-tumoral agent from marine origin currently under Phase II clinical trials against multiple neoplasias. In cultured cells, Aplidin® has been reported to induce an acute apoptotic process in which the rapid activation of Rac1 GTPase linked to the strong and sustained activation of Jun N-terminal kinase (JNK) plays a crucial role. Other kinases such as epidermal growth factor receptor, Src, p38 mitogen-activated protein kinase (p38MAPK), ERK or protein kinase C-δ are also activated by Aplidin® in a cell-dependent context. The objective of this study was to evaluate the possibility of using JNK activation as an in vivo marker of Aplidin® activity. To this end, the level of JNK phosphorylation was examined by Western blotting in tumors grown in athymic mice that were xenografted with human leukemia K-562 cells at different times following Aplidin® treatment. The study showed a clear tendency for increased phospho-JNK levels in tumor samples obtained 4 to 12 h after treatment with Aplidin®. This effect was transient, as phospho-JNK levels were lower at later times (24-48 h). In contrast, no changes were found in the level of phospho-p38MAPK in tumors. Our results show for the first time that JNK activation in tumors is associated with Aplidin® treatment in vivo, suggesting that JNK phosphorylation it is a potential biomarker of Aplidin® activity.
Youth and Adult Arrests for Cannabis Possession After Decriminalization and Legalization of Cannabis
Authors: Andrew D. Plunk, Stephanie L. Peglow, Paul T. Harrell, Richard A. Grucza
Journal: JAMA Pediatrics (2019)

<h3>Importance</h3> Civil liberty advocates typically support legalization of cannabis, which targets adult use, rather than decriminalization, which can affect both adults and youths. However, it is unknown how arrests of youths for cannabis possession change when adult use of cannabis is legalized. <h3>Objective</h3> To model changes in arrest rates of adults and youths after decriminalization and legalization of cannabis. <h3>Design, Setting, and Participants</h3> This quasi-experimental study used the publicly available Uniform Crime Reporting Program Data: Arrests by Age, Sex, and Race administrative data set to examine arrest rates in 38 states from January 1, 2000, to December 31, 2016. Adult (age, ≥18 years) and youth (age, &lt;18 years) arrests for possession of cannabis were examined. States were excluded if they did not report complete arrest data or if a policy was implemented that reduced penalties for possession of cannabis but fell short of decriminalization. Fixed-effects regression was used in an extended difference-in-differences framework. The analyses in their final form were conducted between January 17 and February 28, 2019. <h3>Exposure</h3> Living in a state with a cannabis decriminalization policy (ie, making the penalty for cannabis possession similar to the small fine for a traffic violation) or legalization policy (ie, creating a legal supply of cannabis along with the removal of penalties for possession of a small amount of cannabis for recreational use). <h3>Main Outcome and Measures</h3> State cannabis possession arrest rate per 100 000 population. <h3>Results</h3> Data from 38 states were examined, including 4 states with cannabis legalization policies and 7 states with cannabis decriminalization policies. The adult arrest rate decreased by 131.28 (95% CI, 106.23-154.21) per 100 000 population after the implementation of decriminalization and 168.50 (95% CI, 158.64-229.65) per 100 000 population after the implementation of legalization. The arrest rate for youths decreased by 60 (95% CI, 42-75) per 100 000 population after decriminalization but did not significantly change after legalization in a state (7 per 100 000 population; 95% CI, −15 to 30). <h3>Conclusions and Relevance</h3> Legalization, as implemented through 2016, did not appear to reduce arrests for cannabis possession among youths, despite having benefited adults. The study's findings suggest that decriminalization reduces youth arrests in most cases, but these findings also suggest that any benefit for youths could be lost when adult use has also been legalized. To address this problem, it appears that state decriminalization policies should take the additional step to explicitly describe when youths can be arrested for possession of small amounts of cannabis.
SP0064 AKTIV-HOCH-R – COMBINING EXERCISE AND FUN
Authors: Nicole Stefan-Schick
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Treatment is more than drugs:</h3> People with rheumatic diseases know about the health benefits of physical activity. But many studies show that integrating regular exercise into daily life is not always as easy as it seems, especially while experiencing rheumatic pain and feeling physical limitations. Therefore the German Rheumatism League developed in association with leading experts in sports science and rehabilitation, at the Erlangen-Nürnberg University in Germany, "aktiv-hoch-r". "aktiv-hoch-r" is an evidence-based exercise programme which imparts knowledge of sports science and motivational aspects. So "aktiv-hoch-r" is not just about the physical exercises, but also includes educational aspects to the programme. The aim of "aktiv-hoch-r" is to inspire participants at an early stage to make a personal commitment to regular physical activity by helping them to understand the benefits for their long-term health. The programme should help them to self-motivate themselves to continue this for life. To motivate people with rheumatic diseases to adopt an active lifestyle, "aktiv-hoch-r" uses a holistic approach, involving positive experiences of movement and playful tasks. The focus is on the individual capability of each participant. So in "aktiv-hoch-r" classes participants learn how to move and how to exercise in a health-promoting way. They learn how to dose load in strength and endurance exercises. They also learn about the effects of regular physical activity on the body. There is a strong focus on self-efficacy, attitude and motivation: participants learn how to develop strategies to motivate themselves to do physical activity. This presentation provides some theoretical and practical insights into "aktiv-hoch-r". Nicole Stefan-Schick Sports Science consultant, Deutsche Rheuma-Liga Bundesverband e.V. <h3>Disclosure of Interests:</h3> None declared