tbuckley/cabot-search huggingface dataset:
AB0131 Rheumatoid factor is detected on circulating extracellular vesicles in a subpopulation of rheumatoid arthritispatients with a more severe disease phenotype
Authors: O. Arntz, B. Pieters, R. Thurlings, P.V.D. Kraan, F.V.D. Loo
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Extracellular vesicles (EVs) play a role in cell-cell communication and contain numerous signalling molecules inside and on their cell membrane. Although their function remains to be elucidated, evidence accumulates that EVs play a regulatory role in immunity during health and disease. They contain numerous proteins, lipids, RNA, DNA and sometimes cell organelles such as mitochondria. In a recent study was shown that Immunoglobuline M-Rheumatoid factor (IgM-RF) is present on milk derived exosomes.<sup>1</sup> High IgM-RF levels in Rheumatoid Arthritis (RA) predict a more severe disease and comorbidities, probably due to their involvement in immune complex formation and activation of complement (crucial mediators of the effector phase of inflammation in the pathogenesis of RA). <h3>Objectives</h3> In this study we investigate whether RF +EVs are detectable in the circulation of RA patients and if this relates to parameters of disease activity. <h3>Methods</h3> EVs were isolated from platelet-free plasma of 38 RA patients and from age and sex-matched 24 healthy controls (HC) by size exclusion chromatography. EV markers (tetraspanins) were detected by Western blot and miRNA content by RT-qPCR. Particle size and concentration were measured by electron microscopy and nanosight tracking analysis. Protein concentration was determined by micro-BCA. RF levels were measured using a commercial ELISA. The percentage of RF +EVs was determined by measuring bound and unbound PHK labelled EVs to Protein L magnetic beads in a fluorometer. <h3>Results</h3> Mean EV particle size, concentration and protein content were not different between RA patients and HC. 27 of the 38 RA patients were classified as RF+ (&gt;10 IU/ml) and of the clinical parameters studied only their erythrocyte sedimentation rate (ESR) was higher (31 vs 14 mm/hr). In 14 RF +patients, RF was detectable on a small portion of EVs not exceeding 4% of the total number of circulating EVs. Interestingly, RA patients with RF +EVs showed higher disease activity as assessed by patient global health assessment using a visual analogue scale (63 vs 31), blood C-reactive protein (22 vs 9 mg/L) and ESR (43 vs 19 mm/hr) levels, than RA patients with undetectable RF +EVs. <h3>Conclusions</h3> This study shows for the first time that in a subpopulation of RA patients RF is present on EVs, which might originate from their B-cells. The higher disease activity in RA patients expressing RF on their EVs suggests that RF +EVs are involved in RA pathogenesis. <h3>Reference</h3> [1] Yang M, et al. Comparative proteomic analysis ofmilk-derived exosomes in human and bovine colostrumandmature milk samples by iTRAQ-coupled LC-MS/MS. Food Research International2017;92(2017):17–25. <h3>Disclosure of Interest</h3> None declared
Abstract LB-141: The Adenoma Prevention with Celecoxib (APC) trial: Five-year efficacy and safety results
Authors: Monica M. Bertagnolli, Ann G. Zauber, Ernest T Hawk
Journal: Cancer Research (2008)

Abstract The APC Trial was a placebo-controlled randomized study of celecoxib for prevention of sporadic adenomas in high risk patients. This study showed that, after 3 years of treatment, patients taking 200 mg of celecoxib bid had 33% fewer adenomas and 57% fewer advanced lesions, and patients taking 400 mg of celecoxib bid had 45% fewer adenomas and 66% fewer advanced lesions. This study also found that celecoxib use was associated with a small but significant increase in cardiovascular risk. After completing the 3 year treatment study, APC trial enrollees were offered participation in a 2 year off treatment observational study during which additional safety and efficacy data were collected. Colonoscopies at 5 years after initiating study treatment were performed on 639 patients, and showed a cumulative advanced adenoma incidence of 0.125 in patients taking 200 mg bid celecoxib, and 0.158 in patients taking 400 mg celecoxib bid, compared to 0.212 for patients on placebo (41% and 25% reductions, respectively, P&amp;lt;0.0001). Investigator reported, non-adjudicated selected cardiovascular events occurred 35 times in 676 patients randomized to placebo, 45 times in 683 patients randomized to celecoxib 200 mg bid, and 46 times in 669 patients randomized to 400 mg celecoxib bid. This selected category of events included all reports of myocardial infarction or ischemia, death from any cause, cerebrovascular disease, cardiovascular therapeutic procedures, or venous thrombosis or thromboembolism. One third of APC Trial participants used cardioprotective aspirin, and year 5 colonoscopy data showed increased adenoma incidence and severity in this subset, suggesting the presence of more aggressive disease in aspirin users. These data, together with additional new placebo-controlled analyses of celecoxib cardiovascular safety, suggest that chemoprevention with celecoxib may be safe and effective for some high risk colorectal adenoma patients.
Laryngeal Tube Insertion vs Endotracheal Intubation for Out-of-Hospital Cardiac Arrest
Authors: Liang Huang, Carin Hagberg, Henry Liu
Journal: JAMA (2019)

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Characterisation Of A Whole Blood Transcriptional Signature Of Subclinical Tuberculosis Identified By Fdg-Pet/ct In Asymptomatic Hiv-1 Infected Adults
Authors: H Esmail, P Lai, C M Graham, T Oni, N Bangani, J M Warwick, Q Said-Hartley, D B Young, C E Barry, A O'Garra, R J Wilkinson
Journal: American Journal of Respiratory and Critical Care Medicine (2014)
SAT0329 Fibromyalgia in patient with psoriatic arthritis: relationship with enthesopathy, sleep, fatigue and quality of life
Authors: F. Ulutatar, C. Unal, M.T. Duruoz
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Fibromyalgia is a syndrome characterised by musculoskeletal pain, sleep disturbance and fatigue. Fibromyalgia commonly accompanies rheumatic diseases. Enthesopathy seen in psoriatic arthritis (PsA) patients may have effect on fibromyalgia. <h3>Objectives</h3> To evaluate relationship of fibromyalgia with enthesopathy, sleep, fatigue and quality of life in patients with psoriatic arthritis. <h3>Methods</h3> The psoriatic arthritis patients according to CASPAR criteria were included into the study. Fibromyalgia diagnosis was based on 2010 ACR criteria. Demographic (age, gender, marital status, education, body mass index) and clinical parameters (disease duration, comorbidities, Moll-white classification of PsA) were noted. Disease activity and enthesopathy were evaluated with Disease Activity Score-28 (DAS-28) and Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), respectively. Functional assessment scales in this study were Psoriatic Arthritis Quality of Life (PsAQoL), Pittsburgh Sleep Quality Index (PSQI), Multidimensional Assessment of Fatigue (MAF). Fibromyalgia Impact Questionnaire (FIQ) was used to assess functional status of fibromyalgia. The difference in mean scores between fibromyalgia and the patients without fibromyalgia were analysed with Mann-Whitney U test. Spearman correlation coefficient (rho) was used for correlations between functional parameters. p&lt;0.05 was accepted as significant. <h3>Results</h3> We enrolled 50 PsA patients (32 female, 18 male) with a mean age 49.6 years (SD: 10.4) and mean disease duration 90.2 months (SD: 90.8). Thirty-two patients (64% of PsA patients) fulfilled ACR criteria for fibromyalgia. The mean scores of MASES, PSQI, MAF and PsAQoL were significantly higher in patients with fibromyalgia (p&lt;0.05). The correlations between FIQ and other functional parameters were as follows; MASES (rho=0.73, p&lt;0.0005), PSQI (rho=0.56, p&lt;0.0005), MAF (rho=0.63, p&lt;0.0005), PsAQoL (rho=0.69, p&lt;0.0005). There was no significant correlation between FIQ and disease duration (p&gt;0.05). Weak correlation was existing between FIQ and DAS-28 (rho=0.30, p=0.03). <h3>Conclusions</h3> Coexistence of fibromyalgia in PsA patients is associated with presence of enthesopathy, poor quality of life, sleep disturbance and fatigue. It is an important aspect to diagnose and treat fibromyalgia in PsA patients for comprehensive treatment. <h3>Disclosure of Interest</h3> F. Ulutatar: None declared, C. Unal: None declared, M. T. Duruoz Grant/research support from: ABVIE, Consultant for: NOVARTIS, Speakers bureau: ABDI IBRAHIM
Association Between Postoperative Delirium and Long-term Cognitive Function After Major Nonemergent Surgery
Authors: C. Adrian Austin, Thomas O’Gorman, Elizabeth Stern, Douglas Emmett, Til Stürmer, Shannon Carson, Jan Busby-Whitehead
Journal: JAMA Surgery (2019)

Postoperative delirium is associated with decreases in long-term cognitive function in elderly populations.To determine whether postoperative delirium is associated with decreased long-term cognition in a younger, more heterogeneous population.A prospective cohort study was conducted at a single academic medical center (≥800 beds) in the southeastern United States from September 5, 2017, through January 15, 2018. A total of 191 patients aged 18 years or older who were English-speaking and were anticipated to require at least 1 night of hospital admission after a scheduled major nonemergent surgery were included. Prisoners, individuals without baseline cognitive assessments, and those who could not provide informed consent were excluded. Ninety-day follow-up assessments were performed on 135 patients (70.7%).The primary exposure was postoperative delirium defined as any instance of delirium occurring 24 to 72 hours after an operation. Delirium was diagnosed by the research team using the Confusion Assessment Method (CAM).The primary outcome was change in cognition at 90 days after surgery compared with baseline, preoperative cognition. Cognition was measured using a telephone version of the Montreal Cognitive Assessment (T-MoCA) with cognitive impairment defined as a score less than 18 on a scale of 0 to 22.Of the 191 patients included in the study, 110 (57.6%) were women; the mean (SD) age was 56.8 (16.7) years. For the primary outcome of interest, patients with and without delirium had a small increase in T-MoCA scores at 90 days compared with baseline on unadjusted analysis (with delirium, 0.69; 95% CI, -0.34 to 1.73 vs without delirium, 0.67; 95% CI, 0.17-1.16). The initial multivariate linear regression model included age, preoperative American Society of Anesthesiologists Physical Status Classification System score, preoperative cognitive impairment, and duration of anesthesia. Preoperative cognitive impairment proved to be the only notable confounder: when adjusted for preoperative cognitive impairment, patients with delirium had a 0.70-point greater decrease in 90-day T-MoCA scores than those without delirium compared with their respective baseline scores (with delirium, 0.16; 95% CI, -0.63 to 0.94 vs without delirium, 0.86; 95% CI, 0.40-1.33).Although a statistically significant association between 90-day cognition and postoperative delirium was not noted, patients with preoperative cognitive impairment appeared to have improvements in cognition 90 days after surgery; however, this finding was attenuated if they became delirious. Preoperative cognitive impairment alone should not preclude patients from undergoing indicated surgical procedures.
Two en bloc circumferential endoscopic resections of synchronous esophageal neoplasms: a reality even in the West
Authors: Catarina Félix, Iala Pereira, Susana Marques, Pedro Barreiro, Miguel Bispo, Cristina Chagas
Journal: Endoscopy (2019)

A 50-year-old man with oropharynx cancer (T3N0M0) underwent upper gastrointestinal endoscopy to search for synchronous lesions. Endoscopic examination identified two synchronous extensive flat lesions (T0-IIb) in the esophagus: lesion A – a 5-cm lesion, occupying 75 % of the circumference, located between 16 and 21 cm from the incisors; lesion B – a 5-cm circumferential lesion, located between 26 and 31 cm from the incisors. The intrapapillary capillary loop classification was suggestive of type V3. Endoscopic ultrasound revealed neither submucosal invasion nor locoregional lymphadenopathies. Following multidisciplinary evaluation, endoscopic submucosal dissection (ESD) was planned ([Video 1]).
AB1303 Analysis of symptoms in very early phase in patients with adult-onset still’s disease
Authors: H. Tamai, Y. Kaneko, T. Takeuchi
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The initial symptoms of Adult-onset Still Disease (AOSD) are non-specific and confusing with those of common cold, which can lead to the delay of diagnosis and treatment. <h3>Objectives</h3> To clarify characteristic features in AOSD in very early phase and to find the key symptoms and markers to an earlier diagnosis and treatment. <h3>Methods</h3> We retrospectively reviewed consecutive AOSD patients in our hospital from April 2012 to July 2017. Symptoms and laboratory data before treatment were collected form their charts and analysed. <h3>Results</h3> A total of 62 patients were enrolled. The mean age at diagnosis was 45.9 and female was 81%. The duration from the first symptoms to the first visit to a medical facility was 18.7 days, from the first visit to the first blood test was 5.8 days, from the first blood test to the fulfilment of Yamaguchi's Criteria was 11.0 days, and from the fulfilment of Yamaguchi's Criteria to the treatment was 22.2 days. During the course of developing the disease, fever was found in all patients, skin lesion in 91.9%, arthralgia in 87.1%, sore throat in 66.1%. Laboratory and imaging tests demonstrated liver enzyme elevation in 82.2%, white blood cell count (WBC) increase in 80.6%, lymphadenopathy/splenomegaly in 72.6%, negative RF and ANA in 56.5%, ferritin elevation in 82.3%. Laboratory tests before treatment demonstrated that the mean WBC count 15272.3/μL, AST 101.8 U/L, CRP 15.1 mg/dl, and ferritin 10103.1 ng/ml. Patients who presented with sore throat as the first symptom fulfilled Yamaguchi's Criteria in 13.6 days after the onset, which was shorter than patients with any other symptoms (fever, 24.0 days; arthralgia, 45.7 days; skin lesion, 31.5 days). Before treatment, patients with sore throat as the first symptom showed highest AST of 139.6 U/L (fever, 95.3 U/L; arthralgia, 100.7 U/L; skin lesion, 71.6 U/L) and highest ferritin of 19791.8 ng/ml (fever, 9508.2 ng/ml; arthralgia, 13071.5 ng/ml; skin lesion, 8438.1 ng/ml). However, the duration from the Yamaguchi's Criteria fulfilment to treatment initiation in patients with sore throat as the first symptom was 38.5 days, which was no less than that in patients with the other symptoms (fever, 15.4 days; arthralgia, 31.0 days; skin lesion, 27.0 days). <h3>Conclusions</h3> Although symptoms of AOSD developed rapidly with symptoms of sore throat, fever, liver enzyme elevation and ferritin elevation, the diagnosis was frequently delayed. Our study suggests that the delayed diagnosis can be attributed in part to non-assumption of the disease. Paying attention to the combination of these symptoms can lead to an earlier diagnosis. <h3>Disclosure of Interest</h3> None declared
Cluster-randomised trial of a nurse-led advance care planning session in patients with COPD and their loved ones
Authors: Carmen H M Houben, Martijn A Spruit, Hans Luyten, Herman-Jan Pennings, Vivian E M van den Boogaart, Jacques P H M Creemers, Geertjan Wesseling, Emiel F M Wouters, Daisy J A Janssen
Journal: Thorax (2019)

Rationale Advance care planning (ACP) is uncommon in patients with chronic obstructive pulmonary disease (COPD). Objectives To assess whether a nurse-led ACP-intervention can improve quality of patient-physician end-of-life care communication in patients with COPD. Furthermore, the influence of an ACP-intervention on symptoms of anxiety and depression in patients and loved ones was studied. Finally, quality of death and dying was assessed in patients who died during 2-year follow-up. Methods A multicentre cluster randomised-controlled trial in patients with advanced COPD was performed. The intervention group received an 1.5 hours structured nurse-led ACP-session. Outcomes were: quality of patient-physician end-of-life care communication, prevalence of ACP-discussions 6 months after baseline, symptoms of anxiety and depression in patients and loved ones and quality of death and dying. Results 165 patients were enrolled (89 intervention; 76 control). The improvement of quality of patient-physician end-of-life care communication was significantly higher in the intervention group compared with the control group (p&lt;0.001). The ACP-intervention was significantly associated with the occurrence of an ACP-discussion with physicians within 6 months (p=0.003). At follow-up, symptoms of anxiety were significantly lower in loved ones in the intervention group compared with the control group (p=0.02). Symptoms of anxiety in patients and symptoms of depression in both patients and loved ones were comparable at follow-up (p&gt;0.05). The quality of death and dying was comparable between both groups (p=0.17). Conclusion One nurse-led ACP-intervention session improves patient-physician end-of-life care communication without causing psychosocial distress in both patients and loved ones.
AB0883 Assessment of early myocardial dysfunction using speckle tracking echocardiography in patients with radiographic and nonradiographic axial spondyloarthritis
Authors: V. Emren, O. Gercik, E. Ozdemir, D. Solmaz, S. Gucenmez, N. Eren, M. Tokac, G. Kabadayi, S. Akar
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that mainly affects axial skeleton. Although some differences like sex and objective signs of inflammation were described between these two subgroups, overall disease burden was found to be similar in radiographic (r-) and non-radiographic (nr-) axSPA patients. The association of chronic inflammation with cardiac dysfunction was well documented in many inflammatory rheumatic diseases. However it was not assessed in the subgroups of axSpA patients. Advanced two-dimensional (2D) speckle tracking echocardiographic analysis is more sensitive and accurate method of early detection of myocardial dysfunction than the conventional 2D transthoracic echocardiography (TTE). <h3>Objectives</h3> To evaluate the left ventricular function by using speckle tracking echocardiography in patients with both r- and nr-axSpA. <h3>Methods</h3> In total 64 patients with r-axSpA (70% male) and age– and sex-matched 27 patients with nr-axSpA (63% male) and 30 healthy control subjects (63% male) were included in the analysis. Patients with hypertension, diabetes and known cardiac disease were excluded. All patients underwent detailed echocardiographic examination including M-mode, pulsed-wave Doppler imaging, pulsed-wave tissue Doppler imaging and 2D speckle tracking. <h3>Results</h3> Age and sex distribution were not different between groups. Some demographic and disease related characteristics were shown in the table. BASDAI, BASFI, global assessment of disease activity and ASAS-HI scores were found to be similar between r- and nr-axSpA patient groups. Although ejection fraction (EF) (p=0.112) and the other echocardiographic variables were similar between groups, global longitudinal strain (GLS) (p=0.045) were found to be different among groups (table 1). Post-hoc analysis showed that GLS was similar between nr-axSpA and control groups however GLS was significantly low in r-axSpA patients. In univariate analysis GLS was correlated with age (p=0.025), EF (p&lt;0.001), peripheral arthritis (p=0.047), and smoking (p=0.019). However in regression only peripheral arthritis (p=0.032) and EF (p=0.015) were found as the independent predictors of GLS. <h3>Conclusions</h3> The results of the present study showed that left ventricular function had impaired in r-axSpA patients and speckle tracking echocardiography may be a useful tool for early demonstration of left ventricular dysfunction. <h3>Disclosure of Interest</h3> None declared