tbuckley/cabot-search huggingface dataset:
FRI0555 Muscle elastography as a potential novel imaging biomarker in myositis
Authors: A.M. Alfuraih, A.L. Tan, P. O’Connor, P. Emery, R.J. Wakefield
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Idiopathic inflammatory myopathies are a group of autoimmune muscle disorders characterised by muscle pain, stiffness and weakness. Diagnosis can be challenging; it relies on subjective clinical assessments, expensive MRI scans and invasive muscle biopsies. Novel quantitative ultrasound technologies like shear wave elastography could provide a new valuable non-invasive bedside imaging biomarker for diagnosis and management. <h3>Objectives</h3> 1-to determine if there are muscle elasticity differences between myositis patients and healthy controls. 2-to test the correlation between elasticity and measures of strength, function and muscle enzymes (disease activity). <h3>Methods</h3> Muscle elasticity, evaluated using shear wave velocity (SWV), was measured in 16 active myositis patients (5 males/11 females; 5 dermatomyositis, 5 polymyositis, 2 inclusion body, 4 undifferentiated) with a mean age of 51.3 years and 26 healthy controls (8 males/20 females) with a mean age of 42.0 years. Active myositis was defined as a decreased muscle strength and an elevated muscle enzyme. The investigated muscles included the four quadriceps [vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM) and vastus intermedius (VI)], the three hamstrings [biceps femoris (BF), semitendinosus (ST) and semimembranosus (SM)] and the biceps brachii (BB). The myositis patients performed the expanded timed-get-up-and-go (ETGUG) test to assess walking function in addition to the handgrip strength and isokinetic knee extension/flexion tests to assess muscle strength. Mann-Whitney test and Spearmen's correlation coefficients were utilised to test for difference and correlation respectively. <h3>Results</h3> Myositis patients had a significantly lower SWV (p≤0.001) in all muscles except the BB (table 1 and figure 1). The mean elasticity difference ranged from 12% for VM to 21.1% for SM (table 1). Muscle enzyme (creatine kinase) correlated with SWV for the VM (r=0.50; p=0.04) and BB (r=0.55; p=0.03). A strong correlation was detected between ETGUG walking time and VL (r=−0.73) as well as VI (r=−0.64). Handgrip strength correlated with VL, RF and BF (r=0.64, 0.56 and 0.62 respectively). There was, however, no significant correlation between SWV and isokinetic knee strength. <h3>Conclusions</h3> Muscle elasticity in myositis patients has been shown to be 21% lower in comparison to healthy participants and seems to moderately correlate with disease activity, muscle strength and function. To our knowledge, this is the first study to show that shear wave elastography can detect changes in muscle elasticity in myositis patients. Further validation is required to evaluate the value of this novel ultrasound technology as an imaging biomarker for myositis. <h3>Disclosure of Interest</h3> None declared
Durable Remissions with Humanized CD19-Targeted Chimeric Antigen Receptor (CAR)-Modified T Cells in CAR-Naive and CAR-Exposed Children and Young Adults with Relapsed/Refractory Acute Lymphoblastic Leukemia
Authors: Shannon L Maude, George E Hucks, Colleen Callahan, Diane Baniewicz, Christina Fasano, Christine Barker, Susan R. Rheingold, Richard Aplenc, Amanda M. Dinofia, Amanda Li, David T Teachey, David M. Barrett, Jennifer Brogdon, Regina M Young, John Scholler, Katherine T Marcucci, Bruce L Levine, Noelle Frey, David L Porter, Simon F Lacey, J. Joseph Melenhorst, Carl H June, Stephan A Grupp
Journal: Blood (2017)
Altered Uncinate Fasciculus Microstructure in Childhood Anxiety Disorders in Boys But Not Girls
Authors: Do P.M. Tromp, Lisa E. Williams, Andrew S. Fox, Jonathan A. Oler, Patrick H. Roseboom, Gregory M. Rogers, Brenda E. Benson, Andrew L. Alexander, Daniel S. Pine, Ned H. Kalin
Journal: American Journal of Psychiatry (2019)

Objective: Anxiety disorders are common, can result in lifelong suffering, and frequently begin before adolescence. Evidence from adults suggests that altered prefrontal-limbic connectivity is a pathophysiological feature of anxiety disorders. More specifically, in adults with anxiety disorders, decreased fractional anisotropy (FA), a measure of white matter integrity, has been observed in the uncinate fasciculus, the major tract that connects limbic and prefrontal regions. Because of the early onset of anxiety disorders and the increased incidence in anxiety disorders in females during their reproductive years, it is important to understand whether the reduction in uncinate fasciculus FA exists in children with anxiety disorders and the extent to which this alteration is sex related. To address these issues, the authors assessed FA in the uncinate fasciculus in unmedicated boys and girls with anxiety disorders. Methods: FA measures were derived from diffusion tensor images that were acquired from 98 unmedicated children (ages 8–12); 52 met criteria for generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, or anxiety disorder not otherwise specified, and 46 were matched control subjects. Results: Tract-based results demonstrated that children with anxiety disorders have significant reductions in uncinate fasciculus FA. A significant sex-by-group interaction and post hoc testing revealed that this effect was evident only in boys. No other main effects or sex-by-group interactions were found for other white matter tracts. Conclusions: These findings provide evidence of uncinate fasciculus white matter alterations in boys with anxiety disorders. The data demonstrate that anxiety disorder–related alterations in prefrontal-limbic structural connectivity are present early in life, are not related to psychotropic medication exposure, and are sex specific. Building on these findings, future research has the potential to provide insights into the genesis and sexual dimorphism of the pathophysiology that leads to anxiety disorders, as well as to identify sex-specific early-life treatment targets.
THU0237 Inflammatory lesions of the sacroiliac joints, but not of the spine, are of high utility for axspa recognition: results of the ilos-desir study
Authors: A. Moltó, L. Gossec, M. Lefevre-Colau, V. Foltz, R. Beaufort, J. Laredo, P. Richette, P. Dieudé, P. Goupille, A. Feydy, M. Dougados
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Objectives</h3> To evaluate the performance of MRI inflammatory lesions suggestive of axSpA for the axSpA recognition <h3>Methods</h3> Observational cross-sectional national multicentre study. Patients: a) Recent onset axSpA patients: first, a sample of 100 patients representative in terms of imaging abnormalities of the global DESIR recent onset axSpA cohort were selected. b) Recent onset CBP patients: consecutive in- and outpatients consulting for recent (&gt;3 months but &lt;5 years) mechanical CBP, initiating before the age of 45 y and with a maximum age of 50 y, in four tertiary care Hospitals were included in the study. <i>Imaging:</i> MRI scans (T2-STIR and T1 sequences) of the SIJ and full spine were performed in both groups with identical protocol. <i>Central reading:</i> an experienced reader (AM) centrally read all MRI scans, blinded for clinical diagnosis.<i> Statistical analysis:</i> Sensitivity, specificity and positive likelihood ratio of each lesion were calculated. <h3>Results</h3> A total of 98 patients with recent onset CBP were included, and compared to 100 recent onset axSpA patients. Age and gender were comparable (mean (SD) 36.2 (9.9) vs. 32.2 (8.7)y, and 41.8% and 45% males, in the CBP vs. axSpA groups, respectively). MRI inflammatory lesions of the SIJ were quite frequent in the CBP group (25% patients with at least one inflammatory lesion) but were significantly more frequently observed in the axSpA group (table 1), with a mean SIJ - SPARCC score of 4.9 (8.8) vs. 0.6 (1.3), p&lt;0.001. The ASAS definition of MRI sacroiliitis presented a high specificity and a good positive likelihood ratio. Conversely, prevalence of inflammatory lesions of the spine was very frequent in the CBP group and not significantly lower compared to the axSpA group (SPARCC spine 5.6 (13.5) vs. 3.3 (5.8), NS, in the axSpA vs. CBP groups, respectively). Regardless the definition of a positive MRI for the spine applied, performances were not good <h3>Conclusions</h3> ASAS definition of a positive MRI-sacroiliitis performed very well for axSpA recognition; however, definitions proposed for a positive MRI-spine suggestive of axSpA did not seem to perform adequately in this recent disease stage. This supports the idea of not including a positive MRI of the spine in the ASAS classification criteria. <h3>Disclosure of Interest</h3> None declared
THU0271 Emergence of severe spondyloarthropathy related entheseal pathology following vedolizumab therapy for inflammatory bowel disease
Authors: S. Dubash, T. Marianayagam, T. Al-Araimi, C. Pagnoux, A. Weizman, M.-L. Tran Minh, M. Allez, P. Richette, H. Marzo-Ortega, D. McGonagle
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The Spondyloarthritides (SpA) and inflammatory bowel disease (IBD) share common aetiopathogenetic and clinical manifestations. Vedolizumab, a humanised IgG1 monoclonal antibody to α4β7 integrin, has been approved for the treatment of inflammatory bowel disease (IBD) and inhibits α4β7 integrin at the gut level. Vedolizumab therapy for IBD has been associated with mild SpA related features including sacroiliitis and synovitis. Herein, we report the emergence of severe SpA under therapy with Vedolizumab. <h3>Objectives</h3> We conducted a clinical evaluation of 7 vedolizumab treated patients with IBD that developed severe active SpA and/or enthesopathy with the aim of characterising the vedolizumab associated SpA/entheseal flares. <h3>Methods</h3> Vedolizumab treated IBD patients with SpA/enthesopathy were identified across four hospitals. We identified clinical, biochemical and imaging characteristics within routine case records as part of a clinical evaluation. <h3>Results</h3> We identified 6/7 subjects that developed <i>de novo</i> SpA/enthesopathy and 1/7 (subject 1) with a severe flare of pre-existing SpA. There were 3/7 patients hospitalised due to the severity of skeletal disease. The median time from vedolizumab initiation to flare was 10 weeks (table 1 below). Subject 4 developed new-onset SpA with severe spinal vertebral end-plate oedema (T6–12) and inflammatory Romanus lesions (L3–4) (image below). Acute sacroiliitis was identified on MRI in 3 subjects, one of which showed evidence of radiographic bilateral grade 2 sacroiliitis. In at least 4 cases the IBD disease activity was considered to be low or well controlled. Following vedolizumab discontinuation, so far 3 patients have switched to alternative biologic therapies including certolizumab pegol, golimumab, and 1 subject to sulphasalazine. cpd=cigarettes per day, MTX=methotrexate, AZA=azathioprine, OC=oral corticosteroid, Pred=prednisolone, nr=non radiographic, MRI+ve= MRI positive, XR +ve = radiograph positive, NA=not available. <h3>Conclusions</h3> This case series demonstrates severe vedolizumab associated SpA/enthesopathy that resulted in hospitalised cases. The severity of vedolizumab related SpA flares is relatively severe disease in comparison to the literature. We recognise that vedolizumab is efficacious in IBD, however our observations highlight the need to monitor symptoms to identify patients that develop axial or peripheral SpA several weeks from commencing vedolizumab. <h3>Disclosure of Interest</h3> None declared
Long term recurrence may be lower with laparoscopic repair
Authors: J. Wellwood, D. Stoker
Journal: BMJ (1996)

EDITOR,—In their study comparing laparoscopic with open repair of inguinal hernias Kate Lawrence and colleagues excluded 43% of patients considered for the trial.1 This is a high proportion: in our study five patients (3%) seen during the trial fulfilled our exclusion criteria.2

More complications occurred in the group that had laparoscopy in the authors' study. The surgical technique used probably accounts for three of the complications reported. The 12x8 cm mesh is too small and …
Activity of a FIX-Padua Transgene Product in Commonly Used FIX:C One-Stage and Chromogenic Assay Systems Following PF-06838435 (SPK-9001) Gene Delivery
Authors: Mary Robinson, Lindsey A. George, Benjamin J. Samelson-Jones, Valder R Arruda, Katherine A. High, Marcus E Carr, Stefan Tiefenbacher
Journal: Blood (2018)
Targeting hepatic glucokinase to treat diabetes with TTP399, a hepatoselective glucokinase activator
Authors: Adrian Vella, Jennifer L. R. Freeman, Imogene Dunn, Kit Keller, John B. Buse, Carmen Valcarce
Journal: Science Translational Medicine (2019)

A hepatoselective glucokinase activator reduced hyperglycemia without hypoglycemia or adverse effects on lipids, liver enzymes, or blood pressure.
SAT0634 Does the presence of mri-detected osteitis at diagnosis with rheumatoid arthritis lowers the risk for achieving dmard-free sustained remission? – results of a longitudinal study
Authors: L.E. Burgers, D.M. Boeters, M. Reijnierse, A.H.M. van der Helm-van Mil
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Although infrequent, some rheumatoid arthritis (RA)-patients achieve disease-modifying antirheumatic drug (DMARD)-free sustained remission. Absence of RA-specific auto-antibodies, such as anticitrullinated protein antibodies (ACPA) are known to be associated with this outcome, but furthermore mechanisms underlying the chronic nature of RA are largely unknown. <h3>Objectives</h3> Magnetic resonance imaging (MRI)-detected bone marrow oedema (BME, osteitis) strongly predicts erosive progression and is associated with ACPA-positivity. Therefore, we hypothesised that presence of MRI-detected osteitis is also predictive of not achieving DMARD-free sustained remission and that the presence of osteitis mediates the association between ACPA and DMARD-free sustained remission. <h3>Methods</h3> A 1.5T unilateral hand and foot MRI was performed at disease presentation in 238 RA-patients, evaluating BME, synovitis and tenosynovitis (summed in MRI-inflammation score). The median follow-up duration was 3.8 years. DMARD-free sustained remission, defined as the absence of clinical synovitis after DMARD-cessation that persisted during the total follow-up, was assessed. Associations between the different MRI-detected inflammatory features and this outcome were studied. A mediation analysis was performed to study whether the presence of BME mediated the association between ACPA and DMARD-free sustained remission. Finally, patterns of MRI-detected inflammation (including type, severity and location) with regard to DMARD-free sustained remission were studied using partial least squares (PLS) regression. <h3>Results</h3> Forty-six (19.3%) patients achieved DMARD-free sustained remission. ACPA-positivity associated independently with remission (HR 0.16, 95% CI 0.06–0.39). In contrast, no associations were observed between MRI-detected BME (HR 0.99, 95% CI 0.94–1.03), or other MRI-inflammatory features, and achieving DMARD-free sustained remission. Thus, the presence of BME did not mediate the association between ACPA and DMARD-free sustained remission Furthermore, PLS regression revealed that patients who did or did not achieve remission could not be distinguished by patterns of MRI-detected inflammation. <h3>Conclusions</h3> At disease presentation, osteitis, as well as other MRI-detected inflammatory features, were not associated with achieving DMARD-free sustained remission over time. The data indicate that imaging predictors for joint damage and disease persistence differ. The processes mediating RA chronicity remain largely unsolved. <h3>Disclosure of Interest</h3> None declared
Abstract 18978: Predictive Modeling of 30-day Readmission of Heart Failure Patients Using Admit Labs, Early Clinical Tests, and History and Physical Exam for In-Hospital Modification of Readmission Risk
Authors: Benjamin D Horne, Deborah Budge, José G Benuzillo, Alejandra Bradshaw, Tami L Bair, Colleen A Roberts, Kismet D Rasmusson, Jen Nixon, Rami Alharethi, Abdallah G Kfoury, Donald L Lappé
Journal: Circulation (2013)

Background: All 30-day readmission risk models created to date use hospital discharge data gathered at the end of a hospital’s direct patient impact. Since 30-day readmission penalties are charged to hospitals, predictive models should use data from the time of index admission. This study created risk scores for 30-day readmission from factors available at admission among heart failure (HF) patients. Methods: HF patients aged 65 years or older who were admitted as inpatients to Intermountain Healthcare hospitals from 2005-2012 and not discharged to hospice were studied. Data included 205 predictor variables gathered within 24 hours of index admission and the 30-day readmission outcome. Patients were randomly divided into derivation (70%) and validation (30%) groups. Logistic regression was used to build sex-specific predictive models for 30-day readmission, including all variables (full model), only clinical and H&amp;P factors (clinical model), and only laboratory tests (lab model). Results: C-statistics for Intermountain HF risk scores (iHF) were greater than previous 30-day readmission models for HF patients (Table). Odds ratios (OR) for 30-day readmission for iHF (full model) in validation patients were, for females, OR=1.77 (95% CI=1.17, 2.66; p=0.007) and OR=1.62 (CI=1.07, 2.45) for tertiles 3 vs. 1 and 2 vs. 1, respectively. Among males in the validation group, the iHF full model had OR=2.28 (CI=1.53, 3.38; p&lt;0.001) for tertile 3 vs. 1 for 30-day readmission and, for tertile 2 vs. 1, OR=1.59 (CI=1.05, 2.41). Clinical and lab models were also very predictive despite using a reduced set of variables. Conclusions: The iHF readmission risk scores strongly stratified 30-day readmission risk using HF patient data available within 24 hours of index hospital admission. Discrimination was better than other HF 30-day readmission models, including those created for CMS. Use of iHF at the time of admission empowers hospital-based modification of 30-day readmission risk.
AB1335 Serum mmp-3 is closely related to knee joint symptoms in rheumatoid arthritis patients: a cross-sectional study from kurama cohort
Authors: M. Azukizawa, H. Ito, K. Nishitani, K. Murata, A. Okahata, T. Tomizawa, M. Hashimoto, M. Tanaka, T. Mimori, S. Matsuda
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Joint damage progression occurs within the first 2 years of rheumatoid arthritis (RA).<sup>1</sup> Large joints are often involved in RA patients. The knee joint, in particular, is affected in about 30% of RA patients.<sup>2</sup> Knee joint disability in RA is thought to be one of the most important prognostic factors decreasing quality of life. However, few studies have focused on what would influence knee joint function in RA patients. Therefore, a cross-sectional study on this subject was conducted using a RA patient cohort: the Kyoto University Rheumatoid Arthritis Management Alliance (KURAMA) cohort. <h3>Objectives</h3> The purpose of this study is to clarify risk factors related to functional disability in knee joint from a RA cohort. <h3>Methods</h3> A total of 447 female RA patients (mean age; 63.7 years) were recruited in KURAMA cohort. Clinical data included age, disease duration (DD), Steinbrocker stage and class, anti-cyclic citrullinated peptide antibody (anti-CCP), rheumatoid factor (RF), C-reactive protein (CRP), matrix metalloproteinase-3 (MMP-3), Disease Activity Score 28 using CRP (DAS28-CRP), and visual analogue scale for pain (Pain-VAS). Knee function was assessed by the scores of the Japanese Knee Osteoarthritis Measure (JKOM) questionnaire.<sup>3</sup> The correlations between the total JKOM score and each factor were evaluated by univariate and multivariate regression analyses. <h3>Results</h3> A total score of JKOM had a median value of 17 points, an interquartile range of 5.5 to 43.5 points. Univariate analyses showed that age, DD, stage, class, anti-CCP titer, CRP, MMP-3, DAS28-CRP, and Pain-VAS were significantly correlated with total JKOM score (table 1). Multivariate regression analysis with JKOM as the objective variable revealed that Pain-VAS (β=0.63, p<i>&lt;</i>0.01), age (β=0.23, p<i>&lt;</i>0.01), and MMP-3 (β=0.16, p<i>&lt;</i>0.01) were extracted as significant factors (table 2). <h3>Conclusions</h3> Pain has the most significant influence on knee joint symptoms in RA patients. Serum MMP-3 is closely related to knee joint disability, and attention should be paid to knee joint dysfunction in RA patients with high serum MMP-3. <h3>References</h3> [1] Fuchs HA, et al. J Rheumatol. 1989;16(5):585–91. [2] Drossaers-Bakker KW, et al. Rheumatology (Oxford). 2000;39(9):998–1003. [3] Akai M, et al. J Rheumatol. 2005;32(8):1524–32. <h3>Disclosure of Interest</h3> None declared
Differences in Genomic Patterns between African Americans and Whites with Acute Myeloid Leukemia
Authors: Rachel Hu, Aziz Nazha, Xuefei Jia, Brian P. Hobbs, Hetty E. Carraway, Sudipto Mukherjee, Aaron T. Gerds, Anjali S. Advani, Yasunobu Nagata, Cassandra M. Hirsch, Bartlomiej P. Przychodzen, Babal K. Jha, Jaroslaw P. Maciejewski, Mikkael A. Sekeres
Journal: Blood (2018)
Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis
Authors: Tuomas Lähdeoja, Teemu Karjalainen, Jarkko Jokihaara, Paul Salamh, Lauri Kavaja, Arnav Agarwal, Marinus Winters, Rachelle Buchbinder, Gordon Guyatt, Per Olav Vandvik, Clare L Ardern
Journal: British Journal of Sports Medicine (2019)

Objective To determine the benefits and harms of subacromial decompression surgery in adult patients with subacromial pain syndrome lasting for more than 3 months. Design Systematic review with meta-analysis. Main outcome measures Pain, physical function and health-related quality of life. Data sources Systematic searches for benefits and harms were conducted to 23 July 2018 in MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Database of Abstracts of Reviews of Effects, and Health Technology Assessment. Eligibility criteria for selecting studies Randomised controlled trials comparing subacromial decompression surgery for subacromial pain syndrome with any other treatment(s). For harms, we included prospective cohort studies. Review methods Two reviewers independently determined eligibility, extracted the data and assessed the risk of bias of eligible studies. Thirty patients seeking primary or outpatient care for subacromial pain syndrome and a parallel guideline committee ( BMJ Rapid Recommendations) provided input regarding systematic review design and interpretation. Results There was high certainty evidence of no additional benefit of subacromial decompression surgery over placebo surgery in reducing pain at 1 year following surgery (mean difference [MD] −0.26, 95% CI −0.84 to 0.33, minimally important difference [MID] 1.5) or improving physical function at 1–2 years (MD 2.8, 95% CI −1.4 to 6.9, MID 8.3). There was moderate certainty evidence for no additional benefit of subacromial decompression surgery on health-related quality of life at 1 year (MD −0.03 points, 95% CI −0.11 to 0.06, MID 0.07). There was moderate certainty evidence for six serious harms per 1000 (95% CI 5 to 7) patients undergoing subacromial decompression. Conclusion Subacromial decompression surgery provided no important benefit compared with placebo surgery or exercise therapy, and probably carries a small risk of serious harms. Systematic reviewregistration number CRD42018086862.