tbuckley/cabot-search huggingface dataset:
Anterior cruciate ligament (ACL) reconstruction and meniscal repair rates have both increased in the past 20 years in England: hospital statistics from 1997 to 2017
Authors: Simon G F Abram, Andrew J Price, Andrew Judge, David J Beard
Journal: British Journal of Sports Medicine (2019)

We investigated the temporal trend and the geographical variation in the rate of an anterior cruciate ligament (ACL) reconstruction and meniscal repair (MR) performed in England during a 20-year window.All hospital episodes for patients undergoing ACL reconstruction or MR between 1 April 1997 and 31 March 2017 were extracted by procedure code from the national hospital episode statistics. Age-standardised and sex-standardised rates of surgery were calculated using Office for National Statistics population data as the denominator and analysed over time both nationally and regionally by National Health Service clinical commissioning group (CCG).Between 1997-1998 and 2016-2017, there were 133 270 cases of ACL reconstruction (124 489 patients) and 42 651 cases of MR (41 120 patients) (isolated or simultaneous). Nationally, the rate of ACL reconstruction increased 12-fold from 2.0/100K population (95% CI 1.9 to 2.1) in 1997-1998 to 24.2/100K (95% CI 23.8 to 24.6) in 2016-2017. The rate of MR increased more than twofold from 3.0/100K (95% CI 2.8 to 3.1) in 1997-1998 to 7.3/100K (95% CI 7.1 to 7.5) in 2016-2017. Of these cases, the rate of simultaneous ACL reconstruction and MR was 2.6/100K (95% CI 2.5 to 2.8) in 2016/2017. In 2016-2017, for patients aged 20-29, the sex-standardised rate of ACL reconstruction was 76.9/100K (95% CI 74.9 to 78.9) and for MR was 19.8/100K (95% CI 18.8 to 20.9). Practice varied by region-in 2016-2017, 14.5% (30/207) of the CCGs performed more than twice the national average rate of ACL reconstruction and 15.0% (31/207) performed more than twice the national average rate of MR.The rate of ACL reconstruction (12-fold) and MR (2.4-fold) has increased in England over the last two decades. There is variation in these rates across geographical regions and further work is required to deliver standardised treatment guidance for appropriate use.
Potential Unintended Effects of Medicare’s Bundled Payments for Care Improvement Program—Reply
Authors: Amol S. Navathe, Joshua M. Liao, Ezekiel J. Emanuel
Journal: JAMA (2019)

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SP0144 The importance of maintaining control
Authors: K.E.N. Clark
Journal: Annals of the Rheumatic Diseases (2018)

<h3></h3> The clinical impact of lower gastrointestinal tract involvement in systemic sclerosis will be illustrated by case presentations. This will describe problems including pseudo-obstruction, severe malnutrition, and electrolyte imbalance and anorectal disease. The interplay with comorbidities such as cardiac scleroderma will also be described. Potential therapeutic strategies for these different complications will be introduced through these cases. <h3>Disclosure of Interest</h3> None declared
Survival differences in European patients with AIDS, 1979-89
Authors: J D Lundgren, C Pedersen, N Clumeck, J M Gatell, A M Johnson, B Ledergerber, S Vella, A Phillips, J O Nielsen
Journal: BMJ (1994)

<h3>Abstract</h3> <b>Objectives</b> : To examine the pattern of survival and factors associated with the outcome of disease in patients with AIDS. <b>Design</b> : Inception cohort. Data collected retrospectively from patients9 charts. <b>Setting</b> : 52 clinical centres in 17 European countries. <b>Subjects</b> : 6578 adults diagnosed with AIDS from 1 January 1979 to 31 December 1989. <b>Main outcome measures</b> : Survival after the time of diagnosis. <b>Results</b> : The median survival after diagnosis 20 was 17 months, with an estimated survival at three years of 16% (95 confindence interval 15% to 17%). Patients diagnosed in southern Europe had a shorter survival, particularly immediately after the time of diagnosis, compared with patients diagnosed in central and northern Europe (survival at one year (95% confidnece interval) 54% (52% to 56%) 66% (64% to 68%), 65% (63% to 66%), respectively. The three year survival, however, was similar for all regions. The regional differences in survival were less pronounced for patients diagnosed in 1989 compared with earlier years. Improved survival in recent years was observed for patients with a variety of manifestations used to define AIDS but was significant only for patients diagnosed with Pneumocystis carinii pneumonia. The three year survival, however, remains unchanged over time. <b>Conclusions</b> : Survival of AIDS patients seems to vary within Europe, being shorter in southern than central and northern Europe. The magnitude of these differences, however, has declined gradually over time. Short term survival has improved in remained equally poor, reflecting the fact that the underlying infection with HIV and many of the complicating diseases remains essentially uncontrolled.
THU0399 Female sexual dysfunction in patients with idiopathic inflammatory myopathies
Authors: B. Hermankova, M. Spiritovic, H. Smucrova, S. Oreska, H. Storkanova, K. Pavelka, L. Senolt, H. Mann, J. Vencovsky, M. Tomcik
Journal: Annals of the Rheumatic Diseases (2018)

2015 and November 2017.Exclusion criteria were as follows: not having serum CRP levels within 1 month of iron studies, chronic kidney disease (eGFR <60 ml/ min), haemoglobinopathies, major surgery within one year, overt gastrointestinal (GI) or genitourinary blood loss, active GI cancer and vascular lesions of GI (GAVE, intestinal telengiectasia).Patients who have ferritin levels below cut-off values or were already on iron replacement were considered as iron deficient.To define iron deficient status, threshold levels of serum ferritin 30 ng/mL and 100 ng/mL were used to denote those with normal and high CRP levels (>5 mg/L) respectively.WHO classification system was used to determine the presence and severity of anaemia.Relationship between demographic and disease characteristics and serum iron status was analysed using Fisher's exact and Mann-Whithey U test.Results: 178 patients (76.4% female) were eligible for final analysis.Clinical characteristics are reported in table 1. Median age and disease duration (interquartile range, IQR) were 54.6 (44.8-66.1)and 4.9 (2.1-4.8)years, respectively.ID was present in 43.2% of the patients and 41.6% of these patients was not anaemic.Iron deficient patients were more frequently female and had longer disease duration.Among female patients, ID was significantly more prevalent before the age of 50 (77.6%vs 0%, p<0.001).
AB1296 Genetic polimorphisms and methotrexate safety in rheumatoid arthritis
Authors: E. Chamizo, E. González, C. Carrasco, S. Rojas, J.J. Aznar, P. Dorado, A. Llerena
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Methotrexate (MTX) is the DMARD of choice in the treatment of rheumatoid arthritis (RA). Despite an acceptable efficacy, its use is limited by side effects. The most known adverse events (AE) are gastrointestinal, hepatic, and haematological. <h3>Objectives</h3> To study the effect of clinical characteristics and of different genetic single nucleotide polymorphisms (SNPs) related to the transport and metabolic pathways of MTX, on the toxicity of this compound, in a cohort of RA patients treated with MTX in monotherapy. <h3>Methods</h3> Observational study. Toxicity was defined as the occurrence of AE, global and of haematological, hepatic, and gastrointestinal nature. Factors under study: SNPs of transport (ABCB1 C3435T), glutamation (GGH T16C and FPGS G2782A), transmethylation (MTHFR C677T and MTHFR A1298C) and adenosine (AMPD1 C34T, ADA A534G, ITPA C94A). The association between SNPs and MTX toxicity was analysed using logistic regression models, assessing allele independence (Hardy-Weinberg equilibrium) and interaction with sex. Different models of inheritance of SNPs were analysed. The models were adjusted by the characteristics of the patient, of disease and of treatment. The haplotypes of the MTHFR SNPs (C677T and A1298C) were also analysed. <h3>Results</h3> Bivariate analysis showed that AE, globally considered, are related to lower age at diagnosis (OR=0.98), female sex (OR=1.95), disease activity (OR=1.38), extra-articular manifestations (OR=1.84) and comorbidity (OR=1.14). For the SNPs, the A/G genotype of the ADA A534G decreases the probability of AE (OR=0.55); the G/G of the ADA A534G increases the hepatic AE (OR=10.1) and the genotypes C/T and T/T of the ABCB1 C3435T decrease the risk of haematological AE. According to the adjusted analysis, the probability of global AE increased with the C/T genotypes of MTHFR C677T (OR=1.85) and C/C of GGH T16C (OR=2.53) and decreased with the A/G of ADA A534G (OR=0.49). Gastrointestinal AEs were less frequent in patients with A/G genotype of ADA A534G (OR=0.49) and in men with G/A of FPGS_2782GAc (OR=0.29). The G/G genotype of the SNP ADA_534AG was associated with a significant increase in hepatic AE (OR=12.7), which was also observed in men with the MTHFR A1298C (OR=8.34). The T allele of the ABCB1 C3435T decreases the probability of haematological AE, especially in women (OR=0.06). All the effects were independent of the characteristics of patient, disease and treatment. The C/C haplotype of the combination MTHFR C677T and MTHFR A1298C increases the probability of global (OR=4.35) and hepatic AE (OR=11.9) in men, but not in women. <h3>Conclusions</h3> SNPs related to the transport and metabolism of MTX are associated with liver toxicity of MTX. <h3>Disclosure of Interest</h3> None declared
AB0932 Helicobacter pylori antigen specific antibodies in psoriatic arthritis
Authors: E. Patrikiou, C. Liaskos, E. Zafiriou, G. Efthymiou, T. Scheper, W. Meyer, A. Roussaki-Schulze, L.I. Sakkas, D.P. Bogdanos
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The role of <i>Helicobacter pylori</i> (Hp) infection in the aetiopathogenesis of psoriatic arthritis (PsA) and psoriasis (Ps) is currently inconclusive, as studies reported increased, decreased or comparable to controls frequency of anti-Hp antibodies. <h3>Objectives</h3> To test antigen-specific Hp antibodies in a well-defined cohort of PsA patients and demographically matched Ps patients and healthy controls (HCs). <h3>Methods</h3> A total of 140 serum samples (48 PsA, 37 Ps and 55 HCs) were tested for anti-Hp antibodies by a western blot immunoassay using whole Hp extract as antigenic source. <h3>Results</h3> Overall, anti-Hp seropositivity was similar in PsA (19/48, 39.6%) and Ps (16/37 43.2%, p&gt;0.05) but significantly lower compared to HCs (33/55, 60%, PsA <i>vs</i> HC, p=0.039). Overall, IgG anti-CagA and VacA, the most diagnostically relevant anti-Hp antibodies, were present in 26/48 (54.2%) and 5/48 (10.4%%) PsA patients, respectively, compared to 15/37 (40.5%) (p=ns) and 1/37 (2.7%) (p=ns) Ps respectively, as well as in 39/55 (70.9%), (p=0.079) and 4/55/97.2%) (p=ns) HCs, respectively. Compared to HCs, patients with PsA had higher reactivity to p29 (UreA) (31/48, 64.6% <i>vs</i> 24/55, 43.5%, p=0.033) and to p54 (24/48, 50% vs 15/55, 27.2%, p=0.017) and tended to have higher positivity against p75 antigen (9/48, 18.9%<i> vs</i> 3/55, 5.4%, p=0.062). Reactivity to p50 (15/48, 31.3% vs 50.9, p=0.042) and p33 antigen (3/48, 6.3% vs 10/55, 18.2%, p=0.061) was lower in PsA than in HCs. No differences on anti-Hp antigen specific antibodies was found between PsA and Ps. <h3>Conclusions</h3> Although overall reactivity to Hp in PsA and Ps is lower than HCs, Hp infection cannot safely be considered a protecting microbial agent for these diseases, as reactivities to some Hp antigens are more frequently recognised to these diseases than in HCs. <h3>Disclosure of Interest</h3> E. Patrikiou: None declared, C. Liaskos: None declared, E. Zafiriou: None declared, G. Efthymiou: None declared, T. Scheper Employee of: EUROIMMUN, W. Meyer Employee of: EUROIMMUN, A. Roussaki-Schulze: None declared, L. Sakkas: None declared, D. Bogdanos: None declared
AB0830 Mri evaluation of the effect of ankylosing spondylitis treatment on hip jointsinvolvement
Authors: E. Agafonova, T. Dubinina, A. Dyomina, O. Rumyantseva, S. Erdes
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Coxitis is one of the leading causes of early disability in ankylosing spondylitis (AS) patients. There's no mild course of the disease as soon as hip joints (HJ) are involved, but epidemiological surveys in Russia show that only 7% of AS associated hip damage require total hip replacement. <h3>Objectives</h3> To evaluate case follow-up data in treated AS patients with hip involvement using hip MRI and radiography for dynamic assessment. <h3>Methods</h3> 30 AS patients (mean age of 27.7±17 y.) meeting modified 1984 N-Y criteria with MRI signs of HJ inflammation were followed up for 2 years. Patients' mean age at the onset of the disease was 22.3±18,3 years, 77% of the population were HLA-B27 positive. Median AS duration was 47 (12–144) months, and median BASDAI score was 5.9±3,1. The median duration of clinically manifest coxitis by the time of the study was 45 months. [25‰; 75‰], and pain intensity by numeric ranking scale (NRS) was 6 (2; 8). HJ MRI using T1 and STIR modes was performed in all participants in addition to clinical and radiological examinations. All patients were grouped into three arms based on therapeutic regimens: Group I was administered non-steroidal anti-inflammatory drugs (NSAIDs), Group II – genetically engineered <i>biological agents</i> (GEBA) +NSAIDs, and Group III was treated with a combination of NSAIDs+DMARD (methotrexate or sulfasalazine). In case of baseline regimen failure patients from Group III were switched to NSAIDs+DMARD+ GEBA combination at Mo 6 after initiation of treatment. <h3>Results</h3> <h3>Conclusions</h3> 1. Long-standing MRI symptoms of HJ synovitis should be viewed as the factor predisposing to radiographic progression of coxitis in AS patients. 2. NSAIDs therapy does not modify the radiographic progression of coxitis. 3.GEBA+NSAIDs in combination with DMARDs reduce the risk of further radiographic progression. 4. Future studies are warranted to better understand potential factors contributing to radiographic progression of coxitis. <h3>Disclosure of Interest</h3> None declared
Eltrombopag As Second Line Therapy in Adult Patients with Primary Immune Thrombocytopenia (ITP) in Attempt to Achieve Long-Term Remission. Preliminary Analysis of a Phase II, Multicenter, Prospective Study By Gimema Group (the ESTIT Study)
Authors: Elisa Lucchini, Francesca Palandri, Stefano Volpetti, Nicola Vianelli, Giuseppe Auteri, Elena Rossi, Andrea Patriarca, Giuseppe Carli, Wilma Barcellini, Patrizia Tosi, Ugo Consoli, Federica Valeri, Cristina Santoro, Francesca Paoloni, Paola Fazi, Elena Boggio, Umberto Dianzani, Ilaria Giardini, Monica Carpenedo, Renato Fanin, Francesco Zaja
Journal: Blood (2018)
IGHV Gene Replacement: A Potential Mechanism for Establishing Stereotypy in Certain Cases of Chronic Lymphocytic Leukemia
Authors: Sophia Yancopoulos, Wentian Li, Xiao J. Yan, Andreas Agathangelidis, Anastasia Hadzidimitriou, Frederic Davi, Richard Rosenquist, Paolo Ghia, Kostas Stamatopoulos, Nicholas Chiorazzi
Journal: Blood (2018)
FRI0464 Clinical manifestations of persistent antiphospholipid antibodies in systemic sclerosis patients
Authors: S. Myriam, V. Sobanski, A. Lemaire, J. Giovannelli, E. Hachulla, B. Lopez, M. Lambert, P.-Y. Hatron, S. Dubucquoi, D. Launay
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Antiphospholipid antibodies (aPL) can be detected in systemic sclerosis (SSc) patients. While their clinical signification is well known in the primary antiphospholipid syndrome (APS), their frequency and clinical association remain debated matter of issue. In a previous study, we reported the prevalence and their clinical association of a single aPL testing a French cohort of SSc patients. Yet, the persistence of aPL during follow-up of patients has never been assessed. <h3>Objectives</h3> This study aimed to assess i. the persistence of aPL at least 12 weeks after the first dosage and ii. the clinical associations. <h3>Methods</h3> At least 12 weeks apart after the first test, 213 SSc patients were consecutively tested for lupus anticoagulant (LA), anticardiolipin (aCL) and anti-ß2glycoproteine 1 (anti-ß2Gp1) antibodies. aCL and anti-β2GpI were measured using commercial ELISA assays (Orgentec, Trappes, France), positivity was defined as ≥10 UGPL/mL (aCL) or ≥10 UA/mL (anti-β2GpI). Clinical associations were studied using binomial logistic regressions. <h3>Results</h3> The mean time between two tests was 13.2±6.3 months. One or more type of aPL was persistent in 7 patients (3%). Patients with persistent aPL developed more frequently venous thrombosis (VT) [4/7 (57%) versus 23/205 (11%), p=0.006]. Arterial or/and venous thrombosis were more common in patients with persistent aPL than other patients [4/7 (57%) versus 33/205 (16%), p&lt;0.001]. Persistent aPL was also associated with miscarriages [4/6 (67%) versus 33/155 (21%), p=0.023]. <h3>Conclusions</h3> The prevalence of persistent aPL in our cohort was 3%. VT and miscarriages were associated with persistent aPL. <h3>References</h3> [1] Parodi A, Drosera M, Barbieri L, Rebora A. Antiphospholipid antibody system in systemic sclerosis. Rheumatology (Oxford)2001;40:111–12. [2] Sanna G, Bertolaccini ML, Mamali A, et al. Antiphospholipid anti- bodies in patients with scleroderma: prevalence and clinical signifi- cance. Ann Rheum Dis2005. [3] Marie I, et al. Anticardiolipin, ab2GPI antibodies and lupus-like anticoagulant in SSc. [4] Miryakis S, Lockshin MD, Atsumi T, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost2006;4:295. <h3>Disclosure of Interest</h3> None declared
Long term plan: funding systems are likely to hinder delivery, warns NAO
Authors: Ingrid Torjesen
Journal: BMJ (2019)

Current NHS funding mechanisms could undermine the delivery of the NHS long term plan for a sustainable NHS, a report by the National Audit Office has warned.1

The long term plan sets out how the NHS aims to meet the government’s financial tests in return for a £20.5bn funding boost by 2023-24. The tests are a return to financial balance, growth in productivity of at least 1.1% a year, a slowdown in demand for care, reduced variation in care, and better use of capital investment.2

Current funding flows in the NHS are …
Abstract 16580: A Novel Synthetic Omega-3 Epoxyeicosanoid Analogue Mediates Cardioprotection by Modulating Mitochondrial Function
Authors: Robert Fischer, Tim Wesser, Victor Samokhvalov, Anne Konkel, Janine Lossie, John R. Falck, John Seubert, Wolf-Hagen Schunck
Journal: Circulation (2017)

Introduction: OMT-28 is a first-in-class drug candidate developed for rhythm stabilization and cardioprotection that has just entered clinical phase-1 (EudraCT No.: 2016-003445-28). OMT-28 was desi...
Assessment of a Simulated Case-Based Measurement of Physician Diagnostic Performance
Authors: Souvik Chatterjee, Sanjay Desai, Reza Manesh, Junfeng Sun, Shantanu Nundy, Scott M. Wright
Journal: JAMA Network Open (2019)

Diagnostic acumen is a fundamental skill in the practice of medicine. Scalable, practical, and objective tools to assess diagnostic performance are lacking.To validate a new method of assessing diagnostic performance that uses automated techniques to assess physicians' diagnostic performance on brief, open-ended case simulations.Retrospective cohort study of 11 023 unique attempts to solve case simulations on an online software platform, The Human Diagnosis Project (Human Dx). A total of 1738 practicing physicians, residents (internal medicine, family medicine, and emergency medicine), and medical students throughout the United States voluntarily used Human Dx software between January 21, 2016, and January 15, 2017.Internal structure validity was assessed by 3 measures of diagnostic performance: accuracy, efficiency, and a combined score (Diagnostic Acumen Precision Performance [DAPP]). These were each analyzed by level of training. Association with other variables' validity evidence was evaluated by correlating diagnostic performance and affiliation with an institution ranked in the top 25 medical schools by US News and World Report.Data were analyzed for 239 attending physicians, 926 resident physicians, 347 intern physicians, and 226 medical students. Attending physicians had higher mean accuracy scores than medical students (difference, 8.1; 95% CI, 4.2-12.0; P < .001), as did residents (difference, 8.0; 95% CI, 4.8-11.2; P < .001) and interns (difference, 5.9; 95% CI, 2.3-9.6; P < .001). Attending physicians had higher mean efficiency compared with residents (difference, 4.8; 95% CI, 1.8-7.8; P < .001), interns (difference, 5.0; 95% CI, 1.5-8.4; P = .001), and medical students (difference, 5.4; 95% CI, 1.4-9.3; P = .003). Attending physicians also had significantly higher mean DAPP scores than residents (difference, 2.6; 95% CI, 0.0-5.2; P = .05), interns (difference, 3.6; 95% CI, 0.6-6.6; P = .01), and medical students (difference, 6.7; 95% CI, 3.3-10.2; P < .001). Attending physicians affiliated with a US News and World Report-ranked institution had higher mean DAPP scores compared with nonaffiliated attending physicians (80 [95% CI, 77-83] vs 72 [95% CI, 70-74], respectively; P < .001). Resident physicians affiliated with an institution ranked in the top 25 medical schools by US News and World Report also had higher mean DAPP scores compared with nonaffiliated peers (75 [95% CI, 73-77] vs 71 [95% CI, 69-72], respectively; P < .001).The data suggest that diagnostic performance is higher in those with more training and that DAPP scores may be a valid measure to appraise diagnostic performance. This diagnostic assessment tool allows individuals to receive immediate feedback on performance through an openly accessible online platform.