tbuckley/cabot-search huggingface dataset:
FRI0171 Which imaging outcomes for axspa are most sensitive to change? a 5-year analysis of the desir cohort
Authors: A. Sepriano, S. Ramiro, D. van der Heijde, M. Dougados, P. Claudepierre, A. Feydy, M. Reijnierse, D. Loeuille, R. Landewé
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Several imaging outcomes have become available to assess inflammation and structural damage over time in patients with axial spondyloarthris (axSpA). However, no formal comparison of their sensitivity to change has been made in the early phases of the disease. <h3>Objectives</h3> We aimed to compare the sensitivity to change of different MRI and radiographic scoring methods in patients with early axSpA. <h3>Methods</h3> Patients from the DESIR cohort fulfilling the ASAS axSpA criteria were included. Radiographs and MRI of the sacroiliac joints and spine were obtained at baseline, 1 year, 2 years and 5 years. Each film was scored by 2 or 3 readers in 3 'reading-waves' (wave 1: baseline; wave 2: baseline, 1 year, 2 years; wave 3: baseline, 2 years, 5 years). Outcomes measuring inflammation and structural damage both on MRI and radiographs in the spine and SIJ were assessed (table 1). The analysis of change captured over time was performed using generalised estimating equations (GEE) longitudinal models separately for each outcome, taking into account data from all readers and waves ('integrated analysis'). To allow comparisons across outcomes, these were standardised (difference between the individual score and the mean of all scores divided by the standard deviation, per reader, wave and time-point) before running the models. The higher the standardised coefficient the more change in inflammation/damage is captured. <h3>Results</h3> In total, 345 patients were included (mean (SD) symptom duration: 1.6 (0.9) years; 53% males; 89% HLA-B27 positive). Inflammation on MRI-SIJ (according to both the ASAS definition of sacroiliitis and the continuous SPARCC score) was more sensitive to change as compared to inflammation on the spine that remained essentially unchanged regardless of the outcome (table 1). Structural damage on the SIJ was found to increase over time, but with a higher standardised yearly rate of change on MRI-SIJ (range: 0.015–0.274) as compared to X-SIJ (range: 0.043–0.126). Notably,≥3 Fatty lesions on MRI-SIJ was the structural outcome in the SIJ with highest sensitive to change (0.274), while ≥3 erosions was the least sensitive (0.015). Spine structural damage slowly progressed over time but, in contrast to SIJ, radiographic outcomes (i.e. ≥1 syndesmophytes and mSASSS) were more sensitive to change than MRI structural outcomes. <h3>Conclusions</h3> Our data adds to the body of evidence showing that structural damage assessed in pelvic radiographs only has low sensitivity to change. MRI-SIJ is a promising alternative (especially fatty lesions) capturing more structural changes. In contrast, in detecting structural change in early axSpA radiographic outcomes outperform MRI outcomes. <h3>Disclosure of Interest</h3> None declared
FRI0438 Hospitalisation mortality and associated risk factors in patients with polymyositis and dermatomyositis: a retrospective case-control study
Authors: C. Wu, Q. Wang, L. HE, E. Yang, X. ZENG
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Polymyositis and dermatomyositis (PM/DM) are systemic autoimmune diseases with multiple organ involvements that manifest as muscular and cutaneous disorders, interstitial lung disease (ILD) and malignancies. However, information concerning the outcomes and associated factors for PM/DM patients who are hospitalised is limited. <h3>Objectives</h3> We retrospectively reviewed the medical records of 982 PM/DM patients admitted to our centre from 2008 to 2014 and performed a case-control analysis to identify possible related risk factors for death among PM/DM patients in China. <h3>Methods</h3> We retrospectively reviewed the medical charts of PM/DM patients admitted to a Chinese tertiary referral hospital (Peking Union Medical College Hospital, PUMCH) from 2008 to 2014. The deceased group included 63 patients who had "deceased discharge" status or were confirmed to have died within two weeks of hospital discharge. The demographic data, clinical manifestations, and direct causes of death were analysed retrospectively. Medical records for 126 age- and sex-matched PM/DM patients were selected as controls from 982 inpatients successively admitted to the same centre during the same period. In addition to the comparison of clinical manifestations between the two groups, binary logistic regression was conducted to explore the risk factors related to PM/DM mortality. <h3>Results</h3> Over the past 6 years at PUMCH, the in-hospital mortality rate of PM/DM patients was 4.58%. The male gender and the elder patients had a high risk of death (p=0.031 and p=0.001 respectively). The three most frequent causes of death for PM/DM patients were pulmonary infection (35%), ILD exacerbation (21%) or both conditions (25%). Pulmonary infection (p&lt;0.001, OR=5.63, 95% CI, 2.37–13.36), pneumomediastinum (p=0.041, OR=11.02, 95% CI, 1.10–110.54), Gottron's papules (p=0.010, OR=3.24, 95% CI, 1.32–7.97), and elevated erythrocyte sedimentation rate (ESR) (p=0.005, OR=9.9, 95% CI 2.0–49.0) were independent risk factors for in-hospital mortality of PM/DM patients. <h3>Conclusions</h3> PM/DM patients continue to display high in-hospital mortality. Pulmonary infection is the strongest predictor of poor prognosis in PM/DM patients, followed by pneumomediastinum, Gottron's papules, and elevated ESR. <h3>Reference</h3> [1] Murray SG, Schmajuk G, Trupin L, Lawson E, Cascino M, Barton J, et al. A population-based study of infection-related hospital mortality in patients with dermatomyositis/polymyositis. Arthritis care &amp; research2015;67:673–680. doi:10.1002/acr.22501 <h3>Acknowledgements</h3> This work was supported by the National Natural Science Foundations of China, Grant number: 81471615 and 81601430, URL: http://www.nsfc.gov.cn/. <h3>Disclosure of Interest</h3> None declared
AB1297 High prevalence of seronegative rheumatoid arthritisin a maya-yucateco indigenous population: a cohort community-based study
Authors: F. Morales-Arango, J.F. Moctezuma, A. Loyola-Sanchez, H. Garcia, E. Alvarez-Hernandez, C. García, J. Alvarez-Nemegyei, J. Vazquez-Mellado, H. Ayora-Manzano, G. Cruz-Martin, D. Flores-Aguilar, R. Pereira-Zaldivar, M. Zarate-Dominguez, M. Mendoza, I. Pelaez-Ballestas
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Eighty percent of people living with rheumatoid arthritis (RA) are seropositive. Recent studies show that seronegative RA is associated with a more aggressive clinical presentation; however, this association has not been studied in indigenous populations. <h3>Objectives</h3> To compare the clinical and radiographic characteristics, functioning and quality of life in a group of Maya-Yucateco indigenous patients with RA, based on their seropositivity Rheumatoid Factor (RF- IgM). <h3>Methods</h3> A community-based cohort was formed in 2014 with the aim of detecting and performing a community intervention in a Mayan Municipality in Mexico. Patients who fulfilled ACR/<sup>EULAR criteria 1987/2010</sup> for RA were included and rheumatologists evaluated them every 3 months. All evaluations were conducted in the community with the support of trained translators and included: 1. Clinical examinations. 2. Laboratories (i.e. RF, ESR, CRP). 3. Radiographic evaluations. 4. Functioning (HAQ-DI) and quality of life (EQ5D-3L) assessments. 5. Pharmacological treatment. 6. Non-pharmacological treatment: individual and group exercises. A quantitative comparative analysis was conducted by dividing the cohort in seropositive and seronegative and comparing all variables measured using a χ<sup>2</sup>; test, Student’s <i>t-</i>test or Mann-Whitney <i>U</i> test, as well as Kruskall-Wallis test for the non-parametric variables. <h3>Results</h3> Twenty eight of 430 participants were diagnosed with RA (1.8%, CI95%; 1.2 to 2.6), for an incidence 0.72% (CI95% 0.3 to 1.2) in 4 years. Seventy-eight% were women, the mean age was 53.9 years (standard deviation (SD)=13.2) and the level of education was on average 2 years (0–5.5). We observed high prevalence of family history of rheumatic disease (75%), exposure to woodstove (96.1%), and a Chikungunya virus infection (10.7%) and RF- (65.3%). The treatment given was methotrexate in 64.2% as monotherapy, and 21.4% in combination therapy. NSAIDs were prescribed in 98.2%. Prednisone was prescribed at low doses (&lt;7.5 mg/day) in 14.2%. The level of pain/discomfort assessed through EQ-5D3L dimension was significantly higher in the seropositive group in comparison with the seronegative group. No other differences were detected between these groups (see Table). RD rheumatic diseases; DAS-28 disease activity score; HAQ Health Assement Questionnaire. <h3>Conclusions</h3> The prevalence with negative RF is high in the community studied, however, no differences were observed in the variables studied, except in pain. <h3>Acknowledgements</h3> Funding: CONACYT-233777 <h3>Disclosure of Interest</h3> None declared
Opioid overdose detection using smartphones
Authors: Rajalakshmi Nandakumar, Shyamnath Gollakota, Jacob E. Sunshine
Journal: Science Translational Medicine (2019)

Early detection and rapid intervention can prevent death from opioid overdose. At high doses, opioids (particularly fentanyl) can cause rapid cessation of breathing (apnea), hypoxemic/hypercarbic respiratory failure, and death, the physiologic sequence by which people commonly succumb from unintentional opioid overdose. We present algorithms that run on smartphones and unobtrusively detect opioid overdose events and their precursors. Our proof-of- concept contactless system converts the phone into a short-range active sonar using frequency shifts to identify respiratory depression, apnea, and gross motor movements associated with acute opioid toxicity. We develop algorithms and perform testing in two environments: (i) an approved supervised injection facility (SIF), where people self-inject illicit opioids, and (ii) the operating room (OR), where we simulate rapid, opioid-induced overdose events using routine induction of general anesthesia. In the SIF (n = 209), our system identified postinjection, opioid-induced central apnea with 96% sensitivity and 98% specificity and identified respiratory depression with 87% sensitivity and 89% specificity. These two key events commonly precede fatal opioid overdose. In the OR, our algorithm identified 19 of 20 simulated overdose events. Given the reliable reversibility of acute opioid toxicity, smartphone-enabled overdose detection coupled with the ability to alert naloxone-equipped friends and family or emergency medical services (EMS) could hold potential as a low-barrier, harm reduction intervention.
SAT0510 Cutaneous manifestations in idiopathic inflamatory myopathies: factors associated with calcinosis
Authors: T. Cobo-Ibáñez, F.J. López-Longo, B. Joven, S. Muñoz-Fernández, P. Carreira, M. Á. Blázquez, I. Llorente, J.C. López Robledillo, R. Almodóvar, P. García-De la Peña, M.C. Barbadillo, A. Pérez, L. Lojo, M.J. García de Yébenes, L. Nuño
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Calcinosis is a cutaneous manifestation that produces disability and complications in patients with idiopathic inflammatory myopathies (IIM). Studies about associated factors are limited. <h3>Objectives</h3> To investigate cutaneous manifestations and factors associated with calcinosis in patients with IIM from the REMICAM registry. <h3>Methods</h3> A multicenter retrospective study (1980–2014) was performed. Patients were classified as primary dermatomyositis (DM), primary polymyositis (PM), cancer associated myositis (CAM), overlap myositis (OM), inclusion body myositis, immune-mediated necrotising myopathy (IMNM) and juvenile myositis (JuM). A description of the cutaneous manifestations in each subgroup of IIM was done. The associations between calcinosis and demographic data, clinical characteristics, antibodies and treatments were analysed independently for JuM and adult IIM. <h3>Results</h3> 479 patients were included, of whom 49 (10%) had calcinosis with the following distribution: 27 JuM (55%), 9 DM (18%), 9 OM (18%), 3 PM (6%) and 1 IMNM (2%). Non- characteristic cutaneous manifestations were more prevalent in DM, OM, CAM and IMNM. At multivariate analysis, disease duration (OR=2; p=0.016), immunoglobulin treatment (OR=5.68; p=0.036) and immunosuppressants (OR=8.94; p=0.01) were associated with calcinosis in JuM. In addition, dysphagia (OR=21.3; p=0.008), positivity for anti-PM-Scl (OR=34.1; p=0.01), baseline ESR (OR=1.05; p=0.04) and interstitial lung disease (OR=10.2; p=0.039) were associated with calcinosis in adult. <h3>Conclusions</h3> Our results suggest that factors associated with calcinosis might be different in adult and juvenile myositis, but in both cases, they are related to more severe disease. <h3>Disclosure of Interest</h3> None declared
Abstract 17092: Submassive Pulmonary Embolism is Associated With Short-term and Long-term Mortality: Landmark Analysis of the Long-Term Outcomes Study of Pulmonary Embolism (LOST-PE)
Authors: Osama Dasa, Zaid Ammari, Mohammed Ruzieh, Christopher J Cooper, Rajesh Gupta
Journal: Circulation (2017)

Introduction: Submassive pulmonary embolism (PE) is defined as acute PE with evidence of right ventricular strain and maintenance of normal blood pressure. The prognostic implication of acute subma...
The Real-World Frequency of 24-Hour Urine Protein Electrophoresis (UPEP), Serum Free Light Chain (SFLC), and Serum Protein Electrophoresis (SPEP) Testing in Patients with Multiple Myeloma (MM)
Authors: Rebekah B. Foster, Nicole G. Lipitz, Aracelis Z. Torres, Kenneth R. Carson
Journal: Blood (2018)
AB0422 Cost effectiveness analysis of modified dosing regimen of biological therapy in chronic inflammatory disorder: an observational study
Authors: B.D. Pandey, M. Goyal, M.M. Thabah, A.K. Vishwakarma
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Cost of biologics in rheumatology is a prime concern in India. Due to lack of reimbursement system, a majority of the patients need to pay from their pocket for the therapy. <h3>Objectives</h3> Our objective was to estimate the cost-effectiveness in patients with the chronic inflammatory disorder on biological therapy with modified dosing regimen in patients of a tertiary care clinic. <h3>Methods</h3> In this retrospective observational study, data were captured from patients' record in a tertiary care centre located in North India who received biological therapy in rheumatology care practice between 1 <sup>January 2013</sup> and 31 December 2017. Modification in the dosing pattern was carried out in the patients and cost of therapy were estimated. These patients, who carried out the therapy, were monitored for any safety outcomes for up to 72 weeks. <h3>Results</h3> During the study period, 342 patients received modified dosing of biologicals indicated for rheumatoid arthritis and spondyloarthropathy. The cost comparison of biologics is shown in table <b>1</b>. Among all, 44 (12.86%) patients got reimbursement/claims from central and state government agencies. There were 73 (21.34%) patients who were followed up to 72 weeks (minimum possible) of the period for safety assessment. These patients achieved remission or low disease activity and after six months, mean DAS28 (mean ±SD) was 2.26±0.83, BASDAI (mean ±SD) was 2.32±0.98 and DAPSA (mean ±SD) was 3.11±1.05. A total 11 (3.21%) cases of known adverse events including hematuria (1.05% patient with etanercept), pneumonia (4.34% patient with tocilizumab), sinusitis (3.63% patient with infliximab), mild fungal infection (1.81% patient with infliximab) and urinary tract infection (5.26% patient with adalimumab) were reported. One patient (1.05% patient with rituximab) diagnosed with tuberculosis and diabetes after 37 months of initiation of rituximab and one case of hospitalisation was seen due to community-acquired pneumonia in the patient receiving infliximab. Two cases of mortality were reported in patients receiving etanercept after 18 months (due to clinical parkinsonism with aspirational pneumonia) and adalimumab after one month (reason unknown). After modified dosing, the patients tend to remain longer on therapy with no new safety signal. <h3>Conclusions</h3> In developing countries, out of pocket biological cost can be brought down with a lower dose than suggested. In this study, our data show comparable safety and efficacy of biologics achieved till 72 weeks with modified dosing regimen. <h3>Disclosure of Interest</h3> None declared
AB0196 Endoplasmic reticulum stress in systemic sclerosis
Authors: S. O’reilly
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Systemic sclerosis is an autoimmune connective tissue disease in which their is inflammation and skin fibrosis. Currently there is no disease modifiying treatment due to the limited understanding of the pathogenesis of the disease. Endoplasmic recticulum (ER) stress, characterised by misfolded proteins, can be induced by a variety of stressors such as redox imbalanace and calcium depletion. This activation of ER stress by whatever trigger results in activation of an evolutionary conserved cell sensors and a resulting signalling cascade to help restore homeostasis. It is suggested in other fibrotic diseases that ER stress is prominent. <h3>Objectives</h3> The aim of this study is to determine the role of ER stress in Systemic Sclerosis. <h3>Methods</h3> Healthy dermal fibroblasts where cultured <i>in vitro</i> and stimulated with the ER stress inducer thaspigargin and in some experiments with small interfering RNA to X-Box binding protein-1 or scramble controls at the matched concentration. Cell were then lysed and subjected to western blotting of XBP-1, IRE-alpha, ATF-6, collagen-1 and alpha tubulin for a loading control. In some experiments the dermal fibroblasts were treated with ER stress and 4-phenylbutric acid to inhibit ER stress and makers measured. q-RT-PCR was performed for Fli-1 and 18S using specific primers and subjected to real time with SYBR green and normalised to 18S. <h3>Results</h3> ER stress mediated by thaspigargin results in activation of classical ER stress pathways. Inhibition of these pathways through small interfering RNA results in attenuation of collagen expression in dermal fibroblasts. This was also the case with dermal fibroblasts treated with the chemical inhibitor 4-phenylbutric acid. The epigenetic modifier Fli-1 is reduced after ER stress. This is known to act as a brake on collagen regulation. <h3>Conclusions</h3> ER stress induced collagen accumulation and could be blocked by chemical and genetic reduction of XBP-1. Mechanistically this could be due to reduced Fli-1 therby releasing the brake on collagen1 expression. Modulation of ER stress via chemical inhibitors could be a promising new treatment in SS. <h3>Disclosure of Interest</h3> None declared
Evolving Board Certification — Glimpses of Success
Authors: Alex Macario, Ann E. Harman, Tamar Hosansky, Mary E. Post, Huaping Sun, Graham T. McMahon
Journal: New England Journal of Medicine (2019)

Educators and certifying boards are working to integrate physician education and assessment. In one program, the American Board of Anesthesiology and the Accreditation Council for Continuing Medical Education have linked assessment with CME opportunities.
A Phase 1 Study with Point-of-Care Manufacturing of Dual Targeted, Tandem Anti-CD19, Anti-CD20 Chimeric Antigen Receptor Modified T (CAR-T) Cells for Relapsed, Refractory, Non-Hodgkin Lymphoma
Authors: Nirav N Shah, Fenlu Zhu, Carolyn Taylor, Dina Schneider, Winfried Krueger, Andrew Worden, Sharon Yim, Timothy S. Fenske, Mehdi Hamadani, Bryon Johnson, Boro Dropulic, Rimas Orentas, Parameswaran Hari
Journal: Blood (2018)
FRI0069 Difference of clinical implication regarding the numbers of autoantibodies at presentation in korean patients with early rheumatoid arthritis
Authors: J.Y. Pyo, C.-H. Mun, S.M. Jung, S.W. Lee, J. Song, S.K. Lee, Y.B. Park
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Epitope spreading occurs prior to the clinical diagnosis of rheumatoid arthritis (RA), the number of peptide recognised and its titer increases remarkably as becoming close to the clinical diagnosis. However, the effect of multiple autoantibodies on the clinical outcome is not well known. <h3>Objectives</h3> This study is to investigate the association between the number of autoantibodies at presentation and the clinical aspects in Korean patients with early RA. <h3>Methods</h3> The number of baseline autoantibody (rheumatoid factor, anticitrullinated peptide antibodies (ACPA), and anti-carbamylated protein antibodies (anti-CarP)) was analysed in the Korean Intensive Management of Early Rheumatoid Arthritis (KIMERA) cohort. All patients were disease-modifying antirheumatic drug (DMARD)-naïve RA patients with symptom duration less than 1 year. They were intensively treated by adjusting medications every 4 weeks, and treated to target as DAS28 of &lt;2.6. Patients were classified regarding the number of autoantibodies and clinical characteristics were compared between the groups. <h3>Results</h3> A total of 128 patients were included, seronegative patients showed higher baseline physician global VAS (7.3 vs 4.7 vs 4.6 vs 4.4, p=0.005) and DAS28-ESR (7.1 vs 4.5 vs 5.0 vs 4.7, p=0.003) than patients with 1, 2, and 3 autoantibodies. Also seronegative patients showed a trend to have higher baseline HAQ score and pain VAS. After intensive treatment, there were no differences in remission rate and DAS28-ESR at 12, 24, and 36 months. <h3>Conclusions</h3> Seronegative patients showed higher levels of baseline inflammation than seropositive patients. However, they had favourable treatment response with rapid improvement which resulted in excellent clinical outcome. <h3>Disclosure of Interest</h3> None declared
AllergoOncology: Microbiota in allergy and cancer—A European Academy for Allergy and Clinical Immunology position paper
Authors: Eva Untersmayr, Heather J. Bax, Christoph Bergmann, Rodolfo Bianchini, Wendy Cozen, Hannah J. Gould, Karin Hartmann, Debra H. Josephs, Francesca Levi‐Schaffer, Manuel L. Penichet, Liam O'Mahony, Aurelie Poli, Frank A. Redegeld, Franziska Roth‐Walter, Michelle C. Turner, Luca Vangelista, Sophia N. Karagiannis, Erika Jensen‐Jarolim
Journal: Allergy (2019)

The microbiota can play important roles in the development of human immunity and the establishment of immune homeostasis. Lifestyle factors including diet, hygiene, and exposure to viruses or bacteria, and medical interventions with antibiotics or anti-ulcer medications, regulate phylogenetic variability and the quality of cross talk between innate and adaptive immune cells via mucosal and skin epithelia. More recently, microbiota and their composition have been linked to protective effects for health. Imbalance, however, has been linked to immune-related diseases such as allergy and cancer, characterized by impaired, or exaggerated immune tolerance, respectively. In this AllergoOncology position paper, we focus on the increasing evidence defining the microbiota composition as a key determinant of immunity and immune tolerance, linked to the risk for the development of allergic and malignant diseases. We discuss novel insights into the role of microbiota in disease and patient responses to treatments in cancer and in allergy. These may highlight opportunities to improve patient outcomes with medical interventions supported through a restored microbiome.