Methotrexate Effectively Controls Ocular Inflammation in Japanese Patients With Non-infectious Uveitis

This single-center retrospective study investigated the clinical characteristics and efficacy of methotrexate (MTX) for the treatment of non-infectious uveitis for more than 6 months at Hiroshima University, from February 2016 to May 2021. Outcome variables included changes in systemic immunosuppressive treatment and intraocular inflammation. Out of 448 patients with non-infectious uveitis, 35 patients (14 male patients and 21 female patients; 65 eyes) treated with MTX for more than 6 months were analyzed. There were 15 patients with anterior uveitis and 20 with posterior and panuveitis. The mean dose of systemic corticosteroids decreased from 12.1 mg/day at baseline to 1.3 mg/day at 6 months and 0.6 mg at 12 months after starting MTX, and approximately 90% of patients were corticosteroid-free at 12 months. The percentage of eyes with inactive uveitis at 6, 12, and 24 months was 49.2%, 59.6%, and 90.0%, respectively. Mean relapse rate score also significantly decreased from 2.88 at baseline to 0.85 at 12 months (p < 0.001). Inflammatory control was achieved with MTX doses of 8–16 mg/week, with a median dose of 12 mg/week. Adverse effects of MTX were observed in 34.3% of patients, and 11.4% required discontinuation; most commonly hepatotoxicity (58.3%), followed by fatigue (25.0%), and hair loss (16.7%). No significant differences were found between the survival curves of patients with anterior uveitis and posterior/panuveitis (Wilcoxon rank-sum test). The percentage of eyes without IOP-lowering eye drops was significantly higher in patients with posterior/panuveitis at 24 months (p = 0.001). Our study suggests that MTX is effective in controlling ocular inflammation for Japanese patients with non-infectious uveitis. Relatively high incidence of MTX-related adverse effects in the Japanese population indicates that careful monitoring and dose adjustments are crucial for the long-term use of this therapy.

369 POOR CORRELATION BETWEEN FDG-PET AND PATHOLOGIC RESULTS AFTER EXPERIMENTAL NEOADJUVANT IMMUNOCHEMOTHERAPY FOR GASTROESOPHAGEAL ADENOCARCINOMA: RESULTS OF A CLINICAL TRIAL

A lack of FDG-PET response to neoadjuvant chemotherapy for gastroesophageal adenocarcinoma is considered as indicative of a poor prognosis, whereas pathologic complete or near-complete response (pCR/near-pCR) predicts a more favorable outcome. In a single-arm phase II trial of perioperative immunochemotherapy, we sought to establish a correlation between the results of an FDG-PET performed after the neoadjuvant part of the treatment and the pathologic results obtained after surgery. Methods Inclusion criteria: locally advanced gastroesophageal adenocarcinoma (T3 and/or N+); adequate organ function; ECOG PS 0–1; no contraindication to immunotherapy; Staging: CT, FDG-PET, EUS, diagnostic laparoscopy. Eligible patients receive docetaxel/cisplatin/5-FU (mDCF) on day 1 and avelumab on day 4 of each 2-week cycle and are restaged after 4 cycles. FDG-PET response is defined as reduction of >35% of pre-treatment SUV. Surgery is performed if no disease progression. Four cycles of mDCF/avelumab are administered after surgery. Tumor regression is scored from 0 (no tumor cells) to 3 (no tumor regression). The primary endpoint is the pCR/near-PCR rate (score 0–1). Results As of February 24, 2020, 28 patients have been enrolled and 22 have been operated. Paired FDG-PET response and pathologic response data are available for 21 patients. We observed 16/21 FDG-PET responses and 6/21 pCR/near-pCR. Of the latter, 4 were associated with an FDG-PET response and 2 with no FDG-PET response. Ten patients with score 3 tumor regression had had FDG-PET response. No statistical correlation could be found between FDG-PET response and likelihood of pCR/near-pCR. Conclusion Given the discrepancy observed between FDG-PET and pathologic results, the need for a repeat FDG-PET for gastroesophageal adenocarcinoma after neoadjuvant immunochemotherapy and before surgery should be questioned. Analysis of the tumor microenvironment could possibly explain these results. Future studies will look into correlation between the results presented and survival.

An efficient AI-based method to play the Mahjong game with the knowledge and game-tree searching strategy

The Mahjong game has widely been acknowledged to be a difficult problem in the field of imperfect information games. Because of its unique characteristics of asymmetric, serialized and multi-player game information, conventional methods of dealing with perfect information games are difficult to be applied directly on the Mahjong game. Therefore, AI (artificial intelligence)-based studies to handle the Mahjong game become challenging. In this study, an efficient AI-based method to play the Mahjong game is proposed based on the knowledge and game-tree searching strategy. Technically, we simplify the Mahjong game framework from multi-player to single-player. Based on the above intuition, an improved search algorithm is proposed to explore the path of winning. Meanwhile, three node extension strategies are proposed based on heuristic information to improve the search efficiency. Then, an evaluation function is designed to calculate the optimal solution by combining the winning rate, score and risk value assessment. In addition, we combine knowledge and Monte Carlo simulation to construct an opponent model to predict hidden information and translate it into available relative probabilities. Finally, dozens of experiments are designed to prove the effectiveness of each algorithm module. It is also worthy to mention that, the first version of the proposed method, which is named as KF-TREE, has won the silver medal in the Mahjong tournament of 2019 Computer Olympiad.

Homogeneity Test of Many-to-One Risk Differences for Correlated Binary Data under Optimal Algorithms

In clinical studies, it is important to investigate the effectiveness of different therapeutic designs, especially, multiple treatment groups to one control group. The paper mainly studies homogeneity test of many-to-one risk differences from correlated binary data under optimal algorithms. Under Donner’s model, several algorithms are compared in order to obtain global and constrained MLEs in terms of accuracy and efficiency. Further, likelihood ratio, score, and Wald-type statistics are proposed to test whether many-to-one risk differences are equal based on optimal algorithms. Monte Carlo simulations show the performance of these algorithms through the total averaged estimation error, SD, MSE, and convergence rate. Score statistic is more robust and has satisfactory power. Two real examples are given to illustrate our proposed methods.

Functional and radiological comparison of transforaminal lumbar interbody fusion method with interbody fusion device versus stand-alone bone graft in lumbar canal stenosis or degenerative lumbar instability

<p><strong>Background: </strong>Spinal stability is the vertebral ability to maintain their relationship and limit their relative displacements during physiologic postures and loads.</p><p><strong>Methods:</strong> Hospital based prospective randomized comparative study design between 2 groups included patients of both sex attending SMS hospital Jaipur, from April 2018 to June 2019 or till sample size was achieved, with due permission from institutional ethical committee and review board and after taking written informed consent from patients.</p><p><strong>Results: </strong>Inter group comparison of VAS score showed same results in both groups which showed statistically non-significant results. VAS score showed significantly reduction in both group A and B till the study period. Inter group comparison of ODI score showed same results in both groups which showed statistically non-significant results. ODI score showed significantly reduction in both group A and B till the study period. Inter group comparison of fusion rate score showed same results in both groups which showed statistically non-significant results. Fusion rate score showed significantly increased in both group A and B till the study period and at the 12 month it was 100% fusion rate.</p><p><strong>Conclusions: </strong>In the current series, the TLIF procedure with local bone graft alone improved anterior vertebral translation, disc height, and lumbar lordosis. A proper surgical technique with adequate discectomy and facetectomy would contribute greatly to the improvement of the radiological parameters; however, this improvement was not maintained at the latest follow up.</p><p><strong> </strong></p>

Abstract 108: Work of Breathing Scale to Assess Need of Intubation in Covid-19 Pneumonia

COVID-19 pneumonia presents in most patients with significant hypoxemia but without substantial impairment of lung compliance that would increase the work of breathing (WOB) to levels requiring invasive mechanical ventilation. Thus, the ability to assess the WOB independent of the oxygen needs could help guide management and possibly avoid intubation. We previously developed and implemented in our ICU a WOB scale based on respiratory physiology ranging from 1 to 7 by assigning points to the respiratory rate level and the use of respiratory accessory muscles. We analyzed the use of our WOB scale in 10 patients admitted to our ICU with severe COVID-19 pneumonia. All patients had radiographic evidence of extensive lung disease with significant hypoxemia and multiple risk factors associated with poor outcome. Hypoxemia was successfully managed using high-flow nasal cannula. The WOB level was measured every 4 hours. The maximum WOB was 4.3 ± 0.9, contributed primarily by the respiratory rate with a score of 3.6 ± 0.5 but with infrequent use of respiratory accessory muscles. All 10 patients survived without need of intubation. For comparison, three other patients who needed intubation had a maximal work of breathing within the preceding 24 hours of 5.3 ± 1.2 with a respiratory rate score of 3.7 ± 0.6, as in non-intubated patients, but with more often use of respiratory accessory muscles. Our data suggest that patients with COVID-19 pneumonia can be supported for extended periods using HFNC despite tachypnea provided there is only infrequent use of respiratory accessory muscles, corresponding to a WOB scale ≤ 4, prompting closer assessment for possible intubation when WOB > 4. This approach would be especially advantageous under conditions of high disease intensity when avoidance of intubation is likely to result in a better outcome.

National Early Warning Score Parameters at the Emergency Department as In Hospital Cardiac Arrest Predictors

In Hospital Cardiac Arrest (IHCA) is fairly common occurrence, although it can be prevented. Physiological status monitoring at Emergency Departement (ED) is crucial for early detection of potential IHCA incidence. National Early Warning Score (NEWS) is a scoring system to assess deterioration of patient's condition, but it is not yet known which parameters that have predictive value for IHCA incidence. Examine NEWS parameters of the patients while at the ED that have predictive value of IHCA incidence. This study was conducted retrospectively on inpatient medical records. The NEWS parameters examined were respiration rate score, oxygen saturation score, body temperature score, systolic blood pressure score, pulse rate score and level of consciousness score. Logistic regression analysis was used to test the predictive ability of NEWS parameters. Total score NEWS proved to be correlated with IHCA incidence (p=0.000; r=0.434). Parameters that have predictive value are systolic blood pressure score (p=0.001; OR=14.730), respiration rate score (p=0.000; OR=14.483) and level of consciousness score (p=0.000; OR=6.920). The NEWS parameter when the patients will be transferred from ED to the wards that have predictive value for IHCA incidence are systolic blood pressure score, respiration rate score and level of consciousness score.

FRI0126 POOR ADHERENCE TO METHOTREXATE IS ASSOCIATED WITH PERSISTENT DISEASE ACTIVITY DURING FOLLOW-UP FOR RHEUMATOID ARTHRITIS

Objectives:Although methotrexate (MTX) is the cornerstone therapy in patients with rheumatoid arthritis (RA), adherence to MTX in these patients is typically suboptimal. Thus, we investigated the proportion of RA patients who were adherent to MTX and whether non-adherence to MTX affected the clinical outcome in these patients during follow-up.Methods:We enrolled 331 RA patients from a single tertiary center. Data were collected at the time of enrollment and then annually for 4 consecutive years. Adherence was defined by the proportion of days covered at 1 year. Patients were divided into two groups: patients who took more than 80% of MTX and those who did not. Univariate and multivariate analyses were performed to identify the association between drug compliance and clinical outcome.Results:Of the 331 RA patients, 8.7% had taken less than 80% of MTX during the follow-up period. Non-adherent patients had lower EuroQol-5D scores (P=0.013) and higher RAPID3 scores (P=0.004) at baseline than adherent patients. Leflunomide was more commonly prescribed to adherent patients than non-adherent patients (P=0.012). Non-adherent patients had a higher mean Disease Activity Score 28 (DAS28)-erythrocyte sedimentation rate score (P=0.001), higher mean DAS28-C-reactive protein (CRP) score (P=0.001), and higher mean rate of tender and swollen joints (P=0.003 and P=0.002, respectively) than adherent patients. In the multivariate analysis, poor MTX adherence was significantly associated with a higher mean DAS28-CRP score (odds ratio, 0.270; 95% confidence interval, 0.165–0.444; P<0.001).Conclusion:Adherence to MTX can affect disease activity during follow-up in Korean patients with RA. Our results provide a rationale for patient education to maintain good drug adherence in RA patients, to control disease activity.Disclosure of Interests:None declared