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A vision-based autonomous driving system can usually fuse information about object detection and steering angle prediction for safe self-driving through real-time recognition of the environment around the car. If an autonomous driving system cannot respond fast to driving control appropriately, it will cause high-risk problems with regard to severe car accidents from self-driving. Therefore, this study introduced GhostConv to the YOLOv4-tiny model for rapid object detection, denoted LW-YOLOv4-tiny, and the ResNet18 model for rapid steering angle prediction LW-ResNet18. As per the results, LW-YOLOv4-tiny can achieve the highest execution speed by frames per second, 56.1, and LW-ResNet18 can obtain the lowest prediction loss by mean-square error, 0.0683. Compared with other integrations, the proposed approach can achieve the best performance indicator, 2.4658, showing the fastest response to driving control in self-driving.

Adult-onset Still’s disease (AOSD) is a systemic inflammatory disorder with clinical heterogeneity. Although tocilizumab (TCZ), an interleukin (IL)-6 receptor inhibitor, is an effective treatment for AOSD, the evidence regarding its efficacy on systemic or articular subtypes is conflicting. Furthermore, the predictors of therapeutic response are still elusive and worthy of exploration. This two-center retrospective study analyzed the effectiveness and safety profile of TCZ treatment in 28 patients with refractory AOSD. The 28-joint disease activity score (DAS28) and systemic activity score were assessed before and during TCZ treatment period at weeks 12, 24, 36, and 48. Plasma levels of proinflammatory cytokines at baseline were determined using ELISA method. Among the systemic subtype patients, 10 (58.8%), 13 (76.5%), 14 (82.4%), and 15 (88.2%) patients achieved complete remission at week 12, 24, 36, and 48, respectively, in comparison to 2 (22.2%), 5 (55.6%), 6 (66.7%), and 7 (77.8%) who achieved disease remission (DAS28

Background To investigate the impact of an electronic medical record management system (EMRMS) on disease activity and the frequency of outpatient visits among patients with ankylosing spondylitis (AS). Methods We identified 652 patients with AS who were followed up for at least 1 year before and after the first Ankylosing Spondylitis Disease Activity Score (ASDAS) assessment and compared the number of outpatient visits and average visit time within 1 year before and after the initial ASDAS assessment. Finally, we analyzed 201 patients with AS who had complete data and received ≥ 3 continuous ASDAS assessments at an interval of 3 months, and we compared the results of the second and third ASDAS assessments with those of the first. Results The number of annual outpatient visits increased after ASDAS assessment (5.8 ± 3.4 vs. 5.4 ± 3.4, p

BackgroundTo investigate the impact of an electronic medical record management system (EMRMS) on disease activity and the frequency of outpatient visits among patients with ankylosing spondylitis (AS).MethodsWe identified 652 patients with AS who were followed up for at least 1 year before and after the first Ankylosing Spondylitis Disease Activity Score (ASDAS) assessment and compared the number of outpatient visits and average visit time within 1 year before and after the initial ASDAS assessment. Finally, we analyzed 201 patients with AS who had complete data and received ≥3 continuous ASDAS assessments at an interval of 3 months, and we compared the results of the second and third ASDAS assessments with those of the first.ResultsThe number of annual outpatient visits increased after ASDAS assessment (5.8 ± 3.4 vs. 5.4 ± 3.4, p < 0.001), particularly among those with a high initial disease activity. The average visit time was reduced within 1 year after ASDAS assessment (8.7 ± 3.8 vs. 9.2 ± 4.4 min, p = 0.030), especially among patients whose ASDAS-C-reactive protein (CRP) was ConclusionThe use of an EMRMS increased the frequency of ambulatory visits among AS patients with high disease activity and reduced the visit time among those with an inactive disease. Continual ASDAS assessments may help control the disease activity of patients with AS.Trial registrationInstitutional Review Board (IRB) of Taichung Veterans General Hospital (TCVGH-IRB No.: CE20145B)

Adult-onset Still’s disease (AOSD) is a rare and inflammatory disorder characterized by spiking fever, rash, arthritis, and multisystemic involvement. HLA has been shown to be associated with AOSD; however, it could not explain the innate immunity and autoinflammatory characteristics of AOSD. To assess the genetic susceptibility of AOSD, we conducted a genome-wide association study (GWAS) on a cohort of 70 AOSD cases and 688 controls following a replication study of 36 cases and 200 controls and meta-analysis. The plasma concentrations of associated gene product were determined. The GWAS, replication, and combined sample analysis confirmed that SNP rs11102024 on 5′-upstream of CSF1 encoding macrophage colony-stimulating factor (M-CSF) was associated with AOSD (P=1.20×10-8, OR (95% CI): 3.28 (2.25~4.79)). Plasma levels of M-CSF increased in AOSD patients (n=82, median: 9.31 pg/mL), particularly in the cases with activity score≥6 (n=42, 10.94 pg/mL), compared to the healthy donors (n=68, 5.31 pg/mL) (P<0.0001). Patients carrying rs11102024TT genotype had higher M-CSF levels (median: 20.28 pg/mL) than those with AA genotype (6.82 pg/mL) (P<0.0001) or AT genotype (11.61 pg/mL) (P=0.027). Patients with systemic pattern outcome were associated with elevated M-CSF and frequently observed in TT carriers. Our data suggest that genetic variants near CSF1 are associated with AOSD and the rs11102024 T allele links to higher M-CSF levels and systemic outcome. These results provide a promising initiative for the early intervention and therapeutic target of AOSD. Further investigation is needed to have better understandings and the clinical implementation of genetic variants nearby CSF1 in AOSD.

Background. Anti-melanoma differentiation-associated gene 5 (MDA-5) antibody is associated with respiratory failure and death in patients with idiopathic inflammatory myositis (IIM) and interstitial lung disease (ILD). This study aimed to investigate clinical parameters associated with mortality in anti-MDA-5 antibody-positive patients. Methods. We retrospectively reviewed the clinical and laboratory data, and pulmonary function test results in 55 anti-MDA-5 antibody-positive patients. A comparison was made between the survivors and non-survivors at the 12-month follow-up. Results. A total of 13 patients (23.6%) died within 12 months. Non-survivors had higher GAP scores (gender, age, and physiology score for idiopathic pulmonary fibrosis) (1 vs. 6, p &lt, 0.01) and CA-153 (16.4 vs. 72.9, p &lt, 0.01). In addition, rapid progressive ILD, fever, peak ferritin, leukocyte count, lactate dehydrogenase, CT score, intravenous immunoglobulin, mycophenolic acid, CMV infections, pneumocystis pneumonia, and pneumothorax were significantly associated with increased risks of 1-year mortality, while forced vital capacity, forced expiratory volume in one second, and diffusion capacity for carbon monoxide were correlated with decreased risk of 1-year mortality. Conclusions. Our study results suggest that GAP scores and CA-153 could be prognostic factors for 1-year mortality in anti-MDA-5 antibody-positive patients. A prompt pulmonary function test and CA-153 are essential for these patients to guide further management.

Background: We aimed to investigate the change of hepatitis B virus (HBV) viral loads and HBV reactivation (HBVr) in rheumatoid arthritis (RA) patients after tapering the dose of biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Methods: This two-center analysis retrospectively investigated the virological and biochemical evidence of HBVr in RA patients who underwent b/tsDMARD dose reduction. Serum levels of viral loads were determined using real-time PCR. Serum levels of alanine transaminase (ALT) were determined using spectrophotometry. Results: Among a total of 40 HBsAg+ RA patients who tapered b/tsDMARDs, 14 (35%) used tocilizumab; 12 (30%) used tumor necrosis factor (TNF)-α inhibitors; and the rest used either abatacept or tofacitinib. We found that patients who had detectable HBV DNA before tapering achieved a one-log reduction in HBV DNA levels, in contrast to the findings in the other 12 patients who did not taper b/tsDMARDs (no change in HBV DNA levels with time). The incidence of HBVr (increased viral loads with hepatitis) was 4.62 (95%CI: 2.08, 10.28) and 2.26 (95%CI: 0.56, 9.02) events per 100 person-years before and after b/tsDMARD tapering, respectively. Conclusions: The HBV viral load decreased after the tapering of b/tsDMARDs in RA patients with detectable HBV DNA. Dose reduction in b/tsDMARDs might be beneficial.

Background Mycophenolate mofetil (MMF) is extensively used for induction and maintenance therapy in patients with lupus nephritis (LN). Enteric-coated mycophenolate sodium (EC-MPS) was developed to reduce the adverse gastrointestinal effects of MMF. However, the therapeutic efficacy of MMF and EC-MPS in LN remains unclear. This study aimed to examine the treatment effects of EC-MPS in LN patients with prior MMF exposure. Methods In this medical records review study, we included 54 LN patients, of whom 34 converted from MMF to EC-MPS at equimolar doses in 2016-2018 (nonmedical switching group) and 20 received continuous MMF treatment. Patients achieving complete remission or partial remission before the conversion were categorized as responders, whereas those who had never achieved complete remission or partial remission were categorized as nonresponders. Results Baseline proteinuria was higher in the nonmedical switching group. Although elevation in proteinuria was observed after nonmedical switching, the serum creatinine concentration and estimated glomerular filtration rate both improved. Responders in the nonmedical switching group had lower proteinuria and higher complement 3 levels. In the subgroup analysis, albeit the modest increase in daily urine protein, anti-double-stranded DNA antibody levels, estimated glomerular filtration rate, and complements 3 and 4 seemed comparable after conversion. Conclusion Switching to EC-MPS demonstrated a similar short-term renal response to continuous MMF treatment in LN patients. Prospective randomized trials are required to verify our findings.

Lupus nephritis (LN) is the leading cause of mortality in lupus patients. This study aimed to investigate the treatment outcome and renal histological risk factors of LN in a tertiary referral center. Between 2006 and 2017, a retrospective observational study enrolled 148 biopsy-proven LN patients. After propensity score matching, 75 cases were included for further analysis. The classification and scoring of LN were assessed according to the International Society of Nephrology/Renal Pathology Society. Treatment response was evaluated by daily urine protein and urinalysis at two years after commencing induction treatment and the development of end-stage renal disease (ESRD). In total, 50.7% patients achieved complete remission (CR) or partial remission (PR), while 49.3% patients were categorized as nonresponders. Therapeutic responses in terms of CR/PR rates were associated with Systemic Lupus Erythematosus Disease Activity Index scores (odds ratio (OR): 1.34, 95% confidence interval (CI): 1.12–1.60, p = 0.001). Moreover, higher baseline creatinine levels (hazard ratio (HR): 2.10, 95% CI: 1.29–3.40, p = 0.003), higher renal activity index (HR: 1.30, 95% CI: 1.07–1.58, p = 0.008) and chronicity index (HR: 1.40, 95% CI: 1.06–1.85, p = 0.017) predicted ESRD. Among pathological scores, cellular crescents (HR: 4.42, 95% CI: 1.01–19.38, p = 0.049) and fibrous crescents (HR: 5.93, 95% CI: 1.41–24.92, p = 0.015) were independent risk factors for ESRD. In conclusion, higher lupus activity was a good prognostic marker for renal remission. Renal histology was predictive of ESRD. Large-scale prospective studies are required to verify the efficacy of mycophenolate in combination with azathioprine or cyclosporine in LN patients.

Objective: To evaluate the long-term safety and effectiveness of tocilizumab (TCZ) for the treatment of rheumatoid arthritis (RA) in a real-world clinical setting in Taiwan. Method: All refractory RA patients who initiated intravenous TCZ between August 2012 and March 2015 were enrolled. Data on patient characteristics, drug safety and effectiveness were collected. Results: A total of 114 RA patients were recruited. Despite the majority of them (93%) had previous biologic failure, 43.75% of the patients were able to reach ACR50 after one year. Serious adverse events commonly found were bacterial pneumonia (4.24/100 patient-years) followed by cellulitis (2.12/100 patient-years). Twenty-three patients had old or latent TB infections, 11 patients had chronic hepatitis B. During the 3 years follow-up, none of them had reactivation of TB, or hepatitis B with concomitant use of isoniazid prophylaxis or pre-emptive antiviral treatment. Conclusion: In this 3-year real-world study on RA patients of Taiwan, we found a good long-term effectiveness and similar safety profiles for the TCZ treatment. With prophylactic strategy for latent TB and pre-emptive antiviral treatment for HBV carriers, the risk of reactivation of latent TB and HBV may be reassured. Keywords: Hepatitis B, Rheumatoid arthritis, Safety and effectiveness, Tocilizumab, Tuberculosis

Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder with clinical heterogeneity. Although tocilizumab (TCZ), an interleukin (IL)-6 receptor inhibitor, is an effective treatment for AOSD, the evidence regarding its efficacy on systemic or articular subtypes is conflicting. Furthermore, the predictors of therapeutic response are still elusive and worthy of exploration.This two-center retrospective study analyzed the effectiveness and safety profile of TCZ treatment in 28 patients with refractory AOSD. The 28-joint disease activity score (DAS28) and systemic activity score were assessed before and during TCZ treatment period at weeks 12, 24, 36, and 48. Plasma levels of proinflammatory cytokines at baseline were determined using ELISA method.Among the systemic subtype patients, 10 (58.8%), 13 (76.5%), 14 (82.4%), and 15 (88.2%) patients achieved complete remission at week 12, 24, 36, and 48, respectively, in comparison to 2 (22.2%), 5 (55.6%), 6 (66.7%), and 7 (77.8%) who achieved disease remission (DAS28 2.6) at weeks 12, 24, 36, and 48, respectively, among articular subtype patients. The systemic activity scores and inflammatory parameters were significantly decreased after 12-week TCZ therapy, and TCZ could significantly reduce corticosteroid dose in AOSD patients. Multivariate analysis reveals that baseline IL-18 level is a significant predictor of poor therapeutic response at week 24 (odds ratio 7.86, p 0.05).AOSD patients refractory to high-dose corticosteroids and methotrexate may respond well to TCZ treatment with a steroid-sparing effect and an acceptable safety. A high baseline IL-18 level may be a predictor of poor therapeutic response. Key Points • Tocilizumab may be effective and well-tolerated in refractory AOSD patients regardless of disease subtypes. • High plasma levels of IL-18 may predict poor response to tocilizumab in AOSD patients.

The implications of boosting Omalizumab treatment (OT) in patients with severe allergic asthma (SAA) remain unclear. The study aimed to explore and compare the 12-month effectiveness between continuous, at least 10-month OT (continuation group) and four-month boost of Omalizumab (boost group) in adult patients with SAA. In this retrospective cohort study, clinical data were collected for further analysis. Of all participants (n = 124), a significant reduction in annual exacerbations (baseline = 0.8 ± 1.5, follow-up = 0.5 ± 1.0, p = 0.047 *) and improvement in small airway ventilation as evaluated by forced expiratory flow at 25–75% (baseline = 55.1 ± 11.1%, follow-up = 59.4 ± 8.4%, p &lt, 0.001 *) were found in the continuation group (n = 110). By contrast, the boost group (n = 14) had significantly increased annual exacerbations (baseline = 0.7 ± 1.4, follow-up = 2.9 ± 3.6, p = 0.031 *) and impaired small airway function (baseline = 55.3 ± 12.9, follow-up = 52.1 ± 12.5, p = 0.026 *). Furthermore, the continuation group rather than the boost group had significant decreases in the frequency of oral corticosteroid (OCS) use as controllers (baseline = 32.7%, follow-up = 20.0%, p = 0.047 *, baseline = 50.0%, follow-up = 21.4%, p = 0.237, respectively) and OCS maintenance dose (mg/month) (baseline = 85.9 ± 180.8, follow-up = 45.8 ± 106.6, p = 0.020 *, baseline = 171.4 ± 221.5, follow-up = 50.0 ± 104.3, p = 0.064, respectively), and increases in asthma control test scores (baseline = 16.0 ± 3.0, follow-up = 19.8 ± 4.4, p &lt, 0.001 *, baseline = 14.6 ± 3.8, follow-up = 19.7 ± 4.7, p = 0.050, respectively). Continuous OT would be beneficial for adult patients with SAA, while boost of Omalizumab would worsen their long-term outcomes.

The virtual try-on task is so attractive that it has drawn considerable attention in the field of computer vision. However, presenting the three-dimensional (3D) physical characteristic (e.g., pleat and shadow) based on a 2D image is very challenging. Although there have been several previous studies on 2D-based virtual try-on work, most 1) required user-specified target poses that are not user-friendly and may not be the best for the target clothing, and 2) failed to address some problematic cases, including facial details, clothing wrinkles and body occlusions. To address these two challenges, in this paper, we propose an innovative template-free try-on image synthesis (TF-TIS) network. The TF-TIS first synthesizes the target pose according to the user-specified in-shop clothing. Afterward, given an in-shop clothing image, a user image, and a synthesized pose, we propose a novel model for synthesizing a human try-on image with the target clothing in the best fitting pose. The qualitative and quantitative experiments both indicate that the proposed TF-TIS outperforms the state-of-the-art methods, especially for difficult cases., Accepted by IEEE TNNLS (2021). 14 pages including 2 pages of reference

The pathogenic role of autophagic immune regulation in adult-onset Still's disease (AOSD) is unclear. We investigated the relative levels of autophagy in AOSD patients and healthy controls, its association with disease activity or course, and the change in autophagy after 6 months of therapy. Autophagosome levels were determined from the mean fluorescence intensity of autophagosomotropic dye incorporated into circulating immune cells. The fluorescent signal from lymphocytes, monocytes, and granulocytes from AOSD patients was greater than from controls. Levels of p62 fluorescence measured using flow cytometry in lymphocytes and granulocytes from AOSD patients was greater than in the corresponding cells from healthy controls. Expression of Atg5 and LC3-II mRNA and protein levels of p62 and LC3-II were elevated in AOSD patients. Moreover, AOSD activity scores correlated positively with autophagosome levels in monocytes and granulocytes, p62 levels in circulating immune cells, and levels of Beclin-1, Atg5, and LC3-II mRNA. Autophagosome levels and Atg mRNA expression decreased with disease remission in AOSD patients. Elevated autophagosome formation and p62 levels suggest impaired autophagic flux in AOSD.

Adult-onset Still’s disease (AOSD) is a multi-systemic inflammatory disorder of unknown etiology. To date, no single diagnostic test is available for AOSD. Herein, we investigated the pathogenic role of microRNAs in AOSD. MicroRNA profiles in plasma from AOSD patients and healthy controls were analyzed by microarray analysis, followed by quantitative reverse transcription PCR validation. The biological functions of microRNAs were evaluated using in vitro cell-based assay. Among the differentially expressed microRNAs, microRNA-134 (miR-134) expression was positively correlated with AOSD activity scores and significantly decreased after effective treatment. An increased miR-134 level is significantly associated with the activation of Toll-like receptor 3 (TLR3). The reporter assay identified IL-18 binding protein (IL-18BP) as the target of miR-134. A negative correlation between miR-134 expression and IL-18BP mRNA levels were detected in peripheral blood cells following TLR3 ligand treatment. Lower plasma IL-18BP levels and higher IL-18 levels were also observed in active AOSD patients who had higher miR-134 expression than inactive patients. Upregulation of circulating miR-134 was associated with elevated IL-18 levels by targeting IL-18BP in AOSD patients and was positively correlated with disease activity, suggesting its involvement in AOSD pathogenesis. MiR-134 may be a novel activity indicator or potential prognostic biomarker in AOSD.

Objective.The dysregulation of the NLRP3 (NLR containing a pyrin domain) inflammasome is involved in autoinflammatory diseases. Adult-onset Still disease (AOSD) is regarded as an autoinflammatory disease. However, the pathogenic involvement of NLRP3 inflammasome in AOSD remains unclear and NLRP3 activators in AOSD are currently unknown.Methods.The mRNA expression of NLRP3 inflammasome signaling in peripheral blood mononuclear cells (PBMC) from 34 patients with AOSD and 14 healthy subjects was determined using quantitative-PCR (qPCR). The changes in mRNA and protein levels of NLRP3 inflammasome signaling in PBMC treated with the potential activator [imiquimod (IMQ)] or inhibitor of NLRP3 were evaluated using qPCR and immunoblotting, respectively. The supernatant levels of interleukin (IL)-1β and IL-18 were determined by ELISA.Results.Significantly higher mRNA levels of NLRP3 inflammasome signaling were observed in patients with AOSD compared with healthy controls. NLRP3 expressions were positively correlated with disease activity in patients with AOSD. IMQ (an effective Toll-like receptor 7 ligand; 10 µg/ml and 25 µg/ml) stimulation of PBMC from patients with AOSD induced dose-dependent increases of mRNA expression of NLRP3 (mean ± standard error of the mean, 2.06 ± 0.46 and 6.05 ± 1.84, respectively), caspase-1 (1.81 ± 0.23 and 4.25 ± 0.48), IL-1β (5.68 ± 1.51 and 12.13 ± 3.71), and IL-18 (2.32 ± 0.37 and 4.81 ± 0.51) compared with controls (all p < 0.005). IMQ stimulation of PBMC from patients similarly induced greater increases in protein expressions of NLRP3 inflammasome compared with controls. The protein expressions of NLRP3, IL-1β, and IL-18 on PBMC significantly decreased after treatment with NLRP3 inhibitor in patients with AOSD.Conclusion.Increased expression of NLRP3 inflammasome and its positive correlation with disease activity in AOSD suggest its involvement in disease pathogenesis. IMQ upregulated expressions of NLRP3 inflammasome signaling, and IMQ might be an activator of NLRP3 inflammasome in AOSD.

The image-based virtual try-on system has attracted a lot of research attention. The virtual try-on task is challenging since synthesizing try-on images involves the estimation of 3D transformation from 2D images, which is an ill-posed problem. Therefore, most of the previous virtual try-on systems cannot solve difficult cases, e.g., body occlusions, wrinkles of clothes, and details of the hair. Moreover, the existing systems require the users to upload the image for the target pose, which is not user-friendly. In this paper, we aim to resolve the above challenges by proposing a novel FashionOn network to synthesize user images fitting different clothes in arbitrary poses to provide comprehensive information about how suitable the clothes are. Specifically, given a user image, an in-shop clothing image, and a target pose (can be arbitrarily manipulated by joint points), FashionOn learns to synthesize the try-on images by three important stages: pose-guided parsing translation, segmentation region coloring, and salient region refinement. Extensive experiments demonstrate that FashionOn maintains the details of clothing information (e.g., logo, pleat, lace), as well as resolves the body occlusion problem, and thus achieves the state-of-the-art virtual try-on performance both qualitatively and quantitatively.

The image-based virtual try-on system has raised research attention recently, but it still requires to upload an image of a user with the target pose. We present a novel learning model, Fit-Me network, to seamlessly fit in-shop clothing into a person image and simultaneously transform the pose of the person image to another given one. The proposed Fit-Me network helps users not only save the time used to change clothes physically but also provide comprehensive information about how suitable the clothes are. By facilitating the arbitrary pose transformation, we can generate consecutive poses to help users get more information for deciding whether to buy the clothes or not from different aspects.

Background: The Assessment of Spondyloarthritis international Society Health Index (ASAS HI) has been develop and validated to assess health and function in patients with spondyloarthritis. However, whether ASAS HI differs between men and women is unknown. The aim of this study was to compare ASAS HI between men ans women in patients with ankylosing spondylitis (AS). Objectives: The aim of this study was to compare ASAS HI between men ans women in patients with ankylosing spondylitis (AS). Methods: Since November 2016, we measured and recorded data of demography, comorbidity, family history, medication use, the Ankylosing Spondylitis Disease Activity Score (ASDAS), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and the ASAS HI for AS patients in clinical practice using an electronic patient reported data system linked to an electronic medical record system in Taichung Veterans General hospital (TCVGH). We retrieved the last recorded data of AS patients in TCVGH during 2017/11–2018/10. We assessed the association between gender and the ASAS HI using a multivariable linear regression model. Variables from the univariable linear regression analysis with p Results: A total of 307 AS patients [62 (20.2%) females, mean age 46.4 years (S.D. 13.3), mean symptom duration 20.6 years (S.D. 12.1)] were included. Female patients had an older age at onset (29.2 ± 12.6 vs 24.9 ± 9.6 years, p = 0.015), a shorter symptom duration (15.7 ± 11.6 vs 21.8 ± 12.0 years, p Conclusion: This single center, cross-sectional study revealed that male gender was significantly associated with lower ASAS HI in AS patients. Reference: [1] Kiltz U, van der Heijde D, Boonen A, Akkoc N, Bautista-Molano W, et al. 2018. Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis. Annals of the rheumatic diseases 77:1311-7. Disclosure of Interests: Hsin-Hua Chen Speakers bureau: Johnson & Johnson, Novartis, Pfizer, Abbvie, Roche, UCB, Bristol-Myers Squibb, Chugai, Ting-I Pan: None declared, Yi-Ming Chen Grant/research support from: GSK, Pfizer, BMS, Astra & Zeneca, Consultant for: Pfizer, Novartis, Abbvie, Johnson & Johnson, BMS, Roche, Sanofi, MSD, Guigai, Astellas Inova Diagnostics, UCB Agnitio Science Technology, United Biopharma, Thermo Fisher, Paid instructor for: Pfizer, Novartis, Abbvie, Johnson & Johnson, BMS, Roche, Astra& Zeneca, Sanofi, MSD, Guigai, Astellas UCB Thermo Fisher, Speakers bureau: Pfizer, Novartis, Abbvie, Johnson & Johnson, BMS, Roche, Lilly, GSK, Astra& Zeneca, Sanofi, MSD, Guigai, Astellas UCB Thermo Fisher, Kuo-Lung Lai: None declared, Tsu-Yi Hsieh: None declared, Ching-Tsai Lin: None declared, Wei-Ting Hung: None declared, Yin-Yi Chou: None declared, Chih-Wei Tseng: None declared, Yi-Da Wu: None declared, Chia-Wei Hsieh: None declared, Wen-Nan Huang: None declared, Yi-Hsing Chen: None declared, Der-Yuan Chen: None declared

Background: The Bath ankylosing Spondylitis Disease activity index (BASDAI) has been widely utilized to evaluate disease activity in patients with ankylosing spondylitis (AS). However, the cut-off of BASDAI used to indicate high disease activity (i.e., ≥4) was determined arbitrarily and was suggested as a criterion to initiate biological therapy for aS patients. The ankylosing Spondylitis Disease activity Score (ASDAS) has been developed as a new composite index to assess aS disease activity. The cut-off values for disease activity states has been defined and validated. ASDAS≥2.1 was selected as a criterion of starting biological therapy. However, the BASDAI cut-off values corresponding to the aSDAS cut-off values for disease activity states were unknown. Objectives: The purpose of this study was to estimate the corresponding BASDAI and aSDAS cut-off in a Taiwanese aS cohort. Methods: Since November 2016, we assessed the ankylosing Spondylitis Disease activity Score (ASDAS) and the Bath ankylosing Spondylitis Disease activity index (BASDAI) regularly and recorded demographic data, comorbidity, family history, medication use for aS patients in Taichung Veterans General hospital (TCVGH) using an electronic patient reported data system linked to an electronic medical record system. We identified 489 aS patients with complete baseline demographic and assessment data from the TCVGH electronic data system during 2016/11–2018/10. We used receiver operating characteristic (ROC) curves with Youden’s J statistic to determine the cut-off values of BASDAI that correspond to aSDAS disease activity cut-offs (i.e., 1.3, 2.1 and 3.5). Results: We included a total of 489 aS patients [114 (23.3%) females, mean age 44.1 years (S.D. 13.9), mean symptom duration 18.0 years (S.D. 11.9), 152 (31.1%) current biologic users]. Mean BASDAI, aSDAS-ESR and aSDAS-CRP scores were 2.1 (S.D. 1.5), 1.6 (S.D. 0.8) and 1.5 (S.D. 0.9) respectively. Mean levels of CRP and ESR were 0.6 (S.D. 1.5) mg/dl and 12.2 (S.D. 14.0) mm/hr respectively. Based on aSDAS-CRP, the numbers (%) of aS patients with inactive disease ( Conclusion: The estimated optimal BASDAI value that corresponds to the recommended aSDAS cut-off ≥2.1 for biologial therapy initiation was lower than the recommended BASDAI cut-off of ≥4 in this Taiwanese aS cohort. References [1] Machado P, et al. 2011. Ankylosing Spondylitis Disease activity Score (ASDAS): defining cut-off values for disease activity states and improvement scores. Ann Rheum Dis2011;70:47-53. Disclosure of interests: Hsin-Hua Chen Speakers bureau: Johnson & Johnson, Novartis, Pfizer, abbvie, Roche, UCB, Bristol-Myers Squibb, Chugai, Ting-I Pan: None declared, Yi-Ming Chen Grant/research support from: GSK, Pfizer, BMS, astra & Zeneca, Consultant for: Pfizer, Novartis, abbvie, Johnson & Johnson, BMS, Roche, Sanofi, MSD, Guigai, astellas, inova Diagnostics, UCB, agnitio Science Technology, United Biopharma, thermo Fisher, Paid instructor for: Pfizer, Novartis, abbvie, Johnson & Johnson, BMS, Roche, astra& Zeneca, Sanofi, MSD, Guigai, astellas, UCB, thermo Fisher, Speakers bureau: Pfizer, Novartis, abbvie, Johnson & Johnson, BMS, Roche, Lilly, GSK, astra& Zeneca, Sanofi, MSD, Guigai, astellas, UCB, thermo Fisher, Yi-Hsing Chen: None declared, Wen-Nan Huang: None declared, Tsu-Yi Hsieh: None declared, Kuo-Lung Lai: None declared, Wei-Ting Hung: None declared, Yin-Yi Chou: None declared, Chih-Wei Tseng: None declared, Yi-Da Wu: None declared, Chia-Wei Hsieh: None declared, Ching-Tsai Lin: None declared

Adult-onset Still’s disease (AOSD) is a rare autoinflammatory disease, which has elevated autophagosome levels regulated by autophagy-related gene (ATG) expression. We investigated the associations of ATG polymorphisms with AOSD susceptibility, clinical manifestations, and disease course. The six-candidate single-nucleotide polymorphisms (SNPs) involved in autophagy were genotyped using direct sequencing on samples from 129 AOSD patients and 129 healthy participants. The differentially expressed gene products were quantified using PCR and ELISA. Significant linkage disequilibrium was noted in three SNPs of autophagy-related 16-like 1 (ATG16L1) gene (rs10210302, rs2241880, and rs1045100). Although the AA/CC/TT haplotype of ATG16L1 was not associated with the susceptibility of our AOSD patients compared with other haplotypes, those carrying this haplotype had lower mRNA expression levels of LC3-II, reflecting by autophagosome formation (p = 0.026). Patients carrying AA/CC/TT haplotype also have a significantly higher proportion of skin rash and a lower proportion of arthritis compared with other haplotypes. The AA/CC/TT haplotype was significantly associated with systemic pattern (odds ratio, 3.25, 95% confidence interval, 1.15–9.14, p = 0.026). In summary, the AA/CC/TT haplotype encoded lower levels of autophagosome formation and was associated with a higher proportion of skin rash and systemic pattern of AOSD compared with other haplotypes.

Background:Lupus nephritis is a significant complication of systemic lupus erythematosus and is associated with increased risks of end-stage kidney disease and mortality.Objectives:The retrospective observational study aims to investigate which component of the National Institutes of Health activity and chronic indices of lupus nephritis can predict mortality.Methods:We identified 528 SLE patients with biopsy-proven lupus nephritis between 2006 and 2019. Two patients with class VI lupus nephritis were excluded, and a total of 526 patients were analyzed. Serum creatinine, urine protein-to-creatinine ratio (UPCR), and serologic markers for SLE disease activity were measured at the time of the renal biopsy. The histopathologic findings of renal biopsies were classified by utilizing the International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification.Results:Among 526 patients enrolled, 64 expired, and 44 were female (68.8%, p=0.004). Class IV (± V) comprised the most (n= 39, 60.9%), followed by class V (n= 18, 29.7%). Lower eGFR was observed in the death group, compared with the survival group (median: 24.7 vs. 80.5, pIn the univariable analysis, age, male sex, eGFR, activity index scores, cellular crescents, chronicity index scores, and all CI components (global obsolete glomeruli, tubular atrophy, interstitial fibrosis, fibrous crescents) and tubulointerstitial nephritis were significantly associated with an increased risk of death. When patient characteristics and NIH activity/ chronicity indices were jointly examined in a multivariable analysis, fibrous crescents were significantly associated with increased risk of death in females (HR 5.23 [95% CI: 1.51, 18.09]) (Table 1). In males, the risks of death increased with cellular crescents (HR 1.73 [95% CI: 1.10, 2.73]) but decreased with global obsolete glomeruli (HR 0.12 [95% CI: 0.02, 0.91]).Conclusion:In this single-center observational study, fibrous crescents in females and cellular crescents in males were significantly associated with increased risks of mortality.References:[1]Doria A, Iaccarino L, Ghirardello A, et al. Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med 2006; 119: 700–706.[2]Faurschou M, Starklint H, Halberg P, Jacobsen S. Prognostic factors in lupus nephritis: diagnostic and therapeutic delay increases the risk of terminal renal failure. J Rheumatol. 2006;33(8):1563-1569.[3]Chen YM, Hung WT, Liao YW, et al. Combination immunosuppressant therapy and lupus nephritis outcome: a hospital-based study. Lupus. 2019;28(5):658-666.Table 1.Logistic regression of predictors for mortality in patients with lupus nephritisUnivariableMultivariable (Female)Multivariable (Male)HR95% CIp valueHR95% CIp valueHR95% CIp valueAge1.03(1.01-1.05)0.0021.02(0.98-1.07)0.2671.01(0.95-1.08)0.670Male sex2.10(1.23-3.55)0.006UPCR1.02(0.95-1.09)0.616eGFR0.97(0.96-0.99)0.99(0.96-1.00)0.1830.98(0.96-1.00)0.086Activity Index1.06(1.01-1.11)0.027Cellular crescents1.29(1.12-1.50)1.03(0.63-1.67)0.9171.73(1.10-2.73)0.017Chronicity Index1.16(1.07-1.26)global obsolete glomeruli1.37(1.08-1.76)0.0111.24(0.55-2.77)0.6060.12(0.02-0.91)0.040Tubular atrophy1.65(1.28-2.13)0.41(0.06-2.82)0.3624.77(0.30-75.32)0.267Interstitial fibrosis1.71(1.32-2.23)3.70(0.52-26.24)0.1911.37(0.07-27.40)0.837Fibrous crescents2.38(1.40-4.03)0.0015.23(1.51-18.09)0.0090.00(0-extremely large)0.989Tubulointerstitial nephritis1.70(1.03-2.80)0.037Disclosure of Interests:None declared

In this study we aimed to identify the predictors of drug survival for biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) among patients with rheumatoid arthritis (RA) in a real-world setting. Data from RA patients receiving bDMARDs and tsDMARDs between 2007 and 2019 were extracted from the Taiwan Rheumatology Association Clinical Electronic Registry (TRACER). Patients were categorized into tumor necrosis factor-alpha (TNF-α) inhibitors, non-TNF-α inhibitors, and tofacitinib groups. The primary outcome was 3-year drug retention and the causes of bDMARDs and tsDMARDs discontinuation were recorded. Baseline demographic data before the initiation of bDMARDs and tsDMARDs treatment were analyzed to identify the predictors of 3-year drug survival. A total of 1,270 RA patients were recruited (TNF-α inhibitors: 584; non-TNF-α inhibitors: 535; tofacitinib: 151). The independent protective factors for 3-year drug survival were positive rheumatoid factor (RF) (HR: 0.48, 95% CI: 0.27–0.85,p= 0.013) and biologics-naïve RA (HR: 0.61, 95% CI: 0.39–0.94,p= 0.024). In contrast, positive anti-citrullinated protein antibody (ACPA) (HR: 2.24, 95% CI: 1.32–3.79,p= 0.003) and pre-existing latent tuberculosis (HR: 2.90, 95% CI: 2.06–4.09, pp= 0.037). TNF-α inhibitors were associated with lower cumulative incidence of discontinuation due to inefficacy and adverse events (bothp